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NUR516 Patho & Pharm 1 > final > Flashcards

final Flashcards

1
Q

what cause glomerular disorders

A

immune response triggered by I vote bat iris

I: infecction; hepatitis, endocarditits, vascularitis, STI, abdominal abcess
V: viral: mump, measles, mono, typhoid fever
B: bacterial” kleb
I: immune: lupus

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2
Q

what cause nephrotic syndrome

A

Dic D

D: drug: NSAID, penicillamine
I: infection: strep throat, hepatitis, mono
C: cancer, immune, genetic
D: disease that affect the whole body: lupus, SLE, DM, multiple myoloma, amyloidosis

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3
Q

what’s antidiuretic

A

vasopressin

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4
Q

cause of chronic renal failure 6

A

Dm, HTN
Kidney: polycystic, glomer, obstruction, relfux

DM
hypertension
glomerulonephritis
polycystic kidney disease
prolonged obstruction of the urinary tract
vesicouretral reflux
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5
Q

non proliferative glomerunephritis

A

abnormal podocytes
fibrotic changes in the glomerulus
or a thickened basement membrane

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6
Q

Risk population of kidney stones

A 
white people 
HTN
CKD
poor diet
low exercise

often with at least 1 metabolic abnormality within 24 hour by urine testing

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7
Q

cause of hyperkalemia

A

metabolic acidolsis: DKA
high K intake
drug
AKF

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8
Q

when do we send hypocalcemia to hospital

A

serum Ca< 1.75: hyperreflexia, tetany, generalized seizure, laryngospasm

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9
Q

when do we send hypercalcemia patient to hospital

A

Ca> 3.0: emotional lability, confusion, delirum, psychosis, stupor, coma
>4.5: ECG change, shock, death

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10
Q

Where is paneth cells

A

Small intestine

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11
Q

Signs of lactose intolerance

A

Crampy pain
Bloating
Osmotic diarrhea

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12
Q

Phospholipid and mucous layer help to

A

Buffer bicarb and prevent bacteria adhereence

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13
Q

Can GERD have orange juice

A

No

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14
Q

GERD treatment

A
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15
Q

Sulfasalazine

A
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16
Q

Crohn😩’s disease

A

Abx to give Flagyl / ciprofloxacin

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17
Q

IBS

A
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18
Q

Stimulant laxative

Who shouldn’t have it

A

Sennakot and bliscodyl

Affect smooth muscle of intestine and increase fluid in colon and intestine to increase peristalsis

Patients with fissures or hemorrhoid should not use this

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19
Q

What’s the other antidiarrheal besides loperamide

A

Diphenoxylate

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20
Q

Antispasmodic agents

A

Anticholinergic: relax smooth muscle–> reduce contraction

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21
Q

Secondary constipation

A
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22
Q

Who can’t use bulk form laxative

A

Esophageal structure and GI ulcer

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23
Q

Saline laxative are not for

A

Bowel inflammation
Affect kidney
Not for older than 55 or too young

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24
Q

Urease secreted by H.Pylori. What does it do

A

Neutralize Gastric acid

Cause mucosal damage

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25
Q

Amoxillin interact with what drug

A

Increase warfarin effect

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26
Q

If you are not sure it’s PUD

A

Don’t give anti secretory drug. It might mask symptoms

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27
Q

NO and prostaglandin do

A

Neutralize Ph and increase mucous production

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28
Q

Cisapride

A

Prokinetic drug that increase ACH at myenteric plexus. Increase gastric motility

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29
Q

What’s mild GERD

A

Symptoms are less than 3 times per week

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30
Q

Who are more likely to get inflammatory bowel syndrome

A 
(Think of Crohn)
Genetic 
Colon ca
White or Jewish
Autoimmune
Infection
Stress
Young people 15= 35
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31
Q

Symptoms of ulcerative colitis 5

A 
Bloody diarrhea
Fever 
Increased WBC   Left shift
Abdominal pain
Toxic mega colon
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32
Q

Where does ulcerative colonitis often affect

A

From rectum up

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33
Q

What is infliximab

What to watch for when ordering infliximab

A

TNF alpha inhibitor

Heart failure

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34
Q

Symptoms of mild crohn

A

Ambulatory
No mass
No dehydration no fever

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35
Q

Besides fever and dehydration, what other symptoms of severe crohn

A

Weight loss more than 10%

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36
Q

Gastroenteritis

A

sudden onset nausea, vomiting, abdominal cramping and diarrhea (Gotfried, J., 2021). Patients may describe malaise and myalgia, and note a distended and tender abdomen (Gotfried, J., 2021). While symptoms are usually self limiting, excessive vomiting and diarrhea can lead to hypotension, tachycardia, and hypovolemic shock (Gotfried, J., 2021). Gastroenteritis generally caused by viruses - specifically Norovirus and Rotavirus; however bacterial gastroenteritis is caused by campylobacter, clostridium difficiles, E. coli, salmonella (Gotfried, J., 2021).

