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137 Cards in this Set
- Front
- Back
Incidence |
How many cases over time |
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Prevalence |
How many cases in the current population |
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Etiology |
Cause or Origin of a disease |
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Pathogenesis |
Biological Mechanism of a disease |
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Signs |
Observable conditions that can be measured |
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Symptoms |
subjectively reported by the patient |
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Remission |
reduced intensity of symptoms in a chronic disease |
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Exacerbation |
Increased intensity of symptoms in a chronic disease |
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Idiopathic Disease |
Unknown Cause |
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Inherited vs. Congenital Disease |
Both diseases are present from birth but inherited diseases are genetic while congenital disease might not be |
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Latrogenic Disease |
Illness due to medical treatment lymphedema after breast lymph node removal |
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3 Types of Immunologic Disease |
Hypersensitivity (Allergies) Autoimmune Immunodeficiency |
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_____ Determines which drugs will be over the counter or require a prescription |
FDA |
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Drug Schedule Rank Order |
Schedule 1 is no medical use and highly addictive -Heroin, LSD Schedule 5 is lower potential for abuse -cough medicine with small amounts of opiods |
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Phases of Clinical Trials |
Phase 1 = Healthy Volunteers Phase 2 = Small # of patients with condition Phase 3 = Larger # of patients |
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Drug Names |
Generic Chemical Trade |
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Pharmacokinetics |
Movement and metabolism of drug -Absorption, distribution, biotransformation/metabolism, excretion (ADME) |
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Pharmacodynamics |
Mechanism of action in the body Generally binding to receptor site |
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"First Pass" Effect |
Oral drugs that are metabolized in the liver may lose potency rapidly because blood from the small intestine goes straight to the liver via the Hepatic Portal Vein Inactivated before reaching target organ Can be bypassed through sublingual or IV administration |
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Intrathecal |
Injected into the cerebrospinal fluid to bypass the blood-brain barrier |
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Agonist Drug |
Binds to a receptor site to enhance the cellular activity |
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Antagonist Drug |
Binds to a receptor site to block the activity |
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Drug Affinity |
Attraction between drug and receptor site |
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Efficacy |
The medications ability to cause the expected response Maximal Therapeutic Effect |
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Therapeutic Index |
TI = LD50 / ED50 Difference between Lethal Dose in 50% of patients and Effective Dose in 50% of patients Use dosage and times of administration to maintain balance in therapeutic range |
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Loading Dose |
Larger initial dose to achieve therapeutic dose faster |
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Side Effects |
Typical, predictable response to a drug that is not the purpose of the drug ie GI Distress |
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Adverse Drug Reaction |
Harmful effects of medication Usually unpredicatble |
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Risk factors for Adverse Drug Reaction |
Age (Geriatric) Gender (Female) Mass (Smaller) Polypharmacy (5-10 drugs/day) |
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What causes Drug-Drug interactions? |
-Drugs are metabolized by the same enzyme -Drugs increase or decrease the activity of liver enzymes which effects the metabolism of other drugs -Drugs may bind to the same protein, competing for space |
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How are drugs grouped? |
-Body System -Clinical Indication -Chemical Structure |
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Mechanism of NSAIDs |
COX 1 and 2 inhibitors (COX enzymes form prostaglandins) -Decrease inflammation, analgesic, and antithrombotic |
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Innate Immunity |
First line of non-specific immunity -Skin, Leukocytes, stomach acid |
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Acquired Immunity |
Specialized, disease specific immunity -Recognizes previous infections based on epitopes -B cells, T cells |
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Antigen |
Any foreign molecule not identified as self |
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Epitope |
Protein on the antigen surface that allows recognition by acquired immunity |
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Major Histocompatability Complex |
Molecules on cells that identify them as SELF |
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Pharmacology Bioavailabilty |
