SERM for vulvovaginal atrophy mnemonic

Which of the following is a selective estrogen receptor modulator (SERM) that is prescribed mainly for treatment of genitourinary syndrome of menopause (vulvovaginal atrophy)?

A.) Bazedoxifene
B.) Raloxifene
C.) Phentermine
D.) Lasofoxifene
E.) Ospemifene

Atherosclerosis location mnemonic

Atherosclerosis location mnemonic

"A Cholesterol Plaque In Circles"

Most commonly involved vessels in decreasing order is:

Abdominal Aorta (especially around ostia - openings of major branches)
Coronary Artery
Popliteal Artery
Internal Carotid (especially at carotid sinus)

- Submitted by Murad

Medicollabowesome: Does long-term coffee intake reduce type 2 diabetes mellitus risk?

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Ocular toxoplasmosis and HIV

Here are some fun facts about Ocular Toxoplasmosis and HIV!

Ocular toxoplasmosis usually causes a retinal lesion with inflammation, giving the classical "headlight in the fog"  appearance.

Headlight is the lesion and the fog is due to the inflammation (WBCs).

HIV being an immunodeficient condition, there are lesser number of WBCs and hence there's no fog - Just the headlight.

The drug of choice for treatment of ocular toxoplasmosis is pyrimethamine.

However, it is contraindicated in pregnancy and HIV due to the risk of megaloblastic anemia and neural tube defects, respectively.

In pregnancy, spiramycin is preferred.

In HIV, the preferred drugs are clindamycin, azithromycin or quinolones.

- Written by Dr²

Medicollabowesome: Topic of the month - Diabetes Mellitus

AAMC ERAS: How to assign LoRs quickly to 100+ programs

Since the bulk assign option isn't available before 15th September:

Enucleation, Evisceration & Exenteration

In this post, we will look at the definition, indications and some few details regarding these 3 ophthalmologic surgeries. 

Cytochrome P450 3A4

Hello everyone!

Today lets discuss the Cytochrome P450 3A4

It is the microsomal enzyme involved in metabolism of xenobiotics. Maximum number of drugs are metabolised by CYP 3A4 in our body.

Here’s how you  remember the substrates and the inducers of the enzyme:

“In emergency Straightaway give a CPR and ACT SaNely

The inducers are:

S: St John Wort

CPR: Carbamazepine, Phenytoin, Phenobarbitone, Rifampicin

The substrates are:

ACT SaNely

A-Amiodarone

A-ACT drugs(Anti Histamines) 

*A-Astemizole
 *C-Cisapride

*T-Terfenadine

C- Cyclosporine

T- Tacrolimus

S- Statins
N-Navirs (protease inhibitors)

And how do we remember the inhibitors?

Shout “Fire in the Hole!”

Fluconazole   Ketoconazole

and Ritonavir and Erythromycin

Also you can have some grapefruit juice to chill out! Grapefruit juice is also a Inhibitor of CYP3A4.

That’s all

Thank you,

Chaitanya Inge

Drug interaction

Hello :)

Definition:-
Modification of response  to one drug by another drug or non drug (like food ,beverages like alcohol,smoking) when they are administered simultaneously or in quick succession  .


Factors for drug interactions:-
1.Multiple drugs for same disease.
2.Multiple prescribers.
3.Multiple diseases.
4.Poor patient compliance .
5. Drug factors like it is not palatable or too many in frequency .
6.Multiple unknown action of drugs.
7. Most imp is patients age .

Effects of drug interaction:-
1.Quantitative i.e Increase  or decrease the response intensity.
2. Qualitative:- abnormal /different type of response.

Mechanism of drug interaction :-
A.Pharmacokinetic interactions include,
 1.Absorption (either complex formation ,pH change ,or alteration in motility of GIT.)

