Week 6 Lectures Flashcards by Mary Faragalla

summarize characteristics of a dataset
ex) demographic factors (age, sex, race)

descriptive statistics

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allow you to test a hypothesis, determine associations, or assess whether data is generalizable to the broader population

inferential statistics

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2 or more groups being measured
nominal- descriptive, no order ex) sex
ordinal- “ordered”, can give number ex) strongly agree, neutral, strongly disagree

categorical variable

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can be quantified as a number
continuous- any number is possible btw 2 integers ex) age, weight
interval- degree of difference btw 2 values ex) temperature
discrete- whole integers ex) # of children

numerical variables

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statistical test calculate ___ ___ - a # describing how much the relationship btw variables in your test differs from the H0

test statistic

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indicates likelihood (probability) of obtaining a result at least as extreme as that observed in a study by chance alone
significant at 0.05 or less
doesn’t really give us enough info

p value

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used to make inferences about population parameters

parametric

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data that does not fit a normal or known distribution

nonparametric

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used to compare the MEANS of 2 groups
tells you how significant the difference btw the group means are

T test

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used to compare differences btw means of 3 or more groups

ANOVA

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used when you have the same measure that participants were rated on at more than 2 time points
ex) performing training program study, want to measure participants resting HR one month before they start, at midpoint, and one month after the program ends to see if there is significant difference in mean resting HR across the 3 time points

repeated measures ANOVA

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has 2 independent variables (ex, eye color and BMR category)
main effect: each factors effect considered separately
interaction effect: all factors considered at same time
Have 3 hypotheses
have to calculate an F value for each hypothesis

two way ANOVA

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used to test whether 2 or more categorical variables are related to each other (binary, nominal, or ordinal)
non-parametric hypothesis test of independence, inferential statistical test
best way to organize data is in a contingency table (2x2)
more accurate for and used for LARGE sample

Chi-square (x^2) test

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if the X^2 value is greater than the critical value (found in table/software), then the difference between the observed and expected distributions is:

statistically significant

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if the X^2 value is less than the critical value (found in table/software), then the difference between the observed and expected distributions is:

not statistically significant

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similar to X^2 in that it tests for nonrandom association or relationships btw 2 categorical variables
used for SMALL samples
ex) if total n < 20 or if n is btw 20 and 40 and one of the true expected cell frequencies is < or = 5

Fisher’s Exact Test

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measure of the linear correlation btw 2 variables
denoted by “r”
btw -1 and 1- measure the strength and direction of the relationship btw 2 variables

Pearson correlation coefficient

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descriptive statistic, describing the strength and direction of the linear relationship btw 2 quantitative variables
also an inferential statistic so it can be used to test statistical hypotheses– whether there is a significant relationship btw 2 variables

Pearson correlation coefficient

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used to describe relationships between variables by fitting a line to observed data
allows you to estimate how a dependent variable changes as the independent variable(s) change
linear- has only one independent variable

regression models

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a statistical technique that can be used to analyze the relationship btw a single dependent variable and several independent variable
can be linear or non linear
use when you want to know how strong relationship is btw 2 or more independent variables and one dependent variable (ex) how rainfall and temperature affect crop yield)

multiple regression

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kind of t-test, groups come from same population (ex before and after treatment)

paired t-test

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kind of t-test, groups come from 2 different populations

two sample t-test

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kind of t-test, group is compared against a standard value

one sample t-test

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kind of t-test, assesses whether one population mean is greater or less than the other

one tailed t-test

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kind of t-test, assesses whether the groups are different from each other

two tailed t-test

M agonism (mushroom poison muscarine) used for Dx of asthma (bronchoconstriction)

METHACHOLINE

M agonism (mushroom poison muscarine) used for ileus, atonic bladder

BETHANECHOL (Bethany, Call M3 to activate your bladder)

M agonism (mushroom poison muscarine) used for glaucoma

CARBACHOL

M agonism (mushroom poison muscarine) used for xerostomia in Sjogren (dry eyes and mouth)

PILOCARPINE (let Me activate those tears on your Pil-low"

depolarizing paralytic agent in surgery that acts on Nm receptor, desensitize nACHR (Nn and Nm)

