What is pathophysiology?
physiology of altered health
what is pathology?
deals with the study of the structural and functional changes in cells, tissues, and organs of the body hat cause or caused by disease
What is physiology?
deals with the functions of the human body
What is disease?
acute or chronic illness that one acquires or is born with and that causes physiologic dysfunction in one or more body systems.
what are etiology factors?
causes of disease
what are congential conditions?
defects that are present at birth
what are acquired defects?
those that are caused by events after birth
What is pathogenesis?
explains how disease process evolves
What is morphology?
fundamental structure or form of cells or tissues
What are exacerbations?
aggravation of symptoms and severity of the disease
What are the different spectrums of disease?
- Preclinical stage: the disease is not clinically evident but destined to progress to clinical disease
- Subclinical disease: is not clinically apparent and is not destined to become clinically apparent
- Clinical disease: manifested by signs and symptoms
- Carrier status: person who harbors an organism but is not infected
What is epidemiology?
study of disease occurrence in human populations
What is incidence?
reflects the number of new cases arising in a population at risk during a specified time
What is prevalence?
measure of existing disease in a population at a given point in time
What is morbidity?
the effects an illness has on a person’s life
What is mortality?
provide info about the causes of death in a given population
What is a protoplasm?
intracellular fluid. Composed of: water, proteins, lipids, carbohydrates, and electrolytes. Two distinct regions:
What is karyoplasm?
nucleoplasm is inside the nucleus
What is a cytoplasm?
outside the nucleus. Includes the fluid and organelles outside the nucleus but within the cell membrane surrounding the cell.
What is RNA?
molecules that move from the nucleus to the cytoplasm and carry out the synthesis of proteins.
What are the different types of RNA?
- Messenger RNA (mRNA): made from genetic info transcribed from the DNA in a process called transcription. Travels to ribosomes in the cytoplasm so these instructions can be used to make proteins
- Ribosomal RNA (rRNA): RNA component of ribosomes, the site of protein production
- Transfer RNA (tRNA): transports amino acids to ribosomes so that mRNA can be turned into a sequence of amino acids.
What is the endoplasmic reticulum?
- extensive system of paired membranes and flat vesicles that connect parts of the inner cell.
- produces proteins for the body
What are the two different types of the ER?
- Rough ER: has ribosomes attached. Makes digestive enzymes found in lysosomes and proteins that are secreted, such as the protein hormone insulin (protein synthesis)
- smooth ER: free of ribosomes: lipid synthesis
What is the golgi complex?
four or more stacks of thin, flattened vesicles or sacs. Substances produced in the ER are carried to the golgi in small, membrane-covered transfer vesicles. The golgi modifies these substances and packages them into secretory granules or vesicles. UPS STORE/POST OFFICE
What are lysosomes?
digestive system of the cell. They break down excess and worn-out cell parts as well as foreign substances that are taken into the cell
What are primary lysosomes?
membrane-bound intracellular organelles that contain a variety of enzymes that have not yet entered the digestive process
How do lysosomes break down material?
- heterophagy: digestion of a substance phagocytosed from the cell’s external environment
- autophagy: the digestion of damaged cellular organelles, such as mitochondria or ER
What is atrophy?
cell degeneration; wasting away
What is proteolysis?
breakdown of proteins
What is the cytoskeleton?
skeleton of the cell. Network of microtubules, microfilaments, intermediate filaments, and thick filaments. Controls cell shape and movement
What are the three cytoskeletal filaments?
- Actin filaments:
- polymer of actin monomers
- globular protein arranged in a helix
- major contractile component of muscle cells
- Microfilaments
- filament of tubulin monomers
- play a role in cell structure, organization, mitosis, and movement
- Intermediate filaments
- cytoskeletal filament
- structural protein in eukaryotic cells
______ participate in mitosis and play a role in cilia and flagella
microtubules
What is flagella and cilia?
- They are the means by which many microscopic unicellular and multicellular organisms move from place to place.
