pharmacology GI nephrology urology hepatic biliary oncology integumentary
patho exam 2
What areas can urinary tract pathology manifest at?
upper thigh pain
what are some of the ways that PTA's play a role in treatment for urinary tract disorders?
rehab for dialysis and post transplant patients
conservative Tx with incontinence; pelvic floor
pt. education on s/s of disorders and infections
know that they are co-morbidities and how they affect the rehab process of other unrelated Dx
effects of multiple medications
BPH/benign prostatic hyperplasia
pelvic floor disorders
Hx of surgeries and catheterizations
What do all of these have in common
risk factors for the elderly and urinary tract disorders
Where is kidney pain typically felt?
posterior subcostal or costovertebral region T11-12
How does kidney pain radiate?
forward and around the flank ipsilateral lower abdominal quadrant along the pelvic crest and into the groin. ipsilateral shoulder pain if it presses on the diaphragm.
A pt. came to you c/o these s/s:
flank pain that is dull aching & boring
increased urination urgency
pain unrelieved by change in position
nausea & vomiting
blood in urine
fever & chills
what would you be suspicious of?
what is an infectious inflammatory disease of renal parenchyma of kidney secondary to bacterial entering via urethra?
What are the cells of the kidney called?
how does pylonephritis happen?
acute: associated with bacterial infections
chronic: tublointerstitial disorder from progressive scar formation overlying the parenchyma
A pt. came to you c/o these s/s:
sudden onset of fever and chills
dull pain over kidney and flank
urinary urgency and frequency with dysuria
what would you be suspicious of?
What are some of the risk factors for pylonephritis?
What are some of the things you want to monitor for when working with a pt. who you suspect has pylonephritis?
develops fever of 102+
c/o nausea and vomiting
what is infammation of glomeruli of both kidneys; acute or chronic?
there are 2 different immunologic causes to glomerulonphritis, what are they?
1: injury secondary to deposition of circulation antigen-antibody complexes in the glomeruli
2: injury secondary to antibodies reacting with insoluble fixed lomerular antigens. the antigen can be endogenous as in SLE or exogenous such as with strptococci.
what % of IDDM/type 1 pt.'s will develop glomerulonphritis?
what % of NIDDM/type 2 pt.'s will develop glomerlonphritis?
Other than diabetes, what other pathologys are associated with glomerular lesions?
changes in permeability secondary to glomerulonephritis leads to what?
T/F: clinical manifestations with glomerulonphritis in early stages is typically few overt s/s
What are some of the things you would see that would make you suspect glomerulonphritis?
T/F: due to symptoms being subtle, glomerulonphritis is typically found incidently on urninalysis or elevated BP readings.
What are some of the things you would do to treat glomerulonphritis?
increase protein intake
diuretics to manage edema
low fat diet
immobilization, bone disease hyperparathyroidism, hypercalcemia vitamin d intoxication are risk factors for what type of kidney stone?
UTI's are risk factors for what type of kidney stone?
magnesium ammonium phosphate stones
Acidic urine at 5.5pH, gout and high purine diet puts you at risk for what type of kidney stone?
what is an inherited disorder of amino acid metabolism that is a risk factor for kidney stones?
your pt. comes in with c/o of excruciating pain in the flank and upper outer quadrant of the abdomen, and nausea and vomiting. What would you suspect?
kidney stones; colic pain
your pt. come in with c/o of dull, deep ache in the flank or in the back. What would you suspect?
kidney stones; noncolicky pain
What are the classic triad s/s for kidney CA that only occurs with 10% of those diagnosed?
abdominal or flank pain
palpable abdominal mass
T/F: kidney CA is generally silent during the early stages with symptoms associated with mets usually the initial symptoms noted (cough, convulsions, back pain or pathologic Fx/
What is caused by hypoveloemic shock, infection or prostatitis and is reversible; function returns in 3-12 months?
acute renal failure
what type of renal failure is irreversible, progressive reduction of renal functioning resulting in eventual permanent loss of kidney function?
chronic renal failure
What are some of the things renal failure pt.'s might have difficulty with?
short term memory
fatigue and general weakness
What is cystitis?
how does cystitis develop?
caused by usually ascending UTI, chronic or acute, bacterial
where does the bacterial usually associated with UTI's come from?
what is the most common predisposing factor for cystitis?
catherterization or urinary instrmentation
what populations are more at risk for bladder infections?
