Real World Flashcards
What do topical calcineurin inhibitors do? (ex. Elidel - aka pimecrolimus)
There are two types of topical calcineurin inhibitors called tacrolimus ointment (Protopic 0.03% and 0.1%) and pimecrolimus cream (Elidel). They are classified as immunomodulating agents. This means that they act on the immune system to reduce skin inflammation. Both tacrolimus and pimecrolimus block a chemical called calcineurin which activates inflammation in the skin and causes redness and itching of the skin.
Tacrolimus ointment and pimecrolimus cream are licensed in the UK for the treatment of atopic eczema (atopic dermatitis) in adults, and children over the age of 2 years. Tacrolimus comes in two strengths; 0.03% (weaker) and 0.1% (stronger); the weaker preparation is licensed to be used in children between the ages of 2 and 16, and the stronger preparation in adults over the age of 16. Tacrolimus ointment is also licensed for the prevention of flares of atopic eczema in adults. These topical treatments can also be prescribed for a number of other inflammatory skin conditions such as psoriasis (particularly on the face), seborrhoeic eczema (seborrhoeic dermatitis), lichen planus, lichen sclerosus, vitiligo, cutaneous lupus erythematosus and pityriasis alba but the calcineurin inhibitors are not officially licensed for these skin conditions.
What is psychogenic syndrome
An external stimuli shocks someone so severly the brain suffers an electric short. Can have the presentation of seizure or coma.
Definitive test: raise the patients arm above hus face and let go. A patient in a psychogenic coma has enough capacity to avoid hitting himself.
The treatment: speak reassuringly until your words connect and the patients awaken
Juvenile rheumatoid arthritis (JRA), often referred to by doctors today as juvenile idiopathic arthritis (JIA)
is a type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. It affects approximately 50,000 children in the United States
Juvenile Arthritis Progression:
Over time, children with oligoarthritis (arthritis that affects four or fewer joints) tend to outgrow arthritis, Ilowite says. But for some, the arthritis can go on to affect more joints.
Polyarthritis (arthritis affecting five or more joints), on the other hand, continues to be active and can cause irreversible damage if not treated, he says.
And for children with systemic arthritis, about 40 percent will find that their arthritis goes away after a year or two, while 35 percent will have it for several years, Ilowite says. “About 25 percent have severe unrelenting arthritis that can be destructive,” he says.
Psoriatic arthritis (a type of arthritis associated with the skin condition psoriasis) is more variable. “It can be in a few joints, it can be in a lot of joints, it can be persistent, it can go away, or it can fluctuate,” he says.
Ciclopirox (the shampoo)
is a synthetic antifungal agent for topical dermatologic treatment of superficial mycoses. It is most useful against Tinea versicolor. It is sold under many brand names worldwide
Ciclopirox is indicated for the treatment of tinea pedis and tinea corporis due to Trichophyton rubrum, Trichophyton mentagrophytes and Epidermophyton floccosum, as well as seborrheic dermatitis.
In contrast to the azoles and other antimycotic drugs, the mechanism of action of ciclopirox is poorly understood.
However, loss of function of certain catalase and peroxidase enzymes has been implicated as the mechanism of action, as well as various other components of cellular metabolism
What is C-reactive protein?
A pentameric protein released by the liver in response to inflammation and amplify it. CRP levels rise dramatically in the first 6-10 hours of an infection or injury. The levels can reach 500x baseline level of CRP. Once CRP is in the bloodstream, it enters tissues that are not infected/injured and alerts them of impending attack. IN response to CRP, tissues will produce mediators of inflammation that further promote the inflammation, cytokines.
What is C-peptide?
C-peptide is a product that is created when the hormone insulin is produced and released into the body. The insulin C-peptide test measures the amount of this product in the blood.
C-peptide is measured to tell the difference between insulin the body produces and insulin someone injects into their body.
Someone with type 1 or type 2 diabetes may have their C-peptide level measured to see if their body is still producing any insulin. It may also be measured in cases of low blood sugar to see if the person’s body is producing too much insulin.
C-peptide level is based on blood sugar level. C-peptide is a sign that your body is producing insulin. A low level (or no C-peptide) indicates that your pancreas is producing little or no insulin.
A low level may be normal if you have not eaten recently. Your blood sugar and insulin levels would naturally be low then.
A low level is abnormal if your blood sugar is high and your body should be making insulin at that time.
Lorazepam
lady in what the health takes it for stress
Lorazepam belongs to a group of drugs called benzodiazepines. It affects chemicals in the brain that may be unbalanced in people with anxiety.
Lorazepam is used to treat anxiety disorders.
It can treat seizure disorders, such as epilepsy. It can also be used before surgery and medical procedures to relieve anxiety.
What are the Z-drugs?
