Chapter 2: vitamins, minerals, trace elements Flashcards
(108 cards)
1
Q
Which vitamin is the cofactor for PTH?
A
Vitamin A
2
Q
PTH
A
causes osteoclast activity: Ca up and P down
3
Q
If Ca and P are both down, which vitamin is missing?
A
Vitamin D (allows more Ca to be absorbed)
4
Q
Which vitamins needed for night vision?
A
Vitamin A
5
Q
Vitamin for CSF production?
A
Vitamin A
6
Q
For which pts should we give Vitamin A?
A
- Measles (regenerate epithelium of lung)
- Cancer t(15,17)
- infections that destroy cells
- Burn pts
7
Q
What is the most common cause of free radical formation?
A
infection, mcc viruses
8
Q
Which cells make free radicals and using which enzyme?
A
neutrophils via NADPH oxidase
9
Q
Too much vitamin A?
A
- hyperparathyroidism (Ca up and get moans, groans and stones) 2. pseudotumor cerebri CSF up, brain ventricles dilate causing headache and papilledema
10
Q
Headache with Papilledema steps to diagnosis
A
- Rule out mass (non contrast CT)
- rule out infection (LP)
11
Q
Tx for Pseudotumor Cerebri
A
1.discontinue Vitamin A
2. if acute: serial lumbar puncture 30cc/24hours
3.chronic: weight loss, CA inhibitor: acetazolamide or mannitol
12
Q
carbonic anhydrase inhibitor
A
acetazolamide
13
Q
criteria for bariatric surgery
A
BMI greater than 40
BMI greater than 35 with cormorbidity
BMI greater than 30 with 2 comorbidities
14
Q
Thiamine important for 4 enzymes
A
- pyruvated dehydrogenase
2.alpha-ketoglutarate dehydrogenase
3.branched chain amino acid dehydrogenase
4.transketolase (pentose phosphate pathway)
All use TPP (thiamine pyrophospate)
15
Q
which organs use thiamine?
A
brain uses transketolase; heart uses dehydrogenases
16
Q
Where is the Wernicke area?
A
posterior temporal lobe
17
Q
What is Wernicke’s function?
A
receive spoken or written language
18
Q
Wernicke’s aphasia?
A
receptive aphasia
19
Q
Wernicke-Korsakoff
A
from alcoholism: mamillary bodies involved; confabulation; unable to move short term memory into long term memory
20
Q
What is beriberi and what are the two types?
A
Heart gives out from massive dilation; dry beriberi (until you have heart failure); wet beriberi (fluid in lungs, massive ventricular dilation) from Vita B1 deficiency
21
Q
What is a sign of B2 deficiency?
A
angular cheilosis
22
Q
What is B2 name?
A
riboflavin
23
Q
What is B2 used for?
A
for cofactors (FAD)
24
Q
5 enzymes needed by pyruvated dehydrogenase, a-ketoglutarate dehydrogenase and branched chain AA dehydrogenase
A
Tender Loving Care For Nancy:
Thiamin
Lipoic Acid
CO-A (B5)
FAD (B2)
NAD (B1)
25
What AA is the precursor to Niacin?
Tryptophan
26
4 Ds of Niacin deficiency
diarrhea, dermatitis, dementia, and death (Pellagra)
27
What is the problem in Hartnup's disease?
defective renal transport of tryptophan, causing tryptophan to leak into urine (presents like Pellagra)
28
Besides Niacin, tryptophan also is needed to make what?
serotonin
29
another disease that uses up tryptophan
carcinoid syndrome, serotonin excreted out rapidly, using a lot of tryptophan
30
Niacin supplements can be used for which disorder?
hypertriglyceridemia
31
What are the side effects of using niacin supplements?
flushing, itching due to release of prostaglandins; insulin resistance (because blocks insulin receptors); gout (competes with uric acid)
32
What is the acute management of gout?
indomethacin (inhibits COX 1/2)
33
What is the most effective treatement for gout?
colchicine (blocks tubules); could cause renal failure
34
Which gout drug blocks xanthine oxidase?
Allopurinol
35
Which gout drug is a recombinant of urate oxidase (uricase) that metabolizes uric acid
Rasburicase
36
Which gout drug block reabsorption of uric acid?
Probenecid
37
Which vitamin is needed for all liver transaminases?
B6
38
Which vitamin is needed to make heme?
B6
39
Which TB drug must we supplement B6 (pyridoxine)?
Isoniazid (INH)
40
DOC for chronic neuropathy
TCA
41
MOA for TCA
blocks reuptake of catecholamine (levels rise); block Na, block alpha 1, antihistiminc
42
If heart disease which drug for neuropathy?
gabapentin
43
If shooting/stabbing neuropathy?
carbamazepine (blocks Na/Ca channel
44
What is the first vitamin to run out when a pt has rapidly dividing cells?
folate
45
When are cells rapidly dividing?
0-2 years
4-7 years
puberty
pregnancy
46
folate function
makes tetrahydrofolate (THF) that makes thymidine of DNA
47
anemia of folate deficiency
megaloblastic anemia
48
What could be complications of B9 deficiency in pregnancy?
neural tube defects
49
Vitamin B12 is needed by which two enzymes?
Homocysteine methyltransferase (makes THF)
and Methyl Malonyl CoA mutase (recycles odd FA to make myelin, so deficiency causes neuropathy)
50
How to distinguish B9 from B12 deficiency in megaloblastic anemia?
