Part 13 Flashcards
What are some reasons patients are using complementary/alternative medicine? (3)
- 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
Top 3 conditions that prompt patients to use complemetnary/alternative therapies
- Back pain
- neck pain
- joint pain
The principle of homeopathic medicine
Like cures like
Osteopathic medicine
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
Naturopathic Medicine
An ND, different states have different requirements, seeks to restore and maintain optimum health by emphasizing natures inherent self healing process without physical manipulation
Traditional Chinese Medicine
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
Ayurvedic medicine (where did it originate?)***
Originated in India, idea that there is universal interconnectedness among people and their health and the universe, uses herbs and supplements to treat diseases
Eye movement desensitization and reprocessing (EMDR) therapy
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
a1 adrenergic antagonists therapeutic uses (5)
- essential hypertension
- pheochromocytoma
- raynauds
- bph
- reversal of toxicity brought on by a1 agonists
a1 adrenergic antagonists ADR’s (5)
- orthostatic hypotension
- reflex tachycardia
- nasal congestion
- inhibition of ejaculation or impotence
- Na+ retention and increased blood volume (increase renin)
Prazosin (minipress) drug class and therapeutic uses (2)
- selective a1 blockade adrenergic antagonist
- produces vasodilation treating hypertension and BPH
Prazosin (minipress) ADR 1st dose effect
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
Tamsulosin (flomax)
selectively blocks a1 blockers on smooth muscle of bladder neck and prostatic capsule, only indicated for BPH and NOT effective at treating Htn
phentolamine (regitine) blocks ___ and ___ receptors and is often used in the IV treatment of ______
a1 and a2, pheochromocytoma
B adrenergic antagonists therapeutic uses (4)
(result primarily from blockading B1 receptors in heart)
- hypertension
- angina pectoris
- cardiac arrhythmias
- heart failure (cardioprotective by improving cardiac contractility)
B adrenergic antagonists therapeutic uses (4)
(result primarily from blockading B1 receptors in heart)
- hypertension
- angina pectoris
- cardiac arrhythmias
- heart failure (cardioprotective by improving cardiac contractility)
B1 blockade ADRs (4)
- bradycardia
- reduced cardiac output
- AV heart block
- rebound cardiac excitation
Rebound cardiac excitation
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
B2 blockade ADRs (3)
- bronchoconstriction
- inhibit glycogenolysis (hypoglycemia)
- CNS effects
3rd generation B adrenergic antagonist agents and 2 examples
- Agents that block a adrenergic receptors in addition to B receptors
- carvedilol, labetolol
High lipid solubility and the blood brain barrier
…allows for penetration of BBB easily
Propranol (inderal LA) drug class and therapuetic uses (4) and administration
-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
To avoid Na+ retention and increased blood volume when a patient is on an a adrenergic antagonist, they are often also treeated with…
…a diuretic
2 categories of indirect acting adrenergic agents and what is the net result of these drugs?
- 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
Clonidine (catapres) drug class and mech of action
-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
Clonidine therapeutic uses (3)
- hypertension
- menopausal flushing
- migraine headache
Clonidine ADR’s (3)
- rebound hypertension (large increase in BP following abrupt withdrawal)
- drowsiness
- dry mouth
Bethanechol (urecholine) drug class and therapeutic uses (3)
-direct acting muscarinic agonist
- urinary retention
- GI paralysis
Bethanechol (urecholine) ADR’s (2)
- very few
- can worsen cardiovascular symptoms in hypotensive patients
- high doses abdominal cramping and involuntary defecation
Bethanechol (urecholine) contraindications (3)
- gastric ulcers
- intestinal obstruction
- recent surgery of bowel
Cevimeline (exovac) function
Derivative of Ach actions similar to bethanechol, relieves xerostomia by allowing and promoting salivation
Pilocarpine function
Topical therapy of glaucoma (outdated) or treatment of dry mouth from sjogren’s syndrome
Acetycholine usage pharmacologically
Restricted due to acetycholiesterase destruction, lacks sensitivity and can stimulate all muscarinic and nicotinic receptors but is also rapidly destroyed by cholinesterases
Symptoms of muscarinic agonist poisoning (6)
- profuse salivation
- lacrimation
- visula disturbances
- bronchospasm
- diarrhea
- bradycardia
Atropine (atropen) drug class and mech of action
- 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
Atropine (atropen) therapuetic uses (4)
- 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
Atropine (atropen) ADR’s (4)
- dry mouth
- blurred vision and photophobia (paralysis of ciliary muscle focuses for far vision)
- elevation of intraocular pressure
- urinary retention
Scopolamine (hysoscine HBr) function
Muscarinic atnagonist like atropine but produces CNS sedation opposed to excitement and suppresses emesis and motion sickness
Neostigmine (prostigmin) mech of action
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
Neostigmine (prostigmin) therapeutic use and mech of treatment
- 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
Neostigmine (prostigmin ADR’s (3)
- excess salivation
- increased gastric secretion
- miosis
Cholinergic crisis
Excessive activity of acetycholine causing respiratoyr suppression and urination and defececation and possibly death
Treatment of cholinergic crisis (2)
- IV atropine
- mechanical ventilation
3 common cholinesterase inhibitors used in alzheimer’s disease
- donepezil
- rivastigmine
- galantamine
Myasthenia gravis pathophys
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
Myasthenia crisis
-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
Determining cholinergic from myasthenia criss
- 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
what is the only direct oral anticoagulant approved for dvt prophylaxis in hospitalized patients?