SUCCINYLCHOLINE

AChE inhibitor increases ACh and is a Dx for myotonia gravis

EDPROPHONIUM

AChE inhibitor increases ACh , myasthenia gravis and nerve gas prophylaxis

PYRIDOSTIGMINE

AChE inhibitor increases ACh and crosses BBB, glaucoma, Atropine toxicity

PHYSOSTIGMINE

AChE inhibitor increases ACh, Ileus, Dx and Rx for myotonia gravis

NEOSTIGMINE

AChE inhibitor increases ACh and is used for Alzheimers (4)

TACRINE, DONEPEZIL, RIVASTIGMINE, GALANTAMINE Don Riva forgot her ACh at the Gala

nerve gases and organophosphates inactivate AChE by serine phosphorylation and produce cholinergic crisis, dephosphorylation and regeneration of enzyme done by:

PRALIDOXIME

within 2 hours, a phosphoester bond undergoes cleavage generating an ____ ___ that resists hydrolytic regeneration leading to irreversible AChE inhibition (nerve gases and organophosphate)

anionic (charged) phosphate

Atropine (M antagonist) and _____ (enzyme regenerator) is used to treat nerve gas and organophosphate poisoning

PRALIDOXIME

given to soldiers prophylactically during the days of expected exposure to nerve gases, controlled dose, that temporarily blocks half AChE so nerve gases don't have access

PYRIDOSTIGMINE or PHYSOSTIGMINE

M Block drug, mushroom poisoning, dilate eyes for exam, surgery, reduce saliva and bronchial mucus, prevent bradycardia

ATROPINE

M Block drug, motion sickness, antiemetic, prevent bradycardia in surgery

SCOPOLAMINE

M Block drug, antihistamine and anticholinergic

DIPHENHYDRAMINE

M Block drug, for asthma (2)

IPRATROPIUM TITOTROPIUM

M Block drug, overactive bladder (2)

OXYBUTYNIN PROPANTHELIN

M Block drug, Parkinson rigidity and splasticity (3)

BENZTROPINE MESYLATE TRIHEXPHENIDYL PROCYCLIDINE

Blocks Na+/Choline cotransporter

HEMICHOLINIUM

Nm blockers/antagonist (5)

D-TUBOCURARINE CISTRACURIUM PANCURONIUM VECURONILUM MIVACURIUM (short acting)

blocks V-type H+ ATPase

VESAMICOL

____ toxin degrades SNAP-25 and Syntaxin

Botulinum

VGCC Antibody=

Lambert-Eaton myasthenic syndrome (LEMS)

____ toxin degrades Synaptobrevin preventing GABA release in spinal cord

Tenatus

Nn block

HEXAMETHONIUM

Nn block , antihypertensive in aortic disection

TRIMETHAPHAN

Nn block , antihypertensive in aortic dissection, Tourette (ticks) syndrome)

MECAMYLAMINE

a1 vasoconstriction (strong effect), a2 dec sympathetic outflow, B1 inc ionotropy (heart contraction), B2 vasodilation and bronchodilation, D1 vasodilation (kidney) anaphylactic shock, asystole, asthma, adjunct to local anesthesia

EPINEPHRINE

a1 vasoconstriction (strong effect), a2 dec sympathetic outflow, B1 inc ionotropy low (heart contraction), septic shock

NOREPINEPHRINE

a1 vasoconstriction (high dose), B1 inc ionotropy (med dose), D1 vasodilation (kidney) low dose septic shock

DOPAMINE

a1 vasoconstriction (high dose) nasal congestion, to dilate pupils, hypotension in OR

PHENYLEPHRINE

a2 dec sympathetic outflow (high dose (2)) hypertension, opioid withdrawal hypertension in pregnancy

CLONIDINE A-METHYLDOPA

B1 inc ionotropy (high dose) septic shock

DOBUTAMINE

B1 inc ionotropy (high dose) and B2 vasodilation and bronchodilation (high dose) refractory, Torsades de Pointes

ISOPROTERENOL

a1 adrenergic blockers, 1) pheochromocytoma preop AND 2) pheochromocytoma preop, reverse epinephrine induced vasoconstriction in end artery supplied organs

1) PHENOXYBENZAMINE 2) PHENTOLAMINE

a1 adrenergic blockers, for BPH (4)

PRAZOCIN DOXAZOCIN TERAZOCIN TAMSULOSIN

a2 blocker for erectile dysfunction

YOHIMBINE

B1 blocker (5)

ATENOLOL METOPROLOL (HTN, angina, CHF) ESMOLOL NEBIVOLOL BETAXOLOL

B1 blocker and a1 blocker (2) HTN in pregnancy, HTN emergency HTN + CHF

LABETALOL CARVEDILOL

B1 and B2 blocker (4)

