dua_frank
03-14-2005, 09:13 PM
[drsujitvasanth] hi frank
[drsujitvasanth] is there a steo 2 discussion today?
[dua_frank] hi
[dua_frank] yeah there is but nobody's here yet
[drsujitvasanth] ah ok...
[dua_frank] they'll be here in 5 minutes
[drsujitvasanth] cool
[dua_frank] thanks for the file :)
[drsujitvasanth] no problem...thanks for your file too...
[dua_frank] how was your day at studying today?
[drsujitvasanth] good...i read on my weak subjects....
[drsujitvasanth] Surgery and Obgyn
[dua_frank] those are my weak subjects too. i will be doing those next i guess
[drsujitvasanth] and did a practice test...improved on those sbjects but sam everall score...my familly kept disturbing me....
[drsujitvasanth] will be back in a few minutes....my brother wants some help on excell..
[dua_frank] ok sure
[dua_frank] hi sammy
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[lanny] hey all
[dua_frank] hey lanny
[dua_frank] so today's the day for "left overs"
[dua_frank] shall we start?
[dua_frank] oops sorry
[dua_frank] todays pharmacology
[lanny] yes dua
[dua_frank] man diagnosed with malaria, goes back to USA and now complains of proximal muscle weakness. dx?
[dua_frank] drug induced myopathy
[dua_frank] due to chloroquine
[dua_frank] affects type 1 fibres. steroids affect type 2 fibres of the muscle
[lanny] thx dua
[dua_frank] welcome
[dua_frank] rx of hairy cell lukemia?
[lanny] claridabine
[dua_frank] alpha interferone
[lanny] cladirabin can be used too
[dua_frank] ok thanks
[uniteus] hi
[lanny] hi uni
[dua_frank] can benzodiazapines cause death due to resp depression?
[dua_frank] hi uni
[dua_frank] no they can't
[dua_frank] how about hallucinogens?
[uniteus] yes
[dua_frank] nope
[uniteus] oh ok
[dua_frank] opiates, alcohol, barbs,and cocaine can
[lanny] but they can cause resp depression
[dua_frank] not death lanny
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[lanny] in benzo
[dua_frank] yeah
[lanny] yes dua not death
[dua_frank] but not as severe as barbs
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[lanny] right barbiturates are more
[lanny] what is synergisitc with barb in causing death?
[dua_frank] name all drugs that can be used for v fib
[dua_frank] all cns depressants
[dua_frank] alcohol
[dua_frank] benzos
[uniteus] amiodarone, epinep, lidocaince
[megs] phenytoin, lignocaine
[uniteus] for df
[dua_frank] bretylium, magsulf and procainamide too
[lanny] calcium gluconate
[samantha] lidocaine amiodarone and procainamide
[lanny] if hyperkal
[megs] lanny can u explain pl???
[dua_frank] drugs for A fib?
[lanny] v fib is seen with hyperkalemia megs
[megs] digoxin, gor atrial fibril also deltiazine verapamil
[lanny] or hyperkalemia can cause v ifib
[uniteus] digoxin, bblockers, procainamide, sotalol, amiodarone for af
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[lanny] so give calcuum to protect the heart
[megs] no lanny i was asking about drug reaction of barbturate leading to death???
[dua_frank] good also quinidine and anticoagulants
[dua_frank] drugs for PSVT?
[megs] adenosin verapamil
[lanny] oh alcohol when comined with barb c an cause death i mean like binging on alcohol
[lanny] megs
[uniteus] adenosine for svt
[lanny] agree uni
[dua_frank] yes also verapramil
[lanny] whats s effect of adenosini
[dua_frank] what anticoagulant would you give in Afib?
[lanny] dua whats s effect of verapamil
[uniteus] warfarin? dua
[lanny] you told us some days ago
[dua_frank] yes uni
[dua_frank] it causes nodal block
[lanny] warfarin
[dua_frank] AV nodal
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[lanny] ok thx dua
[dua_frank] welcome
[lanny] adenosine s e is torsades
[dua_frank] what drugs would you use in bradycardia?
[dua_frank] yes
[dua_frank] what was the drug used to trat torsades?
[megs] TARSADE GIVE MAGNESIUM
[lanny] phenytroin
[dua_frank] thanks megs
[dua_frank] brady drugs?
[megs] didnt know lanny that adenosin causes torsades...is it???
[uniteus] atropine, epinephrine
[megs] atropin and isoptotenol dua
[dua_frank] yes
[lanny] megs i thought so am i wrong
[drsujitvasanth] torsades..treat with MgSO4 avoid all other drugs or cardiovert....
[drsujitvasanth] thats what i wsa tauhg anyway lol
[megs] side effects of adenosin are v firillation cardiac arrrest and heart blocks
[drsujitvasanth] and 1 other...
[drsujitvasanth] brchospasm
[drsujitvasanth] contraindictaed in asthmatics
[uniteus] aspirin
[drsujitvasanth] aspirin contraindicated in asthmatics with nasal polyps...
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[megs] what are other contraindicatons of aspirin
[dua_frank] hey sujit, welcome back
[drsujitvasanth] bleeding. asthma with polyps.
[drsujitvasanth] thanks frank...
[megs] history of gi bleeding and other bleeding disorders ..
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[dua_frank] so what will you give to a patient who is contraindicated to aspirin?
[drsujitvasanth] dipyridamole
[drsujitvasanth] or clopidogrel
[uniteus] clopidorel
[drsujitvasanth] depends on the contraindication
[dua_frank] explain please sujit
[megs] teah depend on contraindications
[drsujitvasanth] if the problem is bleeding then you dont give anything
[dua_frank] oh right
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[dua_frank] i was talking about aspirin allergy
[dua_frank] thanks
[lanny] clopidogrel is right
[megs] what nsaid u give for the pt with history of peptic ulcer???
[drsujitvasanth] now none...
[drsujitvasanth] lol
[dua_frank] lol
[drsujitvasanth] cox 2 inhibs cause MI's
[dua_frank] yep
[dua_frank] got to be careful never to answer cox 2 now
[dua_frank] banned
[lanny] dont think so dua
[drsujitvasanth] they still have some use apparently....
[dua_frank] in what sujit?
[dua_frank] its off the market now
[drsujitvasanth] som epatients post CABG/stent get iv cox 2 inhibs...
[dua_frank] never sujit
[drsujitvasanth] i got a pharm letter about it the other week
[dua_frank] those are the patients who presented with MIs too
[drsujitvasanth] lol..i know
[lanny] dua if they bann it it wont be in the options
[dua_frank] it's like yuo're killing them right after treating them lol
[drsujitvasanth] i didnt read the article much so i dont know the details...
[dua_frank] lanny, considering the current events, you're safe never to pick cox 2 now
[megs] so you will not give cox 2 inhibitor
[dua_frank] its a goner
[dua_frank] nope megs, its off the market
[drsujitvasanth] unless the question is old....
[megs] ok
[dua_frank] even in those patients who did not have any previous cardiac problems, its causing MIs lol
[drsujitvasanth] presumably todyas discussion is pharm? What are the commonest ones asked....
[dua_frank] i still remember how badly the surgeons in our CT unit panicked after they read about cox inhibitors
[uniteus] :o scary
[drsujitvasanth] <-- bad at psych pharm
[dua_frank] yeah it was uni, we don't even have a proper record of how many died due to the drug and not post CABG
[drsujitvasanth] frank...the risk actually is v small increase...
[drsujitvasanth] i get the feeling its around 1 extra death per thousand or so...
