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51 Cards in this Set
- Front
- Back
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Proton Pump Inhibitors
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Omeprazole
Pantoprazole Esomeprazole Reduce acid secretion in stomach |
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Splanchnic Vasoconstrictors
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Octreotide
Somatostatin Reduce GI circulation during a bleed |
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Prokinetic Agents
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Erythromycin
Metoclopramide Clear stomach to facilitate endoscopic visualization in an urgent bleed |
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Rockall Score
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Triaging GI Bleeds
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Peptic Ulcer Risk factors
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H Pylori
Physiological stress (Burns, ICU) Acid Hypersecretion (Zollinger-Ellison) Prior PUD NSAIDS |
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Forrest III
Clean Base Rebleed 5% |
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Forrest IIc
Pigmented/Flat spot Rebleed 10% |
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National Pharmaceutical Strategy (NPS)
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Try to establish National Drug Formulary based on safety and cost effectiveness
Assess options for catastrophic drug coverage Accelerate access to breakthrough drugs Pursue purchasing strategies to obtain best prices for drugs Find strategies to ensure effective prescriptions (e-prescribing, EHR) Accelerate access to generics |
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Formulary
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• A preferred list of drug products that typically limits the
number of drugs available within a therapeu'c class for purposes of drug purchasing, dispensing and/or reimbursement. |
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Health Canada Assessment
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Safety, efficacy and qualty
No economic analysis |
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PMPRB
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Patented Medicines Price Review Board
Sets prices for patented medicines in Canada |
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Common Drug Review
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National Review
New drugs and indications Assess effectiveness and economic value |
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Atlantic Common Drug Review
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Line extensions
Class review Older Medications Assess effectiveness and economic value |
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Nova Scotia Drugs and therapeutics committee
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Generic drugs for interchangeability
Assess bioequivalency and appearance (safety) No economic evaluations |
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panCanadian Oncology Drug Review
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Oncology Drugs
Effectiveness and economic value |
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Pituitary disease patterns
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Excess production of hormones
Insufficient production of hormones Compression of adjacent structures |
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Inability to breast feed
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Low prolactin
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Increased adiposity, fatigue, reduced exercise capacity
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Low GH
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Weight loss, fatigue, muscle weakness, postural dizziness, salt craving
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Low Cortisol
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Fatigue, weight gain, cold intolerance
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Low TSH
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Amenorrhea, loss of sexual function, osteoporosis, infertility
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Low LH/FSH
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Forrest IIb
Adherent Clot Rebleed 30% |
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Forrest IIa
Visible vessel Rebleed 50% |
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Forrest Ib
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Oozing
Rebleed 85% |
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Forrest Ia
Spurting Rebleed 100% |
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Therapeutic option for UGI bleed
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Hemoclips
Thermal Coagulation Injection |
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Variceal Bleed therapies
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30% mortality
Endoscopic Band ligation Sclerotherapy TIPS |
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TIPS
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Transjugular Intrahepatic Portosystemic Shunt
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Angiodysplasias
Anywhere in GI 50% have synchronous lesions Ass w renal disease, age, aortic stenosis |
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Mallory Weiss tears
Longitudinal mucosal lacerations Proximal stomach/distal eso 5% of UGI bleeds History of non-bloody emesis or wretching most heal spontaneously |
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Formulary listing options (4)
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Regular benefit
Restricted benefit with criteria Preferential listing Not listed |
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Pituitary compression features (5)
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Headaches,
Seizures vision changes (diploplia- double vision) lateral peripheral vision Features of Diabetes Ins Pituitary insufficiency Nasal Discharge |
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In symptomatic patients a random serum cortisol level of less than _____ is diagnostic of insufficiency
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100 nMol/L
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Diagnostic cortisol insufficiency + Low/normal ACTH =
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Hypothalamopituitary disorder
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Basal 09:00 Cortisol of greater than ____ (in the absence of critical illness) indicates normal cortisol reserves
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400 nMol/L
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If cortisol is between 100-400 mMol/L the next step is (2 options)
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Insulin stress test
Synthetic ACTH stimulation test |
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Absolute peak response to Insulin stress test and synthetic ACTH stimulation (10-15% False negative) test of ____ is indicative of normal
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550 nmol/L
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Dieulafoy's lesion
Dilated, aberrent vessel perforating the gastric mucosa in the absence of an ulcer Large caliber artery Proximal stomach along lesser curve CVD HTN |
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Lower GI Bleed
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Bleeding distal to duodenum
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Causes of LGI Bleed (5)
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Diverticulosis
Angiodysplasia Colon cancer/polyps Colitis (ischemic, ideopathic, IBD) Anorectal (hemorrhoids, fissure, proctitis) |
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Fasting (morning) Urine Osmolality of greater than _______ excludes Diabetes insipidus
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650 mosmol/kg
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If 24h urine volume is less than _______ and serum ____ is normal, it is unlikely Na
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2.5 L, Na
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Label from top to bottom
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Normal
Partial DI Primary polydipsia Partial DI Nephrogenic DI |
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Acromegaly incidence and etiology
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Incidence 3-4 million annually
95% pituitary adenoma |
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Diagnosis of Acromegaly
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75g OGTT: failure to suppress GH
Random serum concentration of < 1 ug/L IGF-1 elevated in most patients |
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Management of Acromegaly
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Surgery, etc.
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Diagnosis methods for LGI Bleeds
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Colonoscopy
Tagged radionuclide imaging CT angiography Angiography |
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Acromegaly management
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Trans-sphenoidal surgery (octreotide to reduce size by 40% first)
Radio therapy Somatostatin analogues (S2, S5 Receptors) effective for 60% Dopamine agonists work for <10% GH receptor blockers under study |
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GH Deficiency Tests
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Insulin Tolerance test < 5 ug/L
GHRH Arginine Stimulation test < 4.1 |
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Cushing's Symptoms
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Excessive weight gain
Easy bruising Purple Striae Proximal muscle weakness (needing help standing up) A/oligomenorrhoea Fatigue Central adiposity |
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Cushing's Screening
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24h urine free cortisol
Overnight dexamethasone suppression Test 48H Low dose dexamethasone suppression test |
