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399 Cards in this Set
- Front
- Back
|
bethanechol
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direct parasympathetic activator
treatment of neurogenic ileus and urinary retention |
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carbachol
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decreases intraocular pressure in glaucoma
direct parasympathetic activator |
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pilocarpine
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glaucoma emergency
direct parasympathetic activator |
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methacholine
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asthma diagnosis
direct parasympathetic activator |
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Direct parasympathetic agonists
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"chols"
bethanechol carbachol pilocarpine methacholine |
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Anticholinesterases/ parasympathetic activators
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neostigmine
pyridostigmine endrophonium physostigmine donepezil galantamine rivastigmine |
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neostigmine
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anticholinesterase
tx of neurogenic ileus, urinary retention reversal of neurogenic blockade |
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pyridostigmine
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anticholinesterase
tx of myasthenia gravis |
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endrophonium
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anticholinesterase
diagnosis of myasthenia gravis |
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physostigmine
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anticholinesterase
tx of atropine OD |
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donepezil
galantamine rivastigmine |
tx of AD by increasing Ach in brain
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organophosphate/insectasides/parathion poisoning
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tx: pralidoxine - regenerates acetylchoinesterase
atropine |
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Parasympathetic Inhibition effects
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Hot as a hare
Dry as a bone Red as a beet Blind as a bat Mad as a hatter Bloated as a toad |
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Parasympathetic Inhibitors
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atropine
benztropine ipratropium oxybutynim oxybutynin methscopolamine |
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atropine
|
parasympathetic inhibitor
used for eye exams |
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benztropine
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parasympathetic inhibitor
tx of PD by decreasing Ach |
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ipratropium
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parasympathetic inhibitor
tx of asthma and COPD (decreases secretions) |
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oxybutynin
tolterodine trospium |
parasympathetic inhibitor
tx of urge incontinence |
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methscopolamine
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parasympathetic inhibitor
tx of peptic ulcer disease |
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epinephrine
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sympathetic activator
a1,a2,b1,b2 tx of anaphylaxis |
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norepinephrine
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sympathetic activator
a1,a2 acts on vessels tx of septic shock by counteracting vasodilation |
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isoproterenol
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sympathetic activator
b1, b2 tx of AV block rarely used |
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dopamine
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sympathetic activator
D1, D2 increases renal profusion |
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dobutamine
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sympathetic activator
b1 tx of cardiogenic shock via increasing O2 consumption of the heart. also used in stress tests and CHF |
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phenylephrine
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sympathetic activator
a1 tx of epistaxis |
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albuterol
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sympathetic activation
b2 tx of acute asthma |
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salmeterol
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sympathetic activation
b2 tx of long term asthma |
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terbutaline
ritodrine |
sympathetic activation
b2 contraction ceasation |
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amphetamine
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sympathetic activator
tx of: narcolepsy, ADHD, major depression acts by releasing stored catacholamines |
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ephedrine
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sympathetic activator
nasal decongestant acts by releasing stored catacholamines |
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cocaine
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sympathetic activator
causes vasoconstriction and local anesthesia acts by blocking reuptake of catacholamines |
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clonidine
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a2
short acting tx for HTN in renal disease SE: rebound HTN |
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a-methyldopa
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tx of HTN in pregnancy
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B blockers
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"olols"
sympathetic inhibitor causes decreased HR, contractility, CO and renin secretion tx of: HTN, aortic dissection, MI, SVT, CHF, glaucoma toxicity: impotence, asthma and CHF exacerbation, masks hypoglycemic sx |
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phenoxybenzamine
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a blocker/sympathetic inhibitor
give prior to pheochromocytoma tumor removal |
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phentolamine
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a blocker/sympathetic inhibitor
tx of pheochromocytoma se: orthostatic hypotension |
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prazosin
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a1 selective blocker/sympathetic inhibitor
tx of HTN and urinary retention/BPH se: first dose orthostatic hTN |
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tamsulosin
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a blocker/ sympathetic inhibitor
specific action a a1AD receptor so only helps with urinary retention, but doesn't treat HTN (great for normotensive pts) |
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mirtazapine
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a2 selective blocker/sympathetic inhibitor
tx of depression SE: sedation and increased appetite good for elderly |
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TMP-SMX
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antibiotic
combination of sulfonamide (inhibits dihydropteroate synthase) and trimethoprim (inhibits dihydrofolate reductase) bad for bone marrow tx is folic acid |
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ciprofloxacin
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fluoroquinolone antibiotic
-inhibits DNA gyrase/topoII -don't take with antacids -TX of URI, PNA, UTI, GI, CF pts with pseudomonas Toxicity: cartilage damage in kids and tendon rupture in adults, don't use in pregnancy |
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metronidazole
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GET GAP on the Metro
Giardia, Entamobea, Trichomonas Gardinerella vaginalis, Anaerobes, Hpylori forms toxic metabolites in bacteria that damage DNA toxicity: disulfram like rxn |
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polymyxins
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-bind cell membranes and disrupt osmotic propertis
-topical use (neosporin) |
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Antibiotics that are nephrotoxic, ototoxic and teratogenic.
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aminoglycosides (30s)
gentamycin neomycin amikacin tobramycin streptomycin |
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Antibiotics that work by inhibiting the formation of the initiation complex resulting in mRNA misreading.
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aminoglycosides/'micins'
gentamycin neomycin amikacin tobramycin streptomycin |
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Antibiotics that work by preventing the attachment of aminoacyl tRNA.
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tetracyclines (30s) / "cyclins"
tetracycline doxycycline demaclocycline minocycline |
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Antiobiotics that cannot be taken with divalent cations such as Ca, Fe, Mg.
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tetracyclines / 'cyclines'
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Antiobiotics that cause teeth discoloration, inhibit bone growth, cause photosensitivity and are contraindicated in pregnancy.
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tetracyclines/ 'cyclines'
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Antiobiotics that work by blocking translocation by binding 23srRNA.
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macrolides (also linezolid)
erythromycin azithromycin clarithromycin |
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Antiobiotics with SE of prolonged QT interval and increased warfarin concentration.
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macrolides
erytromycin azithromycin clarithromycin |
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Antibiotic that causes gray baby syndrome.
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chloramphenichol
due to lack of UDP-glucuronyl transferase in infants |
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Drug of choice for UTI in pregnancy.
