MED 103: Medical Terminology

MED 103: Medical Terminology
Lisa H. Young, RN, BSN, MA Ed.

Elements of a Medical Terms
Roots the constant, unchanging foundation of a medical term usually of Greek or Latin origin nearly all medical terms have one or more roots

Elements of a Medical Terms
Combining vowel has no meaning of its own joins a root to another root joins a root to a suffix makes a word easier to pronounce “o” is the most common combining vowel, followed by “a”

Elements of a Medical Term
Combining form combines a root and a combining vowel can be attached to another root or combining form can precede a suffix Example: enter/o

Elements of a Medical Term
Identify the elements of the following word: gynecologist gynec/ o logist root combining suffix vowel

Greek, Latin, and Old English Words
Some medical terms do not break down (deconstruct) into word elements Examples: Greek: toxin meaning poison Latin: medical meaning to heal Old English: record meaning to remember

Terms That Are Alike Examples: ilium and ileum malleus and malleolus
Many words in the medical language are very similar. Examples: ilium and ileum malleus and malleolus

Chapter 1 Summary Elements Greek, Latin, and Old English Words
prefix, root, combining vowel, combining form, and suffix Greek, Latin, and Old English Words Some do not break down Terms That Are Alike Look alike/sound alike

Suffixes Added to the end of a root/combining form
Changes the meaning of medical terms Use of combining vowel hemat -oma= root + suffix hemat/o -logist = root + combining vowel + suffix

Classification of Suffixes
Diagnostic Diagnosis, procedure, or test Surgical Describes surgical procedures Pathological Describes a sign/symptom of a disease

Classification of Suffixes
Adjectives 28 suffixes mean pertaining to Nouns do not fall under any classifications maintain the root or combining form as a noun

Diagnostic Suffixes Identify the suffixes of the following words:
hematoma hemat/ -oma root suffix hematuria hemat/ -uria

Surgical Suffixes Identify the suffixes of the following word:
appendectomy append/ -ectomy root suffix lithotripsy lith/o -tripsy combining suffix form

Pathological Suffixes
Identify the suffixes of the following words: cystitis cyst/ -itis root suffix cyanosis cyan/ -osis

Adjective Suffixes Suffixes meaning pertaining to: -ac cardiac pertaining to the heart -ary pulmonary pertaining to the lungs -ior posterior pertaining to the back of the body

Noun Suffixes Identify the suffixes of the following words: arteriole
root suffix venule ven/ -ule

Prefixes Added to the beginning of a medical term
Change the meaning of medical terms No use of combining vowel peri-cardium = prefix + root epi-cardium = prefix + root

Position Prefixes Identify the prefixes of the following words:
epidermis epi dermis prefix root hypodermis hypo dermis

Number and Measurement Prefixes
Identify the prefixes of the following word: multipara multipara prefix root Primipara primipara prefix root

Direction Prefixes Identify the prefixes of the following word:
antevert anti- vert prefix root synapse synapse prefix root

Element Review Identify the prefixes and suffixes of the following word: hypogastric hypo- / gastr / -ic prefix root suffix

Chapter 2 Summary Suffixes and Prefixes Suffix Prefix
Change the meaning of medical terms Suffix Added to the end of a root/combining form Use of combining vowel Prefix Added to the beginning of a medical term

Decoding Terms CARD Method Check for the word parts in a term
Assign meanings to the word parts Reverse the meaning of the suffix to the front of the definition Define the term Word: Glossitis Check: gloss/it is Assign: tongue/inflammation Reverse: inflammation/tongue Define: inflammation (of the) tongue

Word Analysis, Definition & Pronounciation
Analyze the following term: endocarditis 1. suffix — itis meaning inflammation 2. prefix endo — meaning inside 3. root card meaning heart 4. put the terms together—inflammation of the inside of the heart

Building Terms Spelling Rules
If the suffix starts with a vowel, a combining vowel is NOT needed to join the parts arthr/o  itis = arthritis If the suffix starts with a consonant, a combining vowel IS needed to join the two word parts arthr/o + plasty = arthroplasty

Building Terms Endo- + cardi/o + itis = Endocarditis
If a combining form ends with the same vowel that begins a suffix, one of the vowels is dropped Endo- + cardi/o + itis = Endocarditis If two or more combining forms are used in a term, the combining form is retained Gastr/o + enter/0 + itis = Gastroenteritis If two or more combining forms are used in a term, the combining vowel is retained between the two, regardless of whether the second combining form begins with a vowel or a consonant. Notice that the combining vowel is KEPT between the two combining forms (even though enter/0 begins with the vowel “e”) and the combing vowel is dropped before the suffic –itis is added.

Building Terms Esophag/o + gastr/o + duoden/o + scopy =
When two or more combining forms are used to make a medical term, special notice must be paid to the order in which the combining forms are joined Esophag/o + gastr/o + duoden/o + scopy = Esophagogastroduodenoscopy (joining the CF reflects the direction in which the scope travels through the body)

Plurals Singular / Plural Rules Ends in –a add –ae vertebraae
Ends in -is add –es arthrosises Ends in –ix or –ex add –ices appendixices Ends in –itis add –itides arthritisitides Ends in –nx add –nges phalanxnges Ends in –um add an –a endocardiumia Ends in –us add an –I digitusi Ends in –y add –ies thearpyies These are the most common singular/plural endings and the rules for using them.

Chapter 3 Summary Word Analysis and Definition
break it down into its component elements Plurals and Pronunciations memorize the plurals of medical terms correct pronunciation is vital Precision in Communication

Composition of the Body
The body is composed of: - organs - tissues - cells - organelles - molecules - atoms The body is composed of many structures. The largest body structures are the organ systems. The organ systems are comprised of organs that are further composed of tissues. Tissues are composed of cells which are made up of organelles. Organelles can be further broken down into molecules and then into microscopic atoms.

Structure and Functions of Cells
Basic Functions of Life - manufacture - production - communication - replication - reproduction All cells must carry out the following basic functions of life. Any errors in these functions will cause deformities or death. Manufacture of proteins and lipids provides nutrition for the cells. Production of energy in order to carry out cellular functions. Communication with other cells allows the proper carrying out of functions. Cells communicate with each other by sending hormones to each other which include messages. Think of hormones as letters in the mail. A person (cell) communicates with another sending a mailed (hormone) message to another to read. Replication of their own individual DNA controls heredity. If DNA is copied wrong, cellular death and/or deformities can occur. Cancer is an example of a cell replicating the wrong DNA. Reproduction provides new cells in place of those that die.

Nucleus The nucleus is the largest organelle of the cell.
Most cells have a nucleus; red blood cells do not have one. The DNA responsible for duplicating the cell is found in the nucleus. The nucleus is surrounded and protected by a nuclear membrane.

Tissues Primary Tissue Groups - connective - epithelial - muscle
- nervous Tissues – within each type of tissue the tissue is either supportive (stromal) or does actual work (parenchymal) Four types: Epithelial – an internal or external covering for organs Connective – internal structural network (bone, blood, and fat) Muscular – three types: heart muscle, skeletal muscle and visceral muscle (all able to contract and relax)

Organs & Organ Systems Integumentary Skeletal Muscular
Skin, hair, nails, sweat glands, sebaceous glandis Skeletal Bones, ligaments, cartilages, tendons Muscular Muscles Major functions Integumentary: protect tissues, regulate body temperature, support sensory receptors Skeletal: provide framework, protect soft tissues, provide attachments for muscles, produce blood cells, store inorganic salts Muscular: Cause movements, maintain posture, produce body heat

Organs and Organ Systems
Nervous Brain, spinal cord, nerves, sense organ Endocrine Glands that secrete hormones: pituitary, thyroid, parathyroid, adrenal, pancreas, ovaries, testes, pineal, thymus Cardiovascular Heart, blood vessels Nervous: Detect changes, receive and interpret sensory information, stimulate muscles and glands Endocrine: control metabolic activities of organs and structures Cardiovascular: Move blood and transport substances throughout the body

Lymphatic Lymph vessels and nodes, thymus spleen Digestive Mouth, tongue, teeth, salivary glands, pharynx, esophagus, stomach, liver, gallbladder, pancreas, small and large intestines Respiratory Control intake and output of air, exchange gases between air and blood

Urinary Kidneys, ureters, urinary bladder, urethra Reproductive Male: scrotum, testes, epididymides, vas deferens, seminal vesicles, prostate, blubourethral glands, urethra, penis Female: ovaries, uterine (fallopian) tubes, uterus, vagina, vulva

Prefixes for Body Organization
ana- up, apart, away cata- down en in endo- within epi above, upon meta- beyond, change para neat, beside, abnormal

Suffixes for Body Organizations
ai, -ous pertaining to -ia, -ism condition, state of -on structure -plasm formation -some body -stasis controlling, stopping -um structure, thing, membrane -us structure

Anatomical Positions, Planes, and Directions
The position in which the body stands erect with face forward, arms at the sides, palms forward, with toes pointed forward. This position is used to describe the surface anatomy of the body, both front (ventral) and back (dorsal).

Anatomical Planes http://www.youtube.com/watch?v=wBAwxZ_yxnE
The body is viewed through imaginary slices. There are three major anatomic planes. Have students identify the three planes. Transverse/horizontal, sagittal, and frontal/coronal Which areas of the body are considered to be superior to and inferior to the transverse plane? Superior—above waist, inferior—below waist

Positional & Directional Terms
Anteroposterior (AP) & Posteroanterior (PA) Anterior & ventral to the front/belly side Posterior & dorsal back of body/back Superior & Cephalad upward/toward head Inferior & Caudad downward/toward tail Medial pertaining to the middle Lateral pertaining to the side Ipsilateral pertaining to same side

Position & Directional Terms
Contralateral pertaining to the opposite side Unilateral pertaining to one side Bilateral pertaining to two sides Superficial on the surface of the body Deep away from the surface of the body Proximal near the origin Distal far from the origin Dextrad toward the right

Position & Directional Terms
Sinistrad toward the left Afferent carrying toward a structure Efferent carrying away from structure Supine lying on back Prone lying on stomach

Body Cavities Identify the five body cavities. Cranial, spinal, thoracic, abdominal, and pelvic Ask students what structures are found in each body cavity. Ask students to identify the only cavity that opens up directly to the outside of the body. Pelvic Cranial cavity: contains the brain within the skull Thoracic cavity: contains the heart, lungs, thymus gland, trachea, and esophagus, as well as, numerous blood vessels and nerves Abdominal cavity: is separated from the thoracic cavity by the diaphragm and contains the stomach, intestines, liver, spleen, pancreas, and kidneys Pelvic cavity: is surrounded by the pelvic bones and contains the urinary bladder, part of the large intestine, the rectum, the anus, and the internal reproductive organs Spinal cavity: contains the spinal cord The abdominal cavity and pelvic cavity are collectively referred to as the abdominopelvic cavity Abdominaopelvic regions are the nine regions that lie over the abdominopelvic cavity. Umbilical: center of the abdominopelvic cavity Lumbar: laterally, to the left and right of the umbilical region and bound by the lumbar vertebrae Hypochondriac: superior to the lumbar region and below the ribs Epigastric: medial to the hypochondriac regions and superior to the umbilical region Hypogastric: inferior to umbilical region Iliac: lateral to the sides of the hypogastric region; right and left iliac regions; sometimes referred to the inguinal regions

Abdominal Regions and Quadrants
The abdomen is divided into 4 quadrants; have students name them. Provide students with the abbreviations for the quadrants—RUQ, LUQ, RLQ, LLQ In a healthy bowel, bowel sounds will be heard in all four quadrants. The mid-abdomen is also divided into 3 regions; have students name them. Epigastric, umbilical, and hypogastric Either side of the epigastric region is hypochondriac region Either side of the umbilical region is the lumbar region Either side of the hypogastric region is the inguinal region

Chapter 4 Summary Organization of the Body
All the elements interact with each other Anatomical Position, Planes, and Directions Describe the location of anatomical structures

Digestive System Alimentary Canal Accessory Organs
Mouth, Pharynx, Esophagus, Stomach, Small Intestine, Large Intestine Accessory Organs Teeth, Tongue, Salivary Glands, Liver, Gallbladder, Pancreas Use the figure to illustrate the entire alimentary canal for the students. The alimentary canal consist of the mouth, pharynx, esophagus, stomach, small intestine, and large intestine. The accessory organs of digestion are teeth, tongue, salivary glands, liver, gallbladder, and pancreas. Define the term gastroenterology. The study of the digestive system How are food elements transported to cells? Through blood and lymph

Functions of the Digestive System
List the six basic functions of the digestive system. Ingestion, propulsion, digestion, secretion, absorption, and elimination. Explain the difference between chemical and mechanical digestion. Chemical digestion breaks large food molecules down into smaller and simpler chemicals. Mechanical digestion breaks large pieces of food down into smaller pieces of food without altering the chemical composition of the food. What are the three main digestive enzyme groups and what do they digest? Amylase digests carbohydrates, lipase digests fats, and proteases digest protein.

