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158 Cards in this Set

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What is Pathophysiology (3)?
the study of abnormalities in physiologic functioning of living beings.
Reveal physiologic responses to disruptions in its internal or external environment.
By discovering common and expected responses to abnormalities in physiologic functioning, we have a general prediction of clinical progression, identification of possible causes, and a selection of possible interventions.
How are etiology and pathogenesis used to predict clinical manifestations and response to therapy (3-4)?
Etiology is the study of the causal factors that provoke a particular disease or injury.
Pathogenesis is a description of how etiologic factors are thought to alter physiologic function and lead to the development of clinical manifestations that are observed in a particular disorder or disease. An understanding of the etiology, pathogenesis and clinical manifestations of a particular disorder may suggest that certain treatments could be helpful (pgs. 3-5).
How are normal and abnormal physiologic parameters defined (6)?
Normal physiologic factors are defined as 95% of the values in the population are expected to fall in the normal range, thus 5% of the normal population may fall outside the normal range despite the absence of disease. The population chosen to serve as the “normal” reference varies in regards to age and genders.
Measurements outside of the normal range are considered to be abnormal.
What general factors affect the expression of disease in a particular person (9-11)?
Age, gender, genetic and ethnic background, socioeconomic factors and lifestyle considerations, and geographic location may affect the expression of disease in a particular individual.
What kinds of information about disease can be gained through understanding concepts of epidemiology (8-9)?
By understanding the concepts of epidemiology, information may be gained by examining the occurrence, incidence, prevalence, transmission, and distribution of diseases in large groups of people and populations. Understanding the concepts of epidemiology is essential for effective prevention and treatment for diseases.
What are the functions of the plasma membrane?
a. Protects organelles from the external environment
b. Transports nutrients and waste products
c. Generates membrane potentials
d. Provides cell recognition, communication, and growth regulation
What is the major function of the nucleus?
Protect and preserve genetic information for replication
What is the major function of the cytoskeleton?
Regulates cell shape, movement, and the intermediate filaments
What is the major function of the Endoplasmic Reticulum?
Transports protein and lipid components

Membrane that extends through the cytoplasm
What is the major function of the Ribosomes?
Minute round particles

Site for protein synthesis
What is the major function of the Golgi Apparatus?
cisternae that look something like a stack of deflated balloons

Central receiving, transporting and directing of proteins and lipids
What is the major function of the Lysosomes?
Spherical single layer organelle originates in the Golgi Apparatus

Membrane bound bags of digestive hydrolase enzymes that degrade intracellular debris, capable of digesting organic molecules, including proteins, nucleotides, fats, and sugars
What is the major function of the Mitochondria?
“power house”; responsible for converting food into usable energy in the form of ATP
What is a protein?
TRANSPORTS nutrients a wastes out of the cell