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nitrofurantoin
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Antibiotic that acts by inhibiting dihydropteroate synthesis.
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sulfonamide
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Antibiotic that acts by inhibiting dihydrofolate reductase.
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trimethoprim
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Antibiotics that work by inhibiting DNA gyrase/topoisomerase II
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fluoroquinolones "floxacins"
ciprofloxacin |
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Antibiotics with SE of cartilage damage in kids and tendon rupture in adults.
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fluoroquinolones "floxacins"
ciprofloxacin |
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Antiobiotic that work by forming toxic metabolites that damage bacterial DNA.
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metronidazole
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uses for metronidazole
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giardia
entamoeba trichomonas gardnerella vvaginalis anaerobes Hpylori |
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Antibiotics that bind proteins inhibiting cell wall synthesis by preventing peptidoglycan formation.
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penicillins
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Antiobiotic that acts by inhibiting D-ala D-ala.
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vancomycin
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Antibiotic that causes red man syndrome.
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vancomycin
pretreat with antihistamine to prevent |
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UTI treatment.
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UTI usually caused by gram - rods
TPMSMX ciprofloxin if pregnant: nitrofurantoin ampacillin cephalexin |
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Skin infection treatment.
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usually caused by gram +
clindamycin - community acquired MRSA TMP-SMX - MSSA cephalexin naphcillin |
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Treatment of anaerobes/gut bacteria.
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clindamycin
metronidozole carbapenems (big gun, last) |
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Treatment of sinusitis and otitis media.
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caused by strep
penicillin amoxacillin or erythromycin or azithromycin if allergic to sulfa |
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Treatment of pediatric meningitis.
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caused by E coli, GBS, listeria
ampicillin + gentamycin add cephataxin to cover strep pneumo |
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Treatment of adult meningitis.
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caused by N meningitis, strep pneumo
cephtriaxone + vancomycin (strep can be resistant to cephtriaxone) |
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Treatment of PNA.
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caused by strep pneumo
typical: penicillin or vancomycin if staph atypical: macrolide or flouroquinolone erythromycin/azythromycin or levofloxicin/moxifloxicin |
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Treatment of n gonorrhea.
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cephtriaxone shot (3rd gen ceph)
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Treatment of clamydia.
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erythromycin
tetracycline azithromycin |
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Treatment of syphillis
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penicillin shot
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Treatment of trichamonas.
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metranoidozole
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Treatment of rickettsial diseases.
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tetracyclines
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Drugs to avoid if a sulfa allergy is present.
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celecoxib
furosemide probenecid thiazides TMP-SMX sulfasalazine sulfonylureas sumatriptan acetasolamide |
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dantrolene
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treatment of malignant hyperthermia
caused by using inhaled anesthetics = succinylcholine also antipsychotic drugs mechanism: prevents the release of Ca from the sarcoplasmic reticulum of skeletal muscle RYR1 mutation makes pts more likely to have malignant hyperthermia reaction |
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high potency neuroleptics/antipsychotics
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haloperidol, trifluoperazine, fluphenazine
have neurologic/extrapyramidal SEs -dystonia, akinesia (PD sxs), tardive dyskinesia (facial mvts) fewer anticholinergic SEs |
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low potency neuroleptics/antipsychotics
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thioridazine, chlorpromazine
more anticholinergic SE than neurologic SEs |
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neuroleptics/antipsychotics
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mechanism is to block dopamine D2 receptors -> increased cAMP
Toxicity: -lipid soluble, stored in fat -extrapyramidal SE (dystonia, akinesia) -galactorrhea -Neuroleptic Malignant Syndrome (tx is dandroline) (excess mm contraction) -tardive dyskinesia (oral-facial movements) only treats positive sx of schizophrenia |
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atypical antipsychotics
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olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone
block 5-HT2, a, H1 and dopamine receptors treats both positive and negative sx of schizophrenia SE: wgt gain, clozapine used last b/c agranulocytosis |
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treatment of schizophrenia
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- neuroleptics - dirty meds; haloperidol and "azines"
block D2 receptors positive sx treatment se: neuroleptic malignant syndrome and tardive dyskinesia - atypical antipsychotics - "apines" block 5-HT2, a, H1 and dopamine receptors positive and negative sx treatment SE: wgt gain |
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Alzheimers drugs
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memantidine
NMDA receptor antagonist donepezil,galantamine, rivastigmine acetylcholinesterase inhibitors |
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Delirium
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waxing and waning level of consciousness with acute onset
often from drugs with anticholinergic effects (often reversible) |
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Dementia
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gradual decline in cognition with no change in level of consciousness
irreversible causes: AD, vascular, HIV, Pick's dz, substance abuse, CJD if pt is aware of mental deficits it is depression, not dementia. |
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Alzheimer's disease
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elderly, downs pts (3 copies of amyloid gene)
decreased Ach senile plaques (B amyloid) neurofibrillary tangles (tau protein) temporal lobe atrophy tx: memantine (NMDA receptor antagonist), donepexil, galantamine, rivastigmine (acetylcholinesterase inhibitors) |
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Pick's disease
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frontotemporal dementia
dementia with aphasia and personality changes |
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Lewy body dementia
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dementia with PD sx, repeated falls and hallucinations
a-synuclein defect |
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Creutzfeldt-Jakob disease
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rapid dementia
prion disease |
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adrenergic receptors for the following:
vascular smooth mm renal vasculature heart pulmonary bronchioles presynaptic neurons pupillary sphincter kidney JG cells B cells of pancreas a cells of pancreas liver |
vascular smooth mm - low dose NE is B2, high dose is a1
renal vasculature - D1 receptor with dilation of renal vasculature heart - B1 increases contractility pulmonary bronchioles - B2 causes vasodilation presynaptic neurons - a2 inhibits NE release pupillary sphincter - a1 causes madriasis kidney JG cells - B1 causes renin release in increased BP B cells of pancreas - a2 inhibits insulin release a cells of pancreas - B2 increases glucagon liver - B2 in creases glyconeogenesis and gluconeogenesis to increase blood sugar |
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drugs with SE of ototoxicity and nephrotoxicity
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aminoglycosides
vancomycin loop diuretics cisplatin |
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gray man syndrome
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caused by anmioderone
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CD surface marker displayed only by Th cells
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CD4
