Saturday, September 26, 2020

Sodium-glucose co-transporter 2 (SGLT2) inhibitors notes and mnemonics

 A short post on SGLT2i!

Examples:
Canagliflozin (brand name Invokana)
Empagliflozin (brand name Jardiance)
Dapagliflozin (Farxiga)
Ertugliflozin (Steglatro)

Mechanism: Blocks renal glucose absorption, resulting in glycosuria.
Mnemonic: GliFlozIN makes Glucose Flow In Nephrons

In addition:
Has beneficial effects on ASCVD events, heart failure, and CKD.
Causes weight loss  (Mnemonic: SGLT2 Surely Generates Less Tummy).
No risk of hypoglycemia.

Side effects:
Genital fungal infections.
Fournier’s gangrene.
Dehydration may result.
Euglycemic diabetic ketoacidosis (should be held 24H prior to scheduled surgeries).
Canagliflozin may increase the risk of leg amputation (should be avoided in those with peripheral vascular disease).

Caution: Renal dose adjustment is required in CKD.

That's all!
-IkaN

Metformin notes and mnemonics

 A short post on Metformin!

Mechanism:
Decreases hepatic glucose output by reducing hepatic gluconeogenesis and glycogenolysis.
Enhances peripheral glucose uptake and enhances insulin sensitivity.
Decreases glucose absorption in the GI tract.
Reduces hemoglobin A1C levels by 1.5%.

In addition:
Decreases triglyceride levels.
Decreases LDL-cholesterol.
May increase HDL-cholesterol.

Side effects:
Diarrhea
Vitamin B12 deficiency may develop
Risk of lactic acidosis in renal or liver disease or CHF

Contraindicated in: GFR <30ml/min.

That's all!
-IkaN

Related posts:
Oral hypoglycemic drugs used for diabetes mellitus mnemonic: Metformin meets glucose and advises it to stay out of the blood. It asks the liver to keep glucose in the house (Inhibits hepatic glucose production) and asks the glucose in the bloodstream to go into adipose and skeletal muscle (Stimulates peripheral uptake of glucose). Metformin never met a glucose molecule and did not tell him to not stay in the blood (Illustration in the original post).

Friday, September 25, 2020

Virtual interview tips

Interview questions for practice

 Hi everyone! 

Here are some of the questions I was asked during my cardiology fellowship interviews. They can be useful to practice during medical school or residency interviews as well, which is why I am writing this post.

How do you answer these questions? Always attach a story (situation) to it. It only comes with practice - so please, practice a lot.

Thursday, September 24, 2020

Fragmented QRS

Fun fact: Fragmented QRS can be caused by conduction around the scarred myocardium, resulting in multiple spikes within the QRS complex.

-IkaN

Friday, September 18, 2020

No-reflow or low reflow phenomenon in total coronary artery occlusion

What is the no-reflow or low reflow phenomenon?

If blood flow to the ischemic tissue continues to be impeded after relief of the occlusion.

Why does this happen?

After prolonged cessation of coronary perfusion and restoration of blood flow to the epicardial coronary arteries, structural damage occurs to the microvasculature that prevents the restoration of normal blood flow to the cardiac myocytes. Various mechanisms are implicated in the genesis of the no-reflow phenomenon.

Friday, September 11, 2020

SLC gene Mutations and related Disease

Hello Awesomites!

Enjoy this crisp post on SLC gene mutations.

SLC= Solute carrier

SLC39A4 

Acrodermatitis enteropathica 

SLC26A4 

Pendred 

SLC6A9 

Hartnup disease 

SLC5A2 

Renal glucosuria


FYI-Diseases associated with SLC6A4 include Anxiety and Obsessive-Compulsive Disorder

For further information read this article SLC transporters as therapeutic targets.

 -Upasana Y.

Fact- Reversible ADP-r inhibitors cause breathlessness

Hi

 Reversible inhibitors of ADP-r (P2Y12) such as ticagrelor, cangrelor, and elinogrel used as anti-platelet drugs have a unique side effect of dyspnea, unlike the irreversible ones. This is hypothesized to occur because of reversible inhibition of ADP-r on sensory neurons. Since half-life of the reversible inhibitors is shorter than that of irreversibles, repeated doses lead to permanent inhibition of the P2Y12 receptors on sensory neurons.

 Moreover, oral administration is found to cause more severe effects on the breathing difficulties than the parenteral route.

 Source- Research gate 

 

That's  all

- Jaskunwar Singh

Thursday, September 10, 2020

Naegele's formula

  

Naegele's formula

The Naegele's formula is a simple arithmetic method for calculating the EDD (estimated date of delivery) based on the LMP (last menstrual period). 

To the date of the first day of the LMP (e.g. 22nd June 2019):

  • add seven days (i.e 29th)
  • subtract 3 months (i.e March)
  • add one year (i.e 2020)
Note: If the interval of cycles is longer, the extra days are to be added and if the interval is shorter, the lesser days are to be subtracted to get the EDD.

Friday, September 4, 2020

Lover's heel

Lover's heel is a term used for Gonococcal tenosynovitis of the Achilles tendon given the sexually transmitted nature of gonorrhea.

I just wanted to share this interesting fact with you.

-IkaN

Saturday, August 15, 2020

Answer: 17-year-old male presents with confusion and drowsiness

A 17-year-old male presents with confusion and drowsiness for 1 day. 

He has been healthy and playing in the high school basketball team for the last 2 years. His practice sessions always included 10 minutes of intense work followed by a period of rest or decreased activity. He also had complaints of dark urine which the previous doctor diagnosed as dehydration and was asked to drink more water. 

He recently started a football club and has been playing football in addition to basketball. He has had oliguria for 4 days. Vitals are BP 124/86 mm of Hg, HR 85 b/min. Pupils are non dilated and reactive to light equally bilaterally. The remainder of the physical examination is within normal limits. Lab work shows:

Question: 17-year-old male presents with confusion and drowsiness

A 17-year-old male presents with confusion and drowsiness for 1 day. 

He has been healthy and playing in the high school basketball team for the last 2 years. His practice sessions always included 10 minutes of intense work followed by a period of rest or decreased activity. He also had complaints of dark urine which the previous doctor diagnosed as dehydration and was asked to drink more water. 

He recently started a football club and has been playing football in addition to basketball. He has had oliguria for 4 days. Vitals are BP 124/86 mm of Hg, HR 85 b/min. Pupils are non dilated and reactive to light equally bilaterally. The remainder of the physical examination is within normal limits. Lab work shows:

Friday, August 14, 2020

Sickle cell retinopathy

 What is the hallmark of sickle cell retinopathy?

Sea fan neovascularization.

All patients with SCD should have dilated funduscopic examinations every 1 to 2 years beginning at age 10, preferably by a retina specialist.

Treatment is usually Laser photocoagulation.

Anti-VEGF medications such as bevacizumab or ranibizumab may lead to partial regression of sea-fan neovascularization.

Sickle cell anemic retinopathy is seen mostly in heterozygous S-C trait and S-Thal trait. 

Fun fact: Sea fans are beautiful soft corals.

-IkaN