Class Assignment #5
Instructor: Ryan O’Malley, DNP, NP-C, CCRN-CMC, CNL
Differentiate Crohn’s disease versus ulcerative colitis
In ulcerative colitis there is continuous inflammation associated with colon region and whereas in Crohn’s disease there are several healthy parts associated with intestine that is mixed between areas that are subjected to inflammation.
Ulcerative colitis affects colon along the inner lining and whereas in Crohn’s disease it occurs in bowel wall layers.
Differentiate DI versus SIADH
In case of DI the body of an individual is only able to make very little amount of ADH and whereas in case of SIADH body is able to make excess ADH.
Anatomically why are ultrasounds typically not ordered to diagnose pancreatitis?
Ultrasounds are considered as very insensitive to carry out diagnosis of pancreatitis which is mainly due to not able to showcase abnormalities.
What is the indication of Creon? Describe patient teaching.
Creon is an indication of exocrine pancreatic insufficiency which is mainly due to cystic fibrosis and chronic pancreatitis. Patient should be advised to take Creon for every meal .
Why is acute pancreatitis worsened by foods?
Acute pancreatitis is generally begins with pain in upper abdomen region that is severe and it might become intense. The pain in abdomen even become worse due to food consumption.
What two clinical findings point towards acute pancreatitis?
Pain in abdomen is suggestive of pancreatitis and
serum amylase and/or lipase levels which is three times higher than the normal level
Describe the major complications of liver cirrhosis
Major complications of liver cirrhosis include
bacterial peritonitis,
portal hypertension,
variceal bleeding,
ascites and
hepatorenal syndrome.
Explain the pathology of hepatic encephalopathy. How does lactulose treat this condition?
The disturbances in blood brain barrier, neurotransmission and neuroinflammatory changes, oxidative stress and abnormalities associated with pathway and blood flow abnormalities present in brain are found to be associated with hepatic encephalopathy. Lactulose administration will decrease rate of urea production which is consistent accompanied by decrease in ammonia entry into blood but it will inhibit the process of degradation of urea.
How are most cancers, including colorectal cancer, staged?
Most of the cancers are staged from one to five level which shows the number when gets increased it indicates the severity of the cancer condition in the patient.
How are most cancers, including colorectal cancer, treated?
Some of the possible treatment strategies include surgery, chemotherapy, and radiation therapy
What is cobblestoning and what is it indicative of?
Cobblestoning refers to uncommon appearance in which polygonal cells will bulge out the process from the surface of mucosa to a degree that is varying which is generally present in posterior pharyngeal wall.
It is indicative of appearance of lumpy structure of lungs, trachea etc.
Why do ulcerative colitis and Crohn’s disease have similar treatments?
Biopsy is one of the treatment procedure in order to extract small tissue as both are associated with gastrointestinal region indicating inflammation.
Why are patients with liver cirrhosis at higher risk of bleeding?
Patients suffering from liver cirrhosis will generally develop hemorrhage at gastrointestinal region present in upper side which is due to variety of lesions that include virtue of hypertension such as varices associated with gastroesophageal region and hypertensive gastropathy and lesions. Due to this chances of bleeding is possible and increase the risk.
What is the MOA of Lomotil? What is its big disadvantage?
Lomotil generally works by spasms prevention that is present in muscles of gut region which cause them to make relax further. It cause many side effects such as drowsiness, appetite loss etc. and it is considered as allergic when administered with other combinations.
Why is morphine contraindicated in pancreatitis?
Morphine is contraindicated in pancreatitis for the treatment of acute pain due to dysfunction of oddi or opioid induced sphincter.
What are the two indications for Reglan? What is its major side effect?
Adults who are diagnosed with gastroesophageal reflux are generally fail to respond to conventional therapy and are subjected to Reglan, a short term therapy i.e. for a period of 1 to 3 months showing symptoms. Side effects include decreased energy, dizziness, headache, nausea and diarrhoea etc.
What do Andre the Giant and Tony Robbins have in common?
Both Andre and Tony exhibited similar symptoms of acromegaly and Tony in addition had inflammation in pituitary gland.
Is it okay to insert a nasogastric tube to a patient with esophageal varicies? Why or why not?
No, it will cause contraindications which include abnormality of coagulation procedures and also chances for causing trauma.
Explain in 1 sentence the pathology of pancreatitis.
It is featured by loss of extracellular or intracellular compartmentation due to obstruction of secretory transport in pancreas and by pancreatic enzymes activation.
