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Pathopharmacology > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Endocrine System

A
  • maintains homeostasis by the use of lots of organs
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2
Q

Thryroid

A
  • produces T3 and T4, need iodine
  • regulates metabolism
  • G&D
  • heat
  • cardiac function
  • GI function
  • Ca balance
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3
Q

How and where does the hypothalamus send messages?

A
  • stimulates the autonomic nerves by releasing hormones from the pituitary gland to the peripehral organs
  • link between endocrine and nervous sytems
  • regulates HR, BP, temp, fluid and electrolytes, appetite, body weight, glandular secretions in stomach and intestines, sleep
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4
Q

Negative Feedback System

A
  • Hypothalamus senses a need for particular hormone
  • Secretes releasing factor directly into anterior pituitary
  • Response = anterior pituitary secretes hormone, and this stimulates the gland
  • Hypothalamus will sense increases for particular hormone and send messages to anterior pituitary to stop producing the hormone

Ex: blood calcium
* parathyroid gland secretes PTH, which regulates Ca in the blood
* if Ca decreases, PT glands sense decrease and secrete more PTH which stim Ca release from bones and increases Ca uptake into blood and vise versa

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5
Q

Anterior Pituitary Gland Functions

A

produces and releases hormones
* ACTH stim adrenal cortex to release ADH and cortisol
* TSH stim thyroid to release T3 and T4
* GH stim liver to produce IGF-1 (insulin-like growth factor)
* FSH/LH stim gonads to release sex hormones
* Prolactin stim breasts to produce milk

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6
Q

Posterior Pituitary Gland Functions

A

produces and releases hormones
* ADH/vasopressin stim kidneys to hold water and release based on volume balance in body
* Oxytocin stim uterus and breasts to contract and produce milk

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7
Q

Adrenal Gland Functions

A

Patho
* sit on top of kidneys
* produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions
* two parts: medulla and cortex

Medulla
* inner part
* produce epi and norepi - fight or flight catecholamines
* increase HR and BP

Cortex
* outer region, each zone is responsible for different hormone
* Cortisol: from zona fasciculata
* Aldosterone: from zona glomerulosa
* DHEA and Androgens: from zona reticularis

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8
Q

Adrenal Cortex

A
  • secretes corticosteroids and mineralocorticoids
  • if they were to become dysfunctional, will not produce enough or too many hormones
  • Addison’s: adrenal insufficiency, cortisol and aldosterine low
  • Cushing’s: cortisol too high, everything big
  • Phenochromocytoma: tumors on cortex that make too much epi and norepi (very high BP)
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9
Q

Addison’s Disease

A
  • decrease in mineralocorticoid, glucorticoid, and androgen secretion
  • ACTH from anterior pit is high, hormones are low

S/S: everything is low
* hypoglycemia
* hypotension
* hyponatremia
* low mood, energy, temp, hair
* HIGH pigmentation and K: bronze pigmentation and EKG changes

If not treated, at risk for
* CV collapse: hyperkalemia
* shock: low BP
* hypoglycemia: cortisol not able to release stored glucose in liver
* Addisonian crisis: critical deficiency of mineralocorticoids and glucorticoids (steroids)

Treatment
* steroids

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10
Q

Adrenal Insufficiency

A

Cause
* rapid withdrawl from exogenous steroids

Complications
* CV collapse
* hypoglycemia
* shock
* similar S/S to Addison’s

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11
Q

Cushing’s Disease

A

Cause
* Adrenal glands secrete excess glucorticoids or excessive androgen secretion from high steroid use

S/S: everything big
* hyperglycemia/hyperNa/hypertension
* round, hairy, face, stretch marks, red face, buffalo hump
* risk for infections and fractures

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12
Q

Diabetes Insipidus

A

Patho
* Absence of ADH allows filtered water to be excretes in the urine instead of reabsorbed
* hypovolemic

S/S
* thirst
* dry mucous membranes
* altered mental staus
* increased UO
* dilute urine
* tachycardia

Treatment
* vasopressin 0.1 munits/kg/hr
* DDAVP
* fluid replacement

NC
* monitor and replace fluids
* check neuro status
* check vitals
* check mucous mem

Ranges
* Serum Na: high >150
* Serum Osmolaity: high >295
* Urine Na: low <30
* Urine Output: high >4
* Urine Osmolality: low <200
* Urine Specific Gravity: low <1.005

