the ers in ders Flashcards
Non-enveloped, icosahedral, single stranded, (+ve) sense RNA
Group 4 replication
Picornaviridae
transmission?
enzyme?
Hepatitis A
-a very stable virus(beats acid, detergent, saltwater) but can be killed by bleach
faecal oral
(transmitted easily bc there is sheding before sx. very high transmission in children)
-group 4s have RNA d RNA p
Complications are rare and include fulminant hepatitis
hepatitis A
99% recover
hepatits B 90% recovery
also hepatitis D (or acute liver failure)
hep A vaccine
when is first does
what type of vaccine
12 months
killed/ inactivated
recommended for children +1yr, travelers, gays. can give before or after exposure
Non-enveloped, icosahedral, single- stranded, (+ve) sense RNA
Hepeviridae
Hepatitis E
group 4 needs RNA p RNA d
➢ Higher mortality rate in pregnant
women
➢ No chronic infections and no____
HEV compared to HAV
-no lab tests, treatment, vaccine, Ig marker
Enveloped, icosahedral, single- stranded, (+ve) sense RNA
Family Flaviviridae
HCV
group 4 needs RNA d RNA p
human blood is resovior
spread by piercings, tattoos, unprotected sex. Mother to baby transmission
HCV
common in HIV pts
diagnosis for HCV
vaccine?
Detection of anti-HCV antibodies using ELISA
Recombinant immunoblot assay (RIBA) also used for detection of
anti-HCV antibodies
RT-PCR used to detect viral genome in blood and liver tissue
Chronic infection is characterized by elevated liver enzymes and
detection of anti-HCV Abs and HCV RNA for at least 6 months
No vaccine
Enveloped, circular, partially dsDNA
group?
stability?
family?
Hepatitis B Virus
group 7: RNA d DNA p
group
-stable at low ph and in freezing temps
hepadna family
hbv vaccine
when is first dose
what kind of vaccine
at birth take first dose
subunit vaccine or immune globulin
Single stranded, (-ve) sense RNA, rod- shaped due to extensive base pairing
structure composition?
HDV
defective virus and needs HBV
-HDV envelope contains HBsAg derived from HBV
HDV capsid protein comprises of small (S-HDAg) and large (L-HDAg) delta antigens (HDAgs)
liver fluke or sheep liver fluke
classification?
source?
hosts?
Fasciola hepatica/gigantica - trematode parasite that is found in the liver and biliary tract of a human
from water or food
and has an intermediate host the fresh water fish with definitive host sheep, cattle, goat(herbovoirs)
fasciola life cycel
and phases of infection
immature eggs shed
eggs >miracidia
miracidia invades snails
snails made and released in cercaia. encysts on aquatic vegetation as metacercaia
-mamals injest the metacercaia**
-metacercaia become adult flukes in the mammal
acute phase: takes 2 -4 months for migration of larvae to liver with generalized flu sx
latent phase is asymptomatic while the parasite matures
chronic phase: biliary colic, no fatty foods, obstructive jaundice, pruitis
Chinese (Oriental) Liver fluke
association?
hosts?