What are the s/s for cystitis?
pain that can be suprapubic
lower abdominal or flank pain
what is inflammation of the urethra
what causes urethritis?
several other organisms
where would a pt. c/o pain with urethritis?
costovertebral angle either unilater or bilateral; can radiate to lower abdomen, upper thigh, testes or labia ipsilaterally
what is a typical wave of pain like for a pt. with urethritis?
crescendo wave of colic, excruciating and severe intensity.
where is the most common site for urinary tract CA?
hematuria and back pain if it metastasizes is a major signs for what type of CA?
what is age related nonmalignant enlargement of prostate gland due to hyperplasia?
benign prostatic hypertrophy
what happens with BPH?
urethra narrows due to hyperplasia and obstructs urination.
98% of all primary prostate tumors; third leading cause of death in US men, most common CA in men.
what are the s/s for adenocarcinoma?
low back, hip, or leg pain from metatasizes
frequenct and/or painful urination
incomplete baldder emptying
what can be the first signs for prostate cancer?
LBP, pelvic or femur pain
impairment of voluntary bladder control
what are the three different types of incontinence?
pressure applied to bladder from caughing sneexing laughing lifting exercising or any physical exertion that increased abdominal pressed and when the pelvic floor musculature cannont counteract the urethral/bladder pressure
invoulntary loss of urine associated with strong desire to void
lack of control or sensation of bladder activity resulting in incontinence due to CVA, or head injury.
what are the 3 types of neurogenic incontinence?
flaccid: LMN dysfunction
spastic: UMN dysfunction
uninhibited: neither flaccid or spastic
symptoms associated with a multitude of different systemic conditons
nausea, vomiting, diarrhea, malaise, fatigue, fever, night sweats, pallor, diaphoresis and dizziness all have what in common?
they are constititutional s/s
acute MI, diabetic acidosis, migraines, hepatobillary and pancreatic disorders, and inner ear issues are all systemic conditions associated with what?
frequent watery stools resulting in poor absorption of water and nutrients?
T/F: chronic diarrhea can lead to dehydration, electrolyte imbalance and weight loss
T/F: diarrhea secondary to antibiotic use can occur 6-8 weeks after the inital dose is taken
diminished appetitie or aversion to food. associated with cancer, heart disease and renal disease
fecal matter too hard to easily pass or bowel movements so infrequent that discomfort occur; low back pain may develop secondary t due to muscle guarding or pressure on sacral nerves from full lower intestine.
T/F: some of the causes for constipation include dehydration, diet, meds chronic diseases, lack of exercise, bed rest, emotional stress, and personality.
A burning sensation in the esophagus usually felt in midline below the sternum in the region of the heart.
How does heartburn happen?
acidic contents of the stomach regurgitate into the esophagus
what are the different causes as to why someone would feel abdominal pain?
mechanical: due to stretching
inflammatory: release of prostaglandins histamine, seratonin or bradykinins that stimulate nerve endings
ischemic: lack of 02
what is often not detectable by the patient but rather need hemocrit test: bleeding caused by gastritis, peptic ulcers or lesions of the intestine often produce occult blood in the stool
vomiting bright red blood
black tarry stools; typically indicates bleeding higher in the gi tract; but if the hi motility is increased upper gi blood in stool may be bright red
bleeding from the rectum or maroon colored stool
what are the major causes of upper GI bleeds?
severly ill due to major trauma, burns, systemic ilness or head injury; pepetic ulcers; nsaids;chronic alcohol use.
