exam 2!!! Flashcards
Nephritic
-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
Nephrotic
-Nephrotic Syndrome: leaking protein!!!
-Proteinuria
-Edema
-Hypoalbuminemia (not enough albumin)
-3.5 g or more protein excreted
Differentiate risk factors, etiologies, and manifestations of prerenal, intrarenal, and postrenal types of acute kidney injury.
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).
Manifestations of acute kidney injury
-decreased GFR, higher BUN, decreased urine output, elevated creatine.
Treatment of acute kidney injury
Treatment: treat the underlying cause, correct acid-base imbalance, manage BP, treat infections, treat nutrition, and re-perfuse kidneys.
State the definition, classifications, and diagnostic criteria for chronic kidney disease.
-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…
Explain the pathophysiologic basis for the development of hypertension, hyperkalemia, uremia, anemia, acidosis, osteodystrophy, hypocalcemia, and hyperparathyroidism associated with chronic kidney disease.
-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
Describe the concept of perfusion and how it relates to oxygenation.
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.
Preload
-Degree of stretch of cardiac muscle (at the end of diastole filling); Amount of blood in ventricles.
-Affected by venous blood pressure.
Afterload
The pressure that the heart must work against to eject blood.
Contractility
The ability of the cardiac muscle to shorten in response to an electrical impulse.
Cardiac Output
Cardiac output is determined by HR and stroke volume.
Hormones
Renin-Angiotensin-Aldosteron (RAAS)
-Angiotensin - Vasoconstriction (most medications block angio receptors)
-Aldosterone - Retention of NA, K, and H2O
ADH (?)
Influence on BP
-Cardiac output, blood volume, viscosity, and blood vessel length/diameter
Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with hypertension.
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
manifestations & complications of hypertension
Manifestations: Headache, dizziness, tinnitus, chest pain, fatigue
Complications: CNS problems (stroke, aneurysm, blurred vision), heart failure, CAD, cognitive impairment.
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.
-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!!!
Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with disorders of systemic arterial blood flow (atherosclerosis, peripheral artery disease).
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).
manifestations/complications of atherosclerosis
Blockages in different parts cause different problems (stroke, heart attack, lower limb issues PAD).
It is a “silent killer!”
Peripheral Artery Disease
-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
Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with disorders of systemic venous blood flow (varicosities, venous insufficiency).
-Impaired venous return
-Venous HTN, circulatory stasis, tissue hypoxia.
-Inflammation and edema.
-Edema becomes worse standing.
manifestations/diagnoses/risks/treatment of venous insufficiency
-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.
Venous thromboses
-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!
Describe etiology, risk factors, pathophysiology, diagnosis, manifestations, and complications associated with dyslipidemia.
-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.
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.
-Colesevelam
-Gemfibrozil
-Ezetimibe
-STATINS
Acute coronary heart syndrome
Insufficient/lack of perfusion to myocardial tissue. there are 3 severe stages of coronary occlusion.
Stable angina: (transient ischemia)
stable blood clot, partial occlusion, increased oxygen demand w/ exertion or stress, relieved with rest and NITRATES!
Chest discomfort, heaviness, pallor, sweating, dyspnea
Unstable angina: Clotting cascade (intermittent)
-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
NSTEMI: Acute heart attack 1: PARTIAL occlusion
-Elevated ST waves
-Sudden onset of pain not relieved by rest
STEMI: Acute heart attack 2: COMPLETE occlusion
-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).
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.
-Heart medications (ACE, ARB,
Calcium channel blockers)
-Diuretics
-Cholesterol-lowering drugs (statins)
-Aspirin
Antiplatelet drugs (Clopidogrel)
