Download CMN 572 Unit 2 150 questions and correct answers latest version 2024/2025 100% verified and more Quizzes Pharmacology in PDF only on Docsity!
CMN 572 Unit 2 150 questions
and correct answers latest
version 2024/2025 100% verified
"Measurement of BP in adults - CORRECT ANSWER=> The guideline recommends greater use of out-of- office BP measurements to confirm the diagnosis of hypertension and titrate medication. In adults who are not using antihypertensive drugs, ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) should be used to detect white coat hypertension (high office BP but normal out-of-office BP) and masked hypertension (normal office BP but high out-of-office BP) White coat hypertension is associated with a CVD risk approximating that of normal BP, whereas masked hypertension carries a CVD risk similar to that of sustained hypertension. In adults already using antihypertensive drugs, the guideline recommends screening for masked uncontrolled hypertension if the office BP is at goal but CVD risk is increased or target organ damage is present. If the office BP is more than 5 to 10 mm Hg above goal in a patient using 3 or more antihypertensive drugs, the guideline recommends HBPM to detect a white coat effect." "Thiazide diuretics - Good side - CORRECT ANSWER=> They are well researched and a very important fact is that research shows morbidity and mortality are decreased when these are part of the treatment regimen They are virtually unsurpassed in preventing cardiovascular complications of HTN May have favorable effect on osteoporosis as they increase calcium reabsorption from urine They are cheap- can usually give ½ of the 25mg = 12.5 mg) They enhance the effects of other antihypertensives Missing one dose of HCTZ every now and then does not generally cause a drastic change in BP as does missing a dose of a beta blocker" "Thiazide diuretics - Bad side - CORRECT ANSWER=> Thiazide types deplete potassium They may worsen acute gout symptoms Hypotension can result, especially in the elderly and those who work outside and sweat a lot (sweating can result in fluid volume depletion) Frequent trips to the bathroom can be inconvenient and may decrease compliance" "Thiazide diuretics - Dosing - CORRECT ANSWER=> Low is the way to go with these drugs. Higher doses have not been shown to give better antihypertensive results. The most commonly ordered doses are 12.5 and 25 mg. Usually start with 12.5 when the HCTZ is monotherapy If your see a new patient who is already on 25 mg, it may be best to avoid changing the dose."
"Triamterene - CORRECT ANSWER=> Treats edema and hypertension Potassium 'sparing' Actually increases potassium retention Use cautiously when treating patients with ACE/ARBs and or potassium replacement" "Diuretic Drug Combo Considerations to Prevent K+ Lowering Effects of Thiazides - CORRECT ANSWER=> The use of an ACE inhibitor or ARB in combination with hydrochlorothiazide has been demonstrated to prevent diuretic-induced potassium loss, eliminating the need for serum potassium replacement therapy Note that using an ACE or ARB and a K+ sparing diuretic (spironolactone) together may result in hyperkalemia" "Metolazone - CORRECT ANSWER=> Zaroxolyn 2.5- 5 mg Does NOT affect (lower) GFR May be used to enhance Lasix (Furosemide) or Bumex (Bumetanide) Watch for potassium wash out" "Loop Diuretics - CORRECT ANSWER=> Cause excretion of sodium and water via their action on the ascending limb of the loop of Henle Bumetanide (Bumex) Furosemide (Lasix) Torsemide (Demadex) Only Demadex is designed for once a day dosing; using others once a day may result in Na+ and water retention when drug wears off (duration of action of Lasix is 4-6 hrs)" "Loop diuretics - drugs and dosing - CORRECT ANSWER=> Furosemide (Lasix) 10 to 80 mg (divided doses)- Will (typically) need potassium replacement Bumetanide (Bumex) FDA approved for treatment of edema (off label HTN) 0.5-2 mg (divided doses Toresamide (Demadex) 5- 10 mg daily Monitor BMP for all patients" "ACE inhibitors- The ".....pril" drugs - CORRECT ANSWER=> Angiotensinogen is produced by the liver; renin acts on angiotensinogen to produce angiotensin I ACE inhibitors prevent angiotensin I from being converted to angiotensin II (angiotensin I has little or no negative effects while angiotensin II is a potent vasoconstrictor) and They increase concentrations of the vasodilator bradykinin by inhibiting its degradation. Bradykinin has been shown to have beneficial effects associated with the release of nitric oxide and prostacyclin (prostacyclin is a prostaglandin that inhibits platelet mediated thrombosis and is a vasodilator), which may contribute to the positive hemodynamic effects of the ACE inhibitors. Bradykinin may also be responsible, however, for some of the adverse drug effects, such as dry cough, hypotension, and angio-edema.
