D 0 2 7 S tu d y G u i d e - A d v a n c e d P at h o p h a r m a c o l o g y N o t e s | Q u e s t i o n s A n d
Answers, Latest Update | 100% Correct Answers | Graded
D027 – Advanced Pathopharmacology
1. Celiac Disease
a. Lining of the small intestine and intolerant of gluten.
i. More pronounced in the duodenum and jejunum.
b. Signs and Symptoms
i. Abdominal pain and distention
ii. Diarrhea – pale, greasy, bulky, foul
iii. Malnutrition complications
1. Rickets
2. Occult blood
3. Anemia
iv. Early bleeds and/or bruises
v. Hypomagnesemia and hypocalcemia
1. Irritability, tremors, convulsions, tetany, bone pain, osteomalacia
c. Lab Value:
i. IgA-tTg
ii. IgA-EMA
iii. Total IgA
1. If deficient, IgG, IgA-DGP, or IgG-AGA may also be ordered.
d. Testing:
i. Serologic measurements of IgA antibodies and HLA-DQ2 or HLA-DQ8
ii. Endoscopy with small intestine biopsy
iii. Duodenal biopsy
e. Avoid BROW
i. Barley, Rye, Oats, Wheat
2. Sjogren’s Syndrome
a. Mostly in older women but can occur at any age and affects primarily those with
Rheumatoid arthritis or SLE
b. Dry eyes and dry mouth
c. Testing: SSA+ and SSB+
3. Herbs
a. Cinnamon
i. Uses
1. Lowers blood glucose
2. Lowers cholesterol
3. Lowers hypertension
4. Lowers risk for bleeding
ii. Adverse Effects
1. Breastfeeding women should avoid as treatment.
2. Avoid with diabetic drugs, anticoagulants, and heart medications.
b. Gingko Biloba
i. Uses
1. Halt progression of dementia.
2. Used for erectile dysfunction
ii. Adverse Effects
1
, 1. Increases bleeding
a. Avoid anticoagulants and antiplatelets.
2. Lowers seizure threshold.
c. Glucosamine
i. Uses
1. For osteoarthritis
d. Green Tea
i. Uses
1. Lose weight, mental clarity
ii. Adverse Effects
1. Hepatotoxicity.
2. Avoid taking with vasodilators, stimulants, and psychoactive
medications.
3. Contains small amount of vitamin K – may decrease effects of
warfarin.
e. Lavender
i. Uses
1. Increases relaxation
2. Used for anxiety, stress, and insomnia
ii. Adverse Effects
1. Constipation, HA, and increased appetite
2. Caution when using CNS depressants.
3. May decreased blood pressure. Avoid taking with anti-
hypertensives.
4. Hypoplastic Left Heart Syndrome
a. Structures
i. LEFT ventricle is underdeveloped or too small.
ii. Mitral valves are not formed or are very small.
iii. Aortic valve is not formed or is very small.
iv. Ascending aorta is underdeveloped or very small.
v. Atrial septal defect – a hole between the left and right atria.
b. Fetal shunts
i. Patent ductus arteriosus: artery connecting aorta to pulmonary artery.
ii. Patent foramen ovale: hole connecting right atrium to left atrium.
c. Survival rates
i. 3–5-year survival rates of 70% for infants who have the Stage I repair.
ii. Children who survive to 12 months have 90% survival rate.
d. Testing: echocardiogram
e. Treatment: 3 stages of surgical procedure
i. Stage I (Norwood Procedure): 1-2 weeks old
1. Enlarges aorta and connect to the right ventricle.
2. Shunt to the pulmonary artery is created (either from aorta or right
ventricle).
3. Patent ductus arteriosus is closed.
ii. Stage II (Glenn Procedure): 4-6 months old
1. SVC is connected to the pulmonary artery.
2
, 2. Shunt from Norwood is removed.
iii. Stage III (Fontan Procedure): 18 to 36 months old
1. IVC is connected to the pulmonary artery.
2. Hole made from the IVC conduit attached to the right atrium.
f. Signs and Symptoms: oxygen-rich blood bypasses poorly-functioning left heart
through the PDA and PFO.
i. Cyanosis of the skin, lips, and nails
ii. Pallor
iii. Sweaty, clammy, or cool skin
iv. Trouble breathing
v. Rapid or pounding heart rate
vi. Cold feet
vii. Poor pulses in the feet
viii. Poor feeding
g. Tests
i. During pregnancy
1. Prenatal tests to check for birth defects and other conditions
2. Ultrasound to identify HLLS
3. Echocardiogram to show the structures of the heart and how it’s
working with the defect.
ii. After birth
1. Based on signs and symptoms through pallor and cyanosis.
2. Newborn will experience signs and symptoms once ductus
arteriosus and foramen ovale close.
h. Medications
i. Tube feedings
ii. Medications to strengthen heart muscles, lower blood pressure, and
remove extra fluid.
