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Biochemistry > Vitamins > Flashcards

Vitamins Flashcards

1
Q

What are the fat soluble vitamins?

A

DrAKE

Vitamin D, A, K, E

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2
Q

What factors affect absorption of fat soluble vitamins

A

Bile, pancreases and intestine

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3
Q

Which vitamins type are more toxic? Fat soluble or water soluble

A

Fat soluble, because they accumulate in fat

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4
Q

What are the mala absorption syndromes with vitamins?

A

Steatorrhea associated with cystic fibrosis and celiac disease, or mineral oil intake can cause fat soluble vitamin defiencies

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5
Q

Vitamin A is also called?

A

Retinol

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6
Q

What are the four As of Vitamin A?

A

Antioxidant- measles, retinitis pigmentosa, APL and AML (all trans retinoic acid)

Acne (isotretinoin oral, for severe cystic acne)

Aura- constituent of visual pigments

Activation- epithelial cell differentiation into specialized tissue (pancreatic cells, mucus secreting cells). Controls keratin growth (psoriaris) (squamous metaplasia)

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7
Q

Defiency of vitamin A leads to?

A

Immunosupression

Night blindness (nyctalopia)

Dry scaly skin (xerosis cutis), corneal degeneration (keratomalacia) Bitot spots (foamy appearnace on conjuctiva)

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8
Q

Acute toxicity of vitamin A leads to ___________

A

Vomiting, vertigo and blurred vision

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9
Q

Chronic toxicity of vitamin A leads to ________

A

Alopecia, heptatic toxicity, arthralgias, and pseudomotor cerebri

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10
Q

Vitamin A has what sources?

A

Liver, leafy vegetables

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11
Q

What vitamin A is uses to treat severe cystic acne

A

Isotretinoin

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12
Q

Which vitamin is used to treat APL

A

All trans retinoic acid (it leads to the complete differentiation of the granulocytes, so that they are non dividing)

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13
Q

Which vitamin A is teratogenic

A

Isotretinoin

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14
Q

Why is isotretinoin teratogenic

A

Cleft palate, cardiac abnormalities

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15
Q

Therefore in order to be safe, a ____________ and two forms of ______________ is precribed before vitamin A intake

A

A negative pregnancy test

Contraception

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16
Q

What is D3’s other name and what is its source?

A

Cholecalciferol

Exposure of stratum basale to sun
Fish, milk, plants

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17
Q

What is D2s other name and what is its source?

A

Ergocalciferol

Ingestion of plants, fungi and yeasts

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18
Q

Both forms of vitamin D are converted into…..

A

25-OH D3 (hydroxylation at the 25 C) which is the storage form in Liver, and then to the 1,25 (OH)2 in kidney, and the enzyme is 1alpha hydroxylase enzyme. This is the active form

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19
Q

25 OH D3 is constantly produced by the ________ and only needed _________

A

Liver

If required by kidney

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20
Q

What is the best serum form of vitamin D when tested for status?

A

The storage form

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21
Q

What are the functions of vitamin d

A

Increases intestinal calcium and phosphate ions
Increases bone mineralization at low levels
Increases bone resorption at high levels

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22
Q

Defiency of vitamin d leads to _______ in _________and ___________ in _______

A

Rickets in children

Osteomalacia in adults

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23
Q

What happens in rickets in children due to vit d def?

A

Decreased mineralization of growth plate

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24
Q

What are the findings of rickets

A

Bow legs (increased rapid growth of distak forearm and knee) and bone pain, delayed fontanelle

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25
Q

What are the x ray findings of children with rickets

A

Bow legs

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26
Q

What are the findings/symptoms of osteomalacia in adults

A

Bone pain and fractures

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27
Q

What are the x ray findings of adults with osteomalacia

A

Decreased bone density

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28
Q

Vitamin d def causes _______tetany

A

Hypocalcemic

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29
Q

What is the cause of osteomalacia

A

Decreased mineralization of newly formed bone

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30
Q

What are the causes of vitamin d def

A

Mala absorption, decreased sun exposure, poor diet

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31
Q

What happens in renal failure in vitamin d def

A

Renal failure

Secretes less phosphate, so phosphate increases, calcium decreases as they make complexes

