pathopharm test 2

Neuro, respiratory, genomics

most common causes of seizures

brain trauma from injury, stroke or sodium imbalance

abnormal HTT assessment findings r/t seziures

asymmetrical rhythmic twitching, ALOC, disorientation, altered RR - depth and pattern, low SpO2, incontinence.

are all seizures treated the same

no, determining the type of seizure and triggers determines the meds used

what is an aura r/t seizures

a visual change/disturbance AND/OR physical (scent, sensation, sound) that appears as a PRECURSOR to a seizure

what is the post-ictal period

the period of time for a patient following their seizure

what to do if your patient has a sizure (4 do’s, 2 do not’s)

turn the patient to the side to keep airway clear, protect the patient from injury

loosen any restrictive clothing (around chest/neck), record start and end times of seizures

what not to do if/when your patient has a seizure

do not hold the patinet down and do not force anythring into the patient’s mouth

expected assessment findings during post-ictal period

sleepy, disoriented, headache, may not communicate verbally, may take hours to return to baseline (hours-days is common)

what are dangers that seizures can cause in everyday life

drowning, burns, falls from stairs or ladders, driving

what are seizures

sudden electrical firing of nuerons in the brian causing a change in function and ehavior.

what are common seizure triggers

alcohol, sleep deprivation, stress, light/patterns

what is epilepsy

a chronic disorder where repeated, unprovoked seizure activity occurs

pt education r/t seizure medications

meds must be taken EVERYDAY at SAME TIME → compliance is crucial

often more than one med is needed, and it is important to manage side effects (sometimes can’t drive bc of specific meds)

how long do you usually need to stay on seizure meds

for life

what is alzheimers disease

irreversible dementia caused by nerve cell death, loss of acetylcholine and brain atrophy

• loss of neurons = loss of synapses and Ach = brain atrophy

what are key physiological findings found in alzheimers disease

BETA AMYLOID PLAQUES - they accumulate outside of nuerons, thus interfering with nerve stimulation

TAU proteins accumulate inside neurons to form NEUROFIBRILLARY TANGLES - that interfere with conduction and cuase DEATH of neurons

Manifestations (S+S) of alzheimers disease

loss of short-term memory and denial of memory loss with eventual disorientatin, impaired abstract thinking

• progressive forgetfulness, disorientation, confusion, loss of problem solving and judgement, behavior changes - agitation, restlessness (with little/no emotional regulation)

what are manifestations of LATE STAGE (near EOL) alzheimer’s disease

non-verbal, non-ambulatory state with difficulty swallowing and eating

how do you diagnose alzheimers?

there are no biological markets, so confirmation is only with autopsy to see beta amyloid plaques and neurofibrillary tangles

• CT/MRI can provide some answers by helping R/O other causes

treatment/plan of care for pt with alzheimer’s

ensure safety (major fall risk), memory aids, maintaining unimpaired cognitive functions, maintaining or improving the general state of hygiene, nutrition and health (involve them in their ADLs), pharmacolgic treamtnets

do you try to reorient a patient with late-stage alzheimers

no, just be a caring and soft pressure and play into their reality

what can cause a decline in functioning for a pt in early stage alzheimers

a major event, hospitalization or injury can cause a patient to often have significant decline that never returns to the patient’s previous baseline

what is the medication prototype for alzheimers

donepezil, an acetylcholinesterase inhibitor

MOA for donepezil

it prevents the breakdown of acetylcholine, which increases the amount of Ach available and results in increased nerve impulses

SE of donepezil

nausea, diarrhea and slow heart rate (bradycardia)

how fast does donepezil work in the body

improvement of memory is seen in 1-4 weeks

what medication is used only for Moderate to Severe Alzheimers

memantine, a n-methyl0d0aspartate (NDMA) recpetor antagonist

what is the MOA for memantine

it blocks glutamate activity, so it can slow the progression of disease in moderate to severe alzheimers

what is the pathophysiology of Parkinson’s disease & what does it cause

the degeneration of basal ganglia, leading to DOPAMINE depletion (and relative excess of acetylcholine

