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Autosomal Dominant - ✔✔-1 parent has, 50% change of child having Autosomal Recessive - ✔✔-Both parents are carriers, 25% change of child having, 50% chance child is a carrier. Cystic Fibro... sis - ✔✔-affects pancreas causing secretions in lungs 21st Trisomy - ✔✔-Down Syndrome Klinefelter Syndrome (XXY) - ✔✔-male has extra X, female like qualities Turner Syndrome - ✔✔-Missing X in females Alpha Thalassemia - ✔✔-inherited blood disorder; mild to severe anemia Beta Thallasemia - ✔✔-low hemoglobin; contraindicated medication ferrous sulfate Prevalence Risk - ✔✔-proportion of the population affected at a certain time Incidence rate - ✔✔-number of new cases divided by population Innate immunity - ✔✔-inflammation; increased vascular permeability B&T lymphocytes - ✔✔-immune response primary malignant tumor - ✔✔-lack of organization of cells glucocorticoids - ✔✔-used in combination with other agent to treat lymphoid tissue (leukemia). glucocorticoids are directly toxic to lymphoid tissues. Selective estrogen receptor modulators (SERM) - ✔✔-for hormone receptor positive and advanced breast cancer. (Tamoxifin reduces risk and recurrence risk) Heart failure - ✔✔-impairment of the ventricle to fill with or eject blood; heart cannot meet metabolic need of the body. CHF - ✔✔-heart cannot keep up with metabolic needs; volume overload in pulmonary area Left Ventricular Dysfunction - ✔✔-reduced ejection fraction; ventricle having issue ejecting blood. normal ejection fraction - ✔✔-55 - 60 % (blood pumped out with each heartbeat) Ejection fraction of 50% - reduced or preserved? - ✔✔-preserved Diastolic CHF - ✔✔-preserved ejection fraction, problem is with filling Systolic CHF - ✔✔-reduced ejection fraction, problem is with ejecting Left sided CHF - ✔✔-pulmonary (JVD, fluid volume overload, rails, S-3 murmurs) ** #1 cause of Right sided CHF BNP - ✔✔-gold standard lab test to diagnose CHF Echocardiogram - ✔✔-Diagnostic tool, evaluates heart structure and function At Risk for HF - Stage A - ✔✔-no structural heart disease or symptoms of heart failure Stage A HF co-morbidities - ✔✔-htn, atherosclerotic disease, diabetes, metabolic syndrome, patients using cardiotoxins with family history Therapy goals of stage A HF - ✔✔-treat htn, encourage smoking cessation, encourage regular exercise, treat lipid disorders, discourage alcohol intake/drug use, control metabolic syndrome Meds: ACEI or Angiotensin II RB for vascular disease or diabetes (avapro, losartan, benicar, diovan, etc) At Risk for HF - Stage B - ✔✔-structural heart disease but no symptoms of heart failure Stage B HF co-morbidities - ✔✔-previous MI, LV remodeling with LV hypertrophy and low EF, asymptomatic valvular disease Therapy goals of Stage B HF - ✔✔-Meds: ACEI or ARB, Beta-blockers, inplantable defibrillators Stage C heart failure - ✔✔-structural heart disease with prior or current symptoms of HF Presentation of Stage C HF - ✔✔-known structural heart disease and shortness of breath and fatigue, reduced exercise tolerance Therapy for Stage C HF - ✔✔-dietary salt restriction, MEDS: diuretic, ACEI, beta blockers. Some patients: aldosterone antagonist, ARBs, digitalis, hydralazine/nitrates, biventricular pacing, inplantable defibrillators Stage D heart failure - ✔✔-refractory HF requiring specialized interventions Presentation of Stage D HF - ✔✔-marked symptoms at rest despite maximal medical therapy (recurrently hospitalized or cannot be safely discharged without specialized interventions) Therapy goals for Stage D HF - ✔✔-compassionate end-of-life care/hospice, extraordinary measures ,heart transplant, chronic inotropes, permanent mechanical support, experimental drugs or surgery Ischemic heart Disease (CAD, MI) presentation - ✔✔-chest discomfort, pain in neck/jaw/chest (crushing, squeezing, sharp), pain worse with exertion (demand requirement is higher), abnormal heart sounds, hypoxia, arrhythmias (afib, ST elevation) Stable angina goal - ✔✔-decrease cardiac oxygen demand Meds for stable angina - ✔✔-nitro first choice, then beta blockers (beta blockers if angina occurs with effort) nitroglycerine dose - ✔✔-sublingual, acts within 5 minutes, max of 3 doses Cardiac glycosides (Digoxin) - ✔✔-Increased myocardial contractile force (increases output), used in ED, exerts positive inotropic action, can cause severe dysrhythmias Digoxin Dosing - ✔✔-therapeutic - 0.5-0.8 ng/ml. ASSESS apical pulse before administering, If lethargic and not acting right, see patient FIRST Goal of Anticoagulant and Antiplatelet Drugs - ✔✔-inactivate and suppress formation of thrombin Warfarin (coumadin) - ✔✔-PO to prevent blood clots; start with half a dose Anticoagulants - ✔✔-Warfarin, heparin, lovenox; Caution about hemorrhage, any patients with risks for bleeding Pneumonia Patho - ✔✔-pathogen reaches airway and overwhelms defenses causing inflammatory cascade; fluid forms, blocking diffusion (gas exchange) causing hypoxia, ultimately leads to respiratory failure Diagnosing pneumonia - ✔✔-Chest X-ray: viral - diffuse widespread whitening; bacterial - patchy, consolidated, lobar Emphysema - ✔✔-destruction of alveolar walls; air goes into lungs, can't get out; leads to hyperinflation Bronchitis - ✔✔-excess mucus production, smooth muscle hypertrophy asthma - ✔✔-chronic inflammatory obstruction of bronchi; trigger causing mucus clogging bronchial tubes; is reversable, give beta antagonists and steroids Foundation meds of asthma and COPD - ✔✔-glucocorticosteroids: Pulmicort and Flovent; taken daily for long term control to suppress inflammation. Oral glucocorticoids - methylprednisone, prednisone; gradually decrease dose Bronchodilators (Beta 2-Adrenergic Agonists) - ✔✔-provide symptomatic relief, do not effect inflammation of disease process; taken PRN during attack (Albuterol), long actinb Beta2 can be used in combo with glucocorticoids Back pain treatment - ✔✔-first 4-6 weeks no imaging needed unless neurologic involved; give NSAIDS and rest, is the #1/2 reason for visits to PCP Types of Endocrine Disorders - ✔✔-Diabetes Acromegaly - overproduction of growth hormone, have overbite and buffalo hump Addison's - decreased production of hormones by adrenal gland Cushing - high cortisol levels Graves - hyperthyroidism (excessive) Stage 1 Kidney Disease (CKD) - ✔✔-kidney damage with normal or increased GFR, treat comorbid conditions to slow disease progression, CVD risk reduction Stage 2 CKD - ✔✔-kidney damage with mild decreased GFR (60-89), Estimation of progression Stage 3 CKD - ✔✔-moderate decreased GFR (30-59), treat complications Stage 4 CKD - ✔✔-Severely decreased GFR (15-29), prepare for kidney replacement therapy Stage 5 CKD - ✔✔-Kidney failure GFR <15 or dialysis, replacement if uremia present How do you start first dose of antihypertensives/heart failure medications? - ✔✔-start first dose at night; do slow position changes, lay down if hypotension occurs Ace Inhibiters (ACEI) *pril - ✔✔-reduce angiotensin II, increase bradykinin, hyperkalemia, dry cough, angioedema; contraindicated in pregnancy (fetal death), first dose causes severe hypotension, can cause renal failure Beta Blockers - ✔✔-prevent chemical messengers; slow HR, relax vessels, lower BP, Class II antidysrhythmic drug nonselective beta blockers - ✔✔-use with caution in people with lung conditions; do not use with asthma Cardio selective beta blockers - ✔✔-metoprolol - only beta-1 receptors affected Third generation beta blockers - ✔✔-labetalol - blocks alpha and beta receptors Calcium Channel Blockers - ✔✔-vasodilation of arterioles and heart, class IV antidysrhythmic drug Verapamil - ✔✔-calcium channel blocker, first choice dihydropyridines CCB - ✔✔-*ine, vasodilators used to treat htn and angina non-dihydropyridines CCB - ✔✔-*dilt, used for arrhythmias Statins - ✔✔-lipid lowering agents (LDL), can increase good HDL, muscle pain can lead to rhabdo, kidney failure, and death Diuretics - ✔✔-2 hours after oral intake, peaks at 4-6 hours, lasts 12 hours Thiazide Diuretics - ✔✔-block reabsorption (10%) in distal convoluted tubule; not used in kidney failure, can cause hypokalemia, not used in sickle cell disease Loop diuretics - ✔✔-Furosemide; blocks reabsorption (20%) in loop of Henle Potassium-sparing diuretics - ✔✔-Spironolactone (Aldactone); distal nephron, holds K, excretes sodium, takes 48 hours to work Angiotensin II - ✔✔-vasocontraction; increased bp by acting on adrenal cortex secreting aldosterone Antiotensin II Receptor Blockers (ARBS) - ✔✔-Sartan; blocks action of angiotensin II, second choice if cannot tolerate ACE for htn and HF Diabetes diagnosis - ✔✔-Hgb A1C is most reliable assessment of blood glucose over 3 month period. Poor control is >9%, goal is <6.5% in healthy people Short acting insulin - ✔✔-lispro (Humalog)/Aspart (NovoLog)/glulisine (aspirdra) Long acting insulin - ✔✔-glargine (Lantus) - most painful; detemir (levemir) Metformin - ✔✔-first drug of choice with new Type 2 Diabetes; inhibits glucose in liver, slightly reduces glycose absorption in gut, increases glucose uptake; DOES NOT drive insulin down, very low risk for hypoglycemia TSH levels - ✔✔-normal range is 0.4 to 4.0 mu/L. If you are being treated for a thyroid disorder, the normal range is 0.5 to 3.0 mu/L. A value above the normal range indicates that the thyroid is underactive. This indicates hypothyroidism. [Show More]

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