PROPRANOLOL PINDOLOL TIMOLOL SOTALOL

reasons for poisoning for less than 6 years and 6-12 years

unintentional- general

reasons for poisoning for teens, adults, and all ages

intentional- suspected suicide

types of poison for adults

analesics, sedative/hypotonics/antipsychotics, antidepressants

types of poisons for adults

analgesics, sedative/hypotonic/antipsychotics, antidepressants

types of poisons for children

cosmetic and personal care products, cleaning substances, analgesics

most people who die from poisoning are ____, and most deaths are ____ rather than accidental

adults intentional

leading cause of accidental poisoning related deaths

drugs

accounts for 20% of adult poisonings

drug abuse

children younger than 6 year old account for ____ poisoning incidents, but only small fraction of deaths

most

children btw 1-2 year old have the highest incidence of ____ poisoning

accidental

___ and ____ are the leading cause of pediatric accidental poisoning fatalities

iron and pesticides

mode of toxicity, incidence and severity are dose-dependent ex) nifedipine-induced hypotension; antipsychotic- induced tardive dyskinesia

pharmacologic toxicity

mode of toxicity, incidence and severity are dose-dependent ex) acetaminophen

pathologic toxicity

mode of toxicity, incidence and severity are dose-dependent ex) ionizing radiation; anti neoplastic agents

genotoxicity

mode of toxicity, incidence and severity are dose-dependent, inhibition or induction of CYP dependent drug metabolism

drug-drug interactions

mode of toxicity, incidence and severity are dose-dependent, abnormal reactivity to a chemical peculiar to a given individual

Idiosyncratic drug reactions

what are the 3 cell death pathways cell death is the final common effect of many toxins

apoptosis necrosis autophagy associated cell death

monitor viral signs as a function of time, obtain a history, perform a toxicological oriented patient exam

poison management

general approach to diagnosis and management of the poisoned patient

ABCs and Altered Mental Status Airway Breathing Circulation

a constellation of clinical signs that may suggest a particular type of ingestion may indicate what type of dugs a patient has taken if they are unwilling to tell you

toxidromes

anticholinergic, cholinergic, sympathomimetic, sedative, hallucinogens, serotonergic are the most commonly seen

toxidromes

cocaine and amphetamine, agitation, increase HR, BP, T and puplil size, also tremor and diaphoresis

sympathomimetic

diphenhydramine and Belladonna atropa, delirium, Increase HR, BP, T, pupil size, also ileus and flushing

anticholinergic

organophosphates, coma/somnolence, Increased RR and Decreased pupil size, other SLUDGE, fasciculation

cholinergic

heroin and oxycodone, coma/somnolence, Decreased HR, RR, and pupil size

opioid

Benzodiazepines and Barbiturates, coma/somnolence, Decreased HR and RR

sedative hypnotic

aspirin, confusion, Increased HR, RR, T, also diaphoresis and vomiting

salicylate

Verapamil, Decreased HR and BP

Ca2+ channel blocker

commonly used OTC drug toxicity

acetaminophen aspirin

when combined with another drug, such as diphenhydramine, codeine, hydrocodone, oxycodone, dextromethorphan, or propoxyphene, the more dramatic acute symptoms caused by the other drug may make the mild and nonspecific symptoms of early ____ toxicity, resulting in a missed diagnosis or delayed antidotal treatment

acetaminophen

exposure: OTC medication, accidental, suicidal, acute or chronic mechanism: GSH depletion, ROS damage presentation: anorexia, nausea, vomiting, liver injury, renal failure diagnosis/treatment: exposure history, specific levels, prolonged PT/INR, treat- NAC

acetaminophen toxicity

exposure: OTC meds, accidental, suicidal, acute or chronic mechanism: CNS resp stimulation, oxidative phosphorylation uncoupling, (-) glucose, FA metabolism presentation: tinnitus, hyperpnea, vomiting, lethargy, initial respiratory alkalosis, followed by metabolic acidosis, coma, seizure, hypoglycemia, hyperthermia, pulmonary edema diagnosis/treatment: exposure history, characteristics ABGs, specific levels, electrolytes, vital function support, bicarb for metabolic acidosis, enhanced elimination

salicylate toxicity

exposure: vitamins, esp prenatal mechanism: enhanced ROS stress, direct corrosive effect presentation: time-dependent evolution, abdominal pain, vomiting, GI mucosal necrosis and hemorrhage, lactic acidosis and MOSF, long term GI disease Dx/Tx: exposure history, clinical presentation, serum iron and ferritin, abdominal radiography, emergency and supportive measures, deferoxamine

