Impetigo Drug Spectrum and Facts

staphylococcus aureus
most common bug to cause of impetigo?

Penicillinase-resistant penicillins (dicloxacillin)
or might try
1st gen cephalosporins (cephalexin)
preferred treatment for impetigo caused by Staph aureus ?

Single IM dose of benzathine, penicillin G, or oral penicillin VK
Treatment for infections caused by S. pyogenes ?

7-10 days, can use 7 day course of topical mupirocin (Bactroban) or retapamulin (Altabax) for mild cases.
Duration of impetigo therapy?

Lotrimin/Lotrimin AF
Clotrimazole or MIconazole Nitrate

Lotrimin Ultra
Butenafine HCl

Cortaid
Hydrocortisone

Betadine First Aid Antibiotics + Moisturizer Ointment
Polymyxin B sulfate 10,000 U/g; bacitracin zinc 500 U/g

Q-tips Treat & Go x
Cotton swabs containing bacitracin 500 U/g

Gold Bond First Aid Antibiotic Ointment
Bacitracin zinc 500 U/g; polymyxin B sulfate 10,000 U/g; neomycin base 3.5 mg/g; pramoxine HCL 10 mg

Neosporin Ointment
Polymyxin B sulfate 5000 U/g; bacitracin zinc 400 U/g; neomycin base 3.5 mg/g

Neosporin Plus Pain Relief Ointment
Bacitracin zinc 500 U/g; polymyxin B sulfate 10,000 U/g; neomycin base 3.5 mg/g; pramoxine HCL 10 mg

Neosporin Plus Pain Relief Cream
Polymyxin B sulfate 10,000 U/g; neomycin base 3.5 mg/g; pramoxine HCl 10 mg

Polysporin Ointment/Powder
Polymyxin B sulfate 10,000 U/g; bacitracin zinc 500 U/g

Cortisporin
Bacitracin + Polymyxin B + Neomycin + Hydrocortisone

NO
Do any otc products cover MRSA?

Bactericidal (inhibits cell wall synthesis) G + and some G –
Bacitracin spectrum?

Bactericidal (aminoglycoside axb that irreversibly binds to 30S subunit to inhibit protein synthesis) G- bacilli and some G +. NOTE (topical has high rate of hypersensitivity reactions)
Neomycin (Neo-Fradin) Spectrum?

Bactericidal (increases cell membrane permeability) almost all strains of G- bacilli except proteus group. NOT effective against G+, fungi, or G- cocci. Only comes as a injection powder for solution
Polymyxin B Spectrum?

topical anesthetic that works by decreasing the neuronal membrane’s permeability to sodium ions
what is pramoxine?

Neosporin Plus Pain Relief Cream
Which otc topical agent does not contain Bacitracin zinc?

the skin is broken because of ointments impermeability.
Don’t use ointments if….

burns and wounds in which the skin is intact
When to use ointments?

Broken skin since they allow some fluid to pass through the film.
Creams are best for what?

Large wound or burn area because it is easy to apply.
Lotions useful for?

wound bed, because they can dry the area, difficult to remove, provide a medium for bacterial growth.
Lotions should not be used on a….

Neomycin, can causes sensitization reaction, contact dermatitis.
Avoid neosporin or polysporin in children?

Treats nasal carriers of MRSA Rx only. b.

Novel MOA of mupirocin: inhibits bacterial protein and RNA synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase; does not demonstrate cross-resistance with other classes. Bacteriostatic at low concentrations and bactericidal at high concentrations

Mupirocin is used to treat what? and what is the unique MOA?

Chapter 4 pathology workbook

bone; cartilage
The two highly specialized connective tissues in the skeletal system are

compact; cancellous
The two major types of bone are

periosteum; endosteum
The two membranes associated with the bone are

dense; structureless
The compact bone appears ______ and ________.

cancellous; spongy
Weblike bone structure consisting of marrow-filled spaces is ______ or _________.

trabeculae
Cancellous bone appears as ________ on the radiographic image.

epiphyseal
Linear bone growth occurs at the ________ plate.

osteoblast; osteoclast
The two special types of bone cells are _______ and ______.

ossification; resorption
The term for bone formation is ______ and the term for bone destruction is _________.

intramembranous ossification
The skull and flat bones do not have a cartilagionous stage in bone formation so bone development occurs through _________.

osteoblasts
The diameter of the long bone expands or grows by ______ in the periosteum, producing new bone.

support, protect, lever, storehouse, and production
What are the five basic functions bones perform?

transitional
A vertebra that has characteristics of the spinal column above and below is considered a ______ vertebra.

spina bifida
A splitting of the bony neural canal is referred to as _______.

achondroplasia
The most common form of dwarfism is __________, which is the result of diminished proliferation of cartilage in the growth plate.

osteoarthritis
_________ is characterized pathologically by loss of cartilage and reactive new bone formation.

bursitis
_________ is inflammation of the small fluid-filled sac located near the joint to reduce friction caused by movement.

osteomyelitis
A deep soft tissue swelling with obliteration or displacement of the fat pads and subtle metaphyseal lucencies describes ________.

mineralization
Vitamin D deficiency in adults causes a loss of _________ as a result of the lack of calcium and phosphorus.

paget’s
The most common metabolic disease of the skeletal system is ______ disease, which affects both osteoblasts and osteoclasts

aneurysmal
An _______ bone cyst contains numerous blood-filled arteriovenous communications.

callus
The continuous external bridge of calcium deposit that extends across a fracture line is _______.

malunion
A fracture that may heal in a faulty position, resulting in impairment of function, is called __________.

rheumatoid arthritis
_______ __________ is a chronic systemic disease of unkown case, usually occurring in the small joints of the hand and feet.

ossification
bone formation from cartilage

intramembranous ossification
connective tissue bone formation

compact bone
dense structureless outer bone

metaphysis
end of the shaft where the bone flares and becomes the epiphysis

epiphysis
ends of long bones where growth occurs

periosteum
fibrous membrane covering the outer surface of the bone

appositional growth
ossification of flat bones on their outer surfaces

endosteum
membrane that lines the medullary cavity

medullary cavity
portion of bone where blood production occurs

osteoclasts
resorbing bone cell enlarging the diameter of the medullary cavity

diaphysis
shaftlike portion of the bone

spongy bone
area that contains trabeculae

paget’s disease
“cotton wool” skull appearance

spondylolysis
a cleft in the pars interarticularis between the superior and inferior articular processes in the vertebra

gout
a deposit of uric acid in the joint

chondrosarcoma
a malignant turmor of cartilaginous origin that may originate anew or within a preexisting cartilaginous lesion

osteoporosis
abnormal decrease in bone density due to lack of calcium deposit

ewing’s sarcoma
arises in the bone marrow of long bones and affects young adults

osteochondroma
benign bone projection with a cartilaginous cap

osteogenesis imperfecta
brittle bone disease

rickets
caused by a vitamin deficiency in children

osteogenic sarcoma
classic “sunburst” pattern with elevated periosteum

osteoarthritis
degenerative arthritis

achondroplasia
failure of cartilage to form properly, resulting in dwarfism

osteomyelitis
infection of the bone and its marrow

bursitis
inflammation of the fluid-filled sac usually due to repeated physical activity

spina bifida
lack of neural tube closure

osteopetrosis
marble bone disease

pott’s disease
most commonly affects the thoracic and lumbar spine with poorly marginated bone destruction often associated with an abcess

fibrous dysplasia
proliferation of fibrous tissue in the medullary cavity

herniated intervertebral disk
rupture of central nucleus pulposus, most frequently L4-L5

unicameral bone cyst
true fluid-filled area surrounded by a fibrous wall

fatigue
bone response to repeated stress

comminuted
composed of more than two fragments

complete
discontinuity between two or more fragments

open
disruption of overlying skin

spiral
encircles the bone shaft

nonunion
fracture healing process stops

avulsion
fragment torn from bony prominence

greenstick
incomplete fracture with the opposing cortex intact

transverse
occurs at a right angle to the long axis of bone

closed
overlying skin is intact

oblique
runs approximately 45 degrees to the bone shaft

displaced
seperation of bone fragments

pott’s
ankle dislocation with fractured malleoli

jones
avulsion fracture at the base of the fifth metatarsal

clay shoveler’s
avulsion fracture of the spinous process

hangman’s
C2 fracture of the arch, usually associated with anterior subluxation of C2-C3

jefferson’s
comminuted fracture of the ring of the atlas

monteggia’s
isolated fracture of the ulna with associated dislocation of the radius in the elbow

seat belt
transverse fracture of the lumbar vertebra

boxer’s
transverse fracture of the neck of the fifth metacarpal

navicular
transverse fracture of the waist of this carpal bone

colle’s
transverse fracture through distal radius with dorsal angulation

scoliosis
when the spine curves in a lateral direction, it is known as

paget’s
the most common metabolic disease of the skeletal system is _____ disease, which affects both osteoblasts and osteoclasts