[dua_frank] its significant in CABG sujit, post CABG mortality rates are high anyway, you don't want to add more to it
[drsujitvasanth] roughly how high?
[dua_frank] in our uni at least one per 50 but thats india for you
[drsujitvasanth] 2%....
[drsujitvasanth] normal operative risk is 1/1000
[dua_frank] oh
[drsujitvasanth] thats pretty high
[dua_frank] yeah it is
[dua_frank] its india :)
[dua_frank] :P
[drsujitvasanth] indian doc are v good...actually ...lol
[dua_frank] yeah but post op care matters too sujit
[dua_frank] 75% of the success depends on post CABG care
[drsujitvasanth] ah...
[dua_frank] unfortunately we don't have the facilities
[lanny] dua are you in india now
[drsujitvasanth] true..
[dua_frank] no i'm in US now lanny
[uniteus] which one cause increase digoxin toxicity high or low K?
[lanny] ok
[dua_frank] low
[lanny] hypo
[drsujitvasanth] low
[uniteus] rt
[uniteus] what is complication of dig toxicity?
[drsujitvasanth] hmph...
[drsujitvasanth] arrythmia
[uniteus] type of arrythmia?
[drsujitvasanth] not sure
[dua_frank] SVT
[dua_frank] all types actually
[drsujitvasanth] ah..
[drsujitvasanth] i think also AF!
[drsujitvasanth] seriously...
[drsujitvasanth] traetment?
[uniteus] not all dua
[dua_frank] dig
[dua_frank] anticoagulants
[uniteus] atrial fib, flutter, mobitx type 1,atrial tachy with av block
[drsujitvasanth] treatmet of dig txicity...
[dua_frank] you expect me to remember all that uni? :P
[uniteus] :)
[drsujitvasanth] thanks uni
[uniteus] urw
[drsujitvasanth] basically its atrial and nodal...
[drsujitvasanth] to summarise lol
[uniteus] agree
[drsujitvasanth] dig toxicity....Rx
[dua_frank] digibind
[drsujitvasanth] yup
[dua_frank] rx arrythmias appropriately
[drsujitvasanth] yup
[drsujitvasanth] 1 more thing...
[dua_frank] potassium?
[drsujitvasanth] yep!
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[drsujitvasanth] well..correct hypokalaemia anyway...
[drsujitvasanth] if its there...
[dua_frank] right
[drsujitvasanth] AIDS medications....does anyone understand them?
[drsujitvasanth] i need help there
[dua_frank] AZT DDI DD
[dua_frank] something
[dua_frank] we can go over them if you like
[drsujitvasanth] ah...
[drsujitvasanth] yes please
[drsujitvasanth] whats the title for todays chat?
[drsujitvasanth] (wanted to make sure to stay on topic)
[dua_frank] pharma
[drsujitvasanth] k
[drsujitvasanth] which drugs and what side FX in AIDS?
[drsujitvasanth] AIDS Rx
[dua_frank] basically you give a combination
[dua_frank] of two nucleoside inhibitors plus one protease inh
[drsujitvasanth] ah...
[drsujitvasanth] that sounds familliar
[dua_frank] N inhs are zidovudine, didanosine, lamivudine, stavudine and zalcitabine
[drsujitvasanth] <-- taking notes
[dua_frank] P inhs are indinavir, nelfinavir, ritonavir and saquinavir
[megs] azt+3tc+indinavir is used mostly
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[drsujitvasanth] thanks meg :)
[dua_frank] the only way it works is just start with 2+1 combo
[dua_frank] and if it doesn't work, try another combo
[drsujitvasanth] got it
[drsujitvasanth] side fx?
[dua_frank] so zidovudine, lamivudine and indinavir basic combo
[dua_frank] so many sujit :(
[drsujitvasanth] they ask them...
[megs] how will u say the drug is working or not???
[megs] what is criteria???
[drsujitvasanth] ?decreased viral load?
[dua_frank] ok let me work this out
[drsujitvasanth] inc CD4?
[uniteus] check the viral load? n cd4 count?????
[megs] yeah uni
[drsujitvasanth] i think htats what conrad ****** says...
[megs] viral load should reduse to 50% by 1 month
[dua_frank] all those that affect nerves causing peripheral neuropathy are DDI,, stavudine, zalcitabine,satquinavir
[megs] then we say drug is working
[drsujitvasanth] <-- taking notes...
[drsujitvasanth] thanks guys. am learning a lot!
[dua_frank] zido causes everything almost
[uniteus] the combonition drug is called HAART (highly active retorviral therapy)
[dua_frank] anemias, hepatomegaly, neuro, pancreatitis etc
[drsujitvasanth] i only remembered 2 - neuropathy and anaemia
[dua_frank] diverse SEs think Zido
[drsujitvasanth] ill add the others...
[dua_frank] i don't think they would ask more than this sujit
[drsujitvasanth] cool!
[drsujitvasanth] hey this is slightly off subject.....
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[dua_frank] but what do i know, not like i'm making the qs :P
[drsujitvasanth] neuro diseases in AIDS.....
[megs] which anti hiv drug causes psycological disturbances???
[drsujitvasanth] ?dunno
[megs] EFAVIRENZ...
[dua_frank] never even heard of it megs *)
[dua_frank] must be new
[megs] its non nuleoside reverse trancriptas inhinbitor
[drsujitvasanth] has been noted! That would be a good q
[dua_frank] oh nice megs, i knew only of nevirapine
[dua_frank] which causes steven johnson's synd or TEN
[megs] what is side effect of nevirapin???
[drsujitvasanth] TEN?
[drsujitvasanth] whats ten?
[megs] nevirapin cause rash///
[uniteus] pcn, sulfa drugs for steven johnso
[megs] so does is cause so severe to cause TEN DUA???
[dua_frank] toxic epidermal necrolysis
[dua_frank] yes megs
[drsujitvasanth] ah
[lanny] im back guys had to leave a bit
[dua_frank] wb lanny
[drsujitvasanth] hi lanny
[drsujitvasanth] wb
[megs] U MEAN ANTI HIV DRUG THAT CAUSES STEVEN JOHNSONS...IS VEVIRAPIN
[dua_frank] yes
[megs] good to know dua
[uniteus] oh i thought u mean in general dua...lol
[dua_frank] HIV drugs causing pancreatitis?
[dua_frank] lol i knew you were sleeping again uni
[uniteus] ddi not anymore
[megs] ddi and ddc
[dua_frank] ddi, lamivudine, zalcitabine
[drsujitvasanth] how do you convert from ddx to the full name?
[megs] why ddi not anymore uni???
[dua_frank] infections
[uniteus] ooh sorry megs...i meant "not anymore" to dua ..that i am not sleeping... sorry
[drsujitvasanth] lol
[megs] ddi is didanosin..and ddc is zalcitabin
[dua_frank] lol
[megs] ok uni
[drsujitvasanth] ah k...
[lanny] indinavir causes pancreatitis dua
[dua_frank] not according to my book lanny
[lanny] oh sorry kidney stones?
[dua_frank] yes that it does
[megs] no lanny i too diagree
[dua_frank] it attacks the BM, kidney and liver
[uniteus] agree megs
[lanny] its kidney stones megs
[dua_frank] so does zido
[dua_frank] kidney stones only for indinavir though
[lanny] agree dua
[uniteus] agree dua
[megs] which hiv drug is teratogenic???
[drsujitvasanth] hmm
[dua_frank] which one attacks optic nerves?
