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First Aid Rapid Review - Classic, Relevant Treatments

rename
rohailmalik3's version from 2015-07-23 04:40

Conditions

αβ ↑ ↓ ∴
Question Answer
Absence seizuresEthosuximide
block T-type Ca2+ channels
hematotoxicity, stevens-johnson
Acute gout attackNSAIDs, colchicine glucocorticoids
binds tubulin to (-) polymerization ∴ (-) leukocyte chemotaxis
GI upset ∴ try ASA 1st
Acute promyelocytic leukemia (M3)All-trans retinoic acid
can lead to DIC
ADHDMethylphenidate, CBT, amphetamines, atomoxetine
Alcohol abuseAA + disulfiram for pxn & Al-Anon for family, acamprosate, naltrexone, supportive care
(-) disulfiram ∴ ↑ acetyl-aldehyde if drink --> N/V/HA
Alcohol withdrawalBenzodiazepines
= diazepam, lorazepam, triazolam
↑ Cl- channel openining --> ↑ GABA
Drowsiness <-- give Flumazanil
AnorexiaNutrition, psychotherapy, mirtazapine
Anticoagulation during pregnancyHeparin
stimulates antithrombin --> ↓ thrombin (for immediate anti-coag), follow PTT
HIT <-- give Protamine sulfate
AnxietyBuspirone
(+) 5HT1a receptor
NO sedation, addiction, tolerance, interaction w/ EtOH
Arrhythmia in damaged cardiac tissueClass IB antiarrhythmic(lidocaine, mexiletine, tocainide)
(-) phase 0 for VT post-MI...↓ AP duration
B12 deficiencyB12
Benign prostatic hyperplasiaTamsulosin
α1-blocker --> (-) smooth m. contraction on prostate
Finasteride
(-) 5α-reductase ∴ no DHT made
gynecomastia
Bipolar disordermood stabilizers
Lithium (-) phosphoinositol; cause tremor, nephrogenic DI, HYPOthyroid, teratogen (Ebstein's anomaly = weakened RV)
valproate (-) Na+ channel; Fat, Bald, Shaky, Neural tube defect
carbamazepine (-) Na+ channel; diplopia, leukopenia, teratogen; ↑ p450
Breast cancer in postmenopausal womanaromatase inhibitor (anastrozole)
Buerger's disease (Thromboangiitis obliterans)smoking cessation
BulimiaSSRIs = fluoxetine, paroxetine, sertaline, citalopram
(-) reuptake of 5-HT
5-HT syndrome <-- give Cyproheptadine
Candida albicansAmphotericin B (systemic), Nystatin (oral thrush, esophagitis)
bind ergosterol & form membrane pore
nephrotoxic - give K+/Mg2+ to offset changes, arrhythmias
Carcinoid syndromeOctreotide
somatostatin analog
steatorrhea
Chlamydia trachomatisDoxycycline (+ ceftriaxone for gonorrhea coinfection) (-) tRNA binding @ A site; teeth & bone abnormalities, photosensitivity, teratogen, Fanconi's syndrome w/ expired meds
Erythromycin eye drops (prophylaxis in infants) (-) translocation; prolonged QT, ↓p450
Chronic goutProbenecid (underexcretor) (-) uric acid reabsorption in PCT; inhibits penicillin secretion
Allopurinol, febuxostat (overproducer) (-) xanthine oxidase; don't use if MTX & 6MP
Chronic hepatitisIFN-α
glycoproteins block replication of RNA & DNA viruses
Neutropenia
Chronic myelogenous leukemiaImatinib
BCR-Abl TKI
Clostridium botulinumAntitoxin
Clostridium difficileOral metronidazole Oral vancomycin (refractory)
forms free radicals --> (-) N.A. synthesis
disulfiram rxn, metallic taste
Costridium tetaniAnti-toxin + vaccine booster + diazepam
Crohn's diseaseCorticosteroids, infliximab
monoclonal TNFα Ab
reactivation of latent TB
Cryptococcus neoformansFluconazole (prophylaxis in AIDS pxns)
(-) ergosterol synthesis by (-) p450 that converts lanosterol --> ergosterol
gynecomastia, liver dysfxn
Cystic fibrosisN-acetylcysteine (mucolytic) + antipseudomonal prophylaxis (tobramycin/azithromycin)
CytomegalovirusGanciclovir foscarnet, cidofovir
5'-monophosphate, guanosine analog --> (-) viral DNA polymerase
leukopenia, neutropenia, thrombocytopenia, renal tox
DepressionSSRIs (1st line)= fluoxetine, paroxetine, sertaline, citalopram
(-) reuptake of 5-HT
5-HT syndrome <-- give Cyproheptadine
Diabetes insipidusDesmopressin (central); HCTZ, indomethacin, amiloride (nephrogenic) - blocks Na+ channels but is K+ sparing
Diabetes mellitus type 1Dietary intervention (low sugar) + insulin replacement
Diabetes mellitus type 2Dietary intervention, oral hypoglycemic, and insulin (possible)
memorize

