Tp2(P3) Test 1

Front 1

Beta Blockers are contraindicated in what drug?

Back 1

cocaine

Front 2

how to tx cocaine

Back 2

no specific antidote
-use benzos +ABCD

Front 3

How to tx heroin

Back 3

naloxone
t/12 is 1H, so monitor or drug will wear off before heroin and pt will die

Front 4

how to tx methampetamine

Back 4

ABCD
if HTN-use vasoDil-phentolamine
tachycard-propanolol

Front 5

never do what when on methamp.

Back 5

Acidify urine-causes rhabomyaslis

Front 6

_______ can kill the first time used

Back 6

inhalants

Front 7

exposure vs poisoning

Back 7

diff is the dose....poisoning shows signs of symptoms

Front 8

whos exposed most?

Back 8

kids-based on population

Front 9

typical outcome of kid being poisoned?
adult?

Back 9

kid-91%noeffect
adult-61%no effect

Front 10

meds that kill a child with 1 dose?

Back 10

BB, CCB
Benzo
Clonidine
TCA,hypoglycemics, theophyliine

Front 11

flumazenil

Back 11

benzo antag(anti-dote)
DON'T USE-causes seizures

Front 12

When is the only time not to flush (decontam) with water?

Back 12

Na++ metals, and hydrocarbons

Front 13

Activated charcoal
-what kinda bond?
-revers or irr?

Back 13

van der waals bond
reversible

Front 14

dose for charcoal

Back 14

peds-1g/kg or 25-50grams
adults 1g/kg or 25-100g
most eff in 2H

Front 15

Gastric dialysis
where does it take place?
what drugs?

Back 15

charcoal in the intestine
carbamazepine, dapsone
phenobarb, quinine, theophylline

Front 16

charcoal dose for gastric dialysis

Back 16

20 to 30g or 1g/kg q 2-3H

Front 17

Gastric lavage

Back 17

only forl ife threatning
orogastric preferred
-use for TCA, + drugs that kill with 1 dose

Front 18

whole bowl irrigation
-indications

Back 18

sustained release
subst. not abs by charcoal
Iron, Lithium

Front 19

whole bowl irrigation
-contraindications

Back 19

no bowel sounds
GI bleeding

Front 20

Hemodialysis
drugs?
what is a nec vital sign to do this?

Back 20

methanol, ethylene glycol, ethanol, salicylates

Need normal BP

Front 21

Characteristics of a dialysiable drug?

Back 21

MW, VD, protein binding

Front 22

Ionized diuresis
drugs?

Back 22

alk. to trap weak acids
salicylates, phenobarb
-use IV bicarb to keep ph >7.5

Front 23

Never acidigy urine...what happens specifically?

Back 23

if you do, the proteins break apart and precip--killing the kidney

Front 24

tylenol is usually metab to 2 metab...what type of reaction is this 1st or 2nd phase

Back 24

2nd-sulf, and glucondation

Front 25

how does tylenol cause the bad metabolite?

Back 25

uses up the sulfur needed for normal metab....so it goes to bad metab....also it uses up the sulfur needed to detox bad metab

Front 26

CYP2E1

Back 26

does not saturate

Front 27

CYP2E1 inducer/inhib?

Back 27

Ethanol
below 100 it induces 2E1
above it inhibits 2E1

Front 28

what do the co-ordinates of the rumack nomogram refer to?

Back 28

hours after ingestion
-must be 4 hours after
-max is 24hours after

Front 29

What are some of the requirements for using the rumack nomogram

Back 29

-must be a one time overdose(acute not chronic)
-not for tylenol with codeine or multiple drugs

Front 30

Whats anti-dote for tylenol overdose?
how does it work?

Back 30

N-acetylsteine
-It replaces the sulfate needed for the tylenol overdose

Front 31

N-aceylcysteine dosing (PO)

Back 31

72H PO regimen
-140mg/kg Load
then 70mg/kg Q 4H for 17 doses

Front 32

alternate N-acetylsteine dosing
-NOT FDA recc.