2. Distribution:- (displacement from plasma protein binding site + inhibition of metabolism /or excretion)

3. Metabolism:- ( induction of enzymes or inhibition of enzymes or hepatic blood flow)

4.Excretion:- ( alteration in urine pH, Competition for active secretion ,renal blood flow)

B. Pharmacodynamic drug interactions include,
1.Antagonism
2. Summation
3.synergism

C.Drug interaction before administration:-
Either mixing before administration.
Or, exposure to light in some cases. (Like sodium nitroprusside).


-Upasana Y.

Blood retinal Barrier

Hello :)

There are two blood retinal Barrier (BRB) :-

1. Outer blood retinal Barrier - Formed by tight junction of retinal pigmented epithelium.

2. Inner blood Retinal Barrier - Formed by Muller cells and pericytes surrounding the lining of microvasculature.

That's all for today.
-Upasana Y. :)

Medicollabowesome: HIV epidemiology

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NPH and hypoglycemia mnemonic

Mnemonic is NPH.

USMLE Step 3: CCS pregnancy case checklist

Hello!

Here are things to do for a CCS pregnancy case -

MIL: Lichen Planus

Read more about Medicowesome Image Library (MIL) here.

Image: Plaques of Lichen Planus

Submitted by: Dr. Manasi Shirolikar

Immunology question

Hola awesomites!!

So, this is answer of our previous question. Lets have a look into it.

Q1)Which of the following features is not shared between T cells and B cells
a)Antigen specific Receptors
b)Class 1 MHC expression
c)Positive selection during development
d)All of the above

Answer is
C) Positive selection during development

Explanation:

Positive selection:
Site is thymic cortex.
-T cells having affinity for MHC molecules are selected since T cells having affinity for MHC molecules can interect with APC  and one who don't have recognisation is killed

Negative selection:
Site:Thymic medulla
Selected T cells are sent to medulla,where there affinity for self antigens are tested.If the have affinity they are programmed to death.

Incase of B cells,if they recognize self antigens they do not undergo death instead there receptors are changed by the process called as "Receptor editing" .If receptor editing dose not take place,then apoptosis takes place.This is negative selection of immature B cells. B cells negative selection occurs in the bone marrow

Both T-cell and B-cell have TCRs and BCRs respectively.
Class I MHC is expressed on both T cells and B cells..

Stay awesome:)

~Ojas

Opioids analgesics classification + NEET notes

Hello awesomites so here is my " Single page notes" on opioid analgesics.
Lets begin.

Let us know the difference between opiates and opioids. 

Chemicals derived from opium or related to morphine chemically are called opiates.

And those having morphine like structures, irrespective of chemical action are called as opioids.

Opioid analgesics are classified as follow

1) Natural opium alkaloids

     - Morphine, Codeine.

 Morphine
 A) Acts on Mu(Causes dependency-Euphoria) , kappa(Dysphoria - Psychomimetic) and delta receptors as agonist. Hence used as supraspinal and Spinal analgesic.
 B) Treatment of poisoning: Naloxone 0.4-0.8 mg i.v. repeatedly for 2-3 minutes.
 C) Can be administered through oral, rectal, i.m, i.v, intrathecal, epidural routes. Used as preanaesthetic medications
 D) Useful in MI and acute pulmonary edema(Both by i.v. route)
 E) Contraindicated in head injury, hypothyroidism patient, pregnancy.

Codeine.
 A) Partial agonist at mu receptor.
 B) 1/10th analgesic of morphine and less efficacious.

2)Semi-syntheic opioids :

Diacetyl morphine(Heroine), Pholcodine, Ethylmorphine.

Heroine:Three time more potent than morphine.

Codeine, pholcodeine, dextromethopran and noscapine are cough suppresants.
Dextromethopran is devoid of constipating action.