 

Question Answer
Diabetic ketoacidosisFluids, insulin, K+
EnterococciVancomycin/ampicillin + aminoglycoside
Erectile dysfunctionSildenafil
(-) PDE-5 ∴ ↑ cGMP --> NO --> vasodilation
ER+ breast cancerTamoxifen = SERM
(-) estrogen binding in breast & bone
↑ risk of endometrial carcinoma
Ethylene glycol/methanol intoxicationFomepizole (alcohol dehydrogenase inhibitor)
Folate deficiencyFolate
Haemophilus influenzae (B)Rifampin (prophylaxis) (-) DNA dependent RNA polymerase; red/orange body fluids; ↑p450
cefriaxone 3rd gen. cephalosporin can cross BBB; disulfiram
Hemorrhagic cystitisMesna
caused by cyclophosphamide
Heparin toxicity (acute)Protamine sulfate
+ charge binds (-) charged heparin
HER2/neu+ breast cancerTrastuzumab
monoclonal Ab against Her2 (erb-B2) TK
cardiotoxicity
HyperaldosteronismSpironolactone
aldo receptor blocker
hyperkalemia, gynecomastia
HypercholesterolemiaStatin (first-line)
(-) HMG-CoA reductase --> forces cells to ↑ LDL receptors
myopathy, liver tox, teratogen
HypertriglyceridemiaFibrate
PPAR agonist to ↑ LPL synthesis which break down TG
liver tox, gallstones, displaces warfarin
Immediate anticoagulationHeparin
stimulates antithrombin --> ↓ thrombin (for immediate anti-coag), follow PTT
HIT <-- give Protamine sulfate
InfertilityLeuprolide, GnRH (pulsatile=agonist)
InfluenzaAmantadine/rimantadine
(-) uncoating of M2 protein
ataxia, slurred speech
Zanamivir, oseltamivir
(-) neuraminidase to (-) virion release
Legionella pneumophilaErythromycin = macrolide
(-) translocation
prolonged QT; ↓ p450
Long-term anticoagulationWarfarin
(-) gamma carboxylation of vit K clotting factors (2, 7, 9, 10, C, S) - measure PT
teratogenic, metabolized by p450
MalariaChloroquine blocks heme polymerase; retinopathy, G6PD hemolysis
mefloquine for prophylaxis
primaquine (for liver hypnozoite = vivax/ovale)
Quinine for resistant - use w/ pyrimethamine/sulfonamide
Malignant hyperthermiaDantrolene
↓Ca2+ release from SR --> muscle relax
Medical abortionMifepristone (also misoprostol)
MigraineAbortive therapies (e.g., sumatriptan, NSAIDs); prophylaxis (e.g., propranolol, topiramate, CCBs, amitriptyline)
MRSAVancomycin
binds d-ala, d-ala to (-) cell wall
nephrotoxic, redman syndrome, ototoxic
Multiple sclerosisβ-interferon
Mycobacterium tuberculosisRIPES
rifampin (-)DNA dependent RNA polymerase; red/orange body fluids, ↑p450
INH ↓ synthesis of mycolic acids; neurotoxic, hepatotoxic -- need to give B6 (pyridoxine); ↓ p450
pyrazinamide (-) pyrazandimidase --> (-) mycolic acid production; hyerpuricemia, hepatotoxic
ethambutol (-) arabinosyltransferase --> ↓ carb polymerization of myco cell wall; optic neuropathy = red/green color blindness
streptomycin
Neisseria gonorrhoeaeCeftriaxone (add doxycycline to cover likely concurrent Chlamydia)
3rd gen. cephalosporin can cross BBB; disulfiram
Neisseria meningitidisPenicillin/ceftriaxone
3rd gen. cephalosporin can cross BBB; disulfiram
rifampin (prophylaxis)
Neural tube defect preventionFolate
Osteomalacia/ricketsVit D supplementation
Patent ductus arteriosusIndomethacin = NSAID
(-) COX --> (-) PGE2 --> close PDA
renal damage, fluid retention, GI ulcer, aplastic anemia
Pheochromocytomaphenoxybenzamine & phentolamine
nonselective α-antagonists
reflex tachy
Pneumocystis jiroveciTMP-SMX (prophylaxis in AIDS pxn when CD4<200)
TMP = trimethoprim (-) DHF reductase --> (-) folate synthesis; megaloblastic anemia, leukopenia, granulocytopenia <--give Leucovorin
SMX = Sulfonamides PABA metabolite --> (-) folate synthesis; hemolytic anemia in G6PD def.. nephrotoxic, kernicterus, displaces drugs from albumin
ProlactinomaBromocriptine/Cabergoline (DA agonists)
Prostate cancer/uterine fibroidsLeuprolide, GnRH (continuous=antagonist)
Prostate carcinomaFlutamide
Pseudomonas aeruginosaAntipseudomonal penicillin (ticarcillin, carbenicillin, piperacillin use w/ clavulonic acid)
+ aminoglycoside (-) initiation complex, "cidal"; nephrotoxic, ototoxic, teratogen
memorize

