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Imhotep > RX FLASH 258 > Flashcards

RX FLASH 258 Flashcards

1
Q

Niacin Uses

A
  • Lipid-lowering agent in patients with cardiovascular disease (reduce triglycerides and VLDL synthesis)
  • Patients w/ low HDL levels
  • And whose LDL do those not control by statins alone
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2
Q
  • Bind transport protein on enterocytes
  • Prevents cholesterol absorption
  • Modest LDL lowering effect
  • NO effect on TG or HDL
A

Ezetimibe

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3
Q

Drug of choice for patients with high levels of triglycerides

A

-Increases peripheral lipolysis
-Decreases hepatic free FA acid extraction
-Patients with HIGH levels of TGs (triglycerides)
-Lowers LDL and increases HDL
FIBRATES via PPAR-Alpha

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4
Q

Almond breath, confusion, HA

A

Cyanide poisoning
Oxygen no longer final electron acceptor in ETC→ Oxidative phosphorylation is shut down→ Anaerobic metabolism for ATP generation→ Lactate increased→ Metabolic acidosis

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5
Q

High ANION GAP METALBOLIC ACIDOSIS (CUTE DIMPLES)

A 
Cyanide→build up of lactic acid
Uremia
Toluene
Ethanol
Diabetic ketoacidosis
Isoniazid
Methanol
Propylene glycol
Lactic Acidosis (SIRS)
Ethylene glycol
Salicylates
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6
Q

5 main causes of metabolic ALKALOSIS

A

1) Loss of hydrogen ions (vomiting or renal loss)
2) Bicarbonate retention (kidneys)
3) Hypokalemia (K+ out of cell and H+ into the cell)
4) Alkalotic agents (bicarbonate or antacids
5) Contraction alkalosis (water lost as a diuretic while bicarbonate is retained)

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7
Q
  • Genital lesions

- Recurrent meningitis (wow): Signs of meningeal irritation w/ increase in CSF lymphocytes

A

HSV-2

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8
Q

Four stages of Paget’s disease

A

1) Initial (V) osteoclastic lesion (increased bone resorption)
2) Mixed period (disorganized bone formation)→ALK elevated
3) Osteoblastic-induced sclerosis
4) Quiescent (low clast and blast activity)

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9
Q

Paget’s Mixed Period (Stage 2)

A
  • ALK up
  • Phosphate normal
  • Calcium normal or a little up
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10
Q

Diagnosis of SLE = 4 of 11 symptoms (BRAIN SOAP MD)

A

Blood dyscrasias- thrombocytopenia or hemolytic anemia
Renal disorder
Arthritis
Immunologic disorder (anti-DNA/anti-smith antibody)
Neurologic Disorder
Serositis (pleuritis or pericarditis)
Oral ulcers
Antinuclear antibody (increased titers w/ out drugs associated with lupus-like)
Photosensitivity
Malar rash
Discoid rash

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11
Q

FQNs (ciprofloxacin)

A

-DNA gyrase inhibitors
-Superinfections, skin rashes, HA dizziness
UNIQUE: tendonitis, tendon rupture, cartilage malformation in children and fetus

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12
Q

IF Keegan Sturgill Mullins OVERDOSES on ADDY what will you see?

A

Sympathomimetic symptoms: pupil dilation, tachycardia, hallucinations, delusions and fever.
Tx: supportive care

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13
Q

Pupillary DILATION ()()

List 4-5

A
  • Cocaine or decongestants (ephedrine and pseudoephedrine)
  • Acid (trippin’ balls)
  • Anticholinergic syndrome (anti-histamines, atropine)
  • Opioid withdraw
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14
Q

Sumatriptan

A
  • Serotonin agonist at 5-HT1D and 5-HT1B
  • First line for acute migraine headaches
  • Can be used to treat cluster headaches too
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15
Q

Triptans can abort or reduce the severity of…

A

Migraine Headaches

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16
Q

Uses of Amitriptyline (TCA)

A
  • Migraine prophylactic
  • Depression
  • Neuropathy
  • Chronic Pain
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17
Q

Methysergide (ergot alkaloid derivative)

A
  • Ergot alkaloid derivative

- Prophylactic use ONLY for migraine attack

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18
Q

Nadolol (B-blocker)

A

-Second-line in migraine prophylaxis as well as HTN and angina
ADRs: Nightmares, paresthesias, bradycardia, fatigue

