sbp exam 1

pathology

investigates essential nature of disease

syndrome

sign / symptom that causes specific diseases

disease

disorder in system / organ that affects body's function

disorder

disruption of disease to normal body functions

what is a constitutional / musculoskeletal symptom

outside of our scope of practice

examples =

• fever

• nausea / vomiting

• diarrhea

• dizziness / fainting

• fatigue

• weight loss

systemic vs musculoskeletal disease

systemic =

• sudden onset

• duration can't be changed

• pain is cyclical, can't be changed

musculoskeletal =

• sudden or gradual onset

• duration can be modified

• movement can be aggravate pain

What 5 things can PT's do when it comes to meds?

1. store meds

2. interpet lab values

3. dispense prescribed meds

4. educate patients

5. refer, prescribe, and order labs for military

(some exceptions by state)

average breakdown of blood (plasma vs cellular components)

55% plasma 45% cellular components

6 types of lab values

1. kidney

2. endocrine function

3. muscular disorders

4. liver

5. lipid panels

6. cardiovascular specific tests

5 types of fluid analysis

1. thoracentesis

2. pericardiocentesis

3. paracentesis

4. lumbar puncture

5. arthrocentesis

thoracentesis

removes excess fluid from pleural space (between lungs & chest wall)

look for pneumothorax (lung collapse) or rxn

pericardiocentesis

removes excess fluid from pericardial sac (around heart) due to infection

paracentesis

removes excess fluid from peritoneum (abdominal cavity)

causes: kidney/pancreatic disease, tumor, infection, liver cirrhosis

lumbar puncture

measures CSF pressure

• look for headaches & numbness

• keep patient on bedrest

arthrocentesis

drain synovial fluid from joint capsule

• keep pressure & ice

• look for infection

• rest

urinalysis

diagnostic tool for urinary symptoms (UTI, kidney / liver pathology, pregnancy, diabetes, cancer, drugs)

toxicology

• urine / blood test for drugs

• done within 4 days of drug being taken

reference range

identified by 95% of normal population (healthy range)

vary based on lab, timing, gender, age, etc

critical values

outside reference range to degree of possible risk (ie cardiac arrest)

• must consider risk vs benefit, better not to ttrear

-pril

ACE inhibitor (hypertension, heart failure)

-sartan

Angiotensin II receptor blockers (hypertension, heart failure)

-azole

antifungal

-barbital

barbiturates (sedatives/ anesthetics / antiseizure)

-epam or -olam

benzodiazepines (sedative / anesthetic / antiseizure + antianxiety)

-olol

beta blockers (hypertension, heart failure, arrhythmia, angina)

-dronate

calcium metabolism regulators (osteoporosis / bone health)

-erol

bronchodilators (andergenic)

-phylline

bronchodilators (xanthine derivatives)

-ipine

calcium channel blockers (hypertension, angina)

-coxib

COX-2 inhibitor (pain & inflammation)

-sone or -olone

glucocorticoids (inflammation, immunosuppresants)

-idine

histamine H2-receptor blockers (gastric ulcers)

-avir

HIV protease inhibitors

3 drug names

1. chemical

2. generic (non-proprietary)

3. brand (proprietary)

pharmacodynamics

how a drug impacts the body (physiologic mechanism)

pharmacokinetics

how body deals with drugs (ADME)

5 causes of adverse drug rxns

1. drug reaches non-tissue target

2. non-desirable effects in GI tract or liver

3. dosage

4. drug/food interaction

5. individual variability

What organ systems does oral drug admin affect?

every system (GI tract, skin, brain/CNS, & heart/lungs)

GI tract drug side effects

most common = nausea

severe = GI bleed

what organ systems does IV drug admin effect

all of them (GI tract, skin, brain/CNS, heart/lungs)

What organ system does dermal drug admin affect?

skin

brain / CNS drug ADRs

common = drowsiness, dizziness

severe = mental change, impaired balance & coordination

What organ system does drug admin via inhalation affect

heart/lungs

heart/lungs ADRs

most common = hypotension

mild allergic rxn symptoms

1. itchy skin

2. rash / hives

3. nausea

severe allergic rxn symptoms

1. hard to breathe

2. mental change

3. loss of consciousness

4. coma / death

drug

substance that modifies (blocks or starts) 1+ function in the body

• targets specific cell/tissue

pharmacogenetics

genetic basis for drug response (especially variation)

2 types of drug mechanisms

1. receptor interactions

2. enzyme interactions

2 types of drugs with receptor interactions

1. selective drugs (primary effects only)

