Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
258 Cards in this Set
- Front
- Back
|
Injury to golmerulus is often:
|
immunological
|
|
|
Two types of injury to glomerulus are:
|
antibody to basement membrane - linear IgG or IgG/complement
and Antibody deposited on basement membrane - antibody-antigen complexes |
|
|
Glomerular nephritis is characterized by:
|
linear IgG deposited or IgG/Complement deposition in basement membrane
|
|
|
Renal disorders with low serum complement
|
MAC3S3
Membranoproliferative Acute post infection glomerulonephritis Cryoglobulinemia Cholesterol Emboli C- Hep C SLE SBE Shunt nephritis |
|
|
5 symptoms of EMC
|
hematuria
palpable purpura proteinuria increased RH factor Low C4 |
|
|
membranous glomerulopathy is most common nephrotic syndrome in:
|
adults
|
|
|
Minimal change disease is most common:
|
nephrotic syndrome in children
|
|
|
Clinical features of nephrotic syndrome include:
|
abdominal distention
anorexia facial edema/puffy eyelids oliguria scrotal swelling SOB weight gain ascites edema HTN orthostatic hypotension skin striae |
|
|
UA in nephrotic syndrome shows:
|
proteinuria
lipiduria glucosuria hematuria foamy urine |
|
|
Microscopic examination of the urine in nephrotic syndrome shows:
|
RBC casts (if mixed)
granular casts hyalinuria fatty casts/oval fat bodies |
|
|
Blood chemistry shows what in nephrotic syndrome
|
low albumin
azotemia Low C3 high cholesterol |
|
|
Are patients with nephrotic syndrome more or less prone to coagulation?
|
More - hypercoagulable state may develop secondary to nephrotic loss of antithrombin III
|
|
|
What is one modality to try in tx nephrotic syndrome?
|
steroid therapy
|
|
|
What renal disease is associated with NSAIDS & Hodgkins?
|
Minimal change disease
|
|
|
Associated with heroin, AIDS & reflux nephropathy
|
focal glomerulosclerosis
|
|
|
Associated with things like syphilis, Hep B, D-penacillamine, and SLE
|
Membranous glomerulopathy
|
|
|
Your physical exam shows a renal vein thrombosis along with kidney disease - what is a possible dx?
|
Membranous glomerulopathy
|
|
|
Hep B & Hep C linked
|
Membranoproliferative glomerulopathy (MPGN)
|
|
|
Associated with a mutation of collagen IV, hearing loss, and visual problems
|
Alport syndrome
|
|
|
Hepatitis C associated
|
EMC
|
|
|
Nasal problems
|
Wegnesr
|
|
|
Spike formations (2)
|
Kimmelstile wilson nodule of diabetic nephropathy & membranous glomerulopathy
|
|
|
factors modulating increased renal blood flow
|
Dopamine!
and NO Prostaglandins Bradykinin Serotonin Histamine "SBH has PND" |
|
|
Factors decresing renal blood flow
|
Epi & Nor Epi
thromboxanes endothelin leukotrienes AT I & II Adenosine |
|
|
GFR
|
120 ml/min
|
|
|
PCT functions
|
bulk isosmotic reabsorption of ultrafiltrate
Active transport of Na - main aspect Also resorbs: Ca++ Amino acids Glucose Phosphate Secretes H+ NH3 |
|
|
What functions of the kidney provides waste excretion?
What are the affected elements? |
glomerular filtration
tubular secretion tubular catabolism urea, creatinine urate, lactate, drugs (diuretics) pituitary hormones, insulin |
|
|
Electrolyte balance is control what mechanism in the kidney?
What are the affected elements? |
Tubular NaCl absorption
Tubular K+ secretion Tubular H+ secretion Tubular water absorption Tubular Ca, Phos, Mg transport Volume status, osmolar balance Potassium concentration Acid-base balance Osmolar balance Ca, Phos, Mg homeostasis |
|
|
Hormonal regulation is controlled by what mechanism in the kidney?
What are the affected elements? |
Erythropoietin production
Vitamin D activation Red blood cell mass Calcium homeostasis |
|
|
Blood pressure regulation is controlled by what mechanism in the kidney?
What are the affected elements? |
Altered sodium excretion
Renin production Extracelluar volume Vascular resistance |
|
|
Glucose homeostasis is controlled by what mechanism in the kidney?
