APEA 3P Exam Study Guide - Core Principles

Vocabulary flashcards covering pharmacology, physical assessment, cranial nerves, hypersensitivity reactions, and lab interpretation patterns from Section 3 of the APEA 3P Exam Study Guide.

First-pass effect

The process where oral drugs pass through the liver first, which lowers bioavailability.

Low albumin impact on drug distribution

Low albumin means more free, active drug for highly protein-bound agents (warfarin, phenytoin).

Lipophilic drug duration in older adults

Older adults have more body fat, so lipophilic drugs last longer.

Hepatic CYP450 metabolism across age groups

Metabolism occurs mostly via hepatic CYP450; neonates and older adults metabolize more slowly.

Renal excretion drug adjustment

Excretion is mostly renal, requiring dose-adjustment by eGFR or creatinine clearance.

Steady state

Reached after $4$ to $5$ half-lives.

Narrow therapeutic index drugs

Warfarin, digoxin, lithium, phenytoin, theophylline, and levothyroxine.

CYP inducers

Drugs including Rifampin, carbamazepine, phenytoin, phenobarbital, and St. John's wort that lower levels of other drugs (warfarin, oral contraceptives).

CYP inhibitors

Drugs including Clarithromycin, erythromycin, azole antifungals, ciprofloxacin, amiodarone, grapefruit juice, cimetidine, fluoxetine, paroxetine, verapamil, and diltiazem that raise levels of other drugs (statins, warfarin).

Drugs to avoid in pregnancy

ACE inhibitors, ARBs, warfarin, statins, isotretinoin, valproate, methotrexate, tetracyclines, fluoroquinolones, and lithium due to teratogenic or fetotoxic effects.

Drugs/substances to avoid in children

Aspirin (Reye syndrome), tetracyclines under age $8$ (tooth staining), codeine and tramadol under $12$, honey under $1$, and OTC cough and cold products in young children.

Beers criteria drugs to avoid in older adults

First-generation antihistamines, other anticholinergics, benzodiazepines, glyburide, long-term NSAIDs, and muscle relaxants, which cause falls, confusion, hypoglycemia, and GI bleeding.

Standard physical assessment sequence

Inspect, palpate, percuss, auscultate.

Abdominal physical assessment sequence

Inspect, auscultate, percuss, palpate (the exception to the standard sequence).

Pediatric physical assessment order

Perform the least invasive assessment first (heart and lungs before ears and throat).

Deep tendon reflexes grading scale

Graded $0$ to $4+$ ($2+$ is normal).

Muscle strength grading scale

Graded $0$ to $5$ ($5$ is normal).

Pitting edema grading scale

Graded $1+$ to $4+$.

Murmur grading scale

Graded $I$ to $VI$ (a thrill starts at grade $IV$).

Cranial Nerve II (Optic)

Acuity, fields, and fundi.

Cranial Nerves III, IV, VI

Extraocular movements (CN III also controls pupil constriction and lid).

Cranial Nerve V (Trigeminal)

Facial sensation, chewing, and corneal reflex.

Cranial Nerve VII (Facial)

Facial expression and taste on the anterior two-thirds of the tongue.

Cranial Nerve VIII (Vestibulocochlear)

Hearing and balance.

Cranial Nerves IX and X (Glossopharyngeal and Vagus)

Gag, swallow, and uvula rise.

Cranial Nerve XI (Accessory)

Shoulder shrug and head turn.

Cranial Nerve XII (Hypoglossal)

Tongue movement.

Hypersensitivity type I

IgE-mediated immediate response; associated with anaphylaxis, urticaria, allergic rhinitis, and allergic asthma.

Hypersensitivity type II

Antibody against cells; associated with Rh incompatibility and hemolytic transfusion reaction.

Hypersensitivity type III

Immune complex-mediated; associated with lupus and post-streptococcal glomerulonephritis.

Hypersensitivity type IV

Delayed T cell-mediated; associated with contact dermatitis and the tuberculin skin test.

Microcytic MCV pattern

MCV under $80\text{ fL}$; associated with iron deficiency and thalassemia.

Normocytic MCV pattern

MCV $80$ to $100\text{ fL}$; associated with chronic disease, acute blood loss, and CKD.

Macrocytic MCV pattern

MCV over $100\text{ fL}$; associated with B12 or folate deficiency and alcohol.

Left shift (raised bands)

Indicates a bacterial infection.

BUN:creatinine over 20:1

Indicates a prerenal cause (dehydration, low perfusion).

AST:ALT 2:1 or higher

Indicates alcohol-related liver injury.

ALT higher than AST

Indicates viral hepatitis or fatty liver.

Primary hypothyroidism lab pattern

High TSH and low free T4.

Hyperthyroidism lab pattern

Low TSH and high free T4.