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Professional Development > Part 13 > Flashcards

Part 13 Flashcards

1
Q

What are some reasons patients are using complementary/alternative medicine? (3)

A
  • Medical professionals do NOT relate to patients as individuals but rather as diseases
  • biomedicine has not had success with many chronic illness
  • high costs of medical care in the US
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2
Q

Top 3 conditions that prompt patients to use complemetnary/alternative therapies

A
  • Back pain
  • neck pain
  • joint pain
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3
Q

The principle of homeopathic medicine

A

Like cures like

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4
Q

Osteopathic medicine

A

A type of western medicine that alongside traditional allopathic training are also trained to focus on the relationship of the body and its function, alignment, and physical manipulation

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5
Q

Naturopathic Medicine

A

An ND, different states have different requirements, seeks to restore and maintain optimum health by emphasizing natures inherent self healing process without physical manipulation

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6
Q

Traditional Chinese Medicine

A

Focused on the balanced flow of qi thru the body, and goal is to balance thru various herbal therapies such as acupuncture or tai chi to treat health problems

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7
Q

Ayurvedic medicine (where did it originate?)***

A

Originated in India, idea that there is universal interconnectedness among people and their health and the universe, uses herbs and supplements to treat diseases

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8
Q

Eye movement desensitization and reprocessing (EMDR) therapy

A

A type of mind body medicine using accelerated info processing method using alternating stimuli either eye movements or sound to desensitize and reprocess emotional wounds, helpful in traumatic processing and recovery

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9
Q

a1 adrenergic antagonists therapeutic uses (5)

A
  • essential hypertension
  • pheochromocytoma
  • raynauds
  • bph
  • reversal of toxicity brought on by a1 agonists
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10
Q

a1 adrenergic antagonists ADR’s (5)

A
  • orthostatic hypotension
  • reflex tachycardia
  • nasal congestion
  • inhibition of ejaculation or impotence
  • Na+ retention and increased blood volume (increase renin)
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11
Q

Prazosin (minipress) drug class and therapeutic uses (2)

A
  • selective a1 blockade adrenergic antagonist

- produces vasodilation treating hypertension and BPH

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12
Q

Prazosin (minipress) ADR 1st dose effect

A

Refers to tendency for about 1% of patients to lose consciousness 30-60 min after receiving first dosage, to minimize effect initial dose must be small then gradually increased, or for administration of initial dose at bedtime

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13
Q

Tamsulosin (flomax)

A

selectively blocks a1 blockers on smooth muscle of bladder neck and prostatic capsule, only indicated for BPH and NOT effective at treating Htn

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14
Q

phentolamine (regitine) blocks ___ and ___ receptors and is often used in the IV treatment of ______

A

a1 and a2, pheochromocytoma

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15
Q

B adrenergic antagonists therapeutic uses (4)

A

(result primarily from blockading B1 receptors in heart)

  • hypertension
  • angina pectoris
  • cardiac arrhythmias
  • heart failure (cardioprotective by improving cardiac contractility)
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16
Q

B adrenergic antagonists therapeutic uses (4)

A

(result primarily from blockading B1 receptors in heart)

  • hypertension
  • angina pectoris
  • cardiac arrhythmias
  • heart failure (cardioprotective by improving cardiac contractility)
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17
Q

B1 blockade ADRs (4)

A
  • bradycardia
  • reduced cardiac output
  • AV heart block
  • rebound cardiac excitation
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18
Q

Rebound cardiac excitation

A

Refers to how long term use of B1 blockades can sensitize the heart to catecholamines, and abrupt cessation of it can result in anginal pain and ventricular arrhythmias (medication must be tapered off) - DO NOT SUDDENLY STOP BETA BLOCKERS

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19
Q

B2 blockade ADRs (3)

A
  • bronchoconstriction
  • inhibit glycogenolysis (hypoglycemia)
  • CNS effects
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20
Q

3rd generation B adrenergic antagonist agents and 2 examples

A
  • Agents that block a adrenergic receptors in addition to B receptors
  • carvedilol, labetolol
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21
Q

High lipid solubility and the blood brain barrier

A

…allows for penetration of BBB easily

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22
Q

Propranol (inderal LA) drug class and therapuetic uses (4) and administration

A

-nonselective B adrenergic antagonist (B1 and B2)

  • HTN
  • Angina pectoris
  • Cardiac arrhythmias
  • stage fright (can easily cross BBB as highly lipid soluble)
  • can also make people less racist.

