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Muscles (Comparisons or General Questions):

Which of the following is not an important functional difference between smooth and skeletal muscles ?
a) actin and myosin are arranged differently - skeletal muscle => linear, sarcomere based structure, - smooth
muscle => network based
b) Ca++ from the sarcoplasmic reticulum is critical to contraction in skeletal but not in smooth muscle
Smooth muscle has
c) Neural stimulation (via synapses) fire each contraction in skeletal but not smooth muscle
d) Kinases and phosphatases are the major mechanism of controlling myosin ATPase activity in more avenues to get Ca
++ in
smooth but not in skeletal muscle

Excitation-contraction coupling in smooth muscle differs from that in skeletal muscle in that:
a) Cytosolic[Ca++] is elevated in smooth muscle.
b) The activation signal reaches myosin rather than actin in smooth muscle.
c) Calmodulin is important in skeletal muscle
d) Myosin light chain kinase is important in smooth muscle.
e) B and D are correct.

Compared to smooth muscle, skeletal muscle


a) is slower to contract in response to a stimulus
b) develops tension more rapidly and relaxes more rapidly
c) sustains contractions longer without fatigue
d) A and C
e) A, B and C

Which one of the following proteins is important for skeletal muscle contraction but not for smooth muscle
contraction?
a) Actin
b) Myosin
c) Ca++ -ATPase
d) Myosin-adenosine triphosphatase (ATPase)
e) Troponin

Which of the following is NOT involved in bringing about muscle relaxation?


a) re-uptake of Ca++ by the sarcoplasmic reticulum
b) removal of ACh at the endplate by acetylcholinesterase
c) refractory membranes
d) tropomyosin interference with myosin activity

Skeletal muscle is similar to smooth muscle in that both types:


a) show sarcomeric organization of thick and thin filaments
b) contract in response to hormonal stimulation
c) contract in response to increases in cytoplasmic Ca++
d) have troponin-linked regulation of crossbridge cycling
e) relax in response to ACh

Skeletal muscle differs from cardiac muscle in that only skeletal muscle:
a) has contraction initiated by binding of Ca++ to troponin
b) regulates force of contraction by regulating release of intracellular Ca++
c) shows a length-active tension curve that depends on filament overlap
d) regulates the speed of contraction by phosphorylation of myosin heads
e) shows temporal summation

Cardiac muscle is similar to skeletal muscle in that


a) both show temporal summation of contractions
b) the contractions of both are initiated by ACh binding
c) muscarinic cholinergic stimulation slows the contractions of both
d) both are equally compliant(have similar passive elastic characteristics)
e) contractions of both require action potentials

Cardiac muscle cells differ tom skeletal muscle cells in that only cardiac muscle cells:
a) utilize an increase in myosin light chain kinase as a mechanism to regulate the strength of contraction
b) contract in response to an increase in cytoplasmic [Ca++]
c) utilize an increase in Ca++-calmodulin as a mechanism to regulate the strength of contraction
d) propagate action potentials along their plasma membrane
e) require trigger Ca++ to release Ca++ from the sarcoplasmic reticulum (CICR)

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Skeletal Muscle Physiology:
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At the neuromuscular junction, acetylcholine (ACh) directly causes the opening of


a) Na+ channels and depolarization toward the Na+ equilibrium potential
b) K+ channels and depolarization toward the K+ equilibrium potential
c) Ca++ channels and depolarization toward the Ca++ equilibrium potential
d) Na+ andK+ channels and depolarization to a value halfway between the Na+ and K+ equilibrium potentials
e) Na+ and K+ channels and hyperpolarization to a value halfway between the Na+ and K+ equilibrium potentials

A motor unit refers to


a) a single motor neuron plus all of the muscle fibers it innervates.
b) a single muscle fiber plus all of the motor neurons that innervate it. c) all of the motor neurons supplying a
single muscle.
d) a pair of antagonistic muscles.
e) a sheet of smooth muscle cells connected by gap junctions.