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CD surface marker displayed only by cytotoxic T cells
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CD8
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CD surface marker found on all T cells
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CD3
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CD surface markers on B cells
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CD19, CD20, CD21
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CD surface marker on NK cells
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CD16
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CD surface marker that inhibits compliment
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CD55, CD59
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CD surface marker on macrophages
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CD14
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Cytokines that promote B cell growth
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IL4,5
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Cytokines produced by Th1 cells
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IL2, IFNy
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Cytokines produced by Th2 cells
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IL4,5,10
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Cytokine secreted by helper T cells to activate macrophages
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IFNy
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Cytokine that inhibits macrophage activation
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IL10
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Cytokine pyogens secreted by monocytes and macrophages
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IL1, IL6, TNFa
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cytokine that inhibit Th1 production
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IL10
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cytokine that inhibits Th2 production
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IFNy
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cytokines that mediate inflammation
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IL1, IL6, TNFa
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Hot TBone stEAk
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IL 1 - pyogen
IL 2 - T cells IL 3 - B cells IL 4 - IgE IL 5 - IgA |
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immunoglobulin that can be a pentamer
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IgM
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immunoglobulin that can be a dimer
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IgA
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immunoglobulin present in secreations
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IgA
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immunoglobulin that crosses placenta and gives infant immunity in first few months of life
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IgG
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immunoglobulins present on B cells
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IgM, IgD
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ADHD medications
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methylphenidate
dextroamphetamine atomoxetine |
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neurotransmitter changes with anxiety
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increased NE
decreased GABA and serotonin |
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neurotransmitter changes with depression
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decreased NE, serotonin, dopamine
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neurotransmitter changes with AD
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decreased ACh
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neurotransmitter changes with HD
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decreased GABA and ACh
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neurotransmitter changes with schizophrenia
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increased dopamine
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neurotransmitter changes with PD
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increased ACh
decreased dopamine |
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Myasthenia Gravis
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antibodies to acetylcholine receptor
presentation: ptosis, diplopia worsening throughout the day thymus association (hyperplasia, atrophy, thymoma) myasthenic crisis - rapidly weakening respiratory mm tx: acetylcholinesterase, corticosteroids, thymectomy, plasmaphoresis |
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lithium
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tx of biopolar disorder
mood stabilizer Toxicity: tremor, hypothyroidism, nephrogenic di, teratogenic (epstien's anomaly of heart) low theraputic index |
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cyclothymic disorder
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mild bipolar symptoms for 2 years
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Major depressive episode criteria
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5/9 for 2 weeks
Sleep disturbance Interest loss (anhedonia) Guilt/worthlessness Energy loss Concentration loss Appetite change Psychomotor retardation Suicidal ideations depressed mood |
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dysthymia
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2 sx of depression for 2 years
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atypical depression
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hypersomnia
overeating mood reactivity tx: MAOis, SSRIs (no TCAs) |
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tricyclic antidepressants
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imipramine
amitriptyline desipramine nortriptyline clomipramine doxepin amoxapine block reuptake of NE and serotonin SE: a-blocking effects (hTN, sedation, dizziness) Toxicity: convulsions, coma, cardiotoxicity (arrhythmia) |
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SSRIs
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fluoxetine
proxetine sertaline citalopram fluvoxemine serotonin reputake inhibitor SE: sexual dysfunction, Serotonin syndrome (hyperthermia, muscle rigidity, CV collapse, diarrhea, seiqures) (tx: cooling and benzos then cyproheptadine) |
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SNRIs
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venlafaxine
duloxetine inhibit serotonin and NE ruptake used for depression and diabetic peripheral neuropathy se: increases BP |
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MAOi
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phenelzine
tranylcypromine selegiline isocarboxazid inhibit MAO so catacholamines can't be broken down tx of atypical depression SE: hypertensive crisis with tyramine ingestion (bad) |
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bupropion
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antidepressant used for smoking cessation
increases NE and dopamine stimulant effect no sexual side effects lower seizure threshold |
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mirtazapine
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a2 antagonist (increases release of NE and serotonin) also potent 5-HT2 receptor antagonist
great for sedation and increasing appetite in elderly |
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trazodone
|
inhibits serotonin reuptake
used for insomnia toxicity: priapism -persistent penile erection |
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mechanism of benzodiazepines
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increase GABA by increasing the FREQUENCY of chloride channel opening
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mechanism of barbiturates
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increase GABA by increasing the DURATION of chloride channel opening
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buspirone
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stimulates 5HT1a receptors
treatment of generalized anxiety disorder |
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treatment of generalized anxiety disorder
|
buspirone
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alcohol withdrawal
|
life-threatening
delerium tremens (tx with benzos), HTN, nausea, seizures, agitations, hallucinations, tremor Lab: elevated GGT, ast>alt |
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opioid withdrawal
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life-threatening
heroin, morphine, methadone yawning, anxiety, insomnia, rhinorrhea, piloerection TX: naloxone + buprenorphine, methadone OD: respiratory suppression, pinpoint pupils/meosis TX: naloxone, naltrexone |
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barbituates and benzodiazepines withdrawal
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life-threatening
OD: respiratory depression TX: flumazenil withdrawal: anxiety, seizures, insomnia, tremors |
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amphetamines and cocaine withdrawal
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OD: pupillary dilation
withdrawal: crash with depression tx: benzos and haloperidol |
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PCP withdrawal
