PathoPharm 1 Cumulative Final Exam

Schedule I

• High potential for abuse & dependance w NO medical acceptance

• EX: Peyote, Heroin, Cocaine, Marijuana

Schedule II

• High potential for abuse and dependence, with accepted medical uses.

• EX: Morphine, Oxycodone, Amphetamines, Fentanyl, Hydromorphone

Schedule III

• Low-Moderate potential for abuse and dependence w accepted medical uses

• EX: Aspirin (w codeine), Testosterone, Ketamine

Schedule IV

• Low potential for abuse and dependence, accepted medical uses

• EX: Ativan, Xanax, Diazepam, Lorazepam

Schedule V

• Low potential for abuse, accepted medical uses.

• EX: Codeine cough med (Robitussin)

Teratogenic Drugs

• Drugs that potentially harm the fetus

  • Category A = Safest

  • Category B-D = Gets progressively more dangerous

  • Category X = Greatest threat

Side effect

• Can be harmful OR therapeutic

• Not as damaging as adverse & usually stops using the drug

Adverse effect

• An undesirable and harmful effect that can occur due to the use of a medication —> discontinuation of the drug

• More severe than side effects

Anaphylaxis

A severe, life-threatening allergic reaction that requires immediate medical attention & can lead to respiratory failure, shock, or death

s/s of anaphylaxis shock

• Hypotension

• AMS

• SOB

• Angioedema r/t massive systemic release of histamine

• Increased BP & HR

Phlebitis

• Inflammation of the vein

Infiltration

Inadvertent administration of NON-VESSICANT(0.9% norm saline) solution into tissues surrounding the vein

s/s of infiltration

• Edema

• Erythema

• Cool to the touch

(improves w ice packs or heat pads & elevate)

Extravasation

Infiltration of vesicant (highly irritating/destructive) medication into tissues surrounding vein

s/s of Extravasation

• NECROSIS!!!

• Burning

• Redness

• Swelling

(stop infusion & notify HCP!)

CVC

Central Venous Catheter

When do we give a patient a CVC?

• A CVC is used as opposed to a peripheral IV because IVs can’t handle some medications so the central line is a better option due to the bigger vein

• Multiple incompatible meds due at same time

• TPN 

• Chemotherapy 

• Someone that needs labs drawn frequently

• Can stay in for 4-6 weeks

• Give highly vesicant solutions & watch out for bloodstream infections!!

Where are the veins that we can place CVC?

• Femoral

• Subclavian

• Internal jugular

What CVC site do we try to avoid r/t infection risk?

Femoral vein

What is a risk for any CVC we place in the chest/neck?

• PNEUMOTHORAX!! (collapsed lung)

  • s/s: absent lung sounds, dyspnea, decreased O2, pleuritic pain, & tracheal deviation)

• SOB

• Hypoxia

What situation would we insert an IO under?

• Life-threatening situation 

• Intraosseous or IO is only for 1 day and only used when PIV cannot be inserted (cardiac arrest situation)

TPN

Total Parental Nutrition

Overview of TPN

• Veins and arms cannot handle a TPN, need a central line (AKA Central Venous Access Device)

• Something is wrong w GI tract

• Change tubing q 24hrs

• Infusion pump & micron filter to prevent air emboli, micro-precipitates, and microorganisms from getting into patient's bloodstream

• Watch for HYPERGLYCEMIA

• HARD ON LIVER (check liver enzymes)

DNC

Do Not Crush

What meds are DNC?

• LA (long-acting)

• XR (extended-released)

• EC (enteric coated)

What is the sodium-potassium pump responsible for?

Maintains excess of Na+ ions outside of the cell & more K+ ions inside of the cell.

(Transports 3Na+ ions to the outside cell & 2k+ ions inside)

Sodium-potassium pump

What is resting membrane potential?

It keeps the inside of the cell more negative than the outside.

Nerve stimulates cell —> sodium channels open —> sodium rushes in = creates action potential

Why is energy needed for the sodium potassium pumps?

Low to high concentration (Na+ out, K+ in)

Process of Glycolysis (draw this out)

Glycolysis

O2 Present: Takes glucose & converts it to pyruvate first & then into Acetyl CoA

NO O2: Pyruvate —> lactic acid

Why is too much lactic acid bad for the body?

