Chapter 10 Form B | Quizalize

Many of water’s biological functions stem from its chemical struc- ture. Recall that in the water molecule, H2O, the hydrogen and oxygen atoms share electrons to form covalent bonds. However, these atoms do not share the electrons equally. The oxygen atom has a greater ability to attract electrons to it because it pulls hydrogen’s electrons towards its nucleus. As a result, as shown in Figure 2-8, the region of the molecule where the oxygen atom is located has a partial negative charge, denoted with a , while the regions of the molecule where each of the two hydrogen atoms are located have partial positive charges, each of which are denoted with a . Thus, even though the total charge on a water molecule is neutral, the charge is unevenly distributed across the water molecule. Because of this uneven distribution of charge, water is called a polar compound. Notice also in Figure 2-8 that the three atoms in a water mole- cule are not arranged in a straight line as you might expect. Rather, the two hydrogen atoms bond with the single oxygen atom at an angle. SECTION 3 OBJECTIVES ● Describe the structure of a water molecule. ● Explain how water’s polar nature affects its ability to dissolve substances. ● Outline the relationship between hydrogen bonding and the different properties of water. ● Identify the roles of solutes and solvents in solutions. ● Differentiate between acids and bases. VOCABULARY polar hydrogen bond cohesion adhesion capillarity solution solute solvent concentration saturated solution aqueous solution hydroxide ion hydronium ion acid base pH scale buffer Copyright © by Holt, Rinehart and Winston. All rights reserved. (a) Electron cloud model (b) Space-filling model H H O The oxygen region of the water molecule is weakly negative, and the hydrogen regions are weakly positive. Notice the different ways to represent water, H2O. You are familiar with the electron cloud model (a). The space- filling model (b) shows the three- dimensional structure of a molecule. FIGURE 2-8 40 CHAPTER 2 Hydrogen bond H H H H H H H H H O O O O O O H H H H H – – – – – – – + + + + + + + + + + + + + + The dotted lines in this figure represent hydrogen bonds. A hydrogen bond is a force of attraction between a hydrogen atom in one molecule and a negatively charged region or atom in a second molecule. FIGURE 2-10 The positive region of a water molecule attracts the negative region of an ionic compound, such as the Cl portion of NaCl. Similarly, the negative region of the water molecule attracts the positive region of the compound—the Na portion of NaCl. As a result, NaCl breaks apart, or dissolves, in water. FIGURE 2-9 CI– Na+ H2O + + – – Solubility of Water The polar nature of water allows it to dissolve polar substances, such as sugars, ionic compounds, and some proteins. Water does not dissolve nonpolar substances, such as oil because a weaker attraction exists between polar and nonpolar molecules than between two polar molecules. Figure 2-9 shows how water dissolves the ionic compound sodium chloride, NaCl. In your body, ions, such as sodium and chloride, are essential to bodily func- tions, such as muscle contraction and transmission of impulses in the nervous system. In fact, dissolved, or dissociated ions, are pre- sent in all of the aqueous solutions found in living things and are important in maintaining normal body functions. HYDROGEN BONDING The polar nature of water also causes water molecules to be attracted to one another. As is shown in Figure 2-10, the positively charged region of one water molecule is attracted to the negatively charged region of another water molecule. This attraction is called a hydrogen bond. A hydrogen bond is the force of attraction between a hydrogen molecule with a partial positive charge and another atom or molecule with a partial or full negative charge. Hydrogen bonds in water exert an attractive force strong enough so that water “clings” to itself and some other substances. Hydrogen bonds form, break, and reform with great frequency. However, at any one time, a great number of water molecules are bonded together. The number of hydrogen bonds that exist depends on the state that water is in. If water is in its solid state all its water molecules are hydrogen bonded and do not break. As water liquifies, more hydrogen bonds are broken than are formed, until an equal number of bonds are formed and broken. Hydrogen bonding accounts for the unique properties of water, some of which we will examine further. These properties include cohesion and adhesion, the ability of water to absorb a relatively large amount of energy as heat, the ability of water to cool surfaces through evaporation, the density of ice, and the ability of water to dissolve many substances.