[lanny] nelfinaveenz
[dua_frank] zido
[megs] acually none of then..except efavirenz..which is shown to be teratogenic in animals
[dua_frank] oh
[dua_frank] but breastfeeding is contraindicated in zido megs
[dua_frank] so what does that mean it is?
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[drsujitvasanth] zido is safe cus its given to preg HIV mothers
[lanny] agree dr
[dua_frank] maybe not to cause additive toxicity or something
[dua_frank] yeah i know sujit
[dua_frank] but it has this contraindication, confusing...
[megs] breast feeding is contraindicated to prevet hiv transmission to baby
[drsujitvasanth] maybe it accumulates in breast milk...
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[drsujitvasanth] ah...meg is right.....
[megs] its not due to..azt ...
[dua_frank] no no
[drsujitvasanth] thats exactly right
[dua_frank] book says what i said
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[megs] dua which book
[dua_frank] refer oxford handbook of clinical medicine
[drsujitvasanth] oh ok...well who knows lol
[dua_frank] page 586
[megs] we give azt to baby too..for 6 weeks
[megs] so i disagree that totally
[dua_frank] yeah but its confusing
[dua_frank] why would they write a contraindication like this then
[drsujitvasanth] try a pharm book....
[dua_frank] esp when you are suppossed to give it
[dua_frank] not giving is like inhumane
[dua_frank] you let both the mother and child die
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[drsujitvasanth] you can just change to a different nuclease inhib lol
[drsujitvasanth] not a matter of life or daeth
[dua_frank] yeah but azt is proved to reduce mortality rates and risk of infection of fetus
[drsujitvasanth] yep..htats the one i think theyll ask...
[megs] http://www.projinf.org/fs/azt.html#who
[dua_frank] thanks
[drsujitvasanth] ok someone pick a topic.....
[dua_frank] how will you manage acute ASA toxicity?
[lanny] 8 % reduction in vert transmission
[dua_frank] from 30% to 8% lanny
[megs] what will give for post exposure prophylaxis to hiv??
[dua_frank] or 25 to 8
[uniteus] alkaline urine, give oxygen, supporitve for ASA toxicity...
[dua_frank] yes uni, hemodialyse if severe
[drsujitvasanth] uni...plus overdose measures....
[uniteus] ok..thx
[drsujitvasanth] charcoal +/-gastric lavage
[lanny] it was 25 % before but if mum starts taking AZT it red to 8%
[drsujitvasanth] megs: is it monotherapy with AZT?
[drsujitvasanth] or combo?
[dua_frank] name drugs with narrow therapeutic index
[lanny] lithium
[drsujitvasanth] Lithium, theophyline
[megs] yeah sujit
[dua_frank] any more?
[drsujitvasanth] thanks megs....
[lanny] valp acid??
[dua_frank] also one of the antiseizure megs
[dua_frank] val or cbz lanny? don't rememebr
[drsujitvasanth] carb i think
[drsujitvasanth] never heard of valproate levels....
[uniteus] MgSO too?
[drsujitvasanth] i dont think so...
[dua_frank] i wish we had a list
[dua_frank] then we can be careful with a case presentation of acute toxicities
[drsujitvasanth] you can give a reasonable amount of MgSO4 before txicity i thauhgt....
[lanny] dua maybe its phenytoin i think
[lanny] it is an aniti seizure drug
[drsujitvasanth] <-- not sure
[dua_frank] never heard of mgso4 too
[lanny] can a woman on phenytuoin breast feed?
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[drsujitvasanth] Phenytoin is v dangerous in overdoes I thaught...
[megs] digoxin...also have very low ther index
[lanny] yes sujit it is an antiarrythmic class1
[drsujitvasanth] ah
[dua_frank] digoxin, lithium, phenytoin, theophylline, warfarin and tricyclic antidepressants
[dua_frank] there you go
[drsujitvasanth] thanks
[uniteus] thx dua
[lanny] good job dua
[drsujitvasanth] <--added to notes
[dua_frank] welcome
[megs] thanx dua
[lanny] can we do infectious dz and drugs of choice plz
[drsujitvasanth] sure..
[drsujitvasanth] thats a tough one
[lanny] lets try
[megs] ok
[lanny] my weakness
[dua_frank] can i continue with my qs while somebody else takes over infectious lanny?
[lanny] ok dua
[drsujitvasanth] gonorrea....and in penicillin allergt
[dua_frank] erythro?
[megs] agree
[drsujitvasanth] < not sure of answer...
[lanny] dua finish your q's
[dua_frank] abd pain, neuro symptoms and hypertension
[dua_frank] what am i talking about?
[lanny] give more dua
[dua_frank] lead poisoning
[megs] yeah dua
[drsujitvasanth] surely not enough info to make that diagnosis
[megs] why hypertension dua??/
[dua_frank] it just occurs sometimes megs
[dua_frank] what else can cause that sujit?
[dua_frank] can some infection do that?
[dua_frank] legionella too i think
[dua_frank] confusion and abd symptoms
[dua_frank] right?
[lanny] yes dua
[dua_frank] i can't think of any other disease
[dua_frank] whats erethism?
[megs] i was thinking of stroke with abdominal angina...dua
[drsujitvasanth] yep...and accelerated hypertension
[megs] when u asked about the lead poisoning q
[dua_frank] thats very rare megs
[dua_frank] or maybe not
[megs] true..agree with u good
[drsujitvasanth] prophyria
[dua_frank] you're right though
[dua_frank] sujit very good
[dua_frank] porphyria yes
[drsujitvasanth] although not really hypertension
[dua_frank] we have all these ugly diseases coming out now ;)
[drsujitvasanth] phaechromocytoma could do it
[dua_frank] pheo and neuro sujit?
[lanny] not CNS sms though
[drsujitvasanth] polycystic kidney desease
[drsujitvasanth] yep...complicated with accelerated (malignant hyertension)
[dua_frank] nice
[drsujitvasanth] sorry lol
[megs] yup PCKD IS AGOOD CHOICE
[megs] now start with infections lanny
[drsujitvasanth] Rx for gonorrhea (was on qbank question)
[lanny] someone else plz megs you go
[lanny] hate antibiotics
[megs] ceftriaxone
[lanny] gonorrhea
[drsujitvasanth] answer: ceftiaxone yes or azithromyin is the recomendation in allergy
[megs] ok lets start with syphilis///
[megs] neurosyphilis??
[drsujitvasanth] hmm...
[drsujitvasanth] no idea...
[dua_frank] erethism is tremor, excitability, memory loss, delirium and insomnia in mercury poisoning
[dua_frank] pen g iv
[drsujitvasanth] penicillin G?
[lanny] agree sujit dua
[megs] why not benxathin penicillin
[drsujitvasanth] < guessed
[drsujitvasanth] no CNSpenetration?
[dua_frank] thats for primary i think
[lanny] IM
[megs] yeah sujit
[drsujitvasanth] <-- guessed..lol
[drsujitvasanth] really..you can just give penicillin?
[dua_frank] rx of CO poisoning?
[dua_frank] nice guess sujit
[uniteus] Oxygen n hyperbaric
[megs] 100% o2 dua
[drsujitvasanth] hyperbaric oxyger, methylene blue...
[dua_frank] yes right
[drsujitvasanth] how would you diagnose it?
[megs] i think methelene blue for cynide/...
[dua_frank] rx of methanol poisoning?
[megs] does it work in CO ALSO??
[drsujitvasanth] oh (oops) :)
[dua_frank] no megs
[lanny] ethanol
[megs] ETHYL ALCOHOL
[dua_frank] yes
[megs] lately haemodialysis
[dua_frank] rx of antifreeze poi?
