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Enodcrine System –

Essay - Negative feedback – Hypothalamus, maintains homeostasis, ie balance of hormonal controls. Diabetes
example, glucagon and insulin –

ADH – Anitdiuretic Hormone – Reabsorption of H2O via the kidneys

Oxytocin – Primary function is uterine contraction, 2nd function is to stimulate milk production

Q- Sympathetic system - What are the only two hormones posterior hormones that activate.

A. ADH and Oxytocin – Neurological, they don’t inhibit they just release

Q – Anterior hormones they inhibit and release

Q. Pituitary Gland – Master Gland

Q. Hypothyroid – Decrease in production of T3 and T4, which will increase the TSH hormone decrease the metabolic
rate, decrease energy, bp and pulse = weight gain , contstipation

Q. Hyperthyroidism – Increase of the T3 and T4 which will decrease the TSH hormone = Increase metabolism,
increase in energy and increase bp and pulse = diarrhea and weight loss

Q. Clinically, there are three possible conditions to check for A. Pituitary gland, hypothalamus, and target cells

Glucocorticoid – main hormone = cortisol

Medulla = secretes nori-epinephrine and epinephrine

Cushing’s disease – Moon face caused with edema

Addison’s Disease –Low thyroid production caused by a decrease in cortisol and aldosterone

Adrenal Gland - Cortex

Three parts(Cortisol =increase blood glucose and anti-inflammatory, mineralcorticoids, regulate electrolytes,
androgens)

Aldosterone – Increase reabsorption of Na and secretes K in the kidney

Pancreas – Has both Exocrine and Endocrine tissue

Endocrine – Do not have ducts – Insulin and glucagon

Exocrine – Have ducts – pancreatic and digestive juice

Thymus – produce thymosis and t cells

Chorionic gonadatropin – (LSH,FSH, and TSH)

Arteries – AWAY from heart

Veins – Capillaries to the heart

Arteriosclerosis – elastacity change

Anterior artery – Circle of willis

Posterior artery – Goes to the vertebral and basilar artery

Extrenal jugular veins = peripheral veins


Internal veins – central veins

1# sign and symptom for vascular blockage – PAIN and cold extremities

HEART

Right side of heart is the posterior side – pumping deoxygenated blood into the lungs

Left side of hear is anterior

Left Ventricle = End diastolic blood pressure

CO=SVXHR

Q. Heart is located in the A.mediastinum

Essay – Inferior and Superior vena cava – the right atrium, through tricuspid valve, right ventricle,

Pulmonary valve - lungs -= left atrium via bicuspid valve, left ventricle – aortic arch – systemic circuit

Angina – Chest pain (unstable vs stabe)

Left anterior descending artery (LAD) if this blocked you are dead due to both arteries being blocked

Essay – The more the heart works, the more the O2 demand, which increases the workload of the heart, which
increases, myocardial o2 consumption.

Q. Right side heart failure is caused by left side

Depolarization – switching of charges, contraction of muscle of the heart – systolic

Repolarization – Resting phase diastolic

If the vagus nerve is stimulated it always – DECREASE in heart rate

P – depolarization of the atrium

QRS, - depolarization of the ventricles

T – Repolarization of the ventricles

Beta 1 – heart

Beta 2 – lungs

Q. IF you see CPK, A. heart issue

Preload – Veins, venous return blood carrying from body to heart inferior/superior vena cava

Afterload – Artery, blood pressure contracts resistance in artery

Alpha 1 agonist is vasocontrict

Alpha 1 blocker – vasodilates

3 Take offs in Aortic arch – Left common carotid, brachicephalic, left subclavian

Starlings Law– In then the right side must go out the left, = to change Starlings Law must change pre-load and
afterload
Laplace – If diameter is decreased resistance increased

(CO=SVxHR)

Blood

Rh – If a woman has negative rh and 1st child is +, ok, if the 2nd child is +, they will be at risk

Hemoglobin A1c – glucose test evaluation for diabetics

Q. Life cycle = A.120 days

WBC – Infection and remove debries

Neutrophil’s = PMN is used for bacteria only

Eosinophil’s = WBC use for allergies

Mast Cells/ Macrophages = Engulf and destroy

Monocytes – One nucleus, uses mono nucleus for fighting

Lymphocytes – Increase with viral infection

Four organs- Bone marrow, liver, spleen, kidney

Reticulocyte – premature red blood nucleus is lost

Q. The number one sign of lack of O2 to the tissue A. pain

Iron – 1# element in the blood

Q. Bilirubin transported to the liver and secreted in the bile causing jaundice or hemolysis of rbc
becomes jaundice

Q. Heparin does not dissolve blood clot, it prevents propagation of clot

Intrinsic pathway – End result is blood clot

Extrinsic pathway –Coming via liver – end result blood clot

Spontaneous and Coagulation = DIC

INR – Coumadin levels

PTT – Heparin

Antidote for heparin = proteinamine sulfate

Antidote Coumadin/Warafin = Vitamin K+

D-dimers – only have this if you have a clot, can lab value

Lab Values – ph 7.35-7.45 CO2 – 35-45, HCO3, 21-28 (ABG’s)