What are the affected elements? |
Gluconeogenesis
Glucose supply (maintained) in prolonged starvation |
|
|
This cast finding is associated with what condition?
Red blood cells casts |
glomerulonephritis
vasculitis |
|
|
This cast finding is associated with what condition?
White blood cells |
Interstitial nephritis
pyelonephritis |
|
|
This cast finding is associated with what condition?
Epithelial cells |
Acute tubular necrosis
Interstitial nephritis glomerulonephritis |
|
|
This cast finding is associated with what condition?
Granular |
renal parenchymal disease (non-specific)
|
|
|
This cast finding is associated with what condition?
Waxy, broad |
advanced renal failure
|
|
|
This cast finding is associated with what condition?
Hyaline |
normal finding in concentrate urine
|
|
|
This cast finding is associated with what condition?
Fatty |
heavy proteinuria
|
|
|
This cell finding is associated with what condition?
Red blood cells |
UTI, urinary tract inflammation
|
|
|
This cell finding is associated with what condition?
White blood cells |
UTI, urinary tract inflammation
|
|
|
This cell finding is associated with what condition?
Eosinophils |
acute interstitial nephritis, atheroembolic disease
|
|
|
This cell finding is associated with what condition?
Squamous epithelial cells |
Contaminants
|
|
|
This crystal(s) is associated with what condition?
Uric acid |
Acid urine, acute uric acid nephropathy, hyperuricosuria
|
|
|
This crystal(s) is associated with what condition?
Calcium phosphate |
alkaline urine
|
|
|
This crystal(s) is associated with what condition?
Calcium oxalate |
acid urine, hyperoxaluria, ethylene glycol poisoning
|
|
|
This crystal(s) is associated with what condition?
Cystine |
cystinuria
|
|
|
This crystal(s) is associated with what condition?
Sulfur |
Sulfa-containing abx.
|
|
|
A calcium oxalate crystal is found in _________ urine and is __________ shaped.
|
acidic, envelope
|
|
|
A uric acid crystal is found in _________ urine and is __________ shaped.
|
acidic, rhomboid
|
|
|
A cysteine crystal is found in _________ urine and is __________ shaped.
|
rare metabolic disorders, benzene (y,z)
|
|
|
A phosphate crystal is found in _________ urine and is __________ shaped.
|
alkaline, coffin lid shaped
|
|
|
Acute nephritic syndrome
|
Abrupt onset of renal insufficiency accompanied by edema and hematuria that is glomerular or tubular in origin
Poststreptococcal glomerulonephritis |
|
|
Nephrotic syndrome
|
Increased glomerular permeability manifested by massive proteinuria (>3.5g/day), edema and hypoalbuminuria
|
|
|
Nephrotic syndrome with bland urine sediment
|
Oval fat bodies, course granular casts
Minimal change disease |
|
|
Asymptomatic urinary abnormalities
|
Isolated proteinuria (<2.0g/day) or hematuria with or without proteinuria
Immunoglobulin A nephropathy |
|
|
Tubulointerstitial nephropathy
|
Renal insufficiency associated with non-nephrotic-range proteinuria and functional tubular defects
Sarcoidosis |
|
|
Acute renal failure
|
An abrupt decline in renal function sufficient to result in retention of nitrogenous waste (BUN & creatinine)
Acute tubular necrosis |
|
|
Rapidly progressive renal failure
|
Rapid deterioration of renal function over a period of weeks to months
Rapidly progressive glomerulonephritis |
|
|
Tubular defects
|
Isolated or multiple tubular transport defects
Renal tubular acidosis |
|
|
Site of action for:
carbonic anhydrase inhibitors |
Proximal tubule
|
|
|
Site of action for:
loop diuretics |
Loop of Henle
|
|
|
Site of action for:
Thiazide diuretics |
Distal convoluted tubule
|
|
|
Site of action for:
Metolazone |
Distal tubule, Proximal tubule
|
|
|
Site of action for:
Aldosterone-agonists |
Cortical collecting duct
|
|
|
Site of action for:
Primary sodium channel blockers |
