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Pathopharm > Patho Exam 1 > Flashcards

Patho Exam 1 Flashcards

1
Q

what closes once food goes into stomach to prevent acid from entering, culprit for GERD

A

lower esophageal sphincter

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2
Q

pyloric sphincter closes when ___________

A

food leaves stomach

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3
Q

what makes the mucus in our stomach? (mucosal blood flow)

A

prostaglandins

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4
Q

The mucosal barrier protects the gastric mucosa from

A

auto digestion

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5
Q

what causes GERD?

A

Decreased pressure in LES or increase in stomach pressures

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6
Q

4 symptoms of GERD

A

heartburn, epigastric pain, dry cough, laryngitis

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7
Q

3 places ulcer development can occur:

A

lower esophagus, stomach, duodenum

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8
Q

H. pylori is present in 100% of __________ ulcers and about 70% of patients with _______ ulcers

A

duodenal, gastric

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9
Q

t/f: H. pylori is the only bacteria known to be “oncogenic”

A

true

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10
Q

organ of nausea

A

duodenum

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11
Q

major site of nutrient absorption

A

small intestine

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12
Q

Bile from the liver and digestive enzymes from the pancreas empty into the __________ to aid in digestion

A

duodenum

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13
Q

normal potassium level

A

3.5-5

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14
Q

BIG FLUID and ELECTROLYTE ORGAN (diarrhea)

A

small intestine

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15
Q

which organ defends against bacteria–normal flora

A

large bowel

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16
Q

the large bowel produces vitamin ___

A

K

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17
Q

Peristalsis and movement of feces in the:

A

large bowel

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18
Q

in the large bowel, _______ triggers peristalsis

A

Acetylcholine (and serotonin)

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19
Q

if chyme passes through large bowel too rapidly=

A

diarrhea and potassium depletion

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20
Q

Primary organ of bowel elimination

A

large intestine

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21
Q

this Extends from the ileocecal valve to the anus

A

large intestine

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22
Q

functions of large intestine:

A

Absorption of water, Formation of feces, Expulsion of feces from the body

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23
Q

during peristalsis movements in intestine; Contractions occur every __ to ___ minutes

A

3 to 12

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24
Q

Peristalsis is under control of the _____________

A

autonomic nervous system

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25
Q

dark sticky feces (GI Bleed)

A

melena

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26
Q

fresh bright red blood

A

hematochezia

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27
Q

Not visible blood

A

occult blood

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28
Q

examples of Constipating foods:

A

cheese, lean meats, eggs, pasta

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29
Q

examples of Foods with laxative effect:

A

fruits and vegetables, bran, chocolate, alcohol, coffee

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30
Q

examples of Gas-producing foods:

A

onions, cabbage, beans, cauliflower

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31
Q

Delay or difficulty in defecation, present for two or more weeks, sufficient to cause significant distress to the patient

A

constipation

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32
Q

this Can be a protective response when irritants in the GI tract

A

diarrhea

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33
Q

normal stool passage

A

3 per day

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34
Q

Which food is a recommended for an older adult who is constipated?

A

fruit

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35
Q

Which of the following direct visualization tests uses a long, flexible, fiberoptic-lighted scope to visualize the rectum, colon, and distal small bowel?

A

colonscopy

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36
Q

Inserted to decompress or drain the stomach of fluid or unwanted stomach contents

A

nasogastric tube

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37
Q

Used to allow the gastrointestinal tract to rest before or after abdominal surgery to promote healing; Inserted to monitor gastrointestinal bleeding

A

nasogastric tube

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38
Q

an elderly client has constipation. what diet would be most therapeutic to aid this GI system disorder?

A

high fiber

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39
Q

increases bulk in the stool, (puts water in) makes stool more formed, safest OTC

A

bulk-forming laxative- psyllium (Metamucil)

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40
Q

lubricates stool & GI tract or softens stool by lowering surface tension, allows water and fat to be absorbed into stool

A

surfactant- emollient (colace)

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41
Q

stimulant intestinal mobility and increase about of water and electrolytes within the intestinal lumen

A

stimulant- bisacodyl (dulcolax)

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42
Q

Passage of loose watery stools or an abnormal increase in the frequency, fluidity and daily volume of stool that is acute or chronic.

