Chat transcript - Pharmacology (renal, cardio, anti inflam,

[Anonymous]

21:05:58 [Step_1] well, everyone usually runs late, so i guess we can get started and they'll join us later

21:06:14 [acestep1] k

21:06:40 [Step_1] so tonight is the 2nd part of pharm, everything except gen, ans and cns

21:07:02 [acestep1] yes

21:07:57 [Step_1] a person with a history of ca oxalate stones has htn. which is a good drug for this pt?

21:08:37 [hutals] thiazides

21:09:17 [acestep1] agree

21:09:53 [Step_1] thiazides are a good choice because they retain ca in blood which means less in urine....so will help reduce chances of ca stones

21:10:28 [acestep1] yes

21:10:35 [Step_1] LOOps LOOse ca and thiazides retain ca (in blood)

21:10:41 [acestep1]

21:11:08 [acestep1] yes

21:12:01 [Step_1] an extremely high yield question is on the different diuretics that work on the different parts of the kidney. look at a pic on it.....let me try to pull it up

21:12:57 [Step_1] loop diuretics (furosemide)- site of action?

21:13:17 [acestep1] tal

21:13:36 [acestep1] thickacsending limb

21:13:36 [hutals] ascending limb

21:14:12 [Step_1] still looking for post with pic....but yes, its thick ascending limb

21:14:32 [acestep1] k

21:14:43 [hutals] contraindications of mannitol?

21:15:17 [acestep1] i think stroke

21:15:57 [acestep1] dunno

21:16:22 [Step_1] chf?

21:16:44 [hutals] anuria, CHF

21:16:55 [hutals] Mannitol- mechanism?

21:17:25 [acestep1] its a sugar so it pulls h2o with it

21:18:24 [Step_1] sorry, cant find it right now....will post it later

21:18:41 [hutals] osmotic diuretic- increase tubular fluid osmolarity, thereby increasing urine flow

21:18:53 [acestep1] np

21:19:10 [hutals] what is mannitols site of action?

21:19:23 [Step_1] proximal tubule

21:19:39 [acestep1] yes mainly

21:20:32 [hutals] yes, mainly prox tube, also thin descending limb, and collecting duct

21:21:23 [hutals] name three ACE inhibitors?

21:21:31 [Step_1] they're the

21:21:36 [Step_1] "prils"

21:21:46 [acestep1] k . but i thought it would act on the whoel tubule

21:21:48 [Step_1] enalapril, captopril

21:21:59 [acestep1] but mainly on teh pct

21:22:14 [acestep1] yes lisinoprils

21:22:18 [acestep1] etc

21:22:41 [hutals] i agree, mainly prox tubule, but also other parts of tubule and collecting duct

21:22:55 [hutals] Captopril, Enalapril, Lisinopril

21:23:41 [acestep1] ok name teh doc in hrt failure

21:24:28 [hutals] is it and ace inhibitor?

21:24:52 [acestep1] yes ace inh

21:24:55 [Step_1] thats what i would go with

21:24:57 [acestep1] v gd

21:25:04 [Step_1] increase survival rates

21:25:12 eppendorfs enters this room

21:25:15 [acestep1] ok my next q can u give ace inh in preg

21:25:17 [hutals] what two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?

21:25:30 [acestep1] yes agree with step1

21:25:31 [eppendorfs] nope u cannot

21:25:56 [hutals] hi eppendorfs

21:25:56 [acestep1] nitartes

21:26:10 [Step_1] hi eppend

21:26:12 [eppendorfs] hi hutals

21:26:17 [eppendorfs] hi step 1

21:26:34 [hutals] yes i think so

21:26:36 [acestep1] yes v gd eppend

21:27:02 [acestep1] is it alpha blkers

21:27:16 [hutals] Hydralazine and Minoxidil

21:27:29 [hutals] tough one

21:27:35 [acestep1] ic

21:27:48 [eppendorfs] ok got it

21:27:57 [hutals] which diuretics cause acidosis?

21:28:02 [acestep1] but hutals even with alpha blkers u have refez tachy

21:28:32 [acestep1] i think k sparing

21:28:44 [acestep1] refex tachy

21:28:49 [eppendorfs] acetazolamide causes acidosis

21:28:58 [acestep1] reflex tachycardia imean

21:28:59 [hutals] will you have the reflex if given with beta blockers?

21:29:04 [acestep1] agree

21:29:40 [eppendorfs] pot sparing should also cause acidosis, agree

21:29:52 [acestep1] didnt egt u hutals

21:30:09 [acestep1] hey step1 wht do u say

21:30:32 [Step_1] sorry, i'm still determined to find that post

21:30:41 [acestep1]

21:30:46 [acestep1] np

21:31:11 [Step_1] which question....CA inhibitors cause met acidosis

21:31:34 [Step_1] also K sparing

21:31:45 [acestep1] no 2 vasodilators which cause relfex atchy

21:31:57 [Step_1] the other two cause alkalosis (thiazides and loops)

21:32:04 [acestep1] reflex tachy imean

21:32:53 [eppendorfs] prazosin causes less reflex tachycardia

21:33:27 [acestep1] but it does

21:33:30 [eppendorfs] remember that NE fedback mechanism is still intact

21:33:41 [Step_1] alpha 1 and alpha 2 blocks will cause reflex tachy

21:33:43 [acestep1] ok name the antihtn drugs

21:33:54 [eppendorfs] prazosin is selective

21:34:01 [acestep1] yes

21:34:28 [eppendorfs] becos the alpha 2 is not blocked, the feedback is still intact

21:34:35 [acestep1] but i guess huatsl said vasodilators i think he emant directly acting vasodilators

21:34:38 [eppendorfs] less reflex tachy as compared to minoxidil

21:34:58 [acestep1] k

21:35:37 [hutals] i got that question from 1st aid.

