Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name Date D027 Cardiovascular & Endocrine Review Q&A for Midterm Study The D027 Cardiovascular & Endocrine Review covers high-yield concepts in pharmacology, pathophysiology, medication safety, and clinical decision-making. For the midterm, students should understand not only what a medication does but also its major adverse effects, contraindications, interactions, monitoring requirements, and patient-teaching points. The review also includes diabetes, thyroid disorders, respiratory and neurologic conditions, musculoskeletal and gastrointestinal disorders, pain management, mental health, stress, genetics, health disparities, pediatrics, aging, and immunization. Cardiovascular Review Questions and Answers What is the most common adverse effect of ACE inhibitors? Answer: A dry, persistent cough. ACE inhibitors such as lisinopril may cause a persistent, nonproductive cough. The reaction is associated with increased bradykinin and other substances in the respiratory tract. If the cough becomes difficult to tolerate, the prescriber may consider an alternative such as an angiotensin II receptor blocker (ARB), depending on the patient’s clinical situation. What should patients taking spironolactone know about potassium? Answer: Potassium supplements and potassium-containing salt substitutes should generally be avoided unless specifically recommended. Spironolactone is a potassium-sparing diuretic. Because it reduces potassium excretion, it can cause hyperkalemia, particularly in patients with impaired kidney function or those taking other medications that increase potassium. Patients should discuss supplements and salt substitutes with their healthcare professional before using them. What should a pregnant patient taking an ACE inhibitor do? Answer: Contact the healthcare provider promptly. ACE inhibitors can cause serious fetal complications and are generally avoided during pregnancy. Potential complications include fetal kidney dysfunction, oligohydramnios, and neonatal problems. A patient who becomes pregnant while taking an ACE inhibitor should contact the prescribing clinician promptly so the medication regimen can be reassessed. Why may metoprolol be combined with nifedipine? Answer: Metoprolol can help control reflex tachycardia associated with nifedipine. Nifedipine is a dihydropyridine calcium channel blocker that relaxes vascular smooth muscle and may cause reflex increases in heart rate. Metoprolol, a beta blocker, slows the heart rate and can reduce this response in appropriately selected patients. How can patients reduce orthostatic hypotension caused by vasodilators? Answer: Change positions slowly and avoid standing abruptly. Vasodilating medications can lower blood pressure and cause dizziness when a person changes position. Patients should move gradually from lying to sitting and from sitting to standing. Adequate hydration, when appropriate, and fall-prevention measures may also be important. Which lifestyle changes can help manage hypertension? Answer: Reduce sodium intake, maintain a healthy weight, exercise regularly, moderate alcohol consumption, and avoid tobacco. Lifestyle modification is an important part of blood pressure management. A heart-healthy eating pattern such as the DASH diet, regular physical activity, weight management, and tobacco avoidance can support cardiovascular health. Family history and other risk factors should also be considered. Which medications can improve outcomes after myocardial infarction? Answer: ACE inhibitors and beta blockers are commonly used when clinically appropriate. Evidence-based medications after myocardial infarction can reduce cardiovascular complications and mortality in appropriate patients. Treatment depends on factors such as left ventricular function, blood pressure, kidney function, comorbidities, and medication tolerance. Which two antiarrhythmic medication groups can produce similar cardiac effects? Answer: Beta blockers and nondihydropyridine calcium channel blockers. Beta blockers and nondihydropyridine calcium channel blockers such as verapamil and diltiazem can decrease heart rate and slow atrioventricular-node conduction. They can also reduce myocardial contractility, although their specific indications and clinical effects differ. What symptom is concerning when a patient taking simvastatin is prescribed azithromycin? Answer: New muscle pain, tenderness, or weakness. Muscle symptoms in a patient taking a statin require attention because they can indicate statin-associated muscle injury. Severe muscle injury can lead to rhabdomyolysis and kidney damage. Potential medication interactions should be reviewed whenever a new drug is added. How is significant warfarin-associated bleeding treated? Answer: Vitamin K and, when indicated, rapid factor replacement therapy. Management depends on the INR, severity and location of bleeding, and overall clinical condition. Serious or life-threatening bleeding may require intravenous vitamin K together with a rapid reversal product such as four-factor prothrombin complex concentrate (PCC). Endocrine Review Questions and Answers What short-term complications should be monitored in a newly diagnosed patient with diabetes? Answer: Hyperglycemia, hypoglycemia, and diabetic ketoacidosis (DKA). Acute glucose abnormalities can develop rapidly and may require urgent treatment. Long-term complications, including neuropathy, kidney disease, and vascular disease, generally develop over a longer period and require ongoing preventive care. Which insulin can be used for rapid correction of premeal hyperglycemia? Answer: Rapid-acting insulin such as lispro, aspart, or glulisine. Rapid-acting insulin analogs have a relatively quick onset and short duration. They are commonly administered around meals according to an individualized insulin plan and glucose-management strategy. What dietary strategy is important for many patients with type 1 diabetes? Answer: Carbohydrate counting. Carbohydrate counting helps patients coordinate food intake with insulin doses. Nutrition planning