WGU D027 Advanced Pathopharmacological Foundations Questions and Answers correct

WGU D027 Advanced Pathopharmacological Foundations Questions and Answers correct What are some physical changes from Alzheimer's dementia? - Brain shrinks dramatically; nerve cell death and tissue loss - Cardinal signs: plaques (abnormal clusters of protein fragments) and tangles (twisted strands of another protein) How is Alzheimer's treated? - There is no cure, but there are pharmacological and non-pharmacological treatments - Cholinesterase inhibitors - Memantine (namenda) What are cholinesterase inhibitors prescribed for? - To treat symptoms related to memory, thinking, language, judgment, and other processes - Helps delay or slow the worsening of symptoms What does cholinesterase inhibitors do? - Prevent the breakdown of acetylcholine, a chemical messenger that is important for learning and memory - Supports communication among nerve cells by keeping the acetylcholine high What are some commonly prescribed cholinesterase inhibitors? - Donepezil (aricept) - Galantamine (razadyne) - Rivastigmine (exeleon) Which cholinesterase inhibitor can be used for all stages of Alzheimer's? - Donepezil (aricept) Which cholinesterase inhibitor can be used for mild-to-moderate stages of Alzheimer's? - Galantamine (razadyne) - Rivastigmine (exeleon) Which cholinesterase inhibitor can be used for mild-to-moderate Alzheimer's and Parkinson's? - Rivastigmine (exeleon) What medication combination is used to treat moderate-to-severe Alzheimer's? - Memantine (namenda) and donepezil (aricept) What is memantine (namenda) used for? - Prescribed to improve memory, attention, reason, language, and the ability to perform simple tasks - Can be used alone or with other Alzheimer's disease treatments How does memantine (namenda) work? - Regulates the activity of glutamate, a chemical involved in information processing, storage, and retrieval - Improves mental functioning and ability to perform daily activities for some people What is the difference in MOA between cholinesterase inhibitors and memantine (namenda)? - Cholinesterase inhibitors prevent the breakdown of acetylcholine, whereas memantine (namenda) regulates the activity of glutamate What is ataxia? - Also known as cerebellum attacks - Degenerative disease of the nervous system - Many symptoms mimic those of being drunk (i.e. slurred speech, stumbling, falling, and incoordination) What causes the symptoms of ataxia? - The damage caused to the cerebellum, the part of the brain that is responsible for coordinating movements - Can also be caused by damage to part of the spinal cord and nerves What is the treatment for ataxia? - No treatment - In some cases, treating the underlying causes (i.e. stopping medications that cause ataxia) - In other cases, it is a result from chicken pox or other viral infections (likely to resolve on its own) - Genetic causes/predisposed disposition is usually chronic What causes ataxia in the pediatric population? - Genetic predisposition - Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) - Prader-Willie Syndrome What is Fragile X syndrome (FXS)? - A genetic condition inherited from parents which results in various developmental problems - Rare, but may be dangerous or life-threatening - Present at birth and is a lifelong condition - Rarely requires lab testing or imaging - Often linked to autism (1/3 do have autism) - X-linked disorder Since Fragile X Syndrome (FXS) is an X-linked disorder, does a specific gender have a greater risk? - Often, females are carriers and males are affected - However, both males and females can be carriers, and both can be affected by the condition - Usually milder in females How did Fragile X Syndrome (FXS) get its name? - The gene Fragile X (the FMR1 gene) is on the X syndrome - Mutation of the FMR1 gene What is the difference between Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) and Fragile X Syndrome (FXS)? - Both caused by mutations on the FMR1 gene, but they are caused by different changes in this gene - FXS is caused by a full mutation - FXTAS is a premutation - FXS is present at birth, but display these features in early life - FXTAS develops in adulthood (usually after age 50) and the symptoms may appear slowly and develop over the years - FXTAS individuals are usually healthy with normal cognitive skills prior to the onset How is Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) diagnosed? - Being a FMR1 premutation carrier - The appearance of neurological features such as ataxia (balance problems), tremors, and other symptoms - MRI findings (changes in the brain) What is Prader-Willie Syndrome? - Genetic disorder that affects many parts of the body and their growth - Causes mental and behavioral problems - Can be dangerous or life threatening if untreated - Combination of contraceptives contraindicated in breast feeding - More common in females - Confirmed from laboratory findings What is the cause of Prader-Willi Syndrome? - Depletion of chromosome 15 from father - Missing or non-working genes on chromosome 15 (15q11-q13) - Most cases are not inherited and occur randomly - Depletion of genes (genes from the region are missing) - Uniparental disomy - both chromosomes are inherited from the mother - Imprinting mutation - genes on the paternal chromosome is inactive What does Prader-Willi Syndrome do to the body? - Caused the hypothalamus to malfunction (the area of the brain that affects hunger, thirst, sex and growth hormones) - In infancy, an individual does not meet development milestones suck as sitting up and walking - Their eyes lack coordination What is a key feature of Prader-Willi Syndrome? - A constant sense of hunger that usually begins around 2 years of age - People with Prader-Willi Syndrome want to eat constantly because they never feel full What are some symptoms in infants with Prader-Willi Syndrome? - Hypotonia with floppy structure and poor muscle tone - Distinct facial features affecting the shape and size of eyes, lips, forehead, etc. - Poor sucking ability making it difficult to feed - Always lethargic and poor responsiveness - Underdeveloped genitals What is celiac