Hypothyroid Disorders: Hashimoto’s disease: Most common. Iodine deficiency most common cause worldwide. Can also be due to pituitary insufficiency or drug-induced (amiodarone, lithium). Diagnose with low free T4, elevated TSH, thyroid antibodies Symptoms: cold intolerance, dry skin, fatigue, weight gain, bradycardia, slow reflexes, coarse skin and hair, periorbital swelling, goiter, menstrual irregularities Levothyroxine is the drug of […]
Adrenal Disorders
Acromegaly – bromocriptine or octreotideHyperprolactinemia – surgical resection, cabergoline or bromocriptine Cushings Disease- Diagnosed by a dexamethasone suppression test or 24-hour urinary cortisone test. Symptoms: central obesity, peripheral fat, myopathies, osteoporosis, back pain, diabetes, hirsutism, hypertension Treatment: Surgical resection if possible Pasireotide: 0.6-0.9 mg BID subQ (adverse effects: hypoglycemia, hypocortisolism, diarrhea, nausea, gallstones, headache, bradycardia) Ketoconazole: Hinders cortisol […]
Obesity
BMI Defined: 18.5-24.9 – Normal 25.0-2939 – Overweight 30-34.9 – Class I Obesity 35-39.9 – Class II Obesity 40 or greater – Class III Obesity Treatment: Orlistat – AE: Hepattoaxity and kidney stones Lorcaserin: AE: headaches, dizziness, nausea and vomiting, dry mouth, memory or attention problems, hypoglycemia. DC if 5% weight not lost in 12 […]
Diabetes
This is a very simply rundown of diabetes. The diabetes information on the ambulatory care board exam is more complex. Knowing the basics of how to diagnose diabetes, goals, how to change insulin and which drugs not to use in which patients is probably enough for the BCPS. Pre-Diabetes Fasting Plasma Glucose: 100-125 mg/dl 2-hour […]
Ketoacidosis
Ketoacidosis is more common in type 1 diabetes than in type 2. The goal treatment is to stop ketosis, not to normalize glucose. Common symptoms: polyuria, polydipsia, vomiting, dehydration, weakness, altered mental status, coma, abdominal pain, Kussmaul respirations, tachycardia, hyponatremia, hyperkalemia Treatment: Fluid replacement: start with 0.45-0.9% NS, change to 5% dextrose or dextrose containing saline […]
Diabetes Insipidus
Decreased anti-diuretic hormone (ADH) production or lack of ADH effect.Symptoms: polydipsia, polyuria, lethargy, and confusionTreatment: desmopressin, chlorpropamide, carbamazepine for central DI, thiazide, low sodium diet and indomethacin in nephrogenic DI.
Acid-Base Disturbances
Summary of Acid-Base Disturbances pH (7.3 – 7.4) H+ HCO3 (22-26) pCO2 (34-45) K+ metabolic acidosis ↓ ↑ ↓ ↓↓↓ ↑ metabolic alkalosis ↑ ↓ ↑ ↑↑↑ ↓ respiratory acidosis ↓ ↑ ↑↑↑ ↑ ↑ respiratory alkalosis ↑ ↓ ↓↓↓ ↓ ↓ Multiple arrows means it is a compensatory mechanism. PCo2 is usually 1.5 times the bicarb + […]
Pressors and Ionotropes
Drug Name Receptor affected HR BP CO Cardiac Vasoconstriction Peripheral Vasculature (B2) Uses Norepinephrine α, β1 ↔ ↑↑↑ ↔ or ↑ ++++ 0 2-40 ug/mincardiogenic shock Epinephrine α, β1, β2 ↑↑↑ ↑↑↑ ↑↑↑ ++++ increased peripheral vasodilation 1-20 ug/mincardiogenic shock and anaphylaxisepi activates everything) Dopamine α, β1, dopaminergic ↑↑ ↑ ↑↑ 0 increased peripheral vasodilation and […]
Shock
Hypovolemic shock: Restore intravascular volume and oxygen carrying capacity. If hemoglobin < 7, administer blood products. Patients may need pressers. Obstructive shock: Must treat actual obstruction. Fluids may improve end-organ perfusion temporarily. Vasodilatory shock: Usually sepsis Septic Shock: Treat with sepsis bundles. Within 3 hours: Obtain labs. Start broad-spectrum antibiotics, ideally within the first hours (obtain […]
Analgesics
Morphine Fentanyl Hydromorphone Onset (min) 5-10 1-2 5-10 Duration (h) 2-4 1-5 2-6 Prolonged in renal yes no no Prolonged in hepatic yes yes yes T 1/2 in hours 1-4 2-5 2-3 Active metabolites yes no no Hypotension yes no yes Flushing yes no yes Bronchospasm yes no no Constipation yes yes yes For […]