- Lipid-lowering agent in patients with cardiovascular disease (reduce triglycerides and VLDL synthesis) - Patients w/ low HDL levels - And whose LDL do those not control by statins alone

- Serotonin agonist at 5-HT1D and 5-HT1B - First line for acute migraine headaches - Can be used to treat cluster headaches too

- Polymerized to form intermediate filaments - Found in mesodermal origin cells (fibroblasts)

RX FLASH 258 Flashcards by Keegan Sturgill

Niacin Uses

Lipid-lowering agent in patients with cardiovascular disease (reduce triglycerides and VLDL synthesis)
Patients w/ low HDL levels
And whose LDL do those not control by statins alone

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Bind transport protein on enterocytes
Prevents cholesterol absorption
Modest LDL lowering effect
NO effect on TG or HDL

Ezetimibe

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Drug of choice for patients with high levels of triglycerides

-Increases peripheral lipolysis
-Decreases hepatic free FA acid extraction
-Patients with HIGH levels of TGs (triglycerides)
-Lowers LDL and increases HDL
FIBRATES via PPAR-Alpha

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Almond breath, confusion, HA

Cyanide poisoning
Oxygen no longer final electron acceptor in ETC→ Oxidative phosphorylation is shut down→ Anaerobic metabolism for ATP generation→ Lactate increased→ Metabolic acidosis

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High ANION GAP METALBOLIC ACIDOSIS (CUTE DIMPLES)

Cyanide→build up of lactic acid
Uremia
Toluene
Ethanol
Diabetic ketoacidosis
Isoniazid
Methanol
Propylene glycol
Lactic Acidosis (SIRS)
Ethylene glycol
Salicylates

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5 main causes of metabolic ALKALOSIS

1) Loss of hydrogen ions (vomiting or renal loss)
2) Bicarbonate retention (kidneys)
3) Hypokalemia (K+ out of cell and H+ into the cell)
4) Alkalotic agents (bicarbonate or antacids
5) Contraction alkalosis (water lost as a diuretic while bicarbonate is retained)

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Genital lesions

- Recurrent meningitis (wow): Signs of meningeal irritation w/ increase in CSF lymphocytes

HSV-2

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Four stages of Paget’s disease

1) Initial (V) osteoclastic lesion (increased bone resorption)
2) Mixed period (disorganized bone formation)→ALK elevated
3) Osteoblastic-induced sclerosis
4) Quiescent (low clast and blast activity)

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Paget’s Mixed Period (Stage 2)

ALK up
Phosphate normal
Calcium normal or a little up

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Diagnosis of SLE = 4 of 11 symptoms (BRAIN SOAP MD)

Blood dyscrasias- thrombocytopenia or hemolytic anemia
Renal disorder
Arthritis
Immunologic disorder (anti-DNA/anti-smith antibody)
Neurologic Disorder
Serositis (pleuritis or pericarditis)
Oral ulcers
Antinuclear antibody (increased titers w/ out drugs associated with lupus-like)
Photosensitivity
Malar rash
Discoid rash

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FQNs (ciprofloxacin)

-DNA gyrase inhibitors
-Superinfections, skin rashes, HA dizziness
UNIQUE: tendonitis, tendon rupture, cartilage malformation in children and fetus

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IF Keegan Sturgill Mullins OVERDOSES on ADDY what will you see?

Sympathomimetic symptoms: pupil dilation, tachycardia, hallucinations, delusions and fever.
Tx: supportive care

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Pupillary DILATION ()()

List 4-5

Cocaine or decongestants (ephedrine and pseudoephedrine)
Acid (trippin’ balls)
Anticholinergic syndrome (anti-histamines, atropine)
Opioid withdraw

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Sumatriptan

Serotonin agonist at 5-HT1D and 5-HT1B
First line for acute migraine headaches
Can be used to treat cluster headaches too

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Triptans can abort or reduce the severity of…

Migraine Headaches

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Uses of Amitriptyline (TCA)

Migraine prophylactic
Depression
Neuropathy
Chronic Pain

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Methysergide (ergot alkaloid derivative)

Ergot alkaloid derivative

- Prophylactic use ONLY for migraine attack

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Nadolol (B-blocker)

-Second-line in migraine prophylaxis as well as HTN and angina
ADRs: Nightmares, paresthesias, bradycardia, fatigue

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Protein important in contraction of striated muscle

- Connects the M-line to the Z-line

Titin (aka Connectin)

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Vimentin

Polymerized to form intermediate filaments

- Found in mesodermal origin cells (fibroblasts)

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SYRINGOMYELIA (C8-t1)
Spinothalamic knocked out bilaterally (sensory)
Cerebellar tonsils and medulla through foramen magnum
Anterior horn (atrophy intrinsic hang muscles) –motor

Arnold-Chiari Malformation Type I

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Digoxin should be avoided in what patients?

Renal failure or hypokalemia

- These patients potentiate the effect

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B-blockers should be used with caution in diabetic…why?

