Final Flashcards
1
Q
what are the three types of assessment basics?
A
- Drug Related Need
- Drug Therapy problem
- Medication experience
2
Q
what questions do you ask for drug related needs?
A
- Appropriate
- Effective
- Safe
- Able/willing to take as instructed
3
Q
what questions do you ask for drug therapy problems?
A
- unnecessary drug therapy
- needs additional
- ineffective drug
- dose too low
- dose too high
- adverse drug
- non-adherence
4
Q
what is a plan and how do you make it for a patient?
A
develop an individualized pt centered plan that should be evidenced based and cost effective
5
Q
what are the three main types of communication?
A
- written documentation
- other written documentation
- verbal communication
6
Q
what is a patient’s personalized care plan?
A
summary of drug/disease/PHI, place to record questions for next visit, given to patient and actively engages the patient in care
7
Q
what is a SOAP note?
A
formal note seen in a medical record, documents a patient encounter or an interaction, sections formally labeled S/O and A/P
8
Q
what is an SBAR note?
A
may include patient medical record or may be used for verbal communication, documents a clinical recommendation of brief patient interaction that requires action, shorter and less detailed than SOAP note
9
Q
what is a progress note?
A
LEAST formal abbreviated documentation, may or may not have a structured format, documents a patient encounter or a decision, often used for short interactions or phone follow-up
10
Q
is the care plan ever entered into the EMR?
A
NO
11
Q
what is a chief complaint?
A
statement of why patient has presented (why they say they’re there)
12
Q
what is past medical history?
A
past/active diagnoses, hospitalizations, surgeries, accidents or injuries
13
Q
what is history of present illness ?
A
S - Symptoms C - Characteristics H - History O - Onset L - Location A - Aggravating factors R - Remitting factors
14
Q
What is medication experience?
A
patients general attitude towards taking medication, what patient wants/expects from drug therapy, understanding of medication etc
15
Q
what is social and family history?
A
social - alcohol/caffeine/illicit drug use/tobacco use
family - conditions in 1st degree relatives (cause of death if applicable)
16
Q
what objective info to collect?
A
- vitals
- labs/diagnostic tests
- physical exam findings
- current meds
- refill records
- immunization records
- history documented in med record
- drug info
17
Q
what are the 4 key questions for analyzing medications?
A
Is the medication indicated?
Is the medication effective?
Is the medication safe?
Can the patient adhere?
18
Q
How do you prioritize problems?
A
(1) most urgent - what’s gonna kill them first
(2) address immediately
(3) Address later
19
Q
what are the dtps associated with indication?
A
unnecessary drug therapy and needs additional drug therapy
20
Q
what the dtps associated with effectiveness?
A
ineffective drug and dose too low
21
Q
what are the dtps associated with safety?
A
dose too high and adverse drug reactions
22
Q
what is the dtp associated with adherence?
A
non-adherence
23
Q
what are some common causes of unnecessary drug therapy?
A
- duplicate therapy
- no medical indication
- non-drug therapy more appropriate
- addiction/recreational drug use
- treating avoidable adverse reactions
24
Q
what are some common causes of needs additional drug therapy?
A
- preventative therapy
- untreated condition
- synergistic therapy
25
what are some common causes of ineffective drug?
- more effective drug available
- condition refractory to drug
- dosage form inappropriate
- contraindication present
- drug not indicated for condition
26
what are some common causes of dosage too low?
- ineffective dose
- needs additional monitoring
- frequency inappropriate
- incorrect administration
- drug interaction
- incorrect storage
- duration inappropriate
27
what are some causes of adverse drug reaction?
- undesirable effect
- unsafe drug for patient
- drug interaction
- incorrect administration
- allergic reaction
- dose increase/decrease too fast
28
what are some common causes of adherence?
- does not understand instructions
- cannot afford drug product
- patient prefers not to take
- drug product not available
- cannot swallow/administer drug
29
what is the difference between MTM and patient counseling?
mtm - requires documentation, compensation for mtm not related to drug product provision
counseling - patient-centered vs product centered
30
mtm eligibility for part D
- drug spend in part d medis > $4,044
- multiple part d meds greater than or equal to 2 to 8
- targeted disease states or any chronic disease greater than or equal to 2 to 8
31
what are the part d mtm targeted disease states (must have at lease 5 to 9)
- alzheimers
- ESRD
- HTN
- CHF
- DM
- HLD
- Respiratory disease
- bone disease
- mental health disorders
32
essential assessment skills
```
inquiry
listening
observational skills
pharmacotherapy knowledge
organization
```
33
what are the 3 activities during assessment
meet the patient
get info from patient/records
make drug therapy decisions
34
what questions do you ask yourself for assessment of drug related needs?
1. Are drug-related needs being met?
2. Are all meds appropriately indicated?
3. Are all meds most effective available?
4. Are all meds the safest possible?
5. Able and willing to take meds as intended?
35
what are the components for goals of therapy?
1. goals for each indication
2. described with clinical/lab parameters to evaluate efficacy and safety
3. include the patient and other practitioners
4. realistic to patients present and potential capabilities
5. include time frame for achievement
36
what are the three categories of interventions?
1. resolve drug therapy problems
2. achieve goals of therapy
3. prevent problems
37
what is a "good" intervention?
