PMCOL 233 Midterm 2

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hypochromic anemia

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hypochromic anemia

chronic blood loss

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megaloblastic anemia

vit b12 or folic acid deficiency (large cells)

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pernicious anemia

fewer cells bc of IF deficiency

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hematinic agents

iron, folic acid, B12

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hematopoietic GF

EPO, gcsf, gmcsf, magakaryocyte,

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iron absorption

ferric iron ingested, ferrous iron absorbed

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iron formualtions (oral)

ferrous sulfate, ferrous fumarate, ferrous gluconate, polysaccharie iron complex

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iron formualtions IV

iron dextran, sodium ferric gluconate, iron sucrose

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iron in body

RBC contain majority of iron in Hb

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iron side effects

GI distrubances, toxic effects

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iron chelators usage

for iron toxicity

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iron chelators examples

desferrioxamine, deferiprone, deferasirox

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desferrioxamine

forms complex to excrete in urine

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deferiprone

orally absorbed alternative to desferrioxamine

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deferasirox

alternative but GI bleeding

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folic acid mechanism

reduction of folic acid to FH4 and FH2 (FH4 for DNA synthesis)

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B12 mechanism

converts methyl FH4 to FH4

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EPO

stimulate RBC production

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EPO mechanism

released in response to hypoxia form kidneys (10% liver) and inhbits apoptosis to prevent early cell death AND proliferation thru JAK2

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EPO side effects

iron deficiency (cant keep up so RBC draw iron from blood), thrombosis (dialysis patients need anticoagulant), hypertension (increased hematocrit and AT2), seizures

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aldosterone effect

increases Na reabsorption in kidney and excretes K+

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aldosterone triggers

low Na+ increase AT II

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loop diuretics examples

furosemide, bumetanide

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loop diuretic mechansm

inhibit NA/K/2Cl carrier so Na+ not reabsorbed and 2Cl and K+ pee out

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loop diuretics adverse effects

excessive loss, hypovolemia, hypoklemia, alkalosis, hypomagnesaemia, hyperuricemia, reduced renal perfusion, hearing loss, rashes, bone marrow depression, contraindicated w sulfa allergy

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thiazides examples

bendroflumethiazide, hydrochlorothiazide

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diuretic purpose purpose

edema, heart failure, cirrhosis, nephrotic syndrome, renal failure, hypertension

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thiazide purpose

hypertension, mild heart failure, resistant edema, diabetes insipidus, hypertension

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thiazide mechanism

bind Cl site of NA/Cl co transporter to stimulate natriuresis and stimulate renin secretion also reduce Ca excretion

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thiazide adverse ffects

erectile dysfunction, hypochloremic alkalosis, impaured glucose intolerance, hyponatremia, hypokalemia, rashes

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aldosterone antagonists examples

sprionolactone, eplernone

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aldosterone antagonist purpose

resistant hypertension, heart failure, hyperaldosteronism, secondary aldosteronism

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aldosterone antagonist mechanism

compete w aldosterone to inhibit Na retention and K secretion

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aldosterone antagonist adverse effects

hyperkalemia, GI upset, gynecomastia, menstrual disorders, testicular atrophy

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triamterene/amiloride

prevent hypokalemia, inhibit Na reabsorption,

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triamterene/amiloride adverse effects

hyperkalemia, GI upset

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osmotic diuretics

only water excretion

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osmotic diuretics adverse effects

risk for precipitating left ventricular fialure, headache, nausea, vomiting

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electrolyte disorders

important in renal failure; hypoerphosphatemia; hyperkalemia

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antihypertensive for renal failure

ACE inhibitors and ARBs; reduce risk for major CV events

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vit D analogues for renal failure (FYI)

used to manage secondary hyperPTH

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diuretics in renal failure

treat edema; lower tendenct to develoop hyperkalemia; decrease blood pressure

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potassium sparing diuretics in renal failure

should be used cautiously, hyperkalemia associated with heart failure

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renal failure and epoeitin

often have impraied EPO levels and anemia; need treatment

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hyperphosphatemia

increased blood phosphate levels

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chronic kidney disease hyperphosphatemia

hallmark, big risk of CV disease

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hyperkalemia

high blood potassium levels; more severe than phosphatemia

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medications inducing hyperkalemia

K+ sparing diuretics, NSAIDs, ACE inhibitors

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phosphate binding agents

prevent absorption by forming insoluble complexes in GI tract

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aluminum hydroxide

bind phosphate in GI

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aluminum hydroxide adverse effects

increase Al levels in dialysis patients (toxic)

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calcium carbonate

binds phosphate in GI tract

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calcium carbonate effects

increase calcium levels: helps hypocalcemia in CKD but may cause calcification

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sevelamer hydrochloride

non calcium based phosphate binder; anion exhcange resin

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sevelamer hydrochloride effects

less likely to lead to tissue calcification, lowers LDL cholestrol, GI disturbances, affects fat soluble vitamin absorption, dont use in hypophsophatemia or bowel obstruction

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how to treat hyperkalemia

cation exchange resin to bind potassium in colon

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sodium or calcium polystyrene sulfonate

binds K in colon in exhcange for Na or Ca

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sodium or calcium polystyrene sulfonate and sorbitol effects

increased risk for GI, bleeding, ischemic cholitis, perfroation, constipation

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glucose + insulin mechanism

insulin activates Na/K ATPase to move K into cells

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salbutamol

B2 agonist linked to Na/K ATPase - causes K uptake into cells

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desmopressin

vasopressin analogue for nocturnal enuresis in kids

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desmopressin mechanism

acts on V1 V2 receptors to faciliate water reabsopriton

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desmopressin adverse effects

water intoxication (hyponatremia)

hypotension when low cardiac output

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anticholinergics for incontinence

mAChR antagonists to prevent contraction s

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M3 selective antagonists

darifenacin, solifenacin

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nonselective mAChR antagonists

oxybutinin, tolterodine

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mirabegron

B3 agonist

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mirabegron mechanism

B3 agonist in detrusor smooth muscle to induce relaxation and increase bladder capacity

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mirabegron adverse effects

BP, bladder pain, dry mouth, headache, dizzy, less UTI likelihood

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2 types hormonal contraceptives

combined pill, progestogen only

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combined pill

ethinyletradiol + progestogen

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2nd gen progestogens (3)

noresthisterone, levonorgestrel, ethynodiol

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3rd gen progestogen (2)

desogestrel, gestodene

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combined pill mechanism

estrogen inhbits FSH to suppress follicular deveoopment, and progestogen inhbits LH to prevent ovulation; discourages implantation

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combined pill adverse effects

nausea, tender breasts, flushing, breakthru bleeding, dizzy, depression, acne, weight gain, thromboembolism

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combined pill benefits

reduce ovarian/ endometrial cancer risk, decreased menstrual symptoms, reduced iron deficient anemia

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progestogen only pill

taken daily no breaks for people who experience complications from estrogen

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progestogen only pill mechanism

makes cervical mucus inhospitable to sperm, inhbits implantation, and alters motility/secretions of fallopian tubes

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progestogen only pill adverse effects

irregular bleeding, less reliable,

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emergency contraception effects

nausea and vomiting

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levonorgestrel

emergency contraception

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long acting progestogen only

depot medroxyprogestogen IM

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oxytocin

nonapeptide to promote contraction- receptor expression induced by estrogen

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oxytocin mechanism

Gq GPCR yo increase Ca2+ to activate calmodulin and stimulate MLCK

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