Final Study Flashcards
Cortisol increases/decreases - 3/2
Increase - Gluconeogenesis Increase - Muscle protein catabolism Increase - Lymph tissue atrophy Decrease - Protein synthesis Decrease - Lymphocytes, Macrophages, Eosinophils
Central Stress Response hormones - 3
Hypothalamus - GHRH
Anterior Pituitary - Growth hormone
Posterior Pituitary - Antidiuretic hormone
Central Stress Response effects - 8
Growth hormone increases lipolysis, protein synthesis, gluconeogenesis
Growth hormone decreases insulin sensitivity, muscle glucose uptake
Beta endorphins reduce pain sensation
ADH increases reabsorption of water
Norepinephrine vasoconstriction, raises BP, pupil dilates
Epinephrine increases gluconeogenesis, inotropy, chronotropy
Epinephrine decreases insulin, muscle/fat glucose uptake, glycogen synthesis
Pro-inflammatory effect
Theories of aging - 4
ROS - free radical damage to cells, builds up over time
Telomere shortening
Errors in transcription produce protein errors
Molecular damage causes aberrant gene expression
Normal aging effects Cardiovascular - 4
Slower resting ad max heart rate
Higher BP
Less ability of heart, vessels to respond to changes/stress
Falls risk, cardio issues, stroke
Normal aging effects Respiratory - 3
Less effective mucous clearance
Reduced capacity for aerobic exercise
Respiratory issues become serious quicker
Normal aging effects Musculoskeletal - 2
Overall stiffness of muscles, joints
Falls risk
Normal aging effects Integumentary - 4
Smaller fat cushion
Less blood flow
Skin less resilient
Skin tears/ulcers, broken bones
Normal aging effects Hepatic - 2
Reduced metabolic function
Drug toxicity, interactions
Normal aging effects Renal - 2
Decreases ability to excrete drug metabolites, toxins
MOST important cause of ADR
Normal aging effects Gastrointestinal - 3
Dry mouth
Early satiety
Dehydration, nutritional deficiencies
Normal aging effects Genitourinary - 4
Changes in sexuality
Urinary retention males
Urinary incontinence females
UTI, skin ulcers
Normal aging effects Neurologic - 4
Slowed mental processing
Alteration in taste, smell
Lower thirst sensation
Nutritional deficiencies, dehydration, falls risk
Normal aging effects Endocrine/Metabolic - 4
Less appetite
Less tolerance to cold
No fever with infection
Nutritional deficiencies, harder to detect and recover from illness
Normal aging effects Immune - 4
Increased risk of infection
Increased incidence certain autoimmune diseases
Increased risk for malignancies
Increased risk of getting sick
Normal aging effects Sleep - 4
Longer time to fall asleep
Frequent awakenings
Shortening/disappearance of parts of non-REM sleep
Falls risk, accident risk
Age related changes effect on PK - 4
Absorption - little change
Distribution - more body fat, lower lean mass, lower body water, lower albumin. Distribution Enhanced
Metabolism - reduced hepatic blood flow/size, enzyme activity, malnutrition. Metabolism Decreased
Excretion - reduced respiratory function, renal function. Excretion Decreased
Geriatric symptoms, what to watch for acronym - 6
Sleep Disorders Problems with eating/feeding Incontinence Confusion and Constipation Evidence of Falls Skin breakdown
HPAA Hormones - 3
Hypothalamus - CRH
Anterior Pituitary - ACTH
Adrenal Cortex - Cortisol
Oocyte to implantation
Oocyte fertilized by sperm
Cleavage to morula then blastocyst
W cell types, inner cell mass and Trophoblast
Day 6 blastocyst implants into uterine wall
Trophoblast becomes placenta
Bilaminar becomes trilaminar becomes 3 germ layers
Ectoderm - nervous system, epidermis
Mesoderm - skeleton, muscles, heart, circulatory, urinary, dermis
Endoderm - liver, pancreas, thyroid, respiratory, gastrointestinal
When is fetal circulation, heartbeat
Fetal circulation 3 weeks
Heartbeat 4 weeks
Fetal circulation differences - 4, when close
Ductus venosus - bypass liver, oxygenated blood to Vena Cava
Ductus arteriosus - bridge pulmonary artery to aorta
Foramen ovale - hole between atriums
Closes within hours of birth
Lung development - name, what happens, weeks - 5
Embrionic - lungs start to form, airways - weeks 3-7
Pseudoglandular - type II pneumocytes - weeks 5-18
Canicular - type I pnuemocytes - week 16-27
Saccular - alveolar saccules, surfactant - weeks 24-38
Alveolar - mature alveoli - weeks 36+, continues in newborn
Pregnancy weight gain - 6 + 1
Total 24 pounds Baby - 7 Placenta, amniotic fluid - 4 Uterus - 2 Breasts - 2 Plasma volume - 6 Fat - 3
Pregnancy levels plasma, blood volume, red cell mass, hematocrit, system vascular resistance, serum creatinine, GFR, renal plasma flow
Plasma level, blood volume, red cell mass go up.
Hematocrit goes down
System vascular resistance, serum creatinine go down
GFR, renal plasma flow go up
Pregnancy and PK
Absorption increased - increased blood flow, slow GI less acid
Distribution increased - increased blood flow
Metabolism increased - increased hepatic blood flow
Excretion increased - increased GFR, renal plasma flow
Avoid and supplement in pregnancy
Avoid: cigarettes, alcohol, illicit drugs, stimulants,
Vitamin A, liver, iodine, some fish/mercury, herbal products, supplements
Supplement: folic acid, iron, calcium
Children PK differences skin
Skin thin, increased body surface area, increased blood flow
Transdermal absorption higher
Children PK differences blood brain barrier
Immature. Drugs reach brain in higher amounts
Children PK differences trachea siaze
Size of straw. Inspired drugs harder to get to lungs
Adverse reaction causing general inflammation serious faster
Children PK differences gastric
Empties slower first year.
Increased time to reach therapeutic concentration
Children PK differences liver
Immature. Metabolism decreased
Children PK differences albumin
Low. Distribution higher for protein binding drugs
Children PK differences kidneys
Immature. Excretion reduced, toxicity risk
Children PK differences water concentration in body
Water concentration higher than adult. Important in water soluble drugs
Children PK differences proportion of fat
Lower in child. Lower doses of lipophilic drugs required
Infant growth - 3
Weight doubles 6 months, triples in a year
Length increases 50% in a year
Head grows fastest. Circumference increases 1.5 cm/month first 6 months, 0.5 cm/month 6-12 months
Toddler growth
4-5 inches, 5 pounds
Pre-school growth, age 2-5
4-5 pounds, 2.5 inches
School age growth
Rapid growth trunk, limbs, in spurts
