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TO Notes Flashcards

1
Q

How long can a limb tolerate acute occlusion of a peripheral artery before irreversible damage?

A

6 hours

Exception is only acute on chronic occlusion where collaterals provide SOME perfusion

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2
Q

Is abnormal pulse in the unaffected limb a sign of emboli or thrombus?

A

Thrombus

Also look for prior history of claudication, vascular intervention, bypass

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3
Q

Gold standard test for diagnosis and grading of aortic dissection

A

CTA

Tear in intima allowing blood to go into media

MRA if CTA contraindicated

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4
Q

What are conditions that predispose to priapism where PDE inhibitors should not be used?

A

Leukemia, myelofibrosis, polycythemia, sickle cell disease

Contraindicated in patients on nitrates due to severe hypotension

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5
Q

Medications for benign prostatic hyperplasia

A
  1. Alpha blockers (terazosin or doxazosin, tamsulosin, afluzosin, silodosin) - watch for headache, leg edema, presyncope
  2. 5 alpha reductase inhibitors (finasteride, dutasteride) - blockers conversion of test to DHT and reduces prostatic volume - watch for sexual dysfunction
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6
Q

Medications for prostate carcinoma

A
  1. GnRH agonist (leuprolide, goserelin, degarelix) - watch for hot flashes, headaches, decreased libido
  2. Non steroidal antiandrogen (flutamide, bicalutamide, abiraterone, enzalutamide) - watch for hepatotoxicty, high triglycerides, periheral edema
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7
Q

What medications can you give for an overactive bladder?

A
  • Oxybutynin (antispasmodic and anticholinergic)
  • Tolterodine, trospium, solifenacin, darifenacin, fesoterodine, proiverine (anticholingerics)
  • Mitabegron (beta3 agonist)
  • Imipramine (TCA) better for stress incontinence
  • Botulinum injection (neurotoxin)
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8
Q

What should all patients with suspected uretehral injury undergo?

A

Retrograde urethrogram or cystoscopy

Blood at meatus, high riding prostate on DRE, penile/scroal hematoma, distended bladder

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9
Q

What meds are NSAIDs and what are their contraindications?

A

Ibuprofen Advil, diclofenac Voltaren (+- misoprostol Arthrotec), naproxen Aleve, meloxicam

Contraindicared in GI bleeds, renal problems, pregnancy or if pt is anticoagulated

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10
Q

What is tylenol (acetaminophen) contraindicated in?

A

Severe liver disease

It is first line for osteoarthritis though

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11
Q

What needs to be done if you are starting a patient on a newer DMARD biologic (ie etanercept, infliximad, adalimumab, golimumab abatacept, rituximab)?

A

Patients require negative TB skin test, CXR, & negative hepatitis B serology

Be mindful that there is increased risk of: infections, worsened heart failure, multiple sclerosis and positive autoantibodies

Do pneumonia, shingles and hepatitis B vaccines 2 weeks prior ideally

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12
Q

Bronchodilator in acute reversible airway obstruction

A

SABA (short acting beta2 agonist)
Salbutamol or albuterol

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13
Q

Maintenance treatment and prevention of bronchospasm in COPD or asthma

A

LABA
Salmeterol, formoterol, indacterol

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14
Q

Short and long acting anticholinergics used in asthma and COPD

A

Short = ipratropium bromide

Long = tiotropium bromide

Watch for palpations, anxiety, dizziness, fatigue

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15
Q

Medication for status asthmaticus

A

Prednisone or methylprednisolone oral

Can also be used for acuter exacerbation of COPD, bad asthma, PCP pneumo

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16
Q

Medications for community acquired pneumonia

A

Amoxicillin

Macrolide - erythromycin, azithromycin, clarithromycin

Tetracycline - Doxycycline

Fluoroquinolone - levofloxacin, moxifloxacin

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17
Q

Pressor medications

Use for hypotension or intropic support

A

Norepinephrine
Phenylephrine
Dobutamine

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18
Q

Who is dialectical behavioral therapy used in?

A

People with borderline personality disorder

Combined CBT and Buddhist Zen mindfullness practices

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19
Q

What dopamine pathways are affected in schizophrenia?

