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157 Cards in this Set
- Front
- Back
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A client with iron deficiency anemia despite eating meat and green leafy vegetables. What other nutrient is needed to properly absorb iron. |
Vitamin C |
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Name 3 factors that can increase the likelihood of getting iron deficiency anemia |
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Why is it important to differentiate iron deficiency anemia from Thalassemia? |
Blood transfusions in Thalassemia can lead to iron overload (and iron is oxidative) |
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Sickle cell anemia is cause by a point mutation leading to structural instability of the RBC. what (3) conditions can increase stress leading to increased deoxyhemoglobin in sickle cell crisis? |
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Anemia of chronic disease can be caused from prolonged inflammation (IL-6, cytokines, infection), which increases level of ____________ to sequester iron in the tissue so that germs can't use the iron to reproduce. |
Hepicidin Synthesized by the liver and controls homeostasis |
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Glucose-6-dehydrogenase is the enzyme that reduces ____1_____ to _____2_____ as part of the hexose monophosphate shunt (ie pentose phosphate pathway). G6PDH deficiency can lead to RBC hemolysis from oxidative stress because ___2____ is no longer available to recycle glutathione. |
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Which transporter assists in uptake of iron from the intestines? |
Divalent Metal Transporter (DMT1) |
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Increased levels of deoxyhemoglobin from altitudes can precipitate a Sickle Cell Crisis. The "T" form of hemoglobin (ie deoxyhemoglobin) is more predominant in peripheral body tissue with (in terms of pH and respiration): |
Decreased pH & Increased CO2 |
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What nutrient binds to intrinsic factor to be properly absorbed? Where is it absorbed in the GI? |
Vit B12 Ileum |
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Elevations of FIGLU in the urine may indicate: |
Functional deficiency of folic acid |
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Folate trap occurs when there is deficient amounts of Vit B12 and folate gets "trapped" in the form of _____________. |
5-Methy-THF |
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Folic acid is composed of (3 parts): |
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Which of the following amino transferases plays a role in the malate-aspartate shuttle and has subcellular isoenzymes located in the mitochondria and cytosol?
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Aspartate amniotransferase (AST) |
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Alanine aminotransferase (ALT) converts alpha-ketogluterate into glutamine, and alanine into _________. |
Pyruvate |
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Glutathione is composed of (3 parts): |
Gamma-glutamyl, cysteinyl, and glycine |
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How many ATP are utilized in the Gamma-glutamyl cycle to resynthesize glutathione? |
3 ATP |
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What 4 factors interfere with the Iodide uptake and utilization by the thyroid? |
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What minerals are selectively symported into the thyroid follicular cell from the bloodstream for the creation of thyroid hormones? |
Iodide and Sodium |
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Iodothyronine Deiodinase 2 converts T4-T3. what cofactor is needed for proper function? |
Selenium |
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Thyroperoxidase (TPO) is responsible for catalyzing what reaction? |
Oxidization of Iodide to Iodine |
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Insulin's effects on target tissue include all the following EXCEPT:
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Insulin does not increase protein degradation Protein degradation is decreased with increased food consumption/insulin while protein synthases with increase. |
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Intra-abdominal (visceral) fat is more dangerous than subcutaneous fat because (3 points): |
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Obesity and chronic overnutrition (excess fed state) in which way and how?
