Clinical Applications for Exam 2

Question 1

What is the babinski reflex in children under 2?

Answer 1

Occurs normally in infants and children under twoy ears old. Reflex involves an upward movement of the big toe and a fanning of the other toes when the sole of the foot is stimulated, due to a reflex contraction of the extensor muscles of the toes.

Question 2

What is the babinski reflex in adults?

Answer 2

Descending pyramidal tracts inhibit this reflex seen in children, in adults the same stimulation usually evokes a downward flexion or curling of the toes. If an adult has the child reflex response it is an indication of CNS damage due to conditions like spinal cord injury, amyotrophic lateral sclerosis, multiple sclerosis, and brain tumors, etc.

Question 3

What does ALS stand for?

Answer 3

Amyotrophic Lateral sclerosis

Question 4

What does ambien inhibit?

Answer 4

a nonbenzodiasepine, ambien, promotes GABA inhibition of the reticular activating system.

Question 5

Kevin’s right foot had a babinski reflex which demonstrated what?

Answer 5

Demonstrated that the corticospinal tract from the left hemisphere was not inhibiting his toe extension like it should (if it was working properly it would have caused flexion of the toes not the babinski reflex seen in kids)

Question 6

What did the cold medication contain that Sofia from the clinical investigation ingested?

Answer 6

Pseudoephedrine.

Question 7

What are sympathomimetic drugs? Give examples

Answer 7

Drugs that mimic the effects of sympathoadrenal stimulation. Such drugs include catecholamines and their analogs, drugs that promote the release of epinephrine and norepinephrine, block their re-uptake from the synaptic cleft, and block their degradation.

Question 8

What are the catecholamines of the body?

Answer 8

Epinephrine, norepinephrine, and dopamine.

Question 9

What abused drugs are sympathomimetic drugs?

Answer 9

Amphetamine, it’s derivatives methamphetamine and mephedrone, and cocaine.

Question 10

What do amphetamine, methamphetamine and mephedrone do that make them sympathomimetic drugs?

Answer 10

Promote the presynaptic release of norepinephrine.

Question 11

What does cocaine do that makes it a sympathomimetic drug?

Answer 11

Blocks the re-uptake of norepinephrine into presynaptic terminals.

Question 12

What does sympathomimetic toxicity cause?

Answer 12

Causes tachycardia, diaphoresis (profuse perspiration), and hypertension, frequently is a cause of cardiac arrest and death from abused drugs.

Question 13

What are Beta Blockers?

Answer 13

Drugs that act as a beta-adrenergic receptor antagonists.

Question 14

Propranolol–what does it target?

Answer 14

It is a beta blocker that is non-selective between beta 1 and beta 2 adrenergic receptors. So it could effect heart rate and contractility as well as dilation of bronchioles and blood vessels. Could help with hypertension but may lead to difficulty breathing because of its antagonistic effects on beta 2 receptors.

Question 15

norepinephrine binding to beta 1 adrenergic receptors causes what? beta 2?

Answer 15

beta 1- increased heart rate and contractility.

beta 2- dilation of bronchioles and blood vessels.

Question 16

Atenolol- target?

Answer 16

a selective beta blocker that targets beta 1 adrenergic receptors causing a lower heart rate and blood pressure in patients with hypertension.

Question 17

What did asthmatics use to inhale as a beta agonist to stimulate beta 2 receptors leading to bronchodilation? What was the problem with it?

Answer 17

Epinephrine, it would act as an agonist and bind to the beta 2 receptors increasing bronchiole dilation, but it wasn’t specific to those receptors so it also bound to beta 1 receptors causing increase heart rate/contractility and blood pressure.

Question 18

What is currently used in inhalers to treat asthmatics?

Answer 18

Selective beta 2 adrenergic receptor agonists such as
Salbutamol (Albuterol)
Terbutaline

Question 19

What normally happens when norepinephrine stimulates alpha 1 adrenergic receptors?

Answer 19

Vasoconstriction in viscera and skin

Question 20

Phenylephrine and Pseudoephedrine are used in what common medications? What drug classification are they? And how do they work?

