Results for "Bicarbonate"

ASSESSMENT OF THE LIVER Anatomic and Physiologic Overview The liver, the largest gland of the body and a major organ, can be considered a chemical factory that manufactures, stores, alters, and excretes a large number of substances involved in metabolism (Hammer & McPhee, 2019; Sanyal, Boyer, Terrault, et al., 2018). The location of the liver is essential because it receives nutrient-rich blood directly from the gastrointestinal (GI) tract and then either stores or transforms these nutrients into chemicals that are used elsewhere in the body for metabolic needs. The liver is especially important in the regulation of glucose and protein metabolism. The liver manufactures and secretes bile, which has a major role in the digestion and absorption of fats in the GI tract. The liver removes waste products from the bloodstream and secretes them into the bile. The bile produced by the liver is stored temporarily in the gallbladder until it is needed for digestion, at which time the gallbladder empties and bile enters the intestine (see Fig. 43-1). Anatomy of the Liver The liver is a large, highly vascular organ located behind the ribs in the upper right portion of the abdominal cavity. It weighs between 1200 and 1500 g in the average adult and is divided into four lobes. A thin layer of connective tissue surrounds each lobe, extending into the lobe itself and dividing the liver mass into small, functional units called lobules (Barrett, Barman, Brooks, et al., 2019; Hammer & McPhee, 2019). The circulation of the blood into and out of the liver is of major importance to liver function. The blood that perfuses the liver comes from two sources. Approximately 80% of the blood supply comes from the portal vein, which drains the GI tract and is rich in nutrients but lacks oxygen. The remainder of the blood supply enters by way of the hepatic artery and is rich in oxygen. Terminal branches of these two blood vessels join to form common capillary beds, which constitute the sinusoids of the liver (see Fig. 43-2). Thus, a mixture of venous and arterial blood bathes the hepatocytes (liver cells). The sinusoids empty into venules that occupy the center of each liver lobule and are called the central veins. The central veins join to form the hepatic vein, which constitutes the venous drainage from the liver and empties into the inferior vena cava, close to the diaphragm (Barrett et al., 2019; Hammer & McPhee, 2019; Sanyal et al., 2018). In addition to hepatocytes, phagocytic cells belonging to the reticuloendothelial system are present in the liver. Other organs that contain reticuloendothelial cells are the spleen, bone marrow, lymph nodes, and lungs. In the liver, these cells are called Kupffer cells (Barrett et al., 2019; Hammer & McPhee, 2019). As the most common phagocyte in the human body, their main function is to engulf particulate matter (e.g., bacteria) that enters the liver through the portal blood. The smallest bile ducts, called canaliculi, are located between the lobules of the liver. The canaliculi receive secretions from the hepatocytes and carry them to larger bile ducts, which eventually form the hepatic duct. The hepatic duct from the liver and the cystic duct from the gallbladder join to form the common bile duct, which empties into the small intestine. The sphincter of Oddi, located at the junction where the common bile duct enters the duodenum, controls the flow of bile into the intestine. Figure 43-1 • The liver and biliary system, including the gallbladder and bile ducts. Reprinted with permission from Norris, T. L. (2019). Porth’s pathophysiology: Concepts of altered health states (10th ed., Fig. 38.1). Philadelphia, PA: Wolters Kluwer. Figure 43-2 • A section of liver lobule showing the location of hepatic veins, hepatic cells, liver sinusoids, and branches of the portal vein and hepatic artery. Functions of the Liver Glucose Metabolism The liver plays a major role in the metabolism of glucose and the regulation of blood glucose concentration. After a meal, glucose is taken up from the portal venous blood by the liver and converted into glycogen, which is stored in the hepatocytes. Subsequently, the glycogen is converted back to glucose through a process called glycogenolysis and is released as needed into the bloodstream to maintain normal levels of blood glucose. However, this process provides a limited amount of glucose. Additional glucose can be synthesized by the liver through a process called gluconeogenesis. For this process, the liver uses amino acids from protein breakdown or lactate produced by exercising muscles. This process occurs in response to hypoglycemia (Barrett et al., 2019; Hammer & McPhee, 2019). Ammonia Conversion The use of amino acids from protein for gluconeogenesis results in the formation of ammonia as a by-product. The liver converts this metabolically generated ammonia into urea. Ammonia produced by bacteria in the intestines is also removed from portal blood for urea synthesis. In this way, the liver converts ammonia, a potential toxin, into urea, a compound that is excreted in the urine (Barrett et al., 2019; Hammer & McPhee, 2019). Protein Metabolism The liver also plays an important role in protein metabolism. It synthesizes almost all of the plasma proteins (except gamma-globulin), including albumin, alpha-globulins and beta-globulins, blood clotting factors, specific transport proteins, and most of the plasma lipoproteins. Vitamin K is required by the liver for synthesis of prothrombin and some of the other clotting factors. Amino acids are used by the liver for protein synthesis (Barrett et al., 2019; Hammer & McPhee, 2019). Fat Metabolism The liver is also active in fat metabolism. Fatty acids can be broken down for the production of energy and ketone bodies (acetoacetic acid, beta-hydroxybutyric acid, and acetone). Ketone bodies are small compounds that can enter the bloodstream and provide a source of energy for muscles and other tissues. Breakdown of fatty acids into ketone bodies occurs primarily when the availability of glucose for metabolism is limited, as in starvation or in uncontrolled diabetes. Fatty acids and their metabolic products are also used for the synthesis of cholesterol, lecithin, lipoproteins, and other complex lipids (Hammer & McPhee, 2019; Sanyal et al., 2018). Vitamin and Iron Storage Vitamins A, B, and D and several of the B-complex vitamins are stored in large amounts in the liver. Certain substances, such as iron and copper, are also stored in the liver. Bile Formation Bile is continuously formed by the hepatocytes and collected in the canaliculi and bile ducts. It is composed mainly of water and electrolytes such as sodium, potassium, calcium, chloride, and bicarbonate, and it also contains significant amounts of lecithin, fatty acids, cholesterol, bilirubin, and bile salts. Bile is collected and stored in the gallbladder and is emptied into the intestine as needed for digestion. The functions of bile are excretory, as in the excretion of bilirubin; bile also serves as an aid to digestion through the emulsification of fats by bile salts. Bile salts are synthesized by the hepatocytes from cholesterol. After conjugation or binding with amino acids (taurine and glycine), bile salts are excreted into the bile. The bile salts, together with cholesterol and lecithin, are required for emulsification of fats in the intestine, which is necessary for efficient digestion and absorption. Bile salts are then reabsorbed, primarily in the distal ileum, into portal blood for return to the liver and are again excreted into the bile. This pathway from hepatocytes to bile to intestine and back to the hepatocytes is called the enterohepatic circulation. Because of the enterohepatic circulation, only a small fraction of the bile salts that enter the intestine are excreted in the feces. This decreases the need for active synthesis of bile salts by the liver cells (Hammer & McPhee, 2019). Bilirubin Excretion Bilirubin is a pigment derived from the breakdown of hemoglobin by cells of the reticuloendothelial system, including the Kupffer cells of the liver. Hepatocytes remove bilirubin from the blood and chemically modify it through conjugation to glucuronic acid, which makes the bilirubin more soluble in aqueous solutions. The conjugated bilirubin is secreted by the hepatocytes into the adjacent bile canaliculi and is eventually carried in the bile into the duodenum. p. 1366 p. 1367 In the small intestine, bilirubin is converted into urobilinogen, which is partially excreted in the feces and partially absorbed through the intestinal mucosa into the portal blood. Much of this reabsorbed urobilinogen is removed by the hepatocytes and secreted into the bile once again (enterohepatic circulation). Some of the urobilinogen enters the systemic circulation and is excreted by the kidneys in the urine. Elimination of bilirubin in the bile represents the major route of its excretion. Drug Metabolism The liver metabolizes many medications, such as barbiturates, opioids, sedatives, anesthetics, and amphetamines (Goldman & Schafer, 2019; Hammer & McPhee, 2019; Sanyal et al., 2018). Metabolism generally results in drug inactivation, although activation may also occur. One of the important pathways for medication metabolism involves conjugation (binding) of the medication with a variety of compounds, such as glucuronic acid or acetic acid, to form more soluble substances. These substances may be excreted in the feces or urine, similar to bilirubin excretion. Bioavailability is the fraction of the given medication that actually reaches the systemic circulation. The bioavailability of an oral medication (absorbed from the GI tract) can be decreased if the medication is metabolized to a great extent by the liver before it reaches the systemic circulation; this is known as first-pass effect. Some medications have such a large first-pass effect that their use is essentially limited to the parenteral route, or oral doses must be substantially larger than parenteral doses to achieve the same effect. Gerontologic Considerations Chart 43-1 summarizes age-related changes in the liver. In the older adult, the most common change in the liver is a decrease in size and weight, accompanied by a decrease in total hepatic blood flow. However, in general, these decreases are proportional to the decreases in body size and weight seen in normal aging. Results of liver function tests do not normally change with age; abnormal results in older patients indicate abnormal liver function and are not a result of the aging process itself. Chart 43-1 Age-Related Changes of the Hepatobiliary System •Atypical clinical presentation of biliary disease •Decreases in the following: •Clearance of hepatitis B surface antigen •Drug metabolism and clearance capabilities •Intestinal and portal vein blood flow •Gallbladder contraction after a meal •Rate of replacement and or repair of liver cells after injury •Size and weight of the liver, particularly in women •Increased prevalence of gallstones due to the increase in cholesterol secretion in bile •More rapid progression of hepatitis C infection and lower response rate to therapy •More severe complications of biliary tract disease Adapted from Townsend, C. M., Beauchamp, R. D., Evers, B. M., et al. (2016). Sabiston’s textbook of surgery: The biological basis of modern surgical practice. Philadelphia, PA: Elsevier. Metabolism of medications by the liver decreases in the older adult, but such changes are usually accompanied by changes in intestinal absorption, renal excretion, and altered body distribution of some medications secondary to changes in fat deposition. These alterations necessitate careful medication administration and monitoring; if appropriate, reduced dosages may be needed to prevent medication toxicity

