Notes in Pharm 232 Lecture 7-8-9

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Published	03/26/2024	{{c1::CAD (aka CHD)}}- {{c2::Coronary artery disease. }} Usually {{c1::asymptomatic}} until patient has {{c2::angina}} or {{c2::MI…
Published	03/26/2024	Anginasymptoms -- {{c1::Chest pain}}, {{c1::pressure}}, {{c1::heaviness}} Unstable Angina - increasing in {{c2::severity}}, {{c2::longer}}&n…
Published	03/26/2024	Acute MI- A “Heart Attack”{{c2::Intense}} and {{c2::unremitting}} chest pain/pressure for {{c1::30-60}} minutes{{c3::Retrosternal}}&nbs…
Published	03/26/2024	Arrhythmia{{c3::Alteration of the heart rhythm}}affecting ability to pump blood symptoms - {{c1::palpitations}}, {{c1::dizziness}}, {{c2::fast or…
Published	03/26/2024	Heart FailureInability of the heart to pump enough blood to {{c1::meet body needs }}symptoms -- {{c3::Shortness of breath}} at rest or exert…
Published	03/26/2024	cardiac assessment - patient history and demographicsnon modifiable{{c2::ageracesexfamily history premature or cardiovascular disease in 1st degr…
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Published	03/26/2024	normal resting pulse rate: {{c1::60 - 100 bpm}}
Published	03/26/2024	A rate of {{c1::<60 bpm}} is referred to as bradycardiaCan be {{c2::physiologically normal}} for some patientsCan be the effect of drugs …
Published	03/26/2024	JVP- jugular venous pressure (JVP) -- estimate of the {{c1::central venous or right atrial (RA) pressure.}}The internal jugular vein connects to the R…
Published	03/26/2024	systole - {{c1::contraction}}diastole - {{c1::relaxation}}S1 - {{c2::lub/ first heart sound}}S2 - {{c2::dub/ second heart sound}}S1 – produced by {{c3…
Published	03/26/2024	Abnormal heart soundsS3 – “{{c1::ventricular gallop}}” produced when blood strikes a {{c1::compliant ventricle}} during {{c2::passive filling}}be…
Published	03/26/2024	Murmurs -- {{c1::the sound of blood passing through a valve}}"{{c1::innocent" or "flow"}} murmurs occur when there is a {{c2::high flow}} across …
Published	03/26/2024	cardiac assessment objective measurements{{c2::BRUIT}} -  {{c1::sound of turbulent blood through an artery}}Can be due to {{c3::narrowi…
Published	03/26/2024	lab blood tests1) Biomarkers of myocardial necrosistests -- {{c1::cTN, CK-MB, Myoglobin}}screening for -- {{c1::MI and stable/unstable angina&nbs…
Published	03/26/2024	MYOCARDIAL NECROSISMyocardial cell death due to {{c1::lack of blood flow. }}Dead myocardial cells {{c1::“leak}}” into the blood where they can be…
Published	03/26/2024	biomarkers or myocardial necrosisSerum MyoglobinFound in {{c1::skeletal}} and {{c1::cardiac}} muscle cells. {{c1::Earliest}} marke…
Published	03/26/2024	biomarkers for myocardial necrosisMB isozyme Creatine Kinase (CK-MB)Used diagnostically when {{c1::Troponins are unavailable}}.Used as an early m…
Published	03/26/2024	Cardiac Troponins ({{c3::cTnI}} and {{c3::cTnT}})cTnI and cTnT are {{c1::contractile proteins}} found only in {{c2::cardiac myocytes.&n…
Published	03/26/2024	Cardiac Troponins- differences between the twocTnIRise within {{c1::3-12 hours}} after MIPeaks in {{c1::24 hours}}Normalizes in {{c1::5…
Published	03/26/2024	markers of inflammation1. C-reactive protein (CRP) – an acute phase reactant produced by {{c1::hepatocytes}} and induced by release of&…
Published	03/26/2024	Markers of hemodynamic stress -- B-type natriuretic peptide (BNP) and its precursor, N-terminal pro-brain natriuretic protein (NT-proBNP)released…
Published	03/26/2024	Ejection Fraction -  {{c1::amount of blood pumped out of the heart on systole}} Measured as a {{c1::%}}Normal is between {{c1::50-70%}}Various te…
Published	03/26/2024	Preserved ejection fraction (HFpEF) – also referred to as {{c1::diastolic heart failure}}.  The heart muscle contracts {{c1::normally}} but the v…