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OD: beligerance, horizontal nystagmus, homicidality
withdrawal: depression, anxiety, violence |
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LSD
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OD: flashbacks, marked anxiety or depression
no withdrawal |
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marijuana
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OD: euphoria, impaired judgment, increased appetite, social withdrawal, hallucinations
Withdrawal: irritability, depression, insomnia, anorexia |
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treatment of mycobacteria leprae
|
dapsone
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dapsone use
|
mycobacteria leprae
PCP/jerovicii PNA |
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leptospira interrogans
|
water contaminated with animal urine
flu like sx plus jaundice |
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lyme disease
|
borrelia burgdorferi
ixodes tick stage 1- rash stage 2- bells palsy, cardiac AV block, meningitis, mycarditis stage 3- chronic monoarthritis, migratory polyarthritis tx: doxycycline (early), ceftriaxone (stage 3) |
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treponema pertenue
|
healing with keloids
facial disfigurement |
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syphilis
|
primary - painless chancre
secondary - constitutional sx, maculopapular rash on palms and soles tertiary - gummas (chronic granulomas), vasa vasorum destruction/tree barking, tabes dorsalis (dorsal column destruction-ataxia), argyll robertson pupil congenital - saddle nose, CN VIII deafness, snuffles TX: penicillin G |
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snuffles in a newborn
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treat for syphilis with penicillin G
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false positive VDRL
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viruses, drugs, rheumatic fever, lupus, leprosy
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rickettsiae triad
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headache, fever, rash
tx: tetracycline |
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peeling of skin on palms and soles
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kawasaki or rickettsia rickettsii (RMSF)
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chlamydia psittaci
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severe life threatening lung disease with avian/bird reservoir
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mycoplasma pneumoniae
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walking pna
headache, non productive cough x-ray worse looking than pt high cold agglutinins/IgM tx: tetracycline or erythromycin or azithromycin cell wall contains cholesterol |
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rifampin
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tx: TB, prophylaxis for meningitis
RNA polymerase inhibitor Revs up microsomal P450 (need higher doses of some drugs) Red/orange body fluids |
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M. avium intracellulare
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azithromycin
AIDS pts CD4 < 100 |
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drug induced lupus
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sulfonamides
hydralozine INH procainamide phenytoin |
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drugs that induce P450
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barbituates
carbamazepine griseofulvin phenytoin quinidine rifampin st johns wart |
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drugs that inhibit P450
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protease inhibitors (HIV drugs)
INH cemetidine ketoconazole erythromycin grapefruit juice sulfonamides |
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drugs that cause photosensitivity
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sulfonamides
amnioderone tetracyclines |
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disulfiram like reaction
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inhibits acetylaldehyde dehydrogenase causing increased acetylaldehyde w/EtOH
nausea flush skin, hTN metronidozole cephalosporins procarbizine sulfonureas disulfram |
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TB treatment
|
INH, rifampin, pyrazinamide, ethambutol
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HOX genes
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HOXD 13 mutation - synpolydactyly
retinoic acid alters expression - teratogenic achondroplasia |
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anterior pituitary embryologic source
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surface ectoderm
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posterior pituitary embryologic source
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neuroectoderm
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ACE inhibitor as a teratogen
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renal damage
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alkylating agents as teratogens (anti CA drugs)
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absence of digits
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aminoglycosides as teratogens
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CNVIII deafness
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diethylstilbestrol
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vaginal clear cell adenocarcinoma
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lithium as a teratogen
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Ebstein's anomaly (atrialized R ventricle)
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tetracyclines as teratogens
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discolored teeth
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thalidomide
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flapper limbs in babies
formerly used in pregnancy |
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valproate and carbamazapine (seizure meds) as teratogens
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interferes with folic acid absorption... have to take a ton of folic acid when pregnant
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fetal blood flow
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umbilical vein
ductus venosus foramen ovale ductus arteriosus |
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PDA opening and closing
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prostaglandins keep open
indomethacin closes |
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aortic arch derivatives
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1st arch - maxillary artery
3rd arch - common carotid artery and internal carotid artery 4th arch - aortic arch, R subclavian artery 6th arch - pulmonary artery, ductus arteriosus |
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R -> L shunts
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Tetralogy of Fallot
Transposition of great vessels (give prostaglandins to keep shunts open) Truncus arteriosus Tricuspid atresia Total anomalous pulmonary venous return |
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Tetralogy of Fallot
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pt squats to improve afterload
pulmonary stenosis RVH (bootshaped) Overriding aorta VSD |
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L -> R shunts
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VSD (most common cardiac problem)
ASD (loud S1, split S2) PDA (machine murmur) |
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coarctation of the aorta
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notching of ribs (due to collateral circulation)
HTN in upper extremities with weak pulses in lower extremities a/w Turners and bicuspid aortic valves |
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tongue innervation
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motor: CN XII hypoglossal
posterior taste and sensation: CN IX glossopharyngeal anterior taste: CN VII facial anterior sensation: V3 trigeminal |
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caudal fold closure defect
|
bladder exstrophy
|
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what codes for testis-determining factor
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SRY gene on Y chromosome
mullerian inhibiting substance is secreted by testes - inhibits paramesonephric ducts |
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5-a-reductase deficiency
|
inability of a male to convert testosterone to DHT (ambiguous genitalia until puberty, then becomes normal)
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treatment for systemic fungal infection
|
amphotericin B
|
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cryptococcus neoformans
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yeast that causes meningitis in AIDS pts; soap bubble brain lesions
|
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pneumocystis jiroveci
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yeast that causes diffuse intersitial pna in immunocompromised pts
tx: TMP-SMX (start AIDS pts CD4<200 |
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aspergillus fumigatus
|
mold that causes allergic bronchopulmonary aspergillosis
acute angle branching pattern |
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Mucor and Rhizopus spp.