Renal Transport of Bicarbonate and Hydrogen Ion Transport

Bicarbonate, Calcium, Phosphate

carbonic acid bicarbonate buffer system

Endocrine System 1. What are hormones and what is their function in the body? Hormones are chemical messengers transported in the bloodstream that stimulate physiological responses in target cells or organs. 2. Types of hormones Endocrine System 1. What are hormones and what is their function in the body? Hormones are chemical messengers transported in the bloodstream that stimulate physiological responses in target cells or organs. 2. Types of hormones based on chemical composition and how they enter target cells: • Steroid hormones: Lipid-soluble, diffuse through cell membrane (e.g., cortisol). • Protein/Peptide hormones: Water-soluble, bind to surface receptors (e.g., insulin). • Biogenic/Monoamines: Derived from amino acids (e.g., T3/T4), may need carriers or membrane receptors. 3. Know all 6 hormones secreted by the anterior pituitary gland and their functions: • TSH: Stimulates thyroid to release T3 and T4. • ACTH: Stimulates adrenal cortex to release cortisol. • GH: Stimulates tissue growth and protein synthesis. • PRL: Stimulates milk production. • FSH: Stimulates egg maturation/sperm production. • LH: Triggers ovulation and testosterone production. 4. What is thymosin? Which gland secretes it? What is its function? Thymosin is secreted by the thymus and helps in the development and maturation of T-cells. 5. Know thyroid gland hormones, the cells that secrete them, and their functions: • T3 & T4 (follicular cells): Increase metabolism and regulate appetite. • Calcitonin (C cells): Lowers blood calcium levels. 6. Know the hormones secreted by the adrenal gland and their specific functions: • Cortex: • Aldosterone: Retains Na⁺, excretes K⁺, raises blood pressure. • Cortisol: Increases glucose, metabolism of fat/protein. • Androgens: Precursor to sex hormones. • Medulla: • Epinephrine/Norepinephrine: Increase heart rate, blood flow, and alertness. 7. Function of glucagon and insulin in maintaining homeostasis: • Insulin (beta cells): Lowers blood glucose. • Glucagon (alpha cells): Raises blood glucose. • Antagonistic: They have opposing effects to balance blood sugar levels. 8. Which cells are involved in spermatogenesis? Where does sperm production occur? • Sertoli (Sustentacular) cells support spermatogenesis. • Leydig (Interstitial) cells produce testosterone. • Occurs in the seminiferous tubules of the testes. 9. Know the hormones secreted by the testes and their functions: • Testosterone: Stimulates male development and sperm production. • Inhibin: Inhibits FSH to regulate sperm production. 10. What causes diabetes insipidus? How is it different from diabetes mellitus? • Diabetes insipidus: ADH deficiency → excessive urination. • Diabetes mellitus: Insulin issues → high blood glucose. 11. Know the 3 “P’s” of diabetes: • Polyuria: Excessive urination. • Polydipsia: Excessive thirst. • Polyphagia: Excessive hunger. 12. How are oxytocin and prolactin different? • Oxytocin: Stimulates uterine contractions and milk letdown. • Prolactin: Stimulates milk production. 13. Name the ovarian hormones and their functions: • Estrogen/Progesterone: Regulate cycle, pregnancy, and secondary sex characteristics. • Inhibin: Inhibits FSH secretion. ⸻ Muscle Physiology 14. Know 3 muscle types, their locations, and function: • Skeletal: Attached to bones; movement; voluntary. • Cardiac: Heart; pumps blood; involuntary. • Smooth: Organs/vessels; propels substances; involuntary. 15. Know the layers surrounding muscle: • Epimysium: Surrounds entire muscle. • Perimysium: Surrounds fascicle (bundle). • Endomysium: Surrounds individual fiber. 16. What is a fascicle? A bundle of muscle fibers. 17. What is a sarcomere? Name its regions: Smallest contractile unit (Z-disc to Z-disc). • Z-band, A-band (dark), I-band (light), H-zone. 18. What are actin and myosin? • Actin: Thin filament. • Myosin: Thick filament that pulls actin during contraction. 19. What is troponin and tropomyosin? • Tropomyosin blocks binding sites on actin. • Troponin binds Ca²⁺ to move tropomyosin and expose sites. 20. What is a motor unit? A motor neuron and all muscle fibers it controls. 21. Role of T-Tubule, SR, Terminal Cisternae: • T-Tubule: Conducts AP into cell. • SR: Stores calcium. • Terminal cisternae: Release calcium. 22. Which neurotransmitter is released at the neuromuscular junction? Acetylcholine (ACh). 23. What role does Ca²⁺ play in muscle physiology? Binds troponin, moves tropomyosin, exposes actin sites. 24. What happens to Ca²⁺ after action potential ends? Reabsorbed into SR by Ca²⁺ ATPase pump. 25. What is the function of ATP in muscle physiology? Powers myosin movement, detachment, and Ca²⁺ reuptake. 26. What is sliding filament theory? Myosin pulls actin filaments → sarcomere shortens → contraction. 27. What are DHP and Ryanodine receptors and their roles? • DHP: Voltage sensor in T-tubule. • Ryanodine: Releases Ca²⁺ from SR. 28. What is the function of AChE? Breaks down ACh to stop stimulation and contraction. 29. Difference between isotonic and isometric contractions: • Isotonic: Muscle changes length (shortens/lengthens). • Isometric: Muscle length stays same; tension builds. ⸻ Respiratory Physiology 30. Difference between conductive and respiratory divisions: • Conductive: Air passageways (nose to bronchioles). • Respiratory: Gas exchange (alveoli). 31. Type I & II alveolar cells and functions: • Type I: Gas exchange. • Type II: Secretes surfactant, repairs alveoli. 32. Dust cells and their functions: Alveolar macrophages that clean up particles/debris. 33. Muscles in relaxed vs. forced respiration: • Relaxed inhale: Diaphragm, external intercostals. • Forced inhale: Accessory neck muscles. • Forced exhale: Internal intercostals, abdominals. 34. What happens to pressure and volume when inhaling/exhaling? • Inhale: Volume ↑, pressure ↓. • Exhale: Volume ↓, pressure ↑. 35. Difference between systemic and pulmonary exchange: • Systemic: Gas exchange at tissues. • Pulmonary: Gas exchange in lungs. 36. What cells are involved in carrying gases? Red blood cells (RBCs). 37. Which enzyme converts CO₂ + H₂O → H₂CO₃? Carbonic anhydrase. 38. What does carbonic acid break into? H⁺ + HCO₃⁻ (bicarbonate ion). 39. What happens in hypoxia (low oxygen)? • ↓O₂, ↑CO₂, ↓pH (acidosis). 40. What happens in hypercapnia (high CO₂)? • ↑CO₂, ↓O₂, ↓pH (acidosis). 41. Receptors for blood pH and their locations: • Central (CSF pH): Medulla oblongata. • Peripheral (O₂, CO₂, pH): Carotid & aortic bodies. 42. CO₂ loading & O₂ unloading at tissues: • CO₂ enters blood → forms HCO₃⁻. • O₂ released to tissues. 43. CO₂ unloading & O₂ loading at alveoli: • CO₂ released from blood to lungs. • O₂ binds to hemoglobin. 44. Brain part for unconscious breathing: Medulla oblongata. 45. Obstructive vs. restrictive disorders + example: • Obstructive: Narrowed airways (asthma). • Restrictive: Reduced lung expansion (fibrosis). 46. Know spirometry volumes (not numbers): • Tidal volume, • Inspiratory/Expiratory reserve volume, • Residual volume, • Vital capacity, • Total lung capacity, • Inspiratory capacity, • Functional residual capacity. 47. Define eupnea, dyspnea, tachypnea, apnea, Kussmaul respiration: • Eupnea: Normal breathing. • Dyspnea: Labored breathing. • Tachypnea: Rapid, shallow breathing. • Apnea: No breathing. • Kussmaul: Deep, rapid (from acidosis Endocrine System 1. What are hormones and what is their function in the body? Hormones are chemical messengers transported in the bloodstream that stimulate physiological responses in target cells or organs. 2. Types of hormones based on chemical composition and how they enter target cells: • Steroid hormones: Lipid-soluble, diffuse through cell membrane (e.g., cortisol). • Protein/Peptide hormones: Water-soluble, bind to surface receptors (e.g., insulin). • Biogenic/Monoamines: Derived from amino acids (e.g., T3/T4), may need carriers or membrane receptors. 3. Know all 6 hormones secreted by the anterior pituitary gland and their functions: • TSH: Stimulates thyroid to release T3 and T4. • ACTH: Stimulates adrenal cortex to release cortisol. • GH: Stimulates tissue growth and protein synthesis. • PRL: Stimulates milk production. • FSH: Stimulates egg maturation/sperm production. • LH: Triggers ovulation and testosterone production. 4. What is thymosin? Which gland secretes it? What is its function? Thymosin is secreted by the thymus and helps in the development and maturation of T-cells. 5. Know thyroid gland hormones, the cells that secrete them, and their functions: • T3 & T4 (follicular cells): Increase metabolism and regulate appetite. • Calcitonin (C cells): Lowers blood calcium levels. 6. Know the hormones secreted by the adrenal gland and their specific functions: • Cortex: • Aldosterone: Retains Na⁺, excretes K⁺, raises blood pressure. • Cortisol: Increases glucose, metabolism of fat/protein. • Androgens: Precursor to sex hormones. • Medulla: • Epinephrine/Norepinephrine: Increase heart rate, blood flow, and alertness. 7. Function of glucagon and insulin in maintaining homeostasis: • Insulin (beta cells): Lowers blood glucose. • Glucagon (alpha cells): Raises blood glucose. • Antagonistic: They have opposing effects to balance blood sugar levels. 8. Which cells are involved in spermatogenesis? Where does sperm production occur? • Sertoli (Sustentacular) cells support spermatogenesis. • Leydig (Interstitial) cells produce testosterone. • Occurs in the seminiferous tubules of the testes. 