Decreases the 1,25 OH D3 inside the body, hence the calcium reabsorption from gut decreases

Hypocalcemia

PTH increases

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32
Q

Give _________ to breast fed infants

A

Vitamin D

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33
Q

Defiency of vitamin D is exacerbated by

A

Dark skin

Premature birth

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34
Q

Excess vitamin d causes

A

Hypercalcemia, hypercalciuria

Loss of appetite, stupor

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35
Q

What happens in sarcoidosis in granulomatous disease

A

Activation of macrophages independent of kidney cause the activation of 1 alpha hydroxylase which leads to 1,25 OH D3 formation

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36
Q

PTH levels in osteomalacia are?

A

Increased

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37
Q

Vitamin Es other names include

A

Tocopherol, tocotrienol

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38
Q

What is the function of vitamin E

A

Anti oxidant (protects RBCs and membranes from free radical damage)

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39
Q

What is the role of vitamin E with vitamin k?

A

May alter metabolism of vitamin K, inhibits it

Enhances the effect of warfarin, increases INR in patients

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40
Q

What are the symptoms of vitamin e defiency?

A

Hemolytic anemia
Muscle weakness
Ataxia
Loss of proprioception/vibration

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41
Q

What is used to differentiate Vitamin b12 and vitamin E def?

A

Ataxia and loss of proprioception/vibration seen with vitamin b12 and also megaloblastic anemia, but in vitamin e, it is hemolytic and also there is muscle weakness (diplopia)

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42
Q

What is used to differentiate Vitamin b12 and vitamin E def on lab findings?

A

Hypersegmented nuetrophils and increased serum methylmalonic levels

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43
Q

What is the risk of vitamin e excess in children

A

Enterocolitis in infants

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44
Q

Vitamin K includes?

A

Phytomenadione,
Phylloquinone
Phytonadione
Menaquinone

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45
Q

What is the function of vitamin K?

A

Gamma carboxylation of glutamate residues in clotting factors 2,7,9 and 10, and protein C and S. After usage, it turns into vitamin oxidised, vitamin epoxide reducate reduces it back to its form

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46
Q

Where is vitamin K synthesized?

A

It is synthesized in the intestinal flora

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47
Q

What inhibits vitamin K?

A

Wafarin inhibits vitamin epoxide reductase

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48
Q

What is the relation with vitamin K and neonates?

A

Neonates have sterile intestine, hence neonatal haemorrhage occurs in which there is increased PT and increased aPTT but normal bleeding time

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49
Q

What is the relation between antiobiotics and vitamin k?

A

Antiobiotics kill the normal flora, are unable to synthesize vitamin K, hence increased chances of bleeding

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50
Q

What is also not present in breast milk?

A

Vitamin k

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51
Q

What then occurs for neonates in order to orevent neonatal bleeding

A

Given IM vitamin K injection

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52
Q

What is the other name for vitamin C

A

Ascorbic acid

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53
Q

What is the function of vitamin C?

A

It is an antioxidant

Converts fe three into fe two (non heme), and then it is easily absorbed into the duodenal cell

Hydroxylation of proline and lysine in collagen synthesis

Necessay for dopamine b hydroxylase which converts dopamine to NE

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54
Q

Where is vitamin c found?

A

Fruits and vegetables

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55
Q

Some drugs cause methemoglobinemia, and ___________ and ________ is used for ancillary treatment

A

oxidise fe two into fe three

Vitamin c (reduces it back to its form)

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56
Q

What does defiency of vitamin c cause?

A

Scurvy

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57
Q

What are the symptoms of scurvy?

A 
Swollen gums
Bruising
Anemia
Hemarthrosis
Perifollicular and subperiosteal hemorrages 
Corkscrew hair
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58
Q

Defiency of vitamin c leads to ____________

A

Weakened immune response

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59
Q

What are the causes of poor wound healing

A

Zinc and vitamin c

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60
Q

Excess of vitamin c leads to

A

Nausea, vomiting, diarrhea

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61
Q

In vitamin c excess, vitamin c metabolizes into _______ and can cause ________

A

Oxalate

Calcium oxalate nephrolithiasis

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62
Q

Vitamin c excess can increase __________in predisposed individuals by increasing ____________

A

Iron toxicity

Dietary iron absorption

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63
Q

The predisposed individuals in vitamin c related iron overload are

A

Hemochromatosis

Transfusion related iron overload

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64
Q

Zinc’s function is?

