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232 Cards in this Set
- Front
- Back
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what does tyramine increase the release of?
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NE
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what category is NE in?
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catecholamine
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action of phenylephrine
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constricts vasculature with its alpha-1 selectivity
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what do you use for priapism?
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phenylephrine
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drug for mydriasis
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phenylephrine or atropine (but atropine will cause cycloplegia and phenylephrine won't
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phenylephrine side effects
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Prostatic hyperplasia worsens
Hyperema Elevated BP - HTNsive crisis |
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receptors that epinephrine acts on
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alpa 1,2 beta 1,2
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effects of epinephrine
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decreased TPR
increased CO big increase in HR possible increase in MAP |
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recepors that NE acts on
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all but beta2
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receptors Isoproterenol acts on
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both betas
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g proteins for alpha 1 and alpha 2 receptors
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q, i
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g proteins for beta 1 beta 2
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s, s
B=S for satisfactory |
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g proteins for D1 D2
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s, i
2Ds make your mama si |
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g proteins for M1 M2 M3
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q, i, q
3M let's you post something qiq-ly |
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What are NN and NM channels for
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sodium
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g proteins for H1 and H2
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q, s
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g proteins for 5HT 1, 2, 3, 4
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i, q, Na, s
Note that 3 is an Na+ channel |
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What kind of a channel is NMDA
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Na+, Ca++, K+
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alpha 1 selective agonist
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phenylephrine
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alpha 2 selective agonist
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clonidine
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beta 1 selective agonist
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dobutamine
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beta 2 selective agonists
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metaproterenol
terbutaline |
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D1 selective agonist
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fenoldopam
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causes of neonatal meningitis
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S. agalactiae
Listeria m E coli ALE |
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causes of meningitis to 6 years
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Pneumo
Neisseria meningitidis H. flu PHeNomenal growth spurt |
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causes of meningitis from 6-60
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Poliovirus
Pneumo M Polite People Maturing |
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causes of aseptic meningitis
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Cocksackie
Echovirus Mumps virus Polio virus |
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fungus that can cause meningitis
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Cryptococcus
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signs of viral meningitis
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protein is up, as for all
BUT no glucose and no increase in pressure |
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viruses for encephalitis
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HSV
rabies Japanese encephalitis T gondii T. brucei |
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Protein A
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Staph aureus
It binds to the Fc portion of IgG |
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desquamation of palms and soles
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staph aureus TSS
Strep pyogenes Scarlet Fever |
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bug for TSS
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staph aureus (via TSST-1 exotoxin)
strep pyogenes |
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bug for Scalded Skin Syndrome
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staph aureus (via ET A, B)
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bug for Ritter's disease (and what is Ritters)
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staph aureus (via ET A,B)
Scalded skin in neonates because of cut umbilicus |
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cocci in clusters
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staph aureus,
staph saprophyticus |
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bug for UTI
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1) e coli
2) staph saprophyticus |
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hemolysin
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staph aureus enzyme to kill RBCs and WBCs
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leukocidin
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staph aureus enyme to kill RBCs and WBCs
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adhesion polysaccharide
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staph epidermidis
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novobiocin sensitive
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staph epidermidis
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catalase positive
coagulate negative novobiocin resistant |
staph saprophyticus
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tx for UTI due to saprophyticus
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TMP-SMX
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M protein
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strep pyogenes
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smokey colored urine
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glomerular nephritis post strep pyognes skin infection
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sandpaper rash
strawberry tongue |
Scarlet fever
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exotoxin A
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strep pyogenes - TSS
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exotoxin B
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strp pyogenes - necrotizing fasciitis
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streptolysin
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destroys RBCs, WBCs
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ASO+
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anti-streptolysiin O antibodies present
= strep pyogenes |
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subepithelial humps
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post strep glomerulonephritis
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Sydenhams chorea
Erythema marginatum Prolonged PR |
Rheumatic Fever (2 major, 1 minor)
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Polyarthritis
+streptococcal antibody fever |
Rheumatic Fever (1 major, 2 minor)
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soon after birth, an infant develops seizures, marked irritability, poor feeding, fever.
