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term 4 > the ers in ders > Flashcards

the ers in ders Flashcards

1
Q

Non-enveloped, icosahedral, single stranded, (+ve) sense RNA
Group 4 replication
Picornaviridae

transmission?
enzyme?

A

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

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2
Q

Complications are rare and include fulminant hepatitis

A

hepatitis A
99% recover

hepatits B 90% recovery

also hepatitis D (or acute liver failure)

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2
Q

hep A vaccine
when is first does
what type of vaccine

A

12 months
killed/ inactivated

recommended for children +1yr, travelers, gays. can give before or after exposure

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3
Q

Non-enveloped, icosahedral, single- stranded, (+ve) sense RNA
Hepeviridae

A

Hepatitis E

group 4 needs RNA p RNA d

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4
Q

➢ Higher mortality rate in pregnant
women
➢ No chronic infections and no____

A

HEV compared to HAV

-no lab tests, treatment, vaccine, Ig marker

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5
Q

Enveloped, icosahedral, single- stranded, (+ve) sense RNA
Family Flaviviridae

A

HCV
group 4 needs RNA d RNA p

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6
Q

human blood is resovior
spread by piercings, tattoos, unprotected sex. Mother to baby transmission

A

HCV

common in HIV pts

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7
Q

diagnosis for HCV

vaccine?

A

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

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8
Q

Enveloped, circular, partially dsDNA
group?
stability?
family?

A

Hepatitis B Virus
group 7: RNA d DNA p
group
-stable at low ph and in freezing temps
hepadna family

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9
Q

hbv vaccine
when is first dose
what kind of vaccine

A

at birth take first dose
subunit vaccine or immune globulin

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10
Q

Single stranded, (-ve) sense RNA, rod- shaped due to extensive base pairing

structure composition?

A

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)

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11
Q

liver fluke or sheep liver fluke
classification?
source?
hosts?

A

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)

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12
Q

fasciola life cycel
and phases of infection

A

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

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13
Q

Chinese (Oriental) Liver fluke

association?
hosts?

A

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

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14
Q

Clonorchis sinensis life cycle

A

MCMC

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15
Q

most common cause of hyperpituitaryism

A

benign adenoma arising in the antior lobe of pituitary
-most commonly a prolactinoma

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16
Q

what causes hyperprolactinemia

A

stress, antipsychotics, oral contrceptives, antidopamine
tumor, prolactinoma

-dopamine counters prolactin

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17
Q

how to diagnose acromegaly

A

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)

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18
Q

diabetes inspidedus is almost always of _________ origin

A

hypothalamic origin
-posterior pituitary dysfunction

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19
Q

Postpartum necrosis of the anterior pituitary

A

sheehan syndrome- hypopituitarism
-during pregnancy the antior pituitary doubles in size but may not have an inc in blood supply…hypoxia

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20
Q

stimulation and supression test

A

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

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20
Q

pattern of likelyhood for pititaryh hornome deficiencies

A

GH(children only) > LH/FSH > TSH > ACTH

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21
Q

most common cause of hyperthyroidism

A

graves disease - diffuse hyperplasia
AI dz with HLA association

second most common cause is toxic multinodular goiter

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22
Q

types of thyroiditis

A

causes hyperthyroidism

  1. DeQuervian-Subacute thyroiditis(thyroid painful, tenderness, fever)
  2. postpartum bc of natural immunosupression during pregnancy
  3. hashitoxicosis: hyperthryoid bc of hashimotio thyroiditis
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23
Q

Characterized by high TSH levels and normal FT4/FT3 levels in an asymptomatic individual

A

subclinical hypothyroidism

-Can convert to hypothyroidism, especially if anti-thyroid antibodies present

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24
Q

antibodies are present in high titres in Hashimoto’s disease vs graves dz

A

Antimicrosomal (antithyroid peroxidase), and antithyroglobulin antibodies

Thyroid stimulating immunoglobulins (TSI) occur in Grave’s disease (is against TSH-R)

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25
Q

pretibial myxedema

A

graves disease
infiltrative dermopathy

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26
Q

Characterized by HLA-associated antibody-mediated immune destruction of
thyroid cells

A

hashimoto disease
-most common hypothyroid dz

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27
Q

Cretinism

A

congenital hypothyroidism
-causes multi system impared development

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28
Q

Psammoma bodies

A

dystrophic calcifications ( concentric
laminated) found in pappillary carcinoma of the thyroid

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29
Q

Nuclei have longitudinal grooves, intranuclear inclusions and appear optically clear due to finely dispersed chromatin

