Exam 1 Flashcards
What 3 electrolytes, if imbalanced, result in neurotransmission and muscular contraction problems?
- sodium
- potassium
- calcium
What are 2 important interruptions that may occur when neurotransmission and muscular contraction occur?
- cardiac rhythm abnormalities
- skeletal muscle function compromise
What are the 2 primary causes of edema?
- elevated hydrostatic pressure
- heart failure can result in increased ECF volume
- decreased osmotic forces in blood
- liver failure and protein malnutrition can result in hypoalbuminemia
What are 2 other ways that edema can result?
- alterations in capillary permeability
- histamine
- inflammation
- sodium retention
- illness
- consumption of salty foods
What are some signs and symptoms of hyponatremia?
- headache
- lethargy
- confusion
- N&V
- diarrhea
- muscle cramps/spasms
How is hyponatremia treated?
slow replacement of sodium with adequate fluids
What are some signs and symptoms of hypokalemia?
- anorexia
- cardiac arrhythmias
- leg cramps
- prominent U wave, flattened T wave, prolonged PR
- digitalis toxicity
What are 2 medications that can cause hypokalemia?
- adrenergic agents – stimulating agents like epinephrine
- use of IV dextrose – stimulates insulin release
How is hypokalemia treated?
replacement of potassium at acceptable rate
rapid infusion (not PO or IV infusion) may result in cardiac arrest – used as a lethal injection
What is 1 way that hyperkalemia may result?
decreased renal perfusion can result in potassium retention
What are symptoms of hyperkalemia?
– early symptoms:
- numbness
- muscle cramps
- diarrhea
– can lead to cardiac arrest
What are some signs and symptoms of hypocalcemia?
- neuromuscular excitability
- paresthesia
- hypotension
- cardiac arrhythmias
What can chronic hypocalcemia result in?
bone pain and bone fragility
What are 2 causes of hypercalcemia?
- elevated parathyroid hormone
- cancer – malignant cells result in bone destruction
What are some signs and symptoms of hypercalcemia?
- decreased neuromuscular excitability
- weakness
- renal calculi
- cardiac arrhythmias
What are 3 causes of hypophosphatemia?
- decreased intestinal absorption
- increased excretion by kidneys
- intracellular shift
What are some signs and symptoms of hypophosphatemia?
- tremors
- muscle weakness
- hyporeflexia
What is the most common cause of hyperphosphatemia?
kidney failure
What does hyperphosphatemia often accompany?
hypocalcemia
Ca2+ and P3+ have a balanced inverse relationship
What are antibiotics? What is the goal of antibiotics?
– chemicals that inhibit specific bacteria
– goal is to decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invader
What are the 3 ways that antibiotics are made?
- living microorganisms
- synthetic manufacture
- genetic engineering
What are bacteriostatic drugs?
substances that prevent the growth of bacteria
What are bactericidal drugs?
substances that kill bacteria directly
Differentiate between gram-positive and gram-negative bacteria.
– gram-positive: bacteria with cell walls that retain a stain, resisting decolorization with alcohol
– gram-negative: bacteria with cell walls that lose stains, decolorized by alcohol
Differentiate between aerobic and anaerobic bacteria.
– aerobic: require oxygen for survival
– anaerobic: do not require oxygen for survival
The longer an antibiotic has been in use, what is more likely to develop?
greater chance that the bacteria will develop resistance (emergence of a resistant strain)
Describe aminoglycosides:
– indication
– bacteriostatic or bactericidal
– contraindications
– adverse effects
– drug-drug interactions
– indication: infections caused by gram-negative aerobic bacilli
– bactericidal
– contraindications:
- renal or hepatic disease
- ototoxic –> hearing loss
- herpes or mycobacterial infection
- myasthenia gravis
- parkinsonism
- lactation
– adverse effects:
- ototoxicity
- nephrotoxicity
– drug-drug interactions:
- penicillins
- cephalosporins
- diuretics
- neuromuscular blockers
- succinylcholine
- citrate anticoagulated blood
Describe carbapenems:
– indication
– bacteriostatic or bactericidal
– contraindications
– adverse effects
– drug-drug interactions
– indication: broad-spectrum (gram+ and gram-) antibiotic
– bactericidal
– contraindications:
- seizure disorders
- meningitis
- pregnancy and lactation
– adverse effects:
- Pseudomembranous colitis
- C. diff diarrhea
- N/V –> dehydration and electrolyte imbalances
- superinfections – because it kills both gram+ and gram-, including gut flora
– drug-drug interactions:
- valproic acid
- meropenem
Describe cephalosporins:
– indication
– bacteriostatic or bactericidal
– contraindications
– adverse effects
– drug-drug interactions
– indication: treatment of infections – similar to penicillin in structure and activity
– bacteriostatic and bactericidal
– contraindications:
