Final Flashcards
Angiotensin II is a potent what?
vasoconstrictor
What causes arrhythmias?
Electrolyte imbalance, hypoxia, structural damage, acidosis, cardiac drugs
Blood Pressure
the pressure of blood pushing against the walls of your arteries
Systolic BP
- the top number
- measures the pressure in your arteries when your heart beats
Diastolic BP
- the bottom number
- measures the pressure in your arteries when your heart rests between beats
Pulse Pressure
- the difference between the upper and lower numbers of your blood pressure.
- helps to predict heart attack or stroke
- tends to increase with age
- normal: 40-60
- wide pressure associated with heart attack
- narrow pressure associated with heart failure
Cardiac Output
- how many liters of blood your heart can pump in a minute
- multiply stroke volume and heart rate
- determines the heart’s strength and health
- need more cardiac output when exercising since body’s cells need more oxygen
- measured when difficulty exercising arises or heart failure present
- normal: 4 to 8 L/min
Perpheral Vascular Resistance
- force that resists the flow of blood through the vessels, mostly determined by the arterioles, which contract to increase resistance; important in determining overall blood pressure
- heart rate, stroke volume, and peripheral vascular resistance are factors that determine BP
- when there is low pressure on the baroreceptors, the medulla is stimulated to increase the sympathetic nervous system to constrict the blood vessels and increase peripheral vascular resistance
What do we need to have a blood pressure in our body?
the amount of blood the heart pumps and how hard it is for the blood to move through the arteries
EKG
- detects the patterns of electrical impulse generation and conduction through the heart and translates that information into a recorded pattern, which is displayed as a waveform on a cardiac monitor
- a measure of electrical activity; it provides no information about the mechanical activity of the heart
Edema
- swelling caused by excess fluid trapped in your body’s tissues
- usually seen on hands, arms, feet, ankles and legs
- occurs when tiny blood vessels in your body (capillaries) leak fluid
- risk factors: CHD, lung diseases, venous insufficiency, long periods of sitting and standing
- treatment of the underlying cause (if possible), reducing the amount of salt (sodium) in your diet, and, in many cases, use of a medication called a diuretic to eliminate excess fluid, using compression stockings and elevating the legs may also be recommended
Endothelial Layer of the Heart
- the innermost layer of the heart and lines the chambers and extends over projecting structures such as the valves, chordae tendineae, and papillary muscles
- endothelial cells release substances that control vascular relaxation and contraction as well as enzymes that control blood clotting, immune function and platelet (a colorless substance in the blood) adhesion
Heart Electrical Conductivity
property of heart cells to rapidly conduct an action potential of electrical impulse
1. starts when your sinoatrial (SA) node creates an excitation signal
2. tells atria (top heart chambers) to contract
3. The atrioventricular (AV) node, delaying the signal until your atria are empty of blood.
4. The bundle of His (center bundle of nerve fibers), carrying the signal to the Purkinje fibers.
5. The Purkinje fibers to your ventricles (bottom heart chambers), causing them to contract.
Hypertension
- Intermittent or sustained elevation of diastolic or systolic blood pressure
- HTN: Systolic blood pressure of 139 mm Hg or higher or a diastolic blood pressure greater than 89 mm Hg
- Pre-HTN: systolic pressure from 120–139 and diastolic from 80-89
Determined by
* amount of blood pumped from ventricles w/ each heartbeat
* Total PVR – resistance of muscular arteries to blood being pumped
* Baroreceptors
* RAAS
Hyperlipidemia
Causes
* When the levels of lipids in the blood increase, hyperlipidemia occurs
* This can result from excessive dietary intake of fats or from genetic alterations in fat metabolism, leading to a variety of elevated fats in the blood
* Hypercholesterolemia, hypertriglyceridemia, alterations in LDL and HDL concentrations
Best Ways to Combat
* reduce intake of saturated fats in dairy and red meat
* Niacin, Fenofibrate, Omega-3
Troponin Labs
chemical in heart muscle that prevents the reaction between actin and myosin, leading to muscle relaxation; it is inactivated by calcium during muscle stimulation to allow actin and myosin to react, causing muscle contraction
Normal Values:
* Troponin I: 0 - 0.04 ng/mL.
* Troponin T: 0 - 0.01 ng/mL.
High Levels Correlate with
* Heart surgery.
* Infections or inflammation in your heart.
* Cardioversion (this is the use of an electric shock to make an irregular heart rhythm return to normal).
Creatine Kinase Labs
An enzyme that’s found in your skeletal muscle, heart muscle and brain.
When any of these tissues are damaged, they leak creatine kinase into your bloodstream.
Elevated CK levels may indicate muscle injury or disease.
Normal
* 22 to 198 U/L
Three Types
* These are CK-MB, CK-MM, and CK-BB. CK-MB is the substance that rises if your heart muscle is damaged. CK-MM rises with other muscle damage. CK-BB is found mostly in the brain.
Myoglobin Labs
measures the amount of myoglobin, a protein found in your skeletal and heart muscles, in your blood or urine.
* Myoglobin is a protein that’s found in your striated muscles, which includes skeletal muscles (the muscles attached to your bones and tendons) and heart muscles. Its main function is to supply oxygen to the cells in your muscles (myocytes).
* High levels generally indicate muscle damage; though, the test cannot determine the cause or location of the muscle damage.
Normal
* For men: Less than 91 ng/mL (nanograms per milliliter).
* For women: Less than 63 ng/mL.
Triglycerides
lipids that give the body energy from the food we eat
Pure cholesterol cannot mix with or dissolve in the blood. Instead, the liver packages cholesterol with triglycerides and proteins called lipoproteins. The lipoproteins move this fatty mixture to areas throughout the body.
* High triglycerides combined with high cholesterol raise your risk of heart attack, strokes and pancreatitis
Levels: 150 or less
Phospholipids
a class of lipids whose molecule has a hydrophilic “head” containing a phosphate group and two hydrophobic “tails” derived from fatty acids, joined by an alcohol residue
antiphospholipid syndrome
* autoimmune disorder that causes blood clots by the body’s immune system attacking proteins bound to phospholipids
* These antibodies make it much more likely that you will have blood clots in your arteries or veins
Cholesterol
found in large quantities in the membrane, and it works to keep the phospholipids in place and the cell membrane stable
* necessary component of human cells that is produced and processed in the liver and then stored in the bile until stimulus causes the gallbladder to contract and send the bile into the duodenum via the common bile duct; a fat that is essential for the formation of steroid hormones and cell membranes; it is produced in cells and taken in by dietary sources
* Normal: less than 200 mg/dL
Chylomicrons
carrier for micelles or lipids in the bloodstream, consisting of proteins, lipids, cholesterol, and so forth
* chylomicrons pass through the wall of the small intestine, are picked up by the surrounding intestinal lymphatic system, travel through the system to the heart, and then are sent out into circulation
VLDL
produced in the liver and released into the bloodstream to supply body tissues with a type of fat (triglycerides)
* High levels of VLDL cholesterol have been associated with the development of plaque deposits on artery walls, which narrow the passage and restrict blood flow.
* An elevated VLDL cholesterol level is more than 30 milligrams per deciliter
IDL
are formed from the degradation of very low-density lipoproteins as well as high-density lipoproteins
* enable fats and cholesterol to move within the water-based solution of the bloodstream
* refers to a density between that of low-density and very-low-density lipoproteins.
LDL
tightly packed fats that are thought to contribute to the development of coronary artery disease when remnants left over from the LDL are processed in the arterial lining
* enter circulation as tightly packed cholesterol, triglycerides, and lipids, all of which are carried by proteins that enter circulation to be broken down for energy or stored for future use as energy
* Lab: 100 or less
HDL
loosely packed chylomicron-containing fats, able to absorb fats and fat remnants in the periphery; thought to have a protective effect, decreasing the development of coronary artery disease
* enter circulation as loosely packed lipids that are used for energy and to pick up remnants of fats and cholesterol that are left in the periphery by LDL breakdown
* Lab: 40 or more
Orthostatic Hypotension
A form of low blood pressure that happens when standing up from sitting or lying down
Causes include dehydration, long-term bed rest, pregnancy, certain medical conditions and some medications.
* commonly seen in the elderly because of age-related impairment in baroreflex compensatory reflexes (maintains blood pressure at constant rate) to upright position
* Hypovolemia: Loss of fluid within the blood vessels is the most common cause of symptoms linked to orthostatic hypotension. This could be due to dehydration brought about by diarrhea, vomiting, and the use of medication, such as diuretics or water pills.
Myocardial Infarction
blockages in coronary arteries within the heart
heart does not get enough O2 from the blockage
Plaque Rupture
Plaques inside the coronary arteries sometimes break open or “rupture.” This is what causes most heart attacks. When a plaque breaks open, it causes a blood clot to form inside the artery. As the clot grows, it can completely block off the flow of blood through the artery.
RAAS
the system of hormones, proteins, enzymes and reactions that regulate your blood pressure and blood volume on a long-term basis
1. When your blood pressure falls, your kidneys release the enzyme renin into your bloodstream.
2. Renin splits angiotensinogen, a protein your liver makes and releases, into pieces. One piece is the hormone angiotensin I.
3. Angiotensin I, which is inactive (doesn’t cause any effects), flows through your bloodstream and is split into pieces by angiotensin-converting enzyme (ACE) in your lungs and kidneys. One of those pieces is angiotensin II, an active hormone.
4. Angiotensin II causes the muscular walls of small arteries (arterioles) to constrict (narrow), which increases blood pressure. 5. Angiotensin II also triggers your adrenal glands to release aldosterone and your pituitary gland to release antidiuretic hormone (ADH, or vasopressin).
6. Together, aldosterone and ADH cause your kidneys to retain sodium. Aldosterone also causes your kidneys to release (excrete) potassium through your urine.
7. The increase in sodium in your bloodstream causes water retention. This increases blood volume and blood pressure, thus completing the renin-angiotensin-aldosterone system.