A

diarrhea

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43
Q

Lasts up to one week; usually related to a bacterial, viral or parasitic infection

A

acute diarrhea

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44
Q

Lasts greater than two weeks; usually related to functional disorder, multiple disease or conditions, medications, food intolerances, intestinal surgery, genetic disorders, or inadequate management of acute diarrhea

A

chronic diarrhea

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45
Q

an elderly client with an acute onset of multiple episodes of diarrhea for the past 24 hours, is transferred from a long-term care facility to the ER. which nursing diagnoses would the nurse select as highest priority risk for patient?

A

deficient fluid volume (dehydration)

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46
Q

Alkaline compounds that neutralize stomach acid Indications:

A

PUD & GERD

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47
Q

Does not stop acid production; react with gastric acid to produce neutral salts

A

MOA (antacids)

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48
Q

Neutralization of gastric acid and decrease in associated pain with gastritis and healing of gastric ulcers; Promotes secretion of mucus (protective barrier) by stimulating production of Prostaglandins

A

therapeutic effect of antacides

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49
Q

wait an hour between other drugs and _________ (interactions-antacid can chelate onto another drug and make non effective)

A

antacids

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50
Q

Rapid acting High ANC (acid -neutralizing capacity) antacid of choice. Liquid form (milk of magnesia). ADVERSE EFFECT: diarrhea ( retention of water in the intestinal lumen)

A

magnesium hydroxide

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51
Q

buffer against HCL

A

sodium bicarbonate

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52
Q

patients with renal insufficiency should NOT get

A

magnesium products

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53
Q

Rapid acting High ANC and long lasting effect. Once considered the ideal antacid but due to concerns with acid rebound (stimulation of acid secretion)

A

calcium carbonate

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54
Q

Aluminum and calcium products=

A

constipation

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55
Q

Use with caution with Kidney stones-

A

calcium products

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56
Q

antacid adhesion to other medication surfaces that are in contact with the antacid - reducing ability for drug to be absorbed

A

adsorption

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57
Q

inactivation of drug and the formation of insoluble complexes

A

chelation

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58
Q

with increased absorption of basic drugs and decreased absorption of acidic drugs

A

increased stomach pH

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59
Q

every alveoli has a ____ ______

A

capillary membrane

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60
Q

where gas exchange occurs, terminal part of respiratory tract

A

alvioli

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61
Q

substance around alveoli that allows it to move freely

A

surfactant

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62
Q

if alveoli collapses, ______ occurs

A

Atelectasis

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63
Q

Process of obtaining O2 & making it available to
organs/tissues

A

oxygenation

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64
Q

ability to oxygenate depends on:

A

PaO2, SaO2

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65
Q

Amount of O2 bound to hemoglobin compared to amount of O2 hemoglobin CAN carry

A

SaO2

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66
Q

t/f: both SaO2 and SpO2 measure saturation in arterial blood

A

true

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67
Q

_______ measures O2 saturation of functional AND nonfunctional hgb, while _______ measures ONLY functioning hgb

A

SaO2, SpO2

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68
Q

Insufficient oxygen in the blood that CAN be measured

A

hypoxemia

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69
Q

Lack of oxygen available to tissue that CANNOT be measured

A

hypoxia

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70
Q

Inspiration or expiration; air moves in and out of the lungs

A

ventilation

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71
Q

Flow of blood to the alveolar capillaries

A

perfusion

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72
Q

Tendency of lungs to return to normal; elastin fibers; normal = passive

A

elastic recoil

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73
Q

Product of elastic recoil, Measure of the ease of expansion

A

compliance

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74
Q

Any obstacle to airflow

A

resistance

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75
Q

Mucin responsible for trapping & transporting inhaled foreign bodies, secretes mucins

A

goblet cells

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76
Q

Hair like projections that move microbes & debris out of airways

A

cilia

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77
Q

2 types of upper respiratory tract infections

A

rhinovirus or influenza

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78
Q

t/f:
treatment of URI’s treats symptoms but DOES NOT eliminate causative pathogen

