1 Flashcards by Kelly MacWhorter

What are the 4 behavior changes in addiction

Pre-contemplative
Contemplative
Active
Relapse

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Contemplative vs Active

Contemplative: Currently interested in changing behavior.
Active: Currently making a behavior change.

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Medications for smoking cessation

bupropion (Wellbutrin, Zyban, Budeprion)
varenicline (Chantix)
nicotine replacement therapy

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Varenicline/Chantix info

Mechanism: Nicotine receptor blocker.
Use: Started a week before the quit date, titrated up, and maintained for two to three months. Should NOT be used with nicotine replacement.
Adverse effects: nausea (30% to 40%), take with food

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Bupropion info

Mechanism: Norepinephrine and dopamine reuptake inhibitor.
Use: It is started a week before the quit smoking date. The dose is titrated up and maintained for two to three months. It may be used in conjunction with nicotine-replacement methods, especially those that can be titrated during the day.
Adverse effects: Bupropion has been associated with an increase in suicide in adolescents and young adults.
Contraindications: It should not be used in patients with seizures and with caution in those with significant renal or hepatic impairment.

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changes associated with dyslipidemia

corneal arcus, xanthelasmas, acanthosis nigricans

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Patients between born between 1945 and 1965 should be screened for what?

HCV

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Eisleen is 48 and has smoked 2 packs of cigarettes for the past 20 years. Should she be screened for lung cancer? And if so, when?

YES, because she has smoked =/> 30 pack years and currently smokes.

Start annual chest CT once she is 55.

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What screening options are there for colonoscopies

fecal occult blood testing
sigmoidoscopy
colonoscopy
Fecal Immunochemical Testing (FIT Test)
Fecal DNA Testing
CT Colography

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When to check fasting lipids?

All over 21 every 4 to 6 years

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What lab to order to screen for chronic kidney disease?

CMP

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When to get an exercise stress test?

Asymptomatic male patients > 45 with one or more risk factors (hypercholesterolemia, hypertension, smoking, or family history of premature coronary artery disease)

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What ECG changes suggest CAD?

Horizontal ST segment depression or downsloping
Convex ST segment elevation
Q waves that are > 25% of succeeding R wave and greater than 0.04 seconds

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benzo receptor agonists used in insomnia

zolpidem (ambien)

eszopiclone (lunesta)

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When assessing the elderly for depression, what other disease may you want to screen for?

dementia

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What are 2 dementia screening tools?

Minicog and MMSE

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Name the 6 main SSRIs

Citalopram (Celexa)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Escitalopram (Lexapro)

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Name the 4 main TCAs

Nortriptyline (Pamelor)
Amitriptyline
Clomipramine (Anafranil)
Doxepin (Sinequan)

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Anti-depressant discontinuation syndrome symptoms

flu-like symptoms
insomnia
nausea
imbalance
sensory disturbances
hyperarousal

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What conditions can cause palpitations?

Cardiovascular: Arrhythmia, cardiomyopathy, hypovolemia
Psychiatric: Anxiety, panic attacks
Medications: Caffeine, stimulants, theophylline, albuterol
Substances: Tobacco, caffeine, alcohol intoxication or withdrawal, cocaine
Endocrinologic: Hyperthyroidism, pheochromocytoma, hypoglycemia
Hematologic: Anemia
Infectious: Febrile illness

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Which medications can induce thyroiditis?

amiodarone, interferon-alpha, interleukin-2, or lithium

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What symptoms does propranolol address in hyperthyroidism?

adrenergic - heat intolerance, palpitations, tremor

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What is a rare but serious side-effect of methimazole?

agranulocystosis

What are two absolute contraindications to radioactive treatment of thyroid disease?

Pregnancy and breastfeeding

Symptoms associated with hypothryoidism

``` Weight gain Cold intolerance Pedal edema Heavy periods Fatigue ```

What symptom is common to both hypo and hyperthyroidism?

fatigue

types of diabetic neuropathy

sensory (think feet) and autonomic (gastroparesis, sexual dysfunction)

HHS

Not a metabolic acidosis No or very little ketones Plasma glucose can be > 600 Can have high mortality rate with older pops and higher plasma glucose

what is the strongest risk factor for delayed ulcer healing and food amputation in diabetes?

peripheral vascular diseases with decreased blood supply to extremities

A patient comes in for routine visit. She has been on metformin for one year. What lab may you want to draw to screen for drug side effect?

Vitamin B 12

What labs to order in a diabetes follow-up in someone not experiencing acute symptoms of hypo or hyperglycemia

``` A1C Serum Creatinine and calculated GFR TSH Lipid Panel Vitamin B12 Spot urine albumin/creatinine ratio ```

How can hypertension affect the heart?

