1
Q
Treatment of PCOS…
A
- cycle regulation via weight reduction (decreased peripheral estrone formation)
- OCPs (prevent endometrial hyperplasia due to unopposed estrogen); clomiphene (ovulation induction)
- spironolactone
- finasteride
- flutamide (tx hirsutism)
2
Q
primary dysmenorrhea treatment (2)
A
- OTC pain relief: NSAIDs,acetaminophen
- hormonal contraceptives
3
Q
3 classes of RAAS drugs (for HTN)
(Other than ACEi, ARB and B-Blockers)
A
- aldosterone antagonist
- K+-sparing diuretics: inhibit ENaC
- ANP/BNP agonists (opposes RAAS)
4
Q
treatment for type 1/distal RTA
A
sodium bicarbonate
5
Q
4 SIADH treatments
A
- demeclocycline
- tetracycline abx
- ADH antogonist
- fluid restriction
6
Q
Hyponatremia treatment:
A
fluid restriction
3% saline
ADH blockers:
(hypernatremia tx: give water and dextrose 5%)
7
Q
Central diabetes insipidus treatment
A
- desmopressin (ADH analog)
(NOT vasopressin as it raises BP)
8
Q
Nephrogenic diabetes inspidus treatment (4)
A
- low-solute diet
- HCTZ (thiazides: increase H20/Na in PCT)
- amiloride
- indomethacin (NSAIDs: increases renal synthesis of prostaglandins which are ADH antagonists)
9
Q
tx for acute cystitis (2)
A
- TMP-SMX
- nitrofurantoin
10
Q
Liddle syndrome tx
A
triamteren or amiloride
11
Q
which loop-diuretic is safe for patients with sulfa drug allergies?
A
Ethacrynic acid
(the only non-sulfa loop diuretic)
12
Q
Tx of ulcerative colitis?
A
sulfasalazine
(anti-inflammatory; 5-ASA)
13
Q
Tx of oxalate-calcium nephrolithiasis
A
- thiazides: pull Ca2+ out of urine and into plasma
- citrate (potassium citrate): binds Ca2+, inhibiting stone formation
14
Q
tx of rhabdomyolysis (3)
A
- fluid resuscitation
- treat electrolyte imbalances
- dialysis
15
Q
Liddle Syndrome tx
A
amiloride: potassium-sparing diuretic that inhibits ENaC activity
16
Q
tx of SAME disease
A
Potassium-sparing diuretics (amiloride, spironolactone)
Or
Dexamethasone (NF on adrenal cells)
17
Q
which drug can cause RTA type 2?
A
acetazolamide: MOA of CA inhibitor has the same result as the defect of RTA type 2: can’t reabsorb bicarb
“Acid”azolamide causes acidosis.”
18
Q
Which medication can cause a type 1/distal RTA?
A
amphotericin B
19
Q
Treatment of type IV RTA
A
Fludrocortisone: mineralocorticoid
20
Q
minimal change disease tx
A
steroids
21
Q
which medications treat secondary and tertiary hyperPTH in renal failure?
A
Phosphate Binders: works in GI tract
22
Q
tx for asymptomatic bacteriuria in pregnant patients
(same tx for cystitis)
A
- nitrofurantoin
- aminopenicillins/B-lactams
- fosfomycin
23
Q
tx for pyelonephritis (upper UTI) in pregnant patients
A
ceftazidime or ceftriaxone
(sx: F/C, CVA tenderness)
24
Q
Renal cell carcinoma is poorly responsive to chemotherapy/radiation. What is used for treatment instead?
A
Recombinant cytokines:
* Aldesleukin (interleukin-2)
(AE: Hypotension, F/C. They appear to have a bad case of the flu during tx)
25
Levetiracetam is currently the preferred seizure medication because...
titrated to clinical effect, well tolerated
26
Subarachnoid hemmorrhage tx
1. clipping or endovascular coiling
1. amlodapine (CCB prevents vasospasm)
27
ischemic stroke tx
thrombolytics
28
hemorrhagic stroke tx
1. BP reduction
1. reverse anti-coagulant
1. surgery
| (heparin, warfarin, anti-platelets may prevent future strokes)
29
post-stroke tx
1. aspirin or clopidogrel
1. EKG (look for arib --> warfarin)
1. ehcho
1. carotid US if stenosis >70% stenosis
30
why is ipratropium used to tx asthma and methacholine used to dx asthma?
ipratropium = Muscarinic blocker
methacholine = muscarinic agonist
| if they wheeze=lungs are sensitive-->asthma likely dx
31
Glaucoma tx (2)
| how do you reduce aqueous humor?
