Integrated Pathophysiology and Pharmacology Review (Lecture Notes)

Flashcards cover substance use disorders, CNS stimulants/depressants, sleep, cardiovascular pathophysiology, antihypertensives, diuretics, endocrine axes, aging, reproductive health, osteoporosis, dermatology/cancer pharmacology, ophthalmology/otolaryngology, pediatrics, neurology (seizures, MS, MG, ALS), obstetrics/neonatal care, and emergency/critical care pharmacology.

What is substance use disorder and how is it categorized?

A pattern of problematic substance use causing distress or impairment; categories range from mild to severe based on criteria (mild 2–3 criteria, moderate 4–5, severe 6+ in DSM-5).

Give one short-term and one long-term effect of drug use.

Short-term: euphoria, impaired judgment, sedation; Long-term: tolerance, dependence, organ damage, withdrawal risks.

What is the nurse's role in recognizing and promoting treatment for nurses with substance use disorders?

Early recognition, confidential, nonpunitive support; referral to treatment; monitoring for safety and relapse; advocacy for treatment while maintaining patient safety.

What are the CNS effects of stimulants?

Increased alertness/energy, heightened CNS activity; possible tachycardia, hypertension, anxiety, insomnia.

Name non-pharmacologic strategies to induce sleep.

Sleep hygiene, cognitive-behavioral therapy for insomnia (CBT-I), relaxation techniques, consistent sleep schedule, and optimized sleep environment.

Which common CNS stimulant is used in ADHD?

Methylphenidate—increases dopamine and norepinephrine activity in key CNS pathways.

What is a common sedative-hypnotic used for sleep initiation?

Zolpidem Tartrate (a non-benzodiazepine sedative-hypnotic).

Which hormone increases plasma volume by promoting water reabsorption in the kidneys?

Antidiuretic hormone (ADH, vasopressin).

Which hormone promotes sodium and water retention, increasing blood volume?

Aldosterone (a mineralocorticoid).

Which hormones promote sodium and water excretion and decrease blood volume?

Natriuretic peptides (ANP and BNP).

Name the key regulators of arterial blood pressure and plasma volume discussed in the notes.

RAAS, ADH, natriuretic peptides, and autonomic nervous system influences.

Differentiate primary vs secondary hypertension.

Primary hypertension is idiopathic; secondary hypertension results from another condition (e.g., renal or endocrine disorders).

What lipid values define CAD risk thresholds according to the notes?

Total cholesterol <200 mg/dL; LDL <100 mg/dL; HDL ≥60 mg/dL; Triglycerides <150 mg/dL.

What is the difference between a thrombus and an embolus?

A thrombus is a clot formed at its site; an embolus is a dislodged clot traveling to another location.

Which assessments are used to evaluate BPH as listed in the notes?

Digital Rectal Exam (DRE), Prostate-Specific Antigen (PSA), Transrectal Ultrasound (TRUS), and Post-Void Residual (PVR) measurement.

Name four antihypertensive drug classes mentioned in the notes.

Beta-adrenergic blockers, alpha-adrenergic blockers, angiotensin II receptor blockers (ARBs), and calcium channel blockers.

What are the three diuretic classes and their key electrolyte risks?

Loop diuretics (hypokalemia), Thiazides (hypokalemia), Potassium-sparing diuretics (hyperkalemia).

List key nursing considerations for diuretic therapy.

Administer in the morning; monitor daily weight, BP, electrolytes, kidney function; observe urine output; assess edema; monitor for orthostatic changes and cardiac rhythm; encourage potassium-rich foods (unless on potassium-sparing diuretics).

What is BNP used for in heart failure management?

BNP level relates to heart failure severity and response to therapy; higher BNP indicates greater HF burden.

What is the mechanism of action of alteplase (tPA) in ACS?

Dissolves clots by catalyzing conversion of plasminogen to plasmin, leading to fibrinolysis.

What are the two major categories of seizures?

Generalized seizures and focal (partial) seizures.

Describe the mechanism and a key nursing consideration for hydantoin (phenytoin).

Mechanism: Stabilizes neuronal membranes by blocking voltage-gated Na+ channels; consideration: narrow therapeutic index (10–20 mcg/mL) and gingival hyperplasia.

Describe the mechanism and a key nursing concern for barbiturates in seizure management.