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13
Q

SIADH

A

Patho
* Disorder of water metabolism caused by an excess of ADH resulting in hypoosmolality
* associated with brain injury, tumors, meds
* hypervolemic

S/S
* thirst
* CNS changes
* risk for cerebral edema
* weight gain w/o edema

Treatment
* fluid restriction
* hypertonic saline
* correction of Na

NC
* restrict fluids and replace Na
* monitor for fluid excess
* monitor I&O
* monitor vitals

Ranges
* Serum Na: low <135
* Serum Osmolality: low <280
* Urine Na: high <30
* Urine Output: low <1
* Urine Osmolality: high >200
* Urine Specific Gravity: high >1.020

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14
Q

Cerebral Salt Wasting

A

Patho
* hyponatremia and extracellular fluid depletion due to inappropriate Na wasting in urine
* associated with subarachnoid hemorrhage

S/S
* NV
* CNS changes: headache, agitation, lethargy, alterned mental status, coma
* dehydration
* hypotension

Treatment
* sodium replacement w/non dextrose isotonic or hypertonic fluids

NC
* monitor vitals
* monitor CNS changes
* give fluids

Ranges
* Serum Na: low <135
* Serum Osmolality: low <280
* Urine Na: high >80
* Urine Output: high 2-3
* Urine Osmalilty: high >200
* Urine Specific Gravity: normal-high >1.010

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15
Q

Glucocorticoid’s Effects on the Body

A

Effects on the body
* hyperglycemia
* protein breakdown (loss of muscle mass)
* inhibition of lymphocytes/antibody formation (risk of infection, poor wound healing)
* increased fat storage
* hypertension
* increased appetite
* decreased inflammation: neutrophil and macrophage action
* neurological changes: mental health and adrenal suppression

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16
Q

Why do we use steroids?

A

reduce rendess, swelling, inflammation
reduce the activity of the immune system
used for
* allergies
* skin disorders
* organ transplants
* cancer
* asthma
* some autoimmune disorders
* adrenal insuffciency
* GI

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17
Q

How do we give steroids?

A
  • oral
  • IV
  • IM
  • eye drops
  • ear drops
  • skin cream
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18
Q

Side Effects of Steroids

A
  • fluid retention
  • hypertension
  • psychological problems
  • weight gain
  • pressure in eyes
  • round face
  • hyperglycemia
  • increased infections
  • thinning bones
  • loss of appetite
  • thin skin
  • oral thrush
  • hoarseness
  • post-injection flare
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19
Q

When should steroids be used carefully? Patient Teaching

A

should only be used for a short period of time while long term treatments should be estabilished
* do not stop them if you are feeling better

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20
Q

Mineralocorticoids

A
  • holds Na and secretes K
  • used for primary and secondary adrenal insufficiency
  • replaces adrenal hormones

NC
* hypoK
* hyperglycemia
* accumulation of fat
* peptic ulcers
* HTN

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21
Q

T1DM

A

Patho
* rapid onset, seen in younger people, from genetics
* destruction of beta cells of the pancreas

S/S
* hypoglycemia: shaky, nervous, polyphagia, confusion, cold, clammy, can occur after exercise
* polyuria, polydipsia, lipolysis, acidosis
* vision changes
* frequenct skin infections

Treatment
* insulin replacement

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22
Q

T2DM

A

Patho
* insulin receptor sites are worn out and do not respond to insulin - insulin resistance
* slow progressive onset, usually occurs in mature adults

S/S
hypoglycemia: shaky, nervous, polyphagia, confusion, cold, clammy, can occur after exercise
* polyuria, polydipsia, lipolysis, acidosis
* vision changes
* frequenct skin infections
* browning of the skin on neck and armpits

Treatment
* meal planning, exercise, meds

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23
Q

What is ketosis?

A

a metabolic state that occurs when your body burns fat for energy instead of glucose
* causes: weight loss, increased ketones in blood

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24
Q

What is acidosis?

A

liver cannot remove all waste products because of insufficient insulin
* will see elevated lactic acid in patients with T1DM

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25
Q

Diabetes Diagnostics

A
  • FBS >126
  • post-prandial BS >200
  • HbA1C >6.5
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26
Q

What is insulin?

