EXAM 1 Cumulative

Chapter 2 — General Assessment & Physical Parameters

• BP

  • numbers

  • measurements

  • measurement errors

• BMI

  • formula

  • numbers

  • risk

• Vital Signs

  • HR

  • RR

  • Measure

• General Assessment & ECA?

Blood Pressure

Numbers

Classification	Systolic	Diastolic
Normal	Below 120	AND below 80
Elevated	120–129	AND below 80
Stage 1 HTN	130–139	OR 80–89
Stage 2 HTN	≥140	OR ≥90

Blood Pressure

Measurement

• BP #

  • First Korotkoff sound = SBP.

  • Sound disappears = DBP.

• Deflating

  • No sound → sound → no sound as cuff deflates.

  • Deflation = 2–3 mmHg/sec.

• Person taking BP

  • Cuff bladder covers ≥80% of arm.

  • Record manual BP in even numbers.

  • Average ≥2 readings separated by 2 minutes.

• Patient

  • Rest 5 minutes.

  • No caffeine, nicotine, exercise within 30 minutes.

  • Arm at heart level, feet flat, back supported.

Blood Pressure

Measurement Errors

Error	Effect
Cuff too small	Falsely HIGH
Cuff too large	Falsely LOW
Arm below heart	Falsely HIGH
Arm above heart	Falsely LOW
Unsupported back/legs dangling	Falsely HIGH

BMI

formula

• BMI = kg/m²

BMI

numbers

BMI	Category
Below 18.5	Underweight
18.5–24.9	Healthy
25–29.9	Overweight
30–34.9	Obesity I
35–39.9	Obesity II
≥40	Obesity III

BMI

risk

• Waist risk: men >40 inches, women >35 inches.

• BMI can misclassify highly muscular patients.

Vital Signs

HR

Finding	Memorize
Normal HR	60–100 bpm
Bradycardia	Below 60
Tachycardia	Above 100

Vital Signs

RR

Normal RR	12–20/min
Bradypnea	Below 12 Opioid overdose → bradypnea.
Tachypnea	Above 20
Normal pulse strength	2+

Vital Signs

Measure?

• Regular rate = count 30 sec ×2.

• Irregular = count 60 sec.

General Assessment & Exam

General Assessment

• Alert/oriented ×3 = person, place, time.

• Cyanosis = blue, poor oxygenation.

• Pallor = pale.

• Jaundice = yellow, liver-related.

• Dysarthria = difficulty articulating words.

• Aphasia = difficulty with language.

• Uneven smile = possible stroke/Bell's palsy.

Exam - IPPA

• Inspection = LOOK (most used by pharmacists).

• Palpation = FEEL.

• Percussion = TAP.

• Auscultation = LISTEN.

Chapter 3 — Pain & Musculoskeletal

• Pain Origin

• Pain Classification

• Pain Assessment

• Musculoskeletal Disorders

  • Osteoporosis

  • RA vs. OA

  • Other Conditions

• Objective Assessment

Pain Origin

Type	Clue
Neuropathic	Burning, tingling, numbness
Somatic	Superficial tissue
Visceral	Internal organs

• Allodynia: normally painless stimulus causes pain.

• Hyperalgesia: exaggerated response to painful stimulus.

Pain Classification

Type	Clue
Acute	Short-term, may cause increased BP/HR
Chronic	Persistent/recurrent, physical signs may be absent

Pain Assessment

⭐⭐⭐ PQRST

Letter	Meaning
P	Palliative/precipitating factors
Q	Quality
R	Region/radiation
S	Severity
T	Temporal relationship

• Pain is subjective → patient report is the primary assessment.

• Numeric pain scale: 0 = no pain; 10 = worst imaginable.

Musculoskeletal Disorders

Osteoporosis

DEXA = measures bone mineral density; More negative T-score = lower bone density.

T-score	Classification
≥−1	Normal
between −1 and −2.5	Osteopenia
≤−2.5	Osteoporosis

Three osteoporosis diagnostic/treatment criteria (A patient needs to meet ONE of these criteria, not all three:)

1. Nontraumatic hip/spine fracture.

2. T-score ≤−2.5.

3. Osteopenia AND FRAX hip risk ≥3% OR major fracture risk ≥20%.

🚨 MEMORIZE: FRAX = 3% HIP / 20% MAJOR.

• FRAX estimates 10-year fracture risk.