5. Parathyroid
a. Function
i. Produces parathyroid hormone that regulates calcium in the bloodstream
and tissues.
1. The more PTH hormone released, the more calcium the bones
release to the blood stream, losing density and hardness.
b. Lab Values
i. Calcium (8.6-10.3 mg/dL)
ii. PTH: 11-51 pg/mL
c. Signs and Symptoms
i. Hyperparathyroidism
1. Osteoporosis
2. Kidney stones
3. Excessive urination
4. Abdominal pain
5. Fatigue, tiring easily
6. Forgetfulness
7. Bone and joint pain
3
, ii. Hypoparathyroidism: High PTH, low T3 and T4.
1. Paresthesia
2. Twitching facial muscles
3. Muscle pains and cramps
4. Mood changes
5. Dry and rough skin
d. Tests
i. Ultrasound
ii. Bone densitometry
iii. Body CT/MRI
e. Medications
i. Hyperparathyroidism
1. Calcimimetics
2. Hormone replacement therapy: helps bones retain calcium
3. Bisphosphonates: slows and prevents bone loss
f. Treatment
i. Hypoparathyroidism
1. Maintain a low serum calcium level in the low normal range or 0.5
mg/dL below normal.
6. Hutchinson-Gilford Progeria Syndrome
a. Progressive genetic disorder causing children to age rapidly. No cure.
i. Appears in the first year or two in life.
b. Caused by aberrant splicing of the LMNA making protein-progerin.
i. Abnormal version of lamin A protein causes the nuclear envelope
surrounding the nucleus to be unstable and progressively damages the
nucleus, causing it to die prematurely.
ii. Test for LMNA mutation.
c. Assessment
i. Measure height and weight
ii. Plot measurements on a normal growth curve chart.
iii. Test hearing and vision.
d. Signs and Symptoms
i. Short stature or slow growth
ii. Slow hair growth
iii. Alopecia
iv. Joint abnormalities
v. Wrinkle and dryness of skin
vi. FTT and delayed tooth development.
e. Treatment
i. Statins – decrease liver’s production of harmful cholesterol
ii. Nitroglycerin
iii. NSAIDs to relieve pain and decrease inflammation.
iv. Bone medications for strengthening and building.
v. Occupational/Physical therapy to restore muscle strength and function.
f. Life Expectancy
i. Ages 10x faster
4
Answers, Latest Update | 100% Correct Answers | Graded
D027 – Advanced Pathopharmacology
1. Celiac Disease
a. Lining of the small intestine and intolerant of gluten.
i. More pronounced in the duodenum and jejunum.
b. Signs and Symptoms
i. Abdominal pain and distention
ii. Diarrhea – pale, greasy, bulky, foul
iii. Malnutrition complications
1. Rickets
2. Occult blood
3. Anemia
iv. Early bleeds and/or bruises
v. Hypomagnesemia and hypocalcemia
1. Irritability, tremors, convulsions, tetany, bone pain, osteomalacia
c. Lab Value:
i. IgA-tTg
ii. IgA-EMA
iii. Total IgA
1. If deficient, IgG, IgA-DGP, or IgG-AGA may also be ordered.
d. Testing:
i. Serologic measurements of IgA antibodies and HLA-DQ2 or HLA-DQ8
ii. Endoscopy with small intestine biopsy
iii. Duodenal biopsy
e. Avoid BROW
i. Barley, Rye, Oats, Wheat
2. Sjogren’s Syndrome
a. Mostly in older women but can occur at any age and affects primarily those with
Rheumatoid arthritis or SLE
b. Dry eyes and dry mouth
c. Testing: SSA+ and SSB+
3. Herbs
a. Cinnamon
i. Uses
1. Lowers blood glucose
2. Lowers cholesterol
3. Lowers hypertension
4. Lowers risk for bleeding
ii. Adverse Effects
1. Breastfeeding women should avoid as treatment.
2. Avoid with diabetic drugs, anticoagulants, and heart medications.
b. Gingko Biloba
i. Uses
1. Halt progression of dementia.
2. Used for erectile dysfunction
ii. Adverse Effects
1
, 1. Increases bleeding
a. Avoid anticoagulants and antiplatelets.
2. Lowers seizure threshold.
c. Glucosamine
i. Uses
1. For osteoarthritis
d. Green Tea
i. Uses
1. Lose weight, mental clarity
ii. Adverse Effects
1. Hepatotoxicity.
2. Avoid taking with vasodilators, stimulants, and psychoactive
medications.
