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Muscles We Eat Exam Review
Quiz by Kaycee Larios
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The human body (man’s body) is very beautiful. It consists of arms, legs, a head, a neck and so on. The eyes help us to see, the ears help us to hear, the mouth and lips help us to speak and eat food. All people have different faces. There are two eyes, a nose, a mouth on our face. We have hair, a neck, two shoulders, ten fingers, ten toes, ten nails, two feet, two knees, two cheeks, two eyebrows, a forehead, a chin. Everybody has his/her own skin. It comes in many colors. People who live in Africa have brown or black skin. People who live in Europe have white skin. Our hair can be straight or curly, long, short, dark, blonde, gray. Humans have muscles, fat, bones, joints. There are two kidneys, two lungs, a heart, a stomach, a liver and other organs in humans’ bodies. There are 32 teeth and one tongue in our mouth. Some people (kids and adults) lose some of their teeth, so they don’t have 32 teeth.Yawn (v) to open your mouth wide and breathe in deeply because you are tired or bored. Ex: Alan stretched and yawned. Sneeze (v) air suddenly comes from your nose, making a noise. Ex: I’ve been sneezing all morning. Reflex (n) a movement of your body that happens naturally in response to something. Ex: The doctor tested her reflexes. Sharp (adj) a very thin edge or point that can cut things easily. Ex: Be careful with that sharp axe. Pull away (p.v) to move away from something. Ex: He tried to pull away before the car hit him. Coordination (n) the way in which your muscles move together. Ex: These dancers have poor coordination. Breathing (n) How the body takes in oxygen and expels carbon dioxide from our lungs. Ex: For most of us breathing is automatic. Movement (n) How we move from one place to another. Ex: She is alert to every movement. Digestion (n) How the body turns food into energy for us to use. Ex: His digestion is bad. Blood circulation (n) How blood carries materials such as oxygen and nutrients around our body. Ex: Exercise will improve blood circulation. Helmet (n) a strong hat that protects your head. Ex: Wear a helmet when you ride your bike. Attendant (n) Someone who looks after customers in public places. Ex: We met an attendant in the office. Evidence (n) facts or signs that show clearly that something exists or is true. Ex: The police found the evidence in the crime scene. Twirl (v) To turn around quickly. Ex: He made the ice twirl in his glass. Frilly (adj) Decorative material on a dress or skirt. Ex: She is wearing a frilly dress. Itch (v) Rub or scratch your skin with your nails. Ex: I itch all over my body. Tantrum (n) When a young child gets angry. Ex: He had a tantrum when his sister used his phone. Shriek (v) Short, loud cry or scream. Ex: She shrieked in fright. Balk (v) Protest (because you don’t want to do something.) Ex: Many people balk at this danger. Frustration (n) The feeling of being annoyed or upset because you can’t achieve something. Ex: Don't take your frustration out on me. Proclaim (v) To say something important. Ex: The president proclaimed a public holidayCELLULAR RESPIRATION CELLULAR RESPIRATION What is it? Cellular respiration is the process by which cells break down glucose (a simple sugar) and other organic molecules to release energy in the form of ATP (adenosine triphosphate), which powers cell activities. Overall equation: C6H12O6 + 6O2 ⟶ 6CO2 + 6H2O + ATP (energy) Stages of Cellular Respiration 1. Glycolysis (in the cytoplasm) • Where it happens: Cytoplasm (outside mitochondria) • What happens: o One molecule of glucose (6 carbons) is split into two molecules of pyruvate (3 carbons each). o 2 ATP are used to start the process. o 4 ATP are produced (net gain = 2 ATP). o 2 NADH (electron carriers) are also produced. Summary of glycolysis products per glucose: • 2 ATP (net gain) • 2 NADH • 2 Pyruvate 2. Krebs Cycle (Citric Acid Cycle) (in the mitochondrial matrix) • Where it happens: Mitochondrial matrix • What happens: o Each pyruvate (3C) is converted to acetyl-CoA (2C) before entering the cycle. o Acetyl-CoA