HTFM Notes Flashcards
1st line pharm therapy for insomnia
Melatonin agonist: melatonin and ramelteon
TCAs: doxepin and mirtazapine
2nd line therapy for insomnia
Z-drugs: zolpidem, zaleplon, eszopiclone
Sedating antihistamines
Benadryl and hydroxyzine
Zyprexa
Antipsychotic drug that can be used for agitation and won’t knock pt out like haldol would
Aceon
Perinodolil- underused ACE inhibitor
Benzo potential side effects
Memory impairment Loss of coordination Daytime somnolence Dependence resp suppression Withdrawal
Theophylline can be used in severe or refractory asthma or COPD but you should lookout for these signs of toxicity
GI upset
Hypotension
Seizures
Dysthymia
Signs of MDD
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Physcomotor changes
Suicidal thoughts
PHQ 2
Do you have little enjoyment or interest in doing things?
Do you feel down, depressed, or hopeless?
SSRIs
Citalopram (Celexa) Escitalopram (lexapro) Parotixine (Paxil) Fluoxetine (Prozac) Sertraline (Zoloft) Fluvoxamine (Zyvox)
*1st line for depression
SNRIs
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
*depression tx that is particularly effective in pts with pain syndrome or significant fatigue
Bupropion
Inhibits uptake of dopamine and norepinephrine.
Wellbutrin for depression. Less GI distress and sexual dysfunction compared to SSRIs
Zyban for smoking cessation
C/I in seizure and eating disorders
Trazodone
Serotonin antagonist and reuptake inhibitor
Used for depression, anxiety, and insomnia
GAD pharmacology management
First line - Antidepressants
Second line - buspirone
Benzos for short term use only
Posterior column spinal cord tract
Vibration and proprioception
Crosses at level of brainstem/medulla
Lateral spinothalamic tract
Pain and temperature
Crosses at level of spinal cord
Anterior spinothalamic tract
Touch
Lateral corticospinal tract
Voluntary movement
Crosses at level of medulla
Brown sequard syndrome
Unilateral damage of spinal cord results in
loss of motor funct on, vibration sense and proprioception of same side and
loss of pain and temp on contralateral side
Central cord damage
Results in loss of pain and temp
Anterior spinal cord damage
Paralysis and loss of pain/temp
Compare and contrast cauda equina syndrome with conus medullaris syndrome
BOTH present with saddle anesthesia
Cauda Equina is asymmetric and presents with more severe pain and weakness. B&B are late and less severe.
Conus medullaris is symmetrical, B&B problems are early and severe.
BOTH are emergencies that need imaging and decompression
What causes transudative pulmonary effusion?
CHF (MC), nephrotic syndrome, cirrhosis, PE
What causes exudative pulmonary effusion?
Infection, inflammation, PE
Light’s criteria
The presence of ANY of these indicates exudative fluid
- pleural protein:serum protein ratio >0.5
- pleural LDH:serum LDH ratio >0.6
- pleural LDH >2/3 ULN
Important professional relationships to build in family med
- cardiologist
- dermatologist
- orthopedist
ENT(kids)
Siliocsis
Mining, quarry work, pottery, sandblasting
Modular opacities in ULF and egg shell calcification of hilar and mediastinal modes
Black lung dz/ coal worker pneumonconiosis
Small upper lobe nodules and hyperinflation
Caplan syndrome
Black lung with RA
Berylliosis
Electronics, aerospace, ceramics, dye and manufacturing
Increased lung marking and possible hikes LAD
Tx with steroids, O2, and methotrexate
Byssinosis/brown lung dz/Monday fever
Pneumoconiosis from cotton exposure
Asbestosis
Old building construction, ship yards, pipe fitters
Pleural plaques and lower lobe lung changes
Acute lipoid pneumonia
Caused by vaping or other oil inhalation
Tx with IV methylprednisone(120-500mg daily) followed by oral prednisone taper
JUPITER trial
Suppression of low grade inflammation by statins improves clinical outcomes in pts even when they don’t have CHD
Tx of otitis externa
Ciprofloxacin/dexamethasone drops
Protect war against moisture (drying agent include isopropyl alcohol and acetic acid)
Mastoiditis
Complication of prolonged or inadequately treated otitis media
CT scan needed
IV abx and myringotomy for drainages followed by possible tympanostomy tube placement
Peak ages of AOM
6-18months
4MC pathogens causing AOM
S pneumo
H flu
M cat
Strep pyogenes
If bulla on TM you should suspect this organism
Mycoplasma pneumo
Tx of AOM
10-14 d amoxicillin is DOC
Cefixime in children
Consider erythromycin-sulfisoxazole if allergic to pcn
Causes of chronic otitis media
AOM, trauma, or cholesteatoma
Tx of Eustachian tube dysfunction
- Decongestants
- Swallowing/yawning
- Intranasal corticosteroids
Presentation of cholesteatoma
Chronic otitis media and painless otorrhea
CSF for bacterial meningitis
Elevated PMN (100-10,000)
Low glucose (<45)
Elevated total protein
Increased ICP
If you suspect bacterial meningitis when do you give abx?