21:35:38 [eppendorfs] wht immunological adverse effect is seen with hydralazine

21:35:52 aer02 enters this room

21:36:00 [Step_1] sle like syndrom

21:36:04 [acestep1] ic

21:36:17 [eppendorfs] correct name more with the same adverse effect

21:36:17 [Step_1] hi aer02

21:36:20 [acestep1] sgree

21:36:24 [hutals] hey are02

21:36:30 [aer02] hi

21:36:31 [acestep1] agree

21:36:36 [aer02] 1st time in chat

21:36:38 [eppendorfs] hi are02

21:36:41 [Step_1] INH, procainamide

21:36:54 [eppendorfs] correct

21:36:57 [eppendorfs] name 2 more

21:37:05 [acestep1] statins

21:37:11 [Step_1] phenytoin??

21:37:12 [eppendorfs] correct

21:37:16 [acestep1] penicllinamine

21:37:26 [eppendorfs] also propylthiouracil

21:37:35 [acestep1] oh

21:37:46 [eppendorfs] can we give propylthiouracil in preg?

21:37:54 [Step_1] we were on the right track....started with a p

21:38:10 [eppendorfs] yup

21:38:16 [hutals] i think contraindicated

21:38:27 [eppendorfs] nope, indicated

21:38:49 [hutals] oops....better safe than sorry was my thinking

21:39:11 [eppendorfs] what majot adverse effect am i concerned when i am administering propylthiouracil

21:39:19 [acestep1] k

21:39:41 [Step_1] i'll take a look back at that question hutals asked when i go over the transcript tommorw and try to find more about it

21:40:09 [hutals] hypothryroidism

21:40:26 [eppendorfs] nope, agranulocytosis

21:40:41 [eppendorfs] what antipsychotic drug also has this deadly adverse effect

21:40:46 [Step_1] eppendorfs, can you change to brighter color from rainbow on right...hard to see text

21:41:05 [Step_1] clazapine

21:41:08 [eppendorfs] ok

21:41:14 [hutals] clozapine

21:41:18 [eppendorfs] excellent

21:41:18 [acestep1] carbemezapine

21:41:22 [acestep1] oosp

21:41:31 [acestep1] mean clozapine

21:41:36 [Step_1] thanks, much better

21:41:42 [eppendorfs] what anti microbial also has this adverse effect

21:42:28 [acestep1] imepenum?

21:42:42 [acestep1] i dont rmeb actually

21:43:03 [eppendorfs] actually my bad, its manily aplastic anemia, seen with chloramphenicol

21:43:17 [acestep1] rek

21:43:21 [Step_1] clindamycin

21:43:22 [acestep1] k

21:43:43 [eppendorfs] clindamycin is psudomembranous colitis

21:43:47 [Step_1] actually a bunch of drugs cause it

21:43:55 [eppendorfs] name 2 other drugs which can cause pseumembranous colitis

21:44:18 [acestep1] amphicillin

21:44:31 [eppendorfs] correct

21:44:42 [eppendorfs] and?

21:44:49 [Step_1] ampicllin most common now, according to gol jan

21:44:55 [acestep1] u tell us

21:44:59 [eppendorfs] correct

21:45:05 [acestep1] ic

21:45:11 [eppendorfs] tetracycline also

21:45:18 [Step_1] metro is used to treat, but can also cause it

21:45:29 [eppendorfs] its a cide if u want it TALC, tetra, ampi linco and ampi

21:45:34 [acestep1] where did u gt this from

21:45:36 [eppendorfs] code*

21:46:00 [eppendorfs] i learnt it in my medical school

21:46:01 [Step_1] the metro part got from kap lan hi lights

21:46:13 [acestep1] k

21:46:18 [acestep1] thnx

21:46:34 [eppendorfs] mechanism of action of metro?

21:46:58 [Step_1] it stood out because the point the lecturer was making is that any kind of prolonged antibiotics can cause it...including metro which is the drug of choice

21:47:18 [acestep1] ic

21:47:19 [eppendorfs] yes, thats correct

21:47:26 [acestep1] thnx

21:47:38 [acestep1] i think unknown moa

21:47:56 [aer02] bacterecidal

21:48:04 [aer02] all thast known abt it

21:48:06 [eppendorfs] yes, but its beleived to be an anti metabolite, ur corect

21:48:21 [acestep1] k

21:48:25 [eppendorfs] major adverse effects of metro?

21:48:27 [acestep1]

21:48:30 [acestep1]

21:48:37 [hutals] Does Heparin have a long, medium, or short half life?

21:48:50 [Step_1] short

21:48:59 [acestep1] hmm . dont remb but i think affects taste

21:49:08 [acestep1] rest i dont remb

21:49:15 [eppendorfs] half life is 2 hours

21:49:20 [acestep1] v short 1/2 life

21:49:44 [eppendorfs] excellent, metallic taste, peripheral neuritis, and most imp is disulfiram like reactions

21:50:08 [hutals] short, what about warfarin?

21:50:11 [acestep1] oh yes

21:50:19 [Step_1] warfarin is long

21:50:25 [eppendorfs] long about 30 i think

21:50:56 [hutals] yep, long

21:51:10 [acestep1] so M et roNi aDzole has three s/e

21:51:30 [eppendorfs] its has more, but i think these ones are really imp

21:51:41 [acestep1] m= metallic taste

21:51:49 [acestep1] n- neuritis

21:51:57 [eppendorfs] i had taken metro once, and the metallic taste is awful

21:52:04 [acestep1] n d= disulfram liek actions

21:52:11 [hutals] good one

21:52:15 [acestep1]

21:52:21 [acestep1] ic

21:52:26 [eppendorfs] name other drugs that cause disulfiram like reactions

21:52:28 [Step_1] very good, love them mneumonics

21:52:42 [acestep1]

21:52:46 [acestep1] yes

21:52:49 [eppendorfs] love ur pnemonic, thanks

21:53:23 [Step_1] cefamandole, cefoperazone, cefotetan, chlorpropamide

21:53:28 [acestep1] is u can amke out from teh name u can always make a wild gues sin teh exam

21:53:36 [acestep1] thnx

21:53:52 [eppendorfs] thanks

21:54:01 [acestep1] also moxalactam

21:54:05 [eppendorfs] also ketoconazole

21:54:27 [hutals] What are four conditions in which H2 Blockers are used clinically?