should be individualized based on insulin regimen, activity, glucose targets, nutritional needs, and other health conditions. Which laboratory test estimates average blood glucose over approximately two to three months? Answer: Hemoglobin A1C (HbA1c). HbA1c reflects average glucose exposure over roughly the previous two to three months. Conditions that change red blood cell lifespan can affect its accuracy, so results should be interpreted in the appropriate clinical context. How is insulin glargine generally administered? Answer: It is generally administered once daily according to the prescribed regimen. Insulin glargine is a long-acting basal insulin designed to provide relatively consistent glucose-lowering activity. It is not intended to replace rapid-acting mealtime insulin when that component is prescribed. What medication may be included in the treatment of thyroid storm? Answer: Propylthiouracil (PTU) may be used as part of a comprehensive treatment regimen. Thyroid storm is a life-threatening manifestation of severe thyrotoxicosis. Management may include a thionamide such as PTU, beta blockade when appropriate, corticosteroids, supportive treatment, and management of the precipitating condition. Which findings are commonly associated with hypothyroidism? Answer: Bradycardia, cold intolerance, fatigue, and reduced body temperature can occur. Hypothyroidism slows metabolic processes. Other possible findings include dry skin,

Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name Date Alzheimer’s Disease Synthesis What is Alzheimer’s Disease? Alzheimer’s Disease (AD) is a chronic and progressive neurological disorder that primarily affects cognitive functions such as memory, reasoning, and thinking. It is the most common form of dementia, responsible for approximately 60% to 80% of all dementia cases worldwide. This condition poses a significant public health challenge, especially in the United States, where Alzheimer’s is ranked as the seventh leading cause of death (National Institutes of Health [NIH], 2021). The disease predominantly affects older adults but is not considered a normal part of aging. What Causes Alzheimer’s Disease? (Pathophysiology) The exact cause of Alzheimer’s Disease is not fully understood, but it is widely accepted that the condition arises from a complex combination of genetic, environmental, and lifestyle factors. At the cellular level, AD is characterized by the accumulation of beta-amyloid plaques outside neurons and neurofibrillary tangles composed of tau protein inside neurons (NIH, 2021). These pathological changes disrupt neuronal communication, leading to the loss of synapses and eventual neuronal death. This neuronal damage impairs the brain’s ability to produce essential neurotransmitters, especially acetylcholine, which plays a crucial role in memory and learning. Brain areas responsible for cognition, such as the hippocampus and cerebral cortex, show significant shrinkage or atrophy in Alzheimer’s patients. Additionally, chronic neuroinflammation and an overactive immune response within the brain accelerate the formation of plaques and tangles, worsening neurodegeneration and cognitive decline. What are the Clinical Manifestations of Alzheimer’s Disease? Alzheimer’s Disease progresses gradually through distinct stages, generally classified as mild (early), moderate, and severe (late stage). Before these stages are clinically evident, there are ten hallmark warning signs that may indicate early disease onset. These signs serve as key indicators for early detection and intervention. Warning Sign Number Symptom Description 1 Memory loss that disrupts daily life 2 Difficulties with planning and problem-solving 3 Trouble completing familiar tasks 4 Confusion about time or place 5 Problems with visual perception and spatial relations 6 New difficulties in speaking or writing 7 Misplacing items and inability to retrace steps 8 Poor or decreased judgment 9 Withdrawal from work or social activities 10 Changes in mood and personality The disease course usually extends over several years. After diagnosis, life expectancy varies widely, averaging between four and eight years, though some individuals may live up to twenty years depending on overall health, disease progression, and care quality. Risk factors associated with Alzheimer’s include advanced age, traumatic brain injury, hypertension, diabetes, obesity, and smoking. Notably, women have a higher likelihood of developing AD compared to men, and African Americans experience about twice the risk relative to other ethnic groups. How is Alzheimer’s Disease Diagnosed? Diagnosing Alzheimer’s Disease requires a comprehensive approach that combines clinical evaluation with diagnostic testing. Healthcare providers begin by gathering detailed information about the patient’s medical history, lifestyle, and any observed behavioral or cognitive changes. Cognitive tests assess areas such as memory, attention, problem-solving, language, and orientation to help distinguish AD from other dementias or cognitive disorders. Laboratory tests such as blood and urine analyses are performed to rule out other causes of cognitive decline, including infections or metabolic disorders. Imaging studies, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), play a critical role in detecting brain atrophy and amyloid plaque deposits, thereby supporting the diagnosis (NIH, 2021). References National Institutes of Health. (2021). Alzheimer’s disease fact sheet. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet Western Governors University. (n.d.). Alzheimer’s disease. Panopto. https://wgu.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=f280f008-5d8e-42b3-8f7ead8a00f1a105 D027 Alzheimer’s Disease (AD) Final Synthesis: Understanding Key Aspects United Health Foundation. (2022). Explore colorectal cancer screening in Virginia: 2021 annual report. America’s Health Rankings. https://www.americashealthrankings.org/explore/annual/measure/colorectal_cancer_screening/state/VA

Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name Date D027 OA Final Exam Study Guide: Essential Concepts and Medical Conditions Cryoablation and Prostate Cancer Treatment What is cryoablation? Cryoablation is a minimally invasive medical treatment used primarily for prostate cancer. This procedure involves freezing cancerous tissue within the prostate gland, leading to cellular destruction and tumor reduction. By applying extreme cold, cryoablation causes ice crystals to form inside cancer cells, disrupting their integrity and inducing apoptosis. It is considered a therapeutic alternative for patients who may not be candidates for surgery or radiation therapy. Occupational Lung Disease What disease is caused by exposure to sandblasting? Silicosis is a lung disease resulting from inhaling silica dust, a common hazard in occupations like sandblasting. The inhaled silica particles trigger chronic inflammation and progressive scarring (fibrosis) in lung tissues, impairing respiratory function. This occupational lung disease is characterized by symptoms such as coughing, shortness of breath, and increased susceptibility to infections. Amyotrophic Lateral Sclerosis (ALS) Which category of ALS is most frequently observed? The most common form of Amyotrophic Lateral Sclerosis (ALS) is sporadic ALS, which arises without identifiable hereditary causes or genetic mutations. This neurodegenerative disorder leads to the progressive loss of motor neurons, causing muscle weakness, twitching, and paralysis over time. Differentiating Types of Arthritis How can osteoarthritis be distinguished from rheumatoid arthritis? Osteoarthritis primarily results from mechanical wear and tear on joints, often manifesting as localized pain and stiffness, especially after activity. In contrast, rheumatoid arthritis is an autoimmune condition characterized by symmetrical joint inflammation, systemic symptoms like fatigue, and involvement of multiple joints. The pathological mechanisms and clinical presentations differ significantly, guiding diagnosis and treatment. Cardiac Conditions Question Answer What does vegetation on an echocardiogram indicate? Vegetation suggests infective endocarditis, where bacterial or fungal growths adhere to heart valves. What defines a Type 2 Myocardial Infarction (MI)? Type 2 MI occurs due to an imbalance between myocardial oxygen supply and demand rather than plaque rupture. What are the classic symptoms of MI? Symptoms commonly include chest pain, pain radiating to the neck or jaw, and vomiting. What is a key risk factor for erectile dysfunction? Cardiovascular diseases, especially underlying heart disease, significantly increase risk. Liver Conditions What does the combination of ascites, jaundice, and elevated AST and ALT suggest? These clinical signs are indicative of liver cirrhosis, a chronic condition where the liver undergoes fibrosis and impaired function. Ascites is the accumulation of fluid in the abdominal cavity, jaundice reflects elevated bilirubin levels, and elevated liver enzymes (AST and ALT) signify hepatocellular injury. Kidney and Hematologic Disorders Question Answer What diagnosis fits decreased urine output, anemia, fatigue, and itchy skin? These symptoms are characteristic of End-Stage Renal Disease (ESRD), where kidney function is severely compromised. What is aplastic anemia? Aplastic anemia is a condition marked by bone marrow failure to produce adequate blood cells, leading to pancytopenia. Genetic and Infectious Diseases Question Answer What is a chromosomal abnormality? It involves changes in chromosome number or structure; Turner syndrome is an example, where a female has a missing X chromosome. Which communicable disease causes rapid muscle weakness or paralysis? Poliomyelitis causes acute muscle paralysis, often developing within hours of symptom onset. What causes malaria? Malaria is caused by Plasmodium parasites transmitted through the bite of infected female Anopheles mosquitoes. Biomarkers and Solutions What is the HE4 biomarker associated with? HE4 is a protein biomarker elevated in ovarian tumors and ovarian cancer, aiding in diagnosis and monitoring of these conditions. Is 0.9% sodium chloride solution isotonic to red blood cells? Yes, 0.9% NaCl (normal saline) is isotonic with red blood cells, meaning it does not cause them to shrink (crenate) or swell (hemolyze) when administered. Causes of Peripheral Neuropathy and Delayed Puberty Question Answer What are common causes of peripheral neuropathy? Peripheral neuropathy can result from vitamin deficiencies, diabetes, stroke, or cardiovascular events. What conditions lead to delayed puberty? Chronic illnesses and systemic diseases can disrupt the normal timing of puberty development. Gynecological and Hematological Conditions Question Answer What symptom is linked to dysmenorrhea? Dysmenorrhea is characterized by painful menstrual cramps. What are common risk factors for cholecystitis? Gallstones, obesity, and infections significantly increase cholecystitis risk. Infectious Diseases and Musculoskeletal Disorders Question Answer What is a symptom of stage one Lyme disease? Early Lyme disease often presents with swollen lymph nodes near the bite site. What is lordosis in spinal curvature? Lordosis refers to an exaggerated inward curvature of the lumbar spine. Neuromuscular Conditions What clinical features and treatment are associated with ALS? Amyotrophic Lateral Sclerosis (ALS) presents with involuntary muscle contractions (fasciculations), progressive weakness, and twitching in the lower extremities. Treatment often includes anti-glutamate medications such as riluzole, which may slow disease progression. Secondary Hypertension What causes secondary hypertension in relation to sleep disorders? Obstructive Sleep Apnea (OSA) is a recognized cause of secondary hypertension due to repeated episodes of hypoxia during sleep. This triggers increased sympathetic nervous system activity, leading to elevated blood pressure. Basic Science Concepts Question Answer What is diffusion? Diffusion is the passive movement of molecules from an area of higher concentration to a lower concentration. What can tympanic membrane