 

Question Answer
Pulmonary hypertensionBosentan
(-) endothelin1 receptor
Rickettsia rickettsiiDoxycycline
(-) tRNA binding @ A site
teeth & bone abnormalities, teratogen, photosensitivity, fanconi's if expired meds
chloramphenicol (esp in context of aplastic anemia)
Ringworm infectionsTerbinafine (-) squalene epoxide --> (-) sterol biosynthesis; abnormal LFTs, visual problems
griseofulvin (-) MT formation --> disrupts mitosis; teratogenic, carcinogenic, ↑ p450
imidazole
Schizophrenia (negative symptoms)5-HT(2A) antagonists (e.g., olanzapine = atypical antipsychotic)
Schizophrenia (positive symptoms)D2 receptor antagonists (e.g., chlorpromazine, haloperidol + "azines")
EPS - dystonia, parkinsonian, akathisia, tardive dyskinesia
Endocrine - ↑ prolactin
SIADHDemeclocycline = tetracycline & ADH antagonist; (-) tRNA binding @ A site
teeth & bone abnormalities, teratogen, photosensitivity, fanconi's if expired meds
lithium (-) phosphoinositol; tremor, nephrogenic DI, HYPOthyroid, teratogen (epstein's anomaly = weakened RV)
Sickle cell anemiaHydroxyurea (↑ HbF)
(-) ribonucleotide reductase --> (-) pyrimidine
myelosuppression
Sporothrix schenckiiItraconazole, Oral KI
stable anginaSublingual nitroglycerin
Staphylococcus aureusMethicillin --> interstitial nephritis
naficillin
Streptococcus bovisPenicillin prophylaxis
Streptococcus pneumoniaePenicillin/cephalosporin (systemic infection, pneumonia)
Vancomycin (meningitis)
Streptococcus pyogenesPenicillin prophylaxis
Temporal arteritisHigh-dose steroids
Tonic-clonic seizuresPhenytoin (-) Na+ channel; nystagmus, gingival hyperplasia, teratogenic, ↑ p450
Valproate (-) Na+ channel; Fat, Bald, Shaky, neural tube defect
Carbamazepine (-) Na+ channel; diplopia, ataxia, teratogenic, ↑ p450
Toxoplasma gondiiSulfonamide + pyrimethamine
Treponema pallidumPenicillin
Trichomonas vaginalisMetronidazole (patient and partner)
forms free radicals --> (-) N.A. synthesis
disulfiram rxn, metallic taste
Ulcerative colitis5-ASA, infliximab
monoclonal TNFα Ab
reactivation of latent TB
UTI prophylaxisTMP-SMX
TMP = trimethoprim (-) DHF reductase --> (-) folate synthesis; megaloblastic anemia, leukopenia, granulocytopenia <--give Leucovorin
SMX = Sulfonamides PABA metabolite --> (-) folate synthesis; hemolytic anemia in G6PD def.. nephrotoxic, kernicterus, displaces drugs from albumin
Warfarin toxicityFresh frozen plasma (acute), vitamin K (chronic)
Wegener's granulomatosisCyclophosphamide, corticosteroids
x-link DNA @ guanine n-7; myelosuppression, hemorrhagic cystitis <--give mesna
memorize