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NSG |! 531 |! - |! Rush |! university- |! Advanced |!
Pharmacology |! Exam |! 3 |! with |! verified |!
detailed |! solutions
what |! is |! the |! difference |! between |! cardiac |! myocyte |! action |! potential |! and |! that |! of |! the |! CNS |! or |! ANS? |! - |! Correct |! answer |! ✔nerve |! cell |! action |! potential |! is |! very |! short cardiac |! action |! potential |! is |! much |! longer they |! are |! longer |! to |! have |! adequate |! filling |! time |! in |! order |! to |! get |! a |! good |! contraction |! for |! a |! reasonable |! bolus |! of |! blood the |! only |! way |! this |! can |! happen |! is |! if |! the |! action |! potential |! is |! longer this |! will |! also |! mean |! that |! the |! refractory |! period |! will |! be |! longer What |! are |! the |! 5 |! phases |! of |! the |! non-pacemaker |! action |! potential? |! - |! Correct |! answer |! ✔ 0 |! - |! depolarization 1 |! - |! partial |! repolarization 2 |! - |! plateau 3 |! - |! repolarization 4 |! - |! resting |! membrane |! potential what |! happens |! during |! phase |! 0 |! of |! the |! non-pacemaker |! action |! potential |! - |! Correct |! answer |! ✔depolarization voltage |! gated |! sodium |! channels |! are |! opening |! up |! until |! we |! get |! past |! threshold
what |! happens |! during |! phase |! 1 |! of |! the |! non-pacemaker |! action |! potential |! - |! Correct |! answer |! ✔partial |! repolarization what |! happens |! during |! phase |! 2 |! of |! the |! non-pacemaker |! action |! potential |! - |! Correct |! answer |! ✔plateau calcium |! channels |! open |! (L-type |! because |! they |! are |! long) potassium |! is |! still |! open potassium |! out |! and |! calcium |! in |! - |! they |! are |! opposing |! each |! other |! in |! voltage |! giving |! the |! plateau this |! is |! when |! the |! ventricles |! are |! filling what |! happens |! during |! phase |! 3 |! of |! the |! non-pacemaker |! action |! potential |! - |! Correct |! answer |! ✔repolarization calcium |! channels |! are |! closed potassium |! channels |! are |! the |! only |! thing |! open |! taking |! their |! positive |! charge |! with |! them |! making |! the |! interior |! more |! negative what |! happens |! during |! phase |! 4 |! of |! the |! non-pacemaker |! action |! potential |! - |! Correct |! answer |! ✔resting |! membrane |! potential |! where |! we |! are |! in |! between |! action |! potentials |! there |! is |! no |! net |! change |! in |! ovltage |! inside |! the |! cell When |! does |! contraction |! take |! place? |! - |! Correct |! answer |! ✔begins |! towards |! the |! end |! of |! repolarization |! and |! ends |! at |! some |! point |! during |! repolarization
something |! is |! coming |! to |! open |! voltage |! gated |! calcium |! channels |! (L-type) |! calcium |! comes |! rushing |! in what |! happens |! during |! phase |! 3 |! of |! the |! pacemaker |! action |! potential |! - |! Correct |! answer |! ✔repolarization potassium |! channels |! now |! open |! up, |! potassium |! rushes |! out, |! repolarizes what |! happens |! during |! phase |! 4 |! of |! the |! pacemaker |! action |! potential |! - |! Correct |! answer |! ✔slow |! depolarization with |! potassium |! rushing |! out |! we |! are |! all |! the |! way |! down |! at |! - funny |! sodium |! channels |! open |! up |! until |! voltage |! reaches |! - T-type |! (transient) |! calcium |! channels |! open |! up |! until |! voltage |! reaches |! - L-type |! calcium |! channels |! then |! open |! back |! up Describe |! how |! non-pacemaker |! APs |! can |! mimic |! pacemkaer |! APs |! - |! Correct |! answer |! ✔Hypoxia |! and |! ischemia |! when |! the |! resting |! membrane |! potential |! is |! not |! getting |! enough |! oxygen |! it |! is |! going |! to |! become |! more |! positive |! because |! you |! need |! oxygen |! to |! produce |! ATP. |! If |! we |! are |! deficient |! in |! ATP |! then |! the |! NA |! K |! ATPase |! pump |! wont |! be |! functioning if |! someone |! is |! hypoxic |! in |! a |! focal |! area |! - |! say |! they |! have |! a |! resting |! membrane |! potential |! at |! -45 |! - |! the |! fast |! sodium |! channels |! won't |! open |! - |! they |! start |! using |! calcium |! to |! open |! - |! so |! they |! would |! convert |! into |! action |! potentials |! that |! use |! calcium |! (hence |! how |! they |! mimic |! pacemaker |! APs)