• causes fine tremors, motor dysfunctinoo and coordination issues

what are the two types of Parkinson’s disease

primary = onset before age 40, common in men and is the progressive degenerative disorder of basal ganglia

secondary = Caused by external or known triggers, such as side effects from certain medications, head trauma, or vascular issues (strokes)

symptoms of Parkinson’s Disease

tremors (PILL ROLLING) in hands and fingers at rest

• tremors increase when fatigued

bradykinesia, abnormal slowness of movement, sluggish physical/mental responses, rigidity with jerky movements, shuffle steps w/ stooped position, blank facial expression with MASKLIKE FACES, loss of coordination and balence.

class + MOA for benztropine mesylate

ant9cholinergic that restores balance of neurotransmitters in the CNS to reduce the rigidity and tremors in patients with Parkinson’s

cautions/CI for beztropine mesylate

patients with angle closure glaucoma, myasthenia gravis or a bowel obstruction

SE of benztropine mesylate

disorientation, confusion, dry eyes and mouth, constipation (antichol)

evaluate for effectivess of benztropine mesylate

causes a decrease in parkinsonian symptoms (mask like face, rigidity, shuffle gait)

patient education for benztropine mesylate

address dry mouth, maintain good oral hygiene - drinking water frequently and use hard candy to stimulate salivation, rinse mouth

• if alertness is impaired, avoid use of machinery/cars

MOA of carbidopa/levodopa

levodopa increases the amount of DOPAMINE available in the CNS. Carbidopa prevents levodopa from being metabolized before it enters the CNS (allowing for lower dosages of levodopa to be administered to achieve the same effect)

cautions for carbidopa/levodopa

patients with cardiac, renal or psychiatric disorders

• recurrence of parkinsonian symptoms appears after a few years of levodopa therapy, so it is reserved for patients with significant symptoms

SE/AE of carbidopa/levodopa

depression, involuntary movements/dyskinesias, orthostatic hypotension

NC/pt education for carbidopa/levodopa

monitor for efficacy/relief of symptoms, change positions slowly (ortho hypo), do NOT administer with a high protein meal, take at regular intervals to maximize benefit, recurrence of parkinsonian symptoms appear after a few years → USE FOR PTS WITH SEVERE SYMPTOMS

S+S of ADHD (attention0deficit Hyperactivity Disorder)

easy distractibility, failure to receive instructions properly, inability to focus on one task at a time, difficulty remembering loss/misplacement of personal items, excessive talking or interrupting, inability to sit still, impulsiveness, sleep disturbance.

how ADHD affects life (not S+S)

affects friendships, causes self esteem issues, diminished social success

treatment basics of ADHD

about 70% of children with ADHD are treated with meds

pharmacotherapy = STIMULANT MEDICATIONS

self medicate → alcohol, drugs later in life

MOA of methylphenidate

activates the RAS in the brain, releases dopamine and norepinephrine → SYMPATHOMIMETIC

uses for methylphenidate

ADHD, narcolepsy, obesity treatment (helps bc stimulant = increased metabolism, and bc helps with satiation)

administration of methylphenidate

sustained release tablets must be swallowed whole

SE/AE of methylphenidate

increase HR, BP and liver toxicity

• high abuse potential → heavily regulated

what is bipolar disorder

aka manic depression, a condition with alternating episodes of mania and depression

S+S of mania r/t bipolar

inflated self esteem or grandiosity, decreased need for sleep, increased talkativeness, flight of ideas (changing topic frequently), distracted or increased goal-directed activity (esp with grandiose ideas), excessive involvement in pleasurable activities (shopping, sex, etc)

what is the general term for the class of meds used to treat bipolar

mood stabilizers

what classes of medications can be used to treat bipolar disorder

some anytiseizure drugs, some antipsychotic medications, lithium

why isn’t lithium used much anymore to treat bipolar disorder

it has a narrow therapeutic index so blood levels constantly need to be evaluated, like every 4-5 days, and if there is a overdose it requires hemodialysis and supportive care

class of olanzapine (zyprexa)

atypical antipsychotic

uses of olanzapine (zyprexa)

schizophrenia and bipolar 1 disorder , along with psychosis/delirium if indicated

