DIT Q's Flashcards
What effect might aminoglycosides have on a developing fetus?
Ototoxicity
What birth defect can result from the following agents:
Ace inhibitors
Folate antagonist
Tetracyclines
Lithium
Ace inhibitors - renal damage
Folate antagonist - neural tube defects
Tetracyclines - teeth discoloration
Lithium - Ebsteins anomaly
What molecule targets proteins in the ER for lysosomes?
Mannose-6-phosphate
What artery supplies…
medullary pyramids and medial lemnisculs in the medulla ?
inferior cerebellar peduncles, nuc ambiguus and lateral STT in teh medulla?
medullary pyramids and medial lemnisculs in the medulla ?
Anterior spinal artery
inferior cerebellar peduncles, nuc ambiguus and lateral STT in teh medulla?
PICA
Labs for hepatic cirrhosis?
AST > ALT (2:1)
“A Scotch and Tonic”
DDX for erectile dysfunction:
- Hormonal disturbances (low T, hyperprolactinemia)
- Depression
- Diabetes
- Psychological/Psyciatrical (performance anxiety)
- Medication adverse side effects (beta blockers, SSRIs, neuroleptics, ethanol)
What is type I (alpha) error?
Study shows difference between two groups when there is no actual difference
What trace element is important for carbonic anhydrase and lactate dehydrogenase?
zinc!
impt also for protein folding
when do we see subluxation of the lenses?
Marfan syndrome
homocystinuria
Tuft of hair in the lower back?
spina bifida occulta
What occurs at the corto-medullary junction of the thymus?
positive and negative selection of T-cells
positively restrict MHC
MHC I - on most nucleated cells
MHC II - only on antigen presenting cells
What is the clinical definition of chornic bronchitis?
productive cough for at least 3 months, in at least 2 consecutive years
Local anesthesia:
lidocaine and other local anesthetics act by blocking sodium channels, preventing firing
small myelinated fibers blocked first
smaller before large
myelinated before unmyelinated
what meds used in
urge incotinence?
Anticholinergic drugs:
oxybutynin
tolterodine
darifenacin
solifenacin
tropsium
different RNAs?
prokaryotes only one RNA, makes everything
Eurkaryotes 3 RNAs
RNA I –> rRNA
RNA II –> mRNA
RNA III –> tRNA
which cells do not req insulin?
muscles and adipose require glut 4 need insulin
brain, RBC< intestines, cornea, kidney, liver DONT require insulin
Kallman syndrome?
sporadic or Xlinked
caused by defective development of GnRH-secreting cells in the hypothalams
men > women
dec FSH, dec LH, low test
fail 2nd sexual characteristics
low sperm counts
associated with anosmia (agensis or hypoplasia of olfactory bulb) and midline facial defects
how can NSAIDs make renal insufficiency worse?
Careful using NSAIDs in pt with renal insufficiency
NSAIDS inhibit COX block prostaglandins
recall prostaglandins DILATE, esp afferent arteriole of glolmerulus!! thus if the afferent arteriole of glomerulus is not dilating, you can low renal plasma flow, low GFR
INC infections of S. Aureus and E.coli? What immunity disfunction increases the risk?
Chronic granulomatous disease
due to a decrease in the NADPH oxidase deficiency
normally allows phagocytes to create oxygen free radicals and hydrogen periodize to kill bacteria in phagosomes
PREDISPOSES CATALASE POSITIVE bacterial infections
(catalase cat)
Causes of metabolic acidosis with increased anion gap?
MUD PILES
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tables / Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates (aspirins)
Attributable Risk
Attributable riks = difference between exposed and unexposed groups, porportion of diease caused by exposure
2X2
AR = (A / A+B) - (C / C+D)
leuprolide
GnRH agonist
binds to GnRH r in anterior pituitary –> not pulsatile! –> downregulation of receptors –> suppression of release of LH and FSH and reduced testosterone production –> helps slow the growth of prostate CA
Urea cycle enzyme deficiencies?
Ornithine transcarbamylase deficiency:
INC ammonia levels within the first days of life
X linked recessive
–> INC orotic acid in blood and urine (part of purine synthesis)
dec BUN, symptoms of hyperammonemia (neurological deficits)
Hyperammonemia: tremor, slurred speech, comnolence, vomiting, cerebral edema, blurred vision
Brachial cleft cyst vs thyroglossal duct cyst?