All living things are made up of one or more cells. A cell is the smallest unit that can carry on all of the processes of life. Beginning in the 17th century, curious naturalists were able to use microscopes to study objects too small to be seen with the unaided eye. Their studies led them to propose the cellular basis of life. Hooke In 1665, English scientist Robert Hooke studied nature by using an early light microscope, such as the one in Figure 4-1a. A light micro- scope is an instrument that uses optical lenses to magnify objects by bending light rays. Hooke looked at a thin slice of cork from the bark of a cork oak tree. “I could exceedingly plainly perceive it to be all perforated and porous,” Hooke wrote. He described “a great many little boxes” that reminded him of the cubicles or “cells” where monks live. When Hooke focused his microscope on the cells of tree stems, roots, and ferns, he found that each had similar little boxes. The drawings that Hooke made of the cells he saw are shown in Figure 4-1b. The “little boxes” that Hooke observed were the remains of dead plant cells, such as the cork cells shown in Figure 4-1c. SECTION 1 OBJECTIVES ● Name the scientists who first observed living and nonliving cells. ● Summarize the research that led to the development of the cell theory. ● State the three principles of the cell theory. ● Explain why the cell is considered to be the basic unit of life. VOCABULARY cell cell theory Robert Hooke used an early microscope (a) to see cells in thin slices of cork. His drawings of what he saw (b) indicate that he had clearly observed the remains of cork cells (300) (c). FIGURE 4-1 (a) (b) (c) Copyright © by Holt, Rinehart and Winston. All rights reserved. 70 CHAPTER 4 Leeuwenhoek The first person to observe living cells was a Dutch trader named Anton van Leeuwenhoek. Leeuwenhoek made microscopes that were simple and tiny, but he ground lenses so precisely that the magnification was 10 times that of Hooke’s instruments. In 1673, Leeuwenhoek, shown in Figure 4-2a, was able to observe a previ- ously unseen world of microorganisms. He observed cells with green stripes from an alga of the genus Spirogyra, as shown in Figure 4-2b, and bell-shaped cells on stalks of a protist of the genus Vorticella, as shown in Figure 4-2c. Leeuwenhoek called these organisms animalcules. We now call them protists. THE CELL THEORY Although Hooke and Leeuwenhoek were the first to report observ- ing cells, the importance of this observation was not realized until about 150 years later. At this time, biologists began to organize information about cells into a unified understanding. In 1838, the German botanist Matthias Schleiden concluded that all plants were composed of cells. The next year, the German zoologist Theodor Schwann concluded the same thing for animals. And finally, in his study of human diseases, the German physician Rudolf Virchow (1821–1902) noted that all cells come from other cells. These three observations were combined to form a basic theory about the cel- lular nature of life. The cell theory has three essential parts, which are summarized in Table 4-1. Anton van Leeuwenhoek (1632–1723) is shown here with one of his hand-held lenses (a). Leeuwenhoek observed an alga of the genus Spirogyra (b) and a protist of the genus Vorticella (c). FIGURE 4-2 TABLE 4-1 The Cell Theory All living organisms are composed of one or more cells. Cells are the basic units of structure and function in an organism. Cells come only from the reproduction of existing cells. (a) (b) (c) www.scilinks.org Topic: Cell Theory Keyword: HM60241 mb06se_csfs01.qxd 5/18/07 10:54 AM Page 70

Lipids are large, nonpolar organic molecules. They do not dissolve in water. Lipids include triglycerides (trie-GLIS-uhr-IEDZ), phospho- lipids, steroids, waxes, and pigments. Lipid molecules have a higher ratio of carbon and hydrogen atoms to oxygen atoms than carbohydrates have. Because lipid molecules have larger numbers of carbon-hydrogen bonds per gram than other organic com- pounds do, they store more energy per gram. Fatty Acids Fatty acids are unbranched carbon chains that make up most lipids. Figure 3-10 shows that a fatty acid contains a long carbon chain (from 12 to 28 carbons) with a carboxyl group, —COOH, attached at one end. The two ends of the fatty-acid molecule have different properties. The carboxyl end is polar and is thus hydrophilic or attracted to water molecules. In contrast, the hydro- carbon end of the fatty-acid molecule is nonpolar. This end tends not to interact with water molecules and is said to be hydrophobic (HIE-droh-FOH-bik), or “water fearing.” In saturated fatty acids, such as palmitic acid, which is shown in Figure 3-10, each carbon atom is covalently bonded to four atoms. The