[megs] what is antiboitic of choice for liesteria???
[megs] again ethanol dua
[dua_frank] metro?
[lanny] megs its ethanol
[dua_frank] yes megs
[megs] listeria infection RX???
[drsujitvasanth] hmm
[dua_frank] whats characteristic in lab data for antifreeze poi?
[drsujitvasanth] anion gap
[drsujitvasanth] ?
[dua_frank] also in methanol poi
[megs] ampicillin...REMEMBER cephalosporin do not works on liesteria
[drsujitvasanth] how do calculate anion gap?
[dua_frank] its calcium oxalate crystals in urine
[lanny] right megs
[dua_frank] oh
[dua_frank] thanks megs
[drsujitvasanth] YES YES! @ megs
[megs] oxalate crystal in urine dua
[drsujitvasanth] thats a biggy...
[dua_frank] good megs
[dua_frank] na+k-cl+hco3
[drsujitvasanth] thanks frank...
[megs] ok rx of lymes dises with rash only???
[dua_frank] (na+k)-(cl+hco3)
[lanny] doxy
[drsujitvasanth] thanks frank
[megs] rx of lymes with meningitis and artritis???
[dua_frank] welcome
[drsujitvasanth] ceftrioxone? iv?
[megs] ampi..is enough for rash dua..why to give broad spectrum
[megs] agree sujit,,,
[dua_frank] i don't know, i didn't even answer your q megs :P
[dua_frank] lanny did, ask him :P
[drsujitvasanth] Uncomplicated lyme dx Rx?
[dua_frank] lol
[megs] oh..lanny
[drsujitvasanth] doxy or ampi?
[dua_frank] amp
[drsujitvasanth] ? really?
[megs] ampi..for rash...that is minor symptoms
[dua_frank] yeah i would agree with megs on that
[drsujitvasanth] k
[megs] facial paly and first degree av block with rash...doxy then
[drsujitvasanth] <-- will make a note...am learning a lot lol
[dua_frank] thanks megs
[dua_frank] what drugs will you be careful not to give to a patient with status epilepticus?
[megs] cryptococcal meningitis rx???
[drsujitvasanth] amphotericin B?
[lanny] guys i disagree minor sms of lyme is not by ampi it is by doxy
[megs] yup sujit
[drsujitvasanth] all serious fungal --> amphoB lol
[lanny] i will chk it again but sure doxy is right
[drsujitvasanth] yeah lanny i thaught so to...but loooked it up online and says ampi
[dua_frank] also if the patient is less than 12 yrs of age
[megs] lanny u may be right but if u have given a choice betn doxy or ampi ..just for rash then what u have been picked??
[dua_frank] you can give amp or pen
[lanny] i am stickong with doxy
[drsujitvasanth] lol
[lanny] will pick doxy
[drsujitvasanth] lanny i just read the recomendations its actually ampi...
[lanny] 3rd gen ceph for serious inf of lyme
[dua_frank] theres a conflict here
[lanny] from where did you read
[megs] b cause if you remember dr fishers lecture..he says never pick up an antibiotic..with extra coverage..usmle expect that from you
[drsujitvasanth] googled it
[drsujitvasanth] ampicillin all over the place lol
[dua_frank] book says for rash doxy or amp/pen if young and late cx give iv benxylpen ceph
[dua_frank] funny
[dua_frank] maybe the recommendations are changing
[lanny] the recommendations are not USMLE friendly
[dua_frank] halperidol, ms relaxanst not to be given in status epilepticus
[dua_frank] they decrease seizure threshold
[drsujitvasanth] o...
[drsujitvasanth] didnt know that
[megs] ok drug of choice for mycoplasma pneumonai??/
[lanny] right synergistic dua mean haldol and m relax?
[lanny] erythromycin
[drsujitvasanth] erythromycin? or azithromycin in the states..
[dua_frank] erythro
[megs] azithro or clarythro
[dua_frank] guess erythro is getting old
[drsujitvasanth] y not erythro?
[dua_frank] ok azithro/clarithro
[megs] legionell rx???
[dua_frank] newer drugs sujit, works better in upper and lower resp tract infections
[drsujitvasanth] erythro
[lanny] erythro is still correct
[drsujitvasanth] ah...
[megs] agree
[megs] klebsiella???
[drsujitvasanth] electrolyte abnormality in Legionella?
[drsujitvasanth] azithro...
[dua_frank] hyperkalemia/
[lanny] tetracyclline for legion?
[megs] third gen cephalosporin..for klebsiella
[drsujitvasanth] i think teracycine would work...
[megs] lanny true
[drsujitvasanth] ok...will make a note....rekleb
[drsujitvasanth] Legionella --> hyponatremia
[drsujitvasanth] apparently characteristic
[drsujitvasanth] meningiis?
[drsujitvasanth] meningitis...
[dua_frank] thanks
[dua_frank] depends on age
[lanny] ceftriaxone
[drsujitvasanth] oh...
[lanny] depends on causative agent
[drsujitvasanth] agree with lanny..
[dua_frank] and agent depends on age
[drsujitvasanth] empiricle first...
[lanny] agree
[lanny] 3rd gen cephalo
[drsujitvasanth] after that yes...depends on bug
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[drsujitvasanth] i was doing qbank and has sme weird questions about psycho pharm side fx...
[drsujitvasanth] sidefx of buspirone/
[drsujitvasanth] ?
[drsujitvasanth] i had no idea
[lanny] agree they are tough
[lanny] never seen those q before
[drsujitvasanth] not too much pharm but its annoying whenyou never heard of them!! (side fx i mean)
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[dua_frank] alelectasis seen in seawater or freshwater drowning?
[lanny] sea
[dua_frank] yes
[dua_frank] intravascular hemolysis?
[lanny] sea
[dua_frank] fresh
[drsujitvasanth] fresh...
[lanny] you kno
[lanny] w why dua
[dua_frank] how will you manage this patient?
[dua_frank] hemodilution lanny
[dua_frank] rbcs swell and burst
[lanny] but there is no osmolar pull in fresh?
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[dua_frank] i'm sorry this is not pharm but thought it was interesting enough to tell about it
[lanny] ok
[dua_frank] there is lanny
[drsujitvasanth] it is...
[dua_frank] fresh water is hypotonic
[dua_frank] so gets absorped by the body easily
[dua_frank] very little fluid will be found in the lungs themselves
[drsujitvasanth] explanation would be appreciated as to mech of atelectasis/haemolysis
[dua_frank] sea water is hypertonic, sucks fluid out of body, causing lungs to be heavy
[dua_frank] this causes surfactant to be washed out by the water resulting in atelectasis
[lanny] agree
[dua_frank] one reason why you would give CPAP to push waster out of alveoli and pop alveoli open
[lanny] dua may be leaving... plz post todays dear dua
[dua_frank] ok lanny
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[dua_frank] i'll name the venom, you tell me what kind of venom
[dua_frank] black widow spider
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[dua_frank] neurotoxic
[dua_frank] cobra?
[dua_frank] cardiotoxic
[dua_frank] rattle snake?
[dua_frank] neurotoxic
[dua_frank] bee sting?
[dua_frank] anaphylaxis
[dua_frank] brown recluse spider?
[dua_frank] cytotoxic
[dua_frank] local tissue destruction
[dua_frank] that was fun :P
[dua_frank] ask and answer yourself :P
[dua_frank] you guys gone?