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All 4 answers are correct:
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Glucogon rises in fasting state and controls metabolism by (3 mechanism): |
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Genetic mutations that deactivate leptin or its receptors lead to _____________. |
hyperphagia and massive obesity |
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High levels of ATP in the cell indicate high levels of energy reserves. Therefore high levels of ATP will: |
Shut down activity of phosphofructokinase and pyruvate kinase (glycolysis step 3 and 10) to slow down ATP production. |
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Hyperglycemia can lead to glycation (glycosylation) reactions. One such glycation reaction with hemoglobin A leads to HbA1C. What level of HbA1C is indicative of diabetes? |
> or = 6.5 |
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One of the maladaptive responses to insulin resistance is dyslipidemia. Increased activity of vascular lipoprotein lipase leads to increased chylomicorn and VLDL release of non-estrified or__________ |
Free Fatty Acids = non-estrified FA |
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Peroxisome Proliferator Activated Receptor (PPAR) is important in FA and glucose metabolism. What 5 factors/nutrients can assist in activation of these receptors: |
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Metabolic syndrome (syndrome X) is a combination of changes that include (5 points): |
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Activation of thrifty gene in maternal under- or over-nutrition may lead to under- or over- weight babies. this can cause increased risk of (3 chronic diseases): |
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Insulin resistance leads to increased cardiovascular disease risk through which of the following:
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All responses are correct |
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Lead can inhibit certain enzymes of heme biosynthesis pathway causing increase in ALA and decline of protoporphyrin IX (elevation of coproporphyrin III). Which 3 enzymes are inhibited by lead in this pathway? |
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Obstruction of the bile duct from gallstones (extrahepatic cholestasis) can cause symptoms of pale clay colored stool and dark urine upon standing. This occurs because: |
The liver regurgitates conjugated bilirubin into the blood, and decline of conjugated bilirubin entering the GI |
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How is porphyrin different from porphyrinogen? |
Porphyrins are the oxidized form of porphytinogen. |
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How can porphyrias arise from low caloric/low glucose diets? |
ALA Synthase 1 will be upregulated to push heme biosynthesis. glucose inhibits ALAS1, therefore unregulated in absence of glucose. That's why glucose is given IV to people with acute porphorias and why these people must avoid crash/low carb diets. |
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How many ATP are needed to create active ALA synthase (fold it, activate it, and transport it into the mitochondria)? |
2 ATP |
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Acute hemolytic crises found in G6PD deficiency and Sickle Cell anemia can cause hyperbilirubinemia and jaundice due to: |
Increase in both unconjugated and conjugated bilirubin. |
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The first step in heme degradation utilizes heme oxygenase to create biliverden. What reductant is required for this step of the pathway to function? |
NADPH |
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Which enzyme in the heme biosynthesis pathway contains Zinc and is located in the cytosol? |
Delta-ALA Dehydrate |
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What's the abbreviation for Isoleucine? |
Ile |
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List the essential Amino Acids (9): |
His Ile Leu Met Phe Thr Lys Trp Val |
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List the large neutral AA (6) |
Trp Tyr Phe Leu Ile Met |
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If there's a defect in the SN1-SN2 transporter allowing Gln into the presynaptic nerve terminal, what will happen to the Glu levels within the presynaptic nerve terminal? |
Glu levels will decline unless the EEAC1 receptor can compensate. |
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GFAT is the rate limiting enzyme in the creation of what? |
Glucosamine, Galactosamine, Sialic acid |
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Periportal heaptic cells respond to increased local acidity by transporting _____1______ through the SN1-SN2 transporter to cleave it into ____2_____, which buffers acidity. |
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NH3 is ___1____ and acts to help buffer ___2____ environments. |
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In the urea cycle, Arginase requires what cofactor to convert Arg -> Orn + urea? |
Mn++ |
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In the urea cycle, Citrulline combines with Aspartate to form __________ via the enzyme ASS (argininosuccinate synthase). |
Argininosuccinate |
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In the urea cycle, Ornathine + Carbamoyl phosphate -> PO4 + Citrulline is catalyzed by what enzyme?
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2. Mitochondrial Ornathine Tricaboxylase (OTC) |
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A defect in the ura cycle enzyme argininosuccinate lyase, will lead to the accumulation of what substrate? |
Argininosuccinate |
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Arganine conversion into Agmatine via the enzyme arganine decarboxylase requires what cofactor? |
P5P AKA B6 |
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T/F: ADMA (asymetric dimethylarginine) activates nitric oxide synthesis and angiogenesis. |
False |
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BCAA are converted to alpha-ketoacids via BCAA Transaminase. This enzyme requires the cofactor: |
P5P AKA B6 |
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Branched Chain ketoacid Dehydrogenase Complex (BCKDC) attaches Coenzyme A to alpha-ketoacids. the nutrients utilized in this reaction (either substrates or cofactors) are: (list 5) |
B1 B2 B3 B5 Lipoic Acid |
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The following reaction requires what two enzymes? Threonine -1-> alpha-ketobutryate +NH3 -2-> propionyl CoA
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Histidine is converted to histamine via Histidine Decarboxylase- What cofactor is required? |
P5P AKA B6 |
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Histamine can either be degraded through hepatic Diamine Oxidase and Aldehyde Dehydrogenase OR through extra-hepatic pathways via Histamine -N-methytransferase. What's the nutrient requirement?
