Download ChemPPT Flashcards Unit 3

Chem PPT Flashcards, Unit 3
What is the function of electrolytes?
What is the major cation of extracellular fluid?
What does Sodium determine in the
extracellular fluid?
When is sodium excreted in the urine?
What happens when serum levels are below 110
mmol/L?
Sodium specimens consist of…?
And should be stored at…?
What are the methods of measuring sodium?
What is the major intercellular cation?
How are high concentrations of potassium
maintained?
Does potassium exhibit a renal threshold?
What are some of the functions of potassium?
How does potassium affect acid-base status?
What should the concentration of K+ be?
How does the release of K+ affect values?
Run maintenance of water homeostasis,
maintenance in acid-base balance and muscle
functions as well as serves as cofactors for
enzymes.
Sodium (Na+)
The osmolality.
When serum sodium exceeds 110-130
mmol/L
All the sodium in the glomerular filtrate is
virtually reabsorbed in the proximal and distal
tubules, a process that is influenced by
aldosterone.
Serum, plasma and urine specimens and may
be stored at 4°C or may be frozen. Lipemic
samples need to be ultracentrifuged.
Atomic Absorption Spectrophotometry (AAS),
Sodium Ion selective electrode (ISE), and
Spectrophotometry.
Potassium (K+)
Na+K+ adenosine triphosphate (ATP) pump
which is fueled by oxidative energy and
continually transports K+ into the cell against
a concentration gradient.
No, however it is excreted into the urine even
in K-depleted states.
Regulation of neuromuscular excitability
(both hypo- and hyperkalemia can cause
muscle weakness) and contraction of the heat
and cardiac rhythm (decrease K+ increases
cardiac excitability and often leads to
arrhythmia. High K+ slows the heart rate).
In hypokalemic states, sodium and H+ ions
move into the cell to replace K+. The H+
concentration is therefore decreased in the
ECF=alkalemia (reverse is true of
hyperkalemia).
In plasma and whole blood the concentration
is 0.1-0.7 mmol/L lower than those in serum.
As few as 0.5% K+ of RBCs will increase K+
values by 0.5 mmol/L. An increase of K+ of
0.6% has been estimated for every 10 mg/L of
plasma hemoglobin (Hb) caused by
hemolysis.
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Chem PPT Flashcards, Unit 3
What causes glycolysis to be inhibited and the
energy-dependent Na+, K+-ATPase will not
maintain the Na+/K+ gradient?
What does a K+ leakage from erythrocytes and
other cells cause?
What causes falsely decreased K+ value?
What are reliable determinations recommended
for K+?
What can falsely increase K+ concentration?
What are methods for the determination of
sodium and potassium?
What is the major anion of the extracellular
fluid?
What is the function of chloride?
Where is chloride absorbed?
What specimens contain chloride?
How is chloride affected by hemolysis, change
in posture or stasis, and tourniquet use?
Methods for chloride determination?
Measurement of sweat chloride (sweat testing)?
Sweat testing and newborn screening…
What phases are done for sweat testing?
What is an abnormal infant sweat testing result?
Bicarbonate is another name for:
True or False: Plasma or serum can be used to
measure bicarb?
When a whole blood specimen is maintained
at 4°C versus 25°C before separation.
It causes an increase in plasma K+.
When an un-separated sample is stored at
37°C because glycolysis occurs and K+ shifts
intracellularly. Leukocytosis will initially
cause falsely decreased K+ concentration at
room temp.
Collect blood with heparin, maintain near
25°C and separate the plasma within minutes
by high-speed centrifugation without cooling.
Skeletal muscle activity as a result of repeated
clenching of fist and application of the
tourniquet.
Ion selective electrodes (ISE) and
spectrophotometric methods.
Chloride (CI-)
Maintains the water distribution, osmotic
pressure, and anion-cation balance in the ECF.
In the intestinal tract and is excreted by
kidneys.
Serum, plasma, urine and sweat.
It is not affected.
Coulometric-amperometric titration of
chloride (cotlove chloridometer technique)
and ion selective electrode methods.
Cystic fibrosis, the most common lethal
genetic disorder of Caucasian population
characterized by increased sweat chloride
concentration.
Are performed in conjunction, with a positive
screening test are referred to as a quantitative
sweat chloride test.
Sweat stimulation by pilocarpine
electrophoresis, collection of sweat,
qualitative or quantitative analysis of sweat,
sodium or conductivity.
≥60 mmol/L = indicative of CF
Total carbon dioxide
True
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Chem PPT Flashcards, Unit 3
True or False: Sample must be centrifuged in
an open tube?
True or False: Ambient air contains far more
CO2 than plasma?
If CO2 is allowed to escape from the sample
into air, ___to___ mmol/L will be lost per hour.
Two ways of measuring total CO2 are
acidification and ____
Acidification is a(n) ___ electrode based
method?
Define osmometry:
Define osmotic pressure:
Define osmosis:
Name 4 colligative properties of solutions:
Colligative properties of solutions are all
directly related to:
The term osmolality expresses:
The term osmolarity expresses:
Plasma and urine osmolality is useful in the
assessment of:
The 4 major osmotic substances in normal
plasma are:
The Henderson-Hasselbalch equation defines
pH as:
The Henderson-Hasselbalch equation is widely
used to calculate the ___ point of proteins.
Total O2 content (cdO2) is:
Oxyhemoglobin (O2Hb) is defined as:
Define the following terms:
pO2 =
pCO2 =
ctCO2 =
HCO3 =
cdCO2 =
False, be must be unopened
False
4-5
Alkalinization
Indirect
a technique for measuring the concentration
of solute particles that contribute to the
osmotic pressure of a solution.
the pressure required to stop osmosis through
a semipermeable membrane between a
solution and pure solvent.
process by which molecules of a solvent tend
to pass through a semipermeable membrane
from a less concentrated solution into a more
concentrated one.
1. Increased osmotic pressure
2. Lowered vapor pressure
3. Increased boiling point
4. Decreased freezing point
total number of solute particles per mass of
solvent.
concentrations relative to mass of the solvent.
concentrations per volume of solution.
Electrolyte and acid-base disorders
Na+ / Cl- / glucose / urea
The negative log of the H+ activity
isoelectric
the sum of the concentrations of hemoglobin-bound
O2 (oxyhemoglobin) and of dissolved O2 (cdO2).
erythrocyte hemoglobin with O2 reversibly
bound to Fe2+ of its heme group.
pO2=partial oxygen pressure.
pCO2=partial carbon dioxide pressure.
ctCO2=total concentration of carbon dioxide.
HCO3=bicarbonate.
cdCO2=concentration of dissolved carbon
dioxide.
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Chem PPT Flashcards, Unit 3
What specimen is used for blood gas analysis?
What is the only clinical reason for an arterial
draw?
PO2 is generally 60 mm Hg ___ in venous
blood.
PCO2 is 2-8 mm Hg ___ in venous blood.
Arterial and venous specimens for blood gas
analysis are best collected:
Lyophilized heparin is preferred to liquid
heparin because:
3 effects of exposing blood gas samples to the
air:
The pCO2 in blood is much ___ than the pCO2
in the air.
On exposure of blood to the air, the total CO2
and the pCO2 both ___
On exposure of blood to the air pO2 __
In blood gas samples, clots are ___
In blood gas samples, air bubbles cause
(increase or decrease) in total CO2, pCO2, pH,
pO2.
What are the reasons for the following changes
in pCO2, pH and pO2 in a sealed specimen left
at room temperature for 2 hours:
Arterialized capillary blood is an acceptable
alternative to arterial blood but it has to be:
The first drop is discarded and the subsequent
free forming drops should be taken up in a:
Transport and analysis of specimen should be
within ___ of collection.
Because electrodes are not stable over long
periods of time, frequent calibration of ___, ___
and ___ is required:
Proper maintenance includes:
Good quality assurance includes:
Whole blood.
PO2 value
Lower
Higher
anaerobically with lyophilized heparin using
glass syringes
liquid heparin dilutes the sample, and the
effect is greatest when the syringe is not
completely filled
Increase in pO2, increase in pH, decrease in
pCO2
greater
decrease
increases
unacceptable
Decrease, decrease, increase, increase.
Increase in pCO2 as a result of continued
metabolism, decrease in pH due to increased
production of carbonic acid and lactic acid
during glycolysis, decrease in pO2 because O2
is consumed during prolonged standing.
freely flowing cutaneous blood.
capillary collection tube containing
lyophilized heparin
30
pH, PCO2, and PO2
-meticulous care.
-adherence to the manufacturer's procedures.
-control of the equipment.
-proper collection and handling of specimens.
-the frequency with which maintenance
should be maintenance = volume of analysis
performed.
-proper maintenance of the instrument.
-use of control materials.
-verification of electrode linearity.
-checking of barometer accuracy.
-accurate measurement of temperature.
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Chem PPT Flashcards, Unit 3
External quality assurance (proficiency testing)
mandated by:
A hormone is:
Hormones are produced at one site in the body
and exert their action(s):
Paracine action is:
Autocrine action is:
Adrenocorticotropic hormone (ACTH), insulin,
parathyroid hormone (PTH) are examples of
___ or ___ hormones
This class of hormone is soluble in:
This class of hormone has a half-life of ___ to
___.
This class of hormone initiates response by:
Cortisol and estrogen are 2 examples of _____
hormones.
Steroid hormones are hydrophobic and water
insoluble.
Steroid hormones circulate in plasma, reversibly
bound to transport proteins with only a small
fraction free or unbound and available to exert
physiological action.
What is the half-life of steroid hormones?
How do steroid hormones enter the cell?
What are 2 examples of amino acid-related
hormones?
Amino acid-related hormones are water soluble.
Amino acid-related hormones interact with
membrane associated receptors and use a
second messenger system.
Amino acid-related hormones circulate in
plasma bound to ______ or _______
Estrogen and androgen are examples of ______
hormones.
What is the ability or tendency of an organism
or cell to maintain internal equilibrium by
adjusting its physiological processes?
In response to a glucose load, _____ is released
from the ______.
CLIA'88
a chemical substance produced in the body by
an organ, cells of an organ, or scattered cells
that has a specific regulatory effect on the
activity of an organ or organs.
at distant sites through what is called the
endocrine system.
action of certain hormones that exert their
effect locally on nearby cells.
action of certain hormones that exert their
effects on the cells of origin.
Polypeptide or Protein
Water/blood
≤10 to 30 minutes
Binding to cell membrane receptors and
exciting the second messenger system.
Steroid
True
True
30-90 minutes
Passive diffusion
Thyroxine and catecholamines
True
True
Proteins, free
Gonadal
Homeostasis
Insulin, pancreas
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Chem PPT Flashcards, Unit 3
What is responsible for regulating the dispersal
of glucose into cells for the metabolism
necessary to produce energy?
What are the counter regulatory hormones that
regulate glucose concentration?
What are some examples of incretins?
What is GLP-1?
What is GIP?
What is CaSR?
The CaSR on the parathyroid gland recognizes
the circulating level of ionized calcium and
regulates the synthesis and secretion of ____.
What is PTH?
PTH enhances renal tubular reabsorption of ?
PTH catalyzes the synthesis of renal hormone
_____ to increase intestinal absorption of
calcium.
The metabolism of water and electrolytes is
regulated by _____, _______, and ______.
Where is aldosterone produced?
Where is renin produced?
Where is vasopressin produced?
What is the posterior pituitary gland called?
Vasopressin is an _______ hormone.
What is the role of hormone receptors?
What are the two types of hormone receptors?
What is a large superfamily of membrane
receptors whose intracellular effects are
mediated by G proteins?
What are a family of proteins involved in
transmitting chemical signals outside the cell,
and causing changes inside the cell?
What are characterized by a hormone binding
domain, DNA-binding domain and an amino
terminal variable domain?
Measurement of hormones
Insulin
Glucagon, cortisol, epinephrine, growth
hotmone and incretins
GLP-1 and GIP
Glucagon-like peptide 1
Gastic inhibitory pepide
Calcium-sensing receptor
PTH
Parathyroid hormone
Calcium
Calcitrol
Aldosterone, renin, vasopressin
Adrenal gland
Kidney
Posterior pituitary gland
neurohypophysis
Antidiuretic
The unique or specific action of a hormone on
its target tissue is a function of the interaction
between the hormone and its receptor
Cell surface receptors
Intercellular receptors
G-protein-coupled receptors (GPCR)
Guanine-nucleotide-binding proteins (G
proteins)
Intracellular receptors
-Bioassay Techniques
-Receptor-Based Assay
-Immunoassay Techniques
-Instrumental Techniques
-Mass Spectrometry (coupled with gas
and liquid chromatography)
-Matrix Assisted Laser
Desorption/Ionization (MALDI)
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Chem PPT Flashcards, Unit 3
What is a monoamine, an organic compound
that has a catechol(benzene with two hydroxyl
side groups) and a side-chain amine?
Where is Catecholamines produced?
Which Catecholamines acts as a
neurotransmitter in the central nervous system,
is largely produced in neuronal cell bodies in
two areas of the brainstem: the substantia nigra
and the ventral tegmental area?
Where does Catecholamines derived from?
Included among catecholamines are:
Fight-or-flight response
Epinephrine (adrenaline) functions as a
hormone released by the
What is a monoamine neurotransmitter,
biochemically derived from tryptophan?
Where does Serotonin primarily found?
How many percent of the human body's total
serotonin is located in the enterochromaffin
cells in the GI tract, where it is used to regulate
intestinal movements?
When platelets bind to a clot, they release?
Once released by the platelets, serotonin serves
as a ______ and helps regulate homeostasis and
blood clotting.
Serotonin also serves as a ______ for some type
of cells, possibly giving it a roll in wound
healing.
What is serotonin mainly metabolized into?
5-HIAA (hydroxyindoleacetic acid) is exerted
by?
Phenylethylamines with hydroxyl groups on
positions three and four of the benzene ring and
on ethylamine sidechain on position one are
called.
Serotonin, norepinephrine,dopamine, and
epinephrine are all types of?
This catecholamine is acted upon by the pineal
Catecholamine (CA)
Catecholamines are produced mainly by the
chromaffin cells of the adrenal medulla and
the postganglionic fibers of the sympathetic
nervous system
Dopamine
Amino acid tyrosine
epinephrine (adrenaline), norepinephrine
(noradrenaline) and dopamine; all of which
are produced from phenylalanine and tyrosine
Release of the hormones epinephrine and
norepinephrine
Adrenal medulla
Serotonin or 5-hydroxytryptamine (5-HT)
Gastrointestinal tract (GI tract), blood
platelets, and the central nervous system
(CNS) of animals, including humans
Approximately 90%
Serotonin
Vasoconstrictor
Growth factor
5-HIAA (hydroxyindoleacetic acid)
The kidneys
Catecholamines
Catecholamines
Serotonin
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Chem PPT Flashcards, Unit 3
gland to produce melatonin.
Tyrosine is converted to 3,4dihydroxyphenylalanine (L-dopa) by the
enzyme...
Conversion of L-dopa to ____is catalyzed by
aromatic-L-amino acid decarboxylase
Dopamine formed is further converted to
_______by dopamine β-hydroxylase
further conversion of norepinephrine to
_______is through the presence of
phenylethanolamine and N-methyltransferase in
the adrenal medullary chromaffin cells
_____is converted to 5-hydroxytryptophan by
the enzyme _______.
Conversion of 5-hydroxytryptophan to ____is
catalyzed by aromatic-L-amino acid
decarboxylase
______is synthesize from ______in the pineal
gland by the serotonin-N-acetyltransferase and
by the hydroxyindole-O-methyltransferase
Monoamines include…
How are monoamines stored
How are monoamines released
The process of releasing monoamines is
stimulated by?
In which nervous system does the presence of
monoamine oxidase (MAO) lead to the
conversion of norepinephrine to 3,4-dihydroxyphenylglycol (DHPG)? Parasympathetic or
Sympathetic
DHPG is then metabolized by cathechol-Omethyltransferase (COMT) in the extraneuronal
tissues to
What is the primary end product of epinephrine
and norepinephrine metabolism?
Where is vanillylmandelic acid produced?
What is the enzyme required for conversion of
MHPG to VMA
What is the product of serotonin deamination?
What is the major urinary excretion product of
serotonin metabolism?
Which system does norepinephrine regulate?
tyrosine hydroxylase
dopamine
norepinephrine
epinephrine
Tryptophan, tryptophan hydroxylase
Serotonin
Melatonin, serotonin
Epinephrine, norepinephrine, serotonin, &
dopamine
Monoamines are stored in secretory granules
in equilibrium with the surrounding cytoplasm
Monoamines are released from secretory
vesicles into the extracellular space through
the process of exocytosis
an influx of calcium and acetylcholine
Sympathetic nervous system.
3-methoxy-4-hydroxyphenylglycol (MHPG).
Vanillylmandelic acid (VMA)
Liver
Alcohol dehydrogenase
5-hydroxyindoleacetic acid (5-HIAA)
5-hydroxyindoleacetic acid (5-HIAA)
The sympathetic nervous system and overall
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Chem PPT Flashcards, Unit 3
Which processes are influenced by dopamine?
Which processes are regulated by serotonin?
How does the sympathetic nervous system
operate?
What does the sympathetic nervous system
regulate?
What happens when the sympathetic nervous
system is activated?
Which system is characterized by the presence
of numerous catecholamine storage granules?
These turn brown when exposed to what?
What does this color change indicate?
What are these cells/granules called?
Adrenal Medullary system secretes what?
What processes are stimulated by the release of
epinephrine?
How does epinephrine raise glucose
concentrations?
What other function does epinephrine affect?
state of attention and vigilance
1) Reward seeking behavior
2) Initiation and maintenance of movement
3) Processing of sensory signals
4) Regulation of hormonal release.