b) fibrous dysplasia
excessive proliferation of fibrous tissue in the medullary cavity describes
a) achondroplasia
b) fibrous dysplasia
c) osteomalacia
d) gout

b) spondylolisthesis
the displacement of L-4/L-5 due to slippage of the inferior and superior intervertebral facets is
a) spondylolysis
b) spondylolisthesis
c) ruptured intervertebral disk
d) a Jefferson fracture

a) a mylelomeningocele
a herniation of the meninges is
a) a mylelomeningocele
b) a meningocele
c) spina bifida occulta
d) a Chiari II malformation

c) osteopetrosis
bone that fails to resorb and causes a loss of bone marrow is referred to as
a) osteomalacia
b) osteoporosis
c) osteopetrosis
d) osteogenesis imperfecta

d) osteogenesis imperfecta
severe osteoporosis and thin defective cortices resulting in multiple fractures occur in patients with
a) osteomalacia
b) osteoorosis
c) osteopetrosis
d) osteogenesis imperfecta

d) congenital hip dysplasia
the hip may “pop” out of joint and a “click” may be felt or heard on clinical evaulation in children with
a) chondromas
b) herniated vertebral disks
c) club feet
d) congenital hip dysplasia

b) rheumatoid arthritis
_____ may undergo spontaneous remission and has symmetrical involvement
a) osteoarthritis
b) rheumatoid arthritis
c) psoriatic arthritis
d) infectious arthritis

a) osteoporosis
in _____ localized bone deficiency occurs as a result of decreased bone mass per unit volume
a) osteoporosis
b) osteomalacia
c) osteopetrosis
d) osteomyelitis

a) gout
after repeated attacks,the inflammatory reaction produces evidence of joint effusion and clumps of crystal urate in patients affected with
a) gout
b) osteoarthritis
c) pyogenic arthritis
d) osteomyelitis

c) rickets
the disease process that results in a descreased absorption of calcium due to a vitamin deficiency is
a) osteopetrosis
b) osteomyelitis
c) rickets
d) scurvy

b) growths parallel to the long axis of a bone
osteochondromas are
a) dense round lesions usually in the outer skull table
b) growths parallel to the long axis of a bone
c) usually found in the small bones of the hands and feet
d) tumors that originate from osteoblastic cells in the bony cortices

b) inferoposterior vertebral displacement
scoliosis is
a) superoanterior vertebral displacement
b) inferoposterior vertebral displacement
c) lateral vertebral displacement
d) posterior sacral displacement

c) sacrum is displaced completely posteriorly from the fifth lumbar vertebra
a first-degree spondylolisthesis is diagnosed when the
a) sacrum is displaced forward
b) fifth lumbar vertebra is displaced forward one fourth of the thickness of the sacrum
c) sacrum is displaced completely posteriorly from the fifth lumbar vertebra
d) fifth lumbar vertebra is displaced anteriorly three quarters of the thickness of the sacrum

d) standing flexion and extension lateral lumbar spine projections
in the diagnosis of spondylolysis, which additional projections will be most helpful
a) standing AP and lateral lumbar spine projections
b) oblique lumbar spine projections
c) flexion and extension lateral lumbar spine projections
d) standing flexion and extension lateral lumbar spine projections

b) decrease kv or d) decrease kv and ma
*Depending on protocol
for patients with severe osteoporosis, how should the exposure factors be adjusted
a) increase kv and ma
b) decrease kv
c) decrease ma
d) decrease kv and ma

d) increase ma and kv
osteopetrosis requires changes in the exposure factors-the radiographer should
a) decrease SID
b) increase kv
c) increase ma
d) increase ma and kv

a) DEXA scan
the modality of choice to demonstrate cortical bone loss in osteoporosis is a
a) DEXA scan
b) quantitative CT scan
c) plain radiograph
d) NM bone scan

b) Paget’s disease
the early stage of this disease process is seen as sharply demarcated radiolucency, which represents the destructive phase of
a) Pott’s disease
b) Paget’s disease
c) gout
d) osteomyelitis

a) slow growing benign cartilaginous tumors
enchondromas are
a) slow-growing benign cartilaginous tumors
b) benign projections of bone with cartilaginous caps
c) eccentric lucent lesions in the metaphysis
d) well-circumscribed, extememly dense round lesions

d) unicameral bone cyst
an expansive lucent lesion with a thin sclerotic rim is a
a)osteoma
b) bone island
c) aneurysmal bone cyst
d) unicameral bone cyst

a) enchondromas
which tumors arise in the medullary cavity of the small bones of the hands and feet
a) enchondromas
b) endodermomas
c) osteochondromas
d) osteosarcomas

a) CT
for osteoid osteoma, what modality is used to best demonstrate the nidus
a) CT
b) MRI
c) US
d) radiography

c) MRI
the most sensitive imaging modality to demonstrate ischemic necrosis is
a) CT
b) NM
c) MRI
d) plain radiographs

b) rickets
insufficient mineralization of the immature skeleton causing a cupped and frayed metaphysis in long bones is
a) osteomalacia
b) rickets
c) osteoporosis
d) Paget’s disease

b) Paget’s disease
a cotton-wool radiographic appearance is visualized in the reparative phase of
a) Pott’s disease
b) Paget’s disease
c) multiple myeloma
d) osteopetrosis

a) radiography
which is the least sensitive modality to demonstrate osteomyelitis because of its inability to demonstrate early destruction
a) radiography
b) CT
c) MRI
d) NM

b) osteoporosis
although the DEXA scan involves less radiation exposure for the patient, quantitative CT is one modality to demonstrate which disease
a) osteopetrosis
b) osteoporosis
c) osteomalacia
d) osteoma

d) unstable
the spine consists of an anterior colum and a posterior column. when both columns are disrupted the injury is considered
a) displaced
b) stable
c) undisplaced
d) unstable

a) Jones
which fracture is a transverse fracture at the base of the fifth metatarsal
a) Jones
b) Pott’s
c) boxer’s
d) Galeazzi’s

a) navicular
it is common in what type of fracture for the healing process to halt and that fragments to remain separate, creating a serious complication, possibly necrosis
a)navicular
b) pathologic
c) boxer’s
d) Jones

b) osteogenic sarcoma
the malignant bone tumor most commonly found in the metaphysis of the knee is a
a) osteochondroma
b) osteogenic sarcoma
c) chondrosarcoma
d) multiple myeloma

a) ewings sarcoma
which tumor causes destruction of the medullary cavity, producing an “onionskin” periosteal reaction
a) Ewing’s sarcoma
b) osteosarcoma
c) chondrosarcoma
d) osteoid osteoma

d) standing lateral lumbar spine image
to evaluate and grade spondylolisthesis, the radiologist needs a
a) standing AP lumbar spine image
b) oblique lumbar spine image
c) lateral lumbar spineimage
d) standing lateral lumbar spine image

a) CT myelogram
to best deomonstrate a herniation of a intervertebral disk requires which of the following procedures
a) CT myelogram
b) PET body scan
c) US of the spinal cord
d) NM bone scan

a) seat belt
which fracture is a transverse fracture of the spine often associated with significant visceral injuries
a) seat belt
b) hangman’s
c) clay shoveler’s
d) Jefferson’s

b) lead
ingestion of which substance is interchangeable with that of calcium in the body, causingdense transverse bands in the metaphysis
a) hypervitaminosis
b) lead
c) vitamin K
d) increased caloric intake

c) standing with equal stance
to best image scoliosis, the patient should be
a) recumbent bending away fro the curvature
b) recumbent prone
c) standing with equal stance
d) recumbent bending toward the curvature

ATI Pharm Infection Test

A health care professional is caring for a patient who is about to begin taking isoniazid (INH) to treat tuberculosis. The health care professional should tell the patient to report which of the following adverse effects of the drug? (Select all that apply.)

Jaundice
Numbness of the hands
Dizziness
Hearing loss
Oral ulcers

Jaundice
Numbness of hands
Dizziness

A health care professional is caring for a patient who is taking ciprofloxacin (Cipro) to treat a urinary tract infection and has rheumatoid arthritis, for which he takes prednisolone (Prelone). Recognizing the adverse effects of ciprofloxacin, the health care professional should tell the patient to report which of the following?

Tachycardia
Hair loss
Insomnia
Tendon pain

Tendon pain

A health care professional is caring for a patient who takes an oral contraceptive and is about to begin rifampin (Rifadin) therapy to treat tuberculosis. The health care professional should include which of the following instructions?

Increase the rifampin dose.
Increase the oral contraceptive dose.
Allow 2 hr between taking the two drugs.
Use additional contraception.

Use additional contraception

A primary care provider should prescribe a lower dose of aztreonam (Azactam) for a patient who has a respiratory tract infection and also has which of the following?

