WK 1: Infection/Immunity/Cellular Adaptation/Into to PathoPharm Flashcards
Pharmacology
study of the biologic effects of drugs that are introduced into the body to cause some sort of change
Pharmacokinetic
what happens to drugs within the body
pharmacodynamics
-MOA
-what do drugs do in the body/how they work
Generic name of a drug
-the official name
-can only have ONE generic name
-usually more complicated name
-lowercase
for the tests, must know generic names
EX: generic name: acetaminophen
Chemical name of a drug
-long and complex
-used within research
EX: N-acetyl-para-aminophenol is the chemical name for Tylenol
Trade name of a drug
-brand name
-easier to remember
-uppercase
EX: Tylenol
What is a prototype of a drug
-typically the first drug that represents a group/class of medication
EX: Tylenol was the prototype for acetaminophen
Therapeutic effects of drugs
-intended effects of drug
-what we want to happen
Side Effects of drugs
-unintended effects
-unavoidable
EX: getting an upset stomach when taking Tylenol
Toxicities of drugs
harmful effects
Adverse Effects of drugs
-unexpected reaction
-dangerous reaction
Allergic reaction of a drug
-unexpected
-potential to be dangerous
-involves immune system response
What do you need to know with each medication?
- generic name
-drug classification
-MOA
-indications
-common/serious adverse effects
-nursing indications
What is a nursing indication?
-thinking about what the nurse needs to consider/ worry about with a certain medication.
-what needs to be assessed prior to giving med?
-any SERIOUS interactions?
-CYP drug?
-any condraindications?
What cooperation approves the use of new drugs?
FDA (food and drug administration)
phases of drug approval through the FDA
- Preclinical trials (animal testing)
- Phase I (human volunteers)
- Phase II (patients w/ intended Dz)
- Phase III (Vast clinical market)
- Phase IV (continued evaluation by FDA)
Schedule 1 controlled substance
NOT approve for medical use
EX: heroin, LSD
Schedule 2 controlled substance
used medically but HIGH POTENTIAL for abuse
-no Rx refills allowed
EX: narcotics, amphetamines
Schedule 3 controlled substance
have less potential for abuse
EX: non barbiturate sedatives, non-amphetamines, stimulants; i.e. lortab, vicodin
Schedule 4 controlled substance
Some potential for abuse
EX: primarily sedatives, anti-anxiety medications; i.e Xanax, valium, Ambien
Schedule 5 controlled substance
Low potential for abuse
medications with small amounts of certain narcotics or stimulants
Ex: cough suppressants with some codeine, ephedrine containing medications
Over the Counter Medications (OTC)
-consumers must be able to diagnose own condition and monitor effectiveness easily
-low risk side effects
-low abuse potential
Dietary and herbal Supplements can only claim affect on what?
body structure or function
NOT medical conditions
Why is it important to get a full health history in regards to medications and daily herbal intake?
Some herbals can increase the toxicity of prescription medications OR cause decreased therapeutic effects
What is a teratogen?
a substance that causes congenital malformations in developing fetuses
Ex: alcohol, weed, nicotine
Categories of Teratogens
A: safe for fetus
B: lack of studies to show benefit/ risk
C: No studies, talk to OB
D: possible risk to fetus, talk to OB
X: known risk that cannot be outweighed
What are some examples of category X tetragens?
-thalidomide
-chemotherapy agents
-Isotretinoin / Retin A (acne treatment)
Pharmacogenomics
study of how genes affect a persons response to drugs
Pathophysiology
study of disease and injury
Disease
disruption in homeostasis
-Physical: injury, HF
-Mental: depression, anxiety
-Social: Autism
Causes of Disease: intrinsic condition
genes
immunity
age
gener
Causes of Disease: extrinsic condition
bacteria
viruses
injury
behaviors
stressors
fungi
Process of Disease
- Identification: Signs (objective) and symptoms (subjective)
- Occurrence: How often, when?
- Diagnosis: identification
- Etiology: cause
- Prognosis: Likelihood of recovery
Stages of Disease
- Exposure: where did they get sick?
- Onset: sudden/insidious/latent/prodromal/manifestations
- Remission
- Convalescence
Types of disease causes:
1. Idiopathic
2. Latrogenic
3. Exacerbation
- unknown cause. Think “idiot”
- caused by some treatment they received/medical reason. think “lateral”
- worsening of a disease, acute decline of chronic disease
Hypo-
below, less than normal
Ex: hypokalemia = low potassium
Hyper-
above normal, excess
Ex: hyperkalemia = high potassium
-penia
decrease, deficiency
Ex: neutropenia: low white blood cells
-cytosis
referring to cells
Ex: phagocytosis= ingesting of old cells
-osis
-a condition, status, or process
-production or increase
-invasion or infection
-itis
disease or inflammation
-pathy
disease or suffering
Three Phases of Drug Action
- pharmaceutic phase
- pharmacokinetic phase
- Pharmacodynamic phase
Phase 1 of drug action: pharmaceutic phase
Dissolution phase, all oral drugs must go through dissolution in order to be absorbed
Phase 2 of drug action: pharmacokinetic phase
-what the body does to the drug
-has four processes:
1) absorption: through small intestines into blood
2) distribution: drug leaving blood, passing through cell membrane to site of action
3) metabolism/biotransformation: liver metabolizes drug
4) excretion: kidney excretion
Drugs crossing the cell membrane
-drugs must be lipid soluble to pass the phospholipid bilayer
-water soluble drugs require passage through channels or pores
First Pass Effect and Bioavailability
-percentage of drug broken down in liver
-bioavailability is the amount of drug left after first pass
-bioavailability of PO meds vary, bioavailability of IV meds are 100%
What are the three routes of absorption?
