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P1: Physiology > 9/21/20 Exam 2 Content > Flashcards

9/21/20 Exam 2 Content Flashcards

1
Q

Endothelin-1 causes contraction of ______

A

smooth muscle

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2
Q

Endothelin-1 is opposed by ______, which _____expression of endothelin-converting enzyme (ECE) and causes _______

A

nitric oxide
decreases
vasodilation

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3
Q

L-arg

A

L-arginine

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4
Q

NOS

A

nitric oxide synthase

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5
Q

PIP2

A

phosphatidylinositol

4,5-bisphosphate

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6
Q

IP3

A

inositol

1,4,5-triphosphate

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7
Q

cGMP

A

cyclic guanosine monophosphate

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8
Q

Gq

A

G protein coupled receptor q

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9
Q

PAD

A

peripheral arterial disease

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10
Q

PAD is characterized by

A

poor blood flow in vessels outside of the heart and brain

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11
Q

PAD is usually associated with

A

atherosclerosis

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12
Q

PAD is defined by an ankle-brachial index of

A

less than or equal to 0.90

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13
Q

people with PAD have a _____ higher risk of ______ or _____

A

6-7x
heart attack
stroke

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14
Q

Main causes of PAD

A

hardening of arteries

plaque builds up in arteries and narrows/blocks blood flow

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15
Q

What is most commonly affected by PAD

A

arteries of the lower extremities

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16
Q

Risk factors of PAD

A 
smoking
diabetes
obesity (BMI >30)
high blood pressure
high blood cholesterol
age > 50
heart disease
sedentary lifestyle
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17
Q

Symptoms of PAD

A 
leg cramps with activity that stop with rest; intermittent claudication
weak pulses in the legs/feet
thickened, discolored  or slow growing toenails
leg numbness, weakness/pain
leg wounds that don't heal
cold leg/foot, especially unilateral
skin color changes; shiny skin
hair loss on legs
erectile dysfunction in men
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18
Q

ABI

A

ankle-brachial index

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19
Q

how to calculate ABI

A

resting systolic BP is measure bilaterally at the ankle and upper arm–the ratio of the ankle pressure to the brachial pressure is calculated

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20
Q

ABI normal score is

A

> 0.90

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21
Q

ABI mild obstruction score is

A

0.71 - 0.90

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22
Q

ABI moderate obstruction

A

0.41 - 0.70

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23
Q

ABI severe obstruction

A

<0.40

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24
Q

ABI =

A

highest ankle pressure/highest brachial pressure

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25
Q

ankle pressure =

A

pressure at posterior tibial and dorsalis pedis arteries in right and left ankle

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26
Q

brachial pressure =

A

pressure at right or left arm

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27
Q

Atherosclerosis is

A

formation of a fatty streak

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28
Q

Step 1 Atherosclerosis

A

LDL accumulation leads to upregulation of endothelial adhesion molecules and recruitment of monocytes

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29
Q

LDL

A

low density lipoprotein

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30
Q

GM-CSF

A

granulocyte-macrophage colony stimulating factor

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31
Q

M-CSF

A

macrophage-colony stimulating factor

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32
Q

IL-1β

A

interleukin 1β

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33
Q

IL-6

A

interleukin 6

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34
Q

CRP

A

C-reactive protein

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35
Q

Step 2 Atherosclerosis

A

monocytes transmigrate into the space

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36
Q

Step 3 Atherosclerosis

A

stimulation of monocytes by GM-CSF and M-CSF produced by endothelium causes differentiation into macrophage

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37
Q

Step 4 Atherosclerosis

A

smooth muscle cells migrate to the intima and become macrophage-like cells, contributing to the fatty streak

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38
Q

Step 5 Atherosclerosis

A

macrophages express scavenger receptors, which take up cholesterol that hardens into crystals into foam cells

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39
Q

Step 6 Atherosclerosis

A

foam cells release IL-1β, which stimulates smooth muscle cells to secrete IL-6
IL-1β and IL-6 are proinflammatory

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40
Q

Step 7 Atherosclerosis

A

released IL-6 signals the liver to produce C-reactive protein

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41
Q

Biomarkers for atherosclerosis

A

elevated levels of circulating IL-6 and CRP

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42
Q

Hallmark of atherosclerosis

A

collections of lipid-containing macrophages (foam cells) under the arterial endothelium forming nascent plaques (fatty streaks)

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43
Q

systolic

A

upper number in BP in mm Hg

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44
Q

distolic

A

lower number in BP in mm Hg

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45
Q

Normal BP

A

S = less than 120
AND
D = less than 80

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46
Q

Elevated BP

A

S = 120-129
AND
D = less than 80

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47
Q

Stage 1 Hypertension

A

S= 130-139
OR
D= 80-89

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48
Q

Stage 2 Hypertension

A

S= 140 or higher
OR
D= 90 or higher

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49
Q

Hypertensive Crisis (consult doctor immediately)

A

S= higher than 190
and/or
D= higher than 120

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50
Q

Increase in systolic BP are mainly attributed to

A

Atherosclerosis and calcification of the large arteries (large artery resistance–LAR)

