medical conditions exam 1 Flashcards
what is a PT’s job in relation to drugs
we can’t prescribe or administer in general, we can only administer for modality use like iontophoresis and phonophoresis
what type of drug is aspirin
anti-platelet
if a patient says they are having a lot of inflammation, can you recommend the use of an NSAID
NO. but you can educate them on different types of OTCs so they can make the best choice but we can’t recommend use of drugs
are drugs removed from the body as active or inactive
can be either one depending on the type of drug and how the body responds
example of ace inhibitor
lisionopril
example of calcium channel blocker
norvasc
what do PTs use drug screenings for
precautions and contraindications for PT intervention
what does the FDA do
direct drug development, give approval for drug marketing, approve new use for older drugs, monitor use of existing drugs, determine if drugs are safe for humans and if they are effective
why are some drugs banned in the US but able to get in other countries
FDA determines if they are safe, most other countries just care if they are effective
what determines if a drug is rx or OTC
OTC have higher theraputic index so side effects are less
give examples of classifications of drugs
traditional vs generic, biologic vs biosimilar
what type of drug must be bioequivalent to the original
generic
what does bioequivalent mean
same dose, strength, ingredients and has the same effect in the blood
which type of drug can be analyzed for its components
traditional
what type of drug comes from living systems like yeast, plants, animals and can’t be replicated
biologic
what kind of drugs aren’t identical to the original but are usually at a lower cost, but we don’t know how therapeutic they are
biosimilar
what are examples of natural alternative therapies
minerals, fish oil, vitamins, etc
what does integrative medicine focus on
health vs disease
how many stages in drug testing does the FDA have and what is stage 4
4 stages, when they continue monitoring for adverse effects even after it’s approved
4 steps in pharmacotheraputics
AADME
what are some things drugs may be used for
maintenance, treatment, replacement, prevention
chemical name drug
long and complicated name, specific compound and structure
generic name
official name usually used in journals
trade name
copyrighted name, assigned by the drug company
how many schedules of drugs are there based on the comprehensive drug abuse prevention and control act
5
what schedule is marijuana in
used to be 1, but now it’s 3
what schedule are cocaine, morphine and adderall in
1
what schedule is testosterone in
3
what schedule are xanax, valium in
4
what schedule is robitussin in
5
risk factors for THC
stroke, fall, MI
what trimester should a pregnant woman make sure she does not consume drugs in
1st trimester
def dose
amt drug reach target site
def potency
amt needed to produce effect
def low dose
no observable effect b/c dose is too low
ceiling effect
dose is high so there is no increase in the response
which type of drug is immunogenic
biological, NOT chemical
which type of drug is stable and has a well-defined structure
chemical
what are some pros and cons of biologics
very expensive but better for the body and can be very specific in what they target
what is the most important thing for us as PTs to know about drugs out patients are taking
why they are taking the drug
what does bioavailability depend on
administrative route and ability to cross membrane barriers
2 types of drug administration
enteric and parenteral
enteric is also known as
alimentary (through GI)
what step of pharmokinetics determines bioavailability
absorption
what is drug absorption affected by
dosage, solubility, blood flow, acidity, concentration, diffusion
what is distribution of drugs affected by
blood flow, plasma protein, binding, anatomic blood barrier
what stage of pharmacokinetics includes the liver breaking it down
metabolism
what happens in the metabolism stage
liver changes drug to inactive form which also impacts how quickly it is excreted from the body
what organ is involved with elimination stage
kidney
what stage of pharmacokinetics is related to clearance or half life
excretion
what methods of taking drugs are parental
sublingual/buccal, IV, IM
what is a disadvantage about rectal administration and PEG tube
unpredictable where the drug will go in the body
example of drug administered via sublingual or buccal
nitroglycerine
