78 GASTROINTESTINAL PHARMACOLOGY What are the Adverse Effects of Osmotic Laxatives? What are the Osmotic Laxatives? What is the Mechanism of Action Metoclopramide? What are the Indications for Metoclopramide? What are the Adverse Effects of Metoclopramide? Diarrhea, dehydration, may be abused by bulimics Magnesium hydroxide, magnesium citrate, polyethylene glycol, Lactulose D2 receptor antagonist; Increase resting Tone, contractility LES tone, motility Diabetic and post-surgery gastroparesis Increased Parkinsonian effects, Restlessness, drowsiness, fatigue, depression, nausea, diarrhea. Drug interaction with digoxin and diabetic ‘agents contraindicated in small bowel obstructionVITAMINS, MINERIAL & GENERAL PRINCIPAL What electrolytes does the low volume state have? What serum pH does the low volume state have? What serum pH does emesis have? What serum pH does diarrhea have? bicarbonate What is a possible cause if pulse rises more than 10 bpm in repositioning from lying to sitting? What happened if your pulse drops more than 10 bpm on standing? What are the symptoms of a Low Energy State? Increased total Na+ (NET) Decreased serum Na (dilution affect) Decreased serum K+ Increased serum pH Alkalotic (due to H+/K+ exchanger) Alkalotic because you vomit out HCI- Acidosis because stool has Hypervolemia ‘Autonomic dysfunction CNS: Mental retardation, dementia, CV: heart failure, pericardial effusion Muscle: weakness, SOB, vasodilation, impotence, urinary retention, constipationVITAMINS, MINERIAL & GENERAL PRINCIPAL What are the Rapidly Dividing Cells of the Energy State? What are the most common signs of the Low Energy State? What are the most common symptoms of the Low Energy State? What are the most common i the Low Energy State? What is the most common cause of death in the Low Energy State? Skin: Dry Nails: Brittle Hair: Alopecia Low Bone Marrow: Suppressed Vasculature: Endothelium breaks down Lungs: Infection / SOB Kidney: PCT effected first GI: N/V/D Bladder: Decreased tone ‘Sperm: Decreased Germ Cells: Predisposed to cancer Breasts: Atrophic Endometrium: Amenorrhea Tachypnea and Dyspnea Weakness and SOB UTI and respiratory infections Heart Failureal VITAMINS, MINERIAL & GENERAL PRINCIPAL Explain Restrictive Lung Diseases: Explain Obstructive Lung Diseases: Restrictive: Interstitial problem that ‘causes trouble breathing in (small stiff lungs). Pulmonary Function Test’s: FEV1/FVC greater than 0.8, decrease vital capacity. AUG: decreased pll, decreased Po2, decreased PcO, (increased respiratory rate). Chest X-ray: reticulonodular pattern, ground glass appearance. Most common cause of death is cor- pulmonale ‘Treatment: PEEP ventilator, increased oxygen, increased respiratory time, Obstructive: Airway structure problem that causes trouble breathing out (mucus filled lungs). PETS: FEV/FVCis less than 0.8, increased RV; Reid index increased (thick airway). ABG: decreased pH, normal to low Po,, increased PcO, Most common cause of Death is Bronchiectasis. Treatment: ventilator to increase respiratory rate and expiratory time, Increase oxygen only if needed82 VITAMINS, MINERIAL & GENERAL PRINCIPAL What symptoms does a "more likely to depolarize" state have? What symptoms does a "less likely to Depolarize” state have? What is the humoral immune response? What is the cell-mediated immune response? What are the Macrophages called in area of the body? What is the CBC for every vasculitis? Brain: psychosis, seizures, jitteriness, ‘Skeletal Muscle: muscle spasms, Tetany, Smooth Muscle: diarrhea, then constipation, Cardiac: tachycardia, arrhythmia Brain: lethargic, mental status changes, depression ‘Skeletal Muscle: weakness, SOB ‘Smooth Muscle: constipation then diarrhea Cardiac: hypotension, bradycardia B-cells and PMN's patrol the blood looking for bacteria T-cells and Macrophages patrol