A

orphan annie nuclei seen in pappillary carcinoma of the thyroid

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30
Q

pappillary carcinoma mutations

A

Pathogenesis is related to several gene mutations like BRAF, and
rearrangements of RET proto-oncogene

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31
Q

Major risk factor predisposing to papillary carcinoma

A

exposure to radiation

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32
Q

More frequent in areas with dietary iodine deficiency

A

follicular carcinoma of thyroid
-follicules are well differentiated

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33
Q

common sites of metastisis for follicular carcinoma of thyroid

A

bones and lungs

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34
Q

follicular carcinoma of thyroid mutations

A

RAS and PIK3CA proto-oncogenes

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34
Q

Originate from the parafollicular cells (C-cells) of the thyroid and produce_________

A

medullary carcinoma of thyroid
-calcitonin which can be desposited as ACal amyloid

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35
Q

mutations for medullary carcinoma of thyroid

A

RET mutation
can be associated with MEN 1/2

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36
Q

Composed of chromaffin cells, which synthesize

A

adrenal medulla
synthesize and secrete catecholamines

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37
Q

primary vs secondary hyperaldosterism

A

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

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38
Q

hyperaldosterism clinical features

A

hypokalemia, metabolic alkolosis, hypertension

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39
Q

tests for hyperaldosterism

A
  • 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

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40
Q

Primary acute adrenal crisis/insufficiency due to hemorrhagic necrosis due to______

leading to___

A

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

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41
Q

Chronic adrenocortical insufficiency resulting from progressive destruction of the adrenal cortex(cortical cells)

A

addisons disease
-all secretions will be decreased

can be AI or can be from Tb infection

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42
Q

most common causes of addisons disease

A

AI
infections from tuberculosis, AIDS, meningitis
from lung and breat metastisis

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43
Q

elevated levels of pro-opiomelanocortin (POMC)

A

causes hyperpigmentation in addisons disease
(which is derived from the anterior pituitary and is a precursor of both ACTH and melanocyte stimulating hormone)

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44
Q

Cosyntropin test

A

screening test for addisons
-invovles administration of ACTH and watching is any adrenal hormones get released

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45
Q

etiology of SIADH

A

small cell carcinoma of lung/paraneoplastic tumor that is releasing ADH, or local injury to hypothalamus or pituitary

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46
Q

Thyroid parenchyma contains a dense lymphocytic infiltrate with germinal centers. Residual thyroid follicles lined by deeply eosinophilic metaplastic
follicular cells called Hürthle cells

A

Hashimoto

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47
Q

Neoplasms composed of chromaffin cells

A

pheochromocytoma

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47
Q

Li Fraumeni syndrome

A

adrenal cortex carcinoma
?when the tumor metastasize to the veins

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48
Q

pheochromocytoma inherited mutation risks

A

MEN 2a and 2b,
Neurofibroma type 1,
Von Hipple Lindae

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49
Q

zellballen

A

nests of cells in a pheochromocytoma in the chromaffin cells

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50
Q

Tumors of the sympathetic ganglia and adrenal medulla that are derived from primordial neural crest cells populating these sites

A

medullary adrenal tumors

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51
Q

Homer-Wright pseudorosettes

A

neuroblastoma
-cells will be dense, not active, not productive

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52
Q

complications of DM

A

end stage renal disease
gangrene
ischemic heart disease
adult blindness

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53
Q

causes of secondary DM

A

Infection: CVM, Mumps, Coxasaxie B, rubella

drugs and toxins

pancreatic disease

hormonal antagonist secretion(cortisol, GH, catecholamines)

genetic: downs and turner

gestational DM

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54
Q

HLA-DR3 & DR4/DQA1& DQB1

A

DM1

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55
Q

role of obesity in DM insulin resistance

A

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

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56
Q

management of diabetic keto acidosis

A

-saline solution for rehydration,
-insulin IV
-potassium supplements
-bicarbonate sometimes

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57
Q

due to severe dehydration resulting from sustained osmotic diuresis

A

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

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58
Q

parathyroid adenoma mutation

A

MEN1 mutation and Cyclin D1 gene rearrangement

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59
Q

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

A

pseudohypoparathyroidism

PTH in the blood but defective

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60
Q

protozoal agents that cause bloody diahrea

misc protozoal GI

A

Enteamobea histolytic
Balantidium coli

Misc: Giardia, Intestinal: Cystoispora belli, Cyclospora (immunocompromised will get chronic diahrea)

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61
Q

Motile protozoa
* Mature Cysts contain four nuclei, Trophozoites are motile
via pseudopodia

A

Entamoeba histolytica

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62
Q

irregular shaped trophozoites with 1 nucleus and may contain ingested RBCs, and/or spherical cysts with 1, 2 or 4 nuclei.