There was premature rupture of membranes during labor |
strep agalactiae neonatal meningitis
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its capsule prevents bile salt degradation
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enterococcus faecalis
strep bovis |
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infection that can herald colon cancer or IBD
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strep bovis, because it invades through GI lesions
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has an antiphagocytic capsule
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strep pneumo
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rusty colored sputum
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strep pneumo
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bacteria to which asplenic patients are quite vulnerable
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strep pneumo (because of capsule)
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patient had several bouts of sore throat as a child
Roth's spots splinter hemorrhages mitral valve vegetations |
strep viridans
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has extracellular dextran
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strep viridans
this helps it bind to heart valves |
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bug involved in brain abscesses
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strep viridans (more specifically s. intermedius)
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old man
UTI 5 days after admission to hospital was on cephalosporins |
enterococcus faecalis
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young guy ate fried rice at an asian restaurant several hours ago
vomiting every 10 minutes for the last hour |
bacillus cereus
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terbutaline side effects
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RAT in the brain; HAT on the heart; PET in the lungs
Restless, Anxiety, Tremor Hyperglycemia, Hypokalemia Angina, Arrhythmias Tachycardia PO2 low, Edema, Tolerance |
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effects of B1 agonists
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up HR
up CO up BP up ATII |
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effects of B2 agonists
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down TPR and BP
up airflow delay labor up plasma glucose and thus down K+ |
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effects of D1 agonists
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increase renal perfusion
decrease TPR and BP |
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effects of D2 agonists
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extrapyramidal motor activity, etc.
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effect of alpa 2 agonists
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decrease sympathetic outflow
decrease intraocular pressure |
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effect of alpha 1 agonists
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increase TPR and BP
decrease urination, especially in BPH mydriasis without cycloplegia ejaculation |
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drugs to use in a hypertensive emergency
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"NFL ENAbled for a fast touchdown"
Nitroprusside, Nitroglycerin (NO) Nicardipine (CCB) Fenoldopam (D1agonist) Labetalol (A1, B antagonist) ENAlaprilat (ACEi) |
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reserpine side effects
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"2SAD"
CNS Sedation, pArkinsonism, Depression GI Secretion of gastric acid, Abdominal pain, Diarrhea |
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med for hot flashes
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clonidine
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clonidine uses
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HOLD (the clown holds the lighter...)
Hypertension and Hot flashes Opioid/alcohol withdrawal Loss of behavioral control in ADHD Diabetic diarrhea from sympathetic neuropathy |
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clonidine withdrawal
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hypertensive crisis
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antihypertensives to use in pregnancy
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alpha-methyldopa (which acts via a metabolite on the presynaptic alpha 2 and thereby decreases NE release) It's best. "Mdopa for Moms."
BBlockers, esp labetalol Ca Channel blockers Hydralazine (all things that keep water) |
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drugs counterindicated in pregnancy
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ACEi
ARBs Diuretics (nothing that gets rid of water) |
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uses of prazosin
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HTN (esp if patient has BPH)
BPH |
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causes first dose syncope
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prazosin
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clinical uses of the Phen....amines
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PHEochromocytoma
Hypertensive crisis Erectile dystunction (Phentolamine + papaverine) |
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drugs causing hypertensive crisis
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Tyramine in MAOI users
Clonidine |
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drugs for ED
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1) sildenafil ("Seal stands still")
2) alprostadil (prostaglandin E1 analog - "Alps") 3) phentolamine&Papaverine ("pen stands tall on papaya") |
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antidote for opioids
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naloxone
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antidone for fibrinolytics
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aminacaproic acid
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antidote for iron
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deferoxamine
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antidoe for methanol or ethylene glycol
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fomeprizole
ethanol |
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antidote for copper
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penicillamine
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antidote for arsenic or mercury
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dimeraprolsuccimer
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antidote for lead
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EDTA
Dimercaprol Succimer |
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antidote for cyanide
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nitrite
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antidote for carbon monoxide
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100% oxygen
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antidote for acetaminophen
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acetylcysteine
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antidote for benzos
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flumenazil
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antidote for digitalis
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digibind
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antidote for TCAs
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bicarbonate, sodium
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poly-D-glutamic acid capsule
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bacillus anthracis
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painless eschar
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anthrax
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protective antigen, and
either edema factor or lethal factor |
anthrax toxin
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what does anthrax edema factor do
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up AC
up cAMP inhibits PMNs |
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what is the role of the protective antigen in anthrax
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mediates endocytic entry of EF or LF
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poly-D-glutamic acid capsule
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bacillus anthracis
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painless eschar
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anthrax
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protective antigen, and
either edema factor or lethal factor |
