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

1. Celiac Disease

• Pathophysiology: Gluten intolerance causes damage to the small intestine lining, especially the duodenum and jejunum.

• Signs & Symptoms:

  • Abdominal pain, bloating

  • Pale, greasy, bulky, foul-smelling diarrhea

  • Malnutrition complications: rickets, occult blood, anemia

  • Easy bruising or bleeding

  • Hypomagnesemia & hypocalcemia → irritability, tremors, convulsions, tetany, bone pain, osteomalacia

• Lab Tests:

  • IgA-tTg, IgA-EMA, total IgA (if IgA deficient, test IgG, IgA-DGP, IgG-AGA)

• Diagnosis:

  • Serologic IgA antibody testing, HLA-DQ2/DQ8 genotyping

  • Endoscopy with duodenal biopsy

• Management: Avoid gluten-containing grains: Barley, Rye, Oats, Wheat (BROW)

2. Sjogren’s Syndrome

• Mostly affects older women, especially those with RA or SLE

• Symptoms: Dry eyes and dry mouth

• Tests: SSA+ and SSB+ antibodies

3. Herbs

• Cinnamon:

  • Benefits: Lowers blood glucose, cholesterol, BP, bleeding risk

  • Caution: Avoid during breastfeeding; interacts with diabetic, anticoagulant, heart meds

• Ginkgo Biloba:

  • Benefits: Slows dementia progression, used for erectile dysfunction

  • Risks: Increases bleeding; avoid with anticoagulants/antiplatelets; lowers seizure threshold

• Glucosamine: Used for osteoarthritis

• Green Tea:

  • Benefits: Weight loss, mental clarity

  • Risks: Hepatotoxicity; avoid with vasodilators, stimulants, psychoactives; contains vitamin K (affects warfarin)

• Lavender:

  • Benefits: Relaxation, anxiety, stress, insomnia relief

  • Risks: Constipation, headache, increased appetite; caution with CNS depressants and antihypertensives

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: 3–5-year survival ~70% post-Stage I repair; 90% survival if beyond 12 months

• Diagnosis: Echocardiogram, prenatal ultrasound

• Treatment: Three-stage surgery

  1. Norwood (1-2 weeks): Aorta enlarged, shunt to pulmonary artery, PDA closed

  2. Glenn (4-6 months): SVC connected to pulmonary artery; Norwood shunt removed

  3. Fontan (18-36 months): IVC connected to pulmonary artery with a conduit to right atrium

• Symptoms: Cyanosis, pallor, cool/clammy skin, tachycardia, poor feeding, weak pulses

• Medications: Tube feeding, heart muscle support, BP lowering, diuretics

5. Parathyroid

• Function: Produces PTH regulating calcium; high PTH → calcium release from bones → bone loss

• Lab Values: Calcium 8.6-10.3 mg/dL, PTH 11-51 pg/mL

• Symptoms:

  • Hyperparathyroidism: osteoporosis, kidney stones, polyuria, abdominal pain, fatigue, forgetfulness, bone/joint pain

  • Hypoparathyroidism: paresthesia, facial twitching, muscle cramps, mood changes, dry skin

• Tests: Ultrasound, bone densitometry, CT/MRI

• Treatment:

  • Hyperparathyroidism: calcimimetics, hormone replacement, bisphosphonates

  • Hypoparathyroidism: maintain low-normal calcium levels

6. Hutchinson-Gilford Progeria Syndrome

• Rare genetic disorder causing rapid aging in children; onset in first 1-2 years

• Caused by LMNA mutation → abnormal progerin protein destabilizes nuclear envelope

• Symptoms: Short stature, slow hair growth, alopecia, joint issues, skin wrinkles/dryness, failure to thrive, delayed teeth

• Treatment: Statins, nitroglycerin, NSAIDs, bone-strengthening meds, physical/occupational therapy

• Life Expectancy: 13-20 years (ages 10 times faster)

7. Neuropathy

• Alternatives to gabapentin for diabetic neuropathy: duloxetine, pregabalin

8. Hydrotherapy

• Useful for MS and Myasthenia Gravis symptom management

9. Pneumothorax vs Hemothorax

• Both: decreased/absent lung sounds

• Pneumothorax: air in pleural space; hyperresonant percussion

• Hemothorax: blood in pleural space; dull percussion anterior and posterior

10. Tuberculosis

• Testing: Tuberculin skin test (PPD), chest X-ray or CT (white lung spots)