Clonorchis sinensis (Opisthorchis sinensis)
Foodborne zoonosis associated with consumption of raw, pickled, smoked fish
first intermediate host is fresh water snail and second host is fresh water fish
Clonorchis sinensis life cycle
MCMC
most common cause of hyperpituitaryism
benign adenoma arising in the antior lobe of pituitary
-most commonly a prolactinoma
what causes hyperprolactinemia
stress, antipsychotics, oral contrceptives, antidopamine
tumor, prolactinoma
-dopamine counters prolactin
how to diagnose acromegaly
measure Gh and IGF-1
-IGF-1 is more stable and more important for diagnosis
Oral Glucose Tolerance Test with GH measuremnt(should be no GH with glucose in the body to allow insulin to work, if there is GH detected then acromegaly)
diabetes inspidedus is almost always of _________ origin
hypothalamic origin
-posterior pituitary dysfunction
Postpartum necrosis of the anterior pituitary
sheehan syndrome- hypopituitarism
-during pregnancy the antior pituitary doubles in size but may not have an inc in blood supply…hypoxia
stimulation and supression test
for. hypopituitarism
-give insulin to make the body in a stressful hypoglycemia state. also gives TRH and GnRH…ant pituitary should stip out prolactin, cortosol, and GH
pattern of likelyhood for pititaryh hornome deficiencies
GH(children only) > LH/FSH > TSH > ACTH
most common cause of hyperthyroidism
graves disease - diffuse hyperplasia
AI dz with HLA association
second most common cause is toxic multinodular goiter
types of thyroiditis
causes hyperthyroidism
- DeQuervian-Subacute thyroiditis(thyroid painful, tenderness, fever)
- postpartum bc of natural immunosupression during pregnancy
- hashitoxicosis: hyperthryoid bc of hashimotio thyroiditis
Characterized by high TSH levels and normal FT4/FT3 levels in an asymptomatic individual
subclinical hypothyroidism
-Can convert to hypothyroidism, especially if anti-thyroid antibodies present
antibodies are present in high titres in Hashimoto’s disease vs graves dz
Antimicrosomal (antithyroid peroxidase), and antithyroglobulin antibodies
Thyroid stimulating immunoglobulins (TSI) occur in Grave’s disease (is against TSH-R)
pretibial myxedema
graves disease
infiltrative dermopathy
Characterized by HLA-associated antibody-mediated immune destruction of
thyroid cells
hashimoto disease
-most common hypothyroid dz
Cretinism
congenital hypothyroidism
-causes multi system impared development
Psammoma bodies
dystrophic calcifications ( concentric
laminated) found in pappillary carcinoma of the thyroid
Nuclei have longitudinal grooves, intranuclear inclusions and appear optically clear due to finely dispersed chromatin
orphan annie nuclei seen in pappillary carcinoma of the thyroid
pappillary carcinoma mutations
Pathogenesis is related to several gene mutations like BRAF, and
rearrangements of RET proto-oncogene
Major risk factor predisposing to papillary carcinoma
exposure to radiation
More frequent in areas with dietary iodine deficiency
follicular carcinoma of thyroid
-follicules are well differentiated
common sites of metastisis for follicular carcinoma of thyroid
bones and lungs
follicular carcinoma of thyroid mutations
RAS and PIK3CA proto-oncogenes
Originate from the parafollicular cells (C-cells) of the thyroid and produce_________
medullary carcinoma of thyroid
-calcitonin which can be desposited as ACal amyloid
mutations for medullary carcinoma of thyroid
RET mutation
can be associated with MEN 1/2
Composed of chromaffin cells, which synthesize
adrenal medulla
synthesize and secrete catecholamines
primary vs secondary hyperaldosterism
primary is conns syndrome(idiopathic of neiplastic)
secondary is inc activity in RAAS system bc of alcohol cirrhosis or hypertensive renal problem
both causing sodium retention
hyperaldosterism clinical features
hypokalemia, metabolic alkolosis, hypertension
tests for hyperaldosterism
- Increased Aldosterone : Renin Ratio (inc ARR) (Screening test)
confirmatory test: oral sodium loading test
-Fludrocortisone suppression test (FST): Cause low urinary and plasma aldosterone levels in normal people
Primary acute adrenal crisis/insufficiency due to hemorrhagic necrosis due to______
leading to___
Waterhouse Friderichsen Syndrome
Due to overwhelming bacterial infection, classically Neisseria meningitidis septicemia which causes acute loss of adrenal cortical cells
leads to DIC and eventually hypotensive shock
Chronic adrenocortical insufficiency resulting from progressive destruction of the adrenal cortex(cortical cells)
