WGU D027 (Advanced Pathopharmacology) Final Exam | Questions and Answers 2023/2024

Asthma meds don't mix with - Beta blockers, Ca Channel blockers 21.Migraine (chronic 15xs/month) treated with Botox 22.SLE (Lupus) - Inflammatory. Immune system makes antibodies and attacks itself, affects joints, skin, kidneys, blood cells, brain, heart, and lungs. a. s/s - Fatigue, Joint pain, Rash, Fever 23.Treatment - Prednisolone, Methyloprednisolone 24.Diabetic Ketoacidosis - body produces excess ketones(acids). 300 bg. Insulin deficiency that metabolizes fat instead of glucose for energy. K+ moves out of cell = hypokalemia a. s/s - Fruity-scented breath, dry mouth, thirst, frequent urination, Fatigue, Dry/flushed skin, Vomiting, Confusion, kussmaul respirations 25.Cellulitis treatment for patients on abx 3d then spikes fever of 101 a. Treatment of antibiotics-induced cellulitis - Start IV antibiotics or continue PO antibiotics, treat fever, educate on completing meds as prescribed, wrap wound 26.Panic Attack, hallucinations, and nightmares a. treatment - Clonazepam (Klonopin) for anxiety, Clonidine (Catapres) for HTN, Prazosin (Minipress) for stress nightmares (PTSD) 27.Multiple sclerosis - most common demyelinating disease. brain, optic nerves, and spinal cord. 28.Kidneys regulate bp through hormones to ↑ reabsorption of sodium and water into the bloodstream. a. hormones - Antidiuretic hormone (ADH), Aldosterone (causes the body to release salt and water, ↓ blood volume and thus ↓ BP) via the Renin-angiotensin system 29.Human Leukocyte Antigen (HLA) reduces immune response on cell surface. a. Allopurinol (Zyloprim) is used to reduce uric acid to treat gout and kidney stones. b. HLA with allopurinol is strongly associated with severe cutaneous adverse reactions (SCAR), such as Steven-Johnson Syndrome and toxic epidermal necrolysis. i. Most common in Korean, Han-Chinese, and Thai descenets. 4 30.Doxycycline (Vibramycin) - ↑ effect of warfarin (Coumadin). Monitor INR! a. Normal INR is 0.8-1.2. High INR = too thin, Low INR = clots i. If a patient comes in with an INR of 2.2 - skip a dose of coumadin 31.Muscle spasms meds - antispasmotics Baclofen (Gablofen)/ Tizanidine (Zanaflex) Gabapentin (Neurontin) b/c anticonvulsant 32.Subdural vs epidural vs intracerebral hematoma a. Epidural hematoma - blood between dura mater (outer covering of brain) and the skull i. Skull → epidural hematoma→ dura matter ii. CNIII Palsy, patients can have lucid periods then rapidly deteriorate to unconscious. iii. biconvex disc on CT b. Subdural hematoma - blood between dura mater and arachnoid membrane i. Dura Matter → subdural hematoma → arachnoid matter ii. Crescent shape on CT 33.Tay- Sachs (GM2 gangliosidosis) - destroys nerve cells in brain/spinal cord. Ashkenazi Jewish patients at ↑ risk b/c they lack enzyme that ↓ down fatty substances/allows toxic build up in the brain. a. Loss of muscle control/motor skillsl, cherry-red spots in the eyes, vision and hearing loss. 34.CKD - GFR 60, must be low for 3 months before diagnosis a. Stage 1: normal/high GFR (60-120mL/min) - proteinuria for 3+ months. b. Stage 2: GFR 60-89 - Mild loss of renal function with proteinuria. kidney damage c. Stage 3: GFR 30-59 - eval and begin treatment d. Stage 4: GFR 15-29 - prep for dialysis e. Stage 5 (ESRD): GFR 15 - begin dialysis 35.Uncomplicated otitis media first treatment - Amoxicillin. mainly caused by S. pneumoniae. 36.Fludrocortisone (Florinef) - Glucocorticoid to treat Addison’s disease and adrenocortical insufficiency. a. Side Effects - Upset stomach, headache, menstrual changes, Color changes of skin, ↑ weight, bleeding/bruising, slow wound healing, signs of infections, bone, joint, and muscle pain, puffy face, swelling of hands/feet, ↑ thirst and urination, muscle weakness 37.Prazosin (Minipress) - relaxes bladder (BPH), PTSD- sleep aid to ↓ nightmares, ↑ circulation in raynaud’s phenomenon 38.Antihypertensive for diabetics - ACE inhibitors for first-line treatment. Captopril (Capoten) 39.Asthma s/s - dry cough, wheezing, breathing through the mouth, chest pressure, ↑HR, throat irritation a. Treatment - Short-Acting Beta Agonists. i. Step 1: SABA PRN - for environmental/exercise/virus/allergy induced 1. Safe and recommended during pregnancy. babies/kids use nebs not inhalers. 