Lecture Note Summary

Intro
Pharmacotherapeutics: the use of specific drugs to prevent, treat, or diagnose a disease (antibiotics)
Pharmacodynamics: what the drug does to the body and its MOA
Pharmacokinetics: how substances are absorbed, distributed, and eliminated

Signs observable measurements (respiratory rate > 20, Tachypnea)

Symptoms what the patient tells you (dyspnea on exertion, shortness of breath)

Administration Routes: 1) Enteral involves the GI system (oral, sublingual, buccal, or rectal)
2) Parenteral does not involve GI system (Intravenous, inhalation, etc)

Receptors cells responsible for responding to molecules. Can be blocked, activated, or at rest.
Agonists causes a response
Antagonists binds and causes no response
Allosteric binding of a molecule to a site other than the active to enhance or inhibit activity

To be effective a drug must 1) bind to a receptor

2) Remain bioavailable until bound to receptor

First Pass Effect drug metabolization before circulation, bioavailability is usually reduced
Clearance ratio of drug disappearance to active plasma conc.
1st order constant half-life regardless of drug amount in body (50% reduction
from original)
2nd order constant elimination regardless of drug conc. (body can only
eliminate so much. Leaves body at a certain rate, regardless of drug amount)

Bioavailability fraction of administered dose that reaches circulation (amount that is action
available for use, biologically)
Biotransformation mechanisms where the body hastens excretion of a drug by making them less
lipid soluble decreasing their reabsorption and activity, ultimately excreting
them as metabolites.
C - Conjugation
H - Hydrolysis
O- Oxidation
R - Reduction
E Elimination

Steady State the amount of drug taken equals the amount of drug excreted
Potency amount of drug needed to produce an effect (too much results in lethality; most
common in anti-psychotics such as lithium)

Side effect problems that occur in addition to the desired effect (bruising, hair loss, etc)
Adverse reaction harm associated with a drug taken at a normal dosage (stroke, GI bleed, etc)
Steroids are effective SHORT TERM; LONG TERM lead to complications

NSAID Functions:
1) Reduce inflammation
2) Pain reliever
3) Fever reducer (decrease in body temp)
4) Blood anticoagulant/thinner

Statins lipid lowering medications, typically used for cholesterol

Rhabdomyolysis excessive breakdown of muscle tissue
Indicators (normal values are low, high levels indicate Rhabdo)
o CPK creatine phosphokinase
o CK creatine kinase

MUSCULOSKELETAL
Muscle Types: 1) Skeletal
2) Cardiac
3) Smooth

Prefix Meaning Suffix Meaning

Myo Muscle Clast Breakdown/cleave bone
Osteo Bone Blast Build up bone
Arthro Joint Itis Inflammation
Teno Tendon Algia Pain

Bones

Either Compact (cortical) denser part of the bone that is solid

Cancellous (spongy or trabecular) softer part of the bone where RBCs develop & is flexible

Healthy bones depend on calcium & vitamin D

Denser bones depend on stress and greater work done by osteoblasts than osteoclasts

Autoimmunity body fails to distinguish self from non-self

Affect women more than men. Affects specific cells up to multiple systems

Complement cascade clump of proteins that punch a hole in foreign substances and kills them
(associated with vasculitis)

Reactive Arthritis reactive arthritis is one that arises after an infectious process presents itself at a site
remote from the primary infection (associated with Reiters syndrome)

FOR DISEASE CHART FOCUS ON DEFINITION OF DISEASE AND PATHOLOGY OF IT

Malignant can be invasive or metastasize (spread from one body part to another)
Benign no tendency to metastasize

Stage 0 not normal (can become dangerous) carcinoma in situ, premalignant, preinvasive

Li-Fraumeni syndrome common predisposition of cancer

Retinoblastoma cancer of the retina

Tender points on the body:

1) Low cervical
2) Second rib
3) Lateral epicondyle
4) Knee
5) Occiput
6) Trapezius
7) Supraspinatus
8) Above gluteal muscles (near PSIS)
9) Greater trochanter

Endocrine lecture
Endocrine: ductless and secretions transported by bloodstream
Exocrine: have ducts that transport secretions to an organ or body surface
Paracrine: hormone secreting cells that act on cells close by or the cell itself

The pancreas is all three types of glands.