Prefixes of the Digestive System
Prefixes for the Digestive System Endo- within Exo- outside Hypo- below Par- near Peri- surrounding Retro- behind Sub- under

Suffixes of the Digestive System
Suffixes for the Digestive System -al, - ar, -ary, -eal, -id, -ine, -ous, -ic pertaining to -ase enzyme -crine to secrete -kinin movement substance -stalsis contraction

Digestive System Define the following root elements: - bari - digest
- laparo - lymph Knowing the meanings of root elements helps you put the pieces of a word together. Define the following root elements: bari—weight digest—to break down laparo—abdomen lymph—lymph

Digestive System Root Elements
Identify and define the root elements of the following terms: - amylase - deglutition - elimination - peristalsis amylase—root is amyl; definition is starch deglutition— oot is deglutit; definition is to swallow elimination—root is elimin; definition is to throw away peristalsis— oot is stalsis; definition is to constrict

Digestive Systems Root Elements
Define the following root elements: - cusp - lingu - mandibul - saliv Knowing root elements assists in building words. Define the following root elements: cusp—point lingu—tongue mandibul—mandible saliv—saliva

Define the following root elements: - chol/e - emuls - gall - hepat By understanding root elements, a word can be built. Ask students to define the following root elements: chol/e—bile emuls—suspend in a liquid gall—bile hepat--liver

Define the following root elements: - amin - hydr - carb - lact Students must memorize root elements in order build words. Define the following root elements: amin—ammonia hydr—water carb—carbon lact—milk

Digestive System Prefixes
Define the following prefixes: mono- di- tri- poly- Adding prefixes to a term can change the meaning. Students must memorize prefixes to understand terminology. Define the following prefixes: mono—one di—two tri—three poly—many

Digestive System Suffixes
Define the following suffixes: - itis - ectomy - osis - dynia - ist o a root can alter the meaning. It is important to recognize and know the meaning of suffixes. Define the following suffixes: itis—inflammation ectomy—surgical excision osis—condition dynia—pain ist—specialist

Digestive System Define the meaning of the following suffixes: - um
- rrhoid - ion - ative Students must memorize suffixes to understand medical terminology. Define the meaning of the following suffixes: um—tissue rrhoid—flow ion—action ative—quality of

Digestive System Define the following suffixes: - um - in - ion - gen
- us Adding suffixes to root elements change their meaning. It is important to not only be able to define a root but suffixes as well. Define the following suffixes: um—structure in—in ion—action, condition gen—produce us—pertaining to

Urinary System Kidneys (nephron) Ureters Bladder Urethra
Anatomy and Physiology Kidneys (nephron) Ureters Bladder Urethra Urinary meatus Trigone Use the figure to illustrate the location of each structure of the urinary system. The urinary system consists of: two kidneys, which filter the blood of waste two ureters, which transport urine from the kidneys to the urinary bladder one urinary bladder, which holds urine prior to excretion, and one urethra, which transports urine to outside the body. Kidneys are primarily responsible for the functioning of the urinary system. Nephrons filter all the blood in the body approximately every 5 minutes. Ureters: thin, muscular tubes that move urine in peristaltic waves from the kidneys to the bladder. Bladder is the sac that stores the urine until it is excreted. Urethra is the tube that conducts the urine out of the bladder. Urinary meatus is the opening of the urethra. The triangular area in the bladder between the ureters’ entrance and the urethral outlet is called the trigone.

Urinary System Functions of the Kidneys
filter blood to eliminate wastes regulate blood volume maintain homeostasis secrete renin secrete erythropoietin synthesize vitamin D The major function of the urinary system is to continually maintain a healthy balance of the amount and content of extracellular fluids within the body. This balance is known as homeostasis The body needs to constantly monitor and rebalance the amounts of building blocks, energy sources and waste products in the blood stream. The kidney is responsible for filtering the blood of excess water and waste, which become urine. The kidney also regulates blood volume by eliminating or conserving water as needed. The kidney maintains homeostasis by controlling how much water and how many electrolytes are eliminated. The kidney secretes renin, which is responsible for maintaining blood pressure. The kidney secretes erythropoietin, which regulates production of red blood cells. The kidney synthesizes vitamin D, which helps maintain normal blood calcium levels.

Urinary System Location Structure Function Micturition
The urinary bladder is located on the floor of the pelvic cavity. The urethra extends from the inferior aspect of the bladder to the outside. The urinary bladder is a hollow muscular organ. The urethra is a hollow tube that varies from 1.5 to 8 inches, depending on gender. The urinary bladder stores urine prior to excretion. The urethra transports urine from the urinary bladder to the outside. Micturition is the process of releasing urine from the bladder. This is possible when the two sphincters in the base of the bladder relax. The urinary bladder stores approximately 200 mL (7 ounces) prior to micturition. The urine exits the urethra via the external urinary meatus. Use the figure to illustrate the location of the urinary bladder, urethra, internal and external sphincters, and urinary meatus.

Urinary System Prefixes for the anatomy of the urinary system
Extra- outside En- in Par- beside, near Retro- backward

Urinary System -ation, -ion process of
Suffixes for the anatomy of the urinary system -al, -ar, -ic pertaining to -ation, -ion process of

Urinary System ectomy excision, resection -lithotomy extirpation
-lysis release -pexy repair, reposition -scopy inspection -stomy bypass, drainage -tomy drainage, division -tripsy fragmentation Common procedure suffixes for the urinary system

Male Reproductive System
Primary Sex Organs Secondary Sex Organs Accessory Glands The male reproductive system consists of primary, secondary, and accessory organs. The primary sex organs, or gonads, are the testes. The secondary sex organs are the penis, scrotum, epididymis, vas deferens, and urethra. The accessory glands are the prostate, seminal vesicle, and bulbourethral glands. Function: to reproduce. In the process of providing half of the genetic material necessary to form a new person- and then successfully storing, transporting, and delivering this material to fertilize the female counterpart, the ovum-the species survives

Testes Location Structure Spermatic Cord Spermatogenesis Use the figure to illustrate the major structures in each testis and to illustrate the spermatic cord. The testes are located in the scrotum. The testes consist of lobules that contain seminiferous tubules. The seminiferous tubules contain cells that are in the process of becoming sperm. The spermatic cord contains blood vessels, nerves, and a passageway through which sperm travel. The functions of the testes are to produce sperm and male sex hormones, called androgens. The major androgen produced by the testes is testosterone. The spermatic cord suspends the testes in the scrotum. Spermatogenesis is the process by which male germ cells differentiate into sperm.

Spermatic Ducts & Accessory Glands
Epididymis Vas deferens Ejaculatory ducts Accessory Glands Prostate Seminal vesicle Bulbourethral glands Spermatic ducts are the pathway of spermatozoa after they exit the testes. The epididymis arises from the testis. It is here that spermatozoa mature and become motile. The vas deferens arises from the epididymis and enters the pelvic cavity through the inguinal canal. The vas deferens is also called the ductus deferens. The ejaculatory duct is formed by the ductus deferens and the seminal vesicle. Use the figure to illustrate the location of the spermatic ducts and accessory glands. The accessory glands include the prostate, seminal vesicle, and bulbourethral glands. The accessory glands add fluid to sperm to produce semen. The bulbourethral glands are also called Cowper’s glands.

Penis erection ejaculation Use the figure to illustrate the parts of the penis. The penis consists of a glans and shaft. The skin covering the glans is the prepuce, also called the foreskin. The shaft of the penis consists of the urethra, surrounded by the erectile tissue of the corpus spongiosum and lying below the erectile tissue of the corpora cavernosa.

Prefixes for the anatomy of the male reproductive system en in par near, beside Suffixes for the anatomy of the male reproductive system -al, -ous, -ar, -ile, -atic, -ic pertaining to -ferous pertaining to carrying -genesis production -one substance that forms

cision resection -ectomy excision, resection -ligation occlusion -pexy repair, reposition -plasty repair, supplement -stomy repair -tomy drainage Common procedural suffixes

Female Reproductive System
Perineum Vulva structures of the vulva Use the figure to illustrate the female external genitalia. The perineum is the region between the thighs. The vulva is the term for the external genitals. The vulva consists of the mons pubis, labia minora and majora, vestibule, and clitoris. The role of the female reproductive system is to create new life through the successful fertilization of an ovum.

Vagina Use Figure 13.2 to illustrate the vagina, cervix, and paraurethral glands. The vagina is also known as the birth canal. There are three functions of the vagina: discharge menstrual fluid receive semen from the penis allow the birth of a baby

Ovaries Fallopian Tubes Uterus Use the figure to illustrate the location of the ovaries, fallopian tubes, and uterus. The ovaries, the sex organs, produce egg cells known as ova, and sex hormones. The fallopian tubes provide a passageway for ova from the ovary to the uterus. The uterus is a muscular organ with a fundus, body, and cervix. The uterus consists of three layers: the perimetrium, myometrium, and endometrium.

Suffixes for the anatomy of the female reproductive system -arche beginning -ation process of -pause stop, cease -salpinx fallopian tube -ectomy excision, resection -pexy repair, reposition -plasty repair, supplement, alteration,replacement -scopy inspection -tomy drainage, division -lysis release -ligation occlusion

Pregnancy Embryo Placenta Fetus
Use the figure to illustrate the embryo at 4.5 weeks of gestation. The embryonic period lasts from the second to eighth weeks of gestation. The role of the placenta is to transport nutrients, oxygen, wastes, antibodies, and hormones to and from the fetus. The fetal period is from the ninth week of gestation to birth.

Pregnancy Suffixes for the A & P of pregnancy
-blast embryonic, immature -cyst sac -gravida, -cyesis pregnancy -para, -tocia delivery Nulligravida: no pregnancy Primigravida: first pregnancy Multigravida: many pregnancies

Childbirth Stage One: dilation and effacement
Stage Two: expulsion of the fetus Stage Three: expulsion of the placenta Use the figure to illustrate the stages of childbirth. Childbirth is divided into three stages. The term labor refers to the entire process of expelling the fetus from the uterus. In stage one, dilation and effacement of the cervix occurs. The fetus is expelled from the uterus in stage two, after the head of the fetus reaches the vaginal opening. In the third stage, the placenta detaches from the uterine wall and is expelled.