Usually do not have the disadvantage (angioedema) of bradykinin increase." "ARB's - What's good... - CORRECT ANSWER=> Similar to ACE Some studies indicate that ARB is THE drug for the type 2 diabetic (ACE for type 1) to slow progression of renal failure from diabetic nephropathy ARBs reduce progression to macroalbuminuria" "ARB's - What's bad... - CORRECT ANSWER=> About the same as ACE except for angioedema See info on ACE regarding creatinine and bilateral renal artery stenosis." "Beta Adrenergic Blockers- The ".....lol" drugs - CORRECT ANSWER=> Blockage of beta adrenergic receptors has these effects: Dilation of arterial blood vessels Bronchoconstriction Decreased: Pulse rate Cardiac output Myocardial O2 demand Blood pressure Renin release, antiotensin II and aldosterone production" "Beta Adrenergic Blockers: Selective vs. Nonselective - CORRECT ANSWER=> Selective (cardioselective) beta blockers (such as Toprol and Zebeta) block beta 1 (myocardial) adrenergic receptors with little effect on beta 2 (pulmonary, vascular, uterine ) adrenergic receptors. Bystolic is highly "cardioselective". Non-selective (such as propranolol) block both beta 1 and beta 2 receptors" "Beta blockers - What's good... - CORRECT ANSWER=> The Good Side of Beta Blockers Especially useful in patients with angina May be beneficial in decreasing migraines Beneficial for patients with resting tachycardia Considered to be a good pre-op antihypertensive" "Beta blockers - What's bad... - CORRECT ANSWER=> The Down Side of Beta Blockers Decreased sexual response Fatigue (due to < blood flow and oxygen to peripheral muscles) Depression May reduce HDL and increase triglycerides (possibly an insignificant amount) May worsen asthma, COPD, peripheral arterial disease, Raynaud's, and may cause marked bradycardia May mask the symptoms of hypoglycemia in diabetics May alter glucose and insulin levels Abrupt cessation of drug may result in rebound BP elevation (taper when discontinuing) Bystolic plus Prozac may result in greatly increased action of the Bystolic"
"Beta blockers - What's bad cont. - CORRECT ANSWER=> They cause decrease in rate of AV conduction - don't order with greater than first-degree heart block (some specialists may order with 2nd degree) In first degree all atrial beats are followed by ventricular beats but there is prolongation of the P-R interval In second degree (partial) only one of 2-3 impulses passes from the atrium to the ventricle In third degree (complete) there is complete dissociation between atrial and ventricular beats." "Calcium Channel Blockers - CORRECT ANSWER=> Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction Results: Decreased force of heart contraction Systemic vasodilatation resulting in decreased BP Coronary vasodilatation, resulting in decreased frequency and severity of angina attacks." "Calcium Channel Blockers - Types - CORRECT ANSWER=> Dihydropyridine CCBs are potent vasodilators, with less action on heart Nifedipine (Procardia) Amlodipine (Norvasc) Isradipine (DynCirc CR) Nisoldipine (Sular) Felodipine (Plendir SR) Nondihydropyridines act primarily to decrease heart muscle contractility (negative inotropic effect) with less vasodilatation Diltiazem (Cardizem, Dilacor, Tiazac) Verapamil (Calan, Isoptin, Verelan, Covera)" "Calcium Channel Blockers - The good... - CORRECT ANSWER=> Usually MORE effective than beta blockers or ACE inhibitors in elderly Useful in patients with angina (Total serum calcium concentrations are not affected by CCBs)" "Calcium channel blockers - The bad... - CORRECT ANSWER=> They may cause ankle edema- more with dihydropyridines (Norvasc, etc) because they are the more potent peripheral vasodilators (tx this edema with ACE inhibitors) Constipation is a severe problem for some - more with nondihydropyridines (Diltiazem & verapamil) (ask about usual bowel habits before ordering a CCB) Due to negative inotropic effects, heart failure (HF) may occur in some patients with ischemic heart disease when receiving a nondihydropyridine CCB (more likely to occur when given with a beta blocker) Tachycardia (dihydropyridines) May increase surgical bleeding Some patients seem to create a "drug hungry" BP that needs a higher and higher dose to stay at goal"