iron toxicity

exposure: paint, occupational, usually subacute or chronic mechanism: binding to SH group (-) multiple Zn and Ca dependent enzymes presentation: multisystem, hypochromic microcytic anemia, nausea, vomiting, abdominal pain, hematemesis, chronic encephalopathy, peripheral neuropathy diagnosis/treatment: exposure history, blood lead level, removal from environment, emergency and supportive measures, EDTA, dimercaprol

lead toxicity

contain 2 or more electronegative groups that form stable coordinate covalent complexes with cationic metals that can be excreted from the body, contain functional groups such as -OH, -SH, and -NH which compete for metal binding with similar groups on cell proteins can bind with metals essential for normal body fn types: EDTA, dimercaprol, succimer, pencillamine, deferoxamine

metal chelating agents

exposure: intention ingestion, alcoholic, children mechanism: metabolism to acidic glycol intermediates causes anion gap metabolic acidosis, oxalate crystal deposition presentation: ethanol like intoxication, gastritis, vomiting, anion gap acidosis, MOSF, delayed neurologic sequelae Dx/Tx: exposure history, urine oxalate crystals, electrolytes, renal and liver function, ECG, emergency and supportive measures, remove from exposure, decontaminate, activated charcoal hemodialysis

ethylene glycol

exposure: ingestion, occupational, solvents, etc, Et-OH substitute by alcoholics mechanism: metabolized by ADH to formic acid, systemic acidosis, optic nerve toxin presentation: inebriation, gastritis, delayed anion gap acidosis, impaired vision, blindness, MOSF Dx/Tx: exposure history, anion gap (normal lactate), osmol gap, serum methanol, formate, electrolytes, renal and liver, ABGs, ECG, emergency and supportive measures, fomepizole or Et-OH, Leucovorin or folic acid, decontamination, enhanced elim

methanol toxicity

exposure: accidental, suicidal, acute or chronic mechanism: (-) mRNA synthesis in metabolically active tissue presentation: mild-moderate gastroenteritis, vomiting, cramps, diarrhea, volume depletion, hypotension, ARF, liver disease, MOSF, DIC, convulsions Dx/Tx: exposure history, anatoxin levels, electrolytes, renal function, PT/INR< emergency and supportive measures, activated charcoal

mushroom (anatoxin)

enter via inhalation and are either absorbed into lungs (gasses) or eliminated by lungs 2 types: reducing types (sulfuroxides) or oxidizing types (NO, hydrocarbons, and photochemical oxidants)

air pollutants/inhaled toxins

colorless, odorless, non irritating gas produced from the incomplete combustion of organic matter, competes for and combines with the oxygen binding site of hemoglobin to form CO-Hb, also binds to cellular respiratory cytochrome, concentrations of 0.1% in air will result in 50% carboxyhemoglobinemia

carbon monoxide (CO)

>15% CO-Hb ---> progressive hypoxia toxidrome: headache, vomiting, syncope, seizures, coma chronic, low level exposure can be harmful to the cardiovascular system and to a developing fetus

carbon monoxide (CO)

an irritating, naturally occurring, bluish gas, found in high levels of polluted air and around high voltage electrical equipment formed from a complex series of chemical reaction involving NO2, UV light and generation of O2 causes free radical-dependent airways inflammation, and if severe, degeneration of alveolar type I cells with alveolar-capillary membrane rupture

ozone (O3)

anticoagulant used in human, is also one of the most widely employed rodenticides antagonizes actions of vitamin K thereby inducing bleeding and hemorrhagic conditions treatment: administer phytonadione (vitamin Kq)

warfarin

___ should be initiated within 1 hr of poisoning ONLY when you can do it safely. Cannot do if corrosives have been ingested, petroleum distillates have been ingested, if patient is comatose or delirious, stimulants have been ingested

emesis (vomiting)

what 2 ways can you reduce drug absorption

emesis gastric lavage

what are 2 approaches to gastric decontamination

activated charcoal cathartics

what 2 approaches are used for promotion of toxin elimination

chemical enhancement of urinary excretion (bicarb) hemodialysis (severe poisoning)

what 2 drugs are inhibitors of mast cell granulation

CROMOLYN SODIUM NEDOCROMIL

sedative first generation H1-antihistamine also used for anti-motion sickness activity (2), can readily cross BBB because neutral at pH 7.4

