thurs jul 30 Flashcards
levadopa MOA
converted to dopamine by DOPA decarboxylase -> increased dopamine in parkinsons patients
peripheral S/E of increased dopamine?
GI distress (nausea, vomiting), arythmias, orthostatic hypotension
central S/E of incraesed dopamine?
psychiatric symptoms -anxiety, hallucinations, etc.
-chronic therapy also causes dyskinesia
what is the wearing off phenomon of levadopa therapy?
with chronic therapy akinesia and dyskinesia reemerge towards the end of each dose
what happens to the therapeutic window as parkinsons progresses?
becomes narrower
carbidopa MOA
peripheral DOPA decarboxylase inhibitor - prevents peripheral conversion of levadopa
tolcapone MOA
central and peripheral COMT inhibitor - inhibits breakdown, increasing bioavailability
entacapone MOA
peripheral COMT inhibitor - inhibits breakdown, increasing bioavailability
tolcapone A/E
hepatic failure
selegiline MOA
MOA-B inhibitor- increases dopamine in CNS
ropinirole MOA
D2 receptor agonist
pramipexole MOA
D3 receptor agonist
treatment of restless leg syndrome?
dopamine receptor agonists
A/E of dopamine receptor agonists?
impulsivity - gambling, hypersexuality, etc.
amantadine MOA
increases endogenous dopamine
what are benztropine and trihexyphenidal?
anti-muscarinics that improve tremor and rigidity in parkinsons (no effect on bradykinesia)
transmural fibrous thickening of aortic branches is seen in…
takayasu
treatment of kawasaki disease?
IV immunoglobulin and aspirin
presentation of kawasaki disease?
child with desquamative rash, oropharyngeal signs (strawberry tongue), adenopathy, chest pain
what is thromboangiitis obliterans?
beurgers disease
Polyarteris nodosa vessel findings
transmural inflammation with fibrinoid necrosis, in renal, coronary and mesenteric arteries
STRING OF PEARLS
which types of arteries does polyarteritis nodosa effect?
medium size - coronary, mesenteric, renal
patients with polyarteritis nodosa may be positive for what marker?
30% are positive for Hepatits B surface antigen
what presentations do henoch schlonlein purpura and cryoglobulinemic vasculitis have in common?
Hematuria
Palpable purpura
Arthralgia
does henoch schlonlein purpura have GI pain?
yes
does cryoglobulinemic vasculitis have GI pain?
no
what deposits in henoch schlonlein purpura?
igA
what is cryoglobulinemic vasculitis associated with?
hepatitis C
what deposits in cryoglobulinemic vasculitis ?
cryoglobulin
treatment of cryoglobulinemic vasculitis ?
treat hep C
churg-strauss syndrome AKA
eosinophilic granulomatosis with polyangitis
churg-strauss is associated with a positive…
p-ANCA
presentation of churg-strauss
asthma/allergic rhinitis
polyps (nasal)
peripheral neuropathy
igE
wegeners aka
granulomatosis with polyangitis
wegeners has a positive…
c-ANCA
what areas are involved in wegeners?
lungs
kidney
nasopharynx
microscopic angiitis has a positive…
p-ANCA
what areas are involved in microscopic angiitis?
lungs and kidneys - not NASOPHARNYX
Digeorge syndrome is caused by defective…
neural cell migration
which enzyme do fibrates inhibit?
cholesterol 7 alpha-hydroxlyase
why do fibrates increase your risk for gallstones?
by inhibting cholesterol 7 alpha-hydroxlyase, the rate limiting step of bile acid synthesis, there is decreased cholesterol solubility in the bile -> gallstones
why can H influenza grow on a blood culture, specifically in the presence of staph aureus?
H influenza requires factors V and X (hematin and NAD).
Staph aureus will secrete NAD and the beta hemolysis of S aureus releases hematin -allowing H influenza to grow
what is the yellow-brown pigment that may be found in the heart and liver of aging persons?
lipofuscin (this is normal)
how does lipofuscin form?
from free radical injury and lipid peroxidation
which ribs overlie the spleen?
left 9th 10th 11th
which ribs overlie the liver?
right 8th 9th 10th 11th
dermatomyositis muscle findings?
PERIMYSIAL inflammatory infiltrates and atrophy in skeletal muscle
describe an ecological study
a study that looks at populations as the sample rather than individuals (compares whole countries)
what are the benefits of injecting epinephrine along with a local anesthetic?
epinephrine will induce vasoconstriction which:
- decreases local bleeding
- increases duration of action because the anesthetic stays at the site
- decreases systemic side effects due to less systemic absorption
diagnosis of P jirovecii?
silver stain
treatment of P jirovecii?
TMP-SMX
what activates tryspin?
enteropeptidase
location of enteropeptidase?
intestinal brush border
how may atheroembolic disease present?
days-weeks after a procedure that would have dislodged a plaque, with skin findings such as livedo reticularis and blue toe
are the artery pulses palpable in atheroembolic disease?
yes, the microemboli do not affect large arteries
what will tissue biopsy show of someone with atheroembolic disease?
needle shaped clefts
all opioids are coupled to which type of receptor?
g protein
MOA of mu opioid drugs (name both mechanisms)
- On presynaptic neurons: decrease calcium influx thus decreasing NT release
- On postsynaptic neurons: opens potassium channels leading to potassium efflux and hyperpolarization
MEDIATED BY G PROTEIN BINDING
osteltamavir MOA
Neuraminidase inhibitor - prevents virion release
what is the best drug for lowering triglycerides?
fibrates
effects of niacin?
increased HDL and decreased LDL
how do uterine fibroids change as menopause approaches?
they regress
which drug is a risk factor for uterine sarcoma?
tamoxifen
leiomyoma =
uterine fibroid
what spreads babesiosis?
ixodes tick
is coal mining associated wiht asbestos?
no
is working with insulation assocaited with asbestos?
yes
