Quiz 13 Flashcards
1
Q
Define pharmacokinetics
A
The actions of the body on the drug
2
Q
Define pharmacodynamics
A
The actions of the drug on the body
Usually this means ‘how does the drug bind to the receptor’
3
Q
Name four examples of pharmacokinetics
A
ADME
Absorption
Distribution
Metabolism
Elimination
4
Q
Define what an agonist is
A
Drug or natural ligand that activates the receptor. Sometimes selective, sometimes not
5
Q
What does the dose response curve look like for an agonist?
A
Sigmoidal
6
Q
Define what an antagonist is
A
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.
7
Q
What happens to the dose response curve when you add an antagonist
A
It shifts the dose-response curve to the right. Slope and shape of the sigmoidal curve remains the same
8
Q
If you have antagonist in solution, how do you overcome this to get a desired effect?
A
Increase the concentration of agonist
9
Q
Define what an allosteric activator is
A
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)
10
Q
Describe the changes to the dose-response curve when an allosteric activator is added
A
The plateau (think Vmax) is raised. This means that the same concentration of agonist brings about a greater effect.
11
Q
Describe what an allosteric inhibitor is
A
It binds to the receptor at a location separate from the agonist site, thus it is noncompetitive. Actions are often reversible.
12
Q
Describe the dose-response curve change that occurs when an allosteric inhibitor is added
A
The plateau (think Vmax) is lowered. Meaning the same concentration of agonist is less effective at bringing about a response
13
Q
True or false… receptors may be active, producing an effect, even in the absence of drug
A
True. Very small amounts however. “In the absence of drugs, the two isoforms of receptors are in equilibrium and Ri is favored”
14
Q
True or false.. If a receptor is bound to drug, it must be in the active form
A
False. “Inactive receptors can exist, even if paired with MOST drugs”
15
Q
Receptors are in equilibrium between the inactive and active forms. Without drug the ____ form is favored. With drug the ____ form is favored.
A
1) inactive
2) active
16
Q
Define full agonist. Describe its dose-response curve
A
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
17
Q
Describe what a partial agonist is. Describe what the dose-response curve looks like
A
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
18
Q
Describe what an inverse agonist is. What doe its dose-response curve look like?
A
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
19
Q
Describe what a conventional antagonist is and what its dose-response curve looks like
A
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.
20
Q
What is EC50?
A
The concentration of agonist at which you get 50% of the effect
21
Q
What is Kd?
A
The concentration of agonist in which half of the receptors are bound.
22
Q
What is IC50?
A
This is the concentration of the ANTAGONIST in which you have 50% of the effect
23
Q
True or false. EC50 = Kd
A
FfAaLlSsEe
24
Q
What happens to EC50 when you add competitive antagonist to the solution?
A
The EC50 shifts to the right (think Km)
25
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)
26
Define threshold
The smallest dose possible that causes a measurable effect
27
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
28
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
29
Describe what an additive drug-receptor interaction is
1+1=2. Drug effect equals the sum of individual effects.
30
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)
31
Describe what an antagonistic drug-receptor interaction is
1+1=0.5
A drug can block the effect of another
32
What is a chemical antagonist?
Does not involve receptor
For example: charge differences due to certain environments
33
What is a physiological antagonist?
Involves endogenous regulatory pathways mediated by different receptors
34
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
35
Define potency
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
36
Define affinity
A measure of the tightness that a drug binds to the receptor
37
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
38
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
39
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
40
True or false... toxicity means leathal dose
False, it is defined for what you want it to be. It can be certain symptoms
41
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
42
What does parenteral mean?
Not by way of the GI tract
43
Name three examples of parenteral drug administration
Intravenous
Intramuscular
Subcutaneous
44
Which is faster absorption, intramuscular or subcutaneous injections?
Intramuscular (about 5 minutes). Large volumes are possible, sometimes painful
45
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
46
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
47
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
48
The initial distribution of drug into the tissues is determined by ____
The rate of blood flow
49
The concentration of drug at a particular site is related to its ____
Affinity
50
What other two factors can play a role in drug distribution?