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51
Q

Increase in diastolic BP up to age 50 are attributed to

A

peripheral vascular resistance in small vessels

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52
Q

Subsequent decrease in BP is tied to

A

LAR = large artery resistance

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53
Q

LAR

A

large artery resistance

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54
Q

HTN

A

hypertension

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55
Q

The underlying cause of hypertension is unknown in most cases leading to a diagnosis of

A

Essential (primary) Hypertension

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56
Q

how many patients treated for HTN fail to meet goal

A

3 quarters

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57
Q

Essential (primary) hypertension leads to

A

generalized, inappropriate treatment and poor compliance

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58
Q

3 subcategories for BP control

A

local mechanisms
global neural mechanisms
renal-endocrine system

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59
Q

NE

A

norepinephrine

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60
Q

NPY

A

neuropeptide Y

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61
Q

TXA2

A

thromboxane

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62
Q

Et-1

A

endothelin-1

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63
Q

NO

A

nitric oxide

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64
Q

PGI2

A

prostacyclin

65
Q

ANG II

A

angiotensin II

66
Q

AVP

A

arginine vasopressin

67
Q

Epi

A

epinephrine

68
Q

ANP

A

atrial naturetic

69
Q

BNP

A

brain naturetic

70
Q

Vasodilators

A 
Epi
ANP
BNP
Shear
NO
RGI2
Adenosine
71
Q

Vasoconstrictors

A 
Ang II
AVP
Stretch
TXA2
ET-1
NE
NPY
72
Q

Local Mechanisms Acutely:

A

vasoconstriction and vasodilation of arterioles –controlled in part by endolthelial autocrine/paracrine signaling

73
Q

Local Mechanisms Chronically:

A

angiogenesis

74
Q

Angiogenesis

A

new vessels and widening of existing ones

75
Q

myogenic

A

response originates within smooth muscle of vessel

76
Q

metabolic

A

normal cellular waste influences vessel tone

77
Q

endothelial

A

eg: nitric oxide, prostacyclin, endothelin

78
Q

Autoregulation of Organ Blood Flow

A

intrinsic maintenance of local flow despite perfusion pressure fluctuations

79
Q

When challenged with a rise of fall in perfusion pressure

A

the vascular beds of many organs are able to restore normal blood flow without the intermediacy of neural or hormonal signals

80
Q

_____ can autoregulate blood flow based on metabolic needs

A

capillary beds

81
Q

the bayliss effect

A

Myogenic Blood Flow Regulation

82
Q

maintains vascular perfusion and protects smaller downstream vessels

A

myogenic–bayliss effect

83
Q

_____ ability of smooth muscle to respond to changes in mechanical load or intravascular pressure

A

intrinsic

bayliss effect-myogenic

84
Q

______ constrict when pressure rises and dilates when pressure falls

A

Arteries and small arterioles

bayliss effect-myogenic

85
Q

most prominent in cerebral circulation

A

bayliss effect-myogenic

86
Q

Step 1 of Myogenic Blood Flow Regulation

A

vascular smooth muscle

87
Q

Step 2 of Myogenic Blood Flow Regulation

A

pressure increases (stretch)

88
Q

Step 3 of Myogenic Blood Flow Regulation

A

Calcium transient receptor potential & chloride channels open

89
Q

Step 4 of Myogenic Blood Flow Regulation

A

influx of Ca2+

binds with calmodulin

90
Q

Step 5 of Myogenic Blood Flow Regulation

A

activate myosin light chain kinase

phosphorylates myosin

91
Q

Step 6 of Myogenic Blood Flow Regulation

A

constriction partially restores original pressure

92
Q

Myogenic regulation particularly important at the

A

afferent arteriole of the kidney

93
Q

Metabolic Blood Flow Regulation

A

acute local flow regulation & is regulation of blood flow in response to metabolic needs

94
Q

When oxygen or nutrient needs change, endothelial cells

A

release vasoactive substances to dilate or constrict vessels to increase or decrease blood flow and restore local metabolic homeostasis

95
Q

provides short-term control

A

metabolic blood flow regulation

96
Q

Vasodilators released from endothelial cells during metabolic blood flow regulation

A

Metabolic: CO2, K+, H+, lactic acid, adenosine

NOT Metabolic:
histamine
NO

97
Q

restoration of normal blood flow is possible within an

A

autoregulatory range

98
Q

control is local and denervation _______-

A

does not prevent autoregulation

99
Q

MAP

A

mean arterial pressure

100
Q

ICP

A

intracranial pressure

101
Q

CVP

A

central venous pressure

102
Q

CPP =

A

MAP - (ICP or CVP whichever is higher)

103
Q

Autoregulation in the brain formula

A

CPP = MAP - (ICP or CVP)

104
Q

if trying to control BP you dont like

A

dont like vasoconstrictors

105
Q

acts by blocking uptake of adenosine by cells, raising the extracellular concentration

A

dipyridamole

106
Q

Step 1 Adenosine as a Vasodilator

A

Adenosine is formed from the enzymatic breakdown of ATP

107
Q

Step 2 Adenosine as a Vasodilator

A

its exported from cells (especially during hypoxia) and serves as a short-lived messenger

