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Muscarinic

antagonists ------ Atropine/homatropine/tropicamideBenztropineScopalamineIpratropium

Oxybutynin/glycopyrrolateMethscopolamine/propanthelin

Alzheimer's specific anticholinesterases ------ DonepzilGalantamineRivastigmine

Indirect cholinergic agonists (anticholinesterases) ------ inhibit the breakdown of ACh

with acetylcholinesteraseNeostigmine - reverse NM

blockadePyridostigmineEdrophoniumPhysostigmine - glaucoma + atropine

overdoseEchothiophate

Direct cholinergic agonists ------ stimulate the parasympathetic muscarinic ACh

receptorsBethanecholCarbacholPilocarpineMethacholine- for challenging asthma only!

pKa (acid dissociation constant) ------ the pH at which the amount of the non-protonated

form (A- or B) equals the amount of the protonated form (HA or BH+)

Maintenance dose ------ steady state concentration x clearance

Clearance ------ (0.7 x Vd)/half life

Loading Dose ------ steady state concentration x Vd

Volume of Distribution ------ amount of drug in the body (IV form)/plasma drug

concentration

Nicotinic antagonist ------ hexamethonium

alpha 1 receptor ------ increases vascular smooth muscle contraction, mydriasis,

increases sphincter muscle contractionG-protein q

alpha 2 receptor ------ decreases sympathetic outflowG-protein i

beta 1 receptor ------ increases HR and contractility G-protein s

beta 2 receptor ------ causes vasodilation and bronchodilation with a compensatory

increase in HRG-protein s

M1 receptor ------ CNS, enteric nervous systemG-protein q

M2 receptor ------ decreases HR and contractility of atriaG-protein i

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M3 receptor ------ increases exocrine gland secretions, increased gut peristalsis,

increased bladder contraction, bronchoconstriction G-protein q

D1 receptor ------ relaxes renal vascular smooth muscleG-protein s

D2 receptor ------ modulates NT release in brainG-protein i

Gq protein ------ phospholipase C cleaves lipids to PIP2two pathways:1) IP3 causesincreased calcium2) DAG activates protein kinase C

Gs protein ------ STIMULATES adenylyl cyclase, which increases cAMP, which activates

protein kinase A

Gi protein ------ INHIBITS adenylyl cyclase, which decreases cAMP levels and

decreases protein kinase A

Epinephrine ------ alpha 1/2, beta 1/2used preferentially for anaphylaxis

NE ------ alpha 1/2 > beta 1used for septic shock

isoproterenol ------ beta 1 = beta 2used for AV block

dopamine ------ D1= D2 > beta > alpha used to increase renal perfusion in shock

dobutamine ------ beta 1 > beta 2used for cardiogenic shock

phenylephrine ------ alpha 1 > alpha 2used for vasoconstriction and nasal decongestion

metaproterenol, albuterol, salmeterol, terbutaline ------ selective beta 2 agonists

treatment of asthma

ritodrine ------ beta 2 agonist treatment of premature uterine contractions (a tocolyticagent)

clonidine/alpha-methyldopa ------ centrally acting alpha 2 agonists that decrease

adrenergic outflow for the treatment of HTN

Radial nerve ------ Main extensor nerve of the arm damage causes loss of arm

extension, loss of sensation in posterior arm, loss of sensation in lateral and posterior

hand, WRIST DROP and Saturday Night Palsy

Ulnar nerve ------ innervates small interosseous muscles of the hand damage results in

an inability to abduct/adduct the fingers CLAW HAND- cannot flex DIP of 4/5 digits,

inability to extend the IP joints when trying to straighten fingers

Median nerve ------ innervates the thumb and pronator muscles damage results in an

inability to pronateHand of benediction - loss of PIP flexion in digits 1,2,3 and loss of

DIP flexion in digits 2,3Ape Hand - cannot oppose thumb Carpal tunnel syndrome -

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median nerve entrapment in the carpal tunnel

Musculocutaneous nerve ------ Main flexor innervation of the arm

thoracodoral nerve ------ innervates the latissimus dorsi muscle damage results in an

inability to extend, adduct, and medially rotate the humerus (cannot wipe bottom)

axillary nerve ------ innervates the deltoid musclesuprascapular nerve ------ innervates infraspinatous and supraspinatous muscles

(supraspinatous controls the first ten degrees of arm abduction)

long thoracic nerve ------ innervates serratus anterior muscle damage results in scapular

winging and inability to raise arm above the horizontal

Chronic Granulomatous Disease ------ lack of NADPH oxidase activity (phagocytes can

engulf organisms but cannot generate oxygen free radicals to kill them)Susceptible to

organisms with catalase Test with nitroblue tetrazolium dye

Ataxia-telangiectasia ------ IgA deficiency!Cerebellar ataxia with poor smooth pursuit of

moving targets with eyes. Telangiectasias of the face increased AFP

Wiscott Aldrich Immunodeficiency ------ "WAITER" thrombocytopenia and purpura

eczema recurrent pyogenic infection slow IgM with high IgA

Severe Combined Immunodeficiency ------ no B/T cells! due to an ADENOSINE

DEAMINASE deficiencyPresentation triad: severe recurrent infections, chronic diarrhea,

failure to thriveNO thymic shadow

Thymic Aplasia (DiGeorge's) ------ 3rd/4th pharyngeal pouches fail to develop

(endoderm)no thymus = noT-cells no parathyroids - low calcium - tetany congenitaldefects in heart and great vessels

Bruton's Agammaglobulinemia ------ (remember the B's)x-linked: BoysB-cell deficiency

causes low levels of all Ig's recurrent Bacterial infections

Anti-U1 RNP ------ mixed CT diseases

Anti-smooth muscle ------ autoimmune hepatitis

Anti-glutamatedecarboxylase (ant-glutamic acid) ------ Type 1 DM

MPO-ANCA ------ elevated in pauci-immune crescenteric glomerulonephritis

Anti-desmoglein ------ Pemphigus vulgaris

Anti-hemidesmosomes ------ Bullous pemphigoid

CD55/59 ------ Decay accelerating factor found on WBCs, RBCs, and platelets.Helps

protect against complement-mediated damage.Deficiency of DAF leads to paroxysmal

nocturnal hemoglobinuria (hemosiderinuria, chronic intravascular hemolysis, and

thrombosis)Diagnose with Ham's test - RBCs lyse at a low pH

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IgE ------ Binds mast cells and basophils; cross-links when exposed to allergens to

mediate type one hypersensitivity through release of inflammatory mediators (i.e.

histamine)Activates eosinophils

IgG ------ Main antibody/most abundantDelayedCan cross the placentaIndicative of apast infection

IgA ------ Prevents attachment of bacteria and viruses to mucous membranesDoes NOT

fix complementCan be either a monomer or a dimer

IgM ------ Produced in the immediate response to an antigenFixes complement but does

