FINAL Flashcards
(95 cards)
1
Q
Stages of Inflammation
A
- Vascular
- Cellular
- Systemic
2
Q
Vascular Phase Steps
A
- Transient vasoconstriction (short)
- Vasodilation (due to histamine, bradykinin)
- Increased capillary permeability (allows plasma, WBCs, and platelets to reach injury site)
- Leads to signs of inflammation
3
Q
Systemic Phase
A
-Inflammatory Mediators: cytokines, prostaglandins, TNF-alpha, interleukins
-Cause:
Fever, lymphadenopathy, leukocytosis, anorexia, fatigue, weight loss
4
Q
Cellular Phase
A
-WBC: migrate to injury site
-Chemotaxis: chemical signals direct WBC movement to affected area
-Margination: WBCs adhere to blood vessel wall
-Diapedesis: WBCs squeeze through capillary pores to enter tissue
-Neutrophils: arrive 6-24hrs
-Monocytes/macrophages: arrive 24-48hrs
-Phagocytosis: WBC engulf and destroy pathogens and debris
5
Q
Adaptive Immunity
A
A specific, learned response developed after antigen exposure, with memory for future protection
6
Q
Components of Innate Immunity
A
- Anatomical barriers
- Cellular defense
- Chemical defense
7
Q
Anatomical Barriers
A
- Skin and mucous membranes
- Respiratory Defense
-Mucus and cilia trap and expel invaders - GI Tract
-saliva, gastric mucus and HCl destroy pathogens
8
Q
Cellular Defense
A
- Phagocytic Cells
-Macrophages and neutrophils
-Engulf and destroy - Natural Killer (NK) Cells
-Lymphocytes that attack virus infected and cancerous cells - Complement System
-Proteins that enhance immune response
9
Q
Chemical Defenses
A
Cytokines, Interferons, HCl
-Protect against infections by modulating inflammation and immune function
10
Q
Adaptive Immunity Response
A
- Cell-Mediated Immunity (T Cells)
-Direct attack on infected cells - Humoral Immunity (B Cells and Antibodies)
-Production of antibodies that neutralize pathogens
11
Q
Types of Lymphocytes
A
- T Lymphocyte (T cell)
- B Lymphocytes (B cell)
12
Q
T Lymphocytes (T Cells)
A
- CD4 Cells (Helper T Cells)
-Coordinate immune responses by stimulating other immune cells - CD8 Cells (Cytotoxic T Cells)
-Directly kill infected or abnormal cells - Regulatory T Cells
-Help prevent autoimmune response
13
Q
B Lymphocytes
A
-Mature into plasma cells which produce immunoglobulins (IGs) (antibodies)
-Form memory B cells for long-term immunity
14
Q
Penicillin Prototype
A
Amoxicllin
15
Q
Penicillin Adverse Reactions
A
-GI Issues
-Superinfections: Candida (oral or vaginal) or C. diff
-Allergic Reaction: RASH, HIVES, anaphylaxis
16
Q
Penicillin Interventions
A
-Monitor for GI upset
-Watch for allergic reactions
-For IM or IV: observe for 30min
17
Q
Penicillin Contraindications
A
-Known penicillin allergy
-Hypersensitivity to procaine or benzathine
-Severe renal impairment
-Oral contraceptive effectiveness may be reduced
18
Q
Vancomycin Use
A
MRSA
19
Q
Vancomycin Adverse Reaction
A
-Renal failure
-Vancomycin Infusion Reaction: tachycardia, hypotension, rash, pruritus, flushing
-Ototoxicity: rare but possible
-IV site irritation
**Monitor trough levels and serum creatinine
20
Q
Vancomycin Interventions
A
-Admin over 60min
-Monitor vs during infusion
-Check trough levels before next dose
-Monitor Kidney function (BUN, creatinine)
-Assess for superinfections (C. diff, oral/vaginal candida
-Watch for ototoxicity
21
Q
Vancomycin Contraindications
A
-Renal Impairment
-Hearing impairment
22
Q
Sulfonamides Uses
A
UTI
Traveler’s diarrhea
23
Q
Sulfonamide Adverse Reaction
A
- Stevens-Johnson syndrome
-Blood Disorders
-Crystalluria (kidney damage d/t crystals in urine)
-Photosensitivity
24
Q
Sulfonamides Interventions
A
-1,200-1,500mL water per day
-Monitor CBC for blood disorders
-Assess for rash or hives
25
Sulfonamides Contraindications
-Pregnancy, breastfeeding
-Severe renal or liver impairment
-Megaloblastic anemia (folic acid deficiency)
26
T1DM Pathophys
T-cell mediated autoimmune destruction of pancreatic beta cells in the islets of Langerhans
27
T1DM S/S
-Polydipsia
-Polyuria
-Polyphagia
-Weight loss
-Fatigue
-Weakness
-Blurred Vision
-Sweaty
-DKA
28
T2DM Pathophys
Insulin resistance. Over time beta cell function decrease
29
T2DM S/S
-Gradual 3Ps
-Visual changes
-Poor wound healing
-Hyperosmolar hyperglycemic syndrome
30
Hypoglycemia Parameters
