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Therapeutics > exam 2 > Flashcards

exam 2 Flashcards

1
Q

koebner phenomenon

A
  • trauma to an area on skin -> psoriatic patch
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2
Q

auspitz sign

A
  • if you peel of silvery scaling in psoriasis it will bleed
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3
Q

nikolsky sign

A
  • press edge of bullae/ vesicle and top epidermal layer separates
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4
Q

treatment for drug eruptions

A
  • d/c offeding agent
  • antihistamines around the clock
  • topical steroids BID for pruritis
  • PO prednisone if bad
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5
Q

SJS and TEN

A
  • TEN covers 30% or more of total body surface area
  • skin comes off in sheets
  • mucosal loss
  • admit to burn unit/ ICU
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6
Q

common causes of SJS or TEN

A
  • phenytoin
  • carbamazepine
  • piroxicom
  • allopurinol
  • vaccines
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7
Q

class I steroids

A
  • very potent
  • severe non-facial and non- intertriginous areas
  • scalp, palms, soles, on thick plaques
  • use for < 4 weeks
  • i.e. clobestasol
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8
Q

class II steroid

A
  • high potency
  • used on non-facial and non-intertriginous areas
  • i.e. mometasone, fluocinonide
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9
Q

class III-V steroids

A
  • medium potency
  • non-facial and non-intertrignous areas
  • ok on flexor surfaces for short periods
  • can use for < 6-8 weeks
  • i.e. mometasone, triamcinolone
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10
Q

class VI-VII

A
  • least potent
  • used for larger areas, thinner skin
  • face, eyelids, genitals
  • limit to 1-2 weeks on face and eyelids to avoid atrophy
  • i.e. desonide, hydrocortisone
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11
Q

steroid absorption

A
  • better absorbed in areas of inflammation and desquamation
  • ointments have higher absorption and potency
  • avoid occlusive dressings d/t atrophy and hypopigmentation
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12
Q

how do you dose steroids

A
  • based on rule of 9s
  • size of palm = 1% BSA
  • dose 0.5 grams for 2% of BSA
  • one finger tip= 0.5 grams
  • one 30 gram tube will cover an entire adult body
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13
Q

how should you treat hair and nail fungal infections

A
  • systemic anti-fungals

- dont respond well to topicals

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14
Q

what is the best treatment for candida

A
  • nystatin
  • not absorbed well in GIT
  • candida= yeast normally found on mucous membranes, GIT and skin
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15
Q

what is the best treatment for dermatophytes

A
  • allylamines
  • naftifine
  • terbinafine
  • butenafine
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16
Q

stage I HTN

A
  • 130-139/ 80-89
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17
Q

stage II HTN

A
  • > 140/90
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18
Q

lifestyle modifications to treat HTN

A
  • Na restriction to < 1500 mg/day
  • weight loss
  • exercise- 90-150 min a week
  • mod alcohol intake
  • eating K-rich foods
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19
Q

how much impact do lifestyle modifications have on BP?

A
  • each likely to reduce SBP by 3-8 mmHg, DBP by 1-4 mmHg
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20
Q

what meds should pts with HTN avoid

A
  • NSAIDs
  • decongestants
  • amphetamines
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21
Q

thiazide diuretics

A
  • net loss of Na and water in urine
  • after 4-6 weeks of tx Na balance and CO regained but BP remains low
  • decreases TPR because Na causes vascular stiffness
  • average fall in BP on low dose is 10 mmHg
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22
Q

how long does HCTZ work

A
  • 24 hours
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23
Q

were do thiazide diuretics work

A
  • distal convoluted tubules
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24
Q

ADRs of thiazide diuretics

A
  • hypokalemia -> possible torsades and sudden death
  • hyperglycemia
  • hyperlipidema (stroke risk)
  • hyperuricemia
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25
Q

at what doses are metabolic effects seen for thiazides

A
  • high doses- 50-100 mg/ day

- dont see them at low doses of 12.5-25 mg

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26
Q

name the thiazide diuretics

A
  • HCTZ
  • chlorthalidone
  • metolazone
  • indapamide
  • chlorothiazide
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27
Q

name the loop diuretics

A
  • furosemide/lasix
  • torsemide
  • bumetanide
  • ethacrynic acid
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28
Q

where do loop diuretics work

A
  • loop of henle/ thick ascending limb
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29
Q

what are the classes of k sparing diuretics

A
  • aldosterone antagonists

- Na channel blockers

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30
Q

list the aldosterone antagonists

A
  • spironoloactone

- eplerenone

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31
Q

list the Na channel blockers

A
  • amiloride

- triamterene

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32
Q

where do k sparing diuretics work

A
  • collecting ducts
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33
Q

when is renin secreted and from where?

A
  • secreted from kidneys
  • decreased arterial BP
  • decreased Na
  • increased sympathetic activity
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34
Q

what does renin act on?

A
  • angitensinogen to convert it to angiotensin I
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35
Q

how do you get angiotensin II?

