Respiratory Flashcards
Most common organisms isolated from patients with bronchiectasis
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
Drugs that cause SI ADH
Sulphylureas
Oculogyrric crisis treatment
intravenous antimuscarinic: benztropine or procyclidine
Adverse effects of cyclosporin
Adverse effects of ciclosporin (note how everything is increased - fluid, BP, K+, hair, gums, glucose)
nephrotoxicity
hepatotoxicity
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection
Quinine toxicity
Quinine toxicity (cinchonism) presents with myriad ECG changes, hypotension, metabolic acidosis, hypoglycaemia and classically tinnitus, flushing and visual disturbances. Flash pulmonary oedema may occu
Unfractionated heparin MoA
Activates antithrombin III
Patients with MI secondary to cocaine use should be given
Patients with MI secondary to cocaine use should be given IV benzodiazepines as part of acute (ACS) treatment
Salicylate overdose management
Treatment
general (ABC, charcoal)
urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
haemodialysis
Adrenaline induced ischaemia treatment
phentolamine
Herceptin monitoring/adverse effect
Trastuzumab (Herceptin) - cardiac toxicity is common
monitoring with an echo
SE of ciclosporin
Ciclosporin side-effects: everything is increased - fluid, BP, K+, hair, gums, glucose
Therapeutic drug monitoring of lithium
ithium
range = 0.4 - 1.0 mmol/l
take 12 hrs post-dose
Therapeutic drug monitoring of digoixin
Digoxin
at least 6 hrs post-dose
Therapeutic drug monitoring of phenytoin
Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:
adjustment of phenytoin dose
suspected toxicity
detection of non-adherence to the prescribed medication
Therapeutic drug monitoring of ciclosporin
Ciclosporin
trough levels immediately before dose
Loss of vision associated with which kind of poisoining
Loss of vision is seen in methanol rather than ethylene glycol poisoning
mechanism of action of allopurinol?
Allopurinol inhibits xanthine oxidase
Metformin MoA
Metformin acts by activation of the AMP-activated protein kinase (AMPK)
TCA overdose management
Management
IV bicarbonate
first-line therapy for hypotension or arrhythmias
indications include widening of the QRS interval >100 msec or a ventricular arrhythmia
other drugs for arrhythmias
+ class 1a (e.g. quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation
class III drugs such as amiodarone should also be avoided as they prolong the QT interval
response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in the management of tricyclic-induced arrhythmias
intravenous lipid emulsion is increasingly used to bind free drug and reduce toxicity
dialysis is ineffective in removing tricyclics
Mercury poisoning characteristics
Mercury poisoning can cause visual field defects, hearing loss and paraesthesia
eatures
paraesthesia
visual field defects
hearing loss
irritability
renal tubular acidosis
associated with eating fish and whale
Lead poisioning features
Lead poisoning may also result from industrial exposure. However, patients typically present with abdominal pain, constipation and neuropsychiatric symptoms as well as blue gum margin lines. Lead poisoning is not associated with visual or hearing issues a
Aspirin MoA
Aspirin decreases the formation of thromboxane A2 resulting in decreased platelet aggregation
(COX1 and COX2 irrevesible inhibitiion)
Alpha 2 action
Alpha-2
mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves)
inhibits insulin
platelet aggregation
This is why alpha 2 agonists like methyldopa and clonidine are used to treat hypertension & agitation
Beta-3 action
Beta-3 receptors are mainly found in adipose tissue where they stimulate lipolysis upon activation by sympathetic stimuli. T
Ketamine
Ketamine is an NMDA receptor antagonist
Alpha 1 MoA
Alpha-1 receptors, on the other hand, are primarily post-synaptic and mediate excitatory responses. They are typically found on vascular smooth muscle cells and cause vasoconstriction when stimulated.
e.g. metraminol, phenylephrine
Abcixumab MoA
Abciximab is a glycoprotein IIb/IIIa receptor antagonist
DOAC MoA
Directly inhibits factor Xa
Acute intermittent porphyria drugs that are safe to use
Drugs which may precipitate attack (Blood Problems Have A Sneaky Behaviour)
* Barbiturates
* Pill- OCP
* Halothane
* Alcohol
* Sulphonamides
* Benzodiazepines
what diabetic drug can cause B12 deficiency
. Metformin, an oral antidiabetic drug, can cause vitamin B12 deficiency by altering small bowel motility, leading to bacterial overgrowth and deconjugation of bile salts, which in turn impairs B12 absorption. The British Society for Haematology guidelines recommends checking B12 levels in patients on metformin if there is suspicion of deficiency.
Side effects of nicorandil:
headache, flushing and anal ulceration
SE of b blockers
- Bronchospasm (especially in asthmatics)
- Fatigue
- Cold peripheries
- Sleep disturbances
Lithium toxicity can be precipitated by ACE inhibitors
Lithium toxicity can be precipitated by ACE inhibitors
ABx that causes pulmonary fibrosis
Nitrofurantoin
Abx class that Inhibits DNA synthesis
quinolones e.g. cipro
Heparin-induced thrombocytopaenia - antibodies f
Antibodies against complexes of platelet factor 4 (PF4) and heparin. This patient has thrombocytopenia, which can be caused by heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated adverse effect of heparin therapy, where antibodies form against complexes of platelet factor 4 (PF4) and heparin. This leads to platelet activation and increased risk of thromboembolic events, despite the low platelet count.
sarcoidosis CXR findings
Sarcoidosis CXR
1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis
indications to treat sarcoidosis
If the Sarcoid cannot PUNCH, leave him alone
P-Parenchymal lung disease
U-Uveitis
N-Neuro involvement
C- Cardio involvement
H- Hypercalcemia
Contraindications to lung cancer surgery
Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
Alpha-1 antitrypsin deficiency geneotype associated with symptoms
PiZZ
Genetics
located on chromosome 14
inherited in an autosomal recessive / co-dominant fashion*
alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z for very slow
normal: PiMM
heterozygous: PiMZ
evidence base is conflicting re: risk of emphsema
however, if non-smoker low risk of developing emphsema but may pass on A1AT gene to children
homozygous PiSS: 50% normal A1AT levels
homozygous PiZZ: 10% normal A1AT levels
Light’s Criteria for exudative effusion r
Light’s Criteria for exudative effusion requires one of more of the following:
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal
Glucose is not used in Light’s Criteria.
Extrinsic allergic alveolitis (same as hypersensitivity pneumonitis) is a type III and IV reaction,
indications for placing a chest tube in pleural infection:
Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage.
The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage.
Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.
chemicals is associated with occupational asthma: most common
isocyanates
LoFGrEN’S
LoFGrEN’S - Lymphadenopathy, Fever, Girls, Erythema Nodosum, Sarcoidosis….
lung condition that prdisposes to TB
scilicosis predisposes to tuberculosis
COPD - LTOT indications
COPD - LTOT if 2 measurements of pO2 < 7.3 kPa
or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
t HRCT shows an eggshell calcification pattern.
scilicosis
responsible for malt workers’ lung?
asprgillus clavetus