Answer 20

They are used in cold medications to stimulate alpha 1 adrenergic receptors in the nasal mucosa, promoting vasoconstriction that relieves nasal congestion but can also raise blood pressure. They are alpha agonist drugs.

Question 21

Name a drug that is an agonist to alpha 2 adrenergic receptors. What does it target?

Answer 21

Clonidine, it acts in the CNS to reduce the activity of the sympathoadrenal system, thereby promoting vasodilation and lowering the blood pressure.

Question 22

Atropine is an antagonist to what receptors? What is this drug used for?

Answer 22

A specific antagonist of the muscarinic ACh receptors, and of the effects of postganglionic parasympathetic axons.
Pupil Dilation for eye exams- Inhibits muscle contraction that constricts the pupils.
Blocks the Vagus Nerve- Vagus nerve would normally induce slowing of the heart so atropine can help treat bradycardia and AV node heart block.
Also reduces the production of saliva and mucus, inhibits spasmodic contractions of intestine and the stomach acid secretion of gastritis, so can be given before general anesthesia

Question 23

Nerve gas and organophosphate pesticide poisoning inhibit what? What drug can be used to treat this?

Answer 23

They inhibit acetylcholinesterase which dangerously increases cholinergic transmission. Atropine can be given to treat this.

Question 24

What is Autonomic dysreflexia? What is it caused by?

Answer 24

It is a condition that can cause stroke, pulmonary edema, and myocardial infarction. It occurs in people with spinal cord injuries at or above T6 of the spinal cord.
Normally sympathetic nerves would cause vasoconstriction and increased heart which raises blood pressure. this pressure would be sensed by receptors and signals would be sent via CN IX and X, the brain would then direct an inhibition of sympathetic activity and increase in parasym. But in a person with spinal cord injury the inhibition of sympathetic response cannot descend below the injury. So high sympathetic nerve activity is maintained below the level of the injury = vasoconstriction that can cause hypertension, cold skin, goose bumps. Above the injury you have bradycardia, nasal congestion, sweaty skin, dangerously high blood pressure.

Question 25

What term is given to the techniques used by a person to have limited but significant control over some autonomic responses?
When could this training be used?
And what monitors are involved in this training?

Answer 25

Biofeedback techniques.
Could be used to help control blood pressure, chronic pain, headaches, urinary incontinence, anxiety, etc.
The training involves use of EEG, EMG, Skin conductivity, and GSR.
EEG- electroencephalograph EMG- electromyography
GSR- galvanic skin response

Question 26

Mr. Mendez that visited the ER with blue toes was taking what medications to help him post-MI and stent placement?

Answer 26

Lipitor- statin to lower cholesterol
Plavix- anti-platelet drug
Atenolol- Beta blocker (targets Beta 1)
Lisinopril- blood pressure reducer.

Question 27

What drug caused the adverse effect seen in Mr. Mendez? (blue toes)

Answer 27

Atenolol- an adverse effect was Raynaud Phenomenon. Caused by the blocking of the beta 1 receptors, lead to over constriction of arteries in the toes.

Question 28

Curare blocks what receptors?

Answer 28

Block the cholinergic (ACh), nicotinic receptors.

Question 29

What medication was Rachel taking for her arthritis but that she stopped abruptly because it was making her look “puffy”?

Answer 29

Prednisolone

Question 30

What symptoms made the doctor think Rachel had Grave’s Disease? And what possible tumor does the doctor think she has?

Answer 30

Difficulty sleeping, uncomfortable warm, sweaty, rapid pulse, high BP, bulging eyes, hypoglycemia.
Possible pheochromocytoma.

Question 31

What gland secretes the glucocorticoid hormone cortisol? What medication was Rachel taking that is derived from cortisol?

Answer 31

Adrenal Cortex. She was taking prednisolone. She could take this orally and it would work because it is a steroid hormone, meaning it is still active when ingested.

Question 32

What are anabolic steroids? Common side effects seen in both men and women?

Answer 32

Androgens that promote protein synthesis in muscles as well as many other effects. It can be used for bodybuilding, weightlifting, and other non-medical but is illegal.
Acne, increased aggressiveness, increase risk of cardiovascular disease because of a rise in LDL and fall in HDL cholesterols, and increase risk of liver disease and liver cancer.