NOT cross the placentaCIrculates as a pentamer

CD14 ------ Endotoxin receptor found on macrophages

CD16 ------ Binds the Fc portion of IgG. Specific to macrophages and NK cells

Chediak-Higashi Disease ------ Defective LYST genes (lysosomal transport) causes

giant cytoplasmic granules in PMNsPresentation triad:Partial albinismRecurrent

respiratory tract/skin infectionsNeurologic disorders

Cytokines secreted by Th2 cells ------ IL-4, IL-5, IL-10

Generation of antibody diversity ------ 1) Random recombination of VJ or VDJ genes2)

Random combination of heavy chains with light chains3) Somatic hypermutation4)Addition of nucleotides to DNA during recombination by terminal deoxynucleotidyl

transferase

scrotum and thigh draining nodes ------ superficial inguinal nodes

lateral side of the dorsum of foot draining nodes ------ popliteal

testes draining nodes ------ para-aortic nodes

duodenum/jejunum draining nodes ------ superior mesenteric

sigmoid colon draining nodes ------ inferior mesenteric

rectum and anal canal above the pectinate line draining nodes ------ internal iliac

anal canal below the pectinate line ------ superficial inguinal nodes

Upper limb/lateral breast draining nodes ------ axillary

stomach draining nodes ------ celiac

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Transduction ------ Mediated by bacteriophages, which are viruses that insert DNA into

bacterial cells

Transposition ------ A segment of DNA that can "jump" from one location to

another.Allows for gene transfer between plasmids and chromosomes.

Conjugation ------ A bacterial plasmid is replicated and transferred through a pilus fromthe F+ cell. Usually only for plasmid DNA.HFr x F- -- an F+ plasmid can get

incorporated into the bacterial chromosome (HFr cell), which allows for transfer of both

plasmid and chromosomal DNA

Transformation ------ A bacterium's ability to take up DNA from the environment (also

known as competence)

C3a ------ Mediates anaphylaxis thru release of histamine. Basophils and mast cells

degranulate, causing increased vascular permeability, leading to vasodilation,

hypotension, and edema.

Cytokines secreted by Th1 cells ------ IL-2, IFN gamma

Shigella toxin ------ Shiga toxin cleaves host cell rRNA, causing hemolytic uremia

syndrome

Clostridium botulinum toxin ------ Blocks the release of acetylcholine, causing

anticholinergic symptoms and flaccid paralysis

Bacillus anthracis toxin ------ Edema factor IS a bacterial adenylate cyclase -- direct

stimulation of cAMP (does NOT affect Gs)Clostridium tetani toxin ------ Blocks the release of the inhibitory neurotransmitters

GABA and glycine (inhibits the inhibitors)causes lockjaw, spastic paralysis, and risus

sardonicus

Clostridium perfringens toxin ------ alpha toxin/lecithinase - a phospholipase causes gas

gangrene

Bordatella pertussis toxin ------ Increases cAMP by inhibiting Gi protein (inhibits the

inhibitor)Causes whooping cough

E. coli toxin ------ Heat labile toxin stimulates adenylate cyclase; heat-stable toxin

stimulates guanylate cyclase

Vibrio cholera toxin ------ ADP ribosylation of Gs stimulates adenylate cyclase. Chloride

and sodium are pumped out of the cell, causing water to follow, resulting in rice water

diarrhea

Corynebacterium diptheriae toxins ------ an ADP-ribosylating toxin that inactivates

elongation factor 2.Causes pharyngitis and a pseudomembrane in the throat

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Group A strep toxins (strep pyogenes) ------ Scarlet fever-erythrogenic toxin causes a

toxic shock-like syndrome Streprolysin O -- a hemolysin

S. aureus toxins ------ TSST-1 -- a superantigen that mediates toxic shock syndrome

exfoliatoxin - mediates staphylococcal scalded skin syndrome enterotoxins - mediatefood poisoning alpha toxin - mediates hemolysis beta toxin - sphingomyelinase proteins

a/b - mediate hemolysis protein c - mediates leukocyte destruction

Endotoxins ------ Found on the cell membrane of most G(-) bacteria.Made of

lipopolysaccharideGenes located within the bacterial chromosomeMediate fever, shock,

edema, hypotension, and DICPoorly antigenic --- cannot be used to generate vaccines

Exotoxins ------ Found in some G(+) and G(-) bacteria. Secreted from the cell. Genes

for exotoxins are located on bacteriophages or plasmids.HIGH toxicity levelsInduces

high-titer antibodies called antitoxins

IgA protease ------ Enzyme that cleaves IgA.SHiN bacteria (strep pneumo, haemophilus

influenza, neisseria Allows colonization of respiratory mucosa (mucosa is where IgA is

generally found)

Protein A ------ Binds the Fc region of IgG and prevents opsonization and

phagocytosis.Found in staph aureus

Obligate anaerobes ------ Lack catalase and superoxide dismutase, making them

susceptible to oxidative damage.Clostridium, Bacteroides, and Actinomyces Treat with

metronidazole and clindamycin CANNOT treat with aminoglycosides, which requireoxygen to enter a bacterial cell.

MacConkey's agar ------ Used to select for lactose fermenting enterics.Bile salts and

cresyl violet inhibit growth of G(+) organismsLactose and neutral red stain are taken up

by lactose-fermenting bugs

Ziehl-Neelson stain ------ Used to stain for acid-fast organisms

Chocolate agar ------ Supplemented with factors V (NAD+) and X (hematin)Used to grow

Haemophilus influenza

Bacteria that do NOT gram stain ------ "These Rascals May Microscopically Lack

Color"T.pallidum, Rickettsiae, Mycoplasma, Mycobacteria, Legionella monocytogenes,

Chlamydia

Plasmid ------ Circular DNA that contains a variety of genes for antibiotic resistance,

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enzymes, and toxins

Capsule ------ Protects against phagocytosisEncapsulated organisms: Kapsules Shield

SHinKlebsiella, Salmonella, Strep pneumo, Haemophilus influenza type B, Neisseria

meningitidis

Peptidoglycan ------ Provides rigid support and protects bacteria against osmoticpressure.A sugar backbone with cross-linked peptide side chains

Outer membrane of Gram (-) organisms ------ Site of endotoxin/lipopolysaccharide/lipid

AInduces TNF and IL-1

Periplasm ------ The space between the cytoplasmic membrane and the outer

membrane in G(-) bacteria. Contains many hydrolytic enzymes, including many beta-

lactamases

Job's syndrome (Hyperimmunoglobulin E syndrome) ------ Deficient interferon gamma

causes PMNs to fail to respond to chemotactic stimuli (C5a, leukotriene B4, IL-8). High

levels of IgE and eosinophils Presentation triad:eczema recurrent COLD s. aureus

abscesses course facial features also common to have retained primary teeth (two rows

of teeth)

Sleep stages ------ Awake- beta wavesAwake with eyes closed - alpha wavesStage 1

light sleep - theta wavesStage 2 deeper sleep with bruxism - sleep spindles+ k

complexes (most of the night is spent here!)Stage3/4 sleep deepest, NREM sleep -

delta wavesREM sleep - beta wavesParamedian Pontine Reticular Formation ------ also known as the conjugate gaze

center; controls extra ocular movements during REM, as well as any other fast,

horizontal eye movement (such as nystagmus and ciccades)

Elderly sleep changes ------ decreased REM and slow wave sleep, increased REM

latency and awakenings spend most of the night in stages 3/4 of sleep

Exceptions to parental notification for minors ------ Parental consent is NOT required for

emergency situations, treatment of STDs, medical care during pregnancy, management

of drug addition, or provision of oral or barrier contraceptives.

