Group 8/19/19 Flashcards
(84 cards)
1
Q
Learning issues
A
- Pharmacokinetics: the dynamics of drug distribution (Goodman’s and Gilman’s within ch 2)
- Pathology of Long bone fractures (Robbins and Cotran)
- Behavior medicine of working with specific populations (adolescents) (Feldman)
2
Q
adolescence
A
the interval between the onset of puberty and the cessation of body growth
adult body image and sexuality emerge, independent moral standards, intimate interpersonal relationships, vocational goals, and health behaviors develop; separation from parents
3
Q
what are health problems in teenagers related to?
A
unwanted pregnancy, STIs, weapon carrying, interpersonal violence, suicidal ideation, alcohol, cigarette, and illicit drug use, dietary and exercise patterns
4
Q
what is the leading cause of death for most populations of teenagers?
A
accidents
5
Q
what are the most common reasons for acute office visits?
A
routine/sports physicals, upper respiratory infections, acne
6
Q
what is a major challenge in caring for teenagers?
A
eliciting a history that reveals health risk behaviors
7
Q
what does the American Medical Association published Guidelines for Adolescent Preventive Services emphasize?
A
prevention, as well as partnership with the patients, parents, schools, communities and health care providers
8
Q
relationship between adolesecent health outcomes and public health
A
adolescent health outcomes are related to the cultural, educational, political, and economic policies; e.g., access to hand guns and bullying policies
9
Q
role of electronic communication and social networks in adolescent health
A
people with chronic diseases may have online support networks
bullying in social networks
helps them to feel connected to their parents, school, and community; decrease likelihood of partaking in health-risky behaviors
10
Q
early adolescence age
A
11-14
11
Q
early adolescents physical
A
- rapid growth, questions about puberty
- somatic (body) preoccupation
12
Q
early adolescents social
A
- peers more involved, family less involved
- opposite sex contact in groups
13
Q
early adolescents cognitive
A
- concrete to abstract thinking
- impulsive behavior
- testing limits at school and home
14
Q
middle adolescence age
A
15-17
15
Q
middle adolescence physical
A
- some issues from early adolescence remain
- most physical development complete
16
Q
middle adolescence social
A
- independence and identity struggles, want to be individual
- peers more important than family, acceptance important
- invincibility and impulsiveness; experiment with drugs and sex
17
Q
middle adolescence cognitive
A
- improve reasoning and abstract thinking
- better interpersonal relationships and empathy
- thinking about future work goals
18
Q
late adolescence age
A
18-24
19
Q
late adolescence physical
A
- no more body growth
- becoming more comfortable with appearance
20
Q
late adolescence social
A
- individual identity and separation complete
- more monogamous interpersonal relationships and less peer support
21
Q
late adolescence cognitive
A
- vocational goals set
- realistic expectations about education and work
22
Q
confidentiality
A
important to tell the adolescent that all the conversations are confidential, unless homocide/suicide threatened or there is ongoing abuse
23
Q
receptiveness
A
the adolescent is more likely to share personal, sensitive information if the provider seems receptive (not disapproving); needs to seem like they have permission to discuss those things
24
Q
legal issues
A
laws differ by state; some states require parental notification about sex, drug, or alcohol problems; life-threatening situations
25
interview organization HEADSS abbreviation
home, education, activities, drug use, sexual practice, and suicidal ideation
26
home questions to ask
who they live with, how often they see each parent, how often they leave and why, if the single parent dates, how they get along with the spouse, what happens when people argue, if anyone gets hurt, if there are guns and who has access to them, ask about siblings and their health
27
education questions to ask
what kind of grades they get, how they compare to last year, learning problems, vision problems, favorite/worst subjects, career aspirations, attendance and discipline problems, stress, what happens if you don't receive high grades
28
activities questions to ask
what do you do for fun, extracurricular activities, gang/srat/frat membership, dietary habits, physical activities, safety when driving
29
drugs questions
