8/4/22 Flashcards
Pharmadynamic vs pharmakinetic
Dynamic - drug A changes Pharma effect of drug B without altering the concentration
Kinetic - drug A changes the concentration of drug B
Hepatic enzyme inducers and inhibitors have what effect on drugs?
Inducers = decreased efficiency of drug as decreasing blood plasma conc. inhibitors = increased efficacy as increasing blood plasma conc.
How many half lives to meet steady state?
5
What drug interacts with grapefruit juice (huge quantities)?
Statins
Side effect of Colchine used in gout?
Diarrhoea
How many days before surgery should warfarin be stopped?
5 days
Name the 3 layers of the adrenal cortex and what they produce?
Go Find Rex, Make Good Sex)
GFR
MGS
Glomerulosa
Fasciculata
Reticularis
Mineralcorcitcoid (aldenosterone)
Glucoccorticoid (cortisol)
Sex hormones (androgens - DHEA and androstenedione)
What is produced by chromaffin cells and where are they found?
Norarenaline and adrenaline
In adrenal medulla (centre of adrenal gland)
How do you calculate a patients likelihood of ovarian cancer?
CA125 level x USS score x menopausal score
What information is needed when submitting an endometrial biopsy?
How is it done?
Age
Date of LMP
Pattern of bleeding
Hormonal therpay?
Trans-vaginally (suction to pull out some endometrium) - called pipelle biopsy
How can a chocolate cyst appear on investigation.
What can this get confused with?
Pelvic mass
High CA125 level
Ovarian cancer
Do a profile on endometriosis.
The patient wants to know the following:
- ‘what is it?’
- why has this happened to me?
- I heard it can reduce fertility - how?
- how did you diagnose it?
- how can we manage it?
Also tell me how she presented first of all
Cyclic deep pelvic pain Dyspareunia Dysuria ~cyclic haematuria and fresh blood in stool Infertility
Endometriosis is a condition caused by parts of your womb lining, called endometrium, growing outside your womb in your pelvic region. This can mean you have parts of endometrium found on your ovaries and sometimes near your bladder and lower bowel.
Endometriosis can be incredibly painful as every month these wee breakaway parts of womb get the same hormonal signals to start bleeding - which is why your periods are so sore. When these bits of endometrium are found near bladder and bowel it can cause monthly bleeding in your urine or stool.
We aren’t entirely sure why it happens. There is suggested to be a genetic factor to it. There are many theories - one being that endometrial lining during a period is normally shed out the vagina with blood as a period but during this process some of the lining has gone back the way and worked it’s to live at other sites in the pelvis. Also a suggestion that during development as baby the cells that should have gone to the womb to make the endometrium ended up at other sites.
It can reduce fertility. This is because all these little bleeds that happen every month can cause irritation in the particular area. This irritation can cause the body to as it heal itself create almost bands of healing tissue. Sometimes these bands of healing tissue can attach different organs together or distort parts of the workings around our womb. They are known as adhesions. Adhesions around our fallopian tubes (which is where sperm meets egg) can cause that nice lovely tube to become disrorted and the sperm can struggle to meet the egg.
Diagnosed:
TVUSS - showed chocolate cysts on ovaries
Speculum
- endometrium in vagina (particularly in posterior fornix)
- fixed cervix
- cervical excitation
GOLD STANDARD - laproscopy
- need to take biopsy to confirm
In the run up to doing the laproscopy which is like keyhole surgery on your tummy to biopsy some of these areas.
COCP - used to stop ovulation adn reduce endo. lining which should help pain
Paracetomol and NSAIDS
Laproscopic surgery - remove areas of adhesions or endometrium outside the womb
- can also be used to increasy fertility
Final stage is hysterectomy and bilateral salpingo-oopherectomy
Imagine been asked to do a diabetic foot station.
Once completed station - asked how you would counsel a patient to reduce their risk of diabetic neuropathy?
Make sure you control your blood sugar levels and are taking medications properly
Lose weight
Eat healthy balanced meals
Exercise - 30 mins x 5 days
Check feet every day - if nerves are getting affected you might not notice when you have hurt yourself which can lead to ulceration
Keep feet dry and clean and toenails trimmed
Come back in as soon as you notice anything not quite right - better to be safe than sorry and easier to treat in the earlier stages
Wear properly supportive shoes
Maintain good blood sugar levels
What muscle makes up the majority of the pelvic side wall?
Obturator internus
What can happen as a result of mothers smoking and drinking during pregnancy?
Both smoking and drinking can cause increased risk of:
- miscarriage
- small for dates (a small baby is not a healthy baby)
- preterm birth (increased risk of complications)
Drinking - characteristic signs of Foetal alcohol syndrome Increased risk of: - behavioural problems - hearing and vision problems - learning difficulties - cerebral palsy
Smoking Increased risk of: - behavioural problems e.g. ADHD - asthma and pneumonia - chest and ear infections
NRT (nictoine replacement therapy) is safe in pregnancy and safer than putting all the harmful toxins in cigarettes into your body and babies
