The test is approximately half Intro/Basic Pharmacology and half Neuro.  Expect a couple matching questions, such as matching drugs to their mechanisms of action or to their therapeutic use or their adverse effects.  For every drug you need to know, you should know at minimum: class, mechanism of action, therapeutic effects, therapeutic use (what conditions is it used for), adverse effects, appropriate assessments, major interactions, and teaching points.  Some content to think about:

• Oxycodone vs Oxycontin
• Long acting medications (XL, LA, CR, etc.)
• Potency vs Efficacy
• Therapeutic range and therapeutic index
• Pharmacokinetics vs Pharmacodynamics
• Know all of the routes (not just PO, IV, IM, SQ; know the broader category: enteral, parenteral and their implications)
• topical vs transdermal
• Recognize different kinds of etiology of disease (pro tip: idiopathic means you don’t know that actual etiology)
• OTC vs Rx vs Scheduled drugs; difference between Schedule II and III.
• Cytochrome P-450 Enzymes; reason out the net result
• Creatinine and creatinine clearance.  (when is each one appropriate)
• Basic sympathetic
• Catecholamines vs sympathemimetics: what each one is used for; adverse effects
• Beta blockers, beta blockers, and more beta blockers.  Metoprolol will be one of the drugs you see most often in practice.
• Alpha blockers: three therapeutic uses and adverse effects

Antibiotics Expect at least one question on each drug class. Usually on the big things talked about, so for example

• Vanco: what makes it special, what is it used for, how is it absorbed, major adverse effects, how is it given and monitored
• Flagyl: what is it used for, what’s the major adverse effect, what is the major interaction
• Linezolid: what is it used for? What is the major interaction, what are the food issues?
• Understand the four basic mechanisms of bacterial resistance
• Understand the CDC recommendations to reduce bacterial resistance
• Know the difference between colonization and infection
• Know the local and systemic signs and symptoms of infection
• Know the WBC levels and Neutrophils/Bands
• Know the difference between shift left/right
• Why is strep throat a big deal?
• What are the alternatives to penicillin?
• C. diff, causes and treatments
• The less time we spent on a drug, the fewer questions will likely be on it.
• UTI types and drugs
• Know the types of Hepatitis, how they’re transmitted, which ones can become chronic, and which ones have a vaccine

There will be a question on this new Hepatis C drug:http://www.everydayhealth.com/hepatitis/1209/new-hepatitis-c-drug-approved-by-fda.aspx

Here are the flu articles that I mentioned:http://www.americanthinker.com/2009/05/swine_flu_in_perspective.htmlhttp://www.americanthinker.com/2009/10/swine_flu_panic_in_perspective.html

Generally speaking there will be at least one question on every major topic:So for the immune system things like:

• Fluid balance (edema control)
• Inflammatory mediators
• WBCs of various types
• Septic Shock
• DIC

Some things in the reading/podcasts that you should know that we did not cover in class

• Pyrogens
• Lab tests for inflammation

70 questions. 35 on Fluids and Electrolytes and 35 on Respiratory. About half patho and half pharm.

1. Know your lab values
2. Know the drugs
3. Know signs/symptoms of fluid overload and dehydration
4. Know the major s/s for each electrolyte imbalance.
5. Know the treatments for each electrolyte imbalance.
6. Pay particular attention to potassium and calcium
7. Know your abgs
8. UNDER NO CIRCUMSTANCES CONFUSE CO2 FOR PaCO2
9. Know what the implications of acidosis and alkalosis are
10. Know the basic respiratory A&P
11. Know at least the names and basic definition of each resp response to disease
12. Know the basic pathophysiology of Asthma, Emphysema, and Chronic Bronchitis
13. Review things from previous chapters that might be applicable such as antibiotics and sympathetic response

Some General Tips:

1. Read the question, and make sure you are answering what it is asking, and not what you THINK it’s asking.
2. On a short answer, less is more. If I ask for a treatment, just give me the treatment. On the other hand, if I ask you to interpret AND give a treatment, make sure you do both.
3. You have scratch paper for a reason. You don’t need to explain every detail of why you think the ABG is that. Do that part on your paper, and then just put down the answer in the computer. Partial credit is already built into the answer, so showing your work doesn’t get you any more points.

Anemias and Clotting. about 60 questions. Half of each.

This test is quite small in amount of content which makes it easier, BUT that also means that the test will be more detailed. You absolutely need to be able to interpret lab values and know of your drugs!!!!

1. know your lab values
2. know the calculations for heparin:
   1. calculate kg: divide pounds by 2.2;
   2. calculate unit dose: multiply the weight based dose by the weight
   3. calculate the mL dose: divide the unit dose by the concentration
3. be ready to interpret CBCs!!!!
4. READ THE QUESTION.
5. On the short answer ONLY answer what’s being asked.
6. On the short answer make sure you answer all parts of a multi part question. (e.g. interpret AND give a treatment)
7. morphology of cbc refers to -cytic -chromic
8. know the major aspects of hematopoiesis
9. know the common s/s of anemia and compensatory mechanism
10. know each type of anemia and its treatment
11. know the ANC and neutropenia precautions
12. know therapeutic ranges for heparin and warfarin (different for different types of problem)
13. know the basic physiololgy of clotting
14. know the major thromboembolic d/o’s, esp MI,AAA, AF, Stroke, DVT, PE.
15. answer what the question is asking.
16. know the difference between antiplatelets, anticoagulants, and thrombolytics.
17. know blood transfusions and different blood products. know which ones are pooled (i.e., more than one donor per unit) and why that’s important.