has both psychological physiological contributing factors
difficulity swallowing causes include neurological dysfunction local trauma or mechanical obstruction
pain during swallowing secondary to esophagitis or esophageal spasm, mimics coronary ischemia relieved by upright positioning and worsened by supine position
kehr's sign, due to free air or blood in abdominal cavity such as when spleen ruptures causing distention
left shoulder pain
the lower esophageal sphincter becomes enlarged allowing stomach to pass through the diaphragm into the thoracic cavity
hiatal hernia due to failure of formation with the diaphragm
hiatal hernia due to blunt trauma or penetrating wounds
What puts you at risk for hiatal hernia?
anything that weakens the disphragmatic muscle or alters the hiatus and or increases intra-abdominal pressure
lifting, straining, bending over, chronic or forceful cough, obesity, pregnancy, CHF, low fiber diet, constipation, and delayed bowel movements can all lead to what?
increasing intra-abdominal pressure
reguritation and heartburn are common s/s for what?
What are the 3 most common causes for GERD?
scleroderma, smoking, caffeine, chocolate, alcohol, CNS depressants, fatty foods, cardiac meds and hiatal hernias are all common causes for what?
heartburn, reflux, dysphagia, painful swallowing with pain described as "burning" that moves up and down and can also radiate to the jaw, neck and back are clinical manifestations for what?
what are the typical over the counter remedies for GERD?
antacids or baking soda
upright position and walking
avoidance of predisposing factors
T/F: there is an incidence of 3:1 men to women ratio of esphogeal CA that dues to heavy pipe and cigar smoking.
inflammation of the lining of the stomach that represents a group of the most common stomach disorders. usually self limiting and heals within several days.
limited to the mucosa and do not extend beyond the musclaris mucosa. can be well localized or distributed diffusely throughout the muscosa.
Who is most at risk for acute gastritis and why?
>65yoa and use of NSAIDS >3 months along with corticosteriod use.
the main symptom is epigastric pain along with the feeling of abdominal distention, loss of appetite, nausea, heartburn, low grade fever. What does this sound like?
There are 3 types of chronic gastritis. What are they?
helicobacter pylori: non erosive CG
chemical gastropathy: chronic reflux
age- primary factor
abnormalities of gastric juices
or combos of all of the above
these are all risk factors for what?
loss of tissue lining the lower esophagus, stomach and most commonly the duodenum.
What is thought to be caused by aggressive action of hydrochloris acid and pepsion on the mucosa?
a bacteria that which inhibits the gastric mucosa of 95% of pple with DU and may either contribute or modify or be associated with the disease.
How would someone with heartburn typically describe their pain?
burning, gnawing, cramping, aching
Where would someone with heartburn typically feel the pain?
over the xiphoid process or referred to the back
When do people with heartburn typically say the feel the most s/s?
when stomach is empty and at 1-2 am
T/F: aspirin and other nsaids can cause ulcerations, hemorrhage, perforation, stricture formation, exacerbation of inflammatory bowel disease.
T/F: nsaid theoretically break down the mucous membrane which protects the gi tract and thus can lead to local injury by allowing stomach acids to dissolve the intestine.
What is the most common for of gastric CA?
What is the typical treatment for gastric CA?
gastrecotmy bc chemo and radiation havent proven to be effective.
Conditions that impair one or more steps in the digestive process
diarrhea, cramping, steatorrhea and flatulance together are all associated with what?
what leads to an intense inflammatory reaction resulting in loss of absorptive villi in small intestine; impairs absoroption of both macro and micronutrients.
Is celiac disease managable?
yes. avoid foods with gluten and foods that may be processed around gluten containing products.
inflammation of vermiform appendix
initially vague pain with episode of nausea that progresses over 2-12 hours to become localized in the right lower quadrant(mcBurneys point) with rebound tenderness and low grade fever.
severe, life threatening disorder that occurs when activated enzymes escape into the pancreas and surrounding tissue.
onset typically abrupt and dramatic. may follow large meal or alcoholic binge. but can vary from mild pain to profound shock with coma and death. usualy initial pain is epigastric and abdominal presenting severely and radiates to back. worse with walking and lying supine and releived by sitting and leaning forward.
what is characterized by progressive destruction of the pancreas mostly due to alcoholism?