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19
Q
  • Protein important in contraction of striated muscle

- Connects the M-line to the Z-line

A

Titin (aka Connectin)

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20
Q

Vimentin

A
  • Polymerized to form intermediate filaments

- Found in mesodermal origin cells (fibroblasts)

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21
Q
  • SYRINGOMYELIA (C8-t1)
  • Spinothalamic knocked out bilaterally (sensory)
  • Cerebellar tonsils and medulla through foramen magnum
  • Anterior horn (atrophy intrinsic hang muscles) –motor
A

Arnold-Chiari Malformation Type I

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22
Q

Digoxin should be avoided in what patients?

A
  • Renal failure or hypokalemia

- These patients potentiate the effect

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23
Q

B-blockers should be used with caution in diabetic…why?

A
  • Mask signs of hypoglycemia

- Careful if on sulfonylureas (risk for hypoglycemia)

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24
Q

Digoxin MOA

A

Inhibits Na/K+ ATPase → increased INTRAcellular Na+→Increased intracellular calcium→positive inotropy

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25
Q
  • Inhibit NaCl reabsorption in early DCT (distal convoluted tubule)
  • Decrease Ca2+ excretion
  • Decrease diluting capacity of kidney
A

Thiazides (HCTZ MOA)

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26
Q

Thiazide adverse effects

A 
Hypokalemic metabolic ALKALOSIS
Hyponatremia
HYPERglycemia
HYPERuricemia
HYPERcalcemia
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27
Q

Inhibits Na/K+ ATPase → increased INTRAcellular Na+→Increased intracellular calcium→positive inotropy

A

Digoxin MOA

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28
Q

Bupropion ADRs

A
  • SEIZURES AT HIGH DOSE (lowers threshold in anorexic hoes)
  • Anxiety
  • Dizzy
  • Agitation
  • Insomnia
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29
Q

Bupropion (weird use)…Normally an antidepressant

A

-Treating patients with obesity

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30
Q

Absence seizures

A
  • Ages 3-7most common
  • Several times a day
  • Momentary LOST consciousness→resume previous activity
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31
Q

Gabapentin

A
  • GABA analog
  • Treats all seizures (EXCEPT ABSENCE)
  • and diabetic neuropathy
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32
Q
  • Drug of choice: for INITIAL seizure RX (especially in adults)
  • Effect in all seizures except ABSENCE
A

Phenytoin

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33
Q

Phenytoin mechanism

A

-Increase sodium channel inactivation by increasing the efflux and decreasing the influx of channels

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34
Q

Diazepam (long acting benzo)

A
  • Status epilepticus (>30 min)

- Increases chloride channel firing→GABA agonist activity

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35
Q

BRC-ABL (PHILLY)

A
  • CML

- Constitutively active TK→ pro growth and survival in granulocytic and megakaryocytic precursor cells

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36
Q
  • Prevents CML→ to accelerated/blast phase (acute leukemia transformation)
  • NOT A CURE (returns blood counts to normal and makes CML quiescent)
A

Imantinib

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37
Q

Daclizumab

A

-Monoclonal antibody against interleukin-2

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38
Q
  • Eosinophilic cytoplasmic inclusion bodies
  • CLEAR HALO surrounding dense core
  • ALPHA-SYNUCLEIN
A

Lewy bodies

Seen in PARKINSONS and Lewy Body Dementia

39
Q
  • Copper accumulation

- Accumulate in liver, brain and DESCEMENT membrane of cornea (KAYSER-FLEISCHER RINGS)

A

Wilson Disease (Hepatolenticular Degeneration)

40
Q

Wilson gene, chromosome and inheritance

A

AR and ATP7B gene on chromosome 13

-mutations in a hepatocyte copper-transporting ATP-ase

41
Q

Wilson Disease symptoms

A
  • Parkinsonian symptoms
  • Presents younger age
  • Liver disease as well as cognitive degeneration
  • psychiatric disease too
42
Q
  • CHIMERIC monoclonal antibody
  • TNF-alpha antibody
  • Refractory Crohn disease, RA and others
A