Plasma binding proteins
Gastric emptying time
51
Name three other methods of drug administration
Inhalation (very fast)
Topical
Transdermal (patches)
52
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
53
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
54
True or false... side effects are always negative effects
False. Side effects are just any unintended effects of the drug, may be positive
55
Define xenobiotic
Chemical not synthesized in the body
56
Absorption of the drug is affected by what four factors?
Route of administration
Blood flow
Drug characteristics
Cell membrane characteristics (diffusion or active transport)
57
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)
Formulation
Concentration
Acidity (basic drugs are not well absorbed in the stomach)
58
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
59
True or false... only non-ionized drugs are soluble lipids
True
60
What are the two types of specialized transport across biological membranes for drug transfer?
Active transport
Facilitated diffusion
61
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
Affected by...
Dissolving of drug in GI tract
Destruction of drug by the liver
Intravenous = 100% bioavailability
62
What are two important determinants for determining dose to be administered to patient?
Distribution and clearance
63
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.
64
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)
65
What are the three physiological compartments and their volumes?
Plasma - 3L
Extracellular space - 14L
Total body water - 42L
66
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
67
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
68
Drugs with very high volumes of distribution have much ____ concentrations in _____ tissue than in the ______ tissue
Higher
Extra-vascular
Vascular
69
Drugs that are completely retained within the vascular compartment, have a ______ _____ volume of distribution equal to the blood component in which they are distributed.
Minimum possible
70
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.
Small
Higher
71
The larger the volume of distribution, the _____ a dose must be to achieve a desired target concentration
Larger
72
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
73
how is the volume of distribution used to calculate half life? What is the formula?
T1/2 = 0.693 Vd/Cl
Cl = clearance rate
74
Clearance = ?
Rate of elimination/concentration of the drug
75
Define clearance
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
76
Drugs are generally eliminated in the ___ but some in the ____
Urine
Feces, lungs (volatile compounds), salivary glands, sweat, and even hair
77
Does drug binding to plasma proteins increase or decrease the amount of drug filtered through the glomerulus?
Deecwease
78
Will a drug that is highly hydrophobic be more or less likely to be reabsorbed in the kidney tubules?
More likely
79
Name two examples of drug transporters
Solute carrier transporters
ATP binding cassette transporters
80
_____ transports drug molecules from cells back into the intestinal lumen for excretion
P-glycoprotein
81
What is the difference between zero order and first order kinetics of drug elimination?
Zero order
100, 80, 60, 40
A constant amount of drug is eliminated per unit time, independently of drug concentration
First order
100, 90, 81, 71.9,
The process that is directly proportional to the drug concnetration
82
true or false... phase 1 always precedes Phase 2 metabolism
False, it usually goes in that order but it can go either way
83
What usually occurs in drug metabolism?
Makes drugs more hydrophilic (thus more easily excreted)
usually makes substances less toxic
84
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)
85
Name two oxidases
NADPH-cyp450-oxidoreductase
cyp450
86
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
87
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
88
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
89
Define substrate
A drug that is the target of a particular enzyme
90
Define inducer
Increases the activity of a p450 enzyme thus increases metabolism and clearance of a drug
91
Define inhibitor
Inhibits the activity of a particular p450 enzyme thus decreases metabolism and clearance of a drug
92
Define phase 2 hepatic metabolism
Includes glucuronidation conjugation to make the drug more hydrophilic (utilizes glucuronic acid)
93
Name four factors that can affect hepatic drug metabolism
Microsomes enzyme inhibiton (many drugs inhibit CYP450)
Microsomes enzyme induction
Liver disease
Plasma binding protein (drugs highly bound will not enter liver (also wont be filtered in the glomerulus) and thus have a longer half-life
94
What percentage of blood returns to the venous system? The remaining fluid is taken up by _____
90%
they lymphatic system
95
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
96
What structure separates the superficial tissues and deep structures of the head and neck?
Deep cervical fascia
97
Lymph can be drained from superficial tissues into.....
