Patho Exam

Roles of carbohydrates in the cell membrane

1. Cell Recognition: Attach to proteins or lipids and act as cell identification markers. They allow the immune system to recognize the body’s own cells and distinguish them from harmful invaders.

2. Protection: Carbs regulate the transport of substances in and out of a cell. face the outside of the cell and form a sticky, protective coating called the glycocalyx. This layer cushions the cell membrane against physical and chemical damage.

3. Cell Communication:  transmit signals to communicate with other cells

What is ATP responsible for? Where in the Mitochondria is ATP found?

1.        Converts glucose into usable energy (glycolsis)

2.        Used to fuel cellular functions (growth, repair, and waste removal), primary energy source used by all living organisms

3.         Allows power for: muscle movement, transportation of substances across cell membranes, sending of nerve signals, biosynthesis, and intracellular signaling

4.        Found: the inner mitochondrial membrane and the mitochondrial matrix

How does Mitochondria link back to healthcare?

Linked to energy production, fatigue, and muscle weakness—important in chronic conditions like mitochondrial diseases.

Function of Endoplasmic Reticulum

ER functions as the cell’s manufacturing and transport system, producing and processing proteins and lipids.

1. Rough ER; protein synthesis and modification

2. Smooth ER: produces lipids, removes medications/toxins, and regulates calcium storage

Outcome of glycolysis

breaks down of one glucose molecule into two pyruvate molecules, with a net yield of two ATP and two NADH molecules

How does enzyme function breakdown lead to disease and what does it disrupt? What are the consequences of enzyme malfunctions?

Enzyme malfunctions disrupt homeostasis and metabolism, causing abnormal buildup or deficiency of substances and impaired cellular function.

The endocrine system is responsible for

breakdown of glucose and insulin

Describe how cell surface receptors function?

Help the cell receive messages from water-soluble signaling molecules that cannot pass through the lipid bilayer. (cell signaling)

How does receptor(responsible for transmitting signals) dysfunction lead to disease

Disrupt cell communication, which stops normal chemical signals or sends wrong messages.

Pharmacokininetics

what the body does to the drug

Pharmacodynamics

what the drug does to the body

Primarily through drug-receptor interactions:

• Receptors: Specialized protein macromolecules located on the cell surface or inside cells that recognize and bind specific chemical messengers.

• Affinity: The chemical force or strength with which a drug binds to its corresponding receptor.

• Intrinsic Activity (Efficacy): The ability of a drug to activate the receptor and generate a downstream cellular or physiological effect after binding.

• Binding Forces: Interactions are driven by reversible bonds (ionic, hydrogen, van der Waals forces) or irreversible, permanent bonds (covalent bonds)

Which organ is responsible for absorption

Small Intestine

Know which of our organs is responsible for metabolism

Liver

What does a high protein binding capacity mean?

The patient will require a lower dose because too much would mean they would have medication toxicity

Where can High medication doses will be found?

We find it in the blood stream.

That’s why we do labs to see the ranges to confirm there is no medication toxicity. We also monitor for S&S for toxicity.

What is the liver responsible for regarding medications?

Responsible for metabolizing the medications. We monitor the patients who have issues.

First pass metabolism?

Medication taken orally is processed by the liver before it reaches the rest of the body. This process can reduce the amount of active medication that enters the bloodstream, so sometimes higher oral doses or alternative routes are needed.

• occurs in Liver

Absorption 

moving the med into systemic circulation

Distribution 

moving it through the body to the site of action

Metabolism (biotransformatin)

chemically altering the drug so it can be excreted

Excretion 

removing it from the body (clearance)

We have a patient who has been prescribed a medication that undergoes extensive first pass metabolism, what is the nurse going to teach the client?

1. Explain that oral medications may need higher doses or alternative routes because the liver reduces the amount of active drug.

2. Discuss possible signs of medication toxicity if liver function is compromised.

3. Emphasize the importance of regular monitoring and reporting any unusual symptoms.

What to do if you have a patient with chronic renal failure, the medication has a high protein binding

monitor the patient for medication toxicity

What is Rhabdomyolysis

A serious medical condition where damaged skeletal muscle tissue

breaks down rapidly and releases its internal contents—such as the protein myoglobin,

electrolytes, and enzymes—into the bloodstream

Side effects

something that is expected to happen

Agonists vs antagonist regarding medications

• Agonist: binds directly to a target receptor and changes how it normally works → produces an alternate response.

• Antagonist: binds to the target receptor but doesn't directly change its activity; instead it blocks/interferes so agonists can't bind → inhibits the receptor's expected function.

High vs low affinity to medication receptor interactions

Higher affinity means a medication is more likely to bind tightly and effectively to its target receptor or protein, which usually results in a stronger or more prolonged effect.

