Patho Pharm 2 Course Page
Below are the topics, handouts, and notes for Pathophysiology and Pharmacology I. If you click on the title of a topic, you will be taken to the lecture files (mp3) for that topic. Alternatively, you may download the lectures as a zip file or subscribe as a podcast.
|Patho Pharm 2 Lectures:||Podcast Feed||Subscribe with iTunes||Download as Zip File (447 MB)|
The podcasts in this section are reviews for the final exam. This section is also a place to put the syllabus and other class handouts.
- The So you think you’re good test is a minimum expectation of what you should know and be able to analyze after taking Patho Pharm 1 and 2. If you can consistently score 100% on it, the rest of nursing school will be a breeze. If you struggle with it you will struggle with the rest of nursing school.
- Herbals do not appear on any podcast but will be on the Final Exam.
- Quiz 1 – Diabetes and Endocrine
- Quiz 2 – Renal and Musculoskeletal
- Quiz 3 – Cardiovascular
- Quiz4 – Neuro, Genetics, HIV
- Quiz5 – GI, Cancer
- 10-Herbal Supplement Handout.doc
- so you think youre good2.doc
Test and Final Exam Reviews
- Final Exam Review
- Test 1
- Test 2
- Test 3
- Test 4
- Kaplan Review
This is a Q&A of drugs from Patho Pharm 1. It was recorded by a student, so the sound quality is not very good. I cleaned it up and amplified the voices, but there’s still a lot of background noise. Review of the So You Think You’re Good test. This is a minimum expected competency. I expect that you can do this cold, in your sleep. So get cracking.
- 1/3 Genetics and HIV
- 2/3 Neuro (1/2 drugs, 1/2 patho)
- Purpose of DNA
- Human Genome (23 pairs, X, Y, etc.)
- Epigenetics (Purpose, mechanisms, and some examples) might want to read the articles
- Inheritance patterns (Autosomal Dominant/Recessive, X-linked, Polygenic, Multifactorial)
- Gene Therapy
- Lifecycle of HIV
- How it infects CD4 cells
- HIV vs AIDS
- Criteria for AIDS
- Lab Tests for Dx and management
- Patterns of transmission in U.S. vs rest of world.
- Goals for treatment
- Risk factors
- Know the cause, symptoms, treatment of every disease listed.
- The longer the material, the more questions on that material
- Know the major drug classes
- Know depression, anxiety, OCD, bipolar (the brief amount we did in class)
- Know the mechanism of neural transmission (resting/action potential)
- Know the mechanism of how a neuron decides to fire in the first place
Areas of Difficulty
- What is psychosis?
- Need to know mechanisms of action of drugs. Weakest on TCAs, Wellbutrin, and Typical Antipsychotics
- Seizures caused by undertreatment
- DT onset: see VoiceThread
- Use of Benztropine (Cogentin) with typical psychotics
- Levodopa: acute loss of effect vs wearing off
- MAO inhibitor: what to avoid
- Anticholinergic effects!!!!!!
- Lithium toxicity
- Signs of liver toxicity
- Parkinson’s treatment
- Horácio Quiroga short story
- Identifying negative symptoms
- Bipolar treatment
- Adverse effects of Wellbutrin
- Teens and depression
- Osteo: gradual wearing away of cartilage. Older adults. Typically affects large joints (knees, hips) and excessive weight or use accelerates. Little inflammation. Typically feels worse as day goes on. Progression: APAP -> NSAIDS -> Opioids -> Joint replacement.
- Rheumatoid: Type III autoimmune disease. Younger patients. Typically affect smaller joints such as hands/fingers. Nodules. Eventually causes deformity. NSAIDS plus immune modulators.
- Gout: excess uric acid in blood crystallizes causing episodic flares with excruciating pain and inflammation. Most commonly affects joint of large toe.
- Acute treatment: NSAID plus Colchicine. Colchicine inhibits white blood cells migration to area of inflammation. Taken every 2 hours. Typically take it until the pain subsides or patient can’t stand diarrhea. Can cause agranulocytosis.