Published	03/26/2024	The ECG can be used to detect:{{c1::Arrhythmias}}Conduction {{c1::disturbances}}Myocardial{{c2::ischemia or infarction}}{{c2::Metabolic disturban…
Published	03/26/2024	lipidsRisk factor for {{c1::CHD (aka CAD)}}Total Cholesterol  {{c1::<200 mg/dL}}LDL- {{c2::<130 mg/dL }}Not usually measured…
Published	03/26/2024	Chest RadiographyChest x-ray provides {{c1::supplemental information}} to the physical examination.It does not provide {{c1::detailed information…
Published	03/26/2024	diabetes mellitus1) type 1 -- {{c1::no insulin produced}}2) type 2 -- {{c1::resistance}} to insulininsulin production can be {{c2::increased}} or {{c2…
Published	03/26/2024	C-peptide test -- differential between type 1 and 2C-peptide is part of the endogenous process of insulin production.C-peptide is {{c1::cleaved off}}&…
Published	03/26/2024	low C-peptide = {{c1::low/ no}} insulin production by the body
Published	03/26/2024	Complications of diabetes and tests used to monitor themKIDNEY—{{c1::Nephropathy}}, {{c1::Proteinuria}}{{c2::eGFR}}, {{c2::CrCl}}, Urine {{c2::Al…
Published	03/26/2024	blood glucose “Normal” range is {{c1::60-110}} mg/dL”Critical” range is {{c1::<40 and >500}} mg/dL
Published	03/26/2024	blood sugar (glucose){{c1::varies}} throughout the day and is dependent on multiple factors. Blood glucose {{c1::should not}} be i…
Published	03/26/2024	medicationsDrugs that {{c1::affect blood sugar }}Diabetes drugsDirectly act on {{c2::insulin release}} or {{c2::are insu…
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Published	03/26/2024	hyperglycemia signs and symptomsfirst signs- {{c1::polyuria}}- {{c1::polydipsia}}- {{c1::polyphagia}}hyperglycemia can lead to {{c2::diabetic ketoacid…
Published	03/26/2024	hemoglobin a1cA1C (HbA1c)-  Glycosylated HemoglobinMeasures the {{c1::long-term average blood sugar.}}Over the last {{c1::2-3}} mo…
Published	03/26/2024	an increase in a1c means {{c1::an increase}} in average glucose level
Published	03/26/2024	hemoglobin a1c used ti: {{c1::Screen}} for diabetes in patients with risk factors Diagnose for {{c1::DM Type 2}}{{c2::> 6.5}}% per A…
Published	03/26/2024	a1c testing frequencyat least {{c1::two times a year}} for patients who are {{c2::meeting treatment goals (and who have stable glycemic cont…
Published	03/26/2024	Interpretation of a1cA1c is an {{c1::AVERAGE}} blood glucose over the last 2-3 months. This includes all {{c1::FASTING}} AND {{c1:…
Published	03/26/2024	SMBG- {{c1::Self Monitoring Blood Glucose}}CGM- {{c1::Continuous Glucose Monitoring}}
Published	03/26/2024	blood glucose self monitoringresults from patient self monitoring must also take into account:{{c1::Storage}} of meter and strips.{{c1::Preparati…
Published	03/26/2024	SMBG IS ONLY A {{c1::SNAPSHOT}} INTO THE DAILY BLOOD SUGAR LEVELS
Published	03/26/2024	SMBG pattern analysisPatient log books are difficult to read and are only good for “{{c1::eyeballing}}” their results. Best data comes from …
Published	03/26/2024	Pattern management involves five basic steps:Know the {{c1::target blood glucose range}}. (pre-meal and post-meal targets should be established.)Gathe…
Published	03/26/2024	CGM - continuous glucose monitoringSkin sensor takes glucose readings every {{c1::1-15 minutes }}Some systems automatically transmit to an {…
Published	03/26/2024	fluid statusTotal body fluids are found:Intracellular (ICF) -- about {{c1::2/3}} of total body water (TBW)Extracellular (ECF) -- about {{c1::1/3}…
Published	03/26/2024	Sodium concentration is regulated by {{c1::WATER}} balanceIntake of {{c1::water}} and {{c1::thirst}}{{c2::ADH (Vasopressin)}}{{c2:…
Published	03/26/2024	Hyponatremia is {{c1::having too much water }}Hypernatremia is {{c1::having too little water}}Hypovolemia is the {{c2::loss of SOD…
Published	03/26/2024	Hypovolemia— ECF volume is {{c1::reduced}} {{c2::Dehydration}}Major {{c2::bleeding}}Euvolemia – {{c1::normal}} fluid levelsHypervo…
