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137 Cards in this Set

  • Front
  • Back

Incidence

How many cases over time

Prevalence

How many cases in the current population

Etiology

Cause or Origin of a disease

Pathogenesis

Biological Mechanism of a disease

Signs

Observable conditions that can be measured

Symptoms

subjectively reported by the patient

Remission

reduced intensity of symptoms in a chronic disease

Exacerbation

Increased intensity of symptoms in a chronic disease

Idiopathic Disease

Unknown Cause

Inherited vs. Congenital Disease

Both diseases are present from birth but inherited diseases are genetic while congenital disease might not be

Latrogenic Disease

Illness due to medical treatment




lymphedema after breast lymph node removal

3 Types of Immunologic Disease

Hypersensitivity (Allergies)


Autoimmune


Immunodeficiency

_____ Determines which drugs will be over the counter or require a prescription

FDA

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

Phases of Clinical Trials

Phase 1 = Healthy Volunteers


Phase 2 = Small # of patients with condition


Phase 3 = Larger # of patients

Drug Names

Generic


Chemical


Trade

Pharmacokinetics

Movement and metabolism of drug




-Absorption, distribution, biotransformation/metabolism, excretion


(ADME)

Pharmacodynamics

Mechanism of action in the body




Generally binding to receptor site

"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

Intrathecal

Injected into the cerebrospinal fluid to bypass the blood-brain barrier

Agonist Drug

Binds to a receptor site to enhance the cellular activity

Antagonist Drug

Binds to a receptor site to block the activity

Drug Affinity

Attraction between drug and receptor site

Efficacy

The medications ability to cause the expected response




Maximal Therapeutic Effect

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

Loading Dose

Larger initial dose to achieve therapeutic dose faster

Side Effects

Typical, predictable response to a drug that is not the purpose of the drug




ie GI Distress

Adverse Drug Reaction

Harmful effects of medication


Usually unpredicatble

Risk factors for Adverse Drug Reaction

Age (Geriatric)


Gender (Female)


Mass (Smaller)


Polypharmacy (5-10 drugs/day)

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

How are drugs grouped?

-Body System


-Clinical Indication


-Chemical Structure

Mechanism of NSAIDs

COX 1 and 2 inhibitors (COX enzymes form prostaglandins)




-Decrease inflammation, analgesic, and antithrombotic

Innate Immunity

First line of non-specific immunity




-Skin, Leukocytes, stomach acid

Acquired Immunity

Specialized, disease specific immunity


-Recognizes previous infections based on epitopes




-B cells, T cells

Antigen

Any foreign molecule not identified as self

Epitope

Protein on the antigen surface that allows recognition by acquired immunity

Major Histocompatability Complex

Molecules on cells that identify them as SELF

Pharmacology




Bioavailabilty

Fraction or percentage of active medication that reaches the systemic circulation following administration

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.

Greater Volume of Distribution means...

Drug is sequestered outside of the vascular compartment by binding to some extravascular tissue (Skeletal muscle)




NOT BLOOD

Lower Volume of Distribution means...

Drug binds to plasma proteins and stays in circulation


(NSAID)




BLOOD

Drug Clearance = ? + ?

Drug Metabolism + Drug Excretion

Drug Clearance of an organ is dependent upon..

Blood Flow to the Organ


Ability of the Organ to Extract the drug

High Extraction Drugs Limiting Factor

High Extraction Ratio (ER) and extensive elimination by that organ




Blood Flow is limiting factor

Low Extraction Drugs Limiting Factor

Smaller Extraction Ratio (ER)




Metabolism of enzymes in the organ is the limiting factor




Not limited by perfusion

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

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

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

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)

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)

Which drugs are more readily absorbed?




Solubility

Lipid-Soluble Drugs

Lipid Soluble Drugs are stored...

In adipose tissue




People with a larger fat percent of body weight may have reduced drug effects

Liver damage can have what effect on Drug Metabolism?