In skeletal muscle, which of the following events occurs before depolarization of the T tubules in the
mechanism of excitationcontraction coupling?
a) Depolarization of the sarcolemmal membrane
b) Opening of Ca++ release channels on the sarcoplasmic reticulum(SR)
c) Uptake of Ca++ into the SR by Ca++ -adenosine triphosphatase(ATPase)
d) Binding of Ca++ to troponin C
e) Binding of actin and myosin

Which of the following temporal sequences is correct for excitation-contraction coupling in skeletal muscle?
a) Increased intracellular [Ca++]; action potential in the muscle membrane; cross-bridge formation
b) Action potential in the muscle membrane; depolarization of the T-tubules; release of Ca++ from the
sarcoplasmic reticulum (SR)
c) Action potential in the muscle membrane; splitting of adenosine triphosphate (ATP); binding of Ca++ to
troponin C
d) Release of Ca++ from the SR;depolarization of the T-tubules; binding of Ca++ to troponin C

One of the major differences among skeletal muscle fiber types is in their resistance to fatigue. The fibers with
the most endurance rely on ____________ for energy.
a) lactic acid accumulation
b) ketone body degradation
c) anaerobic glycolysis
d) oxidative phosphorylation

Which of the following is NOT involved in bringing about skeletal muscle relaxation?
a) re-uptake of Ca++ by the sarcoplasmic reticulum
b) tropomyosin interference with myosin activity
c) closure of ryanodine receptor Ca++ channels
d) MLC phosphatase deactivation of myosin ATPase activity Smooth Muscle
e) troponin conformational shifts.

Within a single skeletal muscle fiber, the tension developed during a twitch can vary because
a) strength of contraction depends on the resting length of the sarcomere
b) the motor neuron releases differing amounts of neurotransmitter into the synapse
c) Calcium induced calcium release can vary with the strength of the stimulus
d) stimuli vary in intensity
e) all of the above

Suppose that you measure the velocity of contraction of a particular muscle as it lifts a certain mass. Adding
additional mass would __________ the velocity of contraction
a) increase
b) decrease
c) not affect

Which of the following is involved in the gradation of muscle contraction?


a) variation in the number of motor units activated
b) variation in the frequency of action potentials initiated in each muscle fiber
c) variation in the size of the action potentials initiated in each muscle fiber
d) Both A and B above.
e) All of these answers.

Within a single fiber, the tension developed during a twitch can vary because
a) the amount of overlap of thick and thin filaments must be sufficient to allow cross-bridge formation
b) the motor neuron releases differing amounts of neurotransmitter into the synapse
c) stimuli vary in intensity and duration

d) stimuli vary in intensity


e) all of the above

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Smooth Muscle Physiology:
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Ca++ is important in the contraction of smooth muscle. Which of the following is not true about smooth muscle
contraction?
a) Ca++ binds to calmodulin.
b) Ca++ enters the cytosol from the sarcoplasmic reticulum.
c) Contraction is immediately triggered by calmodulin binding.
d) MLCK (myosin light chain kinase) forms a complex to activate myosin.
e) When MLCK activates myosin, ATPase activity is high and crossbridge formation is active.

Ca++ is important in the contraction of smooth muscle. Which of the following is not true about smooth muscle
contraction?
a) Ca++ binds to calmodulin.
b) Ca++ enters the cytosol from the sarcoplasmic reticulum.
c) MLCK (myosin light chain kinase) forms a complex to activate myosin.
d) Ca++ dephosphorylates the myosin ATPase
e) When MLCK activates myosin, ATPase activity is high and crossbridge formation is active.

The regulation of smooth muscle contraction is mediated by the phosphorylation of __________ in response to
calcium binding to __________.
a) myosin, calmodulin.
b) actin, calmodulin.
c) troponin, calmodulin. d) myosin, troponin.
e) actin, troponin.