what is the 4th most common cause of death from CA?
smoking is a mahor one with diet coming in second; high fat foods, preservatives, salts, refined sugar, and dehydrated foods. These are risk factors for what?
unknown etiology. involves genetic and immunologic influences on the GI tractsability to distinguish foreign from self antigens and to "down regulate" the mucosal response, allowing persistent increase of the tissue damaging process. both conditions are chronic , medically incurable
inflammatory bowel diseases
inflammation and uleration of the inner lining for the large intestine and rectum
rectal bleeding, diarrhea, nausea and vomiting, anorexia, weight loss, anemia, accompanied by fever in acute disease. These are s/s for what?
what is the prognosis for ulerative colitits
no cure, remission and exacerbations; life expectancy is shortened due to malnutrition issues.
what attacks terminal end of the small intestine and colon but can occur anywhere from the mouth to anus and usually in young adults and adolescents.
pain in periumbilical region and sometimes referred to low back and constant ache or tenderness in advanced disease. These are s/s of wht?
what is the common cold of the stomach?
irritable bowel syndrome
T/F: irritable bowel syndrom may be a reaction to stress, but dont know cause; most common in women in early adult hood.
after how much % of liver function loss does it actually start to show s/s?
what is located above the right kideny, stomach, pancreas, intestines and below diaphragm. has 2 lobes and the right is bigger than the left by 6X?
Why is the liver a frequent site of metastasis?
large blood and lymph supply.
What are the 5 main functions of the liver?
detoxification of harmful substances
destruction of senesent RBC's/formation of bile
synthesizes protins, gluose and clotting factors
What is pear shaped, under the liver, and holds up to 50ml of bile?
What gives skin, poop, and pee is color?
What is bile essential for?
metabolism of fats and absorption of fat soluble vitamins.
Where are some common sites for liver pain referral?
T-spine 7-10; midline to R side
Where are some common sites for gallbladder referral pain?
R interscap area T4/5-8
R subscapular area
yellowness of skin, sclerae, mucous membranes, and excretions (dark urine, light stools) due to bilirubin staining secondary to excess bilirubin not absorbed by liver that has accumlated in blood. Usually first noticed in the eyes
What are the theraputic conditions for someone with liver disease?
need rest/time and should not exercise them
bilateral CTS or tarsal tunnel syndrome
these are all S/S of what type of disease?
white bands across the nail plate
opaque nail beds
nails of terry
these are all diseases related to what organ?
acute infectious inflammation of liver caused by viruses; major uncontrolled public health problem.
oral fecal contamination; often acquired in childhood and mimics the flu.
blood borne form of hep
exposure to blood or blood products; transfusions, needlesticks, IV drugs, no vaccine available.
inflammation of liver for 6 months or more after unresolved flare-up
what represents the end stage of chronic liver disease?
destruction of functional liver cells; replaced with fibrous connective tissue bands. as scarring gets worse, fibrous tissue restricts blood and lymph flow predisposing patient to portal HTN, obstruction of bile flow and cell death.
alcoholism is the most common cause of what?
What are the most common s/s of cirrhosis?
weight loss, weakness, and anorexia.
What are some of the late clinical manifestations of cirrhoisis?
How many drinks a week and a day would consider a man an alcoholic?
how many drinks a week and occasion would consider woman an alcoholic?
what is the definition of a "drink"
1-1.5-oz hard liquor
loss of libido
these are health risks related to what?
failure to fulfill role at work, school or home. recurrent use in hazardous situations. legal problems related to overuse, and continued use despite related social or interpersonal problems are all related to what?
alcoholic determining behaviors during the last 12 months.
monitor for bilateral swelling of the feet
monitoring for blood loss in the stools or hematemesis
monitor for excessive bruising or nosebleeds
prevent increases in intra-abdominal pressure
rest to reduce metabolic needs on the liver.
these are all the things you want to monitor with what disease?
primary tumors are rare, usually due to metastasis form colorectal, breast, lung or urogenital are what form of CA?
T/F: liver CA is usually insidious in the onset and often masked by cirrhosis and chronic hepatitis.