Lower affinity means the drug binds less tightly, so it may have a weaker or shorter effect. This concept is important for both therapeutic effects and how medications can interact with each other in the body.

Adverse effect

something you do not want to happen

Mechanism of action 

how it works in the body to do its function at the cellular level

A patient who has chronic opioid use disorder, what are some side effects or adverse effects? 

You would want to give an antagonist to work against. You can use naloxone, which you can get over the counter.

Therapeutic range

concentration of medication in a client’s blood reaching a desired range that is beneficial but not harmful.

therapeutic index

ratio that compares the blood concentrations of a medication that are therapeutic (effective) versus those that are toxic

A patient who has started a medication and is now experiencing anaphylaxis, you would give them epinephrine which is an antagonist?

What is pharmacogenetic testing 

Study of inherited genetic variations and medication response

• genetic variation and includes individual gene mutations

Pharmacologic classifications

drugs are classified by their mechanism of action

Med absorption rates

IV- Fastest; goes directly into the bloodstream (about 15)
IM- faster than ora slower then IV

Oral meds; slowest 30

Importance of Immunizations

Allows our body to build up antibodies for antigens (foreign substances that enter the body) it helps build immunity

Active immunity vs passive immunity

The body's immune system is activated (by infection or vaccination) to produce its own antibodies and memory cells; takes time to develop but is long-lasting.

Passive Immunity: Ready-made antibodies are transferred to the recipient (e.g., maternal antibodies via placenta/breast milk, or immune globulin infusions); provides immediate, temporary protection without creating memory.

artificial vs natural immunity

• Natural Active: individual gets infection and generates their own antibodies and memory cells

• Artificial Active: Vaccination triggers the immune response.

• Natural Passive: Maternal antibodies cross the placenta or are passed through breast milk.

• Artificial Passive: Preformed antibodies/immune globulin administered directly.

What type of immunity are vaccines classified

artificial active immunity

Different types of vaccines

• Inactivated: Uses killed organisms; cannot replicate or cause disease, but often requires boosters (e.g., inactivated flu, Hepatitis A).

• Live Attenuated: Uses weakened live organisms; incapable of replication under any circumstances(e.g., MMR, Varicella).

• Recombinant/Subunit/Conjugate: Uses specific antigen fragments or links antigens to carrier proteins for a target response (e.g., Hepatitis B, Pneumococcal PCV).

• Toxoid: Inactivated bacterial toxins that stimulate antitoxin immunity (e.g., Tetanus, Diphtheria)

type of vaccine is Pneumococci vaccine

inactivated vaccine

Nursing teaches for immunizations

• Immunizations require a series and sometimes a booster: Example: Hepatitis B vaccine

• Vaccinations are personal choices

• Assess contraindications (e.g., severe allergy to prior dose); educate on common mild side effects (local soreness, low fever, fatigue); outline expectations for boosters; advise reporting severe allergic reactions immediately

What are Herd Vaccines

Occurs when enough of a population is immune to a disease that overall transmission drops, indirectly protecting individuals who cannot be vaccinated.

primary role and how it functions of MRNA vaccines

• It fights off harmful viruses and cancer cells

• provides genetic instructions to cells to make a specific antigen/protein → triggers an immune response and antibody production

Numacaco (Pneumococcal conjugate vaccine (PCV)) vaccine is a what type

Recombinant vaccine; Conjugate vaccines link bacterial capsular polysaccharides to a protein carrier to help the body build a strong, target immune response and long-term memory.

What is severe combined immunodeficiency disease?

A congenital condition causing profound combined T- and B-cell immune dysfunction, leaving patients highly susceptible to severe, recurrent infections

Why will SCID patients need to have vaccinations withheld?

because they can cause severe, life-threatening, or fatal systemic infections. SCID causes deficiency to functioning T cells and B cells. In a healthy individual, a live vaccine introduces a highly weakened (attenuated) pathogen that the immune system easily controls and uses to build immunity.

• Non-live vaccines cannot replicate, but response may be weak.

Patients with HIV and GBS vaccine requirements

Receive vaccinations but will need to have their T cell count within normal limits and viral loads

Pt with Guillain-Barré Syndrome (GBS) will need to have nurse consult provider...

Nursing responsibilities with Vaccines

• Pt can sometimes experience allergic response to a component within the vaccine so vaccine may need to be withheld of consult the doctor 

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what is Pneumococci vaccine

Non-live vaccines targeted against Streptococcus pneumoniae bacteria. Delivered either as a conjugate vaccine (PCV) or a polysaccharide vaccine (PPSV23).

Conditions that affect your immune system

osteoarthritis which is the loss of the cartilage within the joints

what is gout

Inflammatory arthritis caused by hyperuricemia where monosodium urate crystals deposit in joints, producing sudden, intense joint pain and inflammation (often at the first MTP joint

What cells makeup immune cells

• B cells synthesize and secrete antigen-specific immunoglobulins (antibodies)

• T cells are killer cells.