ask about their awareness of others' drug use and their friends' drug use, if they've tried drugs or alcohol, how often and how much, what circumstances, ask about family members' habits, how often they see their parents drunk
30
tips for counseling adolescents about drugs
connect the harmful effects of alcohol to their body image and safety; for example cigarettes causing wrinkled skin, or girls getting raped while drunk
31
sex questions
ask about sexual involvement; number of partners; who they're attracted to; internet partners; birth control techniques; history of sexual abuse
32
suicide questions
questions to show signs of depression; sleep disturbance, decreased appetite, hopelessness, lethargy, thoughts of suicide, hallucinations, illogical thoughts
33
homeless and runaway teens common characteristics
Usually have been in contact with social services, had parental conflict, high rates of physical/sexual abuse, abandonment because of sexual orientation
They are at risk for selling sex or drugs, theft
34
tips for caring for homeless and runaway teens
developing trusting working relationship over several visits, keeping appointments and referrals
35
challenges for teens with chronic illness or disability
teens with chronic illness/disability have issues conforming, leads to poor self-esteem
36
tips for caring for teens with chronic illness or disability
should have realistic discussions about their hopes and expectations
encourage interests/skills that would help to boost their self esteem
encourage friendships, involvement in family activities, and parents that aren't overly protective
37
challenges for teens who are gay/lesbian
social isolation, depression, STIs, substance abuse, interpersonal violence, anxiety, shame, guilt
38
tips for caring for teens who are gay/lesbian
nonjudgmental, supportive attitude and relationship with provider to help them cope with negative stereotypes
39
simple fracture
the overlying skin is intact
40
compound fracture
the bone touches the skin surface
41
comminuted fracture
the bone is fragmented
42
displaced fracture
the ends of the bone at the fracture site are not aligned
43
stress fracture
a slowly developing fracture caused by increased physical activity, bone subjected to repeated loads
44
greenstick fracture
fracture that extends only partially through the bones, especially common in infants because their bones are soft
45
pathologic fracture
fractures caused by bone that's weakened by underlying disease process, such as a tumor
46
how do the osteoprogenitor cells get activated during repair of a fracture?
migrating inflammatory cells and degranulated platelets will release factors like PDGF, TGF-beta, and FGF
47
delayed union/union
sometimes there is a deformity associated with the fracture (e.g. displaced or comminuted fractures). If there is inadequate immobilization (ie putting the bone in its proper place), the callus can't move as well and doesn't form well
48
pseudoarthrosis
a malformed callus from a nonunion of the bone can start to undergo cystic degeneration, and the luminal surface gets lined with synovial-like cells
49
what influences the distribution of a drug in tissues?
cardiac output, regional blood flow, capillary permeability, and tissue volume affect delivery rate and amount of drug that goes to the tissues
50
which tissues tend to receive a drug first versus later?
liver, kidney and brain receive drug first
muscle, viscera, skin, and fat is slower
diffuses quickly into interstitial fluid
51
drugs binding to plasma protein
drugs tend to bind to plasma proteins in the blood, such as albumin. This can interfere with the drug's transport and metabolism
sometimes assays can't differentiate unbound vs bound drugs, and different drugs compete for the same protein-binding sites
52
tissue binding for drugs
drugs tend to accumulate in tissues in higher concentrations that blood and ECF. Drugs can stay there as a reservoir for prolonged effect, or local toxicity
53
what is the BBB and how does it influence drug passage?
blood brain barrier; brain capillary endothelial cells have continuous tight junctions, so drugs need a transcellular transport process. Drug's passage depends on its lipid solubility
54
CSF barrier
this exists at choroid plexus, similar to the BBB but separates blood from the CSF.
55
what kinds of drugs are in bone, how is it as a reservoir?
tetracycline antibiotics and heavy metals can accumulate in bone through absorption through crystal lattice into the crystal surface. Effects are long lasting and prolonged.
