RX Flash 255 Flashcards
(94 cards)
1
Q
A 5-alpha-reducatase inhibitor that inhibits the conversion of testosterone to DHT
A
- Finasteride
- Prevents further growth of the prostate that has been sensitized by elevated estradiol levels
- SIDE EFFECT= Hair growth
2
Q
Shared side-effect of Flutamide, ketoconazole, and spironolactone
A
Gynecomastia
3
Q
Can lead to decreased salivation, lacrimation, urination (bad for BPH), defecation, and peristalsis in GI
A
ANTI-HISTAMINES
4
Q
In polycystic ovarian syndrome what can be used to prevent hirsutism?
A
Spironolactone and ketoconazole
5
Q
- Inhibit phosphodiesterase→increase in cGMP
- Treats ED
- Loss of blue-green color vision
A
Sildenafil and vardenafil
6
Q
PIG-A Gene
A
- Helps to produce glycophosphatidylinositol (GPI)
- Defective in PNH (paroxysmal nocturnal hemoglobinuria)
7
Q
CD59 (membrane attack complex inhibitory factor) and CD55 (decay accelerating factor)
A
-Without GPI on RBCs (lost in PNH), these two complement inhibitors are missing→hemolysis of red blood cells ensues
8
Q
Can exacerbate volume expansion and cause pulmonary edema. Thus it is contraindicated in CHF
A
-Mannitol
9
Q
- HTN
- Diabetes insipidus (nephrogenic) unresponsive to ADH
A
HCTZ
10
Q
HCTZ adverse effects
A
- Hypochloremic metabolic alkalosis, Hypokalemia, Hyperuricemia, Hyponatremia
- Contra: sulfa allergy, history of diabetes, hypersensitivity reactions
11
Q
Mental retardation, facial dysmorphisms, cardiac defects, thrombocytopenia, and TRIGONOCEPHALY (premature fusion of the metopic suture)
A
Jacobsen’s syndrome
12
Q
Jacobsen’s syndrome
A
CCG trinucleotide
Chromosome 11
13
Q
Fragile X Trinucleotide Repeat
A
- CGG
- Most common cause of inherited mental retardation second to Down’s Syndrome
14
Q
Myotonic dystrophy associated trinucleotide repeat
A
CTG on chromosome 19 (AD)
15
Q
Friedreich’s Ataxia (AR)
A
- Pyramidal, dorsal and spinocerebeller tracts affected
- GAA repeat on chromosome 9
16
Q
- Weakness of upper extremities (intrinsic hand and wrist extensors)
- Atrophy of facial muscles (characteristic facies)
- Presents in late childhood with GAIT abnormalities
A
Myotonic dystrophy (AD)
17
Q
Reflex bradycardia effect of norepinephrine
A
NE→increased VR to heart→increased SV→heart no longer needs to beat as fast to maintain sufficient cardiac output→reflex decrease in HR
18
Q
A splice-site mutation in gene intron 16 is one of the mutations….
A
On CFTR that can cause CF, but it is not the most common
19
Q
Inferior vena cava compression
A
- 3rd trimester
- Big ole’ uterus compresses IVC
- SLEEP ON LEFT SIDE or PILLOW UNDER THE HIP
20
Q
- High PTT
- Easy bruising and epistaxis
- Menorrhagia
- Primary hemostasis (prolonged bleeding immediately after trauma invasive procedure)
A
vWD presentation (AD)
21
Q
- Post trauma and surgery show appropriate hemostasis
- Later exhibit hemorrhage into joints (hemarthrosis), muscle compartments (compartment syndrome), or intracranially SECONDARY hemostasis
A
Hemophiliacs (hemophilia A and B)
22
Q
- Inactivation of factors V and VIII normally carried out by protein C
- Prothrombotic if deficient
A
Protein C
23
Q
Factor XIIIa’s function?
A
- Crosslink the alpha and gamma chains of fibrin→reinforce fibrin plug
- Can form a clot without but inadequate to maintain hemostasis
- Detected with 5M urea
24
Q
What is detected with 5M urea?
A
- XIIIa deficiency
- 5M can solubilize clots that have not been cross –linked
25
How is factor XIIIa activated?
