Final Study

Question 1

Cortisol increases/decreases - 3/2

Answer 1

Increase - Gluconeogenesis
Increase - Muscle protein catabolism
Increase - Lymph tissue atrophy
Decrease - Protein synthesis
Decrease - Lymphocytes, Macrophages, Eosinophils

Question 2

Central Stress Response hormones - 3

Answer 2

Hypothalamus - GHRH
Anterior Pituitary - Growth hormone
Posterior Pituitary - Antidiuretic hormone

Question 3

Central Stress Response effects - 8

Answer 3

Growth hormone increases lipolysis, protein synthesis, gluconeogenesis
Growth hormone decreases insulin sensitivity, muscle glucose uptake
Beta endorphins reduce pain sensation
ADH increases reabsorption of water
Norepinephrine vasoconstriction, raises BP, pupil dilates
Epinephrine increases gluconeogenesis, inotropy, chronotropy
Epinephrine decreases insulin, muscle/fat glucose uptake, glycogen synthesis
Pro-inflammatory effect

Question 4

Theories of aging - 4

Answer 4

ROS - free radical damage to cells, builds up over time
Telomere shortening
Errors in transcription produce protein errors
Molecular damage causes aberrant gene expression

Question 5

Normal aging effects Cardiovascular - 4

Answer 5

Slower resting ad max heart rate
Higher BP
Less ability of heart, vessels to respond to changes/stress
Falls risk, cardio issues, stroke

Question 6

Normal aging effects Respiratory - 3

Answer 6

Less effective mucous clearance
Reduced capacity for aerobic exercise
Respiratory issues become serious quicker

Question 7

Normal aging effects Musculoskeletal - 2

Answer 7

Overall stiffness of muscles, joints

Falls risk

Question 8

Normal aging effects Integumentary - 4

Answer 8

Smaller fat cushion
Less blood flow
Skin less resilient
Skin tears/ulcers, broken bones

Question 9

Normal aging effects Hepatic - 2

Answer 9

Reduced metabolic function

Drug toxicity, interactions

Question 10

Normal aging effects Renal - 2

Answer 10

Decreases ability to excrete drug metabolites, toxins

MOST important cause of ADR

Question 11

Normal aging effects Gastrointestinal - 3

Answer 11

Dry mouth
Early satiety
Dehydration, nutritional deficiencies

Question 12

Normal aging effects Genitourinary - 4

Answer 12

Changes in sexuality
Urinary retention males
Urinary incontinence females
UTI, skin ulcers

Question 13

Normal aging effects Neurologic - 4

Answer 13

Slowed mental processing
Alteration in taste, smell
Lower thirst sensation
Nutritional deficiencies, dehydration, falls risk

Question 14

Normal aging effects Endocrine/Metabolic - 4

Answer 14

Less appetite
Less tolerance to cold
No fever with infection
Nutritional deficiencies, harder to detect and recover from illness

Question 15

Normal aging effects Immune - 4

Answer 15

Increased risk of infection
Increased incidence certain autoimmune diseases
Increased risk for malignancies
Increased risk of getting sick

Question 16

Normal aging effects Sleep - 4

Answer 16

Longer time to fall asleep
Frequent awakenings
Shortening/disappearance of parts of non-REM sleep
Falls risk, accident risk

Question 17

Age related changes effect on PK - 4

Answer 17

Absorption - little change
Distribution - more body fat, lower lean mass, lower body water, lower albumin. Distribution Enhanced
Metabolism - reduced hepatic blood flow/size, enzyme activity, malnutrition. Metabolism Decreased
Excretion - reduced respiratory function, renal function. Excretion Decreased

Question 18

Geriatric symptoms, what to watch for acronym - 6

Answer 18

Sleep Disorders
Problems with eating/feeding
Incontinence
Confusion and Constipation
Evidence of Falls
Skin breakdown

