Patho Exam 3 Flashcards
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Pain
Pain that results from injury to tissues
Nociceptive pain
Two types of nociceptive pain
Somatic and visceral
Injury to somatic issues (bones joints muscles)
Somatic pain
Injury to visceral organs (small intestines)
Visceral pain
Results from injury to peripheral nerves, response poorly to opioids
Neuropathic pain
Conscious experience of pain
perception
Pain impulses are enhanced by ______
prostaglandins, substance P (make nerve endings more sensitive to pain)
Brain suppresses pain by using endogenous opioid compounds such as:
endorphins/ enkephalins
what integrates and interprets pain sensations
parietal lobe of the cerebral cortex
what governs the emotional response to pain
cingulate gyrus
relay station- (to and from periphery)- “OUCH! thats a 10 on pain scale!”
thalamus
learning and memory- “don’t forget you did that, idiot”
hippocampus
treating the excruciating pain with narcotics not only activates the pain control system but also activates the dopaminergic reward system
Amygdala/nucleus accumbens
sudden onset pain, usually subsides once treated
acute pain
persistent or reoccurring, lasts 3-6 months, often difficult to treat
chronic pain
Areas of skin that send their sensory
information into specific spinal cord segments, visceral structures share these sensory afferents with skin areas
dermatomes
maximal intensity of the visceral pain are in the _____/______ areas, up neck, down inner arm
retrosternal/ percordial
Arises from internal organs such as the
intestine, bladder and heart, tumor involvement or obstruction
visceral pain
radiated from origin to different site
referred pain
drugs that relieve pain without causing the loss of consciousness
analgesics
most effective pain relievers available
opioids
Increasing the dose beyond the upper limit provides no greater analgesia
Analgesic ceiling
most dangerous acetaminophen interaction
alcohol
hepatotoxicity of acetaminophen can be reversed with ________
acetylcysteine
Works by preventing the hepatotoxic metabolites of acetaminophen from forming
acetylcysteine
Bad-tasting with odor of rotten eggs, Vomiting of oral dose common, Available in IV
acetylcysteine
overdose of acetaminophen
hepatic necrosis
hepatic necrosis symptoms
hepatic failure, coma, death
early symps: N/V, diarrhea, sweating, abdominal pain
Inhibits cyclooxygenase and has antiinflammatory,
analgesic, and antipyretic actions
ibuprofen
Adverse effects of NSAIDs
heartburn, ulceration and GI bleeding, acute renal failure, CV risk, MI, Stroke, thrombotic event
Opium was used primarily as a sedative and
as a
treatment for diarrhea
3 classes of opioid receptors
Mu, Kappa, Delta
Mu receptors:
Analgesia, respiratory depression,
euphoria, sedation, decrease GI motility and
physical dependence
Kappa receptors:
Analgesia, decrease GI motility
and sedation
the prototypical opioid and is used as
the standard of comparison for all other opioids
morphine
Other strong opioid agonists :
Fentanyl, Hydromorphone
moderate to strong opioid agonists:
Codeine, oxycodone, hydrocodone
Relieves pain without affecting other senses (for
example, sight, touch, smell, and hearing), no loss of conciousness
morphine
AE of morphine
resp. depression, constipation, orthostatic hypotension, urinary retention, cough suppression, increased ICP, Euphoria/dysphoria, sedation
State in which an abstinence syndrome will occur if the dependence-producing drug is abruptly withdrawn; it is NOT equated with addiction
Physical dependence
Drug use that is inconsistent with medical or social norms
abuse
Behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm
addiction
Large organ behind stomach, Exocrine & endocrine gland, Role in regulation of
glucose homeostasis
pancreas
Hormone secreting part of pancreas
islets of Langerhans
4 Types of cells: pancreas
alpha, beta, delta, F cells
make & secrete glucagon
alpha cells
make and secrete insulin
beta cells
alpha cells, breakdown for energy
glucagon
beta cells, storage of excess energy
insulin
glucagon secreted
from pancreas (alpha)
hypoglycemia
Provides fuel through glycogenolysis,
breakdown of glycogen into glucose, Causes liver to release glucose to
tissues, increases BG
glucagon
aka dextrose, Primary source of energy in body, simplest form of carb, circulates in blood to meet requirements for quick energy
glucose
low BG level, Confusion, irritability,
tremors, sweating; coma and death
hypoglycemia