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37
Q

What drugs can cause diarrhea

A

Cholinergic and abx

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38
Q

Antidiarrheal drug

A
  1. Antimotility drugs:
    a. Loperamide: bind to u- opioid receptor of myenteric plexus of the large intestine
    b. Phenoxylate: same to loperamide, but has CNS effect, makes you happy & cause potential abuse
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39
Q

Special symptom of celiac disease

A

Steatorrhea

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40
Q

Drug for nausea

A
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41
Q

Stage 5 renal failure GFR

A

< 10

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42
Q

Stage 4 renal failure GFR

A

15-29

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43
Q

Proteinuria in nephritic vs proteinuria in nephrotic

A

< 3.0g in nephritic

> 3.5 g in nephrotic

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44
Q

Diseases in-prerenal causing acute renal failure

A
  1. Hepatorenal: liver disease causing third space, reducing renal perfusion
  2. Sepsis
  3. Aortic dissection
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45
Q

Azotemia

A

Increase urea, often with increased Cr level

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46
Q
  1. Intrinsic azotemia include

2. Most common cause of ARF

A
  1. Glomerulonephritis
    Acute tubular necrosis
    Acute tubule interstitial nephritis
  2. Acute glomerulonephritis
    Acute tubular necrosis
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47
Q

Acute renal failure cause

A
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48
Q

Cause of hyponatremia

A 
HF
Liver disease
Renal disease
Diuretic 
Syndrome of inappropriate anti diuretic hormone
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49
Q

What do you assess if hyponatremia

A 
Na
Hydration status
Renal
Adrenal
Thyroid
Hepatic
Cardiac function
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50
Q

Management for NSAID-PUD

A
  1. D/c NASAID, start PPI/HRI/sulfacrate
  2. If can’t d/c NASAID, lower the dose or change into a coated one, or switched to COX-2, celecoxib
  3. If patient has to take NASAID, take with misoprostol or PPI
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51
Q

PPI drug interaction

A

Reduce plavix

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52
Q

Misoprostol

A

Is not a PUD treatment, is a prevention drug

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53
Q

Bismuth interaction

A

Increase bleeding when using with anticoagulants

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54
Q

Amoxicillin side effect and drug interaction

A

GI discomfort: N/V diarhea if oral

Drug interaction: increase warfarin, deactivate aminoglucoside

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55
Q

Thromycin

A

Macrolide

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56
Q

Tetracycline interaction and side effects

A

dia
Iron, dairy, anti acid reduce this drug
Side effect: GI upset, and photosensitivity

57
Q

Treatment for GERD

What other treatment besides those

A

Prokinetic agent: mitoclopramide (increase gastric motility & gastic empty, also help with Nausea) and cisapride (increase ACH at myenteric plexus–> stimulate gastric motility)

58
Q

Who likely to get inflammatory bowel syndrome

A

Think of crohn’ disease

15-35
White Jewish, genetic, stress, infection, colon ca, autoimmune
Veteran

59
Q

Ulcerative colonist

Symptoms

A

Best friend mea

Bloody diarrhea
fever, chills
elevated WBC (left shift)
abdominal pain
mega colon
60
Q

The cause of irritable bowel syndrome

A
  1. Increase visceral hypersensitivity or hypergesia: Brian-gut axis: serotonin secreting cell: change motility secretion and sensory
  2. Abdominal GI permeability: reduced &slow transit time: constipation; increased permeability &fast transition time: diarrhea
    . Post-inflammatory: infection, affect immune and microbiota
  3. Change in gut microbiota l: affect sensor, immune, and motility of gut
  4. Food allergy: food antigen trigger gut immune
  5. Psychological stress
61
Q

Diagnose criteria of IBS

A

Chronic abd pain more than 3 months with change stool frequency and consistency+ pain is relieved by bowel movement.

