Patho Pharm Exam 1

Patho and Pharm through Winona State University, semester 1, exam 1. Professor Jolly

Locus

specific region on a chromosome

Chromosome Aberration

Euploidy, Polyploidy, Triploidy, Tetraploidy, Aneuploidy

Euploidy

normal amount of chromosomes, 46 chromosomes, 23 pairs.

Polyploidy

2+ complete sets of chromosomes, ex. Liver and rapid cell division. Triploidy: 3 copies, usually stillborn or miscarriage. Tetraploidy: 92 chromosomes, 10% miscarriages.

Aneuploidy

gained or lost chromosomes

Down Syndrome (3 #21)

low nasal bridge, epicanthal fold, protruding tongue, low ears, 20-70 IQ, aneuploidy

Klinefelter (XXY)

aneuploidy, long legs, broad hips, gynecomastia, less hair, small testes, less muscle, infertility

Turner Syndrome (XO)

aneuploidy, short, wide chest, lymphedema, webbed neck, moles, infertility

Single Gene Disorders

Autosomal Dominant, Autosomal Recessive, X-linked Dominant, X-linked Recessive

Autosomal Dominant

disorder is expressed when dominant gene is present. 50% offspring chances

Autosomal Dominant Disease

Huntington’s

Autosomal Recessive

25% offspring will express this disease, presented when both recessive disease genes are expressed.

Autosomal Recessive Disease

Cystic Fibrosis

X-Linked Dominant

in both genders, males usually do not survive. If male survives and has a daughter, then the daughter will have the disease.

X-Linked Dominant Disease

Rhett Syndrome

X-Linked Recessive

the environment can trigger this

X-Linked Recessive Disease

Duchenne Muscular Distrophy

Epigenetic

study of changes in gene function. Behavior and environmental switches the genes on and off. DNA Methylation and Histone Modification

DNA Methylation

methyl groups attach to DNA making it unreadable. Normal: only reading one female X chromosome. Abnormal: cancer, or triggered by unhealthy lifestyle.

Histone Modification

methyl group attaches to a histone, so the wrapped DNA in the histone can not be read. Usually abnormal.

Inherited From Father, 4 Million invisible base pairs. Short, Hypotonia, Small appendages, obesity, mild intellectual disabilities.

Prader-Willi Syndrome

Inherited from mother, 4 million invisible base pairs, seizures, atoxic gait, uncontrollable laughter, severe intellectual disability

Angelmann’s Syndrome

tumor suppressing genes become invisible, BRCA 1 and 2 being methylated

Breast Cancer

Environmental Factors For Methylation

Nutrition: pre and post natal, alcohol, high-fat diet, no microbiome diversity, grilled/charred foods, smoking, UV radiation, pesticides, phthalates, stress, lack of sleep, lack of exercise, parenting

Pharmacology

Pharmakinetics, Pharmacodynamics, Pharmacotherapeutics, Toxicology, Pharmacognosy

Study the movement of medications

Pharmacokinetics

How medications interact with our bodies

Pharmacodynamics

Whats expected of the medication

Pharmacotherapeutics

How medications hurt people, side effects

Toxicology

Study of herbs and natural medications

Pharmacognosy

Selectivity

the more selective a drug is, the less side effects it will have, but nonselective drugs have less intense side effects

7 Rights

Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation, Right Reason

Black-Box Warnings

typical side effects, or drugs that do not pair. FDA set standards. Ex. Levaquin ruptures tendons.

Drug Name

chemical name, generic name, brand name

Pharmacokinetics

channels/pores, transport systems (push with bloodstream), passive transport/diffusion

What Affects Absorption

rate of dissolution, surface area, blood flow (albumen), lipid solubility, route

Tablets

take about 60-90 minutes, if enteric coated then 2 hrs. Sustained release are beads that have a shell, take 12-24 hrs.

First Pass Effect

the medication is broken down by enzymes in the liver, making the dosage less. The better enzymes work, the less bioavailability the medication has.

High Protein Bound Medications

these attach to albumen, making them less free-floating thus usually being excreted with albumen. They kick less protein bound medications off of albumen.

Metabolism

liver break down of a drug

Excretion

kidneys filter and pee out the medication

Peak

this it the maximum amount of medication the body absorbed

Trough

this is considered the half-life of a medication. Taken right before the next prescribed dose.

Therapeutic Levels

Once the half-life finally plateaus

Loading Dose

giving an extra medication so that you don’t have to wait for the therapeutic effect. The side effects of this is its less monitored and could be toxic.

Therapeutic Range

the amount between the peak and trough

Innate Immunity

immunity and cells you are born with, non-specific. Includes inflammation

WBCs

2nd line of defense. Mast cells: allergies, Platelets, Neutrophils: first cells to help, Macrophage/Monocyte: eating and clean up, Basophils, Dendritic cells.

1st Line of Defense

skin, eyelashes, lung lining, gastric acid, tears, saliva, earwax. gut, nose, mouth

Chemotaxis

the migration of WBC

Signs of Acute Inflammation

rubor, calor, tumor (swelling), dolor (pain), functio laesa

Why is Inflammation Good?

prevents invader growth and infection, it also alerts to an injury.

Complement System

30 proteins that are produced by the liver to intensify antibodies, enhance clotting, enhance phagocytosis, and signal neutrophils to bacteria. These proteins can alert and poke holes in bacteria membranes.

Clotting System

Contains extrinsic pathway (external damage) and intrinsic pathway. Needs Ca to clot, so the thrombin from clotting can activate the compliment system.

