D027 Study Guide – Advanced Pathopharmacology Notes

D027 Study Guide – Advanced Pathopharmacology Notes

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 Western Governors University

D027 Advanced Pathopharmacological Foundations

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Date

D027 Study Guide – Advanced Pathopharmacology Notes

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1. Celiac Disease

• Pathophysiology: Damage to the small intestine lining caused by gluten intolerance, mainly affecting the duodenum and jejunum.
• Symptoms:
  • Abdominal pain and bloating
  • Diarrhea (pale, greasy, bulky, foul-smelling)
  • Complications due to malnutrition: rickets, occult blood, anemia
  • Early bruising or bleeding
  • Electrolyte imbalances (hypomagnesemia, hypocalcemia) causing irritability, tremors, convulsions, tetany, bone pain, osteomalacia
• Lab Tests:
  • IgA-tTg, IgA-EMA, total IgA
  • If IgA deficient: IgG, IgA-DGP, or IgG-AGA may be tested
• Diagnosis:
  • Serologic tests for IgA antibodies, HLA-DQ2/DQ8 typing
  • Endoscopy with duodenal biopsy
• Diet: Avoid BROW (Barley, Rye, Oats, Wheat)

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2. Sjogren’s Syndrome

• Mostly affects older women, especially those with rheumatoid arthritis or SLE.
• Symptoms: dry eyes and dry mouth.
• Diagnosis: Positive SSA and SSB antibodies.

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3. Herbal Remedies

• Cinnamon: Lowers blood glucose, cholesterol, blood pressure; may increase bleeding risk. Avoid in breastfeeding and with diabetic, anticoagulant, heart meds.
• Ginkgo Biloba: Slows dementia progression, used for erectile dysfunction; increases bleeding risk, lowers seizure threshold. Avoid with anticoagulants.
• Glucosamine: Used for osteoarthritis.
• Green Tea: Promotes weight loss and mental clarity; risk of hepatotoxicity, interacts with vasodilators, stimulants, psychoactive drugs; contains vitamin K (may reduce warfarin effect).
• Lavender: Relaxes, treats anxiety, stress, insomnia; may cause constipation, headache, increased appetite; caution with CNS depressants and antihypertensives.

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4. Hypoplastic Left Heart Syndrome (HLHS)

• Anatomy: Underdeveloped left ventricle, mitral and aortic valves, ascending aorta; atrial septal defect present.
• Fetal shunts: Patent ductus arteriosus (PDA), patent foramen ovale (PFO).
• Survival: 70% survive 3-5 years post Stage I surgery; 90% survive past 12 months.
• Diagnosis: Echocardiogram, prenatal ultrasound.
• Treatment: Three-stage surgical repair (Norwood, Glenn, Fontan procedures).
• Symptoms: Cyanosis, pallor, sweating, breathing difficulty, rapid heartbeat, cold extremities, poor pulses, poor feeding.

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5. Parathyroid

• Function: Produces parathyroid hormone (PTH) regulating blood calcium by releasing it from bones.
• Lab Values: Calcium 8.6-10.3 mg/dL; PTH 11-51 pg/mL.
• Symptoms:
  • Hyperparathyroidism: osteoporosis, kidney stones, frequent urination, abdominal pain, fatigue, memory issues, bone/joint pain.
  • Hypoparathyroidism: paresthesia, facial muscle twitching, cramps, mood changes, dry skin.
• Tests: Ultrasound, bone densitometry, CT/MRI.
• Treatment:
  • Hyperparathyroidism: calcimimetics, hormone replacement, bisphosphonates.
  • Hypoparathyroidism: maintain low-normal serum calcium.

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6. Hutchinson-Gilford Progeria Syndrome

• Genetic disorder causing rapid aging in children (onset 1-2 years).
• Caused by LMNA gene mutation producing abnormal progerin protein damaging the nuclear envelope.
• Assessment includes growth measurements, hearing, vision.
• Symptoms: short stature, slow hair growth, alopecia, joint problems, skin wrinkles, failure to thrive, delayed teeth.
• Treatment: statins, nitroglycerin, NSAIDs, bone meds, therapy for muscle strength.
• Life expectancy: 13-20 years (ages 10x faster).

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7. Neuropathy

• Alternatives to gabapentin for diabetic neuropathy: duloxetine (Cymbalta), pregabalin (Lyrica).

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8. Hydrotherapy

• Beneficial for multiple sclerosis (MS) and myasthenia gravis (MG).