7 P’s of Arterial Occulusion
condition involving partial or complete blockage of blood flow through an artery, stops flow of oxygen, causing ischemia
1. pistol pain
2. pallor
3. polar (coldness)
4. pulselessness
5. pain
6. paresthesia (pins and needles sensation)
7. paralysis
What regulates the smooth muscles in the heart?
the sinoatrial node of the heart
the pacemaker
Thrombin
an enzyme in blood plasma which causes the clotting of blood by converting fibrinogen to fibrin
One-Way Valves
supports the return of blood flow to the heart through venous circulation
Virchow’s Triad
three contributing factors in the formation of thrombosis: venous stasis, vascular injury, and hypercoagulability
Risk Factors for Venous Stasis
- immobility
- spinal cord injury
- CHF
- venous obstruction
Acute Coronary Syndrome
Patho: Blood supply to the myocardium is interrupted from occlusion of one or more of the coronary arteries.
Causes:
* Atherosclerosis
* Thrombosis
* Platelet aggregation
* Coronary artery stenosis or spasm
Types:
* Unstable angina
* Variant or Prinzmetal’s angina
* Non–ST-elevation myocardial infarction (non-STEMI or non–Qwave MI)
* ST-elevation myocardial infarction (STEMI or Qwave MI)
S/S
* Chest pain, radiating shoulder pain, NV, DOE, SOB
Complications: Damage caused by an MI:
* Reduced contractility with abnormal wall motion
* Altered LV compliance
* Reduced SV
* Reduced EF
* Elevated LV end-diastolic pressure
Treatment
* Treat chest pain
* Stabilize heart
* Reduce cardiac workload
Aneurysms
Patho: a bulge or ballooning in a blood vessel in the brain
may occur in any part of the aorta or major arteries
Causes:
* Usually caused by atherosclerosis (thickening of the arterial walls)
* infection
* trauma
* congenital abnormalities
S/S
* Back pain
* Cough
* Weak, scratchy voice (hoarseness)
* Shortness of breath
* Tenderness or pain in the chest
Atherosclerosis
leading cause of coronary heart disease
Risk Factors:
* age
* male
* women after menopause
* family history
* lifestyle: smoking, obesity, diet
* type 1 and 2
Clinical Manifestations
* Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.
Complications:
* ischemic heart disease, stroke, peripheral vascular disease
Hypercholesterolemia
a lipid disorder in which your low-density lipoprotein (LDL), or bad cholesterol, is too high
* This makes fat collect in your arteries (atherosclerosis), which puts you at a higher risk of heart attack and stroke
* 190 mg/dL or higher without other risk factors.
Higher than 160 mg/dL with another major risk factor.
Above 130 mg/dL with two risk factors.
Risk For:
* stroke
* coronary artery disease
* peripheral artery disease
Vasculitis
inflammation of the blood vessels
* The inflammation can cause the walls of the blood vessels to thicken, which reduces the width of the passageway through the vessel. If blood flow is restricted, it can result in organ and tissue damage.
Arterial Disease of Extremities
peripheral artery disease
* narrowing or blockage of the vessels that carry blood from the heart to the legs
* primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis.
Arterial Anerysms
An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso.
Aortic aneurysms can dissect or rupture: The force of blood pumping can split the layers of the artery wall, allowing blood to leak in between them.
Cardiomyopathy
a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body
Causes:
* Infectious disease
* Diabetes
* Renal failure
* Pregnancy complications
* Alcohol / drug toxicity
* Ischemia, HTN
* Systemic inflammatory disorders
* Nutritional disorders
* Genetic predisposition
* Idiopathic
Types: dilated, hypertrophic, restrictive
* dilated: causes the heart chambers (ventricles) to thin and stretch, growing larger
* hypertrophic: the heart muscle becomes abnormally thick.
* restrictive: the muscles of your heart’s lower chambers (ventricles) stiffen and can’t fill with blood
Coronary Artery Disease
Fatty, fibrous plaques progressively narrow the coronary artery lumens reducing volume of blood flow through them.
* Causes the loss of oxygen and nutrients to myocardial tissue because of poor coronary blood flow.
Causes
* Modifiable vs Nonmodifiable
* Atheroma: Fatty tumors in intima of heart vessels
* Atherosclerosis: Narrowing of the heart vessels
* Angina Pectoris: “suffocating of chest”
* Prinzmetal’s angina: spasms of vessels + narrowing
* MI: Cells in myocardium become necrotic & die
Types
* Stable: No damage to heart; reflexes restore blood flow
* Unstable: Episodes of ischemia occur at rest
* MI: completely occluded coronary vessel unable to deliver blood to heart, that area becomes ischemic and then necrotic -> excruciating pain, NV, and severe sympathetic stress reaction
S/S
* unstable or stable angina
Complications
* heart attack
Right-Sided Heart Failure
In right-sided heart failure, the heart’s right ventricle is too weak to pump enough blood to the lungs. As blood builds up in the veins, fluid gets pushed out into the tissues in the body. Blood clots or thrombus usually causes this.
* The right side of your heart pumps “used” blood from your body back to your lungs, where it refills with oxygen.
* Blood builds up in your veins, vessels that carry blood from the body back to the heart.
* This buildup increases pressure in your veins.
* The pressure pushes fluid out of your veins and into other tissue.
* Fluid builds up in your legs, abdomen or other areas of your body, causing swelling.
Left-Sided Heart Failure
The left ventricle of the heart no longer pumps enough blood around the body.
* As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs).
* This causes shortness of breath, trouble breathing or coughing – especially during physical activity.
* Left-sided heart failure is the most common type
Neural BP Regulation
PSNS, SNS, baroreceptors, chemoreceptors
* PSNS causes relaxation of blood vessels, decreasing total peripheral resistance. It also decreases heart rate. As a result, the blood pressure comes back to the normal level.
* SNS: The increase in sympathetic activity is a mechanism for both initiating and sustaining the blood pressure elevation
* baroreceptors: are sensors located in the carotid sinus and aortic arch. They sense the blood pressure and relay the information to the brain, so that a proper blood pressure can be maintained. Increases in the pressure of blood vessel triggers increased action potential generation rates and provides information to the central nervous system
* chemoreceptors: special nerve cells or receptors that sense changes in the chemical composition of the blood. That information is sent from the chemoreceptors to the brain to help keep the cardiovascular and respiratory systems balanced.
Humoral BP Regulation
RAAS
vasopressin: vasoconstriction and increasing blood pressure
Long-Term BP Regulation
Renal Mechanisms
Diuresis
Sodium Control
Primary HTN
Essential (primary) hypertension occurs when you have abnormally high blood pressure that’s not the result of a medical condition. This form of high blood pressure is often due to obesity, family history and an unhealthy diet. The condition is reversible with medications and lifestyle changes.
Secondary HTN
Secondary hypertension is high blood pressure caused by another condition or disease. Conditions that may cause secondary hypertension include kidney disease, adrenal disease, thyroid problems and obstructive sleep apnea.
Hypertensive Crisis
A hypertensive crisis is a sudden, severe increase in blood pressure. The blood pressure reading is 180/120 millimeters of mercury (mm Hg) or greater. A hypertensive crisis is a medical emergency. It can lead to a heart attack, stroke or other life-threatening health problems.
* Urgent hypertensive crisis. Blood pressure is 180/120 mm Hg or greater. There are no signs of organ damage.
* Emergency hypertensive crisis. Blood pressure is 180/120 mm Hg or greater. There is life-threatening damage to the body’s organs.
HTN Modifiable Factors
diet, obesity, alcohol intake, OCP’s, stress
HTN Non-Modifiable Factors
family history, age, race, insulin resistance, metabolic abnormalities, circadian variations, lifestyle factors
HTN and the Heart
damages the arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease
* causes hypertrophy - thickening of the heart - to pump the blood
HTN and the Brain
dementia and cognitive issues
HTN and PVD
atherosclerosis
HTN and the Kidneys
sclerosis of nephrons
HTN and the Eyes
retinal complications
Peripheral Artery Disease
An accumulation of plaque (fats and cholesterol) in the arteries in your legs or arms. This makes it harder for your blood to carry oxygen and nutrients to the tissues in those areas.
* PAD is a long-term disease, but you can improve it by exercising, eating less fat and giving up tobacco products.
Myocardial Infarction
A lack of blood flow to your heart muscle. The lack of blood flow can occur because of many different factors but is usually related to a blockage in one or more of your heart’s arteries.
* Without blood flow, the affected heart muscle will begin to die. If blood flow isn’t restored quickly, a heart attack can cause permanent heart damage and death.
Varicose Veins
Varicose veins are swollen blood vessels that appear just under your skin’s surface in your lower body. When your vein walls are weak and your valves aren’t working right, blood backs up in your vein. This causes the blue and purple bulges you see on your legs, feet or ankles. Several treatment options can work, but varicose veins can return.
* venous circulation disorder
Thrombophlebitis
An inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs. The affected vein might be near the surface of the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT).
Peripheral Vascular Disease
A slow and progressive circulation disorder. Narrowing, blockage, or spasms in a blood vessel can cause PVD.
* PVD may affect any blood vessel outside of the heart including the arteries, veins, or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected.
DVT
Occurs when a thrombus (blood clot) develops in veins deep in your body because your veins are injured or the blood flowing through them is too sluggish. The blood clots may partially or completely block blood flow through your vein.
* Most DVTs happen in your lower leg, thigh or pelvis, but they also can occur in other parts of your body including your arm, brain, intestines, liver or kidney.
Incompetent Vascular Function
Chronic venous insufficiency occurs when your leg veins don’t allow blood to flow back up to your heart.
* Normally, the valves in your veins make sure that blood flows toward your heart. But when these valves don’t work well, blood can also flow backwards. This can cause blood to collect (pool) in your legs.
Stasis Dermatitis
A common type of eczema that develops in people who have poor blood flow. Because poor blood flow usually develops in the lower legs, stasis dermatitis often appears near your ankles.
Venous Ulcers
A wound on the leg or ankle caused by abnormal or damaged veins.
* Venous ulcers are due to abnormal vein function. People may inherit a tendency for abnormal veins. Common causes of damaged veins include blood clots, injury, aging, and obesity.
Breathing
nose humidifies the air, travels down the trachea into the bronchi, then into the bronchioles, then the lungs.
