PHARMACY TECHNICIAN

PHARMACY TECHNICIAN CHAPTER TWENTY THREE

Amino Acids • The body can produce 11 types of amino acids, referred to as nonessential • There are 9 types of amino acids that the body requires, but cannot produce • These are referred to as essential amino acids (See table 23.9) • Essential amino acids have to be derived from food intake

Vitamin A (Retinol) • Helps with eyesight and epithelial cells and tissues (skin cells) • Deficiencies in vitamin A may cause: • Night blindness • Xerosis (dryness) of the conjunctiva and cornea • Xerophthalmia and keratomalacia • Keratinization of lung, GI tract, and urinary tract • Increased susceptibility to infections • DRI is 900 µg/day for males and 700 µg/day for females

Vitamin D • Helps with the absorption of calcium from the intestine to make stronger bones and teeth • Deficiency causes metabolic bone softening: • Called rickets in children • Called osteomalacia in adults • DRI is 5 µg/day (ages 19–50) for both males and females • DRI is 10 µg/day (ages 51–70) for both males and females

Vitamin E • A strong antioxidant for lipids • Deficiency is generally caused by malabsorption rather than lack of ingestion • Vitamin E deficiency may cause: • Disorders of the reproductive system • Abnormalities of muscle, liver, and bone marrow • Hemolysis of RBCs • Defective embryo genesis • Brain dysfunction • A disorder of capillary permeability • DRI is 15 mg/day for both males and females

Vitamin K • Necessary for blood coagulation • Controls formation of coagulation factors II, VII, IX, and X in the liver • Also needed for calcium uptake in bones • Can be used as an antidote for coumadin overdoses • Deficiency is rare • DRI is 120 µg/day for males and 90 µg/day for females

Vitamin B1 (thiamine) • Necessary for carbohydrate metabolism • Deficiency causes the disease beriberi • Affects the peripheral neurologic, cerebral, cardiovascular, and GI systems • DRI is 1.2 mg/day for males and 1.1 mg/day for females

Vitamin B2 (riboflavin) • Necessary for the health of the mucous membranes in the digestive tract • Aids absorption of iron and vitamin B6 • Deficiency leads to: • Oral, eye, skin, and genital lesions - Dizziness • Hair loss - Insomnia • Light sensitivity - Poor digestion • Retarded growth - Slow mental responses • Burning feet

Vitamin B3 (niacin) • Important in oxidation-reduction reactions • Vital in protein metabolism • Deficiency leads to the disease pellagra: • Affects skin, mucous membranes, GI, and brain/CNS systems • Causes photosensitive rash, scarlet stomatitis, glossitis, diarrhea, and mental aberrations • Deficiency found in diets high in corn • DRI is 16 mg/day for males and 14 mg/day for females

Vitamin B5 (pantothenic acid) • Important for secretion of hormones such as cortisone • Important for maintenance of healthy skin, muscles, and nerves • B5 deficiency extremely rare • Symptoms of B5 deficiency include: • Insomnia • Depression • Nausea • Headache • Muscle spasm

Vitamin B6 (pyridoxine) • Needed for: • Red blood cell formation - Antibody production • Cell respiration - Cell growth • Conversion of tryptophan to niacin • Helps convert stored carbohydrate to glucose to maintain normal blood sugar levels • Synthesis of neurotransmitters such as serotonin and dopamine • Deficiency can cause: • Anemia similar to iron-deficiency anemia • Decreased antibody production • Suppressed immune response • Symptoms such as dermatitis, a sore tongue, depression, confusion, and convulsions

Vitamin B9 (folic acid) • Important for: • Energy production -Formation of red blood cells • Strengthening immune system • Promoting healthy cell division and replication • Protein metabolism • Preventing depression and anxiety • Deficiency can be serious and may result in: • Anemia - Apathy • Digestive disturbances - Fatigue • Growth impairment - Insomnia • Labored breathing - Memory problems • Paranoia - Weakness

Vitamin B12 (cyanocobalamin) • Needed for healthy nerve cells, to make DNA, and for the formation of RBCs • Deficiency leads to irreversible nerve damage • Signs and symptoms include: • Fatigue - weakness • Nausea - constipation • Flatulence - loss of appetite • weight loss - depression • Confusion - poor memory

Vitamin C (ascorbic acid) • Antioxidant • Essential for collagen formation • Maintains integrity of connective tissue, bone, and teeth • Important for wound healing and recovery from burns • Helps the absorption of iron • Severe deficiency results in scurvy: • Characterized by general weakness, bleeding gums, anemia, and skin bleeding • The DRI is 90 mg/day for males and 75 mg/day for females