1. B12 has neuropathy
2. B9 very rapidly depleted; B12 takes years to deplete
3.B12 def. will cause methylmalonic acid in urine to rise
51
MCC of pernicious anemia in the US
Type A gastritis
52
What is vita C used for?
hydroxylates proline and lysine in collagen and elastin
53
Where does hydroxylation occur in a cell?
RER
54
sign of vitamin C deficiency
bleeding from hair follicles and gums
55
Why is it best to drink orange juice with iron supplements?
Vitamin C protects iron from being oxidized in GI tract
56
Vitamin D deficiency in children
rickets
57
Vitamin D deficiency in adults
osteomalacia
58
If a girl has rickets and vitamin D doesn't correct it, what should you suspect?
Vitamin D resistant rickets
(X linked dominant) Dad's give daughters ; defective renal reabsorption of phosphorus
59
Labs seen in Vitamin D resistant rickets?
Low calcium, low phosphorus even with Vita D supplementation.
60
X-linked dominant diseases
1. Vita D resistant rickets
2. pyruvate dehydrogenase deficiency
3.pseudohypothyroidism
61
What is the main antioxidant in blood?
Vitamin E
62
What is biotin necessary for?
carboxylation
63
What is Vita K used for?
gamma carboxylation (adds third gamma carboxyl group to Vita K dependent clotting factors
64
What are Vita K dependent clotting factors?
10, 9, 7, 2 Protein C and S
65
What drug blocks all Vita K clotting factors?
Warfarin
66
Why does warfarin cause clots at first?
Protein C (thrombolytic) is the first factor to lose its function, so there may be local clotting.
67
Why do we give heparin before warfarin?
to prevent clotting
68
How many days is the heparin bridge?
two days
69
If you don't want 2 day heparin bridge which drugs can you consider?
apixaban, rivaraxaban (direct factor X inhibitors)
70
Anticoagulant for pregnant women?
LMWH until 9 months switch to unfractioned heparin
71
What do you give first for venous clots?
heparin
72
What do we check when a pt on warfarin?
PT
73
If PT is too high in warfarin pt?
vita K complex IM; if bleeding acutely, prothrombin complex or FFP
74
duration of warfarin treatment
1st clot with known cause, 3 months; second time with know cause, 12 months; 3rd time or if ever the cause is unknown, lifetime
75
MCC genetic spontaneous venous clot
Factor V Leiden mutation
76
Treatment of Factor V Leiden mutation?
lifetime warfarin
77
desired INR with warfarin
2-3
78
desired INR with warfarin for prosthetic valve pts?
2.5 to 3.5
79
What factors does heparin block?
thrombin, and intrinsic pathway (9,10, 11, 12)
80
What lab do we follow with heparin?
PTT
81
heparin toxicity antidote
protamine sulfate; acutely bleeding FFP
82
SE of heparin
bleeding, hyperlipidemia due to homorne sensitive lipase (milky white plasma); HIT1 from platelet clumping within first 2 days; HIT2 after day three
83
HIT2 cause
Heparin acts as hapten on PLT causing antibodies to form; attack on PLT causing inflammation and vasculitis
84
HIT2 treatment
switch to Argatroban (block thrombin directly); or fondaparinux (factor Xa inhibitor)
85
What can we do if pt. has contraindications to heparin but has venous clots?
IVC filter
86
4 cephalosporins inhibit vita K?
cefamandole, cefotetan, moxalactam, cefoperazone
87
Which three vitamins need to be supplemented for pregnancy?
folate, Ca, Iron
88
cofactor for all kinases
magnesium
89
cofactors of PTH
vita A and magnesium
90
Why should we give K bolus with Magnesium
K and Mg share cotransport protein
91
Which mineral is needed for hair, skin, sperm and taste buds?
zinc
92
Which mineral is needed by complex IV in electron transport chain?
Copper
93
Which mineral is needed by lysine oxidase in formation of collagen?
copper
94
Which disease is caused by ceruloplasmin deficiency?
Wilson's Disease
95
What does ceruloplasmin do?
transports copper from liver to duodenum for excretion; if deficient, cannot excrete copper and copper will accumulate in liver (cirrhosis); brain (basal ganglia) and cornea (Keyser-Fleischer rings)
96
What is DOC for Wilson's?
penicillamine ( cannot use if allergic to penicillin and may cause drug-induced lupus
97
Which movement disorder is caused by trinucleotide repeats?
Huntington's
98
MCC of death in Huntington's
suicide
99
Which area of brain is affected by Huntington's?
caudate nucleus
100
DOC for Huntington's?
antipsychotics (dopamine blocker)
101
5 diseases that have trinucleotide repeats
1. Huntington's
2. Fragile X
3. mytonoic dystrophy
4. Freidrich's ataxia
5.Prader-Willi (5% trinucleotide repeats)
102
What gene is involved in Wilson's?
ATP7B
103
What gene is involved in Menke's?
ATP7A
104
What trace element if deficient may cause DM2?
chromium
105
What is the inheritance pattern for structural proteins?
Autosomal dominant
106
What is the inheritance pattern for enzymes?
Autosomal Recessive
107
What is it called if you inherited the gene but don't have the disease?
incomplete penetrance
108
What is it called when many members of a family have the defective gene but have different problems?
variable expression
