Exam #1 Flashcards
1
Q
pathology
A
branch of medicine that investigates the nature of disease
2
Q
clinical pathology
A
pathology applied to the solution of clinical problems
3
Q
pathogenesis
A
development of unhealthy conditions
4
Q
pathophysiology
A
study of altered body function due to disease
5
Q
morphology
A
fundamental structure or form of cells or tissue
6
Q
histology
A
study of cells and extracellular matrix of body tissues
7
Q
etiology
A
cause of the disease
8
Q
risk factors
A
conditions, events, or substances suspected of contributing to the development of the disease
9
Q
epidemiology
A
study of the cause and distribution of disease in a population
10
Q
incidence
A
number of new cases during a specified time
11
Q
prevalence
A
number of existing cases in a population at a given point in time
12
Q
morbidity
A
effect an illness has on a person’s life
13
Q
mortality
A
rate of death (over a given time, for a given population or disease)
14
Q
signs
A
observable phenomenon
EX: skin rash, cough, joint deformity, etc.
15
Q
symptoms
A
subjective feelings expressed by the patient
EX: I feel pain/tired/dizzy, etc.
16
Q
health
A
no universally accepted definition
- ability to function normally in society
- disease-free state
- WHO: state of complete physical, mental, and social well-being
17
Q
disease
A
dynamic process disrupting physiologic function that manifests itself with a set of signs and symptoms
-has an etiology, pathogenesis, morphologic changes, clinical manifestations, diagnosis and clinical course
18
Q
illness
A
sickness or derivation from a healthy state
-perception and response of the person
19
Q
clinical course of an illness
A
1) acute: rapid onset and short duration
2) subacute: between acute and chronic (days to months)
3) chronic: long-standing illness or disability; may involve exacerbations
20
Q
patient/client management model
A
examination evaluation diagnosis prognosis intervention
21
Q
medical diagnosis
A
identification of pathology
22
Q
PT diagnosis
A
-the label encompassing a cluster of signs/symptoms, syndromes, or categories
-the process of arriving at that label
EX: musculoskeletal, neuromuscular, etc.
23
Q
differential diagnosis
A
determination of which one of several diseases may be producing symptoms
24
Q
primary prevention
A
aimed towards removing or reducing disease risk factors
25
secondary prevention
promote early detection of disease and intervene to avoid further complications
26
tertiary prevention
aimed at limiting the impact of established disease
27
validity
how meaningful is the test
28
reliability
how consistent are the results
29
sensitivity
true positive
| proportion of people with a positive test result who have the condition
30
specificity
true negative
| proportion of people with a negative test who don't have the condition
31
predicative value
degree of certainty that can be associated with a positive or negative finding obtained on a diagnostic test
-probability that a person does or does not have the condition given a particular test result
32
positive likelihood ratio
increase in odds for the condition to be present/proven
33
negative likelihood ratio
decrease in odds for the condition to be present/proven
34
likelihood ratio of 1
test neither proves or disproves the condition
35
snOUT
high Sensitivity, a Negative test rules OUT the diagnosis
- majority of true non-fallers correctly identified
- few false negatives
36
spIN
high Specificity, a Positive test rules IN the diagnosis
- majority of true fallers correctly identified
- few false positives
37
biomedical model of health
focus on disease process
| biological state influences health
38
biopsychosocial model of health
psychological system and social factors interact with one's biology to impact health
39
social-ecological model of health
considers intrapersonal factors in relationship to social and environmental factors
-emphasizes social and organizational factors impacting health
40
factors impacting health
```
sociodemographics
health status
geography
race and ethnicity
age and aging
gender
lifestyle factors
behavioral factors
```
41
sociodemographics
populations shifts --> growing rural population
42
obesity: CNS-mediated endocrine dysfunction
hormonal problem that affects hypothalmic-pituitary-adrenal system
-stress --> cortisol secretion --> stimulates SNS --> hypothalamic arousal --> metabolic syndrome
43
obesity: problem of energy regulation
problem with the Na+/K+/ATP pump
| -less ATPase pumps --> decreased energy
44
obesity: adipose cell theory
excessive number and size of fat cells
45
obesity: microbial theory
altered gut microbes alter energy intake, absorption and storage
46
geography
stress, nutrition, access to medical facilities and safety of the community, treatment variations
47
geographic pathology
infectious and parasitic diseases
48
environmental pathology
contaminants
49
cell membrane
- lipid bilayer: provides structure, relatively impermeable
- proteins: transmembrane, transportation
- carbohydrates: form cell coat
50
nucleus
control center-stores heredity material
51
components of the nucleus
- nucleolus: organelle that manufactures ribosomes
- nuclear envelope/membrane: contains pores-allows passage of material between nucleus and cytoplasm
- chromatin: DNA and proteins
52
DNA
protein synthesis, transmission of genetic material
53
RNA
copies and carries DNA instructions, site for protein synthesis, transports amino acids, production of protein
54
cytoplasm
