Cram

Question 1

The arrival in the ED of a pt with diminished mental status but otherwise normal autonomic signs and symptoms makes you think…

Answer 1

benzo or other sedative; something that acts only in the CNS. adrenergic, cholinergic, serotonergic, and many antihistamines and other drugs would all alter the autonomics (and so would opiates: constipation)

Question 2

How to chelate lead in a person w/ lead poisoning?

Answer 2

EDTA first. it mobilizes lead from bone. EDTA, however, increases serum lead levels as lead is leeched from bone, so follow it up w/ dimercaprol (DMSA) which is a soft tissue chelator

Question 3

Blood dyscrasias (aplastic anemia, agranulocytosis, etc.) from a chelating agent?

Answer 3

penacillamine

pretty much assume that if it’s a bad side effect from a chelator, it’s penacillamine

Question 4

Side effects of deferoxamine?

Answer 4

red pee, tachycardia, hypotension, shock (may add to cardiovascular collapse of iron toxicity)

Question 5

Which herbal supplement is as effective in treating depression as older TCAs and may boost the effectiveness of SSRIs?

Answer 5

SAMe (s-adenosyl-L-methionine)

Question 6

Which herbal supplement can be added to Alzheimer’s regimens of acetylcholinesterase inhibitors to boost effectiveness?

Answer 6

Ginko biloba

Question 7

Which herbal supplement is useful for sleep/anxiety in children w/ ADHD but has less adverse effects than benzos?

Answer 7

Valerian

Question 8

Which herbal supplements inhibit CYP?

Answer 8

Bitter orange, Ginko biloba, ginseng; echinacea inhibits 2 CYPs (1A2 and intestinal 3A4) and induces 1 CYP (3A4)

Question 9

Which herbal supplements induce CYP?

Answer 9

St. John’s wort and Echinacea; echinacea inhibits 2 CYPs (1A2 and intestinal 3A4) and induces 1 CYP (3A4)

Question 10

What effects does echinacea have on CYP enzymes?

Answer 10

echinacea inhibits 2 CYPs (1A2 and intestinal 3A4) and induces 1 CYP (3A4)

Question 11

Herbal supplements w/ natural antiplatelet activity?

Answer 11

garlic and ginko biloba

Question 12

Deficiency of what has been associated w/ low immune status in HIV?

Answer 12

selenium (also an antioxidant that may protect against some cancers)

Question 13

Supplement that may trigger mania in bipolar patients?

Answer 13

Fish oil. but it does boost effectiveness of antidepressants

Question 14

Antimicrobials that can cause bleeding in the elderly?

Answer 14

cephalosporins, penicillins

hypoprothrombinemia, thrombocytopenia, platelet dysfn

Question 15

Drugs that may cause hyponatremia in the elderly?

Answer 15

SSRIs, vinca alkaloids, sulfonylureas (3 drug classes most commonly implicated in SIADH: psychotropics, vinca alkaloids, sulfonylureas)

Question 16

Beers criteria identifies which opiate as inappropriate in elderly people?

Answer 16

meperidine

Question 17

Highest risk of injury to an elderly person taking an opiate is from which opiate?

Answer 17

codeine (opiates are known to increase the risk of falls in the elderly)

Question 18

Important classes of drugs w/ anticholinergic effects in the elderly?

Answer 18

antihistamines, antiparkinson agents, skeletal muscle relaxants, drugs for urinary incontinence

Question 19

How to use benzos in old people?

Answer 19

reduce the dose, use the short to intermediate half-life choices (triazolam, alprazolam, lorazepam)

Question 20

Which antidepressants to use in old people?

Answer 20

SSRIs: citalopram and escitalopram or TCAs w/o a significant anticholinergic effect like nortryptiline, trazodone

Question 21

How to dx elephantiasis?

Answer 21

microfilariae in blood AT NIGHT, serology (IgG4)

Question 22

If the word “proglottids” is mentioned, what bugs do they have to be talking about?

Answer 22

tapeworms (Taenia solium [neurocysticercosis], taenia saginatu, dyphyllobothrium latum, Echinococcus]

Question 23

Which immunodeficiency only increases the number of Candida infxns?

Answer 23

MPO deficiency