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159 Cards in this Set
- Front
- Back
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Lecture 14
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Neuro 5- Cranial Nerves
5 Star Topics***** |
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What brain structure is responsible for extraocular movements during REM sleep? (FA13 p617)
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Paramedian Pontine Reticular Formation (PPRF)
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Name 7 teratogens. (FA13 p507)
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ETOH
Aminoglycosides ACE inhibitors Valproate & Phenytoin (decrease folate levels) Lithium Tetracycline Warfarin Excessive Vit A |
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Which areas of the hypothalamus regulate the autonomic nervous system? (FA13 p414)
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Anterior nucleus (PNS)
Posterior nucleus (SNS) |
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Label the CN as they come off the brainstem (FA13p432-433)
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5 Stars
SG p 32 |
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Which CNs have their nuclei located in the medulla?
(FA13 p434) |
9, 10, 11, 12
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Which CNs have their nuclei in the pons? (FA13 p434)
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5, 6, 7, 8
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Which CNs have their nuclei in the midbrain? (FA13 p434)
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3, 4
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A 19 yo pt presents with a furuncle on his philtrum, and the cavernous sinus becomes infected. What neurological deficits might you see in this patient? (FA13 p436)
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CN 3,4, &6 -- Opthamiapesia
Trigeminal (V1 & V2)-- Hypo or Hyperesthia |
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What are the muscles of mastication? (FA13 p437)
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Muscles that close the jaw:
-Temporalis -Masseter -Medial pterygoid Muscle that opens jaw; -Lateral pterygoid |
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Rapid- Fire Facts: Unilateral facial drooping involving the forehead
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Belly's Palsy
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Rapid Fire Fact: Ptosis, Miosis, and Anhidrosis
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Horner's Syndrome
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Lewis notes: CN VI damage
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Eye directed medially
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Lewis notes: CN IV damage
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Eye drift upwards & lateral
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Lewis notes: CN III damage
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Downward & lateral
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Lecture 15- Neuro 6
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Brainstem and Branchial apparatus
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Which CN is responsible for each of the following actions?
-Eyelid opening -Taste from anterior 2/3 of tongue - Head turning -Tongue movement -Muscles of mastication -Balance -Monitoring carotid body and sinus chem- & baroreceptors (FA13 p 434) |
Eyelid opening-- oculomotor
Taste from anterior 2/3 of tongue-- Facial Head turning-- Spinal accessory Tongue movement-- Hypoglossal Muscles of mastication-- Trigeminal Balance-- Vestibulocochlear Monitoring carotid body & sinus chemo- & baroreceptors-- Glossopharyngeal |
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A woman involved in an accident cannot turn head to the left and has a right shoulder droop. What structure is damaged?
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Right spinal accessor n.--- Sternocleidomastoid
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During what sleep stage would a man have variable BP, penile tumescence and variable EEG? (SU13 p64)
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REM
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What nerves innervate the branchial arches? Later, what structures are derived form these arches? (FA13 p510)
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1st-- Maxillary & Mandibular
2nd-- Facial n. 3rd-- Glossopharyngeal 4th-- Vagus and Inferior & Superior laryngeal n. |
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From which branchial pouch are each of the following structures derived? (FA13 p511)
Middle ear and eustachian tubes Superior parathyroids Inferior parathyroids Epithelial lining of the palatine tonsil Thymus |
Middle ear and eustachian tubes-- 1st
Superior parathyroids-- 4th Inferior parathyroids-- 3rd Epithelial lining of the palatine tonsil-- 2nd Thymus-- 3rd |
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What are clefts, arches,and branches made out of?
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Clefts-- ectoderm
Arches-- mesoderm Branches-- endoderm |
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Lecture 16-- Pharm Basics 1
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Parasympathetic Activation
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Which collagen is typically deficient in Ehlers- Danlos syndrome? In osteogenesis imperfecta? (FA13 p78)
(SU13 p265) |
Ehlers- Danlos syndrome-- Type I & III collagen
OI type 1-- Type I collagen OI type 2-- Type II collagen |
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What are the symptoms of excess parasympathetic activity? (FA13 p233) (SU13 p46)
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DUMBBELSS
Diarrhea Urination Miosis Bronchospasm/Bradycardia Excitation of skeletal m. & CNS Lacrimation Sweating Salivation Treatment/ Antidote: Atropine, Pralidoxime (reactivates inhibited AchE) |
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Alzheimer disease anticholinesterases:
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Donepezil
Galantamine Rivastigmine |
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Myasthenia gravis
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- Antibodies to the ACh receptor
- Most common board question presentation: Ptosis that worsens throughout the day -Tensilon test (Edrophonium test) |
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Myasthenia Gravis thymus pathology
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50% associated with thymic hyperplasia
20% associated with thymic atrophy 15% associated with thymic tumor |
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Myasthenic crisis and treatment
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Rapidly progressing weakness esp. in respiratory muscles
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MG treatment
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Rx: indirect cholinergic agonists
Corticosteroids Azathioprine Cyclosporine Thymectomy Plasmapheresis |
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How does the parasympathetic nervous system affect the following body structures?