Cortical collecting duct
|
|
|
Example of carbonic anhydrase inhibitor
|
acetazolamide
|
|
|
Primary effect of carbonic anhydrase inhibitor
|
blocking of the Na-H exchange
|
|
|
Secondary effects of the carbonic anhydrase inbitor
|
Loss of K+ & HCO3-
|
|
|
Example of loop diuretic
|
furosemide, bumetanide, ethacrynic acid
|
|
|
Example of thiazide diuretic
|
HCTZ
|
|
|
Example of thiazade-like diuretic
|
metolazone
|
|
|
Example of aldosterone antagonist
|
spironolactone
|
|
|
Example of primary sodium channel blockers
|
triamterene, amiloride
|
|
|
Primary effect of loop diuretics
|
decrease Na/K/2 Cl transport
|
|
|
Primary effect of thiazides
|
decrease NaCl co-transport
|
|
|
Primary effect of thiazide like diuretics
|
decrease NaCl reabsorption
|
|
|
Primary effect of aldosterone antagonists
|
decrease Na+ reabsorption
|
|
|
Primary effect of primary sodium channel blockers
|
decrease Na+ reabsorption
|
|
|
Secondary effect of loop diuretics
|
K+ loss
increased H+ secretion increased Ca++ secretion |
|
|
Secondary effect of thiazide diuretics
|
decrease K+ loss
decrease H+ secretion decrease Ca++ secretion |
|
|
Secondary effect of aldosterone agonists
|
decrease K+ loss
decrease H+ secretion |
|
|
Secondary effect of primary sodium channel blockers
(triamterene, amiloride) |
decrease K+ loss
decrease H+ secretion |
|
|
What are the causes of rapidly progressing renal failure?
|
BAM STORM
Bilateral renal artery stenosis Atheromatous embolic disease Multiple myeloma Scleroderma crisis Thrombocytopenia purpurea Obstructive uropathy Rapidly progressing glomeruloneph. Malignant hypertension |
|
|
What is the criteria for rapidly progressing renal failure?
|
50% decline in 3 months
|
|
|
Dysmorphic erythrocytes in urine is indicative of what disease?
|
Tubulointerstitial nephropathy
|
|
|
In acute renal failure, give an example of causes of azotemia pre-renally, renal and post-renal.
|
Pre-renal: FeNa <1 - increased BUN/creatinine ratio
Intrinsic Renal: rapid infection or infarct, parenchymal disease Post-renal: obstruction |
|
|
What are the signs of chronic tubulointerstitial nephropathy?
|
Renal insufficiency
Red blood cell casts Rapidly progressing glomeruloneph. Mild proteinuria Moderate proteinuria Tubular damage Extensive crescent formation Dysmorphic erythrocytes |
|
|
what is the primary noninvasive test in unexplained renal failure?
|
US
|
|
|
What does the urine and serum of patient with DI look like?
|
Urine - less than 250 mOsm
Serum - high serum osmolarity |
|
|
Where is the pathology in central DI?
|
decreased secretion of ADH from posterior pituitary
|
|
|
What are some causes of nephrogenic DI?
|
hypokalemia
hypercalcemia ARF CRF inherited X-linked trait sickle cell drug related - demeclocycline or lithium |
|
|
Major ions of intracellular fluid?
|
K, Mg & PO4, protein
|
|
|
Major ions of the extracellular fluid?
|
Na & Cl, HCO3
|
|
|
What is a fundamental characteristic of fluid/electrolyte homeostasis?
|
protection of ECV
|
|
|
When does ECV not correlate with EFV?
|
CHF
Liver disease Sepsis Nephrotic syndrome - hypoproteinemia Pregnancy Anaphylaxis |
|
|
What are the low pressure afferent sensors?
|
Cardiac atria
pulmonary vasculature |
|
|
What are the high pressure afferent sensors?
|
Carotid sinus
Aortic arch JGA |
|
|
With a decrease in ECV, GFR is maintained how?
|
By prostaglandin release
|
|
|
Volume depletion on labwork shows up how?
|
Increased hematocrit
Increase serum albumin Decreased urinary sodium Urea increase but little change in serum creatinine |
|
|
What diuretics are used for cirrhosis?
|
spironolactone and Lasix
|
|
|
What diuretics are used for kidney stones?
|
Thiazides
|
|
|
What are disorders of osmolality due to?
|
disturbances of H2O, not sodium
|
|
|
What do sodium balance disorders cause?
