Term
| 76 y.o female presents to ED with c/o acute onset severe SOB. PMH significant for dx of Colon CA 3 months ago. Further eval demonstrates hypoxia, tachypnea, tachycardia, and elevated D-dimer assay. You order a CT angiogram to confirm your dx, but as you wait for the imaging, what therapy would you start her on that acts to accelerate the action of antithrombin III? |
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| 68 y.o male presents to the ER complaining of palpitations that started 2 hours ago. He denies any similar prior episodes. PMH is significant for an anterolateral MI 4 months ago. On PE his HR is 122bpm and is irregularly irregular. An EKG confirms that this patient is in A-fib. As you begin to administer Diltiazem to lower the HR, you advise the pt that he will need to be on chronic anticoagulant therapy from now on, as he is at a high risk of thromboembolic stroke. What med will you be starting this pt on? |
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| 73 y.o female presents to the ER complaining of right hip pain after a fall. PMH is significant for heparin induced thrombocytopenia. PE suggests a fx of the hip and imaging studies confirm this dx. The pt is referred to Ortho and scheduled for a surgery. Given this pt is at an increased risk for developing a DVT following her hip surgery, and based on her PMH what med should you give to her as a prophylactic anticoagulant? |
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Definition
| Direct Thrombin Inhibitors - hirudin, bivalirudin, lepirudin, argatroban, melagatran, dabigatran |
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Term
| 11 y/o boy is brought to the ED by his parents after being found unconscious in his bed at home. The parents report that the boy was feeling ill for the last 2 to 3 days and that he had been c/o having "shaking chills" and muscle aches. His temp at home was 102F, which they treated with a common OTC med. Pts liver enzymes are extremely elevated . What condition is this pt suffering from? What med was the underlying cause? |
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| 49 y.o male pt presents with c/o severe, crushing, substernal chest pain that began while he was shoveling his driveway 6 hours ago. He tells you he has experienced this type of pain before, especially after he had exerted himself; however it usually dissipated with rest. An EKG demonstrates some signs of ischemia but his cardiac enzymes are normal, thereby r/o an MI. You dx him with unstable angina pectoris and you admit him to the hospital. The cardiac cath reveals significant stenosis of the LAD coronary artery and a stent is placed. What med is used after the placement of the stent that acts to prevent thrombosis at the stent site, by inhibiting the ADP pathway involved in platelet aggregation? |
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| 67 y.o female presents to your cardiology clinic for f/u visit regarding her recent cardiac stress test. You tell the pt that her stress test demonstrated significant ischemia to the lateral wall of the heart during exercise and that these results indicate that she likely has a blockage in her left circumflex coronary artery. You recommend that she have cardiac catheierization with possible angioplasty or stent placement. As you are describing the details of this procedure you make sure to explain to her the meds that are used. Which drug that you explain acts to prevent thrombosis at the site of the stent placement by inhibiting platelet aggregation through inhibition at the glycoprotein IIb/IIIa receptor present on platelets? |
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Definition
| Abciximab, Eptifibatide, Tirofiban |
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Term
| 54 y.o male presents to the ED c/o a heavy substernal chest pain that radiates to his left shoulder and jaw. He tells you that the pain began 2 hours ago. While you are talking to him, you notice he is breathing heavily and is diaphoretic. You immediately order an EKG, which demonstrates ST elevation and T-wave inversion in leads II, III and aVF, showing that he is suffering from an inferior wall MI. There is no cardiac catheterization lab within 50 miles of your hospital. In hope of minimizing tissue damage caused by his condition, you decide to administer a med that may dissolve the coronary artery blockage by promoting the formation of plasmin. What med did you prescribe? |
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Definition
| A Fibrinolytic Agent: Streptokinase, Urokinase, Anistreplase, Altepase, Reteplase |
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Term
| 20 y.o male presents to the ER with significant bleeding from the gums. Pt has a PMH of hemophilia and a wisdom tooth extraction 1 day ago. Since his dental procedure he has been continually bleeding from the gums. What drug would you administer that would inhibit the plasminogen activation and thus control his bleeding as well as replace his deficient clotting factors? |
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Definition
| Aminocaproic Acid, Tranexamic Acid |
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Term
