Term
|
Definition
| Low level of plasma hgb concentration, decreased RBCs, low total hbg content per unit of volume of blood |
|
|
Term
| What are some causes of anemia (7)? |
|
Definition
| Chronic blood loss, BM abnormalities, increased hemolysis, malignancy, endocrine def, renal failure, poor nutrition |
|
|
Term
| What nutrients are required for Hematopoiesis? |
|
Definition
| Fe, Vit B12, folic acid and hemopoiestic growth factors |
|
|
Term
| What is the MC cause of Chronic anemia? |
|
Definition
|
|
Term
| Fe def commonly results from? |
|
Definition
1. Insufficient intake during growth in children
2. Heavy menstration
3. Prego women |
|
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Term
|
Definition
| In the intestinal mucosal cells as ferritin |
|
|
Term
| What forms of Fe are available (5)? |
|
Definition
1. Ferrous fumerate (highest)
2. Ferrous gluconate (moderate)
3. Ferrous sulfate (mild)
4. Iron dextran
5. Sodium ferric gluconate complex |
|
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Term
|
Definition
| Pallor, fatigue, dizziness, dyspnea on exertion |
|
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Term
|
Definition
| Duodenum, upper jejunum of the intestine |
|
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Term
|
Definition
| In the plasma bound to transferrin via carrier protien |
|
|
Term
| 30% of Fe is stored in... |
|
Definition
|
|
Term
| 60% of Fe is contained in |
|
Definition
|
|
Term
| How is Fe eliminated (4)? |
|
Definition
1. No mechanism for excretion
2. Small amts lost in feces, bile, urine and sweat
3. No more than 1 mg per day
4. Excreted in breast milk and crosses the placenta |
|
|
Term
| Which group(s) of individuals should commonly be given Fe supplements? |
|
Definition
| Premature infants, children during growth periods, prego and lactating women, chronic kidney dz (dialysis) |
|
|
Term
| Indications for Fe usage include: (2) |
|
Definition
1. Inadequate Fe absorption leading to malabsorption (gastrectomy, small bowel dz)
2. Blood loss (MCC in adult- menstrual period, GI bleeds- men and post meno women) |
|
|
Term
| Fe oral therapy includes the following drugs (5). |
|
Definition
1. Ferrous sulfate, hydrated 325 mg 3-4 tab/d
2. Ferrous sulfate, desiccated 200 mg 3-4 tab/d
3. Ferrous gluconate, 325 mg 3-4 tab/d
4. Ferrous fumarate, 100 mg 6-8 tab/d
5. Ferrous fumarate, 325 mg 2-3 tab/d |
|
|
Term
| How long should tx with oral Fe last in order to correct anemia? |
|
Definition
|
|
Term
| Fe parenteral tx is given to those with...(3)? |
|
Definition
1. Fe def who can not tolerate or absorb oral fe
2. Extensive chronic blood loss that cannot be maintained by oral therapy alone
3. IBD, postgastrectomy conditions, previous small bowl resection and advanced chronic renal dz (hemodialysis and tx with erythropoietin) |
|
|
Term
| Type of med given for Fe parenteral tx? Dose? |
|
Definition
| Iron dextran (ferric hydroxide and low-molecular weight dextran). 50 mg iron/ml given IM or IV |
|
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Term
| Acute Fe toxicity involves (4)? |
|
Definition
1. Usually children
2. Urgent tx with whole bowl irrigation
3. Deferoxamine (potent Fe chelating compound)
4. Activated charcoal does NOT bind to Fe |
|
|
Term
| What is chronic Fe toxicity (hemochromatosis)? Common is what type of pts? Tx? |
|
Definition
| "Fe overload"- excessive Fe deposits in the heart, liver, pancreas and other organs. Commonly inherited or accumlated via transfusions over a long period. Tx with intermittent phlebotomy (one unit/wk until excess Fe removed) and Fe chelator deferasirox (approved for Fe overload) |
|
|
Term
|
Definition
| N, D, C, epigastric discomfort, abdominal cramps, black stools, liquid preps can stain teeth |
|
|
Term
| Adverse effects of FE IV: |
|
Definition
| Localized pain, H/A, light headedness, fever, arthralgias, N, V, back pain, flushing, urticaria, bronchospasms, anaphylaxis-give test dose before full dose |
|
|
Term
| Drugs/foods that reduce Fe absorption. |
|
Definition
| Antacids, coffee, tea, eggs, milk, Welchol, PPI's and cimetidine |
|
|
Term
| Fe reduces the absorption of these meds (4): |
|
Definition
1. Tetracyclines
2. Methyldopa
3. Quinolones
4. Levothyroxine |
|
|
Term
| A def in Vitamin B12 leads to: |
|
Definition
| pernicious anemia (Megoaloblastic anemia) |
|
|
Term
| Types of vitamin B12 preps are? stored? Importance? |
|
Definition
Cyanocobalamin, Hydroxocobalamin.