Which of the following pairings is correct for smooth muscle?


a) multiunit smooth musclegut smooth muscle
b) decreased contraction in response to NEvascular smooth muscle
c) phosphorylation of myosinincreased cAMP levels in smooth muscle
d) maintenance of tonelatch bridges
e) dense bodiesorganize the array of thick filaments should be thin filaments

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Cardiovascular Physiology:
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A particular drug acts on the pacemaker cells of the SA node to increase heart rate. Which of the following is a
possible mechanism of action of this drug?
a) binds to L-type Ca++ channels and inhibits their opening
b) binds to and activates cholinergic muscarinic (M2) receptors
c) binds to and activates adrenergic receptors
d) binds to and activates phosphodiesterase
e) binds to Na+ pacemaker channels and inhibits their opening

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In which of the following is a Ca++ channel correctly matched with its function?
a) ryanodine receptor channelformation of IPSP
b) IP3 receptorinflux of trigger Ca++ in cardiac muscle
c) L-type Ca++ channelplateau of ventricular action potential
d) nAChR/channelrelease of neurotransmitter
e) receptor-mediated Ca++ channelinitiates contraction of skeletal muscle

Acetylcholine slows the heart rate by


a) increasing ion influx thus increasing the rate of Phase 4 depolarization
b) increasing the permeability to Ca++ via G protein gated channels
c) increasing the permeability to K+ via G-protein gated channels
d) decreasing the permeability to Ca++ by decreasing adenyl cyclase activity
e) C and D

watch out! one exam


version reversed D,
which made C the
right answer!

Which of the following is NOT a consequence of -adrenergic stimulation of cardiac ventricular muscle? (All
comparisons are made with reference to the absence of adrenergic stimulation.)
a) increased Ca++ concentration in the cytoplasm during contraction
b) increased rate of crossbridge cycling
c) faster clearing of Ca++ from cytoplasm
d) significant lengthening of the duration of the action potential
e) increased storage of Ca++ in the sarcoplasmic reticulum

In cardiac nodal (pacemaker) cells, the pacemaker potential (phase 4) is due to increased ___ conductance, the
upstroke of the action potential (phase 0) is due to increased ___ conductance, and the depolarization phase of
the action potential is due to increased ___ conductance.
a) Ca++, Na+, K+
b) K+, Na+, Ca++
c) Na+, K+, Ca++
d) Na+, Ca++, K+

In the sinoatrial (SA) node, phase 4 depolarization (pacemaker potential) is attributable to


a)an increase in K+ conductance
b)an increase in Na+ conductance FUNNY CURRENT
c) a decrease in Cl- conductance
d) a decrease in Ca++ conductance
e) simultaneous increases in K+ and Cl- conductances

Differences between autorhythmic myocardial cells and contractile myocardial cells include
a) autorhythmic myocardial cells lack the inwardly rectified K+ channel
b) autorhythmic myocardial cells have If channels
c) autorhythmic myocardial cell action potentials do not have a true plateau phase
watch out one version says A & C..
d) B and C
e) A, B and C

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Which statement(s) best describe(s) the regulation of contraction strength of myocardial cells?
a) The higher the intracellular concentration of Ca++ , the stronger the force of contraction will be
b) Catecholamines make voltage-gated Ca++ channels more likely to open, thus allowing higher concentrations
of Ca++ inside the cell.
c) A and B are true

If a drug increases cAMP in SA nodal cells, the most likely response is


a) elevated systolic arterial pressure
b) decreased systolic arterial pressure
c) increased heart rate
d) decreased heart rate
e) nor-epinephrine release

Myocardial contractility is best correlated with the intracellular concentration of


a) Na+
b) K+
c) Ca++
d) Cle) Mg++

The physiologic function of the relatively slow conduction through the atrioventricular (AV) node is to allow
sufficient time for!
a) runoff of blood from the aorta to the arteries !
b) venous return to the atria
c) atrial contraction filling of the ventricles
d) contraction of the ventricles!
e) repolarization of the ventricles!

Phase 4 voltage in ventricular cells is stabilized by !


a) funny channels!
L-type Ca++ channels are
b) L-type Ca++ channels !
c) inwardly rectified K+ channels ! trying to keep it up, inwardly
rectifying K+ are trying to
d) fast Na+ channels
e) acetylcholine!
counteract

Increasing the preload of cardiac muscle


a) reduces the ventricular end-diastolic pressure (VEDP)
b) reduces the peak tension of the muscle
c) decreases the initial velocity of shortening
d) decreases the time it takes the muscle to reach peak tension!
e) increases the ventricular wall tension!

Ventricular end diastolic volume (EDV) is determined directly by the!


a) cardiac output!
b) systemic blood pressure!
c) venous pressure!
Text
d) diastolic blood pressure only!

