Term
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Definition
| Employed at most unctions of the peripheral nervous system |
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Term
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Definition
| Released by most postganglionic neurons |
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Term
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Definition
| Released by the adrenal medulla |
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Term
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Definition
| One of 2 basic categories of receptors of the peripheral nervous system; mediated by Ach |
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Term
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Definition
| One of 2 basic categories of receptors of the peripheral nervous system; mediated by epi and NE |
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Term
Nicotinic N
Nicotinic M
Muscarinic |
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Definition
| Subtypes of cholinergic receptors (Ach) |
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Term
Alpha 1
Alpha 2
Beta 1
Beta 2
Dopamine |
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Definition
| Subtypes of adrenergic receptors (NE, Epi) |
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Term
| Fig 13-6: Locations of cholinergic and adrenergic receptor subtypes |
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Definition
NicotinicN receptors are located on the cell bodies of all postganglionic neurons of the parasympathetic and sympathetic nervous systems. NicotinicN receptors are also located on cells of the adrenal medulla.
2. NicotinicM receptors are located on skeletal muscle.
3. Muscarinic receptors are located on all organs regulated by the parasympathetic nervous system (ie., organs innervated by postganglionic parasympathetic nerves). Muscarinic receptors are also located on sweat glands.
4. Adrenergic receptors—alpha, beta, or both—are located on all organs (except sweat glands) regulated by the sympathetic nervous system (ie, organs innervated by postganglionic sympathetic nerves). Adrenergic receptors are also located on organs regulated by epinephrine released from the adrenal medulla. |
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Term
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Definition
Only one division provides basal control to organ.
Most organs – predominant tone is PNS.
During emergency– predominant tone is SNS. |
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Term
Parasympathetic ______ heart rate.
Sympathetic ________ heart rate. |
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Definition
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Term
| 3 principle functions of ANS |
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Definition
1. Regulate the heart
2. Regulate secretory glands (salivary, gastric, sweat, and bronchial)
3. Regulate smooth muscles (bronchi, blood vessels, urogenital system, and GI tract |
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Term
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Definition
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Term
| Adrenergic Neuromuscular Junctions |
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Definition
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Term
| Disease-producing cellular stresses |
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Definition
| 7: hypoxia or ischemia, chemical injury, physical agents, infection, immune reaction, nutritional imbalance, genetic derangements |
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Term
| 5 Adaptive responses that help cells survive and maintain function |
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Definition
Normal
Atrophy: decreased cell size
Hypertrophy: increased cell size
Hyperplasia: increased cell number
Metaplasia: conversion of one cell type to another
Dysplasia: disorderly growth |
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Term
| Molecular targets of cell injury |
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Definition
1. Cell membrane integrity: Calcium
2. Energy metabolism: Aerobic respiration and ATP production: Reactive Oxygen Species (ROS)
3. Protein synthesis
4. Genes |
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Term
| 2 types of reversible cell injury |
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Definition
1. Hydropic swelling
2. Intracellular accumulation (bruise) |
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Term
Mechanisms of Cellular Accumulation
Copstead p. 67: Fig. 4-02 |
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Definition
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Term
|
Definition
Roles of chaperone proteins in protein refolding and ubiquitin in protein degradation after stress-induced protein damage.
This is how the body repairs aberrant proteins when they’re damaged. What if you don’t have a chaperone protein? (ex. Cystic fibrosis) |
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Term
| 2 Types of irreversible cell injury |
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Definition
1. Necrosis: coagulative, liquefactive, fat, caseous
2. Apoptosis |
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Term
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Definition
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Term
|
Definition
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Term
Loss of Cell Membrane Integrity
cellular injury as a consequence of intracellular calcium overload |
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Definition
|
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Term
|
Definition
|
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Term
| 2 Converging Pathways for Apoptosis |
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Definition
1.Turned on by pathway in mitochondria
2.Death receptor pathway
Drugs target pathways. |
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Term
|
Definition
Reactive Oxygen Species: There are stressors which cause oxygen to have an electron attached to it and hang around as free radicals.