surrounds nucleus
| -contains water, electrolytes, suspend proteins, neutral fats, and glycogen molecules and organelles
55
ribosomes
small particles of nucleus proteins
free-floating or attached to endoplasmic reticulum
site of protein synthesis: attach to mRNA
56
endoplasmic reticulum
transport substances
- rough ER: contains ribosomes, proteins synthesis, modification of protein structure
- smooth ER: lipid synthesis, regulation of intracellular calcium (SER), metabolism and detoxification of hormones and drugs
57
golgi apparatus
modification of large proteins and lipids --> active form
| -proteins synthesized in ER --> packaged in vesicles --> to golgi apparatus --> secreted
58
lysosomes
digestive
| -vesicles containing enzymes that digest worn-out cell organelles, macromolecules, bacteria, or entire cells
59
peroxisomes
degrades peroxides, controls free radicals, breaks down large fatty acids
60
mitochondria
powerhouse
- generates fuel for energy for cellular activity (O2, ATP)
- regulate cell death (apoptosis), dysregulatory apoptosis --> disease
61
cytoskeleton
controls cell shape, transport and movement
62
microtubule specialization
cilia
| flagella
63
catabolism
breaking down of nutrients and body tissues --> energy
- complex molecules into simpler ones
- used for energy production, recycling of molecular components, or excretion
64
anabolism
constructive process
- builds healthy body tissues from dietary calories and protein
- necessary for growth, maintenance and tissue repair
65
G-protein linked cell membrane metabolism
on-off switch for signal transmission
66
Enzyme (kinase)-linked cell membrane metabolism
mediate responses
67
ion-channel linked cell membrane metabolism
involved in electrical synaptic transmission
68
passive movement across cell membrane
without energy expenditure
69
chemical gradient
difference in number of particles on either side of membrane
70
electrical gradient
difference in charged particles or ions
71
simple diffusion
movement through membrane without carrier
72
facilitated diffusion
transport protein
73
ion channels and gates diffusion
open/close
74
osmosis diffusion
diffusion of water across membrane
75
endocytosis
incorporate material from outside the cell
76
exocytosis
enclosed vesicle first fuses with the plasma membrane
77
stress theories: general adaptation syndrome
1) alarm
2) resistance
3) exhaustion
78
stress theories: physiological responses and pathological states
stress --> problems with proteins
79
stress theories: personal factors
determine organ failure related to stress
80
reversible cell injuries
```
atrophy
hypertrophy
pseudohypertrophy
hyperplasia
metaplasia
dysplasia
```
81
atrophy
reversible cell injury
- decrease in cell size or number of cells
- physiologic: shrinkage occurs in development; involves entire body
82
hypertrophy
reversible cell injury
- increased size of cell/organ due to increased workload or hormones
- physiologic: result of normal physiological conditions
- pathologic: result of disease conditions; adaptive or compensatory
83
pseudohypertrophy
reversible cell injury
-increase in size of organ or body part BUT not due to increase in same cell type; RATHER infiltration of other cell types
84
hyperplasia
reversible cell injury
- increase in number of cells resulting from an increased rate of cellular division
- physiologic: due to hormonal stimulation; increased functional demands; compensatory mechanism
- pathologic: abnormal proliferation of normal cells due to excessive hormonal stimulation or effects of growth factors
85
metaplasia
reversible cell injury
| -reversible change in cell morphology --> one type of cell converts into another
86
dysplasia
reversible cell injury
| -increased number of cells with altered morphology and loss of historical organization
87
irreversible cell injuries
cell death: apoptosis, necrosis, gangrene
| pathologic calcifications: dystrophic, metastatic
88
apoptosis
irreversible cell injury
| -controlled cell destruction; programmed cell death
89
necrosis
irreversible cell injury
| -pathologic; unregulated; result of injury to cell integrity
90
gangrene
irreversible cell injury
- variant of necrosis
- dry: decreased arterial blood supply
- wet: decreased venous return and bacterial infection
- gas: infection of Clostridium bacteria dissolve cell membrane
91
dystrophic pathologic calcification
irreversible cell injury
| -occurs in injured or dying tissue
92
metastatic pathologic calcification
irreversible cell injury
| -occurs in normal tissue due to hypercalcemia
93
causes of cell injury
```
ischemia/hypoxia
infections
immune responses
genetics
nutritional factors
physical factors
mechanical factors
chemical factors
free radicals
```
94
hypoxia
cause of cell injury
| -lack of sufficient oxygen, reducing oxygen metabolism and generation of ATP
95
bacterial infection
cause of cell injury
- invades tissue --> release toxins --> cell lysis and degradation of extracellular matrix
- sepsis: blood infection interferes with blood volume/flow -->shock
96
viral infection
cause of cell injury
- direct: RNA virus inserts itself into cell membrane receptor --> disturbs nucleus and/or cell membrane
- indirect: virally encoded protein inserts self into membrane --> forms channel in protein --> alters permeability of cell --> cell swelling and death
97
immune responses
cause of cell injury
- normal: provides a defense against foreign antigens
- abnormal: becomes overzealous (i.e. allergy, etc.)