Disrupts the body’s normal pH balance that could lead to lactic acidosis

Process of Krebs cycle (draw this out)

ETC (Electron Transport Chain)

Creates BULK of ATP (net 36 ATP)

What cycles create the most ATP & what do they require?

Krebs Cycle & ETC

OXYGEN!!

What is apoptosis?

Planned cell death & safely removing old, damaged, or unnecessary cells w/o causing harm

What is an RBCs most important function?

Carry hemoglobin

What does hemoglobin do in the spleen?

• Breaks down as “heme” portion (iron) that moves into bile —> stool

• “globulin” portion (protein) —> recycled by the body

What is necrosis?

Unplanned cell death caused by poisoning, decreased perfusion to the site, & decreased O2 to the site

Process of Necrosis

The body doesn’t respond to the ruptured necrotic cells & so the cells that rupture aren’t cleared away by the macrophages

Explain the life of a cell

RBCs live 120 days —> signal that tells it’s time to die —> goes to spleen to break down

Functions for kidney, liver, & spleen

Kidney = Excretes

Liver = Metabolizes

Spleen = Recycles & destroys

Intrinsic

Warfarin

PT/INR

Warfarin

Extrinsic

Heparin

aPTT

Heparin

What are the 4 clotting factors of the liver?

II

VII

IX

X

What do pts w hepatic impairment indicate?

Impaired coagulation = EXCESSIVE BLEEDING!

Anticoagulants

Warfarin & Heparin

Antiplatelets

Aspirin & Clopidogrel

Who’s at risk for bleeding?

Anybody on anticoagulants, antiplatelets meds or liver failure

What are arterial clots mostly made of?

Platelets

What are venous clots mostly made of?

Fibrin

Arterial clot conditions

• Stroke

• Peripheral arterial occlusion

• MI

Venous clot conditions

• Pulmonary edema

• DVT

What meds can treat venous clots?

Anticoagulants (IV Heparin & PO Warfarin)

What’s heparin’s OD antidote?

Protamine sulfate

What’s warfarin’s & INR OD antidote?

Vitamin K

What foods should be avoided w Warfarin?

Grapefruit juice

What food should be consistent w Warfarin?

Vitamin K & green leafy veggies

DVT s/s

• ELEVATE

• Warm

• Edema

• Pain

• Blue-purple discoloration

Peripheral Arterial Clot s/s

• DEPRESS

• Cold

• Pale

• Pulseless

• Pain

Will go necrotic if we do not restore blood flow!

Anemia

MC from iron-deficiency

Treating mild anemia

Eating meat, fish, whole grains, dark leafy veggies, beans, & shellfish

Treating severe anemia

Give ferrous sulfate (and Vitamin C to help w iron absorption)

What are cautions when taking IV ferrous sulfate?

• Extravasation

• Black, tarry stool

• AVOID ANTACIDS!!

What is sickle cell disease?

A type of anemia that is autosomal recessive (MC in African-Americans & Mediterranean)

Pathophysiology of sickle cell disease

Hgb becomes crescent shaped —> decrease O2 delivery to tissues & clogs blood vessels (especially kidneys & brain)

How long does sickle cell RBCs stay in the body?

20 days

What’s the treatment for sickle cell disease?

HOP

• Hydrate (IVF 0.9 NaCl)

• Oxygen

• Pain meds

S/S of SCD

Vaso-occlusion (Stroke bc RBCs get stuck in vessels of brain, MI, Spleenomegaly, Pain, etc.)

What med do we avoid giving to SCD pts?

Meperidine bc it increases seizures & leads to renal failure

What organs associate w upper GI bleeds?

Esophagus, stomach, & duadenum

What organs associate w lower GI bleeds?

Anything below duodenum (colon, small/large intestines, etc.)

S/S of Hypoperfusion

• Hypotension

• Tachycardia

• Decreased urine

• Dizzy/Lightheaded/AMS/syncope

• Dyspnea

• Hypoxia

• Pale

• Clammy

• Cold extremities

How to stabilize GI bleed

• Lie pt supine, elevate legs (brings BP up.. helps return blood to the heart)

•  Oxygen therapy to maintain pulse ox

• IV fluids (NOT PO!!) - start 2 large bore peripheral IV 

• Insert nasogastric tube to extract blood and gastric secretions that can make the bleeding worse/promote infection or inflammation.