Regional nodes or deep cervical nodes
Regional nodes is more common
98
Occipital lymph node
afferent: _____
efferent: _____
Afferent: back of scalp
Efferent: deep cervical lymph nodes
99
Retro auricular lymph node
Afferent: ____
Efferent: ____
Afferent: strip of scalp above auricle, posterior external auditory meatus
Efferent: Superficial cervical nodes
100
Superficial parotid lymph node
Afferent: ____
Efferent: ____
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)
101
Deep parotid lymph nodes
Afferent: ____
Efferent: ____
Afferent: middle ear
Efferent: deep cervical node (jugulodigastric)
102
About how many parotid lymph nodes are there?
5 to 6
103
buccal lymph nodes
Afferent: ____
Efferent: ____
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
104
Submandibular lymph nodes
Afferent:
Efferent:
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
105
Submental lymph nodes
Afferent:
Efferent:
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)
106
Where are the retropharyngeal lymph nodes located?
Between the pharynx and atlas
107
Which is most superior, the jugulodigastric lymph node or the jugulo-omohyoid lymph node?
Jugulodigastric
108
The gingiva is drained by _____
Submandibular lymph nodes
109
The hard palate is drained by ____
Submandibular nodes and superior deep cervical nodes
110
The soft palat is draine by ____
Retropharyngeal
111
The floor of the mouth is drained by ____
Submandibular and submental nodes
112
The teeth are drained by ____
Submandibular and deep cervical
Submental drains the mandibular incisors
113
The tonsils are drained by ____
Jugulodigastric nodes
114
The tip of the tongue is drained by ____
Submental node
115
The anterior 2/3 of the tongue (excluding the tip) is drained by ____
Submandibular and deep cervical
116
The posterior 1/3rd of the tongue is drained by ___
Jugulodigastric lymph nodes
117
All of the paranasal air sinuses are drained by ____, except for _____ which is drained by _____
Submandibular nodes
Sphenoid sinus
Retropharyngeal nodes
118
What is the only node that drains directly into the jugulo-omohyoid node?
Submental node
119
Dorsal scapular nerve comes off of ____ and innervates ____
Root of C5
Innervates levator scapulae and rhomboids
120
The suprascapular nerve comes off of ____ and innervates _____
Superior trunk
Supraspinatus and infraspinatus
121
What structure separates the anterior and posterior divisions of the brachial plexus?
Axillary artery
122
The brachial plexus is symmetrical except for what feature?
The anterior division of the middle trunk
123
The nerve to subclavius branches off of ____ and innervates _____
Roots of C5 and C6
Innervates the subclavius muscle (duh)
124
The long thoracic nerve branches off of ____ and innervates ____
C5, C6, and C7 roots
Serratus anterior
125
The lateral pectoral nerve branches off of ____ and innervates ____
Lateral cord
Pectoralis major only
126
The medial pectoral nerve branches off of ____ and innervates ____
The medial cord
Pec major and minor
127
The upper subscapular nerve branches off of ___ and innervates ___
Posterior cord
Subscapularis
128
The lower subscapular nerve branches off of ____ and innervates ____
The posterior cord
Subscapularis AND teres MAJOR MAJOR MAJOR
129
The thoracodorsal nerve branches off of ____ and innervates ____
Posterior cord
Latisimus dorsi
130
The medial brachial cutaneous and medial antebrachial cutenous branch off of ____ and innervate ____
Medial cord
Upper arm and muscles
Lower arm and muscles
131
Which terminal nerves of the brachial plexus are involved in flexion?
Median
Ulnar
Musculocutaneous
132
Which terminal nerves of the brachial plexus are involved in extension?
Radial
133
What percentage of the U.S population has diabetes?
About 10%
134
True or false... sucrose results in higher spikes of blood glucose and insulin. Eating lots of insulin can bring about insulin insensitivity
True
135
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
Nocturnal enuresis
136
Name two symptoms that are more severe in type 2 diabetes than type 1
Blurred vision
Peripheral neuropathy
137
What are three signs of diabetes?
Sweet tasting urine
Sweet smelling breath
Impaired wound healing
138
The onset of type 1 diabetes usually occurs when? What hormone levels are elevated at onset?
