Deeper to Nan Tan Flashcards
Which cells in the differential are immature cells and are elevated when there has been a “shift to the left”?
- A.K.A “stabs” and “bands”
Immature white blood cells- specifically neutrophils
- A “shift to the left” refers to an increase in the number of immature white blood cells, specifically neutrophils, known as “bands” or “stabs”.
- Historically, the immature cells were listed on the left side
What is Pneumocystis pneumonia (PCP)?
A serious lung infection caused by the fungus Pneumocystis jirovecii
Also known as Pneumocystis jirovecii pneumonia (PJP)
Which fungus causes Pneumocystis pneumonia?
Pneumocystis jirovecii
This fungus is a significant pathogen in immunocompromised individuals.
Who is primarily affected by Pneumocystis pneumonia?
Individuals with weakened immune systems
This includes those with HIV/AIDS, cancer, or on immunosuppressive medications.
True or False: Pneumocystis pneumonia can affect healthy individuals.
False
It primarily affects individuals with compromised immune systems.
Fill in the blank: Pneumocystis pneumonia is also known as _______.
Pneumocystis jirovecii pneumonia (PJP)
This alternative name reflects the causative agent.
What type of infection is Pneumocystis pneumonia?
Lung infection
It specifically targets the respiratory system.
Decerebrate (Extensor) Posturing
Increased muscle excitability leading to specific rigid body positioning.
- Arms: Rigid with palms turned away from the body.
- Legs: Stiffly extended.
- Feet: Plantar flexion (toes pointed down).
Cause:
- Rostral-to-caudal deterioration: Lesions in the diencephalon affecting the midbrain and upper brain stem.
: Abnormal body posture indicating severe brain injury.
Characteristics:
Arms: Flexion of arms, wrists, and fingers with adduction of the upper extremities.
Legs: Internal rotation and plantar flexion of the lower extremities.
Cause:
Lesions: In the cerebral hemisphere or internal capsule
Decorticate (flexor) posturing
: A serious fungal infection of the membranes (meninges) surrounding the brain and spinal cord.
Risk Factors: Primarily affects immunocompromised individuals (e.g., HIV/AIDS, organ transplant recipients, patients on immunosuppressive therapy)
Cryptococcal meningitis
Tests for Cryptococcal meningitis
Spinal tap
- to examine cerebrospinal fluid (CSF) - blood tests
-for fungal markers
Symptoms:
Headache
Fever
Neck stiffness
Sensitivity to light
Altered mental status
Severe cases: Seizures and coma
Cryptococcal meningitis
A group of bacteria causing lung disease, primarily affecting immunocompromised individuals
-found in soil, water, and dust
Symptoms:
Chronic cough
Fatigue
Weight loss
Fever
Night sweats
Tests: Sputum culture, chest X-ray, or CT scan
Mycobacterium Avium Complex (MAC)
bicarbonate loss in urine leads to increased potassium excretion and shifts potassium into cells, both of which contribute to _________.
hypokalemia
how does bicarbonate loss in urine relate to hypokalemia?
Through several mechanisms:
Electroneutrality:
When bicarbonate is excreted in the urine, it carries a negative charge. To maintain electrical balance, positively charged ions like potassium (K+)are also excreted along with it
Volume Depletion:
Loss of bicarbonate often occurs in conditions that cause volume depletion (e.g., vomiting, diuretic use). The kidneys respond by increasing sodium reabsorption to conserve water, which can lead to increased potassium excretion
Metabolic Alkalosis:
Conditions causing bicarbonate loss can also lead to metabolic alkalosis (elevated blood pH). In this state, potassium shifts from the blood into cells, further lowering blood potassium levels
Dopamine’s ability to increase blood pressure through vasoconstriction at higher doses makes it an effective vasopressor in _______ and _______ care settings.
emergency, critical
___________ effects vary with the dose:
Low doses (1-3 mcg/kg/min):
- Primarily stimulate dopamine receptors, leading to vasodilation in the kidneys and increased urine output.
Moderate doses (5-10 mcg/kg/min): -Stimulate beta-1 adrenergic receptors, _________ heart rate and cardiac output.
High doses (10-20 mcg/kg/min): - Stimulate alpha-1 adrenergic receptors, causing vasoconstriction and increased blood pressure
Dopamine’s, increasing
Lymphocytes are elevated in blood differential of those infected with a virus because
Lymphocytes are essential for identifying, attacking, and remembering viral pathogens
__________ is a potassium-sparing diuretic used to treat
edema caused by congestive heart failure, liver disease, hypertension, hyperkalemia, and
hyperaldosterone.
Spironolactone
Leukocytes vs. Lymphocytes
Scope: Leukocytes encompass all white blood cells, while lymphocytes are a subset of leukocytes.
Role: Leukocytes provide broad immune defense, whereas lymphocytes are specialized for adaptive immunity
A CBC blood test that includes a ________ measures the different types of white blood cells (WBCs) in your blood.
-To check the levels and proportions of different WBCs, which can indicate infections, immune disorders, and other health issue
differential
WBC differential: slightly elevated WBC, high amounts of more mature neutrophils (segs) indicates what immune response?
Inflammatory response
a differential with higher WBC overall, would indicate a _________ infection
bacterial
What is the primary cause of UTIs that are treated with antimicrobial therapy?
E. coli
Which medications are commonly used for UTI treatment?
- Fluoroquinolones
- Macrobid
- Bactrim
- Fosfomycin
- Nitrofurantoin
What is the action of urinary tract anti-infectives?
