Exam 2 Flashcards
1
Q
lower esophageal sphincter/ LES
A
circular muscle that prevents regurgitation of stomach contents into esophagus
2
Q
barrett esophagus
A
when the body adapts to chronic reflux by replacing squamous epi tissue w/ tougher columnar tissue → cancer risk
3
Q
GERD & sx
A
when LES relax at wrong time or doesn’t close tight enough causing reflux of stomach contents back up & dmg esophagus
s/sx: burning CP / belching / vomit / PM onset after meals
“GERD”
G= generally known as Heartburn
E= epigastric pain & spasm after meals
R= radiate to arms & chest
D= diet therapy, antacid, stop smoking
4
Q
causes of GERD
A
-weak esophageal sphincter
-increased ABD pressure
-hernia
-meds
-smoking
-NG intubation > 4 days
5
Q
GERD meds
A
antacids
PPI
sucralfate
H2 receptor antagonist
6
Q
Patho changes w/ chronic GERD
A
esophagitis
metaplasia
strictures
7
Q
Crohn’s disease & sx
A
intermittent skip lesions in any GI area
cobblestone, fibrosis
malabsorption
s/sx: RLQ pain, diarrhea, fistula, obstruction
8
Q
ulcerative colitis & sx
A
chronic bleeding ulcers continuously in rectum & colon
s/sx: bloody stool, tenesmus, cramps, perforation, cancer
9
Q
viral hepatitis
A
inflammation of liver due to viral infections, toxin, or autoimmune
HEP A : most srs
HEP B
HEP C
HEP D
HEP E
10
Q
Acute hepatitis
A
HEP A, E
fecal-oral route
liver necrosis
recover in few months
11
Q
Chronic hepatitis
A
HEP B, C, D
body fluid route
decrease liver function > 6 months
necrosis, fibrosis, cirrhosis, cancer
12
Q
prodromal period
A
highly contagious
sx begins
13
Q
icterus period
A
illness
sx apparent
14
Q
convalescent period
A
recovery
die if edema or encephalopathy
15
Q
cirrhosis & sx
A
irreversible
end stage liver failure
liver tissue replaced by fibrosis
sx: portal HTN, ascites, jaundice, nutritional deficiency
16
Q
Sucralfate
A
mucosal protectant
for duo ulcers in PUD
side effects:
constipation
ed:
1h before ea meal and PM on empty stomach
eat fiber & fluids
separate from other meds
“SUCMETH”
S= separate frm other meds
u= ulcers in PUD
c= constipation
m= mucosal protectant
e= eat 1h before meals
t= take on empty stomach, PM
h= hydrate, fiber
17
Q
H2 receptor antagonist / blockers
A
“dine”
Ranitidine , Famotidine
suppress gastric acid secretion
Monitor GI bleed, take PM
contraindication: liver dmg
effects: rare CNS effect in elderly
ed: avoid alcohol, caffeine, smoke
DINE
d= dont drink, smoke, coffee
i= increase liver dmg
n= night med
e= elderly- CNS
*GI bleed
18
Q
PPI / proton pump inhibitor
A
“prazole”
omeprazole , pantoprazole
decrease gastric acid production
effects:
pneumonia, osteoporosis, rebound acid hypersecretion
*don’t crush, taper
ed: take AM before meals, avoid NSAIDs
“PRONE”
P= pneumonia
R= rebound acid - taper
O= osteoporosis
N= never w NSAIDs
E= eat AM before meals
19
Q
PUD / peptic ulcer disease & sx
A
imbalance btwn gastric mucosal defenses & gastric acid/pepsin.
H.pylori, NSAIDs dmg mucosal lining.