excitation-contraction |! coupling |! - |! Correct |! answer |! ✔sequence |! of |! events |! from |! motor |! neuron |! signaling |! to |! a |! skeletal |! muscle |! fiber |! to |! contraction |! of |! the |! fiber's |! sarcomeres conversion |! of |! depolarizing |! currents |! into |! contractile |! force L-type |! calcium |! channels |! open |! up |! in |! phase |! 2 |! in |! nonpacemaker |! - |! calcium |! comes |! flooding |! into |! myocytes, |! so |! we |! now |! have |! calcium |! in |! the |! cell |! and |! a |! sarcoplasmic |! recticulum |! (a |! resovior |! for |! calcium) receptors |! called |! RYR |! (ligand |! gated |! calcium |! channels) calcium |! then |! comes |! out |! - |! coming |! int |! the |! cell |! from |! the |! calcium |! channels |! and |! the |! sarcoplasmic |! recticulum describe |! how |! calcium |! binds |! to |! cause |! contraction |! - |! Correct |! answer |! ✔when |! there |! is |! an |! influx |! of |! calcium |! in |! the |! cell |! there |! is |! a |! myosin |! head |! separated |! by |! troponin. |! little |! binding |! sites |! for |! the |! myosin |! exist |! on |! the |! aktin |! but |! it |! can't |! get |! to |! it |! because |! of |! the |! troponin. |! calcium |! therefore |! binds |! to |! the |! tropinin |! causing |! a |! confirmational |! change |! in |! troponin |! so |! it |! will |! move |! and |! take |! the |! tropomyosin |! with |! it. |! the |! myosin |! can |! then |! bind |! to |! the |! aktin |! molecules |! when |! it |! binds |! it |! activates |! ATP the |! ATP |! will |! be |! used |! to |! generate |! the |! sliding |! of |! the |! aktin |! and |! the |! myosin |! filaments |! against |! each |! other |! shortening |! the |! muscle |! cell |! causing |! contraction Describe |! how |! adrenergic |! stimulation |! increases |! the |! force |! of |! contraction |! through |! inotropic |! effects |! - |! Correct |! answer |! ✔NE |! and |! epi |! bind |! to |! adenylyl |! cyclase |! coupled |! g |! proteins |! (beta |! 1) leads |! to |! phosphorylation |! of |! Ca |! channels |! and |! opens |! them increases |! inward |! movement |! of |! Ca there |! is |! also |! increased |! release |! of |! Ca |! from |! the |! SR
can |! bind |! to |! t-type |! calcium |! channel |! - |! opens |! after |! funny |! sodium |! and |! before |! L-type |! - |! if |! it |! binds |! it |! will |! inhibit |! it |! which |! will |! decrease |! the |! heart |! rate it |! can |! also |! bind |! to |! potassium |! channels |! increasing |! intracellular |! potassium |! causes |! repolarization |! and |! actually |! hyperpolarization both |! will |! have |! negative |! chronotropic |! effects |! and |! decrease |! the |! heart |! rate reduces |! opening |! of |! Ca2 |! channels |! on |! the |! surface |! of |! the |! nodal |! cells |! - |! Ach |! opens |! K+ |! channels |! and |! hyperpolarizes |! nodal |! cells |! moving |! them |! further |! away |! from |! threshold heart |! block |! - |! Correct |! answer |! ✔one |! of |! the |! main |! phenomena |! causing |! pathological |! disturbances |! in |! rhythms arises |! from |! fibrosis |! or |! ischemia |! damage |! in |! the |! conducting |! system |! - |! usually |! in |! the |! AV |! node ectopic |! pacemaker |! - |! Correct |! answer |! ✔one |! of |! the |! main |! phenomena |! causing |! pathological |! disturbances |! in |! rhythms pacemaker |! activity |! can |! arise |! from |! other |! tissue |! when |! there |! is |! ischemia |! or increased |! catecholamines |! they |! increase |! intracellular |! Ca2 |! concentration |! raise |! resting |! membrane |! potential |! and |! can |! close |! Na |! channels after |! depolarizations |! - |! Correct |! answer |! ✔one |! of |! the |! main |! phenomena |! causing |! pathological |! disturbances |! in |! rhythms