APGAR ------ Appearance, Pulse, Grimace, Activity, Respiration

3 month milestones ------ rolls over, laughs/squeals, can put hands together

6 month milestones ------ can sit up/sit alone, single syllables, pass a cube, and self

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feed

12 month milestones ------ can stand/walk, 1-3 words, can put cube into a cup, can drink

from a cup

15 month milestones ------ can walk backward/run, 6 words, build a two cube tower, use

a fork and spoon18 month milestones ------ can climb stairs/kick a ball, combine words into simple

sentences, build a four cube tower, and brush teeth with help

2 year milestones ------ can jump up, is half understandable to strangers, builds a six

cube tower, washes and dried hands

3 year milestones ------ can jump forward and ride a tricycle, is completely

understandable, can copy lines, dress themselves and play board games ,gender

identity develops between two and three years

4 year milestones ------ Can hop on one foot, copy a cross, button clothes, has

imaginary friends

Preferred Provider Organization ------ much like an HMO, except that it includes an

insurance company, who is charged to be part of the organization.Patients have open

access to specialists.

HMO ------ Health Maintenance OrganizationPrimary care provider is often a gatekeeper

to the specialist, though it is possible to have open access to specialists. Only certain

procedures are paid for, and physician visits are only paid for if the physician is in thenetwork.

CHIP ------ Children's Health Insurance Program matching state and federal government

funding for child health care coverage

Third party payers ------ insurance companies collect money from a large population to

pay medical bills you contribute a certain amount of money, which is then pooled to pay

medical bills for those who need it

Medicaid ------ For the destitute

Medicare ------ For the elderlyPart A - covers the hospitalPart B- covers outpatient

proceduresPart C - medicare parts a/b benefits, but paid by an outside insurerPart D -

prescription drug coverage

Capitation basis ------ a type of physician's payment fixed payment for time

periods/shifts, regardless of the number of procedures or patients seen

Salary-based ------ a type of physician's payment hospitals, HMOs, universities pay a

fixed salary

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Infants - leading causes of death ------ congenital anomalies, short gestation/low birth

weight, SIDS, maternal complications of pregnancy

Ages 1-14 -- leading causes of death ------ Injuries, cancer, congenital anomalies

Ages 15 - 24 -- leading causes of death ------ Accidents, homicide, suicideAges 25 - 64 -- leading causes of death ------ Cancer, heart disease, injuries

Ages 65+ -- leading causes of death ------ Heart disease, cancer, stroke

Fee for service ------ a type of physician's payment billing and coding payment for each

procedure

Confidence Interval ------ Range of values in which a specified probability of the means

of repeated samples would be expected to fall. The "true" population mean is expected

to fall within these values. CI = mean +/- SEM(z)CI for means should not cross 0CI for

odds ratio or relative risk should not include 1

Hawthorne Effect ------ occurs when a group being studies changes its behavior owing

to the knowledge of being studied

Standard Error of the Mean ------ SEM = standard deviation/square root of n

standard deviations ------ 1 - 68%2 - 95%3- 99.7%1.645- 90%

Procedure Bias ------ subjects in different groups are not treated the same for example,

more attention is paid to the treatment group, resulting in greater compliance

Berkson's bias ------ studies performed on patients that have been hospitalized,introducing bias of symptoms, disease severity, access to care, and popularity of the

institution

Pygmalion Effect ------ occurs when a researcher's belief in the efficacy of a treatment

changes the outcome of that treatment

Number Needed to Harm ------ 1/AR

Late-look bias ------ information is gathered at an inappropriate time (a type of recall

bias)for example, using a survey to study a fatal disease, as only those patients that are

still alive can return the survey

Absolute Risk Reduction ------ The reduction in risk associated with a treatment as

compared to a placebo.This is the same as attributable risk, but looks at risk factor

reducers rather than risk factors.

Number Needed to Treat ------ 1/ARR

Relative Risk ------ (a/a+b) / (c/c+d)used for cohort studiesRR

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Attributable Risk ------ (a/a+b) - (c/c+d)the difference in risk between the exposed and

the unexposed groups, or the proportion of disease occurrences that are attributable to

the exposure

Odds ratio ------ ad/bc used in case-control studies approximates the relative risk is the

disease prevalence is lowPrevalence ------ point prevalence = total cases in the population at a given time/total

population at risk at a given time prevalence = incidence x disease duration

Incidence ------ = NEW CASES in the population over a given time period/total

population at risk during that time prevalence is greater than incidence for chronic

diseases prevalence = incidence with acute diseases

Negative Predictive Value ------ Given a negative test result, the likelihood of NOT

having the disease.NPV is inversely regulated with prevalence. Increased prevalence =

decreased NPV.

Positive Predictive Value ------ Given a positive test result, the likelihood of actually

having the disease. PPV increases with increased prevalence of disease, and vice

versa.

Specificity ------ The probability that a person who does not have a disease will test

negative for that disease. Specific tests are used as diagnostic tests, as they are used

to rule disease IN.

Sensitivity ------ The probability that a person with the disease will test positive for that

disease. Sensitive tests are used as screening tests to rule OUT disease (like casting a

very wide net).Meta analysis ------ Pools data from several studies to come to an overall conclusion.

Achieves greater statistical power and is considered to be the highest echelon of

clinical evidence. However, meta-analysis cannot overcome the biases and problems

introduced in individual studies.

Cross-sectional study ------ Collects data from a group of people to asses frequency of

disease (and related risk factors) at a particular point in time. Used to establish disease

prevalence. It can show risk factor association, but does NOT establish causality!

Relative risk ------ Given that a patient has a particular exposure, what is their risk of

developing a specific disease?

Cohort study ------ A group of patients HAS a particular EXPOSURE and researchers

follow them prospectively forward in time to look for development of a disease.Analyze

with Relative Risk

Case-control study ------ Patients HAVE the DISEASE; researchers look retrospectively

for possible exposure (risk factors)Analyze with odds ratio

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Odds ratio ------ Given that the patient has the disease, what are the odds that they had

a particular exposure?