A
  • angtiotensin I converted to angiotensin II via ACE
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36
Q

main role of angiotensin II

A
  • powerful vasoconstrictor
  • causes aldosterone release -> Na retention
  • mainly concerned about the ATI receptor
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37
Q

other effects of angiotensin II

A
  • vasoconstriction of renal arterioles -> glomerular damage
  • decreased NO release
  • decreased fibrinolysis in blood
  • increased thirst
  • mitogenic effect- cell proliferation
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38
Q

overall “bad” effect of angiotensin II

A
  • volume overload and increased TPR
  • cardiac hypertrophy/ remodeling
    HTN
  • myocardial infarction
  • renal damage
  • CV morbidity and mortality
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39
Q

benefits of ACEI

A
  • reverse cardiac and vascular hypertrophy
  • no postural hypotension or electrolyte abnormalities
  • safe in asthmatics and diabetics
  • reverse ventricular hypertrophy
  • increase lumen size
  • no rebound HTN
  • no hyperuricemia, lipid impact
  • renal perfusion maintained
  • prevent secondary hyperaldosteronism and K loss
40
Q

indications for ACEI

A
  • HTN
  • CHF
  • MI
  • prophylaxis of high CV risk pts
  • diabetic nephropathy
  • scleroderma crisis
41
Q

side effects of ACEI

A
  • cough d/t bradykinin inhibition
  • angioedema
  • hyperkalemia- in renal failure, k sparing diuretics, NSAIDs
  • AKI
42
Q

contraindications for ACEI

A
  • pregnancy
  • bilat renal artery stenosis
  • hypersensitivity
  • hyperkalemia
43
Q

ARBs

A
  • specific to AT1 receptors
  • less incidence of cough
  • get vasodilation
44
Q

CCB

A
  • cause SMC relaxation and vasodilation
  • non-DHPs good for rate control
  • no metabolic effects
  • no sedation
  • can be given in asthma, angina, and PVD
  • no renal or male sexual dysfunction
45
Q

contraindications for CCB

A
  • unstable angina
  • HF
  • hypotension
  • post infarct
  • severe aortic stenosis
46
Q

list some nonselective BB

A
  • propranolol
  • nadolol
  • timolol
  • pindolol
  • labetolol
47
Q

list some selective BB

A
  • metoprolol
  • atenolol
  • esmolol
  • betaxolol
48
Q

effect of BB

A
  • both classes have similar anti-HTN effect
  • reduce CO and BP slowly
  • reduce Na release
  • central sympathetic outflow reduction
  • nonselective BB reduce GFR
49
Q

advantages of BB

A
  • no postural hypotension
  • no Na and water retention
  • low incidence ADRs
  • low cost, dosed once a day
  • pref in young non-obese pts
  • prevent sudden cardiac death in post MI pts and progressive CHF*
50
Q

patients you should consider cardio-selective BB in

A
  • young non-obese HTN
  • angina pectoris and post angina pts
  • post MI pts
  • carvedilol in elderly- vasodilatory effect
51
Q

ADRs of BB

A
  • fatigue, lethargy, decreased work capacity
  • loss of libido/ impotence
  • forgetfulness
  • bradycardia
  • bronchospasm
  • c/i in insulin dependent diabetics
  • increased TG, decreased HDL
52
Q

what drugs should not be combined with BB

A
  • CCB

- NSAIDs blunt BB effect

53
Q

alpha adrenergic blockers

A
  • not used in chronic essential HTN
  • may be used for pheochromocytoma
  • really only used for BPH
  • can be adjunct when pts failing diuretics or BB
54
Q

ADRs of alpha adrenergics

A
  • postural hypotension
  • fluid retention when used as monotx- avoid in CHF
  • HA
  • dry mouth
  • weakness
  • blurred vision
  • rash
  • drowsiness
  • failure to ejaculate
55
Q

hydralazine MOA

A
  • direct acting vasodilator

- liberates NO and decreases TPR

56
Q

hydralazine indications

A
  • NOT as monotx

- only in severe or refractory HTN

57
Q

ADRs of hydralazine

A
  • rebound tachycardia
  • hypotension
  • fluid retention
  • lupus like syndrome
58
Q

mechanism sodium nitroprusside

A
  • RBCs convert nitroprusside to NO
  • direct acting vasodilator
  • rapid acting
  • reduces TPR and CO
59
Q

nitroprusside indications

A
  • HTN emergency

- improves ventricular fn in HF by reducing preload

60
Q

ADRs of nitroprusside

A
  • palpitations
  • abdominal pain
  • disorentation
  • psychosis
  • weakness
  • lactic acidosis
  • d/t release of cyanides
61
Q

methyldopa

A
  • centrally acting
  • prodrug
  • used for HTN in pregnancy
62
Q

ADRs of methyldopa

A
  • cognitive impairment
  • postural hypotension
  • pos coombs test
63
Q

HTN and CKD

A
  • ACEI and ARB preferred

- CKD- abnormal kidney structure and fn present for > 3 mo, usually classified based on albuminuria > 30

64
Q

HTN and elderly

A
  • favorable data for low dose thiazides
  • some data for DHP, CCB, ACEI
  • consider fall risk and hypoperfusion
  • tight BP regulation -> decreased blood to brain -> syncope
65
Q