Fraction or percentage of active medication that reaches the systemic circulation following administration |
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Pharmacology Volume of Distribution |
Ratio of how much drug appears in the plasma relative to the total amount of drug administered. Then compared to total body water Vd = amount administered / Plasma conc. |
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Greater Volume of Distribution means... |
Drug is sequestered outside of the vascular compartment by binding to some extravascular tissue (Skeletal muscle) NOT BLOOD |
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Lower Volume of Distribution means... |
Drug binds to plasma proteins and stays in circulation (NSAID) BLOOD |
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Drug Clearance = ? + ? |
Drug Metabolism + Drug Excretion |
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Drug Clearance of an organ is dependent upon.. |
Blood Flow to the Organ Ability of the Organ to Extract the drug |
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High Extraction Drugs Limiting Factor |
High Extraction Ratio (ER) and extensive elimination by that organ Blood Flow is limiting factor |
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Low Extraction Drugs Limiting Factor |
Smaller Extraction Ratio (ER) Metabolism of enzymes in the organ is the limiting factor Not limited by perfusion |
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Effects of Exercise on Subcutaneous Injections |
Diffusion and blood flow increased when actively exercising muscle is the one that was injected Massage like effect Ex. Diabetes and insulin injections |
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Effects of Exercise on Bioavailability |
Increase tissue heat which increases diffusion of drug molecules across membranes Increase Blood Flow **Orally administered drugs may not see this effect because, though diffusion is increased, The blood flow to the digestive organs is decreased during exercise |
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Effects of exercise on Drug Distribution (Volume of Distribution) |
Vd decreases because plasma concentration of the drug is increased Bioavailability is increased and Clearance is decreased |
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In what situation would Volume of Distribution increase? |
Digoxin More of the drug is drawn out of the blood and into extravascular tissue (Skeletal Muscle) |
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Effects of Exercise on Drug Clearance |
Decrease Clearance! Hepatic blood flow is decreased as the intensity of exercise increases Greater effect on High Extraction Drugs (blood flow limited) |
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Which drugs are more readily absorbed? Solubility |
Lipid-Soluble Drugs |
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Lipid Soluble Drugs are stored... |
In adipose tissue People with a larger fat percent of body weight may have reduced drug effects |
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Liver damage can have what effect on Drug Metabolism? |
Decrease in microsomal enzyme activity therefor decreasing metabolism and increasing blood concentration of the drug |
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2 Enzyme Steps of Drug Metabolism |
1. Inactivation of Drug 2. Produce Water-Soluble metabolites that can be excreted by the kidneys |
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Drug Potency |
The Amount of drug required to produce efficacy |
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Combination Drug Therapy |
2 drugs with the same therapeutic effect used so that lower doses of both can be used Reduce Side Effects |
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Difference in Drug Metabolism Neonates |
Possible toxic reactions due to immature metabolic processes |
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Difference in Drug Metabolism Teenagers |
Shorter drug half lives Higher drug metabolism |
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Difference in Drug Metabolism Geriatrics |
Decrease in the liver size and kidney function Decreased Metabolic Activity |
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Inappropriate Medication Use in Nursing Home Residents |
-Daytime sedation -Dizziness, Confusion, Amnesia -Orthostatic Hypotension -Extrapyramidal Reactions |
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Innate Leukocytes |
Phagocytes -Neutrophils * -Monocytes * -Eosinophils - Parasite diseases -Basophils - Allergies *Most numerous |
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Where are leukocytes produced? |
Bone Marrow Think Leukemia |
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Which leukocytes are capable of dividing at the infection site |
Monocytes move to infection site and develop into macrophages after arrival Neutrophils can't and must move in from somewhere else |
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Macrophages eat antigens and present epitopes to.... |
T4 lymphocytes |
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Natural Killer Cells |
Attack infected host cells |
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Mast Cells |
Located in Connective Tissue -Innate defense is tissue Release histamines (involved in allergies) |
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Tumor Necrosis Factor |
Sectreted by macrophages Pro-inflammatory and pyrogenic |
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Cytokines |
Communication Regulate immune response |
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Active immunity |
