Introduction to Disease Process

Class Schedule
• Please see course calendar on Blackboard
Course/Subject Description
• This course will be an introduction to human disease,
documentation, treatments and pharmacology.

• Topics include:
• inflammation, infection and immune disorders
• cancer
• cardiovascular disorders
• pathology of the endocrine, respiratory, renal and
gastrointestinal systems
• Including investigation on types of drugs and treatments as
well as mechanisms of action
Course Outcomes
• Understand drug nomenclature.
• Create patient documents applying to a variety
of clinical situations using a selection of
commonly used charting formats, appropriate
language, and standard medical abbreviations.
• Differentiate the cause and physical
characteristics and physiological progression of
benign and malignant neoplasms.
• Define the major pharmacological classes of
chemotherapeutic agents.
Course outcomes
• Distinguish and discuss the following conditions of the blood
and cardiovascular system:
• 1- atherosclerosis
• 2- hypertension
• 3- myocardial infarct
• 4- congestive heart failure
• 5- cerebrovascular accident
• 6- anaemia

• Major classes of pharmacological agents used to treat

diseases of the cardiovascular and haematological systems.
Course Oucomes
• Distinguish, discuss, and contrast the causative factors for and
presenting symptoms for:
• 1- asthma
• 2- pneumonia
• 3- COPD
• 4- anaphylaxis

• Predict the pharmacological interventions used for each of the

respiratory diseases identified above.
Course Outcomes
• Compare and contrast the conditions of:
• 1- gastro-oesophageal reflux
• 2- hiatus hernia
• 3- peptic ulcer disease
• 4- ulcerative colitis
• 5- Crohn disease
• 6- irritable bowel syndrome
• 7- diverticular disease

• Predict the pharmacological interventions used for each of the

gastrointestinal diseases above.
Course Outcomes
• Categorize the conditions of:
• 1- alcoholic liver
• 2- Hepatitis A, B, C,
• 3- cholelithiasis
• 4- colitis

• Contrast the pharmaceutical interventions common to

hepatobiliary disease.
 Learning Outcome #1
1. Differentiate the aetiology, physical characteristics and physiological
progression of benign and malignant neoplasm.
• Cancer: http://www.youtube.com/watch?v=LEpTTolebqo
• Cancer :http://www.youtube.com/watch?v=Q9cuEYSt0GE&feature=related
• Cancer treatments: http://
www.youtube.com/watch?v=8LhQllh46yI&feature=endscreen&NR=1

http://www.scienceclarified.com/
 Learning Outcome
2. Distinguish and discuss the following conditions of the blood and
cardiovascular system: atherosclerosis, hypertension, myocardial infarct,
congestive heart failure, cerebrovascular accident, and anaemia.
(Cognitive/Analysis)

Atherosclerosis: http://www.youtube.com/watch?v=fLonh7ZesKs
Congestive heart failure: http://www.youtube.com/watch?v=3YddwXPWVSc
Aplastic Anemia: http://www.youtube.com/watch?v=w8-jx1dtg0U
Sickle cell anemia: http://www.youtube.com/watch?
v=Qd0HrY2NlwY&feature=related
 Learning Outcome
3. Distinguish, discuss, and contrast the causative factors for and presenting
symptoms for asthma, pneumonia, and anaphylaxis. (Cognitive/Analysis)

Asthma: http://www.youtube.com/watch?v=7EDo9pUYvPE
Anaphlaxis: http://www.youtube.com/watch?v=TTcL7u05aUU
 Learning Outcome
4. Compare and contrast the conditions of gastro-oesophageal reflux, hiatus
hernia, and peptic ulcer disease. (Cognitive/Analysis)

Gastro-oesophageal reflux: http://www.youtube.com/watch?

v=TdK0jRFpWPQ

Hiatus hernia: is an anatomical abnormality in which part of the stomach

protrudes through the diaphragm and up into the chest

Peptic ulcer disease: is an ulcer in the lining of the stomach, duodenum, or

esophagus.
 Learning Outcome
5. Categorize the conditions of the alcoholic liver, cholelithiasis, and colitis.
(Cognitive/Comprehension)

Alcoholic liver: https://www.youtube.com/watch?v=1PY3rKXutQ8

Colitis: http://www.youtube.com/watch?v=loF9CsOZI7A

Cholelithiais is the presence of stones in the gallbladder or common bile

duct.