Pompe's disease ------ Restrictive cardiomyopathy and exercise intoleranceFanconi's anemia ------ a genetically inherited anemia that often progresses to AMLshort

stature, increased incidence of tumors/leukemia, aplastic anemia

von Hippel-Lindau disease ------ Autosomal dominant tumor suppressor gene mutation

that results in renal cell carcinoma, hemangioblastoma, angiomatosis, and

pheochromocytoma

Paroxysmal Nocturnal Hemoglobinuria ------ Presents with red urine in the

morningCaused by a deficiency of CD55/59 that results that allows complement to lyse

RBCsPositive Ham test - RBC lysis at low pH

Fanconi's syndrome ------ A proximal tubular reabsorption defect.Polyuria, acidosis,

growth failure, and electrolyte imbalances.

Job's syndrome (hyper-IgE-syndrome) ------ A neutrophil chemotaxis abnormality that

results in recurrent colds, unusual/truncal eczema, high serum IgE, and cold staph

aureus abscesses

Drug Cocktail for the treatment of TB ------

Rifampin

INHPyrazinamide

Ethambutol

Antibiotic used for the prevention of MAI/MAC in AIDs patients ------

Azithromycin

Administer when the patient's CD4 count drops below 100

Side effect of ethambutol ------

Affects the eyes -- causes decreased visual acuity and red-green color blindness

Mechanism of action of INH?

Inhibits mycolic acid synthesis

Side effects of INH? ------

Side effects include drug-induced lupus, neurotoxicity, and hepatotoxicity. Treat

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neurotoxicity with Vitamin B6

What drugs cause drug-induced lupus? ------ Its not "HIPPS" to get lupus

Hydralazine

INHProcainamide

Phenytoin

Sulfonamides

Infections in which Rifampin is used ------

TB

Exposure to HiB or meningococcal meningitis

INHIBITORS of cytochrome P450 ------ "PICK EGS"

Protease inhibitor

INH

Cimetidine

Ketoconazole

Erythromycin

Grapefruit juice

Sulfonamides

INDUCERS of cytochrome P450 ------ "BCG-PQRS"

Barbiturates

Carbamazepine

Griseofulvin

Phenytoin

Quinidine

Rifampin

St. John's Wort

Clinical uses for macrolides ------ "PUS"

atypical Pneumonias -- Legionella, Chlamydia, Mycoplasma

URI's -- strep pneumo

STDs

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Drugs that have photosensitivity reactions ------ "SAT" for a photo

Sulfonamides

Amiodarone

Tetracyclines

Disulfiram-like reactions ------ Inhibition of acetaldehyde dehydrogenase causes a

buildup of acetaldehyde, leading to hangover symptoms such as flushing, headache,

and nausea.

Drugs that cause this reaction include: Metronidazole, Cephalosporins, 1st generation

sulfonylureas, Procarbazine, and disulfiram

High potency neuroleptics ------ Haloperidol, fluphenazine, thiotixene

High-potency neuroleptics are associated with more extra-pyramidal side effects, but

less anticholinergic side effects

Low potency neuroleptics ------ Chlorpromazine, thioridizine

Low potency neuroleptics are associated with less extra-pyramidal side effects, but tend

to have more anticholinergic side effects

Moderate potency neuroleptics ------ Molindone, Loxapine, Trifluperazine

Atypical antipsychotics ------ Olanzapine, Quetipine, Risperidone, Clozapine,

Aripiprazole

Atypical antipsychotics block 5-HT2, alpha, and H1 receptors. They have fewerextrapyramidal and anticholinergic side effects, but will cause weight gain and sedation

due to blockage of the H1 receptors.

Side effect of Clozapine ------ Agranulocytosis, requiring weekly WBC monitoring

Thus, this drug is reserved for refractory cases only.

Buspirone ------ Serotonin receptor agonist

Used to treat GAD ONLY!

Tricyclic antidepressants ------ Inhibit NE and serotonin reuptake.

Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine

Nortriptylene, in particular, has the least anticholinergic side effects, so it is good for

administration in elderly patients.

TCA side effects ------ Convulsions, Coma, Cardiotoxicity

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SSRI's ------ Serotonin-specific reuptake inhibitors

Fluoxetine, paroetine, sertraline, citalopram, fluvoxamine

SSRI side effects ------ Sexual dysfunction

"serotonin syndrome" when given with any drug that increases serotonin (MAOIs,

SNRIs, St John's Work, Tryptophan, amphetamines). Causes hyperthermia, musclerigidity, CV collapse, flushing, diarrhea, and seizures.

SNRIs ------ Inhibit serotonin and NE reptake

Venlafaxine, duloxetine, sibutramine

MAOIs ------ Nonselective MAO inhibition causes increased levels of amine

neurotransmitters (because MAO normally breaks down neurotransmitters).

Phenelzine, tranycypromine, isocarboxazid, selegiline (a selective MAO-B inhibitor, for

the treatment of parkinson's dz).

Can cause hypertensive crisis when given in conjunction with tyramine.

Buproprion ------ Atypical antidepressant that increases NE and DA. Also used for

smoking cessation. Has NO SEXUAL side effects, but lowers the seizure threshold and

may cause seizures in bulemic patients.

Mirtazapine ------ alpha-2 antagonist allows increased release of NE and serotonin from

nerve terminals. Also a potent 5 HT-2/3 receptor antagonist. Causes sedation andincreased appetite, thus making it an appropriate choice for depressed patients with

trouble sleeping or eating.

Trazodone ------ An atypical antidepressant that primarily inhibits serotonin reuptake.

Used for the treatment of insomnia at low dose (requires high doses for antidepressant

effects).

Can cause PRIAPISM!

Diencephalon ------ gives rise to the thalamus and hypothalamus

Mesencephalon ------ gives rise to the midbrain

Telencephalon ------ gives rise to the cerebral hemispheres, amygdala, basal ganglia,

and hippocampus

Metancephalon ------ gives rise to the pons and cerebellum

Myelencephalon ------ gives rise to the medulla

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1st aortic arch ------ gives rise to the maxillary artery

2nd aortic arch ------ gives rise to the stapedial and hyoid arteries

3rd aortic arch ------ gives rise to the common carotid and ICA

4th aortic arch ------ gives rise to the aortic arch on the right, the subclavian artery on theleft

6th aortic arch ------ gives rise to the proximal part of the pulmonary arteries and the

ductus arteriosus (on the left only)

Fetal erythropoiesis ------ "Young Liver Synthesizes Blood"

Order of erythropoiesis - yolk sac, liver, spleen, bone marrow

Right common cardinal vein and right anterior cardinal vein ------ Gives rise to the SVC

Fetal circulation ------ oxygenated blood from the placenta enters the fetus through the

umbilical vein -- bypasses hepatic circulation through the ductus venosis -- enters the

IVC and is dumped into the right atrium, along with blood from the SVC -- from the right

atrium, blood may go through the foramen ovale to the left atrium and out to systemic

circulation, or it may enter the right ventricle -- pulmonary artery -- and be shunted

though the ductus arteriosus into the aorta to go to systemic circulation. VERY LITTLE

blood goes to the fetal lungs!

