Exam 1 Flashcards
pathophysiology
the study of altered health; the cellular and organ changes w/ disease and the effect that they have on the whole body
disease
interruption in normal body function
etiologic factors
thing that cause the disease to occur
risk factors
things that increase potential for development of disease
clinical manifestations
what does the disease present
signs
objective; something observer sees
symptoms
subjective; what patient says
syndrome
a lot of signs and symptoms together
complications
something happens b/c of the disease or treatment
sequelae
impairment following or are caused by disease
pharmacology
the study or science of drugs
pharmacotherapeutics
drug therapy; same drug may have different effects depending on patient factors (ex. age)
therapeutic effect
positive effect
adverse effect
negative effect
pharmacogenomics
influence of genetic factors on response to drugs
pharmaceutics
science of preparing and dispensing drugs
pharmacoeconomics
study of economic factors impacting the cost of drug therapy
pharmacognosy
study of drugs obtained from plant or animal source
toxicology
study of toxic drug effects and methods to manage
indication
why the drug is being used (condition)
prototype
agent to which all other drugs in the classification are compared.
combination drugs
drugs with more than one active ingredient
prodrug
inactive before metabolized
contraindication
condition that makes the drug potentially harmful to the patient
brand name
owned by company (capitalized)
generic name
name of the drug (lower case)
bioavailability of the drug
amount of the drug that can be used by the tissues; IV= 100%
pregnancy category A
studies in pregnant women have not shown a risk to the baby
pregnancy category B
animal studies, no risk, no sufficient evidence to show risk in animal or pregnant women
pregnancy category C
animal studies show risk, no human studies; use may be acceptable
pregnancy category D
evidence that risk but benefit may outweigh the risk
pregnancy category X
studies show fetal abnormalities or reaction. risk outweighs benefit
controlled substances are classified by their
abuse potential, defined control of distribution, storage, dispensing and use.
Schedule I
dispensing restrictions are only with approved protocol and an example is heroin or marijuana. the illegal drugs
Schedule II
dispensing restrictions are with written prescription only with no refills and must have a warning label, an example is cocaine or codeine.
Schedule III
dispensing restrictions are with written or oral prescription that expires in 6 months with no more than 5 refills in 6 months and must have a warning label, an example is hydrocodone.
Schedule IV
dispensing restrictions are with written or oral prescription that expires in 6 months with no more than 5 refills in 6 months and must have a warning label, an example is phenobarbital.
Schedule V
is with prescription or over the counter (can vary with state law), an example is cough medicine.
which route you use for the drug depends on
how quick it is absorbed
sublingual is _____ absorption than buccal due to the amount of blood flow
faster
pharmacodynamics
what the drug does to the body, the therapeutic effect
Pharmacokinetics
what the body does to the drug, example peak effect, absorption metabolism
pharmacokinetical processes determine
onset of drug, action, peak drug effect and duration of drug action
four main processes of pharmacokinetics
absorption (onset of drug action), distribution, metabolism (by the liver), excretion (by the kidneys, bile, lungs)
absorption of the drug
determines onset of action; affected by route of administration
oral medications can be affected by
presence of food or other drugs in the stomach (fatty foods slow absorption), acidity of the stomach (breaks down compounds), motility of the GI tract (anti-cholinergics slow peristalsis), and blood flow of the GI
first pass effect
extent to which the drug is metabolized in the portal circulation prior to being absorbed into the systemic circulation
increased first pass effect equals
higher concentration of the drug (cant be given orally if first pass is too large)
depot drugs
slow absorption of drug over days/ months/ longer (some types of birth control)
for injections increase heat means
increased blood flow and increased onset
if the drug is stored (mostly in fat) there is ____ duration
increased
if bound to protein the drug is
inactive
when unbound drug (active) goes into the tissues, drug concentration decreases and
inactive drugs unbind from the protein
if the patient has low protein levels, there will be higher amounts of unbound proteins which leads to
toxicity
more bound drug means
an increase in duration