Water • 60% of an adult’s body weight is water • Forms a major portion of every tissue • Provides the medium in which most of the body’s activities are conducted • Facilitates many of the metabolic reactions that occur in the body • Helps transport vital materials to the cells • Vehicle in which glycogen is transported into muscle cells

PHARMACY TECHNICIAN CHAPTER TWENTY FOUR

Bone • Composed of two different kinds of bony tissue • Cancellous or “spongy” bone—porous, inner bone that provides volume • Compact bone—hard, outer covering that provides strength and shape • The rounded end of a bone is covered with smooth, slippery articular cartilage • Many bones are hollow, and contain marrow: • Red marrow in children • Fatty yellow marrow in adults

Bone and Muscle

Types of Muscle • Skeletal muscles—attached to bones; provide body movement • Voluntary, striated in shape, contain multiple peripheral nuclei • Cardiac muscle—tissue that composes the heart • Contracts rhythmically, coordinated by transmission of electrical impulses from nerve to muscle fibers Smooth or “visceral” muscle—attached to or lines other organs such as the stomach, intestines, lungs, and blood vessels

Five Categories of Bone: • Flat bones—generally more flat than round • Irregular bones—have no defined shape • Sesamoid bones—have cartilage or fibrous tissue mixed in • Short bones—generally cube-shaped • Long bones—the most common bone • Epiphysis (the rounded end of the bone) • Diaphysis (the main shaft or central part of the bone)

Disorders of the Bone Osteomyelitis • Bacterial Infection Inside the Bone Destroys bone tissue • Original site of infection is frequently in another part of body • Infection spreads to the bone via the blood Osteoporosis—bone brittleness due to lack of calcium • Prevalent in postmenopausal women because of estrogen deficiency Paget’s disease—changes the normal process of bone growth • Causes bone to break down more quickly and grow back softer than normal bone

Musculoskeletal Diseases/Disorders • Bursitis—inflammation of the small, fluid-filled pouches between bones • Tendonitis—inflammation of the cords of connective tissue that attach muscle to bone • Myalgia—muscle pain

Bone Marrow Disorders (cont.) • Anemia—failure of the bone marrow to produce red blood cells • Most common cause is lack of iron • Lack of red blood cells leads to a systemic decrease in oxygen • Causes fatigue • Leukemia—blood-borne cancer; cancer of the blood • Begins when DNA of white blood cells is damaged or mutated • Damaged DNA is copied and passed on to subsequent generations of cells • Abnormal, cancerous cells do not die off like normal cells • Multiply unchecked within the body

Arthritis—Inflammation of a Joint • Rheumatoid—an autoimmune disorder • Osteoarthritis—caused by physical degeneration of connective tissue • Gout—caused by crystals of uric acid in blood

Treatments Osteomyelitis • Anti-infective agent is best treatment for osteomyelitis Osteoporosis • Vitamin D and mineral calcium replacement therapy • Hormone therapy (estrogen, calcitonin) and bisphosphonates • SERMs for postmenopausal women • Gold compounds used to treat osteoarthritis

Treatments Gout • Colchicine used to alter ability of phagocytes to attack uric acid crystals • Anti-inflammatory analgesics can be used to reduce pain and inflammation Inflammation • Salicylates relieve inflammation by inhibiting the synthesis of prostaglandin • Topical corticosteroids treat most causes, including chemical, mechanical, microbiological, and immunological

Treatments Multiple Sclerosis • Autoimmune disease in which body’s immune system begins to attack normal body tissue • Treatment of MS includes steroidal anti-inflammatory agents and corticosteroids Cerebral Palsy • Affected person has poor control of the brain, muscles, and joints • Pharmaceutical therapy includes drugs to prevent seizures and spasticity

Musculoskeletal Pharmaceuticals • ASA (acetylsalicylic acid) • Relieves inflammation by inhibiting the synthesis of prostaglandin • Salicylates are also used as analgesics and antipyretics • NSAIDs (nonsteroidal anti-inflammatory drugs) • Inhibit or block the enzyme that starts the reaction of inflammation by making prostaglandin • COX-2 inhibitors • Block only the cyclooxygenase II that makes PGE-2, but not C-1 (PGE-1) • Inflammation is inhibited, but not the viscosity of the mucosal linin

Musculoskeletal Pharmaceuticals (cont.) • Antigout agents—may be hypouricemic agents or uricosuric agents • Hypouricemic agents decrease production of uric acid in the blood • Uricosuric agents increase the excretion of uric acid through urination • Calcitonin—indicated for fragile or soft bones • Inhibits bone resorption • Decreases the number of bone fractures from low bone density

Musculoskeletal Pharmaceuticals • Bisphosphonates—indicated for osteoporosis • Mimic the natural organic bisphosphonate salts found in the body • Inhibit bone resorption and osteoclast activity • Restore bone mass and density • SERMs (selective estrogen receptor modulators) • Indicated for postmenopausal women • Protective effect on bones and heart • Skeletal muscle relaxants—used to relax specific muscles in the body • Relieve pain, stiffness, and discomfort • Block muscle contraction at the neuromuscular junctio

PHARMACY TECHNICIAN CHAPTER TWENTY FIVE

The Respiratory System • Divided into the upper respiratory tract and the lower respiratory tract • The upper respiratory tract consists of: • Nose or nasal cavity • Paranasal sinuses • Pharynx and larynx

The Respiratory System (cont.) • The lower respiratory tract consists of: • Trachea • Two lungs • Two main bronchi

The lower respiratory tract.