carbon atoms are in effect full, or saturated. In contrast, linoleic acid, also shown in Figure 3-10, has carbon atoms that are not bonded to the maximum number of atoms to which they can bond. Instead, they have formed double bonds within the carbon chain. This type of fatty acid is said to be unsaturated. Triglycerides Three classes of lipids important to living things contain fatty acids: triglycerides (fats), phospholipids, and waxes. A triglyceride is composed of three molecules of fatty acid joined to one molecule of the alcohol glycerol. Saturated triglycerides are composed of saturated fatty acids. They typically have high melting points and tend to be hard at room temperature. Common dietary saturated triglycerides include butter and fats in red meat. In contrast, unsaturated triglycerides are composed of unsaturated fatty acids and are usually soft or liquid at room temperature. Unsaturated triglycerides are found primarily in plant seeds where they serve as an energy and carbon source for germinating plants. Phospholipids Phospholipids have two, rather than three, fatty acids attached to a molecule of glycerol. They have a phosphate group attached to the third carbon of the glycerol. As shown in Figure 3-11, the cell membrane is made of two layers of phospholipids, called the lipid bilayer. The inability of lipids to dissolve in water allows the mem- brane to form a barrier between the inside and outside of the cell. Hydrophilic “head” Phospholipids Hydrophobic “tail” Phospholipids Water Water The lipid bilayer of a cell membrane is a double row of phospholipids.The “tails” face each other.The “head” of a phospholipid, which contains a phosphate group, is polar and hydrophilic.The two tails are two fatty acids and are nonpolar and hydrophobic. FIGURE 3-11 H C H C O OH H C H H C H H C H H C H H C H H C H H C H H C H H C H H C H H C H H C H C H H H H C H H C H H C H H C H H C H C O OH H C H H C H H C H C H C H C H H C H H C H C H H C H H C H C H H H H C H Fatty acids have a polar carboxyl head, highlighted in purple, and a nonpolar hydrocarbon tail, highlighted in green. FIGURE 3-10 Palmitic acid Linoleic acid mb06se_bchs02.qxd 5/18/07 10:49 AM Page 59 60 CHAPTER 3 1. Compare the structure of monosaccharides, dis- accharides, and polysaccharides. 2. How are proteins constructed from amino acids? 3. How do amino acids differ from one another? 4. Describe a model of enzyme action. 5. Why do phospholipids orient in a bilayer when in a watery environment, such as a cell? 6. Describe how the three major types of lipids differ in structure from one another. 7. What are the functions of the two types of nucleic acids? CRITICAL THINKING 8. Applying Information Before a long race, run- ners often “carbo load.” This means that they eat substantial quantities of carbohydrates. How might this help their performance? 9. Recognizing Relationships High temperatures can weaken bonds within a protein molecule. How might this explain the effects of using a hot curling iron or rollers in one’s hair? 10. Applying Information You want to eat more unsaturated than saturated fats. Name examples of foods you would eat more of and less of. SECTION 2 REVIEW Waxes A wax is a type of structural lipid consisting of a long fatty-acid chain joined to a long alcohol chain. Waxes are waterproof, and in plants, form a protective coating on the outer surfaces. Waxes also form protective layers in animals. For example, earwax helps pre- vent microorganisms from entering the ear canal. Steroids Unlike most other lipids, which are composed of fatty acids, steroid molecules are composed of four fused carbon rings with various functional groups attached to them. Many animal hor- mones, such as the male hormone testosterone, are steroid com- pounds. One of the most familiar steroids in humans is cholesterol. Cholesterol is needed by the body for nerve and other cells to func- tion normally. It is also a component of the cell membrane. NUCLEIC ACIDS Nucleic acids are very large and complex organic molecules that store and transfer important information in the cell. There are two major types of nucleic acids: deoxyribonucleic acid and ribonucleic acid. Deoxyribonucleic acid, or DNA, contains information that deter- mines the characteristics of an organism and directs its cell activi- ties. Ribonucleic (RIE-boh-noo-KLEE-ik) acid, or RNA, stores and transfers information from DNA that is essential for the manufactur- ing of proteins. Some RNA molecules can also act as enzymes. Both DNA and RNA are polymers, composed of thousands of linked monomers called nucleotides (NOO-klee-uh-TIEDS). As shown in Figure 3- 12, each nucleotide is made of three main components: a phosphate group, a five-carbon sugar, and a ring-shaped nitrogenous base.

