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IB 117 > Topic 7: Cardiovascular System & Phytomedicines Cardiovascular Disease, Lipids and & phytomedicines > Flashcards

Topic 7: Cardiovascular System & Phytomedicines Cardiovascular Disease, Lipids and & phytomedicines Flashcards

1
Q

Thrombus

A

a soft gel-like coagulated phase of blood resulting from conversion of fibrinogen to fibrin that may or may not be occlusive to the vessel

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2
Q

Thrombosis

A

clotting in a blood vessel that can result in infarction of tissues supplied by the vessel

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3
Q

Hypertension

A

high arterial blood pressure

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4
Q

Coronary Arteries

A

arteries that provide oxygenated blood to the heart

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5
Q

Coronary Artery Disease (Ischemic Heart Disease)

A

plaque deposition in the coronary arteries which over time can result in a reduction or blockage of the arterial blood supply and oxygen supply to cardiac muscle
if blood supply is reduced or interrupted for a long enough time the cardiac muscle becomes ischemic (low in blood supply) resulting in infarction and death of the muscle tissue supplied by the clogged artery

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6
Q

Angina Pectoris

A

ischemia to the heart from coronary artery disease results in constricting pain in the chest that sometimes radiates to the shoulder and down the inside of the arm

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7
Q

Infarction

A

sudden blood supply insufficiency due to thrombus, emboli, or vascular torsion resulting in a macroscopic area of necrosis due to tissue death

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8
Q

Myocardial Infarction (MI) (Heart Attack)

A

infarction of an area of the heart muscle secondary to coronary artery occlusion
death may result if infarction is sufficiently large and/or in a vulnerable area of the heart muscle

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9
Q

Environmental Triggers that Modulate Genetic Predisposition to Cardiovascular Disease

A
  • diet/overall caloric intake
  • obesity
  • level of physical activity
  • stress, physiological/social
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10
Q

Nutrition Constituents

A
  • protein
  • fats
  • carbohydrates
  • vitamins
  • minerals
  • phytochemicals/secondary metabolite compounds
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11
Q

Plant Constituents in Human Nutrition

A
  • vitamins: carbon containing organic substances present in minute amounts in food plants that are essential to normal metabolism
  • minerals: inorganic substances that contain elements other than carbon and are present in minute amounts in food plants
  • phytochemicals/secondary metabolite compounds: organic substances present in minute amounts in food and medicinal plants that may have beneficial effects for humans
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12
Q

Chemical Classes From Plants

A
  • carbohydrates and lipids: intermediates or products of primary plant metabolism
  • alkaloids: nitrogen atom in heterocyclic ring; major source is flowering plants but also found in toads, ants, birds
  • nitrogen-containing compounds (excluding alkaloids): amino acids, proteins, peptides, amines, cyanogenic glycosides, purines, pyrimidines
  • phenolics, polyphenols: aromatic ring containing at least one hydroxyl group, flavonoids, lignins, tannins, melanin, coumarins, quinones
  • terpenoids: largest group of natural plant compounds, derived from 5-carbon precursor isoprenes, camphor, digitalin, gossypol, carotenoids, cucurbitacins
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13
Q

Protein

A
  • macromolecules with carbon, hydrogen, and nitrogen-containing amino acids in peptide linkages
  • there are 20 amino acids of which 9 are essential in the human diet and all 9 of these are found in plant foods
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14
Q

Carbohydrates

A

-small molecules (mono- and disaccharides):
mono: glucose, fructose, galactose
di: sucrose (glucose + fructose = table sugar), lactose (glucose + galactose = milk sugar
-larger molecules
polysaccharides: starch, glycogen, cellulose
refined grain polysaccharides: much of fiber, phytochemicals and vitamins have been removed
unrefined whole grain polysaccharides: rich in fiber, phytochemicals, vitamins
-inverse relationship between level of fiber in diet and risk for death

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15
Q

Exogenous Fatty Acids (Fat, Saturated Fatty Acids, Trans Fatty Acids)

A

fat: oily or greasy components that contain glycerol esters
saturated fatty acids: possess no double bonds and are solid at room temperature
trans fatty acids: mono- or polylunsaturated vegetable oils are hydrogenated which results in them becoming solid at room temperature; these fats are worse than saturated fats on cardiovascular health