- microtubule-filled cellular extensions surrounded by a membrane that is continuous with the cell membrane
The cell membrane is _______ aka it helps determine what can and cannot enter and exit cells. It also helps regulate cell growth and division.
semipermeable
What are peripheral proteins?
temporarily bound to one side or the other of the membrane and do not pass into the lipid bilayer, and they have functions involving the inner or outer side of the membrane where they are found
What are integral proteins (transmembrane proteins)?
cross the entire lipid bilayer and function on both sides of the membrane or transport molecules across it. Form ion channels and are selective for which substances move through them.
How can cells communicate?
- Autocrine signaling: when a cell releases a chemical into the extracellular fluid that affects its own activity
- Paracrine signaling: acts mainly on nearby cells
- Endocrine signaling: relies on hormones carried in the bloodstream to cells throughout the body
- Synaptic signaling: occurs in the nervous system, where neurotransmitters are released from neurons to act only on neighboring cells at synapses
what are protein kinases?
modifies other proteins by adding phosphate
What is downregulation?
- when excess chemical signals are present, the number of active receptors decreases
- Receptors are proteins, usually cell surface receptors, which bind to ligands and cause responses in the immune system, including cytokine receptors, growth factor receptor and Fc receptor. … Receptors can induce cell growth, division and death; control membrane channels or regulate cell binding.
What are G-Protein-liked receptors (GPCR)?
largest family of cell surface receptors. Participate in cellular responses for many types of first messengers. These cell surface receptors act like an inbox for messages in the form of light energy, peptides, lipids, sugars, and proteins. Such messages inform cells about the presence or absence of life-sustaining light or nutrients in their environment, or they convey information sent by other cells.
What are ion channel-linked receptors?
involved in the rapid signaling between electrically excitable cells such as neurons and muscle cells
cause the formation of an electrical current
What are the steps of the cell cycle?
G0: when the cell may leave the cell cycle and either remain in a state of inactivity or reenter the cell cycle at another time
G1: when the cell begins to prepare for mitosis by increasing proteins, organelles, and cytoskeletal elements
S: synthesis phase; when DNA synthesis or replication occurs and the centrioles begin to replicate
G2: premitotic phase and is similar to G1 in terms of RNA activity and protein synthesis
M: cell mitosis occurs
What is energy metabolism?
the processes by which the calorie-containing fats, proteins, and carbs from the foods we eat turn into energy
What is active transport?
the movement of molecules or ions across a cell membrane into a region of higher concentration. Cells use an input of energy to move substances against an electrical or chemical gradient
What is primary active transport?
directly uses chemical energy to transport all species of solutes across a membrane against their concentration gradient.
What is secondary active transport?
What are the two types?
- transport of molecules across the cell membrane utilizing energy in other forms than ATP. This energy comes from the electrochemical gradient created by pumping ions out of the cell.
- use the energy from the transport of one substance for the cotransport of a second substance.
Two types:
o Symport or cotransport: substances are transported in the same direction
o Antiport or countertransport: substances are transported in the opposite direction
What is catabolism?
breakdown of complex molecules in living organisms to form simpler ones
What is anabolism??
builds more complex molecules from simpler ones
Energy transformation takes place within the cell through what two types of energy production pathways?
- Anaerobic glycolytic pathways occurs in the cytoplasm
o EX: glycolysis – energy is released from glucose - Aerobic pathway occurs in the mitochondria
o EX: Citric acid cycle
o EX: Electron transport chain
What are the three different ways movement can occur in the cell membrane?
- By simple diffusion following the concentration gradient
- By carrier proteins, which are responsible for transporting only one type of molecule and may be involved in active transport
- By channel proteins, which transfer water-soluble molecules and serve as the ion selectivity filter
What is endocytosis?
brings material into the cell
What is exocytosis?
removes substances from the cell
What is passive transport?
- type of transport that does not require energy to move substances across cell membranes
- move from a high to low concentration
What is diffusion? What are the types of diffusion?
move from an area of higher to lower concentration
- Facilitated diffusion: uses integral proteins (type of membrane protein that is attached to the membrane)
- Osmosis: water crosses membranes through water channels down the concentration gradient for water, moving from a higher to lower concentration. Regulated by the concentration of substances on either side of a membrane that cannot diffuse across the membrane.