Published	03/26/2024	causes of hypovolemia (ECF volume depletion) causesresults from {{c1::loss of sodium and water }}from the following sites:{{c2::gastrointestinal}…
Published	03/26/2024	hypovolemia signs and symptoms{{c1::orthostatic hypotension}}Low {{c1::blood pressure}} and increased {{c1::heart rate (HR)}}Reduced{{c2::ju…
Published	03/26/2024	dehydrationIs when the {{c1:: ICF }} has lost significant amount of fluidAs body loses water, {{c1::osmolality}} and {{c1::Na+ concentration…
Published	03/26/2024	hypervolemiacauses Excessive {{c1::sodium/ fluid intake}}Inappropriate I{{c2::V hydration}} therapy --> wrong fluids/ratesInges…
Published	03/26/2024	Edemaoccurs when a patient {{c1::retains fluid (Na and H2O)}} and then the excess fluid moves out of the {{c1::vasculature}} and into t…
Published	03/26/2024	iron by itself is {{c1::toxic}} in the body#1 cause of {{c1::poisoning}} in childreniron is in the {{c2::blood}} and it is stored in the {{c2::body}}b…
Published	03/26/2024	Serum ferritin– low means {{c1::low iron stores/ iron deficiency }}Normal and High need careful evaluationFerritin is an {{c2::acute ph…
Published	03/26/2024	evaluating iron body storesTransferrin (TRF)- {{c1::protein that carries serum iron in the serum.}}TIBC- {{c1::Total Iron Binding Capacity }}Meas…
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Published	03/26/2024	red blood indices -- used to help diagnose anemia (too few rbc)Main indices{{c1::Hgb}}, {{c1::Hct}}, {{c2::RBC}} count, and {{c2::MCV}}Secon…
Published	03/26/2024	Hgb - {{c1::concentration of hemoglobin in g/dL}}Hct - {{c1::Hematocrit / packed cell volume}} -- {{c2::packed spun volume of bloo…
Published	03/26/2024	RBC Indices - MCVHigh MCV ({{c1::macrocytic}}) usually caused by {{c2::Folate}} or {{c2::B12}} deficiencyMost common {{c6::macrocytic a…
Published	03/26/2024	RBC Indices - RDWRed cell distribution widthCoefficient of {{c1::variation of the MCV}}RDW = {{c1::Standard deviation of RBC size ÷ MCV x 100}}In…
Published	03/26/2024	RBC Indices -- MCH and MCHCMCH - {{c1::Mean Corpuscular Hemoglobin}}{{c1::Amount of Hgb per RBC cell count}}{{c3::(Hgb/RBC count) x10 = MCH}…
Published	03/26/2024	RBC Indices -- reticulocyte countreticulocytes -- {{c1::Newly formed RBCs}}1% of RBCs are destroyed daily and replaced with new RBCsLife span of …
Published	03/26/2024	anemia assessmentanemia -- {{c1::when RBC creation < destruction}}due to lack of {{c2::nutrients (iron, folate, b12, etc.)}}{{c2::bone marrow}…
Published	03/26/2024	physical presentation of anemiaPhysical presentation{{c1::Pallor}}{{c1::Fatigue}}{{c2::Tachycardia}}{{c2::Orthostatic hypotension}}{{c3::Koilonychia}}…
Published	03/26/2024	factors in assessmentHgb, HCT, and RBC count are all {{c1::concentrations}} and depend on the {{c2::red blood cell mass (RCM)}} and {{c…
Published	03/26/2024	anemia assessmentAfter determining that the H&H and/or RBC is low, the next step is to {{c1::evaluate the MCV}}MCV– Mean corpuscular volumeLo…
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Published	03/26/2024	macrocytic anemia{{c1::High}} MCVcause -- {{c1::B12 and Folate deficiency}}  Can be drug induced  {{c2::Bactrim (SMX-TMP…
Published	03/26/2024	iron deficiency anemia (IDA)Most {{c1::common}} anemia {{c1::MICROCYTIC}}----But can be {{c2::normocytic}}Depends on the {{c2::extent of the defi…
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Published	03/26/2024	ANEMIA OF CHRONIC DISEASE (INFLAMMATION) Also Known As:  {{c1::ACD}} or {{c1::ACI}}Presents similarly to {{c1::IDA}}Differential …
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Published	03/26/2024	hemolytic anemiaUsually has a MCV that is {{c1::normal-Normocytic}}Usually an {{c1::increased destruction of RBCs}} leading to an average li…
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