Sorry some dumb medical questions from a PGY1
I have some really dumb questions, if anyone would be willing to answer them!
1. Do you hold all GDMT or just the beta blocker during heart failure exacerbation? What about Farxiga? Is Amlodipine or Nifedipine contraindicated in HFrEF/HFpEF?
2. Are there any formal guidelines on when to start pharmacology for weight loss, such as Phentermine-topiramate?
3. How do you know if a chest tube is currently to suction, on water seal, or clamped?
4. How exactly do you diagnose DKA? Do you need...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - September 16, 2023 Category: Universities & Medical Training Authors: lotsofquestions101 Tags: Internal Medicine and IM Subspecialties Source Type: forums
CHF treatment options
Why are calcium channel blockers (CCB) contra-indicated in congestive heart failure, while beta-blockers aren't?
I understand that CCB may worsen the situation with a significant drop in cardiac output (CO), since they're negative inotropes and can further deteriorate the cardiac function.... but don't beta-blockers ultimately do the same thing? They're negative chronotropes, so they will also cause a decrease in CO. Why can they be used in heart failure while CCB cannot?
Thanks in advance. (Source: Student Doctor Network)
Source: Student Doctor Network - February 8, 2023 Category: Universities & Medical Training Authors: a_zed24 Tags: Medical Students (MD) Source Type: forums
Paradoxical new-onset intrusive thoughts with beta blocker
Patient is female, mid-30s, pmh of single MDE treated to remission with SSRI, seen in a PCMHI context. Was prescribed the lowest possible dose of a beta blocker (propranolol) for borderline HTN and reported experiencing sudden, new-onset intrusive thoughts after starting it. I know BBs are often used to treat anxiety but have you ever heard of a paradoxical reaction where they cause it?
Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - November 14, 2022 Category: Universities & Medical Training Authors: stilllooking Tags: Psychiatry Source Type: forums
How would you approach this case?
Love seeing the discussions you geniuses have about cases. So here is one I did a few weeks back.
55y 152kg M scheduled for Maxillectomy, Parotidectomy, neck dissection, and radial arm free flap.
PMH: sub orbital SCC, IDDM (A1c 9.9), NAFLD s/p OLT about 7 years ago, moderate cervical stenosis on MRI, OSA (not on CPAP), HTN on beta blocker, HLD. No documented CAD, COPD, or CVA history.
No known airway involvement by tumor, but physical exam shows Mallampati 4
PSH:OLT, Carpal tunnel, MOHS...
How would you approach this case? (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2020 Category: Universities & Medical Training Authors: thetoddJR Tags: Anesthesiology Source Type: forums
RN to MD/DO or PA?
Hi,
I am currently an RN (been working almost 2 years now) thinking about eventually going back to school for either PA or MD/DO. I know the next step for an RN would generally be NP, but I honestly don't think that is the right track for me. The nursing model is great - I like the holistic approach to patient care, but I want to know more and why we do what we do. Why are we giving beta blockers for patients heart failure? Why amiodarone or calcium channel blockers for AFib? What...
RN to MD/DO or PA? (Source: Student Doctor Network)
Source: Student Doctor Network - June 7, 2020 Category: Universities & Medical Training Authors: calduson Tags: Nontraditional Students Source Type: forums
Ventricular electrical storm
Over this last turkey holiday - my brother (an ICU/anesthesiologist) - was telling me about a case were he had some one with ventricular electrical storm - and to fix it (or control it at least) - he used isoproterenol to overdrive the ventricle. He said it worked well.
I had never heard of that and thought the idea was pretty brilliant.
Does this sort of thing happen a lot in ICUs? And is a beta-agonist commonly used?
My pea-brain would have used a beta-blocker instead of a beta...