What is endocytosis? What are the two types?
Endocytosis: cells surround and take in materials from their surroundings.
Include:
- Pinocytosis: cell drinking
- Phagocytosis: cell eating
What are voltage-gated channels?
open or close w/ changes in the membrane potential
What are ligand-gated channels? (chemical gated channels)
aka chemically gated channels; open or close when chemicals bind to the channels
What are mechanically gated channels?
open or close in response to such mechanical stimulations such as vibrations, tissue stretching, temp, pressure
What is the membrane potential?
- potential gradient that forces ions to passively move in one direction
- is the difference in electric potential between the interior and the exterior of a biological cell.
What is depolarization? hyperpolization?
Depolarization: less negative charge in the cell
Hyperpolarization: more negative charge in the cell
What are dendrites?
receive signals that change which ion channels are open
What are tissues?
group of cells that work together
What are the four types of tissues?
- epithelial: diffusion, filtration, secretion, stretching, protection
- muscle: movement
- nerve: electrical impulse
- connective tissue: tendon, fascia, attaches skin to tissue
What is cell differentiation?
Formation of different types of cells and the placement of these cells into tissue types. Controlled by cell memory
What are the three-layered structures of the embryo?
- Ectoderm = outer
- Mesoderm = middle
- Endoderm = inner
What’s the difference between the generic name of a drug and the brand or trade name of a drug?
generic name: it is the “official name”. They are never capitalized
EX: acetaminophen
Brand or trade name: drugs commercial or proprietary name. It is always capitalized
EX: tylenol
**They are the same thing
What is hypertropy?
enlargement of organ or tissue
What is hyperplasia?
increased reproduction
What is metaplasia?
abnormal changes in the nature of cells/tissue
what is dysplasia
abnormal type of cell growth - proceeds to cancer
What is reversible cellular injury?
- loss of ATP
- failure of sodium potassium pump
- cellular swelling
- detachment of ribosomes
- autophagy of lysosomes
What is irreversible cellular injury?
point of no return - structurally when severe vacuolization of the mitochondria occurs and Ca2+ move into the cell
What are the four basic causes of cell injury?
- Something “tipped TIPD” the balance of homeostasis
- T: toxin or cytotoxic substance
- I: infection, Immune, Inflammatory
P: physical insult or injury
D: Deficit (lack of O2, H20, nutrients
What does it mean when there is a hypoxic injury to the cell?
NOTE: this is a deficit injury
an inadequate flow of nutrients and oxygen to the cell.
**If tissue perfusion continues to be insufficient, hypoxia occurs and the cell resorts to anaerobic metabolic pathways for energy production.
- this is the most common type of injury
Can also occur from:
- ischemia (occlusion decreases blood flow)
- decrease in oxygen
- decrease in hemoglobin
- decreased respiratory or cardio function
- poisoning of oxidative enzymes
What is ischemia?
inadequate blood supply to an organ or part of the body, especially the heart muscles
What happens when a chemical injury occurs in the cell?
NOTE: THIS IS A TOXIC INJURY TO THE CELL
- reaction between the toxin and the cell membrane
- direct injury to cell component
- formation of reactive free radicals and lipid perioxidation
What are the symptoms to lead poisoning?
NOTE: THIS IS A TOXIC INJURY TO THE CELL
- Nervous: seizures, delirium, paralysis
- Hematopeotic: anemia due to decrease production of RBCs and increase lysis of RBCs
- GI: weight loss, nausea, vomiting
- Teeth: grey stain
What is a free radicals injury?
NOTE: THIS IS A TOXIC INJURY TO THE CELL
- Free radicals are electrically uncharged atom with an unpaired electron
- reactive oxygen species
radicals bind with protein, lipids, CHO which breaks cell membrane
What is a free radical?
an uncharged molecule (typically highly reactive and short-lived) having an unpaired valence electron.
What are diseases that are linked to free radical cellular damage?
- heart disease
- diabetes
- alzheimer
- parkinsons
- aging
What occurs during physical cell injury?