A

hormone produced in the pancreas which regulated the amount of glucose in the blood, allows glucose to enter the cells to provide energy

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27
Q

What is glucagon?

A
  • Released from alpha cells into islets of Langerhans in response to low blood glucose
  • Causes immediate mobilization of glycogen stored in lover and raises blood glucose levels
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28
Q

Metabolic Syndrome

A

need 3 or more criteria to be diagnosed
* hyperglycemia: over 100 fasting
* abdominal obesity: 35 for females, 45 for males
* increased triglycerides
* decreased HDL: high cholesterol
* increased BP
* systemic inflammation

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29
Q

Hypothyroidism

A

Patho
* thyroid hormone deficiency
* high TSH, low T3 and T4
* Hashimoto’s disease

Causes
* absence of thyroid or tumor in pituitary
* lack of iodine needed to produce needed levels of thyroid hormone
* Lack of sufficient functioning thyroid tissue due to tumor or autoimmune disorder

S/S: everything low
* low RR/HR/BP
* low temp, energy, metabolism
* low mental staus, libido, depression
* hair loss
* constipation, dry skin
* weight/water gain

Complications: Myxedema coma
* Low RR – respiratory failure
* Priority: place tracheostomy kit by bedside
* Low BP and HR
* Low temp
* Can be caused by thyroidectomy or abrupt stop of levothyroxine

Treatment
* Gradual thyroid hormone replacement with synthetic hormone levothyroxine
* Diet of low calories, low cholesterol, salts, and fats
* Frequent rest periods
* levothyroxine (synthroid)

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30
Q

Synthroid (Levothyroxine)

A
  • Lifelong drug
  • Long slow onset for 3-4 weeks
  • Early morning and empty stomach daily
  • 1 hr before breakfast
  • Very hyper: report symptoms of hyperthyroidism like agitation and confusion
  • Pregnancy safe
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31
Q

Hyperthyroidism

A

Patho
* Metabolic imbalance caused when thyroid hormone is overproduced: high energy
* Excessive amounts of thyroid hormones are produced and released into circulation - high T3 and 4
* Grave’s disease

Cause
* excessive iodine intake and stress
* Thyroid stimulating hormone secreting pituitary tumor
* Subacute thyroiditis
* Too many hypothyroid meds – levothyroxine

S/S: high and hot
* grape eye and goiter
* high HR, BP, RR
* heart palp
* intolerance to heat
* weight loss
* diarrhea
* thin skin

Complications
* thyrotoxic crisis: thyroid storm
* Onset is almost always abrupt and evoked by stressful event
* Agitation, confusion, restlessness, extreme temp, high hr and bp

Treatment: Meds
* Methimazole
* PTU
* SSKI
* Beta Blockers
* Radioactive Iodine Uptake: destroys thyroid

Other Treatments
* Grape eyes: tape eyelids down or use eye patch
* High diet in calories (4-5k per day), high protein and carbs, frequent meals and snacks
* No fiber, caffeine, spicy food

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32
Q

Roles of the Digestive System

A
  • ingest food
  • digest through mechamical chewing
  • chemical digestion in stomach
  • reabsorption in the intestine
  • excretion to form stool
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33
Q

Appendicitis

A

Patho: Inflammation of the vermiform appendix
* Inflammation accompanies the ulceration and temporarily obstructs the appendix
* Obstruction, if present, is usually caused by stool
* Mucus outflow is blocked, which distends the organs
* Pressure within appendix increases and appendix contracts
* Bacteria multiply and inflammation and pressure continue to increase, affecting blood flow to the organ and causing severe abdominal pain

S/S
* Periumbilical pain with progression and radiation to **RLQ **
* With rebound tenderness
* Pain between right hip area and belly button
* Low-grade fever

Complication
* Rupture is life threatening, appendectomy is only treatment
* Perforation: peritonitis
* High fever
* Tachycardia and pnea
* Rigid board like abdomen

Treatment
* Watch and wait
* Antibiotics
* Surgery
* No heating pads
* No laxatives and enemas: no added pressure to bowels

Need CT scan for diagnosis

34
Q

Cholecystitis

A

Patho
* Inflammation of the gallbladder caused by gallstones
* Block ducts, creates backup of bile and inflammation