1) Memory
2) learning
3) feeding behavior
4) sleep patterns
5) thermoregulation
6) pain modulation
7) cardiovascular function
8) Regulation of pituitary hormones.
It operates below the level of consciousness in
controlling the physiological function of many
organs and tissues of the body.
It regulates cardiovascular function in
response to postural, exertional, thermal and
mental stress
Activation increases heart rate, constricts
peripheral blood vessels, dilates skeletal
arterioles, and elevates blood pressure.
Adrenal Medullary system
1) Potassium bichromate solution
2) Ammoniacal silver nitrate
3) Osmium tetroxide
Oxidation and polymerization of epinephrine
and norepinephrine.
Chromaffin cells/chromaffin granules
Epinephrine
1) Lipolysis
2) Ketogenesis
3) Thermogenesis
4) Glycolysis
Stimulates glycogenesis and gluconeogenesis
Pulmonary function causing the dilation of
airways
What is dopamine?
A neurotransmitter produced in sympathetic
nerves and the adrenal medulla
In the kidneys, what does dopamine regulate?
Sodium excretion
Where else are dopamine metabolites produced? In the GI tract
What is the major urinary dopamine metabolite? Homovanillic acid (HVA)
What is the Enteric nervous system (ENS)?
An independent and integrated system of
neurons and supporting cells located in the
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Chem PPT Flashcards, Unit 3
The ENS is composed of what two networks?
How is the ENS connected to the CNS?
What are examples neuroendocrine tumors that
produce catecholamine?
What are serotonin producing tumors?
Pheochromocytomas occur within what gland?
Paragangliomas occur outside what gland that is
commonly referred to as extra adrenal
pheochomocytoma’s?
Hypertension, headaches, palpitations,
diaphoresis, pallor, nausea, attacks of anxiety
and generalized weakness are all symptoms of
what referring to the adrenal gland?
Patients with higher risk for pheochromocytoma
include those with a
_____ predisposition to the tumor and finding
of an ______ ______ during a routine
abdominal imagine procedure.
In terms of pheochromocytoma and
paraganglioma, this type of diagnosis are based
on evidence of excess production of
catecholamines by measurements id
metanephrines in urine or plasma.
Presence of most pheochromocytomas are __%
benign of adrenal tumors and ___% of extraadrenal tumors are malignant.
This is a neoplasm that id derived from
primordial neural crest cell of the sympathetic
nervous system.
Neuroblastoma causes sporadic ______
cancer, common malignancies in the first year
of life
Mutations of neuroblastomas activate in the
______ kinase domaine of the anapestic
lymphoma kinase oncogene account for most
cases of heredity
Neuroblastomas have Variable biological
behavior but most are ____?
____ and ____ are most widely used for
diagnosis of neuroblastoma.
Diagnosis of neuroblastoma is diagnosed
gastrointestinal tract, gallbladder and pancreas
1) Myenteric plexus
2) Submucous plexus.
It is connected by intrinsic sympathetic and
parasympathetic motor neurons and by spinal
and vagal sensory neurons.
1) Pheochromocytomas
2) Paragangliomas
3) Neuroblastomas
Carcinoid tumors
Adrenal gland
Adrenal gland
Pheochromocytoma and Paragangliomas
hereditary
adrenal mass
Biochemical Diagnosis
15%
35%
Nueroblastoma
pediatric
tyrosine
aggressive
HVA and VMA
catecholamine
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Chem PPT Flashcards, Unit 3
mainly on measurements of
_______ metabolites.
Gastroenteropancreatic neuroendocrine and
carcinoid tumors are tumors from the
____________ cells.
Gastroenteropancreatic neuroendocrine and
carcinoid tumors are most common in the _____
or lungs, _____ or jejunum, _____ and rectum.
Gastroenteropancreatic neuroendocrine and
carcinoid tumors usually appear in ____
(pediatrics, older adults)
These tumors are characterized by large
quantities of serotonin.
In carcinoid tumors, ______ is converted to
serotonin and is stored in circulatory granules
and in platelets.
What type of test result elevations are seen in
wide ranges of serotonin rich foods or
medication?
What type of false result can be caused by
alcohol and other drugs?
Neuroendocrine tumors derive from
enterochromaffin cells of the respiratory tracts
and _______. Bowel obstruction and abdominal
pain are presented.
Biochemical diagnosis of carcinoids depends
mainly on measurements serotonin, serotonin
metabolites (____), and the serotonin precursor
(____) in urine, plasma, whole blood and
platelets.
What type of false result are a common problem
resulting from dietary influences.
For catecholamines and their metabolites,
serotonin and its metabolites and urinary or
plasma metanephrines are determined by
laboratory what type of methods?
What kind of anticoagulant should be used for
whole blood measurement of serotonin?
Aliquots of blood is removed to count what?
How are blood serotonin samples stored?
Platelet rich plasma is prepared from whole
blood using what speed on the centrifuge?
Why should platelet rich plasma be prepared
within 1 hour after collection and be placed on
ice?
Plasma and platelets should be stored at what
enterochromaffin
bronchus
ileum
rectum
older adults
Carcinoid tumors
5-HTP
False-positive
False-positive
gastrointestinal
(5-HIAA)
(5-HTP)
False-positive
Analytical methods
EDTA, gently mixed and placed on ice and
transferred to a storage tube
Platelets
Frozen at -20C within 2 hours after collection
Low-speed
To prevent lowering of serotonin
concentration
-20C
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Chem PPT Flashcards, Unit 3
temperated?
Plasma and platelets are analyzed within how
many weeks after collection?
How are 24-hour urine samples for serotonin
and 5-HIAA collected?
What pH lever are urine samples acidified to?
What is used to acidify urine samples before
freezing?
True or False?
Urine samples don’t have to be refrigerated
during collection.
How do drugs affect monoamine systems?
Give an example of a drug from the above
question.
Drugs that affect monoamine systems are the
major reason of false-positive results for the
measurements of what?
What kind of dietary food sources should you
avoid 3-4 days before and during urine
collection?
True or False?
Metanephrines and methoxytyramine are
present in plasma and urine
How is urinary and plasma fractionated
metanephrines measured?
What kind of preparation step is taken for
measurement of urinary and plasma fractionated
metanephrines?
What detection methods are used for plasma
catecholamines?
What is LC-EC?
What does VMA stand for?
What does HVA stand for?
What is the major end product of epinephrine
and norepinephrine metabolism?
HVA is the major end product of the
metabolism of what?
Urinary VMA and HVA are used for the
diagnosis of what?
What methods are used to detect VMA and
HVA?
What does 5-HIAA stand for?
Serotonin and 5-HIAA are measured in what?
1-2 weeks
In 2 L brown polypropylene bottles each
containing 250 mg of sodium metabisulfite
and EDTA as preservatives
pH 4
Acetic acid
False. Urine specimens should be refrigerated
during collection.
By Inhibiting monoamine reuptake
Tricyclic anti-depressants
Norepinephrine and normetanephrine
Dietary sources of 5-hydroxyindole such as
walnuts, avocado, bananas, eggplants,
pineapples, plums, and tomatoes.
True
By LC-MS/MS
An ion exchange chromatography
LC-EC
Liquid chromatography with electrochemical
detection
Vanillylmandelic Acid
Homovanillic Acid
VMA
Dopamine
Neuroblastoma
Gas or liquid chromatography and LCMS/MS
5-hydroxyindoleacetic acid
Whole blood, platelet rich plasma, or patelet
pellets
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Chem PPT Flashcards, Unit 3
What can serotonin and 5-HIAA identify?
What is used to measure serotonin and 5HIAA?
Fill in the blank:
Water soluble vitamins are retained (less/more)
and excreted (less/more) in the urine
Water soluble vitamins can function as what?
Give 2 examples
True or False?
Fat soluble vitamins are soluble in organic
solvents
Fat soluble vitamins are absorbed, transported,
and stored for (shorter/longer) periods of time
Give 4 examples of fat soluble vitamins
What are sources of vitamin A?
What are sources of beta-carotene?
Retinol is principally stored as what?
Where is retinol obtained?
Provitamin A carotenoids are obtained from
what?
What is a major function of vitamin A?
What are other functions?
What else does it provides protection against?
Deficiency of Vitamin A causes?
What is the laboratory assessment?
What is the chemical assessment?
What are sources of vitamin D?
When does the body make vitamin D?
What is vitamin D’s main circulating form?
What is its biologically more active form?
What is vitamin D3?
Tumors deficient in aromatic amino acid
decarboxylase
Liquid chromatography with fluorometric or
electrochemical detection, HPLC
Less; more
Coenzymes; B-complex group vitamins and
Vitamin C
True
Longer
Vitamins A, D, E, K
Eggs, meat, and dairy
Green leafy vegetables, and vibrant colored
fruits and vegetables.
of retinyl esters (palmitate) and includes
dietary carotenoids such as α-carotene, βcarotene, and β-cryptoxanthin
from liver, other organ meats, fish oils, full
cream milk, butter and fortified margarines.
yellow or orange pigment fruits and green
leafy vegetables
Good vision
include its role in reproduction, growth,
embryonic development and immune
function.
cancer by blocking tumor promotion,
inhibiting proliferation, inducing apoptosis
and inducing differentiation
Night blindness (nyctalopia), Xerophthalmia,
Keratomalacia, Dryness /roughness of the
skin, papular eruptions and follicular
hyperkeratosis
Measurement of RBP (retinol binding protein)
and transthyretin (thyroxine-binding
prealbumin) by nephelometry
Carr-Price and Neeld-Pearson methods
Cheese, margarine, butter, fortified milk,
healthy cereal, fatty fish
When exposed to sunlight
25 hydroxyvitamin D [25(OH)D],
1, 25 dihydroxyvitamin D [1,25 (OH)2D],
the parent compound of the naturally
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Chem PPT Flashcards, Unit 3
What is vitamin D2?
What are ways Vitamin D may be acquired?
Vitamin D2 and vitamin D3 are metabolized to
what?
Metabolites are further metabolized by?
What is the biologically most active form of
vitamin D
occurring family and is produced in the skin
from 7 dehydrocholesterol on exposure to the
UV B portion of sunlight
the parent compound of the other vitamin D
family, manufactured by irradiation of
ergosterol produced by yeast
by exposure of skin to sunlight or ingestion of
foods containing vitamin D, primarily fish
liver oils, fatty fish, egg yolks and liver
25(OH)D2 and 25(OH)D3, respectively, in
the liver by vitamin D-25-hydroxylase.
in the kidneys and also in the placenta of
pregnant women by 25(OH)-D-1αhydroxylase.
? is 1,25 (OH)2D
What is the main circulating form of vitamin D? 25(OH)D.
How vitamin D plays in control of calcium
Hypercalcemia reduces 25(OH)-D-1αlevels?
hydroxylase activity and production of
1,25(OH)D.
Hypocalcemia increases the synthesis of 1,25
(OH)2D by increasing 25(OH)-D-1αhydroxylase activity
How vitamin D plays in control of phosphate?
Hyperphosphatemia reduces 25(OH)-D-1αhydroxylase activity and production of
1,25(OH)D.
Hypophosphatemia increases the synthesis of
1,25 (OH)2D by increasing 25(OH)-D-1αhydroxylase activity
Where are calcium and phosphate
intestine, bone, kidney, and parathyroid.
concentrations in serum that are maintained by
the actions of 1,25(OH)2D?
How does 1,25 (OH)2D act?
1,25 (OH)2D reduces 25(OH)-D-1αhydroxylase activity and production of
1,25(OH)D.
It also induces 25(OH)D-24-hydroxylase, an
enzyme producing 24,25-dihydroxyvitamin D
(24,25 [OH]2D), which is the most prevalent
dihydroxylated vitamin D form in serum. The
activity of this enzyme may reduce the
formation of biologically active 1,25(OH)2D.
How does1,25(OH)2D act on intestine ?
1,25(OH)2D stimulates calcium absorption
How does 1,25(OH)2D act on bones?
1,25(OH)2D increases bone resorption and
increases the circulating concentration of bone
14
Chem PPT Flashcards, Unit 3
How does 1,25(OH)2D act on kidney?
How does 1,25(OH)2D act on parathyroid?
What does measurement of 25(OH)D use?
What does measurement of 1,25(OH)2D use?
What are measurements of vitamin D
metabolites?
What is the nutrition term for the group of
vitamin E?
How are tocopherols and tocotriennols found?
What is the major form of vitamin D in many
plant seeds?
Where isVitamin E absorbed in the human
body?
How vitamin E is secreted?
How isVitamin E excreted?
What is Vitamin E necessary for?
What is Vitamin E?
What are the risks of deficiency of vitamin E?
alkaline phosphatase (BALP), and the noncollagenous bone protein osteocalcin (OC)
1,25(OH)2D inhibits its own synthesis and
stimulates its metabolism
1,25(OH)2D acts directly to inhibit the
synthesis and secretion of PTH
Useful in evaluating hypocalcemia, vitamin D
status, and bone disease
Useful in detecting in adequate or excessive
hormone production in the evaluation of
hypercalcemia, hypercalciuria, hypocalcemia
and bone and mineral disorders
1. Competitive Protein Binding Assay
(CPBA)
2. Immunoassay
3. UV absorbance after separation by High
Performance Liquid Chromatography (HPLC)
4. Liquid Chromatography-Tandem Mass
Spectrometry (LC-MS/MS)
These are tocopherols and tocotriennols.
principal sources of dietary vitamin E are oils
and fats, particularly with germ oil and
sunflower oil, grains and nuts
γ-tocopherol
Vitamin E is absorbed from the small
intestines in the presence of bile
It is secreted in chylomicron particles which
are then transported to the peripheral tissue,
mainly adipose tissue, with the aid of
lipoprotein lipase (LPL)
The liver takes up the chylomicrons where the
α-tocopherol is incorporated into VLDL
Vitamin E is excreted via the bile and in the
urine as tocopheronic acid and its βglucuronide conjugate
Vitamin E is necessary for neurological and
reproductive functions, protection of red cells
from hemolysis, prevention of retinopathy in
premature infants and inhibition of freeradical chain reactions of lipid peroxidation.
Vitamin E is an antioxidant that acts as a
scavenger for molecular oxygen and free
radicals and has a role in cellular respiration
Deficiency of vitamin E are generally
15
Chem PPT Flashcards, Unit 3
Excess of vitamin E?
What is the method of choice to quantify
tocopherols in serum?
What is Phylloquinones (Vitamin K1 type)?
What is Menaquinones (Vitamin K2 type)
How does vitamin K get destroyed?
What are the Dietary sources of
phylloquinones?
What are the Dietary sources of menaquinones?
Where is vitamin K absorbed from?
Where do the traces of urinary metabolites of
vitamins of K-1 and K2 appear in?
What does vitamin K promote? What is vitamin
K required for?
What is the risk factor of vitamin K?
What are the labrotory assessments for vitamin
K?
What do the Dietary sources of vitamin B1
include?
Where does absorption of Vitamin B1 Occur?
Where is vitamin B1 Stored?
observed in premature and low birth weight
infants
It is primarily due to dietary supplementation
and may cause deficiency of fat soluble
vitamins D and K by competitive absorption.
High performance liquid chromatography
(HPLC)
Synthesize in plants
Bacterial origin
It Got destroyed by alkaline solution and
reducing agents and are sensitive to ultraviolet
light
Dietary sources of phylloquinones are green
vegetables, margarines and plant oils.
Dietary sources of menaquinones our cheese,
eggs and milk products
Vitamin K is absorbed from the small
intestines in the presence of bile, bound to
chylomicrons.
Only traces of urinary metabolites of vitamins
K-1 and K2 appear in urine
Vitamin K promotes clotting of the blood and
is required for the conversion of several
clotting factors and prothrombin.
Risk of vitamin K deficiency is increased in
fat malabsorption states such as bile duct
obstruction, cystic fibrosis, chronic
pancreatitis and liver disease. Risk is also
increased by the use of drugs that interfere
with vitamin K metabolism such as coumarin
anticoagulants (warfarin) and some antibiotics
(cephalosporin).
Laboratory Assessment includes:
Prothrombin time (PT) determination
direct measurement of plasma phylloquinone
by High Performance Liquid Chromatography
(HPLC)
Dietary sources include unrefined cereal
grains, breakfast cereals and enriched flour.
Absorption occurs primarily in the proximal
small intestines.
About half of the body stores are found in
skeletal muscles, with much of the remainder
in the heart, liver, kidneys and nervous tissue
including the brain which contains most of the
triphosphate.
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Chem PPT Flashcards, Unit 3
What is the function of Thiamine in Vitamin
B1?
What are the two general reactions of Thiamine
in Vitamin B1?
What is thiamine necessary for?
What does the deficiency results to? What are
the symptoms?
What is the deficiency in thiamine due to?
What is the labrotory assessment for vitamin
B1?
What is an essential component of Riboflavin?
(Vitamin B2)
What do the dietary sources include in Vitamin
B2
What is Vitamin B2 absorbed in?
Thiamine functions to form the coenzyme
thiamine pyrophosphate (TPP), which is
required for the essential decarboxylation
reactions catalyzed by the pyruvate and 2oxoglutarate complexes.
The two general reactions are:
1. Oxidative decarboxylation of 2-oxo acids
catalyzed by dehydrogenase complexes
2. Formation of 2-ketols (ketoses) as
catalyzed by transketolase
Thiamine is necessary for the metabolism of
carbohydrates, fats and alcohol.
Deficiency results to beriberi, involving the
nervous and cardiovascular systems.
Symptoms include mental confusion,
anorexia, muscular weakness, ataxia,
peripheral paralysis, opthalmoplegia, edema
(wet beriberi), muscle wasting (dry beriberi),
tachycardia and an enlarged heart.
