Cleanup Flashcards
Inhaled corticosteroids
Fluticasone, budesonide
Long lasting beta 2 agonists for asthma
Salmeterol, formoterol
Theophylline need
Inhibition of bronchodilation by inhibiting phosphodiesterase and increasing cAMP, narrow therapeutic window
Clomiphene
Antagoinst of estrogen receptors in hypothalamus preventing the normal feedback inhibition and leading to increased release of LH and FSH from the pituitary which stimulates ovulation
Tamoxifen
Estrogen antagonist at breast and an agonist at bone and uterus; increases risk of thromboembolic events and endometrial cancer
Raloxifene
Antagonist at breast, uterus; agonist at bone; increased risk of thromboembolic events but no increased risk of endometrial cancer; used to treat osteoporosis
Aromatase inhibitors
Anastrozole, letrozole, exemastane
Mechanism of aromatoase inhibitors and use
- Mech: Inhibit peripheral conversion of androgens to estrogen
- Use: ER + breast cancer in post menopausal women
Minoxidil side effects
Used as an arteriolar vasodilator; causes androgenic alopecia, severe hypertension
Finasteride
5 alpha reductase inhibitor used for BPH and male pattern baldness
Flutamidre
Nonsteroidal competitive inhibitor at androgen receptors. Used for prostate carcinoma
Ketoconazole
Inhibits steroid synthesis
Spironolactone
Inhibits steroid binding
Side effects of ketoconazole and spironolactone
Gynecomastia and amenorrhea
Epinephrine and brimonidine uses for glaucoma
- Epi is alpha 1, briomidine is alpha 2
- Decreased aqueous huumor synthesis via vasoconstriction (epi)
- Decreased aqueous humor synthesis (brimonidine)
TImolol, betaxolol, carteolol
Decreased aqueous humor synthesis
tazolamide
Decreased aqueous humor synthesis via inhibition of carbonic anhydrase
Bimatoprost and latanoprost for glaucoma
Increased outflow of aqueous humor via decreased resistance to flow therough uveoscleral pathway; can cause darkening of the iris, eyelash growth
When does dressler syndrome occur
Occurs several weeks after MI. Autoimmune phenomenon resulting in fibrinous pericarditis
Ivabradine mech and AE
- Mech: Selective inhibition of funny sodium channels prolonging the slow depolarization phase and decreased SA node firing and a negative chronotropic effect
- AE: Luminous phenomena/visual brightness, hypertension, bradycardia
Terbinafine AE
GI upset, headaches, hepatotoxicity, taste disturbance
Which 3rd gen cephalosporin can kill pseudomonas
Ceftazidime
Which cephalosporin can cover pseudomonas
Cefepime
Antiviral drugs NRTIs
NNRTIs
END
- Efavirenz
- Nevirapine
- Delavirdine
Protease inhibitor AE
Hyperglycemia, lipodystrophy, GI intolerance
Metformin mechanism
Decreased gluconeogenesis, increased glycolysis, increased peripheral glucose uptake
What is cilostazol and dipyridamole used for?
Intermittent claudication, coronary vasodilation, prevention of stroke or TIAs
What kind of hallucinations are a common feature of medical illness rather than psuchiatric
Visual; auditory is usually psychiatric
Membranous nephropathy has what kind of appearance on microscopy?
- IF: Granular as a result of immune complex deposition. Nephrotic presentation of SLE
- LM: GBM thickening
- EM: Spike and dome
Microscopic appearance of FSGS
- LM: segmental sclerosis and hyalinosis
- IF: can be positive for nonspecific focal deposits of IgM, C3, C1
Minimal change disease microscopic appearance
- LM: Normal glomeruli
- IF: negative
- EM: effacement of foot processes
Diffuse proliferative glomerulonephritis appearance
- LM: Wire looping of capillaries
- EM: Subendothelial IgG based ICs often with C3 deposition
- IF: Granular
Acute poststreptococcal glomerulonephritis appearance
- LM: Glomeruli enlarged and hypercelllar
- IF: Starry sky appearance due to IgG, IgM, C3 deposition
- EM: Subepithelial immune complex humps
What stage of sleep occurs in sleep terror disorder?
N3 when the person is cannot move
How long does it take for buspar to take effect? How does it work?
Stimulates 5HT1A receptors; takes about 2 weeks to work
Osteosarcome
- Common malignant bone tumor
- Codmans triangle on sunburst pattern on x-ray
- Aggressive, resect immediately
- Metaphysis of long bones
- Young and old bimodal distribution
Giant cell tumor is also known as….
