Exam 1 Flashcards
1
Q
Atrophy
A
Decrease in cellular size
2
Q
Hypertrophy
A
Increase in cellular size
3
Q
Hyperplasia
A
Increase in # of cells
4
Q
Dysplasia
A
Deranged cellular growth
5
Q
Metaplasia
A
Replacement of type of cell with another
6
Q
Cellular Injury
A
Reversible and irreversible inability to maintain homeostasis
7
Q
Hypoxic Injury
A
Reduced amt of O2 in the air, loss of hemoglobin, decreased RBC production, resp/cardio diseases, poison
8
Q
Ischemia
A
Inadequate blood supply to an organ
9
Q
Free Radicals and Reactive O2 Species (ROS)
A
Electrically uncharged atom or group of atoms having unpaired electron
10
Q
Chemical Cellular Injury
A
Xenobiotics (Lead, CO Monoxide, Ethanol, Mercury)
11
Q
Infectious Cellular Injury
A
Invasion/Destruction, Toxin production, hypersensitivity reactions
12
Q
Necrosis
A
Cell death (sum of changes after local cell death)
13
Q
Apoptosis
A
Programmed cellular death
14
Q
Autophagy
A
Self-destructive/survival mechanism, aging!
15
Q
Cellular Aging
A
Atrophy, decreased function, loss of cells
16
Q
Tissue and systemic aging
A
Progressive stiffness and rigidity (sarcopenia)
17
Q
Frailty
A
Mobility, balance, muscle strength, nutrition, falls, fractures, etc
18
Q
Somatic Death
A
Death of an entire person
19
Q
Postmortem Changes
A
Algor mortis (body temp), livor mortis (discoloration), rigor mortis (muscle stiffening), postmortem autolysis (enyme release)
20
Q
DNA Replication
A
Untwisting and unzipping of DNA strand (DNA is template)
21
Q
Mutation
A
Any alteration of genetic material
22
Q
Mutagen
A
Agent known to increase the frequency of mutations (radiation/chemicals)
23
Q
Central Dogma of Bio
A
DNA (transcription) - RNA (translation) - Protein
24
Q
Proteins
A
One or more polypeptides - composed of amino acids (20 aa, directed by sequence of bases)
25
Somatic Cells/Gametes Chromosomes
Somatic: 46 chromosomes
Gametes: 26 chromosomes
26
Autosomes
First 22 of 23 pairs of chromosomes (virtually identical - homologous)
27
Sex Chromosomes
Remaining pair of chromosomes - XX (female) XY (male)
28
Aneupoidy
Somatic cell that does not have multiple of 23 chromosomes (better to have extra than less)
29
Locus
Position of gene on chromosome
30
Homozygous
Loci on a pair of chromosomes with IDENTICAL genes
31
Heterozygous
Loci on a pair of chromosomes with DIFFERENT genes
32
Allele
Different form of a gene at a given locus
33
Genotype
Composition of genes (what they have)
34
Phenotype
Appearance of the genetics (what they look like)
35
Penetrance
Percentage of individuals with genotype who express the phenotype
36
Expressivity
Extent of phenotype variation
37
3 properties of an ideal drug
Effectiveness, Safety, Selectivity
38
5 "rights" related to drugs
Drug, Patient, Dose, Route, Time
39
Absorption - affecting factors
Rate of dissolution, absorbing surface, blood flow, lipid solubility, pH partitioning
40
Parenteral Benefits
No barrier to absorption, rapid onset, large amts, dispersed quickly
41
Parenteral Problems
Cost, convenience, not reversible, infection, embolism, water solubility
42
Factors affecting enteral absorption
Solubility, GI pH, gastric emptying, stomach contents, drug coatings, etc
43
Disadvantages: Enteral
Variable absorption, food inactivation, awake/alert, GI upset
44
Distribution
Movement of drug through body
45
Distribution factors (med admin)
Blood flow, ability to exit and enter vascular system or cells
46
Excretion
Removal of drug from the body (filtration, reabsorption, secretion)
47
Factors effecting excretion
pH, competition for tubular transport, age
48
Aging effects on distribution of fluids
Decreased free fat mass, decreased muscle mass, renal decline, diminished thirst perception
49
Hydrostatic Pressure
PUSH: force exerted by water in the bloodstream (pushes water out of vascular)
50
Osmotic Pressure
Pressure by solutes in solution (low conc to high)
51
Oncotic Pressure
Force by albumin in blood stream
52
Pressures that favor filtration
Capillary hydrostatic pressure and intersititial oncotic pressure
53
Pressures that favor reabsorption
Capillary Oncotic Pressure and interstitial hydrostatic pressure
54
Causes of edema
Increase in capillary hydrostatic pressure, decrease in plasma oncotic pressure, increase in permeability, lymph obstruction
55
Different types of edema
Localized, Generalized, Dependent (legs dangling), Pitting edema
56
ADH
(from hypothalamus/pituitary gland) - water balance! Increases water reabsorption into the plasma
57
Aldosterone
(from adrenal cortex) - Na balance!