- Blunt: tearing, shearing or crushing
- Contusion: bruise or bleeding into tissues
- Abrasion: scrape from friction
- Laceration: tear or rip
- Fracture
- Stab wounds: deeper than long cuts
- Puncture wounds: may be very serious
- Chopping: axes
- Gunshot wounds: penetrating bullet remains in body; or perforating bullet exits
What are the consequences of cell injury?
- cellular accumulations infiltrations
- Fluid balance
- water - cell swells; Na/K pump fails due to decrease ATP
- Increase Na in cells increase osmotic pressure
- cellular swelling: reversible
- oncosis: cell death from swelling
Necrosis vs apopotis
- apoptosis is a predefined cell suicide, where the cell actively destroys itself, maintaining a smooth functioning in the body
- Necrosis is an accidental cell death occurring due to the uncontrolled external factors in the external environment of the cell
What is lupas?
don’t have enough normal cells
What is neoplasm?
an abnormal growth of cells in the body, also described as a tumor.
What is cancer?
abnormal reproduction of abnormal cells
What is carcinogenesis?
cancer development
What are the steps in carcinogenesis (cancer growth)?
- initiation-introduction of the agent
- promotion-initiation of uncontrolled growth
- progression-permanent malignant changes
What are clinical manifestations of cancer?
CAUTION
Change in bowel or bladder habits A sore that doesn't heal Unusual bleeding or discharge Thickening or lump in the breast or elsewhere Indigestion or difficulty swallowing Obvious change in a wart or mole Nagging cough or hoarseness
What are some complications of cancer?
- Anemia
- Cachexia
- Fatigue
- Infection
- Leukophenia
- Thromboxytopenia
- Pain
What are the main 3 goals to treat cancer?
- curative
- palliative: treat symptoms
- Prophylactic: removing breasts for reduction in getting breast cancer
What are the phases of drug evaluation (testing)
- Preclinical trials: chemicals tested on lab animals
- Phase I studies: chemicals tested on human volunteers
Phase II studies: drug tried on informed pts
Phase III: (FDA approved) drug used in vast clinical market
Phase IV: continual evaluation of the drug (never leaves this phase)
What are the different schedules for the controlled substances in the US?
Give examples
Schedule 1: drugs w/ no currently accepted medical use and high potential for abuse. EX: heroin, LSD, marijuana, Ecstasy, Meth
Schedule 2: drugs with a high potential for abuse, with use potentially leading to sever psychological or physical dependence. EX: cocaine, adderall, oxycodone, fentenyl
Schedule 3: Drugs with a moderate to low potential for physical and psychological dependence. EX: ketamine, testosterone, steroids, tylenol, codeine
Schedule 4 drugs: Drugs with a low potential for abuse and low risk of dependence. EX: xanax, soma, valium, tramadol
Schedule 5: drugs with lower potential for abuse than schedule 4 and consist of preparations containing quantities of certain narcotics. EX: cought medicine, lyrica
What are arterial blood gases (ABGs)?
primarily the concentrations of oxygen and carbon dioxide in the bloodstream
Acid-base pH balance is regulated by…..
lungs, kidneys, and bones
The more hydrogen the ______ the pH
lower
- hydrogen is an acid
What are the 3 systems that work to maintain acid-base balance
- buffers
- respiratory system
- renal system
What are buffers?
- chemicals that combine with an acid or base to change pH (keep it in balance)
- immediate reaction to counteract pH variations until compensation is initiated
What are the four major buffer mechanisms?
- bicarbonate-carbonic acid system
- phosphate system
- hemoglobin system
- protein system
How can lungs work as buffers?
- increased CO2 released with respirations (Blowing off CO2)
How can kidneys act as buffers?
- kidneys reabsorb HCO3 - aka bicarb
Potassium and _____ move interchangeable in and out of the cell to balance pH
hydrogen
With extracellular excess, hydrogen moves inside the cell for buffering, and, in exchange, potassium moves out
This means: potassium imbalances can lead to pH imbalances
What is metabolic acidosis?
pH and bicarbonate both acidic
pH<7.35
HCO3<22
- buffering system is overwhelmed
- the respiratory system’s efforts to compensate for the increase in metabolic acids results in kussmaul respirations
What is metabolic alkalosis? What does it cause?
pH>7.45
HCO3>26
Causes: overuse antacids, loss of gastric juices; diuretics that waste K+: causes increase loss of H+
What is respiratory acidosis?