HTN and blacks

A
  • thiazides and CCB preferred for monotx
  • have low plasma renin activity
  • increased Na/fluid loading
  • very responsive to thaizides
66
Q

diabetes and HTN

A
  • no role in deciding initial tx
  • ACE/ARB should be part of regimen, esp first line if albuminuria
  • prefered to reduce/ prevent nephropathy
67
Q

resistant HTN

A
  • BP above goal despite use of 3+ meds
  • usually diuretic + ACEI/ARB + CCB
  • must r/o secondary causes before you dx someone with resistant HTN
68
Q

risk factors for resistant HTN

A
  • age, female
  • high BP at baseline
  • obesity
  • salt intake
  • CKD
  • DM
  • LVH
  • AA
69
Q

secondary causes for HTN

A
  • obstructive sleep apnea
  • primary aldosteronism
  • advanced CKD or renal artery stenosis
  • volume overload
  • excessive alcohol intake
  • obesity
  • meds
70
Q

meds to check if pt is using before dx of resistant HTN

A
  • NSAIDs, COX2
  • vasoconstrictors
  • stimulants, cocaine, illicit drugs
  • decongestants
  • diet pills
  • OCP
  • steroids, cyclosporine, tacrolimus
  • erythrpoietin
71
Q

meds to treat resistant HTN

A
  • k sparing diuretics- spironolactone best
  • BB- can consider if HR > 80 bpm, usually carvedilol or labetolol
  • alpha 1 blockers if low HR and/or BPH
72
Q

PO drugs that cover MRSA

A
  • bactrim
  • clindamycin
  • tetracyclines
  • linezolid
73
Q

IV drugs that cover MRSA

A
  • vanco
  • daptomycin
  • linezolid
  • tigecycline
  • telavancin
  • ceftaroline
74
Q

drugs that cover pseudomonas

A
  • zosyn
  • cetazidime
  • cefepime
  • fluoroquinolines (only PO option from list)
  • aztreonam
75
Q

treatment for MSSA infections

A
  • dicloxacillin PO
  • nafcillin or oxacillin IV
  • cefazolin, cephalexin, cefadroxil
  • bactrim
76
Q

treatment for otitis media

A
  • amoxicillin first line
  • augmentin ES if recurrent or severe
  • ofloxacin drops- tubes or perf
  • bactrim, axithromycin or clinda if PCN allergy
  • IM ceftriaxone one dose of pt is throwing up
77
Q

risk factors for otitis media

A
  • parents who smoke
  • not breast fed
  • sleeping with bottle
  • not vaccinated
78
Q

treatment for lyme disease

A
  • doxycycline first line- 100 mg BID X 21 days

- amoxicillin or cefuroxime as alt for pregnancy or kids

79
Q

abx to avoid in pregnancy

A
  • bactrim
  • fluoroquinolones
  • tetracyclines
80
Q

abx to avoid in kids

A
  • tetracyclines
  • fluoroquinolones
  • consider child if med is administered to breast feeding mother
81
Q

fluoroquinolone ADRs

A
  • BBW tendinopathies
  • hypo/hyperglycemia
  • delirium in elderly
  • QTc prolongation
  • decreased seizure threshold
  • c/i in kids and pregnancy
82
Q

which drugs have seizure risk

A
  • all beta lactams if not dosed based on renal function
  • highst- cefepime, carbapenems
  • fluoroquinolones
83
Q

treatment for throat infections

A
  • PCN

- macrolide of PCN allergy

84
Q

most common cause of throat infections

A
  • strep pyogenes
85
Q

most common cause of otitis media

A
  • s pneumoniae
  • f flu
  • m catarrhalis
86
Q

when do you use MRI for ortho

A
  • soft tissue eval
  • occult fx eval
  • need xray first
87
Q

when do you use CT for ortho

A
  • obvious fx seen on xray -> surgical planning

- assess articular surface

88
Q

when do you use US for ortho

A
  • injection guidance

- superficial tissue eval

89
Q

treatment for stable fx

A
  • splint
  • crutches/ sling
  • RICE
  • pain meds
  • refer to ortho
90
Q

treatment for unstable fx

A
  • splint
  • pain meds
  • consult ortho
  • further imaging?
  • surgery?
91
Q

treatment for sprain

A
  • splint/ boot
  • sling/ crutches
  • RICE
  • NSAIDs/ tylenol
92
Q

treatment for tendinosis/ tendinopathy

A
  • splint/ sling
  • RICE
  • NSAIDs/ tylenol
  • PT
  • refer to ortho
93
Q

treatment for dislocation

A
  • get xrays
  • pain meds
  • reduce joint
  • crutches/ sling
  • RICE
  • refer to ortho
94
Q

treatment for disc herniation +/- radiculopathy

A
  • steroid taper
  • pain meds?
  • MRI?
  • refer to ortho
95
Q

treatment for metastatic lesions

A
  • further imaging like MRI or bone scan?
  • consult ortho
  • ORIF/ IM rodding/ hemiarthroplasty?
  • pain meds?

Therapeutics (5 decks)

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