98
genetics
cause of cell injury
- alter number or structure of chromosomes
- produce single gene mutations --> alter proteins
- cause multiple gene mutations --> multi-factor problems
99
contusion
bleeding into the skin or underlying tissues as consequence of a blow that squeezes or crushes soft tissue and ruptures blood vessels
100
abrasion
skin injury produced by shearing force
101
laceration
skin or soft tissue injury produced by sharp, incisional force
102
hematoma
collection of blood in soft tissue/enclose space
103
programmed change theory of cellular aging
aging is genetically programmed
| activation of particular gene(s) after a number of cell divisions
104
error theory of cellular aging
accumulation of random events or damages to vital cell membranes
105
somatic mutation theory of cellular aging
mutations in DNA/deficit in repair mechanism
106
oxidative free radical theory of cellular aging
free radical damage
107
wear and tear theory of cellular aging
accumulated damage to vital parts of the cell
108
telomerase theory of cellular aging
in absence of telomerase, telomeres shorten --> decline in gene expression and inhibition of cell replication
109
rigor mortis
muscle stiffening occurs when the myosin cannot detach from the actin (due to deficient ATP) until lysosomal enzymes break down myofilaments
110
pharmacology
study of how chemical substances affect living tissue
111
pharmacotherapeutics
use of chemical agents to cure, prevent and diagnose medical disease
-goal is to deliver the appropriate amount of drug for a reasonable length of time to achieve desired beneficial effects while minimizing adverse effects
112
pharmacokinetics
how drugs get through the body and what happens to them in the body
-absorption --> distribution --> metabolism --> excretion
113
pharmacodynamics
potency and efficacy
114
pharmacogenomics
effect or influence of genetics on drugs
115
phases of human (clinical) testing
1) safety assessment
2) drug effectiveness -small patient sample
3) drug effectiveness -large patient sample
4) post-market surveillance
116
parts of a prescription
prescriber's name and contact info
patient's name and date
superscription: method of administration, treatment method
inscription: drug name, dose, quantity to dispense
signa: instructions to patient
refill instructions
prescriber's signature
117
PO
by mouth
118
IV
intravenous
119
IM
intramuscular
120
QD
once a day ("daily")
121
BID
twice a day
122
TID
three times a day
123
QID
four times a day
124
HS
at night
125
pharmacotherapeutic drug
drug's action on a specific disease process
126
pharmacological drug
result of drug action on the body
127
"gated" ion channels
ligand and voltage-gated
quick opening and closing of channels
allows for ion transfer along concentration gradient
128
G-protein coupled receptors
- G-proteins made of alpha, beta, gamma subunit
- slower (more prolonged) opening of channels (seconds) than seen in ion channels and remain open longer
- production of second messengers
129
kinase-linked receptors
- transmembrane helical region with large extracellular space for ligand binding
- size of extracellular space related to size of endogenous ligand
- slower
130
DNA-coupled receptors
intracellular: in nucleus
| stimulate gene transcription --> protein and enzyme synthesis
131
drug-receptor interaction: specificity
acting on only one type of receptor
132
drug-receptor interaction: selectivity
acting on one subtype of receptor
133
drug-receptor interaction: agonist
binds to receptor to create response
| -when all receptors are occupied by agonist --> maximum response (not infinite)
134
drug-receptor interaction: antagonist
blocks receptor site; binds to receptor but doesn't cause change
- competitive: antagonist can be overcome with greater concentration of agonist
- noncompetitive: antagonist blocks receptor site permanently; no effect with increased concentrations of agonist
135
graded dose-response curve: Emax
maximum response point
136
graded dose-response curve: Efficacy
strength of response
137
graded dose-response curve: Kd (ED50)
median effective dose
138
graded dose-response curve: Potency
concentration of drug needed to produce a given response
139
quantal dose-response curve: LD50
lethal to 1/2 of subjects
140
quantal dose-response curve: TD50
toxic/adverse effect in 1/2 of subjects
141
administration of drugs: oral
most convenient, most favored, most complex
| first pass metabolism: liver metabolism
142
administration of drugs: sublingual and buccal
rapid absorption due to tissues and proximity to capillaries
143
administration of drugs: rectal
solutions, suspensions, or suppositories
144
administration of drugs: intravenous
requires injection
145
administration of drugs: subcutaneous
given under skin into fat (usually stomach)
146
administration of drugs: intramuscular
directly into skeletal muscle
147
administration of drugs: epidural
drug delivered into spinal column, but outside dura mater
148
administration of drugs: intrathecal
into spinal subarachnoid space
149
distribution of drug depends on
- blood flow (if IV administered)
- lipid solubility: lipid soluble drugs pass blood-brain barrier quickly
- plasma protein binding: some portion of drug bound to albumin, but need free drug for effects --> must increase overall dose --> prone to more drug-to-drug interaction
150
metabolism of drugs
takes place primarily in the liver
| -reduces lipid solubility
151
phase one of metabolism of drugs: catabolic
- mechanisms: inactivation of drug, various mechanisms
- alterations in process: differences in enzymes around people, effect of diet and environment, competition for same enzyme slows metabolism
152
phase two of metabolism of drugs: conjugation
hydrophilic groups attach to drug --> inactive compound --> less lipid soluble --> prepares for excretion
153
first-order elimination
rate of elimination is directly proportional to concentration of drug
154
half-life elimination
50% of drug is cleared per unit of time
| -dependent on clearance and volume of distribution (Vd)
155
steady state
amount of drug excreted during unit of time equals amount of drug administered
156
classifying medication effects: A,B,C,D,E
```
A: augmented = dose-related, predictable
B: bizarre = unrelated to dose; unpredictable
C: chronic = dose and time-related
D: delayed
E: end of treatment
```
157
drug-drug interactions
- diminished response (subtraction)
- additive response (addition)
- synergistic response (multiplication)
158
pharmacokinetic basis: A,D,M,E
A: absorption
D: distribution
M: metabolism
E: excretion
159
Type 1 drug allergy
anaphylactic reactions
- degranulation of mast cells and/or basophils
- histamine --> severe allergic reaction
- cardiovascular and respiratory collapse within minutes to an hour
- epinephrine = treatment of choice
160
radiology
branch of medicine concerned with radiant energy and radioactive substances
161
radiograph
production of an image of an anatomical part
162
radiodensity
tissues produce various shades of gray, depending on their density
-thickness and composition
163
attenuation
any mechanism by which photons (x-ray) are lost
| -due to absorption or scattering
164
radiolucent
lesser density = lesser absorption
165
radiopaque
greater density = greater absorption
166
systematic approach to film evaluation: A,A,B,C,C,S
```
A: architecture
A: alignment
B: bone density
C: contour
C: cartilage
S: soft tissue
```
167
computed tomography
vertebral column, sternum, ribs, etc.