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9. Pneumothorax vs Hemothorax

• Both cause decreased/absent lung sounds.
• Pneumothorax: Air in pleural space, hyper-resonant percussion.
• Hemothorax: Blood in pleural space, dull percussion anterior/posterior.

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10. Tuberculosis

• Testing: Tuberculin skin test (PPD) with induration criteria; chest X-ray or CT shows lung lesions.
• Medications: Isoniazid, Rifampin (avoid with oral contraceptives), Ethambutol, Pyrazinamide.

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11. Thyroid

• Lab values:
  • TSH: 0.5-5.0 mIU/L (treatment range 0.5-3.0)
  • T3: 80-220 ug/dL
  • T4: 5-12 ug/dL
• Autoimmune markers: TPO antibodies (Hashimoto’s and Graves’ disease).
• Hyperthyroidism: Symptoms include increased HR, nervousness, muscle weakness, heat intolerance, exophthalmos; treated with PTU, methimazole.
• Hypothyroidism: Symptoms include fatigue, cold intolerance, dry skin; treated with levothyroxine.

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12. Crohn’s Disease vs Ulcerative Colitis

• Crohn’s: Inflammation of entire GI tract, skip lesions, cobblestone appearance, symptoms include diarrhea, pain, fistulas. Tests: ASCA antibody, colonoscopy, imaging. Treatment: aminosalicylates, steroids, immunosuppressants, antibiotics.
• Ulcerative Colitis: Inflammation limited to colon and rectum lining, symptoms include bloody diarrhea, urgency, weight loss. Tests: pANCA, colonoscopy, blood tests. Treatment: anti-inflammatories, corticosteroids, immune suppressors.

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13. Sickle Cell Disease

• Newborns at risk for infections due to spleen dysfunction; anemia common.
• Crisis types: vaso-occlusive (pain, swelling), splenic sequestration (enlarged spleen, shock), aplastic crisis (sudden anemia).
• Prevention: hydration, avoid extremes in temperature and altitude.
• Treatment: IV fluids, analgesia, oxygen, hydroxyurea; penicillin prophylaxis in newborns.

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14. UTI Medications

• Pregnancy: Safe—fosfomycin (one dose), cephalexin; avoid nitrofurantoin, trimethoprim-sulfamethoxazole, fluoroquinolones.
• Pediatrics: Trimethoprim-sulfamethoxazole first line; alternatives include amoxicillin-clavulanate, cephalosporins; IV cephalosporins if vomiting.

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15. Pregnancy Immunizations

• Recommended: influenza, TDAP (27-36 weeks), pneumococcal, Hepatitis A/B, meningococcal.
• Contraindicated: varicella, MMR.

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16. Varicella (Chickenpox)

• Caused by varicella-zoster virus.
• Symptoms: rash in multiple stages (papules, vesicles, crusts), low-grade fever, sometimes abdominal pain.
• Testing: rash exam, blood tests, lesion culture.
• Treatment: acyclovir, IV immune globulin (within 24 hours of rash), acetaminophen (avoid ibuprofen), calamine lotion, cool baths.

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17. Schizophrenia Medications

• Symptoms:
  • Positive: hallucinations, delusions, disorganized speech
  • Negative: anhedonia, flat affect, social withdrawal, lack of speech/motivation
• First-generation antipsychotics: chlorpromazine, haloperidol, fluphenazine (treat positive symptoms); side effects include extrapyramidal symptoms, anticholinergic effects, orthostatic hypotension, sedation.
• Second-generation antipsychotics: risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone (treat positive & negative symptoms); side effects include metabolic syndrome and agranulocytosis (clozapine).
• Vitamin support: folic acid, thiamine.

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18. PPD (Tuberculosis)

• BCG vaccine may cause >10 mm induration but not a positive test.
• Skin test checked 48-72 hours after administration.

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19. Benign Prostatic Hyperplasia (BPH)

• Tamsulosin (Flomax), an alpha-1 antagonist, relaxes prostate and bladder muscles.
• Educate patients about possible hypotension.

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20. Congestive Heart Failure (CHF)

• Types:
  • Left-sided (pulmonary symptoms, JVD, fluid overload, rales, S3)
  • Right-sided (peripheral edema, abdominal distention)
• Ejection fraction:
  • Normal: 55-70%
  • Reduced (HFrEF): <40%, systolic dysfunction
  • Preserved (HFpEF): 40-49%, diastolic dysfunction
• Tests: BNP (>100 indicates HF), echocardiogram.