MOA of olanzapine/zyprexa

binds to dopamine and serotonin receptors. It leads to a decrease in positive symptoms in patients, including hallucinations, delusions and disorganized speech, though and behavior (DECREASES PSYCHOSIS SYMPTOMS)

AE of olanzapine/zyprexa

drowsiness (most common), weight gain, DECREASED insulin sensitivity (monitor BG levels), can cause dopamine blockade = increased risk of dyskinesia and extrapyramidal symptoms (tongue clicking, eye twitch, other physical movements)

class of lithium

antischizophrenic, mood stabilizer, anti-inflammatory properties

uses of lithium

bipolar 1 disorder, adjunct for refractory depression in patients with mood disorders

MOA for lithium

not well studied, but increased inhibitory neurotransmitters and decreases excitatory neurotransmitters in the brain

AE of lithium

amount of salt in the body indfluences effects of this medication and it ca increase salt lsos from the body → causing electrolyte imbalences

• QT elongation (risk for V-tach_)

• hand tremor in 25-50% of pts

NARROW THERAPEUTIC INDEX = MONITOR FOR TOXICITY

• ringing of ears, loss of coordination, diarrhea, vomiting, serotonin syndrome

S+S of lithium toxicity

ringing of ears, loss of coordination, diarrhea, vomiting, serotonin syndrome (also confusion and disorientation)

patient education/NC for lithium

take at same time each day in morning, encourage salt-steady diet (do not use salt substitutes bc need Na in the body not K), drink plenty of fluids (avoid caffeine), educate of toxicity S+S, and constant checking of lithium levels

what is serotonin syndrome & what can it be caused by

high levels of serotonin the body, causing altered mental status

• can be from lithium toxicity, SSRI & MAOI medications

S+S of serotonin syndrome

AMS (altered mental status), hyperthermia, sweating, myoclonus/ocular clonus (rhythmic muscle twitching), rigidity (that can cause rhabdo bc extended period of use from being stiff), diarrhea, restlessness.

S+S of depression

difficulty sleeping (or excessive sleeping), feeling tired/fatigued, abnormal eating, inability to concentrate or make decisions, feelings of despair, guilt and misery/lack of self-worth, lack of interest in personal appearance/sex/doing hobbies, delusions or hallucinations

what are the different types of depression

situational (loss of job/loved one), postpartum, seasonal effective disorder, psychotic depression

what do antidepressants do / used for

to enhance/stabilize mood, may be prescribed for other disorders (phobias, panic, anxiety, etc)

what is the major BBW for all antidepressants

closely monitor adults and children taking antidepressants FOR WARNING SIGNS OF SUICIDE. weekly (or daily) checks are required until mood elevates → which can be up to 12 weeks.

• children and adolescents are at HIGHER RISK

what is a common side effect between antidepressants

weight gain

long long does it take for meds to cause full effects

several weeks

pharmacologic class of sertraline (zoloft)

SSRI - selective serotonin re-uptake inhibitor

uses of sertraline (zoloft)

for depression, social anxiety and obsessive-compulsive disorder

• has both antidepressant and anxiolytic properties

MOA of sertraline (zoloft)

prevents the reuptake of serotonin from the synapse, which leads to increased levels of serotonin → making people often feel better bc serotonin = feel-good neurotransmitter

administration of sertraline (zoloft)

abrupt discontinuation can cause withdrawal symptoms (nausea, sweating, agitation, tremors, seizures)

• BBW for suicide/worsening mental health

SE of sertraline (zoloft)

decreased libido (experienced by 70% of people on it), weight gain

class of buproprion (wellbutrin)

atypical antidepressant

uses for buproprion (wellbutrin)

used for treatment of depression and to assist in smoking cessation (r/t dopamine), off-label use for children with ADHD

MOA for buproprion (wellbutrin)

not well understood, known to inhibit the reuptake of norepinephrine and dopamine weakly.