Available PO or IV

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23
Q

To avoid Na+ retention and increased blood volume when a patient is on an a adrenergic antagonist, they are often also treeated with…

A

…a diuretic

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24
Q

2 categories of indirect acting adrenergic agents and what is the net result of these drugs?

A
  • adrenergic neuron blocking agents (drugs that act on terminals of synaptic neurons to decrease norepi release)
  • centrally acting antiadrenergic agents (drugs that act within CNS to reduce flow of impulses along sympathetic nerves)

-net result is reduction in stimulation of peripheral adrenergic receptors

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25
Q

Clonidine (catapres) drug class and mech of action

A

-CNS a2 adrenergic agonist

-Centrally acting antiadrenergic agent
whose effects result from stimulating a2 receptors in brain not in periphery, exerts inhibitory influence on regions of brain that regulate sympathetic activity resulting in reduction of sympathetic outflow to blood vessels and heart

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26
Q

Clonidine therapeutic uses (3)

A
  • hypertension
  • menopausal flushing
  • migraine headache
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27
Q

Clonidine ADR’s (3)

A
  • rebound hypertension (large increase in BP following abrupt withdrawal)
  • drowsiness
  • dry mouth
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28
Q

Bethanechol (urecholine) drug class and therapeutic uses (3)

A

-direct acting muscarinic agonist

  • urinary retention
  • GI paralysis
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29
Q

Bethanechol (urecholine) ADR’s (2)

A
  • very few
  • can worsen cardiovascular symptoms in hypotensive patients
  • high doses abdominal cramping and involuntary defecation
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30
Q

Bethanechol (urecholine) contraindications (3)

A
  • gastric ulcers
  • intestinal obstruction
  • recent surgery of bowel
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31
Q

Cevimeline (exovac) function

A

Derivative of Ach actions similar to bethanechol, relieves xerostomia by allowing and promoting salivation

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32
Q

Pilocarpine function

A

Topical therapy of glaucoma (outdated) or treatment of dry mouth from sjogren’s syndrome

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33
Q

Acetycholine usage pharmacologically

A

Restricted due to acetycholiesterase destruction, lacks sensitivity and can stimulate all muscarinic and nicotinic receptors but is also rapidly destroyed by cholinesterases

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34
Q

Symptoms of muscarinic agonist poisoning (6)

A
  • profuse salivation
  • lacrimation
  • visula disturbances
  • bronchospasm
  • diarrhea
  • bradycardia
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35
Q

Atropine (atropen) drug class and mech of action

A
  • anticholinergic muscarinic antagonist
  • Competes to cause blockage of muscarinic receptors, no effect itself but prevents activation of muscarinic receptor by endogenous Ach and at high doses nicotinic receptors as well
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36
Q

Atropine (atropen) therapuetic uses (4)

A
  • preanasthetic meds
  • opthalmic inducing mydriasis and parlysis of ciliary muscle
  • can accelerate heart rate in bradycardia
  • intestinal hypermotility reducing frequency of bowel movements and abdominal cramps
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37
Q

Atropine (atropen) ADR’s (4)

A
  • dry mouth
  • blurred vision and photophobia (paralysis of ciliary muscle focuses for far vision)
  • elevation of intraocular pressure
  • urinary retention
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38
Q

Scopolamine (hysoscine HBr) function

A

Muscarinic atnagonist like atropine but produces CNS sedation opposed to excitement and suppresses emesis and motion sickness