Back 32

70mg/kg until APAP level is <5mg/L

Front 33

IV acetylcysteine dosing

Back 33

150mg/kg over 15mins
then 50mg/kg over 4H
then 100mg/kg over 16H

Front 34

what is the time acetylcysteine must be used by?

Back 34

must start within 8 hours of ingestion

Front 35

what is the toxic metab of tylenol?
t/12

Back 35

NAPQI
t1/2=seconds

Front 36

when dose ethanol switch from inhib to inducing 2E1?

Back 36

6-7 hours after the last drink

Front 37

which toxic alcohols have
-toxic METABOLITES?

Back 37

methanol
ethylene gycol

Front 38

which toxic alcohols have
LESS-toxic METABOLITES?

Back 38

ethanol
isopropanol

Front 39

Anion gap is due to?

Back 39

plasma proteins
urea

Front 40

normal anion gap is?

Back 40

12+/- 2

Front 41

Typically anion gap is elevated cause?

Back 41

an acid in the body is using up the bicarb

Front 42

Anion gap is caused by?
acronym

Back 42

MUDPILES
-methanol
-uremia
-DKA
-Paraldehyde(dont'care)
-Iron
-Lactic acidosis
-ethylene gylcol
-salicylate

Front 43

CO2 is carried in body as?
3 ways

Back 43

dissolved in blood
BICARB
in proteins

Front 44

once you look at pts PH to determine acidic or alkaline
is it metabolic or resp?
what tells you?

Back 44

lets say acidosis
-then look at PaCO2, if <35 its metabolic
if >45 its respiratory

Front 45

How to determine if MUDPILES is cause?

Back 45

pH is acidic <7.3
and PaCO2 is <35, metabolic
and theres an anion gap

Front 46

formula for calculated osmolality

Back 46

2(Na) + Gluco/18 + BUN/2.8

Front 47

to determine the measured osmolality of methanol....use what?

Back 47

freeze point depression

Front 48

normal osmolar gap?
abnormal?

Back 48

0

>5-10

Front 49

osmolar gap can be used to determine?

Back 49

the pt's alcohol concentration

Front 50

Describe timing of anion gap and osmolar gap

Back 50

methanol-->formic acid
osmolar gap is seen first cause methanol is osmotically active then later the anion gap is seen cause formic acid is electrically active

Front 51

ethylene glycols toxic metab is?
what does it cause?

Back 51

oxalic acid
its byprotic, it binds Ca++, causing insoluble deposits in brain, kidneys, heart

Front 52

ethylene glycol stage 1

Back 52

1-onset 30 mins, osmolar gap present, acting drunk

Front 53

ethylene glycol stage 2

Back 53

2-onset 12H, anion gap,metabolic acidosis

Front 54

ethylene glycol stage 3

Back 54

3-onset 24H, oxalate crystals, renal failure-dialysis, can be revers.

Front 55

indications for treatment in ethylene glycol

Back 55

anion gap>12
osmolar gap>10
oxalate crystals(envelopes)

Front 56

ethylene glycol tx options

Back 56

-ethanol-inhibs alcohol dehydrog. competively
-FOMEPIZOLE
-Dialysis

Front 57

ethanol dosing

Back 57

PO or IV(PO!!!!!!)
Load-750mg/kg
Maint-100-150mg/kg/H

if on dialysis-use 175-250mg/kg/H

Front 58

how often to monitor serum ethanol

Back 58

q2H
-lab can't keep up

Front 59

Fomepizole

Back 59

ehylene glycol tx
-non comp. inhib
adv over ethanol-no hypoglycemic events(kids)

Front 60

Fomepizole doses

Back 60

IV only
Load 15mg/kg (max1g) in 100ml NS infused over 30mins

Maint.-10mg/kg Q12H for 4 doses, then 15mg/kg
-if dialysis Q 4H

Front 61

how to measure serum osmolality for ethylene glycol

Back 61

freezing point method

Front 62

ethylene glycol tx
sodium bicarb dosing

Back 62

adult- 1-2mEq/kg/H

kid- 1mEq/kg/H

Front 63

methanols toxic metabolite?