- individualized based on conditions, drug-related needs, and drug therapy problems
- all therapeutic alternatives to resolve DTPs are considered and the best selected
- developed in collaboration with patient, family and/or caregivers, and practitioner
- documented
- provides for continuity of care
38
establishing a follow-up schedule
1. determined by goals of therapy
2. evaluate efficacy
3. evaluate safety
39
what are the reasons for early follow-up
- past treatment failures
- past adverse effects
- worsening clinical status
- lack of full capability to engage in plan
- high risk medications (and not at goal)
40
what are the "high risk" medications?
1. digoxin
2. warfarin/anticoagulants
3. antiplatelets
4. hypoglycemic
5. insulin
41
what are key factors in determining implementation?
1. practice site
2. scope of privileges
3. type of plan used
42
what are the only two outcomes in which a change to drug therapy is needed?
worsened or failure
43
the RESPECT model
R - respect: connect on social level
E - empathy: verbally acknowledge and legitimize patient's feelings
S - support: ask about, try to understand, and help patient over barriers to care
P - partnership: be flexible
E - expectations: often check understanding
C - cultural competence: respect the patient and his/her beliefs
T - trust: work to establish trust
44
what are non-supportive responses
judging, advising, reassuring, generalizing, distracting
45
what are the signs of limited literacy?
- excuses
- length of time to complete forms
- inappropriate answers or blanks on forms
- does not turn paper "right-side" up
- frequent errors
- missed appointments
- nonverbal behaviors
46
what is motivational interviewing?
- person centered
- guided
- goal directed
- seeks patient's arguments to change
- enhances intrinsic motivation to change by exploring and resolving ambivalence and resistance
47
READS model
```
R - rolling with resistance
E - expressing empathy
A - Avoiding argumentation
D - developing discrepancies
S - supporting self-efficacy
```
48
Change talk DARN model
D - Desire
A - Ability
R - Reason
N - Need
49
What are the MI tools?
1. Ask permission
2. The envelope
3. The insurance card
4. A look over the fence
5. importance/confidence rulers
50
FIG and creating the conversation
F - Follow (reflect)
I - Inform (ask permission) and identify
G - Guide
51
Tertiary resources
information that has been summarized to provide an overview of a topic
ex) textbooks, internet webistes
52
Secondary resources
Pubmed
53
Primary literature
journals
54
P1 perceived orietation
Acceptance
55
P1 developmental orientation
minimization
56
BMI
body mass index
57
BP
blood pressure
58
BPM
beats per min
59
CV
cardiovascular
60
DBP
diastolic blood pressure
61
HTN
hypertension
62
mmHg
millimeters of mercury
63
RPM
respirations per minute
64
SBP
systolic blood pressure
65
Physical appearance (assessment)
```
age
skin color
facial features
level of consciousness
signs of distress
nutrition
body structure
dress/grooming
behavior
mobility
```
66
what meds can cause weigh gain?
steroids, antipsychotics, antidepressants, diabetes meds
67
what meds can cause weight loss?
ADHD meds, antidepressants, diabetes meds
68
what is edema?
fluid leaking into tissues or swelling
69
what are some causes of edema?
Chronic - heart function, kidney function, liver function, meds
Acute - inflammation, injury, diet, blood clot/obstruction, pregnancy, meds
70
for edema contact MD if
- stretched and shiny skin
- pitting edema(3+ and 4+)
- edema that will not go away after prolonged sitting
71
when to refer a fever
adults and children: greater or equal too 104 degrees F(either symptomatic or nonresponsive and lasts longer than 3 days)
72
cluster headache
```
Cluster Headaches
Characteristics:
Male Female
Onset around 30 years old
Duration of 15 minutes up to 3 months
Causes
Hypoxia
Sudden release of histamine or
serotonin
```
73
cluster headache symptoms
```
Cluster Headaches
Symptoms
Constant and severe pain
Usually unilateral; centered around the eye
Episodic or chronic
Tearing of affected eye
Drooping eyelid
Nasal stuffiness
Nausea and vomiting
Photophobia
Phonophobia
```
74
migraine characteristics/causes
```
Migraine Headaches
Characteristics:
Female Male
Causes
Hormonal, vascular changes, or neuronal changes
Change in sleeping patterns
Missing meals
Increased intake of fatty foods
Weather changes
Onset between 15 - 35 years old
Duration per episode: 4 hours - 3 days
```
75
migraine symptoms
```
Migraine Headaches
Symptoms
Pulsating or throbbing pain
Usually unilateral near the temples
Nausea/Vomiting
Sensitivity to light, sound, movement
Warning signs may occur hours to days before episode
Psychologic, neurologic, or autonomic
Roughly 10% of patients experience an aura
```
76
tension headache
```
Tension Headaches
Most common type of headache
Causes
Stress or anxiety
Symptoms
Often described as "band-like" pain
Dull, non-pulsating tightness/pressure
Usually bilateral
Episodic or chronic
Sensitivity to light and sound (photophobia and phonophobia)
```
77
when to refer a headache
```
Referral
Refer if any factor is present
• Patient has symptoms suggestive of migraine or
cluster headache
• Headache associated with significant
hypertension
• Headache lasting >10 days
• >3 headaches per week
• Last trimester of pregnancy (preeclampsia)
• Stiff neck (possible infection)
• Head trauma
• Symptoms resistant to self-care
```
78
conjunctivitis
```
Conjunctivitis
