PathoPharm Exam 2 2025

Heart failure

Condition where heart cannot pump effectively.

Heart failure causes

hypertension

ischemic heart disease (MI)

valvular disease

cardiomyopathy

Left Sided heart failure: What is happening?

Left ventricle fails and blood backs up into the lungs

Left sided heart failure symptoms

Pulmonary congestion(crackles, cough, dyspnea, orthopnea)

S3

Pulmonary edema

Right sided heart failure -what is happening?

Right ventricle fails and blood backs up into systemic circulator

Right sided heart failure symptoms

peripheral edema, JVD, weight gain, fatigue

Common cause of right side heart failure

Left sided heart failure

Angina

Chest pain due to myocardial ischemia(reduced blood flow to the heart muscle)

Stable angina

relieved by rest, occurs with exertion, relieved by nitroglycerin

Unstable angina

Occurs at rest, not relieved by nitro

Beta blockers

decrease heart rate and dilate arteries by blocking beta receptors

-olol

ACE inhibitors

-pril

used to treat: hypertension, heart failure, and diabetic nephropathy

decrease BP and afterload

interfere with the RAAS, a hormonal pathway that regulates blood pressure.

Cardiac Output

Amount if blood the heart pumps per min

Preload

volume of blood in ventricles at end of diastole

Afterload

Resistance heart must overcome to eject blood.

Atherosclerosis

plaque buildup leading to narrowing and hardening of arteries

Digoxin (cardiac glycoside) functions and uses

Increase heart contractility

Lower HR

Raise CO

Used for heart failure and a fib

Statins- Atorovasain Functions and Uses

Lowers LDL cholesterol

Used for hyperlipidemia/artherosclerosis risk

Loop diuretic-furosemide-lasix USES

HF

Edema

HTN

Chron's disease

A chronic inflammatory bowel disease that affects the lining of the digestive tract.

IBD

Ulcerative colitis

chronic inflammation of the colon with presence of ulcers

IBD

ulcerative colitis symptoms

bloody diarrhea and abdominal pain

Chron's disease symptoms

-rectal bleeding

-loss of appetite

-fatigue

-fever

-night sweats

-cramping

IBD vs IBS

IBS has no inflammation/tissue damage

IBS is triggered by

stress, foods, hormones

Symptoms of IBS

Abdominal pain, bloating, constipation, diarrhea

GERD

Backflow of stomach acid into esophagus due to weak LES

GERD symptoms

Symptoms:

Heartburn, regurgitation, dysphagia, chronic cough

Complications: Barrett’s esophagus, esophagitis

Barrett's esophagus symptoms

Frequent heartburn and regurgitation of stomach contents, Difficulty swallowing food, Less commonly—chest pain

Barret's esophagus

a condition that occurs when the cells in the epithelial tissue of the esophagus are damaged by chronic acid exposure

Liver functions

metabolic regulation, hematological regulation, bile production

Liver disease causes

- Viral infection: Hep C & B

- Excessive alcohol consumption

- ↑ fat collection in liver

- Bile duct problems

- Diabetes

- Autoimmune

Bilirubin

formed in the liver by the breakdown of hemoglobin and excreted in bile.

Is bilirubin high or low in liver disease?

High bilirubin=liver disease

Albumin function

osmotic balance, pH buffering, keep water out of third space

Why is albumin low in liver disease?

The liver is the only site of albumin synthesis!

Ascites

abnormal accumulation of fluid in the abdomen

Can be caused by liver disease

Pancreatitis causes

gallsones, alcohol use

Pancreatitis symptoms

LUQ pain

Fever

Abdominal distention

Cullens sign and turners sign

Low Ca(hypocalcemia)

High glucose

Senna- stimulant laxative

Stimulates intestinal motility → ↑ peristalsis

Use: Constipation, bowel prep

Side Effects: Abdominal cramps, diarrhea, electrolyte imbalance, dependency with long-term use

MiraLax-Polyethylene glycol- osmotic laxative

Draws water into bowel → softens stool, increases volume

Use: Constipation, bowel cleansing

Side Effects: Bloating, cramping, diarrhea, dehydration, electrolyte loss

Docusate sodium-Colace

Stool softener

Lowers stool surface tension → allows water/fat into stool

Use: Prevents constipation (post-op, postpartum, after MI)

Side Effects: Mild cramps, diarrhea

Omeprazole- Proton pump inhibitor

Blocks gastric acid secretion by inhibiting proton pumps

Use: GERD, ulcers, esophagitis, H. pylori (with antibiotics)

RISK OF C DIFF

H. Pylori symptoms

An ache or burning pain in your abdomen.

Abdominal pain that's worse when your stomach is empty.

Nausea.

Loss of appetite.

Frequent burping.

Bloating.

Unintentional weight loss.

Type one diabetes

no insulin produced

Treatment of type one diabetes

Insulin

Type 2 diabetes

Insulin resistance + decreased insulin production over time

Onset: Adult, often linked to obesity & inactivity

Type 2 diabetes traments

Lifestyle: Diet, exercise, weight loss

Oral meds (e.g., metformin, glipizide)

May need insulin

Insulin action

Insulin binds to receptors on cells (especially muscle and fat cells).

This opens “channels” allowing glucose to move from the blood into the cells.

Without insulin → glucose stays in blood → hyperglycemia.

Lispro, Aspart- Kinds of insulin?

Take with meals

Rapid acting insulin

Glargine-Lantus

Long acting insulin

Metformin

Treats type two diabetes

↓ hepatic glucose production, ↑ insulin sensitivity

Glupizide

Stimulates pancreas to release more insulin

Treats Type 2 diabetes

Risks of chronic hyperglycemia?