combines with oxaloacetate (4C) to form citric acid (6C). o Through a series of enzyme-controlled reactions, citric acid is broken down, releasing CO₂, ATP, NADH, and FADH₂. Summary of Krebs Cycle products (per 2 pyruvates): • 2 ATP • 6 NADH • 2 FADH₂ • 4 CO₂ (exhaled as waste) 3. Electron Transport Chain (ETC) & Oxidative Phosphorylation (in the inner mitochondrial membrane) • Where it happens: Inner mitochondrial membrane (cristae) • What happens: o NADH and FADH₂ donate high-energy electrons to proteins in the ETC. o As electrons move through the chain, protons (H⁺) are pumped across the membrane, creating a proton gradient. o This gradient powers ATP synthase, which makes lots of ATP (like a turbine powered by flowing water). o Oxygen acts as the final electron acceptor, combining with electrons and hydrogen to form water (H₂O). Summary of ETC products: • About 34 ATP • H₂O Total Energy Yield from One Glucose (Aerobic Respiration) • Glycolysis → 2 ATP • Krebs Cycle → 2 ATP • ETC → ~34 ATP Total: ~38 ATP (usually 36 in eukaryotes due to energy costs) Anaerobic Respiration (When Oxygen is Absent) If oxygen is not available, cells switch to fermentation: • Alcoholic Fermentation (yeast & some bacteria): pyruvate → ethanol + CO₂ • Lactic Acid Fermentation (muscles & some bacteria): pyruvate → lactic acid These processes only make 2 ATP per glucose, much less efficient than aerobic respiration. Key Takeaway: Cellular respiration is like the cell’s power plant: glycolysis breaks glucose into smaller pieces, the Krebs cycle extracts more high-energy electrons, and the ETC uses those electrons to generate the bulk of ATP. Oxygen is essential for the final step, which is why we need to breathe to stay alive.Name: Marco Ramirez - “I Am Not Batman” TW: language It’s the middle of the night. And the sky is glowing like mad radioactive red. And if you squint, you could maybe see the moon through a thick layer of cigarette smoke and airplane exhaust that covers the entire city like mosquito net that won’t let the angels in. And if you look up high enough you could see me-standing on the edge of a eighty seven story building. And up there-a place for gargoyles and broken clock towers that have stayed still and dead for maybe like a hundred years-up there is me. And I’m freakin Batman. And I gots Bat-mobiles and Bat-a-rangs and freakin Bat-caves like for real, and all it takes is a broom closet or a back room or a fire escape and Danny’s hand-me-down jeans are gone. And my navy blue polo shirt? – The one that looks kinda good on me but has a hole on it near the butt from when it got snagged on the chain linked fence behind Arturo’s but it isn’t even a big deal cause I tuck that part in and its like all good? –that blue polo shirt? – It’s gone too. And I get like, like transformational. And nobody pulls out a belt and whips Batman for talking back –-Or for not talking back –And nobody calls Batman simple –- Or stupid –- Or skinny –- And nobody fires Batman’s brother from the Eastern Taxi Company ‘cause they was making cutbacks, neither, ‘cause they got nothing but respect, and not like afraid-respect. Just like respect-respect. ‘Cause nobody’s afraid of you. Cause Batman doesn’t mean nobody harm. Ever. Cause all Batman really wants to do is save people and maybe pay Abuela’s bills one day and die happy and maybe get like mad famous. For real.…And kill the Joker. Tonight, like most nights, I’m all alone. And I’m watching…And I’m waiting… Like a eagle. Or like a –no, yea, like a eagle. And my cape is flappin’ in the wind (‘cause it’s freakin’ long), and my pointy ears are on, and that mask that covers like half my face is on too, and I got like bulletproof stuff all in my chest so no one could hurt me and nobody – nobody – is gonna come between Batman, And Justice. From where I am I could hear everything. Somewhere in the city there’s a old lady picking Styrofoam leftovers up outta a trash can and she’s putting a piece of sesame chicken someone spit out into her own mouth. And somewhere there’s a doctor with a whack haircut in a black lab coat trying to find a cure for the diseases that are gonna make us all extinct