Three distinct groups of CNS sedative-hypnotics:
- Zolpidem (Stilnoct, Ambien, Ambien CR, Intermezzo, Stilnox) - 1.5-2.4 hr half life
- Zopiclone (Imovane, Zimovane, Imrest), eszopiclone (Lunesta) - 1.4 – 4.5 hours
- *Zaleplon (Sonata, Starnoc, Andante): 1 hr half life
they work in a similar way to the benzodiazepine drugs inside the brain. They are GABA agonists meaning they somewhat mimic the action of gamma-Aminobutyric acid, the inhibitory neurotransmitter and thereby induce sleepiness. Benzodiazepines act on GABA-A receptors that include subunits of the alpha-1, alpha-2, alpha-3, and other classes. The Z-drugs are more selective for the alpha-1 subclass which seems to drive sleepiness but not anti-anxiety.
Cyclobenzaprine
Cyclobenzaprine, sold under the brand name Flexeril among others, is a muscle relaxer medication used to relieve skeletal muscle spasms and associated pain in acute musculoskeletal conditions.[5] It is the best-studied drug for this application.[6] It has also been used off-label for fibromyalgia treatment.[7]
After sustaining an injury, painful muscle spasms may occur to stabilize the affected body part and prevent further damage. Cyclobenzaprine is used to treat such muscle spasms associated with acute, painful musculoskeletal conditions.[5] It decreases pain in the first two weeks,[6][9] peaking in the first few days, but has no proven benefit after two weeks.[6][10] Since no benefit is proven beyond that, therapy should not be continued long-term.[11] It is not useful for spasticity due to neurologic conditions such as cerebral palsy
Side effects: significantly increased rates of drowsiness (38% of patients), dry mouth (24%), dizziness (10%), and adverse events of any kind in patients taking cyclobenzaprine versus placebo
Topirmate (brand name topamax)
Topiramate (brand name Topamax) is an anticonvulsant (antiepilepsy) drug. In late 2012, topiramate was approved by the United States Food and Drug Administration (FDA) in combination with phentermine for weight loss. The drug had previously been used off-label for this purpose.
Topiramate is used to treat epilepsy in children and adults, and it was originally used as an anticonvulsant.[7] In children, it is indicated for the treatment of Lennox-Gastaut syndrome, a disorder that causes seizures and developmental delay. It is also Food and Drug Administration (FDA) approved for, and most frequently prescribed for, the prevention of migraines.[7] The drug is also used to treat migraines due to the effect it has on the blood vessels in the brain. It has been found to be increasingly effective for migraine sufferers with limited side effects.
Prozac: Fluoxetine
Selective Serotonin Reuptake Inhibitor (SSRI)
It can treat depression, obsessive-compulsive disorder (OCD), bulimia nervosa, and panic disorder.
What does a Cpap machine do?
Continuous positive airway pressure therapy (CPAP ) uses a machine to help a person who has obstructive sleep apnea (OSA) breathe more easily during sleep. A CPAP machine increases air pressure in your throat so that your airway doesn’t collapse when you breathe in.
It does this by gently blowing air when you inhale to increase pressure on the walls. When you exhale, there is still continuous air being blown to keep the airway open. The blown air pushes the carbon dioxide out through tiny holes in the mask
What is osteoarthritis?
Degeneration of joint cartilage and the underlying bone, most common from 65 onward. It causes pain and stiffness, especially in the hip, knee, lower back, neck, big toe, small joints of fingers and thumb joints. The most common chronic condition of the joints, affecting 27 million Americans.
MOA: cartilage breaks down causing pain, swelling and problems moving the joint. As OA worsens over time, bones may break down and develop growths caused spurs. Bits of bone and cartilage can chip off, an inflammatory process occurs and cytokines and enzymes develop that further damage the cartilage.
Does calcium lower increase bone health?
“calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women” - conclusion: an adequate vitamin D intake in associated with a lower risk of osteoporotic hip fractures in postmenopausal women. Neither milk nor a high-calcium diet appears to reduce risk. Because women commonly consume less than the recommended intake of vitamin D, supplement use or dark fish consumption may be prudent
What are casomorphins?
Casomorphins are peptides derived from the digestion of milk protein casein which is what makes up dairy products. They go to brain and attach to the same receptor that heroin attaches to. They are not as strong as heroin, the cheese brings you back. Can play a role in SCIDs, fetal sudden death syndrome, that is why babies are recommended to drink maternal milk
How does diabetes cause kidney disease.
When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.
Diabetes can damage this system. High levels of blood glucose make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.
When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.
In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).
What is protamine?
Heparin is often given as an emergency anticoagulant. Heparin is a proteoglycan with a ton of negative charges but the danger is bleeding out. The antidote is PROTamine which has a ton of positive charges to counter heparin.
What is melanoma?
Melanoma, also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.[1] Melanomas typically occur in the skin but may rarely occur in the mouth, intestines, or eye.[1][2] In women they most commonly occur on the legs, while in men they are most common on the back. Sometimes they develop from a mole with concerning changes including an increase in size, irregular edges, change in color, itchiness, or skin breakdown.
