WGU D027 Final Exam Complete Study Guide (Latest 2023/ 2024 Update) Advanced Pathopharmacological Foundations| Questions and Verified Answers| 100% Correct
WGU D027 Final Exam Complete Study
Guide (Latest 2023/ 2024 Update) Advanced
Pathopharmacological Foundations|
Questions and Verified Answers| 100%
Correct
Q: Hypoplastic Left Heart Syndrome – structure
Answer:
LEFT ventricle is underdevel- oped
Mitral valves not formed properly Aortic valve not formed properly Ascending aorta
underdeveloped Atrial septal defect
Q: Hypoplastic Left Heart Syndrome – fetal shunts
Answer:
patent ductus arteriosus – artery connecting aorta to pulmonary artery
patent foramen ovale – hole connecting right atrium to left atrium
Q: Hypoplastic Left Heart Syndrome – survival rates
Answer:
3-5 year survival rates of
70% for infants with stage 1 repari
Children who survive 12 months have 90% survival rate
Q: Hypoplastic Left Heart Syndrome – treatment stage 1
Answer:
1-2 weeks old (nor- wood procedure)
Enlarges aorta and connects to the right ventricle, shunt to pulmonary artery is created, patent
ductus arteriosus is closed
Q: Hypoplastic Left Heart Syndrome – treatment stage 2
Answer:
4-6 months old (glenn procedure)
SVC is connected to pulmonary artery, shunt from norwood is removed
Q: Hypoplastic Left Heart Syndrome – treatment stage 3
Answer:
18-36 months old
(fontan procedure)
IVC is connected to pulmonary artery, hole is made from the IVC conduit attached to the right
atrium
Q: Hypoplastic Left Heart Syndrome – s/s
Answer:
cyanosis, pallor, sweaty/clammy/cool skin, trouble breathing, rapid HR, cold feet, poor pedal
pulses, poor feeding
Q: Hypoplastic Left Heart Syndrome – testing
Answer:
during pregnancy – prenatal tests to check for birth defects, ultrasound to identify HLLS,
echocardiogram to show structures of heart
after birth – based on s/s through pallor and cyanosis, newborn will experience s/s once ductus
arteriosus and foramen ovale close
echocardiogram
Q: Hypoplastic Left Heart Syndrome – medication
Answer:
tube feedings, medications to strengthen heart muscles, lower BP, and remove extra fluid
Q: Parathyroid – function
Answer:
produces parathyroid hormone that regulates calcium in the bloodstream/tissue – more PTH
released = more calcium in bones released to blood/tissue = losing density and strength
Q: Parathyroid – labs
Answer:
calcium (8.6-10.3 mg/dL) PTH (11-51 pg/mL)
Q: Parathyroid – s/s hyperparathyroid
Answer:
osteoporosis, kidney stones, excessive urination, abdominal pain, fatigue, forgetfulness,
bone/joint pain
Q: Parathyroid – s/s hypoparathyroid
Answer:
High PTH, low T3/T4
paresthesia, twitching of facial muscles, muscle pains/cramps, mood changes, dry/rough skin
Q: Parathyroid – testing
Answer:
ultrasound, bone densitometry, body CT/MRI
Q: Parathyroid – medications
Answer:
calcimimetics, hormone replacement, biphospho- nates
Q: Parathyroid – treatment
Answer:
maintain low serum calcium level in hypoparathyroid
Q: Hutchinson-Gilford Progeria Syndrome – definition
Answer:
progressive genetic dis- order causing children to age rapidly – no cure – appears in first two
years of life
Q: Hutchinson-Gilford Progeria Syndrome – causes
Answer:
abberant splicing of the
LMNA making protein – progerin
Causes the nuclear envelope to surround the nucleus to be unstable and damages
it, causing it to die
test for LMNA mutation
Q: Hutchinson-Gilford Progeria Syndrome – assessment
Answer:
measure height/weight, plot measurements on normal growth curve chart, test hearing and
vision
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Celiac Disease – definition
intolerance of gluten – more pronounced in the duodenum and jejunum
Celiac Disease – s/s
Abdominal pain/distention, diarrhea (pale, greasy, bulky, foul), malnutrition complications (rickets, occult blood, anemia), early bleeds/bruises, hypomagnesemia/hypocalcemia (irritability, tremors, convulsions, tetany, bone pain)
Celiac Disease – labs
IgA-tTg, IgA-EMA, total IgA
Celiac Disease – testing
serologic measurements of IgA antibodies and HLA-DQ2 or HLA-DQ8, endoscopy with small intestine biopsy, duodenal biopsy
Sjoren’s Syndrome – definition
immune disorder characterized by dry mouth and dry eyes, mostly in older women
Sjoren’s Syndrome – testing
SSA+ and SSB+
Cinnamon – Uses
Lowers BG, Cholesterol, hypertension, risk of bleeding
Cinnamon – adverse efects
avoid use with diabetic drugs, anticoagulants, and heart meds – breastfeeding women should avoid as a treatment
Gingko Biloba – uses
halt progression of dementia, used for erectile disfunction
Gingko Biloba – adverse effects
increases risk of bleeding (avoid using with anticoagulants) and lowers seizure threshold
Glucosamine – uses
osteoarthritis
Green Tea – uses
lose weight, mental clarity
Green Tea – adverse effects
