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150 Cards in this Set

  • Front
  • Back
what is the mechanism of opiod analgesics?
act as agonists at opiod receptors to modulate synaptic transmission
what opiod works at the mu receptor?
what opiod works at the delta receptor?
what opoid workds at the kappa receptor?
how do you treat opiod toxicity?
naloxone or naltrexone (opiod receptor antagonists)
what is contraindicated in morphine overdose?
O2 - might contribute to respiratory failure
toxicity of opiods?
respiratory depression, miosis (pinpoint pupils), additive CNS depression with other drugs, constipation, addiction
how do NSAIDs work?
reversibly inhibit COX-1 and COX-2; block prostaglandin synthesis
what is used to close a PDA?
toxicity of NSAIDs?
renal damage, aplastic anemia, GI distress, ulcers
how do celecoxib, valdecoxib work?
selectively inhibit COX-2, which is found in inflammatory cells and mediates inflammation and pain
why should COX 2 inhibitors not have the corrosive effects of other NSAIDs on the GI lining?
spares COX-1, which helps maintain the gastric mucosa
what are COX 2 inhibitors used for?
rheumatoid and osteoarthritis
what is the mechanism of acetominaphen?
reversibly inhibits cyclooxygenase, mostly in CNS; inactivated peripherally
what is the antidote for acetominaphen toxicity?
what drug is used for acute gout?
this gout drug depolymerizes microtubules, impairing leukocyte chemotaxis and degranulation
what acute gout drug is less toxic than colchicine and therefore is used more frequently?
this drug is used for chronic gout - it inhibits resorption of uric acid
what gout drug inhibits secretion of penicillin?
what is the mechanism of allopurinol? what is it used for?
inhibits xanthine oxidase, decreasing conversion of xanthine to uric acid; used for chronic gout (when under control)
what gout drug is also used in lymphoma and leukemia to revent tumor lysis-associated nephropathy?
what is etanercept?
recombinant form of human TNF receptor that binds TNF-alpha
what is etanercept used for?
RA, psoriasis, ankylosing spondylitis
what is infliximab?
TNF-alpha antibody
what is infliximab used for?
Crohn's disease, RA, ankylosing spondylitis
this drug binds to cyclophilins, and the complex blocks the differentiation and activation of T cells by inhibiting calcineurin, thus preventing production of IL-2 and its receptor
when is cyclosporine used?
suppresses organ rejection after transplantation; selected AI disorders
the nephrotoxicity associated with cyclosporine is preventable with what?
mannitol diuresis
what toxicity is associated with cyclosporine?
predisposes to viral infections and lymphoma
what is the mechanism of action of tacrolimus (FK-506)? what drug is it similar to?
binds to FK-binding protein, inhibiting secretion of IL-2 and other cytokines; similar in action to cyclosporine
what is tacrolimus used for?
potent immunosuppressive used in organ transplant recipients
what toxicities are associated with tacrolimus?
significant nephrotoxicity, peripheral neuropathy, hypertension, pleural effusion, hyperglycemia
this drug is an antimetabolite derivative of 6-mercaptopurine that interferes with the metabolism and synthesis of nucleic acids; it is toxic to proliferating lymphocytes
when is azathioprine used?
kidney transplants; AI disorders including glomerulonephritis and hemolytic anemia
toxic effects of this drug may be increased by allopurinol
azathioprine - active metabolite mercaptopurine is metabolized by xanthine oxidase
what is the major toxicity associated with azathioprine?
bone marrow suppression
acetomeniphen metabolite depletes what in the liver?
glutahione and forms toxic tissue adducts
low doses of uricosuric agents and salicylates do what to the serum uric acid concentration?
increase it
what type of ossification is not affected in achondroplasia?
membranous - skull, facial bones, and axial skeleton are normal
Heberden's nodes (DIP) and Bouchard's nodes (PIP)
pain in weight-bearing joints after use that improves with rest
destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, and eburnation are associated with what?
what are joint mice? what are they associated with?
osteophytes that fracture and float into synovial fluid along with fragments of separated cartilage - seen in osteoarthritis
pannus formation in joints, especially MCP, PIP
rheumatoid arthritis
morning stiffness improving with use; symmetric joint involvement, and systemic symptoms (fever, fatigue, pleuritis, pericarditis)
rheumatoid arthritis
Rx for severe cases of osteoporosis?
bisphosphonates or pulsatile PTH
type I osteoporosis?
postmenopausal - increased bone resorption due to decreased estrogen levels
type II osteoporosis?
senile osteoporosis - affects men and women over 70
what types of fractures are associated with type I osteoporosis?