[dua_frank] ok then since its time to leave, see you all tomorrow
[dua_frank] bye all
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[drsujitvasanth] is there a steo 2 discussion today?
[dua_frank] hi
[dua_frank] yeah there is but nobody's here yet
[drsujitvasanth] ah ok...
[dua_frank] they'll be here in 5 minutes
[drsujitvasanth] cool
[dua_frank] thanks for the file :)
[drsujitvasanth] no problem...thanks for your file too...
[dua_frank] how was your day at studying today?
[drsujitvasanth] good...i read on my weak subjects....
[drsujitvasanth] Surgery and Obgyn
[dua_frank] those are my weak subjects too. i will be doing those next i guess
[drsujitvasanth] and did a practice test...improved on those sbjects but sam everall score...my familly kept disturbing me....
[drsujitvasanth] will be back in a few minutes....my brother wants some help on excell..
[dua_frank] ok sure
[dua_frank] hi sammy
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[lanny] hey all
[dua_frank] hey lanny
[dua_frank] so today's the day for "left overs"
[dua_frank] shall we start?
[dua_frank] oops sorry
[dua_frank] todays pharmacology
[lanny] yes dua
[dua_frank] man diagnosed with malaria, goes back to USA and now complains of proximal muscle weakness. dx?
[dua_frank] drug induced myopathy
[dua_frank] due to chloroquine
[dua_frank] affects type 1 fibres. steroids affect type 2 fibres of the muscle
[lanny] thx dua
[dua_frank] welcome
[dua_frank] rx of hairy cell lukemia?
[lanny] claridabine
[dua_frank] alpha interferone
[lanny] cladirabin can be used too
[dua_frank] ok thanks
[uniteus] hi
[lanny] hi uni
[dua_frank] can benzodiazapines cause death due to resp depression?
[dua_frank] hi uni
[dua_frank] no they can't
[dua_frank] how about hallucinogens?
[uniteus] yes
[dua_frank] nope
[uniteus] oh ok
[dua_frank] opiates, alcohol, barbs,and cocaine can
[lanny] but they can cause resp depression
[dua_frank] not death lanny
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[lanny] in benzo
[dua_frank] yeah
[lanny] yes dua not death
[dua_frank] but not as severe as barbs
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[lanny] right barbiturates are more
[lanny] what is synergisitc with barb in causing death?
[dua_frank] name all drugs that can be used for v fib
[dua_frank] all cns depressants
[dua_frank] alcohol
[dua_frank] benzos
[uniteus] amiodarone, epinep, lidocaince
[megs] phenytoin, lignocaine
[uniteus] for df
[dua_frank] bretylium, magsulf and procainamide too
[lanny] calcium gluconate
[samantha] lidocaine amiodarone and procainamide
[lanny] if hyperkal
[megs] lanny can u explain pl???
[dua_frank] drugs for A fib?
[lanny] v fib is seen with hyperkalemia megs
[megs] digoxin, gor atrial fibril also deltiazine verapamil
[lanny] or hyperkalemia can cause v ifib
[uniteus] digoxin, bblockers, procainamide, sotalol, amiodarone for af
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[lanny] so give calcuum to protect the heart
[megs] no lanny i was asking about drug reaction of barbturate leading to death???
[dua_frank] good also quinidine and anticoagulants
[dua_frank] drugs for PSVT?
[megs] adenosin verapamil
[lanny] oh alcohol when comined with barb c an cause death i mean like binging on alcohol
[lanny] megs
[uniteus] adenosine for svt
[lanny] agree uni
[dua_frank] yes also verapramil
[lanny] whats s effect of adenosini
[dua_frank] what anticoagulant would you give in Afib?
[lanny] dua whats s effect of verapamil
[uniteus] warfarin? dua
[lanny] you told us some days ago
[dua_frank] yes uni
[dua_frank] it causes nodal block
[lanny] warfarin
[dua_frank] AV nodal
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[lanny] ok thx dua
[dua_frank] welcome
[lanny] adenosine s e is torsades
[dua_frank] what drugs would you use in bradycardia?
[dua_frank] yes
[dua_frank] what was the drug used to trat torsades?
[megs] TARSADE GIVE MAGNESIUM
[lanny] phenytroin
[dua_frank] thanks megs
[dua_frank] brady drugs?
[megs] didnt know lanny that adenosin causes torsades...is it???
[uniteus] atropine, epinephrine
[megs] atropin and isoptotenol dua
[dua_frank] yes
[lanny] megs i thought so am i wrong
[drsujitvasanth] torsades..treat with MgSO4 avoid all other drugs or cardiovert....
[drsujitvasanth] thats what i wsa tauhg anyway lol
[megs] side effects of adenosin are v firillation cardiac arrrest and heart blocks
[drsujitvasanth] and 1 other...
[drsujitvasanth] brchospasm
[drsujitvasanth] contraindictaed in asthmatics
[uniteus] aspirin
[drsujitvasanth] aspirin contraindicated in asthmatics with nasal polyps...
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[megs] what are other contraindicatons of aspirin
[dua_frank] hey sujit, welcome back
[drsujitvasanth] bleeding. asthma with polyps.
[drsujitvasanth] thanks frank...
[megs] history of gi bleeding and other bleeding disorders ..
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[dua_frank] so what will you give to a patient who is contraindicated to aspirin?
[drsujitvasanth] dipyridamole
[drsujitvasanth] or clopidogrel
[uniteus] clopidorel
[drsujitvasanth] depends on the contraindication
[dua_frank] explain please sujit
[megs] teah depend on contraindications
[drsujitvasanth] if the problem is bleeding then you dont give anything
[dua_frank] oh right
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[dua_frank] i was talking about aspirin allergy
[dua_frank] thanks
[lanny] clopidogrel is right
[megs] what nsaid u give for the pt with history of peptic ulcer???
[drsujitvasanth] now none...
[drsujitvasanth] lol
[dua_frank] lol
[drsujitvasanth] cox 2 inhibs cause MI's
[dua_frank] yep
[dua_frank] got to be careful never to answer cox 2 now
[dua_frank] banned
[lanny] dont think so dua
[drsujitvasanth] they still have some use apparently....
[dua_frank] in what sujit?
[dua_frank] its off the market now
[drsujitvasanth] som epatients post CABG/stent get iv cox 2 inhibs...
[dua_frank] never sujit
[drsujitvasanth] i got a pharm letter about it the other week
[dua_frank] those are the patients who presented with MIs too
[drsujitvasanth] lol..i know
[lanny] dua if they bann it it wont be in the options
[dua_frank] it's like yuo're killing them right after treating them lol
[drsujitvasanth] i didnt read the article much so i dont know the details...
[dua_frank] lanny, considering the current events, you're safe never to pick cox 2 now
[megs] so you will not give cox 2 inhibitor
[dua_frank] its a goner
[dua_frank] nope megs, its off the market
[drsujitvasanth] unless the question is old....
[megs] ok
[dua_frank] even in those patients who did not have any previous cardiac problems, its causing MIs lol
[drsujitvasanth] presumably todyas discussion is pharm? What are the commonest ones asked....
[dua_frank] i still remember how badly the surgeons in our CT unit panicked after they read about cox inhibitors
[uniteus] :o scary
[drsujitvasanth] <-- bad at psych pharm
[dua_frank] yeah it was uni, we don't even have a proper record of how many died due to the drug and not post CABG
[drsujitvasanth] frank...the risk actually is v small increase...
[drsujitvasanth] i get the feeling its around 1 extra death per thousand or so...