"AHA/ACC 2017 HTN Guidelines - CORRECT ANSWER=> Five main areas of focus: -Stresses accurate BP measurement -New classification system -A different way to choose treatment while taking into account cardiovascular risk -Lowers BP targets -Emphasis on lifestyle approach and offers suggestions for controlling BP" "BP measurement - CORRECT ANSWER=> Seated unless assessing for orthostatic changes (the record should say "seated" when BP is recorded) Arm is to be supported at heart level Cuff should fit, cuff to skin Do not hesitate to check the BP yourself. A very common problem is that many health care workers don't inflate the cuff enough before they listen and some may deflate the cuff too fast, thus missing the true systolic reading, especially if the pulse is slow" "When is ambulatory of home BP monitoring advised - CORRECT ANSWER=> Report of hypotensive symptoms (feeling "faint") Episodic hypertension Autonomic dysfunction (more common in diabetics) Drug (antihypertensive) resistance Report of more normal readings from patient at other times" "Two types of HTN - CORRECT ANSWER=> Primary (aka essential) - no specific known cause - about 95% of hypertension is this type, slow onset, overweight/obesity, lipid abn, insulin resistance are associated Secondary - due to a specific, identifiable pathology - historically, most HTN in children has been secondary - this may be changing with lower numbers being used to diagnose HTN, and due to obesity and sedentary life styles" "Secondary HTN causes - CORRECT ANSWER=> Kidney Disease : Renal artery stenosis, Pyelonephritis, Glomerulonephritis, Kidney tumors, Polycystic kidney disease (usually inherited), Injury to the kidney, Radiation therapy affecting the kidney Hormonal Disorders: Hyperaldosteronism - too much aldosterone produced by adrenal glands (adrenal cortex) Cushing's syndrome - high levels of cortisol. May be due to: A pituitary disorder (excess ACTH), An ACTH secreting tumor elsewhere in the body, An adrenal disorder, Long term treatment with corticosteroid such as prednisone Pheochromocytoma - tumor of adrenal glands causes too much epinephrine and norepinephrine to be released (rare) Drugs: OCPs (estrogen causes liver to release more angiotensinogen), Corticosteroids used to treat asthma or arthritis, Erythropoiten (suppresses rejection of transplants), Cocaine or amphetamines, Alcohol abuse, Licorice (excessive amounts of REAL licorice) Other:
Coarctation of the aorta, Pregnancy induced hypertension (PIH), Preeclampsia or eclampsia, Acute intermittent porphyria, Acute lead poisoning, Hyperthyroidism" "Be suspicious of secondary HTN - CORRECT ANSWER=> Newly diagnosed HTN The young (especially under 15 yrs) Elderly (>65 yrs of age) with recent onset of moderately severe or severe HTN Persistent elevations of BP after triple-drug therapy that includes a diuretic Known and treated hypertensive patients with sudden marked increase in BP HTN with symptoms of headache, unusual patterns of sweating and palpitations (signs of pheochromocytoma - a tumor of the sympathoadrenal system that produces catecholamines, i.e. norepinephrine & epinephrine and which is rare)" "Target Organ Damage from HTN - CORRECT ANSWER=> Left ventricular hypertrophy Angina MI Heart failure Stroke or TIA Kidney damage Peripheral arterial disease Retinopathy Ischemic heart disease (IHD) is the most common form of target organ damage associated with HTN- This may be prevented with antihypertensive therapy, lipid management, aspirin (wait to give ASA until AFTER blood pressure is lowered to prevent hemorrhagic CVA)" "Lifestyle modifications for HTN - CORRECT ANSWER=> Lose weight Follow the DASH diet (Dietary Approaches to Stop Hypertension) Less than 1500 mg sodium intake per day Increase potassium to 3500 mg po/dietary intake Physical activity- at least 20 minutes 3 x per week Decrease ETOH to 2 drinks per day or less. NOTE: The usual impact of each lifestyle change is a 4-5 mm Hg decrease in SBP and 2-4 mm Hg decrease in DBP; but diet low in sodium, saturated fat, and total fat and increase in fruits, vegetables, and grains may decrease SBP by approximately 11 mm Hg." "Starting drug treatment for stage 2 HTN - CORRECT ANSWER=> ACC/AHA recommends beginning 2 drugs of 2 different classes when B/P is Stage 2." "Isolated Systolic Hypertension - CORRECT ANSWER=> Most common in the elderly Diuretics and CCBs are the drugs of choice. Another note is that thiazide diuretics are usually effective in the elderly due to low activity of the renin- angiotensin system but can be ineffective due to age related and heart failure mediated reduction in glomerular filtration rate."