Exposure to an antigen -Vaccine or getting a cold |
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Passive immunity |
Passed from one individual to another -Mother to child through breast milk |
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Humoral Immunity |
Circulation - In bodily fluids B lymphocytes |
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Cell-Mediated Immunity |
Antigens in cells sought out and destroyed T lymphocytes |
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B-Cells General function, Types |
**Recognize Foreign Antigens Plasma B Cells = produce and secrete specific antibodies Memory B Cells = Recognize antigens and initiate immune response |
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What Lymphocytes are coated in immunoglobulin? |
B Cells |
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Types of Immunoglobulin |
G - Most numerous M - Largest A - External (mucous membranes) D - Antigen receptor E - Parasitic and allergic reactions |
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Helper T Cells |
Activate B cells
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Suppressor T Cells |
Suppress immune system to prevent autoimmune dysfunction
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Cytotoxic T Cells |
Kill infected Self cells |
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Memory T Cells |
Antigen specific cells that recognize returning infections |
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Allergies |
IgE produces immediate histamine release and signals Mast cells and Basophils -Inflammatory response |
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Anaphylaxis is characterized by ... |
Bronchoconstriction and Vasodilation |
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Histamine causes... |
Vasodilation Bronchoconstriction Increased blood vessel permeability |
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Systemic Lupus Erythmatosus (SLE) |
Autoimmune
-Targets proteins in the cell nucleus -Malar Face Rash (butterfly) -Arthritis symptoms without bone errosion -Cardiovascular disease from corticosteroid therapy -HTN and Hyperlipidemia may be treated aggressively |
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Vasculitis |
Inflammation of cutaneous blood vessels
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Corticosteroids |
Inhibits cytokines
Reduces inflammation |
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Crohn's Disease |
Autoimmune
-Attacks alimentary canal -Humira inhibits Tumor Necrosis Factor -Bowel obstructions, fistulas, sepsis, etc. |
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AIDS |
-Caused by HIV
-Bloodborne pathogen -Targets Helper T-cells Antiretroviral therapy = (2) Reverse transcriptase inhibitors and (1) viral protease inhibitors |
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Immune Changes with Age |
Decreased phagocyte activity and number of T-Cells
Increased platelet aggregation |
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Exercise effects on immunity Athletes vs moderate chronic ex |
Moderate exercise -Increase innate immunity -Decrease inflammation -Increased IgA -Increased Neutrophils High Intensity -Decreased IgA -Decreased Neutrophils -Increased Natural Killer **IgA decrease associated with Upper Respiratory Tract Infections |
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Inflammatory Response |
1. Stop Bleeding (hemostasis) 2. Clean up and repair cells |
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3 types of Genetic injuries |
1. Chromosomal - Downs Syndrome 2. Single Gene Mutation - Sickle Cell 3. Multiple Gene Mutation - Type II Diabetes |
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Free radicals |
Unpaired oxygen is reactive (Electrons want to be paired) Antioxidants have spare electrons (Vitamin C) |
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Cardinal signs of Inflammation |
Redness Heat Swelling Pain |
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Fibronectin |
-Binds proteins together -attracts fibroblasts and macrophages -binds collagen and proteoglycans |
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Fibroblasts secrete... |
Collagen proteins Most common Connective Tissue cells |
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Proteoglycans |
Stabilize repairing tissue Secreted by Fibroblasts |
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Collagen |
Structure and tensile strength Type I is most common Type II is articular cartilage and ear and nose Type II is in newborns and initial healing |
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Elastin |
Provide elasticity to tissues allows arteries to accommodate pressure |
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Tissue Regeneration vs repair |
Regeneration is when the wound is healed with like cells. Inflammatory period needs to be short and basement membrane undamaged -Labile: Divide continuously -Stable: Divide with stimuli Repair is when cells are permanent and cannot divide SCAR TISSUE! |
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Cortical Bone |
Outer layer 80% of skeleton |
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Cancellous Bone |
Trabecular Spongy inner part Produces WBC |
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Tendon |
Type I Collagen and glycosaminoglycans (GAG) Muscle to Bone |
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Ligament |
Type I Collagen and glycosaminoglycans (GAG) Bone to Bone Poor healing potential due to low vacularization |
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Types of Cartilage |