anthrax toxin
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what does anthrax edema factor do
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up AC
up cAMP inhibits PMNs |
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what is the role of the protective antigen in anthrax
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mediates endocytic entry of EF or LF
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poly-D-glutamic acid capsule
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bacillus anthracis
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painless eschar
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anthrax
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protective antigen, and
either edema factor or lethal factor |
anthrax toxin
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what does anthrax edema factor do
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up AC
up cAMP inhibits PMNs |
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what is the role of the protective antigen in anthrax
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mediates endocytic entry of EF or LF
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tx for anthrax
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parenteral penicillin G
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the only medically important bacteria with a protein rather than a polysaccharide capsule
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anthrax
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shaped like a tennis racket
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clostridium tetani
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risus sardonicus
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c tetani
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blocks release of inhitibory GABA and glycine from Renshaw cell interneurons of spinal cord
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tetanospasmin of c tetani
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tx for tetanus
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clean wound
antitoxin DTP booster penicillin, metronidazole diazepab (GABA agonist) |
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diplopia
dysarthria dysphagia descending paralysis dizziness dry throat ptosis |
botulism
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mouse test
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botulism
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diarrhea in tremendous volumes, preceded by clindamycin a couple of weeks ago
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c diff
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yellow-white plaques on sigmoidoscopy
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c diff
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what toxins does c diff have?
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A - watery diarrhea Iand maybe hypoalbuminemia)
B - pseudomembrane |
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tx for c diff
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oral metronidazole or vancomycin
withdraw causative antibiotic |
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air bubbles below the skin
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crepitis in c perfringens celllulitis
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What enzymes released by c perfringens cuase crepitus
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collagenase
hyaluronidase |
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which c perfringenes toxin cuases muscle cell necrosis
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alpha toxin = lecithinase
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the only non-motile clostridium?
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perfringenes (it's frigid)
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survives in poorly pasteurized milk
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listeria monocytogenes
campylobacter |
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listeria tx
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ampicillin +- gentamicin
or TMP-SMX |
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can survive both intracellularly (in macrophages and PMNs) and extracellularly
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listeria
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looks like Chinese letters
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Corynebacterium dphtheriae
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large gray mucous film on oropharynx
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corynebacterium
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ST-T wave changes on EKG
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corynebacterium
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black colonies on potassium tellurite culture
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diphtheria
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whats diphtheria toxin
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AB toxin which ADP ribosylates EF-2 and prevents protein synthesis in all cells!!!!!! CN takes a DIP
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pus-filled, painless sinus forming
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actinomyces israelii
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causes abscesses in mouth
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actinomyces israelii
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yellow sulfur granules
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actinomyces
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bacteria that looks like a fungus and stains acid fast
vs bacteria that looks like a fungus and has sulfur granules |
Nocardia
Actinomyces |
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tx for actinomyces vs nocardia
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actinomyces - penicillin G
nocardia - TMP-SMX |
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what distinguishes TB from nocardia
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although both acid fast and both in lungs, only nocardia grows in a beaded, filamentous pattern
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intracellular kidney bean-shaped diplococci
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neisseria meningitidis
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waterhouse-friderichsen
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fulminant neisserial meningococcemia affecting the Adrenals
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how does neisseria evade IgA and colonize the nasal epithelium
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IgA protease
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metabolizes maltose and glucose (vs something else that does only glucose)
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neisseria meningitidis vs gonorrhoeae
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grows on Thayer Martin
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gonorrhea
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tx for gonorrhea
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ceftriaxone for both; penicillin for meningitidis
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meningitis in an army base
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neisseria
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how does neisseria gonorrhoeae evade hosts
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Pili - antigenic variation
pili - prevents phagocytosis |
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vaginal yellow-prurulent discharge
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neisseria gonorrhoea
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neisseria gonorrhoeae infecting liver capsule
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Fitz-Hugh-curtis syndrome
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ophthalmia neonatorum
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neisserian gonorrhoeae
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tx for gonorrhoeae
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ceftriaxone
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most common cause of septic arthritis
|
gonorrhea
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has a really big capsule
|
Klebsiella
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capsule
currant jelly sputum cavities in the right upper lobe |
Klebsiella with its Kapsule Kastle, amking Kurrant jelly and forming RUL Kavities that drugs Kan't Kick
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has K O and H antigens (and what do they each do?)