References:
- Antkiewicz-Michaluk L, Michaluk J, Mokrosz M, Romanska I, Lorenc-Koci E, Ohta S, Vetulani J. Different action on dopamine catabolic pathways of two endogenous 1,2,3,4-tetrahydroisoquinolines with similar antidopaminergic properties. J Neurochem. 2001;78:100–108. doi: 10.1046/j.1471-4159.2001.00391.x. [PubMed] [CrossRef] [Google Scholar]
- Antkiewicz-Michaluk L, Karolewicz B, Romanska I, Michaluk J, Bojarski AJ, Vetulani J. 1-Methyl-1,2,3,4- tetrahydroisoquinoline protects against rotenone-induced mortality and biochemical changes in rat brain. Eur J Pharmacol. 2003;466:263–269. doi: 10.1016/S0014-2999(03)01565-6. [PubMed] [CrossRef] [Google Scholar]
- Antkiewicz-Michaluk L, Wardas J, Michaluk J, Romanska I, Bojarski A, Vetulani J. Protective effect of 1-methyl-1,2,3,4-tetrahydroisoquinoline against dopaminergic neurodegeneration in the extrapyramidal structures produced by intracerebral injection of rotenone. Int J Neuropsychopharmacol. 2004;7:155–163. doi: 10.1017/S1461145703004036. [PubMed] [CrossRef] [Google Scholar]
- Antkiewicz-Michaluk L, Lazarewicz JW, Patsenka A, Kajta M, Zieminska E, Salinska E, Wasik A, Golembiowska K, Vetulani J. The mechanism of 1,2,3,4- tetrahydroisoquinolines neuroprotection: the importance of free radicals scavenging properties and inhibition of glutamate-induced excitotoxicity. J Neurochem. 2006;97:846–856. doi: 10.1111/j.1471-4159.2006.03756.x. [PubMed] [CrossRef] [Google Scholar]
- Antkiewicz-Michaluk L, Wasik A, Romanska I, Bojarski A, Michaluk J. Both stereoselective (R)- and (S)-1-Methyl-1,2,3,4-tetrahydroisoquinoline enantiomers protect striatal terminals against rotenone-induced suppression of dopamine release. Neurotox Res. 2011;20:134–149. doi: 10.1007/s12640-010-9228-5. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
- Berenbaum MC (1989) What is synergy? Pharmacol Rev 41:93—141 Erratum published in (1989) Pharmacol Rev 41:422 [PubMed]
- Bertrand S, Nouel D, Morin F, Nagy F, Lacaille JC. Gabapentin actions on Kir3 currents and N-type Ca2 + channels via GABAB receptors in hippocampal pyramidal cells. Synapse. 2003;50:95–109. doi: 10.1002/syn.10247. [PubMed] [CrossRef] [Google Scholar]
- Boissier JR, Tardy J, Diverres JC. Une nouvelle méthode simple pour explorer l’action tranquilisante: le test de la cheminée. Med Exp (Basel) 1960;3:81–84. doi: 10.1159/000134913. [CrossRef] [Google Scholar]
- Brodie MJ, Schachter SC. Fast facts—epilepsy. 2. Oxford: Health Press; 2001. [Google Scholar]
- Cadart M, Marchand S, Pariat C, Bouquet S, Couet W. Ignoring pharmacokinetics may lead to isoboles misinterpretation: illustration with the norfloxacin-theophylline convulsant interaction in rats. Pharm Res. 2002;19:209–214. doi: 10.1023/A:1014233102342. [PubMed] [CrossRef] [Google Scholar]
- Cheng JK, Chen CC, Yang JR, Chiou LC. The antiallodynic action target of intrathecal gabapentin: Ca2+ channels, KATP channels or N-methyl-d-aspartic acid receptors? Anesth Analg. 2006;102:182–187. doi: 10.1213/01.ane.0000189550.97536.83. [PubMed] [CrossRef] [Google Scholar]
- Coulter DA, Huguenard JR, Prince DA. Characterization of ethosuximide reduction of low-threshold calcium current in thalamic neurons. Ann Neurol. 1989;25:582–593. doi: 10.1002/ana.410250610. [PubMed] [CrossRef] [Google Scholar]
- Crunelli V, Leresche N. Block of thalamic T-type Ca(2+) channels by ethosuximide is not the whole story. Epilepsy Curr. 2002;2:53–56. doi: 10.1046/j.1535-7597.2002.00024.x. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
- Czuczwar SJ, Patsalos PN. The new generation of GABA enhancers. Potential in the treatment of epilepsy. CNS Drugs. 2001;15:339–350. doi: 10.2165/00023210-200115050-00001. [PubMed] [CrossRef] [Google Scholar]
Define cardiac output
Cardiac output refers to blood volume which is pumped by heart by both right and left ventricle in unit time. It is also referred to as heart output.
What is MAP? Why is it so important to maintain a MAP of at least 60mmHg?
MAP refers to mean arterial pressure that is used to blood perfusion to all tissues present in body in order to maintain the function. Mechanism of MAP is to maintain at least 60 mm Hg which facilitates blood to reach effectively to all tissues present in the body.