sx: heartburn, gas, N/V, GI bleed, perforation, obstruction
20
Q
Loperamide
A
anti-diarrheal
slows bowel motility to increase water absorption
effects: constipation, drowsy
*monitor for ileus & bowel sounds / obstruction
contraindication: bacterial infection / C. diff, acute dysentery
ed: don’t exceed prescribed dose
CANTGO
C= constipation
a= acute dysentery
n= no c.diff
t= to slow bowels
g= got ileus, bowel sounds
o= obstruction
21
Q
Bismuth Subsalicylate
A
anti-diarrheal
coats stomach lining to reduce inflam / irritation
effects: black tongue / stool (norm)
Reyes (kids)
salicylism (tinnitus, dizzy)
contraindication: ASA allergy, kids
22
Q
primary biliary cirrhosis
A
inflammation and scarring of bile ducts
enlarged, green liver
23
Q
secondary biliary cirrhosis
A
prolonged obstruction of extra biliary tree / gallbladder stones
24
Q
alcohol-induced cirrhosis
A
*fatty liver disease= triglyceride accumulation
enlarged, yellow liver
reversible
*alcoholic hepatitis= liver cell inflam & necrosis
*cirrhosis
25
prostaglandin analog
Misoprostol
prevents NSAID induced ulcer, labor induction
effects: diarrhea, ABD pain, miscarriage
*verify neg pregnancy test before giving
contraindication: pregnancy, caution IBD
ed: use effective contraception, take w meals
MISTOP
m= miscarriage
i= induce labor
s= stops NSAID ulcers
t= take w meals
o= over toilet- diarrhea
p= pain in ABD
26
antacids
calcium carbonate , Mg hydroxide, Aluminum
neutralize gastric acid
effects:
calcium= constipation , kidney stones, hypercalcemia (musc weakness)
mg= diarrhea , hypermagnesemia (resp depression)
aluminum= constipation
*separate frm other meds by 2h
contraindication: kidney disease (Mg accumulation)
ed: don't overuse , take after meals PRN
CAM
c= c+ carbonate (constipation, kidney stone, hypercal- musc weak)
a= aluminum (constipation)
m= mg hydroxide (diarrhea, hypermg- resp depression)
SAN
s=separate med 2h
a= avoid kidney disease
n= neutralize acid
27
diverticulitis sx & complication
small pouches (diverticula) in colon become inflamed bc increased pressure, trapped food, bacteria, chronic low fiber diet or constipation
sx: LLQ pain, fever, nausea, diarrhea/constipation
complication: abscess, obstruction, perforation, peritonitis
28
general ed for constipation
Hydrate (2-3 L daily)
High fiber diet
Avoid laxatives if absent bowel sounds / obstruction
monitor electrolyte for imbalances
29
osmotic laxatives
Lactulose , Mg hydroxide
for constipation- draws water into intestine
lactulose: "latches" to ammonia and excretes it
*for hepatic encephalopathy in cirrhosis
effects: diarrhea , dehydration
contraindication: bowel obstruction
ed: hydrate, expect freq BM- esp if hepatic
30
stimulant laxative
Bisacodyl , Senna
stimulates peristalsis
effects: cramping, dependence
contraindication: ABD pain, obstruction
ed: don't use long term, expect BM in 6-12h, hydrate
BASCOD
b= BM in 6-12h
a= ABD pain
s= stimulates peristalsis
c= cramps
o= obstruction
d= dependence
31
Ondansetron
anti-emetic
for N/V
effects:
rare prolonged QT
*monitor ECG w cardiac hx , give before nausea starts
ed: cause drowsiness, report irregular HR
32
Promethazine
anti-emetic
for N/V
effects:
sedation, resp depression (esp kids), extravasation risk,
extra pyramidal sx
*(stop taking & treat w benadryl)
*avoid kids
ed: avoid other CNS depressants. don't drive or operate heavy machinery
ETHER
e= extravasation, extra pyramidal
t= treat w benadryl
h= hold if kids- OD
e= extra sedative
r= reject CNS depressants
33
cannabinoids
Dronabinol
Chemo-induced N/V, appetite stimulant
*derived from marijuana
effects: euphoria, dizzy, paranoia
ed: avoid hazardous activities, take as directed
CAPE
C= chemo n/v
a= appetite stim
p= paranoia
e= euphoria
34
Psyllium
laxative - bulk forming
for constipation
effects: obstruction if dehydrated
*take w 8oz fluid
ed: fiber & hydrate
35
docusate sodium
stool softener for constipation
effects: mild ABD cramping
*works slowly (1-3 days)
ed: hydrate
36
compensated cirrhosis & sx
liver is severely damaged but can still function by
compensating for damage
sx: vascular spiders, red palms, AM indigestion, gas dyspepsia, abd pain, firm, enlarged liver
37
decompensated cirrhosis & sx