addisons disease
-all secretions will be decreased
can be AI or can be from Tb infection
most common causes of addisons disease
AI
infections from tuberculosis, AIDS, meningitis
from lung and breat metastisis
elevated levels of pro-opiomelanocortin (POMC)
causes hyperpigmentation in addisons disease
(which is derived from the anterior pituitary and is a precursor of both ACTH and melanocyte stimulating hormone)
Cosyntropin test
screening test for addisons
-invovles administration of ACTH and watching is any adrenal hormones get released
etiology of SIADH
small cell carcinoma of lung/paraneoplastic tumor that is releasing ADH, or local injury to hypothalamus or pituitary
Thyroid parenchyma contains a dense lymphocytic infiltrate with germinal centers. Residual thyroid follicles lined by deeply eosinophilic metaplastic
follicular cells called Hürthle cells
Hashimoto
Neoplasms composed of chromaffin cells
pheochromocytoma
Li Fraumeni syndrome
adrenal cortex carcinoma
?when the tumor metastasize to the veins
pheochromocytoma inherited mutation risks
MEN 2a and 2b,
Neurofibroma type 1,
Von Hipple Lindae
zellballen
nests of cells in a pheochromocytoma in the chromaffin cells
Tumors of the sympathetic ganglia and adrenal medulla that are derived from primordial neural crest cells populating these sites
medullary adrenal tumors
Homer-Wright pseudorosettes
neuroblastoma
-cells will be dense, not active, not productive
complications of DM
end stage renal disease
gangrene
ischemic heart disease
adult blindness
causes of secondary DM
Infection: CVM, Mumps, Coxasaxie B, rubella
drugs and toxins
pancreatic disease
hormonal antagonist secretion(cortisol, GH, catecholamines)
genetic: downs and turner
gestational DM
HLA-DR3 & DR4/DQA1& DQB1
DM1
role of obesity in DM insulin resistance
induced by adipokines, free fatty acids, and chronic inflammation in adipose tissue
Pancreatic β cells compensate for insulin resistance by hypersecretion of insulin…until compensation mechanism fails
management of diabetic keto acidosis
-saline solution for rehydration,
-insulin IV
-potassium supplements
-bicarbonate sometimes
due to severe dehydration resulting from sustained osmotic diuresis
Hyperosmolar Hyperosmotic Syndrome
-you got diabetes and you dont drink water…in DN2 there is relative insulin insufficiency which will prevent ketoacidosis but will not prevent hyperglycemia and then the dehydration
parathyroid adenoma mutation
MEN1 mutation and Cyclin D1 gene rearrangement
Decreased responsiveness of target organs because of problems with PTH receptors
* Sex-linked; males affected twice as often as females
* Skeletal features : short stature, short metacarpals and short metatarsals
* Other features: cataracts, mental retardation and testicular atrophy
pseudohypoparathyroidism
PTH in the blood but defective
protozoal agents that cause bloody diahrea
misc protozoal GI
Enteamobea histolytic
Balantidium coli
Misc: Giardia, Intestinal: Cystoispora belli, Cyclospora (immunocompromised will get chronic diahrea)
Motile protozoa
* Mature Cysts contain four nuclei, Trophozoites are motile
via pseudopodia
Entamoeba histolytica
irregular shaped trophozoites with 1 nucleus and may contain ingested RBCs, and/or spherical cysts with 1, 2 or 4 nuclei.
Entamoeba histolytica
O&P
anchovy sauce
Entamoeba histolytica
the reddish brown aspirate from a amebic extra intestinal disease
A flask shaped ulcer
in intestinal epithelium
Entameba histolytica
Ciliate protozoan (50-200 μm)
* Cyst and trophozoite stage
-primary resovior:
Balantidium coli
pigs
Balantidium coli complication
fuliment colitis which can lead to colonic ulcers or intestinal perforation
Flagellate protozoan
* Trophozoites have an unmistakable pear-shaped appearance with 2 nuclei and 4 pairs of flagell
Mature cysts are spherical with 4 nuclei and resistant to ________ and resovior_____
Giardia intestinalis
resistant to: chlorine and stomach acid
resovior: beavers, cats, dogs
After an incubation period of 1-2 weeks, (after ingestion of as few as 10 cysts) symptom onset may be gradual or dramatic, with diarrhea, foul smelling, greasy stools, bloating, nausea, and flatulence. Lactose intolerance, protein and fat malabsorption (steatorrhea) may result.
G. intestinalis
infection and diagnostic as a cyst
Fecal microscopy with Direct Fluorescence antibody (DFA) test kites
G. intestinalis
Non-motile coccidian parasite
(22-33 μm)
* Displays both sexual and asexual replication
-different infective and diagnostic stages?
clinical present?