CONNECTS plasma membrane to adjacent cells

RECEPTORS responding to external stimuli and catalyze biochemical reactions

Extends across the bilayer and has contact with intra and extracellular fluids

Transduction: Extracellular signals to intracellular messages
What is the structure and function of the lipid bilayer?
Composed of:
1. Cholesterol:
2. Glycolipids:
3. Phospholipids:
All three are amphipathic (able to form bilayers in aqueous solutions)
What is cholesterol?
Comprises 50% of the lipid cell membrane
Decreases permeability & prevents of H2O soluble molecules
What are glycolipids?
Contain sugar molecules at the polar head
Involved in cell recognition and cell to cell communication
What are phospholipids?
Differ is size, shape and charge of polar head.
Membrane bound proteins require specific phospholipids
How does a cell conducts cellular metabolism?
Either by 1. anabolism (energy-using) Fats --> Energy
or
2. catabolism (energy-releasing) Glucose --> ATP
to provide cellular energy and biochemicals.
What are the three types of catabolism?
1. Glycolysis
2. Citric Acid Cycle
3. Oxidative Phosphorylation
What is glycolysis?
Second phase anaerobic process takes place in the cytosol. Net gain of two ATP molecules per glucose molecule. Glycolysis will continue in reduced O2 conditions.
What is citric acid cycle?
Third phase of catabolism. Takes place in the mitochondria. Complete oxidation of glucose; making it ready for phosphorylation.
Without cellular oxygenation the result is lactic acid -->Poison
What is oxidative phosphorylation?
Produces ATP by reaction of ADP plus inorganic phosphate.
Oxygen is required at this phase. Hence, oxidative phosphorylation.
What is Pinocytosis?
Ingesting fluids and small molecules process is common to most cells
What is Phagocytosis?
Ingestion of large particles such as microorganisms.
Practiced by specialized WBC
How does a cell transport small molecules (pumps) and large molecules (Endocytosis) across the plasma membrane?
Small molecules are transported by an electrochemical gradient through active and passive transport.
Large molecules are transported through endocytosis and exocytosis: cellular ingestion of extracellular molecules by Pinocytosis and Phagocytosis
What is an Electrochemical Gradient?
The intra and extracellular components differ in charge and concentration
What is Active Transport?
ATP is needed to transport ions or particles across the cell membrane
What is Passive Transport?
No expenditure of ATP is used to transport particles or ions. Membrane transport proteins not ATP driven are:
1. Na+ driven
2. Passive transport Carriers
How is bacteria categorized and classified?
Cell wall shape/ movement
Morphology
Gram stain
Aerobic/anaerobic
What is a Na+ driven Carrier?
Specific sites in body require a secondary active transport by using the Na
gradient to pull in nutrients and ions into the cell
What is a passive transport carrier?
Transporters not linked to Na gradient. Example: Glucose Transporters who depend on insulin to be activated.
What are the three types of membrane transport proteins for small molecules?
1. ATP Driven pumps
2. Carriers
3. Channel Proteins
What is an ATP driven pump (Active Transport pumps)?
Process whereby PTP move solutes across the membrane against an electrochemical or concentration gradient. ATP is necess. to run the pumps.
There are three:
1. Na+ K+ pump
2. Membrane Calcium transporters
3. ABC transporters
What is the Na+K+ pump?
Located on plasma membrane
Serves to maintain low Na K intracellularly
What are membrane calcium transporters?
Found in ER and mitochondrial membrane. Pumps on ER maintain low levels of intracellular Ca
Mitochondria kicks in when dangerous levels are reached.
What are ABC transporters?
Largest of membrane transporters.
Chloride channel --> cystic fibrosis
Bacteria use ABC to pump ABX out for resistance.
What is a carrier?
Sodium- Driven carriers
What is a channel protein?
A water filled pore that goes through the lipid bilayer.
Open and closes to allow ions to pass through the membrane.
What is the Latent Period?
Time between exposure of tissues to injurious agent and fist appearance of signs and/or symptoms
What is the Acute Clinical course?
Short-lived (hours, day, or a few weeks); may have severe manifestation (5)
What is the Chronic Clinical course?
May last months to years, sometimes following an acute course (5)
What type of cell do you know that wants to eat what is floating around outside the cell?
Macrophage
What is a Gap Junction?
Found on most tissues in large numbers

Connecting channels between cells allowing for communication

Used in synchronized functions: Cardiac muscles
What is cell-to-cell communication?
Found on receptors with signaling molecules on other cells or extracellular matrix.

Develop cell recognition to avoid autoimmune diseases.

Important in the development of fetal immunity
What are secretion of chemical mediators?
Ligands: water-soluble molecules or ions (have charge) that interact with receptors on the cell surface
There must be a specific ligand to bind to a specific receptor
What are the two main characteristics of cellular injury?
1. Hydropic swelling
2. Inctracellular accumulations
What is Hydropic swelling?
First manifestation of reversible cell injury
Cellular swelling due to accumulation of water because of the accumulation of sodium ions within the cell.
Disruption of Na+ K+ pump by lack of ATP production.
Characteristics:
Clear/pale cytoplasm
Dilated endoplasmic reticulum: synthesis of plasma membrane components disrupted
Swollen Mitochondria: Na+K+ pump does not receive ATP to function
What is intracellular accumulations?
The accumulations become toxic

Provoke immune response: Chaperone cells (stress proteins) help rescue the protein strands

