Test 88: All Flashcards
Venous component of internal hemorrhoids drain where
- Middle and superior rectal veins
- internial iliac vein
- inferior mesenteric vein
- portal system
What is venous drainage for external hemorrhoid
- Inferior rectal vein
- internal pudendal vein
- internal iliac vein
- common iliac vein
- IVC
Name drugs used for bipolar? which one is also used for seizure prophylaxis
- lithium
- valproate ( seizure prophylaxis)
- carbamazepine
- lamotrigine
Carbamazepine is first line treatment for what
trigeminal neuralgia
what is a common side effect for Carbamazepine
Agranulocytosis
What is a common side effect for valproate
hepatotoxicity
What is the side effect for Lamotrigine
Stevens-Johnson syndrome
What does Carbamazepine do to CYP450
inducer
Ethosuximide is the anticonvulsant choice for what type of seizure
absence seizures
Carbon tetrachloride causes what type of injury
free radical injury
carbon tetrachloride is oxidized by what system
P450
- creates free radicals
Furosemide is what drug
loop diuretic that works by inhibiting Na-K-2Cl simperers in loop on Henle
Furosemide stimulates the release of what
prostaglandin ( vasodilates afferent arteriole)
What goes wrong with concurrent use of NSAIDs and loop diuretics?
decrease diurectic response
role of endothelin
vasoconstrictor
Side effects of erythropoiesis-stimulating agents
- thromboembolic events
- hypertension
MOA of Allopurinol
- competitively inhibits xanthine oxidase
Allopruinol interacts with what drug and how
- increases conversion of azathioprine to its active metabolic
MOW of Ganciclovir
competitively inhibits incorporation of deoxyguanosine triphosphate into viral DNA
MOA for trimethoprim
inhibits bacterial dihydrofolate reductase
Tetrahydrobiopterin (BH4) is a cofactor used for the synthesis of what
tyrosine
dopamine
serotonin
What is the hallmark of phenylketonuria
intellectual disability
What is elevated and depressed in phenylkeonuria
- increased phenylalanemia
- decreased serotonin
Treatment for phenylketonuria
- low phenylalanine diet
- BH4 supplementation
Female patient comes in with abdominal pain, bloody vaginal discharge, orthostatic hypotension and a positive pregnancy test is highly concerning for
ectopic pregnancy
Why must the patient wait at least 2 weeks after discontinuing an MAO inhibitor before taking SSRI?
must allow enough time for MAO regeneration
MOA for Phenelzine
monoamine oxidase inhibitor
Name the Monoamine oxidase inhibitors
MAO Takes Pride In Shanghai
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- Selegiline
Why is co-administration of an SSRI and an MAO inhibitor contraindicated
risk of serotonin syndrome
MOA for caspofungin
glucan component of the fungal cell wall
MOW for cyclosporine
immunosuppressant
- decrease synthesis of IL-2
MOA for Fucytosine
nucleotide analog that competitively inhibits RNA synthesis in fungal cells
Propanolol can treat what endocrine problem
- decreases peripheral conversion of T4 to T3
MOA for propylthiouracil and methimazole
inhibit thyroid peroxidase
- decrease thyroid hormone
What is the dose-limiting side effect of Vincristine therapy
neurotoxicity
Common side effect for cyclophosphamide
hemorrhagic cystitis
common side effect for doxorubicin
congestive heart failure
common side effect for bleomycin
- pulmonary fibrosis
- flagellate skin discoloration
Common adverse effect of highly-active antiretroviral therapy
lipoatrophy/lipodystrophy
How is fat redistributed in viral drugs
- lipoatrophy: loss of subcutaneous fat, from face, extremities and buttocks
- central fat deposition on abdomen
What hormone increases the most after ovulation
Progresterone
Digoxin toxicity
- cardiac arrhythmias
- nonspecific GI
- neurological ( confusion/weakness)
- visual symptoms
What serum level is a sign of digoxin toxicity
elevated potassium
mechanism behind the ACE inhibitor induced cough
- accumulation of bradykinin, substance P or prostaglandins
Do angiotensin receptor blockers have a side effect of cough
no
Role of ACE
degrades bradykinin
Nonnucleoside reverse transcriptase inhibitors (NNRTIs) do not require what
do not require activation via intracellular phosphorylation
Name the NNRTI’s
Delavirdine
Efavirenz ( common)
Nevirapine ( common)