T/F: the prognosis for liver CA is 7% 5-year survival rate.
what are cholelithiasis?
what is cholecystitis?
inflammation of the gallbladder due to gallstones impacted in cystic duct.
who are more at risk for gallstones and why?
women; elevated estrogen levels which cause more cholestrol to be secreated into the bile.
T/F: most gallstones are asymptomatic but can become very painful with c/o pain in the RUQ and abdomin that can radiate to the mid-upper back, below right shoulder or btw scapulae.
what are the 3 most common ways to treat gallstones?
low fat diet for mild symptoms
lithotripsy: (shock waves)
RUQ pain, nausea with vomiting, anorexia, fever, excessive belching and heartburn are common s/s for what?
T/F: typically cholecystitis resolves in 1-7 days.
protects body from the enviroment
interfaces btw internal and external environment
prevents fluid from leaving the body
synthesizes vitamin D
area for heat exchange
touch, pressure, temperature, and pain sensation
What are these a function of?
physician is unaware
lesion is changing
What do these have in common?
they are general rules for MD referral for rash
rapidly spreading rash
accompanied by systemic c/o fever, fatigue, malaise
accompanied by joint pain
what do these have in common?
urgent referral to MD for rash
inadequate pulmonary gas exchange, notable in the mucous membranes, lips, tongue, and nails
slowing of cutaneous blood flow; notable in the fingers, toes, nails and nailbeds, nose or outter surfaces of the lips.
what does it mean when someone starts to turn gray or brown (hyperpigmentation)?
disturbance of adrenocortical hormone
what do all of these have in common?
common skin disorders
common, chronic, relapsing, pruritic type of eczematous disorder.
How does atopic dermatitis present in babies?
red, oozing crusting rash
how does atopic dermatitis present in adults?
found in folds of extremities on flexor surfaces
acute or chronic skin inflammation caused by exposure to chemical, mechanical, physical, or biologic agent
superficial inflammation of skin die to irritant exposure, allergic sensitization or genetics and is common in the elderly?
_____________ and ______________ are common bacterial skin infections.
_________________, ____________________, and ________________ are viral skin infections.
herpes simplex 1 & 2
___________________ and _________________ are the most common forms of fungal skin infections.
what form of bacterial skin infection is most common in infants, childern 2-5, elderly and is contagious and spreads easily?
sm. macules develop into vesicles which become pustular, vesicles break and form thick yellow curst producing pain, erythema, cellulitis, itching, scratching, and causes autoinoculation.
suppurative inflammation of the dermis and subcutaneous tissues.
skin is erythematous, edematous, tender sometimes nodular, commonly will develop lymphsangms as well and has a tendency for recurrence.
who is most at risk for cellulitis?
presence of wounds, ulcers, or burns.
local disease secondary to reactivation of chicken pox virus.
there are two types of the herpes. What are they?
type 1: cold sore, fever blister; contagious and incurable.
type 2: genital lesion; contagious and incurable.
common, benign, viral infections of skin caused by human papilloma viruses (HPVS)
what is tinea corpora more commonly known as?
what is tinea pedis more commonly known as?
What are the 4 types of skin CA?
basal cell carcinoma
squamous cell carcinoma
slow growing surface epithelial skin tumor originating from undifferentiated basal cells in epidermis.
basal cell carcinoma
T/F: basal cell carcinoma rarely metastasize beyond skin; occurs in men and women age 30-40 and above and is the most common malignant tumor affecting white people due to the sun.
T/F: squamous cell carcinoma is the 2nd most common cancer among white people.
usually occurs on rim of ear, face, lips, mouth, dorsum of hands where exposed to sun. More common in fair skinned people and peak incidence at age 60 men > women, caused by UV exposure.
squamous cell carcinoma
most serious, arises from pigmented cells in skin called melanocytes that synthesize melanin pigment.
T/F: UV radiation damages DNA inside epidermal cells, tanning is bodys respone to uv exposure to block further UV rays attempts to destroy DNA. DNA lesions not repaired increase the risk for skin CA; the darker the tan the more UV damage there is to be repaired.