Crowd out Organelles: Organelles cannot function and therefore do not allow for active or passive transport.
What are the 5 types reversible injury?
1. Atrophy
2. Hypertrophy
3. Hyperplasia
4. Metaplasia
5. Dysplasia
What is Atrophy?
When the cells shrink and reduce their differentiated functions in response to a variety of normal injurious factors
• Caused by disuse, denervation, ischemia, nutrient starvation, interruption of endocrine signals, persistent cell injury and aging.
• After an accident the broken bone will be less than what it was due to the lack of use
What is Hypetrophy?
: Increase in cell mass
• Increase in cell size r/t physiologic or pathophysiologic demands
• Tropic hormones-breasts/uterus, liver-toxins, Heart-disease HTN
• Tissue whose size has increased
o Child entering puberty (Breasts or Penis)
• Problem: Hypertrophy in organs  heart or liver growing to over compensate
What is Hyperplasia?
Increase in the number of cells
• Increased in mitotic cell number r/t physiologic demands or hormonal stimulation
• Tropic hormones-breasts/uterus, enlargement: liver, heart, thyroid, corns, and calluses
• Puberty: Some will grow bigger in a response to hormones and create more cells in their breasts for example
What is Metaplasia?
The replacement of one differentiated cell type with same type but better able to withstand injurious stimulations
• Smokers, change in cell type in esophagus and maybe a precursor to cancer
• Cellular adaptation
What is dysplasia?
The disorganized appearance of cells because of abnormal variations in size, shape, and arrangement.
• Distorted and the size, shape, and arrangement has changed
• High probability to become cancer
• Think Cancer until it is ruled out with biopsy
What is irreversible injury?
Two processes that contribute to cell death:
1. Necrosis including gangrene
2. Apoptosis
What is Necrosis?
Usually occurs as a consequence of ischemia or toxic injury  lack of O2 the cell does not have the energy to live
• Characterized by cell rupture, spilling of contents into extracellular fluid, and inflammation
o Swells so much that it spills or is no longer functional
• Localized injury or death of tissue
• Four Primary Types:
1. Coaguative: Dry gangrene
2. Liquefactive: Wet gangrene
3. Fat
4. Caseous
What is gangrene?
Involves large area of tissue. Interruption of major blood supply (72-73)
o No longer O2 going to the area, the larger the area is not being fed O2 the larger the gangrene will spread
o Three types of Gangrene
1. Dry- Common to extremities: Blackened, dry, wrinkled tissue separated healthy tissue by line of demarcation from healthy tissue
2. Wet- Common to internal organs: cold, black, foul smell
3. Gas- May occur throughout the body. Anaerobic Bacterial Agent: Clostridium. May be fatal without aggressive Rx.
What is apoptosis?
A normal physiologic process that regulates normal system function; does not elicit and inflammatory response (73-74)
• Natural: RBC lives 120 days natural death cycle is Apoptosis (biological death)
• Pathologic cellular death occurs when an injury is too severe or prolonged to allow – adapt or repair
• Other cells can recognize when cells are going through apoptosis because they do not want to go through the apoptosis as well
• Injured cells will have to die and go away
• An orderly and tidy process
• Two triggers for Apoptosis
1. Survival signals from neighboring cell or extracellular matrix is suppressed
2. Cell triggers its own death
What is the difference between apoptosis and necrosis?
Necrosis is usually a consequence of disrupted blood supply and can result in local and systemic symptoms, including pain, inflammation and loss of function.

Apoptosis results from activation of intracellular signaling cascades that cause cell suicide and is not usually associated with systemic manifestations of inflammation
What is the difference between necrosis and gangrene?
Necrosis is usually a consequence of disrupted blood supply and can result in local and systemic symptoms, including pain, inflammation and loss of function.

Gangrene an interruption of the blood supply and O2 is no longer going to the area, the larger the area not being fed O2, the larger gangrene will spread
What are the two types of physiologic aging?
1. Programmed Senescence Theory
2. Free radical theory
What is Programmed Senescence theory?
Cells under go a finite number of replications because the chromosomes shorten a bit with each cell division until a critical point is reached.
What is the Free Radical Theory?
Cumulative and progressive damage to cell structures [cell membrane]
What is the difference between physiologic aging and disease?
Physiologic Aging: include a decrease in functional reserve or an inability to adapt to environmental demands
- Age-related changes are irreversible and have a universal nature
-Somatic Death: Death of an entire organism; absence of HR and respiration.
-Within minutes of cardiac arrest: body temperature drops, pale skin, blood and body fluids pool.
-Rigor Mortis-post mortem contractures followed by limp tissue.
-With in 24-48 hrs. the tissues begin to deteriorate-postmortem autolysis.
What is the difference between apoptosis and necrosis?
Apoptosis is natural cell death?