Breast Anatomy of breast Mammary gland
Use the figure to illustrate the parts of the breast. The mammary gland develops during pregnancy, and consists of alveoli, lactiferous ducts, and lactiferous sinuses. The alveoli produce milk; the lactiferous ducts transport milk to the nipple; the lactiferous sinuses store milk prior to release by the nipple.

Nervous System Functions of the Nervous System Sensory Input
Motor Output Evaluation and Integration Homeostasis Mental Activity CNS Brain and spinal cord PNS Nerves all over the body Function: The nervous system plays a major role in homeostasis, keeping the other body systems coordinated and regulated to achieve optimum performance. It accomplishes this goal by helping the individual respond to his or her internal and external environments. The nervous and endocrine systems are responsible for communication and control throughout the body. There are three main neural functions: Collecting information about the external and internal environment; processing this information and making decisions about action; directing the body to put into play the decisions made A & P: Nervous system: central nervous system- brain and spinal cord. Peripheral nervous system – nerves that extend from the brain and spinal cord to the tissues of the body. Sensory nerves carry impulses to the brain and spinal cord. Motor nerves carry impulses away from the brain and spinal cord. Somatic nervous system: voluntary in nature- return instructions to skin, muscles and joints. Autonomic nervous system- mostly involuntary and in return, motor impulses from the CNS are sent to involuntary muscles; the heart, glands and organs. The brain receives messages from receptors all over the body regarding seeing, hearing, smelling, tasting, and feeling (sensory input). The brain stimulates muscles to contract, enabling movement of body parts (motor output). The brain and spinal cord process sensory input, initiate a response, and store the event in memory. The brain uses sensory input to maintain a stable internal environment, from correct levels of gases and fluids, to the correct processing of nutrients and waste. Mental activity responsible for thinking, feeling, understanding, responding, and remembering takes place in the brain. Use the figure to illustrate the two divisions of the nervous system. The CNS (central nervous system) consists of the brain and spinal cord. The PNS (peripheral nervous system) consists of all of the other nerves, located all over the body.

Nervous System Suffixes -cyte cell -glia glue -on structure
-stasis stopping, controlling -tome instrument used to cut Suffixes and Root Operations -ectomy excision, resection, destruction -emphraxis destruction -exeresis extraction -plasty repair, supplement -stomy bypass, drainage -tomy drainage, division, destruction

The Brain Divisions of the Brain Cerebrum Cerebellum Brain stem
The brain is divided into three portions. The cerebrum is the largest portion of the brain and consists of two halves, or hemispheres. The cerebellum is a smaller portion of the brain that lies inferior to the cerebrum and coordinates skeletal muscle activity to maintain posture and balance. The brainstem is an elongated portion of the brain that lies inferior to the cerebrum and anterior to the cerebellum. The brainstem connects the brain and spinal cord.

The Cerebrum Four Cerebral Lobes Frontal lobe Parietal lobe
Temporal lobe Occipital lobe The cerebrum is divided into four lobes in each hemisphere of the brain. Use the figure to point out each lobe of the brain to students. Ask students to state the location and function(s) of each lobe. The frontal lobe is located behind the forehead. It is responsible for memory, intellect, concentration, problem solving, emotions, and the planning and execution of behavior. The parietal lobe is located above the ear. It is responsible for receiving and interpreting sensations of pain, pressure, touch, temperature, and body part awareness. The temporal lobe is located behind the ear. It is responsible for interpreting sensory experiences, sounds, and spoken words. The occipital lobe is located at the back of the head. It is responsible for interpreting visual images and the written word.

Functions of the Brain Functional Regions of the Brain thalamus
hypothalamus basal nuclei limbic system brainstem cerebellum Use the figure above to illustrate the functional regions of the brain. Have students briefly list the function of each region of the brain. The thalamus receives sensory stimuli and channels them to the correct lobe for processing. The hypothalamus regulates blood pressure, body temperature, water and electrolyte balance, hunger, body weight, sleep, wakefulness, and the digestive tract. Basal nuclei control voluntary muscular movements and posture, emotion, and cognition. The limbic system controls emotional experience, fear, anger, pleasure, and sadness. The brainstem serves as a relay station for sensory impulses and contains centers to control heart rate, breathing, diameter of the blood vessels, and waking the cerebrum. The cerebellum coordinates skeletal muscle activity to maintain posture and balance.

Spinal Cord Four Regions: cervical thoracic lumbar sacral
Use the figure to point out the four regions of the spinal cord. Ask students to list the areas innervated by each region of the spinal cord. The cervical spine innervates the neck, shoulders, and arms. The thoracic spine innervates the chest, ribs, vertebral column, and back muscles. The lumbar spine innervates the hips and the front of the legs. The sacral spine innervates the buttocks, genitals, and the back of the legs.

Cardiovascular System
Functions of the Cardiovascular System Pulmonary circulation Systemic circulation Arteries (great, upper and lower) Veins (upper & lower) The primary function of the circulatory system is to provide a means of transportation for nutrients, water, oxygen, hormones, and body salts and wastes the cells of the body. Also protective role by dispatching specialized defensive cells through the lymphatic system Pulmonary Circulation: blood on the right side of the heart that is being pumped to the lungs for oxygenation Systemic Circulation: blood from the left side of the heart to the cells of the body which is oxygenated A & P of the cardiovascular system: Heart and great vessels (IVC and SVC, pulmonary arteries and veins and the aorta) Blood flow through the heart Conduction mechanism system: systole and diastole (BP); electrical conduction pathway; EKG; fetal circulation The heart has three main functions: 1 - pump blood—contractions pump blood to all vessels within the body. 2 - route blood—blood flows in only one direction. The right side of the heart pumps blood where? To the lungs The left side of the heart pumps blood where? To the body What structures ensure this one-way flow. Heart valves 3 - regulate blood supply—tissue needs for blood supply are regulated by the force and frequency of heart contractions.

Cardiac Cycle - electrical properties of the heart Use the figure to highlight the pacing components of the heart. The conduction system of the heart consists of five components: sinoatrial node (SA node)—it is the pacemaker of heart rhythm. atrioventricular node (AV node)—electrical gateway to the ventricles. bundle of His—bundle of conduction fibers located at the uppermost portion of the ventricles. bundle branches—electrical fibers found in the ventricles. Purkinje fibers—fibers that spread through the myocardium in the ventricles to conduct an electrical impulse.

Prefixes con- together infra- under inter- between Intra- within oxy- oxygen semi- half supra- above Suffixes -ar, -ary, -ic, -al, -id, -eal pertaining to -cyte cell -ia condition -ion process of -um structure Suffixes and Root Operations -centesis drainage -tripsy occlusion

Circulatory System Functions of the Peripheral Circulation
- carry blood - transport - maintain homeostasis - regulate blood pressure The peripheral or body circulation has 4 main functions: To carry oxygenated blood to the body and deoxygenated blood to the heart To transport nutrients, hormones, and oxygen to tissues and transport waste products from tissues To maintain homeostasis by making sure tissues receive their metabolic needs for them to function correctly To regulate blood pressure to maintain a steady flow of blood and blood pressure to the tissues

Circulatory System Suffixes -cyte cell -ia condition -ion process of
-ar, -ary, -ic, -al, -id, -eal pertaining to -cyte cell -ia condition -ion process of -um structure

Hematology Components of Blood Formed Elements - RBCs - hematocrit
- WBCs - platelets - plasma - serum Forty-five percent of blood consists of formed elements. RBC is an abbreviation for what formed element? Red blood cell Red blood cells transport oxygen needed by tissues. Hct is the abbreviation for hematocrit. Hematocrit is the percentage of blood volume composed of RBCs. WBC is an abbreviation for what formed element? White blood cell White blood cells are active within the immune system. Platelets are responsible for clotting blood. What is plasma? Clear, liquid, yellowish fluid that contains albumin, globulin, and fibrinogen. How is serum similar to plasma? Serum is identical to plasma except that it does not contain any clotting proteins.

Hematology Functions of Blood - maintain body temperature
- maintain homeostasis - maintain body temperature - transport nutrients, vitamins, and minerals - transport waste products - transport hormones - transport gases - protect against foreign substances - form clots - regulate pH and osmosis The blood has nine very important functions. Blood maintains body temperature by circulating warm fluid to the interior organs and extremities. Where are vitamins, minerals, and nutrients stored for release into the blood? In the digestive system What organs detoxify blood? The liver and kidneys What type of glands secretes hormones into the blood, endocrine or exocrine? Endocrine What gases are transported by the blood to and from the lungs? Oxygen and carbon dioxide Cells and chemicals in the blood protect the body from foreign substances. Clot formation is the first step in the healing process. A neutral pH is 7; less than 7 is acidic; greater than 7 is alkaline. The blood utilizes a buffer system which is responsible for keeping the blood pH between 7.35 and 7.45. Osmosis is the passage of a liquid through a semi-permeable membrane. This is how nutrients, gases, and waste products pass between blood and body tissues. Viscosity describes how thick or thin a liquid is. The thicker the viscosity of blood, the harder the heart has to work to pump it.

Hematology Common Prefixes a- without anti- against inter- between
mono one poly- many pro- before

Hematology Suffixes cyte cell -phil attraction
-exia condition -poiesis formation -gen producing -poietin forming -globin protein substance substance -in substance siderin iron -kine movement substance -leukin white substance - stasis controlling, -lysis breaking down stopping -osis abnormal condition -thrombin clotting substance

Immune & Lymphatic Systems
BODY DEFENSE MECHANISMS Physical Mechanisms Cellular Mechanisms Humoral Defense Mechanisms There are three lines of defense against pathogens. Physical mechanisms include skin, mucosa, tears, saliva, perspiration, nostril hairs, cilia, and mucus, all of which protect the body from pathogens. Cellular mechanisms include lymphocytes that attack cancer, transplanted, viral, or parasitic cells in order to protect the body. Humoral mechanisms include antibodies that bind to pathogens, causing their destruction.

Lymphatic System Vessels Cells, Tissues, Organs Lymph Nodes Lymph
The lymphatic system has three components: 1. Lymphatic capillaries and vessels are found in almost every tissue in the body. 2. Lymphatic cells, tissues, and organs produce immune cells. Lymph nodes filter lymph and remove from it any foreign matter. 3. Lymph is a clear, colorless fluid similar to blood plasma. Lymph flows through lymph vessels and capillaries. Use the figure to demonstrate the location of the lymphatic system structures.

Lymphatic System Functions absorption removal
The functions of the lymphatic system are to: 1. absorb dietary fats from the small intestine. 2. remove foreign chemicals, cells, and waste from the tissues. 3. absorb excess tissue fluid and return it to the blood. Use the figure to illustrate the flow of lymph.

Lymphatic System T lymphocytes B lymphocytes Null Cells Macrophages
T lymphocytes, or T cells, mature in the thymus gland, destroy or assist in the destruction of target cells, and remember previous invaders. Some T cells suppress activation of the immune system. B lymphocytes, or B cells, cause the production of antibodies. Null cells are large, killer cells. Macrophages perform phagocytosis.

