Firecracker 1 Flashcards by Caitriona McGovern

Dantrolene is used to treat which medical emergencies?

1) Malignant Hyperthermia

2) Neuroleptic Malignant Syndrome:

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: a genetically predisposed hypermetabolic syndrome caused by exposure to inhalation anesthetics or succinylcholine

Malignant Hyperthermia

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a toxic hypermetabolic side effect in patients using combination antipsychotic drugs or associated with withdrawal of L-Dopa medication. Such side effects include rigidity, autonomic instability, fever, and coma. Unlike malignant hyperthermia, there is no genetic predisposition.

Neuroleptic Malignant Syndrome:

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How do sulfonylurea drugs (eg, tolbutamide, glyburide) work?

stimulate insulin secretion by causing the closure of the ATP-sensitive K+ channels in β cells.

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Name two sulfonylurea drugs

tolbutamide, glyburide

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Name 3 long acting insulins.

Ultralente (Insulin glargine, insulin detemir, Protamine-zinc)

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What is their onset and duration of action of long-acting insulins?

Onset: 4 hr
Duration: 36 hr
Note: insulin glargine has no peak

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Acetaminophen pathways of actions

Acetaminophen reduces the oxidized form of the COX enzyme, preventing it from forming pro-inflammatory chemicals; it also also modulates the endogenous cannabinoid system. It is metabolized to AM404, which inhibits the reuptake of anandamide (an endogenous cannabinoid/ vanilloid) by neurons and inhibits sodium channels, similarly to the anesthetics lidocaine and procaine

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These drugs act to halt bone remodeling. Due to their negative charge, they bind to calcium in bones, then are engulfed by osteoclasts (which are specialized macrophages) and effectively kill them.

Bisphosphonates

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Alendronate,
Etidronate,
ibandronate, 
risedronate, 
zoledronic acid

bisphosphonates

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Important side effects of bisphosphonates →

pill esophagitis, osteonecrosis of the jaw

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High fever (hyperpyrexia)
Tachycardia out of proportion to fever
Tachyarrhythmias
Shock due to heart failure and/or vomiting
Coma

Symptoms of thyroid storm

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What artery supplies the bladder?

Internal iliac

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Valproic acid side effect

hepatotoxicity

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Topiramate side effect

kidney stones

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carbamazepine side effects

agranulocytosis, aplastic anemia

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phenytoin side effect

megaloblastic anemia

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Acts to inhibit sodium channels, T-type calcium channels, and GABA transaminase, the latter resulting in increased synaptic GABA concentrations. It is indicated as a first line therapy for generalized tonic-clonic seizures.

Valproic acid

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Clinical manifestations include increasing fever, tachycardia, tachypnea, rhabdomyolysis (brown color urine), electrolyte disturbances, and eventual circulatory collapse.

MH, caused by exposure to certain drugs used during general anesthesia (volatile agents, succinylcholine)

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Name 2 clinical conditions in which serum amylase is elevated.

↑ in pancreatitis and mumps

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what does amylase do?

breaks down starch

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Patients do not develop tolerance to which two side effects of opioids?

constipation and miosis.

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Wilms tumor chromosome

blocks voltage gated sodium channels by prolonging their inactivated state. It is indicated in the treatment of partial seizures, generalized tonic-clonic seizures, and as a first line prophylaxis of status epilepticus.

Phenytoin

Along with BLANK and BLANK, phenytoin exhibits zero order kinetics, meaning it has a constant rate of elimination.

ethanol and aspirin

the following are side effects of what med? - Neurologic signs such as nystagmus, diplopia, ataxia, and peripheral neuropathy - Sedation - Megaloblastic anemia - Gingival hyperplasia - Drug-induced SLE - Stevens-Johnson syndrome - P-450 induction - Teratogenic

phenytoin

Medullary thyroid carcinoma multiple Mucosal neuromas Marfanoid habitus Pheochromocytoma

MEN2b

Because first generation antihistamines are WHAT they can easily cross the blood-brain barrier and thus cause significant sedation. Also has mild anticholinergic effects.

lipophilic

diphenhydramine, chlorpheniramine, hydroxyzine, and brompheniramine.

first generation antihistamines

first generation antihistamines MOA

H1-receptor antagonists – prevent the action of histamine, thus reducing itching, rhinorrhea and sneezing.