perforation cause? A perforated tympanic membrane can allow bacteria to enter the middle ear, resulting in infections such as otitis media. Hematological and Genetic Triggers What triggers vaso-occlusive crises in sickle cell anemia? Episodes of acidosis and dehydration are common triggers for vaso-occlusive crises in sickle cell anemia. These conditions promote sickling of red blood cells, leading to blockage of small blood vessels and ischemic pain. Renin-Angiotensin-Aldosterone System (RAAS) What is the function of the RAAS system? The Renin-Angiotensin-Aldosterone System plays a vital role in maintaining blood pressure and fluid balance by inducing vasoconstriction and promoting sodium and water retention, which increases blood volume. Gastrointestinal Conditions What is a pouch-like protrusion found in the sigmoid colon called? This condition is known as diverticulosis, where small pouches (diverticula) form in the colon wall, often due to increased intraluminal pressure or weakening of the

Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name Date D027 Shadow Health Treatment Plan for Dr. Douglas: Phase 3 Guide Patient Overview: Dr. Anita Douglas Who is the patient? Dr. Anita Douglas is a 72-year-old African American woman who resides at home with her spouse. She is retired, having previously served as a Veterinary Chief. Her demographic and occupational background contribute to understanding her overall health status and lifestyle considerations. Presenting Complaints and Symptom History What symptoms is the patient currently experiencing? Dr. Douglas reports a one-day history of fever and nasal congestion lasting three days, characterized by yellow-green mucus discharge. She also describes a productive cough with rust-colored sputum, accompanied by discomfort localized in the right lower chest area that intensifies during coughing or deep breathing. Additionally, she experiences fatigue and generalized muscle soreness, indicative of systemic involvement. Lifestyle and Activity Patterns What is Dr. Douglas’s level of physical activity? She participates in light physical activity, which includes walking approximately 10 minutes, two to three times per week. This limited activity level may influence her recovery pace and overall cardiovascular health. What dietary habits does she follow? Dr. Douglas adheres to a lacto-ovo vegetarian diet, incorporating dairy products and eggs while excluding meat. This diet impacts her nutritional status and potentially her immune function. Vaccinations and Allergy Status Vaccination Date Administered Influenza 3 months ago Pneumococcal 12 years ago Does Dr. Douglas have any known allergies? She has no known drug allergies (NKDA) or food allergies (NKFA), which simplifies the selection of pharmacological treatments. Medical History and Current Medications What are the significant medical conditions in Dr. Douglas’s history? Dr. Douglas has a history of chronic kidney disease stage 2 (CKD-2) for the past nine years, pulmonary hypertension (P-HTN), and hypertension (HTN) for 14 years. These conditions require careful consideration when managing new illnesses and prescribing medications. Which medications and supplements is she currently using? Medication/Supplement Dose/Frequency Purpose Trandolapril/Verapamil 2 mg / 180 mg daily Blood pressure management Chlorothiazide 500 mg twice daily Diuretic for hypertension Aspirin 325 mg as needed Pain relief, anti-inflammatory Calcium 1200 mg daily Bone health Vitamin D 15 mcg daily Bone and immune support Does Dr. Douglas smoke or consume alcohol? She is a non-smoker, consumes 1-2 glasses of wine weekly, and reports no use of illicit drugs. Diagnosis What is the confirmed diagnosis for Dr. Douglas? Dr. Douglas has been diagnosed with Community-Acquired Pneumonia (CAP). This condition is a common respiratory infection, typically bacterial or viral in origin, manifesting with symptoms such as fever, productive cough, and chest discomfort. Discharge Treatment Plan What instructions have been provided for Dr. Douglas’s care post-discharge? Instruction Details Rest Ensure 8 hours of sleep nightly Hydration Increase fluid intake to 64 ounces per day Antibiotic Therapy Start Amoxicillin/Clavulanate and Doxycycline Medication Adjustment Discontinue Aspirin Pain and Fever Management Use Tylenol (acetaminophen) as needed Treatment Compliance Complete the full course of antibiotics Missed Dose Protocol Take missed dose immediately upon remembering Prescription Details Medication Dose/Instructions Amoxicillin/Clavulanate 500 mg/125 mg orally every 12 hours for 5 days (10 capsules). Take with water before or after meals; do not crush or chew. Doxycycline 100 mg orally every 12 hours for 5 days (10 capsules). Take on an empty stomach (1 hour before or 2 hours after food). Drink plenty of fluids to prevent throat irritation. Important Medication Precautions What precautions should Dr. Douglas follow with her medications? Doses should be spaced evenly every 12 hours, preferably in the morning and evening. It is essential to adhere strictly to all instructions provided with the medications. If any allergic reactions arise — such as hives, rash, swelling, throat tightness, difficulty swallowing or breathing, or chest pain — she must immediately discontinue the medication and seek emergency care. Follow-Up and Emergency Guidance When should Dr. Douglas seek further medical assistance? A follow-up appointment is arranged one week post-discharge to evaluate her recovery. If symptoms worsen or new symptoms emerge, she should promptly seek medical attention, either at the clinic or the emergency room after hours. References Centers for Disease Control and Prevention. (2023). Community-Acquired Pneumonia (CAP). Retrieved from https://www.cdc.gov/pneumonia/community-acquired.html Musher, D. M., & Thorner, A. R. (2014). Community-acquired pneumonia. New England Journal of Medicine, 371(17), 1619–1628. https://doi.org/10.1056/NEJMra1312885 Smith, R. J., & Smith, T. L. (2021). Management of bacterial pneumonia in adults. American Family Physician, 104(10), 1055–1063.

Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name Date D027 CCM1 CPE Activity: Phases 1-3 Synthesis & Feedback Summaries Phase 1: Timeline and Estimated Completion Task Description Proposed Completion Date Estimated Time to Complete 1a. CPE schedule table June 10, 2024 30 minutes 1b. Feedback and Synthesis Improvement Plan June 25, 2024 2 hours 1b. Pathophysiology Synthesis June 25, 2024 2 hours 1c. Three screenshots of GoReact and reflection June 25, 2024 1.5 hours Phase 2: Timeline and Estimated Completion Task Description Proposed Completion Date Estimated Time to Complete 2a. Review CPE schedule table for progress June 30, 2024 30 minutes 2b. Feedback and Synthesis Improvement Plan June 30, 2024 2 hours 2b. Patient or Healthcare Consumer-Focused Synthesis June 30, 2024 2 hours 2c. Three screenshots of GoReact and reflection June 30, 2024 1.5 hours Phase 3: Timeline and Estimated Completion Task Description Proposed Completion Date Estimated Time to Complete 3a. Review CPE schedule table for progress July 4, 2024 30 minutes 3b. Feedback and Synthesis Improvement Plan July 4, 2024 2 hours 3b. Preceptor or Colleague-Focused Synthesis July 4, 2024 2 hours 3c. Feedback and Synthesis Improvement Plan July 4, 2024 2 hours 3c. Patient or Healthcare Consumer-Focused Treatment Plan July 4, 2024 2 hours 3d. Three screenshots of GoReact and reflection July 4, 2024 2 hours Phase 1.1B: Advanced Professional Nurse or Colleague Pathophysiology Synthesis What is Chronic Lower Respiratory Infection, and What Are Its Pathophysiological Mechanisms? Chronic lower respiratory infections encompass a range of enduring lung diseases characterized by inflammation and structural damage to the lower airways. These conditions lead to persistent respiratory symptoms and diminished pulmonary function (World Health Organization [WHO], 2017). The underlying pathophysiology differs among specific diseases: What Are the Clinical Manifestations and Diagnostic Procedures? Patients with chronic lower respiratory infections commonly experience: Diagnosis involves multiple approaches: How Are Chronic Lower Respiratory Infections Treated? Treatment aims to alleviate symptoms, slow disease progression, and improve lung function. Approaches vary by condition: What Feedback Was Received on the Synthesis? Healthcare professionals reviewed the pathophysiology synthesis and described it as well-structured, clear, and informative. It effectively covered essential aspects such as etiology, clinical signs, diagnostics, and treatments. Despite positive feedback, no specific recommendations were suggested, indicating that the synthesis met its educational goals successfully. Reviewers demonstrated thorough understanding by accurately summarizing the disease characteristics, supporting the synthesis’s clarity and comprehensiveness. Phase 1C: GoReact Video Reflection Summary The development of the chronic lower respiratory infection synthesis was intended to provide healthcare providers with a comprehensive yet concise educational resource. Drawing from clinical experience as a Medical-Surgical Telemetry nurse, the content was carefully researched and supported with credible academic references. One of the main challenges was condensing detailed clinical information into a single-page format without losing critical details. Peer feedback was very positive, highlighting the clear, well-organized presentation, which made complex concepts easier to understand. However, reviewers were familiar with the topic, which might have limited the scope of suggestions for improvement. Nevertheless, their ability to clearly articulate the key points reflected strong comprehension. Phase 2.2B: Patient or Healthcare Consumer-Focused Synthesis What Is a Stroke and What Are Its Types? A stroke, also called a cerebrovascular accident (CVA), occurs when the blood supply to part of the brain is interrupted, either by a blockage (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). This interruption causes brain cells to die due to lack of oxygen (American Heart Association, 2021). What Are the Signs and Symptoms? Symptoms depend on the affected brain region but commonly include: The mnemonic F-A-S-T (Facial drooping, Arm weakness, Speech difficulties, Time to call emergency services) aids rapid identification of stroke symptoms (National Institute of Neurological Disorders and Stroke [NINDS], n.d.). How Is Stroke Diagnosed? Diagnosis involves: What Treatments Are Available? Treatment focuses on quickly restoring blood flow and minimizing brain damage: What Preventive Measures Are Recommended? Stroke prevention emphasizes managing risk factors through lifestyle changes such as controlling blood pressure, maintaining a healthy diet, quitting smoking, and increasing physical activity (NINDS, n.d.). What Feedback Did Healthcare Consumers Provide? Consumers found the stroke synthesis clear and informative, appreciating its practical guidance on recognizing symptoms and responding promptly. They suggested enhancing the document by bolding key terms to aid retention. Their ability to restate the information confirmed the effectiveness of the patient-focused synthesis in improving health literacy. Phase 2C: GoReact Video Reflection Summary The stroke synthesis was crafted specifically for healthcare consumers to simplify medical jargon. The primary challenge was balancing the need for brevity while maintaining accessibility for readers without medical backgrounds. Feedback was positive, highlighting the clarity and conciseness of the material. The recommendation to