21:54:49 [Step_1] ulcers

21:54:55 [Step_1] ZE

21:54:56 [acestep1] k

21:55:02 [eppendorfs] acid peptic disease

21:55:06 [eppendorfs] ZES

21:55:10 [eppendorfs] GERD

21:55:10 [acestep1] gastritis

21:55:10 [Step_1] refux

21:55:37 [hutals] 1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger-Ellison syndrome

21:55:48 [hutals] What are four H2 Blockers?

21:56:00 [eppendorfs] cimetedine

21:56:01 [eppendorfs] itine

21:56:08 [eppendorfs] famotidine

21:56:10 [Step_1] cimitidine, ramandidine

21:56:18 [eppendorfs] ranitidine

21:56:25 [Step_1] forgive spelling....typing fast

21:56:46 [acestep1] np

21:56:52 [eppendorfs] i cant think of a 4th one

21:56:52 [Step_1] the other -idine

21:57:00 [eppendorfs] lol

21:57:31 [eppendorfs] what is the majorr adverse effect of cimetidine?

21:57:31 [Step_1] thank goodness, they give us multiple choice

21:57:38 [hutals] 1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

21:58:01 [eppendorfs] yeah, i remember nizatidine now, thanks hutals

21:58:20 [hutals] np

21:58:26 [hutals] What are signs of Sildenafil (Viagra) toxicity?

21:58:45 [Step_1] one very happy old man

21:58:51 [eppendorfs] cardiovasculat failure?

21:59:26 [Step_1] flushing

21:59:38 [eppendorfs] oh ok

21:59:47 [eppendorfs] and ofcourse can cause MI

21:59:48 [hutals] Headache, flushing , dyspepsia, blue-green color vision.

22:00:09 [eppendorfs] wow, thanks

22:00:21 [eppendorfs] i did not know the vision changes

22:00:29 [Step_1] agree, be careful in pts with high risk of MI

22:00:30 [eppendorfs] which other drug do we have vision changes

22:00:58 [aer02] rifampicin?

22:01:03 [acestep1] digoxin

22:01:14 [eppendorfs] correct, orange vision there, any other drug

22:01:16 [eppendorfs] correct

22:01:21 [eppendorfs] halos seen there

22:01:46 [acestep1] yes

22:01:51 [acestep1] true

22:01:52 [eppendorfs] which drug causes optic neuritis or retrobulbar neuritis

22:02:17 [acestep1] ethambutol

22:02:29 [eppendorfs] excellent

22:02:31 [hutals] alcohol can give double vision ....does that count? lol

22:02:50 [eppendorfs] hehehe, yes, that can too

22:02:59 [acestep1] ok ame sulfa drugs

22:03:07 [Step_1] aer, can you pick a brighter color from rainbow on right, hard to read text

22:03:14 [acestep1] name the sulfa drugs imean

22:03:14 [eppendorfs] which drug toxicity am i concerned for loss of vision

22:03:28 [acestep1] methanol?

22:03:29 [eppendorfs] sulacetamide

22:03:40 [eppendorfs] correct methanol

22:03:47 [acestep1] k

22:03:55 [eppendorfs] sulfinnpyrazole

22:04:05 [eppendorfs] sulfamethoxazole

22:04:10 [acestep1] good

22:04:17 [eppendorfs] thiazides

22:04:25 [eppendorfs] acetazolamide

22:04:26 [hutals] wow...good stuff, didnt know that one

22:04:37 [eppendorfs] sulphonylureas

22:04:38 [acestep1] v gd

22:04:48 [eppendorfs] loop diuretics

22:04:56 [hutals] What are three clinical uses of the NSAIDs?

22:05:03 [acestep1]

22:05:13 [eppendorfs] actually u need to know this , becos all these are contraindicated in sulfa allergic patients

22:05:33 [acestep1] yes

22:05:43 [eppendorfs] anti inflammatory agents for reducing inflammation and pain

22:05:53 [Step_1] anti inflammatory, antipyretic,

22:06:02 [eppendorfs] used in Patent ductus ateriosis

22:06:02 [acestep1] antipyretic as well

22:06:05 [Step_1] and pain

22:06:27 [hutals] 1. Antipyretic 2. Analgesic 3. Anti-inflammatory

22:06:30 [acestep1] plt aggretion inh but asprin is most useful

22:06:37 [aer02] uric acid

22:06:39 [hutals] which one not covered by tylenol?

22:06:47 [aer02] i mean used to reduce it in blood

22:07:09 [Step_1] thanks for changing colors aer, much better

22:07:12 [eppendorfs] its a very very weak analgesic

22:07:29 [eppendorfs] also prophylactic in MI

22:07:31 [Step_1] tylenol is not for antiinflammatory

22:08:08 [eppendorfs] correct

22:08:11 [eppendorfs] thanks

22:08:16 [hutals] yes thats true also

22:08:28 [eppendorfs] what do we use in tylenol poisoning

22:08:59 [Step_1] acetylcyteine (sp?)

22:09:06 [eppendorfs] correct

22:09:12 [aer02] g.l.

22:09:16 [eppendorfs] what is the other use of n-acetylcysteine

22:09:22 [Step_1] mucomyst...easier to spell ...lol

22:09:35 [eppendorfs] perfect

22:09:48 [Step_1] used in CF to break down thick mucus secretions

22:09:48 kmonica26 enters this room

22:09:54 [eppendorfs] its also used to treat haemorragic cystitis

22:09:59 [Step_1] hu monica

22:10:17 [eppendorfs] but whats the classical drug we use to treat H'ragic cystitis

22:10:21 [eppendorfs] Hi monica

22:10:22 [Step_1] i thought that was mesna

22:10:34 [hutals] hey mon

22:10:38 [eppendorfs] yes, thats correct

22:11:17 [eppendorfs] what antidote for doxorubicin tox?

22:12:39 [acestep1] hey guys i gtg now

22:12:49 [acestep1] must get some sleep

22:12:50 [eppendorfs] alright ace... good luck

22:12:58 [Step_1] i know it causes cardiac tox, not sure about antidote?

22:13:08 [acestep1] thnx eppend . same 2 u

22:13:11 [Step_1] good night ace....see you in next chat

22:13:13 [eppendorfs] dexrazoxane

22:13:17 [acestep1] yes agree with step1

22:13:23 [hutals] nite acestep

22:13:34 [acestep1] yes if im up ill definitely b here

22:13:36 [aer02] g'nite

22:13:43 [acestep1] thnx hutals

22:13:45 [Step_1] didnt know that, thanks

22:13:46 crusher enters this room

22:13:54 [acestep1] gn aero

22:14:00 [crusher] hi everyone

22:14:02 [Step_1] hi crusher

22:14:03 [acestep1] take care all of u

22:14:12 [hutals] hey crush

22:14:12 [eppendorfs] hi crusher

22:15:49 [Step_1] both these drugs were asked in real questions describing someone with prostate cancer....name some drugs that can be used? hint, one is anti androgen and other is GnRH analog

22:16:09 [eppendorfs] flutamide

22:16:21 [hutals] leuprolide is a GnRH analog

22:16:41 [eppendorfs] leuprolide

22:16:51 [Step_1] yes, those were two separate real questions

22:17:43 [Step_1] another said which drug acts in same phase as vincristine / vinblstine?

22:18:16 [eppendorfs] paclitaxel

22:18:35 [Step_1] paclitaxil was the only choice i saw that also worked in M phase.....good job!

22:18:54 [crusher] flutamide and leuprolide...oneisGnRh anaolog and other is anti androgen

22:19:04 kmonica26 enters this room

22:19:19 [Step_1] yes, everyone is correct on the prostate question....excellent

22:19:45 [Step_1] another real one described a patient with wilsons dis and asked for treatment?

22:19:58 [kmonica26] Hi evryone

22:19:59 [eppendorfs] pencillamine

22:20:05 [eppendorfs] hi monica

22:20:06 [hutals] penicilamine

22:20:14 [hutals] hey mon

22:20:16 [kmonica26] Penicillaamine

22:20:31 [Step_1] yes, penicillimine is correct....great

22:20:35 [crusher] yes penicillamine

22:20:50 [kmonica26] Hi Hutals,eppendorf

22:20:53 [crusher] but whats is mOA?

22:21:03 [eppendorfs] can i administer penicilllamine in someone who is allergic to penicillin?

22:21:05 KAUKAB enters this room

22:21:12 [eppendorfs] it chelates copper

22:21:21 butter enters this room

22:21:23 [Step_1] its a metal chelator

22:21:33 [crusher] ok

22:21:34 [Step_1] hi butter and kaukab

22:21:49 [hutals] hey kaukab

22:21:53 [eppendorfs] hi butter and kaukab

22:21:54 [hutals] hey butter

22:22:31 [Step_1] what is the metal chealator that is used for lead tox?

22:22:47 [hutals] EDTA

22:22:59 [kmonica26] edta, Succimer

22:23:02 [eppendorfs] dimercaprol

22:23:12 [kmonica26] dimercaptol

22:23:33 [eppendorfs] dIMercaprol = fiven IM

22:23:36 [eppendorfs] given

22:23:51 [Step_1] Edetate (EDTA) and succimer are correct. i think that dimercaprol is for arsenic and mecury

22:24:07 [eppendorfs] what would u give in B blocker overdose

22:24:17 [eppendorfs] dimercaprol is also for lead

22:24:33 [Step_1] you're right that its IM along with EDTA while succimer is oral

22:24:39 [Step_1] oh, ok....thanks

22:24:40 [eppendorfs] succimer is manily for children

22:25:01 [Step_1] EDTA can also be given IV

22:25:32 [eppendorfs] corect

22:25:38 [kmonica26] Glucagon

22:25:48 [eppendorfs] perfect

22:25:53 [eppendorfs] do u know why?

22:26:05 [kmonica26] No

22:26:14 [aer02] blocks

22:26:25 [aer02] hypogycemic signs

22:26:27 [aer02] ?

22:26:52 [aer02] i mean hyper

22:27:05 [eppendorfs] B blockers prevent CAMP formation and glucagon stimulates it

22:27:08 [kmonica26] I htought thats why they were not used In DM

22:27:37 [aer02] opoops

22:28:04 [eppendorfs] ok, tell me some uses of B blockers

22:28:06 [kmonica26] that makes sense..thanks

22:28:27 [kmonica26] Hypertion, glaucoma, asthma

22:28:36 [aer02] p[heoch

22:28:44 [aer02] pheochromocytoma

22:28:51 [eppendorfs] correct

22:29:00 [eppendorfs] prophylaxis in migraine

22:29:11 [aer02] post MI

22:29:13 [eppendorfs] in cirrohis

22:29:13 [Step_1] beta blocks contraindicated in pheochromocytoma and astha....right?

22:29:34 [eppendorfs] its contraindicated in asthma

22:29:44 [kmonica26] oh yes

22:29:52 [aer02] AND HEART BLOCK

22:29:52 [kmonica26] b agonists

22:29:56 [eppendorfs] and it Pheo it may shoot the blood pressure if only alpha action persists

22:29:59 [kmonica26] are used in asthma

22:30:06 [aer02] heart block

22:30:20 [eppendorfs] yes

22:30:37 [eppendorfs] in hyperthyroidism

22:30:52 [eppendorfs] in alcohol and opiate withdrawal

22:30:57 [Step_1] use labetolol or carvediol for pheochromocytoma because alpha 1 would be unapposed with others

22:31:01 [eppendorfs] in heart failure

22:31:28 [aer02] in my exam i had a q abt b-blockers masking hyperglyc. property

22:31:28 [eppendorfs] in cardiac arrhythmias

22:31:44 [eppendorfs] thats correct

22:32:09 [Step_1] heroin user comes in with dialated pupils, erected hairs on arms, etc. what would worsen these symptoms? methadone, morphine, naloxone? ( another real question)

22:32:22 [aer02] morphine

22:32:31 [eppendorfs] methadone

22:33:55 [eppendorfs] i could be wrong

22:34:01 [Step_1] this one really had me thinking. notice the dialated pupils....what do heroin overdose pts normally present with as far as pupils?

22:34:17 [kmonica26] miosis

22:35:03 [eppendorfs] ok

22:35:12 [kmonica26] i tlooks like he is having withdrawal

22:35:46 [Step_1] yes, so this pt has dialated pupils, goose bumps (going cold turkey)....he's going thru opiod withdrawal. if you give opiod, it will help take away symptoms. if you give naltrexone, it will worsen because its a partial opiod antagonist

22:35:50 [aer02] isnt cocaine od =miosis

22:36:07 [aer02] ?

22:36:27 [eppendorfs] be right back

22:36:46 [Step_1] so the question asked which would worsen symptoms presented. the correct answer is naloxone.

22:37:11 [aer02] understand now

22:37:25 [kmonica26] thanks

22:38:40 [Step_1] other withdrawal symptoms include lacrimation, yawning, sweating, restlessness, goose bumps, tremor, hot and cold flashes, diarrhea, cramps, muscle spasms, bone and muscle pain

22:39:48 [hutals] What enzyme does Zileuton inhibit?

22:40:03 [kmonica26] lipoxy?

22:40:17 [Step_1] lipoxygenase

22:40:25 [kmonica26] lipooxygenase

22:40:50 [hutals] yep Lipoxygenase

22:41:07 [hutals] What enzymes are inhibited by NSAIDs, acetaminophen and COX II inhibitors?

22:41:18 [Step_1] COX

22:41:30 [Step_1] cyclooxygenase

22:41:59 [hutals] yep Cyclooxygenases (COX I, COX II)

22:43:32 [eppendorfs] sorry people, but got to go niow

22:43:38 [hutals] name a specific COX 2 inhib

22:44:04 [Step_1] thanks for great chat eppendorfs. see you next chat

22:44:19 [hutals] good nite eppend

22:44:35 [aer02] gnite eppend

22:44:41 [kmonica26] rofecoxib

22:44:43 [Step_1] celecoxib

22:44:54 [kmonica26] bye eppen

22:45:00 [hutals] yep both correct

22:45:08 vladi enters this room

22:45:19 [Step_1] hi vladi

22:46:14 [vladi] hi everybody- good to see you again

22:46:14 [eppendorfs] thank u all

22:46:16 [eppendorfs] nite all

22:46:20 [eppendorfs] talk to u later people

22:46:36 [hutals] hey vladi

22:47:43 [Step_1] another real one asked which NSAID would enhance the oral hypoglycemics the least. Actually described pt on oral hypoglycemics with all the signs and symptoms of DM and asked which drug can be used for something (cant remember). choices were all NSAIDS

22:49:34 [Step_1] This is another one that had me scratching my head because I always learned that NSAIDs enhance activity of oral hypoglycemics. But after looking it up, it says that the agent with least amount of interference is ibuprofen.

22:50:04 [Step_1] i thought that question was a bit unfair, but they asked it

22:50:43 [vladi] i've never heard about that

22:50:45 [hutals] What is a common side effect of Colchicine used to treat acute gout, especially when given orally?

22:51:04 [crusher] sulfonureases???

22:51:15 [crusher] gi disturbance s...colcxhine

22:51:28 [Step_1] i found the answer in kap lan, just never bothered to look at it until i saw the question

22:51:48 [Step_1] agree, gi disturbances

22:52:04 [aer02] in k it says inc activity of sulf hpoglycemics

22:52:12 [aer02] i havent seen that they do it the least

22:52:16 [hutals] yes, GI side effects. (Note: Indomethacin is less toxic, more commonly used.)

22:53:02 [aer02] peripheral neurop[athy

22:53:08 [crusher] sulfonureases with i bufoen???

22:53:33 [Step_1] under the NSAIDS, it says that they all increase their activity, then underneath as a side note, it mentions that the one with least interference (still increases activity) is ibuprofen

22:53:48 [aer02] ok

22:54:41 [Step_1] so dont give ibuprofen unless the other choices are worse (i.e other choices are all NSAIDs)

22:54:50 [vladi] thanks step 1-we'll know

22:55:05 [Step_1] np

22:56:40 [crusher] which anti hypertensive drug enhance sthe hypoglycemic effect of oral hypoglycemic agents

22:57:41 [hutals] K channel blockers??

22:57:46 [kmonica26] b blockers??

22:57:55 [aer02] i thought it was b-blockers

22:58:26 [vladi] b-blokers for sure

22:58:28 [hutals] b blockers sounds better to me too

22:59:05 [vladi] actually they mask hypoglycemia

23:00:00 [crusher] its ANG2 inhibitors..captopriln analpril..thisis the ans ii have although beta blockers seems to correct too

23:00:09 [aer02] mask insulin od sign

23:00:25 [aer02] which is inc. hr

23:01:47 [Step_1] 31 yo pt comes presents abdominal pain and has neg preg test. Diagnosed with ulcer from taking NSAID, so you prescribe misoprostol. What warning should be given?

23:02:59 [crusher] ...do not get pregnant,,abortificant

23:03:36 [vladi] actually it's PG 1 and can stimulate uterus contractions

23:03:51 [Step_1] that was another real one. misoprostol is used to treat ulcers caused by the use of NSAIDs, but it's contraindicated in pregnancy. Do not get pregnant and use reliable birth control.....good job crusher and vladi

23:07:21 [Step_1] anyone else want to discuss anything specific?

23:07:30 [vladi] i meant PGE2

23:08:01 [Step_1] had another question about mech of action of abciximab?

23:08:09 [crusher] as i missed most of the chat ...i donot what u guys have already discuss....one thing im know that mECH of actions are imp

23:09:39 [vladi] actually - it's monoclonal Ab

23:09:42 [Step_1] its a GP IIb / IIIa receptor antagonist....cant remember the question, but that was the main point

23:11:34 [Step_1] here are another couple....they mention postmenopausal women who are concerned about breast cancer. what drug to give? what if concerned about breast and uterine cancer?

23:11:56 [Step_1] to prevent post men bone loss that is?

23:13:30 [crusher] estrogen

23:13:35 [hutals] raloxifene

23:14:15 [crusher] 1..tamoxifen...for CI of uterine breast ca----raloxifen

23:14:20 [vladi] biphosponate

23:14:37 [Step_1] raloxifene is an estrogen agonist on bone, antagonist on both breasts and uterus. its used for prevention of post menopausal bone loss without inc risk of breast or uterine cancer. tamoxifen is an estrogen agonist on bone, and antagonist in breat and partial agonist in uterus. used for breast...

23:15:09 [Step_1] cancer in post menopausal women. there is an inc risk for endometrial cancer with tamoxifen

23:16:27 [Step_1] the boards love those drugs for some reason

23:18:00 [hutals] What is the clinical use for Clomiphene?

23:18:19 [crusher] raloxifen is sensthanks for inform..

23:18:37 [Step_1] no problem

23:18:43 [Step_1] infertility

23:18:55 [crusher] i think induction of ovulation....

23:19:27 [hutals] Treatment of infertility (fertility pill)

23:20:04 [hutals] What type of gout is treated with Allopurinol?

23:20:33 [kmonica26] chronic

23:20:33 [Step_1] chronic gout with allopurinol. it inhibits xanthine oxidase

23:20:40 [aer02] chronic

23:20:52 [crusher] chronic...

23:21:13 [hutals] chronic. What type of gout is treated with Colchicine?

23:21:23 [Step_1] acute

23:21:27 [aer02] acute

23:21:48 [crusher] acute but indometacin is preffered

23:22:17 [hutals] Acute gout..agree with crusher

23:22:27 [hutals] What type of gout is treated with Probenacid?

23:22:41 [aer02] chronic

23:22:42 [Step_1] chronic

23:23:16 [hutals] Chronic gout.

23:23:25 [crusher] by depolarization of microtubules

23:23:55 [hutals] What type of patient should not take Misoprostol and why?

23:24:20 [crusher] pregnant reason abortificant just discussed

23:24:36 [Step_1] misoprostol is containdicated in preg women

23:25:00 [hutals] good point, already discussed sorry

23:25:26 [crusher] no harm in repeating

23:25:57 [crusher] in exam i they repeat same concept over again also

23:26:46 [hutals] sorry, its late here, so i'm having trouble thinking clearly

23:26:48 [vladi] typical Q- if pat has peptic ulcer and acute gout, DOC is colchicine, otherwise- indometacin

23:27:33 [Step_1] interesting vladi....thanks

23:28:08 [Step_1] which antihyperglcemic known to cause lactic acidosis?

23:28:11 [vladi] np

23:28:26 [crusher] step1 i like to discuss Q,s on ans with regard to b.p hr,,,E.NE phynel ,like combo of two drugs with asking what drug added

23:28:37 [crusher] metformin

23:28:39 [hutals] metformin

23:29:20 [Step_1] yes metformin (glucophage) is notorious for lactic acidosis

23:29:57 [Step_1] also know that it is drug of choice for those allergic to sulfa drugs since its not a sulfa

23:30:32 [Step_1] crusher, i had a couple of real ones on that

23:30:52 [crusher] plz ask so step1

23:31:18 [vladi] go ahead step 1

23:31:56 [Step_1] ok, pt given contol which inc hr and bp.....

23:33:07 [Step_1] scratch that.....not a good example.....let me start over....need a sec

23:33:37 [Step_1] the problem is that i have them on diagrams, so hard to describe, let me look up a text question

23:34:02 hagh enters this room

23:34:12 [hagh] hi

23:34:32 [hagh] this is pharm chat room

23:34:35 [aer02] hi

23:34:37 [vladi] so far crush - what other drugs act on mictotubule and what pmeumonic for that

23:34:51 [Step_1] hi hagh

23:34:58 [hagh] hi step1

23:35:42 [Step_1] following treatment with atropine, IV administration of NE would cause what effect on HR and BP?

23:37:06 [crusher] INC B.P N INC HR?????

23:37:56 [crusher] VINKAALKALOID...COLCHINE.....

23:38:17 [hagh] can I ask a question?

23:38:28 [Step_1] NE has alpha1 and beta1 activity. this will produce increase in TPR and CO. pt will become HTN and this will be followed by relex bradycardia. reflex bradycardia is going to be mediated via musc recept assoc with vagus. atropine is musc block and will block reflex. so it will be inc HR and BP

23:38:36 [Step_1] yes, go for it hagh

23:38:52 [hagh] Which of the following drugs cause vasoconstriction that is not blocked by prozosin and bradycardia that is blocked by scopolamin

23:39:10 [vladi] tricky Q- let's think : probably we cannot get relex bradicardia

23:39:12 [Step_1] hagh, you might want to pick brighter color from rainbow on right because hard to read text

23:39:17 [hagh] Option are A) Phenylephrin

23:39:29 [hagh] B) Angiotensin

23:39:41 [hagh] C) Amphetamin

23:39:50 [hagh] D) Norepinephrin

23:39:59 [hagh] E) Dopamin

23:40:10 [hagh] F) Propanolol

23:40:20 [hagh] F) Timolol

23:40:29 [hagh] G) TCAs

23:40:53 [hagh] s

23:40:58 [hagh] Is it better

23:41:29 [Step_1] yes, much better hagh, thanks

23:41:54 [hagh] ok, any idea about question

23:42:11 [Step_1] lets think this thru. prazosin is an alpha 1block

23:42:41 [hagh] it was NMBE Q assessment test

23:42:52 [crusher] RIGHT IT CANNOT BE DRUG OF aALPHA1 RECPTOR AGOINST

23:43:17 [Step_1] an the bradycardia is a reflex because it is blocked by an antimusc

23:43:35 [hagh] yes

23:43:36 [crusher] SOMETHING ELASE THAT INC B.P AND BRADY CARDIA INHIBITED BY ANTIMUSCURANIC

23:43:46 [Step_1] NE?

23:44:41 [vladi] it supposed to be b1 and cholinergic drug- norepinephrin

23:44:44 [hagh] maybe NE

23:45:06 [hagh] but here is my rational

23:45:14 [hagh] i think its angiotesin because its vasconsticoion effect can't be blocked with alpha blocker since its not acting on alpha receptor and can cause reflex bradycardia through muscrinic receptor acivation in the heart this effect can be blocked with antimuscrinic drug like scoplamine ...please correct

23:45:40 [crusher] I,M AGREE WITH U

23:45:43 [hagh] me if I am wrong

23:46:21 [crusher] COS THE DRUG SHOLD BBE THAT SHOULD NOT HAVE A1 ACTIVIUTY....COS ne HAS A1,B1 AND A2 ACTIVITY

23:46:33 [hagh] Is anybody heard about muscarinic effect of angiotensin

23:46:49 [vladi] thanks hagh- good Q- probablyy you are right

23:46:56 [Step_1] thats a good point. NE has vasoconstriction via alpha 1, so probably effected by prazosin. and i hadnt really thought about angiotensin....good point

23:48:03 [Step_1] very good question hagh



23:48:40 [kmonica26] Bye guys have to go..thanks for an excellent chat


23:49:03 [hagh] buy kmonica

23:49:04 [crusher] I THINK WE SHOULD

23:49:09 [Step_1] good night monica....see you next chat

23:49:19 [hutals] nite mon

23:49:19 [kmonica26] good night


23:49:50 [Step_1] sure, go for it hagh.

23:49:51 [hagh] for example what happen on administration of epi if cAMP is blocked


23:50:40 [hagh] there is a experimental question asking what happen of administration of epi nephrine if researchers blocked cAMP

23:50:56 [hagh] no , I have a black bird, she told me

23:51:14 [hagh] any idea

23:51:25 [crusher] HER NAME IS SHELLA?

23:52:40 [Step_1] yes....got an idea about it....

23:52:42 [hagh] YES, how you know

23:52:56 [hagh] So you know my shilla

23:53:10 [hagh] she is hear, say hi to you

23:53:12 [Step_1] i think it has to do with the g proteins

23:53:13 [crusher] I HAVE ANOTHER BIRD ,,SHE IS SHEILLA FRIEND SHE TOLD ME

23:53:28 [hagh] Ok,

23:53:29 [vladi] epinephrin acts to G-protein coupled Gs and thus activates adenylate cyclase, inc cAMP and activate PKA

23:53:42 [crusher] my hi to shiella

23:53:51 [hagh] I know she was talking with neighborhood birds these days

23:53:53 [Step_1] Gs increases adenlyly cyclase which inc cAMP

23:54:11 [vladi] disrupting cAMP we disrupt a whole chain

23:54:16 [Step_1] this would effect beta 1 and beta 2

23:54:18 [hagh] i know but what happen if we block cAMP

23:54:31 [crusher] my bird go to usmle,net too thats why she know shilla

23:54:49 [Step_1] Gi dec adenylyl cyclase which is alpha 2

23:54:53 [hagh] so we have inc adenyl Cyclase

23:55:02 [hagh] Ok,

23:55:50 [Step_1] i think the cAMP would be blocked so the Beta 1 and 2 effects might be lowered??

23:55:50 [hagh] Inc Adenyl cyclase but dec protein kinase A

23:56:00 [hagh] I am right or what

23:56:29 [vladi] it will inhibit B1.b2, H2,V2 and D1

23:57:10 [hagh] I agree but the question ask about the mechanism

23:57:32 [hagh] Why is the rule of game in exam guys from Goljan

23:57:57 [hagh] Mechanism, WHY not what

23:58:10 [Step_1] remember one and the other is the other.....also, play odds

23:58:32 [hagh] So we agree on inc adenyl cyclase and dec Prot Kinase A

23:58:48 [hagh] yes, step, Are we sharp in this room or what

23:59:20 [Step_1] not so sharp this late....but we were on a role earlier

23:59:32 [hagh] now get back to question, question asks what happen on enzym phosphorrylation

00:00:24 [hagh] this is the poin, dec Prot Kinase dec enzyme phosphorylation

00:00:38 [vladi] why PHA decrease when it supposed to inc- i did catch your point

00:00:58 [Step_1] ok, so its combining physiology with pharm. we know that its beta 1 and 2 that they are probably talking about, maybe even alpha 1. now we need to look at the physiological mech

00:01:02 [hagh] dec enzyme phosphorylation like the mechanism of action of Glucagon

00:01:15 [hagh] God darn them for making this hard question, Amin

00:01:49 [hagh] step 1, don't mess with beta one or two, concentration of mechanism of how cAMP work

00:02:13 [Step_1] they're getting real tough with those epi and NE questions....always asked...very high yield

00:02:15 [hagh] becuase the question said if we block cAMP

00:02:27 [vladi] thanks hagh and all- i gotta go- good night

00:02:35 [hagh] you darn right step1, darn right

00:02:45 [hagh] I mean darn

00:02:57 [hagh] what is wrong, why I can't type darn

00:03:02 [hagh] is says darn

00:03:09 [Step_1] word censor got you hagh

00:03:24 [crusher] keep space d a m

00:03:29 [hagh] shet, it is my favorite word

00:03:42 [hagh] Ok, D A M N right

00:03:47 [Step_1] good night vladi....we're just wrapping it up anyway since its midnight eastern

00:03:57 [hagh] anyway any idea

00:04:11 [hagh] , BTW my name is Mike

00:04:26 [hagh] please folks any idea about the question, Am i right

00:04:37 [Step_1] i would need to think that one though a bit more tomorrow.....been at this too long tonight and the brain isnt working right now

00:05:00 [hagh] Ok, just answer the next one and we are

00:05:16 [hagh] pt on warfarin and is given Metronidazole



00:05:26 [crusher] ok step1n thanks for coming with as always with great q..

00:05:44 [hagh] what happen on PT, and the question ask HOW metronidazole interact here

00:06:07 [hagh] step 1, I heard bad thing about Mock exam

00:06:15 [Step_1] on PT as in PT, PTT in blood?

00:06:30 [hagh] is anybody know what is the interaction between Metro and warfarin

00:06:50 [hagh] Warfarin, so we are talking about PT

00:07:10 [crusher] i think inc PT

00:07:14 [hagh] yes, PT in the blood, common so where, in urine

00:07:29 [hagh] inc PT why

00:08:29 [hagh] no idea, common move your little gray cells in the brain

00:08:58 [hagh] don't disappoint me in my first visit, I hope that you can help me

00:09:15 [hagh] I don't know the answer, but I THINK

00:09:46 [hagh] metro effect plasma prot involved in transformation of Warfarin in the blood

00:10:07 [hagh] so , displace warfarin from plasma prot

00:10:14 [hagh] HELLO , Is anybody HOME

00:10:24 [Step_1] i'm looking it up. you might have better luck posting the questions in the step 1 forum because most people have already left

00:10:25 [crusher] i,m not sure but

00:11:10 [hagh] oK, 3 person not bad, this was last one

00:11:20 [Step_1] Inhibition of S-warfarin Clearance

00:11:38 [hagh] Ohh, really

00:11:45 [hagh] clearance

00:12:07 [hagh] Ok, dec Clear or Inc clearance of warfarin

00:12:20 [Step_1] As noted, medications can inhibit the metabolic clearance of warfarin in a stereoselective or nonstereoselective manner Examples of medications that inhibit the clearance of S-warfarin via inhibition of the CYP2C9 isoenzyme include trimethoprim/sulfamethoxazole (Bactrim, Septra) and metronidazole

00:12:36 [crusher] if its showing inc PT it means there is inc warfain conc..so metronidazole must have effect on its either metabolism either p450 or clearence

00:12:52 [Step_1] (Flagyl). Inhibition of S-warfarin’s clearance by these and other compounds would serve to potentiate warfarin’s effect on PT/INR, possibly placing the patient at increased risk of bleeding complications

00:13:48 [hagh] there were 2 option, Cytochrome and Kidney

00:14:14 [hagh] ok, inc PT due to effcet on Cytochrome P450

00:14:32 [crusher] i think first need to check metroniadazole in p450 inhibitor or not???

00:14:45 [hagh] so metro is an inducer, right

00:15:07 [hagh] i don't know, I couldnot find metro in the list

00:15:22 [hagh] anybody knows it is inducer or inhibitor

00:15:44 [hagh] but step 1, thanks for info

00:15:49 [Step_1] CYP2C9 isoenzyme i assume is cytochrome, so cytochrome would be my guess

00:16:02 [crusher] it can be inducer so that it can lead 2 inc warfarin conc

00:16:23 [hagh] Yes, no doubt, CYP2C9 is a cytochrome

00:16:32 [crusher] i,m sorry i mean inhibitor===metronida

00:17:42 [Step_1] ok, now the brain is really fried....i think that put it over the edge...time to go to bed

00:17:51 [hagh] so Metro is inhibitor

00:17:59 [hagh] Ok, step 1, good night

00:18:03 [hagh] OK

00:18:15 [crusher] i gotta go tooo.quite a late

00:18:32 [crusher] good night everyone!

00:18:35 [hagh] have agood night both,

00:18:38 [Step_1] i'll look over the transcript tomorrow in the step 1 forum and look up the other question to try to find an =answ

00:18:45 [hagh] I and shilla, continue our discussion

00:18:53 [Step_1] thanks for the great chat....see everyone in the next chat

00:19:01 [Step_1] good night

00:19:14 [hagh] Ok, i don't go there anymore.but may come back next week here

00:19:19 [hutals] good nite all and thanks

00:19:23 [hagh] good night