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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