Question Thread - Choose the Best Answer

DrIreland · 15-02-06, 18:26

32 year old man infected with HIV is diagnosed with Hodgkin lymphoma. If the patient's CD4 count is 505/mm3 which of the following agents would be suitable for the treatment of the patient's lymphoma without further compromising his immune system?

A Busulfan
B Cisplatin
C Cyclophosphamide
D Paclitaxel
E Vincristine

Mfurfur · 15-02-06, 21:06

Vincristine is my answer, an inhibitor of mitosis and does not supress bone marrow function.

Busulfan - alkylating agent with severe BMS, management of CML
Cisplatin - alkylating agent with severe BMS, management testicular and ovarian CA
Cyclophosphamide - nitrogen mustard, BMS, management of breast, testicular, leukemia and lymphoma
Paclitaxel - antimicrotubule agent, profound neutropenia, ovarian and breast

Mfurfur · 15-02-06, 21:09

50 year old woman with urinary incontinence is diagnosed with detrusor instability on urodynamic evaluation. Stimulation of which of the following results in contraction of this muscle?

A Alpha-adrenergic receptors
B Beta adrenergic receptors
C Muscarinic receptors
D Nicotinic receptors

Pversicolor · 16-02-06, 07:58

I think the answers breaks down to either the muscarinic receptors (acetylcholine) or beta adrenergic (epinephrine) that act on the detrusor muscle. Since we don't want to wee went we're running and we want to wee when we're relaxed, i've got to go with muscarinic receptors!

DrIreland · 17-02-06, 08:44

Right on with muscarinic receptors! If we think pharmacologically we can treat detrusor instability with anticholinergics (oxybutynin) and we clearly understand why we get urinary retention with TCAs.

Alpha receptors function in contraction of the trigone of the bladder and smooth muscle of the urethra. So alpha agonists are used in stress incontinence and alpha antagonists can be used in treating overflow incontinence resulting from bladder outlet obstruction.

DrIreland · 17-02-06, 08:48

64 year old man presents to his physician with aching burning pain after meals. His physician takes him off his self prescribed antacids and instead places him on a combination of ranitidine and sucralfate. Why is this combination a bad idea?

A Ranitidine increases the toxicity of sucralfate
B Ranitidine inhibits the action of sucralfate
C Sucralfate and ranitidine coprecipitate
D Sucralfate increases the toxicity of ranitidine
E Sucralfate inhibits the action of ranitidine

Mfurfur · 17-02-06, 22:38

This question confused me because in the literature it indicates that ranitidine is commonly coadministered with sucralfate. However i did read here that if a large dose of sucralfate can inhibit the absorption of ranitidine therefore inhibiting its action.

My answer is choice E. There has been nothing mentioned about increasing toxicities and there is no observation that ranitidine does anything to the bioavailability or toxicity of sucralfate. If anyone finds anything else out let me know!!

Mfurfur · 17-02-06, 22:41

A nice multistepper!

A 26-year-old woman is undergoing surgery and is anesthetized with an inhalant anesthetic. She is also given an IV dose of succinylcholine. Within minutes, she develops a heart rate of 124 and increasing core body temperature. What is the mechanism of action of the drug of choice for this patient's condition?

A. It interferes with the release of Ca2+ from the sarcoplasmic reticulum

B. It is a competitive antagonist of ACh at the motor end plate

C. It is a GABA receptor agonist that enhances inhibition of nerve impulses

D. It uncouples oxidative phosphorylation, thereby preventing heat formation

doctor_b · 27-07-06, 09:31

You seem to be describing Malignant Hyperthermia in a patient who received Halothane anaesthesia. I'm not sure of the point of succinylcholine (a.k.a. the paralysing agent suxamethonium in this part of the world) here other than it too may rarely cause MH. Anyhoo...the treatment of choice is Dantrolene, a muscle relaxant that works directly on the ryanodine receptor to prevent the release of calcium. from the SaR - thus the answer is "A".

So, i ask - what are the 6 major drugs associated with drug-induced systemic lupus erythematosus?

opisthotonus · 07-08-06, 10:52

6 Drugs that can cause SLE are HIPPPE
Hydralazine - a vasodilator used in HTN
Isoniazid - an ant-tuberculosis medication
Phenytoin - an anticonvulsant medication
Penicillamine - a chelator in heavy-metal poisoning
Procainamide - a Class Ia (i.e. Na channel blocker) antiarrhythmic
Ethosuxamide - anti-epileptic medication

What drug do I Rx for bacterial carrier-states (S. aureus, N. meningitidis, H. influenzae)?

