1sac that encloses the heart
pericardium
2function of the right side of the heart
brings blood to the lungs
3function of the left side of the heart
collects blood from the lungs to bring to the body
4major cause of death globally
cardiovascular disease
5four major types of cardiovascular disease
1. coronary heart disease
2. cerebrovascular disease
3. peripheral arterial disease
4. aortic athersclerotic disease
6cause of coronary heart disease
lack of oxygen to the heart
7difference between a normal artery and an atherosclerotic artery
athersclerotic arteries have plaque built up along the sides, making them more narrow
8type of heart disease that causes fluid to father in the lungs
congestive heart failure
9most common cause of congestive heart failure
coronary heart disease
10cause of myocardial infarction
one area of cardiac muscle is deprived of blood flow/oxygen, tissue starts to die
11umbrella term for conditions due to ischemic heart disease
acute coronary symdrome
12most sensitive and specific biomarkers for cardiac healthh
cardiac troponins
133 criteria for myocardial infarction diagnosisc
1. history
2. ecg/ekg
3. serum cardiac biomarkers
14function of en electrocardiogram (ecg/ekg)i
records electrical signals in the heart
15information gathered from an ecg/ekgh
- heart rhythmate
- hypertrophy
- chamber enlargement
- evidence of impaired blood supply
16three main historical serum cardiac markers
ASt, LD, CK-MB
17function of troponin
moves calcium signal that triggers muscle contraction
183 isoforms of troponin
TnT, TnI, TnC
19how soon after a myocardial injury is troponin detected
3-12 hrs
20when do troponin levels peak after cardiac injury
12-24 hrs
21how long are troponin levels elevated after myocardial injury
8-21 days for TnT, 7-14 days for TnI
22preferred biomarkers for myocardial necrosis (troponin isoforms)
cTnI, cTnT
23which troponin isoform is only found in the heart
TnI
24how long after the onset of chest pain does CK-MB start to rise
4-6 hrs
25when does CK-MB return to normal after the onset of chest pain
2-4 days
26function of myoglobin
binds iron and oxygen aiding in muscle funciton
27where is myoglobin typically found
striated (cardiac/skeletal) muscle; rarely in circulation
28what causes the release of myoglobin
damage to striated muscle
29how does a test for myoglobin compare to a test for CK-MB
more sensitive, less specific
30when does myoglobin rise after a myocardial injury
1-4 hrs; earliest indicator
31when does myoglobin peak after a myocardial injury
8-12 hrs
32when does myoglobin return to baseline after a myocardial injury
8-12 hrs
33which two cardiac biomaarkers have the most noticeable peak after a myocardial injury
TnT, TnI
34most common cause of heart failure
coronary heart disease
35common markers of heart failure
natriuretic peptides
36cause of natriuretic peptide secretion
increased pressure/volume load
37what does BNP stand for
B-type natruiuretic peptide
38natriuretic peptides used to dintinguish cardiac vs noncardiac causes of dyspnea
BNP, proBNP
39dyspnea
shortness of breath
40how goes BNP secretion change during congestive heart failure
increases
41where is BNP secreted from
cardiac ventricles
42why are pro-BNP and BNP tested when a patient presents with dyspnea
in congestive heart failure, the heart can't pump enough blood, resulting in dyspnea
43what protein is associated with the presence of inflammation
crp - c-reactive protein
44what condition is associated with crp levels that are above normal but below the threshold for infection
atherosclerosis
45how does stimulus from inflammatory cytokines affect crp levels?
rapidlt synthesized in the liver, levels can increase 1000x
46which of the following are functions of the kidney
- urine formation
- fluid/electrolyte balance
- hormone storage
- hormone, drug, and waste secretion
- acid-base regulation
- protein production
47what are the inner and outer regions of the kidney called
outer is the cortex, inner is the medulla
48location of the proximal/distal convoluted tubules
cortex
49where does urine go after it exits the nephron?
