Glycolysis

• irreversible reaction
• glucose to glucose 6 phosphate

“Hungry Peter Pan And The Growling Pink Panther Eat Pussy”

• 1. Hexokinase
• 2. Phosphogluco isomerase
• 3. Phosphofrutokinase 1 (PFK-1)
• 4. Aldolase 
• 5. Triose Phosphate 
• 6. Glyceraldehyde 3 phosphate dehydrogenase 
• 7. Phophoglycerate kinase
• 8. Phosphoglycerate mutase 
• 9.Enolase 
• 10. Pyruvate kinase 

• affects step six ( glyceraldhye3 phosphate dehydrogenase)
• no phosphorylation in step 7 
• no net gain of ATP

• inhibits enolase step 9 
• affects phosphorylation in step 10

• last step in glycolysis which is also the 2nd substrate level phosphorylization
• Hemolytic anemia 
• generates 50% less ATP

in order to get NAD+ because Glycolysis cannot happen within it

recycle lactate into sugar ( glucose) in the liver in gluconeogensis

• neurology
• gross 
• embryology 
• histology 
• Never Go home Empty (Handed )

• serial homology 
• bilater symmetry 
• ceolmates
• differentiated cells

4 major colems : upper and lower limbs; abodmen and pelvis, back and throax, and head and neck

• integumentary
• skeletal 
• reproductive
• urinary /excretory 
• muscular
• netvour
• circulatory 
• endocrine 
• respiratory 
• lympathic
• digesttive

• alot of lactate in the blood plasma
• pH of blood decreases 
• causes include
• no NAD+
• pyruvate carbxylase defenciency 
• excess NADH ( ethanol intoxication)
• Impaired pyruvate dehydrogenase 
• impair O2
• imparied respiration

• insulin
• it is the only one that responds to insulin

G6P

• low because it has a high affinity for glucose 
• Vmax is also low

• The Km is high; allows alot of glucose to be phosphorylate in the liver
• Large Vmax ; remove suagr from circulation quickly

• postively by Fructose 16 Bo 
• inhibited by ATP and Glucagon 
• Glucagon phosphorylates PK which makes it inactive

• (L)liver 
• (M1/M2)muscles other muscles 
• (R) RBC

• AMP 
• ADP 
• Fructose 26 Bisphosphate

ATP citrate and H+

fructose 2,6 bisphosphate is called the tandem enzyme

PFK-2 phosphofructokinas-2  changes Fructose 6 phophatse to F@^ phosphate with ATp help

• FBPase-2 
• Fructose2,6 bisphophotase

• dephosphoenzyme use ATP to work and incorpate it into their product 
• phosphoenzymes release a phophate and does not use ATP to carry on their reaction.

phosphotase

storage

When there is a high insulin to glucagon level there is low protein kinase A this leads to the dephosphorylation of the bifunctional enzyme  and PFK-2 is activated this Frustose2,6,Bisphosphate can be created and Gycolysis is stimulated at step 3 seeing that F26bisphosphate is a potent activator of PFK-1 which is the rate-limiting step of glycolysis

Because the bifunctional enzyme is active when protein kinase A i low and it is dephosphorylated

low ATp:AMp ratio

• PFK-2 and FBPase-2
• They are alternately active

• All New physicians Empower their Good samaritans via empath 
• - Active listening
• -Non verbal communication
• -Partnering/Reassurance 
• -Empowering the Patient 
• -Transitions
• -Guided questioning
• -Summarization 
• -Validation 
• -Empathy

• how to show empathy 
• Naming: " you seem upset about this"
• Understanding: " I can see how this is frustrating"
• Respecting: " you have been through alo; it is great how you have keep a great perspective"
• Support/partnership: " This is how I can help.."

• awareness 
• communication 
• collaborative partnership

The 4 C's of trusting

• Cultural humility 
• Competence of knowledge 
• Compassion and empathy 
• communication

• FIFE
• feeling 
• ideas
• function
• expectation
• when you want the patient to elaborate about their life you ask about their fife