Common side effects for NNRTI
rash and hepatoxicity
Zidovudine and emtricitabine are what type of drugs
NRTI
MOA for Enfuvirtide
bind to HIV envelope gp41 and blocks fusion
MOA for Ritonavir
inhibitor of HIV protease that prevents assembly and maturation of the virus
Why should non-selective beta blockers should be given with cation to a diabetic mellitus patient
- drug exacerbates hypoglycemia
- masks its adrenergic symptoms mediated by norepinephrine and epinephrine
What is the sickle cell mutation
DNA point mutation of glutamic acid to valine at positive 6
Theophylline MOA
- adenosine receptor antagonist
- indirect adrenergic agnet
- phosphodiesterase inhibitor
Theophylline is metabolized by what
cytochrome P450
Amoxicillin and cephalexin MOA
beta-lactams that inhibit bacterial cell wall synthesis
NItrofurantion MAO
inactivates or alters bacterial ribosomal proteins
What is the drug interaction between Ciprofloxacin and theophylline
theophylline metabolized by CYP450, however Cipro increases [theophylline]
how does spinal stenosis present
- posture-dependent lower extremity pain, numbness/paresthesia and weakness
Most common causes of spinal stenosis
- intervertebral disk herniation
- ligamentum flavum hypertrophy
- osteophyte formation
Aldosterone excess causes what
- hypertension
- hypokalemia
- metabolic alkalosis
- depressed renin
Conn syndrome
Primary hyperaldosteronism
Treatment for Conn’s syndrome
Spironolactone/Eplerenone
Cribiform plate
CN I olfactory bundles
Optic canal
CN II
ophthalmic artery
central retinal vein n
superior orbital fissure
CN III, IV, V1, VI
ophthalmic vein
sympathetic fibers
Foramen rotundum
CN V2 maxillary
Foramen ovale
CN V3 mandibular
Foramen spinosum
Middle meningeal artery and vein
Internal acoustic meatus
CN VII, VIII
Jugular foramen
CN IX, X, XI
Jugular vein
hypoglassal canal
CN XII
Foramen magnum
Spinal roots of CN XI
brain stem
vertebral arteries
What muscle opens the jaw
lateral pterygoid
Third ( mandibular) branch of trigeminal nerve innervates what
- muscles of mastication ( masseter, medial and lateral pterygoids, and temporals muscles)
How is PAH excreted from blood to tubules
via carrier protein-mediated process
Characterize giant cell arteritis
granulomatous inflammation of the media
- medium and small branches of carotid artery ( temporal artery)
treatment for giant cell
glucocorticoid therapy `
Elderly women with beaches, muscular pain, and a rapid response to glucocorticoid therapy
giant cell arteritis
What is tranmural inflammation of the arterial wall with fibrinoid necrosis
polyartertis nodosa
What anti-inflammatory agent does not impair platelet aggregation
Celecoxib
MOA for Celecoxib
reversibly inhibits cox-2
How is glucose moved across cell membrane
Facilitated diffusion
Where is GLUT 4 found
skeletal muscle and adipocytes
Role of GLUT 2
export of glucose from liver, small intestines, and kidneys into circulation
What enzyme inactivates 6-mercaptopurine
xanthine oxidase
6-MP requires activation by what
HGPRT
hypoxanthine-guanine phosphoribosyl transferase
Incidence of cancer in women, top 3
- breast, lung, colon
extra renal manifestations of autosomal dominant polycystic kidney isease
- liver cyst
- intracranial aneurysm
Statins are metabolized by what? exception
P-450 3A4
- pravastatin
Erythromycin and P450
inhibits P450
The presence of erythroid precursor cells in the liver and spleen indicative of what
extramedullary hematopoiesis
Extramedullary hematopoiesis is most frequently cause by severe
severe chronic hemolytic anemias
Niemann-Pick is deficiency in what
Sphingomyelinase
What accumulates in Niemann pcik
Sphingomyelin accumulaiton
Clinical findings for Niemann pick
- hepatosplenomegaly
- neurologic regression
- “cherry-red” on macula
Patient with alcohol use, epigastric pain , and steatorrhea likely has
chronic pancreatitis
Candida is normally located where
GI tract (oral cavity)
How does cleaning something with alcohol disinfect it
disorganizing lipid structure in membranes, causing them to be leaky, and by denaturing cellular proteins
Main mechanism of excess copper removal in healthy human body is
hepatic excretion into bile
How do you reduce the risk of wrong-site surgery
“dual identifies”
- nurse and physician independently confirm
