Hematologic, DMARDS, and NSAIDs Drugs

Question 1

What are the neurologic defects of vitamin B12 deficiency?

Answer 1

Ataxic gait (SCT)
Impaired position (DC) and Vibratory (LCST) sense
Spasticity

Question 2

How many 500 mg Aspirin tablets must be ingested to produce toxicity? death?

Answer 2

toxic dose = 150 mg/kg
150 mg/kg x 70 kg / 500 mg/tab = 21 tabs

lethal dose = 500 mg/kg
500 mg/kg x 70 kg / 500 mg/tab = 70 tabs

Question 3

What is the triad of aspirin hypersensitivity?

Answer 3

SAMTER TRIAD
Asthma
Aspirin sensitivity
Nasal polyps

Question 4

What is the expected acid-base abnormality in salicylate poisoning?

Answer 4

Respiratory Alkalosis with HAGMA

Question 5

What is the difference between in presentation of aspirin intoxication in children and adults?

Answer 5

ADULTS=mixed acid-base disorder (Respiratory Alkalosis with HAGMA)
CHILDREN=pure acid-base disorder (HAGMA)

Question 6

What is the difference between an inhibitor and an uncoupler of oxidative phosphorylation?

Answer 6

INHIBITORS: completely halt ETC
UNCOUPLERS: dissipate proton gradient without interrupting ETC

Question 7

What laboratory tests will you request to assess the extrinsic and intrinsic coagulation pathways?

Answer 7

PiTT = PTT for intrinsic pathway
Pet = PT for extrinsic pathway

Question 8

In patients requiring anticoagulation, why is an overlap between heparin and warfarin usually done?

Answer 8

• warfarin’s effect requires elimination of preformed clotting factors (8-60h)
• to bypass the initial prothrombotic effect of warfarin (skin necrosis)

Question 9

What is stage I of paracetamol Overdose?

Answer 9

0.5 to 24 hours –> nausea, vomiting, diaphoresis, pallor, lethargy, malaise

Question 10

What is stage II of paracetamol Overdose?

Answer 10

24 to 72 hours –> elevated liver enzymes, oliguria, azotemia, increased PT, hyperbilirubinemia

Question 11

What is stage III of paracetamol Overdose?

Answer 11

72 to 96 hours –> jaundice, hepatic encephalopathy, bleeding diatheses, acute tubular necrosis, HAGMA, coma, death

Question 12

What is stage IV of paracetamol Overdose?

Answer 12

4 days to 2 weeks –> recovery