Adam Shared "Learn - Mine" - 410 Picmonics
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Learn - Mine
Beta 3 Receptor
- Increases Lipolysis
- Skeletal muscle thermogenesis increase
- Gs Protein Class
- Increased CAMP
Atypical Antipsychotic Names
- These are all second generation antipsychotics
- Varied effects on 5-HT2 (antagonism), dopamine, and α- and H1-receptors
- Aripiprazole (Abilify) - D2 partial agonist
- Asenapine, Clozapine, Quetiapine, Olanzapine
- -pine associated with metabolic syndrome (Weight gain, Diabetes, Hyperlipidemia, tracking fasting glucose and lipid profile)
- Clozapine and olanzapine carry the greatest risk of metabolic syndrome side effects
- U. Olanzapine can be used for acute mania and anorexia
- Olanzapine has affinity for muscarinic receptor
- Most common side effects of olanzapine are sedation and weight gain
- Most common side effects are metabolic syndrome and sedation (histamine)
- Iloperidone, lurasidone, paliperidone, risperidone, ziprasidone
- Ziprasidone most associated with QT prolongontion
- Risperidone most associated with elevated prolactin
- Ziprasidone, lurasidone and aripiprazole all have lower incidence of metabolic syndrome
- Quitiepine is sedating and is often used in insomnia (or bipolar with insomnia); has an oral dissolving form
- O. Risperidone has higher likelihood of EPS, all the drugs cause QT prolongtion
- Olanzapine has a IM long acting as well as a rapid acting IM version for emergencies
Hypo and Hypernatremia
- Hypernatremia: Greater than 145, Irritability, stupor, coma, thirst
- Hyponatremia: Less than 135, Nausea, malaise, stupor, coma, seizure
Hyper and Hypophosphatemia
- Hyperphosphatemia: Renal stones, metastatic calcifications, hypocalcemia
- Hypophosphatemia: Bone loess, osteomalacia (adults), Rickets (Children)
- Muscle weakness and paralysis
- Rhabdomyolysis, paresthesia, respiratory failure
- Can be due to alcoholism
- Critically ill frequent ly develop intracellular phosphate defic iencies due to poor oral phosphate intake
- Clinically silent until caloric supplementation with intravenous dextrose, a component of total parenteral nutrition (TPN)
- Critically ill patients initiated on TPN --> monitor serum phosphate so that phosphate can be administered if a deficiency deve lops
- Manifestation of refeeding syndrome
- Can cause seizures, rhabdomyolysis, life-threaten ing cardiovascular complications (eg, arrhythmia, CHF)
SIADH Causes and Treatment
- Causes: Small Cell (Oat Cell) Carcinoma, CNS disorders/Trauma, Pulmonary disorders, cyclophosphamide
- Treatment: Slowly correct sodium, Fluid Restriction, sodium tablets, IV hypertonic saline, diuretics, conivaptan, tolvaptan, demeclocycline
- Tolvaptan And Conivaptan are ADH antagonists
- CNS disturbance (eg, stroke, hemorrhage, trauma)
- Medications (eg, carbamazepine, SSRls, NSAIDs)
- Lung disease (eg, pneumonia )
- Pain &/or nausea can be a cause
- Treatment: Fluid restriction ± salt tablets
- Hypertonic (3%) saline for severe hyponatrem ia
- VAPTANS ARE NO LONGER EVER THE ANSWER
- Unless there are neurologic symptoms arising from the hyponatremia , it should be corrected slowly with water restriction
- Once water restriction is initiated , the plasma sodium concentration will slowly begin to normalize
- An ideal rate of increase is 0.5 mEq/h
- Patients must be simultaneously monitored for volume depletion as a sodium deficit may become apparent , requiring concomitant administration of salt
- Demeclocycline (preferred) and lithium are indicated in patients with persistent severe hyponatremia
- Valproic acid is another cause
Adrenoleukodystrophy
- X linked recessive (usually affects males)
- Disrupts very-long-chain fatty acids metabolism
- Impaired ability to add coenzyme A to fatty acids
- Fatty acid build up in nervouse system (especially white matter of the brain), adrenals, testes
- Progressive disease that can lead to long-term coma/death
- Can cause adrenal gland crisis
Multiple Sclerosis Interventions