the tissues looking for non-bacteria Blood: Monocytes Brain: Microglia Lung: Type 1 Preumocytes Liver: Kupffer cells, Spleen: RES cells Lymph: Dendritic cells kidney: Mesangial cells Peyer's Patch: M cells ‘kin: Langerhan cells Bone: Osteoclast cells Connective Tissue: Histiocytes, Gant cells, Epithelioid cols Decreased: RBC and platelets, Increased: WBC; T-cells; Monocytes; Schistocytes; ESR33 VITAMINS, MINERIAL & GENERAL PRINCIPAL What is the time course of the inflammatory response? What state does Estrogen mimic? What do high GABA levels lead to? What determines the prognosis of Cancer? What ion has the least movement at rest? What ion has the greatest movement at rest? How would you know the patient has a Vitamin A (Retinoic Acid) Deficiency? How would you know the patient has a Vitamin 81 (Thiamine) Deficiency? hour: Swelling, Day1: PMIN's show up Day 3: PMN's peak Day 4: Monocytes/ Macrophages and T-cells show up Day 7: Monocytes/ Macrophages and T-cells pea Day 30: Fibroblasts peak, Month 3-6: Fibroblasts complete scar formation Fibroblasts arrive ‘The Neuromuscular disease state. Estrogen is a muscle relaxant Bradycardia, lethargy, constipation, impotence, memory loss Depth of invasion, any choice that has to do with depth - the deeper it is = the worse the prognosis Chloride Potassium, Poor night vision, Hypoparathyroidism, dry skin Beriberi, Wernicke's Encephalopathy, Wernicke-Korsakoff SyndromeVITAMINS, MINERIAL & GENERAL PRINCIPAL How do | know the patient has a Vitamin B2 (Riboflavin) Deficiency? How do | know the patient has a Vitamin B3 (Niacin) Deficiency? How do | know the patient has a Vitamin B4 (Lipoic Acid) Deficiency? How do | know the patient has 2 Vitamin 85 (Pantothenic Acid) Deficiency? How do | know the patient has a Vitamin 86 (Pyridoxine) Deficiency? How do | know the patient has a Vitamin B9 (Folate) Deficiency? How do | know the patient has a Vitamin 812 (Cyanocobalamin) Deficiency? How do | know the patient has a Vitamin C (Ascorbic Acid) Deficiency? How do | know the patient has @ Vitamin D Deficiency? ‘Angular Cheilosis, Pellagra. (4 D's: Diarrhea, Dermatitis, Dementia, Death) No deficiency state No deficiency state Peripheral Neuropathy Megaloblastic anemia, hypersegmented neutrophils, neural tube defects Megaloblastic anemia, hyperzegmented neutrophils, Neuropathy Scurvy Rickets (children), Osteomalacia (adults)85 VITAMINS, MINERIAL & GENERAL PRINCIPAL How do | know the patient has a Vitamin E Deficiency? What happens when there is a biotin Deficiency? How do | know the patient has a Vitamin k Deficiency? What is seen in Calcium deficiency? What is seen in Magnesium deficiency? What is seen in Zinc deficiency? What ie seen in Copper deficiency? What is seen in Iron deficiency? What disease has a chromium deficiency? What disease has a Selenium deficiency? What is seen with Tin deficiency? Increased free radical damage, hemolytic anemia, ataxia gait, impaired position and vibration Loss of carboxylase function Bleeding, Loss of gamma carboxylation Poor bone and teeth development Loss of kinase function, hypoparathyroidism Dysgeusia, anosmia, Poor wound healing Menky Kinky Hair Syndrome Anemia Diabetes Dilated cardiomyopathy Poor hair growthVITAMINS, MINERIAL & GENERAL PRINCIPAL What is seen with Molybdenum deficiency? Lose xanthine oxidase function What is seen with Manganese deficiency? Lose xanthine oxidase function What is seen with Fluoride deficiency? Poor teeth and bone growth87 HEMATOLOGY What does high WBC and High PMN's tell you? What does a high WBC and <5% Blasts tell you? What does high WBC and Bands tell you? What does high WBC and >5% Blasts tell you? What does high WBC and B Cells tell you? What diseases have high Eosinophils? What diseases have high Monocytes (15%)? What do high Reticulocytes (>1%) tell you? Stress