Final Flashcards
1
Q
Which vitamin is associaed with induced hydrocephalus?
A
Vitamin A
2
Q
Which vitamin is associated with induced hypercalcemia?
A
vitamin D
3
Q
Supplemental vitamins my abe needed in special cases:
A
-pregnancy.lactation
-improper absorption (due to diarrhea, hyperthyroidism, alcoholism, liver disease)
-abx therapy(may lower GI bacterial synthesis of Vitmain K)
-hemodialysis
-hyperailmentation
-poor diet
4
Q
Function of Thiamine (B1) (water soluble)
A
-converted to active coenzyme (thiamine pyrophosphate
-needed for decarboxylation reactions (pyruvate to Ac-CoA)
-pyruvate necessary to produce Acetyl-CoA
-also used by pentose in hexose-monophosphate shunt
5
Q
What is indicative of thiamine deficiency?
A
high pyruvate plasma concentration
6
Q
BeriBeri is due to low ____________
A
thiamine
7
Q
BeriBeri causes:
A
-muscle weakness,
-decreased appetitie
-peripheral edema
-decreased BP and
-decreased temperature
8
Q
Severe deficiency of Thiamine (B1)
A
Korsakoff’s syndrome (alcoholics)
associated with peripheral polyneuritis, loss of feeling in legs, memory impairment and encephalopathy
9
Q
What ECG changes are associated with thiamine deficiency?
A
T-wave flattening and inversion and prolonged Q-T interval
10
Q
Hyperailmentation (high glucose) requires more_____
A
B1 thiamine
11
Q
In cases of high carb load, what vitamin do you need more of?
A
Thiamine B1
12
Q
Function of Riboflavin (B2)
A
-converted to coenzymes flavin mononucleotide and flavid dinucleotide
-important in hydrogen ion transport oxidative enzyme processes
-Chlorpromazine and TCA’s intervene with flavokinase conversion to coactive coenzymes
13
Q
Riboflavin deficiency (B2)
A
-pharyngitis and angular stomatitis; first symptoms followed by glossitis, denuded lips and dermatitis of face, trunk and extremities
-anemia, peripheral neuropathy, cataracts may occur
14
Q
function of nicotinic acid (Niacin)
A
converted to nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP) coenzymes
-required for oxidation/reduction reactions in tissue respiration
15
Q
What is Pellegra
A
nicotinic acid (niacin) B3 deficiency
16
Q
symptoms of Pellegra (niacin deficiency)
A
-dermitits
-diarrhea
-salivation
-N/V
-swollen tongue
-dementia
-motor and sensory nerve disturbances
17
Q
What blocks the conversion of nicotinic acid to NAD?
A
INH
isoniazid
18
Q
niacin toxicity seen as
A
-flushing
-prurutis
-hepatotoxicity
-hyperuricemia
-peptic ulcers
19
Q
niacin needs can also be filled by:
A
nicotinamide and tryptophan which are converted to niacin
20
Q
function of pyridoxine (B6) water soluble
A
-converted to pyridoxal phosphate by pydridoxal kinase
-acts as coenzyme for conversion of tryptophan to serotonin and methionine to cysteine necessary for amino acids
21
Q
defiicencys of Pyridoxine (B6) commonly seen in
A
alcoholics
22
Q
symptoms of Pyridoxine (B6) deficiency
A
symptomes include:
-dermititis
-CNS dysfunction
-seizures
-peripheral neuritis
decreased seizure threshold due to decreased GABA production (required B6)
23
Q
INH and hydralazine inhibit__________
A
pyridoxal kinase (B6 deficiency)
24
Q
pyridoxine increases decarboxylation of L-dopa which may then be contraindicated in patients taking L-dopa unless they are also taking carbidopa (Sinequan)
A
25
function of pantothenic Acid (water soluble)
-converted into coenzyme A
-needed for enzymatically driven acetylation reactions
26
deficiency of pantothenic acid
-rare due to its presence in many foods and production by intestinal bacteria
-thus no obvious need for supplementation even though it is usually a component of multivitamins
27
function of biotin (water soluble)
coenzyme for carboxylation reactions and fatty acid synthesis
28
deficiency of biotin
symptoms:
-glossitis
-anorexia
-dermititis
mental depression
-seen more frequently in infants, so formulas should contain supplements
-may be seen in prolonged hyperalimentation
29
function of folic acid
-absorped from SI in a transport form
-B12 required for conversion to active form (tetrahydrofolate)
-acts as a carbon transfer agent in conversion of homocysteine to methionine, serine to glycine, purine and DNA synthesis
-can cause anemia
-diet is primary source
-high level of enterohepatic recirculation lowers dietary needs
-cooking (heat) destroys up to 90% infood)
30
deficiency of Folic acid
-GI diseases and disorders most common cause