• Medications: Isoniazid, Rifampin (avoid with oral contraceptives), Ethambutol, Pyrazinamide

11. Thyroid Disorders

• Labs: TSH 0.5–5.0 mIU/L, T3 80-220 ug/dL, T4 5-12 ug/dL

• Autoimmune:

  • Hashimoto’s (hypothyroidism): High TPO, Tg antibodies

  • Graves’ (hyperthyroidism)

• Hyperthyroidism Symptoms: Tachycardia, nervousness, insomnia, muscle weakness, heat intolerance, exophthalmos (Graves)

• Medications: PTU, Methimazole

• Hypothyroidism Symptoms: Puffy face, dry skin, hair loss, fatigue, cold intolerance

• Medication: Levothyroxine

12. Crohn’s Disease vs Ulcerative Colitis

• Crohn’s:

  • Affects entire GI tract with skip lesions and cobblestone appearance

  • Symptoms: abdominal pain, diarrhea, bleeding, fistulas, mouth ulcers

  • Tests: ASCA antibody, CBC, occult blood, CRP, colonoscopy, capsule endoscopy

  • Treatment: Aminosalicylates, steroids, immunosuppressants, antibiotics

  • Diet: Low-residue, avoid caffeine/alcohol, no sharp-edged foods

• Ulcerative Colitis:

  • Affects colon lining and rectum only

  • Symptoms: bloody diarrhea, rectal pain, urgency

  • Tests: pANCA antibody, colonoscopy, blood tests, stool studies

  • Treatment: Anti-inflammatory, corticosteroids, immunosuppressants, antidiarrheals

13. Sickle Cell Disease

• Risks in infants: Pneumococcal infections, anemia, jaundice, pain episodes

• Crisis Types:

  • Vaso-occlusive (pain, swelling, fever)

  • Splenic sequestration (enlarged spleen, low hemoglobin)

  • Aplastic (sudden anemia, low reticulocytes)

• Prevention: Hydration, avoid extreme temperatures and low oxygen environments

• Treatment: IV fluids, analgesics, oxygen, transfusions

• Medications: Hydroxyurea (reduces crises), avoid iron supplements

• Newborn prophylaxis: Penicillin, folic acid, vaccines

14. Urinary Tract Infection (UTI) Medications

• Pregnancy safe: Fosfomycin (one-time dose), Cefalexin

• Avoid in pregnancy: Nitrofurantoin, Trimethoprim-sulfamethoxazole, Penicillin, Fluoroquinolones

• Pediatrics: Trimethoprim-sulfamethoxazole (first choice), Amoxicillin-Clavulanate, Cephalosporins

15. Pregnancy Immunizations

• Recommended: Influenza, TDAP (27-36 weeks), Pneumococcal, Hep A/B, Meningococcal

• Contraindicated: Varicella, MMR

16. Varicella (Chickenpox)

• Contagious viral infection with itchy, vesicular rash starting on chest, back, face

• Symptoms: low-grade fever, sometimes abdominal pain

• Treatment: Antivirals (Acyclovir), IV immune globulin, acetaminophen (avoid ibuprofen), calamine lotion, soothing baths

17. Schizophrenia Medications

• Symptoms: Positive (hallucinations, delusions), Negative (anhedonia, flat affect)

• First Generation: Chlorpromazine, Haloperidol, Fluphenazine (treat positive symptoms)

• Side Effects: Extrapyramidal symptoms, anticholinergic effects, orthostatic hypotension, sedation

• Second Generation: Risperdal, Abilify, Zyprexa, Seroquel, Geodon (treat positive & negative symptoms)

• Side Effects: Metabolic syndrome, agranulocytosis (clozapine), neuroleptic malignant syndrome

• Helpful vitamins: Folic acid, Thiamine (B1)

18. PPD and BCG Vaccine

• BCG vaccination causes >10mm induration but not positive PPD

• Skin test read 48-72 hours after injection

19. Benign Prostatic Hyperplasia (BPH)

• Treated with Tamsulosin (Flomax), an alpha-1 antagonist (educate on hypotension risk)

20. Congestive Heart Failure (CHF)

• Left-sided: pulmonary symptoms (JVD, rales, S3 murmur)

• Right-sided: peripheral edema, abdominal distension

• Ejection Fraction (EF):

  • Normal 55-70%

  • Reduced EF <40% (systolic failure)

  • Preserved EF 40-49% (diastolic failure)

• Testing: BNP (>100 indicates heart failure), echocardiogram

21. Pleural Effusion

• Symptoms: Chest pain, dry cough, dyspnea, orthopnea, fever

• Testing: Chest X-ray, CT, ultrasound

• Treatment: Thoracentesis, chest tube, diuretics, antibiotics, oxygen therapy

22. Diabetes

• Antihypertensives: ACE inhibitors (e.g., captopril), ARBs

• Insulin types and timings summarized (Regular, NPH, Lispro, etc.)