What does it cause?
pH<7.35
CO2>45
renal compensation leads to excretion H+ and retention of HCO2
Causes: drug overdose, hypoventilation, airway obstruction, chest trauma
What is respiratory alkalosis?
pH>7.45
CO2<35
caused by blowing off too much CO2
paperbag over the mouth works because u get more CO2
What is it called when there is too little potassium?
hypokalemia
What are some signs and symptoms of hypokalemia?
- cardiac arrhythmias (BP lowers when pt gets up
- muscle fatigue
- weakness
- deep tendon reflex
- nausea
- EKG shows a shallow T wave and prominent U wave
What are some treatments of hypokalemia?
- potassium supplements
- ## PO or IV
What is it called when there is too much potassium?
hyperkalemia
What does hyperkalemia cause?
- renal failure
- excess intake
- addison disease (too little aldosterone and too high K+)
EKG shows spiked T wave
What are signs and symptoms of hyperkalemia?
- muscle weakness
- decreased contractility of heart
- abnormal heart rhythm
What are treatments for hyperkalemia?
- insulin and dextrose (glucose) and calcium gluconate
- sodium polysterene sulfonate
Magnesium and ____ are similar because they are both excreted by the kidneys
potassium
What is magnesium?
- intracellular cation
- mostly stored in the bone and muscle
- excreted through the kidneys
- dietary intake main source
- plays a role in muscle and nerve function, cardiac rhythm, immune function, bone strength, blood glucose management, blood pressure, energy metabolism, and protein synthesis
What does it mean when you have too low magnesium?
hypomagnesium
What causes hypomagnesemia?
- prolonged diarrhea
- laxative abuse
- increased renal excretion of magnesium
- sepsis
- burns
- serious wounds requiring debridement
What are the symptoms of hypomagnesemia?
- neuromuscular manifestations
- cardiac arrhythmias
- muscle paralysis, heart block, coma
How can you treat hypomagnesesmia?
- Magnesium sulfate through the IV
- Magnesium hydroxide, oxide, and citrate
What is it called when there is too much magnesium?
hypermagnesemia
What are symptoms of hypermagnesemia?
- hyporeflexia
- muscle weakness
- cardiovascular effects
- cardiac arrest
- kidney failure
How can you treat hypermagnesemia?
- calcium gluconate IV
- push slowly
- may cause metal taste in mouth
What is the purpose of the renin-angiotension system?
Regulates BP when it drops
What are the steps of the renin-angiotension system?
- BP drops
- Sympathetic nervous system stimulates
- Kidneys juxtaglomerular cells release renin
- renin enters circulation and activates angiotensinogen that is in the liver
- angiotensinogen turns into angiotensin I
- ACE (found on lung and kidney endothelium) turns angiotensin I to angiotensin II. This causes the vessels to constrict and the blood volume to increase
- when this occurs it stimulates the Kidneys (keep Na and H20), the adrenal cortex (aldosterone and keeps K+ low), and the pituitary gland (ADH: keeps water)
What is aldosterone?
- a hormone
What does aldosterone do?
increases re-absorption of Na and secretion of K in the distal tubule of the kidney
- great sodium saver
Where is aldosterone made and secreted?
adrenal cortex
Sodium and ______ concentrations are directly related (If one goes up then the other goes up)
Chloride
What is a natriuretic hormone?
compounds that act in an endocrine or paracrine fashion to regulate extracellular fluid volume and blood pressure (BP) through the stimulation of sodium excretion by the kidney.
What produces natriuretic hormones?
atrial muscles of the heart
What’s it called when there is too much sodium?
hypernatremia
What are some side effects to hypernatremia?
- fever/respiratory infection
- diabetes
- sweating
- diarrhea
- dehydration
- tachycardia
- weak pulses
What happens when water moves from the ICF (intracellular fluid aka within cells) to the ECF (extracellular fluid aka outside of cells)?
intracellular dehydration, cells shrink
What’s it called when there is too little sodium?
hyponatremia
What does hyponatremia cause?