excellent bone detail
radiation
168
magnetic resonance imaging
```
soft tissue
T1: anatomical detail
T2: pathology (tumor)
multi-planar
expensive
```
169
scintigraphy
bone scans
identify bone metastases
poor spatial resolution
170
ultrasonography
visualize structures
inexpensive
poor bone detail
171
What does neoplastic mean?
cancer-related
172
What does psychogenic mean?
a psychology problem manifests themselves as health problems
173
What are free radicals?
atoms with unpaired electron --> react to
| interrupt normal physiological activity
174
What does idiopathic mean?
no known cause
175
What does iatrogenic mean?
due to medical action/treatment
176
The PT role in diagnosis, what should they do?
formulate PT diagnoses
recognize need to refer to another discipline
communicate & collaborate with other HCPs
177
How are PTs being seen as primary care providers?
direct access
| legislative, professional, and educational initiatives
178
Why are PTs being viewed as primary care practitioners?
- exploding patient population demanding quick & easy access
- increasing # of patients
- decreasing appointment times because increasing demand for profit
- use of PTs as "physician extenders"
179
What do PTs use laboratory tests for?
- determine appropriateness for treatment
- make necessary adjustments to plan of care
- reference range
180
What are the 6 criteria to evaluate diagnostic tests?
- validity
- reliability
- sensitivity
- specificity
- predictive value
- likelihood ratio
181
What is the equation for sensitivity?
(true +) / (true + + false -)
182
What is the equation for specificity?
(true -) / (true - + false +)
183
What is a false negative?
a person who tests as negative but who is actually positive
184
What is a false positive?
a person who tests as positive but who is actually negative
185
What is the likelihood ratio equation?
sensitivity/ 1 - specificity
186
How does race and ethnicity affect health care?
- increase of individuals living in lower socioeconomic environment
- less accessible for minorities and rural populations
- routine healthcare more for affluent, better educated, & higher income people
- African-Americans less likely to receive rehab services & less intense
187
In the U.S. half of deaths are due from________ & _______.
behavioral & lifestyle factors
188
How does being male affect health?
- poorer health
- decreased life expectancy
- less likely to seek medical treatment
- more likely to engage in risky behavior
- considered the norm
189
How does being female affect health?
- more likely to seek medical help
- more likely to practice preventative medicine
- more likely to have a PCP
- tend to use a "tend and befriend" approach to managing stress
190
What is the self-efficacy?
ability or confidence of a person to implement an effective behavior
191
What is a negative cellular response to stress includes?
when stress is overwhelming or adaption is ineffective, injury, maladaptive changes, & cell death occur
192
What is a positive cellular response to stress includes?
stress to a body & tissues can be beneficial ex: hypertrophy
193
What are cell injuries that are reversible?
- sub-lethal
- after removal of stressor--> cell recovers
- can become chronic
- examples: swelling, atrophy, hypertrophy
194
What are cell injuries that are irreversible?
- due to significant injury to cell, resulting in cell death
- alterations in nucleus, mitochondria, & lysosomes
- rupture of cell membrane
- leads to necrosis
195
What makes up the alarm phase of general adaptation syndrome theory?
- fight, flight, freeze
| - mobilize resources
196
What makes up the resistance/adaptation phase in general adaptation syndrome theory?
how they cope with stressor
197
What makes up the exhaustion phase of the general adaptation syndrome theory?
reserves depleted
198
What is physiological atrophy?
shrinkage that occurs in development & involves entire body ex: aging related
199
What is physiological hypertrophy?
result of normal physiological conditions
| ex: increased muscle mass with exercise
200
What is pathological hypertrophy?
results of disease conditions (adaptive or compensatory)
201
What is adaptive hypertrophy?
- pathologic hypertrophy
| - myocardial hypertrophy from heart disease
202
What is compensatory hypertrophy?
- pathologic hypertrophy
| - enlargement of remaining organ or tissue after portion removed (liver)
203
What is physiologic hyperplasia?