Glaucoma
Closed-head injury
Heart failure
Renal impairment

Renal impairment

A health care professional is caring for a patient who is about to begin taking cephalexin (Keflex) to treat bacterial meningitis. The health care professional should explain to the patient the need to monitor which of the following laboratory tests?

Prothrombin time
Creatinine
Aspartate aminotransferase
Potassium

Creatinine

A primary care provider is prescribing drug therapy for a patient whose sputum culture results indicate methicillin-resistant Staphylococcus aureus (MRSA). Which of the following drugs should be administered?

Trimethoprim/sulfamethoxazole (Bactrim)
Tetracycline
Cephalexin (Keflex)
Vancomycin (Vancocin)

Vancomycin

A health care professional is caring for a patient who is about to begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. The health care professional should tell the patient to report which of the following adverse effects of the drug?

Constipation
Dark brown urine
Cough
Tremors

cough

A health care professional is caring for a patient who is about to begin gentamicin therapy to treat an infection. The health care professional should monitor the patient for which of the following?

Bowel function
Peripheral pulses
Urine output
Level of consciousness

Urine output

A patient who is taking amoxicillin (Amoxil) to treat a respiratory infection contacts the health care professional to report a rash and wheezing. Which of the following instructions should the health care professional provide?

Wait 1 hr and contact the provider if there is no improvement.
Skip today’s dose of amoxicillin and resume taking the drug tomorrow.
Call emergency services immediately.
Take an NSAID to reduce the skin and airway inflammation.

call emergency services immediately

A health care professional is caring for a patient who is about to begin using nystatin (Mycostatin) to treat oral Candida albicans that resulted from tetracycline therapy. Which of the following instructions should the health care professional include about using the antifungal preparation?

Swish the suspension in the mouth before swallowing it.
Rinse the mouth immediately with water.
Drink the suspension with a straw.
Use a cotton-tipped applicator to dab the mouth lesions with the suspension.

swish the suspension in the mouth before swallowing it

A health care professional is caring for a patient who is about to begin taking ketoconazole to treat a fungal infection. The health care professional should tell the patient to report which of the following adverse effects of the drug?

Tingling in the hands and feet
Joint pain
Gynecomastia
Excessive sweating

gynecomastia

A patient who is taking ciprofloxacin (Cipro) to treat a respiratory tract infection contacts the health care professional to report dyspepsia. The health care professional should recommend which of the following instructions?

Take an antacid at least 2 hr after taking the drug.
Take the drug with a cup of coffee.
Take an iron supplement with the drug.
Drink 8 oz of milk with the drug.

take an antacid at least 2 hr after taking the drug

A patient who is taking tetracycline orally to treat a chlamydia infection contacts the health care professional to report severe blood-tinged diarrhea. Recognizing the adverse effects of tetracycline, the health care professional should suspect which of the following?

Hemorrhoids
Pseudomembranous enterocolitis
Diverticular disease
Small bowel obstruction

Pseudomembranous enterocolitis

Which of the following drugs should a provider prescribe for a patient who has streptococcal pharyngitis and is allergic to penicillin?

Nafcillin (Unipen)
Erythromycin
Cephalexin (Keflex)
Amoxicillin/clavulanic acid (Augmentin)

Erythromycin

A patient who is taking imipenem (Primaxin) to treat a bacterial infection contacts the health care professional to report an inability to eat because of mouth pain. Recognizing the adverse effects of imipenem, the health care professional should suspect which of the following?

Malabsorption
Suprainfection
Anorexia
Dental caries

Suprainfection

When administering erythromycin to a patient who has pneumococcal pneumonia, the health care professional should monitor for which of the following adverse effects of the drug?

Hypothermial
Blurred vision
Constipation
Cardiac dysrhythmias

Cardiac dysrhythmias

A health care professional is caring for a patient who is about to begin taking acyclovir (Zovirax) to treat a herpes simplex infection. The health care professional should monitor which of the following laboratory values for the patient?

Prothrombin time
Hct
BUN
Aspartate aminotransferase

BUN

A health care professional is preparing to administer amphotericin B IV to a patient who has a systemic fungal infection. Which of the following drugs should the health care professional administer prior to the infusion to prevent or minimize adverse reactions during amphotericin B administration? (Select all that apply.)

Aspirin (Ecotrin)
Hydrocortisone (Solu-Cortef)
Acetaminophen (Tylenol)
Diphenhydramine
Ibuprofen (Advil)

Acetaminophen (Tylenol)
Diphenhydramine

A health care professional is caring for a patient who is about to begin taking metronidazole (Flagyl) to treat an anaerobic intra-abdominal bacterial infection. The health care professional should recognize that cautious use of the drug is indicated if the patient also has which of the following?

Seizure disorder
Hearing loss
Asthma
Anemia

Seizure disorder

A health care professional is caring for a patient who is about to receive gentamicin to treat a systemic infection. The health care professional should question the use of the drug for a patient who is also taking which of the following drugs?

Furosemide (Lasix)
Diphenhydramine
Acetaminophen (Tylenol)
Levothyroxine (Synthroid)

Furosemide (Lasix)

A health care professional is caring for a patient who is taking warfarin (Coumadin) and is about to begin taking trimethoprim/sulfamethoxazole (Bactrim) to treat a urinary tract infection. The health care professional should question the drug regimen because taking these two drugs concurrently can increase the patient’s risk for which of the following?

Bleeding
Thrombosis
ECG changes
Ototoxicity

bleeding

A health care professional is caring for a patient who is about to begin taking chloroquine (Aralen) to prevent malaria. When talking with the patient about taking the drug, the health care professional should include which of the following instructions? (Select all that apply.)

Wear sunglasses outdoors.
Take the drug with an antacid.
Avoid driving.
Take the drug with lemonade.
Take the drug with food.

Wear sunglasses outdoors
Avoid driving
Take drug with food

While administering IV cefotetan to a patient to treat bacterial meningitis, the health care professional finds the IV insertion site warm and reddened. Which of the following actions should the health care professional take?

Slow the cefotetan infusion.
Administer diphenhydramine.
Request a prescription for another antibiotic.
Stop the cefotetan infusion.

Stop the cefotetan infusion.

A health care professional is caring for a patient who is about to begin receiving acyclovir (Zovirax) IV to treat a viral infection. The health care professional should recognize that cautious use of the drug is essential if the patient also has which of the following?

Heart failure
Dehydration
Asthma
Tinnitus

Dehydration

A primary care provider is considering the various pharmacologic options for a patient who has a gynecologic infection and a history of alcohol use disorder. Which of the following medications can cause a reaction similar to disulfiram (Antabuse) if the patient drinks alcohol while taking it? (Select all that apply.)

Nitrofurantoin (Macrodantin)
Amoxicillin (Amoxil)
Aztreonam (Azactam)
Cefotetan
Metronidazole (Flagyl)

Cefotetan
Metronidazole (Flagyl)

ATI: Pharmacology Made Easy 3.0 – The Cardiovascular System

A health care professional is caring for a patient who is about to begin taking verapamil (Calan) to treat atrial fibrillation. The health care professional should tell the patient to avoid grapefruit juice while taking verapamil because it can cause _______.
A) tachycardia
B) Dehydration
C) Diarrhea
D) Hypotension
D) Hypotension

Rationale: Large amounts of grapefruit juice increases blood levels of verapamil by inhibiting its metabolism. The excess amount of drug can intensify otherwise therapeutic effects like hypotension, causing serious risks for syncope and dizziness.

While talking with a patient about drug therapy options for hypertension, the provider notes that the patient also has some manifestations of depression that require treatment. Which of the following antihypertensive drugs is inappropriate for the patient?
A) Reserpine
B) Captopril (Capoten)
C) Hydralazine
D) Eplerenone (Inspra)
A) Reserpine

Rationale: Severe depression and an increased risk for suicide are adverse effects of adrenergic neuron blockers, such as reserpine. These effects can persist after patients stop taking these drugs. These adverse effects develop because of the depletion of serotonin and norepinephrine.

When talking with a patient about taking amiodarone (Cordarone) to treat atrial fibrillation, which of the following should the health care professional tell the patient to avoid?
A) Grapefruit juice
B) Milk
C) Foods high in Vitamin K
D) NSAIDs
A) Grapefruit juice

Rationale: In particularly large amounts can cause toxicity of potassium channel blockers, such as amiodarone.

A health care professional is caring for a patient who is about to begin taking simvastatin (Zocor) to treat hypercholesterolemia. The health care professional should tell the patient to report which of the following indications of a serious adverse reaction that could warrant stopping drug therapy?
A) Bronchoconstriction
B) Muscle pain
C) Lip numbness
D) Somnolence
B) Muscle Pain

Rationale: It can cause myopathy or pain in muscles and joints that can progress to rhabdomyolysis. With this rare but serious side effect, muscle protein breaks down and its excretion causes kidney damage.

