Farias-Test II Drug Actions Spring 2007
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| Alpha Cells | Glucagon
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| D cells | Somatostatin
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| Beta Cells | Insulin, Amylin
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| Proteases | Typsinogen, Chymotrypsinogen, Procarboxypeptidase (digest proteins and peptides)
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| Lipases | Triglycerides into monoglycerides and free fatty acids
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| Amylases | hydrolyze starch into maltose
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| insulin | glucose into live, muscle, and adipose tissue
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| glucagon | inc. glycogenolysis, gluconeogenesis, and lipolysis
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| Somatostatin | supress release of pancreatic hormones, GI homrones, GH, and TSH
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| Amylin | slows gastric emptying, promotes satiety, and regulates glucagon secretion
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| acute pancreatitis | clinical syndrom of acute inflammation and destructive auto digestion of pancreas and extrapancreatic tissue
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| Acute Pancreatitis etiology | Alcohol, Biliary tract obstruction, viral or bacterial, trauma, familiar
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| acute pancreatitis pathophysiology mild | no hemmorrhage, infiltraiton of neutrophills, swelling of pnacrease, suppuration
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| acute pancreatits severe | massive necrosis, liquefaction, avscess, hemorrhage, pancreatic ascites, fat necrosis
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| acute pancreatitis clinical manifestations | pain, severe, deep, constant, N/V, Fever, Shock, coagulopathy, metabolic irregularities (acidodis, hyperkalemia, hypocalcemia), jaundice
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| Kalikrien | edema inflammation
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| chymotrypsin activation | edema vascular damage
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| elastase activation | vascular damage, hemorrhage
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| phospholipase A2 activation | coagulation, necrosis
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| lipase | fat necrosis
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| Chronic Pancreatitis | relapsing; inflammatoiin of parenchyma, progressive destruction of acini, ductule stenosis, dilation, fibrosis
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| chronic pancreatitis etiology | alchol, long term obstruction of pancreatic duct, autoimmunity, idiopathic
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| chronic pancreatitis pathophysiclogy | scaring, fibrosis, shrinkingi, stenosis, dilation of ducturles, lymphocyctic infiltrate, increase ductlin permeability due to chronic inflammation, inc. free radicals, toxic metabolites, lysosomal activity
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| chornic pancreatitis manifestations | sever ab. pain, N/V, weight loss, steatorrhea, hyperglycemia, jaundice
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| pancreatic insuffienciency | maldigestion resulting from disorders interfering with effective pancreatic enzyme activity
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| pancreatic insufficiency etiology | chronic pancreatitis, cystic fivrosis, surgery, increased gastreic acid, hyperlipidemia
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| pancreatic insuffieciency pathophysiology | fat melabsorption, decrease in lipase of bicarbonate
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| pancreatic insuffienciency clinical manifestation | steatorrhea, diarrhea, hypoclacemia, nephrolithiasis, Wieght loss, edema/ascites
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| diabetes mellitus acute manifestation | hyperglycemia, hypoglycemia, glucosuria, polyuria, polydipsia, pholyphagia, diabetic ketoacidosis, hyperosmolar coma
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| DM clinical chronic manifestations | blindness, nephropathy, atherosclerosis, endotherlial dysfunction, hypertension, neuropathy, diabetic foot ulcers, infections
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| throid hormone | increase activity of metabolic enzymes and NA/K atpases, o2 consumption, protein catabolism-adult, anabolism-children, normla development of NS
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| parathyroid hormone | inc. vit. D synthesis, renal calcium adsorption, born resortion, increase plasma calcium levels
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| Graves disease manifestations | nervouseness, irritability, alertness, muscular weakness, palpitations, tachycardia, DEC. TSH; INC T4, metabolic rate, exophtalmos, optic nerve pressure -> blindness
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| Hashimotos Thyroiditis | myxedema (skin irritation), hyothermia, DEC. basla metabolic rate, mental retardation in children, slow thinking, ataxia, forgetfulness, lethargy in adults, bradycardia, INC TSH; DEC T4
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| Hyperparathyroidism | excess PTH secretion and hypercalcemia
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| hyperparathyroidism etiology | adenoma, idiopathic, iatrogenic
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| hyperparathyroidism pathiophysiology-primary | excess autonomous produciton and release of PTH by PTH gland