vertebral crush fractures - acute back pain, loss of height, kyphosis
what type of fractures are associated with type II osteoporosis?
distal radius (Colles') fractures, vertebral wedge fractures
in this disease there is a failure of normal bone resorption that leads to thickened, dense bones
osteopetrosis (marble bone disease)
in this disease osteoclasts function abnormally
what level of alk phos is osteopetrosis associated with?
what causes osteitis fibrosa cystica?
this disease is characterized by 'brown tumors', high serum calcium, low serum phosphorus, and high alk phos
osteitis fibrosa cystica
these are cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood
brown tumors (seen in osteitis fibrosa cystica)
in this disease there is abnormal bone architecture caused by an increase in both osteoblastic and osteoclastic activity
Paget's disease (osteitis deformans)
what level of alk phos is Paget's disease associated with?
increased (normal serum calcium, phosphorus, adn PTH)
in this disease, bone is replaced by fibroblasts, collagen, and irregular bony trabeculae
polyostotic fibrous dysplasia
Albright's syndrome is a form of what?
polyostotic fibrous dysplasia
multiple unilateral bone lesions, unilateral ppigmented skin lesions, precocious puberty
Albright's syndrome
pain and stiffness in shoulders and hips, often with fever, malaise and weight loss; doesn't cause muscular weakness
polymyalgia rheumatica
what is polymyalgia rheumatica associated with?
temporal (giant cell) arteritis; occurs in patients over 50
is ESR increased or decreased in polymyalgia rheumatica?
progressive proximal muscle weakness caused by CD8+ T cell-induced injury to myofibers
muscle biopsy with evidence of inflammation is diagnostic for what?
increased CK, increased aldolase, and positive ANA, anti-Jo-1
Raynaud's, arthralgias, myalgias, fatigue, esophageal hypomotility
mixed CT disease
antibodies to U1RNP?
mixed connective tissue disease
what is the classic triad of Sjogren's syndrome?
xerophthalmia, xerostomia, arthritis
patients with Sjogren's syndrome are at increased risk for what?
B cell lymphoma
what is enlarged in Sjogren's syndrome?
what patients does Sjogren's primarily affect?
females between 40-60
autoantibodies to ribonucleoprotein antigens, SS-A (Ro), SS-B (La)
fever, fatigue, weight loss, nonbacterial verrucous endocarditis, hilar adenopathy, and Raynaud's
what are the kidney findings in SLE?
wire loop lesions in kidney with immune complex deposition (with nephrotic syndrome)
what part of the SI does celiac sprue tend to affect?
what skin finding is celiac sprue associated with?
dermatitis herpetiformis
what malignancy is celiac sprue most strongly affiliated with?
T cell lymphoma
blunting of villi and lymphocytes in the lamina propria are suggestive of what?
celiac sprue
what type of crystals precipitate in gout?
monosodium urate
what type of diuretics is gout associated with?
needle shaped negatively birefringent
with what type of crystals is pseudogout associated?
calcium pyrophosphate
rhomboid crystals that are weakly positively birefringent
what type of joints does pseudogout usually affect?
large joints, especially the knee
what is the treatment for pseudogout?
pulmonary hemorrhages leading to hemoptysis, renal lesions leading to hematuria, anemia, crescentic glomerulonephritis
Goodpasture's syndrome
what type of hypersensitivity reaction does Goodpasture's represent?
type II
anti-glomerular basement membranes produce what type of staining on immunofluorescence?
what population does Goodpasture's usually affect?
men 20-40
what level is elevated in sarcoidosis?
immune-mediated, widespread noncaseating granulomas common in black females
what do the epithelial granulomas contain in sarcoidosis?
microscopic Schaumann and asteriod bodies
why is hypercalcemia associated with sarcoidosis?
elevated conversion of vitamin D to its active form in epitheliod macrophages
restrictive lung disease, bilateral hilar lymphadenopathy, erythema nodosum, Bell's palsy are associated with what?
patients with what disorder have decreased sensitivity and often anergy to skin test antigens?
chronic inflammatory disease of spine and SI joints -> ankylosis, uveitis, and aortic regurgitation
ankylosing spondylitis
this disorder is characterized by excessive fibrosis and collagen deposition throughout the body
scleroderma (progressive systemic sclerosis)
widespread skin involvement, rapid progression, early visceral involvement
diffuse scleroderma
CREST syndrome
calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia
idiopathic, segmental, thrombosing vasculitis of intermediate and small peripheral arteries and veins; seen in heavy smokers
Buerger's disease
intermittent claudication, superficial nodular phlebitis, and cold sensitivity, severe pain in affected part (may lead to gangrene) are characteristic of what?
