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Week 4-7 Cardiovascular > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Small arteries and arterioles are the greatest contributor to ___ ___ ___.

A

Total peripheral resistance

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2
Q

Normal end-systolic volume is approx. ___ mL and normal end-diastolic volume is approx. ___ mL.

A

Normal ESV - approx. 75 mL

Normal EDV - approx. 150 mL

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3
Q

For any given volume of blood, ventricular pressure depends on ___ of the wall (diastole) and ___ ___ in the wall (systole).

A

Compliance of wall - diastole

Active tension in wall - systole

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4
Q

The ___ ventricle is thicker and ___ compliant than the right ventricle.

A

Left is thicker and less compliant c.f. right

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5
Q

Stroke volume can be increased by increasing end ___ volume and increasing ventricular ___.

A

Increase end diastolic volume

Increase ventricular contractility

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6
Q

The ___ nervous system can increase contractility by the ___ nervous system has NO major role in contractility.

A

SNS can increase contractility

PNS - NO major role in contractility

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7
Q

If contractility ___ or if compliance ___, then pressure generated at any given volume is increased.

A

Contractility increases

Or compliance decreases

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8
Q

Afterload is the load encountered by the ventricle as it commences contraction. Afterload is a ___ load due to arterial hypertension or an LV outflow tract obstruction.

A

Pressure

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9
Q

Preload is the stretch on myocyte fibres before they commence contraction. Preload is a ___ (___-___ ___) load due to increased ___ ___.

A

Preload is a volume (end-diastolic volume) load due to increased venous return

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10
Q

Arteries are ___ compliant than veins.

A

Less

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11
Q

You increase blood in systemic arteries by ___constriction, and NOT by decreasing ___ ___ or decreasing ___ ___ ___.

A

Increase blood in systemic arteries by venoconstriction

NOT by decreasing cardiac output or decreasing total peripheral resistance

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12
Q

65% of total blood volume is in systemic ___, 13% of total blood volume is in systemic ___ and 5% of total blood volume is in systemic ___.

A

65% in systemic veins
13% in systemic arteries
5% in systemic capillaries

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13
Q

In autotransfusion, there is ___constriction to increase volume in arteries if ___ ___ is too low.

A

Venoconstriction to increase volume in arteries if blood pressure is too low

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14
Q

What is the definition of mean circulatory filling pressure?

A

It is the mean vascular pressure that exists after a stop in cardiac output and redistribution of blood, so that all pressures are the same throughout the system

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15
Q

Mean circulatory filling pressure depends on ___ of blood and ___ of vessels. Mean circulatory filling pressure is approx. ___ mmHg.

A

Depends on volume of blood and compliance of vessels

Approx. 7 mmHg

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16
Q

Venous pressure ___ as cardiac output increases.

A

Decreases!

Heart fills with venous blood to increase CO, so venous pressure decreases

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17
Q

If venous pressure drops under ___ pressure, then superficial veins will collapse.

A

Atmospheric

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18
Q

___ ___ ___ is the pressure in the great veins (SVC/IVC) outside the heart, and is slightly higher than ___ ___ pressure.

A

Central venous pressure (approx. 1-5 mmHg)

Slightly higher than right atrial pressure

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19
Q

Bradykinin mediates dilation by acting on ___, but mediates constriction by acting on ___ ___ directly.

A

Dilation - endothelium

Constriction - smooth muscle

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20
Q

Antagonist potency is mostly determined by ___.

A

Affinity

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21
Q

Antagonists may be ___ (binds to same site as agonist) or ___-___ (may bind at receptor, or at other sites).

A

Competitive

Non-competitive

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22
Q

In the context of allosteric modulation, the GABA binding site on the GABA(A) receptor is called the ___ site.

A

Orthosteric

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23
Q

___ bind to the allosteric site on the ___ receptor to increase binding of its ligand resulting in ___ and decreased brain activity.

A

Benzodiazepines
GABA(A) receptor
Hyperpolarisation

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24
Q

Receptor active/orthosteric sites are usually conserved, but there is no evolutionary conservation of ___ binding sites. Therefore, there is significant selectivity between different allosteric receptor subtypes - useful for drug design.

A

Allosteric

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25
Q

Allosteric antagonists produce incomplete ___ so that physiological modulation can continue.

A

Antagonism

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26
Q

If a competitive reversible antagonist doesn’t change the maximum response to an agonist, it is a ___ antagonist.

A

Surmountable

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27
Q

While propranolol (beta adrenoceptor antagonist) can be surmounted by a large dose of ___ (beta adrenoceptor agonist), physical activity/physiological responses may not be able to surmount the antagonism e.g. climbing up stairs.