A

Mineral essential for the activity of 100 plus enzymes

65
Q

What are zinc fingers?

A

They are proteins attached to zinc and can act as transcriptional factors on dna

66
Q

What is the defiency of zinc symptoms

A

Hypogonadism

Decreased adult hair

67
Q

What causes supressed immunity

A

Zinc and vitamin c

68
Q

Which mineral def causes dysgeusia

A

Zinc

69
Q

Whuch mineral def causes anosmia

A

Zinc

70
Q

Zinc defiency leads to the autosomal recessive disorder of __________

A

acrodermatitis enteropathica

Hyperpigmented skin near the peri anal and around mouth parts

71
Q

Which mineral may predispose to alchoholic cirrhosis

A

Zinc

72
Q

Kwashiorkor is due to __________

A

Protein deficit

73
Q

what is the MEALS in kwashiorkor

A

Malnutrition
Edema (decreased plasma oncotic pressure)
Anemia
Liver (fatty) due to decreases apolipoproteins
Skin lesions (hyperkeratosis, dyspigmentation)

74
Q

What is Marasmus’ cause

A

Total caloric deficit

75
Q

Is there edema in Marasmus

A

No

76
Q

What does the diet consist of in patients w marasmus

A

Diet is deficient in calories but no nutrients are entirely absent

77
Q

Marasmus leads to?

A

Muscle wasting

78
Q

What is bitamin b1 called?

A

It is called thiamine

79
Q

What is the function of thiamine? It acts as cofactor for how many enzymes? And what enzymes?

A

3

Think ATP B

Alpha keto gluterate dehydrogenase,
Transketolase
Pyruvate dehydrogenase
Branched chain ketoacid dehydrogenase

80
Q

A defiency of thiamine will lead to ?

A

Impaired glucose breakdown, there is atp depletion

81
Q

The atp depletion in thiamine defiency is worsened by?

A

Glucose infusion

82
Q

What tissues are affected first by thiamine defiency

A

Aerobic tissues like brain and heart

83
Q

What are the two manifestation of thiamine defiency

A

Wet beri beri

High output cardiac failure (dilated cardiomyopathy), edema

Dry beri beri

Polynueropathy, symmetrically muscle wasting

84
Q

What are the symptoms of wernicke korsakoffe syndrome

A

Confusion, opthalmoplegia, ataxia

Classic triad

Plus there is confabulation, personality change, memory loss

85
Q

In wernicke korsakoff syndrome, there is damage to what?

A

Medial dorsal nucleus of thalamus and mamillary bodies

86
Q

In malnourished and alcoholic patients, what should be given first theoretically and why?

A

Malnourished and alcoholics with wernike korsakoff: thiamine decreased, glucose also decreased

Give thiamine first so that glucose can be broken down and in order to avoid worsening of wernicke encephalopathy

87
Q

How is diagnosis made in vitamin b1 defiency

A

Increased rbc transketolase activity after giving b1

88
Q

B1 vitamin is converted into

A

Thiamine pyrophosphate

89
Q

What is vitamin b2 also called?

A

Riboflavin

90
Q

What ia the function of riboflavin

A

Makes FAD and FMN

91
Q

Which enzymes require FAD

A

Succinate dehydrogenase in the tca cycle

92
Q

What is the def symptoms of b2

A

Cheilosis inflammation of lips, scaling and fissures at the corners of mouth, corneal vascularization

The two Cs of vitamin b2

93
Q

What is vitamin b3 called

A

Niacin

94
Q

What is the function of vitamin b3

A

Component of NAD plus and NADP plus

95
Q

What is vitamin b3 derived from, what does it require

A

Tryptophan, requires b2 and b 6

96
Q

What is niacin used to treat

A

Dyslipidemia, lowers levels of vldl and raises levels of hdl

97
Q

What is the defiency symptoms of vitamin b3

A

Glossitis

Severe defiency leads to pellagra

Dermatitis (c3/c4 dermatome circumferential broad collar rash (casal necklace) hyperpigmentation of sun exposed limbs)

