mod 3 exam 1 pathopharm

inflammatory response signs/symptoms

erythema(redness), heat, edema, pain - indicates vasodilation so that cells like leukocytes can reach tissue to fight off offending agents

extravasation (margination + emigration)

phys journey of the leukocytes out of blood stream
margination = white blood cells drift to edges and stick to vessel wall

emigration = stuck tgt mass squeezes into tissue

chemokines — chemotaxis

chemical trail tells leukocytes where to go

cytokines

promote activation, proliferation, and differentiation - change what cells do

corticosteroid

block chem rxn associated w inflammation

antihistamine

block release of histamine — initial phase of inflam response

salicylatesn

treat mild-moderate pain, fever, inflam by decreasing platelet aggregation

absorbed in stomach, peak 5-30min, liver metabolize, excrete in urine

side effect: gi bleed

contraindication: known allergy, bleeding disorder, impaired renal function, viral infection

NSAIDS (non-steroidal anti-inflam drugs)

anti-inflam, anti-inflammatory, analgesic, and anti pyretic effects

MOA

•Blocks two enzymes, COX 1 and COX 2

•Pharmacokinetics: rapid absorbed in GI tract, peak: 1-3 hours, metabolized: liver, excreted: urine

Side Effects

•NVD, dyspepsia, GI pain, constipation, GI bleed, platelet inhibition, hypertension, bone marrow suppression

Contraindication

•allergy to NSAID or salicylate, sulfa, hypertension, stomach ulcer, GI bleed, pregnancy

Drug-Drug Interaction

•decreased loop diuretic, anti-hypertensive with some cardiac medications

acetaminophen

Pain, fever, MSK: arthritis

• Directly on the thermoregularity cells of the. hypothalamus

• MOA: mostly unknown

• HA, hemolytic anemia, renal dysfunction, skin rash, fever, hepatotoxicity

• liver dysfunction, renal dysfunction, ETOH, pregnancy

• Oral anticoagulants: increase bleeding

• Hepatotoxicity: barbiturates, rifampin

type 1: anaphylactic rxn (IgE)

first time IgE antibody made for allergen and gets embeded in mast cells and basophils, 2nd time is rxn - histamine released which causes vasodilation and increased vascular permeability
can be localized rxn or systemic

rhinorrea

runny nose

uticaria

raised bumps/welts that turn white when pressed but norm red

pruritus

itchy

dyspnea

shortness of breath

type 2: cytotoxic hypersensitivity (IgG/IgM)

IgG/IgM antibodies accidentally bind to antigens on surface of own cells which leads to destruction of that cell

type 3: immune complex (location/deposition)

antibody and antigen r floating in blood and form immune complex which diffuses out of blood into tissue complement cascade activates in tissue which causes inflam

type 4: cell mediated - T cells

delayed response

autoimmune disease

when type 2,3,4 turn permanent — body cant recognize specifc cells as own cells
Rheumatoid Arthritis

o Psoriasis

o Lupus

o Thyroids Diseases

o Type 1 Diabetes

Systemic Lupus Erythematosus

(SLE)

Risk Factors

o Women 9x more than men

o More common in African Americans

• Symptoms

o Joint inflammation

o Rash: butterfly rash of face

o Fatigue, abd, dizziness

• Organ damage

o Kidneys and cardiovacular

• Increased risk for cardiac disease

Rheumatoid

Arthritis

Rheumatoid Disorders

Rheumatoid Factor: antibody

testing

Risk Factors

• Women

• Advanced age

• Family history

Organs and Tissues Impacted

• Joints, heart, lungs, eyes, skin

Symptoms

• Symmetrical joint pain and

swelling

• Fatigue and decreased mobility

Immuno-stimulants

Goal: energize or increase the action of the immune system

Indications:

• Stimulate immune function in patients with certain cancers

• Reduce the incidence of infection in pts with bone marrow

suppression

Drug Classes/Examples

• Interferons, Interferon Alfa-2b

• Interleukins, Aldesleukin

• Colony Stimulating Factors, Filgrastim

Administration

• All given by parenteral route

interferons

prevent virus from replicating - cancer and chronic

interleukins

amplify communication between lymphocytes, boost natural killer cells, inhibit tumor growth