Heart, Eye, Salivary glands, Bronchiolar smooth muscle, Bladder, Male GU, GI tract |
Heart: decrease HR & small decrease in contractility
Eye: Miosis, contraction of ciliary m. Salivary glands: increase saliva production & secretion Bronchiolar smooth muscle: contract Bladder: contract bladder wall, relax sphincter Male GU: erection GI tract: contract intestinal wall, relax sphincter |
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What drug regenerates acetylcholinesterases after organophosphate poisoning?
(FA13 p233) (SU13 p29, 379) |
Pralidoxime
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What is the antidote for organophosphate poisoning? (FA13 p233) (SU13 p29)
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Atropine
Pralidoxime |
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Which anticholinesterases are used in the treatment of Alzheimer's disease?
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Donepezil
Galantamine Rivastigmine |
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Rapid fire fact: Amyloid deposits in gray matter of the brain
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Alzheimer's (senile plaques)
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Rapid fire facts: Drooling farmer
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Organophosphate poisoning
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Lecture 17: Pharm Basics 2
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Parasympathetic inactivation
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What are the symptoms of excess parasympathetic activity?
(FA13 p233) |
DUMBELLS
Diarrhea Urination Miosis Bronchospasm/ Bradycardia Excitation of skeletal m. & CNS Lacrimation Sweating Salivation |
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Atropine is not effective in reversal of organophosphate poisoning. What drug would best help this patient?
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Pralidoxime
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What are the components of the blood- brain barrier? (FA13 p413)
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Astrocyte foot processes
Basement membrane of capillary Capillary endothelial cells with tight junctions (non- fenestrated) |
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What are the symptoms of inhibiting parasympathetic activity? (FA13 p 234)
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Anti- DUMBELLS
Hot as a hare-- hyperpyrexia (lack of sweating) Red as a beet-- flushing Blind as a bat-- cycloplegia, mydriasis (lack of accomodation) Mad as a hatter-- confusion, delirum Bloated as a toad-- constipation, urinary retention Tachycardia-- decrease vagal tone |
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What drugs inhibit parasympathetic activity? What are their uses? (FA13 p233)
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Muscariinic antagonists
Atropine Homatropine Tropicamide Cyclopentolate Benztropine Scopolamine Ipratopium & Tiotropium Oxybutynin |
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What anticholinergics are used in the treatment of urge type urinary incontinence?
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Oxybutynin
Tolterodine Darifenacin and Solifenacin Trospium |
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In what patient populations is atropine contraindicated? (FA13p 234) (SU13 p340)
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BPH
Hyperthremia/ fever Elderly GI obstruction Acute- angle glaucoma* (important) |
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Identify the following drugs as a direct cholinergic agonist, anti-cholinesterase, anti- muscarinic, or cholinesterase regeneratior
Physostigmine, Pilocarpine, Oxybutynin, Atropine, Donepezil, Pralidoxime, Bethanechol, Neostigmine, Darifenacin, Iparatropium, Tropicamide, Benztropine, Scopolamine, Edrophoinum, Tolterodine,Trospium, Rivastigmine, Homatropine, Pyroidostigmine, Carbachol **** 4/5 star topic |
• Physostigmine – Anticholinesterase
• Pilocarpine – Direct Muscarinic agonist • Oxybutynin – Muscarinic antagonist • Atropine – Muscarinic antagonist • Donepezil – Anticholinesterase • Pralidoxime – Regenerator of acetylcholinesterase • Bethanechol – Cholinergic agonist • Neostigmine - Anticholinesterase • Darifenacin – Muscarinic antagonist • Ipratropium – Muscarinic antagonist • Tropicamide – Muscarinic antagonist • Benztropine – Muscarinic antagonist • Scopolamine – Muscarinic antagonist • Edrophonium – Anticholinesterase • Tolterodine – Muscarinic antagonist • Trospium – Muscarinic antagonist • Rivastigmine – Anticholinesterase • Homatropine – Muscarinic antagonist • Pyridostigmine – Anticholinesterase • Carbachol – Cholinergic agonist |
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What other medications have anticholinergic side effects?