|
wide angle molds
disease in DKA pts frontal lobe abscess after sinus disease |
|
|
sabouraud's agar
|
fungal agar
|
|
|
malassezia furfur
|
causea tinea versicolor
areas of depigmentation 'spaghetti and meatball" appearance on KOH |
|
|
histoplasmosis
|
PNA after Mississippi and Ohio river valley
lives inside macrophages, much smaller than a RBC bird and bat droppings (caves) |
|
|
blastomycosis
|
east of Mississippi river
broad base budding granulomatous nodules |
|
|
coccidioidomycosis
|
southwestern US, california, Joaquin valley, desert
PNA and meningitis huge, filled with endospores (20 - 60 um) |
|
|
paracoccidioidomycosis
|
latin america
budding yeast with captian's wheel formation |
|
|
bird associated infections
|
histoplasmosis (mississippi)
cryptococcus (meningitis in AIDS) chlamydia psittaci avian influenzae west nile virus |
|
|
sporothrix shenckii
|
rose gardener's disease
ascending lymphangitis tx: itraconazole or potassium iodide |
|
|
amphotericin B
|
treatment for systemic fungal infections
Mechanism: binds ergosterol and tears a hole in membrane/forms pores can be injected directly into CSF/intrathecally Toxicity: nephrotoxic, IV phlebitis, fever, chills |
|
|
nystatin
|
antifungal: binds ergosterol and disrupts membrane
too toxic for systemic use swish and swallow for thrush topical tx for diaper rash or vaginal candidiasis |
|
|
azoles
|
antifungals that inhibit fungal sterol synthesis
can cross BBB - tx for cryptococcal meningitis in AIDS pts Toxicity: hormone synthesis inhibition (gynocomastia), inhibitor of P450 |
|
|
flucytosine
|
antifungal: inhibits RNA and DNA synthesis by conversion to 5-fluorouracil
used with amphotericin B |
|
|
caspofungin
|
antifungal: inhibits cell wall synthesis by inhibiting b-glucan synthesis
tx of aspergillosis |
|
|
terbinafine
|
antifungal that inhibits enzyme squalene epoxidase (sterol synthesis)
tx of dermatophytoses (ringworm, jock itch) topically tx of tinea capitus and toe nail infection orally |
|
|
griseofulvin
|
antifungal: interferes with microtubule function
deposits in keratin-containing tissues teratogenic, increases P450, liver problems |
|
|
giardia lamblia
|
foul smelling fatty diarrhea after camping
trophozoite cysts in stool tx: metronidozole |
|
|
entamoeba histolytica
|
bloody diarrhea
liver abscess tx: metronidazole |
|
|
toxoplasma gondii
|
brain abscess in HIV , ring enhancing lesion; congenital toxoplasmosis - triad chorioretinitis, hydrocephalus, intracranial calcifications
tx: sulfadiazine + pyrimethamine |
|
|
leishmania donavani
|
sandfly is vector, dogs
spiking fevers, hepatosplenomegaly, pancytopenia tx: sodium stibogluconate |
|
|
trypanosoma cruzi
|
chagas disease (big stuff)
tx: nifurtimox |
|
|
plasmodium
|
causes malaria (cyclic fever, headache, anemia, splenomegaly)
anopheles mosquito is vector merozoite form of protozoa causes fever and chills tx: primaquine, quinine, chloroquine |
|
|
babesia
|
maltese cross on RBCs
fever and hemolytic anemia northwestern US ixodes tick tx: clindamycin and quinine |
|
|
enterobius vermicularis
|
pinworm
causes anal pruritus (scotch tape test) tx: bendazoles and pyrantel pomoate |
|
|
taenia solium
|
intestinal tapeworm from larvae in pork
brain lesions, CNS problems tx: praziquantel |
|
|
schistosoma
|
snails are host
can lead to squamous cell carcinoma of the bladder tx: praziquantel |
|
|
congenital rubella associated heart defect
|
PDA
|
|
|
Marfan's syndrome associated heart defect
|
aortic insufficiency
|
|
|
chromosome 22q11 deletion disorder associated heart defects
|
truncus arteriosis
tetralogy of fallot |
|
|
tricyclic antidepressent toxicity
|
convulsions
coma cardiotoxicity |
|
|
anti-seiqure drugs used to treat bipolar disorder
|
lamotrigine
valproic acid carbamazipine |
|
|
blood supply to SA and AV nodes
|
RCA
also supplies inferior portion of LV |
|
|
LAD occlusion causes what kind of MI
|
anterior wall MI/anterior interventricular septum
|
|
|
posterior part of heart
|
left atrium
|
|
|
hoarseness
|
compression of recurrent laryngeal nerve
|
|
|
dysphagia
|
compression of the esophageal nerve
|
|
|
elevated leads in LAD MI
|
V1-V5
anterior wall |
|
|
elevated leads in L circumflex MI
|
aVL, V5 and V6
lateral wall |
|
|
elevated leads in R coronary MI
|
II, III, aVF
inferior wall or V4 posterior wall |
|
|
increase in CO with exercise
|
initially due to increased SV (returning the peripheral blood to heart), then from increased HR
|
|
|
what increases cardiac O2 demand?
|
hypertrophy
increased afterload increased contractility increased HR |
|
|
how can you decrease cardiac O2 demand during an MI when the heart isn't being sufficiently perfused?
|
decrease afterload - hydralazine, ACE inhibitors, ARBs
decrease contractility - beta blockers decrease HR - beta blockers |
|
|
ventricular action potential and drugs that modify it
|
Na depolarizes - Na channel blockers increase refractory period
Ca contracts K repolarizes - K channel blockers increase refractory period and increase action potential duration |
|
|
cardiac pacemaker action potential
|
Ca depolarizes/phase 0 - Ca channel blockers increase ERP
K repolarizes - B blockers decrease phase 4 slope |
|
|
how does a carotid massage work?
|
helps with SVT/tachycardia
transmits information about increased or decreased BP (increased in this case) via the glossopharyngeal nerve to the solitary nucleus of the medulla -> decreased HR |
|
|
S3 and S4 heart sounds
|
S3 think overfull ventricle
S4 think stiffened ventricle |
|
|
advantage of thiazide diuretics
|
keep Ca in bones
great if you have renal stones or are at risk for osteoporosis |
|
|
hydralazine
|
tx of severe HTN, and HTN in pregnancy
vasodilates arterioles > veins therefore reducing afterload drug induced lupus |
|
|
dihydropyridine calcium channel blockers
|
great for relaxing smooth muscle
tx of: Prinzmetal's angina, Raynaud's, esophageal spasm "dapines" nifedipine amlodipine felodipine nicardipine nisoldipine |
|
|
antihypertensive a/w se of first dose orthostatic hypotension
|
a1 blockers/zosins
|
|
|
antihypertensive a/w se of ototoxicity when used with aminoglycosides
|
loop diuretics
furosimide |
|
|
antihypertensive a/w se of hypertrichosis
|
aka hair growth
minoxidil |
|
|
antihypertensive a/w se of cyanide toxicity
|
nitroprusside
|
|
|
antihypertensive a/w se of bradycardia, impotence and asthma exacerbation
|
B blockers
|
|
|
antihypertensive a/w se of hypercalcemia and hypokalemia
|
thiazides
|
|
|
HMG-CoA reductase inhibitors
|
"statins"
decrease LDL cholesterol SE: increase LFTs, rhabdomyolysis |
|
|
Niacin
|
increases HDL cholesterol
SE: red face (prevent with ASA), hyperglycemia, gout exacerbation |
|
|
Fibrates
|
decreases triglycerides
SE: increased LFTs, rhabdomyolysis (same as statins, so don't give together) |
|
|
omega 3 fatty acids
|
lower triglycerides
can be used with statins reduce rheumatic dx sxs |
|
|
what kind of drug do you use to decrease LDL, triglycerides, increase HDL?