hepatotoxicity, avoid taking with vasodilators/stimulants/psychoactive medications, contains small amounts of vitamin K
Lavender – uses
increases relaxation, helps with anxiety/stress/insomnia
Lavender – adverse effects
constipation, headache, increase appetite, decrease BP, caution with CNS depressants
Hypoplastic Left Heart Syndrome – structure
LEFT ventricle is underdeveloped
Mitral valves not formed properly
Aortic valve not formed properly
Ascending aorta underdeveloped
Atrial septal defect
Hypoplastic Left Heart Syndrome – fetal shunts
patent ductus arteriosus – artery connecting aorta to pulmonary artery
patent foramen ovale – hole connecting right atrium to left atrium
Hypoplastic Left Heart Syndrome – survival rates
3-5 year survival rates of 70% for infants with stage 1 repari
Children who survive 12 months have 90% survival rate
Hypoplastic Left Heart Syndrome – treatment stage 1
1-2 weeks old (norwood procedure)
Enlarges aorta and connects to the right ventricle, shunt to pulmonary artery is created, patent ductus arteriosus is closed
Hypoplastic Left Heart Syndrome – treatment stage 2
4-6 months old (glenn procedure)
SVC is connected to pulmonary artery, shunt from norwood is removed
Hypoplastic Left Heart Syndrome – treatment stage 3
18-36 months old (fontan procedure)
IVC is connected to pulmonary artery, hole is made from the IVC conduit attached to the right atrium
Hypoplastic Left Heart Syndrome – s/s
cyanosis, pallor, sweaty/clammy/cool skin, trouble breathing, rapid HR, cold feet, poor pedal pulses, poor feeding
Hypoplastic Left Heart Syndrome – testing
during pregnancy – prenatal tests to check for birth defects, ultrasound to identify HLLS, echocardiogram to show structures of heart
after birth – based on s/s through pallor and cyanosis, newborn will experience s/s once ductus arteriosus and foramen ovale close
echocardiogram
Hypoplastic Left Heart Syndrome – medication
tube feedings, medications to strengthen heart muscles, lower BP, and remove extra fluid
Parathyroid – function
produces parathyroid hormone that regulates calcium in the bloodstream/tissue – more PTH released = more calcium in bones released to blood/tissue = losing density and strength
Parathyroid – labs
calcium (8.6-10.3 mg/dL)
PTH (11-51 pg/mL)
Parathyroid – s/s hyperparathyroid
osteoporosis, kidney stones, excessive urination, abdominal pain, fatigue, forgetfulness, bone/joint pain
Parathyroid – s/s hypoparathyroid
High PTH, low T3/T4
paresthesia, twitching of facial muscles, muscle pains/cramps, mood changes, dry/rough skin
Parathyroid – testing
ultrasound, bone densitometry, body CT/MRI
Parathyroid – medications
calcimimetics, hormone replacement, biphosphonates
Parathyroid – treatment
maintain low serum calcium level in hypoparathyroid
Hutchinson-Gilford Progeria Syndrome – definition
progressive genetic disorder causing children to age rapidly – no cure – appears in first two years of life
Hutchinson-Gilford Progeria Syndrome – causes
abberant splicing of the LMNA making protein – progerin
Causes the nuclear envelope to surround the nucleus to be unstable and damages it, causing it to die
test for LMNA mutation
Hutchinson-Gilford Progeria Syndrome – assessment
measure height/weight, plot measurements on normal growth curve chart, test hearing and vision
Hutchinson-Gilford Progeria Syndrome – s/s
short stature or slow growth, slow hair growth, alopecia, joint abnormalities, wrinkle/dry skin, FTT and delayed tooth development
Hutchinson-Gilford Progeria Syndrome – treatment
statins – decrease liver’s production of harmful cholesterol, NSAID – relieve pain, bone medications – strengthen/build bones, OT/PT
Hutchinson-Gilford Progeria Syndrome – life expectancy
Age 10x faster
13-20 years of age – average is 13
Neuropathy – medications
Gabapentin (Neurontin)
Duloxetine (Cymbalta)
Pregabalin (Lyrica)
Hydrotherapy – uses
Helps with multiple sclerosis and myasthenia gravis
Pneumothorax – definition/testing
collapsed lung – air between lungs and chest cavity – percussion is hyper-resonant
Hemothorax – definition/testing
collapsed lung – blood between lungs and chest cavity – percussion is dullness on both anterior and posterior
Tuberculosis – testing
Tuberculin skin test – inject 0.1 of tuberculin PPD into forearm ID, after 48-72 hours if induration is >15mm the test is positive(if >5mm = positive to immunocompromised, if >10mm = positive to people born in countries with TB and/or work in areas with high-risk
Chest X-Ray or CT – white spots in lungs where the immune system has walled off TB
Tuberculosis – medications
Isoniazid
Rifampin – don’t take with oral contraceptives
Ethambutol
Pyrazinamide
Thyroid levels
TSH – 0.5-5.0 mIU/L
T3 – 80-220 ug/dL
T4 – 5-12 ug/dL
Hyperthyroidism – assessment