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21. Pleural Effusion

• Symptoms: chest pain, dry cough, dyspnea, orthopnea, fever.
• Diagnosis: chest X-ray, CT, ultrasound.
• Treatment: diuretics, antibiotics, anticoagulants; thoracentesis or chest tube if needed; oxygen and energy conservation.

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22. Diabetes

• Antihypertensives: ACE inhibitors (e.g., captopril), ARBs.
• Insulin types and timing summarized (regular, NPH, ultralente, lispro).
• Symptoms of diabetic ketoacidosis: fruity breath, thirst, polyuria, fatigue, vomiting, confusion.

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28. Cellulitis

• Treatment: start IV antibiotics, switch to oral, manage fever, educate patient, and dress wound properly.

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29. Panic Attack, Hallucinations, and Nightmares

• Medications: clonazepam (anxiety), clonidine (hypertension), prazosin (nightmares).

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30. Multiple Sclerosis

• A demyelinating disease damaging the myelin sheath of nerves in brain, optic nerves, and spinal cord.

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31. Kidney and Blood Pressure Regulation

• Hormonal control of blood pressure involves kidneys increasing sodium and water reabsorption into the bloodstream. Key hormones:
  • Antidiuretic hormone (ADH)
  • Aldosterone
  • Renin-angiotensin system

32. HLA-B*58:01 Allele and Allopurinol (Zyloprim)

• Allopurinol reduces uric acid to treat gout and kidney stones.
• The HLA-B*58:01 allele is strongly linked to severe skin reactions (SCAR), such as Stevens-Johnson Syndrome and toxic epidermal necrolysis.
• This allele is most common in Korean, Han-Chinese, and Thai populations.

33. Doxycycline (Vibramycin)

• Enhances the anticoagulant effect of warfarin (Coumadin).
• Monitor INR (normal range: 0.8–1.2).

34. Muscle Spasms

• Medications:
  • Baclofen (Gablofen) – treats muscle spasms
  • Gabapentin (Neurontin) – anticonvulsant and nerve pain relief

35. Types of Brain Hematomas

• Anatomy involved: skull, epidural hematoma, dura mater, subdural hematoma, arachnoid mater, pia mater, brain.
• Epidural hematoma:
  • CN III palsy
  • Lucid interval (patient initially alert, then rapid decline)
  • Biconvex shape on CT scan
• Subdural hematoma:
  • Crescent-shaped lesion on CT scan

36. Tay-Sachs Disease and Ashkenazi Jewish Population

• Tay-Sachs is a GM2 gangliosidosis caused by lack of an enzyme to break down fatty substances, leading to toxic buildup in brain cells.
• Symptoms: loss of muscle control, cherry-red spots in eyes, vision and hearing loss, motor skill regression (e.g., crawling, sitting).

37. Chronic Kidney Disease (CKD) Stages

• Stage 1: GFR 90-120 mL/min (normal) with proteinuria >3 months
• Stage 2: GFR 60-89, mild kidney function loss with proteinuria
• Stage 3: GFR 30-59
• Stage 4: GFR 15-29
• Stage 5 (ESRD): GFR <15

53. Color Blindness

• Caused by mutation in OPN1MW gene on X chromosome, inherited from mother to son.
• The defective gene is dominant; only one affected X chromosome causes color blindness.

54. G6PD Deficiency (Hemolytic Anemia)

• Genetic mutation causing premature RBC destruction, leading to hemolytic anemia. Mostly affects males.
• Symptoms: pale skin, jaundice, dark urine, fever, weakness, dizziness, enlarged spleen/liver, increased heart rate.
• Avoid: fava beans, mothballs, red wine, blueberries, soy products, tonic water, camphor, and certain medications (aspirin, chloroquine, methyldopa, etc.). Risk of hemolysis is dose-dependent.

55. Transfusion Reactions

• Managed by slowing transfusion rate and administering acetaminophen, diphenhydramine, steroids, and meperidine for rigors.

56. Small Cell Lung Carcinoma

• Neuroendocrine tumor, accounts for 15% of lung cancers and 25% of deaths.
• Central lung origin, poor prognosis.
• Caused primarily by tobacco smoking.
• Diagnosed by EGFR testing and chest X-ray.

57. Thrush in Infants

• White/yellow patches in mouth, cracked skin at mouth corners.
• Caused by Candida albicans, often linked to inadequate nipple drying and yeast growth.
• Risk factors: low birth weight, maternal yeast infection, antibiotics, corticosteroids, pacifier use, weak immunity.
• Treatment: topical nystatin, oral antifungals (fluconazole), treat both mother and baby.

