MT Flashcards
Associated with morbid obesity and can be associated with the CNS
Central sleep apnea
Periods of apnea due to mechanical or functional blockage of flow
Obstructive sleep apnea
___ people with sleep apnea are obese
2/3
Losing weight can help improve symptoms of sleep apnea both subj and obj
Increased lung volume
Decreased pharyngeal collapse
What sleeping position can help with symptoms of sleep apnea
Side lying
Avoid ___ for sleep apnea
Alcohol
CPAP can help reduce
Hypertension which improves quality of life, reduces depression and MVA
Surgical options for sleep apnea
Removal of nasal polyps
Correcting deviated septum
Removing tonsils, adenoids, or the uvula
Restless leg syndrome
Iron supplementation is beneficial
65 mg of elemental iron given 1-3 times daily as needed
Other drugs for RLS
Alpha 2 delta drugs which affect calcium channels
Neurontin (gabapentin)
Lyrica (pregablin)
Gabapentin enacarbil (horizant)
Thiazolidinones classification
Actose
Attaches to nuclear receptors in the cells to cause an increase in production of cellular proteins that facilitate glucose transport
Actose
Side effects of actose
Can worsen CHF Stomachache pain Blurred vision Chest pain Swelling
Classification biguanides
Metformin
Does NOT increase insulin production
Helps to bind insulin to insulin receptors and potentate insulin activity
Metformin
Used to treat type 2 diabetes
Metformin
Side effects metformin
Abdominal pain
Nausea and vomiting
May interfere with the absorption of folic acid and B12 or amino acids
Patient may complain of metallic or bitter taste
Metallic or bitter taste
Metformin side effect
Insulin drugs
Novolog (RCA) Lantus (RCA) Humulin Novolin Lletin 2 Humalog (RCA)
RCA
Recombinant human analogs extracted from pork
RCA lower blood sugar by
Increasing peripheral uptake in muscles na dfat
Promotes conversion of glucose to glycogen
RCA
Most common cause of dementia in the US
Alzheimers
Accounts for 65-75% of all dementia cases in US
Alzheimer’s
Women with this tend to live longer than men
Alzheimer’s
Alzheimer’s accounts for ___ in lost productivity
100 billion
Accumulation of senile plaques in the cerebral cortex and subcortical gray
Alzheimer’s
Plaques contain ___ and are made of ____
Beta amyloid and neurofibrillary tangles
Tau protein
Depression is a risk factor for
Alzheimer’s
Low vitamin D levels
___ can help prevent dementia but insignificant for alzheimer’s
Estrogen
Smoking increases the risk for
Alzheimers
Hippocampal atrophy may be predicative in for conversion to
Alzheimer’s
Management alzheimre’s
Early and correct diagnosis are important
cannot be cured
Cognitive and behavioral problems may be managed medically
Cognitive probelms are treated with cholinesterase inhibitors such as tacrine (cognex) and donepeezil (aricept)
Inhibit the degeneration of acetylcholine at the synaptic cleft
Cholinesterase inhibitors
Disease altering strategies alzheimer’s
Ginko blioba
Vit E
NSAIDs
Elderly account for __ of prescription drug purchases and ___ of non-prescription
30%
40%
__ of the elderly must take at least one drug a day to perform ADLs
40%
Many medical physicians rely on medications to achieve treatment goals because
It cuts down on time and there is immediate patient satisfaction
The patient seeks care from multiple physicians and will ____ info on other prescriptions they’re taking
Forget or purposefully omit
The patient will take a friends and faimly members medications because
They feel they have the same symptosm
Erectile dysfunction most common cause
Diabetes
Risk factors for ED
CV disease
Metabolic syndrome
Smoking
Age
Age ED
52% higher in 40-72
Prevalence is 50-70
ED drugs
Viagra
Cialis
Levitra
Side effects ED drugs
Orthostatic hypotension
Headaches
Flushing of the skin
Avoid grapefruit adn limit alcohol intake while taking these meds
Selective cyclic guanisine monophodiesterase inhibitor
Cialis
Cialis side effects
HA Dizziness Abdominal pain Chest pain Myalgias
Phosphodiesterase 5 inhibitor
Causes vasodilation in corpus cavernous
Levitra
Side effects of levitra
Facial edeam Postural hypotension Palpations MI Angina Gout Dermatitis
Causes vasodilation in corpus cavernous in effect with nitric oxide
Viagra
Side effects viagra
Facial edema, postural hypotension, palpations, MI angina, gout, dermatitis
Enzyme blocker for phosphodiesterase type 5 causing increase in blood flow to penis
Levitra(vardenafil HCL)
Side effects levitra (vardenafil HCL)
HA
Indigestion
Flushing
Stuffy nose
OA nutritional supplements
Glucosamine and chondroitin
Those with knee ligament or meniscal injury’s demonstrated a higher risk for developing
Degenerative changes earlier
Nutrition for OA
Glucosamine 1500 mg and chondroitin sulfate 1200 mg divided into 4 servings
If someone is trying to become active they should start with
Low impact or no weight
Possible reduction in breast pain
100-400 IU/day
No side effects
Vitamin E
Cofactor in production of dopamine
400-1000 IU/day
High dosage may cause diarrhea
Magnesium
Used to treat anxiety and as a sleep aid
2-3 g taken 1-3x/day
Should only use freash