15-02-06, 18:26	#1
DrIreland Erik Administrator Join Date: Jan 2006 Posts: 168	Question Thread - Choose the Best Answer 32 year old man infected with HIV is diagnosed with Hodgkin lymphoma. If the patient's CD4 count is 505/mm3 which of the following agents would be suitable for the treatment of the patient's lymphoma without further compromising his immune system? A Busulfan B Cisplatin C Cyclophosphamide D Paclitaxel E Vincristine
OFF CALL

15-02-06, 21:06	#2
Mfurfur Member Join Date: Jan 2006 Posts: 55	Vincristine is my answer, an inhibitor of mitosis and does not supress bone marrow function. Busulfan - alkylating agent with severe BMS, management of CML Cisplatin - alkylating agent with severe BMS, management testicular and ovarian CA Cyclophosphamide - nitrogen mustard, BMS, management of breast, testicular, leukemia and lymphoma Paclitaxel - antimicrotubule agent, profound neutropenia, ovarian and breast
OFF CALL

15-02-06, 21:09	#3
Mfurfur Member Join Date: Jan 2006 Posts: 55	50 year old woman with urinary incontinence is diagnosed with detrusor instability on urodynamic evaluation. Stimulation of which of the following results in contraction of this muscle? A Alpha-adrenergic receptors B Beta adrenergic receptors C Muscarinic receptors D Nicotinic receptors
OFF CALL

16-02-06, 07:58	#4
Pversicolor Junior Member Join Date: Jan 2006 Posts: 25	I think the answers breaks down to either the muscarinic receptors (acetylcholine) or beta adrenergic (epinephrine) that act on the detrusor muscle. Since we don't want to wee went we're running and we want to wee when we're relaxed, i've got to go with muscarinic receptors!
OFF CALL

17-02-06, 08:44	#5
DrIreland Erik Administrator Join Date: Jan 2006 Posts: 168	Right on with muscarinic receptors! If we think pharmacologically we can treat detrusor instability with anticholinergics (oxybutynin) and we clearly understand why we get urinary retention with TCAs. Alpha receptors function in contraction of the trigone of the bladder and smooth muscle of the urethra. So alpha agonists are used in stress incontinence and alpha antagonists can be used in treating overflow incontinence resulting from bladder outlet obstruction.
OFF CALL

17-02-06, 08:48	#6
DrIreland Erik Administrator Join Date: Jan 2006 Posts: 168	64 year old man presents to his physician with aching burning pain after meals. His physician takes him off his self prescribed antacids and instead places him on a combination of ranitidine and sucralfate. Why is this combination a bad idea? A Ranitidine increases the toxicity of sucralfate B Ranitidine inhibits the action of sucralfate C Sucralfate and ranitidine coprecipitate D Sucralfate increases the toxicity of ranitidine E Sucralfate inhibits the action of ranitidine
OFF CALL

17-02-06, 22:38	#7
Mfurfur Member Join Date: Jan 2006 Posts: 55	This question confused me because in the literature it indicates that ranitidine is commonly coadministered with sucralfate. However i did read here that if a large dose of sucralfate can inhibit the absorption of ranitidine therefore inhibiting its action. My answer is choice E. There has been nothing mentioned about increasing toxicities and there is no observation that ranitidine does anything to the bioavailability or toxicity of sucralfate. If anyone finds anything else out let me know!!
OFF CALL

17-02-06, 22:41	#8
Mfurfur Member Join Date: Jan 2006 Posts: 55	A nice multistepper! A 26-year-old woman is undergoing surgery and is anesthetized with an inhalant anesthetic. She is also given an IV dose of succinylcholine. Within minutes, she develops a heart rate of 124 and increasing core body temperature. What is the mechanism of action of the drug of choice for this patient's condition? A. It interferes with the release of Ca2+ from the sarcoplasmic reticulum B. It is a competitive antagonist of ACh at the motor end plate C. It is a GABA receptor agonist that enhances inhibition of nerve impulses D. It uncouples oxidative phosphorylation, thereby preventing heat formation
OFF CALL

27-07-06, 09:31	#9
doctor_b Gary Administrator Join Date: Jan 2006 Location: Dublin, Ireland Age: 31 Posts: 145	You seem to be describing Malignant Hyperthermia in a patient who received Halothane anaesthesia. I'm not sure of the point of succinylcholine (a.k.a. the paralysing agent suxamethonium in this part of the world) here other than it too may rarely cause MH. Anyhoo...the treatment of choice is Dantrolene, a muscle relaxant that works directly on the ryanodine receptor to prevent the release of calcium. from the SaR - thus the answer is "A". So, i ask - what are the 6 major drugs associated with drug-induced systemic lupus erythematosus?
OFF CALL

07-08-06, 10:52	#10
opisthotonus Junior Member Join Date: Jul 2006 Posts: 9	6 Drugs that can cause SLE are HIPPPE Hydralazine - a vasodilator used in HTN Isoniazid - an ant-tuberculosis medication Phenytoin - an anticonvulsant medication Penicillamine - a chelator in heavy-metal poisoning Procainamide - a Class Ia (i.e. Na channel blocker) antiarrhythmic Ethosuxamide - anti-epileptic medication What drug do I Rx for bacterial carrier-states (S. aureus, N. meningitidis, H. influenzae)?
OFF CALL