1 Flashcards
What are the 4 behavior changes in addiction
Pre-contemplative
Contemplative
Active
Relapse
Contemplative vs Active
Contemplative: Currently interested in changing behavior.
Active: Currently making a behavior change.
Medications for smoking cessation
bupropion (Wellbutrin, Zyban, Budeprion)
varenicline (Chantix)
nicotine replacement therapy
Varenicline/Chantix info
Mechanism: Nicotine receptor blocker.
Use: Started a week before the quit date, titrated up, and maintained for two to three months. Should NOT be used with nicotine replacement.
Adverse effects: nausea (30% to 40%), take with food
Bupropion info
Mechanism: Norepinephrine and dopamine reuptake inhibitor.
Use: It is started a week before the quit smoking date. The dose is titrated up and maintained for two to three months. It may be used in conjunction with nicotine-replacement methods, especially those that can be titrated during the day.
Adverse effects: Bupropion has been associated with an increase in suicide in adolescents and young adults.
Contraindications: It should not be used in patients with seizures and with caution in those with significant renal or hepatic impairment.
changes associated with dyslipidemia
corneal arcus, xanthelasmas, acanthosis nigricans
Patients between born between 1945 and 1965 should be screened for what?
HCV
Eisleen is 48 and has smoked 2 packs of cigarettes for the past 20 years. Should she be screened for lung cancer? And if so, when?
YES, because she has smoked =/> 30 pack years and currently smokes.
Start annual chest CT once she is 55.
What screening options are there for colonoscopies
fecal occult blood testing sigmoidoscopy colonoscopy Fecal Immunochemical Testing (FIT Test) Fecal DNA Testing CT Colography
When to check fasting lipids?
All over 21 every 4 to 6 years
What lab to order to screen for chronic kidney disease?
CMP
When to get an exercise stress test?
Asymptomatic male patients > 45 with one or more risk factors (hypercholesterolemia, hypertension, smoking, or family history of premature coronary artery disease)
What ECG changes suggest CAD?
Horizontal ST segment depression or downsloping
Convex ST segment elevation
Q waves that are > 25% of succeeding R wave and greater than 0.04 seconds
benzo receptor agonists used in insomnia
zolpidem (ambien)
eszopiclone (lunesta)
When assessing the elderly for depression, what other disease may you want to screen for?
dementia
What are 2 dementia screening tools?
Minicog and MMSE
Name the 6 main SSRIs
Citalopram (Celexa) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) Escitalopram (Lexapro)
Name the 4 main TCAs
Nortriptyline (Pamelor)
Amitriptyline
Clomipramine (Anafranil)
Doxepin (Sinequan)
Anti-depressant discontinuation syndrome symptoms
flu-like symptoms insomnia nausea imbalance sensory disturbances hyperarousal
What conditions can cause palpitations?
Cardiovascular: Arrhythmia, cardiomyopathy, hypovolemia
Psychiatric: Anxiety, panic attacks
Medications: Caffeine, stimulants, theophylline, albuterol
Substances: Tobacco, caffeine, alcohol intoxication or withdrawal, cocaine
Endocrinologic: Hyperthyroidism, pheochromocytoma, hypoglycemia
Hematologic: Anemia
Infectious: Febrile illness
Which medications can induce thyroiditis?
amiodarone, interferon-alpha, interleukin-2, or lithium
What symptoms does propranolol address in hyperthyroidism?
adrenergic - heat intolerance, palpitations, tremor
What is a rare but serious side-effect of methimazole?
agranulocystosis
What are two absolute contraindications to radioactive treatment of thyroid disease?
Pregnancy and breastfeeding
Symptoms associated with hypothryoidism
Weight gain Cold intolerance Pedal edema Heavy periods Fatigue
What symptom is common to both hypo and hyperthyroidism?
fatigue
types of diabetic neuropathy
sensory (think feet) and autonomic (gastroparesis, sexual dysfunction)
HHS
Not a metabolic acidosis
No or very little ketones
Plasma glucose can be > 600
Can have high mortality rate with older pops and higher plasma glucose
what is the strongest risk factor for delayed ulcer healing and food amputation in diabetes?
peripheral vascular diseases with decreased blood supply to extremities
A patient comes in for routine visit. She has been on metformin for one year. What lab may you want to draw to screen for drug side effect?
