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DPC > Group 8/19/19 > Flashcards

Group 8/19/19 Flashcards

1
Q

Learning issues

A
  • Pharmacokinetics: the dynamics of drug distribution (Goodman’s and Gilman’s within ch 2)
  • Pathology of Long bone fractures (Robbins and Cotran)
  • Behavior medicine of working with specific populations (adolescents) (Feldman)
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2
Q

adolescence

A

the interval between the onset of puberty and the cessation of body growth
adult body image and sexuality emerge, independent moral standards, intimate interpersonal relationships, vocational goals, and health behaviors develop; separation from parents

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3
Q

what are health problems in teenagers related to?

A

unwanted pregnancy, STIs, weapon carrying, interpersonal violence, suicidal ideation, alcohol, cigarette, and illicit drug use, dietary and exercise patterns

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4
Q

what is the leading cause of death for most populations of teenagers?

A

accidents

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5
Q

what are the most common reasons for acute office visits?

A

routine/sports physicals, upper respiratory infections, acne

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6
Q

what is a major challenge in caring for teenagers?

A

eliciting a history that reveals health risk behaviors

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7
Q

what does the American Medical Association published Guidelines for Adolescent Preventive Services emphasize?

A

prevention, as well as partnership with the patients, parents, schools, communities and health care providers

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8
Q

relationship between adolesecent health outcomes and public health

A

adolescent health outcomes are related to the cultural, educational, political, and economic policies; e.g., access to hand guns and bullying policies

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9
Q

role of electronic communication and social networks in adolescent health

A

people with chronic diseases may have online support networks
bullying in social networks
helps them to feel connected to their parents, school, and community; decrease likelihood of partaking in health-risky behaviors

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10
Q

early adolescence age

A

11-14

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11
Q

early adolescents physical

A
  • rapid growth, questions about puberty

- somatic (body) preoccupation

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12
Q

early adolescents social

A
  • peers more involved, family less involved

- opposite sex contact in groups

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13
Q

early adolescents cognitive

A
  • concrete to abstract thinking
  • impulsive behavior
  • testing limits at school and home
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14
Q

middle adolescence age

A

15-17

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15
Q

middle adolescence physical

A
  • some issues from early adolescence remain

- most physical development complete

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16
Q

middle adolescence social

A
  • independence and identity struggles, want to be individual
  • peers more important than family, acceptance important
  • invincibility and impulsiveness; experiment with drugs and sex
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17
Q

middle adolescence cognitive

A
  • improve reasoning and abstract thinking
  • better interpersonal relationships and empathy
  • thinking about future work goals
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18
Q

late adolescence age

A

18-24

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19
Q

late adolescence physical

A
  • no more body growth

- becoming more comfortable with appearance

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20
Q

late adolescence social

A
  • individual identity and separation complete

- more monogamous interpersonal relationships and less peer support

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21
Q

late adolescence cognitive

A
  • vocational goals set

- realistic expectations about education and work

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22
Q

confidentiality

A

important to tell the adolescent that all the conversations are confidential, unless homocide/suicide threatened or there is ongoing abuse

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23
Q

receptiveness

A

the adolescent is more likely to share personal, sensitive information if the provider seems receptive (not disapproving); needs to seem like they have permission to discuss those things

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24
Q

legal issues

A

laws differ by state; some states require parental notification about sex, drug, or alcohol problems; life-threatening situations

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25
Q

interview organization HEADSS abbreviation

A

home, education, activities, drug use, sexual practice, and suicidal ideation

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26
Q

home questions to ask

A

who they live with, how often they see each parent, how often they leave and why, if the single parent dates, how they get along with the spouse, what happens when people argue, if anyone gets hurt, if there are guns and who has access to them, ask about siblings and their health

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27
Q

education questions to ask

A

what kind of grades they get, how they compare to last year, learning problems, vision problems, favorite/worst subjects, career aspirations, attendance and discipline problems, stress, what happens if you don’t receive high grades

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28
Q

activities questions to ask

A

what do you do for fun, extracurricular activities, gang/srat/frat membership, dietary habits, physical activities, safety when driving

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29
Q

drugs questions

A

ask about their awareness of others’ drug use and their friends’ drug use, if they’ve tried drugs or alcohol, how often and how much, what circumstances, ask about family members’ habits, how often they see their parents drunk