The importance of the plateau phase of the action potential of myocardial cells is in
a) preventing overstretching of the cells
b) enhancing the efficiency of oxygen use by the cells
c) preventing fibrillation
d) preventing tetany
e) regulating Ca++ availability to the cells

In cardiac muscle tissue,


a) Ca++ release from the sarcoplasmic reticulum initiates contraction
b) Ca++ enters the cell from the extracellular fluid, directly initiating contraction
c) Ca++ enters the cell from the extracellular fluid, which causes more Ca++ to be released from the
CICR
sarcoplasmic reticulum
d) both A and C are correct

You can increase cardiac output by all of the following EXCEPT:


a) increasing venous return
b) increasing heart rate
c) constricting the arterioles
d) increasing stroke volume

If the HR is 72 bpm and the SV is 72 mL, the cardiac output would be approximately equal to
a) 5.2 liters/minute
b) 144 mL/minute
c) neither of these choices are correct

The steep repolarization to rest potential phase of the action potentials of myocardial contractile cells occurs
when conductance to which ion(s) decrease?
a)Ca++
"Steep repolarization to the rest
b)K+
potential".....if Ca++ can't depolarize it
c)Na+
any more than what it did, then resting
d)A and B
can be restored. Na+ only causes the
e)A and C
initial repolarization.

Important effects of events during the plateau phase of the action potential of myocardial cells include
a) initiating calcium-induced calcium release
b) enhancing the efficiency of oxygen use by the cells
c) preventing tetany
d) A and C
e) all of the above

Factors affecting the strength of contraction (contractile work) in ventricular cells the following except
a)amount of Ca++ released by the sarcoplasmic reticulum
b) pre-load (LVEDP)
c) Myosin light chain kinase activity stimulated by calmodulin
d) opening of precapillary sphincters in the papillary muscles
e) C and D

The pulmonary veins:


a) return blood to the left atrium
b) carry relatively deoxygenated blood
c) BOTH a and b
d) NEITHER a nor b

The force of contraction of the cardiac muscle is affected by


a) the length of the muscle fiber at the beginning of contraction
b) the contractility of the heart
c) the end diastolic volume
d) the amount of blood entering the heart
e) all of these

Manganese ions block the calcium channels in the cardiac muscle membrane. How would the presence of
manganese in the ECF affect the contraction of the heart muscle?
a) the plateau phase of contraction would be longer Would be shorter, since Ca influx lengthens plateau phase
b) the refractory period would be shorter
c) the heart would beat less forcefully Definition of Contractility (force of beats)
d) the heart rate would increase
e) the contraction phase would be prolonged

Parasympathetic activation slows heart rate by release of the neurotransmitter _______________ which then
stimulates the opening of a ____ channel. The resulting ionic current slows the rise of the ______________
potential.
a) NE, Na+, Resting Membrane
b) NE, K+, Action
c) NE, Na+, Pacemaker
d) ACh, Na+, Action
e) ACh, K+, Pacemaker

Ivabrandine selectively blocks If channels in the heart. Which statement would be true concerning a patient
who is taking this drug?
a) The drug would slow down this individuals heart rate.
b) This patient must have been suffering from bradycardia.
c) This drug would decrease the contractility of the patients heart.
d) This drug would raise the blood pressure of the patient.
e) The amount of calcium entering the patients heart cells would increase.

The fibrous skeleton of the heart is important because it


a) forces electrical activity to be conducted through the atrioventricular node
b) transmits electrical activity from the atria to the ventricles
c) helps guide the blood into the proper chambers in sequence
d) directs the flow of blood into the arteries

The ventricles are completely depolarized during which isoelectric portion of the electrocardiogram (ECG)?
a) PR interval
b) QRS complex
c) QT interval
d) ST segment
e) T wave

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The ventricles repolarize during which portion of the electrocardiogram (ECG)?


a) PR interval
b) QRS complex
c) QT interval
d) ST segment
e) T wave

Atrial contraction starts during the:


a)P wave of an EKG
b)QRS complex of an EKG
c) T-wave of an EKG
d) None of the above

Ventricular contraction is most closely correlated with the:


a)P wave of an EKG
b)QRS complex of an EKG
c) T-wave of an EKG
d) None of the above

The bulk of ventricular filling is most closely associated with the:


a) P wave and PR interval
b) QRS complex
c) BOTH a and b
d) NEITHER a nor b

Filling of the atria with blood:


a) occurs during the P wave of an EKG
b) is called atrial diastole
c) BOTH a and b
d) NEITHER a nor b

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Scenarios:
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Short Scenarios:
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Joe Average has just been frightened by a very loud noise as he was taking a very difficult physiology exam. In
response, his adrenal glands have released a large amount of adrenaline into his circulation.

