NOTE: In Fall 2020, curricular changes required  a complete redeisgn of Patho Pharm 1 and 2.  The original versions are preserved at https://patheyman.com/nursing/courses/patho-pharm-1-old

Below are the topics, handouts, and notes for Pathophysiology and Pharmacology I. Click on the lecture boxes to see the lecture files (mp3) for that topic. Alternatively, you may download the lectures as a zip file or subscribe as a podcast.

Patho Pharm 1: Podcast Feed Subscribe with iTunes Download as Zip File (392 MB)

Overall Course Materials

Test Guides

Test 1

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
Renal Areas of Challenge:
  • Diuretic mechanisms and adverse effects
  • Kidney stones U/A
  • Proteinuria occurs long long long before elevated creatinine
  • Pre, intra, postrenal failure
  • Complications of chronic renal failure
  • How does kidney control acid-base
  • Sodium-potassium pump
  • UTI vs Pyelonephritis

Test 4

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.

Test 5

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

Final exam

There are 110 questions plus a few short answer.

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


Unit 1 Introduction

Note:  The Introduction to Pharmacology and Fluid & Electrolytes are no longer part of Patho Pharm.  Intro is now included as part of Fundamentals of Nursing, and F&E and Acid Base are now included as part of Medical Surgical Nursing I.  They are included here as references, and you’ll be expected to know that material throughout Patho Pharm 1 and 2.

The Fundamentals Introduction Pharmacology is also missing a few slightly more complex topics such as Cytochrome P-450.  The VoiceThread contains the original full Introduction.  The videos show the new slimmed Fundamentals versions.

Topics Include:

  • Pathophysiology Terms and Concepts
  • Pharmacology Terms and Concepts

Class notes:

Introduction Lectures:

Intro VoiceThread

Introduction to Pharmacology Video

Pharmacology in Long Term Care and Common Drugs Video


Unit 1.1: Fluid & Electrolytes and Acid Base Balance

Note: This Unit is not technically part of Patho Pharm 1.  It is now included in Medical-Surgical Nursing I Theory.  That said, I DO expect your to know this material for the course.  So I’ve included it here.

  • Fluid physiology and types of fluids
  • Electrolyte interpretation and medications
  • Acid Base Balance

Class Handouts:

Class notes:

Lectures

Fluids and Electrolytes

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)

VoiceThread - Electrolytes and Acid/Base

Video - Fluid and Electrolytes

Vidoe: ABGs and Acid/Base

 


Unit 2: Introduction to Parasympathetic and Sympathetic Response

I am including the full Peripheral Neuro lectures for the sake of completeness for those of you who are nerds.  But the only testable material in Patho Pharm I will be the introduction to Sympathetic Response and alpha and beta-blockers (and clonidine).  The other drugs will mainly be presented in Patho Pharm 2.  (There is one exception.  You’ll need to know atropine for anti-diarrheals.)  Eventually, I’ll get around to cutting this material down to just what you need, but for now…there’s no kill like overkill.

Topics Include

  • Basic Neuro physiology
  • Divisions of Nervous System
  • Pharmacology of Peripheral Nervous System

Class Handouts:

Class notes:

Neuro Lectures

VoiceThread: Neuro Drugs

VoiceThread: Neuro Drugs

New Lectures: Neuro Intro Video

New Lectures: Neuro Drugs Part 1 Video

New Lectures: Neuro Drugs Part 2 Video

 


Unit 4 Introduction to Inflammation

Previously, this module covered both Inflammation and Immunity.  In the updated course, this is ONLY an introduction to Inflammation, BUT for now, everything is included in the lecture..  This module covers the cells and organs of the immune system, inflammatory processes, and their control mechanisms. It also covers infections and allergies (hypersensitivity reactions).

Class Handouts:

Class notes:

Inflammation and Immunity Lectures

Inflammation and Immunity Lectures

Inflammation and Immunity 1: Fluid physiology and edema

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

VoiceThread

New Lectures: Inflammation Part 1

You should watch the first 2 hours of this video.

New Lectures: Neuro Drugs Part 2

Watch Steroids: 1:25 to end.


Unit 3 Antibiotics and Infections

This module covers antibiotics, antifungals, and antimicrobials as well as general infection topics. You will need to know that fever and high WBCs are associated with infection.
Class Handouts:

Class notes:

Antibiotics Lectures

Antibiotics

VoiceThread


Renal and Diuretics

Fluid and Renal physiology Kidney Diseases Diuretics Class notes:

VoiceThread: Renal


 

Unit X: Hematologic (Anemias

  • Physiology of blood
  • CBC interpretation
  • Anemia physiology and pharmacology
  • Blood Products

Class Handouts:

Class notes:

Lectures

Blood Physiology and Lab Values

Physiology of BloodComposition and functions of blood, Hematopoeisis, Lab values, Review of WBCs

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

CBC interpretationThe details of the lab values you need to memorize are slightly different than the podcast. Please refer to the current lab sheet. I will not ask you questions with lab values that are vague.

