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130 Cards in this Set
- Front
- Back
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HIV |
RNA virus that was discovered in 1983 |
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RNA viruses are called ___________ because they replicate in a "backward" manner |
retroviruses |
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HIV binds to specific ____________ on cell's surface |
CD4 receptors |
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Once HIV is inside the cell, how does it integrate its RNA into the host cell's DNA? |
with the assistance of an enzyme made by HIV called reverse transcriptase
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HIV DNA becomes a permanent part of the cell's geneti structure, how? |
By using an enzyme called integrase, it splices itself into the genome of the host cell |
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What are the 2 consequences of HIV becoming a permanent part of the cell's genetic structure? |
- All genetic material is replicated during cell division, so all daughter cells of the infected cell will be infected as well - Genome of host cell now contains viral DNA, so the cell's genetic codes can direct the cell to produce HIV |
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Mode of transmission for HIV |
Infected body fluids: - semen - vaginal and anal secretions - blood - breast milk |
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Which cells do HIV infect? |
Cells that have CD4 receptors on their surfaces. This includes: lymphocytes, macrophages, monocytes, dendritic cells |
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Immune dysfunction in HIV disease is caused predominantly by: |
damage to and destruction of CD4+ T cells |
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Generally, the immune system will remain healthy with more than _____ CD4+ T cells per microlitre
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500 |
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Immune problems start to occur when the count drops to ______ to ______ CD4+ T cells |
200 - 499 |
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The major concern related to immune suppression is the development of ________________ |
opportunistic diseases |
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Acute retroviral syndrome |
CD4+ T cell count falls temporarily but quickly returns to baseline - experience flu-like symptoms that occur 1-3 weeks after initial infection, and last 1-2 weeks |
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Early chronic HIV infection |
CD4+ T cell count remains above 500, viral load is low - often asymptomatic, but can experience nonspecific symptoms such as fatigue, headache, fever, night sweats - this period can last about 10 years |
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Intermediate chronic HIV infection |
CD4+ T cell count drops to 200-500 - become symptomatic: persistent fever, drenching night sweats, diarrhea, recurrent headaches, fatigue - often see THRUSH during this phase - other infections can occur during this phase (shingles, bacterial infections, Kaposi's sarcoma, oral hairy leukoplakia) |
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Late Chronic HIV infections can also be referred to as: |
AIDS |
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AIDS is diagnosed when: |
an HIV-infected patients develops an AIDS-defining illness |
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What does screening for HIV infection generally involve? |
Laboratory analysis of blood to detect HIV antibodies (Enzyme immunoassay) |
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If the EIA is positive, what happens? |
The test is repeated |
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After the 2nd positive EIA, what is the next step? |
Western blot (WB) or Immunofluorescence assay (IFA) completed |
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Which two tests monitor the progression of HIV infection?
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- CD4+ T-cell counts - CD4 fraction |
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A CD4 fraction of less than ___ is associated with immune compromise |
15% |
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Viral load |
counts the number of viral particles in a sample of blood |
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Genotype assay |
detects drug-resistant viral mutations that are present in the reverse transcriptase and protease genes |
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Phenotype assay |
measures the growth of the virus in various concentrations of antiretroviral drugs |
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What are phenotype and genotype assays useful for? |
making decisions about new drug combinations in patients who are not responding to their current therapies |
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What are the goals of drug therapy in HIV infection? |
- decrease the viral load - maintain or raise CD4+ T-cell counts - delay the development of HIV-related symptoms and opportunistic diseases - prevent transmission |
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Nucleosidereverse transcriptase inhibitors (NRTIs) Mechanism of action |
Insert a bit of protein into developing HIV DNA chain, blocking development and leaving production of the new HIV DNA strand incomplete |
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Adverse effects of NRTIs |
- lactic acidosis with hepatic steatosis (rare but life threatening) - lipodystrophy - mitochondrial toxicity - neutropenia - anemia - myopathy - neuropathy - GI effects |
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Common NRTI drugs |
Azidothymidine (AZT); Stavudine, Lamivudine, Abacavir, Emtricitabine |
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Nonnucleoside reverse transcriptase inhibitors (NNRTIs) |
Combine with reverse transcriptase enzyme to block the process needed to convert HIV RNA into HIV DNA |
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Common adverse effects of NNRTIs |
- rash - hepatotoxicity - headache - fatigue - GI upset - neutropenia |
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Common NNRTI drugs |
Nevirapine, Delavirdine, Efavirenz, Rilpivirine |
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Nucleotide reverse transcriptase inhibitors (NtRTIs) |
Inhibit the action of reverse transcriptase |
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Common adverse effects of NtRTIs |
- mild GI symptoms - drowsiness, fatigue - strange dreams - increased pigmentation on palms and soles of feet |
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Common NtRTI drugs |
Tenofovir, Truvada, Atripla |
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Protease inhibitors (PIs) |
Prevents protease enzyme from cutting HIV protein into proper length to allow viable virions to assemble |
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Common adverse effects of PIs |
- dysglycemia - hyperlipidemia - lipodystrophy |