Mask signs of hypoglycemia

- Careful if on sulfonylureas (risk for hypoglycemia)

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Digoxin MOA

Inhibits Na/K+ ATPase → increased INTRAcellular Na+→Increased intracellular calcium→positive inotropy

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- Inhibit NaCl reabsorption in early DCT (distal convoluted tubule) - Decrease Ca2+ excretion - Decrease diluting capacity of kidney

Thiazides (HCTZ MOA)

Thiazide adverse effects

``` Hypokalemic metabolic ALKALOSIS Hyponatremia HYPERglycemia HYPERuricemia HYPERcalcemia ```

Inhibits Na/K+ ATPase → increased INTRAcellular Na+→Increased intracellular calcium→positive inotropy

Digoxin MOA

Bupropion ADRs

- SEIZURES AT HIGH DOSE (lowers threshold in anorexic hoes) - Anxiety - Dizzy - Agitation - Insomnia

Bupropion (weird use)…Normally an antidepressant

-Treating patients with obesity

Absence seizures

- Ages 3-7most common - Several times a day - Momentary LOST consciousness→resume previous activity

Gabapentin

- GABA analog - Treats all seizures (EXCEPT ABSENCE) - and diabetic neuropathy

- Drug of choice: for INITIAL seizure RX (especially in adults) - Effect in all seizures except ABSENCE

Phenytoin

Phenytoin mechanism

-Increase sodium channel inactivation by increasing the efflux and decreasing the influx of channels

Diazepam (long acting benzo)

- Status epilepticus (>30 min) | - Increases chloride channel firing→GABA agonist activity

BRC-ABL (PHILLY)

- CML | - Constitutively active TK→ pro growth and survival in granulocytic and megakaryocytic precursor cells

- Prevents CML→ to accelerated/blast phase (acute leukemia transformation) - NOT A CURE (returns blood counts to normal and makes CML quiescent)

Imantinib

Daclizumab

-Monoclonal antibody against interleukin-2

- Eosinophilic cytoplasmic inclusion bodies - CLEAR HALO surrounding dense core - ALPHA-SYNUCLEIN

Lewy bodies | Seen in PARKINSONS and Lewy Body Dementia

- Copper accumulation | - Accumulate in liver, brain and DESCEMENT membrane of cornea (KAYSER-FLEISCHER RINGS)

Wilson Disease (Hepatolenticular Degeneration)

Wilson gene, chromosome and inheritance

AR and ATP7B gene on chromosome 13 | -mutations in a hepatocyte copper-transporting ATP-ase

Wilson Disease symptoms

- Parkinsonian symptoms - Presents younger age - Liver disease as well as cognitive degeneration - psychiatric disease too

- CHIMERIC monoclonal antibody - TNF-alpha antibody - Refractory Crohn disease, RA and others

Infliximab

- Topoisomerase II inhibitor→ DNA degradation | - TX: SCLC, prostate, and testicular caner

Teniposide

The cerebral vessels most vulnerable to damage by HTN are…

Those that supply the basal ganglia

Spongy form change w/in the NUEUROPHIL

- Seen in spongiform encephalopathies such as Creutzfeldt-Jakob, kuru, and fatal familial insomnia - Extensive vaculoation and neural cell loss - Ataxia→rapid progressive dementia→ early death

DCLO decreases in …

COPD/ emphysema (diffusion limited exchange)

TPA contraindications ( 3-4.5 hours post-event = past window)

Greater than: >185 systolic BP >110 diastolic BP INR > 1.7

- Males - Arrest B lymphocyte development - No production of antibodies - NORMAL T-CELLS

X-linked (BRUTON) Agammaglobulinemia -Bruton tyrosine kinase mutations

- Most common - Prone to candida infections and pneumocystis pneumonia - Excessive dATP→inhibits production of other nucleotides - Toxic to cells that divide rapidly (T and B lymphocytes) - BONE MARROW TRANSPLANT WORKS

SCID (ADA deficiency)

- T lymphocyte CD40 ligand (CDL40) | - Prevents isotype class switching by B lymphocytes

X-linked hyper-IgM syndrome mutation

What is necessary for production of IgG antibodies?

A CD40-CD40L interaction is a necessary co-stimulatory signal

Leading cause of death in 65+

Heart disease

AAT deficiency late-stage cirrhotic liver (hepatic side of disease)

- No longer produces clotting factors→ coagulopathy | - Decrease in clotting factors→ elevated PT/INR (normal=1) and PTT

Hemochromatosis (AR) gene mutation

``` HFE gene (C282Y>H63D) on chromosome 6 -abnormal iron sensing leading to increased intestinal absorption ```

X-linked hyper-IgM syndrome mutation

- T lymphocyte CD40 ligand (CDL40) | - Prevents isotype class switching by B lymphocytes

Decreased Ceruloplasmin

- Wilson’s disease (AR) | - Defect in incorporation of copper into ceruloplasmin

Osteoporosis is defined by bone mineral density T-score of > or equal to:

2.5 standard deviations below the mean of the ideal population (1-2.5 SD = osteopenia)

Bleeding Ulcer (stomach or esophagus) = Sit upright for an hour after poppin’

BISPHOSPHONATES (ex: alendronate)