Juvenile
Glucagon
139
In type 1 diabetes, ____, ____, and ____ are dysregulated and released within the blood
Glucose, fats, amino acids
140
Does improper fatty acid metabolism increase or decrease ketone body production and release?
Increase
141
How long after the environmental trigger does type one diabetes form?
Highly variable. Days to weeks to months to years
142
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)
143
Reduced glucose uptake will result in what three things?
Elevated blood glucose
Fatty acid oxidation
Cellular energy deficiency
144
Fatty acid oxidation will lead to...
Increased liver gluconeogenesis (which contributes to elevated blood glucose)
Elevated blood ketone bodies
145
Elevated blood glucose and elevated blood ketone bodies contribute to ____
Osmotic diuresis (this is losing excessive amount of fluids through the kidneys)
146
Do elevated blood ketone bodies increase or decrease the blood pH?
Decrease the pH (more acidic)
147
Type 1 diabetes requires insulin replacement therapy. What are the three coordinated interventions?
Insulin administration
Glucose monitoring
Diet (low carbs)
148
The goal of insulin administration is to maintain fasting blood glucose levels between ____ and ____
80 and 140 mg/dl
149
What are the two approaches for insulin administration? What is the normal blood glucose range?
Injections
Pump
60-90
150
Define type two diabetes
Progressive increase in fasting glucose due to reduced insulin sensitivity followed by a degeneration of insulin production
151
Name the three possible mechanisms of insulin insensitivity
Adipokine signaling
Ectopic lipid storage and free fatty acids
Inflammatory signaling
152
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
153
Type two diabetes is managed by what three approaches?
Lifestyle
Oral hypoglycemic drugs
Insulin
154
Name four common drugs for treating hyperglycemia
Sulfonylureas
Metformin
Peroxisome proliferator-activated receptor agonists - increases glut 4 expression
Alpha-glucosidase inhibitors
-prevents carb absorption
155
What are sulfonylureas?
An oral hypoglycemic that serves to increase B cell insulin secretion. There types of this drug are glipizide, glyburide, and glimepiride
156
What is metformin?
An oral hypoglycemic that reduces gluconeogenesis and lipogenesis
Involves the ampk signaling pathway
157
What are the five primary methods for detecting diabetes?
```
Urinalysis
Glucose monitoring (tested over a long period of time)
HBA1c
Glucose tolerance test (tested in a day)
C-peptide test
```
158
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
159
What are the signs of hypoglycemia?
Exhaustion
Dizziness
Loss of speech
Death
Increased heart rate
Sweating
Trembling
160
What are the causes of hypoglycemia?
Excess insulin
Physical activity
Insufficient food
Illness
161
What is the treatment for hypoglycemia?
Immediate sugar
Glucagon
Test blood sugar
162
What are some symptoms in hyperglycemia, different from hypoglycemia? What causes it? What is the treatment?
Thirst, dry mouth
Excessive urination
Ketones
High blood sugar, lack of insulin, inactivity, excess food
Insulin, oral hypoglycemic, physical activity, diet
163
What are the long-term diabetic complications for diabetes?
```
Cardiovascular disorders
Blindness
Kidney disease
Neurological complications
Impaired wound healing
```
164
Name the four fat soluble vitamins
Vitamin K
Vitamin A
Vitamin D
Vitamin E
165
Name the vitamins that have toxicity reported
```
Vitamin D
Vitamin A
Vitamin B3
Vitamin B6
Vitamin C
```
166
What is the common name for vitamin B9? What about Vitamin C?
Folic acid
Ascorbic acid
167
What is the only water soluble vitamin that is stored for long periods of time?
Vitamin B12
168
Water soluble vitamins are absorbed by...