[dua_frank] its significant in CABG sujit, post CABG mortality rates are high anyway, you don't want to add more to it
[drsujitvasanth] roughly how high?
[dua_frank] in our uni at least one per 50 but thats india for you
[drsujitvasanth] 2%....
[drsujitvasanth] normal operative risk is 1/1000
[dua_frank] oh
[drsujitvasanth] thats pretty high
[dua_frank] yeah it is
[dua_frank] its india :)
[dua_frank] :P
[drsujitvasanth] indian doc are v good...actually ...lol
[dua_frank] yeah but post op care matters too sujit
[dua_frank] 75% of the success depends on post CABG care
[drsujitvasanth] ah...
[dua_frank] unfortunately we don't have the facilities
[lanny] dua are you in india now
[drsujitvasanth] true..
[dua_frank] no i'm in US now lanny
[uniteus] which one cause increase digoxin toxicity high or low K?
[lanny] ok
[dua_frank] low
[lanny] hypo
[drsujitvasanth] low
[uniteus] rt
[uniteus] what is complication of dig toxicity?
[drsujitvasanth] hmph...
[drsujitvasanth] arrythmia
[uniteus] type of arrythmia?
[drsujitvasanth] not sure
[dua_frank] SVT
[dua_frank] all types actually
[drsujitvasanth] ah..
[drsujitvasanth] i think also AF!
[drsujitvasanth] seriously...
[drsujitvasanth] traetment?
[uniteus] not all dua
[dua_frank] dig
[dua_frank] anticoagulants
[uniteus] atrial fib, flutter, mobitx type 1,atrial tachy with av block
[drsujitvasanth] treatmet of dig txicity...
[dua_frank] you expect me to remember all that uni? :P
[uniteus] :)
[drsujitvasanth] thanks uni
[uniteus] urw
[drsujitvasanth] basically its atrial and nodal...
[drsujitvasanth] to summarise lol
[uniteus] agree
[drsujitvasanth] dig toxicity....Rx
[dua_frank] digibind
[drsujitvasanth] yup
[dua_frank] rx arrythmias appropriately
[drsujitvasanth] yup
[drsujitvasanth] 1 more thing...
[dua_frank] potassium?
[drsujitvasanth] yep!
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[drsujitvasanth] well..correct hypokalaemia anyway...
[drsujitvasanth] if its there...
[dua_frank] right
[drsujitvasanth] AIDS medications....does anyone understand them?
[drsujitvasanth] i need help there
[dua_frank] AZT DDI DD
[dua_frank] something
[dua_frank] we can go over them if you like
[drsujitvasanth] ah...
[drsujitvasanth] yes please
[drsujitvasanth] whats the title for todays chat?
[drsujitvasanth] (wanted to make sure to stay on topic)
[dua_frank] pharma
[drsujitvasanth] k
[drsujitvasanth] which drugs and what side FX in AIDS?
[drsujitvasanth] AIDS Rx
[dua_frank] basically you give a combination
[dua_frank] of two nucleoside inhibitors plus one protease inh
[drsujitvasanth] ah...
[drsujitvasanth] that sounds familliar
[dua_frank] N inhs are zidovudine, didanosine, lamivudine, stavudine and zalcitabine
[drsujitvasanth] <-- taking notes
[dua_frank] P inhs are indinavir, nelfinavir, ritonavir and saquinavir
[megs] azt+3tc+indinavir is used mostly
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[drsujitvasanth] thanks meg :)
[dua_frank] the only way it works is just start with 2+1 combo
[dua_frank] and if it doesn't work, try another combo
[drsujitvasanth] got it
[drsujitvasanth] side fx?
[dua_frank] so zidovudine, lamivudine and indinavir basic combo
[dua_frank] so many sujit :(
[drsujitvasanth] they ask them...
[megs] how will u say the drug is working or not???
[megs] what is criteria???
[drsujitvasanth] ?decreased viral load?
[dua_frank] ok let me work this out
[drsujitvasanth] inc CD4?
[uniteus] check the viral load? n cd4 count?????
[megs] yeah uni
[drsujitvasanth] i think htats what conrad ****** says...
[megs] viral load should reduse to 50% by 1 month
[dua_frank] all those that affect nerves causing peripheral neuropathy are DDI,, stavudine, zalcitabine,satquinavir
[megs] then we say drug is working
[drsujitvasanth] <-- taking notes...
[drsujitvasanth] thanks guys. am learning a lot!
[dua_frank] zido causes everything almost
[uniteus] the combonition drug is called HAART (highly active retorviral therapy)
[dua_frank] anemias, hepatomegaly, neuro, pancreatitis etc
[drsujitvasanth] i only remembered 2 - neuropathy and anaemia
[dua_frank] diverse SEs think Zido
[drsujitvasanth] ill add the others...
[dua_frank] i don't think they would ask more than this sujit
[drsujitvasanth] cool!
[drsujitvasanth] hey this is slightly off subject.....
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[dua_frank] but what do i know, not like i'm making the qs :P
[drsujitvasanth] neuro diseases in AIDS.....
[megs] which anti hiv drug causes psycological disturbances???
[drsujitvasanth] ?dunno
[megs] EFAVIRENZ...
[dua_frank] never even heard of it megs *)
[dua_frank] must be new
[megs] its non nuleoside reverse trancriptas inhinbitor
[drsujitvasanth] has been noted! That would be a good q
[dua_frank] oh nice megs, i knew only of nevirapine
[dua_frank] which causes steven johnson's synd or TEN
[megs] what is side effect of nevirapin???
[drsujitvasanth] TEN?
[drsujitvasanth] whats ten?
[megs] nevirapin cause rash///
[uniteus] pcn, sulfa drugs for steven johnso
[megs] so does is cause so severe to cause TEN DUA???
[dua_frank] toxic epidermal necrolysis
[dua_frank] yes megs
[drsujitvasanth] ah
[lanny] im back guys had to leave a bit
[dua_frank] wb lanny
[drsujitvasanth] hi lanny
[drsujitvasanth] wb
[megs] U MEAN ANTI HIV DRUG THAT CAUSES STEVEN JOHNSONS...IS VEVIRAPIN
[dua_frank] yes
[megs] good to know dua
[uniteus] oh i thought u mean in general dua...lol
[dua_frank] HIV drugs causing pancreatitis?
[dua_frank] lol i knew you were sleeping again uni
[uniteus] ddi not anymore
[megs] ddi and ddc
[dua_frank] ddi, lamivudine, zalcitabine
[drsujitvasanth] how do you convert from ddx to the full name?
[megs] why ddi not anymore uni???
[dua_frank] infections
[uniteus] ooh sorry megs...i meant "not anymore" to dua ..that i am not sleeping... sorry
[drsujitvasanth] lol
[megs] ddi is didanosin..and ddc is zalcitabin
[dua_frank] lol
[megs] ok uni
[drsujitvasanth] ah k...
[lanny] indinavir causes pancreatitis dua
[dua_frank] not according to my book lanny
[lanny] oh sorry kidney stones?
[dua_frank] yes that it does
[megs] no lanny i too diagree
[dua_frank] it attacks the BM, kidney and liver
[uniteus] agree megs
[lanny] its kidney stones megs
[dua_frank] so does zido
[dua_frank] kidney stones only for indinavir though
[lanny] agree dua
[uniteus] agree dua
[megs] which hiv drug is teratogenic???
[drsujitvasanth] hmm
[dua_frank] which one attacks optic nerves?