Conjunctiva
Clear membrane lining the inner
surface of the eye and eyelid
Conjunctivitis (AKA pink eye)
0 Inflammation of the conjunctiva
Meds that cause conjunctivitis:
Amiodarone
Isotretinoin
Bisphosphonates
COX-2 inhibitors
```
79
viral conjunctivitis
```
Viral Conjunctivitis
Cause
Typically preceded by sore throat or cold (Adenovirus)
c
Contagious
Symptoms
Pink/red eye
Watery discharge
Blurred vision
Low-grade fever
Duration: 1-3 weeks
Only symptomatic treatment
Lubricants (e.g. artificial tears)
Ocular decongestants (e.g. Naphazoline -
Naphcon-A @ )
```
80
bacterial conjunctivitis
```
Bacterial Conjunctivitis
Common bacterial causes: S. aureus, S. epidermidis, S. pneumoniae, H. influenzae
Symptoms
Pink/red eyes
Purulent discharge (green(yellow)
Eye discomfort/pressure
Crusted eyelids
Eyelid edema
Blurred vision
Duration: roughly 2 weeks
Treatment: requires antibiotics
Contagious
```
81
allergic conjunctivitis
```
Not Contagious
Allergic Conjunctivitis
Cause: exposure to allergens
Signs/symptoms
Pink/red eyes
Clear watery discharge
May be stringy and white
Burning or itching
Eye discomfort
Eyelid edema
Usually affects BOTH eyes
Treatment
0 Topical antihistamine
Pheniramine eyedrops - Naphcon-A
Mast cell stabilizers
Cromolyn eyedrops
Anti-inflammatory agents
Naphazoline eyedrops - Naphcon-A
```
82
glaucoma
```
Glaucoma
Group of eye disorders involving optic
neuropathy
Changes in optic disc
o
Loss of visual sensitivity & field
```
```
Caused by:
Reduced blood flow, retinal ischemia,
increased intraocular pressure
Primary (hereditary) vs. Secondary
(disease, trauma, or drugs)
Not Contagious
Development of Glaucoma
Healthy eye
Vitreous body
Flow Of
aqueous
humour
Drainage canal
Glaucoma
1. Drainage
canal blocked;
build-up of fluid
2. Increased pressure
damages blood vessels
and optic nerve
Symptoms
Occurs after significant damage
```
83
blepharitis
```
Blepharitis
Infection of eyelid which may lead to sty formation
Caused by bacteria
Hands
Cosmetics
Contact Lenses
Symptoms
Lump on or near edge of eyelid
Painful
Swollen
Pus-filled
Treatment
Warm compress
Lubricants (e.g. artificial tears)
```
84
eye problems when to refer
```
Referral
Refer if any factor is present
• Symptoms of infection
• Conditions resistant to self-care (72 hours)
• Exposure to chemicals
• Trauma to eye
• Glaucoma
• Signs/symptoms of vision loss
```
85
eye drop administration instructions
Eye Drop Administration
up PATIENT
CARE
IMPLEM
1.
2.
3.
4.
5.
6.
7.
Wash your hands with soap and water before using this medicine.
Remove cap without touching the dropper lid
Lie down or tilt head back. With your index finger, pull down the lower lid of
your eye to form a pocket and hold the dropper directly over eye with other
hand (without allowing dropper to touch eye or eyelid)
Look up (away from tip) and place drop into the pocket made between your
lower lid and eyeball
Hold eyelid for a moment allowing solution to spread
Gently close your eyes apply light pressure to nasolacrimal opening on side of
nose for 15-30 seconds to limit systemic absorption or loss of product
Wash hands thoroughly again
86
otitis media
```
Otitis Media
Inflammation of middle ear
Common in children <3
o
years of age
Causes
o
o
o
o
Bacterial
Viral
Allergies
Irritants ( e.g. cigarette
smoke)
```
87
types of otitis media
Types of Otitis Media
```
L......J AOM
Most common
Rapid onset symptoms: pain, fever,
discharge, redness, pulling at ears,
irritable, crying
Treatment: antibiotics, analgesics,
antipyretics, local heat
I.............J OM + E
Not associated with symptoms of infection
Symptoms: rhinitis, cough, diarrhea
Treatment of symptoms: analgesics,
antipyretics, local heat
```
88
otitis externa
```
Not Contagious
Otitis Externa (Swimmer's ear)
Inflammation of skin lining the outer ear
canal
Causes
0 Prolonged exposure to moisture or
injury to ear
Bacterial or fungal growth
Risk factors:
Disrupting the externa with cotton
swabs or hairpins
Symptoms
Pain, ear discharge, hearing loss,
itching, swelling or redness,
burning, stinging,
fever
Treatment
Antibiotics, glucocorticoids,
acidifying solutions such as
aluminum acetate
Warm water or saline
```
89
cerumen impaction
```
Not Contagious
Cerumen Impaction
Buildup of cerumen (ear wax) leading to blockage of ear canal
Ear wax protects the ear
Traps dust and prevents bacteria and small objects from entering ear
o
Too much wax can block the ear canal
o
Symptoms
Earache, fullness in ear, tinnitus, partial hearing loss, itching
o
Treatment
0
o
0
o
Carbamide peroxide (Debrox@)
Baby oil
Glycerin (Neotic @)
Ear candling (not recommended)
```
90
water clogged ears
```
Water Clogged Ears
Causes
Swimming
Bathing
Scuba diving
Being in a humid climate
Symptoms
Ear fullness
Gradual hearing loss
Itching
o
Ear drying agent
Isopropyl alcohol (Swim-
Ear plugs (prevention)
Low heat
```
91
ototoxicity
```
Ototoxicity
Damage to the hearing or balance
functions of the ear
0 Reversible vs. Irreversible
Causes
0 Chemicals
Infections
Symptoms
Tinnitus, hearing loss, dizziness,
loss of balance
Medications Causing Ototoxicity =
Quinine
Salicylates (aspirin)
Aminoglycosides
Platinum antineoplastic agents
Loop Diuretics
```
92
ear problems: when to refer
```
Referral
Refer if any factors are present
Hearing loss, ear pain, drainage, tinnitus
• Symptoms of infection
• Symptoms of otitis media and externa
• Perforated eardrum
Foreign objects in ear
```
93
ear drop administration
Ear Drop Administration
up PATIENT
CARE
IMPLEM
1.