Can have urgency leading to incontinent diarrhea

62
Q

When to refer IBS to a specialist 6

A

Ca, in, bleed, progressive, 50, weight loss

Family history of colorectal ca
Inflammatory bowel disease
GI bleed
Nocturnal or progressive symptoms
Onset after 50 yr 
Weight loss.
63
Q

Lab assess when suspect IBS

A

Ferritin
Celiac assess
CBC

64
Q

How to differentiate IBS from Crohn’s disease

A

Crohn is fever, chronic diarrhea, weight loss

IBS: constipated/ diarrhea, gasy, abdominal cramp

65
Q

What are prokinetic besides cisapride & mitoclopramide

A

Linaclotide

Prucalopride

66
Q

When to use tricyclic antidepressant in IBS and what are they

A

Amitriptyline

Good for chronic IBS. Also help mood and sleep

67
Q

Stimulate laxative mechanism of action

A

Affect intestinalsmooth muscle to increase fluid accumulation in colon and intestine. Increase peristalsis

68
Q

What patients can’t stimulating laxative

A

Fissure and hemorrhoid

69
Q

Side effect of rifaximin

A

Ha Professor (PS)

Headache
Peripheral edema
Agioedema
Skin problem ( dermatitis or rash)

70
Q

Diagnostic test for melena

A
  1. CBC
  2. coagulation profile
  3. endoscopy( can stop bleeding, see location of bleeding, not for unstable patient)
71
Q

Good and bad about prodrug

A
  1. Better pharmacokinetic: without giving this direct active form, drug can cross some barriers, easier to distribute
  2. Better oral absorption
  3. Better chemical stability, solubility and better taste and flavour

Bad:

  1. systemic toxicity
  2. Require good liver function to turn it to active form
  3. Cross BBB
72
Q

What’s the risk if using PPI for long term

A

Change gut microbiota

  1. C-diff
  2. Pneumonia
  3. Higher risk for Drug to drug interaction: reduce plavix
  4. Reduce Ca
73
Q

Hemorrhoid treatment

A

Non-drug: fibre, water, warm sits bath, bulk, reduce fat in diet, regular exercise, anal hygiene, avoid straining or reading in washroom

Drug:

  1. Oral flavonoid: increase vascular tone, treatment venous insufficiency and edema
  2. Calcium dobesilate: in diabetic patient or chronic venous insuffiency. Treat acute haemorrhoid. –> reduce capillary permeability, inhibit platelet aggregation, and improve blood viscosity–> helping with edema & bleeding
  3. Topical treatment: help symptom, don’t treat diseases
    a. Glyceryl trinitrate 0.2% ointment:
    b. Local nifedipine/ nitrate: relax internal anal sphincter
    c. Vasoconstriction: phenylephrine
    d. Petrolatum, light mineral oil
74
Q

Cholecystitis
S&S
Diagnosis:

A

Gallbladder inflammation-

often caused by gallstone ( need low fat diet)
Chronic post meal epigastric / RUQ pain last for 6 hours.

If not caused by gallstone, it’s called “ acalculous cholecystitis” because the draining out of bile duct is blocked, causing gallbladder to distent and inflamed

A emergency situation. Need to go to hospital.
Can also have fever. Chill if it’s acute.

75
Q

Abx to treat c-diff

A

Flagyl

Vancomycin

76
Q

What drug can cause constipation

A 
Antidepressant
Antiparkinson
Diuretic
Al 
Ca
77
Q

Who are more likely to get diverculosis

A 
Goosa 
Genetic
Older
Obesity
Aspirin/NSAID 
Smoking
78
Q

Particular signs of diverculistis.

A

LLQ pain

79
Q

Pathophysiology of celiac disease

A
80
Q

Treatment for nausea

A

PAS

81
Q

Hypertonic

A

D5+ NacL /+LR

82
Q

Hypotonic

A

<0.9Nacl

2.5%D5W

83
Q

Isotonic

A

D5W
LR
Nacl0.9

84
Q

What happen in hypernatremia

A

Hypernatremia: cell shrinks–> intracellular dehydration
High Na makes water shifts from inside cell to outside—> thirst—> ADH—-> reduce water excretion + drink water—-> lower Na

85
Q

What Inhibit ADH’s release

A

Hypoosmolality
Dilatin
Ethanol

86
Q

Stimulate ADH 7

A 
Stress
Hyperosmolality
Nausea
Pregnancy
Low sugar
Nicotine
Morphine.
Antidepressant
87
Q

High Na and natiuretic peptide

A

High Na pull water from inside cell to outside—> make atrial stretch—-> release Naiuretic peptide—-> increase Na and Water excretion

88
Q

What can cause low NA in general

A 
Diarrhea 
Vomiting
Diuretic
HF
Cirrhosis
89
Q

What’s called when you correct Na too quickly and causing brain injury

How quick should you correct

A

Osmotic demyelination syndrome

8-12 mmol per 24 hour

90
Q

Definition of AFR

A

Rapidly fall in GFR leading to rapid increase in Urea and Cr

91
Q

Cr and GFR which one is better to check renal function.

