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1

What hormone is increased or decreased in:
1) Cushing's syndrome?
2) Conn's syndrome?
3) Addison's disease (aka primary adrenal insufficiency)?
4) Graves' disease?

1) increased cortisol
2) increased aldosterone
3) decreased cortisol and decreased aldosterone
4) increased thyroid hormone

2

Function of MacConkey's agar?

1) Select out gram (+), only gram (-) grow (crystal violet and bile salts inhibit gram (+) growth)
2) Distinguish lactose and non-lactose fermenters. Lactose is only carb that grows in agar; lactose fermenters form PINK colonies; non-lactose fermenters form other color or white colonies.

3

List 5 classes of drugs used to treat Glaucoma:

1) alpha-agonists
2) Beta-blockers
3) Diuretics (carbanic anhydrase inhibitors like acetazolamide, and mannitol)
4) Cholinergic agonists (cholinomimetics)
5) Prostaglandins (PGF-2alpha)

4

Symptoms:
-facial angiofibroma
-ash-leaf spots of skin depigmentation
-history of seizures
-mental retardation

Tuberous scelorosis
--> patients are at increased risk of developing these neoplasms: cardiac rhabdomyoma, astrocytoma, angiomyolipoma

5

What's the cause of achalasia?
How is it diagnosed?

Achalasia = failure of relaxation of lower esophageal sphincter (LES) d/t loss of myenteric (Auerbach's) plexus.
--> uncoordinated peristalsis --> progressive dysphagia to solids AND liquids.

DX by barium swallow: shows dilated esophagus with an area of distal stenosis. "Birds beak" on barium swallow.

Associated with increased risk of esophageal carcinoma.

6

Leading causes of death in 15-24 year olds:

-injury
-homicide
-suicide
-cancer
-heart disease

7

Leading causes of death in 25-64 year olds:

-cancer
-heart disease
-injuries
-suicide
-stroke

8

anti-GBM antibodies (Immunofluorescence)

Goodpasture's syndrome

9

Kimmelstein-Wilson lesions (LM)

Diabetic nephropathy

10

"spike-and-dome" appearance (EM)

Membranous GN

11

"tram track" of subendothelial humps (EM):

membranoproliferative GN

12

subepithelial humps (EM)

Post-streptococcal GN

13

clinical uses for Metronidazole:

GET GAP:
Giardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobes (Bacteriodes, C. dificile)
H. Pylori (triple therapy = metronidazole + bismuth + amoxicillin or tetracycline)

*note: pts must avoid alcohol while on this drug -- has disulfiram-like reaction with alcohol
*side effects = headache, metallic taste

14

2 most common post-MI complications?

1) Cardiac arrhythmias --> ventricular fib = most lethal/severe complication
2) LV failure --> leads to pulmonary edema and Right-sided heart failutre

15

What is Dressler's syndrome?

autoimmune disease, occurs post-MI's, results in fibrinous pericarditis

16

What is the WAGR complex?

a mnemonic for Wilm's tumor (nephroblastoma) = a renal tumor; most common tumor of early childhood (spec 2-4 yo)
Wilms' tumor
Aniridia (lack of an iris)
Genitourinary malformation
Retardation - mental-motor

17

What's the cause of chronic granulomatous disease?
What are the consequences of chronic granulomatous disease?

Cause: Lack of NADPH oxidase activity
Results in: "impotent neutrophils or phagocytes"; lysosomes don't work
Consequences = susceptible to opportunistic infections (because no neutrophils)

18

4 main pharmacokinetics equations:

1) Vd = amount of drug given (by IV) / [drug in plasma]

2) Clearance:
CL = (0.7 X Vd) / t1/2
= k X Vd
( where k=elimination constant = 0.7/t1/2)

3) Loading Dose:
LD = Css X Vd
(where Css = concentration of steady state = desired concentration)

4) Maintenance Dose:
MD = Css X CL

19

What's the pKa?

pKa = acid dissociation constant = ph at which the amount of the non-protonated form = the amount of protonated form

20

if pH < pKa:

this is an acidic environment; have more of hte protonated form; basic drugs gets trapped

21

if pH > pKa:

this is a basic environment; there will be more of hte non-protonated form; acidic drugs get trapped

22

How to treat an acidic drug OD (ie salicylates = aspirin)?