58
Renin-angiotensin-aldosterone system (RAAS)
1. Decreased blood flow to kidney
2. Juxtaglomerulus apparatus in kidney - secretes renin
3. Renin changes angiotensinogen to angiotensin I
4. Angiotensin-converting-enzyme (ACE) converts angiotensin I to angiotensin II
5. Angiotensin stimulates release of aldosterone (Na + H2o retention) and vasoconstricts - raises BP!
59
Natriuretic Hormone
Protects from volume overload
Reduces BV/BP by excretion of Na and water
Increases vascular permeability
60
Isotonic alterations
Total body water (no change in electrolyte/water) eg. dehydration and hypovolemia
61
S/S of Isotonic Fluid Loss
Weight loss, increased thirst, dry skin
62
S/S of Isotonic Fluid Excess
Weight gain, decreased albumin, increased BP, increased neck veins, crackles, edema
63
Causes of isotonic fluid excess
IV therapy, aldosterone increase, drugs (cortisone)
64
Hyponatremia Causes
Pure sodium loss, low intake, dilutional hyponatremia
65
Hyponatremia S/S
Ability to polarize/repolarize, cell swelling, changes in LOC
66
Hypernatremia Causes
Gain in Na - IV, Cushing syndrome, fever, diabetes, sweating
67
Hypernatremia S/S
Thirst, weight gain, bounding pulse, increased BP, muscle twitching, coma, convulsions
68
Hypochloremia
(when bicarb increases, chloride decreases) ANION
69
Hypochloremia causes
Loss of Na, Increased Bicarb, Vomiting
70
Hyperchloremia causes
Hypernatremia, bicarb deficit (metabolic acidosis)
71
Potassium Role
Cellular membrane potential (cardiac/nerve) and buffering systems
72
Hypokalemia causes
Reduced intake of potassium, increased entry into cells, increased loss (upper gi - acid loss, lower gi - diarrhea, renal - diuretics)
73
Hypokalemia S/S
Dysrhythmias, Muscle weakness
74
Hyperkalemia Causes
Increased intake, insulin deficiency, cell trauma
75
Hyperkalemia S/S
Dysrhythmia, Neuromuscular irritability, loss of muscle tone, paralysis
76
Volatile Acids
H2CO3 (eliminated as CO2)
77
Nonvolatile Acids
Organic acids, eliminated by renal tubules
78
Bicarbonate Carbonic Acid Buffering System
In lungs and kidneys - extracellular - carbonic acid
79
Bicarbonate Carbonic Acid Buffering System (Lungs)
CO2 excretion adjusts pH (reduce carbonic acid by blowing off CO2 and leaving H2O OR increase carbonic acid by holding CO2 and combining with H2O)
80
Kidneys (Bicarbonate Carbonic Acid Buffering)
HCO3- excretion adjusts pH to bring back to normal
81
Respiratory Acidosis
Increase in pCO2 (Ventilation Depression)
82
Respiratory Alkalosis
Decrease of CO2 (Alveolar Hyperventilation)
83
Metabolic Acidosis
Decrease in HCO3
84
Metabolic Alkalosis
Increase in HCO3
85
Metabolic Acidosis Causes
Ketoacidosis, Lactic Acid, Renal Failure, Diarrhea
86
Metabolic Acidosis compensation
BiCarb Buffering, Increased ventilation, Eliminate H+
87
Metabolic Acidosis Treatment
IV Ringers Lactate, Na Bicarb IV
88
Metabolic Alkalosis Causes
Loss of Acid, Accumulation of Bicarb
89
Metabolic Alkalosis compensation
Decreased ventitlation, eliminate HCO3, retain H+
90
Metabolic Alkalosis Treatment
IV Saline
91
Respiratory Acidosis
HYPOventilation
92
Respiratory Acidosis Treatment
Restore ventilation, mechanical ventilation, administer O2
93
Respiratory Alkalosis
HYPERventilation (initial response to hypoxia)
94
Goal of Renal System
Balance H2O/Solutes, Excrete waste, conserve nutrients, regulate acid/base
95
Endocrine Function of Renal System
Regulate BP (Renin), Erythrocyte Production (Erythropoietin), Calcium Metabolism (vitamin D)
96
How much urine does a bladder hold before it senses the urge to urinate?
