Breakdown

• HIV ~12 questions
• Neuro ~60 questions  (1/2 drugs, 1/2 patho)

HIV

• 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
• Medications
• Risk factors
• controversies

Neuro

• 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

1. What is psychosis?
2. Keppra
3. Need to know mechanisms of action of drugs. Weakest on TCAs, Wellbutrin, and Typical Antipsychotics
4. Seizures caused by undertreatment
5. DT onset: see VoiceThread
6. Use of Benztropine (Cogentin) with typical psychotics
7. Levodopa: acute loss of effect vs wearing off
8. MAO inhibitor: what to avoid
9. Anticholinergic effects!!!!!!
10. Lithium toxicity
11. Signs of liver toxicity
12. Parkinson’s treatment
13. Guillain-Barre
14. Epigentics
15. Horácio Quiroga short story
16. Identifying negative symptoms
17. Bipolar treatment
18. Adverse effects of Wellbutrin
19. Teens and depression

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.

BP

• low and high

CAD

• angina: stable, Prinzmetal, and unstable
• MI dx and treatment
• atherosclerosis
• cholesterol (what they are, what each type is/means and treatment guidelines)

Dysrhythmias

• 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.

Heart Failure

• Shock and Chronic heart failure
• mechanisms
• systolic/diastolic, left/right
• treatment

Things from Patho/Pharm 1 you might want to remember:

• Neuro
• Pain
• Inflammation
• Electrolytes
• Acid-Base
• Anemia
• Anti-clotting drugs

Areas of Weakness

1. Atherogenesis steps
2. Big five drugs for heart failure
3. A Fib and cardiac output
4. ICU treatment of HF vs Med-Surg
5. Conditions necessary for atherogenesis
6. MI standard of care aimed at reducing workload of the heart
7. ACE inhibitors in DM
8. Hypertensive crisis
9. Calcium channel blockers plus HF è Death
10. Number one cause of death 72 hours after MI
11. Thrombolysis
12. Diastolic/Systolic failure
13. Beta blocker education
14. Potassium supplementation
15. CCB adverse effects
16. ACE inhibitor adverse effects
17. Cholesterol screening guidelines
18. Shock

Areas of weakness in the past:

1. You need to read up on ischemic (stress) ulcers, also called Curling Ulcers: causes and prevention
2. Barrett’s esophagus
3. Interpretation of IgG and IgM
4. Lactulose plus ______
5. Chronic vs Acute Pancreatitis
6. Encephalopathy prevention vs treatment
7. Bilirubin interpretation
8. 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?
9. Clindamycin induced diarrhea? What could be the cause of that? What would be used to treat it?
10. Diarrhea, when to treat orally vs aggressive therapy
11. Small Bowel obstructions
12. Most common laxative post op
13. Diagnostic test for Mg containing laxatives
14. Conservative vs aggressive therapy for diverticulitis
15. I did not know that THC causes multiple personality d/o
16. 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.
17. Myeloma produces large amounts of antibodies, which are protein. So what lab value would high?
18. Calcium Carbonate adverse effects: constipation
19. Why are patients with no ulcers or GERD given H2 blockers or PPIs in the hospital?
20. ANC interpretation
21. E coli symptoms
22. Someone calls in about diarrhea, and you tell them what to do without asking about what the stool looks like?
23. How does AZT work

I’ve looked at the test and here are some pointers:

1. There are quite a few drug calculation questions. Study up on your math.
2. 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:
   1. 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.
   2. Blood transfusions
   3. Tuberculosis drugs and therapy
   4. Rheumatoid diseases like Lupus and rheumatoid arthritis
   5. Drugs used in alcohol addiction
   6. Fluid and electrolytes
   7. 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.
   8. You may want to read the section on muscle relaxants (it’s only 2 pages and we didn’t really cover it in PP1).
3. 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.
4. Focused reviews to do in preparation
   1. Pharmacology
   2. Parenteral therapy
   3. Drug calculations

Neuro Intro: A&P, Diagnostic tests

Psychotropics 1: Antidepressants

Psychotropics 2: Sedative-hypnotics, Anxiolytics

Psychotropics 3: Benzodiazepines cont, Hypnotics, Barbiturates, Anxiolytics

Psychotropics 4 – Katie Taylor discusses psychotropics from the perspective of a student that has taken Psychiatric and Mental Health Nursing

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

Genetics 1 Heredity: Genes, Karyotype, DNA: chromatin, chromosome, Protein Synthesis: codon, transcription, translation, mutations

Genetics 2 Heredity: Inheritance: Autosomal dominant, Autosomal recessive http://patheyman.com/sites/default/files/nursing/lectures/01-pp2-genetics-02.mp3

Genetics 3 Heredity: Inheritance Cont: Sex-linked, Polygenic inheritance, Multifactorial; Genetic Testing, Genetic Therapies, Congenital (Non-Genetic) Defects

• Transcription and Translation Video 1
• Transcription and Translation Video 2
• Epigenetics Video 1
• Epigenetics Video 2

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

Documentary on ELISA and rapid testing http://www.youtube.com/watch?v=OajiyoWmKiE http://www.youtube.com/watch?v=1-jpq0VylQ4

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.

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 (not HIV related):

http://www.imdb.com/title/tt0277434/combined

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

Endocrine 2: Hyperthyroid cont, Hyperprolactinemia, SIADH, Diabetes, insipidus, Cortisol and Steroid Medications, Aldosterone

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

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 Diseases 2: Angina pectoris, Acute MI, Case study assignment

Coronary Artery Diseases 3: Treatment of Acute MI

Coronary Artery Diseases 4: Treatment of Acute MI continued

Coronary Artery Diseases 5: Treatment of Acute MI cont

CV drug – Nitroglycerine

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

Cholesterol 2: Cardiovascular risk factors and treatment goals, Statins

Dysrhythmias 2: Dysrhythmias continued, Drugs and other treatments

Dysrhythmias 3: Last minute dysrhythmias wrap up

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.

Cardiovascular Review 05 – Review of dysrhythmias.

http://patheyman.com/sites/default/files/nursing/lectures/09-pp2-GI01-upper-01.mp3 Upper GI 2: PUD, Partial Gastrectomy http://patheyman.com/sites/default/files/nursing/lectures/09-pp2-GI01-upper-02.mp3 Upper GI 3: H2 blockers, PPIs, Antacids http://patheyman.com/sites/default/files/nursing/lectures/09-pp2-GI01-upper-03.mp3 Upper GI 4: Vomiting, Antiemetics

http://patheyman.com/sites/default/files/nursing/lectures/09-pp2-GI01-upper-04.mp3

• 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.

• 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