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Common PI drugs |
Saquinavir, Indinavir, Ritonavir, Nelfinavir, Kaletra, Atazanavir, Fosamprenavir |
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Integrase inhibitors |
Prevent viral DNA integration into CD4+ cell chromosome |
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Common adverse effects of integrase inhibitors |
Diarrhea, headache, nausea, fever |
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Common integrase inhibitor drugs |
Raltegravir |
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Fusion and entry inhibitors |
Prevent binding of HIV to cells, thus preventing entry of HIV into healthy cells |
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Common adverse effects of fusion and entry inhibitors |
- ISRs - fatigue, nausea, diarrhea - insomnia - peripheral neuropathy - hypersensitivity reaction - pneumonia |
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Common entry inhibitor drugs |
Enfuvirtide, Maraviroc |
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Which legal substances account for most of the total cost of substance abuse? |
Tobacco and alcohol |
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Substance abuse |
cravings, complusioin recurrent harmful substance use with failure to fulfill major work, school or home responsibilities |
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Substance dependence |
Loss of control (unable to limit amount) |
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Physical dependence |
Cessation causes severe emotional, mental, or physiologic reactions |
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Tolerance |
repeated use decreases the responsiveness and/or number of dopamine receptors, leading to need for increasing amounts of drug/alcohol to achieve original euphoria |
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Which area of the brain produces dopamine? |
substantia nigra |
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What are the 5 A's of intervention? |
- Ask - Advise - Assess - Assist - Arrange |
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Which substance is the leading cause of respiratory disease and premature death? |
Tobacco |
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Nicotine is a _________ substance |
psychoactive |
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What causes dependence in nicotine? |
Alkaloid properties |
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Nicotine effects |
- increase P, BP, coronary blood flow - cutaneous vasoconstriction - increased alertness, arousal - increased GI motility, secretion - release of prolactin, growth hormone, vasopressin, endorphins, cortisol - |
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When do nicotine withdrawal symptoms begin? |
Within a few hours of stopping |
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Nicotine withdrawal symptoms peak |
24-48 hours |
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What is the primary cause of nicotine relapse? |
Cue induced cravings |
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Most widely consumed substance of abuse |
Alcohol |
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Long term effects of Alcohol |
- Korsakoff's psychosis - Wernicke's encephalopathy - malnutrition |
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Individuals with alcohol dependence are more likely to develop: |
- anemia - cancer - cardiovascular disease - dementia, depression - pancreatitis - cirrhosis - esophageal varices - hepatic encephalopathy |
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Alcohol withdrawal syndrome begins how many hours after last drink? |
6-12 hours |
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Symptoms of alcohol withdrawal syndrome |
- nausea - vomiting - shaking - sweating - anxiety - agitation |
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Symptoms of alcohol withdrawal delirium |
- hallucinations - confusion - disorientation - seizures - tachycardia - hypertension - hyperthermia - tachypnea - tremors |
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A score of less than 10 on the CIWA scale indicates? |
no treatment required |
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A score of 10-20 on the CIWA scale indicates: |
requires, at minimum, further assessment |
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A score of greater than 20 on the CIWA scale indicates: |
start treatment or increasing current treatment |
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Alcohol withdrawal treatment |
- administer benzodiazepines - thiamine, multivitamins - maintain a quiet, calm environment |
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Peak blood levels of cocaine |
5-30 mins |
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Cocaine effects |
- euphoria - increased P, BP, T - dysrhythmias - vasoconstriction - tremors - nausea and vomiting - decraesed appetite |
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When does cocaine withdrawal begin? |
~ 9 hours after last dose |
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Cocaine Tx |
administer benzodiazepines and naloxone for CNS depression - monitor cardiac and respiratory function |
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Mesolimbic centre |
reward/pleasure system |
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When does opioid withdrawal peak? |
2-3 days |
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When does opioid withdrawal resolve? |
5-7 days |
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Obesity |
a complex, chronic, multifactorial disease that develops from the interaction between genetics and the environment; manifests as an abnormal increase in the proportion of fat cells in the body |
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Primary obesity |
calorie intake exceeds body's metabolic demands |
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secondary obesity |
Can result from various congenital anomalies, chromosomal anomalies, metabolic problems, or lesions and disorders of the CNS |
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BMI |
ratio of weight to height; higher ranges are associated with increasing health risk |
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Overweight (BMI range) |
BMI of 25-29.9 |
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Obese (BMI range) |
BMI of 30-40 |
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Morbidly obese |
BMI greater than 40 |
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waist-to-hip ratio |
used to assess the health risks associated with obesity; reflects the distribution of both subcutaneous and visceral adipose tissue |
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Optimal WHR |
less than 0.80 |
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Apple shaped body |
more fat distribution in the abdominal area and upper body |
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pear shaped body |
