gpsbrar
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Aminoglycosides are accumulated in the microorganisms via an O2 dependent uptake, thus anaerobes are innately resistant.
Ototoxicity of aminoglycosides is due to hair cell damage which includes deafness and vestibular dysfunction which is not readily reversible.
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| gpsbrar
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<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
In general, a P450 substrate is any drug that uses the cytochrome p450 enzyme pathway. P450 inhibitors (INH) generally increase concentrations of other drugs. P450 inducers (<?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />IND) generally decrease concentrations of other drugs. P450 enzymes are classified using Roman numerals and letters. Almost half of all human drugs use p450 3A4; another 30 percent use p450 2D6.
NRTIs
Name
p450 pathway/action
AZT, ddI, ddC, 3TC, d4T, abacavir
Most of drug is excreted unchanged from kidneys in urine.
NNRTIs
Name
p450 pathway/action
nevirapine
Moderate p450 IND; 3A4 INH
delavirdine
3A4 INH, 2D6 INH
* DMP 266 (efavirenz, Sustiva)
Moderate p450 IND; uses multiple pathways; has some inhibitory effect
NUCLEOTIDE DRUGS
Name
p450 pathway/action
adefovir dipivoxil
100 percent excreted from kidneys in urine
PROTEASE INHIBITORS
Name
p450 pathway/action
saquinavir
Weak 3A4 INH
ritonavir
Strong 2D6 INH, 3A4 INH, moderate p450 inducer; also: INH 1A2, 2C9, 2C19, 2E1
indinavir
3A4 INH, 2D6 INH
nelfinavir
Moderate 3A4 INH and moderate p450 inducer
* amprenavir (141W94)
3A4 INH and substrate
CHOLESTEROL/TRIGLYCERIDE/LIPID LOWERING DRUGS
Name
p450 pathway/action
Colestid
Not p450 metabolized, but affects absorption of drugs in GI tract
Questran
Not p450 metabolized, but affects absorption of drugs in GI tract
Niacin
Not liver metabolized; excreted in urine
HMC COA Reducatase Inhibitors
All use p450 3A4; may interact with statins avoid in patients with liver disease
Troglitazone
2C9 INH, 2C19 INH, 3A4 INH; an insulin sensitizer, stresses liver
Lopid (gemfibrozil)
Partly liver metabolized
Atromid-S (clofibrate)
Partly liver metabolized
Lorelco (probucol)
Not p450 metabolized. Risk for individuals with arrythmia
DRUGS USED TO TREAT WASTING:
Name
p450 pathway/action
serostim (growth hormone)
Some liver metabolism, cleaved in kidneys
Testosterone ethanate
3A4, 3A5-7
17-ALKYLATED ANABOLIC STEROIDS
Name
p450 pathway/action
Oxandrolone/Oxandrin,
Likely 3A4; 60 percent of drug unchanged in urine excreted
Decadorobulin (nandrolone decanoate)
Likely 3A4; increases serum estradiol
Methonolone steroid (primbolon depot)
Likely 3A4; illegal in U.S.,imported, best for women
OTHER COMMONLY USED DRUGS
Name
p450 pathway/action
hydroxyurea
50 percent of drug excreted unchanged from kidneys in urine; the rest metabolized in liver
caffeine
1A2, 3A4 IND
Ethinyl Estradiol
1A2, 3A4, 3A5-7
oral contraceptives (general)
3A4
Biaxin (clarithromycin)
3A4
acetaminophen
1A2, 2E1
doxorubicin
2D6, 3A4 substrate
(R) warfarin
1A2, 2C19
(S) warfarin
2C9, 2C19
cyclophosphamide
2C19, 2B6, 3A4
ibuprofen
2C9
Codeine
D6 INH, minor 3A4
Calcium channel blockers
3A4
Beta blockers
2D6
Antidepressants: clomipramine, in part; desipramine, imipramine
Mostly 2D6
trimetrexate
1A2
vincristine
3A4, 3A5-7
gluccocorticoids
3A4 IND (primarily a substrate)
p450 inhibitors
Name
p450 pathway/action
grapefruit juice
3A4 INH, (in gut wall), 1A2
TMP/SMX (Bactrim, Septra)
2C9 INH
erythromycin
1A2 INH, 3A4 INH
clarithromycin
IA2, 3A4 INH
ketoconazole
Strong 3A4, INH, 3A5-7, INH, 2C19, 1A2
itraconazole
Strong 3A4 INH
flucanazole
2C9 INH, 3A4 INH
cimetidine
Strong 1A2 INH, 3A4 INH, 2C
lovastatin
2C9
vinblastine
2D6, INH, 3A4, 3A5-7
p450 inducers
Name
p450 pathway/action
Viagra
weak inhibitor, p450 inducer
nicotine
1A2 IND
progesterone
2C19 IND, 3A4
rifabutin
Strong 3A4 IND
rifampin
Strong 3A4 IND, 1A2 IND, 2C9 IND, 2C19 IND, 3A5-7 IND
insulin
1A2
prednisone
2C19
dilantin
Moderate inducer, 3A4, 2D6, 1A2, 2C
tegretil
Moderate 3A4, 2D6, 2C
isoniazid
2E1 IND, 2C
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| gpsbrar
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Steven Johnson's syndrome - A severe inflammatory eruption of the skin and mucous membranes, usually occurring in children and young adults following a respiratory infection or as an allergic reaction to drugs or other substances.