3. Contains small amount of vitamin K – may decrease effects of
warfarin.
e. Lavender
i. Uses
1. Increases relaxation
2. Used for anxiety, stress, and insomnia
ii. Adverse Effects
1. Constipation, HA, and increased appetite
2. Caution when using CNS depressants.
3. May decreased blood pressure. Avoid taking with anti-
hypertensives.
4. Hypoplastic Left Heart Syndrome
a. Structures
i. LEFT ventricle is underdeveloped or too small.
ii. Mitral valves are not formed or are very small.
iii. Aortic valve is not formed or is very small.
iv. Ascending aorta is underdeveloped or very small.
v. Atrial septal defect – a hole between the left and right atria.
b. Fetal shunts
i. Patent ductus arteriosus: artery connecting aorta to pulmonary artery.
ii. Patent foramen ovale: hole connecting right atrium to left atrium.
c. Survival rates
i. 3–5-year survival rates of 70% for infants who have the Stage I repair.
ii. Children who survive to 12 months have 90% survival rate.
d. Testing: echocardiogram
e. Treatment: 3 stages of surgical procedure
i. Stage I (Norwood Procedure): 1-2 weeks old
1. Enlarges aorta and connect to the right ventricle.
2. Shunt to the pulmonary artery is created (either from aorta or right
ventricle).
3. Patent ductus arteriosus is closed.
ii. Stage II (Glenn Procedure): 4-6 months old
1. SVC is connected to the pulmonary artery.
2
, 2. Shunt from Norwood is removed.
iii. Stage III (Fontan Procedure): 18 to 36 months old
1. IVC is connected to the pulmonary artery.
2. Hole made from the IVC conduit attached to the right atrium.
f. Signs and Symptoms: oxygen-rich blood bypasses poorly-functioning left heart
through the PDA and PFO.
i. Cyanosis of the skin, lips, and nails
ii. Pallor
iii. Sweaty, clammy, or cool skin
iv. Trouble breathing
v. Rapid or pounding heart rate
vi. Cold feet
vii. Poor pulses in the feet
viii. Poor feeding
g. Tests
i. During pregnancy
1. Prenatal tests to check for birth defects and other conditions
2. Ultrasound to identify HLLS
3. Echocardiogram to show the structures of the heart and how it’s
working with the defect.
ii. After birth
1. Based on signs and symptoms through pallor and cyanosis.
2. Newborn will experience signs and symptoms once ductus
arteriosus and foramen ovale close.
h. Medications
i. Tube feedings
ii. Medications to strengthen heart muscles, lower blood pressure, and
remove extra fluid.
5. Parathyroid
a. Function
i. Produces parathyroid hormone that regulates calcium in the bloodstream
and tissues.
1. The more PTH hormone released, the more calcium the bones
release to the blood stream, losing density and hardness.
b. Lab Values
i. Calcium (8.6-10.3 mg/dL)
ii. PTH: 11-51 pg/mL
c. Signs and Symptoms
i. Hyperparathyroidism
1. Osteoporosis
2. Kidney stones
3. Excessive urination
4. Abdominal pain
5. Fatigue, tiring easily
6. Forgetfulness
7. Bone and joint pain
3
, ii. Hypoparathyroidism: High PTH, low T3 and T4.
1. Paresthesia
2. Twitching facial muscles
3. Muscle pains and cramps
4. Mood changes
5. Dry and rough skin
d. Tests
i. Ultrasound
ii. Bone densitometry
iii. Body CT/MRI
e. Medications
i. Hyperparathyroidism
1. Calcimimetics
2. Hormone replacement therapy: helps bones retain calcium
3. Bisphosphonates: slows and prevents bone loss
f. Treatment
i. Hypoparathyroidism
1. Maintain a low serum calcium level in the low normal range or 0.5
mg/dL below normal.
6. Hutchinson-Gilford Progeria Syndrome
a. Progressive genetic disorder causing children to age rapidly. No cure.
i. Appears in the first year or two in life.
b. Caused by aberrant splicing of the LMNA making protein-progerin.
i. Abnormal version of lamin A protein causes the nuclear envelope
surrounding the nucleus to be unstable and progressively damages the
nucleus, causing it to die prematurely.
ii. Test for LMNA mutation.
c. Assessment
i. Measure height and weight
ii. Plot measurements on a normal growth curve chart.
iii. Test hearing and vision.
d. Signs and Symptoms
i. Short stature or slow growth
ii. Slow hair growth
iii. Alopecia
iv. Joint abnormalities
v. Wrinkle and dryness of skin
vi. FTT and delayed tooth development.
e. Treatment
i. Statins – decrease liver’s production of harmful cholesterol
ii. Nitroglycerin
iii. NSAIDs to relieve pain and decrease inflammation.
iv. Bone medications for strengthening and building.
v. Occupational/Physical therapy to restore muscle strength and function.
f. Life Expectancy
i. Ages 10x faster
4