- Enteral: GI tract (EC/PO/SL/buccal/rectal)
2.Parenteral:
(SQ, IM, IV, Intrathecal, epidural)
- Topical/ Transdermal (eyes/ears/skin/nose/lungs)
why cant you give a patient a PO drug rectally?
they have a different bioavailability
Where do enteric coated medications break down?
the small intestine
Where do PO medications break down?
the stomach
what are some disruptions in medication distribution?
-decreased blood flow
-PVD
-abscesses
-tumors
What is the blood brain barrier (BBB)?
cells in capillary wall of brain with very tight junctions that prevent drug passage through
what kind of drugs can cross the blood brain barrier?
What else can cross the BBB?
-drugs that have a transport system
-drugs that are lipid-soluble
-alcohol
-glucose
think of how they affect mental state
what is the major organ/site for drug metabolism?
the liver
what is the major site for excretion?
kidney
kidney disease or dysfunction can cause decreased drug excretion, what does this lead to?
the drug can build up and cause toxicity
serum half-life (T 1/2)
time required for the serum concentration of a drug to decrease by 50%
-this dictates how often a drug is given and how far apart the dosing is
what is a “steady state”
when intake of a drug is equal to the amount of drug metabolized and excreted
-goal of elimination is having a steady state
onset of a medication
time it takes for drug to elicit therapeutic response
peak of a medication
time it takes for drug to reach its maximum therapeutic effect
duration of medication
time drug concentration is sufficient to elicit a therapeutic response
receptors
proteins that are located on cell surfaces
Agonist vs. Antagonist
Agonist: stimulates / activates
Antagonist: inhibits / blocks
(produces action by preventing other natural substances from binding)
Therapeutic Index
the measure of relative safety of drugs
Black Box Warning
required by the FDA for dangerous drugs
-strongest safety warning a drug can have while still being on the market
What are some high alert drugs?
Insulin
Heparin
Opioids
Injectable potassium chloride ( IV KCL)
Neuromuscular blocking agents
chemotherapy drugs
how can the nurse minimize drug interactions?
-minimize # of drugs patient receives
-thorough drug history
-vigilant monitoring of patients taking drugs with a narrow therapeutic index
Drug interactions that increase therapeutic effects
- Additive effects: 2 drugs w/ similar MOA
- synergism/potentiation: 2 drugs w/ different MOA but combined effect
- activation: decreases metabolism rate of drug
- displacement: displacement of one drug by second drug increases effect of displaced drug
Antidote
drug given to ANTAGONIZE the toxic effects of another drug
Older adults and pharmacokinetic consequences
-Hepatic Changes: drugs metabolize slower
-GI Changes: decreased absorption of oral drugs
-Cardiac/ Circulatory
-Renal Changes: drugs excreted less completely
Inflammation
-d/t cell injury
-protective mechanism
“-itis”
-Acute (<2wks) vs. chronic
Localized signs of inflammation
redness, swelling, heat, pain, loss of function
Two causes of inflammation
- Exogenous: external -> surgery, burns
- Endogenous: Internally -> tissue ischemia
chemotaxis
process by which neutrophils are attracted to inflamed tissue
types of inflammatory exudates
- Serous: water, mild inflammation
- Serosanguineous: pink tinged
- Purulent: severe inflammation w/ bacterial infection
- Hemorrhagic: lots of RBC, most severe
systemic manifestations of Cytokines IL-1, IL-6, and TNFa
*cytokines are responsible for systematic responses to inflammation
fever
increased neutrophils
lethargy
muscle catabolism
B-cells
-Humoral immunity
-two kinds: Memory cells and plasma cells
T-cells
-Cell-mediated (recognize antigens on surface of cells)
-part of adaptive defense mechanism
What are the five classes of antibodies?
- IgG: most common. protect against bacterial/viral infections
- IgM: for cytotoxic functions
- IgA: Secretory functions (saliva, tears, etc..)
