4/4 micro/rapidreview Flashcards
Direction dilation of arteries & inhibition of platelet aggregation: which drugs?
cilostazol & dipyridamole.
-PDE3 inhibitors: inc. cAMP in platelets + also vasodilate.
cilostazol
- mech:
- use?
PDE 3 inhibitors.
- inc cAMP in platelets = prevents aggregation.
- arterial vasodilator.
argatroban
- mech:
- use?
direct thrombin inhibitor
- Derivative of hirudin (used by leeches).
- used instead of heparin in pts w/HIT.
*same as bivalirudin.
cardinal ligament
- aka?
- contains which vessels?
transverse cervical ligament
-contains uterine vessels.
musculocutaneous nerve
-provides sensory info to which region?
lateral forearm.
Forceful injury involving separation of neck and shoulder
-which nerve is in trouble?
musculocutaneous
medial forearm sensory inn?
ulnar n.
heard best over cardiac apex and radiates to axilla
-which murmur
mitral regurg
Why do pts w/Crohns disease get gallstones?
dec bile acid resorption leads to too much cholesterol in your bile.
- get cholesterol gallstones.
- dont confuse kidney stones w/gallstones.
binge alcohol drinking can precipitate which murmur?
-what will EKG show?
afib.
* pericarditis & inc. sym tone can also precipitate it.
- no discrete P waves.
varenicline
-mech:
partial agonist at nicotinic receptor.
MEN 1
-mnemonic:
3 Ps
-pituitary, parathyroid, pancreas.
MEN 2A
-mnemonic:
PPM
- parathyroid, pheochromocytoma, medullary thyroid carcinoma.
- remember, that has the one that seems to be contradictory - bc medullary thyroid carcinoma releases calcitonin & parathyroids release PTH.
- opposite hormones.
MEN 2B
-mnemonic:
MMP
- medullary thyroid carcinoma.
- marfanoid habitus
- pheochromocytoma
- neuromas
Normal pressures:
-RV:
max = 25 min = 4
Normal pressures
-RA:
max = 8 min = 0
Normal perssures
-Pulm art:
max = 25 min = 9
which area has higher diastolic/minimum pressure?
RV or pulm art?
Pulm. art.
Normal pressure
-LA:
max = 12 min = 2
RA vs LA
-which ones normal minimum pressure can drop to 0?
RA.
cystine kidney stones
-precipitate at which pH?
acidic
Opening snap heard in which murmur?
mitral stenosis
Chloroquine
-mech
-Blocks detoxification of heme into hemozoin. Heme accumulates and is toxic to plasmodia.
Chloroquine
- which malarial organism is it not effective against?
- why?
P. falciparum.
-Resistance due to membrane pump that dec. intracellular concentration of drug.
How do you treat P. falciparum?
Artemether/lumefantrine or atovaquone/proguanil.
For life-threatening malaria, :use
quinidine in U.S. (quinine elsewhere) or artesunate.
Chloroquine
-tox:
-Retinopathy; pruritus (especially in dark-skinned individuals).
Zanamivir, oseltamivir
- mech:
- use:
- Inhibit influenza neuraminidase => dec. the release of progeny virus.
- Treatment and prevention of both influenza A and B.
Zanamivir, oseltamivir
-mnemonic:
zaNAmivir & oselNAmivir = NA inhibitors.
Ribavirin
-mech:
-inhibiting IMP DH which converts IMP => GMP.
mycophenolate
-mech:
Inhibit IMP DH.
-blocks IMP => GMP.
Ribavirin
-use:
RSV, chronic hepatitis C.
Ribavirin
-tox:
Hemolytic anemia. Severe teratogen.
- depletes intracellular ATP => causes non-immune mediated extravascular hemolysis.
- no ATP = rigid RBC = cant make it thru spleen w/o being phagocytosed = extravascular hemolysis.
- Kind of like same mechanism as pyruvate kinase deficiency.
chronic hep C
-Tx:
alpha-interferon & ribavirin.
Valacyclovir
-what is it?
Valacyclovir converted to acyclovir by first past metabolism in small intestine & liver.
Acyclovir
-how is it activated?
Monophosphorylated by HSV/VZV thymidine kinase.