Deficiency of thiamine is due to:
1. Inadequate intake caused by diets largely
dependent on milled, non-enriched grains
2. Ingestion of raw fish containing microbial
thiaminases
3. Chronic alcoholism
4. Those receiving total parenteral nutrition
(TPN) without adequate thiamine
supplementation
5. Elderly patients taking diuretics
6. Patients undergoing long-term renal
dialysis
Laboratory Assessment:
Measurement of transketolase
• Brin procedure
Direct measurement of circulating thiamine in
plasma, erythrocytes or whole blood using
High Performance Liquid Chromatography
(HPLC)
Is an essential component of flavin adenine
dinucleotide (FAD) and flavin
mononucleotide (FMN), coenzymes that are
involved in many redox reactions.
Dietary sources include liver, kidney, heart
and milk.
It is primarily absorbed in the proximal small
intestines in the presence of bile, tightly
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Chem PPT Flashcards, Unit 3
Does vitamin B2 trace in urine?
What are signs of riboflavin deficiency?
What are the 4 laboratory assessment for
riboflavin?
What are the 3 natural forms of vitamin B6?
What are the dietary sources of Vitamin B6?
What is the major coenzyme of vitamin B6?
What is the main catabolite excreted in urine
from vitamin B6?
What are the steps for laboratory assessment for
vitamin B6?
bound to immunoglobulins.
Because little storage of riboflavin occurs,
urinary excretion reflects dietary intake.
Deficiency of riboflavin is characterized by
sore throat, hyperemia, edema of the
pharyngeal and oral mucous membranes,
cheilosis, angular stomatitis, glossitis
(magenta tongue), seborrheic dermatitis and
normochromic, normocytic anemia.
Laboratory Assessment:
1. Determination of urine riboflavin excretion
2. A functional assay using the activation
coefficient of stimulation of the enzyme
glutathione reductase by FAD
3. Direct measurement of riboflavin or its
metabolites in plasma or erythrocytes
4. HPLC combined with fluorometric
detection is the method of choice
Three natural forms of vitamin B6:
- pyridoxine [pyridoxol] (PM)
- pyridoxamine (PM)
- pyridoxal (PL)
All three are converted to pyridoxal
phosphate, which is required for synthesis,
catabolism and inter-conversion of amino
acids
Dietary sources include meat, poultry and
fish, used certain seeds, bran, bananas and
fortified ready-to-eat cereals.
The major coenzyme (PLP pyridoxal-5’phosphate) used by the PLP dependent
enzymes that are involved in amino acid
metabolism.
The main catabolite excreted in urine is 4pyridoxic acid (4-PA)
Laboratory Assessments :
1.Measurement of PLP (pyridoxal-5’-phosphate) in
plasma or red cells
2. Measurement of its metabolite, 4-pyridoxic acid
(4-PA) in urine or plasma
3. Measurement of the activity and activation
coefficient of red cell aminotransferases (aspartate
and alanine)
4. Tryptophan load metabolite excretion tests
5. High Performance Liquid Chromatography
(HPLC) with fluorescence detection
18
Chem PPT Flashcards, Unit 3
What are some characteristics of vitamin B12?
A water-soluble hematopoetic vitamin that is
required for the maturation of erythrocytes.
- Cyanocobalamin is a stable compound that
forms dark red, needlelike crystals.
- It is the reference compound used to calibrate
serum cobalamin methods
- The predominant physiological form in
serum is methylcobalamin, whereas that in
cytosols is adenosylcobalamin.
Cyanocobalamin is gradually destroyed on exposure
to light
What are the dietary sources of Vitamin B12?
Dietary sources are meat and meat products,
dairy products, fish and shellfish and fortified
ready-to-eat cereals.
Where is vitamin B12 secreted?
It is continually secreted in the bile, but
most is reabsorb and available for
metabolic functions.
Where will excess vitamin B12 be excreted?
If circulating vitamin B12 concentrations
exceed the binding capacity of the blood, the
excess will be excreted in the urine.
Where is the greatest loss of vitamin B12
In most circumstances, the greatest looses of
occurring?
vitamin B12 occur through the feces.
What is vitamin B12 deficiency associated
Deficiency of vitamin B12 is associated with
with?
megaloblastic anemia and neuropathy.
The most common cause of vitamin B12
deficiency is pernicious anemia.
What are the hematological effects of vitamin
The hematological effects of vitamin B12
B12 deficiency?
deficiency are indistinguishable from those of
folate deficiency. The classic morphological
changes in the blood are hypersegmentation of
neutrophils, macrocytosis, anemia, leukopenia
and thrombocytopenia with megaloblastic
changes in bone morrow accompanying
peripheral blood changes.
What is the laboratory assessment of vitamin
Laboratory Assessment:
B12 ?
Indirect tests include:
1. Assays for urinary and serum
concentrations of methylmalonic acid
2. Assays for plasma homocysteine
3. The deoxyuridine suppression test
4. Vitamin B12 absorption tests
Direct tests include:
1. Microbiological Competitive Protein
Binding (CPB)
2. Immunoassay
19
Chem PPT Flashcards, Unit 3
What are the characteristics of Vitamin C?
What are Laboratory assessment for VITAMIN
C- ASCORBIC ACID?
What are good sources of biotin?
What characteristic Biotin has?
What is the principal biochemical function of
Biotin or Vitamin H?
In what disorders Biotin deficiency may be
seen?
What test organism is used in microbiological
assay for Vitamin H?
What is considered to be a better indicator of
biotin status?
What is the function of Folate and folic acid?
Folate and Folic acid are derived from ………..
and the principal form is ……………...
What are food source for Folic acid?
What causes deficiency of folate?
-
Serves as a reducing agent in several
important hydroxylation reactions in
the body
- One of the most effective watersoluble antioxidants in biological
fluids
- Dietary sources include citrus fruits,
berries, melons, tomatoes, green
peppers, broccoli,
- Brussels sprouts and leafy green
vegetables.
The gastrointestinal absorption is regulated by
a combination of sodium dependent active
transport at low concentrations, and simple
diffusion at high concentrations.
1. Direct measurement of plasma, urine, or
tissue concentrations of ascorbic acid or total
vitamin C.
2. Measurement using ascorbate oxidase
enzyme
3. High Performance Liquid Chromatography
(HPLC) methods
Liver, kidney, pancreas, eggs, yeast and milk.
Biotin in the diet is largely protein bound and
digested by gastrointestinal enzymes.
To serve as a cofactor for carboxylation
reactions.
TPN (total parenteral nutrition) without biotin
supplementation and in patients with a genetic
deficiency of biotinidase.
Lactobacillus plantarum
Urinary excretion of biotin and
3-hydroxyisovaleric acid
functions as coenzymes in the processing of
one carbon units
pteroic acid, 5-methyltetrahydrofolate
Liver, spinach, and other dark green leafy
vegetables, legumes such as kidney and Lima
beans and orange juice.
Absence of intestinal microorganisms, poor
intestinal absorption, insufficient dietary
intake (chronic alcoholism), and excessive
demands is in pregnancy, liver disease and
malignancies, administration of anti-folate
20
Chem PPT Flashcards, Unit 3
What is the major clinical manifestation of
folate deficiency?
What are laboratory assessment for folic acid?
What the term Niacin refer to?
What are sources of Niacin?
What is the main circulating form of Niacin in
the plasma after absorption or release from
hydrolyzed liver NAD?
In what form Excess niacin is excreted in liver?
Name the Vitamin that is essential for the
coenzymes NAD and NADP?
What is the function of Nicotinic acid, when
used as a pharmaceutical agent?
What disease is result of Niacin deficiency?
What is characterization of pellagra?
What are laboratory assessments for NIACIN
and NIACINAMIDE?
What Vitamin is a component of Coenzyme A?
What is the most common commercial synthetic
form of pantothenic acid?
What are the source of Pantothenic acid?
What is the function of Pantothenic acid?
What are Pantothenic Acids two major
metabolic roles?
drugs and anticonvulsant therapy leading to
increase folate requirements.
Megaloblastic anemia (characterized by large,
abnormally nucleated erythrocytes in the bone
morrow)
Measurement of folate concentration using C
room erythrocyte or whole blood the
specimen
CPB (Competitive Protein Binding) assays
1. Nicotinic acid (pyridine-3-carboxylic acid)
2. it's amide niacinamide (nicotinamide)
3. Derivatives that show the same biological
activity as nicotinamide
Yeast, lean meats, liver, poultry, milk, canned
salmon and several leafy green vegetables,
corn and wheat.
Nicotinamide
N-methylnicotinamide (NMN)
Niacin
It has important anti-atherogenic properties. It
effectively lowers triglycerides, raises HDL
cholesterol, and shifts LDL particles to a less
atherogenic phenotype.
Pellagra is the classic deficiency disease
associated with niacin and tryptophan
Chronic wasting disease presentation
associated with dermatitis, dementia and
diarrhea.
Urinary measurement of N'methylnicotinamide and N'-methyl-2pyridone-5-carboxamide using HPLC.
Pantothenic acid
Calcium salt
It is widely distributed in foods, mostly within
Co-A containing compounds like animal
sources, legumes, whole-grain cereals, egg
yolk, kidney, liver and yeast.
It is required for the metabolism of fat,
protein, and carbohydrate via the citric acid
cycle.
It is part of coenzyme A and is a prosthetic
group of the acyl-carrier protein, ACP.
21
Chem PPT Flashcards, Unit 3
What methods are used in determining the
whole blood or urine concentrations of
Pantothenic Acid?
What are trace elements?
What are referred to as trace and ultratrace
elements?
What type of specimens are tested for trace
elemeants?
What types of contamination should be
avoided?
Is it proper procedure to remove white cells and
platelets from blood before testing for trace
elements?
Which variables may affect trace element
determination?
Is knowledge of any acute phase reactions
required before testing for trace elements?
Is there a possibility of contamination wich
containers made of rubber, cork, or colored
plastics?
What type of tube should be used when testing
trace elements in blood plasma?
What type of tube should be used when testing
trace elements in blood serum?
What type of tube should be used when testing
ultratrace metals (Mn,Cr)?
How are containers cleaned?
What type of tube should be used when testing
trace elements in urine?
By microbiological assay, radio
immunoassay, gas chromatography, gas
chromatography mass spectrometry and a
stable isotope dilution assay.
Inorganic molecules found in human and
animal tissues in milligrams per kilogram
amounts or less.
Those present in body fluids (µg/dL) and in
tissues (mg/kg) are referred to as trace
elements, and those of found at ng/dLor µg/kg
as “ultratrace elements.”
Specimens commonly submitted include
whole blood, plasma, serum, or anybody fluid
or tissue.
Contamination from environmental pollution,
cosmetics, shampoos must always be avoided.
No, separation of white cells and platelets in
whole blood before trace element analysis is
subject to serious problems of contamination.
Variables that can affect trace element
determination include age, sex, ethnic origin,
time of sampling in relation to food intake,
time of day, history of medication and tobacco
usage.
Yes, knowledge of the extent of any acute
phase reaction is required.
Yes, avoid contamination with sample
containers made up of rubber, cork and
colored plastics.
For blood plasma, plastic tubes with lithium
heparin as an anticoagulant are suitable for
most analyses.
For blood serum, plain glass containers have
been used.
For the ultratrace metals (Mn, Cr), special
arrangements have to be made to collect blood
via plastic cannulae or siliconized steel
needles, and then the sample is placed into
acid washed containers.
It is a good practice to run dilute acid blanks
through all containers and collection systems
to ensure that all batches remain as free from
contamination as possible.
For 24 urine collection, polyethylene bottles
with glacial acetic acid should be used as a
22
Chem PPT Flashcards, Unit 3
What methodologies are used to test for trace
elements?
What are speciation methods?
What occurs naturally in various crystal
materials?
How is Chromium used of and disposed?
What are some good sources of chromium?
What does Chromium do after ingestion?
What physiological effect does Chromium
have?
What does a deficiency in Chromium lead to?
Does Hexavalent Chromium have any toxic
effects?
What type of specimen should be used when
testing directly for chromium?
What vitamin is cobalt an essential integral part
of?
What can hip prostheses and increased exposure
to cobalt lead to?
What are some dietary sources of copper?
preservative.
1. Spectrophotometry
2. Atomic Absorption Spectrophotometry
(AAS)
3. Inductively Coupled Plasma-Optical
Emission Spectrometry (ICP-OES)
4. Inductively Coupled Plasma Mass
Spectrometry (ICP-MS)
5. Accelerator Mass Spectrometry (AMS)
6. X-ray based techniques
Involve techniques to separate the chemical
complexes of individual elements present in
any particular medium. They are regarded as
crucial for an understanding of the absorption,
utilization, function of elements and problems
of excess and potential toxicity.
Chromium
It is a transitional element with many
industrial uses and is discharged into the
environment as industrial waste.
Good sources of chromium include processed
meats, whole-grain products, green beans,
broccoli and some spices
After absorption, chromium binds to plasma
transferrin with an affinity similar to that of
iron.
It functions to enhance the response of insulin
receptors and potentiates kinase activity to
normalize glucose and insulin levels.
Poor chromium nutritional status plays a role
in impaired glucose tolerance, diabetes and
cardiovascular disease.
Hexavalent chromium is a recognized
carcinogen, and industrial exposure to fumes
and dusts containing this metal is associated
with increased incidence of lung cancer,
dermatitis and skin ulcers.
Blood plasma or urine should be used.
Vitamin B12
High mean urinary cobalt concentrations
Organ meats, shellfish, nuts, whole grain
cereals, and cocoa containing products
23
Chem PPT Flashcards, Unit 3
How is absorbed copper transported to the
liver?
What happens to absorbed copper in the liver?
What is the function of copper?
What does DMO stand for?
What does DMO require as a cofactor for the
conversion of dopamine to norepinephrine?
What is tyrosinase?
What diseases is copper deficiency associated
with in infants?
How is laboratory assessment of copper toxicity
done?
What element is the most widely used of the
pharmacologically beneficial trace elements?
Where are fluoride ions absorbed?
How is excess fluoride excreted?
How does toxicity occur in children?
Bound to albumin in portal blood
It is incorporated by hepatocytes into
cuproenzymes and then exported in peripheral
blood mainly as ceruloplasmin to tissue and
organs.
It functions for energy production, connective
tissue formation, iron metabolism,
norepinephrine and serotonin metabolism,
synthesis of melanin, antioxidant functions,
and regulation of gene expression and
intercellular copper handling.
Dopamine mono-oxygenase
Copper
A copper containing enzyme that is present in
melanocytes and catalyzes the synthesis of
melanin.
Menkes disease, Wilson disease,
malabsorption syndromes, cardiovascular
disease, anemia, and neuropathy
By determination of plasma copper and
ceruloplasmin levels
Fluoride
The stomach and the small intestines
In the urine
By the mottling of enamel in the erupting
teeth of children, possibly caused by ingestion
of fluoride containing toothpaste.
What sort of exposure to fluoride has resulted in Occupational exposure to inhaled fluoride
sever bone abnormalities in adults?
dust among cryolite workers during aluminum
refining
How is fluoride level determined in drinking
Direct determination using fluoride specific
water and urine?
electrode is performed.
What is manganese bound to when present in
Protein in the 2+ or 3+ valence state
biological systems?
What functions does manganese serve in the
Formation of connective and bony tissue,
body?
growth and reproductive functions, and
carbohydrate and lipid metabolism.
What are some dietary sources of copper?
include whole-grain foods, nuts, leafy
vegetables, soy products and tea
What sort of enzyme activator does manganese Non-specific
act as?
What can deficiency in manganese result in?
Impaired growth and reproductive function,
skeletal abnormalities, impaired glucose
24
Chem PPT Flashcards, Unit 3
How is manganese assessed in the laboratory?
What do molybdenum enzymes facilitate?
What are some dietary sources of molybdenum?
What is the essential need for molybdenum
based on?
How is molybdenum level assessed in the
laboratory?
What element is a constituent of the enzyme
glutathione peroxidase?
What is glutathione peroxidase believed to be
closely associated with?
What do the most important biologically active
compounds contain?
What is selenocysteine
What are some dietary sources of selenium?
What is seleniums major route of excretion?
What does urinary output of selenium reflect?
What are some selenium dependent diseases
associated with selenium deficiency?
How is selenium measured?
What is the major selenium containing plasma
protein?
How is selenoprotein P determined?
How can long-term dietary selenium intake be
measured?
Next to iron, what is the most abundant trace
element in the body?
What is it usually bound to in zinc rich foods
like red meat and fish?
What is impaired in wound healing for people
with zinc deficiency?
What is the function of zinc in sperm?
Which factors help absorption of zinc in breast
milk?
What are the clinical effects of ingestion of a
zinc contaminated diet?
tolerance and impaired cholesterol synthesis.
By measurement of nonhemolyzed whole
blood manganese using plastic cannulae for
phlebotomy.
Important carbon, nitrogen, and sulfur cycles.
Peas, lentils and beans, grains and nuts.
Its incorporation into metalloenzymes
By measuring urate or sulfite in the urine as a
means of confirming molybdenum cofactor
disorders or possible molybdenum deficiency.
glutathione peroxidase
Vitamin E and its function
Selenocysteine
Amino acid in which selenium is substituted
for sulfur in cysteine.
Wheat and other cereal products
Urinary output
Recent dietary intake of selenium
Keshan disease, and Kashin-Beck disease, and
also associated with thyroid function, immune
function, reproductive disorders, mood
disorders, inflammatory conditions, cancer
chemoprevention and viral virulence.
Carbon furnace atomic absorption
spectroscopy (CFAAS) is widely used to
measure plasma and/or serum selenium.
selenoprotein P
By immunological methods
Hair and nail selenium analysis
Zinc
Proteins
Wound Healing
Maintain vitality and sperm motility
Picolinate and citrate
Abdominal pain, diarrhea, nausea, vomiting.
25
Chem PPT Flashcards, Unit 3
Why are plasma zinc determination preferred
over zinc serum samples?
What are good sources of boron?
How is boron absorbed and secreted?