<70
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Hyperglycemia parameters
Fasting: >126
Postprandial: >200
A1c: >6.5%
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Prediabetes Parameters
Fasting: 100-125
A1c: 5.7-6.4%
33
Biguanides (Metformin) Indication
T2DM
34
Biguanides MOA
-Increase insulin sensitivity
-Inhibit hepatic gluconeogenesis
35
Biguanides Contraindications
-Renal impairment
-Hepatic Dysfunction
36
Sulfonylurea Indication
T2DM
37
Sulfonylurea MOA
Stimulate insulin release by binding to pancreatic beta-cell receptors, enhancing insulin exocytosis
-Must have functioning beta-cells
38
Sulfonylurea Contraindications
-Sulfa allergy
-Alcohol use
39
GLP-1 Indication
T2DM
-Decreased GLP-1 with obesity and insulin resistance
40
GLP-1 MOA
Enhance glucose-dependent insulin secretion
-Suppress postprandial glucagon, delays gastric emptying, promotes satiety, weight loss, and improves beta cell mass
41
GLP-1 Contraindications
-T1DM
-DKA
-Severe GI disease
42
GLP-1 Adverse Reactions
-Mild to moderate GI and neurological symptoms
-Injection site reaction
-Hypoglycemia risk increase with sulfonylureas
43
Hyperthyroid Causes
Grave's Disease Most Common Cause
44
Grave's Disease pathophys
TSH receptor antibodies stimulate excessive T3/T4 production
45
Primary Hyperthyroid pathophys
Excess thyroid hormone from thyroid gland
46
Secondary Hyperthyroid pathophys
Elevated TSH from pituitary
47
Hyperthyroid Presentation
-Weight loss
-Heat intolerance
-Nervousness
-Palpitations
-Exophthalmos
48
Hyperthyroid Treatment
-Methimazole
-PTU
-Radioactive Iodine
-Surgery
49
Thyroid Storm Triggers
-Trauma
-Infection
-Surgery
50
Thyroid Storm Symptoms
-High fever
-Tachycardia
-Delirium
-Coma
51
Thyroid Storm Treatment
-Methimazole
-PTU
-Radioactive Iodine
-Beta-blockers
52
Hypothyroid Causes
-Genetic Disorders
-Hashimoto's
-Surgery
-Radiation
-Meds
53
Hashimoto's Pathophys
-TSH receptor antibodies block normal TSH stimulation
54
Hypothyroid Presentation
-Cold intolerance
-Weight gain
-Fatigue
-Sluggishness
-Puffy face
-Hoarse voice
-HLD
-Anemia
-Myxedema
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Hypothyroid Diagnosis
Primary: high TSH and low T3/T4
Secondary: Low TSH and low T4
56
Hypothyroid Treatment
Levothyroxine
57
Inflammatory Bowel Disease (IBD)
-Crohn's Disease
-Ulcerative Colitis
58
IBD Onset
15-30yo
55-65yo
59
Crohn's Disease Etiology
-Associated With: smoking, stress, fat-rich diet
-Genetic Factors
60
Crohn's Disease Pathophys
-Transmural inflammation --> granuloma formation, SKIP LESIONS, cobblestoning
-Immune Activation: Neutrophils, T-cells, cytokines-- sustain chronic inflammation
61
Crohn's Disease Complications
-Fistulas, abscesses, strictures, short bowel syndrome
-Toxic megacolon, nutritional deficiencies, malabsorption
-Extraintestinal: arthritis, liver disease
62
Crohn's Disease Clinical Manifestations
-GI symp: Diarrhea (non-bloody), crampy abd, weight loss, fatigue, fever
-Nutritional Effects: Anemia, electrolyte imbalance, vitamin deficiencies (B12)
63
Crohn's Disease Diagnosis
-Colonoscopy with biopsy
-CT/MRI
64
Crohn's Disease Treatment
Pharm:
- 5-ASA (mesalamine)
-Biologics: infliximab, adalimumab
Surgery
-Required in 75-80% over lifetime
65
Ulcerative Colitis Etiology
-No known cause, likely genetic, immune, microbial
-Autoantibodies against intestinal cells and microbiome play roll
66
Ulcerative Colitis Pathophys
-Inflammation is continuous starting at rectum and moving up through COLON
-Limited to mucosa and submucas
NOT TRANSMURAL
-Features: crypt abscesses, pseudopolyps , goblet cell loss
-TOXIC MEGACOLON: may occur
67
Ulcerative Colitis Presentation
-GI: Bloody diarrhea (can exceed 20/day), colicky abd pain, dehydration, weight loss
-Extrainestinal: Uveitis, pyoderma gangrenosum, erythema nodosum
68
Ulcerative Colitis Diagnosis
Colonoscopy and biopsy
69
Ulcerative Colitis Treatment
First Line: topical 5-ASA (mesalamine)
Severe Cases: Oral 5-ASA, corticosteroids, immunomodulators
Surgery: colectomy
70
Irritable Bowel Syndrome (IBS)
Abdominal discomfort or pain accompanied by changes in bowel habits diarrhea, constipation, or both-in
the absence of detectable structural or biochemical abnormalities.