9. Know the hormones secreted by the testes and their functions: • Testosterone: Stimulates male development and sperm production. • Inhibin: Inhibits FSH to regulate sperm production. 10. What causes diabetes insipidus? How is it different from diabetes mellitus? • Diabetes insipidus: ADH deficiency → excessive urination. • Diabetes mellitus: Insulin issues → high blood glucose. 11. Know the 3 “P’s” of diabetes: • Polyuria: Excessive urination. • Polydipsia: Excessive thirst. • Polyphagia: Excessive hunger. 12. How are oxytocin and prolactin different? • Oxytocin: Stimulates uterine contractions and milk letdown. • Prolactin: Stimulates milk production. 13. Name the ovarian hormones and their functions: • Estrogen/Progesterone: Regulate cycle, pregnancy, and secondary sex characteristics. • Inhibin: Inhibits FSH secretion. ⸻ Muscle Physiology 14. Know 3 muscle types, their locations, and function: • Skeletal: Attached to bones; movement; voluntary. • Cardiac: Heart; pumps blood; involuntary. • Smooth: Organs/vessels; propels substances; involuntary. 15. Know the layers surrounding muscle: • Epimysium: Surrounds entire muscle. • Perimysium: Surrounds fascicle (bundle). • Endomysium: Surrounds individual fiber. 16. What is a fascicle? A bundle of muscle fibers. 17. What is a sarcomere? Name its regions: Smallest contractile unit (Z-disc to Z-disc). • Z-band, A-band (dark), I-band (light), H-zone. 18. What are actin and myosin? • Actin: Thin filament. • Myosin: Thick filament that pulls actin during contraction. 19. What is troponin and tropomyosin? • Tropomyosin blocks binding sites on actin. • Troponin binds Ca²⁺ to move tropomyosin and expose sites. 20. What is a motor unit? A motor neuron and all muscle fibers it controls. 21. Role of T-Tubule, SR, Terminal Cisternae: • T-Tubule: Conducts AP into cell. • SR: Stores calcium. • Terminal cisternae: Release calcium. 22. Which neurotransmitter is released at the neuromuscular junction? Acetylcholine (ACh). 23. What role does Ca²⁺ play in muscle physiology? Binds troponin, moves tropomyosin, exposes actin sites. 24. What happens to Ca²⁺ after action potential ends? Reabsorbed into SR by Ca²⁺ ATPase pump. 25. What is the function of ATP in muscle physiology? Powers myosin movement, detachment, and Ca²⁺ reuptake. 26. What is sliding filament theory? Myosin pulls actin filaments → sarcomere shortens → contraction. 27. What are DHP and Ryanodine receptors and their roles? • DHP: Voltage sensor in T-tubule. • Ryanodine: Releases Ca²⁺ from SR. 28. What is the function of AChE? Breaks down ACh to stop stimulation and contraction. 29. Difference between isotonic and isometric contractions: • Isotonic: Muscle changes length (shortens/lengthens). • Isometric: Muscle length stays same; tension builds. ⸻ Respiratory Physiology 30. Difference between conductive and respiratory divisions: • Conductive: Air passageways (nose to bronchioles). • Respiratory: Gas exchange (alveoli). 31. Type I & II alveolar cells and functions: • Type I: Gas exchange. • Type II: Secretes surfactant, repairs alveoli. 32. Dust cells and their functions: Alveolar macrophages that clean up particles/debris. 33. Muscles in relaxed vs. forced respiration: • Relaxed inhale: Diaphragm, external intercostals. • Forced inhale: Accessory neck muscles. • Forced exhale: Internal intercostals, abdominals. 34. What happens to pressure and volume when inhaling/exhaling? • Inhale: Volume ↑, pressure ↓. • Exhale: Volume ↓, pressure ↑. 35. Difference between systemic and pulmonary exchange: • Systemic: Gas exchange at tissues. • Pulmonary: Gas exchange in lungs. 36. What cells are involved in carrying gases? Red blood cells (RBCs). 37. Which enzyme converts CO₂ + H₂O → H₂CO₃? Carbonic anhydrase. 38. What does carbonic acid break into? H⁺ + HCO₃⁻ (bicarbonate ion). 39. What happens in hypoxia (low oxygen)? • ↓O₂, ↑CO₂, ↓pH (acidosis). 40. What happens in hypercapnia (high CO₂)? • ↑CO₂, ↓O₂, ↓pH (acidosis). 41. Receptors for blood pH and their locations: • Central (CSF pH): Medulla oblongata. • Peripheral (O₂, CO₂, pH): Carotid & aortic bodies. 42. CO₂ loading & O₂ unloading at tissues: • CO₂ enters blood → forms HCO₃⁻. • O₂ released to tissues. 43. CO₂ unloading & O₂ loading at alveoli: • CO₂ released from blood to lungs. • O₂ binds to hemoglobin. 44. Brain part for unconscious breathing: Medulla oblongata. 45. Obstructive vs. restrictive disorders + example: • Obstructive: Narrowed airways (asthma). • Restrictive: Reduced lung expansion (fibrosis). 46. Know spirometry volumes (not numbers): • Tidal volume, • Inspiratory/Expiratory reserve volume, • Residual volume, • Vital capacity, • Total lung capacity, • Inspiratory capacity, • Functional residual capacity. 47. Define eupnea, dyspnea, tachypnea, apnea, Kussmaul respiration: • Eupnea: Normal breathing. • Dyspnea: Labored breathing. • Tachypnea: Rapid, shallow breathing. • Apnea: No breathing. • Kussmaul: Deep, rapid (from acidosis Endocrine System 1. What are hormones and what is their function in the body? Hormones are chemical messengers transported in the bloodstream that stimulate physiological responses in target cells or organs. 2. Types of hormones based on chemical composition and how they enter target cells: • Steroid hormones: Lipid-soluble, diffuse through cell membrane (e.g., cortisol). • Protein/Peptide hormones: Water-soluble, bind to surface receptors (e.g., insulin). • Biogenic/Monoamines: Derived from amino acids (e.g., T3/T4), may need carriers or membrane receptors. 3. Know all 6 hormones secreted by the anterior pituitary gland and their functions: • TSH: Stimulates thyroid to release T3 and T4. • ACTH: Stimulates adrenal cortex to release cortisol. • GH: Stimulates tissue growth and protein synthesis. • PRL: Stimulates milk production. • FSH: Stimulates egg maturation/sperm production. • LH: Triggers ovulation and testosterone production. 4. What is thymosin? Which gland secretes it? What is its function? Thymosin is secreted by the thymus and helps in the development and maturation of T-cells. 5. Know thyroid gland hormones, the cells that secrete them, and their functions: • T3 & T4 (follicular cells): Increase metabolism and regulate appetite. • Calcitonin (C cells): Lowers blood calcium levels. 6. Know the hormones secreted by the adrenal gland and their specific functions: • Cortex: • Aldosterone: Retains Na⁺, excretes K⁺, raises blood pressure. • Cortisol: Increases glucose, metabolism of fat/protein. • Androgens: Precursor to sex hormones. • Medulla: • Epinephrine/Norepinephrine: Increase heart rate, blood flow, and alertness. 7. Function of glucagon and insulin in maintaining homeostasis: • Insulin (beta cells): Lowers blood glucose. • Glucagon (alpha cells): Raises blood glucose. • Antagonistic: They have opposing effects to balance blood sugar levels. 8. Which cells are involved in spermatogenesis? Where does sperm production occur? • Sertoli (Sustentacular) cells support spermatogenesis. • Leydig (Interstitial) cells produce testosterone. • Occurs in the seminiferous tubules of the testes. 9. Know the hormones secreted by the testes and their functions: • Testosterone: Stimulates male development and sperm production. • Inhibin: Inhibits FSH to regulate sperm production. 10. What causes diabetes insipidus? How is it different from diabetes mellitus? • Diabetes insipidus: ADH deficiency → excessive urination. • Diabetes mellitus: Insulin issues → high blood glucose. 11. Know the 3 “P’s” of diabetes: • Polyuria: Excessive urination. • Polydipsia: Excessive thirst. • Polyphagia: Excessive hunger. 12. How are oxytocin and prolactin different? • Oxytocin: Stimulates uterine contractions and milk letdown. • Prolactin: Stimulates milk production. 13. Name the ovarian hormones and their functions: • Estrogen/Progesterone: Regulate cycle, pregnancy, and secondary sex characteristics. • Inhibin: Inhibits FSH secretion. ⸻ Muscle Physiology 14. Know 3 muscle types, their locations, and function: • Skeletal: Attached to bones; movement; voluntary. • Cardiac: Heart; pumps blood; involuntary. • Smooth: Organs/vessels; propels substances; involuntary. 15. Know the layers surrounding muscle: • Epimysium: Surrounds entire muscle. • Perimysium: Surrounds fascicle (bundle). • Endomysium: Surrounds individual fiber. 16. What is a fascicle? A bundle of muscle fibers. 17. What is a sarcomere? Name its regions: Smallest contractile unit (Z-disc to Z-disc). • Z-band, A-band (dark), I-band (light), H-zone. 18. What are actin and myosin? • Actin: Thin filament. • Myosin: Thick filament that pulls actin during contraction. 19. What is troponin and tropomyosin? • Tropomyosin blocks binding sites on actin. • Troponin binds Ca²⁺ to move tropomyosin and expose sites. 20. What is a motor unit? A motor neuron and all muscle fibers it controls. 21. Role of T-Tubule, SR, Terminal Cisternae: • T-Tubule: Conducts AP into cell. • SR: Stores calcium. • Terminal cisternae: Release calcium. 22. Which neurotransmitter is released at the neuromuscular junction? Acetylcholine (ACh). 23. What role does Ca²⁺ play in muscle physiology? Binds troponin, moves tropomyosin, exposes actin sites. 24. What happens to Ca²⁺ after action potential ends? Reabsorbed into SR by Ca²⁺ ATPase pump. 25. What is the function of ATP in muscle physiology? Powers myosin movement, detachment, and Ca²⁺ reuptake. 