2. nonselective drugs (have side effects)

2 types of drugs with enzyme interactions

1. agonists --> start functions

2. antagonists --> block functions

enzyme induction

increase metabolism of another drug ("cocktail)

enzyme inhibition

allows lower dose drug to be used --> decreases side effects

drug threshold

minimum amount needed to achieve an effect

ceiling effect

maximum amount of drug that can be taken before efficacy wears off

therapeutic index

measure of relative drug safety (bw therapeutic & toxic effect)

drug absorption

from site of administration --> circulation

4 factors affecting drug absorption

1. type of admin

2. GI motility / disease

3. age (less motility, more sensitive)

4. liver disease

2 main types of drug admin

1. enteral (via alimentary canal)

2. parenteral (not via alimentary canal)

2 types of enteral drug admin

1. oral (convenient, but chance of first-pass liver inactivation)

2. sublingual (no first-pass liver inactivation)

4 types of parenteral drug admin

1. inhalation (rapid onset)

2. injection (more direct, but chance of infection)

3. topical (surface of skin)

4. transdermal (doesn't break skin)

drug distribution

circulation of drug to target tissues

3 factors affecting drug distribution

1. tissue permeability

2. blood flow

3. binding

drug metabolism

biotransformation (breakdown)

Where does drug metabolism take place

USUALLY liver

SOMETIMES

• lungs

• GI tract

• epithelium

• kidney

• skin

drug excretion

in kidney

• filtered

• reabsorbed or excreted

2 measurements of drug elimination

1. clearance

2. half life

how do drug elimination rates impact dosage

• LOW rate --> toxic buildup

• HIGH rate --> no therapeutic effect

Half-life calculations

time required to eliminate 50% of drug

• If you know half life, divide or multiply by 2

noxious

harmful

nociception

neural process of encoding noxious stimuli

nociceptor

sensory receptors indicating potential tissue damage

pain

unpleasant sensory & emotional experience associated with or resembling actual or potential tissue damage

2 scales of pain measurement

1. numeric pain rating

2. Wong Baker faces scale

SINSS (symptom behavior)

S = Severity I = Irritability N = Nature S = Stage S = Stability

Severity

• intensity of pain

• impact on ADLs

• amount type of pain meds needed

• present at night?

mild, moderate, or maximal

irritability

• ratio of aggravating to easing factors

mild, moderate, or maximal

nature

• type of pain (specific condition, patient characteristics)

stage

clinician's assessment of timeframe in which condition is presenting

acute, subacute, chronic

acute on chronic, subacute on chronic

stability

progression of symptoms over time

improving, worsening, not changing, waning & waxing

3 categories of pain

1. nociceptive

2. neuropathic

3. nociplastic

nociceptive

• due to activation of nociceptors

• response to tissue injury

• comes & goes quickly

• musculoskeletal or visceral

neuropathic pain

caused by lesion/disease of sensory nervous system

• highly irritable

• varied onset & intensity

allodynia

pain due to not normally painful stimulus (ie light touch)

hyperalgesia

increased pain due to normally stimulus (ie pin prick)

paresthesia

abnormal sensation (ie tingling)

dysesthesia

unpleasant abnormal seation

Nociplastic

pain from altered nociception despite no clear evidence of actual or threatened tissue damage

• disproportionate to injury

• persists beyond expected tissue healing

• highly irritable & widespread

4 distinguishers of pain types

1. diagnostic imaging (neuropathic)

2. NSAID response (nociceptive)

3. absence of psychological features (neuropathic/nociceptive)

4. multiple somatic symptoms (nociplastic)

treatment goal of acute pain

eliminate pain

treatment goal of chronic pain

restore functionality

3 categories of pain classification

1. acute

2. chronic

3. cancer

additional risks with chronic pain

• insomnia

• depression

• dependence / tolerance

4 etiologies of cancer pain

1. disease

2. organ obstruction

3. treatment

4. diagnostic procedures

analgesic

pain-killing drug

4 types of analgesics

1. non-opioid analgesics

2. central analgesics

3. opioid analgesics

4. adjuvant analgesics

What types of pain do non-opioids?

mild pain:

1. nociceptive

2. cancer-related bone pain

3. functional pain

Do non-opioids have a ceiling effect?

yes

What 2 generic classes of drugs are classified as non-opioids?

acetaminophen & NSAIDs

acetaminophen mechanism

• weak COX inhibitor

• blocks prostaglandin