Pathopharmacology Exam 1 Official Study Guide

Traditional NSAIDs

Medications that work by inhibiting prostaglandin synthesis to reduce pain, fever, and inflammation.

Aspirin

Used for pain, fever, inflammation, and as an antiplatelet for MI/stroke prophylaxis.

Nursing: Monitor for ototoxicity (tinnitus) and GI bleeding. Avoid in children with flu-like symptoms due to Reye’s syndrome.

Indomethacin

Used for arthritis, gout, and PDA closure in infants.

Nursing: Black box warning for cardiac risks (MI, stroke) and GI bleeding. Give with food or milk

shuts the DOor on the ductus

Ibuprofen

Used for general pain, fever, and inflammatory disorders.

Monitor renal function (BUN/Creatinine) and check for peripheral edema.

IBU i beat up inflammation

Meloxicam

Used primarily for chronic joint pain like OA and RA. inhibits COX1 and COX2

Monitor for hepatic failure (jaundice) and serious skin reactions like Stevens-Johnson Syndrome. risk of GI bleeding

Celecoxib

Selectively inhibits COX-2, which helps reduce GI side effects compared to traditional NSAIDs.

Nursing: Black Box Warning for serious cardiovascular thrombotic events (MI, stroke). Avoid in patients with sulfonamide allergies

Prednisolone

Corticosteroid that suppresses inflammation and immune response.

Nursing: Monitor for hyperglycemia and hypokalemia. Must taper off over 5–10 days to prevent adrenal crisis.

Infliximab

A monoclonal antibody that neutralizes TNF-α for conditions like Crohn’s and RA.

Nursing: Black Box Warning for fatal infections; patients must be tested for TB before starting.

Colchicine

Used for acute gout flares and prevention.

Nursing: Monitor for toxicity (numbness, weakness, severe N/V/D). Increase fluids to 2000 mL/day.

Cuts off leukocyte production, decreasing inflammation

Allopurinol

Reduces uric acid synthesis for chronic gout

Nursing: Discontinue immediately if a rash develops (hypersensitivity). Avoid purine-rich foods (organ meats, beer).

Acetaminophen

Used for pain and fever; works in the CNS, not the periphery.

Nursing: Hepatotoxicity is a major risk; limit dose to 4 g/day. Acetylcysteine is the antidote for overdose.

Sumatriptan

Causes cranial vasoconstriction to treat acute migraines.

Nursing: Monitor for Serotonin Syndrome (tremors, fever, hypertension) and chest tightness.

Amoxicillin

Broad-spectrum antibiotic; binds to bacterial cell walls to cause lysis.

can decrease effectiveness of hormonal contraceptives

Penicillin G

Natural penicillin used for respiratory infections and syphilis.

Nursing: Black Box Warning: benzathine must NEVER be given IV (IM only).

Cefazolin/Cephalexin (1st Gen)

Cephalosporin antibiotic often used for surgical prophylaxis.

Ceftriaxone (3rd Gen)

Broad spectrum antibiotic; resistant to beta-lactamases.

do not mix with calcium

Vancomycin

Used for MRSA and C. diff (oral form).

Nursing: Monitor for Red Man Syndrome (slow infusion to >1 hr). Risks include nephrotoxicity and ototoxicity.

reye’s syndrome

A potentially fatal condition that causes swelling in the liver and brain, often associated with the use of aspirin in children recovering from viral infections.

ASPIRE

A nti platelet

S welling ↓

P ain ↓

I nflammation ↓

R educes fever

E nteric-coated caution

stevens johnson syndrome

A serious skin reaction characterized by the detachment of the epidermis, often triggered by medications, infections, or allergens.

selective cox 2 inhibitors

A class of nonsteroidal anti-inflammatory drugs (NSAIDs) that selectively inhibit the cyclooxygenase-2 enzyme, reducing pain and inflammation while minimizing gastrointestinal side effects.

nonselective cox inhibitors

A class of nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit both cyclooxygenase-1 and cyclooxygenase-2 enzymes, providing pain relief and anti-inflammatory effects but increasing the risk of gastrointestinal side effects.

Acetylcysteine

antedote for tylenol overdose

serotonin syndrome

agitation, confusion, rapid heart rate, and muscle rigidity can be caused by sumatriptan (anti migraine) mixed with SSRIs

prophylaxis

the process of preventing disease or complications by administering medication or taking proactive measures.

red man syndrome

an adverse reaction characterized by flushing, rash, and hypotension after rapid infusion of vancomycin.

Fat soluble

vitamins D E and K are ___

Vitamin K

is essential for the synthesis of clotting factors and can ANTAGONIZE the anticoagulant effect of warfarin if intake is increased.

