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Which of these has a pH of 2 in a healthy adult?

65-year-old Robert B. has a history of chronic stable angina and was admitted to the hospital two days ago for observation for an unrelated urology problem. This afternoon Dr. Snow tried to do a minor procedure in the patient’s room.  During the procedure he administered IV atropine. Dr. Snow calls you into the room in a panic because Robert is now clutching his own chest and crying out, “Ah!  My normal angina chest pain is back but it is much worse; I feel like an elephant is crushing my chest!  This moron Dr. Snow says gave me the normal pill I use when I have my angina pain but it didn’t help!  I’m dying!  Get me a real doctor!”   A.  What is Robert B.’s current acute problem?

Indications for alpha-1 adrenergic antagonists (blockers) include which of the following? Select All That Apply

Which of the following warnings are associated with propranolol (Inderal)?  Select All That Apply

B. 5 minutes later Joffrey is still having a seizure.  Dr. Snow is frozen in panic.  What will you suggest be done next?

(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-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.   

BRONCHIOLES:  IV ATROPINE will cause bronchial passages to become

Nick F. is a 62-year-old retired military general with type 2 diabetes. He is taking metformin (Glucophage). One of metformin’s more feared side effects is:

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? _______