exam 2!!!

Question 1

Nephritic

Answer 1

-Nephritic Syndrome: Immune response (hematuria)
-Glom. inflammation
-Cola-colored urine (Lana: my p tastes like Pepsi cola)
-Oliguria - decreased urine
-HTN
-High WBC
-Low GFR

Question 2

Nephrotic

Answer 2

-Nephrotic Syndrome: leaking protein!!!
-Proteinuria
-Edema
-Hypoalbuminemia (not enough albumin)
-3.5 g or more protein excreted

Question 3

Differentiate risk factors, etiologies, and manifestations of prerenal, intrarenal, and postrenal types of acute kidney injury.

Answer 3

Prerenal: decreased blood flow to the kidneys.
cause: ischemia of nephrons.

Intrarenal: damage to kidney structures
cause: thrombosis, toxins, trauma, tumor, infections, ischemia.

Postrenal: obstruction of urine outflow from the kidneys.
cause: kidney stones, tumors, neurogenic bladder (can’t empty).

Question 4

Manifestations of acute kidney injury

Answer 4

-decreased GFR, higher BUN, decreased urine output, elevated creatine.

Question 5

Treatment of acute kidney injury

Answer 5

Treatment: treat the underlying cause, correct acid-base imbalance, manage BP, treat infections, treat nutrition, and re-perfuse kidneys.

Question 6

State the definition, classifications, and diagnostic criteria for chronic kidney disease.

Answer 6

-Abnormalities in kidney structure/function for a minimum of 3 months.

-GFR <60ml/min

-Manifestations: persistent hematuria, structural abnormalities, loss of nephron function

-Man (2): endocrine problems, hypertension, acid-base problems, GI problems, nitro wastes, anemia (less erythropoietin), CNS problems, sexual dysfunction, decreased inflammation

-Less sodium, too much potassium!!!

-Altered drug elimination b/c of loss of albumin!!! albumin helps with drug transport…

Question 7

Explain the pathophysiologic basis for the development of hypertension, hyperkalemia, uremia, anemia, acidosis, osteodystrophy, hypocalcemia, and hyperparathyroidism associated with chronic kidney disease.

Answer 7

-Hypertension - Fluid overload!
-Hyperkalemia - Less K excretion, more Na retention
-Uremia (kidneys can’t filter waste products from the blood) - accumulated nitro wastes cause complications
-Anemia - decreased erythropoietin
-Acidosis - issues with acid-base balance
-Osteodystrophy - decreased vit D activation - more PTH, less osteoblasts (renal bone disease)
-Hypocalcemia - reduced PTH, decreased vit D

Question 8

Describe the concept of perfusion and how it relates to oxygenation.

Answer 8

Perfusion - circulation throughout the entire body (pulmonary circ, systemic circ).

Perfusion is blood flow through the blood vessels. Ensures blood reaches all organs in the body.

Oxygenation - the process of delivering oxygen to the cells/tissues.

Question 9

Preload

Answer 9

-Degree of stretch of cardiac muscle (at the end of diastole filling); Amount of blood in ventricles.
-Affected by venous blood pressure.

Question 10

Afterload

Answer 10

The pressure that the heart must work against to eject blood.

Question 11

Contractility

Answer 11

The ability of the cardiac muscle to shorten in response to an electrical impulse.

Question 12

Cardiac Output

Answer 12

Cardiac output is determined by HR and stroke volume.

Question 13

Hormones

Answer 13

Renin-Angiotensin-Aldosteron (RAAS)

-Angiotensin - Vasoconstriction (most medications block angio receptors)

-Aldosterone - Retention of NA, K, and H2O

ADH (?)

Question 14

Influence on BP

Answer 14

-Cardiac output, blood volume, viscosity, and blood vessel length/diameter

Question 15

Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with hypertension.

Answer 15

Etiology: Complex. Could be primary OR secondary reasons.

Primary: Genetics, Race, History, Age
Risks (1): Increased salt, obesity, excessive alcohol.

Secondary: From another disease
Risks (2): Diseases, Renal problems, Overactivated RAAS (too much Na and H2O being retained), Sleep Apnea, Drugs

Question 16

manifestations & complications of hypertension

Answer 16

Manifestations: Headache, dizziness, tinnitus, chest pain, fatigue

Complications: CNS problems (stroke, aneurysm, blurred vision), heart failure, CAD, cognitive impairment.

Question 17

Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug-drug interactions associated with drugs used for the treatment of hypertension.

