Pharm Exam 3 (no meds)

Anasarca

body edema

Anuria

no urine

Ascites

fluid buildup in the abdomen

Edema

swelling

Extracellular fluid

fluid outside the cell

Intracellular

fluid in the cell

Primary function of kidneys

regulate volume, BP regulation, composes urine, regulates pH, elimination, etc

Kidneys receive blood from?

afferent arteriole

Blood leaves the kidney through the?

efferent arteriole

Regions of the kidney?

Outer cortex, inner medulla, renal pelvis

Glomerular Filtration

blood components and fluid passing thru glomerulus

Tubular secretions

active movement of substances from the blood thru the renal tubule

Tubular reabsorption

movement of substances from renal tubule back into the system

Glomerular Filtration Rate (GFR)

125mL/min

Where is the loop of Henle found?

nephron

Conditions requiring diuretics

CV, Renal, Hepatic, Burns, Allergies, and Reactions

Dependent Edema

lowest point

Pulmonary Edema

fluid in lungs dangerous

T or F: Edema only occurs when the heart no longer functions efficiently

False

Diuretics

increase urine formation and output

Drug class: Loop Diuretics

furosemide

Drug class: Thiazide and similar

Hydrochlorothiazide (HCTZ), Metolazone

Drug class: Potassium sparing

spironolactone

Drug class: osmotic diuretics

Mannitol

Carbonic Anhydrase Inhibitors

Acetazolamide

When are loop diuretics preferred?

rapid diuretic effect or renal impairment

When is potassium sparing preferred?

concurrently used to prevent or manage hypokalemia

Preventing Hypokalemia (<3.5)

low dose diuretics, supplement, potassium-sparing med, etc.

Preventing Hyperkalemia (5<)

potassium wasting, avoid supplements, maintain urine output

Is a common cold bacterial or viral?

viral

Sinusitis

inflammation of paranasal sinuses, movement via cilia impaired due to swelling

Common Respiratory Disorder S/S?

nasal congestion, cough, and increased secretions

T or F: Sympathomimetic drugs are used to relieve nasal obstruction and discharge

True, it mimics the SNS, reducing blood flow to mucosa

OTC cold Remedies

Vicks Nyquil: many containing antihistamine, nasal decongestant, and analgesic

What is the common mucolytic that liquefies mucus?

Acetylcysteine

Cold remedies labeled as “nondrowsy” or “daytime” formulas DONT contain what?

first generation antihistamine

What can occur if a decongestant (Oxymetazoline) is used longer than stated by the package?

Rebound Congestion

What is Histamine?

-1st chemical mediator

-Found in mast cells and basophils

-Released in response to stimuli (allergy or injury)

-After release its target cells are in vessels, respiratory, and GI tract

Allergic Response

-Contracts smooth muscle in respiratory tract

-Increased permeability of veins and capillaries

-Stimulation of peripheral nerve endings

-Increased HR and force

-Dilation of capillaries in skin

Hypersensitivity Reaction

exaggerated allergic response, can cause tissue damage and illness, abnormal immune reaction

4 Types of Hypersensitivity Reactions

• Type I, II, III: antibody molecules

• Type IV: antigen-specific T cells

Type I Hypersensitivity

Immediate, occurs within minutes, IgE induced mast cell activation

• Mild: itching, rhinitis

• Severe: anaphylaxis-respiratory distress, cardiac collapse, life-threatening

Type II Hypersensitivity

Cytotoxic

• Mediated IgG or IgM, direct damage to cell surface, blood transfusion reactions, hemolytic disease of newborns

Type III Hypersensitivity

Immune Complex

• Mediated IgG or IgM, forms antigen-antibody complexes, acute inflammatory reaction in tissue, serum sickness

Type IV Hypersensitivity

Delay Hypersensitivity

• cell mediated, lymphocytes react with antigen causing inflammation

• Ex: tuberculin test, contact dermatitis, and graft rejection

T or F: Histamine is the first chemical mediator during inflammatory response?

True

Allergic Rhinitis S/S

• Nasal congestion

• Itching, sneezing

• watery drainage

• itching of throat, eyes, and ears

Allergic Rhinitis Types

Seasonal (Hay fever): response to airborne particles

Perennial: response to nonseasonal, dust mites, mold, and animal dander

Allergic food reaction

response to ingestion of protein: shellfish, fish, corn, seeds, bananas, soy, milk, nuts, etc.

higher risk to trigger anaphylaxis

Child Food allergies

may outgrow the allergy

no known preventative

Drug Reactions

any body tissue can be involved, S/S vary, may occur 7-10 days after exposure

• S/S: rash, itching, fever, hematologic, or hepatic reactions

T or F: Allergic Rhinitis is caused by Type III hypersensitivity?

False: it’s Type I

Antihistamines

relieves S/S, not hypersensitivity

• For: allergic rhinitis, anaphylaxis, allergic conjunctivitis, drug allergies, blood product transfusion

How does first gen. H1 antagonists differ from second gen. H1 anti-histamines?

second gen. don’t cross the blood brain barrier

Broncho constrictive Disorder

airway hyperresponsiveness, inflammation mucosal edema,

Excessive mucus production

• Asthma, bronchitis, Emphysema

Asthma Etiology and Stimulus

• Etiology: genetic IgE hypersensitivity, occurs at any age, common in African Americans and Hispanics

• Stimulus: viral infections, environmental irritants, stress, and strenuous activity

Asthma Pathphys. and Long Term Care

• Pathophysiology: constriction of airway, Inflammatory Response: Mast Cells and Cytokines released

• Long Term:

Mild to Moderate: recurrent and reversible

Advanced or Severe: chronic inflammation, structural changes, less reversible

Manifestations of Asthma

dyspnea, wheezing, chronic cough, acute flare lasts mins-hrs

Status Asthmaticus

acute severe asthma, doesn’t respond to usual treatments, life threatening

Chronic Bronchitis

frequent productive cough more than 3 mos/ year

Increased mucus leads to airway narrowing and chronic changes

Emphysema

usually in smokers, enlarged and damaged alveoli due to lung damage, loss elasticity and surface area, CO2 trapping

Bronchitis vs. Emphysema

• color dusky to cyanotic

• recurrent cough/ sputum

• hypoxia

• use of accessory muscles to breath

Bronchitis vs. Emphysema.

Emphysema

• CO2 retention

• dyspnea

• barrel chest

• prolonged expiratory rate

• puffy lips

COPD

chronic bronchitis and emphysema, develops /w long-standing exposure to airway irritants

S/S: dyspnea, activity intolerance, air trapping

Patients /w broncho constrictive disorder report issues with what?

exhaling

Drug Therapy for Broncho Constriction

Goal: prevent airway inflammation

Treatments: bronchodilation and anti-inflammatories

bronchodilators in inhalation is the best treatment for acute asthma

Bronchodilators

adrenergics, anticholinergics, and xanthines

Anti-inflammatories

corticosteroids, leukotriene modifiers, mast cell stabilizers, and immunosuppressants

Beta 2 Adrenergic Agonists

Rescue Inhalant: quick, short acting drug, used during acute symptoms

Maintenance inhalant: long-term control drugs used to maintain prophylactic control of asthma (everyday inhaler)

Relievers (acute problem)

Albuterol

Controllers (Maintenance)

Salmeterol, Ipratropium

Preventers (prevent issues)

theophylline, beclomethasone, montelukast, cromolyn, omalizumab