The primary cause of melanoma is ultraviolet light (UV) exposure in those with low levels of skin pigment.[2][7] The UV light may be from either the sun or from other sources, such as tanning devices. About 25% develop from moles.[2] Those with many moles, a history of affected family members, and who have poor immune function are at greater risk.[1] A number of rare genetic defects such as xeroderma pigmentosum also increase risk.[8] Diagnosis is by biopsy of any concerning skin lesion.
Melanoma is the most dangerous type of skin cancer. Globally, in 2012, it newly occurred in 232,000 people.[2] In 2015 there were 3.1 million with active disease which resulted in 59,800 deaths.[5][6] Australia and New Zealand have the highest rates of melanoma in the world. There are also high rates in Northern Europe and North America, while it is less common in Asia, Africa, and Latin America.[2] Melanoma is more common in men than women.[8] Melanoma has become more common since the 1960s in areas that are mostly Caucasian.[2][8]
Xeroderma pigmentosum
Xeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet (UV) light is deficient.[2 In extreme cases, all exposure to sunlight must be forbidden, no matter how small; as such, individuals with the disease are often colloquially referred to as “Moon child”.[3] Multiple basal cell carcinomas (basaliomas) and other skin malignancies frequently occur at a young age in those with XP; metastatic malignant melanoma and squamous cell carcinoma[4] are the two most common causes of death in XP victims. This disease is present in both genders and in all races, with an incidence of 1:250,000 in the United States.[5] XP is roughly six times more common in Japanese people[4] than in other groups.
Symptoms include:
Severe sunburn when exposed to only small amounts of sunlight. These often occur during a child’s first exposure to sunlight.
Development of many freckles at an early age
Rough-surfaced growths (solar keratoses), and skin cancers
Eyes that are painfully sensitive to the sun and may easily become irritated, bloodshot and clouded
Blistering or freckling on minimum sun exposure
Spider Veins
Limited growth of hair on chest and legs
Scaly skin
Dry skin
Irregular dark spots on the skin
Corneal ulcerations
Describe isoniazid
Isoniazid, also known as isonicotinylhydrazide (INH), is an antibiotic used for the treatment of tuberculosis.[1] For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol.[2] For latent tuberculosis it is often used by itself. It may also be used for atypical types of mycobacteria, such as M. avium, M. kansasii, and M. xenopi. It is usually taken by mouth but may be used by injection into muscle.
Common side effect include increased blood levels of liver enzymes and numbness in the hands and feet. Serious side effects may include liver inflammation.[1] It is unclear if use during pregnancy is safe for the baby. Use during breastfeeding is likely okay.[3] Pyridoxine (B6) may be given to reduce the risk of side effects.[4] Isoniazid works in part by disrupting the formation of the bacteria’s cell wall which results in cell death.[1]
What is lidocaine?
anesthetic and anti-arrhythmic agent
Lidocaine is a medication used to numb tissue in a specific area.[4] It is also used to treat ventricular tachycardia and to perform nerve blocks. Lidocaine mixed with a small amount of adrenaline (epinephrine) is available to allow larger doses for numbing, to decrease bleeding, and to make the numbing effect last longer.[4] When used as an injectable, it typically begins working within four minutes and lasts for half an hour to three hours.[4][5] Lidocaine mixtures may also be applied directly to the skin or mucous membranes to numb the area
What is atropine used for with the heart?
Injections of atropine are used in the treatment of bradycardia (a heart rate < 60 beats per minute).
Atropine was previously included in international resuscitation guidelines for use in cardiac arrest associated with asystole and PEA, but was removed from these guidelines in 2010 due to a lack of evidence for its effectiveness.[14] For symptomatic bradycardia, the usual dosage is 0.5 to 1 mg IV push, may repeat every 3 to 5 minutes up to a total dose of 3 mg (maximum 0.04 mg/kg).[15]
Atropine is also useful in treating second-degree heart block Mobitz type 1 (Wenckebach block), and also third-degree heart block with a high purkinje or AV-nodal escape rhythm. It is usually not effective in second-degree heart block Mobitz type 2, and in third-degree heart block with a low Purkinje or ventricular escape rhythm.
Atropine has also been used in an effort to prevent a low heart rate during intubation of children; however, evidence does not support this use.[16]
Metformin is the go to prescribed drug for type 2 diabetes. What does it do?
Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
What is portacaval shunting?
Portacaval shunting is major surgery. It involves a large cut (incision) in the belly area (abdomen). The surgeon then makes a connection between the portal vein (which supplies most of the liver’s blood) and the inferior vena cava (the vein that drains blood from most of the lower part of the body.)
The new connection diverts blood flow away from the liver. This reduces blood pressure in the portal vein and decreases the risk for a tear (rupture) and bleeding from the veins in the esophagus and stomach.
Normally, blood coming from your esophagus, stomach, and intestines first flows through the liver. When your liver is very damaged and there are blockages, blood cannot flow through it easily. This is called portal hypertension (increased pressure and backup of the portal vein.) The veins can then break open (rupture), causing serious bleeding.