what type of drug administration is 100% bioavailable
IV and IA
what type of administration are phonophoresis and iontophoresis
transdermal
what is intrathecal baclofen therapy
uses baclofen to decrease abnormal tone and deliver drug into CSF to manage severe spasticity
volume of distribution
ratio of drug administered to the concentration of drug in plasma
where are most drugs stored in the body
adipose tissue b/c lipid soluble
what are prodrugs
required to be active, liver breaks it down to create a stronger response
what should you not take if you are taking tetracycline
antacid b/c decreases antibiotic effects
risk of long term NSAID use
stomach ulcer, high BP, increase risk of heart attack
def drug selectivity
how the drug knows where to go
def affinity
attraction b/w drug and receptor
clearance (CL)
volume plasma cleared per unit time, predicts elimination in relation to blood serum concentration
what effect of drugs tells us when the next dose should be taken
clearance
what does half life ensure
maximum dose is administered at each time
what does a higher half life mean
longer time it takes for the drug to leave the system
what does a lower half life mean
the dose needs to be taken more often b/c doesn’t stay in the body for as long
does chemo have a high or low therapeutic index
low b/c it is very dangerous
how many of the most prescribed drugs that are prescribed for Americans are for hypertension
6/15
what are some conditions that have very costly drugs associated with them
diabetes, hep C, cholesterol
what are some of the most commonly prescribed drugs in the US
asthma, diabetes, cholesterol, GERD
vyvanse
ADHD
lyrica
seizure
lantus
DM
ventolin
COPD
crestor
cholesterol
advair
COPD
spiriva
COPD
januvia
DM
2018 GA prescription drug monitoring program
requires MDs to check database before rx opioids or cocaine
are analgesics an opioid
yes they are
do analgesics relive pain
no, they just alter the perception of pain
examples of non-opiods
NSAID, anti-inflammatory, glucocorticoids
examples of opiods
codeine, morphine, fetanyl, hydrocodone, heroin
what are some effects of opioids
sedation, mood change, constipation, depression, orthostatic hypotension
what does a PCA do
allows pt to control amount of opioid given to them via pump, shown to decrease addiction rates and side effects b/c constant supply instead of running out and asking for more
what is a benefit of cox 1 and 2 drugs
causes less GI upset
functions of acetaminophen
analgesic and antipyretic NOT anti-inflammatory
why would a dr combine acetaminophen and opiods
both used for pain relief but when used together the dose of opioid can be less
what does NSAID inhibit in the body
prostaglandis
what does a steroid do
anti-inflammatory and supresses immune system
what negative effects do NSAIDS have
liver damage, distrupt bone and cartilage healing
why are steroid packs given as packs instead of just a few doses
want to prevent adrenal suppression from removing it too fast from the body
what does a statin do
lower cholesterol in the body by slowing down the production of it
examples of statins
crestor, zocor, ezallor, lipitor
PPI treats what
GERD
example of PPI
nexium
what was amoxicillin used to treat for a while until drs realized they were becoming resistant to it
ear infections in kids
what does glucophage treat
type 2 diabetes
example of glucophage
metformin: leads to an increased response to insulin
example of diuretic
hydrocholorathiazide
what do diuretics treat
high BP or edema
what do ambien or zolpidem treat
insomnia
are there different types of drugs for insomnia
yes, some are oral, spray, sublingual depending on the purpose and how quick they would act
examples of SSRIs
prozac, zoloft, paxil, celexa, laxapro
bupropion and wellbutrin
works on dopamine to increase effectiveness on other drugs instead of increases the dosage of the more intense drug
benzodiazepines examples
xanax, valium
benzodiazepine purpose
promote sleep, decrease muscle spasm, alcohol withdrawl, anxiety and agitation
examples of stimulants
adderall, ritalin, concerta
angina
chest pain
nitroglyerin
tx angina, is sublingual administration
perocet combination of
opioid and acetamenophen
what type of drug is hydrocholorothalazide
diuretic, treats HTN and CHF
what does hemodynamic stability mean
considered stable based on the lab values available
if hematocrit levels are 25% what does that mean for the HCP
decide if they can continue on w/ tx, may or may not depending on clinical judgement