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16
Q

Exogenous Fatty Acids (Unsaturated Fatty Acids, Omega-3 Fatty Acids, Essential Fatty Acids)

A
  • unsaturated fatty acids: possess one or more double or triple bonds and are liquid at room temperature (mono- and polyunsaturated)
  • omega-3 Fatty Acids: polyunsaturated fatty acids with double bond three carbons from methyl moiety (flaxseed oil, walnut oil, hemp oil, salmon oil)
  • essential fatty acids: unsaturated fats from plants essential in human diet (linoleic and linolenic acids found in soy oil)
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17
Q

Dietary and Coronary Artery Disease

A

problem: saturated fat is main dietary factor that influences LDL cholesterol levels; high LDL cholesterol levels contribute to coronary artery disease
dietary solution: reduce saturated fat in diet to high insulin and high triglycerides (not desirable)
protein -> high insulin and high triglycerides (not desirable)
healthy fat -> monounsaturated/polyunsaturated (desirable)

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18
Q

Monounsaturated Oils

A
  • olive oil
  • canola oil
  • peanut oil
  • avocado oil
  • sesame oil
  • almond oil
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19
Q

Omega-3 Fatty Acids

A
  • polyunsaturated fatty acids with double bond three carbons from methyl moiety
  • rich sources of omega-3-fatty acids: flaxseed, walnut, hemp, salmon, and black current oil
  • omega-3-fatty acids reduce risk for cardiovascular disease and have antiinflammatory effects
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20
Q

Endogenous Lipids in Humans

A
  • cholesterol
  • TG = triglycerides
  • LDL = low density lipoprotein
  • HDL = high density lipoprotein
  • desirable to have low cholesterol, TG, and LDL
  • desirable to have high HDL
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21
Q

Coronary Artery Disease (Ischemic Heart Disease)

A
  • plaque deposition in the coronary arteries which over time can result in a reduction or blockage of the arterial blood supply and oxygen supply to cardiac muscle
  • if blood supply is reduced or interrupted for a long enough time the cardiac muscle becomes ischemic (low in blood supply) resulting in infarction and death of the muscle tissue supplied by the clogged artery
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22
Q

Dietary Fat and Cardiovascular Health

A

replacing saturated and hydrogenated trans fatty acids with non-hydrogenated monounsaturated and polyunsaturated fats is more effective in preventing coronary artery disease in women than reducing overall fat intake

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23
Q

Syndrome X

A 
-cluster of metabolic abnormalities secondary to insulin resistance and compensatory elevated insulin levels:
high triglycerides
low HDL cholesterol
high blood clotting
high blood pressure
high coronary artery disease
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24
Q

Oxidative Stress on Vascular System

A

-clinical endpoints: TG level and LDL oxidation
high TG level -> high LDL oxidation -> high atherogenesis -> high CAD (coronary artery disease)
low TG level -> low LDL oxidation -> low atherogenesis -> low CAD (coronary artery disease)

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25
Q

Diet and Coronary Artery Disease

A

-problem: saturated fat is main dietary factor that influences LDL cholesterol levels; high LDL cholesterol levels contribute to coronary artery disease
-dietary solution: reduce saturated fat in diet to high insulin and high triglycerides (not desirable)
protein -> high insulin and high triglycerides (not desirable)
healthy fat: mono-/polyunsaturated (desirable)

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26
Q

Diet and Coronary Artery Disease Optimum Nutrient Ratios to Reduce Insulin Resistance

A

15% protein
45% complex carbohydrates
40% fat with majority monounsaturated and polyunsaturated sources
<10% of total calories as saturated fat

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27
Q

Coronary Artery Disease Development

A
  • low-density lipoproteins (LDLs) can be oxidized by free radicals (molecular fragments) and become part of artery clogging plaque
  • flavonoids in tea and other plant foods are thought to cause an antioxidant effect as: free-radical scavengers and/or act on enzymes that influence blood clot formation
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28
Q

Lycopersicum esculenta

A
  • antioxidants/coronary artery disease
  • from Solanum
  • active ingredient: lycopene
  • plant pigment carotenoid found in tomato paste and also in watermelons and grapefruit
  • consumption of lycopene-rich foods work as potent antioxidants to reduce the risk of heart attacks
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29
Q