drugs that are highly lipid soluble are ____ likely to pass through the BBB and reach the CNS
more
biotransformation
the liver is the most important site, breaks down meds, Cytochrome P450 enzyme is responcible for most drug metabolism
steady state (therapeutic range)
when the amount of drug absorbed equals the amount of drug excreted; maximum therapeutic effect at this level, can only occur with repetitive administration
therapeutic drug monitoring
monitoring plasma levels of drugs with low safety margins (peaks and troughs)
therapeutic index
how quick the drug goes from minimum effectiveness to toxicity, larger number= safer dose
drugs act by
receptors, enzymes, nonselective interactions
efficacy
greatest maximal response that can be produced from a particular drug
receptor interactions
tighter fit = stronger reaction, lock (cell receptor site) key (drug)
agonist
binds to the receptor and cause natural response
partial agonist
causes the agonist response but not as strong
antagonist
causes the opposite response of natural chemicals (blocks any response) or competes with other drugs for same receptors
selective toxicity
when drug attacks only foreign cells, not healthy cells
nonselective interactions
target is cell membrane or metabolic activity in the cell
factors influencing drug effect
patient condition, psychological factors (placebo effect), drug dependence, drug tolerance
acute therapy
immediate, intensive drug treatment for the critically ill (OJ for low blood sugar)
maintenance therapy
to prevent progression of disease (anti-hypertensive for high BP)
supplemental therapy
supplies the body with what is needed for normal function (insulin)
palliative therapy
relief of pain, to improve quality of life
supportive therapy
maintains body functions when patient is recovering from illness (IV fluids)
prophylactic therapy
prevent illness (antibiotics before surgery)
empiric therapy
based on probabilities (treat pneumonia before culture is back)
adverse drug events
undesirable occurrence involving meds, can be non/preventable, can be from med error or just from the medication dose
idiosyncratic reaction
not the result of something known about the drug and not the result of an allergy, unexpected reaction
black box warning
significant potential for adverse effect
teratogenicity
any drug that causes harm to developing fetus or embryo
presence of food can ___ absorption and drug effect
decrease
additive drug effect
two drugs with similar classification produce combined response, 2+3=5
synergistic drug effect
effect of two drugs is greater than just adding the two together, 2x3=6
antagonistic drug effect
adding second drug causes a decrease in pharmacologic response, reverse effect
incompatibility
two drugs are mixed and a chemical deterioration is caused
the most accurate measurement of creatinine clearance is
with a 24 hour urine collection
creatinine is in the muscles and is released with decreased muscle mass, this can cause a false _____ creatinine level
normal
Ways fluid moves
Intracellular, interstitial, and intravascular
Intracellular compartment
2/3 of fluid in body
Extracellular compartment
Interstitial spaces, plasma, transcellular
Diffusion
Particles move from high concentration to low concentration
Osmosis
Movement of water across semipermeable membrane, water moves to higher concentration
Normal serum osmolarity is
275- 295 mOsm/kg
Hypotonic fluids
Makes cells swell, less concentration of solutes than plasma, used for dehydration and hypernatremia
Hypertonic fluids
Makes cells shrink, greater concentration of solutes than plasma
Isotonic fluids
No change in cell size, causes little osmosis
Capillary hydrostatic pressure
Pushes water into intravascular to interstitial
Capillary oncotic pressure
pulls fluid into intravascular by protein
tonicity
solution cause a change in water movement across a membrane due to osmotic forces
increased tonicity = _______ stuff or solute
increased
isotonic IV fluids
normal saline, ringer’s solution, lactated Ringer’s solution, D5 1/4 NS
hypotonic IV fluids
5% dextrose in water (DW5), 0.45% saline (1/2 NS) and 0.225 saline (1/4 NS)
hypertonic IV fluids
saline greater than 0.9% (3% and 5% saline), dextrose solutions greater than 5% (dextrose 10% and 50%), D5 NS, D5 LR, D5 1/2 NS
colloid volume expanders
pull fluid to it, mobilizes edema from interstitial to vascular then the heart pumps it and the kidney filters it, ex. albumin or plasma protein fraction
the most objective measure of fluid volume status is
a daily weight
ADH
causes the reabsorption of water from the renal tubule, secreted from the pituitary
low sodium or increase K causes the release of
aldosterone
decreased renal perfusion causes the release of ____.