What is inductively coupled plasma- atomic
emission spectrophotometry (ICP-AES) and an
ICP time-of-flight mass spectrometer (TOFMS) developed for?
What is silicon primarily used for in the body?
How is the laboratory assessment for silicon
done?
How is vanadium found in neutral solutions?
How is vanadium helpful in treating diabetes?
How is plasma and urine concentrations are
usually measured?
What is hemoglobin and what is it responsible
for?
Because of possible zinc contamination from
erythrocytes platelets and leukocytes during
clotting and centrifugation.
Fruits, leafy vegetables, nuts and legumes.
It is sufficiently absorbed as boric acid and is
efficiently excreted in the urine.
Investigation of boron neutron capture in
cancer therapy.
Structural Identity.
By determination of healthy fasting plasma
concentration of silicon.
Metavanadate (V3)
By reducing the requirement for insulin by
activating the cellular response without the
presence of insulin.
GF-AAS or ICP-AES
Hemoglobin is the oxygen-carrying pigment
of the erythrocytes. It is for transportation of
O2 from lungs to the body tissues, as well as
CO2 from peripheral tissues to the lungs.
Where is hemoglobin formed?
Hemoglobin is formed by the developing
erythrocyte in the bone marrow.
What composes hemoglobin?
composed of two types of globins organized
into four subunits
How does the heme bind with the globin portion The heme chelates with the globin portion.
of hemoglobin?
How is hemoglobin classified?
Hemoglobins are classified into different
types, depending on the combination of the
two sets of globin units
What are the most common types of globin
α-globins and β-globins
units in adult humans?
What is a prosthetic group?
A prosthetic group is any tightly-bound non-protein
entity,that is essential for the structural and functional
integrity of the protein.
What is the prosthetic group of hemoglobin?
The heme group.
What composes the heme group?
Porphyrin ring, which is formed by the
combination of four heterocyclic rings called
pyrroles with an Fe2+ ion in the center of the
ring bound to the nitrogen of the pyrroles.
What is the function of the function of the iron
It is this central iron which provides the
ion in hemoglobin?
reversible binding to oxygen and carbon
dioxide molecules
26
Chem PPT Flashcards, Unit 3
What is Hemoglobin?
What is oxyhemoglobin or
carbaminohemoglobin?
What is deoxyhemoglobin?
What is oxyhemoglobin?
What is carboxyhemoglobin?
What is methemoglobin?
What is the cause of methemoglobinemia?
What is Sulfhemoglobin?
What is the adduct Hbs?
Where do you see carbamylated Hb?
How is glycated, glycosylated Hb if form?
What is fetal Hb (HbF)
•
Is the oxygen-carrying pigment of the
erythrocytes that is formed by the
developing erythrocyte in the bone
marrow.
• It is mainly responsible for the
transportation of oxygen from lungs to
the body tissues, as well as carbon
dioxide from peripheral tissues to the
lungs.
Each hemoglobin molecule is composed of
two types of globins organized into four
subunits
The heme is bound to an oxygen molecule or
carbon dioxide molecule.
When the heme groups of hemoglobin
molecule are not bound by any molecule.
Is the bright red color of blood?
When hemoglobin binds with carbon
monoxide, compromising the oxygen-carrying
ability of Hb.
Is the formed as a result of a change in
oxidation state of the iron atom in heme from
the normal ferrous state (2+) to ferric (3+)
state, resulting in decreased oxygen-carrying
ability.
Is caused by the presence of nitrate in well
water.
Is commonly resulting from exposure to
certain drugs, is formed when one or more
oxygen atoms in the porphyrin rings of heme
is replace by sulfur. Removal of the source of
the chemical leads to restoration of normal
Hb.
Are formed by the attachment of molecule to
the globin chins most commonly at the Nterminal amino acid, but may also occur
anywhere along the globin chain.
In patients with end-stage renal disease, is
formed by the attachment of urea.
Is form by the attachment of glucose to the Nterminus of the Beta globin chain, It (HbA1c)
is clinically important in diagnosis and
monitoring of glycemic control in patients
with diabetes mellitus
Is the main oxygen transport protein in the
human fetus during the last seven months of
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Chem PPT Flashcards, Unit 3
What is the Function of HbF?
What are the disease or disorders that related to
Hemoglobin?
What is Thalassemia’s?
What is hemoglobinopathies?
What are the etiology of Thalassemias?
What are the etiology of Thalassemias?
What are the classifications of B-Thalassemia?
What is the Hereditary Persistence of Fetal
Hemoglobin (HPFH)
What is Hemoglobinopathy?
What is Hemoglobinopaties?
development in the uterus and persists in the
newborn until roughly 6 months old.
Fetal hemoglobin differs most from adult
hemoglobin in that it is able to bind oxygen
with greater affinity than the adult form,
giving the developing fetus better access to
oxygen from the mother's bloodstream.
1.
Thalassemia’s and Hemoglobinopathies
Insufficient globin chain production.
Are structural hemoglobin variants arising
from mutations in the globin genes and
resulting in disruptions in the normal amino
acid sequence in one or more of the globin
chains of hemoglobin.
Are identified according to the globin chains
in which there is a production deficiency:
α-thalassemia arise from defective α-globin
chain production
β-thalassemia arise from defective β-globin
chain production
δβ-thalassemia arise from deficiencies in
production of both δ- and β-globin chains.
Are also classified by the extent of reduction in
globin chain production and resultant anemia:
Single gene deletion = Silent α-thalassemia ( αα/α-)
Two gene deletion = α-thalassemia trait or αthalassemia minor (αα/- or α-/α-)
Three gene deletion resulting in HbH disease
Four gene deletion commonly called Hb
Bart’s hydrops fetalis
β°-Thalassemia (β-Thalassemia Major)
Sometimes called Cooley’s anemia
+
Β -Thalassemia (β-Thalassemia Intermediate)
β-Thalassemia (β-Thalassemia Minor)
Sometimes called β-thalassemia trait
Used to describe a group of genetic conditions
in which the concentration of HbF is
increased above the reference interval with
reduction β-globin synthesis and a
compensatory increase in γ-globin synthesis.
Is a kind of genetic defect that results in
abnormal structure of one of the globin chains
of the hemoglobin molecule.
Are inherited single-gene disorders; in most
28
Chem PPT Flashcards, Unit 3
What is the Cyanmethemoglobin?
What is the Analytical Methodology for Hb
Determination of Cyanmethemoglobin?
What method is used for hemoglobin
determination?
What is the completed blood count method?
What is FBC?
What is FBE?
What is the other method of hemoglobin
determination?
What type of statins are used in hemoglobin
determination?
How does the hemoglobin behave on agarose
gel?
What is the advantage of using HPLC in
hemoglobin determination?
What is the advantage of HPLC over
electrophoresis on hemoglobin?
cases, they are inherited as autosomal codominant traits. Common
hemoglobinopathies include sickle-cell
disease.
The oxidation of the Fe2+ of hemoglobin to
the Fe3+ of methemoglobin by ferrycyanide,
with methemoglobin then converted into
stable cyanmethemoglobin by the addition of
potassium cyanide (KCN).
Absorbance is measured at 540 nm and is
used to calculate the concentration of
hemoglobin.
Based upon the oxidation of the Fe2+ of
hemoglobin to the Fe3+ of methemoglobin by
ferrycyanide, with methemoglobin then
converted into stable cyanmethemoglobin by
the addition of potassium cyanide (KCN).
Completed Blood Count
It is a test that evaluates the cells that circulate
in blood; also known as full blood count
(FBC), full blood exam (FBE), or blood panel.
It consists of counts of cells such as RBCs
(erythrocytes), WBCs (leukocytes), and
platelets
A measure of hemoglobin; Estimates of the
volume of red cells; and an estimation of
white blood cells subtype (differential
counting for neutrophils, lymphocytes,
basophils, eosinophils, and monocytes).
Electrophoresis; Using agarose gel and a pH
9.2 barbital buffer
Stains would include Ponceau S (reddish
staining), or preferably Amido black (dark
blue to black staining)
Cannot accurately quantify HbA2, and comigration of many hemoglobin variants is
observed
HPLC (High Performance Liquid
Chromatography); Uses a column packed with
cation exchange resin to quantify HbA2 and
HbF
Advantages over electrophoresis:
superior resolution of hemoglobin variants
rapid assay time
accurate quantification of hemoglobin
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Chem PPT Flashcards, Unit 3
How does the Capillary Electrophoresis being
used in hemoglobin determination essay?
What is the use of Electrospray Mass
Spectrometry in hemoglobin variation?
What is the used of DNA analysis for
hemoglobin:
What is the HbS Solubility Test?
When does the hemoglobin S produce visible
turbidity?
List the substances used for determination of
hemoglobin S in the sample?
How is HbS indicated in the sample?
What are the False-positive test results of HbS
Solubility?
How are the False-negative results of HbS
obtained on samples?
What is the HbH test?
fractions, including HbA2 and HbF
Separation in an alkaline buffer using high
voltages is based on (1) charge differences,
(2) electrolyte pH, and (3) electro-osmotic
flow.
Has become the method of choice for the
characterization of hemoglobin variants and
hemoglobin adducts since it immediately
establishes:
(1) whether the variant is an α or β-chain
variant;
(2) the location and identity of the amino acid
residue substitution;
(3) the quantity of variants present.
Diagnose and characterize α-thalassemia
Investigate potentially life-threatening
disorders of hemoglobin synthesis in the fetus
Characterize the β-thalassemia genotype
Distinguish between conditions that have
similar clinical and laboratory presentations
but are due to different genetic conditions
Tests for specific hemoglobin variants; The
most common type of abnormal hemoglobin
and the basis of sickle cell trait and sickle cell
anemia
HbS when oxygenated, is insoluble in
concentrated phosphate buffer and produces
visible turbidity, unlike the other hemoglobins
(A, F, C, E and D)
1) Using a reducing substance, sodium
hydrosulfite (Na2S2O4, sodium
dithionate);
2) Used to deoxygenate the hemoglobin
and saponin to lyse the RBCs;
HbS is indicated by increased turbidity in the
sample.
False-positive results are found in samples
with Heinz bodies;
• High concentrations of monoclonal
protein or cold agglutinins.
False-negative results are obtained on anemic
patients or on samples with hematocrit less
than 15%.
Tests for specific hemoglobin variants;
It is a beta 4 (β4) insoluble tetramer moderate
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Chem PPT Flashcards, Unit 3
What are the charactistic of variant
hemoglobins on HbH test?
How to detect unstable hemoglobins?
What is Iron?
What is the importance of Iron in oxygen
transport?
Where is iron distributed into?
What is/are stored iron form(s)?
What is/are transport iron form?
3+
What is apotransferin/Fe comple called?
What is the regulator of iron absorption?
What are common conditions decrease serum
iron concentration?
What other conditions decrease serum iron
to severe form of α-thalassemia characterized
by pronounced microcytic hypochromic
hemolytic anemia.
It punctuate inclusions, usually described as looking
like "golf balls", are found in the RBCs of a
peripheral blood smear that has been stained with
new methylene blue or brilliant cresyl blue at 37°C.
an increase in turbidity or complete
precipitation in the blood sample was treated
with heat at 55°C to 60°C or with isopropanol
is used to detect the presence of unstable
hemoglobins which precipitate in 3 to 4
minutes under this conditions.
metal at the active site of many important
redox enzymes dealing with cellular
respiration and oxidation and reduction in
plants and animal
forms complexes with molecular oxygen in
hemoglobin and myoglobin; these two
compounds are common oxygen transport
proteins in vertebrates
- Hemoglobin
- storage iron (ferritin and hemosiderin)
- myoglobin
- A labie iron pool
- other tissue iron
- transport iron (transferrin and
apotransferrin)
- ferritin
- hemosiderin.
apotransferin.
Transferrin
Hepcidin , A peptide hormone produced by
the liver, is the central regulator of iron
absorption
Children dietary deficiency because milk has
low iron content and iron requirements for
growth and development are high.
adults, iron deficiency is almost always the
result of chronic blood loss or childbearing.
patients with iron deficiency anemia and with
chronic inflammatory disorders, such as (1)
acute infection, (2) immunization, and (3)
myocardial infarction.
- blood donation
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Chem PPT Flashcards, Unit 3
concentration?
Measurement of iron deficiency includes
What is IRON OVERLOAD?
What is the best term used to describe iron
overload at tissue level?
In what condition, serum iron levels will be
elevated?
What are the analytical methods for iron
determination?
What are the Methods for the determination of
the serum Ferritin?
What’s conditions known to affect serum iron
concentration, TIBC and transferrin ssturarion
%?
What is Bilirubin?
Where is Bilirubin extracted and metabolized?
Where is Bilirubin excreted?
What is Bilirubin the end product of?
hemorrhage
menstruation.
Serum iron determination
Iron binding capacity
Serum ferritin
Stainable iron in the bone marrow
Erythrocyte protoporphyrin
Circulating transferrin receptor and
reticulocyte hemoglobin
- DNA analyses
Hemochromatosis and types of anemia
associated with ineffective erythropoiesis.
- Hemosiderosis
- siderosis
- patients with aplastic anemia
- children with acute iron poisoning
- after oral or parenteral iron use
- acute liver injury
- The use of hormonal contraceptive
- Colorimetric method
- Transferrin Saturation %
- TIBC = UIBC + serum iron
- Serum transferrin (g/L) = 0.007 x
TIBC (ug/dL)
- Immunoradiometric assay
- Enzyme-linked Immunosorbent assay
(ELISA)
- Immunochemiluminescence assays
- Immunofluorometric methods
- Diurnal variation
- Menstrual cycle
- Pregnancy
- Ingestion of iron
- Oral contraceptives
- Iron dextran injections
- Hepatitis
- Acute inflammation
- Iron deficiency
- Iron overload
Bilirubin is the orange yellow pigment
derived mainly from aging red blood cells that
are destroyed in the reticuloendothelial cells
of the liver, spleen and bone morrow.
In the liver.
In bile and in the urine.
Hemoglobin metabolism.
-
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Chem PPT Flashcards, Unit 3
Bilirubin
Metabolism
Continuation of Bilirubin
Metabolism
Bilirubin (B1)
Attaches to
albumin
Liver
UDP-glucoronyl transferase
(uridine diphosphate)
Continuation of Bilirubin
Metabolism
Bilirubin monoglucoronide
Bilirubin monoglucoronide
UDP-glucoronyl transferase
(uridine diphosphate)
Bilirubin diglucoronide (B2)
Bile
Intestines
Continuation of Bilirubin
Metabolism
Intestines (normal flora)
Urobilinogen
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Chem PPT Flashcards, Unit 3
Oxidation
Unchanged
Stercobilinogen
Urobilins
(stool)
Stercobilin
(stool)
Continuation of Bilirubin
Metabolism
Reabsorb by the
enterohepatic circulation
(Enterohepatic cycle)
Urobilin
(urine)
What are other names of Bilirubin 1?
What are other names of Bilirubin 2?
What are some clinical significance of
Bilirubin?
How does someone with Jaundice or
hyperbilirubinemia looks like?
What is another name for this?
1) Unconjugated bilirubin
2) Water insoluble / Non-polar bilirubin
3) Indirect reacting bilirubin
4) Hemobilirubin
5) Free bilirubin / Unbound bilirubin
6) Prehepatic bilirubin
!) Conjugated bilirubin
2) Water soluble / Polar bilirubin
3) Direct reacting bilirubin
4) Cholebilirubin / cholestatic bilirubin
5) One-minute bilirubin / Prompt bilirubin
6) Post hepatic bilirubin
7) Obstructive bilirubin
8) Regurgitative bilirubin
Jaundice or hyperbilirubinemia
They have yellow discoloration or
pigmentation of the skin, sclera and mucous
membranes.
Also called Icterus
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Chem PPT Flashcards, Unit 3
When does hyperbilirubinemi~a becomes
clinically evident?
What are some classifications of Jaundice?
When serum bilirubin levels exceed 2.5
mg/dL (normal 0.3-1.0 mg/dL)
1) Increased serum unconjugated bilirubin.
2) Result of excessive bilirubin presented to
the liver.
The classifications of Jaundice are also seen in? 1) HDN (hemolytic disease of the newborn)
2) Malaria
3) Extensive hematoma
4) Hemolytic transfusion reaction
Post- Hepatic jaundice increased ____ bilirubin High levers of unconjugated
Kernicterus refers to ?
The yellow staining caused by bilirubin
Kernicterus is commoly seen in ?
Newborns
If levels of bilirubin are very high the substance Brain tissue
will move out of the blood and collect in
What are some of the symtoms of kernicterus?
Yellow of the eyes
Excess bilirubin in the blood
Treatment of kernicterus ?
Light therapy
Exchange transfusions
Jaundice types?
Pre-hepatic (hemolytic)
Hepatic (hepatocellular)
Post-hepatic (obstructive)
Hemolytic anemia can cause ____ Jaundice
Pre-hepatic
True or false failure of bile to flow to the
True
intestines due to an obstruction in the biliary
tree
Where has post hepatic seen in ?
Choledocholelithiasis
Biliary atresia
Parasitism
Caused of hepatic jaundice ?
By increase of both unconjugated and
conjugated bilirubin levels
Clinical examples of intrahepatic jaundice cause Gilberts syndrome, dubin –johnson and rotor
by genetic errors in bilirubin metabolism
syndronme
Prehepatic jaundice caused by hemolysis
Autoimmune abnormal Hb
Intrahepatic jaundice caused by infection?
Hep A,B,C
Clinical examof intrahepatic jaundice seen in
Physiologic
neonates
What is lucey driscoll syndrome ?
Familial form of unconjugated
hyperbilirubinemia caused by circulating
inhibitor of bilirubin conjugation
How long does hyperbilirubinemia lasts?