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1st generation H1 blockers
-Diphenhydramine (Benadryl) -Doxylamine (Unisom) -Chlorpheniramine Neuroleptics -Thioridazine -Chlorpromazine -Clozapine -Olanzapine Tricyclic antidepressants -Amantadine |
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Lecture 18- Pharm Basics 3
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Cellular communication
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What agents are used in the tx. of urge incontinence?
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• Oxybutynin
• Tolterodine • Darifenacin • Solienacin • Trospium |
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What group of genes is responsible for skeletal development?
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• HOX gene
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What cell types are derived from the neural crest?
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• Autonomic nervous system
• Celiac ganglia • Chromaffin cells of the adrenal medulla • Dorsal root ganglia • Cranial nerves • Schwann cells • Pia mater and arachnoid mater • Bones of the skull • Odontoblasts • Parafollicular (C) cells of the thyroid • Thyroid and laryngeal cartilage • Melanocytes • Aorticopulmonary septum |
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Fill in the diagram of acetylcholine synthesis and neurotransmission
3 Star topic (***) |
Study Guide pg 93
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4 Fates of ACh *** (3 star)
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Bind to its post-synaptic receptor
Bind to an auto-receptor on the pre-synaptic cell which regulates further ACh release Diffuse away from the synaptic cleft Degraded by AChE (Inhibited by neostigmine) |
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Diagram of the Norepinephrine synthesis and neurotransmission
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Study guide pg 94
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G-protein Second Messengers**** (4 star topic)
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7 pass transmembrane receptor
Adrenergic receptors -α1 receptors: Vascular smooth muscle contraction (vasoconstriction) -α2 receptors : Inhibit NE release, Vasodilation -β1 receptors: increase heart rate & myocardial contractility -β2 receptors: Vasodilation, Bronchodilation Cholinergic receptors -M1 receptors: Enteric nervous system, “Rest and digest” -M2 receptors: decrease contractility and heart rate in the Atria at the SA node -M3 receptors: Increase bladder contraction, Increase gut peristalsis, Lacrimation or tearing, Miosis, Bronchoconstriction Other G-protein coupled receptors: Dopamine receptors -D1 receptors: Relax renal vascular smooth muscle -D2 receptors: Found in the brain Histamine receptors -H1 receptors • Allergy symptoms • Pruritis • Bronchoconstriction -H2 receptors: gastric acid secretion Vasopressin receptors (ADH) -V1 receptors: increase vascular smooth muscle contraction -V2 receptors: increase reabsorption in collecting tubule |
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What substances inhibit the reuptake of NE?
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Cocaine
TCAs |
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What substances stimulate the release of NE from neurons?
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Ca2+
Amphetamines Ephedrine Tyramine |
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What G-protein class does each of the following receptor stimulate? (****)
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• α1 – Gq
• α2 – Gi • β1 – Gs • β2 – Gs • M1 – Gq • M2 – Gi • M3 – Gq • D2 – Gi |
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Outline the pathway by which stimulation of a Gs receptor activates protein kinase A (****)
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Gs Stimulates Adenylyl cyclase, which stimulates ATP which leads to an increase in cAMP, which increases Protein Kinase A
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Lecture 19: Endocrine 1
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Endocrine Overview
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Which cytokine is particularly important in maintaining granulomas? (FA13 p216)
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TNF-a
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What is the function of the lysosome? (FA13 p75)
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Breaksdown cellular waste & debris
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Outline the pathway by which stimulation of the Gq receptor activates protein kinase C? (FA13 p231)
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Gq receptors activate phospholipase C
Phospholipase C converts lipids into PIP2 PIP2 activates IP3 & DAG DAG activates protein kinase C |
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Know this list of Hormones/Signaling pathways****
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cAMP
-Anterior Pituitary o FSH o LH o ACTH o TSH -Other hormones that use cAMP: o CRH o hCG o ADH o MSH o PTH o Calcitonin o Glucagon IP3 o GHRH o GnRH o TRH o Oxytocin (posterior pituitary) o ADH (posterior pituitary) Tyrosine kinases o GH o Insulin o Insulin-like growth factor (IGF-1) o Platelet-derived growth factor (PDGF) o Fibroblast growth factor (FGF) o Cytokines o Prolactin cGMP o ANP o Nitric oxide |
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List the steroid hormones (Know)
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Sex hormones
- Estrogen - Progesterone -Testosterone Glucocorticoids Aldosterone Thyroid Hormones Vitamin D |
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Mechanism of Action of Steroid Hormones
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Act on intracellular receptors
Help regulate gene transcription Circulate in the blood bound to Binding Globulins -Clinically important because the availability of the Binding Globulin affects the amount of FREE hormone, which effects the activity of the steroid hormone -Thyroid hormone :Thyroid binding globulin (TBG) -Sex hormones: Sex hormone binding globulin Pregnancy increases sex hormone binding globulin production |
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What hormone has each of the following action(s)?