Stored primarily in the liver.
Essential for cell growth and replication of nerve coverings (myelin sheath) |
|
|
Term
| Vitamin B12 requires _________ for absorption. |
|
Definition
|
|
Term
|
Definition
| meat, eggs, and dairy products (microbrial derived vitamin). Not synthesized by animals or plants |
|
|
Term
| S/S of a vitamin B12 def: |
|
Definition
| paresthesias, weakness in peripheral nerves, spasticity and ataxia. |
|
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Term
| What is the most common cause of Vitamin B12 def? Where is the defect? What does the Schillings test show? |
|
Definition
| Pernicious Anemia. Defective secretion of IF. Schilling test shows diminshed absorption of Vitamin B12 |
|
|
Term
| __________ often masks a B12 def. |
|
Definition
| Folic acid. Do NOT give folic acid only for megablastic anemia |
|
|
Term
| Is a Folic acid def common? What type of anemia is it? What causes it? |
|
Definition
| NO. Its' a megaloblastic anemia w/o neuro sx. Caused by diminished synthesis of purines and pyramidines |
|
|
Term
| Folic acid def is common in what types of people? |
|
Definition
| Alcoholics, liver dz, prego, pts with hemolytic anemia, malaborption syndrome, renal dialysis and drug use (methotrexate, phenytoin) |
|
|
Term
| Erythropoitetin agents do what (2). They are used to tx/prevent what? Most common adverse effect? |
|
Definition
| They are glycoproteins that stimulate RBC proliferation and they induce release of reticulocytes from the BM. Used to tx/prevent anemia. MC adverse effect- HTN and thrombotic complications. |
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|
Term
| Erythropoietin is used to tx what in specific populations? |
|
Definition
| (Erythropoietin agent) Chronic renal failure, HIV, cancer-aplastic anemia, leukemia, myeloproliferative and myelodysplastic disorders. |
|
|
Term
| Darbepoetin is what? It is used to tx what? |
|
Definition
| Erythropoietin agent. It is used to tx anemia of chronic renal failure. Has delayed onset of action, therefore not recommended in acute tx. |
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|
Term
| Definition of a Schedule 1 drug. Examples. |
|
Definition
| Have no accepted medical use in the US, high abuse potential, cannot be prescribed. Examples: Heroin, Cathinone, Fenethylline, Methcathinone, Methylaminorex, Amphetamine variants. |
|
|
Term
| Definition of Schedule 2 drugs. Examples. |
|
Definition
| High abuse potential with severe physical dependence, rx must be written in ink or typewritten and signed by MD. (In emergency MD is required to supply written confirmation of the verbal order with 72 hrs), NO REFILLS! Examples: Coke, Dextroamphetamine (Dexedrine), Hydromorphone, Methylphenidate (Ritalin) |
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Term
| Definition of Schedule 3 drugs. Examples. |
|
Definition
| Prescriptions may be oral or written, up to 5 renewals are permitted within 6 months. Examples: Benzphetmine (Didrex), Chlorphentermine, Clortermine. |
|
|
Term
| Definition of Schedule 4 drug. Examples. |
|
Definition
| Rx may be oral or written (up to 5 renewals are premitted within 6 months). Examples: Norpseudoephedrine, Fencamfamin, Fenproporex, Phentermine (Adipex), Mazindol (Sanorex, Mazanor), Mefenorex, Modafinil (Provigil), Pipradrol, Sibutramine (Meridia), Alprazolam (Xanax) |
|
|
Term
| Definition of Schedule 5. Examples. |
|
Definition
| Consist of preparations containing limited quantities of certain narcotic drugs and are generally for anti-tussive and anti-diarrheal purposes, Rx may NOT be required. Example: Pyrocalerone, Soma, etc. |
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|
Term
| Dependence is not only seen with drug abuse. Individuals can depend on: |
|
Definition
| Broncodilators, nitrate vasodilators and sympathomimetic vasoconstrictors |
|
|
Term
|
Definition
| "Psychological dependence" Consists of compulsive, relapsing drug use despite negative consequences |
|
|
Term
| What system do addictive drugs activate? |
|
Definition
| Mesolimbic dopamine system |
|
|
Term
| Drugs are ONLY addictive if they inhibit? |
|
Definition
|
|
Term