* alveoli: where gas exchange occurs
* breathe in O2, breathe out CO2
Ventilation
the movement of air through the conducting passages between the atmosphere and the lungs
* mechanical movement
Respiration
gas exchange
* CO2 goes from blood into alveoli
* respiratory center in the brain: medulla oblongata
* chemoreceptors monitor CO2 and O2 in blood
Asthma
Patho:
* Form of COPD that’s a chronic reactive airway disorder that can present as an acute attack
* Causes episodic airway obstruction resulting from bronchospasms, increased mucus secretion, and mucosal edema
Causes
* genetic
* environmental
S/S
* Marked respiratory distress
* Marked wheezing or absent breath sounds
* Pulsus paradoxus greater than 10 mm Hg
* Chest wall contractions
Complications
* Status Asthmaticus
* Can progress to ARF.
* Intubation of an asthmatic is rarely a good thing. It takes them a long time to come off the vent, if they do.
Treatment
* Long-acting bronchodilators
* Corticosteroids
* Combined medications
* Leukotriene modifiers
* Mast cell stabilizers
* Immunomodulators
COPD
Patho:
* lower respiratory disease, permanent and chronic obstruction of airways
* air is trapped in the lower respiratory tract
* alveoli degenerate and fuse together
* airflow obstruction on expiration
* overinflated lungs and poor gas exchange
Causes:
* smoking
Types:
* emphysema
* chronic bronchitis
S/S:
* SOB
* Impaired gas exchange –altered ABGs
* Clubbing of fingers
* “pink puffer” vs “blue bloater”
Treatment:
* Bronchodilators
* Judicious oxygen use – too much can knock out drive to breath (over saturating with oxygen decreases CO2 accumulation)
* Symptomatic treatment
* Education on smoking cessation
Chronic Bronchitis
inflammation of bronchi to bronchioles
productive cough
increased mucus and inflammation within the bronchi
Emphysema
poor gas exchange in alveoli
Form of COPD that’s the abnormal, permanent enlargement of the alveoli accompanied by destruction of the alveolar walls
Chronic Respiratory Disorders
- get flu shots
Go to PCP
* More breathless than usual
* Less energy for your daily activities
* Increased amounts or change in consistency of your phlegm/mucus
* Needing to use your rescue inhaler or nebulizer more often
* Coughing more than usual
* Feel like you have a “chest cold”
* Awakening at night due to breathing problems
* Feeling like your medicine is no longer helping
Go to Emergency Room
* Severe shortness of breath (with rest or activities)
* Unable to do any activities because of your breathing
* Unable to sleep because of your breathing
* Fever or shaking chills
* Confusion or drowsiness
* Coughing up blood
* Chest pains
Hypoxemia
when oxygen levels in the blood are lower than normal
* Hypoxemia can happen if you can’t breathe in enough oxygen or if the oxygen you breathe in can’t get to your blood. Air and blood flow are both important to having enough oxygen in your blood. This is why lung disease and heart disease both increase your risk of hypoxemia.
* use supplemental oxygen, CPAP, bronchodilators, inhalers, steroids, meds to get rid of fluid in lungs
Hypercapnia
excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration
Pneumonia
Acute infection of the lung
* A cough that produces thick, blood-tinged or yellowish-greenish sputum with pus.
* Viruses attacking bronchiolar epithelial cell
* Bacterial or viral invasion of the tissue
S/S
* Dyspnea on exertion (DOE)
* SOB
* CRACKLES – focal assessment
Assessment
* low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a low oxygen saturation
Pneumothorax
Accumulation of air in the pleural cavity that leads to partial or complete lung collapse
* spontaneous or traumatic
* very life threatening
* NEEDLE Decompression
* Symptomatic treatment
* Oxygen
Pulmonary Embolism
Obstruction of the pulmonary arterial bed caused by a dislodged thrombus, heart valve growths, or a foreign substance
S/S:
* Tachycardia
* “Air hunger”
* Productive cough
* Low-grade fever
* Pleural effusion
Originates:
* in the leg veins or pelvis
Complications in Body
* shock
* cardiac death
* arrythmias
* cor pulmonale
* severe hypoxia
Scoliosis: Restrictive Lung Disease
Scoliosis results in a restrictive lung disease with a multifactorial decrease in lung volumes, displaces the intrathoracic organs, impedes on the movement of ribs and affects the mechanics of the respiratory muscles
Spinal Hardware: Restrictive Lung Disease
helps to fix scoliosis and improve lung functioning
Kyphosis
Hunchback (kyphosis) usually refers to an abnormally curved spine.
Causes extrapulmonary restriction of the lungs and gives rise to impairment of pulmonary functions
Pectus Excavatum
A condition in which a person’s breastbone is sunken into his or her chest.
* Can compromise lung and heart capacity, especially when the condition is severe, causing fatigue, shortness of breath, chest pain, and a fast heartbeat
Sinusitis
A condition in which the cavities around the nasal passages become inflamed.
Nephrons
functional unit of the kidney
very vascular and filter/clean blood
7 functions
1. volume regulation
2. electrolyte control
3. regulate BP
4. erythropoietin production
5. acid-base balance
6. medication/waste excretion
7. Ca-P balance
Renal Tubules
reabsorb electrolytes and water to maintain homeostasis
Glomeurlar Filtration
- blood goes to glomeurlus
- flows to Bowman’s capsule
- proximal convoluted tubules
- loop of Henle
- distal convoluted tubules
- lastly to collecting duct
what is not absorbed becomes urine
ADH
holds onto water and sodium
Aldosterone
holds onto water and sodium while excreting potassium
Atrial Natriuretic Peptide
hormone secreted from the right atrium in response to atrial stretch from hypervolemia as well as in response to hypertension
* excretes sodium
Benign Prostatic Hyperplasia
Age-associated prostate gland enlargement that can cause urination difficulty.
doxazosin (Cardura) & Alpha-adrenergic blocker
BUN
blood, urea, nitrogen
can fluctuate with protein intake
indicator of hydration
6 to 24 mg/dL
Urine Changing Color
Pigments and other compounds in certain foods and medications can change your urine color.
Bacteria can make it cloudy.
Darker urine means dehydration.
Chronic Kidney Disease
Progressive and irreversible
* End result of gradual tissue destruction and loss of kidney function
Will Disrupt
1. volume regulation
2. electrolyte control
3. regulation of BP
4. erythropoietin production
5. acid-base balance
6. medication/waste excretion
7. Ca-P balance
Creatinine
a breakdown product of creatine phosphate from muscle and protein metabolism
men: 0.7 to 1.3 mg/dL
women: 0.6 to 1.1 mg/dL
elevated levels: sign of poor kidney function
Erythropoietin
tells bone marrow to make more RBC’s
increases O2 carrying capacity
GFR
Rate at which glomeruli filter blood
based on permeability of capillary walls, Vascular pressure, Filtration pressure
indicator of renal function and number of functional nephrons in the kidneys
* Normal rates 107 and 139 mL/minute for males
* 87 and 107 mL/minute for females
Glomerulonephritis
Inflammation of the glomeruli, commonly following streptococcal infection
* The epithelial layer of the glomerular membrane is disturbed and Goodpasture’s disease cause this
Menses: Regulation of Cycle
OCP: combination of estrogen and progesterone
28d packs or 91d packs
* less bleeding for those with iron deficiency anemia for 91d
Nephrotic Syndrome
A kidney disorder that causes your body to pass too much protein in your urine.
Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
* Symptoms include swelling around the eyes and in the feet and ankles, foamy urine, and weight gain due to excess fluid retention.
* Treatment addresses underlying conditions and might include blood pressure medications and water pills.
Nephritic Syndrome
The nephritic syndrome is a clinical syndrome that presents as hematuria, elevated blood pressure, decreased urine output, and edema.
* The major underlying pathology is inflammation of the glomerulus that results in nephritic syndrome.
* It causes a sudden onset of the appearance of red blood cell (RBC) casts and blood cells, a variable amount of proteinuria, and white blood cells in the urine.
* The primary pathology can be in the kidney, or it can be a consequence of systemic disorders.
Acute Kidney Injury
Sudden interruption of renal function from poor circulation or kidney disease
* Prerenal: occurs when a sudden reduction in blood flow to the kidney (renal hypoperfusion) causes a loss of kidney function. In prerenal acute kidney injury, there is nothing wrong with the kidney itself. From Intravascular volume depletion either from dehydration or excessive fluid loss
* Intrarenal: a disease process causes damage to the kidney itself
* Postrenal: when an obstruction in the urinary tract below the kidneys causes waste to build up in the kidneys
Need to treat the underlying cause of these three
Pylonephritis
The inflammation of the kidney is due to a specific type of urinary tract infection (UTI). The UTI usually begins in the urethra or bladder and travels to the kidneys.
* Fever, frequent urination, and pain in the back, side, or groin are symptoms.
* Treatment includes antibiotics and often requires hospitalization.
Renal Calculi
Hard deposits made of minerals and salts that form inside your kidneys. Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones.
* very painful, may see N/N
* Calcium Calcli: avoid nuts, seeds, beets, spinach, and buckwheat flour
* Uric Acid Calcli: avoid red meat, organ meats, beer/alcoholic beverages, meat-based gravies, sardines, anchovies and shellfish
* Oxilate Calculi: avoid beets, chocolate, spinach, rhubarb, tea, and most nuts
Stress Incontinence
happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine
Urge Incontinence
When you have a strong, sudden need to urinate that is difficult to delay. The bladder then squeezes, or spasms, and you lose urine.
UTI
Infection anywhere in the urinary tract
Hematuria
S/S
* Bladder pain/spasms, Burning, stabbing w/urination, Dysuria, Cloudy urine, Disorientation/confusion in older adults, Pyuria, Urinary frequency
* Acute pyelonephritis –chills, fever, flank pain, and tenderness
Neonates: Bacteria and other infection-causing microbes may enter the urinary tract when an infant has a dirty diaper or when babies are wiped from back to front.