- allergies to cephalosporins or penicillin
- renal or hepatic impairment
– adverse effects:
- GI tract:
- N/V
- diarrhea
– drug-drug interactions:
- aminoglycosides
- oral anticoagulants
- ETOH (ethanol)
Describe fluoroquinolones:
– indication
– bacteriostatic or bactericidal
– contraindications
– adverse effects
– drug-drug interactions
– indication: broad spectrum antibiotic, but mostly used against gram-
– bactericidal
– contraindications:
- pregnancy or lactation
- renal dysfunction
– adverse effects:
- h/a
- dizziness
- insomnia
- depression
– drug-drug interactions:
- iron salts
- sucralfate
- mineral supplements
- antacids
- quinidine
- theophylline
- NSAIDs
Describe penicillins and penicillinase-resistant antibiotics:
– indication
– bacteriostatic or bactericidal
– contraindications
– adverse effects
– drug-drug interactions
– indication: broad spectrum antibiotic – interferes with ability of bacteria to build cell walls
– bactericidal
– contraindications:
- allergies to penicillins or cephalosporins
- renal disease
- caution with pregnant or lactating women
– adverse effects:
- GI tract
– drug-drug interactions:
- tetracyclines
- parenteral aminoglycosides
Describe sulfonamides:
– indication
– bacteriostatic or bactericidal
– contraindications
– adverse effects
– drug-drug interactions
– indication: broad spectrum antibiotic – inhibits folic acid synthesis
– bacteriostatic
– contraindications:
- thiazide diuretics
- pregnancy
– adverse effects:
- GI tract
- renal effects – filtration of the drug
– drug-drug interactions:
- tolazamide
- glyburide
- cyclosporine
Describe tetracyclines:
– indication
– bacteriostatic or bactericidal
– contraindications
– adverse effects
– drug-drug interactions
– indication: treatment of various bacterial infections and acne when penicillin is contraindicated
– bacteriostatic
– contraindications:
- allergies to tetracyclines or tartrazine
- pregnancy or lactation
- renal or hepatic dysfunction
- penicillin G
- oral contraceptive therapy
- methoxyflurane
- digoxin
– adverse effects:
- GI tract
- damage to teeth and bones
- photosensitivity
– drug-drug interactions:
- penicillin G
- oral contraceptives
- digoxin
- administer on empty stomach
What are the 5 ways that anemia could develop?
- deficiencies
- iron
- vitamin B12
- folic acid
- poor nutrition
- blood loss
- chronic
- acute
- GI bleeds
- hemoglobinopathies
- medications
- hemolysis
What are the major signs and symptoms of anemia?
- GI tract blood loss
- menorrhagia – heavy menstrual periods
- pale complexion
- tachycardia
- jaundice
- splenomegaly – breakdown and collection of RBCs
- nutritional anemia:
- glossitis
- cheilitis – inflammation of lips
- koilonychia – spoon nails
- pica
– anemia can be asymptomatic
Describe iron:
– indication
– pharmacokinetics
– adverse effects
– food-drug interactions
– indication: treatment of iron deficiency anemias; adjunctive therapy with Epoetin Alfa – raises serum iron
– pharmacokinetics:
- absorbed in small intestines
- binds to transferrin
- transported in the blood
- small amounts lost in sweat, urine, sloughing of skin, mucosal cells, and intestinal cells
– adverse effects:
- oral – GI irritation and CNS toxicity
- parenteral iron – anaphylaxis, local irritation, staining of tissues, phlebitis
– food-drug interactions:
- eggs
- milk
- coffee
- tea
- acidic liquids
What 2 things could result from a vitamin B12 deficiency?
- anemia
- neurological issues
What are some ways that vitamin B12 deficiency could develop?
- lack of intrinsic factor – needed for B12 absorption
- pernicious anemia – intestines cannot absorb B12
- dietary deficiency
- gastric atrophy
- chronic Helicobacter pylori infection
- chronic alcoholism
- gastric bypass surgery
- Crohn’s disease
What are the 2 ways that vitamin B12 anemia is treated?
- address underlying etiology
- IM B12 injections
What are erythropoietins?
secreted by the kidneys; stimulate the bone marrow to make more RBCs
What are 3 drugs that mimic the action of erythropoietin?
- Epoetin Alfa (Epogen, Procrit)
- treats anemia associated with renal failure and AIDS
- decreases need for blood transfusions in pts undergoing surgery
- Darbopoetin Alfa (Aranesp)
- treats anemia associated with chronic renal failure – pts on dialysis
- Methoxy Polyethylene Glycol-Epoetin Beta (Mircera)
- treats anemia associated with chronic renal failure – pts on dialysis
Describe antiplatelets:
– actions
– indications
– pharmacokinetics
– actions:
- inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane
- anagrelide – blocks production of platelets in bone marrow
– indication:
- reduce risk of transient ischemic attacks (TIAs), stroke, and MI
- anti-inflammatory
- analgesic
- anti-pyretic
– pharmacokinetics:
- well absorbed
- binds to plasma proteins
- metabolized in liver
- excreted in urine
Name one type of antiplatelet drug.
