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CHEM 183: McGill University: Chem of Drugs

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CHEM 183: Chem of Drugs Final Exam Notes Chem of Drugs McGill University Final Exam. All lectures needed for final Exam, in depth, almost every single word from Recording. Did very well on online exams with these notes. Easy to command find during exam.

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Uploaded on November 29, 2023
Number of pages 53
Written in 2023/2024
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Professor(s) Joe schwartz.
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Education Chemistry
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Chem of Drugs Final Exam Notes
Heart Disease A
The heart is widely regarded as most important part of the body aside from brain

History:
 According to Ancient Egyptians: Heart was the center of emotions and intellect
 When they create the mummies, heart was left in the bodies because they thought that this was the seed of the soul and
would be important in afterlife. Other body organs were taken out and removed and stores in canopy jars but not the heart.
 The sarcophagus and the canopy gold jars were put into the tomb
 Idea was that in after life maybe the body would be able to make use of the organs once again, but the heart was left inside
the mummy.
 Romans Thought: The heart synthesized blood, it made it and then pumped it through the arteries to deliver what they
called the vital spirit. They weren’t totally wrong; heart does pump blood through the body.

Leonardo Da Vinci  Drew amazing diagrams of the heart. In those days, artists needed knowledge of anatomy for painting human
body, had to study anatomy. Drawing that Da Vinci made that a surgeon much later on was able to use those drawings to develop a
new type of surgical procedure.
 He was not only an artist, but also an inventor, he drew diagrams for helicopters for tanks and extremely interested in
anatomy

William Harvey 1578-1657  Modern study of the heart begins with William Harvey, English physician of 16 th and 17th centuries.
Widely regarded as father of circulatory system.
 He described what happens in the body and how the heart actually is a pump.

Heart as a Pump: A very Sophisticated Pump
Heart has 2 functions:
1. It will circulate deoxygenated blood
2. Take oxygenated blood from lungs to circulate though body.

 Usually, blue used to show blood with no oxygen (deoxygenated) and red for oxygenated blood (with oxygen)
 Oxygen carried by red blood cells, hemoglobin molecules which have an iron atom embedded in their center and it is that
iron atom on to which oxygen is attached.
 Heart has four chambers
o The top two chambers are known as the atria – atrium.
o Bottom chambers are the ventricles.
 Used blood returns to the top right-hand portion of the heart.
o Right hand as if you are looking at your own heart. Near you right arm. Not as if you are looking at a pic.

How the Heart Circulates Blood:
 Used blood is gathered by body through the vena cava
 It flows direction into top right-hand portion of heart which is right atrium
 Through tricuspid valve into lower part of heart which is the right ventricle
 A muscle there contracts and pushes used blood (deoxygenated blood) through pulmonary valve and out through the heart
towards the lungs, this is the pulmonary artery.
 **The pulmonary artery is the only artery that carries deoxygenated blood.
 Arteries carry oxygenated blood, except for this one which carried blood from the heart, used blood to lungs.
 As blood circulates through the lungs, it picks up oxygen from the air that we inhale and then it comes back into the heart
and comes through pulmonary veins.
 Veins: Blood vessels that flow towards the heart.
 Pulmonary veins transport blood to top atrium on the left side and then through the mitral valve
 It flows down into the left ventricle and from left ventricle, out through the aortic valve into the aorta, which is the largest
blood vessel in the body.
 **Aorta is the largest or biggest blood vessel in the body.
 Aorta sub divides and it will send blood everywhere around the body through the arteries which then subdivide further into
tiny blood vessels called arterial walls.

 Every minute the heart pumps 5-6 liters of blood per minute through 100 000 km of blood vessels beating up to 2.6 billion times
throughout a lifetime. - 100 000 km is really a lot when you consider that the circumference of the earth is only about 40 000 km.

, Chem of Drugs Final Exam Notes

We have so many blood vessels in out body because they keep dividing until they reach every part of the body.

 BLUE for VEINS used to show blood with no oxygen (deoxygenated) and RED for ARTERIES for oxygenated blood (with oxygen) (In
most diagrams)

 Smallest Division of Blood Vessels in the Body: Arterioles. These connect arteries to the veins. Single red blood cells can flow
through. Very small – only allow one single cell at a time through.

Problems that arise that we put into the category of heart disease:
 Failure to pump enough blood
 Impairment of electrical activity: Electrical stimulation needed to force contractions of heart to push out blood
 Reduced flow of blood through coronary arteries:
o Coronary Arteries are arteries that feed the heart itself. The heart is a muscle, and as with any muscle, the heart
needs blood to flow to it. Coronary arteries get their name because they sit on top of the heart like a crown. These
arteries supply oxygenated blood to the heart – if these are blocked, obviously the heart itself is lacking oxygen
which can cause or result in a heart attack.
 Improper functioning of heart valves: If there is a malfunction, the blood will not be pumped efficiently through the lungs or
the rest of the body.