Risk Factors
* Obesity and high calorie, high cholesterol diet
* Increased estrogen levels
* Use of clofibrate
* Age over 40
* Diabetes mellitus, ileal disease, blood disorders, liver disease, or pancreatitis

S/S
* RUQ pain that radiates to right shoulder
* N/V
* high WBC
* Fevers with chills
* Tachycardia
* High bilirubin: jaundice, dark urine, light colored stools
* Lack of enzymes from pancreas can make steatorrhea

Treatment
* Dietary modification
* Lifestyle modifications
* NPO, IVF, antibiotics
* Surgical removal
* Gallbladder removal
* Choledochotomy
* Exploration of common bile duct

35
Q

Cholelithiasis

A

gallstones in the gallbladder, made of cholesterol
* RUQ pain

36
Q

Constipation

A

Patho
* Infrequent bowel moments
* Less than 3 stools per week
* Lumpy, hard stools
* Straining to have a bowel movement

Causes
* stress
* low fluid and fiber
* lack of exercise

Treatment
* high fluid and fiber
* ambulation
* laxatives

Complications
* Fecal incontinence (encopresis): leakage of stool
* laxative overdose: NVD, abdominal cramping from dehydration and electrolyte

37
Q

Diarrhea

A

Patho
* loose, watery and possibly more-frequent bowel movements
* may be an indicator of IBS, IBD, celiac, C-diff

Causes
* viruses, bacteria, parasites
* meds
* lactose intolerance
* digestive disorders

S/S
* abdominal cramping and bloating
* NV
* vomiting
* fever
* blood or mucus in stool

Treatment
* IV fluids
* check electrolytes
* add antidiarrheals when no infections are present

38
Q

C-diff

A

Patho
* Infection in colon caused by imbalance in normal flora of the gut causing profuse diarrhea

Causes
* overuse of antibiotics
* hospital acquired infection - most common

S/S
* three or more liquid stools per day for more than 2 days

Complication
* GI bleed

Treatment
* oral or IV antibiotics: vancomycin, fidaxomicin, metronidazole

39
Q

Diverticulitis

A

Patho
* small, bulging pouches (diverticula) develop in your digestive tract and become inflammed

Causes
* constipation, withholding stool

S/S
* diarrhea
* abdominal pain
* feeling need to defecate and cannot

Complication
* perforation

Treatment
* diet modifications, exercise
* fluid replacement
* meds: antibiotics, analgesics, antispasmodics
* colon resection, temporary colostomy

40
Q

Esophageal Varcies

A

Patho:
* abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus)
* commonly occurs with people with serious liver diseases
* normal blood flow to liver is blocked by clot or scar tissue in liver

41
Q

GERD

A

Patho
* Backflow of gastric or duodenal contents into esophagus and past lower esophageal sphincter
* Heartburn
* Can lead to inflammation and even cancer

Causes
* Weakened lower esophageal sphincter
* Increased abdominal pressure
* Hiatal hernia: upper part of the stomach bulges, and acid gets stuck
* Medications
* Food or alcohol ingestion or cigarette smoking
* Nasogastric intubation for more than 4 days

S/S
* NV
* Burning sensation in throat, chest
* Epigastric pain following a meal
* Radiating pain to the arm and chest

Treatment
* diet therapy: small meals
* positioning: lie down 3 hours after a meal
* increased fluid intake
* stop smoking
* surgery: tighten LES
* Upper gastrointestinal endoscopy: see if the lower esophageal sphincter is closing properly
* Meds: antacids, H2 blockers, PPI

42
Q

GI Bleed

A

Causes
* Upper: gastritis, GERD, peptic ulcer, esophageal varcies from cirrhosis
* Lower: hemorrhoids, colorectal cancer, diverticulosis, UC

S/S
* Upper: vomiting “coffee ground emesis” - blood that has been digested
* Melena stool: blood from upper and made it through digestion

Complications
* Hypovolemic shock - hemorrhagic shock
* Low CBC: H&H

43
Q

Hepatitis

A

Patho
* most common infection that leads to liver failure

Cause
* Post viral infection
* Alcohol
* Autoimmune diseases
* Unprotected sex
* Sharing blood and body fluids