When talking with a patient about taking eplerenone (Inspra) to treat hypertension, the health care professional should include which of the following instructions?
A) Avoid drinking grapefruit juice.
B) Use sunscreen and protective clothing.
C) Avoid the use of salt substitutes.
D) Stop taking the drug if dizziness occurs.
C) Avoid the use of salt substitutes.

Rationale: Eplerenone, an aldosterone antagonist, can cause hyperkalemia. Many salt substitutes contain significant amounts of potassium. Patients who take the drug should not use salt substitutes that contain potassium.

A health care professional is caring for a patient who has moderate to severe hypertension and is about to begin hydralazine therapy. The health care professional should monitor the patient for which of the following severe adverse reactions to the drug?
A) A flu-like syndrome
B) Extrapyramidal symptoms
C) A lupus-like syndrome
D) Hypertensive crisis
C) A lupus-like syndrome

Rationale: A systemic lupus erythematosus-like syndrome can develop with hydralazine, a direct-acting vasodilator. Manifestations include facial rash, joint pain, fever, nephritis, and pericarditis. High doses make it more likely. Fluid retention and edema can also develop.

A health care professional should question the use of nifedipine (Procardia) for a patient who has a history of which of the following?
A) Bradycardia
B) Liver disease
C) Unstable angina pectoris
D) Second-degree AV block
C) Unstable Angina Pectoris

Rationale: Nifedipine, a calcium channel blocker, can cause reflex tachycardia, an adverse effect that can worsen angina pain because it increases cardiac oxygen demand.

A patient who is taking digoxin (Lanoxin) develops ECG changes and other manifestations that indicate severe digoxin toxicity. Which of he following drugs should the health care professional have available to treat this complication?
A) Acetylcysteine (Acetadote)
B) Flumazenil (Mazicon)
C) Fab antibody fragments (Digibind)
D) Deferoxamine (Desferal)
C) Fab antibody fragments (Digibind)

Rationale: Fab antibody fragments, also called Digoxin Immune Fab, binds to digoxin and blocks its action.

A health care professional should question the use of milrinone (Primacor) for a patient who currently has which of the following?
A) Acute myocardial infarction
B) Peripheral vascular disease
C) Ulcerative colitis
D) Ventricular tachycardia
A) Acute myocardial infarction

Rationale: Milrinone, a phosphodiesterase inhibitor, is contraindicated for patients who have had an allergic reaction to phosphodiesterase inhibitors and for patients who have an acute myocardial infarction and aortic or pulmonary valve disorders.

A provider is considering the various drug therapy options for treating a patient’s cardiac dysrhythmia. He should be aware that which of the following antidysrhythmic drugs is appropriate only for short-term use because of its severe adverse effects with long-term use?
A) Quinidine
B) Procainamide
C) Nitroglycerin
D) Verapamil (Calan)
B) Procainamide

Rationale: This is a poor choice because of its risk for serious adverse effects, including cardiotoxicity and arterial embolism.

A health care professional is caring for a patient who is about to begin captopril (Capoten) therapy to treat hypertension. When talking with the patient about taking the drug, the health care professional should tell her to report which of the following adverse effects because they can indicate a need to stop drug therapy? (Select all that apply.)
– Rash
– Distorted taste
– Swelling of the tongue
– Photosensitivity
– Dry cough
– Rash
– Distorted taste
– Swelling of the tongue
– Dry cough

A health care professional is about to administer atenolol (Tenormin) to a patient who has hypertension. Which of the following assessments should the health care professional perform prior to giving the patient the drug?
A) Respiratory rate
B) Level of consciousness
C) Serum glucose
D) Apical pulse
D) Apical Pulse

Rationale: Atenolol, a beta1 adrenergic blocking agent, can cause bradycardia and orthostatic hypotension. Health care professionals should withhold the drug for an apical pulse rate slower than 60/min and notify the primary care provider.

A health care professional should question the use of dobutamine for a patient who is receiving which of the following types of drugs? (Select all that apply.)
– ACE inhibitor
– Monoamine oxidase inhibitor
– General anesthetic
– Tricyclic antidepressant
– Beta blocker
– Monoamine oxidase inhibitor
– General anesthetic
– Tricyclic antidepressant
– Beta blocker

A health care professional is caring for a patient who is about to begin taking ethacrynic acid (Edecrin) to treat heart failure. The health care professional should tell the patient to report which of the following indications of a potentially serious adverse reaction?
A) Shortness of breath
B) Hearing Loss
C) Swelling in the legs
D) Blurred vision
B) Hearing Loss

Rationale: This medication is a high-ceiling loop diuretic similar in actions and effects to furosemide (Lasix), can cause ototoxicity, which can lead to permanent hearing loss.

When talking with a patient about taking clonidine (Catapres) to treat hypertension, the health care professional should explain that discontinuing clonidine therapy abruptly can result in which of the following adverse effects?
A) Constipation
B) Hypertension
C) Drowsiness
D) Dry mouth
B) Hypertension

Rationale: Abruptly discontinuing clonidine, a centrally acting alpha2 agonist, can cause rebound hypertension. The drug’s target receptors are in the CNS. By stimulating these receptors, sympathetic outflow to the peripheral blood vessels decreases. Thus, the blood vessesls dilate and the heart rate slows. Stopping drug therapy causes rebound outflow fro the SNS and a sudden and significant rise in blood pressure that can lead to a hypertensive crisis.

A health care professional is assessing a patient following the administration of nifedipine (Procardia). Recognizing the adverse effects of nifedipine, the health care professional should be prepared to administer which of the following drugs?
A) Prazosin (Minipress)
B) Doxazosin (Cardura)
C) Propranolol (Inderal)
D) Enalapril (Vasotec)
C) Propranolol (Inderal)

Rationale: Nifedipine, a calcium channel blocker, can cause reflex tachycardia, an adverse effect that increases cardiac oxygen demand. Administering a beta-adrenergic blocker, such as propranolol, will minimize the adverse effects.

A health care professional is caring for a patient who is about to begin taking propranolol (Inderal) to treat a tachydysrhythmia. The health care professional should caution the patient about taking which of the following type of over-the-counter drugs?
A) Antihistamines
B) Potassium supplements
C) NSAIDs
D) Antacids
D) Antacids

Rationale: Antacids and vitamin C can decrease absorption of propranolol, a beta adrenergic blocker. Patients should avoid taking these OTC preparations and discuss appropriate alternatives with their PCP.

A health care professional is caring for a patient who is taking spironolactone (Aldactone) to treat hypertension. Which of the laboratory values should alert the health care professional to take further action?
A) Serum sodium level of 140 mEq/L
B) Serum potassium level of 5.2 mEq/L
C) Serum chloride level of 100 mEq/L
D) Serum magnesium level of 1.9 mEq/L
B) Serum potassium level of 5.2 mEq/L

Rationale: This level exceeds the reference range of 3.5 to 5.0 mEq/L and warrants immediate intervention.

A health care professional is caring for a patient who is about to begin taking gemfibrozil (Lopid) to treat hypercholesterolemia. Which of the following instructions should the health care professional include when talking with the patient about the drug? (Select all that apply.)
– Take the drug with food.
– Report any new intolerance to fried foods.
– Report muscle tenderness.
– Expect periodic liver function testing.
– Take the drug once a day.
– Report any new intolerance to fried foods.
– Report muscle tenderness.
– Expect periodic liver function testing.

A health care professional is caring for a pateint who is about to begin aliskiren (Tekturna) therapy to treat hypertension. The health care professional should monitor the patient for which of the following adverse effects of the drug? (Select all that apply.)
– Hyperkalemia
– Throat swelling
– Constipation
– Cough
– Joint pain
– Hyperkalemia
– Throat swelling
– Cough

A patient who takes carvedilol (Coreg) for hypertension is about to begin taking an oral antidiabetes drug to manage newly diagnosed type 2 diabetes mellitus. The health care professional should make sure the primary care provider is aware that the patient is at increased risk for which of the following if she takes both drugs?
A) Hyperglycemia
B) Bradycardia
C) Hypotension
D) Hypoglycemia
D) Hypoglycemia

Rationale: Carvedilol potentiates the hypoglycemic effects of insulin and oral hypoglycemic drugs and can mask tachycardia in a patient who has hypoglycemia.

A health care professional is caring for a patient who has a glomerular filtration rate of 10 mL/min and a reduced urine output. The health care professional should question the use of hydrochlorothiazide for the patient because of which of the following characteristics of the drug?
A) The drug can cause hypoglycemia in patients who have a low urine output.
B) The drug does not reduce blood pressure for patients who have a low urine output.
C) The drug can increase the risk of pulmonary edema for patients who have renal insufficiency.
D) The drug does not promote diuresis for patients who have renal insufficiency.
D) The drug does not promote diuresis for patients who have renal insufficiency.

Rationale: Adequate kidney function is essential to promote urine production and excretion effectively.

