Chat transcript - Pharmacology (Gen, ANS, CNS)

[Anonymous]

21:09:21 [Step_1] sure, we can get stated and others can join in when they make it

21:09:57 [Step_1] tonights chat is on pharm (gen, ans, cns) so we can start with gen principles

21:10:09 [Step_1] or whatever else comes to mind

21:10:50 [Step_1] a zero or vs first order rate of elimination....what is the main difference?

21:11:34 [hutals] zero order is a constant amount eliminated per time and 1st order is constant fraction

21:12:21 [Step_1] thats correct hutals. name some drugs following zero order

21:12:44 [hutals] alcohol is the only one i remember

21:12:50 [fkhan] phenobarbital,salicyclates

21:13:16 crusher enters this room

21:13:39 [crusher] hi aLL

21:13:43 [Step_1] not sure about benzos, but i know that alcohol, aspirin and phenytoin are zero order. most others are 1st order

21:13:49 [Step_1] hi crusher

21:13:52 [fkhan] sorry not phenobarbital,its phenytoin

21:14:12 [crusher] MOST DRUGS FOLLOW FIRST ORDER KINETICS

21:14:19 [Step_1] ah ok....good job

21:14:31 [hutals] hey crush

21:14:37 [crusher] zero order are ALCOHOL,PHYENTOIN AND ASPRIN

21:14:51 [crusher] HELLO HUTALS

21:15:49 [Step_1] what is the formula for dose?

21:16:12 [crusher] zero order is straight graph and constant amout of drug eliminated per time and has no effect on plasma conc

21:16:17 [hutals] D=VdxC

21:16:33 [fkhan] dose is vd/co

21:17:09 [crusher] dose=Vd/C

21:17:12 [Step_1] is it mult or division?

21:17:30 [crusher] multip

21:17:45 [fkhan] sorry for typo...its multipl

21:17:56 [fkhan] crusher is rt

21:18:03 [Step_1] good info crusher. what if you see a linear curve on a log value?

21:18:23 [Step_1] yes its mult. good job everyone

21:19:40 [Step_1] dont get fooled by the linear curve and assume its zero order. look to see if they are log values or not. if linear it is zero order, but if log and linear its 1st order

21:20:12 kmonica26 enters this room

21:20:13 [crusher] is it first order

21:20:32 [hutals] hey mon

21:20:46 [kmonica26] hi

21:20:54 [kmonica26] having problem with the site

21:21:46 [Step_1] as long as you made it

21:22:01 [kmonica26] yep

21:22:16 jwls29 enters this room

21:22:34 [jwls29] hello all

21:22:41 [jwls29] i will be observing

21:22:44 [Step_1] real question had pt who had phenytoin tox and was other drugs. name other possible drugs which might cause this and why?

21:22:51 [Step_1] hi jwls

21:22:58 [hutals] hey jwls

21:23:36 [hutals] it might have to do with p450 since phenytoin is a p450 inducer

21:23:53 [jwls29] i'm all out of whack with the schedule. Is this the first week of the new schedule or are we finishing up the last week?

21:24:01 [hutals] i guess any of the p450 inhibitors

21:24:25 nne enters this room

21:24:55 [Step_1] the schedule is constantly revolving. but we're doing pharm this week, next week is supposed to be off, but we decided to do more gol jan path

21:25:00 [Step_1] then we start over

21:25:05 [jwls29] ok

21:25:10 [jwls29] good

21:25:19 [nne] hey everyone

21:25:23 [Step_1] good hutals, but name them

21:25:25 [Step_1] hi nne

21:25:31 [hutals] hey nne

21:25:33 [jwls29] just sent in my $ for the test. Very scared. Have to be more diligent and more serious about studying

21:25:38 [jwls29] hi nne

21:26:15 [Step_1] thats what these chat sessions and schedules are for....they keep you on track at least they did for me

21:26:21 [nne] i had to go get a new pc , my computer has dealt with me

21:26:30 [jwls29] yup

21:26:48 [nne] It got a virus that wouldn't let me do anyyhing

21:27:21 [hutals] cimetidine, erythromyocin, chloramphenicol

21:27:21 [nne] what is the topic?