As the adrenaline reaches the heart , which of the following effects would you expect to see in cardiac cells?
a) increased phase 4 depolarization due to increased funny channel conductance
b) hyperpolarization of pacemaker cells due to increased conductance of G protein activated K+
channels
c) lower peak sarcoplasmic Ca++ concentrations due to lower ryanodine receptor opening
d) A and B
e) A and C

Among the organ level responses expected as the adrenaline has its effect are:
a) decreased heart rate
b) increased heart rate with shorter systolic periods
c) increased stroke work at a given LVEDP (pre-load)
d) B and C
e) none of the above

Joe flinches at the sound, jabs his pen into his thumb drawing blood. Joe hates blood and his parasympathetic
nervous system responds by dumping a significant load of acetylcholine in the heart.

As the acetylcholine affects the heart , which of the following effects would you expect to see in cardiac
cells?
a) increased phase 4 depolarization due to increased funny channel conductance
b) hyperpolarization of pacemaker cells due to inc conductance of G protein activated K+ channels
c) lower peak sarcoplasmic Ca++ concentrations due to lower ryanodine receptor opening
d) A and B
e) A and C

Among the organ level responses expected as the acetylcholine has its effect are:
a) decreased heart rate
b) increased heart rate with shorter systolic periods
c) increased stroke work at a given LVEDP (pre-load)
d) B and C
e) none of the above

Long Scenarios:

Out of this World Scenario


Mary has a bacterial infection of the lung (pneumonia) which is causing some respiratory problems but
the immediate concern is that her blood pressure is dangerously low despite the fact that her heart is beating
rapidly and strongly. Assuming that she had become dehydrated, you gave her IV fluids without any benefit.
Confused, you measure her central venous blood pressure (pressure in the large veins, and found it normal to
slightly low). More fluids dont help either. Using a special catheter, you measure her cardiac output and find it
to be quite high (12L/min instead of the expected 5L/min).

ACh Increases
Bill is having a vaso-vagal episode which results in acetylcholine being released onto the atria from
fibers running in the vagus nerve.

Ed[Andy in Sp14] just fell and cut his forehead. The cut isnt that bad, but like many head wounds, it
bleeds fairly freely and gaudily, although not enough to affect cardiovascular function. Unfortunately Ed is one
of those folks who gets weak at the sight of blood, particularly his own. He suffers a diffuse release of
acetylcholine from the parasympathetic nervous system. Hes been spared any respiratory effects and is
generally fairly healthy.

NE Increases
Carrie is one of those people who cant eat certain chocolate based sweets because in her body some of
the compounds are modified into norepinephrine analogues (chemicals that act like nor-epinephrine).
Unfortunately she fell off the wagon and just ate some of those candies and the nor-epinephrine analogues are
now reaching her blood stream.

Angela is one of a minority of people in whom some chocolate based sweets are largely metabolized to
norepinephrine analogues (chemicals that act like nor-epinephrine). She unwittingly just ate several of those
confections. She is otherwise healthy.

Tom has taken a dose of cocaine. One of the actions of cocaine is to block the re-uptake of
norepinephrine (and related catecholamines) into the synaptic bulbs that released them. (Re- uptake is the
normal mode of limiting the effect of nor-epinephrine at synapses.) Thus, the effect of any nor-epinephrine
released is magnified.

Frodo has been taking a new diet pill that acts in two ways. First, it mimics nor-epinephrine at most
sympathetic post-ganglionic synapses, second it prevents the re-uptake of norepinephrine at the same synapses
by competitively inhibiting there-uptake system. (Re-uptake is the normal mode of limiting the effect of norepinephrine at synapses.) Thus, the effect of any nor-epinephrine released is magnified.