Dementia

Diarrhea

98
Q

______ dermatome circumferential broad collar rash (______necklace) hyperpigmentation of sun exposed limbs) is called

A

C3/ C4
Casal
dermatitis

99
Q

Defiency of niacin is due to which syndromes and diseases

A

Hartnup disease, carcinoid syndrome and isoniazid use

100
Q

Hartnup disease is the _________. Defiency of ___________ in the _____________ and on ___________ will lead to nuetral __________ and decreased __________ and decreased _______

A

Autosomal recessive

Amino acid transporter

Pct

Enterocytes

Nuetral aminoaciduria, decreased absorption from the gut, decreased conversion of tryptophan to niacin

101
Q

Treatment of hartnup disease

A

Treat with high protein diet and also nicotinic acid

102
Q

In treating patients with hyperlipidemia, _______ is symptom of niacin excess. Treatment?

A

Facial flushing due to induced prostaglandin

aspirin

103
Q

Besides facial flushing what other symptoms of niacin excess are there

A

Hyperglycemia hyperuricemia

104
Q

Defiency of niacin_________

Excess of niacin_________

A

Pellegra

Podagra

105
Q

What is vitamin B5 called

A

Pantothenic acid

106
Q

What is vitamin b5 essential component of?

A

Coenzyme A and fatty acid synthethase

107
Q

Defiency of vitamin b5 will lead to

A

Dermatitis enteritis alopecia adrenal insufficiency burning feet

Very rare widely distributed in foods

108
Q

What is vitamin b6 called

A

Pyridoxine

109
Q

What is vitamin b6 converted into

A

Pyridoxal phosphate PLP

110
Q

What is vitamin B6 involved in which reactions

A

Used in transamination reactions, decarboxylation reactions, glycogen phosphorylase

TGD

111
Q

Where is vitamin b6 involved in? Synthesis wise

A

Cystathionine, heme, niacin, histamine and neurotransmitters serotonin, epi/nor, dopamine and gaba

112
Q

In heme synthesis, if theres b6 defiency, there is decreased _______ synthesis. Iron accumulates in the rbc because it cannot be ______________. This is called

A

Heme

Incorporated into heme

Sideroblastic anemia

113
Q

The drug ________ is similar to the structure of ________. Hence it forms _________. Enyzmes mistake it for the active real form and this leads to defiency. Treatment?

A

Isoniazid

B6

Inactive pyridoxal phosphate

Supplement b6 before isoniazid

114
Q

Defiency of B6 will lead to ________, side effect of medicine ______________

A

Peripheral nueropathy

Isoniazid

OCPs

115
Q

What ofher symptoms of vitamin b6 defiency besides peripheral nueropathy

A

Convulsions, hyper irritability

116
Q

What is vitamin B7 called?

A

Biotin

117
Q

What is the function of vitamin b7?

A

Cofactor for carboxylation reactions

Pyruvate carboxylase

Acetyl coa carboxylase

Propionyl coa carboxylase
PAP

118
Q

Defiency of vitamin b7 can be due to consumption of which food?

A

Avidin in egg whites avidly bind biotin

119
Q

Defiency of vitamin b7 can lead to which symptoms

A

Dermatitis enteritis alopecia

120
Q

Vitamin b7 def can also be due to ________

A

Antiobiotic use

121
Q

What is the other name for vitamin b9

A

Folate

122
Q

What is it converted into?

A

Folate is converted into DHF

Which is converted into THF

Then N5 N10 methylene THF which gives one carbon to ump to make tmp

123
Q

It is important for the synthesis of ___________

A

Nitrogenous bases like dna and rna

124
Q

Where is folate found

A

Leafy green veggies

125
Q

Where is it absorbed

A

Into the jejenum

126
Q

Folate acts as the small reserve pool primarily in the _________

A

Liver

127
Q

Megalobastic anemia is due to defiency in either _______ or ________

A

Folate or vitamin b12

128
Q

In megaloblastic anemia, there is increased ________ and decreased _______. There are also __________ seen

A

Increased mcv
Decreased rbc count
Hypersegmented neutrophils (PMNs)

129
Q

Megaloblastic anemia can also be due to which drugs involved in pyrmidine synthesis leading to folate defiency

A

Trimethaprim, methotrexate, FU, hydroxyurea, sulfa drugs

130
Q

Which anti epileptic drugs can be involved in folate defiency?