|
Alterations in EFV
|
|
|
What water repletion action is more powerful?
|
non-osmotic pathway (circulation)
|
|
|
What is the cardinal cause of hyponatremia?
|
Volume contraction
|
|
|
How is hyponatremia defined?
|
Na levels under 135 mEq/L
|
|
|
SIADH has...
|
Low BUN and uric acid level (serum)
Urine Na> 30 mEq/L |
|
|
Hypovolemia has what BUN & serum uric acid & urinary sodium?
|
High BUN & uric acid level (serum)
Urine Na is low |
|
|
In SIADH are you euvolemic or hypervolemic? Hypertonic or hypotonic?
|
Euvolemic, hypotonic
|
|
|
In SIADH, what two tests need to be ordered?
|
CT & CXR
|
|
|
CNS disorders that cause SIADH?
|
PITT
Porphyria Infection Tumors Trauma |
|
|
Pulmonary disorders that cause SIADH?
|
PPT
Positive pressure ventilation Pneumonia Tuberculosis |
|
|
Neoplasia that cause SIADH?
|
Carcinoma - bronchiogenic, pancreatic, ureteral, prostatic, bladder
Lymphoma & leukemia Thymoma & mesothelioma |
|
|
Drugs that increase ADH release?
|
Chlorpropamide
Clofibrate Carbamazapine Vincristine |
|
|
Drugs that potentiate ADH release?
|
Chlorpropamide
Cyclophosphamide NSAIDS |
|
|
Treatment of choice for SIADH?
|
fluid restrict
|
|
|
When do seizures occur in hyponatremia?
|
under 112
|
|
|
Urine osmolality of _______ despite _________ indicates __________.
|
<250 mOsm/kg; hypernatremia; DI
|
|
|
nephrogenic DI may occur as a result of:
|
lithium therapy, hypokalemia, hypercalcemia, or renal disease
|
|
|
Urine osmolality of _____ despite ______ indicates DI
|
< 250 mOsm
hypernatremia |
|
|
Diuretics inhibit
|
sodium retention
|
|
|
signs and symptoms of hypokalemia
|
1. weakness
2. hyporeflexia 3. ileus 4. respiratory paralysis 5. nephrogenic DI 6. dehydration |
|
|
Bartter's Syndrome
|
hypokalemia, salt wasting, extracellular volume depletion and secondary hyperaldosteronism
all due to a decrease in the Na-K-2Cl pump of thick ascending LOH |
|
|
Gitelman Syndrome
|
Bartters + low magnesium
|
|
|
urinary excretion of K+ should be what per day
|
9000 mEq/day
|
|
|
In hyperkalemia, what is the urinary excretion of potassium?
|
less than 200
|
|
|
What are the redistribution causes of hyperkalemia?
|
acidosis
decreased insulin Beta blockers arginine infusion succinylcholine digitalis OD periodic paralysis |
|
|
what are low aldosterone causes of impaired K secretion with a GFR > 20
|
Addison's disease
Hyporeninemic hypoaldosteronism Drugs |
|
|
If there is normal or high aldosterone with a GFR > 20 and hyperkalemia what might be the causes?
|
Primary tubular disorders:
- acquired - renal transplant - SLE - amyloid - sickle cell - obstructive uropathy Drugs: - spironolactone - triamterene - amiloride |
|
|
what condition has a U wave on EKG?
|
hypokalemia
|
|
|
Increased PTH causes serum calcium to ___ and serum Phosphorus to go ____/
|
ca goes up
phosphorus goes down |
|
|
what does low calcium produce on EKG?
|
prolonged QT
|
|
|
Trousseaus and Chvosteks are associated with...
|
hypocalcemia
|
|
|
causes of hypercalcemia
|
sarcoidosis
TB Pheos Thiazides Lithium |
|
|
hypermagnesemia causes what to occur
|
at 3.5 DTRs disappear
at 4.5 muscle weakness then hypotension & respiratory depression |
|
|
who most likely get low magnesium?
|
chronic alcoholics
|
|
|
most common cause of wide anion gap?
|
lactic acidosis
|
|
|
bicarb and what go hand in hand?
|
Potassium!
|
|
|
when there is hemodynamic instability in wide anion gap acidosis what should you give?