high BG level, polyuria, polydipsia,
polyphagia, weight loss, fatigue
hyperglycemia
Secreted from pancreas, Goes to liver, Breaks down glycogen into
glucose
glucagon
Storage of glucose in the liver
glycogen
Source of energy, Stored in liver as glycogen
glucose
Daily secretion of insulin
40-50 U
Increased _____ release when food is
digested
insulin
Balance of glucagon & insulin fail, Issues with insulin supply or poor use of available insulin
diabetes mellitus
Leading cause of adult blindness, end stage renal disease, & lower limb amputation, More that half have hypertension & high cholesterol
DM
Hgb A1C 6.5% or HIGHER=
- random glucose of 200mg/dL or HIGHER
DM
Measures glycosylated hemoglobin as a percentage of total Hgb
hemoglobin A1C
ADA normal < ____%
5.7%
ADA hgbA1C goal for patient
with diabetes < __-__%
6.5-7%
Autoimmune disorder, antibodies developed against b cells, Lack of insulin production/ production of defective insulin, B cell destruction for months before symptoms
Type 1 DM
Type 1 DM: 3 P’s
polyuria, polydipsia, polyphagia
Body cannot get glucose; breaks down
fat & protein- attempt for energy
weight loss in DM type 1
Body cells lack needed energy from
glucose
weakness/fatigue in Dm type 1
insulin resistance and/or inadequate insulin secretion, Combination of inadequate insulin secretion,
insulin resistance, ineffective use of insulin, pancreas makes SOME insulin
type 2 Diabetes mellitus
Distinction between type 1 and type 2 = presence of ______ ___
endogenous insulin
S/S of hyperglycemia- appear when 50-
80% of Beta cells are
no longer secreting
insulin
type 2 DM
autoimmune destruction, No endogenous insulin, Juvenile onset; < 20, normal insulin receptors and insulin treatment
Type 1 DM
overweight, age, family hx,
genetic, Normal to high insulin; then reduced, Decreased or defective receptors
treatment of weight loss, diet/exercise, oral meds, maybe insulin
type 2 DM
_____ restores patient’s ability to:
* Metabolize carbs, fats, & proteins
* Store glucose in the liver
* Convert glycogen to fat stores
insulin
number of units of insulin per milliliter
concentration
Deliver long and rapid/short acting insulin
basal-bolus insulin
long – acting insulin to keep BG from
fluctuating
basal
Rapid acting insulin to mimic burst
insulin in response to ↑ BG levels
bolus
2 different insulins: 1 intermediate & 1
rapid/short acting
fixed-combination insulins
Simulate varying levels of endogenous
insulin that occur naturally, mealtime and basal coverage
fixed-combo
when mixing insulin,
first draw up regular or rapid acting insulin (clear), then intermediate or NPH insulin (cloudy)
Method to correct blood glucose levels;
Sub-q doses of rapid/short acting insulin
adjusted based on BG levels
sliding-scale insulin
main cause of uncomplicated, community-acquired UTIs and cause of less than 50% of hospital-acquired UTIs
E. coli
blood flow to kidneys through _____ artery, out though ____
afferent, efferent
80-85% of nephrons lie in _____ cortex
renal
basic functioning unit of kidney, 1.5 million per
kidney in normal birth weight individuals
nephron
_____ artery arises from the aorta, dividing into smaller branches, all forming an ______ arteriole
renal, afferent
Afferent arteriole divides into a capillary
network:
glomerulus
80% of electrolytes get reabsorbed at the ______
Proximal convoluted tubule:
at the descending Loop of Henle, ____ gets reabsorbed
water, some sodium, urea, other solutes
at the ascending Loop of Henle, _____ gets reabsorbed
chloride, sodium
causes are factors external to kidneys that reduce renal blood flow (cause is BEFORE kidneys)
prerenal
prerenal causes:
severe dehydration, heart failure, decrease CO
t/f: acute kidney failure is typically reversible
true
Decreases glomerular filtration rate, causes oliguria, Autoregulatory mechanisms attempt to preserve blood flow
prerenal
Causes include conditions that cause direct damage to kidney tissue, (occurs IN the kidney)
intrarenal
____ Results from prolonged ischemia- can cause acute
tubular necrosis.
intrarenal
Inflammation of glomerulus usually autoimmune
intrarenal
Results from ischemia, nephrotoxins, or sepsis. epithelial cells that dont get oxygen, they start to slough off causing obstruction
acute tubular nephrosis
_____ causes include Benign prostatic hyperplasia, Prostate cancer, Calculi, Trauma, Extrarenal tumors
(occurs AFTER kidneys)
postrenal
First line drugs for all patients with volume overload. Watch electrolytes!!