What medication is used to prevent gouty arthritis

Allopurinol

Pharmacologic class: Xanthine oxidase inhibitor

What are Insaids

• Reversibly inhibit COX-1 and COX-2 enzymes to lower prostaglandin synthesis

• Used to reduce pain, fever, and inflammation (e.g., Ibuprofen).

what is capsaicin and its classification

Topical analgesic that activates and then desensitizes TRPV1 nociceptors to decrease substance P signaling.

what is cox2 inhibitors and its classification

Anti-inflammatory NSAIDs that selectively inhibit the COX-2 enzyme over COX-1 to reduce inflammation with less gastrointestinal and platelet impact (e.g., Celecoxib).

what is osteo arthritis

A progressive, non-autoimmune joint disease caused by mechanical/biochemical breakdown of cartilage, causing joint pain that worsens with activity and morning stiffness lasting <30 minutes.

what is Celecexoiv

A selective COX-2 inhibitor NSAID used as an analgesic and anti-inflammatory.

difference between gram negative and gram positive bacteria

• Gram-Positive: Thick peptidoglycan cell wall, no outer membrane, stains purple.

• Gram-Negative: Thin peptidoglycan cell wall with an outer lipopolysaccharide (LPS) membrane containing lipid A (endotoxin), stains pink/red

UTI caused by E.coli which is a gram-negative bacterium

Antibiotics

kill bacteria

• With antibiotics pts can develop infections if the dose not completed as prescribed.

• Bacteria can become resistant

Antivirals

fight viruses

what is prednisone

steroid

A glucocorticoid (corticosteroid) anti-inflammatory and immunosuppressant that alters gene transcription to suppress inflammatory pathways

Keys about steroid usage

You do not suddenly stop, you temporarily slow it down

What is Clindamycin

• broadly used

• lincosamide antibiotic that inhibits 50S ribosomal protein synthesis; highly associated with C. difficile colitis.

What is Metrolnitozol

A nitroimidazole anti-infective that forms reactive metabolites in anaerobes to disrupt DNA

• Requires avoiding alcohol during and after treatment

What drug is used to treat active TB

antimycobacterial medications such as Rifampin which can cause discoloration, urine turns orange

What is Ciprofloxin

A fluoroquinolone antibiotic that inhibits bacterial DNA gyrase and topoisomerase IV; carries risks of tendonitis/tendon rupture and requires separation from mineral antacids/supplements.

What is tetracyclin antibiotics

Bacteriostatic agents that bind the 30S ribosomal subunit to block tRNA attachment; cause photosensitivity and bind to polyvalent cations (calcium, iron, antacids)

Antibiotics Causing Photosensitivity

Tetracycline and Ciprofloxacin 

What is nitrofurantoin

A urinary antibiotic used specifically for uncomplicated lower UTIs; it concentrates in urine and is not suitable for systemic infections or pyelonephritis.

What is Amoxicillin

A broad-spectrum beta-lactam penicillin antibiotic that inhibits bacterial cell-wall synthesis.

what is Vancomycin

A glycopeptide antibiotic that inhibits bacterial cell wall synthesis; given IV for systemic Gram-positive infections (e.g., MRSA) and orally strictly for intestinal C. difficile.

Bactericidal vs Bacteriostatic

= KILLS bacteria
= STOPS bacteria from growing/reproducing 🛑 → then the immune system kills them

Bioavaliability

• The amount of drug available for distribution. 

• Oral = lowest bioavailability; This is why oral doses are often larger than IV doses of the same drug.

• IV = 100%. 

Allopurinol vs colchicine - medications for gout (gouty arthritis caused by high uric acid levels)

AC - allopurinol is used for chronic prevention

CA - colchicine is used for acute flare ups

Corticosteroids

Synthetic cortisol, improves/reduces inflammation in short doses; medications

will end with -sone (prednisone, dexamethasone, hydrocortisone); cannot be stopped cold turkey,

must be tapered off!

Glucocorticoids

 typical corticosteroids used for inflammation, asthma

Celecoxib

 COX 2 inhibitor that is associated with less gastric and bleeding side e!ects

Aspirin - salicylate, a type of NSAID that permanently inhibits COX, reason for Aspirin 81 mg used

long term for blood thinning, 325+ mg is used for pain

NSAIDs

increased risk of bleeding, gastric ulcers, AKI (acute kidney injury) while reducing inflammation, pain & fever

Sulfonamide

• Bactrim blocks folic acid synthesis in bacteria leading to impaired

• replication/growth

• SIDE EFFECTS BONE MARROW SUPPRESSION, RASH, RENAL DYSFUNCTION;

RASH CAN INDICATE STEVEN-JOHNSON SYNDROME (SJS) - severe allergic response (purplish/red

• rash turns to blisters, blistering of mucosa lining (mouth, eyes, throat)

• Metronidazole - damages the bacterial DNA directly; avoid alcohol while taking (causes severe

• nausea/vomiting & flushing)

STEVEN-JOHNSON SYNDROME (SJS)

severe allergic response (purplish/red)

Aminoglycosides

strong antibiotics

• NEPHROTOXIC & OTOTOXIC; monitor for tinnitus (ear ringing), hearing loss, monitor I&O (if <30 mL per hr), renal function (BUN & Creatinine); peak & trough

• Vancomycin - inhibits cell wall synthesis; primarily used IV for systemic infections, oral for C.