Vt Decreases
Mort has had a viral gut infection leading to substantial diarrhea and (because he hasnt felt like eating
or drinking) dehydration. In toto, his total body fluids are about 4 L below their usual levels, of which 1.5 L
come from the extracellular fluid (~ 450 ml from the blood). Such diarrhea can sometimes be associated with
significant changes in the concentrations of ions in body fluids (like Na+, K+, Ca+, HCO3- ), but that does not
seem to be the case with Mort.

Gimli has been working hard in a desert environment, but has neglected to drink any water to replace the
2L of fluid lost via sweat and respiratory losses (think 600 ml lost from the blood volume). He had to stop
working because he felt weak, but still feels poorly after a few minutes of rest.

Mary fell, experiencing a deep cut that lead to the loss of around 500 ml of blood. The bleeding has been
stopped, but no fluids have been given to replace the lost blood.
Bill[Sp14], is in the process of developing Acute Tubular Necrosis (ATN), a malfunction of the kidneys,
in this case due to a viral infection. ATN can have several effects, but most of them have not yet developed.
What is a problem for now is that, due to his disease, his kidneys have been producing a large amount of urine.
Some of that volume has been drawn from the cardiovascular system and his vascular volume is down by about
700 ml. Before the viral infection, Bill was healthy. Curiously enough, the viral infection itself is largely
resolved.

Histamine Released into Bloodstream


Hank has just been stung by a bee to which he is highly allergic. Huge amounts of histamine are being
released from a series of mast cells. Histamine causes (among other things) the relaxation of smooth muscles in
the arterioles and veins.

Steve is allergic to nuts and has just unknowingly ingested some in a piece of cake. Luckily he is spared
the respiratory problems such folks often have, but large quantities of histamine are being released from his
cells. Histamine has a large number of physiological effects, but the critical one is that it tends to cause the
smooth muscles in the large veins to relax. Aside from his allergies, Steve is a healthy young man.

ATP Supply Decreases


Joe is suffering from a spasm in his left main coronary artery impairing blood flow to the heart. This can
cause considerable pain, but what concerns us here is that delivery of oxygen to most of the heart is impaired
limiting myosin ATPase function and contraction of the ventricular muscle

Gandalf is having an episode of atypical angina in which blood flow to the heart through the coronary
arteries is reduced by constriction of the coronary arteries while he is at risk. The episode results in decreased
supply of oxygen to the ventricles, impaired ATP production, and thus, reduced ATP availability at, and use by,
the ventricular muscle.

Tension Increased
Milly is a subject in a early phase clinical trial. She receives a drug that increases the tension developed
by both cardiac muscle cells and by the smooth muscle cells in the large systemic veins. As required by the
study design, Milly is healthy young woman.

Random Drugs Affecting Channels


Chris has inadvertently taken a reasonably large dose of his roommates verapamide, a new slow
calcium channel inhibitor. It impairs Ca++ movement across the plasma membrane in the heart and affects both
heart rate and contractility. This new drug does not affect Ca++ transport in smooth muscles.
Rich just made a mistake. Hes supposed to make an oral presentation today. To allay some of the
nervous jitters he usually suffers from making presentations, he borrowed a few of his fathers Cardial (1
adrenergic receptor blocker that acts quite specifically at the heart). He took three (instead of the one his father
takes). Now the drug is kicking in. Aside from his nerves hes healthy.

A TV show that I saw this year posed an interesting problem. In this show, several athletes (well use
Bob as our example) are given an injection that causes most of their systemic arteries and arterioles to produce
huge quantities of nitric oxide. As we discussed, nitric oxide interacts with guanyl cyclase to produce cGMP and
cause local vascular muscle to relax.

It was a bad morning, Fran mistakenly took her husbands slow channel blocker instead of the
multivitamin she was reaching for. Slow channel blockers reduce the Ca++ conductance of the long acting
channels responsible for the entry of Ca++ across the plasma membrane in muscle cells. Frans husbands
medicine works almost exclusively at the heart, but affects all cardiac cells. Fran is otherwise healthy.