-By thrombin in the presence of calcium
26
11B-Hydroxylase deficiencies
- 11-deoxycorticosterone builds up (the precursor)
- Acts as a weak mineralocorticoid, HYPERtension, and salt retention
- Masculinization (androgen build up)
27
17alpha-Hydroxylase deficiencies
- Blocks glucocorticoid and sex hormone production→excess aldosterone (mineral corticoids)
- Hypertension
- Default female gender (lack of mullerian-inhibiting factor)
- Immature female phenotype
28
Hold on more…CF patients also susceptible to
- Pseudomonas aeruginosa and Burkholderia Cepacia
| - Cause obstruction and dilation of bronchi (bronchiectasis)
29
The most common cause of lung abscesses
-Staph Aureus
30
Antiphospholipid antibodies react to what in VDRL positive (syphilis)
-Cardiolipin
31
```
Irregular boarders
Ulcerations
Radial and vertical growth
Origin= neural crest cells
Sun exposed locations
```
Malignant melanoma
32
Phases of ALL treatment
1) Induction
2) Consolidation
3) Maintenance
4) CNS prophylaxis
33
Induction therapy for ALL 4 drug regime
1) STEROID (prednisone or dexamethasone)
2) Asparaginase
3) Doxorubicin/Duanorubicin
4) Vincristine
34
Phenelzine
- MOA inhibitor rarely used
- ADRs: HTN crisis, subarachnoid hemorrhage, stroke in patients who consume tyramine-containing foods (red wine, aged cheese, liver)
- Tyramine= vasoactive
- Tyramine on MOA inhibitor is not adequately metabolized→ Drastic increase in BP and HTN crisis
- Serotonin storm if taken with meperidine, SSRI or TCA
35
Lithium ADRs
- Diarrhea
- Edema
- Weight GAIN
- Hypothyroidism
- Nephrogenic diabetes insipidus
36
Venlafaxine (heterocyclic antidepressant) ADRs
- Anxiety
- Agitation
- H/A
- Weight loss
- Insomnia
37
Best first line treatment for a patient with persistent a-fib in the presence of structural heart damage (mitral stenosis→enlarged left atrium)
-Metoprolol (beta1-seletive antagonist)
38
- QT prolongation
- Lupus-like syndrome (slow acetylators)
- Arrhythmias
- HYPOtension
- N/V
Procainamide (Class Ia antiarrhythmic) ADRs
39
Propafenone
- Class Ic antiarrhythmic
- NO EFFECT ON PHASE 3 repolarization or on the AP duration
- Last resort for SVT and V-fib that progress to ventricular fibrillation
- Do NOT use in post MI or structural heart damage
40
- Hepatotoxicity
- Blue-grey photodermatitis
- Bradycardia
- Heart block
- Pulmonary fibrosis
- Hypo or Hyperthyroidism
AMIODARONE (Class III antiarrhythmic)
41
Requirements for Amiodarone
MONITOR: pulmonary, liver, and thyroid function tests frequently
42
Warfarin Overdose w/ symptoms antidote
Fresh frozen plasma
43
Warfarin Overdose w/out symptoms
Vitamin K
44
What acts as a carrier for factor VIII?
vWF (protects from hepatic clearance)
45
- Low levels of factor VIII
- Qualitative or quantitative deficiency of vWF
- It can be mild with increased bleeding with menses or with dental procedures
- Or it can be severe and mimic hemophilia
- Prolonged PTT
Von Willebrand Disease
46
Factor IX deficient
- Severely deficient→Hemophilia B/Christmas disease that is clinically identical to hemophilia A
- Tx: Recombinant factor IX
47
- Emergent IV Diazepam
| - Note: can start patient on phenytoin too (prophylaxis for SE)
Status Epilepticus Tx
48
Phenytoin and Valproic acid
| -Can also be used for tx of simple and complex partial seizures
First line treatment for tonic clonic seizures
49
- Gingival hyperplasia
- Eosinophilia
- Megaloblastic anemia via B9 (folate deficiency)
- Teratogenesis
- Systemic SLE-like symptoms
Adverse effects of phenytoin
50
Phenytoin MOA (CLASS Ib antiarrhythmic)
- Blocks Na+ channels
| - Use dependent effect→altering conductance and transmission of the epileptic focus
51
Ethambutol mechanism of action
Inhibition of polymerization of cell wall precursors
52
Heparin MOA
- Catalyzing the activation of antithrombin III
| - Prevents further clot formation but does NOT break down existing clots
53
Inhibit the ADP pathway involved in the binding of fibrinogen to platelets during aggregation
Clopidogrel and Ticlopidine
54
Petechiae
Think Thrombocytopenia
55
Common sites of tophus formation in gout
- Achilles tendon
| - Helix of the external ear
56
- Bind tubulin→ inhibits microtubule polymerization
- Blocks mitosis as well as neutrophil migration
- 2nd line tx of ACUTE gout due to low therapeutic window and risk of toxicity
- GI upset and diarrhea in 80% of people
Colchicine MOA and facts
57
- ANGII receptor inhibitor
- HTN tx and delay progression of diabetic nephropathy
- Moderately potent uricosuric effect thus can be used in chronic gout but not first line
Losartan
58
- Canned goods (duh) and SMOKED FISH
| - Toxin cleaves SYNAPTOBREVIN, snap25, synaptin (?) (preventing release of acetylcholine)
Botulism
59
OH DANG (loop diuretics) ADRs
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Ototoxicity
Hypokalemia
Dehydration
Allergy (sulfa) and metabolic alkalosis
Nephritis (interstitial)
Gout
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60
- Indirect Bilirubin elevated
- Decreased hematocrit
- Lactate dehydrogenase INCREASED
- Normal PT and PTT
- Schistocytes on smear
TTP
61
- HSM
- Chipmunk face (extramedullary hematopoiesis)
- Blood transfusions since birth
- Increased HbF (alpha2gamma2)
- Increased HbA2 (alpha2delta2)
- Absence of HbA1 (alpha2beta2)…in minor it is decreased but not absent
Beta Thalassemia MAJOR (Cooley’s anemia)
62
Beta thalassemia minor = mild protective effect against what?