3) Synthetic opioids:

-Pethidine(Meperidine):
 A) To control shivering after anesthesia
 B) Used during labour as analgesic
 C) Safer in asthma.
 D) Pethidine and pentazosin both are anticholinergics. Hence they causes tachycardia. Perhaps, they are contraindicated in MI but useful in biliary colic

-Fentanyl:

 A) Causes truncal rigidity due action on mu receptor.
 B) Can be given as transdermal patch and as well as buccal transmucosal

-Methadone 

 A) Agonist action on mu receptor + blocks NMDA reuptake of monoamines and hence useful in neuropathic and cancer pain (Not controlled by morphine)
 B) Can be given by oral, rectal, i.v, s.c, routes.
 C) Long plasma half-life hence less dependency and tolerance. Therefore used as maintenance therapy in opioid dependency

-Dextropropoxyphene

 A) At high doses it causes seizures.

-Tramadol

 A) It is a weak mu receptor agonist and decrease reuptake of NA and 5-HT hence used as analgesia. This is abolished by Ondasteron.

By ojas 

MIL: Impetigo

Read more about Medicowesome Image Library (MIL) here.

Image: Impetigo contagiosa

Submitted by: Sagar

MIL: Polar cataract

Read more about Medicowesome Image Library (MIL) here.

Image: Polar cataract

Submitted by:  Sushrut

MIL: Rhabdomyosarcoma of the Right Eye

Read more about Medicowesome Image Library (MIL) here.

Image: Rhabdomyosarcoma of the Right Eye

Submitted by: Does not wish to reveal identity

MIL: Psoriasis

Read more about Medicowesome Image Library (MIL) here.

Image: Plaques of psoriasis

Submitted by: Dr. Manasi Shirolikar

Introducing Medicowesome Image Library (MIL)

Hello everyone!

I wish to create a visual learning experience by adding images and videos along with what we write.

But since most images on Google have copyright issues, the Medicowesome authors can't use them :(

That is why, I'm asking medical students, residents and acquaintances to send me images of what they see to help create the Medicowesome Image Library (MIL).

It can be anything - a histology slide, a microbiology agar, a pathology specimen, a rash, an instrument, an x-ray - anything!

Treatment of streptococcal tonsillopharyngitis: Important points for USMLE

Hello!

Here's a quick post of treatment of "strep throat" (my slang for "Tonsillopharyngitis due to Streptococcus pyogenes, also known as group A Streptococcus.")

Question on sedative-hypnotics

Hello awesomites! Let us discuss about our previous question.

Question) Which of the following statement(s) is/are true regarding benzodiazepines?
A) It acts as GABA agonist
B) Diazepam is a short acting benzodiazepine
C) Diazepam causes lesser respiratory depression than midazolam
D) Nitrazepam is metabolized in liver
E) Diazepam has higher abuse potential than midazolam
#Pharmacology
#Medicowesome

So here is answer of our previous pharmacology question
Correct answer is C and D.
C) Diazepam causes lesser respiratory depression than midazolam
D) Nitrazepam is metabolized in liver.

Explanation:
BZDs has facilitatory action. They are not a GABA agonist.
Diazepam has rapid onset of action but prolonged action due to formation of active metabolite.
BZDs like nitrazepam, flurazepam etc are metabolised in liver by dealkylation and hydroxylation.
The dependence producing liability of BZD is low. They are Infrequently used now.

-Ojas

Classification of sedatives & hypnotics + notes for NEET

Hello awesomites!! So, here are my "Single page notes" on sedative-hypnotics. To the end of this post I have uploaded picture of my notes. So lets begin.

Classification:It is classified into 3 categories.

1)Barbiturates

Key points : 
a) No antidote.Poisoning treated by gastric lavage, symptomatic treatment and forced alkaline diuresis
b) Steep curve dose.
c) Inhibits all areas of CNS. Most sensitive is reticular system
d) It inhibits all areas of CNS. Mostly reticular system which leads to inability to maintain wakefullness.
e) May cause "Hyperalgesia".
f) Duration of REM sleep and stage 3, 4 of sleep cycle decreases
g) Contraindictated in acute intermittent porphyria
i) Hangover is common
                       
Barbiturates are further classified into three types. 

A) Long acting  
Phenobarbitone.

B) Short acting.
Butobarbitone
Pentobarbitone.