Right horn of the sinus venosus ------ gives rise to the smooth part of the right atrium

Primitive ventricle ------ gives rise to a portion of the left ventricle

Primitive atria ------ gives rise to the trabeculated right and left atria

Left horn of the sinus venosus ------ gives rise to the coronary sinus

Truncus arteriosus ------ gives rise to the ascending aorta and pulmonary trunk

Bulbus cordis ------ gives rise to the right ventrible and smooth parts of the left and right

ventricle

Vitelline duct abnormalities ------ In the fetus, the vitelline duct connects the yolc sac to

the midgut lumen, and should obliterate by week seven.

Vitelline fistula - failure of duct to close results in meconium discharge from the

umbilicus.

Can also have a Meckel's diverticulus, with only partial closure and a patent portion

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attached to the ileum. Gastric mucosa secretes acid and irritates the gut.

Failure of the urachus to obliterate ------ The urachus is the primitive duct between the

bladder and the yolk sac. Failure of the urachus to obliterate leaves a patent urachus,

with urine discharge from the umbilicus. May also have a vesicourachal diverticulum --an out pouching of the bladder

maternal component of the placenta ------ decidua basalis - derived from the

endometrium

Fetal component of the placenta ------ cytotrophoblast - inner layer of the chorionic villi

(cyto makes cells)

Lithium as a teratogen ------ Causes Ebstein's anomaly (an atrialized right ventricle)

Thalidomide as a teratogen ------ Causes limb defects -- flipper limbs

Valproate and carbamazepine as teratogens ------ Requires that a pregnant woman take

10x the dose of folate, as they inhibit intestinal folate absorption (4g/day)

ACE inhibitors as teratogens ------ Known to cause renal damage (paradoxical in that

you give ACE inhibitors to women to prevent renal damage from HTN)

Aminoglycosides as teratogens ------ CN VIII toxicity

DES as a teratogen ------ known to cause vaginal clear cell adenocarcinoma later in life

syncytiotrophoblast - outer layer of the chorionic villi (secretes hCG, which is structurallysimilar to LH, stimulating the corpus luteum to secrete progesterone during the first

trimester until the placenta can secrete its own hormones)

Mesoderm ------ Muscle/bone/CT and the spleen

Endoderm ------ Enteric structures - gut tube epithelium and its derivatives

Neural crest ------ PNS and non-neural structures

Cranial nerve, melanocytes, chromaffin cells, enterochromaffin cells, parafollicular cells,

bones of the skull, pia, odontoblasts, aorticopulmonary septum

Neuroectoderm ------ CNS and brain structures -- brain, neurohypophesis (posterior

pituitary), neurons, oligodendrocytes, astrocytes, ependymal cells, retinal, spinal cord

Surface ectoderm ------ gives rise to the adenohypophesis (anterior pituitary - from

Rathke's pouch), lens of the eye, epithelial lining of the oral cavity, sensory organs of

the ear, retina, epidermis, salivary, sweat and mammary glands

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Week 1 ------ hCG secretion begins after implantation of the blastocyst

(syncytiotrophoblast secretes hCG)

Week 2 ------ Rule of twos -

2 germ layers (epiblast and hypoblast)

2 cavities (amniotic cavity and yolk sac)2 components to the placenta (cytotrophoblast and syncytiotrophoblast -- fetal

components)

Week 3 ------ Rule of 3's: 3 germ layers (ectoderm, mesoderm, endoderm)

Week 4 ------ Rule of 4's: 4 heart chambers + 4 limb buds

Weeks 3-8: embryonic period ------ neural tube is formed by neuroectoderm and closed

by week four organogenesis extreme susceptibility to teratogens

Week 10 ------ genitalia are present, fetus has male/female characteristics

Homeobox genes ------ Involved in segmental organization

FGF gene ------ (fibroblast growth factor)

Produced at the apical ectodermal ridge and stimulates mitosis of underlying

mesoderm, providing for lengthening of limbs (makes sense, right? problems with this

gene causes achondroplasia)

Sonic Hedgehog gene ------ Produced at the base of the limb buds in the zone of

polarizing activity. Mediates ectodermal functions and is associated with

holoprosencephaly.

Wnt-7 gene ------ Produced at the apical ectodermal ridge; necessary for properorganization along the doral-ventral axis.

Holoprosencephaly ------ Due to a defect in the sonic hedgehog protein, causes

decreased separation of the cerebral hemispheres across the midline, resuling in

cyclopia or eyes that are set very close together. Is associated with trisomy 13 (patau's

syndrome), severe fetal alchohol syndrome, and cleft lip/palate.

Arnold Chiari type II malformation ------ cerebellar tonsillar herniation through the

foramen magnum with aqueductal stenosis and hydrocephaly. Often presents with

syringomyelia or thoracolumbar meningomyelocele.

Dandy Walker malformation ------ large posterior fossa with an absent cerebellar vermis

and cystic enlargement of the fourth ventricle

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Syringomyelia ------

Enlargement of the central canal of the spinal cord. Decussating fibers of the

spinothalamic tract are just anterior to the central canal, and are typically damaged first,

resulting in a cape like distribution of bilateral loss of pain and temperature sensation inthe upper extremities. May also compress the anterior horn, resulting in weakness and

atrophy of the hand muscles.

Most commonly located C8-T1.

Precursor to the brachial arches ------ mesoderm

1st brachial arch ------ think "M's and T's"

Meckel's cartilage, Mandible, Melleus, incus, sphenoMandibular ligament, Muscles of

Mastication -- Masseter, lateral and Medial pterygoids, Mylohyoid, Tensor

Tympani, Tensor veli palatini, anterior 2/3 of the tongue.

