Exam #5: Review Material Flashcards Preview

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Flashcards in Exam #5: Review Material Deck (106):
1

How does smooth muscle differ from skeletal muscle?

- Smooth muscle is non-striated vs. striated skeletal muscle
- Different types of smooth muscle exist (multi-unit vs. unitary) in different organs

2

What contractile component is missing from smooth muscle that is present in skeletal muscle?

Troponin Complex
- Indicative of a different role of Ca++ in smooth muscle

Smooth muscle does contain actin, myosin, and tropomyosin

3

How are myosin heads arranged in smooth muscle? How is this different from skeletal muscle?

Mysoin heads in smooth muscle are NOT all arranged in the same direction

4

What takes the place of z-discs in smooth muscle?

Dense bodies

5

What is the function of dense bodies?

- Transmission of force from once cell to another
- Anchor for thin filaments

6

How does the point of regulation differ from skeletal muscle to smooth muscle?

Remember, smooth muscle DOES NOT contain TnC; thus:

Skeletal=
1) Ca++ from SR binds TnC
2) Ca++/TnC= tropomyosin moves to expose myosin binding sites on actin

Smooth
1) Ca++ binds Calmodulin
2) Ca++/Calmodulin increase MLCK
3) MLCK increases Myosin ATPase
4) Phosphorylated myosin binds actin

7

What is different between contraction of skeletal muscle & smooth muscle?

1) In smooth muscle ECF Ca++ is the PRIMARY source of Ca++, NOT SR Ca++ as in skeletal muscle
2) MLCK is only present in smooth muscle
3) Myosin ATPase is constitutively active in skeletal muscle; smooth muscle, this is regulated

8

What are the signs and symptoms of Type II DM?

1) Asymptomatic initially
2) Infections become more frequent b/c of the energy (glucose) source for microorganisms
3) Neuropathy
4) Classic severe insulin deficiency signs occurs late in the progression of symptoms
5) Obesity & metabolic syndrome

*****#4, note that type II DM becomes apparent when the Beta-cells are no longer able to compensate for increased resistance to insulin

9

What are the distinguishing features between Type I and Type II DM related to B-cell function?

Type I= absolute beta cell destruction leading to beta cell destruction
- Decrease in beta-cell mass

Type II= insulin resistance followed by an insulin secretory defect
- Increase in beta-cell mass

*Note that there are 2x subtypes of DM-I, a & b. A= autoimmune, B= idiopathic--diagnosis is based on NOT finding autoantibodies

10

What are the distinguishing features between Type I and Type II DM related to insulin sensitivity?

- In type-II DM the body is NOT responding to insulin i.e. a decrease in insulin sensitivity, which initially results in an INCREASE in insulin secretion--a compensatory mechanism

- Type I, the body simply is NOT producing insulin

11

What are the therapeutic strategies employed & rationale for these strategies in treating Type I DM?

1) Diet i.e. balanced carbs, fat, and protein

2) Patient education on:
- Carb counting
- Insulin action
- Blood glucose targets

3) Insulin ABSOLUTELY required it must be non-PO route b/c insulin is a peptide that will be degraded in the GI tract

12

What are the therapeutic strategies employed & rationale for these strategies in treating Type II DM?

First, remember that potential therapies for the DM may have a negative impact on the overall Metabolic Syndrome in DM-II, which presents a challenge to treating DM-II

1) Diet
2) Patient education
3) Pharmacologic strategies

*Insulin is used ONLY when other agents DO NOT allow for achievement of therapeutic goals

13

What are the acute complications potentially experienced by DM patients? How are these addressed?

Hypoglycemia (e.g. insulin overdose)
- Glucose
- Glucagon

DKA
- Restore plasma volume
- Reduce blood glucose
- Correct acidosis
- Replenish electrolytes

14

Outline the different pharmacological strategies that are used to treat DM-II.

1) Increase insulin secretion
2) Increase insulin action
3) Inhibit gluconeogenesis
4) Inhibit glucose digestion & absorption from the GI tract
5) Suppress glucagon secretion

15

How can you pharmacologically increase insulin secretion in DM-II?

