Drugs, Elec, Extra

Front 1

bumetanide, torsemide moa

Back 1

- They inhibit theNa+/K+/2Cl− pump in the thick ascending limb of the loop of Henle.

- inhibits potassium reabsorption at the thick ascending limb of the loop of Henle.

Furosemide ethacrynic acid

Front 2

Spironolactone and eplerenone

Back 2

specifically block the epithelialsodium channel (ENaC).

Front 3

Conivaptan

Back 3

inhibits the V2 receptor of the collecting duct.

Conivaptan and tolvaptan exclusively block water reabsorption by blocking antidiuretichormone (ADH).

Front 4

Morphine, in CHF or cardiac cases, works by..?

Back 4

dilating pulmonary veins and decreasing hydrostatic pressure incapillaries.

Front 5

Clopidogrel, prasugrel, and ticagrelor

Back 5

Blockade of P2Y12 ADP receptor

Front 6

heparin

Back 6

Potentiation of antithrombin III

Front 7

argatroban, lepirudin

Back 7

Thrombin inhibition

Front 8

aminocaproic acid

Back 8

Plasmin inhibition

Front 9

All patients with unstable angina (acute coronary syndrome [ACS]) need two antiplateletmedications. - name them

Back 9

aspirin and clopidogrel

Front 10

thrombolytic administration and time in MI

Back 10

Thrombolytics are useful for an ST-segment elevation MI:

- 12 hours after the onset of pain. They do not work for NSTEMI.

- Use them for 3 to 4.5 hours for a stroke.

- Once in the ED, you should have thrombolytics in the patient’s needle within 30 minutes of coming to the door.

Front 11

When is tPA used MI?

Back 11

TPA is used only for chest pain with ST elevation and new left bundle branch block (LBBB)

Front 12

Mortality Benefit in Myocardial Infarction

Back 12

• Aspirin

• Second antiplatelet drug

• Angioplasty

• Thrombolytics

• Beta-blockers

• Statins

Front 13

Dabigatran

Back 13

Dabigatran is a direct thrombin inhibitor. No INR monitoring is needed.

Front 14

Rivaroxaban

Back 14

Rivaroxaban is a factor Xa inhibitor. No INR monitoring is needed.

Front 15

In hypotensive pts., if two to three fluid boluses with NS do not raise BP >90 mm Hg, then use..?

Back 15

levarterenol orpseudoephedrin - pure alpha-1-agonists.

Front 16

in cardiac tamponade, cardiac catheterization would show?

Back 16

Cardiac catheterization shows equalization or pressures in all chambers in diastole.

Front 17

electrolyte imbalance during vomiting

Back 17

vomiting causes hypochloremic metabolic alkalosis and hypokalemia

Front 18

Succinylcholine contraindication. Alternative?

Back 18

- Succinylcholine is a depolarizing neuromuscular blocker that can cause life-threatening hyperkalemia. It should not be used in patients with or at high risk for hyperkalemia, such as burn and crush injury patients and patients with prolonged demyelination - GBS.

- Non-depolarizing agents such as vecuronium or rocuronium are a better choice in these patients.

Front 19

Chronic alcoholic pt. with Hypokalemia. Imp. thing to remember?

Back 19

Hypomagnesemia, causes refractory hypokalemia; therefore it is important to correct the magnesium along with the potassium levels to be able to correct the electrolyte abnormalities of such patients.

Front 20

Hypovolemic hypernatremia - Rx

Back 20

- Mild cases can be treated with 5% dextrose in 0.45% saline.

- Severe cases should be initially treated with 0.9% saline.

Front 21

Drugs that cause HyPERkalemia

Back 21

Nonselective beta blockers,

ARBs, ACEi,

K+ sparing,

Digitalis,

Cyclosporine,

Heparin,

NSAIDs,

Succinylcholine

TMP-SMX

Front 22

TMP-SMX can cause hyperkalemia and increased Creat. mechanism?

Back 22

Trimethoprim can cause hyperkalemia due to blockade of the epithelial sodium channel in the collecting tubule. Trimethoprim also competitively inhibits renal tubular creatinine secretion and may cause an artificial increase in serum creatinine without affecting the glomerular filtration rate.

Front 23

Agents used to shift potassium intracellularly include..?

Back 23

insulin and glucose, sodium bicarbonate, and beta-2 agonists.

Front 24

A-a gradient in hypoventilation

Back 24

normal

Front 25

lactic acidosis after a seizure. next step?

Back 25

Postictal lactic acidosis commonly occurs following a tonic-clonic seizure. It is a transient anion gap metabolic acidosis that resolves without treatment within 60 to 90 minutes following resolution of seizure activity.

Front 26

Brief psychotic disorder—lasting

Back 26

< 1 month,

Front 27

Schizophreniform disorder—lasting

Back 27

1–6 months.

Front 28

Schizoaffective disorder—

Back 28

> 2 weeks of hallucinations or delusions without majormood episode (major depression or mania), plus periods of concurrent major mood episode with schizophrenic symptoms.

Front 29

Delusional disorder - duration

Back 29

lasting > 1 month.

Front 30

Manic episode duration

Back 30

lasting at least 1 week.

Front 31

Hypomanic episode - define and duration

Back 31

Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. No psychotic features.Lasts at least 4 consecutive days.

Front 32

Major depressive disorder duration

Back 32

lasting 6-12 months

Front 33

Grief duration

Back 33

< 6 months

Front 34

Generalized anxiety disorder duration

Back 34

> 6 months

Front 35

Adjustment disorder duration

Back 35

< 6 months

Front 36

PTSD duration

Back 36

> 1 month

Front 37

Acute stress disorder duration

Back 37

3days - 1 month

Front 38

Bulimia nervosa - symptom duration

Back 38

occuring weekly for 3 months

Front 39

Narcolepsy Rx

Back 39

daytime stimulants (eg, amphetamines, modafinil) andnighttime sodium oxybate (GHB).