Chapter One: Management Today The challenges of working in the new economy recognize: 1.1 Working Today Talent Talented people- What they know, what they learn and what they can achive The source of organisational performance Develop skills and improve What is intellectual capital The combined brain power and shared knowledge of an organization's employees TO orginzations: Intellectual capital resents a strategic asset as human creativity, insight and decision making can be converted into superior performance To individuals: Intellectual capital is a personal asset, one to be nurtured and continually updated Things evolve, make sure we keep updated Intellectual capital: The package on intellect skills and capabilities that set us apart making us valable to potential employers Maintaining your talent: There is no escaping the fact that your career success will require a lot of initiative, self awareness and continuous learning Technology Tech is in our everyday lives Latest developments Smart phone, smart apparel, smart cars, smart homes We struggle to keep up with social media ana staying connected with messaging, full of email and voicemail What happenings as younger workers advance into management Flexibility Work ethic It is critical to build and maintain a high Tech IQ! What is Tech IQ: The ability to use current technologies at work and in your personal life, combined with the commitment to keep yourself updated as technology continues to evolve Intellectual capi5la is a combination of: Commitment x Competency = Intellectual capital How to make the world a better place Globalisation The worldwide interdependence of resources flows, product markets and business competition Under the influence, government leaders worry and about the competitiveness of nations just as corporate leaders worry about business competitiveness Emerging markets will power global growth over the next 20 years. By 2025 overall global consumption is forecast to reach $62 trillion, twice its 2013 level and fully half of this increase will come from the emerging world Consequence: Going to fast in uses resources, inflation, corporate greed It's cheaper to have things made in different countries (wages are low and going down) Shamrock organization 1 leaf - full time employees- standard career paths 2 leaf - “freelancers” 3 leaf - Part times without benefits (first to lose their jobs when employers face economic difficulties) The rising of emerging markets Now account for 60% of all low and medium technology manufacturing worldwide Total value add in high tech manufacturing from a low 26% in the 1970s to 48% at present China strategy to upgrade its industries and move the manufacturing value ching by prioritising 10 sectors Information technology, robotic, aerospace, maritime equipment, modern railway equipment, alternative energy vehicles, power equipment, agriculture equipment, advanced materials, biopharma and medical products Ethics A code of moral principa;s that sets standards for conduct that is “good” and “right” as well as “bad” and “wrong” Enron company huge corruption even in elections same thing happened with The Mechanism 1.2 - Organizations Organizational Purpose An orgnizations is a collection of people working together to achieve a common purpose Unique social phenomenon that enables its members to perform tasks far beyond the reach of individual accomplishment (synergy) The broad purpose of any orginzation is to provide goods or services of value to customers and clients A clear sense of purpose tied to: Quality of products and services Customer satisfaction Social responsibility Can be an important source of organisational strength and performance advantage All organisations are open systems (Systems that interact with its environment for renewal and growth) Organizations as systems All organizations are open systems that interact with their environment Continual process of obtaining resource inputs-people, information, resources and capital- and transforming them into outputs in the form of finished goods and services for customers One simple way to assess the impact of any organisation is to ask the question: How is the world different because it existed Value Creation: Organisations create value when they use resources well to produce good products and take care of their customers One simple way to assess the impact of any organization is to ask the questions: How is the world different because it existed? The 3 Ps of organizational performance Profit - is the decision economically sound? People - Does the decision treat people with respect and dignity? Planet - Is the decision good for the environment? Productivity: An overall measure of the quantity and quality of work performance with recourse utilisation taken into account Performance effectiveness: An output measure of task or goal accomplishment Performance efficiency: An input measure of the resource costs associated with goal accomplishment. Workplace changes that impact management Focus on valuing human capital Demise of “Command and control” Emphasis on teamwork Pre-eminence of technology New workforce expectations Importance of networking Concern for sustainability 1.3 Managers Importance of human resources and manger People are not ‘costs to be controlled’ High performing organizations treat people as valuable strategic assets Three takeaways 1. Give leaders broad authority 2. Encourage them to think like CEO 3. Challenge strong performers ealy with big opportunities Direct support, supervise and help activate the work efforts of others The people who managers help are the ones whose contributions represent the real work of the organisation Types of managers Line managers are responsible for work activities that directly affect organization’s output Staff managers use technical expertise to advise and support the efforts of line workers Functional managers are responsible for a single area of activity Quality of work life (QWL) An indicator of the overall quality of human experiences in the workplace QWL Indicators Respect Fair pay Safe working conditions Opportunities to learn and use new skills Room to grow and progress in a career Protection of individuals rights The organization as an upside-down pyramid A manager’s job is to support worker’s efforts The best managers are known for helping and supporting Customers at the top served by worker who are supported by managers 1.4 The management Process Managers achieve high performance for their organizations by best utilizing its humans and material resources Management is the process of planning, organizing, leading and controlling the use of resources to accomplish performance goals All managers are responsible for the four functions The functions are carried on continually Characteristics of managerial work Long hours Intense pace Fragmented and varied tasks Many communication media Filled with interpersonal relationships Managerial agendas and networks Agenda setting Develops action priorities for accomplishing goals and plans Networking Process of building and maintaining positive relationships with people who can help advance agendas Social Capital Capacity to attract support and help from others Learning The change in a behaviour that results from experience Lifelong learning The process of continuously learning from daily experiences and opportunities