- not phosphorylated in uninfected cells = few adverse effects.
Acyclovir
-mech:
-guanosine analog.
-lack the 3’ -OH, so once they are incorporated
into DNA, they are chain terminators.
*guanosine = nucleoside = no phosphates on it.
Acyclovir
-use:
- HSV and VZV. Weak activity against EBV.
* NO effect on latent forms!
Herpes Zoster
-Tx:
Famciclovir
Acyclovir
- tox:
- usually seen in which scenario?
Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated.
*usually seen in HSV-1 encephalitis in hospitalized pt receiving IV acyclovir.
Acyclovir
-mech of resistance?
Mutated viral thymidine kinase.
Ganciclovir
-how is it activated?
CMV viral kinase.
Ganciclovir
-mech:
guanosine analog.
-Preferentially inhibits viral DNA polymerase via chain termination, like acyclovir.
Ganciclovir
-which form has best oral bioavailability?
valGANciclovir
Ganciclovir
-tox:
Leukopenia, neutropenia, thrombocytopenia, renal toxicity.
*watch out when giving w/other meds that cause BMS like zidovudine.
Foscarnet
-mech:
- Viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme.
- Does not require activation by viral kinase.
Foscarnet
-use:
- CMV retinitis in immunocompromised patients when ganciclovir fails
- acyclovir-resistant HSV.
- usually these will be AIDS pts.
Foscarnet
-tox:
- Nephrotoxicity, seizures.
- can chelate calcium
- induces renal wasting of magnesium => hypomagnesemia.
- reduction of PTH release => hypocalcemia.
- both hypomagnesemia & hypocalcemia can => seizures.
Foscarnet
-dont use w/pentamidine. Why?
- Watch drug interaction w/pentamidine (treat pneumocystis jiroveci in HIV pts) which is also nephrotoxic.
- You can get life threatening hypocalcemia when these two drugs are combined.
Cidofovir
-mech:
Preferentially inhibits viral DNA polymerase. Does not require phosphorylation by viral kinase.
*kind of like foscarnet.
Cidofovir
-mech:
CMV retinitis in immunocompromised patients; acyclovir-resistant HSV. Long half-life.
Cidofovir
- tox:
- how to dampen toxicity?
Nephrotoxicity (coadminister with probenecid and IV saline to dec. toxicity).
HAART therapy
-includes what?
2 NRTIs + (1 NNRTI or 1 protease inhib or 1 integrade inhib).
Protease inhibitors
- suffix?
- mnemonic:
- navir.
- Navir (never) tease a protease.
Which protease inhibitor inhibits P450 system?
ritonavir
Protease inhibitors
- tox:
- mnemonic:
- Hyperglycemia, GI intolerance (nausea, diarrhea), lipodystrophy.
- Nephropathy, hematuria (indinavir).
- side effects look like Cushing syndrome.
-chicks w/hyperglycemia & central weight NAVIR getting
into the club. Even though they have to diarrhea/pee so bad they have hematuria.
NRTIs
- which is the only nucleotide in the group?
- mnemonic?
tenofovir
-perfect 10 (ten), doesn’t need anything else (no phosphorylation required).
How do you reverse the BMS of NRTIs?
Can be reversed with granulocyte colony-stimulating factor [G-CSF] and erythropoietin.
NRTIs
-tox:
- BMS (give G-CSF & EPO to reverse)
- peripheral neuropathy
- lactic acidosis (nucleosides)
- rash (non-nucleosides)
- anemia (ZDV)
- pancreatitis (didanosine).
Which NRTI causes anemia?
zidovudine (ZDV) (AZT)
Which NRTI causes pancreatitis?
didanosine
-dan died by commiting a “sin” and drinking so much he got pancreatitis.
Tenofovir
-what is it?
NRTI
*nucleotide
Emtricitabine
-what is it?
NRTI
Didanosine
-what is it?
NRTI
*pancreatitis
Abacavir
-what is it?
NRTI
NNRTIs
- name them:
- mnemonic:
Efavirenz
Nevirapine
Delavirdine
“HIV doesnt have to be the END w/NNRTIs.”
NNRTIs
-tox:
- Rash and hepatotoxicity
- Vivid dreams and CNS symptoms w/efavirenz.