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30
Q

tips for counseling adolescents about drugs

A

connect the harmful effects of alcohol to their body image and safety; for example cigarettes causing wrinkled skin, or girls getting raped while drunk

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31
Q

sex questions

A

ask about sexual involvement; number of partners; who they’re attracted to; internet partners; birth control techniques; history of sexual abuse

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32
Q

suicide questions

A

questions to show signs of depression; sleep disturbance, decreased appetite, hopelessness, lethargy, thoughts of suicide, hallucinations, illogical thoughts

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33
Q

homeless and runaway teens common characteristics

A

Usually have been in contact with social services, had parental conflict, high rates of physical/sexual abuse, abandonment because of sexual orientation
They are at risk for selling sex or drugs, theft

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34
Q

tips for caring for homeless and runaway teens

A

developing trusting working relationship over several visits, keeping appointments and referrals

35
Q

challenges for teens with chronic illness or disability

A

teens with chronic illness/disability have issues conforming, leads to poor self-esteem

36
Q

tips for caring for teens with chronic illness or disability

A

should have realistic discussions about their hopes and expectations
encourage interests/skills that would help to boost their self esteem
encourage friendships, involvement in family activities, and parents that aren’t overly protective

37
Q

challenges for teens who are gay/lesbian

A

social isolation, depression, STIs, substance abuse, interpersonal violence, anxiety, shame, guilt

38
Q

tips for caring for teens who are gay/lesbian

A

nonjudgmental, supportive attitude and relationship with provider to help them cope with negative stereotypes

39
Q

simple fracture

A

the overlying skin is intact

40
Q

compound fracture

A

the bone touches the skin surface

41
Q

comminuted fracture

A

the bone is fragmented

42
Q

displaced fracture

A

the ends of the bone at the fracture site are not aligned

43
Q

stress fracture

A

a slowly developing fracture caused by increased physical activity, bone subjected to repeated loads

44
Q

greenstick fracture

A

fracture that extends only partially through the bones, especially common in infants because their bones are soft

45
Q

pathologic fracture

A

fractures caused by bone that’s weakened by underlying disease process, such as a tumor

46
Q

how do the osteoprogenitor cells get activated during repair of a fracture?

A

migrating inflammatory cells and degranulated platelets will release factors like PDGF, TGF-beta, and FGF

47
Q

delayed union/union

A

sometimes there is a deformity associated with the fracture (e.g. displaced or comminuted fractures). If there is inadequate immobilization (ie putting the bone in its proper place), the callus can’t move as well and doesn’t form well

48
Q

pseudoarthrosis

A

a malformed callus from a nonunion of the bone can start to undergo cystic degeneration, and the luminal surface gets lined with synovial-like cells

49
Q

what influences the distribution of a drug in tissues?

A

cardiac output, regional blood flow, capillary permeability, and tissue volume affect delivery rate and amount of drug that goes to the tissues

50
Q

which tissues tend to receive a drug first versus later?

A

liver, kidney and brain receive drug first
muscle, viscera, skin, and fat is slower
diffuses quickly into interstitial fluid

51
Q

drugs binding to plasma protein

A

drugs tend to bind to plasma proteins in the blood, such as albumin. This can interfere with the drug’s transport and metabolism
sometimes assays can’t differentiate unbound vs bound drugs, and different drugs compete for the same protein-binding sites

52
Q

tissue binding for drugs

A

drugs tend to accumulate in tissues in higher concentrations that blood and ECF. Drugs can stay there as a reservoir for prolonged effect, or local toxicity

53
Q

what is the BBB and how does it influence drug passage?

A

blood brain barrier; brain capillary endothelial cells have continuous tight junctions, so drugs need a transcellular transport process. Drug’s passage depends on its lipid solubility

54
Q

CSF barrier

A

this exists at choroid plexus, similar to the BBB but separates blood from the CSF.

55
Q

what kinds of drugs are in bone, how is it as a reservoir?

A

tetracycline antibiotics and heavy metals can accumulate in bone through absorption through crystal lattice into the crystal surface. Effects are long lasting and prolonged.

56
Q

what kinds of drugs are in fat, how is it as a reservoir?

A

lipid soluble drugs here, stable reservoir because low blood flow

57
Q

what is redistribution?