21:27:24 [jwls29] how do i change my profile to female??

21:27:39 [jwls29] what about warfarin?

21:27:48 [jwls29] it's pharm,nne

21:28:33 [Step_1] you want a sex change? click on your name on the right and it will pop up your profile. then change sex....sex change

21:28:45 [crusher] hi nne and jwls 29

21:28:51 [kmonica26] cimetidine

21:29:35 [nne] crusher we need to talk on yahoo messenger, i'll send you off line messages

21:29:53 [Step_1] cimetidine was the only choice i saw in the test, but others would include chloramphenicol, acute alcohol, macrolides, fluroquinolones, cisapride

21:30:04 [crusher] oh ihavenot check it ..but i willnne

21:30:37 [kmonica26] chloramphenicolthanks

21:31:01 [Step_1] nne, private messages via chat can be sent by clicking on the persons name and only you and them will see it

21:31:09 [Step_1] what are inducers of p 450?

21:31:44 [kmonica26] phenytoin,barbiturates, carbazepine

21:31:57 [fkhan] carbamazepine,phentoin,rifampiin,chronic ethanol

21:32:15 [crusher] choric alcolo,,,barbiturates,aromatic Hc,gresiofulvin,carbamezapine

21:32:26 [kmonica26] glucocorticoids

21:32:43 [crusher] haloparidol isoniazide

21:32:56 [Step_1] very good, they include carbamazepine,phenytoin,rifampiin,chronic ethanol, smoking, INH, and some others

21:33:00 [crusher] phyenetoin

21:33:38 [Step_1] half life of drug is 2 hrs. how long to reach steady state? choices coming....

21:34:04 [Step_1] 6 hrs, 10 hrs, 12 hrs, 20 hrs, 24 hrs?

21:34:22 [hutals] 10 hours

21:34:42 [crusher] 6 hrs ..it takes 3-4 half life

21:35:10 [fkhan] 6hrs

21:35:20 [Step_1] it takes 4 to 5 half lives to reach clinical steady state, so they will only give one of the two in the answer choices

21:36:07 [Step_1] think about what percent you would have in 3 half lives....

21:36:43 [crusher] 90 5

21:36:49 [crusher] 90%

21:37:03 [Step_1] 50% in first half life, 25% left in 2nd half life, 12.5% in 3rd half life

21:37:40 [Step_1] or 88%

21:37:50 [Step_1] or 90 if estimating

21:38:02 Buzza enters this room

21:38:24 [Step_1] steady state is around 95% or 4 half lives

21:38:39 [crusher] so it will be 6 hours so,so ans is 10 step??

21:39:03 [crusher] i mean the ans of ur Q is 10 hours??

21:39:05 [Step_1] after that, the clinical amount is insignificant with 97& for 5 half lives, 99% for 6

21:39:48 [Step_1] 10 hrs is correct, or it could be 8 if that were an option, but only one will be given because both correct

21:39:52 [nne] how did you get that? don't understand how the 2 hrs will need 6 hrs for steady state

21:40:07 [nne] pls explain step 1

21:40:56 [Step_1] ok, but it wont reach steady state in 6 because only at 90%.....steady state in 8 or 10 hrs....or 4 or 5 half lives

21:41:14 [crusher] not 6 hours nne but 10 hours cos it takes 4-5 half lives

21:41:35 [nne] ok

21:41:36 [Step_1] this is how i figure it out. each half life gets rid of half the drug....

21:41:58 [Step_1] so 1 half life has how much drug remaining?

21:42:21 [hutals] 50%

21:42:22 [crusher] 50%

21:42:28 [fkhan] 50%

21:42:34 [Step_1] right, 50% remaining

21:42:52 [Step_1] how much time went by for that in our example?

21:43:01 [hutals] 2 hours

21:43:36 [Step_1] right 2 hours. what about 2 half lives? how much is left and how much time went by?

21:43:56 [hutals] 25% and 4 hours

21:44:10 [Step_1] right, now 3 half lives?