A

Entamoeba histolytica

O&P

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63
Q

anchovy sauce

A

Entamoeba histolytica
the reddish brown aspirate from a amebic extra intestinal disease

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64
Q

A flask shaped ulcer

A

in intestinal epithelium
Entameba histolytica

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65
Q

Ciliate protozoan (50-200 μm)
* Cyst and trophozoite stage

-primary resovior:

A

Balantidium coli
pigs

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66
Q

Balantidium coli complication

A

fuliment colitis which can lead to colonic ulcers or intestinal perforation

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67
Q

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_____

A

Giardia intestinalis

resistant to: chlorine and stomach acid

resovior: beavers, cats, dogs

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68
Q

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.

A

G. intestinalis

infection and diagnostic as a cyst

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69
Q

Fecal microscopy with Direct Fluorescence antibody (DFA) test kites

A

G. intestinalis

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70
Q

Non-motile coccidian parasite
(22-33 μm)
* Displays both sexual and asexual replication
-different infective and diagnostic stages?
clinical present?

A

Cystoisospora belli

I: mature oocyte
D: Immature Oocyte
presents: watery diahrea with ab cramps

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71
Q

Fecal O&P examination (wet mounts) for oocysts

Modified Ziehl-Neelsen (Acid-Fast) staining

Autofluorescence with UV fluorescence microscope

A

Cystoisospora belli and Cyclospora cayetanensis
diagnostic tests

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72
Q

Non-motile coccidian parasite
(8-10 μm)
* Displays both sexual and asexual reproduction
* Oocysts requires sporulation before becoming
infective

clinical present?

A

Cyclospora cayetanensis

watery diahrea

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73
Q

helminths that primarily cause GI distress

vs helminths that are migratory and have GI distress

A

just GI: Enterbius vermis, trichurus trichuria, diphyllobothrium, hymenolpis nana

migratory too: Ascarias limbricodiosis, Acyclostoma duodenale/ neccator americanus, strongylodosis

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74
Q

Nematode, 6-13 mm
* Transparent, oval, planoconvex eggs

sx?
diagnostic?

A

Enterobius vermicularis (Pinworm) causes itchy butt

Cello-tape/Scotch tape for EGGS (diagnostic stage)

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75
Q

Nematode, 30-45 mm
* produces barrel-shaped, bi-
operculate or bi-polar eggs

A

Trichuris trichiura (Whipworm)

bi polar eggs are diagnostic

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76
Q

Trichuris trichiura (Whipworm) complications in general and in children

A

general diahrea, peripheral blood eosinophilia, asx

children: iron deficiency anemia(microcytic), rectal prolapse, dec growth

77
Q

Cestode, largest (up to 30 feet)
* Requires 2 intermediate hosts:

infective and diagnostic stage?

A

Diphyllobothrium latum (Fish tapeworm)

small crustaceans
(copepods) and freshwater fish
-very common in raw fish…infective stage is the larvae
-diagnostic: eggs in feces

78
Q

Parasite competes with host for dietary Vitamin B12 leading to Vitamin B12 deficiency

A

Diphyllobothrium latum (Fish tapeworm)

causes megaloblastic anemia

79
Q

Cestode, 7-50 mm
* Eggs are immediately infective making person to
person transmission and autoinfection possible

diagnostic and infective stage

A

Hymenolepis nana (Dwarf tapeworm)

both diagnostic and infective is egg

80
Q

nematode with knobby-coated oval eggs

A

Ascaris lumbricoides (Roundworm)

81
Q

Loeffler’s syndrome

A

seen in Ascaris lumbricoides and Strongyloidioes

Tracheal irritation, pulmonary eosinophilia and patchy infiltration
-makes it look like pneumonia but its not

82
Q
  • Nematode, 9-11 mm
  • Filariform larva is infective stage

clinical presentation

A

Ancylostoma duodenale & Necator americanus (Intestinal Hookworm)

macule and papulaes upon sight on penetration, iron def anemia

83
Q

infection migratory, starts in the lungs gets coughed up and then swallowed into the GI

A

Ancylostoma duodenale & Necator americanus (Intestinal Hookworm)
and
Strongyloides stercoralis (Threadworm)

