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T/F
"Though connected to the kidneys, the adrenal glands play no role in the functioning or, or health of the kidneys" - wikipedia
false
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2 organs of stress
- 1. kidneys
- -Latin: renes (renal, renin, adrenal, adrenaline)
- -Greek: nephros (nephron, nephrology, epinephrine)
- 2. adrenal glands (cortex and medulla)
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context: 2 organs of stress
hormones secreted by kidneys
- 1. renin (aka - angiotensinogen-ase)
- 2. EPO (erythropoietin)
- remember: Ren and Stimpy, REPO Men
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context: 2 organs of stress
hormones secreted by adrenal glands
- -cortex (endocrine cells):
- 1. aldosterone
- 2. cortisol
- 3. testosterone
- -medulla (neuroendocrine cells):
- 1. epinephrine (aka - adrenaline)
- 2. norepinephrine (aka - noradrenaline)
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2 types of stress
- 1. acute (aka - alarm phase, Eustress 'good stress')
- 2. chronic (aka - resistance phase, distress 'bad stress')
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context: 2 types of stress
acute stress
- aka: alarm phase, Eustress 'good stress'
- -lasts: seconds --> hours
- proactive: short term response to protect/maintain homeostasis (alert --> alarm --> panic)
- evolved to protect us from short term injury (cliffs and bears)
- quick responses: neurons (neurons --> hormones) and fast acting hormones
- 1. adrenal gland - epinephrine/norepinephrine (by ACh)
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context: 2 types of stress
chronic stress
- aka: resistance phase, distress 'bad stress' (failed to escape the stressor and when "fight or flight" via E/NE did not work well enough, "conserve and survive" via cortisol, aldosterone, renin, EPO, more occur)
- -lasts: hours --> weeks or more
- reactive: long term response to recover homeostasis
- evolved to protect us from long term injury (dehydration or starvation)
- slower responses: hormones (hormones --> hormones)
- 1. kidneys - renin, EPO
- 2. adrenal gland - aldosterone (by renin), cortisol (by ACTH)
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5 goals/results of sympathetic stimulation for acute stress (fight/flight)
- brain: NE -->
- 1. alert/memory
- neurons and blood: NE, E/NE -->
- 2. mobilization of glucose reserves
- 3. changes in circulation
- 4. increases in heart and respiratory rates
- 5. increased energy use by all cells
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context: acute stress
2 branches
- 1. functions of hypothalamus
- 2. functions/effects (dominant) of high E/NE
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context: acute stress - 2 branches
2 functions of the hypothalamus
- 1. releases norepinephrine into brain
- - increases alertness and memory
- 2. sends neural signals to organs
- -ACh --> neurons --> NE directly onto most organs
- -ACh --> adrenal medulla --> E/NE indirectly to organs via blood
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context: acute stress - 2 branches
high E/NE effects on 4 areas
- 1. blood vessels
- -less blood to skin, kidneys, intestines
- -more blood to lungs, cardiac muscles, skeletal muscles
- 2. fat tissues and liver
- -release more glucose into blood
- 3. lungs and heart
- -increased oxygen and blood delivery
- 4. sweat glands
- -increased body sweating (ACh --> muscarinic receptors)
- -increased hand/foot sweating (E/NE --> alpha-1 receptors
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pathway for creation of epinephrine/norepinephrine by adrenal medulla (middle)
- adrenal medulla - under neuronal control
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context: adrenal medulla creation
storage of epinephrine and norepinephrine
in granules
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context: adrenal medulla creation
release of epinephrine and norepinephrine
- activated by: "stress" --> activate neurons from hypothalamus --> release acetylcholine (ACh) at the adrenal medulla --> immediately releases ~80% epinephrine (binds to adrenergic receptors: a-1, a-2, b-1, b-2) and 20% norepinephrine (binds to adrenergic receptors: a-1, a-2, b-1, b-2) into blood
- -effect peaks at 30 seconds, persists for several minutes
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context: adrenal medulla creation
2 ways for prepare for fight or flight (purpose)
- 1. accelerate delivery of nutrients/oxygen to cells
- -increase in HR, SV, BP, Bronchiodilation
- 2. accelerate conversion of nutrients to ATP
- -glycogen --> glucose --> ATP (for strength and endurance
- -lipids --> fatty acids --> ATP (for strenth and endurance)
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Name the 13 common adrenergic drugs (generics)
- 1. Tamsulosin
- 2. Terazosin
- 3. Doxazosin
- 4. Clonidine
- 5. Tizanidine
- 6. Atenolol
- 7. Metoprolol
- 8. Bisoprolol
- 9. Propanolol
- 10. Albuterol
- 11. Salmeterol
- 12. Pseudoephedrine
- 13. Carvedilol
- *many used for cardiovascular and/or respiratory disorders
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context: adrenergic drugs (13)
Tamsulosin
- adrenergic receptor: alpha-1
- endogenous agonist: Epinephrine, Norepinephrine
- function: antagonist