Osteoclastoma
What occurs in antiphospholipid syndrome?
Anticardiolipin antibodies, antiphospholipid antibodies, lupus anticoagulant, abortions and arterial thrombosis
What are the actions of acitominophen
Antipyretic, analgesic but NOT antinflammatory
NSAIDs are
Antipyretic, antiinflammatory, and analgesic
What must be present for the diagnosis of autism spectrum disorder to be made?
Childhood presentation. Repetitive ritualize behaviors, poor social interactions, social communication deficits, restricted interests
What is the definition of a hypomanic episode
Like a manic episode except mood disturbance is not severe enough to cause marked impairmetn in social and/or occupational functioning or to necessitte hospitalization
Membranoproliferative glomerulonephritis
Tram track appearance on MPAS stain and H&E stain due to GBM sl=plitting caused by mesangial ingrowth
Type II membranoproliferative glomerulonephritis
C3 nephrritiic factor causing a dense deposit disease
Most common tracheoesophageal fistula
COnnection of the distal end
Best way to shorten the duration of the flu?
Oseltamivir or zanamivir taken within 48 hours of onset
Adverse effects of foscarnet
- Nephrotoxicity
- Hyper or hypophosphatemia
- Hypo or hypercalcemia
- Hypokalemia
- Hypomagnesmia
- Seizures
Indinavir specifically AE
Nephropathy ,hematuria, thrombocytopenia
A wave cause
atrial contraction leading to a closed tricuspid valve bulging into the atrium
C wave cause
RV contraction against a closed tricuspid valve leading to bulding into the atrium
V wave cause
Increased right atrial pressure due to filling against a closed tricuspid valve
Y descent cause
RA emptying into RV. Prominent ni constrictive pericarditis and absent in cardiac tamponade
Class 1A uses
Both atrial and ventricular arrhythmias especially a reenty circuit and ectopic SVT and VT
Class 1C uses
SVTs including afib. Only a last resort
Class1B uses
Decreased AP duration for ischemic or depolarized purkinje and ventricular tissue
Hydralazine mech and sue
- Increase cGMP leading to smooth muscle relaxation. Dilates arterioles more than veins to reduce afterload
- Use: severe hyertension HF, safe during pregnancy
- Usually coadministered with a beta blocker to prevent reflex tachycardia
What are the reasons for the increased cortisol in cushing syndrome?
- Exogenous corticosteroids decreasing ACTH and leading to bilateral atrophy
- Adrenal adenoma, hyperplasia, or carcinoma causing decreased ACTH and atrophy of the uninvolved adrenal gland
- ACTH secreting pituitary adenoma: increased ACTH and bilateral adrenal hyperplasia
What is the reason for exopthalmos in graves disease?
Thyroid stimulating immunoglobulin stimulates TSH receptors on the thyroid BUT also the dermal fibroblasts leading to the pretibial myxedema seen early, but also the infiltration of activated T cells into the retroorbital space which stimulate fibroblasts whic deposit GAGs
What occurs in larson syndrome
Defective growth hormone receptors and decreased linear growth. Increased GH is seen and decreased IGF1. Short height, small head circumference, saddle nose and prominent forehead
Mech and use of cyclobenzaprine
- Mech: Structurally related to TCAs, similar antichoniergic side effects, centrally acting skeletal muscle relaxant
- Use: Muscle spasm
Baclofen
GABAb receptor activator in the spinal cord eliminating muscle spasms and helping with MS
What is the main difference between tamoxifen and raloxifene
Tamoxifen has increased risk of endometrial cancer
What do macrolides treat
- Atypical pneumonia (mycoplasma, chlamydia, legionella)
- STIs (Chlamydia)
- Gram + cocci (streptococcal infections in patients allergic to penicillin)
- Pertussis
AE of macrolides
MACRO
- Motility issues (diarrhea)
- Arrhythmia (QT)
- Chloestatic hepatitis
- Rash
- eOsinophilia
Flucytosine mech
- Inhibits DNA and RNA biosynthesis by conversion to 5FU by cytosine deaminase
- Treats sustemic fungal infections in combination with Amphotericin B
What does mitral or tricuspid regurg sound like?