A

Isoprenaline

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28
Q

ADME refers to ___. What does ADME mean?

A

Pharmacokinetics

ADME is absorption, distribution, metabolism and excretion

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29
Q

Highly lipid soluble drugs may be sequestered in ___, resulting in slow distribution (because capacity is large and blood supply is poor).

A

Fat

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30
Q

Only ___ soluble drugs can cross the BBB.

A

Lipid

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31
Q

Cells act as a reservoir for the antimalarial drug ___ - it accumulates in liver cells which is useful to target the malaria parasite.

A

Quinicrine

32
Q

The does “volume of distribution” mean?

A

Volume of body water in which a drug appears to be dissolved in after it has distributed throughout the body i.e. how widely the drug is distributed

33
Q

Drugs may be eliminated by ___ (mainly by kidney) or ___ (mainly by liver).

A

Excretion - by kidney

Metabolism - by liver

34
Q

In terms of excretion (by kidney), drugs bound to plasma protein are NOT ___.

A

Filtered

35
Q

What does renal clearance mean?

A

The amount of blood from which drug is removed by the kidneys per time (i.e. L/min)

36
Q

Drug metabolism increases ___ solubility to facilitate excretion.

A

Water

37
Q

Phase ___ metabolism creates chemical functional groups on drugs. This often involves the ___ ___ enzymes.

A

Phase I metabolism

Cytochrome p450s

38
Q

Phase ___ metabolism involves ___ of water soluble molecules to functional groups on drugs. Therefore, phase ___ metabolites with added functional groups may undergo phase ___ metabolism.

A

Phase II - conjugation of water soluble molecules to functional groups on drugs
In phase I - addition of functional groups, so can undergo phase II after phase I

39
Q

In anaemia, there is ___ oxygen delivery to tissues except if there is a compensatory increase in ___ ___.

A

Reduced oxygen delivery

Except if there is compensatory increase in cardiac output

40
Q

What are the clinical signs of anaemia?

A

Pallor, lethargy, failure to thrive, hypoxia (e.g. dizziness), ischaemia, tachycardia (usually in acute blood loss c.f. chronic)

41
Q

Anaemia may be classified as regenerative or aregenerative. In regenerative anaemia, ___ is depleted rapidly and therefore, O2 delivery and patient health can deteriorate rapidly.

A

Hb

42
Q

Reticulocytes and polychromasia are signs of ___ production of RBCs, and jaundice, haptoglobins and LDH are signs of ___ destruction.

A

Increased

Increased

43
Q

RBCs are replaced every ___ days, WBCs are replaced every ___-___ days and platelets are replaced every ___ days.

A

RBCs - 120 days
WBCs - 3-5 days
Plts - 10 days

44
Q

In the first weeks of life, haemopoiesis occurs in the ___ ___.

A

Yolk sac

45
Q

From 6 weeks to 7 months of life, haemopoiesis occurs in the ___ and ___. Therefore if there is blood diseases, these organs may be enlarged. From 7 months onwards, blood cells are produced in ___ ___.

A

Liver and spleen

Bone marrow

46
Q

3 main haematinics - nutrients required for RBC production/development in bone marrow?

A

Iron
Vitamin B12
Folate
Vitamin B12 and folate are important for production of all cells, but esp. for rapidly proliferating cells and blood cells

47
Q

What is Virchow’s triad and what are the 3 parts of the triad?

A

Virchow’s triad are the three main factors that contribute to thrombosis
Blood flow - i.e. haemodynamics
Blood composition - i.e. hypercoagulability
Vessel wall i.e. endothelial dysfunction/damage

48
Q

Carbon ___ binds 200x more tightly to haem than O2 - this is because it binds to haem at a straight angle, but O2 binds to haem at an angle of ___ degrees.

A

Monoxide

O2 binds haem at 120 degrees - easily unbound

49
Q

Hb has high affinity for O2 when O2 saturation is ___ (e.g. in the ___). but has lower affinity for O2 when O2 saturation is ___ (e.g. in muscle). The affinity of Hb is represented by a ___ curve on a graph.

A

High affinity when O2 saturation is high e.g. in lungs
Low affinity when O2 saturation is low e.g. in muscle - dissociates from Hb easily and transfers to Mb in muscle
Sigmoidal curve

50
Q

Myoglobin is a monomer therefore, does NOT exhibit ___ unlike Hb.

A

Cooperativity

51
Q

Hb is composed of 2 ___ and 2 ___ subunits.

A

2 alpha and 2 beta

52
Q

O2 is both a ligand and a homotropic (same ligand) ___ modulator of Hb. Therefore, binding of Hb at one site enhances binding of Hb at another site i.e. cooperativity.