A

GFR is better because Cr has lag. It only works when the patient’s been stable over days.

And Dialysis get Cr out. So need to check Cr before dialysis. So Cr is not as good.

GFR is sensitive.

92
Q

Lab indicate ARF

A

Serum Cr increase more than 26.4 mmol/L or increase 1.5 or 2 times than the baseline.

93
Q

Hypovelmic hypernatremia

Euvolumic hypernatremia

Hypertonic hypernatremia

A

Hypovelmic hypernatremia: loos body water more than loos Na: loop diuretic, hyperglycaemia, kidney can’t concentrate urine

Euvolemic hypernatremia: exercise, don’t drink enough water, hyperventilation, fever, diabetes insipidus, sweating

Hypervolmic hypernatremia: rare. Drowning in salt water. Giving too much hypertonic saline solution.

94
Q

What’s the most commonly seen electrolyte imbalanced in hospital and what are the symptoms

A

Hyponatremja

  1. Lethargy
  2. N/V
  3. Confusion
  4. Reduced LOC
  5. Seizure.

Na < 115 is serious.
<125 become symptomatic.

95
Q

What are the electrolyte imbalance in diabetes insipidus

A

Hypernatremia
Serum hyperosmolality

Concentrate of other electrolyte are not usually affected

Caused by reduced ADH recreation leading to increase peeing unconcentrated urine & water

96
Q

Normal Mg level

A

1.5-3.0 mg/dL

Mg is antagonist of Ca

Low: low albumin, low K (Mg inhibit K channel that get K to outside of cell, without Mg, K moves to extracellular & get peeped out), insulin resistance, osteoporosis, DM
Signs of low Mg is similar to low Ca.
High: >3.9: depress muscle contraction (bradycardia, hypotension, resp depression, muscle weakness)& nerves function

97
Q

Typical cystitis S&S

A

Foul smell urine

Pelvic abdominal pressure

98
Q

UTI diagnosis

A

Symptoms and urianalysis

Symptom: frequency, urgency, dysuria

Urianalysis:

Leukocyte: > 5 leukocyte /field
Bacteriuria: > 1000000 bacteria/ml
Dipstick: nitrate( urea-splitting)
Hematuria

99
Q

Cystitis treatment

A

1st line:
N:nitrofurantoin
T:Trimethoprin/sulfamethoxazole
D: fosfomycin

2nd:
F: fluquinolone.

100
Q

What to watch about pentosan

A

It takes 2-4 month to show effect.

101
Q

What do you do if patients’s prostate and super swollen and urination is narrowed.

A

Send to hospital

He has urinary obstruction caused by prostatic edema compress the urethra. Medical emergency

102
Q

Cyclobenzaprine

A

A muscle relaxant
Anticholinergic and alpha blocker

Can cause confusion, hallucination, SNS strong effect

Can’t be used long than 3 weeks.

103
Q

The other name of non bacterial chronic prostatic is

A

Chronic pelvic pain syndrome.

104
Q

Barett’s esophagus

A

If people get GERD long enough, their esophagus cells can become lower GI lower cells

105
Q

What’s prebiotic

What’s example of prebiotic

A

Prebiotic is to help gut to develop probiotic. They are fibres. Such as oligosaccharides

106
Q

* in test review

What are antispasmodic agents 
How do they work
What are they
Side effect
Not for whom
A

Anticholinergic that relax GI tracts smooth muscle> reduce contraction & reduce secretion

(completely blocking Ach at muscarnic cholinergic receptor)

Dicyclomine
Hypcyamine

Side effect: SNS effect
Contradiction: asthma, glucoma, COPD, myasthenia gravis, cardiac arrhythmias