Back 63

formic acid

Front 64

when to use dialysis tx
methanol conc?
ethylene glycol conc?

Back 64

methanol->40mg/dl

ethylene glycol- >50mg/dl

OR acidosis resistance to bicarb

Front 65

serum methanol
toxic conc?
very toxic conc?

Back 65

toxic->20

very toxic->40

Front 66

fomepizole for tx of methanol

Back 66

same as ethylene glycol
load-15mg/kg diluted in 100ml of NS infused over 30mins

maint-10mg/kg q 12H for 4 doses, then 15mg/kg
if dialysis Q4H

Front 67

isopropanol labs

Back 67

Anion gap NOT usually present
Osmolar gap
>150mg =coma

Front 68

when to dialysis for isopropanol

Back 68

serum isoprop is >500

Front 69

what is the fasting glucose levels that show pre-diabetes?
whats the impaired glu tolerance?

Back 69

100-125

tolerance-140-199

Front 70

fasting blood sugar for diabetes diagnosis?

Back 70

>or= 126

Front 71

2hour postprandial blood sugar level for diabetes diagnosis

Back 71

>200

Front 72

Hemoglobin a1c values for diabetes diagnosis

Back 72

>6.5%

Front 73

Diabetes goals of therapy
-preprandial glucose
-postprandial glucose

Back 73

pre 70-130
post <180

Front 74

Diabetes goals of therapy
a1c?
BP?

Back 74

a1c <7%
BP <130/80

Front 75

Diabetes goals of therapy
Lipid panel

Back 75

ldl- <100
hdl >40(M) >50(F)
Triglyc <150

Front 76

type 2DM that need insulin
-whats their glucose?
a1c?

Back 76

glucose->250
a1c>9%

Front 77

RAIs

Back 77

glulisine
aspart
lispro
-onset 10-30mins

Front 78

how to dose aspart if pt is on basal insulin + OAD and not at goal

Back 78

first try 1 bolus injection at largest meal
2nd try 10% of total basal dose for each meal, should be round 4-6 units/meal

Front 79

GLULISINE dosing in DM2
(basal insulin + OAD)

Back 79

add glulisine once to largest meal-then increase to 2, then 3 over time

start: 4units/meal...incr. by 2 units every 3 days till 2h post prandial level

Front 80

NPH
appearance?
dosing for DM1, DM2

Back 80

cloudy app.(need to roll)
BID for DM1 +DM2(insulin only)

1QHS for DM2 on OAD's

Front 81

glargine dose for DM2 not on any other insulin

Back 81

10units QHS or .2units/kg daily

Front 82

once daily NPH->Glargine
dose?

Back 82

1:1 ratio

Front 83

BID NPH-> to glargine

premix-->glargine

Back 83

80% of total NPH dose

80% of total intermed. insulin

Front 84

glargine titration

Back 84

2 units/3 days till FBG is 70-130

if >180 do 4 units/3days

Front 85

hypoglycemia
glargine titration

Back 85

if FBG <70 decrease dose by 4 units or 10%if dose is >60units

Front 86

detemir dosing
-naive pts?

Back 86

10units or .2units/kg with dinner

Front 87

detemir dosing
if 3day avg FBG is >110

Back 87

increase dose by 3 units

Front 88

detemir dosing
hypoglycemia?

Back 88

if <70 decrease dose by 4 units or 10% if >60units

Front 89

split mixed BID dosing

Back 89

calc total units(.5/kg)
am: 2/3->then 2/3NPH 1/3RAI
pm:1/3->then 2/3NPH 1/3RAI OR 1/2 + 1/2

Front 90

Split mixed TID dosing

Back 90

am:2/3->then 2/3NPH, 1/3RAI

pm 1/3-> then 1/2 RAI at dinner
1/2 NPH at bedtime

Front 91

basal bolus dosing

Back 91

calc total units
50%-basal
50% bolus-then divid by 3

Front 92

Adjust basal insulin by?