Respiration • Diaphragm—dome-shaped layer of muscle that lies across bottom of chest cavity • Breathing occurs as diaphragm contracts and relaxes • Carbon dioxide pushed out of the lungs during relaxation • Oxygen pulled into the lungs during contraction

Structure of Lungs • About 10 percent solid tissue • Remainder of structure filled with air and blood • The functional structure can be divided into two parts: • Conducting airways (bronchi and bronchioles)—tubes lined by cilia and respiratory mucosa • Cartilage—supports and cushions the bronchi

Common Cold • Caused by a viral infection that inflames the membranes in nose and throat • Antibiotics will not cure a cold or any other viral infection • Treatment is considered symptomatic Cough • May be a symptom of a cold, flu, respiratory problems, or nonrespiratory diseases • Most likely begins with an irritation of nerves in the respiratory tract • Nonproductive cough treated with cough suppressant • Productive cough treated with an expectorant

Allergies and Asthma Allergies • Caused by the immune system reacting to a substance that does not cause disease • Treatment may be palliative, with antihistamines and antitussives • Treatment may be preventive, with mast cell stabilizers Asthma • Chronic respiratory disease • Characterized by inflammation of airways, tightening of muscles around airways • Treatment is palliative with albuterol and other bronchodilators

Emphysema • Chronic destruction of alveoli • External exchange interrupted when alveoli become permanently damaged • Treatment may be palliative, with stimulant inhalers • Treatment may be preventive, with anti-inflammatory corticosteroids

Nasal Congestion and Rhinitis Nasal Congestion • Inflamed, stuffy nose • Treatment may be palliative, to promote easier breathing • Indications for use of decongestants are nasal and bronchial congestion Rhinitis • Inflammation of nasal membranes, and/or runny nose • Common component of colds and allergies • Treatment is considered symptomatic

Bronchoconstriction • Occurs when the smooth muscles encircling the airways or tubes tighten, causing the airways to spasm • Treatment may be palliative • Treatment may be preventive

Chronic Obstructive Pulmonary Disease (COPD) • Umbrella term for emphysema and chronic bronchitis • Characterized by partially blocked bronchi and bronchioles • Causes shortness of breath • Treatment may be palliative, with bronchodilators • Treatment may be preventive, with mast cell stabilizers

PHARMACY TECHNICIAN CHAPTER TWENTY SIX

The heart.

Anatomy of the Heart • Composed of four chambers: two upper and two lower • Atria—top two chambers • Ventricles—bottom two chambers • Septum—divides heart into right and left sides

Valves of the Heart • Tricuspid valve—located between the right atrium and the right ventricle • Pulmonary valve—located between the right ventricle and the pulmonary artery • Mitral or bicuspid valve—located between the left atrium and the left ventricle • Aortic valve—located between the left ventricle and the aorta

Layers of the Heart • Pericardium—fluid-filled sac that surrounds and protects the heart • Permits free movement of the heart during contraction • Endocardium—innermost wall layer; covers the inside surface of the heart • Myocardium—surrounds heart and causes chamber contractions

Function of the Heart • Provides oxygenated blood throughout the body by a pumping mechanism • Oxygenated blood deposits materials necessary for growth and nourishment • Receives from tissues the waste products resulting from metabolism

Hypertension • Sustained elevation of systemic arterial blood pressure • Symptoms include: • Severe headache • Chest pain • Irregular heartbeat • Fatigue • Pharmaceutical treatment includes diuretics, vasodilators, ACE inhibitors, beta blockers, and calcium channel blockers

Congestive Heart Failure • Heart pumps out less blood than it receives • Results in weakened and enlarged heart • Symptoms of CHF include: • Upright posture or leaning forward • Anxiety and restlessness • Cyanotic and clammy skin • Persistent cough • Rapid breathing • Fast heart rate • Edema of the lower limbs • Pharmaceutical treatment includes cardiac glycosides, diuretics, vasodilators, ACE inhibitors, beta-adrenergic blockers, and phosphodiesterase inhibitors

PHARMACY TECHNICIAN