collecting duct carries it to the renal pelvis
503 basic processes that occur in the nephron
- glomerular filtration
- tubular secretion
- tubular reabsorption
51charge of the glomerulus' basement membrane
negative
52average glomerular filtration rate
1200-1500 mL/min
53tubular reabsorption
returns valuable substances to the blood
54tubular secretion
removal of metabolic waste products
55what 3 substances are reabsorbed in the loop of henle
water, sodium, chloride
56what is reabsored in the descending loop of henle
water
57what is reabsorbed in the ascending loop of henle
solutes (sodium, chloride)
58which 2 hormones dictate function of the distal convoluted tubule
AVP, aldosterone
59function of the distal convoluted tubules
makes small adjustments to electrolyte levels to preserve acid-base balance
60final site of concentrating or diluting urine
collecting duct
612 hormones that control reabsorption in the collecting duct
AVP, aldosterone
62former name of AVP (arginine vasopressin)
ADH (antidiuretic hormone)
63where is urea produced
liver
64creatine results in the waste product ______
creatinine
65final product of purine metabolism
uric acid
66kidneys work by excreting ______ and reclaiming _______ from the glomerular filtrate
acid, bicarbonate
67the kidneys work to correct
- metabolic acidosis
- respiratory acidosis
- metabolic alkalosis
- respiratory alkalosis
68what makes the kidneys a primary endocrine site
they produce their own hormones
69what makes the kidneys a secondary endocrine site
serves as a target for endocrine hormones produced elsewhere
70two hormones made by the kidneys
renin, erythropoietin
71urinalysis results/casts associated with glomerulonephritis
blood, protein, RBC casts, hyaline casts, granular casts
72what kind of casts differentiate acute and chronic glomerulonephritis
waxy casts - typically found in chronic
73what protein is typically found in urine in cases of acute/chronic glomerulonephritis
albumin
74how does lipid production change in cases of nephrotic syndrome?
liver produces more lipids, resulting in lipidemia
75what kidney condition is associated with edema
nephrotic syndrome
76potential causes of acute kidney injury (AKI)
heavy metal poisoning, antifreeze, analgesic toxicity, sepsis, hemorrhagic shock, burns, cardiac failure
77what substance is used to test glomerular filtration rate
creatinine - cleared essentially only by glomerular filtration
78standard lab determination of the earliest stages of renal failure
creatinine clearance
79what 2 tests are required in order to calculate creatinine clearance
serum creatinine, 24hr urine
80microalbuminuria
presence of albumin in urine
81what disease is associated with microalbuminuria
diabetes mellitus
82purpose of a beta 2-microglobulin test
evaluates kidney damage, differentiate between glomerular and renal issues
83therapeutic range of a drug
dose/concentration range of a drug that produces the desired effects
843 factors that affect drugs and TDM
1. route of admin
2. drug absorption
3. drug secretion
85most common/least invasive route of drug admin for patients
oral
86route of admin that offers the most direct and effective delivery
intravenous (IV)
87bioavailability
fraction of the admin dose that eventually reaches its site of action
88some factors that affect efficacy of oral drugs
1. drug dissociation
2. solubility in GI fluids
3. diffusion across GI membranes
89to interact with its site and elicit a response, drugs must be in their _______ form
- unbound
- bound
- dissociated
- original
90after the GI tract, where do drugs go for processing?
hepatic portal system
91first-pass effect
drug is metabolized before entering circulation
92where doea a drug end up after leaving the liver?