Colitis is inflammation of the inner lining of the colon and is associated with
diarrhea, pain, and blood in the stool.
Method(s) and Frequency of Evaluation
of Student Performance
Weekly Quizzes 20%
Midterm 1 25%
Midterm 2 25%
Final Exam 30%

Textbook: Damjanov, Ivan. (2012). Pathology for the Health Professions

(4th ed). St. Louis: Elsevier. ISBN: 978-1-4377-1676-4
Important Concepts
• Disease Process: How a disease develops
• Pathology: Study of Disease*
• Pathophysiology
• Patho: suffering, disease
• Physiology: function of body
• Normal
• Disease

• * what it is made up of.

Development of Disease
• Aetiology : Study of causation or origination
• Pathogenesis : Development of disease
• Manifestations
Aetiology
• Inherited or familial
• Congenital
• Toxic
• Infectious
• Traumatic
• Degenerative
Etiology of Diabetes
Causes of
Diabetes
Beverages Chemical Additives (in Foods) Medicine
Sugary sodas MSG (Monosodium Glutamate) Antidepressant drugs (SSRIs)
High-fructose corn syrup Autolyzed proteins
Insulin
Sugary punch drinks Hydrolyzed proteins
Foods Yeast extract Chemotherapy
Refined grains Torula yeast Nutritional Deficiencies
White rice Sodium Nitrite Vitamin D deficiency
White flour Pancreatic cancer Chromium deficiency
Instant oatmeal Processed meats B vitamins deficiency
White bread, pancakes, muffins, etc. Lunch meat
Trace minerals deficiency
Refined sugars Pepperoni
Corn syrup Hot dogs Stress
High-fructose corn syrup Sausage Excess adreneline
Sucrose Bacon Chronic low-level stress
Table syrup Artificial sweeteners
Processed jellies, jams, spreads Artificial colors
Saturated animals fats Behaviors
Processed cheese Lack of exercise
Processed dairy Watching television
Ice cream
Fried foods
Donuts
Anything deep fried
 The etiology of Diabetes – Concept /
Mind Map

http://www.mindmeister.com/6416899/causes-of-diabetes
Pathogenesis
• Natural History
Manifestations/Clinical
Features
• Morphology
• Subclinical (pertaining to an early stage of a disease)
• Symptoms (a sign or indication of a disease)
• Signs
• Lesion (any localized, abnormal structural change in the body)
• Sequela(e)
(an abnormal condition resulting from a previous disease)
• Complications (a concurrent disease, accident, or adverse
reaction that aggravates the original disease)
• Resolution
Important Concepts Cont.
• Drug, Prodrug
• Pharmacology
• Pharmacotherapeutics
• Effectiveness
• Safety: Therapeutic Range and Index
• Selectivity
• Reversible action
• Predictability
• Administration
Important Concepts Cont.
• Interactions
• Cost
• Chemical Stability
• Name: Generic, Trade, Chemical, Experimental
• Therapeutic Objective
Intensity of Drug Response
• Administration
• Route
• Medication errors
• Patient Compliance
• Pharmacokinetics
• Absorption
• Distribution
• Metabolism
• Excretion
Intensity of Drug Response
• Pharmacodynamics
• Drug-receptor interaction
• Patient’s functional state
• Placebo effects

• Individual Variation
• Physiologic variables
• Pathologic Variables
• Genetic variables
• Drug interactions
Healthcare professional
Responsibilities
• Pre-administration assessment
• Baseline data
• Stratification of risk