- non-renal causes: vomiting, diarrhea, NG suctioning, diuretics
- renal failure
- excess sweating leads to continued H20 drinking
- causes decreased osmolality and cellular swelling (decreases the ECF osmotic pressure, and water moves into the cells causing cells to swell)
What are signs and symptoms of hyponatremia?
- headache
- lethargy
- apathy
- confusion
- nausea
- vomiting
- diarrhea
Where is chloride found?
gastric secretions, pancreatic enzymes,
calcium and _______ travel together
magnesium
calcium has an inverse relationship with _______
phosphorus
Where is calcium found?
teeth and bones
What is calcium regulated by?
- vitamin K
- PTH
- calcitonin
What is it called when there is too low calcium?
hypocalcemia
What causes hypocalcemia?
deficient intake: decreased dietary intake, alcoholism, absorption disorders
excessive losses: hypoparathyroidism, renal failure, alkalosis, pancreatitis, laxative, diarrhea
What are the signs and symptoms of hypocalcemia?
- muscle spasms of the face
- seizures
- hypotension
- parasthesias around the mouth, hands, and feet
- neuromuscular irritability
What is chvostek’s sign?
facial spasm
caused by hypocalcemia
What is trousseau’s sign?
carpal spasm
caused by hypocalcemia
What is it called when there is too much calcium?
hypercalcemia
What causes hypercalcemia?
- immobilization
- vitamin D deficiency
- calcium supplements
- cancer
how does calcium work to fix heartburn?
calcium neutralizes the acids
What are signs and symptoms of hypercalcemia?
- muscle weakness
- bone tenderness
- depression
- kidney stones
- anorexia
What are treatments for hypercalcemia?
- increase excretion (increase hydration to increase excretion in the kidney)
- Diuretics
- increase GI excretion
- prevent bone reabsorption
What does phosphorus play a role in?
- bone and tooth mineralization
- cellular metabolism
- acid-base balance
- cell membrane formation
What is it called when you have too low phosphorus?
hypophosphatemia
What are symptoms of hypophosphatemia?
- tremors
- muscle weakness
- bone pain
What is it called when you have too much phosphorus?
hyperphosphatemia
What is the most common cause of hypophosphatemia?
kidney failure
Intracellular fluid is ____ of total body water
2/3rds
what is interstitial fluid?
Fluid found in the spaces around cells
What is edema?
- increase in water in interstitial space
- increase in hydrostatic pressure (increase in BP)
- decreases plasma oncotic pressure
- increased capillary permeability (infections, trauma)
What is localized edema?
- limited to site of trauma or within affected organ system
- EX: my knee
What is generalized edema?
- more uniformally distributed in interstitial spaces
- generalized throughout body; edema in legs
What is third spacing?
- too much fluid inbetween cells
- the accumulation of fluid from the blood within body cavities, intestinal areas, or areas of the body that normally contain little fluid.
How is water balanced in the body?
- ADH and thirst
- ADH tells renal tubular cells to reabsorb water
When is ADH secreted?
- when there is a decrease in intravascular volume
- BP is decreased
- when there is an increase in plasma osmolality
What is osmolality?
Osmolality is a measure of the number of dissolved particles in a fluid
How does the body maintain the balance of fluid?
- ADH
- Thirst response
- Osmosis
- Kidneys filter the blood and eliminate waste and return water and electrolytes back into circulation
What are electrolytes?
minerals in the body that are able to conduct electrical charges.
Where are electrolytes found?
blood, urine, tissues, and other body fluids
What are electrolytes responsible for?
o Maintaining the balance of water in the body
o Balancing the blood pH level
o Moving nutrients into the cells
o Moving wastes out of the cells
o Maintaining proper function of the body’s muscles, heart, nerves, and brain
What are the three main fluid compartments?
- Intracellular space: space within a cell. Holds 67% of the body’s water
- Extracellular space: the space outside the cell which includes the interstitial (contains 25% of the body’s water) and intravascular areas
- Intravascular areas: the space within the vascular system including that within the chambers of the heart, the arteries and veins. Holds the remaining 8% of body water.