demargination. (Stress response ~ post trauma) Leukemoid reaction - seen in burn patients or any extreme stress (extreme demargination looks like Leukemia), Metamyelocytes Myelocytes. Left shift - they have an infection Leukemia Bacterial infection "NAACP" N- Neoplasm (Lymphoma) A- Allergy / Asthma ‘A Addison's disease (no cortisol - relative eosinophilia) C- Collagen vascular disease P—Parasites “STELS" ‘Syphilis: chancre, rash, warts TB: Hemoptysis, night sweats EBV: Teen sick for a month Listeria: Sick baby Salmonella: Food poisoning RBC is being destroyed peripherallyHEMATOLOGY What do low Retics tell you? What is Poikilocytosis? What is Anisocytosis? What is the RBC normal lifespan? What is the RBC lifespan when there is a problem? What is the Platelet lifespan? What does "Penia" tell you? What does "Cytosis" tell you? What does "Cythemia" tell you? What is the difference between Plasma and Serum? What are the Microcytic Hypochromic ‘Anemias? Decreased production of bone marrow - not working right RBC's of different shapes RBC's with different sizes 120 days 60-90 days. (same time as the shelf life of blood bank units) 7 Days Low Levels - (Usually due to virus or drugs) High levels High levele Plasma: No RBC’s Serum: No RBC's or Fibrinogen Defect in Hb synthesis (RBC small and pale) "FAST lead" F -Fe Deficiency ‘A- Anemia of Chronic Disease S- Sideroblastic Anemia T- Alpha and Beta Thalassemia's L- Lead poisoning29 HEMATOLOGY What will you see with Iron Deficiency Anemia? What will you see with Anemia of Chronic Disease? What will you see with Sideroblastic Anemia? What will you see with Alpha Thalassemia? What will you see in Beta Thalassemia? What will you see in Lead Poisoning? What are the Megaloblastic Anemias? What are some causes of Vitamin B12 def.? What are some causes of Folate Deficiency? Increased TIBC associated with menses, Gl bleeding, and Koilonychia Decreased TIBC Decreased dALA synthase common with blood transfusions Seen in African Americans and Asian ‘Americans. (chromosome 16- deletion) Seen in Mediterranean's. (chromosome 11-point mutation) Decreased dALA dehydrogenase, decreased Ferrachelatase, blue lines ‘on x-ray, history of eating old paint chips Vitamin B-12 deficiency, folate deficiency, alcohol ‘Tapeworms, Vegans, Type A gastritis, Pernicious Anemia Diet, Old food, you will see Glossitis with the patientHEMATOLOGY What is the effect of Alcohol on the fetus? What are the Intravascular Hemolytic Anemias? What are some causes of G6PD Deficiency? What are some causes of Cold Autoimmune? What are the Extravascular Hemolytic Anemias? What ie seen in Spherocytozic? What is seen in Warm Autoimmune? What is seen in Paroxysmal Cold Auto Autoimmune? Fetal alcohol syndrome, smooth philtrum, short, polyclonal, midface hypoplasia, thin superior Vermilion border G6PD deficiency, IgM cold agglutinins, autoimmune Sulfa drugs, mothballs, fava beans, sudden drop in Hb Mononucleosis, Mycoplasma infection. Antibody (IgM) bind to RBC’s membrane, cold temperature and causes agglutination, Hep C Spherocytosis warm autoimmune Paroxysmal Nocturnal Hemoglobinuria cold autoimmune Sickle Cell Anemia Defective Spectrin or Ankyrin Positive Osmotic Fragility test, High level of MCHC rouleaux formation Anti-Rh Ab, Dapsone, PTU, antimalarials, and sulfa drugs. Antibody (IgG) binds to RBC’s membrane in warm temperature Bleeds after cold exposure Donath- Landsteiner Ab91 HEMATOLOGY What is seen in Sickle Cell Anemia? What are the Production Anemias? What is seen in Diamond-Blackfan Anemia? What is associated with Aplastic Anemia? What is Basophilic Stippling? What is a Bite Cell? What are a Burr Cell / Echinocyte? What Is Cabot's Ring Body? What is a Dohle Body? What is a Drepanocyte? Crew-cut on x-ray Avascular Necrosis of femur Diamond-Blackfan, Aplastic Anemia They have low RBC’s