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Term
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Definition
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Term
| Ischemia Reperfusion Injury |
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Definition
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Term
| Reperfusion injury & stroke |
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Definition
Cellular edema in stroke patients kills patient. Brain swells, has nowhere to go, goes through foramen, herniates and dies. |
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Term
| Other types of cellular injury |
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Definition
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Term
| Programmed senescence theory |
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Definition
Telomeres are the end caps of chromosomes. They serve to keep the contents of the chromosome in place. Shortening of the telomere is associated with aging and cancer. Telomerase is the enzyme which repairs the telomere. Only certain cell types have telomerase such as germ cells (sperm and ova) and stem cells. |
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Term
Physiologic changes of aging
p. 83: Table 4-5
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Definition
•Age-related decrease in functional reserve
•Inability to adapt to environmental demand
•Somatic death |
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Term
| Cell Injury Summary Diagram |
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Definition
|
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Term
|
Definition
| Most often Chemical messengers exert their effects by binding to membrane receptors (proteins) that convert the chemical signal into signals within a cell. |
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Term
| 5 Membrane transport types |
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Definition
Endocytosis, exocytosis (macromolecules)
Electrochemical gradient (ions)
Active transport pumps (Na-K pump; membrane Ca transporters; ABC transporters)
Transport carriers (Na driven; Passive transport carriers;
Channel proteins (integral) |
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Term
|
Definition
| receptor-->vesicle-->endosome-->free cholesterol (for example)-->receptor back to cell surface |
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Term
|
Definition
| Three Na+ ions bind to sodium-binding sites on the carrier's inner face. At the same time an energy-containing adenosine triphosphate (ATP) molecule produced by the cell's mitochondria binds to the carrier. The ATP breaks apart, transferring its stored energy to the carrier. The carrier then changes shape, releases the three Na+ ions to the outside of the cell, and attracts two K+ ions to its potassium-binding sites. The carrier then returns to its original shape, releasing the two K+ ions and the remnant of the ATP molecule to the inside of the cell. The carrier is now ready for another pumping cycle. |
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Term
|
Definition
Ex: Insulin
receptor-->transport protein translocates to cell surface to grab insulin |
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Term
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Definition
| Always a resting cell membrane which changes. Depolarization is the response to the signal-->contraction. Mediated by voltage-gated ion channels. Triggered by binding of NT which opens the channels. |
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Term
| High or low potassium levels can cause |
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Definition
| arrhythmias, because cell’s ability to respond is different because ion levels off. |
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Term
| 3 possible states of voltage-gated sodium channel |
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Definition
Open--gate open, channel open
Refractory--gate closed, channel open
Closed--gate closed, channel closed |
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Term
| Plasma membrane (cell surface) receptors |
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Definition
voltage gated (ion channel): activated by NT
ligand-gated (enzyme coupled): activated by ligand (hormone)
G-protein receptors
mechanically-gated: activated by physical compression
other receptors (metaboreceptors) |
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Term
| Cellular communication. 3 primary ways to maintain homeostasis. |
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Definition
1. Remote by Secreted Molecules: Use receptor proteins inside the target cell and the signal molecule has to
enter the cell to bind to them
2. Direct by Surface Molecules: Display plasma-bound signaling molecules (receptors) that affect the cell itself
and other cells in direct physical contact
3. Direct via Gap Junctions: Form protein channels (gap junctions) that directly coordinate the activities of
adjacent cells |
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Term
| Overview of Signal Transduction |
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Definition
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Term
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Definition
| a state in which all symptoms are in balance at an ideal “set point” despite alterations within the body |
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Term
|
Definition
activity necessary to maintain or re-establish homeostasis (several levels)
Carried out by a set of systems that support homeostasis in light of environmental and lifestyle changes |
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Term
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Definition
Demands that require constant psychological, behavioral and physiological adjustment
Hans Selye 1930s |
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Term
|
Definition
1. psychological (anxiety, worry)
2. environmental (natural disasters)
3. physical (exercise, trauma, illness)
4. immunological (infection, physical illness) |
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Term