| 74 y.o male with ESRD, requiring hemodialysis, presents to your clinic for a f/u visit. During his history he tells you he has been feeling more fatigued lately. PE reveals a thin, pale man with a stable HR and BP. Lab studies demonstrate anemia with a hematocrit of 29%. Iron studies are consistent with an anemia of chronic inflammation. Furthermore, a workup for GI bleeding is negative. What do you suspect this pts anemia is related to, and how will you treat it? |
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Definition
| Related to his ESRD; Give Synthetic Erythropoietin |
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Term
| 59 y.o women present to your Endocrinology office for a f/u of her type 2 DM. She tells you she is having difficulty maintaining optimal control of her blood sugar. She currently takes metformin. Her HA1C level is 7.7, indicating that her glycemic control over the past 3 months was not ideal. You decide to add another med to the metformin that will lower her blood sugar by stimulating increased insulin release from the B-cells of her pancreas. What med will you add? |
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Definition
Sulfonylureas:
1st Generation - Chlorpropamide, Tolbutamide, Tolazamide
2nd Generation - Glyburide, Glipizide
3rd Generation - Glimepiride |
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| 48 y.o male presents to the primary care physician's office for an annual check up. He reports that over the past few months, he has noticed that he has been thirstier and has been urinating more frequently. His FHx is significant for Type 2 DM in both of his parents. His fasting glucose level is 152mg/dl, all other lab studies are normal. You dx the pt with Type 2 DM and you decide to start him on a med that will reduce his blood sugar by inhibiting glucose production by the liver, what med are you starting him on? |
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| 61 y.o female pt presents to clinic for a f/u visit. She has recently been diagnosed with mild type 2 DM, and she has been trying to control her blood sugar with diet and exercise. Today, her random blood glucose level is 254. You advise her to seriously consider pharmocologic therapy as an adjunct to diet and exercise to help gain better control of her blood sugar. She becomes concerned, and relates to you that she had a cousin on diabetes medication that ended up with extensive liver damage as a result of the drug. You reassure her that that particular med was taken off the market and other similar drugs in the same class have NOT been shown to cause liver failure. What diabetes drug was her cousin prescribed? What other drugs are in this class? |
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Definition
Cousin's Med - Troglitazone
Other Thiazolidinediones - Pioglitazone, Rosiglitazone |
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Term
| 48 y.o male presents to your endo clinic for the management of his type 2 DM. He is currently on glyburide, metformin and pioglitazone, but his HA1C is still elevated at 9.7%. He adamantly refuses to begin insulin or any other med that requires an injection. He asks you if there is another oral med he can add to his regimen to treat his diabetes. You tell him you can start him on a med that acts to decrease absorption of postprandial carbs in the GI tract, but you warn him of the SE of flatulence and diarrhea. What med did you prescribe? |
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Definition
| A-glucosidase inhibitors - Acarbose, Miglitol |
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Term
| 62 y.o man presents to your office for a f/u of his type 2 DM. He is currently taking metformin, glipizide, and rosiglitazone which he takes regularly. Despite his medication regimen and his attempts to control his diet, his most recent HA1C is still slightly elevated at 7.5%. He wants to avoid insulin if possible and asks you about a drug he saw on TV that treats DM by mimicking glucagon-like peptide-1. What drug is he referring to? |
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| 52 y.o male presents to your office for a routine visit. He has not seen a physician in 5 years, but states that he has been feeling well. You note he is mildly overweight; however, PE is otherwise unremarkable. Labs reveal an elevated total cholesterol level of 307 with an LDL of 187. His HDL and trigs are WNL. You explain to him the findings and you recommend a med that lowers cholesterol by inhibiting the body's production of cholesterol, as well as recommending changes to his diet and exercise regimen. What med did you recommend? |
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Definition
| Atorvastatin (also pravastatin, lovastatin, rosuvastatin, simvastatin, flucvastatin) |
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Term
| 49 y.o women presents to your office for a routine f/u to her abnormal lipid levels. Six months ago, initial assessment of her cholesterol levels had demonstrated elevated LDL levels, although her trigs and HDL were WNL. At that time you started her on atorvastatin, but due to the myalgias, she was unable to tolerate the med. You then tried a different med. Current lab studies show a marked decrease in her LDL level. You tell her the good news and she is pleased with the results, although she does c/o diarrhea and a terrible taste with the med. What med is this pt on? |
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Definition
| Cholestyramine (also colestipol and colesevelam) |