• Common risk factors: postmenopause, older age, chronic steroids, smoking.

Musculoskeletal Disorders

RA vs. OA

RA	OA
Autoimmune inflammation	Cartilage deterioration
Morning stiffness >1 hour	Morning stiffness <30 min
Multiple small joints	Weight-bearing joints
Symmetric, generally	Often asymmetric
Swan-neck/boutonnière	Heberden/Bouchard nodules
RF may be positive	Crepitus

Musculoskeletal Disorders

Other Conditions

Condition	Key clue
Carpal tunnel	Median nerve, first 3½ digits, Phalen/Tinel
Gout	Sudden severe pain in one red/swollen joint
Bursitis	Inflamed bursa Fluid-filled sac that cushions joints
Tendinitis	Inflamed tendon Tissue connecting muscle to bone
TMJ	Jaw pain + clicking/popping
Strain	Muscle/tendon injury
Sprain	Ligament injury

Musculoskeletal Disorders

Objective Assessment

• ROM: abduction = away; adduction = toward.

• Muscle strength 5/5 = normal.

• CRP/ESR = inflammation markers; RF = associated with RA.

• ADLs = activities of daily living.

Chapter 4 — Cardiovascular & Peripheral Vascular

• Cardiovascular Risk

  • Hypertensive Crisis

  • Dyslipidemia

  • PREVENT Calculator

• Coronary / Heart Conditions

  • Ischemic Heart Disease (IHD)

  • Acute Coronary Syndrome (ACS)

  • Heart Failure (HF)

  • Arrhythmias

  • Valvular Disease

• Vascular Conditions

  • Peripheral Artery Disease (PAD)

  • VTE → DVT / PE

Cardiovascular Risk

Hypertensive Crisis

• BP ≥180/110 in slides.

• Markedly elevated BP = NO acute target-organ damage.

• Hypertensive emergency = YES acute target-organ damage.

Cardiovascular Risk

Dyslipidemia

High LDL/TG and low HDL = adverse lipid profile.

Cardiovascular Risk

PREVENT Calculator

Risk	Category
0–<3%	Low
3–<5%	Borderline
5–<10%	Intermediate
≥10%	High

Coronary / Heart Conditions

Ischemic Heart Disease (IHD) vs. Acute Coronary Syndrome (ACS)

1. Ischemic Heart Disease (IHD)

• IHD = CAD = CHD (same disease) - Chronic coronary plaque/narrowing

• Stable angina → Exertion, relieved by rest/nitro

• Prinzmetal angina → Coronary artery spasm, often at rest

2. Acute Coronary Syndrome (ACS) - Sudden coronary event

• Unstable angina → Pain at rest/worsening

• NSTEMI → Heart attack without ST elevation

• STEMI → Heart attack with ST elevation

  • ACS Symptoms

    • Chest → Crushing/pressure-like pain.

    • Spreads → Arm, jaw, back.

    • Sick → SOB, sweating, nausea/vomiting.

3. Diagnostic Tests

   • IHD → stress test; positive result may lead to angiogram.

   • ACS → ECG + cardiac enzymes (troponin, CK-MB).

Coronary / Heart Conditions

Heart Failure

Recognize these findings:

• Orthopnea = SOB lying flat.

• PND = waking up suddenly with SOB.

• Bilateral pitting edema.

• JVD/HJR = fluid overload.

• Crackles and S3 gallop.

ECHO = primary diagnostic test.

EF	Classification
≤40%	HFrEF
≥50%	HFpEF

NYHA classes

• I = No activity limitation.

• II = Symptoms with moderate activity.

• III = Symptoms with ADLs.

• IV = Symptoms at rest.

🚨 Lab numbers: Your professor said to know BNP/pro-BNP numbers. This is one change from my previous cram sheet.

• BNP >100 pg/mL → warrants HF evaluation.

• NT-proBNP thresholds on slides:

  • Under 50 years: >450.

  • 50–75 years: >900.

  • Over 75 years: >1800.

I'd memorize BNP 100 first, then review the three proBNP age thresholds.

Coronary / Heart Conditions

Arrhythmias

• Irregular heart rate/rhythm.

• Palpitations, dizziness, syncope.

• ECG/Holter monitor.

Coronary / Heart Conditions

Valvular Disease

• Stenosis = valve has difficulty opening.