-alcoholism decreases food intake and may decrease enterohepatic recirculation
-some drugs (methotrexate, trimethoprim) inhibit conversion enzyme (dihydrofolate reductase)
-leucovorin used as a rescue agent
-most common symptom is megaloblasic anemia
-onset usually faster than seen in B12 deficiency due to limited storage
31
Cyanocobalamin (B12) function
-generic terms for a group of cobalt-containing compounds
-binds to glycoprotein intrinsic factor in stomach and is transported via carrier into the circulation in the ileum
-binds to transcobalamin II in blood for transport to tissues
-liver acts as a storage site
-needed for DNA synthesis so tissues with high turnover need most
32
deficiency of B12
-rare since found in most foods
-unless caused by decreased intrinsic or gastric achlorhydria
-GI bacterial infections may decrease availability
-nitrous oxide oxidizes cobalt atom in B12 thus rendering it ineffective
-symptoms usually involve blood (erythrocytes most) and nervous systems
-megaloblastic anemia usually first sign
-demyelination of nerves in spinal cord and cerebral cortex causes neuron death and is seen as paresthesias
33
What test is used to test for B12 deficiency?
Schilling's test
34
treatment of B12 deficiency
-folic acid corrects anemias but not nervous system symptoms
-because most involve improper absorption oral supplements little value
-IM admin of B12 and oral dosing of folic acid best in severe cases
-while hematopoietic system usually responds rapidly (iron supplement?) nervous system response slower and may never fully recover
-therapy must continue monthly due to decrease in GI carriers
35
Function of Ascorbic Acid (vitamin C) Water soluble
-structurally related to glucose
-acts as coenzyme in many reactions
-well absorbed from GIT
-found in high levels in citrus fruits (juice) and used in foods as antioxidant
-megadoses widely claimed to be able to treat colon cancer and the sommon cold
36
what deficiency causes scurvy
vitamin C (ascorbic acid)
37
are hummans able to synthesize vitamin C
no
38
symptoms of Ascorbic acid (vitamin C) deficiency
-gingivitis
-petechia
-decreased wound healing
39
Vitamin C deficiency common in
-alcoholics
-drug addicts
-elderly
40
excretion of vitamin C enhanced by
Tetracyclines
Barbiturates
salicyclates
41
Vitamin A function
-function of retina, mucosal and epithelial cells, bone development, reproduction and embryonic growth
-stabilizes membranes and controls membrane permeability
-may be involved in synthesis of certain proteins and has been implicated in controlling development of some cancers-high doses required to be antineoplastic are hepatiotoxic
42
Major dietary sources of Vitamin A
-liver
-cheese
-butter
-milk
-fish
fruits and veggies
43
deficiency of vitamin A
-most common in infants and children
-symptoms not obvious unless severe deficiency
-skin lesions and infections early symptoms
-night blindness in severe deficiency
-pulmonary infections seen due to loss of bronchial cell secretions and drying
-urinary calculi, decreased spermatogenesis, spontaneous abortion
-taste and smell defieicny reports
44
hypervitaminosis vitamin A
-treat by removing source, symptoms usually resolve in 7 days
-symptoms irritability, vomiting, dermatitis
-loss of body hair, diplopia, nystagmus, gingivitis
Severe symptoms
hepatosplenomegaly with cirrhosis, increased intracranial pressure with neuro symptoms
-hypercalcemia due to bone destruction by increased osteoclast activity
-congenital defects when mothers consume abnormally high amounts
45
function of Vitamin D
-generic term for several sterols that acts as hormones
-responsible for proper maintenance of plasma calcium and phosphate levels
-regulates absorption of calcium and phosphate from GIT and mobilization from bone
-may act on proximal renal tubules to control calcium and phosphate exxcretion rate
-major sterol, 7-dehydrocholesterol, synthesized in skin and converted by sunlight to vitamin D
-also absorbed from GIT but requires bile salts
-hydroxylated in liver to calcitriol in active form
-calcitriol synthesis regulated by negative feedback system
46
Vitamin D deficiency
-seen as decrease in calcium and phosphate plasma levels
-this then stimulates parathyroid hormone secretion which tries to increase plasma calcium from bone
-in children this can cause rickets