C) Ultra short acting
Thiopentone.
Methohexitone.

2)Benzodiazepines

Key points:
a) Antidote:Flumazenil is competitive antagonist. It takes 30-60 minutes for its action.
b) Flat dose curve.
c) Duration of REM sleep decreases but frequency increases.
d) Hangover less common
                
They are further classified into three categories

A) Hypnotics

-Diazepam:Causes analgesia(Barbiturates causes hyperalgesia as mentioned earlier.) and it also causes muscle relaxation
-Flurazepam :Paradoxical simulation and increase nightmare
-Nitrazepam:Increase REM sleep (Rest decreases)
-Temazepam
-Flunitrazepam : Tasteless BZD called as "
" Date rape drug"
-Midazolam:Causes blackouts and ataxia.
-Alprazolam
-Triazolam:Responsible for paranoia and other psychiatric disturbances.

B)Anti-anxiety

Remember OLA-CD

-Oxazepam
-Lorazepam:Absorption from intramuscular site is regular for other drugs its irregular.
-Alprazolam
-Chlordiazepoxide.
-Diazepam.

C) Anti-convulsants :

-Diazepam
-Lorazepam
-Clonazepam
-Clobazam

Remember: EasT LOT
E=Estazolam
T=Temazepam
L=Lorazepam
O=Oxazepam
T=Triazolam

These drugs directly conjugated without metabolism to active products. These are short acting and can be used in liver failure

3)Newer non-benzodiazepine hypnotics:

-Zopiclone:

a) Increases stage 3 and stage 4 duration

b) Indicated for patients BZDs for induction of sleep
c) Less rebound insomnia and hangover.
b) Active metabolite is eszopiclone.

-Zolpidem
a) Lacks anti-anxiety, muscle relaxants, and anti-convulsants actions.
b) Use in short term treatment of insomnia.
c) No rebound insomnia and hangover.

-Zaleplon
a) Decreases sleep latency without affecting sleep time.

-Suvorexant:
a) Its is Orexin antagonist. Orexin is wake-fullness receptor.

Ojas

Medicowesome secret project: Red

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Medicowesome secret project: Addictions

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Medicollabowesome: What is HIV PrEP and PEP?

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Image Based MCQ on Instruments

Hello awesomites!
Yesterday we posted an Image based MCQ on Instruments and here is the answer to the question.
#Image_based
#Instruments
Q. What is the inner diameter of the device shown in the picture if it is to be used in adults?

A. 2-3 mm
B. 8-9 mm
C. 12-15 mm
D. 21-23 mm
The correct answer is B. 8-9 mm. The image given shows an Endotracheal tube that is available in different sizes for different age groups.
Internal diameter 3mm - 6mm is used for Paediatric cases.
Typically, an 8.0 or 8.5 mm for adult men and 7.5 to 8.0 mm for adult women is an ideal choice.

Thanks for your active participation in the question.

MD Mobarak Hussain (Maahii)

Cushing Vs Curling Ulcer

Hello!

Its time to differentiate between two confusing ulcers - Cushing and Curling.

What is Cushing Reflex?
It is a triad of Bradycardia, Hypertension and altered respiration following Head injury.

What is Cushing Ulcer?
Stress Ulcer following Head injury.
Most common site - Acid producing area of Stomach.

What is Curling Ulcer?
Stress Ulcer following Burn.
Thomas Blizzard Curling.
Reduced plasma volume leads to ischemia and cell necrosis of the mucosa.
Most common site - 1st part of Duodenum.
cURling = bURn

This may help you to remember the difference between these two.

Thanks

MD Mobarak Hussain (Maahii)

Latanoprost and Pilocarpine never go together

Latanoprost increases the uveoscleral outflow of the aqueous humor. Pilocarpine has a constrictive effect on the ciliary body as a whole. Hence, when the two are used together, their effects end up getting nullified with the physician bungling to achieve the target IOP.

That's all!

-Sushrut Dongargaonkar