2 to 3 week’s of life
Difference between type 1 and type 11 criger
Type 11 is less severe with a response to
najjar syndrome ?
phenobarbital p450 inducer
What are the two inherited disorders in which
Dubin Johnson syndrome, rotor syndrome
bilirubin is conjugated ?
What is the origin of Physiologic Neonatal
Hepatic
Jaundice?
35
Chem PPT Flashcards, Unit 3
Deficiency of which enzyme leads to
Physiologic Neonatal Jaundice (Physiological
Jaundice of the Newborn)?
What are the factors contributing to
physiological jaundice?
How is the physiological jaundice of the
newborn is treated?
How bilirubin is measured in body fluids?
Which substance acts as coupling accelerator in
Evelyn and Malloy?
Which substance acts as coupling accelerator in
Doumas and colleagues?
Van den Bergh and Muller method.
Total Bilirubin method.
Direct Bilirubin method.
What s ditaurobilirubin?
Application of High-Performance Liquid
Chromatography (HPLC)
Enzymatic methods for bilirubin determination.
uridine diphosphate glucuronyl transferase
(not fully developed)
- Increased bilirubin load in the newborn
-Decrease conjugation of bilirubin resulting
from relative lack of UDPGT enzyme
-Exposure of breast-feeding infants to
pregnanediol, nonesterified fatty acids, and
other inhibitors of bilirubin conjugation
It is treated with phototherapy; the infant is
exposed to light of approximately 450nm that
disrupts intramolecular hydrogen bonds in the
bilirubin molecule and yields photoisomers
that are water-soluble and thus are excreted in
the bile.
1. Spectrophotometric (Diazo - Chemical,
Direc Spectrophotometric, Enzymatic, and
Transcutaneous) methods
2. Chromatographic methods
Methanol
Sodium Benzoate
Involves the coupling of bilirubin with
diazotized sulfanilic acid (Ehrlich diazo
reagent)
Serum is added to an aqueous solution of
caffeine and sodium benzoate, and after 10
minute incubation at room temperature
alkaline tartrate is added.
Bilirubin monoconjugates and di-conjugates
(mainly glucuronides) and δ- bilirubin,
because they are water-soluble, react with the
diazo reagents in the absence of accelerator.
It is a water-soluble synthetic material, is used
by instrument manufacturers for calibrating
direct bilirubin methods; it is also present in
materials used for quality control and for
proficiency testing.
It is used for rapid separation and
quantification of 4 main bilirubin fractions:
(1) α-unconjugated bilirubin; (2) β-bilirubin
monoglucuronide; (3) γ-bilirubin
diglucuronide; and (4) δ-bilirubin
At the pH near 8 and in the presence of
sodium cholate and sodium dodecylsulfate, on
36
Chem PPT Flashcards, Unit 3
Which form of bilirubin is excreted in urine
and its presence indicates conjugated
hyperbilirubinemia.?
What is Porphyrins?
What is the parent porphyrin?
What are the functions of porphyrins?
What does ALA stands for?
What does PBGstands for?
Which are the precursors of porphyrin?
Solubility of porphyrin precursors.
Which is the major component of hemoglobin?
Which tissue organ made Heme?
What is the main function of Heme?
Which are the enzymes used for the Heme
biosynthesis?
What are functions of Heme?
four bilirubin fractions are oxidized to purple
and finally colorless products.
The decrease in absorbance at 425 or 460nm
is proportional to the concentration of total
bilirubin
Conjugated Bilrubin (B2)
Porphyrins are a group of heterocyclic
macrocycle organic compounds, composed of
four modified pyrrole subunits interconnected
at their α-carbon atoms via methene bridges.
The parent porphyrin is porphin
Porphyrins are essential for the function of
hemoglobin — a protein in red blood cells
that links to porphyrin, binds iron, and carries
oxygen to different organs and tissue.
Aminolevulinic acid
Porphobilinogen
Aminolevulinic acid (ALA) and
Porphobilinogen (PBG)
porphyrin precursors that are highly water
soluble.
Heme is a major component of hemoglobin,
Heme is made mainly in the bone marrow and
liver through the production of porphyrin and
linkage with iron.
The protein in red blood cells that carries
oxygen from the lungs to all parts of your
body.
5-Aminolevulinate Synthase, ALAS
5-Aminolevulinic Acid Dehydratase, ALAD
Hydroxymethylbilane Synthase, HMBS
Uroporphyrinogen-III Synthase, UROS
Uroporphyrinogen Decarboxylase, UROD
Coproporphyrinogen Oxidase, CPOX
Protoporphyrinogen Oxidase, PPOX
Ferrochelatase, FECH
Heme containing proteins participate in a
variety of redox reactions:
-Oxygen transport (by hemoglobin in the
blood) and storage (by myoglobin in muscle)
-Mitochondrial respiration
-Enzymatic destruction of peroxides (by
catalase and peroxidase)
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Chem PPT Flashcards, Unit 3
Which are the Precursors Excretion of Heme in
urine?
Which are the Precursors Excretion of Heme in
feces?
What is the Porphyria?
Which organs are affected by the Porphyria?
Types of porphyria.
Types of Acute pophyrias.
Which are the factors cause acute porphyrias?
Which are the drugs cause acute porphyrias?
Which are the Possible signs and symptoms of
acute porphyria?
The following symptoms of High blood
pressure, Anxiety or restlessness, Seizures,
Mental changes, such as confusion,
hallucinations, disorientation or paranoia,
-Drug metabolism
-Desaturation of fatty acids
-Tryptophan metabolism (by tryptophan
oxygenase
Aminolevulinic acid (ALA), porphobilinogen
(PBG), uroporphyrinogen, and
coproporphyrinogen III are excreted in urine
Protoporphyrin, protoporphyrinogen and
coproporphyrinogen-I are excreted in feces
Porphyria refers to a group of disorders that
result from a buildup of natural chemicals that
produce porphyrin in the body.
Porphyria mainly affects your nervous system,
skin and other organs. The signs and
symptoms of porphyria can vary, depending
on the specific type and severity.
-porphyria — acute, which mainly affects the
nervous system,
- nonacute or cutaneous, which mainly
affects the skin.
Acute porphyrias include forms of the
disease that typically cause nervous system
symptoms, which appear quickly and can be
life-threatening.
Acute intermittent porphyria (AIP)
Variegate porphyria (VP)
Hereditary coproporphyria (HCP)
The most important precipitating factors are
(1) drugs, (2) alcohol, especially binge
drinking, (3) the menstrual cycle, (4) calorie
restriction, (5) infection, and (6) stress.
Drugs known to provoke acute attacks include
(1) barbiturates, (2) sulfonamides, (3)
progestogens, and (4) many anticonvulsants.
-Severe abdominal pain
-Swelling of the abdomen (abdominal
distention)
-Pain in your chest, legs or back
-Constipation or diarrhea
-Vomiting
-Insomnia
-Heartbeat (palpitations)
ACUTE PORPHYRIA
38
Chem PPT Flashcards, Unit 3
Breathing problems, Muscle pain, tingling,
numbness, weakness or paralysis, Red or brown
urine are associated with what?
What type of porphyria(s) include forms of the
disease that cause skin symptoms as a result of
oversensitivity to sunlight, but does don't
usually affect the nervous system?
What type of porphyria have attacks that last for
several days, with some forms, signs and
symptoms that may start during infancy or
childhood?
What are the two categories of nonacute or
cutaneous porphyrias?
Name 1 type of symptom of CUTANEOUS
PORPHYRIAS As a result of sun exposure.
Exposure to various toxins such as lead can
cause what effects?
The definitive test is used for lead toxicity and
measures what?
Secondary coproporphyrinuria is also caused by
what?
What is Hereditary tyrosinemia type I?
What is going on physiological during Renal
disorders?
Hepatobiliary disorders cause what?
Cutaneous or nonacute porphyrias
CUTANEOUS PORPHYRIAS
1) Bullous skin lesions:
Porphyria Cutanea Tarda (PCT)
Congenital Erythropoietic Porphyria (CEP)
2) Acute photosensitivity:
Erythropoietic protoporphyria (EPP)
X-linked dominant protoporphyria (XLDPP)

Sensitivity to the sun and sometimes
artificial light, causing burning pain
 Sudden painful skin redness
(erythema) and swelling (edema);
blisters that take weeks to heal
 Itching, fragile skin
 Scars or skin color changes from
healing blisters
 Increased hair growth
 Red or brown urine
Increases the urinary ALA and
coproporphyrin-III excretion and cause
accumulation of zinc protoporphyrin (ZPP) in
erythrocytes.
Measurement of blood lead and ZPP
measurements
Toxic effects of alcohol, arsenic, other heavy
metals and various drugs.
Succinylacetone, which accumulates in this
disease, has a structural resemblance to ALA
and therefore a competitive inhibitor of
ALAD.
Patients suffer neurological crisis very similar
to attacks of acute porphyria.
Impaired glomerular function reduces the
clearance of water-soluble porphyrins
normal excreted in the urine
Urinary excretion of coproporphyrin-I is
39
Chem PPT Flashcards, Unit 3
Give an example a Hematological disorders
Dietary, bacterial, and gastrointestinal bleeding
factors cause what?
What is Pseudoporphyria?
There are 8 different Laboratory Diagnosis for
Porphyria, name 1.
All samples for porphyrin assay must be
protected from what?
Urinary concentrations decrease by up to
percentage if exposed to light for 24 hours
Porphyrins and PBG are best analyzed in fresh,
early-morning (10 to 20 mL) specimens
collected without preservative. They are stable
in urine in the dark at 4°C for up to how many
hours and for at least a month at -20°C.
Specimens for ALA should be properly
refrigerated. Urine specimens can be stored at
4°C in the dark for at least ? weeks without
significant loss of ALA, and frozen specimens
are stable for weeks.
PBG is more stable around pH ?, ALA is more
stable around pH ? , although more acidic
environments greatly reduced ALA stability.
increased in Dubin-Johnson syndrome, Rotor
syndrome and in Gilbert's disease.
1)In iron deficiency anemia, zinc acts as an
alternative substrate for ferrochelatase
(FECH, also known as heme synthase),
leading to increased ZPP.
2)Increased red cell protoporphyrin (mostly
ZPP) may also occur in sideroblastic,
megaloblastic and hemolytic anemia
Porphyrins may also come directly from the
diet
additional protoporphyrin and other
dicarboxylic porphyrins may be formed by the
action of gut flora on heme-containing
proteins derived from the diet or by
gastrointestinal hemorrhage.
Patients with PCT likely skin lesions with no
accumulation of porphyrin's demonstrated
1.Urinary porphobilinogen (PBG)
determination
2.Fecal and Urine Porphyrin determination
3.High Performance Liquid Chromatography
(HPLC)
4.Fluorescence Emission Spectroscopy
5.Erythrocyte/Whole blood Porphyrin
measurement
6.Analysis of Plasma Porphyrins
7.Enzyme measurements
8.DNA analysis
light
50%
48 hours
2 weeks
PBG pH of 8 to 9
ALA pH of 3 to 4
40
Chem PPT Flashcards, Unit 3
How many grams wet weight of feces is
adequate for porphyrin measurements stable for
many months at what temperature?
EDTA whole blood shows no loss of
protoporphyrin for how many days at room
temperature? and for at least eight weeks at 4°C
in the dark
EDTA whole blood shows no loss of
protoporphyrin for how many weeks being
refrigerated in the dark?
All samples received from patients with
suspected bullous porphyria are treated as what
and why?
What are 4 methods that are used for searching
for metabolites of Porphobilinogen (PBG)?
What color does Watson-Schwartz and Hoesch
methods stain Porphobilinogen?
How is 5-Aminolevulinic acid (ALA) usually
converted into an Ehrlich-reacting pyrrole?
What is this method known as?
What does the spectrophotometric scanning of
acidified of porphyrins in urine or fecal extracts
for the presence of?
Name 3 other methods that are used to look for
porphyrin in Urine and Feces.
5 to 10 and -20°C
8 days
8 weeks
"High risk" because the frequency of infection
with hepatotrophic viruses, particularly HCV,
is increased in PCT
 Watson-Schwartz and Hoesch methods
 High performance liquid chromatography
(HPLC)
 Ion Exchange Chromatography
Tandem Mass Spectrometry
• Rose-red or Magenta
By condensation with a reagent such as
• acetylacetone, after separation from PBG.
Mauzerall and Granick method
Soret band



Fluorometric methods
Paper and Thin Layer Chromatography
Reversed-phase High Performance Liquid
Chromatography (HPLC)
What is the current method of choice for
a. Reversed-phase High Performance Liquid
looking for porphyrin in Urine and Feces?
Chromatography (HPLC)
What are the 3 methods used to look for blood
 Piomelli method
 Blake et al method
porphyrins?
 Spectrofluorometric method
What are the 2 methods used to look for plasma Fluorescence Emission Spectroscopy
porphyrins?
HPLC
Enzyme measurements are?
Rarely required, but useful for family studies
and for identification of subtypes.
DNA analysis is?
Identification of mutation from family
member with definite diagnosis.
DNA analysis is used to?
Screen of relatives for mutation
What is Therapeutic Drug
A process used to measure blood drug levels
Monitoring/Management (TDM)?
so that the most effective dosage is
maintained and toxicity prevented.
Therapeutic Drug Monitoring/Management
Drug dosages
41
Chem PPT Flashcards, Unit 3
(TDM) is a multidisciplinary science of
individualization of what?
What does Therapeutic Drug
Monitoring/Management (TDM) do to
synthesize clinical information and laboratory
testing results?
Therapeutic drug monitoring allows assessment
of what?
What does therapeutic drug monitoring
indicate?
What is pharmacogenomics?
What is pharmacodynamics (PD)?
What is another statement used for
pharmacodynamics?
The pharmacologically active substance
produces an effect on a living organism or in a
biochemical system is known as?
What is the site of action?
Most drugs exert their effects by binding to a
protein target such as?
Many drugs have increasing effects with ____
dose.
Explain some of a therapeutic drug’s
mechanism of action
What is a Drug biologic half-life or terminal
half-life?
To facilitate selection of the optimal drug and
dose for each patient
 Therapeutic compliance and efficacy
 Detection of drug interactions
 Drug-induced toxicity
How much of the drug has been absorbed, distributed,
metabolized, and eliminated.
The study of the inherited variations in genes that
dictate drug response and the way these can be used
to predict individual responses to a drug, using a
genome-wide approach.
The study of the physiological response to drugs
which encompasses the interaction of drugs with
target sites, and the biochemical and physiological
consequences that lead to therapeutic or adverse
effect
“What the drug does to the body?”
Mechanism of action
The location (organ or specific cell type) of
the target molecules upon which a drug acts
Enzyme or a transporter
Increasing
Therapeutic drugs mechanism of action
include:
Therapeutic Range:
•Represents the relationship between
minimum effective concentration (MEC) and
minimum toxic concentration (MTC).
Trough concentration:
•The lowest concentration achieved just
before the next dose
Peak concentration:
•The highest concentration achieved within
the dosing cycle.
The time it takes for a drug to lose half of its
pharmacologic, physiologic, or radiologic
42
Chem PPT Flashcards, Unit 3
What is xenobiotics?
Define Pharmacokinetics (PK)
What is ADME ?
How can pharmacokinetic absorption be
describe?
What is the most direct route of administering a
drug?
What is a drug’s bioavailability?
How does a drug distribution work?
What does distribution of a drug depends on?
What are some of the plasma protein drugs bind
to?
Which protein do acidic or basic drugs bind to?
activity.
This means that it takes 4 to 5 times the halflife for a drug's serum concentration to reach
steady state after regular dosing is started,
stopped, or the dose changed.
A chemical compound that is foreign to a
living organism
Pharmacokinetics (PK) is Øthe mathematical
description of the physiological disposition of
xenobiotics or endogenous chemicals,
“what the body does to a drug”
The processes of Absorption, Distribution,
Metabolism, and Elimination included in the
activity or fate of drugs in the body over a
period of time. These processes are affected
by factors specific to the individual receiving
the drug including disease state, comedication, age and sex.
Oral dosing requires the drug to pass from the
GIT into the vascular system through a
process known as absorption.
To be absorbed, the drug has to be dissociated
(called liberation) then must cross through
cell membranes by passive diffusion.
Intravenous (IV) delivery
Bioavailability is the amount of drug absorbed
relative to the quantity given.
Bioavailability is affected by first-pass
metabolism (intestines and liver) which will
reduce the quantity of drug to reach the
systemic circulation.
Drugs undergo distribution once in the
bloodstream, and spreads throughout the
systemic circulation and into various tissues.
The distribution of a drug to a particular site
depends on (1) molecular size, (2) degree of
ionization, (3) lipid solubility, (4) extent of
protein binding and (5) body composition.
Drugs that distribute extensively into tissues
tend to be lipophilic, as this facilitates passage
through cell membranes.
Albumin, globulins, and lipoproteins.
Acidic drugs associate primarily with albumin
Basic drugs preferentially bind globulins and
43
Chem PPT Flashcards, Unit 3
What is a Pharmacokinetic drug metabolism?
What is elimination?
What are the steps in elimination?
List some of the clinical utility of Therapeutic
Drug Monitoring/Management (TDM)
What is a major asset of consistent use of
TDM?
What are some concerns in Therapeutic Drug
Monitoring (TDM)?
What does GC-MS stand for?
What does LC-MS/MS stand for?
What does HPLC-UV stand for?
Name 6 traditional antiepileptics?
lipoproteins
It is the biotransformation of a compound,
whether endogenous or exogenous.
Drug metabolism is typically the result of
enzymatic activity, found in the liver, GIT and
kidneys.
The final removal of drugs from the body
Most common routes are excretion into urine
or stool. Drugs are eliminated into breast
milk, sweat and hair.
Clearance can be measured directly and renal
elimination can be estimated by using the
glomerular filtration rate.
In practice, urine is rarely used for TDM
purposes
TDM can be used to assess compliance,
address physiological or pathological changes,
and maintain optimal dosing for each
individual patient.