Left ventricular hypertrophy, angina or myocardial infarction, heart failure.

secondary causes of hypertension

``` Obstructive sleep apnea Primary aldosteronism Renovascular disease Renal parenchymal disease Drug or alcohol induced (including NSAIDS, sympathomimetics, cocaine, etc.) Pheochromocytoma Coarctation of the aorta Thyroid or parathyroid disease Cushing's syndrome Primary hyperparathyroidism ```

Which electrolyte abnormalities may thiazide diuretics cause?

hyponatremia and hypokalemia

In a patient with a history of gout, which HTN med may cause problems?

thiazides, can precipitate flares

What is the ceiling dose of benefit from hydrochlorothiazide?

25mg

A patient is newly diagnosed with hypertension. What labs should be run?

``` TSH Fasting lipid panel CMP UA ECG Urine albumin/creatinine ratio ```

Why not use both ACEi and ARB for hypertension management?

Risk of hyperkalemia and damage to kidneys

What is Homans sign?

Used in diagnosis of DVT - pain with passive dorsiflexion of foot

What easy test can be done to diagnose peripheral vascular disease?

Ankle-Brachial Index, take BP of each; An ABI of <0.9 is consistent with the disease

What is the use of d-dimer in DVT diagnosis?

D-dimer can help rule it out because it has high sensitivity, but specificity is poor. So + result doesn't tell you much.

What criteria can help determine likelihood of DVT?

Wells Criteria. Takes into consideration smoking, immobility, cancer, etc.

What lab findings can you look at quickly to determine renal function

BUN and creatinine

3 options for DVT tx

1) Monotherapy Xa inhibitors (rivaroxaban and apixaban) 2) Dabigatran + LMWH bridge 3) Warfarin + LMWH bridge

How long is LMWH bridge?

5-10 days

LMWH vs unfractionated?

LMWH: 1) longer half-life so less frequent dosing 2) no lab monitoring required 3) thrombocytopenia less likely 4) dosing is fixed 5) can be used in outpatient setting 6) bleeding complications less common

How does initiation of warfarin work?

Monitor warfarin dose by measuring the INR and titrate the warfarin dose every three to seven days to an INR of 2.0-3.0

What are downsides of Xa inhibitors?

Expensive and difficult to reverse anticoagulation in setting of bleed

NAme a direct thrombin inhibitor

Dabigatraban

How can dabigatraban anticoagulation be reversed?

reversal agent (idarucizumab)

how long to anticoagulate after unprovoked thromboembolic event?

3 months

When would you screen someone for thrombophilia in event of DVT?

1) Initial thrombosis occurring prior to age 50 without an immediately identified risk factor (e.g., idiopathic or unprovoked venous thrombosis). 2) family history of venous thromboembolism. 3) Recurrent venous thrombosis. 4) Thrombosis occurring in unusual vascular beds such as portal, hepatic, mesenteric, or cerebral veins.

Causes of palpitations

``` Hyperthyroidism Valvular heart disease Coronary artery disease Anemia Drugs Anxiety/panic disorder Vasomotor symptoms of menopause ```

When and why take aspirin for preventative measures?

WHY: For prevention of CVD and colorectal cancer (CRC) WHO: 50-59 years who have a 10 percent or greater 10-year CVD risk; are not at increased risk for bleeding; have a life expectancy of at least 10 years; and are willing to take low-dose aspirin daily for at least 10 years.

What are the 3 most common causes of back pain?

Age-related degenerative joint changes Herniated disc Lumbar strain/sprain

A patient presents with back pain. What questions to ask to rule out red flags?

``` Fever Unexplained weight loss Pain at night Bowel or bladder incontinence Neurologic symptoms Saddle anesthesia ```

Difficulty with toe walk is associated with ______

S1 disc herniation