Lymphatic Organs Spleen Tonsils Adenoids Thymus Gland
The spleen, located in the upper, left part of the abdominal cavity, has four functions: to phagocytize bacteria to initiate immune response to hemolyze old cells to serve as a reservoir for erythrocytes and thrombocytes Tonsils, located in the oropharynx, trap inhaled and ingested bacteria and viruses and form lymphocytes and antibodies. Adenoids, located in the nasopharynx, trap bacteria and viruses and form lymphocytes and antibodies. The thymus gland allows for the maturation of T cells and secretes a group of hormones that stimulate the production of T-cells.

Immune System Immunity Humoral Immunity specificity memory
discrimination Immunity Cellular Humoral Natural Active Immunity Natural Passive Immunity Artificial Active Immunity Artificial Passive Immunity The immune system is composed of cells in different locations in the body that recognize foreign substances and inactivate them. A normal immune system protects the body from pathogens—bacteria, viruses, cancer cells, and foreign substances. A weakened immune system allows pathogens to cause disease in the body. There are three lines of defense: physical mechanisms, cellular mechanisms, and humoral defense mechanisms. Three differences separate the humoral defense mechanisms from the first two lines of defense: Humoral immunity is specifically directed toward a particular pathogen and changes from pathogen to pathogen. Humoral immunity has the capability of “remembering” each pathogen in order to mount the pathogen-specific defense when presented with this pathogen. Humoral immunity “learns” to recognize self-antigens and foreign antigens. When the immune system attacks self-antigens as if they were foreign, autoimmune diseases result. Cellular immunity involves lymphocytes, which directly attack foreign or abnormal cells and destroy them. T cells, B cells, and macrophages are involved in cellular immunity. Humoral immunity involves the production of antibodies, which bind to antigens, inactivating them. Antibodies are also known as immunoglobulins. Immunoglobulins have specific jobs. Among their jobs is neutralizing antigens, binding to antigens, preventing their travel, and causing them to be heavy enough to attract phagocytes. The immunoglobulins prepare antigens for destruction. There are four classes of immunity. Passive immunity is short-term immunity. Active immunity usually lasts longer than passive immunity and may even be life-long immunity. Each will be described in the next four slides. Natural active immunity is when a person naturally makes (in response to a pathogen or disease) his or her own antibodies to each disease he or she is exposed to. Natural passive immunity is when a person received naturally made (in response to a pathogen or disease) antibodies from another person. Natural passive immunity is received by a fetus, neonate, or breast-feeding baby from his or her mother via the placenta or via breast milk. Artificial active immunity is when a person makes his or her own antibodies after the administration of a vaccination or immunization containing an attenuated (weakened) or killed virus. Artificial passive immunity is when a person receives antibodies made by another person or animal such as receiving immune serum for snakebite.

Blood & Immune System Prefixes for A & P a- without anti- against
inter- between mono- one poly- many pro- before

Blood & Immune System Suffixes for the A & P
-cyte cell phil attraction -exia condition -poiesis formation -gen producing -poietin forming -globin protein substance substance -in substance siderin iron -kine movement substance -leukin white substance - stasis controlling, -lysis breaking down stopping -osis abnormal condition -thrombin clotting substance Suffixes and Root Operations -ectomy excision, resection

Respiratory System Structures of the Respiratory System
- nose - pharynx - larynx - trachea - bronchi and bronchioles - alveoli Functions of the Respiratory System - exchange of gases - regulation of blood pH - protection - voice production - olfaction Functions: delivery of oxygen to the blood for transport to cells in the body, excreting the waste product of cellular respiration, carbon dioxide, filtering, cleansing, warming, and humidifying air taken into the lungs, regulating the pH of the blood, helping the production of sound for speech and singing, providing the tissue that receives the stimulus for the sense of smell, olfaction A & P: divided into conduction passageways and gas exchange surfaces. The upper respiratory tract: nose, pharynx, and larynx. The lower respiratory tract: trachea, bronchial tree, and lungs. Gas exchange surfaces are the alveoli of the lungs and the cells of the body External respiration: process of exchanging oxygen and carbon dioxide between the lungs and the blood Internal respiration: the exchange of gases between the blood and the cells of the body Cellular respiration or cellular metabolism: use of oxygen to generate energy One of the functions of the respiratory system is the exchange of gases. Cells need oxygen from inhaled air and produce carbon dioxide, which is then exhaled. Use the figure to illustrate the organs of the respiratory system. Trace the flow of air into the respiratory tract, structure by structure. Changing carbon dioxide levels regulates blood pH. The respiratory system protects against some foreign bodies and microorganisms. Movement of air across the vocal cords produces sound. Olfactory receptors, responsible for the sense of smell, are located in the nasal cavity.

Respiratory System Prefixes ex- out in- in inter- between oxy- oxygen
para- near re- again Suffixes -centesis drainage -ectomy excision, resection -lysis release -plasty alteration, reposition, repair, replacement, supplement -rrhaphy repair -tomy drainage

Musculoskeletal System
List the four components of the skeletal system. Bones, cartilage, tendons, and ligaments Describe the functions of the skeletal system. Support, protection, movement, blood formation, mineral storage, balance, detoxification.

Prefixes Ab- away from Ad- toward Amphi- both Bi- two Circum- around Dia- through, complete Endo-, end- within Epi- above, upon Ex-,e- out In- n Inter- between Intra- within Peri- surrounding, around Pro- forward Re- back Syn- together,joined

Suffixes -ar, -al, -ic, -ous, -eal pertaining to -blast embryonic -clast breaking down -cyte cell -genesis production, origin -oid resembling, like -physis growth -poiesis formation -sis condition -um structure Suffixes and Root Operations -clasis division -desis fusion -ectomy excision, resection, extirpation -pexy repair, reposition -plasty repair, replacement, supplement, alteration -tomy release, division, drainage

Joints Classes of Joints - fibrous - cartilaginous - synovial
Functions and Structure of Skeletal Muscle - functions Fibrous joints occur where two bones are bound tightly by fibrous tissue. Ask students to give examples of fibrous joints. Skull sutures, attachment of tibia and fibula to ankle, and joints between teeth and their sockets Cartilaginous joints occur where two bones join with cartilage. Ask students to give examples of cartilaginous joints. Ribs and costal cartilage, and pubic bones Synovial joints contain fluid and allow a lot of movement to the joint. Ask students to give examples of synovial joints. Knees, wrists, and shoulders Ask students to identify the 5 functions of skeletal muscle: movement, posture, body heat, respiration, and communication. Use the figure to demonstrate the function of contraction. Why is skeletal muscle control called voluntary control? It is under conscious control. What structures are found in muscle bundles? Muscle fibers, blood vessels, nerves, and connective tissue

Muscles and Tendons Functions and Structure of Skeletal Muscle
Define striations. Skeletal muscle fibers with alternating light and dark patterns of protein filaments Use the figure to illustrate the structure of skeletal muscle. Describe the difference between muscles that hypertrophy and those that atrophy. Hypertrophy is enlarging muscle with exercise; atrophy is wasting of muscle from non-use. At what age do you stop adding muscle fibers in numbers? Late childhood

Integumentary System Functions of the Skin Epidermis
The skin receives more care and treatment than any other body system. Ask students to describe the functions the skin plays in our physical well-being. Ask students to describe how the skin plays an important part in our self-image—compare the self-esteem/self-image of those with a perfect complexion vs. those with acne From what does our skin protect us? The skin protects us from injury, chemicals, ultraviolet rays, microbes, and toxins. Prevents water from leaking into or out of the body tissues. Discuss the difference between vasodilation and vasoconstriction. Dilation is an expansion or opening up of a blood vessel; constriction is a narrowing or closing of a blood vessel. Why is vitamin D so important? It is needed for bone growth and maintenance. Our skin has more nerve endings than any other body part. What sensations do the nerves on our skin detect? They detect touch, pressure, heat, cold, pain, vibration, and tissue injury. What is secreted by the body through sweat glands? Water, salt, and products of cell metabolism Why is sweating important? It regulates our temperature by cooling us when we are too hot. Ask students how skin depicts our moods — examples — 1. The skin reddens when we are embarrassed or mad. 2. The skin pales when we are frightened or ill. 3. The facial skin wrinkles when we don’t like something. 4. Goose bumps occur when we are cold. The epidermis is the outermost layer of skin. The epidermis has no blood vessels in it. Skin cells are continually shed and renewed throughout your lifetime. The dermis is the thick layer of connective tissue that is found under the epidermis. This layer contains blood vessels, sweat glands, nerves, hair follicles, and nails. Epidermal ridges prevent the dermis and epidermis from slipping on one another and provide our fingerprints. Use the figure to demonstrate the structures found within the dermis. . Functions of the Skin Protection Water resistance Temperature regulation Vitamin D synthesis Sensation Excretion and secretion Social functions Epidermis - protects underlying structures - withstands pollution of life - sheds superficial cells and renews them - provides a waterproof barrier

Integumentary System Prefixes Suffixes a- no, not without
apo- separate, away from ec- out, outward epi- above eu- healthy, normal hypo-, sub- under, below par- near Suffixes -al, -ar, -ous, -ic pertaining to -crine to secrete -cyte cell -ferous pertaining to carrying -ium structure Suffixes and Root Operations -abrasion extraction -ectomy excision,resection,alteration -graft repair -plasty repair, replacement, reposition, supplement -tomy drainage

Special Senses of the Eye & Ear
Suffixes and Root Operations -ectomy excision, resection -plasty reposition, repair, replacement, supplemental -rrhaphy repair -tomy drainage, repair The function of the eyes and adnexa (accessory structures) is to provide an individual with the sense of vision by capturing ligth rays and focusing them on the retinal to produce an image. Interpretation of this image is the responsibility of the nervous system. A & P: Ocular adnexa – the structures that surround and support the function of the eyeball- and the structures of the globe of the eye itself; the eyeball. Eyeball consist of cornea, middle/vascular layer (Uvea), inner/nervous layer (retina). What purpose do the eyelids serve? Protection; keep out visual stimuli during sleep. What purpose do the eyelashes serve? To keep debris out of the eye. Identify the term used to describe the corners where the upper and lower eyelids meet. Canthi The cornea is the dome-shaped protective membrane. The iris is the colored area of the eye. The iris color is determined by genes. The pupil is the black center of the iris which controls the amount of light entering the eye. The retina contains the rod and cone receptors which receive an image for the brain to interpret. The retina is about the size of a postage stamp and is the final destination of light rays. What nerve transmits the signals from the retina to the brain? Optic nerve Explain color blindness. A hereditary lack of one of the three cone mixtures in the retina What is the most common form of color blindness? The inability to distinguish red and green colors Have students give some examples of causes of night blindness. Uncorrected nearsightedness, cataracts, retinitis pigmentosa, vitamin A deficiency, and glaucoma The eye is divided into two cavities: anterior and posterior. In which cavity is the aqueous humor found. Anterior What function does the aqueous humor serve? It removes waste products from the eye and maintains the internal chemical environment of the eye. What is the vitreous body and where is it located? It is a transparent jelly in the posterior cavity that maintains the shape of the eyeball. Where are visual stimuli interpreted? In the occipital lobes of the brain What is presbyopia? Difficulty with near vision due to loss of flexibility of the lens. What strategy is used to treat presbyopia? Convex bifocal or transitional lenses. What vision problems can be corrected using LASIK? Myopia, hyperopia, and astigmatism