diuretics
Furosemide (Lasix) is a _____ diuretic
loop
Hydrochlorothiazide is a _____ diuretic
thiazide
Spironolactone is a _____ diuretic
potassium-sparing
works at ascending loop of henle, puts sodium and chloride back into tubule system, causing ostmotic effect because water (and electrolytes) always follows sodium
Furosemide diuretic
most of electrolytes taken back in (reabsorbs the most), produces most diuresis
proximal convuluted tubule
distal convoluted tubule only takes back in ___% of electrolytes
10%
Blockade of sodium and chloride
reabsorption into body, allow into tube then into toilet
diuretics
Acts on ascending loop of Henle to block reabsorption
furosemide
if given furosemide PO, ___ mins, IV, ___ mins
60, 5
uses of furosemide
Pulmonary edema, Edematous states, Hypertension
Adverse effects of furosemide
Hyponatremia, hypochloremia, dehydration, Hypotension, Hyperuricemia, ototoxicity
Hormone produced by the adrenal gland; functional unit of the kidney it’s job is to conserve sodium and water and excrete potassium.
aldosterone
produced by the hypothalamus and released from the posterior pituitary in response to osmoreceptors
located in the hypothalamus, fluid is held back (restricted)
Antidiuretic Hormone
t/f: Adh turns on by itself at night to stop from urinating all night long
true, if no Adh at night: nocturia
____ receptors on the distal tubule and collecting duct
Adh
kicks in around midnight with water conservation and reduced urination at night
Diurnal rhythm
excess hydrogen ions in blood=
acidic
bicarb level:
22-26
if kidney fails, Retention of water— causing what?
edema, weight gain, HTN
if _____ fails, also retention of urea (BUN), creatinine, Na+ (HTN), K+ (hyperkalemia, life threatening cardiac arrythmias), phosphorus(hyperphosphatemia)
kidney
plasma (serum) creatinine level:
0.5-1
Urea is a commonly used marker for the diagnosis of renal failure/kidney injury; by-product of protein metabolism (not produced at a constant rate)
BUN
BUN level
8-18 mg/dL
reasons for elevated BUN
decreased GFR, dehydration
is released from skeletal muscle at
a relatively constant state, is freely filtered at
the glomerulus, and is not reabsorbed or
metabolized by the kidneys
creatinine
if the kidneys are not filtering properly, ______ will be retained and the ____ ______will be
increased
creatinine, serum creatinine
Can be influenced by age, gender, muscle mass, diet,
concomitant diseases, & drugs
serum creatinine
The NIH Consensus recommends that
patients with chronic kidney disease be
referred to a renal team when the
serum creatinine begins to elevate.
determination of how much the glomerulus
filters; can be determined by how much
creatinine is CLEARED into the toilet (also
known as creatinine clearance)
glomerular filtration rate
5 fn of kidneys
-maintain fluid/electrolye balance
-maintain acid-base balance
-Vitamin D and calcium metabolism
-RBC production via hormone erythropoietin
-main BP via renin-angiotensin-aldosterone system
a GFR of less than ___ mL/min represents a loss of more than half of normal kidney function
60
The kidney converts the vitamin D from
the skin and diet to the active form of vitamin D, also called
calcitriol
________ __ is necessary for the absorption
of calcium from the GI tract
vitamin D
Calcium and phosphorus must always be
“__ _____” in the blood
in balance
Normal Phosphorus level:
2.4-4.4mg/dL
Normal Calcium level:
8.6 -10.2 mg/dL
hypocalcemia causes:
Neuromuscular Excitability:
- tetany, paresthesias, hyperactive
DTRs, Trousseau’s sign,
Chovstek’s sign, seizures
contraction of the hand and finger when blood flow occluded
Trousseau’s sign
elicited by tapping the facial nerve
Chovstek’s sign
Serum level greater than10.2 mg/dL
hypercalcemia
hypercalcemia causes:
malignancy and hyperparathyroidism, bone loss related to immobility
Manifestations of ________: Loss of cell membrane
excitability: fatigue, weakness, lethargy,
incoordination
hypercalcemia
when phosphorus levels go to high, _____ goes low
calcium
Most abundant intracellular cation, Extracellular concentrations are low
potassium
potassium level:
3.5-5
potassium lives inside or outside cell?