Mechanism: Potentiate GABA-mediated CNS depression; concern: significant sedation, tolerance, dependence, respiratory depression.

What is the mechanism of succinimides and what seizures are they used for?

Inhibit low-threshold calcium currents in thalamic neurons; primarily used for absence seizures.

What is a major nursing consideration for benzodiazepines when used as antiseizure meds?

Rapid anticonvulsant effects but risk of tolerance/dependence; sedation; monitor for respiratory depression and taper gradually.

What is the mechanism and a key risk of valproic acid?

Multiple mechanisms including increased GABA; risks include hepatotoxicity, pancreatitis, weight gain, and teratogenicity.

What is the difference between general and local anesthesia as per the notes?

General anesthesia: systemic anesthesia with stages of anesthesia and various routes; major risks include respiratory and hemodynamic changes. Local/topical anesthesia: nerve conduction blockade at a specific site with fewer systemic effects; topical anesthesia is used for surface areas.

Describe the Hypothalamic-Pituitary-Thyroid axis.

Hypothalamus releases TRH → Anterior pituitary releases TSH → Thyroid produces T3 and T4; T3 is the active form; T4 is converted to T3 in tissues.

What are the pituitary hormones in the anterior pituitary (FLAT PiG)?

FSH, LH, ACTH, TSH, Prolactin, Growth Hormone (GH).

What hormones are released by the posterior pituitary?

Oxytocin and ADH (vasopressin).

Name the two major adrenal cortex hormones and their roles.

Glucocorticoids (cortisol) in stress/metabolism; Mineralocorticoids (aldosterone) in Na+/water balance and BP.

What are the clinical features of Alzheimer disease pathology?

Beta-amyloid plaques and neurofibrillary tangles; loss of cholinergic (ACh) neurons leading to cognitive decline.

What is the autoimmune target in myasthenia gravis?

Acetylcholine receptors at the neuromuscular junction; leads to decreased neuromuscular transmission and fatigable weakness.

What are the major motor syndromes described in neuroanatomy (CNS functioning)?

CNS motor, motor unit, pyramidal, extrapyramidal, cerebellar, upper and lower motor neurons with characteristic patterns of weakness, tone, and reflex changes.

Define negative and positive feedback in hormone regulation with examples.

Negative feedback: hormone release is inhibited by its end product (e.g., cortisol inhibits CRH/ACTH). Positive feedback: hormone release stimulates more release (e.g., oxytocin during labor).

What are the typical anterior pituitary hormones' targets and effects?

Trophic hormones regulate other glands (thyroid, adrenal, gonads); GH influences growth; Prolactin influences lactation.

What is the role of calcitriol and calcitonin in calcium homeostasis?

Calcitriol increases intestinal calcium absorption; calcitonin inhibits bone resorption to lower serum calcium in certain contexts.

What is the mechanism and key adverse effects of levothyroxine?

Synthetic T4; monitor TSH; take on an empty stomach; potential symptoms of hyperthyroidism if overdosed.

What are the prototype drugs listed for pituitary, thyroid, parathyroid, and adrenal disorders?

Levothyroxine, Calcitriol, Prednisone; Methimazole/PTU; Calcitriol (parathyroid), Calcitonin; Fludrocortisone (mineralocorticoid).

Explain the pathophysiology and clinical manifestations of polycystic ovarian syndrome (PCOS).

Elevated androgens, insulin resistance, chronic anovulation leading to irregular menses, hirsutism, acne, obesity, infertility; treated with lifestyle changes, CHCs, metformin, antiandrogens.

What is the Beers Criteria used for?

Identify potentially inappropriate medications for older adults to minimize adverse drug events.

Name two drugs used to manage benign prostatic hyperplasia (BPH) and their general actions.

5-alpha-reductase inhibitors (shrink prostate tissue) and alpha-adrenergic blockers (relieve dynamic obstruction by relaxing smooth muscle).

What are combined hormonal contraceptives (CHCs) considerations in nursing judgment?

Assess risk factors (smoking, HTN, migraines with aura, VTE), counsel on backup methods, monitor BP, teach signs of serious adverse events (ACHES).

What are the three broad cancer pharmacology categories in the notes?

Cytotoxic chemotherapy, targeted therapies (monoclonal antibodies, TKIs, mTOR inhibitors, proteasome inhibitors, angiogenesis inhibitors, etc.), and hormonal/antiandrogen therapies.