Plasmodium falciparum
63
Common cause of death of Beta Thal Major
Cardiac failure secondary to hemochromatosis
64
ASD murmur
Wide and fixed S2
65
PDA murmur
Continuous machine like murmur that is loudest at S2
66
Congenital absence of Vas Deferens
CF patient
| Infertility not sterility
67
LAD (leukocyte adhesion deficiency)
LFA-1 integrin (CD18) defect
Recurrent bacterial infections with no pus
Delayed separation of the umbilicus at birth
68
Abetalipoproteinemia (AR)
- Hereditary inability to synthesize lipoproteins due to …
- Apo B100 and B48
- Failure to thrive, steatorrhea, acanthocytosis (spur cell), NIGHT blindness and ataxia
69
Zinc Finger
- Zinc atom bound to four cysteine amino acids
| - Steroid receptors
70
Histological findings of Craniopharyngioma
Cystic spaces filled with motor oil-like fluid; cholesterol clefts; calcifications
71
Histological findings of pituitary adenoma
Sheets of lactotrophs, acidophilic staining
72
Hypothyroidism, Growth failure, DIABETES insipidus, supratentorial tumor
-Craniopharyngioma
73
Adverse effects of haloperidol → acute dystonia
Benztropine (or other anticholinergic agents)
74
Acanthocytes (spur cells) are associated with…
Abetalipoproteinemia and liver disease
75
Target cells associated with…
Thalessemia, liver disease, HbC disease, and asplenia
76
Bochdalek Hernia
Abdominal contents herniate into thorax
77
Foregut is the embryonic precursors to…
- Lungs, esophagus, stomach, duodenum, liver, gallbladder, and part of pancreas
- Celiac trunk is arterial supply
78
Polyhydramnios is common in (weird)
Congenital diaphragmatic hernia
79
What is considered a high anion gap? (Na-HCO3-Cl)
>12mmol/L
80
TTP and Legionella
Legionella can cross-react with ADAMTS13→TTP
81
Legionella pneumophila infection culture
- Buffered charcoal yeast extract agar with iron and cysteine
- Typical gram stain shows large neutrophils but no organisms
82
Laryngeal carcinoma most common modifiable risk
- Alcohol
| - Smoking (greatest)
83
Benign laryngeal polyps on true vocal cords
-HPV 6 and 11
84
Squamous cell carcinoma is the most common cancer of …
Head and neck (heavy alcohol and tobaccy use)
85
Amphotericin B 4 ADRs
1) Renal toxicity
2) Acute febrile reaction (shaking and chills w/ infusion)
3) Anemia
4) Phlebitis
86
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Hot as a hare
Dry as a bone
Red as a Beat
Blind as a Bat
Mad as a hatter
```
Anti-muscarinic side effects:
87
Mental status changes, HYPOtension, and anticholinergic (flushing, hyperthermia, dilated pupils, intestinal ileus, and urinary retention)
Classic Sings of TCA overdose
88
Mechanism of TCAs (amitriptyline and imipramine)
Inhibit neuronal reuptake of NE and serotonin in the central nervous system
89
- Misinterpretation that other people’s (often famous) statements or actions or neutral objects in the environment are directed towards oneself, when of course they are not
- The notion that everything one perceives in the world relates to one's own destiny
Idea of reference
90
Atherosclerosis associated aortic dissection
- DESCENDING AORTA or AORTIC ARCH
| - Smoking, HTN, Diabetes, Hyperlipidemia, middle aged or older
91
Aortic Dissection in Marfan’s
-Cystic medial necrosis
92
Marfan’s Characteristics
- Pectus excavatum
- Hyperextensible joints
- Tall
- Long fingers
- MVP and aortic aneurysms
- Ectopia Lentis (up and out)
- Hyperextensible joints
93
ED (Ehlers-Danlos Syndrome)
Joint hypermobility, skin hyperelasticity, easy bruising and tissue weakness
Type IV collagen is most common
94
New-onset of seizures in an HIV patient with a CD4 count less than 100?
Toxoplasmosis
- Ring-enhancing lesion
- Encephalitis (seizures or focal neurological defects)
- Chorioretinitis (eye pain)