for real one day. And somewhere there’s a man, a man in a janitor’s uniform, stumbling home drunk and dizzy after spending half his paycheck on forty-ounce bottles of twist-off beer and the other half on a four hour visit to some lady’s house on a street where the lights have all been shot out by people who’d rather do what they do, in this city, in the dark. And half a block away from JanitorMan there’s a group of good-for-nothings who don’t know no better waiting to beat JanitorMan with rusted bicycle chains and imitation Lousiville Sluggers, and if they don’t find a cent on him – which they won’t – they’ll just pound at him till the muscles in their arms start burning, till there’s no more teeth to crack out. But they don’t count on me. They don’t count on no dark night (with a stomach full of grocery store brand macaroni-and-cheese and cut up Vienna sausages), Cause they’d rather believe I don’t exist, And from eighty-seven stories up I could hear one of the good-for-nothings say “Gimmethecash” real fast (like that) just “Gimmethefuckingcash” and I see JAnitorMan mumble something in drunk language and turn pale and from eighty-seven stories up I could hear his stomach trying to hurl its way out of his Dickies. So I swoop down like and fast and I’m like darkness. I’m like SWOOSH –- And I throw a Bat-a-rang at the one naked lightbulb –- And they’re all like “whoa-motherfucker-who-just-turned-out-the-lights?” –“What’s that over there?” –-“What?” –- “Gimme whatchou got old man” –- “Did anybody hear that?!” –- “No, really” –- “There ain’t. No. Bat.” – But then –- One out of three good-for-nothings gets it to the head! And number Two swings blindly into the dark cape before him but before his fist hits anything I grab a trash can lid and –-- Right into the gut, and number One comes back with a jump-kick but I know judo-karate too so I’m like –-- Twice –-- but before I can do any more damage suddenly we all hear a CLIC – CLIC –And suddenly everything gets quiet And the one good-for-nothing left standing grips a handgun and aims straight up, like he’s holding Jesus hostage, like he’s threatening maybe to blow a hole in the moon. And the good-for-nothing who got it to the head who tried to jump-kick me and the other good-for-nothing who got it in the gut is both scrambling back away from the dark figure before him. And the drunk man the JanitorMan is huddled in a corner, praying to Saint Anthony ‘cause that’s the only one he could remember. And there’s me, Eyes glowing white, cape blowing softly in the wind. Bulletporoof chest heaving. My heart beating right through it in a Morse code for “fuck with me, just once, come on, just try.” And the one good-for-nothing left standing, the one with the handgun, he laughs he lowers his arm, and he points it at me and gives the moon a break, and he aims it right between my pointy ears, like goalposts and he’s special teams. And JanitorMan is still calling Saint Anthony but he ain’t pickin’ up, And for a second it seems like…maybe I’m gonna lose. Naw. SHOO – SHOO! FUACATA! --“Don’t kill me man!” –“SNAP! – Wrist CRACK – Neck – SLASH! – Skin – meets – acid – “AHH!!” –And he’s on the floor. And I’m standing over him. And I got the gun in MY hands now. And I hate guns, I hate holding ‘em cause I’m Batman, and –Batman don’t like guns ‘cause his parents got iced by guns a long time ago – but for just a second, my eyes glow white, and I hold this thing, for I could speak to the good-for-nothing in a language he maybe understands…CLIC – CLIC…And the good-for-nothings become good-for-disappearing into whatever toxic-waste-chemical-sludge-shit-hole they crawled out of. And it’s just me and JanitorMan. And I pick him up. And I wipe sweat and cheap perfume off his forehead. And he begs me not to hurt him and I grab him tight by his JanitorMan shirt collar and I pull him to my face, and he’s taller than me, but the cape helps so he listens when I look him straight in the eyes and I say two words to him: “Go home.” And he does, checking behind his shoulder every ten feet. And I SWOOSH from building to building on his way there, ‘cause I know where he lives. And I watch his hands where