Flashcards in Quiz 13 Deck (215):
The actions of the body on the drug
The actions of the drug on the body
(Usually this means 'how does the drug bind to the receptor')
Name four examples of pharmacokinetics
Define what an agonist is
Drug or natural ligand that activates the receptor. Sometimes selective, sometimes not
What does the dose response curve look like for an agonist?
Define what an antagonist is
Binds to the receptor in the same location as the agonist would. However it does not activate a response. Thus it interferes with the agonist.
What happens to the dose response curve when you add an antagonist
It shifts the dose-response curve to the right. Slope and shape of the sigmoidal curve remains the same
If you have antagonist in solution, how do you overcome this to get a desired effect?
Increase the concentration of agonist
Define what an allosteric activator is
It binds to the receptor at a separate location from where the agonist binds and potentiates the effect.
(It changes the configuration of the receptor to better receive the agonist)
Describe the changes to the dose-response curve when an allosteric activator is added
The plateau (think Vmax) is raised. This means that the same concentration of agonist brings about a greater effect.
Describe what an allosteric inhibitor is
It binds to the receptor at a location separate from the agonist site, thus it is noncompetitive. Actions are often reversible.
Describe the dose-response curve change that occurs when an allosteric inhibitor is added
The plateau (think Vmax) is lowered. Meaning the same concentration of agonist is less effective at bringing about a response
True or false... receptors may be active, producing an effect, even in the absence of drug
True. Very small amounts however. "In the absence of drugs, the two isoforms of receptors are in equilibrium and Ri is favored"
True or false.. If a receptor is bound to drug, it must be in the active form
False. "Inactive receptors can exist, even if paired with MOST drugs"
Receptors are in equilibrium between the inactive and active forms. Without drug the ____ form is favored. With drug the ____ form is favored.
Define full agonist. Describe its dose-response curve
This agonist has a much higher affinity for the active receptor, thus the equilibrium favors the Ra-D form the most, resulting in the largest effect.
The curve has the highest plateau
Describe what a partial agonist is. Describe what the dose-response curve looks like
A partial agonist produces a lower response than full agonists because the agonist has intermediate affinity for both Ri and Ra. (Meaning the equilibrium is shifted more towards the Ri side, resulting in less of a response). The Ra-D complex is less stable.
This simply lowers the plateau on the curve
Describe what an inverse agonist is. What doe its dose-response curve look like?
this agonist has a greater affinity for Ri, thus equilibrium favors the Ri-D complex (very stable), resulting in a decrease of activity compared to the constitutive activity. Thus, inverse agonists can produce contrasting physiologic results.
The plateau shifts down, even below the constitutive activity
Describe what a conventional antagonist is and what its dose-response curve looks like
A conventional antagonist has equal affinity for the Ra and Ri, thus has NO CHANGE in constitutive activity.
The dose-response curve is flat, at the same level as constitutive activity.
What is EC50?
The concentration of agonist at which you get 50% of the effect
What is Kd?
The concentration of agonist in which half of the receptors are bound.
What is IC50?
This is the concentration of the ANTAGONIST in which you have 50% of the effect
True or false. EC50 = Kd
What happens to EC50 when you add competitive antagonist to the solution?
The EC50 shifts to the right (think Km)
What happens to EC50 when you add noncompetitive antagonist (allosteric inhibitor) to the solution?
EC50 doesn't change. However, the plateau shifts down (think Vmax)
The smallest dose possible that causes a measurable effect
What are spare receptors?
Extra receptors that dont really make a difference. You can take away these receptors and see no change in the maximal effect
Why is it that if you add partial agonist with full agonist that you see a decrease in the maximal effect (plateau)?
The partial agonist is taking up some of the receptors, shifting the equilibrium more towards the Ri-D complex, thus lowering the maximum effect. Thus, the mixture of partial and full agonist will be intermediate between the full agonsit maximal effect and the partial agonist maximal effect
Describe what an additive drug-receptor interaction is
1+1=2. Drug effect equals the sum of individual effects.
Describe what a synergistic drug-receptor interaction is
1+1=5. The sum of the two drug effects is much greater than the sum of the individual parts.
(Deals with more than one drug at a time)
Describe what an antagonistic drug-receptor interaction is
A drug can block the effect of another
What is a chemical antagonist?
Does not involve receptor
For example: charge differences due to certain environments
What is a physiological antagonist?