renin
renin causes ______ and ______
vasoconstriction (increase BP) and release of angiotensin
angiotensin I coverts to angiotensin II with _____
ACE (angiotensin converting enzyme)
Angiotensin II causes ______ and ______
vasoconstriction (increase BP) and release of aldosterone
aldosterone
reabsorbs NA and H2O and eliminate K
increased ADH = _____ urine out
decreased
natriuretic hormones
secreted in response to hypernatremia, promotes urinary excretion of sodium and water, decreases BP
hypodipsia
decreased thirst
polydipsia
increased thirst
edema can be caused by
increased capillary hydrostatic pressure, decreased capillary oncotic pressure, increased capillary permeability, and decreased lymphatic flow
pitting edema
can be anywhere, localized (ankle sprain) or generalized (distributed in the interstitial space)
third spacing
edema, trapping of ECF in the transcellular space such as peritoneal cavity pleural space, pericardium
chief intracellular electrolyte
K+
chief extracellular electrolyte
Na+
sodium normal levels
135-145 mEq/L
sodium is important in ______ and ____
generation of nerve impulses and regulation of acid base
why do we retain sodium with high bp
increase blood volume
average adult requirement for sodium
.5 to 2.7 g
hyponatremia
from water dilution or sodium loss, lead to hypotonic cells and lung/ brain edema
signs of hyponatremia
n/v, anorexia, abdominal cramping, altered neurological function, coma, muscle twitching
hyponatremia treatment
tolvaptan (pee off the water) or sodium replacement
hypernatremia
water loss or sodium gain, cell dehydration, should feel thirsty ADH releases to gain water
hypernatremia SALT
Seizures muscle twitching skin flushed, Altered mental status agitation, Lethargy low grade fever, Thirst
treatment of hypernatremia
daily weights, low sodium diet, if severe and hypovolemic hypotonic fluids, if severe and hypervolemic hypertonic fluids
potassium
normal levels 3.5-5 mEq/L, insulin moves K into liver and muscles via NA K pump, 90% of daily intake is excreted by kidneys, needed for cardiac muscle contraction and electrical conduction
high potassium sources
oranges, leafy greens, nuts, potatoes, and salt substitutes
cells fire less easily with
decrease K+ or increased Ca or Mg
cells fire more easily with
increase K or decreased Ca or Mg
hypokalemia
need a heart monitor
direct IV push K
can be fatal, never be IV push or IM
_____ mEq per hour is the fastest K can be given and only if ______
20, if pt is on a heart monitor and through a deep line
decreased urine volume to less than 20-30 mL/hr for 2 hours
should stop K infusion until situation is evaluated
hyperkalemia
level rises above 5 mEq/l, less common but life threatening, release of aldosterone can cause kidney failure
pseudohyperkalemia
hemolysis of blood sample due to tourniquet use, draw blood above site of K infusion, gives a false high K
decrease K levels from
insulin. alkalosis, beta adrenergic stimulation, rapid cell building
increased K levels from
acidosis, trauma to cells, exercise
calcium
found in bones, reciprocal relationship with phosphate, normal level 8.6- 10.2 total, transmission of nerve impulses, blood clotting
calcium 3 serum forms
bound to protein (40%), ionized calcium (50%), and bound to others such as phosphate (10%)
hypocalcemia
less than 8.6 mg/dL, signs are muscle cramps dry brittle nails and hair trousseau’s sign and chvostek’s sign
Trousseau’s sign
BP cuff 10mm above systolic for 3 mintues, causes carpopedal spasm
Chvostek’s sign
tapping facial nerve anterior to ear results in ispsilateral facial muscle twitch
hypercalcemia
level above 10.2, 50% mortality if not treated promptly, can cause kidney stones need to drink 3-4 L
magnesium
normal level 1.5-2.5 mEq/L, generates ATP, smooth muscle relaxant, helps with blood clotting and bone formation, prevents seizures
high magnesium sources
spinach broccoli potatoes whole grains tuna beef pork chicken raisins nuts milk tap water bananas oranges peanut butter
hyperaldosteronism, insulin injection and loop diuretics
decrease potassium in blood
PTH increase or calcitonin decrease =
calcium increase
clinical manifestations of mg and ca
are similar but not equal
hypomagnesium can be from
alcoholism
hypermagnesium can be from
renal failure or chronic use of antacids or laxatives
phosphate
normal- 2.7-4.5 mg/dl, in fish nuts and organ meat, deposited with Ca in bones and teeth, excreted by kidneys
hyperphosphatemia
results from renal failure chemo large intake of vitamin D, s&s tetany and bleeding issues
hypophosphatemia
from alcohol withdraw or malnourishment, manifestations of muscle weakness and confusion
chemotaxis
wbc into site of injury
Margination
lining of cells with wbc
diapedesis
wbc out of blood to tissues
after cell injury brief _____ occurs then _____ immediately follows
vasoconstriction, vasodilation
vasodilation chemical mediators
endothelial cells retract, increase capillary permeability, and movement of fluid from capillaries into tissue (increased protein)
Inflammation is
nonspecific
fluid in the tissue first contains _____ then ____ and _____ causing the tissue to become ______.