• Stimulates bone and muscle growth • Stimulates milk production and secretion • Stimulates milk secretion during lactation • Responsible for female secondary sex characterizes • Stimulates metabolic activity • Increases blood glucose level and decreases protein synthesis Responsible for male secondary sex characteristics • Prepares endometrium for implantation / maintenance of pregnancy • Stimulates adrenal cortex to synthesize and secrete cortisol • Stimulates follicle maturation in females and spermatogenesis in males • Increases plasma calcium, increases bone resorption • Decreases plasma calcium, increases bone formation • Stimulates ovulation in females and testosterone synthesis in males • Stimulates thyroid to produce TH and uptake of iodine |
Stimulates bone and muscle growth
-GH, which works by stimulating the production of IGF-1 Stimulates milk production and secretion -Prolactin Stimulates milk secretion during lactation -Oxytocin Responsible for female secondary sex characterizes -Estrogen -Estradiol Stimulates metabolic activity -TH Increases blood glucose level and decreases protein synthesis -Glucocorticoids Responsible for male secondary sex characteristics -Testosterone Prepares endometrium for implantation / maintenance of pregnancy -Progesterone Stimulates adrenal cortex to synthesize and secrete cortisol -ACTH Stimulates follicle maturation in females and spermatogenesis in males -FSH Increases plasma calcium, increases bone resorption -PTH Decreases plasma calcium, increases bone formation -Calcitonin Stimulates ovulation in females and testosterone synthesis in males -LH Stimulates thyroid to produce TH and uptake of iodine -TSH |
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From where is each of the following hormones secreted?
•Growth hormone (GH) anterior pituitary •Thyroid hormone •Glucocorticoids (cortisol) •Progesterone •Prolactin •Oxytocin •Atrial natriuretic hormone (ANH) •Glucagon •Testosterone •Follicle-stimulating hormone (FSH) •Vasopressin (ADH) •Calcitonin •Thyroid-stimulating hormone (TSH) •Epinephrine and Norepinephrine •Insulin •Estradiol •Estriol |
• Growth hormone (GH): Anterior pituitary
• Thyroid hormone: Thyroid gland • Glucocorticoids (cortisol): Adrenal cortex (zona fasciculata) • Progesterone: Ovaries, Placenta • Prolactin: Anterior pituitary • Oxytocin: Made in the hypothalamus (paraventricular nucleus), Stored in the Posterior pituitary • Atrial natriuretic hormone (ANH): Atria of the heart • Glucagon :Alpha cells of the pancreas • Testosterone: Testes in men, Ovaries in women, Zona reticularis of the adrenal cortex • Follicle-stimulating hormone (FSH): Anterior pituitary • Vasopressin (ADH): From the hypothalamus (supraoptic nucleus), Stored in the Posterior pituitary • Calcitonin: Parafollicular cells of the thyroid • Thyroid-stimulating hormone (TSH): Anterior pituitary • Epinephrine and Norepinephrine: Chromaffin cells of the adrenal medulla • Insulin: Beta cells of the pancreas • Estradiol: Ovaries |
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From where is each of the following hormones secreted?
• Estriol • Estrone • Estrogen in males • Parathyroid hormone (PTH) • Somatostatin • Luteinizing hormone (LH) • Mineralocorticoids (aldosterone) • Adrenocorticotropic hormone (ACTH) |
• Estriol: Placenta
• Estrone: Fat cells • Estrogen in males: Testes • Parathyroid hormone (PTH): Parathyroid glands • Somatostatin: Delta cells of the pancreas • Luteinizing hormone (LH): Anterior pituitary • Mineralocorticoids (aldosterone): Zona Glomerulosa of the adrenal cortex • Adrenocorticotropic hormone (ACTH): Anterior pituitary |
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In what part of the cell would you find steroid hormone receptors?
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• Cytoplasm
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What clinical finding would you except to find a man with high sex hormone binding globulin?
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• Low free testosterone leads to Gynecomastia
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What clinical finding would you expect to find in a woman with low sex hormone binding globulin?