|
1 amp HCO3 for pH<7.1
|
|
|
normal anion gap metabolic acidosis conditions =
|
CARD
Carbonic anhydrase inhibitors Aldosterone inhibitors RTA Diarrhea |
|
|
Wide Anion gap metabolic acidosis conditions =
|
CO
ASA Toulene Mehtanol Uremia DKA Paraldehyde INH, infection, Iron Lactic acidosis Ethylene glycol Starvation/sulfates |
|
|
Respiratory alkalosis causes include:
|
PM RASH
Pregnancy Mechanical venitlation Respiratory Alkalosis Sepsis Hyperventilation |
|
|
what are the causes of metabolic alkalosis
|
MAMA VD
Metabolic Alkalosis Mineralocorticoids Alkali ingestion VOmiting Diuretics |
|
|
T/F
Pus in urine with a negative culture is indicative of occult bacterial infection. |
true - indicative of sterile pyuria - be thinking gonorrhea
|
|
|
If you see eosinophil casts what dx should immediately come to mind?
|
AIN
|
|
|
What is the confirmatory stain for AIN?
|
wright or hansels
|
|
|
If WBCs present in urine, is that definitive for a UTI?
|
no, can be AIN
|
|
|
If pt has dysuria and classic signs and symptoms of infection with no + wbcs on UA what should you look at?
|
White cell count! Are they neutropenic?
Do a urine culturE! |
|
|
If you make a patient hypotensive in the operating room, what should the diagnosis be? what's the next confirmatory step?
|
ATN
look at urine for dirty brown coarse granular casts |
|
|
A white cell count + a fever could mean what 2 things?
|
UTI or AIN
Remember, AIN has triad of: Fever Rash Peripheral eosinophilia |
|
|
Remember to check what before you order a CT with contrast?
|
GFR
|
|
|
A kid with a confirmed UTI get what?
That is why we must do what? |
US & voiding cystourethrogram - that is why it is important to do a culture on every kid urine so that you know its really infection and not a dirty specimen
|
|
|
What drugs are associated with DI?
|
Demeocycline
Lithium |
|
|
describe EKG waves in general in hypokalemia
|
flat - low voltage
|
|
|
WHat are the signs on EKG of hyporkalemia?
|
flattened* or inverted T waves (* = same as hypo)
Increased prominence of U waves Depression of ST segment PVC Low voltage QRS Prolonged PR & QT |
|
|
what are the EKG findings in hyperkalemia?
|
first sign = peaking of T waves
Flattening of P waves Prolongation of PR inteval Widening of QRS complex final event is sine wave |
|
|
Chronic interstitial nephritis at the proximal tubule is caused what type of conditions?
|
Multiple myeloma
Heavy metal toxicity |
|
|
Chronic interstitial nephritis at the distal tubule is caused by what conditions?
|
Chronic obstruction or amyloidosis
|
|
|
CIN with medullary involvement arises from what conditions
|
analgesic nephropathy
sickle cell disease PKD |
|
|
What is the most common cause of renal dysfunction in patients with sarcoidosis
|
hypercalcemia
|
|
|
what is the triad of lead nephropathy?
|
HTN
gout chronic renal insufficiency |
|
|
CAD, Angina, HTN require what med regimen?
|
BB then CCBs
|
|
|
DM and HTN, prescribe what anti HTN?
|
ACE I
|
|
|
Decreased LV fxn, CHF - prescribed what anti-HTN?