Vitamin E

A
  • antioxidants/coronary artery disease

- daily vitamin E intake resulted in an angiographic reduction in coronary artery lesion progression

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30
Q

Phytoestrogen Compounds

A
  • isoflavones from Glycine max (soybeans), lignans from Linum usitatissimum (flaxseed), and coumestans in Helianthus annuus (sunflowers)
  • non-steroidal estrogens in foods that contain a phenyl substitute like estradiol
  • have affinities for estrogen receptors in humans
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31
Q

Phytoestrogens and Atherogenesis

A

-at the site of arterial injury genistein reduces the development of atherogenesis through the following actions:
inhibits platelet activation/aggregation
inhibits thrombin formation
prevents activation of thromboxane A2
prevents activation o fcollagen-induced platelets
inhibits growth factors
enhances vasodilation

32
Q

Aspirin (Overview)

A

-from Filipendula (=Spiraea) ulmaria in Rosaceae and Salix alba in Salicaceae
-common name: meadowsweet from Eurasia
-habitat/habit: small tree in meadows and swamps
-part used: bark
-ethnomedical use: inflammation, pain, fever
-pharmaceuticals: salicylic acid
-chemical class: glycoside
-chemical derivatives: salicylic acid-> acetylization -> acetylsalicylic acid (aspirin)
-

33
Q

Aspirin (Administration)

A 
taken orally as:
analgesic
antiinflammatory
antipyretic
antiplatelet (makes platelets less sticky which reduces likelihood of clot formation)
34
Q

Aspirin (Chemistry)

A

antiimflammatory mechanism of action:
aspirin blocks cyclooxygenase (proostaglandin synthase) which ->
low conversion of arachidonic acid to endoperoxide -> low formation of thromboxane A2
low prostaglandin synthesis/inflammation and inhibits platelet hemostasis (makes platelets less sticky which reduces likelihood of clot formation)
plasma C-reactive protein concentrations may be reduced

35
Q

Aspirin (Antiinflammatory Effects on CV Disease)

A
  • C-reactive protein marker for systemic inflammation
  • base-line plasma C-reactive protein concentrations are higher among men who went on to develop myocardial infarction or ischemic stroke compared to men who did not develop vascular events
  • aspirin consumption -> reduction of plasma C-reactive protein, reduction in myocardial infarctions
36
Q

Aspirin Effect on Platelet Aggregation, Arterial Thrombosis, and Isochemic Heart Disease

A
  • inhibition of platelet aggregation by aspirin reduces the incidence of acute and chronic ischemic complications of atherothrombotic diseases
  • after acute myocardial infarction, aspirin lowers rates of recurrent infarction and death by 20%
  • aspirin reduces myocardial infarctions by 30% in patients with unstable angia
  • best antiplatelet agent for the chronic protection of patients with ischemic heart disease
37
Q

Coumadin

A
  • anticoagulant
  • Melilotus officinalis in the Fabaceae
  • common name: sweet clover
  • geography: Eurasia, naturalized in North America
  • habitat/habit: open fields; herb
  • plant part used: aerial parts
  • ethnomedical uses: carminative, spasmolytic
38
Q

Coumadin (Chemistry)

A

-active compounds: dicoumarol
-chemical derivatives: coumadin (=warfarin Na), phenprocoumon, acenocoumarol
-mechanism of action: antagonizes vitamin K, results in inhibition of formation of prothrombin in the liver which is dependent on vitamin K to form
modern medical use: anticoagulant

39
Q

Antihyperlipidemics

A

Allium sativum in Alliaceae (garlic)
-geography: Eurasian origin, now worldwide
-therapeutic use: fresh garlic taken in diet as an antihyperlipidemic
Avena sativa in Poaceae (oats)
-geography: mediterranean origin, now worldwide
-mechanism of action: oat bran in diet binds lipids in GI tract and reduces its absorption
Pinus spp. in Pinaceae (pine)
-geography: northern hemisphere
-habitat: forests of scandinavia
-active compound: sitostanol (benecol) is a sterol compound
-therapeutic use: benecol margarine is eaten as a food to lower cholesterol