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

Cell Size Cells differ not only in their shape but also in their size. A few types of cells are large enough to be seen by the unaided human eye. For example, the nerve cells that extend from a giraffe’s spinal cord to its foot can be 2 m (about 6 1/2 ft) long. A human egg cell is about the size of the period at the end of this sentence. Most cells, how- ever, are only 10 to 50 μm in diameter, or about 1/500 the size of the period at the end of this sentence. The size of a cell is limited by the relationship of the cell’s outer surface area to its volume, or its surface area–to-volume ratio. As a cell grows, its volume increases much faster than its surface area does, as shown in Figure 4-5. This trend is important because the materials needed by a cell (such as nutrients and oxygen) and the wastes produced by a cell (such as carbon dioxide) must pass into and out of the cell through its surface. If a cell were to become very large, the volume would increase much more than the surface area. Therefore, the surface area would not allow materials to enter or leave the cell quickly enough to meet the cell’s needs. As a result, most cells are microscopic in size. Comparing Surface Cells Materials microscope, prepared slides of plant (dicot) stem and ani- mal (human) skin, pencil, paper Procedure Examine slides by using medium magnification (100). Observe and draw the sur- face cells of the plant stem and the animal skin. Analysis How do the surface cells of each organism differ from the cells beneath the surface cells? What is the function of the surface cells? Explain how surface cells are suited to their function based on their shape. Quick Lab Small cells can exchange substances more readily than large cells because small objects have a higher surface area–to-volume ratio. FIGURE 4-5 mb06se_csfs02.qxd 5/18/07 10:54 AM Page 73 74 CHAPTER 4 BASIC PARTS OF A CELL Despite the diversity among cells, three basic features are common to all cell types. All cells have an outer boundary, an interior sub- stance, and a control region. Plasma Membrane The cell’s outer boundary, called the plasma membrane (or the cell membrane), covers a cell’s surface and acts as a barrier between the inside and the outside of a cell. All materials enter or exit through the plasma membrane. The surface of a plasma mem- brane is shown in Figure 4-6a. Cytoplasm The region of the cell that is within the plasma membrane and that includes the fluid, the cytoskeleton, and all of the organelles except the nucleus is called the cytoplasm. The part of the cytoplasm that includes molecules and small particles, such as ribosomes, but not membrane-bound organelles is the cytosol. About 20 percent of the cytosol is made up of protein. Control Center Cells carry coded information in the form of DNA for regulating their functions and reproducing themselves. The DNA in some types of cells floats freely inside the cell. Other cells have a mem- brane-bound organelle that contains a cell’s DNA. This membrane- bound structure is called the nucleus. Most of the functions of a eukaryotic cell are controlled by the cell’s nucleus. The nucleus is often the most prominent structure within a eukaryotic cell. It maintains its shape with the help of a protein skeleton called the nuclear matrix. The nucleus of a typical animal cell is shown in Figure 4-6b. Most animal cells have a cell membrane, a nucleus, and a variety of other organelles embedded in a watery substance. The surface of the cell membrane can be seen in (a). The organelles inside the cell are labeled in the diagram (b). FIGURE 4-6 (a) (b) Mitochondrion Microfilaments Lysosome Golgi apparatus Smooth ER Ribosomes Cell membrane Microtubules Rough ER Nuclear pore Nuclear envelope Nucleolus Nucleus Copyright © by Holt, Rinehart and Winston. All rights reserved. Cell wall Ribosome Cell membrane Peptidoglycan Pili Flagellum DNA CELL STRUCTURE AND FUNCTION 75 A prokaryotic cell lacks a membrane- bound nucleus and membrane-bound organelles. Most prokaryotic cells are much smaller than eukaryotic cells are. FIGURE 4-7 A white blood cell (eukaryotic) changes shape as it attacks purple- stained bacterial cells that are much smaller (prokaryotic). FIGURE 4-8 TWO BASIC TYPES OF CELLS Fossil evidence suggests that the earliest cells on Earth were simple cells similar to some present-day bacteria. As cells evolved, they differentiated into two major types: prokaryotes and eukaryotes. Prokaryotes Prokaryotes (proh-KAR-ee-OHTS) are organisms that lack a membrane- bound nucleus and membrane-bound organelles. Although prokaryotic cells lack a nucleus, their genetic information—in the form of DNA—is often concentrated in a part of the cell called the nucleoid. Figure 4-7 shows a typical prokaryotic cell. Prokaryotes are divided into two domains: Bacteria and Archaea (ahr-KEE-uh). The domain Bacteria includes organisms that are similar to the first cellular life-forms. The domain Archaea includes organisms that are thought to be more closely related to eukaryotic cells found in all other kingdoms of life. Eukaryotes Organisms made up of one or more cells that have a nucleus and membrane-bound organelles are called eukaryotes (yoo-KAR-ee-OHTS). Eukaryotic cells also have a variety of subcellular structures called organelles, well-defined, intracellular bodies that perform specific functions for the cell. Many organelles are surrounded by a mem- brane. The organelles carry out cellular processes just as a person’s pancreas, heart, and other organs carry out a person’s life processes. Eukaryotic cells are generally much larger than prokary- otic cells, as seen in Figure 4-8, which shows a white blood cell (eukaryote) destroying tiny bacterial cells (prokaryotes).