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4. Diamine Oxidase is copper-dependent |
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Lysine does NOT undergo initial transamination requiring B6, but downstream, conversion of alpha-aminoadipic acid (a-AAA) to alpha-Ketoadipate DOES require B6. What nutrient is required for the initial conversion of Lys --> Saccharopine? |
B3 AKA Niacin |
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Conversion of Lys to Carnitine is important because carnitine is needed to shuttle FA is not the mitochondria for beta-Oxidation. Along with Lys, what nutrients would improve enzymatic function of this pathway? (5) |
SAMe, a-KG, B3, FE++, Vit C |
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Phenylalanine hydroxylase (PAH) requires what nutrients for conversion of Phe --> Tyr |
Iron, B3, BH4 |
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What 2 nutrients are required by both tyrosine hydroxylase (TH) and phenylalanine hydroxylase (PAH)? |
Fe, BH4 |
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Conversion of norepinephrine -> epinephrine via the enzyme Catechol-O-Methytransferase (COMT) utilizes what nutrient in this reaction? |
SAMe |
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Tryptophane monooxygenase (ie tryptophan hydroxylase) like tyrosine hydroxylase and phenylalanine hydroxylase require what cofactor for proper function? |
Fe, BH4 |
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Degradation of serotonin -> 5HIAA via monoamine oxidase (MAO) requires what two minerals for functionality? |
Cu, Fe |
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Alpha-amino-N-butyric acid (AANB) may be elevated in alcoholism. What may be deficient when AANB is elevated? |
B6 |
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What enzyme requiring B6 converts Glutamate -> Gamma-amino-N-butyric acid (GABA)? |
Glutamic acid decarboxylase (GAD) |
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Methionine adenosyltransferase converts Met -> to _________ with the assistance of ATP and H2O. |
SAMe |
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Both Methionine Synthase (MS) and Betaine Homocycteine Methyltransferase (BHMT) can convert homocycteine to methionine with the assistance of what mineral? |
Zn++ |
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Heme iron, B6, betaine and SAMe assist Cystathionine Beta-Synthase (CBS) in activating the transulfuration pathway in oxidative stress to convert homocysteine + ________ -> cystathionine. |
Serine |
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Homocycteine is considered the _____________ form of homocystine
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Reduced |
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Supplements with what vitamin raise betaine levels? |
folic acid |
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T/F: Oxidative stress activates the transulfation pathway to divert sulfur-containing amino acids into creation of glutathione, a major antioxidant. |
True |
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Glutathione reductase converts GSSG -> 2 GSH. What nutrients assist this process? |
FAD, Cu++ |
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Taurine, utilized in the skelatal muscle and bile, can be created from cycteine with the assistance of what nutrients (4)? |
Fe, P5P, FAD, NAD |
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What AA is a precursor to serine and component of gluathion? |
Glycine |
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While the Glycine Cleavage System utilizes Gly, NAD, and THF in the chain reactions to create 5,10-Methylene THF, it also contains a __________ binding domain and _____________ prosthetic group. |
FAD Lipoic Acid |
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Serine Hydroxymethyltransferase (SHMT) interconverts serine and glycine with assistance of what nutrients? |
5,10-Methylene THF, P5P, Mn++ |
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Sarcosine (aka N-methylglycine) can be a storage of buffer for excess methyl groups that are transferred from ___________ to Glycine to create sarcosine. |
SAMe |
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What nutrients are required for the creation of connective tissue components Hydroxyproline (HPro) and Hyroxylysine (HLys)? |
Vit C, Fe |
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In biochemistry, an enzyme ends with "-ase" like lactase, a sugar ends in "-ose" like lactose, and the ionized form of an organic acid ends in "____" |
"-ate" butryate |
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Proteins require the use of _________ for the conversion of ketoacids in acetyl-CoA. (list 5 cofactors) |
B1, B2, B3, B5 and lipoate |
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Carbohydrates require the use of __________ for the conversion to acetyl-coA and entry into he TCA cycle. (list 5 cofactors) |