liver cant make proteins or clotting factors
sx: ascites, jaundice, muscle wasting, wt loss, clubbing, hypotension, sparse body hair
38
hypertension
>130/80
heart works harder to pump against resistance
leads to heart and blood vessel dmg
BP= CO x R
39
essential HTN
AKA primary / idiopathic
chronic cardiovascular disease causing abnormally high BP for unknown reasons
40
secondary HTN
HTN caused by another disease
41
malignant HTN
severe, fulminant form
42
heart failure
heart cant pump to meet body's O2 demands
43
afterload
the resistance the ventricles pump against
*must overcome this pressure to pump properly
44
preload
amt of blood heart must pump w/ each beat
45
CHF
heart can't pump properly → fluid overload, pulmonary congestion, decreased perfusion
blood in lungs = SOB and cant oxygenate blood → hypoxia
46
L-sided heart failure
L-ventricle cant contract = Lungs
"DROWNING"
D= dyspnea (nocturnal and on exertion)
R= rale / crackle / wheeze
O= orthopnea
W= weak, fatigue
N= nagging Cough (bloody, pink, frothy sputum)
I= increase HR
N= nocturia & Confusion
G= got Cyanosis
47
R-sided heart failure
R ventricle can't contract due to L-sided failure = Body
"SWELLING"
S= super high venous pressure
W= w/ ascites
E= enlarged spleen, liver
L= lots of wt change
L= large neck veins / JVD
I= irregular HR
N= note dependent edema
G= GI issues
48
stroke vol
vol of blood ejected from ventricles w/ ea contraction
49
anti-coagulants
"HEW"
Heparin - monitor aPTT
Enoxaparin
Warfarin - monitor INR & PT
*Vit K antagonist
thins blood to prevent clots & stop them from getting bigger
50
long-term anti-coags
Apixaban
Rivaroxiban *factor Xa blocker
less monitoring
51
Anti-platelets
ASA
clopidogrel
prevents platelets from sticking tg (aggregating) to stop clots
side effect: GI bleed, tinnitus
contraindication: PUD, bleeding disorders
ed: take w food to reduce GI discomfort
52
thrombolytics
Alteplase
clot buster
for ischemic stroke, MI, PE
contraindication: pregnancy, bleeding
53
Beta Blockers
anti HTN
"lull heart to sleep"
decrease BP & HR
ends in "lol"
"1 Heart, 2 Lungs"
cardioselective= targets beta blockers in heart (metoprolol, atenolol)
non-cardioselective= targets beta blockers in heart & lungs (carvedilol, labetolol)
side effect: brady, hypotension, bronchospasm (nonselective)
*hold if HR <50 or systolic BP <90
contraindication: heart & BP issues
ed: taper (rebound HTN)
54
ACE inhibitor
anti HTN
blocks angiotensin 1 to 2, decreasing preload & afterload
ends in "pril"
side effect:
cough
hyperkalemia
angioedema (swelling mouth) *emergency
*monitor BP, liver, potassium
contraindication: preggo, angioedema
ed: report persistent cough, avoid potassium
ACH
a= angioedema
c= cough
h= hyperkalemia
55
C+ channel blocker
vasodilate arteries to lessen heart's workload
stops C+ influx to reduce Resistance & BP
some ends in "pine"
Amlodipine, Verapamil
side effect: peripheral edema, dizzy, cardio-suppression (rare), ortho hypotension, rebound HTN
*hold if BP <90
contraindication: digoxin, beta blockers, grapefruit
ed:
report irregular HR, SOB, edema
change positions slowly
CHANNER - pine
C= cardiosuppression - rare
h= hypotension, hold if BP < 90
a= avoid grapefruit
n= no digoxin
n= no beta blockers
e= edema- peripheral
r= rebound HTN
56
ARBS
anti HTN
blocks effects of angiotensin 2
"ARB ARTAN!"
Losartan
contraindication: ACE inhibitor, preggo, renal stenosis
side effect:
hyperkalemia, angioedema, hypotension
ed: avoid potassium
ARTAN
A= anti HTN
r= rly high K+
t= test preg
a= Angioedema
n= no ACE, renal stenosis
57
Hydralazine
vasodilator
dilates blood vessels to lower BP
contraindication: heart issues
side effects: tachy, flushing, HA
58
Loop Diuretics
Furosemide
Stops sodium reabsorption in loop of Henle, reducing preload
helps control BP
side effect: hypokalemia, ototoxicity (tinnitus, hearing loss), dehydration
*monitor electrolytes, check BP before giving
contraindication: severe electrolyte depletion, gentamycin
ed: take AM to prevent nocturia, increase potassium
FOREST
f= for BP
o= ototoxic (tinnitus, hearing loss)
r= review BP before giving
e= electrolytes & K+ depletion
s= stop NA+ reabsorption
t= take AM
59
What to do before giving anti-hypertensives?
