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51 Cards in this Set

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Proton Pump Inhibitors
Omeprazole
Pantoprazole
Esomeprazole
Reduce acid secretion in stomach
Splanchnic Vasoconstrictors
Octreotide
Somatostatin
Reduce GI circulation during a bleed
Prokinetic Agents
Erythromycin
Metoclopramide
Clear stomach to facilitate endoscopic visualization in an urgent bleed
Rockall Score
Triaging GI Bleeds
Triaging GI Bleeds
Peptic Ulcer Risk factors
H Pylori
Physiological stress (Burns, ICU)
Acid Hypersecretion (Zollinger-Ellison)
Prior PUD
NSAIDS
Forrest III
Clean Base
Rebleed 5%
Forrest IIc
Pigmented/Flat spot
Rebleed 10%
National Pharmaceutical Strategy (NPS)
Try to establish National Drug Formulary based on safety and cost effectiveness
Assess options for catastrophic drug coverage
Accelerate access to breakthrough drugs
Pursue purchasing strategies to obtain best prices for drugs
Find strategies to ensure effective prescriptions (e-prescribing, EHR)
Accelerate access to generics
Formulary
• A preferred list of drug products that typically limits the
number of drugs available within a therapeu'c class for
purposes of drug purchasing, dispensing and/or reimbursement.
Health Canada Assessment
Safety, efficacy and qualty
No economic analysis
PMPRB
Patented Medicines Price Review Board
Sets prices for patented medicines in Canada
Common Drug Review
National Review
New drugs and indications
Assess effectiveness and economic value
Atlantic Common Drug Review
Line extensions
Class review
Older Medications
Assess effectiveness and economic value
Nova Scotia Drugs and therapeutics committee
Generic drugs for interchangeability
Assess bioequivalency and appearance (safety)
No economic evaluations
panCanadian Oncology Drug Review
Oncology Drugs
Effectiveness and economic value
Pituitary disease patterns
Excess production of hormones
Insufficient production of hormones
Compression of adjacent structures
Inability to breast feed
Low prolactin
Increased adiposity, fatigue, reduced exercise capacity
Low GH
Weight loss, fatigue, muscle weakness, postural dizziness, salt craving
Low Cortisol
Fatigue, weight gain, cold intolerance
Low TSH
Amenorrhea, loss of sexual function, osteoporosis, infertility
Low LH/FSH
Forrest IIb
Adherent Clot
Rebleed 30%
Forrest IIa
Visible vessel
Rebleed 50%
Forrest Ib
Oozing
Rebleed 85%
Forrest Ia
Spurting
Rebleed 100%
Therapeutic option for UGI bleed
Hemoclips
Thermal Coagulation
Injection
Variceal Bleed therapies
30% mortality
Endoscopic Band ligation
Sclerotherapy
TIPS
TIPS
Transjugular Intrahepatic Portosystemic Shunt
Angiodysplasias
Anywhere in GI
50% have synchronous lesions
Ass w renal disease, age, aortic stenosis
Mallory Weiss tears
Longitudinal mucosal lacerations
Proximal stomach/distal eso
5% of UGI bleeds
History of non-bloody emesis or wretching
most heal spontaneously
Formulary listing options (4)
Regular benefit
Restricted benefit with criteria
Preferential listing
Not listed
Pituitary compression features (5)
Headaches,
Seizures
vision changes (diploplia- double vision) lateral peripheral vision
Features of Diabetes Ins
Pituitary insufficiency
Nasal Discharge
In symptomatic patients a random serum cortisol level of less than _____ is diagnostic of insufficiency
100 nMol/L
Diagnostic cortisol insufficiency + Low/normal ACTH =
Hypothalamopituitary disorder
Basal 09:00 Cortisol of greater than ____ (in the absence of critical illness) indicates normal cortisol reserves
400 nMol/L
If cortisol is between 100-400 mMol/L the next step is (2 options)
Insulin stress test
Synthetic ACTH stimulation test
Absolute peak response to Insulin stress test and synthetic ACTH stimulation (10-15% False negative) test of ____ is indicative of normal
550 nmol/L
Dieulafoy's lesion
Dilated, aberrent vessel perforating the gastric mucosa in the absence of an ulcer
Large caliber artery
Proximal stomach along lesser curve
CVD HTN
Lower GI Bleed
Bleeding distal to duodenum
Causes of LGI Bleed (5)
Diverticulosis
Angiodysplasia
Colon cancer/polyps
Colitis (ischemic, ideopathic, IBD)
Anorectal (hemorrhoids, fissure, proctitis)
Fasting (morning) Urine Osmolality of greater than _______ excludes Diabetes insipidus
650 mosmol/kg
If 24h urine volume is less than _______ and serum ____ is normal, it is unlikely Na
2.5 L, Na
Label from top to bottom
Normal
Partial DI
Primary polydipsia
Partial DI
Nephrogenic DI
Acromegaly incidence and etiology
Incidence 3-4 million annually
95% pituitary adenoma
Diagnosis of Acromegaly
75g OGTT: failure to suppress GH
Random serum concentration of < 1 ug/L
IGF-1 elevated in most patients
Management of Acromegaly
Surgery, etc.
Diagnosis methods for LGI Bleeds
Colonoscopy
Tagged radionuclide imaging
CT angiography
Angiography
Acromegaly management
Trans-sphenoidal surgery (octreotide to reduce size by 40% first)
Radio therapy
Somatostatin analogues (S2, S5 Receptors) effective for 60%
Dopamine agonists work for <10%
GH receptor blockers under study
GH Deficiency Tests
Insulin Tolerance test < 5 ug/L

GHRH Arginine Stimulation test < 4.1
Cushing's Symptoms
Excessive weight gain
Easy bruising
Purple Striae
Proximal muscle weakness (needing help standing up)
A/oligomenorrhoea
Fatigue
Central adiposity
Cushing's Screening
24h urine free cortisol
Overnight dexamethasone suppression Test
48H Low dose dexamethasone suppression test