Special Senses of the Eye & Ear
Function: The ears provide an individual with the sense of hearing and balance, or equilibrium A & P: the ear is regionally divided into the outer, middle, and inner ear. External Ear or outer ear: collects sound waves and funneled into the external auditory canal Middle Ear: conducts sound to the air-filled tympanic cavity of the middle ear; function is to supply air for sound conduction and pressure equalization. Inner Ear: once sound is conducted to the oval window, sound is transmitted to the temporal lobe of the brain. The ear is made up of three sections: inner, middle, and external ear. The figure illustrates the three sections and the structures within each. The pinna of the external ear is visible to us without the use of an otoscope Name the wing-shaped structure that directs sound waves into the ear. Auricle or pinna What is the function of cerumen? It protects the ear canal from foreign objects. What instrument is used to visualize the external auditory canal and tympanic membrane? An otoscope Define otitis externa. An infection of the lining of the external ear Identify conditions that aid in causing otitis externa. Use of ear plugs, earphones, trauma while cleaning canal, hearing aids, and some skin diseases. Describe two methods of removing ear wax. Irrigation or removal with a curette What is the common name for the tympanic membrane? Eardrum What does the eustachian tube connect the ear to? The nasopharynx At what age is the eustachian tube fully developed? Age 5 What condition does a poorly developed eustachian tube lead to in young children? Otitis media What nerve transmits sound wave impulses to the brain? The auditory nerve Ask students to give examples of causes of conductive hearing loss. pathology, impacted cerumen, infected external canal, and foreign body in external canal What are the organs of balance? The vestibule and the semicircular canals What cells detect rotational movement? The cells of the crista ampullaris Define vertigo. The sensation of spinning or whirling Define tinnitus. ringing in the ears Suffixes and Root Operations -centesis drainage -ectomy excision, resection -lysis release -plasty repair, replacement -scopy inspection -stomy drainage -tomy drainage

Endocrine System Major Organs: - hypothalamus - pituitary gland
- pineal gland thyroid gland - parathyroid glands - thymus gland - adrenal gland pancreas - testes ovaries In addition to the major organs of the endocrine system, there are also endocrine cells found in tissues all over the body. Endocrine cells and organs secrete hormones. Hormones affect the target cells that have receptors for them. The hypothalamus produces eight hormones. Six of the eight hormones produced by the hypothalamus regulate the production of hormones by the anterior pituitary gland. The other two, oxytocin and antidiuretic hormone, are stored in the posterior pituitary gland. The pineal gland secretes serotonin and melatonin. Use the figure to show the location of the hypothalamus, pituitary, and pineal glands. The anterior pituitary is also known as the adenohypophysis. Follicle-stimulating hormone stimulates the ovaries to develop ova and stimulates the testes to produce spermatozoa. Luteinizing hormone stimulates ovulation in females and stimulates the testes to produce testosterone. Thyroid-stimulating hormone stimulates the thyroid gland to produce thyroxine. Adrenocorticotropic hormone stimulates the adrenal glands to produce corticosteroids. Prolactin stimulates the mammary glands to produce milk. Growth hormone stimulates cells to increase in number and in size. The posterior pituitary is also known as the neurohypophysis. Oxytocin is produced by the hypothalamus and stored in the posterior pituitary; it stimulates uterine contractions and lactation. Antidiuretic hormone is also produced by the hypothalamus and stored in the posterior pituitary; it regulates urine production by the kidneys. The thyroid gland is located just below the Adam’s apple and is composed of two soft vascular lobes and an isthmus. The thyroid hormones include thyroxine (T4), triiodothyronine (T3), and calcitonin. The term thyroid hormone refers to T3 and T4 collectively Thyroxine and triiodothyronine stimulate the tissues in the body to produce proteins, increase the oxygen use of the cells, and control the body’s metabolic rate. Calcitonin increases calcium storage and bone growth. The four parathyroid glands are located in the posterior surface of the thyroid gland. Use the figure to demonstrate the location of parathyroid glands. The parathyroid glands secrete parathyroid hormone (PTH), which raises blood calcium levels. Why are PTH and calcitonin antagonists? They perform opposite functions. Hypoparathyroidism is a deficiency of PTH. Hyperparathyroidism is an excess of PTH. The thymus gland is located in the mediastinum. Use the figure to demonstrate the location of the thymus gland. The thymus gland secretes thymosin, which stimulates the production of T-lymphocytes, a specific WBC. DiGeorge syndrome is a condition in which the thymus is underdeveloped and immunity is weak. Thymomas and thymic carcinomas are tumors of the thymus. The adrenal glands lie atop the kidneys. Use the figure to show the location of the adrenal glands. The outer portion, the adrenal cortex, produces and secretes corticosteroids The inner portion, the adrenal medulla, produces catecholamines. The adrenal cortex produces and secretes three groups of corticosteroids: glucocorticoids, mineralocorticoids, and sex steroids. Glucocorticoids regulate the use of fat and protein as energy and regulate blood glucose levels. Mineralocorticoids regulate electrolytes. The sex steroids include estradiol and androgens. The adrenal medulla produces catecholamines, specifically, epinephrine and norepinephrine. Epinephrine and norepinephrine are also known, respectively, as adrenaline and noradrenaline; they prepare the body for physical activity. The pancreas is located in the abdominal cavity, near the duodenum. The pancreas has cells that secrete digestive enzymes into the duodenum and cells that secrete hormones. The endocrine cells secrete glucagon, insulin, and somatostatin. Glucagon raises blood glucose, and insulin lowers it; somatostatin inhibits the production of both insulin and glucagon. Diabetes mellitus is characterized by hyperglycemia due to impaired or absent insulin production and secretion. Diabetes mellitus is classified by whether or not the patient is dependent on supplemental insulin. Insulin-dependent diabetes mellitus is characterized by destruction of 90% of the insulin-producing cells. Noninsulin-dependent diabetes mellitus is characterized by impairment of insulin effectiveness and response. Diabetes mellitus is classified by the time of onset. Gestational diabetes mellitus occurs in pregnancy. Functions: The endocrine and nervous systems work together and separately to achieve the delicate physiologic balance necessary for survival termed homeostasis. A & P: Endocrine system is composed of several single and paired ductless glands that secrete hormones into the bloodstream. Pituitary gland: a tiny gland located behind the opitc nerve in the cranial cavity. Sometimes called the master gland because of its role in controlling the functions of other endocrine glands. Thyroid gland: a single organ that is divided into right and left lobes that are joined by a thin structure termed the isthmus. It is located in the anterior part of the neck and is bounded by the trachea behind it and the thyroid cartilage above it. It regulates the metabolism of the body and normal growth and development, and controls the amount of calcium deposited into the bone. Parathyroid gland: four small glands (right, left, superior and inferior) located on the posterior surface of the thyroid gland in the neck. It secretes parathyroid hormone to increase levels of calcium in the blood Adrenal glands: paired; one on top of each kidney; secretes hormones Pancreas: located inferior and posterior to the stomach, is a gland with both exocrine and endocrine functions; releases digestive enzymes; regulates level of glucose in the blood by stimulating the liver; secretes insulin that decreases the level of glucose in the blood when levels are high Thymus gland: located in the mediastinum above the heart; releases a hormone called thymosin that is responsible for stimulating key cells in the immune response.

Endocrine System Prefixes Suffixes endo- within exo- outward
hypo- under, deficient supra- above Suffixes -al pertaining to -crine to secrete -logy study of -us, -is structure

Mental Health http://www.youtube.com/watch?v=koqGEVKYU78
Psychology is the scientific study of behavior and mental processes. Psychological treatment often involves talking therapy or behavior therapy. Behavior is anything you do. Mental processes are your private, internal experiences. Psychiatry is the diagnosis and treatment of mental, emotional, and behavior disorders. Psychiatric treatment often involves medication therapy. Mental disorder is any behavioral or emotional state that causes distress to the self or is harmful to the self or others. Insanity is a legal term for severe mental illness present at the time a crime was committed, and is not used clinically in the medical field as a diagnosis.

Geriatrics Senescence of Organ Systems Theories of Senescence
Gerontology is the study of the social, mental, and physical aspects of aging. Professionals from diverse fields call themselves gerontologists. Geriatrics is the medical field that involves the study, care, and treatment of the elderly, and a medical specialist in geriatrics is called a geriatrician. It is important for the student to know the scope of each medical specialty. Geriatrics is the medical specialty that deals with the problems of old age. Gerontology is the specialty of aging. The skin becomes thinner, less elastic, wrinkly, and loses melanocytes as we age. In addition, senile lentigines (age spots) appear, and hair loss occurs. Sight and hearing decline in age. Osteoporosis, as well as joint and bone pain, occurs in old age. The rib cage expands and the elderly become “barrel-chested.” Muscle mass is replaced by fat, causing muscle atrophy and dysfunction, especially of fine motor skills. Motor coordination, intellectual functioning, and short-term memory decline in old age. Atherosclerosis causes a decline in cardiac output, and narrowed vessels increase the risk for thrombi to form. Respiratory function declines in old age, as well. There are several theories about why we age and die. Heredity plays a role because longevity or early death tends to run in families. Protein abnormalities in cells may cause them to become dysfunctional and to degenerate. Free radicals cause cancer and myocardial infarction, and they may also be responsible for senescence. The immune response may be activated by the body’s own antigens, leading to autoimmune diseases more common in old age, such as rheumatoid arthritis. This may also lead, ultimately, to senescence. The appearance of symptoms of aging depends on the remaining healthy reserves of organs as they decline with age. For example, renal impairment can be part of aging, but renal failure is not. Delirium in the elderly can be caused by something as simple as constipation. Some elderly people may have difficulty describing their symptoms, particularly if they have cognitive impairment. Many elderly patients take multiple medications, sometimes prescribed by different specialists without reference to other medications prescribed by other specialists. This polypharmacy can result in adverse drug interactions. Senescence of Organ Systems Theories of Senescence Complex Effects of Aging

Oncology (Cancer) Malignant Benign Carcinogenesis
Malignant tumors grow quickly and in an unrestrained fashion, invade adjacent tissue, invade the lymph system, and are transported to locations around the body and metastasize through the blood stream. Benign tumors grow slowly and are encapsulated and do not invade adjacent tissue, the lymph system, or the blood stream. Benign tumors can compress adjacent tissue, causing functional problems. Cancer is in the top-three causes of death in the United States. Use the figure to illustrate the possible locations of metastases from primary breast cancer. Carcinoma in situ refers to an early form of cancer in which there is no invasion of surrounding tissues. Use the table to illustrate the classes of cancer. Non-small cell lung cancer accounts for 75% of lung cancer, with a mortality rate of 80% within five years of diagnosis. Small cell lung cancer accounts for 15-25% of all lung cancers, with most patients dying within 18 months. Mesothelioma is a rare tumor of the cells of the pleura. Mesothelioma is associated with asbestos and accounts for 5% of all lung cancers. Cancer is due to an abnormal rate of cell division as a result of damaged DNA causing gene mutation. Protooncogenes are healthy genes that promote normal cell growth. Mutated oncogenes cause a malfunction in the normal growth mechanism. Tumor suppressor genes normally suppress mitosis and are activated by DNA damage. Mutated tumor suppressor genes allow the abnormal cells to divide and proliferate. Cancer is due to genetic injury and mutations. Mutagens are agents that cause mutations. Mutagens that cause cancer are called carcinogens. Students should know the similarities and differences among related or similar terms. Carcinogen is a noun meaning an agent that causes cancer. Carcinogenesis is a noun meaning the origin and development of cancer. Carcinogenic is an adjective that refers to a cancer-causing agent. More than 50% of cancers could be prevented by changes in lifestyle and environment. Stopping smoking alone would reduce the 30% of all cancer deaths caused by lung cancer. Reduction in the more than 2 billion pounds of toxic air pollutants emitted would result in cleaner air and a reduction in the incidence of cancer. Obesity is linked to 10% of breast and colorectal cancers and linked to 40% of kidney, esophageal, and endometrial cancers. Losing weight would decrease the risk, in an obese person, for these cancers. There is some proof that phytochemicals such as lycopene and flavonoids may offer protection against cancer. Cancers may be detected by a hands-on examination, called palpation, in which body parts are felt for lumps. A physician may perform examination by palpation or a patient may perform self-examination. Use the figure to illustrate breast self-examination. Observation may be used to detect changes in skin in an attempt to diagnose malignant melanoma. Blood tests such as prostate specific antigen can also be used. Sigmoidoscopy, a specific type of endoscopy, may detect colorectal cancer. Pathology studies, such as the Pap smear, can be used to detect cellular and histologic changes Mammography is x-ray of the breast, and is recommended every one to two years beginning at age 40. Digital mammography records images in computer code instead of on x-ray film. This technique assists in enhancing subtle tissue changes. Computer-aided detection involves a computer enhancement of suspicious areas. Computer-aided detection is being evaluated for effectiveness