71
IBS Etiology and Risk Factors
-Disruptions in gut-brain axis (GBA)
-Visceral hypersensitivity
-Altered GI Motility
-Microbiome dysbiosis
72
IBS Pathopys
-GI motility abnormalities
-Visceral Hypersensitivity
-Microbiome imbalance
73
IBS Presentation
-Abdominal pain or discomfort for at least 6mo
-Altered bowel habits
Symptoms:
-Bloating, flatulence, nausea, vomiting
-Mucus in stools
-Pain relieved by defecation
-Anxiety and stress frequently reported
-Normal physical exam
74
IBS Alarming Symptoms
Rectal bleeding
Anemia (especially iron-deficiency)
Unintentional weight loss
Family history of colon cancer or celiac disease
Abdominal or rectal masses
Inflammatory markers elevated
75
IBS Diagnosis
ROME IV Criteria (Gold Standard):
-Recurrent abdominal pain at least 1 day per week in the last 3 months, with 2 or more of:
-Related to defecation
-Associated with a change in stool frequency
-Associated with a change in stool form (appearance)
76
IBS Pharm
Constipation: PEG (MiraLAX)
Diarrhea: Loperamide
77
Sulfasalazine (5-ASA): Indications
IBD: Ulcerative Colitis
78
Sulfasalazine (5-ASA): MOA
Locally acting anti-inflammatory action in the colon, where activity is probably a result of inhibition of prostaglandin synthesis
79
Sulfasalazine (5-ASA): Adverse Reaction
-Rash
-DRESS
-Exfoliative Dermatitis
-SJS
Monitor CBC and liver function
80
Senna Indications
Constipation
81
Senna MOA
Alter water and electrolyte transport in the large intestine, resulting
in accumulation of water and increased peristalsis
82
Senna Adverse Reaction
GI cramping, diarrhea, nausea
83
Docusate (colace) Indication
-PO prevention of constipation
-Rectal: Used as enema to soften fecal impaction
84
Docusate (colace): Action
Promotes incorporation of water into stool, resulting in softer fecal mass
May also promote electrolyte and water secretion into the colon.
85
Docusate (colace): Adverse Reaction
-Dependence may develop with excessive or prolonged used
-Discontinue use if results aren't prompt
86
Polyethylene glycol: Indication
Occasional constipation
87
Polyethylene glycol: Action
Acts as osmotic agent, drawing water into GI tract
88
Polyethylene glycol: Adverse Reactions
-Derm: urticaria (hives)
GI: Abd bloating, cramping, farting, nausea
89
Ondansetron (zofran) Indication
Prevent nausea and vomiting
90
Ondansetron (zofran) Action
Blocks the effects of serotonin at 5-HT, receptor sites (selective antagonist) located in vagal nerve terminals
and the chemoreceptor trigger zone in the CNS
91
Ondansetron (zofran): Adverse Reaction
-Myocardial ischemia
-QT prolongation, Torsades de pointes
-SJS
92
Metoclopramide (Reglan) Indication
-Prevention of nausea and vomiting associated with emetogenic chemotherapy
-Prevention of postoperative nausea and vomiting when nasogastric suctioning is undesirable
-Facilitation of
small bowel intubation in radiographic procedures.
93
Metoclopramide (Reglan) Action
Blocks dopamine receptors in chemoreceptor trigger zone of CNS
Stimulates motility of upper GI tract and accelerates gastric emptying
94
Metoclopramide (Reglan): Adverse Reaction
-Neuroleptic Malignant Syndrome
-Tardive Dyskinesia
- Tremor
-Drowsiness, dysgeusia, restlessness, anxiety, cog-wheel rigidity
95