Involves endogenous regulatory pathways mediated by different receptors
Define efficacy in regards to pharmacology
This is the number of receptors that must be activated to yield a maximum response. A drug with high efficacy only needs to activate a small amount of receptors.
(Think up and down) A drug with high efficacy will have a high plateau
The relative concentrations of two or more drugs that produce the same drug effect. Usually refers to EC50
(Think side to side). A drug that is more potent with be shifted towards the left
A measure of the tightness that a drug binds to the receptor
The therapeutic index = ____. Which is better a high therapeutic index or a low therapeutic index?
TD50 (toxic dose)/ED50 (Therapeutic dose)
A high therapeutic index is favorable
When referring to the therapeutic range, The Y axis of the graph is ____ and the X axis is _____
Y axis = blood concentration
X axis = drug dosage
What is the margin of safety?
The amount of drug lethal to 1% divided by the amount of drug that causes a beneficial effect in 99%
You want this to be a high number
True or false... toxicity means leathal dose
False, it is defined for what you want it to be. It can be certain symptoms
The amount of drug that gets to the target is inversely proportional to what two things?
Distance of the site of administration to the target
Amount of tissue that the drug must pass through
What does parenteral mean?
Not by way of the GI tract
Name three examples of parenteral drug administration
Which is faster absorption, intramuscular or subcutaneous injections?
Intramuscular (about 5 minutes). Large volumes are possible, sometimes painful
True or false... subcutaneous injections allow for larger volumes of drug to be administered in comparison to intramuscular injections
False... intramuscular injections allows for larger volumes to be administered
What does enteral mean? Give two examples of enteral drug administration
Enteral - by way of the GI tract
Oral - most common and convenient, effect takes about 30 minutes
Rectal - less first pass effect than oral
What is enteral drug administration less predictable than parenteral?
You dont know how much will be absorbed because it can change due to pH, food, etc.
side note: absorption occurs in duodenum. This is called first pass metabolism
The initial distribution of drug into the tissues is determined by ____
The rate of blood flow
The concentration of drug at a particular site is related to its ____
What other two factors can play a role in drug distribution?
Plasma binding proteins
Gastric emptying time
Name three other methods of drug administration
Inhalation (very fast)
What is a loading dose?
The first big dose given to the patient to load the system with a high enough concentration to get the effects within the therapeutic range quickly. Then the effects are maintained within the therapeutic range by consecutive smaller doses
What is the difference between drug and medicine?
Drug - any substance that brings about a change in biological function through its chemical actions
Medicine - a subset of drugs used for selective, THERAPEUTIC effects
True or false... side effects are always negative effects
False. Side effects are just any unintended effects of the drug, may be positive
Chemical not synthesized in the body
Absorption of the drug is affected by what four factors?
Route of administration
Cell membrane characteristics (diffusion or active transport)
What are five drug characteristics to take into consideration?
Is it water soluble or lipid soluble?
Is the size of the molecule large or small? (Large molecules cant go to as many places and cant be absorbed as well as small molecules can)
Acidity (basic drugs are not well absorbed in the stomach)
What are the two mechanisms of drug passive transfer across biological membranes?
Filtration - water soluble drugs small enough can go through aquaporins
Simple diffusion - lipid soluble drugs can freely cross the cell membrane
True or false... only non-ionized drugs are soluble lipids
What are the two types of specialized transport across biological membranes for drug transfer?
What is bioavailability? What two things affect bioavailability? What method of drug administration has the highest bioavailability?
The fraction of unchanged drug reaching the systemic circulation following administration by any route
Dissolving of drug in GI tract
Destruction of drug by the liver
Intravenous = 100% bioavailability
What are two important determinants for determining dose to be administered to patient?
Distribution and clearance
What is volume of distribution? What is its formula?
It is the measure of the apparent space in the body available to contain a drug.
V= amount of drug in body/concentration of drug
It can exceed any physical volume in the body because it is the volume apparently necessary to contain the amount of drug homogeneously at the concentration found in the blood/plasma/water.
If you give someone 100mg of a drug. Then take a plasma sample that is 33mg/l, what is the volume of distribution? What does it mean?
100/33 = 3L
3L means that the drug is restricted to the central compartment (blood)
What are the three physiological compartments and their volumes?
Plasma - 3L
Extracellular space - 14L
Total body water - 42L
What are four major variables affecting the volume of distribution (Vd)?
Binding to plasma proteins (makes drug stay in blood better)
Binding to tissue proteins (makes drug leave blood better)
Absorption into adipose tissue
Drug lipophilicity, hydrophilicity, MW
What does it mean if the volume of distribution is 300L?