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| Hyperparathyrodism pathophysiology-secondary | defect outside glands, sever calcium or vit. d deficiency; chronic renal failur, dec. calsium reabsorption, skeletal resistance to PTH
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| hypoparathyroidism | low PTH secreation and hypocalcemia
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| hypoparathyroidism etiology | uncommon, truama, surgical damage, autoimmunity
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| hypoparathyroidism clinical manifestations | confusion, weakness, mental retardation, tetany, seizure, CHF, enamel hypoplasia of teeth
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| Asthma | airway inflammation and airflow obstuction and bronchial hyperresponsiveness
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| asthma etiology | most common, 3-5%, hyper-immune response, increased reactivity of airway, triggers: histamine, cold, polution, viruses, allergens, genetic
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| asthma clinical manifestations | cough, wheezing, dyspnea, tachypnea, tachycardia, hypoxemia, bronchial hyper-responsiveness, poor performance on pulmonary function test
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| Chronic bronchitis | air inflammation and airflow obstruction
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| chronic bronchitis etiology | cigarrettes, irritants: ozone, coal burning
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| chronic bronchitis clinical manifestations | wheezing, CRACKLES, dyspnea, PULMONARY HTN, poor performance on pul. perf. test., hypoxemia, polycythemia
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| Emphysema | decreased recoil tension, expiration more work, trouble getting air out
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| emphysema etiology | cigarettes, genetics (alpha 1 proteatse inhibitor deficiency, alpha-1 antitrypsin deficiency
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| emphysema CM | NO PRODUCTIVE COUGH, dyspnea, decreased beath sounds, HYPER INFLATION, tachycardia, hypoxemia, poor pef. pul. funct. test, HYPERCAPNIA, polycythemia
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| Pulmonary Fibrosis | scarring of lung parenchyma (air trouble in and out)
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| plumonary Fibrosis Etiology | chornic inflammation of alveolar walls, diffuse and professive severe fibrosis, recruitment and activation of inflammatory cells, cigarette smoke main cause
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| pulmonary fibrosis CM | NONPRODUCTIVE COUGH, tachypnea, INSPIRATORY CRACKLES, pulmonay HTN, SMALL VOLUME, hypoxemia, hypercapnia,
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| Pulmonary Edema | accumulation of excess fluid in the extravascular space
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| Pulmonary Edema CM-cardiogenic | dyspnea, non-productive cough, ORTHOPNEA, SHALLOW TACHYPNEA, hypoxemia, wheezing, INSPIRATORY CRACKLES, increase hyrostatic pressure, protein poor edema fluid
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| Pulmonary Edema CM-non cardiogenic | mechanical ventailation, may lead ot pulmonary fibrosis, protein rich edema fluid, normal hydrostatic pressure
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| Pulmonary Embolism | venous thrombi from legs migrate to lung circulation
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| pulmonary embolism | secondary to disease, virchow's triad of risk factors
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| virchows triad of risk factors, | statis of blood, injury to vessel wall, increased clotting
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| pulmonary embolism CM | dyspnea, PLEURITIC CHEST PAIN, HEMOPTYSIS, SYNCOPE, swollen, tender, warm, red calf, abnormal ECG.
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| Alzheimers | degernerative disease of brain with insidious onset of dementia
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| alzheimse Pathophsyiology | plaque build up-amyloid b-peptide, presenilin mutaitons, apo-lipoprotein E, neurofibrillary tangles, astrocytosis, microglial proliferaiton, neuronal loss
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| Alzheimers Disease CM | dementia, 5-10 years, memory loss, impairment of learning, spatial disorientation, aphasia, anomia
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| Parkinsons disease | progessive degenerative neurological disease
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| parkinsons disease Pathophysiology | degeneration of dopamine cells in SN, lewis bodies, abnormal protein degreadation, oxidative stress
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| parkinsons disease CM | bradykinesia, freezing, involuntray movements, motor fluctuations, postural instability, orthostatic hypotension, rigidity,tremor
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| Epilepsy | disorder of recurrent seizures
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| epilepsy-pathophysiology | after brain lesion, abnormal calcium currents, GABA dyscuntion, paroxysmal disturbances, synchronous discharge of cortical neurons
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| epilepsy-CM-partial seizures | small brain lesion, concious or unconcious
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| epilepsy-CM absences | staring in childhood, brieg loss of conciousness, slight head movement, spacing out, alert after seizure