Name a few examples of targeted cancer therapies discussed.

Bevacizumab (angiogenesis inhibitor), Erlotinib (EGFR inhibitor), Imatinib (TKI), Rituximab (monoclonal antibody), Bevacizumab (also listed as monoclonal).

What are two classic eye drugs used in glaucoma treatment mentioned in the notes?

Latanoprost (prostaglandin analog) and Timolol (beta-blocker); both reduce intraocular pressure by increasing outflow and reducing production respectively.

Describe the normal blood flow sequence through the heart (valves and chambers).

RA to RV via tricuspid; RV to PA; PA to lungs; from lungs via pulmonary veins to LA; LA to LV via mitral; LV to aorta via aortic valve; systemic circulation.

What factors influence cardiac output (CO)?

Heart rate (HR) multiplied by stroke volume (SV): CO = HR x SV.

What is the pathophysiology of atherosclerosis leading to CAD?

Dyslipidemia and inflammation cause plaque formation, arterial narrowing, and reduced coronary blood flow, potentially causing ischemia or infarction.

List signs and management considerations for acute pulmonary embolism (PE) vs venous thromboembolism (VTE).

PE presents with SOB, chest pain, tachycardia; management includes anticoagulation to prevent ongoing clotting and, if massive, thrombolysis or surgical intervention.

What is the clinical use of digoxin in heart disease and key toxicity signs?

Cardiac glycoside used to improve contractility in heart failure; monitor apical pulse, potassium, and digoxin level (0.5–2 ng/mL). Toxicity signs: N/V, anorexia, fatigue; visual changes (yellow halos); bradycardia or arrhythmias.

Name the three major forms of shock and their basic pathophysiology.

Hypovolemic (low volume from fluid loss), Cardiogenic (pump failure), Distributive (vasodilation/capillary leak; includes septic, anaphylactic, neurogenic).

What are key signs of neonatal respiratory distress syndrome (RDS) and its management?

Tachypnea, grunting, nasal flaring, retractions, cyanosis; management includes exogenous surfactant via endotracheal tube, oxygen support, and possibly mechanical ventilation or CPAP.

What is the purpose and timing of Rho(D) immune globulin (RhoGAM) in pregnancy?

Prevents maternal anti-D formation; given at ~28 weeks gestation and within 72 hours after delivery of an Rh-positive infant (and after fetomaternal hemorrhage events).

What are the phases of a seizure (prodroma, aura, ictus, postictal)?

Prodroma: hours-days before; Aura: focal sensory phenomena preceding seizure; Ictus: actual seizure; Postictal: period after with confusion/fatigue.

What are the three phases of the clinical judgment nursing process model used for pharmacology chapters?

Recognize cues → Analyze cues → Determine hypotheses → Generate solutions → Take action → Evaluate outcomes.

Explain the roles of the kidney hormones (ADH, aldosterone, natriuretic peptides) in fluid balance.

ADH promotes water reabsorption; Aldosterone promotes Na+/water retention; ANP/BNP promote Na+/water excretion and lower BP.

How is COPD-related or age-related macular degeneration commonly described in pathophysiology terms from the notes?

AMD: central vision loss due to retinal degeneration; glaucoma: elevated intraocular pressure causing optic nerve damage.

What is the first-line drug class and key teaching points for topical ocular therapy such as latanoprost?

Prostaglandin analog to increase aqueous humor outflow; side effects include iris darkening and eyelash growth; administer at bedtime; avoid contact with the dropper.

What is the mechanism and a key safety note for tiolol-containing eye drops (timolol)?

Timolol reduces aqueous humor production; monitor for bronchospasm in asthma/COPD and check systemic absorption with proper lacrimal duct pressure after instillation.

What is the role of surfactant replacement therapy in neonates and how is it administered?

Exogenous surfactant administered via endotracheal tube to reduce alveolar surface tension and prevent atelectasis; rotate infant to distribute evenly.

Name the four mechanisms of hormone regulation discussed (negative/positive feedback, anterior/posterior pituitary roles).

Negative feedback (inhibits release when sufficient), Positive feedback (stimulates further release, e.g., oxytocin in labor); Anterior pituitary FLAT PiG; Posterior pituitary hormones (ADH, oxytocin).