- Chronic treatment: reduce high purine foods (turns into uric acid): Red wine, red meat, sea food. Allopurinol increases secretion of uric acid. **CAUTION** Allopurinol also causes blood to become more acidic. If a flare is in progress, it can increase the crystallization of uric acid, making the flare worse. So, never start Allpurinol during a flare. If a patient is already on it, then keep them on it.
- What constitutes intensive insulin therapy
- Kidney stones U/A
- Bone scan vs bone density.
- Loss of height for osteoporosis
- Smoking doesn’t cause diabetes, nor does high fat diet
- CAD risk factors FTW
- Which drugs reduce insulin resistance
- Ya gotta know the treatment goal for A1C
- Polys are ACUTE symptoms of fairly HIGH blood sugar. -opathys are chronic complications that occur even with slightly high blood sugars after a long period of time.
- Proteinuria occurs long long long before elevated creatinine
- Acarbose priority education
- Goiter U.S. vs world!!!
- Thyroxine or cytomel
- Cushing Cushings
- Pharmacological effects of steroids!!
- Mechanisms of drugs!!!
- Which drugs cause hypoglycemia
- Insulin: what labs to monitor
- Review from PP1: What is flail chest?
- Pre, intra, postrenal failure
- Complications of chronic renal failure
- How does kidney control acid-base
- Sodium-potassium pump
- UTI vs Pyelonephritis
There are about 65 questions total. About half patho/half pharm
You need to know the following areas: General:
- overall CV components (pipes, pump, and fluid)
- control mechanisms (sympathetic, renal, RAAS, ANP/BNP, endothelium, Starling’s law, etc.)
- All the CV drugs plus the ones from last semester that are pertinent such as anti-clotting drugs.
- low and high
- angina: stable, Prinzmetal, and unstable
- MI dx and treatment
- cholesterol (what they are, what each type is/means and treatment guidelines)
- ECG characteristics of each one
- What goes wrong in the body for each one
- How each one is treated
- On the quizzes, there are several ECG strips. The quiz questions ask you what the rhythm is. On your test you will have the exact same strips but will be asked what the symptoms are or what the treatment is.
- Shock and Chronic heart failure
- systolic/diastolic, left/right
Things from Patho/Pharm 1 you might want to remember:
- Anti-clotting drugs
Areas of Weakness
- Atherogenesis steps
- Big five drugs for heart failure
- A Fib and cardiac output
- ICU treatment of HF vs Med-Surg
- Conditions necessary for atherogenesis
- MI standard of care aimed at reducing workload of the heart
- ACE inhibitors in DM
- Hypertensive crisis
- Calcium channel blockers plus HF è Death
- Number one cause of death 72 hours after MI
- Diastolic/Systolic failure
- Beta blocker education
- Potassium supplementation
- CCB adverse effects
- ACE inhibitor adverse effects
- Cholesterol screening guidelines
Areas of weakness in the past:
- You need to read up on ischemic (stress) ulcers, also called Curling Ulcers: causes and prevention
- Barrett’s esophagus
- Interpretation of IgG and IgM
- Lactulose plus ______
- Chronic vs Acute Pancreatitis
- Encephalopathy prevention vs treatment
- Bilirubin interpretation
- Phenergan adverse effects. Which is more important, something that almost everyone gets that can cause accidents, or something very rare that although permanent, is just a nuisance?
- Clindamycin induced diarrhea? What could be the cause of that? What would be used to treat it?
- Diarrhea, when to treat orally vs aggressive therapy
- Small Bowel obstructions
- Most common laxative post op
- Diagnostic test for Mg containing laxatives
- Conservative vs aggressive therapy for diverticulitis
- I did not know that THC causes multiple personality d/o
- Bone scan. We went over this one for Test 2. It’s a nuclear medicine test that detects bone metabolism. Hot spots are indicative of cancer. Cold spots of necrosis.
- Myeloma produces large amounts of antibodies, which are protein. So what lab value would high?
- Calcium Carbonate adverse effects: constipation
- Why are patients with no ulcers or GERD given H2 blockers or PPIs in the hospital?
- ANC interpretation
- E coli symptoms
- Someone calls in about diarrhea, and you tell them what to do without asking about what the stool looks like?
