Important Mnemonics for Oral hypoglycaemic drugs in Diabetes

Hello everyone .. 

I make mnemonics for some important side effects of oral hypoglycemic drugs. 

You must know that because you may prescribe it for 1 out of 11 adults in whole population the of world….!!

Side effects of Oral hypoglycaemic drugs along with it's class & mechanism of action 

#Mnemonic 1

Big Men ForminG Poor Diabetic neuropathy ( D/Dx B12 Deficiency ➡️ confirmed by doing  B12 LAB test.)

Biguanide = Metformin 

Inhibit mGPD 

It causes Vitamin B12 Deficiency & Lactic Acidosis (LA) 

#Mnemonic 2 

1st Key to SUccess is Lord "Ram"

1st Gen SUlfonylureas

Closes K+ Channel 

Ram = Disulfiram like reaction….

#Mnemonic 3 

Paragliding makes your heart failed or maybe a fracture or bladder injury 

Para = PPAR Y

Gliding = Glitazone activates it...

#Mnemonic 4

"Rosy red Blood don't reach to heart (MI) but goes into Pee = Red Pi ( Pee = Urine in Bladder Cancer )

MI (rosiglitazone) 

Bladder cancer (pioglitazone)

#Mnemonic 5

“Change your Daily Personal Passivity (DPP) otherwise your heart fails” 

DPP  = DPP-4 inhibitors 

#Mnemonic 6

“Candid Status is Very Good in Love Test”

SGLT-2 inhibitors can cause Vulvovaginal Candidiasis 

Drugs category & their Suffix 

Pramlintide = Amylin Analogue 

1st gen Sulfonylureas = “Amide”

2nd gen Sulfonylureas = “Ride” & “Zide”

Meglitinides = “Nide”

DPP-4 Inhibitors = “Gliptin”

Glitazones / thiazolidinediones = “Zone”

SGLT -2 Inhibitors = “Flozin”

#Mnemonic 7

Alpha glucosidase inhibitors = "Please Side your Car & Pay Toll"

Acarbose & Miglitol 

#Clinical Pearls 

Weight neutral = DPP 4 & Alpha Glucosidase inhibitors 

SGLT2 inhibitors & GLP-1 = Used in CVD

( Cardiovascular diseases) patients

In case of Renal failure you can only give 2 type of drugs orally = DPP 4 inhibitors & Glitazones 

Injectables can be given in renal failure.

3 times / day dosing = Pramlintide , Alpha Glucosidase inhibitors & Glinide 

Regular Insulin ( Short acting ) is preferred for 

DKA ( IV)

Hyperklaemia (Add Glucose)

Stress Hyperglycemia

Thank you :)

- Dr. Drashtant Prajapati

Therapeutics in Sickle Cell Anemia

Apart from Hydroxyurea, Analgesics and vasodilators like phosphodiesterase inhibitors, certain tantalizing novel drugs have been approved for Sickle cell anemia.... Let's take a closer look at them.

(1) Voxelotor (HbS polymerization inhibitor) binds covalently to N-terminal valine of alpha chain of HbS (around 30% of HbS in individual cell) stabilizing it's oxygenated form and causing left ward shift of dissociation curve without impairing oxygen delivery to tissues.

Consistently reduces hemolysis and viscosity with in 2 weeks of administration... FIRST EVER therapy targeting core defect.

Benign vs Malignant pulmonary calcifications mnemonic

A nice mnemonic to differentiate benign and malignant pulmonary calcifications is:

Malignant calcifications are ***SuPER bad*** :P
S: Spiculated
P: Punctate
E: Eccentric
R: Reticular

I use those 3 starts (***) to remind me of punctate.(vs the other P of Popcorn in the benign lesions)

Bening ones are the rest:
Popcorn, laminated, concentric and diffuse homogeneous

-Murad

NB: these calcification types suggest benign vs malignant lesions and are not diagnostic per se.

Check the other amazing mnemonic by Drashtant in the comments section below  :)

Inferior wall MI treatment mnemonic

Inferior wall MI is different than other MIs . It is associated with sinus bradycardias and AV block.

Lower back pain notes

Hello!

Here are my quick and dirty notes on Low back pain (LBP) mostly seen in ambulatory medicine! I will not be going into evidence-based medicine (EBM) physical examination (PE) findings but I have put a quick note for conditions you can test on PE so you can look them up.

Hepatorenal Syndrome: An Overview

Hello good folks! Let's discuss HepatoRenal Syndrome (HRS) in brief.

Cirrhosis + Ascites + Renal Failure = HRS, after excluding other causes of kidney damage.

How common is HRS?
1 in 10 patients of advanced cirrhosis or acute liver failure develop HRS.