Toddlers: not wiping properly
Elderly: decreased urine flow, decreased mobility, incontinence, catheters, weaker immune systems
Catheters: germs can travel along the catheter and cause an infection in your bladder or your kidney
Vitamin D
kidneys make this vitamin usable
helps body to absorb Ca and use it
Costovertebral Tenderness
Located on your back at the bottom of your ribcage at the 12th rib
* Pain in this flank area may indicate a kidney infection
Assessment
* Patient in sitting position.
* Gently press the costovertebral angle.
* Percuss the costovertebral angles.
* Feel the paravertebral muscles to assess the tone.
* Assess tenderness of ribs, paraspinal muscle and spine.
* Auscultate the costovertebral angle for bruit.
Diuretics
used for fluid removal of the heart, HTN, renal disease, pulmonary edema
Labetatol
NON-SELECTIVE ADRENERGIC BLOCKING AGENTS
For: HTN
* lowers BP and pulse and increases renal perfusion
MOA: Competitively block the effects of norepinephrine at the alpha and beta receptors throughout the SNS
AE: Dizziness, insomnia, fatigue, nausea, vomiting, arrhythmias, hypotension, CHF, pulmonary edema, bronchospasm
CI: Allergy, shock, heart block, bradycardia, CHF
Caution: bronchospasms, asthma, DM, pregnancy
Drug-Drug: Enflurane, halothane or isoflurane anesthetics,
Diabetic agents, Calcium channel blockers
Phentolamine
NONSELECTIVE ALPHA-ADRENERGIC BLOCKING AGENTS
For: It can prevent and control high blood pressure during surgery. It can treat and prevent skin injury caused by norepinephrine injection. It is also used to diagnose an adrenal gland tumor (pheochromocytoma).
MOA: Blocks postsynaptic alpha1 and presynaptic alpha2 receptors, decreasting symp tone and vasculature = vasodilation
AE: hypotension, orthostatic hypotension, angina, MI, CVA, Arrhythmia, weakness, and dizziness
CI: Allergy, CAD, MI
Caution: pregnancy/lactation
Drug-Drug: Ephedrine, EPI, alcohol
Doxazosin
ALPHA1-SELECTIVE ADRENERGIC BLOCKING AGENTS
For: HTN and BPH
MOA: blocks postsyn alpha1 receptor site to create vasodilation, metabolized in the liver
AE: Postural dizziness, fatigue, weakness, HA, NVD, abdominal pain, hypotension, arrhythmia, edema, CHF, angina
CI: Allergy, lactation
Caution: CHF, renal failure
Drug-Drug: Vasodilators or antihypertensive drugs
Propranolol
NONSELECTIVE BETA-ADRENERGIC BLOCKING AGENTS
For: HTN, angina, migranes, MI reinfarction
MOA: competitive blocking of beta-receptors in SNS by blocking them in the heart and nephrons
AE: Fatigue, dizziness, depression, sleep disturbances, bradycardia, heart block, hypotension, bronchospasm, NVD, decreased libido
CI: Allergy, DM, bradycardia, heart block, shock, or CHF, COPD, asthma, pregnancy and lactation
Caution: DM, hepatic dysfunction
Captopril
ACE Inhibitor
For: HTN, CHF, diabetic nephropathy, left ventricular dysfunction following an MI
MOA: Blocks ACE from converting Angio 1 to 2, which decreases BP, aldosterone, and small increases in K levels with Na and fluid loss
AE: Related to the effects of vasodilatation and alterations in blood flow, GI irritation, Renal insufficiency, Cough
CI: Allergy, impaired renal function, pregnancy/lactation
Caution: CHF
Drug-Drug: Allopurinol
Losartan
Angiotensin II Receptor Blocker
For: HTN
MOA: binds with angio 2 receptors in smooth muscles in adrenal coretex to block vasoconstriction and the release of aldosterone
AE: Headache, dizziness, syncope, weakness, GI complaints, skin rash or dry skin
CI: Allergy, pregnancy/lactation
Caution: Hepatic or renal dysfunction, and hypovolemia
Drug-Drug: phenobarbital
Atenolol
Beta 1 Selective Adrenergic Blocking Agent
For: HNT, angina
MOA: blocks beta 1 receptors in SNS
AE: Fatigue, dizziness, sleep disturbances, bradycardia, heart block, CHF, hypotension, symptoms in respiratory tract range from rhinitis to bronchospasm, NVD, decreased libido and impotence
CI: Allergy, sinus bradycardia, heart block, cardiogenic shock, CHF, and hypotension
Caution: COPD, diabetes, thyroid disease
Drug-Drug: Clonidine, NSAIDs, rifampin, barbiturates, epinephrine, prazosin, verapamil, cimetidine, methimazole, propylthiouracil
Diltiazem
Calcium Channel Blockers
For: Decrease BP, cardiac workload, and myocardial oxygen consumption, Treatment of essential HTN – extended release
Prinzemental’s angina: spasm in the heart’s arteries that temporarily reduces blood flow
MOA: inhibits Ca ions across membranes in heart and arterial muscle cells, leading to slowed conduction, decreased myocardial contractility, dilation of arterioles - lowers BP and decreases myocardial O2 consumption
AE: Related to effects on cardiac output, GI symptoms, CV symptoms, skin reactions, headache
CI: Allergy, heart block or sick sinus syndrome, renal or hepatic dysfunction, pregnancy, and lactation
Drug: Cyclosporine
Food: Grapefruit Juice
Nitroprusside
Vasodilator
For: severe HTN, malignant hypertension, hypertensive emergencies
MOA: directly on smooth muscle to create muscle relaxation = vasodilation and drop in BP
AE: Related to changes in the blood pressure, GI upset, Cyanide Toxicity
CI: Allergy, pregnancy, lactation, cerebral insufficiency
Caution: Peripheral vascular disease, CAD, CHF, or
tachycardia
Digoxin
Cardiac Glyoside
For: Heart Failure, AFib
MOA: increases force of contarctions, CO, renal perfusion, and output
* Decreaes BV to slow HR and conduction through AV node
* Increases intracellular Ca during depol, positive inotrophic effect, increase renal perfusion, decrease renin release
AE: Headache, weakness, drowsiness, and vision changes, GI upset and anorexia, arrhythmia development, reflex changes with toxicity, can see yellow halos with toxicity
CI: Allergy, Ventricular tachycardia or fibrillation, heart block, or sick sinus syndrome, Idiopathic hypertrophic subaortic stenosis, Acute MI, renal insufficiency, and electrolyte abnormalities
Caution: Pregnancy and lactation, Pediatric and geriatric
Drug-Drug: Verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, or cyclosporine, Potassium losing diuretics, Cholestyramine, charcoal, colestipol, bleomycin, cyclophosphamide, or methotrexate
Propranolol
Class II Antiarrhythmic
For: SVT (Supraventricular tachycardia) and PVCs (Premature ventricular contraction)
MOA: block beta receptors causing depression of phase 4 of action potential
* block beta receptor sites in heart and kidney
* decreases HR, cardiac excitability, CO
* slow conduction through AV node
AE: CNS – Dizziness, insomnia, dreams, and fatigue, CV – Hypotension, bradycardia, AV block, arrhythmias, Respiratory – Bronchospasm and dyspnea, GI – Nausea, vomiting, anorexia, Misc. – Loss of libido, decreased exercise tolerance, alterations in blood glucose levels
CI: Sinus bradycardia, AV block, cardiogenic shock, CHF, asthma, or respiratorydepression, pregnancy, and lactation
Caution: Diabetes, thyroid dysfunction, renal or hepatic dysfunction
Drug-Drug: Verapamil, Insulin
Amiodarone
Class III Antiarrhythmic
For: life-threatening ventricular arrhythmias, maintenance of sinus rhythm after conversion of atrial arrythmias
MOA: blocks K channels to slow outward movement of potassium during phase 3 of AP - prolongs it
AE: Nausea, vomiting, constipation, weakness, dizziness, arrhythmia, heart failure
Caution: Shock, hypotension, respiratory depression,
prolonged QT interval, renal or hepatic disease
Drug-Drug: Digoxin or Quinidine
Diltiazem
Class IV Antiarrhythmic
For: SVT, control ventricular response to rapid atrial rates
MOA: block Ca ions moving across cell mem, delaying phases 1 and 2 of repolarization = slows automaticity and conduction through AV node
AE: Dizziness, weakness, fatigue, depression, GI upset, hypotension, CHF, and shock
CI: Allergy, sick sinus syndrome or heart block, pregnancy, lactation, CHF, hypotension
Caution: Idiopathic hypertrophic subaortic stenosis
Nitroglycerin
Antianginal Drug
For: angina pectoris
MOA: improve blood delivery to heart by dilating BV = increases O2 levels
decreases work of heart with improving blood delivery = decrease the demand for O2
restore appropriate supply-and-demand ratio of O2 delivery when rest is not enough
AE: NS – Headache, dizziness, and weakness, GI – Nausea, vomiting, CV – Hypotension, Misc. – Flushing, pallor, increased perspiration
CI: Allergy, Severe anemia, Head trauma or cerebral hemorrhage,
Pregnancy and lactation
Caution: Hepatic or renal disease, Hypotension, hypovolemia, and conditions that limit cardiac output
Drug-Drug: Ergot derivatives, Heparin
Metoprolol
Beta-Blockers
For: stable angina, HTN, prevent reinfarction in MI, stable CHF
MOA: Competitively blocks beta-adrenergic receptors in the heartand kidneys, decreases the influence of the SNS on thesetissues; decreases cardiac output and the release of renin
AE: CNS – Dizziness, fatigue, emotional depression, GI – Nausea, vomiting, colitis, CV – CHF, decreased cardiac output, and arrhythmias, Respiratory – Bronchospasm, dyspnea, and cough
CI: Bradycardia, Heart block, Cardiogenic shock, Asthma or COPD, Pregnancy and lactation
Caution: DM, PVD, Thyrotoxicosis
Drug-Drug: Clonidine, NSAIDs
Cholestyramine
Bile Acid Sequestrants
For: Prevention of CAD by decreasing serum cholesterol levels, Reduces elevated serum cholesterol in patients with primary hypercholesterolemia, pruritus associated with partial biliary obstruction