Can you describe how/why C-peptide is useful?

C-peptide is essential for proper folding of insulin. Also, because of its longer half-life, C-peptide is a good indicator of insulin production and secretion in early diabetes.

What type of cell does excessive NAPQI interact with?

NAPQI binds to, and interacts with vital cellular proteins and the lipid bilayer of hepatocyte membranes

Potentiates the effect of GABA by increasing the frequency of chloride channel opening. Thus, these drugs are ineffective in the absence of GABA.

Benzodiazepines

activates AMPK→ ↑ expression of orphan nuclear receptor SHP→ inhibits expression of liver PEPCK and glucose-6-phosphatase, thus repressing hepatic gluconeogenesis. It also increases peripheral insulin sensitivity and utilization of glucose.

Metformin

Metformin side effects (3)

- GI distress (eg, diarrhea) - Weight loss - Lactic acidosis (rare, but 50% mortality when it occurs), especially in patients with underlying renal disease.

what is a biguanide?

METFORMIN

What is the mechanism of action of sumatriptan?

5HT serotonin agonist that causes vasoconstriction

sumatriptan utility

acute migraines and cluster headaches

sumatriptan toxicity

coronary vasospasm (contraindicated in patients with Prinzmetal’s angina)

Plasma cell disorders such as multiple myeloma are associated with which type of amyloidosis?

Primary amyloidosis of the amyloid light chain (AL) type

What drug can be administered to try to reverse the effects of serotonin syndrome?

cyproheptadine (a 5HT2 receptor antagonist)

What is the antidote for acetaminophen poisoning?

N-acetylcysteine (NAC), a precursor of glutathione and increases the available glutathione to conjugate NAPQI

What are some examples of systemic non-volatile anesthetics?

ketamine, propofol, droperidol, and etomidate, benzodiazepines, barbiturates, and opiates

What are common causes of nephrogenic diabetes insipidus?

- lithium - demeclocycline - hypercalcemia - sickle cell disease

nuclei with uniform staining, which appear empty

orphan annie eye inclusions (papillary thyroid cancer)

round concentric collection of calcium

psammoma bodies (papillary thyroid cancer)

GnRH, Oxytocin, ADH (V1 receptor), and TRH use what kind of signaling mechanism?

IP3-Ca2+

acts by enhancing the inhibitory effects of GABA neurons. In the context of epilepsy, it is indicated in the treatment of all seizure types except absence, as well as in the second line treatment of status epilepticus.

phenobarbital

loratadine, fexofenadine and cetirizine

2nd gen antihistamines

why are second generation antihistamines less sedating?

lipophobic

adverse effects of second gen antihistamines

mild anticholinergic effects such as dry eyes or dry mouth

approved for adjuvant therapy of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures. It has an unknown mechanism of action.

Levetiracem

Sides effects associated with levetiracetam include

dizziness, sleep disturbances, headache, and weakness.

A diabetic patient with long term analgesic use presents with hematuria and colicky flank pain. What might an IVP show to lend evidence to your suspicions?

Sloughing of papilla can be seen as a “ring defect” on intravenous pyelogram (IVP): dark lesion surrounded by bright rings of excreted contrast material.

- Platelets: Reversibly inhibit platelet activity → ↑ risk for bleeding. - Stomach: Inhibition of prostaglandin synthesis → inhibition of synthesis of protective barrier (e.g. mucus) in stomach → ↑ risk for ulcer. - Kidneys: ↑ risk for interstitial nephritis and ATN.

NSAID side effects

Describe the relationship between free serum Ca2+ levels and PTH secretion.

↓ Free serum Ca2+ causes ↑ PTH secretion

what mediates PTH release in response to low calcium

Ca2+-sensing receptors on chief cells