Week 1 Block 11: PRR Flashcards
Test taken 4/25/2014 Test reviewed 4/25/2014
Toxicity mechanism: After taking opioid analgesic, Severe abdominal pain making it impossible to lie still, Tenderness over right upper ab quadrant
Opiod analgesics contract smooth muscles in sphincter of Oddi, leading to increased pressures in bile duct & gall bladder. Increased pressures can lead to rare painful crisis, biliary colic. Although meperidine reported to cause less constriction of soO, little evidence to support this notion.
A. Absorption location: (1) Iron (2) Ascorbic acid (Vitamin C) (3) Pyridoxine (Vitamin B6) (4) Biotin (vitamin B7) (5) Pantothenic acid (vitamin B5); B. Nutritional impact of gastrectomy/gastric bypass
(A. 1) duodenum and proximal jejunum (2) distal bowel (active transport) (3) jejunum and ileum (passive) (4) & (5) small and large intestine (via sodium-dependent multivitamin transporter) B. Malabsorption of iron, vitamin B12, folate, fat-soluble vitamins (especially vitamin D), and calcium
Terbinafine mechanism as antifungal
Inhibition of squalene epoxidase
(1) Acute extrapyramidal sx e.g.’s (2) Related mechanism (3) Most likely clinical cause
(1) Dystonic reactions, akathisia, parkinsonism (2) Imbalance between dopamine (D2) and muscarinic (M1) activity in nigrostriatal tract (3) Traditional high-potency antipsychotics (haloperidol, fluphenazine) strongly block D2 receptors and are most likely to cause extrapyramidal sx
(1) Most likely Dx: High synovial fluid white blood cell count (100,000/uL) (2) Next steps
(1) Strongly suggest bacterial joint infection. Septic arthritis requires immediate antibiotic tx to prevent joint destruction, osteomyelitis, and sepsis (Note: Gout also causes acute monoarticular arthritis, but synovial fluid white blood cell count is usually < 20,000/mm^3) (2) For definitive dx, gram stain, culture, & microscopy for crystals. While test results pending, start ceftriaxone to cover gonococcus.
(1) 3 stimulators of final common pathway of gastric acid secretion (2) Drugs that block it/all 3 stimulators
(1) Acetylcholine, histamine, & gastrin (2) Proton pump inhibitors block parietal cell apical membrane H+/K+-ATPase proton pump (e.g., Lansoprazole)
What’s special about structure and activation of Cidofovir?
Acyclovir, the acyclovir prodrug valacyclovir, famciclovir, and ganciclovir are all nucleoside analogues that require both herpes viral and cellular kinases for conversion to their active nucleoside triphosphate form. Cidofovir is a nucleoside monophosphate (ie., nucleotide) that requires only cellular kinases for activation.
Most likely dx: young Caucasian patient, recurrent respiratory infections with Pseudomonas aeruginosa, diarrhea, & failure to thrive
(1) Cystic fibrosis (2) CF causes steatorrhea and failure to thrive due to malabsorption secondary to pancreatic insufficiency, which can be corrected by pancreatic enzyme supplementation
(1) Sucinnylcholine mechanism (2) Its Train-of-four stimulation & when to add Neostigmine
(1) Depolarizing neuromuscular junction (NMJ) blocker (2) Depolarizing blockers show sustained and equal reduction of all 4 twitches during phase I blockade. Continued administration of succinylcholine results in eventual transition to phase II blockade. The twitch responses during this phase mimic those seen in nondepolarizing NMJ blockade and show a fading pattern with progressive reduction in each of 4 responses.
Reviews stages of Lyme disease
(1) Early - flu-like symptoms, erythema chronicum migrans (2) Second - AV block, Bell’s palsy (3) Chronic - asymmetric large joint arthritis & encephalopathy
Compare/Contrast mechanism of action of (1) Polyethylene glycol to (2) Lactase deficiency
(1) Osmotic laxatives - Nonabsorbable or poorly absorbable substances that attract water into the intestinal lumen, thus distending the intestinal wall and increasing peristalsis (2) Disease state characterized by osmotic diarrhea. Inherited/acquired deficiency of intestinal brush border enzyme lactase (i.e., disaccharidase) causes inability to break down lactose into glucose and galactose. Undigested lactose is a nonabsorbable osmotic substance, and its accumulation in the small intestine leads to increase in secretion of water and electrolytes into the intestinal lumen.
Diphenoxylate: (1) Mechanism (2) Clinical Advisory/Administration protocols
Opiate anti-diarrheal structurally related to Meperidine. It binds to mu opiate receptors in GI tract and slow motility. Low therapeutic doses allow for potent anti-diarrheal effects without euphoric effects. Since higher doses can lead to euphoria and physical dependence, the drug ins combined with atropine at therapeutic doses to discourage abuse.
Succinylcholine: (1) Major electrolyte toxicity & mechanism (2) Patients at risk
(1) Succinylcholine can cause significant potassium release and life-threatening arrhythmias in patients at high risk for hyperkalemia, including (2) those with burns, myopathies, crush injuries, and denervating injuries or disease
Meanings of suffixes on biological agents: (1) -mab (2) -cept (3) -nib
(1) Monoclonal antibody (2) Receptor molecule (3) Kinase inhibitor
Arthritis treatments in different contexts: (1) Elderly, acute relief of RA (2) Moderate to severe RA (3) Mild, early, seronegative RA (4) Acute/Chronic Gout
(1) Glucocorticosteroids (short term for RA only, since unfavorable side effect profile) (2) Methotrexate (3) Sulfasalazine, hydroxychloroquine, & Minocycline (4) Colchicine
