WGU D027 ADVANCED PATH PHARMACOLOGICAL EXAM 2025

WGU D027 ADVANCED PATH PHARMACOLOGICAL EXAM 2025 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 Alzheimer’s is 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 WGU D027 WGU D027 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 WGU D027 WGU D027 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 WGU D027 WGU D027 - 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 WGU D027 WGU D027 - 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 WGU D027 WGU D027 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 WGU D027 WGU D027 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 What are some pharmacologic treatments for ulcerative colitis? - -- Anti-inflammatory drugs - Corticosteroids (prednisone) are reserved for moderate to severe conditions that do not respond to other treatments - Immunosuppressants to suppress the immune response that starts with inflammation - Antidiarrheals, pain relievers, antispasmodics, iron supplements What diet is best for patients with ulcerative colitis? - -- No firm evidence that what you eat actually causes it - Certain foods and beverages can aggrate signs and symptoms - Limit dairy products - Small meals - Drink plenty of liquids - Avoid alcohol and beverages that stimulate the intestines and can worsen diarrhea; carbonated drinks can produce frequent gas What is the cause of color blindness? - -- Occurs when there is a problem with the pigments in certain nerve cells (cones) of the eye that sense color - Genetics: comes from the mother, 50% chance - Passed down in families - 1:10 men are colorblind, very few women are WGU D027 WGU D027 What gene is mutated for color blindness? - -- Mutated gene OPN1MW on chromosome 23 (X-linked) What is the diagnostic method to test for color blindness? - -- Simple test that consists of multiple dots that make up a number, letter, etc. What is achromotopsia? - -- Most severe form of color blindness - Rare - Person cannot see any color, only shades of grays What is COPD? - -- Chronic inflammatory lung disease that causes obstructed airflow from the lungs - Typically caused by long-term exposure to irritating gases from cigarette smoke What are some symptoms of COPD? - -- Symptoms don't appear until significant lung damage has occurred and usually worsens over time - Shortness of breath - Wheezing - Chest tightness - Chronic cough What are common conditions that can lead to a COPD exacerbation? - -- Emphysema - Chronic bronchitis What is emphysema? - -- Condition in which the alveoli at the bronchioles of the lungs are destroyed as a result of damaging exposure to cigarette smoking and irritating gases and particulate matter - Air goes into the lungs and is unable to leave, causing hyperinflation What is chronic bronchitis? - -- Inflammation of the lining of the bronchial tubes (which carries air to and from the alveoli of the lungs) - Characterized by daily cough and sputum production (excess mucus production and smooth muscle hypertrophy) What is the most common method of diagnosing COPD? - -- Spirometry/pulmonary function test (PFT) which measures lung function and capacity What is usually the first line of treatment for patients with COPD? - -- Short-acting bronchodilators (on a regular basis is not generally recommended) What do bronchodilators do? - -- Medications that increase FEV1 and/or change other spirometrics variables - In COPD patients, used to prevent or reduce symptoms What are some pharmacological treatments for COPD patients? - -- Beta2-agonists WGU D027 WGU D027 - Inhaled or oral steroids - Antimuscarinic drugs - Combination inhalers What are beta2-agonists? - -- Type of bronchodilator - Relaxes airway smooth muscles by stimulating beta2-adrenergic receptors, which increases cyclic AMP and produces functional antagonism to bronchoconstriction - Both short-acting (SABA) and long-acting (LABA) What are some long-acting beta2-agonists (LABA)? - -- Formoterol and salmeterol - twice daily that significantly improves FEV1 and lung volumes, dyspnea, health status, exacerbation rate, and number of hospitalizations; but have no effect on mortality or rate of decline of lung function - Indacaterol - once daily that improves breathlessness, health status, and exacerbation rate - Oladaterol and vilanterol - once daily to improve lung function and symptoms What are some side effects of beta2-adrenergic receptors? - -- Sinus tachycardia and has the potential to precipitate cardiac rhythm disturbances - Exaggerated somatic tremor How do antimuscarinic drugs help COPD patients with their symptoms? - -- Block the bronchoconstrictor effects of acetylcholine on M3 muscarinic receptors expressed in airway smooth muscle What is some short-acting antimuscarinic (SAMA)? - -- Ipratropium (provided small benefits of SABA in terms of lung function, health status, and requirement for oral steroids) - Oxitropium What is some long-acting antimuscarinic (LAMA)? - -- Tiotropium - Aclidinium - Glycopyrronium bromide - Umeclidium - Greater exacerbation rates for LAMA vs LABA What is the purpose of using combination bronchodilator therapy for patients with COPD? - -- Combining bronchodilators with different mechanisms and durations of action may increase the degree of bronchodilation with a lower risk of side-effects in comparison to increasing the dose of a single bronchodilator - Combinations of SABAs and SAMAs are superior compared to either medication alone in improving FEV1 and symptoms When would you consider using inhaled corticosteroids (ICS) and long-acting beta2 agonists (LABA)? - -- Moderate to very severe COPD exacerbations - More effective in improving lung function, health status, and reducing exacerbations WGU D027 WGU D027 What treatment is recommended if a patient has failed long-acting beta2-agonists (LABA)? - -- Albuterol? What is asthma? - -- Condition in which your airways narrow and swell; may produce extra mucus - Can make breathing difficult, trigger coughing, wheezing, and shortness of breath - Trigger causes mucus to clog the bronchial tubes - Reversible What is the treatment for asthma? - -- Beta-agonists, steroids - Glucocorticoids (foundation) - Bronchodilators - Anti-inflammatory What are some long-term inhaled corticosteroids used for patients with asthma? - -- Fluticasone (Flovent HFA) - Budesonide (Pulmicort flexhaler) - Mometasone (Asmanex twisthaler) - Beclomethasone (Qvar Redihaler) - Ciclesonide (Alvesco) What medication should you avoid for patients with asthma? - -- Beta-blockers - Use calcium channel blockers to treat heart condition What some symptoms of patients with asthma? - -- Dry cough that occurs during the night or exercise - Chest pressure - Anxiety - Early awakening - Fast heart rate - Throat irritation - Difficulty breathing, wheezing, mouth breathing, shortness of breath What are some short-term pharmacological treatments for asthmatic patients? - -- Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) - provides symptomatic relief, no effect on the inflammation of the disease process - Levalbuterol (Xopenex HFA) - Metaproterenol - Terbutaline What are some triggers that asthmatic patients should avoid? - -- Pollen or particular grasses - Animals and pet dander - Pest - Mold WGU D027 WGU D027 - Smoke What is the first step in asthma treatment? - -- Inhaled SABA (short-a