250-300
97
Urge to void
Parasympathetic fibers of ANS
98
Length of Urethra (Female)
3-4cm
99
Length of Urethra (Male)
18-20 cm
100
Parts of kidney that collect urine
Calyx
101
Structure unit of kidneys
Lobes (14-18 per kidney)
102
Functional unit of kidneys
Nephron (1.2 mill)
103
Proximal Tubule function
Reabsorption of Na, Glucose, K+, AA
Secretion of H+, drugs
104
Loop of Henle function
Concentration of urine
Water Absorption
Urea secretion
105
Distal Tubule
Reabsorption of Na, H2O, HCO3
Secretion of urea, K+, H+
Aldosterone
106
Collecting Duct
Reabsorption of H2O (ADH required)
Secretion of Na+, H+, K+
107
Nephron Function
Filters plasma, reabsorbs different substances, forms a filtrate, regulates body fluid volume, electrolytes, and pH
108
Renal Blood Flow
20-25% of C/O
1-2 L of Urine
109
Glomerular Filtration Rate (GFR)
Filtration of plasma per unit of time
Movement of solutes across capillary membrane
110
GFR is related to:
Perfusion pressure of capillaries, renal blood flow
111
What is the minimal urine output?
30ml
112
Favoring force in GFR
Glomerular hydrostatic pressure (is impermeable too large molecules)
113
Opposing forces in GFR
Hydrostatic pressure
Plasma oncotic pressure
114
Filtration
Water, free of proteins, blood cells, electrolytes, organic molecules
115
Reabsorption
Movement of particles and water into plasma
116
Secretion
Movement of particles from plasma into tubules
117
Nephron Hormones
ADH, Aldosterone, Natriuretic Peptides (Urodilantin - distal tubules and collecting duct)
118
Kidney Hormones
Vitamin D, Erythropoietin
119
Erythropoietin
Stimulates production of RBCs
Senses low Oxygen
Anemia - Low production of Epo
120
Urea
Protein metabolism (50% urine, 50% in kidneys) - Individuals w/ protein deprivation do not maximally concentrate urine
121
Urinary Tract Obstruction (Upper)
Smooth muscle, urine above blockage (common is renal calculi)
122
Hydroureter
Dilation of ureter
123
Hydronephrosis
Kidney swells and cannot get rid of pee
124
Renal Calculi - Stones
Nephrolithiasis (mass of crystals/protein) - cause infection
125
Types of Renal Calculi
Calcium (70-80)
Struvite (15%)
Uric (7%)
126
Stone Formation
Supersaturation/Precipitation - Crystallization - Growth - No inhibitors
127
Renal Calculi Risk Factors
Immobilization, Diet (high sodium, lots of nuts and coffee, supplements), lack of H2O
128
Infection from Renal Calculi
Increases saturation of substance, bacteria, staghorn formation
129
Renal Calculi Symptoms
Pain (flank, cva, groin), hematuria, oliguria
130
Renal Calculi Treatment
Pain management, lithotripsy (laser), nephrolitotomy
131
Lower Urinary Tract Obstruction
Storage/Emptying of Urine
132
Incontinence Examples
Urge
Stress
Overflow
Mixed
Functional
133
Urinary Tract Infection
Infection of any part of the urinary tract, diagnosed by presence of microorganism
134
Defense mechanisms to UTI
1. Urine flow, pH, osmolality, uromodulin
2. Antibaterial effect of mucosa
3. Bacterioocidal of prostatic fluid
4. Ureterovesical junction
5. Length of urethra
135
Acute Cystitis
Bladder Infection
136
Acute Cystitis Risk Factors
Sexual activity, poor hygiene, neurogenic bladder, obstruction, diabetes mellitus
137
Acute Cystitis Symptoms
Asymptomatic, Dysuria, Frequency, Urgency, Suprapubic pain, hematuria
138
Acute Cystitis Treatment
1-3 days of antibiotic (may develop into pyelonephritis)
139
Pyelonephritis
Inflammation of renal pelvis and interstitium
140
Most common bacteria of pyelonephritis
E. Coli
141
Glomerular Disorder
1. Inflammation of glomerulus
Damaged by:
2. Chemicals, radiation, hypoxemia, infection, etc.
3. Damaged/Inflamed glomerulus resulting in sediment (nephrotic, nephritic)
142
Nephrotic Syndrome
Protein, lipids
- Glomerulonephritis
143
Nephritic Sediment
Blood
- Infection
144
Glomerulonephritis Symptoms
Hematuria with RBC, Proteinuria, HTN, Decreased GFR
145
Nephrotic Syndrome (Progressive Glomerulonephritis)
Group of symptoms caused by loss of protein (greater than 3.5 of protein), edema, hyperlipidemia, infection
146
Acute Kidney Injury (Acute Renal Failure)
Abrupt reduction in GFR and increase in BUN + Creatinine
- Oliguria
147
Prerenal AKI
Hypoperfusion (hypotension in kidneys)
- Hypovolemia
- Vasodilation
- Renal vascular obstruction
- Inadequate C/O
148
Intrarenal - Intrinsic AKI
Caused by Acute Tubular Necrosis
- Ischemic or Nephrotoxic
149
Postrenal AKI
Obstruction to outflow
- Benign Prostatic Hypertrophy
- Nephrolithiasis
- Tumors
150
Most common kind of AKI
Acute Tubular Necrosis (ATN) caused by ischemia and nephrotoxins
151
AKI risk factors
Increased in volume depletion
Elderly
Pre-existing renal disease
Post-Op
Anesthesia
152
Initiation Phase - AKI
24-48 hr post event (period of reduced perfusion is evolving)
153
Maintenance Phase - AKI
"Oliguric state"
- Hyperkalemia
- Metabolic Acidosis
- Anemia
- Fluid retention
154
Recovery Phase - AKI
Diuretic stage
- Output: >400cc/day
- Dehydration
- Hypokalemia/Hyponatremia
155
Chronic Kidney Disease (CRF)
Maintain function when 50% is damaged
- Progressive loss of kidney function
156
Stages of Disease
Stage I - Normal (90ml/min)
Stage II - 60-89
Stage III - 30-59
Stage 4 - (15-29)
Stage V - Dialysis/Transplant
157
CKD Clinical Manifestations
Azotemia/Uremia (irritates all body parts)
Atherosclerosis, HTN, Pericarditis, CHF
Kussmaul, Pneumonitis
Anemia (reduced EPO, increase bleeding, risk for clots)
Skin pallor, pruritis, uremic frost
Hiccups, Anorexia, Ulcers
Drowsiness, Concentration, Seizures, Asterixis
Osteodystrophy
158
CKD Treatment
Dietary Control,Medications, Dialysis/Transplant
159
Uses of Diuretics
Treatment of HTN
Mobilization of Fluid
Prevent renal failure
160
Osmotics (Mannitol) Site
Proximal Convoluted Tubule
161
Loops (Furosemide) Site
Thick Ascending Henles Loop
162
Thiazides Site
Convoluted Tubule
163
K+ Sparing (spironolactone or triamterene)
Distal Convoluted Tubule and Collecting Duct
164
Loop Diuretics Action
Block amounts of NaCl reabsorption
165
Loop Diuretics Pharmacology
60 min - PO / 5 min - IV
5 hr - PO / 2 hr - IV
166
Loop Diuretics Use
Conditions required significant fluid loss
Edema
167
Loop Diuretics adverse drug reactions
Dehydration
Hypotension
Electrolyte Imbalance
Ototoxicity
Hyperuricemia
168
Loop Diuretics Drug Interactions
Digoxin - Lithium levels
Ototoxic Drugs - NSAID, K+ Sparing, Antihypertensives
169
Loop Diuretics Examples
Furosemide (Lasix), Ethacrynic Acid (Edecrin), Bumetanide (Bumex)
170
Thiazide Diuretics Action
Block absorption of Na/Cl in distal CT
Dependent on renal function **
171
Thiazide Diuretics Pharm
Po - 1-2hr (lasts 6-12)
Slow release available
172
Thiazide ADR
Same as loops (hypokalemia)
Hyperlipidemia (increased cholesterol)
Hypersensitivity
Not ototoxic
173
Thiazide Diuretics Drug Interactions
Same as Loop (except for ototoxic)
Bile acid resins can bind to drug
174
Thiazide Drugs Examples
8 - End in Thiazide (hydrochlorothiazide)
All PO except Chlorothiazide
175
K+ Sparing diuretics action (Sprinolactone - Aldactone)
Blocks action of aldosterone in collecting duct
Causes excretion of Na and retention of K
Minimal diuresis
176
K+ Sparing Uses
HTN + Edema
Used with thiazides or loops (prevent hypokalemia)
Block effects of aldosterone in pts with hyperaldosteronism
177
K+ Sparing - ADR
Hyperkalemia
Hormone irregularities
Drug reactions - elevate potassium levels
178
Osmotic Diuretics (Mannitol) Action
Sugar that creates osmotic force in glomerulus
Increases osmotic pressure (water is not reabsorbed)
Little effect on electrolytes
**ICP
179
Osmotic - Mannitol Pharm
IV only
Does not cross GI endothelium
Crosses Capillary endothelium but not in brain
180
Mannitol - ADR
Edema
181
Mannitol - Uses
Renal Failure, Reduction of ICP, Reduction of intraocular pressure