Cystoisospora belli
I: mature oocyte
D: Immature Oocyte
presents: watery diahrea with ab cramps
Fecal O&P examination (wet mounts) for oocysts
Modified Ziehl-Neelsen (Acid-Fast) staining
Autofluorescence with UV fluorescence microscope
Cystoisospora belli and Cyclospora cayetanensis
diagnostic tests
Non-motile coccidian parasite
(8-10 μm)
* Displays both sexual and asexual reproduction
* Oocysts requires sporulation before becoming
infective
clinical present?
Cyclospora cayetanensis
watery diahrea
helminths that primarily cause GI distress
vs helminths that are migratory and have GI distress
just GI: Enterbius vermis, trichurus trichuria, diphyllobothrium, hymenolpis nana
migratory too: Ascarias limbricodiosis, Acyclostoma duodenale/ neccator americanus, strongylodosis
Nematode, 6-13 mm
* Transparent, oval, planoconvex eggs
sx?
diagnostic?
Enterobius vermicularis (Pinworm) causes itchy butt
Cello-tape/Scotch tape for EGGS (diagnostic stage)
Nematode, 30-45 mm
* produces barrel-shaped, bi-
operculate or bi-polar eggs
Trichuris trichiura (Whipworm)
bi polar eggs are diagnostic
Trichuris trichiura (Whipworm) complications in general and in children
general diahrea, peripheral blood eosinophilia, asx
children: iron deficiency anemia(microcytic), rectal prolapse, dec growth
Cestode, largest (up to 30 feet)
* Requires 2 intermediate hosts:
infective and diagnostic stage?
Diphyllobothrium latum (Fish tapeworm)
small crustaceans
(copepods) and freshwater fish
-very common in raw fish…infective stage is the larvae
-diagnostic: eggs in feces
Parasite competes with host for dietary Vitamin B12 leading to Vitamin B12 deficiency
Diphyllobothrium latum (Fish tapeworm)
causes megaloblastic anemia
Cestode, 7-50 mm
* Eggs are immediately infective making person to
person transmission and autoinfection possible
diagnostic and infective stage
Hymenolepis nana (Dwarf tapeworm)
both diagnostic and infective is egg
nematode with knobby-coated oval eggs
Ascaris lumbricoides (Roundworm)
Loeffler’s syndrome
seen in Ascaris lumbricoides and Strongyloidioes
Tracheal irritation, pulmonary eosinophilia and patchy infiltration
-makes it look like pneumonia but its not
- Nematode, 9-11 mm
- Filariform larva is infective stage
clinical presentation
Ancylostoma duodenale & Necator americanus (Intestinal Hookworm)
macule and papulaes upon sight on penetration, iron def anemia
infection migratory, starts in the lungs gets coughed up and then swallowed into the GI
Ancylostoma duodenale & Necator americanus (Intestinal Hookworm)
and
Strongyloides stercoralis (Threadworm)
Microscopic identification of rhabditiform larvae in stool sample
Strongyloides stercoralis (Threadworm)
Wermer syndrome
-what is is
-what is the mutation
aka MEN1
Inclined to tumors of the 1. parathyroid 2. anterior pituitary 3. pancreatic (gastrinoma, insulinoma, VIPoma, glucagonoma
mutation in the MEN1 *tumor suppressor gene which encodes menin
ZES
PUD of stomach, duodenum, and jejunum bc of pancreatic tumor and too much gastric acid
aka gastrinoma
RET proto- oncogene on chromosome 10
MEN2A and B mutation
MEN2A characterized by
- pheochromocytoma, 2. *medullary carcinoma of the thyroid, and 3. parathyroid hyperplasia
MEN2B
*Medullary Thyroid Cancer (MTC) and pheochromocytoma but not hyperparathyroidism
-more severe side complications then MEN2A with all kinds of neonatal deformities and damaged mucosal neurons
Chelation by EDTA and hypoalbuminemia caused by
hypocalcemia
also causes tetany and uncontrolled cramps
hyperphosphatemia seen in
hypoparathyroid
causes deposition of calcium salts into normal tissue
hyperphosphatemia with also high calcium
BPH treatment
5-alpha reductase inhibitors (e.g., finasteride
TURP procedure– Transurethral resection of prostate
what are contributing factors to prostatic adenocarcinoma
–inc androgens(any),
-carcinogens (esp. red meat), -MYC oncogene mutation or loss function of BRCA2 or mismatch repair genes like in Lynch syndrome
-Prostatic intraepithelial neoplasia(PIN)has been recognized as a precursor lesion
