patient passes tape worm segments (proglottids) - most likely Taenia saginata (beef tapeworm) or a patient who likes to eat sushi passes tapeworm segments - most likely to be Diphyllobothrium latum (fish tapeworm)

Tx? 

niclosamide or praziquantel

Patient may have Taenia solium, pork tapeworm, which may

produce cysticercosis (larval cysts) in the brain, orbit, muscles, liver and lungs. 

Tx cysticercosis w albendazole

Patient has unknown type of tape worm 

Praziquantel is DOC if identity of the type of tapeworm is uncertain

Baby w anal itching (pruritis) and a postive “cellophane tape” test = pinworm infestation 

tx w mebendazole or pyrantel pamoate

Patient w mixed infestation = cestode (tapeworm) + trematode (fluke) 

 praziquantel

immunocompromised patient w mucocutaneous HSV infection

acyclovir

patient w HSV encephalitis

acyclovir

patient w genital HSV infection

Acyclovir

Keratoconjunctivitis caused by HSV

trifluridine (trifluororthymidine)

immunocompromised patient w CMV infection, 

Ganciclovir 

Patient w gonorrhea 

- tx w penicillin for 8 weeks 

patient w gonorrhea --> treated --> patient returns with similar symptoms but no diplococci in urine (no longer has gonorrhea) 

what does pt have? tx? 

patient has Chlamydia

infection - tx w doxycycline unless patient is a pregnant female, then tx w erythromycin

Patient has Streptococcus infection and is allergic to PCNs 

tx w erythromycin or

              another macrolide (azithromycin, clarithromycin)

Patient w AIDS develops infection w Pneumocystis carinii 

Tx w trimethoprim –

                        sulfamethoxazole (T-S)

            patient w pneumonia, but bug negative for gram stain - probably an atypical bug 

   macrolide like erythromycin

gram (+) pneumonia

 probably Streptococcus pneumoniae

tx w cephalosporin

schizophrenic patient w depression 

SSRI like fluoxetine

depressed pt w hypotension 

SSRI like Fluoxetine 

Depressed patient being tx w antidepressant suffers from sedation and hypotension 

TCA

Two drugs that cause sleepiness and hypotension

MAOis and TCA

TCA >> MAOis 

*TCA greater orthostatic hypotension 

small child w nocturnal enuresis 

What effect on urinary bladder?

TCA for atropine like-effect

What neurotransmitter is involved in OCD 

5-HT

Tx for OCD

clomipramine or SSRI (e.g fluoxetine)

depresssed patient w CHF tx w digoxin is given TCA 

inverts or flattens T-waves, slows conduction in fast fibers so QRS increased

 OD with imipramine

usual effects are ↓ BP from alpha-blockade; ↑­ HR from ↓ BP and anticholinergic effects; decreased AV conduction with ↑­ Q-T interval

serotonin syndrome = results from excessive stimulation of central 5-HT receptors

­↑ BP, HR and respiration; increased muscle activity (muscle twitching, shivering, myoclonus) causing hyperthermia and sweating; pupillary dilation; confusion, agitation, hallucinations

MAOI + TCA 

hyperpyrexia, convulsions, coma, death

patient being treated for Giardia + some other infection (e.g., bacterial) develops n/v and headache after drinking a beer. Which drug causes this rx 

metronidazole

morphine is DOC for pain and pulmonary edema caused by acute MI bx it acts on CNS to dec SNS activity

dec preload and afterload

tx of female w acute pain from gallstones w morphine causes greater pain. Why? 

Morphine contracts smooth muscle of gall bladder

female on methadone has emergent surgery and is tx w butorphanol; patient  experiences S/S of opiate withdrawal.  Why?  