Branchia cleft cyst @ lateral neck, does NOT move with swallowing
Thyroglossal duct @ midline, MOVES with swallowing
remnant is foramen cecum
thyroid diverticulum arises form the flor of the primitive pharnyx and descents to the beck at foramen cecum –> thyroid remains connects to tongue by thyroglossal duct (if persists!!); if duct persist it becoems the pyramidal lobe of thyroid
clozapine major side effect
Cauess agranulocytosis
needs to monitor WBC weekly!!
anteiror shoulder dislocation vs a posterior shoulder dislocation?
ant dislocation:
external rotation, slight abduction
axillary artery, axillary nerve
scenarios - blow to the arm while abducted, externally rotated and extended
PE- prominent acromion process (if thin, loss of normal roundness of the shoulder, appears more angular
Posterior dislocation:
internal rotation, adduction, unable to externally rotate the arm
unusual to have any neurovascular compromise
scenario - seizure, electrocution
PE: bulge in the posterior shoulder area, anterior aspect of the shoulder is relatively flat
cyclosporine:
Use: immuno supp for transplat, psoriasis
MOA: binds to cyclophilin –> inhibits calcineurin
normally calcineurin activates nuclear factor of activated T-cells cytoplasmic (NFATc), which upregulated IL-2 (impt for T cell growth and differentiation)
–> inhibition of T-cell growth, activation and differentiation
central pontine myelinolysis:
when sodium is corrected too quickly
(such as in SIADH)
could cause: diplopia, dysarthria, paralysis, locked-in syndrome (pt alert and awkae up unable to move)
pericarditis casues?
idiopathic, coxackivirus a/b, tb, uremia, lupus, scleroderma, radioation of the chest, acute RF, dressler syndrome, cancer mets
Sx of fat-soluble vitamin deficiencies:
A: night blindness, dry skin
D: rickets, osteomalacia, hypocalcemium, tetany
E: fragile RBC, muscle weakness, demyelination of CNS
K: coagulation factor defects, osteoporosis, CAD
Meckles arches:
Meckles - 1st brachial arch
CN V2 and V3
Mesoderm - muscles and arteries
Neural crest - bones and cartilage
mean, median, mode relationship in normal, positive and left skewed graphs
normal
mean = mode = median
positive - shifted to the left, tail to the
mean > median > mode
negative- shift to the right, tail to the left
mode > median > mean
problems with mercury during pregnancy?
brain damage
rate order: zero vs first
zero order elimination = constant amt of drug eliminated per unit of time
- linear graph
- amt metabolized stays constant regardless of concentration
first order elimination = a constant fraction of the drug is metabolized per unit time
- curved
what artery supplies distal colon vs proximal 2/3 of colon?
what structures are they derived from?
proximal 2/3: SMA
from midgut
distal 1/3: IMA
from hindgut
status epilepticus
acute vs prophylaxis
acute - stop seizure: benzos
once it has stopped, treat with anti-convulsant for further seizures: phenytoin first line
Treatment of asthmas …
chronic asthma - fluticasone, budesonide (corticosteroids)
acute exacerbations - albuterol, levalbuterol (b2 agonist)
narrow therapeutic index, drug of last resort - theophylline
blocks conversion of arachidonic acid to leukotriene - Zileuton
inhibits mast cell release of mediators, used for prophylaxis only - cromolyn
inhaled treatment that blocks muscarinic receptors - ipratropium, tiotropium
inhaled long-actin B2 agonist - salmeterol
blocks leukotriene receptors - montelukast, zafirlukast
hyperaldosteronism treatment and side effects
spironolactone, eplerone
hyperkalemia, spironolactone (adrogen antagonist –> gynecomastia in men, progesteron agonist –> menstrual irregularities in women)
neomycin
aminoglycoside
prevent bac from syn proteins by binding to the 30s subunit of the bac ribsomomes inhibitng formation of the initiation complex
toxicities: nephrotoxic, ototoxic, teratogenic
fluamide vs finasteride?
Flutamide:
for prostate CA;
competitive testosterone receptor inhibitor
Finasteride
BPH, male pattern baldness
inhibits 5 alpha reductase (T –> DHT)
bone injured when falling on an outstretch hand?
scaphoid bone is the most commonly injuryed
PCP intoxication
psychomotor agitation, impulsiveness, psychosis, belligerence, homicidality, aggression/violence, fever, tachy
*verticle and horizontal nystagmus*
interferon gamma
Th1 secreted
stimulates macrophages and inhibits T2 helper cells
benzo’s vs barbiturates?