|
E coli
K is on the Kapsule O is on the Outer membrane H is on the hairs (flagella) |
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bloody diarrhea, fatigure, confusion
anemia, thrombocytopenia, uremia |
E coli
|
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metallic green stool clture
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e coli
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ETEC
EPEC EHEC EIEC |
T - travellers
P - flattens villi - malabsorption H - HUS via Shiga like toxin I - invades mucosa and secretes SLT |
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how does Shiga toxin kill
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invades 60S ribosome
|
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fever
hemolytic anemia thrombocytopenia acute renal failure |
HUS
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Vi capsule
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salmonella typhi
allows survival of phagocytes in Peyer's patches and then these phagocytes go to the gallblader, liver and spleen |
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perisisten high fever, mailaise
constipation enlarged spleen tender abdomen red macules |
salmonella typhi - typhoid fever
|
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can be carried forever in the gall bladder
|
salmonella typhi
|
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turtles
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salmonella enteritidis (enteriturtle)
|
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bloody diarrhea
hemorrhagic mucosa ulcerations |
shigella dysenteriae
|
|
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dysuria
alkaline urine "struvite" stones - which can cause persistent UTI |
proteus mirabilis
|
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what does proteus have to do with the Weil Felix reacton
|
WF uses Proteus vulgaris antigens to diagnose rickettsia, because the antigens can cross react with a patient's serum antibodies to rickettsia
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comma shaped bacteria
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cholera
cholera comma |
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mechanism of cholera toxin
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ribosylates Gs, up AC, up cAMP
so crypt cells secrete more Cl- villous cells absorb less Na+ |
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one flagella
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cholerpseudomonas can have one or more
|
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what needs to be in the recipe for cholera rehydration
|
glucose and Na
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which blood group is more vulnerable to cholera
|
chOlera
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otitis externa
|
pseudomonas
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blue/green colonies on culture
|
pseudomonas
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tx for pseudomonas
|
tricky because of resistance
anti-pseudomonal penicillin + aminoglycoside |
|
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mesenteric adenitis
|
yersinia
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localizes in terminal ileum
|
yersinia
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bloody diarrhea with appendicitis-like pain
|
yersinia
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bloody diarrhea with arthritis
|
yersinia
|
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produces mucinase
|
cholerae
|
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what does metoprolol do
|
beta 1 blocker
decreases IOP |
|
|
drugs for treating CHF
|
metal carved bee:
Metorprolol carvedilol bisoprolol |
|
|
what's propranolol
|
nonselective beta blocker
lowers IOP (vs. beta 1 only) constricts smooth muscle (which becomes a problem for asthmatics) |
|
|
useful in:
Thyroid storm Tachycardia in pheochromocytoma Essential tremor Esophageal variceal bleeding in cirrhosis Anxity and Alcohol withdrawal |
propranolol, nadolod etc
non-selective beta blockers (the rest of the things they do are like beta 1s) |
|
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what's labetalol? carvedilol?
|
lock for alpha 1 and Beta
|
|
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labetolol side effects
|
Liver toxicity
hypOtension |
|
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what's cholinomimetic vs muscarinic
|
same thing!
|
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what's special about carbachol
|
mixed cholinergic agent
activates all nicotinic and muscarinic BUT it's only used as a topical cholinomimetic agent in ophthalmology |
|
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what receptor is responsible for accommodation for near vision
|
M3
|
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what class is edrophonium
|
reversible ChE inhibitor
|
|
|
difference between echothiophate and pphysostigmine
|
both are anti-ChE
echothiophate covalently bonds by phosphorylation to ChE and is resistant to hydrolysis the "igmines" are convalently bond via Carbamoylation and can by hydrolysed |
|
|
so if echothiophates can't be hydrolysed, how do you reverse their action?