|
decrease LDL - HMG-CoA reductase inhibitors "statins"
decrease triglycerides - fibrates and omega 3 fatty acids increase HDL - niacin |
|
|
evolution of an MI
|
day 1: contraction bands and release of CPK and troponin
day 2-4: acute inflammation w/ neutrophils; muscle shows coagulative necrosis day 5-10: macrophages and granulation tissue days >10: scar |
|
|
clopidogrel
ticlopidine |
mechanism: inhibit platelet aggregation by irreversibly blocking ADP receptors
used in pts with chest pain |
|
|
abciximab
|
mechanism: monoclonal ab that binds to glycoprotein receptor IIb/IIIa on activated platelets
used in pts with chest pain |
|
|
hypertrophic cardiomyopathy
|
cause of sudden death in young athletes
stiffened/hypertrophied IV septum leading to mitral valve obstruction |
|
|
antidote to acetaminophen
|
N-acetylcysteine
|
|
|
antidote to salicylates
|
NaHCO3
|
|
|
antidote to amphetamines
|
NH4Cl
|
|
|
antidote to anticholinesterases/organophosphates
|
atrophine and pralidoxime
|
|
|
antidote to atropine
|
psysostigmine
|
|
|
antidote to B blockers
|
glucagon
|
|
|
antidote to digitalis
|
stop dig
anti-dig Fab |
|
|
antidote to iron
|
deferoxamine
|
|
|
antidote to lead
|
CaEDTA
dimercaprol |
|
|
antidote to mercury, arsenic, gold
|
dimercaprol
|
|
|
antidote to copper, arsenic, gold
|
penicillamine
|
|
|
antidote to cyanide
|
nitrate
hydroxocobalamin |
|
|
antidote to methemoglobin
|
methylene blue
|
|
|
antidote to opiods
|
naloxone/naltrexone
|
|
|
antidote to benzos
|
flumazenil
|
|
|
antidote to TCAs
|
NaHCO3
|
|
|
antidote to heparin
|
protamine
|
|
|
antidote to warfarin
|
Vit K
fresh frozen plasma |
|
|
antidote to tPA
|
aminocaproic acid
|
|
|
antidote to theophylline
|
B blocker
|
|
|
rheumatic heart disease
|
aschoff bodies (granuloma with giant cells)
type II hypersensitivity group A beta hemolytic streptococci mitral valve prolapse migratory polyarthritis antibodies to M protein |
|
|
vasculitis in a young asthmatic
|
Churg-Strauss syndrome
granulomatois vasculitis with eosinophelia p-ANCA |
|
|
child with lower extremity palpable purpura, arthritis, abd pain and URI
|
Henoch-Schonlein purpura
IgA immune complexes self limiting |
|
|
smoker with vasculitis
|
Buerger's disease
tx: stop smoking |
|
|
Kawaski disease
|
asian kids
fever lip/oral problems coronary aneurysms peeling of palms or soles TX: ASA |
|
|
polyarteritis nodosa
|
hep B associated
vasculitis not in pulmonary arteries |
|
|
DNA viruses
|
herpes viruses/HSV,varicella zoster/VZV,EBV,CMV
Hepadnaviruses/HBV Adenovirus Parvovirus/B19 Papillomavirus Poxvirus |
|
|
temporal lobe encephalitis
|
herpes/HSV1
|
|
|
Tzanck test
|
tests vesicles for multinucleated giant cells looking for HSV and VZV
|
|
|
EBV
|
infects B cells
abnormal circulating cytoxic T cells cervical lymphadenopathy tonsillitis positive monospot/IgMabs give amoxacillin -> rash |
|
|
HHV6
|
Roseola
kids get it febrile seizures possible followed by rash |
|
|
treatment of herpesviruses
|
acyclovir
monophosphorylated by herpes thymidine kinase; inhibits viral DNA polymerase HSV1 HSV2 VZV EBV |
|
|
treatment of CMV
|
ganciclovir
inhibits viral DNA polymerase, requires activation by viral kinase |
|
|
foscarnet
|
antiviral that is more potent than acyclovir and ganciclovir
viral DNA polymerase inhibitor that DOES NOT require activation by viral kinase |
|
|
only hepatitis virus that is double stranded DNA
|
HBV
DNA dependent DNA polymerase sexual transmission |
|
|
HCV treatment
|
a interferon
riboviron |
|
|
hepatitis serologic markers: HBsAg
|
active disease (IgM rises first, then IgG) or chronic carrier
|
|
|
hepatitis serologic markers: HBsAb
|
pt has recovered from dz
|
|
|
pink eye
|
adenovirus
DNA virus |
|
|
hepatitis serologic markers: HBcAb
|
hx of disease
|
|
|
RNA viruses
|
rotavirus
rhinovirus poliovirus rubella coronavirus parainfluenza RSV Rubeola mumps rabies coxsackievirus west nile virus |
|
|
polio virus location
|
lives in motor neurons of anterior horn
|
|
|
congenital rubella manifestations
|
PDA
pulmonary artery stenosis |
|
|
croup
|
parainfluenza
steple sign on x ray/narrowing of larynx |
|
|
RSV
|
bronchiolitis (small tubes)
high pitch cough |
|
|
HIV associated infections by CD4 counts
|
< 400
< 200 start TMPSMX (pneumocystis pna) < 100 start azithromycin (toxo, histo) < 50 start fluconizole (antifungal) |
|
|
HIV therapy - protease inhibitors
|
"navirs"
inhibit viral assembly toxicity: GI, P450 inhibitors, glucose and lipid changes indidavir - kidney stones |
|
|
HIV therapy - reverse transcriptase inhibitors
|
aidovudine, didanosine, zalcitabine, stavudine, lamivudine, abacavir
prevent copy from being formed toxicity: pancreatitis, peripherial neuropathy; zidovudine - bone marrow suppression |
|
|
HIV therpay - NNRTIs
|
nevirapine, delavirdine, efavirenz
positive caniboid test SE: rash |
|
|
HIV therapy - fusion inhibitor
|
enfuvirtide
bind gp41 subunit blocking replication |
|
|
HIV therapy by envelope protein targeting drugs
|
gp120 - meracavir
gp41 - enfervatide |
|
|
diarrhea from gram - nonmotile organism that does not ferment lactose
|
shigella
|
|
|
diarrhea from c or s shaped organism
|
campylobacter
|
|
|
diarrhea from gram - motile organism that does not ferment lactose
|
salmonella
|
|
|
diarrhea from gram - lactose fermenting bacteria w/o fever