B1, B2, B3, B5 and lipoate |
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Citrate, cis-aconitate, Isocitrate are locaed at the begining of the TCA cycle. Elevations of Cis-aconotate can indicate dysfunction of the enzyme aconitase, which requires the mineral _______ and cysteine. |
Fe++ |
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Low urinary Citrate levels have been associated with kidney stone formation. What kind of diet may increase the risk of kidney stone formation? |
High protein, low carbohydrate |
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High MMA can inhibit the ________ transporter, leading to elevations of it in the urine. Hence elevations in this TCA cycle intermediate can be from B12 deficiency. |
Malate |
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The conversion of alpha-ketoglutarate (a-KG) to succinyl-CoA via enzyme a-KG-dehydrogenase is similar to other dehydragenase complexes (like BCKDC) in that it also requires the same nutrients for functionality: ______________. (5 cofactors) |
B1, B2, B3, B5 and lipoate |
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Isocitrate dehydrogenase converts isocitrate to a-KG with the assitance of (3 cofactors): ________ |
Mg++, Mn++, NAD++ |
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Inhibition of CoQ10 synthesis from statin drugs will tpically reveal elevations in urinary ____________. |
Hydroxymethylglutarate |
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High levels of suberate, adipate and ethylmalonae can be reduced with Vitamin _______, which is utilized by the flavoprotein enzyme Fatty Acyl-CoA Dehydrogenase, |
B2 |
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Elevations in lacate can indicate disruption of carbohydrate metabolism and the body's need to regenerate the vitamin ________ to keep the glycolytic pathway functioning. |
B3 |
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high urinary oxalates can occur from which of the following?
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All of the above |
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Elevations in lactate can indicate disruption of carbohydrate metabolism and the body's need to regenerate the vitamin/cofactor _______ to keep the glycolytic pathways functional. |
NAD+ |
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Elevations in lactate, pyruvate, and beta-hydroxybuyrate indicate abnormalities in __________ metabolism. |
Carbohydrate |
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It is importan to note that elevations in Xanthurenate indicate that you should NOT supplement with any amino acids till you have first supplemented with Vitamin ______ because transamination function is impaired. |
B6 |
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Formiminotransferase utilizes _________ to convert FIGLU to glutamate. |
THF |
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The marker for biotin deficiency is ________ |
Beta-hydroxyisovalerate |
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Catabolism of several AA and odd-chain FA eventually yields methymalonyl CoA (MMA). Conversion via enzyme MMA mutase requires the vitamin _________ |
B12 |
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Elevations of the jynurenin pathway constituent 3-hydroxykynurenin leads to its side conversion into xnathurenate, which spills into the urine and can indicate insufficiency of vitamin _______. |
B6 |
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Breakdown of serotonin into 5HIAA occurs via he enzyme ____1_____ which requires ____2_____ (2 cofactors). |
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Homovanillate is the degradation product of ________ catabolism. |
Dopamine |
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COMT utilizes _________ and __________ to degrade the catecholamines dopamine, norepinephrine and epinephrine. |
SAMe and Mg++ |
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High protein diets increase activity of ACMSD (alpha-amino-beta-carboxymuconate-E-semialdehude decarboxylase) which converts 2-amino-3-carboxymuconate into the organic acid ______________ and leads to the upregulation of NO synthase, shifts Tryptophan metabolism away from B3 formation, and leads to the activation of inflammatory chemokines. |
Picolinate |
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Copper deficiency can lead to reduced activity of dpamine beta-monooxygenase (DBM) which converts dopamine to norepinephrine. Hence in copper deficiency you can find elevated urinary ____1____ and reduced urinary ____2____. |
1. HVA (OA metabolite of dopamine elevated) 2. VMA (OA metabolite of NE reduced) |
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The ratio of kynurenate to quinolinate (KYNA:QUIN) is important because?