Colony-Stimulating Factors Filgrastim (Neupogen)

act directly on bone marrow to churn out more white blood cells, which is why they're used for neutropenia
bone pain as a side effect makes sense once you know the drug is stimulating marrow activity

immunosupresants

used when the immune system is the problem, either in autoimmune disease or after an organ transplant

monoclonal antibodies

bind to specific target and try to prevent from enter cells

tumor necrosis factor blockers

work by neutralizing tumor necrosis factor, a cytokine macrophages release to drive inflammation — block that signal, and you blunt the inflammatory cascade that damages joints in rheumatoid arthritis, psoriatic arthritis, and related conditions

Antimetabolites

interfere with metabolic pathways cells need to grow and divide (like DNA synthesis)

diagnose and treat infection

infection from bac, fungi, virus, parasites

Culture: sample taken, and pathogen grown in a lab

Sensitivity: exposing the bacteria grown to an antibiotic on the slide

serology: antibody testing

DNA and RNA Sequencing

o Method of identifying infectious agents through detection of pathogen DNA/RNA

o PCR testing: Polymerase Chain Reaction

penicillin ‘‘cillin‘

Broad spectrum

• Gram (+)

MOA

• Bactericidal-inhibit building cell wall

side effects

• Gastrointestinal: nausea, vomiting, diarrhea (NVD)

contradiction

• renal impairment, pregnancy/lactation

considerations

• Old drug, widely used: bacterial resistance: beta-lactamase

• High rate of allergies: cross sensitivity with cephalosporins

Cephalosporin- “Cef”aclor

Acts like penicillin’s (PCN) and treat suspectable bacteria

• Gram (+) and (-)

• Bactericidal and bacteriostatic (interfere with cell wall and bacteria

division)

Side Effects

• GI-NVD

Contraindication

• allergy to PCN, liver/renal impairment, pregnancy/lactation

Drug-Drug Interaction

• Aminoglycosides, oral anticoagulants, ETOH

carbapenems “penem“

broad spectrum antibiotic to treat serious inf against gram +/-

MOA

bactericidal-cell wall weakener

side effects

superinfections: cdiff

nausea vomit - electrolyte abnormalities

considerations:

used for serious so can have severe side effects

tetracyclines “cycline“

broad spectrum gram +/-

MOA

bacteriostatic-inhibit synth no rep

side effects

GI- Nausea,Vomit,Diarrhea bone damage, teeth discoloration - esp during growth phases

considerations

common indications treat acne, genitourinary inf, tick, penicillin allergies alternative

aminglycosides - “icin”

powerful antibiotic, treat serious inf caused by gram neg - narrow spectrum

MOA bactericidal inhibitor of protein synth

side effects

ototoxic

nephrotoxic (kidneys)

contradiction

think abt the risks

sulfonamides “(ox) azole”

broad spectrum gram +/-

MOA

bacteriostatic inhibit folic acid RNA/DNA cant form

side effects

GI-NVD, renal dysfunction

contradiction

pregnant need folic acid for fetus

fluoroquinolones “floxacin”

broad spectrum synthetic

MOA

bactericidal: DNA rep interfered - prevent

all PO/IV (by mouth/intravenous)

common side effect

headache, dizziness, insomnia, depression

serious side effects

black box- warning only take if rlly need to

antifungal flucon “azole”

systemic and local fungal infection

MOA

cause cell death and inhibit glucan synth

strong inhibitor of cyp 450

sude effect

liver toxicity, teratogenic

contradiction

liver/renal dysfunction, pregnancy/lactation

topical antifungal clotrim “azole”

prevents replication fungal death

MOA

alter cell permeability of fungus

side effects

topical administration leads to topical apical eczema

irritation, burning, rash, swelling (local)

considerations

local infection, topical treament

no systemic absorb