Sodium cotransporters
169
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
170
Vitamin A
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
171
Vitamin B1
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
Thiamine
B1 is an essential coenzyme for the pyruvate bridge (TPP will help convert pyruvate to acetyl coA)
172
Vitamin B2
Essential for carbohydrate and lipid metabolism (forms FAD)
Riboflavin
173
Vitamin B3
Necessary for NAD+
Deficiency results in PELLAGRA (dermatitis, diarrhea, inflamed mucus membranes, delusions)
174
Vitamin B5
Pantothenic acid
Coenzyme A synthesis
175
Vitamin B6
Forms PLP. Involved in amino acid metabolism and neurotransmitter synthesis
PLP - involved in amino-transferase reactions
Pyridoxine
176
Vitamin B7
Biotin
Involved in fatty acid synthesis (acetyl coA carboxylase) and amino acid catabolism
Produced by bacteria in the gut
177
Vitamin B9
What is the daily adequat intake?
Folic acid
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
178
Vitamin B12
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
179
Vitamin C
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.
180
Vitamin D
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
181
Vitamin E
Involved in immune signaling, involves prostaglandin synthesis
Deficiency results in an impaired immune response
182
Vitamin K
Required for production of clotting factors
Deficiency results in bleeding and hemorrhaging, osteoporosis
183
Name the 13 essential vitamins
```
A
B1,2,3,5,6,7,9,12
C
D
E
K
```
184
Name the two essential fatty acids
Linoleate and alpha-linolenate
185
Name the two pathways for nervous system control of organ system
Autonomic nervous system
Neuroendocrine system
186
What structure in the brain is responsible for regulating all organ function in the body? Describe the two pathways of control
Hypothalamus
It receives info from every organ in the body.
Directly controls the autonomic nervous system
Indirectly controls the neuroendocrine system
187
What neurotransmitter is involved in the sympathetic nervous system? What about parasympathetic?
What about enteric?
Epinephrine and norepinephrine
Acetylcholine
Epinephrine, acetylcholine, serotonin
188
What processes produces CO2?
Betaoxidation and carbohydrate metabolism
189
Chemoreceptors and baroreceptors feed back to the nucleus of ____
The solitary tract
190
Increased blood pressure ____ tonic sympathetic activity and ____ vagal parasymphatic activity
Decreases
Increases
Decreased blood pressure does just the opposite
191
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
192
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
193
PGE1 (prostaglandin E1) is an example of what class of hormone? What is it used for?
Eicosanoid
Used in the inflammatory response
194
NADPH is produced in the ____ cycle and is involved in....
Pentose phosphate
Lipid synthesis and dealing with free radicals
195
What are the four fates of glucose 6 phosphate in the liver?
Glycolysis
Glycogenesis
Pentose phosphate pathway
Converted to glucose by glucose 6 phosphatase and released into the blood
196
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)
197
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
Albumin
198
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
199
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.
200
What things inhibit a-cells from secreting glucagon?
When is glucagon constitutively released?
Insulin
Somatostatin
At low glucose levels
201
Insulin drives glucose ____, glycogen ____, and lipid _____
Uptake
Storage
Synthesis
202
Glucagon drives glucose ____, amino acid and fatty acid ____.
Release
Breakdown
203
During starvation, you create more ketone bodies due to a lack of ____
Oxaloacetate
Without oxaloacetate, acetyl coa cannot enter the citric acid cycle and acetyl coa accumulates. The excess acetyl coa are converted into ketone bodies
204
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
205
Name 6 regional neck lymph nodes
```
Retropharyngeal
Paratracheal
Infrahyoid
Prelaryngeal
Pretracheal
Lingual
```
206
The paratracheal lymph nodes drain ____ and dumps into ____
Thyroid gland
Deep cervical
207
Name the three anterior cervical nodes
Infrahyoid
Prelaryngeal
Pretracheal
208
True or false... the teeth can be drained directly by deep cervical nodes
True
209
True or false... the anterior 2/3 of the tongue can drain directly into the deep cervical nodes
True
210
Name the supraclavicular nerves of the brachial plexus
Dorsal scapular
Nerve to subclavius
Long thoracic
Suprascapular
211
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
212
Fat soluble vitamins require ___ for uptake
Cholesterol esterase
213
Water soluble vitamins are absorbed by sodium trasnporters besides ____
B9 and b12
214
What enzyme directs genetic recombination? (Crossing over)?
Recombinases
215
What are the three classses of transposable elements?
DNA only transposons
Retroviral like retrotransposons
Nonretroviral retrotransposons