1. M agonist (carbachol, pilocarpine)
1. B blocker (timolol)
32
OAB tx (3)
1. oxybutynin (anticholinergic)
1. mirabegron (B3 agonist)
1. botox (if other meds fail)
33
Which 2 Rx activate alpha receptors?
| hint: tx septic shock (ex: pneumonia, hypotension)
1. Norepinephrine
1. Phenylephrine (don't confuse w/Pseudoephedrine altho both can be used for nasal congestion)
| action: alpha agonist --> vasoconstriction
34
2 alpha2 agonists used to tx HTN
1. clonidine
1. methyldopa
35
corneal abrasion tx
ciprofloxacin
| prevents **pseudomonas** infection
36
tx of closed angle glaucoma
| lower IOP
1. acetazolamide
1. mannitol
1. timolol
1. pilocarpine
| "kitchen sink approach" while waiting for surgery
37
MS tx (3)
1. IFN-B
1. glatiramer acetate
1. natalizumab
38
MS flares tx?
IV steroids
39
tx for spasticity in MS (2)
* baclofen
* GABAa agonist
40
Tourette Syndrome tx
1. Dopamine blockade
1. Tetrabenazine (preferred): VMAT blockade; less released
1. Alpha-2 agonists (ADH & Tourette Syndrome)
41
tx for bipolar 1 vs. bipolar 2
both: mood stabilizers
bipolar 2: you can add SSRI
42
Which lipid-lowering drug may cause neurologic symptoms (delirium, dementia) and myalgia?
PCSK9 inhibitors
(alirocumab & evolucumab)
43
tx for methanol or ethylene glycol poisoning
fomepizole; inhibits alcohol dehydrogenase
"**FOME**prizole is **F**or **O**verdoses of **M**ethanol or **E**thelyne glycol"
44
tx for cocaine intoxication
(cocaine crawlies, fever, paranoia, fever, psychosis)
benzos
(decreases the sympathetic drive: agitation, anxiety, tachycardia, HTN, NO B-Blockers!)
45
tx of arsenic toxicity
(think environmental exposure + GI sx, hypotension, delirium or hemolysis)
1. Dimercaprol
1. succimer
46
tx: cyanide poisoning (3)
| (cyanide blocks complex IV of ETC --> blocks use of O2)
1. hydroxocobalamin (binds cyanide)
OR
1. nitrites + sodium (oxidize Hb--> methemoglobin --> binds cyanide -->less toxic)
1. sodium thiosulfate (binds cyanide --> thiocyanate --> renal excretion)
47
Iron (Fe) toxicity tx
(sx: bloody diarrhea, hypotension/shock. chronic can cause hyperpigmentation like arsenic
1. DeFEroxamine
1. DeFErasirox
1. DeFEriprone
48
opioid w/d treatment
opioid agonists: buprenorphine or methadone
clonidine (alpha agonist blunts SNS activation)
(opioid use disorder treated w/buprenorphine + naloxone, so they can't inject, if they do, naloxone will block as it is not absorbed nasally)
49
what are 3 sympathomimetic recreational drugs?
1. amphetamines
1. cocaine
1. LSD
(stimulants are cocaine, amphetamine, nicotine, and caffeine)
50
tactile hallucinations are a/w which 2 recreational drugs?
