Quick Med Review - Quick review of medical information

Pyelonephritis

admin — Tue, 01 Aug 2006 20:19:32 -0500

Pyelonephritis refers to a upper urinary tract infection, versus "cystitis" seen in the lower urinary tract. The most common organism is E. Coli, followed by Staph. saprophyticus.

Si/Sx

flank pain/CVA tenderness
nausea, vomiting
fever (> 38C)
frequency, dysuria
hematuria
pyuria

Urinalysis (“UA”) signs indicative of pyelonephritis include:

many WBC
nitrite + (nitrite indicates organisms able to reduce nitrate to nitrite, and does not include certain organisms such as enterococci)
esterase +
white cell casts: rare, indicate a renal source for pyuria
*note: the presence of epithelial cells indicates that the specimen was contaminated by contents outside the urinary tract. Epithelial cells are not found in the urinary tract.

A pelvic exam should be completed, as pelvic inflammatory disease is often confused with pyelonephritis. A pregnancy test should also be completed if LMP is unknown. Urine culture is also indicated, as resistance to empiric therapy may have serious sequelae.

Sequelae

Ischemia

admin — Mon, 31 Jul 2006 15:29:54 -0500

Signs of ischemia include "QRST-T"

Abnormal Q waves:

- defined as > 0.04 seconds (1 small box) and greater than 1/3 the height of the R wave

- are normal in AVR, III?

T wave

- T wave inversion (TWI) is normal in lead III, AVR, V1

Coumadin

admin — Fri, 21 Jul 2006 18:30:20 -0500

Mechanism

Prevents the liver synthesis of vitamin K dependent factors (2, 7, 9, 10)

Monitor

Coumadin (Warfarin) is monitored by PT, "WEPT"

Uses

Anticoagulation for:

post myocardial infarction
mechanical heart valves
thrombosis prevention in atrial fibrillation
post PE/DVT

Heparin - Low Molecular Weight

admin — Fri, 21 Jul 2006 18:24:08 -0500

Mechanism

Fractionated heparin that binds more specifically to factor X, LMWH has a better safety profile and does not require monitoring

Uses

Myocardial infarct / Unstable angina
Deep venous thrombosis / Pulmonary Embolus

Reversal

Also by protamine sulfate

Heparin

admin — Fri, 21 Jul 2006 18:20:36 -0500

Mechanism

Binds antithrombin III, inactivates clotting factors IX, X, and XII. Heparin will prevent new clots from forming, but does not lyse existing clots.

Monitoring

PTT is used to monitor heparin, adequate dosing is roughly 1.5 to 2 times normal

Reversal

Protamine Sulfate

Digoxin

admin — Fri, 21 Jul 2006 18:16:03 -0500

Mechanism

Disrupts sodium-potasium ATP-ase in cardiac myocardium, resulting in

Negative chronotropy
Positive inotropy

Uses

Rate control in atrial fibrillation
To increase inotropy in LV dysfunction

Side Effects

Overdose

Adenosine

admin — Fri, 21 Jul 2006 18:12:27 -0500

Mechanism

Causes AV nodal conduction block, short half-life (10 seconds)

Indications

Diagnosis of supraventricular tachycardias

Class IV Antidysrhythmics

admin — Fri, 21 Jul 2006 14:00:21 -0500

Mechanism

Blockade of slow calcium channels

Examples

Verapamil, Diltiazem

primarily affect heart, "give your heart VD"

Nifedipine

primarily affect vessels

Primary Uses

Dilt and verapamil:

to control ventricle in rapid a-fib (like Class II)
to control ventricle in SVT

Class III Antidysrhythmics

admin — Fri, 21 Jul 2006 14:00:17 -0500

Mechanism

Sodium channel activation and potassium channel blockade

Examples

Amiodarone, bretylium, sotalol, ibutilide

Primary Uses

Ibutilide: to break new onset a-fib

Class IC Antidysrhythmics

admin — Fri, 21 Jul 2006 14:00:12 -0500

Mechanism

Large blockade sodium channel

Prolong repolarization and action potential duration

Examples

Propafenone, flecainide, encainide

Primary Uses