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What is exenatide?
- GLP-1 mimetic. inc. insulin production and inhibits glucagon breakdown. given when insulin would normally be given 60mins before breakfast and dinner.
- given with other T2DM drugs.
- causes weight loss.
Gliptins e.g. sitagliptin are DPP-4 inhibitors. also new class, can also be started second line.
- give PPI if with NSAID
- Dont give with triptans
- consider mirtazapine if taking warfarin or heparin.
- 4 weeks ex fluoxetine.
- 2 week check-up when starting or 1 week for children.
TB drug causing hepatitis and gout?
alkylating agent that can cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma?
immunosuppressant drug that can cause cardiomyopathy. acts by inhibiting DNA and RNA synthesis
Drugs causing acute pancreatitis?
azathioprine, mesalazine, bendroflumeth, furosemide, steroids, sodium valproate.
How is CV risk assessed in NSTEMI?
- GRACE score to get 6 month CV risk.
- >1.5% clopi for 12 months
- >3% add IIb/IIIa inhibitor e.g. tirofibran.
- give heparin unless going to angio in next 24h (considered if 6 months mortality risk is >3%).
MOA of heparin?
activates antithrombin III which inhibits f Xa.
Standard monitoring of lithium?
- TFT UAE prior to treatment
- TFT UAE every 6 months.
- weekly lithium levels until stabalised then every 3 months
Standard monitoring of glitazones?
LFTs before starting and 'regularly' during treatment.
monitoring of statins?
LFT at baseline, 3 and 12 months.
Monitoring for methotrexate?
Monitoring of FBC LFT, UAE weekly until stabalized then every 2-3 months.
How do you interpret Webers test?
- Sound localises to affected side in conductive loss (sound amplifyed on that side!).
- Sound localises away from affected side in sensorineural.
- Rinne's then shows:
- AC>BC = normal
- BC>AC = Conductive hearing loss.
A doctor is exposed to hep C blood at work. What is the routine protocal?
monthly PCR and interferon +/- ribavarin if seroconversion occurs.
Major criteria of RF?
- erythema marginatum
- subcutaneous nodules
Minor criteria of RF?
- raised ESR/CRP
- prolonged PR.
proportion of patients with condition who have a positive results?
negative predictive value?
Chance that pt does not have condition if test result is negative.
correct false tests / total number of false tests.
positive likelyhood ratio?
How much the odds of the disease increase when the test is positive.
Drug used for severe resistent HTN?
- potassium channel activator given with a diuretic and beta blocker (as can cause fluid retention and tachycardia).
- SE: hypertrichosis, elevated creatinine and urea.
pt presents with absent radial pulse, fainting and lethargy.
large vessel vasculitides?
- giant cell arteritis
- Takayasu's (young, female, asian)
restless leg syndrome?
antibody associated with limited cutaenous systemic sclerosis?
- This is the CREST varient with internal organs less involved.
- risk of pulmonary hypertension.
- ANA positive in 90% all types.
anti Scl 70 antibody?
also called anti topoisomerase 1
- assocaited with diffuse cutaneous SS. (poor prognosis)
- inc. skin and organ involvement.
- inc. risk of lung fibrosis and renal disease if Ab present therefore.
management of acute stroke?
- exclude haemorrhage.
- alteplase if within 3 hours.
- aspirin 30mg ASAP
- warfarin if in AF but wait 2 weeks.
- long term treatment = clopi for 12 months post ischaemic. or aspirin + dipyridamole if contraindicated.
- Don't lower BP.
- Start statin if >3.5
Management of SAH?
- CT to confirm. LP after 12h if nothing found.
- oral nimodipine 4 hourly.
- No anti-fibrinolytics or anticoagulants!
- image cerebral vessels.
- repair aneurysms with endovascular ablation.
How many squamous cancers can you think of?
- head and neck
beta blockers indicated in heart failure?
carvedilol and bisoprolol
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