S/S
* Three or more liquid stool/day for more than 2 days
* Flu like symptoms
* NV
* Elevated liver enzymes: ALT and AST, bili: jaundice
* Pruritus: itching
* Dark colored urine
* Clay colored stools
* Elevated PT and aPTT: bruising
* Low albumin: edema, cannot attact water

Treatment
* New drugs vs interferon alpha
* Post-viral infection commonly resolves within a few weeks
* Apply moisturizer and use cold compresses, stay out of sun

44
Q

Prevention for Hepatitis

A
  • Avoiding risky behaviors, such as sharing needles, having unprotected sex and drinking large amounts of alcohol
  • Avoid sharing personal items, such as razors or toothbrushes
  • Avoid contact with body fluids
45
Q

Which hepatitis can we give vaccines for? Which one is required for healthcare?

A

A & B
B is for healthcare

46
Q

Which hepatitis is the most transmissable for dialysis patients?

A

B&C

47
Q

What is viral hepatitis?

A

an infection that causes liver inflammation and damage from a virus

48
Q

Hep A

A
  • fecal-oral route from food
  • can spread up to 3 months
  • obtaining antibodies = immunity
49
Q

Hep B

A
  • blood and body fluids
  • can lead to Hep if not treated
50
Q

Hep C

A
  • blood and body fluids
  • treatment: direct-acting antiviral (DAA) tablets
51
Q

H. pylori

A

bacteria that can cause an infection in the stomach or duodenum
* risk for duodenal ulcers and gastric ulcers
* found via serum antibody test
* treatment: PPI, antibiotics

52
Q

Intestinal Obstructions

A

a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon)
* Causes of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery; hernias; colon cancer; certain medications; or strictures from an inflamed intestine caused by certain conditions, such as Crohn’s disease or diverticulitis.

53
Q

Pancreatitis

A

Patho:
* Inflammation of the pancreas
* Autodigestion of own enzymes: protease, lipase, amylase

Cause
* Biliary tract disease
* Alcoholism
* Gallbladder disease
* CF
* Surgery that causes trauma: ERCP procedure, clears gallstones

Diagnostics
* Elevated enzymes - amylase, lipase
* Elevated glucose, lack of insulin
* Elevated WBC over 10k: fever
* Elevated coagulation time: PT and aPTT
* Elevated bili

S/S
* LUQ pain, may have epigastric pain or pain radiating to the back
* Bruising: Turner’s sign - on side of body, Cullen’s - on abdomen near bellybutton
* Liver disease symptoms: jaundice, HTN

Treatment
* maintain circulation, fluid volume, and pain relief
* NPO because eating stim more enzymes
* IV pain meds: hydromorphone
* meds: antacids, PPI, H2 blockers
* diet low in fat and sugars, enzymes with meals

54
Q

Portal Vein HTN

A
  • occurs during cirrosis
  • elevated pressure in your portal venous system: over 10mm Hg in vein
  • spleen will enlarge with enlarged esophagus
  • forces pressure into the esophagus: esophageal varcies
  • fluid will spill over into the abdomen: ascites
  • if the esophagus pops, will throw up blood, turn patient on side
55
Q

Peptic Ulcer Disease

A

Patho
* Open sores in mucosal membrane of upper GI tract - stomach
* Erosions in lining of stomach and adjacent areas of the GI tract from the gastric acid

Types
* duodenal
* gastric
* stress: from traumatic event

Cause: Gastric
* gastric pain
* Gnawing, dyspepsia: burning pain to the back, often occurring after meals
* weight loss
* vomiting blood

Duodenal
* Pain decreased with food, 2-3 hours after meals
* Worst at night
* Weight gain
* Blood in stool “melena” dark tarry stool

Complication
* GI bleed

Treatment
* drugs and surgery

56
Q

Atopic Dermatitis

A

Patho
* Parts of the skin become itchy, red, patchy, rough, can have serous exudate
* Autoimmune disease
* Tends to flare up periodically when exposed to allergens

57
Q

Seborrheic Dermatitis

A

Patho
* A skin condition that causes scaly patches and red skin, mainly on the scalp.
* It can also occur on oily areas of the body, such as the face, upper chest, and back.
* Can cause stubborn dandruff

58
Q

Avulsion

A
  • A small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. The muscles, tendoms, and tissues are then exposed.
  • Examples: tearing off an ear or finger, normally occurs in hips, elbows, and ankles
59
Q