Acute amphetamine toxicity is similar to cocaine and tx is similar." "Pts. in which Stage of HTN should have lifestyle modifications instructions? - CORRECT ANSWER=> All: Elevated B/P Stage 1 Stage 2 AND why not also give instructions to those without hypertension?" "A patient has Stage 1 HTN and an estimated 10 year risk score of 13%. Will you begin meds? - CORRECT ANSWER=> Yes" "A pt. has been diagnosed with Stage 2 HTN. She has been started on an antihypertensive medication. When will you give her a follow up appt? What is her B/P goal? - CORRECT ANSWER=> One month <130/80" "Your patient has B/Ps in Elevated range in your office, but reading brought from home indicate higher B/Ps. What might this be called? How would you proceed? - CORRECT ANSWER=> The patient may have masked Stage 1 (or 2) hypertension ABPM would be appropriate Lifestyle modifications might also be appropriate" "Patient is new to your office, has a B/P of 158/90. What should your intervention be? - CORRECT ANSWER=> Recheck B/P using the appropriate methods Recheck B/P 2 or more times on 2 or more occasions. Get thorough history to reveal a previous dx. of HTN and consider secondary hypertension Perform thorough PE Lifestyle modifications, if needed" "Your patient has Stage 1 hypertension and a previous history of an MI. How many medications should this patient be started on? - CORRECT ANSWER=> 2, in different classes" "A 59 year old male has a B/P of 168/92 and has pitting edema of LEs as well as SOB. What would you consider to be target organ damage r/t hypertension in this patient and how would you proceed? - CORRECT ANSWER=> Congestive heart failure Nephropathy Order labs/heart tracings/radiographs to help diagnose Assess present B/P meds and maximize for normalizing B/P" "An 18 year old presents for immunization update to enter college. B/P is 148/90. Her BMI is WNL and she is active in sports. What questions do you ask? - CORRECT ANSWER=> Previous B/P problems Energy drinks Alcohol, tobacco, meds/drugs (legal and illegal) Sleep disturbance
Stress level OCPs Pregnancy Others?" "An elderly patient c/o dizziness and feeling weak? She lives alone, is on a diuretic and a CCB for her HTN. What would you want to assess initially in this patient regarding HTN? - CORRECT ANSWER=> Dehydration (elderly have decreased thirst mechanism) as she is on diuretic. Assess if dizziness occurs upon standing (possible postural hypotension). Take B/P readings sitting, standing. Consider reducing hypertensive meds (elderly fall and break hips, arms, etc.) Other meds/symptoms?" "An 11 year old is found to have a B/P above the 90th percentile based upon age, sex, and ht. How do you proceed? - CORRECT ANSWER=> Check for obesity Rule out secondary hypertension Possible lifestyle modifications Assure accurate B/P measurements Labs?" "Why should pts. with DM, CKD, or >65 years old and have Stage 1 HTN be started on pharmacological agent(s)? - CORRECT ANSWER=> Because by definition they are at high risk of having an EVENT in the next 10 years AND we use treatment for HTN to reduce that risk." "Anemia algorithm by MCV -- <80 - CORRECT ANSWER=> Microcitic -- Do Iron studies Low iron, ferritin and high TIBC = iron defficiency Low iron, ferritin and TIBC = anemia of chronic disease "Metzner index" MCV/RBC <13 = Thalessemia (>13 = possible Iron defficiency)" "Anemia algorithm by MCV -- 80-100 - CORRECT ANSWER=> Normocytic Reticulocyte count < 2% Hypopoliferative = Leukemia, aplastic anemia, pure RBC aplasia
2% Hyperproliferative = Hemorrhage, hemolytic anemia" "Anemia algorithm by MCV -- >100 - CORRECT ANSWER=> Megaloblastic Assess megalocytes, seg neutrophils on peripherial smear Present = Megaloblastic = B12, folate deficiency, drug induced Absent = Non-megaloblastic = Alcohol abuse, myledysplastic syndrome, liver disease, congenital bone marrow failure symptoms" "Iron deficiency anemia - CORRECT ANSWER=> Microcytic (small cells) and hypochromic (pale cells) Caused by insufficient iron intake or excess blood loss