Necrosis is the lack of O2 traveling to the cell --> killing the cell
To what 8 injuries are cells susceptible?
Cellular injury and death can result from a variety of cellular assaults, including
1. ischemia
2. hypoxic injury
3. reperfusion injury
4. nutritional deficits
5. infectious and immunologic injury
6. chemical
7. physical
8. mechanical factors
What is Hypoxia?
Leads to a decreased production of ATP
What is Ischemia?
Interrupts blood supply, allows build up of metabolic wastes and disrupts glycolysis
What is a gene?
A linear sequence of DNA that codes for a particular protein
What is a chromosome?
A linear thread of DNA that becomes visable under a microscope during mitosis; contains 46 or 23 pairs
What is a helix?
A double strand of DNA that must be separated into single strands that can be passed on to daughter cells during cell division.
What is a Telomier?
The end part of a helix.
How does a gene prevent defective base pairs from being sent to the newly synthesized cell.
The newly replicated DNA helix is “proof read” for base pairing.
o Incorrect pairings are replaced with correct base pairs. There are enzymes that go up and down the chain and inspect and correct the best pair
What are the four differentiated cell/tissue types?
1. Epithelial
2. Connective
3. Muscle
4. Nerve
What is epithelial tissue?
Covers the majority of the external surfaces of the body and line the glands, blood vessels, and internal surfaces.
There are three basic shapes: squamous, cuboidal, and columnar
What is connective tissue?
Most abundant and diverse tissue in the body, including cell types, as different as bone, fat cells, and blood cells
There are three types: Fibrcartilage, Dense, Hematopoitic
What is muscle tissue?
Tissues specialized for contraction.
There are four types: Skeletal, cardiac, smooth, and myoepithelial
What is nervous tissue?
Widely distributed throughout the body, providing a rapid communication network between the CNS and various body parts.
There are three parts to a nerve cell: Axon, dendrite, and body
What is neoplasia?
Altered expression of cellular genes in an accelerated mode
• Cellular replication may harm the host if benign and most assuredly if malignant.
What is cancer?
Primarily a disorder of gene expression

Regardless of the site, the tumor will harm the host

Metastasis is evident

Invasive and not contained

Anaplasia: Variation in cell size, shape and distortion of organelles
What is benign growth?
Site of tumor will determine if it will harm the host

Do not invade adjacent tissue or spread to distant sites

Many are encapsulated

Resemble the tissue type or origin
What is a proto-oncogene?
- The over activity of a gene
What is a tumor suppressor cell?
- Little gene expression
- Both copies of TSG's must be inactivated to eliminate its function
IDENTIFIED BY:

FUNCTION: Contribute to cancer, only when they are not there and may silence itself through epigenetic process
What is pharmacokinetics?
How the body effects the drugs through
- Absorption
- Distribution
- Metabolism
- Excretion or elimination
- ADME
What are the eight routes for administration?
1. PO- Oral
2. SL- Sublingual
3. Inhaled
4. Topical and Trasndermal
5. PR- Rectal
6. IM- Intramuscular
7. SC- Subcutaneous
8. IV- Intravenous
What is the Rb Gene?
The "master break" in cell proliferation be removing a major restraint on cell division

Common to a number of cancers
What is BRCA1 and BRCA2?
The "Breast Cancer Gene", a person is at high risk 85% if the gene is spotted
What is P53?
Inhibits cell cycling when the cell is damaged to allow time for DNA repair "Checks and balances"

Important in initiating apoptosis of cellular or unwanted cells
What is a metastasis?
Dissemination of cancer cells from the location of origin to other distant areas in the body

