Deck 5 Flashcards
Why is it dangerous to give fibrates with statins?
Fibrates inhibit P-450 needed to metabolize statins. Excaberate myopathy. If statins aren’t good enough add niacin before fibrates
What drug causes folate deficiency? What is it used for?
TMP-SMX. First line for UTI’s
What is Berger dz?
IgA nephropathy. Nephritic syndrome with mesangial deposits of IgA. Different from PSGN because 2-3 days after and not 2 weeks
Fractional excretion of Na with intrarenal problems?
Between 2-4%
How do you know its prerenal?
BUN:Cr greater than 15, Fractional excretion of sodium <1%
Post renal failure?
Fractional excretion of sodium >4%
What would cause interstial nephritis?
Allergic reaction to penicillins, cephalosporins, sulfonamides
Muddy brown casts are pathognomonic for what?
ATN. From Rhabdo, chemo agents, aminoglycosides
White blood cell casts?
Intrarenal- pyelonephritis
What effect does ATII have on bicarb and H+?
Increase bicarb, unchanged H. exchanges more H in distal that then can help reabsorb more bicarb in collecting duct (as H20 and CO2 by carbonic anhydrase)
What is Conn syndrome?
aldosterone secreting tumor of adrenal cortex- hyperaldosteronism. Hypokalemia, alkalosis, low renin
Signs of hyperkalemia? Like from spironolactone for example
nausea, vomiting, diarrhea, areflexia, weakness, parasthesias, flaccid paralysis, arrythmias, tall peaked T waves
What HLA alleles make a person more susceptible to DM type 1
HLA3/HLA4
What effects do iodine insufficiency have?
Neurologic impairment and growth delay. In SE asia and Africa
What is NADPH derived from?
Niacin (Vit B3)
What do you give for hyperthyroid in pregnant women?
PTU- methimizole is contraindicated. However, PTU can cause hepatotoxicity
What is octreotide/ what is it used for?
Somatostatin analog for carcinoid, acromegaly, VIPoma, acute esophageal variceal bleed
What is side effect of metformin in person with renal insufficiency?
Lactic acidosis (anion gap). It promotes conversion of glucose to lactic acid. Probably inhibits gluconeogenesis
What hormones do neurophysis 1/2 transport?
1= oxytocin 2= ADH
Why does exercise help with diabetes?
Increase translocation of GLUT4 to cell surface. = insulin dependent receptor
Histology of diabetic nephropathy?
Nodular glomerulosclerosis (Kimmelstiel-Wilson nodules) and thickened basement membrane
What does GH do to fasting glucose?
Increase. Acts like anti-insulin agent
What is renal osteodystrophy and causes?
HyperPTH secondary to renal dz. Less P excretion, less 1,25OHD3 made from kidneys. PTH rises in response
What does VIP do?
Acts on gut mucosa to promotes sodium secretion causing secretory diarrhea. Also incr. potassium secretion in colon . Also inhibits gastric acid secretion. WDHA SYNDROME= Water Diarrhea, Hypokalemia, Achlorhydria
Different presentations of 21 and 11-hydroxylase deficiency?
Both = virilization. But 21 = hypotension and 11 = HYPERtension (11 deoxycorticosterone is released and leads to hypertension)
Medication for primary hyperaldosteronism (Conn syndrome)?
Spirinolactone. SE = gynecomastia
What effect does somatostatin have on body?
AKA Octreotide (analog) blocks GHRH at hypo to reduce GH. In GI, SST is released from mucosal D cells to decr gastric secretion/motility. In pancreas reduces glucagon/insulin secretion
What is the active form of Vit D, where is it made? And what enzyme?
1,25-dihydroxycholecalcetriol (calcetriol) is made in kidney by 1alpha-hydroxylase
What’s first line, second line treatment of BPH?
1 = alpha1 antagonists (tamsulosin) but can cause hypotension. 2= 5a reductase inhibitors (finasteride) but take 6-12 months to work and can decrease libido
What happens with K with DKA?
Acidosis shifts K out of cells and makes it look like hyperkalemia. Add K when giving insulin, because insulin makes it go into cells and can cause hypokalemia
Hormones that use Gs receptors?
TSH, LH, FSH, ACTH, ADH, PTH, glucagon, GHRH
Hormones that use Gi receptors?
Somatostatin
Hormones that use Gq receptors?
TRH, GRH, oxytocin, Ang II, bradykinin. Use phospholipase C and IP3/DAG pathway
Hormones that use tyrosine kinase?
IGF-1, insulin
Hormones that use non-tyrosine kinase?
Prolactin, GH, G-CSF, EPO
What diseases cause granuloma formation?
Tuberculosis, histoplasmosis, sarcoidosis
Treatment of C diff?
Oral vancomycin, metronidazole
Treatment of UC? Hint: Purine synthesis
Azathioprine: Inhibits purine synthesis. Can affect WBCs and can cause leukopenia
What can be complications of celiac’s?
Iron deficiency, autoimmune thyroiditis, type 1 diabetes, T cell lymphoma
