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Biochem > Vitamins and Minerals > Flashcards

Vitamins and Minerals Flashcards

1
Q

In what organs is excess iron stored

A

Liver, spleen, bone marrow

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2
Q

Pathophysiology of iron poisoning

A

Causes peroxidation of membrane lipids and free radical generation

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3
Q

symptoms of acute iron poisoning

A

GI: nausea/vomiting, gastric bleeding (iron settles in the stomach), hematemesis, abdominal pain. If bleeding severe - hypovolemic shock

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4
Q

Symptoms of iron poisoning 6-72 hours after ingestion

A

Metabolic acidosis

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5
Q

Symptoms of iron poisoning 2-8 weeks after ingestion

A

Scarring of GI tract, obstruction

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6
Q

Ferritin

A

Iron-protein complex of ferric acid and apoferritin, is cellular storage protein for iron
An acute phase reactant - take it away from circulation from bacteria who like iron

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7
Q

Transferrin

A

Protein that binds ferric molecules and transports them through plasma
Made in liver

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8
Q

What are the levels of transferrin in iron deficiency

A

Increased - cells hungry for iron so looking for transport molecule to bring them more

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9
Q

Half life of transferrin

A

8 days

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10
Q

Function of Zinc

A 
Essential for 100+ enzymes
Important in formation of zinc fingers (transcription factor motif)
Healing, immune system
Essential for carbonic anhydrase
Essential for lactate dehydrogenase
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11
Q

Zinc deficiency

A 
Delayed wound healing
Decreased body and facial hair
Hypogonadism
Anosmia
Dysgeusia
Decr immune response
Rash around eyes, mouth, nose, anus (acrodermatitis)
Anorexia and diarrhea
Growth retardation
Depressed mental function
Infertility
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12
Q

What is acrodermatitis

A

Rash seen in zinc deficiency - around eyes, mouth, nose, and anus

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13
Q

Signs of lead poisoning

A

Decreased IQ, hearing problems, growth impairment, impaired peripheral nerve function (wrist, foot drop), lead lines in growing bones and teeth (burton’s lines)
With severe: Anemia, colic/abd pain, nephropathy, encephalopathy

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14
Q

What enzymes does lead inhibit

A

Ferrochelatase and ALA dehydratase –> decreased heme synthesis and increased RBC protoporphyrin

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15
Q

What is basophilic stippling

A

RBCs retain aggregates of rRNA because lead inhibits rRNA degradation

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16
Q

Treatment of lead poisoning in kids vs adults

A

Remove exposure
1st line: Dimercaprol (SEVERE) and EDTA
Kids: Succimer

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17
Q

Where does mercury accumulate

A

Kidney and brain

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18
Q

Side effects of mercury poisoning

A

Neuropsych effects

Acrodynia - peeling of fingertips

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19
Q

Bluish colored lines on gingivae

A

Burton’s lines = lead poisoning

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20
Q

Ergocalciferol

A

D2 - ingested form - from plants

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21
Q

Cholecalciferol

A

D3 - synthesized in skin

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22
Q

25-OH D3

A

Made in the liver from D3

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23
Q

1,25 DHCC

A

Physiologic active form in vitamin D, made in kidneys

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24
Q

FUnction of 1,25 DHCC

A
  • Increases Calcium uptake in intestine by increasing expression of calcium binding protein
  • Works in intestine to increase absorption of Mg and P
  • Stimulates PTH-dependent reabsorption in distal tubules
  • Stimulates bone reabsorption when necessary (with PTH)
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25
Q

Vit D deficiency mechanisms

A
  1. Inadequate dietary
  2. Impaired hydroxylation by liver
  3. Impaired hydroxylation by kidneys
  4. End organ insensitivity
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26
Q

Vit D deficiency clinical

A

Rickets/Osteomalacia
Demineralization problems of bone
Bone tenderness, skeletal deformities, bowing of legs, growth problems, pathologic fractures, dental problems

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27
Q

Pathophysiology of Vit D deficiency

A

Serum calcium drops so PTH increases which breaks down bone, decreasing serum phosphate and trying to increase serum calcium

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28
Q

Vitamin D toxicity

A

Too much Vitamin D supplementation
Hypercalcemia
From sarcoidosis - increase conversion to 1,25 from macrophages in granulomas

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29
Q

Vitamin K

A

Involved in post translational modification of clotting factors
Made in intestinal flora

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30
Q

Clotting factors dependent on K

A

Protein C and S
Prothrombin
2, 7, 9, X

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31
Q

Vitamin K deficiency

A

Medications: Coumadin (vitamin K antagonist), Anticonvulsants (phenytoin), antibiotics (wipe out gut flora)

32
Q

Vitamin A

A

Retinol, Retinal
Retinol: Eye, immune system, epithelial and mucus cell maintenance
Beta carotene - cleaved in intestine to get two molecules of retinol

33
Q

Vitamin A used clinically

A 
Acne - tretinoin
Isotretinoin
Decrease size and secretion of sebaceous gland
Measles
AML (M3 subtype)
34
Q

Vitamin A deficiency

A

Night blindness
Xerophthalmia - corneal ulcerations
Keratomalacia - wrinkling and clouding of cornea
Bitot spots - in bulbar conjunctiva

35
Q

Vitamin A toxicity

A

HA, N/v, stupor, increased ICP
Dry and pruritic skin
Too much beta carotene - orange, but not vitamin A tox
Hepatomegaly, bone and joint pain, alopecia
From eating polar bear - high levels
Arthralgias

36
Q

Vit A supplementation a bad idea in..?