Betrixaban
frequent repositioning for decubitus ulcers
minimum of every 2 hours
do noninfected decubital ulcers require antibiotics?
NO
2 drugs of choice for fever
tylenol and aspirin
acetaminophen effect, max dose in normal and liver disease patients, ADR
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
aspirin effects, dosage, adverse effects (2)
analgesia, antipyretic, antiinflammatory, and antiplatelet, max dose 4 grams per day, dyspepsia and GI bleeding, hypersensitivty esp samter’s triad,
how long does aspirin antiplatelet activity last?
1 week after a dose
when changing to a new narcotic because of poor response or pt intolerance, the new med should be started at…
50% the equianalgesic dose to account for incomplete cross tolerance
tramadol MOA, interactions, ADR’s (2)
both opioid agonist and a centrally acting nonopioid analgesic, should not be given in patients taking a MAOI, constipation, respiratory depression
why is methadone so effective at treating opioid withdrawal
It has an extended half life with short analgesic duration mitigating the symptoms of opioid withdrawal
hydromorphone compared to strength of morphine, fentanyl compared to strenght of morphine
5-7 times more potent, 100 x more potent
drug of choice for acute management of agitation and psychosis
haloperidol PO or IM/IV
benzo overdose treatment of choice
flumazenil - a benzo antagonist
Ductus arteriosus becomes what at birth?
Ligamentum arteriosum
In fetal circulation there is blood shunting from…
Upon birth this changes to…
….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
Atrial septal defect (primum and secundum)
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
Borders of the mediastinum
thoracic inlet superiorally diaphragm inferiorally sternum anteriorally spine posteriorally pleura laterally left and right
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 ___
left ventricle, left atrium, right ventricle, Right atrium, left ventricle
Where is the AV node located in the heart?
In the intraventricular septum
How many pumonary veins are there?
4
How many pulmonary arteries are there
2
Right coronary artery pathway and what does it supply
Right coronary artery travels in the groove between the right atrium and right ventricle supplying both of them
Left coronary artery pathway and what does it supply
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
Marginal branch vs diagonal branch
Marginal branch comes off the right coronary artery while the diagonal are branches coming off LAD
Vasovasorum
Blood supply to the vessels that travels thru the tunica externa of large vessels in the body
Coronary sinus
Main venous blood return from the entire heart, drains over half the deoxygenated blood of the heart and empties into the right atrium
3 Great vessels off aortic arch
Brachiocephalic trunk, left common carotid, left subclavian
3 vessels that come off anterior side of aorta and are not paired and what they supply
- 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)
Fahraeus-lindqvist effect
Idea that viscosity of blood changes inversely with the diameter of the tube it travels thru. In small vessels, the viscosity is lower.
Central venous pressure (CVP)
Pressure in the venous system typically measured as close to the heart as possible, tends to be very similar thru the entire venous system
Pulmonary artery capillary wedge pressure (PACWP)
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
Mean arterial pressure=
cardiac output x systemic vascular resistance
Cardiac output=
Stroke volume x heart rate
Stroke volume=
LV end diastolic volume x contractilty
2 pathways the fetal heart shunts blood from the right side of the body to the left side while avoiding the pulmonary circulation
- foramen ovale between right to left atrium
- ductus arteriosus between pulmonary trunk and aortic arch
Shear force is most likely to cause a tear in the aorta in traumatic aortic rupture at this point
The ligamentum arteriosum (start of desending aorta)
Where is the SA node located in the right atrium?
At the junction between superior vena cava and right atrium posterior wall
The aortic valve has ___ leaflets
The right and left leaflets have the….