Radiology and Nuclear Medicine
X-rays were first discovered in 1895 by Wilhelm Conrad Röntgen. These x-rays, like light and radio waves, are a form of electromagnetic radiation. Characteristics and effects of x-rays: Velocity: X-rays in a vacuum travel at the speed of light, 186,000 miles per second. Wavelength: X-rays have a very short wavelength compared to other electromagnetic waveforms. Invisibility: X-rays cannot be detected by sight, sound, or touch, so health professionals working in radiology wear a film badge to detect and record radiation to which they are exposed. Ionization: An ion is an atom or group of atoms carrying an electric charge by having gained or lost one or more electrons. A special type of photographic film is used to record x-ray pictures. The x-rays are converted into light and the more energy that passes through body tissues to reach the photographic film or plate, the darker that region of film will be. Lungs will be dark; bones that prevent the passage of energy will be white. X-rays can now also be detected electronically using a recorder similar to that used in a digital camera. This means that they can be read immediately and stored more easily. In many situations where x-ray images are taken, the x-ray tube that produces the radiation, the patient, and the photographic film, must be aligned to direct the x-ray beam to the lesion being examined in the best possible way. Terms describing the direction of the projection of x-ray beams are of importance in chest x-rays and are; Posteroanterior (PA) in which x-rays travel from a posterior source to an anterior placed image receiver. This is the most common chest x-ray view. Anteroposterior (AP) in which x-rays travel from an anterior source to a posterior placed image receiver. Lateral view. In a left lateral view, x-rays travel from a source located to the right of a patient and travel to an image recorder to the left of the patient. This is reversed in a right lateral view. Oblique view in which x-rays travel at an angle from the perpendicular plain to pass behind the heart and lung hilum to show structures normally hidden in PA and AP views. The terms anterior and posterior and other directional terms are described in Chapter 4. Interventional radiology (IR) uses minimally invasive procedures both for diagnostic purposes (e.g., angiogram) and for treatment (e.g., angioplasty). X-ray images are used for guidance and the basic instruments used are needles and catheters. Computed Tomography (CT) scans use x-rays in conjunction with computer algorithms to produce a computer-generated cross-sectional image (tomogram) in the axial plane. From these images, the computer can reconstruct coronal and sagittal images. Medical ultrasonography uses ultrasound (high-frequency sound waves) to visualize soft tissue structures in the body functioning in real time. Magnetic Resonance Imaging (MRI) uses strong magnetic fields to align atomic nuclei in tissues, then uses a radio signal to disrupt the nuclei and observes the radio frequency signal as the nuclei return to their baseline states. Teleradiology involves the transmission of radiographic digital images from one location to another for interpretation by a radiologist. It can provide real-time emergency radiology services and expert consultation round the clock.

