CLINPHARM M3 - Theoretical (Part 2: Other Biomarkers)

Creatinine

Primarily used to evaluate renal function by measuring glomerular filtration rate

Creatinine

Produced in the muscles and undergoes complete glomerular filtration

Cockroft Gault formula

Creatinine is used to measure eGFR by using _______________

15% less

Creatinine clearance of females is _____% less than males

Serum creatinine

most practical way to measure creatinine

60 years

Cockroft-Gault Formula is only applicable for people _______ years of age or more

Urea

It is a by-product of protein metabolism

Protein > Amino Acids > Ammonia > Urea

Give the cycle of protein conversion to urea

Glomerulus

Urea is eliminated in the urine via filtration from the blood by the ___________, it undergoes significant tubular reabsorption

Less reliable

Urea tests are (more/less) reliable than creatinine in measuring renal function

Blood Urea Nitrogen (BUN)

Urea is measured in the body through means of ___________

Arterial Blood Gases

Provides rapid and accurate assessment of oxygenation, alveolar ventilation and acid base status

Aorta

The largest artery in the body

Femoral and radial artery

ABG Blood samples are extracted from arteries, particularly in the peripheral arteries _______ and _______

Pulse oximeter

For measuring O2 Saturation

COPD

The condition of loss of elasticity of the Alveoli

Decreased pH, Increased PaCO2

In respiratory acidosis, there is (increased/decreased) pH and (increased/decreased) PaCO2

Carbonic acid (H2CO3)

In respiratory acidosis, an increase in PaCO2 also causes an increase in ________

Bicarbonate (HCO3)

During respiratory acidosis, the body compensates in the drop of pH by releasing ___________ from the Kidney

COPD

Example of condition wherein respiratory acidosis may occur

Increased pH, decreased PaCO2

In respiratory alkalosis, there is (increased/decreased) pH and (increased/decreased) PaCO2

Carbonic acid (H2CO3)

In respiratory alkalosis, a decrease in PaCO2 also causes an decrease in ________

Hyperventilation and Pulmonary Embolism

Two conditions where respiratory alkalosis may be observed

Hyperventilation = INCREASED PaO2, Pulmonary Embolism = DECREASED PaO2

Difference between hyperventilation and pulmonary embolism in terms of PaO2

Anxiety attacks

Hyperventilation may happen during ________

Pulmonary embolism

A condition described with clot in the lungs, causing blockade

Streptokinase

When pulmonary embolism is diagnosed, the patient should be immediately given with ____________

Hypoventilation

High PaCO2 means (hypo/hyper)ventilation

Hyperventilation

Low PaCO2 means (hypo/hyper)ventilation

Arterial O2 tension (PaO2)

Measurement of oxygen in arterial blood

Oxygen Saturation (O2 sat)

Extent to which hemoglobin is saturated with oxygen

Decreased pH, decreased HCO3

In metabolic acidosis, there is (increased/decreased) pH and (increased/decreased) HCO3

Lactic acid

During metabolic acidosis, there is also an increase in lactate, and thus also increasing _____________ levels (decreasing pH)

Anaerobic respiration

Metabolic acidosis happens when you're not eating due to occurrence of ________________

Diabetic ketoacidosis

Metabolic acidosis happens when there is an increase in ketone levels in the body, causing ____________

H+

An increase of _____________ ion may also cause metabolic acidosis. This occurs due to kidney failure, as the patient cannot urinate due to such condition, therefore the _____ ions are not excreted and instead increase in concentration more

Diarrhea

Metabolic acidosis also happens due to a decrease in HCO3. This is mainly caused by ______________

Increased pH, Increased HCO3

In metabolic alkalosis, there is (increased/decreased) pH and (increased/decreased) HCO3

H+

Vomiting can decrease the levels of ________ ions in the body, causing metabolic alkalosis

Aldosterone

H+ ions can also be reduced by the increase of ____________ made by the kidneys, causing metabolic alkalosis

Thiazide and Loop

Class of diuretics that can cause metabolic alkalosis

Extracellular

Glucose is determined by the balance of glucose moving into, and leaving the (intracellular/extracellular) compartment

Renal tubules

These tubules has the capacity to reabsorb glucose

Fasting blood sugar (FBS)

Glucose test with fasting

Oral Glucose Tolerance Test (OGTT)

Glucose test without fasting

HbA1C

Glycated hemoglobin is also known as ______________

Glycated Hemoglobin

Glucose binds to a part of the hemoglobin molecule to form a small glycated fraction

5%

Approx. ____% of hemoglobin is glycated

Glycated hemoglobin

It is a well-established indicator of glycemic control in patients with diabetes. This is accurate since the glucose is bound in the blood

90-120 days

Erythrocyte lifespan

Uric Acid

End product of purine metabolism which is catalyzed by xanthine oxidase

xanthine oxidase

enzyme linked to oxidative stress, endothelial dysfunction and heart failure

Purines

These are used for nucleic acid synthesis and are produced from the breakdown of nucleic acid from ingested meat (also legumes, sardines) or synthesized within the body

Increased rate of ingestion, reduced excretion

Uric acid elevation is usually due to (increased/reduced) rate of ingestion and (increased/reduced) excretion

It is mainly deposited in the tissues and joints. It becomes the main determinant of gout as it causes pain and inflammation within tissues and joints due to increased concentration of cytokines.