Increase HR, dysrhythmia, angina, stimulated CNS (nervous, insominia, rapid thoughts/speech), skeletal muscles weak/atrophy, increase metabolic rate, increased appetite, warm/moist skin, intolerant to heat
Hyperthyroidism – medications
Propylthiouracil (PTU)
Methimazole (Papazole)
Hypothyroidism – assessment
Pale, puffy, expressionless face, cold/dry skin, brittle hair and hair loss, lowered HR and temperature, lethargy, fatigue, cold intolerance
Hypothyroidism – medications
Levothyroxin (synthroid)
Crohn’s Disease – defintion
inflammation/scarring of the digestive tract, throughout intestines (generally small intestine), patients with atopic dermatitis/eczema have increased risk
Crohn’s Disease – s/s
skip lesions (mucosal lesions where inflammation exists), cobble stones on biopsy, intestinal bleeding, chronic diarrhea, abdominal pain/cramping, fistula, fissure, ileus, mouth ulcers, worse AFTER eating
Crohn’s Disease – testing
Antibodies – anti-saccharomyces cerevisiae antibody test for ASCA protein
CBC to check h/h, heme occult for blood in stoole, CRP and ESR for inflammation, electrolyte panel, iron/b12
Crohn’s Disease – diagnosis
kidney/ureter/blader x-ray, colonoscopy/sigmoidoscopy to check for lesions, barium xray or video capsule endoscopy
Crohn’s Disease – medications
Aminosalicylate (sulfasalazine, mesalamine)
Oral steroids if Aminosalicylate is not effective or for exacerbation
Immunosuppresive therapy (methotrexate)
Antibiotics to manage bacterial overgrowth
IV Corticosteroids for 3-5 days
Crohn’s Disease – diet
low residue (low fiber, lean proteins, refined grains, low fat food)
Avoid caffeine, alcohol, and sharp edged/large grains
Ulcerative Colitis – definition
chronic inflammation of the digestive tract – mostly in the innermost lining of the large intestine/rectum
Ulcerative Colitis – s/s
diarrhea (with blood or pus), abdominal pain/cramping, rectal pain/bleeding, urgency to defecate and inability despite urgency, weight loss, fatigue, fever, FTT
Ulcerative Colitis – testing
perinuclear anti-neutrophyil cystoplasmic antibody test for pANCA, colonoscopy or flexible sigmoidoscopy, blood tests for anemia or inflammation (CBC, LFT, electroltyes, ANA, CRP, ESR), stool studies, X-ray, CT
Ulcerative Colitis – medications
anti-inflammatory drugs, corticosteroids, immune system suppressors, anti-diarrhea, antispasmodics, iron supplements
Sickle Cell – newborn
under 5 years old increased risk for pneumococcal infections d/t non-functional spleens and decreased immune response
Infants will be anemic
Sickle cell – vaso-occlusive crisis
dactylitis – severe pain and swelling of both hands and feet, pain affecting the extremities/back/chest, fever
Sickle cell – splenic sequestration
acute painful enlargment of the spleen, drop in hemoglobin levels, hypovolemic shock, seen in a CT
Sickle cell – aplastic crisis
sudden pallor or weakness, dropping hemoglobin levels, reticulocytopenia (low immature RBC)
Sickle cell – prevention
hydrate, avoid being too hot/cold, avoid high altitudes or places with low oxygen
Sickle cell – treatment vaso-occlusive crisis
IV fluids for hydration
IV analgesia
High flow O2
Sickle cell – medications
Ibuprofen or IV analgesia
Hydroxyurea to reduce painful episodes (prevents abnormal RBC but increases risk of infection)
Avoid iron medications
Penicillin for newborns
UTI – safe pregnancy medications
Fosfomycin (Monurol) – one time dose
Cefalexin (Keflex)
Ofloxacin (Floxin)
UTI – unsafe pregnancy medications
Nitrofurantoin (Furadantin, Macrobin)
Trimethoprim-sulfamethoxazole (Bactrim)
Penicillin
Levofloxacin (Levaquin)
Ciprofloxacin (Cipro)
UTI – safe pediatric medications
Trimethoprim-sulfamethoxazole (Bactrim)
Amoxicillin-clavulanate (Augmentin)
Cefixime (Suprax)
Cefpodoxime
Cefporozil (Cefzil)
Cephalexin (Keflex)
Pregnancy Immunizations – recommended
Influenza
TDAP – 27-36 weeks
Pneumococcal
Hep A and B
Menigococcal
Pregnancy Immunizations – contraindicated
Varicella vaccine
MMR
Varicella – definition
contagious disease caused by the varicella-zoster virus
Varicella – assessment
pleomorphic rash – small itchy blisters eventually scabbing over (start on chest, back, and face)
low grade fever preceeding the skin manifestations by 1-2 days
abdominal pains (in some)
Varicella – testing
rash assessment
blood tests
culture of lesion sample
Varicella – treatment
antivirals – Acyclovir (Zovirax)
Immune globulin IV (Privigen) – given within 24 hours after the first rash appears
Tylenol – for pain
Calamine lotion
Cool baths with baking soda, uncooked oatmeal, or colloidal oatmeal
Schizophrenia – positive s/s
hallucinations (auditory, visual, olfactor, gustatory, tactile)
Delusions (persecutory, referential, somatic, erotomaniac, religious, grandiose)
Confused thoughts/disorganized speech
Schizophrenia – negative s/s
anhedonia, flat affect, withdrawal, alogia, avolition
