Monday, December 25, 2006






I hope that everyone is having a great holiday and enoying not even thinking about st*dying. I just wanted to wish eveyone a Merry Christmas and Happy Holidays! See you all, very soon!

-Delia

Tuesday, December 12, 2006

TAKE A BREAK

UPDATE: Biochem Tomorrow!!!

Hey guys! I wanted to post some help, but I do not seem to have a recent file that is small enough. If you have anything helpful that is under 1 KB please send it to me or the google group.
I do know the breakdown:
40% Webster (1 20pt and 2 10 pt questions)
40% Mcbride (MULTIPLE CHOICE!)
20% Riggs (10 2pt multiple choice)

Hope it helps!!!!

Sunday, December 10, 2006

breakdown of p&p test

Wilborn : Cell, transport, signal transduction, electrophysiology, muscle - 14
Sowell : NS and special senses - 9
Waldrop : NS and Dopamine - 6
Sowell : CV - 7
Luthin CV - 7
Waldrop : Blood - 3
Wilborn : Skin - 2
Wilborn : Bone - 2
Bumgardner : Immunology - 15

Saturday, December 09, 2006

for casey!

here is an old dosage review, maybe it will help
also this: (thanks Michael)
Excipients:

Acidifying agents- Citric acid, HCl, H2SO4
Alkalinizing agents- NaOH, Sodium Bicarb
Adsorbent- activate charcoal
Antifungal- ___paraben, benzoic acid, sodium benzoate
Antimicrobial- Benzalkonium Chloride, benzyl alcohol (gasping baby syndrome...I think this what it caused), thimersol, pheylmercuric nitrate, phenol, cetypridinium chloride
Buffering agents- potassium phospate, sodium acetate, sodium citrate
Emulsifying Agents- acacia, cetyl alchohol, glycerol monostearate
Humectant- glycerin, propylene glycol
Levigating agents- mineral oil, glycerin, propylene glycol
Suspending/viscosity agents- agar, betonite, xantham gum, acacia, carrageen, micro crystalline cellulose, any cellulose, silicon dioxide, tragacanth, carbomer, bentonite, veegum
Emulsifying Agents- Water soluble polymers- celluloses, Natural polymers- acacia, agar, pectin, sodium alginate, xantham gum, gelatin Cellulose derivatives- stuff with cellulose in the name
"Flowability" of powder excipients- silicon dioxide
Glidants- Magnesium Stearate (see above as well)
Sugar, enteric, and film coatings
Drugs and things stressed about them:
Aspirin- ester hydrolysis
Amoxycilin- hydrolysis
Vancomyacin
Premarin
Penicillans- stability and basic structure
Sulfa drugs
Acetomenophen- basic structure
Phenylpropylnylamine (dimatab)-
Nasacort- triamcinolone acetonide, suspension
Maxidex- dexomethasone, suspension
Pred forte- this is a gimme, suspension usage
Cyclosproin- drug that is oil soluble used in emulsions
Tetracylcin- milk problems
Birth control and enteroepatic circulation
Prozac weekly- film coating protection, long half life
Duoneb- albuterol and imotropine bromide
Budesonide- corticosteroid
Triamcinlone acetonide- corticosteroid
Beclometasone- corticosteroid

physiology stuff

Here is a review of Dr. wilborns stuff from last years exam!
Also does anyone have a list of the medications and excipients from dosage that I could post!
Keep up the good work! I will post more stuff tonight, and anything that yall want up please email it to me!

Wednesday, December 06, 2006

Amazing!!!


I just wanted everone to know, that while we were studying and resting this weekend, Emily Morris ran the St. Jude marathon in Memphis. I'm not sure but I think that is like 26 or so miles!!! So congratualtions Emily!!!!

Info Systems Review

(a little birdie sent me this...is not meant to be comprehensive, just something to get youstarted!)

You should be able to copy it and paste it into word!!!

Hope it helps!!!


Plagiarism


  1. When an author presents as his or her ideas, language, data, graphs, or even scientific protocols created by someone else without giving proper credit.

  2. There are 2 basic reasons to cite:

    • documentation (to support an idea)

    • acknowledgement (avoid plagiarism)

  3. Rule of practice: place citation number closest to actual material you are referencing.

  4. Personal communication is listed in running of text, not as works cited page. Use date of communication, oral or written, affiliation of person to est. relevance.

  5. Place registered trademark with first use of word, then omit.

  6. Sample citations:

Journal article

Smith J, Canton EM. Weight-based administration of dalteparin in obese patients. Am J Health-Syst Pharm. 2003;60:683-687.


Books with 2 or more authors

Aronoff GR, Berns JS, Brier ME, et al. Drug Prescribing in Renal Failure. 4th ed. Philadelphia, PA: American College of Physicians;1999:39.


Chapter in a book

Wallace RJ Jr., Griffith DE. Antimycobacterial agents. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:951-952.


(authors of chapter, title of chapter only capitalize first word. In: author(s) of book OR EDITITORS, title of book italic or underlined. X ed. Place, State: Publisher; year: page number.


Package Insert

Lamasil [package insert]. East Hanover, NJ: Sandoz Pharmaceuticals Corp; 1993.


eBook

Rennie D, Guyatt G, eds. Users’ Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice [book online]. Chicago, IL:AMA Press; 2002. http: ……Accessed December 5, 2006.


Lexi programs

Lexi-Comp, name of book or data base (Lexi-Drugs, Comp + Specialties) [computer program]. Compiler of data base Skyscape; date and/or version/date of program






Tertiary Literature


Literature Hierarchy

3’ textbooks, review articles

2’indexing/abstracting sources

1’ original research


I. Tertiary Literature:

  • established knowledge

  • consists of package inserts; textbooks; review articles; full-text databases, PDA programs, and practice guidelines.

  • Provides an “overview” of topics gathered from primary lit, condensed in organized format.


