NUR 641E ADVANCED PATHOPHYSIOLOGY
QUESTIONS AND ANSWERS SET A+
✔✔Left heart failure - ✔✔The heart does not adequately circulate blood to systemic
system. Due to pressure overload or volume overload
✔✔Right heart failure - ✔✔The heart does not adequately circulate blood to the
pulmonic system. Can be due to volume overload or regurgitation in Tricuspid Valve or
Pulmonic Valve.
Can lead to systemic edema, back up of blood in liver and lower extremities
✔✔Furosemide (Lasix) - ✔✔Loop diuretic; A drug that relieves heart failure symptoms
but does not reduce mortality.
✔✔Loop diuretics - ✔✔are potent diuretics, can cause diuretic resistance and
hypokalemia, and work on receptors in the thick ascending renal loop of Henle. They
also inhibit the re-absorption of sodium and chloride at this site in the kidney.
✔✔Potassium-sparing diuretics - ✔✔spironolactone, triamterene, amiloride
✔✔Milrinone - ✔✔phosphodiesterase inhibitor, used for acute heart failure.
✔✔Tetralogy of Fallot - ✔✔congenital malformation involving four (tetra-) distinct heart
defects
✔✔Tetralogy of Fallot treatment - ✔✔Children that are diagnosed can stop hypoxic
spells by squatting down (a compensatory mechanism)
✔✔Patent ductus arteriosus (PDA) - ✔✔an abnormal opening between the pulmonary
artery and the aorta caused by failure of the fetal ductus arteriosus to close after birth; a
congenital heart defect with a continuous machine-like murmur heard over the left upper
sternal border in both systole and diastole, a bounding pulse and a thrill on palpation.
,✔✔Patent ductus arteriosus (PDA) - ✔✔can be effectively treated with IV NSAIDs such
as indomethacin.
✔✔Raynaud's Disease - ✔✔a vasospastic disorder typically seen during cold weather;
involves the small arteries and arterioles in the fingers; occasionally, the toes are also
involved; is treated with dihydropyridine-type calcium channel blockers (e.g., nifedipine)
because they cause peripheral vasodilation.
✔✔Respiratory system: Asthma - ✔✔is an obstructive airway disease associated with
airflow obstruction, mucus production, hyperactivity of the bronchial tissue, and
inflammation.
✔✔Asthma - ✔✔*Mild persistent asthma is best treated with a short-acting beta-2
agonist (SABA) plus an inhaled corticosteroid.
*Moderate persistent asthma is best treated with an inhaled low-dose corticosteroid and
a long-acting bronchodilator.
*Severe persistent asthma is best treated with a long-acting beta-2 agonist (LABA) plus
a high-potency inhaled corticosteroid plus an oral corticosteroid drug.
✔✔Asthma treatment - ✔✔*Inhaled short-acting beta-2 agonists (SABA) are indicated
only for PRN use.
*Long-acting beta-2 agonists (LABA, e.g., salmeterol) should never be used in an acute
asthma exacerbation; use a short-acting beta-2 agonist (SABA, e.g., albuterol).
*Short-acting beta-2 agonists (SABA) are used in acute asthmatic attacks, but can
increase heart rate, tremors, nervousness, and reduce serum potassium levels.
✔✔Asthma: Corticosteroid teaching - ✔✔Instruct a patient on any inhaled corticosteroid
product to rinse the mouth after each use of the inhaled corticosteroid product.
✔✔Asthma: different types of inhalers used for treatments - ✔✔*Advair (fluticasone and
salmeterol) is an example of a long-acting beta agonist and a corticosteroid.
*Anoro Ellipta (umeclidium/vilanterol) is an example of a long-acting beta agonist and an
anticholinergic agent.
*Combivent (albuterol/ipratropium) is an example of a short-acting beta agonist and an
anticholinergic agent.
*Tiotropium is long-acting anticholinergic agent, not for acute asthmatic attacks, and is
used once a day in asthma and COPD.
✔✔Cystic fibrosis (CF) - ✔✔hereditary disorder of the exocrine glands characterized by
excess mucus production in the respiratory tract, pancreatic deficiency, and other
symptoms
✔✔Cystic fibrosis (CF) - ✔✔a pulmonary disorder typically seen in childhood, with an
increased production of a protein-producing thick mucus that blocks the airways,
pancreatic ducts, sweat gland ducts and vas deferens.
, ✔✔Cystic fibrosis (CF) - ✔✔CF of the pancreas is also known as fibrocystic disease of
the pancreas.