-spontaneous |! depolarizations |! of |! nonpacemaker |! cells |! during |! either |! phase |! 3 |! (repolarization) |! or |! phase |! 4 |! (RMP); |! occur |! after |! ERP what |! causes |! after |! depolarizations |! - |! Correct |! answer |! ✔most |! often |! caused |! by |! elevated |! intracelluar |! calcium |! that |! triggers |! abnormal |! action |! potentials associated |! with |! hypercalcemia |! and |! excessive |! catecholamines treated |! with |! calcium |! channel |! blockers |! and |! beta |! blockers what |! are |! the |! main |! phenomena |! causing |! pathological |! disturbances |! in |! rhythms |! - |! Correct |! answer |! ✔after-depolarizations heart |! block ectopic |! pacemaker re-entry Re-entry |! - |! Correct |! answer |! ✔one |! of |! the |! main |! phenomena |! causing |! pathological |! disturbances |! in |! rhythms a |! signle |! impulse |! re-enters |! an |! area |! of |! the |! heart |! and |! repeatedly |! excites |! it the |! impulse |! circles |! around |! and |! is |! not |! extinguished typically |! impulses |! run |! into |! each |! other |! and |! die |! out if |! they |! have |! a |! unidirectional |! block |! there |! is |! no |! second |! impulse |! coming |! around |! to |! block |! the |! other |! one |! that |! will |! then |! circle conditions |! leading |! to |! re-entry |! - |! Correct |! answer |! ✔physiologic |! ring unidirectional |! block conduction |! time>ERP
class |! II |! - |! beta |! adrenergic |! blockers class |! III |! - |! potassium |! channel |! blockers |! - |! drugs |! that |! prolong |! cardiac |! action |! potential |! increase |! in |! the |! refractory |! period Class |! IV |! - |! calcium |! channel |! blockers Class |! I |! anti-arrhythmic |! agents |! - |! Correct |! answer |! ✔act |! on |! myocytes |! not |! pacemaker |! cells |! (driven |! by |! sodium) effect |! on |! the |! action |! potential |! is |! to |! prolong |! depolarization |! (phase |! 0) are |! use |! dependent |! because |! they |! work |! better |! at |! faster |! heart |! rates |! (bind |! preferentially |! to |! open |! or |! inactivated |! channels) what |! are |! the |! three |! states |! that |! the |! sodium |! channels |! exist |! in |! - |! Correct |! answer |! ✔threshold depolarizing |! spike refractory Class |! IA |! antiarrhythmics |! - |! Correct |! answer |! ✔-slow |! depolarization |! (phase |! 0) -bind |! to |! open |! Na |! channels -dissociate |! from |! Na |! channels |! with |! intermediate |! kinetics -also |! prolong |! repolarization |! and |! refractory |! period |! by |! blocking |! potassium |! channels examples |! - |! disopyramide, |! quinidine, |! procainamide competitive |! reversible |! antagonists |! - |! prolonging |! repolarization
afib |! atrial |! flutter |! v |! tach Class |! Ib |! anti-arrhythmic |! - |! Correct |! answer |! ✔dissociate |! from |! the |! Na |! channels |! with |! rapid |! kinetics |! (come |! off |! fast |! - |! they |! gon |! on |! and |! stay |! on |! long |! enough |! to |! block |! ectopic |! impulse |! but |! allow |! a |! normal |! impulse |! to |! occur) preferentially |! bind |! to |! inactivated |! channels |! which |! results |! in |! preferential |! effects |! in |! ischemic |! tissue ischemic |! tissues |! characterized |! by |! depolarization they |! take |! longer |! to |! repolarize |! (phase |! 3) thus |! Na |! channels |! are |! in |! inactivated |! state |! longer |! than |! in |! normal |! tissue don't |! bind |! to |! K |! channels |! (no |! effect |! on |! ERP) more |! selective |! - |! look |! for |! areas |! of |! hyperexcitability |! - |! ischemic |! areas |! - |! keep |! in |! inactive |! state |! longer Class |! Ic |! anti-arrhythmic |! - |! Correct |! answer |! ✔dissociate |! from |! Na |! channel |! with |! slow |! kinetics |! - |! stay |! on |! longer bind |! to |! open |! Na |! channels cause |! general |! reduction |! in |! excitability |! because |! they |! stay |! on |! longer don't |! bind |! to |! K |! channels could |! end |! up |! blocking |! a |! normal |! impulse |! because |! they |! stay |! on |! so |! long what |! are |! the |! main |! differences |! in |! action |! with |! Class |! Ia |! Ib |! and |! Ic |! antiarrhythmic |! durgs |! - |! Correct |! answer |! ✔1a |! - |! inbetween |! in |! terms |! of |! fast |! on |! off. |! they |! like |! open |! channels. |! slow |! rate |! of |! depolarization |! prolong |! repolarization