A

Allosteric

53
Q

___,___-___ is a heterotropic ___ modulator of Hb. Heterotropic means it is different from the normal ligand of Hb - O2.

A

2,3-bisphosphoglycerate

Allosteric

54
Q

2,3-BPG is synthesised in ___ ___ ___ more than in other tissues.

A

Red blood cells

55
Q

At ___ altitude, 2,3-BPG level increases. This allows more efficient unloading of O2 in tissues.

A

High

56
Q

In RBCs stored before transfusion, there is depletion of ___, therefore there can be temporary but clinically significant impairment of O2 transport.

A

Depletion of 2,3-BPG

57
Q

Foetal Hb (HbF) has ___ affinity for O2 than maternal/adult Hb (HbA).

A

Higher - takes O2 from mother

58
Q

___-___ fibres come from the CNS and ___-___ fibres come from autonomic ganglia.

A

Pre-ganglionic from CNS

Post-ganglionic from autonomic ganglia

59
Q

The autonomic nervous system includes ___ and ___ nervous systems, and is a ___ fibre system - using ___-___ and ___-___ fibres.

A

Sympathetic and parasympathetic nervous systems

2 fibre system - uses pre-ganglionic and post-ganglionic fibres

60
Q

The somatic nervous system is a ___ fibre system that innervates ___ muscle.

A

Single fibre system

Innervates skeletal muscle

61
Q

Parasympathetic ___ are generally close to the organ that the post-ganglionic fibre innervates.

A

Ganglia

62
Q

Sympathetic ganglia are found in the sympathetic ___ near the ___ ___.

A

Sympathetic chain near the spinal cord

63
Q

The major PNS neurotransmitters include ___ and ___.

A

ACh and noradrenaline

64
Q

The amino acid ___ is a precursor in the production of L-DOPA and dopamine and therefore ___ and ___.

A

Tyrosine

Noradrenaline and adrenaline

65
Q

ACh is mainly inactivated by degradation by ___ ___ on the post-junctional membrane into choline and acetate. ___ is recycled.

A

Acetylcholine esterase

Choline

66
Q

Noradrenaline is mainly inactivated by uptake by high-affinity uptake 1 on ___-___ neuron or low-affinity uptake 2 on ___-___ neuron into the synapse.

A

HA uptake 1 on pre-junctional neuron

LA uptake 2 on post-junctional neuron

67
Q

Atropine and curare are ___ of ACh receptors.

A

Antagonists

68
Q

___ inhibits exocytosis of vesicles with ACh so there is no release of ACh into the synapse.

A

Botox

69
Q

Myasthenia gravis is an autoimmune disease in which there are antibodies to ___ ___ receptors on ___ muscle. Antibodies bind to the receptors and activate complement resulting in damage of the muscle membrane and ___ of the receptor.

A

Nicotinic cholinergic receptors on skeletal muscle

Internalisation of receptor

70
Q

Basal release of ___ ___ regulates vascular tone.

A

Nitric oxide

71
Q

Lipid mediators are derived from ___ acid. This has ___ carbons and ___ double bonds.

A

Arachidonic

20 carbons, 4 double bonds (i.e. C20:4)

72
Q

Arachidonic acid is bound to ___ in circulation, then uptaken to cells and ___ in membrane phospholipids.

A

Albumin

Esterified in membrane phospholipids

73
Q

Increase in intracellular calcium activates ___ ___ resulting in the release of arachidonic acid.

A

Phospholipase A2

74
Q

COX enzymes are expressed in ___ cells. COX-1 is ___ expressed for production of physiological prostaglandins, but COX-2 is ___ by inflammatory stimuli e.g. IL-1.

A

ALL cells
COX-1 - constitutive
COX-2 - inducible

75
Q

Aspirin ___ or irreversibly binds to the serine active site of ___ enzymes.

A

Covalently

COX

76
Q

Platelets in the GI circulation are exposed to ___ [aspirin] and because they lack a ___, they cannot re-synthesise ___ enzymes. But [aspirin] in systemic circulation is ___ and endothelial cells have a ___ so they can resynthesise ___. The ___/___ is increased so aspirin is cardioprotective.

A

High [aspirin] to platelets in GI circulation
No nucleus in platelets - no resynthesis of COX enzymes
Low [aspirin] in systemic circulation AND endothelial cells have nuclei
SO they can resynthesise COX anyway
PGI2/TXA2 ratio is increased because endothelium produces PGI2 and platelets produce TXA2 - TXA2 decreases but PGI2 is maintained!

77
Q

Montelukast is a ___ receptor antagonist.

A

Leukotriene

Week 4-7 Cardiovascular (4 decks)

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