- Long-acting synthetic insulin that is used in combo w/ a short acting insulin (lispro) - Provides continuous baseline level of insulin in the blood - Feasible initial treatment for newly diagnosed type 1 diabetes mellitus

RX FLASH 257 Flashcards by Keegan Sturgill

Random plasma osmolality = up/concentrated/hypertonic
Random urine osmolality = down/hypo-osmolality/dilute (no ADH to concentrate urine)
Urine osmolality during water deprivation= no change
Urine osmolality after IV DDAVP= up/hyperosmolarity/concentrated
Plasma ADH= down (low ADH)

Central DI- THINK elderly lady w/hypernatremia and dilute urine

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Random plasma osmolality = hypertonic/up
Random urine osmolality = hypotonic/dilute
Urine osmolality during water deprivation= no change
Urine osmolality after IV DDAVP= NO CHANGE (interstitial is not concentrated)
Plasma ADH= normal to increased

NEPRHOGENIC DI

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Random plasma osmolality = Down/hypotonic/dilute
Random urine osmolality = down/ Dilute
Urine osmolality during water deprivation= Increased/Concentrated
Urine osmolality after IV DDAVP= Increased/ CONCENTRATED
Plasma ADH= Decreased

Primary polydipsia

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Cluster A personality disorders

Paranoid
Schizoid
Schizotypal

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Cluster A personality disorders associated illness

Schizophrenia

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Cluster C personality disorders

Avoidant
Obsessive-compulsive
Dependent

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Cluster C personality disorders associated illness

Anxiety disorder

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Mood disorder and substance abuse are associated with what cluster of personality disorders?

Cluster B (histrionic, anti-social, borderline, narcissistic)

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A thiazolidinedione that acts to sensitize peripheral tissues to insulin and increase target cell response
Not a mono therapy b/c does it does not compensate for insulin deficiency

Rosiglitazone

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Glargine

Long-acting synthetic insulin that is used in combo w/ a short acting insulin (lispro)
Provides continuous baseline level of insulin in the blood
Feasible initial treatment for newly diagnosed type 1 diabetes mellitus

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Only double stranded RNA virus known to infect humans

Reoviruses:
Coltivirus→Colorado tick fever
Rotavirus→ Gastroenteritis

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ABCDE’s for melanoma

Asymmetry
Borders (irregular)
Color Variation
Diameter >6mm
Elevation/Evolution

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What happens to B12-Rproteins in the duodenum?

B12 is released from are Rproteins (via pancreatic enzymes)
B12 binds intrinsic factor
It is then endocytosed by enterocytes in the ILEUM

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B12 Pernicious Anemia

Autoimmune→Loss of parietal cells (IF deficiency and chronic gastritis)
Autoimmune→Anti-bodies against IF

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Negative Schilling Test in Pernicious Anemia

No radiolabeled cyanocobalamin seen in urine

IT WAS SHIT OUT

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What cells are seen in non-Hodgkin’s lymphomas?

Neoplastic B cells

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What neoplastic cells are seen in AML?

Myeloblasts

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What are the neoplastic cells seen in Hodgkin disease?

Reed-Sternberg cells

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What is the only non-Hodgkin’s lymphoma not associated with neoplastic B-lymphocytes?

Lymphoblastic lymphoma = T-lymphocytes

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Typical have a greater risk than atypical anti-psychotics for what?

EPS (extra-pyramidal symptoms)—Jaw or buccolingual spasms
ACUTE DYSTONIA (blockade of Dopa receptors in striatum)

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What are the typical anti-psychotics?

1) Haloperidol (worst for acute dystonia due to potent Dopa antagonist w/ few anticholinergic effects)
2) Thioridazine
3) Chlorpromazine
4) Fluphenazine

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Thioridazine (typical) ADRs

Retinal Pigmentation

- Cardiac affects→sudden death possible

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What is used to treat neuroleptic-induced acute dystonia?