2. Medications - Albuterol (Salbutamol, Proventil, Ventolin), Levalbuterol (Xopenex) ii. Step 2: Low-dose ICS or Alternatives - Worsening respiratory symptoms from asthma, Nighttime awakening, No systemic effects with oral meds. for peds with SOB at night iii. Step 3: Medium-dose ICS or SABA plus low dose ICS - may stunt teen growth. iv. Step 6 - oral corticosteroids for acute exacerbations (all-day coughing/wheezing). prednisone v. Leukotriene Receptor Antagonist - Montelukast (Singulair) vi. Mast Cell Stabilizers - Cromolyn (Intal) vii. Long-Acting Beta Agonists - Formoterol (Foradil, Perforomist), Salmeterol (Serevent), Indacaterol (Arcapta) viii. ICS + LABA meds - Fluticasone/Salmeterol (Advair), Fluticasone/Vilanterol (Breo Ellipta), Budesonide/Formoterol (Symbicort), Mometasone/Formoterol (Dulera) 40.Myasthenia Gravis - Autoimmune neuromuscular disease. Causes weakness. ↑ after activity/↓ after rest. Antibodies against nicotinic acetylcholine receptors between the nerve and muscles. 5 a. Sometimes caused by MuSK (Muscle-Specific Kinase). Prevents nerve impulses from triggering muscle contractions. b. Thymus gland causes autoimmune disease c. S/s - Ocular myasthenia – weakness of eye muscles, Ptosis, Diplopia (blurred/double vision), Difficulty swallowing, inability to cough or gag, SOB, slurred speech, weakness in arms, hands, fingers, legs, and neck, ↑ heart rate, ↑ BP d. Myasthenic Crisis - Severe muscle weakness, Respiratory failure e. Testing - Tensilon Test ↑ acetylcholine at the neuromuscular junction, differentiates between myasthenic vs cholinergic crisis. i. Blood Tests - Acetylcholine, Anti-MuSK antibody ii. Electrodiagnostics - Single fiber electromyography (EMG) iii. CT or MRI - Detects presence of a thymoma. f. Medications - Cholinesterase Inhibitors (Neostigmine/Pyridostigmine) i. Side Effects - ↑ mucus, salivation, urination, sweating, abdominal cramps, muscle twitching, nausea, vomiting, diarrhea, decreased pupil size, slowed or slurred speech, convulsion, dizziness, headache, low blood pressure, shortness of breath ii. Therapeutic levels of Cholinesterase Inhibitors Produce mild stimulation. Toxic levels depress the CNS. Treat with respiratory support and atropine. iii. Autoimmune treatments - Prednisone. Use 4-6 weeks then taper. g. Non-Pharmacologic Treatments - Plasmapheresis, IV immunoglobulin, Thymectomy, Hydrotherapy h. Cholinergic Crisis - ↑ salivation, lacrimation, sweating, urination, abdominal cramping, emesis, Bronchospasm, tachycardia, muscular weakness, fatigue, fasciculation leading to paralysis, respiratory muscle weakness, respiratory failure. treat with atropine. 41.Thyrotoxicosis or thyroid storm - Crisis. Rare. death can occur within 48h without treatment. a. May develop spontaneously, but occurs in individuals who have undiagnosed or partiallytreated severe hyperthyroidism with excessive life stress. b. Causes - Infection, Pulmonary or cardiovascular disorders, Trauma, Burns, Seizures, Surgeries especially thyroid surgeries, Obstetric complications, Emotional distress, Dialysis c. s/s - Sudden release/↑ of thyroxine (T4) and triiodothyronine (T3), Hyperthermia, Tachycardia, Atrial tachydysrhythmias, High-output HF, Agitation/delirium, Nausea, vomiting, or diarrhea contributing to fluid volume depletion d. Treatment - (Propylthiouracil (PTU) – inhibits thyroid hormone conversion, Thiamazole/ Tapazole), BB for cardio symptoms, Corticosteroids, Iodine, Supportive care, Plasma exchange, Thyroidectomy 42.Uncomplicated HTN first line Meds - Hydrochlorothiazide (Microzide) 43.Ataxia - degenerative disease of the nervous system, damages the cerebellum. Genetic predisposition or trauma to the spinal cord/other nerves. a. s/s mimic being drunk - Slurred speech, stumbling, falling, incoordination, wide-based gait, difficult with writing and eating, slow eye movements 44.Fragile X Syndrome – breaks/gaps in X chromosome. Late-onset, after 50 years old. Developmental delays, learning disabilities, social/behavior problems. Problems with movement/cognition. 