- HFE→increased iron absorption due to IMPAIRED REGULATION OF IRON STORES - Cirrhosis, DM, Cardiomyopathy - Increased transferrin saturation, Increased Iron, and Decreased TIBC

Hemochromatosis (AR HFE gene on chromosome 6)

After ruling out a hemorrhagic stoke w/ imaging, it is standard to treat patients with…

- Antiplatelet medications (Aspirin, Clopidogrel, Dipyridamole) - Clopidogrel can also be used in non-ST acute coronary syndrome

Uses of Abciximab (antibody against glycoprotein receptor IIb/IIIa on activated platelets)

- Acute coronary syndrome | - Percutaneous transluminal coronary angioplasty

-Under-perfusion most often through the artery of Adamkiewicz

Anterior spinal artery syndrome

11p13 Deletion

``` WAGR Wilm’s Tumor Aniridia—PAX6 Genital anomalies Mental retardation ```

Sjogren Syndrome Triad

- Keratoconjunctivitis Sicca (dry eyes) - Xerostomia (dry mouth) - ARTHRITIS

Sjogren Syndrome HLA and risk

HLA-DR3 | Increased risk of lymphoma

Werdnig-Hoffman Disease (AR)

- Degeneration of anterior horns of spinal cords | - FLOPPY BABY SYNDROME

- Hypochromic microcytic RBCs - Elevated RBC counts - Normal to low hematocrit - Target cells (also in liver disease and Hemoglobin C)

B-Thal

MGUS what do you monitor?

M-protein and Bence Jones proteinuria periodically for the rest of their lives

What works well in multiple myeloma but not MGUS?

Thalidomide

When are helmet cells seen?

DIC and traumatic hemolysis

- IgM spike - Fever, weight, loss, night sweat and fatigue - Paraneoplastic neuropathy - Hyperviscosity - Tx: emergent plasmapheresis

Waldenstrom Macroglobulinemia

- Monoclonal gammopathy of undetermined | - Premalignant dysproteinemia

MGUS

Chrug-Stauss can have preexisting asthma and allergic rhinitis and…

-ELEVATED EOSINOPHILS -Lungs involved Random symptoms: conductive hearing loss, uveitis, and muscle/joint pain -Gastroenteritis may precede onset of other symptoms

- Lesion in the left parietal lobe - Changes in visual acuity (angular gyrus) - Four primary symptoms: dyscalculia, Agraphia, left/right disorientation and finger Agnosia

Gerstmann aphasia

- Fatigue - Insomnia - Difficulty concentrating - Irritability - GENERALIZED ANXIETY - PRESENT FOR 6 MONTHS before diagnose

GAD patient (comorbid depression common)

DRUGS for GAD

- Behavioral therapy (lol) - SSRI - Buspirone - Benzo (short term only)

- Depression and anxiety within 3 months of a psychosocial stressor (DIVORCE OR JOB LOSS) - Does not last longer than 6 months (after even is over…could be long divorce)

Adjustment disorder

PTSD

- Last more than a month | - At least a month after the event

Most common initial sign of peripheral neuropathy in DM patients

- Loss of vibrational sensation | - Tuning Fork test

Where is Neuroblastoma usually found?

- Adrenal Medulla (Neuroblastoma = neural crest cell orgin) | - Second most common childhood malignancy

- 17p deletion | - Cerebellum of child

Medulloblastoma

Retinoblastoma

- Inactivating mutation in both alleles of RB1 | - Chromosome 13q14 (codes for tumor suppressor)

Examples of normal tissues with stratified squamous epithelium

- Skin - Mouth - Anus - Vagina - Esophagus

Smoker’s pseudostratified ciliated columnar epithelium in bronchi →

Undergoes metaplasia→ stratified squamous (not an adaption in this case but rather a genetic mutation)

Courvoisier sign:

Jaundice and a palpable enlarged gallbladder | Seen in patients with cancer of pancreatic head (blocking gallbladder emptying)

Whipple Procedure

-Resection of the pancreatic head, duodenum and gallbladder

- Stone in common bile duct - RUQ pain esp. while eating (fatty foods) - TX: cholangiopancreatography and papillotomy with stone extraction

Choledocholithiasis

- Stone in gallbladder | - NO JAUNDICE and no enlarged gallbladder

Cholelithiasis

- Oncogene (transcription factor) - NEUROBLASTOMA - Amplifications in gene

N-myc

Pain and Temp C= slow, Unmyelinated fibers A-delta= fast myelinated All skin, epidermis, some viscera

Free Nerve Endings

- Dynamic, fine/light touch - POSITION SENSE - Glabrous (hairless) skin - Large, myelinated; adapt fast

Meissner corpuscles

Pressure, Deep static touch (shapes, edges), position sense Fingertips, superficial skin Large myelinated SLOW adaption

Merkel discs

Dendritic ending with CAPSULE (adapt slowly) Fingertips and joints Pressure, slippage of objects along surface of skin Joint angle change

Ruffini corpuscles

- VIBRATION and PRESSURE - Large myelinated fibers - ADAPT quickly - Deep skin layers, ligaments, and joints

Pacinian corpuscles (diabetic neuropathy)

RX FLASH 258 Flashcards

(94 cards)