Patho - Exam 1 Review - Lecture notes 1-5 PDF

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Complete notes on all of Exam One content. EX 253 offers open-note exams, these notes contain all the information that may come up during the exam. Utilizing these notes, all information to all the given questions may be answered correctly....

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Patho & Pharmacology Exam 1 Principles of Pathophysiology Pathophysiology = Study of functional & physiological changes in body that result from a disease process - W.H.O. definition of Health - A state of complete (beyond just disease) physical, mental, & social well-being - Possible to be diagnosed with disease AND still be healthy; Ex: Type I diabetes patient can partake in a healthy lifestyle (nutrition & physical activity & disease management) - Idea of sick goes beyond just physical state of individual - Normal vs Abnormal: DON’T describe person; Measures/Observations/Test findings Terminology in Diagnostics: ● Signs = Direct observation by examiner; Something that’s observed/seen (not told/reported by patient) ● Symptoms = Relayed/reported to examiner by patients or guardian ● Gross Examination = Observed with naked eye; Something with skin/ROM/etc ● Microscopic Examination = Observed in magnified sampled ● Screening/Testing (NOT all the same and cannot be compared) ○ Vary in terms of specificity & sensitivity (may have false positive/negative → further testing) ○ Sensitivity - Is A disease present; Test will help determine if disease is present but not what disease is ○ Specificity - Distinguish disease; Ability to be negative in absence of disease and more specific as to what disease is ■ Highly sensitive test likely to test positive in presence of disease BUT tendency for false positives ■ Highly specific test likely to be negative in absence of disease BUT tendency for false negatives ● Prognosis = Prediction of disease outcome (Ex: lifespan from point of diagnosis/survival rate/etc) ● Acute Disease = Recent in onset & Observable (clear to see) ● Chronic Disease = Ongoing (At least 3-6 months) ● Syndrome = Collection of signs & symptoms, could be used for several different diseases (Ex: Down syndrome - different genetic causes present similar S&S to down syndrome) ● Onset = When did disease start… ○ Recent → Sudden/Acute ○ Sneaky/Gradual Progression → Insidious (start with mild signs) ● Subclinical = No obvious manifestations (No S&S but test positive) ● Latent = Disease in inactive state (common with virus/HIV/chicken pox → shingles)

Sequelae = Unwanted effects of disease, often avoidable (Ex: Liver disease in diabetes) Morbidity = Functional impairment/Illness rate of disease (Ex: Blindness from diabetes) Mortality = Death rate of disease Incidence = Number of new case of disease Prevalence = Number of new & existing cases (influenced by morbidity/mortality) ○ Higher morbidity → Higher prevalence; Higher mortality → Lower prevalence ★ ETIOLOGY = Cause of disease (Idiopathic = Unknown; Iatrogenic = Caused by another treatment/procedure - Ex: Immunosuppression) **NOTE: Cause of disease different than risk factor that increases risk Cell Injury - Terminology: ➢ Hypoxia - Lack of oxygen; Ischemia - Lack of blood supply leading to lack of oxygen (hypoxia & ischemia are most common causes of cell injury/death) ➢ Direct physical effects (force/temperature/radiation) ➢ Toxic molecular injury (chemical’s/heavy metals) ➢ Microbes - Infection of cell with bacteria/virus ➢ Inflammation/immune reactions ➢ Nutritional imbalance - Inadequate vitamins/minerals (Ex: Iron Anemia) ➢ Genetic (Ex: sickle cell disease) ➢ Aging (Degenerative effects; Ex: Joints/Arthritis) Cellular Adaptation & Change: ● Atrophy - Cells shrink (Ex: Immobilization due to cast); Number of cells stays the same ● Hypertrophy - Cells grow (Ex: Strength training); Number of cells stays the same ● Hyperplasia - Increase in cell number (Monitor - can progress to cancer OR normal in uterine lining) ● Metaplasia - One mature cell type replaces another mature cell type (Ex: Smokers Ciliated cells in trachea replaced with less sensitive/nonciliated cells - adaptive change) ● Dysplasia - Cells vary in size/shape (often precursor to cancer/neoplasia) ● Neoplasia - New growth (tumor -benign or malignant/cancer) Cell Death - 3 Main Types: ● Necrosis - Pathologic/Abnormal cell death due to some event or disease ○ Type of cell/location of cell death dictates type of necrosisOccurs due to events of disease; Depending on cell type/location determines type of necrosis ■ Coagulative (most common - by infarct/ischemia); Congealed/dead tissue ■ Liquefactive (open vacuoles - Ex: brain tissue - dead tissue liquifies) ■ Caseous (Cheese like - Ex: Lungs & Tuberculosis) ● Apoptosis - Programmed/Normal Cell Death ● Autophagy - “Self-Eating” (Removal of damaged cells; Usually done by immune system) ● ● ● ● ●

