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2011-02-09 21:57:47

Exam 1
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  1. What are the 2 types of hearing loss?
    • conductive hearing loss
    • sensorineural hearing loss
  2. Conductive Hearing Loss (causes?)
    • occurs when sound is not conducted efficiently through the outer ear canal to the middle ear
    • usually involves a reduction in sound level, or the ability to hear faint sounds
    • often corrected medically or surgically
    • causes: otitis media, perforated eardrum, benign tumors, impacted earwax (cerumen), foreign body, malformation of the outer ear, ear canal, or middle ear
  3. Sensorineural Hearing Loss (causes?)
    • occurs when there is damage to the inner ear (cochlea)
    • involves a reduction in sounds level, ability to hear faint sounds, affects speech and understanding
    • not corrected medically or surgically
    • causes: birth injury, ototoxic drugs, noise exposure, viruses, head trauma, aging, tumors
  4. Meniere's Disease
    • an inner ear disorder associated with excess fluid in the labyrinth
    • typically, the attack is characterized by a combination of vertigo, tinnitus, and hearing loss lasting several hours
    • causes is unknown
    • treatment: low sodium diet, no caffeine, alcohol or tabacco, decrease stress, diruretics, antiemetics, antivert
  5. Ototoxicity ("ear poisoning")
    • due to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve, which sends balance and hearing information from the inner ear to the brain
    • can result in temporary or permanent disturbances of hearing, balance, or both
  6. Otitis externa "swimmer's ear"
    • an infection of the ear canal from bacteria or fungi
    • symptoms: primary symptoms is ear pain, swelling of canal, full feeling in ear, redness and swelling in outer ear, swollen lymph nodes, discharge from ear
    • treatment: wick, antibiotics, steroids
    • pain with application of pressure on the tragus is a hallmark sign
  7. Acute otitis media "middle-ear"
    • the presence of fluid, typically pus, in the middle ear, typically viral
    • symptoms: pain, redness of the eardrum, and possible fever
    • treatment: motrin, tylenol for pain and fever, antibiotics only for bacteria infections (rare)
  8. What are some viral infections of the integumentary system?
    • verrucae/warts
    • herpes simplex (HSV)
    • herpes zoster (shingles)
  9. Verrucae or Warts
    • benign papilloma caused by papillomarviruses
    • thickening of stratum corneum
    • treatment: liquid nitrogen, acid chemicals, cryotherapy, salicylic acid paint
  10. Herpes Simplex (HSV)
    • HSV-1: occurs above the waist
    • HSV-2: genital region
    • begin with burning or tingling sensation
    • develop vesicles and erythema, and progress to putules, ulcers, and crusts
    • heals within 10-14 days
    • recurrent lesions percipitated by stress, sunlight, menses, or injury
    • treatment: antivirals-shorten duration only
  11. Herpes Zoster (shingles)
    • vesicles with erythematous bases that are restricted to areas of sensory neurons
