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53 Cards in this Set
- Front
- Back
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When a patient has complications from a disease, the organs I worry about most are...
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Brain, Heart, Kidney
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I monitor a disease's effect on a deteriorating patient by measuring the function of...
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kidney (then heart, then brain)
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What are the functions of Vitamin A?
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Necessary for CSF production
Needed for night vision Is a cofactor for PTH Is a mild antioxident |
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What are the clues for Vitamin A deficiency?
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Poor night vision
Decreased CSF production Hypoparathyroidism |
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What are the clues for Vitamin A excess?
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Pseudotumor cerebri
Hyperparathyroidism - moans/groans (pancreatitis b/c increased Ca++ causes fat necrosis in pancreas) bones and stones |
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What do we expect to see on CT with dx of pseudotumor cerebri? What is the treatment? What is the main complication?
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Enlarged ventricles
Tx: d/c vitamin A, serial LPs - 30cc at a time, Acetazolamide to block prodcution of CSF Comp: blindness |
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What is another name for Vitamin B1?
Where are the enzymes used that Vitamin B1 is used in? |
Thiamine
Used in Heart and Wernicke's area |
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What are the results of Thiamine deficiency?
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Beriberi - dry if no heart symptoms; wet if heart symptoms
Wernicke's encephalopathy - receptive aphasia (pt can't understand written or spoken language Wernicke-Korsakoff syndrome - confabulation 2/2 inability to move short-term memory to long-term memory |
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What is another name for Vitamin B2? How is it used by the body? From what source do we obtain it? What happens when it is deficient?
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Riboflavin
Cofactor for FAD Milk (broken down by sunlight) Angular cheilosis |
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What is another name for Vitamin B3? How does the body use it? What do we see in Vitamin B3 deficiency?
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Niacin
Cofactor for NAD, NDAH, NADP, NADPH Pellagra (4 Ds): Dermatitis, diarrhea, dementia, death |
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What is Hartnup's disease?
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Renal disease that presents just like Pellagra
2/2 defective renal transport of tryptophan (which is needed to make Niacin) |
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What other disease can present as a Niacin deficiency? What is the mechanism of that disease?
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Carcinoid syndrome
Hypersecretion of serotonin but serotonin is made from tryptophan which is then not available to make niacin --> niacin def. |
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For what indication is Niacin used as a drug? What are the side effects?
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Used in conjunction with Probucol
Hypertriglyceridemia or low HDL (raises HDL more than any other drug) Side effects: Flushing/Itching (2/2 prostaglandin release - prevent with aspirin); insulin release; worsens gout |
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What is the most effective treatment for gout? What is the treatment we currently use for acute gout? Chronic gout?
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Most effective: Colchicine
Acute: Indomethacin Chronic: Allopurinol (blocks xanthine oxidase)/Probenacid (inhibits reabsorption of uric acid by kidney |
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What is another name for Vitamin B4? What is the result of Vitamin B4 deficiency?
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Lipoic Acid
No deficiency state |
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What is another name for Vitamin B5? What is the result of Vitamin B5 deficiency?
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Pantothenic Acid
No deficiency state |
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What is another name for Vitamin B6? What is B6 used for in the body? What is the result of Vitamin B6 deficiency?
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Pyridoxine
Needed by all transaminases Def: neuropathy |
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What is the first line treatment for neuropathy? What is the tx for neuropathy in a patient with heart disease?
What is the treatment for neuropathy in a patient with shootin/stabbing pain? |
1st - Amitryptiline
Heart dz: Gabapentin Shooting pain: Carbamazepine |
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What is another name for Vitamin B9? What is the function of B9 in the body?
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Folate
Used to make tetrahydrofolate which is required to make nucleotides |
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What is the result of Vitamin B9 deficiency?
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Megaloblastic anemia
Hypersegmented neutrophils Neural tube defects in fetus |
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What is another name for Vitamin B12? What is the function of B12 in the body? What 2 enzymes require the use of Vit B12?
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Cyanocobalamin
Used to make THF and to recycle odd-numbered carbon fatty acids (i.e. myelin) Methylmalonyl-CoA mutase Homocysteine methyl transferase |
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What drug pulls vitamin B6 out of the body?
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INH (always give B6 at the same time)
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Where is Vitamin B12 absorbed?
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Parietal cells of stomach (make intrinsific factor that is required for vit B12 absorption)
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What is the result of Vitamin B12 deficiency?
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Megaloblastic anemia
Hypersegmented Neutrophils Neuropathy |
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What is the function of Vitamin C?
What is the result of Vitamin C deficiency? |
Used for hydrolyation
Main antioxidant in GI system Scurvy - bleeding from gums and hair follicles |
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What is the function of Vitamin D?