Vitamin B 12
What labs to order in a diabetes follow-up in someone not experiencing acute symptoms of hypo or hyperglycemia
A1C Serum Creatinine and calculated GFR TSH Lipid Panel Vitamin B12 Spot urine albumin/creatinine ratio
How can hypertension affect the heart?
Left ventricular hypertrophy, angina or myocardial infarction, heart failure.
secondary causes of hypertension
Obstructive sleep apnea Primary aldosteronism Renovascular disease Renal parenchymal disease Drug or alcohol induced (including NSAIDS, sympathomimetics, cocaine, etc.) Pheochromocytoma Coarctation of the aorta Thyroid or parathyroid disease Cushing's syndrome Primary hyperparathyroidism
Which electrolyte abnormalities may thiazide diuretics cause?
hyponatremia and hypokalemia
In a patient with a history of gout, which HTN med may cause problems?
thiazides, can precipitate flares
What is the ceiling dose of benefit from hydrochlorothiazide?
25mg
A patient is newly diagnosed with hypertension. What labs should be run?
TSH Fasting lipid panel CMP UA ECG Urine albumin/creatinine ratio
Why not use both ACEi and ARB for hypertension management?
Risk of hyperkalemia and damage to kidneys
What is Homans sign?
Used in diagnosis of DVT - pain with passive dorsiflexion of foot
What easy test can be done to diagnose peripheral vascular disease?
Ankle-Brachial Index, take BP of each; An ABI of <0.9 is consistent with the disease
What is the use of d-dimer in DVT diagnosis?
D-dimer can help rule it out because it has high sensitivity, but specificity is poor. So + result doesn’t tell you much.
What criteria can help determine likelihood of DVT?
Wells Criteria. Takes into consideration smoking, immobility, cancer, etc.
What lab findings can you look at quickly to determine renal function
BUN and creatinine
3 options for DVT tx
1) Monotherapy Xa inhibitors (rivaroxaban and apixaban)
2) Dabigatran + LMWH bridge
3) Warfarin + LMWH bridge
How long is LMWH bridge?
5-10 days
LMWH vs unfractionated?
LMWH:
1) longer half-life so less frequent dosing
2) no lab monitoring required
3) thrombocytopenia less likely
4) dosing is fixed
5) can be used in outpatient setting
6) bleeding complications less common
How does initiation of warfarin work?
Monitor warfarin dose by measuring the INR and titrate the warfarin dose every three to seven days to an INR of 2.0-3.0
What are downsides of Xa inhibitors?
Expensive and difficult to reverse anticoagulation in setting of bleed
NAme a direct thrombin inhibitor
Dabigatraban
How can dabigatraban anticoagulation be reversed?
reversal agent (idarucizumab)
how long to anticoagulate after unprovoked thromboembolic event?
3 months
When would you screen someone for thrombophilia in event of DVT?
1) Initial thrombosis occurring prior to age 50 without an immediately identified risk factor (e.g., idiopathic or unprovoked venous thrombosis).
2) family history of venous thromboembolism.
3) Recurrent venous thrombosis.
4) Thrombosis occurring in unusual vascular beds such as portal, hepatic, mesenteric, or cerebral veins.
Causes of palpitations
Hyperthyroidism Valvular heart disease Coronary artery disease Anemia Drugs Anxiety/panic disorder Vasomotor symptoms of menopause
When and why take aspirin for preventative measures?
WHY: For prevention of CVD and colorectal cancer (CRC) WHO: 50-59 years who have a 10 percent or greater 10-year CVD risk; are not at increased risk for bleeding; have a life expectancy of at least 10 years; and are willing to take low-dose aspirin daily for at least 10 years.
What are the 3 most common causes of back pain?
Age-related degenerative joint changes
Herniated disc
Lumbar strain/sprain
A patient presents with back pain. What questions to ask to rule out red flags?
Fever Unexplained weight loss Pain at night Bowel or bladder incontinence Neurologic symptoms Saddle anesthesia
Difficulty with toe walk is associated with ______
S1 disc herniation