• Regurgitation = valve doesn't close properly.

• Murmur = characteristic finding.

• ECHO = diagnostic test.

Vascular Conditions

Peripheral Artery Disease (PAD)

• Intermittent claudication = leg pain with walking, relieved by rest.

• Critical limb ischemia = severe ischemia with pain at rest.

• Weak peripheral pulse, cool skin, hair loss, poor capillary refill.

ABI = ankle SBP / brachial SBP

ABI	Meaning
1.0–1.29	Normal
0.91–0.99	Borderline
≤0.90	PAD
Below 0.40	Severe

Vascular Conditions

DVT vs. PE

DVT	PE
Usually unilateral swelling	Sudden SOB/dyspnea
Leg pain + warmth	Chest pain/tightness
May have redness	May have tachycardia/tachypnea
Duplex ultrasound	Spiral CT or V/Q scan

• VTE = DVT + PE.

• D-dimer = clot-related blood test used in evaluation.

• Warfarin → INR monitoring.

• HF swelling usually bilateral; DVT usually unilateral.

Chapter 1 — Patient Assessment Process, Health & Medication Histories, SOAP Notes, TBL

• Patient Assessment Process

  • Patient Care Process

  • Pharmacist's Role

• Health & Medication Histories

  • Subjective vs. Objective

  • QuEST — Self-Care Assessment

  • MAC

  • Health History Components

    • SCHOLAR — HPI

• SOAP Notes

  • SOAP

  • Medication Therapy Problems

• TBL

Patient Assessment Process

Patient Care Process

Step	Meaning
Collect	GET information
Assess	THINK / identify problems
Plan	PICK treatment
Implement	DO
Follow-up	CHECK

• Throughout: Collaborate + Communicate + Document.

• Center: Person-Centered Care.

Patient Assessment Process

Pharmacist's Role

Ensure medication therapy is:

• Safe

• Effective

• Indicated

• Convenient

• Economical

Main goal: Identify, resolve, and prevent medication-therapy problems.

Health & Medication Histories

Subjective vs. Objective

• Subjective - Patient/caregiver TELLS you

  • PMH → Subjective for THIS CLASS, even when documented in the chart.

• Objective - Measured, observed, or verified

Health & Medication Histories

• Patient says they miss doses →

• Fill history shows late refills →

• Patient says they miss doses → Subjective.

• Fill history shows late refills → Objective.

Health & Medication Histories

QuEST — Self-Care Assessment

Letter	Meaning
Q	Quickly and accurately assess patient
E	Establish appropriate self-care candidate
S	Suggest appropriate self-care strategies
T	Talk with patient

Health & Medication Histories

Health History Components

• CC = Chief Complaint → Patient's main concern, in their own words.

• HPI = History of Present Illness → SCHOLAR.

• PMH = Past Medical History → Current/past conditions.

• Family Hx = Parents, siblings, children.

• Social Hx = Alcohol, smoking, drugs, diet, exercise.

• ROS = Review of Systems → Other patient-reported symptoms.

Pertinent negative = Important symptom the patient denies.

Health & Medication Histories

SCHOLAR — HPI

Letter	Meaning
S	Symptoms
C	Characteristics
H	History
O	Onset
L	Location
A	Aggravating factors
R	Remitting factors

• Characteristics = Bulk of SCHOLAR, according to your professor.

• SCHOLAR information belongs in HPI.

Health & Medication Histories

MAC

• M = Medications (Rx, OTC, supplements).

• A = Allergies.

• C = Conditions.

Medication history should also cover -

• indication, dose, schedule, duration,

• effectiveness, adverse reactions, and adherence.

SOAP Notes

Section	Meaning
S — Subjective	Patient/caregiver reports
O — Objective	Measurable/observable data
A — Assessment	Analyze S + O; identify problems Include goal of therapy; Use relevant supporting information. NO NEW information in Assessment.
P — Plan	Pharmacologic recommendations. Nonpharmacologic recommendations. Monitoring. Specific follow-up timeframe.

SOAP

Medication Therapy Problems

INDICATION

• Unnecessary medication therapy

• Needs additional medication therapy

EFFECTIVENESS

• Ineffective medication

• Dosage too low

• Needs additional monitoring

SAFETY

• Adverse medication event

• Dosage too high

• Needs additional monitoring

ADHERENCE

• Adherence/non-adherence

• Cost