Anticholinergic agents/ acetylcholine receptors blockers

- BENZTROPINE

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1st generation H1 blocker
Can be used to treat acute dystonia (anticholinergic)
Also a competitive inhibitor of histamine

Diphenhydramine

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Long term used of anti-psychotics

-Prolactin increased (due to Dopa block) -Prolactin inhibits GnRH synthesis and release→ leads to low GnRH→low FSH and LH release from anterior pituitary Thus a patient very well may present with amenorrhea

- Acute onset hyperpyrexia - Sever pneumonia - Neutrophils - Shitty gram stain

Legionella pneumophila

Name 4 Class III (K+ blockers) antiarrhythmics (BIAS)

- Bretylium - Ibutilide - AMIORDARONE - Sotalol

-Prolong phase III→ prolonged ERP

Class III (K+ blockers) antiarrhythmics affect what phase of myocyte action potential? How?

First-line agents for treatment of depression and are the preferred choice in patients who express suicidal ideation

``` SSRIs 1) Fluoxetine 2) Paroxetine 3) Citalopram 4) Sertraline Note: Effects take 4-6 weeks (8-12 in elderly) ```

ADRs of SSRIs

- You suck at sex - You get pissed (lol)—agitation - Serotonin storm (careful with other serotonergic medications esp. MOAIs)

- Prevent reuptake mechanism that terminates actions of NE and 5HT (more in cleft now) - Have anti-cholinergic effects (avoid in glaucoma)→ mydriasis may reduced caliber of aqueous humor outflow tract

TCAs (nortriptyline and amitryptiline)

- Heterocyclic antidepressant with serotonergic properties - Profound sedation - GREAT FOR INSOMNIA (bad for patient w/ fatigue)

Trazodone (TRAZOBONE)

Anti-depressant with weak dopaminergic and noradrenergic mechanisms NO SEXUAL DYSFUCTION BUT…can’t use in seizure, bulimia, or anorexic people

Bupropion

Risk of total thyroidectomy

Hypoparathyroidism → Hypocalcemia and hyperphosphatemia | Accidental removal of the parathyroid glands

What is B7?

Co-stimulatory molecule on antigen presenting cells | Necessary for proper T-cell activation

What is CTLA4

- T-cell “off switch” | - Inhibitory signal to T-cells

Recombinant IL-2/ALDESLEUKIN/T-cell growth factor

- Stimulates T-cells to proliferate | - Used to treat renal cell carcinoma

Cricoid cartilage and arytenoid cartilage

Sixth pharyngeal arch

Crosslink with DNA (alkylating agent) Cycle NONSPECIFIC (also Cisplatin) ADR: pulmonary fibrosis

Busulfan

M-phase specific Hyperstabilizes polymerized microtubules and prevent mitotic spindle breakdown ADR: Bone marrow suppression

Paclitaxel

G2-phase-specific Testicular cancer and lymphoma Induces free radicals→ breaks in DNA ADR: pulmonary fibrosis, skin pigment changes

Bleomycin

Most common brain stem stroke

Lateral medullary syndrome= Wallenberg’s Syndrome - Thrombosis of vertebral artery = supplies lateral tegmentum of the medulla is most common cause - Infarct of PICA = another common cause

Symptoms of Wallenberg’s syndrome (lateral medullary syndrome) 5

1) Contralateral body pain and temp decreased (decussate near lesion) 2) Ipsilateral face pain and temp decreased (Trigeminal nucleus and tract) 3) Ipsilateral ataxia (falling to affected side due to Inferior cerebellar peduncle) 4) Hoarseness and dysphagia = Nucleus ambiguus 5) Ipsilateral decreased taste= Nucleus solitarius

Black woman in 30’s Bilateral Hilar LAD INCREASE IN ACE (weird) Erythema Nodosum (inflammatory panniclulits/ tender red bumps) Increased activation of vitamin D by macrophages→Hypercalcemia

Sarcoidosis

- Inflammation of microvasculature and mucous membranes | - ADRs, HSV, mycoplasma (most often)

Erythema multiforme

-High methylmalonic acid and homocysteine

Cobalamin (B12) deficiency

- Prolongation of PR (esp. AV nodal cells) - Useful in preventing nodal arrhythmias - Decrease in upslope of phases 0 and 4

Diltiazem (non-DHP)

- Tumor suppressor involved in cellular adhesion | - Mutations in some breast and stomach cancers

E-cadherin

HYPOVOLEMIC STATES (blood loss)

-Heart rate is increased Vasoconstriction -Renin and vasopressin increased→ vasoconstriction and H20 reabsorption

Tumor suppressor genes such as APC (gastrointestinal tumors and melanoma) and NF1 inhibit…

Signal transduction

Classic MS triad

1) Nystagmus 2) Intention tremor 3) Scanning Speech (word syllables are separated by pauses)

HIV encephalitis is caused by infection of what in the brain?

Macrophages and microglia

- Complexes with FK-BP12 (an immunophilin)→ inhibits calineurin→inhibits T-lymphocyte signaling - P450 CYP3A metabolism

Tacrolimus

Normal: DOPA neurons inhibit the putamen (which inhibits GPe)→ Disinhibition of GPe→ Leads to inhibition of subthalamic (which stimulates GPi)→ GPi now not stimulated→ thalamus is not inhibited and can provide excitatory input to motor cortex→ increased motion Parkinson’s: No inhibition of putamen→ over-inhibition of GPe→ Disinhibition of subthalamic→STIMULATES GPi→ Thalamus is inhibited→ decreased excitatory input to motor cortex→ decreased motion

Parkinson’s pathophysiology vs. Normal

Wernicke’s Encephalopathy (Confusion, Opthalmoplegia, Ataxia)

-Symmetric lesions in the paraventricular regions of the thalamus, hypothalamus, mammillary bodies and PAG region of midbrain