Colchicine

DOC for Gout

Albumin

The most important protein synthesized in the liver

Edema

Albumin accounts for 80% serum colloid osmotic pressure and reduction will lead to ___________

Albumin

Plays an important role in binding of calcium, bilirubin, and many drugs

liver disease, increase in volume of distribution, fluid retention

Ways to decrease albumin levels (3)

Anticonvulsants (phenytoin, valproic acid, carbamazepine); Antibiotics (vancomycin); Cardiac Glycosides

Examples of high protein-bound drugs

20% and 25%

Available concentrations of synthesized human albumin

Bilirubin

Heme is broken down into ________, a yellow-colored pigment and is water-soluble, thus ready for excretion through urine

Liver

Bilirubin elevated counts usually indicate ______ disease, but not always

Bilirubin

It is responsible for the yellow color of bruises, feces, and jaundice

Hemolysis

Most common cause of bilirubin elevation is _____________

Cirrhosis, infections (leptospirosis)

Jaundice, can be caused by these two conditions

Jaundice

A newborn can develop __________ after being born. This occurs when the parents of the child have different blood types. Babies have the blood of their mother during labor. When they are born, and their blood type is different that of their mother, the moment the baby starts producing its own blood, hemolysis of its old blood cells (that came from the mother) will occur. It is due to the body's response that the baby's blood is different.

Alkaline Phosphatase

A test for liver function; It transports metabolites across cell membranes; Has several isoenzymes all throughout the body

Aspartate transaminase, Alanine transaminase

They catalyze the transfer of alpha-amino group of aspartate and alanine to the alpha-keto group of ketoglutaric acid to generate oxalacetic and pyruvic acid

Liver

AST and ALT are both specific for the _________

Gamma-Glutamyl Transpeptidase

Sensitive indicator of hepatobiliary disease but cannot differentiate cholestatic from hepatic

Gall bladder

GGT is more sensitive as test for cholestatic injuries, which means that most probably the problem will be at the ____________

Gamma-Glutamyl Transpeptidase

Used for identifying cause of raised alkphos

Cholelithiasis

Gallstones, clinical term

Ammonia

Used for measurement of extent of hepatic encephalopathy

Valproic acid

Ammonia levels can also be used to measure toxicity levels of ______________

Amylase

An enzyme produced mainly by pancreas and salivary glands

Amylase

It is highly sensitive test for pancreatitis

Meperidine (Demerol)

DOC for pancreatitis-induced pain

Troponin I and Troponin T

These are regulatory proteins that control calcium-mediated interaction between actin and myosin in cardiac muscle

Troponins

Preferred biomarker for myocardial necrosis because of near absolute myocardial tissue specificity

Calcium channels

Opening of _________ ion channels is important for action-potential

Troponins

These cardiac markers cannot discriminate between ischemic or non-ischemic mechanisms of myocardial injury

Creatinine Kinase

Enzyme present in high concentrations in heart muscle, skeletal muscle, brain

Creatinine Kinase

Used to detect/assess progression of muscle damage such as in rhabdomyolysis

CK-MB

CK isoenzyme specific for heart

CK-MM

CK isoenzyme specific for skeletal muscles

CK-BB

CK isoenzyme specific for brain

L1 and L2

Lactate Dehydrogenase isozymes that occurs after MI

L3

Lactate Dehydrogenase isozyme specific for the lungs

L4 and L5

Lactate Dehydrogenase isozyme specific for liver and skeletal muscle

Red Blood Cells

Produced in the bone marrow by erythropoiesis

Erythropoietin

Major stimulant of RBC is ___________ which is produced by the kidney

Hypoxia

Increased production of RBC may be a response to _________

Respiratory acidosis

An increase in RBC is also observed in respiratory (alkalosis/acidosis)

Alfa (Eprex); Beta (Recormon)

Two types of erythropoietin

Reticulocytes

Earliest non-nucleated red cells; Fine net-like appearance of their cytoplasm which contains the RNA

Mean (Corpuscular) Cell Volume

Average volume of single red cell

microcytic or macrocytic anemia

MCV can be used to measure ___________