MOA: lower serum levels of cholesterol, binds to bile acids in intestine to allow excretion in feces instead of reabsorption
* causes cholesterol to be iodized in liver and serum cholesterol levels to fall
AE: Headache, fatigue, and drowsiness, Direct GI irritation – Nausea, constipation, Increased bleeding times, Vitamin A and E deficiencies
CI: Allergy, Complete biliary obstruction, Abnormal intestinal function, Pregnancy and lactation
Drug-Drug: Malabsorption of fat-soluble vitamins, Thiazide diuretics, digoxin, warfarin, thyroid hormones, andcorticosteroids
Atorvastatin
HMG-COA Reductase Inhibitors
For: elevated cholesterol, triglycerides, and LDL, increase HDL-C, treat familial hypercholesterolemia and two+ risk factors for CAD
MOA: the early rate-limiting step cellular cholesterol synthesis involves the enzyme HMG–CoA reductase. If this enzyme is blocked, serum cholesterol and LDL decrease
* Inhibits HMG-CoA, decreases serum cholesterol levels, LDLs, and triglycerides, increases HDL levels
AE: GI symptoms: Flatulence, abdominal pain, cramps, nausea, vomiting, and constipation, CNS: Headache, dizziness, blurred vision, insomnia, fatigue, Liver failure, Rhabdomyolysis
CI: Allergy, Active liver disease or history of alcoholic liverdisease, Pregnancy or lactation
Caution: impaired endocrine function
Drug: Erythromycin, cyclosporine, gemfibrozil, niacina,
Digoxin or warfarin, Estrogen
Food: Grapefruit juice
Ezetimibe
CHOLESTEROL ABSORPTION INHIBITORS
For: Lower serum cholesterol levels; treat homozygous familial hypercholesterolemia; treat homozygous sitosterolemia to lower sitosterol and campesterol levels
MOA: Works in the brush border of the small intestine to inhibit the absorption of cholesterol
AE: abdominal pain, diarrhea, Headache, dizziness, fatigue, URI, back pain, Muscle aches and pain
CI: Allergy, Pregnancy or lactation if combined with a statin
Caution: Pregnancy or lactation (monotherapy), Elderly
patients, Liver disease
Drug: Cholestyramine, fenofibrate, gemfibrozil, or
antacids, Cyclosporine, Fibrates, Warfarin
Hydrochlorothiazide
Thiazide Diuretic
For: edema from CHF, acute pulmonary edema, liver disease, renal disease, HTN, conditions that cause hyperK
MOA: Increase the amount of urine produced by the kidneys. Increase sodium excretion
* Action is to block the chloride pump. Keeps chloride and the sodium in the tubule to be excreted in the urine, thus preventing the reabsorption of both in the vascular system
AE: GI upset, fluid and electrolyte imbalances, hypotension, increased blood glucose levels, alkalinized urine
CI: Allergy to thiazides or sulfonamides, Fluid and electrolyte imbalances, Renaland liver disease
Caution: Gout, SLE, Liver disease, Hyperparathyroidism, Bipolar disorder, Pregnancy and lactation, Diabetes or glucose tolerance abnormalities
Drug: Cholestyramine or colestipol, Digoxin,
Antidiabetic agents, Lithium
Furosemide
Loop Diuretic
For: edema with CHF, acute pul edema, liver disease, renal disease, hypertension, hyperK
MOA: increase amount of urine produced by kidneys, increase Na excretion, block Cl pump in loop of Henle - reabsorption of Na and Cl
AE: Related to the imbalance in electrolytes and fluid, Hypokalemia, Alkalosis, Hypocalcemia
CI: Allergy, Electrolyte depletion, Anuria, Severe renal failure, Hepatic coma, Pregnancy and lactation
Caution: SLE, gout, and diabetes mellitus
Drug: Aminoglycosides or cisplatine, Anticoagulation,
Indomethacin, ibuprofen, salicylates, or NSAIDs
Acetazolamide
CARBONIC ANHYDRASE INHIBITORS
For: Edema associated with congestive heart failure, Acute pulmonary edema, Liver disease (including cirrhosis), Renal disease, Hypertension, Conditions that cause hyperkalemia
* Carbonic Anhydrase Inhibitors: Adjuncts to other diuretics, Glaucoma (dec. IOP by fluid)
MOA: used as adjucts to other diuretics when more insense diuresis is needed
* Block the effects of carbonic anhydrase; slow down the movement of hydrogen ions, More sodium and bicarbonate are lost in the urine
AE: Related to disturbances in acid and base balance and electrolyte balances, Metabolic acidosis, Hypokalemia, Paresthesia of extremities, confusion, drowsiness
CI: Allergy, Noncongestive angle-closure glaucoma
Caution: Pregnancy and lactation, Fluid or electrolyte imbalances, Renal or hepatic disease, Adrenocortical insufficiency, Respiratory acidosis, COPD
Drug: Salicylates and lithium
Spironolactone
K Sparing Diuretics
For: Edema associated with congestive heart failure, Acute pulmonary edema, Liver disease including cirrhosis), Renal disease, Hypertension, Conditions that cause hyperkalemia
* K+ sparing: Adjuncts with thiazide or loop diuretics. Patients who are at risk for hypokalemia.
MOA: These drugs are used as adjuncts to other diuretics when a more intense diuresis is needed
* Cause a loss of sodium while retaining potassium. Block the actions of aldosterone in the distal tubule (Not as powerful as the loop diuretics)
AE: hyperkalemia
CI: Allergy, Hyperkalemia, renal disease, or anuria, Patients taking amiloride or triamterene
Caution: Pregnancy and lactation
Drug: Salicylates
Mannitol
Osmotic Diuretic
For: Osmotic Diuretics: Increased cranial pressure or acute renal failure due to shock, drug overdose, or trauma
MOA: Creates a very intense diuresis = Pull water into the renal tubule without sodium loss.
AE: Related to sudden drop in fluid levels, Nausea, vomiting, hypotension, light-headedness, confusion, and headache
CI: Renal disease and anuria, Pulmonary congestion, Intracranial bleeding, dehydration, CHF
Dextromethorphan
Antitussive
For: Suppresses cough, Control nonproductive cough
MOA: Act directly on the medullary cough center of the brain to depress the cough reflex
AE: Drying effect on the mucous membranes, CNS adverse effects and GI upset, Consider type of cough, age, and if patient should be taking
CI: Patients who need to cough to maintain the airway, Head injury or impaired CNS
Caution: Hypersensitivity or history of narcotic addiction
Drug: MAOIs
Tetrahydrozoline
Topical Nasal Congestants
For: Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis, Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions
MOA: Decrease the overproduction of secretions by causing local vasoconstriction to the upper respiratory tract
* Sympathomimetic, Affects sympathetic nervous system to cause vasodilatation, Causing less inflammation of the nasal membrane
AE: Local stinging and burning, Rebound congestion,
Sympathomimetic effects, NV, mild HA
* Consider nasal membranes, glaucoma, DM, thyroid disease, HTN, respiratory status
CI: Lesion or erosion in the mucous membranes
Caution: Any condition that might be exacerbated by
sympathetic activity
Drug: Cyclopropane or halothane
Pseudoephedrine
Oral Decongestant
For: Promotion of drainage in the sinuses and improving air flow
* Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions
MOA: Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis
* Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes
AE: Rebound congestion, Sympathetic effects, dizziness, anxiety
* Consider HTN, pregnancy/lactation, HTN, Hyperthyroidism, CAD, prostate hyperplasia, DM
CI: Any condition that might be exacerbated by sympathetic activity
Drug: OTC products that contain pseudoephedrine; taking concurrently can cause serious side effects
Flunisolide
Topical Nasal Steroid Decongestants
For: Seasonal allergic rhinitis, Inflammation after the removal of nasal polyps
* Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions
MOA: Relieves inflammation at site of use – blocks complexes, Exact mechanism of action is not know
AE: Local burning, irritation, stinging, dryness of the mucosa, and headache, Suppression of healing can occur in a patient who has had nasal surgery or trauma
CI: Acute infection
Caution: Active infection, Avoid exposure to airborne
infections
Diphenhydramine
Antihistamines
For: Seasonal allergies, allergic reaction, motion sickness
* Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema
MOA: Selectively blocks of Histamine1 Receptors. Atropine (anticholinergic) like effect, antipruritic, sedative
effects
AE: Drowsiness and sedation, Anticholinergic effects
* Consider prolonged QT interval, respiratory status
CI: pregnancy/lactation
Caution: Renal or hepatic impairment, History of
arrhythmias
Guaifenesin
Expectorant
For: Symptomatic relief of respiratory conditions characterized by a dry, non-productive cough
MOA: Increase productive cough to clear the airways.
* They liquefy lower respiratory tract secretions, reducing the viscosity of these secretions and making it easier for the patient to cough them up
* Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions
AE: GI symptoms, Headache, Dizziness, Mild rash, Prolonged use may result in masking a serious underlying disorder
* Consider smoker, asthmatic, someone with emphysema and what their cough is like
Acetylcysteine
Mucolytics
For: Patients who have difficulty coughing up secretions, who develop atelectasis, with tracheostomies undergoing diagnostic bronchoscopy, and postoperative patients
* Given IV or PO w/ acetaminophen OD to protect liver
MOA: Increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions. Decrease viscosity of mucous, and protects liver cells.