A health care professional is caring for a patient who is about to begin taking losartan (Cozaar) to treat hypertension. The health care professional should tell the patient to report which of the following indication of an adverse reaction to the drug?
A) Facial edema
B) Sleepiness
C) Peripheral edema
D) Constipation
A) Facial edema

Rationale: Can cause angioedema often manifesting as redness and swelling around the eyes and lips. Patients should stop taking the drug and seek medical attention.

A health care professional is reviewing the history of a patient who is about to begin furosemide (Lasix) therapy to treat hypertension. Which of the following drugs that the patient takes should alert the health care professional to take further action?
A) Lithium (Lithobid) for bipolar disorder
B) Phenytoin (Dilantin) for a seizure disorder
C) Erythromycin (Erythrocin) for bronchitis
D) Warfarin (Coumadin) to prevent blood clots
A) Lithium (Lithobid) for bipolar disorder

Rationale: Furosemide is high-ceiling loop diuretic, increases sodium loss and can cause reabsorption of lithium, a mood stabilizer.

A health care professional is caring for a patient who is about to begin using transdermal nitroglycerin (Nitro-Dur) to treat angina pectoris. When talking with the patient about the drug, the health care professional should include which of the following instructions? (Select all that apply.)
– Apply a new patch at the onset of anginal pain.
– Apply the patch to dry skin and cover the area with plastic wrap.
– Apply the patch to a hairless area and rotate sites.
– Apply a new patch each morning
– Remove patches for 10 to 12 hr daily.
– Apply the patch to a hairless area and rotate sites.
– Apply a new patch each morning
– Remove patches for 10 to 12 hr daily.

Medications for Infection ATI Pharm

Penicillins
destroy bacteria
medication of choice for pneumonia, meningitis, endocarditis, pharyngitis, syphilis
adverse effects: allergies/anaphylaxis, renal impairment (monitor I&O), dysrhythmias
Don’t give to patients w/ allergies of penicillin or cephalosporin
Report signs of allergic reposes, complete ENTIRE course of therapy of you can get candidiasis

Cephalosporins
cephalexin, cefazolin, cofactor, cefotetan, ceftriaxone, cefotaxime, cefepime
Broad-spectrum: UTI, post-op infections, pelvic infections, meningitis

cephalosporins adverse effects
allergic reaction/anaphylaxis, bleeding tendencies, thrombophlebitis, pseudomembranous colitis like diarrhea

cephalosporin interactions
disulfiram reaction so don’t take with alcohol

which cephalosporin is the most effective
cefepime

Imipenem-cilastatin
destroys bacterial cell walls used for serious infections such as pneumonia, peritonitis, and UTI
adverse effects: allergy and supra infection

vancomycin
destroys bacterial cells walls
used for serious infections such as staph aureus, e. coli, or staph epidermis. and for C.DIFF

adverse effects of vancomycin
ototoxicity (don’t give with loop diuretics)
infusion reaction (red man syndrome: rashes, flushing, tachycardia, hypotension)

If you get red man syndrome (flushing, rashes, tachycardia, hypotension) what do you do?
this is for vanc. you infuse SLOWLY OVER 60 min. DONT STOP

When don’t you give vancomycin
when taking loops, when allergic to corn

Tetracycline or -cyclines
bacteriostatic antibiotic (protein)
helps with acne, typhus fever or rocky mountain spotted fever or pneumonia, etc.

tetracycline adverse effects
discoloration of tooth enamel (don’t give to pregnant women or children less than 8)
hepatotoxicity
supra infection of the bowel

what do you not give tetracycline with?
calcium or iron products

tetracycline nursing administartion
empty stomach, don’t lie down, complete entire course, second form of birth control

Erythromycin
this is usually for clients with an allergy to penicillin
It is used in wooing cough, diphtheria, chlamydia, respiratory tract infections, etc.
adverse effect: ototoxicity and dysrhythmias

Gentamicin
antibiotic of choice for E. coli, klebsiella, etc.
adverse effects: ototoxicity, nephrotoxicity,hypersensitivity, neuro disorder
Look at peak and trough levels

Sulfamethoxazole-Trimethoprim
UTI

Sulfamethoxazole-Trimethoprim adverse effects
Steven-Johnson Syndrome (look for rash and STOP)
Blood dyscrasisas (anemia, agranulocytosis, leukopenia, thrombocytopenia)
Crystalluria
Jaundice, increased bilirubin levels
photosensitivity

Nitrofurantoin
acute UTI and prophylaxis

Nitrofurantoin adverse effects
GI discomfort, hypersensity with severe pulmonary manifestations, blood dycrasias (agranulocytosis, leukopenia, thrombocytopenia, etc.)
Peripheral neuropathy

Nitrofurantoin nursing considerations
urine will have brownish discoloration
Don’t crush because teeth staining
don’t take while pregnant

Ciprofloxacin or any -floxacin
Used for severe infections and medication of choice for prevention of anthrax!

ciprofloxacin adverse effects
Achilles tendon rupture (pain, swelling, redness)
supra infection
photoxicity (severe sunburn)

Who do you not give ciprofloxacin to
children younger than 18 because of risk to tendon rupturing
or clients that have increased risk of C.diff

how long do you give ciprofloxacin?
60 days to monitor for anthrax

Phenazopyridine
local anesthetic on the urinary tract to help relieve burning on urination
medication changes urine orange or red

Isoniazid
anti-microbial therapy
for active and latent TB
very specific and time strenuous (6-9 months)
Adverse effects: peripheral neuropathy, hepatotoxicity
For active: Direct Observation Therapy to make sure of adherence

Rifampin
also an anti-microbial therapy drug

rifampin adverse effects
discoloration of body fluids (NORMAL)
hepatotoxicity

effectiveness of rifampin
clear breath sounds, no night sweats, increased appetite, no rises in temp
3 negative sputum cultures (3-6 months)

Metronidazole
anti-protozoal (C.diff, vaginalis, h.pylori)

metronidazole adverse effects
GI discomfort
darkening of urine
CNS symptoms (seizures, ataxia) STOP MED
Don’t take with alcohol!!!!!!

Amphotericin B
anti fungal
adverse effects: infusion reactions (test a dose, infuse slowly, pretreat with diphenhydramine or acetaminophen), nephrotoxicity (BUN and creatinine) and bone marrow suppression
This med is highly toxic so it needs to be reserved for severe life threatening fungal infections
Infuse SLOWLY and administer 1L of saline before hand

Antivirals
acyclovir (herpes and varicella zoster)
Ganciclovir (Cytolomegalo virus)

acyclovir and ganciclovir adverse effects
nephrotoxicity for acyclovir
and suppressed bone marrow for ganciclovir

when would you not give ganciclovir
if their neutrophil counts are less than 500 or platelet counts less than 250,000

acyclovir adminsitartion
except symptom relief but not a cure
infuse 1 hour or longer because nephrotoxic
wash affected area w/ soap and water 3-4 times day
refrain from sexual contact while lesions are present
healed lesions should still have condoms to prevent transmission

Respiratory-Pharmacology (USMLE)

Chronic inflammatory reversible disease of tracheobronchial airways characterized by airflow obstruction and increased responsiveness to a variety of stimuli
asthma

– inflammation of bronchial wall
– increased mucus secretion
– bronchiolar smooth muscle constriction

List 3 s/s of bronchoconstriction.
chest tightness

shortness of breath

wheezing

rapid respirations

use of accessory muscles of respiration

cough

Review bronchoconstriction and drugs
Review bronchoconstriction and drugs

What class of drugs inhibit phospholipase A2?
What class of drugs inhibit phospholipase A2?
corticosteroids

List 3 classes of drugs that can be used to treat acute asthmatic attack.
beta-agonists

muscarinic antagonists

theophylline

List the 2 most important types of drugs used for long-term preventive treatment of asthma.
corticosteroids (most important)

release inhibitors (e.g. cromolyn)

Acute bronchial asthma treatment of choice
short-acting beta2-agonists

Are long-acting beta2-agonists used in acute asthma or prophylaxis?
prophylaxis

List 3 bronchodilators used to treat asthma.
beta2-agonists

muscarinic antagonists

methylxanthines

List 3 anti-inflammatory agents used to treat asthma.
steroids

anti-IgE antibodies

release inhibitors

List 2 leukotriene antagonists (based on mechanism) used to treat asthma.
lipoxygenase inhibitors

leukotriene receptor blockers

List 3/4 short-acting beta2-agonists used to treat asthma.
albuterol (prototype)

terbutaline

metaproterenol

pirbuterol

List 2 long-acting beta2-agonists used to treat asthma.
salmeterol

formoterol

List 2 methylxanthines used to treat asthma.
theophylline

aminophylline

List 2 muscarinic antagonists used to treat asthma.
ipratropium

tiotropium

List 2 mediator inhibitors used to treat asthma.
cromolyn

nedocromil

List 2 I.V. corticosteroids used to treat asthma.
prednisolone (active metabolite of prednisone)

hydrocortisone

List 3 leukotriene antagonists used to treat asthma.
zafirlukast, montelukast

zileuton

List a monoclonal anti-IgE antibody used to treat asthma.
omalizumab

Why do beta2-agonists in higher doses cause tachycardia, arrhythmias, and tremors.
activate beta1-adrenoceptors at high levls