and double jointed thumbs Pancytopenia Autoimmune, Benzene, AZT, Chloramphenicol, and radiation, Parvovirus MRNA. (seen in lead poisoning) Unstable Hb inclusions (seen in G6PD Deficiency) Seen in Pyruvate Kinase deficiency, Liver disease, and post splenectomy Seen in vitamin B-12 deficiency and lead poisoning PMN Leukocytosis (caused by infections, steroids, tumor) Seen in Sickle Cell AnemiaWhat is a Heinz Body? What is a Howell-Jolly Body? What is a Pappenheimer Body? What are a Pencil Cell / Cigar Cell? What is Rouleaux formation? What is a Schistocyte? What is a Sideroblast? What are a Spur Cell / Acanthocyte? What is a Stomatocyte? What is a Target Cell / Codocyte? 92 HEMATOLOGY ‘Seen when Hb precipitates and sticks to cell membranes in G6PD deficiency The spleen or bone marrow should have removed nuclei fragments. (Seen in Hemolytic Anemia, spleen trauma, and cancer) Iron inside cell (sideroblastic anemia) Seen i n deficiency anemia Seen in Multiple Myeloma, Spherocytosis (Stacked coin look) Broken RBC. (seen in DIC and artificial heart valves, TTP and others) Macrophages pregnant with Iron. (caused by genetics and or multiple transfusions) Lipid bilayer disease Seen in liver disease ‘These have less Hb. (seen in Thalassemias or iron deficiency)93 HEMATOLOGY What is a Tear Drop Cell / Dacrocyte? What do Platelet problems cause? What do Clotting factor problems cause? What causes increased PTT and Bleeding Time? What is Bernard-Soulier? What is Glanzman's? How does Factor 13 Deficiency present? What is Factor V - Leiden? How does Von Willebrand Disease (VWD) present? RBC's squeezed out of bone marrow. (Seen in Hemolytic Anemia and bone marrow cancer) Bleeding from skin and mucosa Bleeding into cavities and joints Von Willebrand disease and SLE Baby with bleeding from skin and (Big platelets and LOW GP-1b) Baby with bleeding from skin and mucosa (LOW GP-2b3a) Umbilical stump bleeding, (this is. the first time a baby has to stabilize aclot) Protein C cannot break down Factor 5 Heavy menstrual bleedingHEMATOLOGY What are the types of VWD (Willie's)? What is Hemophilia A? What is Hemophilia 8? What is Polycythemia Vera? What is Essential Thrombocythemia? What does the Coombs Test Tell you? What does the Direct Coombs Test Tell you? What does the Indirect Coombs Test tell you? Type 1 (AD): Decreased VW Factor production Type 2 (AD): Decreased VW Activity (+ Ristocetin Aggregation test) ‘Type 3 (AR): No VWF Defective Factor 8 (<40% Activity), Bleed into cavities (head, abd., etc.) Factor 9 deficiency Bleed into joints (knee, etc.) EPO, Budd-Chiari Plethora, “Pruritis after bathing” Very high platelets increased RBC's and WBC's Histiocyte proliferation Kid with Eczema, skull lesions Hand-Schiiller—Christian disease Antibody involved Antibody on surface (Seen in Hemolytic Anemias) ‘The Antibody is freely circulating in the serum,95 HEMATOLOGY What is Type and Cross? What is Type and Match? What is Forward Typing? What is Backward Typing? What does blood type A tell you? What does blood type 0 tell you? What does blood type AB tell you? What does Rh+ tell you? What does Rh- tell you? What is Hemolytic Disease of the Newborn? What is RhoGam? Blood that is matched by blood type and cross-reacted with the patient's blood for rejection. Blood type and Wait Uses Antibodies to detect Antigens Used Antigens to detect Antibodies ‘They have the A antigen and B antibodies ‘They have no antigens. (Universal donor) Have both Antigens. (Universal recipient) Has D Antigen Does not have the D Antigen Rh- mom's blood mixes the Rh+ fetal blood in first pregnancy. No risk to this child. All pregnancies to follow will be a risk, leading to fetal demise. Anti-D IgGHEMATOLOGY When do you give RhoGam? ‘Ist Dose: Week 28 gestation 2nd Dose: 72 hours post-delivery Any time a procedure would mix mom and