mostly inside, because levels are only 3.5-5
Conducting nerve impulses, Maintaining the electrical
excitability of muscle, Regulating acid-base balance
potassium
regulation of potassium levels Primarily by the ______
kidneys
Renal excretion increased by _______, also most diuretics
aldosterone
insulin is key to the ____, puts poatssium back into them
cells
Potassium uptake enhanced
alkalosis
Potassium exits cells
acidosis
Serum potassium levels less than 3.5 mEq/L
hypokalemia
Dosages for prevention: oral potassium
16-24 mEq/day
Dosages for deficiency: oral potassium
40-100 mEq/day
dont push ______, unless cannot take PO and if IV needed, dilute it and push SLOWLY
potassium
NEVER push _____ ________, results in cardiac arrest
potassium chloride
Contraindications to potassium (treatment for hypokalemia): do not use in patients predisposed to
hyperkalemia (severe renal impairment)
Excessive elevation of serum
potassium
hyperkalemia
causes of _______:
Severe tissue trauma
Acute acidosis (draws potassium out
of cells)
Misuse of potassium-sparing
diuretics
Overdose with IV potassium
hyperkalemia
Disruption of electrical activity of the
heart is a consequence of
- mild elevation:
severe elevation:
hyperkalemia
- 5-7
- 8-9
Noncardiac signs of hyperkalemia
Confusion, anxiety, dyspnea,
weakness or heaviness of legs,
numbness/tingling of hands/feet/lips
hyperkalemia treatment:
no food or meds with potassium
***Sodium polystyrene sulfonate
(Kayexalate) should not be given to a
patient with a ______ ____ because
bowel necrosis can occur. Auscultate
bowel sounds prior to administration.
paralytic ileus
Concentration within the cells much
higher than outside the cell. Plasma
Mg levels 1.5-2.4mEq/L
magnesium
Most bound to protein uncharged, Helps regulate neurochemical transmission and excitability of
muscle, Obtained from food, excreted in urine and stool
magnesium
Serum level less than 1.3 mg/dL
hypomagnesium
Causes of hypomagnesium
alcoholism, GI losses, enteral or parenteral
feeding deficient in magnesium, medications, burns
Manifestations of hypomagnesium
neuromuscular irritability, muscle
weakness, tremors, ECG changes and dysrhythmias,
alterations in mood and level of consciousness
Second most common infection, in sexually active young women and older adults in nursing homes
UTI
upper UTI in _______
-Acute pyelonephritis
-Acute bacterial prostatitis
kidneys
upper UTI in _______
-Acute pyelonephritis
-Acute bacterial prostatitis
kidneys
lower UTI in _____ and _____
-Acute cystitis
-Acute urethral syndrome
bladder and urethra
When the bladder fills, the distal end of the
______ closes to prevent urine from backing up
into the kidney
ureter
If this mechanism is not working properly
bacteria can reflux into the ureters and up to the
kidneys—
vesicoureteral reflux
Lower urinary tract infections
cytisis
Frequently the treatment of choice for oral
therapy of UTIs
Trimethoprim/sulfamethoxazole
(TMP/SMZ)
Suppress bacterial growth by
inhibiting tetrahydrofolic acid, a
derivative of folic acid or folate
sulfonemides and trimethoprim
Moderate
infection (treatment at home with
oral antibiotics)
mild pyelonephritis
Requires
hospitalization and IV antibiotics
severe pyelonephritis
Inflammation of the prostate caused by local
bacterial infection
- high fever, chills, malaise, myalgia, localized
pain, dysuria, nocturia, urinary urgency,
urinary frequency, urinary retention
Acute Bacterial Prostatitis
total inability to pass urine.
acute urinary retention
incomplete bladder emptying
despite urination.
chronic urinary retention
AE of trimethroprim/sulfamethoxazole
N/V, GI, rash, hyperkalemia
found on heart muscle; increases HR and strength of contraction
B1
skeletal muscle, bronchioles of lungs, arteries of legs, pilorection
B2
arteriole smooth muscle
a1
regulates CNS output of SNS; hypothalamus
a2
alpha-1 receptors
are also located on the smooth
muscle of the ______ gland
prostate
normal pH
7.35-7.45
normal CO2
35-45
normal bicarb
22-26
2 things that control pH
respiratory and metabolic; because kidneys hold onto bicarb, resp holds onto CO2
ROME:
Resp
Opposite
Metabolic
Equal
resp acidosis common for
COPD, CO2 builds up
drug OD, CO2 builds up, also
resp acidosis
too much CO2 let out, ex anxiety attack
resp alkalosis
breathe out/lose CO2, become
alkali