Benzo increases the FREQUENCY of GABAa receptor Cl- channel opening
Barbiturates increases the DURATION of GABAa receptor Cl- channel opening
–> CNS depressive effects, respiratory (hypovent), CV depression (bradycardia)
NOT a good mixture with alcohol
Decompression sickness
when divers come up too quickly nitrogen gas forms bubbles in the blood
joint and muscle pain, neurologic sx (dizziness, syncope, paralysis), the chokes (sob, PE, death – occlusion in the lung)
could use carbonic anhydrase inhibitors (acetozolamide)
Clinical presentation:
resting tremor, postural instability, mask like facies
antiviral drug?
parkinsonisms
amantadine - causes increase release of dopamine
which anti-cancer drugs are responsible for restrictive lung disease
bleomycin – induces free radicals
methotrexate
busofin?
ACUTE medical treatment for esophageal varices
octreotide
antidote for digoxin tox?
digoxin immune Fab fragments (digiFab) - too expensive
most of the time give nl potassium and magnesium, give lidocaine for any arrhythmias…
What is related with a hydatiform mole?
2% of complete moles are associated with choriocarcinoma
tumor marker: b-hCG (make sure it goes down!)
incomplete paramesonephric ducts could lead to what clinical presentation?
-> bicornate uterus, which a women could present with frequent miscarriages
fallopian, uterus, upper portion of the vagina
aka: mullerian ducts
Crescent shaped hemorrhage?
Subdural hematoma
bridging veins
Test for hereditary spherocytosis?
Hereditary sperhocytosis is a defect in RBC cytoskeleton proteins such as spectrin, band 3, pallidin, ankyrin
Test: osmotic fragility test, or flow cytometry
keep putting RBC in increasing osmotic fluids, which are more fragile
Findings: microcytic, round with no central pallor, increase RDW, INC MCH
spleen –> extravascular hemolysis
negative coombs tests
Splenomegaly, gallstones, aplastic crises with stress
nucleosome
8 histoproteins in nucleosome core with DNA surrounded around
lots of + charged dna around (lysine, arginine)
Histone H1 ties nucleosomes together
Visual blackout G-force?
Visual black out
occurs at 4-6 Gs because G forces pulling blood down to the abdomen and legs and not enough going to the brain
Dorsal root ganglia
neural crest derived from ectoderm
Complements:
Which..
Opsonizes: C3b
Neutrophil chemotaxis: C5a
MAC: C5b, C6 -C9
blood supply of the adrenals
superior adrenal artery arises from teh inferior phrenic artery
middle adrenal artery arises from the aorta
inferior adrenal artery arises from the renal artery
Frequent neisseria infections?
C5-C9 deficiency
frequent pyogenic respiratory tract infections?
C3
H. influ
paroxysmal nocturnal hemoglobinuria
CD55, CD59, prevents the complement from attacking RBCs
K activating factor DAF
increased frequency of type III hypersensitivity
C3 deficiency
(ie - glomerular nephritis)
ACTH –> cushing syndrome – small cell lung CA
PTH- related peptide –> hypercalcemia – squamous cell lung CA
Erythropoietin –> polycythemia – renal cell CA, hemangioblastoma, HCC, pheochromocytoma
ADH –> SIADH – small cell lung CA, intracranial neoplasms
Homan’s sign?
Pain in the calf upon dorsiflexion
Possible DVT
Why do we see osmotic damage to some cells in diabetic pt?
glucose –> sorbitol via aldose reductase –> fructose via sorbitol dehydorgenase
Schwann cells, retina and kidneys don’t have sorbitol dehydrogenase; so the aldose reductase coverts glucose to sorbitol which then acts as an osmotic agent –> damage
type II B error
study that shows no error when in fact there is error
risk factors for osteosarcoma?
Bone infarcts, radiation, paget disease of hte bone, familial retinoblastoma, male sex, ages 10-20 yrs
cotton wool spots in the retina
chronic HTN
diabetic retinopathy
aids lupus
temporal arteritis
wegnere glume
poly adeno.
anovulation
elevated cortisol, central –> cushing syndrome
amenorrhea + hirstuism + obsesity –> PCOS
T3 and T4 production
TSH stimulation causes the uptake of iodine with a I/Na+ cotransporter… Iodine then gets exported into the colloid, there it undergoes oxidation into I- by periodixase and then organification, with the addition of thyroglobulin –> MIT or DIT then condensation into T3 and T4 boud to TG…released into the blood stream after the proteolytic removal of TG (recycled)
Active = T3
Most that is made is actually T4 but converted in the periphery
zollinger ellision syndrome
gastrinoma, gastrin secreting tumor
stimulates the release of acid into the stomach
does not respond to PPIs
duodenism or pancreas
peptic ulcers (ZE) + kidney stones + hypogonadism??
