ADVANCED PHARMACOLOGY NSG COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS RATED A+
✔✔why are free radicals bad? - ✔✔they bind to the phospholipid bilayer of a cell and
drill holes in its membrane
✔✔what are reactive oxygen species? - ✔✔highly reactive forms of oxygen typically
from the mitochondria
✔✔why are antioxidants important - ✔✔protect cells from free radicals and ROS
✔✔are antioxidants increased or decreased in oxidative stress - ✔✔decreased :(
✔✔what are three diseases linked to oxygen-derived free radicals? - ✔✔1.
Atherosclerosis
2. Cancer
3. Diabetes
✔✔define oxidative stress - ✔✔Injury induced by free-radicals and ROS
✔✔two endogenous accumulations - ✔✔1. Lipids
2. Bilirubin
✔✔define reperfusion injury - ✔✔when blood flow is restored to ischemic tissues,
additional damage can occur resulting in cell death
✔✔proposed reasons for reperfusion injury (5) - ✔✔1. oxidative stress
2. nitrogen-based free radicals
3. increased intracellular calcium
4. inflammation
5. complement activation
✔✔explain oxidative stress as it relates to reperfusion injury - ✔✔reoxygenation
generates ROS and nitrogen species, which damages membrane proteins and
phospholipids
✔✔what four ROS are generated in oxidative stress? - ✔✔1. Hydroxyl radical
2. superoxide radical ion
3. nitric oxide-derived peroxynitrite
4. hydrogen peroxide
✔✔what happens when nitrogen-based free radicals are formed in reperfusion injury? -
✔✔further damage to the cell membrane occurs and calcium overloads the
mitochondria
,✔✔explain bilirubin - ✔✔a pigment that is released when RBC break down --> pigment
is released into the bloodstream as unconjugated bilirubin, which cannot be excreted
into the urine --> taken up by the liver cells --> binds to glucuronic acid --> becomes
conjugated bilirubin, which can be excreted in the urine
✔✔two ways bilirubin leaves the liver cells - ✔✔1. diffusion once bilirubin concentration
is high
2. some bilirubin becomes bile --> exits liver cell through hepatic duct/common bile duct,
then into the duodenum
✔✔three issues with hyperbilirubinemia - ✔✔1. hemolytic jaundice
2. hepatocellular jaundice
3. obstructive jaundice
✔✔explain hemolytic jaundice - ✔✔excessive amounts of hemoglobin is broken down,
resulting in too much bilirubin in the bloodstream that cannot be delivered to the liver
cells
✔✔signs of hemolytic jaundice - ✔✔yellow discoloration of the skin and connective
tissue
✔✔explain hepatocellular jaundice - ✔✔normal amount of bilirubin, however, liver cells
do not function at either a) uptake, b) conjugation, or c) excretion
✔✔explain obstructive jaundice - ✔✔hepatic/common bile duct is obstructed resulting in
conjugated bilirubin accumulating in the liver cell, resulting in more bilirubin diffusing into
the bloodstream than normal
✔✔pyknosis - ✔✔clumping of the nucleus
✔✔kayrorrhexis - ✔✔fragmentation of nuclear material
✔✔karyolysis - ✔✔dissolution of nucleus
✔✔define autophagy - ✔✔type 2 programmed cell death of "Eating of self"
✔✔list five types of necrosis - ✔✔1. liquefactive
2. coagulative
3. caseous
4. fat
5. gangrenous
✔✔describe liquefactive necrosis - ✔✔- dead cells transform into a viscous liquid (pus)
, - commonly the result of hypoxic injury to the CNS and in fungal/bacterial infections
✔✔describe coagulative necrosis - ✔✔- dead cells turn into opaque scar tissue
- localized area (infarct)
✔✔describe caseous necrosis - ✔✔- "cheese like"
- commonly seen in granulomas and TB
✔✔describe fat necrosis - ✔✔- trauma to high fat areas; lipolysis
- common in breasts and pancreas
- opaque and chalky white
✔✔saponification - ✔✔Process of soap formation in fat necrosis due to lipases breaking
down triglycerides --> release fatty acids --> combine with Ca, Mg, and Na ions
✔✔describe gangrenous necrosis - ✔✔- usually lower limb or gut with low O2
(anaerobic bacteria)
- large areas of tissue death
✔✔three types of gangrene necrosis - ✔✔1. dry
2. wet
3. gas
✔✔describe dry gangrene - ✔✔- coagulative necrosis
- skin is dry, disheveled, and black
✔✔describe wet gangrene - ✔✔- secondary to liquefactive necrosis
- cold, black, swollen, foul odor
✔✔describe gas gangrene - ✔✔- Presence of clostridium
- soil-contaminated puncture wounds
- bubbles of gas in dead tissue
✔✔define cell necrosis - ✔✔- irreversible injury
- rapid plasma membrane structure loss
- organelle swelling
- mitochondrial dysfunction
✔✔what happens in cell necrosis - ✔✔- cell membrane is ruptured
- leakage of cell contents
- ATP is lost
- organelles swell
- severe mitochondrial damage
- local inflammation
QUESTIONS AND ANSWERS RATED A+
✔✔why are free radicals bad? - ✔✔they bind to the phospholipid bilayer of a cell and
drill holes in its membrane
✔✔what are reactive oxygen species? - ✔✔highly reactive forms of oxygen typically
from the mitochondria
✔✔why are antioxidants important - ✔✔protect cells from free radicals and ROS
✔✔are antioxidants increased or decreased in oxidative stress - ✔✔decreased :(
✔✔what are three diseases linked to oxygen-derived free radicals? - ✔✔1.