26. What is sliding filament theory? Myosin pulls actin filaments → sarcomere shortens → contraction. 27. What are DHP and Ryanodine receptors and their roles? • DHP: Voltage sensor in T-tubule. • Ryanodine: Releases Ca²⁺ from SR. 28. What is the function of AChE? Breaks down ACh to stop stimulation and contraction. 29. Difference between isotonic and isometric contractions: • Isotonic: Muscle changes length (shortens/lengthens). • Isometric: Muscle length stays same; tension builds. ⸻ Respiratory Physiology 30. Difference between conductive and respiratory divisions: • Conductive: Air passageways (nose to bronchioles). • Respiratory: Gas exchange (alveoli). 31. Type I & II alveolar cells and functions: • Type I: Gas exchange. • Type II: Secretes surfactant, repairs alveoli. 32. Dust cells and their functions: Alveolar macrophages that clean up particles/debris. 33. Muscles in relaxed vs. forced respiration: • Relaxed inhale: Diaphragm, external intercostals. • Forced inhale: Accessory neck muscles. • Forced exhale: Internal intercostals, abdominals. 34. What happens to pressure and volume when inhaling/exhaling? • Inhale: Volume ↑, pressure ↓. • Exhale: Volume ↓, pressure ↑. 35. Difference between systemic and pulmonary exchange: • Systemic: Gas exchange at tissues. • Pulmonary: Gas exchange in lungs. 36. What cells are involved in carrying gases? Red blood cells (RBCs). 37. Which enzyme converts CO₂ + H₂O → H₂CO₃? Carbonic anhydrase. 38. What does carbonic acid break into? H⁺ + HCO₃⁻ (bicarbonate ion). 39. What happens in hypoxia (low oxygen)? • ↓O₂, ↑CO₂, ↓pH (acidosis). 40. What happens in hypercapnia (high CO₂)? • ↑CO₂, ↓O₂, ↓pH (acidosis). 41. Receptors for blood pH and their locations: • Central (CSF pH): Medulla oblongata. • Peripheral (O₂, CO₂, pH): Carotid & aortic bodies. 42. CO₂ loading & O₂ unloading at tissues: • CO₂ enters blood → forms HCO₃⁻. • O₂ released to tissues. 43. CO₂ unloading & O₂ loading at alveoli: • CO₂ released from blood to lungs. • O₂ binds to hemoglobin. 44. Brain part for unconscious breathing: Medulla oblongata. 45. Obstructive vs. restrictive disorders + example: • Obstructive: Narrowed airways (asthma). • Restrictive: Reduced lung expansion (fibrosis). 46. Know spirometry volumes (not numbers): • Tidal volume, • Inspiratory/Expiratory reserve volume, • Residual volume, • Vital capacity, • Total lung capacity, • Inspiratory capacity, • Functional residual capacity. 47. Define eupnea, dyspnea, tachypnea, apnea, Kussmaul respiration: • Eupnea: Normal breathing. • Dyspnea: Labored breathing. • Tachypnea: Rapid, shallow breathing. • Apnea: No breathing. • Kussmaul: Deep, rapid (from acidosis based on chemical composition and how they enter target cells: • Steroid hormones: Lipid-soluble, diffuse through cell membrane (e.g., cortisol). • Protein/Peptide hormones: Water-soluble, bind to surface receptors (e.g., insulin). • Biogenic/Monoamines: Derived from amino acids (e.g., T3/T4), may need carriers or membrane receptors. 3. Know all 6 hormones secreted by the anterior pituitary gland and their functions: • TSH: Stimulates thyroid to release T3 and T4. • ACTH: Stimulates adrenal cortex to release cortisol. • GH: Stimulates tissue growth and protein synthesis. • PRL: Stimulates milk production. • FSH: Stimulates egg maturation/sperm production. • LH: Triggers ovulation and testosterone production. 4. What is thymosin? Which gland secretes it? What is its function? Thymosin is secreted by the thymus and helps in the development and maturation of T-cells. 5. Know thyroid gland hormones, the cells that secrete them, and their functions: • T3 & T4 (follicular cells): Increase metabolism and regulate appetite. • Calcitonin (C cells): Lowers blood calcium levels. 6. Know the hormones secreted by the adrenal gland and their specific functions: • Cortex: • Aldosterone: Retains Na⁺, excretes K⁺, raises blood pressure. • Cortisol: Increases glucose, metabolism of fat/protein. • Androgens: Precursor to sex hormones. • Medulla: • Epinephrine/Norepinephrine: Increase heart rate, blood flow, and alertness. 7. Function of glucagon and insulin in maintaining homeostasis: • Insulin (beta cells): Lowers blood glucose. • Glucagon (alpha cells): Raises blood glucose. • Antagonistic: They have opposing effects to balance blood sugar levels. 8. Which cells are involved in spermatogenesis? Where does sperm production occur? • Sertoli (Sustentacular) cells support spermatogenesis. • Leydig (Interstitial) cells produce testosterone. • Occurs in the seminiferous tubules of the testes. 9. Know the hormones secreted by the testes and their functions: • Testosterone: Stimulates male development and sperm production. • Inhibin: Inhibits FSH to regulate sperm production. 10. What causes diabetes insipidus? How is it different from diabetes mellitus? • Diabetes insipidus: ADH deficiency → excessive urination. • Diabetes mellitus: Insulin issues → high blood glucose. 11. Know the 3 “P’s” of diabetes: • Polyuria: Excessive urination. • Polydipsia: Excessive thirst. • Polyphagia: Excessive hunger. 12. How are oxytocin and prolactin different? • Oxytocin: Stimulates uterine contractions and milk letdown. • Prolactin: Stimulates milk production. 13. Name the ovarian hormones and their functions: • Estrogen/Progesterone: Regulate cycle, pregnancy, and secondary sex characteristics. • Inhibin: Inhibits FSH secretion. ⸻ Muscle Physiology 14. Know 3 muscle types, their locations, and function: • Skeletal: Attached to bones; movement; voluntary. • Cardiac: Heart; pumps blood; involuntary. • Smooth: Organs/vessels; propels substances; involuntary. 15. Know the layers surrounding muscle: • Epimysium: Surrounds entire muscle. • Perimysium: Surrounds fascicle (bundle). • Endomysium: Surrounds individual fiber. 16. What is a fascicle? A bundle of muscle fibers. 17. What is a sarcomere? Name its regions: Smallest contractile unit (Z-disc to Z-disc). • Z-band, A-band (dark), I-band (light), H-zone. 18. What are actin and myosin? • Actin: Thin filament. • Myosin: Thick filament that pulls actin during contraction. 19. What is troponin and tropomyosin? • Tropomyosin blocks binding sites on actin. • Troponin binds Ca²⁺ to move tropomyosin and expose sites. 20. What is a motor unit? A motor neuron and all muscle fibers it controls. 21. Role of T-Tubule, SR, Terminal Cisternae: • T-Tubule: Conducts AP into cell. • SR: Stores calcium. • Terminal cisternae: Release calcium. 22. Which neurotransmitter is released at the neuromuscular junction? Acetylcholine (ACh). 23. What role does Ca²⁺ play in muscle physiology? Binds troponin, moves tropomyosin, exposes actin sites. 24. What happens to Ca²⁺ after action potential ends? Reabsorbed into SR by Ca²⁺ ATPase pump. 25. What is the function of ATP in muscle physiology? Powers myosin movement, detachment, and Ca²⁺ reuptake. 26. What is sliding filament theory? Myosin pulls actin filaments → sarcomere shortens → contraction. 27. What are DHP and Ryanodine receptors and their roles? • DHP: Voltage sensor in T-tubule. • Ryanodine: Releases Ca²⁺ from SR. 28. What is the function of AChE? Breaks down ACh to stop stimulation and contraction. 29. Difference between isotonic and isometric contractions: • Isotonic: Muscle changes length (shortens/lengthens). • Isometric: Muscle length stays same; tension builds. ⸻ Respiratory Physiology 30. Difference between conductive and respiratory divisions: • Conductive: Air passageways (nose to bronchioles). • Respiratory: Gas exchange (alveoli). 31. Type I & II alveolar cells and functions: • Type I: Gas exchange. • Type II: Secretes surfactant, repairs alveoli. 32. Dust cells and their functions: Alveolar macrophages that clean up particles/debris. 33. Muscles in relaxed vs. forced respiration: • Relaxed inhale: Diaphragm, external intercostals. • Forced inhale: Accessory neck muscles. • Forced exhale: Internal intercostals, abdominals. 34. What happens to pressure and volume when inhaling/exhaling? • Inhale: Volume ↑, pressure ↓. • Exhale: Volume ↓, pressure ↑. 35. Difference between systemic and pulmonary exchange: • Systemic: Gas exchange at tissues. • Pulmonary: Gas exchange in lungs. 36. What cells are involved in carrying gases? Red blood cells (RBCs). 37. Which enzyme converts CO₂ + H₂O → H₂CO₃? Carbonic anhydrase. 38. What does carbonic acid break into? H⁺ + HCO₃⁻ (bicarbonate ion). 39. What happens in hypoxia (low oxygen)? • ↓O₂, ↑CO₂, ↓pH (acidosis). 40. What happens in hypercapnia (high CO₂)? • ↑CO₂, ↓O₂, ↓pH (acidosis). 41. Receptors for blood pH and their locations: • Central (CSF pH): Medulla oblongata. • Peripheral (O₂, CO₂, pH): Carotid & aortic bodies. 42. CO₂ loading & O₂ unloading at tissues: • CO₂ enters blood → forms HCO₃⁻. • O₂ released to tissues. 43. CO₂ unloading & O₂ loading at alveoli: • CO₂ released from blood to lungs. • O₂ binds to hemoglobin. 44. Brain part for unconscious breathing: Medulla oblongata. 45. Obstructive vs. restrictive disorders + example: • Obstructive: Narrowed airways (asthma). • Restrictive: Reduced lung expansion (fibrosis). 46. Know spirometry volumes (not numbers): • Tidal volume, • Inspiratory/Expiratory reserve volume, • Residual volume, • Vital capacity, • Total lung capacity, • Inspiratory capacity, • Functional residual capacity. 47. Define eupnea, dyspnea, tachypnea, apnea, Kussmaul respiration: • Eupnea: Normal breathing. • Dyspnea: Labored breathing. • Tachypnea: Rapid, shallow breathing. • Apnea: No breathing