Risk Factors: Predispose people to heart disease (Everything Underlined)
Family History: Very important. History of heart attacks and strokes in the family, then they are more prone.
 A particular crease in the ear lobe – seen in people who are more likely to have heart disease. Crease in the earlobe does
not cause heart disease. It is a sign; we don’t know why it’s happening. Genetic factors related to heart disease also related
to this crease in the ear.
 Men who go bald early – more prone to heart disease. Many be due to imbalances of hormones. Hormones that cause
baldness may play a role in heart disease.
 Being Male: Men are more likely to develop heart disease than women.
o BUT: Heart disease is still the #1 killer of women. Less prevalent than it is in men.
o Estrogen may be responsible for less heart disease in women. Women have more estrogen and at menopause –
Estrogen production decreases and we know that after menopause men and women are equally as likely to suffer
from heart disease.
o Can you protect women after menopause with estrogen supplements? Many women take estrogen supplements to
reduce symptoms of menopause. Does that also reduce risk of heart disease? But it doesn’t. Estrogen
Supplementation after menopause does NOT reduce risk of heart disease. It was a viable option but turns out it
doesn’t work. When you lose estrogen, you lose bone density. Taking estrogen to prevent osteoporosis is good.

 Smoking: Very important risk factor. More important risk factor for heart disease than for lung cancer probably. Carbon
Monoxide is part of the smoke and that will reduce ability of the blood to carry oxygen.
o Smoking introduces all kinds of particulate matter and combustion by-products into the body which body senses as
a foreign substance and it mounts an inflammatory attack on it.

 Obesity: Overweight people are much more prone to heart disease. They are more prone to diabetes, which itself
predisposes to heart disease. The more weight you have the harder the heart has to work to supply the oxygen needed by
all of those cells all over the body.
 Diabetes: Diabetes 2 (II), Diabetes is an independent risk factor for heart disease. Diabetes’s is essentially an increased
concentration of glucose in the bloodstream.
o Glucose is essential because it is the main source of energy in the body. Also, the main nutrient that brain uses for
energy source.
o Too much glucose in the blood will lead to a reaction between glucose and fats and glucose and proteins to form
“Advanced Glycation End Products” (AGEs) that damage tissues and damage coronary arteries and that initiates
inflammation which can result in a heart attack.
o How do you know if you have high blood glucose? Only one way  You have to measure it. There is no way to
know without measuring it. 2 systems: mg/dL (US) and we use mmol/L x 18 (Similar how to Celsius and F - temp
difference in units). To convert you multiple by 18 or divide by 18.
o 126 mg/dL = 7 mmol/L
o Fasting Blood Glucose: You don’t eat anything overnight and blood test in the morning.

, Chem of Drugs Final Exam Notes
 (Diabetes > 7 mmol/L , Prediabetes 5.5-7 mmol/L) You repeat test if there are questionable values.
o If something is unclear, they will do an oral glucose tolerance test – better indication. You are given 75 grams of a
sugar drink solution and your blood glucose is measured 2 hours later.
 (Diabetes > 11 mmol/L , Prediabetes 7.8.-11 mmol/L)
o Hemoglobin A1c: Used to monitor blood sugar over 2-3 months. Blood test that will tell you average blood glucose
over past few months. If value is less than 7%, that corresponds to average blood glucose of 8.3 mmol/l.
 You want hemoglobin A1c to be under 7%.
o Blood glucose can be measured easily for diabetics – many ways. There is a patch that can be attached to body
with needle and info is transmitted to a device
o Many devices – some prick your finger.
o Up to 50% of prediabetics will develop
diabetes in 5 – 10 years. Must monitor!!!

Avoiding starchy food is a way to monitor – DIET.
It means avoiding many sugary and high carb food.
Starch in the body converts to glucose. Contains many
Vegetables, beans, fish, oils are okay. Cake, bread, and pasta
Should be restricted.

 Blood Cholesterol: Only way you can know if you have high cholesterol is through means of a blood test.
o Cholesterol is not a poison; it is an essential biochemical
o The body needs cholesterol because it is used for synthesis of sex hormones and used for synthesis of adrenal
gland hormones.
o We cannot live without it. The body can manufacture cholesterol – we do NOT need it from an outside source.
o If we synthesize or ingest too much cholesterol, it can build up in coronary arteries and cause a heart attack.
o HEALTHY LEVELS OF CHOLESTEROL  Total = Less than 5 mmol/l , LDL = Less than 3 mmol/l , HDL = Greater than 1
o LDL = Bad cholesterol and HDL = good cholesterol
o Cholesterol itself is not soluble in water and blood is water. Cholesterol has to be attached to a lipo protein to get
around the system.
o If there is too much LDL – then some of it starts to build up in the coronary arteries and that is what can trigger
inflammation and that in turn triggers heart disease.
o HDL is good cholesterol that is attached to rescue vessels. These “boats” pick up any excess cholesterol and
transport it out of the system.
o We want LDL level to be low and HDL level to be higher.
Genetic Components to Heart Disease: APOE4 gene carriers are prone to high cholesterol and Alzheimer’s disease. Low-fat diets can
help reduce the risk for these diseases. APOE4 is more common (20-30% occurrence) in Africans and Caucasians than in other ethnic
groups. *Requires evaluation through genetic profiling and only done when there is a reason to suspect that someone has this gene.