SE/AE of buproprion (wellbutrin)

many, most notable = lowered seizure threshold (more likely to occur if you have epilepsy/seizure condition), worsening of suicidal ideation, weight loss

how long does wellbutrin (buproprion) take to take effect in the body

full effect is seen around 4 weeks.

what do MAOIs do

monoamine oxidase inhibitors terminate the action of neurotransmitters such as dopamine, norepinephrine and epinephrine

when is treatment with MAOIs indicated

because of their low safety margin, they are used only when SSRI’s or other meds have NOT WORKED !! (not first line medications)

what is the major food/drug interaction with MAOIs?

any foods with TYRAMINE

• a form of amino acid tyrosine, when taken with MAOIs - there is a sudden release of norepinephrine which leads to acute HYPERTENSION accompanied by stuff neck, HA, flushing, palpitations, diaphoresis and nausea

what foods have tyramine (to educate patients on MAOIs)

avoado’s, bananas, cheese, yogurt, alcohol, deli meats, raisins or papaya

class of methylprednisolone

corticosteriod

uses for methylprednisolone

anti-inflammatory, immunosuppressive (used for spinal cord injury!)

MOA for methylprednisolone

modifies protein synthesis in leukocytes, to inhibit leukocyte (WBC) infiltration at inflammation site, interfere with the function of mediators of inflammatory response and suppress humoral immune responses

AE of methylprednisolone

long term use → can cause Kaposi’s sarcoma = cancer

myopathy (muscle breakdown because decreased protein = decreased repair), impaired wound healing, osteoporosis, risk of INFECTION, HYPERGLYCEMIA, mood swings/irritability

risk factors for respiratory disorders

allergies, chest injury, crowded living conditions, exposure to chemical and pollutants, family history of infectious diseases, frequent respiratory illness, travel to foreign country, smoking, surgery, viral syndromes

what is pnenumonia (and its pathophysiology)

infection of the lower respiratory tract that causes:

• widespread inflammation in the lungs

• increased neutrophils

• T cells and B cells arrive, causing tissues to fill with debris and exudate

• microorganism release toxins and further damage the lung tissue

how does the inflammation r/t pneumonia worsen the condition

edema caused by inflammation stiffens the lung, thus decreasing lung compliance (ability of lungs to move) and vital capacity → causing HYPOXEMIA

what is pneumonia caused by

bacteria, viruses, fungi, protozoa or parasites

• can be from inhalation of microorganism

• aspiration of secretions/food (that can become infected over time)

what are three common types of pneumonia

community acquired, nosocomial, ventilator acquired (VAP)

community acquired pneumonia

MRSA, INFLUENZA!!!, streptococcus oneumoniae = most common

Nosocomial pneumonia

hospital acquired, r/t staphylococcus aureus & MRSA

Ventilator acquired pneumonia

subtype of nosocomial, d’t bacteria on bottom cuff of ET (endotracheal) tube

clinical manifestations (S+S) of pneumonia

URI (upper respiratory tract infection), fever, chills, PRODUCTIVE cough, pleural pain = dyspnea, hemoptysis, pulmonary consolidation (fluid in air sacs), inspiratory crackles, rhonchi and wheezing

how do you diagnose pneumonia

CXR - chest xray, looking for pulmonary consolidation/cloudy lung fields, elevated EBC, sputum cultres positive

what two general classes of medications are used to treat pneumonia

antibiotics, antivirals

most common cause of bacterial pneumonia and its treatment

streptococcus pneumonia

• treat with antibiotics