A

Phenytoin

131
Q

Are there any neuologic symptoms involved in folate defiency?

A

No

132
Q

In labs, in folate defiency, what are the findings? In terms of homocysteine and methylmalonic acid

A

Increased homocysteine

But normal methylmalonic acid

133
Q

Folate defiency is seen in which two common conditions?

A

Alcholism and pregnancy

134
Q

What should be done to pregnant ladies in order to avoid folate def

A

Supplement maternal folic for at least one month prior conception and during early pregnancy to decreased nueral tube defects

135
Q

What is vitamin b12 called

A

Cobalamin

136
Q

What is the function of vitamin b12

A

N5methyl ThF—————-THF

At the same time

Homocysteine————-methionine
Methionine synthase

Cofactor for methyl malonyl coa mutase

                   Methylmalonylcoa 
                                  || 
                                  V
                           Succinylcoa

Succinyl coa leads to heme synthesis. B6 as cofactor
Succinyl coa leads to TcA cycle

137
Q

Where is vitamin b12 found

A

Animal products

138
Q

How is it synthesized p, vitamin b12

A

By microorganisms

139
Q

How is it stored in the liver, as small pool or large pool?

A

As large pool

140
Q

Vitamin b12 def leads to which type of anemia?

A

Megaloblastic anemia, macrocytic, hypersegmented PMNs

141
Q

Increased __________ in vitamin b12 defiency leads to which type of nueropathies?

A

Increased methyl malonyl coa

Peripheral neuropathy and sunacute combined degneration

142
Q

In scd, there is degeneration of the ____________ columns (3)

A

Dorsal columns, lateral corticospinal tracts, spinocerebellar tracts

143
Q

There is abnormal __________ in subacute combined degeneration

A

Abnormal myelin

144
Q

In subacute combined degneration, there is more involvement of _______. Symptoms are ______. There is also loss of ______, ______ and ________

A 
Legs 
Bilateral
Vibration and position sense 
Ataxia (falling Q)
Parasthesia
145
Q

Vitamin b12 defiency is associated with increased _______ and ________, along with secondary ________ defiency

A

Homocysteine and methyl malonic acid

Folate defiency

146
Q

Prolonged defiency of vitamin b12 can lead to

A

Irreversible nerve damage

147
Q

The vitamin b12 defiency can be due to which enteropathies which lead to malabsorption of vitamin b12

A

Sprue, enteritis, achlorhydria

148
Q

Which tapeworm causes vitamin b12 def

A

Diphyllobothrium latum

149
Q

Vitamin b12 can also be due to ______ overgrowth and _______ excess

A

Bacterial

Alcohol

150
Q

Vitamin b12 defiency is also due to lack of _______

A

Intrinsic factor, which is vital to absorb vitamin b12

151
Q

Lack of intrinsic factor can be due to which type of anemia?

A

Pernicious anemia

152
Q

Pernicious anemia is what type of hypersensitivity

A

Type 2, there is antibodies against intrinsic factor or against the parietal cells which secrete instrinsic factor

153
Q

Pernicious anemia is associated with which type of hla antigens

A

Hla dr

154
Q

Prolonged pernicious anemia is can lead to

A

Gastric adenocarcinoma

155
Q

Due to the auto antibodies involved in pernicious anemia, there is what type of inflammation of gastric body

A

Chronic

156
Q

What other factors contribute to lack of intrinsic factor

A

Surgical resection of terminal iluem in crohns disease

Gastric bypass

157
Q

Which type of antibodies are diagnostic for pernicious anemia

A

Anti intrinsic factor antibodies

158
Q

Folate supplementation can mask the Hematologic symptoms of b12 def but not

A

Nuerologic symptoms

Biochemistry (11 decks)

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