✔✔respiratory distress syndrome (RDS) - ✔✔a severe respiratory disease that is
characterized by rapid respiratory failure; a lung disorder characterized by increased
pulmonary resistance and caused by Cystic fibrosis (CF) which is a surfactant
deficiency.
✔✔Musculoskeletal: NSAIDS - ✔✔NSAIDS have anti-inflammatory, analgesic and anti-
pyretic activity. The NSAID which is considered safe to use by individuals with heart
disease is naproxen.
✔✔Acetaminophen - ✔✔analgesic and anti-pyretic activity, but not anti-inflammatory
activity
✔✔Gout - ✔✔hereditary metabolic disease that is a form of acute arthritis, characterized
by excessive uric acid in the blood and around the joints; treated with antigout drugs
(e.g., allopurinol, colchicine, febuxostat) and uricosuric drugs (probenecid,
sulfinpyrazone). The only drugs that directly work on the pathophysiological causes of
gout are allopurinol and febuxostat.
✔✔`Gout - ✔✔Renal calculi can occur as a comorbid condition in patients with gout.
✔✔Colchicine - ✔✔reduces the inflammatory response seen in gout, reduces the pain
in an acute gout attack, but does not stop gout from developing into chronic gouty
arthritis. Colchicine efficacy is affected by its incidence of adverse effects.
✔✔Xanthine oxidase - ✔✔Xanthine oxidase is a form of xanthine oxidoreductase, a
type of enzyme that generates reactive oxygen species. These enzymes catalyze the
oxidation of hypoxanthine to xanthine and can further catalyze the oxidation of xanthine
to uric acid. Allopurinol treats chronic gout by decreasing uric acid production by
inhibiting this substance.
✔✔Urate lowering therapy (ULT) - ✔✔can initiate an acute gouty attack; concomitant
colchicine, NSAIDS or corticosteroids are used with ULT drugs to decrease the
incidence of ULT-induced acute gouty attacks.
✔✔Allopurinol - ✔✔the agent of choice for individuals with gout and high serum urate
levels with underlying renal dysfunction, history of tophaceous gout, or urinary calculi.
✔✔Acute gouty attacks - ✔✔are treated preferentially with NSAIDS e.g., indomethacin,
ibuprofen, naproxen, sulindac).
QUESTIONS AND ANSWERS SET A+
✔✔Left heart failure - ✔✔The heart does not adequately circulate blood to systemic
system. Due to pressure overload or volume overload
✔✔Right heart failure - ✔✔The heart does not adequately circulate blood to the
pulmonic system. Can be due to volume overload or regurgitation in Tricuspid Valve or
Pulmonic Valve.
Can lead to systemic edema, back up of blood in liver and lower extremities
✔✔Furosemide (Lasix) - ✔✔Loop diuretic; A drug that relieves heart failure symptoms
but does not reduce mortality.
✔✔Loop diuretics - ✔✔are potent diuretics, can cause diuretic resistance and
hypokalemia, and work on receptors in the thick ascending renal loop of Henle. They
also inhibit the re-absorption of sodium and chloride at this site in the kidney.
✔✔Potassium-sparing diuretics - ✔✔spironolactone, triamterene, amiloride
✔✔Milrinone - ✔✔phosphodiesterase inhibitor, used for acute heart failure.
✔✔Tetralogy of Fallot - ✔✔congenital malformation involving four (tetra-) distinct heart
defects
✔✔Tetralogy of Fallot treatment - ✔✔Children that are diagnosed can stop hypoxic
spells by squatting down (a compensatory mechanism)
✔✔Patent ductus arteriosus (PDA) - ✔✔an abnormal opening between the pulmonary
artery and the aorta caused by failure of the fetal ductus arteriosus to close after birth; a
congenital heart defect with a continuous machine-like murmur heard over the left upper
sternal border in both systole and diastole, a bounding pulse and a thrill on palpation.
,✔✔Patent ductus arteriosus (PDA) - ✔✔can be effectively treated with IV NSAIDs such
as indomethacin.
✔✔Raynaud's Disease - ✔✔a vasospastic disorder typically seen during cold weather;
involves the small arteries and arterioles in the fingers; occasionally, the toes are also
involved; is treated with dihydropyridine-type calcium channel blockers (e.g., nifedipine)
because they cause peripheral vasodilation.
✔✔Respiratory system: Asthma - ✔✔is an obstructive airway disease associated with
airflow obstruction, mucus production, hyperactivity of the bronchial tissue, and
inflammation.