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2. KYN blocks NMDA receptors reducing glutamate excitoxicity |
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Homogentisate (HGA) may be elevated in urine due to excess supplementation of the amino acid _____________. |
Tyrosine |
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_________________ is a metabolite of Tyrosine, cell proliferation marker, and may indicate normal tissue growth or tumor growth. |
p-Hydroxyphenyllacetate (HPLA) |
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When the DNA oxidative damage marker _________ is seen elevated in urin with high QUIN and HPLA, this indicates sustained inflammatory responses and increased cell proliferation rates caused by increased ROS, which lead to DNA damage via oxidation. |
8-hydroxy-2'-deoxyguanosine (8-OHDG) |
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High ammonia levels from urea cycle dysfunction can lead to accumulation of ___1____. Treatment with __2/3___ may help urea cycle function better and decrease urinary ____1___ levels. |
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High urinary _________, a marker for phase I & II liver detoxification, may indicate exposure to pesticides, petrochemicals, alcohol and drugs. |
Glucarate |
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Elevations in urinary pyroglutamate indicates that supplementation with __________ maybe indicated. (list 5) |
NAC, Glycine, GSH, antioxidants, Mg++ |
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Elevations in ___1____ from xylene exposure may warrant supplementation with ____2/3____ to assist cytochrome P450 oxidase enzymes and phase II conjugation reactions. |
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lpha-hydroxybuterate appears elevated in the urine when there has been a shift from trans-__1____ to trans- ___2____ to increase creation of ___3____. |
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Deficincy of the mineral _______ can lead to decreased incorporation of cystine into protein, allowing sulfate to spill into urine. |
Zinc |
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Poor absorption of the AA ____1____, can lead to the assumulation of the dysbiosis metabolite ___2____. |
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Clostridia species like C. Difficile can lead to elevations in several dysbiosis markers such as:
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All 3 |
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Bacterial ingestion of dietary polyphenols can lead to the creation of the intestinal dysbiosis markers ___________ (list 4). |
Benzoate, Hippurate, Phenylacetate, Phenylpropionate. |
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Elevations in benzoate and not hippurate indicate:
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All of the responses |
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High urniary D-lactate may indicate a person:
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All of the responses |
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Sugars ingested by yeast and fungi produce the intestinal dysbiosis marker: |
D-Arabinitol |
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When considering toxic exposure, through what barriers and routes of entry can lipophilic toxins be absorbed?
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All of the responces |
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The insecticide DDT, a chlorinated hydrocarbon pesticide, has been banned in the US since the 970's but is still causing toxic effects today because it's:
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all of the responces |
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Toxins can cause cell injury by interfering with DNA regulatory mechanisms, increasing oxidative stress, and altering enzymatic function. The damage is extensive and cannor be easily repaired, the DNA itself will be damaged as indicated by a rise in ___________. |
8-OHDG |
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Testing toxin load can be compplicated by deposition in different tissues like the extracellular matrix and the need to test for ___________ in the urine.
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4. multiple metabolites |
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Phthalates are found in plastics, cosmetics and many convenience items found in developed countries. Phthalates are considered "steroid hormone disruptors" because:
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all the responses |
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Advanced glycation end-products (AGE) are created when glucose reacts spontaneously with ____1____ on proteins to create ____2_____ products that spontaneously and irreversibly degrade to form AGE's. |
1. Amino acids 2. Maillard reaction |
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Treatments to reduce AGE's and ALE's include:
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All the responses. |
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ALA + ALA --> porphobilinogen via the enzyme ___1___ which requires (cofactor) ____2____. |
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Porphyrin accumulation indicates:
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All the responses |
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Iron deficiency blocks the last step of Heme creation, where iron in inserted into the protoporphyrin IX. Hence there's a rise in:
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3. RBC protoporphyrin and Zn protoporphyrin |
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UROD is blocked by both ___1/2____. The difference between the two heavy metals is that ____3____ causes a high pentacarboxyporphyrin because it slows UROD down, making the last decarboxylation step difficult.