The larger the tumor, the further along the metastasis.
What are the 5 steps for metastasis?
1. Escape from basement membrane of the organ by digesting the membrane and squeeze through the hole
2. Move through extracellular space
3. Digest the cell wall of blood or lymph vessel, and enter
4. Reaches tissue to be colonized, digests basment membrane and squeezes through
5. Acquires nutrients and a blood supply and starts to colonize
What are the common effects cancer has on the body?
In regards to the patient's response to the metastasis, the thought is LOCATION!!!
Common effects are:
1. Pain
2. Cachexia
3. Bone Marrow Suppression
4. Infection
- Immune suppression with subsequent infection is a primary cause of cancer associated death
What are the treatment options for Benign and Malignant tumors?
Treatment is primarily dependent on the staging procedure
Option include:
1. Surgery
2. Radiation therapy
3. Drug Therapy
4. Immotherapy
5. Gene and molecular therapy
6. Stem cell transplant
How can over expression or proto-oncogenes lead to abnormal cellular proliferation?
- normally POG's are coded for cell-signaling systems that promote cell proliferation through
1. Growth Factors (mitogens)
2. Receptors
3. Cytoplasmic signaling molecules
4. Nuclear transcription factors
What is growth factor (mitogens)?
Cells do not produce GF to stimulate their own proliferation

The proliferation/inhibiting signals must be produced by the cell’s environment.

Brain cancers and connective tissue cancers
What is a growth factor receptor?
Peptide growth factors can not penetrate the cell membranes extremely specific receptors are needed.

A mutational event: receptors are not present, excessively present, or have high affinity.
What are cytoplasmic signaling molecules?
Production of excessive or abnormal components of the intracellular signaling pathways. An example is the RAS gene.
What are nuclear transcription factors?
- Normally sequestered and prevented from indiscriminate activity

- Mutations may cause overproduction or interference of normal mechanisms.
What are the 4 types of pathogenic organisms?
1. Bacteria
2. Fungi
3. Viruses
4. Parasites
How do pathogenic organisms enter the host?
1. Bacteria: Contamination and hygiene
2. Fungi: live in the body as normal flora and become pathogenic when the immune defenses are down
3. Viruses: Stick to the host CM and trick it into phagocytosis or penetrates the CM and injects viral genetic material
4. Parasites: Ingested of contaminated food/water. Opportunistic
What is Pharmacodynamics?
What the drug does to the body
- How it reacts in the body and
- How it will alter function
What are 5 viral pathogens and what specific infection do they cause?
1. Influenza virus- Influenza
2. HIV -1- AIDS
3. Hepatitis B- Hepatitis B
4. JC virus- Warts
5. Herpes Simplex Virus- Herpes
What do fungi candidiasis, histoplasmoisis?
1. Normal flora that can become pathogenic
2. California, Arizona, Nevada
What are the clinical manifestations of parasites like protozoa and plasmodium (malaria).
1. Protozoa - GI: cramping and bloody diarrhea
and if not treated can cause peritonitis
2. Plasmodium - Systemic: fever chills rigor, causes brain damage and attacks the nervous system
What is the first line of defense?
Nonspecific Defense Mechanisms
1. Skin
2. Mucous membrane
3. Secretions of skin and mucous membranes
What is the second line of defense?
Nonspecific Defense Mechanisms
1. Phagocytic white blood cells
2. Antimicrobial Proteins
3. The inflammatory response
What is the third line of defense?
Specific Defense Mechanisms (Immune System)
1. Lymphocytes
2. Antibodies
What is chemotaxis and the 3 steps?
The process by which phagocytes are attracted to the site of infection
1. Tissue injury: release of chemical signals
2. Dilation and increased permeability of capillaries
3. Phagocytosis of pathogens
What is the inflammatory response?
- A process so important, its activation must be guaranteed