II. Advantages of 3’ Lit

  1. convenient

  2. concise

  3. easy to use format

  4. updated (some)

  5. efficient

  6. organized


III. Disadvantages of 3’ Lit

  1. incomplete information

  2. biased info

  3. lag time

  4. varied interpretations


MONOGRAPHS

Provides extensive overview of a medication

Examples of monograph references:

-package insert

-drug facts n comparisons

-AHFS

-USPDI vol 1

- Lexi-Drugs

-Clinical Pharmacology

-PDR (physicians desk reference)


PACKAGE INSERTS

-contain info from manufacturer

-info provided is FDA approved

-found in 1. Online and http://www.drugname.com/ 2. medication bottles 3. PDR




SECTIONS OF MONOGRAPH

  1. Drug name- brand/generic

  2. Description- chemical name, structure, dosage form info, inactive ingredients

  3. Clinical Pharmacology- explains how rx works in body, differences in action based on gender, age, or ethnicity, and contains drug-drug interactions.

  4. Indications/usage- lists uses that are FDA approved, conditions that have adequate date from clinical trials are included

  5. Pregnancy/Lactation Category- rankings and lists if product is compatible in breast milk

  6. Contraindications- lists situations rx should not be used, warns prescribers not to use rx in conditions in which more prone to adverse effect

  7. Warnings/Precautions- discusses serious side effects that may occur in people, BLACK BOX WARNINGS- severe or life-threatening

Precautions- advises how to use rx safely and effectively, alerts prescribers to patients that need close observation, lab test info, pregnancy, geriatric and ped info in this section. Also lists DRUG INTERACTIONS

  1. Adverse Reactions- lists all side effects that were reported in people who took rx wile it was tested. May be grouped by body systems. May include frequency of occurrence.

  2. Overdosage- effects and treatment

  3. Dosage/ administration- recommended doses, time and route,

  4. How supplied- available forms of Rx, formulation description (color, shape, markings) Storage instructions, and number of units/package.


DRUG FACTS AND COMPARISONS

    • -updated monthly

    • -black box warnings

    • Investigational drugs

    • Manufacturer index

    • Orphan drugs

    • Normal lab values

    • Drug ID database

    • Rx, otc, and herbal info

    • Extensive product listings

    • Patient leaflets


AHFS

  • American Society of Health-System Pharmacists

  • Official source for unlabeled drug uses

  • Incorporates evidence based medicine principles from nationally recognized organizations

  • Most used by hospital pharmacists




USPDI VOL 1

  • Official source of unlabeled drug uses

  • Contains auxiliary information

  • Does not have all drugs

  • Monthly updates online


MICROMEDEX

  • Online database

  • Contains info related to ID of drug products

  • Info of foreign drugs, drug interactions, and IV compatibility

  • May contain info about FAQ related to drug therapy

  • OFFICIAL COMPENDIUM for unlabeled drug uses


PDR (PHYSICIANS DESK REFERENCE)

  • Contains selected package inserts for paid manufactures

  • Medications organized by manufacture

  • Contains photo of RX

  • Updated annually

  • Most used by Drs.


MOSBY’S DRUG CONSULT

  • Contains Package inserts of all drugs

  • Updated annually

  • Contains photo of RX


CLINICAL PHARMACOLOGY

  • Online database

  • Contains info related to id, availability, choice for condition, interactions, alternative medicine

  • Contains patient info in espanol


LEXI-COMP

  • Online, print and PDA

  • Contains drug interaction checker and drug ID

  • Patient info in several languages

  • Special population databases

  • Retail prices

  • Photos of RX

  • International brand names available

  • Compounding formulas


Free monograph references include

-RxList.com

-drugs.com



DRUG THERAPY REFERENCES

  • Pharmacotherapy

  • Applied therapeutics


UNLABELED USES

  • AHFS

  • USPDI vol 1 official compendia

  • Micromedex

  • Lexi-comp

  • Facts n comparisons


GENERAL VS SPECIFIC

General offers overview

Specific have more comprehensive, focused info. Includes in-depth discussions of the topic and practice-related experiences to a greater extent than general


OTC/HERBAL

  • Handbook of Nonprescription Drugs

  • Natural Medicines Comprehensive Database


ADRs

  • Meyler’s Side effects of Drugs

  • Monograph references


COMPOUNDING

  • Allen’s Compounding

  • Pediatric Drug Formulations


DRUG INTERACTIONS

  • Drug Interaction Analysis and Management (Hansten and Horn)

  • Drug Interaction Facts

  • Lexi- Interact


IV STABILITY/COMPATABILITY

  • Handbook on Injectible Drugs

  • King’s Guide to Parenteral Admixtures


PATIENT COUNSELING

  • USPDI Vol 2

  • MedFacts Patient Information (online or print)

  • Lexi- Pals




COST

  • Drug Topics Red Book

  • Lexi-Comp (retail only)

  • Clinical Pharmacology (retail only)

  • Mosby’s Drug Consult (AWP)


PREGNANCY CATEGORY/ LACTATION

  • Drugs in Pregnancy and Lactation (Briggs)

  • Monographs (non-specialty)


DRUG INFORMATION CENTERS (Biomedical Lit Section of Notebook)

  • Began in 1962, University of Kentucky

  • “Source of selected, comprehensive drug information for staff physicians and dentists to evaluate and compare drugs”

  • Questions generated by health care professionals

  • Specialists usually trained in drug info practice

  • Majority of questions concern therapeutic recommendations, ADRS, drug ID, and dosage

  • Most (70%) DICS are in hospitals or medical centers; other areas include: colleges, libraries, and poison control centers


DIC DUTIES


  • Answer questions

  • Provide pharmacy and therapeutic support

  • Develop policies and procedures

  • Develop medication use programs

  • Conduct research

  • Train students/residents


POISON CONTROL CENTERS

  • Accurate and timely info to enhance quality of care of patients calling

  • Questions mostly generated by consumers

  • More urgent responses required

  • Specialists trained in clinical toxicology

  • Some nationally certified

  • Free service









ANSWERING DRUG INFORMATION QUESTIONS

Modified Approach (1986)

Step I: Secure demographics of requestor

  1. requestor occupation

  2. determine method of delivery

  3. contact info

Step II: Obtain background information

  1. essential for effectively using approach

  2. used to help clarify question

  3. determine if question is patient specific vs general

  4. if patient specific acquire info concerning age, weight, allergies, organ function, ect.