Check BP & HR
Hold if systolic BP <100 or HR < 60
60
Angina
CP caused by myocardial ischemia from reduced blood flow to heart bc atherosclerosis narrows vessels
61
Nitroglycerin (SL)
Dilates coronary arteries to improve blood flow and O2 delivery
decrease preload → decrease heart's work load & O2 demand
For angina
side effect: HTN, HA, dizzy, weak
*monitor BP before & after giving, stay w pt
contraindication: PDE-5 blocker, liver/kidney disease
ed: take while sitting, avoid alcohol, don't > 3 tabs (call 911 if still hurts)
store in dark, dry, cool place
NITROBID
n= never take > 3 tabs
i= increase blood flow
t= take while sitting
r= review BP before & after
o= oh so dizzy, HTN, HA
b= blocks PDE-5
i= in dark, dry, place
d= don't take w viagra
62
HMG-CoA Reductase Inhibitor
Statin
lowers cholesterol
for CAD - slows CAD to prevent MI
side effect: rhabdomyolysis, myopathy, hepatotoxicity, GI issues
*give PM
*check HDL, LDL, liver function test
contraindication: pregnancy, liver disease
ed: avoid grapefruit juice, report dark urine
HMG COA
h= hepatotoxic
m= myopathy, rhabdo
g= GI issues
C= CAD / cholesterol
o= overly dark urine
a= avoid grapefruit
63
Cardiac Glycoside
Digoxin
Increase cardiac contractility and decrease HR
For heart failure & arrhythmias
side effect:
brady
digoxin tox (brady, N/V, vision- yellow halos, GI issues)
*Digoxin Immune Fab = antidote for digoxin tox
*check apical HR & electrolytes before giving
*hold if HR < 60
contraindication: V-Fib, MI, heart block
ed: maintain consistent potassium intake, take same time ea day
CARDIAC
c= contraction increase
a= arrhythmia, heart failure
r= reduce HR
d= digoxin tox (vision)
i= intake same time daily
a= apical HR, hold if <60
c= consistent K+
64
Potassium-Sparing Diuretic / Aldosterone Antagonist
Spironolactone
Blocks aldosterone, promoting sodium excretion while retaining potassium
side effect: Hyperkalemia, gynecomastia
contraindication: hyperkalemia, kidney failure
ed: avoid potassium
RAGS
R= retain k+
a= aldosterone blocker
g= gynecomastia
s= sodium excretion
65
Thiazide Diuretic
Hydrochlorothiazide
Increase sodium & water excretion, reducing blood vol & BP
side effect: Hypokalemia, dehydration, hyperglycemia
*monitor electrolytes, check BP before giving
contraindication: sulfa allergy, anuria
ed: increase potassium
RIGHT
R= review BP before
I= increase sodium, water excretion
g= got hypokalemia
h= hyperglycemia
t= try avoiding anuria, sulfa allergy
66
Direct Renin Inhibitor
Aliskiren
Blocks renin, reducing angiotensin I and II → vasodilation & decrease BP
side effect: Hyperkalemia, hypotension, angioedema
contraindication: preggo, angioedema, ACE, ARB
ed: take at same time daily, avoid high fat meal
BLAATH
B= blocks renin to lower BP
L= low fat meal
a= angioedema
a= avoid ACE, ARB
t= take same time daily
h= hyperkalemia
67
Potassium
Electrolyte Supplement
Replace K+ lost due to diuretics
side effect: hyperkalemia, arrhythmia
*monitor K+, give w food
contraindication: hyperkalemia, kidney issue
ed: don't crush/chew XR tabs
68
hypotension & sx
<90/60
CO decrease due to hypovolemia, sepsis, shock, dehydration
sx: tachy, blurry vision, pallor, diaphoresis, dizzy, CP, LOC
69
positive inotropic
increase force of contraction
70
negative chronotropic
slows SA node signals
71
negative dromotropic
slows travel of impulse thru conduction system
72
stable angina
CP during exercise
resolves quickly
better w rest or NTG
73
unstable angina
plaque broke off
CP w exercise or at rest
lasts longer, worsens ea time
74
myocardial infarction / MI
CP unrelieved by rest or NTG
lasts > 30mins
SOB, N/V, diaphoresis
75
Stroke / CVA (cerebrovascular accident) & sx
interruption of blood flow to brain
brain cant get O2 / nutrients → brain dmg
hemorrhagic stroke= ruptured artery in brain
ischemic stroke= blood clot (thrombotic or embolic)
thrombotic: clot in artery
embolic: clot that travels to brain frm another place in body
sx: unilateral weakness, face drooping, vision, speech
*L = language, R= reckless
76
hyperlipidemia
high cholesterol
body makes own cholesterol, also comes from dairy, eggs, meat
too much causes atherosclerosis
risk for stroke or MI
77