disease? - Autoimmune disease - Damages to the small intestinal epithelium when there is ingestion of gluten - Loss of mucosal surface and brush border enzymes leads to severe malabsorption that is more pronounced in the duodenum and jejunum What strong genetic disposition does celiac disease have? - Human leukocyte antigen DQ2 (HLA-DQ2) and HLA-DQ5 What test is recommended for celiac disease? - IgA-tTG - Total IgA - Simple, inexpensive, widely available, typically covered by insurance, and is very accurate in untreated celiac disease What are the recommended tests for celiac disease? - Total IgA - IgA-tTg - IgA-EMA - If IgA is deficient, it is recommended that IgG/IgA-DGP also be ordered What are diagnostic methods of celiac disease? - Serologic measurements of antiendomysial and antitrandsglutaminase IgA antibodies and HLA-DQ2 or HLA-DQ8 - Duodenal biopsy Why is it important to remain on a normal, gluten-containing diet prior to testing for celiac disease? - Alter the results of the test - If the blood tests and symptoms indicate the disease, a physician will likely suggest a biopsy for the lining of the small intestine to confirm the diagnosis Which part of the bowels is more affected by celiac disease? - Duodenum and jejunum What are some symptoms of celiac disease? - Pale, greasy, bulky, and foul smelling diarrhea - Easily bruises and/or bleeds - Abdominal pain - Hypomagnesemia and hypocalcemia (irritability, tremors, convulsions, tetany, bone pain, osteomalacia, and dental abnormalities) What is the treatment for celiac disease? - Lifelong adherence to a gluten free diet - Steroids and immunosuppressants may be required What are some foods that are contain gluten? - Wheat - Rye - Barley - Malt What is Crohn's disease? - A chronic inflammatory bowel disease that affects the lining of the digestive tract - May cause intestinal bleeding, chronic diarrhea, abdominal pain, cramping, fissure, malabsorption, ileus, bowel resection, pancreatitis, mouth ulcers, kidney stones, inflammation of the eyes - A lot of times, they do not absorb iron and some other minerals and vitamins, thus, patients may have issues getting all minerals and vitamins What are tests are used in the diagnosing Crohn's disease? - Anti-saccharomyces antibody test (ASCA) - CBC (H/H, WBC) - Heme-occult - C-reactive protein (sign of inflammation) - Electrolyte panel (K due to diarrhea) - Erythrocyte sedimentation rate (ESR) (amount of inflammation) - Iron and B12 levels - KUB - Upper endoscopy - Barium x-rays - CT/MRI (external view) - Video capsule endoscopy Which tests may show lesions for patients with Crohn's disease? - Barium x-ray - in the small intestines - Colonoscopy or sigmoidoscopy (primarily) - in the large intestines Which two lab tests measure inflammation? - C-reactive protein - Erythrocyte sedimentation rate (looks at the amount of inflammation by measuring the amount of time it takes for erythrocytes to fall to the bottom of the tube) What are some medications/treatments used to treat Crohn's disease? - Aminosalicylates - Corticosteroids - Immunosuppressants - Biologics (remicade) - Antibiotics - Surgical incision of the affected area Why are aminosalicylates used for in patients with Crohn's disease? - Reduce inflammation What are some aminosalicylates that are used to treat Crohn's disease? - Sulfasalazine - Mesalamine Why are corticosteroids used for in patients with Crohn's disease? - Reduce inflammation - Only used if aminosalicylates are not effective during an exacerbation What are some immunosuppressants that are used for in patients with Crohn's disease? - Azathiroprine - Cyclosporine - Tactolimus - Methotrexate - Infliximab Why are antibiotics used to manage patient's with Crohn's disease? - To manage intestinal bacterial overgrowth What diet is best for patients with Crohn's disease? - Low residue diet: low fiber foods, lean proteins, small/refined grains, fully cooked/non cruciferous vegetables (help prevent gas/bloating), low fat foods, probiotics (when there is not an exacerbation), and nutritional shakes - Avoid alcohol and caffeine (dehydrating and diuretics) - Hydration and electrolyte replacement drinks What are patients with atopic dermatitis and eczema have an increased risk for? - Crohn's disease - Celiac disease How does patients with Crohn's disease's bowels look like? - "Skip lesions" on the bowel tissue (mucosal lesions where inflammation exists) - Tissue may appear as cobblestones on biopsy What is the difference between ulcerative colitis and Crohn's disease in terms of symptoms and body impacts? - Crohn's is inflammation and scarring in the intestine (bowel) disease lining of all of the digestive tract and worsens after eating - Ulcerative colitis is inflammation of the bowel/digestive tract and is only in the innermost lining of the large intestines (colon) and rectum Which test is used to diagnose ulcerative colitis vs Crohn's disease? - Ulcerative colitis: Perinuclear anti-neutrophil cytoplasmic antibody test (PANCA) - Crohn's disease: Anti-saccharomyces antibody test (ASCA) Where in the bowels does Crohn's disease affect? - Can be throughout the entire intestinal lining - Generally, in the small intestines Where in the bowels does ulcerative colitis affect? - Only the innermost lining of the large intestines (colon) and rectum What causes the pain to worsen in patients with Crohn's? - After eating - Pain is usually around the navel or lower right abdomen What is ulcerative coloitis? - Inflammatory bowel disease (IBD) causes inflammation and ulcers (sores) in the digestive tract - Affects the innermost lining of your large intestines (colon) and rectum What are some symptoms of ulcerative colitis? - Varies on the inflammation and where it occurs - Diarrhea, often with blood or pus - Abdominal pain and cramping - Rectal pain/bleeding - Urgency to defecate and inability - In children, failure to grow What are some diagnostic methods for ulcerative colitis? - Ulcerative colitis: Perinuclear anti-neutrophil cytoplasmic antibody test (PANCA) - CBC, CRP, ESR, LFT, electrolyte panel - ANA (anti-nuclear antibody) - Colonoscopy - Flexible sigmoidoscopy - Stool studies - X-rays, CT scan, MRI