What is ADH?
- hormone excreted by the hypothalamus in the brain which maintains BP and fluid volume
- It tells your kidneys how much water to conserve. ADH constantly regulates and balances the amount of water in your blood. Higher water concentration increases the volume and pressure of your blood.
What is parathyroid hormone?
secreted by the parathyroid gland which regulates serum calcium concentration
What are three imbalances that can threaten homeostasis
- Dehydration
- Hypovolemia: the body has too little water
- Hypervolemia: fluid overload, the body has too much water
What are solutions used to treat fluid imbalances?
- Crystalloid solutions: fluids that contain solutes such as electrolytes or dextrose
- Colloidal solutions: IV solutions that contain large molecules unable to pass through capillary membranes
What is hypotonic?
solution which has fewer solutes than cell components and results in fluid moving into the cell
What is isotonic?
solutions which has the same number of solutes than cell components which results in no fluid movement into or out of the cell
What is hypertonic?
solution which has more solutes than are present within the cell and results in fluid movement out of the cell
What is the formula for calculating the IV drip rate?
Total volume to be infused x drop factor / total time
What is a central venous access device (CVAD)?
an IV device that is placed in larger veins
What are peripheral intravenous catheters?
single-lumen plastic cannulas inserted into a peripheral vein
What are Peripherally inserted central catheters (PICCs)?
device inserted peripherally through a vein in the arm with the tip centrally located to administer fluids, blood, medications and other therapies
What is phlebitis?
inflammation of the vein as evidenced by localized redness, pain, heat, and swelling
What is vesicant?
IV fluid that is damaging to the surrounding tissue outside the vein
What is circulatory overload?
complication of IV therapy in which too much fluid is administered too quickly
What is infiltration?
: occurs when medication or fluids move from the vein into the surrounding tissue
What are the advantages to IV therapy?
- IVs administer medication directly into a vein, so the medication takes effect almost immediately
- IV administration allows for the delivery of precise amounts of a medication
- IV route can administer medications are irritating to tissues and thus cannot be administered by other routes
- can prevent the discomfort that can occur with subcutaneous or intramuscular injection
What are isotonic IV solutions?
- osmolarity of 250 to 350 milliosmoles per liter
- used to maintain or increase the volume within the vascular system
- can cause fluid overload
What are two types of isotonic IV solutions?
- 0.9 sodium chloride: aka saline. Mixture of sodium and water. It is a diluent for mixing IV medications prior to administration. Preferred solution to use when giving blood
- Lactated Ringer’s: contains electrolytes, sodium, chloride, potassium, calcium, and lactate. Used for acidosis
What are hypotonic IV solutions?
- have an osmolarity of less than 200 miliosmoles per liter.
- used to treat a fluid and electrolyte imbalance by moving water into cells
What are hypertonic IV solutions?
- have an osmolarity greater than 350 milliosmoles per liter.
- used to correct fluid and electrolyte imbalances
- more concentrated than body fluids.
- they pull fluid from the interstitial spaces and cells into the veins
What are examples of hypertonic IV solutions?
- 3% sodium chloride solution
- 10% dextrose in water
The movement of a drug from the site of administration to various tissues of the body is what kind of pharmacokinetic action?
absorption
the movement of a drug by the circulatory system to the intended site of action is what kind of pharmacokinetic action?
distribution
What is glycolysis and oxidation?
(anaerobic metabolism) breaks down glucose. oxidizes glucose to form pyruvate. Glycolysis occurs in the cytoplasm
doesn’t need oxygen
produces lactic acid
What is the citric acid cycle
(Krebs cycle) completes the breakdown of glucose into energy
What is the difference between glycolysis and the citric acid cycle
Glycolysis is the first step involved in the process of respiration and occurs in the cytoplasm of the cell. While Krebs Cycle is the second process of respiration which occurs in the mitochondria of the cell.