Family Hx, blonde or red headed, marked freckling on the upper back, Hx of 3+ or more blistering sunburns prior to 20 yoa, Hx of 3+ outdoor summer jobs during adolescence
what are these risk factors for?
What is the ABCD method for early detection of melanoma?
type of skin CA presenting as skin disorder, used to occur in jewish and italian men, now common in patients with AIDS (specifically homosexual males)
What are some common immune dysfunctions of the skin?
chronic, inherited, recurrent, inflammatory dermatosis characterized by well defined erythematous plaques covered with silvery scales.
appear on scalp, chest, nails, elbows, knees, buttocks, itching, pain due to dry cracked lesions that can recur and persist.
T/F: psoriasis lesions can develop into psoriatic arthritis
what term refers to a large group of diseases characterized by uncontrolled growth and spread of abnormal cells
abnormal growth of new tissues that serves no useful purpose, does not respond to normal body controls and may harm the host organism by competing for blood and nutrients
either an overgrowth or neoplasm; benign or malignant
the process of describing the extent of disease at the time of diagnosis
what is the purpose of staging cancer?
aids in Tx planning
what does cancer staging reflect?
rate of growth
extent of neoplasm
T/F: the most important predictors for recurrent CA are the stage at initial diagnosis and the histological findings.
What stage is carcinoma in situ?
what is the early stage of local CA?
What stage do yo have an increased risk of spread due to tumor size?
What stage has local cancer spread but may not have spread to distant sites
What stage has metastasis usually occurred?
What is the TNM staging system for CA?
T: primary tumor
N: lymph nodes
M: distant mets
differ from normal cells in structure, size, function, rate of growth, and occurs due to a basic disturbance in cellular DNA
discrete stages that suggest a singler alteration can only partially push a cell to carcinogenisis.
stages of tumor development
What are some of the potential carcinogens that cause CA?
viruses: HPV, karposi's
chemical: smoking, asbestos
drugs: steroids, chemo
hormones: ovarian and prostate CA
excessive alcohol consumption
What do the impacts of carcinogens depend on?
individual susceptibility of resistance
potency of carcinogen
dose and duration of exposure
what is the progression of carcinogenesis?
dysplasia: alteration and disorganization of adult cells
anaplasia: loss of cellular differentiation
neoplastic hyperplasia: results in formation of a tumor
Carcinoma in situ: localized area of cancer cells
metastatic carcinoma: the process of spreading to the other parts of body
What two ways can metastasis occur?
travel through the blood or lymph to lodge OR
penetrate into adjacent structures
once the primary tumor starts to move by local invasion, blood vessles from surrounding tissue grow into the solid tumor
T/F: the pattern of metastasis differs from CA to CA.
where are the 5 most common sites of mets?
what percent of newly Dx pt.'s have clinically detectable mets?
what % of pt.'s have occult mets?
causative agents are usually calssified as _______________ and _____________ and it is suspected that most cancers evolve as a result of the ____________________________________.
interplay of multiple causative agents
what is the single most signifacnt risk factor for CA?
AGE! 25 yoa and continues to increase at every 5 year mark.
cancer gene that can contribute to development of cancer pathologic activation
T/F: when immune system response is altered, blocked, or overpowered by a large number of malignant cells, it fails to function and cancer growth increases.
what enviromental factors lead to alterations in the cellular DNA causing uncontrolled cellular reproduction and growth of CA Cells
food, drink, smoke, radiation, workplace exposures, drugs, sexual behavior, substances in air/water/soil.
T/F: lifestyle plays a major role in CA development.
strong link to CA; chronic emotional and physical_________causes both hormonal and immunological changes that faciliate the growth and proliferation of CA cells.
What ethinic group is more commonly Dx and die from CA?
What are the most common CA's that show a familial pattern?