This means that the drug is restricted to a smaller region of the body
Drugs with very high volumes of distribution have much ____ concentrations in _____ tissue than in the ______ tissue
Drugs that are completely retained within the vascular compartment, have a ______ _____ volume of distribution equal to the blood component in which they are distributed.
Drugs with a _____ volume of distribution are limited to certain areas within the body. Whereas those with a ____ volume of distribution penetrate extensible into tissues throughout the body.
The larger the volume of distribution, the _____ a dose must be to achieve a desired target concentration
If a drug has a volume of distribution of 15-18L, what might you assume?
The distribution is limited to the extracellular fluid because this is the approximate volume of extracellular fluid
how is the volume of distribution used to calculate half life? What is the formula?
T1/2 = 0.693 Vd/Cl
Cl = clearance rate
Clearance = ?
Rate of elimination/concentration of the drug
It is the process of drug elimination from the body from a single organ without identifying the individual processes involved
May also be defined as the volume of fluid cleared of drug from the body per unit of time
Drugs are generally eliminated in the ___ but some in the ____
Feces, lungs (volatile compounds), salivary glands, sweat, and even hair
Does drug binding to plasma proteins increase or decrease the amount of drug filtered through the glomerulus?
Will a drug that is highly hydrophobic be more or less likely to be reabsorbed in the kidney tubules?
Name two examples of drug transporters
Solute carrier transporters
ATP binding cassette transporters
_____ transports drug molecules from cells back into the intestinal lumen for excretion
What is the difference between zero order and first order kinetics of drug elimination?
100, 80, 60, 40
A constant amount of drug is eliminated per unit time, independently of drug concentration
100, 90, 81, 71.9,
The process that is directly proportional to the drug concnetration
true or false... phase 1 always precedes Phase 2 metabolism
False, it usually goes in that order but it can go either way
What usually occurs in drug metabolism?
Makes drugs more hydrophilic (thus more easily excreted)
usually makes substances less toxic
Where are microsomes derived from? Where are they derived if they have ribosomes in them? What do the smooth microsomes contain?
Purified liver endoplasmic reticulum?
Rough endoplasmic reticulum
Mixed function oxidases (monooxygenases)
Name two oxidases
Describe phase 1 hepatic metabolism
Includes oxidation, reduction, and hydrolysis
Phase 1 metabolites that are hydrophilic are excreted. The other metabolites go on to phase 2 metabolism
What is cytochrome p450?
Heme-containing enzymes primarily found in liver hepatocytes and small intestine enterocytes
Key for drug metabolism (oxidation), biotransmoration, and detoxification
Each enzyme is referred to as an ISO form
What are the two most common types of cytochrome p450s? Which is most abundant in human liver and intestines?
CYP3A4 and CYP2D6
CYP3A4 is most obundant in human liver and intestines
A drug that is the target of a particular enzyme
Increases the activity of a p450 enzyme thus increases metabolism and clearance of a drug
Inhibits the activity of a particular p450 enzyme thus decreases metabolism and clearance of a drug
Define phase 2 hepatic metabolism
Includes glucuronidation conjugation to make the drug more hydrophilic (utilizes glucuronic acid)
Name four factors that can affect hepatic drug metabolism
Microsomes enzyme inhibiton (many drugs inhibit CYP450)
Microsomes enzyme induction
Plasma binding protein (drugs highly bound will not enter liver (also wont be filtered in the glomerulus) and thus have a longer half-life
What percentage of blood returns to the venous system? The remaining fluid is taken up by _____
they lymphatic system
Explain the difference between the right lymphatic duct and the thoracic duct
The thoracic duct drains the left side and inferior portion of the body
The right lymphatic duct only drains the right head, and right arm
What structure separates the superficial tissues and deep structures of the head and neck?
Deep cervical fascia
Lymph can be drained from superficial tissues into.....
Regional nodes or deep cervical nodes
Regional nodes is more common
Occipital lymph node
Afferent: back of scalp
Efferent: deep cervical lymph nodes
Retro auricular lymph node
Afferent: strip of scalp above auricle, posterior external auditory meatus
Efferent: Superficial cervical nodes
Superficial parotid lymph node
Afferent: strip of scalp above the parotid salivary gland, lateral surface of auricle, anterior wall of external auditory meatus, lateral part of the eyelid
Efferent: deep cervical node (Jugulodigastric)
Deep parotid lymph nodes
Afferent: middle ear
Efferent: deep cervical node (jugulodigastric)
About how many parotid lymph nodes are there?