what are normal hematocrit levels
37-52 ish
how is anemia related to hematocrit and hemoglobin
decreased levels of both, hemoglobin is a better predictor
ESR def
rate of RBC settle out of unclotted plasma in 1 hour
what does ESR measure
inflammation in the body
leukocytosis def
increase in WBC that may be associated w/ malaise, lethargy, fever, bruising
what does basic metabolic panel include
electrolyte level, acid-base balance, blood sugar, kidney status
when pt is in the hospital is blood sugar expected to be higher or lower than normal
higher
what is HBA1c of someone w/ diabetes
> 6.5%
leukopenia def
decrease in WBC that may be associated w/ anemia, weakness, fatigue
what does a liver enzyme test for
billirubin and other enzymes to see what the quantity of them is like
what may lead to hypoalbuminum
poor nutrition b/c not getting adequate protein
what area of the body would liver problems cause pain
RUQ
what do pts w/ DVT usually complain of
dull pain the calf that doesn’t go away
3 things that together cause cancer
carciongen causes irreversible changes, endogenous + exogenous factors, non-carcinogen agent that promotes growth of cancer
what type of cells are platelets
thrombocytes= initiate clotting
what is good blood glucose level
140-180 mg/dL
what is an increased blood glucose level
200 mg/dL
what HBA1c levels are important to know
<5.7% is normal
>5.7 is pre-diabetes
what electrolyte is very important for controlling heart muscle function
potassium
what are blood urea nitrogen
waste elimated from kidneys
what is waste from liver called
bilirubin, recycled into RBC
what protein is made by the liver and can lead to poor wound healing
albumin
PT
prothrombin time
PTT
partial thromboplastin time
INR
international normalized ratio
normal INR
0.8-1.2
what level of INR requires MD consult
> 4.6
what level of INR increases risk of hemarthrosis during exercise
> 3.6
what is the leading cause of preventable death in the hospital
DVT
why is DVT risky
increase viscosity which decreases blood flow and makes it easier to clot and travel
is homan’s sign a valid test for DVT
no, don’t use it. refer to MD for ultrasound if DVT is suspected
tx for DVT
eliquis, pradaxa, xarelto
types of cholesterol
HCL- good
LDL- bad
5 common places for cancer to spread to
bone, brain, lung, lymph, liver
what is most leading cause of death in people under 85 yo
cancer
what is the second leading cause of death in children
cancer
what is the most fatal type of cancer
lung
what is the most aggressive type of cancer
pancreatic
what’s an example of chemoprevention
preventative mastectomy, taking tomoxiphan; both will prevent breast cancer
main risk factors of cancer
> 50, ethnicity, environment, family history, obesity, age of menstration, skin color, etc
what is a very good screening tool to prevent a specific type of cancer
colorectal screen= 90%
screen for pancreatic cancer
none exists currently
who should be screened for ovarian cancer
if have BCRA 1 or 2 mutations
difference b/w malignant and benign cells
don’t invade, differentiated, encapsulated
compress and invade, undifferentiated, invasive
what is a word to describe malignant cells
anaplastic: DNA loses ability to make codes that allow for mature cell function
what cancer is associated w/ BCRA 1 and 2 mutaiton
mostly breast cancer but also increase risk for ovarian
what is the #1 cause of preventable disease death in the US
smoking
what cancers can exercise lead to a decrease in risk
breast and colon
what cells are ideal to target in early detection screenings
mataplasia b/c they are reversible
are dyslasia cells cancerous or not
no they are not cancerus, they are abnormal and they may progress to be cancerous but at their current state they aren’t
what is the most advanced type of metaplasia cells
anaplasia, have metastacized
what is the most common type of cancer cell
carcinoma, begins in epithelial and moves internal towards the lymph and organs
who are carcinoma cells common in
kids like lymphoma and leukemia
if a tumor is benign what will its suffix be
-oma
what cancers are most associated w/ age
lekemia, breast, GI, prostate, urinary
how many grades of cancer are there
4
what does grade 1 of cancer mean
best prognosis, least threatening, most differentiated
TNM system includes what 3 factors
size/area of tumor, # lymph, metastases presence
what are tumor markers
biomarkers made by a tumor that is found in high levels for people with cancer
