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
- Course Syllabus
- Lab Values
- Druglist: Memorize these drugs
- Drug Quiz: How you will be tested on the list above
- Make sure you know what you should have learned in A&P.
- So you think you’re good test/review.
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
Some things in the reading/podcasts that you should know that we did not cover in class
- Lab tests for inflammation
- 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
70 questions. 35 on Fluids and Electrolytes and 35 on Respiratory. About half patho and half pharm.
- Know your lab values
- Know the drugs
- Know signs/symptoms of fluid overload and dehydration
- Know the major s/s for each electrolyte imbalance.
- Know the treatments for each electrolyte imbalance.
- Pay particular attention to potassium and calcium
- Know your abgs
- UNDER NO CIRCUMSTANCES CONFUSE CO2 FOR PaCO2
- Know what the implications of acidosis and alkalosis are
- Know the basic respiratory A&P
- Know at least the names and basic definition of each resp response to disease
- Know the basic pathophysiology of Asthma, Emphysema, and Chronic Bronchitis
- Review things from previous chapters that might be applicable such as antibiotics and sympathetic response
Some General Tips:
- Read the question, and make sure you are answering what it is asking, and not what you THINK it’s asking.
- 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.
- 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!!!!
- know your lab values
- know the calculations for heparin:
- calculate kg: divide pounds by 2.2;
- calculate unit dose: multiply the weight based dose by the weight
- calculate the mL dose: divide the unit dose by the concentration
- be ready to interpret CBCs!!!!
- READ THE QUESTION.
- On the short answer ONLY answer what’s being asked.
- On the short answer make sure you answer all parts of a multi part question. (e.g. interpret AND give a treatment)
- morphology of cbc refers to -cytic -chromic
- know the major aspects of hematopoiesis
- know the common s/s of anemia and compensatory mechanism
- know each type of anemia and its treatment
- know the ANC and neutropenia precautions
- know therapeutic ranges for heparin and warfarin (different for different types of problem)
- know the basic physiololgy of clotting
- know the major thromboembolic d/o’s, esp MI,AAA, AF, Stroke, DVT, PE.
- answer what the question is asking.
- know the difference between antiplatelets, anticoagulants, and thrombolytics.
- 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:
- Aplastic Anemia comes in two forms
- Pure RBC Aplasia
- Pancytopenia (when RBCs, WBCs, AND platelets are all three low)
- Too many RBCS
- Polycythemia (often an adaptation to poor oxygenation or living at elevation)
- 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
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.
- Pathophysiology Terms and Concepts
- Pharmacology Terms and Concepts
Lectures: Intro (Click to expand)
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
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)
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
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.
- Basic Neuro physiology
- Divisions of Nervous System
- Pharmacology of Peripheral Nervous System
- Neurophysiology notes in PDF
- Neurophysiology notes in Powerpoint
- Neuropharmacology notes in PDF
- Neuropharmacology notes in PDF
Lectures: New in 2019 (Click to expand)
Peripheral Neuro Introduction
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
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).
Inflammation and Immunity Lectures
New Inflammation and Immunity Lectures (2019)
Inflammation and Immunity Lectures
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
New Lectures: Inflammation Part 1
New Lectures: Neuro Drugs Part 2
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.
- Antimicrobial Intro Notes in PDF
- Antimicrobial Intro Notes in PowerPoint
- Antimicrobial 1 notes in PDF
- Antimicrobial 1 notes in PowerPoint
- Antimicrobial 2 notes in PDF
- Antimicrobial 2 notes in PowerPoint
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 and Diuretics
Fluid and Renal physiology Kidney Diseases Diuretics Class notes:
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
Unit X: Hematologic (Anemias
- Physiology of blood
- CBC interpretation
- Anemia physiology and pharmacology
- Blood Products
Blood Physiology and Lab Values
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
VoiceThread - Physiology of Blood and Anemias
- Blood pressure
- Arterial and venous diseases
- Heart Failure (2nd part of Dysrhythmia lecture)
Blood Pressure and Treatment Lectures
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
Coronary Artery Disease
CV drug – Nitroglycerine
Clotting review: Review of clotting process and drugs from Patho Pharm 1
Cholesterol and Cardiovascular Risk Factors
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.
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 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.
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 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
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.
Upper GI Lectures
Upper GI 2: PUD, Partial Gastrectomy
Upper GI 3: H2 blockers, PPIs, Antacids
Upper GI 4: Vomiting, Antiemetics
Lower GI Lectures
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
Liver, Gall Bladder, Pancreas Lectures
Pancreas and Gall bladder: Pancreatitis, Cholecystitis
VoiceThread: Upper GI
VoiceThread: Lower GI
VoiceThread: Accessory GI
- 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.
Review peripheral nervous system Big CNS disorders: Alzheimer’s, Epilepsy, Parkinson’s Psych Drugs: Antidepressants, Anxiolytics, Hypnotics, Antipsychotics Miscellaneous nervous disorders Class Handouts:
Neuro Intro Lecture
Neuro Disorders Lectures
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
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:
New Pain Lectures (2019)
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
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
Bleeding and Clotting
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