2.
3.
4.
5.
6.
7.
8.
9.
Wash hands with soap and water, then dry
Clean outside of ear with a damp cloth, don't let water into ear
Hold container in your hands for a few minutes to warm drops
If the contents are cloudy, shake the container
Tilt head to the side, open container, draw solution into dropper (don't touch
the dropper to the ear)
Pull ear back/upwards (adult) or back/downwards (child)
Drop appropriate amount of drops into ear, keep head tilted several minutes or
insert piece of cotton to prevent drops from draining out
Apply light pressure to tragus to ensure appropriate administration
Wipe excess, close container, and wash hands
94
sinusitis
Sinusitis (head cold)
Inflammation and swelling of sinuses
Interferes with drainage & causes mucus buildup
Viral sinusitis
Symptoms last up to 10 days
0 Symptoms: HA, congestion, low fever, nasal discharge , and
halitosis
Bacterial sinusitis
Symptoms increase in severity after 7-10 days
Contagious
Symptoms: worsening congestion, facial pain, thick yellow-green
nasal discharge, toothache, fever, halitosis
Treat symptoms with oral or topical decongestants
(e.g. Pseudoephedrine - Sudafed @ or oxymetazoline - Afrin @ )
AVOID antihistamines
SINUSITIS
95
allergic rhinitis
```
Not Contagious
Allergic Rhinitis
Inflammation of nasal mucous membrane
Cause
0 Exposure to allergen
Types:
Seasonal
Persistent (perennial)
Treatment:
Oral or topical antihistamines
Symptoms
0
0
0
Clear rhinorrhea
Sneezing
Congestion
Post-nasal drip
Itching eyes, ears, nose, throat
Watery eyes
Periorbital swelling
(Oral: Cetirizine - Zyrtec @; Topical: Azelastine -Astelin @)
0 Oral or topical decongestants
(Oral: Pseudoephedrine - Sudafed @; Topical: Oxymetazoline - Afrin @ )
Intranasal corticosteroids
o
(e.g. Fluticasone - Flonase @)
```
96
nasal self care
```
Self Care
Non-pharmacologic options
Allergan avoidance
Nasal rinses (Neti Pot)
Vaporizers
Adequate hydration
Saline nasal sprays
```
97
nasal refer if
```
Referral
Refer if any factors are present
Severe HA not relieved by OTC products
Symptoms of systemic infection
Symptoms lasting >10 days
Cold that worsens after 7 days
Changes in vision
Symptoms resistant to self-care
```
98
nasal spray administration
Wash hands thoroughly with soap and water
Blow nose gently before using spray
Tilt head slightly forward
Breathe out slowly
Gently insert the bottle tip into one nostril, pointing the tip away from inside of
nose (septum)
Squeeze the pump while breathing in slowly
Repeat in other nostril
Wash hands thoroughly with soap and water
99
cold sores
```
Cold Sores
Blisters located on lips, chin, cheeks, or in
nostrils
Common cause: Herpes simplex virus 1 (HSV-I)
Recurrences likely due to stress or
weakened immune system
Symptoms
Red, painful blisters, oozing/yellow
crusting of blister, tingling & itching
Treatment (self limiting)
Topical antivirals - docosanol (Abreva
Contagious
```
100
canker sores
```
Not Contagious
Canker Sores
Small, round sores inside of mouth
0 Cheek, under tongue, gums, or in back of throat
Causes
0 Stress
o Food allergies
Hormonal changes
0 Malnutrition
B-12, folate, zinc, iron
Symptoms
Sore usually has red edge with white center
0 Painful
Treatment (self-limiting)
Local anesthetics (benzocaine)
```
101
gingivitis
```
Not Contagious
Gingivitis
Inflammation of the gums
Causes
Bacteria leading to accumulated plaque
Poor hygiene
Symptoms
Red/tender gums
Swollen gums
Gums that bleed easily
Receding gums
Bad breath
```
102
thrush
```
Not Contagious
Oral Candidiasis (Thrush)
Fungal infection of the mouth
Cause
Candida albicans
Risk Factors
Symptoms
Creamy white lesion
Cottage cheese appearance
Slight bleeding if lesions are scraped
'Cotton mouth' sensation
```
```
Weak immune system
Dentures
Infants
Steroid medications
Smoking
Dry mouth
Loss of taste
```
103
oral problems refer if
```
Referral
Refer if any factors are present
• Lesions associated with significant pain/large area
• Gingivitis
• Oral candidiasis
• Symptoms lasting >14 days
• Immunocompromised patients
• Frequent recurrence of cold sores
• Symptoms resistant to self-care
```
104
pharyngitis
```
Pharyngitis
Inflammation of the throat
Non-infectious
Allergies
Sinusitis
Post-nasal drip
Malignancies
Viral
Cough
Scratchy throat
Bacterial (strep throat)
Contagious
Pain (worse when swallowing or talking)
Scratchy throat
Dry throat
Swollen or red glands/tonsils
White patches on tonsils
```
105
oral problems refer if
```
Referral
Refer if any factors are
present
Symptoms of infection (strep throat)
Difficulty breathing
Difficulty swallowing
Symptoms >7 days
```
106
basic CV pathophys
Electrical impulse generated by the sinoatrial (SA)
node
Impulse travels to the AV node
1/10 second delay, passes through Bundle of His,
then right and left branches
Impulse spread throughout ventricular myocardium