|
pralidoxime
|
|
|
gold standard tx for MG
|
pyridostigmine, and anti-ChE
|
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what's an indirect cholinomimetic
|
an anti-ChE
|
|
|
what's physostigmine usually used for
|
glaucoma
|
|
|
tacrine
galantamine rivastigmine Donepezil |
anti ChE inthe brain and so improve cognitive function in alzheimer's
rivastigmine is used in PD |
|
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problem with tacrine
|
hepatic toxicity
|
|
|
memantadine
|
NMDA receptor antagonist used in Alzheimers
|
|
|
main use for echothiophate
|
open angle claucome
|
|
|
what are all of these used for?
piocarpine carbachol demecarium echothiophate physostigmine |
glaucoma
|
|
|
treats farmer's organophosphate poisoning
|
Atropine
Pralidoxime |
|
|
what receptors does scopolamine block?
|
M1 and H1
|
|
|
why do anesthesiologists think about atropine?
|
because it prevents laryngospasm induced by irritant anesthetics such as ether
|
|
|
what do these have in common?
atropine antihistamines Neuroleptics TCAs |
antimuscarinic effects
|
|
|
what's oxybutynin used for
|
OAB
bladder spasm |
|
|
name 2 ganglionic blockers
how do they work? |
trimethaphan, hexamethonium
they antagonize postsynaptic nicotinic NN receptors which THEN blocks sympathetic and parasympathetic outflow to target organs and REVERSES autonomic tones |
|
|
MOA of diazepam
|
dilates GABA-a with increased frequency
|
|
|
diazepam toxicities
|
dependence and tolerance
anterograde amnesia suppression of respiration and circulation |
|
|
Which of the following open the GABAa channel with increased frequency or duration?
midazolam flurazepam corazepate phenobarbital secobarbital |
the barbitals are the ones that act by proloning the duration of the channel opening
|
|
|
What's flumenazil for?
|
benzo reeptor blockade used in overdose
|
|
|
major phenobarb trouble
|
CP 450 induction
porphyrin synthesis (so can't be used in porphyria) |
|
|
what receptor does zolpidem work on
|
binds BZ1 on the alpha unit of GABAa
This is a ligand gated Cl- channel This means it works for insomnia, but not as a muscle relaxor or seizure suppressor |
|
|
why do you have to be careful prescribing zolpidem
|
DDIs, e.g., increased metabolism by rifampin
|
|
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what receptor does buspirone work on
|
5HT1a, which is Gi coupled
|
|
|
what are the benefits of buspirone over benzos
|
no risk of dependence
no withdrawal reactions no marked sedation or psychomotor impairment (but it can cause nervousness) |
|
|
how do the -CAINEs work?
|
block Na channels, keeping positive Na out and therefore hyperpolarize
|
|
|
What's the special feature of the -CAINEs?
|
use dependent block which favors fibers that are:
small myelinated high firing rate |
|
|
major side effect of the FLURANEs
|
malignant hyperthermia if used with succinylcholine, in genetically susceptible individuals with mutated CRC channel genes
|
|
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how do the FLURANEs work
|
activatae GABAa
|
|
|
relationship between MAC, ED50 and potency
|
MAC=ED50=1/Potency
|
|
|
how do propofol and etomidate work?
|
like FLURANEs, they facilitate GABAa
|
|
|
what's the benefit and problem with etomidate
|
benefit is that it stabilizes the heart and llungs
downside is that it can cause pain at injection site, post op nause and vomiting, etc |
|
|
use of ketamine
|
anesthesia in patients with hypotension or at risk of bronchospasm
|
|
|
main side effect of ketamine
|
emergence delirium
|
|
|
what class are fentanyls
|
opioid analgesics that activate Gi coupled receptors
down cAMP PKA inactivated K+ out Ca not in hyperpolarization |
|
|
what's fentayl used for
|
post op analgesia
|
|
|
what class are tubocurarine and succinylchonline?
how are they different? |
NM blockers that paralyze skeletal muscle
decrease Ach release by blocking presynaptic sodium channels tubocurarine is not depolarizing succinylcholine gets the NM to suck in the whole AC and then choke on it. More longlasting effect |
|
|
how do spasmolytics work
|
GABAb agonists
alpha 2 agonists ACh release inhibitors Ca++ release channel blockers |
|
|
what is baclofen
|
a spasmolytic, activates presynaptic Gi-coupled GABAb receptors
|
|
|
what is baclofen used for
|
skeletal muscle spasticity, as in ALS
|