45.Athletic Heart Syndrome - Enlarged heart and lower HR. as low as 30 to 40 bpm. expected. 46.Hypertension and CKD a. First line antihypertensives is ACE or ARB. b. If CKD in stage 3+, start on Amlodipine (Norvasc). 47.COPD s/s - Breathing difficulty, Cough, wheezing, Sputum production a. Causes i. Emphysema – alveoli are destroyed due to irritating gases and particulate matter. ii. Chronic bronchitis – inflammation of the lining of the bronchial tubes, which carry air to and from the alveoli. Daily cough and sputum production. 6 b. Testing - Spirometry /Pulmonary Function Test (PFT) to measure lung function/capacity. exhale. Chest Xray, CT Scan, ABGs c. Medications - i. SABA ii. SABA + theophylline (relaxes smooth muscles in airway = better air flow). ↑ effects of LABA or LAMA. Works quickly for SOB iii. LABA - Formoterol (Perforomist), Salmeterol (Serevent), Indacaterol (Arcapta) iv. SAMA - Ipratropium bromide v. LAMA - Tiotropium (Spiriva) vi. LAMA then LAMA + LABA vii. Then LABA + ICS viii. Then LAMA + LABA +ICS ix. Then PDE4 inhibitor - Roflumilast (Daliresp) with chronic bronchitis, Macrolide in former smokers. Azithromycin (Zithromax), Clarithromycin, Erythromycin 48.Medullary thyroid cancer - Occurs in C cells. Secretes calcitonin and carcinoembryonic antigen. a. RET proto-oncogene is located in chromosome 10. Genetic mutation of RET is seen in hereditary and sporadic MTC. b. s/s - Painless lump on the front neck. c. Testing - Fine needle aspiration biopsy of a thyroid nodule i. Blood test if positive - Calcitonin elevated, Carcinoembryonic antigen (CEA) elevated d. Genetic Counseling - Patients/1st degree relatives. Thyroid removed before MTC develops. 49.Postural Orthostatic Tachycardia Syndrome POTS a. Criteria - HR ↑ 30bpm or 120bpm within 10m of standing. no ortho hypotension. i. Peds ↑ 40bpm b. s/s - may/may not be hypotensive, hypovolemia, ↑ norepinephrine when standing, small fiber neuropathy, fatigue, HA, lightheadedness, heart palpitations, exercise intolerance, nausea, diminished concentration, shaking, syncope, chest pain, SOB, coldness or pain in the extremities, reddish-purple color in the legs upon standing (blood pooling/poor circulation) c. Testing - Tilt Table Test, orthostatic vitals (HR and BP supine, standing at 2, 5, 10 mins) i. Quantitative Sudomotor Axon Reflex Test (QSART) - sweat stimulation through mild electric shock ii. Thermoregulatory sweat test, skin biopsy for small fiber nerves, gastric motility studies 50.Color blindness - Gene Mutation, OPN1MW on chromosome-23 (x-linked). Mom to son when the diseased gene is dominant. Only one X gene is necessary to be affected. 51.G6PD (hemolytic anemia) - Glucose-6-phosphate dehydrogenase deficiency. genetic disorder (point mutation) that causes RBCs to break down prematurely. RBCs destroyed faster than replaced. Men a. s/s - Pale skin, Jaundice, dark-colored urine, fever, weakness, dizziness, confusion, trouble with physical activity, enlarged spleen and liver, ↑ HR, murmur b. Food to avoid - all beans (fava), moth balls (naphthalene), red wine, blueberries, soya, tonic water, camphor c. Meds to avoid - ASA, ascorbic acid (Vitamin C), chloroquine, methylene blue, methyldopa (aldomet), sulfisoxazole/pediazole (risk of hemolysis is dose-related). 52.PRN meds for anxiety (benzodiazepines, vistaril, seroquel, SSRIs and Wellbutrin) 53.Gingko biloba/garlic increase in the risk of bleeding 54.CYP3A4 - Important in metabolism of codeine. a. St. John’s wort induces CYP3A4 and can accelerate the metabolism of drugs, causing a loss of therapeutic effects. Avoid taking with digoxin. 55.Alzheimer’s - Most common type of dementia with 60-80% of the cases. a. Progressive symptoms. Average lifespan: 4-8 years after diagnosis. up to 20 years b. Younger-Onset Alzheimer’s Disease - 66y