- How does AZT work
I’ve looked at the test and here are some pointers:
- There are quite a few drug calculation questions. Study up on your math.
- In terms of content the test is pretty decent, and we’ve covered most of what’s on it. Here are some things that you may want to review:
- How to administer meds: TechSkill stuff like IV, IM, Inhalers, SL, otic drops, ophthalmic drops, topical, transdermal. Keep in mind that sometimes you think a question is asking you about a specific med but really it’s asking you about appropriate general technique for the route of admission. The harder questions are combining both.
- Blood transfusions
- Tuberculosis drugs and therapy
- Rheumatoid diseases like Lupus and rheumatoid arthritis
- Drugs used in alcohol addiction
- Fluid and electrolytes
- There are a few questions on drugs used at birth. You should be able to figure most of them out just from your general pharmacology knowledge, so don’t be intimidated. The one exception is drugs used for Rh incompatibility.
- You may want to read the section on muscle relaxants (it’s only 2 pages and we didn’t really cover it in PP1).
- One more thing to keep in mind is that these types of tests often used older drugs, whereas in class we use more commonly used drugs. It shouldn’t be a problem as long as you remember what class the drugs belong to.
- Focused reviews to do in preparation
- Parenteral therapy
- Drug calculations
Review peripheral nervous system
Big CNS disorders: Alzheimer’s, Epilepsy, Parkinson’s
Psych Drugs: Antidepressants, Anxiolytics, Hypnotics, Antipsychotics
Miscellaneous nervous disorders
- Neuro Intro Lecture
- Psychotropics Lectures
- Neuro Disorders Lectures
DNA and Protein synthesis
Simple Mendelian genetics, polygenic inheritance, Multifactorial inheritance
Common genetic disorders
- Genetics Lectures
- Additional Genetics Resources
Human Immunodeficiency Virus and AIDS
There is an updated lecture on VoiceThread.
- HIV Lecture
- Additional Notes and Resources
Because the overwhelming majority of patients with HIV in the U.S. contracted it sexually, they also tend to have other STDs. Herpes in particular is very common and much nastier. Tuberculosis is also very common.
Life Cycle Video (includes how the drugs work) http://www.youtube.com/watch?v=RO8MP3wMvqg
Now you can test yourself in the comfort of your own home: http://www.fda.gov/forconsumers/consumerupdates/ucm310545.htm
House of Numbers Documentary: http://www.youtube.com/watch?v=I-2FGC2ZTlY
Clip we saw in Class http://www.youtube.com/watch?v=XSSpoFq7uhM
Full (hour long interview) with Luc Montagier http://www.youtube.com/watch?v=PyPq-waF-h4
Interestingly, when you see a claim that an HIV test is 99.9% sensitive and specific, what they’re testing it against is other HIV tests, not the actual presence of the HIV virus. Interestingly, all immunoassays are susceptible to cross-reactivity, and areas with high levels of parasites (malaria, shistosomoiasis, etc., such as sub-saharan Africa) will have a high number of false positives.
PCR (Viral load) supposedly detects a fragment of viral RNA that is unique to HIV (but has never been isolated, however, AIDS patients who are worse off have higher levels). So the idea is that by targeting treatment at viral load, we can reduce the likelihood of progressing to AIDS.
The Ryan White Story True story about a boy with hemophilia who contracts AIDS. http://www.imdb.com/title/tt0098237/combined
And the Band Played On Dramatization about some of the political and research issues surround the early days of HIV/AIDS http://www.imdb.com/title/tt0106273/combined
And if you want a movie that will make me cry guaranteed: http://www.imdb.com/title/tt0277434/combined
Diabetes is a BIG topic. It’s actually several diseases, all characterized by high blood sugar. You have to know the acute and chronic results of high blood sugar, plus the intricacies of the two major forms of the disease (which are nothing alike) AND the treatments and drugs.