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High free testosterone leads to hirsutism
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Lecture 20: Endocrine 2
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Pituitary
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A gardener presents with shortness of breath, salivation, miosis, and diarrhea. What caused this? What is the mechanism of action?
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Cause: Organophosphate poisoning (insecticides)
Mechanism of action: Organophosphates--Inhibitors of acetylcholinesterase causes excess of acetylcholine; cholinergic stimulation of Muscarinic receptors |
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A 30-year-old schizophrenic man now has urinary retention due to his neuroleptic. What do you treat it with?
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Urinary Retention--Caused by anticholinergic effects (many neuroleptics)
Tx: cholinergic agonist (bethanechol) |
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What enzyme catalyzes the conversion of tyrosine to dopa?
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Tyrosine hydroxylase
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A pts MRI reveals replacement of tissue in the sella turcica with CSF. What is the most likely clinical presentation?
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Empty sella
Most are subclinical |
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Which hormones share a common alpha subunit?
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TSH
FSH LH hCG |
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What is the most common presentation of hyperprolactinemia in a female patient?
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• Pre-menopausal: hypogonadism
• Post-menopausal: asymptomatic |
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What are some of the possible clinical features of acromegaly?
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Large hands/feet
Coarse face -Large nose -Large ears -Large tongue Increased spacing of teeth Deep voice Impaired glucose tolerance |
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Rapid fire fact: Inability to breastfeed, amenorrhea, cold intolerance
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Sheehan’s syndrome
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Rapid fire fact: Infertility, galactorrhea and bitemporal hemianopsia
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Prolactinoma
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Lecture 21: Endocrine 3
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Adrenal Steroid synthesis
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What is the precursor molecule of ACTH synthesis?
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Pro-opiomelanocortin (POMC)
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What is required for a molecule to enter into the nucleus through a nuclear pore?
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Nuclear localization signals: 4-8AA sequences that are rich in Lysine, Arginine, Proline
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What are the various clinical applications of atropine?
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•Atropine
- Decrease airway secretions - Pupillary dilation and Cycloplegia - Decrease stomach acid secretion - Decrease gut motility - Decrease urgency/bladder spasms |
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Know the steroid synthesis pathway ***** (5 stars)
Study Guide pg. 117 |
KNOW KNOW KNOW
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What features characterize a deficiency in 3β-hydroxysteroid dehydrogenase?
KNOW! |
•Inability to produce
- Glucocorticoids - Mineralocorticoids - Estrogens - Androgens •Early death, and excessive sodium urine excretion |
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What features characterize a deficiency in 17α-hydroxylase?
KNOW! |
•Inability to produce sex hormones and cortisol
- Phenotypic female unable to mature •Increased production of Mineralocorticoids leads to sodium and fluid retention which causes -HTN |
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What features characterize a deficiency in 21α-hydroxylase?
KNOW! |
•Inability to produce cortisol:
- Increases ACTH •Inability to produce Mineralocorticoids causes: -Hypotension •Increased production of sex hormones causes: -Masculinization |
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What features characterize a deficiency in 11β-hydroxylase?
KNOW! |
•Inability to produce
-Cortisol -Corticosterone -Aldosterone •Increased production of deoxycorticosterone (a weak mineralocorticoid) causes: -HTN •Increased production of sex hormones causes: -Masculinization |
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*** 1 in the first digit = hypertension ***
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• 11β-hydroxylase deficiency: Hypertension and masculinization
• 17α-hydroxylase deficiency: Hypertension • 21α-hydroxylase deficiency: Hypotension and masculinization |
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*** 1 in the second digit = masculinization ***
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•11β-hydroxylase deficiency: Hypertension and masculinization
•17α-hydroxylase deficiency: Hypertension •21α-hydroxylase deficiency: Hypotension and masculinization |
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What are the symptoms of 21α-hydroxylase deficiency?
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HYPOtension
Masculinization |
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What are the symptoms of 11β-hydroxylase deficiency?
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HYPERtension
Masculinization |
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What food substance is an essential starting point in the synthesis of adrenal steroids?
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Cholesterol
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Lecture 22: Endocrine 4
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Glucocorticoids and Cushing Syndrome
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What are the symptoms of inhibiting parasympathetic activity?