MEN 1!
recall MEN 1 is: parathyroid, pituitary and pancreatic involvement
PCOS
- adnrogen excess
- polycystic ovaries
- anovluation or oligoovualation
clomiphene = estrogen antagonist, blocking normal feedback –> increasing release of LH and FSH
–> induces ovulation
when is consent NOT required by the patient
- emergency situations
- pt lacks decision making capacity –> can’t make consent thus power of attorney or spouce
- waiver giving conset to other
Amiodarone…
what needs to be measured
PFTs, LFTs, TFTs
Pulmonary fibrosis, hepatotox, thyroid dysfunction (hypo or hyper)
corneal deposits, neuro probs, constipation, photsensitivity, blue gray skin discoloration since amiodarone is about 40% iodine by weight
when is a fetus most susceptible to teratogens??
Embryonic perio weeks 3-8, when organs are formed!
How is the body affected if stayed in space for too long?
DEC all of the following:
blood volume, RBC, muscle strength and work capacity, maximum cardiac output
LOSS of CALCIUM and PHOSPHATE from the bones –> loss of bone mass
what is the most common gynecologic neoplasm?
leiomyoma = firboids
common
smooth muslce bundles in different dirrections - whorled pattern
benign
polycythemia vera
myeloproliferative disorder bone marrow is making too many RBC
not cancerous, benign
inc plasma volume, inc red cell mass, normal O2 and decrease erythropoietin
treatment for vWd?
Desmopressin - synthetic analog of ADH
releases vWF stored in endothelium
recall that AVP - factor 8, vWD, and pressor
N-acetylcystein
- inhaled to lose mucus plugs
- orally for acetominophen overdose
- orally prophylaxis ad IV contrast induced nephropathy
granuloma annulare?
asympto (no itching, burning..)
no-scaly, slightly erythematous annular plaque
irregular, well-defined edges
thick, rope-like border (different from ring worm etc..)
small –> grows out
usually localized to the wrist, ankles,dorsal surfaces of hands/feet
Kallmann syndrome
clinical pres: hypogonadims (due to decreased synthesis of GnRH in the hypothalamus), anosmia, lack of secondary sexual characteristics
flow of blood into and out of the thyroid gland:
arterial supply:
external carotid —> superior thyroid artery
Thyrocervical trunk –> inferior thyroid artery
Venous:
superior, middle and inferior thyroid vein
First degree AV block
first degree = prolongation of the PR interval > 200 msec (.2 sec)
>5 little boxes or 1 big box
asymptomatic
Pericarditis clinical presentation
Chest pain, that is sharp and pleuritic, worse with inspiration and relieved by sitting up and leaning forward
DEC capacity of the right ventricle, fluid backs up –> JVD
w/constrictive pericarditis –> kussmaul sign = JVD with inspiration
(normally inspiration decrease intrathoracic pressure so that blood from the superior vena cava flows to the right atrium and ventricle – but constriction of the heart by constrictiv pericarditis could prevent this thus –> JVD
Friction rub doesnt coincide with any specifc part of the cardiac cycle
EKG - diffuse ST elevation and diffuse PR depression
Guaifenesin
Expectorant—thins respiratory secretions; does not suppress cough reflex
Stimulates the VAGUS NERVE to generate low viscosity secretion in the bronchial tree
NOT a cough suppresant
Encapsulated bacteria:
what test is used to detect?
What meds are used?
SHiNE SKiS
Strep pneumo
H. influ type B
N. meningitidis
E. Coli
Salmonella
Klebsiella pneumo
Strep grou B
Encapsualted bacteria are opsonized and then cleared by the spleen – their capsules serve as an antiphagocytic virulence factor
asplenics have a DEC opsonizing ability and thus incerased risk for severe infections
**give vaccines for: S. pneumo, H. influ and N. meningitis**
capsule + protein conjugate serves as an antigen in vaccines
Test: add serum that contains anticapsular antibodies – look for the QUELLUNG reaction [capsule appears to swell in response to the antibodies– quellung/swellung]
carpal bones
some loves try positions that they can’t handle
@ proximal radial side: scaphoid, lunate, triquetrum, pisiform
@ distal radial side: trapeziume, trapezoid, capitate, hamate
why do we NOT want to use
diphenhydramine – antihistamine but also anticholinergic side effects which could make elderly indviduals delirious and confused, urinary retention (also bad for BPH!)