aspirin
Describe anticoagulants:
– action
– contraindications
– indications
– adverse effects
– action: interferes with normal cascade of clotting process
– contraindications:
- allergy
- pregnancy
- renal or hepatic disorders
– indications:
- prevents and treats thrombus and PE formation
- treats atrial fibrillation
– adverse effects:
- bleeding
- GI upset
- hepatic dysfunction
- alopecia
- dermatitis
- bone marrow suppression
- prolonged and painful erection
Name one type of anticoagulant.
heparin
Describe thrombolytics:
– action
– indications
– pharmacokinetics
– adverse effects
– action: breaks down thrombi that have been formed by stimulating plasmin system
– indications:
- acute MI
- PE
- ischemic stroke
– pharmacokinetics:
- must be injected
- are cleared from the body after liver metabolism
- pregnancy and lactation
– adverse effects:
- bleeding
- cardiac arrhythmias
- hypotension
- hypersensitivity – rash, flushing, bronchospasm, anaphylaxis
Name one type of thrombolytic.
urokinase
What are the 5 functions of the kidneys?
- acid-base balance
- waste elimination
- secretory function
- vitamin D synthesis and calcium balance
- glucose homeostasis
How do the kidneys function in acid-base balance?
excrete and absorb H+ ions and bicarbonates as needed
How do the kidneys aid in waste elimination?
eliminate urea, uric acid, creatinine, and drugs from the blood
What are the kidneys’ secretory functions?
- secretion of erythropoietin (EPO)
- increase RBCs in response to hypoxia
- secretion of renin
- released in response to low BP or perfusion
- activation of renin-angiotensin-aldosterone (RAAS)
How do the kidneys function in vitamin D synthesis and calcium balance?
- kidneys activate vitamin D
- vitamin D aids in calcium absorption
How do the kidneys function in glucose homeostasis?
- renal threshold to reabsorb glucose (180 mg/dL)
- if exceeded, glucose excreted in urine
- degradation of insulin
- gluconeogenesis
What are the 3 categories of renal dysfunction? Describe each.
- prerenal: decreased blood flow and perfusion to the kidney
- intrarenal: actual injuries to the kidney
- postrenal: obstruction of urine outflow from the kidney
Describe thiazide diuretic:
– action
– indication
– adverse effects
– action: blocks chloride pump, increasing excretion of Na+, Cl-, H2O
– indication: treatment of edema associated with HF, cirrhosis, corticosteroid or estrogen therapy, and renal dysfunction; treatment of HTN
– adverse effects:
- GI upset
- CNS complications
- hypovolemia
Name one type of thiazide diuretic.
hydrochlorothiazide
Describe loop diuretics:
– action
– indication
– adverse effects
– action: blocks chloride pump in ascending loop of Henle
– indication: treatment of edema associated with HF, acute pulmonary edema, and hypertension
– adverse effects:
- hypokalemia
- volume depletion
- hypotension
- hyperglycemia
- GI upset
Name one type of loop diuretic.
furosemide
Describe potassium-sparing diuretics:
– action
– indications
– adverse effects
– action: blocks effects of aldosterone in renal tubule, causing loss of sodium and water, and retension of potassium
– indication:
- treatment of hyperaldosteronism
- treatment of edema associated with HF, nephrotic syndrome, hepatic cirrhosis
- treatment or prevention of hypokalemia
– adverse effects:
- hyperkalemia
- diarrhea
Describe osmotic diuretics:
– action
– indications
– adverse effects
– action: elevates osmolarity of glomerular filtrate, causing loss of water, sodium, and chloride
– indications:
- prevention and treatment of oliguric phase of renal failure
- reduction of intracranial pressure – treats cerebral edema
- diagnostic measurement of GFR
– adverse effects:
- hypotension
- GI upset
- fluid and electrolyte imbalances
What is obstructive uropathy?
inability of urine to drain from the urinary tract; most common pathophysiological problem in the urinary tract
What are renal calculi?
kidney stones
Who commonly gets kidney stones? What is a common cause?
– men 60+ years old
– BPH common cause
What may occur if kidney stones obstruct the urinary tract for too long?
- prolonged obstruction leads to increased hydrostatic pressure in nephrons, decreasing GFR
- urine backs up into kidneys (hydronephrosis)
- results in nephron death – nephron function does not recover
How common are UTIs in the US? What population experiences UTIs most frequently? What types of patients are at greater risk for developing UTIs?
– 2nd most common infection in the US
– females experience UTIs more frequently
– patients with indwelling catheters or intermittent catheterization are at greater risk
What are some signs and symptoms of UTIs?
- urinary frequency
- urgency
- burning with urination – associated with cystitis (inflammation of the bladder)
- chills, fever, flank pain, tenderness – associated with acute pyelonephritis (kidney infection)
What organisms are the most common cause of lower UTIs?
- E. coli
- Proteus – more commonly associated with catheterization or use of urinary instruments
- Pseudomonas
- Klebsiella
Where are bacteria normally located in a healthy urinary tract?
urethral opening only
What factor increases the risk of urinary tract infection?
stagnant urine
Name one type of potassium-sparing diuretic.
spironolactone