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39
Q

Neostigmine (prostigmin) mech of action

A

Binds of AchE but rxn takes place extremely slowly tying up AchE and thus leaving Ach levels higher
This allows for identical muscarinic responses compared to the muscarinic agonists

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40
Q

Neostigmine (prostigmin) therapeutic use and mech of treatment

A
  • myasthenia gravis
  • prevents inactivation of Ach thereby intensifying effect of Ach at motor end plates, provides symptomatic relief with small dosage titrated upward until optimal level of muscle functioning has been produced
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41
Q

Neostigmine (prostigmin ADR’s (3)

A
  • excess salivation
  • increased gastric secretion
  • miosis
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42
Q

Cholinergic crisis

A

Excessive activity of acetycholine causing respiratoyr suppression and urination and defececation and possibly death

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43
Q

Treatment of cholinergic crisis (2)

A
  • IV atropine

- mechanical ventilation

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44
Q

3 common cholinesterase inhibitors used in alzheimer’s disease

A
  • donepezil
  • rivastigmine
  • galantamine
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45
Q

Myasthenia gravis pathophys

A

disease characterized by muscle weakness and predisposition to rapid fatigue, common see difficulty swallowing, ptosis, and severe trouble breathing due to paralysis of respiratory muscles due to autoimmune antibodies against nicotinic II receptors on skeletal muscle, results in muscle weakness

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46
Q

Myasthenia crisis

A

-patient may experience if inadequately medicated, characterized by extreme weakness caused by insufficient ach at the NMJ and will lead to death by paralysis of respiratory muscles unless cholinesterase inhibitor used

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47
Q

Determining cholinergic from myasthenia criss

A
  • History of meds can provide diff diagnosis
  • If inadequate, use ultra short acting cholinesterase agent and if symptoms alleviated then myasthenic, if intesnivides then cholinergic
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48
Q

what is the only direct oral anticoagulant approved for dvt prophylaxis in hospitalized patients?

A

Betrixaban

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49
Q

frequent repositioning for decubitus ulcers

A

minimum of every 2 hours

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50
Q

do noninfected decubital ulcers require antibiotics?

A

NO

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51
Q

2 drugs of choice for fever

A

tylenol and aspirin

52
Q

acetaminophen effect, max dose in normal and liver disease patients, ADR

A

antipyretic and analgesic actions without antiinflammatory or antiplatelet properties only working in the CNS***, normal max dose is 4 grams per day but 2 grams per day in liver patients, adverse effect is hepatic toxicity

53
Q

aspirin effects, dosage, adverse effects (2)

A

analgesia, antipyretic, antiinflammatory, and antiplatelet, max dose 4 grams per day, dyspepsia and GI bleeding, hypersensitivty esp samter’s triad,

54
Q

how long does aspirin antiplatelet activity last?

A

1 week after a dose

55
Q

when changing to a new narcotic because of poor response or pt intolerance, the new med should be started at…

A

50% the equianalgesic dose to account for incomplete cross tolerance

56
Q

tramadol MOA, interactions, ADR’s (2)

A

both opioid agonist and a centrally acting nonopioid analgesic, should not be given in patients taking a MAOI, constipation, respiratory depression

57
Q

why is methadone so effective at treating opioid withdrawal

A

It has an extended half life with short analgesic duration mitigating the symptoms of opioid withdrawal

58
Q

hydromorphone compared to strength of morphine, fentanyl compared to strenght of morphine

A

5-7 times more potent, 100 x more potent

59
Q

drug of choice for acute management of agitation and psychosis

A

haloperidol PO or IM/IV

60
Q

benzo overdose treatment of choice

A

flumazenil - a benzo antagonist

61
Q

Ductus arteriosus becomes what at birth?