• Planning and Implementation: Dosage and Administration

• Understand the correct dosing range
• Appropriate safety measures
Healthcare professional
Responsibilities
• Evaluating and Promoting Therapeutic Effect
• Evaluating Therapeutic Response
• Promoting compliance/adherence
• Implementing non-drug measures
• Minimize Adverse Effects
• Minimize Adverse Interactions
• Managing Toxicity
• Patient education
Approval of Drugs: Drug
Legislation
• 1906: A drug must be what it says it is
• 1938: Drugs must be tested for safety and approved by FDA
• 1962: Drugs must be effective for what they claim: testing
procedures
• 1970: Controlled Substances Act
• 1992: Relaxed procedures for Cancer and AIDS drugs
• 1997: FDA Modernizing Act
• Fast track for AIDS, cancer, and other life threatening conditions
• Manufacturers must give 6 month notice before discontinuing a drug
• FDA can require testing in children
• Clinical trial database
• Drug companies can provide physicians with articles on “off-label” uses
Drug Approval: Process
• Preclinical testing
• Toxicity
• Pharmacokinetics
• Possible Useful Effects
• Clinical Testing (in Humans)
• Phase I: Normal subjects; metabolism and side effects
• Phase II: Patients, therapeutic utility and dosage range
• Phase III: Patients; safety and effectiveness
• Conditional Approval
• Phase IV: Posmarketing Surveillance
• Limitations of Process
• Women and children
• Failure to detect all adverse effects
Drug Names
• Chemical (N-acetyl-para-aminophenol)
• Generic (acetaminophen)
• International name (paracetamol)
• Trade Name (Tylenol)
• Easier to remember
• Emotional allusions
• Multiple trade names for one drug
• Same trade name with more than one product
Availability
• OTC
• Scheduled
• V: Least dangerous & addictive: Ambien
• IV: Less dangerous & addictive
• III: dangerous & addictive: hydrocodone, codeine
• II: highly dangerous & addictive: morphine, cocaine
• I: dangers outweigh benefits: marijuana, heroin
Ways to cross a cell
membrane
• Channels and Pores
• Transport systems
• Direct penetration of membrane – must be lipid soluble
• Polar molecules
• Ions
Pharmacokinetics
• Absorption – movement of drug from site of
administration to blood
• Rate of dissolution
• Surface area
• Blood flow
• Lipid solubility
• pH partitioning
• Distribution
• Metabolism
• Excretion
Absorption: Routes of
Administration
• Enteral – gastrointestinal (mouth, rectum, tubes)
• First Pass Effect
• Parenteral – injection (IM, IV, SC)
• Topical
• Transdermal
• Inhaled
• Other routes
Drug Distribution
• Blood flow to tissues
• Exiting the Vascular system
• Typical Capillary Beds
• Blood-Brain Barrier
• Placental Drug Transfer
• Protein Binding
• Entering Cells
Metabolism
• Hepatic Drug-Metabolizing System
• P450 cytochrome system
• hepatic microsomal enzyme system
• Therapeutic Consequences of Drug Metabolism
• Accelerated Renal Drug Excretion
• Drug Inactivation
• Increased Therapeutic Action
• Activation of prodrug
• Increased or Decreased Toxicity
Metabolism
• Considerations
• Inductions of P450 system
• Competition between drugs
• First Pass Effect
• Nutritional status
Drug Excretion
• Removal of Drug from the body (urine, sweat, bile, saliva,
breast milk, lungs)
• Renal Drug Excretion
• Glomerular Filtration
• Passive Tubular Reabsorption
• Active Tubular Secretion
• Breast Milk
• Bile
Pharmacodynamics
• Dose – Response Relationships
• Maximal Efficacy
• Potency
• Drug – Receptor Interactions
• Receptor-Types
• Selectivity
• Theories
• Mode of Action
Dose Response
Maximal Efficacy
Potency
Receptor Types
• Cell Membrane-Embedded Enzymes
• Ligand-Gated Ion Channels
• G Protein-Coupled Receptor Systems
• Transcription factors

• Selectivity
• Lock and key
Mode of Action
• Agonists
• Antagonists
• Partial Agonists
• Regulation of Sensitivity
Therapeutic Index
Drug Interactions
• Drug-Drug Interactions
• Intensification: Effect and/or Adverse Effects
• Reduction
• Food-Drug Interaction
• Absorption
• Metabolism
• Toxicity
• Action
• Food-Herb Interactions
Adverse Effects
• Side Effect
• Toxicity
• Allergic Reaction
• Idiosyncratic: also known as type B reactions, are drug
reactions that occur rarely and unpredictably amongst the
population
• Iatrogenic (i·at·ro·gen·ic) :  refers to being caused by the
action of doctors and/or surgeons
• Physical Dependence: state resulting from chronic use of a
drug that has produced tolerance and where negative physical
symptoms of withdrawal
• Carcinogenic:  capable of causing cancer
• Teratogenic: an agent, which can cause a birth defect
Medication Errors
• Any preventable event that may cause or lead to
inappropriate medication use or harm
• Several sources and types of errors
• Causes of Medication Errors (90%)
• Human factors
• Performance deficits (30%)
• Knowledge deficits (14%)
• Miscalculation of doses (13%)
• Communication Mistakes (15%) – handwriting, confusing
abbreviations, decimals, apothecary vs. metric units
• Name Confusion
Examples of Several Sources and
Types of Medical Errors
• Misdiagnosis of an illness, failure to diagnose or delay of a diagnosis. This
type of error could be a direct mistake of a doctor or caused when the
doctor is acting on incorrect information supplied by some other person.
• Giving the wrong drug or (wrong patient, wrong chemical, wrong dose,
wrong time, wrong route)
• Giving two or more drugs that interact unfavorably or cause
poisonous metabolic byproducts
• Wrong-site surgery, such as amputating the wrong limb
• Retained surgical instruments. In particular, gossypiboma, resulting from a
surgical sponge being left behind inside the patient after surgery
• Patients' implementation of drugs and treatments
• Transplanting organs of the wrong blood type
• Incorrect record-keeping