more fat distribution in the upper legs |
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Android obesity |
individuals with apple-shaped bodies |
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Gynoid obesity |
individuals with a pear shaped body |
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Obesity occurs because: |
energy intake exceeds energy output |
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How does visceral fat actively harm the body? |
Decreases insulin sensitivity and levels of HDLC and increases BP - also releases more free fatty acids into the bloodstream |
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What do adipokines regulate? |
- food intake - lipid storage/metabolism - insulin sensitivity - vascular homeostasis - blood pressure - angiogenesis - inflammatory + immune response - female reproduction + energy metabolism |
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Regulation of appetite and satiety are controlled by: |
- brain stem, hypothalamus, and ANS |
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Which type of obesity is worse? |
Android - more at risk for obesity related complications |
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What are the most common diseases associated with Obesity? |
- Cardiovascular - NIDDM - Cancer |
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How is obesity connected with sleep apnea and obesity hypoventilation syndrome? |
- reduced chest wall compliance - increased work of breathing - decreased total lung capacity - functional residual capacity |
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Obesity is correlated with an incraesed incidence of osteoarthritis as a result of: |
stress put on weight-bearing joints |
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Why might hypertension occur in obesity? |
Because of: - increased circulating blood volume - abnormal vasoconstriction - decreased vascular relaxation - increased cardiac output |
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Metabolic syndrome |
Collection of risk factors that increase an individual's chance of developing cardiovascular disease and diabetes |
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What are the diagnostic criteria for metabolic syndrome? |
- Increased waist circumference (abdominal obesity) - Elevated triglycerides - Low HDL - Increased BP - Fasting BG > 10 |
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Metabolic syndrome is diagnosed if an individual meets how many of the diagnostic criteria? |
It's diagnosed if an individual has 3 or more conditions |
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Define pain |
an unpleasant sensory and emotional experience associated with actual or potential tissue damage |
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Nociception |
activation of the primary afferent nociceptors (PANs) with peripheral terminals (free nerve endings) that respond differently to noxious stimuli |
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Suffering |
state of severe distress associated with events that threaten the intactness of the person |
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Transduction |
conversion of a mechanical, thermal, or chemical stimulus to a neuronal action potential |
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Transmission |
movement of pain impulses from the site of transduction to the brain |
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Perception |
conscious experience of pain |
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Modulation |
Neurons originating in the brainstem descend to the spinal cord and release substances that inhibit nociceptive impulses |
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Which drugs block action potential initiation? |
Local anesthestics - antiseizure drugs - corticosteroids |
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Which drugs block prostaglandin production? |
- NSAIDs |
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Which drugs interrupt the Transmission pathway of pain? |
Opioids |
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Which drugs interrupt the Perception pathway of pain? |
- opioids - NSAIDs - Adjuvants |
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Which drugs interrupt the Modulation pathway of pain? |
- tricyclic antidepressants |
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sensory-discriminative component of pain |
recognition of the sensation as painful |
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motivational-affective component of pain |
emotional responses to the pain experience |
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behavioural component of pain |
comprises the observable actions used to express or control pain |
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Nociceptive pain |
caused by damage to somatic or visceral tissue |
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Somatic pain |
characterized as aching or throbbing, localized, arises from bone, joint, muscle skin or connective tissue |
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Visceral pain |
results from stimuli such as tumour involvement or obstruction, arises from internal organs |
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Neuropathic pain |
damage to nerve cells or changes in spinal cord processing - described as burning, shooting, stabbing, or electrical - sudden, intense, short-lived, or lingering |
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Deafferentation pain |
injury to either the peripheral or the CNS |
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sympathetically maintained pain |
associated with dysregulation of the autonomic nervous system |
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Basic principles of pain treatment: |
- routine assessment - unrelieved acute pain complicates recovery - patient's self-report of pain should be used whenever possible |
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equinanalgesic dose |
refers to a dose of one analgesic that produces pain-relieving effects equivalent to those of another analgesic |
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titration |
dosage adjustment that is based on assessment of the adequacy of analgesic effect versus the adverse effects produced |
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When pain is mild (1-3) |
nonopioid analgesics may be used |
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ceiling effect |
incraesing the dose beyond an upper limit provides no greater analgesia |
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Drug therapy for mild to moderate pain (4-6 on a scale of 0-10)
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opioids are used |
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Opioid agonists |
bind to receptors and cause analgesia |
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opioid antagonists |
bind to the receptors but do not produce analgesia, also block other effects of opioid receptor activation such as sedation and respiratory depression |