    • may last 2-3 weeks
    • severe pain and paresthesia are common
    • pain in elderly may persist for 1 year
    • treatment: antivirals
  12. What are some fungal infections that affect the integrumentary system?
    • Candida Albicans (thrush, candidiasis)
    • tinea (fungal)
  13. Candida Albicans (thrush)
    • overgrowth of yeast. mucous membranes, large skin folds, GI tract, vagina, uncircumcised penis
    • treatment: antifungals
  14. Tinea
    • capitis-head or scalp, corporis-ringworm, pedis-athletes foot
    • treatment: topical antifungals
  15. Impetigo
    • staphylococci or streptococci infection
    • formation of vesicles, pustules, and yellowish crusts
    • primarily over mouth and nostrils
    • treatment: topical antibacterial cream
  16. Discoid Lupus Erythematosus (DLE)
    • red, scaly, thickened, well-circumscribed patches with enlarged follicles and elevated borders
    • may atrophy, scar, and cause pigment changes
    • butterfly rash over checks and bridge of nose, scalp, ears, arms, and chest
    • treatment: avoid sun exposure (bc of photosensitivity), topical corticosteroids, antimalaria drugs, Thalidomide
  17. Seborrheic Dermatitis (Cradle cap)
    • chronic inflammation of the scalp, eyelids, ear canals, nasolabial folds, axillae, chest, and back
    • scaly, white or yellowish plaques or oozing and crusted
    • treatment: shampoos with sulfur, salicyclic acid, tar, topical corticosteriods
  18. Psoriasis
    • genetic predisposition
    • increased cell turnover rate result in classic features: erythematous plaques covered by silvery white, loosely adherent scales
    • remissions are common
    • treatment: emollients, keratolytic agents, topical corticosteriods, UV light, tar
  19. Pityriasis Rosea
    • possibly viral origin
    • primary eruption: single, salmon pink lesion on the trunk, 2-10 days
    • secondary eruptions: trunk and upper extremeties, scaly, red-ring shaped, clear center, symmetrical, 2-10 weeks
    • treatment: UV light, topical corticosteriods depending on severity
  20. Acne Vulgaris
    • sebaceous oils and loose epithelial cells obstruct follicular canals
    • causes rupture of the wall and tissue inflammation
    • treatment: soaps, lotions, and gels containing sulfur, rsorcinol, salicyclic acid, or benzoyl peroxide, astringents, topical antibiotics, retinoic acid, accutane
  21. Atopic Dermatitis (Eczema)
    • predisposition: family history of asthma, allergic rhinitis, dry skin, and exzema
    • release of inflammatory mediators, ch. by intense itching, scratching leads to erythema, weeping, scaling, and lichenification
    • treatment: avoid irritants, lubricate, preserve skin moisture, topical corticosteroids, treat infection, control itching
  22. Allergic Contact Dermatitis
    • delayed hypersensitivity to a specific allergen
    • poison ivy, poison oak, poison sumac
    • pruritus, followed by erythema and vesicle formation
    • may be spread as long as allergen remains on surface of skin
    • treatment: topical corticosteriods, lotions, cooling baths, wet dressings
  23. Irritant Contact Dermatitis
    • non-immunologically mediated inflammation of the skin
    • lesions begin in the area of contant
    • soaps, detergents, acids (urine) contribute to inflammatory lesions
    • treatment: remove source of irritation, topical corticosteoids
  24. Urticaria or drug erruptions
    • adverse reaction to drugs
    • erythema or whitish swellings (wheals) of the skin or mucous membranes
    • treatment: discontinue drug, oral antihistamines, antipruritic lotions, make sure person knows never to take the drug again
  25. Scabies
    • mites, burrow under skin, finger webs, wrists, umbilicus, groin area
    • intense pruritic erruption and spreads
    • parasitic infection
    • treatment: ectoparasitical drugs
  26. Lice
    • parasitic infection
    • visible mites, surface dwellers
    • treatment: ectoparasitical drugs
  27. Ticks
    • burrow in the epidermis
    • carry bacteria and viruses
    • need to remove head of tick
    • treatment: ectoparasitical drugs
  28. What is the problem associated with using ectoparasitical drugs for parasitic infections?
  29. Basal Cell Carcinoma
    • most common malignant tumor of the skin
    • arise from epidermal cells along the basal layer of the epidermis which can erode into surrounding organs
    • rarely metastasizes
    • presents as a single firm, skin colored nodule with a raised parameter
    • have telangiectatic vessels on the surface, bleeds frequently
    • treatment: cryotherapy, topical chemotherapy, curettage
  30. Squamous Cell Carcinoma
    • second most common malignancy
    • occasionally metastasize
    • malignant neoplasm of keratincytes
    • affects skin and mucous membranes
    • presents with an ulcerated, scaly, thickened nodule or tumor
    • CA that arises in sun-damaged skin usually do not metastasize and rarely cause death
    • CA arising on areas not exposed to the sun have the greatest risk of metasizing
    • treatment: surical excision
  31. Malignant Melanoma
    • rare but highly malignant
    • arises from the melanin-producing cells
    • at risk: fair complexion and persons with a family history
    • slightly elevated black/brown lesion, irregular border, uneven surface that tends to ulcerate and bleed
    • prognosis: <1mm thick 90-100%/5 yrs, 3mm or < 50%/5 yrs