highlight key terms supports better engagement and learning. This process reinforced the importance of adapting health education to the audience’s literacy level for maximum impact. Phase 3: 3B Advanced Professional Nurse or Colleague Synthesis and Patient Treatment Plan Case Overview: COPD Patient Ms. O’Connor Ms. O’Connor is a 55-year-old woman experiencing worsening symptoms of COPD, including productive cough and bronchospasm. Despite efforts with nicotine replacement therapy, she continues to smoke 3 to 5 cigarettes daily. Spirometry reveals a forced expiratory volume in 1 second (FEV1) of 1.37 liters, which is 49% of the predicted value. Her family history includes smoking-related illnesses, and she has gained significant weight over two years. What Is COPD Pathophysiology? COPD is a chronic inflammatory disease of the lungs caused by inhaling harmful particles, resulting in airway narrowing, loss of lung elasticity, and air trapping (Agarwal et al., 2023). These structural changes lead to symptoms such as cough, shortness of breath, and sputum production. What Are the Common Signs and Symptoms? Typical manifestations include: How Is COPD Diagnosed? Diagnosis is based on: What Are the Treatment Options and Potential Medication Side Effects? Treatment Type Medication Examples Purpose Potential Side Effects Bronchodilators Short-acting: Albuterol Relax airways Tremors, tachycardia, headaches   Long-acting: Tiotropium Maintain airway openness Dry mouth, cough Inhaled Corticosteroids Formoterol Reduce airway inflammation Oral thrush, hoarseness (use mouthwash) Smoking Cessation Bupropion Support smoking cessation

Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name Date D027 – Comprehensive Study Guide for Health Disorders and Treatments Genetics and Inheritance What is the difference between autosomal dominant and autosomal recessive inheritance? Autosomal dominant disorders occur when one parent carries the gene responsible for the disease, resulting in a 50% chance that their child will inherit the condition. In contrast, autosomal recessive disorders require both parents to be carriers of the gene mutation; the child then has a 25% chance of developing the disease and a 50% chance of being a carrier without symptoms. What are some common genetic disorders and their characteristics? Genetic Disorder Inheritance Pattern Key Features Cystic Fibrosis Autosomal Recessive Pancreatic dysfunction, lung mucus build-up Trisomy 21 (Down Syndrome) Chromosomal Intellectual disability, facial features Klinefelter Syndrome Extra X chromosome (XXY) Male with some female traits Turner Syndrome Monosomy X Female with single X, short stature Alpha Thalassemia Autosomal Recessive Anemia severity varies Beta Thalassemia Autosomal Recessive Low hemoglobin; ferrous sulfate contraindicated Color Blindness X-linked Vision color perception affected, gene OPN1MW Sickle Cell Disease Autosomal Recessive Abnormal hemoglobin, crises Epidemiology and Immunology How are prevalence risk and incidence rate defined? Prevalence risk refers to the proportion of individuals in a population affected by a disease at a specific time. In contrast, incidence rate measures the number of new cases of a disease in a population over a particular period. What components constitute the immune response? Innate immunity involves immediate defense mechanisms such as inflammation and increased vascular permeability, which allow immune cells to access affected tissues quickly. Adaptive immunity includes B and T lymphocytes, essential for specific immune responses and immunological memory. Oncology What characterizes a primary malignant tumor? Primary malignant tumors lack cellular organization and exhibit uncontrolled growth. These tumors can invade surrounding tissues and metastasize to distant organs. How are glucocorticoids and selective estrogen receptor modulators (SERMs) used in cancer treatment? Glucocorticoids are often combined with other agents to treat lymphoid cancers like leukemia due to their direct toxicity to lymphoid tissue. SERMs, such as Tamoxifen, are used to treat hormone receptor-positive advanced breast cancer by blocking estrogen receptors, thereby reducing the risk of cancer recurrence. Cardiovascular Diseases What is the difference between heart failure (HF) and congestive heart failure (CHF)? Heart failure refers broadly to the heart’s inability to adequately fill or eject blood to meet the body’s metabolic demands. Congestive heart failure is a type of HF where volume overload, especially in the lungs, causes congestion and fluid retention. What are the types of left ventricular dysfunction? Heart Failure Stage Description Management Goals Medications and Devices Stage A At risk, no symptoms/structural disease Control risk factors (hypertension, diabetes) ACE inhibitors or ARBs (e.g., losartan, benicar) Stage B Structural heart disease, no symptoms Prevent progression ACE inhibitors/ARBs, beta blockers, defibrillators Stage C Structural disease with symptoms Symptom management Salt restriction, diuretics, ACE inhibitors, beta blockers, aldosterone antagonists, digitalis, pacing devices Stage D Refractory HF requiring advanced care End-of-life care, transplant options Mechanical support, experimental therapies What are the clinical signs of left-sided congestive heart failure? Patients typically present with pulmonary congestion, jugular vein distention, fluid overload, and an S3 heart sound. Left-sided failure is often the precursor to right-sided CHF. What diagnostic tests are used to confirm CHF? Ischemic Heart