Give NaHCO3 --> traps the acidic drug in basic urine

23

How to treat basic drug OD (ie amphetamines)?

Give NH4Cl (ammonium chloride) --> traps basic drug in the acidic urine

24

What are the symptoms of excess parasympathetic activity?

DUMBBELSS:
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of skeletal muscle and CNS
Lacrimation
Salivation
Sweating

*Parasympathetic drugs make you "leaky"!

25

Ptosis or Diplopia that worsens throughout the day?

Myasthenia gravis

26

Tensilon test = Endrophonium test:

Dx for myasthenia gravis; give endrophonium, if symptoms improve then dx as MG

27

4 treatment options for myasthenia gravis:

1) acethylocholinesterase inhibitors (indirect cholinergic agonists) (b/c in MG have abs to ach receptor; so ach-ase inhibitors increase ach in synapse)
2) corticosteroids
3) thymectomy
4) plasmapheresis

28

What drug regenerates acetylcholinesterases after organophosphate poisoning?

(organophosphates = anti-cholinesterases = parathion = insecticide)

Pralidoxime (regenerates active AchE); also can give atropine to treat symptoms

29

What are symptoms of inhibiting parasympathetic activity? (ie from giving atropine)

Hot as a hare (increased body temp)
Dry as a bone (decreased sweating)
Red as a beet (flushed skin)
Blind as a bat (cycloplegia= ciliary body paralysis--> loss of accommodation = blurry, near vision)
Mad as a hatter (disorientaion, delirium)
Bloated as a toad (constipation, urinary retention)

30

What anti-cholinergics are used to treat urge-type urinary incontinence?

-oxybutinin
-tolterodine
-darifenacin and solifenacin
-trospium

31

What drugs inhibit parasympathetic activity?

-atropine, homatropine, tropicamide (all muscarinic antagonists)
-benztropine
-scopolamine
-ipratropium
-oxybutynin
-glycopyrrolate
-methscopolamine
-propatheline

32

In what disease/s does one have increase Ach?
In what disease/s does one have decrease Ach?

*increased Ach in: Parkinson's disease (treat with muscarinic antagonists)
*decreased Ach in Huntington's disease and in Alzheimer's disease (treat with cholinergic drugs)

33

In what pt populations is atropine contraindicated?

-Glaucoma
-Prostatic hypertension or any urinary retention
-GI obstruction (ie ileus)
-Dementia, Delirium, Elderly
-Infant with fever (because can cause hypoterhmia in infants)

34

G-protein second messengers:
-receptors and G-protein class
-second messengers; what each class does

qiss and qiq until you're siq of sqs
α1 --> Gq
α2 --> Gi
B1 --> Gs
B2 --> Gs
M1 --> Gq
M2 --> Gi
M3 --> Gq
D1 --> Gs
D2 --> Gi
H1 --> Gq
H2 --> Gs
V1 --> Gq
V2 --> Gs

Gq ---> Phospholipase C ---> converts lipids to PIP2 --> PIP2 forms DAG and IP3
-DAG (diacylglycerol) --> Protein kinase C
-IP3 (inositol triphosphase) --> increased incracellular Ca2+
(q-c = "cutesy")

Gs--> stimulates adenylyl cyclases --> converts ATP to cAMP ---> CAMP activates protein kinase A ---> get increased intracellular Calcium (in heart) and inhibition of myosin light-chain kinase in smooth muscle.

Gi --> inhibits adenylyl cyclase

35

Drugs that inhibit cytochrome P-450:

PICK EGS:
Protease inhibitors
Isoniazid
Cimetidine
Ketoconazole
Erythromycin
Grapefruit juice
Sulfonamides

36

Cholinomimetic Drugs:
-Direct cholinergic agonists
-Indirect cholinergic agonists

Direct agonists:
-Bethanechol
-Carbachol
-Pilocarpine
-Methacholine

Indirect Agonists = Anticholinesterases:
-Neostigmine
-Pyridostigmine
-Edrophonium
-Physostigmine
-Echothiophate
-Donepezil