A

true

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79
Q

Inflammatory mediator

A

histamine

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80
Q

2 Types of histamine receptors:

A

H1 and H2

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81
Q

smooth muscle contraction & dilation of capillaries

A

H1

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82
Q

acceleration of heart rate & gastric acid secretion

A

H2

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83
Q

H1 antagonists:

A

• Aka H1 blockers
• Known as ”antihistamines”

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84
Q

Prevent release & actions of histamine stored in cells, Do not push histamine already bound; compete for
unoccupied receptors

A

MOA (antihistamine)

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85
Q

this prevents: Vasodilation
-GI, respiratory, salivary, & lacrimal secretions
-Increased capillary permeability and edema

A

antihistamine (MOA)

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86
Q

things H1 antagonists work for:

A
  • Nasal & seasonal allergies
    • Symptoms of common
    cold
    • Allergic reactions
    • Motion Sickness
    • Vertigo
    • Sleep aids
    • Parkinson’s dx
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87
Q

adverse effects of H1 antagnoists

A

Drowsiness
• Dry mouth, vision
changes, difficulty
urinating & constipation
(anticholinergic)

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88
Q

nonsedating, Developed to eliminate unwanted
effects of older antihistamines, Work peripherally

A

2nd generation H1 antagonists

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89
Q

indications: insomnia to motion sickness, Work peripherally and centrally, sedative

A

1st Generation H1 antagonists

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90
Q

Antihistamines have _______ S/E
- Rest & digest (↑ salivation, lacrimation, urination, diarrhea)

A

anticholinergic

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91
Q

Anticholinergic Side Effects:

A

can’t pee, can’t spit, can’t see, can’t shit

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92
Q

what is not for use in asthma, lower respiratory tract dx, at risk for PNA

A

antihistamines

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93
Q

things to monitor for with antihistamines:

A

allergic reaction & drug interactions

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94
Q

reason for nasal congestion

A

Blood vessels that surround nasal sinuses dilate, swelling blocks nasal passageway

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95
Q

a good medication for nasal congestion is Anticholinergics because they

A

decrease salivation, dry you up

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96
Q

Stimulate the sympathetic nervous
system, aka sympathomimetics

A

ephedrine

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97
Q

constrict small blood vessels surrounding nasal sinuses, Shrink engorged nasal mucus membranes; relieve stuffiness

A

ephedrine

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98
Q

Adverse Effects of Adrenergic Nasal Decongestants

A

Nervousness
Insomnia
Palpitations
tremors

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99
Q

Intranasal Adverse Effects for Adrenergic Nasal Decongestants

A

Mucosal irritation
Dryness
systemic effects in excessive dosages (HTN, palpitations,
headache, etc)

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100
Q

used to prevent or relieve a cough, suppress cough reflex

A

antitussive

101
Q

promotes secretion of sputum by air passages, used to treat coughs

A

expectorant

102
Q

Same as opioids

A

MOA (Non-Opioid Antitussives: Dextromethorphan)

103
Q

Most common chronic lung diseases with ↑ resistance to airflow d/t airway obstruction & narrowing (problem getting air in and out)

A

Obstructive Pulmonary Diseases

104
Q

causes of Chronic Obstructive Pulmonary Disease

A

cigarette smoking, noxious particles & gases

105
Q

episodes of recurrent but reversible shortness of breath, Airways of lung (bronchi &
bronchioles) become narrow bc of Bronchospasm, Inflammation, Edema, Production of mucus

A

asthma

106
Q

symptoms of asthma attack

A

wheezing, difficulty breathing

107
Q

asthma attack becomes medical emergency when they don’t respond to meds

A

status asthmaticus

108
Q

pt exposed to known allergens, allergic asthma

A

extrinsic

109
Q

2 meds for asthma

A

-Bronchodilators
-Inhaled corticosteroids

110
Q

Relax bronchial smooth muscle, Causes dilation of bronchi & bronchioles, used during acute phase of attack

A

bronchodilators

111
Q

Beta 1 i located mostly on the ____ and Beta 2 on the ____

A

heart, lungs

112
Q

is Beta2 Adrenergic Agonist: Albuterol short or long acting?