| Can antidepressants can addiction? WHY? |
|
Definition
| NO. Bc they ONLY inhibit NE and serotonin uptake, NOT dopamine uptake. |
|
|
Term
| CNS stimulants can be divided into 2 groups: |
|
Definition
| Psychomotor (Amphetamine, Methyphenidate, caffeine, cocaine and nicotine) and Halluncinogen (LSD, PCP, THC and rimonabant) |
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|
Term
| Major depressants include: |
|
Definition
| Barbs, alcohols (strongest) and benzos |
|
|
Term
| What are the most commonly abused opioids? |
|
Definition
| Morphine, heroin, codeine, meperidine and oxycodone (risk of addiction is 4 out of 5) |
|
|
Term
| Naloxone is useful in tx? |
|
Definition
| Reversing the effects of morphine or heroin in minutes. |
|
|
Term
| Methadone is useful in tx? |
|
Definition
| opiod addiciton. Has long acting activity and given once daily. |
|
|
Term
| Marijuana is known as a __________? It contains? |
|
Definition
| Exogenous cannabinoid. It contains THC (tetrahydrocannabinol) which is a powerful psychoactive substance. Its' 1/2 life is 4 hours. |
|
|
Term
| Effects of cannabinoids include? |
|
Definition
| Euphoria, relaxation, altered perception of time. High doses can result in hallucinations and psychotic episodes. |
|
|
Term
| What is the only FDA approved cannabinoid marketed in the US? |
|
Definition
| THC analog dronabinol (risk of addiction is 2 out of 5) |
|
|
Term
| Medical uses of cannabinoids include: |
|
Definition
| Increased appetite, attenuation of N, decreased IOP and relief of chronic pain. |
|
|
Term
|
Definition
| Gamma-Hydroxybutyric Acid. First introduced as a general anesthetic. Known as "liquid ecstasy" "date rape drug". It is odorless and dissolves in drinks. Max concentration 20-30 min. Effects: euphoria, enhanced sensory perceptions and amnesia. |
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|
Term
| What do amphetamines do in the body? |
|
Definition
| Block reuptake of catecholamines into the pre-synaptic end--> increase and prolong their action in the PNS and CNS--> dopamine prolongation--> euphoria |
|
|
Term
| Amphetamines release what NT? Effects? |
|
Definition
| Release dopamine and stimulate the cerebrum, brainstem and medulla. Effects: increase alertness, motor and speech activity and tiredness and decrease appetite. |
|
|
Term
| Where are amphetamines metabolized? Excreted? |
|
Definition
| Liver. Excreted in urine by kidneys. |
|
|
Term
| Therapeutic uses of amphetamines include: |
|
Definition
1. ADHD- Methylphenidate and dextoamphetamine
2. Narcolepsy- Methyphenidate, Phenelzine and Modafinil
3. Wt control |
|
|
Term
SE of amphetamines include:
Overdose? |
|
Definition
Dysphoria, H/A, confusion, dizziness, fatigue, delirium, cardiac arrhythmias.
Over dose- psychotic rxns, circulatory collapse, coma |
|
|
Term
| How do you tx an amphetamine overdose? |
|
Definition
| Acidification of the urine to increase excretion. |
|
|
Term
| Acute toxic effects of ecstasy (MDMA) include: |
|
Definition
| Hyperthermia and dehydration (fatal at rave parties) and serotonin syndrome (mental status change, hyperactivity, neuromuscular abnormalities and seizures) |
|
|
Term
| What does cocaine do to the body? |
|
Definition
Blocks the reuptake of monamines (serotonin, NE and dopamine) into the pre-synaptic end--> increase and prolong their action in the PNS and CNS--> dopamine prolongation--> euphoria
Impairs sweating and skin vasodilation --> hyperthermia--> increase death |
|
|
Term
| Max effect of cocaine peaks in? |
|
Definition
| 10-20 min and lasts 1-2 hrs |
|
|
Term
| Is there an antagonist tx for cocaine overdose? |
|
Definition
|
|
Term
|
Definition
1. Increase HR, HTN which may produce or exacerbate angina MI and arrhythmias
2. Increase dose may cause hyperpyrexia and seizures
3. Anxiety, sweating and paranoia
4. CNS stimulation followed by depression and agitation (esp after withdrawl)- tx with benzos |
|
|
Term
| Does cocaine cross the placenta? Affect breast milk? |
|
Definition
| YES- accumulates in the fetus, causes increase rate of spont abortion, fetal growth anomalies. Can be transported to baby via breast milk also. |
|
|
Term