• Prevent hypothermia 

• Blood transfusion 

When do we admin blood transfusions?

If their blood is 7- 8g/dL

What clotting factor is missing in hemophilia A?

Clotting factor 8

What clotting factor is missing in hemophilia B?

Clotting factor 9

Tx for Hemophilia A

Desmopressin bc it releases VIII in the body

What is innate immunity?

ALWAYS PRESENT, READY TO FIGHT, RESPONDS IMMEDIATELY!!

First line of defense that protects against infections & ANY foreign substance in the body (ex: paper cut)

What is adaptive immunity?

NOT ALWAYS PRESENT! TAKES 7-10 DAYS TO BE ACTIVATED! “SHARPSHOOTERS”

For stronger & more protection against specific invaders

What do adaptive immunity produce?

• Humoral B-cells **antibodies to remember the pathogen for future**

• Cell-mediated T-cells **activates b-cells**

  • Cytotoxic T-cells (CD8)

  • Helper T-cells (CD4)

  • Memory B-cells

Process of innate immunity (5 steps) (ex: paper cut)

• Trauma & tissue damage trigger the inflammatory response & prostaglandin (AKA histamine & pain receptors) (erythema, edema, heat, and pain)

S1: Vasoconstricts to prevent blood loss

S2: —> Vasodilation to bring WBC to injury site

S3: —> Leukocytes go to capillary walls, then into tissue space

S4: —> Neutrophils & macrophages gobble up pathogens. Basophils, eosinophils, & mast cells contain histamine = more vasodilation & more WBCs to injury site

S5: —> (inactive protein, activated with damage) turns into fibrin “net” to make a stable blood clot

What are pyrogens?

Helps cause fever by released from macrophages when they are exposed to bacteria

What impact do pyrogens have on the body?

Travel to the hypothalamus (thermostat in the body) to turn the temp. up in the body to inhibit/limit bacterial growth

Are pyrogens good for the body?

Yes, bc it inhibits bacterial growth & promotes healing process

Are pyrogens bad for the body?

Yes, bc severe fevers can cause seizures (life-threatening)

Fever for immunocompromised

101.4°F

Function of spleen (5)

• RBCs go there to die

• Erythropoiesis (RBC production) happens in spleen

• Stores some blood & platelets in case

• Filters blood & traps antigens

• Produce T & B lymphocytes

Why do we give immunosuppressants?

To try to STOP the immune system from “over-reacting” to an antigen/allergic reaction or bc an organ transplant from another person

Drugs r/t causing immunosuppression

• Corticosteroids/Glucocorticoids (Prednisone0

• Cyclosporine

• Infliximab

• NSAIDs (not as strong as cortico.)

Naturally Active Immunity

natural exposure (ex: kids getting sick in school from contact) & then makes their own antibodies to never have the disease again (ex: chicken pox)

Artificial Active Immunity

Induced by vaccines

ex: after exposure to tetanus, botulinum, HBV, or rabies

Naturally Passive Immunity

Maternally passed down —> transfer of IgA antibodies found in breast milk

ex: mom to baby by feeding breast milk

Artifically Passive Immunity

Healthcare CREATED immunizations to prevent illness

ex: recovering serum/plasma from COVID-19 pts

Convalescent

Recovering

Stage 1 HIV s/s

Presents like almost any viral infection

• Fever, lymphadenopathy (swollen lymph nodes), pharyngitis (sore throat), rash, arthralgia (joint pain), and myalgia (muscle pain). “Worst flu ever.”

• High viral load but may or may not test positive for antibodies

• CD4 T cells count < 500 (normal: 800-1000)

• Transmissible

Stage 2 HIV-II s/s

Latency (may last years or decades with antiretroviral therapy (ART)

• Lymphadenopathy, may be asymptomatic, & will test positive for antibodies.

• CD4 T cell count < 200

Stage 3 HIV-III s/s

Profound reduction in immunity, high risk for infection, and increased risk for cancer

• ALL body systems are impacted: GI, respiratory, neuro, cardio, & skin.

• OI (opportunistic infections) occur 

• CD4 T cells count < 200

• Wasting syndrome (10% or greater unintended weight loss)

• AIDS related dementia

• Weakness and malaise (tired)

• Psychosocial: Anxiety, depression, body image.