Ventricular electrical storm (Source: Student Doctor Network)
Source: Student Doctor Network - December 3, 2019 Category: Universities & Medical Training Authors: epidural man Tags: Anesthesiology Source Type: forums
Poor Studies drive me nutz
Perioperative Beta Blockers Trade Fewer MIs for More Deaths
The POISE Trial is just one of these studies that make no sense and actually have great potential to harm pts. (Source: Student Doctor Network)
Source: Student Doctor Network - April 1, 2018 Category: Universities & Medical Training Authors: Noyac Source Type: forums
beta blockers and stroke volume
kind of confused about this point -- there is a usmle-rx question that says that metoprolol reduces contractility but does not reduce stroke volume - rather, it decreases heart rate and allows more diastolic filling time to increase SV.
however, in FA (p.273) it says that stroke volume is affected by contractility (??)
so i'm a tad confused since the logic can seem to go either way. why doesn't a decrease in contractility directly decrease SV? Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - December 4, 2017 Category: Universities & Medical Training Authors: dorian24 Source Type: forums
Beta Blockers
AV nodal repolarization is mediated primarily by K+, so how do Beta blockers prolong AV nodal repolarization? (And CCBs too)
Any help, its melting away my brain? (Source: Student Doctor Network)
Source: Student Doctor Network - September 27, 2017 Category: Universities & Medical Training Authors: Brucelaa67 Source Type: forums
Propranolol vs Selective BB for anxiety d/o
Can anyone elaborate why a non-selective BB, classically propranolol, is the beta blocker of choice in performance anxiety and other anxiety disorders?
If the mechanism is via reduction of adrenergic activity resulting in slowing HR, reducing tremor, etc.. Shouldn't beta-1 selective BB's be just as effective? Where might blocking B2 receptors be helpful in this?
Has anyone had success using b1 selective drugs for generalized anxiety and performance anxiety? Also if you have some...
Propranolol vs Selective BB for anxiety d/o (Source: Student Doctor Network)
Source: Student Doctor Network - September 16, 2017 Category: Universities & Medical Training Authors: SCPA Source Type: forums
Migraine treatment
The pathophysiology of migraines is still controversial with two or three predominant theories. Vasodilation of perivascular sensory afferents is thought to be the key to the pain portion of the migraines. This makes sense as some of the termination medications are triptans which vasoconstricts vessels. However, I don't understand why beta-blockers and calcium channel blockers are used as preventative medications, since they cause vasodilation, particularly calcium channel blockers. Could...
Migraine treatment (Source: Student Doctor Network)
Source: Student Doctor Network - June 5, 2017 Category: Universities & Medical Training Authors: iBS1972 Source Type: forums
AV block and beta blockers
It seems literature says to go ahead and use beta blockers if first degree but not if second or third. What do most cardiologists do- this or just don't mess with beta blockers for any type of block? j/c. (Source: Student Doctor Network)
Source: Student Doctor Network - April 16, 2017 Category: Universities & Medical Training Authors: meerkat111 Source Type: forums
MI management, basic question
Hey all, intern here trying to get all this jazz straight. I know there's a bazillion mnemonics out there, but I'm just trying to make sure my management of STEMI and NSTEMI is correct for what we do in the emergency department. In addition to oxygen, monitor, and IV access:
STEMI --> Aspirin, clopidogrel, nitro (if no contraindications), heparin (ufh vs lmwh depending on institution, I guess), beta blocker (f no contraindications), PCI (and if going to PCI, give IIb/IIIa drug like...
MI management, basic question (Source: Student Doctor Network)
Source: Student Doctor Network - November 30, 2016 Category: Universities & Medical Training Authors: Fungi121 Source Type: forums
Just fail the NAPLEX, MPJE or CPJE, here is PLAN B
For most books, the information is overwhelming, overwhelming and overwhelming!!
Plan B - SIMPLIFIED, SIMPLIFIED and SIMPLIFIED everything!!
Use these strategies (logic) for every diseases states.
You need to ask ourselves:
1) Where is the problem? Angina – answer is the coronary arteries (or the arteries that carry oxygen to the heart).
2) What drugs can improve the disease state?
3) How do they work? Think of oxygen supply and demand.
Beta blockers - decrease the amount of oxygen...
Just fail the NAPLEX, MPJE or CPJE, here is PLAN B (Source: Student Doctor Network)
Source: Student Doctor Network - August 30, 2016 Category: Universities & Medical Training Authors: EllieNguyen Source Type: forums
Beta-blockers and septic shock
MS4. Sorry in advance if inappropriate or dumb. I'm just curious if/how/how often you're using beta-blockers in septic shock.
What prompted this: there was an interesting back-and-forth last month in ICM. It had to do with another Morelli paper on physiological parameters...
Beta-blockers and septic shock (Source: Student Doctor Network)
Source: Student Doctor Network - July 19, 2016 Category: Universities & Medical Training Authors: lymphocyte Source Type: forums