Vitamin D

is synthesized in the skin upon exposure to UV radiation and is essential for calcium absorption.

deficiency causes rickets in children, osteomalacia in adults, common bone fractures

Vitamin E

Protect cellular components from being oxidized, Protect RBCs from hemolysis

water soluble

Vitamins B and C are ____

Vitamin B 12

essential for DNA synthesis, comes from meat, fish, poultry, dairy, eggs

deficiency can cause weakness, anorexia, memory loss, mood changes, psychosis

vitamin C

aids in absorption of iron and conversion of folic acid

comes from fruits and vegtables

deficiency resulys in poor wound healing

iron

Used in the treatment and prevention of anemia and for nutritional supplementation

Food sources: Liver, lean meats, egg yolks, dried beans, spinach, fruit

Deficiency: Anemia, fatigue, weakness, shortness of breath, pallor, GI bleeding

bleeding risk

ginseng, garlic, gingko, chamomile, saw palmetto

st john’s wort

an herbal supplement used for treating depression and mood disorders. It may interact with various medications, reducing their effectiveness.

epinephrine

Class: Adrenergic Agonist.

Action: Stimulates alpha and beta receptors; increases vasoconstriction, blood pressure, heart rate, and cardiac output; promotes bronchodilation.

Indication: Anaphylaxis, anaphylactic shock, bronchospasms, status asthmaticus, and cardiac arrest.

Side Effects/Adverse Reactions: Hypertension, tachycardia, palpitations, and nervousness.

albuterol

adrenergic agonist (Beta 2)

promotes bronchodilation by relaxing bronchial smooth muscle

side effects are tachycardia, tremors, palpitations

monitor HR and breath sounds

bethanechol

cholinergic agonist

stimulates cholinergic receptors to increase bladder contraction and GI motility to treat urine retention

Side effects are GI distress, bradycardia, increased secretions

Contraindicated in Asthma because it can cause bronchoconstriction

atropine

Cholinergic Antagonist (Anticholinergic).

BLOCKS ACETYLCHOLINE

Action: Increases heart rate, promotes pupil dilation, and decreases salivary/gastric secretions.

Indication: Bradycardia and pre-operatively to dry secretions.

Side Effects/Adverse Reactions: Dry mouth, blurred vision, urinary retention, and constipation.

Nurse Considerations/Teaching: Contraindicated in Glaucoma as it increases intraocular pressure.

adrenergic therapy

mimick the actions of the sympathetic nervous system

catecholamines

are a class of drugs that include epinephrine, norepinephrine, and dopamine, which are used in adrenergic therapy to stimulate the sympathetic nervous system. usually given IV

noncatecholamines

a class of adrenergic drugs that mimic fight or flight and are usually given orally and last longer than catecholamines, which trigger fight or flight. example is albuterol

A1

mediates vasoconstriction and increases peripheral resistance to increase BP

A2

inhibits neurotransmitter release and causes a decrease in sympathetic outflow, reducing blood pressure.

B1

stimulates heart rate and contractility, leading to increased cardiac output and heart rate

B2

causes bronchodilation and vasodilation and decreases peripheral resistance, contributing to reduced blood pressure.

epinephrine

activates A1 B1 and B2 receptors

epinephrine

contraindications are cardiac arrythmias, narrow angle glaucoma, hypertension

albuterol

activates B2 receptors

B2

adrenergic receptor subtype, primarily found in bronchial tissues, mediates bronchial dilation and smooth muscle relaxation.

cholinergic therapy

medications that affect the parasympathetic nervous system

bethanechol

parasympathomimetic that mimics acetylcholine, promotes urination and bowel motility

bethanechol contraindications

the drug is a direct cholinergic (parasympathomimetic) agonist

Contraindications include recent surgery on the bladder or bowels, bradycardia, hypotension, asthma

Monitor I and Os, adventitious breath sounds

atrophine

 parasympatholytic, blocks acetylcholine, result is increased HR and CO. used to treat overactive bladder and bradycardia, can also be used to dilate pupils during eye exams

atropine contraindications

Contraindications include narrow angle glaucoma , myasthenia gravis (can lead to worsening muscle weakness), obstructive urinary or intestinal disorders, heart failure

active transport

Water soluble drugs require ______ for absorption

lipid soluble

type of drugs that cross membranes more easily through passive diffusion.