Use special chemical messengers called hormones which are transported by the blood stream to the
cells and organs on which they have a regulatory effect

Endocrine Glands
Pituitary (a) sends messages; (p) controls other brain functions
Thyroid
Parathyroid calcium metabolism
Adrenal bodys response to stress; fight or flight reactions
Pancreas - (endocrine metabolism of sugar) (exocrine helps with digestion)
Gonads sexual orientation

Five general Functions of the endocrine system

1) Differentiation of the reproductive and central nervous system of developing fetus
2) Stimulation of sequential growth and development during childhood and adolescence
3) Coordination of the male and female reproductive systems
4) Maintenance of optimal internal environment throughout the lifespan (homeostasis)
5) Initiation of corrective and adaptive responses when emergency demands occur

Endocrine system meets the NS at the hypothalamic-pituitary interface.

Inflammation usually results in glandular hypofunction

Musculoskeletal issues are secondary to endocrine disorders

Radioactive iodine is high in Graves disease; low in thyroiditis

4 types of thyroid cancer:

Papillary (90%) thyroid cancer: most common type, develops in follicular cells
Follicular (90%) thyroid cancer: develops from follicular cells and is usually slow growing
Medullary (5%) thyroid cancer: makes up 5% of thyroid cancers, develops in C cells
Anaplastic (5%) thyroid cancer: rare, fast-growing, poorly differentiated

Parathyroid glands secrete PTH which regular calcium and phosphorus

Chief cells produce PTH
99% of Calcium stored in bones

PTH increases renal and intestinal absorption of calcium (decreased osteoblastic and increased
osteoclastic function)
Effect on intestines- increase absorption of plasma calcium (from blood to plasma)
Effect on Bone- decrease osteoblast, increase osteoclast) (calcium from bone to blood)
Effect on Kidney- increase absorption of plasma calcium (from blood into kidney)

Vitamin D intestinal absorption of calcium

Calcitonin secreted by parafollicular cells, C cells of THYROID cells

Plasma calcium concentration in lower
Cellular uptake of calcium is increased
Renal excretion of calcium is increased
Bone formation is increased

Adrenal Glands

Zona glomerulosa mineralocorticoid secretion, such as aldosterone (gain Na, lose K) (affected renal
metabolism)
Zona fasciculata glucocorticoid secretion, such as cortisol (maintains BP & glucose) (good anti-
inflammatory) (Glucocorticoids can weaken joints and ligaments by affecting the collagen structures)
Zona reticularis androgen secretion (maintaining proper hair growth) (dehydroepisterone DHDA)

Increased stress increased cortisol enlarged adrenal gland

Decrease stress decreased cortisol shrunken adrenal gland

Hyperlipidemia adipose tissue is considered an endocrine organ

Fats are able to secrete regulatory molecules for fat metabolism, feeding behavior, homeostasis,
vascular tone, energy balance, and insulin sensitivity.
High cholesterol and triglycerides
Osteoporosis MOST common metabolic bone disease. PARATHYROID organs affect calcium balance the
most

Diabetes Mellitus
Leading cause of blindness and renal failure
Insulin is a hormone secreted by B-beta cells that transport glucose into the cell for energy and
storage as glycogen (food into energy)

3 major metabolic problems with Type I:

1. Decreased utilization of glucose
2. Increased fat mobilization
3. Impaired protein utilization

Cell types:
A cells secrete glucagon
B cells produce insulin
D cells secrete somatostatin
F cells secrete pancreatic polypeptide

Risk factors Type I:

Type I DM in first degree relative
+ family Hx
Autoantibodies
Presence of HLA, DR3, and DR4

Risk factors Type II:

+ family Hx
Ethnic origin
Obesity/age/sedentary lifestyle
Hypertension/vascular disease

Pathophysiology of Diabetic Complications

Atherosclerosis: lipid accumulation in blood vessels
Cardiovascular: metabolic disturbances
Retinopathy: damage to eye blood vessels
Nephropathy: destruction of renal filtration structures (kidney)
Musculoskeletal problems: CTS, Dupuytrens, trigger finger, and frozen shoulder
Sensory, motor, and autonomic neuropathy: burning, numbness, or complete loss of sensation

Limited Joint Mobility in diabetic patients due to overuse, inflammation, trauma, impingement, or
genetic issues.

TX of Diabetes
Insulin Preparations: Animal sources, DNA recombinant insulin, or biosynthetic insulin analogs
Administration: subcutaneous injection, insulin pumps, or inhalation
Intensive insulin therapy: for those who require exogenous insulin (TYPE 1)
Adverse effects: hypoglycemia (d/t to increased medications) or allergic response to insulin
 Exercise programs that are low impact (walking, cycling, or swimming) and resistive to improve
mobility and strength

Other Meds for DM

Glucagon to treat hypoglycemia induced by insulin
Immunosuppressants to treat autoimmune response of pancreatic beta cells in TYPE 1
Aldose reductase reduces possible neuropathy complications
Low dose aspirin
Statins for high cholesterol
Anticonvulsants Lyrica
SSRIs Cymbalta