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 the small intestine lining (duodenum, jejunum).
Signs & Symptoms: Abdominal pain, bloating, pale/greasy/foul-smelling diarrhea, malnutrition (rickets, anemia, occult blood), easy bruising, hypomagnesemia/hypocalcemia causing irritability, tremors, convulsions, tetany, bone pain, osteomalacia.
Lab Tests: IgA-tTg, IgA-EMA, total IgA (test IgG, IgA-DGP, IgG-AGA if IgA deficient).
Diagnosis: Serologic IgA antibodies, HLA-DQ2/DQ8 genotyping, duodenal biopsy via endoscopy.
Management: Gluten-free diet (avoid Barley, Rye, Oats, Wheat — BROW).

2. Sjogren’s Syndrome

Common in older women, especially with RA or SLE.
Symptoms: Dry eyes, dry mouth.
Tests: Positive SSA and SSB antibodies.

3. Herbs

• Cinnamon: Lowers blood glucose, cholesterol, BP, bleeding risk. Avoid breastfeeding; interacts with diabetic, anticoagulant, heart meds.
• Ginkgo Biloba: Slows dementia, treats erectile dysfunction. Increases bleeding risk; avoid with anticoagulants; lowers seizure threshold.
• Glucosamine: Used for osteoarthritis.
• Green Tea: Aids weight loss, mental clarity. Risk of hepatotoxicity; avoid with vasodilators, stimulants, psychoactives; contains vitamin K (interferes with warfarin).
• Lavender: Relieves anxiety, stress, insomnia. May cause constipation, headache, increased appetite; caution with CNS depressants, antihypertensives.

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% at 3–5 years post-Stage I surgery; 90% if surviving 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: Tube feeding, cardiac support, BP control, diuretics.

5. Parathyroid

Function: Produces PTH regulating calcium; high PTH causes bone calcium release → bone loss.
Lab Values: 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:
• Hyperparathyroidism: calcimimetics, hormone therapy, bisphosphonates.
• Hypoparathyroidism: maintain low-normal calcium.

6. Hutchinson-Gilford Progeria Syndrome

Rare genetic disorder causing rapid aging in children (onset 1-2 years).
Cause: LMNA mutation → abnormal progerin protein → nuclear envelope instability.
Symptoms: Short stature, slow hair growth, alopecia, joint issues, skin wrinkles, failure to thrive, delayed teeth.
Treatment: Statins, nitroglycerin, NSAIDs, bone-strengthening meds, therapy.
Life Expectancy: 13–20 years (aging 10x faster).

7. Neuropathy

Alternatives to gabapentin for diabetic neuropathy: duloxetine, pregabalin.

8. Hydrotherapy

Helps symptom management in Multiple Sclerosis and Myasthenia Gravis.

9. Pneumothorax vs Hemothorax

• Both cause decreased/absent lung sounds.
• Pneumothorax: air in pleural space; hyperresonant percussion.
• Hemothorax: blood in pleural space; dull percussion anterior/posterior.

10. Tuberculosis

Testing: Tuberculin skin test (PPD), chest X-ray or CT (white spots).
Medications: Isoniazid, Rifampin (avoid with oral contraceptives), Ethambutol, Pyrazinamide.

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).
Hyperthyroidism: Tachycardia, nervousness, insomnia, weakness, heat intolerance, exophthalmos. Treat with PTU, Methimazole.
Hypothyroidism: Puffy face, dry skin, hair loss, fatigue, cold intolerance. Treat with levothyroxine.

12. Crohn’s Disease vs Ulcerative Colitis

• Crohn’s: Affects entire GI tract, skip lesions, cobblestone mucosa. Symptoms: pain, diarrhea, bleeding, fistulas, mouth ulcers. Tests: ASCA antibody, colonoscopy. Treatment: aminosalicylates, steroids, immunosuppressants. Diet: low-residue, avoid caffeine/alcohol, no sharp foods.
• Ulcerative Colitis: Affects colon and rectum lining only. Symptoms: bloody diarrhea, rectal pain, urgency. Tests: pANCA antibody, colonoscopy. Treatment: anti-inflammatories, steroids, immunosuppressants.

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 and low oxygen.
  Treatment: IV fluids, analgesics, oxygen, transfusions.
  Medications: Hydroxyurea (reduces crises), avoid iron supplements.
  Newborn prophylaxis: Penicillin, folic acid, vaccines.

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.

15. Pregnancy Immunizations

Recommended: Influenza, TDAP (27-36 weeks), Pneumococcal, Hepatitis A/B, Meningococcal.
Contraindicated: Varicella, MMR.

16. Varicella (Chickenpox)

Highly contagious viral illness 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.

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).

18. PPD and BCG Vaccine

BCG vaccine causes >10mm induration but doesn’t yield positive PPD.
Skin test read 48-72 hours post-injection.

19. Benign Prostatic Hyperplasia (BPH)

Treated with Tamsulosin (Flomax), an alpha-1 antagonist. Educate about hypotension risk.

20. Congestive Heart Failure (CHF)

• Left-sided: pulmonary symptoms (JVD, rales, S3 murmur).
• Right-sided: peripheral edema, abdominal distension.
  Ejection Fraction (EF): Normal 55-70%; Reduced EF <40% (systolic failure); Preserved EF 40-49% (diastolic failure).
  Testing: BNP (>100 suggests HF), echocardiogram.

21. Pleural Effusion

Symptoms: Chest pain, dry cough, dyspnea, orthopnea, fever.
Testing: Chest X-ray, CT, ultrasound.
Treatment: Thoracentesis, chest tube, diuretics, antibiotics, oxygen.

22. Diabetes

Antihypertensives: ACE inhibitors (e.g., captopril), ARBs.
Insulin: Types & timing (Regular, NPH, Lispro, etc.).
Hyperglycemia/Ketoacidosis: Fruity breath, polyuria, fatigue, confusion.

28. Cellulitis

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

29. Panic Attack, Hallucinations, Nightmares

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

30. Multiple Sclerosis

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

31. Kidney & Blood Pressure Regulation

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

32. HLA-B*58:01 & Allopurinol

Linked to severe skin reactions (SJS, TEN), especially in Korean, Han-Chinese, Thai patients.

33. Doxycycline

Increases warfarin effect—monitor INR carefully.

34. Muscle Spasms

Treated with Baclofen and Gabapentin.

35. Hematomas

• Epidural: lucid interval, CN III palsy, biconvex CT shape.
• Subdural: crescent-shaped CT.

36. Tay-Sachs Disease

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

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)

53. Color Blindness

X-linked mutation OPN1MW on X23 chromosome; dominant in males.

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).

55. Transfusion Reactions

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

56. Small Cell Lung Carcinoma

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

57. Infant Thrush

White/yellow oral patches, cracked mouth corners caused by Candida albicans.
Treat infant and mother with topical nystatin, antifungals, fluconazole.

58. CYP3A4

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

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.

60. Beta Thalassemia

Inherited hemoglobin disorder common in Mediterranean descent.
Symptoms: anemia, jaundice, fatigue, chest pain, bone marrow expansion.
Treatment: Regular transfusions, erythropoietin.

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.

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.

63. Contraception

Progestin: pregnancy, 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: smoking, age >35, breastfeeding, clot history.