Schizophrenia – first generation medications
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
FLuphenazine (Modecate)
Schizophrenia – first generation side effects
EPS, Antimuscarinic effects, alpha-1 receptor antagonism, histamine antagonism
Extra Pyramidal Symptoms
Dystonia (continuous spasms and muscle contractions), Akathisia (restlessness), Parkinsonism (rigidity), Bradykinesia (slowing of movement), Tardive dyskinesia (irregular jerky movements of lower face/distal extremities)
Antimuscarinic effects
Dry mouth, constipation, blurred vision, urinary retention
Alpha-1 Receptor antagonism
orthostatic hypotension
Histamine antagonism
weight gain, sedation
Schizophrenia – second generation medications
Risperdal, Aripiprazole (Abilify), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon)
Schizophrenia – second generation side effects
Antimuscarinic effects, metabolic side effects, agranulocytosis and neutropenia (clozapine), neuroleptic malignant syndrome
Metabolic side effects
weight gain, dyslipidemia, hyperglycemia
Neuroleptic malignant syndrome (NMS)
fever, altered mental status, muscle rigidity, autonomic dysfunction
Benign Prostatic Hyperplasia – medications
Talmusolin (Flomax) – helps relax the prostate muscles and the bladder (educate on hypotension)
Congestive Heart Failure – defintion
volume overload in pulmonary area; left ventricular dysfunction
Congestive Heart Failure – left
pulmonary cause; JVD, FVE, Rales, S3 murmur
Congestive Heart Failure – right
peripheral vascular cause; LE edema, abdominal distention
Congestive Heart Failure – assessment
Normal ejection fraction – 55-60%
Reduced ejection fraction, preserved ejection fraction
Reduced ejection fraction
systolic heart failure; ineffective contraction and less oxygen-rich blood pumped in the body, less than 40%
Preserved ejection fraction
diastolic heart failure; ineffective relaxation during filling, 40-49%
Congestive Heart Failure – testing
BNP – over 100% heart failure is present and more severe
Echocardiogram – evaluate structure and function
Pleural effusion – s/s
Chest pain, dry/nonproductuve cough, dyspnea, orthopnea, fever
Pleural effusion – testing
chest x-ray, CT, ultrasound
Pleural effusion – medications
Diuretics (CHF and pulmonary edema)
Antibiotics (parapneumonic effusion and empyema)
Anticoagulation (PE)
Pleural effusion – treatment
Thoracentesis, chest tube, pleural drain, oxygen, positioning, avoid exacerbating activities
Regular insulin (clear)
30-60min onset; 2-4hr peak; 6-12hr duration
NPH insulin Humulin N (cloudy)
1-1.5hr onset; 4-12hr peak; 24hr duration
Ultralente (Humalin Ultralente)
4-8hr onset; 10-30hr peak; 20-36hr duration
Lispro (Humalog)
<15min onset; 30-90min peak; 2-5hr duration
Aspart (Novolog)
10-20min onset; 1-3hr peak; 3-5hr duration
Glargine (Lantus)
60-70min onset; no peak; 24hr duration
Glulisin (Apidra)
2-5min onset; 30-90min peak; 2hr duration
Detemir (Levemir)
1-2hr onset; 3-6hr peak;5.7-23.3hr duration
Diabetes contraindicated medications
Beta-blockers (masks hypoglycemia) and MAOI (glucose reduction)
Migraine patient – treatment
Botox
Systemic Lupus Erythematosus (SLE) – definition
inflammatory disease caused when the immune system attacks its own tissues; can affect joints, kidneys, skin, blood cells, brain, heart, and lungs
Systemic Lupus Erythematosus (SLE) – assessment
Fatigue, joint pain, rash, fever
Systemic Lupus Erythematosus (SLE) – treatment
Prednisolone and Methyloprednisolone
Diabetic Ketoacidosis – definition
complication where the body produces excess blood acids (ketones)
BG >250
Serum bicarb <18
Serum pH <7.3
Anion gap
presence of ketones in serum and urine
Diabetic Ketoacidosis – assessment
fruity scented breath, thirst/dry mouth, frequent urination, fatigue, dry/flushed skin, vomiting, confusion
Diabetic Ketoacidosis – contributing factors
intercurrent illness, infection, trauma, surgery, MI, poor insulin compliance
Diabetic Ketoacidosis – treatment
insulin to lower BG, fluids to replace volume, monitor potassium levels, monitor sodium/phosphorus levels
Cellulitis – definition
infection of dermis and sub cutaneous tissue
Cellulitis – treatment
IV antibiotics, PO antibiotics, treat temperature, educate on medication regimen, wrap the wound
Panic attack/hallucinations/nightmares – treatment
clonazepam (klonopin) for anxiety, clonidine (catapres) for hypertension, prazosin (minipress) for nightmares
Multiple Sclerosis – defintion
demyelinating disease that results in damage to the protective covering (myelin sheath) that surrounds nerve fibers in the brain, optic nerves, and spinal cord
Kidney and BP regulation
BP regulation through hormonse that casue the kidneys to increase the reabsorption of sodium and water into the bloodstream. The kidney contributes renin.