1. alcohol withdrawal
1. stimulant use ("cocaine crawlies")
(delusional parasitosis)
51
recreational drugs, such as amphetamines and cocaine can cause which respiratory pathology?
pulmonary arterial hypertension
52
2 treatments for PCP intoxication
1. benzo
1. haloperidol (rapid-acting anti-psychotic)
(LSD tx is supportive care)
53
Treatment of LSD intoxication
supportive care
54
Treatment of Serotonin Syndrome
cyproheptadine: 5 –HT antagonist
55
barbituate OD tx
supportive
(like LSD)
56
treatment for benzodiazepine withdrawal
benzodiazepines
(this is the only withdrawal syndrome treated by the drug that caused it)
57
TCA OD treatment
sodium bicarbonate (extra sodium overcomes TCA Na-blockade & increased pH favors inactive form of Rx)
58
Treatment for NMS
(fever, rigidity w/in 7 days of starting neuroleptic)
1. Dantrolene/Dantrium, Revonto, Ryanodex. (msk relaxer)
1. Bromocriptine/Parlodel, Cycloset. (D agonist)
(same tx as for malignant hyperthermia)
59
Treatment for Bradykinesia aka "drug-induced parkinsonism"
1. benztropine/cogentin
1. amantadine/Gocovri/Symadine/Symmetrel
60
tx for tardive dyskinesia EPS
Valbenazine/Ingrezza
(VMAT2 inhibitor)
61
Neuroleptic malignant syndrome can occur during surgery or ...
taking too much anti-psychotics (EPS)
(rigidity, increased CK & WBC)
62
Treatment of Neuroleptic Malignant Syndrome induced by taking too much anti-psychotic
(life-threatening EPS)
3 D's:
1. D/c anti-psychotic
1. Dantrolene
1. DA agonist (give them some back)
63
Tx for serotonin syndrome
(remember the 3 A's: **A**gitation, **A**utonomic hyperactivity, NM hyper**A**ctivity)
Cyproheptadine/Periactin
(Dantrolene/Dantrium/Revonto/Ryanodex = tx for NMS)
64
Findings in NMS (usu 7 days after tx started: fever and rigid muscles)
(rare reaction to neuroleptics)
1. elevated creatinine kinase
1. myoglobinuria (rhabdo)
65
Tx for schizotypal PD
Psychotherapy
(2nd line: antipsychotic)
66
treatment plan for schizophrenia
1. typical neuroleptic + atypical neuroleptic
2. family or group therapy
67
treatment plan for schizophreniform disorder
hospitalization
3-6 months of antipsychotic
psychotherapy
(2/3 will progress to schizoaffective or schizophrenia)
68
Which 2 drugs are held before ECT?
1. lithium (worsens memory impairment post-tx)
1. benzos (anti-convulsants)
69
Treatment plan for catatonia (4)
(seen in depression, bipolar and/or schizophrenia)
1. benzos
1. ECT
2. bed-sore prevention
3. DVT prophylaxis
(antipsychotics can make it worse)
70
Treatment for new-onset acute mania
lithium + antipsychotic
(alternative: valproic acid + antipsychotic)
71
treatment for lithium toxicity: d/c lithium and dialysis for levels greater than ...
(n/v, diarrhea, confusion, tremor, seizure)
5.0 mEq/L or 2.5 mEq/L with symptoms
72
Treatment for the MC symptom of lithium toxicity (tremor)
propranolol
73
Tx for bipolar patients who develop diabetes insipidus from lithium
(serum AND urine will be hyperosmolar; ADH is not able to pull water back in to dilute serum (balance Na+ levels)
amiloride (blocks lithium re-entry)
(Li+ is pulled into the cell with Na+ and blocks the cell from responding to ADH)
74
Work-up prior to begin lithium treatment
1. EKG (sinus rate; lithium can suppress SA node)
1. Chemistries (BUN, Cr, Ca; Li+ can cause chronic tubulointerstitial nephropahty)
1. TSH (Li+ can inhibit thyroid release, cause goiter)
1. Pregnancy test (causes Ebstein's anomaly)
1. Urinalysis
75
prazosin is used to tx PTSD nightmares. What is an important side effect?
orthostatic hypotension
76
tx for acute stress disorder
CBT, no drugs
(resolves after one month, adjustment disorder also does not require Rx)
77
Binge Eating first-line tx
CBT
(then vyvanse or topiramate)
78
tx for pregnant patients with mania
ECT
(mood stabilizers are teratogenic)
79
Best tx options for psychosis in parkinson disease (3)?