Infliximab

43
Q
  • Topoisomerase II inhibitor→ DNA degradation

- TX: SCLC, prostate, and testicular caner

A

Teniposide

44
Q

The cerebral vessels most vulnerable to damage by HTN are…

A

Those that supply the basal ganglia

45
Q

Spongy form change w/in the NUEUROPHIL

A
  • Seen in spongiform encephalopathies such as Creutzfeldt-Jakob, kuru, and fatal familial insomnia
  • Extensive vaculoation and neural cell loss
  • Ataxia→rapid progressive dementia→ early death
46
Q

DCLO decreases in …

A

COPD/ emphysema (diffusion limited exchange)

47
Q

TPA contraindications ( 3-4.5 hours post-event = past window)

A

Greater than:
>185 systolic BP
>110 diastolic BP
INR > 1.7

48
Q
  • Males
  • Arrest B lymphocyte development
  • No production of antibodies
  • NORMAL T-CELLS
A

X-linked (BRUTON) Agammaglobulinemia

-Bruton tyrosine kinase mutations

49
Q
  • Most common
  • Prone to candida infections and pneumocystis pneumonia
  • Excessive dATP→inhibits production of other nucleotides
  • Toxic to cells that divide rapidly (T and B lymphocytes)
  • BONE MARROW TRANSPLANT WORKS
A

SCID (ADA deficiency)

50
Q
  • T lymphocyte CD40 ligand (CDL40)

- Prevents isotype class switching by B lymphocytes

A

X-linked hyper-IgM syndrome mutation

51
Q

What is necessary for production of IgG antibodies?

A

A CD40-CD40L interaction is a necessary co-stimulatory signal

52
Q

Leading cause of death in 65+

A

Heart disease

53
Q

AAT deficiency late-stage cirrhotic liver (hepatic side of disease)

A
  • No longer produces clotting factors→ coagulopathy

- Decrease in clotting factors→ elevated PT/INR (normal=1) and PTT

54
Q

Hemochromatosis (AR) gene mutation

A 
HFE gene (C282Y>H63D) on chromosome 6
-abnormal iron sensing leading to increased intestinal absorption
55
Q

X-linked hyper-IgM syndrome mutation

A
  • T lymphocyte CD40 ligand (CDL40)

- Prevents isotype class switching by B lymphocytes

56
Q

Decreased Ceruloplasmin

A
  • Wilson’s disease (AR)

- Defect in incorporation of copper into ceruloplasmin

57
Q

Osteoporosis is defined by bone mineral density T-score of > or equal to:

A

2.5 standard deviations below the mean of the ideal population
(1-2.5 SD = osteopenia)

58
Q

Bleeding Ulcer (stomach or esophagus) = Sit upright for an hour after poppin’

A

BISPHOSPHONATES (ex: alendronate)

59
Q
  • HFE→increased iron absorption due to IMPAIRED REGULATION OF IRON STORES
  • Cirrhosis, DM, Cardiomyopathy
  • Increased transferrin saturation, Increased Iron, and Decreased TIBC
A

Hemochromatosis (AR HFE gene on chromosome 6)

60
Q

After ruling out a hemorrhagic stoke w/ imaging, it is standard to treat patients with…

A
  • Antiplatelet medications (Aspirin, Clopidogrel, Dipyridamole)
  • Clopidogrel can also be used in non-ST acute coronary syndrome
61
Q

Uses of Abciximab (antibody against glycoprotein receptor IIb/IIIa on activated platelets)

A
  • Acute coronary syndrome

- Percutaneous transluminal coronary angioplasty

62
Q

-Under-perfusion most often through the artery of Adamkiewicz

A

Anterior spinal artery syndrome

63
Q

11p13 Deletion

A 
WAGR 
Wilm’s Tumor 
Aniridia—PAX6
Genital anomalies
Mental retardation
64
Q

Sjogren Syndrome Triad

A
  • Keratoconjunctivitis Sicca (dry eyes)
  • Xerostomia (dry mouth)
  • ARTHRITIS
65
Q

Sjogren Syndrome HLA and risk

A

HLA-DR3

Increased risk of lymphoma

66
Q

Werdnig-Hoffman Disease (AR)

A
  • Degeneration of anterior horns of spinal cords

- FLOPPY BABY SYNDROME

67
Q
  • Hypochromic microcytic RBCs
  • Elevated RBC counts
  • Normal to low hematocrit
  • Target cells (also in liver disease and Hemoglobin C)
A

B-Thal

68
Q

MGUS what do you monitor?