- There are multiple mechanisms that are required to CONFINE IT, CONTROL IT, and REGULATE IT.
What are the four major symptoms of inflammation?
Infection = Inflammation
1. Redness – Vasodilation due to histamine, kinins, Prostaglandins, and leukotrines
2. Heat – Increased blood flow
3. Edema – Vascular permeability
4. Pain – Nerve irritation
What are the 3 stages of inflammation?
1. Vasodilation
2. Phagocyte migration
3. Tissue repair.
What are the 3 chemical mediators?
1. Histamine: Dialates arteries, increases capillary permeability
2. PG: Causes vasodilation, increases capillary permeability, pain and fever
3. Kinin: Causes powerful reactions dilate the arterioles and increases capillary permeability
What are the four consequences of complement activation
1. Cytolysis: Membrane Attack Complex (MAC)
2. Inflammation: Release of histamine
3. Opsonization: Promotes phagocytosis
4. Inactivation of complement:
What are the two primary lymphoid organs and their functions?
1. Bone Marrow: Hematopoiesis
a) Red: Active (houses B lyphocytes)
b) Yellow (not active, stays in reserve)
2. Thymus: Takes in naive cells and activates them to active B-cells, T-cells, or Killer cells
- Very selective on which cells get activated
What are the 4 secondary lymphoid organs?
1: tonsils: used in chronic infections
2. Spleen: filtration and interacts with blood borne pathogens
3. Nodes: House T, B, and marcrophages that trap foreign substances
4. Peyer Patches: Contains B cells found in mucosal tissue
What is a CBC and a C dif?
CBC: Complete Blood Count
Cdif: Tells the percentage of each WBC found in sample
A. Granulocytes
1. Neutrophils (70%)
2. Basophils (1%)
3. Eosinophils (4%)
B. Monocytes/ Marophages (5%)
C. Lymphocytes (20%)
- Tells how well the WBC are working to fight an infection
What are Natural Killer Cells?
o Attack the body’s own cells that have become infected
o Attack potential cancer cells, before they form tumors
o Secrete Perforin which makes a hole in the cell membrane of the target cell - killing it
What is the function of a suppressor T Cell?
- Suppresses the activities of t cells
- Recognize that a pathogen is gone therefore, help to end immune response
What is the difference between an Antigen and an Antibody?
Antigen: An endogenous or exogenous molecule that simulates the immune response
- Has sites that the antibody can bind to

Antibody: Protein produced by B-cells that destroys or inactivates a specific antigen
What is the function of a mast cell?
- Central cell in inflammation; contains lots of histamine
- Its important to look at the airway and make sure there is not a universal response
- Activated by chemotaxis needing help
- Chemical release happens in two ways
1. Degranulation: The release of histamine (vasodilation)
2. Synthesis of lipid-derived chemical mediators
- Arachidonid Acid: (leukotrienes and PG’s) kicking in the immune response
- Platelets- help because capillaries are leaky and may tear and bleed
How do macrophages and Antigen Presenting cells work together?
After macrophages ingest the foreign invader, it displays a piece of the antigen on their cell membrane receptors. This tells the other types of immune system cells to what to look for
What is the composition and function of cytokines?
- hormone like proteins that regulate intensity and duration of immune responses
Composed of:
1. Interleukins (ILs): enhances the acquired immune response
2. Interferon: protects against viral infections
o Produced & released by virally infected host cells
3. Tumor necrosis factor- alpha (TNF-α): induces fever, acting as endogenous (pathogen from within) pyrogen (causing fever)
o Secreted by macrophages in response to PAMP (Pathogen associated molecular patterns) by toll-like receptor
What are the characteristics of a systemic infection?
- Infection that involves the entire body
1. Fever: Caused by exogenous and endogenous pyrogens, Act on the hypothalamus
2. Leukocytosis >10K: Increased number of circulating leukocytes
3. Increased plasma protein synthesis: C reactive protein, fibrogen. Acute phase reactants
hat are the characteristics of a local infection?
- Local infection may involve the skin or internal organ and may progress to systemic
1. Redness
What are the two types of allergic responses?
1. Mild: Rhinitis, itching, localized edema; use benedril (histamine) to cure

2. Severe Allergic Reactions (Anaphylaxis); Must use epinephrine to cure
What are the four types of secreted Antibodies?
1. IgM – Sit below the dermis and activate IgG
2. IgG – most common form
3. IgA - Sit below the dermis and activate IgG
4. IgE – Allergic and parasitic infections
What are the four ways allergens are contracted?
1. Ingestion: Food, medication
2. Inhalation: Pollen, dust, molds, chemicals
3. Injection: Medication, sting of an insect/plant
4. Skin contact: plants, animals, pollen, latex
What is Type 1 and Type 4 Hypersensitivity?
Requires prior sensitization, Antigen specificity
The second allergic reaction will be greater than the first
Type 1: Immediate Hypersensitvity
- onset within minutes of antigen challenge
- examples are allergies to molds, nuts, insect bites and drug allergies
- may give anaphylaxis
Type IV: delayed hypersensitivity
- inflammation by 2-6 hours; peaks by 24-48 hours
- examples include poison ivy and chronic asthma, tuberculosis
What does Endocrine dysfunction equal?
= electrolyte dysfunction because the hormones are set off by the endocrine hormones.
- Electrolytes are at the mercy of the larger functions
- Mg+
-K+
- Cl-
How much does 1 liter of H2O equal?
1 kg. or 2.2 lbs
What is the normal sodium levels?
135-145 mEq/L
What are normal calcium levels and how many uses does it have in the body?
4.5-5.5 mEq/L