|
e coli
|
|
|
diarrhea from gram - comma shaped organism w/o fever
|
v colera
|
|
|
CSF findings in meningitis
|
bacterial - PMNs/neutrophils w decreased glucose
fungal - lymphocytes w decreased glucose viral - lymphocytes with normal glucose |
|
|
UTI drugs in pregnancy
|
cephalosporin 1,2
aminopenicillins |
|
|
TORCHES infections
|
Toxoplasma gondi - chorioretinitis, hydrocephalus, intracranial calcifications
Rubella - PDA, pulmonary artery stenosis, carteracts, deafness CMV - hearing loss unilateral HIV HSV - encephalitis of temporal lobe Syphilis - hydrops fetalis, saddle nose, notched teeth |
|
|
organism known to form renal stones
|
proteus
|
|
|
encapsulated organism that causes meningitis in HIV pts
|
cryptococcus
|
|
|
imediatamente
|
immediately
|
|
|
vimentin stain
|
stains connective tissue
IDs sarcomas |
|
|
desmin stain
|
stains muscle
IDs rabdomyocarcoma, liomyosarcoma |
|
|
cytokeratin stain
|
stains epithelial cells
IDs carcinomas |
|
|
Downs syndrome associated neoplasm
|
ALL (and AD)
|
|
|
tuberous sclerosis associated neoplasms
|
astrocytoma
angiomyolipoma cardiac rhabdomyoma |
|
|
tumor suppressor genes and associated cancers:
Rb p53 APC WT1 CPC |
Rb - retinobloastoma, osteosarcoma
p53 - most cancers APC - colorectal cancer WT1 - wilms tumor DPC - pancreatic cancer |
|
|
Tumor markers:
PSA CEA a-fetoprotein B-hCG CA-125 S-100 CA-19-9 |
PSA - prostate ca
CEA - colorectal and pancreatic a-fetoprotein - hepatocellular carcinoma B-hCG - hydatidiform moles/chorio CA-125 - ovarian S-100 - melanoma, astrocytoma CA-19-9 - pancreatic adenocarcinoma |
|
|
paraneoplastic effects of tumors:
Cushing's syndrome SIADH hypercalcemia polycythemia/ elevated erythropoietin Lambert-Eaton Gout |
Cushing's syndrome - small cell lung carcinoma
SIADH - small cell lung carcinoma hypercalcemia - multiple myeloma. squamous cell lung polycythemia - renal cell carcinoma Lambert-Eaton - thymoma (weakness that improves with use via Ca release) Gout - leukemias and lymphoms |
|
|
Psammoma bodies
|
rings on a tree
1. papillary adenocarcinoma of thyroid 2. serous cystadenocarcinoma of ovary 3. meningioma 4. malignant mesothelium |
|
|
Mets to the brain
|
melanoma
lung and breast |
|
|
mets to the liver
|
colon
pancreas lung and breast |
|
|
mets to the bone
|
prostate
testes lung and breast |
|
|
anti CA drug that forms a complex between topoisomerase II and DNA
|
etoposide
|
|
|
anti CA drug that alkylates DNA and has toxicity of pulmonary fibrosis
|
busulfan
|
|
|
anti CA drug that fragments DNA with toxicity of pulmonary fibrosis
|
bleomycin
|
|
|
anti CA drug that blocks purine synthesis and is metabolized by zanthine oxidase
|
6MP
|
|
|
anti CA drug that cross-links DNA and is nephro and ototoxic
|
cisplatin and carboplatin
|
|
|
anti CA drug that is nitrogen mustard and alkylates DNA
|
cyclophosphamide
|
|
|
anti CA drug that is a folic acid analog that inhibits dihydrofolate reductase
|
methotrexate
|
|
|
anti CA drug that prevents tubulin disassembly
|
paclitaxel
|
|
|
anti CA drug that intercalates DNA, is cardio toxic and produces oxygen free radicals
|
doxorubicin
|
|
|
anti CA drug that prevents tubulin assembly
|
vincristine
|
|
|
anti CA drug that inhibits thymidylate synthesis therfore decreasing nucleotide synthesis
|
5 fluorouracil
|
|
|
anti CA drug that is a SERM, blocking estrogen bindin to ER+ cells
|
toxoxifen and raloxifene
|
|
|
anti CA drug that is a monoclonal ab against HER-2
|
trastuzumab
|
|
|
anti CA drug that inhibits PRPP synthetase
|
6 MP
|
|
|
treatment for AML
|
cytarabine
|
|
|
treatment for CML
|
busulfan
|
|
|
prevents breast CA
|
tamoxifin, raloxifene
|
|
|
treatment of testicular CA
|
bleomycin, etoposide, teniposide
|
|
|
treatment of childhood tumors
|
dactinomycin
|
|
|
inhibits ribonucleotide reductase
|
hydroxyurea
|
|
|
antibody against Philadelphia chromosome
|
imatinib
|
|
|
anti cancer drug that inhibits thymidylate synthase
|
5 FU
|
|
|
zona occludens
|
tight junction
|
|
|
zona adherens
|
cadherins
|
|
|
macula adherens
|
aka desmosomes
dz: pemphigus vulgaris |
|
|
gap junction
|
communication for electrical and metabolic functions
|
|
|
hemidesmosome
|
cc: bulous pemphagoid
basement membrane |
|
|
LAD
|
intigrin deficiency
delayed separation of umbulicus |
|
|
nerve and artery at risk with anterior shoulder dislocation
|
anxillary nerve
posterior circumflex artery |
|
|
drug that inhibits ryanodine receptor
|
dantrolene (malignant hyperthermia treatment)
|
|
|
achondroplasia
|
failure of longitudinal bone growth
FGFR3 |
|
|
osteopetrosis
|
thick, dense bones prone to fracture
pancytopenia flask bones that flare out |
|
|
osteomalacia/rickets
|
vit D deficiency
high PTH |
|
|
osteitis fibrosa cystica
|
hyperparathyroidism causes ca to be pulled from bone
brown tumor in bones |
|
|
Paget's disease/osteitis deformans
|
increased hat size, hearing loss
increased osteoblast and osteoclast activity crazy high ALP |
|
|
RA
|
type III hypersensitivity
positive rheumatoid factor, anti IgM ab against IgG morning stiffness with improvement with use |
|
|
gout
|
monosodium urate crystals, negatively birefringent
colchicine - inhibits tubulin polymerization alopurinol - inhibits xanthine oxidase |
|
|
pseudogout
|