Acute Inflammation

8-10 days from onset to healing. Local Signs: warm, redness, pain, exudate (blood, serous, fibrinous, purulent drainage)

Systemic Manifestations of Acute Inflammation

fever: interleukins tell hypothalamus, leukocytosis: increased WBC and neutrophils, plasma protein synthesis: RBCs fall fast in ESR and CRP increased w/ liver chemical activation

Chronic Inflammation

more than 2 weeks, abnormal scarring, localized signs, granulomas (macrophages surround and harden around foreign objects)

1st Phase of Wound Healing (seconds-minutes)

Homeostasis: vasoconstriction and dilation, followed by clotting to keep in blood

2nd Phase of Wound Healing (minutes)

Inflammation: to heal and get rid of bacteria

3rd Phase of Wound Healing (3-4 days)

Proliferation: new blood vessels (angiogenesis) brings nutrients to new cells. Granulation and fibroblast activation.

4th Phase of Wound Healing

Remodel and Maturation: scar tissue with rigid barrier.

If the wound doesn’t heal?

Ischemia, bleeding, fibrin, predisposing disorder, obesity, infection, inadequate nutrition, drugs, tobacco, poorly controlled diabetes, lack nutrients and oxygen

Bad Scars

keloids: excessive scar tissue, hypertrophic scar, fibrous adhesions (something that moves is attached to something static), dehiscence ulcer.

Do meds go to the Mother?

fetal blood has poor albumen, the placenta is fatty, cant cross to placenta if ionized/polarized.

Pregnancy

slower GI time, increased blood to kidney, increased metabolism in liver

Tetratogens

anything ingested by a pregnant woman that can affect the baby creating gross anatomical abnormalities

PLLR

(Pregnancy and lactation labeling rule), risk summary, clinical considerations, and data proof. Provides information for HCP and patients

Dangerous Meds While Pregnant

pump and dump, switch medications, avoid long half-lives, take med right after breastfeeding

Pediatrics

irregular GI tract, thinner skin, slow metabolism in liver, decreased blood to kidney, immature blood brain barrier, immature albumen, less stomach acid. 80% water for infants

Administering Meds to Pediatrics

calculate by body weight and larger body surfaces. Once meds are swallowed, never readminister. Never stop a prescription!

Elderly (65+)

less protein and water, decreased liver metabolism, permeable blood brain barrier, decreased blood to kidney (check with a GFR or BUN)

Elderly Meds

Make up 18% of pop, but take 40% of prescription and OTC medication. 90% take at least 1 medication.

PolyPharmacy

drug interactions; compatibility, dispensing errors, unnecessary prescriptions, non-compliance

Noncompliance With Meds

Intentional: multiple meds, no schedule, no reminders, other financial responsibilities, blown off education and instructions

Unintentional Noncompliance

impaired memory, can’t open packaging, side effects outweigh medication, low income, lack education

3rd Space Fluid

fluid shifts to body cavities, very little fluid.

Osmotic Forces

pull water with electrolytes (Na, glucose, K)

Oncotic Forces

pull water with proteins (albumen)

Hydrostatic Forces

push water, filtration, BP in arteries.

Edema

there is a drop in osmotic forces due to lack of Na, water hydrostatically leaves the bloodstream and goes towards the cells. This increased permeability in capillaries.

Isotonic Fluid Loss

patient loses Na and water in BALANCE. Decreased output and BP, dry mucous membranes and skin. Cause: sweating, bleeding, low fluid intake

Isotonic Fluid Gain

too much IV fluids, high cortisone, hypertension, edema, dyspnea

Hypertonic Imbalance

excess Na in diet, kidney disease, loss of water, concentrated blood.

Hypotonic Imbalance

drinking too much water, diluted blood, not enough Na in diet, diarrhea

Hypovolemic Hyponatremia

lots of lost Na and a little water. cause is diarrhea or vomiting

Hypervolemic Hyponatremia

increased Na and water retention, why CHF patients can’t have excess salt.

BMP (basic metabolic panel)

glucose, Ca, K, CO2, Cl, BUN, creatine

CMP (comprehensive metabolic panel)

protein, glucose, Ca, K, CO2, Cl, BUN, creatine, GFR, liver function

Na

levels 135-145 MEQ/L

Hypernatremia

high Na, seizures, flushed skin, restless, tachycardia

Hyponatremia

diuretic use, excess water, kidney failure, vomiting, diarrhea. Hypotension, seizures, limp limbs, lethargy

K; relationship with blood pH, Na, insulin, and directly with Mg.

levels 3.5-5 MEQ/L

Hypokalemia

not eating K, diarrhea, Mg loss, diuretics, alkalosis shoves K into cells. Muscle spasms, twitching, dampened T- wave, paresthesia, depression, anxiety,

confusion

Hyperkalemia

excess K, kidney failure, K sparring diuretic. Free floating H move to cells and take over in acidosis. Muscle weakness, paresthesia, lethal Rhythms (Peaked T wave)

Ca

levels 8.8-10.5 MG/DL

P

levels 2.5-5 MG/DL

Hypocalcemia

‘not taking Ca or Vit. D, kidney disease. Muscle spasms (chvostek’s), twitching, lethal Rhythms (Dampened T- wave), paresthesia , depression, anxiety, confusion

Hypercalcemia

excess Ca, Vit. D, or bone cancer. Muscle weakness, paresthesia, lethal Rhythms (Peaked T wave), Kidney stones

Mg

levels 1.8-2.6 MG/DL

Hypomagnesemia

abdominal surgery cant metabolize, malnutrition, alcohol. Muscle spasms, twitching, lethal T-wave dampened, paresthesia, depression, anxiety, confusion