- More than 150 uses in the body
What are normal magnesium levels?
1.5-2.5 mEq/L
What are normal phosphate levels?
2.5-4.5 mg/dl
What are normal potassium levels?
3.5-5.0 mEq/L
Which hormones are needed for homeostasis?
1. Epinephrine - (K+)
2. Insulin - (K+ & PO4+)
3. PTH - (Ca+ & PO4+)
4. Aldosterone - (Na+)
5. ADH - (H2O)
Positive Trousseau Sign due to low levels of Ca+ and Mg+.
Positive Chvostek sign due to low levels of Ca+ and Mg+
What are the four functions of fluids?
1. Surrounds and permeates the cells
2. Lubricant and solvent for metabolic chemical reactions
3. Transports O2, nutrients, chemical messengers, and waste products to their destinations
4. Important in regulating body temperature
What is the difference between a proto-oncogene and a tumor suppressor cell?
The proto-oncogene is the over activity of a gene

The TSG is characterize as little gene expression
What are the six Nursing Roles Beyond the Six Rights?
1. Pre administer Assessment
- Restriction parameters, drug preparation, labs, etc
2. Dosage and Administration
3. Assessing the Patient for Self Care
4. Minimizing adverse Effects
5. Minimizing adverse Interactions
6. Making PRN decisions
- The RN purview
7. Managing Toxicity
What is the difference between Pharmacokentics and pharmacodynamics?
Pharmacokenetics: What the body does to the drug.

Pharmacodynamics: What the drug does to the body
What are Kinetics?
The energy of motion, ie. drugs on the move!
What is Peak and Troth?
IV Peak- 3 min
Oral Peak- 30 min
Rectal Peak- 40-50 min
- Used to manage toxicity
What is the quickest route for administration?
Intravenous
What are the 5 factors effecting metabolism?
1. Age
2. Health
3. Environment
4. Lifestyle
5. Genetics
What type of sheath covers the Blood Brain Barrier and what type of medications are used to get through?
The BBB is covered with a lipid sheath, therefore only lipid bound drugs can get through.
What is Cytochrome P450?
• Super family of enzymes in liver, helps the liver metabolize drugs
o Done through:
1. Oxidation
2. Hydrolysis
3. Hydroxylation
• CyP450 is damaged when the liver is damaged
• CyP450 comes in and converts drugs to hydroxyl groups
o Hydroxyl groups allow enzyme to be excreted by the kidneys
What is GFR?
Glomerular Filtration Rate: How we know that the kidneys are working properly
What is normal GFR?
125 mil/min
1-2 mil/kg/hr
What is the movement of drugs following GI Absorption?
What is a Active Metabolite?
When an inactive "pro-drug" is biologically transformed to its active state.
What is the Active metabolite for the "pro-drug" Codeine?
Morphine
What is the Active metabolite for the "pro-drug" Allopurinol?
Oxypurinol
What is the first pass effect?
- Dugs absorbed orally are transported to the general circulation via the liver through the portal blood flow
- Some of the drug will be lost when taken orally and the first time taken when passing through the liver
What is Creatine Clearance?
•Removal of drug from the body – final element of elimination

•Renal ability to clear drugs is estimated through surrogate substrate: creatinine

•Actual elimination rate is determined by 24 hour urine collection for excreted creatinine to determine creatinine clearance.
What does a low GFR mean?
Low blood pressure and the patient is more susceptible shock.
What does it mean if you do not hear peristalsis in the patients lower abdomin?
An ileus is/may be present.