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| Epilepsy CM tonich clinic seizures | loss of conciousness, tonich limb and back, confusion after regain conciousness
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| Myasthenia Gravis | autoimmune disorder or neuromuscular transmission
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| myasthenia gravis-pathophysiology | Ab formed against nicotine receptors, less nicotine recptions, stufcutally deficient synaptic clefts
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| myasthenia gravis CM | fluctuating fatige, weakenss that gets better with rest, mild to severe weakness in ocular and skeletal muscles
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| MS | autoimmune disorder of demylination
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| MS-pathophysiology | T&B cell immunity involved, CNS demylination, relapsing vs. chronic
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| MS-CM | visual loss, extra-ocular movement, parathesias, loss of senation, weakness, dysarthria, spasticity, ataxia, bladder dysfunction
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| hypothalamic insuffieciency | anterior pituitary trophic hormones
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| hypothalamic insufficiency Etiology | developmental, traumatic, neoplastic, inflammatory, vascular, infection
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| hypothalamic insuffienciency-pathophysiology | PROP-1 mutation, TF mutations -> deficiency GH, PRL, TSH, gonadotropin
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| hypothalamic insuffieciency-CM | Kallman, Laurence-Moon-Bardet-Beidl, Frolich, Prader Willi
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| Kallman syndrome | defective GnRH color blindness, nerve eagness, cleft palate, low FSH, LH
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| Laurence-Moon-Bardet-Beidl syndrome | mental retardation, obesity, hexadactyly, brachydactyly, retinal degeneration (blind before 30)
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| Frolich syndrom | hypothalmic lesions, central hypogonadism, hyperphagia, obesity
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| Prader Willi Syndrome | mental retardation, hyperphagia, obesity, TII diabetes, muscle hypoonia, multiple somatic defects
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| Anterior Pituitary Hyperprolactinemia | hypersecretion of prolactin; most common
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| Hyperprolactinemia-etiology | pituitray adenoma, pregnancy, lactation, radiation, trauma, systemic disorders (renal failure, hypthyroidism, cirrhoisis, epileptic seizures)
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| Hyperprolactinemia-CM | amenorrhea, galactorrhea, diminished libido or visual loss, PRL lvls >1000 ug/L
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| Anterior Pituitary-Growth hormone disorders | hyper or hyposecreiton of GH
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| pituityar dwarfism | anterior pituitary, short stature, high pitch voice, hypoglycemia, GHRH receptor mutations, growth hormone insensitivity, GH respons <7 ug/L
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| Anterior Pit-Acromegaly | GH hypersecretion, acral bony, voice deepening, oily skin, arthropathy, kypohosis, muscle weakness, fatigue, GH supress less 1ug/L challenged with glucose, surgery is only option
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| Anterior Pit-Adrenocorticotropin hormone disorder | hyper or hyposecretion of ACTH
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| ACTH deficiency | Anter. pit hypo; surgery, supression of HPA axis, ademnoma, low serum corticsol, fatigue, weakness, anorexia, nausea, vomiting, hypoglycemia
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| cushings disease | ant. hormone, pit corticotrop adenoma, iatrogenic, ectopic tumor secreting ACTH; thin brittle skin, cetnral ovesity, HTN, plethoric moon faces, purple striae, diabetes, osteoporisis, leukocytosis, lymphopenia, eosinopenia, immune supression, DXM diagnosis
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| Ant. Pit.-FSH and LH | gonadotropin
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| gonadotorpin deficiency | kallman syndrom, DAX1 gene mutation, stress, anorexia, starvations, extreme exercise, amenorrhea, infertility, decresed libido, dec. muscle mass, reduced body hair
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| gonadotropin producing adenoma | FSH, LH, optic X pressure, menstrual disturbances, ovarian hyperstimulation
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| Ant-Pit. TSH hormone def. | low basal TSH, altered biological activity, low thyroid hormone, pituity hypothyroidism, TRH increase TSH 2-3 times
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| TSH secreting adenoma | rare, large, locally invasive, thyroid goiter, hyperthyroidism, high TSH and T4, positive MRI
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| syndrome inappropraite vassopressin secretion | acute inflammation and destructive auto digestion of the pancreas and extra pancreatic tissue
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| inappropriate vasopressin secretion-etiology | primary: agenesis destruciton of neurohyphpysis, Xq28 gene disruption, secondary: excessive intake of fluid, polydipsia
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| vasopressin secretion-pathophysiology | decresase urin concentraiton, diabetes insipidus
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| vasopressin secretions-CM | decreased vasopression secretion, nocturia, enuresis, polyuria
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