rhomboid calcium pyrophosphate positively birefringent crystals
|
|
|
HLA-B27
|
Psoriatic arthritis
Ankylosing spondylitis IBD arthritis Reactive arthritis (Reiter's) tx: anti TNF agents ("mabs") |
|
|
SLE
|
anti double stranded DNA
anti smith abs wire looping of kidneys false positive syphilis test (RPR/VDRL) due to antiphospholipid abs |
|
|
antihistone antibodies
|
drug induced lupus
sulfonamides hydralazine INH phenatoin procainamide |
|
|
sarcoid
|
restrictive lung disease
bilateral hilar lymphadeopathy erythema nodosum (painful nodule of fat) hypercalcemia |
|
|
Lambert Eaton syndrome
|
autoantibodies to presynaptic Ca channels resulting in decreased ACh release
proximal muscle weakness improves with use a/w small cell lung ca |
|
|
CREST syndrome
|
anticentromere antibody
Calcinosis (Ca in skin) Raynaud's Esophageal dysmotility Sclerodactyly Telangiectasia |
|
|
somatostatin
|
anti-pituitary hormone
anti-GI hormone tx of diarrhea or too much prolactin |
|
|
short 4th and 5th digits
|
pseudo hypo parathyroidism
no kidney response to PTH |
|
|
Graves/ hyperthyroidism labs
|
increased thyroid hormone
decreased TSH autoimmune, abs against TSH receptors type II hypersensitivity |
|
|
Hashimoto's thyroiditis puts pts at risk for:
|
lymphoma
|
|
|
ketoconazole
|
antifungal
inhibits conversion of cholesterol to pregnenolone therefore inhibiting the production of steroid hormones |
|
|
finasteride
|
inhibits 5 a reductase and the conversion of testosteron to DHT
tx of male pattern baldness |
|
|
episodic hypertension
|
pheochromocytoma (adrenal medulla tumor)
|
|
|
neuroblastoma
|
adrenal medulla tumor in kids
N-myc oncogene bombasin - tumor marker neurofiliment stain |
|
|
MEN I
|
parathyroid, pituitary, pancreatic tumors
|
|
|
MEN 2A
|
medullary thyroid carcinoma, pheochromocytoma, parathyroid tumors
ret gene |
|
|
MEN 2B
|
Medullary thyroid carcinoma, pheochromocytoma, oral/intestinal ganglioneuromatosis
ret gene |
|
|
Pancreatic a cells make -
pancreatic b cells make - pancreatic g cells make - |
glucagon
insulin somatostatin |
|
|
GLUT 1 location
GLUT 2 location GLUT 4 location |
1 - RBCs, brain
2 - B islet cells, liver, kidney 3 - (insulin responsive) adipose tissue, and skeletal muscle |
|
|
sulmonylureas
|
oral DM drug
depolarizes membrane to kick insulin out of B ce;;s glyburide glimepiride glipizide SE: hypoglycemia |
|
|
biguanides
|
metformin
decreases gluconeogenesis pt has to have functional pancreas cells SE: lactic acidosis |
|
|
glitazones
|
pioglitazone
rosiglitazone increases insulin sensitivity PPAR agonists SE: CHF |
|
|
a-glucosidase inhibitors
|
acarbose
miglitol inhibit intestinal brush border so decreases postprandial hyperglycemia SE: GI |
|
|
Restrictive Lung Disease
|
FEV1/FVC > 80%
polio, myasthenia gravis, guillian barre, scoliosis, obesity, ARDS, silicosis, sarcoid, wegener's, goodpasture, amioderone - antiarrhythic bleomycin - testicular ca tx busulfan - CML tx |
|
|
Turcot Syndrome
|
hereditary
APC mutation = pyloposis and meduloblastoma hMLH1 mutation = mismatch repair leading to polyposis and glioblastoma multiforme |
|
|
Gardner syndrome
|
colorectal polyps
osteomas soft tissue tumors |
|
|
Kawasaki syndrome
|
effects medium and small arteries
anti-endothelial abs aka anti smooth muscle abs fever cervical lymphadeopathy skin rash with desquamation erythema of conjunctivae, oral mucosa, hands kids younger than 4 yrs leads to coronary artery aneurysm tx is high dose ASA |
|
|
carcinoid syndrome
|
1. chronic diarrhea
2. intermittent facial flushing 3. tricuspid stenosis (diastolic murmor over T position) usually from GI/small bowel beginning at ligament of Treitz. carcinoid tumor secretes serotonin which is measurable once mets to liver has occured -> facial flushing and GI sx EM - salt and pepper granulation of cells elevated 5-HIAA is diagnostic |
|
|
Hodgkin's disease
|
constitutional symptoms (night sweats, fever, fatigue, weight loss)
mediastinal lymphadenopathy Reed-Sternberg cells (owl's eyes) tx: doxyrubicin |
|
|
Hodgkin's lymphoma
|
30's
night sweats, low grade fever, wgt loss Owl's eye cells, mediastinal lymphadenopathy tx: Adriamycin/Doxorubicin - free radical formation (cardiotoxic) Bleomycin - forms free radicals (pulmonary fibrosis) Vinblastine - inhibition of microtubule formation Dacarbazine |
|
|
Waterhouse-Friderichsen syndrome
|
caused by meningococcemia
bilateral hemorrhage into adrenal gland -> adrenal insufficiency hTN tachycardia petechial skin lesions DIC coma |
|
|
india ink stain
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cryptococcus neoformans
meningitis in AIDs pts TS: IV amphotericin (toxicity: fever, chills hTN, nephrotoxicity, arrhythmias(QT prolongation, Mg and K imbalance) |
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medulloblastoma
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located in cerebellar vermis
gait ataxia small blue cells arranged in perivascular rosettes, high n:c ratio |
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Churg-Strauss syndrome aka allergic granulomatosis and angiitis
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ANCA associated
preexisting asthma and allergic rhinitis elevated eosinophils uveitis conductive hearing loss muscle and joint pain tx: cyclophosphamide autoabs against neutrophils |