|
Definition
| agents or conditions that can produce stress and endanger homeostasis |
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Term
|
Definition
not stressors, but conditions or situations that increase the likelihood of encountering a stressor
Modifiable (diet) or non-modifiable (gender, genetic) |
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Term
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Definition
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Term
|
Definition
inadequate adaptation mechanisms or overwhelming allostatic load
inability to maintain homeostasis |
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Term
|
Definition
| perceived inability to cope with a stressor |
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Term
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Definition
| biopsychosocial process of change in response to new or altered circumstances, internal or external in origin |
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Term
|
Definition
| behavioral adaptive response to a stressor using culturally based coping mechanisms |
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Term
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Definition
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Term
|
Definition
| General adaptation syndrome |
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Term
|
Definition
1. Alarm reaction:
fight-or-flight response due to stressful stimulus
Allostatic state: Refers to the activity of various systems in attempting to restore homeostasis
2. Stage of resistance:
The activity of the nervous and endocrine systems in returning the body to homeostasis
3. Stage of exhaustion:
point where body can no longer return to homeostasis
Allostatic overload: “cost” of body’s organs and tissues for an excessive or ineffectively regulated allostatic response |
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
| Simplified HPA axis Activation |
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Definition
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Term
| Sympathetic vs Parasympathetic |
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Definition
Sympathetic revs things up: parasympathetic might inhibit. Autonomic nervous system is kind of a 4-way street.
Sympathetic turns on, increases, turn off, decreases. Parasympathetic turns on, decreases, turns off, increases. Important to really understand autonomic nervous system for beta blockers, etc. |
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Term
| Catecholamines as neurohormonal mediators of stress and adaptation |
|
Definition
norepinephrine and epinephrine
Play an integral role in allostasis
Sympathico-adrenal system response mediates the flight-or-fight response |
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Term
| Adrenocortical steroids as neurohormonal mediators of stress and adaptation |
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Definition
cortisol and aldosterone
Critical to maintenance of homeostasis
May synergize or antagonize effects of catecholamines |
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Term
| Endorphins and enkephalins |
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Definition
endogenous opioids (body’s natural pain relievers)
Raise pain threshold; produce sedation and euphoria |
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Term
| Immune cytokines (e.g., interleukin-1 IL-1) |
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Definition
secreted by macrophages during stress response
Enhance immune system response |
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Term
| Consequences of Drug-Drug Interactions |
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Definition
Intensification of effects
Increased therapeutic effects
Increased adverse effects
Reduction of effects
Reduced therapeutic effects
Reduced adverse effects
Creation of a unique response |
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Term
| 4 basic mechanisms of drug-drug interactions |
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Definition
1. Direct chemical/physical interaction (IV precipitation)
2. Pharmacokinetic interaction (induce vomiting)
3. Pharmacodynamic interaction (inhibitory)
4. Combined toxicity |
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Term
| Risk for serious drug interaction is directly proportional to |
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Definition
| the number of drugs a patient is taking. |
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Term
|
Definition
| any noxious, unintended, undesired effect that occurs at a normal drug dose; Elderly and very young |
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Term
| 8 Types of Adverse Drug Reactions |
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Definition
Side effect (recognized during trials, expected)
Toxicity
Allergic reaction- immune
Idiosyncratic effect (weird, rare)
Iatrogenic disease (worsens/causes a disease)
Physical dependence-body adapts to drug exposure
Carcinogenic
Teratagenic (cause mutations) |
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Term
| 4 pregnancy risk categories |
|
Definition
1: tested totally safe (there are none)
2: no cause for concern
3: cause for concern
4: known harm--drug of last resort
4 |
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Term
|
Definition
Variation from neonate to
toddler to adolescent
Neonates/BBB
Protein stores
Dose based on body surface area (BSA)
chart
Children > 1yr similar to adults but metabolize drugs faster
Route of administration varies |
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Term
|
Definition
Absorption (not much change)
Distribution
Protein (albumin)
Fat (increased)
Water
Metabolism
hepatic
Excretion
renal |
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Term
|
Definition
|
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Term
|
Definition
Phase 1 – toxicity; studied in healthy people; huge numbers
Phase 2 – efficacy and dosing; appropriate dose to achieve effect
Phase 3 – does this work in the population that has the disease we’re interested in? Can now apply for patent and use.