NOT for chronic insomnia – helps people fall asleep (side effect of sedation) BUT it disrupts normal sleep architecture
CD4?
CD8?
CD4 = T helper cells
CD8 = cytotoxic T cells – bind to target cells and induce apoptosis (neoplastic cells, virally infected cells + cells from transplant donor)
What breast pathology best describes the following…
msot common breast tumor in women under 25? fibroadenoma
Most common breast mass in postmenopausal women? invasive ductal CA
most commob breast mass in premenopausal women? fibrocystic change of the breast
most common form of breast cancer? invasive ductal CA
what are the positive and negative symptoms of schizophrenia
Positive
delusions, hallucinations, disorganized speech, disorganied or catatonic behavior
Negative:
flat affect, social withdrawl, lack of motivation, lack of speech/thought
femorath sheath
deep to inguinal ligament, find: artery, vein and lymph
NOT the nerve!
femoral line
palapate the nervous pulse –> palpate the femoral artery and insert the needle medial to the artery
kluver bucy
bilateral amygdala / temporal lobe
HSV1 esp
hypersexuality, disinhibited behavior, hyperorality
too many transfusions could be bad because…
iron overload –> hemosiderosis/hemochromatosis
iron is hard to remove from the body
Cheyne-stokes respiration
repeating cycles of apnea, hypercapnia
followed by compensatory phase of hyperventilation and hypocapnia
due do diminished sensitivity to medullary center
caused by drug overdose, cerebral atherosclerosis, cerebral lesions and prolong circulation time from heart failure
what is the function of the following APO proteins
Apo A-I –> activates LCAT (necessary for the maturation of HDL)
APO B-48 –> mediates chylomicro secretion from enterocytes
APO B-100 –> binds LDL R (from the liver)
APO C-II –> removes FFA from lipid particles
APO E (on all lipoprotein particles) –> mediates extra/remnant uptake; related to numerous disorders including Alz Dz
Neostigmine
Reverse neuromuscular blockade
Ileus
Bladder atony
Physostigmine
atropine overdose
or overdose of other anti-muscarinic drugs
Edrophonium
aka Tensilon
diagnosis of myasthenia gravis
pyridostigmine
treat myasthenia gravis
echothiphate
treat open-angle glaucoma
donepezil, rivastigmine, galatamine
treat Alz Dz
clavulanic acid, sulbactam, tazobactam
used in combo with penicilins to degrade penicilinase/b-lactamse produced by bacteria that break down the penicilin structure and preven the abx from working apporpriately.
warfarin overdose/antidote?
heparin overdose/antidote?
Warfarin: vitamin K, fresh frozen plasma
heparin: protamine sulfate
vitamin D activation
- LIVER
–> 25-OH vitamin D (calcidiol)
- KIDNEY
–> 1,25 (OH)2 vitamin D (calcitriol) *ACTIVE*
How do the following drugs affect the blood pressure?
phnoxybenzamine, epinephrine, phenylephrine
phenoxybenzamine: irreversible alpha blocker
Epinephrine: alpha and beta agonist –> stimluate beta2 on vascular smooth muscle and casue peripheral vasodilation –> pressure will drop
Phenylephrine: rev alpha agonist –>pure alpha and not induce B2 mediated vasodilation thus will vasoconstrict
AC–> alpha constrict
BD –> beta dilate
Serotonin Syndrome
TOO MUCH SEROTONIN
ie) MAO + SSRI
SX: tremor, hyperreflexia, muscle, rigidity/clonus, hyperthermia, diaphoresis, flushed skin, agitation, seizures, cardiovascular collapse
- STOP drug, give BENZO + supportive care*
- if this fails –> give, cyproheptadine [blocks serotonin R]*
common carotid and jugular vein?