Immediately treat empirically for suspected bacterial
DO NOT wait for LP or CT results
If you suspect bacterial meningitis when do you get a CT before an LP?
> 60yo, immunodeficiency, hx of CNS dz, AMS, focal neurological findings, and papilledema
MC bacterial meningitis pathogens and tx based on age
<1 month: GBS and listeria. Ampicillin
1mo-50yo: neisseria meningitidis or strep pneumo. Ceftriaxione and vanco.
> 50: strep pneumo or listeria. Ampicillin and ceftriaxone
*add dexamethasone if strep suspected
Cervical cancer screening schedule
21-29: pap every 3 years
30-65: pap and HPV every 5 years
Broca’s aphasia
Damage to the left frontemporal region
Results in difficulty with language production
Wernickie’s aphasia
Damage to left temporal-parietal lobe
Results in difficulty understanding speech so pt can produce fluent speech but it’s meaningless
1st line tx for unstable bradycardia
Atropine
*exception 3rd degree block . In this case pacing is 1st line
2 “shockable” using defibrillator
Ventricular fibrillation
Pulseless ventricular tachycardia
Tx for unstable tachyarrhythmia
Synchronized cardioversion
Signs of unstable cardiac status
Hypotension
AMS
Refractory chest pain
Acute heart failure
Wide QRS stable tachycardia tx
Amiodarone
*exception WPW: procanimide if stable and cardioversion if unstable
Normal QRS stable tachycardia tx
A flutter or Afib: BB or CCB
Other: cavalier maneuvers, adenosine and then BB or CCB
How to determine cardiac axis
Look at leads I and aVF
Both positive: normal axis
Positive I and negative aVF: LAD
Negative I and positive aVF: RAD
How do you evaluate atrial enlargement?
Look at lead II for morphology of P waves and look at V1 to evaluate if p wave is more positive or negative
How do you evaluate ekg for ventricular Hypertrophy?
R: V1 R>S or R is >7mm
L: add S if V1 to R in V5or6 (>35mm in men or 30in women). R in aVL + S in V3 (>28men or 20women)
Wide QRS+slurred R in V5or6+deep S in V1=
LBBB
Wide QRS+RsR in V1or2+wide S in V6=
RBBB
MC type of PSVT
Orthodromic(narrow QRS) AV nodal reentry
Which accessory pathways cause AV reciprocating tachycardia?
Bundle of kent(WPW) and bundle of James(LGL)
Tx for narrow QRS SVT
1st: Adenosine
2nd: AV nodal blockers (BB and CCB)
Doxylamine
Antihistamine/sedative-hypnotic for insomnia
Labs to dx diabetes
Fasting plasma >126
2hr GTT >200
A1c >6.5%
Random glucose with sx >200
Impaired fasting glucose
Fasting glucose 100-125
Impaired glucose tolerance
2hr GTT 140-199
How does A1c correlate to avg blood sugar
6%= 120 7%=150 8%=200 9%=250 10%=300 11%=350
DM2 drugs that cause weight loss
glp1 and SGLT2
DM2 drugs that cause weight gain
Sulfonylureas and insulin
*same DM2 drugs associated with hypoglycemia
Long acting insulins
Glargine, Detroit, degludec
Intermediate/basal insulins
Hamlin N and Novolin N
Regular/short acting insulins
Humbling R and novolin R
Rapid acting/bolus (mealtime or correction) insulin
Glulisine, aspartame’s, lispro, apedria