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Arsenic blocks UROD at the beginning step, while mercury blocks the last step of UROD. |
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Precoproporphyrin may elevate when _____ blocks the last step of UROD, leading to accumulation of pentacarboxyporphyrinogen, which is converted by CPOX to precoproporphyrin. |
Mercury (Hg) |
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The heavy metal _______ causes preferential elevation in Copro I: Copro III because it blocks the early steps of UROD decarboxylation, leading to the accumulation of uroporphyringen I, which converts to coproporphyringen I. |
Arsenic (As) |
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AST, ALT, CPK, and _____ are all enzymes that can be indicatos of liver damage, which in turn means impaired liver function. |
gamma-glutamyl transoeotidase (GGT) |
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Elevations in total bilirubin levels indicte impaired degredation of heme as seen in Gilbert's syndrome. This indicates impaired ______, a pathway in phase II detoxification. |
glucuronidation |
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Elevations in BUN indicate increased load of ammonia. Check OA profile, you find high orotate levels, which could indicate there is a genetic SNP in the enzyme. |
Ornithine transcarboxylase (OTC) |
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CYP1A2 and CYP2E1 are important to remember because these pathways are activated by:
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3. caffeine Also activate by acetominophen |
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Alcohol, high protein diets, high brassica diets, saturated fats, steroid hormones, charcoal-broiled meats (AGE's), oranges, exhaust fumes, pesticides, niacin and riboflavin all have the following in common:
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1. induce CYP enzymes |
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One of the 3 major pathways of the phase I detoxification includes:
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3. Hydroxylation The other 2 are oxidation and reduction |
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Clearance of the compound _______ is used to determine activity level of phase I detoxification. |
Ceffeine |
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A low rate of caffeine clearance can indicate:
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All the responses |
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Phase II detoxification involves conjugation of water soluble constituent to a functional group on the toxin. These conjugation reactions can occur:
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all the responses |
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Location of the enzyme ___1____ in the ER right next to the cytochrome P450 enzymes enables it to reach the phase I metabolites before other phase II detox enzymes. The isoform ____2___ acts on the highest number of substrates (40%), including bile, morphine, and codeine. |
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Immune responses can occur from the creation of _____________, like when acyl groups migrate from C1-acyl glucuronides to another protein, covalently conf this new protein, and create substance that is now considered foreign and antigenic to the body. |
haptens |
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The activated form of glucoronic acid __1____ is used in th glucuronidation reactions and is produced from the oidation of ____2_____. |
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_______ are S-derivatives of N-acetylcysteine synthesized from glutathione.
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1. Mercapturic acids |
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There are 2 major types of sulfotransferases. One type is membrane-bound in the golgi apparatus and sulfates GAG's and glycoproteins, while the other is located in the _____ and conjugates steroids, catacholamines, T4, bile acids, and xenobiotics. |
Cytosol |
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Sulfate conjugation requires the activated form of sulfate, _________, which is created using the substrate SO4 +ATP and catalyzed by the enzyme ATP sulfurylase. |
3-phosphoadenosine-5'-phosphosulfate (PAPS) |
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Amino Acid conjugation requires 2 steps. the first step is activation of the xenobiotic carboxylic acid using the enzyme __1____, which requires ATP and _______.
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The rate of acetylation is important in detoxification because: |
slow acetylators accumulate higher blood concentrations of the active drug |
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Biomethylation to remove arsenic requires the use of ______ (number) SAMe as a methyl donor. |
One |
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Methylation for single carbon transfer is needed in far greater quantities for ___1____ than for ____2____.
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T/F: Oral challenge with aspirin reveals higher glycine conjugate than glucuronides. This is a normal interpretation. |
True |
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Oral challenge with benzoic acid reveals high benzoate. Supplementation with __1__ and ___2___ will help with conversion of benzoate to hippurate. |
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Match the pathways of alcohol degradation with the appropriate enzyme:
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Alcohol can deplete numerous nutrients. Match the nutrient depletion with the type of symptom/problem than can occur when the nutrient is depleted: a. B1 & B6 b. B6 & B9 c. B1 d. Vit D
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a. B1& B6 --> 1. neurological symptoms b. B6 & B9 --> 2. hematologic symptoms c. B1 --> Wernick-Korsakoff syndrome d. Vit D --> osteoperosis |
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Match the appropriate detox function with the specific nutrient: a. vit C b. glycine, sulfate c. Se, Mn, Cu, Zn, NAC d. Met, SAMe e. Ca f. cruciferous
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