Step III: Determine/ Categorize ultimate question

  1. confirm request by restating question to requestor

  2. aids in directing researcher to specific resource or type of resources

  3. establish timeline for response

  4. Classifications from practicum and website (adrs, bioequivalence, compounding, patient education, ect.)

Step IV: Develop search strategy and conduct search

a. choose references that complement question categorization

b. begin with established knowledge (3’ lit)

c. Secondary lit can be used

d. primary lit can be “consulted”

Step V: Perform evaluation, analysis, and synthesis

  1. evaluate info located

  2. answers may not be clearly stated

  3. confirm answers in multiple references (> 2)

Step VI: Formulate and provide response

  1. restate question with background info

  2. include a brief review of search strategy and references used

  3. include assessments of conflicting data

Step VII: Conduct follow-up and documentation

  1. document question and response

  2. conduct follow up

  • protects against legal liability

  • justification of professional value

  • future reference

  • quality control

  • new info may become available








SECONDARY LITERATURE

Indexing and abstracting services of the primary and tertiary literature


PUB MED vs IPA


PubMed

  • Scope is biomedical literature

  • Contains information related to drugs and diseases

  • Contains biomedical lit related to clinical practice

  • Began in 1966 by national library of medicine

  • Contains > 11 million references

  • Indexes review articles, clinical trials, practice guidelines, editorials, letters, ect

  • Updated daily

  • Shortest lag time

  • Freely accessible

  • Contains full-text journal articles in addition to abstracts

  • Contains links to articles that have fee

  • Controlled vocabulary is Medical Subject Headings (MeSH)


IPA

  • Pharmacy practice

  • Clinical and technical drug info

  • Pharmaceutical education

  • Legal aspects of pharmacy

  • Compounding formulations

  • Medication protocol

  • Produced by American society of health systems pharmacy

  • Began in 1964

  • Indexes > 750 journals, abstracts of papers presented at pharmacy meetings, US state journals, letters, editorials, and reviews

  • Updated once monthly

  • May have long lag time

  • Contains journal articles in English, foreign languages, hum and non human subjects

  • Only contains abstracts

  • Controlled voc is SUGGEST

  • Boolean operators and, or, not


ADVANTAGES/ DISADVANTAGES OF SECONDARY LITERATURE

Advantages

  • Indexed by topic

  • Uses controlled vocab

  • Efficient method to search literature

  • Organized format

  • Different scopes per database

  • Citations contain abstracts

  • Full text journal articles may be available (PUBMED)

  • Special search features (limits)

  • Can store, email searches

Disadvantages

  • Lag time for some databases (IPA)

  • Limited scope

  • Indexing methods

  • Full text journals not available in some

  • Equipment required

  • Costs


PRIMARY LITERATURE

  • Original publications published in biomedical journals; new information

  • Most current resource of information

  • Provides details of research methods and results

  • Basis of secondary/tertiary lit


ADVANTAGES:

  • current

  • most subjected to peer review

  • less lag time

  • reader can critically evaluate to determine usefulness

  • organized format

  • provides specific details of study and results


DISADVANTAGES:

  • flaws in study methods may exist

  • all investigators do not follow format

  • may not provide reader with enough info

  • limited access

  • results may be biased

  • conclusions may be inflated

  • interpretations may be varied


DESCRIPTIVE: CASE REPORT/SERIES

  • records observations related to a drug or technology applied to a single patient or group of patients

  • retrospective, observational

  • does not involve multiple treatment periods

  • useful in identifying drug toxicities

  • results may or may not be compared to a control group

  • hypothesis generating; results should be confirmed with a controlled, clinical trial


ADVANTAGE

  • id treatments for rare disorders where large subject populations do not exist

  • early recognition of drug toxicities

  • hypothesis generating


DIS

  • difficult to determine cause and effect

  • interpretation can be difficult

  • design and methods for conducting case report not well defined

  • usually only applied when all treatment options have failed


EXAMPLE: 50 year old man presents to ER with a 36 yr history of painless decreased vision in his left eye after a visit to his family MD 3 days prior with complains of dizziness. The MD prescribed fosinopril 20mg/d and HCTZ 25 mg/d. The next morning the patient noted loss of vision in his left eye.


OBSERVATIONAL STUDIES

  1. CASE CONTROL:

  • useful for studying rare conditions

  • short duration

  • relatively small numbers of patients needed; inexpensive

  • aid in generating hypothesis about causes of a new disease

  • difficult to sort exposure and outcome

  • only one outcome can be studied

  • relies on self-report

  • possible incomplete/inaccurate information on patients

  • difficult to determine cause and effect

  • risk factor may not be reason for group differences


  1. COHORT

  • describes incidence and investigates potential causes of a condition

  • provides a view of “real life” since they reflect natural unfolding of a disease state or exposure to certain condition