| LSD, Mescaline and Psilocybin are classified as..? |
|
Definition
| Hallunincogens/Psychotomimetics |
|
|
Term
| What are the effects of hallucinogens on the body? |
|
Definition
| They alter perception and consciousness--> individual incapable of rationalizing or making normal decisions, sensing things not present and flashbacks |
|
|
Term
| What are the psychosis-like manifestations produced by hallucinogens? Do they produce dependence/addiction? Long-term effects? |
|
Definition
| Depersonalization, hallucinations and distorted time perception. No dependence/addictive properties. DO have long-term effects. |
|
|
Term
| How does nicotine affect the body? |
|
Definition
Interacts with Ach receptor on the postsynaptic membrane on autonomic ganglia--> stimulation
One of the MOST addictive drugs! (4/5) |
|
|
Term
| Where is nicotine absorbed? Where is it metabolized? Eliminated? |
|
Definition
| Absorbed through skin, respiratory tract and buccal. Metabolized: liver and lungs. Eliminated: kidneys. Excreted in breast milk. |
|
|
Term
|
Definition
| Tremors, convulsions (large doses-depressive effect); small doses stimulate respirations; stimulate release of ADH; tachycardia, increased BP, increase bowel motility, increase salivary and bronchial secretion at first (then blocked) |
|
|
Term
| Benzodiazepines are prescribed as? |
|
Definition
| Anxiolytics and sleep meds. |
|
|
Term
| Are Benzo's commonly abused? |
|
Definition
| Yes. They are commonly mixed with other drugs to lengthen their euphoric effects. |
|
|
Term
| When are the effects of alcohol dependence seen? |
|
Definition
| 6-12 hrs after cessation of heavy drinking |
|
|
Term
| Withdrawl effects of alcohol include: |
|
Definition
| hand tremor, N/V, sweating, agitation and anxiety (no single receptor mediates all effects) |
|
|
Term
| Oxazepam and Lorazepam are _____________ used in the tx of _________. |
|
Definition
|
|
Term
| Disulfiram is useful in treating what? Causes? |
|
Definition
| Aversion to drinking. Causes N/V and dysphoria. |
|
|
Term
| Naltrexone is useful in treating? Effects? |
|
Definition
| Decrease effects of alcoholism. Has only modest effects, combination with behavior therapy has shown to enhance effectiveness. |
|
|
Term
| Is Topiramate FDA approved for alcohol tx? Effects? |
|
Definition
| NO- but it DOES decrease dopamine release and reduces cravings |
|
|
Term
| Ketamine and Phencyclidine (PCP) are used as? |
|
Definition
| general anesthetic. ONLY ketamine is still used. |
|
|
Term
| What form does Ketamine and PCP come in? (AKA "special K, angel dust, hog") |
|
Definition
| Pure forms are white crystalline powders but sold on the street as liquids, capsules, pills (are snorted, ingested, injected and smoked). |
|
|
Term
| Ketamine and PCP effect the body by? |
|
Definition
| Decreasing the reuptake of dopamine, 5HT and NE block ion channel regulated by NMDA |
|
|
Term
| Ketamine and PCP's psychedelic effects last? SE? |
|
Definition
| 1 hour (vivid dreams and halluncinations). SE: HTN, impaired memory, visual alterations |
|
|
Term
| Nitrates, ketones, aliphatic and aromatic hydrocarbons are types of? |
|
Definition
| Inhalants that are found in household and industrial products. |
|
|
Term
| Inhalants are taken into the body by which 3 ways? |
|
Definition
| Sniffing (inhalation from an open container), Huffing (soaking of a cloth in vapors then inhaling), Bagging (breathing in and out of a bag with fumes) |
|
|
Term
| Inhalants commonly produce feelings of? |
|
Definition
| Euphoria and excitability. |
|
|
Term
| Amyl nitrate (poppers) are? Produce what type of effects on the body? |
|
Definition
| Inhalants. Produce smooth muscle relaxation and enhance erection |
|
|
Term
| Chronic use of inhalants are seen in internal organs, esp __________________. |
|
Definition
| White matter lesions in CNS |
|
|
Term
| What is LSD? How does it affect the body? SE? |
|
Definition
| (Lysergic acid diethylamide) Serotonin agonist. Binds to 5-HT1 and 5-HT2 receptors--> stimulate SNS--> pupillary dilation, increase BP and increase temp. SE: N/V, muscle weakness, color hallucinations and psychosis. |
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