Combank 2 Flashcards
The only anti-epileptic medication that is an inhibitor of cytochrome p450 enzymes
Valproic Acid
What class of drugs is Glyburide in and what does it treat?
sulfonylurea; treatment of diabetes
MOA of sulfonylureas
block ATP dependent potassium channels thus depolarizing pancreatic beta cells which leads to insulin release (release mediated by calcium influx)
Carbamazepine, oxcarbazepine and phenytoin are inducers or inhibitors of the CYP450 system?
Inducers
What is valproic acid commonly used to treat?
a common epileptic medication for tonic-clonic seizures; also used for partial seizures and absence seizures
What is the MOA of valproic acid?
inactivates Na+ channels and increases GABA concentration in the synapse
First line option for tonic clonic seizures
Carbamazepine
What is another use of Carbamazepine other than treating seizures?
Trigeminal neuralgia
Does phenobarbitol induce or inhibit CYP enzymes?
Induce
What is the first line prophylaxis for status epilepticus?
Phenytoin
How does erysipelas present?
A painful raised lesion with sharply demarcated borders
How is cellulitis different from erysipelas?
Cellulitis can also present with symptoms of pain, erythema and pruritis, but does NOT have a raised lesion with sharply demarcated borders
What is the major causative agent for both erysipelas and cellulitis?
Streptococcus pyogenes (Group A strep)
What is the drug of choice to treat streptococcal erysipelas?
Penicillin
Group B strep is also known as?
Strep agalactiae
Group A strep is also known as
Strep pyogenes
The viscerosomatic reflex for the head and neck correspond to what vertebral levels?
T1-T4
What type of hypersensitivity reaction is Guillain-Barre syndrome?
Type IV
How are type IV hypersensitivity reactions mediated?
T cells that come into contact with the antigen activate macrophages
Guillain-Barre can occur several days after an infection with what causative agents?
Campylobacter jejuni, CMV, or influenza
Goodpasture syndrome and rheumatic fever are examples of what type of hypersensitivity?
Type II, cytotoxic
Graves disease and myasthenia gravis are examples of what type of hypersensitivity?
Type II, noncytotoxic
Rheumatoid arthritis and polyarteritis nodosa are examples of what type of hypersensitivity?
Type III
Agranulocytosis and aplastic anemia are AEs of which AED medication that is first line for tonic clonic seizures and trigeminal neuralgia?
Carbamazepine
Gingival hyperplasia is a AE of which AED?
Phenytoin
This AED used to treat absence seizures works by depressing the nerve transmission in the motor cortex thereby increasing the threshold for seizures
Ethosuximide
Absence seizures can be treated with which two drugs?
Valproic acid or Ethosuximide
What other drug can be used to treat and prevent congenital syphilis in the case that the patient is allergic to penicillin?
Doxycycline
What is the first line treatment for syphillis in both pregnant mothers and the neonate?
Penicillin G
What type of drug is Alendronate and what is it used for?
It is a bisphosphonate that inhibits bone resorption (osteoclast activity) and is used to increase bone density in women with post menopausal osteoporosis
The description of lancet shaped bacteria points to …
strep pneumoniae
Name the causative agent - aerobic, gram positive, catalase negative, ALPHA HEMOLYTIC cocci, optochin sensitive
strep pneumoniae
Name the hepatitis virus - DNA genome, reverse transcriptase used to make DNA from viral RNA in the cytoplasm
Hepatitis B
How is hepatitis B transmitted?
blood contact, sexual contact
Name the hepatitis virus - picornavirus, spread through food, prevented by giving a vaccine before travel, self limiting
Hepatitis A
Name the hepatitis virus - RNA flavivirus, spread through blood, no vaccine available, most develop chronic hepatitis
Hepatitis C
Name the hepatitis virus - RNA delta virus, requires coinfection with hepatitis B
Hepatitis D
Name the hepatitis virus - RNA hepevirus, fecal oral spread, causes acute hepatitis, common in developing countries
Hepatitis E
How does hepatitis C infect hepatocytes?
HCV coats itself with low density and very low density lipoproteins
Which hepatitis virus is associated with high infant mortality when occuring in pregnant women?
Hepatitis E (no vaccine is available)
What is the DOC for Loa Loa infection?
diethylcarbamazine
Name the causative agent - transient migratory angiodema, pruritis, localized urticaria in the arms and legs (usually wrists, ankles), ocular symptoms
Loa Loa
What is used to treat gram negative anaerobic rods?
metronidazole or clindamycin
What is the first line treatment for mild persistent asthma?
start an inhaled steroid controller - ex beclomethasone
An anticholinergic drug used as an alternative to albuterol in the treatment of acute asthma. MOA is blocking the M3 receptors found in the bronchi causing bronchodilation.
Ipratropium
Where is Histoplasma capsulatum found?
Mississippi and Ohio River Valleys; located in caves
How would Histoplasma capsulatum present on sputum microscopy?
small intracellular yeasts residing within macrophages
Where is Coccidioides immitis found?
San Joaquin Valley of California and other areas of the southwestern US
How does Coccidioides immitis present on sputum microscopy?
Presence of spherules within endospores
Where is Blastomyces dermatitidis found?
Mississippi and Ohio River basins
Where is Paracoccidioides brasiliensis found?