What 4 personal behaviors lead to CA?
sexual and reproductive
urban air pollution
indoor smoke from household fuels
contaminated injections in healthcare
what do these have in common?
they are modifiable risk factors for CA deaths worldwide
T/F: oncologic pain is not an early symptom of CA, but rather occurs when tumor is well advanced. occurs in 50-70% of clients in earlier stages and 60-90% in late stages.
bone destruction usually secondary to metastasis
obstruction of hollow visceral organs and ducts
infiltration or compression of peripheral nerves, arteries or veins
infiltration or distention of skin or tissue
inflammation, infection and necrosis of tissue.
what do all of these things have in common?
mechanisms implicated in development of chronic CA pain.
There are 2 main types of CA Tx, what are they?
biotherapy or BRM
these are all what type of CA Tx?
these are all what type of CA Tx?
nausea and vomiting
these all have what in common?
they are side effects to CA Tx
what type of effect does CA Tx have on the nutritiona status of a pt?
altered appetite, weight loss and malnutrition
adversely affect how the body digests, absorbs and uses foods
if no recurrence of cancer in _________ after initial Dx, a pt. is considered cured.
What is the CAUTION acronym and what is it for?
early warning signs for cancer
C: changes in bowel/bladder
A: a sore that does not heal in 6 wks
U: unusual bleeding/discharge
T: thickening or lumps
I: indegestion/difficulty swallowing
O: obvious change in wart/mole
N: nagging dry caugh or hoarseness
what local and systemic S/S can a pt. present with?
muscular weakness; proximal
T/F: CA pt's have an increased fall risk due to both the local effects of Ca and the systemic effect of CA Tx.
what blood levels would you not exercise a CA pt?
WBC: <300/ml OR >10,000 with fever
absolute granulocytes (the phills):<50/ml
What would you check before and after exercise with a CA pt?
what target HR would you want to exercise a CA pt at?
you would never want to exceed ____ on the borg perceived exertion scale and you do not allow the pt go ______________.
distended neck veins, facial and arm lymphadema with lung CA?
superior vena cava syndrome
back pain, muscle weakness or gait changes associated with mets from lung, breast, prostate, colon and multiple myeloma
spinal cord compression
chemo can cause acute renal failure most pronounced 6-72 hrs after chemo; muscle weakness and cramping, tachycardia, decreased BP or arrhythmias during activity
tumor lysis syndrome
what is the most common cause of death from CA in women and men since 1987 and sadly enough it is the most preventable form of CA?
change in respiratory pattern
recurrent pnemonia or bronchitis
sharp pain increased during inspiration
atrophy and weakness of arm and hand muscles
S/S of lung cancer
small cell or oat cell carcinoma
large cell carcinoma
what do these have in common?
types of lung cancers
T/F: metastases usually occur to regional lymph nodes, adrenal glands, brain, bone, and liver in lung cancer?
any chemical agent that affects living processes, used to prevent or alter disease processes, modifies biochemical or physiologic functioning capabilities of cells.
defines the chemical structure, rarely used in medical practice
common name given to a drug by the united states adopted name council; non-proprietary name
name given to a drug by a specific pharmacetical compay
proprietary or trademark name
the fate of drugs in the body; how the body acts upon a drug
the actions and effects of the drug on tissues and organs of the body; how the drug accts on the body
transport of the drug to its target site and removal of the drug and its metabolites from the body
drugs must pass through lipid membranes to enter the blood stream unless they are given intravenously.
most common route, most convenient route, and the most economical route for drug delivery.
How long does a drug take to take effect if given orally?
30 min to an hour; depends on metabolism
T/F: drugs that are effective after oral adminstration are absorbed through the intestinal epithelium and enter the blood vessels of the intestinal tract
T/F: oral administered drugs are carried directly to the live first.
what is the first pass effect?
when a drug is rapidly metabolized by the liver and very little will enter into the blood stream.
quickest onset of action; drug must be in solution form, difficult to self administer.
absorption via mucous membranes of the oral cavity; fairly rapid absorption and onset of actions
placed directly on the skin.
drugs absorbed through the skin to treat systemic diseases
tight junctions btw endothelial cells of the capillaries in the brain, presences of the basement membrane and the processes of astrocytes.
blood brain barrier
what does pharmcokinetic distribution depend on?
blood flow so tissues with better perfusion will receive more exposure to the drug.