Principles of Pharmacology: Pharmacology = The effects of drugs on the body (both therapeutic & adverse) as well as bodies effects on drugs Definition of a Drug: ➢ Biological response (drug makes body do something BUT nothing it can’t already do; NO new tissue or organ function) ➢ Drug may have multiple actions (Ex: Pain reliever & Fever reducer - ibuprofen) ➢ Drug may interact with receptors/enzymes (caffeine/alcohol/herbal supplements meet this criteria - subjective in their definition as drug) Function of Drug: ➢ Replacement - Ex: Levodopa used to increase/rep;ace dopamine in those with parkinsons ➢ Interruptions - Ex: Beta blockers (block β-receptors in CV system → reduce heart rate) ➢ Potentiation (enhance something) - Uses enzymes/catalyze existing reaction Drug Development - Takes Several Years:

Drug Names - All Drugs have Multiple Names: ● Chemical name (based on chemical structure) - Ex: 2-(4-Isobutylphenyl) propionic acid ● Generic name (based on original patent company) - Ex: Ibuprofen ● Proprietary/Trade name (brand name) - Ex: Advil/Motril **Could be multi-drug product - Ex: Nyquil (many active ingredients)** Drug Classifications: ● Based on: Chemistry (what it looks like - ex: steroid family), Mechanism of Action (what it does - ex: beta-blockers/proton pump inhibitors), Legal ramifications - (Rx/OTC, Controlled/Scheduled) ○ Over the Counter (OTC) Drugs - Rigorous/Specific testing & approval by FDA to show drug is safe enough for consumer to take without doctors advice ○ Prescription (Rx) Drugs - Substance more controlled/scheduled; don’t know what to take without doctors eval (ex: antibiotics); drug is new & need guidance ★ Controlled Substance - Some potential for abuse; Numbered/Ranked 1-5 based on potential for abuse (C-1 = Most abused - C-5 = Least abused) Phases of a Drug: ➔ Pharmaceutical Phase - Drug broken down; Disintegration & Dissolution ➔ Pharmacokinetic Phase - After dissolution, Available for absorption distributed/metabolized/excreted

➔ Pharmacodynamic Phase - Drug available for action; Drug receptor interaction → effect Pharmaceutical Phase: ● Consists of disintegration & dissolution (depends on dosage from & route of administration) ● Dosage form is solid (tablet or capsule) or liquid (syrup/elixir/suspension/emulsion) ● Route of Administration: ○ Enteral (Use of GI tract) ★ Oral (most common) - Convenient/Safer in event of maluse/Cheapest ○ Good absorption BUT goes through liver first (hepatic first pass effect - some of drug inactivated prior to function; Oral dose slightly higher to account for this) ● Gastral/Stomach - Low pH & Low surface area ● Small Intestine - Large surface area & more neutral pH ★ Sublingual (under tongue/buccal) - More parenteral route, bypass liver → more immediate effect - absorbed directly into bloodstream) ★ Rectal - Suppository (address something local or can’t swallow) Parenteral Administration: ★ More rapid in onset & bypass hepatic/liver → lower dosage ○ Subcutaneous (underskin); Intramuscular (Directly into muscle); Intravenous (IV; directly into vessel immediate effect/fastest route); Intrathecal (Directly into CSF - past blood brain barrier); Epidural (Diffuse into CSF) Local Administration - Specific Location: ● Intra-Articular (Directly into joint - Ex: Arthritis - Steroid into joint) ● Topical - Skin or transdermal patch (Ex: Nicotine patch) ● Pulmonary - Lung treatment (Ex: Asthma - Inhale drug) Pharmacokinetics - Phases: ● Absorption - All drugs exist as weak acid or weak base (solubility/absorption depends on pH of environment) ○ Weak acid drug in acidic media (non-ionized/non-polar/lipid-soluble) ○ Weak acid in basic media (ionized/polar/water-soluble) ○ Weak basic drug in acidic media (ionized/polar/water-soluble) ○ Weak basic in basic media (non-ionized/non-polar/lipid-soluble) ● Transport across Membrane ○ Membrane openings (drug can go from lumen → Interstitium via channel) ○ Passive transport - Diffusion ○ Active transport - USe ATP to get drug into cell ● Distribution - Physical Size/Surface area/Body weight contribute to distribution rate; Barriers:

■ Blood Brain Barrier - Tight junctions in brain (need active transport/form to get through endothelial membrane into CNS space) ■ Placenta - Not selective/protective like BBB ● Drug Reservoirs ○ Plasma proteins - Ex: Albumin (If drug is bound to albumin it is INACTIVE; Buffer system) ○ Tissue binding - Have affinities for fats/minerals/etc ● Metabolism & Excretion ○ Metabolism occurs in liver in case of oral drugs - Some metabolism prior to circulation (hepatic first pass) ○ Excretion (clearance) through kidneys (water-soluble) or bile (lipid-soluble) Pharmacodynamic Phase: ● Mechanism of action (how drug works) - Either alters cellular environment or cellular function ○ Receptor interaction (binding) ■ Agonist: Active site similar shape of ligand; Binds to & activates receptor ■ Antagonist: Can bind to receptor but produces no effect; Blocks receptor ○ Enzyme interactions (INteract with enzyme proteins) ■ Catalyze or block reaction ○ Non-Specific Interaction (No interaction with receptor or enzyme - Just changes environment) ● Plasma level profile (Graph of drug concentration over time) Therapeutic range, minimum effective concentration (MEC), Toxicity ○ Dose-Response relationship: Concentration vs response ● Biological Half Life - Time for ½ of drug to be inactivated ○ Bioavailability - how much drug is available for use by tissues/cells Therapeutic Index & Margin of Safety: ❖ Therapeutic Index = Ratio indicating relative safety: ➢ TI Ratio = Lethal Dose (for 50% of pop.)/Effective dose (for 50% of pop.) ➢ The closer TI ratio is to 1 = The less safe/Higher risk of toxicity ❖ Margin of safety looks at toxic dose of 1% compared to effective dose in 99% (less affected by dose response curve); TD01/ED99 (Don't see overlap between LD & ED) Drug Interactions - Can occur with other drugs/herbals/foods: ● Enzyme induction/inhibition ● Protein binding (Ex: Reversible binding of drug albumin) ● Excretion/Absorption (Ex: Antacid → changes pH where drug normally absorbed) Interactions May Be: ➔ Additive: 1 + 1 = 2

➔ Synergistic (2 drugs have greater effect together than alone): 1 + 1 = 4 ◆ Ex: Tylenol + Codeine ➔ Antagonistic (2 drugs together weakens effect): 1 + 1 = 1 ◆ Ex: β-Blockers & Albuterol Adverse Drug Responses (ADRs) & Side-Effects: ● ADRs: Side effects/Adverse reaction, Allergic reaction, Organ toxicity ● Predictable side effects: Age, Body mass, Gender (hormones), Environment, Time of administration, Pathological state (kidney/liver damage), Genetic factors, Psychological factors (emotions/perceptions) Allergic Reactions & Toxicity: ● Allergic reactions - Involve immune system (Range from rash to anaphylaxis) ● Cytotoxicity (could be permanent damage) - Liver/Kidney Exercise & Pharmacology: ● Exercise → Blood flows to surface of skin & muscles; Decrease blood flow to GI system (decrease oral absorption) - Don't take oral meds prior to exercise ● Vasodilation in skin from exercise distribute topical.intramuscular injection more (ice pack to reduce/confine spread) Fluid, Electrolyte, & Acid-Base Balance: - On average 60% of adult body weight is water/fluid - 70% of infant body weight; Females less than makes (women higher body fat %); Obese have less % fluid, Elderly have less % fluid - Older women approx 45% body weight is fluid (thus - different populations/groups affected more by electrolyte imbalance) Terms: ● Intracellular (ICF) = Inside cell ● Extracellular (ECF) = Outside cell - Composed of several types of fluid: ○ Intravascular (IVF) - Ex: Plasma (fluid within vessels) ○ Interstitial (ISF) - Fluid between cells/tissues ○ CSF & Transcellular (Ex: Synovial, Pericardial) Fluid Control: ➢ Thirst - Controlled by hypothalamus using osmoreceptors (osmotic pressure) ➢ ADH (Antidiuretic Hormone): Promotes water reabsorption in kidneys (retain water) ➢ Aldosterone - Part of R-A-A system (renin-angiotensin-aldosterone); Part of how kidneys reabsorb Sodium (water tends to follow where Na+ goes - as part of osmosis) ➢ ANP (Atrial Natriuretic Peptide) - Made by myocardial cells in atrium; Inhibits ADH & Renin to lower blood pressure through fluid loss - Effects GFR (ANP increases filtration rate at glomerulus) ➢ Hydrostatic Pressure (like blood pressure) - Based on mechanical pressure/volume ➢ Osmotic Pressure (colloid/oncotic); Based on amount of proteins/solutes in solution