Atherosclerosis, MI, stroke

Diabetic nephropathy → kidney failure

Retinopathy → blindness

Neuropathy → numbness, pain, foot ulcers

Poor wound healing, infections

Amputation risk from poor blood flow

ADH

Causes kidneys to retain water → ↓ urine output.

Helps regulate fluid balance and blood pressure.

SIADH

Too much ADH, water retention

diabetes insipidus (DI)

oo little ADH, dry, water lost

Vasopressin (Pitressin)

ADH replacement, vasoconstriction, raise bp and water

Demeclocycline

Action: ↓ Kidney’s response to ADH

Effect: Promotes water excretion → ↑ Na⁺

Aldosterone

Na and water reabsorption

K excretion

Raise BP

RAAS

Cortisol

stress hormone

Cushings disease

HYPERSECRETION of cortisol

(Remember: UP, UP, UP, DOWN, UP)

- HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia

Pituitary tumor

Moon face

Obesity

Treatment: Reduce steroids

Addison's disease

Hyposecretion of cortisol

Hyponatremia

Hyperkalemia

Low vol

Low BP

Low BG

Weight loss

Treatment: Steroids

Primary vs secondary hormone disorder

primary- gland impacting

secondary- pituitary or hypothamaus effecing

Pressure ulcer stages

Stage 1: non-blanchable redness

Stage 2: partial thickness loss

Stage 3: full thickness loss, w/o undermining, see fat

Stage 4: 3+ undermining, see tendon, muscle

first degree burn

epidermis

red painful dry no blister

second degree burn

Epidermis + part of dermis

Blisters, moist, very painful

Third degree burn

Epidermis + dermis ± subcutaneous

White, charred, leathery; may be painless (nerve damage)

Fourth degree burn

Extends to muscle/bone

Black, dry, no sensation

TBSA

Total Body Surface Area affected by burns.

Rule of 9s

Age related skin changes

Thinner epidermis → more fragile, slower healing

Decreased collagen/elastin → wrinkles, sagging

Decreased subcutaneous fat → less insulation, more injury risk

Decreased sweat/oil glands → dry skin, impaired thermoregulation

Reduced melanocytes → uneven pigmentation, increased sun d

Osteoclasts

Break down bone → release calcium into blood

Osteoblasts

Build bone → deposit calcium into bone matrix

Osteoarthritis

degenerative joint disease

Relieved by rest

wt bearing joints

Rheumatoid arthritis

small joints effected

autoimmune inflammation

improves with activity

Osteoporisis

Low bone density → fragile bones → ↑ fracture risk

Rhabdomyolysis

Muscle breakdown → release of myoglobin, electrolytes, and proteins into blood

Trauma, crush injuries, prolonged immobility, strenuous exercise, statins, drugs/alcohol

Rhabdo symptoms

Early: Muscle pain, weakness, swelling, dark “cola-colored” urine

Labs: ↑ CK (creatine kinase), ↑ myoglobin, ↑ K⁺, ↑ phosphate, ↑ uric acid, ↓ calcium (early)

Complications of rhabdomyolisis

Acute Kidney Injury (AKI)

Hyperkalemia

Hyperphosphatemia

Hypocalcemia (early)

Hypercalcemia (late)

Metabolic acidosis

Cardiac dysrhythmias

Treatment of rhabdo

Early phase: ↓ Ca²⁺

Late phase (recovery): ↑ Ca²⁺

fluid and electrolyte

GERD is worsened by...

GERD worsened by: NSAIDs, alcohol, smoking, fatty foods, caffeine, lying down after eating.

Risk factors of Chron's

family history, immune dysregulation

Amylase

Digestive enzyme that breaks down starch.

What is amylase elevated in?

pancreatitis

Jaundice is caused by..

bilirubin

Cause of HTN?

Unknown

Calcium function

muscle contraction, nerve conduction, and clotting.

STORED IN BONE

Hyper______ can cause arrhythmias

hyperkalemia

Fractures of the pelvis or femur increase risk of....

hemorrhage due to large blood supply

ROME

respiratory opposite (pH and CO2)

Metabolic equal (pH and HCO3)

Troponin

Protien of the heart

Indicative of cardiac muscle injury

-prils

ACE inhibitor(decrease BP)

Often used in CKD, hypertension

-lols

Beta blocker, decrease HR and BP

HF, MI, HTN

Varices

Dilated veins due to portal hypertension (impaired blood flow from GI tract → liver).

IBS is a(functional or autoimmune) disorder

functional

Emphysema vs chronic bronchitis

emphysema- alveoli lose elasticity; THIN, CACHECTIC, usually older pts; difficulty exhaling- air pocket walls expand, thin out, then collapse Pink puffer-barrel chest

chronic bronchitis- excess mucus production, chronic productive cough Blue bloater

SABA LABA SAMA LAMA

SABA: Short-acting beta-agonist (rescue, e.g., albuterol).

LABA: Long-acting beta-agonist (maintenance).

SAMA: Short-acting muscarinic antagonist (rescue, anticholinergic).

LAMA: Long-acting muscarinic antagonist (maintenance).

________, or high CO2, is common in COPD

Glucocorticoids

↑ cortisol → ↑ blood glucose, fluid retention, weight gain, hypertension, mental disturbances.

What medication would treata Addison's disease? Why?

Glucocorticoids are used to treat Addison’s disease

It is a hyposecretion of cortisol