It is also useful in the management of many
conditions requiring long-term
pharmacological therapy like hyperlipidemia
and hypertension.
TDM can also guide initial selection and
dosing of a drug.Routine TDM is also helpful
for detecting and managing alterations in drug
dispositions within an individual.
The potential to detect noncompliance

The need for accurate, reproducible
methods
 Requirement for quality assurance and
proficiency testing programs
Necessity for establishing target ranges
Gas Chromatography-Mass Spectrometry
Liquid Chromatography-Mass
Spectrometry/Mass Spectrometry
High Performance Liquid ChromatographyUltraviolet
 Benzodiazepines
 Carbamazepine
 Ethosuximide
 Phenobarbital and Primidone
 Phenytoin and Fosphenytoin
 Valproic acid
44
Chem PPT Flashcards, Unit 3
What are the effects of Benzodiazepines?
Benzodiazepines work by?
What are 2 kinds of benzodiazepines?
Carbamazepine toxicity is associated if levels
exceed?
What is the mode of action of Carbamazepine
and what are its effects?
Ethosuximide (Zarontin) is used for the
treatment of?
How does Ethosuximide take effect in the
body?
Phenobarbital (Luminal) and Primidone
(Mysoline) affect the body in what manner?
Phenytoin (Diphenylhydantoin, Dilantin) and
Fosphenytoin (Cerebyx) are used in the
treatment of?
What is the mode of action and the effects of
phenytoin and fosphenytoin?
Valproic acid (Depakote) is most commonly
used for treatment of?
What is the mode of action and the effects of
Valproic acid?
Hepatic toxicity and acute toxic encephalopathy
have been associated with what concentration of
valproic acid?
Name 6 contemporary antiepileptics:
Which contemporary antiepileptic promotes the
release of GABA but does not interact directly
with the GABA receptor?
sedative, hypnotic (sleep-inducing),
anxiolytic (anti-anxiety), anticonvulsant, and
muscle relaxant properties.
Enhancing the effect of the neurotransmitter
gamma-aminobutyric acid (GABA) at the
GABAA receptor.
Diazapam (Valium) and Clonazepam
15 mg/L
Modulates the synaptic sodium channel,
which acts to reduce central synaptic
transmission, aiding in control of abnormal
neuronal excitability
Absence seizures characterized by brief loss
of consciousness.
It reduces the flow of calcium through T-type
calcium channels in the synapse and slows the
rate of this seizure inducing pulses.
By reducing synaptic transmission through
action on the GABAA receptor, resulting in
decreased neuronal excitability.
Used in the treatment of all but absent
seizures
They interfere with sodium channel activity
by prolonging inactivation, which reduces
synaptic transmission and assist in control of
abnormal neuronal excitability.
absence seizures
It inhibits the enzyme GABA transaminase,
resulting in increased concentrations of
GABA and overall inhibition of neuronal
activity in the brain.
Concentrations greater than 100 mg/L







Gabapentin
Lamotrigine
Levetiracetam
Oxcarbazepine
Topiramate
Zonisamide
Gabapentin (Neurontin)
45
Chem PPT Flashcards, Unit 3
What is Lamotrigine and how does it affect the
body?
A broad spectrum antiepileptic drug that acts
through multiple mechanism including blocking
sodium and calcium channels and reducing
glutamate release
Levetiracetam (Keppra)
Name the broad spectrum antiepileptic that acts
through synaptic vesicle protein SV2A, which is
involved in the release of neurotransmitters
from presynaptic terminals?
What antiepileptic drug is metabolized to
Oxcarbazepine (Trileptal)
monohydroxycarbamazepine (MHC), the
metabolites responsible for the therapeutic
effect?
Which broad spectrum antiepileptic drug that
Topiramate (Topomax)
has sodium and calcium channel blocking
activity, potentiates the activity of GABA, and
inhibits glutamate release?
What is Zonisamide (Zonegran)?
Is a sodium and calcium channel blocker and
considered a broad spectrum antiepileptic
Antifungal or Antibacterial agents?
1) Antibacterial
1) Aminoglycosides
2) Antifungal
2) Triazoles
3) Antibacterial
3) Vancomycin
4) Antibacterial
4) Amikacin
5) Antibacterial
5) Gentamicin
6) Antibacterial
6) Tobramycin
How does bacterial susceptibility to antibiotics
Bacterial susceptibility to antibiotics is
being measured?
commonly measured in terms of the minimum
inhibitory concentration (MIC), the
concentration of drug sufficient to inhibit
growth of an organism.
What is minimum inhibitory concentration
The concentration of drug sufficient to inhibit
mean?
growth of an organism.
Gentamicin is an example of Aminoglycosides
They inhibit protein synthesis to kill aerobic,
which inhibits what?
gram-negative bacteria
What do you call a glycopeptide antibiotic with Vancomycin (Vancocin)
activity against antibiotic-resistant bacteria,
including methicillin-resistant Staphylococcus
aureus (MRSA)?
What most common pathogen species are being The most common pathogens are species of
inhibited by antifungal agents?
Candida yeast or Aspergillus molds
Voriconazole (Vfend) and Posaconazole (
Triazole
Noxafil) are examples of what type of
antifungal agent?
__________ is an antifungal agent that has a
Posaconazole ( Noxafil)
broad-spectrum compounds that kills by
inhibiting synthesis of the major fungal sterol,
46
Chem PPT Flashcards, Unit 3
ergosterol.
What do you call a chemotherapeutic drug that
inhibits the growth of malignant cells by
alkylating DNA?
What antitumor agent can also minimize the
risk of secondary tumor development and
growth retardation in children when compared
with irradiation?
What anti-neoplastic s or anti-cancer drugs is
being used in the management of acute
lymphoblastic leukemia, choriocarcinoma,
elated trophoblastic tumor, and in maintenance
of remission in leukemia and treatment of
severe psoriasis?
_____________ inhibits DNA synthesis and
competitively inhibits the enzyme dihydrofolate
reductase.
What are arrhythmias?
What is the most common serious arrhythmia?
Many antiarrhythmic drugs exert their action by
regulation of what cation channels?
What cardioactive drug is obtained from
Digitalis plants such as the foxglove, it is a
cardiac glycoside used in the treatment of
arrhythmias and heart failure?
What does Digoxin (Lanoxin) do to your heart
rate?
What cardioactive drug is particularly
prescribed in cases of congestive heart failure?
Identify to which immunosuppressant they
belong to:
1) Cyclosporine
2) Tacrolimus
3) Mycophenolate Mofetil
4) Sirolimus
5) Everolimus
What do you call the drugs capable of
suppressing immune responses used to treat
autoimmune diseases, allergies, multiple
myeloma, other cancers and chronic nephritis,
and most important, to prevent rejection in
Busulfan
Busulfan
Methotrexate
Methotrexate
Arrhythmias are disturbances in normal
cardiac sinus rhythm and are sometimes
associated with substantial morbidity and
mortality.
Atrial fibrillation
Na+, K+ or Ca2+
Digoxin (Lanoxin)
It acts by slowing heart rate, increases the
strength and velocity of cardiac contraction
and regulate the nervous (sympathetic) and
endocrine (renin-angiotensin) system.
Digoxin (Lanoxin)
1) Calcineurin inhibitor
2) Calcineurin inhibitor
3) IMPDH inhibitor
4) mTOR inhibitor
5) mTOR inhibitor
Immunosuppressant drugs
47
Chem PPT Flashcards, Unit 3
organ or bone marrow transplantation?
_________is important in optimizing
immunosuppressant therapy because of possible
serious consequences of under dosing or
overdosing.
What prevents drug-related toxicity and is used
to evaluate compliance?
Cyclosporine is a immunosuppressant
derived from bacterial sources. True or
False
Cyclosporine is a fat______ cyclical peptide
that______ the activation of T lymphocytes
via a multifaceted mechanism.
A soluble, blocks
B insoluble, enables
C neutral, inhibits
D rich, starts
Tacrolimus has two names. Identify them.
A. Prograf
B. FK506
C. BGM109
TLM1
Cellcept arrests T-cell proliferation by the
suppression of guanine nucleotide
production when IMPDH is inhibited by
MPA. True or False
A. True
B. False
T
Opioids can be monitored in urine to detect
compliance, diversion, and use of nonperscribed opioids?
A. True
False
Codeine is a fully synthetic opioid. True or
False?
A. True
False
Which one of these choices is a nueraleptic
agent?
A. Lithium
B. Classical Antipsychotics
C. A and B
None of the above
Toxicology is most specifically a branch of ___
Toxicology is concerned with the study of
TDM (Therapeutic drug monitoring)
TDM (Therapeutic drug monitoring)
False; it comes from Fungus
A
A and B
A
A.
B
C
Pharmacology
Living organisms
48
Chem PPT Flashcards, Unit 3
adverse effects of chemicals on ___.
There are 9 different procedures for detection of
drugs. Name as many as you can:
Spot tests are qualitative or quantitative?
Do Spot tests suggest or prove:
Name two examples of spot tests for salicylate:
What is the formula used to identify increased
anion gap?
What is the reference interval for anion gap
determination?
What are the common causes of anion gap?
What is the MUDPILES mnemonic?
Name the causes of persistent anion gap.
Correct interpretation of results facilitates:
What is one of the screening procedure
for detection of drugs
What are the formulas to determine Osmol
Gap?
What are the formulas to determine Osmol
Gap?
How do you determine the Osmol Gap
What is the method of choice for initial
screening of most drugs of abuse
True or False
Spot test, determination of anion gap,
electrocardiogram, determination of Osmol
gap, immunoassay, planar chromatography,
gas chromatography, high performance liquid
chromatography, point of care devices
qualitative
Suggest
Ferric chloride test, Trinder test
AG = [Na+] - [Cl- + HCO3-]
8 to 16 mmol/L
MUDPILES mnemonic
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron, inhalants, isoniazid, ibuprofen
Lactic acidosis
Ethylene glycol, ethanol ketoacidosis
Salicylates, starvation ketoacidosis,
sympathomimetics
Continued absorption of exogenous acids
Formation of acidic metabolites
Cellular ischemia with worsening lactic
acidosis
Laboratory testing
Diagnosis of poisoning
Management
Electrocardiogram (ECG)
OSMc (mOsm/kg) = 2Na (mmol/L) + glucose
(mg/dL)/18 + urea (mg/dL)/2.8
OSMc (mOsm/kg) = 2Na (mmol/L) + glucose
(mmol/L) + urea (mmol/L)
OSMc (mOsm/kg) = 1.86 Na (mmol/L) +
glucose (mg/dL)/18 + urea (mg/dL)/2.8 + 9
OSMc (mOsm/kg) = 1.86 Na (mmol/L) +
glucose (mmol/L) + urea (mmol/L)+ 9
OSMg = OSMm – OSMc
Difference between Actual osmolality
(measured) and the calculated osmolality
Immunoassay
True
49
Chem PPT Flashcards, Unit 3
Immunoassay tests for drugs of abuse are
capable of semiquantitative results.
Planar Chromatography is also referred to as..
Specimens for planar chromatography to
determine drugs of abuse include?
What is the specimen of choice for planar
chromatography and why?
What is one type of screening procedure for the
detection of drugs?
What else is gas chromatography known as?
Why is gas chromatography used in drug
screening?
It is widely used for what two kinds of drug
analysis?
How does gas chromatography analyze
specimens? What are some parts of the
procedure?
What procedure achieves the greatest accuracy
in drug screening?
What procedure is used for comprehensive drug
screening in biological fluids?
What are some advantages HPLC has over gas
chromatography?
The incorporation of a diode array detector has
what effect?
What are some advantages of Point-of-care
devices?
What body fluids are used in these types of
point of car devices?
Carbon monoxide (CO) are agents that cause
____ _____.
You are considered legally intoxicated at
0.08% if you consume what?
Bought over the counter and can cause hepatic
and renal toxicity with overdose.
Acetylcholine is what type of agent
Any drug that is repeatedly and deliberately
used in a way other than prescribed or socially
sanctioned is considered what?
DFSA is abbreviation for?
Thin layer chromatography
Urine, serum, gastric contents.
Urine, because most drugs and drug
metabolites are present in urine in relatively
high concentrations.
Gas Chromatography
Gas liquid chromatography (GLC, GC)
It is rapid, and capable of resolving broadspectrum of drugs
Qualitative and quantitative
It uses capillary column, flame ionization and
alkali flame ionization for analysis
Gas chromatography coupled to a mass
spectrometer (GC-MS)
High-Performance liquid chromatography
(HPLC)
1) It can analyze polar compounds
without derivatization
It can analyze thermally labile drugs
It greatly increases the discriminatory power
of this technique
1) Easy to use
2) durable
3) portable
4) rapid
may be adjusted to detect one or many drugs
Urine and Saliva
Cellular Hypoxia
Alcohol
Non-prescription Analgesics
Cholinergic
Drug Abuse
Drug Facilitated Sexual Assault
50
Chem PPT Flashcards, Unit 3
What does CO stand for?
How can CO be described?
What is CO the product of?
CO will combine readily to what?
What is the produce when CO binds with Heme
Fe2+?
True or False
The binding affinity of hemoglobin for CO is
about 250 times weaker than that for oxygen
What will CO compete with for hemoglobin?
CO will decrease what content?
What is the treatment for the above situation?
How can CO be measured in the blood?
Which method of measurement for CO is
described:
Accurate, precise, and considered to be the
reference procedure
Which method of measurement for CO is
described:
Fast, convenient, accurate, precise
What will Cyanide bind to?
Carbon Monoxide
Colorless, odorless, and tasteless
Incomplete combustion of carbonaceous
material
Heme Fe2+ of hemoglobin
Carboxyhemoglobin
False. The binding affinity for hemoglobin
and CO is 250 times greater than that for
oxygen
Oxygen
Blood oxygen content and oxygen’s
availability to tissue
Remove individual from contaminated area
and administer oxygen
Gas chromatography and spectrophotometry
Gas chromatography
Spectrophotometry
Heme iron in the cytochrome within
mitochondria and cross biological membranes
What are symptoms of rapid onset of hypoxia?
Flushing, headaches, tachypnea, dizziness,
and respiratory depression
What is tachypnea?
Abnormal rapid breathing
What can respiratory depression lead to?
Coma, seizures, complete heart block, and
death
What is the treatment for cyanide?
Hydroxycobalamin, or the cyanide antidote kit
How is methemoglobin formed?
When the heme iron in hemoglobin (Fe2+) is
oxidized to the Fe3+ state
Does methemoglobin bind to oxygen?
no
What is the enzyme responsible for
nicotinamide adenine dinucleotide (NADH)maintaining hemoglobin iron in the
methemoglobin reductase
reduced state?
Where is the deficiency of the enzyme is in congenital methemoglobinemia
seen?
Acquired toxic methemoglobinemia may various drugs and chemicals.
be caused by what?
A normal pO2 in a cyanotic patient
is a significant indication of the possible presence of
indicates what?
methemoglobinemia.
Specific therapy for toxic
the administration of methylene blue.
methemoglobinemia involves what?
Methemoglobinemia is measured in
taking automated multi-wavelength measurements
51
Chem PPT Flashcards, Unit 3
blood manually or by using what
with a co-oximeter.
automated method?
Where should keep Methemoglobin-forming
Since methemoglobin is not stable at room
Agent?
temperature, specimens should be kept on ice
or refrigerated but not frozen (freezing results
in an increase in methemoglobin
concentration).
What is toxic that most widely used and often
abused chemical substances?
Ethanol is one of several alcohols that is toxic
and medically important.
Where do the actions of ethanol involve?
Central nervous system (CNS) depressant
How is the blood alcohol concentration that is
allowed by DMV?
You are considered legally intoxicated at a
BAC of 0.08% (80 mg/dL)
How long is take for BAC level to release
alcohol?
It can take up to 6 hours for BAC level to
drop from a 0.08 to a 0.00
Where does Ethanol metobolize?
Ethanol is metabolism by the liver alcohol
dehydrogenase to acetaldehyde, which is
subsequently oxidized to acetic acid by
aldehyde dehydrogenase
Ethanol is a teratogen and alcohol
consumption during pregnancy can result in
the birth of a baby with fetal alcohol spectrum
disorder (FASD) which may include physical,
mental, behavioral and learning disabilities
with lifelong implications.
Blood analysis: serum, plasma, or whole
blood
• Higher concentrations in serum than in
blood
• Venipuncture site should be cleansed with
an alcohol-free disinfectant (aqueous
benzalkonium chloride)
• Specimens should be capped to avoid
evaporative loss.
Blood may be stored, when properly sealed,
for 14 days at room temperature or at 4°C,
with or without preservative.
• Blood analysis: serum, plasma, or whole
blood
•
For longer storage or for non-sterile
postmortem specimens, sodium fluoride
should be used as a preservative to
What is the side effect of Ethanol?
How can we analyze Ethanol In blood?
How can we analyze Ethanol In blood?
52
Chem PPT Flashcards, Unit 3
What ratio is breath alcohol analysis based on?
What is the deprivation period for breath
alcohol analysis?
What safeguard is there to ensure against mouth
alcohol contamination?
What is the use of urinalysis in ethanol
analysis?
What are some analysis of Ethyl Glucuronide
(EtG)
and Ethylsulfate (EtS)?
Where methanol is used?
prevent a decrease or occasionally an
increase (via fermentation) in ethanol
concentration.
To measure ethanol in serum/plasma, the
enzymatic assay is the method of choice
(alcohol dehydrogenase)
Evidential breath alcohol measurements are
based on the ratio of 2100:1 (blood/breath)
Before breath alcohol analysis, a deprivation
period of at least 15 minutes is recommended
to allow for clearance for any residual alcohol
that may be present in the mouth from very
recent drinking, use of alcohol-containing
mouthwash, or vomiting of alcohol-rich
gastric fluid.