``` Neurofibrillary tangles (abnormally phosphorylated TAU) Found in frontal and temporal lobes ```

Alzheimer’s Disease

Polymyxins B and E

Cationic basic proteins Act as detergents that bind cell membranes Disrupt the osmotic and cell membrane integrity Used in resistant gram negative infections

Polymyxins B and E ADRs:

Neurotoxicity, | Acute renal tubular necrosis

SSRI and Carbamazepine can both cause…

SIADH

Amiodarone

-Prolongs action potential in cardiac phases 1 and 3 via blockage of sodium AND potassium channels.

Lithium Toxicity

Nephrogenic diabetes insipidus b/c it acts as an ADH antagonist Lithium can be used to treat SIADH (lol wow lol)

Threonine dehydrogenase (catabolism)

Converts threonine to pyruvate

Cystic medionecrosis

-Feature of BVs in Marfan’s syndrome

In carotid sheath, anterior to vagus and lateral to the common carotid

Location of internal jugular

Basic Metabolic panel quantifies serum…

Sodium, potassium, chloride, bicarb, creatinine, BUN and glucose

Risk of Beta-agonist overuse: Example: Salmeterol (LABA) and albuterol (SABA)

- Tremor - Tachycardia - HYPOKALEMIA

- Chromosome 17 - Encodes GTPase- activating protein that decreases the activity of Ras (a signaling molecule important in cell proliferation)

WOW more NF1 things you do not know (AD)

- MENIIA and MENIIB - Tyrosine Kinase on 10q11.2 - Medullary carcinoma of thyroid

Ret proto-oncogene

Xeroderma pigmentosum inheritance

Breast cancer risks factors

- Late menopause (>55 years old) *more ovulations - Early menarche (30 years old) - Family history of a relative with breast cancer at a young age

“Sundowning”

-Increased severity of symptoms seen at night (a specific time) in patients with delirium

- Oculocutaneous albinism (devils eyes), light hair and skin - Mutation is in TYROSINase (Rate-limiting step of melanin production) - Impairs conversion of tyrosine to dopaquinone…to…Melanin

Albinism (AR)

Galactokinase deficiency (AD)

- Impairs conversion of galactose into glucose | - Galactosemia and galactosuria

What is the congenital deficiency in Alkaptonuria? (AD)

- Homogentisic acid oxygenase - Black urine after long periods of standing or when wake up - Arthralgias

How does MENSA work?

Binds cyclophosphamide metabolites in the urine and neutralizes them

- Homogentisic acid oxygenase - Black urine after long periods of standing or when wake up - Arthralgias

What is the congenital deficiency in Alkaptonuria? (AD)

- Impairs conversion of galactose into glucose | - Galactosemia and galactosuria

Galactokinase deficiency (AD)

RX FLASH 257 Flashcards

(77 cards)