Question 33

Why can men taking anabolic steroids develop gynecomastia? Why are they at a risk for male pattern baldness, enlarged prostate, testes atrophying, and reduced sperm count?

Answer 33

Gynecomastia is the appearance of breasts in men. This happens because the anabolic steroids increase the amount of testosterone in the body which is converted in adipose tissue and the liver into estrogens. This increase in estrogens causes the gynecomastia , premature male patterned baldness and enlarged prostate. The high levels of androgens in general inhibit FSH and LH the testes atrophy and sperm count is reduced.

Question 34

What are the side effects for women taking anabolic steroids?

Answer 34

Masculinization, reduced fat, coarsening of the skin, more body hair, growth of the clitoris, deepening of the voice.

Question 35

What can happen to adolescents taking anabolic steroids?

Answer 35

premature closure of epiphyseal plates leading to cessation of growth.

Question 36

What drug do premenopausal patients who are ER positive generally receive?

Answer 36

Tamoxifen- which is a selective estrogen receptor modulator. SERM–has anti-estrogenic effect in the breast, but promotes estrogen actions on bone and the endometrium of the uterus.

Question 37

About 75% of brest cancers test positive for what?

Answer 37

Estrogen Receptor, so they are stimulated to grow by estrogen.

Question 38

What drug do postmenopausal patients who are ER positive generally receive?

Answer 38

Aromatase Inhibitor- a drug that blocks the ability of aromatase to convert testosterone into estradiol.

Question 39

Methyxanthines are a chemical class that includes both theophylline and caffeine. What do these chemicals do?

Answer 39

These compounds block adenosine receptors and inhibit phosphodiesterase. Theophylline is sometimes used medically as a supplementary treatment for asthma if the person is already taking an inhaled beta 2 agonist drug and a corticosteroid to reduce inflammation.

Question 40

Theophylline–describe it’s inhibition process

Answer 40

Inhibition of phosphodiesterase raises the cAMP levels in the cell, enhancing the stimulation of cAMP production by epinephrine’s activation of the beta 2 adrenergic receptors in the bronchioles and promoting bronchodilation.

Question 41

What happens when cAMP levels are raised in myocardial cells?

Answer 41

It duplicates epinephrine action in the heart, causing increased cardiac rate and strength of contraction.

Question 42

What is dwarfism?

Answer 42

Dwarfism is short stature produced by inadequate secretion of growth hormone during childhood, and is often accompanied by a deficiency in the other anterior pituitary hormones. it can be treated with injections of recombinant growth hormone.

Question 43

Gigantism

Answer 43

Caused by over-secretion of GH during childhood, usually the result of an adenoma of the anterior pituitary. Over-secretion of GH during adulthood cannot cause further growth in height because epiphyseal plates are closed. Instead it produces the disfigurement characteristic of acromegaly.

Question 44

Treatment for over secretion of GH in gigantism and acromegaly?

Answer 44

Over secretion of GH for both gigantism and acromegaly can be treated with somatostatin, a hypothalamic hormone that inhibits GH secretion, or by surgery.

Question 45

What is pitocin? When and why may it be given?

Answer 45

A brand name for an oxytocin injection. May be given to a pregnant woman to hasten a vaginal delivery. Oxytocin receptors become more plentiful in the myometrium during pregnancy to promote more forceful contractions. It can be given in premature situations and Rh incompatibility.

Question 46

A syndrome resulting from chronically high levels of glucocorticoids.
What does it cause?
Common causes?

Answer 46

Cushing’s Disease.
Causes lipolysis and redistribution of fat that can produce a “buffalo hump”, a moon face, and other symptoms.
Common causes include sustained high does of glucocorticoid medicines like prednisone, prednisolone, and dexamethasone.
Could also be caused by a pituitary tumor that secretes excessive ACTH or a benign tumor of the adrenal that secretes excessive cortisol without ACTH stimulation.

Question 47

Adrenal Insufficiency–Another name for this disease?