Decrease in microsomal enzyme activity therefor decreasing metabolism and increasing blood concentration of the drug

2 Enzyme Steps of Drug Metabolism

1. Inactivation of Drug


2. Produce Water-Soluble metabolites that can be excreted by the kidneys

Drug Potency

The Amount of drug required to produce efficacy

Combination Drug Therapy

2 drugs with the same therapeutic effect used so that lower doses of both can be used




Reduce Side Effects

Difference in Drug Metabolism




Neonates

Possible toxic reactions due to immature metabolic processes

Difference in Drug Metabolism




Teenagers

Shorter drug half lives




Higher drug metabolism

Difference in Drug Metabolism




Geriatrics

Decrease in the liver size and kidney function




Decreased Metabolic Activity

Inappropriate Medication Use in Nursing Home Residents

-Daytime sedation


-Dizziness, Confusion, Amnesia


-Orthostatic Hypotension


-Extrapyramidal Reactions

Innate Leukocytes

Phagocytes


-Neutrophils *


-Monocytes *


-Eosinophils - Parasite diseases


-Basophils - Allergies




*Most numerous

Where are leukocytes produced?

Bone Marrow




Think Leukemia

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

Macrophages eat antigens and present epitopes to....

T4 lymphocytes

Natural Killer Cells

Attack infected host cells

Mast Cells

Located in Connective Tissue


-Innate defense is tissue




Release histamines (involved in allergies)

Tumor Necrosis Factor

Sectreted by macrophages




Pro-inflammatory and pyrogenic

Cytokines

Communication




Regulate immune response





Active immunity

Exposure to an antigen




-Vaccine or getting a cold

Passive immunity

Passed from one individual to another




-Mother to child through breast milk

Humoral Immunity

Circulation - In bodily fluids




B lymphocytes

Cell-Mediated Immunity

Antigens in cells sought out and destroyed




T lymphocytes

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

What Lymphocytes are coated in immunoglobulin?

B Cells

Types of Immunoglobulin

G - Most numerous


M - Largest


A - External (mucous membranes)


D - Antigen receptor


E - Parasitic and allergic reactions



Helper T Cells

Activate B cells

Suppressor T Cells

Suppress immune system to prevent autoimmune dysfunction

Cytotoxic T Cells

Kill infected Self cells

Memory T Cells

Antigen specific cells that recognize returning infections

Allergies

IgE produces immediate histamine release and signals Mast cells and Basophils




-Inflammatory response

Anaphylaxis is characterized by ...

Bronchoconstriction and Vasodilation

Histamine causes...

Vasodilation


Bronchoconstriction


Increased blood vessel permeability

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

Vasculitis

Inflammation of cutaneous blood vessels

Corticosteroids

Inhibits cytokines



Reduces inflammation


Crohn's Disease

Autoimmune

-Attacks alimentary canal


-Humira inhibits Tumor Necrosis Factor


-Bowel obstructions, fistulas, sepsis, etc.


AIDS

-Caused by HIV

-Bloodborne pathogen


-Targets Helper T-cells




Antiretroviral therapy = (2) Reverse transcriptase inhibitors and (1) viral protease inhibitors


Immune Changes with Age

Decreased phagocyte activity and number of T-Cells

Increased platelet aggregation


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

Inflammatory Response

1. Stop Bleeding (hemostasis)


2. Clean up and repair cells

3 types of Genetic injuries

1. Chromosomal - Downs Syndrome


2. Single Gene Mutation - Sickle Cell


3. Multiple Gene Mutation - Type II Diabetes

Free radicals

Unpaired oxygen is reactive (Electrons want to be paired)




Antioxidants have spare electrons (Vitamin C)

Cardinal signs of Inflammation

Redness


Heat


Swelling


Pain

Fibronectin

-Binds proteins together


-attracts fibroblasts and macrophages


-binds collagen and proteoglycans

Fibroblasts secrete...

Collagen proteins




Most common Connective Tissue cells

Proteoglycans

Stabilize repairing tissue




Secreted by Fibroblasts

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

Elastin

Provide elasticity to tissues


allows arteries to accommodate pressure

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!