bloodstream
93two primary mechanisms through which a druga can be eliminated
hepatic, renal filtration elimination
94drugs are converted to their water ________ forms through enzymatic reactions in the liver before being pumped into the bile or released into circulation
soluble
95what part of the nephron filters out drugs or their metabolites
glomerulus
96pharmacokinetics
movement of drugs in the body
97single msot important factor in therapeutic drug monitoring
timing
98five cardiac drugs
- digoxin
- lidocaine
- quinidine
- procainamide
- disopyramide
99two antibiotics
- aminoglycoside (aka gentamycin)
- vancomycin
100four antiepileptics
- phenobarbital
- phenytoin
- valproic acid
- carbamazepine
101bronchodilator
theophylline
102immunosuppressive drugs
- cyclosporine
- tacrolimus
103antineoplastics (cancer treatment)
methotrexate
104primary use of digoxin
treats congestive heart failure
105route of admin for digoxin
oral
106elimination mech for digoxin
renal filtration
107toxic effects of digoxin
nausea, vomiting, visual disturbance
108use of digibind
treat digoxin overdose
109main purpose of quinidine, disopyramide, and procainamide
treat cardiac arrythmic situations
110route of admin for quinidine, disopyramide, and procainamide
oral
111elimination mech for quinidine
hepatic
112toxic effects of quinidine
nausea, vomiting, abdominal discomfort, cardiovascualr toxicity
113body's natural pacemaker
sinoatrial node
114tachycardia
increased heart rate
115bradycardia
decreased heart rate
116arrythmia
disturbed heart rhythm
117route of elimination for procainamide
renal filtration and hepatic
118toxic effects of procainamide
myocardial depression, arrythmia
119route of elimination for disopyramide
renal filtration
120toxic effects of disopyramide
dry mouth, constipation, caardiac symptoms
121examples of aminoglycosides
gentamicin, tobramycin, amikacin, kanamycin
122purpose of aminoglycosides
treats gram negative bacterial infections
123route of admin for aminoglycosides
IV or intramuscular injection
124route of elimination for aminoglycosides
renal filtration
125toxic effects of aminoglycosides
nephrotoxicity, ototoxicity
126purpose of vancomycin
treat infections by gram positive cocci and bacilli
127route of admin for vancomycin
IV
128route of elimination for vancomycin
renal filtration
129toxic effects of vancomycin
red man syndrome, nosphrotoxicity, ototoxicity
130how can you differentiate vancomycin and aminoglycoside toxicity based on symptoms?
vancomycin toxicity may manifest as red man syndrome, aminoglycosides will not
131purpose of primidone
controls grand mal seizures that are resistant to other drugs
132route of admin for primidone
oral
133route of elimination for primidone
hepatic
134primidone is broken into _______ in the liver
phenobarbital
135purpose of phenobarbital
slow acting, controls many types of seizures
136route of admin of phenobarbital
oral
137route of elimination for phenobarbital
mostly hepatic, also some renal elimination
138side effects of phenobarbital
drowsiness, fatigue, depression, lowered mental capacity
139purpose of phenytoin (dilantin)
treat seizure disorders, prevent loss of functional tissue during brain injuries
140route of admin for phenytoin
oral
141route of elimination for phenytoin
hepatic
142toxic effects of phenytoin
more seizures, hirsutism, vit D/folate deficiency
143purpose of valproic acid
treat petit mal and absence seizures
144route of admin for valproic acid
oral
145route of elinination for valproic acid
hepatic
146toxic effects of valproic acid
nausea, lethargy, weight gain, pancreatitis, hallucinations, hepatic dysfunction
147purpose of carbamazepine
general seizure disorders when other drugs don't work
148route of admin for carbamazepine
oral
149route of elimination for carbamazepine
hepatic
150toxic effects of carbamazepine
liver dysfunction, rashes, leukopenia, nausea, vertigo
151purpose of ethosuximide
control petit mal seizures
152route of admin for ethosuximide
oral
153route of elimination for ethosuximide
mostly hepatic, some renal filtration
154side effects of ethosuximide
nausea, vomiting, anorexia, dizziness, lethargy
155purpose of lithium