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context: adrenergic drugs (13)
Terazosin
- adrenergic receptor: alpha-1
- endogenous agonist: Epinephrine, Norepinephrine
- function: antagonist
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context: adrenergic drugs (13)
Doxazosin
- adrenergic receptor: alpha-1
- endogenous agonist: Epinephrine, Norepinephrine
- function: antagonist
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context: adrenergic drugs (13)
Clonidine
- adrenergic receptor: alpha-2
- endogenous agonist: Epinephrine, Norepinephrine
- function: agonist
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context: adrenergic drugs (13)
Tizanidine
- adrenergic receptor: alpha-2
- endogenous agonist: Epinephrine, Norepinephrine
- function: agonist
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context: adrenergic drugs (13)
Atenolol
- adrenergic receptor: beta-1
- endogenous agonist: Epinephrine, Norepinephrine
- function: antagonist
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context: adrenergic drugs (13)
Metoprolol
- adrenergic receptor: beta-1
- endogenous agonist: Epinephrine, Norepinephrine
- function: antagonist
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context: adrenergic drugs (13)
Bisoprolol
- adrenergic receptor: beta-1
- endogenous agonist: Epinephrine, Norepinephrine
- function: antagonist
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context: adrenergic drugs (13)
Propanolol
- adrenergic receptor: beta-1, beta-2
- endogenous agonist: Epinephrine, Norepinephrine
- function: antagonist for both
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context: adrenergic drugs (13)
Albuterol
- adrenergic receptor: beta-2
- endogenous agonist: Epinephrine, Norepinephrine
- function: agonist
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context: adrenergic drugs (13)
Salmeterol
- adrenergic receptor: beta-2
- endogenous agonist: Epinephrine, Norepinephrine
- function: agonist
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context: adrenergic drugs (13)
Pseudoephedrine
- adrenergic receptor: alpha/beta
- endogenous agonist: Epinephrine, Norepinephrine
- function: agonist
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context: adrenergic drugs (13)
Carvedilol
- adrenergic receptor: alpha/beta
- endogenous agonist: Epinephrine/Norepinephrine
- function: antagonist
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4 goals/results of chronic stress
- 1. prevention of dehydration and hypotension
- 2. delivery of more oxygen
- 3. prevention of starvation
- 4. prevention of excessive inflammation
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context: 4 goals of chronic stress
prevention of dehydration and hypotension
- via hormone: renin, angiotensin, aldosterone, ADH
- Process: low BV or BP stimulate kidneys to release renin into blood --> renin converts angiotensinogen to angiotensin I --(ACE in lungs)--> angiotensin I converted into angiotensin II --> angiotensin II stimulates:
- 1. posterior pituitary to release ADH (ADH makes kidneys more permeable to water)
- 2. adrenal cortex to release aldosterone (aldosterone stimulates kidneys to hold onto Na+)
- -Less water out of kidneys = more water in blood
- Pathophysiology: chronic psychological stress --> hypertension
- Pharmacology: treat the psychological problem
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context: 4 goals of chronic stress
delivery of more oxygen
- via hormone: erythropoietin (EPO)
- Process: low erythrocytes, plasma, and/or oxygen --> kidneys release EPO --> EPO stimulates RBC production by bone marrow
- Pathophysiology: -
- Pharmacology: patients with anemia (due to chemotherapy, athletes
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context: 4 goals of chronic stress
prevention of starvation
- via hormone: glucocorticosteroids/glucocorticoids/corticosteroids (cortisol)
- Process: mobilization of glucose from reserves for wound healing and maintaining glucose to CNS:
- -adipose --> fatty acids + glycerol into blood
- -skeletal muscle --> amino acids into blood
- -stimulate liver --> convert glycerol and a.a. to glucose
- -non-CNS tissues --> use fatty acids not glucose
- Pathophysiology: disorders of cortisol
- -problem with hypothalamus, pituitary, or adrenal gland
- -Addison's Disease/Syndrome: absent cortisol (less mobilization of energy stores during stress)
- -Cushing's Disease/Syndrome: copious cortisol (excess mobilization of energy stores during stress, increased infections)
- Pharmacology: -
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context: 4 goals of chronic stress
prevention of excessive inflammation
- via hormone: glucocorticosteroids/glucocorticoids/corticosteroids (cortisol)
- Process: inhibit:
- -WBC proliferation
- -WBC migration
- -WBC inflammatory mediators
- Pathophysiology: -
- Pharmacology: glucocorticoids can be used to inhibit dangerous inflammation
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context: Glucocorticosteroid Therapy
2 uses of glucocorticosteroid
- 1. adrenal insufficiency
- 2. suppression of immune system
- -autoimmune disorders, allergies, asthma, transplants
- -any acute/chronic symptom of inflammation/pain
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context: Glucocorticosteroid Therapy
7 ways of administrations
- 1. I.V.