BTW sternocleidomastoid muscle you’ll find the cartoid artery and jugular –>common carotid is medial the internal jugular
how do you know that surfactant is at its appropriate level in a fetus?
lecithin:Sphingomyelin ratio >2:1
for lung maturity
proper name: dipalmitoylphosphatidylcholine
spooning of the nails vs clubbing of the nails:
spooning = Koilonychia –> indicative of iron deficiency
clubbing of the nails –> oxygen deprivation/hypoxemia
what are the phases of making drugs?
phase 1: assesses the safety of the drug on normal patients
phase 2: determines if the drug actually works on dz patients
phase 3: head to head trial with another drug
phase 4: post-marketing surveillance trial of pt after approval
obligate intracellualr bacteria?
Rickettsia
chamydia
coxiella burnetti
drug clearance?
CL = 0.7xVd/ half life
FOX P3??
Found on the X chromosome
Codes for Forkhead Box Protein P3
Regulatory T cells – impt for self-tolerance
absence/mutation has been implicated in AI dz, lethal immune dysregulation, polyendocrinopathy, exocrinopathy, and X-linked I PEX syndrome
Where are the following found in a lymph node?
B cells, Tcells, macrophages
amino acids necessary for purine synthesis?
glycine, aspartate and glutamine
What are langerhan cells?
What characteristic finding would you see on electron microscopy of a dendritic cell with Langerhans cell histiocytosis?
Birbeck granule
“tennis rackets” or rod shape
Collective group of proliferative disorders of dendritic (Langerhans) cells.
Presents in a child as lytic bone lesions and skin rash
or as recurrent otitis media with a mass involving the mastoid bone.
Cells are functionally immature and do not effectively stimulate primary T cells via antigen presentation
Cells express S-100 (mesodermal origin) and CD1a.
Lung cancer mets?
liver, bones, adrenal glands, brain
Lithium teratocenicity:
Ebstein anomaly
Tricupsid leaflets displaced inferiorly
RV hypoplasia
Tricuspid regurgitation or stenosis
Other anti-psychotic meds that are also teratogenic:
Carbamazepine [neural tube defects, craniofacial defects, IUGR, developmental dealy, hypoplastic fingernails]
Valporate – inhibit folate absoprtion, neural tube defects
Aripiprazole/risperidone are not technically teratogenic but can cause extrapyramidal symptoms in the newoborn
Name the glycogen storage disease:
Severe hypoglycemia with elevated lactate: Von Gierke (type I)
hypoglycemia without elevated blood lactate: Cori (type III)
cardiomegaly: pompe [trashes the pump]
Myoglobinuria associated w/exercise: McArdle disease (type V)
organophosphate poisoning?
inhibits the AChe –> increasing the ACh in the synaptic cleft
symptopms: DUMBBELSS
what is normal pulmonary artery pressure?
NL: 8-20 mmHg
Pulmonary HTN >25 mmHg
conditions associated with oligohydramions?
Polyhydraminos?
Oligo - less amniotic that nl
associated with: placental insufficiency, bilateral renal agenesis, posterior urethral valves / decrease fluid production
POTTER sequence: bilateral renal agenesis –>olighydramnios –> congenital abnormalities
P- pulm hypoplasia
O- oligohydraminos
T- twisted skin
T - twisted face
E-extremity/limb deformities
Poly- excess amniotic fluids -
esophageal or duodenal atresia, anecephaly, maternal diabetes
what are the phases of drug metabolism?
What part of metabolism of drugs do elderly people lose first?
Phase 1 reactions - elderly pop loses first!
includes - oxidation, reduction, hydrolysis
**P450**
Phase 2: conjucation reaction
essential amino acids:
PVT TIM HALL
phenyalanine
Valine
Threonine
Tryptophan
Isoleucine
methionine
Histidine
Arginine (only in children)
Leucine
Lysine
insomnia
melatonin
antihistamies (diphenhydramine)
Trazadone
TCAs - amitriptyline (heart arrythmia)
Long acting bezos - addicting (temazepam, lorazepam)
Zolpidem/ambien
Zaleplon
eszopiclone/lunesta
ramelteon
What arises from…
bulbus cordis: right ventricle and outflow tracts of left and right ventricle
left horn of sinus venous: coronary sinus
Primitive atrium - fibrous (trabeculated) portions of the left and right atria
Truncus arteriosus - ascending aorta and the pulmonary trunk
Primitive ventricle- fibrous (trabeculated) portions of the left and right ventricles
Right horn of sinus venous - smooth part of the right atrium
Right common and anterior cardinal veins - SVC
