Diseases and Medications:

Diseases and Medications:

Pulmonary diseases:

• Risk factors for drug-induced lung injury:

• Age over 60

• Preexisting lung disease (e.g., interstitial pneumonia)

• Impaired respiratory function

• History of lung resection

• Oxygen use

• Radiation exposure

• Renal impairment

• Smoking

• Drugs causing cardiogenic pulmonary edema:

• Diltiazem

• Propranolol

• Albumin

• Non-cardiogenic pulmonary edema:

• Aspirin

• Methotrexate

• Risk factors for pulmonary embolism:

• Estrogen-containing medications (e.g., birth control pills)

• Antipsychotic medications

• Factors causing CO2 retention-induced weakness:

• Aminoglycosides (e.g., amikacin)

• Penicillin A

• Procainamide

• Methotrexate-induced lung injury:

• Risk factors: Diabetes, low albumin, older age, pleuritis due to rheumatic fever

• Allergic mechanism

• Cough due to ACE inhibitors:

• More common in women than men

• Latency period up to 15 months

Hepatic diseases:

• Pre-jaundice:

• Appears within 1 week

• Mild fever without cold symptoms

• Flu-like symptoms

• Jaundice:

• Appears from 2-6 weeks

• Jaundice increases, dark yellow urine

• Fever subsides, fever resolves

• Transmission routes of hepatitis viruses:

• HAV: oral-fecal route

• HBV, HCV, HDV: blood, mucocutaneous contact, sexual contact, mother-to-child

• HEV: fecal-oral route

• Acute, subacute, fulminant hepatic failure:

• Fulminant hepatic failure: under 7 days

• Acute hepatic failure: 8-28 days

• Subacute hepatic failure: 4 weeks – 28 weeks

• Acute hepatitis AST, ALT:

• Cirrhosis

• Alcohol-induced hepatitis:

• Acute: AST/ALT < 1

• Cirrhosis: AST/ALT > 1

• Alcohol: AST/ALT > 2

• Hepatocellular dysfunction syndrome:

• Sleep, digestion, coagulation disorders

• Jaundice, icterus

• Spider angioma

• Erythema, palmar erythema

• Pedal edema

• Ascites

• Albumin, cholesterol decrease

• Globulin, bilirubin increase

• Portal hypertension syndrome:

• Ascites

• Splenomegaly

• Portal-caval shunt

• Hemorrhoids

• Gastrointestinal bleeding

• Hypersplenism

• Iron overload, copper overload:

• Iron: skin pigmentation

• Copper: Wilson’s disease

• Diagnosis of cirrhosis:

• Liver biopsy is the gold standard

• Classification of hepatitis:

• Based on clinical and paraclinical features (hepatocellular dysfunction, portal hypertension)

• Stage diagnosis of gastrointestinal bleeding, jaundice, ascites, infection, hepatic encephalopathy (compensated – decompensated)

Renal diseases:

• Urinalysis:

• Positive, false negative

• Time of sample collection:

• False (+): Myoglobinuria

• False (-): Urine containing ascorbic acid, nitrites, high protein, pH < 5

• Collect first morning urine, midstream

• Non-proteinuria:

• Minimal change disease

• Similar red blood cells:

• Renal tuberculosis

• Non-hematuria:

• Bilirubin

• Porphyrin, myoglobin, hemoglobin: hematuria

• Important test for renal edema:

• Proteinuria

• Conditions for hypertension grading:

• >= 18 years old

• Primary essential hypertension

• Not using blood pressure medication

• No acute medical conditions

• Calcium channel blockers (hypertension):

• Used for older adults (half-life of thiazide)

• Side effects: Facial flushing, palpitations, ankle edema, nocturia

• Beta-blockers:

• Caution with abrupt discontinuation, bradycardia, asymptomatic hypoglycemia

• Effective volume depletion:

• Heart failure

• Infection

• Ascites

• Acute pancreatitis

• Loss into the third space

• True volume depletion:

• Gastritis-enteritis

• Chronic diarrhea

• Excessive diuretics

• Poor diet

• Prevention of contrast-induced nephropathy:

• Use the lowest possible dose, avoid repeat imaging for 24-48 hours

• Avoid NSAIDs or diuretics for at least 24 hours

• Monitor renal function 24-48 hours

• Acute tubular necrosis:

• Aminoglycosides

• Amphotericin B

• Hemolytic drugs:

• Colchicine

• Ciprofloxacin

• Paracetamol

• Chronic interstitial nephritis, associated risks:

• Use of acetaminophen, aspirin > 1g > 2 years

• Risk factors for acute kidney injury due to contrast media:

• > 60 years old

• Diabetes

• Heart failure

• Infection

• Reduced circulating volume

• Underlying kidney disease > 60 ml/minute

• Prevention of drug-induced kidney injury:

• Measure drug levels

• Use alternative medications if available

• Modify risk factors if possible

• Adequate hydration before and during treatment

• Assess renal function before treatment (MDRD)

• Monitor and adjust drug doses (Cockroft-Gault)

• Avoid nephrotoxic drug combinations

• Drugs causing more severe hypertension:

• NSAIDs

• Erythropoietin

• Cyclosporine

• Ergotamine

• Estrogens

• Corticosteroids

• Alcohol

• Cocaine

• Anticholinergics

Gastrointestinal diseases:

• Risk factors for increased gastric ulcers in Hp-infected individuals:

• Infection with CagA & VacA bacteria

• Salty diet

• Consuming canned food

• Not a risk factor: alcohol

Cardiovascular diseases:

• Acute myocardial infarction:

• ST-elevation myocardial infarction

• Non-ST-elevation myocardial infarction

• Unstable angina

• Causes of coronary artery disease:

• Atherosclerosis

• Takayasu’s disease, Kawasaki’s disease

• Hyperthyroidism

• Thrombosis, embolism

• Risk factors for coronary artery disease:

• Increased LDL

• Decreased HDL

• HbA1c

• Systolic blood pressure

• Smoking

• Classification of myocardial infarction:

• 5 types:

• Type 1: Occurs naturally (primary)

• Type 2: Secondary myocardial infarction due to myocardial oxygen imbalance

• Type 3: Sudden death myocardial infarction

• Type 4a: Myocardial infarction related to intervention, procedure

• Type 4b: Myocardial infarction related to stent intervention

• Type 5: Myocardial infarction related to bypass surgery

• Optimal aspirin dose for coronary artery disease:

• 75-150 mg

• Most sensitive test in coronary artery disease:

• Exercise electrocardiogram

• Drug groups that improve prognosis for patients with chronic peripheral artery disease:

• Statins

• Aspirin

• ACEi, ARB

• Drug groups that improve symptoms of peripheral artery disease:

• Beta-blockers

• Calcium channel blockers

• Nitrate group