[lanny] nelfinaveenz
[dua_frank] zido
[megs] acually none of then..except efavirenz..which is shown to be teratogenic in animals
[dua_frank] oh
[dua_frank] but breastfeeding is contraindicated in zido megs
[dua_frank] so what does that mean it is?
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[drsujitvasanth] zido is safe cus its given to preg HIV mothers
[lanny] agree dr
[dua_frank] maybe not to cause additive toxicity or something
[dua_frank] yeah i know sujit
[dua_frank] but it has this contraindication, confusing...
[megs] breast feeding is contraindicated to prevet hiv transmission to baby
[drsujitvasanth] maybe it accumulates in breast milk...
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[drsujitvasanth] ah...meg is right.....
[megs] its not due to..azt ...
[dua_frank] no no
[drsujitvasanth] thats exactly right
[dua_frank] book says what i said
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[megs] dua which book
[dua_frank] refer oxford handbook of clinical medicine
[drsujitvasanth] oh ok...well who knows lol
[dua_frank] page 586
[megs] we give azt to baby too..for 6 weeks
[megs] so i disagree that totally
[dua_frank] yeah but its confusing
[dua_frank] why would they write a contraindication like this then
[drsujitvasanth] try a pharm book....
[dua_frank] esp when you are suppossed to give it
[dua_frank] not giving is like inhumane
[dua_frank] you let both the mother and child die
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[drsujitvasanth] you can just change to a different nuclease inhib lol
[drsujitvasanth] not a matter of life or daeth
[dua_frank] yeah but azt is proved to reduce mortality rates and risk of infection of fetus
[drsujitvasanth] yep..htats the one i think theyll ask...
[megs] http://www.projinf.org/fs/azt.html#who
[dua_frank] thanks
[drsujitvasanth] ok someone pick a topic.....
[dua_frank] how will you manage acute ASA toxicity?
[lanny] 8 % reduction in vert transmission
[dua_frank] from 30% to 8% lanny
[megs] what will give for post exposure prophylaxis to hiv??
[dua_frank] or 25 to 8
[uniteus] alkaline urine, give oxygen, supporitve for ASA toxicity...
[dua_frank] yes uni, hemodialyse if severe
[drsujitvasanth] uni...plus overdose measures....
[uniteus] ok..thx
[drsujitvasanth] charcoal +/-gastric lavage
[lanny] it was 25 % before but if mum starts taking AZT it red to 8%
[drsujitvasanth] megs: is it monotherapy with AZT?
[drsujitvasanth] or combo?
[dua_frank] name drugs with narrow therapeutic index
[lanny] lithium
[drsujitvasanth] Lithium, theophyline
[megs] yeah sujit
[dua_frank] any more?
[drsujitvasanth] thanks megs....
[lanny] valp acid??
[dua_frank] also one of the antiseizure megs
[dua_frank] val or cbz lanny? don't rememebr
[drsujitvasanth] carb i think
[drsujitvasanth] never heard of valproate levels....
[uniteus] MgSO too?
[drsujitvasanth] i dont think so...
[dua_frank] i wish we had a list
[dua_frank] then we can be careful with a case presentation of acute toxicities
[drsujitvasanth] you can give a reasonable amount of MgSO4 before txicity i thauhgt....
[lanny] dua maybe its phenytoin i think
[lanny] it is an aniti seizure drug
[drsujitvasanth] <-- not sure
[dua_frank] never heard of mgso4 too
[lanny] can a woman on phenytuoin breast feed?
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[drsujitvasanth] Phenytoin is v dangerous in overdoes I thaught...
[megs] digoxin...also have very low ther index
[lanny] yes sujit it is an antiarrythmic class1
[drsujitvasanth] ah
[dua_frank] digoxin, lithium, phenytoin, theophylline, warfarin and tricyclic antidepressants
[dua_frank] there you go
[drsujitvasanth] thanks
[uniteus] thx dua
[lanny] good job dua
[drsujitvasanth] <--added to notes
[dua_frank] welcome
[megs] thanx dua
[lanny] can we do infectious dz and drugs of choice plz
[drsujitvasanth] sure..
[drsujitvasanth] thats a tough one
[lanny] lets try
[megs] ok
[lanny] my weakness
[dua_frank] can i continue with my qs while somebody else takes over infectious lanny?
[lanny] ok dua
[drsujitvasanth] gonorrea....and in penicillin allergt
[dua_frank] erythro?
[megs] agree
[drsujitvasanth] < not sure of answer...
[lanny] dua finish your q's
[dua_frank] abd pain, neuro symptoms and hypertension
[dua_frank] what am i talking about?
[lanny] give more dua
[dua_frank] lead poisoning
[megs] yeah dua
[drsujitvasanth] surely not enough info to make that diagnosis
[megs] why hypertension dua??/
[dua_frank] it just occurs sometimes megs
[dua_frank] what else can cause that sujit?
[dua_frank] can some infection do that?
[dua_frank] legionella too i think
[dua_frank] confusion and abd symptoms
[dua_frank] right?
[lanny] yes dua
[dua_frank] i can't think of any other disease
[dua_frank] whats erethism?
[megs] i was thinking of stroke with abdominal angina...dua
[drsujitvasanth] yep...and accelerated hypertension
[megs] when u asked about the lead poisoning q
[dua_frank] thats very rare megs
[dua_frank] or maybe not
[megs] true..agree with u good
[drsujitvasanth] prophyria
[dua_frank] you're right though
[dua_frank] sujit very good
[dua_frank] porphyria yes
[drsujitvasanth] although not really hypertension
[dua_frank] we have all these ugly diseases coming out now ;)
[drsujitvasanth] phaechromocytoma could do it
[dua_frank] pheo and neuro sujit?
[lanny] not CNS sms though
[drsujitvasanth] polycystic kidney desease
[drsujitvasanth] yep...complicated with accelerated (malignant hyertension)
[dua_frank] nice
[drsujitvasanth] sorry lol
[megs] yup PCKD IS AGOOD CHOICE
[megs] now start with infections lanny
[drsujitvasanth] Rx for gonorrhea (was on qbank question)
[lanny] someone else plz megs you go
[lanny] hate antibiotics
[megs] ceftriaxone
[lanny] gonorrhea
[drsujitvasanth] answer: ceftiaxone yes or azithromyin is the recomendation in allergy
[megs] ok lets start with syphilis///
[megs] neurosyphilis??
[drsujitvasanth] hmm...
[drsujitvasanth] no idea...
[dua_frank] erethism is tremor, excitability, memory loss, delirium and insomnia in mercury poisoning
[dua_frank] pen g iv
[drsujitvasanth] penicillin G?
[lanny] agree sujit dua
[megs] why not benxathin penicillin
[drsujitvasanth] < guessed
[drsujitvasanth] no CNSpenetration?
[dua_frank] thats for primary i think
[lanny] IM
[megs] yeah sujit
[drsujitvasanth] <-- guessed..lol
[drsujitvasanth] really..you can just give penicillin?
[dua_frank] rx of CO poisoning?
[dua_frank] nice guess sujit
[uniteus] Oxygen n hyperbaric
[megs] 100% o2 dua
[drsujitvasanth] hyperbaric oxyger, methylene blue...
[dua_frank] yes right
[drsujitvasanth] how would you diagnose it?
[megs] i think methelene blue for cynide/...
[dua_frank] rx of methanol poisoning?
[megs] does it work in CO ALSO??
[drsujitvasanth] oh (oops) :)
[dua_frank] no megs
[lanny] ethanol
[megs] ETHYL ALCOHOL
[dua_frank] yes
[megs] lately haemodialysis
[dua_frank] rx of antifreeze poi?