Not taken while prego or as sleep enhancers
Valerian
Works synergistically with 5 HTP also an anti-inflammatory and has analgesic properties
St. Johns wart
3x daily up to 600 mg 3x/day
Taken with 5 HTP reduce the 5 HTP dose to 100 mg/day
St. Johns wart
Side effects st. Johns wart
Possible stomach irritation, tiredness, HA, restlessness
Possible decrease in menstrual cramping
40 mg/day throughout cycle, 100mg/2 hours as peeded during menses
High dose may cause diarrhea
Magnesium and vit B6
Relieves cramping
200 mg/day, 100mg/day every 2-3 hours during cramps
Not effective unless taken 7-10 days prior to menstrual flow
Niacin
Side effects niacin
Flushing effect
HA
Stomachache
800-1000 IU/day
Taken for 3 months to determine effectiveness
Vit E
May reduce symptoms of hot flashes
1200 mg and 1200 mg of bioflavonoid hesperidin
Vit C
Side effects vit C
Diarrhea
High levels of vit C can deplete body of copper
Adaptogenic effect on female hormonal system
Dong quai
3-4g/day
Not recommended for prego or lactating
May cause sensitivity to light
Dong quai
Endometriosis is found in an estimated ___ of reproductive age women
15-20%
Mainly found in age 25-29
Laproscopy id definitive dx
Endometriosis
Classic triad endometriosis
Dysmenorrhea
Dyspareunia
Infertility
3rd most common gynecologic cancer
Cervical cancer
Considered an STD
Average age is 50
First sign is usually painful intercourse
Cervical cancer
5 year survival rate for early stage and late stage cervical cancer
80-90%
15%
Mainly in 60-65 age
Increased risk with HPV history
Poorly differentiated lesions that have spread = 15-20% 5 year survival
Small differentiated lesions 5 year survival = 70%
Vaginal cancer
2nd most common gynecologic cancer
Ovarian cancer
Cuases more deaths than the rest
Seen in areas where there is a high fat intake
Ovarian cancer
Ovarian cancer 5 year survival
5-40%
___ of women have advanced cases at time fo dx for ovarian cancer
75%
Geriatric cancer seen in women over 70
Vulvar cancer
Only 3-4% of all gynecologic cancers
Vulvar cancer
Most common presentation vulvar cancer
Palpable often visable vulvar lesions with pruritis
5 year survival widespread and local
15%
90%
Most common discharge
Candidiasis
Accounts for 15-20% of all vaginal infections
Candidiasis
Causes extreme pruritus especially at night
Candidiasis
Gardnerella accounts for 50-60% of vaginal infections
Bacteral vaginosis
Accounts for 15-20% of all vaginal infections
Trichomoniasis
Foudn when pH of vagina gets more alkaline
Trichomoniasis
Tubal disease infertility
20%
Endometriosis infertility
5-10%
Male factors infertility
20-25%
Unexplained infertility
30%
___ of asymptomatic cancer can be caught on normal breast exams
50%
Women 50 or older account for ___ of breast cancer cases
70%
Mutations in BRACA 1 gene have a higher risk for
Developing cancer
___ of women over 40 who are multiparous after age 30 account for 16% of new breast cancer cases each year
21%
Survival rate breast cancer
60%
Most recurrences develop within
2-6 years
Risk factors breast cancer
Family hx
Previous hx
Benign breast disease
Menstrual relationship before 12 or menopause after 55
Giving birth after age 30 for first time
Mutation of BRACA 1 gene inc lifetime risk by 85%
Types breast cancer
Non-invasive
Invasive
Account for 10% of breast cancers
Comedo is aggressive
Non comedo is slower growing over longer periods of time
Non invasive
Ductal carcinoma accounts for 80% of cases
Lobular carcinoma accounts for 10% of cases
Invasive
Staging breast cancer 1
Lesion less than 2 cm and no lymph involvement
Intermediary stage iwht small lesions with lymph node enlargement or larger lesions without lymph node involvement
Stage2
Larger than 5 cm, with lymph involvement
Stage3
Metastasis
Stage 4
Self imposed weight loss due to distorted body image
Anorexia nervosa
Majority anorexia are
Affluent white females 85%
Weight is 15% below expected normal
Intense fear of gaining weight even though underweight
Distorted sense of self
Absence of at least 3 consecutive menses
Anorexia
Binge purge cycle in effort to avoid weight gain
Bulimia nervosa
Seen in about half of AN patients
Bulimia
Seen in about 20% of college students
Bulimia
Parotid or salivary gland swelling Bruising of knucklesa Pharyngitis from reflux of gastric acid Dental erosions Conjunctival hemorrhages from retching Problems may arise from hypokalemic hypochloremic metabolic acidosis
Bulimia
Women are twice as likely as men to be affected
Incontinence
Incontinence affects about ___ of older males
30-50%
Bone loss in early menopause
5-10%/decade
1-5%/year
Risk factors osteoporosis
White or asian background Early menopause Lean body habitus Lack of exercise Glucocorticoids, loop diruretics, warfarin Heavy alcohol consumption Smoking Low calcium intake High homocysteine levels
X-rays can only detect osteoporosis once ___ of bone has been lost
30-50%
Most sensitive for osteoporosis
Single and dual photon absorptiometry (SPA, DPA)
DEXA is now the tool of cohice
Supplementation osteoporosis
1000mg premenopausal
1500mg post menopausal
For elderly consider vit D