Duplicate tests, performed 3 to 10 minutes
apart, typically must agree within 20 mg/dL
(0.02%) as an additional safeguard against
mouth alcohol contamination.
Detection of alcohol in urine represents
ingestion of alcohol within the previous 8 to
12 hours.
- Minor metabolites of ethanol
- Ethyl glucuronide (EtG) may be
detected as long as 80 hours after
ethanol consumption and is found
even when small amounts of alcohol
are consumed.
Used as a marker of recent ethanol intake due
to its long urinary elimination time and its
specificity for ethanol exposure.
Commercial solvent for products such as
deicers and windshield washer fluids.
methanol
Name the agent that cause cellular hypoxia and
it is metabolized by liver alcohol dehydrogenase
to formaldehyde?
Formaldehyde is subsequently oxidized to
Formic acid
…………….by aldehyde dehydrogenase.
Methanol causes what type of disorders?
acidosis, optic neuropathy, resulting in
blindness, or death if not treated promptly
Between ethanol and methanol which one
methanol
oxidized slower?
What are the mainstay of therapy for methanol
Administration of ethanol or fomepizole as a
toxicity?
competitive alcohol dehyrogenase inhibitor
Administration of either folate/folinic acid
Dialysis
53
Chem PPT Flashcards, Unit 3
What percentage of aqueous isopropanol is
rubbing alcohol?
What is isopropanol metabolized to? By which
enzyme?
Does isopropanol have the same CNS
depressant action as ethanol?
Does Acetone have CNS depressant activity?
What is Ethylene Glycol commercially known
as?
Are the effects of Ethylene Glycol harmless?
70% aqueous solution of isopropanol =
rubbing alcohol
Isopropanol metabolized by alcohol
dehydrogenase to acetone, which is eliminated
much more slowly.
It has about twice the CNS depressant action
as ethanol.
Yes
Antifreeze
Relatively harmless initially, but metabolites
like oxalic acid and glycolic acid can be lethal
What metabolite would be measured after
Determination of ethylene glycol and glycolic
ingesting Ethylene Glycol?
acid provides useful clinical and confirmatory
analytical information in cases of ethylene
glycol ingestion
What is the treatment for accidental ingestion of Treatment: Administration of ethanol or
Ethylene Glycol?
fomepizole as a competitive alcohol
dehydrogenase inhibitor dialysis and dialysis
What is Flame Ionization Gas Chromatography? It is the most common method used to detect
and quantify volatile alcohols in biological
samples. It distinguishes types of alcohol and
measure concentrations as low as 10 mg/dL
(0.01%)
How are samples prepared for Flame Ionization They are prepared by direct injection and
Gas Chromatography?
headspace analysis.
Is a prescription required for acetaminophen?
No
What type of drug is acetaminophen?
Antipyretic
What can overdose of acetaminophen cause?
Hepatic and renal toxicity
What is the treatment for acetaminophen
Administration of N-acetylcysteine (NAC)
overdose?
What does Rumack-Matthew nomogram do?
relates serum acetaminophen concentration
and time after acute ingestion to the
probability of hepatic necrosis
What are other screening methods for
Spectrophotometry and immunoassays
acetaminophen?
In the Rumack-Matthew Nomogram what hour The x-axis are in 4 hour increments.
increments are used on the x-axis?
What does the Rumack-Matthew line indicate in Any values (concentration) above the line
the Nomogram?
may indicate hepatic damage.
What is the treatment line in the RumackMatthew Nomogram?
The treatment line is 25% less than the
rumack matthew line, which is the threshold
for acetaminophen toxicity.
54
Chem PPT Flashcards, Unit 3
What is the common name for Acetylsalicylic
acid?
Aspirin
What is Acetylsalicylic acid used for?
Analgesic, antipyretic, antiinflammatory
What does Acetylsalicylic acid enhance and
inhibit?
Acetylsalicylic acid enhances anaerobic
glycolysis but inhibit the Krebs cycle and
transaminase enzymes.
How does one treat Acetylsalicylic acid
toxicity?
Acetylsalicylic acid toxicity is treated by decreasing
further absorption, increasing elimination, and
correcting acid-base
and electrolyte disturbances.
What can be used to treat Acetylsalicylic acid?
 Activated charcoal (prevents
absorption)
 Alkaline diuresis (elimination)
 NaHCO3 (alleviates metabolic
acidosis)
What is Trinder Tests?
Spot Tests, HPLC, fluorescent polarization
immunoassay, salicylate hydroxylasemediated photometry, gas and liquid
chromatography methods.
What is Tricyclic Antidepressants?
• Represent a class of drugs frequently
prescribed for the treatment of depression
• Therapeutic mechanism is the blockade of
neuronal reuptake of serotonin and/or
norepinephrine
• Measured by chromatographic methods or
by immunoassay
What is the use of Antipsychotic Drugs?
Generally used for psychiatric and other
disorders
What is the effect of Antipsychotic Drugs?
Principal manifestation involve the CNS and
cardiovascular system
What methods are used to measure the
Measured by chromatographic methods or by
concentration of Antipsychotic Drugs?
immunoassay
What is the use of Antihistamines?
Used to treat allergies and aid sleep
Does Antihistamines available over the counter? Many available over the counter
What is Histamine role in the body?
Histamine is released from mast cells and
plays an important physiological role in
immediate hypersensitivity and allergic
response
What is the function of Histamine?
Histamine functions as a neurotransmitter in
the CNS and stimulates gastric acid secretion.
What methods are used to determine Histamine Spectrographic methods: GC-MS/MS, LCconcentration?
MS/MS
What are the characteristics of Antimuscarinic
Synonymous with anticholinergic, inhibiting
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Chem PPT Flashcards, Unit 3
Agents?
What is the best use of Antimuscarinic drugs?
How does the Antimuscarinic agent go inside
the body?
Is there any treatment involved for
Antimuscarinic?
What is Acetylcholine?
How do agents Related to the
Cholinergic Toxidrome act?
What is duration of acetylcholine action is
controlled by?
Where is Acetylcholinesterase found?
Where is Butyrylcholinesterase found?
What is Organophosphate poisoning results
from?
What is most commonly Organophosphate
poisoning?
How does Organophosphates work?
What is the purpose of AChE?
What does diagnosis of organophosphate and
carbamate toxicity depend on?
What is the treatment for organophosphates and
carbamate?
Measurement of organophosphates and
carbamate?
the action of acetylcholine, a neurotransmitter
in the parasympathetic nervous system.
Antimuscarinic drugs relax smooth muscle,
decrease the secretion of saliva, sweat, and
digestive juice, and dilate the pupil of the eye.
May be eaten or ingested in tea
Treatment: based on clinical presentation
an essential neurotransmitter that affects
parasympathetic synapses (autonomic and
CNS), sympathetic preganglionic synapses,
and the neuromuscular junction
by producing uncontrolled acetylcholine
transmission through inactivation of
cholinesterase enzymes or direct stimulation
of acetylcholine receptors
- Acetylcholinesterase
butyrylcholinesterase / pseudocholinesterase
- in red blood cells
- nervous tissue
- skeletal muscle.
Butyrylcholinesterase is found in plasma,
liver, heart, pancreas and brain.
from exposure to organophosphates (OPs),
which cause the inhibition of
acetylcholinesterase (AChE), leading to the
accumulation of acetylcholine (ACh) in the
body
results from exposure to insecticides or nerve
agents
Organophosphates inhibit AChE, causing OP
poisoning by phosphorylating the serine
hydroxyl residue on AChE, which inactivates
AChE.
It’s critical for nerve function, so the
irreversible blockage of this enzyme, that
causes acetylcholine accumulation, results in
muscle overstimulation.
Mainly on exposure history, physical
presentation, clinical suspicion, and laboratory
support.
Administration of atropine, pralidoxime.
Spectrophotometric measurement of
acetylcholinesterase and butyrylcholinesterase
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Chem PPT Flashcards, Unit 3
What are drugs of abuse?
What are the drugs of abuse?
What are the drugs mentioned above
collectively known as?
Under which department do the SAMHSA drug
tests are required?
What are Barbiturates?
Barbiturates are also effective as?
What is one of the problems that you face when
taking Barbiturates?
Barbiturates have now largely been replaced by
benzodiazepines in routine medical practice –
for example, in the treatment of anxiety and
insomnia – mainly because?
In what cases are Barbiturates still being used?
What are some of the barbiturates confirmatory
test ?
What are the immunoassay techniques ?
What is the main action of barbiturates ?
What are some main uses of barbiturates?
activity. GC-MS and GC-MS/MS of urine for
organophosphate and carbamate metabolites?
Any drug that is repeatedly and deliberately
used in a way other than prescribed or socially
sanctioned.
1. Tricyclic antidepressants
2. Benzodiazepines
3. Barbiturates
4. Methadone
5. Methylenedioxymethamphetamine
(MDMA)
6. Methylenedioxyethylamphetamine
(MDEA)
7. Oxycodone
8. Amphetamines
9. Cocaine
10. Marijuana
11. Opiates
12. Phencyclidine
SAMHSA (Substance Abuse and Mental
Health Services Administration) or NIDA
(National Institute on Drug Abuse).
Department of Transportation.
They are drugs that act as central nervous
system depressants, with wide spectrum of
effects, from mild sedation to total anesthesia.
As analgesics, anxiolytics, hypnotics, and
anticonvulsants.
They have addiction potential, both physical
and psychological
Because benzodiazepines are significantly less
dangerous in overdose as there is no specific
antidote for barbiturate overdose.
Barbiturates are still used in general
anesthesia, for epilepsy, for the treatment of
acute migraines and cluster headaches.
Gc with flame Ionization detection,
Nitrogen phosphorus detection,
mass spectrometry MS detection
capillary electro
Screening test
Suppression of cns sedative-hypnotic drugs
Induce anesthesia, treat seizures, decreased
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Chem PPT Flashcards, Unit 3
Are barbiturates acids or bases? Weak or
strong?
What are the active duration time of long acting
?
Which class of of drugs sometimes called
benzos are a class of psychoactive drugs that
enhanced effect of the neutransmitter gammaaminobutyric?
If used alone, do benzodiazepines commonly
cause fatal cns depression ?
True or false the prototype benzodiazepines are
diazepam nordiazepam (n-desmethyldiazepam)
Uses of benzodiazepine.
Classification of Benzodiazepines.
Confirmatory tests of Benzodiazepines
Where is the Cannabinoids derived from?
What are the effects of Cannabinoids?
Which is the primary psychoactive component
of Cannabinoids?
Cannabinoids measure by which specimen?
which methods used to measure Cannabinoids?
Where is the Opiates derived from?
Which Form of Opiates is better In medical?
What are primarily used in medicine for the
intracranial pressure, enthanasia
Weak acids
2-6 days
48-52
Benzodiazepines
No but at high doses will cause hyponosis and
stupor
True
useful in treating anxiety, insomnia, agitation,
seizures, muscle spasms, alcohol withdrawal
and as a premedication for medical or dental
procedures.
They are categorized as either short-,
intermediate-, or long-acting. Short- and
intermediate-acting benzodiazepines are
preferred for the treatment of insomnia;
longer-acting benzodiazepines are
recommended for the treatment of anxiety.
-extraction procedures by Liquid-Liquid
extraction or Solid-Phase extraction, analysis
of urine specimens by GC-MS, LC with UV
detection, LC-MS and LC-MS/MS.
Cnnabinoids found in the marijuana plant
Cannabis sativa
Psychotropic effects are euphoria, distorted
perception, relaxation and a feeling of wellbeing.
Delta-9-tetrahydrocannabinol (THC) is the
primary psychoactive component
Delta-9-tetrahydrocannabinol (THC), which is
measured in urine.
presumptive positive result using
immunoassay method should be confirmed by
quantitative GC-MS/MS or LC-MS/MS
Opiates found naturally in the opium poppy
plant Papaver somniferum.
In a medical context the term usually indicates
medications that are artificially made rather
than extracted from opium.
Opioids
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Chem PPT Flashcards, Unit 3
treatment of pain?
sedation, respiratory depression, constipation,
and a strong sense of euphoria are side effects
of what?
Opioid ? can develop with ongoing
administration, leading to a withdrawal
syndrome with abrupt discontinuation.
Opios can cause death in overdose from what?
Opioids work by binding to opioid receptors,
which are found principally iwhere? These
receptors mediate both the psychoactive and the
somatic effects of opioids
Although the term opiate is often used as a
synonym for opioid, the term opiate is properly
limited to the natural alkaloids found in the
resin of the___?___ while opioid refers to
synthetic substances
Natural Opium Alkaloidsare Phenanthrenes
which include what?
opioids
dependence
respiratory depression.
the central and peripheral nervous system and
the gastrointestinal tract.
Papaver somniferum (opium poppy),
Morphine
Codeine
Thebaine
Natural Opium Benzylisoquinolines are what?
Papaverine
Noscapine
Poppy seeds (Papaver somniferum) are a type of Opium
natural _____?___
Semisynthetic Opiates are what?
Heroin
Hydrocodone
Hydromorphone
Oxycodone
Oxymorphone
Name the 5 Fully Synthetic Opioids.
 Fentanyl
 Meperidine
 Methadone
 Propoxyphene
Tramadol
Name the 3 antagonist to Opioids.
 Buprenorphine
 Naloxone
Naltrexone
What method of choice is used for urine
Immunoassay
screening?
What are the 3 Confirmatory test used for
 Gas chromatography mass spectrometry
Opioids
(GC-MS)
 Liquid chromatography mass spectrometry
(LC-MS)
Liquid chromatography Tandem Mass
Spectrometry (LC-MS/MS)
Sympathomimetic drugs are stimulant
Effects of agonists of the sympathetic nervous
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Chem PPT Flashcards, Unit 3
compounds which mimic the what effects?
system such as the catecholamines.
Give some examples of catecholamines.
epinephrine (adrenaline)
norepinephrine (noradrenaline)
dopamine
Cardiac arrest, low blood pressure, or even
delay premature labor, among other things.
Amphetamine, Methamphetamine,
Ephedrine, Pseudoephedrine,
Phenylpropanolamine
To increase dopamine, serotonin,
norepinephrine (extracellular monoamine
neurotransmitters); Also increase blood
pressure, heart rate, body temperature and
motor activity, relaxed bronchial muscle and
depress the appetite.
Central and peripheral nervous system.
Sympathomimetic drugs are used to treat what?
List some drugs considered to have a high
potential of abuse
What is Amphetamine and Methamphetamine
primary action?
What is the main system Amphetamine and
Methamphetamine affect?
Where do Ephedrine and Pseudoephedrine
naturally occurs?
What kind of receptor is Ephedrine?
Explain the mechanism of Ephedrine
How is Pseudoephedrine primarily used?
Name a psychoactive drug of the
phenethylamine and amphetamine chemical
classes which is used as a stimulant,
decongestant, and anorectic agent.
Phenylpropanolamine (PPA) is a metabolite of?
PPA is commonly used in prescription and
over-the-counter for?
Designer Amphetamines are also known as?
Short-term effects of designer amphetamines
include:
Long-term effects of designer amphetamines
include:
In plants of Ephedra genus
Ephedrine is both an α- and β- adrenergic
receptor agonist
It enhances the release of norepinephrine from
sympathetic neurons and is considered a
mixed-acting sympathomimetic drug causing
hypertension, tremors, myocardial infarction,
seizures and stroke.
As a decongestant because of its
vasoconstrictive properties (alpha adrenergic
action), and as a precursor for the illicit
synthesis of methamphetamine.
Phenylpropanolamine (PPA)
Ephedrine and pseudoephedrine
cough and cold preparations.
“club drugs” or “designer drugs”
euphoria, energy, desire for social interaction,
distortion of visual and auditory sensation
 Serotonin syndrome
 Hepatotoxicity
 Neurotoxicity
 Psychopathology
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Chem PPT Flashcards, Unit 3
What psychostimulant used to treat attention
deficit hyperactivity disorder and narcolepsy?
What drugs has clinical effects similar to those
of amphetamines
Because of stimulant and purported aphrodisiac
properties, increasingly subject to diversion and
abuse, what drugs is this?
What do you call a drug that is chemically
alkaloid methylbenzoylecgonine found in
Erythroxylum coca
A kind of drug used for local anesthesia and
vasoconstriction in nasal surgery, and to dilate
pupils in ophthalmology?
What is this form of cocaine that is
administered by nasal insufflation or snorting?
What is this form of cocaine that is heated and
its vapors inhaled?
What drug is a potent CNS stimulant that elicits
a state of increased alertness and euphoria
(same as amphetamine but of shorter duration)?
What analyte of choice in screening for cocaine
use?
What is the initial screening method by choice
for cocaine use?
LSD is structurally similar to________.
A. Melatonin
B. ADH
C. Serotonin
D. Epinepherin
LSD causes several psychological effects.
These include:
A. perceptual distortions of color
B. depersonalization
C. loss of body image
D. All of the above
LSD is made from bacteria. True or False.
A. True
B. False
Current ways of use for LSD include:
A. Postage Stamps
B. Gel Caps
C. Tablets
D. All the above
Current detection methods for LSD as an
analyte include:
 Abuse
Methylphenidate (Ritalin)
Methylphenidate (Ritalin)
Methylphenidate (Ritalin)
Cocaine
Cocaine
hydrochloride salt (powder)
freebase known as crack cocaine
Cocaine
Benzoylecgonine (BE)
Initial screening is by immunoassay detection
GC-MS is the confirmatory method of choice
C
D
B
D
D
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Chem PPT Flashcards, Unit 3
A. GC-MS/MS
B. LC-MS/MS
C. LC-MS
D. All of the Above
Can drugs facilitate sexual assault?
