Step3 16 Flashcards
Varenicline use, moa, and side effects
Used for smoking cessation
Partial nicotine acetylcholine agonist
Decreases withdrawal symptoms and reduces rewarding effects of nicotine
May worsen depression or other mood disorders.
Stop medication if this happens
Screen for mood symptoms before
Indication for plasma exchange in HELLP sd
Fulminant hepatitis
Aspartate aminotranferase >2000
Lactate dehydrogenase >3000
Treatment for Seborrheic dermatitis
Topical antifungals: selenium sulfide, ketoconazole
Topical dermatitis
Topical calcineurin inhibitors (pimecrolimus)
Retreatment every 1 or 2 weeks
Treatment for tinea
Griseofulvin
Treatment for prolactinomas
Dopamine agonist
Bromocriptin, carbegoline
Surgery if medical treatment fails
Symotoms of hypoganidsm in women
Vaginal dryness
Amenorrhea
Osteoporosis
HPV vaccine recommendation
Women from 11-26 (up to 45)
Men 11-21 (up to 26)
HIV 11-21
2 doses before 15, 3 doses after 15
Not indicated in pregnancy
Hypertrigliredemia induced pancreatitis
RISK FACTORS
Familial predisposition
Uncontrolled diabetes
Hypertrigliredemia induced pancreatitis
CLINICAL FINDINGS
Meets two 2 of 3 symptoms of pancreatitis
- —– Classic abdominal pain
- —– Lipase elevation
- —– Radiologic findings
Triglycerides >1000
+/- Xanthomas
Hypertrigliredemia induced pancreatitis
Management
Supportive. IV fluids
Insulin if not severe
Apheresis if severe (fever, leukocytosis, acidosis, hypocalcemia)
Fibrates
Effect of insulin on lipids
Activates lipoprotein lipase which Increases movement of triglycerides out of the plasma into the tissue
Treatment for nausea and vomiting in pregnancy
- Small frequent meals
- B6 and H1 antihistamines
- Oral dopamine (metoclopramide) or serotonin (ondansetron) antagonist
- IV Fluids and antiemetics
- Steroids
- TPN or tube feedings
Management of acid secretions during pregnancy
H2 antagonist (cimetidine) safe
PPIs… not well studied
Laboratory findings in hyperemesis gravidarum
Hypokalemia
Hypochloremia
Metabolic alkalosis
Ketosis if starvation
Test of choice for diagnosing pneumothorax
Bedside ultrasound (in the acute setting and/or if the patient can not sit upright)
AP upright chest Xray (if there is no chance of decompensation)
Management of constipation in children
Increase fiber and water intake
Reduce milk consumption <24 oz/day
Osmotic laxative
Stimulant laxative for impaction (can cause abdominal pain)
Enema (eg. phosphate enema (open rectum and stimulate bowel muscle movement). Can cause abdominal pain, nausea, diarrhea, and electrolyte imbalance
Types of cranial hematomas
Caput succedaneum: above the periosteum, crosses suture line. Resolve in days
Cephalohematoma: does not cross suture lines. Subperiosteal bleed. Can cause hyperbilirubinemia. Resolves in weeks
Subgleal bleeding: dangerous, manage with iv fluid, serial CBC, and ICU
Parvo B19 presentation
Young children:
First: flu-like symptoms
Slapped cheek rash
Rarely arthritis
Adolescents and adults
First: flu-like symptoms
Symmetric arthralgias, Joint inflammation in PIP and metacarpal phalangeal joints
Treatment is supportive. NSAID
Remember Parvo in an adult patient with arthralgias after a cold and contact with kids
Types of arthritis in and rash associated with each one
Parvo
SLE
Lyme
Rheumatic fever
Parvo: symmetrical arthralgias PIP and MCP joint after a cold (faint malar rash in adults, kids present with slapped cheek but rarely arthralgias)
SLE: polyarticular arthritis, discoid rash, malar rash, photosensitivity, systemic symptoms
Lyme: monoarthritis, erythema migrans, tick bite. Lyme endemic area
RF: 2-4 after a throat infection. Migratory polyarthritis of big joints (knee, elbow). Erythema marginatum
Anthracyclines side effects
Doxorubicin and daunorubicin
Cardiotoxicity
Monitor with radionuclide ventriculography or MUGA (multigated acquisition scan)
Anthracline contraindicated i EF < 30%
CHEMO MAN
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