DIMENHYDRINATE (Dramamine) DIPHENHYDRAMINE (Benadryl)

second generation antihistamine with minimal sedation; do not cross BBB because ionized at pH 7.4

CETIRIZINE (Zyrtec)

What kinds of drugs penetrate the BBB because they are neutral and readily cross? Name the 3 kinds and an example

first generation H1 classic antihistamine (DIPHENHYDRAMMINE) tricyclic antidepressant (AMITRIPTYLINE) first generation antipsychotic drug (CHLORPROMAZINE)

these drugs are ionized at ph 7.4 and do not cross the BBB. The difference in BBB penetration explains the more sedative effects of the ___ ____ H1 antihistamine

second generation first generation

antihistamine drug (H1) smooth muscle endothelium, Gq Inc IP3, DAG --> Inc Ca2+ and PKC

MEPYRAMINE CETIRIZINE

antihistamine drug (H2) gastric mucosa, cardiac, mast cells, brain, Gs inc cAMP

CIMETHIDINE RANTIDINE

ACE inhibitor used to treat hypertension

LISINOPRIL

because ACE degrades bradykinin, antihypertensive therapy with ACE inhibitors may lead to accumulation of bradykinin in tissues and manifest clinically as what?

angioedema or dry cough

increase of NO in septic shock leads to what

vasodilation

NO donors in angina (chest pain due to reduced blood flow to heart)

NITROGLYCERINE ISOSORBIDE DINITRATE

NO donors in hypersensitive emergencies

SODIUM NITROPRUSSIDE

NO in erectile dysunction. PDE5 inhibitor increases cGMP in corpora cavernosa

SILDENAFIL

due to failure of baroreceptor reflex dizziness, syncope, temporary decrease in vision or hearing upon standing with/during -awakening in morning, postprandial period, ambient warming, exercise

orthostatic hypotension

medication to increase blood pressure for orthostatic hypotension rx a-1 agonist for capacitance vessels

MIDODRINE

medication to increase blood pressure for orthostatic hypotension rx synthetic precursor of NE

DROXIDOPA

early symptoms include: impotence, overactive or atonic bladder, cold feet, GI constipation, dry irritated eye, anhidrosis, Orthostatic hypotension

autonomic disorders

most disabling autonomic disorder, caused by dysfunction of the ANS = neurogenic

Orthostatic Hypotension

brain autonomic disorder autonomic failure (Orthostatic Hypotension or neurogenic bladder) + Parkinsonism (MSA-p- more common) or cerebellar syndrome

Multiple System Atrophy

peripheral autonomic neuropathy, demyelinating polyradiculoneuropathy due to antiganglioside antibodies

Guillain Barre syndrome

consists of triad of ophthalmoplegia, ataxia, and areflexia

Miller Fisher syndrome

a 65 year old man was brought to the ED after suffering crushing substernal pain for the past hour. Vital sign on admission were T 36.7, BP 88/50, pulse 115 bpm, RR 30/min, SpO2 92% in room air. A diagnosis of cardiogenic shock due to myocardial infarction was made and antishock therapy was started with an IV drug. Which drug was given?

Dobutamine

cardiomyocyte contraction done by what receptor

B1 (Gs)

muscarinic ACh ____ receptor in SA node slows done heart rate (bradycardia )

naturally produces bradycardia

acetylcholine

M BLOCKER, produces tachycardia (inc HR), Rx of bradyarrhythmiaia

ATROPINE

adrenergic receptor ____ in SA, AV node and in myocardium accelerated HR (tachycardia), Inc conduction velocity, enhances myocardial contraction

two natural B1 agonist (inc HR)

norepinephrine and epinephrine

B1 agonist Rx of cardiogenic shock

DOBUTAMINE

B1 blocker Rx of tachyarrhythmia, CHF

METOPROLOL

agonist for a1, a2, B1 vasoconstriction by a1 without antagonism from B2

norepinephrine

agonist for a1,a2, b1, b2, b3 vasodilation by B2 overrides its a1 action

epinephrine

there is NO parasympathetic innervation of ___, but ACh in plasma can produce vasodilation via M3 (Gq) agonism on EC and release NO