Are beta1- or beta2-agonists associated with tolerance?
beta2-agonists

What non-specific beta-agonist is used in the treatment of asthma?
isoproterenol

– primary use is for bradycardia or heart block

Methylxanthines MOA
inhibits PDE

*PDE degrades cAMP to AMP
*narrow therapeutic index

List 3 adverse effects of methylxanthines.
CNS (tremors, insomnia, convulsions)

cardiac stimulation (arrhythmias)

increased GI motility

*erythromycin, coffee, tea, cigarette-smoking can affect the effects of the drug
*beta-blockers can be useful in undoing CVS toxicity from theophylline

What derivative of theophylline is used in intermittent claudication to decrease the viscosity of blood?
pentoxifylline

Is ipratropium or tiotroipoium longer-acting?
tiotropium

Ipatropium and tiotropium MOA
competitive blockers of muscarinic receptors

What drug (based on mechanism) is preferred over beta2-agonists in COPD (associated with bronchospasm)?
antimuscarinic agents (ipratropium and tiotropium)

Cromolyn and nedocromil adverse effects (2)
cough and irritation of respiratory tract may occur with aerosol

List 2 IV steroids used in life-saving treatment of status asthmaticus.
hydrocortisone

prednisolone

List 3/5 surface-active corticosteroids used to treat moderate to severe asthma.
beclomethasone

dexamethasone

fluticasone

budesonide

flunisolide

How do corticosteroids affect beta-adrenoceptor responsiveness in the respiratory tract?
increase responsiveness

What drugs bind to intracellular receptors and activate glucocorticoid response elements in the nucleus?
steroids

– synthesis of substances that inhibit expression of inflammation and allergy

What drug class is a 1st line treatment for asthma in patients who are not responding well to beta2-agonists?
corticosteroids

– prevent modeling of respiratory tract, which may occur in severe, progressive inflammation of chronic asthma

Corticosteroids adverse effects (3/4)
oropharyngeal candidiasis

mild growth retardation may occur in children, but eventually reach full recovery of growth as adult

small degree of adrenal suppression may occur

major systemic toxicities (reduced with alternate day therapy)

What is the preferred drug in a case of bradycardia or heart block with a history of bronchial asthma?
isoproteronol

What 2 drug classes are used in antigen-, exercise-, and aspirin-induced asthma, but not in acute asthma?
antileukotrienes
– zafirlukast, montelukast

lipoxygenase pathway inhibitor
– zileuton

What 2 disorders are associated with antileukotriene use?
very rarely may produce Churg-Strauss syndrome and allergic granulomatous angiitis

What organ damage is associated with zileuton use?
liver

– elevation of liver enzymes

Omalizumab MOA and use
binds to IGE on sensitized mast cells and prevents activation by triggers

– prevents release of leukotrienes and other mediators

prophylactic management in asthmatic patients

Long-term treatment for patient with less than 2 bronchoconstrictive episodes per week with near normal spirometry
Long-term treatment for patient with less than 2 bronchoconstrictive episodes per week with near normal spirometry

Long-term treatment for patient with more than 2 bronchoconstrictive episodes per week with near normal spirometry
Long-term treatment for patient with more than 2 bronchoconstrictive episodes per week with near normal spirometry

Long-term treatment for patient with daily bronchoconstrictive episodes with 60-80% of normal spirometry
Long-term treatment for patient with daily bronchoconstrictive episodes with 60-80% of normal spirometry

Long-term treatment for patient with continual bronchoconstriction with less than 60% of normal spirometry
Long-term treatment for patient with continual bronchoconstriction with less than 60% of normal spirometry

Mild COPD FEV1% predicted and treatment
Mild COPD FEV1% predicted and treatment

Moderate COPD FEV1% predicted and treatment
Moderate COPD FEV1% predicted and treatment

Severe COPD FEV1% predicted and treatment
Severe COPD FEV1% predicted and treatment

Very severe COPD FEV1% predicted and treatment
Very severe COPD FEV1% predicted and treatment

List 2 uses of N-acetylcysteine in cystic fibrosis and drug overdose.
breaks disulfide bonds in mucus and liquefies it, making it easier to cough out

management of acetaminophen overdose

Which asthma drugs block the actions of adenosine?
methyxanthines (theophylline)

Vascular pathology

ex. nevus flammeus
port wine stain
salmon patch

angiokeratomas are
dilated blood vessels located just below epithelium

different types of angiokeratomas
– Angiokeratoma corporis diffusum – (trunk)
– Angiokeratoma of Mibelli- (dorsal aspect of fingers, hands, feet)
– Angiokeratoma of Fordyce- (red to blue papules on the scrotum or vulva)
– Angiokeratoma solitary – (small, bluish-black, warty papule that occurs predominantly on the lower extremities)

Fabry´s disease (angiokeratoma corporis diffusum)
* deficiency of the lysosomal enzyme hydrolase α-galactosidase
* X linked disease

pathogenesis farby´s
glycosphingolipids, predominantly trihexosylceramide, accumulate within the lysosomes of endothelial cells, fibroblasts,pericytes, and smooth muscle fibers of the dermis. (also accumulation in other organs – ggl cells, heart etc.)

pyogenic granuloma
overgrowth (from trauma, irritation, hormones etc.) in tissue such as mucosa and skin

epithelioid hemangioma
* AngioLymphoid Hyperplasia with Eosinophilia
* 20-40 y, F>M
* skin, sotf tissues, head, neck (ear)

juvenile hemangioma is also called
strawberry nevus

most common non.malignant neoplasm in children
juvenile hemangioma (1/100)

when does the juvenile hemangioma undergo involution?
within 7 years

Senile (cherry angioma, Campbell de Morgan spot) hemangioma locations
arms, legs, smaller than CH

cavernous hemangioma
tumor composed of large cavernous spaces

cavernous hemangioma location
Skin, soft tissues, internal organs

cavernous hemangioma often involve the deeper tissues with resultant
pressure necrosis

spindle cell hemangioma
Non-malignant, Composed of spindle cells, Have cavernous and dilated blood vessels

spindle cell hemangioma location
peripheral location

Kaposiform hemangioendothelioma mostly effects
children, teenagers

Kaposiform hemangioendothelioma location
skin, soft tissues (but retroperitoneum is most common)

Kaposiform hemangioendothelioma regression?
no

Hemangioendothelioma
intermediate malignancy – between haemangioma and angiosarcoma
* may be benign as well as malignant

Epithelioid Hemangioendothelioma
Superficially located or in soft t., lungs, bones, liver
Infrequent in children, F=M

ex. low grade vascular malignancy
Dabska tumor
Retiform Haemangioendothelioma

dabska tumor
Infants, young children
Head, neck, extremities,
Metastases to regional lymphnodes
VEGFR-3+

Retiform Haemangioendothelioma
Adults,
Extremities
VEGFR-3 +

dabska + RH=
hobnail hemangioendothelioma
*40-60% recurrence, regional metastases 10%

HHV-8 (rhadinovirus)
Kaposi´s sarcoma-associated herpes virus

Kaposi-sarcoma
low grade malignant proliferation associated with HHV-8

kaposi-sarcoma presents as
purple patches, plaques, and nodules on the skin may also
involve visceral organs

kaposi-sarcoma classically seen in
1. Older Eastern European males—tumor remains localized to skin; treatment involves surgical removal.
2. AIDS—tumor spreads early; treatment is antiretroviral agents (to boost immune system).
3. Transplant recipients—tumor spreads early; treatment involves decreasing immunosuppression.
4. endemic: middle aged men and children in equatorial Africa, lower legs – visceral involvment is common

kaposi-sarcoma stages
1. patch (macular stage)
2. plaque stage
3. nodular stage

angiosarcoma
malignant proliferation of endothelial cells; highly aggressive

angiosarcoma common sites
skin, breast, and liver.
1. Liver angiosarcoma is associated with exposure to polyvinyl chloride, arsenic, and Thorotrast.