56
what kinds of drugs are in fat, how is it as a reservoir?
lipid soluble drugs here, stable reservoir because low blood flow
57
what is redistribution?
drug effects can stop if they are redistributed from its site of action to other tissues or sites. Usually happens in lipid-soluble drugs
58
how does the fetal placenta protect from drug entry?
has transporters from the ABC family to prevent drug entry to fetus
fetus plasma is more acidic so basic drugs get ionically trapped
59
what kind of diffusion dominates transmembrane movement of most drugs?
passive diffusion
60
what are two types of carrier-mediated mechanisms of transport?
active transport and facilitated diffusion
61
what is passive diffusion?
drug molecule penetrates by diffusion along a concentration gradient, depending on its solubility in lipid bilayer
62
what does the pKa mean for drugs?
the pH at which half the drug is in its ionized form
63
what is ion trapping?*
weak acids will be trapped in basic environments, and the H+ dissociates
weak bases will be trapped in acidic environments, and the proton has not dissociated
64
what form of drugs will dominate at acidic vs basic pH?
acidic pH will have more protonated forms
| basic pH will have more anion forms
65
what is facilitated diffusion?
a carrier-mediated transport process in which the driving force is the electrochemical gradient of the transported solute.
66
what is active transport?
requires energy and allows movement of the solute against an electrochemical gradient, saturability, selectivity, and competitive inhibition
67
antiporters vs symporters
an antiporter uses energy stored in an ion gradient to actively transport another ion, so that they are being transported in opposite directions
a symporter moves the ion and the solute in the same direction
68
what is paracellular transport?
solutes and fluids can go through intracellular gaps, and these are so big that the main impediment to their flow is the blood.
Areas like the CNS and some other epithelial are too small for easy paracellular passage
69
what is absorption?
the movement of a drug from its site of administration into the central compartment
70
pros and cons of orally administered drugs
safe, convenient
limited absorption of drugs because of solubility or membrane permeability, digestion and absorption issues, delayed gastric emptying
71
controlled-release preparations
produce slow, uniform absorption of the drug; patient takes it less often, prolonged therapeutic effect, less side effects
72
advantages of sublingual route
when absorbed here, bypasses intestinal and hepatic first-pass metabolism
73
parenteral injection
does not go in via the GI tract, can be IV, subcutaneous or intramuscular. Can deliver drug in its active form, makes the drug available more predictably and accurately, but can be painful and need to maintain asepsis (ie absence of bacteria)
74
pros and cons of IV route
complete bioavailability, accurate and immediate drug delivery
unfavorable reactions from high concentrations of the drug accumulating in plasma and tissues, can't take back a dose, some interfere badly with blood
75
advantages of subcutaneous route
constant absorption for slow, sustained effect
76
advantages of intrathecal
can give local and rapid effects of the drugs on meninges or cerebrospinal axis. Drug is injected directly into the spinal subarachnoid space.
77
advantages of pulmonary absorption
rapid access to circulation because of big surface area of lungs, no hepatic first-pass loss
78
topical application advantages
quick absorption through mucous membranes, transdermal absorption better if skin moist or drugs are lipid-soluble
79
rectal route pros and cons
half of drug absorbed will bypass the liver, but can be incomplete absorption and irritating
80
bioequivalent definition
drug products can be pharmaceutically equivalent; and they also need to have same rate and extent of bioavailability under identical conditions
81
zero order elimination*
rate of elimination is constant regardless of the Cp; a constant amount of drug is eliminated per unit time, decreases linearly with time
PEA is round, shaped like a zero: Phenytoin, Ethanol, Aspirin (at high or toxic concentrations)
has capacity-limited elimination
82
capacity limited elimination*
clearance is saturable usually at or near therapeutic concentration of drug. Once saturation occurs clearance rate fails to increase with increasing plasma drug concentrations
83
first order elimination*
First order elimination is directly proportional to the drug concentration, constant Fraction of drug eliminated per unit time. Cp decreases exponentially with time, applies to most drugs. Flow-dependent elimination.
84
how does urine pH affect drug elimination?*
ionized species are trapped in urine and cleared quickly; neutral forms can be reabsorbed
