Rotation Learning

Lactulose: Usual Use

Used in Cirrhosis to lower Ammonia Levels

Rifaximin: Usual Use

Used in Cirrhosis to lower Ammonia Levels

Which has higher Bioavailability, Cephalosporin - Bactrim? Cephalosporin - Flouroquinolones?

Bactrim, Flouroquinolones

Loperamide Indication, MOA?

Diarrhea, Mu-receptor agonist, targets receptors in the gut, utilizes opioid receptor constipation side effect (inhibits acetylcholine & prostaglandin release to slow motility and increase absorption of water and electrolytes)

Statin Indication, MOA?

Hyperlipidemia, HMG CoA -reductase inhibitor, prevents synthesis of cholesterol in the liver and lowers levels of LDL in the blood stream

What is empiric treatment for uncomplicated Pyelonephritis?

Bactrim or Fluoroquinolones

What is mixed with TK, what is it, and what are the stats in stroke use

Sterile water, Clot Buster, 50% will help, 50% will not, 2/100 will have bleeding complications

Common Beta-Lactams? (4)

Penicillins, cephalosporins, Carbpenems, Monobactam (Azetreonam)

MOA of Beta-lactams?

Beta-lactam inhibitor component binds to beta-lactamase of the bacteria and inactives the enzyme, allowing the other antibiotic component to target the bacteria

What is the MOA of warfarin?

Vitamin K epoxide reductase inhibitor in the liver prevents oxidized vitamin K from being reduced and inhibiting formation of blood clotting factors

What can be used to reverse warfarin?

KCentra PCC (Vitamin K), FFP (fresh frozen plasma), Vitamin K (Takes longer)

What is 4 medication empiric regimen for encephalitis

Acyclovir, Ceftriaxone, Ampicillin, Vancomycin

What is covering Listeria in empiric treatment for encephalitis?

Ampicillin

MOA of anti-epileptics?

Sodium Channel Inhibition/blocking of voltage-gated channels, closing channels, reducing excitability, and stabilizing neurons in an inactivated state

MOA of typical Anesthetics?

Sodium Channel Inhibition/blocking of voltage-gated channels, closing channels, reducing excitability, and stabilizing neurons in an inactivated state

What are 3 antibiotic's that can have large impacts on INR in someone on Warfarin?

Bactrim, Flagyl, ciprofloxacin

What does CK measure?

Muscle breakdown in the blood

Which MRSA test has a very high negative predictive value?

Nasal Swab

Describe Cirrhosis:

Fibrosis of the liver caused by toxin buildup or trauma

Describe Portal Hypertension:

Engorged blood vessels surrounding the liver that work harder because of increased resistance in vessels due to inadequate blood flow

Describe Varices: What is the primary concern?

Varices are areas of blood vessels around the liver that are weakened or bulging due to high pressure of blood that has built up over time, primary concern is bleeding

Describe Hepatic Encephalopathy:

Build up of ammonia causes inflammation near the BBB and causes disruption of the barrier allowing Ammonia into the cranial space and causing cognitive effects

Describe Ascites:

Build up of fluid in the peritoneal cavity (abdomen) due to portal hypertension. Fluid leaks from blood vessels and into the abdominal cavity

Treatments of Portal Hypertension

Beta-blockers (Carvedilol, Propranolol, Nadalol)

Treatments of Ascites

Furosemide - Spironolactone (2:5), Paracentesis

Treatments of Hepatic Encephalopathy

Lactulose + Rifaximin

Treatments of Varices (Variceal Bleeding)

Propranolol (Prophylaxis), Octreotide, Someostatin, Variceal banding/Litigation

What is the indication of Linzess? MOA?

IBC/chronic constipation, binds to guanylate cyclase-C receptors on the surface of the intestines as an agonist, increased secretion of bicarbonate and chloride in the intestinal lumen, pulling fluid into the intestines, resulting in softened stool and more frequent bowel movements

What is the MOA of Lactulose?

Reduces ammonia by 3 ways; creates a more acidic PH increasing the conversion from ammonia to ammonium, suppresses bacteria that produce ammonia via the acidic environment, and accelerates bowel transit shortening time that ammonia can be absorbed before being excreted

NSTEMI Treatment?

Nitroglyercin, Aspirin, Antiplatelets, Anticoagulants, Statins

STEMI Treatment?

PCI, Clot Busters (TnK, AlT)

What is CHASVASC scoring?

Risk of stroke

What is PADUA scoring?

Risk of VTE

What is the MOA of Ondansetron?

Selective Serotonin (5-HT3) Antagonist that acts in the Brainstem and GI, preventing serotonin binding that would have triggered the vomiting reflex

What is the MOA of Metoclopramide?

Dopamine antagonist (D2 in CTZ of medulla), Serotonin antagonist (5-HT3)

What is the MOA of Promethazine?

Dopamine antagonist (D2: CTZ of medulla) and blocks M1 as well --> anticholinergic properties

What is the MOA of Buprenorphine?

Strong partial mu agonist (ceiling effect of euphoria and respiratory depression) and kappa antagonist (antidepressant/anti-craving effect)

Describe SAH:

Subarachnoid Hemorrhage: Bleeding between the dura mater and arachnoid mater layers, usually caused by trauma or aneurysms of blood vessels.

Treating SAH:

DC anticoagulants/give reversal agents, Calcium channel blockers to lower blood pressure <140 (careful to maintain adequate blood perfusion to give brain enough oxygen), Give nimodipine 60 mg Q4 x 21 days to prevent vasospasm (Vasoconstriction of blood vessels, high dosing since bioavailability is low and has short half-life)

What is apixaban dosing for atrial fibrillation?

5mg BID

What is the most common hematological side effect of Abilify?

Leukopenia

What effect on secretions does high levels of dopamine cause?

Increased secretions