treat bipolar, depression, or other behavioral disorders (+ migraines and cluster headaches)
156route of elimination for lithium
renal filtration
157toxic effects of lithium
lethargy, apathy, speech difficulty, muscle weaknessigidity, seizures, coma
158drugs considered tricyclic antidepressants (3)
imipramine, amitriptyline, doxepin
159purpose of tricyclic antidepressants
treat depression, insomnia, loss of libido, apathy
160route of admin for tricyclic antidepressants
oral
161route of elimination for tricyclic antidepressants
hepatic
162toxic effects of tricyclic antidepressants
drowsiness, constipation, blurred visionm memory loss, seizures, cardiac arrhythmia, loss oc consciousness
163two main test methods for therapeutic drug monitoring
immunoassay or chromatography
164atypical antipsychotic used for treatment-resistant schizophrenia
clozapine
165thienobenzodiazepine derivative used for schizophrenia, manic episodesm and recurrent bipolar episodes
olanzapine
166purpose of theophylline
respiratory disorders (asthma, COPD)
167route of admin for theophylline
oral, IV
168route of elimination of theophylline
mostly hepatic, some renal filtration
169tosic effects of theophylline
insomnia, arrhythmia, seizures, cardiorespiratory arrest
170purpose of cyclosporine
immunosuppressant
171route of admin of cyclosporine
oral
172route of elimination of cyclosporine
hepatic
173toxic effects of cyclosporine
renal tubularlomerular dysfunction, hypertension
174purpose of tacrolimus
immunosuppressant
175route of admin for tacrolimus
oral
176toxic effects of tacrolimus
nephrotoxicity, thrombus formationm anemia, leukopenia, thrombocytopenia, hyperlipidemia
177purpose of sirolimua
antifungal immunosuppressant
178RDA approved drug for prophylaxis of graft rejection in solid organ transplant
everolimus
179lymphocyte proliferator inhibitor for renal transplant patients
mycophenolic acid
180antineoplastics
prevent, inhibit, of half neoplasm; includes most chemo drugs
181how quickly are antineoplastics metabolised after admin
seconds to minutes - makes it hard to assess by TDM
182purpose of methotrexate
chemo; high doses w leucovorin can treat neoplasms
183how does methotrexate work as chemo?
inhibits DNA synthesis in all cell types, indirectly kills neoplastic cells since they divide more rapidly than normal cells
184poison
any substance that causes harm, typically exogenous
185xenobiotic
chemicals/drugs not normally found in the body, ie antibiotics or antidepressants
186toxin
endogenous substance made in living cells or microorgs
187td50
dose of a drug that would result in a toxic effect in 50% of the population
188ld50
dose of a drug that would kill 50% of the population
189ed50
dose of a drug that would result in effective therapeutic effects in 50% of the population
190therapeutic index
ld50:ed50 or td50:ed50
191how does alcohol affect the cns
acts as a depressant
192indicators of alcohol abuse
high ggt, ast, alt, ast:alt ratio
193why is carbon monoxide dangerous
200x higher affinity for hemoglobin than oxygen, binds and forms carboxyhemoglobin
194how does cyanide express toxicity
binds to heme iron, depleting ATP
195trinder reaction
immunoassay method that tests for salicylate
196how does acetominophen cause liver injury
overdose overwhelms the liver, requiring the body to process it through the alternative cytochrome p-450 system, forming NAPQI (toxic compound)
197trace elements
iron, copper, zinc, molybdenum
198ultratrace elements
selenium, chromium, manganese
199nonessential trace elements
aluminum, arsenic, cadmium, lead, mercury
2002 testing methods for trace elements
- atomic absorption spec
- inductively coupled plasma mass spec
201this essential ultratrace element heightens the function of insulin
chromium
202hemochromatosis aka celtic curse
iron overload
203primary plasma iron transport protein
transferrin
204major iron storage protein
ferritin
205most common organ where excess iron is stored
liver
206two categories of vitamins
fat soluble, water soluble
207fat soluble vitamins
vit A, E, D, K
208water soluble vitamins
niacin (vit B3), folate (B9), cobalamin (B12), ascorbic acid (C), thiamine (B1), riboflavin (B2), pantothenic acid (B5), pyridoxine (B6), biotin (B7)