Butorphanol is a partial agonist at mu

              receptors.  The partial agonists pentazocine, nalbuphine and buprenorphine can also cause

              S/S of opiate withdrawal in a patient taking methadone.

which opiate does not cause a dose-related inhibition of respiration 

 the partial agonists pentazocine, butorphanol and nalbuphine

newborn baby has respiratory depression bx mom received an opiate during labor

I dont know where he was going with this

patient with MI tx with morphine, why?  

  Morphine acts centrally to decrease pain and to decrease

              sympathetic outflow.  Decreased activity of the SNS decreases preload and afterload and

Anaphylaxis w/ severe hypotension 

tx w EPI + diphenhydramine (H₁-blocker) and

             cimetidine (H₂-blocker) bx hypotension via stimulation of H₁- and H₂-receptors

  A patient w GERD is being treated with cimetidine requires allergen testing by a dermatologist

Must d/c cimetidine to ensure accuracy of skin tests.  Tx GERD w

             omeprazole during allergy testing.

Patient has insomnia from depression

tx with a TCA but patient still has insomnia.  Give

            an antihistamine (e.g., diphenhydramine) to induce sleep, and patient gets urinary retention

What drug induces emesis by stimulating D₂-receptors in the CTZ?

apomorphine

A patient with S/S (confusion/coma) of portal-systemic encephalopathy needs tx

lactulose which acidifies the bowel to trap ammonia as ammonium ion; ammonium lost in feces; plasma [ammonia] falls; coma and confusion disappear

Which antiulcer drug does not alter stomach pH

sucralfate

Patient on propranolol takes cimetidine for heartburn and develops severe bradycardia

Bx cimetidine inhibits CYP450 and thus blocks the metabolism of propranolol

antacids and GI tract

Aluminum: ?

Magnesium: ? 

Al: Constipation

Mg: Diarrhea

Pat being tx w doxycycline; which drug contraindicated? 

Al/Mg antacids

 Patient needs emergency surgery; need to empty stomach/prevent reflux. 

metoclopramide = prokinetic in stomach and bowel and tightens the LES

Cancer chemo patient has n/v and noctural acid reflux  

metoclopramide

Patient has post-operative paralytic ileus Tx 

metoclopramide, bethanechol, cisapride

Patient treated with drug for Crohn’s disease or ulcerative colitis develops hepatic damage or bone marrow depression.  

Sulfasalazine; patient is a slow acetylator

tx for patient diagnosed with ulcerative colitis or Crohn's disease

mesalamine, olsalazine

s/s of laxative abuse w castor oil or bisacodyl 

constipation, hypokalemia, muscle

            weakness, abnormal architecture inner GI wall

half-life of aspirin as only 1 h, why does it inhibit platelet inhibition for a longer period?

Aspirin irreversibly acetylates active site of COX-1 in platelets

How does aspirin prevent platelet aggregation when it is not taken in doses large enough to maintain a steady-state plasma concentration?

Aspirin irreversibly acetylates active site of COX-1 in platelets

patient has intermittent episodes of hemiplegia which resolve spontaneously; would like to treat with aspirin, but patient has aspirin “hypersensitivity”; Tx w? 

clopidogrel, ticlopidine

What is the causative compound in aspirin hypersensitivity? 

Leukotrienes

DOC for menstrual cramps 

 ibuprofen

   Baby has patent ductus arteriosus

Close with? 

indomethacin

Want to keep ductus arteriosus open prior to surgery: what drug will do this ? 

alprostadil = PGE₁ analog dilates the ductus arteriosus

pat tx with NSAID develops GI ulceration

MOA = inhibition of gastric PG synthesis

A patient with nasal polyps who has wheezing with aspirin needs a antipyretic drug

DOC  = acetaminophen

Acetaminophen

anti-pyretic or antiinflammatory? 

anti-pyretic

Drug OD; initially blood chemistries normal, but 36 h later see increase in AST and ALT? Q: what is the drug

acetaminophen; treat with n-acetylcysteine to replenish glutathione

Patient on NSAID for tendonitis for 2 weeks develops fever and hematuria: diagnosis?

acute interstitial nephritis

histologic photo of kidney tissue with lots of lymphocytes: diagnosis?

