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 Neuron physiology: resting, action potential
• Neuromuscular function: myasthenia gravis and Nicotnic-M blockers
• Malignant hyperthermia
• Basic sympathetic and parasympathetic function.
• Anticholinergics: effects, which drugs are used, adverse effects
• Catecholamines vs sympathemimetics: what each one is used for; adverse effects
• Shock: different kinds and treatments
• Heart failure: inotropic (catecholamines) vs beta blockers
• 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
• What’s a pheochromocytoma, and how is it treated?

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.html http://www.americanthinker.com/2009/10/swine_flu_panic_in_perspective.html

~60 questions Half immune/inflammation and Half pain Also about half patho, half pharm

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
• Complement
• WBCs of various types
• Differences between T cells
• Life cycle of a T cell
• Same for B cells
• Four types of antibodies and purpose of each type
• Four functions of antibodies
• Types of vaccines
• Septic Shock
• DIC
• Hypersensitivity
• Wound healing
• How the immune and inflammatory side work together
• Pain Tolerance/Threshold
• Acute/Chronic Pain
• Steps in pain process
• Principles of Pain management
• Addiction
• All the drugs

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

• Pyrogens
• Lab tests for inflammation
• Article on IV Acetaminophen
• Finally, Do the So You Think You’re Good Quiz on my website (through pain)
• Contemporary Addiction Model (starts at minute 27 in the video below).

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.Intro Know the definitions, Pharmacokinetics, Therapeutic index, range, efficacy versus potency, etc.

2. Neuro basic physiology drugs and uses myasthenia gravis

3. Antibiotics

4. Inflammation purpose/basic physiology Signs, symptoms, lab tests such as ESR, CRP, WBCs, fever, etc Major 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. Pain Know 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 imbalances Normal values etiology/signs/symptoms/treatments Fluids ABGs

7. Respiratory COPD/asthma/pneumonia in detail definitions of others e.g. bronchiolitis, bronchiectasis ARDS: risk factors, screening, diagnosis, death ABGs hyper capnea: increase K+ –> ecg problems, incr. cerebral dilation –> ICP –> somnolence, coma, death

8. Anemias etiology, s/s/, treatment normal values

9. Bleeding/clotting basic physiology drugs therapeutic 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

Intro to Neuropharm:

Cholinergic Drugs and Alpha-1 Drugs:

Recap and Beta-1 and Beta-2 drugs:

Intro to Inflammation: and Fluid Physiology

Inflammation: 2

Inflammation: 3

Pain 1

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)

Respiratory 01 A&P Lungs, bronchi A&P. Glucose + O2 –> H20 + CO2 Respiratory 02 A&P Anatomy continued. Alveoli –> Increases surface area. Circulation to the lungs Respiratory 03 A&P Control of breathing Bronchoconstriction and dilation “Enhance this: beta-2 stimulation” or “Inhibit this: parasympathetic system” Respiratory 04 A&P Defense of Respiratory Tract Mechanics of breathing Oxygen diffusion Respiratory 05 A&P Oxygen transport in blood. Hemoglobin

Respiratory 01 Manifestations Dyspnea, Breathing Patterns Respiratory 02 Manifestation Hypoventilation, Hyperventilation, Hypercapnia, Cough, Cyanosis, Chest Pain Respiratory 03 Manifestation Recap Clubbing, Sputum sample, Hypercapnia, Perfusion of lung, Respiratory Failure Respiratory 04 Manifestation Respiratory 05 Manifestation

Respiratory 01 Diseases ARDS Post op Respiratory failure Respiratory 02 Diseases Asthma Respiratory 03 Diseases COPD: Chronic Bronchitis Respiratory 04 Diseases COPD: Emphysema Respiratory 05 Diseases Respiratory infections: Rhinitis, Sinusitis, Pharyngitis, Bronchitis, Pneumonia Pulmonary embolism Cancer