through Purkinje fibers
107
ASCVD
```
10/24/19
Atherosclerotic Cardiovascular Disease (ASCVD)
• Acute coronary syndromes (ACS)
• History of Ml
• Stable or unstable angina
Coronary ot other arterial revascularization
• Stroke/TlA
Peripheral artery disease (atherosclerotic origin)
7
Atherosclerotic
Cardiovascular
Disease (ASCVD)
8
Risk Factors for Coronary Heart Disease
Causative
• Cigarette smoking
• Hypertension
• Low high-density lipoprotein cholesterol (<40 mg/dL)
• High total and low-density lipoprotein cholesterol
• Type I and type 2 diabetes mellitus
Predisposing
• Obesity/overweight
• Physical inactivity
• Family history of premature coronary heart disease (in male, first-degree
relative <55 years; in female, first-degree relative <65 years)
• Age (men 245 years; women 255 years)
• Insulin resistance
4
```
108
angina
intermittent chest pain cause by temporary oxygen insufficiency and myocardial ischemia
109
HF - compensatory responses
Cardiac dilation - Residual blood accumulated in the ventricle - Causes stretching of myocardial fibers and dilation of ventricle Cardiac hypertrophy - An adaptation to the increase diastolic volume - Causes increased ventricular muscle mass and wall thickness Activation of sympathetic nervous system - Release of norepinephrine and other catecholamines in response to reduced CV output and tissue perfusion - Causes increased HR and contractility to maintain normal CV output Stimulation of reninangiotensin-aldosterone system (RAAS) - Due to reduced renal perfusion through sympathetic nervous system activation - Causes aldosterone release àsodium and water retention àincreased venous pooling of blood due to failing ventricle
110
HTN
Elevated SBP > 140 mmHg, DBP > 90 mmHg, or both ● 90% of patients have idiopathic HTN ○ Secondary causes (10%): renal disease, adrenal disorders (primary aldosteronism, Cushing’s Syndrome, or pheochromocytoma), or pregnancy
111
lipid disorders
Triglycerides (TG) - Consist of FFA and glycerol, used for stored energy - Levels above 500 can increase risk of pancreatitis - Dependent on dietary fat Lipoproteins - LDL is the “bad cholesterol” àlodges in arterial walls and stimulates atherosclerotic plaque development - HDL is the “good cholesterol” àremoves cholesterol from arterial wall, takes to liver for disposal - Lipoprotein (a) àsimilar to LDL, genetically determined, higher tendency to form clots Apolipoproteins - Play major role in binding, solubilizing, and transport of lipids - Include Apo B and A1 (as examples)
112
FEV1
forced expiratory volume in 1 second
113
FVC
forced vital capacity
114
FEV1/FVC
fraction of air exhaled in the first second relative to the total volume exhaled
115
COPD
chronic obstructive pulmonary disease
116
CXR
chest xrap
117
SOB
shortness of breath
118
DOE
dyspnea on exertion
119
CAP/HAP
community/hospital acquire pneumonia
120
PNA
pneumonia
121
COPD common signs and symptoms
```
COPD- Common Signs & Symptoms
Dyspnea
Accessory
Muscle Use
Wheezing
Chronic
Cough
Pursed Lip
Breathing
Inspiratory
Crackles
Chronic
Sputum
Production
Chest Pain
Decreased
FEVI
OLLEC
SSES
Barrel Chest
Decreased
Breath
Sounds
History of
Smoking
```
122
what happens to FEV1/FVC during COPD
decreased
123
COPD goals of treatment
```
PLAN
Goals of Treatment
Acute Exacerbation
• Minimize negative impact of current exacerbation
• Prevent recurrence of events
Chronic
Reduce symptoms
Reduce frequency and severity of exacerbations
Improve exercise tolerance
Improve health status
```
124
asthma signs and symptoms
```
Asthma- Common Signs & Symptoms
Wheezing
Chest Pain/
Tightness
Coughing
(particularly
at night)
Decreased
FEVI
Possible
Activity
Interference
Dyspnea
Change in
Inhaler Use
```
125
spirometry in asthma
Spirometry in Asthma
Decreased FEVI
Normal or increased FVC
Decreased FEVI/FVC
126
lung infections signs and symptoms
```
cough
fever
sputum
chest tightness
aches and pains
sore throat
wheezing
chills
dyspnea
headache
```
127
goals of infections management
```
Goals of Infection Management
• Eradication of the infecting organism
' Prevention of complications or worsening
of infection
Smoking Cessation
' Vaccinations against infection
```
128
endocrine system
complex regulatory system that releases hormones that act as chemical messengers into the bloodstream
129
diabetes mellitus common signs and symptoms
```
polyuria
polydipsia
polyphagia
neuropathy
nephropathy
retinopathy
fatigue
```
130
CVD
cardiovascular disease
131
ADA
American Diabetes Association
132
BG
Blood glucose
133
CGM
continuous glucose monitoring
134
CKD
Chronic kidney disease
135
other sites to test blood than fingertip
palm or forearm
136
purpose of diabetes foot exams
- early identification of risk
- early detection, diagnosis and referral for problems