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Dry as a bone - Decreased secretions, salivation
Hot as a hare - Increased temperature Red as a beet – peripheral vasodilation Blind as a bat – Mydriasis and Cycloplegia Mad as a hatter – agitation and delirium Bloated as a toad – constipation and urinary retention Tachycardia—decreased vagal output |
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Outline the pathway for the generation of norepinephrine for tyrosine? (FA13 p108) (SU13 p47)
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•Phenylalanine + Phenylalanin hydroxylase produces Tyrosine
•Tyrosine + tyrosine hydroxylase produces DOPA •DOPA + DOPA-decarboxylase & Vit B6 produces Dopamine •Dopamine + Vitamin C produces Norepinephrine |
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What hormones arise from the anterior pituitary?
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• FSH
• LH • ACTH • TSH • Prolactin • Growth hormone • Melanotropin (MSH) |
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An adult male with elevated serum cortisol levels and signs of Cushing syndrome undergoes a dexamethasone suppression test. 1mg of dexamethasone does not decrease cortisol levels, but 8mg does. What is the diagnosis?
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ACTH- producing pituitary tumor (Cushing disease)
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What effect does cortisol have on bone formation and immune system functioning?
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Reduces bone formation & causes immune suppression
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What are the potential side effects of glucocorticoid use? ***HIGH YIELD – 4 stars***
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• Moon facies
• Buffalo humb • Muscle wasting • Truncal obesity • This skin • Easy bruisability • Insomnia • Psychosis • Glaucoma • Acne • Osteoporosis • Peptic ulcers • Glucose intolerance or diabetes |
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Rapid fire fact: Most common causes of Cushing syndrome
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Exogenous steroid use (cortisol)
Ectopic ACTH Cushing disease Adrenal adenoma (rare) |
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Lecture 23: Endocrine 5
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Other Adrenal Pathology
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What hormone has the following actions?
•Stimulates milk secretion during lactation •Stimulates metabolic activity •Increases blood glucose level and decreases protein synthesis •Stimulates ovulation in females and testosterone synthesis in males |
•Stimulates milk secretion during lactation—oxytocin
•Stimulates metabolic activity—Thyroid hormone •Increases blood glucose level and decreases protein synthesis—cortisol •Stimulates ovulation in females and testosterone synthesis in males—LH |
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What enzymes are used in the catabolism of NE?
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•Catechol- O-Methyltransferase (COMT)
•Monoamine Oxidase (MAO) |
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A 50 yo woman complains of double vision, amenorrhea, and headaches. What is the most likely diagnosis?
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•Prolactinoma
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Multiple Endocrine Neoplasia (MEN) *** 3 star topic ***
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•MEN 1
-Parathyroid adenomas -Pituitary adenomas -Pancreatic tumors • MEN 2A - Medullary thyroid cancer: will secrete calcitonin which and deposit in the tissue and build up as amyloid causing amyloidosis - Pheochromocytoma - Parathyroid hyperplasia •MEN 2B -Meduallary thyroid cancer -Pheochromocytoma -Ganglioneuromatosis (mucosal neuromas)—oral & GI ulcers *** Both MEN 2A and MEN 2B are associated with the RET oncogene *** |
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MEN 1 (3 P’s)
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• Parathyroid
• Pituitary • Pancreas |
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MEN 2A ( 2 P’s & 1 M)
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• Parathyroid
• Pheo • Medullary thyroid cancer |
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MEN 2B (1 P & 2 M’s)
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• Pheo
• Meduallary thyroid cancer • Mucosal neuromas |
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What are the clinical manifestations of Addison disease? What is the cause of Addison disease?
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Clinical manifestations
- Increase skin pigmentation -Hypotension -Weakness and malaise -Anorexia and weight loss Cause: Autoimmune destruction of the adrenals -Adrenal atrophy -Decrease aldosterone -Decrease cortisol |
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What tumor locations are associated with the 3 different types of multiple endocrine neoplasia?
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•MEN 1
-Parathyroid -Pituitary -Pancreas •MEN 2A -Parathyroid hyperplasia -Pheochromocytoma -Medullary thyroid cancer •MEN 2B -Medullary thyroid cancer -Pheochromocytoma -Mucosal neuromas |
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What might a lab detect in the urine of a patient with pheochromocytoma?
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•Catecholamine breakdown products
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A very tan child with a pale male presents to your clinic and is found to be hypotensive. What is the most likely diagnosis?
