Test 6 - IM Flashcards
A man has PMH T2DM, HTN, LV hypertrophy and ST and T segment abnormalities, and microalbuminuria. He is on glyburide and thiazide diuretic. What drug do you need to start him on?
ACE inhibitor
Why? Microalbuminuria is a sensitive marker of renal microvascular damage. Even is a patient has normal blood pressure, microalbuminuria is enough to warrant more treatment in order to avoid kidney failure. ACE inhibitors are indicated in microglobinuria both because they reduce blood pressure AND directly reduce intraglomerular pressure.
Picmonic: ACE inhibitor
.
Picmonic: Thiazide diuretic
.
Glyburide: Use, MOA,
Glibenclamide (AAN, BAN, INN), also known as glyburide (USAN), is an antidiabetic drug in a class of medications known as sulfonylureas, closely related to sulfa drugs.
The drug works by binding to and activating the ATP-sensitive potassium channels (KATP) inhibitory regulatory subunit sulfonylurea receptor 1 (SUR1) [7] in pancreatic beta cells. This inhibition causes cell membrane depolarization, opening voltage-dependent calcium channels. This results in an increase in intracellular calcium in the beta cell and subsequent stimulation of insulin release. (aka increases insulin sensitivity)
What is nimodipine? When do you give it?
Class IV anti-arrythmic: Ca 2+ channel blocker
MOA: nimodipine binds specifically to L-type voltage-gated calcium channels. There are numerous theories about its mechanism in preventing vasospasm, but none are conclusive.[8]
Originally developed for HTN, but now used to prevent the main complication of subarrachnoid hemorrhage: vasospasm
A patient presents to the ER with right sided weakness, aphasia, and urinary incontinence. Head CT shows no bleeding. What do you do?
This pt has ischemic stroke. If within 3h of onset, start tPA aka tissue plasminogen activator aka alteplase aka thrombolytic therapy
What changes do you see in diabetic nephropathy?
Proteinuria and progressive decrease in GFR
Microscopically: glomerular basement membrane changes
nodular glomerular sclerosis is hallmark but diffuse glomerularsclerosis is more common
Suspected pulmonary embolism treatment steps
- Stabilize pt with O2 and IV fluids
- Asses contraindications for anticoagulation.
- If no contraindications for anticoagulation, asses for PE with modified Wells Criteria.
- If likely PE, empirically treat with anticoagulation (low-molecular weight heparin)
- If unlikely PE, diagnostic testing before anticoagulation (usually with CT angiogram)
- If PE likely, but contraindications for anticoagulation exist, consider IVC filter.
Signs of a PE
Sudden onset pleuritic chest pain, dyspnea (shortness of breath), tachypnea (rapid breathing), and hypoxemia after a period of prolonged immobilization.
Elevated heart rate and hypotension is also often seen.
Traveler associated diarrhea that lasts longer than 2 weeks. What are the possible causative agents?
Cryptosporidium, Cyclospora, Giardia
Differentiating traveler associated diarrhea that lasts longer than 2 weeks.
Cryptosporidium: chronic illness in immunosuppressed patients
Cyclospora: may cause prolonged, relapsing infection
Giardia: common in wild/rural US areas, asymptomatic patients may continue to spred.
Alcoholic pt is presenting with signs of acute pancreatitis. What do you do?
Conservative management. Most attacks are self limiting in 4-7 days. Analgesics for pain, IV fluids, NPO so as to not irritate that pancreas further, possible NG suction to prevent gastric acid from progressing through GI tract.
What is ERCP? What is it used for?
Endoscopic retrograde cholangiopancreatography
Used for treatment of biliary pancreatitis because it allows for sphincterotomy and removal of stone. Not useful in alcoholic pancreatitis because there is no blockage.
What is AERD? Patient population most often seen in?
Asprin-Exacerbated Respiratory Disease, a pseudo allergic reaction to NSAIDS. Not IgE mediated.
Typically seen in: patients with comorbid asthma, chronic rhino sinusitis with nasal polyposis, or chronic urticaria. 10-20% of patients asthma may develop this.
Presentation of AERD? Trt?
Presentation: coughing, wheezing, nasal congestion, facial flushing within 30 minutes to 3 hours of NSAID ingestion.
Treatment: manage asthma, avoid NSAIDs.
