SSRI OD s/s
Psychiatric symptoms, hypotension, hallucinations, tachycardia, hypothermia, seizures
SSRI OD tx
Gastric lavage, charcoal, sorbitol,
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What do you need to watch for w/ a SSRI OD?
Serotonin syndrome (temp spike)
What do you treat serotonin syndrome with?
Dantrolene Na
Narcotic OD s/s
Relaxation, euphoria, pupil constriction, decreased LOC
Narcotic OD tx
Gastric lavage, charcoal, narcan admin and satol
Benzo OD tx
Reverse w/ flumazenil or flumazicone
What does organ rejection look like?
Flu-like prodrome w/ immediate organ failure (renal - UO just stops)
What is the priority if one suspects organ rejection?
Call specialist in for bx
What are the three cateogry of meds to prevent organ rejection?
Anti-metabolites, steroids, calcium neuron inhibitors (Tacrolimus, celcept, adeltasome)
BB OD
Bradycardia, bronchospasm, decreased LOC, coma
BB OD tx
IV Glucagon, activated charcoal if appropriate (if recent ingestion), gastric lavage, atropine if needed
What is important to monitor in a BB OD?
Monitor airway
Herpes Zoster
Grouped vesicle eruption w/ exudate along a dermatome
Can an HIV pt receive the varicella vaccine?
No, live vaccine
Tx for herpes zoster?
Anti-viral: acyclovir, valacyclovir, famciclovir
What do you do if the patient has HZ on the side of the face?
Go to ER, can go blind, emergency
Tx for HZ pain?
Pregabalin, gabapentin - SE: lethargy, weight gain
Atino kerotosies
Sun exposed area, pre-malignant to SCC, rough, raised areas that are hyperpigmented - Tx: liquid nitrogen
SCC
Firm, irregular, papules or nodules, 3-7% metastases, usually in sun exposed areas, kerotictic (bleeds easily) - Tx: Bx and surgical excision (MOSS procedure)
Subarea Keratoses
Not pre-malignant, sun exposed and NOT sun exposed areas, golferes, bald headed men, develops plaque, - No tx, could freeze but not ideal
BCC
Most common skin CA, slow growing - classic "volcano" lesion, waxy purely experience (may be skiny red) with telegenia vesels - Tx: shave, punch bx w/ surgical exicision
Malignant melanoma
Most deadly, can metastasize anywhere. ABCDE (2 yeses = MM, need referral), >6mm diameter - Tx: Bx and excision
S/s of DM type 1
Ketone development, polyuria, polyphagia, polydipsia, weight loss, Random BS >200 (then do fasting BS >126)
BUN/Cr in Type 1 DM
Elevated
What's the normal range for BUN?
10-20
What can cause a bump in BUN?
Dehydration, protein breakdown, GI bleed, high protein/no carb diet (fluctuates independently of renal function)
What can cause a bump in Cr?
SOME form of kidney failure
What's the ideal range of HgA1C?
5.5-7 (6 is considered a good range)
What does HgA1C tell us?
The BS control over the past 2-3m
What is a normal fasting glucose?
60-99mg/dL
Pre-diabetes
Impaired glucose tolerance (IGT), bring back for repeat fasting BS, consider renal profile and CV risk factors
What percentage of diet should be carbs?
55-60%
When do you start insulin in a type 1 diabetic?
When ketonemia, ketonuria occurs...diet and exercise is not enough
What is the dose of starting insulin?
0.5u/k/d with 2/3 dose in the AM and 1/3 dose in the PM
What type of insulin is lispro?
Rapid onset
What is the Symogi phenomenon?
Rebound hyperglycemia, nocturnal hypoglycemia develops and stimulates hormones to increase glucose
What will a BS look like at 3 am if the pt has Symogi?
Glucose is low
What is the tx for Symogi?
Reduce or omit PM dose
What is the Dawn phenomenon?
Tissues become desensitized to nocturnal insulin (Dawn IS RISING)
What will a BS look like at 3 am if the pt has Dawn phenomenon?
Glucose is high
What is the tx for Dawn's phenomenon?
Increase regimen
What is the major complication of Type 1 DM?
DKA
What is DKA?
Intracellular dehydration as a result of elevated glucose levels (may be the presentation of BS)
What does a pt w/ DKA look like?
Like a diabetic in shock - polyuria, kussmaul breathing (fast, blowing off CO2), fruity breath, hypotension, BS >250/300, ketonuria, ketonemia, hyperkalemia (bc ph is low - acidosis)
What does DKA cause hyperkalemia?
Hydrogen goes into the cell, K comes out of the cell into the blood stream
Does alkalosis have accompanying hyperkalemia or hypokalemia?
Hypokalemia
What is a normal serum osmolality?
275-280, excellent way to assess fld status of the patient [Show Less]