- Diabetes Patho
- Diabetes Pharmacology
Diabetes 1: Basic definitions and glucose physiology. Hormones: insulin, glucagon. Types and causes of Diabetes: Type I, Type II, Gestational, Cushing’s Diabetes 2: Insulin Resistance. Symptoms and pathophysiology of hyperglycemia. Ketoacidosis: KEY Items: Bicarb low, Potassium is low (because of the urine issue) (I say it wrong on the audio), ketouria, kussmaul breathing, fruity breath Diabetes 3: Macrovascular complications. Diagnosing diabetes: update HgbA1C is now an option for screening and diagnosis. Dawn Phenomenon vs Somogyi effect (patho and treatment). Acute Hyperglycemia. Type I diabetes. Diabetes 4: Type I continued. Type II diabetes. Metabolic Syndrome. Incretin and Amylin. Diabetes 5: Type II diabetes continued. Treatment approaches.
Endocrine disorders and treatments
Main two are hyper/hypothyroid
And hyper/hypo Cortisol (Cushing’s/Addision’s)
- Endocrine Lectures
And arthritis (no notes or podcasts for arthritis)
Renal and Diuretics
Fluid and Renal physiology
- Renal Lectures
This is the biggest unit this semester and extremely important. For those of you who don’t deserve to be nurses, you’ll get a chance to redeem yourself (hint, the answer is aspirin). This unit builds heavily on last semester and renal. Review the peripheral nervous system, inflammation, and anticoagulants/antiplatelets. You will also need to memorize the CK-MB and Troponin lab values. The unit is broken up into:
- Blood pressure
- Arterial and venous diseases
- Coronary Artery Disease and Myocardial Infarction
- Dysrhythmias and Heart Failure
- Cardiovasular review questions like you cannot believe!!
- Journal Article about atherogenesis
- Cardiac Bypass Surgery Controversy: Letter to President Bill Clinton
- Blood Pressure and Treatment Lectures
- Vascular Diseases
- Coronary Artery Disease
- Cholesterol and Cardiovascular Risk Factors
- Heart Failure
- Cardiovascular Review
Falls into three main areas:
Upper GI (Esophagus, Stomach, Duodenum)
Lower GI (Colon)
Accessory GI (Liver, Gall Bladder, Pancreas)
- Upper GI Lectures
- Lower GI Lectures
- IBD Lectures
- Liver, Gall Bladder, Pancreas Lectures
- Additional Notes
When Diverticulosis becomes Diverticulitis
Asymptomatic → Symptomatic
High fiber diet → Liquid diet plus antibiotics and pain management
- In mild episodes, a clear liquid diet is advised. Clinical improvement should occur within 2-3 days, and the diet can then be advanced as tolerated.
- Administer nothing by mouth in episodes of moderate-to-severe acute diverticulitis.
- Studies imply a high-fiber diet will prevent progression of diverticulosis. However, after patients have become symptomatic, the benefit of fiber supplementation is less clear. Recommending to patients to avoid seeds and nuts is currently less common, since it is now thought that seeds and nuts may not play a significant role in the development of diverticulitis, as believed in the past.
- Long-term management probably includes a high-fiber, low-fat diet.
Cellular Adaptations and Neoplasms
Pathogenesis and Manifestations of Cancer
Basic Chemotherapy principles
- Cancer Lectures
- Additional Cancer Resources
- Interview with a woman with breast cancer who opted for naturopathic therapy. Includes discussion of limitations of “scientific” cancer approaches as well as specifics on some naturopathic therapies.
- Documentary on Hoxsey Cancer Treatment: How Healing Becomes a Crime
- Interview a survival instructor who talks about what it is like for a tough guy to get cancer undergo hormonal treatment. Skip to minute 47 for the cancer part.
- My Life Cancer movie that I mentioned with Michael Keaton featuring therapeutic touch. Main story line is about how he prepares himself and his family to die. http://www.imdb.com/title/tt0107630/combined
- The Ultimate Gift Featuring Little Miss Sunshine Herself as a patient. http://www.imdb.com/title/tt0482629/?ref_=nm_flmg_act_23
- My Sister’s Keeper Also Featuring Little Miss Sunshine in a movie about a family that has another child to be a donor for the older sibling. http://www.imdb.com/title/tt1078588/?ref_=nm_flmg_act_16