Innervated by V2/V3 -- Maxillary and Mandibular divisions of the trigeminal nerve

Maxillary artery

2nd brachial arch ------ Think "s-structures"

Stapes, Syloid process, Stylohyoid ligament, muscles of facial expression, Stapedius,

Stylohyoid

Innervated by CN VII

Stapedial artery

3rd brachial arch ------ think pharyngeal structuresgreater horn of the hyoid , stylopharyngeus, glossopharyngeal nerve (CN IX)

4th/6th brachial arches ------ think structures around the voice box

thyroid, cricoid, arytenoid, corniculate and cuneiform cartilages, cricothyroid, pharyngeal

constrictors, muscles of the larynx

Innervated by CN X

Precursor of the brachial clefts ------ eCtoderm

1st brachial cleft ------ develops into the external auditory meatus

2nd through 4th brachial clefts ------ form temporary cervical sinuses that should be

obliterated by proliferation of the 2nd arch mesenchyme. Persistent cervical

sinus -- brachial cleft cyst within the lateral neck

Precursor to the brachial pouches ------ Endoderm

1st brachial pouch ------ develops into the middle ear cavity, eustachain tube, and

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mastoid air cells (the endoderm-lines structures of the ear)

2nd brachial pouch ------ develops into the epithelial lining of the palatine tonsils

3rd brachial pouch ------ develops into the INFERIOR parathyroids and the thymus

4th brachial pouch ------ develops into the SUPERIOR parathyroids

Anterior 2/3 of tongue ------ taste via CN VII

Sensation via V3

Posterior 1/2 of tongue ------ taste and sensation both via CN IX

motor innervation to the tongue ------ CN XII

Forgut ------ pharynx to the duodenum, supplied by the celiac artery

Midgut ------ duodenum to 2/3 the distance of the transverse colon, supplied by the

superior mesenteric artery

Hindgut ------ 2/3 across the trasverse colon to the rectum, supplied by the inferior

mesenteric artery

Gastroschisis ------ failure of the lateral body folds to fuse, resulting in extrusion of the

abdominal contents through the abdominal folds.

There is no covering sac, but there is also no liver protruding from the abdominal wall.

This defect is usually lateral to the umbilicus, most commonly on the right.

Omphalocele ------ persistence of herniation of the abdominal contents into the umbilical

cord, covered by peritoneum. This is actually the worse abnormality to have, as it is

associated with a protruding liver.

Ventral pancreatic bud ------ MOST of the pancreas comes from the ventral pancreatic

bud, which becomes the pancreatic head, uncinate process, and the main pancreatic

duct.

Dorsal pancreatic bud ------ becomes the body, tail, ithsmus, and accessory pancreatic

duct

Uteretic bud ------ arises from the meSonephros -- gives rise to the ureter, pelvises,

calyces, and collecting ducts (basically gives rise to the drainage system of the kidney)

Metanephric mesenchyme ------ gives rise to the glomerulus and renal tubuls -- basically

the functional unit of the kidney

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Glans penis ------ glans clitoris

Corpus cavernosum and spongiosum ------ vestibular bulbs

Bulbourethral glands (of Cowper) ------ Greater vestibular glands of bartholin

Prostate glands ------ urethral and paraurethral glands (of skene)

Ventral shaft of the penis ------ Labia minoraScrotum ------ Labia majora

Pseudohermaphroditism ------ disagreement between the phenotypic sex and gonadal

sex.

Female pseudohermaphrodite -- ovaries present, but the external genitalia are virulized.

Male pseudohermaphrodite -- testes present, but external genitalia are female. Most

common form is androgen insensitivity syndrome.

True hermaphrodite ------ Both ovary and testicular tissue present; ambiguous genitalia

Androgen insensitivity syndrome (46 XY) ------ defect in the androgen receptor results in

a normal appearing female with testes that develop in the labia majora (which must be

surgically removed to prevent malignancy)

5 alpha reductase deficiency ------ Inability of males to convert testosterone into DHT.

Ambiguous genitalia are present until puberty, when increased testosterone causes

masculinization and increased growth of the external male genitalia.

Hydroxyurea ------ Inhibits ribonucleotide reductase and decreases DNA synthesisUsedto treat sickle cell disease

Dactinomycin ------ DNA intercalatorUsed to treat childhood tumors (Wilm's tumor,

Ewing's sarcoma, rhabdomyosarcoma)"Children ACT out" - dACTinomycin

Drugs used to treat testicular cancer ------ "Eradicate Ball

Cancer"EtoposideBleomycinCisplatin

Trastuzumab ------ Monoclonal antibody against HER-2, helps kill breast cancer cells

that overexpress HER-2.

Cytarabine ------ Pyrimidine antagonist that inhibits DNA polymerase (a mechanism

similar to acyclovir and foscarnet)Used to treat AML

Tamoxifen/Raloxifene ------ SERMs - block estrogen from binding to ER(+)

cellsAntagonists in breasts, Agonists in bone, partial agonist effects in the endometrium

(in tamoxifen only)Also useful to prevent osteoporosis

5-FU ------ Pyrimidine analog that inhibits thymidylate synthase, inhibiting the production

of the pyrimidine thiamine (decreased nucleotide synthesis)Used to treat basal cell

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carcinoma and actinic keratosis.Overdose rescue with thymidine

Vincristine/VInblastine ------ Alkaloids that block polymerization of microtubules so that

the mitotic spindle cannot form.Vincristine - neurotoxicityVinblastine - bone marrow

suppression

Doxyrubicin/daunurubicin ------ Intercalates DNA and generates free radicals that causestrand breaks.Toxicity - CARDIOTOXIC

Nitrosureas ------ (--mustines)DNA alkylating agents used in brain cancer (are able to

cross the BBB)Can cause CNS toxicity

Paclitaxel ------ Hyperstabilizes polymerized microtubules in M phase so that mitotic

spindle cannot break down

Methotrexate ------ Folic acid analog that inhibits dihydrofolate reductaseUses in uterine

pathology and immunosuppression.Myelosuppression is reversible with leucovorin

rescue (a folinic acid)

Cyclophosphamide ------ A DNA alkylating agent that covalently x-links DNA; a nitrogen

mustardSide effect of hemorrhagic cystitis due to the formation of a toxic metabolite of

cyclophosphamide

CIsplatin/carbaplatin ------ Cross-links DNAnephrotoxicity and ototoxicity (aucoustic

nerve damage)

6-mercaptopurine ------ Purine analog that blocks purine synthesis by inhibiting PRPP

synthetase (which converts ribose into PRPP, a purine analog)Activated by HGPRTase

and metabolized by xanthine oxidase

Busulfan ------ Alkylates DNA, used to treat CMLtoxicity - pulmonary fibrosisBleomycin ------ Induces formation of free radicals, which cause breaks in DNA

strandstoxicity - pulmonary fibrosis

Etoposide/tenoposide ------ Inhibits topoisomerase II (DNA gyrase)a mechanism similar

to fluoroquinolones

Imanitib ------ Antibody against the philadelphia chromosomeUsed to treat CML or AML

that has the philadelphia chromosome

Side effects of prednisone ------ Cushing-like symptoms, immunosuppression, cataracts,

acne, hypertension, psychosis, insomnia, osteoporosis, peptic ulcers, hyperglycemia

Drugs that interfere with microtubules ------ Vincristine/VinblastinePaclitaxelGriseofulvin-

bendazolesColchicine

Lateral geniculate nucleus ------ VisualProjects from the retina to the optic lobe, via the

optic radiations

Medial geniculate nucleus ------ AuditoryProjects via the brachium of the inferior colliculi

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to the primary auditory cortex