21:44:33 [hutals] 12.5% and 6 hours

21:44:36 [fkhan] 12.5% and 8hrs

21:45:29 [Step_1] 6 or 8 hrs? which one.....remember 3 half lives would be 3 time 2 (half life is 2 hours)

21:45:51 [crusher] 2*2=4 hours and 2 half lives=25%

21:45:59 [Step_1] so it would be 12.5% and 6 hours....what about 4?

21:46:11 [fkhan] ok i got that.it would be 6

21:46:47 [hutals] about 6% and 8 hours

21:47:10 [Step_1] right, one more.....what about 5 half lives?

21:47:28 [hutals] 3% and 10 houts

21:47:36 [fkhan] 3%and 10hrs

21:48:39 [Step_1] to reach 100, it would actually take 7 half lives mathematically, but we care only about clinically. which is the point where half of the drug is very little or around 6 %

21:49:08 [Step_1] so the number of half lives needed to ready CLINICAL stead state is what?

21:49:21 [hutals] 4 to 5

21:50:40 [Step_1] yes. so 4 x 2 hours = 8 hrs. and 5 x 2 hrs = 10 hrs. so its either 8 hours or 10 hrs. the boards will never give both options because both correct

21:51:06 [hutals] good explanation

21:51:17 [Step_1] does that make sense?

21:51:25 [nne] thank you, makes it easier

21:51:31 [fkhan] definitely.

21:51:37 [fkhan] thanx

21:52:19 [Step_1] ok, lets move onto ans drugs...which is probably the most important part of pharm

21:53:21 [Step_1] what toxic will prevent the release of ACh from the presyn nerve ending....real question?

21:53:31 [Step_1] sorry i meant toxin

21:53:56 [hutals] botulism

21:53:57 [fkhan] botulinum toxin

21:54:34 [Step_1] yes, its botulinum toxin....good job. thats the basis for botox

21:55:25 [Step_1] pt treated for parkinsons develops dry mouth. what drug is this pt like taking?

21:55:48 [hutals] an anticholinergic?

21:56:15 [fkhan] benztropine...m blocker

21:56:18 [kmonica26] benztropine

21:57:05 [Step_1] yep, benztropine and trihexyphenidyl both antimusc used for parkinsons

21:57:14 [Step_1] very good!

21:57:32 [hutals] Cocaine shares is mechanism of action with what antidepressant?

21:58:01 [Step_1] Tricyclics

21:58:32 kiranadi enters this room

21:58:59 [hutals] yep, TCAs

21:59:34 [Step_1] what are common musc side effects?

22:00:20 [hutals] pupil constriction, dec heart rate, sweating

22:00:41 [fkhan] miosis,bradycardia,sweating,salivation,bronchocons triction,diarrhea

22:00:55 [kmonica26] dumbbelss

22:01:41 [Step_1] mneumonic is DUMBELS which is Diahrrhea, Urination, Miosis, Bradycardia, Excitation (cns), Lacrimation, Sweating and Salivation....very good

22:03:42 [Step_1] a real question described patient with those symptoms after being exposed to insecticides. what treatment to regenerate AChE?

22:04:14 [hutals] 2 PAM

22:04:32 crusher enters this room

22:04:40 [kmonica26] atropine and pralidoxime

22:04:44 [fkhan] atropine plus pralidoxime

22:04:46 [crusher] sorry i got Dc

22:05:50 [Step_1] yes, the atropine is to control musc symptoms and the pralidoxime (2-PAM) is to regenerate AChE

22:06:06 [hutals] Dobutamine used for the tx of shock acts on which receptors?

22:06:37 [Step_1] Mostly B1, but also some B2

22:07:17 [fkhan] b1 mostly nd on b2 also

22:07:48 [hutals] yep, Beta1 more than B2

22:08:45 [hutals] As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt, what do you use?

22:09:28 [Step_1] succinylcholine

22:09:31 [kiranadi] succinyl choline

22:09:42 [fkhan] duccinylcholoine

22:09:48 [crusher] succinyl choline..