- due to hormonal stimulation, increased functional demands, compensatory mechanism
- example: increased breast and increased liver
204
What is pathologic hyperplasia?
- abnormal proliferation of normal cells due to excessive hormonal stimulation or effects of growth factors
- example: warts
205
What physiologic processes is apoptosis involved in?
normal physiologic processes
- embryonic development
- control of immune cell numbers
- regression of breast tissue after weaning from breast- feeding
Abnormal processes
- cancer (failure of apoptosis)
- viral infections (destruction of targeted cells)
206
What are characteristics of dry gangrene?
- caused by decreased arterial blood supply
- tissue dry, dark brown/black
- almost exclusively limited to the extremities
- often complication of diabetes, frostbite, arteriosclerosis
- loss of blood to cells
207
What are characteristics of wet gangrene?
- caused by decreased venous return & bacterial infection in an area of tissue
- neutrophils invade the site, causing necrosis
- wound is cold, swollen, black, & foul smelling
208
What are characteristics of gas gangrene?
- infection of Clostridium bacteria dissolve cell membranes
- bubbles of hydrogen sulfide gas form
- high mortality rate if not treated
209
What are causes of hypoxia?
- inadequate O2 in air
- respiratory disease
- ischemia-decreased blood flow
- anemia
- edema
- inability of cells to use O2
210
What are the results of hypoxia?
- reliance on anaerobic metabolism
- lactic acid builds up in cells from glycolysis
- lowered pH damages cell structures & impairs cell function
211
What causes an allergy?
caused by specific antibodies (IgE) on surface of specialized cells
212
What is anaphylactic shock?
can result in circulatory collapse; kidney dysfunction
213
What is hyperglycemia?
increased glucose causing obesity
214
What is hyperlipidemia?
increased lipoproteins causing fat deposits in heart, liver, and muscle
215
What are the effects of hyperthermia?
inactivates temperature-sensitive enzymes, damages vessels, accelerates cell metabolism
216
What are the effects of hypothermia?
- induces vasoconstriction & increases blood viscosity
| - can rupture cell membrane
217
What is ionizing radiation & how does it affect the cell?
- causes radiolysis of water-->production of radicals-->kills cells, interrupts cell replication, or causes genetic mutation
- swelling, disruption of mitochondria & other organelles, alterations in cell membrane-->can lead to gene mutations
- rapidly-dividing cells more vulnerable
218
What are characteristics of electrical injuries?
-tissue damage greatest in tissues with least resistance
-bone-->fat-->tendons-->skin-->muscle-->blood-->nerves
(greatest resistance-t---------------------------->least resistance)
-may interrupt brain function, respiration, and other vital functions
219
What can a free radical injury cause?
- can create reactions with cellular components
- can cause chain reaction-->damage to cell membrane, changes in proteins, changes in DNA
- cause of degenerative conditions (Parkinson's)
- defenses against:
- anti-oxidants: neutralize free radicals
- moderate exercise
220
What are characteristics of cellular aging?
- aging occurs at the cellular level
- # of cell functions decline with age
- DNA prime target
- reduced ability to divide
- reduced ability to withstand microorganisms
- result-->reduced
- functional reserve
- ability to resist infection
- pathological changes
221
What is somatic death?
death of a person
222
What is pharmacokinetics?
is what the body does to the drug
223
What is pharmacodynamics?
what the drug does to the body
224
What are the 2 steps of drug development before human testing?
- 1st target a market (media/society)
| - 2nd preclinical testing (animal studies)
225
What is phase 1 of human testing in drug development?
- safety assessment
- healthy volunteers
- about 2 years
226
What is phase 2 of human testing in drug development?
- drug effectiveness
- small patient sample
- 1-2 years
227
What is phase 3 of human testing in drug development?
- drug effectiveness
- large patient sample
- 3-6 years
228
What is phase 4 of human testing in drug development?
- post-market surveillance
| - last for an infinite amount of time
229
What are barriers to drug development?
- lack of funding
- clinical syndromes without specific markers
- lack of animal model for screening
230
What is a meta-analysis and what is it used for?
- combines data from multiple small drug trials to assess patterns of effects
- statistical technique
- way to combat problem of small sample sizes
231
What is treatment investigational new drugs (IND) status?
- FDA mechanism for approving drugs for life-threatening conditions
- special priority through approval process
232
Research demonstrates that up to _____ of adverse drug events are preventable.
50%
233
What are schedule 1 class of drugs?
- research only
- high abuse
- no medical use
- examples: LSD & coke
234
What are schedule 2 class of drugs?
- high abuse potential but accepted medical use
- no refill w/o new prescription
- DEA number required on prescription
- example: Oxycontin
235
What are schedule 3 class of drugs?
- lower abuse potential
- 5 refills in 6-month period
- steriods
236
What are schedule 4 class of drugs?
- less abuse potential than above classes
- 5 refills in a 6-month period
- example: valium
237
What are schedule 5 class of drugs?
- lowest abuse potential
- may be available without a prescription
- example: cough syrup
238
What is a chemical name?
specific molecular structure
239
What is the generic name of a drug?
- "official name"
- may be similar to other drugs in same class
- used in scientific documentation
240
What is the trade/brand name of a drug?