Answer 47

Addison’s Disease

Question 48

What happens in Addison’s disease?

Answer 48

Caused by inadequate secretion of corticosteroids. Inadequate cortisol produces hypoglycemia, inadequate aldosterone, which produces sodium and potassium imbalances, dehydration and dangerously low blood pressure.

Question 49

What causes Primary Adrenal insufficiency? Secondary Adrenal Insufficiency?

Answer 49

Primary- results from autoimmune destruction of the adrenal cortex. Results in minimal corticosteroid secretion and because of the absence of negative feedback, very high ACTH secretion. The high levels stimulate melanocytes causing a darkening of the skin. This can be fatal if not treated by hormone replacements.
Secondary- Caused by inadequate ACTH secretion from the anterior pituitary maybe because of a tumor or more often occurs when a patient takes exogenous corticosteroids, which inhibits the pituitary secretion of ACTH, and then abruptly stops taking them.

Question 50

What is Pheochromocytoma?

Answer 50

Tumor of the catecholamine-secreting cells of the adrenal medulla. Leads to excessive secretion of norepinephrine and epinephrine. This causes vasoconstriction, increased cardiac rate, and strength of contraction, hypertension, and other symptoms. Can lead to heart disease and stroke if not treated with alpha and beta blockers and surgical removal of affected adrenal gland.

Question 51

Examples of exogenous glucocorticoids?

What are they used for?

Answer 51

Prednisone, Prednisolone, and Dexamethasone.
Used medically to suppress humoral and cell mediated portions of the immune system, and suppress inflammation that may results from many causes. Often used to treat asthma, autoimmune disease, and to suppress the immune rejection of transplanted organs.

Question 52

How do exogenous glucocorticoids work?

Answer 52

Work through negative feedback to suppress the secretion of pituitary ACTH and thus can lead to atrophy of the adrenal cortex. This is why the drugs should be tapered off and not stopped abruptly.

Question 53

Which autoimmune disorder is caused by autoantibodies binding to the receptors for TSH on thyroid gland follicular cells?

Answer 53

Grave’s Disease- Causes growth of a goiter, stimulates the excessive secretion of thyroid hormones. Thyroid continues to be stimulated by the thyrotropin receptor antibodies to grow and secrete thyroxine=hyperthyroid.
Bulging of the eyes, exophthalmos, graves disease is the most common cause of hyperthyroidism.
TSH levels are low but thyroxine levels are high.

Question 54

Type one Diabetes mellitus

Answer 54

Fasting hyperglycemia and presence of glucose in the urine. Insulin dependent diabetes, caused by destruction of the beta cells and the resulting lack of insulin secretion.

Question 55

Type two Diabetes mellitus

Answer 55

Fasting hyperglycemia and presence of glucose in the urine. Cause largely by insulin resistance, or decreased tissue sensitivity to the effects of insulin, so that larger than normal amounts of insulin are required to produce a normal effect.

Question 56

What is it called when a pregnant woman experiences insulin secretion that is inadequate to meet the increased demand imposed by the fetus and the anti-insulin effect of placental hormones?

Answer 56

Gestational diabetes

Question 57

DMD, what is it? How is it caused?

Answer 57

Duchenne muscular dystrophy, most severe from of muscular dystrophy usually appears between the ages of three and five. The disease is caused by mutations in a recessive gene located on the X chromosome. So it is passed mother to son. The gene codes for a protein called dystrophin. Dystrophin protein is normally located just under the sarcolemma where it provides support by bridging the cytoskeleton and myofibrils in the muscle fiber with the extracellular matrix. but mutations that cause the MD result in activity induced damage to the sarcolemma that cannot be repaired by the satellite cells.Cause muscle fiber necrosis and replacement by fibrous connective and fatty tissue.

Question 58

What is the name of the condition that produces an increased in the concentration of creatine kinase in the blood, referring to skeletal muscle damage producing muscle weakness and pain?

Answer 58

Rhabdomyolysis

caused by different drugs, various forms of trauma, certain toxins.

Question 59

Another name for Lou Gehrigs Disease

Answer 59

Amyotrophic Lateral Sclerosis (ALS)