How does HRS happen?
Abnormal haemodynamics, that's how. Pathogen, faulty immune system and mesenteric angiogenesis result in splanchnic and systemic vasodilation but renal vasoconstriction. Other factors maybe contributory.

Types and management
Type 1: Rapidly progressive, median survival about 2 weeks. Haemodialysis may be required.

Type 2: Slowly progressive, median survival about 6 months. Transjugular Intrahepatic Portosystemic Shunt (TIPS) maybe required.

Liver and/or kidney transplant maybe considered for both types.



Thanks for reading.
- Ashish Singh.

Dihydropyridine vs non-Dihydropyridine CCBs mnemonic

Dihydropyridine vs non-Dihydropyridine CCBs were always a struggle to me because they are both CCBs but at the same time they have some differences.

I hope that the following mnemonic will help in reminding you which one is Dihydro and which one is not :D :

The mnemonic (remember DIE HARD movie and Bruce Willis)

I am a DIe Hard FAN

DIHydropyridine CCBs:
FAN
F- felodipine
A- amlodipine
N- nicardipine

So non-Dihydropyridine CCBs are Verapamil and Dilitazem.

The original FAN mnemonic was posted here:
http://woanchyi818.blogspot.com/2015/03/calcium-channel-blockers-ccbs.html

good luck :)

Murad

Topical vs Oral antifungal mnemonic

Hey my friends, a common question in qbanks is when to use topical vs oral antifungals in Tinea infections.
Well, you can use the following mnemonic:

Tinea CAPitis => Imagine a CAP covering your head/scalp so you need a systemic treatment => Oral treatment (eg: Terbinafine) to reach it.
Scientifically, the systemic/oral treatment is needed to reach the hair shaft.

Tinea Corporis: Since Tinea Capitis is the oral one, Tinea Corporis is the topical one :)


Murad :)

Classification and causes of hyponatremia mnemonics + notes

Hi!

Classification and causes of hyponatremia mnemonics + notes:

1. Hyponatremia with low osmolality :

     (i) reduced effective blood volume

              (A) increased ECF volume -

                               - Edematous kidney (nephrotic syndrome)

                               - Cirrhosis of liver

                               - Failure of heart

              (B) REduced ECF volume -

                                - Renal loss of Na ( Diuretics, Ketonuria, Addison's disease)

                                - Extrarenal loss of Na ( sweating, diarrhea, vomiting, peritonitis, pancreatitis)

    (ii) Normal/ increased EBV

                - Inadequate ADH syndrome

                - Constant thirst

                - Renal failure (chronic)

2. Hyponatremia with raised osmolality :

( H & M)

- Hyperglycemia 

- Mannitol administration 

Note -

- Hyponatremia per se does not produce any significant clinical features. The low osmolality that it causes is responsible for various features.

- Slow correction of hypotonicity produces gradual rise in osmolality without any significant risk. But rapid correction of hyponatremia produces loss of brain water resulting in brain damage!

- The rate of correction should be around 0.6 mEq/L/hr. In severely symptomatic patients, total correction in a day should not exceed 8-10 mEq/L/hr.

That's all

Hope it helps

- Jaskunwar Singh

Attrition

In simple words, Attrition is the loss of tooth structure occlusally due to excessive forces by the occluding teeth, grinding of teeth, deep bite.

Aurora kinases

Hello friends, Let's talk about Aurora kinases today.... Aurora sounds so beautiful, right ?

Aurora kinases represent serine threonine kinases with instrumental role in cell division.

Specifically, Aurora kinase A is required for duplication and separation of centromere, and Aurora B is required for attachment of microtubules to centromere.

They are often over expressed in tumors resulting in defective cytokinesis during cell division, eventually causing aneuploidy and driving the carcinogenesis.

Now, it really gets interesting; usually when functioning of microtubules are perturbed say by paclitaxel, then spindle check point inhibitor is activated leading to cell demise by upregulation of P53, PUMA and other mediators.

But in case of Aurora kinase inhibition, cells keep on dividing especially in case of P53 mutated cells. Since centromeres will not segregate, it ultimately leads to tetraploid genome and four centromeres in a cell, causing catastrophic mitosis in subsequent cell cycle effectively tearing apart the genome.

They are significant because often when other tyrosine kinase inhibitors targeting EGFR, VEGFR, FGFR are used, tumors over express Aurora kinases, there by over riding the inhibition mediated by tyrosine kinase inhibitors.... So targeting them is key to maintain remission in patients already on kinase inhibitors.

Few examples of drugs in trials: Monastrol, Hesperidin.

It's called Aurora because of the similarity between the appearance of microtubule spindles during cell division and Aurora Borealis.

Pretty Majestic, right?

Submitted by Kirtan Patolia 

Risk factors for puerperal sepsis mnemonic

Hi!