84
Q

Microscopic identification of rhabditiform larvae in stool sample

A

Strongyloides stercoralis (Threadworm)

85
Q

Wermer syndrome
-what is is
-what is the mutation

A

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

86
Q

ZES

A

PUD of stomach, duodenum, and jejunum bc of pancreatic tumor and too much gastric acid
aka gastrinoma

87
Q

RET proto- oncogene on chromosome 10

A

MEN2A and B mutation

88
Q

MEN2A characterized by

A
  1. pheochromocytoma, 2. *medullary carcinoma of the thyroid, and 3. parathyroid hyperplasia
89
Q

MEN2B

A

*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

90
Q

Chelation by EDTA and hypoalbuminemia caused by

A

hypocalcemia

also causes tetany and uncontrolled cramps

91
Q

hyperphosphatemia seen in

A

hypoparathyroid

92
Q

causes deposition of calcium salts into normal tissue

A

hyperphosphatemia with also high calcium

93
Q

BPH treatment

A

5-alpha reductase inhibitors (e.g., finasteride

TURP procedure– Transurethral resection of prostate

94
Q

what are contributing factors to prostatic adenocarcinoma

A

–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

95
Q

besides hepatitis virus what are other infectious organisms to cause hepatits

A

HSV, EBV, CMV, Yellow Fever Virus YFV

96
Q

What makes HAV stable and unstable

A

stable: acid
instable: chlorine, heat, formalin, radiation

hep B is also stable in acid and in cold temps

97
Q

Dane particle

A

Hep b

98
Q

HEP b structure

A

-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

99
Q

MHC class I–restricted, CD8+ cytotoxic T lymphocytes: Directed against multiple epitopes on core, polymerase and envelope of this virus

A

HEP b

-not directly cytopathic to the liver its the immune

-this is cell mediated immunity

100
Q

window period

A

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)

101
Q

Hep B carriers in serum

A

All carriers have anti-HBcAg and some anti-HBeAg

Anti-HBc-Ab always present

102
Q

hepatitis treatment

A

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

103
Q

cholangitis, biliary hyperplasia, obstruction, cholangiocarcinoma
organism

A

clonorchiasis
/ opisthorchiasis

104
Q

hepatic fibrosis and necrosis, cholangitis, biliary obstruction, biliary cirrhosis

A

fascialiasis

105
Q

operculated, broadly ellipsoidal

A

Fascioliasis
Clonorchis sinensis (Opisthorchis sinensis)

106
Q

what are the NTs and the R for release of gastric acid

A

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

107
Q

antacids with coadministeration of _____________ causes decreases absorptoipn

A

tetracyclines, fluoroquinolones, itraconazole and iron

108
Q

major AE of all H2 antagonists

A

Increased gastric pH: B12 deficiency and myelosuppression

cimetidine has a bunch tho(anti-androgen and CNS effects)

109
Q

contraindications for cimetidine

A

it is a potent inhibitor for CYP 450 so will make the high/ toxic concentrations of Warfarin, Diazepam, Phenytoin

110
Q

AE for PPIs

A

B12 def dec reduced pepsin, inc risk for C.diff, osteopenia(hip fractures)

111
Q

contraindications for omeprazole

A

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

112
Q
  • Stimulates mucus and bicarbonate secretion * Enhances mucosal blood flow
A

mucosal protective agents

113
Q

Approved for prevention of NSAID-induced ulcers

A

misopristol

114
Q

Forms a viscous paste that binds selectively to ulcers according to pH

A

Sucralfate

115
Q

initial management of gastroesophageal reflux
disease in pregnancy

A

sucralfate

116
Q

Suppresses H. pylori (has no neutralizing action on gastric acid)

other uses

A

Bismuth Subsalicyalte

also used for travelers diahrea and dec fluid secretion

117
Q

Bismuth Subsalicylate
side effects and contraindications

A

side effect: black stool (harmless)

contraindications: renal failure

118
Q

Used for long-term maintenance of IBD remission

A

Aminosalicylates

or for mild presenting

118
Q

pro kinetic agent targets

A

motilin, serotonin, Ach

onto the enteric nerve to enhance coordinated Gi mobility

119
Q

which pro kinetic drugs effect what receptors

A

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)

120
Q

cisapride AE

A

ventricular arythmies

121
Q

metoclopromide AE

A

Extrapyramidal effects due to DA antagonism

-unopposed prolactin causes galactoria

122
Q

antiemetics for motion sickness

A

anti-muscarinics, H1 antag

both also used for postoperative N/V

D2 antag as well but also used for mild CINV

123
Q

act on vestibular afferents and the brain stem

A

H1 antagonist ant-emetics

124
Q

Central Dopaminergic Blockade
- Potential for adverse extrapyramidal effects - Prolongation of QT Interval