besides hepatitis virus what are other infectious organisms to cause hepatits
HSV, EBV, CMV, Yellow Fever Virus YFV
What makes HAV stable and unstable
stable: acid
instable: chlorine, heat, formalin, radiation
hep B is also stable in acid and in cold temps
Dane particle
Hep b
HEP b structure
-envelope has 3 glycoproteins HBsAg(S, M, L)
-core has core protein is HBcAg,
-Reverse Transcriptase, and viral DNA genome
-will also see non infective particles: long filament, spheres
-hep D has HBsAg (S, L ) from this
MHC class I–restricted, CD8+ cytotoxic T lymphocytes: Directed against multiple epitopes on core, polymerase and envelope of this virus
HEP b
-not directly cytopathic to the liver its the immune
-this is cell mediated immunity
window period
hep B when there is no detective HBsAg or Anti-HBs at about month 5 of exposure
to avoid this issue test the Anti-HBc
not seen in chronic hepatitis( no anti-HbC)
Hep B carriers in serum
All carriers have anti-HBcAg and some anti-HBeAg
Anti-HBc-Ab always present
hepatitis treatment
Treatments include:
C
➢ Interferon
➢ Antivirals-polymerase inhibitors (nucleoside/nucleotide analogs)
➢ Antivirals-protease inhibitors (unique to HCV)
B
➢ Interferon
➢ Antivirals-polymerase inhibitors (nucleoside/nucleotide analogs)
D
➢ Interferon alpha
E nothing
A vaccine
cholangitis, biliary hyperplasia, obstruction, cholangiocarcinoma
organism
clonorchiasis
/ opisthorchiasis
hepatic fibrosis and necrosis, cholangitis, biliary obstruction, biliary cirrhosis
fascialiasis
operculated, broadly ellipsoidal
Fascioliasis
Clonorchis sinensis (Opisthorchis sinensis)
what are the NTs and the R for release of gastric acid
Histamine to H2(Gs)++
PGE2 to EP3(Gi) –
Gastrin to CDDKa(Gq) ++
Ach to M3(Gq) ++
gastrin and ash released from vagus
all towards the proton pump
antacids with coadministeration of _____________ causes decreases absorptoipn
tetracyclines, fluoroquinolones, itraconazole and iron
major AE of all H2 antagonists
Increased gastric pH: B12 deficiency and myelosuppression
cimetidine has a bunch tho(anti-androgen and CNS effects)
contraindications for cimetidine
it is a potent inhibitor for CYP 450 so will make the high/ toxic concentrations of Warfarin, Diazepam, Phenytoin
AE for PPIs
B12 def dec reduced pepsin, inc risk for C.diff, osteopenia(hip fractures)
contraindications for omeprazole
like cimetidine it is also a a cyp450 inhibitor so will cause inc/toxic levels of Warfarin, Diazepam, Phenytoin
Clopidogrel oppositely will never activate with cyp450 inhibited instead give R/P-stazole
- Stimulates mucus and bicarbonate secretion * Enhances mucosal blood flow
mucosal protective agents
Approved for prevention of NSAID-induced ulcers
misopristol
Forms a viscous paste that binds selectively to ulcers according to pH
Sucralfate
initial management of gastroesophageal reflux
disease in pregnancy
sucralfate
Suppresses H. pylori (has no neutralizing action on gastric acid)
other uses
Bismuth Subsalicyalte
also used for travelers diahrea and dec fluid secretion
Bismuth Subsalicylate
side effects and contraindications
side effect: black stool (harmless)
contraindications: renal failure
Used for long-term maintenance of IBD remission
Aminosalicylates
or for mild presenting
pro kinetic agent targets
motilin, serotonin, Ach
onto the enteric nerve to enhance coordinated Gi mobility
which pro kinetic drugs effect what receptors
erythromycin: motion(block causes dec in R and rapid tolerance to this drug)
cisapride: 5HT4 agonist and 5HT3 antagonist(smooth muscle stim)
metoclopramine: 5HT4 agonist, 5HT3 central and vagus antagonist, D2 antagonist(confined to the upper GI functioning)
cisapride AE
ventricular arythmies
metoclopromide AE
Extrapyramidal effects due to DA antagonism
-unopposed prolactin causes galactoria
antiemetics for motion sickness
anti-muscarinics, H1 antag
both also used for postoperative N/V
D2 antag as well but also used for mild CINV
act on vestibular afferents and the brain stem
H1 antagonist ant-emetics
Central Dopaminergic Blockade
- Potential for adverse extrapyramidal effects - Prolongation of QT Interval