108
Q

adenosine

A

potent vasodilator in most capillary beds–notably in the heart

109
Q

adenosine exerts activity at 4 receptor subtypes

A

A1
A2A
A2B
A3

110
Q

adenosine is not used to treat

A

CAD

111
Q

CAD

A

coronary artery disease

112
Q

adenosine is used for

A

paroxysmal supraventricular tachycardia, because of its hyperemic effect, for cardiac stress testing

113
Q

ANS

A

autonomic nervous system

114
Q

ANS provides

A

global control of blood flow regulating cardiac output and arterial BP

115
Q

SNS

A

sympathetic nervous system

116
Q

SNS is largely responsible for

A

global control of arterial pressures

117
Q

parasympathetic nervous system primarily does what in the global neural mechanisms

A

innervates the heart

118
Q

the most important blood pressure monitors are the

A

arterial baroreceptores

119
Q

respond to stretch and found on the carotid sinus and in the aortic arch

A

mechanoreceptors

120
Q

Mean arterial pressure (MAP) flow from increase in BP (stretch)

A

increase in BP leads to
increase in signaling via cranial nerves IX and X
attenuation of SNS outflow to heart and peripheral vessels–vasodilation resulting in
restoration of normal MAP

121
Q

Mean arterial pressure (MAP) flow from decrease in BP

A

decrease in BP leads to
decrease in signaling which leads to increase of sympathetic nervous system outflow to heart and the peripheral vessels–vasoconstriction which leads to
restoration of normal MAP

122
Q

the arterial baroreceptor reflex is a ________ regulator of MAP

A

short-term

123
Q

together with nonarterial baroreceptor inputs, integrating centers in the brainstem raise or lower the _____ for arterial pressure

A

set-point

124
Q

present in the periphery (carotid arteries, aortic arch) monitor arterial pO2, pCO2, and pH
also monitors others within CNS (medulla) pCO2 and pH

A

chemoreceptors

125
Q

Chemoreceptors monitors what

A

pO2
pCO2
pH

126
Q

what does the carotid bodies do

A

originate the respiratory response of peripheral chemoreception

127
Q

what does the aortic bodies do

A

originate the cardiovascular response

128
Q

a fall in pO2 is

A

hypoxemia

129
Q

increase in pCO2 is

A

hypercapnia

130
Q

fall in pO2, increase in pCO2 or fall in pH ______ sympathetic output

A

increases

131
Q

fall in pO2, increase in pCO2 or fall in pH increases sympathetic output

A

increase inspiratory drive
increase heart rate and force of contraction
increase peripheral vasoconstriction

132
Q

fall in pO2, increase in pCO2 or fall in pH _______ sympathetic output and ______ parasympathetic output which ______ heart rate

A

increases
decreases
increases

133
Q

RAAS

A

Renin-Angiotension-Aldosteron System

134
Q

RAAS is

A

the key mediator of mean arterial blood pressure

135
Q

RAAS compensates

A

hypotension, hypovolemia, and hypoatremia

136
Q

Renin is an enzyme also known as

A

angiotensinogenase

137
Q

an aspartyl protease synthesized in the kidney as the enzymatically inactive prorenin

A

renin (angiotensinogenase)

138
Q

Renin does what to angiotensinogen

A

hydrolyzes angiotnesinogen to angiotensin I

139
Q

renin is the ______ in synthesis of ______

A

rate-determining enzyme

angiotensin II

140
Q

renin is secreted by _______ from ________

A

juxtaglomerular cells

storage granules

141
Q

renin is secreted by juxtaglomerular from storage granules in response to

A

a fall in renal arteriolar pressure (baroreceptors)
SNS stimulation of β-adrenergic receptors
low (Na+) detected by the macula densa

142
Q

a fall in renal arteriolar pressure is

A

baroreceptors

143
Q

transmembrane metalloenzyme

A

ACE

144
Q

ACE

A

angiotensin-converting enzyme

145
Q

ACE has 2 isozymes

A

somatic (sACE)

germinal (gACE; testis)

146
Q

how many catalytic sites in sACE

A

2

147
Q

how many catalytic sites in gACE

A

1

148
Q

how many coordinated Zn ion per site

A

1

149
Q

Ang I –> Ang II activity highest at

A

C-terminal site

150
Q

sACE expressed in vascular endothelium and several tissues, notably in

A

lungs and kidney

151
Q

what is important for male fertility

A

gACE

152
Q

soluble form of ACE released by ________

A

ACE sheddase

153
Q

octapeptide hormone with a central role in cardiovascular homeostasis

A

Angiotensin II (Ang II)

154
Q

what is a potent vasoconstrictor

A

angiotensin II

155
Q

what is a regulator of electrolyte balance by the ______ makes its activity a key target of pharmacological intervention in hypertension management

A

angiotensin II is a regulator and

balanced by the kidney

156
Q

how many angiotensin II receptors are they

A

multiple

157
Q

list some angiotensin receptors

A

AT1 and AT2

158
Q

what mediates most of the responses target by pharmaceuticals

A

AT1

P1: Physiology (2 decks)

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