|
diuretic, ACEI, BB, spironolactone
|
|
|
alpha adrenergic inhibitors cause what to happen
|
central vasoconstriction
|
|
|
Beta adrenergic inhibitors cause what to happen
|
peripheral and central vasoconstriction
|
|
|
ace i cause what side effects
|
angioedema
hyperkalemia rash protienuria neutropenia leukopenia |
|
|
the preferred anti HTN drugs in
diabetes |
ACEI, CCB
|
|
|
the preferred anti HTN drugs in
Systolic heart failure |
ACE I, diuretics
|
|
|
the preferred anti HTN drugs in
diastolic heart failure |
ACE I, BB, CCB
|
|
|
the preferred anti HTN drugs in
Angina |
BB, CCB
|
|
|
the preferred anti HTN drugs in
MI |
BB, ACEI
|
|
|
the preferred anti HTN drugs in
Pregnancy |
Methyldopa, BB, hydralazine
|
|
|
the preferred anti HTN drugs in
Obstructive lung disease |
ACE I
|
|
|
the preferred anti HTN drugs in
Renal insufficiency |
Diuretics, ACE I if creatinine <3
|
|
|
Problematic Drugs in HTN and
DM |
BB, high dose diuretics
|
|
|
Problematic HTN Drugs in systolic heart failure
|
CCBs
|
|
|
Problematic HTN Drugs in diastolic heart failure
|
diuretics
|
|
|
Problematic HTN Drugs in angina
|
short acting dihydropyridine
|
|
|
Problematic HTN Drugs in MI
|
short acting dihydropyridien
|
|
|
Problematic HTN Drugs in Pregnancy
|
ACE I, AII receptor blockers
|
|
|
Problematic HTN Drugs in obstructive lung disease
|
BB, combined AB blockers
|
|
|
Problematic HTN Drugs in renal insufficiency
|
ACE I, AII blockers, K+ sparing agents
|
|
|
classic renal carcinoma triad only presents 10% of the time and is:
|
gross hematuria, flank pain, palpable mass
|
|
|
what are dializable drugs
|
Penobarb
Methanol Theophylline Isopropyl alcohol Lithium Ethanol Salicylates "SPLIT ME" |
|
|
in SAH, what is given to reverse vasospasm associated with subarachnoid bleed?
|
lomotopine
|
|
|
HTN with pumonary edema is a result of:
|
increased PVR
|
|
|
Standard therapy for pulmonary edema =
|
MOND
|
|
|
what medication is protective in aortic dissection?
|
BB
|
|
|
BP reduction in a HTN emergency should not exceed _____ in ____ minutes/
|
20-25% in 30-60 minutes
|
|
|
what is the risk of quick BP reduction in HTN emergency?
|
cerebral hypoperfusion, increased risk of stroke
|
|
|
nicardipine is contraindicated in:
|
aortic stenosis
|
|
|
what needs to be avoided in hypertrophic cardiomyopathy?
|
sublingual nitro
|
|
|
What is the TOC for LV insufficiency, Pulmonary edema?
|
sublingual nitro
|
|
|
nifedipine should not be used in the tx of:
|
HTN, angina, myocardial infarction
|
|
|
what are the 5 drugs for HTN urgencies
|
Nitro
Labetolol Clonidine Captopril Losartan |
|
|
two most common drugs causing Lupus
|
hydralazine
pentamidine |
|
|
Factor V Leiden is also known as:
|
Protein C resistance
|
|
|
What is the tx for hyperhomocystinemia?
|
Folic acid
|
|
|
what are acquired forms of hypercoagulable states
|
pregnancy
OCPs Lupus anticoagulants anticardolipon antibodies malignancy Myeloproliferative disease Nephrotic syndrome HIT |
|
|
Trousseau's syndrome is associated with:
|
multiple DVTs
CA pancreatitis |
|
|
most congential protein deficiency states that cause hypercoagulable states are managed
|
with lifelong warfarin therapy once a thrombotic event has occurred
|
|
|
hypercoagulability states associated with cancer are managed with what therapy?
|
heparin - warfarin does not respond
|
|
|
Plasmapharesis is required in TTP to remove what>
|
abnormal Factor VIII protein
|
|
|
who are in high risk hypercoagulable states according to VTE risk stratification?
|
multiple inherited defects
AT III deficiency protein C/S deficiency antiphospholipid antibody syndrome active malignancy idiopathic VTE |
|
|
Antithrombin III deficiency is autosomal ______ and is a ______ or ______ defect.
|
dominant
qualitative or quantitative |
|
|
Protein C deficiency is what type of genetic disorder
|
autosomal dominant, heterogenous disorder
|
|
|
Protein C is dependent on what for synthesis
|
vitamin K
|
|
|
what are effective medications for lowereing platelet counts in myeloproliferative disorders?
|
hydroxyurea
anagrelide |
|
|
Patients with a protein C deficinecy are predisposed to what when they are on coumadin without heparin>
|
skin necrosis
|
|
|
Protein C resistence is also known as
|
factor V leiden
|
|
|
what is the most common inherited disorder resulting in a hypercoagulable state?