**Elevated hydrostatic pressure - Push fluid out; Elevated osmotic pressure - Pulls fluid in (balance of pressures - Ex: Arterial & Venous side of capillaries)** Excess Fluid - Edema: 1.) Elevated/High Hydrostatic Pressure (High blood pressure) - Filtration pressure high; Pushes excess fluid out but it cant return easily to capillaries as pressure is so high 2.) Low osmotic pressure - May be due to loss of plasma proteins (Ex: Albumin - helps provide colloid pressure); Lose plasma proteins in vessel → Decrease in capillary osmotic pressure (Force that pulls fluid into capillaries can no longer do so - Not enough plasma proteins to exert osmotic pressure → more fluid leaves capillaries) 3.) Lymphatic Obstruction - Lymphatic system allows absorption of excess tissue fluid; Blockage/loss of lymph capillaries → build up of protein/water in interstitial space 4.) Increased capillary permeability - Most commonly due to vasodilation from inflammation (separates cells lining blood vessel - easier for fluid to exit) Dehydration: ● Chain reaction: Reduce fluid → compensate with increased HR & drop BP ● Graded based on percent of body weight lost ○ Mild (-2%); Moderate (-5%); Severe (-8%) ● Infants & Elderly more at risk (smaller fluid reserve/less adaptability) ○ Infants also higher BMR; Elerdly also less efficient kidneys Causes of Fluid Loss: ● Hypotonic Dehydration (Lose more electrolytes than water); Isotonic Dehydration (Lose equal amounts electrolytes/water); Hypertonic Dehydration (Lose more water than electrolytes) ● Vomiting & Diarrhea - Normally short-term imbalance of electrolytes ● Excessive sweating - Electrolyte imbalance/Na+ loss ● DKA (Diabetic KetoAcidosis) - Too much blood glucose in diabteic → lose large amounts of water to flush out ● Insufficient water intake OR intake of fluid with concentrated electrolytes Effects of Edema & Dehydration: ➢ Edema - Swelling/Pitting, Increase in body weight, Functional impairment in affected area, Pain, Circulatory impairment, Skin breakdown ➢ Dehydration - Dry membranes/mouth, Decreased skin turgor/elasticity, Lower BP, weak pulse, fatigue, Increased HCT (hematocrit = % blood cells relative to fluid), Confusion, Higher HR, Pale/cool skin, Less urine Sodium Imbalance: ➔ Sodium = Primary cation (+ charge) in ECF; Affecting osmotic pressure (90% of solute present in ECF) ➔ Hyponatremia - Direct loss of sodium or relative excess of water ◆ Causes: Excessive sweating, Vomit/Diarrhea, Diuretics/low salt diet, Hormonal imbalance (ADH/Aldosterone). Chronic renal failure, Excess water intake