-in adults=osteomalacia
-phenytoin decreases effectiveness of vitamin D and can lead to rickets and osteomalacia
47
vitamin D hypervitaminosis
symptoms:
-hypercalcemia
-muscle weakness
-fatigue
-headaches
-hypercalcemia affects the renal system causing pu/pd, proteinuria
48
treatment of vitamin D hypervitaminosis
-withdrawing source
-increasing fluid intake
-corticosteroids
49
Vitamin E functions
-found mainly in plants
-not much evidence for need in humans
-potent antioxidants
-seems to help absorption of Vitamin A
-used to prevent spontaneous aborptions but proof lacking
-antioxidant effects in preventing CAD by inhibiting oxidation of lipids
50
Function of Vitamin K
-required bile salts for absorption
-not stored for very long, need is continual
-used as cofactor in production of factors 2,7,9,10 from glutamic acid
-prothrombin time (2) measured as an index of vitamin K activity
51
Vitamin K 1
phytonadione
found in foods
52
Vitamin K 2
snythesized by gram + bacteria in GIT and supplies 50% of needed
53
deficiency of vitamin K may be due to :
-diet
-decreased bacteria flora
-decreased absorption
-hepatic disease
54
minerals are essential components in general function of body systems including:
-maintenace of osmotic pressure
-O2 transport
-nervous system function
-muscle function
-bone and tissue growth
-blood cell formation
55
Large minerals
-calcium
-phosphorus
-sodium
-potassium
-magnesium
sulfur
-chorline
56
trace minerals
-iron
-cobalt
-copper
zinc
-chromium
-selenium
-manganese
-molybdenum
-nickel
-tin
--silicon
-arsenic
57
hyperalimentation for prolonged periods may require ______supplementation
mineral
58
more _____ in the body than any other mineral
calcium
59
calcium is under control of________
vitamin D-parathyroid hormone-calcitonin system
-in blood also bound to albumin, phosphate or citrate
-arterial pH changes alter ionized concentration
-increased pH decreases concentration
60
calcium important in:
neuro function
-muscle contraciton
-blood coagulation
-release of neurotransmitters and autocoids
-bone formation
61
calcium cardiovascular effects
IV admin causes a brief increase in myocardial contractility and cardiac output while also decreasing heart rate
-arterial and venous pressure remain unchanged
-decreased heart rate due to increased vagal activity or a slowing of signal passage through the AV node
62
hypocalcemia most commonly seen due to _________.
dereased albumin concentration
63
other causes of hypocalcemia
-hypoparathyroidism
-Vitamin D deficiency
-renal failure with hyperphosphatemia
-acute pancreatitis
-rare: malabsorption of calcium or vitamin d
64
smyptoms of hypocalcemia
-tetany
-increased neuromuscular excitability
-laryngospasm
-seizures
-hypotension
65
treatment of hypocalcemia
-IV calcium (chloride, gluconate, gluceptate)
-IM calcium gluceptate as well as oral calcium in patients with minor calcium deficiency
66
how much elemental calcium is in calcium chloride?
27mg/ml
-calcium chloride is irritating to veins and may cause discomfort
67
how much elemental calcium is in calcium gluconate?
8mg/ml
68
most common cause of hypercalcemia
-a cancer which activates osteoclasts by secretion of cytokines (such as TNF)
also
patients with hypoalbuminemia may appear to have normal free calcium but total plasma calcium is reduced
-hyperparathyroidism can cause milder form of hypercalcemia
69
smyptoms of hypercalcemia
-sedsation
-vomiting
-ECG abn: prolonged P-R , wide QRS, shortened Q-T
renal damage
70
treatment of hypercalcemia
-proper hydration
-bisphosponates given I to bind up excess calcium
-imporatnt not to decrease calcium too rapidly (best over 24-48 hours)
-also decrease osteoclast activity and thus are used to treat postmenopausal osteo
-other agents used to decrease calcium such as corticosteroids act more slowly (7-14 days)
71
bisphosponates
-etidronate (Didronel)
-pamidronate (aredia
-alendronate (fosamax)
72
role of K
-osmotic pressure control
-needed in many enzymatic reactions
-excitable cell membrane (nerves, cardiac and skeletal muscle
-kidney function
73
aldosterone and ADH act at ______ to increase sodium reabsorption at the sacrifice of K
collecting ducts
74
Beta adrenergic agonists shifts K _____cells
into
can be used to treat hyperkalemia
75
Other drugs that shifts K into cells
theophylline
-insulin
76
Which antibiotics cause K loss?