he lives. And I watch his hands tremble as he pulls out his keychain and opens the door to his building. And I’m back in bed before he even walks in through the front door. And I hear him turn on the faucet and pour himself a glass of warm tap water And he puts the glass back in the sink. And I hear his footsteps, And they get slower as they get to my room. And he creaks my door open like mad slow. And he takes a step in, which he never does. And he’s staring off into nowhere, his face the color of sidewalks in summer, and I act like I’m just waking up, and I say, “What’s up, Pop?” And JanitorMan says nothing to me. But I see, in the dark, I see his arms go limp and his head turns back, like towards me, and he lifts it for I could see his face, For I could see his eyes, And his cheeks is dripping but not with sweat. And he just stands there, breathing, like he remembers my eyes glowing white. Like he remembers my bulletproof chest. Like he remembers he’s my pop. And for a long time I don’t say nothing. And he turns around, hand on the doorknob, and he ain’t looking up my way but I hear him mumble two words to me. “I’m sorry.” And I lean over and open my window just a crack.… If you look up high enough you could see me. And from where I am? I could hear everything.LESSON 4. Cellular Respiration • Define cellular respiration • Identify the stages of clan respiration You have just learned how the energy from the sun is captured, processed, and stored in the form of glucose. Cellular respiration, another important life process, is the means by which cells release the stored energy in glucose to make adenosine triphosphate (ATP). The primary goal of this life process is to convert stored energy into usable form, such as ATP, for the cells to carry out their functions. Cellular respiration involves several chemical reactions. The reactions can be summed up in the following equation: C6 H12 O6 + 602 ----- 6 CO₂ +6H₂O + ATP Glucose oxygen carbon dioxide water energy Aerobic respiration reactions, or cellular respiration that takes place in the presence of oxygen, can be grouped into three stages glycolysis, Krebs cycle, and electron transport chain (ETC). Stage 1: Glycolysis Glycolysis is the process that breaks down one molecule of 6-C glucose into 3-C pyruvates or pyruvic acids. It also releases four molecules of ATP. This process occurs in the cytoplasm of the cell. The following is the step-by-step process of glycolysis. Take note that several enzymes are involved in this process. 1. The first step of glycolysis requires energy. It can only proceed when the two ATP molecules donate energy to the glucose by transferring a phosphate group with the help of an enzyme, producing glucose 6-phosphate 2. Then, a specific enzyme promotes the rearrangement of the atoms, producing the fructose 6-phosphate. 3. The action of the enzyme in step 2 promotes the transfer of a phosphate group from another ATP molecule, forming fructose 1,6-bisphosphate. 4. The resulting fructose 1,6-bisphosphate molecules, with the help of another enzyme, splits into two molecules, each with three carbon backbones. These two sugars are dihydroxyacetone phosphate and glyceraldehyde 3-phosphate. 5. Another important enzyme then rapidly interconverts the molecules of dihydro-xyacetone phosphate and glyceraldehyde 3-phosphate. This produces two molecules of glyceraldehyde 3-phosphate or 3-phosphoglyceraldehyde (PGAL) 6. The succeeding step involves another enzyme-mediated action. The hydrogen (H) from PGAL is transferred to the oxidizing agent, nicotinamide adenine dinucleotide (NAD), which forms NADH. A phosphate (P) is also added from the cytosol of the cell to oxidize the two molecules of PGAL, forming two 1.3-bisphosphoglycerate. 7. A phosphate (P) from 1,3-biphosphoglycerate is transferred to ADP to form ATP. This happens for each of the two 1,3-bisphosphoglycerate. resulting to a yield of two ATP and two 3-phosphoglycerate molecules. 8. A phosphate is transferred from 3-phosphoglycerate molecules from the third carbon to the second carbon, forming 2-phosphoglycerate molecules A hydrogen atom and a hydroxyl ((OH) group is released, which then combines to form water (H2O). The removal of H2O from 2-phosphoglycerate results in the formation of 2- phosphoglycerate molecules. 