PAD / peripheral arterial disease
caused by atherosclerosis & arterial ischemia
restricted blood flow to extremities→ less O2 → cell death
better w rest - intermittent claudication (worse on exercise)
pale, shiny skin
hair loss
atrophic changes
smooth ulcer on toe
cap refill > 3s
diabetes
78
PVD / peripheral venous disease
peripheral veins cant pump blood from extremities
blood pools, can't get back up
caused by incompetent veins / skeletal muscle pumps / obstructions
better w activity
elevate
brown pigmentation
edema, warmth
irregular bleeding ulcer
HTN, diabetes
79
anemia
not enough RBC to carry O2
heart overworked
80
megaloblastic anemia & sx / rx
Folic Acid Deficiency
disrupts norm DNA synthesis, leading to large, dysfunctional RBC
sx: Fatigue, pallor, glossitis, irritability, neural tube defects in pregnancy
treat: Folic acid
81
iron deficiency anemia & sx / rx
Low iron, menstruation
sx: Fatigue, pallor, brittle nails, glossitis, pica (craving non-food items like ice, dirt, starch)
*treat: Ferrous sulfate (iron)
82
pernicious anemia & sx / rx
Vit B12 Deficiency
deficiency of intrinsic factor needed for B12 absorption, leading to impaired RBC production
*autoimmune
sx: Fatigue, pallor, neuropathy (tingling/numb in hands/feet), glossitis, memory/balance issues
*treat: lifelong Cyanocobalamin injections (vit B12)
83
Deep Vein Thrombosis (DVT) & sx
clot in deep vein of legs due to venous stasis, endothelial injury, or hypercoagulability
can lead to PE
sx:
Unilateral edema, warmth
+ Homan’s sign (pain in calf when dorsiflexing foot)
84
Pulmonary Embolism (PE) & sx
clot dislodges and travels to lungs
obstruct pulmonary circulation and impair gas exch
sx:
Sudden dyspnea/tachypnea, CP, hemoptysis, hypoxia
85
Heparin / Enoxaparin
blocks thrombin and Factor Xa, preventing clots
side effects:
Bleeding
HIT (heparin-induced thrombocytopenia)
osteoporosis (long-term use)
*Monitor aPTT for unfractionated heparin;
*protamine sulfate = antidote
contraindication: bleeding, thrombocytopenia
ed: Avoid activities that increase bleeding risk
ENOX-HP
e= examine aPTT
n= no bleeding
o= osteoporosis (long term use)
x= factor xa, thrombin blocker
h= HIT
p= protamine sulfate = antidote
86
Warfarin
vit K antagonist
blocks vit K-dependent clotting factors (II, VII, IX, X)
side effects: Bleeding, necrosis, teratogenic
*monitor INR (therapeutic range: 2-3)
*Vit K = antidote
contraindication: Pregnancy, surgery, bleeding
ed: vit K diet, Avoid alcohol and NSAIDs
VITK
v= vit k blocker
i= INR (2-3)
t= teratogenic
k= known necrosis
87
Direct Factor Xa Inhibitor
Rivaroxaban
blocks Factor Xa, preventing clots
side effect: Bleeding, liver toxicity
*monitor for liver enzyme elevation
contraindication: bleeding, liver dmg
ed: take w food
88
Antiplatelet Agent
Clopidogrel
stops platelet aggregation by blocking ADP receptors
side effect: Bleeding, TTP (thrombotic thrombocytopenic purpura)
*monitor CBC, platelets
contraindication: bleeding
ed: avoid NSAIDs and alcohol, report petechia
89
Erythropoietin (Epoetin Alfa)
Stimulates RBC production in bone marrow to counteract anemia caused by CKD
side effect: HTN, clots, edema, HA
*increased risk of cardiovascular issues
*Monitor Hgb (discontinue if >11 g/dL to prevent clots)
contraindication: Uncontrolled HTN, hx stroke or thrombotic disorders
90
Neutropenia & sx
abnorm low levels of neutrophils, a WBC for fighting infections
sx: Freq infections, fever, sore throat, mouth ulcers, fatigue
91
G-CSF (Granulocyte Colony-Stimulating Factor)
Filgrastim
Stimulates production of neutrophils in bone marrow to reduce infection risk
side effects: Bone pain, splenic rupture, allergic rxn
contraindication: allergy to E. coli-derived proteins
ed: avoid crowds, maintain good hygiene
GRASS
G= good hygiene
r= rupture spleen
a= allergy to E.coli
s= severe bone pain
s= stim neutrophils
92
aPTT / INR test
measures the time it takes for blood to clot
93
Hct test
measures % of RBCs in total vol of blood
94
ferrous sulfate
for low iron anemia
GI upset
dark stools
teeth stain *use straw
FE toxicity in kids
take w Vit C to increase absorption
avoid antacid 2h
95
BNP
balance fluids
>100 = heart failure
the higher, the worse it is