cutaneous angiosarcoma
1. Angiosarcoma of the face and scalp ot the elderly
2.Angiosarcoma following lymphedema (post mastectomy AS, Stewart-Treves syndrome)
3. Post-irradiation angiosarcoma

angiosarcoma with lymph edema 95% of patients
post mastectomy with lymphedema

AS with lymph edema males
inherited or acquired (filaria) lower legs lymphedema of lower leg, 20years duration

artery vasoconstrictors
endothelins, ACE

artery vasodilators
NO, PGI2

artery growth stimulators
PDGF, CSF, FGF

artery growth inhibitors
TGF-, heparin

anticoagulants
prostacyclin
thrombomodulin
plasminogen activ.
heparin-like factor

procoagulants
F VIII -vWF
F XII
plasmin.activ. inhibitor

intimal thickening:
* vascular injury -> smooth muscle cell growth
* injury -> neointima -> migration of endothelium, migration and proliferation of smooth muscle cells through elastica interna, ECM -exaggerated healing -> intimal thickening

atherosclerosis
hardening of arteries, thickening and loss of elasticity of arterial wall
intimal plaque that obstruct the blood flow

atherosclerotic plaques
fibrous cap and grumous, lipid rich core (necrotic lipid core – mostly cholesterol)

atherosclerotic plaques undergo which calcification
dystrophic

pathogenesis atherosclerosis
1. Damage to endothelium allows lipids to leak into the intima.
2. Lipids are oxidized and then consumed by macrophages via scavenger receptors, resulting in foam cells.
3. Inflammation and healing leads to deposition of extracellular matrix and proliferation of smooth muscle.

complications of atherosclerosis
calcifications
rupture, ulceration (cholesterol, atheroemboli)
hemorrhage
superimposed thrombosis
weakened media – aneurysms

major risk factors atherosclerosis
age, male gender, family history, genetic abnormal.
hyperlipidemia
hypertension
cigarette smoking
diabetes

minor risk factors atherosclerosis
obesity, physical inactivity, stress (type A personality), homocysteine, postmenopausal estrogen defic., alcohol, saturated fat, chlamydia

two types hypercholerestolemia
1. familial hypercholesterolemia is caused by defects in LDL receptor leading to inadequate hepatic uptake of LDL

2. due to apoprotein E variant that fails to bind properly to LDL receptor

hypertension stage 1-4
1. 140-159/90/99
2. 160-179/100-109
3. 180-209/110-119
4. >210/>120

reasons for secondary hypertension may be
renal, endocrine, cardiovascular, neurologic

renal hypertension reasons
glomerulopathies
polycystic disease
renal artery stenosis
renal vasculitis
renin-producing tumors

endocrine hypertension reasons
-adrenocortical (Cushing, primary aldosteronism, adrenal hyperpl., licorice ingestion)
-exogenous hormones
-pheochromocytoma
-acromegaly
-hypo/hyperthyroidism
-pregnancy-induced

cardiovascular hypertension reasons
coarctation of aorta
polyarteritis nodosa
volume overload
increased cardiac output
rigidity of aorta

reasons for vasculitis
direct infection, immunlogic, unknown

ex. direct infection vasculitis
Neisseria, Rocky Mountain sp. fever, syphilis, fungi, herpes zoster – varicella

ex. immunologic vasculitis
*immune complex mediated, SLE, RA, hepatitis, IgA, drug induced, cryoglobulinemia, serum sickness
*ANCA: Wegener, Churg-Strauss, microscopic polyarteritis)
direct antibody attac:Goodpasture (anti-GBM), Kawasaki (antiendothelial)
*cell mediated: transplant rejection, IBD, paraneoplastic

ex. unknown vasculitis
temporal arteritis
Takayashu arteritis
polyarteritis nodosa

symptoms vasculitis
non-specific symptoms of infl: e.g., fever, fatigue, weight loss, and myalgias
Symptoms of organ ischemia—due to luminal narrowing or thrombosis of the inflamed vessels

ex. large vessel vasculitis
temporal (giant cell) arteritis
takayasu arteritis

most common form of vasculitis in older adult
temporal (giant cell) arteritis, usually affects females

temporal (giant cell) arteritis
Granulomatous vasculitis that classically involves branches of the carotid artery

Takayasu Arteritis
Granulomatous vasculitis that classically involves the aortic arch at branch points

takayasu arteritis presentation
Presents in adults < 50 years old (classically, young Asian females) as visual and neurologic symptoms with a weak or absent pulse in the upper extremity ('pulseless disease'). ESR is elevated.

ex. medium vessel vasculitis
polyarteritis nodosa
kawasaki disease
buerger disease

polyarteritis nodosa
necrotizing inflammation involving multiple organs; lungs are spared

polyarteritis nodosa presentation
Classically presents in young adults as hypertension (renal artery involvement),
abdominal pain with melena (mesenteric artery involvement), neurologic disturbances, and skin lesions. Associated with serum HBsAg

kawasaki´s disease presentation
asian children < 4 y/o, nonspecific signs including fever, conjungitis, erythematous rash of palms and soles, enlarged cervical lymph nodes

kawasaki – coronary artery involvment leads to risk for
(1) thrombosis with myocardial infarction and
(2) aneurysm with rupture.

treatment kawasaki
aspirin and 1VIG; disease is self-limited

buerger disease
Necrotizing vasculitis involving digits, Highly associated with heavy smoking; treatment is smoking cessation.

buerger disease presentation
ulceration, gangrene, and autoamputation of fingers and toes; Raynaud phenomenon is often presen

ex. small vessel vasculitis
Wegener Granulomatosis, Microscopic Polyangiitis, Churg-Strauss Syndrome, He noch-Schön lein Purpura

Wegener Granulomatosis
Necrotizing granulomatous vasculitis involving nasopharynx, lungs, and kidneys

Wegener Granulomatosis presentation
middle-aged male with sinusitis or nasopharyngeal ulceration, hemoptysis with bilateral nodular lung infiltrates, and hematuria due to rapidly progressive glomerulonephritis

Microscopic Polyangiitis
Necrotizing vasculitis involving multiple organs, especially lung and kidney

Microscopic Polyangiitis presentation
similar to Wegener granulomatosis, but nasopharyngeal
involvement and granulomas are absent.

Churg-Strauss Syndrome
Necrotizing granulomatous inflammation with eosinophils involving multiple organs, especially lungs and heart

Churg-Strauss Syndrome presentation
Asthma and peripheral eosinophilia are often present

Henoch-Schön lein Purpura
Vasculitis due to IgA immune complex deposition; most common vasculitis in children

Henoch-Schön lein Purpura presentation
palpable purpura on buttocks and legs, GI pain and bleeding, and hematuria (IgA nephropathy); usually occurs following an upper respiratory
tract infection

sting-of-pearls appearance is associated with which disease?
Polyarteritis nodusa

polyarteritis nodusa involves which arteries?
muscular arteries (typically involving renal and visceral vessels but sparing the pulmonary circulation)

Raynaud phenomenon is
vasospasm -> discoularation
white->blue->red

c-ANCA levels correlates with which disease(s)
weger granulomatosis

p-ANCA levels correlates with which disease(s)
microscopic polyangitis and churg-strauss syndrome

Hydronephrosis Pathology

What is the “official” definition of Hydronephrosis?
Hydronephrosis is an obstructive disorder of the urinary system that causes dilation of the renal pelvis and calyces with urine. If hydronephrosis is long-standing, the resultant increases in intrarenal pressures causes ischemia, parenchymal atrophy, and loss of renal function.

What is the “etiology” (causes) of Hydronephrosis?
The most common cause of hydronephrosis is a calculus, it can also occur as a congenital defect or because of a blockage of the system by a tumor, stricture, blood clot, or inflammation.

What is the “prognosis” of Hydronephrosis?
The long term challenges of hydronephrosis are reversible if the cause of obstruction is relieved early in the process. Treatment may include a ureteral stent that allows the ureter to drain into the bladder, a nephrostomy tube that allows the blocked urine to drain through the back and antibiotics for infection.

What is the “incidence” of Hydronephrosis in the United States?
Unilateral hydronephrosis occurs in approximately 1 in 100 people; its also fairly common in babies.

What is the “prevalance” of Hydronephrosis in the United States?
Some researchers have found that up to two percent of all babies, mostly boys, have prenatal hydronephrosis (this usually clears up on its own). Men, particularly those older than 60, are also more likely to be affected because, as men age, the prostate gland tends to increase in size and block the flow of urine.

What is the “mortality rate” of Hydronephrosis in the United States?
Morbidity and mortality due to urinary tract obstruction is secondary to renal insufficiency/failure, salt-loosing nephropathy, urinary concentrating defects, renal tubular acidosis, hyperkalemia, hypomagnesium, hypophosphatemia, urinary tract infection, renal calculi, hypertension, polycythemia, neonatal ascites and post-obstructive diuresis.

What is the “morbidity rate” of Hydronephrosis in the United States?
Blockage can usually be relieved, but if relief takes too long, the kidney can be damaged permanently. However, because one normally functioning kidney is enough to sustain the body, permanent kidney failure is unlikely to develop unless both kidneys have been blocked for some time, usually at least a few weeks. The prognosis also depends on the cause of obstruction. For example, an untreated infection is more likely to cause kidney damage than a kidney stone.

Under which “causative agent” can Hydronephrosis be classified?
Endogenous

Which classification is Hydronephrosis? Additive or Destructive
Additive

Radiographically, how is Hydronephrosis portrayed on a general imaging study?
CT is quickly replacing the conventional IVU exams that would typically be used to diagnose hydronephrosis. However an IVU may be necessary to help differentiate renal system or stones from hydronephrosis. When contrast is used, the renal pelvis and calyces will appear dilated and radiopaque.