    • treatment: surigcal exicison including lymph nodes
  32. Hints to melanomas: ABCDE
    • A = asymmetry
    • B = border irregularity
    • C = color variation
    • D = diameter
    • E = elevation above the skin level
  33. Kaposi's Sarcoma
    • skin cancer associated with immunosupression (common with patients with HIV)
    • presents as a purple lesion that becomes nodular, may itch or hurt
    • treatment: surgically excision, chemotherapy, comfort measures
  34. antiseptic
    used to clean the skin
  35. Disinfectant
    cleans inanimate objects
  36. astringents
    • an agent that has a constricting or binding effect
    • used for drying effects on exudative lesions
    • priniciple astringents are salts and metals, aluminum salts, zinc oxide
  37. emollients
    • fatty or oily substances that softens or soothes irritated skin
    • can be used to prevent friction, lubricate a catheter before insertion, or moisturize dry skin
    • priniciple emollients are: KY jelly, petroleum jelly, lanolin
  38. Cleaners or Baths
    • free of soap or modified soap products
    • recommended for sensitive, dry, or irritated skin
    • principle cleaners: aveeno, pHisoDerm
    • principle baths: oatmeal, starch, gelatin
  39. Rubs/Liniments
    • indicated for pain relief when skin is intact
    • principle rubs: BenGay, Vicks Vaporub, Aspercreme
  40. Corticosteriods/Glucocorticoids
    • used for relief of inflammatory and pruritic dermatitis
    • available as creams, gels, lotions, ointments, or solutions
    • principle corticosteriods: Cylocort cream, Hytone Ointment
  41. Protectives
    • soothing, cooling preparations that form a barrier on the skin
    • skin must be washed and dried throughly between applications
    • principle protectives: Zinc Oxide, Talcum powder
  42. Keratolytics
    • soften scales and loosen outer horny layer of the skin
    • used to treat warts, corns, acne, and chronic types of dermatitis
    • principle keratolytics: compound W, silver nitrate
  43. Antiinfectives
    • antibacterial
    • antifungal
    • antiviral
  44. Ectoparasiticidal
    • kills bugs on outer surface of the body blocking or inhibiting the function of thier CNS
    • must treat all contacts and clean entire house
    • major problem in schools due to noncompliance with treatment
    • principle ectoparasiticidals: Kwell, Lindane, Scabene
  45. Acne Medications
    Benzoyl Peroxide, Retin A, Accutane
  46. Benzoyl Peroxide
    • topical antibiotic acne medication
    • used to treat mild to moderate acne
    • reduces the amount of P. acnes bacteria and promotes keratolysis (peeling of the horny layer of the epidermis)
    • adverse effects: drying, peeling, burning, blistering, scaling, swelling
    • contraindications: formulas containing sulfites which can cause serious allergic reactions especially in asthma patients
  47. Retina A
    • topical antibiotic acne medication
    • used for mild to moderate acne
    • normalizes hyperproliferation of epithelial cells within hair follicles thus unclogging pores and preventing new plugs
    • causes thinning of the stratum corneum and can facilitate penetration of other drugs
    • adverse effects: stinging, redness, dryness, itching, scaling, mild burning, edema
    • contraindications: increased susceptibility to the sun
  48. Accutane
    • oral antibiotic
    • used to treat severe acne when other methods have failed
    • decreases sebum production which decreases the skins population of the microbe P. acnes, sebaceous gland size, inflammation, and keratinization all decreased
    • side effects: nosebleeds, inflammation of lips/eyes, dryness or itching, pain or tenderness in the joints, sensitization to the sun, cataracts and other eye ds, elevated trigylceride levels, depression
    • contraindications: pregnant woman (highly teratogenic risk category X), avoid the use of alcohol
    • requirements for users: register with iPLEDGE, 2 pregnancy tests prior to initial prescription, 1 negative pregnancy test required for montly refills, use of 2 effective forms of birth control, patient education
  49. neuropharmacology
    the study of drugs that alter processes controlled by the nervouse system
  50. What are the 2 categories of neuropharmacologic agents?
    • peripheral nervous system drugs
    • central nervous system drugs
  51. What are the basic mechanisms of neuropharmalogical agents?
    • synaptic transmission
    • axonal conduction
  52. Synaptic transmission
    • information is carried acorss the neuron gap and the postsynaptic cell
    • most neuropharmacologic agents act by altering synaptic transmission and can produce effects that are more selective
  53. Axonal Conduction
    • action potential is carried down the axon
    • not very selective
    • conduction will take place in all nerves to which it has access
    • ex. local anesthetics
  54. Five steps in synaptic transmission
    • 1. transmitter synthesis: drugs can increase or decrease transmitter synthesis, can enhance effect of transmitter by making super transmitter
    • 2. transmitter storage: stored until released from the vesicle
    • 3. transmitter release: release after triggered by action potential
    • 4. receptor binding: neuropharmacologic drugs that act directly on the receptors and bind can cause activation, prevent activation, or enhance activation