Vascular SMC

35 year old man comes to the office for a routine health maintenance examination. The patient has a 5 year history of bronchial asthma, for which he uses ALBUTEROL inhaler during the day an average of twice a week. In addition, his asthma wakes him up from sleeping approximately 3-4 times per month. The patient is allergic to dust mites and ragweed, but has no other medical issues and takes no other medications. He dos not use tobacco, alcohol, or recreational drugs. His family history is significant for asthma in his grandfather. Vital signs are normal. Lung auscultation indicates normal breath sounds without wheezing. Heart sounds are normal. What is the mechanism of action of this inhaled drug.

increased cAMP?

a 30 year old woman is administered IV CEFTRIAXONE for pneumonia. A few minutes later, she develops dyspnea, urticaria (hives) on her chest and back, and angioedema of her throat. Her skin is war. Her BP is 80/60 mm Hg. IV infusion is started and EPINEPHRINE is administered. The therapeutic effect of the drug was mediated by which of the following pair of receptors?

a1 and B2 a1agonism (vasoconstriction- skin, splanchnic) B2 agonism (bronchodilation)

why is epinephrine effective for anaphylactic shock but norepinephrine is not

Epi- a1 agonist (Gq) = vasoconstriction b2 agonist (Ga) = bronchodilation NOR DOES NOT HAVE B2 AGONIST

B2 agonist dilates bronchi in asthma

ALBUTEROL

B2 agonism dilates bronchi in anaphylaxis

EPINEPHRINE

M blocker dilates bronchi in asthma

IPRATOPIUM

D1 agonist made in CNS and proximal tubule cells local diuretic and natriuretic

DOPAMINE

D1 agonist indication: HTN emergency

FENOLDOPAM

D2 agonist, indication : CHF, sepsis, shock

DOPEXAMINE

central a2 agonist --> ___ sympathetic outflow from LC agonists: CLONDINE, A-METHYLDOPA, DEXMEDETOMIDINE, TIZANIDINE

decrease

a 35-year-old farmer was brought to the emergency department with severe abdominal cramps and vomiting. He reported that he was working in a field with an organophosphate pesticide. Physical exams reveal salvation, decreased blood pressure, difficulty breathing, miosis, diarrhea, sweating, bradycardia, and urinary urgency. Activation of which of the following receptors is mediated the eye symptom in patient?

what receptor is predominate in miosis (constrict pupil)

what receptor is predominate in mydriasis (dilate pupil)

what receptor facilitates skeletal muscle movement for eyeball

A 60-year-old man presents to the family physician with one-month history of urinary frequency, urgency, and histation. Vital signs and physical examinations are unremarkable. Digital rectal examination reveals an enlarged prostate with a rubbery consistency. Drug with which of the following mechanisms of action is appropriate for the patient?

a1 antagonist

M agonist for atonic bladder (cannot urinate)

BETHANECHOL

M blockers for overactive bladder

OXYBUTYNIN PROPANTHELIN

a1 blockers for BPH SE: Orthostatic hypotension

PRAZOCIN DOXAZOCIN TERAZOCIN

a1 blockers for BPH SE: Orthostatic hypotension

PRAZOCIN DOXAZOCIN TERAZOCIN

B3 agonists for overactive bladder

MIRABEGRON

A 34-year-old man comes to family physician with a lack of erection. A postage stamp test is positive for the presence of nocturnal tumescence. SILDENAFIL is prescribed. Which of the following is MoA for drug?

increased cGMP

what neuron is NO mediated and is parasympathetic for erection

NANC

what receptor is involved in sympathetic mediated ejaculation and detumescence

what drug is used for erectile dysfunction that inhibits PDE5 and degrades GMP so there is an increase in cGMP

SILDENAFIL

Usually seen in children , Hypokalemic manifests later in life (before age 40), Demographic of thyroidism (Asian) Muscle strength test (out of 5) 5/5 full strength (normal) 4/5 force against resistance less than full strength 3/5 moves against gravity but not against resistance 2/5 moves from side to side but not against gravity 1/5 minimal movement 0/5 no movement Reflex testing 4+ hyperrflexia + clonus 3+ hyperreflexia 2+ normal 1 + hyporeflexia 0 Areflexia

hyperthyroid hypokalemic periodic paralysis

increases tissue responsiveness to adrenergic stimulation by increasing the abundance of B-adrenergic receptors

Thyroid hormones

overactivity may cause hypokalemia by increasing epi action (inc B receptors) or synergizing insulin action (insulin goes up after a carb meal)

thyroid hormone

toxin inactivates Syntaxin and SNAP 25

Botulism

antibodies against Nm receptors (muscle weakness)

Myasthenia gravis