Answer 17

-Diuretics - decrease blood vol.
-Beta-blockers - decrease HR and contraction strength; vasodilates
-ACE inhibitors - block angio 1 conversion to 2
-Angiotensin 2 blockers - block angio 2 effects
-Calcium channel blockers - relax smooth muscle; decrease contractility; vasodilates!
-Vasodilators - dilation of arteries!!!

Question 18

Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with disorders of systemic arterial blood flow (atherosclerosis, peripheral artery disease).

Answer 18

Atherosclerosis:
Etiology - Hardening/narrowing of arteries due to buildup of plaque; Abnormal accumulation of lipid deposits.

Risks 1 - Primary: family, history, age, MALES

Risks 2 - Secondary: The obvious (diabetes, sedentary, obesity, HTN, tobacco, dyslipidemia).

Question 19

manifestations/complications of atherosclerosis

Answer 19

Blockages in different parts cause different problems (stroke, heart attack, lower limb issues PAD).
It is a “silent killer!”

Question 20

Peripheral Artery Disease

Answer 20

-Etiology - atherosclerosis of arteries perfusing to lower extremities
-Risks - atherosclerosis
-Manifestations - cramping, pallor, thin skin, WEAK PULSE!
-Diag - ultrasound, MRI, inspection
-Treatment - decrease plaque formation

Question 21

Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with disorders of systemic venous blood flow (varicosities, venous insufficiency).

Answer 21

-Impaired venous return
-Venous HTN, circulatory stasis, tissue hypoxia.
-Inflammation and edema.
-Edema becomes worse standing.

Question 22

manifestations/diagnoses/risks/treatment of venous insufficiency

Answer 22

-Manifestations: Skin atrophy; dermatitis; Stasis ulcers; Wounds that can’t heal; Varicosities.
-Diagnoses: Ultrasound - to see what’s going on inside.
-Risks: Age, FEMALE, standing long, obesity, preg
-Treat: Compression stocks! exercise, elevating legs.

Question 23

Venous thromboses

Answer 23

-Attached to wall or embolus -> traveling
-superficial or deep
-Issues: pain, swelling, fever, deep muscle tenderness
-Prevention: leg elevation, compression stockings, leg exercises. PREVENTION ONLY!!!
-Treat: surgery, elevate legs rest, thrombolytics, anticoagulation meds
-Med: Anticoagulation meds!

Question 24

Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with dyslipidemia.

Answer 24

-Lipoproteins: transport cholesterol around the body (LDL, HDLS).
-Imbalance of lipoproteins.
-Increased sensitivity to dietary cholesterol.
-Physical manifestations

Primary: genetics

Secondary: nephrotic syndrome;hypothyroid;obesity;liver disease
-Goals for treatment: reduce LDL and HDL levels with meds
-Dietary changes,stop smoking,lose weight, increase physical activity.

Question 25

Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug-drug interactions associated with drugs used for the treatment of dyslipidemia.

Answer 25

-Colesevelam
-Gemfibrozil
-Ezetimibe
-STATINS

Question 26

Acute coronary heart syndrome

Answer 26

Insufficient/lack of perfusion to myocardial tissue. there are 3 severe stages of coronary occlusion.

Question 27

Stable angina: (transient ischemia)

Answer 27

stable blood clot, partial occlusion, increased oxygen demand w/ exertion or stress, relieved with rest and NITRATES!

Chest discomfort, heaviness, pallor, sweating, dyspnea

Question 28

Unstable angina: Clotting cascade (intermittent)

Answer 28

-Chest pain @ rest and persists, NEG CARDIAC ENZYMES

-Chest pain, dyspnea, sweating, anxiety

-Treat fast before a heart attack!

-Treat with nitrates and blood thinners

Question 29

NSTEMI: Acute heart attack 1: PARTIAL occlusion

Answer 29

-Elevated ST waves
-Sudden onset of pain not relieved by rest

Question 30

STEMI: Acute heart attack 2: COMPLETE occlusion

Answer 30

-Pain not relieved by rest
-Positive troponin!!!! (indicates myocardial cell death). Remains elevated 7 days after a STEMI.
-Chest pain - radiates to left jaw, neck, and arm; chest pressure, dyspnea, sweating, anxiety, BP issues
-Diagnoses: ECG, checking cardiac enzymes (blood test).

Question 31

Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug-drug interactions associated with drugs used to treat acute coronary syndrome.

Answer 31

-Heart medications (ACE, ARB,
Calcium channel blockers)
-Diuretics
-Cholesterol-lowering drugs (statins)
-Aspirin
Antiplatelet drugs (Clopidogrel)