Antidiuretic hormon (ADH)
Aldosterone
Renin-angiotensin syndrome
Human Leukocyte Antigen (HLA-B*58:01) allele on allopurinol (Zyloprim) – allopurinol
used to reduce the uric acid to treat gout and kidney stones
Human Leukocyte Antigen (HLA-B*58:01) allele on allopurinol (Zyloprim) – definition
strongly associated with severe cutaneous adverse reactions (SCAR), such as Steven-Johnson Syndrome and toxic epidermal necrolysis
common in Koreans, Han-Chinese, and Thai descendants
Doxycycline (Vibramycin)
enhances anticoagulant effect of warfarin (MONITOR INR – normal is 0.8-1.2)
Muscle Spasms – medications
Baclofen (Gablofen)
Gabapentin (Neurontin)
Anatomy of the Skull w/ hematoma
Skull
Epidural hematoma
Dura mater
Subdural hematoma
Arachnoid mater
Pia mater
Brain
Epidural hematoma assessment
CN3 Palsy
Lucid Interval (pt comfortable and alert followed by rapid deterioration)
Biconvex disk on CT
Subdural hematoma
crescent shape on CT
Tay-Sachs disease
Ashkenazi Jewish patients at a higher risk
Tay-Sachs disease – definition
lack of enzyme that breaks down fatty substances, building up to toxic levels in the brain effecting the function of nerve cells in the brain and spinal cord
Tay-Sachs disease – s/s
loss of muscle control, cherry-red spots in the eyes, vision/hearing loss
Chronic Kidney disease – stage 1
normal or high GFR (90-120mL/min NORMAL), normal renal function with proteinuria for 3+ months
Chronic Kidney disease – stage 2
GFR 60-89mL/min, mild loss of renal function with proteinuria
Chronic Kidney disease – stage 3
GFR 30-59mL/min, mild hypertension
Chronic Kidney disease – stage 4
GFR 15-29mL/min, moderate hypertension, anemia, hyperphosphatemia
Chronic Kidney disease – stage 5 (end stage)
GFR<15, severe hypertension, hyperphosphatemia, anemia
Uncomplicated otitis media – causes
mainly caused by Moraxella Catarrhalis
Uncomplicated otitis media – treatment
amoxicillin is first line treatment in pediatric patients
Fludrocortisone (Florinef) – indication
used to treat Addisons’s disease and adrenocortical insufficiency
Fludrocortisone (Florinef) – side effects
Upset stomach, headache, menstrual changes
Color changes of skin or increase in fat
Easy bleeding/bruising
Slow wound healing, signs of infections
Bone, joint, and muscle pain
Puffy face, swelling of hands/feet
Increased thirst and urination
Weight gain and muscle weakness
Prazosin (minipress) – uses
relaxes outflow of the bladder and helps with prostate enlargement with BPH; PTSD associated nightmares; Raynaud’s phenomenon
Asthma – assessment
dry cough, wheezing, breathing through mouth, tachypnea, chest pressure, fast HR, throat irritation
Short Acting Beta2 Agonists (SABA) – indications
Step 2
used to treat environmental triggers, exercise-induced, virus-induced, or allergies
Safe in pregnancy
newborn or children should use nebulizers
Short Acting Beta2 Agonists (SABA) – medications
Albuterol (Salbutamol, Proventil, Ventolin)
Levalbuterol (Xopenex)
Inhaled Corticosteroids (ICS) – indications
Step 2/3
worsening respiratory symptoms from asthma, nighttime awakening, no systemic effects from taking oral corticosteroids
Inhaled Corticosteroids (ICS) – medications
Fluticasone (Flovent)
Budesonide (Pulmicort)
Mometasone (Asmanex)
Beclomethasone (QVar)
Leukotriene Receptor Antagonist – indications
Step 2
prescribed to growing children d/t long-term effects of a medium dose of ICS
Leukotriene Receptor Antagonist – medications
Montelukast (Singulair)
Mast Cell Stabilizers – indications
Step 2
low-dose ICS or alternatives; given to growing kids d/t long-term effects of medium dose of ICS
Mast Cell Stabilizers – medications
Cromolyn (Intal)
Long Acting Beta2 Agonists (LABA) – indications
Steps 3/4/5/6
Long Acting Beta2 Agonists (LABA) – medications
Formoterol (Foradil, Perforomist)
Salmeterol (Serevent)
Indacaterol (Arcapta)
Oral Corticosteroids – indications
all day coughing and wheezing, acute exacerbations
Oral Corticosteroids – medications
prednisone
ICS + LABA – medications
Fluticasone/Salmeterol (Advair)
Fluticasone/Vilanterol (Breo Ellipta)
Budesonide/Formoterol (Symbicort)
Mometasone/Formoterol (Dulera)
Myasthenia Gravis – definition
autoimmune disorder that causes weakness in the skeletal muscles
antibodies against nicotinic acetylcholine receptors at the junction between the nerve and muscles
Thryroid gland can cause this
Myasthenia Gravis – s/s
ocular myasthenia (weak eye muscles), ptosis (eye droop), diplopia (blurred/double vision), difficulty swallowing/coughing, SOB, slurred speech, weakness in arms/hands/fingers/legs/neck, increase HR/BP
Myasthenic crisis
severe muscle weakness – respiratory failure
Myasthenia Gravis – testing
Tensilon test, blood tests (acetylcholine, anti-MuSK antibody), electro diagnostics(Single fiber electromyography), CT/MRI
Tensilon test
Edrophonium briefly relieves weakness by blocking the break down of acetylcholine and increasing the leves.