A couple things that don’t always get mentioned class:

1. Aplastic Anemia comes in two forms
   1. Pure RBC Aplasia
   2. Pancytopenia (when RBCs, WBCs, AND platelets are all three low)
2. Too many RBCS
   1. Polycythemia (often an adaptation to poor oxygenation or living at elevation)
   2. Polycythemia vera (RBCs, WBC, AND Platelets high) usually precursor to cancer

If I were you, I would take the quizzes and study all the questions I got wrong and the ones that I wasn’t sure about. Then I would do the So You Think You’re Good.

More or less 10 questions each on the following topics:1.IntroKnow the definitions, Pharmacokinetics, Therapeutic index, range, efficacy versus potency, etc.

2. Neurobasic physiologydrugs and usesmyasthenia gravis

3. Antibiotics

4. Inflammationpurpose/basic physiologySigns, symptoms, lab testssuch as ESR, CRP, WBCs, fever, etcMajor mediators such as leukotrienes, histamine, prostaglandins, etc.Role of complement: MAC, opsonization, activation pathways Antibodies/B cells T cells Other White blood cells TNF-alpha Septic Shock

5. PainKnow the major drug classes as well as individual drugs discussed in class and listed on drug table Know the physiology of pain Know the major pain management strategies. Don’t give too much acetominopen

6. Electrolyte imbalancesNormal valuesetiology/signs/symptoms/treatmentsFluidsABGs

7. RespiratoryCOPD/asthma/pneumonia in detaildefinitions of others e.g. bronchiolitis, bronchiectasisARDS: risk factors, screening, diagnosis, deathABGs hyper capnea: increase K+ –> ecg problems, incr. cerebral dilation –> ICP –> somnolence, coma, death

8. Anemiasetiology, s/s/, treatmentnormal values

9. Bleeding/clottingbasic physiologydrugstherapeutic applications

Intro 1

Intro 2

Intro 3

Intro 4

Intro 5

Intro 6

Intro 7

Intro 8

Intro 9

Intro 10

Intro 11

Intro 12

Intro 13

Fluids and Electrolytes 1: Definitions, normal values, Fluid spaces, Basic fluid physiology, osmosis and diffusion

Fluids and Electrolytes 2: Fluid physiology cont, Blood pressure, distribution, organs and control, Assessment

Fluids and Electrolytes 3: Dehydration and Fluid Overload, Sodium imbalances, Fluid replacement solutions

Fluids and Electrolytes 4: Electrolytes, BMP interpretation, Potassium, Calcium, Magnesium, Sodium

Fluids and Electrolytes 5: Potassium imbalances and treatments, Calcium imbalances and treatments (more detail in Patho-pharm 2)

Acid Base 1: Normal Acid-base physiology and buffers, ABG interpretation

Acid Base 2: ABG interpretation continued

Acid Base 3: Respiratory acidosis

Acid Base 4: ABG interpretation examples

Intro to Neuropharm:

Cholinergic Drugs and Alpha-1 Drugs:

Recap and Beta-1 and Beta-2 drugs:

Neuro 2 Intro: Receptor interactions, Sympathetic and parasympathetic, Neurotransmitters

Neuro 3 Intro:

Neuro 4 Intro

Neuro 5 Intro

Neuro 7 Pharm

Neuro 8 Pharm

Neuro 9 Pharm

Neuro 10 Pharm

Neuro 11 Pharm

Neuro 12 Pharm

Neuro 13 Pharm

Neuro 14 Pharm

Intro to Inflammation: and Fluid Physiology

Inflammation: 2

Inflammation: 3

Inflammation and Immunity 2: Inflammation in general; S/S

Inflammation and Immunity 3: Zymogens, White Blood Cells

Inflammation and Immunity 4: Recap, Inflammation vs Immunity, Adaptive (or Specific) Immune System

Inflammation and Immunity 5: WBCs continued, Lymphocytes, Basic Immune process

Inflammation and Immunity 6: Antibodies and B cells, Antigens, MHC, Complement

Inflammation and Immunity 7: The big picture. Interplay of Inflammation and Immunity, Cell mediated and humoral immunity

Inflammation and Immunity 8: Types of shock. Memory, vaccines

Inflammation and Immunity 9: Recap and the big picture, Healing and Wounds

Inflammation and Immunity 10: Age related changes and other factors affecting healing, Hypersensitivity reactions.

Inflammation and Immunity 11: Hypersensitivity reactions continued, Measures of immune function and lab values.