Risk factors for puerperal sepsis mnemonic:
PUERPERAL SEPSIS

Maternal complications of diabetes in pregnancy mnemonic

Hi!

Maternal complications of Diabetes in pregnancy mnemonic:
PREGNANCy

JVP documentation

Hi everyone!

Someone questioned on how to document JVP. Just saying JVP is 8 cm is not enough - Say what is your reference for better documentation :)

Cryoprecipitate

Hey! =)

What does cryoprecipitate contain? 
Cryoprecipitate preparations contain concentrated amounts of fibrinogen (factor I), factor VIII (antihaemophilic factor), von Willebrand factor, factor XIII (fibrin-stabilizing factor), and fibronectin.

Why is it called cryoprecipitate?

Radiologic features seen in Osteosarcoma mnemonic

Hi!

Radiologic features seen in Osteosarcoma mnemonic:

SARCOMAtous BONE

Features suggestive of fractured patella mnemonic

Hi!

Features suggesting fracture of patella mnemonic :

Bruised PATELLA

Complications of Colles' fracture mnemonic

Hi!

Complications of Colles' fracture mnemonic:
COMPSSS

Features suggesting severe upper GI bleeding

Hi!

Features suggesting severe UGI bleeding:

Hyperkalemia and hypokalemia causes mnemonics

Hi!

Pharmacologic treatment of pulmonary hypertension (notes and mnemonics)

Hi!

Vasodilator response: A favorable vasodilator response is defined as a fall in mPAP of 10 mm Hg or greater to less than 40 mm Hg with an unchanged or improved cardiac output, in response to an agent such as inhaled NO or IV epoprostenol.

Cardiovocal syndrome - Ortner syndrome

In 1897, Norbert Ortner described hoarseness caused by recurrent laryngeal nerve paralysis in patients with a large left atrium due to mitral valve stenosis.

Istradefylline

Istradefylline (Selective Adenosine 2A receptor antagonist), inhibits the adenosine's inhibitory effect on GABAergic transmission in direct nigro-striatal pathway while simultaneously inhibiting adenosine's stimulatory effect on GABAergic transmission in indirect nigro-striato-pallidal pathway, ultimately leading to stimulation of thalamo-stimulatory direct pathway and inhibition of thalamo-inhibitory indirect pathway.

Selinexor

Selinexor (Selective inhibitor of nuclear export) inhibits XPO1 (exporter protein 1).

XPO1 is often overexpressed in tumors leading to transport of tumor suppressor proteins like p16, p14, p27 from nucleus to cytoplasm and there by evading the apoptosis.

Luspatercept

Here is a submission by Kirtan on Luspatercept!

Luspatercept (recombinant fusion protein containing Activin receptor type IIB moeity) blocks excessive SMAD2/3 activity (Mothers against decapentaplegic homolog) lying downstream of TGF-beta signalling by binding endogenous TGF-beta family members, including Bone morphogenetic proteins (BMP), Activin, Inhibin, Lefty A/B, Artemin, Persephin, GDF, GDNF and MIS.

Acute type-II respiratory failure causes mnemonic

Hi!

Causes of Acute type-II Respiratory failure mnemonic:
DEPRESSION

Radiologic features seen in pulmonary emphysema mnemonic

Hi!

Radiologic features seen in a case of pulmonary emphysema (Chest X-ray PA view):

mnemonic: PSTR-ANTR

Clinical features of Pneumococcal Pneumonia mnemonic

Hi!

Clinical features of pneumococcal pneumonia mnemonic:

HI STREPTOCOCCUS

Risk factors for pneumococcal pneumonia mnemonic

Hi!

Risk factors for pneumococcal pneumonia mnemonic:

PNEUMONIA

Ventricular demand pacing

Hey!

I came across a patient with VVIR pacing today. I was wondering why we didn't do DDD instead. Let's learn what it is and why (In short!)

Five position code for pacemakers

Hello!

For those who don't know about pacemakers:

Mnemonic to remember colors in Doppler echocardiography

Short post :)

The mnemonic is BART:

Causes of primary hypothyroidism mnemonic

Hi!

Common causes of primary hypothyroidism:
( mnemonic: DR. HIT )

Fact of the day - BUC in UGI bleed

Hi!

Blood urea levels are positively associated with upper GI bleed. But here's the fact:

Causes of elevated serum amylase mnemonic

Hi!

Causes of elevated serum amylase mnemonic:

RAISED-AM

Causes of Acute Pancreatitis mnemonic

Hi!

Causes of Acute Pancreatitis mnemonic :

ABCDEFGHIjK

Differential Diagnosis of Acute Pancreatitis mnemonic

Hi!