- GLP1 analogs are used to activate GLP1 receptors to promote insulin secretion
- DPP4 (enzymes that breaks down GLP1) inhibitors, which indirectly promote insulin secretion
- Inhibition of ATP-sensitive K+ channels on B-cells to eventually cause insulin release

16

What is the relationship between flow, velocity or flow, and cross-sectional area in the vascular system?

v= Q/A

v= velocity of flow (cm/sec)
Q= flow (mL/sec)
A= cross-sectional area (cm2)

*Velocity is slower in larger vessels

17

What is Ohm's law as it relates to the vascular system?

Q=dP/R

Q= flow (mL/min)
dP= pressure difference mmHg
R= resistance

*Thus, flow increases with pressure & decrease with increasing resistance--main source of resistance is arterioles.

18

What is Poiseuille's Law?

R= 8nl/pir4

R= resistance
n= viscosity of blood
l= length of BV
r4= radius raised to 4th power

19

What is TPR? How does TPR systemic compare to TPR pulmonic?

TPR= dP/CO

TPR-systemic= Psystemic-RAP/CO
TPR-pulmonic= Ppulmonic-LAP/CO

*****Note, CO= HR x SV
Also, TPR ~MAP/CO

20

TEMPERATURE INCREASE--Explain temperature-induced changes in skin blood flow, sweating, shivering, thermogenesis, & piloerection.

Generally, remember that the temperature regulating center is located in the anterior hypothalamus. In response to temperature increase, mechanisms are activated to increase heat-loss:

1) Vasodilation= warm blood from core at surface-->heat loss to environment
- Alpha-1 adrenergic inhibition
2) Sweating leads to evaporation & heat loss
- SNS CHOLINERGIC stim.
3) Shivering, thermogenesis, piloerection are INHIBITED

21

TEMPERATURE DECREASE--Explain temperature-induced changes in skin blood flow, sweating, shivering, thermogenesis, piloerection.

Generally, remember that the temperature regulating center is located in the anterior hypothalamus. In response to temperature increase, mechanisms are activated to increase heat-loss:

SNS:
1) Vasoconstriction= decreased thermal conductivity
- Alpha-1 mediated/ NOREPINEPHRINE
2) Thermogenesis= metabolic generation of heat
- Beta-adrenergic mediated/ EPINEPHRINE
- PNS-->TRH-->TSH--Thyroxine

Posterior Hypothalamus
3) Shivering= skeletal muscle heat generation

Sweating is inhibited

22

What are the differences between myelinated & unmyelinated nerves? Specifically, where are the voltage-gated Na+ channels? Which conducts more rapidly? Which conducts more efficiently?

Myelinated nerves are myelinated & non-myelinated ones are not.
- Nodes of Ranvier
- Myelinated neurons BOTH conduct more rapidly & are more efficient

23

How does myasthenia gravis affect synaptic transmission? is the problem pre-synaptic or post-synaptic? Is this an autoimmune disease?

- Autoimmune
- Post-synaptic
- Antibodies against NAChR, an important mediator of EPPs

24

How does Eaton-Lambert Syndrome affect synaptic transmission? is the problem pre-synaptic or post-synaptic? Is this an autoimmune disease?

- Often occurs in patients with small-cell carcinoma of the lung (& breast cancer)
- Patients have antibodies to voltage gated Ca++ channels
- Autoimmune & pre-synaptic
- Less Ca++ enters pre-synaptic terminals; thus, less ACh is released, which results in muscle weakness

25

How does botulinum toxin affect synaptic transmission? is the problem pre-synaptic or post-synaptic? Is this an autoimmune disease?

- Botulinum toxins cleave SNARE proteins*
- Vesicles will not properly dock to pre-synaptic membrane
- ACh will not be released
- Symptoms:
1) NMJ paralysis
2) Muscle weakness

*As does tetanus toxin, but tetanus causes tetanic contraction.

26

How does a-bugarotoxin affect synaptic transmission? is the problem pre-synaptic or post-synaptic? Is this an autoimmune disease?

- A peptide from the venom of a banded krait (snake)
- Irreversibly blocks NAChR
- Post-synaptic

27

What is the difference between GPIba, GPVI, GPIIb/IIIa

- GPIba binds vFW to mediate platelet tethering
- GPVI binds collagen for strong platelet adhesion & activation
- GPIIb/IIIa binds fibrinogen, forming the platelet plug

28

What is the P2Y12 receptor? What drug antagonises this receptor?