58. CYP3A4 Enzyme

• Important in codeine metabolism.
• Induced by St. John’s wort, which can reduce drug effectiveness (e.g., digoxin).

59. Alzheimer’s Disease

• Most common dementia (60-80% of cases), progressive over years, average survival 4-8 years after diagnosis (up to 20 years).
• Younger-onset occurs under age 66, sometimes in 40s or 50s.
• Features: brain shrinkage, nerve cell death, plaques, tangles.
• Symptoms include memory loss, difficulty planning, confusion, language problems, poor judgment, social withdrawal, mood changes.
• Stages:
  • Mild: independent but forgetful
  • Moderate: needs increasing care, confusion, wandering risk
  • Severe: full-time care, loss of awareness, physical decline
• Medications: cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and NMDA antagonist (memantine).

60. Beta Thalassemia

• Inherited disorder with reduced/absent hemoglobin, common in Mediterranean populations.
• Symptoms: jaundice, fatigue, dizziness, chest pain, paleness, shortness of breath, bone marrow expansion.
• Treatment: regular transfusions, erythropoietin (epoetin alfa).

61. Chronic Joint Pain

• Defined as pain lasting 3-6 months or more.
• Signs: redness, swelling, tenderness, stiffness, loss of motion.
• Diagnosis: history, exam, X-rays, blood tests.
• Treatment: NSAIDs, topical analgesics, steroids, physical therapy, electrical nerve stimulation, acupuncture, lifestyle changes.

62. Community-Acquired Pneumonia

• Risk factors: age, comorbidities, smoking, alcohol abuse.
• Common causes: Streptococcus pneumoniae, influenza A, Mycoplasma pneumoniae, Chlamydiophila pneumoniae.
• Symptoms: cough, dyspnea, chest pain, fever, malaise, abnormal breath sounds.
• Diagnosis: chest X-ray, blood tests, sputum culture.
• Treatment: oxygen, chest physiotherapy, antibiotics within 4 hours.

63. Contraception

• Non-hormonal methods: condoms, diaphragm, vaginal sponges, natural family planning, withdrawal, spermicides, copper IUD (Paragard).
• Hormonal methods:
  • Progestin-only (e.g., Mirena, Skyla, Nexplanon, Depo-Provera)
  • Combination (estrogen + progestin): oral pills, patch, ring
• Contraindications: smoking over age 35, breastfeeding, history of clots for estrogen; pregnancy, unexplained bleeding, breast cancer for progestin.

64. Depression

• Symptoms: depressed mood, loss of interest, weight changes, sleep issues, fatigue, poor concentration, suicidal thoughts.
• Treatments: SSRIs (citalopram, fluoxetine, sertraline), TCAs, MAOIs (avoid tyramine-rich foods), psychotherapy, ECT.

65. Diaper Dermatitis

• Red, tender patches on baby’s bottom, fussiness during cleaning.
• Causes: wet diapers, irritation, infections, new products, antibiotics.
• Treatment: keep area clean/dry, mild hydrocortisone, antifungal creams, antibiotics if needed.

66. Generalized Anxiety Disorder (GAD)

• Excessive worry >6 months with symptoms like restlessness, muscle tension, irritability, fatigue, concentration difficulties, sleep problems.
• Diagnosis: presence of ≥3 symptoms for >6 months.
• Treatment: SSRIs, SNRIs, NDRIs (bupropion), antihistamines (hydroxyzine), benzodiazepines (clonazepam), second-generation antipsychotics (quetiapine), and CBT.

67. Influenza

• Risk factors: age, immune status, chronic illness, pregnancy, obesity.
• Symptoms: fever, muscle aches, cough, sore throat, fatigue, sometimes vomiting/diarrhea in children.
• Diagnosis: rapid antigen or molecular tests.
• Treatment: annual vaccination, antivirals within 48 hours of symptom onset.

68. Social Determinants of Health (Healthy People 2020 & 2030)

• Economic stability: employment, food security, housing, poverty
• Education access and quality
• Health care access and quality
• Neighborhood environment: food access, safety, housing quality
• Social/community context: discrimination, incarceration, social cohesion

69. Group A Streptococcal Pharyngitis

• Cause: Group A Streptococcus
• Symptoms: sudden fever, sore throat, inflamed tonsils with exudate, cervical lymphadenopathy
• Diagnosis: rapid antigen detection test (RADT)

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