A

Droperidol

125
Q

drug of choice for prophylaxis against Acute CINV

A

5HT3 antagonist

**not effective in delayed CINV or motion sickness

126
Q

Highly effective adjuvants in the treatment of nausea in patients with metastatic cance

A

Corticosteroids

Via suppression of peritumoral inflammation and prostaglandin production

127
Q

NK1 antagonist contraindication

A

undergoes extensive CYP3A4 metabolism and may affect the metabolism of warfarin and oral contraceptives

128
Q

NK1 tx regimen

A

Given orally in combination with dexamethasone and 5HT3 receptor antagonist

129
Q

Relatively contraindicated in patients who are immobile or in long-term opioid therapy as intestinal obstruction may result

what to use instead

A

bulk forming lacitives
-not for long term use

instead use castor oil for bed bound and neurologicaly impaired pts

130
Q

-works by distending the colon walls to promote peristalsis

A

bulk forming lactivites

131
Q

Directly stimulate the enteric nervous system to increase intestinal motility

A

cathartic laxatives

132
Q

Minimal systemic absorption, thus it is safe for both acute and
long-term laxative use

MOA

A

bisacodyl

acts on nerve fibers in the mucosa of the colon

133
Q

melanosis coli

A

Senna

134
Q

ricinoleic acid

A

castor oil

135
Q

castor oil contraindications

A

pregnancy bc it causes uterine contractions

136
Q

Surfactants which allow water and lipids to penetrate and thereby soften formed stool in the bowel

use as a laxative?

A

stool softeners

-prophylaxtic bc takes make days to work

137
Q

what not to give with mineral oils

A

docusate

-they would cancel each other out somehow

138
Q

metabolized by colonic bacteria and can lead to severe flatus with abdominal cramping

A

lactulose

139
Q

laxative Should not be used for prolonged periods in persons with
renal insufficiency as they may cause ___________

A

magnesium salt

cause hypermagnesemia

140
Q
  • 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
A

PEG

141
Q

Stimulates the type 2 chloride channels of the small intestine

A

lubiprostone

the inc cl stiulates intestinal mobility

142
Q

Indicated for chronic constipation and IBS with predominant constipation

contraindication?

A

Lubiprostone

not for children

143
Q

Tx Both acute and chronic use of opioid analgesics causes constipation due to decrease in intestinal motility
(not subject to tolerance)

A

Mu receptor antagonists

144
Q

diabetic gastersis tx

A

metoclopramide and erythromycin

145
Q

inhibit ACh release and decrease gut peristalsis

A

opiod agonists

146
Q

opiod agonist contraindications

A

children and severe colitis

147
Q
  • Secretory diarrhea due to neuroendocrine tumors such as carcinoid and VIPoma
  • Diarrhea caused by vagotomy, dumping syndrome, short bowel syndrome and AIDS
A

somatostatin analogue octreotide

148
Q

octreotide AE

A

dec pancreatic exocrine function=steratorea, def in fat vitamins

inhibits gallbladder contraction leading to biliary sludge and gallstones

149
Q

azoreductase

A

enzyme that makes sulfalzine into sulfapyridine and 5ASA

the sulfapyridine is what often causes side effects in pts

150
Q

Used to induce remission of acute exacerbations of IBD
* Not indicated for maintaining remission

A

glucocorticoids

151
Q

dont give allopurinol with what drugs

A

6-MP or azathioprine which need xanthine oxidase to metabolize and will become toxic levels and lead to life threatening leucopenia

152
Q
  • Reduces the inflammatory actions of Interleukin-1 * Stimulates increase release of adenosine
A

methotrexate

-inhibites dihydrofolate reductase

153
Q

Calcineurin is a phosphatase necessary for activation of a T-cell-specific transcription factor: NFAT. cyclophilin

A

cyclosporine

154
Q

cyclosporine AE

A

nephrotoxicity
neurotoxicity
HTN
hyperglycemia
hyperkalemia

155
Q

what IBD drug is effective for resistant chrons disease

A

natalizumab

156
Q

natalizumab AE

A

Reactivation of the human polyomavirus (JC virus) resulting in progressive multifocal leukoencephalopathy

157
Q

when to give pracrelipase

A

cystic fibrosis, pancreatic resection, chronic pancreatitis

158
Q

renal stones and diahrea

A

pancrelipase

159
Q

bind to the SUR1 subunit→block the ATP-sensitive K+ channel in the beta cell membrane.