Droperidol
drug of choice for prophylaxis against Acute CINV
5HT3 antagonist
**not effective in delayed CINV or motion sickness
Highly effective adjuvants in the treatment of nausea in patients with metastatic cance
Corticosteroids
Via suppression of peritumoral inflammation and prostaglandin production
NK1 antagonist contraindication
undergoes extensive CYP3A4 metabolism and may affect the metabolism of warfarin and oral contraceptives
NK1 tx regimen
Given orally in combination with dexamethasone and 5HT3 receptor antagonist
Relatively contraindicated in patients who are immobile or in long-term opioid therapy as intestinal obstruction may result
what to use instead
bulk forming lacitives
-not for long term use
instead use castor oil for bed bound and neurologicaly impaired pts
-works by distending the colon walls to promote peristalsis
bulk forming lactivites
Directly stimulate the enteric nervous system to increase intestinal motility
cathartic laxatives
Minimal systemic absorption, thus it is safe for both acute and
long-term laxative use
MOA
bisacodyl
acts on nerve fibers in the mucosa of the colon
melanosis coli
Senna
ricinoleic acid
castor oil
castor oil contraindications
pregnancy bc it causes uterine contractions
Surfactants which allow water and lipids to penetrate and thereby soften formed stool in the bowel
use as a laxative?
stool softeners
-prophylaxtic bc takes make days to work
what not to give with mineral oils
docusate
-they would cancel each other out somehow
metabolized by colonic bacteria and can lead to severe flatus with abdominal cramping
lactulose
laxative Should not be used for prolonged periods in persons with
renal insufficiency as they may cause ___________
magnesium salt
cause hypermagnesemia
- Commonly used for complete bowel preparation before gastrointestinal endoscopic procedures
- Does not produce significant flatus or cramping
- May be preferred for management of chronic constipation
in selected patients
PEG
Stimulates the type 2 chloride channels of the small intestine
lubiprostone
the inc cl stiulates intestinal mobility
Indicated for chronic constipation and IBS with predominant constipation
contraindication?
Lubiprostone
not for children
Tx Both acute and chronic use of opioid analgesics causes constipation due to decrease in intestinal motility
(not subject to tolerance)
Mu receptor antagonists
diabetic gastersis tx
metoclopramide and erythromycin
inhibit ACh release and decrease gut peristalsis
opiod agonists
opiod agonist contraindications
children and severe colitis
- Secretory diarrhea due to neuroendocrine tumors such as carcinoid and VIPoma
- Diarrhea caused by vagotomy, dumping syndrome, short bowel syndrome and AIDS
somatostatin analogue octreotide
octreotide AE
dec pancreatic exocrine function=steratorea, def in fat vitamins
inhibits gallbladder contraction leading to biliary sludge and gallstones
azoreductase
enzyme that makes sulfalzine into sulfapyridine and 5ASA
the sulfapyridine is what often causes side effects in pts
Used to induce remission of acute exacerbations of IBD
* Not indicated for maintaining remission
glucocorticoids
dont give allopurinol with what drugs
6-MP or azathioprine which need xanthine oxidase to metabolize and will become toxic levels and lead to life threatening leucopenia
- Reduces the inflammatory actions of Interleukin-1 * Stimulates increase release of adenosine
methotrexate
-inhibites dihydrofolate reductase
Calcineurin is a phosphatase necessary for activation of a T-cell-specific transcription factor: NFAT. cyclophilin
cyclosporine
cyclosporine AE
nephrotoxicity
neurotoxicity
HTN
hyperglycemia
hyperkalemia
what IBD drug is effective for resistant chrons disease
natalizumab
natalizumab AE
Reactivation of the human polyomavirus (JC virus) resulting in progressive multifocal leukoencephalopathy
when to give pracrelipase
cystic fibrosis, pancreatic resection, chronic pancreatitis
renal stones and diahrea
pancrelipase
bind to the SUR1 subunit→block the ATP-sensitive K+ channel in the beta cell membrane.