Module 1: Inorganic Pharmaceutical Chemistry - Part 4.4 - Compounds - Bicarbonates, Silicates, Cyanides/Nitriles, Others

Please wait outside until I let you in, and put all your stuff at the back just like we've done about 20 times already this semester. Okay? Or this semester and last, and you will be just fine. Now your lecture exam too is 90 marks big. It is 90 multiple choice questions. Okay. It is going to be on cardiovascular disorders, urinary system, fluid balance, Okay. So let's start talking about them. First of all, okay, you need to know the difference between a myocardial infarct, ischemic attack, a congestive heart failure, and angina pectorals. You need to know what a low level inflammatory response that develops over time where the endothelium is damaged due to the aging or prolonged hypertension, where LDLs accumulate, and the endothelium is repaired with collagen is called. That might take you a long time to read. Okay? But it is a good question. Okay? You need to know now be really, really clear on these. Okay? You absolutely need to know the difference between right ventricular hypertrophy and left ventricular hypertrophy and what they cause. Because there's two questions on here, and so far, this one hasn't been done very well. Okay? Make sure you understand what right ventricular hypertrophy leads to and you understand what left ventricular hypertrophy leads to. Now the original term, congestive heart failure, that refers to left ventricular hypertrophy leading to backup in the lungs. K? You need to know what arteries or vessels are used in bypass surgery. You need to know what a mini stroke is. Okay? You need to know the difference between thrombus and ballast occlusion and arthroma. You need to know what is a restriction in blood supply generally due to factors in the blood vessels with resultant damage or dysfunction of tissue. You need to know, what are the consequences of an aging cardiovascular system. And then I I've got a matching question for you. You need to match the basic function of the proximal convoluted tubule, the glomerulus, and the peri colic duct. And then two of my favorite questions. Are you ready? Okay. You have to find out which of the following is the best explanation for why the cells of the proximal convoluted tubule contain so many microclonary. Oh, isn't that lovely? Okay. And then the other one you need to know is you need to find the best explanation for the microvilli on the apical surface of the proximal convoluted tubules. So don't get that one wrong because we've talked about microvilli about a bazillion times. Okay? This picture is gonna be on there, folks. Okay? This is the picture of the of the nephron from your textbook. Okay. You need to label things like glomerulus glomerulus afferent arteriole collecting duct nephron move. Okay. Where do you find the granular cells? Okay. The difference between the medulla and the cortex. Make sure you know all of those things. I'll read you this one. This is a good question too. Hydrostatic pressure is the primary driving force of plasma through the filtration membrane into the capsular space. All the publicly following statements reflects why hydrostatic pressure is so high in the glomerular capillaries. Select the one statement that does not explain the high pressure within the glomerular capillaries. So you need to know why glomerular capillary pressure is higher than the rest of the capillaries in the body. You need to know how or why cells or transport proteins are prevented from moving through how yeah. What drives reabsorption of organic nutrients in the proximal condylated tubule? Who drives thus? You need to know the mechanism that establishes the medullary osmotic gradient the The functional and structural unit of the kidneys is what? The g force pushing the blood and solids out of the blood across the filtration membrane is what? Okay. The macular densities cells do what? Function in angiotensin two is to do what? What is, specific gravity or density? Okay. If you talk about the specific gravity or density of urine, how is it different from water? You need to actually, this is just one question, but it should be a pretty simple one. Okay? You need to place the following and correct sequence from the formation of a drop of urine to its elimination of the body. And so you have to go through from well, I'll just read it to you. Major calyx, minor calyx, nephron, urethra, ureter, and collecting that. So you need to put those in order from start to finish. Okay? What would happen if the capsular hydrostatic pressure were increased above normal? You need to know what would happen. Reabsorption of bilevels of glucose and amino acids in the filtrate is accomplished. The 44 more. Okay. So you need to match to their definition. All of your hypo and hypers. Make sure you have some under control. Okay? And then you need to match possible causes. So there's possible causes of respiratory alkalosis, metabolic alkalosis, metabolic acidosis, and respiratory acidosis. Respiratory alkalosis, metabolic alkalosis, metabolic acidosis, and respiratory acidosis. There are possible causes for those four things. You need to match the disorder to the cause. Okay? And then you need to know, the body's motor volume is mostly tied to the level of then I have a couple of clinical correlation questions for you, but they are multiple choice this time. So something happened to Jane. You have to tell me what's happening to Jane. Okay? Now whereas sodium is mainly found in the extracellular fluid, most is found in intracellular systems are. Okay. Which of the following is not a likely source of hydrogen ions in blood plasma, so there's a few types in the tablets, so make sure you know which ones are going to produce acids and which ones aren't. And then Annie had something happen to her as well. Across capillary walls is what? Regulation of potassium balance is what? Now Dave Dave did something silly. Okay? Dave ran a marathon. Okay? And then Dave did something even more silly afterwards. I want you to tell me what happened to Dave. And in addition to that, Nancy is having a panic attack. So I want you to tell me what's happening to Nancy in terms of respiratory aesophosis and respiratory aldosterone. Okay. If thyroid and parathyroid glands were surgically removed, which of the following would go out of balance without replacement therapy? Falling arterial blood pressure holds which? An illness, Doug. Doug has severe diarrhea. Okay. And, is accompanying the loss of bicarbonate or secretions. So how is Doug gonna compensate for that for Doug? Okay. You need to know what the medical term for kidney stones is. You need to know what happens, or what could cause the passage of proteins, red blood cells, and white blood cells into the urine. You need to know how to solve prostatic enlargement, and, you need to know what the presence of white blood cells in urine is called and what is causing it. Okay? And then there's a picture of the lymphatic of the lymph node. Okay. You need to label the lymph node picture. And then you there is going to be a matching question on lymphatic structures, so you need to know what happens in the spleen, the lymph nodes, the thoracic duct, the lymph, and the pyre patches. There's a list, a small short list. Okay? So in other words, you're going to need to know what is classified as a lymphoid organ and what does not. Okay? So make sure you know what your lymphoid organs are. You need to know the pathway of lymph. So it starts in lymph capillaries. Where does it end? Make sure you know all the steps along the way. And then you need to know the functions of the spleen. What did what does the spleen do? And that is it for an example