T/F: the purpose of pharmacokinetics distribution are b/c of small fluctuation in pH, hormone levels, and amino acids secondary to routine daily activities are potentially damaging to the nervous system.
the amount of drug that reaches its target of action
T/F: when a drug binds to protein in the blood stream and are considered inactive.
T/F: free or unbound drugs are the only ones available to interact with receptors or to be metabolized.
T/F: drugs that do not bind to plasma proteins generally have a quicker onset of action and a shorter duration of action that drugs that are heavily bound to plasma proteins.
enzymatic alteration of a drug; can lead to the formation of either a more active or less active metabolite or a toxic metabolie; usually occurs in the liver.
the time in which the concentration of the frug falls to one half of its original amount
There's two ways biotransformation can happen on the liver. what are they?
chemical modification or inactivation
conversion of lipid soluble substances to water soluble derivatives
when repeated doses of a drug are given at regular intervals, the blood concentration will increase until an _______________ is reached.
at equilibrium the dose administered equals the amount eliminated
steady state or plateau level
how many half-lives are required for steady state to be reached?
if reaching a plateau in a shorter time is desired, a higher does or a _______________ can be admistered initially.
T/F: steady state levels are important to achieve in chronic drug therapy so that a therapeutic range can be achieved and maintained
level below which the desired effect is usually not seen and above which toxic effects are seen.
which drugs are harder to keep within the therapeutic range?
the duration of effect of the drug which can be more important than plasma concentration in the case when drugs continue to exert an influence without a presence.
where a drug produces its effect
site of action
may be on the cell membrane or inside the cell; triggers a reaction
reversible, and how much drug is bound to a receptor depends upon the affinity of the drug for the receptor and concentration of the drug
a drug that binds to a receptor and produces and action
a drug that binds to the a receptor and does not produce an action but rather blocks another substance from binding
how a drug produces its effect at the cellular level.
mechanism of action
what are the different mechanisms of action for a drug?
alter membrane properties
change ion permability
alter enzyme activity
alter synthesis of products
the response to a drug depends on the dose of the drug. the higher the does the greather the response up to a ceiling.
amount of drug needed to produce a certain effect of similarly acting drugs
the maximum response to a drug. you adapt and have to increase the dose.
the intended medicinal effect of a drug
predictable pharmacological effects that occur within therapeutic ranges that are not the intended medical affects and are undesireable.
affects that are harmful
include side effects and toxic effects; causes can either be dose related or non-dose related.
what are the 4 classifications for adverse effects of drugs?
an adverse effect; the most common cause is an allergic reaction that develops after a few weeks of use and cannot be explained by the pharmcological effects of the drug.
T/F: drug fever is important to recognize because if often occurs before more serious effects of drug reactions
who is more susceptible to actions of a drug?
elderly and children
T/F: most investigational drug testing is done in young adult men so we dont know the effective dose toxicity and other factors for children infants elderly and women.
do men or women typically metabolize drugs faster and why?
women; lower fat:lean ratio and hormones may play a role
what may account for the decreased effectiveness of certain drugs in the obese?
adipose tissue stores fat soluble drugs
How does genetic variation have an effect on drug metabolism?
allergies: drug fever
hypo-reactors: diminished response
hyper-reactors: exaggerated response
when the same dose on repeated occasions produces a lower response or when a dose increase is required to maintain the same response?
the improvement in medical status unrelated to an action of a drug but being given a "sugar" pill
requires cooperation of the MD prescribing the drug, the pt. and others involved in the care of the pt.
may occur when two or more drugs are administered together or close in time?
who is most likely at risk for drug interactions and how could you prevent it?
elderly because they are typically on several medications. ASK THE PHARMACIST!
often produce a unique form of analgesia- alter the perception of pain rather than eliminating the painful sensation entirely.
what would you expect to see a pt. being given if they are in moderate to severe pain that is fairly constant?
______________ & __________________ are the main not so great effects of opioids.