40
Q

Congestive Heart Failure

A
  • cardiac glycosides from plants
  • digoxin (lanoxin) from leaves of Digitalis lanata from Europe
  • digitoxin (chrystodigin) leaves of Digitalis purpurea from Europe
  • ouabain (= G-strophanthin) from seeds of Strophanthus gratus from Africa
41
Q

Digitalis lanata and D. purpurea

A
  • plant family: Scrophulariaceae
  • common name: foxglove
  • geography: europe
  • habitat/habit: gardens, open fields, herb
  • plant part used: leaves
  • ethnomedical uses: cardiac stimulant, congestive heart disease
42
Q

Digitalis lanata

A

-active compounds: digoxin (lanoxin), digitoxin (chrystodigin)
-chemical class: cardiac glycoside steroid
-modern medical uses:
digoxin (lanoxin): congestive heart disease, atrial tachyarrhythmias
digitoxin (chrystodigin): congestive heart disease

43
Q

Digitalis purpurea

A

-active compounds: digitalin, digitoxin
-modern medical uses:
digitoxin (chrystodigin): congestive heart disease
digitalin: cardiotonic
gitalin: cardiotonic

44
Q

Cardiac Glycosides (Mechanisms of Action)

A

-potent and selective inhibitors of the active transport of sodium and potassium across cell membranes
-site of binding is on:
extracytoplasmic surface alpha subunit of Na+, K+, ATPase
equivalent of an enzymatic cellular “Na+ pump”
-inhibition of alpha subunit of Na+, K+, ATPase results in:
increase of cytosolic Ca+ availability to interact with contractile proteins during systole
increase the force of the cardiac muscle contraction resulting in slower but stronger heart beat
-regulates conduction of electrical impulse through AV (atrial-ventricular) node

45
Q

Cardiac Glycoside Arrow Poisons from Africa

A

Acokantheran oppositifolia

  • plant family: Apocynaceae
  • geography: east and southern Africa
  • ethnomedical use: arrow poison from wood

Strophanthus gratus

  • plant family: Apocynaceae
  • geography: africa
  • ethnomedical use: arrow poison from seeds

active compound: ouabain (=G-strophanthin)
therapeutic use: cardiotonic, congestive heart failure

46
Q

Anti-arrythmic Cardiac Drugs

A
  • verapamil: derived from papaverine extracted from Papaver somniferum from southeastern europe
  • lidocain, procainamide, and tocainide derived from cocaine extracted from Erythroxylum coca from South America
  • quinidine: derived from Cinchona officinalis from teh amazon rainforest of south america
  • atropine: extracted from Atropa belladonna from europe
47
Q

Papaver somniferum

A
  • found in Papaveraceae
  • common name: opium
  • geography: southeastern europe
  • chemical derivative: papaverine -> verapamil
  • mechanisms of action: verapamil: vasodilator of coronary and other arteries, Ca2+ channel blocker
  • modern medical use: verapamil: hypertension, cardiac arrhythmias
48
Q

Cardiac Arrhythmias and Local Anesthesia

A

Erythroxylum coca

  • plant family: Erythroxylaceae
  • common name: coca
  • geography: andes mountains, south america
  • habit: shrub, small tree
  • ethnomedical uses: leaves used as stimulant, cardiac stimulant, enhance endurance, appetite suppressant
49
Q

Cocaine and Derivatives (Mechanisms of Action)

A

local anesthetic
-procain HCl -> blockade of nerve impulses (short duration of action)
-tetracaine -> blockade of nerve impulses (long duration of action)
-lidocaine -> blockade of nerve impulses (intermediate duration of action)
anti-arrhythmic cardiac activity
-lidocaine, tocainide, and procainamide -> block open and inactivated cardiac Na+ channels -> slows conduction

50
Q

Cocaine and Derivatives (Modern Medical Uses)

A

cocaine

  • applied topically by dentists and nose and throat experts
  • local anisthetic
  • local vasoconstrictor that shrinks mucosal tissue

tetracaine
-topical anesthetic applied to cornea by ophthalmologists

procain HCl

  • infiltrative anesthetic used by dentists for nerve blocks
  • local anesthetic and tx of ventricular arrhythmias

tocainide (Tonocard)
-tx of ventricular arrhythmias

procainamide
-tx of supraventricular arrhythmias and ventricular arrhythmias

51
Q

Cinchona officinalis and C. ledgeriana (Overview)

