Asthma classification figures
moderate: 50-75% PEF, no other symptoms
- acute severe 33-50% PEF, Resp >25, Heart rate >110. Can't complete breaths in one sentence
- life-threatening <33% O2Sats <92%
laxative - lactulose
function and indications
increase bulk by retaining water.
Takes 48 hrs to act and must be given regularly.
Why are ACEI drugs good for heart failure?
lower BOTH arterial and venous resistance.
Effective for many gram -ve bacteria.
Used to treat anthrax - postexposure prophylaxis of inhalational anthrax.
serious adverse effects; tendonitis and tendon rupture.
alters blood glucose, phototoxicity, prolongation of QT interval
Contraindicated; children, adolescents, pregnant and lactating women.
Peptic ulcers location
upper part of duodenum
Indications for senna; stimulant laxative
+ side effect
Increase mobility by stimulating the myenteric plexus.
mobility maybe damaged due to drug use.
Side effect: abdominal cramps
* don't use for impacted feces *
What drugs treat TB? (mycobacterium tuberculosis)
Rifampicin (prevents RNA transcription). Resistance develops quickly, therefore needs to be combined with other drugs; isoniazid
Differences between UC and CD
What are the QRS complexed like with LBBB?
Sometimes W-shaped complex in V1
Sometimes M pattern in V4-V6
Management of AF
cardioversion if < 48 hour onset
Rate and rhythm control
CCB - verapamil or a Beta Blocker
Rate control; amiodarone
anticoagulants to prevent thromboembolism/ stroke
surgical catheter ablation
What are the symptoms of hypovolaemia?
- orthostatic hypotension
- absence of JVP at 45 degrees
- dry mucous membranes
- absent axillary sweat
- decreaed skin turgor
- organ failure
Three rules of fluid replacement
- Replace blood with blood
- Replace extracellular fluid depletion with saline
- REHDRATE with DEXTROSE. NOT FOR RESUSCITATION
Which receptors are abundant in the CTZ of the medulla?
D2 dopamine receptors
Ticarcillin and be combined with clavulanate to treat......
(ticarcillin is an antipseudomonal penicillin)
Angina drug management
First step: Nitrates - reduce preload
Second step: Diltiazem; vasodilator of arteries incl. coronary. Thus reduces afterload. Also < cardiac rate and contractility (reducing oxygen demand)
Statins - reduce atherosclerotic plaque risk
Beta-blockers (less popular) if tachycardic.
Some signs and symptoms of infective endocarditis
Similar to metoclopramide but doesn't cross the blood-brain barrier and rarely causes sedation or extrapyramidal effects.
What is metaplasia?
the transformation of one type of tissue into another
Acute asthma treatment; what O2 levels should be maintained?
What should be continued after discharge?
40-50mg prednisolone for 5 days minimum.
moa, indications, side effects
Also has prokinetic effect on the gut, and increases the absorption of many drugs.
Relationship of aldosterone and spironolactone
Aldosterone raises BP by stimulating Na+ absorption.
Spironolactone competitively blocks the binding of aldersterone.
* weak diuretic *
SE: severe hyperkalaemia, especially in px with renal impairment.
Indications: Liver disease with ascites, severe heart failure, Conn's syndrome
What are the symptoms of hypervolaemia? overfilling
- jugular venous distension
- S3 gallop
- pulmonary oedema
- pleural effusions
- peripheral oedema
Physiology of heart failure
Insufficient cardiac output unable to perfuse tissues. Adaptive changes; increases in heart rate and force, increases in renal volume and increase blood pressure.
Heart unable to compensate and physiological changes further decrease cardiac output.
What's the problem with taking nitrates for angina?
Reflex tachycardia (prevented by taking beta blockers)
Tolerance to nitrates can occur.
Signs of aortic regurgitation
made in hypothalamus
released via posterior pituitary gland
osmoreceptors in hypothalamus
What is CHA₂DS₂-VASc Score?