Ventral posterior nucleus, lateral part (VPL) ------ Somatosensory information from the

body (via the medial lemniscus and the spinothalamic tracts)Proprioception, pressure,

pain, touch, vibration

Ventral posterior nucleus, medial part (VPM) ------ Facial sensation via CNVTrigeminothalamic and taste pathways to the somatosensory cortex

Ventral anterior ------ motor controlbasal ganglia to the prefrontal, premotor, and orbital

cortices

Ventral lateral ------ motor control cerebellum (dentate nucleus) and basal ganglia to the

motor cortex

Medial dorsal ------ Communications with the prefrontal cortexResults in memory loss if

destroyed

Anterior ------ Mamillothalamic tract to the cingulate gyrus (part of the Papez circuit)

Pulvinar ------ Integration of visual, auditory, and somesthetic input

Syndromes with DNA repair defects ------ XP, Ataxia-telangiectasia, Bloom's syndrome,

HNPCC, BRCA1/2

mRNA stop codons ------ UGA, UAA, UAG

DNA pol delta ------ Replicates the leading strand(eukaryotic)

DNA pol I ------ Degrades RNA primer and fills in the gap

DNA pol alpha ------ replicates the lagging strand, synthesizes RNA primer(eukaryotic)DNA pol beta/epsilon ------ Repairs DNA(eukaryotic)

DNA pol gamma ------ Replicates the mitochondrial DNA(eukaryotic)

DNA pol III ------ Elongates the leading strand by adding deoxynucleotides to the 3' end.

Elongates the lagging strand until it reaches the primer of the preceding fragment.

Primase ------ makes the RNA primer upon which DNA pol III can initiate replication

Lesch-Nyhan syndrome ------ Defective purine salvage owing to absence of HGPRT.

Results in excess uric acid formation.Findings: gout, retardation, self-mutilation,

aggression, hyperuricemia, choreoathetosis

Adenosine deaminase ------ (ADA)enzyme responsible for conversion of adenosine to

inosine in the purine salvage pathway deficiency of ADA causes SCID

APRT ------ Adenine phosphoribosyl transferaseenzyme responsible for the conversion

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of adenine to AMP in the purine salvage pathway

HGPRT ------ hypoxanthine guanine phosphorybosyl transferaseenzyme responsible for

the conversion of guanine to GMP and hypoxanthine to IMP in the purine salvage

pathway

xanthine oxidase ------ enzyme responsible for the conversion of xanthine to uric acid

Orotic aciduria ------ Inability to convert orotic acid to UMP in the de novo pyrimidine

biosynthesis pathway.Causes increased orotic acid in the urine without

hyperammonemia, failure to thrive, and megaloblastic anemia that does not improve

with B12 or folate administration.Tx: bypass the pathway with oral uridine administration

Rate-limiting step of pyrimidine synthesis ------ CPS2ATP+CO2+Glutamine form

carbamoyl phosphate

Sources of carbon in the synthesis of pyrimidines ------ Aspartate, CO2

Amino acids necessary for purine synthesis ------ Glycine, Aspartate, Glutamine

Sources of carbon in the formation of purines ------ THF, CO2, glycine

RNAP I ------ Makes rRNA in the nucleolus

RNAP II ------ makes mRNA in the nucleoplasminhibited by alpha-amantin

RNAP III ------ makes tRNA in the nucleoplasm

Degeneracy ------ More than one codon can code for the same AA

Unambiguous ------ Each codon codes for only one AA

Three ways to degrade proteins ------ 1) ubiquitin-protein-ligase complex2) lysozomes3)

calcium-dependent enzymes

Alpha subunit of hormones ------ common subunit to TSH, LH, FSH, and hCG

Beta subunit or hormones ------ determines hormone specificity

Diezoxide ------ Used in the treatment of insulinoma Keeps potassium channels open,

so that pancreatic beta cells cannot deploarize and release insulin

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TRH ------ Positively regulates TSH and prolactin

Dopamine ------ NEGATIVELY regulates prolactin

CRH ------ Positively regulates ACTH, which in turn regulates cortisol production

GHRH ------ positively regulates growth hormone, which in turn regulates IGF-1Somatostatin ------ NEGATIVELY regulates GH and TSH

GnRH ------ Positively regulates FSH and LH

Prolactin ------ Inhibits GnRH

Endocrine hormones that use cAMP ------ FSH, LH, ACTH, TSH, CRH, hCG, ADH,

MSH, PTH, Calcitonin, Glucagon

Endocrine hormones that use cGMP ------ VASODILATORS!NO, ANP

Endocrine hormones that use IP3 ------ GnRH GHRH, Oxytocin, ADH, TRH

Endocrine hormones that use steroid receptors ------ Progesterone, Estrogen,

Testosterone, Cortisol (glucocorticoids), Aldosterone, T3/T4, Vitamin D

Endocrine hormones that use tyrosine kinases ------ Insulin, IGF-1, FGF, PDGF,

Prolactin, GH

Jod-Basedow phenomenon ------ thyrotoxicosis is a patient with iodine deficiency goiter

is made iodine repleteclassic scenario - a patient that is receiving radiocontrast dye that

becomes hyperthyroid

Pseudoypoparathyroidism type 1A (Albright's hereditary

osteodystrophy) ------ autosomal recessive kidney unresponsiveness to PTH causes

hypocalcemiaAssociated with shortened 4/5th metacarpals and short stature

Sulfonylureas ------ Glyburide, Glimepiride, GlipizideClose potassium channels in beta

cells so that the cell depolarizes and releases insulin (stimulates endogenous release of

insulin)First generation has disulfiram effectsSecond generation can cause

hypoglycemia

Biguanides ------ MetforminDecreases gluconeogenesis and acts as an insulin-

sensitizer.May cause lactic acidosis, contraindicated in patients with renal/liver failure

and CHF

Glitazones/Thiazolidinediones ------ PPAR gamma agonists that increase insulin

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sensitivity in peripheral tissueCauses hepatotoxicity and CV toxicity

alpha glucosidase inhibitors ------ Acarbose, MiglitolInhibit intestinal brush border alpha

glucosidases, leading to decreased postprandial hyperglycemia.

Exenataide ------ GLP-1 derived, prolongs incretin secretion which decreases glucagon

secretion and increases insulin secretion, delays gastric emptying

Sitagliptin ------ Inhibits DPP-IVProlongs incretin secretion which decreases glucagon

secretion and increases insulin secretion, delays gastric emptying

Wallenberg's Syndrome ------ aka - lateral medullary syndrome/PICA syndrome caused

by occlusion of one of the posterior inferior cerebellar arteries loss of pain and temp

over contralateral body loss of pain and temp over ipsilateral face hoarseness,difficulty

swallowing, loss of gag reflex ipsilateral Horner's syndrome vertico, nystagmus, N/V

ipsilateral cerebellar deficits

Mifepristone ------ A competitive inhibitor of progestins at progesterone receptors.Used

to terminate pregnancy. Administered with misoprostol (a PGE1 analog) to help

contract the uterus.