"B12 deficiency anemia - pernicious anemia - CORRECT ANSWER=> Megaloblastic (macrocytic) or normocytic and hyperchromic B12 is needed to support a normal nervous system and to produce RBCs. Deficiency results in neurologic problems Vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs, milk, and milk products. Vitamin B12 is generally not present in plant foods Pernicious anemia develops slowly, Average age of patient is 60 years, stomach acid decreases, less B absorption in some people, especially those with fair complexions, leading to pernicious anemia. These folks may experience paresthesias and can precipitate or worsen angina pectoris, claudication or dementia. May be an autoimmune condition - type 1 diabetics and those with other autoimmune conditions at greater risk Pernicious anemia is usually caused by a lack of intrinsic factor - not dietary deficiency. Intrinsic factor is a protein produced by the stomach that binds to vitamin B12. The combination of vitamin B12 and intrinsic factor is absorbed in the lower part of the small intestine. When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb Vitamin B12. Autoimmune condition may destroy stomach's ability to make intrinsic factor" "Anemia of Chronic Disease - CORRECT ANSWER=> Production of RBCs decreased RBCs have slightly shorter lifespan and iron appears to be "held up" in inflammatory cells, rather than being recycled to create new RBCs. May occur with chronic infections or inflammatory conditions such as: AIDS Cancer Chronic bacterial endocarditis Chronic kidney disease Crohn's disease Hepatitis Juvenile rheumatoid arthritis Osteomyelitis Rheumatic fever Rheumatoid arthritis Ulcerative colitis Possibly due to inflammatory disease effect that causes increase in hepciden, a hormone produced by the liver and that in increased in inflammatory diseases and that suppresses erythopoiesis even when iron intake in sufficient." "Physiologic anemia of newborn - CORRECT ANSWER=> Physiologic Anemia: Baby is born with Hgb F instead of Hgb A. Hgb A steadily increases during the first 6 mos of life. Hgb F causes RBCs to have a shortened life. It also depresses the production or erythropoietin (hormone released by kidney that stimulates RBC production) Around 2-3 months, most babies will have physiologic anemia because of the suppression of erythropoietin. Iron supplements are not indicated, unless baby is premature."
"G6PD (Glucose 6 phosphate dehydrogenase deficiency) -‐ ‐ CORRECT ANSWER=> G6PD is an enzyme that helps RBCs function Genetic x linked genetic condition so most common in males.‐ Any race but occurs in over 10% of black males and in large number of Kurdish Jews. Certain oxidative drugs such as Bactrim or Macrodantin or antimalarial drugs, foods such as fava beans or infections such as fifth disease can cause an exacerbation by depressing G6PD activity and resulting in hemolysis of RBCs" "Aplastic anemia - CORRECT ANSWER=> Low RBC count due to faulty bone marrow activity. May be caused by chemotherapy Patient has decreased values for all formed elements of the blood (RBCs, platelets, and WBCs) Refer" "Sickle Cell Anemia - CORRECT ANSWER=> Hereditary - both parents must be carriers o Autosomal recessive" transmission If both parents have trait, the chance of child having disease is 25% If both parents have disease, the chance of child having disease is 100% Sickle Cell "Trait" occurs when only one parent carries gene Most common in Blacks Between 1 in 7 12 Blacks is a carrier‐ Disease occurs in 1 of 350 Black babies Those affected appear to have some resistance to malaria" "Sickle cell screening and diagnosis - CORRECT ANSWER=> Screening with Sickledex or Sickle Cell Prep. o Screening shows positive even for those with trait because they have at least a few sickled cells o Since 1988, all babies in Alabama are screened for hemoglobinopathies. Diagnosis with Hgb electrophoresis - separates those with trait (carriers) from those with disease." "Sickle cell anemia Pathology and Sickle Cell Crises - CORRECT ANSWER=> Under conditions of decreased tissue oxygenation (may occur at high altitudes) and/or dehydration, infection, trauma, or vasoconstriction from smoking or alcohol, red blood cells become odd shaped (sickle shaped), fragile and don't carry oxygen well, this creates a vicious cycle because there is more sickling in response to the poor oxygen carrying ability of the now deformed cells. Deformed (sickle shaped) RBCs mean that they are fragile and are easily destroyed (hemolysis). Destruction and loss of RBCs worsens tissue oxygenation problems. As cells sickle they become clogged in arterioles and create pain crisis or sickle cell crisis - think of wire coat hangers getting tangled in a tight space. Clogging may cause vessels to rupture resulting in bleeding into the tissues. This tends to happen most often to children under the age of 7 yrs. o These episodes are called pain crisis or sickle cell crisis Some patients have few crises, some have many. There is no way to predict number of crises when disease diagnosed. During a crisis tissues in vital organs are often injured or die.