Differential Diagnosis of Acute pancreatitis mnemonic:

HI-PANC

Extra - articular manifestations of RA ( Notes and mnemonic )

Hi!

Extra- articular manifestations of Rheumatoid arthritis :

( mnemonic - NOVELA is FrickiN' Hot! )

How to read CSF analysis report?

Video by Jay!

Multiple Myeloma notes and mnemonics

Hi!

Multiple myeloma - everything P

- malignant Proliferation of Plasma cells derived from a single clone.

- Immunoglobulin produced is a "ParaProtein" (M- protein)

- POEMS syndrome

BONE MARROW INVOLVEMENT

- Pancytopenia

PERIPHERAL BLOOD

- plasma cell leukemia ( greater than 2,000 per mm3 )

BONE INVOLVEMENT

- punched-out lesions in radiographs of flat bones

- bone pain

- pathological fractures

RENAL INVOLVEMENT

- Bence -Jones proteinuria

- production of excess Amyloid protein

- hyPer- calci -emia and -uria

These three result in renal damage and renal failure.

IMMUNE SYSTEM INVOLVEMENT

- prone to infections, particularly in respiratory and urinary tract.

HYPERVISCOSITY SYNDROME

( mnemonic - HPRVSCST )

- Headache

- Postural hypotension

- Retinal venous congestion

- Vertigo

- Strain (blurred vision)

- Congestive cardiac failure

- subtype IgA

- nysTagmus

CLOTTING PROBLEMS

- purpura

- profuse bleeding ( epistaxis, gastrointestinal )

NEUROLOGICAL MANIFESTATIONS

- peripheral neuropathy

- compressive myopathy

- carpal tunnel syndrome ( nerve entrapment)

- Amyloidosis.

SERUM STUDIES

- total serum protein raised

- low albumin

- high globulin ( decreased A:G ratio )

- high beta-2 microglobulin ( greater than 5.5 mg/dL means poor prognosis; stage III)

Plasmacytomas in Paraskeletal soft tissues - poor prognosis; treated by palliative radiotherapy.


That's all
Anything more to add, you're most welcome :)
- Jaskunwar Singh

How to calculate SVR and PVR using Ohm's law

Hi!

Ohms law: Current (I) equals the voltage difference (ΔV) divided by resistance (R)
Simplified, V=IR

In hemodynamics, what is voltage difference? The pressure difference or pressure gradient! (ΔP)

Drugs causing Thrombocytopenia mnemonic

Hi!

Drugs inhibiting platelet function/ causing Thrombocytopenia :-

ABCDE - HI

Obstructive Sleep Apnea features mnemonics

Hi!

Obstructive sleep apnea (OSA)

Urinary neutrophil gelatinase-associated lipocalin (NGAL)

Neutrophil gelatinase-associated lipocalin (NGAL) is an iron-transporting protein.

Mnemonic: Cerebellar Signs

Hey guys,

Here's a short and sharp mnemonic post.

Hope it helps.

Pulmonary hypertension notes

Hi!

Pulmonary hypertension (PH) is defined as a resting mean pulmonary artery pressure of 25 mm Hg or greater measured during right heart catheterization.


(How I remember the number 25 - PH: 2 letters, Hyper: 5 letters).

Classification of Pulmonary Hypertension mnemonic

"A heart lung chronic thrombotic unclarity"
1: pulmonary Arterial hypertension
2: PH due to left-sided heart disease
3: PH due to lung diseases and/or hypoxia
4: Chronic thromboembolic pulmonary hypertension and other pulmonary artery obstructions
5: PH with unclear or multifactorial causes

The transpulmonary pressure gradient (TPG): The difference between mean pulmonary arterial pressure (mPAP) and left atrial pressure (LAP, commonly estimated by pulmonary capillary wedge pressure PCWP).

A TPG of >12 mmHg would result in a diagnosis of “out of proportion” pulmonary hypertension - suggesting intrinsic pulmonary vascular disease in patients with left-heart conditions associated with increased pulmonary venous pressure.

Will update post as I learn more... 

-IkaN

Step 3 NBME Form 4 answers explanations

Publishing incomplete post form drafts :)

Platypnea-Orthodeoxia Syndrome in interatrial right-to-left shunt

Hi everyone! This is a short post :)

Platypnea (flat breathing): Dyspnea induced by upright posture and relieved by recumbency.

Orthodeoxia: Arterial oxygen desaturation accentuated by upright posture and improved by recumbency.

Peripartum heart failure associated with prolonged tocolytic therapy

Did you know?

What's Wrong With My Gallbladder, Doc?

A quick mini-post to help you make a quick diagnosis.

[Please click on the image to enhance it]

Please remember to practise caution as the presentations may overlap.

Thank you for reading.

- Ashish Singh