Bicarbonate Buffer System

Digestion Notes (Biology 12) I. Introduction/Overview • Digestion: Breakdown of food into small, soluble molecules • Occurs physically and chemically • Absorption: The process of taking specific compounds into the body • Elimination: Expulsion of materials not absorbed into the body • Excretion: Removal of waste from metabolic processes II. Location of Parts and Function A. Teeth • Type of teeth depends on diet: • Carnivores: Sharp teeth for grasping prey and severing meat • Herbivores: Flat teeth for crushing plant fibers • Omnivores: A combination of tooth types for eating both meat and plants • Structure: • Enamel: Hard outer layer • Dentin: Bony layer under enamel • Pulp: Living part of the tooth (contains nerves and blood vessels) • Teeth are embedded in sockets in the jaw B. Tongue • Functions: • Taste: Detects salt, sour, sweet, and bitter flavors • Positioning food for chewing C. Salivary Glands • Three pairs: • Parotid (side of face; swells with mumps) • Sublingual (under tongue) • Submandibular (lower jaw) • Produce saliva, which contains enzymes for digestion D. Palates • Located at the top of the mouth • Hard palate: Front, separates the mouth from the nasal cavity • Soft palate: Back, ends in the uvula E. Pharynx • Area between mouth and esophagus • Used for both breathing and eating • Epiglottis: Closes over the glottis when swallowing to prevent choking F. Esophagus • Muscular tube that pushes food into the stomach using peristalsis • Composed of five tissue layers: 1. Mucosa (epithelial lining) 2. Submucosa (connective tissue) 3. Muscularis (two muscle layers: circular and longitudinal) 4. Serosa (outer epithelial layer; secretes fluid for lubrication) G. Cardiac Sphincter • Muscle at the junction of the esophagus and stomach • Opens to allow food into the stomach H. Stomach • J-shaped organ, located left of the body’s center • Capacity: About 1 liter • Inner lining contains gastric glands: • Parietal cells → Produce HCl • Chief cells → Produce pepsinogen, activated by HCl into pepsin • Epithelial cells → Produce mucus (protects stomach lining) • Functions: • Storage of food (empties in 2-6 hours) • Digestion using pepsin and salivary amylase • Absorption of water, ethanol • Regulation of pepsin production by the hormone gastrin I. Pyloric Sphincter • Muscle at the junction of the stomach and small intestine • Opens to allow chyme (partially digested food) into the small intestine J. Small Intestine • Length: ~ 3 meters (10 feet) • Highly convoluted to increase surface area for absorption • Interior folds covered with villi (tiny projections that increase surface area) • Divided into three parts: 1. Duodenum (first 25 cm): Produces lactase, peptidase, maltase, nuclease 2. Jejunum 3. Ileum • Functions: • Completes digestion • Absorbs nutrients into the bloodstream K. Liver • Largest organ in the body • Monitors blood composition via the hepatic portal vein L. Pancreas • Produces pancreatic juice (digestive enzymes and sodium bicarbonate to neutralize stomach acid) • Produces insulin (regulates blood glucose) M. Ileo-Caecal Opening • Joins the small intestine to the large intestine N. Caecum • Blind pouch at the end of the small intestine • No function in humans (vestigial), but in herbivores, it helps digest cellulose O. Large Intestine • Parts: 1. Ascending colon 2. Transverse colon 3. Descending colon 4. Rectum (stores feces) 5. Anus (controls feces release) • Functions: • Reabsorbs water (~95% of 10L daily intake) • Forms feces • Produces vitamins B and K using E. coli bacteria III. Digestive Enzymes Enzyme Source pH Digested Food Product Salivary Amylase Salivary Glands 7 Starch Maltose Pepsin Stomach 2 Protein Peptides Pancreatic Amylase Pancreas Basic Starch Maltose Trypsin Pancreas Basic Protein Peptides Lipase Pancreas Basic Fat Glycerol & Fatty Acids Peptidases Small Intestine Basic Peptides Amino Acids Maltase Small Intestine Basic Maltose Glucose Nuclease Pancreas Basic DNA/RNA Nucleotides IV. Swallowing and Peristalsis • Swallowing: Food forms a bolus (food ball) and is moved down the esophagus • Peristalsis: Rhythmic contractions of smooth muscle that push food through the digestive tract V. The 7 Functions of the Liver 1. Detoxifies harmful substances (e.g., alcohol) 2. Stores glucose as glycogen 3. Destroys old red blood cells (recycling heme into bile) 4. Produces urea from amino acid breakdown 5. Makes blood proteins 6. Stores iron and vitamins A, D, E, K 7. Converts amino acids to glucose if needed (gluconeogenesis) VI. Digestive Juices & Hormones Gastric Juice (Stomach) • Contains HCl, pepsinogen (activated into pepsin), and mucus • Helps digest proteins into peptides Pancreatic Juice • Contains sodium bicarbonate (neutralizes acid) • Enzymes: Pancreatic amylase, trypsin, lipase, nuclease Bile (Liver & Gallbladder) • Breaks down fats into small droplets for lipase to act on VII. Control of Digestive Gland Secretions • Nervous Reflex: Presence of food triggers digestion • Conditioned Reflex: External stimuli (e.g

Chapter 9 – Skeletal Muscles 1. Connective Tissue Surrounding a Skeletal Muscle: • Epimysium: Surrounds the entire muscle. • Perimysium: Surrounds bundles of muscle fibers (fascicles). • Endomysium: Surrounds individual muscle fibers. 2. Histology and Function of Sarcomeres: • Histology: Sarcomeres are the structural and functional units of skeletal muscles, composed of repeating units between two Z-lines. • Function: They enable muscle contraction through the sliding filament mechanism. 3. Main Components: • Thin Filaments: Actin, tropomyosin, and troponin. • Thick Filaments: Myosin. 4. Function of Transverse Tubules and Sarcoplasmic Reticulum: • Transverse Tubules (T-tubules): Transmit action potentials deep into the muscle fiber. • Sarcoplasmic Reticulum: Stores and releases calcium ions for muscle contraction. 5. Motor Unit: A motor neuron and all the muscle fibers it innervates. 6. Neuromuscular Junction: The synapse where a motor neuron meets a muscle fiber, allowing for signal transmission. 7. Synapse: A junction between two neurons or a neuron and a muscle cell where communication occurs. 8. Actions of Acetylcholine (ACh): • Initiates muscle contraction by binding to receptors on the sarcolemma. • Degraded by: Acetylcholinesterase. 9. Neurotransmitter Released at Motor Axon Terminals: Acetylcholine. 10. Steps in Excitation-Contraction Coupling: • Action potential travels along sarcolemma. • Calcium is released from the sarcoplasmic reticulum. • Calcium binds to troponin, causing tropomyosin to move, exposing binding sites on actin. • Myosin heads form cross-bridges and initiate contraction. 11. Order of Muscle Fiber Contraction: • Action potential → Calcium release → Cross-bridge formation → Power stroke → ATP binding → Cross-bridge detachment. 12. Mechanism of Muscle Contraction: • Sliding filament theory: Actin and myosin filaments slide past each other. 13. Interaction of Actin, Myosin, and Calcium: • Calcium binds to troponin, shifting tropomyosin to expose myosin-binding sites on actin, enabling cross-bridge cycling. 14. Cross-Bridges: Myosin heads that bind to actin during contraction. 15. Contraction Types: • Isotonic: Muscle length changes. • Eccentric: Muscle lengthens under tension. • Isometric: Muscle tension without length change. • Concentric: Muscle shortens under tension. 16. Force of Muscle Contraction: • Controlled by motor unit recruitment. • Partial Tetany: Incomplete relaxation. • Fused Tetany: Sustained contraction without relaxation. 17. Bones and Muscles as Levers: • Fulcrum: Pivot point of the lever. 18. Synergist and Antagonist: • Synergist: Assists the primary mover. • Antagonist: Opposes the primary mover. 19. Muscle Atrophy: Wasting of muscle due to disuse or disease. 20. Myasthenia Gravis: Autoimmune disorder causing muscle weakness by targeting ACh receptors. 21. Linea Alba: A fibrous structure running down the midline of the abdomen. 22. Origin, Insertion, and Actions of Specific Muscles: (Let me know which specific ones you’d like to focus on.) Chapter 17 – Digestive System 1. Alimentary Canal: A continuous muscular tube extending from the mouth to the anus. 2. Functions of the Digestive System: • Ingestion, digestion, absorption, and elimination. 3. Breakdown and Absorption: • Carbohydrates: Begin in the mouth (amylase). • Proteins: Start in the stomach (pepsin). • Fats: Start in the small intestine (lipase, bile). 4. Layers of Alimentary Canal Walls: • Mucosa, submucosa, muscularis, serosa. 5. Accessory Organs: • Liver, pancreas, gallbladder. 6. Sympathetic vs. Parasympathetic Effects: • Sympathetic: Decreases digestion. • Parasympathetic: Enhances digestion. 7. Hormones: • Gastrin: Stimulates gastric juice secretion. • Cholecystokinin (CCK): Stimulates bile and pancreatic juice. • Secretin: Stimulates bicarbonate secretion. 8. Peristalsis vs. Segmentation: • Peristalsis: Wave-like contractions. • Segmentation: Mixing movements. 9. Epiglottis Function: Prevents food from entering the trachea. 10. Heartburn: Caused by stomach acid reflux into the esophagus. 11. Stomach Parts: Fundus, body, pylorus. 12. Secretions: • Parietal Cells: Hydrochloric acid, intrinsic factor. • Chief Cells: Pepsinogen. 13. Digestive Enzymes and Substances: • Amylase: Breaks down starch. • Pepsin: Digests proteins. • Trypsin: Protein digestion. • Lipase: Fat digestion. • Bile Salts: Emulsify fats. 14. Liver, Gallbladder, Pancreas Functions: • Liver: Produces bile. • Gallbladder: Stores bile. • Pancreas: Produces enzymes and bicarbonate. 15. Anatomy of Bile Ducts: • Common hepatic, cystic, and pancreatic ducts form the common bile duct. 16. Functions of Large Intestine: • Absorption of water, vitamin production, and feces formation. 17. Defecation Reflex: Triggered by rectal wall distension. Chapter 18 – Nutrition 1. Excess Glucose Storage: As glycogen in the liver and muscles. 2. Tissue Requiring Glucose: Nervous tissue (brain). 3. Triglyceride Components: Glycerol and three fatty acids. 4. Essential Amino Acids: Cannot be synthesized by the body