- early intervention and treatment to prevent from worsening
- teach self-management and preventative strategies
137
signs/symptoms of hypothyroidism
```
bradycardia
facial puffiness
decreased sweating
decreased systolic BP
coarse, thinning hair
cold intolerance
increased diastolic BP
fatigue
depression
dry/coarse/cold skin
weight gain
constipation
brittle nails
hoarse voice
decreased libido
```
138
signs/symptoms of hyperthyroidism
- tachycardia
- silky/fine textured hair
- increase bowel habits
- increased systolic BP
- warm/moist skin
- palpitations
- decreased diastolic BP
- fine tremor
- irritability
- proptosis/lid lag/exophthalmos
- inappropriate weight loss
- rapid speech
- onycholysis
- increased sweating/heat intolerance
- amenorrhea
139
why are thyroid hormones important for children
normal growth and development, abnormalities may result in neurological problems
140
why are thyroid hormones important for elderly
- thyroid hormone secretion decreases
- TSH secretion increases
- less likely to exhibit signs and symptoms of thyroid disorders
- may present as myxedema coma
141
thyroid hormones and pregnancy
- increase in chorionic gonadotropin that stimulates thyroid gland
- increase in urinary iodide excretion
- increase in thyroxine-binding globulin
- hypothyroidism rare
142
acute somatic pain
superficial: throbbing, burning or prickling caused by pain stimulation in skin or subq tissue
deep: dull, aching pain which is usually localized due to injury to skeletal muscles/tendons/ligaments
143
acute visceral pain
deep/dull/aching/squeezing or pressure like pain that is hard to localize due to injury to an organ
144
malignant (cancer) pain
pain at primary cancer site and/or metastases
145
non-malignant pain
neuropathic: burning, tingling, numbing pain which due to nerve injury or unknown reasons
musculoskeletal: aching pain due to injury, chronic diseases, meds/medical treatments, or unknown reasons
146
what is the FLACC scale used for
patients unable to communicate pain
147
osteoarthritis
localized, degenerative joint disease caused by deterioration of articular cartilage
148
OA clinical presentation
asymmetrical joint involvement (pain/tenderness/short lived AM stiffness/bony spurs)
149
OA treatment
first line-acetaminophen
| second line- nsaids/opioids
150
RA
autoimmune disorder marked by systemic and symmetrical inflammation of synovial joints
151
RA clinical presentation
lab findings: rheumatoid factor
| signs/symptoms: prolonged AM stiffness, swan necked hand deformities, systemic signs(fever, rash, fatigue)
152
RA treatment
OTC (acetaminophen, NSAIDs)
| Rx ( DMARDs, corticosteroids)
153
gout
disorder of uric acid metabolism results in increased uric acid levels
154
gout clinical presentation
rapid onset of pain/tenderness/and swelling
155
gout treatment
colchincine/nsaids/corticosteroids
156
gout prevention
allopurinol/colchicine/febuxostat/probenecid
157
OA
decrease in bone mineral density resulting in bone fragility
158
OA clinical presentation
hunching/back pain/increased risk of fractures
159
OA prevention/treatment
OTC: calcium and vitamin D
Rx: bisphosphonates, calcitonin, raloxifene, teriparatide
160
fibromyalgia
chronic disease characterized by generalized musculoskeletal pain and fatigued
161
fibromyalgia clinical manifestations
aching/fatigue/insomnia due to pain
162
fibromyalgia treatment options
amitriptyline
duloxetine
gabapentin
pregabalin
163
the psych interview
medical history
social history
developmental history
164
categories of metal disorders
- anxiety
- obsessive-compulsive and related disorders
- trauma and stressor-related disorders
- mood
- psychotic
- neurocognitive disorders
- substance use disorders
- personality disorders
- neurodevelopmental disorders
165
bipolar disorders
experience of both mania/hypomania and depression in distinct episodes, may have "mixed" features with symptoms of both mood poles
166
depression therapy
```
novel antidepressants
SSRIs
SNRIs
MAOIs
Adjunctive therapy
```
167
bipolar therapy
- anticonvulsant mood stabilizers
- antipsychotic mood stabilizers
- lithium
168
positive schizophrenia symptoms
hallucinations, delusions, disorganized thinking
169
negative schizophrenia symptoms
anhedonia, social isolation, hygiene problems
170
cognitive symptoms
concentration difficulties, changes in executive functioning
171
mood symptoms
depression
172
MMSE
mini-mental state exam - evaluates cognition
173
PANSS
positive and negative syndrome scale - schizophrenia
174
HAM-D
Hamilton depression scale - depression
175
MADRS
Montgomery-asberg depression rating scale - depression
176
HAM-A
Hamilton anxiety scale - anxiety
177
YMRS
young mania rating scale
178
GAF
global assessment of functioning - current functioning
179
meds that cause anxiety