  • difficult to determine cause and effect

  • expensive

  • inefficient way to study rare outcomes


  1. CROSS SECTIONAL

  • do not have to wait for outcome to occur

  • inexpensive

  • short duration

  • difficult to establish cause and effect

  • not useful for rare diseases

  • subject to transient effects that may occur during study


  1. CLINICAL TRIALS

-gold standard

- can determine cause and effect

- can quantify differences between groups

-provides evidence for/against clinical practice use

-costly

-time consuming

- may not be able to apply results into clinical practice

-publication of results may be delayed


EDITORIALS

  • commentaries about current controversies

  • commentaries from experts in the field related to a study

  • may be biased


LETTERS TO EDITORS

  • brief reports

  • preliminary observations

  • may ask authors of a recent study questions


STRUCTURE OF CLINICAL STUDY REPORT

  1. Abstract- article summary

  2. Introduction- rational of study/ background info/ objective or purpose

  3. Methods- study design/ patient inclusion/exclusion info/ explanation of what was measured/description of intervention and control/statistical analysis

  4. Results- patient demographics/ measurements for endpoint(s)/ medication side effects reported

  5. Discussion- interpretation of study results

  6. References/ Bibliograph

  7. Fine Print- acknowledgements/ funding/ peer review dates



BIOMEDICAL EXTRAS- LECTURE BY DR. LAUDERDALE 10/26/06

  1. Peer review process

GOALS

    1. to raise quality of end product (journal)

    2. provide mechanism for fair and objective decision making

ADVANTAGES

  1. incorrect work filtered out

  2. increased accuracy and clarity of end product

DISADVANTAGES

  1. decreased timeliness and increased time to publication

Upon peer-review have options of:

Accept manuscript

Accept manuscript with minor revisions

Accept manuscript with major revisions

Reject manuscript


Journal supplements

Not a regular issue of journal

Usually a theme-disease or drug

Differences exist between supplement and parent journal

May not be peer reviewed

Can be sponsored by pharmaceutical company which is way to push their drug


Pure Food and Drug Act of 1906

  • prohibit adulteration and misbranding of food and drugs

  • only prevent false statements for strength, quality, purity, but not false or misleading claims of cure or efficacy


Food, Drug and Cosmetic Act of 1938

  • sulfanilamide elixir

  • had to prove drug was safe

  • required testing with results

  • directions for use and habit forming properties

  • exempted all pre-1938 drugs


Durham- Humphrey Amend. 1951

  • federal law prohibits dispensing without a prescription

  • started OTC vs prescription drugs


Kefauver-Harris Amend 1962

  • Thalidomide

  • Required drug not only to be safe, but effective

  • Retroactive to 1938


Orphan Drug Act 1983

  • provided tax incentives exclusitivity and grants to companies developing drugs for diseases that affect small number of people


Drug Price Competition and Patent Term Restoration Act 1984

  • streamline generic approval (ANDA) but still aid and encourage research with patents


Dietary Supplement Health and Education Act 1994

  • defined dietary supplement- permitted some claims on drug

  • no regulation of strength, FDA must prove Unsafe before removal from market


Food and Drug Administration Modernization Act 1997

  • expedite availability of drugs

  • fast track designation for key drugs

  • ensured continuation of pharmacy compounding





FDA APPROVAL PROCESS

Phase I

  • determine the safety and toxicity of a drug

  • pharmacokinetics

  • pharmacology

  • dose range

  • last 6 months to 1 year

  • patient population of 20-80 HEALTHY volunteers


Phase II

  • determine efficacy of drug in targeted disease state

  • duration- 2 years

  • patient base 100-200 with disease state


Phase III

  • further build on safety and efficacy established

  • duration 3 years

  • patients 600-1000


NDA


PHASE IV

  • post marketing trials

  • additional information on drug’s risks and benefits

  • evaluates different doses

  • safety in extended patient population


1


Tuesday, December 05, 2006

getting ready for finals

Hey everyone! This afternoon I filed all of our extra handouts. So if you have missed a class or lost your handout you can probably find a copy of it in the filing cabinet in the back of the room. They are organized by class and instructor. Hope it helps!!!

Friday, December 01, 2006

Physiology

Yea!!! The physiology test is over!!!! The Learn Team is planning on meeting with Dr. Wilborn the coming Monday, and we want your feedback. The test key is posted so go look at it and give us your feedback. You can put your comments and questions in the folder located in the back of the room or email them to me (deliacharest@bellsouth.net).

Also Dr. Bumgarner is going to have extended office hours before the final. Here is the schedule!!!

this sunday dec 3 2pm - 6pm

next week:

monday - thursday 5pm - 9 pm
saturday 10am - 2 pm
sunday 2pm - 9 pm * this is the day before our final*

his office phone is 726 - 2981
he prefers you coming in person, and second he would like you to call him
email is his third choice b/c "immunology is hard to explain over the email"

good luck with studying!!!! Have a good weekend!

ps if you have anything that you would like for me to post, please just email it to me!

Thursday, November 30, 2006

How to make pickles!!!!

Preparing and Canning Fermented and Pickled Foods


General Information


The many varieties of pickled and fermented foods are classified by ingredients and method of preparation.


Regular dill pickles and sauerkraut are fermented and cured for about 3 weeks. Refrigerator dills are fermented for about 1 week. During curing, colors and flavors change and acidity increases. Fresh-pack or quick-process pickles are not fermented; some are brined several hours or overnight, then drained and covered with vinegar and seasonings. Fruit pickles usually are prepared by heating fruit in a seasoned syrup acidified with either lemon juice or vinegar. Relishes are made from chopped fruits and vegetables that are cooked with seasonings and vinegar.


Be sure to remove and discard a 1/16-inch slice from the blossom end of fresh cucumbers. Blossoms may contain an enzyme which causes excessive softening of pickles.



Caution: The level of acidity in a pickled product is as important to its safety as it is to taste and texture.



  • Do not alter vinegar, food, or water proportions in a recipe or use a vinegar with unknown acidity.
  • Use only recipes with tested proportions of ingredients.
  • There must be a minimum, uniform level of acid throughout the mixed product to prevent the growth of botulinum bacteria.


Ingredients



Select fresh, firm fruits or vegetables free of spoilage. Measure or weigh amounts carefully, because the proportion of fresh food to other ingredients will affect flavor and, in many instances, safety.