[megs] what is antiboitic of choice for liesteria???
[megs] again ethanol dua
[dua_frank] metro?
[lanny] megs its ethanol
[dua_frank] yes megs
[megs] listeria infection RX???
[drsujitvasanth] hmm
[dua_frank] whats characteristic in lab data for antifreeze poi?
[drsujitvasanth] anion gap
[drsujitvasanth] ?
[dua_frank] also in methanol poi
[megs] ampicillin...REMEMBER cephalosporin do not works on liesteria
[drsujitvasanth] how do calculate anion gap?
[dua_frank] its calcium oxalate crystals in urine
[lanny] right megs
[dua_frank] oh
[dua_frank] thanks megs
[drsujitvasanth] YES YES! @ megs
[megs] oxalate crystal in urine dua
[drsujitvasanth] thats a biggy...
[dua_frank] good megs
[dua_frank] na+k-cl+hco3
[drsujitvasanth] thanks frank...
[megs] ok rx of lymes dises with rash only???
[dua_frank] (na+k)-(cl+hco3)
[lanny] doxy
[drsujitvasanth] thanks frank
[megs] rx of lymes with meningitis and artritis???
[dua_frank] welcome
[drsujitvasanth] ceftrioxone? iv?
[megs] ampi..is enough for rash dua..why to give broad spectrum
[megs] agree sujit,,,
[dua_frank] i don't know, i didn't even answer your q megs :P
[dua_frank] lanny did, ask him :P
[drsujitvasanth] Uncomplicated lyme dx Rx?
[dua_frank] lol
[megs] oh..lanny
[drsujitvasanth] doxy or ampi?
[dua_frank] amp
[drsujitvasanth] ? really?
[megs] ampi..for rash...that is minor symptoms
[dua_frank] yeah i would agree with megs on that
[drsujitvasanth] k
[megs] facial paly and first degree av block with rash...doxy then
[drsujitvasanth] <-- will make a note...am learning a lot lol
[dua_frank] thanks megs
[dua_frank] what drugs will you be careful not to give to a patient with status epilepticus?
[megs] cryptococcal meningitis rx???
[drsujitvasanth] amphotericin B?
[lanny] guys i disagree minor sms of lyme is not by ampi it is by doxy
[megs] yup sujit
[drsujitvasanth] all serious fungal --> amphoB lol
[lanny] i will chk it again but sure doxy is right
[drsujitvasanth] yeah lanny i thaught so to...but loooked it up online and says ampi
[dua_frank] also if the patient is less than 12 yrs of age
[megs] lanny u may be right but if u have given a choice betn doxy or ampi ..just for rash then what u have been picked??
[dua_frank] you can give amp or pen
[lanny] i am stickong with doxy
[drsujitvasanth] lol
[lanny] will pick doxy
[drsujitvasanth] lanny i just read the recomendations its actually ampi...
[lanny] 3rd gen ceph for serious inf of lyme
[dua_frank] theres a conflict here
[lanny] from where did you read
[megs] b cause if you remember dr fishers lecture..he says never pick up an antibiotic..with extra coverage..usmle expect that from you
[drsujitvasanth] googled it
[drsujitvasanth] ampicillin all over the place lol
[dua_frank] book says for rash doxy or amp/pen if young and late cx give iv benxylpen ceph
[dua_frank] funny
[dua_frank] maybe the recommendations are changing
[lanny] the recommendations are not USMLE friendly
[dua_frank] halperidol, ms relaxanst not to be given in status epilepticus
[dua_frank] they decrease seizure threshold
[drsujitvasanth] o...
[drsujitvasanth] didnt know that
[megs] ok drug of choice for mycoplasma pneumonai??/
[lanny] right synergistic dua mean haldol and m relax?
[lanny] erythromycin
[drsujitvasanth] erythromycin? or azithromycin in the states..
[dua_frank] erythro
[megs] azithro or clarythro
[dua_frank] guess erythro is getting old
[drsujitvasanth] y not erythro?
[dua_frank] ok azithro/clarithro
[megs] legionell rx???
[dua_frank] newer drugs sujit, works better in upper and lower resp tract infections
[drsujitvasanth] erythro
[lanny] erythro is still correct
[drsujitvasanth] ah...
[megs] agree
[megs] klebsiella???
[drsujitvasanth] electrolyte abnormality in Legionella?
[drsujitvasanth] azithro...
[dua_frank] hyperkalemia/
[lanny] tetracyclline for legion?
[megs] third gen cephalosporin..for klebsiella
[drsujitvasanth] i think teracycine would work...
[megs] lanny true
[drsujitvasanth] ok...will make a note....rekleb
[drsujitvasanth] Legionella --> hyponatremia
[drsujitvasanth] apparently characteristic
[drsujitvasanth] meningiis?
[drsujitvasanth] meningitis...
[dua_frank] thanks
[dua_frank] depends on age
[lanny] ceftriaxone
[drsujitvasanth] oh...
[lanny] depends on causative agent
[drsujitvasanth] agree with lanny..
[dua_frank] and agent depends on age
[drsujitvasanth] empiricle first...
[lanny] agree
[lanny] 3rd gen cephalo
[drsujitvasanth] after that yes...depends on bug
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[drsujitvasanth] i was doing qbank and has sme weird questions about psycho pharm side fx...
[drsujitvasanth] sidefx of buspirone/
[drsujitvasanth] ?
[drsujitvasanth] i had no idea
[lanny] agree they are tough
[lanny] never seen those q before
[drsujitvasanth] not too much pharm but its annoying whenyou never heard of them!! (side fx i mean)
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[dua_frank] alelectasis seen in seawater or freshwater drowning?
[lanny] sea
[dua_frank] yes
[dua_frank] intravascular hemolysis?
[lanny] sea
[dua_frank] fresh
[drsujitvasanth] fresh...
[lanny] you kno
[lanny] w why dua
[dua_frank] how will you manage this patient?
[dua_frank] hemodilution lanny
[dua_frank] rbcs swell and burst
[lanny] but there is no osmolar pull in fresh?
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[dua_frank] i'm sorry this is not pharm but thought it was interesting enough to tell about it
[lanny] ok
[dua_frank] there is lanny
[drsujitvasanth] it is...
[dua_frank] fresh water is hypotonic
[dua_frank] so gets absorped by the body easily
[dua_frank] very little fluid will be found in the lungs themselves
[drsujitvasanth] explanation would be appreciated as to mech of atelectasis/haemolysis
[dua_frank] sea water is hypertonic, sucks fluid out of body, causing lungs to be heavy
[dua_frank] this causes surfactant to be washed out by the water resulting in atelectasis
[lanny] agree
[dua_frank] one reason why you would give CPAP to push waster out of alveoli and pop alveoli open
[lanny] dua may be leaving... plz post todays dear dua
[dua_frank] ok lanny
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[dua_frank] i'll name the venom, you tell me what kind of venom
[dua_frank] black widow spider
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[dua_frank] neurotoxic
[dua_frank] cobra?
[dua_frank] cardiotoxic
[dua_frank] rattle snake?
[dua_frank] neurotoxic
[dua_frank] bee sting?
[dua_frank] anaphylaxis
[dua_frank] brown recluse spider?
[dua_frank] cytotoxic
[dua_frank] local tissue destruction
[dua_frank] that was fun :P
[dua_frank] ask and answer yourself :P
[dua_frank] you guys gone?
[dua_frank] ok then since its time to leave, see you all tomorrow
[dua_frank] bye all
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