CO2 + H2O <--> H2CO3 (carbonic acid) <--> H + HCO3 (bicarbonate)

Chem- Determination of Bicarbonate (final)

Sodium Bicarbonate

Sodium Bicarbonate

BICARBONATE

Module 1: Inorganic Pharmaceutical Chemistry - Part 4.4 - Compounds - Bicarbonates, Silicates, Cyanides/Nitriles, Others

Pharmacology Basics a. What types of assessments and evaluations are important to do before and after giving a medication? -Vital signs -Modified head to toe exam -Pt allergies -Labs - Med history -Speci drug data -Pt understand of drugs - Age related concerns -Liver failure? Malabsorption syndrome? Renal disease? -Pt home drugs? - When intended effect will happen - Urine outpit - Lung sounds - Monitoring (desired outcome obtained? What was drug response? Any adverse effects? Any toxic effects?) b. What are the 9 rights you must consider before giving a medication? - Right pt - Right drug - Right dose - Right route - Right time - Right indication - Right documentation - Right response - Right to refuse c. What drugs are considered to be controlled substances and why? - Schedule 1-5 drugs due to the high abuse potential d. What are black box warnings? - Highest safety-related warning for meds that are assigned by FDA. This warning is intended to bring the consumer and the nurses attention to the major risk of the drug. e. Why do you have to know the generic name of a drug? - This is the name used on the NCLEX and the DR can call/prescribe it by either name. f. What is Pharmaceutics? - Developing a chemical to be used as a drug. g. What are enteral drugs? - PO drugs, it has to pass through intestines/ be absorbed in GI tract h. What are parenteral drugs? -Drug given by injection (passing outside the intestines) i. What is Pharmacokinetics? - Study of what happens to the drug while it is in the body j. Why do we consider the absorption of the drug? - Absorption affects the speed and concentration at which a drug may arrive at its desired location of effectg - k. What factors affect the absorption of a drug? - CYP450= enzyme in liver responsible for breaking down drugs and making them bioavailable l. What is the First Pass phenomenon? m. Which route of administration will be absorbed fastest and slowest? - IV/ parentral drugs are absorbed faster. - n. Why do we consider the distribution of the drug? • -Distribution describes how a substance is spread throughout the body. To be effective, a medication must reach its designated compartmental destination, described by the volume of distribution, and not be protein-bound in order to be active. o. What factors affect the distribution of a drug? - biochemical properties of the drug as well as the physiology of the individual taking that medication, ; protein bound drugs, if it has protein bound to it, it makes it harder to reach the site. p. What is a drug to drug interaction and why does this occur? - Drug- drug interaction occurs when taking more than one medication together. q. What is the importance of drug metabolism? - Metabolism changed drug to inactive metabolite to more soluble form, to a more potent active metabolite. Affecting the liver. r. What are the cytochrome P-450 enzymes and why are they so important to medication administration? - This is an active enzyme used to break down the drug; there are multiple enzymes used to break down drugs by PY450 is common; if that enzyme is already in use for a drug the enzyme may not be effective for another drug taken at the same time requiring the action of that enzyme. s. What organ is responsible for most drug metabolism? - Liver t. What labs do we monitor to make sure that organ is not damaged from metabolizing the drugs? - Liver labs u. What factors affect the metabolism of drugs? - The enzymes. Certain enzymes might make a drug more effective potentially causing toxicity and some enzymes can impede a drugs effectiveness. v. What organ is most frequently responsible for excretion of drugs? - Kidneys w. What labs do we monitor to make sure that organ is not damaged excreting the drugs? -Kidney function x. What is the onset of action of a drug? - Time required for drug to take effect y. What is the peak level of a drug? - Time required for drug to reach its maximum therapeutic response. z. What is the half-life of a drug - Time required for 50% of the drug to be eliminated from the body. aa. What is the duration of action of a drug? - Length of time that drug concentration is sufficient enough to elicit a therapeutic response. bb. How do these time factors affect the way we nurses administer and evaluate drug affects? - If a drug has a long half-life then we have to delay or put more time in between giving another dose. cc. What are the common ways that drugs exert their actions? - Through receptors, by effecting enzymes, nonselective interactions (will bind to multiple receptors because we haven’t been able to target just the one area which is why we have side effects) dd. What is acute drug therapy used for? - Antibiotics, given for a short amount of time to get rid of something specific ee. What is maintenance drug therapy used for? - BP meds, taken for a long time to maintain a function ff. What is palliative drug therapy used for? - Given to make someone more comfortable at end of life. gg. What is prophylactic drug therapy used for? - Given to prevent something hh. What are adverse effects or adverse reactions to drugs and why are they important for nurses to recognize? - Adverse effects are basically negative effects or responses to the drug from external sources; ie grapefruit garlic don’t react well with certain meds ii. What is important to consider when giving a drug to a pregnant woman? - What trimester pt is in and category drug jj. What is important to consider when giving a drug to a pediatric patient? - Pt weight kk. What is important to consider when giving a drug to a geriatric patient? - Polypharmy, other drugs taken, physiologic issues, financial issues ll. Why are drugs categorized related to pregnancy? - To determine the potential effects to the fetus mm. What are some cultural or genetic factors you must consider when administering drugs? - Speak different languages, may use herbal remedies that you need to ask about, how thee culture handles illness, be considerate of religious belief because some could affect care , how they feel about the treatment nn. Why is it important to educate patients about their prescribed medications? - So they will know what is happening and how it is happening oo. What are some factors that will improve the patient’s ability to learn about their medications? - Pt age, language barrier, cognitive abilities, literacy level, emotional status, environment at home, barriers of learning, any physical/psych/cognitive limitations pp. What are the different routes of medication administration? - PO, IM, IV, subcutaneous, topical, inhalation, nebulized, rectal, sublingual, intrathecal (epidural/spinal, transdermal qq. Why are drugs ordered to be administered using different routes? - Maybe poor liver, can’t swallow, needs to act quicker rr. What are common causes of drug administration errors? - Abbreviation, misinterpretation, drugs with similar spelling or pronunciation, staff nurse “work around”, high alert medication have more sever consequences w. error, not doing med reconciliation w/ new pt, given to wrong pt, wrong route and time ss. How can we prevent drug administration errors? - 3 checks of the 9 routes, limit telephone orders, multiple systems of checks and balances, be aware of look alike- sound alike drugs, any doubt CALL THE PHARMACIST. tt. What should you do if you make a medication administration error? - Be honest, follow the institutions policies and procedure, complete incident report, stay with pt to monitor for adverse reaction, document accurately thoroughly and objectively include info 2. Pain Medications a. Opioids i. How do you assess pain? - Onset - Location - Duration - Character - Aggravating/ - Relieving Factors - Timing - Severity ii. What are the different types of pain? iii. What are the receptors in the central nervous system that are responsible for pain transmission? -Mu, kappa, and delta -Mu has most side effects/ targeted effects iv. What does an agonist drug do in the body? -Acute, chronic, somatic, vascular, superficial, deep, visceral, neuropathic, referred, phantom, and cancer pain -Binds to receptor, alters function of receptor, and triggers physiologic response for that receptor. (ex: opiates) v. What does an antagonist drug do in the body? - Binds to receptor, but fails to activate physiologic response, vi. What happens when an opioid agonist binds to a Mu receptor? - You get all the effects of the Mu receptor (gi motility, euphoria, respiratory depression, etc) lots of side effects vii. What are the generic names of the frequently prescribed opioids? - Morphine and