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•Addison disease
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Rapid fire fact: Most common tumor of the adrenal
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Adrenal adenoma
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Rapid fire fact: Most common tumor of the adrenal medulla (in adults)
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Pheochromocytoma
In kids-- neuroblastoma |
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Rapid fire fact: Most common cause of primary hyperaldosteronism
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Adrenal adenoma
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Rapid fire fact: Medical treatment for hyperaldosteronism
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Spironolactone
Eplerenone |
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Rapid fire fact: Medical treatment for pheochromocytoma
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Nonselective alpha-blocker: Phenoxybenzamine, Phentolamine
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Rapid fire fact: Pheochromocytoma, medullary thyroid cancer, and hyperparathyroidism
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MEN 2a
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Rapid fire fact: Pheochromocytoma, medullary thyroid cancer, and mucosal neuromas
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MEN 2B
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Rapid fire fact: Adrenal disease associated with skin hyperpigmentation
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Addinson’s disease
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Rapid fire fact: HTN, hypokalemia, metabolic alkalosis
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Conn syndrome (hyperaldosteronism)
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Lecture 24: Pharm Basics 4
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Sympathetic activation
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What are the symptoms of organophosphate poisoning? What are the symptoms of atropine overdose?
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•Organophosphate poisoning
-Diarrhea -Urination -Miosis -Bronchospasm -Bradycardia -Excitation of skeletal muscle/CNS -Lacrimation -Sweating -Salivation -Abdominal cramping •Atropine overdose -Decreased secretions -Elevated temperature -Constipation -Urinary retention -Cycloplegia and Mydriasis -Confusion and disorientation |
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What are the 3 different G proteins and what are their downstream effects? Which receptors use these G protein?
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•Gq
o Activates phospholipase C o Phospholipase C generates IP3 o IP3 increases intracellular calcium o Generates DAG o DAG activates protein kinase C •Gs o Stimulates adenylyl cyclase o Adenylyl cyclase (ATP--cAMP--Activates protein kinase A) •Gi o Inhibits adenylyl cyclase o Decreases cAMP production o Decreases protein kinase A activity •Gq: H1, α1, V1, M1, M3 •Gi: M2, α2, D2 •Gs: β1, β2, D1, H2, V2 |
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What regulates prolactin secretion from the pituitary?
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•TRH increases prolactin
•Dopamine inhibits prolactin •Prolactin inhibits prolactin |
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Adrenergic Receptors: a1, a2, B1, B2 (very high yield)
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•α1 Stimulation: Vascular smooth muscle contraction
-Increased peripheral resistance -Increased blood pressure -Mydriasis - Increased bladder sphincter muscle contraction •α2 -Only found on certain effector organs: Beta cells of the pancreas, certain smooth muscle cells -Most important location of these receptors: on the pre-synaptic nerve itself -When stimulated: Act to inhibit NE release (negative feedback mechanism), Also inhibit insulin release •β1 Stimulated: -Tachycardia - Increase lipolysis - Increase myocardial contractility -Increase release of renin •β2 Stimulated: -Vasodilation - Slightly decreased peripheral resistance -Bronchodilation - Increase lipolysis - Increase insulin release - Decrease uterine tone |
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Which receptors are stimulated by each of the following sympathomimetics?
α1 α2 β1 β2 |
•Clonidine: α2
•Dopamine - High doses: α1,α2 -Medium doses: β1, β2 -Low doses: D1, D2 •Phenylephrine -α1 > α2 •Albuterol -β2 > β1 •Norepinephrine :α1,α2,β1 •Isoproterenol: β1 = β2 •Epinephrine :α1, α2,β1,β2 •Dobutamine: β1 > β2 •Terbutaline: β2 > β1 |
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Which sympathomimetic matches each of the following statements?
•Given as a nebulizer for asthma •Drug of choice for anaphylaxis •Most common first line agent for patients in cardiogenic shock •Most common first line agent for patients in septic shock •Given SubQ for asthma •Used by ENT to vasoconstrict nasal vessels |
•Given as a nebulizer for asthma
-Albuterol -Levalbuterol •Drug of choice for anaphylaxis -Epinephrine Most common first line agent for patients in cardiogenic shock -Dobutamine •Most common first line agent for patients in septic shock -Norepinephrine •Given SubQ for asthma -Terbutaline •Used by ENT to vasoconstrict nasal vessels -Phenylephrine -Cocaine |
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Lecture 25: Pharm Basics 5
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Sympathetic inhibition
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What is the main inhibitory neurotransmitter of the CNS? In which diseases are levels altered?
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•GABA
•Diseases w/ altered GABA levels: -Decreased GABA: Anxiety, Huntington’s disease (also decreased acetylcholine) |
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What are the classic presenting symptoms of syringomyelia?
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Bilateral loss of pain and temperature sensation in the Upper Extremities
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What drug inhibits the cellular sodium-potassium ATPase?