amphetamines, caffeine, beta-blockers, pseudoephedrine, estrogen, mefloquine, NSAIDs, theophylline, thyroid, varenicline
180
meds that cause depression
efavirenz, clonidine, beta-blockers, phenytoin, topiramate, vigabatrin, triptans, corticosteroids, oral contraceptives, tamoxifen, varenicline, interferons
181
meds that cause psychosis
albuterol, amphetamines, anabolic steroids, ACE inhibitors, corticosteroids, dextromethorphan, digoxin, efavirenz, ganiciclovir, H2-blockers, mefloquine, opiates, pseudoephedrine, quinidine, statins, SMX-TMP, zolpidem
182
common signs and symptoms of BPH
- lower urinary tract symptoms
- obstructive symptoms
- irritative symptoms
183
BPH symptoms
lab values
1. increased urea nitrogen BUN
2. elevated serum creatinine
3. elevated prostate specific antigen
184
what can exacerbate BPH
testosterone replacement, decongestants, antihistamines, tricyclic antidepressants, caffeine
185
pharmacologic treatment of BPH
rx: alpha adrenergic antagonists, 5-alpha reductase inhibitors
OTC: saw palmetto
186
ED basic pathophysiology
- result from single abnormality or combination
- disease that compromise vascular flow or nerve conduction can contribute
- sub physiologic levels of testosterone
187
ED common signs and symptoms
- failed to achieve penile erection
- hypogonadism
- decreased libido
188
what can exacerbate ED
antihistamines, tricyclic antidepressants, dopamine antagonists, spironolactone, cimetidine, CNS depressants
189
ED lab assessments
blood glucose, serum testosterone, lipid profile
190
ED complications
poor intimate relationships, depression, performance anxiety
191
ED treatment goals
improvement in quantity and quality of penile erections suitable for intercourse and considered satisfactory by patient and partner
192
ED questions to ask
1. onset
2. frequency
3. duration
4. quality
5. time
6. satisfaction
193
are herbal products effective for EF
NO
194
menstrual conditions goals of treatment
symptom control, reduce disease burden, improve quality of life
195
menstrual conditions questions to collect
symptoms, what makes is better/worse, previously tried
196
menstrual conditions treatment for moderate to severe symptoms
SSRIs/SNRIs, hormonal contraceptives
197
pregnancy/lactation assessment
1. symptoms
2. trimester
3. disease state control
4. med history
198
pregnancy/lactation complications or considerations
1. physiologic changes
2. transplacental drug transfer
3. drug use during lactation
199
major pathogen for yeast infection
candida albicans
200
yeast infection risk factors
oral/genital contact, antibiotic use
201
common signs/symptoms for yeast infection
1. itching or irritation
2. burning on urination
3. redness
4. cottage cheese like and/or odorous discharge
202
yeast infection assesment
```
vaginal pH(normal)
microscopy
```
203
yeast infection goals of treatment
resolution of symptoms
204
yeast infection treatment
OTC topical antifungals, Rx fluconazole (Diflucan), lifestyle modifications, others
205
menopause assessment
risks/benefits of different therapies, symptoms, med history
206
menopause treatment algorithm
- non pharmacologic : Lifestyle modifications
- hormone replacement therapy : moderate to severe vasomotor symptoms, vulvovaginal atrophy, prevention of postmenopausal osteoporosis
- non hormonal : SSRIs, SNRIs, gabapentin, vaginal moisturizers/lubricants
207
what is endoscopy used to diagnose
PUD, GERD, esophageal varices, carcinoma, H. Pylori, Barrett's esophagus, pancreatitis
208
what is colonoscopy used to diagnose
colon cancer, diverticulitis, Crohn's disease, ulcerative colitis
209
radiography with or without contrast used to diagnose
with contrast: tumors, polyps, ulcers, hiatal hernia
| without contrast: abdominal pain work up, bowel obstruction, free air
210
what can an ultrasound be used to diagnose
AAA, gallstones
211
what can computed tomography (CT) be used to diagnose
with contrast: abscess, infection, inflammation
| without contrast: AAA, bowel obstruction, free air
212
what can MRI diagnose
neoplasm, stones, sclerosing, cholangitis
213
what is gastroenteritis
inflammation of the stomach and intestines
214
what causes gastroenteritis
infection(usually viral), contaminated food/water, reaction to a new food, meds
215
Gastroenteritis symptoms
N/V, diarrhea, abdominal cramping, low grade fever
216
when to refer gastroenteritis
immediately refer if: bloody diarrhea, high fever, dehydration, vomiting > 2 days, diarrhea > 1 week
217
what is GERD
most common disorder of the esophagus in which there is decreased lower esophageal sphincter pressure, increased gastric volume, impaired esophageal motility
218
what make GERD worse
dietary: large meals, eating before bedtime, dietary fat
miscellaneous: tight clothing, pregnancy
meds: lower LES tone (anticholinergics, barbiturates, benzos, beta blockers....)