A

Ligamentum arteriosum

62
Q

In fetal circulation there is blood shunting from…

Upon birth this changes to…

A

….right to left because right is higher pressure than left in fetal circulation
….left sided pressure higher than right due to the inflation of the lungs dropping pressure

63
Q

Atrial septal defect (primum and secundum)

A

Occurs when there is an incomplete closure of the septum wall, primum occurs much lower in the heart wall close to the ventricle while secundum occurs higher closer to the base of the heart

64
Q

Borders of the mediastinum

A 
thoracic inlet superiorally
diaphragm inferiorally
sternum anteriorally
spine posteriorally
pleura laterally left and right
65
Q

The entire posterior face of the heart is the ____ and ___
The entire anterior surface of the heart is the____
The entire right side of the heart is the ____
The entire left side of the heart is the ___

A

left ventricle, left atrium, right ventricle, Right atrium, left ventricle

66
Q

Where is the AV node located in the heart?

A

In the intraventricular septum

67
Q

How many pumonary veins are there?

A

4

68
Q

How many pulmonary arteries are there

A

2

69
Q

Right coronary artery pathway and what does it supply

A

Right coronary artery travels in the groove between the right atrium and right ventricle supplying both of them

70
Q

Left coronary artery pathway and what does it supply

A

divides into LAD and circumflex artery, LAD goes between right ventricle and left ventricle (majority of supply for the left) circumflex goes between groove between left atrium and ventricle around on the posterior side supplying the left atrium

71
Q

Marginal branch vs diagonal branch

A

Marginal branch comes off the right coronary artery while the diagonal are branches coming off LAD

72
Q

Vasovasorum

A

Blood supply to the vessels that travels thru the tunica externa of large vessels in the body

73
Q

Coronary sinus

A

Main venous blood return from the entire heart, drains over half the deoxygenated blood of the heart and empties into the right atrium

74
Q

3 Great vessels off aortic arch

A

Brachiocephalic trunk, left common carotid, left subclavian

75
Q

3 vessels that come off anterior side of aorta and are not paired and what they supply

A
  • celiac trunk (stomach liver spleen pancreas duodenum
  • superior mesenteric (all of jejunum, ileum, most of ascending and part of transverse colon)
  • inferior mesenteric (remainder of transverse colon and descending colon)
76
Q

Fahraeus-lindqvist effect

A

Idea that viscosity of blood changes inversely with the diameter of the tube it travels thru. In small vessels, the viscosity is lower.

77
Q

Central venous pressure (CVP)

A

Pressure in the venous system typically measured as close to the heart as possible, tends to be very similar thru the entire venous system

78
Q

Pulmonary artery capillary wedge pressure (PACWP)

A

An indirect measure of left atrial pressure that can estimate intravascular volume obtained by using a catheter that travels into the right atrium to right ventricle then to pulmonary vasculature until it is eventually obstructed at a small vessel, with the pressure sensor in it measuring everything downstream and therefore left atrial pressure

79
Q

Mean arterial pressure=

A

cardiac output x systemic vascular resistance

80
Q

Cardiac output=

A

Stroke volume x heart rate

81
Q

Stroke volume=

A

LV end diastolic volume x contractilty

82
Q

2 pathways the fetal heart shunts blood from the right side of the body to the left side while avoiding the pulmonary circulation

A
  • foramen ovale between right to left atrium
    • ductus arteriosus between pulmonary trunk and aortic arch
83
Q

Shear force is most likely to cause a tear in the aorta in traumatic aortic rupture at this point

A

The ligamentum arteriosum (start of desending aorta)

84
Q

Where is the SA node located in the right atrium?

A

At the junction between superior vena cava and right atrium posterior wall

85
Q

The aortic valve has ___ leaflets
The right and left leaflets have the….

A

3, openings to the left and right main coronary arteries

86
Q

During diastole, mitral and tricuspid valves are ___ and aortic and pulmonic valves are ____

A

open, closed

87
Q

During diastole, mitral and tricuspid valves are ___ and aortic and pulmonic valves are ____

A

open, closed

88
Q

Isovolumetric contraction

A

Refers to short period where ventricular pressure rises above atrium that results in mitral and tricuspid valves shutting to prevent backflow (S1), but before the pressure has built enough to exceed the resistance of the aortic and pulmonic valves in which they open

89
Q

When aortic pressure exceeds ventricular pressure in systole, what happens?