- Slow progression with disease modifying therapies: B-interferon, glatiramer, natalizumab
- Acute flares: IV steroids
- Neurogenic Bladder: Catheterization, muscarinic antagonists
- Spasticity: Baclofen, GABA B agonist or tizanidine (alpha-2 adrenergic agonist)
- Pain: Opioids
- Acute attack and disabling --> high-dose IV glucocorticoids (eg, methylprednisolone), Plasma exchange in non responders
- Chronic: can also use Fingolimod
- Symptomatic: urine retention (Bethanechol), incontinence (Amitriptyline), neuropathic pain (gabapentin)
- Disease-modifying (eg, beta-interferon, glatiramer) indicated for chronic maintenance in relapsing-remitting multiple sclerosis
- Pregnancy: slightly increased C-section/assisted delivery (forceps) rates, treat exacerbations with IV corticosteroids
- Lower disease activity during pregnancy and higher disease act ivity in the postpartum period, most MS drugs are safe during pregnancy
- Teriflunomide and mitoxantrone are not safe during pregnancy
- Fatigue
- Sleep hygiene, regular exercise
- Amantadine
- Stimulants (eg, methylphenidate, modafinil)
- Spasticity
- Physical therapy & stretching
- Massage therapy
- Baclofen or tizanidine
- Depression
- SSRI/SNRI
- Neuropathic pain
- Gabapentin or duloxetine
- Urge urinary incontinence
- Timed voiding
- Fluid restriction (<2 Uday)
- Anticholinergic medication (eg, oxybutynin, tolterodine)
Pseudogout
- Causes: Hemochromatosis, idiopathic, hyperparathyroidism and joint trauma
- Pseudo-gout or pseudo-arthritis
- Crystals (from synovial fluid) are rhomboid and are weakly birefringent under polarized light (blue when parallel)
- Colchicine: Both treatment and prophylaxis
- Synovial fluid analysis will show an inflammatory effusion
- In addition to synovial fluid analysis, X-ray can also be useful to diagnose and typically reveals chondrocalcinosis
- Intra-articular glucocorticoids
- Synovial fluid analysis will show an inflammatory effusion (15,000-30,000 cells/mm3)
- Urate gout will have up to 50,000 cells/mm3 and septic arthritis will have >50,000 cells/mm3, + organisms on Gram stain
- Hyperparathyroidism with hypercalcemia
Beta Blocker Antidote and Side Effects
- Antidote: Glucagon (causes increase in cAMP which causes calcium release --> cardiomyocite contraction), saline, atropine
- Erectile dysfunction
- Cardiovascular adverse effects (bradycardia, AV block, HF)
- CNS adverse effects (seizures, sedation, sleep alterations)
- Dyslipidemia (metoprolol)
- Asthma/COPD exacerbations
- Use with caution in cocaine users and pheochromocytoma due to risk of unopposed α-adrenergic receptor agonist activity
- Except the nonselective α- and β-antagonists carvedilol and labetalol
- Despite theoretical concern of masking hypoglycemia in diabetics, benefits likely outweigh risks; not contraindicated
- Propranolol can exacerbate vasospasm in Prinzmetal angina
- First steps in management are to secure the airway and give isotonic fluid boluses and intravenous (IV) atropine
- In patients with refractory or profound hypotension , the next step is to administer IV glucagon
- Not bold: Other therapies include IV calcium, vasopressors (epi/norepinephrine), high-dose insulin and glucose, IV lipid emulsion therapy
Embryonal Carcinoma
- Female
- Malignant tumor
- Large primitive cells
- Aggressive with early metastasis
- Stromal tumor
- Male
- All same as above female characteristics
- May produce glands
- Hemorrhagic mass with necrosis
- Hematogenous spread
- Chemotherapy may cause differentiation into another germ cell tumor
- Possible increase in B-hCG or when its mixed increased AFP
- Painful
- Often a "mixed" with other tumors
Prostatitis
- Acute
- Causes in young adult causes: Chlamydia Trachomatis, Neisseria Gonorrhoeae
- Causes in older adults: E. Coli and Pseudomonas
- Dysuria
- Fever
- Chills
- Tender and boggy on digital rectal exam
- Prostate secretions shows WBCs with bacteria
- Chronic
- Dysuria with pelvic pain or low back pain
- Prostate secretions have WBCs but culture negative
- Either bacterial or nonbacterial (eg, 2° to previous infection, nerve problems, chemical irritation)