Holosystolic blowing murmur
- Mitral radiates to the axilla
- Tricuspid is loudest in the tricuspid area
Best antiarrhythmic to give post MI
1B
What are the beta blockers in class II
Metoprolol, propranolol, esmolol, atenolol, timolol, carvedilol
Which beta blocker can cause:
- Dyslipidemia:
- Vasospasm
- Dyslipidemia: Metoprolol
- Vasospasm: Propranolol
Fludrocortisone
Aldosterone analog with little to no glucocorticoid effects used for mineralocorticoid replacement in primary insufficiencyt
Wilson disease details
- AR
- ATPase copper transporter on chromosome 13
- Decreased copper excretion of ble and incorporation into apoceruloplasmin
- Copper accumulates in liver brain cornea and kidneys
What is the cause of primary hemochromatosis
Increased intestinal iron absorption
SLE drugs
SHIPP-E
- Sulfa drugs
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
- Etanercept
Drugs that cause coombs positive hemolytic anemia
Methyldopa, penicillin
What is the symptoms of whipple disease?
- PAS+ foamy macrophages
- Cardiac symptoms
- ARthralgias
- Neurologic symptoms common
Waht are the symptoms of hemochromatosis as it progresses?
- Cirrhosis
- diabetes mellitus
- skin pigmentation
- Restrictive cardiomyopathy, dilated cardiomyoathy,
- hypoghonadism
- arthropathy
- HCC
Triad of Multiple sclerosis
Scanning speech
Intentino tremor and Internuclear opthalmoplegia
Nystagmus
Tramadol mechanism and side effects
- Mech: K opioid receptor agonist and mu agonist to produce analgesia
- Can cause withdawal symptoms if patient is also take full agonist
- Overdose not easily reversed
Pentazocine
- Mech: K agonist and mu weak antagonist or partial agonist
- AE: Can cause withdrawal if patient is taking full antagoinst
Names of nondepolarizing NMJ blockers
Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium (CUR in name)
How do you reverse a nondepolarizing NMJ drug?
Neostigmine given with atropine to prevent muscarinic side effects, edrophonium, other cholinesterase inhibitors
MAOIs
Tranylcypromine, phenelzine, isocarboxazid, selegiline
How long do you wait after stopping MAO inhibitors before starting serotonergic drugs or stopping dietary restrictions
2 weeks
First generation antihistamines
Diphenhydramine, dimenhydrinate, chlorpheniramine
Second generation antihistamines
Loratidine, fexofenadine, desloratadine, cetrizine
Adverse effects seen in antihistamines
Sedation, antimuscarinic, anti-alpha adrenergic
Anticholinergic side effects
Blind as a bat (dilation), mad as a hatter, hot as a hare, red as a beet
1B antipsychotics
Lidocaine, MexileTine
What are the two retroviruses
What are the two retroviruses
HTLV and HIV
Danazol
Synthetic androgen that acts as partial agonist at androgen receptors for treataing endometriosis and hereditary angioedema
Ceftaroline covers
Listeria, MRSA, E faecalis, but not Pseudomonas
When do you want to use rifabutin instead of rifampin?
When youre also using a protease inhibitor
Use of alpha methyldopa
Hypertension in pregnancy, but can cause coombs + hemolysis, SLE like syndrome
Atropine overdose drug
Physostigmine
Pyridostigmene use
Gets RID of MG myasthenia gravis
Neostigmene
Urinary retention, myasthenia gravis, reversal of NMJ blockade, doesnt cross CNS
Which diabetic drugs are weighy neutral
Gliptans
What diabetes drugs cause weight gain?
Sulfonylureas, glitazones, meglitinindes
Which glomerular disease has IgG, IgM and C3 deposits?
Acute poststreptococcal glomerulonephritis
Deposits seen in focal segmental glomerulosclerosis
IgM, C3 and C1
Which lung tumor produces PTHrP
Squamous cell
Small cell lung cancer is marked by
Neuroendocrine kulchitsky cells, chromogranin A, neuron specific enolase
Turner syndrome
CLOWNS
- Coarctation of aorta
- Lymphedema
- Ovarian streaks
- Webbed neck
- Nips Spread out
- Short
- ALSO CYSTIC HYRGOMA
- DECREASED ESTROGEN LEADS TO INCREASED LH AND FSH
Klinefelter syndrome
KLINEF
- Kryptochidism
- Leydig hyeprtrophy
- Increased gonadotrophs
- Negative chromatic
- Elongeated legs
- Failure of secondary sex characterstics
features of 46 XX DSD
- Ovaries present, but external genitalia virilized or ambiguous due to excessive or inappropriate exposure to androgenic steroids during early gestation
46XY DSD
- Testes present but external genitalia are female or ambiguous most common form is androgen insensitivity syndrome
Androgen insensitivity syndrome
Defect in androgen leading to a normal appearing femal with femal external genitalia with scant pubic hair, a rudimentary vagina, uterus and fallopian tubes absent
Aromatase deficiency
Inability to synthesize estrogens from androge leading to masculinization of an XX female and increased testosterone and androstenedione
What is toxic multinodular goiter
Focal patches of hyperfunctioning follicular cells distendd with colloid working independently of TSH. Hot nodules rarely malignant
Bedwetting treatment
Oral desmopressin
Order of nerve blockade of local anesthetics
Small myelinated then small unmyelinated then large myelinated then large unmyelinated
In an alkalilne environment, will an acidic anesthetic be able to penetrate?