Cellulitis

A

Patho
* Deep skin infection of the dermis and subq tissue from Staphylococcus entering the body through a break in the skin
* Found near lower limb of the tibia
* Can spread by direct contact

Risk Factors
* trauma
* diabetes
* lymphedema
* obesity
* venous insuffcuency
* history of cellulitis or athletes foot

S/S
* Fever
* Red, swollen, painful tenderness on skin
* Erythema
* If untreated, leads to an abscess -> sepsis -> edema

60
Q

Compartment Syndrome

A

Patho
* Increased pressure from a cast that compromises muscle and nerve perfusion, causing ischemia and potential tissue death

S/S
* Pain: Unrelieved with morphine or other meds, Extreme pain with passive movement: suffocation
* Parensthesia: Tingling, burning, numbness (24-48hrs), Problem moving or extending fingers or toes, great difficulty

Treatment
* Fasciotomy: incision through skin and fascia to reduce swelling and pressure

61
Q

Dislocation

A

Patho
* a separation of two bones where they meet at a joint
* occurs in knee, hip, ankle, shoulder, usually larger joints
* from trauma

62
Q

Subluxation

A

Patho
* partial dislocation of joints
* occurs commonly in shoulders, fingers, kneecaps, ribs, wrists, ankles, and hips

63
Q

Gout

A

Patho
* Uric acid build-up causes pain and inflammation in the joints, either from limited excretion or overproduction
* Causes destruction inside the joints and crystals in connective tissue
* Can lead to arthritis

S/S
* red skin, tender joint, hot
* usually seen in great toe

Causes
* Genetic predisposition to overproduction of uric acid
* High purine food: meat, alcohol, seafood
* Obese, diabetes, stress on the body, dehydration

Treatments
* achieve healthy weight
* avoid high purine foods (meat, seafood, alcohol, and some vegetables)
* increase fluid intake
* monitor I and O
* meds: allopurinol, colchicine

64
Q

Fractures

A

Patho
* closed: does not break the skin
* open: surface of skin is broken and bone is shown
* any way the bone breaks

Treatment
* immobilize, reduce pressure, preserve function

Delayed Bone Healing
* age
* meds
* disease
* poor circulation
* disordered coagulation
* malnourishment

65
Q

How do bones regenerate?

A
  • Inflammatory Stage: body sends out signals for inflammatory response
  • Reparative Stage: starts within a week of injury, callus (soft bone) replaces blood clot formed by inflammatory stage, becomes harder and stronge
  • Remodeling Stage: regular bone replaces callus
66
Q

Muscle Spasms

A

Patho
* Often results from injury to musculoskeletal system
* Caused by flood of sensory impulses coming to spinal cord from injured area
* from overuse of muscles, electrolyte imbalance, CNS damage, sustained injury, permanent if occurs at birth

Treatment
* meds: direct or centrally acting skeletal muscle repaxants

67
Q

Osteoarthritis

A

Patho
* Protective cartilage cushion at the end of bones wears out over time – creates bone on bone friction

Causes
* old age, women
* obese
* smoking
* repetitive stress on joints

S/S
* joint pain and stiffnesss
* crepitus
* more pain with activity and relief with rest
* node formation: joint swelling in hands
* Osteophytes and bone spurs: bony lumps that grow around the spine and in the joints
* Subchondral cysts
* Loss of range of motion
* Pain with weight bearing

Treament
* exercise, weight loss
* NSAIDS, steroids
* surgery: total knee replacements

68
Q

Osteomyelitis

A

Patho
* inflammation or swelling that occurs in the bone
* usually from infection - staph
* can spread to blood stream: sepsis

Treatment
* antibiotics
* surgery

69
Q

Osteopenia

A

Patho
* loss of bone mineral density that weakens bones
* common in older women
* no S/S - need screening test
* lifestyles changes to preserve bone density

70
Q

Osteoporosis

A

Patho
* Fragile, porous bones
* Low bone density
* Increased rate of bone reabsorption, or body makes too little bone – Ca leaves bone and goes into the blood stream
* osteopenia and osteomalacia: decrease vit D

Causes
* female, older, white & asian
* Excessive caffeine intake
* Smoking or alcohol abuse
* Medications: anticonvulsants, steroids