22:09:51 [fkhan] succinylcholine

22:10:08 [hutals] yep, Succinylcholine

22:10:10 [kiranadi] hi i'm new to this chatting.....can i join you guys

22:10:44 [Step_1] of course, newcomers are always welcome

22:10:54 [hutals] welcome kirandi

22:11:01 [kiranadi] i'll be a silent guest today......as i'm not prepared

22:11:07 [kiranadi] thank you

22:11:22 [Step_1] kirandi, you might want to pick a brighter color from rainbow on right

22:11:45 [kiranadi] i just now did it

22:12:07 [hutals] sure, sit back and join in whenever you feel comfortable.....it took me a good month before i built up the courage, now i can shut up

22:12:28 [Step_1] much better kiranadi, thanks

22:12:33 [kiranadi] thank you

22:13:04 [hutals] By what mechanism does this drug (siccinylcholine) help?

22:13:36 [Step_1] something about calcium release i think

22:13:37 [kiranadi] inhibiting choline esterase...i think

22:13:57 [crusher] hby blocking ACE

22:14:26 [fkhan] its is an agonist at Nm rec.and causes membrane depolarization

22:14:44 [hutals] Prevents the release of Ca from SR of skeletal muscle

22:15:38 [hutals] A group of pts are rushed into the ER complaining of excessive sweating, tearing, salivation, HA, N and V, muscle twitching, difficulty breathing and diarrhea. What drug would be the most effective immediate tx?

22:16:13 [Step_1] give antimuscarinic

22:16:45 [hutals] this is like the question asked before, so thought i'd put it up

22:16:47 [crusher] by 2 PAM?or atropine

22:16:56 [fkhan] m blockers

22:17:35 [Step_1] yep, atropine or other musc blocker is immediate. 2 pam after that

22:17:49 [hutals] thats right

22:18:15 [hutals] Atropine pts are suffering from Cholinestrase inhibitor poisining(Nerve gas/Organophosphate poisining)

22:18:43 [hutals] A fellow passenger on a Carnival cruise ship looks pale and diaphoretic, what antimuscarinic agent would you give them?

22:19:06 [Step_1] scopolamine

22:19:31 [fkhan] scopolamine-anti motion sickness

22:19:31 [crusher] yes scopolamine for cruise

22:19:45 [hutals] scopolamine is right

22:20:14 [hutals] A 12yo patient was treated for a reaction to a bee sting, what drug provides the best coverage of sympathomimetic receptors?

22:20:47 [Step_1] epi

22:20:47 [crusher] epinephrine

22:20:58 [fkhan] epinephrine

22:21:06 [crusher] vasoconstrictor

22:21:47 [hutals] Epinephirine(Alpha1,2 and Beta 1,2)

22:22:53 [crusher] in a dose response graph if two drugs are not parallel to each other what does they mean in terms of RECEPTORS

22:24:00 [Step_1] non competetive receptors

22:24:22 [Step_1] antagonists

22:24:44 [Step_1] that was also a real one

22:25:02 [hutals] agree

22:25:23 [crusher] also these two drugs act on different receptors

22:25:54 [Step_1] except to make it harder, they showed the graph and asked which drugs represent which curves...

22:26:22 [Step_1] so not only need to know what they represent, but which drugs have those effects

22:27:57 [Step_1] for example, NE is the control drug and given a parallel curve to the right. which drug represents curve? prazosin or phenoxybenzamine?

22:28:36 [crusher] phenoxy benz

22:29:31 [Step_1] actually, let me make it easier, phentolamine or phenozybenzamine (since both have same effects)

22:29:43 [Step_1] alpha 1 and 2 that is

22:30:55 [fkhan] phentolamine coz its competitive

22:31:46 [Step_1] phentolamine is a competitive short acting alpha 1 and 2 blocker and phenoxybenzamine is a noncomp long acting alpha 1 and 2 blocker, so phentolamine would be the parallel line

22:32:57 [Step_1] that was a real question that can get you if not prepared because it ties in a couple of different concepts into one thing....boards love it

22:34:36 [Step_1] another real one and a board favorite is a 70 yo male pt with history of HTN presents with difficultly urinating. rectal exam shows enlarged prostate. what is the drug of choice for this pt?

22:35:19 [hutals] prazosin?