Inflammation and Immunity 12: Anti-inflammatories: Antihistamine, NSAIDS (no detail), Steroids, Immunosuppressants

Inflammation and Immunity 13: Steroids continued

Antibiotics 2: Penicillins

Antibiotics 3 Cephalosporins, “Intro to Antibiotics”, CDC 12 steps to prevent bacterial resistance.

Antibiotics 4: Inhibitors of Protein Synthesis, Tetracycline, Macrolides, Clindamycin

Antibiotics 5: Linzeolid (and MAO inhibition), Aminoglycosides

Antibiotics 6: Sulfonamides, Fluoroquinolones, UTIs, Tuberculosis drugs

Antibiotics 7: Antifungals

Antibiotics 8: Antivirals, Herpes, Zoster, CMV, Hepatitis

Antibiotics 9: Hepatitis Continued, Flu

Renal 1: Renal Physiology, Renal & Fluid Assessment

Renal 2: Diuretics, Loop, Thiazide, Potassium sparing, Osmotic; Renal insufficiency

Renal 3: Kidney Disorders

Renal 4: Renal Failure: Acute and Chronic

Renal 5

WBC review and Platelets, WBC w/differential, ANC calculation, Platelets

Red blood cells and Hemoglobin, Erythropoiesis, Hemoglobin, Lab values, B12 and Folate

Hemoglobin Continued, Folic acid continued, Iron, Hemoglobin breakdown products

Anemias OverviewOverview of AnemiasMajor types and Common Signs and SymptomsPernicious Anemia

Anemias 2Folic acid deficiency anemiaIron deficiency anemia

Anemias 3Post-hemorrhagicAplasticHemolyticAnemia of Chronic Disease

Anemias 4HemolyticAnemia of Chronic Disease

;

Blood pressure 2: Physiology continued. Preload and afterload

Blood pressure 3: Renin Angiotensin Aldosterone System. Hypertension Etiologies

Blood pressure drugs 1: Methods of lowering blood pressure. ACE inhibitors

Blood pressure drugs 2: ARBs. Calcium channel blockers. Review of neuro antihypertensives: Beta blockers, alpha blockers, clonidine

Blood pressure drugs 3: Vasodilators, Treatment of Hypertension

Blood pressure drugs 4: Hypertension treatment strategies

Arterial diseases 2: Endothelial dysfunction, Claudication, Coronary Artery Disease, Stroke

Arterial diseases 3 and venous diseases: Review, Raynaud’s disease, Varicosities, DVT

CV drug – Nitroglycerine

Clotting review: Review of clotting process and drugs from Patho Pharm 1

Cholesterol 2: Cardiovascular risk factors and treatment goals, Statins

Heart Failure 2: Types of heart failure. Etiology

Heart Failure 3: Symptoms, Evaluation, Treatment

Cardiovascular Review 02 – Review of Coronary Artery Disease including atherosclerosis, stable angina, unstable angina, and myocardial infarction.

Cardiovascular Review 03 – Review of Cholesterol, structure, screening, therapeutic targets and brief review of drugs.

Cardiovascular Review 04 – Review of chronic heart failure.

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.

Diabetes Treatments 2: Insulin therapy continued. Ignore Exubera (it’s no longer on the market). Sidebar physician hand writing. Insuling regimens.

Diabetes Treatments 3: Insulin Treatment Complications. Oral Hypoglycemics: Sulfonylureas, Meglitinides, Metformin.

Diabetes Treatments 4: Oral Hypoglycemics recap and continue

Upper GI 2: PUD, Partial Gastrectomy

Upper GI 3: H2 blockers, PPIs, Antacids

Upper GI 4: Vomiting, Antiemetics

Lower GI 2: Constipation

Lower GI 3: Intestinal Obstructions, Perforations

Lower GI 4: Malabsorption

Lower GI 5: Laxatives

Lower GI 6: Antidiarrheals

IBD 2: Crohn’s Disease, Diverticulitis, Irritable bowel disease

IBD 3: IBD drugs

Pancreas and Gall bladder: Pancreatitis, Cholecystitis

• 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.

Neuro Diseases 1: Parkinson’s disease

Neuro Diseases 2: Alzheimer’s disease

Neuro Diseases 3: Alzheimer’s recap, Epilepsy

Neuro Diseases 4: Epilepsy cont, Seizure drugs

Neuro Diseases 5: Brain trauma, Stroke

Neuro Diseases 6: Stroke continued, Meningitis (Story referenced in the lecture.), Encephalitis, Multiple Sclerosis, Guillain-Barre, ALS

Pain 1

Pain 2: Theory of Pain, Pain physiology continued, Acute vs Chronic Pain

Pain 3: Pain Management; nonpharmacologic; pharmacological, Local anesthetics, Opioids, Narcan

Pain 4: Off-topic (Transplants), Morphine (detail)

Pain 5: Morphine (detail continued), Narcan, Pain management, ICP

Pain6: Pain management schedules and techniques (Routine, PRN, PCA), Tolerance, Addiction

Pain 7: Prostaglandins, Inflammation, NSAIDS, ASA, Acetaminophen

Pain 8: COX-2 inhibitors, OTC pain medications