Describe Starlings law of contractility
Starlings law describes contractility as the ejection of volume of stroke facilitated by heart at extreme pressures that is greater. For any pressure that is filling ,the corresponding volume of stroke is greater if heart’s contractility is greater.
Describe and define the 3 determinates of SV
Three determinants of stroke volume are
Preload : Heart filling pressure at diastole end.
Contractility: Inherent contraction vigor associated with muscles of heart during the process of systole
Afterload: Pressure that is exerted that will enhance the heart to eject blood during the systole process.
What is JNC8?
JNC8 is 8th Joint national committee that has been released in recent times related with evidence based recommendations for the treatment procedures of goals, medications, thresholds during the process of management of hypertension especially in adults.
According to JNC8, how is HTN defined?
Hypertension(HTN) refers to increase in pressure of blood in patient is experiencing systolic pressure greater than 140mm Hg and diastolic blood pressure is 90mm Hg.
What are some consequences of HTN? Physiologically, how does HTN damage tissue/organs?
Some of the consequences of HTN include stroke and heart attack. Presence of hypertension will cause thickening of arteries and also get hardened. This can lead to heart attack or stroke in an individual and also lead to other complications.
Name the classes of medication that can treat HTN.
ACE inhibitors, Beta blockers, Alpha blockers, Renin inhibitors, Calcium channel blockers and anti-hypersensitive drugs are some of the classes that are primarily used for the treatment of HTN.
How is malignant HTN defined and what are some of the s/s? How does malignant HTN differ from HTN?
Malignant HTN is characterized by presence of blood pressure at extreme level which develops very rapidly and able to cause damage of organs. Normal blood pressure in an individual is 120/80 and whereas malignant HTN is with 180/120. This shows it is higher than HTN levels i.e. 150/90.
Why is CAD more lethal in young people?
Young people are characterized by risk factors such as hypertension, obesity and have ability predispose the young people and increase the chances of risk that leads to coronary events that are considered as acute. Diabetes and hypertension are major risk factors related with Coronary arterial diseases among young people.
How is CAD treated?
Use of Nitroglycerin ,patches and sprays will control the pain in chest region for temporary period by means od dilation of coronary arteries and thereby reduces demand of heart for blood. Inhibitors such as angiotensin converting enzyme and angiotensin 2 receptor blockers are used to treat coronary artery disease.
What are some modifiable risk factors you as a nurse can help patients change to reduce their risk of CAD?
Some of the risk factors that can be avoided by cultivating healthy eating habits, lose weight, decrease stress and maintain blood sugar levels, decrease blood pressure, limit the consumption of alcohol and exercise regularly.
As a bedside nurse, what clinical signs or symptoms would lead you to suspect a AAA?
AAA refers to Abdominal aortic aneurysm. The signs and symptoms associated with it mainly include pain in chest region, lower back region, feeling of pulsation in abdomen. In addition to this weight loss and symptoms of cold foot is associated with AAA.
Differentiate between R versus L heart failure
Right heart failure is characterized by unable to pump adequate blood to lungs as it becomes too weak.
Left heart failure is characterized by not able to pump blood to the body any more.
Describe the MOA (see illustration on Lecture #2), name 1-2 major side effects, and give an example of the following:
Beta-blockers: Acebutolol and Atenolol .Side effects include dizziness and fatigue.
Vasodilators: Sodium nitroprusside and Hydralazine. Side effects include tachycardia and Nausea.
Calcium channel blockers-Amlodipine and Cilnidipine. Side effects include low blood pressure and drowsiness.
ARBs- Azilsartan and Candesartan. Side effects include headache and fainting.
ACI : Novoflam and Acicloflex .Side effects include Nausea and indigestion.
Diuretics
Thiazides : Indapamide and Chlorthalidone. Side effects include increase in blood sugar level and uric acid levels.
Potassium sparing: Amiloride and Eplerenone. Side effects include too high potassium levels and skin rash
Loop :Bumetanide and Furosemide. Side effects include presence of irregular periods and spotting between periods.
Define HLD and hypertriglyceridemia
HLD or Hyperlipidemia is associated with presence of abnormal elevated levels of lipoproteins or lipids present in blood.
Hypertriglyceridemia is associated with presence of elevated levels of triglycerides.
Describe the MOA of the following, name 1-2 major side effects, and given an example of the following:
Statins- Side effects include constipation and vomiting. Example is Atorvastatin.
Bile acid sequestrants- Side effects include constipation and bloating. Example is Cholestyramine.
Niacin- Side effects include redness and mild dizziness. Example include foods such as Avocado and peanuts.
Fibric acid agents- Side effects include nausea and diarrhea. Example is Antara.
Differentiate between dilated vs hypertrophic vs restrictive cardiomyopathies.