What is oxyidative phopsherlation?
occurs in the mitochondria, breaks down CHO, lipids, and proteins
part of the citric acid cycle and electron transfer
What is substrate phosphorlyation
(anaerobic glycolysis)
breaks down CHO to lactic acid
What is lactic acid?
the three-carbon waste product of lactic
acid fermentation that causes a burning
feeling in muscles during exercise
If the cell has pyruvate and has oxygen to convert it into ATP what occurs?
What if it doesn’t have oxygen?
oxygen - the pyruvate goes through the citric acid cycle
no oxygen - goes through the lactic acid cycle
What are some examples of an isotonic solution?
normal saline 0.9%
lactated ringers
D5W
What are some examples for a hypotonic solution?
D5W
- 25% NaCl
- 45% NaCl
What are some examples for a hypertonic solution?
D5 NaCl
D5 in Lactated Ringers
D5 ½ NS
Is the cell slightly more positive or negative compared to the outside of the cell?
negative
What is mitosis?
division of the nucleus
What is meiosis
a type of cell division that results in four daughter cells each with half the number of chromosomes of the parent cell, as in the production of gametes and plant spores.
What is the biggest signs for lead poisoning in children?
paralysis
As cells age, what happens?
Atrophy, ↓ function, loss of cell
↓DNA repair
↑ neoplasm
↓ elastin- -collagen becomes rigid
↑ free radicals
What are the 4 major buffer mechanisms?
the bicarbonate-carbonic acid system
the phosphate system
the hemoglobin system
the protein system
What hormone increases the loss of K+?
aldosterone
What are the branches of pharm?
pharmaceutics
pharmacokinetics
pharmacodynamics
pharmacotherapeutics
What is pharmaceutics?
The study of how various drug forms influence the way in which the drug affects the body
What is pharmacokinetics
the study of drug movement throughout the body
absorption, distribution, metabolism, excretion of drugs
What is pharmacodynamics?
The study of what the drug does to the body
biochemical changes that occur in the body as a result of taking a drug
What is pharmacotherapeutics?
the study of the therapeutic uses and effects of drugs
What features of oral drugs influence rate of absorption?
enteric-coated drugs
extended-release drug
what does an extended-release drugs mean?
release over a period of time
What are parenteral drugs?
injectable drugs
Administer: intravenously into a vein (IV), subcutaneously (sub-Q), and intramuscularly into muscle tissue (IM)
Where does enteric-coated drugs get metabolized?
dissolved in the intestines
What is the absorption rate of an IV drug?
immediate and complete
What is the absorption rate of a Sub-Q and IM drug?
Highly Water-soluble -faster absorption rate
Client has slowed or impaired circulatory blood flow or tissue perfusion the absorption is slower
What is an additive reaction?
1 + 1 = 2
What is a synergistic reaction?
1+1=more than 2
one substance exacerbates the effect of the other
What is an antagonistic effect?
1+1=less than 2
when two drugs are given that have opposite effects are administered together with the two drugs canceling each other out.
What age range is considered an neonate?
less 1 month old
If less than 38 weeks gestation, premature or preterm infants
What age range is considered infant?
between 1 month and 1 year old
6-8 months gastric emptying is slower
What age considered a child?
between 1 year and 12 years old
Gastric pH is higher until age 2
What are the pregnancy drug categories?
Category A - appropriate human studies - no risk
Category B - insufficient human studies, but animal research suggests saftey or vise versa
Category C - Insufficient human studies, but animal studies show problems or no animal studies, and insufficient human studies
Category D - Human studies, with/without animal research show fetal risks, but the drug is important to some women to treat their conditions
Category X - fetal risks are evident, there are no situations where the risk/benefit justifies use
How is Na and Cl balanced in the body?
aldosterone
increased reabsorption of Na and of excretion K+ in urine
What is a new, or altered form of a drug called?
metabolite
What is anaphylactic shock?
an exaggerated response of the body’s immune system to a drug, which precipitates a massive release of histamine and other chemical mediators into the body
What is the treatment for anaphylactic shock?
re-establishment of an airway and oxygen therapy
administer epinephrine
give diphenhydramine (Benadryl) to block additional release of histamine
What are the 6 rights of medication administration?
Right patient Right medication Right dose Right time Right route Right documentation