- copyrighted by pharmaceutical company
| - usually easier for the public to recognize
241
Pharmacotherapeutic classification is?
drug's action on a specific disease process
242
What is pharmacological action?
result of the drug action on the body
243
What is the molecular action?
result of the drug action on the molecular target
244
What is a ligand?
a substance that is able to bind to and form a complex with a biomolecule to serve a biological purpose
245
What is an endogenous ligand?
- formed within the body
| - hormones
246
What is an exogenous ligand?
- formed outside the body
| - medication
247
What is a ligand-gated channel?
a ligand must bind to the receptor to open it
248
What is a voltage-gated channel?
- a change in voltage opens the channel
| - example: Na/K pump
249
what is the ideal drug-receptor interactions?
a drug would bind to only one type of receptor (doesn't happen)
250
What is a competitive antagonist?
can be overcome with greater concentration of the agonist
251
What is a noncompetitive antagonist?
blocks receptor site permanently; no effect with increased concentrations of the agonist
252
In a dose-response curve, the larger the dose, ______ the response.
larger (to a point)
253
What is a partial agonist in a dose-response curve?
smaller response for more meds
254
What is the therapeutic index?
- ratio of LD50 to ED50
| - the bigger/wider the safer the drug is
255
What are the limitations of ED50, LD50, & TI?
- do not take into account drug-drug interaction
- patients & docs may not agree on what is "effective" outcome for drug
- patients may not be compliant in drug usage
- info on lethality/toxicity done mainly in animal studies
256
What is absorption & what factors influence it?
- drug transferred from administration site-->systemic circulation
- factors
- movement of drug through membrane
- administration methods
- dosage formula
- physiochemical properties of drug
- administration method
257
What are absorption and irritation issues with oral intake of medication?
- many medications cause GI upset
- mechanisms to delay disintegration
- coated (enteric) tablets slow-release agents
258
What is the effect of food in the stomach and oral intake of medication?
- increasing gastric mobility improves drug delivery to small intestine (but balance with malabsorption from excessive peristalsis)
- food in GI tract usually delays absorption
259
What is bioavailability?
denotes amount (percentage) of drug actually reaching the cardiovascular system
260
What is first pass metabolism of oral intake?
- liver metabolism = 1st pass & key location
| - drug is partially dismantled here prior to entering circulation
261
What are the pros and cons of rectal administration?
Pros:
-for children and those vomiting or unable to swallow
Cons:
-inconsistent absorption
262
What are the pros and cons of IV administration?
Pros: multiple sites available
Cons: no margin for error
263
What are the pros and cons of subcutaneous administration?
```
Pros: ease of self-administration
Cons:
-repeated injections -->lipoatrophy
-variable absorption
-impacted by immobilization, heat, exercise
```
264
What are the pros and cons of intramuscular administration?
Pros: more rapid absorption than subcutaneous
Cons: painful, difficult to self-administer, effect of exercise
265
What are the pros and cons of intrathecal administration?
Pros: lower dose effective
Cons: infection risk
266
What effect does exercise have on absorption?
- variable effect for orally administered drugs
- may increase absorption of drugs administered via
- intramuscular
- subcutaneous
- transdermal
- inhalation
267
If IV administered, distribution is based on _______.
- blood flow
- greatest in brain, heart, liver, and kidney
- less in muscle, skin, & fat
268
What is lipid solubility?
- lipid soluble drugs pass blood-brain barrier quickly--> other lipid tissues-->diffuse out & back into brain
- amount of body fat can impact dose required
269
How does plasma protein binding work?
-some portion of drug bound to albumin
BUT
-need free drug for effects so must increase overall "dose" so, prone to more drug-to-drug interactions
270
What are characteristics of the blood-brain barrier and the placenta?
- blood-brain barrier
- lipid soluble drugs pass easily into the brain
- water soluble drugs don't
- placenta
- less of a barrier to drugs, but....diffusion delayed
271
What are the characteristics of the metabolic processes?
- biotransformation
- inactivation
- preparation for elimination
- Takes place primarily in the liver
- decreases drug's activity
- reducing lipid solubility is key
272
What are the different types of elimination?
- renal excretion (glomerular filtration to enter tubules)
- fecal excretion
- drug uptake into hepatocytes leads to elimination in bile
- better route for larger molecular-weight compounds
273
What is half-life principle dependent on?
dependent on clearance & volume of distribution
274
What are characteristics of first-order elimination and dosing?
- because of 1st order elimination, it takes a long time for the drug to build up in the body
- steady state: typically occurs within 4-5 half-lives
275
What is zero-order elimination?
elimination not dependent on plasma concentration; constant amount lost per unit of time
276
What are age-related factors affecting pharmacokinetics?
- more drugs = more drug-drug interactions
- more competition for P450 enzymes
- decreased serum albumin concentration
- lean body mass decreases
- liver & renal finction decrease
- changes in drug-receptor interactions
- reduced blood flow in GI tract
277
What are genetic factors affecting pharmacokinetics?
- gene mutations tend to control production of enzymes
| - can also see mutations in genes that code for drug transporters and drug receptors
278
What are disease factors affecting pharmacokinetics?