|
Protein C resistence
|
|
|
Protein C resistance results in a ____ % increase in hypercoagulability
|
20%
|
|
|
what makes up the secondary hypercoagulable states?
|
antiphospholipid antibody, phospholipid antibody syndrome, or lupus inhibitor syndrome
|
|
|
In a secondary hypercoagulable state, does bleeding occur?
|
No.
|
|
|
Is the PT/PTT prolonged in a secondary hypercoagulable state?
|
No
|
|
|
what are antiplatelet therapies for thromboembolic disease?
|
Inhibitors of cyclooxygenase
ADP receptor antagonists phosphodiesterase inhibitors GPIIb/IIIa & RGD blockers |
|
|
what medication is used in pregnancy and breastfeeding with women in hypercoagulable states?
|
heparin
|
|
|
What are the antiplatelets for arterial thromboembolic states
|
ASA
Ticlodopine Plavix Dipyrimadole Prostacyclin |
|
|
What does Heparin accelerate?
|
antithrombin III inhibition of thrombin
|
|
|
Warfarin blocks what part of the coag cascade (numbers)
|
extrinsic - 2, 7, 9, 8, 10
"1972 + 8" |
|
|
Warfarin has a ____ delay in effect
|
24-36 H
|
|
|
what is a desirable INR in antithromboembolic prophylaxis
|
2-3
1.5 - 2 prophylaxis 2.5 - 3.5 valve prosthesis |
|
|
what does warfarin do
|
block vitamin K
|
|
|
what is a common side effect of anti-thrombotics
|
intracranial hemorrhage - within first 4 hours (1%)
|
|
|
How is intracranial hemorrage from antithrombotics tx?
|
cryoprecipitate
|
|
|
#1 cause of ED =
|
impotence
|
|
|
where is blood retained in penis during erection
|
corpus cavernosum
|
|
|
what are most impt. causes leading to erectile dysfunction
|
CV disease
DM Neuro probs hormonal insufficiencies drug side effects |
|
|
in psychological impotence, there is a strong response to:
|
placebo tx
|
|
|
first line tx in ED
|
PDE5 inhibitor drugs
|
|
|
what are second line txs for ED
|
prostaglandin (alprostadil) tablets in urethra
intracavernous injections w/fine needle into penis penile prosthesis penis pump vascular reconstructive surgery |
|
|
2 most important predictors of ED =
|
age
health |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with BB |
common
uncommon |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with sympatholytics |
expected
common |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with alpha 1 agonists |
uncommon
uncommon |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with alpha 2 agonists |
common
less common |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with alpha 1 antagonists |
uncommon
less common (retrograde ejaculation 30%) |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with ACE I |
Uncommon
uncommon |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with diuretics |
less common
uncommon |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with antidepressants |
common
uncommon esp uncommon with SSRIs |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with antipsychotics |
common
common |
|
|
Decreased erectile rigidity
& ejaculatory dysfunction with anticholinergics |
less common
uncommon |
|
|
what drugs most commonly cause decreased erectile rigidity & ejaculatory dysfuction?
|
antidepressants & nicotine
|
|
|
BB can cause what physical deformity of the penis?
|
Peyronie's disorder
|
|
|
ED is ___ x's higher in men in their 60s vs. men in their 40's
|
4 times
|
|
|
What is a key cause of erectile dysfunction
|
smoking
|
|
|
a smoker with heart disease has a what % chance of ED
|
56%
|
|
|
A nonsmoker with heart disease has a what % chance of ED?
|
8.5%
|
|
|
a pt with HTN who smokes has what % chance of ED?
|
20%
|
|
|
anatomic site that is the MCC of ED =
|
neuromuscular jxn
|
|
|
erection can be managed by 2 different mechanisms:
|
reflex (touch) - peripheral n and the lower part of spinal cord;
psycogenic - limbic system |
|
|
what is required for a successful erection?
|
intact neural system
secretion of NO adequate levels of testosterone intact pituitary |
|
|
MC endocrine disorder causing ED
|
DM
|
|
|
what tests are done generally to preclude underlying disease in pts with ED?
|
Testosterone
FSH LH |
|
|
T/F
A significant amount of men who have no sexual dysfunction do not have nocturnal erections |
True
|
|
|
Overall response to PDE5 inhibitors =
|
70%
|
|
|
cheap tx for ED
|
aerobic exercise
|