A

M-protein and Bence Jones proteinuria periodically for the rest of their lives

69
Q

What works well in multiple myeloma but not MGUS?

A

Thalidomide

70
Q

When are helmet cells seen?

A

DIC and traumatic hemolysis

71
Q
  • IgM spike
  • Fever, weight, loss, night sweat and fatigue
  • Paraneoplastic neuropathy
  • Hyperviscosity
  • Tx: emergent plasmapheresis
A

Waldenstrom Macroglobulinemia

72
Q
  • Monoclonal gammopathy of undetermined

- Premalignant dysproteinemia

A

MGUS

73
Q

Chrug-Stauss can have preexisting asthma and allergic rhinitis and…

A

-ELEVATED EOSINOPHILS
-Lungs involved
Random symptoms: conductive hearing loss, uveitis, and muscle/joint pain
-Gastroenteritis may precede onset of other symptoms

74
Q
  • Lesion in the left parietal lobe
  • Changes in visual acuity (angular gyrus)
  • Four primary symptoms: dyscalculia, Agraphia, left/right disorientation and finger Agnosia
A

Gerstmann aphasia

75
Q
  • Fatigue
  • Insomnia
  • Difficulty concentrating
  • Irritability
  • GENERALIZED ANXIETY
  • PRESENT FOR 6 MONTHS before diagnose
A

GAD patient (comorbid depression common)

76
Q

DRUGS for GAD

A
  • Behavioral therapy (lol)
  • SSRI
  • Buspirone
  • Benzo (short term only)
77
Q
  • Depression and anxiety within 3 months of a psychosocial stressor (DIVORCE OR JOB LOSS)
  • Does not last longer than 6 months (after even is over…could be long divorce)
A

Adjustment disorder

78
Q

PTSD

A
  • Last more than a month

- At least a month after the event

79
Q

Most common initial sign of peripheral neuropathy in DM patients

A
  • Loss of vibrational sensation

- Tuning Fork test

80
Q

Where is Neuroblastoma usually found?

A
  • Adrenal Medulla (Neuroblastoma = neural crest cell orgin)

- Second most common childhood malignancy

81
Q
  • 17p deletion

- Cerebellum of child

A

Medulloblastoma

82
Q

Retinoblastoma

A
  • Inactivating mutation in both alleles of RB1

- Chromosome 13q14 (codes for tumor suppressor)

83
Q

Examples of normal tissues with stratified squamous epithelium

A
  • Skin
  • Mouth
  • Anus
  • Vagina
  • Esophagus
84
Q

Smoker’s pseudostratified ciliated columnar epithelium in bronchi →

A

Undergoes metaplasia→ stratified squamous (not an adaption in this case but rather a genetic mutation)

85
Q

Courvoisier sign:

A

Jaundice and a palpable enlarged gallbladder

Seen in patients with cancer of pancreatic head (blocking gallbladder emptying)

86
Q

Whipple Procedure

A

-Resection of the pancreatic head, duodenum and gallbladder

87
Q
  • Stone in common bile duct
  • RUQ pain esp. while eating (fatty foods)
  • TX: cholangiopancreatography and papillotomy with stone extraction
A

Choledocholithiasis

88
Q
  • Stone in gallbladder

- NO JAUNDICE and no enlarged gallbladder

A

Cholelithiasis

89
Q
  • Oncogene (transcription factor)
  • NEUROBLASTOMA
  • Amplifications in gene
A

N-myc

90
Q

Pain and Temp
C= slow, Unmyelinated fibers
A-delta= fast myelinated
All skin, epidermis, some viscera

A

Free Nerve Endings

91
Q
  • Dynamic, fine/light touch
  • POSITION SENSE
  • Glabrous (hairless) skin
  • Large, myelinated; adapt fast
A

Meissner corpuscles

92
Q

Pressure, Deep static touch (shapes, edges), position sense
Fingertips, superficial skin
Large myelinated
SLOW adaption

A

Merkel discs

93
Q

Dendritic ending with CAPSULE (adapt slowly)
Fingertips and joints
Pressure, slippage of objects along surface of skin
Joint angle change

A

Ruffini corpuscles

94
Q
  • VIBRATION and PRESSURE
  • Large myelinated fibers
  • ADAPT quickly
  • Deep skin layers, ligaments, and joints
A

Pacinian corpuscles (diabetic neuropathy)

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