AE: GI upset, Stomatitis and/or rhinorrhea, Bronchospasm, Rash
* Consider presence of acute bronchospasm, peptic ulcer and esophageal varices
Caution: Acute bronchospasm, peptic ulcer, and esophageal varices
Theophylline
Xanthines
For: Symptomatic relief or prevention of bronchial asthma and for reversal of bronchospasm associated with COPD
MOA: Direct effect on the smooth muscles of the respiratory tract, both in the bronchi and in the blood vessels = increasing vital capacity and force of diaphragmatic muscle
AE: Related to theophylline levels in the blood, GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death
* Consider presence of Peptic ulcer, gastritis, renal or hepatic dysfunction, and coronary disease
CI: GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, or
hyperthyroidism
Drug: cigarette substances
Epinephrine
Sympathomimetics
For: Acute asthma attach, Bronchospasm in acute or chronic asthma, Prevention of exercise-induced asthma
* Anaphylactic reactions
MOA: Mimic effects of the sympathetic nervous system: dilation of bronchi with increased rate and depth of respiration, increased HR & BP
* Beta 2 selective adrenergic agonists
AE: Sympathomimetic stimulation, CNS stimulation, GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, and flushing
* Consider presence of CVD, smoking, pregnancy, DM, hyperthyroidism
CI: Depends on the severity of the underlying condition
Drug: general anesthesia
Ipratropium
Anticholinergic
For: Maintenance treatment of bronchospasm associated with COPD
* Seasonal rhinitis, asthma exacerbations
MOA: Patients who cannot tolerate the sympathetic effects of the sympathomimetic might respond to the anticholinergic drugs
* Anticholinergic that blocks vagally mediated reflexes by antagonizing the action of acetylcholine
AE: Related to the anticholinergic effects of the drug, Dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpitations, and urinary
retention
* Consider presence of acute bronchospasms, BPH, HR, BP, bladder obstruction
Caution: Any condition that would be aggravated by the anticholinergic effects of the drug
Drug: other anticholinergic
Budesonide
Inhaled Steroids
For: Prevention and treatment of asthma, Treat chronic steroid-dependent bronchial asthma
MOA: Decrease the inflammatory response in the airway
AE: Sore throat, Hoarseness, Coughing, Dry mouth, Pharyngeal and laryngeal fungal infections
* Consider presence of active infection
CI: Not used for emergency during an acute attack or status asthmaticus, Pregnancy or lactation
Zafirlukast
Leukotriene Receptor Antagonists
For: Prophylaxis and chronic treatment of bronchial asthma in adults and in patients younger than 5 years of age
MOA: Selectively and competitively block or antagonize receptors for the production of leukotrienes. Blocks leukotrienes which are slow responders to anaphylactic reaction = blocks airway edema, airway inflammation
AE: Headache, dizziness, myalgia, nausea, diarrhea and abdominal pain, elevated liver enzyme concentrations, vomiting, and generalized pain
* Consider presence of Acute bronchospasm or asthmatic attack, hepatic/renal impairment
Caution: Hepatic or renal impairment, Pregnancy and lactation
Drug: Propranolol, theophylline, terfenadine, or warfarin, Calcium channel blockers, cyclosporine, or aspirin
Fosfomycin
Antiinfectives
For: Chronic UTI, Adjunctive therapy in acute cystitis and pyelonephritis, Prophylaxis with urinary tract anatomical abnormalities and residual urine disorders.
MOA: Act specifically within the urinary tract to destroy bacteria.
* They act either through direct antibiotic effect or through acidification
AE: Nausea, vomiting, anorexia, bladder irritation, and dysuria. Vaginitis. Pruitus, urticaria, headache, dizziness, nervousness, and confusion
CI: Allergy
Caution: Renal dysfunction, Pregnancy and lactation
Oxybutynin
Urinary Tract Antispasmodics
For: bladder spasm, dysuria
MOA: Blocking parasympathetic activity. Relaxing the detrusor and other urinary tract muscles; inhibits Ach at muscarinic receptors
* Block the spasms of urinary tract muscles caused by various conditions
AE: Related to blocking of the parasympathetic system; Decreased sweating, dry mough, nausea, drowsiness, blurry vision, urinary retention, tachycardia
CI: Allergy, Pyloric or duodenal obstruction, Recent surgery, Obstructive urinary tract problems, Glaucoma, myasthenia gravis, or acute hemorrhage
* Caution: Renal or hepatic dysfunction, Pregnancy and lactation
Drug: Phenothiazines, Haloperidol
Phenazopyridine
Urinary Tract Analgesia
For: Pain involving the urinary tract can be very uncomfortable and lead to urinary retention and increased risk of infection
* Relieve symptoms related to urinary tract irritation from infection, trauma, or surgery
MOA: When phenazopyridine is excreted in urine, it exerts a direct topical analgesic effect on the urinary mucosa
AE: GI upset, headache, rash, reddish-orange coloring of the urine and staining of contact lenses
* Renal and hepatic toxicity
CI: Allergy, renal dysfunction
Caution: Pregnancy and lactation
Drug: antibacterial agents
Pentosan Polysulfate Sodium
Bladder Protectant
For: Used to coat or adhere to the bladder mucosal wall and protect it from irritation related to solutes in urine.
* Interstitial Cystitis
MOA: Heparin-like compound that has anticoagulant and fibrinolytic effects.
* Adheres to the bladder wall mucosal membranes and acts as a buffer to control cell permeability, preventing irritating solutes in the urine from reaching the bladder wall cells
AE: Bleeding that may progress to hemorrhage, Headache, alopecia, GI disturbances
CI: Condition that involve a risk of bleeding, Heparin induced thrombocytopenia
Caution: Hepatic or splenic dysfunction, Pregnancy or lactation
Drug: Anticoagulants, aspirin, or NSAIDs
Finasteride
Drugs that Block Testosterine Production
For: benign prostatic hyperplasia (BPH) and male pattern hair loss, also called androgenetic alopecia
MOA: blocks the action of an enzyme called 5-alpha-reductase. This enzyme changes testosterone to another hormone that causes the prostate to grow or hair loss in males. It will increase testosterone levels in the body, which decreases prostate size and increases hair growth on the scalp.
Endocrine System
- maintains homeostasis by the use of lots of organs
Thryroid
- produces T3 and T4, need iodine
- regulates metabolism
- G&D
- heat
- cardiac function
- GI function
- Ca balance
How and where does the hypothalamus send messages?
- 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
Negative Feedback System
- 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
Anterior Pituitary Gland Functions
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
Posterior Pituitary Gland Functions
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
Adrenal Gland Functions
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
Adrenal Cortex
- 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)
Addison’s Disease
- 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
Adrenal Insufficiency
Cause
* rapid withdrawl from exogenous steroids
Complications
* CV collapse
* hypoglycemia
* shock
* similar S/S to Addison’s
Cushing’s Disease
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
Diabetes Insipidus
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
SIADH
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
Cerebral Salt Wasting
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
Glucocorticoid’s Effects on the Body
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
Why do we use steroids?
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
How do we give steroids?
- oral
- IV
- IM
- eye drops
- ear drops
- skin cream
Side Effects of Steroids
- 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
When should steroids be used carefully? Patient Teaching
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
Mineralocorticoids
- holds Na and secretes K
- used for primary and secondary adrenal insufficiency
- replaces adrenal hormones
NC
* hypoK
* hyperglycemia
* accumulation of fat
* peptic ulcers
* HTN
T1DM
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
T2DM
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
What is ketosis?
a metabolic state that occurs when your body burns fat for energy instead of glucose
* causes: weight loss, increased ketones in blood
What is acidosis?
liver cannot remove all waste products because of insufficient insulin
* will see elevated lactic acid in patients with T1DM
Diabetes Diagnostics
- FBS >126
- post-prandial BS >200
- HbA1C >6.5
What is insulin?
hormone produced in the pancreas which regulated the amount of glucose in the blood, allows glucose to enter the cells to provide energy
What is glucagon?
- 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
Metabolic Syndrome
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
Hypothyroidism
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)
Synthroid (Levothyroxine)
- 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
Hyperthyroidism
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
Roles of the Digestive System
- ingest food
- digest through mechamical chewing
- chemical digestion in stomach
- reabsorption in the intestine
- excretion to form stool
Appendicitis
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
Cholecystitis
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
Cholelithiasis
gallstones in the gallbladder, made of cholesterol
* RUQ pain
Constipation
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
Diarrhea
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
C-diff
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
Diverticulitis
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
Esophageal Varcies
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
GERD
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
Hepatitis
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
GI Bleed
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
Prevention for Hepatitis
- 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
Which hepatitis can we give vaccines for? Which one is required for healthcare?
A & B
B is for healthcare
Which hepatitis is the most transmissable for dialysis patients?
B&C
What is viral hepatitis?
an infection that causes liver inflammation and damage from a virus
Hep A
- fecal-oral route from food
- can spread up to 3 months
- obtaining antibodies = immunity
Hep B
- blood and body fluids
- can lead to Hep if not treated
Hep C
- blood and body fluids
- treatment: direct-acting antiviral (DAA) tablets
H. pylori
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
Intestinal Obstructions
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.
Pancreatitis
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
Portal Vein HTN
- 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
Peptic Ulcer Disease
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
Atopic Dermatitis
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
Seborrheic Dermatitis
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
Avulsion
- 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
Cellulitis
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
Compartment Syndrome
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
Dislocation
Patho
* a separation of two bones where they meet at a joint
* occurs in knee, hip, ankle, shoulder, usually larger joints
* from trauma
Subluxation
Patho
* partial dislocation of joints
* occurs commonly in shoulders, fingers, kneecaps, ribs, wrists, ankles, and hips
Gout
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
Fractures
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
How do bones regenerate?
- 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
Muscle Spasms
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
Osteoarthritis
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
Osteomyelitis
Patho
* inflammation or swelling that occurs in the bone
* usually from infection - staph
* can spread to blood stream: sepsis
Treatment
* antibiotics
* surgery
Osteopenia
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
Osteoporosis
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
Rhabdomyolysis
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
Rheumatoid Arthritis
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
Steven Johnson’s Syndrome
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
Toxic Epidernal Necrolysis
Patho
* a life-threatening skin disorder characterized by a blistering and peeling of the skin
* large areas of peeling skin (30% of body)
Toxic Shock Syndrome
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
Sprain
- stretching or tearing of ligaments
- occurs in ankles “rolling”
- caused when a joint is forced to move into an unnatural position
Strain
- A stretched or torn muscle or tendon
- Often occur in the lower back and in the muscle in the back of the thigh
Strain
- A stretched or torn muscle or tendon
- Often occur in the lower back and in the muscle in the back of the thigh
Lupus
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
Vitamin D
- necessary for strong bones and muscles
- needed to absorb Ca
PTH and Calcitonin’s Effects on
Bone
- 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
Prednisone
Corticosteroids/Glucocorticoids
For
* Short-term treatment of many inflammatory disorders. To relieve discomfort. To give the body a chance to heal from the effects of inflammation. In illnesses like cancer, ulcerative colitis, asthma, anaphylaxis/allergies.