Disease and Angina How does ischemic heart disease present? Typical symptoms include chest pain or discomfort often radiating to the neck or jaw, worsening with exertion. Physical examination may reveal abnormal heart sounds or arrhythmias. What is the treatment goal for stable angina? The primary goal is to reduce myocardial oxygen demand. Which medications are used to treat angina? What precautions should be taken when administering cardiac glycosides like digoxin? Digoxin increases cardiac contractility but carries a risk of dysrhythmias. Therapeutic levels range from 0.5 to 0.8 ng/mL. Always check the apical pulse prior to administration to avoid toxicity. Anticoagulants and Antiplatelets What is the goal of anticoagulant therapy? The goal is to prevent thrombus formation by inhibiting clotting factors, especially thrombin. Medication Route Notes Warfarin (Coumadin) Oral Initiate at half dose; monitor INR Heparin Injection Used in acute settings; monitor bleeding risk Lovenox (Enoxaparin) Injection Low molecular weight heparin; bleeding caution Respiratory Diseases What causes pneumonia and how is it diagnosed? Pneumonia results from pathogen invasion of the airway, triggering inflammation and fluid accumulation, which impairs gas exchange and causes hypoxia. Diagnosis is confirmed by chest X-ray showing diffuse whiteness in viral pneumonia or patchy consolidation in bacterial pneumonia. What distinguishes emphysema, bronchitis, and asthma? What medications are used for asthma and COPD management? Musculoskeletal Disorders What is the recommended approach to back pain? Imaging is generally not indicated within the first 4–6 weeks unless neurological symptoms arise. Initial management includes NSAIDs and rest. Back pain remains a leading cause for primary care visits. Endocrine Disorders What are common endocrine disorders and their features? What are thyroid disorder lab values and treatment? Medications and Treatments What are the effects and uses of antihistamines? What are the blood pressure stages? What medications are prescribed post-myocardial infarction? Beta blockers are recommended for six months to reduce cardiac workload and prevent recurrent events. What drugs are used for ischemic vascular disease? Aspirin or other antithrombotics are prescribed to prevent clot formation. What are cervical cancer screening guidelines? Women aged 21–64 should have cytology every 3 years. From ages 30–64, co-testing with cytology and HPV testing every 5 years is recommended. Infectious Diseases and Vaccinations How is the PPD test interpreted? A positive result is defined by an induration greater than 10 mm at 48–72 hours post-test. Prior vaccination (BCG) can cause false positives; repeated testing should be avoided in these individuals. What is the CURB-65 score used for? It is a clinical tool to guide decisions on hospitalization for pneumonia patients. Which antibiotics are preferred for urinary tract infections during pregnancy? Fosfomycin (single dose) and cephalexin are preferred, while nitrofurantoin and Bactrim should be avoided due to potential fetal risks. Neurological and

Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name Date D027 E-Portfolio: Advanced Pathopharmacological Foundations Instructions To fulfill the requirements of the course, completion of the Clinical Practice Experience (CPE) Record is mandatory. You can access the CPE Record under the “Supporting Documents” section within your Assessment Task Overview, where all necessary deliverables are outlined. These deliverables should be integrated into your e-portfolio. Written reflections and submissions may be entered directly into this template. Additionally, you can embed previously created Word or PDF documents by following these steps: 1a. CPE Schedule Table This table is designed to assist with time management and workload organization. Please copy it into your e-portfolio and complete it by adding estimated times and target completion dates. Required CPE Activity (Deliverable) Estimated Time Anticipated Completion Date CPE Schedule Table (Phase 1) 30 minutes 08/31/24 Feedback and Synthesis Improvement Plan (Phase 1) 2 hours 09/01/24 GoReact Video (Phase 1) 1 hour 09/01/24 Peer Responses (Phase 1) 30 minutes 09/01/24 Reflection Summary (Phase 1) 30 minutes 09/01/24 CPE Schedule Table (Phase 2) 30 minutes 09/02/24 Feedback and Synthesis Improvement Plan (Phase 2) 2 hours 09/02/24 GoReact Video (Phase 2) 1 hour 09/04/24 Peer Responses (Phase 2) 30 minutes 09/04/24 Reflection Summary (Phase 2) 30 minutes 09/04/24 CPE Schedule Table (Phase 3) 30 minutes 09/06/24 Feedback and Synthesis Improvement Plan (Phase 3) 2 hours 09/06/24 Feedback and Synthesis Improvement Treatment Plan (Phase 3) 2 hours 09/06/24 GoReact Video (Phase 3) 1 hour 09/09/24 Peer Responses (Phase 3) 30 minutes 09/07/24 Reflection Summary (Phase 3) 30 minutes 09/07/24 1b. Feedback and Synthesis Improvement Plan What is Alzheimer’s Disease? Alzheimer’s disease is a progressive, irreversible neurodegenerative condition primarily affecting cognitive functions and memory. It begins with mild memory loss and gradually deteriorates into an inability to perform routine tasks. This degeneration results from neuronal death causing brain atrophy. According to the Centers for Disease Control and Prevention (CDC), Alzheimer’s ranks among the top 10 leading causes of death in the United States and is the foremost cause of dementia among older adults (Kumar et al., 2024). What are the Pathophysiological Features of Alzheimer’s Disease? Alzheimer’s disease pathology is