Buerger's disease
what is the treatment for Buerger's disease?
quit smoking
what type of arteries does Takayasu's arteritis affect?
medium and large arteries
granulomatous thickening of aortic arch and/or proximal great vessels; elevated ESR
Takayasu's arteritis ("pulseless disease")
who does Takayasu's arteritis primarily affect?
Asian females under 40
what are the symptoms of Takayasu's arteritis?
fever, arthritis, night sweats, myalgia, skin nodules, ocular disturbances, weak pulses in upper extremities:
this is the most common vasculitis that affects medium and small arteries, usually branches of the carotid
temporal/giant cell arteritis
unilateral headache, jaw claudication, impaired vision (occlusion of ophthalmic artery, which can lead to blindness)
temporal/giant cell arteritis
half of patients with temporal arteritis have what?
systemic involvement and polymyalgia rheumatica (proximal muscle pain, periarticular pain)
what is elevated in temporal arteritis? what is the treatment?
elevated ESR; steroids are Rx
necrotizing immune complex inflammation of medium-sized muscular arteries, typically involving renal and visceral vessels
polyarteritis nodosa
approximately 30% of patients with polyarteritis nodosa are seropositive for what?
Hep B
multiple aneurysms and constrictions are seen on angiogram in what disease?
polyarteritis nodosa
what is the treatment for polyarteritis nodosa?
corticosteroids, cylophosphamide
what is the triad associated with Wegener's granulomatosis?
necrotizing vasculitis, necrotizing granulomas in the lung and upper airway, and necrotizing glomerulonephritis
perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, and hematuria are associated with what disease?
Wegener's granulomatosis
what is a strong marker of Wegener's granulomatosis?
what might be seen on chest x ray in Wegener's?
large nodular densities
what is the treatment for Wegener's?
cyclophosphamide and corticosteroids
this vasculitide is like Wegener's but lacks granulomas and is associated with P- or C-ANCA
microscopic polyangitis
this is a vasculitis limited to the kidney
primary pauci-immune crescentic glomerulonephritis
granulomatous vasculitis with eosinophilia that involves lungs, heart, skin, kidneys, nervous system; often seen in atopic patients
Churg-Strauss syndrome
this is an acute, self-limiting disease of infants/kids; acute necrotizing vasculitis of small/medium sized vessels; fever, congested conjunctiva, changes in lips/oral mucosa, lymphadenitis
Kawasaki disease/ mucocutaneous lymph node syndrome
what potentially serious outcome can result from Kawakaki disease?
coronary aneurysms
what is the most common form of childhood systemic vasculitis?
Henoch-Schonlein purpura
skin rash, arthralgia, intestinal hemorrhage, abdominal pain, and melena in kid?
Henoch-Schonlein purpura
where do giant cell bone tumors most commonly occur? in what age group?
epiphyseal end of long bones - 20-40 years old
this is a locally aggressive benign tumor often around the distal femur, proximal tibial region
giant cell tumor
what type of bone tumor has a 'soap bubble' or 'double bubble' appearance on x-ray?
giant cell tumor
spindle-shaped cells with multinucleated giant cells found in what type of benign bone tumor?
giant cell tumor
what is the most common benign bone tumor?
osteochondroma (exostosis)
this type of bone tumor is usually found in men <25 and commonly originates from long metaphysis
this is a benign cartilaginous neoplasm found in intramedullary bone, usually in the distal extremities
what is the most common malignant tumor of bone?
this malignant bone tumor's peak incidence is in men 10-20 years old and is commonly found in the metaphysis of long bones
name some predisposing factors for osteosarcoma
Paget's disease of bone, bone infarcts, radiation, and familial retinoblastoma
what organism causes scalded skin syndrome?
how do you distinguish pemphigus vulgaris from bullous pepmphigoid?
pemphigus vulgaris is associated with oral ulcers
atuoantibody directed against transmembrane cadherin adhesion molecules induces acantholysis (breakdown of epithelial cell-cell connections) with resulting intraepidermal blister formation
pemphigus vulgaris
molluscum contagiosum is related to infection with what virus?
honey-brown crusted lesions in various stages? what organism?
impetigo - strep pyogenes or staph aureus; distinguish by catalase test
autoimmune attack on hair follicles
alopecia areata
androgenic alopecia
common male pattern baldness
fine, nonblotchy truncal rash in a not-very-ill kid with no Koplik spots
target lesions
erythema multiforme
granular complement and IgG at the dermal-epidermal junction
rash biopsy in SLE
biopsy of xanthomas shows what?
multinucleated giant cells