Phase 4 – post-marketing surveillance; all healthcare workers are part of surveillance—adverse effects must be reported
Off-label use is somewhat common; ex. Viagra used for heart disease was re-approved for heart disease and marketed under a different label. |
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Term
| Ideal Drug (doesn't exist) |
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Definition
Effective
Safe
Predictable
Reversible
Affordable |
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Term
|
Definition
|
|
Term
| Pharmacodynamics: Dose Response Curves |
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Definition
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Term
|
Definition
|
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Term
| Clinical application of pharmacodynamics (4) |
|
Definition
Educate patients about their medications
Make PRN decisions (pain, nausea, temp)
Evaluate patients for drug responses (both beneficial and harmful)
Collaborate with physicians about drug therapy |
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Term
|
Definition
| The largest effect that a drug can produce (height of the curve; see Figure 5-2, A). |
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Term
| 4 Drug mechanisms of action |
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Definition
| ion, g-protein, tyrosine, transport to nucleus to activate transcription (this will take a long time) |
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Term
| Properties of receptors: Drugs can only |
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Definition
| Mimic or block the body's own regulatory molecules |
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Term
| 4 Primary receptor families |
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Definition
1, Cell membrane–embedded enzyme.
2, Ligand-gated ion channel.
3, G protein–coupled
receptor system (G = G protein).
4, Transcription factor. |
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Term
|
Definition
| Intensity of drug response = # of occupied receptors |
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Term
|
Definition
Ability of the drug to activate a receptor upon binding
measure of the ability of a drug once bound to the receptor to generate an effect activating stimulus and producing a change in cellular activity. |
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Term
|
Definition
| Mimics NE at cardiac receptors |
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Term
| Agonists _____ receptors. |
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Definition
|
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Term
|
Definition
block receptor activation by endogenous regulatory molecules and drugs; they have affinity but no intrinsic activity
blockers |
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Term
|
Definition
Agonists that have only a moderate intrinsic activity.
The maximal effect that a partial agonist can produce is less than that of a full agonist.
Can act as antagonists as well as agonists. |
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Term
| Regulation of receptor sensitivity |
|
Definition
|
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Term
|
Definition
| Antacids, antiseptics, saline laxatives, chelating agents |
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Term
|
Definition
Larger/higher = safer drug
LD50/ED50 = lethal/effective |
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Term
| 2 Goals in the clinical application of drug therapy: |
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Definition
Maximize beneficial effects and minimize harm
Patient safety |
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Term
|
Definition
| transmembrane protein that transports a wide variety of drugs out of cells |
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Term
| Ions: 3 ways they can be used to target drugs |
|
Definition
1. quaternary ammonium compounods: N and always +
2. pH-dependent ionization: ionize in opposite pH
3. ion trapping (pH partitioning): accumulate on opposite side |
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Term
|
Definition
|
|
Term
| 3 factors of drug distribution |
|
Definition
Blood flow to tissues (tumors/abcess)
Exiting the vascular system
Entering cells |
|
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Term
|
Definition
| An average resting cardiac output would be 5.6 L/min for a human male and 4.9 L/min for a female. |
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Term
| Only drugs that are ______ or have a ___________ can cross the BBB to a significant degree |
|
Definition
lipid soluble
transport system
due to tight junctions |
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Term
|
Definition
limits free drug available
albumin |
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Term
|
Definition
more enzymes available; ↑ drug metabolism;
CYP450 enzyme system |
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Term
|
Definition
less enzymes available; drug metabolism
CYP450 |
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Term
|
Definition
Filtrations: drugs from blood to urine (unless protein bound)
Passive Reabsorption: Lipid sol back to blood; polar and ionized stay in urine
Active transport: organic acids and based blood to urine
Secretion |
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|
Term
| Two plasma drug levels defined |
|
Definition
Minimum effective concentration
Toxic concentration
Therapeutic range |
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