Interstitial nephritis caused by aspirin or another NSAID

Patient with CHF takes ibuprofen; effect on kidney = ?

Constriction of afferent arteriole lowers RBF and GFR to cause salt\water retention; no PG's to partially inhibit the effects of ADH in the collecting duct = water retention.

Patient tx with NSAID for arthritis exhibits ↓ [Hb] and Hct and has occult blood in his stool.  Which drug could be addded to tx to reverse this pathology?  

misoprotol

Patient with a renal transplant is taking the immunosuppressant drug: azathioprine.

allopurinol

bx azathioprine is converted to the cytotoxic agent 6-mercaptopurine (6-MP) which kills antigen presenting cells and T- and B-lymphocytes, and 6-MP is inactivated (metabolized) by xanthine oxidase.

Patient with lymphoma tx with chemo.  Which drug will prevent ↓ in renal function?  

allopurinol

**Chemo kills lymphoma cells which release  nucleic acids which are converted to urate; excessive urate in urine crystalizes to occlude the collecting ducts, pelvis and ureters; rapid, progressive renal dysfunction develops; allopurinol prevents the formation of urate

Which drug is not uricosuric?  

allopurinol and colchicine

DOC for severe hyperuricemia

allopurinol

Patient with gout treated w probenecid gets remineralization of bone.  Why?

increased urinary excretion of urate

patient takiing a small daily dose of aspirin may develop gout whereas a large daily dose of aspirin is used to treat gout. 

Why the discrepancy?  

Small doses of aspirin enhance urate

            reabsorption in the renal tubule whereas large doses of aspirin are uricosuric

Patient being tx for gouty arthritic develops leukopenia.  Which drug ? 

colchicine

Patient treated with propranolol; which drug will still bronchodilate?

theophylline or aminophylline act via intracellular inhibition of PDEase

Asthmatic patient treated with theophylline develops a sinus infection which requires

            tx w an AB;  Which AB would require adjustment of the daily dose of theophylline?

Erythromycin because it inhibits CYP450 which is the enzyme that metabolizes theophylline

asthmatic patient taking theophylline develops seizures after taking an OTC drug for heartburn. drug = ?  

cimetidine which blocks the CYP450 which metabolizes theophylline

 Which drug causes the greatest increase in FEV₁ with the smallest increase in HR?

albuterol

patient  w exercise-induced asthma uses cromolyn prophylactically.  MOA ? 

cromolyn

   prevents Ca⁺⁺ influx into mast cells when IgE bridges form = no mast cell degranulation

A patient with normochromic, macrocytic anemia has distal paresthesias.  The patient is treated with p.o. folate and the anemia disppears, but  the neurological S/S worsens. 

What happened?  

 Folate will correct the megaloblastic anemia, but the neurological syndrome results from B₁₂ deficiency because B₁₂ is needed for the synthesis of myelin.

A patient being treated with phenytoin, isoniazid, pyrimethamine, trimethoprim or methotrexate develops normochromic, macrocytic anemia.  Why?  

Phenytoin and isoniazid interfere with the GI absorption of folate.  Pyrimethamine, trimethoprim and methotrexate inhibit DHF reductase.  Reverse megaloblastic anemia in pat on methotrexate w leucovorin

A patient on hemodialysis develops normochromic, macrocytic anemia.  Why and what to do about it?  

Hemodialysis removes plasma folate.  Patients on hemodialysis must  be treated with erythropoetin (EPO), folate and ferrous iron.

A patients with a Hct. 24 is started on hemodialysis.  After tx with EPO, folate ferrous iron, the patient develops HT.  Why?  

As the Hct is increased by increased production of RBC's, the viscosity of blood rises.  According to Poiseuille's law, resistance is directly related to viscosity. The increase in Hct increases the resistance to flow, so BP increases.