- IgD: “B-cell helpers”
- IgE: against allergic reactions/parasites
Passive Immunity
-think breastfeeding
-transfer of plasma containing antibodies from immunized person to non-immunized person
Active Immunity
-vaccines
Types of vaccinations
- Traditional: inactive or killed organisms (flu shot)
- Attenuated: weakened but still live vax. (flu vax nasally) CANNOT give to people with weakn immune systems/underlying conditions
- Toxoids: inactive toxins (tetanus)
- Conjugate: H. Influenzae type B
- mRNA: newest
What is an infection?
colonization of a host by a microbial species
-can be localized or systemic
Virus caused infection
-cannot multiple without a host cell
-common
-DNA/RNA with protein shell
Bacteria caused infection
-single celled
-can reproduce inside or outside cells
-common
Fungal infection
-spore forming organism
-rare
Ex: yeast infection
Protozoa infection
-rare
-live in water
Ex: maleria
Helminths infection
-rare
-parasitic worms
Prions infection
-rarest
-only composed on proteins
Direct vs. Indirect transmission of infection
Direct: kissing, sex, direct contact from soil
Indirect: airborne, vehicle or vector borne
Vector vs. Vehicle borne transmission
Vector: something else is carrying the Dz. Ex: mosquitos ad ticks
Vehicle: carried by water, blood, food
Ex: Hepatits ??
Different portals of entry for organisms
1.Oropharynx and nasopharynx (airways, lungs, stomach, GI tract)
2. GU tract (UTI)
3. Skin (biggest vulnerability)
4. Translocation (movement of bacteria across intestinal lining)
5. Blood (needle-stick)
6.MAternal-Fetal Transmission
Stages of Infection
- Incubation Period
(organism entering body/multiplying) - Prodromal Stage
(pre-symptoms/not feeling well) - Acute Stage
(Full blown symptoms) - Convalescent Stage
(Dz getting better, feeling better)
5.Resolution Phase
(pathogen eliminated. Some never reach this phase, like chickenpox, why?)
The Infectious Process Steps
- injury
- increased permeability
- immigration of leukocytes
4.phagocytosis - exudate
- systemic symptoms
The Infectious Process: Injury
-initial insult to area occurs
-short period of vasoconstriction(why?)
-prolonged period of vasodilation (why?)
The Infectious Process: Increased permeability
-fluid pulled into vascular space
-fluid moves out of vessel to the place of injury
The Infectious Process: Immigration of Leukocytes
-neutrophils attracted to area of injury
The Infectious Process: phagocytosis
WBC’s recognize, engulf, and destroy invading organisms
The Infectious Process: Exudate
purpose of exudates are to transport the leukocytes to injured area, dilute toxins and transport nutrients for healing process
The Infectious Process: systemic symptoms
-can occur if infectious process does not stay localized
-stimulates hypothalamic fever set point
Colonization vs. Infection
-if an infection sticks around longer than a systemic infection it can turn into a colonization
-colonization: in a specific body site, no S/Sx present. Ex: staph Infection
-Infection: clinical S/Sx of illness/inflammation present, colonization can develop into infection
Nosocomial
Infections that occur within a healthcare facility
Drug resistant infections
-MRSA: METHICILLIN resistant staph aureus
-CRE: CARBAPENEM (class of Abx) resistant enterobacteriaceae
-MDRO: MULTI-DRUG resistant organism
what is a superinfection?
an new infection that occurs during treatment for a different infection
-Abx killing normal/helpful flora, then drug resistant pathogens cause superinfection
Ex: C-Diff
Cellular adaption
changes in the cells to permit survival & maintenance of cellular function
-cells can change size/form
Abnormal cellular changes can occur due to…?
radiation, medication, lack of oxygen
Atrophy of cells
-shrinking of cell size
-all atrophic cells have decreased function
-Physiologic: d/t developmental issue
-Pathologic: d/t environmental conditions
Hypertrophy of cells
-increased size of cell
-can increase function
-can also occur with Dz processes/negative effect
Hyperplasia of cells
-increase in # of cells d/t increased cellular devision usually in response to injury
-hyperplasia usually turns into dysplasia
Normal hyperplasia examples versus abnormal
Normal: pregnancy related changes, wound healing
Abnormal: BPH, thyroid hyperplasia, endometrial hyperplasia
Dysplasia cells
abnormal changes in size/shape/organization of mature cells.can be reversible
-can be precursor to cancer, BUT does not indicate cancer.
Metaplasia cells
-most associated with cancer
-allows cells to survive better in hostile environment, IS reversible
Neoplasm
irregular growth b/c of gene mutation
Anaplasia
cancer cells
-neoplasia and anaplasia used interchangeably
Cancer
uncontrolled cellular growth with rapid uncontrolled proliferation and loss of ability of cells to differentiation
Neoplasms: Benign vs. Malignant
Benign: more mature, stay in one spot, usually do not cause issues, usually encapsulated
Malignant: not mature cells, often metastasize, no capsule
Necrosis
cellular injury that can lead to cellular death d/t Dz, injury, or failure of blood supply.
-irreversible, can lead to gangrene
Liquefactive necrosis
in tissues with lots of lipids.
release of proteolytic enzymes
Dry Gangrene
-blackened/dry/wrinkled
-spreads slow
-has demarkation line
Wet Gangrene
-foul smell, can be systemic, liquefaction
-extensive bacterial infection
-cold, pulseless, swollen
-NO line of demarkation
Gas Gangrene
-anaerobic, spore forming
-destroys connective tissue
-gaseous bubbles
-w/ severe trauma / compound fractures