A

Pregnancy - risk teratogenesis

37
Q

Vitamin E

A

alpha-tocopherol

Primarily an antioxidant: Prevents non-enzymatic oxidation of cell components by oxygen-free radicals (RBC’s important)

38
Q

Vit E deficiency

A

Hemolytic anemia - less protection for RBCs
Spinocerebellar degeneration -> ataxia
Peripheral neuropathy and proximal muscle weakness

39
Q

Vitamin C

A

Antioxidant
Involved in hydroxylation of proline and lysine residues of collagen
Required in conversion of dopamine to NE (dopamine beta hydroxylase)
Facilitates iron absorption in gut (keeps it in reduced state)

40
Q

Scurvy

A 
Sore spongy gums
Loose teeth
Fragile blood vessels -> hemorrhages
Swollen joints
Hemarthrosis
Impaired wound healing
Anemia
41
Q

Treatment of choice for rickets or osteomalacia

A

Vitamin D

42
Q

Vitamin B1

A

Thiamine
Pyruvate to acetyl CoA
Alphaketoglutarate to succinyl CoA
Ribose 5 P to G3P (transketolase)

43
Q

Thiamine deficiency

A

Poor nutrition (EtOH), malabsorption, dialysis
Can’t breakdown glucose to make ATP
Damage to medial thalamus and mamillary bodies of posterior HT
Generalized cerebral atrophy

44
Q

Wernicke-Korsakoff syndrome

A

Wernicke: Acute
Korsakoff: Chronic

45
Q

Triad of wernicke encephalopathy

A

Encephalopathy, oculomotor dysfunction, gait ataxia

Also stupor, coma, hypotension, hypothermia

46
Q

Korsakoff syndrome

A

Memory loss (retro and anterograde)
Confabulation
Personality change
Apathy

47
Q

Beriberi

A

Another problem of thiamine deficiency - from dehusked rice
Wet or Dry
Wet: Nerves
Dry: Heart

48
Q

Dry beri beri

A 
Nonspecific peripheral neuropathy w/myelin degeneration
Toe, wrist, foot drop
Muscle weakness
Hyporeflexia
Areflexia
49
Q

Wet beri beri

A

Peripheral vasodilation
High output HF
Peripheral edema
Cardiomegaly

50
Q

B2

A

Riboflavin - two active forms
1. FMN
2. FAD
Cofactors for redox reactions, eg succinate dehydrogenase

51
Q

B2 deficiency

A

Dermatitis, glossitis, cheilosis (inflammation of lips, scaling at corners of mouth), corneal vascularization

52
Q

B3

A 
Niacin - two active forms
1. NAD
2. NADP
Derived from tryptophan
Used in pts w/dyslipidemia
53
Q

Niacin deficiency

A

Pellagra

  1. Dermatitis
  2. Diarrhea
  3. Dementia
54
Q

What diseases can cause Pellagra

A
  1. Hartnup disease
  2. Malignant carcinoid syndrome (increased tryptophan metabolism)
  3. INH - inhibits B6 and B3
55
Q

B5

A

Pantothenate

Component of coenzyme A

56
Q

B5 deficiency

A

Nonspecific: Dermatitis, enteritis, alopecia, adrenal insufficiency

57
Q

Vitamin B6

A

Pyradoxine
Active: Pyridoxal phosphate
Coenzyme for many enzymes including AA metabolism (Trans and deaminations)
Converting AA precursors into things like heme, GABA, etc

58
Q

B6 deficiency

A

Angular chelosis
Glossitis
Unique: Convulsions (need gaba), hyperirritability, peripheral neuropathy

59
Q

B7

A

Biotin

Apoenzyme for carboxylation reactions

60
Q

B7 deficiency causes

A

Avidin found in egg whites prevents absorption of biotin

Abx

61
Q

Vitamin B9

A 
Folate
Biol active form: THF
Crucial for synthesis of DNA and repair of DNA
Syntehsis of purines and pyrimidines
Rapid cell division and growth
62
Q

B9 deficiency causes

A

Medications
malnutrition
Pregnancy

63
Q

Medications that can cause B9 deficiency

A

Phenytoin
Sulfonamide
TMP
MTX

64
Q

B9 deficiency

A

In utero: NTD
Growth failure
Megaloblastic anemia
Nonsp: glossitis, diarrhea, depression, confusion

65
Q

B12

A

Cobalamin

Cofactor with homocysteine methyltransferase to make methionine from homocysteine, in the process THF is used.

66
Q

B12 deficiency sx

A

Megaloblastic anemia
Elevated MMA or homocysteine
Neuro sx: paresthesias, ataxia, memory loss, dementia, severe weakness

67
Q

How is B12 absorbed

A

Bound IF in duodenum
Complex absorbed in terminal ileum
IF is produced by parietal cells in stomach
Pernicious anemia, gastric bypass (decreased IF)

68
Q

Causes of B12 deficiency

A

Pernicious anemia, gastric bypass

Crohn’s, celiac sprue, enteritis

69
Q

Convulsions and irritability - deficiency?

A

B6 - required for GABA

70
Q

Where is B12 absorbed in gut

A

Terminal ileum

71
Q

Peripheral neuropathy and glossitis

A

B12

72
Q

Dermatitis, diarrhea, dementia

A

B3

73
Q

Used in oxidative/reduction reactions

A

B2 and B3

74
Q

Used in carboxylation reactions

A

Biotin

75
Q

Used by pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase

A

Thiamine B1

76
Q

Cobalt is found with this vitamin

A

B12

77
Q

Dilated cardiomyopathy, edema, and polyneuropathy

A

Wet Beriberi (B1 deficiency)

Biochem (10 decks)

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