Front 40

for all schizophrenia or possible psych cases, orders in CSS?

Back 40

CBC, Elec, Ca..etc.

TSH

VDRL

serology for HIV

Urine tox

temporal lobe epilepsy -- rule it out (dont add)

Front 41

when you suspect depressive disorder, what else should you consider and exclude?

Back 41

Other medsHypothyroidismParkinsonssubstance disorder - ask CAGE

Front 42

Major depressive disorder Mngt?

Back 42

- Admit if suicidal or homocisal or paranoia

- SSRIs

- benzos if agitated

- ECT - bets choice if acutely suicidal

Front 43

dysthymic disorder Rx

Back 43

Bi - long term invidual insight-oriented psychotherapy.

- if fails, SSRIs

Front 44

seasonal affective disorder - Rx?

Back 44

Phototherapy or sleep deprivationsad winters and happy summers

Front 45

bipolar duration

Back 45

atleast 1 week

Front 46

Acute mania (manic episode) Mngt

Back 46

- Hospitalize

- Lithium for remission (takes one week for effect)

- Risperidone for mania

- IM depot phenothiazine if noncomplaint or severe

- antidepressants ONLY if recurrent depression or mood stabilizer doesnt work/help

Front 47

rapid cycling bipolar? cause?

Back 47

>4 mania episodes per year.

- can happen if antidepressants are given to bipolar pts. proflylactically - so dont give antidepressants.

- can also be cause by hypOthyroidism

Front 48

rapid cycling bipolar - Rx?

Back 48

gradually stop - antidepressants, stimulants, caffeine, benzos and alcohol.

Front 49

maniac episodes in preganant pt. Rx?

Back 49

if pt. is taking lithium, stop it.ECT if 1st trimester. Lamitrigine in 2nd and 3rd.

Front 50

Bipolar disorder Rx?

Back 50

- First line - Lithium/Lamotrigine/risperidone

- second line - Aeipiprazole/quetiapine/olanzapine

- recurrent - combination therapy

- psychotherapy and cognitive behavioral therapy

- avoid lithium, valproate and carbamazepine in females

Front 51

cyclothymia - define and Rx?

Back 51

- depression + mania > 2 years

- Psychotherapy

- if fails add divalproex

Front 52

Postpartum psychosis. what should you remember while giviing Rx?

Back 52

Avoid meds if breastfeeding, instead choose ECT.

Front 53

ECT indications.

Back 53

- Major depressive episodes unresponsive to meds

- high risk of immediate suicide

- contraindiction to antidrepressent meds.

- Good response to ECT in the pastDO NOT GIVE IF PT. HAS space occupying lesion. ECT induced transient intracranial pressure (and memory loss too)

Front 54

what should you switch to if the antipsychotic pt. is taking is causing Weight gain or impotence?

Back 54

Bupropion - (side-effect is seizure)

Front 55

what should you switch to if the antipsychotic pt. is taking is causing poor appetite, wt. loss or insomia?

Back 55

Miratazapine (causes wt. gain)

Front 56

depression + chronic neuropathic pain. med?

Back 56

Amitriptyline or duloxitin check spelling

Front 57

depression + bed wetting. med?

Back 57

Imipramine

Front 58

depression + severe insomia

Back 58

Trazodone (strongly sedating)

Front 59

don't give this SSRI in pregnancy.

Back 59

Paroxetine

Front 60

Lithium side-effects.

Back 60

- acne, wt. gain

- dose related tremors, GI distress, headaches (decrease dose)

- hypothyroidism (5%)

- polyuria

- DO NOT USE IN PREGNANcY

Front 61

Pancreatitis and Gallstones together. next step?

Back 61

treat pancreatiti first (IVF, NPO, pain control) after few/6-8 weeks when it resolves you can take care of gallstoes

Front 62

Thalamic stroke features?

Back 62

Hemi-sensory loss with severe dysesthesia (abnormal sensation) of the affected area is typical for a thalamic stroke.

Front 63

The most common site of ulnar nerve entrapment is..?

Back 63

the elbow where the ulnar nerve lies at the medial epicondylar groove.

Front 64

Steroid-induced myopathy - define, labs

Back 64

- result of chronic corticosteroid use

- painless proximal muscle weakness

- slowly improves once the offending medication is discontinued

- normal CK and ESR

Front 65

Drug approved for use in amyotrophic lateral sclerosis and Mech.

Back 65

Riluzole is a glutamate inhibitor.

Front 66

Parkinson's/resting tremor vs. Essential tremor,

Back 66

resting tremor - occur at rest, improve with activity.essential tremor - occur with activity, improve with rest.

Front 67

Parkinson's/resting tremor and Essential tremor Rx

Back 67

Trihexyphenidyl and Propranolol, respectively.

Front 68

Argatroban MOA

Back 68

Direct thrombin inhibitor that reversibly binds to the active thrombin site of free and clot-associated thrombin.

Front 69

How would an oulier ( an extreme and unusual observed in a dataset) affect Mean, Median and Mode?

Back 69

An outlier is defined as an extreme and unusual observed in a dataset. The mean is very sensitive to outliers and easily shifts toward them. The median and mode are more resistant to outliers.

Front 70

What is the substitute for ampicillin for Listeria if penicillin allergic?

Back 70

TMP/SMX for listeria, but you cant use ceftriaxone is ANAPHYLAXIS to penicillin. Use moxifloxacin