Use canning or pickling salt. Noncaking material added to other salts may make the brine cloudy. Since flake salt varies in density, it is not recommended for making pickled and fermented foods. White granulated and brown sugars are most often used. Corn syrup and honey, unless called for in reliable recipes, may produce undesirable flavors. White distilled and cider vinegars of 5 percent acidity (50 grain) are recommended. White vinegar is usually preferred when light color is desirable, as is the case with fruits and cauliflower.





Firming agents



Alum may be safely used to firm fermented pickles. However, it is unnecessary and is not included in the recipes in this publication. Alum does not improve the firmness of quick-process pickles. The calcium in lime definitely improves pickle firmness. Food-grade lime may be used as a lime-water solution for soaking fresh cucumbers 12 to 24 hours before pickling them. Excess lime absorbed by the cucumbers must be removed to make safe pickles. To remove excess lime, drain the lime-water solution, rinse, and then resoak the cucumbers in fresh water for 1 hour. Repeat the rinsing and soaking steps two more times. To further improve pickle firmness, you may process cucumber pickles for 30 minutes in water at 180°F

. This process also prevents spoilage,

but the water temperature should not fall below 180°F. Use a candy or jelly thermometer to check the water temperature.



Preventing spoilage



Pickle products are subject to spoilage from microorganisms, particularly yeasts and molds, as well as enzymes that may affect flavor, color, and texture. Processing the pickles in a boiling-water canner will prevent both of these problems. Standard canning jars and self-sealing lids are recommended. Processing times and procedures will vary according to food acidity and the size of food pieces.



Sunday, November 26, 2006

physiology test #4

The break-down:

CV - 24
Blood - 11
Bone - 8
Special Senses - 7

There are no questions from old material except for background material pertaining to the above lectures.

Old tests:
2003
2004
If someone will send me 2005, I will put it up also!

Multiple Choice Questions:


1. The body controls blood pressure by:

a) Increase vasoconstriction of blood vessels
b) Increasing cardiac output
c) Using the kidneys to decrease blood volume
d)A and C
e)All of the Above


Answer: D


2. The body controls blood pressure by:

a) Increase vasoconstriction of blood vessels
b) Increasing cardiac output
c) Using the kidneys to decrease blood volume
d)A and C
e)All of the Above


Answer: D


3. A patient with hypertension comes into the pharmacy with a prescription for an ACE inhibitor, you (the pharmacist) notice that the patient is already on a diuretic. Would it be a good idea to give the patient an ACE inhibitor with a diuretic?


A) Yes, an ACE Inhibitor blocks the conversion of ANG I to ANG II which will lower blood pressure
B)Yes, an ACE Inhibitor will cause less aldosterone to be released and cause a decrease in blood pressure
C) No, ACI Inhibitors increase blood pressure
D) both A and B
E) None of the Above


Answer: D


4. There are many chemicals that can mediate arteriolar vasoconstriction and vasodilation. Which of the following leads to vasoconstriction?

  1. Nitric Oxide

  2. Histamine

  3. Angiotensin II

  4. Epinephrine on β2 receptors

Answer: C


5. Which of the following would not lead to disruption of capillary exchange?

  1. Heart Failure

  2. Hypotension

  3. Inflammation

  4. Hypertension

Answer: B

6. When precapillary sphincters are relaxed, blood flows through ______________________.

a. All arteries in the body
b. Venules only
c. All capillaries in the bed
d. All of the above
e. a and c only

Answer: C

7. If a patient is diagnosed with left heart failure you will see:

  1. Hypertension

  2. Edema in the periphery

  3. Malnutrition

  4. Edema in the lungs

  5. A and D only

Answer: E

8. Which of the following IS NOT involved in regulation of blood pressure?


A) Peripheral Sensory Receptors
B) Medulla Oblongata
C) Cranial Nerve #10
D) Neurotransmitters
E) They are all involved in the regulation of blood pressure

Answer: E

9. Mean arterial blood pressure (MAP) if affected by:

a. blood volume
b. effectiveness of the heart as a pump
c. resistance of the system to blood flow
d. neurotransmitters
e. A,B, and C only

Answer: E

10. Which of the following is NOT true concerning capillaries

    1. Metarterioles allow white blood cells to bypass the capillary bed

    2. Precapillary sphincters control flow into the capillary beds

    3. Capillaries have a low blood flow velocity

    4. All of the above are true of capillaries

Answer: D

11. Which factor affects mean arteriole pressure?

A) blood volume
B) diameter of arterioles
C) cardiac output
D) diameter of veins
E) all of the above

Answer: E

12. A change in hydrostatic blood pressure can cause:


A. elevated blood pressure
B. decreased venous pressure
C. blood loss
D. increased capillary hydrostatic pressure
E. C and D

Answer: C

13. A drug that selectively inhibits β1 receptors will cause:

A: An increase in heartrate and an increase in myocardial contractility

B: A decrease in heartrate and a decrease in myocardial contractility

C: A decrease in heartrate and an increase in myocardial contractility

D: An increase in heartrate and a decrease in myocardial contractility

Answer: B

14. Risk factors for Cardiovascular disease include:
A. Obesity
B. Hypotension
C. Diabetes
D. A and C
E. A, B, and C

Answer: D

15. With respect to pressure, flow and resistance, the ____________________________ is the primary determinant of velocity.

a resistance to flow
b. pressure gradient
c. cross-sectional area
d. radius of the vessel

Answer: C

16. White blood cells are enabled to bypass capillary beds via ____________________.

  1. Capillaries

  2. Venules

  3. Arteries

  4. Metarterioles

  5. None of the above

Answer: D


17. What disease state(s) decreases proteins in the bloodstream, resulting in a decreased osmotic pressure?

A. Hypertension
B. Cirrhosis
C. Malnutrition
D. A, B, and C
E. B and C only


Answer: E


18. What are factors that effect venous return?
a. Skeletal Muscle Pump
b. Respiratory Pump
c. Sympathetic Nerve Innervation
d. Both a and c
e. All of the above