5 to 6
buccal lymph nodes
Afferent: lower eyelid, buccinator, facial vein
Efferent: submandibular lymph node... then to deep cervical.
***this one drains into a regional node before going to the deep cervical
Submandibular lymph nodes
Afferent: a bunch of stuff... lips, nose, air sinuses, upper and lower teeth (***except mandibular incisors), anterior 2/3 tongue (***except tip), floor of mouth
Efferent: deep cervical nodes
Submental lymph nodes
Afferent: tip of tongue, floor of mouth beneath tongue, incisors, central part of lower lip, skin over chin
Efferent: submandibular node oooorrrr deep cervical nodes (specifically the jugulo-omohyoid node)
Where are the retropharyngeal lymph nodes located?
Between the pharynx and atlas
Which is most superior, the jugulodigastric lymph node or the jugulo-omohyoid lymph node?
The gingiva is drained by _____
Submandibular lymph nodes
The hard palate is drained by ____
Submandibular nodes and superior deep cervical nodes
The soft palat is draine by ____
The floor of the mouth is drained by ____
Submandibular and submental nodes
The teeth are drained by ____
Submandibular and deep cervical
Submental drains the mandibular incisors
The tonsils are drained by ____
The tip of the tongue is drained by ____
The anterior 2/3 of the tongue (excluding the tip) is drained by ____
Submandibular and deep cervical
The posterior 1/3rd of the tongue is drained by ___
Jugulodigastric lymph nodes
All of the paranasal air sinuses are drained by ____, except for _____ which is drained by _____
What is the only node that drains directly into the jugulo-omohyoid node?
Dorsal scapular nerve comes off of ____ and innervates ____
Root of C5
Innervates levator scapulae and rhomboids
The suprascapular nerve comes off of ____ and innervates _____
Supraspinatus and infraspinatus
What structure separates the anterior and posterior divisions of the brachial plexus?
The brachial plexus is symmetrical except for what feature?
The anterior division of the middle trunk
The nerve to subclavius branches off of ____ and innervates _____
Roots of C5 and C6
Innervates the subclavius muscle (duh)
The long thoracic nerve branches off of ____ and innervates ____
C5, C6, and C7 roots
The lateral pectoral nerve branches off of ____ and innervates ____
Pectoralis major only
The medial pectoral nerve branches off of ____ and innervates ____
The medial cord
Pec major and minor
The upper subscapular nerve branches off of ___ and innervates ___
The lower subscapular nerve branches off of ____ and innervates ____
The posterior cord
Subscapularis AND teres MAJOR MAJOR MAJOR
The thoracodorsal nerve branches off of ____ and innervates ____
The medial brachial cutaneous and medial antebrachial cutenous branch off of ____ and innervate ____
Upper arm and muscles
Lower arm and muscles
Which terminal nerves of the brachial plexus are involved in flexion?
Which terminal nerves of the brachial plexus are involved in extension?
What percentage of the U.S population has diabetes?
True or false... sucrose results in higher spikes of blood glucose and insulin. Eating lots of insulin can bring about insulin insensitivity
Name four symptoms that are more severe in type one diabetes than type 2 diabetes
Polyuria and thirst
Weakness and fatigue
Polyphagia and weight loss
Name two symptoms that are more severe in type 2 diabetes than type 1
What are three signs of diabetes?
Sweet tasting urine
Sweet smelling breath
Impaired wound healing
The onset of type 1 diabetes usually occurs when? What hormone levels are elevated at onset?
In type 1 diabetes, ____, ____, and ____ are dysregulated and released within the blood
Glucose, fats, amino acids
Does improper fatty acid metabolism increase or decrease ketone body production and release?
How long after the environmental trigger does type one diabetes form?
Highly variable. Days to weeks to months to years
The lack of insulin will cause glucagon levels to (increase/decrease) and leptin levels to (increase/decrease).
Increase (this is like a positive feedback loop that will result in hyperglycemia)
Decrease (this leads to increased amount of eating, contributing to hyperglycemia)
Reduced glucose uptake will result in what three things?
Elevated blood glucose
Fatty acid oxidation
Cellular energy deficiency
Fatty acid oxidation will lead to...