- 2. I.M.
- 3. S.C.
- 4. oral
- 5. topical
- 6. inhaled
- 7. intra-articular
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context: Glucocorticosteroid Therapy
Name 10 synthetic glucocorticosteroids
- 1. Cortisol (hydrocortisone)
- 2. Prednisone
- 3. Prednisolone
- 4. Methylprednisolone
- 5. Triamcinolone
- 6. Dexamethasone
- 7. Betamethasone
- 8. Fluticasone
- 9. Mometasone
- 10. Budesonide
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context: 10 synthetic glucocorticosteroids
Cortisol (hydrocortisone)
- half-life: <1.5 hours
- potency: 1x
- Top 200 listing: -
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context: 10 synthetic glucocorticosteroids
Prednisone
- half-life: 2-5 hours
- potency: 4x
- Top 200 listing: generic
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context: 10 synthetic glucocorticosteroids
Prednisolone
- half-life: 2-5 hours
- potency: 4x
- Top 200 listing: -
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context: 10 synthetic glucocorticosteroids
Methylprednisolone
- half-life: 2-5 hours
- potency: 5x
- Top 200 listing: generic
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context: 10 synthetic glucocorticosteroids
Triamcinolone
- half-life: >5 hours
- potency: 5x
- Top 200 listing: generic, Nasacort AQ™
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context: 10 synthetic glucocorticosteroids
Dexamethasone
- half-life: >5 hours
- potency: 20-50x
- Top 200 listing: Tobradex™ (2 agents)
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context: 10 synthetic glucocorticosteroids
Betamethasone
- half-life: >5 hours
- potency: 20-50x
- Top 200 listing: generic (2 agents)
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context: 10 synthetic glucocorticosteroids
Fluticasone
- half-life: -
- potency: ?
- Top 200 listing: Flonase™, Flovent™
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context: 10 synthetic glucocorticosteroids
Mometasone
- half-life: -
- potency: ?
- Top 200 listing: Nasonex™
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context: 10 synthetic glucocorticosteroids
Budesonide
- half-life: -
- potency: ?
- Top 200 listing: Rhinocort AQ™
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Chronic Stress diagram
- Hypothalamus:
- -psycho or physio distress
- -renin, ADH, ACTH
- Blood loss:
- -direct: renin, EPO
- Goals:
- -recover blood cells
- -retain fluid --> BV, BP
- -regulate energy
- -suppress WBCs
- Diuretics:
- -increase fluid loss
- -to lower blood pressure
- -to decrease heart's effort
- Types of diuretics:
- 1. ACE inhibitors
- 2. Angiotensin II receptor antagonists
- 3. Aldosterone receptor antagonists
- 4. many others that work directly on the kidneys
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The heart as an endocrine gland
-over-hydration is also a form of biological stress
- 5 step process:
- (1) blood volume increases --> (2) atria chamber of heart stretches --> (3) triggers release of Atrial Natriuretic Peptides (ANP) --> (4) ANP triggers Na+ and water loss via kidneys --> (5) blood volume decreases
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