• di! infection; PRIMARILY NEPHROTOXIC (monitor renal function & I&O); monitor for RED MAN

• SYNDROME (flushing, pruritus, redness, and hypotension when infusion is given faster than

• expected (typically given over an 1 hr+)

Macrolides

 Azithromycin/Z Pack, erythromycin; inhibits protein synthesis (bacteriostatic);

CAUSES QT PROLONGATION (leads to serious/dangerous arrhythmias), so perform EKG before and during the course

risk taking Fluroquinolones/ ciprofloxacin when it comes to the tendon

Instruct the patient to stop taking ciprofloxacin, avoid bearing weight on the leg, and notify the prescriber immediately.

(Your answer)

Correct answer

Fluoroquinolones (like ciprofloxacin) carry a black box warning for tendinitis and tendon rupture (most commonly the Achilles tendon). At the first sign of tendon pain/inflammation, the drug must be held, weight-bearing avoided, and the provider notified.

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Tetracyclines

 Doxycycline: inhibits protein synthesis (bacteriostatic); causes photosensitivity (must wear extra clothing & sunscreen to prevent sunburns); also causes tooth discoloration & abnormal bone growth (seen in young children & pregnant women)

What is Titration

Gradually adjusting the dose up/down based on lab values and clinical response to maintain a therapeutic range.

mechanism of mRNA vaccines

Deliver mRNA instructions into the cell cytoplasm to temporarily synthesize a viral antigen, stimulating immune memory without altering host DNA.

peptic ulcer disease

hole in stomach

*risk if pt is taking aspirin

prednisone

Do not stop taking prednisone abruptly; the dose must be gradually tapered to prevent acute adrenal crisis.

Exogenous systemic glucocorticoids suppress the hypothalamic-pituitary-adrenal (HPA) axis. Abrupt discontinuation can lead to life-threatening acute adrenal insufficiency (adrenal crisis).

What are adverse effects associated with prolonged systemic glucocorticoid (prednisone) therapy?

• Osteoporosis and increased fracture risk with long-term use.

Glucocorticoids inhibit osteoblasts, enhance osteoclast activity, and decrease intestinal calcium absorption, leading to bone loss.

• Increased susceptibility to infection and masking of fever symptoms.

Glucocorticoids suppress immune leukocyte migration and cytokine release, masking signs of infection while impairing host defense.

• Hyperglycemia and steroid-induced diabetes.

Glucocorticoids promote gluconeogenesis and induce peripheral insulin resistance, raising blood glucose levels.

Which clinical features correctly differentiate Osteoarthritis (OA) from Gouty Arthritis?

• Morning joint stiffness in OA usually lasts less than 30 minutes.

Brief morning stiffness (<30 min) is characteristic of OA, unlike rheumatoid arthritis, where stiffness persists for hours.

• Osteoarthritis involves progressive mechanical degradation of articular cartilage, with pain worsening with joint activity.

OA is a degenerative joint disease where cartilage breaks down; pain typically worsens with joint use and improves with rest.

• Gout involves monosodium urate crystal deposition in synovial joints, causing abrupt, intense inflammatory flares.

Gout is a metabolic inflammatory disease triggered by hyperuricemia and urate crystal deposition.

Morphine> Class> key points

Opioid agonist (analgesics)

IV form acts faster than oral (~15 min IV onset vs. ~30 min

oral) because it goes directly into the bloodstream. Example:

patient still in pain after oral Tylenol → IV morphine given for

faster relief.

Acetaminophen

non-opioid analgesics

Capsaicin 

Topical analgesic 

Used for osteoarthritis & nerve pain; good alternative route for

patients who cannot take NSAIDs.

Naloxone (Narcan) 

Opioid antagonist 

Reverse opioid effect/overdose

Know when to give morphine (agonist) vs. Narcan (antagonist) in an opioid patient.

Ibuprofen 

NSAID 

inhibits COX enzymes → ↓ prostaglandin synthesis → ↓

inflammation, pain, fever.

Epinephrine 

Antagonist (emergency use)

First-line treatment for anaphylactic reaction to a medication.

Naloxone (Narcan) 

Opioid antagonist