No it will need a higher concentration to achieve effect
SAME
Symptom of apparent mineralocorticoid excess
- Deficincy in 11 beta hydroxysteroid dehydrogenase which normally converts cortisol to cortisone.
- Excess cortisol in theses cells from enzyme deficiency leads to hypertension, hypokalemia, and metabolic alkalosis with LOW ALDOSTERONE LEVELS
- Comes from glycyrrhetinic acid (licorice)
Licorice disease
Hypokalemia, metabolic alkalosis, low aldosterone, SAME
Meglitinides mechanism
Stimulate insulin release by binding to K+ channels on beta cell membranes (similar to sulfonylureas but at a different site
What is the mechanism of glitazones?
Increased insuln sensitivity in peripheral tissue by binding to the PPAR-y transcription regulator
Fibrates mechanism
- Upregulate LPL leading to clearance of triglycerides
- Activates PPAR-alpha to induce synthesis of HDL
PCSK9 inhibitors mechanism
Inactivation of LDL degradation increasing the amount of LDL removed from the blood
Staples of hypertension treatment regardless of what it is paired with
- Diuretics (commonly thiazides)
- ACE/ARBs
- Calcium channel blockers
MUST BE GIVEN to hypertension patients with diabetes
ACE inhibitors or ARBs
What are the side effects seen with nonDHPs
AV block, cardiac depression, hyperprolactinemia, constipation
What are the effects of nitrates on
- :End diastolic volume:
- Blood pressure:
- Contractility:
- HR:
- Ejection time
- MVO2
- :End diastolic volume: decreased
- Blood pressure: decreased
- Contractility: no effect
- HR: increased (reflex)
- Ejection time: Decreasd
- MVO2: Decreased
Effects of beta ablockers on:
- :End diastolic volume:
- Blood pressure:
- Contractility:
- HR:
- Ejection time
- MVO2
- :End diastolic volume: no effect or increased
- Blood pressure: decreased
- Contractility: decreased
- HR: decreased
- Ejection time: increased
- MVO2: decreased
Effects of nitrates and beta blockers on
- :End diastolic volume:
- Blood pressure:
- Contractility:
- HR:
- Ejection time
- MVO2
- :End diastolic volume: no effect or decreased
- Blood pressure: decrease
- Contractility: no effect
- HR: no effect
- Ejection time no effect
- MVO2: decreased
Beta 1 selective blockers
acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol (first half of the alphabet)
Nonselective beta blockers
nadalol, pindolol, propranolol, timolol (second half of the alphabet)
Cidofovir use and AE
- Inhibits DNA polymerase and does not require phosphorylation
- CMV retinitis in immunocompromised patients
- HSV resistant to acyclovir
- AE: nephrotoxicity
How is shigella and yersinia distinguished between salmonella and proteus
H2S production on TSI agar
Symptoms of babesiosis
fever and hemolytic anemia in the northeastern united states as a result of a bite from the ixodes tick
Cardiac myxomas are usually composed of
Gelatinous material, myxoma cells immersed in glycosaminoglycans
Ranolazine mech
- Inhibit late phase of sodium current recuding diastolic wall tension and oxygen consumption
- AE: Can cause constpiation, dizziness, headache, nausea, QT prolongation
Adenosine mechanism
Increased k+ out of cells leading to hyperpolarization and decreasing AV nodal conduction
What is seen in SIADH?
Excessive water retention, euvolemic hyponatremia with combined urinary Na+ excretion. Urine osmolality>serum osmolality
How does the body respond to SIADH
Dedcreasing aldosterone and increasing ANP and BNP, leading to euvolemic hyponatremia.