Answer: E


19. How do the baroreceptor pathways in the central nervous system affect the sympathetic and parasympathetic fibers?
A. Increase PNS activity
B. Decrease SNS activity
C. Increase SNS activity
D. Decrease PNS activity
E. A & B only


Answer: E

20. An increase in which of the following, will cause an increase in the flow of a system.

A. length of the vessel
B. viscosity of the blood
C. radius of the vessel
D. A & C
E. All of the above

Answer: C

21. Which of the following is a paracrine factor in regulation of blood flow
A. epinephrine
B. Acetylcholine
C. Histamine
D. Prostaglandins
E. C and D

Answer: E

22. Which of the following does not affect venous return?
A. Skeletal Muscle Pump
B. Respiratory Pump
C. Resistance
D. Sympathetic Nerve Innervation
E. All of the above affect venous return

Answer: C

23. If a person had problems with nicotinic receptors on smooth muscles in their lower legs, which of the following effects would the problem have on blood flow to the legs?

a: Oxygenated blood would not reach the tissue of the legs.
b: Deoxygenated blood would not make it back to the heart from the legs.
c: The blood would pool in the leg.
d: b and c are correct
e: all of the above are correct

Answer: d

24. Which type of capillary exchange uses vesicular transport for proteins and macromolecules?

A. Paracellular
B. Transcellular
C. Transcytosis
D. Fenestrated

Answer: C

25. What is the major determinant of systemic vascular resistance?
A)Skeletal Muscle Pump
B)Arteriolar diameter
C)Cardiac Output
D)Heart Rate

Answer: B

26. Fenestrated capillaries

    1. allow water and small dissolved solutes to pass through endotheilial cell juctions

    2. Uses trancytosis to bring macrmolecules across endothelium

    3. Uses temporary channels made by fused vesicles

    4. B and C

    5. A, B and C

Answer: D

27. Regarding Blood Flow:

A) Blood Flows up its concentration gradient to other tissues in the body.
B) Flow is measured in L/min or mL/min
C) Resistance and Flow are inversely related.
D) If the Length of the Blood Vessel increases, Flow will increase.
E) B and C

Answer: E

28. Which of the following is true concerning the role of epinephrine?

a) It is released from the Adrenal Medulla
b) It binds only to alpha adrenergic receptors.
c) It binds to both alpha and beta adrenergic receptors
d) A & B
e) A & C

Answer: E

29. Metarterioles primary function is _________________.

    1. to regulate blood flow through capillaries.

    2. to be a site of exchange between blood and interstitial fluid.

    3. to allow white blood cells to go directly from arterioles to venous circulation.

    4. a & c

    5. none of the above

Answer: d


30. What are the four factors that affect Mean Arterial Pressure?

  1. Blood Volume

  2. Resistance of the system to blood flow

  3. Relative distribution of blood between arteries and veins

  4. A and B

  5. All the above

Answer: D


31. If blood pressure suddenly rises, baroreceptors would send impulses to the ________ to increase __________ activity in order to ________ heart rate.

a. cerebellum/sympathetic/increase
b. hypothalamus/parasympathetic/decrease
c. medulla/parasympathetic/decrease
d. hypothalamus/parasympathetic/increase
e. none of the above


Answer: C


32. Which of these statement(s) are NOT true?


a. Total blood flow at any level of circulation is equal to the cardiac output.

b. Epinephrine released from adrenal medulla binds to both alpha and beta adrenergic receptors.

c. The heart has the highest blood flow per unit weight.

d. a & c

e. all of the above are true.

Answer: C


33. Which of the following describe functions of the lymphatic system?

  1. Pathogen filtration

  2. Transfer of fat absorbed from intestinal system to circulatory system

  3. pump-mediated flow of fluid from circulation to tissues

  4. A and B only

  5. All of the above

Answer D


34. Which of the following are vasodilators?

A. Acetylcholine
B. Angiotensin II
C. Bradykinin
D. Answers A and B
E. Answers A and C


Answer: E


35. If the radius of a blood vessel increases to twice its previous size, blood flow would:

  1. Decrease to 1/16 original flow

  2. Double

  3. Remain unchanged

  4. Increase to 16 times original flow

  5. Decrease by half

Answer: D


36. Arteries are primarily composed of:

a. Endothelim
b. Elastic tissue
c. Smooth muscle
d. Fibrous tissue


Answer: C


37. The difference between systolic pressure and diastolic pressure is ______________, while diastolic pressure plus 1/3 pulse pressure is ________________________.

A. Pulse Pressure/MAP
B. MAP/Pulse Pressure
C. Pulse Pressure/Systolic Pressure
D. None of the Above


Answer: A

38. Sympathetic neurons innervate blood vessels by:

a. epinephrine to alpha-2 -> vasodialation

b. acetylcholine to beta- 2 -> vasodialation

c. Norepinephrine to alpha- 2 -> vasoconstriction

d. acetylcholine to beta-2 -> vasodialation


Answer: C

39. If blood pressure suddenly drops, the baroreceptor reflexes would cause:

  1. heart rate to increase

  2. peripheral vasodilation

  3. increased force of contraction

  4. A & C only

  5. A, B, & C

Answer: D

40. Which of the following is FALSE?

  1. The primary determinant of velocity of flow is the total cross-sectional area of the vessel(s).

  2. Blood flows if a pressure gradient is present.

  3. Blood flows from areas of lower pressure to areas of higher pressure.

  4. Three factors affecting resistance are radius of the blood vessels, viscosity of the blood, and length of the system.

Answer: C

41. What happens to a patient's blood pressure if he/she is administered calcium channel blockers?
A) a decrease in blood pressure due to an increased ability of the cardiac and smooth muscle to contract
B) a decrease in blood pressure due to a decreased ability of the cardiac and smooth muscle to contract
C) an increase in blood pressure due to an increased ability of the cardiac and smooth muscle to contract
D) an increase in blood pressure due to a decreased ability of the cardiac and smooth muscle to contract