first pass metabolism

Oral drugs absorbed from GI tract → portal circulation → liver → metabolized before reaching systemic circulation

bioavailability

Percentage of administered drug available for activity

Iv always 100%

oral drugs always <100%

liver

primary site of metabolism or biotransformation

metabolism/biotransformation

the process by which the body transforms the drug into a form that can be excreted

excipients

things like simple syrup, vegetable gums, powder, or honey used in drug preparation to allow the drug to take on a particular size and shape to enhance drug dissolution

pharmacokinetics

The process of drug movement throughout the body to achieve drug actions

pharmacodynamics

the study of the effects of drugs on the body

liver disease

leads to decreased metabolism which causes drug accumulation and puts the patient at risk of toxicity

excretion

primary route is through the kidneys, can also be eliminated through bile, lungs, sweat, breast milk

sympathomimetics

adrenergic agonists

sympatholytics

adrenergic antagonists

parasympathomimetics

cholinergic agonists

anticholinergics

cholinergic antagonists

muscarinic and nicotinic

cholinergic receptors

muscarinic receptors

stimulate smooth muscle, slow HR mediate the parasympathetic nervous system's "rest and digest" responses by binding to acetylcholine

nicotinic receptors

affect skeletal muscles

steady state

occurs when the amount of drug administered equals the amount eliminated, creating a plateau drug level. This balance is necessary for optimal therapeutic benefit.

Approximately 3-4 half-lives

loading dose

a large initial dose that achieves therapeutic effects quickly

innate immunity

Present from birth, the body's first line of defense against pathogens, involving physical barriers and immune cells that respond to infections immediately.

inflammatory process

works to neutralize and dilute the inflammatory agent, whether it's from infection, injury, trauma, chemicals, allergens, or other causes, helps clear away necrotic (dead) materials and cellular debris from the site of injury, the process creates an environment suitable for tissue healing and restoration.

mast cell

rapidly induce inflammation by releasing preformed mediators (histamine, chemotactic factors, cytokines) through degranulation within seconds of activation, and by synthesizing new mediators (prostaglandins, leukotrienes) over hours. Histamine binds to H1 receptors, causing vasodilation, increased vascular permeability, and bronchoconstriction—delivering immune cells and plasma proteins to the injury site for defense and healing. In allergic reactions, mast cells degranulate when exposed to allergens, triggering rapid symptoms in the skin, GI tract, and airways.

inflammation

is an immunologic defense against tissue injury, infection, or allergy—a protective process initiated to minimize or remove harmful agents and promote healing, a non-specific response to disease and injury, can be acute or chronic

bradykinin

causes vasodilation (dilation of blood vessels), induces pain (working with prostaglandins), triggers smooth muscle contraction (bronchoconstriction), and increases vascular permeability, key to inflammatory response

fibrin

the end product of the clotting system

absorbic acid

aka vitamin C, is essential for wound healing

complement system

a cascade of plasma proteins (about 10% of serum protein) that enhances antibodies and phagocytes to clear pathogens, activate inflammation, and destroy microorganisms directly.

antibodies

do the actual fighting of antigens

IgG

the most abundant antibody class in human serum is

cancer

monoclonal antibodies, which are lab produced, are most often used for the treatment of

hypersensitivity

an excessive or inappropriate response of the immune system to a sensitizing antigen. 

viruses

simple microorganisms that lack metabolic organelles found in bacteria or human cells. They cannot replicate on their own and depend entirely on infecting a host cell to reproduce.

opportunistic infections

infections that are more frequent or more severe in individuals with compromised immune systems. These infections are caused by microorganisms that are commonly present in healthy individuals but do not cause disease in persons with an intact immune system.

virulence

the capacity of a pathogen to cause disease

cytokine storm

an excessive, uncontrolled release of pro-inflammatory cytokines that leads to systemic inflammation and potentially life-threatening complications. Instead of a protective immune response, the body's inflammatory reaction becomes harmful.

nociceptors

sensory receptors that respond to harmful stimuli, signaling pain to the nervous system, found in skin, internal organs, and surrounding tissues

visceral pain

a type of pain that originates from the internal organs, often described as deep, squeezing, or aching, and can be difficult to localize.

somatic pain

pain that originates from the skin, muscles, or joints, often described as sharp or dull, and is typically well-localized.

neuropathic pain

pain caused by damage or dysfunction in the nervous system, often described as burning, tingling, or shooting, and may occur without an obvious injury.

anticholinergics

decrease parasympathetic nervous system action

acts on the muscarinic receptors

cholinergic agonists

increases parasympathetic nervous system action

acts on the muscarinic receptors

sympatholytics

decreases sympathetic nervous system action

acts on the alpha and/or beta receptors

adrenergic agonists

Increases sympathetic nervous system action

Acts on alpha and/or beta receptors