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

VoiceThread - Physiology of Blood and Anemias

;


Cardiovascular

  • Blood pressure
  • Arterial and venous diseases
  • Atherosclerosis
  • Heart Failure (2nd part of Dysrhythmia lecture)

Class Handouts:

Class notes:

Blood Pressure and Treatment Lectures

Blood pressure 1: Blood pressure intro. Anatomy and Physiology

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

Vascular Diseases

Arterial diseases 1: Arterial diseases such as high blood pressure and embolism. Atherosclerosis.

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

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

Coronary Artery Disease

Coronary Artery Diseases: Risk factors, Oxygen demand/supply, Starling’s Law of the Heart

CV drug – Nitroglycerine

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

Cholesterol and Cardiovascular Risk Factors

Cholesterol 1: Cholesterol overview, Testing, Treatment goals, Statins

Cholesterol 2: Cardiovascular risk factors and treatment goals, Statins

Heart Failure

Heart Failure 1: Digoxin, Physiological response to lowered cardiac output

Heart Failure 2: Types of heart failure. Etiology

Heart Failure 3: Symptoms, Evaluation, Treatment

Cardiovascular Review

Cardiovascular Review 01 – Review of Hypertension.

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.

New Video Lecture: Intro to CV and Blood Pressure

New Video Lecture: Coronary Artery Disease

New Video Lecture: Atherosclerosis

New Video Lecture: Dysrhythmias and Heart Failure

 


Diabetes

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.

Class Handouts:

Class notes:

Audio: Diabetes Patho


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.

Audio: Diabetes Pharmacology

Diabetes Treatments 1: Insulin.

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

VoiceThread: Diabetes Patho

VoiceThread: Diabetes Pharmacology

VoiceThread: Diabetes Pharmacology Part 2

New Video Lecture: Diabetes Full


Gastrointestinal

Falls into three main areas: Upper GI (Esophagus, Stomach, Duodenum) Lower GI (Colon) Accessory GI (Liver, Gall Bladder, Pancreas). Accessory GI will be covered in Patho Pharm 2.

Class Handouts:

Class notes:

Liver, Gall Bladder, Pancreas Lectures

VoiceThread: Upper GI

VoiceThread: Lower GI

VoiceThread: IBD

VoiceThread: Accessory GI

Additional Notes

When Diverticulosis becomes DiverticulitisAsymptomatic → SymptomaticHigh fiber diet → Liquid diet plus antibiotics and pain managementhttp://emedicine.medscape.com/article/173388-overview

  • 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 (Central)

Review peripheral nervous system Big CNS disorders: Alzheimer’s, Epilepsy, Parkinson’s Psych Drugs: Antidepressants, Anxiolytics, Hypnotics, Antipsychotics Miscellaneous nervous disorders Class Handouts:

Class notes:

Neuro Intro Lecture

Neuro Disorders Lectures

VoiceThread - Central Nervous Disorders and Misc Neuro

Video - Central Nervous Disorders and Misc Neuro

 

Unit 5 Pain

Anatomy and Physiology of pain, non pharmacologic measures, and drugs used in pain management:

  • Anesthetics
  • NSAIDS
  • Acetaminophen
  • Opioids

Class notes:

Pain Lectures

Pain Lectures

Pain 1: Pain definitions and transmission

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

VoiceThread

Video: Pain, Opioids, NSAIDs, Addiction

 


Unit 9: Bleeding and Clotting

  • Physiology of clotting
  • Various clotting and bleeding disorders
  • Lab tests of clotting
  • Antiplatelet drugs
  • Anticoagulant drugs
  • Thrombolytic drugs

Class notes:

Lectures

Bleeding and Clotting

Clotting 1http://patheyman.com/sites/default/files/nursing/lectures/10-patho-pharm1-clotting-01.mp3Clotting 2http://patheyman.com/sites/default/files/nursing/lectures/10-patho-pharm1-clotting-02.mp3Clotting 3http://patheyman.com/sites/default/files/nursing/lectures/10-patho-pharm1-clotting-03.mp3Clotting 4http://patheyman.com/sites/default/files/nursing/lectures/10-patho-pharm1-clotting-04.mp3Clotting 5http://patheyman.com/sites/default/files/nursing/lectures/10-patho-pharm1-clotting-05.mp3Clotting 6http://patheyman.com/sites/default/files/nursing/lectures/10-patho-pharm1-clotting-06.mp3

VoiceThread

Subscribe for Free Updates

Learn how you too can be buff for the beach.

Powered by ConvertKit
Thank you for enrolling.