10mg tensilon prepared lasting 10 minutes
Myasthenia Gravis – medications
Cholinesterase inhibiters (Neostigmine, Pyridostigmine), autoimmune treatments (prednisone)
Myasthenia Gravis – non-pharmacologic treatment
Plasmapheresis, IV immunglobulin, thymectomy, hydrotherapy
Cholinergic crisis
Looks like myasthenis crisis but occurs 30-60mins after taking anticholinergic med
Thyroid storm – definition
worsening of the thyrotoxic state, in which death can occur within 48 hours without treatment; may develop spontaneously but occurs in individuals who have undiagnosed/partially treated severe hyperthyroidism
Myasthenia Gravis – causes
Infection, pulmonary/cardiac disorders, trauma, burns, seizures, surgeries, obstetric complications, emotional distress, dialysis
Myasthenia Gravis – assessment
sudden release and increased action of T3/T4
Hyperthermia, tachycardia, high output HF, agitation, delirium, nausea/vomiting/diarrhea
Myasthenia Gravis – treatment
medications that block TH synthesis (propylthiouracil, thiamazole), beta blockers, corticosteroids, iodine, supportive care, plasma exchange, thyroidectomy
Uncomplicated hypertension – treatment
Hydrochlorothiazide (Microzide)
Ataxia – definition
degenerative disease of the nervous system – damage to the cerebellum; genetic predisposition or trauma to the spinal cord or other nerves
Ataxia – assessment
mimic those of being drunk, slurred speech, stumbling, falling, incoordination, wide-based gait, difficulty writing and eating, slow eye movement
Fragile X Syndrome
Break in X chromosome where there is a folate deficiency
Repeats of CGG in first exon of the fragile X chromosome.
Most individuals have less than 50. But Fragile X Syndrome has more than 200
repeats.
Late-onset, usually after 50 years old.
Developmental delays, learning disabilities, social and behavior problems.
Problems with movement and cognition.
Second most common cause of genetic intellectual disability after Down
Syndrome.
Athletic Heart Syndrome
Enlarged heart and lower HR
HR can be as low as 30-40
Hypertension – definition
Systolic BP >130 or Diastolic BP of >80
Hypertension – mechanism
lead to increase total peripheral resistance –> increased afterload; sodium absorption resulting in volume expansion; impaired response to renin-angiotensin-aldosterone system; increased activation of SNS
Hypertension – assessment
two office measurements on two separate occasions
increased BP
Pedal edema
Aortic valve disease (S4)
Renal vascular disease (renal bruit, carotid bruit)
Hypercortisolism (thin skin, easy bruising, hyperglycemia)
Thyroid disorders
Hypertension – elevated stage
systolic 120-129 and diastolic <80
Hypertension – stage 1
systolic 130-139 and diastolic 80-89
Hypertension – stage 2
systolic >140 and diastolic >90
Hypertension – medications
ACE (-pril)
ARBs (-sartan)
Diuretics
CCBs (-pine)
BBs (-lol)
Hypertension – non-pharmacologic
weight management, salt restriction, smoking cessation, obstructive sleep apnea management, exercise
COPD – assessment
breathing difficulty, wheezing, cough, sputum production
COPD – causes
emphysema, chronic bronchitis
COPD – testing
Spirometry or PFT, chest x-ray, CT, ABGs
COPD – medications
SABA, LABA (Formoterol – Performist, Salmeterol – Serevent, Indicaterol – Arcapta), SAMA (Ipratropium bromide), LAMA (Tiotropium (Spiriva)
COPD – medication order after trials
LAMA then LAMA + LABA
then LABA + ICS
then LAMA + LABA + ICS
then PDE4 inhibitor (Roflumilast – Daliresp or Macrolide)
Medullary thyroid cancer – definition
occurs in C cells and secretes calcitonin and carcinoemryonic antigen
Medullary thyroid cancer – assessment
painless lump on the front of the neck
Medullary thyroid cancer – testing
fine needle aspiration of biopsy, blood test if positive (calcitonin elevated and carcinoembryoni antigen elevated)
Medullary thyroid cancer – genetic counseling
to patients and first-degree relatives so thyroid if removed before MTC
Postural Orthostatic Tachycardia Syndrome (POTS) – criteria
HR increase >30 or >120 within first 10mins of standing w/o hypotension
Postural Orthostatic Tachycardia Syndrome (POTS) – assessment
may/may not have hypotension, hypovolemia, high levels of norepinephrine while standing, small fiber neuropathy, fatigue, headache, dizziness, palpitations, nausea, tremors, syncope, chest pain, SOB, coldness, reddish-purple legs when standing
Postural Orthostatic Tachycardia Syndrome (POTS) – testing
Tilt test, orthostatic vital signs, Quantitative Sudomotor Axon Reflex Test (QSART – measure sweat grand stimulation), thermoregulatory sweat test, skin biopsy, gastric motility studies
Postural Orthostatic Tachycardia Syndrome (POTS) – pharmacologic treatments
increase blood volume, reduce HR, peripheral vasoconstriction medications
Color Blindness – definition
OPN1MW on chromosome 23 (X-LINKED); comes from mother to son; disease is dominant
G6PD (Hemolytic Anemia) – definition