Importance of daily penicillin if prescribed - do not run out of medication for even one day Watch for constipation if child is taking pain relievers" "Sickle cell anemia immunizations and prophylactic medications - CORRECT ANSWER=> Stress importance of Haemophilus immunization and all other vaccines o penicillin begun about age 3 mos o folic acid (one of the B complex) is needed for production of erythrocytes (especially needed for pregnant women with sickle cell) o pain at home: tx first with Tylenol, if no relief: Tylenol with codeine -- don't be stingy with analgesics" "Sickle cell reproductive issues - CORRECT ANSWER=> In females puberty may be delayed but after puberty, there is usually no problem with conceiving If OCPs are requested, use progestin only OCPs rather than combination. Estrogen may promote stasis/congestion of blood. During Pregnancy women with trait have more UTIs but usually have good outcomes, while the women with actual disease are at risk for many complications including infections, crises, and PIH. Pregnancy actually aggravates and causes disease to become more active. o First trimester usually goes well, but serious problems become common in second and third trimesters --see these patients frequently. o Watch for placental infarction -- a nonreactive NST (nonstress test) indicates placental dysfunction. o Preterm labor and stillbirth may occur. o The stress of the birth process may induce sickling. o Recovery during the postpartum period is usually prolonged. Priapism from clogged arteries and/or bleeding may result in male impotence." "Sickle cell anemia ER Emergency treatment for pain crisis: - CORRECT ANSWER=> ER Emergency treatment for pain crisis: o first initiate fluids (at least 2 times maintenance) o start IV antibiotics o packed cells if needed o bed rest o warmed oxygen at 100% (not all practitioners agree) o narcotic analgesics" "Sickle cell anemia teaching - CORRECT ANSWER=> Teach to prevent infections and report any infection to health care provider ‐parent education very important: provide written instructions so they can read and reread when they are up at 3 am wondering what to do with a sick child discuss proper diet or refer to dietician teach proper amount fluid; involve them in deciding how to be sure child gets proper amount. Be sure they understand that hot weather or increased activity will increase demands for fluid - hemodilution helps the sickled cells which are always present in some percentage, to move through the blood vessels
handwashing --question and remind on every visit, for infants caution mother to make everyone wash hands before holding daycare is not a good place for these kids provide with a thermometer if possible and make sure they know how to use it temp above 38.3 C or 101 F or greater is a medical emergency - be sure they know to tell ER personnel that child has sickle cell watch for subtle signs of illness such as decreased appetite and lethargy (stop playing or increase sleep periods or inability to sleep) increased respiratory rate report any episode of vomiting or diarrhea" "Thalassemias - CORRECT ANSWER=> Hereditary anemias occurring in populations that border the Mediterranean Sea and those from Southeast Asia. Results in defective hemoglobin Cells appear deformed and abnormally small (microcytic) and normochromic or slightly hypochromic Two major types are Alpha and Beta - type depends on which part of the hemoglobin protein is affected Both Alpha and Beta thalassemia have a major and minor Alpha thalassemia is usually not as severe Thalassemia Major occurs when abnormal gene is received from both parents (offspring of two parents who carry gene have 25% chance of having disease) Minor occurs when abnormal gene is received from only one parent - symptoms resemble iron deficiency anemia It can be mild or severe - most cases are mild Treatment with transfusions and chelation to remove excess stored iron that results from multiple transfusions. "Hemosiderosis" is iron overload. If untreated bone marrow expands as it attempts to increase RBC production this causes deformities, notably of the cranial and