Back 92

Fasting blood glucose
1-2 units at a time, or 3-4units

Front 93

RAIs may be decrease blood glucose how much?

Back 93

25-50 mg/dl

Front 94

premix insulin titrations

Back 94

-2units every 30mg/dl under

blood glucose of 80-109 no change

+2 units for every 30mg over 110

Front 95

prebreakfast doses are titrated based on

Back 95

predinner readings

and visa-versa

Front 96

somogyi effect

Back 96

post hypoglycemic hyperglycemia

to tx decrease evening NPH

Front 97

dawn phenomenon

Back 97

rise in blood glucose in AM

to tx-increase NPH dose

Front 98

pramlinitide

Back 98

slows gastric emptying
dec. postprandial glucagon secretion

for DM1, DM2 with insulin
-good for postprandial levels

Front 99

pramlintide dosing
DM1

Back 99

DM1- 15mcg AC meals, increase in 15mcg increments
maint. 30-60 AC meal

Front 100

pramlinitide dosing
DM2

Back 100

initiate at 60mcg AC meals
increase to 120 per meal if no nausea
MEALTIME INSULIN MUST BE DECREASED BY 50%

Front 101

DM2 algorithm

Back 101

1)Lifestyle + met
2) add SU or Basal ins. to 1
3) lifestyle + met + BI +RAIs

Front 102

Less validated DM2

Back 102

1) style + met(ALL havethis)
2) 1+TZD
3) 1+GLP1
4) 1+TZD+SU
5) 1+BI
6) 1 + BI +RAIs

Front 103

Metformin MOA

Back 103

-dec. hepatic gluconeogenesis
-incr. insulin sensitiv.

Front 104

Metformin good things

Back 104

-not bad on weight gain
-may be used to prevent DM2 in high risk pts

Front 105

Metformin concerns
(who shouldnt take this)

Back 105

-lactic acidosis(avoid in renal impaired)
-GI distrubances
-avoid in CHF, MI,Contrast procedures

Front 106

SU MOA
-concerns?

Back 106

Bind to B cells and increase insulin
-weight gain
-hypoglycemia

Front 107

TZDs MOA

Back 107

bind to PPARG
- increase insulin sensitivity

Front 108

TZD for ovulation

Back 108

normalizes sex horomones

Front 109

TZD tolerability

Back 109

weight gain, edema, Bone fractures, bladder cancer

Front 110

Incretin mimetics

Back 110

Exanatide + Liraglutide
exanatide-for DM2 mono or combo

Front 111

Exanatide + Liraglutide
MOA

Back 111

enhance insulin secretion
supp glucagon secretion
slows gastric emptying

Front 112

Exenatide dosing

Back 112

Exenatide: 5mcg BID within 60mins of meal-MUST BE BEFORE

Front 113

Liraglutide dosing

Back 113

week1: .6mg/day
week2: 1.2mg/day
does NOT have to be with meal
(first dose is to get pt used to drug, not dec BG)

Front 114

Byetta and BC interaction

Back 114

take BC 30mins before or it will be ineffective

Front 115

sitagliptin dosing

Back 115

crcl >51min/ml- 100mg/day
crcl 30-50min/ml 50mg/day
crcl <30 or dialysis 25mg/day

Front 116

Saxagliptin dosing

Back 116

2.5-5mg/day
crcl<50 2.5mg/day

Front 117

linagliptin

Back 117

5mg/day with or withoutfood

Front 118

DPP-4 Inhib
MOA

Back 118

slows down the inactivation of incretins->prolongs action of GLP1

Front 119

Repaglinide dosing

Back 119

initial .5-2mg TID AC meals
-tx niave .5mg prepandially
tx exp. or a1c >8% 1-2mg preprandially

SKIP DOSE,IF SKIPPED MEAL

Front 120

Nateglinide dosing

Back 120

120mg TID before meals

Front 121

Meglitinides MOA

Back 121

Stim insulin release
-not comboed with SU

Front 122

Meglitinides SE

Back 122

Hypoglycemia
Weight gain

Front 123

alpha gluc. inhib MOA

Back 123

inhibt hydrolsis of complex carbs into simple sugars
-dec. postprandial blood sugar

Front 124

alpha gluc inhib dosing

Back 124

initial 25mg daily with first bite of meal

skip dose, if skipped meal

Front 125

welchol MOA
dose?