Acidification of urine, causing bacterial cell death
What specific patient population should not be given Fosfomycin?
Children <12 years
Which medication is recommended for use in pregnancy for UTI treatment?
Fosfomycin
What adverse effects are associated with urinary tract anti-infectives?
- Nausea
- Vomiting
- Diarrhea
- Bladder irritation
- Confusion
- Photosensitivity
What is lorazepam used to treat?
Anxiety, insomnia, aggression, ETOH withdrawal
What is the mechanism of action for lorazepam?
Acts on limbic system to enhance GABA, interferes with neuron firing
What are common adverse effects of lorazepam?
- Sedation
- Hypotension
- Drowsiness
- Lightheadedness
- Confusion
- Dry mouth
- Decreased libido
- Palpitations
What is the main difference between buspirone and benzodiazepines?
Buspirone does not have sedative or anticonvulsant properties
What is amitriptyline classified as?
Tricyclic Antidepressant (TCA)
What is the action of amitriptyline?
Blocks reuptake of norepinephrine and serotonin
What are the adverse effects of amitriptyline?
- Sedation
- Anticholinergic effects
- Hypotension
- Hallucinations
- Weakness
- Tremors
- Fatigue
- BP changes
- Arrhythmias
- MI
- Angina
- Palpitations
What is fluoxetine commonly known as?
Prozac
What is the mechanism of action of fluoxetine?
Blocks reuptake of serotonin, increasing its concentration in the synapse
What are the indications for fluoxetine?
- Depression
- OCD
- Panic attacks
- Bulimia
- Premenstrual dysphoric disorder
What are the adverse effects of fluoxetine?
- Headache
- Nervousness
- Insomnia
- Drowsiness
- Anxiety
- Tremor
- Dizziness
- Sweating
- Rash
- Nausea
- Vomiting
- Diarrhea
- Dry mouth
- Anorexia
- Sexual dysfunction
- Upper respiratory infections
- Weight loss
- Fever
True or False: Chlorpromazine is a typical antipsychotic.
True
What is the action of chlorpromazine?
Blocks postsynaptic dopamine receptors in the brain
What are common adverse effects of chlorpromazine?
- Drowsiness
- Insomnia
- Vertigo
- Extrapyramidal symptoms
- Orthostatic hypotension
- Photophobia
- Blurred vision
- Dry mouth
- Nausea
- Vomiting
- Anorexia
- Urinary retention
- Photosensitivity
What is a major risk when using lithium?
Toxicity leading to severe CNS, renal, and pulmonary problems
What are therapeutic levels of lithium?
0.6 to 1.2 mEq/L
What is the action of phenytoin?
Stabilizes nerve membranes throughout the CNS by influencing ionic channels
What is a contraindication for the use of phenytoin?
Hepatic impairment
What are the adverse effects of phenytoin?
- Depression
- Confusion
- Drowsiness
- Lethargy
- Ataxia
- Dysarthria
- Slurred speech
- Mental confusion
- Dizziness
- Fatigue
- Tremor
- Headache
- Dermatitis
- Stevens-Johnson syndrome
- Nausea
- Gingival hyperplasia
- Liver damage
What is the action of carbamazepine?
Inhibits polysynaptic responses and blocks sodium channels
What is the indication for levodopa?
Treatment of Parkinson’s disease
What is the combination commonly given with levodopa?
Carbidopa
What adverse effects are associated with levodopa?
- Adventitious movements
- Ataxia
- Increased hand tremor
- Dizziness
- Numbness
- Weakness
- Agitation
- Anxiety
- Anorexia
- Nausea
- Dry mouth
- Dysphagia
- Urinary retention
- Flushing
- Cardiac irregularities
What is cyclobenzaprine used for?
Relief of acute skeletal muscle injury in adults
What is the action of dantrolene?
Interferes with the release of calcium, preventing muscle contraction
What is the indication for morphine?
Relief of moderate to severe chronic and acute pain
What are the common adverse effects of opioids?
- Light-headedness
- Dizziness
- Sedation
- Nausea
- Vomiting
- Dry mouth
- Constipation
- Respiratory depression
- Apnea
- Circulatory depression
What is the action of dopamine as an adrenergic agonist?
Stimulates both beta and alpha receptors
What is clonidine used to treat?
Essential hypertension, chronic pain, opiate withdrawal
What are the risks of abruptly stopping adrenergic blocking agents?
Myocardial infarction, stroke, and arrhythmias
What is the indication for non-selective beta-adrenergic blocking agents?
Treatment of hypertension and angina pectoris
What are the risks associated with abruptly stopping beta blockers after long-term use?
Angina, myocardial infarction (MI), hypertension, and stroke due to receptor hypersensitivity.
What is the primary indication for Propranolol?
Treatment of hypertension, angina pectoris, and prevention of reinfarction after MI.
What action does Propranolol perform in the body?
Competitively blocks beta-adrenergic receptors in the heart and reduces vascular tone in the CNS.
List some adverse effects of Propranolol.
- Allergic reaction
- Bradycardia
- Heart failure
- Cardiac arrhythmias
- Cerebrovascular accident
- Pulmonary edema
- Gastric pain
- Flatulence
- Impotence
- Decreased exercise tolerance
- Bronchospasm
True or False: Metoprolol is a beta1-selective adrenergic blocking agent.
True
What is the indication for Bethanechol?
Treatment of urinary retention.