Which drug could be used for "blood doping" (i.e., increased Hct) in competitive cycling?  

EPO, epoetin alfa, darbepoetin

Which drug suppresses cellular immunity, blocks the synthesis of PG’s and LT’s and increases neutrophil count in blood?

Glucocorticoids

 Pg woman develops hyperthyroidism.  How to treat? 

propylthiouracil (PTU) 

What are the usual causes of hyperprolactinemia and their treatment?  

A: blockade of

            D₂-dopamine receptors and increased TRH in hypothyroidism cause hyperprolactinemia.  A: in hypothyroidism, tx w thyroxine to suppress plasma [prolactin]

patient w recurrent v. tach/v. fib. develops hyper- of hypothyroidism while taking amiodarone.  Why?  

Amiodarone is 37% iodide by weight.  This iodide can either prevent the conversion of T₄ to T₃ (hypothyroidism), or it can serve as

substrate for the synthesis of T₃ by thyroid peroxidase

A patient with type 2 DM develops lactic acidosis while taking a drug.  drug = ?  

A: metformin bx metformin increases glucose utilization via anaerobic pathways (glucose → lactate → lactate)

Which drug decreases hepatic glucose production in a type 2 diabetic patient without enhancing the pancreatic secretion of insulin?  

metformin

why are metformin and pioglitazone given together? 

they have additive effects to decrease insulin resistance

patient with malar (buterfly) rash, arthritis, polyserositis: urine shows proteinuria and microscopic hematuria  Dx = ? tx? 

SLE  Tx w ? A: prednisone or any other –sone or –lone drug

Pt tx w/ β-blocker for angina --> d/c drug --> increased cardiac β-receptor stimulation --> increased O2 demand --> pt gets angina and MI!!

what happen? 

Beta-blocker w/drawal S/O: tachycardia, tremor, palpitations, chest pain 

Patient w/ hyperthyroidism 

Tx and why? 

Propanolol to ↓ tachycardia and tremor and prevent the peripheral conversion of T4 --> T3

Type 1 diabetic pt tx w/ glaucoma rx which causes hypoglycemia. 

Which rx is pt taking? 

Timolol

**decreases IOP w/ cyclopegia but blocks glucagon secretion caused by blockage of B-receptors in the pancreas. 

Ace inhibitors MOA in treating CHF? 

1) increase CO by decreasing preload and afterload

2) reverse cardiac remodeling caused by Ang II

HTN pt w/ DM

tx w/ what? 

ACE I to ↓BP and ↓proteinuria

Pt w/ DM and microalbuminuria 

Tx w/ ACEI and ARB to ↓proteinuria 

Pt tx w/ OCP containing estrogen + norethindrone develops hirsutism- why?  and how to tx? 

Hirsutism results from androgenic effects of progestin norethindrone which is a derivative of 19-norestosterone.

Tx w/ spironolactone. 

Pt w/ adrenal tumor or hyperplasia has ↑BP and plasma HCO3, ↓plasma K+ and PRA, plasma [Na+] is normal.

dx and tx? 

1° hyperaldosteronism, tx w/ spironolactone

Pt w/ atrial fibrilation given quinidine to slow ventricular rate, but ventricular rate ↑ soon after quinidine 

Why? what about it? 

Immediate atropine-like effect of quinidine

tx w/ verapamil and diltiazem to ↑AV conduction and slow ventricular rate. 

Pt requires an antiplatelet drug after MI or stroke, but pt has aspiring hypersensitivity? 

How to tx? 

Clopidogrel or Ticlopidine

Pt ODs w/ warfarin or attempts suicide w/ rat poison? which clotting factors? 

↓2, 7, 9, and 10

Pt has a cardiac dysrhythmia and tx w/ warfarin? 

which dysrhythmia is it? 

Atrial fibrillation

Pt w/ MI treated w/ several rx, and develops intracranial bleeding --> which drug caused it? 

Streptokinase