Class |! III |! drugs |! - |! Correct |! answer |! ✔blocking |! of |! K |! channels |! prolong |! action |! potentials |! by |! increasing |! time |! of |! repolarization increase |! the |! refractory |! period |! of |! the |! membrane |! action |! potential |! without |! altering |! the |! phase |! of |! depolarization |! or |! the |! resting |! membrane |! potential block |! K |! channel |! you |! are |! going |! to |! extend |! the |! length |! of |! the |! action |! potential |! increasing |! time |! of |! repolarization class |! III |! drug |! effect |! on |! non-pacemaker |! action |! potential |! - |! Correct |! answer |! ✔substantially |! prolongs |! phase |! 3 class |! IV |! drugs |! - |! Correct |! answer |! ✔block |! L-type |! calcium |! channels slow |! conduction |! through |! SA |! and |! AV |! node |! and |! increase |! the |! duration |! of |! phase |! 0 |! depolarization |! (negative |! chronotropic |! effects) cause |! negative |! inotropic |! effects cause |! dilation |! of |! blood |! vessels we |! don't |! want |! to |! block |! the |! t-type |! which |! bridge |! the |! gap |! from |! funny |! to |! L decrease |! HR |! and |! BP Cardiac |! Glycosides |! (digoxin) |! - |! Correct |! answer |! ✔stimulate |! the |! vagus |! (negative |! chronotropic |! effect) inhibit |! NaKATPase |! pump |! (positive |! inotropic |! effect)
(decreased |! HR |! due |! to |! stimulation |! of |! the |! vagus) |! (increase |! force |! of |! contraction |! due |! to |! action |! on |! the |! pump) increased |! intracellular |! Na |! slows |! the |! extrustion |! of |! Ca |! via |! the |! NaCa |! pump increased |! intracellular |! Ca |! increases |! actin/myosin |! interaction |! and |! force |! of |! contraction digoxin |! inhibits |! the |! Na |! Ca |! exchange |! pump intracellular |! sodium |! is |! going |! to |! effect |! the |! calcium |! out if |! sodium |! is |! higher |! because |! of |! the |! inactivation |! of |! the |! pump |! we |! have |! more |! calcium |! hanging |! around |! so |! force |! of |! contraction |! goes |! up. inflammation |! - |! Correct |! answer |! ✔response |! to |! injury |! or |! infection involves |! redness, |! swelling, |! heat, |! loss |! of |! function histamine |! release |! - |! Correct |! answer |! ✔released |! by |! basophils |! (circulating |! in |! the |! plasma) |! and |! mast |! cells |! (extravasate |! from |! the |! plasma |! and |! get |! in |! tissue) |! in |! response |! to |! direct |! trauma |! or |! exposure |! to |! allergen both |! WBCs |! contain |! histamine |! waiting |! to |! be |! released |! in |! response |! to |! direct |! trauma |! or |! allergen what |! produces |! IgE |! - |! Correct |! answer |! ✔b |! lymphocytes |! in |! response |! to |! exposure |! to |! allergen each |! antibody |! has |! a |! part |! of |! the |! antibody |! that |! is |! specific |! and |! will |! only |! bind |! to |! its |! allergen another |! part |! has |! the |! FC |! that |! binds |! to |! the |! FC |! receptor |! on |! the |! surface |! of |! cells |! such |! as |! mast |! or |! basophils
effects |! of |! histamine |! on |! the |! heart |! - |! Correct |! answer |! ✔minor |! increase |! in |! contractility |! and |! HR effects |! of |! histamine |! on |! the |! stomach |! - |! Correct |! answer |! ✔increased |! gastric |! acid |! secrtion peptic |! ulcer |! disease, |! heart |! burn effects |! of |! histamine |! on |! the |! CNS |! - |! Correct |! answer |! ✔neurotransmitter circadian |! rhythms, |! wakefulness what |! does |! activation |! of |! the |! histamine |! 1 |! receptor |! increase |! - |! Correct |! answer |! ✔intracellular |! Ca histamine |! binds |! to |! the |! histaminne |! 1 |! receptor histamine |! binds |! to |! g |! coupled activating |! g |! alpha |! cub |! unit phospholipase |! c |! beta IP binds |! to |! ER release |! of |! calcium what |! is |! the |! difference |! between |! H1 |! and |! H2 |! histamine |! receptors |! - |! Correct |! answer |! ✔H1 |! - |! smooth |! muscle, |! contraction |! of |! the |! cells |! in |! the |! vascular |! endothelium, |! weightfulness |! in |! the |! brain
