Jen's Last-Minute Review

Question 1

glucagon: effect on cAMP?

Answer 1

increases cAMP

Incr Protein Kinase A

–> gluconeogenesis

FASTING state

Question 2

insulin: effect on cAMP?

Answer 2

decr cAMP

decr PKA

more glycolysis

FED state

Question 3

drug for pt with HTN + BPH?

Answer 3

alpha1 blockers

(doxazosin, prazosin, terazosin)

Question 4

drug for pt with HTN + coronary artery disease or CHF?

Answer 4

cardioselective beta-blockers

(metoprolol, atenolol)

Question 5

drug for pt with HTN + DM?

Answer 5

ACE inhibitors (ramipril)

ARBs (Irbesartan)

Question 6

drug NOT to use for pt with HTN + diabetes, hyperCa, or gout?

Answer 6

Thiazides

Question 7

drug for pt with HTN + vasospasm?

(Raynauds, Prinzmetal angina)

Answer 7

Ca blockers

(cerapamil, amlodipine)

Question 8

First line for essential hypertension?

Answer 8

HCTZ

(also first line for isolated systolic HTN)

(also first line for osteoporosis)

Question 9

drug for pt with HTN + pregnancy?

Answer 9

alpha2 blocker

(methyldopa)

Question 10

drugs that affect microtubules?

Answer 10

Microtubules Get Constructed Very Poorly

Mebendazole (anti-helminth)

Griseofulvin (anti-fungal)

Colchicine (anti-gout)

Vincristine (anti cancer)

Paxlitaxel (anti cancer)

Question 11

drug that halts DNA in metaphase? use?

Answer 11

Colchicine

anti-gout

used to do karyotype analysis (need chromosomes in condensed/metaphase state)

Question 12

Electron transport chain inhibitors?

(decr H+ gradient, block ATP sythesis)

Answer 12

R - A C CO

Rotenone (Complex I)

nothing (Complex II = succinate dehydrogenase)

Antimycin A (Complex III)

Cyanide, CO (Complex IV = Cytochrome C)

Question 13

ATP synthase inhibitor?

Answer 13

Oligomycin (blocks Complex V = ATP synthase)

increases protin gradient

No ATP produced

Question 14

uncoupling agents?

Answer 14

2,4 dinitrophenol (illicit weight loss)

aspirin (fever due to OD)

thermogenin (brown fat)

Question 15

muscle tissue cannot do gluconeogenesis why?

Answer 15

lacks glucose-6-phosphatase

muscle can only break down glycogen stores for its own use

Question 16

difference between odd chain FAs and even chain FAs?

Answer 16

odd chain can produce propionyl-CoA –> succinyl-CoA (source of glucose via TCA)

even chain can only produce acetyl-CoA equivalents - no new glucose.

Question 17

tissues that use the HMP shunt? (4)

Answer 17

RBCs

lactating mammary glands

liver

adrenal cortex (to synth FAs or steroids)

Question 18

isolated elevated alkaline phosphatase level indicates what disease?

Answer 18

Paget disease of bone

localized imbalance between clast and blast activity

mosaic pattern of lamellar bone

incr hat size

alk phos elevation due to incr blast activity (alk phos creates alkaline env’t for osteoid to be mineralized with Ca)

Question 19

treatment for Paget disease of bone?

Answer 19

calcitonin - inhibits osteoclast function, anti-PTH

bisphosphonates - induce osteoclast apoptosis

Question 20

complications of Paget disease of bone?

Answer 20

high output cardiac failure (AV shunts through bone!!)

osteosarcoma (incr cellular activity overall)

Question 21

most common cause of osteomyelitis overall?

Answer 21

staph aureus

invasive: alpha toxin can lyse host cell membranes, has superantigens

Question 22

most common cause of osteomyelitis in SA young adults?

Answer 22

N gonorrhea

Question 23

most common cause of osteomyelitis in sickle cell pts?

Answer 23

Salmonella

Question 24

most common cause of osteomyelitis in diabetics?

Answer 24

Pseudomonas

Question 25

most common cause of osteomyelitis in IVDU?

Answer 25

Pseudomonas

Question 26

most common cause of osteomyelitis in pts with a dog/cat bite?

Answer 26

Pasteurella

Question 27

most common cause of osteomyelitis in vertebrae?

Answer 27

Mycobacterium tuberculosis | (pott disease)

Question 28

complications of Rheumatoid arthr?

Answer 28

- pleural effusions - tophi (rheumatoid nodules) - anemia of chronic disease (chronic inf, production of acute phase reactants incl hepcidin, sequesters iron in RBCs) - secondary amyloidosis

Question 29

Reiter syndrome triad

Answer 29

arthritis (seroneg spond), urethritis, conjunctivitis (cant see cant pee cant climb a tree) *usually after a GI of chlamydia inf*

Question 30

extra-articular complications of seroneg spond?

Answer 30

uveitis aortitis (think axial skeleton and what allows you to move it/see where you're going?)

Question 31

Myasthenia Gravis associated with what other finding?

Answer 31

thymic hyperplasia or thymoma removal of thymus improves symptoms!

Question 32

Acronym for defects of Mesodermal derivatives?

Answer 32

VACTERL Vertebral Anal atresia Cardiac Tracheo-Esophageal fistula Renal Limb (bone and muscle)

Question 33

Enalapril

Answer 33

ACE inhibitor CHF, diabetic nephropathy, pulmonary HTN

Question 34

Clopidogrel

Answer 34

inhibits platelet aggregation tx for atherosclerotic ischemia, to prevent stent thrombosis

Question 35

Indomethacin

Answer 35

COX 1 and COX 2 inhibitor decreases prostaglandin synthesis anti-inflammatory, pain relief

Question 36

etanercept

Answer 36

monoclonal antibody binds TNF anti-inflammatory for RA, psoriasis, psoriatic arthritis

Question 37

bosentan

Answer 37

endothelin receptor antagonist primary pulmonary arterial hypertension

Question 38

endothelin

Answer 38

vasoconstrictor stimulates proliferation of endothelium

Question 39

metformin SE?

Answer 39

lactic acidosis GI upset renal failure (monitor serum creatinine)

Question 40

Cardio vs vascular selectivity of Verapamil Diltiazem Nifedepine

Answer 40

(all are calcium channel blockers) Most cardioselective: Verapamil Most selective for peripheral vasculature: Nifedepin Diltiazem = in the middle

Question 41

drugs with high hepatic clearance have what other qualities?

Answer 41

tend to be lipophilic (because these drugs are filtered in kidney but then re-enter circulation via prox tubule - ie, not excreted) tend to have high volume of distribution (if low distribution, don't make it to the liver)

Question 42

captopril v losartan

Answer 42

Captopril: ACE inhibitor. can cause dry cough due to increased levels of bradykinin Losartan: ARB. good for HTN & diabetes

Question 43

asthma due to atopy - treatment?

Answer 43

anti-leukotriene acetylcholine

Question 44

possible side effect with first dose of ACE inhibitor?

Answer 44

first-dose hypotension make sure patient is not on thiazide diuretics

Question 45

Thiazide diuretics: HYPER and HYPO?

Answer 45

_HYPER:_ calcium uricemia (gout) glycemia lipidemia (cholesterol) _HYPO:_ kalemia (common to all diuretics except K sparing) tension