A

short (SABA)

113
Q

Prevention/relief of bronchospasm

A

albuterol

114
Q

Covert drug solutions to mist, Inhaled through facemask or
mouthpiece

A

nebulizer

115
Q

Similar to natural steroid hormones in body (glucocorticoids)

A

corticosteroids

116
Q

Stabilize membranes of cells that release
bronchoconstriction substances

A

corticosteroid

117
Q

obstructed airway, barrel chest, resp, muscles can’t function, Air trapping leads to damaged
alveolar walls

A

COPD

118
Q

breakdown of alvioli, Air spaces enlarge d/t
destruction of alveolar wall (no gas exchange/loss of elasticity= air trapped)

A

Emphysema

119
Q

excessive mucus production from goblet cells

A

chronic bronchitis

120
Q

symptoms of chronic bronchitis

A

Productive cough, Wheezing, Dyspnea, Hypercapnia & hypoxemia, Pulmonary Hypertension (if
severe), Flat Diaphragm

121
Q

force exerted by blood against walls of blood vessel

A

blood pressure

122
Q

BP and tissue perfusion require ____ and _____ vascular effects

A

system, local

123
Q

amount of pressure in arteries during systole, when heart contracts

A

systolic BP

124
Q

amount of pressure in arteries during diastole, when heart relaxes

A

diastolic BP

125
Q

total blood flow through systemic or pulmonary circulation in 1 minute

A

cardiac output

126
Q

average CO

A

4-8 L/min

127
Q

what is CO impacted by

A

HY, contractility, conductivity

128
Q

amount of blood pumped out of left ventricle with each contraction

A

stroke volume

129
Q

average stroke volume

A

70 ml

130
Q

how many times heart beats/contracts in one minute

A

heart rate

131
Q

less time for filling and perfusion of coronary arteries =

A

increase in heart rate

132
Q

impacted by preload, contractility, afterload

A

Stroke volume

133
Q

if SV and HR increase, what demand gets higher?

A

O2

134
Q

volume of blood stretching the ventricles at the end of diastole,
(end diastolic volume)
THE STRETCH

A

preload

135
Q

preload is increased in patients with:

A

HTN and hypervolemia

136
Q

preload is decreased in patients with

A

higher HR and hypovolemia

137
Q

resistance left ventricle needs to overcome to circulate blood
(occurs during systole)
THE RESISTANCE

A

afterload

138
Q

afterload depends on:

A

size of ventricle, wall tension, arterial BP

139
Q

afterload is increase in patients with:

A

hypertension, vasoconstriction

140
Q

The force of contraction during systole
(impacts CO)
THE SQUEEZE

A

contractility

141
Q

inotropic=

A

contractility

142
Q

contractility increases because of

A

epinephrine & norepinephrine from SNS

143
Q

↑ contractility raises SV by increasing what?

A

ventricular emptying

144
Q

Force opposing the movement of blood within the blood vessels

A

vascular resistance (SVR)

145
Q

Vascular resistance depends on

A

diameter of arteries/arterioles

146
Q

change in diameter =

A

change in SVR

147
Q

Arteries narrowed =

A

resistance to blood flow increased

148
Q

Arteries dilated =

A

resistance to blood flow decreased

149
Q

BP=
(formula)

A

CO x SVR

150
Q

is sympathetic nervous a system short or long term mechanism?

A

short term (seconds)

151
Q

SNS activation =
(wide vasoconstriction)

A

↑ BP, HR, contractility

152
Q

Increases CO & SVR =

A

increase in BP

153
Q

epinephrine and norepinephrine =

A

neurotransmitters

154
Q

epinephrine and norepinephrine =

A

neurotransmitters

155
Q

epinephrine and norepinephrine are released from

A

SNS

156
Q

what Activate receptors located throughout body

A

SNS (neurotransmittors)
(response depends on receptor)

157
Q

When baroreceptors are stimulated (↑ in BP) =

A

send inhibitory impulses

158
Q

baroreceptors are sensitive to

A

stretching

159
Q

SNS inhibited=

A

↓HR, ↓ force of contraction, & vasodilation in peripheral arterioles

160
Q

If sense a fall in BP, ____ is activated

A

SNS

161
Q

baroreceptors become adjusted & recognize BP as the “new normal” =

A

extended hypertension

162
Q

Mimic effects of SNS neurotransmitters, stimulate SNS
(alpha and beta receptor sites throughout)