107
Q

Difference between diverticulum, diverticulitis, diverticulosis

A

Diverticulum is seen from inside the colon, little hole like

Diverticulitis: inflammed diverticulosis

Diverticulosis: outpouching

108
Q

Treatment of c-diff

A

Flagyl

Vacomycin

109
Q

PPI side effect

A

Reduce Ca

110
Q

Antiemetics

A
  1. Anticholinergics: hyoscine, cicyclomine
  2. H1 antihistamine: “clizine”, promethazine, diphenhydramine, doxylamine, cinnarazine
  3. Neuroleptics (D2)blockers: chlorpromazine, prochlorperazine, Haldol
  4. Prokinetic: metoclopramine, domperidone, cisapride, other “pride”
  5. 5HT3 antagonist (serotonin antagonist): setron. Ondansetron
111
Q

Hematochaezia

A

Bloody stool

112
Q

How goes GI bleed affect BUN/Cr

A

Elevated BUN/Cr

113
Q

Diarrhea go to drugs

A
  1. Loperamide: opioid receptor agonist, affect myenteric plexus
  2. Bismuth subsalicylates: stimulate fluid reabsorption, inhibit PG & binds to E.coli toxins
  3. Diphenoxylate/atropine: anticholinergic
114
Q

Bacteria adhesion in the urinary tract

A

Fimbrae

115
Q

Empiric treatment for prostatitis

A

No ta

  1. Norfloxacin
  2. TMP-SMZ (mild to moderate)
  3. Ampicillin + gentamicin (severe)
116
Q

Glomerular filtration rate is best estimated by

A

Creatinine clearance

117
Q

Acute management of kidney stone in adults

A
  1. Hydration
  2. Antispasmodics to help stone pass:
    a. Alpha-blocker: doxazosin, tamsulosin, prazosin
    b. Calcium channel blocker: nifedipine
  3. Pain management: opioid: tylenol+ codeine. Hydrocodone+Tylenol
118
Q

Thiazide works primarily at

A

Distal tubule

119
Q

Thiazide drugs
What are they
Side effect

A

Hydrochlorothiazide
Indapamine
Chlorthalidone

Reduce: K, Na
Increase: Ca, glucose, uric acid, LDL

Not for gout, diabetes patients

120
Q

Signs of glomerulonephritis

A

Think of both nephrotic & nephritic

  1. Bloody urine
  2. Proteinuria: > 3-5g/day with albumin as major protein
  3. Foamy urine
  4. Increased BUN, Cr, cholesterol, triglyceride
  5. Joint & muscle ache
121
Q

Common cause of acute renal failure

A

Infection

122
Q

Diabetes inspidus

A

Not enough of ADH lead to polyuria, polydipsia (frequent drinking)

123
Q

Azotemia

A

Elevated urea, or nitrogenous compound

124
Q

If the patient had used trimethoprim-sulfamethoxazole in the within 6 month

A

Don’t prescribe this again

125
Q

What hyponatremia can cause especially in elderly patients

A

Fall risk & osteoporosis

Confusion & irritability

126
Q

Bile acid sequants used in IBS

A

Diarrhea: cholestyramine helps bile acid absorption

Constipation: colesevelam increase colon transit time

127
Q

How long do you wait after GERD patient change their lifestyle to see if it works, and what do you do if it doesn’t work

A

2 weeks

Order more diagnostic test and upgrade the drug

128
Q

What’s mild ulcerative colitis symptoms

What do you do if mild ulcerative colitis symptoms doesn’t go away with rectal or po 5ASA?

A

less than 4 BMs per day (with or without blood)
Normal ESR

Po/rectal corticosteroid

129
Q

Who can’t use suldasalazine

A

Aspirin, sulfa allergy

130
Q

What’s Thiopurine drugs

A

“Purine”

Azathioprine

131
Q

What’s selective adhersion molecule inhibitor

A

Natalizumab
Vedolizumab

“Lizumab”

132
Q

How loperamide HCL works

A

Inhibit peristaliac activity–> prolong transit time & increase anal sphincter tone

133
Q

How does Diphenoxylate work

A

Relax smooth muscle in GI tract–> reduce motility, reduce propulsion, reduce gastric secretion

134
Q

Demopressin

A

Antidiuretic

Helps with overactive bladder syndrome
Especially nocturnal

135
Q

What anticholinergic are the best in treating overactive bladder syndrome

A
  1. Trospium
  2. Darifennacin

Less interaction
Don’t across BBB

136
Q

Lower UT

A

Including bladder and below bladder

137
Q

Drug can cause hypokalemia

A

Insulin and beta adrenergic agonist

138
Q

What disease have mega toxin colon

A

Ulcerative colonist

NUR516 Patho & Pharm 1 (3 decks)

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