Cortical Bone

Outer layer




80% of skeleton

Cancellous Bone

Trabecular




Spongy inner part




Produces WBC

Tendon

Type I Collagen and glycosaminoglycans (GAG)




Muscle to Bone

Ligament

Type I Collagen and glycosaminoglycans (GAG)




Bone to Bone




Poor healing potential due to low vacularization

Types of Cartilage

Articular (Hyaline)


Fibrocartilage - Intervertebral disk


Elastic - Earlobe


Fibroelastic - Meniscus

Wallerian degeneration

Nerve is severed




Myelin and Axon degenerate

Coccus

Round

Round

Bacillus

Rod

Rod

Spirilla

Spiral

Spiral

Gram Positive


Peptidglycan layer




Stain Dark Blue

Gram Negative

Impermeable lipid membrane




Does not absorb stain




Stain thin and red/pink

Pathogen Transmission

Contact


Droplet - Fall out of air at about 3-6 ft


Airborne


Vector

Diagnosis of Infectious Disease

Visualization of organism


Detect Antigen or Antibodies


Grown in Culture


Genetic Sequencing of known microorganism

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

Post-Herpetic Neuralgia

Shingles




Nerve pain persists after flare-up/rash subsides

Antibiotics




Penicilin

Broad Spectrum




Gram Positive




Inhibit Cell Wall Synthesis

Antibiotics




Macrolides

Gram Positive




Aerobic or Anaerobic

Antibiotics




Floroquinolones

Broad Spectrum




Gram Positive and Negative

Antibiotics




Sulfonamides

Sulfo Prefix




Gram Positive and Negative

Antibiotics




Tertracyclines

Anaerobic or Aerobic




Gram Positive or Negative




**Limited by resistance




Stop Protein Synthesis

Antibiotics




Aminoglycosides

Gram Negative




Aerobic




Gentomyocine - Side effect Hearing Loss!




Treats Tuberculosis

Colostridium Difficile




C-Diff

Gram Positive, Spore producing bacteria




Diarrhea




Treated with Flagyl - Disrupt DNA synthesis




**Spores not killed by alcohol hand gel

Cellulitis

Streptococcus or Staphylococcus bacterial infection in skin (of LE)




Red streaks/fingers away from main rash




Necrotizing fascitis

Methicillin Resistant Staphylococcus Aureus




MRSA

Skin infection




Systemic: bacteremia, catheter infections, Necrotizing pneumonia, osteolmyelitis




Treated with Vancomycin -inhibits cell wall and RNA

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

Lymphatic Filariasis

Parasitic nematode enters circulation through mosquito bite




Adult worms live in lymph system




Cause Lymphedema




Treat with Diethylcarbamazine (DEC)

Lymphedema

Circulates through skeletal contraction and empties into the subclavian veins




Orange peel effect




Treat with compression treatment, layered bandages, massage, and elastic garments

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

Candidiasis

Fungal (Yeast infection)




Thrush = oral, Panis = fat fold




Treated with Nystatin

Universal Precautions

Assume every patient has a communicable disease




Gloves and handwashing




Gowns and shields if splashes are expected

Contact Precautions

Gloves and yellow gown




Pseudomonas aeruginosa



Droplet Precautions

Gloves, Gown, and standard face mask




Influenza and Pneumonia




Clean surfaces in room

Airborne Precautions

Negative Pressure room


N95 Fitted face mask




Tuberculosis, Measles, SARS

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

Time for Handwashing and Hand Gel Use

Handwashing 40-60 Seconds



Alcohol Gel 20-30 seconds


Pseudomonas Aeruginosa

Contact Precautions




-Gram Negative, Aerobic, Waterborne


-Bright Green and sweet smelling


-Treated with a Penicilin and Aminoglycoside (Gentamycin = ototoxicity)


-"Hot Tub Rash"

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

Steps of Tissue Repair

Hemostasis


Inflammation


Proliferation and Migration


Remodeling and Maturation