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Digoxin
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Beta Blockers Adverse Effects ***VERY HIGH YIELD***
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•Erectile dysfunction
•Rebound tachycardia or arrhythmia (if stopped abruptly) •Bronchoconstriction -Avoid in asthmatics •Hypoglycemia/ perceiving hypoglycemia •Contraindications: uncontrolled CHF |
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Will see on test!!! ************
-DOC for aortic dissection -Tachycardia related to cocaine overdose |
•B-blockers are DOC for aortic dissection
•Do NOT give B-blockers for tachycardia related to cocaine overdose -Will cause unopposed a- agonism which will inncrease BP |
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How does blood pressure response to Phenylephrine administration change if an α-blocker is administered beforehand? Why is this different than the change seen when epinephrine is used rather than Phenylephrine?
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•Phenylephrine after α-blocker
-No effect on blood pressure •Epinephrine after α-blocker -β2 vasodilation effect - Which will decrease blood pressure |
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What are the common side effects of β-blockers? Which patient populations should use caution when taking β-blockers? ***HIGH YIELD***
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•Bronchospasm
-Use with caution in: Asthmatics, COPD •Raise blood glucose and mask sympathetic symptoms of hypoglycemia - Use with caution in Diabetics •Bradycardia and AV block -Use caution in acute CHF patients |
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What are the various clinical applications of beta-blockers?
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•Hypertension
•CHF •Supraventricular tachycardia •Angina •MI •Glaucoma |
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Lecture 26: GI I
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Oropharynx
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Direct cholinergic agonists:
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Carbachol
Bethanechol Pilocarpine |
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Cholinergic antagonists
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o Atropine
o Ipratropium Scopolamine Benztropine Oxybutynin Glycopyrrolate |
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Sympathomimetics
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A1, a2, B1, B2 agonist
-Epinephrine A1, a2, B1 agonist -NE D1=D2> B1>a1 agonist -Dopamine B1=B2 agonist -Isoproterenol B2>B1? (video had B1>B2—I need to look this up) agonist -Dobutamine A1> A2 agonist -Phenylephrine |
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Indirect cholinergic agonists (anti-acetylcholinesterase)
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o Neostigmine
o Echothiophate o Donepezil o Edrophonium |
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Nicotinic antagonist
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Hexamethonium
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Cholinesterase regenerator
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Pralidoxime
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A-adrenergic antagonists (a-blockers)
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o Terazosin
o Prazosin o Doxazosin o Phenoxybenzamine (non-selective) o Phentolamine (non-selective) |
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B- blockers
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Non-selective
-Propranolol -Timolol -Labetalol B1-selective -Atenolol -Esmolol -Metoprolol |
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Which portions of the hypothalamus are inhibited by Leptin? Which are stimulated?
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•Leptin
-Inhibits the lateral area -Stimulates the ventromedial nucleus |
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Which cranial nerve relays the following types of information?
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•Hypoxia measured by the carotid body
-Glossopharyngeal nerve (IX) •Motor information for swallowing -Glossopharyngeal nerve (IX) -Vagus nerve (X) •Blood pressure from the aortic arch -Vagus nerve (X) •Salivation from the sublingual glands -Facial nerve (VII) •Salivation form the parotid gland -Glossopharyngeal nerve (IX) •Blood pressure from the carotid -Glossopharyngeal nerve (IX) |
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What is the most common location of salivary gland tumors?
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Parotid Gland
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What is the most common salivary gland tumor? What is the histological appearance of this tumor?
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•Most common salivary tumor
-Pleomorphic adenoma •Histology -Epithelial and Mesenchymal differentiation |
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What is the second most common benign salivary gland tumor?
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•Warthin Tumor -- structural similar to a lymph node
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What is the most common malignant salivary gland tumor (the second most common tumor overall of the salivary gland)
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Mucoepidermoid Carcinoma
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What medication is often used in the treatment of allergic rhinitis, nasal polyps, and Eustachian tube dysfunction?
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Intranasal steroids
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Lewis Notes **** (4 stars)
Posterior 1/3rd of tongue - Origin -Taste - Glossopharyngeal - Sensation - Motor |
Origin-- 3rd & 4th arches
Taste-- Glossopharyngeal (CN IX) Sensation-- Glossopharyngeal (CN IX) Motor-- Hypoglossal n. (CNXII) |
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Lewis notes ****
Taste |
Vagus (CN X)
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Lewis notes **** Anterior 2/3rds of tongue Origin, Taste, Sensation, Motor
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Origin-- 1st arch
Taste-- Facial n. (CN VII) Sensation-- Trigeminal: Mandibular (V3) Motor-- hypoglossal (CN XII) |
