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(5 points) Ned sits down on the end of the hospital bed and…

(5 points) Ned sits down on the end of the hospital bed and tells Dr. Snow to stop asking about the propranolol he takes every day for his migraine because he has chest pain.    Dr. Snow (foolishly) decides Ned must have PTSD from being a war veteran and googles “PTSD in old men” on his smartphone.  A user called “DoctorFromOhio” on www.reddit.com suggests alpha-blockers are good for PTSD.  Dr. Snow shrugs, gives Ned a dose of IV terazosin, and turns away to type into the hospital computer.  Moments later Ned falls to the floor on his face, unconscious.   Dr. Snow immediately checks Ned pulse.  What happens?    (Stop! Only about 1/5 students get this question correct.  Take a second to think about it.  Figure out the BP change due to the IV terazosin in this patient who is already taking propranolol, then determine the heart rate reflex to see if it changed from 60 beats per minute.)   What is Ned’s heart rate when Dr. Snow checks it? 

(5 points) One of your slightly less compliant patients, 55-…

(5 points) One of your slightly less compliant patients, 55-year-old Richard G., has advanced type 2 diabetes for which PO and injectables are not working well enough.  He works as a pathologist and eats at irregular times, sometimes skipping lunch.  But he is reasonably active, works full-time, does check his own blood glucose before taking his insulin, and gets regular sleep. (His wife and staff watch over/nag him as well.) Suggest an insulin plan for Richard that will take his lifestyle into account.  Explain your choice.   

A new drug ad for Letsfixit® ran on television last year cal…

A new drug ad for Letsfixit® ran on television last year called “Maya’s Excerpts from the ad transcript are written below.  In each blank, write the reason for the statement given, or the name of the syndrome or condition described. The ad begins: Actress: “I struggle with bipolar depression, and it’s tough.  It makes me feel sad and empty, or makes me do things I normally wouldn’t.  So I talked to my doctor, and she prescribed Letsfixit.”   Narrator: There are many forms of depression.  Letsfixit is FDA-approved to treat bipolar depression, which is different from other types of depression.  Letsfixit is approved to treat bipolar depression in adults, either on its own or with lithium or valproate.   Results may vary.   Elderly dementia patients on Letsfixit have an increased risk of fever, death or stroke. Call your doctor about fever, stiff muscles or confusion, as these might be signs of a life-threatening reaction:   _______ …or if you have uncontrollable muscle movements as these may be permanent: _______ Other side effects include abnormal milk production: _______ and dizziness upon standing: _______ Avoid grapefruit and grapefruit juice _______ Ask your doctor if once-daily Letsfixit is right for you.” Letsfixit is a member of what class of drugs? _______

(8 points) There is an endocrine disorder we did not get a c…

(8 points) There is an endocrine disorder we did not get a chance to discuss called central diabetes insipidus, in which the pituitary gland does not make sufficient ADH (anti-diuretic hormone), leading to abnormally high amounts of urination.  The condition is treated using desmopressin (Minirin), a synthetic version of human ADH hormone.    Desmopressin is available as a nasal spray taken once daily.  It is not significantly metabolized.   Please answer both question A and B in the space provided (there is more than enough room)   A. (3 points) If a patient were to take this as an IV dose once daily, would the IV dose be much larger, much smaller, or about the same amount as the nasal spray dose?   B. (5 points) A potential side effect of desmopressin is hyponatremia (very low blood sodium levels).  Patients with very low plasma sodium levels are at high risk of brain seizures.  Explain the pathophysiologic mechanism by which hyponatremia lowers the threshold for a seizure in the brain.