o You can lower cholesterol levels through diet. Low sugar diet will lower cholesterol.
o North American diet is prone to higher levels of blood cholesterol.
o Eggs are a source of cholesterol – many people stay away. Eggs are very nutritious
o Studies show people who eat eggs do not have higher risk of coronary heart disease even among APOE4 carriers.
o It is not the cholesterol that we ingest in the diet – it is cholesterol that body forms in excessive amounts and those
reactions are triggered by the ingestion of saturated fat. Lard and butter and hydrogenated fats like margarine,
these are the ones more responsible for high blood levels of cholesterol.
o 6-12 eggs a week in context of a healthy diet does not raise LDL cholesterol, triglycerides, or blood sugar in people
with or at risk for diabetes.
o We eat eggs not only when we cook eggs, but they are also a part of many pastries and cake.
*Saturated Fats and Hydrogenated Fats and Trans Fats in our diet that are the problem!
o Emphasize the Polyunsaturated and Monounsaturated fat
o Olive oil is a good source of mono
o Canola oil is poly
o Limit saturated fat intakes and these are heavy creams and butter this will increase blood cholesterol

, Chem of Drugs Final Exam Notes
o High Fat and High Sugar  Donuts and Pastries and any kind of tropic oil like palm or coconut oil is high in
saturated
o Hydrogenated Fats: Chemical process of hydrogenation is to convert an unsaturated fat to a saturated fat because
saturated fats work better in baking and commercial kitchens. Comes with formation of Trans fats.
o Trans Fats are still unsaturated fats but have a different kind of chemistry.
 Trans fat is in the same category of saturated fats. They are more prone to building up cholesterol in our arteries.
o 1/3 One third of all heart attacks and strokes can be avoided in people at high risk by using statin drugs to lower
cholesterol.
o Statin Drugs: Stop cholesterol formation in the body by interfering with an enzyme that is involves in the synthesis
of cholesterol. They also act as an anti-inflammatory substance which helps against heart disease.
o Lipitor: Classic Staten Drug. Most widely prescribed drug in the world.
 There are side effects, but they don’t affect the vast majority of the people taking this drug.
 Most complaints are about muscle aches
 Reduces risk of heart disease
o Homocysteine: Another chemical produced in the body liked to heart disease.
 Tends to build up in the body when there is an insufficient intake of B vitamins, and the theory is that
homocysteine can also result in the buildup of deposits in the coronary arteries – contributing to heart
disease. This theory was DISPROVED.
 What is true: Insufficient/ Inadequate vitamin B intake, homocysteine reaches levels that are toxic to the
cells that line blood vessels.
 Experiments were done where people with high homocysteine were supplemented with multivitamins to
try to reduce levels, it didn’t make any difference.
 Might be that Homocysteine can be a marker for disease but not involved in actually triggering heart
disease.
 B Vitamins are found in fruits and vegetables – Recommended for anyone who is trying to control the risk
of heart disease. What we should eat anyway.
 Same diet recommended for lowered homocysteine as anything else. Mostly plant based. Reduces risk

Inflammation: The Secret Killer - Most active area of research today.
 Responsible for playing a role in many conditions:
o Cardiovascular disease, cancer, arthritis, diabetes II, autoimmune diseases, arthritis, Alzheimer’s, lung diseases.
Caused by or exacerbated by inflammation.
 Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as disease-causing
organisms, damaged cells, or irritants. The protective response involves immune cells, changes in blood flow and various
molecular mediator. The function of inflammation is to eliminate the initial cause of cell injury, clear our dead cells and
tissue damage from original insult and initiate tissue repair.
 The Classical Signs of Inflammation: Heat, Pain, Redness and Swelling and loss of function.
 Inflammation is the body trying to protect itself from foreign invaders. Things the body perceives as being foreign.
 Most of the mechanism for the body to remove the foreign invaders involve white blood cells.
 Inflammation happens on the outside it is easy to see. Inside the body – in a coronary artery it’s hard to know that it is
there.
 Many types of blood cells involved. White blood cells with different functions
 Mass Cells: Release histamine, these will allow opening up of arteries so that more white blood cells can come to the sight
of infection.
 As they are delivered, Neutrophils (Classic White Blood Cells) will basically digest bacteria and viruses.
 Macrophages: Release cytokines which are signaling molecules and bring other white blood cells to try to attack invader
 All of this is part of immune reaction 

*The buildup of cholesterol and other substances can set off
an inflammatory response. Body perceives building up
as a foreign substance. Sustained low levels of
inflammation may promote the growth of plaques, loosen
plaque in arteries and trigger blood clots.
*Blood Clots are the primary cause of heart attacks + strokes.

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