Back 125

reduces hepatic insulin resistance

3tabs BID (3750mg daily)

Front 126

Bromocriptine MOA
dosing?

Back 126

seems to sensitize insulin

.8mg daily, increased weekly by 1 tab(.8mg)
max is 4.8mg

Front 127

AIc reduction
metformin?
SU?
TZD

Back 127

Met-1%
SU-1-2%
TZD .5-1.4%

Front 128

A1c Reduction
DPP4 Inhib
Meglitinides
alpha gluc inhib

Back 128

.75%
.75%
.5-1%

Front 129

primary thyroid problem

central problem

Back 129

thyroid

hypothalamus-->or ant. pitu.

Front 130

TSH
high or low in hypothyro
high or low in hyperthyro

Back 130

hypo--high levels of TSH

hyper-low levels of TSH

Front 131

T4 mainly bound to?

Back 131

thyroxine binding globulin
(TBG)

Front 132

pregnant women and estrogen do what to TBG-->thus FT3+FT4 will?

Back 132

increases TBG
-Free T3,T4 will decrease cuz T3,T4 is bound more

Front 133

diff btwn reg hypothroidism and preg women hypothroidism

Back 133

reg hypo-no new equillibrium is set

pregnancy-new equill is reached

Front 134

hypothyroidism antibodies?
hyperthroidism antibodies

Back 134

both have thyroglobulin and thyroperoxidase antibodies

Front 135

positive thyroid receptor IgG antibody =?

Back 135

graves disease

Front 136

RAIU

Back 136

iodine uptake test of thyroid gland

Front 137

RAIU exposes

Back 137

hot + cold areas
cold=cancer

Front 138

causes of hypothyroidism

Back 138

Hashimotos disease
-ATgA + TPO >100IU/ml

iodine def.
dec release of TRH or TSH

Front 139

Diagnosis of PRIMARY hypothyroidism

Back 139

increased TSH, low TT4, low FT4, low RAIU

Front 140

Diagnosis of Pituatary insuff hypothyroidism

Back 140

low TSH, low TT4, low FT4

Front 141

Normal lab values for thyroid
FT4? TSH?

Back 141

FT4 0.8-2.7

TSH 0.5-4.7

Front 142

Synthroid
dosing
monitoring

Back 142

1.6-1.7mcg/KG/d

cardiac probs: 12.5-25mcg/Day

monitor TSH 6 weeks later

Front 143

Synthroid dosing,
whats the TSH goal

Back 143

0.5-2mcU/ml

Front 144

Armour thyroid ratio

Back 144

T4:T3
2:1
OR
3:1 It's never the same amt

Front 145

Liotrix ratio

Back 145

fixed ratio
T4:T3
4:1 more normalized, but expensive

Front 146

Liothyronine
ratio?
t/12?
SE?

Back 146

synthetic T3
T1/2= 1.5 days
Myxedema coma

Front 147

pregnancy dosing for moms on TRT

Back 147

increase pre-preg dose 30-50% in T4

Front 148

T4 interactions

Back 148

-high fiber meals bind T4
-Estrogen, tamoxifen increase TBG
-take 12h apart from raloxifene, 4h from Ca++(antacids) cholestryamine

Front 149

hypothyroid pt counseling
-when do symp resolve
-monitor what?

Back 149

take on empty stomach
sympt resolve in 2-3 weeks, full effect in 6-8weeks

monitor TSH, FT4 6 weeks after initiation

Front 150

Thyroid storm
tx?

Back 150

sudden release to TH
BB, SSKI, PTU, steroids

Front 151

Graves disease

Back 151

antibodies that mimic TSH (TRaB) and attack thyroid receptors

Front 152

Plummers disease
and tx?