Answer: B

42. Which of the following statements is true?

A. Blood flow fastest through the capillaries
B. Arterioles are the main site of variable resistance and their diameter can be altered by neural input
C. Veins have highest blood pressure, carry high-oxygenated blood, and their diameter cannot be altered by neural input
D. Veins store pressure generated by the heart
E. None of the above

Answer: B

43. Which of the following factors affect venous return?

A. Skeletal Muscle Pump
B. SNS intervation
C. PNS intervation
D. A & B
E. A & C

Answer: D

44. Muscle vasculature would contain ___ receptors while digestive organ’s vasculature would contain ______ receptors with respect to fight-or-flight mechanisms.

A. α1 and β1 : β2 and α2
B. β2 : α1
C. β1 : β2
D. α1 and α2 : β2 and β1
E. None of the above

Answer: B

45. ________________ have the most surface area and the ________________ rate of flow.

  1. Capillaries, slowest

  2. Arterioles, fastest

  3. Capillaries, fastest

  4. Arterioles, slowest

Answer: A

46. A condition that could alter capillary exchange might be

a. heart failure
b. blood loss
c. liver failure
d. malnutrition
e. all of the above

Answer: E

47. Angiotensin II is involved in which of the following

A. Constriction of the vasculature
B. Increase in volume and maintenance of osmolarity of blood
C. Increase in bradykinin
D. both A and B
E. A, B, and C

Answer: D

48. Blood pressure is decreased by

  1. the release of acetylcholine by parasympathetic fibers onto muscarinic receptors of the SA node.

  2. a decrease in the amount of norepinephrine released by sympathetic fibers onto β-receptors of the SA node and ventricular myocardium.

  3. vasodilation of arteriolar smooth muscle.

  4. all of the above.

  5. none of the above.

Answer: D

49. Which of the following is/are true regarding the velocity of blood flow?
a. Velocity is directly proportional to flow.
b. Velocity is indirectly proportional to flow.
c. Velocity is indirectly proportional to cross-sectional area.
d. Both a and c
e. Both b and c

Answer: D

50. What factors will cause edema, interstitial fluid retention?


A)Increase hydrostatic pressure
B)Decrease osmotic pressure
C)Decrease hydrostatic pressure
D)A and B
E)B and C

Answer: D

51. Which of the following will cause vasoconstriction?

A. Epinephrine binding to alpha-1 adrenergic receptors

B. Epinephrine binding to beta-2 receptors

C. Bradykinin

D. Vasporessin released form the posterior pituitary

E. Both A and D

Answer: E

52. Which of the following is NOT true of the lymphatic system?
A. Flow is pump-mediated
B. It has one-way valves
C. It filters pathogens
D. A and C
E. None of the above

Answer: A

53. With respect to the cardiovascular system, if you stimulate the Vagus nerve which of the following will occur?

  1. Parasympathetic fibers increase activity to decrease heart rate, cardiac output, and blood pressure.

  2. Stretch receptors are inhibited therefore lowering blood pressure.

  3. Sympathetic innervation decreases so heart rate decreases along with cardiac output and blood pressure.

  4. A and C

  5. All of the above are true.

Answer: D


54. Which of the following factors affect mean arterial blood pressure?

  1. Blood volume

  2. Cardiac output

  3. Resistance of the system to blood flow

  4. Relative distribution of blood between arterial and venous blood vessels

  5. All of the above

Answer: E

55. A lipophilic drug will undergo ________________ into the capillaries from the intestine via _____________capillary exchange.

A) filtration; transcellular

B) absorption; paracellular

C) absorption; transcellular

D) endocytosis; transcellular

Answer: C

56. Which of the following is true concerning blood flow in the body?


A. The driving pressure for blood flow is reflected by the mean arterial pressure.
B. At rest the brain receives more blood than the heart.
C. The skeletal muscle pump plays an important role in pumping blood to various body tissues.
D. A & B
E. A, B, & C

Answer: D

57. Where is the Cardiovascular Control Center located?

A. Cerebellum

B. Hypothalmus

C. Vegas nerve

D. Medulla oblongata

E. Baroreceptors

Answer: D


58. Blood performs capillary exchange...


A: In order to perform white blood cell exchange.
B: In order for blood to bypass a tissue.
C: To minimize blood lost at the site of a wound.
D: A and B only
E: Both A,B, and C.


Answer: D


59. A high protein diet could result in;

a) Decreased colloid osmotic pressure
b) Increased capillary filtration
c) Ascites
d) none of the above


Answer: D


60. Which of the following determines the mean arterial blood pressure?

A. Blood volume
B. Diameter of the arterioles
C. Venous return
D. A and B only
E. All the above are correct


Answer: E


61. Which of the following receptors are associated with the SA node?

A) β1
B) α1
C) M2
D) Both A and C
E) None of the above

Answer: D


62. How does the body compenstate high CO2 levels in the tissues?

A. Vasoconstriction of vessels
B. Vasodilation of vessels
C. Decreased blood flow through the capillaries
D. None of the above


Answer B


63. Activation of stretch receptors will activate vagus nerve and

a. increase heart rate
b. decrease SNA
c. decrease blood pressure
d. both A and B are true
e. both b and c are true


Answer: E


64. Which of the following is true about mean arterial pressure (MAP)?

A. An increase in heart rate will cause an increase in MAP.
B. Binding of norepinephrine to alpha-1 receptors will cause an increase in MAP.
C. Binding of norepinephrine to beta-1 receptors will cause an increase in MAP.
D. A and C
E. A, B and C