Increased liver gluconeogenesis (which contributes to elevated blood glucose)
Elevated blood ketone bodies
Elevated blood glucose and elevated blood ketone bodies contribute to ____
Osmotic diuresis (this is losing excessive amount of fluids through the kidneys)
Do elevated blood ketone bodies increase or decrease the blood pH?
Decrease the pH (more acidic)
Type 1 diabetes requires insulin replacement therapy. What are the three coordinated interventions?
Diet (low carbs)
The goal of insulin administration is to maintain fasting blood glucose levels between ____ and ____
80 and 140 mg/dl
What are the two approaches for insulin administration? What is the normal blood glucose range?
Define type two diabetes
Progressive increase in fasting glucose due to reduced insulin sensitivity followed by a degeneration of insulin production
Name the three possible mechanisms of insulin insensitivity
Ectopic lipid storage and free fatty acids
In type two diabetes, When adipocytes reach capacity, they secrete _____, which causes macrophages to ____, resulting in....
Macrophage chemotaxis protein
Macrophages to break up fat and release it into blood
This will interfere with the glucose channels, causing lipids to be used for energy instead of glucose
Type two diabetes is managed by what three approaches?
Oral hypoglycemic drugs
Name four common drugs for treating hyperglycemia
Peroxisome proliferator-activated receptor agonists - increases glut 4 expression
-prevents carb absorption
What are sulfonylureas?
An oral hypoglycemic that serves to increase B cell insulin secretion. There types of this drug are glipizide, glyburide, and glimepiride
What is metformin?
An oral hypoglycemic that reduces gluconeogenesis and lipogenesis
Involves the ampk signaling pathway
What are the five primary methods for detecting diabetes?
Glucose monitoring (tested over a long period of time)
Glucose tolerance test (tested in a day)
What is the purpose of the C-peptide test? How does it work?
The C-peptide test differentiates between type one and type two diabetes. When proinsulin is cleaved to produce insulin, C-peptide is released. If C-peptide is present in the blood, it is type 2. If no C-peptide is present, it is type 1
What are the signs of hypoglycemia?
Loss of speech
Increased heart rate
What are the causes of hypoglycemia?
What is the treatment for hypoglycemia?
Test blood sugar
What are some symptoms in hyperglycemia, different from hypoglycemia? What causes it? What is the treatment?
Thirst, dry mouth
High blood sugar, lack of insulin, inactivity, excess food
Insulin, oral hypoglycemic, physical activity, diet
What are the long-term diabetic complications for diabetes?
Impaired wound healing
Name the four fat soluble vitamins
Name the vitamins that have toxicity reported
What is the common name for vitamin B9? What about Vitamin C?
What is the only water soluble vitamin that is stored for long periods of time?
Water soluble vitamins are absorbed by...
What is the difference between a vitamin and a vitamer?
Vitamers are grouped under the umbrella group of vitamins. The vitamers for a type of vitamin can do the same things, but have slightly different structures
Involved with vision
Deficiency leads to night blindness and skin problems
Used to treat acne (accutane), except if you take while pregnant it can result in abnormalities in the baby
Deficiency can result in wernicke karsakoff syndrome, memory problems, weight loss. Berrieberrie- peripheral neuropathy (caused impaired sensory and motor)
Chronic alcoholism and diabetes is associated with B1 deficiency
B1 is an essential coenzyme for the pyruvate bridge (TPP will help convert pyruvate to acetyl coA)
Essential for carbohydrate and lipid metabolism (forms FAD)
Necessary for NAD+
Deficiency results in PELLAGRA (dermatitis, diarrhea, inflamed mucus membranes, delusions)
Coenzyme A synthesis
Forms PLP. Involved in amino acid metabolism and neurotransmitter synthesis
PLP - involved in amino-transferase reactions
Involved in fatty acid synthesis (acetyl coA carboxylase) and amino acid catabolism
Produced by bacteria in the gut
What is the daily adequat intake?
Forms tetrahydrofolate, essential for amino acid metabolism (forms methionine)
Daily adequate intake: 400 ug/day, 600 ug/day for pregnant women
Deficiency during pregnancy increases the risk of neural tube defects in baby
Deficiency also associated with abnormal nucleated erythrocytes
TAking too much B9 cause it results in masking B12 deficiencies
B9 (folic acid) intake should not exceed 1 mg per day because it will mask the megoblasic anemia (abnormally nuculeated erythrocytes)affects of B12 without correcting neurological deficits leading to persistent deficiency and nerve damage.