A

The aortic valve closes (S2)

90
Q

Dicrotic notch

A

Small downward deflection observed in pressure readings of the ventricle where the aortic valve slams shut indicating end of systole and start of diastole

91
Q

Preload

A

The weight of the volume being ejected from the heart that must be overcome to perfuse blood (intravascular volume)

92
Q

Afterload

A

The weight of the volume of blood in circulation that the heart must eject against in order to overcome and perfuse blood (The peripheral vascular resistance)

93
Q

Naturopathic medicine

A

Holistic medicine that emphasizees prevention, treatment, and optimal health thru use of therapeutic methods and substances to assist the whole person in maximizing the body’s inherent self healing capacity

94
Q

Hippocrates naturopathic taeching

A

“Nature is the healer of all diseases”

95
Q

Ayurveda definition

A

Holistic system of healing evolved among Brahmin sages of ancient India some 3-5000 years ago, includes use of herbal meds, mineral or metal supplements, surgical techniques, or application of oil by massages, emphasizes proper nutrition, massage, meditation, and natural meds

96
Q

The Tridosha

A

Based on the concept that everything in the universe is made up of combo of 5 elements and the tridosha is the regulator of everything physiological and psychological in the living organism, including space (ether), air, fire, earth, and water

97
Q

Materia medica

A

A list of thousands of remedies listed in a homeopathic text, all FDA approved, OTC, and come from plant, mineral, and animal sources

98
Q

__% of the world uses herbal medicine

A

80%

99
Q

Anticatarrhals and examples (3)**

A

Herbal properties that eliminate or counteract the formation of mucus including black pepper, cayenne, ginger

100
Q

FDA responsibilities regarding herbal products

A
  • prohibit poisonous or deleterious substances or any dietary supplement or ingredient that presents significant unreasonable risk of injury, impose requirements on sanitary conditions, collect and oversee mandatory reports of ADR’s, prohibit any ingredient which there is inadequate info to provide reasonable assurance that it does not present significant or unreasonable risk of illness or injury, regulate dietary labels and prohibit misbranding
  • do NOT standardize product in terms of ingredients and conc. FDA is NOT responsible for research about the efficacy
101
Q

Chamomile use and mech of action and ADR’s (1)

A
  • Primarily used for dyspepsia, flatulance, insomnia
  • Apigenin and azulene (antiinflammatories comparable to NSAIDS)
  • allergic to aster (ray) flowers should not use
102
Q

Ginseng use and mech of action and dosing and ADR’s (4)

A
  • Main kind is panax gensing (American or Asian) used as an aphordisiac and stimulant
  • Acts like caffeine when consumed but without a sudden kick
  • dose has been standardized to .03%, ensure patient cycles dose
  • worsens hypertension, diabetes, low blood pressure, and caffeine potentiation
103
Q

Echinacea use and mech of action and ADR’s (3)

A

Used for immunostimulation to prevent URI’s cold, UTI, cancer, etc

  • increases WBC and has antiinflammatory properties
  • Avoid in autoimmune, allergic, or diabetic neurpathy
104
Q

Milk thistle use and mech of action and ADR (1)

A
  • Liver tonic/detox and mushroom poisoning
  • antioxidant
  • contraindicated in hormone sensitive conditions
105
Q

Kava use and mech of action and ADR (1)

A
  • Addictive sedative alleviates depression and anxiety and can cause somnolence
  • kavalactones that act on the limbic system
  • liver failure with chronic use
106
Q

Valerian use and mech of action and ADRs (2)

A
  • Sedative for sleep disorders and anxiety
  • Inhibits reuptake of GABA
  • can have opposite effects in certain individuals with ADHD, sleepiness
107
Q

Peppermint use and mech of action and ADR’s (1)

A
  • GI spasm, indigestion, IBS, analgesia
  • Stimulates bile production
  • worsens gallbladder disease
108
Q

Ginkgo biloba use and mech of action and ADR (1)

