pathopharm 2 - exam 1

CBC (Complete Blood Count)

Measures platelet count/size/shape; RBCs, WBCs, Hgb, Hct; RBC size and color

CBC - Decreased Hgb/Hct

Indicates anemia

CBC - Increased WBCs

Indicated inflammation or infection

CBC - Decreased platelets

Increased bleeding risk

D-dimer

Measures fibrin degradation products

Elevated D-dimer

Indicates recent clotting (PE, DIC, thromboembolism)

Fibrin Degradation Products (FDPs)

Reflect clot formation and breakdown

Increased FCPs

Recent blood clot formation and lysis

Fibrinogen

Reflects clotting ability and activity

Low fibrinogen

Decreased production or increased consumption

High fibrinogen

Infection or inflammation

aPTT (Activated Partial Thromboplastin Time)

Evaluates intrinsic coagulation pathway

Prolonged aPTT

Factor deficiency, factor VIII inhibition, lupus anticoagulant, or heparin therapy

Platelet Aggregation Test

Measures platelet adhesion and clumping ability

Abnormal platelet aggregation

Increased bleeding risk (e.g., von Willebrand disease)

PT (Prothrombin Time)

Evaluates extrinsic coagulation pathway

Prolonged PT

Seen in warfarin therapy or clotting disorders

INR (International Normalized Ratio)

Standardized PT comparison

INR >1

Prolonged clotting time

P2Y12 Receptor Inhibitors

Clopidogrel, Ticagrelor, Ticlopidine, Prasugrel, Cangrelor

Thrombin Receptor Inhibitor

Vorapaxar

Platelet Aggregation Inhibitor

Dipyridamole

GPllb/llla Receptor Antagonists

Abciximab, Eptifibatide, Tirofiban

Heparin

Anticoagulant; monitor PTT/Anti-Xa; reversal: protamine sulfate

Enoxaparin (Lovenox)

LMWH; reversal: protamine sulfate

Warfarin (Coumadin)

Vitamin K antagonist; monitor PT/INR; reversal: vitamin K

Dabigatran (Pradaxa)

Direct thrombin inhibitor; reversal: idarucizumab

Rivaroxaban (Xarelto)

Factor Xa inhibitor; reversal: andexanet alfa

Apixaban (Eliquis)

Factor Xa inhibitor; reversal: andexanet alfa

tPA

Alteplase

Recombinant tPA Variants

Reteplase, Tenecteplase

Other Thrombolytics

Streptokinase, Urokinase, Prourokinase, Anistreplase

HIT (Heparin-Induced Thrombocytopenia)

Immune reaction to heparin; decreased platelets with increased thrombosis risk; not bleeding-related

ITP (Immune Thrombocytopenic Purpura)

Autoimmune platelet destruction; bleeding, petechiae, purpura

TTP (Thrombotic Thrombocytopenic Purpura)

Microvascular thrombosis; pentad: thrombocytopenia, hemolytic anemia, thrombosis, fever, neuro changes

Filgrastim (Neupogen)

Stimulates neutrophil production; colony-stimulating factor

Iron Therapy

Treats iron-deficiency anemia

Iron Key Points

Vitamin C increased absorption; oral causes GI upsest/constipation; IV risk anaphylaxis

Vitamin B12 Oral Dose

1,000-2,000 mcg daily

Vitamin B12 IM Regimen

Six 1,000-mcg injections q3-7 days, then q3 months

Folic Acid Dose

1 mg orally daily

Antifungals Drug Ending

-azole

Common Antifungals

Miconazole, Fluconazole

Antivirals Drug Ending

-ovir/-ivir

Common Antiviral

Acyclovir

Antibiotic Selection

Based on culture & sensitivity

Antibiotics + Oral Contraceptives

Reduced effectiveness; use barrier method

Pediatric Antibiotics

Often available in flavored syrups

Tetracycline Precautions

Empty stomach; full glass water; avoid <8 years

Gentamicin Risk

Irreversible ototoxicity

Fluoroquinolones Risk

Tendon rupture; avoid <18 years

Aminoglycosides Risk

Nephrotoxicity (BBW)

Ampicillin Side Effect

Temporary tongue discoloration

Doxycycline Side Effect

Photosensitivity

Hypothyroidism Treatment

Levothyroxine

Hyperthyroidism Treatment

PTU, methimazole, carbimazole, radioactive iodine

Radioactive Iodine Precautions

Avoid close contact 3 days; wash linens separately; flush toilet twice

PPIs

Omeprazole, Pantoprazole

H2 Blockers

Famotidine, Ranitidine

GERD Monitoring

Montior serum magnesium

Ondansteron (Zofran)

QT prolongation; torsades risk

Promethoazine (Phenergan)

BBW: no use <2 years; deep IM only; severe tissue injury risks

Prochlorperazine (Compazine)

Causes drowsiness

Fiber Supplements

Increase stool bulk

Colace

Stool softener

Miralax

Osmotic laxative

Magnesium Laxatives

Osmotic agents

Fleet Enema

Rectal stimulant/osmotic

Parkinson's Disease Drug

Carbidopa/Levodopa

Dementia - Antipsychotics

Haloperidol, Risperidone, Olanzapine, Quetiapine

Dementia - Cholinesterase Inhibitors

Donepezil, Rivastigmine, Galantamine

Dementia - NMDA Antagonist

Memantine

Common Antiseizure Drugs

Topiramate, Gabapentin, Valproate, Carbamazepine, Lamotrigine, Penytoin, Levetiracetam

NSAIDs Risks

GI bleed, CV events, renal dysfunction, HTN

NSAIDs Pre-Surgery

Hold 5-7 days

Acetaminophen Key Point

Not NSAID; max 4g/day; hepatotoxicity

Opioid Risks

Addiction, respiratory depression, constipation

Opioid Reversal Agent

Naloxone (Narcan)

Triptans

Sumatriptan, Rizatriptan, Eletriptan

Triptan Mechanism

Selective serotonin agonists --> vasoconstriction

Tripran Caution

Avoid CAD, PAD, angina, uncontroled HTN

OTC Antihistamines

Cetrizine, Loratidine, Fexofenadine, Diphenhydramine

OTC Decongestants

Pseudoephedrine, Phenylephrine, Oxymetazoline

Decognestant Caution

Increase BP; avoid HTN and "-D" products

Prescription Nasal Steroids

Beclomethasone, Mometasone

OTC Nasal Steroids

Fluticasone, Budesonide, Triamcinolone

Leukotriene Modifier

Montelukast (only FDA-approved)

Type 1 DM Genetic Predisposition

HLA-linked susceptibility often triggered by viral infection

Immune Response in Type 1 DM

Autoimmune attack against pancreatic beta cells

Beta Cell Injury

Progressive immune-mediated damage

Beta Cell Destruction

Complete autoimmune destruction of beta cells

Insulin Deficiency in Type 1 DM

Absolute deficiency of insulin

Type 1 Diabetes Mellitus

Autoimmune disease with total loss of insulin production

Former Name of Type 1 DM

Juvenile diabetes

Common Diagnosis Setting

Often diagnosed in the ER due to DKA

3 P's of Diabetes

Polyuria, polydipsia, polyphagia

Polydipsia

Increased thirst

Polyuria

Increased urination

Polyphagia

Increased appetite

Other Type 1 DM Symptoms

Fatigue, blurred vision, yeast infections, decreased concentration