A

drug effects can stop if they are redistributed from its site of action to other tissues or sites. Usually happens in lipid-soluble drugs

58
Q

how does the fetal placenta protect from drug entry?

A

has transporters from the ABC family to prevent drug entry to fetus
fetus plasma is more acidic so basic drugs get ionically trapped

59
Q

what kind of diffusion dominates transmembrane movement of most drugs?

A

passive diffusion

60
Q

what are two types of carrier-mediated mechanisms of transport?

A

active transport and facilitated diffusion

61
Q

what is passive diffusion?

A

drug molecule penetrates by diffusion along a concentration gradient, depending on its solubility in lipid bilayer

62
Q

what does the pKa mean for drugs?

A

the pH at which half the drug is in its ionized form

63
Q

what is ion trapping?*

A

weak acids will be trapped in basic environments, and the H+ dissociates
weak bases will be trapped in acidic environments, and the proton has not dissociated

64
Q

what form of drugs will dominate at acidic vs basic pH?

A

acidic pH will have more protonated forms

basic pH will have more anion forms

65
Q

what is facilitated diffusion?

A

a carrier-mediated transport process in which the driving force is the electrochemical gradient of the transported solute.

66
Q

what is active transport?

A

requires energy and allows movement of the solute against an electrochemical gradient, saturability, selectivity, and competitive inhibition

67
Q

antiporters vs symporters

A

an antiporter uses energy stored in an ion gradient to actively transport another ion, so that they are being transported in opposite directions
a symporter moves the ion and the solute in the same direction

68
Q

what is paracellular transport?

A

solutes and fluids can go through intracellular gaps, and these are so big that the main impediment to their flow is the blood.
Areas like the CNS and some other epithelial are too small for easy paracellular passage

69
Q

what is absorption?

A

the movement of a drug from its site of administration into the central compartment

70
Q

pros and cons of orally administered drugs

A

safe, convenient
limited absorption of drugs because of solubility or membrane permeability, digestion and absorption issues, delayed gastric emptying

71
Q

controlled-release preparations

A

produce slow, uniform absorption of the drug; patient takes it less often, prolonged therapeutic effect, less side effects

72
Q

advantages of sublingual route

A

when absorbed here, bypasses intestinal and hepatic first-pass metabolism

73
Q

parenteral injection

A

does not go in via the GI tract, can be IV, subcutaneous or intramuscular. Can deliver drug in its active form, makes the drug available more predictably and accurately, but can be painful and need to maintain asepsis (ie absence of bacteria)

74
Q

pros and cons of IV route

A

complete bioavailability, accurate and immediate drug delivery
unfavorable reactions from high concentrations of the drug accumulating in plasma and tissues, can’t take back a dose, some interfere badly with blood

75
Q

advantages of subcutaneous route

A

constant absorption for slow, sustained effect

76
Q

advantages of intrathecal

A

can give local and rapid effects of the drugs on meninges or cerebrospinal axis. Drug is injected directly into the spinal subarachnoid space.

77
Q

advantages of pulmonary absorption

A

rapid access to circulation because of big surface area of lungs, no hepatic first-pass loss

78
Q

topical application advantages

A

quick absorption through mucous membranes, transdermal absorption better if skin moist or drugs are lipid-soluble

79
Q

rectal route pros and cons

A

half of drug absorbed will bypass the liver, but can be incomplete absorption and irritating

80
Q

bioequivalent definition

A

drug products can be pharmaceutically equivalent; and they also need to have same rate and extent of bioavailability under identical conditions

81
Q

zero order elimination*

A

rate of elimination is constant regardless of the Cp; a constant amount of drug is eliminated per unit time, decreases linearly with time
PEA is round, shaped like a zero: Phenytoin, Ethanol, Aspirin (at high or toxic concentrations)
has capacity-limited elimination

82
Q

capacity limited elimination*

A

clearance is saturable usually at or near therapeutic concentration of drug. Once saturation occurs clearance rate fails to increase with increasing plasma drug concentrations

83
Q

first order elimination*

A

First order elimination is directly proportional to the drug concentration, constant Fraction of drug eliminated per unit time. Cp decreases exponentially with time, applies to most drugs. Flow-dependent elimination.

84
Q

how does urine pH affect drug elimination?*

A

ionized species are trapped in urine and cleared quickly; neutral forms can be reabsorbed

DPC (11 decks)

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