- Delavirdine and efavirenz are C/I in pregnancy.
Which NNRTI can cause vivid dreams?
efavirenz
Which NNRTI is used in pregnancy?
Nevirapine
- single dose at time of devliery will decrease changes of mother passing HIV to baby (vertical transmission) by 50%
- its also an inducer of P450
- ZDV also given to mothers for prophylaxis of vertical transmission.
Raltegravir
- what is it?
- menmonic?
Integrase inhibitor
-ralTEGRAvir = inTEGRAse inhibitor.
Raltegravir
-tox:
Hypercholesterolemia.
Fusion inhibitors
-name them:
Enfuvirtide
Maraviroc
Enfuvirtide
- what is it?
- mnemonic:
enFUviritide = FUsion inhibitor.
Enfuvirtide
- mech:
- tox:
- Binds gp41, inhibiting viral entry. *fusion inhibitor.
- Skin reaction at injection sites.
Maraviroc
-mech:
Binds CCR-5 on surface of T cells/monocytes,
inhibiting interaction with gp120.
*fusion inhibitor.
IFN-α
-use:
- chronic hepatitis B and C
- Kaposi sarcoma
- hairy cell leukemia
- condyloma acuminatum (HPV).
- renal cell carcinoma
- malignant melanoma.
IFN-β
-use:
multiple sclerosis
IFN-γ
-use:
chronic granulomatous disease
Interferons
-side effects:
Neutropenia, myopathy, depression.
What can sulfonamides cause in pregnancy?
kernicterus
What can aminoglycosides cause in pregnancy?
ototoxicity
ABxs to avoid in pregnancy:
-mnemonic?
SAFe Children Take Really Good Care.
- Sulfonamides: Kernicterus
- Aminoglycosides: Ototoxicity
- Fluoroquinolones: Cartilage damage
- Clarithromycin: Embryotoxic
- Tetracyclines: Discolored teeth, inhibition of bone growth
- Ribavirin (antiviral): Teratogenic
- Griseofulvin (antifungal): Teratogenic
- Chloramphenicol: “Gray baby”
Two non-obvious cancers associated w/smoking?
Cervical & pancreatic.
Piecemeal necrosis is characteristic of:
Chronic active HBV or HCV infection.
Does HCV IgG confer immunity?
No!
Viral hepatitis -> hepatocyte apoptosis predominately in which zone?
Predominantly zone 1.
Most common cause of viral myocarditis in the USA:
Coxsackie B
-Others include: T. Cruzi, B. Burgdorferi, & diptheria.
Only protozoa that can phagocytose RBC:
entamoeba histolytica
What are some things that gut bacteria will eat up?
bile salts
B12
Which tissues are resistant to invasion by cancer?
cartilage & elastic tissue.
Diuretics: make you lose what type of solution?
hypertonic salt solution.
*hypertonic relative to plasma conc.
Sweat: what type of solution?
hypotonic salt solution
- hypotonic relative to plasma.
- gatorade & pedialyte = hypotonic salt solution.
How does fiber dec. chance of colorectal cancer?
Sequesters lithocolic acid away from intestines & into the toilet bowl.
screen test for anything in the pancreas:
CT
Which lysosomal storage disorders present w/cherry-red macula?
-mnemonic?
Tay-Sachs or Niemann-Pick.
-cherry-red macula = hyphenated term, so are tay-sachs & neimann-pick.
Neimann Pick
- mnemonic:
- whats the letter?
- “I”
- nIemann-pick: sphIngomyelinase: sphIngomyelin: bIg organs: lIpid-laden macro.
- also cherry red macula.
Tay sachs:
- mnemonic:
- whats the letter?
- “A”
- tAy-sAchs: hex-A: gAngliosides: chArry-red mAcula: brAin.
Gaucher disease
- mnemonic?
- whats the letter?
- “U”
- gaUcher: glUcocerebrosidase: glUcocerebroside: hUge organs: U survive: crUnched up paper.
lysosomal storage diseases
-inheritance?
- you know its going to be recessive since they’re enzyme deficiencies.
- All = auto rec except Hunter/Fabry = x-linked rec.