A

Mesolimbic = high dopamine causes positive symptoms

Mesocortical = low dopamine causes negative symptoms

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20
Q

Medications for the treatment of acute psychosis in the emergency setting

A

Haloperidol IM
Loxapine PO or IM
Olanzapine PO or IM
Risperidone Liqui

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21
Q

Typical antipsychotics

A

Haloperidol, fluphenazine, zuclopenthixol, perphenazine, loxapine, chlorpromazine

Chlorpromazine and haloperidol highest risk of QT prolongation

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22
Q

Atypical antipsychotics

A

Risperidone, paliperidone, olanzapine, asenapine, ziprasidone, aripiprazole, quetiapine, clozapine

Ziprasidone and clozapine highest risk of QT prolongation

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23
Q

Neuroleptic malignant syndrome features

A

FARM (think of going crazy on the farm)

Fever
Autonomic changes (high HR/BP, sweating)
Rigidity
Mental status changes

IF THERE IS SHIVERING, RESTLESSNESS, TWITCHINESS, VOMITING, DIARRHEA OR STOMACH PAIN THINK MORE OF SEROTONIN SYNDROME

More due to antipsychotics causing dopamine disturbances

Young pt with mental health changes, fever, ridigity, autonomic instability over 2-3 days with increased creatine phosphokinase, leukocytosis, myoglobinuria

RX: STOP MED, COOL, DANTROLENE, AMANTADINE OR BROMOCRIPTINE

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24
Q

What meds block the affects of dopamine and what are generalised side effects?

A

Antipsychotics

EPS, galactorrhea, amenorrhea, erectile dysfunction, weight gain

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25
Q

Name the extrapyramidal symptoms

A

DYSTONIA sustained abnormal posture, muscle spasms, oculogyric crisis
AKATHISIA crawling sensation relieved by walking
PARKINSONISM tremor, rigid, absent arm swing, stooped posture, shuffling gait
DYSKINESIA purposelessness, involuntary facial and mouth movements, can sometimes show up as hiccups

RX BENZTROPINE, DIPHENHYDRAMINE (anticholergics but DO NOT GIVE FOR TD AS THESE WORSEN SYMPTOMS - can try clozapine for TD)

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26
Q

How long does it take antidepressants to work?

A

1-3 weeks for neuro vegetative and physical symptoms

2-6 weeks for emotional and cognitive symptoms

MONITOR FOR SUICIDAL BEHAVIOR FOR FIRST TWO WEEKS

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27
Q

SSRI medications and what they are useful for

A

Fluxoetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram

Good for typical and atypical depression, seasonal, anxiety, OCD and other eating disorders

28
Q

Which SSRI is best in pregnancy and breast feeding

A

Sertraline

29
Q

SNRI medications and what conditions they are useful for?

A

Venlafaxine, desvenlafaxine, duloxetine

Good for depression, anxiety, neuropathic pain

sad, scared, suffering

30
Q

What type of medication is bupropion?

A

NDRI

Increases risk of seizures

Contraindicated in strokes or head injury

Bad for anxiety as it has stimulating effects

31
Q

Which TCA is good in OCD?

A

Clomipramine gold standard

Required ECG monitoring, highly lethal in overdose

32
Q

What kind of medications are nortriptyline and desipramine?

A

TCAs (secondary amines)
Prefered because less anticholinergic effects

33
Q

What medication class good for refractory depression?

Hint: cheese

A

MAO inhibitors such as phenelzine and tranylcypromine

34
Q

What medications are mood stabilizers are what is their main indication?

A

Divaloproex, lamotrigine, carbamazepine, lithium

Use for long term stabilization of bipolar disorder or monotherapy/conjunction with atypical for acute bipolar disorder

35
Q

What mood stabilizer do you need to order LFTs before initiating?

A

Divalproex and carbamazepine

Of note they both riase the seizure threshold

36
Q

What drugs increase risk of lithium toxicity?

A

NSAIDs, thiazides, ACEi, metronidazole

37
Q

Which mood stabilizer is associated with Steven Johnson Syndrome?

A

Lamotrigine

38
Q

Who are benzos contraindicated in?

A

Myasthenia gravis, major depression (unless it is an adjunct), drug/alcohol misuse history, caution in pregnancy/breastfeeding

Cause GABA to bind it receptors to decrease neuronal activity

39
Q

Benzos that are safe in impaired liver function

A

LOT
Lorazepam
Oxazepam
Temazepam

LIVER OK THINGS

40
Q

What is the preferred med for generalized anxiety disorder?

A

Buspirone

Non sedating
Does not react with alcohol
Does not alter seizure threshold
Not prone to abuse

41
Q

What are the short acting benzos?

A

LOAT
Lorazepam - high dependency
Oxazepam - use for alcohol withdrawl or GAD
Alprazolam - As above
Temazepam - dont use
Triazolam - overnight plane travel but risk of rebound insomnia

42
Q

What is WHO’s Pain Relief Ladder steps

A

Non opioid + adjuvant
Then add opioid
Then add stronger opioid

43
Q

Pediatric otitis media treatment

A

Amoxicillin

44
Q

Colic definition

A

Paroxysms of unexplained irritability and crying for more than 3 hours per day for more than 3 days per week for more than 3 months in an otherwise healthy baby

Rx: Relief and reassurance and rest, maybe try changing feeding technique, try eliminating allergens

44
Q

When to initiate treatment in primary enuresis?