• Symptoms of hyperglycemia and ketoacidosis: fruity breath, polyuria, fatigue, confusion

28. Cellulitis

• Treat with IV and oral antibiotics, temperature control, wound care, patient education

29. Panic Attack, Hallucinations, Nightmares

• Medications: Clonazepam (anxiety), Clonidine (hypertension), Prazosin (nightmares)

30. Multiple Sclerosis

• Demyelinating CNS disease affecting brain, optic nerves, spinal cord

31. Kidney & BP Regulation

• Hormones involved: ADH, aldosterone, renin-angiotensin system

32. HLA-B*58:01 & Allopurinol

• Associated with severe skin reactions (SJS, TEN), especially in Korean, Han-Chinese, Thai patients

33. Doxycycline

• Increases warfarin effect—monitor INR closely

34. Muscle Spasms

• Treated with Baclofen and Gabapentin

35. Hematomas

• Epidural: lucid interval, CNIII palsy, biconvex CT shape

• Subdural: crescent-shaped CT

36. Tay-Sachs Disease (Ashkenazi Jewish risk)

• Enzyme deficiency causing fatty substance buildup → neurodegeneration, cherry-red eye spots

37. Chronic Kidney Disease Stages

• Stage 1: GFR 90-120 (normal + proteinuria)

• Stage 2: GFR 60-89 (mild loss)

• Stage 3: GFR 30-59 (moderate loss)

• Stage 4: GFR 15-29

• Stage 5: ESRD (<15)

53. Color Blindness

• X-linked mutation OPN1MW on chromosome X23; dominant disease in males

54. G6PD Deficiency

• X-linked genetic enzyme deficiency causing hemolytic anemia

• Symptoms: pallor, jaundice, dark urine, enlarged spleen/liver

• Avoid fava beans, certain foods, and drugs like aspirin (acetaminophen safe)

55. Transfusion Reactions

• Manage with slow transfusion, acetaminophen, diphenhydramine, steroids, meperidine for rigors

56. Small Cell Lung Carcinoma

• Aggressive neuroendocrine tumor linked to smoking

• Diagnosed with EGFR testing and chest X-ray

57. Infant Thrush

• White/yellow oral patches, cracked mouth corners

• Caused by Candida albicans

• Treat both infant and mother with topical nystatin, antifungals, fluconazole

58. CYP3A4

• Metabolizes codeine; St. John’s Wort induces CYP3A4 causing reduced drug efficacy

59. Alzheimer’s Disease

• Most common dementia type; progressive brain atrophy, plaques, tangles

• Signs: memory loss, confusion, mood changes, language difficulties

• Stages: mild (independent), moderate (need help), severe (full care)

• Medications: cholinesterase inhibitors (donepezil), memantine

60. Beta Thalassemia

• Inherited hemoglobin disorder common in Mediterranean descent

• Symptoms: anemia, jaundice, fatigue, chest pain, bone marrow expansion

• Treatment: regular transfusions, erythropoietin (epoetin alfa)

61. Chronic Joint Pain

• Lasting 3-6 months+; redness, swelling, stiffness, decreased motion

• Testing: physical exam, X-ray, labs

• Treatment: NSAIDs, steroids, physical therapy, TENS, nerve stimulation, acupuncture

62. Community-Acquired Pneumonia

• Risks: age, comorbidities, smoking

• Causes: Strep pneumoniae, influenza, Mycoplasma, Chlamydia

• Symptoms: cough, dyspnea, fever, chest pain

• Diagnosis: chest X-ray, labs, sputum culture

• Treatment: oxygen, antibiotics within 4 hours

63. Contraception

• Non-hormonal: condoms, diaphragm, natural family planning, withdrawal, spermicides, copper IUD

• Hormonal:

  • Progestin-only (Mirena, Nexplanon, Depo-Provera)

  • Combination estrogen-progestin (oral pills, patches, rings)

• Contraindications:

  • Estrogen: smoking, age >35, breastfeeding, history of clots

  • Progestin: pregnancy, unexplained bleeding, breast cancer, drug interactions