CHF - Shortness of breathe, chest pain, hemodyanmically unstable, fatigue

BP -= (CoXSVR)SVR- Systemic Vascular Resistance

Respiratory

Q. What would be the primary cause to breathe – A. PCO2, chemical


Q. Primary stimulus to breathe – PCO2

What is the back up for breathing CO2, O2

Respiratory

Essay -Hypoxic drive –

Q. If you start O2 therapy – A. Low and titrate up

Q. Define alkalosis and acidosis

Q. Type 2 cells lungs surfactant, lubricant increasing surface area, assist the alveoli and
prevents collapsing of them

Q. Surfactant cells, propagated at 36 weeks

Q If a baby is born prior to 36 weeks A. Hylane disease

Q. Trachea is placed where do you insert A. Just above the Carina

Q. Trachea – composed of C-rings

Q. Boyles Law – pressure is inversely related to volume

Q. Tension, Pnuemothorax – air in chest cavity, puncture the lungs

Q. FEV1 = Forced Expiritory volume – Peak flow

Q. Tidal Volume – 500ml amount of gas inspired and expired in normal breathing

Q. Epiglititis – Jaw drops, toxic looking, open mouth and drools

Q. Croupe – Infection – larynyx, Bark or Seal, cough

Q. How do you deliver specific O2 level to patient A. Ventrui mask or dial up

Q. If you give 100% oxygen, cause blindness than you kill them
TERMINOLOGY

1. Chief cells – Cell that releases an enzyme(gastric, pepsinogin and rennin and parathyroid
releases-parathyroid hormone)

2. Parietal Cells – Produce HCL in response to histamine, acethylcholine, and gastin – contain
secretory caniculli, and for active transport, H+, K+, ATPase

3. CPK – Enzyme that increases the creatine due to trauma

4. Troponin – Lab values increase in regard to heart detection

5. Cardiac Muscle – Striated and intercoalated disk

6. Pro Drugs = Require a healthy liver – active after first pass effect

Hypertension classifications

Primary = Ideopathic

Secondary = secondary cause to disease

Essential – multi factored

7. Thiazide diuretics = Work in the distal tubules Na and K exchange, H2O,K+,Na+ loss

8. Adrengergenic Drugs – Alpha 1 blood vessels 2nd = prostate and uterine bleeding

• Clonidine(Catapres) –Heroin addicts, or opiate w/d, failed forms of hypertension treatment

• Methyldopa(Aldomet)PIH, Pregnancy induced hypertension

• Prazosin(Minipress) First dose at bedtime. Massive vasoldilation-educate pt on fall


risk/safety precautions

• Labetalol and carvedilol (little B1 and A1 combination)

High incidence of orthostatic hypotension – Drop bp = tachycardia

(ANGIOTENSIN CONVERTING – Enzyme inhibitors)ACE DRUGS (END IN IL, captopril, enalapril, lisinopril)

ACE – Drugs of choice for (hypertensive and diabetics) Are cardio and renal protective

1# Side effect – Hyperkalemia, dry cough, and edema/kankles

• Lisinopril – is NOT a prodrug


ARB’s (Angiotensin II Receptor Blocker’s) Same as ACE with/out dry cough or hyperkalemia

Ace if 1st choice – ARB’s Next

ARB’s – (end in ar or an)

Calcium Channel Blockers – Decrease bp and vasodilate

Relax smooth muscle blocks Calcium binding to receptors. Decreases muscle tone and vascular
resistance.

• Varapamil – 1#SVT

• Amlodipine, nicardipine,nifedipnine

Uses – (Angina, Hypertension, Dysrhythmias, migraine headaches= calcium channel-Beta blockers,


Raynauds disease = periphery spasms – calcium channel).

1# drug class for – Beta Blockers and Calcium channel Diuretics

• Angina

• Hypertension

• dysrythmias

1# drug class for white = Ace inhibitors and Beta Blockers

1# drug class for black = Calcium Channel / Diuretics

Drug of choice Thiazide Diuretics – Loop diuretics, (IV, Lasix, Bumix) Heart failure = VERY POTENT

Antiganginal Drugs

1# Nitrates/Nitrites (sublingual=immediate)or(IV)

Beta blockers = decrease heart rate , respiration, and broncho dilates

Calcium channel blockers = vasodilate (varapomil)

*INCREASE BLOOD FLOW TO HEART AND DECREASE MYOCARDIAL OXYGEN DEMAND

Alpha + Beta

Alpha 1 = Blood vessels

Alpha 2 =

Beta 1 – Heart

Beta 2 – Lungs
Agonist = vascoconstriction = sympathetic

Blockers = Vasodilation

Beta 1 – Selective drugs = stimulate specific

Case Study –

Patient comes in with Left Ventricle blockage of 70% obstruction

• Has angina that comes on with exertion

• Increases heart rate

• Increased work load

• Increased O2 supply

Clinical – Vasodilate peripheral = (change preload, diuretic, bleed, vasodilation)

Afterload – Arterial dilate, mess with Alpha 1=vasoconstrict, = arterial vasodialator

Pharmacology

Thiazide type diuretics – Should be the initial drug therapy for most patients with hypertension (alone
or with other drugs)

ACE Inhibitors = have been found more effective in white patients than African American patients

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