A

adrenergic

163
Q

Vascular smooth muscle; heart
Stimulation by NE = constriction

A

alpha 1 receptor

164
Q

Vascular smooth muscle; heart
Stimulated by NE & epi = ↑ HR, force of contraction & speed of conduction

A

Beta 1 receptor

165
Q

Smooth muscle of coronary blood vessels & lungs
Activated by epi = vasodilation

A

Beta 2 receptor

166
Q

Beta1 stimulation will increase:

A

-Force of contraction (inotropic)
-Heart rate (chronotropic)
-Conduction of cardiac electrical
impulses (dromotropic)

167
Q

Force of contraction

A

inotropic

168
Q

heart rate

A

chronotropic

169
Q

Conduction of cardiac electrical impulses

A

dromotropic

170
Q

B1 on juxtaglomerular cells of kidney=

A

Increased renin secretion

171
Q

alpha 1 ____ arteries

A

constricts

172
Q

alpha 2 ____ arteries

A

dilates

173
Q

beta 1 ____ heart vessels

A

constricts

174
Q

beta 2 _____ lungs

A

dilates

175
Q

Released in times of stress, relaxes bronchioles, increase HR and force of contraction
-Contracts blood vessels (keeping BP up)

A

neurotransmitters and beta receptors

176
Q

Maintain BP under conditions (pain, stress, & exercise)

A

SNS

177
Q

Causes ↑ CO & BP to adjust to O2 demands

A

SNS

178
Q

Postural changes =

A

↓ in BP

179
Q

vasoconstriction to increase venous return to the heart =

A

SNS response

180
Q

If no reaction –> blood flow inadequate =

A

syncope or dizziness

181
Q

Short term BP regulation mechanism
cell layer that lines blood vessels
Regulation of vasodilation & vasoconstriction

A

VASCULAR ENDOTHELIUM

182
Q

Releases vasoactive substances that dilate or constrict

A

VASCULAR ENDOTHELIUM

183
Q

Smoking & diabetes reduce function of _____ cells

A

endothelial

184
Q

Kidneys contribute to __ regulation

A

BP

185
Q

Control sodium (Na) excretion & extracellular fluid (ECF) volume

A

renal system

186
Q

is renal system short or long term mechanism

A

long term

187
Q

Na retention =

A

water retention –> EFC volume ↑

188
Q

More volume =

A

↑ venous return to heart & SV

189
Q

is renin angiotensin aldosterone system (RAAS) short or long term mechanism?

A

long term

190
Q

Juxtaglomerular apparatus in kidneys secrete ____

A

renin

191
Q

enzyme that converts angiotensinogen to angiotensin 1

A

renin

192
Q

renin is secreted if:

A

↓ BF through kidneys
↓ serum Na concentration

193
Q

Baroreceptors tell kidneys to release _____

A

renin

194
Q

Renin reacts with ______

A

angiotensinogen (liver enzyme)

195
Q

Conversion of angiotensinogen to

A

angiotensin I

196
Q

Angiotensin I converted to angiotensin II (in the lungs) by ________

A

angiotensin converting enzyme (ACE)

197
Q

Angiotensin II =

A

increases BP

198
Q

angiotensin II Directly stimulates adrenal cortex to secrete ______

A

aldosterone

199
Q

stimulates kidneys to retain sodium & water

A

aldosterone

200
Q

Increase in blood volume & osmolarity stimulates release of ____ ______

A

antidiuretic hormone (ADH)

201
Q

ADH Increases ECF by reabsorption of water in ______

A

tubules of kidney

202
Q

increase of blood volume =

A

increase of CO and BP

203
Q

high blood pressure

A

hypertension

204
Q

46% of adult/ 75 million in the US have ____

A

htn

205
Q

heart disease = ____% of deaths

A

23.7% of deaths

206
Q

what can htn cause?

