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 damages small intestine lining (duodenum, jejunum).

• Symptoms: Abdominal pain, bloating, pale/greasy/foul diarrhea, malnutrition (rickets, anemia), easy bruising, irritability, tremors, convulsions, tetany, bone pain, osteomalacia.

• Labs: IgA-tTg, IgA-EMA, total IgA; if IgA deficient, test IgG, IgA-DGP, IgG-AGA.

• Diagnosis: Serologic IgA antibodies, HLA-DQ2/DQ8 genotyping, duodenal biopsy via endoscopy.

• Management: Gluten-free diet (avoid Barley, Rye, Oats, Wheat — BROW).

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2. Sjogren’s Syndrome

• Common in: Older women, especially with RA or SLE.

• Symptoms: Dry eyes and dry mouth.

• Tests: Positive SSA and SSB antibodies.

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3. Herbs

• Cinnamon: Lowers glucose, cholesterol, BP, bleeding risk; avoid breastfeeding; interacts with diabetic, anticoagulant, and heart meds.

• Ginkgo Biloba: Slows dementia, treats erectile dysfunction; increases bleeding risk; avoid with anticoagulants; lowers seizure threshold.

• Glucosamine: Used for osteoarthritis.

• Green Tea: Supports weight loss, mental clarity; risk of liver toxicity; avoid with vasodilators, stimulants, psychoactive drugs; contains vitamin K (interferes with warfarin).

• Lavender: Eases anxiety, stress, insomnia; may cause constipation, headache, increased appetite; caution with CNS depressants, antihypertensives.

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4. Hypoplastic Left Heart Syndrome (HLHS)

• Anatomy: Underdeveloped left ventricle, mitral/aortic valves, ascending aorta; atrial septal defect present.

• Fetal shunts: Patent ductus arteriosus (PDA), patent foramen ovale (PFO).

• Survival: ~70% survive 3–5 years after Stage I surgery; 90% if beyond 12 months.

• Diagnosis: Echocardiogram, prenatal ultrasound.

• Treatment: Three-stage surgery — Norwood (1-2 weeks), Glenn (4-6 months), Fontan (18-36 months).

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

• Medications: Cardiac support, BP control, diuretics, tube feeding.

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5. Parathyroid

• Function: Produces PTH regulating calcium; high PTH causes bone calcium release → bone loss.

• Labs: Calcium 8.6-10.3 mg/dL, PTH 11-51 pg/mL.

• Symptoms:

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

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

• Tests: Ultrasound, bone density scan, CT/MRI.

• Treatment:

  • Hyper: Calcimimetics, hormone therapy, bisphosphonates.

  • Hypo: Maintain low-normal calcium.

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6. Hutchinson-Gilford Progeria Syndrome

• Cause: LMNA mutation → abnormal progerin → nuclear envelope instability.

• Symptoms: Rapid aging in children (1-2 yrs onset), short stature, alopecia, joint problems, skin wrinkles, delayed teeth.

• Treatment: Statins, nitroglycerin, NSAIDs, bone-strengthening meds, therapy.

• Life Expectancy: 13–20 years (10x accelerated aging).

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7. Neuropathy

• Alternatives to gabapentin for diabetic neuropathy: Duloxetine, pregabalin.

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8. Hydrotherapy

• Helps manage symptoms in Multiple Sclerosis and Myasthenia Gravis.

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9. Pneumothorax vs Hemothorax

• Both show decreased/absent lung sounds.

• Pneumothorax: Air in pleural space; hyperresonant percussion.

• Hemothorax: Blood in pleural space; dull percussion anterior/posterior.

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10. Tuberculosis

• Tests: Tuberculin skin test (PPD), chest X-ray/CT showing white spots.

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

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11. Thyroid Disorders

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

• Autoimmune: Hashimoto’s (hypothyroid; high TPO, Tg antibodies), Graves’ (hyperthyroid).

• Symptoms & Treatment:

  • Hyperthyroidism: Tachycardia, nervousness, insomnia, heat intolerance, exophthalmos; treat with PTU, Methimazole.

  • Hypothyroidism: Puffy face, dry skin, hair loss, fatigue, cold intolerance; treat with levothyroxine.

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12. Crohn’s Disease vs Ulcerative Colitis

• Crohn’s: Affects whole GI tract, skip lesions, cobblestone mucosa. Symptoms: pain, diarrhea, bleeding, fistulas, mouth ulcers. Tests: ASCA, colonoscopy. Treatment: aminosalicylates, steroids, immunosuppressants. Diet: low-residue, avoid caffeine, alcohol, sharp foods.

• Ulcerative Colitis: Affects colon/rectum lining only. Symptoms: bloody diarrhea, rectal pain, urgency. Tests: pANCA, colonoscopy. Treatment: anti-inflammatories, steroids, immunosuppressants.

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13. Sickle Cell Disease

• Risks in infants: Pneumococcal infections, anemia, jaundice, pain crises.

• Crisis Types:

  • Vaso-occlusive: pain, swelling, fever.