distinguished by two hallmark features: neuritic plaques and neurofibrillary tangles. What Are the Clinical Manifestations of Alzheimer’s Disease? Alzheimer’s symptoms develop progressively and can be categorized into stages: How Is Alzheimer’s Disease Diagnosed? Diagnosis is comprehensive and includes: 2b. Feedback and Synthesis Improvement Plan What is Heart Disease? Cardiovascular disease (CVD) is the leading global cause of mortality and encompasses conditions such as coronary artery disease, cerebrovascular disease, peripheral artery disease, and aortic atherosclerosis. The fundamental issue is reduced myocardial blood flow, resulting in ischemia and symptoms like angina or myocardial infarction (Lopez, 2023). What Is the Pathophysiology of Heart Disease? The primary pathological process in heart disease is atherosclerosis, characterized by the gradual buildup of lipid deposits, inflammatory cells, and fibrous tissue within arterial walls. This process leads to narrowing (stenosis) and reduced blood flow. Atherosclerosis starts early in life and progresses due to lipid accumulation, immune responses, and endothelial cell dysfunction (Lopez, 2023). What Are the Clinical Manifestations? Symptom Description Chest pain Angina caused by myocardial ischemia Shortness of breath Due to decreased cardiac output Coughing May indicate fluid accumulation Swelling (legs, feet) Peripheral edema from heart failure Fatigue Reduced oxygen supply to tissues Palpitations Arrhythmias or irregular heartbeats How Is Heart Disease Diagnosed? Diagnostic Test Purpose Electrocardiogram (ECG) Detect cardiac rhythm abnormalities and ischemia Echocardiogram Visualize heart structure and function Blood tests Identify cardiac injury biomarkers Chest X-ray Assess heart size and lung conditions Stress test Evaluate cardiac function under exertion What Are Common Treatments and Lifestyle Changes? Treatment often involves medications such as beta-blockers, diuretics, statins, aspirin, and anticoagulants. Essential lifestyle modifications include balanced nutrition, regular physical activity, stress management, weight control, smoking cessation, and monitoring blood pressure and cholesterol levels (Lopez, 2023). 3b. Chronic Obstructive Pulmonary Disease (COPD) Synthesis Patient Case Overview Ms. O’Connor, aged 55, presents with worsening COPD symptoms, including bronchospasms, fatigue, and productive cough with rusty sputum. Despite using nicotine replacement therapies, she smokes 3 to 5 cigarettes daily since age 15. She reports no allergies, and spirometry reveals an FEV1 of 1.37L. Family history includes a father who succumbed to a heart attack and a mother who died from smoking-related pneumonia. She has gained 30 pounds over the last two years. What Is the Pathophysiology of COPD? COPD arises from chronic airway inflammation caused by prolonged exposure to harmful particles or gases, predominantly tobacco smoke. This inflammation causes airway narrowing, loss of lung elasticity, excessive mucus production, and airflow obstruction. Thickened airway walls contribute to air trapping and lung hyperinflation, impairing respiratory function (Agarwal, 2023). What Are the Signs and Symptoms? Sign/Symptom Description Chronic cough Persistent and productive Increased mucus Excessive sputum production Dyspnea Shortness of breath Pursed-lip breathing Technique to control airflow Wheezing Audible airway obstruction Muscle atrophy Loss of muscle mass due to inactivity Barrel chest Enlarged chest diameter from hyperinflation Cyanosis Bluish discoloration due to low oxygen Finger clubbing Nail deformity linked to chronic hypoxia How Is COPD Diagnosed? Diagnosis is based on clinical evaluation, spirometry and pulmonary function tests, imaging such as chest X-rays and CT scans, arterial blood gases (ABG) analysis, and alpha-1 antitrypsin deficiency screening when indicated (Agarwal, 2023). What Are Common Treatments? Treatment Type Examples and Purpose Bronchodilators Short-acting (e.g., albuterol), long-acting (e.g., tiotropium) to relax airway muscles Inhaled corticosteroids Reduce airway inflammation Smoking cessation aids Medications like bupropion to support quitting smoking Vaccinations Annual flu and pneumonia vaccines Pulmonary rehabilitation Enhances exercise capacity and symptom management What Are Possible Side Effects of Medications? Medication Potential Side Effects Bronchodilators Tremors, anxiety, increased heart rate, headaches Inhaled corticosteroids Hoarseness, oral thrush Bupropion Insomnia, dry mouth, headaches, tremors, sweating Reflection Summaries Phase 1 Reflection My choice to focus on Alzheimer’s disease was inspired by personal experience with a family member affected by it. My research illuminated the disease’s core pathological features: neuritic plaques composed of amyloid-beta

Student Name Western Governors University D027 Advanced Pathopharmacological Foundations Prof. Name 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 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: 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 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 13. Sickle Cell Disease Risks in infants: pneumococcal infections, anemia, jaundice, pain crises.Crisis Types: 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) 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 36. Tay-Sachs Disease Ashkenazi Jewish risk; enzyme deficiency causing fatty buildup → neurodegeneration, cherry-red macula. 37. Chronic Kidney Disease Stages 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.