what viruses are associated w/ cancer
EBV, HIV, leukemia, Hep B&C
why are metastasis especially concerning
even after they are killed w/ chemo or radiation they can come back in 15-20 years
what are some yellow flags in patients who could have cancer
24 hour pain, unexpected pain, weight loss/gain
what is the goal of neoadjuvant therapy
shrink the cancer before typical treatment begins
what are examples of neoadjuvant therapy
chemo, radiation, hormone
who is adjuvant therapy given to
lower cancer reoccurance risk because it may be undetectable
what does cancer surgery do
take out some tissue for pain relief, to relieve obstruction or debulk (take out entire thing)
fulguration tx
uses electrical current to destroy the cancer
excisional vs incisional biopsy
remove tumor and normal tissue vs use for diagnostic purposes and only take out tumor
what is radiofrequency ablation therapy
high energy radio waves that use needles to kill cancer
what is a thoroscopic treatment for cancer
use a tube with a video camera to create an incision in the chest
what are some benefits of robotic cancer treatment
decrease in blood loss, more accurate
what is en bloc resection
removing the entire tumor without taking part of the capsule
pros of cryosurgery
limited side effects, less money and less recovery time
what types of cancers can be treated with cryosurgery
liver, prostate, cervical, bone
what is an advantage of radiation therapy
increase the dose to the tumor and use the other tissues much less
what are some side effects of radiation therapy
red skin, looks burned, peeling after, xerostomia, mycositis, alopecia
what is the goal of radiation therapy
break down the chemical bonds to shrink the tumor
what do about half of patients use for cancer treatment
radiation therapy
what is the difference b/w adjuvant and prophylactic radiation
near the original site, gets to it before the cells spread
side effects of radiation
aloplecia and erythema may be long lasting
example of systemic treatment
iodine injected to kill thyroid cancer
what does chemotherapy do
mutates the DNA of cells to do apoptosis or be self-destructive
types of chemotherapy
oral, topical, IV, IA, injection
what type of cancer treatment may be used after surgery
chemo
what are some side effects of chemotherapy
anemia, increased infection risk, nausea, decrease dual task stability, increase fall risk, decrease vision and executive function
most common and effective chemo administration
IV
when are cancer patients immunocompromised
only during treatment itself, not after the treatment
what are some benefits of target therapy
stimulate immune system to destroy cells in specific areas, protect healthy cells
what does hormone therapy do
stop the production of some hormones in the uterus, prostate, breast, etc
what are the stages of a clinical trial
- determine safe dose, 2. investigate efficacy, 3. considered safe
what are most lung cancer cells
non-small cell carcinoma (80-85%)
what type of lung cancer spreads faster and is more fatal
small cell carcinoma
what PT tx is related to lung cancer
dry needling of levator scapula, train posture and rib cage
who’s most likely to get lung cancer
smokers who are >65 yo
cause of prostate cancer
no known cause
risk factors for prostate cancer
STI, vasectomy, smoking, obesity
where does prostate cancer rank in most common for men
2nd most common, behind lung cancer
who is most likely to get prostate cancer
african american males over 50 yo
s/s of prostate cancer
polyuria, urinary hesitation, blood in urine, irritation
what’s the survival rate for prostate cancer
very high, especially in the long term
what test should be done for prostate cancer
PSA, biopsy, DRE (feel for bumps)
breast cancer def
abnormal cells that accumulate in milk ducts
what genes are associated w/ breast cancer
BRCA 1 and BRCA 2 mutation
what tests can be done to screen for breast cancer
breast exam, ultrasound, mamogram
if breast cancer is caught early what’s the treatment and survival rate like
very good prognosis if caught early
where is breast cancer metastasis most likely found in
bone after breast tissue
is breast cancer common
yes, 1/8 women in the US have it
how has the death rate of melanoma changed over time
increased prevalence but great decreas in death rate b/c it is treatable
who’s most at risk for melanoma
less than 50 yo females and greater than 50 yo males
warning signs of melanoma
abnormal shape, asymmetrical, large, multicolor