Pharmacology There are more than 2,400 drugs that can be prescribed by licensed practitioners. Each drug has at least three names and is controlled by the Food and Drug Administration (FDA) which determines if it can be disseminated and sold. Three different drug names: The drug’s chemical name, which specifies the chemical makeup of the drug, is often long and complicated. The drug’s generic name identifies the drug legally and scientifically; there is only one generic name for each drug. The drug’s brand (trade) name is the name each manufacturer gives to the drug. These names are the manufacturer’s private property. There can be several brand names of a particular drug, depending on how many different companies are manufacturing the drug. The brand names are always capitalized (e.g., Xanax). Over-the-counter (OTC) drugs, which are also called nonprescription drugs, are used to treat conditions that do not generally require care or a prescription from a health professional. Examples of these drugs include: Analgesics, such as aspirin or acetaminophen. Antihistamines, such as Chlor Trimeton and Dramamine. Some sleeping aids, such as doxylamine and melatonin. In addition, herbal preparations, vitamins, minerals, and food supplements are available without a prescription. When a drug manufacturer receives U.S. Food and Drug Administration (FDA) approval to sell a particular drug, it is allowed to have 20 years of protected proprietary manufacture of the drug (patent) from the date of invention. After that period of time the generic name of the drug becomes public property, and any drug manufacturer can manufacture and sell the drug under that generic name. If a specific brand name of medication is ordered on a prescription by a physician and is designated “dispense as written,” no generic or other brand name may be substituted. Generic drugs are usually cheaper than brand name drugs. Certain groups of prescription drugs that are considered to have a potential for abuse are called controlled drugs. Regulation of these drugs is the responsibility of the U.S. Justice Department’s Drug Enforcement Administration (DEA). Controlled substances are divided into five schedules, depending on their currently accepted medical use in treatment, their potential for abuse, and likelihood of causing dependence. Schedule I--Controlled substances have a high potential for abuse and have no accepted medical use in treatment in the United States. Examples include heroin, marijuana, and LSD. Drugs listed in Schedule I cannot be prescribed, administered, or dispensed, but marijuana is legal for medical use in some states. Schedule II--controlled substances have a high potential for abuse. Abuse of these substances may lead to severe psychological or physical dependence. Examples include some narcotics, such as morphine, methadone, meperidine (Demerol), and oxycodone (OxyContin); stimulants, such as amphetamine, methamphetamine, and methylphenidate (Ritalin); cocaine; and barbiturates, such as pentobarbital. Schedule III-controlled substances have less potential for abuse than substances in Schedules I and II. Abuse of these substances may lead to moderate or low physical dependence or high psychological dependence. Examples include certain narcotics, including combination products with less than 15 milligrams of hydrocodone per dose (for example, Vicodin) and combination products with less than 90 milligrams of codeine per dose (for example acetaminophen [Tylenol] with codeine). Schedule IV-controlled substances have a lower potential for abuse than Schedule III drugs. An example of a Schedule IV narcotic is proxyphene (for example, Darvon and Darvocet N 100). Other Schedule IV substances include benzodiazepines (for example, alprazolam [Zanax] and diazepam [Valium]). Schedule V-controlled substances have a lower potential for abuse compared to Schedule IV substances and consist primarily of preparations containing limited quantities of certain narcotics. These are generally used for antitussive, antidiarrheal, and analgesic purposes. Examples include Robitussin AC and Phenergan with codeine. Routes of administration are usually classified according to the location on the body to which the drug is applied. Toxicology is the path by which a drug or other substance is taken into the body. The routes of administration distinguish whether a drug’s effect is local (as in topical) or systemic (as in enteral or parenteral administration). The bioavailability of a drug reveals what proportion of the drug reaches the systemic blood circulation and is available to reach the intended site(s) of action. A drug’s route of administration and its formulation (for example, tablet, capsule, or liquid) clearly influence its bioavailability. Pharmacokinetics—the absorption, distribution, metabolism, and elimination of drugs. Pharmacodynamics is a drug’s interaction at its target site(s) of action. Enteral administration is through the gastrointestinal (GI) tract. Oral is the most frequently used, convenient, and economical method of drug administration. The sublingual route and the buccal routes provide a rich supply of blood vessels through which drugs can be directly absorbed into the systemic circulation. Rectal administration in the form of suppositories or enemas is popular in some European countries, but is not easily accepted by patients in the United States. Topical administration allows a drug to be available directly at the site of action without going through the systemic circulation. The most common route of administration of medications is the self-administered oral route. Seventy-nine percent of adults older than 65 are on medications, with 39% of them taking five or more prescription drugs and 90% of them also taking OTC drugs. In a large study of women older than 65, 12% took 10 or more medications and 35% experienced an adverse effect (AE) from a drug. AEs are harmful and undesired effects secondary to the main or therapeutic effect of the medication. Research has also found that adverse drug reactions (ADRs) caused by intolerance, susceptibility, or interaction with another drug occurred in the hospitalization of some 35% of patients. In addition to hospitalization, severe ADRs can result in death or permanent impairment of physical activities and/or quality of life. Before a caregiver administers a drug (medication) to a patient by any route, five factors should be addressed by the caregiver (Figure 22.6). Right patient Identify the patient by a bracelet or name badge. Asking the patient’s name can lead to confusion, particularly in the assisted living environment. Right drug Check the medication record for the name of the drug and compare with the drug in hand at three points: When taking hold of the package that contains the drug. When opening the package. When returning the package to storage. Right route Check the medication record for how to administer the drug and check the labeling of the drug to make sure it matches the prescribed route. Right dose Check that the medication record orders the same dose as that in hand. Right time Check that the time ordered or the frequency matches the current time. Documentation of having given medication is a vital responsibility of the caregiver. Medication errors must be documented and should clearly state if it was one or more of the Five Wrongs. the wrong patient, the wrong drug, the wrong route, the wrong dose, or the wrong time. Cardiovascular Drugs Beta blockers diminish the effects of epinephrine and other stress hormones. All beta blockers are approved for the treatment of hypertension. Specific beta blockers are approved for treatment of: angina atrial arrhythmias coronary artery disease heart failure hypertension early post-traumatic stress disorder Beta blockers are also sometimes used in the prevention of migraines. There are some 20 different beta blocking agents altogether, including propanalol (Inderal), atenolol (Tenormin), metoprolol (Lopressor), piridolol (Visken), labetalol (Normodyne), and carvedilol (Coreg). Allergy Drugs Nasal corticosteroids are a safe and effective treatment for both allergic and nonallergic rhinitis in adults and children. Eight preparations are on the market in the United States, each differing in chemistry, delivery device, propellant, potency, and dosing frequency. They include beclamethasone (Qvar, Beconase), budesonide (Rhinocort), fluticasone (Flonase, Flovent), mometasone (Nasonex), triamcinalone (Azmacort), and a combination of budesonide and formoterol (Symbicort). These drugs cause few side effects in adults, but among children their use slightly increases the risk of stunted growth. Antihistamines inhibit the effects of histamine at specific cell receptors. They have a number of clinical indications including allergic conditions (for example, rhinitis, dermatoses, atopic dermatitis, contact dermatitis, allergic conjunctivitis, hypersensitivity reactions to drugs, mild transfusion reactions, and urticaria), chronic idiopathic urticaria (CIU), motion sickness, vertigo, and insomnia. ACE inhibitors inhibit, or slow, the activity of the enzyme ACE. This action decreases the formation of angiotensin II, so blood vessels dilate more and blood pressure falls. Some 10 different ACE inhibitors have been approved to control hypertension, treat heart failure, prevent strokes, and improve survival rates after heart attacks. Angiotensin-receptor blockers (ARBs) block the interaction between angiotensin and the angiotensin receptors on the muscles in the wall of blood vessels, allowing blood vessels to dilate. They are used when patients are unable to tolerate ACE inhibitors because of persistent cough or, more rarely, angioedema. Calcium-channel blockers (CCBs) inhibit the flow of calcium through channels in cardiac muscles and in the muscles in the walls of blood vessels. This leads to a decrease in muscle contraction and dilation of the blood vessels. More than 20 CCBs have been approved to treat hypertension, particularly in elderly patients, angina, arrhythmias, and Raynaud disease (see Chapter 10). A high mortality rate has been reported among people who take the drugs over an extended dosage period. Statins are a class of drugs that block the enzyme in the liver that is responsible for making cholesterol, an essential component in all cell membranes that is necessary for the production of bile acids, steroid hormones, and Vitamin D. However, the body’s production of cholesterol also contributes to the development of atherosclerosis. Seven statins are approved by the FDA for use; they vary in their potency to decrease cholesterol levels. Chronotropic drugs alter the heart rate. Epinephrine (adrenaline), norepinephrine (noradrenaline), and atropine increase the heart rate. Quinidine (Quinidex), procainamide (Pronestyl), lidocaine (Xylocaine), and propranolol (Propanalol) slow the heart. Inotropic drugs alter the contractions of the myocardium. Digitalis and its derivatives, digoxin and digitoxin, increase the strength of contractions of the myocardium, thus leading to increased cardiac output. Dermatologic Drugs Antibacterials—topical agents that eliminate the bacteria that cause epidermal infections. The antibiotic neomycin is frequently used in ointments for this purpose. Antifungals—topical agents that eliminate or inhibit the growth of fungi; terbinafine (Lamisil) is used as a cream, gel, spray, or tablet; nystatin (Mycostatin, Nilstat) is used as a cream or ointment or as oral drops for oral candidiasis. A class of drugs called imidazoles is available in many forms, including creams, sprays, lotions, and shampoos. They include clotrimazole (Canesten, Clomazol) and ketoconazole (Ketopine, Daktagold). In oral preparations, amphotericin B (Fungizone) is used to treat oral candidiasis (thrush), and in intravenous therapy, it is used for systemic fungal infections. A recent study has shown that OTC mentholated ointments, such as Vicks VapoRub, can be effective in treating toenail fungus infections. Parasiticides—topical agents that kill parasites living on the skin; hexachlorocyclohexane (Lindane 1%) is used in lotion or shampoo form to kill lice if other methods have failed. Keratolytics—topical agents that peel the skin’s stratum corneum away from the other epidermal layers. Salicylic acid is used for this purpose as a keratolytic or exfoliating agent. It is used in the treatment of acne, psoriasis, ichthyoses, and dandruff. It is available in the form of wipes, creams, lotions, gels, ointments, shampoos, and patches in strengths varying from 3% to 20%. Anesthetics—topical agents that relieve pain or itching on the skin’s surface. Benzocaine (ethyl ester of para-amino-benzoic acid) is used for this purpose as a numbing cream. It is given prior to injections, for infant teething, for oral ulcers, and for hemorrhoids. Retinoids—derivatives of retinoic acid (Vitamin A) that are used in the treatment of acne, sun spots, and psoriasis. Retinoids are powerful drugs that are only used under the strict supervision of a physician; tretinoin (Retin-A) is used topically for the treatment of acne; isoretinoin (Accutane) is taken orally for the treatment of severe acne; etrinate (Tegisan) is taken orally for the treatment of severe psoriasis, and adaptalene (Differin) is used topically for the treatment of psoriasis. Endocrine Drugs Antidiabetic drugs treat diabetes mellitus by lowering blood glucose levels. Diabetes mellitus type 1 is caused by lack of insulin and is treated predominantly by subcutaneous injections of insulin. All insulin is sold in liquid form, but in different strengths. The most common strength prescribed in the U.S. is U-100, which is 100 units of insulin per milliliter of liquid. The four synthetic types of insulin are: Rapid-acting insulin, which begins to work after 5 to 10 minutes, peaks in about an hour, and lasts for 2 to 4 hours. Examples include insulin lispro (Humalog) and insulin aspart (Novolog). Regular-acting insulin reaches the bloodstream within 30 minutes, peaks after 2 to 3 hours, and is effective for 2 to 3 hours. Examples include insulin isophane (Humulin-R and Novolin-R). Intermediate-acting insulin reaches the bloodstream after 2 to 4 hours, peaks 4 to 12 hours later, and is effective for 12 to 18 hours. Examples include insulin isophane (Humulin-N and Novolin-N). Long-acting insulin reaches the bloodstream after 6 to 10 hours and is effective for 20 to 24 hours. Examples include insulin glargine (Lantus) and insulin detemir (Levemir). Insulin pumps deliver rapid- or regular-acting insulin continuously over a 24-hour period through a subcutaneous catheter. Buttons on the pump allow an additional bolus of insulin to be given if blood sugar levels become too high. Diabetes mellitus type 2 is caused by resistance of the body’s cells to insulin. Several types of drugs, mostly given orally, can be effective in its treatment. They are often given in combination. Biguanides increase the uptake of glucose by body cells; metformin (Glucophage) is a first-line medication for type 2; it can be used in combination with other oral diabetic medications, particularly rosiglitazone (see below). It is the most widely prescribed antidiabetic drug in the world: In the United States in 2010, more than 48 million prescriptions were written for its generic formulations. Thiazolidinediones, also known as glitazones, enhance use of glucose by the body’s cells. The two which have FDA approval are rosiglitazone (Avandia) and pioglitazone (Actos); however, rosiglitazone is currently being evaluated for potential adverse cardiac effects. Sulfonylureas stimulate insulin release from the pancreatic beta cells. Only effective in the treatment of type 2 diabetes, they can be used in combination with metformin or thiazolidinediones. First-generation agents included tolbutamide (Orinase) and chlorpropamide (Diabinese). More effective second-generation agents include glipizide (Glucotrol) and glyburide (Micronase). Exenatide (Byetta) is the first injectable, or subcutaneous, drug approved for type 2 diabetes. It is injected subcutaneously 60 minutes before the first and last meals of the day. It stimulates insulin production from the pancreatic beta cells. Three new oral drugs which stimulate insulin production have been approved for type 2 diabetes: sitagliptin (Januvia, approved 2006), saxagliptin (Onglyza, 2009), and linagliptin (Tradjenta, 2011). These drugs are often used in combination with metformin. Hormones HRT uses estrogen and progestin to treat symptoms of menopause. The hormone therapy comes as a tablet, patch, injection, vaginal cream, or vaginal ring. HRT protects against osteoporosis and reduces the risk for uterine cancer, but it may increase the risk for blood clots, breast cancer, heart disease, stroke, and gallstones. At this time, short-term (up to 5 years) use of HRT given in the lowest possible dose to treat the symptoms of menopause appears to be safe for many women. Estrogen makes hormone-receptor-positive breast cancers grow. HT medications treat hormone-receptor-positive breast cancers by lowering the amount of estrogen in the body