Is the receptor for ADP on platelets, which leads to platelet activation

*Plavix is a P2Y12 antagonist

29

What are PARs? Why are PARs important?

PAR stands for "Protease activated receptors," which are GPCRs on the surface of platelets that are activated by thrombin

*Activation of PARs leads to further platelet activation & is important because this links the platelet & coagulation systems

30

What is the Thromboxane A2 receptor?

A platelet receptor

Thromboxane A2 works in an autocrine fashion, increasing platelet activation; it also is a vasoconstrictor

31

What are Collagen, vWF, and fibrinogen ligands for?

Collagen= GPVI
vFW= GPIba
Fibrinogen= GPIIb/IIIa

32

What are Thromboxane A2, ADP, & thrombin ligands for?

TXA2R
P2Y12R (plavix antagonist)
PARs

33

Outline the vascular response to tissue damage. Specifically address the functions of ADP, 5-HT, and Thromboxane A2.

1) Damaged tissue secretes factors that cause vasoconstriction
2) Platelets become activated
3) Activated platelets secrete Thromboxane A2 & Serotonin, leading to further vasoconstriction

Vasoconstriction prevents blood loss & slows flow to give platelets a better chance of adhering.

34

Describe the effects of constricting either the afferent or the efferent arteriole on renal blood flow (RBF).

Afferent= decrease RBF
Efferent= decrease RBF

35

Describe the effects of constricting either the afferent or the efferent arteriole on GFR.

Afferent= decreased GFR
Efferent= increased GFR

36

How could you increase the glomerular hydrostatic pressure by constricting the efferent or afferent arterioles?

Constricting the efferent arteriole

37

What is the source of fibroblast growth factor 23 (FGF 23).

Osteoblasts and osteocytes in bone

38

What is FGF23?

"fibroblast growth factor 23"

39

What are the effects of FGF23 on the kidney?

1) Decreased reabsorption of phosphate
2) Decreases the production of calcitriol

40

What stimulates the secretion of FGF23?

1) Elevated phosphate levels
2) Calcitriol i.e. active Vitamin D

41

What are the relationships between FGF23 and parathyroid hormone and calcitriol and their actions?

Vitamin D= increased reabsorption of Ca++ & phosphate

FGF23= decreased reabsorption of Ca++ & phosphate

PTH= increased absorption of Ca++. decreased absorption of phosphate

42

How does the autonomic nervous system differ from the somatic nervous system in terms of neruons?

- In the somatic nervous system, there is one large neuron that synapses directly on the effect cell
- In the ANS, there are two neurons (preganglionic & post ganglionic, with an intervening ganglia)

43

How do the sympathetic & parasympathetic nervous systems differ organization of the neurons?

- Sympathetic= Short pre-ganglionic & long post-ganlgionic fiber
- Parasympathetic= Long pre-ganglion & short post-ganglionic

*Note that the the ganglia of the PNS are clustered within the walls of visceral organs

44

What is the alternate name for the sympathetic nervous system?

Thoraco-lumbar division

45

What is the intermediolateral cell column?

- Lateral horn of the spinal cord
- Location of the cell bodies of autonomic ganglia

46

Describe the path of sympathetic outflow.

1) Cell body in the intermediolateral column
2) Preganglionic axon exits the spinal cord via the ventral root w/ somatic motor neurons
3) Diverge from somatic & enter the white rami communicantes

47

Describe cranial outflow.

- Preganglionic fibers follow certain cranial nerves
- Ganglia lie very close to target organs

Specific cranial nerves= oculumotor, fascial, glossopharyngeal, & vagus

48

Describe sacral outflow.

- Parasymathetic fibers emerge from the spinal cord in a bundle known as the nervi erigentes
- Synapse with pelvic ganglia
- Short postganglionic fibers to target organs

49

What is the enteric nervous system?

Two ganglia sandwhiched between the layers of the gut:
- Myenteric (Auerbach's)
- Submucosal (Meissner's)

50

Specifically, where is the myenteric plexus located? What does the myenteric plexus control?