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Stimulates osteoblastic activity
Stimulates calcium and phosphorous absorption and reabsorption Mineralizes bone and teeth |
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What are the results of Vitamin D deficiency?
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In Children: Ricketts - lateral bowing
In Adults: Osteomalacia |
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What X-linked dominant disease presents like a Vitamin D deficiency?
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Vitamin D resistant ricketts - defective renal absorption of phosphorous (Ca and phos go together)
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What are the X-linked dominant diseases?
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Vitamin D resistant ricketts
Pseudoparathyroidism Pyruvate Dehydrogenase Def |
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What is the funtion of Vitamin E?
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Antioxidant in the blood
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What is the function of Biotin?
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Necessary for carboxylation
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What is the function of Vitamin K? Where do we get Vitamin K?
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Needed for gamma-carboxylation of Vit. K-dependent clotting factors (2, 7, 9, 10 Prot. C and S)
We get Vit K from E. coli in our gut (babies don't have so give IM Vit. K) |
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Why do we start Heparin before Warfarin when a patient has a venous thromboembolism?
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We start heparin before warfarin with a 2 day overlap because Protein C has the shortest half-life and its role is to prevent extension of clots. Without Protein C we are in a hypercoagulable state. Therefore, Heparin must be given until Warfarin can cause production of Antithrombin III to take the place of Protein C once it is no longer being produced.
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What indicator of clotting do we follow when a patient is on heparin?
What is the tx for increased bleeding from heparin overdose? |
PTT, Protamine sulfate, If pt. bleeding, give FFP
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What disease does my patient have if I give Heparin and PTT does not increase?
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Antithrombin III deficiency
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What disease does my patient have if I give warfarin and patient comes back with a necrotic area of skin?
What is the treatment? |
Protein C deficiency
Tx: stop warfarin immediately |
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What are the functions of calcium?
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Extracellular Ca++: smooth muscle needs for 2nd messenger systems, cardiac ventricles need to trigger its intracellular Ca++ release
Intracellular Ca++: needed for all smmooth muscle contraction Used by atrium and thalamus for depolarization Used for axonal transport Presynatptic influx of Ca++ needed for release of ALL neurotransmitters Needed for normal bone and teeth development |
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What is the funtion of magnesium?
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Cofactor for all kinases
Cofactor for PTH Interacts with K+ in the early DCT (both go in same direction) |
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How do I determine the cause of hypercaclemia?
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If Ca and Phos go in same direction --> hormone problem
If Ca++ and phos go in different directions --> Vit D problem |
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What is the function of zinc? What is the result of Zinc deficiency?
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Needed by hair, skin, sperm, and taste buds
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What is the function of copper?
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needed by lysine hydroxylase in the formation of collagen. Also needed by complex IV of electron transport system
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Copper excess results in what disease process? What enzyme is deficient? What is the treatment?
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Wilson's disease: autosomal recessive
ceruloplasmin deficiency results in copper deposition in lenticular nucleus (basal ganglia), iris, and liver Tx: penicillamine |
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What is the result of copper deficiency?
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Minky's Kinky Hair syndrome
orange-colored hair hair feels like copper wire |
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90% of movement disorders in a middle-aged person are caused by? The otehr 10% are likely caused by?
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90% Huntington's - involves caudate nucleus, tx: antipsychotics
10% Wilson's disease - involves lenticular nucleus tx: penicillamine |
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Which diseases have trinucleotide repeats?
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Huntington's
Fragile X Fredriech's Ataxia Prader Willi (but usally caused by uniparental disomy) Myotonic dystrophy |
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What is the funtion of iron?
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Needed for formation of heme and hemoglobin
Needed by complex III and IV of electron transport system Ferrous iron binds O2 |
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What is the funtion of Chromium? What results from Chromium deficiency?
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enhances insulin action
Def: diabetes |
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What is the funtion of Selenium? What happens when there is Selenium excess? What happens in Selenium deficiency?
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Needed primarily by the heart
Excess: breath smells like garlic Def: dilated cardiomyopathy |
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What is the function of fluoride? What is the result of fluoride excess?
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Needed for teeth and bone growth
Excess: blocks enolase (needed to use glucose) --> low energy state! |
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What is the most common cause of Vitamin B12 deficiency?
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Destruction of parietal cells which are needed to make intrinsic factor
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What are the X-linked dominant diseases?
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Pseudoparathyroidism
Pyruvate Dehydrogenase deficiency Vitamin D-resistant rickets |
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Describe the pathophysiiology causing Vitamin D deficient Rickets
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Defective renal absorption of phosphorous --> Phos leaks out and pulls Ca with it
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How does heparin function?
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It acts as a cofactor for antithrombin III and blocks thrombin as well as clotting factors IX, X, XI, and XII
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