9. A hydrogen atom and a hydroxyl ((OH) group is released, which then combines to form water (H2O). The removal of H2O from 2-phosphoglycerate results in the formation of two phosphoenolpyruvic acid (PEP) 10. Phosphate (P) from PEP is transferred to ADP (and forms ATP) and the final product, pyruvic acid. This reaction yields two molecules of pyruvic acid and two ATP molecules In summary, a single glucose molecule that undergoes the process of glycolysis produces two molecules of pyruvic acid, four molecules of ATP, two molecules of NADEL and two molecules of H.O. However, only two molecules of ATP are counted as net products since two molecules of ATP are spent throughout the process. Stage II: Krebs Cycle The Krebs cycle, named after its proponent Sir Hans Adolf Krebs, is a cyclical series of enzyme-controlled reactions. This stage of cellular respiration occurs in the matrix of the mitochondria. It is sometimes. called the citric acid cycle (CAC) since it produces citric acid. Citric acid contains three carboxyl (COOH) groups; hence, it is also called the tricarboxylic acid cycle (TCA). This requires the pyruvic acids produced during glycolysis. The main function of this cycle is to produce high-energy-yielding molecules, namely, NADH and flavin adenine dinucleotide (FADH) that will later on be used in the electron transport chain reaction. Figure 6-7. Summary of glycolysis and corresponding products in each reaction presented (See Appendix F on page 285 for an enlarged and complete version of the image.) An initial process is needed for the Krebs cycle to begin. As a pyruvate molecule from glycolysis enters the mitochondrion, it undergoes an important preliminary ate to form acetyl-CoA reaction. Coenzyme-A (COA) combines with pyruvate help of an enzymatic complex. This conversion also produces CO, and NADH. The Krebs cycle is summarized as follows. Take note that several enzymes are involved in this process. 1. The Krebs cycle technically begins when the acetyl-CoA combines with oxaloacetic acid (OAA), a 4-C molecule, to produce citric acid, a 6-C molecule. 2. With the aid of an enzyme, the citric acid now goes through a series of reactions that releases energy. Water molecule is removed from the citric acid and is returned in a different location. The-OH group is repositioned, forming the molecule isocitrate. 3. Isocitrate is then oxidized, forming the a-ketoglutarate, a 5-C molecule. The byproducts of this reaction are NADH and CO, 4 The a-ketoglutarate loses its CO, and a coenzyme-A is added in its place. The decarboxylation occurs with the help of NAD, which then becomes NADH. The resulting molecule is called succinyl-CoA. 5. Succinyl-CoA is converted into succinate. Also in this reaction, a molecule of guanosine triphosphate (GTP) is synthesized. The GTP molecule has similar structure and energy properties to that of ATP and is used by cells the same way. The free phosphate group attacks the succinyl-CoA molecule, which detaches the COA. Then, phosphate is attached to GDP to come up with GTP, similar to the process that occur in ATP synthesis (from ADP to ATP). 6. Two hydrogens are removed from succinate, A molecule of flavin adenine dinucleotide (FAD), a coenzyme similar to NAD, is reduced to FADH, as it takes the hydrogens from the succinate. This reaction produces the fumarate. 7. Fumarate is then converted into malate as the addition of a water molecule is catalyzed. The final reaction is the regeneration of oxaloacetate. The resulting byproduct of this regeneration is NADH Recall that two pyruvate molecules were produced during glycolysis, causing the Krebs cycle to turn twice. Each tuts produces three molecules of NADH, single ATH one FADIH, and the by-product CO, which is exhaled. Stage III: Electron Transport Chain The electron transport chain (ETC) is a series of photon pumps on the inner membrane of the mitochondrion. Electron transport is the last stage of the cellular respiration. In this stage, the energy from NADH and FADH, from the Krebs cycle is