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