Case 4: Peptic Ulcer Disease – Flashcards
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AA from lumen into intestinal epithelial cell
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mostly Na dependent transport Driven by low intracellular Na concentrations (maintained by Na/K ATPase on basolateral)
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AA from intestinal epithelial cell to interstitial fluid
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facilitated transporters (Bidirectional)
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Renal epithelium AA transport
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Na depdendent transport proteins (reabsorption of aa in glomerular filtrate)
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Hyperaminoaciduria in ___ disease
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Hartnup
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AA pool
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diet and degradation of existing proteins
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Lysosomal Protein turnover
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...
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Ubiquitin-Proteosome pathway
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targets intracellular proteins for degradation 19S ___
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Lysosomal protein turnover during starvation
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Activation AMPK (favors proteolysis) Activates TSCI/TSC2 --> INACTIVATES Rheb and mTOR FAVORS AUTOPHAGY
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Lysosomal protein turnover during high energy state
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(insulin) Activation of AKT (favors protein synthesis) Inactivates TSC1/TSC2 Activates Rheb and mTOR INHIBITS AUTOPHAGHY
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Cystinuria
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unable to absorb cystine and 3 nonessential aa from intestine and glomerulous ....
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Erythropoietin
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hormone regulation of RBC production
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What conditions cause increased rate of RBC production?
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...
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Formation of hemoglobin
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1. 2. 3. 4.
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Condition in which the number of RBCs in circ increased by hypoxia or genetic aberration is?
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polycthemia
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Iron deficiency anemia can result from
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1. Dietary lack (infants, poor, elderly, teenagers) 2. Impaired absorption (sprue, chronic dia) 3. Increased requirement (child, premeno woman) 4. Chronic blood loss
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Dx of Iron deficiency
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Decreased Hct, Hb, serum iron and ferritin Blood smear: microcytic + hypochromic, poikilocytosis (abnormal shape) Increased TIBC
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Iron deficiency in adult male or post-menopausal woman, must first rule out?
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Gastrointestional bleeding
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Drugs that decrease acid
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H2 receptor antagonists "dine" Proton pump inhibitors "prazole"
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H2 receptor antagnoists
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"dine" competively inhibit Cimetidine (inhibits Cyto P450)
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Proton pump inhibitors
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"prazole" Omeprazole May decrease efficacy antiplatelets (clopidogrel)
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Drugs that neutralize acid
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Antacids "- hydroxide"
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Antacids
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AlOH (constipation) MgOh (diarrhea) use together
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Drugs that promote mucosal defense
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Sucralfate (doesn't alter pH) Collodial bismuth Prostaglandins (Rx: NSAID included ulcers)
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sucralfate
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viscous gel
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Misoprostol
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prostaglandin analogue
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Eicosanoid
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three classes Prostglandins, thromboxanes, leukotrienes 20C inflamm response, smooth m contraction, BP reg, broncoC/D
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pathway of arachodonic acid, start with diet
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Linoleate --> Arachodonic acid --> 1. Epoxides 2. Leukotriene 3. thromboxane 4.
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Arachidonic acid to prostaglandins
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AA --> PGG2 --> PGH2 --> 1. Thrombaxane (hex ring) 2. Prostaglandin (pent ring)
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PG nomenclature
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PG: prostaglandin A/D/E/F/G/H: family, refers to substituents 1/2/3: how many double bones in substituents *Series 2 naturally forms in body
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Cyclo-oxygenase
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initial biosynthesic step forms five-membered ring add four atoms of oxygen to ___
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Action of aspirin
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acetylates group to COX enzyme IRREVERSIBILY inactivating it
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NSAIDS besides aspirin action
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Reversible block both COX1 and COX2 Celebrx and ____
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Prominent eicosanoids formed in platelets?
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TXA2 (thromboxane)
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Eicosanoids related to asthma
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Prostaglandings and leukotrienes PGD2 LTB4, LTC4, LTD4
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Eicosanoids related to inflammatory bowel disease
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...
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Eicosanoids related to rheumatoid arthritis
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...
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Eicosanoids related to glomerulonephritis
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...
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Eicosanoids related to cancer
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...
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Eicosanoids related to cardiovascular disease
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...
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Cyclo-oxygenase inhibitors
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NSAIDs (all but aspirin are reversible) affect COX1+2
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serious adverse effects of aspirin
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hepatic encephalopathy aspirin induced airway activity
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Thromboxane antagonists mechanism
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block TXA2 creation or receptors
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Leukotrine inhibition mechanism
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inhibition 5-oxygenase, which inhibits the lipoxygenase pathway
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5-LO
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...
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Linoleic acid is an omega-__?
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6
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PGI2
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vasoD, inhibit platelet agg
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TXA2
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vasoC, platelet ACTIVATION
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PGH2 converts to
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PG D/E/F/I 2 TXA2
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PGD2
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...
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PG
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...
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Alpha-Lenolenic acid -->
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EPA
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Resolvins and protectins, d-series maresins
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...
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A-lenolenic-->
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DHA
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COX inhibitors
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NSAIDs Glucocorticoids
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NSAIDs prevent conversion of ___ to ___?
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prevent arachidonic acid to subsequent prostaglandins and thromboxanes
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Leukotrienes
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...
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Zileuton
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inhibits 5-lipoxygenase
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Zafirlukast and Montelukast
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antagonize cysteinyl leukotriend receptor receptor *instead of zileuton
