Know your shit. Flashcards
Back Pain Ddx? pearl? Imaging for strain,Trauma, hx of/exam issues? pearl for pts over 60yo? Tx for acute lower back pain? what is vicoden?
-Muscle strain(if unprovoked think serious)
-Aortic Aneurysm
-Disc herniation
-Nerve impingment
-Degeneratie disc dz
-Spinal stenosis
-Cauda equina syn
-IVDU;spinal epidural abscess
-prostate cancer or colon cancer metastases to the bone.
Pearl? Give it a catagory=mechanical or musculoskeletal
Imaging?
strain=no imaging
trauma=plain film, fx=MRI
hx of/exam issues=MRI
Give ptsa over 60yo vicoden not NSAIDS
Tx of acute lower back pain?
Ibuprofen 600mg
Valium
Vicoden
ice/heat
pillow between the legs
Pearl=Acetominophen and NSAIDS o.k
but, Tylenol and vicoden=No fucking way!!!
too much acetominophen
HTN Physical Exam
pearl?
Head
-Nose= HTN can cause nose bleeds
-Eye=hypertensive retinopathy=Hypertensive retinopathy is damage to the retina from high blood pressure, Using an instrument called an ophthalmoscope, your health care provider can see narrowing of blood vessels, and signs that fluid has leaked from blood vessels.
-Mouth=if pt is smoker look into the mouth
-Neck=check thyroid, carotid for bruits.
-Cardiac= listen for murmurs then ask them to lean forward as you listen.
-Abdominal=Abdominal Aortic Aneurysm
-Neuro=Always make them walk
pearl=always ask the pt(any changes recently)
HTN HPI?
Fam hx?
Social Hx?
-HPI= feel well?
pain, edema, concerns
-Fam hx=anyone else with HTN, stroke, MI, DM, Kidney Dz
-Social hx=Diet, Exercise, caffeine, stress, changes recently?
HTN ROS?
ROS=
general= wt loss?
skin=rashes, sweating?
head=cephalgia?
eye= papilledema, copper wiring, spots specks, blurred vision?
Neck=thyroid?(hyperthyroidism)
lungs=pleurisy, cough?
cardiac=everything
abdo=pain, briuts, changes in stool, neusea, vomit?
urinary=heamturis, anuria, oliguria, nocturia, ployuria, dysuria, stream issues(kidney prob), impotence
muscleskeletal=jt pain, swelling(reumatic issues)
peripheral vascular=varicose veins, ulcers?
neurologic= make them walk
hematologic=easy bruising, bleeding?
Primary (essentail) (idiopathic)HTN
red flags
age fam hx smoking obesity diet ETOH ethnicity
Secondary HTN
- results from medical conditions
- c2-h2-r2-p2
- others
Cushings, Coarctation, Contraception
Pheochromocytoma, Primary Aldosteronism
Renal Parychemal Dz, Renal vascular Dz
others=Obstructive sleep apnea, hyperparathyroidism, hyperthyroidism, drugs(stimulants)
HTN labs?
urinalysis EKG=left ventricle hypertrophy Echo=engorged ventricles D stick=DM risk CMP TSH levels CBC=Anemia, Platelets, hematocrit for baseline tox screen= opiates, stimulants, meth Serum Uric Acid test=If you give diruetics, Gout is a contra indication because diuretics will increase serum concentration of uric acid.
HTN drugs
BB
pearl=all pts with DM and HTN….
“blocker blocker…bad…bad
Propanalol=crosses BBB, slows the contraction of the heart, good to tx= angina, migriane, HTN, post MI Labetalol=does not cross the BBB, preg class C, good to tx=refractory HTN Contra=asthma, H failure, Bradycardia pearl=should be on a Ace inhibitor dont ever pt a pt on Ca+ blocker and Beta blocker together....
Alpha Antagonist what are they...what do they do contra. ADE: name 3
Blood vessels are primarily under alpha receptor control and Alpha Antagonists cause vasodilation. Not a 1st line drug but rather a combination drug.
PRAZOSIN=They are good for symptomatic b/p(helps urination) and HTN
Give at bedtime to minimize orthostatic hypertension
TERAZOSIN= ADE, asthenia(lack of strength) blurred vision, peripheral edema….
DOXAZOSIN=
Is it possible?
Its unlikely, but possible….
Ace Inhibitors what are they...what do they do contra. ADE: name 3
Suppresses the renin-angiotensin by blocking conversion of angiotensin 1 to angiotensin 2 resulting in reduced vasoprtessor activity and decrease aldosterone secretion.
BLACK BOX WARNING=pregnancy
Contra=angioedema hx
ADE= hypotension, hyperkalemia, dizziness, COUGH, ANGIOEDEMA!!!!!!(gastrointestinal)
remember the clinic for surgery?
Lotensin and Capoten
Calcium Channel Blockers (dihydropyridines) what are they...what do they do contra. ADE: name 3
A slow calcium channel antagonist. Inhibits Ca influx into cardiac muscle reducing cardiac contraction and oxygen demands of myocardium.
Contra=Rifampin
ADE= hypotension, palpitations, peripheral edema, flushing, dizziness, COUGH, dyspnea
Procardia and Cardizem, Isoptin
Loop Diuretics what are they...what do they do contra. ADE: name 3
Blocks the absorption of Na and Cl into the proximal and distal tubules causing a profound increase in urine output.
BLACK BOX WARNING=can lead to diuresis(excessive urine production) and electrolyte depletion.
Contra= Anuria
ADE= hyperuricemia(high uric acid level) hypomagnesemia, orthostatic hypotension
Lasix, Bumex, Demadex
Anti-Emetics what are they...what do they do contra. ADE: name 3
Block 5-HT3 receptors on vagal nerve and on chemoreceptor trigger zone.
ADE= constipation, xerostomia, HA, prolonged QT
Zofran, Dramamine, Reglan, phenergan, compazine
3 opiates
morphine 4-8mg Iv/Im
dilaudid 1-2mg IV/IM
fentanyl 50-100mcg IV/IM