fetal blood What is INR ratio determined by? Measured PT / Control PT therapeutic level is between 2-3. Normal level is7 IMMUNOLOGY Which cytokine is released when a macrophage is activated? Which cytokines do T-helper cells stimulate? Which enlarged lymph nodes are most likely malignant? What is CD8? Which of your cells express MHC-1? What are the classifications of MHC-1? What are Immuno-privileged sites? wa AILIU's except IL-1 ‘Supraclavicular, Epitrochlear (above the elbow), inguinal T-killer or T-suppressor cell, Responds to MHC-1 complex (self) All nucleated cells except the immune-privileged cells/tissues, RBC’s and Platelets HLA-A, HLA-B and HLA-C ‘Areas of the body that have no lymphatic flow, no antigens, and these areas can be transplanted without fear of rejection, (brain, cornea, thymus, and testes) they do ot express MHC-1IMMUNOLOGY Which cells express MHC-2? What are the classifications of MHC-2? What are CD4 cells? What type of immunity does TH1 provide? What type of immunity does TH2 provide? What do B cell deficiency patients die of? What is Common Variable Immuno. Def.? Antigen presenting cells (macrophages, dendrite cells and neutrophils) HLA-DP, HLA-DQ and HLA-DR T-helper cell - Responds to MHC-2 (foreign attack) Enhances cell mediated immunity Enhances humoral immunity Bacterial Infection Young adults with B cells that do not workIMMUNOLOGY What is Bruton's Agammaglobulinemia? What is Job's Syndrome? What is Multiple Myeloma? What is Heavy Chain Disease? What is selective Ig62 Deficiency? What is Selective IgA Deficiency? What is Hairy Cell Leukemia? Kids (<1 y/o) with defective tyrsine kinase; they have no antibodies and have x-linked transmission Seen in red headed females they are stuck in the IgE stage Multiple osteolytic lesions, Increased IgG and kappa light chains, Rouleaux formation seen on slide |gA and multiple Myeloma of the GI tract Seen in patients with recurrent encapsulated Infections Seen in transfusion, anaphylaxis, and mucus membrane infections Cells have a fried egg / Sunburst appearance and TRAP +100 IMMUNOLOGY What is Ataxia Telangiectasia? What is Hyper leM Syndrome? What do T cell deficiency patients die of? What is DiGeorge Syndrome? What is Chronic Mucocutaneous Candidiasis? What is SCID? What is Wiskott-Aldrich? Patients have low IgA and neurological problems, difficulty ambulating and spider like blood vessels High IgM and all other Ie's are low Viral Infections, fungal etc., except bacterial No Thymus, inferior Parathyroid and low calcium T-cell defect against Candida Albicans and chronic fatigue No Thymus (no T-cells), frayed long bones (no B-cells), and baby dies by 18 months Low IgM, Low Platelets, High leA, Eczema, Petechiae and X-linkedWhat does the viral load tell you? What organs have the most CD4 receptors? What are the 3 tests used to screen for HIV? What is the definition of AIDS? What are the LIVE Vaccines? 101 IMMUNOLOGY Progression of HIV Blood vessels, brain, testicles, cervix, and rectum ELISA: Detects IgG Ab to p24 Ag Western Blot: Proteins PCR: Detects virus (used in babies) CD4 count less than 200 or defining illness "Bring Your Own Very Small Virus and MMR" B-ace Y- Yellow Fever (0 - OPV (Sabin V-Varicella S~ Smallpox \V- Rotavirus M- Measles = Rubeola M-—Mumps R - Rubella = German 3 day measles102 IMMUNOLOGY What is a Neutrophil? The Phagocyte (It has Antimicrobials, most abundant) What is an Eosinophil ‘The parasite destroyer and allergy Inducer What is a Basophil? ‘The allergy helper (IgE receptor - histamine release) What is a Monocyte? The destroyer - macrophage (has hydrolytic enzymes and a coffee bean nucleus) What is a Lymphocyte? The warrior - T, B, and NK cells What is a Platelet? ‘The clotter (has no nuclei and ‘smallest cells) What is a Blast? Baby Hematopoietic cell What is 2 Band? Baby Neutrophil