A Picture is Worth...this AED
For this AED, Christine gave a slide showing GINGIVAL HYPERPLASIA, seen in 20% of the patients taking this drug
phenytoin (Dilantin)
This drug for PD patients, ONLY used in conjunction with levadopa/carbadopa (Sinemet) therapy is one that Christine compared to the famous Gangster, Al Capone. What is the generic name of this drug?
tolcapone (Tasmar), or the later generation entacapone, both of which Christine said we might remember for our NCLEX if we think of them like MOBSTERS. They are selective, reversible COMT inhibitors (COMT being an enzyme involved in the brain metabolism/breakdown of dopamine)
When it comes to treating PD, according to Christine, "It's all about the..." [name the neurotransmitter]
GABA
The intro slide show TEETH that were stained due to the use of this abx
tetracycline
An "absence" seizure is defined as this
For this AED, Christine focused on the lower jaw of a person with swollen lips and cheeks, s/s that, along with a swollen tongue, is characteristic of ANGIOEDEMA, seen in 12% of the patients on this drug
pregabalin (Lyrica)
When levadopa is given alone, out of a 500 mg initial dose of levadopa, only 10 mg ultimately crosses the BBB and makes it to brain receptors. In a picture that Christine depicts showing the action of levadopa assisted by carbidopa, out of a 100 mg initial dose, this much ultimately crosses the BBB and makes it to brain receptors
ALSO 10 mg. In other words, without carbidopa, 2% levodopa (a dopimine "precursor") crosses, but with carbidopa, a 5x higher percentage crosses with a one fifth initial dose (smaller dose means fever adverse effects, longer period of effectiveness of the drug)
"Take the culture before the bug meets the drug" means what, and why is it so important that Christine repeated it THREE times in her lecture
One needs to take a culture before delivering any antibiotics because it's important to get a sample to a lab to IDENTIFY the pathogen correctly and as soon as possible. This would hopefully allow the Proscriber to switch as soon as possible to a NARROW SPECTRUM abx that the lab has shown the pathogen to be sensitive to. Following this process helps reduce the chance of resistance being developed to the abx employed
Name one of two abx drugs that Christine COULD have chosen to illustrate with the picture of an EAR due to their risk in both cases for OTOXICITY as an AE.
vancomycin (Vancosin): pictured on the intro slide with an ear;
gentamicin (Garamycin), which Christine claimed the following week is "even more ototoxic," and the RF ototoxicity is heightened when these two are given to a pt. in COMBO
Explain the difference between Mechanical Obstruction and Dynamic Obstruction in BPH, and name the two drugs that treat each
MECHANICAL OBSTRUCTION=the hypertrophy (overgrowth) of the epithelial cells in the male prostate gland, whose swelling pinches and ultimately blocks the ureter flow. Treated by finasteride (Proscar).
DYNAMIC OBSTRUCTION=the hypertrophy of the smooth muscle cells in the bladder neck (trigone and sphincter) which pinches and blocks the flow through the urethra. Treated by tamsulosin (Flomax)
ALZHEIMER'S disease
Name TWO of the three muscles that are intimately involved in the voiding of the Urinary BLADDER
(1) DETRUSSOR MUSCLE (which contracts);
(2) TRIGONE and (3) SPHINCTER muscles (which both relax in the voiding process)
The intro slide to this abx showed a TENDON RUPTURE
ciprofloxacin (Cipro), for one of its AE's is "tendon rupture" which Christine suspects may be "more common than not"
State what the acronym DOT means
"Drug Observed Therapy," which is used, for instance, in insuring the compliance of people taking meds long term for Tuberculosis (TB)
Christine's introductory picture for this AED showed a person pouring water on their head in an attempt to illustrate how a person taking this drug may OVERHEAT due to an inability to sweat, a condition called HYPOHIDROSIS
topiramate (Topamax)
In MAO-B Inhibitors such a this overview drug used to treat PD, patients are educated to avoid TYRAMINE RICH FOODS, some of which are pictured on a lecture slide. Name both the drug prototype and at least two of the foods that are rich in tyramine.
selegiline (Eldepryl, Carbex), with Tyramine-rich foods including CHEESE, WINE, MEATS, CHOCOLATE, SMOKED FOODS, and PICKLED FOODS. Christine referred to these foods as the "kind one might often think about taking on a picnic"
List the FOUR different routes by which the Anti-Epileptic drugs work for their MOA. Which one has only one drug that uses that path?
(1) Suppression of Na+ influx
(2) Suppression of Ca2+ influx
(3) Antagonism of Glutamate
(4) Potentiation of GABA
Only topiramate (Topamax) uses route three, antagonizing the excitatory neurotransmitter Glutamate.
This abx drug was introduced by a slide showing an EKG screen that includes the "QT interval"
erythromycin (Macrolide), for one of this drug's AE's is "QT prolongation"
MIC = "Minimun Inhibitory Concentration" and represents the lowest concentration of ABX needed to completely suppress bacterial growth;
MBC = "Minimum Bactericidal Concentration" and represents the concentration of an ABX that reduces bacterial density by 1000-fold in 24 hours
The slide introducing this AED depicted a person YAWNING in order to illustrate how this drug is used off label to produce sedation and sleep induction, and DROWSINESS is its most common side effect, regardless of what the drug was prescribed for
phenobarbital (Luminal), which is classified as a BARBITURATE (and an FDA controlled substance).
MYASTHENIA GRAVIS, an autoimmune disease characterized by ptosis, difficulty swallowing, and skeletal muscle weakness. The single prototype we were given for tx is pyridostigmine (Mestinon) -- which incidentally can also be used to reverse poison snake bites as well as the action of neuromuscular blocking agents often administered during surgery.
One part of the problem of antimicrobial resistance to abx is the overuse and misuse of antibiotics. First, give at least one example each of overuse and inappropriate use; second, explain what Christine calls the _OTHER_ PART TO THE PROBLEM
Overuse: Such as when broad spectrum antibiotics are used in inappropriate situations (such the use of a "big gun" such as linezolid (Zyvox) when a more narrow spectrum abx would work just as well, giving bacterial more exposure to (and more chance to build resistance to) linezolid. Misuse: proscribing an abx for a viral infection, or to treat a FUO. THE OTHER PART OF THE PROBLEM: The (over)use of abx in the meat industry.
Christine SHOULD have introduced this abx drug, which she hardly talked about and is one we only need to know on overview, with a picture of a LITTLE OLD LADY who likely takes it regularly and prophylactically to ward of recurring UTIs.
nitrofurantoin (Macrobid)
Explain the difference between akinesia, bradykinesia, and ataxia
BRADYKINESIA means either a slowed movement or an inability to move, often seen with PD pts. AKINESIA is literally an absence of movement, characterized by rigid limbs, also often seen in patients with PD. ATAXIA defines a person who is not able to control their muscle movements, and is an AE of a number of anti-epileptic medications