Dilated cardiomyopathy is a condition where muscle associated with heart will become thin and ventricle present on left side will become dilated and due to this heart is not able to squeeze properly thereby decreasing blood amount which is pumped to the body of an individual.
Hypertrophic condition is due to muscle disease associated with heart will become thickened and it is present in lower chamber referred to as left ventricle. There are chances of blockage of flow of blood from left ventricular region to aorta.
In restrictive muscle to not able to relax due to rigidness that makes uneasy to fill with blood and due to this abnormal relaxation is observed due to irregular heart rhythms that are linked with heart failure.
What is the risk for a triglyceride level >500?
This clearly indicates presence of inflammation inside pancreas and this will damage tissue permanently and some of the symptoms include pain in abdomen that might be severe.
Which cholesterol is the “good” cholesterol, and which is the “bad” cholesterol and why?
High density lipoproteins is considered as good cholesterol which generally absorbs the cholesterol which again carries it to liver. It lowers risk of heart disease and stroke.
Low density lipoproteins is considered as bad cholesterol which is mainly make up the level of cholesterol and some of the risk factors include stroke and heart disease.
References
- Dalby NO, Nielsen EB. Comparison of the preclinical anticonvulsant profiles of tiagabine, lamotrigine, gabapentin and vigabatrin. Epilepsy Res. 1997;28:63–72. doi: 10.1016/S0920-1211(97)00031-4. [PubMed] [CrossRef] [Google Scholar]
- Deckers CLP, Czuczwar SJ, Hekster YA, Keyser A, Kubova H, Meinardi H, Patsalos PN, Renier WO, Van Rijn CM. Selection of antiepileptic drug polytherapy based on mechanism of action: the evidence reviewed. Epilepsia. 2000;41:1364–1374. doi: 10.1111/j.1528-1157.2000.tb00111.x. [PubMed] [CrossRef] [Google Scholar]
- Dudra-Jastrzebska M, Andres-Mach MM, Ratnaraj N, Patsalos PN, Czuczwar SJ, Luszczki JJ. Isobolographic characterization of the anticonvulsant interaction profiles of levetiracetam in combination with clonazepam, ethosuximide, phenobarbital and valproate in the mouse pentylenetetrazole-induced seizure model. Seizure. 2009;18:607–614. doi: 10.1016/j.seizure.2009.06.009. [PubMed] [CrossRef] [Google Scholar]
- Goldlust A, Su TZ, Welty DF, Taylor CP, Oxender DL. Effects of anticonvulsant drug gabapentin on the enzymes in metabolic pathways of glutamate and GABA. Epilepsy Res. 1995;22:1–11. doi: 10.1016/0920-1211(95)00028-9. [PubMed] [CrossRef] [Google Scholar]
- Gomora JC, Daud AN, Weiergräber M, Perez-Reyes E. Block of cloned human T-type calcium channels by succinimide antiepileptic drugs. Mol Pharmacol. 2001;60:1121–1132. [PubMed] [Google Scholar]
- Haefely W. Benzodiazepines. Mechanisms of action. In: Levy R, Mattson R, Meldrum B, Penry JK, Dreifuss FE, editors. Antiepileptic drugs. 3. New York: Raven; 1989. pp. 721–734. [Google Scholar]
- Hutson SM, Berkich D, Drown P, Xu B, Aschner M, LaNoue KF. Role of branched-chain aminotransferase isoenzymes and gabapentin in neurotransmitter metabolism. J Neurochem. 1998;71:863–874. doi: 10.1046/j.1471-4159.1998.71020863.x. [PubMed] [CrossRef] [Google Scholar]
- Johannessen SI, Battino D, Berry DJ, Bialer M, Krämer G, Tomson T, Patsalos PN. Therapeutic drug monitoring of the newer antiepileptic drugs. Ther Drug Monit. 2003;25:347–363. doi: 10.1097/00007691-200306000-00016. [PubMed] [CrossRef] [Google Scholar]
- Kotake Y, Tasaki Y, Makino Y, Ohta S, Hirobe M. 1-Benzyl-1,2,3,4-tetrahydroisoquinoline as a parkinsonism inducing agent: a novel endogenous amine in mouse brain and parkinsonian CSF. J Neurochem. 1995;65:2633–2638. doi: 10.1046/j.1471-4159.1995.65062633.x. [PubMed] [CrossRef] [Google Scholar]
Kotake Y, Yoshida M, Ogawa M, Tasaki Y, Hirobe M, Ohta S. Chronic administration of 1-benzyl-1,2,3,4- tetrahydroisoquinoline, an endogenous amine in the brain, induces parkinsonism in a primate. Neurosci Lett. 1996;217:69–71. doi: 10.1016/0304-3940(96)13065-2. [PubMed] [CrossRef] [Google Scholar]