Penicillins
aminoglycosides
77
symptoms of hypokalemia
-skeletal muscle weakness
-cardiac dysrhythmias
78
first sign of hyperkalemia
ecg changes such as peaked T wave
as concentration further increases there is increased P-R and widened QRS
79
treatment of hyperkalemia
-calcium given to help counteract cardiac effects
-sodium bicarb used as it shifts K into cells
-beta agonists
80
phosphate
-imporatnt in energy metabolism and maintenance of acid-base balance
-acts as a buffer, allowing large amounts of H ions to be sequestered
-decreased plasma levels decrease bone deposition of calcium and increase plasma calcium levels
81
______increases phosphate abosrption from GIT and proximal renal tubules
vitamin D
82
hypophosphatemia
may limit ATP production and can lead to skeletal muscle weakness and CNS dysfunction
83
magnesium ____% iin bone, ____% in muscle
50% in bone
20% in musucle
84
mangesemia
mainly bound to proteins in plasma
-normal levels controlled via GI absorption and renal excretion of mechanisms
-usually see imbalances associated with other ion imbalances
85
role of magnesium
-very important in certain enzymatic reactions mainly related to energy production
-ATP chelated to magnesium
-regulates calcium entry into cells and cellular actions
-ats as antagonist of calcium
86
common causes of hypomagnesemia
-alcoholism
-hyperalimentation
-malabsorption and continued V/D
87
symptoms of hypomagnesemia
-skeletal muscle weakness
-spasms, seizures
coma
cardiac surgery requiring pump -bypass may be cause due to dilation by pump priming solutions or diuretic use
88
hypermagnesemia
-rarely seen since mag is poorly abosrbed and renal excretion rapid
-can offur when given IV or in chronic renal failure
89
symptoms of hypermagnesemia
-sedation
-myocardial depression
-decreased neuromuscular function from Ach release
-direct relaxant effect on skeletal muscles
90
magnesium uses
-OB for prophylaxis and tx of convulsion in patient with gestational proteinuric HTN
-control arythmias associated with digitalis
-hypokalemia
-alcoholism
-MI
91
iron is absorbed in SI then bound to ____ for transport to tissues
transferrin
transferrin def can lead to iron def
most enters bone marrow for incorporation into new erythrocytes
92
patients should stop taking herbals_ ____prior to planned sx
2 weeks
93
Echinacea uses
-boosts immune system
-helps fight colds and flu
-wound healing
used for UTIs and bronchitis
94
concerns for echinacea
-hepatitis in conjunction with anabolic steroids and methotrexate
-hepatotoxicity
-decreased effectiveness of corticosteroids
95
ephedra uses (Ma-Huang)
-diet aid
-asthma
-bronchitis
-antitussive
96
concerns with ephedra
-arrythmias
-sympathetic crisis with MAOIs
increased BP and HR
97
feverfew uses
-migraine headaches
-fever
-allergies
-arthritis
-rheumatic diseaes
98
concerns of feverfew
-platelet inhibition-may increase bleeding, especially if used with other anticoags
-rebound migraines
-gi irritation.ulcers
99
garlic uses
-cholesterol/lipid lowering
-antihypertensive
-anticoagulant
100
concerns with garlic
-platelet inhibition-may increase bleeding, especially if used with other anticoags
101
ginger uses
-antiemetic
-antispasmotic
102
concerns with ginger
inhibits thromboxane synetase, resulting decreased clotting
103
ginkgo biloba uses
increased blood circulation and oxygenation
-enhanced mental alterness and memory
104
concerns of ginkgo biloba
-platelet inhibition-may increase bleeding, especially if used with other anticoags
105
ginseng uses
-increased physical stamina
-enhanced mental concentration
-antiox
106
concerns for ginseng
-platelet inhibition-may increase bleeding, especially if used with other anticoags
-post menopausal bleeding
0increated BP /HR
mania with phenelzine (nardil)
decreased effectiveness of warfarin
107
goldenseal uses
-laxative
diuretic
antiinflammatory
108
goldenseal concerns
-enhanced sodium retention
-edema
HTN
109
Kava kava used
-anxiolytic
-muscle relaxant
110
concerns with Kava KAva
increased duration of anesthetics
enhanced efefcts of other CNS depressants