- Both
- Possible slight PSA increase
- U. (not sure acute or chronic) obstructive urinary symptoms,
- purulent dyscharge, lower back/abdominal/pelvic pain, prostate may be boggy or nodular
- Frequency; urgency; low back pain; warm/tender/enlarged prostate
Sertoli/Leydig Tumor
- Sertoli tumor is comprised of tubules and is usually silent
- Leydig Males: produces androgen or estrogen causing precocious puberty in children and gynecomastia in adults; golden brown in color
- Resemble sex cord stromal tissue of testicle
- Reinke crystals may be seen histologically
- Golden brown color; contains Reinke crystals (eosinophilic cytoplasmic inclusions)
- Leydig/Sertoli in females: May cause hirsutism or virulization (androblastoma of the ovary), clitoromegally, deep voice, young women usually
- Hollow or solid tubules lined by round Sertoli cells and surrounded by a fibrous stroma
- Benign
Rickettsia prowazekii and typhi
- Rickettsia prowazekii
- Rash travels outwards, spares the hands and feet
- Commonly in POW camps and military camps
- Caused by lice arthropod, defecates near feeding sites and the scratching that actually introduces it to the blood
- Causes epidemic typhus; myalgia/arthralgia, pneumonia, encephalitis and coma
- Rickettsia typhi
- Causes endemic
- Caused by flea
Chlamydia pneumoniae and Chlamydia psittaci
- Chlamydia Pneumoniae
- Causes atypical pneumonia
- Most common in young adults
- Chlamydia psittaci
- Causes atypical pneumonia
- Transferred by birds, often parrots
- Both
- Treatment: Azithromycin (favored due to single dose), Doxycycline
- Aerosol trasmission
- Reactive arthritis (triad of arthritis, uveitis and urethritis
Streptomycin
- Aminoglycoside drug class
- Interferes with 30S component of ribosome
- Mycobacterium tuberculosis (2nd line)
- IV only
- Resistance in mycobacterium is via ribosomal alterations (as well as other aminoglycoside mechanisms of resistance)
- Side Effects
- Tinnitus
- Vertigo
- Ataxia
- Nephrotoxicity especially with aminoglycosides
Penicillinase-resistant penicillins
- Dicloxacillin, nafcillin, oxacillin (several more with oxacillin at the end)
- Same as penicillin. Narrow spectrum
- Penicillinase resistant because bulky R group blocks access of β-lactamase to β-lactam ring
- Clinical use: S aureus (non MRSA)
- Hypersensitivity reactions, interstitial nephritis
- Bactericidal
- Methcillin not used anymore do to several side effects
- Same side effects as penicillin
- Resistance occurs via altered PBPs
Oxazolidinones (Linezolid)
- Inhibit protein synthesis by binding to 50S subunit and preventing formation of the initiation complex
- Bacteriostatic
- Indications: Gram ⊕ species including MRSA and VRE
- Side effects
- Bone marrow suppression (especially thrombocytopenia)
- Peripheral neuropathy (optic most common but also glove and stocking peripheral nephropathy)
- Serotonin syndrome due to MAOI activity
- Sideroblastic anemia
- Resistance
- Point mutation of ribosomal RNA
- Binds to the 23s portion
Dapsone
- MOA: Similar to sulfonamides, but structurally distinct agent (Inhibit dihydropteroate synthase)
- Indications
- Leprosy (lepromatous and tuberculoid)
- Pneumocystis jirovecii prophylaxis
- Dermatitis herpetiformis (celiac disease)
- Side effects
- Hemolysis if G6PD deficient
- Fever, rash and methemogloinemia
- Pigment changes
Daptomycin
- MOA: Lipopeptide that disrupts cell membrane of gram ⊕ cocci; Bactericidal
- Indications
- S aureus skin infections (especially MRSA), bacteremia, endocarditis, VRE
- Not used for pneumonia (avidly binds to and is inactivated by surfactant)
- Depolarizes cellular membrane by creating transmembrane channels
- Side effects
- Myopathy
- Rhabdomyolysis
- CPK elevation
Pyrazinamide
- Mechanism uncertain
- Pyrazinamide is a prodrug that is converted to the active compound pyrazinoic acid
- Works best at acidic pH (eg, in host phagolysosomes)
- Indications: Mycobacterium tuberculosis
- Side effects
- Hyperuricemia (gout)
- Hepatotoxicity (hepatitis)