genetic disorder that causes RBC’s to break down prematurely, causing them to be destroyed faster than they can be made; X-LINKED RECESSIVE
G6PD (Hemolytic Anemia) – s/s
pale skin, jaundice, dark-colored urine, fever, weakness, dizziness, confusion, trouble with physical activity, enlarged spleen/liver, increased HR
G6PD (Hemolytic Anemia) – avoid
beans, moth balls, red wine, blueberries, soya products, tonic water, cmaphor
G6PD (Hemolytic Anemia) – medications
Aspirin, Ascorbic acid (vitamin C), Chloroquine, Methylene blue, Methyldopa (Aldomet), Fulfisoxazole (Pediazole)
Transfusion reaction
IGM – (ABO incompatability)
Slow rate of transfusion
Acetaminophen
Diphenhydramine
Steroids
Meperidine (Demerol) given for rigos
Small cell lung carcinoma – causes
tobacco smoking
Small cell lung carcinoma – testing
Epidermal Growth Factor Receptor (EGFR)
Chest X-ray
Thrush (Infants) – assessment
White or yellow irregularly shaped patches or sores in the gums or tongues
Cracked skin in the corners of the mouth
Thrush (Infants) – causes
Cadida Albicans
May develop if breast is not properly dried after feeding and yeast grows
Common in newborns under 2mo
Thrush (Infants) – risk factors
Very low birth weight; vaginal birth from mom w/ yeast infection; taken antibiotics; taken inhaled corticosteroids; pacifier use; weak immune system
Thrush (Infants) – medications
nystatin applied to inside of mouth multiple times a day for 10 days; liquid antifungal medicine; fluconazole (diflucan)
CYP3A4
Important in metabolism of codeine
St. John’s Wort induces this; accelerates metabolism of drugs –> loss of therapeutic effect; avoid with digoxin
Alzheimer’s – assessment
Brain shrinks – nerve cell death and tissue loss; plaques build up – abnormal clusters of these protein fragments; tangles form – twisted strands of another protein
Alzheimer’s – 10 warning signs
Memory loss that disrupts daily life; challenges in planning/solving problems; difficulty completing familiar tasks; confusion with time/place; trouble understanding visual images or spatial relations; new problems with words in speaking/writing; misplacing things; decreased/poor judgement; withdrawal from work/social activities; changes in mood/personality
Alzheimer’s – mild stage
Able to function independently; forgetting familiar words, losing everyday objects; trouble remembering names/performing tasks; forgetting material just read
Alzheimer’s – moderate stage
Requires increasing care; forgetfulness of personal history; confusion r/t place/time; need for help with ADL’s; increased risk of wandering
Alzheimer’s – severe stage
Longest stage; requires full-time care; loss of awareness of recent experiences; changes in physical abilities (walking, sitting, swallowing); vulnerable to infections
Alzheimer’s – Cholinesterase Inhibitors
Donapezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon)
Treats symptoms r/t memory loss, thinking, language, judgement, and thought process; prevents breakdown of Ach; delays/slows worsening symptoms; side effects – nausea, vomiting, loss of appetite, increased bowel movements
Alzheimer’s – N-Methyl-D-Aspartate receptor antagonist
Memantine (Namenda)
Improves memory, attention, reason, language, and ability to perform simple tasks); regulates glutamate activity; improves mental function/ability to do ADL’s; side effects – headache, constipation, confusion, dizziness
Beta Thalassemia – definition
Inherited disorder characterized by reduced/absent abounts of hemoglobin; found mostly in Mediterranean ancestry
Beta Thalassemia – s/s
Yellowing eyes; fatigue, dizziness, fainting; low BP, palpitations, rapid HR; chest pain; paleness, coldness, yellowing of skin; SOB, muscle weakness; changes in stool color, splenic enlargement; delays in growth and development; bone marrow expansion
Beta Thalassemia – treatment
regular blood transfusions
Epoetin Alfa (epogen) – increased production of RBC
Chronic Joint Pain – assessment
Joint redness, swelling, tenderness, and warmth; limping, locking of joint; loss of ROM; stiffness, weakness
Chronic Joint Pain – testing
medical history, physical exam, x-ray, blood tests
Chronic Joint Pain – medications
NSAIDs
Steroids
Topical analgesics
Chronic Joint Pain – treatments
Physical therapy; Transcutaneous Electrical Stimulator (TENS) – low voltage current to provide relief; Implanted electric nerve stimulation – sends mild current to spinal cord; Deep brain or spinal stimulation – treat movement problems, eases symptoms; acupuncture/meditation; weight loss, diet, exercise
Community Acquired Pneumonia – causes
Streptococcus pneumoniae; influenza A; Mycoplasma pneumoniae; Chlamydiophila pneumoniae
Community Acquired Pneumonia – s/s
Cough w/ or w/o sputum; dyspnea; pleuritic chest; tachypnea; adventitious breath sounds; tactile fremitus and dullness; fever; malaise; chest pain; chills; fatigue; leukocytosis w/ leftward shift
Community Acquired Pneumonia – testing
chest radiograph – pulmonary opacities d/t WBC and fluid (viral = diffuse widespread whitening; bacterial = patchy and consolidated); blood tests (ESR, CRP, procalcitonin); sputum culture and gram stain
