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DT4 Exam 3 > Clinical > Flashcards

Clinical Flashcards

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1
Q

can cause liver toxicity

A

herbal therapies

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2
Q

interacts with grapefruit juice

A

simvastatin, pravastatin, atorvastatin

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3
Q

raises blood pressure

A

licorice

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4
Q

thyroid medication administration

A

empty stomach 30 min before eating and other meds or 2 hrs after a meal

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5
Q

administration bisphosphonates

A

empty stomach 1 hr before eating and other meds, cannot lie down

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6
Q

functional changes in elderly that impact medications

A 
GFR declines 35-50%
body fat increases
serum albumin decreases
hepatic blood decreases
less stomach acid-hard to absorb iron and Ca
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7
Q

problems with anticholinergics

A

memory loss and confusion

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8
Q

problems with NSAIDS

A

GI bleeding without warning

give PPI with it (but can cause renal insufficiency)

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9
Q

problems with benzodiazepines

A

confusion and falls, diazepam can have prolonged half life due to fat soluble

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10
Q

Beers list

A

potentially inappropriate medications for the elderly

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11
Q

new recommendations

A

nitrofurantoin until GFR>30
dont use benzos-can use trazodone
avoid PPI greater than 8 weeks, use H2 blockers

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12
Q

reduce dose for GFR

A

gabapentin/pregabalin
H2 blockers-rantidine, famotidine
endoxaban/rivaroxaban
avoid NSAIDs if low GFR

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13
Q

life expectancy

A

Hispanic women longest

Black men shortest

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14
Q

homeostenosis

A

decreased reserve with aging

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15
Q

body composition changes with aging

A

loss of lean body mass
decrease in skeletal muscle mass
decrease in bone mass
increase in total body adipose tissue-more fat, accumulates in muscles and organs

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16
Q

implications change in body composition changes with aging

A

increase in half life of lipophilic drugs

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17
Q

temperature change in elderly

A

risk increased for hyper and hypothermia

does not mount fever to infection

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18
Q

body fluid regulation in elderly

A

total body water decreased

thirst sensation diminished

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19
Q

blood pressure regulation in elderly

A

higher BPs or orthostatic hypotension

>150/90 acceptable (not HTN)

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20
Q

changes in senses in elderly

A

dark adaptation decreases
near vision declines
high frequency hearing declines
sense of smell declines

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21
Q

cardiovascular changes in elderly

A 
increase wall thickness
decreased elastin
both systolic and diastolic BP increase
adipose infiltrates SA node
calcification-aortic sclerosis
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22
Q

beta adrenergic stimulation in elderly

A

basal and stress levels of epi and NE are higher

tissue response is diminished

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23
Q

neurological system in elderly

A 
encoding slower
storage and retrieval slower
decreased multi task
reduction in number and size of spinal cord motor neurons 
decrease nerve terminals and NT release
neuropathy
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24
Q

respiratory changes in elderly

A

decreased elasticity
decreased FEV1
decreased O2 sat

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25
GI changes in elderly
presbyesophagus | hepatic metabolic function may decline
26
renal changes in elderly
steady decline in most | implications in drug metabolism
27
immune changes in elderly
thymic involution-less naive lymphocytes decreased T cell proliferation decrease in some cytokines decreased Ab response to vaccines
28
skeletal changes in elderly
loss of cortical thickness increase in porosity thinning of trabeculae, loss of trabecular connections
29
shorter elderly
war of discs | pathologic-from arthritis or osteoporosis
30
changes in reproductive system
vaginal dryness | BPH (avoid alpha agonist decongestants)
31
pain in elderly
blunting sensation may minimize complaints
32
HA in elderly
uncommon as new complaint | could be from temporal arteritis, trigeminal neuralgia, herpes zoster, subdural hematoma, metastatic disease
33
chest pain in elderly
pain causing MSK disorders more common in elderly | Zoster as pain before rash
34
abdominal pain in elderly
more life threatening | more serious
35
pneumonia in elderly
can present as change in mental status or delirium
36
weakness and fatigue in elderly
apathetic hyperthyroidism | takes longer to recover from immobility
37
anorexia and weight loss in elderly
``` malignancy and inflammatory disorders CHF or COPD drug SE memory loss depression hyperthyroidism ```
38
strategies for demented patient
``` get attention speak calmly use yes or no repeat and rephrase do not argue ```
39
congenital adrenal hyperplasia
impaired cortisol synthesis | AR
40
classic CAH
salt wasting 75%-hypovolemic shock, hyperkalemia high risk of adrenal insufficiency precocious puberty short stature
41
nonclassic CAH
no genital ambiguity onset in adolescence angregen excess-oligomenorrhea, hirsutism, acne
42
genetics of 21 hydroxylase locus
HLA linkage 6p21.3 point mutations-salt wasting CAH
43
effective treatment CAH
glucocorticoid and mineralocorticoid treatment
44
prenatal diagnosis and treatment
``` dexamethasone at risk chorionic villus sampling at 8-10 weeks -karyotype, DNA analysis (RFLP, PCR) amniocentesis at 16 weeks -karyotype, DNA analysis, HLA typing, amniotic fluid for 17Oh progesterone ```
45
male treatment
stop dexamethasone
46
unaffected females
stop dexamethasone
47
affected females
continue dexamethasone
48
MEN I
parathyroid neoplasia pituitary neoplasia pancreatic islet neoplasia AD
49
MEN II
thyrocalcitonin (medullary carcinoma) pheochromocytoma parathyroid neoplasia AD
50
MEN IIa
medullary thyroid carcinoma pheochormocytoma parathyroid neoplasia
51
MEN IIa variants
familial medullary thyroid carcinoma MEN 2a with cutaneous lichen amyloidosis MEN 2a with Hirschsprung disease
52
MEN IIb
medullary thyroid carcinoma pheochromocytoma marfinoid habitus, intestinal ganlioneuromatosis and mucosal neuromas
53
medullary thyroid carcinoma
neoplasm of follicular cells secretes cacitonin, CEA hyperpalsia to nodular to micro carcinoma to macro carcinoma most common in MEN 2B death-airway obstruction, liver and lung mets
54
RET proto-oncogene
tyrosine kinase receptor knocks out-GI, kidney, sympathetic nervous system interacts with glial cell-derived neutrophic factor
55
MEN 2a screening
pentagastrin stimulated calcitonin and 24 h urine metanephrines yearly calcium biyearly
56
familial medullary throid carcinoma
no RET mutation | annual calcitonin and neck US
57
steps involved in work up of genetic patient
``` history examination testing establishment of diagnosis counseling ```
58
family history
pedigree-3 generations include miscarriages ask about consanguinity inquire about ethnic origins
59
testing for chromosomes
routine high resolution microdeletion FISH microarray CGH
60
molecular/DNA testing
disease specific testing | whole geneome/exome sequencing
61
metabolic studies
amino acids | organic acids
62
microdeletion syndromes
``` Williams Langer-Giedion WAGR Prader-Willi Angelman Smith Magines Miller Dieker Retinoblastoma DiGeorge VeloCardioFacial ```
63
Ashkenazi Jew disorders
``` Tay Sachs Canavan familial dysautonomia Fanconi anemia C NP type A Bloom syndrome mucolipidosis IV Gaucher CF ```

DT4 Exam 3 (5 decks)

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