A
  • cerebrovascular insufficiency, cognitive disorders, dementia, SSRI induced sexual dysfunction
  • vasodilator
  • Bleeding disorders
109
Q

Saw Palmetto use and mech of action and ADR (1)

A
  • Treat BPH, increase libido, prevents male pattern baldness
  • inhibits 5-a-reductase conversion of testosterone to dihydrotestosterone
  • breast cancer patients
110
Q

Yohimbe use and mech of action and ADR (2)

A
  • Used to increase blood flow to genitals in males
  • a2 adrenergic blocker
  • patients with angina or hypertension should avoid
111
Q

St. John’s Wort use and mech of action and ADR (2)

A
  • Treats mild to moderate depression, the redder the oil the more potent***
  • Has dopaminergic or SSRI effects
  • sunburn susceptibility and certain drug metabolism DO NOT TAKE WITH SSRI
112
Q

Black cohosh use and mech of action and ADR’s (1)

A
  • Dysmenorrhea, menopausal symptoms, premenstraul syndrome
  • blocks serotonin reuptake
  • hormone sensitive conditions
113
Q

Cinnamin bark (cassia cinnamon)

A

Herb often used for GI upset or for diabetes control, must be limited in ingestion to prevent high levels which can cause hepatotoxic effects

114
Q

Lavender

A

Herb often used for anxiety, alopecia, and as bug repellant but can cause constipation orally or gynecomastia when applied as an oil

115
Q

L-lysine

A

Herb often used for athletic performance enhancement, can cause diarrhea and abdominal pain as well as kidney issues

116
Q

Licorice root

A

Herb often used for adrenocortical insufficiency, can cause hypertension as a side effect

117
Q

Turmeric

A

Herb often used for antioxidant and anti-inflammatory properties, excess use can cause GI upset

118
Q

Niacin B3 herbal benefits

A

Herb often used to lower LDL and raise HDL and lower triglycerides, can cause flush and pruritis as side effects

119
Q

Red yeast rice

A

Herb often used to lower high LDL cholesterol, should not use if cannot tolerate statins (its the same thing)

120
Q

High velocity low amplitude (HVLA)

A

Short, quick manipulations of individual joints using hands or instrument to restore joint mobility and alleviate pain used in chiropractic medicine and osteopathic medicine

121
Q

4 principles of osteopathic medicine

A
  • The body is a unit of body, mind, and spirit
  • body is capable of self regulation, healing, and health maintenance
  • structure and function are reciprocally interrelated
  • rational treatment is based on the understanding of the basic principles of body unity, self regulation, and interrelationship of structure and function
122
Q

The 7 chakras**

A

1) root chakra (foundation or feeling grounded, base of spine in tailbone area)
2) sacral chakra (connection and ability to accept others, lower abdomen)
3) solar plexus chakra (confidence and control of life, upper abdomen and stomach)
4) heart chakra (ability to love, chest just above heart)
5) throat chakra (ability to communicatite, the throat)
6) third eye chakra (ability to focus on and see big picture, forehead between eyes)
7) crown chakra (represents ability to be fully connected spiritually, top of head)

123
Q

Meridians

A

14 primary energy pathways in the body that sustain the body’s organs and tissues. each associated with particular color, smell, emotion, sound, etc. Energetically feed the muscles of the body, allowing biofeedback to be used to systematically test muscles that are spread by a specific meridian

124
Q

Applied kinesiology muscle testing

A

A technique some practitioners perform to determine what substances the body needs or should not have by having the patient hold a vile of a substance and then testing the strength

125
Q

Acupuncture

A

A treatment that involves the painless insertion of very fine needles shallowly into the skin at points all over the body that correspond to specific meridians (channels of flow) through out the body

126
Q

Aspertame

A

A controversial nutritive sweetener that is much sweeter despite containing much fewer calories with the hopes that consumers will use less, concluded by FDA to be safe for general population under certain conditions (not those with phenylketouria) except in others who have anecdotally had poor reactions to it

Professional Development (19 decks)

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