Complications
* fractures in hip, spine, waist

Treatment
* Ca/Vit D, bisphosphonates, SERMs

71
Q

Rhabdomyolysis

A

Patho
* Breakdown of skeletal muscle that causes release of intracellular components
* Myocytes: high in K, P, myoglobin, creatinine kinase for energy and metabolism
* can cause acute renal failure with CK levels greater than 15k

S/S
* Malaise
* Myalgia
* Weakness
* Hyperkalemia: can make cardiac problems
* Hyperphos: can create HypoCa - spasms, parensthesia, anxiety, seizures
* High myoglobin: AKI - low urine output, brown urine

Treatment
* maintain adequate fluid resuscitation and prevent acute kidney injury
* watch I and O
* watch electrolytes
* may need dialysis

72
Q

Rheumatoid Arthritis

A

Patho
* Body attacks own joints – causes systemic inflammation
* Autoimmune disorder
* More common in women

Diagnostics
* Synovial fluid aspiration to test
* Arthoscopy
* Blood Tests: RF (rheumatoid factor), ESR (erythrocyte sedimentation rate) general inflammation, CRP (c-reactive protein)general inflammation

S/S
* Fatigue, anorexia, weight loss
* **Morning joint stiffness **
* Symmetrical pain and swelling in the small joints of the hands
* Joint pain that has relief with activity and more pain at rest
* Pannus: hard tissue around the joints – scar tissue
* Ankylosis: stiffness and immobility
* Iron deficiency anemia

Treatment
* Meds: DMARDs, NSAIDs, Steroids

73
Q

Steven Johnson’s Syndrome

A

Patho
* Deadly skin disorder that can result in toxic necrolysis
* usually 10% of body

S/S
* From meds
* Flu-like symptoms
* Painful rash: widespread erythema, skin peeling and blistering
* Leads to denuded skin and mucosa: top layer of skin dies and falls off, very vulnerable to infections and sepsis

Interventions
* Everything must be sterile to prevent infection
* Wound care: sterile, moist dressings
* Warm room – prevent hypothermia
* Eye care: cool compresses and eye lubricants
* Fluids, food, pain management

74
Q

Toxic Epidernal Necrolysis

A

Patho
* a life-threatening skin disorder characterized by a blistering and peeling of the skin
* large areas of peeling skin (30% of body)

75
Q

Toxic Shock Syndrome

A

Patho
* Inflammatory response form S. aureus or Strep. Pyogenes
* Large amounts of inflammatory cytokines are released from toxic exoproteins from infection
* Causes capillary leakage and tissue damage – shock then multiorgan dysfunction
* Staph toxin – most common

S/S
* Erythroderma: arms and legs
* Fever
* Low BP
* NVD
* Dizziness
* Disorientation
* Peripheral edema
* Oliguria

76
Q

Sprain

A
  • stretching or tearing of ligaments
  • occurs in ankles “rolling”
  • caused when a joint is forced to move into an unnatural position
77
Q

Strain

A
  • A stretched or torn muscle or tendon
  • Often occur in the lower back and in the muscle in the back of the thigh
77
Q

Strain

A
  • A stretched or torn muscle or tendon
  • Often occur in the lower back and in the muscle in the back of the thigh
78
Q

Lupus

A

Patho
* an autoimmune disorder where the body attacks itself, causing major inflammation in the skin, joints, kidneys, & heart resulting in organ failure over time, most often in the kidneys

Causes
* unknown
* mostly in pre-menopausal women

S/S
* Butterfly-shaped rash
* Fever higher than 100
* Joints: painful and swollen

Triggers
* Sun
* Smoking
* Stress
* Sepsis

Treatment
* steroids
* immunosupporessants

79
Q

Vitamin D

A
  • necessary for strong bones and muscles
  • needed to absorb Ca
80
Q

PTH and Calcitonin’s Effects on
Bone

A
  • two peptide hormones that play important roles in calcium homeostasis through their actions on osteoblasts (bone forming cells) and osteoclasts (bone resorbing cells)
  • PTH is responsible for stimulating the enzyme that transforms vitamin D your skin makes from sun exposure into calcitriol
  • Calcitonin decreases calcium levels by blocking the breakdown of bone calcium and by preventing your kidneys from reabsorbing calcium

Pathopharmacology (6 decks)

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