A
  • geography: native to south america, introduced to africa and asia
  • habitat/habit: forest, trees, shrubs
  • plant part used: bark of stem and root
  • ethnomedical use: fever
  • active compounds: alkaloids quinin, quinidine, cinchonidine, cinchonine (over 20 different alkaloids found in bark)
  • chemical derivatives: chloroquine, mefloquine
52
Q

Cinchona officinalis and C. ledgeriana (Chemistry)

A
  • mechanisms of action: antiplasmodial, cardiac antiarrhythmic (quinidine) by blocking Na channels -> block cardiac Na+ channels -> slows conduction
  • modern medical uses: treatment of malaria, cardiac arrhythmias, prevention and treatment of nocturnal recumbancy leg muscle cramps
53
Q

Cardiac Arrhythmias

A

Atropa belladonna

  • plant family: Solanaceae
  • common name: belladonna
  • geography: europe
  • habit: herb
  • plant parts used: leaves, roots
  • pharmaceuticals: atropine, scopolamine (hyoscine)
  • chemical class: alkaloid
54
Q

Atropine for Cardiac Arrhythmias

A
  • mechanisms of action: anticholinergic, at muscarinic type cholinergic receptors
  • modern medical uses:
    atropine: cardiac stimulant, treatment of ventricular bradycardia and premature ventricular contractions associated with a slow atrial rate
55
Q

Angina Pectoris (Crataegus monogyna, C. laevigata, C. oxyacantha, C. spp. (hawthorne) in Rosaceae)

A
  • ethnomedical uses: leaf and flower preparations of this small tree taken to treat coronary artery disease, angina, circulatory disorders
  • mechanisms of action: dilation of coronary arteries
  • modern medical uses: coronary artery disease, angina, circulatory disorders
56
Q

Angina Pectoris (Ammi visnaga in Apiaceae)

A
  • geography: mediterranean environments in southern europe, north africa, naturalized in north america
  • cultural origins: berber in north america
  • ethnomedical use: fruit extract from this herb taken orally to treat angina pectoris and asthma
  • mechanisms of action: increased blood flow to coronary arteries to treat angina pectoris
  • therapeutic use: friend extracts taken orally to treat angina pectoris
57
Q

Angina Pectoris (Theobroma cacao in Malvaceae)

A
  • common name: chocolate
  • principle active compound: theobromine
  • therapeutic uses: smooth muscle relaxant, angina pectoris, coronary artery dilator, myocardial stimulant, diuretic
58
Q

Anti-hypertension Drugs

A
  • metoprolol (lopressor) and atenolol (tenormin) are beta-blockers derived from ephedrine extracted from Ephedra sinica from china
  • verapamil derived from papaverine extracted from Papaver somniferum from southeastern europe
  • dark chocolate and theobromine from Theobroma cocoa from south america
59
Q

Ephedra sinica

A
  • plant family: Gnetaceae
  • common names: E. sinica (Ma Huang)
  • plant part used: aerial parts
  • ethnomedical uses: asthma, sinusitis, stimulant
  • pharmaceutical: ephedrine
  • chemical class: alkaloid
60
Q

Adrenergic Alpha-1 Receptors

A

high arteriole constriction
low gland secretion
low instestinal motility

61
Q

Adrenergic Alpha-2 Receptors

A

low secretion of insulin from beta-islet cells in the pancreas

62
Q

Adrenergic Beta-1 Receptors

A 
high heart rate
high heart contractility
high cardiac conduction velocity
high cardiac automaticity
high renin secretion by kidney which increases blood pressure
63
Q

Adrenergic Beta-2 Receptors

A

high tracheal and bronchiole relaxation and dilation

64
Q

Ephedrine Derivatives That Are Beta Blockers

A

B1 and B2 competitive blockade
-nadolol (corgard): tx hypertension
-timolol (timoptic): tx hypertension and glaucoma
both these medicines can cause bronchospasm in some patients which results in difficulty breathing, so they can not be used in these patients
B1 competitive blockade: tx hypertension
-metoprolol tartate (lopressor)
-atenolol (tenormin)