- Between the external longitudinal & deep circular smooth muscle layers
- Motility

51

Specifically, where is the submucosal plexus located? What does the submocosal plexus control?

- Between the circular muscularis mucosae
- Ion & fluid transport

52

What NT is released from all of the preganglionic fibers?

ACh

*Regardless of system, all preganglionic fibers release ACh

53

What do the postganglionic fibers of the PNS release?

ACh

54

What do the postganglionic fibers of the SNS release?

NE/Epi or DA

55

What is the exception to postganglionic fibers of the SNS releasing NE/Epi or DA?

Thermoregulatory sweat glands, which posses muscarinic receptors & respond to ACh

56

What neurotransmitter do postganglionic fibers to the renal vascular smooth muscle release?

DA

57

What NTs are released by the adrenal medulla?

Epi & NE

58

What receptors are present in the target organs of the PNS?

Muscarinic ACh

59

What receptors are present in the thermoregulatory sweat glands?

Muscarinic ACh

60

What receptors are present in the target organs of the SNS? What are the two exceptions to this?

- Alpha & Beta Adrenergic
- Exceptions:
1) thermoregulatory sweat
2) renal vasculature

61

What receptors are present in the renal vasculature?

DA-1

62

What receptors are present in skeletal muscle?

Nicotinic ACh

63

How is ACh synthesized?

1) Uptake of choline from the ECF via the Na+ dependent choline transporter (CHT)
2) Conjugation by ChAT (AcetylCoA + Choline)
3) Final product: ACh

Note that acetylcholine is synthesized in BOTH the cytoplasm & in the mitochondria. ChAT= choline acteyltransferase

64

What drug can block the choline transporter (CHT)?

Hemicholiniums

*Note that these are not used clinically.

65

How is ACh stored?

Once ACh is synthesized, it is transported into the storage vesicle via the "vesicle assocaited transporter" (VAT)

66

What drug blocks VAT?

Vescamicol

67

How is ACh released?

1) Depolarization of nerve
2) Voltage-dependent Ca++ entry
3) Ca++ binds Calmodulin, activating "vesicle associated membrane proteins," VAMPs & "synaptosome-assocaited proteins," (SNAPs)
4) Exocytosis

68

What is the function of the VAMPs & SNAPs?

- Docking storage vesicles on the inner surface of the nerve terminal facing the synapse
- Fusion of the synaptic vesicle with the neural membrane

69

What does botulinum toxin block?

VAMPs & SNAPs

*Botulinum toxin enzymatically removes two amino acids from one or more of these fusion peptides

70

How is ACh action terminated?

1) Rapid hydrolysis of ACh via acetylcholine esterase (AChE)
2) Choline re-uptake into terminals
3) ACh interaction with ACh autoreceptors

71

What does acetylcholine esterase break ACh into?

Choline & Acetate

72

What drug blocks Acetylcholine esterase? What happens at the synapse in response to these drugs? Give an example of an AChE inhibitor.

- AChE inhibitors
- Increase ACh concentrations & over-stimulation of receptors

*Neostigmine is an AChE inhibitor

73

How are catecholamines synthesized?

1) Tyrosine is converted to DOPA via Tyrosine Hydroxylase*
2) DOPA is converted to Dopamine
3) Dopamine is converted to Norepinephrine

*Note that this is the rate-limiting step*

74

What drug blocks tyrosine hydroxylase? What step of the catecholamine synthesis process does this drug block?

- Metyrosine
- Conversion of Tyrosine to DOPA

75

What part of catecholamine synthesis only occurs in the adrenal medulla?

Norepinephrine is converted to Epinephrine

76

What is tyramine?

Tyramine is a naturally occurring monoamine compound, and a trace amine derived from the metabolism of tyrosine (alternative to DOPA)

77

What causes an increase in Tyramine?

Ingested of naturally occurring fermented cheese

78

What is Tyramine a precursor of?

Norephinephrine

79

How are catecholamines stored?

Synthesized catecholamines are transported into vesicles for storage via the "Vesicular Monoamine Transporter (VMAT)"

*Note that the conversion of norephinephrine to epinephrine occurs in the vesicle, if the converting enzyme is available.