Cohesion and Adhesion Water molecules stick to each other as a result of hydrogen bond- ing. An attractive force that holds molecules of a single substance together is known as cohesion. Cohesion due to hydrogen bonding between water molecules contributes to the upward movement of water from plant roots to their leaves. Related to cohesion is the surface tension of water. The cohe- sive forces in water resulting from hydrogen bonds cause the mol- ecules at the surface of water to be pulled downward into the liquid. As a result, water acts as if it has a thin “skin” on its sur- face. You can observe water’s surface tension by slightly overfill- ing a drinking glass with water. The water will appear to bulge above the rim of the glass. Surface tension also enables small crea- tures such as spiders and water-striders to run on water without breaking the surface. Adhesion is the attractive force between two particles of differ- ent substances, such as water molecules and glass molecules. A related property is capillarity (KAP-uh-LER-i-tee), which is the attrac- tion between molecules that results in the rise of the surface of a liquid when in contact with a solid. Together, the forces of adhe- sion, cohesion, and capillarity help water rise through narrow tubes against the force of gravity. Figure 2-11 shows cohesion and adhesion in the water-conducting tubes in the stem of a flower. Temperature Moderation Water has a high heat capacity, which means that water can absorb or release relatively large amounts of energy in the form of heat with only a slight change in temperature. This property of water is related to hydrogen bonding. Energy must be absorbed to break hydrogen bonds, and energy is released as heat when hydrogen bonds form. The energy that water initially absorbs breaks hydro- gen bonds between molecules. Only after these hydrogen bonds are broken does the energy begin to increase the motion of the water molecules, which raises the temperature of the water. When the temperature of water drops, hydrogen bonds reform, which releases a large amount of energy in the form of heat. Therefore, during a hot summer day, water can absorb a large quantity of energy from the sun and can cool the air without a large increase in the water’s temperature. At night, the gradually cooling water warms the air. In this way, the Earth’s oceans stabilize global temperatures enough to allow life to exist. Water’s high heat capac- ity also allows organisms to keep cells at an even temperature despite temperature changes in the environment. As a liquid evaporates, the surface of the liquid that remains behind cools down. A relatively large amount of energy is absorbed by water during evaporation, which significantly cools the surface of the remaining liquid. Evaporative cooling prevents organisms that live on land from overheating. For example, the evaporation of sweat from a person’s skin releases body heat and prevents over- heating on a hot day or during strenuous activity. Adhesion Cohesion Hydrogen bonds Cohesion, adhesion, and capillarity contribute to the upward movement of water from the roots of plants. FIGURE 2–11 www.scilinks.org Topic: Hydrogen Bonding Keyword: HM60777 mb06se_cols03.qxd 5/18/07 10:47 AM Page 41 42 CHAPTER 2 Density of Ice Unlike most solids, which are denser than their liquids, solid water is less dense than liquid water. This property is due to the shape of the water molecule and hydrogen bonding. The angle between the hydrogen atoms is quite wide. So, when water forms solid ice, the angles in the molecules cause ice crystals to have large amounts of open space, as shown in Figure 2-12. This open space lattice structure causes ice to have a low density. Because ice floats on water, bodies of water such as ponds and lakes freeze from the top down and not the bottom up. Ice insulates the water below from the cold air, which allows fish and other aquatic crea- tures to survive under the icy surface.

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