Deck 3 Flashcards
what prophylaxis drug in preventing Pre-eclampsia and it’s complication ( post partum hemorrhage) in pregnancy?
Aspirin 150 mg nocte - start end of first trimester - 12th week
In pre-eclampsia what is the pathogenesis?
sFLT (anti-angiogenic) is very high - VEGF/PIGF (platelet growth factor) is low = endothelial dysfunction
Can use PIGF test to check
Nausea and vomiting of pregnancy (NVP) versus Hyperemesis gravidarum?
NVP - mild to moderate disease
HG = severe + electrolyte abnormalities + 5% weight loss
Prophylaxis against clots in subsequent pregnancy if?
Antenatal and post-partum period?
Antenatal + post-partum
- Anti-Thrombin III deficiency
- Previous VTE - inc. ESTROGEN PROVOKED
otherwise after pregnancy
Prednisolone in pregnancy if given before 8th week?
Cleft palate
Peri-partum cardiomyopathy pathogenesis?
Oxidative stress by prolactin fragment ( cardiotoxic) - Cathepsin D cleaves prolactin
Obstetric cholestasis versus intrahepatic cholestasis of pregnancy
Pathogenesis?
ICP - Bile acids > 40 = Delivery at 39/ 40 weeks
OC = Bile acids > 100 = Delivery at 35 weeks if not stillbirth!
Estrogen disrupts bile acid flow into hepatic canaliculi - Mom’s bile acid flows into fetus instead
Swansea criteria to dx what?
Acute fatty liver of pregnancy
Calcium intake to prevent Pre-eclampsia?
Only in low baseline dietary calcium intake
Steroids can cause immunosuppression - how?
Inhibit cytokine transcription factors
Inhibit IL1, TNF-a = macrophage dysfunction
Inhibit IL2 and thus Th1 differentiation- no T cell
Inhibit IL5 - no eosinophils
what medications induces hyperkalemia via
- reduces/inhibit adrenal aldosterone synthesis?
- Blocks Na channel
- Inhibits NA/K/-ATPase
- ACEI/ARB/CNI/Heparin
- Trimethoprim/ Amiloride
- Digoxin
Lithium causes what clinical side effects?
Polyuria and polydipsia
Kidney not responsive to ADH = Nephrogenic DI
HyperCALCIUM, Hyper PTH
New drugs for Hyperkalemia
Patiromer vs Na Zirconium Cyclosilicate difference?
Patiromer
- Bind K, exchange for Calcium
- Acts at Distal colon
- SE - hypoMg and GI side effects
Na Zirconium Cyclosilicate
- Binds K, exchange for sodium
- Acts everywere in GI tract
- SE : Oedema and GI side effects
Trimethoprim causes elevated creatinine - why?
Blocks creatinine secretion from proximal tubule
Tacrolimus target level
- few months after transplant?
- after 1st year?
- presence of malignancy/infection/BK viremia
- few months after transplant = 10 ng
- 1st year = 5 ng
- malignancy/infection/BK viremia = 3 ng
Pre-eclampsia definition?
BP > 140/90 at 20th week of pregnancy
Proteinuria
Maternal - organ dysfunction ( neuro/liver/renal/heam complications)
Fetus dysfunction - fetal growth restriction, stillbirth
Most defining feature of cell apoptosis?
Pyknosis - irreversible condensation of chromatin in cell’s nucleus
Other features
- cytoplasmic shrinks, Eosinophils increased
- apoptotic bodies
- mitochondrial can be swollen ( may be noT)
What differentiates cell apoptosis and cell necrosis?
Cell apoptosis is programmed cell death - NO INFLAMMATION
-dead cells quickly phagocytosed
Cell necrosis is unintended cell death due to uncontrollable external factors- release cytokines and inflammation
Circulating free DNA (cfDNA) released by?
Cell necrosis/apoptosis triggered by cancer
*Can be found in lower levels of healthy person
- double stranded fragments
- short half-life
Muscles involved in rotator cuff syndrome?
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Difference between GLUT and SGLT2 channel?
SGLT - active transporter
GLUT- passive transporter
What is Bing-Neel syndrome?
Walderstron Macroglobulinemia that infiltrates optic nerve
- nil optic disc oedema and optic nerve enhancement
- Have OPTIC NEURITIS
What yeast organism is resistant to Amphotericin?
Aspergillus Terreus
Scedosporium
What yeast is resistant to Fluconazole?
Candida Kruzei