MOA
* Enter target cells and bind to cytoplasmic receptors. Initiate many complex reactions responsible for anti-inflammatory and immunosuppressive effects, Hydrocortisone, cortisone, and prednisone have some mineralocorticoid activity
AE
* Related to route of administration. Systemic use is associated with endocrine disorders. HA, HTN, agitation, weight gain, can induce DM, Na/H20 retention, immunosuppression, impaired wound healing
CI: Known allergy, Acute infection, Lactation
Caution: Diabetes, Acute peptic ulcer, infection
Drug
* Increase in drug when given with erythromycin, ketoconazole, or troleandomycin. Decrease in drug when given with salicylates, barbiturates, phenytoin, or rifampin.
Cortisone
Mineralocorticoid
For
* Replacement therapy in primary and secondary adrenal
insufficiency
MOA
* Holds sodium, and with it, water in the body. Causes the excretion of potassium & hydrogen by acting on the renal tubule
AE
* Increase fluid volumes. Allergic reactions. Headaches, arthralgias. Heart failure
CI: Known allergy. HTN. CHF. Cardiac disease
Caution: Pregnancy. Presence of any infection. High sodium intake
Drug
* Decrease effectiveness with salicylates, barbiturates, hydantoins, rifampin, and anticholinesterases
Levothyroxine
Thyroid Replacement Hormones
For
* Replacement therapy in hypothyroidism; pituitary TSH suppression in the treatment of euthyroid goiters, management of thyroid cancer; thyrotoxicosis in conjunction with other therapy; myxedema coma
* “Leaves T3 and T4 in the body”
* L = life long drug; long, slow onset (3-4 wks)
* E = early morning on empty stomach (30-60 min before eating)
* V = very hyper, high HR/BP/temp, report agitation and confusion
MOA
* Increases the metabolic rate of body tissues, increasing oxygen consumption, respiration, and heart rate; the rate of fat, protein, and carbohydrate metabolism; and growth and maturation
AE
* Skin reactions, Symptoms of hyperthyroidism, Cardiac stimulation, CNS effects, Nervousness, palpitations, NVD, HA, tachycardia, loss of hair (children)
* Assess for MI, Addison’s disease, VS, hormone levels, Thyrotoxicosis, thyroid storm
CI: Known allergy, Thyrotoxicosis, Acute MI
Caution: Lactation, Hypoadrenal conditions such as Addison’s
* preg safe!
Drug
* Cholestyramine, Oral anticoagulants, Digitalis, Theophylline
Propylthiouracil / Sodium Iodine
Antithyroid Agents
For
* hyperthyroidism
* PTU = puts the thyroid underground
MOA
* Thioamides: prevent formation of thyroid hormone within the thyroid cells, lowering the serum level, partially inhibit conversion of T4 to T3
* Iodine Solutions: high doses block thyroid function
AE
* Thioamides: Thyroid suppression
* Iodine Solutions: Hypothyroidism - resp failure
CI: Known allergy, pregnancy
Caution: Lactation
Drug
* Thioamides: Oral anticoagulants, theophylline, metoptolol, propranolol, digitalis
* Iodine Solutions: Anticoagulants, theophylline, digoxin, metoprolol, propranolol
Alendronate (Fosamax) / ibandronate (Boniva)
Bisphosphonates
For
* Osteoporosis, Padget’s disease, Steroid induced osteoporosis
MOA
* Slow or block bone resorption; by doing this, they help to lower serum calcium levels, but they do not inhibit normal bone formation and mineralization
AE
* headache, NVD; bone pain with Paget’s disease
CI: Bisphosphonates- Hypocalcemia, pregnancy and lactation, renal dysfunction, GI disease
Drug
* antacids, calcium products, iron, or multiple vitamins and aspirin
Insulin
For
* Treatment of type 1 diabetes mellitus
* Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents
MOA
* Hormone that promotes the storage of the body’s fuels, Facilitates the transport of various metabolites and ions across cell membranes, Simulates the synthesis of glycogen from glucose, Reacts with specific receptor sites on the cells.
AE
* hypoglycemia, ketoacidosis
Caution: Pregnancy and lactation
Drug
* When given with any drug that decreases glucose levels; Beta blockers
Glyburide
Sulfonylureas
For
* T1DM
* T2DM where diabetes cannot be controlled by diet and other agents
* Adjunct to diet and exercise to lower blood glucose in T2
MOA
* Bind to potassium channels on pancreatic beta cells, may improve insulin binding to insulin receptors and increase number of insulin recep tors
* Stimulate insulin release from beta cells in the pancreas; they improve binding to insulin receptors
AE
* NVD , skin reactions, hypoglycemia
CI: T1, diabetic complications, allergy
Caution: preg and lactation
Drug
* do not intereact with as many protein bound drugs
* drugs that acidifies the urine, Beta Blockers, alcohol
Glucagon
Glucose Elevating Agent
For
* Treatment of hypoglycemia
* Raise the blood level of glucose when severe hypoglycemia occurs (<40 mg/dL)
MOA
* Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose
AE
* GI upset; Vascular effects
CI: Known allergy; Pregnancy and lactation
Caution: Hepatic dysfunction or cardiovascular disease
Drug
* Thiazide diuretics; Anticoagulants
Glargine (Lantus)
Long Acting Insulin
* no peak
* no mix
* “old guys”
* duration: 24 hrs
* “large lasting”
NPH
Intermediate Acting Insulin
* never IV
* mix clear to cloudy
* given 2x a day
* duration 14 hrs
* Peak: 4-12 hrs
Regular Insulin
Short-Acting Insulin
* Ready to go IV
* the ONLY IV insulin
* Duration: 5-8 hrs
* Peak: 2-4 hrs
Lispro / Aspart
Rapid Acting Insulin
* Most Deadly - 15 min onset
* Must be given during meals
* Duration 2-5 hrs
* Peak 30-90 min
* Always monitor for hypoglycemia
Metformin
Biguanide
* reduce output of glucose through liver and increase insulin sensitivity
* minimal chance of low sugar
* major liver and kidney toxic
* Hold 48 hrs before cath lab: lactic acidosis
7 S’s of Steroid Precautions
- Swollen: water gain = weight gain, report 1lb in 1 day or 2-3lbs in a few days
- Sepsis: low WBC, fever is priority
- Sugar: increases, hyperglycemia
- Skinny: muscles and bones - osteoporosis
- Sight: cataract risk - refer to optometrist
- Slowly taper off: prevent adisonian crisis
- Stress and surgery: increase the dose
Cimetidine
Histamine-2 Antagonist
“-tidine”
For
* Short-term treatment of active duodenal ulcer or benign gastric ulcer. Treatment of pathological hypersecretory conditions such as Zollinger–Ellison syndrome. Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical patients. Treatment of erosive gastroesophageal reflux. Relief of symptoms of heartburn, acid indigestion, and sour stomach (OTC preparations)
MOA
* Block the release of hydrochloric acid in response to gastrin
* Selectively block histamine-2 receptor sites. This blocking leads to a reduction in gastric acid secretion and reduction in overall pepsin production
AE
* GI effects (diarrhea), CNS effects (dizzy, somnolence, HA), Cardiac arrhythmias and hypotension
CI: Known allergy
Caution: Pregnancy, lactation, renal/liver impairment
Drug
* Warfarin, phenytoin, beta blockers, alcohol, quinidine, lidocaine, theophylline, chloroquine, benzodiazepines, nifedipine, pentoxifylline, tricyclics, procainamide, and carbamazepine
Sodium Bicarbonate
Aluminum salts, Magnesium salts, Calcium salts
Antacids
For
* Symptomatic relief of upset stomach associated with hyperacidity, as well as hyperactivity
MOA
* A group of inorganic chemicals that neutralize stomach acid
* Neutralize stomach acid by direct chemical reaction
AE
* Relate to their effects on acid-base levels and electrolytes, Rebound acidity, Alkalosis, Hypercalcemia, Constipation or diarrhea, Hypophosphatemia
* Hypokalemia – intracellular K+ shift.
CI: Known allergy
Caution: Any condition that can be exacerbated by electrolyte imbalance
GI obstruction
Drug
* many drugs - affects the absorption
Omeprazole
PPI
“-prazole”
For
* Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis, and benign active gastric disease.
* Long-term treatment of pathological hypersecretory conditions
MOA
* Suppress the secretion of hydrochloric acid into the lumen of the stomach
* Act at specific secretory surface receptors to prevent the final step of acid production and thereby decrease the level of acid in the stomach
AE
* CNS effects: Dizziness, headache, asthenia, vertigo, insomnia, apathy.
* GI Effects: Diarrhea, abdominal pain, and tongue atrophy.
* Upper respiratory tract symptoms: Cough, stuff nose, hoarseness, and epistaxis.