22:35:34 [fkhan] prazosin

22:36:25 [crusher] compitative are reversiable and give give parallel curev while non compitative are irreversiable and give nion parallel and dec both the affinity and efficacy of agoist

22:36:48 [Step_1] this patient has both BPH AND HTN. An alpha 1 blocker can take care of both problems. So alpha 1 blockers are "the 3 sins" which are prazoSIN, terazoSIN, and doxazoSIN

22:37:15 [crusher] prazocin alpha 1 antagoist

22:37:56 [Step_1] thats right crusher. since phentolamine was the competitive antagonist then that was the one which gave the parallel curve. good job

22:38:42 [crusher] for ref see caplan page 21

22:39:51 [crusher] what is duality of partial agoinst??

22:39:59 [Step_1] pt given cardioselective beta blocker and returns for follow up. labs show increased serum lipids. what drug most likely?

22:40:55 [Step_1] choices are acebutolol, atenolol, esmolol, propranolol

22:41:05 [crusher] propranolo....b2 blocker ,cos inc ldl or tg

22:41:16 [hutals] atenolol

22:41:20 [fkhan] atenolol or metoprolol

22:41:52 [Step_1] its a trick question by the way, take a good look at the wording....cardioselective

22:43:18 [Step_1] atenolol and metoprolol are the 2 cardioselectives which cause increased lipids. propranolol and timolol also cause inc serum lipids, but are not cardioselective. that was another real one

22:43:46 [crusher] i didnot pay attension

22:44:33 [Step_1] thats ok, it was a trick question, better to get it now than on test day

22:44:42 [crusher] what is duality of partial agoinst??

22:47:36 [Step_1] that is because can increase or decrease a drug response depending on other drug. if give with a full agonist, the partial agonist will bring down the total effect. if given alone (or with another drug that has no effect or negative effect) it will increase the effect

22:47:36 [fkhan] partial agonist can cause maximal response (if u increase its dosage after pretreating with full agonist ) and it can act as antagonist (by displacing full agonist from receptor)

22:48:40 [Step_1] so can be used as antag or agonist, depending. make sense?

22:49:24 [crusher] very good both step1 and fkhan..partial agonist with full agnoist displaces it from it receptor and act as antgoist and with other drugs it inc the effect of agoist

22:49:45 [hutals] A 57 yo heart failure pt develops cardiac decompensation, what drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension?

22:50:14 [Step_1] dopamine

22:50:16 [crusher] dopamine

22:50:46 [hutals] yep its Dopamine

22:51:59 [hutals] Norepi feedbacks and inhibits the presynaptic receptor by what mechanism

22:52:59 [Step_1] acts on alpha 2 receptors

22:53:28 [crusher] by reuptake inhibition!?

22:53:57 [hutals] yep Binding to the presynaptic alpha 2 release modulating receptors

22:55:03 [Step_1] actually, reuptake inhibition is by cocaine and Tricyclics

22:55:38 [Step_1] whereas alpha 2 inhibits the release of NE

22:56:53 [hutals] Which drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal

22:57:49 [Step_1] indirect would be by displacement of mobile pool, so tyramine, amphetamine, ephedrine

22:58:31 [hutals] Amphetamine and Ephedrine, i guess tyramine too, but not in the answer

22:58:59 [hutals] What antimuscarinic agent is used in asthma and COPD?

22:59:44 [Step_1] ipratropium?

23:00:30 [hutals] yep Ipratropium

23:00:59 [Step_1] which antimusc for peptic ulcers?

23:01:29 [hutals] glcopirolate i think

23:01:50 [Step_1] glycopyrrolate is correct. good job

23:02:24 [Step_1] lets do a little cns

23:03:40 [Step_1] what drug causes gingival heperplasia, cleft lip and palate, has low therapeutic index, induces p450 and is zero order?

23:03:53 [jwls29] phenytoin

23:03:57 vladi enters this room

23:04:12 [hutals] phenytoin

23:04:19 [Step_1] hi vladi

23:04:34 [hutals] hey vladi

23:04:57 [Step_1] phenytoin is correct. great job

23:04:59 [vladi] hi everybody-nice to see you again

23:06:51 [Step_1] a bulemic/anorexic 23 yr old ballet dancer presents with seizures. past medical history includes med for smoking sessation and antidepressant. what is likely drug that caused seizure?