Question 19

HPAA Hormones - 3

Answer 19

Hypothalamus - CRH
Anterior Pituitary - ACTH
Adrenal Cortex - Cortisol

Question 20

Oocyte to implantation

Answer 20

Oocyte fertilized by sperm
Cleavage to morula then blastocyst
W cell types, inner cell mass and Trophoblast
Day 6 blastocyst implants into uterine wall
Trophoblast becomes placenta

Question 21

Bilaminar becomes trilaminar becomes 3 germ layers

Answer 21

Ectoderm - nervous system, epidermis
Mesoderm - skeleton, muscles, heart, circulatory, urinary, dermis
Endoderm - liver, pancreas, thyroid, respiratory, gastrointestinal

Question 22

When is fetal circulation, heartbeat

Answer 22

Fetal circulation 3 weeks

Heartbeat 4 weeks

Question 23

Fetal circulation differences - 4, when close

Answer 23

Ductus venosus - bypass liver, oxygenated blood to Vena Cava
Ductus arteriosus - bridge pulmonary artery to aorta
Foramen ovale - hole between atriums
Closes within hours of birth

Question 24

Lung development - name, what happens, weeks - 5

Answer 24

Embrionic - lungs start to form, airways - weeks 3-7
Pseudoglandular - type II pneumocytes - weeks 5-18
Canicular - type I pnuemocytes - week 16-27
Saccular - alveolar saccules, surfactant - weeks 24-38
Alveolar - mature alveoli - weeks 36+, continues in newborn

Question 25

Pregnancy weight gain - 6 + 1

Answer 25

``` Total 24 pounds Baby - 7 Placenta, amniotic fluid - 4 Uterus - 2 Breasts - 2 Plasma volume - 6 Fat - 3 ```

Question 26

Pregnancy levels plasma, blood volume, red cell mass, hematocrit, system vascular resistance, serum creatinine, GFR, renal plasma flow

Answer 26

Plasma level, blood volume, red cell mass go up. Hematocrit goes down System vascular resistance, serum creatinine go down GFR, renal plasma flow go up

Question 27

Pregnancy and PK

Answer 27

Absorption increased - increased blood flow, slow GI less acid Distribution increased - increased blood flow Metabolism increased - increased hepatic blood flow Excretion increased - increased GFR, renal plasma flow

Question 28

Avoid and supplement in pregnancy

Answer 28

Avoid: cigarettes, alcohol, illicit drugs, stimulants, Vitamin A, liver, iodine, some fish/mercury, herbal products, supplements Supplement: folic acid, iron, calcium

Question 29

Children PK differences skin

Answer 29

Skin thin, increased body surface area, increased blood flow | Transdermal absorption higher

Question 30

Children PK differences blood brain barrier

Answer 30

Immature. Drugs reach brain in higher amounts

Question 31

Children PK differences trachea siaze

Answer 31

Size of straw. Inspired drugs harder to get to lungs | Adverse reaction causing general inflammation serious faster

Question 32

Children PK differences gastric

Answer 32

Empties slower first year. | Increased time to reach therapeutic concentration

Question 33

Children PK differences liver

Answer 33

Immature. Metabolism decreased

Question 34

Children PK differences albumin

Answer 34

Low. Distribution higher for protein binding drugs

Question 35

Children PK differences kidneys

Answer 35

Immature. Excretion reduced, toxicity risk

Question 36

Children PK differences water concentration in body

Answer 36

Water concentration higher than adult. Important in water soluble drugs

Question 37

Children PK differences proportion of fat

Answer 37

Lower in child. Lower doses of lipophilic drugs required

Question 38

Infant growth - 3

Answer 38

Weight doubles 6 months, triples in a year Length increases 50% in a year Head grows fastest. Circumference increases 1.5 cm/month first 6 months, 0.5 cm/month 6-12 months

Question 39

Toddler growth

Answer 39

4-5 inches, 5 pounds

Question 40

Pre-school growth, age 2-5

Answer 40

4-5 pounds, 2.5 inches

Question 41

School age growth

Answer 41

Rapid growth trunk, limbs, in spurts