Yes or No
A. Yes
B. No
Current drugs that DFSA(defined as the use of
alcohol, drugs, and/or chemical agents to
incapacitate an individual can facilitate sexual
assault) include:
A. Alcohol
B. Benzodiazepine
C.Chloral hydrate
D. All of the above
All or most athletes are required to undergo
drug screening. The procedure is defined as:
A. Drug screening
B. In competition testing
C. Prescreening
D. Out of competition testing
Drug abuse can be detected using several
samples taken from patients.
Choose the answer you think is correct.
A. Blood, Plasma, Serum
B. Meconium, Hair, Sweat
C. Oral Secretions(Saliva)
D. All of the above
Heavy metal poisoning is ___
Symptoms and physical findings associated
with heavy metal poisoning
Name 5 heavy metals, essential to body
function in very small amounts. But, if these
metals accumulate in the body in concentrations
sufficient to cause poisoning, then serious
damage may occur
The heavy metals most commonly associated
with poisoning of humans are
Heavy metal poisoning may occur as a result of
(6 ways).
What is AA-F?
What is AA-ETA?
A
D
D
D
the accumulation of heavy metals, in toxic
amounts, in the soft tissues of the body
vary according to the metal accumulated
zinc, copper, chromium, iron and manganese
lead, mercury, arsenic and cadmium
industrial exposure, air or water pollution,
foods, medicines, improperly coated food
containers, or the ingestion of lead-based
paints
Atomic absorption spectrometry with flame
Atomic absorption spectrometry with
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Chem PPT Flashcards, Unit 3
What is ICP-ES?
What is ICP-MS?
What is LC-ICP/MS?
Patients with renal failure are candidates for
what?
Aluminum avidly binds to proteins such as?
Aluminum has been implicated in which
disease?
What accumulates in blood if not filtered by
kidney?
Aluminum is neurotoxic, targeting the central
nervous system, which can lead to?
The primary side-effect or "wake-up call" that
indicates aluminum has intoxicated the brain is
a very serious condition called?
Symptoms of aluminum hypersensitivity
include:
What metal can cause the following symptoms,
becoming easily frightened or alarmed
sometimes become overly disturbed and
provoked, displaying irrational outbursts of
anger, road rage, and bad temper
What are the sensory symptoms caused by
hypersensitivity to aluminum?
What are the emotional symptoms caused by
hypersensitivity to aluminum?
electrothermal atomization furnace
Inductively coupled plasma emission
spectrometry
Inductively coupled plasma mass
spectrometry
High performance liquid chromatography
inductively coupled mass spectrometry
Aluminum toxicity
Transferrin
Alzheimer's Disease
Aluminum
Serious immunological and neurodegenerative
disorders
HYPERSENSITIVITY
-Heightened sensitivity to light or darkness.
-Abnormal sensitivity to hot and cold
temperatures.
-An aversion to noise, touch, movement,
odors, etc.
-Unexplained feelings of apprehension or
uneasiness.
-Feelings of inferiority, embarrassment or
shame.
-Feelings of irritability, agitation or
annoyance.
-Those who are easily frightened or alarmed
sometimes become overly disturbed and
provoked, displaying irrational outbursts of
anger, road rage, and bad temper
Aluminum hypersensitivity
Overly sensitive to all of the five senses.
-Heightened sensitivity to light or darkness.
-Sensitivity to hot and cold.
-Aversion to noise, touch, odors, movements.
Emotional variance of all types of negative
emotions.
-Unexplained feelings of apprehension, dread,
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Chem PPT Flashcards, Unit 3
What are some industries were exposure to
aluminum can happen?
What is another source of aluminum exposure?
What foods can lead to aluminum exposure?
What drugs are sources of aluminum exposure?
What vaccines are sources of aluminum
exposure?
What cosmetics and personal care products are
sources of aluminum exposure?
What are some other sources of aluminum
exposure?
uneasiness
-feelings of shame, embarrassment, and
inferiority
-irritability annoyance and and agitation
-these feelings can become violent.
1) Mining industry
2) Factory work
3) Welding
agriculture
Aluminum vapors are ingested every time the
nose catches cigarette smoke wafting by.
1) Baking powder
2) Self-rising flour
3) Salt
4) Baby formula
5) Coffee creamers
6) Baked and processed foods
Coloring and caking agents
1) Antacids
2) Analgesic
3) Anti-diarrheals
Additives such as magnesium stearate
1) Hepatitis A and B
2) Hib
3) DTap
4) Pneumococcal vaccine
Gardasil (HPV) and others
1) Antiperspirants
2) Deodorants
3) Lotions
4) Sunscreens
shampoos
Aluminum products including
1) foil
2) cans
3) juice pouches
4) tins
5) water bottles
Red meats cooked in aluminum foil showed an
increase in aluminum by 89 to ___ percent.
Poultry is increased by 76 to ____ percent when
cooked in aluminum foil.
Aluminum levels increase with ___ (longer/higher)
cooking temperatures and longer cooking times.
378
How can Antimony toxicity occur?
Through occupational exposure or during
214
higher
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Chem PPT Flashcards, Unit 3
What can occupational exposure cause?
True or False?
Antimony trioxide is possibly carcinogenic to
humans
What can antimony be used for therapeutically?
What is the major toxic side-effect of
antimonials as a result of therapy?
Where are the above side-effects mostly seen
in?
How/where can antimony be measured in?
Arsenic is a heavy metal. It exists in compounds
that may be organic or inorganic. Which form is
toxic?
Why is arsenic toxic?
What is an effective antidote?
What is the one of the most widely known toxic
metal?
What are the most common routes of exposure
to arsenic?
Where are major sources of inhaled arsenic may
come from?
Where is arsenic found?
What is shown to have high levels of inorganic
Arsenic?
What is the effect of Beryllium poisoning?
What is the toxicity of Beryllium?
therapy
Respiratory irritation, pneumoconiosis,
antimony spots on skin, and gastrointestinal
symptoms
True
Treatment of leishmaniasis and
schistosomiasis
Cardiotoxicity and pancreatitis
HIV and visceral leishmaniasis co-infections
Urine, feces, and blood
It is highly toxic in its inorganic form.
on many cell enzymes, which affect
metabolism and DNA repair
British anti-lewisite (BAL), The active agent
in BAL is dimercaprol, a sulfhydryl-reducing
agent.
It is Arsenic (As)
Ingestion and inhalation are the most common
routes of exposure to arsenic, and they are the
routes that most commonly lead to illness
Major sources of inhaled arsenic may come
from air emissions from burning of fossil
fuels that contain arsenic, cotton gins, glass
manufacturing operations, pesticide
manufacturing facilities, smelters, and tobacco
smoke
Meat, fish, and poultry account for 80% of
dietary arsenic intake. Fish, bivalve shellfish,
and algae also contain arsenic in the form of
arsenobetaine and arsenocholine, sometimes
referred to as "fish arsenic."
Recent studies have shown one form of
seaweed, hijiki, to contain high levels of
inorganic arsenic
Beryllium poisoning is illness resulting from
the toxic effect of beryllium in its elemental
form or in various chemical compounds
The toxicity of beryllium depends upon the
duration, intensity and frequency of exposure
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Chem PPT Flashcards, Unit 3
What are some uses of Beryllium in everyday
life?
What is Chronic berylliosis?
What is the cause of Chronic berylliosis?
What is the form of Acute beryllium disease?
Is the quantification of Beryllium in serum or
urine useful in making the diagnosis?
Nam specific metal which is Byproduct of zinc
and lead smelting?
What does breathing the fumes of Cd vapors
lead to?
What is a common source of chronic exposure?
(features of dose), as well as the form of
beryllium and the route of exposure (i.e.
inhalation, dermal, ingestion).
It has been used in electronics, ceramics,
research and development labs, aircraft, and
the atomic energy and defense industry
It is a pulmonary and systemic granulomatous
disease
Exposure to beryllium.
Chemical pneumonitis.
No, air analysis (TLV threshold limit value),
is the preferred method of exposure
evaluation.
Cadmium (Cd)
Nasal epithelial deterioration and pulmonary
congestion resembling chronic emphysema.
Spray painting of organic base paints without
the use of protective breathing apparatus
Cadmium (Cd)
Auto repair mechanics represent a workgroup
that has significant opportunity for exposure to What does exposure to Cadmium cause?
Cd toxicity present with renal dysfunction
with proteinuria. Chronic exposure causes
accumulated renal damage.
What is a side effect of tobacco smoke?
Moderately increased blood Cadmium
At what concentration would you observe acute If blood concentration exceeds 50 ng/mL
toxicity by Cadmium?
By what methods would you be able to quantify Cadmium is usually quantified by atomic
Cadmium?
absorption spectrometry, but it also has been
accurately quantified by ICP-MS
Occupational exposure to which element is
Chromium
considered hazardous?
Which work industries use Chromium?
Used in the manufacture of stainless steel,
chrome plating, tanning of leather, as a dye
for printing and textile manufacture, as a
cleaning solution, as an anticorrosive agent in
cooling systems, and in metallic orthopedic
implants.
What is the toxic form of Cr?
Toxic form of Cr is Cr6+.
Which would be the best method of analyzing
ICP MS is the preferred technology for
Chromium?
quantification of chromium in body fluids
What is an essential cofactor for vitamin B12?
Cobalt.
What are symptoms of acute Cobalt exposure?
Cardiomyopathy and Renal Failure.
What kind of sample is usually used to
Urine.
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Chem PPT Flashcards, Unit 3
determine excessive exposure of cobalt?
Where is cobalt usually found?
How is cobalt quantified in biological tissues?
What is Copper (Cu)?
Deficiency in Copper cause what Disease?
What is the specimen of choice for diagnosis
Wilson Disease?
Where does Copper circulate in the body?
What is Gadolinium (Gd)?
What is the name of an agent involved in
nephrogenic systemic fibrosis?
When will be the most consistent risk factor in
GBCA?
How is GBCA excreted?
How Lead (Pb) has been found in the
environment?
Where is Lead (Pb) commonly found?
They are found in metal alloys that are hard
and resistant to corrosion.
It is quantified by atomic absorption
spectrometry or by ICP-MS.
• Found in common pesticides, marine
antifouling paints, and wood
preservatives
• Ingestion of copper produces
gastrointestinal symptoms, hemolytic
anemia, hepatitis with jaundice, and
renal damage.
The classical presentation of Cu toxicosis is
represented by the genetic disease of Cu
accumulation known as Wilson's disease. This
disease is typified by hepatocellular damage
(increased transferases) and/or changes in
mood and behavior caused by accumulation of
Cu in central neurons.
Evaluation of serum and urine copper
concentration is useful in diagnosing Wilson's
disease.
Since copper circulating in blood is bound to
ceruloplasmin and ceruloplasmin formation is
decreased in Wilson's disease, serum copper
concentration is less than the reference
interval for serum, and urinary copper
concentrations are increased.
A chemical element found in image contrast
agents used during Magnetic Resonance
Imaging (MRI) and Magnetic Resonance
Angiography (MRA) procedures.
Gadolinium based contrast agent (GBCA) is
thought to be involved in nephrogenic
systemic fibrosis.
Exposure to GBCA during a condition of low
glomerular filtration rate appears to be the
most consistent risk factor.
Because GBCA is excreted by the kidney,
exposure is prolonged in patients with renal
insufficiency.
Commonly found in the environment that is
an acute and chronic toxin.
Common in paints, ceramics, leaded gasoline
in automobiles and in soil.
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Chem PPT Flashcards, Unit 3
How does a person exposure to Lead?
What is the main reason of measuring blood
Pb?
What is the Pb concentration in adults to be
considered of significant exposure?
What is the Lead concentrations required
chelation therapy
What is analysis of Lead routinely performed
by?
What is the specimen of choice for lead
analysis?
What are other methods can be used in urine
quantification?
What is Manganese?
How can you get toxicity from Manganese?
What can accumulation of Manganese in the
brain cause?
What can be tested for indication of Manganese
in the body?
What is Mercury commonly known as?
What was Mercury formerly named as?
What is Mercury?
What is Mercury used in?
What is Mercury replaced by?
What are some applications for use of mercury?
What is mercury used for as an almalgam
material?
What is the name of a medical condition caused
by exposure to mercury?
Toxic effects of Mercury
Exposure to Pb is through ingestion,
inhalation or dermal --contact.
The definitive test for lead toxicity is
measurement of blood Pb
WHO has defined blood Pb concentrations
>30 µg/dL in adults as indicative of
significant exposure
Is >60 µg/dL
ICP MS, electrothermal atomic absorption
spectrometry, or anodic stripping voltammetry
EDTA blood
Urinalysis
Ubiquitous in environment used as a binding
agent in red bricks, An anti-corrosive in most
steel alloys, a cleaning agent for glassware,
and a common pigment in paints and glazes.
Toxicity comes as a result of exposure from
dust from mining, ore crushing, machining of
alloys, manufacture or destruction of bricks.
Manganism (Parkinson-like
neurodegenerative disorder).
Blood and urine concentrations are good
indicators of exposure.
Quicksilver
Hydrargyrum
A heavy, silvery d-block element, mercury is
the only metallic element that is liquid at
standard conditions for temperature and
pressure.
Mercury is used in thermometers, barometers,
manometers, sphygmomanometers, float
valves, mercury switches, mercury relays,
fluorescent lamps.
Replaced by alcohol- or galinstan-filled glass
thermometers and thermistor- or infraredbased electronic instruments.
Clinical scientific research application data
Dental restoration
Hydrargyria
Includes damage to the brain, kidneys and
lungs. Mercury poisoning can result in several
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Chem PPT Flashcards, Unit 3
Symptoms of Mercury.
What is the used of Nickel (Ni)?
What happened when Nickle exposed to air?
Uses Platinum (Pt) in chemotherapy.
Platinum (Pt) measured by Which methods?
Selenium is a Essential element that may play a
role in mitigating biological damage caused by
what?
Selenium is a cofactor required to maintain
what type of activity?
What type of muscle is the most susceptible to
selenium deficiency ?
Name one type of Symptom caused by Se
poisoning
diseases, including acrodynia (pink disease),
Hunter-Russell syndrome, and Minamata
disease.
It includes sensory impairment (vision,
hearing, speech), disturbed sensation and a
lack of coordination. The type and degree of
symptoms exhibited depend upon the
individual toxin, the dose, and the method and
duration of exposure.
Used in the production of metal alloys, Nibased rechargeable batteries, and as a catalyst
in the hydrogenation of oils
Patients exposed to Ni carbonyl exhibit rapid
onset of pulmonary congestion and inability to
oxygenate hemoglobin, followed by
development of lesions of the lung, liver,
kidney, adrenal glands and spleen.
Pt-containing anti-neoplastic agents, cisplatin
and carboplatin are used in chemotherapy
-Cause nephrotoxicity
-Can induce neutropenia
-Can induce renal failure if administered with
nephrotoxic antibiotics
Measured by AA-ETA and ICP-MS
oxidative damage.
glutathione peroxidase
Cardiac (cardiomyopathy)
hair loss, muscle cramps, nausea, vomiting,
diarrhea, joint pain, fatigue, fingernail
changes and blistering skin
Selenium deficiency is also related to what?
What is the most abundant element in earth's
environment (26% of earth's crust)
total parenteral nutrition
silicon
Silicon toxic forms include what?
asbestos and silicone
Inhalation of asbestos containing dust leads to
the position of asbestos fibers in the pulmonary
alveoli causing asbestosis with the presence of
what?
Diagnosis of silicon toxicity can be made by
asbestos bodies
chest radiograph and presence in sputum and
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Chem PPT Flashcards, Unit 3
what type of tests?
How does dangerous exposure to asbestos
occur?
What is asbestosis?
What does asbestosis cause?
What are pleural plaques?
What significantly increases lung cancer?
What is the Silver analysis limited to?
What is argyria?
When is argyria produced?
Which toxic metal is a byproduct of lead
smelting, coal combustion, and cement
manufacture?
Which toxic metal is formerly used in rodent
poisons?
Thallium is absorbed by____(1)____, ,
___(2)____and ___(3)____
What are the effects of exposure to high doses
of thallium?
What toxic metal is the 9th most abundant
element in the earth's crust?
If ingested, titanium is rapidly excreted where?
True or False
Titanium dust is irritating and almost
completely fibrogenic.
Where does titanium-containing alloys being
used?
What allows osseointegration?
True or False
Concerning titanium, serum concentrations are
used to monitor prosthesis degradation.
Vanadium is not a recognized occupational
hazard. True or False
A. True
B. False
Vanadium is a byproduct of refining,
lung biopsy
When materials containing the fibers are
disturbed.
Fibers accumulate in the lungs’ narrow
branches, inflamming, and scarring airways.
Chronic cough and chest pain
The needle-shapes fibers may also migrate
into the pleural lining. Pleura becomes
inflamed, plaques builds up and may restrict
breathing.
Smoking
Silver analysis is limited to monitoring of
burn patients treated with silver sulfadiazine,
and monitoring of patients treated with silvercontaining nasal decongestants.
graying of the skin
Argyria is produced when Silver (Ag) is
deposited in many organs including the subepithelium of the skin and mucous membranes
Thallium (Tl)
Thallium (Tl)
1) ingestion
2) inhalation
3) skin contact
hair loss, peripheral neuropathy and seizures,
and renal failure
Titanium
urine and stool
False(nonirritating and almost completely
nonfibrogenic)
in artificial joints, prosthetic devices, and
implants
Titanium dioxide
True
A
D
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Chem PPT Flashcards, Unit 3
Specifically:
A. Iron
B. Titanium
C. Uranium
D. All of the Above
A clinically significant reaction of
Vanadium by the human body includes:
A. Green tongue
B. Runny Nose
C. Green blood at venipuncture
D. Discoloration of Nails
A patient sample has a flag for Vanadium, a
clinically significant toxin. What are the
possible causes for the elevated serum
concentrations present?
A. Compromised renal function and
dialysis
B. Joint replacement
C. Prosthesis degradation
D. All of the above
A
D
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