Fentanyl viii. What is drug potency? - How much drug is needed to produce the effect you need ix. What are the indications for the use of opioids? - Moderate to severe pain, cough suppression, anti diarrhea, local anesthesia, x. What are the adverse reactions that are frequently seen with the use of opioids? - Respiratory depression, CNS depression (sedation, mental clouding, coma), constipation, n/v, itching, rash, wheal formation, orthostatic hypotension, - Zofran reduces nausea when taking opiates xi. When evaluating the effects of an opioid, what body system must the nurse assess? - Respiratory and cardiac xii. What are the signs and symptoms of opioid overdose or toxicity? - Respiratory depression, CNS depression (sedation, mental clouding, coma), miosis xiii. What should the nurse do if there is a suspected opioid overdose? - Notify provider, use naloxone (antagonist for opiate) xiv. What does it mean to be opioid naïve? - First time user xv. What is drug tolerance and how does it affect a patient? - Larger dose is required to produce the same response, xvi. What is drug dependance and how does it affect a patient? - If you take the drug away they will freak out. xvii. What education should you provide to a patient taking an opioid? - Don’t increase your dose without talking to your doctor - Don’t stop abruptly - Don’t crush or chew ER or controlled release tablets - Can cause drowsiness, don’t partake in hazardous activities while using med - If become light headed or dizzy, sit down; change position slowly - Don’t drink alcohol or other CNS depressants while taking opiods xviii. When is the onset of action of morphine? - 5-10minutes xix. When is the peak action of morphine? Onset : 5-10 Peak: 30 minutes xx. How do we give morphine in the hospital? - IV, PO xxi. How quickly do you push IV drugs? - Slow push xxii. What are appropriate indications (what is it used for) for the use of Fentanyl? - Chronic pain, xxiii. What education should you provide to a patient who has a prescription for a Fentanyl patch? - Shave area and clean, don’t apply heat, flush down toilet, remove old patch first, keep away from children, change patch q72hrs, periodically check that oatch has not fallen off xxiv. What is Naloxone used for? - Opioid antagonist xxv. How should you educate a person or the family of a person that might need to use Naloxone? - After giving it to the step back, call provider/911, be prepared to give second dose if they relapse b. NSAIDS i. What are the main classes of NSAIDS? - Salicylate ( Asprin_ ) ii. What are the three main indications for NSAIDS? - Pain/ fever/ inflammation iii. How do NSAIDs work? - Blocks COX 1&2 enzymes - COX 2 is given for arthritis and causes less GI upset iv. What is the difference between “Protective Prostaglandins” and “Pathologic Prostaglandins”? - Protective goes through GI system (saves liver and kidney) by vaso constricting of dilating, increase clotting factors, v. What are the names of 9 different NSAID drugs? - Aspirin - Diflunisal - Indomethacin - Ketorolac (Toradol) - Diclofenac (Voltaren) - Celecoxib(Celebrex - Ibuprofen (Motrin, Advil) - Naproxen (Aleve) - Oxaprozin (Daypro) - Acetic acid derivatives - Cox 2 - Enclic acid derivatives - Proprionic acid derivatives (Ibuprofen/ Naproxen vi. What are 3 major contraindications for using NSAIDs? - Never in 3rd trimester of pregnancy - Not to be given to pts going to surgery (stop one week prior) - ASA or salicylates not to be given to children with viral illness or fever ages 4-12 vii. What is the major adverse effect that nurses should monitor for in patients taking NSAIDs? - GI Bleed - Reyes Syndrome - Acute renal failure viii. What is Reyes Syndrome and why is understanding this syndrome important? -brain swell and your liver lose function after a viral illness or infection like flu or chickenpox. Common among children who take aspirin to treat symptoms during a viral infection or illness - Don’t give children under 12 asprin ix. What is the Black Box Warning for NSAIDs? - Be aware that patient may be at increased risk for CV events, GI bleed, renal insufficiency; monitor accordingly, don’t give to 3rd trimester x. What are drugs and herbs that will interact with NSAIDs? - Garlic (increases bleeding), fish oil, ginger ginko, feverfew, alcohol, anticoagulants, ulcerogenic drugs, diuretics, lithium xi. What are important considerations for enteric coated or sustain released pills? - Don’t crush or chew xii. What are important patient education points the nurse should provide to patients taking NSAIDs? -don’t crush or chew, take with meal xiii. What is the most common reason a patient will take 81 mg of aspirin? - Cardiovascular issues, preventing thrombosis xiv. What are the signs and symptoms of aspirin toxicity in adults? - Tinnitus (ringing in ears), hearing loss xv. What are the signs and symptoms of aspirin toxicity in children? - Dizziness, increased breathing, coma, confusion, tachypnea xvi. What treatment should the nurse expect to be used for patients with aspirin toxicity? - xvii. What is Ketorolac? - xviii. How long should a patient be taking Ketorolac? - Can’t take for more than 5 days xix. What are common indications for Ketorolac? - Post op surgery/ pain control xx. How is Celecoxib different than other NSAIDS? -Blocks COX 2 and has more anti inflammatory properties, used for joint pains xxi. What are the indications for Acetaminophen use? - Preferred antipyretic med for children and adolescents due to Reye’s Syndrome xxii. What patients should be careful when using Acetaminophen? xxiii. What are the potential adverse effects of Acetaminophen? - N/V, liver toxicity xxiv. What is the antidote for Acetaminophen toxicity? - Acetylcysteine (Give within 10 hours of overdose) xxv. What is the recommended daily dose for Acetaminophen? -3,000mg xxvi. What is the recommended daily dose of Acetaminophen for patients with liver disease? - Less than 2,000 xxvii. What is Tramadol? - Used for seizures and constipation, moderatre to severe pain (adverse effects similar to opiods, no more than 400mg per day xxviii. What are the most common indications for the use of Tramadol? - Alleviate pain xxix. What are the names of 3 drugs used to treat Gout? - NSAIDS - Allopurinol - Colchicine xxx. What is Allopurinol and how does it work to treat gout? - Purine inhibitor, maintenance for gout xxxi. What are potential adverse effects of Allopurinol? - Steven Johnson Syndrom, flu like symptom, xxxii. What is Steven Johnson Syndrome? - eruption of mucous membrane leading to bleed out xxxiii. What is Colchicine and how does it work to treat gout? - NSAID xxxiv. What are potential adverse effects of Colchicine? - Don’t give to pregnant in 3rd trimester, GI/GU bleed, Drugs Used for Anesthesia a. What is the goal of Balanced General anesthesia? - b. What are the classes of drugs used in Balanced General anesthesia? - Benzo, analgesics, anasthetics, muscle relaxants c. What are 3 IV general anesthetics? - Dexmedetomidine - Ketamine - IV - Propofol d. What are 3 inhaled general anesthetics? - Sevoflurane - Suprane - Nitrous oxide e. What is malignant hyperthermia? - disease that causes a fast rise in body temperature and severe muscle contractions when someone receives general anesthesia with one or more of the following drugs: halothane, isoflurane, sevoflurane, desflurane or succinylcholine f. What are the signs and symptoms of malignant hyperthermia? - Cramping, seizure, lockjaw, increase temperature, sweating g. What drug should be given if a patient experiences malignant hyperthermia? - Dantrolene (2mg/kg) repeat every 5mins till stable h. What are other nursing interventions that are useful in patients who have malignant hyperthermia? - Chill them, hydrate, critical care meds i. What is Moderate sedation? - Medication that numbs them, but they are awake and alert. j. What are neuromuscular blocking drugs use for? - Muscle relaxant k. What is the name of a neuromuscular blocking drug used in surgery? - succinylcholine l. What is the black box warning for neuromuscular blocking drugs? -cardiac arrest -arrythmia m. What is local anesthesia? - Targeted to numb just that area. n. What is the most commonly used local anesthetic? - Lidocaine - Procaine - Bupivacaine o. What is Local Anesthetic Systemic Toxicity and how does it occur? - Local anestheic doesn’t leave spot, prolonged numbess; too much of the anesthetic. p. What is a spinal headache? - When anesthetic goes into blood stream, cause change in pressure of cebreal spinal fluid, increase ICP, (Pt needs to lay don flat on their back for 5 minutes - q. Why is Epinephrine added to Lidocaine for local anesthesia? - To control bleeding SALYSISM is aspirin poisoning, treat with bicarbonate

CC2 - Electrolytes (Intro-Bicarbonate) (copy)

CC2 - Electrolytes (Intro-Bicarbonate)

EMS Medication: Sodium Bicarbonate