Random Pearls Flashcards
What are anticholinergics and what are examples?
They block the neurotransmitter acetylcholine which inhibits parasympathetic nerve impulses.
PSNS controls involuntary movement of SM in GI, URINARY TRACT, LUNGS.
3 types
- antimuscarinics: atropine, ipratropium (atrovent), oxybutynin (bladder diff)
- antinicotinic
- ganglionic blocker
What are the hypothermia changes on ECG?
Moderate < 32
Severe < 30
Prolonged QRS, sinus bradycardia
Severe as above plus J WAVE or OSBORN WAVE CHANGES
What is ADVANCE DIRECTIVE?
Advance directive is a general term for:
- enduring power of attorney for financial matters
- enduring power of guardianship for lifestyle and health care
- medical power of attorney for medical treatment
The advanced care directive form is a written statement that describes medical treatment pt may or may not want when they are incapable of making these decisions.
What are the three drugs that interfere with renal impairment?
NSAIDs
ACE-I
DIURETICS
Overblockade of pg synthesis causing hypo perfusion
Diff between pharmocokinetics vs pharmacodynamic
Pharmacodynamics - What drug does to body
Pharmokinetics - What body does to drug
Elderly concerns when prescribing?
Poor recognition of SEs and withdrawal
Less physiological reserve
Polpharmacy
Poor adherence
What is metabolic syndrome?
Refers to the co-occurrence of different risk factors for diabetes and insulin resistance
E.g. Abdominal obesity, dyslipidaemia, HTN, hyperglycemia
Why do you get oedema in kidney disease?
Consequence of hypoalbuminemia exchanging albumin for salt and water in the kidneys
What is the only B-blocker that is almost exclusively renally cleared?
Atenolol.
Therefore can be used in end stage liver disease.
What is glibenclamide and what is it’s problem?
Sulphonurea - anti diabetic
Causes release of intra cellular calcium in beta cells and stimulates insulin release
Increased likelihood of hypo
What beta blockers for HF
Carvedilol
Bisoprolol
Extended released metropolol
Nebivolol
What is cauda equina syndrome? What signs? What clinical tests should be done?
Damage to cauda equina (bundle of spinal nerves and roots, from L1-L5 and S1-S5) causing acute loss of function in the lumbar plexus.
LMN lesion
Severe back pain Saddle anaesthesia Bladder and bowel dysfunction Sciatic type pain Sexual dysfunction
PR exam
How do you check for digoxin toxicity?
ECG - reversed tick
What is asbestosis?
It’s a pneumoconiosis (lung disease from inhalation of foreign particles) causing
1) asbestosis
2) pleural disease
3) malignancy (non SCC, SCC and mesothelioma)
What are the 4 stages of mesotheliomas?
TNM
1 - tumour confirmed to PLEURA
and is relatively small
2 - tumour grown in size IN PLEURA and spread to another tissue (diaphragmatic muscle)
3 - tumour has regional lymph node involvement
4 - tumour has distant metastases, unresectable disease
What is a suprapubic catheter?
Catheter inserted directly through to your bladder via a small hole in your belly.
What are your respiratory accessory muscles?
Inspiratory
- Sternocleidomastoid muscles
- Scalene
- Nasal flaring
Expiratory
- abdominal intercostal muscles
What is a tracheal tug?
Abnormal movement of trachea during systole down -> aneurysm of aortic arch
How do you differentiate areas of MMSE?
Delirium will have reduced attention, registration and orientation.
Vascular will have ok short term memory?
AD will have poor short term memory/recall
How do you treat CAP?
Ceftriaxone
Tazocin if severe (pseudomonas)
How do you classify diabetic foot ulcers?
1 - superficial ulcer
2 - deep ulcer, penetrate muscle or ligaments
3 - deep causing cellulitis or abcess formation, often OM
4 - localized gangrene
5 - extensive gangrene of entire foot
What is the QT interval? Why is it important? What is the corrected QT?
Time taken for depolarisation and repolarization of the ventricles.
Corrected QT takes into account the HR.
QT = QT/(square root of RR)
What is GFR? What is eGFR? What is CrCl?
Rate of flow of filtered fluid through the kidney.
eGFR is based on Creatinine level, age, sex and race
What is CrCl - volume of blood plasma cleared of creatinine per unit time
What are the stages of CKD?
Stage 1 - >/= 90 2 - 60-89 3 - 30-59 4 - 15-29 5 - < 15
What is a PICC line? Why are they preferred over central venous catheters.
Peripherally inserted central catheter.
Usually inserted into cephalic, basilic or brachial vein. Then advanced proximally to heart until it rests in the SVC.
Form of IV access that can be used for a prolonged time. Used as an alternative to central venous catheters due to high rates of infection.
What is spireva and what is atrovent?
Both used to treat COPD
Anti cholinergics that cause bronchodilation
Spireva requires HandiHaler device to inhale the dry powder. Atrovent is available as a spray.
Spiriva is tiotropium bromide
Atrovent is ipratropium bromide
What is rombergs test?
Ask the patient to close their eyes with feet together.
It’s based on the fact that you need two of the following: proprioception vestibular function (the ability to know one’s head position in space) and vision.
Rombergs takes away vision.
Why are sulphonylureas not well advocated?
Potent and long acting especially glibenclamide
What are the principles of pharmacokinetics?
Liberation - process of release of drug from pharmaceutical form
Absorption (includes bioavailability i.e. 100% IV) - process of entering the blood
Distribution - dispersion of substance through tissues
Metabolism - transformation by host once recognises foreign substance has entered
Excretion - removal of substances from body
Side effects of corticosteroids?
Myopathy Osteoporosis Weight gain Psychological/sleep disturbances Hyperglycemia Growth retardation Immunosuppressive
Immunisations for travel to Bali?
Typhoid - water
Hep A - water (usually combined with typhoid)
Hep B - tattoos, IV drugs, sex
Hep C can’t vaccinate
Rabies - 4 different shots, stay away from animals