Back 152

multiple nodules on TG that secrete T3
-rx-radioactive Iodine

Front 153

diagnosis of hyperthroidism

Back 153

low TSH, increased FT4, TT4, and increased FT3
increased RAIU

Front 154

hyperthyroid monitoring

Back 154

monthly till symptoms resolve and TSH normalizes
then 1-2 times a year

Front 155

Thionamides uses

Back 155

decreases FORMATION of NEW thyroid...not existing

use prior to radiation...stop 4 days PRIOR to RAI, restart 4 days after RAI

Front 156

Thionamides SE

Back 156

Neutropenia
hepatitis(PTU more so)

both cause preg problems but PTU less..so use it

Front 157

Iodides MOA
uses?

Back 157

acutely blocks horomone release
-for thyroid storm
-decreases size of gland-surgery
-NOT for pregnancy

Front 158

Potassium iodide
come as? dose?

Back 158

SSKI=38MG of Iodide per drop
3-10drops(120-400mg) in water/juice

lugols=6.3mg iodide/drop

Front 159

when to use potassium iodide?

Back 159

surgery prep= admin 7 to 14 days before surgery

RAI-use 3-7 days AFTER RAI tx, NOT before

Front 160

RAI tx

Back 160

for thyroid destruction-for graves and nodular goiters

makes pts hypothyroid for life
NOT for pregnancy

Front 161

drugs that may induce thyroid disease

Back 161

amiodarone-contains iodine-can cause hypo or hyperthy

lithium-blocks iodine transport-causes hypo

Front 162

Toxidromes-Sympathomimetics
alpha acting

Back 162

phenylephrine
phenylpropanolamine

Front 163

Toxidromes-Sympathomimetics
Beta acting

Back 163

albuterol
caffeine
theophylline

Front 164

Toxidromes-Sympathomimetics
mixed

Back 164

ephedrine
PSE
Methylphenidate
cocaine
amphetamine
MDMA(ectasy)

Front 165

Toxidromes-cholinergic
muscarinic

Back 165

organophos.
carbamate
insectidies

Front 166

Toxidromes-cholinergic
Nicotinic

Back 166

nicotine
organophos
succinylcholine

Front 167

Anti-Cholinergic properties

Back 167

Mad
Dry
Blind-Dilated pupils
Hot-fever

Front 168

Anti-cholinergic toxidrome
drugs

Back 168

TCA's
phenothiazines
atropine
anti-histamines

Front 169

Sedative-hypnotic properties

Back 169

hypotension
Dilated pupils
hypothermia

Front 170

Opioid Toxidrome

Back 170

pinpoint pupils
hypothermia

Front 171

Serotonin syndrome diagnosis

Back 171

1)tremors + hyperreflexia
2)spontaneous clonus
3) muscle rigidity, fever + (ocular clonus or induicible clonus)
4)ocular clonus +(diaphoresis or agitation)
5) induicible clonus + (same as above)

Front 172

Bradycardia
-cholinergic drugs
-sympathomimetics
-membrane depressants

Back 172

cholinergic
-digatlis, organophos, phyostigmine
sympatho
-BB, opiates, clonidine
membrance depress
-antiarrythmia 1A, 1C

Front 173

Drugs causing hypertension
with tachycardia

Back 173

amphetamines
anticholintergics-antihistamines, TCA
etoh withdrawl
nicotine

Front 174

Drugs causing hypertension with bradycardia

Back 174

clonidine, ergots, NE, phenylephrine

Front 175

hypothermia drugs

Back 175

barbs, ethanol
phenothiazines(+hyperthermia)

Front 176

hyperthermia drugs

Back 176

phenothiazines
anti-histamines
anti-cholinergics
TCA's

Front 177

drugs causing seizures

Back 177

caffeine
haloperidol
phenothiazines
TCAs
Withdrawl
salicylates

Front 178

Miosis(constricted) drugs

Back 178

clonidine, opiates, phenothiazines, organophosphates, nicotine, pilocarpine

Front 179

Mydriasis(dilated) drugs

Back 179

amphetamines
cocaine
anti-histamines, atropine, TCAs