HENOCH SCHOLEIN PURPURA

• purpura in Henoch scholein purpura is due to vasculitis and not due to thrombocytopenia.
• small and medium sized vessels involved.
• usally seen in children (infact it is the most common small vessel vasculitis in children ).
• vasculitis is caused by immune complex deposition.
• most common antibody seen in these immune complexes is IgA.  (IgA levels are elevated.)
• platelet count is normal
• sr complement level is normal

 

clinical pentad of TTP

1. Microangiopathic Hemolytic Anemia (Coomb's negative) :- Haemolysis , Fragmentation of RBC's , Increased LDH (elevated due to intravascular hemolysis)
2. Thrombocytopenia :- ( due to consumptions of platelets)
3. Decreased renal function:-(due to deposits in the Renal Vasculature)
4. Disturbed NEUROLOGICAL function:-characteristically diffuse and non focal eg-confusion,aphasia,alteration in consciousness
5. Fever

 

 

 

Advantages of PRAZOSIN

Prazosin (selective a1 blocker)

Advantages:-

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• improved carbohydrate metabolism
• symtomatic improvement in PVD and BPH
• favorable effect on lipid profile
• no impairment in cardiac contractility 

PROSTAGLANDINS and their use

· PGF2a (carboprost) ---- abortifacient , postpartum hemorrhage

· Latanoprost ----- glaucoma

· PGE2 (dinoprost) ----- induction of labour , abortifacient , bronchodilator , cervical ripening

· PGE1 (alprostadil) ---- to maintain patency of ductus arteriosus , intravenous injection for impotence

· PGE1 (misoprostol) ---- gastric peptic ulcer NSAID induced

· PGI2 (epoprostinol) ---- to avoid damage to platelets , primary pulmonary hypertension

Alkaline Phosphatase-importance in bone diseases

sources of Alkaline Phosphatase-

• bone
• intestine
• liver
• placenta

importance of alkaline phosphatase in bone disesese:

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• Serum alkaline phosphatse is the most valuable enzyme for assessment of bone disesases and serves as index of osteoblastic activity.
• Increased level of alkaline phosphatase are seen in-

                         a.Pagets diseases:-level of alkaline phosphatase are higher in Pagets disease than in any other condition. (excpt hereditary hypophosphatasia).

                         b.Hyperparathyroidism:-serum alkaline phosphatase may be raised depending upon degree of involvement of bone. 

ECG

Hyperkalemia

• narrowing and peaking of T waves
• AV conduction  delay
• diminution of P waves
• prolonged PR interval and widening of QRS interval
• sine-wave pattern

Hypokalemia

• flattening or inversion of T waves
• prominent U waves
• ST segment depression
• prolonged QU  interval
• severe hypokalemia-prolonged PR interval, decreased voltage and widening of QRS complex

Hypermagnesemia

• changes similar to those of hyperkalemia

Hypomagnesemia

• changes similar to those of hypokalemia

Hypercalcemia

• shortening of QT interval

Hypocalcemia

• prolongation of QT interval

Uraemia

• changes similar to those of hypocalcemia in association with hyperkalemia

Hypothermia

• prolongs repolarization, usually with a distinct convex elevation of the J point ( Osborn Wave)

Pericarditis

• in acute phase , there is ST segment elevation with convexity upwards diffusely in all leads except aVR and there is no reciprocal ST depression.

Digitalis effect

• the T wave is flattened at therapeutic levels and there is no reciprocal ST depression

SAH

• marked QT prolongations with deep , wide T wave inversions  ( CVA-T wave pattern)

WPW syndrome

• wide QRS , short PR interval and slurring of the initial part of the QRS (delta wave) 

Pulmonary thromboembolism

• sinus tachycardia ( most common manifestation) , S wave in lead I , a Q wave in lead III and an inverted T wave in lead III ( S1 Q 3 T3)

IMMUNOSUPPRESSANTS

•             Specific T cell inhibitor (calcineurin inhibitor)---

          cyclosporine , tacrolimus

•             Cytotoxic drugs(antiproliferative drugs)---azathioprine , cyclophosphamide , methotrxate , chlorambucil , mycophenolate mofetil

•             Glucocorticoids----prednisolone & others

•             Antibodies----muromonab cd3 , antithymocyte globulin , rho Ig

•             DRUGS CAUSING CHOLESTATIC JAUNDICE---chlorpropamide , erythromycin , rifampicin , amocillin , nitrofurantoin , methimazlole , ocp's , chlorpromazine , carbamezipine , nifedipine , verapamil

•             IMP. ADVERSE EFFECTS OF ORAL HYPOGLYCEMICS-----hypersensitivity ( rashes , photosensitivity , agranulocytsis , cholestatic jaundice [ only by cholrpropamide] ) ; disulfiram like effect---chlorpropamide , not safe in pregnancy [sulfonylureas ] , secreted in mmilk

•             DRUGS CAUSING HEMOLYSIS IN G6PD DEF----sulfonamides , nitrofurantoin , antimalarials eg- primaquine , chloramphenicol , cotrimoxazlole , dapsone , aspirin , phenacetin , probenicid

•             ABOUT BROMOCRIPTINE------bromocriptie is a dopmine analogue which decrases prolactin release , it has greater affinity on D2 receptors , increase GH release in normal indivudals but decrease the same from pituitary tumor causing acromegaly , can be used in parkinsonism , stimulates dopaminergic receptors in ctz---therefore produces emesis