Community Acquired Pneumonia – treatment
Adequate ventilation and O2; deep breathing; coughing; chest PT; antibiotics w/i 4 hours of presentation for bacterial
Contraception – non-hormonal
Condoms; diaphragm; vaginal sponges; natural family planning; withdrawal; spermicides; copper IUD (paragard)
Contraception – hormonal (progestin)
Levonorgestrel – keeps uterine lining thin to prevent implantation (Mirena or Skyla); Nexplanon – implantable rod under the skin of arm; Depo-Provera – injection every 12 weeks; oral contraceptive
Contraception – hormonal (combination)
Oral contraceptives; patch and ring
Contraception – Estrogen contraindications
Smoking; over 35 years old; breast feeding; personal/family hx of blood clots
Contraception – Progestin contraindications
Current pregnancy; unexplained vaginal bleeding; breast cancer; use of medications that interact w/ progestin
Depression – assessment
depressed/irritable mood; loss of interest and pleasure; >5% weight gain/loss in a month; insomnia/hypersomnia; psychomotor agitation or retardation; fatigue, loss of energy, worthlessness; poor concentration, indecisiveness, thoughts of suicide
Depression – treatments (SSRI)
Citalopram (Celexa); Escitalopram (Lexapro); Fluoxetine (Prozac); Sertraline (Zoloft)
Depression – treatments (TCA)
Amitriptyline (Elavil); Imipramine (Tofranil)
Depression – treatments (MAOI)
Phenelzine (Nardil)
Depression – treatment
Psychotherapy; electroconvulsive therapy
Diaper Dermatitis – assesment
Patchwork of bright red tender-looking skin on baby’s bottom; changes in baby’s disposition; fussy or cries when diaper area is washed/touched
Diaper Dermatitis – causes
wet/infrequently changed diapers; irritation from stool/urine; chafing; irritation from a new product; bacterial/fungal infection; introduction to new foods; sensitive skin; antibiotics
Diaper Dermatitis – treatment
keep baby’s skin as clean/dry as possible; mild hydrocortisone cream; antifungal cream; topical/oral antibiotics
General Anxiety Disorder – assessment
Excessive worry/anticipation of disaster; difficulties controlling worries
General Anxiety Disorder – 6 major symptoms
Restlessness; muscle tension; irritability; easily fatigued; difficulty concentrating; difficulty sleeping
General Anxiety Disorder – testing
diagnosed >6mo of excessive worrying and has at least 3 of the 6 major symptoms
General Anxiety Disorder – medications (SSRI)
Indicated to use for PTSD-related anxiety; Citalopram (Celexa); Escitalopram (Lexapro); Fluoxetine (Prozac); Paroxetine (Paxil); Sertraline (Zoloft)
General Anxiety Disorder – medications (SNRI)
Duloxetine (Cymbalta); Venlafaxine (Effexor)
General Anxiety Disorder – medications (NDRI)
Bupropion (Wellbutrin)
General Anxiety Disorder – medications (antihistamine)
Hydroxyzine (Vistaril/Atarax)
General Anxiety Disorder – medications (benzo)
Clonazepam (Klonopin) – first-line treatment; Alprazolam (Xanax); Lorazepam (Ativan); Diazepam (Valium)
General Anxiety Disorder – medications (2nd gen antipsychotic)
Quetiapine (Seroquel)
General Anxiety Disorder – non-pharmacologic
Cognitive behavioral therapy
Influenza – risk factors
age, living/working conditions; weakened immune system, chronic illnesses; race, aspirin use under 19yo; pregnancy, obesity
Influenza – assessment
Fever; aching muscles; chills; sweats; headache; dry/persistent cough; SOB; tiredness/weakness; sore throat; runny/stuffy nose; eye pain; vomiting/diarrhea
Influenza – testing
Rapid Influenza Diagnostic Test (RIDT) – swab, results in 10-15mins, detects antigens; Rapid Molecular Assays – detect genetic material of virus, more accurate, results in 15-20mins
Influenza – treatment
Annual flu vaccine; antiviral drugs (best when taken within 48hrs of onset)
Social determinants of health – economic stability
employment; food insecurity; housing instability; poverty
Social determinants of health – education access and quality
early childhood education and development; enrollment in higher education; high school graduation; language and literacy
Social determinants of health – health care access and quality
access to health care; access to primary care; health literacy
Social determinants of health – neighborhood and built environment
access to foods that support healthy eating patterns; crime and violence; environmental conditions; quality of housing
Social determinants of health – social and community context
civic participation; discrimination; incarceration; social cohesion
Strep A Pharyngitis – causes
group A streptococcus
Strep A Pharyngitis – assessment
sudden-onset fever accompanying a sore throat; inflammation of the pharynx and tonsils with patchy exudates and cervical lymph node adenopathy
Strep A Pharyngitis – testing
Rapid Antigen Detection Test (RADT) – latex agglutination
Strep A Pharyngitis – treatment
self-limiting; antibiotics recommended (Macrolides; Amoxicillin for pediatrics)