Clinical Phar_mIDTERMS

• What is Acute Coronary Syndrome (ACS)?


  A spectrum of conditions associated with sudden, reduced blood flow to the heart.
• What are the typical conditions included in ACS?

  Unstable angina, NSTEMI, and STEMI.
• What is the pathophysiology of ACS?

  It involves plaque rupture, thrombosis, and occlusion.
• What are some risk factors for ACS?

  Hypertension, diabetes, smoking, dyslipidemia, obesity, and family history.
• What are common clinical presentations of ACS?

  Chest pain, shortness of breath, diaphoresis, nausea, and referred pain.
• What is the role of ECG in diagnosing ACS?

  It shows ST elevation (STEMI) or non-ST elevation (NSTEMI).
• Which biomarkers are used in the diagnosis of ACS?

  Troponin and CK-MB.
• What is the initial management for ACS?

  • MONA:
  • Morphine (for pain relief)
  • Oxygen (if hypoxic)
  • Nitrates (vasodilation)
  • Aspirin (antiplatelet)
• What medications are added to aspirin for dual antiplatelet therapy?

  Clopidogrel or Ticagrelor.
• What are the reperfusion therapies for ACS?

  • Percutaneous Coronary Intervention (PCI): Preferred for STEMI if available within 90 minutes.
  • Thrombolysis: Used if PCI is unavailable within a timely window.
• What is the role of beta-blockers in ACS treatment?

  They reduce myocardial oxygen demand and prevent arrhythmias.
• What do ACE inhibitors/ARBs do in ACS treatment?

  They lower blood pressure and reduce heart workload.
• What is the function of statins in ACS treatment?

  They lower cholesterol and stabilize plaque.
• What is the purpose of anticoagulants in ACS treatment?

  To prevent further clot formation.
• What are the complications of ACS?

  • Arrhythmias
  • Heart failure
  • Cardiogenic shock
  • Recurrent myocardial infarction (MI)
• What is the definition of Major Depressive Disorder (MDD)?

  Persistent low mood and loss of interest in activities lasting at least 2 weeks.
• What are the pathophysiological factors of MDD?

  Neurotransmitter imbalance, neuroinflammation, and genetic factors.
• What are common symptoms of MDD?

  Low mood, anhedonia, fatigue, sleep disturbances, weight changes, guilt, and suicidal ideation.
• How is MDD diagnosed?

  Through clinical assessment using DSM-5 criteria.
• What are the treatment options for MDD?

  • Pharmacotherapy:
  • SSRIs: First-line treatment (e.g., sertraline, fluoxetine).
  • SNRIs: Effective for more severe cases or if SSRIs are ineffective.
  • Atypical Antidepressants: Bupropion, mirtazapine for alternative mechanisms.
  • Psychotherapy:
  • Cognitive Behavioral Therapy (CBT): Targeting negative thought patterns.
  • Interpersonal Therapy (IPT): Focus on relationships and social roles.
  • Other Treatments:
  • Electroconvulsive Therapy (ECT): For severe, treatment-resistant depression.
  • Transcranial Magnetic Stimulation (TMS): Non-invasive brain stimulation.
• What are the complications associated with MDD?

  Suicide risk and social/occupational dysfunction.
• What are the types of sleep disorders?

  Insomnia, sleep apnea, narcolepsy, and restless legs syndrome.
• What is insomnia?

  Difficulty initiating or maintaining sleep.
• What is sleep apnea?

  It includes obstructive (airway collapse) and central (brain dysfunction) types.
• What are the symptoms of narcolepsy?

  Excessive daytime sleepiness, cataplexy, and hallucinations.
• What is restless legs syndrome?

  Uncomfortable leg sensations and an urge to move.
• How are sleep disorders diagnosed?

  Through sleep history, polysomnography, and actigraphy.
• What are the treatment options for insomnia?

  • Cognitive Behavioral Therapy for Insomnia (CBT-I): Standard of care.
  • Sleep Hygiene: Establishing regular sleep schedules, avoiding caffeine.
  • Medications: Melatonin, sedative-hypnotics, but limited to short-term use.
• What are the treatment options for sleep apnea?

  • Continuous Positive Airway Pressure (CPAP): Keeps airways open.
  • Lifestyle: Weight loss, positional therapy.
• What are the treatment options for narcolepsy?

  • Stimulants: Modafinil or amphetamines.
  • Sodium Oxybate: To reduce cataplexy and improve nighttime sleep.
• What are the treatment options for restless legs syndrome?

  • Dopaminergic Agents: Pramipexole, ropinirole.
  • Iron Supplementation: If iron levels are low.
• What is a major symptom of Major Depressive Disorder (MDD)?

  Low mood
• What is the first-line medication for Major Depressive Disorder?

  SSRIs (e.g., fluoxetine, sertraline)
• What are the categories of substance-related disorders?

  Alcohol, opioids, stimulants, cannabis, and hallucinogens.
• What therapy is recommended to add for treating Major Depressive Disorder?

  Cognitive Behavioral Therapy (CBT)
• What is the pathophysiology of substance-related disorders?

  Neuroadaptive changes in reward pathways.
• What should be considered if there is no improvement in MDD treatment?

  Consider alternative SSRI or SNRI
• What are common symptoms of substance-related disorders?

  Dependence, withdrawal, tolerance, and behavioral changes.
• What is recommended for resistant cases of Major Depressive Disorder?

  Augment with atypical antipsychotic or ECT
• What are the treatment options for alcohol-related disorders?

  • Detoxification: Benzodiazepines to manage withdrawal symptoms.
  • Naltrexone and Acamprosate: To reduce cravings and prevent relapse.