facial bones. Heart failure and liver problems may result Jaundice may result Bones become brittle Growth is slow in affected children Bone marrow transplant is cure o Thalassemia B Major or Cooley's Anemia is the most severe type" "Menopause - CORRECT ANSWER=> The absence of menstruation for at least 12 consecutive months May be a normal part of aging or due to surgical removal of the ovaries Premature menopause: failure* of the ovaries resulting in menstrual cessation before age 40 Western Society- average age of menopause is 51 years of age Symptoms vary from person to person At least 80% of women will be symptomatic with menopausal changes
- failure being a broad term which may include a decrease in follicle size, quantity, and or quality of follicles" "Risk Factors for Early Onset of Menopause - CORRECT ANSWER=> Smoking [9, 10] Hysterectomy Oophorectomy
The empty follicle is filled by cellular activity --> Corpus Luteum Corpus Luteum releases progesterone to support pregnancy LH binds to Leydig Cells in the testes to produce testosterone in men Lab Values for LH: women in the follicular phase of the menstrual cycle: 1.9 to 12.5 IU/L women at the peak of the menstrual cycle: 8.7 to 76.3 IU/L women in the luteal phase of the menstrual cycle: 0.5 to 16.9 IU/L pregnant women: less than 1.5 IU/L women past menopause: 15.9 to 54.0 IU/L women using contraceptives: 0.7 to 5.6 IU/L men between the ages of 20 and 70: 0.7 to 7.9 IU/L men over 70: 3.1 to 34 IU/L" "Progesterone - CORRECT ANSWER=> Prepares the uterus to receive a fertilized egg Helps support pregnancy Higher levels indicate successful ovulation Female (pre-ovulation): less than 1 nanograms per mililiter (ng/mL) or 3.18 nanomoles per liter (nmol/L) Female (mid-cycle): 5 to 20 ng/mL or 15.90 to 63.60 nmol/L Male: less than 1 ng/mL or 3.18 nmol/L Postmenopausal: less than 1 ng/mL or 3.18 nmol/L Pregnancy 1st trimester: 11.2 to 90.0 ng/mL or 35.62 to 286.20 nmol/L Pregnancy 2nd trimester: 25.6 to 89.4 ng/mL or 81.41 to 284.29 nmol/L Pregnancy 3rd trimester: 48 to 150 to 300 or more ng/mL or 152.64 to 477 to 954 or more nmol/L" "The Use of Progesterone in HRT - CORRECT ANSWER=> Used in combination with estrogen in patients with an intact uterus May be progestin (synthetic progesterone) Can be used alone or in combination with estrogen in patients without a uterus for treatment of hot flashes Side effects include : Breast tenderness Weight gain Sleepiness Vaginal bleeding/resumption of menses" "Dehydroepiandrosterone (DHEA) - CORRECT ANSWER=> Hormone created by the adrenal gland and in the brain Leads to the production of estrogens and androgens Production decreases after age 30 years Low DHEA levels are found in many disease states including: Hormone disorders HIV Alzheimer's CAD
Depression Diabetes Inflammation Immune disorders Osteoporosis *May contribute to ovarian, prostate, and breast cancers" "Testosterone - CORRECT ANSWER=> Considered a 'male' hormone Is produced by the ovaries Contributes to estrogen production (see previous slides) Testosterone production (although decreased) continues even after estrogen production ceases Contributes to libido May help with bone and muscle mass High testosterone levels Polycystic ovaries" "Summary of hormone lab results - CORRECT ANSWER=> FSH Higher in early menopause transition Accompanied by decrease in estrogen LH Higher than in ovulation LH testing not required to make the diagnosis of menopause Estrogen Considerably lower than in reproductive years Progesterone Considerably lower than in reproductive years Testosterone May be lower/patient may complain of decreased libido" "Menopause symptoms include... - CORRECT ANSWER=> Hot flashes or flushes (most common) Insomnia Vaginal atrophy Weight gain and bloating Mood changes Irregular menses Mastodynia (breast pain) Depression Headache" "Hot Flushes/Flashes - CORRECT ANSWER=> Intense heat Associated with physical flushing and sweating May be felt before menses cease (minor to mild as much as 6 years prior to cessation) African American women reported longer vasomotor symptoms Symptoms may persist for as long as 7 years after menses cease