23:07:30 [hutals] buproprion?

23:07:40 [crusher] bpriopion

23:07:55 [crusher] for smoking cessation

23:08:19 [vladi] that's right- only buproprion might be used for cessation of smoking

23:08:37 [Step_1] wellbutrin or buproprion is an antidepressant used for smoking sessation, but contraindicated in anorexics/bullemics because can cause seizures....good job

23:10:24 [Step_1] you switch her to another antidepressant in same class and her younger brother comes in a month later complaining of priapism. which drug?

23:10:43 [crusher] t****don

23:10:50 [Step_1] meant to say that her younger brother has been taking her meds

23:10:56 [jwls29] t****done

23:11:16 [vladi] trazodon

23:11:19 [Step_1] thats right, t****done causes priapism

23:12:12 [vladi] also it has tankvilazing effect in case of insomnia- typical HY Q

23:12:55 [crusher] what is phase3 clinical testing

23:13:08 [Step_1] tankvilazing?

23:13:39 [vladi] venlafaxin- what we have to screen carefully

23:14:12 [jwls29] >1000 people with target disease to see effects and side effects

23:14:25 [Step_1] conducted on large populations of afflicted patients

23:14:32 [vladi] i mean sedativee ( as tranvilazator)- step 1

23:14:43 usmle80 enters this room

23:14:55 [Step_1] ah, ok. thanks

23:15:00 [crusher] it deals with how does the drug work n common side effect....evalution in >1ooo in clinically disease pat and double blind

23:15:04 [vladi] crush- it's randomizing comparative study

23:15:23 [jwls29] forgot the double blind part

23:15:31 [usmle80] hello

23:15:42 [Step_1] hi usmle

23:15:50 [jwls29] hi

23:15:51 [hutals] hey usmle

23:16:15 [vladi] hi usmle

23:16:21 [crusher] what is phase 1 ?

23:16:43 [jwls29] phase 1 is study done with volunteers who do not have target disease

23:17:01 [hutals] small populations of healthy humans to specifically determine a drug's toxicity, absorption, distribution and metabolism.

23:17:39 [crusher] saftety of drug .studies in small group and ppl with NON DISEASE

23:18:34 [vladi] phaze 1- figure out a drug toxicity, dosage in small-scale study-30-40 ppl

23:18:42 [crusher] howdoes nitric oxide work on blood vessels?

23:19:58 [usmle80] causes vasodilation thru cGMP that causes dephosphorylation of myosin light chains causing inhibition of interaction with actin

23:20:19 [vladi] phaze 2- efficacy and tolerability in pats with disease in intermediate group of pats- up to 70-100

23:20:37 [hutals] agree with usmle

23:20:49 [jwls29] ok folks calling it a night

23:20:55 [jwls29] goodnite

23:21:03 [jwls29] thanks for the chat

23:21:04 [usmle80] oh no

23:21:22 [usmle80] r u people ending ur discussion

23:21:26 [hutals] good nite jwls

23:21:29 [jwls29] no no

23:21:37 [jwls29] i'm leaving

23:21:50 [usmle80] ok good bye

23:21:51 [jwls29] 'nite

23:21:56 [vladi] phaze 3- not nesseserely double blind, but in large scale up to 1000 pats

23:22:06 [hutals] been here since 9 and we usually go till about 12 at most

23:22:11 [crusher] NOrelease either by activation of muscuranic rec or kistamine release.....activate guanalate cylase which stimulate cGMP which cause dephosphorylation of mysoin lugh chain (no activation of actin) hence vasodilation of blood vessels

23:22:18 [usmle80] oh ic

23:22:29 [hutals] some stay late if they came later

23:22:35 [usmle80] ok

23:22:46 [vladi] another Q from my real exam- what's mean clinical trial in 12 000 pats

23:23:02 [usmle80] i just saw ur message hutuals on usmle.net forum abt chat

23:23:04 [Step_1] btw, almost forgot, Hmmmm said very sorry couldnt make it tonight but will be here next time

23:23:20 [crusher] clinical trial of phase 3

23:23:28 [usmle80] phase 3

23:24:12 [hutals] yes, i almost feel like i'm spamming when i leave those. if you all get a chance on those other sites, please help me spread the word every wed and sat so that our group can stay big and we can all help each other

23:24:21 [vladi] no - try again

23:24:27 [crusher] 1 zero for phase12 zero for phase2 three zero for phase 3..e.g 20..100...12000

23:25:46 [crusher] plz eloborate ur Q..vladi

23:25:57 [vladi] it's phaze 4- so called post-marketing trial to figure out even rare side-effects

23:26:44 [Step_1] i agree with hutals who has been doing a great job of helping to keep everyone informed about the subjects each week on other sites. we should all give him a hand with that so that our chats can continue to grow....the more the better

23:27:19 [Step_1] what is the drug of choice for status epilepticus? real question will describe pt with loss of consciousness, tonic contraction, loss of posture control, rhythmic contraction of all 4 limbs, continuous, doesnt regain conciousness (unlike tonic clonic).

23:27:29 [usmle80] yeah, he is indeed doing good job

23:27:43 [crusher] give an example of receptor that function as transmembrane enzymes

23:27:46 [vladi] thank you so much hutals- you are doing a great job

23:28:08 [vladi] diazepam

23:28:08 [hutals] just trying to pitch in. thanks all.

23:28:11 [usmle80] lorazepam

23:28:20 [hutals] diazepam

23:28:57 [Step_1] diazepam and lorazepam can both be used....good job

23:29:34 [usmle80] EGF,PDGF

23:30:17 [vladi] actually in <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>FA</a>- they mentioned both but in princeton on-line - diazepam

23:30:24 [crusher] yes its Epidermal Gf,latellete derived growth factor

23:31:07 [vladi] sorry - i mean <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>First Aid</a>

23:31:48 [Step_1] i think that diazepam is slowly getting replaced by lorazepam as the drugs of choice, but they wont likely put both on exam because either can be used

23:32:46 [Step_1] pt comes into ER with benzo overdose. which drug to give?

23:33:08 [usmle80] flumazenil

23:33:18 [hutals] flumazenil

23:33:49 [Step_1] thats correct. flumazenil is a benzo antagonist....good job

23:34:21 [crusher] i gotta leave

23:34:44 [Step_1] i gotta go soon too

23:34:50 [crusher] thanks for Q,s n particio\pation everyone

23:34:59 [crusher] good night

23:35:07 [Step_1] thanks for the great chat crusher

23:35:16 [hutals] good nite

23:35:18 [usmle80] good bye crusher

23:35:21 [vladi] thanks and good night guys

23:36:27 [Step_1] sorry have to go a little early tonight, but morning report starts at 8 am and gotta be there early

23:37:05 [usmle80] r u resident step1

23:37:27 [Step_1] nope, just a third year med student

23:37:42 [vladi] it'a all right- don't worry step1- probably we have to fonish tonight

23:37:43 [Step_1] the ones the residents pick on in morning report

23:38:14 [usmle80] oh ok

23:38:15 [Step_1] they have me paranoid so need to be well rested

23:39:15 [vladi] thanks so much- i gotta go either- have a good night

23:39:16 [Step_1] you guys can continue and i'll post the transcript up to now. if anyone is staying can someone post the remainder of transcript?

23:39:39 [vladi] what;s for saturday

23:39:55 [hutals] i think i'll be going now too. whats the topic sat?

23:40:01 [usmle80] majority is leaving so i guess i should also go

23:40:46 [Step_1] the topic sat is the remainder of pharm, so diuretics, cardio, antimicrobials, etc

23:41:15 [Step_1] no morning report on sunday, so i'll stay till 12 or however long is needed

23:41:19 [usmle80] thanx a lot and good night to everyone

23:41:26 [vladi] thanks again-i''be on saturday

23:42:00 [Step_1] good night all. thanks for great chat...see you all on sat (or in the forum before then)

23:42:12 [hutals] good nite and thanks

[Roxanita]

Hi Step 1
I sent you a pm, please check it.

Roxy.