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Term
| 44 y.o women presents to the ER c/o severe epigastric pain. She tells you she also has N/V associated with the pain. Lab studies reveal elevated amylase and lipase levels, leading to a dx of acute pancreatitis. She denies PMH of alcohol abuse or gallstone dz, leading you to search for other causes of her pancreatitis. A lipid profile reveals a trig level of 1500, so you immediately start her on a med to lower her trigs and explain to her, that this high trig count was the probable culprit for her acute pancreatitis. What med do you start her on? |
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Definition
| Gibfibrate (or another fibrate - ciprofibrate, bezafibrate, fenofibrate) |
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| 69 y.o women presents with c/o 1-week hx of back pain. She admits that the pain began after she had been lifting some heavy boxes while cleaning out her husband's study. She denies any neurological symptoms. On PE she has no pain with the straight leg maneuver, thereby suggesting she has not herniated her disk: however she does have point tenderness around the T12 to L1 region. You send her for imaging studies, which reveal a vertebral compression fx of L1. A bone scan reveals the presence of significant osteoporosis. You decide to treat this with a med that acts by decreasing osteoclastic bone reabsorption, what med are you giving her? |
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Definition
| Bisphosphonates - Alendronate, Etidronate, Ibrandronate, Zolendronate, Pamidronate, Risedronate |
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Term
| 39 y.o women presents to the ER c/o a "Racing heart". She tells you that she has experienced these sorts of palpitations several times over the past 6 months. Upon further questioning you discover she has lost 20 lbs over that time period and she is having 2 to 3 episodes of diarrhea a day and is also having difficulty sleeping. Her PE is remarkable for the presence of exopthalmus and a mildly enlarged thyroid gland. What med would you give to this women, especially if she has a possibility of becoming pregnant? |
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| 72 y.o male presents to the urgent care clinic with c/o severe pain in his big toe of his R foot. He denies any trauma to the toe and states that he has had episodic symptoms similar to this 1 month previously. PMH is significant for non-hodgkin's lymphoma, for which he is currently receiving tx. On PE you note that the first metatarsal joint of his R foot is swollen and tender to the touch. Lab studies reveal significantly elevated uric acid levels. What med would you begin that will decrease the migration of inflammatory cells to the affected joints and what med would you also prescribe to prevent similar attacks that acts by inhibiting xanthine oxidase? |
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Definition
Acute Attack = Colchicine
Future Attacks = Allopurinol |
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Term
| 42 y.o women presents with c/o weakness and fatigue over the past month. PE reveals areas of hyperpigmentation over her knuckles, knees, and elbows. Initial lab studies reveal hypoglycemia, hyperkalemia, and hyponatremia. You decide to order several other lab tests and you begin to suspect the sx may be due to an AI process and that she will likely need replacement therapy of specific hormones to treat her symptoms. What condition is she suffering from? What treatment will she begin? |
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Definition
Primary Adrenal Insufficiency (Addison's)
Tx with Hydrocortisone and fludrocortisone |
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Term
| 42 y.o male presents to your office for an initial weight loss evaluation. He is morbidly obese with a BMI of 43. His PMH is significant for DM type 2 for which he takes insulin, HTN and osteoarthritis of bilateral knees. He would like to avoid bariatric surgery and asks you if there is any oral med available to treat his obesity. You inform him that you can subscribe him a med that helps with weight loss by inhibiting intestinal fat absorption, but that the SE of this med is fecal incontinence. What med are you recommending? |
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| 79 y.o male presents to your clinic c/o difficulty urinating . On taking a complete hx, you learn that he has had trouble in starting and stopping the stream of urine for the last 4 months. He also tells you he has lost 10 lbs over the last 2 months. On DRE the prostate is easily palpable and you find prostatic nodules that are firm, enlarged and irregularly shaped. Lab tests demonstrate an elevated PSA level, and a biopsy of a prostatic nodule confirms the diagnosis of prostate CA. You decide on a med that will treat the prostate CA by acting on competitive antagonist at androgen receptors, what med is it? |