3, openings to the left and right main coronary arteries
During diastole, mitral and tricuspid valves are ___ and aortic and pulmonic valves are ____
open, closed
During diastole, mitral and tricuspid valves are ___ and aortic and pulmonic valves are ____
open, closed
Isovolumetric contraction
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
When aortic pressure exceeds ventricular pressure in systole, what happens?
The aortic valve closes (S2)
Dicrotic notch
Small downward deflection observed in pressure readings of the ventricle where the aortic valve slams shut indicating end of systole and start of diastole
Preload
The weight of the volume being ejected from the heart that must be overcome to perfuse blood (intravascular volume)
Afterload
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)
Naturopathic medicine
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
Hippocrates naturopathic taeching
“Nature is the healer of all diseases”
Ayurveda definition
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
The Tridosha
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
Materia medica
A list of thousands of remedies listed in a homeopathic text, all FDA approved, OTC, and come from plant, mineral, and animal sources
__% of the world uses herbal medicine
80%
Anticatarrhals and examples (3)**
Herbal properties that eliminate or counteract the formation of mucus including black pepper, cayenne, ginger
FDA responsibilities regarding herbal products
- 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
Chamomile use and mech of action and ADR’s (1)
- Primarily used for dyspepsia, flatulance, insomnia
- Apigenin and azulene (antiinflammatories comparable to NSAIDS)
- allergic to aster (ray) flowers should not use
Ginseng use and mech of action and dosing and ADR’s (4)
- 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
Echinacea use and mech of action and ADR’s (3)
Used for immunostimulation to prevent URI’s cold, UTI, cancer, etc
- increases WBC and has antiinflammatory properties
- Avoid in autoimmune, allergic, or diabetic neurpathy
Milk thistle use and mech of action and ADR (1)
- Liver tonic/detox and mushroom poisoning
- antioxidant
- contraindicated in hormone sensitive conditions
Kava use and mech of action and ADR (1)
- Addictive sedative alleviates depression and anxiety and can cause somnolence
- kavalactones that act on the limbic system
- liver failure with chronic use
Valerian use and mech of action and ADRs (2)
- Sedative for sleep disorders and anxiety
- Inhibits reuptake of GABA
- can have opposite effects in certain individuals with ADHD, sleepiness
Peppermint use and mech of action and ADR’s (1)
- GI spasm, indigestion, IBS, analgesia
- Stimulates bile production
- worsens gallbladder disease
Ginkgo biloba use and mech of action and ADR (1)
- cerebrovascular insufficiency, cognitive disorders, dementia, SSRI induced sexual dysfunction
- vasodilator
- Bleeding disorders
Saw Palmetto use and mech of action and ADR (1)
- Treat BPH, increase libido, prevents male pattern baldness
- inhibits 5-a-reductase conversion of testosterone to dihydrotestosterone
- breast cancer patients
Yohimbe use and mech of action and ADR (2)
- Used to increase blood flow to genitals in males
- a2 adrenergic blocker
- patients with angina or hypertension should avoid
St. John’s Wort use and mech of action and ADR (2)
- 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
Black cohosh use and mech of action and ADR’s (1)
- Dysmenorrhea, menopausal symptoms, premenstraul syndrome
- blocks serotonin reuptake
- hormone sensitive conditions
Cinnamin bark (cassia cinnamon)
Herb often used for GI upset or for diabetes control, must be limited in ingestion to prevent high levels which can cause hepatotoxic effects
Lavender
Herb often used for anxiety, alopecia, and as bug repellant but can cause constipation orally or gynecomastia when applied as an oil
L-lysine
Herb often used for athletic performance enhancement, can cause diarrhea and abdominal pain as well as kidney issues
Licorice root
Herb often used for adrenocortical insufficiency, can cause hypertension as a side effect
Turmeric
Herb often used for antioxidant and anti-inflammatory properties, excess use can cause GI upset
Niacin B3 herbal benefits
Herb often used to lower LDL and raise HDL and lower triglycerides, can cause flush and pruritis as side effects
Red yeast rice
Herb often used to lower high LDL cholesterol, should not use if cannot tolerate statins (its the same thing)
High velocity low amplitude (HVLA)
Short, quick manipulations of individual joints using hands or instrument to restore joint mobility and alleviate pain used in chiropractic medicine and osteopathic medicine
4 principles of osteopathic medicine
- 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
The 7 chakras**
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)
Meridians
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
Applied kinesiology muscle testing
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
Acupuncture
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
Aspertame
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