all |! things |! we |! would |! expect |! of |! calcium H2 |! - |! g |! couple |! dlinked |! to |! adenylyl |! cyclase |! increases |! cAMP |! instead how |! does |! H1 |! increase |! smooth |! muscle |! contraction? |! - |! Correct |! answer |! ✔by |! increasing |! Ca increases |! when |! Ca |! enters |! the |! cell |! and |! is |! released |! from |! the |! sarcoplasmic |! reticulum |! simultaneously How |! does |! H2 |! receptor |! activation |! induce |! HCL |! release |! - |! Correct |! answer |! ✔H |! largely |! found |! in |! the |! stomach ATP |! to |! cAMP |! which |! is |! a |! second |! messenger takes |! hydrogen |! potassium |! ATPase |! and |! moves |! it |! from |! the |! cytoplasm |! to |! the |! cell |! membrane every |! time |! the |! pump |! cycles |! it |! pumps |! out |! 1 |! hydrogen |! ion |! and |! pumps |! in |! one |! potassium |! ion hydrogen |! out |! into |! the |! stomach |! binds |! with |! chloride |! and |! forms |! HCl How |! does |! histamine |! act |! in |! the |! CNS |! - |! Correct |! answer |! ✔H3 |! receptors H3 |! on |! the |! presynaptic |! neuron binding |! of |! histamine |! to |! H3 |! receptors |! inhibits |! the |! further |! release |! of |! histamine |! from |! that |! neuron there |! are |! H3 |! receptors |! expressed |! on |! other |! neurons |! other |! than |! those |! that |! release |! histamine |! so |! histamine |! can |! regulate |! the |! release |! of |! other |! neurons
what |! are |! the |! main |! differences |! between |! first |! and |! second |! generation |! antihistamines |! - |! Correct |! answer |! ✔benadryl |! (1st) |! crosses |! BBB |! - |! antimuscarinic |! effects claritin |! (2nd) |! does |! not |! cross |! the |! BBB |! due |! to |! water |! solubility |! and |! does |! not |! have |! antimuscarinic |! effects |! - |! selective Eicosanoids |! - |! Correct |! answer |! ✔lipids |! derived |! from |! arachidonic |! acid prostaglandins, |! thromboxanes, |! and |! leukotrienes similar |! to |! hormones where |! is |! arachidonic |! acid |! located? |! - |! Correct |! answer |! ✔fatty |! acid |! tails |! of |! the |! cell |! membrane what |! does |! phospholipase |! a2 |! do? |! - |! Correct |! answer |! ✔cleaves |! arachidonic |! acid |! off |! the |! phospholipid |! -does |! this |! in |! response |! to |! a |! stimulus activated |! by |! cytokines, |! pH, |! O2, |! temperature, |! etc. when |! is |! the |! rate |! of |! release |! of |! arachidonic |! acid |! increased? |! - |! Correct |! answer |! ✔in |! an |! inflammatory |! state what |! are |! the |! three |! different |! pathways |! that |! arachidonic |! can |! act |! within |! after |! being |! cleaved |! from |! the |! phospholipid |! - |! Correct |! answer |! ✔COX LOX CYP
What |! does |! the |! COX |! pathway |! produce? |! - |! Correct |! answer |! ✔prostaglandins prostacyclins thromboxanes what |! are |! prostaglandins |! involved |! in |! - |! Correct |! answer |! ✔inflammation |! and |! pain in |! the |! stomach |! increase |! mucous |! secretion |! which |! provides |! protection |! against |! the |! low |! pH |! environment maintain |! blood |! flow |! in |! kidneys maintain |! vascular |! homeostasis what |! are |! prostacyclins |! involved |! in |! - |! Correct |! answer |! ✔proliferation what |! are |! thromboxanes |! involved |! in |! - |! Correct |! answer |! ✔platelet |! aggregation Cox |! 1 |! - |! Correct |! answer |! ✔enzyme |! that |! is |! expressed |! in |! virtually |! all |! tissues when |! arachidonic |! acid |! is |! cleaved |! off |! and |! acted |! on |! by |! cox |! 1 |! we |! get |! prostaglandins cox-1 |! are |! also |! in |! platelets |! so |! that |! they |! can |! produce |! thromboxane |! when |! their |! arachidonic |! acid |! is |! acted |! on Cox |! 2 |! - |! Correct |! answer |! ✔not |! present |! already |! - |! it |! is |! induced |! in |! response |! to |! a |! stimulus an |! inflammatory |! signal |! like |! cytokines |! is |! what |! causes |! certain |! cells |! to |! synthesize |! cox-2 |! - |! (WBC |! in |! response |! to |! cytokines)