- most profound effects found with diseases of the liver & kidneys
- some illnesses decrease function of P450 enzymes
- effects of other drugs taken for disease processes (competing activity)
279
Drug vs. Drug interactions
- increasing incidence due to increasing number of medications that our patients are taking (polypharmacy)
- often results in adverse effects/reactions
280
Patients taking >/= _____ medications associated with higher risk of preventable adverse drug events.
7
281
What are side effects?
minor, unintended effects
282
What is an adverse drug reaction?
significant, unintended effect at therapeutic dosage
283
What is an adverse drug event?
negative outcome not necessarily related to chemistry of drug
284
What is the risk/benefit ratio?
- present for every drug
- ratio increases as patient ages
- risks are present due to
- drug-drug interactions
- food-drug interactions
- patient-related factors
- allergic reactions
- side effects
285
According to WHO, adverse effects are?
any unintended or unwanted effects of a drug that may occur at acceptable dose levels
286
What is the beneficial effect?
is why you're taking the drug
287
What is an adverse effect?
is anything else that occurs while you're taking the drug
288
What is augmented classifying medication effects?
- dose-related, predictable
| - example: warfarin (hemorrhage), insulin (hypoglycemia)
289
What is bizarre classifying medication effects?
- unrelated to dose, unpredictable
| - example: penicillin (allergic reaction)
290
What is chronic classifying medication effects?
- dose & time related
| - example: sinemet (dyskinesia)
291
What is delayed classifying medication effects?
carcinogenic
292
What is end of treatment classifying medication effects?
Oxycontin (opioid withdrawal)
293
What is a drug allergy and drug-induced illness?
- drug + protein = "foreign body"
- body produces an antibody
- next dose of drug= TROUBLE
294
What is a Type II (cytotoxic reaction) drug allergy type?
- cell death
| - non-urticarial rashes
295
What is a Type III (autoimmune reaction) drug allergy type?
- inflammatory response
| - urticaria rash
296
What is a Type IV (cell-mediated hypersensitivity) drug allergy type?
- contact dermatitis
| - non-urticarial rashes
297
What can we do to prevent/decrease the risk of ADEs?
- clear communication
| - gather accurate medication history
298
What is the relevance of diagnostic imaging to PTs?
- to assure a comprehensive PT exam
- support, refute, or explain the PT exam
- inform the plan of care
299
What is reflective imaging & what is an example?
- energy inserted into body-->captured--> converted into an image
- example: MRI
300
What is ionizing radiation and an example?
- ionizing radiation penetrates matter-->detected
| - examples: X-ray & CAT scans
301
What is emission imaging and an example?
- blood drawn-->tagged with radiopharmaceutical agent--> reintroduced-->picked up by scintillation camera
- example: scanner
302
What are the advantages of digital imaging?
- decreased dose per study
- image reproduction virtually instantaneous
- no need to re-develop film
- total portability
- finer images produced
- decreased cost of film & storage space
303
What are the disadvantages of film imaging?
- potential for increased radiation dose to patient
- cost of film
- repeat exposure
- time for chemical development
- inability to alter image
- need to physically transport & store film
304
What is the attenuation coefficient?
determines the average intensity of x-rays of a particular energy that transmitted
305
Reading a plain film you need to understand.......
- densities of tissues
- anatomical planes of the body
- general rules/guidelines/processes
- orientation of radiograph
306
What are the rules of positions & projections?
- one view is no view
| - films are typically AP except hand & chest
307
The higher the mu (attenuation coefficient), the less x-ray is transmitted (less scattered) & the more _____ the tissue appears.
radiopaque
308
What composes architecture of a image?
size & appearance
309
What information does alignment offer?
stability & integrity (info from alignment of bone or joint)
310
What is bone density?
- texture of bone altered due to osteolytic changes
| - local bone density may increase as a function of a repetitive process
311
What is contour?
trace cortical line of bone for irregularities, smoothness, & continuous
312
What is cartilage space?
- difficult to see on radiograph
| - better if you can see normal x-ray first
313
What is soft tissue?
muscles are not viewed with distinction but gross bruising, edema, atrophy & hemorrhage can be viewed
314
What are advantages of radiographs?
- cheap
- readily available
- familiar
- easy to read
- cover large areas
- good spatial resolution
- reproducible
315
What are the disadvantages of radiographs?
- some limitations in early disease/fracture
- limited soft tissue information
- 2D image
- storage/loss
- operator error
316
What is a fluoroscopy?
- radiograph movie
- contrast exam of GI tract to follow the course of the barium
- guide in performing arterial & venous catheter insertion
- joint observation
- swallowing
317
What is an angiography?
away to study blood vessels & organs
318
What are the advantages of CT scans?
- good for viewing: vertebral column, sternum, ribs & sella furcica
- readily available
- excellent bone detail
- good for complex anatomy
- soft tissue contrast
319
What are the disadvantages of CT scans?
- ionizing radiation
- attention to technique
- limited axial slice
- limited effectiveness in assessment of soft tissue
320
What are the advantages of a MRI?
- excellent for viewing soft tissue, bone marrow, & joints
- very good spatial resolution
- best method for joint evaluation
321
What are the disadvantages of a MRI?
- expensive
- risk of claustrophobia
- poor cortical bone detail
- metal artifact can't go in
322
What are the advantages of nuclear medicine?