    • 5. termination of transmission: by reuptake, enzymatic degradation, diffusion
  55. What are the 2 divisions of the nervous system? How are they linked?
    • central nervous system (brain and spinal cord)
    • peripheral nervous system- somatic motor and autonomic (ANS) (parasympathetic and sympathetic)
    • linked by cranial nerves and muscle fibers
  56. What are the priniciple functions of the ANS?
    • regulation of the heart
    • regulation of the secretory glands (salivary, sweat, gastric, bronchial)
    • regulation of smooth muscle (muscles of bronchi, blood vessels, urogenital system and gastrointestinal tract)
  57. What are the principle transmitters of the PNS?
    • acetylcholine
    • norepinephrine
    • epinephrine
    • dopamine
  58. What are cholinergic and adrenergic receptors of the PNS mediated by?
    • cholinergic mediated by Ach
    • adrenergic mediated by NE and Epi
  59. What is the function of the cholinergic receptor nicotinic n?
    • promotes ganglia transmission
    • promotes release of epi
  60. What is the function of the cholinergic receptor nicotinic m?
    contraction of the skeletal muscles
  61. What is the function of the muscarinic cholinergic receptor?
    activate PNS
  62. What are the main functions of the SNS?
    • regulation of cardiovascular system
    • regulation of body temperature
    • implementation of "fight or flight" response
  63. What is the function of alpha 1 adrenergic receptor?
    • vasoconstriction
    • ejaculation
    • contraction of trigon and sphincter in bladder neck and prostate capsule
  64. What is the function of beta 1 adrenergic receptor?
    • in heart: increases heart rate, contraction, and velocity of conduction in AV node
    • in kidney: renin release
  65. What is the function of beta 2 adrenergic receptor?
    • bronchodilation
    • glycogenolysis
    • vasodilation
    • relaxes uterus
  66. What is the function of the dopamine receptor?
    dilates renal blood vessels
  67. Epi activates which receptors?
    alpha 1 & 2, beta 1 & 2
  68. NE activates which receptors?
    alpha 1 & 2, beta 1
  69. dopamine activates which receptors?
    • dopamine receptors
    • can also activate beta 1 receptor
  70. What are the 4 phases of pharmacokinetics?
    • absorption
    • distribution
    • metabolism
    • excretion
  71. the study of drugs "movement" throughout the body from the time it enters until its excreted
  72. the process by which a drug moves from its site of administration, across the cell membranes, and enters into the blood
  73. the rapid inactivation of some oral drugs as they pass through the liver after being absorbed
    first pass effect
  74. movement of a drug throughout the body to gain access to its target cell and allow the drug to exit the vascular system for elimination
  75. the site of action where the drug response occurs
    target cell
  76. the biological transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite
  77. What organ is responsible for most of a drugs metabolism?
    liver (enzyme P450)
  78. the removel of drugs from the body
  79. What organ is the primary site for excretion?
  80. drugs in the bile are secreted into the intestine, some is reabsorbed into the blood, the rest is secreted in the feces
    enterohepatic recycling
  81. time interval between administration of a drug and the first sigh of action
    onset of action
  82. the lowest plasma concentration that will produce a therapeutic effect
    minimal effective concentration (MEC)
  83. the highest plasma concentration attained from a single dose
    peak plasma effect
  84. time interval between onset of action and termination of action
    duration of action
  85. the range of plasma concentration in which the drug effect is produced without producing toxicity
    therapeutic range
  86. The wider the therapeutic range....
    more safe the drug is to use
  87. The narrower the therapeutic range....
    the more difficult a drug is to use safely
  88. the plasma concentration of a drug that results in dangerous adverse effects
    toxic level
  89. period of time in which the drug effect is no longer seen
  90. the time required for the amount of drug in the body to decrease by 50%
  91. The half-life of a drug determines...
    dosing intervals
  92. How many half-lives does it take for a drug to reach a steady state?
    4-5 half-lives
  93. the concentration of a drug in the blood which correlates to a drug's response
    plasma drug levels
  94. When should a nurse measure the peak and trough plasma drug levels?
    • peak-1.5 hours after initial administration
    • trough-30 minutes prior to next dose
  95. How do you reduce fluctuations in plasma drug levels?
    • continuous infusions
    • reduce dosage size and interval
    • loading dose v. maintenance dose
  96. When would a nurse administer a loading dose?
    when a drug has a long half-life