A

Not until 7 years old because there is a high rate of spontaneous cure

Bladder control has never been attained

45
Q

Leading cause of death of 1-12 month old babies

A

SIDS

Risks: prematurity, alcohol use, soft bed, low birthweight, Indigneous, no prenatal care, smoking in household, prone sleep position, poverty, bed sharing, drugs

46
Q

MC congenital heart defect in children

A

VSD

47
Q

Baby who throws up (non bilious) very soon after birth and is drooling, choking, in resp distress, cannot feed and cyanotic

Excessive secretions SOON AFTER BIRTH

A

Think TE fistula
On exam you wont be able to advance the NG tube
Do upper GI series with contrast

48
Q

Baby who projectile vomits (non bilious) within 30 minutes of feeding, is fatigued and dehydrated and has palpable olive mass in RUQ

A

Think pyloric stenosis

Look for hypokalemic, hypochloremic metabolic acidosis on ABG

49
Q

What is the most common cause of pediatric hearing loss?

A

Otitis media with effusion
90% resolve in 3 months

Surgical rx: myringotomy with tempanostomy

50
Q

What are vesiscles/erosions on the pharynx/tongue caused by vs buccal mucosa/tongue?

A

Pharynx = posterior = Coxsackie A (Hand foot and mouth)

Buccal = anterior = herpes simplex

51
Q

Medical treatment for GAS

A

Penicillin V or amoxicillin or erythromycin (if penicillin allergy)

PEA

Pharyngitis, sclarlet fever, rheumatic fever, PSGN

52
Q

What is piperacillin with tazobactam used to treat?

A

Pseudomonas coverage
Gram +
Gram - aerobes

53
Q

What nasal sprays are bad in pts with preexisting HTN?

A

Decongestants like xylometazoline, oxymetazoline, phenylephrine

54
Q

What medications are used for migraine prophylaxis vs acute migraine

A

Prophylaxis = topiramate or propanolol

Acute = sumatriptan or dihydroergotamine

55
Q

Which medications are loops and what electrolyte changes do they cause?

A

Furosemide, bumetanide, ethacrynate, torsemide

Hypokalemia
Hyponatremia
Hypocalcemia but hypercalciuria (stones)

Precipitate gout

56
Q

Which medication class increases calcium excretion? Which decreases it?

A

Loops LOSE calcium (increased excretion)

Thiazides TIGHTLY hold calcium
(decreased excretion - used for hypercalciuria and stones)

57
Q

Features of malignant lymphadenopathy

A

Firm
Non tender
Enlarging
Immobile
Worrisome location like supraclavicular or generalized
Abnormal imaging or bloodwork
Constitutional symptoms

Fluctuance, warmth, or tenderness are more suggestive of benign nodes

58
Q

How many doses of MMR are required?

A

2 doses of MMR after 12 months and at least 28 days apart

59
Q

Drugs that prolong QT

A

Normal QTc 350-450

Antiarrhythmics
Antipsychotics (hal/zip)
Antibiotics (macrolides ery/azi)
Antidepressants (cital)

60
Q

Things that decrease QT

A

Digoxin
Hypothyroid
Increased calcium

61
Q

Signs of adrenal insufficiency

A

Fatigue
Weight loss
GI issues
Hypotension
Electrolyte disturbance

Do ACTH stimulation test

62
Q

Guillain Barre cause and presentation

A

MC a/w Campylobacter
Acute rapidly evolving demyelinating inflammatory polyradiculoneuropaty that starts in the lower limbs and moves up

Look for a child with paresthesias, weird walk, poor propioception and vibration, weakness, areflexia, BP dysregulation and bladder dysfunction

Consider CSF to look for HIGH PROTEIN AND NORMAL WBC (albumocytologic dissociation)

Treat with IVIG and pain management

63
Q

First line treatment for severe hypercalcemia

A

FLUIDS
THEN furosemide to prevent heart failure from high volume saline
THEN Alendronate and/or calcitonin (take 24-48 hours to work)

64
Q

Most common cutaneous malignancy in immunocompromised patients such as organ transplant recipients

A

Squamous cell carcinoma

65
Q

HTN and hypokalemia

A

Consider primary hyperaldosteronism

Underdiagnosed cause of HTN

K could be normal

TEST WITH PLASMA ALDOSTERONE TO PLASMA RENIN ACTIVITY RATIO (should be more than 20 in normal)

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