A

Sulfonylureas and Meglitinides

allows less K to leave the cell which deploys ad lets ca in for insulin to be released

160
Q

sulfonylurea AE

A

hypoglycemia and weight gain

-after all it is an insulin analouge ish…same side effects for Meglitinide

160
Q

Chlorpropamide AE and contraindiations

A

hypoG, hyperemic flush with alcohol, SAIDH

contra: elderly, renal, hepatic problems

161
Q

DM2 but has a sulfur allergy

A

Meglitinides

162
Q

when is Meglitinides used

A

postprandial, short half life

163
Q

which Meglitinides causes inc hypoglycemia

A

Repaglinide

164
Q

activated AMPK

A

metformin

165
Q

metformin AE

contraindication

A

GI
B12 def
lactic acidosis

contra: renal and hepatic disease, states of hypoxemia, or alcoholism, radiologic contrast

166
Q

metformin monitorinf
TZD monitor tin
acarbose monitor

A

met:renal function
Tzd: liver function
Acarbose: liver

167
Q

Binds to PPAR- gamma receptor

A

TZD, giltazone

-very slow onset

168
Q

TZD, glitazone AE

contraindications?

A

fluid retention and weight gain
dec bone density

causes CHF, not for people in heart failure

169
Q

Decreases postprandial hyperglycemia and hyperinsulinemia and will not cause hypoglycemia

A

acarbose

-rare but if does cause hypoglycemia need to give pure glucose

170
Q

acarbose contraindications

A

IBS(should not be on something that causes more gas)

171
Q

how do glp1 inhibitors improve glycemic control

A

slows gastric emptying, dec apeitie, suppresses postprandial glucose release and enhances incretins

172
Q

glp1 inhibitor AE and contraindications

A

AE: acute pancreatitis

contraindicated in gastroperisis(Pramlintide is also contraindication in gastroperisi)

173
Q

DPP AE

A

URT infection and acute pancreatits

174
Q

Inhibits food intake, gastric emptying, and glucagon
secretionG

A

amylin analouge
Pramlintide

175
Q

blocks SGLT2 in proximal tubule

A

canagliflozin

dec glucose absorption(with Na)…this inc chance of UTI and contraindicated in renal insufficiency

176
Q

Insulin is warranted as initial therapy for type 2 diabetes patients with the following:

A

Ongoing catabolism (weight loss).
* Significant hyperglycemic symptoms
* Ketonuria.
* HbA1c > 10%
* Random glucose > 300 mg/dL

177
Q
  • Beta-Blocker Poisoning
A

glucagon

178
Q

Mediates effects via cell surface receptors that activate JAK/STAT signaling cascades

A

Somatotropin

179
Q

Mecasermin AE

A

Hypoglycemia, intracranial HTN, rise in liver enzymes

179
Q

growth hormone AE children and adults

contrindications

A

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

180
Q

Growth Hormone Receptor Antagonist

A

Pegvisomant

inhibits the JAKSTAT

180
Q

Somatostatin: inhibits release of

A

GH, TSH glucagon, insulin & gastrin

181
Q

Acute control of bleeding from esophageal varices

A

octreatide, vasopressin(also for colonic diverticular bleeding)

182
Q

octreatide AE

A

B12 def

183
Q

dopamine antag AE

A

Nause (bromo>caber) othrostatic hypertention,

high dose: cold induced digital vasospasm
chronic high dose: pulmonary infiltrates

184
Q

gonadotropin replacements AE women and men

A

women: ovarian hyperstimulation, multiple pregnancies

men: gynecomastia

185
Q

Prevent LH surge during controlled ovarian hyperstimulation

A

GnRH Receptor Antagonists:
Cetrorelix, Ganirelix

competitive

186
Q

Act via MC2R (GPCR → cAMP) to stimulate adrenal cortex to secrete glucocorticoids, mineralocorticoids & androgen
precursors

use?

A

ACTH

diagnostic tool, West syndrom (infantile spasms)

187
Q

use for oxytocin

A

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

188
Q

DOC delayed CINV

A

aprepiant

189
Q

TNF alpha inhibitor AE

A

severe infection, lymphoma, acute liver fail

190
Q

anti intern AE

A

infection, activate JC virus

191
Q

Inhibits hepatic gluconeogenesis and Increases glucose utilization in muscle and liver`

A

metformin

term 4 (13 decks)

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