South and Central America
How does Paracoccidioides brasiliensis present on sputum analysis?
one large mother cell produces multiple daughter cells that arise from multiple sites - resembles a “pilots wheel”
What type of drug is furosemide and how does it work?
Loop diuretic; blocks Na/K/Cl pump in the thick ascending limb of the LOH
What type of drug is Hydrochlorothiazide and how does it work?
Thiazide diuretic; blocks the sodium/chloride channel in the DCT
How does Acetazolamide work?
Reversibly inhibits carbonic anhydrase resulting in reduction of hydrogen ion secretion at the renal tubule and an increased renal excretion of Na, K, HCO3 and H2O
What are some common potassium sparing diuretics?
spironolactone, amiloride, triamterene
How does Amiloride and triamterene work?
Inhibit the Na/K ATPase on the renal distal convoluted tubule which prevents sodium resorption from the lumen
This condition results in upper respiratory symptoms, lower respiratory symptoms and renal symptoms; characterized by inflammation of small and medium sized blood vessels
Wegener’s granulomatosis
Wegener’s granulomatosis is usually positive for what antibodies?
c-ANCA antibodies
What are rales?
crackling sounds that result from small bronchioles and alveoli popping open due to fluid build up
Name the causative agent - common cause of pneumonia in alcoholic or elderly, currant jelly sputum
Klebsiella pneumoniae
Describe the lab profile of Klebsiella pneumoniae
gram negative lactose fermenting rod; indole negative (vs. E coli is indole positive)
What type of drug is ketamine and how does it work?
intravenous anesthetic; rapid onset, short duration; interacts with NMDA receptors and stimulates sympathetic outflow causing tachycardia, HTN, increased CO; causes vivid dreams and hallucinations during recovery
What is an isotonic contraction?
constact muscle tension as a muscle changes length - ex. push up
MAO-A degrades …
NE and serotonin
MAO-B degrades …
dopamine
The frontal bone is a paired or unpaired bone?
paired
This suture is present at birth and runs vertically through the center of the frontal bone separating the frontal bone into two halfs
Metopic suture
A patient with suspected cervicitis should be treated with antibiotics that cover which two causative agents?
Neisseria gonorrhea and Chlamydia trachomatis
Chandelier sign
cervical motion tenderness
Chandelier sign is positive in what condition?
Pelvic inflammatory disease
DOC for Chlamydia trachomatis
Azithromycin or doxycycline; azithromycin preferred due to single dose therapy vs. doxycycline’s 7 day dosing
DOC for Neisseria gonorrhoeae
Ceftriaxone
Erythromycin inhibits or induces P450 system?
inhibits
Rifampin inhibits or induces P450 system?
induces
What is a unique AE of rifampin?
red/orange color change that occurs in bodily fluids
What type of mutation causes sickle cell anemia?
point mutation causing glutamic acid to be replaced by valine
How does Clopidogrel work?
inhibits platelet aggregation by irreversibly blocking ADP receptors, which does not allow for GPIIb/IIIa expression thus inhibiting fibrinogen binding
How does hydroxyurea work and what is it indicated for?
Anti-neoplastic agent; indicated for reducing the rate of painful occlusive attacks in patients with sickle cell disease; increases production of fetal hemoglobin
What is a common cause of osteomyelitis in patients with sickle cell disease?
Salmonella
Most common cause of osteomyelitis in general population (those w/o sickle cell disease)
Staph aureus
What are the clinical manifestations of paroxysmal nocturnal hemoglobinuria?
hemolytic anemia, hypercoagulable state, diminished hematopoiesis
What causes paroxysmal nocturnal hemoglobinuria?
genetic defect in red blood cell membrane anchor proteins; there is an absence of CD 59 and CD 55 which act to inhibit membrane lysis, thus there is un-inhibited complement mediated hemolysis
Crohn’s disease most often affects what part of the GI tract?
terminal ileum
How does Ezetimibe work?
impairs biliary and dietary cholesterol absorption at the intestinal brush border by inhibiting specific receptors at the border
Name 3 bile acid sequestrants
cholestyramine, chlesevelam, colestipol
How do bile sequestrants work?
bind bile acids in the intestine and prevent their absorption at the brush border
What is the MOA of Niacin as a lipid lowering agent?
decreasing hepatic LDL and VLDL production as well as hepatic triglyceride esterification
What is Sjogren syndrome?
chronic systemic inflammatory d/o characterized by lymphocytic infiltrates in exocrine organs
Patient’s with Sjogren syndrome are at risk of developing what condition?
lymphoma
What antibodies are positive in Sjogren syndrome?
Anti-Ro and Anti-La antibodies
What antibodies are positive in CREST syndrome? (calcinosis, raynaud disease, esophageal dysmotility, sclerodactyly, telangiectasia
Anti-centromere antibodies
What antibodies are positive in SLE?
Anti-ds DNA antibodies
What antibodies are found in polymyositis/dermatomyositis?
Anti-Jo1 antibodies
What antibodies are positive in scleroderma?
SCL 70 antibody
What is the DOC for pregnant women with hyperthyroidism in the first trimester?
Propylthiouracil
T4 analog used to treat hypothyroidism
Levothyroxine
What medications are used to treat antipsychotic-induced EPS?
Benztropine, amantadine, diphenhydramine