A

myocardial infarction, stroke, heart failure, renal disease, retinopathy

207
Q

t/f: SBP increases with age

A

true

208
Q

DBP rises until age __; then decreases

A

55

209
Q

idiopathic, ↑ BP without a cause

A

primary hypertension

210
Q

↑ BP with specific cause that can be identified

A

secondary hypertension

211
Q

“silent killer”- “normal” htn symptoms

A

• Asymptomatic until severe HTN
• Fatigue, dizziness, palpitations, angina,
dyspnea

212
Q

cardiovascular complications of htn:

A

-Heart disease
• Coronary artery disease (CAD)
• Left ventricular hypertrophy
• Heart failure

213
Q

Pharmacological treatment of htn

A

Decrease volume of circulating blood, Reduce SVR

214
Q

non-pharmacological treatment of htn

A

lifestyle changes;
DASh diet, weight loss, avoid tobacco products, sodium reduction, physical activity

215
Q

for htn, start with

A

diuretic, sodium channel blockers, ACE or ARB

216
Q

If NO calcium =

A

muscles of blood vessels CANNOT contract

217
Q

Crosses the cell membrane, excitation of heart

A

calcium/ heart

218
Q

Cause smooth muscle relaxation, Promotes muscle relaxation -> dilation of coronary arteries
• Decreased BP, SVR & afterload

A

MOA (calcium channel blocker)

219
Q

Prevent Ca+ from binding =

A

muscle relaxation

220
Q

contradictions of calcium channel blockers:

A

drug allergy
heart attacks

221
Q

drug interactions with CCB

A

grapefruit juice
(CCB wont be metabolized)

222
Q

Calcium channel blocker pneumonic for its side effects

A

SHRED
S- slower HR
H-hypotension/headaches
R-reflex tachycardia
E-edema
D-dizziness

223
Q

CCB: Dihydropyridines “dipines”

A

amlodipine

224
Q

CCB: Nondihydropyridines “Non dipines”

A

diltiazem

225
Q

Treat HTN because vaso-selective

A

Dihydropyridines ”dipines”

226
Q

Used more to treat tachyarrhythmias & vasospasm

A

Nondihydropyridines

227
Q

More effect on vasodilation; less effect on heart

A

dipines

228
Q

Less effect on vasodilation; MORE effect on heart

A

non-dipines

229
Q

1st line drugs for HTN

A

ACE inhibitor

230
Q

Reduce vasoconstriction & sodium/H2O retention
Reduce BP by reducing SVR
Prevent breakdown on bradykinin & substance P

A

MOA (ACE inhibitors)

231
Q

brings blood to the glomerulus
(Constrict in response to adrenergic stimulation, decreased GFR)

A

Afferent arteriole

232
Q

carries blood away from the glomerulus
(Angiotensin 2 constricts arteriole to maintain pressure)

A

efferent arteriole

233
Q

Decrease in angiotensin 2 =

A

vasodilation of kidneys efferent arteriole

234
Q

vessel carrying blood AWAY from glomerulus is more ____

A

dilated

235
Q

ACE inhibitors =

A

decreased pressure in glomerulus

236
Q

t/f: ACE inhibitors are good for people with good kidneys, but not for bad kidneys

A

true

237
Q

contraindications of ACE inhibitors:

A

drug allergies, angioedema, baseline potassium > 5, renal artery stenosis

238
Q

adverse effects of ACE

A

1st dose hypotensive, hyperkalemia, angioedema, renal impairment

239
Q

ACE inhibitor drug interacts with

A

NSAIDS (reduces effect of ACE, renal failure)

240
Q

Drug that is inactive in its administered form, Must be metabolized to its active form in the body

A

prodrug

241
Q

prodrugs are ideal for

A

liver dysfunction

242
Q

is catopril a prodrug

A

no, doesnt need anything to help metabolize it (doesn’t need liver, good for someone with liver failure)

243
Q

Use ACE inhibitor cautiously in older adults and patients with

A

renal dysfunction

244
Q

Block SNS stimulation of beta receptors by competing with norepinephrine & epinephrine

A

Beta blockers (MOA)

245
Q

ARB adverse effects:

A

hypoglycemia (masks symptoms)

246
Q

will stimulate all beta receptors

A

if non-selective

247
Q

decreased contractility & worsening heart failure with BB

A

heart failure

248
Q

beta 1 blockers =

A

cardiac only effects

249
Q

Relaxes arterial & venous smooth muscle, dilates vessels, Result is decreased preload & SVR

A

nitroglycerin

Pathopharm (8 decks)

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