Poorly absorbed in gut
Deficiency can result in irreverbable nerve damage
Deficiency results in Scurvy (fatigue, malaise, progressive weakening of CT, joint pain)
Provides antioxidant activity, promotes collagen synthesis
Excessive vitamin C is toxic and can result in goute and kidney failure.
Interacts with receptors to exert hormonal control of calcium and phosphate metabolism integration into bone
Sunlight exposure converts provitamins to vitamin D
Deficiency can result in rickets (bone softness) or osteomalacia (bone weakness), or muscle weakness
Involved in immune signaling, involves prostaglandin synthesis
Deficiency results in an impaired immune response
Required for production of clotting factors
Deficiency results in bleeding and hemorrhaging, osteoporosis
Name the 13 essential vitamins
Name the two essential fatty acids
Linoleate and alpha-linolenate
Name the two pathways for nervous system control of organ system
Autonomic nervous system
What structure in the brain is responsible for regulating all organ function in the body? Describe the two pathways of control
It receives info from every organ in the body.
Directly controls the autonomic nervous system
Indirectly controls the neuroendocrine system
What neurotransmitter is involved in the sympathetic nervous system? What about parasympathetic?
What about enteric?
Epinephrine and norepinephrine
Epinephrine, acetylcholine, serotonin
What processes produces CO2?
Betaoxidation and carbohydrate metabolism
Chemoreceptors and baroreceptors feed back to the nucleus of ____
The solitary tract
Increased blood pressure ____ tonic sympathetic activity and ____ vagal parasymphatic activity
Decreased blood pressure does just the opposite
True or false... very small amounts of releasing hormones are needed to stimulate the pituitary. Nanograms of hypothalamus releasing hormones signal the pituitary gland to secret micrograms of hormone to stimulate the adrenal gland to secrete milligrams of final hormone
True or false... sympathetic nerves innervate the adrenal medulla to secrete epinephrine and norepinephrine.
True. And the sympathetics release ACH to allow this to happen
PGE1 (prostaglandin E1) is an example of what class of hormone? What is it used for?
Used in the inflammatory response
NADPH is produced in the ____ cycle and is involved in....
Lipid synthesis and dealing with free radicals
What are the four fates of glucose 6 phosphate in the liver?
Pentose phosphate pathway
Converted to glucose by glucose 6 phosphatase and released into the blood
Why is the nitrogen produced from amino acid catabolism transferred through alanine from muscle cells to the liver instead of glutamine?
It prevents a-ketogluterate from leaving the muscle (which is used in the citric acid cycle)
How do fatty acids get from the diet to the liver? How do fatty acids get to the liver from adipose tissue?
Chylomicrons produced in the intestines
When adipose tissue reaches capacity, it releases leptin. What does leptin do?
Eat less, catabolize fatty acids, inhibits fatty acid synthesis.
Also it inhibits the pathway that causes you to eat more, synthesize fatty acids
Explain how increased levels of glucose will cause B cells to secrete insulin
Glucose enters b cells via GLUT 2, this produces ATP. The increase of ATP will inhibit ATP-gated K channels. This causes depolarization, which will open voltage gated calcium channels to allow the influx of calcium. The influx of calcium will cause insulin granules to be exocytosed.
What things inhibit a-cells from secreting glucagon?
When is glucagon constitutively released?
At low glucose levels
Insulin drives glucose ____, glycogen ____, and lipid _____
Glucagon drives glucose ____, amino acid and fatty acid ____.
During starvation, you create more ketone bodies due to a lack of ____
Without oxaloacetate, acetyl coa cannot enter the citric acid cycle and acetyl coa accumulates. The excess acetyl coa are converted into ketone bodies
the superficial cervical lymph nodes drain the ____ and feeds into the ____
Skin over the angle of the jaw, and skin over apex of parotid gland and lobule of the auricle
Deep cervical nodes
Name 6 regional neck lymph nodes
The paratracheal lymph nodes drain ____ and dumps into ____
Name the three anterior cervical nodes
True or false... the teeth can be drained directly by deep cervical nodes
True or false... the anterior 2/3 of the tongue can drain directly into the deep cervical nodes
Name the supraclavicular nerves of the brachial plexus
Nerve to subclavius
of the three ketone bodies, which can be used as fuel, which is toxic?
Acetone is toxic
Acetoacetate and B-hydroxybutyrate can be used as fuel
Fat soluble vitamins require ___ for uptake
Water soluble vitamins are absorbed by sodium trasnporters besides ____
B9 and b12
What enzyme directs genetic recombination? (Crossing over)?