Articular (Hyaline) Fibrocartilage - Intervertebral disk Elastic - Earlobe Fibroelastic - Meniscus |
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Wallerian degeneration |
Nerve is severed Myelin and Axon degenerate |
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Coccus |
Round |
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Bacillus |
Rod |
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Spirilla |
Spiral |
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Gram Positive |
Peptidglycan layer Stain Dark Blue |
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Gram Negative |
Impermeable lipid membrane Does not absorb stain Stain thin and red/pink |
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Pathogen Transmission |
Contact Droplet - Fall out of air at about 3-6 ft Airborne Vector |
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Diagnosis of Infectious Disease |
Visualization of organism Detect Antigen or Antibodies Grown in Culture Genetic Sequencing of known microorganism |
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Chicken Pox / Shingles |
Varicella Zoster Contact or Droplet Shingles is nerve axon inflammation from latent Herpes Zoster in Dorsal Nerve Root Ganglia Disseminated = 3+ dermatomes |
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Post-Herpetic Neuralgia |
Shingles Nerve pain persists after flare-up/rash subsides |
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Antibiotics Penicilin |
Broad Spectrum Gram Positive Inhibit Cell Wall Synthesis |
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Antibiotics Macrolides |
Gram Positive Aerobic or Anaerobic |
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Antibiotics Floroquinolones |
Broad Spectrum Gram Positive and Negative |
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Antibiotics Sulfonamides |
Sulfo Prefix Gram Positive and Negative |
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Antibiotics Tertracyclines |
Anaerobic or Aerobic Gram Positive or Negative **Limited by resistance Stop Protein Synthesis |
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Antibiotics Aminoglycosides |
Gram Negative Aerobic Gentomyocine - Side effect Hearing Loss! Treats Tuberculosis |
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Colostridium Difficile C-Diff |
Gram Positive, Spore producing bacteria Diarrhea Treated with Flagyl - Disrupt DNA synthesis **Spores not killed by alcohol hand gel |
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Cellulitis |
Streptococcus or Staphylococcus bacterial infection in skin (of LE) Red streaks/fingers away from main rash Necrotizing fascitis |
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Methicillin Resistant Staphylococcus Aureus MRSA |
Skin infection Systemic: bacteremia, catheter infections, Necrotizing pneumonia, osteolmyelitis Treated with Vancomycin -inhibits cell wall and RNA |
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Malaria |
Protozoa parasite transmitted by mosquitos Sickle Cell protected Matures in Liver and reproduces in RBC Lysing causes symptoms and side effects since Chloroquinine Phosphate also lyses RBCs |
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Lymphatic Filariasis |
Parasitic nematode enters circulation through mosquito bite Adult worms live in lymph system Cause Lymphedema Treat with Diethylcarbamazine (DEC) |
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Lymphedema |
Circulates through skeletal contraction and empties into the subclavian veins Orange peel effect Treat with compression treatment, layered bandages, massage, and elastic garments |
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Creutzfeldt-Jacob Disease CJD |
Prion Neurodegenerative human variant of Mad Cow Rapid dementia, Myoclonus, Visual Disturbance, Cerebellar Signs, Akinetic Mutism Always Fatal NOT killed in autoclaves disinfection |
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Candidiasis |
Fungal (Yeast infection) Thrush = oral, Panis = fat fold Treated with Nystatin |
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Universal Precautions |
Assume every patient has a communicable disease Gloves and handwashing Gowns and shields if splashes are expected |
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Contact Precautions |
Gloves and yellow gown Pseudomonas aeruginosa |
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Droplet Precautions |
Gloves, Gown, and standard face mask Influenza and Pneumonia Clean surfaces in room |
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Airborne Precautions |
Negative Pressure room N95 Fitted face mask Tuberculosis, Measles, SARS |
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5 Moments for Hand Hygiene |
1. Before Patient Contact 2. Before Aseptic Task 3. After Bodily Fluid Exposure 4. After Patient Contact 5. After contact with Patient Surroundings |
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Time for Handwashing and Hand Gel Use |
Handwashing 40-60 Seconds
Alcohol Gel 20-30 seconds |
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Pseudomonas Aeruginosa |
Contact Precautions -Gram Negative, Aerobic, Waterborne -Bright Green and sweet smelling -Treated with a Penicilin and Aminoglycoside (Gentamycin = ototoxicity) -"Hot Tub Rash" |
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Tuberculosis |
Airborne Precautions Cough lasting > 3 weeks Hemoptysis: Coughing up blood Diagnosed by skin or blood test -If those are positive (vaccine), then Chest X-Ray Treated with Isoniazid |
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Steps of Tissue Repair |
Hemostasis Inflammation Proliferation and Migration Remodeling and Maturation |