65
Q

Rauvolfia serpentina

A
  • plant family: Apocynaceae
  • common name: rauvolfia
  • geography: India, Indomalasia
  • habit: climbing shrub
  • plant parts used: root
  • ethnomedical uses in Ayuverdic medicine: antihypertensive, sedative, tranquilizer, antipsychotic
66
Q

Rauvolfia serpentina (Active Compound)

A

resperine

  • mechanism of action: reduce catecholamine and 5-hydroxytrytomine levels in the CNS and peripheral tissues
  • therapeutic uses: psychosis, mania, hypertension
67
Q

Papaver somniferum

A
  • in Papaveraceae
  • common name: opium
  • geography: southeastern europe
  • chemical derivative: papverine -> verapamil
  • mechanism of action (verapamil): vasodilator of coronary and other arteries, Ca2+ channel blocker
  • modern medical use (verapamil): hypertension, cardiac arrhythmias
68
Q

Theobroma cacao

A
  • plant family: Malvaceae
  • ethnomedical uses: dark chocolate taken orally as antihypertensive, reduces coronary artery disease, aphrodisiac
  • active molecule: theobromine
  • mechanism of action: smooth muscle relaxant cause blood vessels to dilate
69
Q

Migrane Headache (tx with caffeine + ergotamine)

A 
sources of caffeine:
-Coffee robusta (coffee)
-Camellia sinensis (tea)
-Theobromacacao (chocolate)
-Cola (cola nut)
source of ergotamine:
-Claviceps purpurea (ergot fungus)
70
Q

Migraine Headache (tx with Tanacetum parthenium)

A

Tanacetum parthenium found in Asteraceae

  • common name: feverfew
  • geographical: SE europe
  • plant part used: inflorescence decoction
  • ethnomedical therapeutical use: migraine headaches, fever
71
Q

Varicose Veins and Chronic Venous Insufficiency

A
  • Aesculus hippocastanum in Hippocastanaceae
  • common name: horse chestnut
  • geography: eurasia
  • habitat: temperate forest tree
  • ethnomedical use: seeds used in europe to treat varicose veins and chronic venous insufficiency
72
Q

Aesculus hippocastanum (Peripheral Vascular Disease tx)

A
  • active compound: aescin
  • mechanism of action: inhibits capillary permeability to protein
  • modern medical use: seed extract applied topically to treat varicose veins and chronic venous insufficiency
73
Q

Theobroma cacao (Peripheral Vascular Disease tx)

A
  • pentoxifylline derived from theobromine
  • common names: chocolate, cacao
  • geography: andes foothills in south america
  • habitat: tropical forest tree
  • plant part used: seeds
  • ethnomedical uses: stimulant, euphoriant
74
Q

Pentoxifylline

A
  • active compounds in Theobroma cacao: alkaloids theobromine, caffeine, theophylline
  • chemical derivative: theobromine -> pentoxifylline
  • thereapeutic uses (theobromine): smooth muscle relaxant, coronary artery dilator to treat angina pectoris, myocardial stimulant, diuretic, CNS stimulant
  • therapeutic uses (pentoxyfylline): peripheral vascular disease, treats chronic occlusive arterial disease with claudication
75
Q

Ginkgo biloba (Peripheral Vascular Disease tx)

A
  • origin: China
  • ethnomedical use: increases blood circulation of brain and extremeties
  • modern therapeutic use: peripheral vascular disease, Raynaud’s disease (poor circulation of hand and feet)
76
Q

Pausinystalia johimbe (Impotence tx)

A
  • common name: Yohimbine
  • plant part used: bark
  • origin: west africa
  • ethnomedical use: taken orally as aphrodisiac in west africa by mny different ethnolinguistic groups
  • active compound: yohimbine taken orally as pharmaceutical
  • mechanism of action: competitive blockade on adrenergic alpha receptors
  • therapeutic use: taken orally as an aphrodisiac and to tx impotence
77
Q

Papaver somniferum (Impotence tx)

A
  • active compound: papaverine (alkaloid) from Papaver somniferum
  • mechanism of action: vasodilator, smooth muscle relaxant
  • therapeutic use: penis injections of papaverine produce prolonged penile erections to treat impotence and as an aphrodisiac

IB 117 (9 decks)

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