Sulfonylureas and Meglitinides
allows less K to leave the cell which deploys ad lets ca in for insulin to be released
sulfonylurea AE
hypoglycemia and weight gain
-after all it is an insulin analouge ish…same side effects for Meglitinide
Chlorpropamide AE and contraindiations
hypoG, hyperemic flush with alcohol, SAIDH
contra: elderly, renal, hepatic problems
DM2 but has a sulfur allergy
Meglitinides
when is Meglitinides used
postprandial, short half life
which Meglitinides causes inc hypoglycemia
Repaglinide
activated AMPK
metformin
metformin AE
contraindication
GI
B12 def
lactic acidosis
contra: renal and hepatic disease, states of hypoxemia, or alcoholism, radiologic contrast
metformin monitorinf
TZD monitor tin
acarbose monitor
met:renal function
Tzd: liver function
Acarbose: liver
Binds to PPAR- gamma receptor
TZD, giltazone
-very slow onset
TZD, glitazone AE
contraindications?
fluid retention and weight gain
dec bone density
causes CHF, not for people in heart failure
Decreases postprandial hyperglycemia and hyperinsulinemia and will not cause hypoglycemia
acarbose
-rare but if does cause hypoglycemia need to give pure glucose
acarbose contraindications
IBS(should not be on something that causes more gas)
how do glp1 inhibitors improve glycemic control
slows gastric emptying, dec apeitie, suppresses postprandial glucose release and enhances incretins
glp1 inhibitor AE and contraindications
AE: acute pancreatitis
contraindicated in gastroperisis(Pramlintide is also contraindication in gastroperisi)
DPP AE
URT infection and acute pancreatits
Inhibits food intake, gastric emptying, and glucagon
secretionG
amylin analouge
Pramlintide
blocks SGLT2 in proximal tubule
canagliflozin
dec glucose absorption(with Na)…this inc chance of UTI and contraindicated in renal insufficiency
Insulin is warranted as initial therapy for type 2 diabetes patients with the following:
Ongoing catabolism (weight loss).
* Significant hyperglycemic symptoms
* Ketonuria.
* HbA1c > 10%
* Random glucose > 300 mg/dL
- Beta-Blocker Poisoning
glucagon
Mediates effects via cell surface receptors that activate JAK/STAT signaling cascades
Somatotropin
Mecasermin AE
Hypoglycemia, intracranial HTN, rise in liver enzymes
growth hormone AE children and adults
contrindications
children: diabetic syndrome, otitis media in turners syndrome, hypothyroid
adult: hand and wrist swelling that causes carpal tunnel
contraindication: Cytochrome P450 inducer,
Patients with a known malignancy
Growth Hormone Receptor Antagonist
Pegvisomant
inhibits the JAKSTAT
Somatostatin: inhibits release of
GH, TSH glucagon, insulin & gastrin
Acute control of bleeding from esophageal varices
octreatide, vasopressin(also for colonic diverticular bleeding)
octreatide AE
B12 def
dopamine antag AE
Nause (bromo>caber) othrostatic hypertention,
high dose: cold induced digital vasospasm
chronic high dose: pulmonary infiltrates
gonadotropin replacements AE women and men
women: ovarian hyperstimulation, multiple pregnancies
men: gynecomastia
Prevent LH surge during controlled ovarian hyperstimulation
GnRH Receptor Antagonists:
Cetrorelix, Ganirelix
competitive
Act via MC2R (GPCR → cAMP) to stimulate adrenal cortex to secrete glucocorticoids, mineralocorticoids & androgen
precursors
use?
ACTH
diagnostic tool, West syndrom (infantile spasms)
use for oxytocin
induce labor
control uterine hemoragine
excess stimulation of contractions can induce e fetal distress or uterine rupture is also a slight vasopressive so can lead to hyponatremia
antioxitocin to stop a pret3erm brith
DOC delayed CINV
aprepiant
TNF alpha inhibitor AE
severe infection, lymphoma, acute liver fail
anti intern AE
infection, activate JC virus
Inhibits hepatic gluconeogenesis and Increases glucose utilization in muscle and liver`
metformin