* Other: Rash, alopecia, pruritis, dry skin, back pain, and fever
CI: Known allergy
Caution: pregnancy/lactation
Drug
* Benzodiazepines, phenytoin, warfarin. Ketoconazole, theophylline. Sucralfate, Clopidogrel
Sucralfate
GI Protectant
For
* Ulcer healing
* Take on an empty stomach: 1-2 hrs before or after food or meds
* Best at bedtime
MOA
* Coat any injured area in the stomach to prevent further injury from acid
* Forms an ulcer-adherent complex at duodenal ulcer sites, protecting the sites against acid, pepsin, and bile salts
AE
* GI effects – Constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth, Dizziness, Sleepiness. Vertigo. Skin rash. Back pain
CI: Known allergy, renal failure
Caution: pregnancy/lactation
Drug
* Aluminum salts
* Phenytoin, fluoroquinolone, or penicillamine
Misoprostol
Prostaglandin
For
* Protect the stomach lining
* Prevention of NSAID-induced gastric ulcers: on an NSAID therapy
* Treatment of duodenal ulcers
MOA
* Inhibits gastric acid secretion and increases bicarbonate and mucous production in the stomach
AE
* GI effects – Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, and constipation; GU effects – Miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstrual disorders, increases cervical ripening
CI: Pregnancy - have to give preg test before taking this
Caution: Lactation
Drug
* Aluminum salts, antacids
* Phenytoin, fluoroquinolone, or penicillamine
Pancrelipase
Digestive Enzymes
For
* Substances produced in the GI tract to break down foods into usable nutrients
* Replacement therapy for CF patients
* Must be eaten with every meal and snack
* Open capsule and sprinkle contents on food without chewing
MOA
* Saliva substitute – Contains electrolytes and carboxymethylcellulose to act as a thickening agent in dry mouth conditions. Pancreatic enzymes are replacement enzymes that help the digestion and absorption of fats, proteins, and carbohydrates
AE
* Saliva – Complications from abnormal electrolytes – increased levels of magnesium, sodium, or potassium
Pancreatic enzyme – GI irritation, nausea, abdominal cramps, and diarrhea
CI: Saliva – Allergy; Pancreatic enzymes - Allergy
Caution: Saliva – CHF, hypertension, or renal failure; Pancreatic enzyme – Pregnancy and lactation
Drug
* Aluminum salts
* Phenytoin, fluoroquinolone, or penicillamine
Castor Oil
Bisacodyl, Senna
Chemical Stimulant
For
* Producing stool
MOA
* Begin working at the beginning of the small intestine and increase motility throughout the rest of the GI tract by irritating the nerve plexus
* Chemically irritate the lining of the GI tract
AE
* GI: diarrhea, abdominal cramping, nausea. CNS: dizziness, headache, weakness. Sweating, palpitations, flushing,
fainting. Cathartic dependence. Castor oil: blocks absorption of fats and fat-soluble vitamins
ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern,
nausea, or vomiting
CI: Acute Abdominal Disorder
Caution: Heart block, CAD, debilitation. Pregnancy and lactation
Psyllium / Methylcellulose
Laxatives - Bulk Stimulants
For
* Producing stool
MOA
* Increase motility by increasing size of fecal material, which will increase fluid in the GI tract, cause more stretch on GI tract, stimulate local stretch receptors, and activate local GI activity
* Cause the fecal matter to increase in bulk
AE
* *GI: diarrhea, abdominal cramping, nausea. CNS: dizziness, headache, weakness. Sweating,
palpitations, flushing, fainting
ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting
CI: Acute Abdominal Disorder
Caution: Heart block, CAD, debilitation. Pregnancy and lactation
Drug
* other prescribed meds
Magnesium Citrate
Saline Laxatives
For
* Producing Stool
MOA
* Draw more water into GI tract and stimulate increased GI motility
AE
* GI: diarrhea, abdominal cramping, abdominal bloating, nausea; dehydration: dry mouth, dizziness, light-
headedness. CNS: dizziness, headache, weakness. Sweating, palpitations, flushing, fainting. Rectal irritation
* ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting
CI: Lactulose: appendicitis, acute surgical abdomen, fecal impaction, intestinal obstruction
Caution: Lactulose: Diabetes. Magnesium: Renal insufficiency. Polyethylene glycol: seizures
Drug
* Other prescriptions. Magnesium: neuromuscular junction blockers
Mineral Oil
Lubricant
For
* Producing Stool
MOA
* Forms a slippery coat on the contents of the intestinal tract
AE
* GI: diarrhea, abdominal cramping, nausea; leakage and staining with mineral oil. CNS: dizziness, headache, weakness. Sweating, palpitations, flushing, fainting
* ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting
CI: Allergy. Acute abdominal disorders
Caution: Heart block, CAD, debilitation. Pregnancy and lactation
Drug
* Frequent use of mineral oil can interfere with absorption of the fat-soluble vitamins A, D, E, and K
Metoclopramide
Gastrointestinal Stimulant
For
* Rapid movement of GI contents
MOA
* Blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine. Leads to increased GI activity and rapid movement of food through the upper GI tract
* Stimulate parasympathetic activity within the GI tract. Increase GI secretions and motility
AE
* Nausea, vomiting, diarrhea, intestinal spasms, cramping, decreased blood pressure and heart rate, weakness, and
fatigue
* ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting
CI: Allergy. GI obstruction
Caution: Pregnancy. Lactation
Drug
* Digoxin. Cyclosporine. Alcohol
Loperamide
Antidiarrheal Drugs - an Opioid
For
* Relief of symptoms of acute or chronic diarrhea
* Reduction of volume of discharge from ileostomies
* Prevention and treatment of travelerʼs diarrhea
MOA
* Slow the motility of the GI tract through direct action on the lining of the GI tract
* Allows increased time for absorption of fluid and electrolytes
AE
* Abdominal distension. Abdominal discomfort. Nausea. Dry mouth. Toxic megacolon. Fatigue. Weakness. Dizziness
* ASSESS for: intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting
CI: Allergy.
Caution: Pregnancy. Lactation. History of GI obstruction History of acute abdominal conditions. Diarrhea due to poisonings
Drug
* depends
Prochlorperazine
Phenothiazines - Antiemetics
For
* Antianxiety drug that blocks the responsiveness of the CTZ to stimuli, leading to a decrease in nausea and vomiting
MOA
* Depresses various areas of the central nervous system (CNS)
AE
* Drowsiness, dizziness, weakness, tremor, headache. Hypotension, hypertension, cardiac arrhythmias. Dry mouth, nasal congestion, anorexia, pallor, sweating, urinary retention. Menstrual disorders, galactorrhea, and gynecomastia. Photosensitivity
CI:Coma, severe CNS depression, brain damage or injury. Severe hypotension or hypertension. Severe liver dysfunction
Caution: Renal dysfunction. Moderate liver impairment. Active peptic ulcer. Pregnancy and lactation
Drug
* Other CNS depressants, including alcohol
Ondansetron
Serotonin (5-HT3) Receptor Blockers - Antiemetic
For
* Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, prevention of postoperative nausea and vomiting
* Give before chemo and before/with pain meds
MOA
* Acts to reduce the responsiveness of the nerve cells in the CTZ to circulating chemicals that induce vomiting
AE
* Drowsiness. Fatigue. Restlessness. Extrapyramidal symptoms
* Serotonin Syndrome: agitation, tachycardia, high BP, muscle rigidity
CI: Coma, severe CNS depression, brain damage or injury. Severe hypotension or hypertension. Severe liver dysfunction
Caution: Renal dysfunction. Moderate liver impairment. Active peptic ulcer. Pregnancy and lactation.
Drug
* Other CNS depressants, including alcohol
Sodium Docusate
Stool Softener
* Increases water content in the stools to soften bowels
Lactulose
Osmotic Laxatives
* Laxative for
* Ammonia levels-decreasing
* Cognition returns - improved mental status
For
* cirrosis patients to decrease ammonia levels
* hepatic encephalopathy
Should See
* 2-3 soft stools per day
* ammonia levels decrease
* cognition improves
Sulfasalzine
Pharmacologic Therapies for IBD
MOA
* decreases colon inflammation by inhibiting prostaglandin
* immunosuppresive
* continue even after symptoms subside
Side Effects (normal)
* discoloration of skin and urine
AE
* Sun dried: need sunblock, dry out body
* Urine Crystals - kidney stones
* Low urine output and high gravity - 1.030
* Fluid and folic acid: need these
Contraindicated
* sulfa allergies
Baclofen
Cyclobenzaprine, Tizanidine
Centrally Acting Skeletal Muscle Relaxants
For
* Alleviation of signs and symptoms of spasticity; use in spinal cord injuries or diseases
MOA
* Work in upper levels of CNS to interfere with reflexes causing muscle spasm; Possible depression anticipated with their use; Lyse or destroy spasm (spasmolytics); Exact mechanism unknown, thought to involve action in upper or
spinal interneurons
AE
* Drowsiness, Fatigue, Weakness, Confusion, Headache,
Nausea, Dry mouth, Hypotension
CI: Known allergy; Rheumatic disorders
Caution: Epilepsy; Cardiac dysfunction; Conditions marked by muscle weakness
Drug
* CNS depressants, Alcohol
Dantrolene
Botox
Direct Acting Skeletal Muscle Relaxants
For
* Treatment of spasticity directly affecting peripheral muscle contraction. Management of spasticity associated with neuromuscular diseases
MOA
* Interfering with the release of calcium from the muscle tubules. This prevents the fibers from contracting. Does not interfere with neuromuscular transmission
AE
* Fatigue. Weakness. Confusion. GI irritation. Enuresis
CI: Known allergy. Spasticity - that contributes to locomotion, upright position, or increased function. Hepatic disease. Lactation
Caution: Women. All patients older than 35 years. Cardiac disease
Drug
* Estrogen. Neuromuscular junction blockers and others that interfere with neuromuscular transmission
Methotrexate
DMARD
For
* RA
MOA
* Stops folic acid metabolism, which stops cell reproduction
AE
* Low immunity - infections, suppresses B and T
* Low platelets - serious bleeding
* Fetal death
Caution: preg, crowds, live vaccines, razors, brushing teeth hard
Infliximab
TNF Blocker
For
* relieve the symptoms of certain autoimmune disorders
* RA, Crohn’s, UC
MOA
* act to decrease the local effects of TNF, a locally released cytokine that can cause the death of tumor cells and stimulate a wide range of proinflammatory activities
AE
* Demyelinating disorders have occurred, including multiple sclerosis and various neuritis conditions
* Myocardial infarction (MI), heart failure, and hypotension
Drug: other immunosup drugs, live vaccines
Need neg TB test before taking it, may activate TB
Hydroxychloroquine
DMARD
For
* inflammatory disorders, lupus
MOA
* decreases the inflammatory response on skin and joints
AE
* retinal damage and vision problems: get eye appts
Allopurinol & Colchicine
Xanthine Oxidase Inhibitors / Anti-Gout
For
* Given for Gout - uric acid build up causes inflammation in the joints
* A = prevents gout
* C = acute gout attacks
* not given to reduce pain, just reduce uric acid
MOA
* competitively inhibits reabsorption of uric acid at the proximal convoluted tubule
AE
* Mild rash: report to HCP
Make sure to increase fluid intake