  • Splenic sequestration: enlarged spleen, low hemoglobin.

  • Aplastic: sudden anemia, low reticulocytes.

• Prevention: Hydration, avoid extreme temperatures/low oxygen.

• Treatment: IV fluids, analgesics, oxygen, transfusions.

• Medications: Hydroxyurea reduces crises; avoid iron supplements.

• Newborn prophylaxis: Penicillin, folic acid, vaccines.

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14. Urinary Tract Infection Medications

• Pregnancy-safe: Fosfomycin (single dose), Cephalexin.

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

• Pediatrics: Trimethoprim-sulfamethoxazole (1st choice), Amoxicillin-Clavulanate, Cephalosporins.

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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)

• Features: Highly contagious with itchy vesicular rash (starts chest, back, face).

• Symptoms: Low-grade fever, sometimes abdominal pain.

• Treatment: Acyclovir, IVIG, acetaminophen (avoid ibuprofen), calamine lotion, soothing baths.

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17. Schizophrenia Medications

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

• 1st Gen: Chlorpromazine, Haloperidol, Fluphenazine (treat positive symptoms). Side effects: EPS, anticholinergic effects, hypotension, sedation.

• 2nd Gen: Risperdal, Abilify, Zyprexa, Seroquel, Geodon (treat both symptoms). Side effects: metabolic syndrome, agranulocytosis (clozapine), neuroleptic malignant syndrome.

• Helpful vitamins: Folic acid, Thiamine (B1).

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18. PPD and BCG Vaccine

• BCG vaccine causes >10 mm induration but doesn’t cause a positive PPD test.

• Skin test read 48-72 hours after injection.

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19. Benign Prostatic Hyperplasia (BPH)

• Treated with Tamsulosin (alpha-1 antagonist). Warn about risk of hypotension.

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20. Congestive Heart Failure (CHF)

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

• Right-sided: Peripheral edema, abdominal distension.

• Ejection Fraction: Normal 55–70%; Reduced EF <40% (systolic failure); Preserved EF 40–49% (diastolic failure).

• Testing: BNP (>100 suggests HF), echocardiogram.

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21. Pleural Effusion

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

• Testing: Chest X-ray, CT, ultrasound.

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

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22. Diabetes

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

• Insulin: Types and timing (Regular, NPH, Lispro, etc.).

• Hyperglycemia/Ketoacidosis: Fruity breath, polyuria, fatigue, confusion.

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28. Cellulitis

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

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29. Panic Attack, Hallucinations, Nightmares

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

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30. Multiple Sclerosis

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

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31. Kidney & Blood Pressure Regulation

• Key hormones: ADH, aldosterone, renin-angiotensin system.

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32. HLA-B*58:01 & Allopurinol

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

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33. Doxycycline

• Increases warfarin effect — monitor INR closely.

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34. Muscle Spasms

• Treated with Baclofen and Gabapentin.

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35. Hematomas

• Epidural: Lucid interval, CN III palsy, biconvex CT shape.

• Subdural: Crescent-shaped CT.

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36. Tay-Sachs Disease

• Ashkenazi Jewish risk; enzyme deficiency → fatty buildup → neurodegeneration, cherry-red macula.

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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)

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53. Color Blindness

• X-linked mutation OPN1MW on X23 chromosome; more common in males.

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54. G6PD Deficiency

• X-linked enzyme deficiency causing hemolytic anemia.

• Symptoms: Pallor, jaundice, dark urine, enlarged spleen/liver.

• Avoid fava beans, certain drugs (aspirin unsafe, acetaminophen safe).

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55. Transfusion Reactions

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

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56. Small Cell Lung Carcinoma

• Aggressive neuroendocrine tumor linked to smoking. Diagnosed by EGFR testing, chest X-ray.

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57. Infant Thrush

• White/yellow oral patches, cracked mouth corners caused by Candida albicans.

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

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58. CYP3A4

• Metabolizes codeine; St. John’s Wort induces CYP3A4, reducing drug effectiveness.

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59. Alzheimer’s Disease

• Most common dementia; brain atrophy, plaques, tangles.

• Signs: Memory loss, confusion, mood/language changes.

• Stages: Mild (independent), moderate (needs help), severe (full care).

• Medications: Cholinesterase inhibitors (donepezil), memantine.

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60. Beta Thalassemia

• Inherited hemoglobin disorder common in Mediterranean descent.

• Symptoms: Anemia, jaundice, fatigue, chest pain, bone marrow expansion.

• Treatment: Regular transfusions, erythropoietin.

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61. Chronic Joint Pain

• Duration >3–6 months; redness, swelling, stiffness, decreased motion.

• Tests: Physical exam, X-ray, labs.

• Treatment: NSAIDs, steroids, physical therapy, TENS, acupuncture.

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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.

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63. Contraception

• Progestin: Pregnancy prevention, unexplained bleeding, breast cancer, drug interactions.

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

• Hormonal:

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

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

• Contraindications: Estrogen use contraindicated in smokers, age >35, breastfeeding, clot history.