transferred to ADP to produce ATP. This process is generally known as oxidative phosphorylation. This energy coupling mechanism in the cell was revealed by the work of Peter stored energy in the form of proton (1) gradient to phosphorylate (add phosphate) ADP and produce ATP. The pumping of hydrogen sons across the inner membrane creates higher concentration ions in the inner membrane than on the outside of the membrane. This chemiosmotic gradient causes the ions to flow back across the membrane where the concentration of ions is lower. ATP synthase lined in the matrix serve as a channel protein, helping the ions to move across the membrane. The chemiosmotic gradient powers the phosphorylation of ADP to ATP, which also occurs in the ATP synthase. After passing through the ETC, the oxygen, being the final hydrogen acceptor, combines with two electrons and two protons, forming a water molecule. Water is a by-product of cellular respiration and is excreted. MINI TEST 6-3 1. Which energy-releasing pathway yields the most ATF in each glucose molecule? 2. Briefly describe the two stages of aerobic respiration that follow glycolysis: (a) Krebs cycle (b) Electron transport chain Anaerobic Respiration Most cells carry out arrobic respiration when oxygen is present. Aerobic respiration is an efficient process that yields a lot of ATP. However, many organisms thrive in mud, marshes, animal gut, canned goods, sewage treatment pond, and deep oceans where oxygen is scarce. Organisms that can live without oxygen are called anaerobes. Cellular respiration that proceeds without the presence of oxygen is called anaerobic respiration. In the event that the oxygen supply becomes low, aerobic cells also perform fermentation and lactic acid fermentation anaerobic pathways. There are two common anaerobic pathways in these cells, alcoholic fermentation and lactic acid fermentation. In alcoholic fermentation, ethyl alcohol and carbon dioxide are produced by some cells using the pyruvate from glycolysis. Each pyruvate molecule is rearranged into acetaldehyde and carbon dioxide, which is eventually released. NADII gives up electrons to acetaldehyde to form ethanol Fermentation is widely used in the industry. Yeast, a fungus used in making bread. can undergo anaerobic respiration. Bakers aux sugar, flour, water, and yeast to form the bread dough. The dough rises due to the carbon dioxide and alcohol released by the yeast cells trapped in air bubbles. Beer and wine manufacturers, we yeast to ferment the sugars in wheat and grape juice, forming alcoholic beverages such as beer and wine. In some cells, glycolysis produces two pyruvates, two NADH molecules, and two ATP molecules. Pyruvate itself becomes the final acceptor of the electrons from the NADH that produces the final product: lactate. Oftentimes, this product is called lactic acid. Human skeletal muscles can carry out fermentation when the blood cannot supply the cells with adequate oxygen during strenuous activities. When lactic acid builds up in the muscles, fatigue, burning sensation, and cramps result. Lactic acid will continue to build up until there is adequate supply of oxygen. Lactic acid is then converted back into pyruvate in the liver. Muscles also restore normal functions. Have you ever wondered why milk or cream turns sour after some time? Bacterial cells that undergo fermentation are responsible in producing lactate that turns the milk sour. These bacteria are used in manufacturing yogurt and sour milk products. Fermentation pathways do not breakdown and utilize the glucose completely. ATP is no longer produced beyond the process of glycolysis. Thus, energy produced is just enough for some single-celled organisms, or the energy can only be used by multicellular organisms for a short period.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 Drug Alpha1 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 Drugs Alpha 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 Inhibitors aka 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 HTN Treatment 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)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.Muscles