80

What blocks VMAT? What is the mechanism of action?

Reserprine, blocks VMAT & causes a depletion of catecholamine stores

*Still used today for "resistant hypertension*

81

How are the catecholamines released?

Similar exocytosis mechanism as ACh

82

What drug blocks VAMP?

Bretylium

83

How is catecholamine transmission terminated?

1) Diffusion into the circulation & metabolized by liver COMT (catechol-O-methyl transferase)
2) Binding to an autoreceptor on the pre-synaptic nerve terminal
3) Neuronal Re-uptake via NET1 (NE transporter on the presynaptic nerve terminal), where:
- Repackaged in vesicles
- Metabolized by mitochondiral monoamine oxidase (MAO)
4) Extraneuronal uptake via extraneuronal transporters (ENT or NET2)

84

What is the mechanism of action of cocaine & tricyclic antidepressants?

NET1 antagnoists that leads to an increase in NE in the synaptic cleft

85

What is the effect of MAO antagonists? How are they related to Tyramine?

MAO is a mitochondrial enzyme that metabolizes catecholamines
- Irreversible MAO antagonists enhance the availability of Tyramine
- Can lead to hypertensive crisis

86

What is the rate-limiting step in catecholamine synthesis?

Conversion of Tyrosine to DOPA via Tyrosine Hydroxylase

87

What are the muscles of inspiration?

Diaphragm
External intercostals
Scaleni
SCM

88

What are the muscles of expiration?

Abdominal wall muscles

89

What is FVC?

Forced vital capacity= total amount of air that can be forcibly expired after maximal inspiration

90

What is FEV1?

The volume of air that can be forcibly expired in the first second

*Speed

91

Why is the FEV1/FVC ratio important?

It is a reflection of RESISTANCE to airflow

- Big ratio= small resistance
- Small ratio= big resistance (obstructive)

.75- 0.8= normal

92

What is FEF 25, 50, & 75?

Forced expiratory flow rate at varying volumes of air out

93

How does the FEV1/FVC ratio change in obstructive lung disease? Why?

Less than 0.7

- FCV & FEV1 decreased, but FEV1 is decreased more than FVC

94

How does the FEV1/FVC ratio change in restrictive lung disease? Why?

Greater than 0.8

FVC & FEV1 are decreased, but FEV1 is decreased less than FVC

95

Draw the flow volume curve curve in obstructive lung disease.

N/A

96

Draw the flow volume curve curve in restrictive lung disease.

N/A

97

Draw the flow volume curve curve in upper airway obstruction.

N/A

98

How does restrictive lung disease effect FEV1, FVC & FEV1/FVC ratio?

asdf

99

How does obstructive lung disease effect FEV1, FVC & FEV1/FVC ratio?

asdf

100

What are the three most prevalent obstructive lung disorders?

Asthma
Chronic Bronchitis
Emphysema

101

What are the main differences between asthma, chronic bronchitis, and emphysema?

- Asthma is the most reversible of obstructive lung diseases
- Chronic bronchitis is hallmarked by increased sputum production
- Emphysema involves the most damage to the alveolar wall

102

Outline the pathophysiology of allergic asthma.

In response to an allergen, a myraid of inflammatory cells release inflammatory mediators that result in:
1) Bronchoconstriction
2) Plasma exudation
3) Edema
4) Vasodilation
5) Mucus hypersecretion
6) Activation of sensory nerves

Chronic inflammation leads to structural changes including:
1) Thickening of the basement membrane
2) Smooth muscle hypertrophy & hyperplasia
3) Angiogenesis
4) Hyperplasia of mucus-secreting cells

103

What are the therapeutic options in asthma?

Acute reliever
Controller

104

What are the receptors for rescue treatments?

- B-2 adrenergic (bronchodilation)
- Anticholinergics (M3)

105

List the controller treatments used for asthma.

Inhaled corticosteroids
Antileukotrienes
Long-acting B-agonists
Theophylline
Systemic corticosteroids
Anti-IgE

106

How is asthma manifested on PFT?

Decreased airflow rates throughout the vital capacity
- Decreased PEFR
- Decreased FEV1
- Decreased MMEFR

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