- fairly available
- physiological information
- effective in identifying bone metastases
- entire body
- vascular/soft tissue/bone
- stress factor
323
What are the disadvantage of nuclear medicine?
- poor spatial resolution
| - tracer activity depends on vascular supply & tissue
324
What is a PET scan used for?
- used in research to detect cognitive decline & early Alzheimer's
- In patients with cancer, used to detect disease & monitor treatment effectiveness
325
What is sepsis?
- bacterial infection
| - blood infection-->interferes with blood volume/low-->shock
326
What is toxicity?
adverse drug event at high dosage
327
What is DNA?
- genetic information found in the nucleus
- composed of different combinations of nucleic acids--> contain instructions for assembling amino acids --> structural units of proteins
328
What is a gene?
- chemical messenger of heredity
- composed of DNA molecules along a double helix
- carry instructions for synthesizing proteins
329
What are chromosomes?
- organization & storage of genetic information
- arranged in pairs (homologous chromosomes)
- 46 singles or 23 pairs
- 22 autosomes & 1 sex
330
What is the genetic code?
- a sequence of 3 bases form a triplet code=codon
- 4 bases
- molecular language
- if there is a misspelling that alters the protein
331
What is meiosis?
- cell division of reproductive cells
- shuffles genetic material from each parent into new form
- 4 "daughter" cells
332
What is mitosis?
- cell division of somatic cells
- exact reproduction of cells that normally die off
- skin cells
- 2 'daughter' cells (exact copies)
333
What is a mutation?
- a change in the normal DNA pattern of a gene
| - 2 types (somatic & gamete)
334
What is a somatic mutation?
- random mutations, not transmittable
| - most are corrected by repair mechanisms
335
What is a congenital defect?
- an abnormality present at birth
| - may or may not, be due to genetic factors
336
What is a gamete mutation?
inherited mutation (or ability to be)
337
What is a genetic disorder?
- a discrete event that affects gene expression in a group of cells related to each other by gene linkage
- may be apparent @ birth or may arise later in life
- various causes, most due to DNA sequence issues
338
What are single-gene disorders?
- caused by a single defective or mutant gene involving autosome or x-chromosome (lead to abnormal proteins)
- characterized by patterns of transmission (dom or res)
- single mutant gene often expressed in multiple parts of the body
- likelihood of developing disease based on probability
339
What is an allele?
alternate forms of a gene, one from each parent
340
What is a locus?
position of gene on the chromosome
341
What is a genotype?
- genetic info stored in the code
| - example: BB, Bb, bb
342
What is a phenotype?
- associated recognizable traits
| - example: hair color or eye color
343
What is heterozygous pattern of inheritance?
- person with different alleles
| - example: Bb
344
What is homozygous pattern of inheritance?
- person with same alleles
| - example: BB or bb
345
What is an autosomal dominant?
- trait expressed only in homozygous or heterozygous pairing
- acts regardless of what else is present
- example: BB or Bb
346
What is an autosomal recessive?
- trait expressed only in homozygous pairing
- acts only if unopposed
- example: bb
347
What is autosomal dominant disorders?
- 50% chance of inheritance
- age of onset often delayed
- variable gene penetrance & expression
- commonly affects complex metabolic pathways or key components of structural proteins (e.g. collagen)
348
What is an autosomal recessive disorders?
- manifested only when both alleles are affected
- age of onset frequently early & symptoms more uniform
- characteristically caused by deficiencies in enzymes rather than structural proteins
349
What are x-linked disorders?
- almost always associated with X chromosome & typically are recessive (seen more in males b/c they only have 1 X chromosome)
- mother usually carries 1 normal and mutant X, has 50% chance of passing on
- females typically not affected & males are affected
350
What are multifactorial inheritance disorders?
- caused by multiple genes & often influenced by environment
| - do not follow clear-cut pattern of inheritance
351
What are the chromosomal disorders?
- leading cause of mental retardation & miscarriage
- 1 major mutation occurs in 1 to 12 conceptions
- 50% result in "spontaneous abortions" in the 1st trimesters
- usually develop during meiosis
- various mechanisms lead to these disorders
352
What is the deletion mechanism of chromosomal defects?
broken chromosomes & loss of DNA
353
What is the duplication mechanism of chromosomal defects?
excessive DNA (generally less serious than deletions)
354
What is the inversion mechanism of chromosomal defects?
breaking then reinserting in an inverted position
355
What is the translocation mechanism of chromosomal defects?
interchanging of non-homologous chromosomes
356
What is the unequal cross-over mechanism of chromosomal defects?
chromosomes crossover unequally
357
What are uses of genes in medicine?
- prenatal screening
- gene testing
- gene therapy
358
What is gene testing?
- a potential way to sure wide variety of hereditary & age-related conditions
- may be able to be used to:
- replace injured tissue
- build new coronary blood vessels
- alter drug sensitivity
- obstacles/concerns
- how to avoid immune response
- ethics (designer babies)
359
What is gene testing?
- done to identify those with faulty gene that may or may not lead to disorder
- concerns
- psychological implications
- uncertainty regarding who should be tested
- safeguards & protocols may not be set
- privacy