1. quetipine
1. clozapine
2. decrease carbadopa-levodopa (increases DA --> risk of psychosis)
(Olanzapine = atypical antipsychotic that blocks DA further)
80
hepatic encephalopathy tx (2)
1. lactulose (increases NH4+ generation)
2. rifaximin (decreases NH3-producing gut bacteria)
3. liver transplant
81
myastenia gravis tx
pyridostigmine or neostigmine
glycopyrrolate or hyoscyamine to control pyridostigmine adverse effect
82
which indirect cholinomimetic reverses muscle blockade after surgery
neostigmine
83
which 4 medication classes can cause orthostatic hypotension?
| other than benzoes
1. alpha blockers
1. beta blockers
1. anticholinergics (oxybutynin, TCA, etc)
1. antipsychotics
84
how can an anticholinergic medication like oxybutinin cause orthostatic hypotension?
decreased CO & PVR
85
cholinergic toxidrome tx
1. atropine (M blocker)
1. pralidoxime (regen AChE)
86
tx of anticholinergic toxidrome
physostigmine
87
Which Rx tx motion sickness
scopolamine (blocks M1 receptors)
| antihistamines also (meclizine, diphenhydramine)
88
3 Anesthetics used for Induction (put patient to sleep)
1. Propofol
1. Etomidate
1. Ketamine
89
methemoglobinemia tx
| "chocolate blood"
methylene blue
90
nerve commonly damaged during abdominal surgery?
iliohypogastric
(presents w/burning at incision site that radiates to suprapubic area & weakness to transversus abdominis & internal oblique)
91
Which 6 medications may cause a false-positive for PCP on a routine drug test?
1. Diphenhydramine
1. DXM
1. doxylamine
1. ketamine
1. tramadol
1. venlafaxine
92
tx for actinomycetes israleii
beta-lactams (penicillin)
Or
Ceftriaxone
93
which medication can cause cyanopsia?
| blue-tinted vision
sildenafil
| it inhibits PDE6 as well in the photoreceptors
94
Rx used postop to tx NM blockade
neostigmine
(increases ACh, doesn't cross BBB)
95
RX used postop to tx postop hypertension
fenoldopam (D1 agonist)
96
Treatment of which posterior lumbar CS point involves **flexion** of the hip?
(the rest use extension)
lower pole L5
(upper pole L5 = Extension & adduction. posterior lumbar = Extension & RA)
97
Rx that prevents the release of progeny virus
(hint: tx of Influenza A, B)
1. Oseltamivir
1. Zanamivir
("**-mivir** keeps 'em in th(v)ere". Baloxavir prevents nucleic acid synthesis; endonuclease inhibitor)
98
mechanism of Ribavirin
(hint: tx RSV, HCV)
Guanine nucleotide synthesis
(guanosine analog = acyclovir/gancyclovir; remdesivir = adenosine analog)
99
List the 4 protease inhibitors (HIV tx)
1. **Ataza**navir
1. **Daru**navir
1. **Lopi**navir
1. **Rito**navir
("-navir (never) tease a protease". prevents maturation of new virion after release from CD4 cell)
100
PC1 tender point location?
tx position?
inferior nuchal line (lateral to inion)
FLX OA
(this & PC3 are the ONLY posterior neck CS points that utilize FLXN)
101
cerebral toxoplasmosis tx
TMP-SMX
(HIV-AIDS prophylaxis at CD4 less than 200 cells/mm3)
102
4 adverse effects of taking too much magnesium hydroxide (antacid).
1. Diarrhea
1. hyporeflexia
1. hypotension
1. cardiac arrest
"Mg2+ = Must go 2 the bathroom"
103
for a patient who presents for the **first-time** with a-fib, what is the treatment?
warfarin **+ heparin **
(it takes days for warfarin to begin working, heparin terminated after iNR is optimized)
104
Drugs that act on microtubules (microtubules get constructed very terribly):
* Mebendazole (antihelminthic)
* Griseofulvin (antifungal)
* Colchicine (antigout & acute pericarditis)
* Vinca alkaloids (anticancer)
* Taxanes (anticancer)