serous fluid, plasma proteins, albumin, edematous
the injured cell activates ____ from ____ which creates ____ and traps _____
fibrin, fibrinogen, a blood clot, bacteria to prevent spread
blood flow through the capillaries in the area of inflammation ______ as fluid is lost and viscosity ____
slows, increases
neutrophils
first to arrive at injury site, phagocytize bacteria and foreign material, short life spam (24-48 hrs), released by bone marrow
neutrophils as pus is composed of
dead neutrophils at the site, digested bacteria, other cell debris
increased use of immature neutrophils (bands) causes a
shift to the left
inflammation does not
always equal infection
monocytes
second WBC to the injury, attracted to the site by chemotactic factors, there within 3-7 days after inflammation, when the enter the tissue they transform to macrophages
macrophages
assist in phagocytosis, have a longer lifespan and can multiply, often from chronic inflammation, can fuse to form a giant cell
lymphocytes
arrive later at site, primarily for cell mediated (t cells) immunity and humoral (B cells) immunity, differentiate into b lymphocytes and T lymphocytes
chemical mediators
histamine (vasodilation, swelling, itching), serotonin (same as hist. but also stimulates smooth muscle contraction) kinins (ex bradykinin, smooth muscle contraction, vasodilation, and pain)
cytokines
sounds the alarm, directors
prostaglandins
potent vasodilators, part of fibril response
thromboxane
powerful vasoconstrictor, promote clots, causes brief vasoconstriction at site
leukotriene
form the slow reacting substance of anaphylaxis (constricts smooth muscle, increase vascular permeability), stimulates chemotaxis
serous exudate
clear, blister, early inflammation
serosanguineous exudate
RBC and serous fluid, surgical drain
fibrinous exudate
sticky, fibrin leaking into interstitial space
catarrhal exudate
mucus, runny nose
purulent exudate
pus, WBC and dead cells
response to inflammation
increased C reactive protein (created in the liver), increased pulse and RR, malaise lethargy fever
types of immunity
innate (from birth, first line defense) and acquired (developed, active or passive)
adaptive immunity is specific to an ____, has ____, and is ____
antigen, memory, systemic
acquired passive immunity
doesn’t last, natural (from mother to child) and artificial (injection of serum from immune human)
acquired active immunity
natural (contact with antigen through infection) and artificial (immunization with antigen)
antigens are the
invader
thymus gland
shrinks with age (decrease cellular immunity), involved in differentiation and maturation of t lymphocytes
natural killer cells
involved in cell mediated immunity, large lymphocytes, don’t require prior sensitization
b lymphocytes
humoral immunity (antigen antibody response), plasma cells (secrete antibodies), memory b cells (more intense faster second exposure)
t cytotoxic cells
CD8 lab, attack antigens, antigen specific by exposure to antigen, some become t memory cells instead of attacking
t helper cells
CD4 lab, regulate cell mediated and humoral response, produce cytokines
5 immune globulins
IgG, IgA, IgM, IgD, IgE
IgM
largest in size, primary immune response, active disease (pt is miserable)
IgG
largest in amount, only one that can cross placenta, secondary immune responce
IgA
found in secretions
IgD
found in plasma, assists in differentiating and activation of B lymphocytes
IgE
causes symptoms of allergic reaction
effects of aging on the immune system
more tumors, thymus shrinks (decreased cell mediated immunity) delay in allergy response, decreased primary and secondary responses