direct irritants: aspirin, NSAIDs, Iron, alendronate
219
GERD presentation (typical)
heartburn, water brash, belching, regurgitation
220
GERD presentation (atypical)
non-allergic asthma, chronic cough, hoarseness, pharyngitis, chest pain, dental erosions
221
when to refer GERD
constant pain, dysphagia, odynophagia, unexplained weight loss, choking
222
GERD self care
non-pharmacologic: avoid aggravating foods, elevate head of bed, consume small frequent meals, avoid eating within 3 hrs of bedtime, avoid alcohol, weight loss, smoking cessation
pharmacologic: antacids and acid suppressant
223
Peptic ulcer disease (PUD)
ulcerative disorders that occur in upper GI tract due to exposure to acid-pepsin secretions
224
what are the most common types of PUD
gastric ulcer and duodenal ilcer
225
what are the two top causes of PUD
H. pylori infection and NSAID use
226
PUD risk factors
```
age >60yrs
corticosteroid therapy
anticoagulant therapy
high dose NSAID use
hx of PUD or GI bleed
chronic diseases
```
227
PUD complications
GI bleed
perforation
gastric outlet obstructions
228
PUD signs/symptoms
- dark sticky stools, BRBPR, anemia, coffee ground like stool
- epigastric pain, anorexia, weight loss, belching, bloating, abdominal distention
229
when to refer for PUD
immediately refer if patient exhibits S/Sx - no OTC symptoms - Rx (antibiotics, acid suppressants, antacids, mucosal protectants)
230
PUD self care
avoid aggravating factors: ASA and NSAIDs, cigarette smoking and alcohol
231
what is inflammatory bowel disease (IBD)
crohn's disease and ulcerative colitis
232
what is the goal of IBD treatment
induce remission
233
when to refer for IBD
patients with incapacitating symptoms
234
IBD maintenance treatments
aminosalicylates, corticosteroids, biologics
235
IBD acute treatments
anti-inflammatory meds, FEN therapy, supportive therapies
236
what is hepatitis
inflammation of the liver usually from viral and chemical or drug related causes
237
S/Sx hepatitis
- jaundice
- malaise, fatigue, anorexia, myalgias, elevated ALT, AST bili, GGTP, LDH
- positive antibody studies
- decreased total protein
238
what is cirrhosis
wide spread hepatic cell destruction
239
S/Sx cirrhosis
- jaundice
- anorexia, NVD, fatigue, pruritus
- prolonged PT
- hypoalbuminemia
- increased/decreased total AST, ALT, GGTP, bili
240
what is cholecystitis
inflammation of the gall bladder
241
causes of cholecystitis
gall stones, tumor, bile duct blockage
242
S/Sx cholecystitis
N/V, fever, severe pain in upper right abdomen, occur after large or fatty meal, tenderness upon palpitation
243
cholecystitis treatment options
pain control, antibiotics, limiting oral intake, surgery
244
what is celiac disease
immune reaction to gluten
245
causes of celiac disease
exact cause unknown, possible genetic component, may be triggered by stressful event
246
S/Sx celiac disease adults
weight loss, diarrhea, bloating, fatigue, headache, osteoporosis, itching, dental erosion, nerve damage, joint pain
247
S/Sx celiac disease children
diarrhea, constipation, short stature, delayed puberty, ADHD
248
celiac disease self care options
gluten free diet
249
lactose intolerance
lactase deficiency
250
causes of lactose intolerance
increase in age, result of injury or illness, congenital
251
S/Sx of lactose intolerance
diarrhea, N/V, abd cramping, bloating, flatus
252
lactose intolerance self care options
lactase enzyme tablets or drops, reduced lactase dairy products, consuming dairy with meals, consuming lower lactose dairy products
253
what is the #1 cause of medication induced constipation
opioid analgesics
254
what is diarrhea
increase in the number of fluid content of bowel movement
255
when to refer diarrhea
blood in stool
| signs of dehydration
256
when to refer for N/V
```
weight loss
intractable vomiting
blood in vomit
constant pain
odynophagia
```
257
what is jaundice
icterus or yellowish discoloration of skin and sclerae
258
potential causes of jaundice
cirrhosis
hepatitis
bile duct blockage
liver cancer
259
define pediatric
birth to 18 yrs
260
define neonate
0-28 days
261
define infant
28 days/1month up to 12 months
262
define child
1-11yrs
263
define adolescent
12-18 yrs
264
what is a corrected age?
postnatal - weeks born early
265
what is failure to thrive
weight or rate of weight gain is below children of similar age/sex
266
as child ages, does BP go up or down
up
267
as child ages, does HR go up or down
down
268
as child ages, does RR go up or down
down
269
when should children start having their BP checked regularly
at 3 yrs of age
270
what is generally considered a fever
> 100.4 deg F
271
when to refer a fever
- < 3 months of age
- fever > 24 hrs if less than 2 yrs of age
- fever > 72 hrs if > or equal to 2 yrs of age
- fever > 104
- no improvement w/ treatment
272
what is the CrCl for children
0.413 * (height in cm/SCr)
273
what is considered "sensory motor"
age - 0 to 2 yrs with no understanding of self
274
what is considered "preoperational"
age 2 to 7 yrs consider only part of the situation, only here and now
275
what is considered "concrete operations"
ages 7 - 11 yrs, consider multiple parts of a situation, difficulty with hypothetical situations
276
what is considered "formal operations"
ages > or equal to 12 - can understand hypothetical situations