Ch. 24 Vital Signs

When assessing an infant’s axillary temperature, it will be
One degree lower than oral temperature

When assessing an infant’s axillary temperature, it will be
arm

An older adult client monitors her BP at home. Lately she has been experiencing dizziness and nausea, followed by a headache when she arises from lying down for a nap. She was worried it was her BP so she began taking it after she arose from her nap and found that her BP would drop shortly after getting up from her nap. She followed up with her health care practitioner and was diagnosed with orthostatic hypotension. What is the most appropriate nursing diagnosis to be included in the teaching plan for this patient at this time?
Risk for falls related to inadequate physiologic response to postural (positional) changes

What equipment is needed to take an apical pulse?
In adults, the apical pulse rate is counted for 1 full minute by listening over the apex of the heart with a stethoscope.

A client is taking medications to treat a heart dysrhythmia. Which site should be used to assess pulse in this client?
Apical

A nurse is assessing an apical pulse on a cardiac client. The client is taking digoxin, which is a cardiac medication. The nurse can anticipate that the digoxin will do what?
decrease apical pulse

Based upon circadian rhythms, when would the nurse note the highest temperature during a 24-hour period?
5:00 PM

The temperature is 102° during a heat wave. The nurse can expect admissions to the emergency room to present with
Body temperature can fluctuate with exercise, changes in hormone levels, changes in metabolic rate, and extremes of external temperature.

A nurse is assessing the pulse volume of a client with influenza. The nurse notes that the client has a thready pulse. Which of the following is a description of a thready pulse?
Thready pulse is felt with difficulty or not easily felt, and slight pressure causes it to disappear. A weak pulse is stronger than a thready pulse, and light pressure causes it to disappear. A normal pulse is felt easily, and moderate pressure causes it to disappear. A bounding pulse is strong and does not disappear with moderate pressure.

A nurse needs to measure the blood pressure of a client who has just undergone a bilateral mastectomy. How should the nurse measure the blood pressure?
over the client’s thigh

Which of the following are considered vital signs? Select all that apply.
• Respiratory rate
• Temperature
• Pulse
• Blood pressure

Which of the following sites results in measuring a client’s core body temperature?
Rectal

Of the following clients, who should not have a temperature assessed rectally?
The rectal route is contraindicated in clients with diarrhea, those who have undergone rectal surgery, those with rectal diseases, and those with cancer who are neutropenic.

What is the pulse pressure of a client whose blood pressure is 132/82 mm Hg?
50

A nurse is assessing the blood pressure of a client using the Korotkoff sound technique. The nurse notes that the phase I sound disappears for 2 seconds. What should the nurse document on the progress record?
An auscultatory gap is a period during which sound disappears. An auscultatory gap can range as much as 40 mm Hg. A widening in the diameter of the artery takes place in the phase II of the Korotkoff sound technique. An adult diastolic pressure takes place in the phase IV of the Korotkoff sound technique.

The nurse knows that a client that is being taught to perform home blood pressure monitoring (HBPM) needs further teaching when he makes which statements? Select all that apply.
The client needs further teaching if he or she states that the instructions that come with the home monitor can be discarded because he or she should review those instructions and refer to them when needed. Also, the client needs further teaching if he or she states that he or she must rest for 5-10 minutes before taking the BP. Three to five minutes is sufficient resting time before taking the BP. The client is correct if he or she states that the arm should be elevated to heart level; avoid food, caffeine, and tobacco 30 minutes before taking BP; and that BP should be taken before a meal.

The nurse is teaching the parents of an infant with an irregular heartbeat how to check the pulse rate. The infant’s pulse is very high and irregular. What will the nurse have to do in order to teach these parents how to monitor their infant’s pulse rate?
The parents will have to be taught how to use a stethoscope so that they can listen to and count the infant’s apical pulse

A client has smoked most of his life and has labored respirations. He is experiencing
dyspnea

An ultrasonic Doppler is used for
Auscultating a pulse that is difficult to palpate

A nurse applies a cuff of the automated blood pressure device around the client’s arm in preparation for serial blood pressure recordings. The nurse checks the cuff frequently based on which rationale?
When using electronic automated blood pressure devices for serial blood pressure recording, frequently checking the cuffed limb ensures adequate arterial perfusion and venous drainage between measurements. The nurse does not check the cuffed limb to see if it is warm or cold, but to ensure that there is adequate arterial perfusion and venous drainage between measurements. Elevating the arm above the head between cuff measurements automatically speeds venous return to the heart.

Which peripheral pulse site is generally used in emergency situations?
Carotid

A pulse deficit is the difference between ..
the apical pulse and the radial pulse rate
Explanation:
When a pulse deficit is present, the radial pulse is always lower than the apical pulse rate.

While assessing vital signs of a client with a head injury and increased intracranial pressure (IICP), a nurse notes that the client’s respiratory rate is 8 breaths/minute. How will the nurse interpret this finding?
Bradypnea

The nurse is talking to an older client that performs home blood pressure monitoring (HBPM) and finds that recently her BP measurements have consistently been low. What factors may contribute to causing this client’s BP to be falsely decreased?
• Using cracked or kinked tubing
• Applying too wide a cuff
• Releasing the valve rapidly

A nurse is assessing the blood pressure of a team of healthy athletes at the heath care facility. Which of the following observations can be made by the nurse and athletes by measuring the blood pressure?
The ability of the arteries to stretch

During measurement of a rectal temperature, the thermometer probe should be inserted about 1.5 inches in an adult and .5 inches in an infant.
True

A nurse is assessing the respirations of a 60-year-old female patient and finds that the patient is breathing so shallowly that the respirations cannot be counted. What would be the appropriate initial nursing intervention in this situation?
Auscultate the lung sounds and count respirations.

A 62-year-old female client being treated for hypertension did not take her daily BP medication over the weekend because she was out of medication and the pharmacy was closed. Her average home blood pressure monitoring (HBPM) reading has been 130/82. Today her BP has been 138/90, 135/85, and 142/86. She calls the on-call nurse for her health care provider. What is the most appropriate thing for this nurse to advise this client?
To take the recommended daily dose of medication and call the health care provider if the average of her HBPM readings increase/decrease by 10, or if she has any other concerns.

A client that has been taught to monitor her pulse calls the nurse because she is having difficulty feeling it strongly enough to count. She states that she takes her pulse before taking her cardiac medication. She sits down with her nondominant arm on a firm service, palm up. She uses her three fingers to feel just below the wrist on the side closest to the body. She does not press hard and she has a watch with a second hand to use to count it, but she has a very difficult time feeling it. What does the nurse recognize that she is doing wrong?
A client is taught to take his or her own pulse before certain medications or after exercise, depending on the individual client’s needs. When teaching a client to take his or her own pulse, the nurse should teach the client to sit down and place an arm on a hard service with the palm upward. Then using three fingers, the client should feel just below the wrist on the outer side of the arm for the pulse. The client should be taught not to press too hard or the pulse can be obliterated and to use a watch or clock with a second hand to count the pulse.

A client being treated for hypertension is monitoring her own BP at home. She was informed by the nurse to take three measurements at one sitting and average them together to get a BP to record. Her measurements at one sitting were 140/86, 125/78, and 130/82. She wants to know if she averaged them correctly. Which is the correct average?
132/82

A client has had a left-side mastectomy. How does this affect the blood pressure assessment?
If the client has had a mastectomy, blood-pressure monitoring on the same side can further impede circulation, contributing to lymphedema.

Clients demonstrating apnea have what?
Temporary cessation of breathing

Which patient would the nurse consider at risk for low blood pressure?
A patient with low blood volume

The nurse knows that a client who is being taught to perform home blood pressure monitoring (HBPM) understands the teaching plan when he makes which statement about the size of the BP cuff? The cuff should:
fit snug around the upper arm with room to slip a fingertip under the cuff and should be 1 inch above the crease of the elbow.

What is the ideal method for monitoring response to treatment for high blood pressure (BP)?
The review of home blood pressure monitoring (HBPM) readings.

An obese patient has developed peripheral edema as a consequence of heart failure, making it very difficult for the student nurse to accurately palpate the patient’s peripheral pulses. How should the nurse proceed with this assessment?
Auscultate the patient’s apical pulse

A client has smoked most of his life and has labored respirations. He is experiencing
dyspnea

The nurse is assessing a patient’s brachial artery blood pressure. Which nursing actions are performed correctly? (Select all that apply.)
• The nurse centers the bladder of the cuff over the brachial artery about midway on the arm.
• and increases in intensity as the diastolic pressure.
• The nurse has the patient lying or sitting down with the forearm supported at the level of the heart and the palm of the hand upward.
• The nurse wraps the cuff around the arm smoothly and snugly and fastens it. f. The nurse repeats any suspicious reading before one minute has passed since the last reading.