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| 69 y.o male presents to your office for his annual visit. He states that he feels healthy overall, except that he has begun to experience an increased frequency of urination. He denies any pain or blood with his urination. Upon further questioning, he admits to having difficulty starting and stopping the stream of urine. A DRE reveals a diffusely enlarged prostate gland. Lab results demonstrate an increased total PSA with a proportionate increase in the fraction of free PSA, consistent with a likely dx of BPH. You reassure the pt that his symptoms are not caused by a malignancy and you start him on a med that will decrease the production of dihydrotestosterone and thus decrease the size of his prostate with consequent relief of his urinary sx. What med are you starting him on? |
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| 85 y.o man presents to your oncology clinic for consultation regarding his metastatic prostate carcinoma. He was initially dx with CA when his PCP checked a PSA level after feeling a hard prostatic nodule on his DRE. A subsequent bone scan revealed several areas of bony metastases and a prostate biopsy confirmed the dx. During this initial visit you explain to him that you will be treating him with a regimen of meds that include a drug which acts as a gonadotropin-releasing hormone agonist. What med are you referring to? |
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Definition
| Leuprolide (or other GnRH agonists - Naferelin, Goserelin) |
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| 21 y.o female present for her annual PE. She is feeling well with no complaints. On SHx she tells you she is sexually active and in a monogamous relationship. She is currently using condoms for BC, but is interested in other forms of BC. She denies any PMH of FHx of blood clots and she does not smoke. You decide to prescribe her a form of BC that may also reduce her risk of developing endometrial of ovarian CA. What BC did you prescribe? |
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Definition
| Combined estrogen/progesterone OC |
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Term
| 45 y.o man presents to the ER complaining of large volumes of bloody vomit. His PMH is significant for cirrhosis secondary to alcohol abuse. PE is significant for HR of 100 bpm, a BP of 90/60 and some epigastric pain. You call GI for an endoscopy, which demonstrates the presence of several esophageal varices. You start the pt on a synthetic analog of naturally occurring pancreatic hormone, which causes vasoconstriction of his esophageal varices. What med did you use? |
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| 51 y/o female presents to ER c/o recurrent HA. She denies neurological symptoms or a hx of migraines; however a thorough review of systems reveals she has been extremely thirsty lately and that she has been urinating frequently. Her PE, including a neurologic exam is WNL. Lab tests reveal normal glucose levels, increased serum osmolality and hypernatremia. You refer her to an endocrinologist in order to determine the etiology of her d/o. In the meantime you believe she will benefit from the tx with a med that causes an increase in the permeability to water in the collecting ducts of the kidney, thereby resulting in increased reabsorption of water. What med are you recommending? |
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Definition
| Vasopressin (or another is Desmopressin) |
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Term
| 71 y.o women presents to your clinic c/o pain in her R knee. Upon further questioning she tells you she has noticed the pain is usually worse in the evening after a full day of activity. PE reveals a swollen, tender R knee with minimal joint effusion. You also notice bony nodules on her DIP and PIP. You tell the pt you suspect she has OA and you recommend an OTC med to help relieve her symptoms by reversibly inhibiting cyclooxygenase 1 and 2. What med did you suggest? |
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Definition
| Ibuprofen or Indomethacin - both work for OA and both are COX 1 & 2 inhibitors (although Ibuprofen is available OTC, while Indomethicin is not) |
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Term
| 43 y/o woman presents to your Rheum clinic for consultation regarding her newly dx RA. The pt explains to you that her biggest concern is that she has had gastric ulcers in the past and she heard some meds used to treat RA can aggravate the lining of her stomach. You explain to the pt that there are many treatment options for RA, some of which can modify the progression of her dz, while others are appropriate for symptom relief. As you begin to write out prescriptions for her, you explain that one of the drugs will act as an anti-inflammatory agent, but will have less risk of her developing gastric ulcers as a SE when compared to other drugs. However you do warn her that this med can increase her risk for a stroke. What med did you prescribe? |
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| 25 y/o female calls your clinic with a Q regarding the tx of her HA. She tells you that she has been suffering from occasional HA that are usually worse at night especially at the end of a stressful day. She also often feels shoulder tightness and she mentions that she is under a lot of stress at work. After more questioning, you feel comfortable enough to dx her with likely tension HAs. You tell her that she can treat her HA with the use of common OTC meds that inhibit cyclooxygenase in the nervous system and you instruct her to set a f/u appt at the clinic if her symptoms worsen. What med did you suggest? |
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