✔✔Asthma - ✔✔*Mild persistent asthma is best treated with a short-acting beta-2
agonist (SABA) plus an inhaled corticosteroid.
*Moderate persistent asthma is best treated with an inhaled low-dose corticosteroid and
a long-acting bronchodilator.
*Severe persistent asthma is best treated with a long-acting beta-2 agonist (LABA) plus
a high-potency inhaled corticosteroid plus an oral corticosteroid drug.
✔✔Asthma treatment - ✔✔*Inhaled short-acting beta-2 agonists (SABA) are indicated
only for PRN use.
*Long-acting beta-2 agonists (LABA, e.g., salmeterol) should never be used in an acute
asthma exacerbation; use a short-acting beta-2 agonist (SABA, e.g., albuterol).
*Short-acting beta-2 agonists (SABA) are used in acute asthmatic attacks, but can
increase heart rate, tremors, nervousness, and reduce serum potassium levels.
✔✔Asthma: Corticosteroid teaching - ✔✔Instruct a patient on any inhaled corticosteroid
product to rinse the mouth after each use of the inhaled corticosteroid product.
✔✔Asthma: different types of inhalers used for treatments - ✔✔*Advair (fluticasone and
salmeterol) is an example of a long-acting beta agonist and a corticosteroid.
*Anoro Ellipta (umeclidium/vilanterol) is an example of a long-acting beta agonist and an
anticholinergic agent.
*Combivent (albuterol/ipratropium) is an example of a short-acting beta agonist and an
anticholinergic agent.
*Tiotropium is long-acting anticholinergic agent, not for acute asthmatic attacks, and is
used once a day in asthma and COPD.
✔✔Cystic fibrosis (CF) - ✔✔hereditary disorder of the exocrine glands characterized by
excess mucus production in the respiratory tract, pancreatic deficiency, and other
symptoms
✔✔Cystic fibrosis (CF) - ✔✔a pulmonary disorder typically seen in childhood, with an
increased production of a protein-producing thick mucus that blocks the airways,
pancreatic ducts, sweat gland ducts and vas deferens.
, ✔✔Cystic fibrosis (CF) - ✔✔CF of the pancreas is also known as fibrocystic disease of
the pancreas.
✔✔respiratory distress syndrome (RDS) - ✔✔a severe respiratory disease that is
characterized by rapid respiratory failure; a lung disorder characterized by increased
pulmonary resistance and caused by Cystic fibrosis (CF) which is a surfactant
deficiency.
✔✔Musculoskeletal: NSAIDS - ✔✔NSAIDS have anti-inflammatory, analgesic and anti-
pyretic activity. The NSAID which is considered safe to use by individuals with heart
disease is naproxen.
✔✔Acetaminophen - ✔✔analgesic and anti-pyretic activity, but not anti-inflammatory
activity
✔✔Gout - ✔✔hereditary metabolic disease that is a form of acute arthritis, characterized
by excessive uric acid in the blood and around the joints; treated with antigout drugs
(e.g., allopurinol, colchicine, febuxostat) and uricosuric drugs (probenecid,
sulfinpyrazone). The only drugs that directly work on the pathophysiological causes of
gout are allopurinol and febuxostat.
✔✔`Gout - ✔✔Renal calculi can occur as a comorbid condition in patients with gout.
✔✔Colchicine - ✔✔reduces the inflammatory response seen in gout, reduces the pain
in an acute gout attack, but does not stop gout from developing into chronic gouty
arthritis. Colchicine efficacy is affected by its incidence of adverse effects.
✔✔Xanthine oxidase - ✔✔Xanthine oxidase is a form of xanthine oxidoreductase, a
type of enzyme that generates reactive oxygen species. These enzymes catalyze the
oxidation of hypoxanthine to xanthine and can further catalyze the oxidation of xanthine
to uric acid. Allopurinol treats chronic gout by decreasing uric acid production by
inhibiting this substance.
✔✔Urate lowering therapy (ULT) - ✔✔can initiate an acute gouty attack; concomitant
colchicine, NSAIDS or corticosteroids are used with ULT drugs to decrease the
incidence of ULT-induced acute gouty attacks.
✔✔Allopurinol - ✔✔the agent of choice for individuals with gout and high serum urate
levels with underlying renal dysfunction, history of tophaceous gout, or urinary calculi.
✔✔Acute gouty attacks - ✔✔are treated preferentially with NSAIDS e.g., indomethacin,
ibuprofen, naproxen, sulindac).