Anastrozole/Exemestane ------ Aromatase inhibitors used in postmenopausal women

with breast cancer. Inhibits formation of estrogen via aromatization.

Tamoxifen ------ SERM - antagonist at breast tissue, agonist at bone and endometrial

tissueUsed to prevent recurrence of ER-positive breast cancer

Raloxifene ------ SERM - agonist at bone, antagonist at breast tissueUsed to prevent

recurrence of breast cancer and treats osteoporosis

Clomiphene ------ SERM - a partial agonist at estrogen receptors in the hypothalamus.

Prevents normal feedback inhibition and increases release of LH and FSH from

pituitary to stimulate ovulation.Used to treat infertility and PCOS.

Estrogens as pharmacologic agents(ethinyl estradiol, DES, mestranol) ------ Bind

estrogen receptorsUsed to treat hypogonadism or ovarian failure, menstrual

abnormalities, HRT; can be used in men with androgen-dependent prostate cancer

Toxicity: increased risk of endometrial cancer, clear cell adenocarcinoma in women

exposed to DES in utero, increased risk of thrombi

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hCG ------ secreted from the syncytiotrophoblast of the placentaacts to maintain the

corpus luteum (and thus progesterone) for the first trimester of pregnancy in the 2nd/3rd

trimester, the placenta is mature enough to synthesize its own estriol and progesterone,

so the corpus luteum degenerates.

mittselschmerz ------ blood from the ruptured ovarian follicle can cause peritoneal

irritation some women have instantaneous pain, but this is uncommon; most women

feel nothing

Functions of progesterone ------ Stimulation of endometrial glandular secretions and

spiral artery developmentMaintains pregnancy Decreases myometrial

excitabilityProduces thick cervical mucous to inhibit sperm entry into the uterus

Increases body tempInhibits LH/FSHRelaxes uterine smooth muscleDecreases

estrogen receptor sensitivity

2 Cell Theory of Estrogen ------ GnRH secreted in a pulsatile fashion from the arcuate

nucleus of the hypothalamus. Causes release of LH and FSH. LH acts on theca cells,

which convert cholesterol to androstendione via 17 beta hydroxylase. FSH acts on

granulosa cells, which convert androstendione to estradiol via aromatase.

Functions of estrogen ------ Development of genitalia, breast, female fatdistributionFollicle growth, endometrial proliferation, increases myometrial excitability

Upregulates estrogen, LH, and progesterone receptorsFeedback inhibits FSH, LH and

LH surge Stimulates prolactin secretion but blocks its action on the breastIncreases

transport of proteins, SHBG, increases HDL, decreases LDL

estrone ------ made in the blood via aromatization

estriol ------ weakest form of estrogenmade in the placenta (thus, there is 1000-fold

increase during pregnancy and can be used as an indicator of fetal well-being)

estradiol ------ strongest form of estrogenmade in the ovary

Dinoprostone ------ A PGE2 analog that causes cervical dilation and uterine

contractions, inducing labor.

Ritodrine/Terbutaline ------ beta 2 agonists that relax the uterus to reduce premature

uterine contractions

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Abruptio placentae ------ Premature detachment of the placenta from the uterus.

Causes PAINFUL bleeding and results in fetal demise. Increased risk with smoking,

trauma, abuse, hypertension, cocaine use, and MVA.

Placenta accreta ------ Defective decidual layer allows the placenta to grow into the

myometrium; thus, there is no separation of the placenta after birth.Increased risk withprior C-section, inflammation, and placenta previa

Placenta previa ------ Attachment of the placenta to the lower uterine segment, possibly

occluding the cervial os. Causes PAINLESS bleeding.Increased risk with multiparity and

prior C-sections.

Type Four collagen ------ Basement membrane or basal lamina

Type Three collagen ------ BLOODY collagenskin, blood vessels, uterus, fetal tissue,

granulation tissue

Type Two collagen ------ SLIPPERY collagenCartilage, vitreous body, nucleus pulposus

Type One collagen ------ STRONG collagenbones, skin, tendon, dentin, fascia, cornea,

late wound repair

Drugs that act on

microtubules ------ Mebendazole/thiabendazoleGriseofulvinVincristine/VinblastinePaclita

xelColchicine

Nuclear lamins ------ Intermediate filaments of the nuclear envelope and the DNA within

Proteins modified by the golgi apparatus ------ Modifies N-oligosaccharides on

asparagine Adds O-oligosaccharides to serine and threonine

Neurofilaments ------ Intermediate filaments of axons within neurons

Cytokeratin ------ Intermediate filament of epithelial cells

Glial fibrillary Acid Proteins (GFAP) ------ Intermediate filaments of astrocytes, schwann

cells, and other neuroglia

Peripherin ------ Intermediate filaments of neurons

Cyclin-CDK complexes ------ phosphorylate target proteins to drive the cell cycle

Vimentin ------ Intermediate filament of connective tissue (fibroblasts, leukocytes,

endothelium)

Desmin ------ Intermediate filament of muscle cells (smooth, skeletal, heart)

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SIldenafil, vardenafil, tidalafil ------ Inhibit cGMP phosphodiesterase, causing an

increase in cGMP, smooth muscle relaxation in the corpus cavernosum, increased

blood flow, and penile erection. Used to treat erectile dysfunction.Toxicity: headache,

flushing, life-threatening hypotension, impaired blue-green color vision.

Tamsulosin ------ alpha-1 antagonist used to treat BPH by inhibiting smooth musclecontraction. Selective for alpha-1AD receptors that are found only in the prostate (thus,

there is no risk of first dose orthostatic hypotension because this drug does not inhibit

vascular alpha-1 receptors)

Flutamide ------ A nonsteroidal competitive inhibitor of androgens at the testosterone

receptor.Used to treat prostate adenocarcinoma.

Finasteride ------ 5 alpha reductase inhibitor -- causes decreased conversion of

testosterone to DHT.Used to treat BPH and male-pattern baldness.

Spermatocele ------ Dilated epididymal duct

Ballanitis ------ Infection of the foreskin, commonly caused by Candida

Hydrocele ------ Increased in fluid secondary to an incomplete fusion of the processus

vaginalis (common in newborns, resolves spontaneously)

Leydig cell functions ------ Secrete testosteroneRespond to LH stimulation

Varicocele ------ Dilated vein in pampiniform plexus; can cause infertilityOften described

as a "bag of worms"

Sertoli cell functions ------ Support spermatogenesisSecrete inhibin -- feedback topituitary to inhibit FSHSecrete androgen binding proteinSecrete anti-mullerian

hormoneRespond to FSH stimulation

Emission innervation ------ sympathetic -- hypogastric nerve

Ejaculation innervation ------ visceral and somatic nerves -- pudendal nerve

Erection innervation ------ parasympathetic -- pelvic nerve