Atherosclerosis
2. Cancer
3. Diabetes
✔✔define oxidative stress - ✔✔Injury induced by free-radicals and ROS
✔✔two endogenous accumulations - ✔✔1. Lipids
2. Bilirubin
✔✔define reperfusion injury - ✔✔when blood flow is restored to ischemic tissues,
additional damage can occur resulting in cell death
✔✔proposed reasons for reperfusion injury (5) - ✔✔1. oxidative stress
2. nitrogen-based free radicals
3. increased intracellular calcium
4. inflammation
5. complement activation
✔✔explain oxidative stress as it relates to reperfusion injury - ✔✔reoxygenation
generates ROS and nitrogen species, which damages membrane proteins and
phospholipids
✔✔what four ROS are generated in oxidative stress? - ✔✔1. Hydroxyl radical
2. superoxide radical ion
3. nitric oxide-derived peroxynitrite
4. hydrogen peroxide
✔✔what happens when nitrogen-based free radicals are formed in reperfusion injury? -
✔✔further damage to the cell membrane occurs and calcium overloads the
mitochondria
,✔✔explain bilirubin - ✔✔a pigment that is released when RBC break down --> pigment
is released into the bloodstream as unconjugated bilirubin, which cannot be excreted
into the urine --> taken up by the liver cells --> binds to glucuronic acid --> becomes
conjugated bilirubin, which can be excreted in the urine
✔✔two ways bilirubin leaves the liver cells - ✔✔1. diffusion once bilirubin concentration
is high
2. some bilirubin becomes bile --> exits liver cell through hepatic duct/common bile duct,
then into the duodenum
✔✔three issues with hyperbilirubinemia - ✔✔1. hemolytic jaundice
2. hepatocellular jaundice
3. obstructive jaundice
✔✔explain hemolytic jaundice - ✔✔excessive amounts of hemoglobin is broken down,
resulting in too much bilirubin in the bloodstream that cannot be delivered to the liver
cells
✔✔signs of hemolytic jaundice - ✔✔yellow discoloration of the skin and connective
tissue
✔✔explain hepatocellular jaundice - ✔✔normal amount of bilirubin, however, liver cells
do not function at either a) uptake, b) conjugation, or c) excretion
✔✔explain obstructive jaundice - ✔✔hepatic/common bile duct is obstructed resulting in
conjugated bilirubin accumulating in the liver cell, resulting in more bilirubin diffusing into
the bloodstream than normal
✔✔pyknosis - ✔✔clumping of the nucleus
✔✔kayrorrhexis - ✔✔fragmentation of nuclear material
✔✔karyolysis - ✔✔dissolution of nucleus
✔✔define autophagy - ✔✔type 2 programmed cell death of "Eating of self"
✔✔list five types of necrosis - ✔✔1. liquefactive
2. coagulative
3. caseous
4. fat
5. gangrenous
✔✔describe liquefactive necrosis - ✔✔- dead cells transform into a viscous liquid (pus)
, - commonly the result of hypoxic injury to the CNS and in fungal/bacterial infections
✔✔describe coagulative necrosis - ✔✔- dead cells turn into opaque scar tissue
- localized area (infarct)
✔✔describe caseous necrosis - ✔✔- "cheese like"
- commonly seen in granulomas and TB
✔✔describe fat necrosis - ✔✔- trauma to high fat areas; lipolysis
- common in breasts and pancreas
- opaque and chalky white
✔✔saponification - ✔✔Process of soap formation in fat necrosis due to lipases breaking
down triglycerides --> release fatty acids --> combine with Ca, Mg, and Na ions
✔✔describe gangrenous necrosis - ✔✔- usually lower limb or gut with low O2
(anaerobic bacteria)
- large areas of tissue death
✔✔three types of gangrene necrosis - ✔✔1. dry
2. wet
3. gas
✔✔describe dry gangrene - ✔✔- coagulative necrosis
- skin is dry, disheveled, and black
✔✔describe wet gangrene - ✔✔- secondary to liquefactive necrosis
- cold, black, swollen, foul odor
✔✔describe gas gangrene - ✔✔- Presence of clostridium
- soil-contaminated puncture wounds
- bubbles of gas in dead tissue
✔✔define cell necrosis - ✔✔- irreversible injury
- rapid plasma membrane structure loss
- organelle swelling
- mitochondrial dysfunction
✔✔what happens in cell necrosis - ✔✔- cell membrane is ruptured
- leakage of cell contents
- ATP is lost
- organelles swell
- severe mitochondrial damage
- local inflammation