Risk for stroke for AF patients
helps determine the 1 year risk of a thromboembolic event in a non-anticoagulated patient with non-valvular AF.
Which lung cells secrete surfactant?
pneumocytes type II
Prophylactic tx for angina
Aspirin + Clopidogrel (anti-platelet)
Dabigatran - doesn't need monitoring. Fixed dose. MOA: direct thrombin inhibitor.
Problem: no antidote if bleeding occurs.
Coronary arteries territories
What would you use for impacted stool?
Glycerol suppositories stimulate the rectum because glycerol is mildly irritant.
May need to be repeated. Digital assistance needed.
Common causes of acute mitral regurgitation
ruptured chordae tendineae
ischaemic papillary muscle rupture
What is vancomycin used for?
+ what happens if >> infusion rate?
MRSA (rem. staphlococcus) - given orally.
Adminstered parenterally to treat systemic infections.
>>> infusion rate = hypotension, erythematous rash on face/ upper body "red man syndrome"
Extragastrointestinal manifestations of IBD
Skin rashes; pyoderma gangrenosum, erythema nodosum
What are the main causes of heart failure?
- CORONARY HEART DISEASE
- valvular disease
moa, drugs, indications, side effects
erythromycin, clarithromycin, azithromycin
Three abnormal types
Upright in all leads except aVR and V1
- Flattened T waves (hyperkalaemia)
- Inverted T waves
- Hyperacute T waves
narrow therapeutic index
Renal excretion + nephrotoxic
ototoxicity (VIIIth cranial nerve)
Beta blockers and asthma?
Don't do it!
What do u waves signify?
moa, indications, side effects
Inhibits NaCl reabsorption in the thick ascending loop of Henle
Indications; oedema with heart failure.
effective in patients with << GFR
High doses; endolymph disturbances and deafness.
Adverse : 4 hypos; hypokalaemia (little), hyponatraemia, hypotension, hypovolaemia.
IMP. >>> CALCIUM and >>> MAGNESIUM excretion
What's the function of cholecystokinin?
stimulates pancreatic secretions when food enters the duodenum, and stimulates bile release from gall bladder.
Cholecystokinin is synthesized and secreted by cells in the duodenum.
What does a collapsing pulse indicate?
severe aortic regurgitation
Act on early segment of the distal tubule. Inhibit NaCl reabsorption.
Side effects (due to >> excretion of K+ and H+ ions)
Hyperuricaemia. Increase in uric acid levels may result in gout.
Glucose tolerance; thiazides are contraindicated in patients with non-insulin-dependent diabetes.
What pneumonia can gentamicin treat?
Life-threatening Gram -ve infections, eg. pseudomonas aeruginosa
Which group of drugs are indicated for unusual organisms such as Mycoplasma pneumoniae and Legionnaire's disease?
triple therapy for gastric ulcers
What do D cells (pancreas) produce?
Most common cause of aortic stenosis and physiological effect
Heart has to work harder to push blood through the stenotic valve.
>> Volume load = hypertrophy + myocardial dysfunction, arrhythmias, heart failure.
is often used as a method of estimating GFR
from knowledge of serum creatinine, age and weight:
The calculation is unreliable if the patient has unstable renal function, is very obese, or is oedematous.
What is flucloxacillin indicated for?
infections caused by penicillinase-producing penicillin-resistant staphylocci.
i.e. most hospital-acquired staphlococcal infections.
A good drug for gram +ve bacteria?
because they accumulate 100 x of the drug.
Blood flows back into the ventricle at start of diastole.
causes; infective endocarditis
Usually asymptomatic until LVF
Apart from conserving water via >> reabsorption, what else does ADH do?
<< sweat in glands
>> arteriole constriction, therefore BP rises
pericarditis ECG changes (findings in first two weeks)
saddleback ST elevation and PR depression throughout most of the leads.
RECIPROCAL deviation in lead aVR
Commonest cause of mesothelioma?
- persistent chest wall pain
- pleural effusion