Answer: D

65. If firing of the baroreceptors in the carotid artery increases,

A. the SNS output decreases
B. the PNS output decreases
C. Blood pressure will increase
D. A and C


Answer: A


66. When the ________ is/are relaxed, blood flows through all capillaries in the bed.


a. arterioles

b. venules

c. aorta

d. precapillary sphincters

e. superior vena cava


Answer: D


67. Paracellular exchange is

A. around endothelial cells
B. through endothelial cells
C. vesicular transport of proteins & macromolecules
D. all of the above
E. none of the above

Answer: A

68. What are NOT the functions of the lymphatic system?

  1. Returning fluid and proteins filtered out of the capillaries to the circulatory system.

  2. Transferring wastes that the cells eliminate

  3. Serving as a filter to help capture and destroy foreign pathogen.

  4. Picking up fat absorbed at the small intestine and transferring it to the circulatory system.

Answer: B

69. Which of the following could change hydrostatic pressure?

A) Elevated venous pressure
B) Liver failure
C) Blood Loss
D) Both A and C

Answer: D

70. Which of the following is true?

A) The skeletal muscle pump, respiratory pump, and parasympathetic nerve innervation all affect venous return.

B) When precapillary sphincters are relaxed, blood flows through all capillaries in the bed.

C) Liver, bone, and stomach have special capillaries called sinusoids.

D) Without lymphatic absorption of fluid, net loss of fluid to the ECF would be greater than 5mL/day

Answer: B

71. An increase in arterial blood pressure stretches the baroreceptor and as a result, the firing rate of the receptor ___________. In addition, you could also see a/an ___________in ANP, a/an___________in aldosterone, and a/an _____________ in ADH.


A. increases, decrease, increase, increase

B. decreases, increase, decrease, decrease

C. increases, increase, decrease, decrease

D. decreases, increase, increase, increase


Answer: C


72. Epinephrine, released from the adrenal medulla, will do all of the following except


a. bind to alpha and beta adrenergic receptors

b. cause alpha 1 receptors to mediate vasoconstriction

c. stimulate beta 2 receptors in the arterioles innervating skeletal muscle, liver, and heart

d. stimulate beta 1 receptors on cardiac muscle, and mediate a decrease in heart rate and contractility

e. all of the above are correct


Answer: D


73. A decrease in blood pressure could be due to:


A) Decrease in parasympathetic output

B) Increase in amount of NE released

C) Decrease in sympathetic output

D) Increase in ventricular force of contraction

E) Increase stimulation of SA node


Answer: C


74. Considering hormonal regulation of tissue blood flow, which of the following act as vasodilators in the body?


  1. Bradykinin

  2. Angiotensin II

  3. VIP

  4. A and C

E) A, B, and C

Answer: D

75. Functionally, metarterioles:


A. regulate blood flow into capillary beds via means of shunting.

B. are the site of exchange between the blood and the interstitial fluid.

C. act as bypass channels for white blood cells.

D. A & C are correct.

E. All of the above are correct.

Answer: D

76. How would one increase MEAN ARTERIAL BLOOD PRESSURE?

A. Decreasing the rate of transmission of epinephrine.

B. Increasing the diameter of the arterioles.

C. Decrease the sensitivity of Beta 2 receptors to norepinephrine.

D. Decrease fluid loss by regulation at the kidneys.

Answer: D

77. Which of the following factors affect venous return?
a. Skeletal Muscle Pump
b. Respiratory Pump
c. Sympathetic Nerve Innervation
d. a and b only
e. all of the above

Answer: E

78. Interstitial fluid has low osmotic pressure because of:

A. lymph capillaries
B. water
C. leaked proteins
D. A and C only
E. All of the above


Answer: D


79. Which of the following statements is NOT correct concerning epinephrine.

A. Epinephrine binds to alpha 1 receptors which cause vasoconstriction.

B. Epinephrine binds to both alpha and beta adrenergic receptors.

C. When epinephrine binds to beta 1 receptors it causes a decrease in heart rate and a decrease in contractility.

D. When epinephrine binds to beta 2 receptors, it increases flow to liver and skeletal muscle for flight or fight response.


Answer: C


80. An increase in tissue blood flow following a period of low perfusion is known as ______________.

  1. Vasodilatation

  2. Reactive hypoxemia

  3. Active hyperemia

  4. Reactive hyperemia

  5. None of the above

Answer: D

81. What are some common risk factors for CV disease?

  1. Race

  2. Obesity

  3. Sedentary lifestyle

  4. A & C

  5. A, B, & C

Answer: E

82. Which of the following statements is/are false?

A. Arteriolar diameter is the major determinant of systemic vascular resistance.

B. Baroreceptors sense pressure changes and relays information to the nucleus ambiguous.

C. The primary determinant of velocity is cross-sectional area.

D. A decrease in mean arterial pressure leads to an increase in peripheral resistance.

E. B and D


Answer: B


83. Which of the following factors does not affect mean arteriole pressure?

A. Resistance of the system to blood flow

B. Blood viscosity

C. Effectiveness of the heart as a pump

D. Distribution of blood between arterial and venous blood vessels

E. None of the above


Answer: B





















Wednesday, November 08, 2006

Monday, October 30, 2006

LETHAL OVERDOSE


EVERYONE COME AND SUPPORT "LETHAL OVERDOSE" IN THE FLAG FOOTBALL CHAMPIONSHIP!!! THIS TUESDAY NIGHT AT 9:30 PM AT SEIBERT STADIUM!!!!

Pathways...so far


Sunday, October 29, 2006

P&P this Thursday!!!

I'm sure that everyone has had a wonderful weekend of studying!!! The physiology test is coming up on Thursday, and I thought it might be good for us all to have a way to "check" what we have learned so far. So here ya go: