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Vecuronium, atracurium, tubocuraine
NMJ blockers (i.e. they block nicotinic ACh receptors). Reversible the whole time, unlike succinylcholine.
For cholinesterase inhibitor poisoning: Used to regenerate cholinesterase. (Use with atropine.)
Glaucoma -- anti-cholinesterase
Muscarinic antagonists for GU -- ex. reduce urgency w/cystitis
Methscopolamine, pirenzepine, propantheline
GI -- for peptic ulcers
Nicotinic antagonist: blocks reflex bradycardia after NE administration (Experimental drug)
Amphetamine & ephedrine vs. cocaine
Cocaine inhibits catecholamine reuptake, while amphetamines & ephedrine cause release in 1st place
B2-agonist for premature labor contractions
Glucocorticoid to stimulate surfactant production in premature babies
False aortic aneurysm
Entire vessel wall ruptures -- post-MI, or at vascular graft anastomosis
Plaque in blood vessel walls, from hyperlipidemia
In atherosclerosis, what forms the fibrous plaque cap?
Foam cells recruit smooth muscle cells, via PDGF & FGF-Beta
Enzymes assoc w/plaque rupture vs. stability
Rupture = MMP's, stability = lysyl oxidase (strengthens collagen fibers of cap)
It induces vasospasm in Prinzmetal's angina pts. These pts will still respond to NG.
Necrosis did occur, but only a partially occlusive thrombus
Medications that slow HF progress
Captopril (ACE inhibitor), & B-blockers inhibit ventricular remodeling
In tissues w/collaterals: liver, lung, intestine... or following reperfusion anywhere
Injury: MI, Prinzmetal's (even though it still responds to NG), aortic dissection, pericarditis (but no CK-MB elevation)
Can't load cholesterol onto HDL (ABCA transporter), so macrophages pick it up instead --> foam cells. Orange tonsils
Earliest MI changes
- Contraction bands -- 1-2 hours (eosinophilic sarcomeres around infarct borders)
- Coagulative necrosis -- 4 hours (pyknotic nuclei)
1 day post-MI
Neutrophil infiltration. Most common cause of death: v.fib. Fibrinous pericarditis overlying the necrotic segment.
Complications 7 weeks post-MI
Dressler's syndrome, ventricular aneurysm. Inc'd collagen, dec'd cellularity.
Most specific protein marker for MI. Rises after 4 hours, stays elevated for 10 days.
Endocarditis: Loeffler vs. Libman-Sacks
- Libman-Sacks: SLE causes LSE. Sterile; usually asymptomatic, but mitral regurg.
- Loeffler endocarditis: hypereosinophilia --> fibrosis --> restrictive cardiomyopathy
Kerley B lines
Increased LA pressure (heart fail) --> pulm edema: more fluid in lung interstitium
Culture-neg endocarditis. Haemophilus, actinobacillus, eikenella, cardiobacter, kingella
Syphilis heart disease
Vasa vasorum of aorta disrupted --> dilation of aorta, calcification of aortic root --> aneurysm, incompetent aortic valve.
Long-QT hereditary syndromes
- Jervell & Lange-Nielsen: Auto R, neurosensory deafness
- Romano-Ward: Auto D, no deafness
- Like Wegener's (nasal/lung/kidney), but lacks granulomas.
- Type III hypersensitivity, from antibiotic use -- often penicillin
- Med-sized vessels: kidney, melena, cutaneous, neuro.
- Young adults, Hep B.
Diazoxide vs. minoxidil
- Both open K+ channels. Diazoxide = for HTN emergencies, hyperglycemia.
- Minoxidil = hypertrichosis, pericardial effusion
Thyroid conditions associated with:
1) Lymphocytic infiltrate w/germinal centers
2) Granulomas, elevated ESR
3) Iodinde deprivation, followed by restoration
- 1) Hashimoto's
- 2) Subacute thyroiditis
- 3) T3/4 release --> toxic multinodular goiter (thyrotoxicosis = Jod-Basedow)
Chvostek's & Trousseau's signs
- Tetany due to hypocalcemia (hypoparathy).
- Chvostek's = tap on facial nerve --> contract muscles
- Trousseau's = BP cuff causes carpal spasm (occlude brachial A)
Dopamine agonists -- shrink pituitary adenoma
DM complications that are due to osmotic damage (glucose --> sorbitol --> fructose)
Cataracts, neuropathy. When you have high glucose, it really accumulates in tissues not dependent upon insulin for glucose uptake!
2 bugs common in: 1) diabetics & 2) DKA
- 1) Klebsiella, Pseudomonas
- 2) Mucor, Rhizopus
Somatostatin analog for carcinoid syndrome