and/or blocking the action of estrogen on breast cancer cells. They are used after surgery to help slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers. There are three main types of HT agents: Aromatase inhibitors (AIs), which stop the production of estrogen from androgen in post-menopausal women. These medications are anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). Each is given in a pill form taken once a day. Anastrozole and letrozole are available in generic form. Selective estrogen receptor modulators (SERMs), which block estrogen in the estrogen receptors of breast cells so that the cells can’t grow and multiply. The SERMs are tamoxifen (Nolvadex), raloxifene (Evista), and toremifene (Fareston). Estrogen-receptor downregulators (ERDs) act just like SERMs, sitting in the receptors of breast cells to block estrogen; fulvestrant (Faslodex) is the only approved ERD at this time. Thyroid Drgus Thyroid hormone replacement is used to treat hypothyroidism and to suppress further growth of thyroid tissue in people with thyroid cancer. Levothyroxine (Levoxyl, Synthroid, Unithroid), which is identical to the thyroid hormone T4, is the most commonly prescribed form of thyroid replacement. It is taken orally once a day. Anti-thyroid drugs treat an overactive thyroid gland (hyperthyroidism) by decreasing its output of thyroid hormone; propylthiouracil (PTU) blocks the production of thyroid hormone inside the gland; methimazole (Tapazole) acts the same as PTU. Both drugs may take 1 to 4 months to normalize thyroid levels. Beta-blockers can help block the body’s cells reaction to excess thyroid hormone, and iodide solutions (Lugol’s solution) can prevent the release of thyroid hormone from an overactive thyroid gland. Radioactive iodine (131-iodine, I-131), a radioactive isotope, is used to kill both normal and cancerous thyroid cells in hyperthyroidism and thyroid cancer. Gastrointestinal Drugs Antacids, which are taken orally, neutralize gastric acid and relieve heartburn and acid indigestion. Examples of antacids include: aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta) magnesium hydroxide (Milk of Magnesia) calcium carbonate (Tums, Rolaids) Histamine-2 receptor antagonists (H2-blockers) block signals that tell the stomach cells to produce acid. They are used to treat gastroesophageal reflux (GERD) and esophagitis. Examples include: cimetidine (Tagamet) famotidine (Pepcid) ranitidine (Zantac) nizatidine (Axid) Less potent OTC variants of these drugs are also available. Proton pump inhibitors (PPIs) suppress gastric acid secretion in the lining of the stomach by blocking the secretion of gastric acid from the cells into the lumen of the stomach. Examples include: omeprazole (Prilosec) lansoprazole (Prevacid) esomeprazole (Nexium) A new form of PPI called imidazopyridine (Tentoprazole) appears to be extremely effective in reducing gastric acid. Misoprostol (Cytotec) inhibits the secretion of gastric acid and is approved for the prevention of NSAID-drug-induced gastric acid. Sucralfate (Carafate) reacts with gastric acid (HCL) to form a paste that binds to stomach mucosal cells and inhibits the diffusion of acid into the stomach lumen. It also forms a protective barrier on the surface of an ulcer. Its main use is in the prophylaxis of stress ulcers. Anti–H. pylori therapy (see Chapter 5) for the treatment of peptic ulcer and chronic gastritis is given with a combination of two antibiotics (for example, amoxicillin (generic) and clarithromycin (generic) and a proton pump inhibitor. Antiemetics, drugs that are effective against vomiting and nausea, are used to treat motion sickness and the side effects of opioid analgesics, general anesthetics, and chemotherapy. The types of antiemetics include: Serotonin antagonists, which block serotonin receptors in the CNS and GI tract. They are used to treat postoperative and chemotherapy nausea and vomiting. Examples include dolasetron (Anzemet), granisetron (Kytril), and ondansetron (Zofran). Dopamine antagonists, which act in the brain. They are inexpensive, but have an extensive side effect profile and have been replaced by serotonin antagonists. Examples include chlorpromazine (Thorazine), and prochlorperazine (Compazine). Antihistamines, which are used to treat motion sickness, morning sickness in pregnancy, and opioid nausea. Examples include diphenhydramine (Benadryl) and promethazine (Phenergan). Cannabinoids, which are used in patients with cachexia or who are unresponsive to other antiemetics. Examples include cannabis (medical marijuana) and dronabinol (Marinol). Laxative drugs are used to treat chronic constipation: If increased water and fiber is unsuccessful, OTC forms of magnesium hydroxide are the first-line agents to be used. Lubiprostone (Resolor) has received FDA approval; it acts on the epithelial cells of the GI tract to produce a chloride-rich fluid that softens the stool and increases bowel motility. Antidiarrheal drugs are widely available OTC. Examples include loperamide (Imodium A-D, Maalox), which reduces bowel motility; bismuth subsalicylate (Pepto-Bismol), which decreases the secretion of fluid into the intestine; and attapulgite (Kaopectate), which pulls diarrhea causing substances away from the GI tract, as well as enzymes and nutrients. A combination of diphenyloxylate and atropine (Lomotil), a Schedule V drug, reduces bowel motility. Musculoskeletal Drugs Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit enzymes that are involved in the inflammatory process. They have analgesic and antipyretic effects and are used for treatment of tissue injury, pyrexia, rheumatoid arthritis, osteoarthritis, gout, and nonspecific joint and tissue pains. The three major NSAIDs, each of which is available OTC, are: Acetylsalicylic acid (aspirin), which in addition to the above effects and uses also has an antiplatelet effect due to its inhibition of one of the COX enzymes; thus, it is often used in the prevention of heart attacks. Ibuprofen (Advil, Motrin, and several other trade names), which acts by inhibiting both the COX enzymes, essential elements in the enzyme pathways involved in pain, inflammation, and fever. It is taken orally, but in 2009 an injectable form of ibuprofen (Caldolor) was approved for use. In some studies, ibuprofen has been associated with the prevention of Alzheimer and Parkinson diseases, but further studies are needed. Naproxen (Aleve and many other trade names), which is taken orally once a day and also inhibits both the COX enzymes. Indomethacin, an NSAID that inhibits both COX enzymes, is a potent drug with many serious side effects. It is not used as an analgesic for minor aches and pains or for fever. Paracetamol (acetaminophen), an active metabolite of phenacetin (not an NSAID), is a widely used OTC analgesic and antipyretic. It is used for the relief of minor aches and pains and is an ingredient in many cold and flu remedies. Skeletal muscle relaxants are FDA approved for spasticity (baclofen, dantrolene, tizanidine) or for musculoskeletal conditions like multiple sclerosis (carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, orphenadrine). The only drug with available evidence of efficacy in spasticity is tizanidine (Zanaflex, Sirdalud), but cyclobenzaprine (Amrix) appears to be somewhat effective. Neurological Drugs Drugs that affect the nervous system, include: Opioids depress nerve transmission in the synapses of sensory pathways of the brain and spinal cord. They also bind to opioid receptors found principally in the central and peripheral nervous systems and the GI tract. There are a number of broad classes of opioids: Natural opiates are alkaloids contained in the resin of the opium poppy—primarily morphine and codeine. Semi-synthetic opioids, which are created from the natural opiates, include heroin, hydromorphone (Dilaudid), hydrocodone (Vicodin), oxycodone (Dinarkon), and buprenorphine (Subitex). Fully synthetic opioids include fentanyl (Sublimage), pethidine (Demerol), and methadone (Symoron). Natural opioid peptides are produced naturally in the body; they include endorphins, enkephalins, and endomorphins. Indications for opioids are moderate to severe pain, cough, severe diarrhea, anxiety due to shortness of breath (SOB), and opioid dependence (in which case methadone and buprenorphine are used). Opiates are addictive because they produce tolerance and physical dependence. Opiate antagonists, such as naloxone (Narcan) and naltrexone (Repia, Depade), prevent opiates from acting in the synapses. They can be used in cases of drug overdose and to help recovering heroin addicts stay drug-free. Analgesics are drugs used to relieve pain. The major classes are: NSAIDs and Paracetamol (acetaminophen) (see the previous spread on musculoskeletal drugs). Opiates (see above). Combinations of the two previous classes. Examples of these prescription drugs include acetaminophen with hydrocodone (Anexsia) and acetaminophen with oxycodone (Percocet). Triptans are effective serotonin receptor agonists in the treatment of migraines and cluster headaches (see Chapter 9) that do not respond to NSAIDs. They do not provide preventative treatment and are not a cure. Some 17 brand names of triptans are available. Inhaled anesthetics, such as isoflurane, act similarly to but are more powerful than sedatives, but they are being replaced by IV agents such as propofanol (Diprivan). Antiepileptic act in different ways on the synaptic junctions to keep stimuli from passing across the synapse; phenobarbitol, phenytoin (Dilantin), and carbamazepine (Calepsin) are examples. Alzheimer drugs cannot reverse the disease process nor stop the underlying destruction of nerve cells; only two types of drugs are FDA approved: Cholinesterase inhibitors boost the amount of acetylcholine available at synapses. Three cholinesterase inhibitors are available: Donepezil (Aricept) is approved for all stages of Alzheimer disease. Galantamine (Razadyne) is approved for mild to moderate Alzheimer disease. Rivastigmine (Exelon) is approved for mild to moderate Alzheimer disease. Memantine (Namenda), which regulates a different messenger chemical at the synapses, is approved for moderate to severe Alzheimer disease. All of these drugs are only modestly effective in reducing the rate of cognitive decline. Multiple sclerosis (MS) drugs used to treat remissions are restricted to corticosteroids, which reduce the inflammation that occurs during a relapse. Drugs that attempt to modify the course of the disease include beta interferons (Avonex, Betaseron, Extavia, Rebif), glatiramer (Copaxone), fingolimod (Gilenya), and natalizumab (Tysabrin). Of the four, beta interferons are used most frequently. Psychiatric Drugs Antidepressants all increase the amount of serotonin at the synapses where serotonin is a neurotransmitter (see Chapter 9). Sertraline HCL (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac) are examples. Stimulants, such as caffeine, nicotine, amphetamines (Dexedrine, Adderall, Ritalin), and cocaine, enhance stimulation provided by the sympathetic nervous system. They cause the level of dopamine to rise in the synapses, leading to the pleasurable effects associated with these drugs. Sedatives, such as barbiturates and benzodiazepines, decrease the sensitivity of the postsynaptic neurons and quiet nervous excitement. They also act on the sleep centers to induce sleep and treat insomnia. Newer sedative hypnotics, such as zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), act on gamma-aminobutyric acid receptors. Ramelton (Rozerem) is a selective melatonin receptor agonist. Tranquilizers, such as chlorpromazine (Thorazine), haloperidol (Aloperidin), and the benzodiazepines (Librium, Valium, Xanax), calm like sedatives but without including a sleep-inducing effect. Mood stabilizers, which focus on diminishing manic episodes, include lithium carbonate (Carbolith) and carbamazepine (Tegretol). Antipsychotics are used to treat symptoms of psychosis, including schizophrenia. Chlorpromazine (Thorazine), haloperidol (Haldol), and trifluoperazine (Stelazine) are examples. Psychedelics distort sensory perceptions—particularly sight and sound. They can be natural plant products, such as mescaline, psilocybin, and dimethyltryptamine, or they can be synthetic, such as lysergic acid diethylamide (LSD), methylenedioxymethamphetamine (MDMA or “ecstasy”), and phencyclidine (PCP or “angel dust”). They increase the amount of serotonin in the synaptic junctions, and some deliver additional amphetamine stimulation. Marijuana has the active ingredient tetrahydrocannabinol (THC). It produces sedative-like drowsiness, like alcohol; dulls pain, like opiates; and, in high doses, distorts perception, like psychedelics. Unlike opiates or sedatives, tolerance does not occur. Immunosuppressive Drugs Immunosuppressive drugs are agents that inhibit or prevent activity of the immune system. They are used to: Prevent the rejection of transplanted organs and tissues. Treat autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis (MS), systemic lupus erythematosus (SLE), or ulcerative colitis. Attempt to control nonimmune diseases, such as long-term asthma. They are classified into four groups: Glucocorticoids influence all types of immunological and inflammatory responses, no matter what their cause. Examples include hydrocortisone and prednisone. Cytostatics inhibit cell division. Examples include cyclophosphamide (Cytoxan), which os probably the most potent immunosuppressive agent; methotrexate (Amethopterin); azathioprine (generic); cyclosporine (CyclosporinA); mechlorethamine (nitrogen mustard); and the antibiotic dactinomycin (Actinomyci-D), which is used in kidney transplants. Antibodies are used as early immunosuppressive therapy to prevent acute rejection of transplants. Monoclonal antibodies are directed toward specific antigens and are used to prevent the rejection of transplanted organs. Examples include bevacizumab and panitumumab for cancer, infliximab and adalimamab for autoimmune diseases such as rheumatoid arthritis, and basilxumab and daclizamab for preventing the rejection of kidney transplants. Targeted immune modulators are a new category of drugs used for such diseases as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Evidence of their effectiveness is evolving, but not yet conclusive. Chemotherapy Drugs Chemotherapy is the treatment of cancer with antineoplastic drugs, which kill the rapidly dividing cancer cells. Unfortunately, this means that chemotherapy also harms normal cells that divide rapidly, such as those in the bone marrow, digestive tract, and hair follicles. As a result, chemotherapy commonly has side effects, such as decreased production of blood cells, nausea and vomiting, and alopecia (hair loss). Chemotherapy is often combined with other treatments, such as surgery and radiation (see Chapter21). The types of chemotherapeutic agents include alkaloids, such as vincristine (Oncovin) and vinblastine; DNA modifiers, such as cyclophosphamide (Cytoxan) and chlorambucil (Leukeran); and cytotoxic antibiotics, such as actinomycin (generic). Respiratory Drugs Bronchodilators relax the smooth muscles of the bronchioles—bronchodilation. Examples are theophylline and aminophylline (theophylline + ethylene diamine), taken orally but used rarely these days, beta2-agonists, such as albuterol (Proventil), metaproterenol (Alupent), formoterol (Foradil), and salmaterol (Serevent), which are inhaled, and anticholinergics, such as ipratropium (Atravent), which is inhaled, and tiotropium (Spiriva), which is taken orally. Newer groups of bronchodilators are leukotriene inhibitors, montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo), which are taken orally, and mast cell stabilizers, cromolyn sodium (Intal) and nedocromil (Tilade), which are inhaled. Anti-inflammatory drugs, such as corticosteroids, are given by inhalation (for example, beclamethasone [Vancerl, Beclovent], budenoside [Pulmicort], fluticasone [Flovent], and triamcinolone [Azmacort]). They can also be used orally or intravenously in acute episodes of asthma or COPD. Combinations of drugs are frequently used (for example, beta2-agonist + anticholinergic, albuterol + ipratropium [Combivent], and inhaled corticosteroid + beta2-agonist budesonide + formoterol [Symbicort], and fluticasone + salmeterol [Advair]). An oral leukotriene inhibitor is often taken in association with an inhaled corticosteroid to reduce the dose of corticosteroid. Mucolytics are agents that break up mucus to allow it to be cleared more effectively from the airways. Examples are guaifenesin (common in over-the-counter cough medications), and N-acetylcysteine (Mucomyst), taken through a nebulizer. Antibiotics are used when a bacterial infection is present in COPD. Penicillin, erythromycin, cefotaxime (Claforan), and flucloxacillin (Floxapen) are frequently used. Oxygen is used in hypoxia and can be given by nasal cannula or by mask and intubation. Patients with severe, chronic COPD can be attached to a portable cylinder of oxygen.

MED 103: Medical Terminology

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