◆ Effects: Nerve conditions (fatigue, muscle cramps, abdominal cramps → nausea), Decreased BP (due to low blood volume), Confusion ➔ Hypernatremia - Too much sodium in diet or low water intake/water loss ◆ Causes: Insufficient ADH, loss of thirst mechanism, Watery diarrhea, prolonged rapid respiration (exhale water) ◆ Effects: Weakness/agitation, Firm subcutaneous tissue, Thirst, Dry membranes, Less urine (except if cause if low ADH) Potassium Imbalance: ➔ Primary cation in (+ charge) in ICF; Influenced by acid-base balance (acidosis moves K+ out of cells, alkalosis moves K+ into cells) ➔ Hypokalemia - Not enough K+ ◆ Causes: Diarrhea, Diuretics (usually cause K+ loss), Imbalance of aldosterone/glucocorticoids (cushings), Insulin in DKA (Cause change in K + in blood stream) ◆ Effects: Cardiac dysrhythmias, Neuromuscular function (weakness), Paresthesias (pins/needles), Decreased digestive motility, Shallow breathing, Renal function (severe cases) ➔ Hyperkalemia - Too much K+ ◆ Causes: Renal failure, Aldosterone deficit, K + sparing diuretics, Injuries/burns (rupture cells → ICf ions into blood stream), Acidosis ◆ Effects: Cardiac dysrhythmias, Muscle weakness, Fatigue, Nausea, Paresthesia **Blood tests necessary to determine hypo or hyperkalemia Calcium Imbalance: Extracellular cation (Ca2+ = Double positive charge) ➔ Heavily influenced by: Parathyroid hormone (PTH), Calcium, Vit. D/Phosphate, Bones, Kidneys, & GI System ➔ Ca2+ regulation: Store in bones, Reabsorb in kidneys/excrete, absorb from diet in GI, & all dependent on Vit. D produced in skin; Vit. D & Phosphate reciprocal: HIGH phosphate → LOW calcium (& vice versa) ➔ Hypocalcemia - Low Ca2+ ◆ Causes: Low PTH in hypothyroidism, malabsorption, Low serum albumin (related to Ca2+ transport), Alkalosis, Renal failure (high levels of phosphate, can’t get out of kidneys in renal failure → Ca2+ levels drop) ◆ Effects: Excitable skeletal nerves (tetany = hyper-excitable muscle contractions; Chvostek's sign = lip/face spasms when front of ear tapped; Trousseau’s sign = Involuntary finger contraction when BP cuff blocks circulation to hand), Weak heart contractions, Arrhythmias ➔ Hypercalcemia - High Ca2+ ◆ Causes: Bone malignancy (Ca2+ leached from bones → blood stream), Too much PTH in hyperthyroidism, Immobility (loss of bone density → demineralization), Increased Ca2+ intake (milk alkali syndrome)

◆ Effects: Muscle weakness, lethargy, cognitive, anorexia/nausea, polyuria (ADH interference), stronger cardiac contractions, dressed bone density Acid-Base Balance Hard to maintain: lactic acid, Keto acids, H+ in krebs cycle: ● Normal Range = 7.35 - 7.45 pH in blood stream ● Control & Compensation: 1.) Buffer Pairs - Relation between weak acid & alkaline salt; Sodium bicarb Carbonic acid, phosphate system, hemoglobin system, protein synthesis 2.) Respiratory Rate - pH too low → breath out CO2 (less H2CO3 produced) 3.) Kidney Excretion - Combine bicarb & Na+ (Na+ + HCO3- → NaHCO3); Excrete via urine Acid-Base Imbalance: ● Acidosis (low pH) ○ Respiratory Acidosis - Increased CO2 (Increased carbonic acid) ○ Metabolic Acidosis - Decrease in bicarb (alkaline that usually neutralizes acid) ● Alkalosis (high pH) ○ Respiratory Acidosis - Decreased CO2 (Decrease in carbonic acid) ○ Metabolic Acidosis - Increase in bicarb (bicarb is alkaline → alkalosis in excess) Acid-Base Cause & Effect: ➢ Acidosis Causes: ○ Respiratory - Acute respiratory problems (pneumonia/chest), COPD (chronic increase in CO2) ○ Metabolic - Loss of bicarb through diarrhea, lactic acidosis/DKA, renal disease (can’t rid of acids) ○ Acidosis Effects: Headache, lethargy, weakness, confusion, coma, death ○ Acidosis Compensation: Deep/Rapid breathing ➢ Alkalosis Causes: ○ Respiratory - Hyperventilation (decrease in CO2 → decrease in carbonic acid) ○ Metabolic - Loss of HCL (hydrochloric acid), hypokalemia, antacids ○ Alkalosis Effects: Muscle twitching, tingling/numbness, seizures, coma ○ Alkalosis Compensation: Renal (limit acid excretion) Inflammation & Healing: Bodies Defense Mechanisms - 3 Lines: 1.) Skin/Mucosal Membranes (Physical/Mechanical membranes): Ex: Skin, Tears/Saliva a.) Non-Specific; First line of defense, function to keep things out of body b.) Reacts same regardless of what comes in contact (non-specific) 2.) Process of Phagocytosis & Inflammation (Phagocytosis - Process of engulfing invaders) a.) WBCs (neutrophils & macrophages), Interferons (protein that helps protect nearby cells from viral infection & aids in cancer prevention) b.) Inflammation (a long with phagocytosis) - Big part of preventing infection/rid of forgein objects, Non-Specific

3.) Immune System (Takes a lot longer to occur due to specificity) a.) Specific defense mechanism; Specificity (uniqu...