increased suicidal risk in depressed patients
-hepatotoxicity
-aggravation of parkinsons disease symptoms
111
licorice uses
GI ulcers
antitussive
112
concerns with licorice
may increase BP and edema and cause hypokalemia
113
uses of saw palmetto
BPH
114
concerns with saw palmetto
may interact with other hormone therapies
may increase bleeding times
115
st johns wort uses
CNS depression or anxiety
sleep disorders
116
concerns for St. Johns wort
may prolong the effects of anesthesia
decreased effectiveness of administered HIV protease inhibitors and reverse transcriptase inhibitors
-may decrease plasma digoxin levels
117
valerian uses
sedative or anxiolytic
118
concerns for valerian
potentiation of other CNS depressants including anesthetics
119
Black licorice (Glycyrrhiza) can cause _______
potassium loss and subsequent cardiovascular instabilities
prolongs PR and QT intervals
120
Tyramine containin foods that may increase nervous system activity and blood pressure especially in patients taking MAOIs
-chocolate
-hot dogs
-processed meats
-aged cheese
-draft beer
121
which herbals can cause decreased clotting and increased bleeding:
Garlic
Ginger
Ginkgo Biloba
Ginseng
Feverfew
-saw palmetto
122
which herbals increase duration of anesthesia and enhance effect of other CNS stimulants
Kava-Kava
-St. Johns wort
valerian root
123
Ephedra linked to
cardiac arrythmias
increased BP /HR
124
Pregnancy Class A
reasonable research shows no increased risk of fetal abnormalities.
125
Pregnancy Class B
Animal studies have not demonstrated increased risk to the fetus, however human studies lack proof of safety.
126
Pregnancy Class C
No proof of safety in animal or human studies. Animal studies may indicate an increased risk.
127
Pregnancy Class D
Human studies have shown an increased risk to the fetus. However, risk/benefit ratio may override risk.
128
Pregnancy Class X
Human and/or animal studies have demonstrated a definite link to fetal abnormalities. Drugs in this category are considered contraindicated during pregnancy or in women who may become pregnant.
129
Maternal CO can be increased by _____% in first trimester which will increase absorption rate of drugs via topical routes
50
130
Pregnancy: pulmonary uptake is enhanced due to:
increased minute ventilation and decreased FRC
this will not increase induction rate of IA due to tissue redistribution which is not effected
131
which enzymes have increased metabolism during metabolism
CYP3A4 (midazolam), CYP2D6 (propranolol), CYP2C9 (phenytoin) , and UGT (morphine) isozyme metabolism
132
Which enzymes are decreased during pregnancy
CYP1A2 (theophylline), and CYP2C19 (warfarin) activity is decreased.
133
How is pseudocholinesterase activity affected in pregnancy:
While pseudocholinesterase activity is decreased in pregnancy, the expected increase in duration of succinylcholine is not seen primarily due to an increased volume of distribution.
Postpartum patients may show an increased duration of succinylcholine due to the volume of distribution returning to normal
134
Renal blood flow in pregnancy
Renal blood flow is increased up to 80% and GFR up to 50% (less near term) causing an increased elimination of renally excreted drugs (e.g. cephalosporins, digoxin).
135
The placenta contains a high concentration of UGT isozymes and may contribute to increased maternal metabolism by that route.
136
Are lipid soluble drugs a major determinant of drug transfer?
no
137
Which drugs are demonstrated to be present in high enough concentrations to cause CNS depression in breastfeeding infants?
meperidine and codeine
138
Pain thresholds are increased in pregnancy by the endogenous opiates and seem to be related to estrogen and progesterone concentrations.
Primary pathways effected are spinal delta and kappa opioid systems along with descending spinal alpha-2 noradrenergic pathways.
139
In US propofol is _______ in pregnancy
not recommended and may cause neonatal depression
not not contraindicated
140
Tocolytics
CCB (Nifedipine)-may delay delivery up to one week
Beta 2 agonists (Salbutamol)
NSAIDS (Sulindac
Magnesium
141