Reyes's syndrome - Viral infection + Asprin in kids
Jarisch Herxheimer's reaction in the treatment of syphillis Ampicillin or amoxicillin
Tourette's syndrome A severe neurological disorder characterized by multiple facial and other body tics, usually beginning in childhood or adolescence and often accompanied by grunts and compulsive utterances, as of interjections and obscenities. Also called Gilles de la Tourette syndrome.
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| 4mymd
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| leen
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wow u guys r cool........ ..
I was wondering if we have to remember all of the inhibitors n inducers posted here....pl advice
thanks
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| gpsbrar
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No. Absolutely not. Just read them once and that is it. You will have an idea. Grapefruit juice, cimetidine are the USMLE fave.
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| gpsbrar
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Anton's Syndrome: Occlusion of posterior cerebellar arteries.
Cortical Blindness and Denial of blindness
Gertsmann Syndrome:
Lesions of dominant parietal lobe,
Agraphia, acalculia, finger agnosia, rightside disorientation, dysfunction in this area account for aproportion of learning disabilities.
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| cool_guyp4u
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4mymd,
How do you upload the pictures directly here? I have some Qs to post but you know I don't know how to post them directly like you?? ThanQ
4mymd wrote:
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| gpsbrar
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I think you have to go thru advanced button (right side of submit button) and then attach file.
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| gpsbrar
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Horner's Syndrome: Miosis (puppillar constriction), Ptosis (drooping of eyelids) and anhidrosis ( lack of sweating).
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| vallia
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Glycogenoses- type I, von Gierke disease, enzime deficiency-glucose-6-phosphatase
morfologic changes-hepatomegaly-intracitoplasmatic accumulation of glycogen and small amounts of lipid; intranuclear glycogen
renomegaly-intracitoplasmic accumulation of glycogen in cortical tubular epithelial cells
clinical features- failure to thrive, stunted growth, hepatomegaly, renomegaly, hypoglicemia due to failure to glucose mobilization often leading to convulsions, hyperlipidemia, hyperuricemia, gout and skin xanthomas, bleeding tendency due to platelet disfunction. With treatment most survive and develop late complications, eg hepatic adenomas.
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| gpsbrar
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Elevate the Mandible:
Masseter, temporalis, medial pterygoid
Depress the mandible:
Digastric, mylohyoid and suprahyoid
Grinding motion of the jaw:
Lateral and medial Pterygoid
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| gpsbrar
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chk attached file
Attached Files:
Oral Contraceptive Pill Use and Possible Drug Interactions.doc (33 KB, 9 downloads)
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| gpsbrar
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Swelling of lymphnodes on the back of the neck, in the posterior cervical chain of lymph nodes, as trypanosomes travel in the lymphnodes and cause inflammation. FAMOUS TSE TSE FLY or AFRICAN SLEEPING SICKNESS.
Chk for high Ig's in CSF fluid.
attached is image from CDC website.
Attached Files:
Winterbottom sign.jpg (194 KB, 16 downloads)
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| tolito
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DM AND DISEASES
2 specific diseases associated with dm
1. malig otitis externa by pseudomonas aeruginosa
2. mucor mycosis by mucor and rhizopus
achilles tendon and cholesterol
deposits of cholesterol seen in achiles tendon in familial cholesterolemia
MICROBIOL
all cocci are GP EXCEPT nisseria and moraxella
all spore formers are GP
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| gpsbrar
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There is a significant association between S. bovis bacteremia and and carcinoma of the colon abd other colonic diseases. Every pt with S. bovis dx should go in for cardiac evaluation.
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| tolito
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aspirin-induced astma, mechanism. aspirin blocks cycloxygenase and not lipoxygenase, leading to reduced ratio of PG (bronchodilator) via cyclox inhib and leukotrienes (bronchoconstrictor)
splenectomy induced lack of phagocytosis of encapsulated org. mech.. the spleen produces IgG2 and IgM which are used in opsonisation of encapsulated org. lack of spleen leads to low levels leading to poor opson
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| tolito
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interleukines
5 is produced as response to intestinal worms, stimulates IgA production and Eosinophilia
failure of 2 leads to clonal anergy of Tcells
4 inhibits macrophages strongly and is required for class switch of Bcells.
TH1 prod il2, and gama interferon. ( 2 stim TH and TC, stim more 2 fomation and 2 receptor formation) is important for CMI.
TH2 prod il4, 5, 10. 4, as above and may predispose to type 1 sensitivity cos it enhances synth IgE and IgG, 5 is also known as B cell differentiation factor. 10 inhibits 1.
12 is prod by macrophage and inhibits TH2 and promotes TH1 production. ( stands to reason!!!)
1,6 and gamma interferon involved in acute phase protein synth in liver
il3 is for myeloid stimulation ( see 3 as sideways m)
il7 is for Lymphoid stimulation ( see 7 as upside L)
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| tolito
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caspace activation is a universal feature of apoptosis regardless of initiating factor.
activation of P53 gene leads to apoptosis
bcl-2, NF-kb are anti-apoptotic proteins ( inhib release of cyt c which activates caspace). they favor cell survival
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| cool_guyp4u
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Differential Diagnosis for ring-enhancing lesions:
MAGICAL DR (Infact only Magic can cure most of these lesions!)
M - Metastasis, MS
A - Abscess (also cerebritis)
G - Glioblastoma, Granuloma
I - Infarct (esp. Basal ganglia)
C - Contusion (rare)
A - AIDS (Toxo, etc.)
L - Lymphoma (in aids)
D - Demyelination (active)
R - Resolving hematoma, Radiation change (necrosis)
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| cool_guyp4u
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Ring enhancing lesions:
Edited by cool_guyp4u on 05/14/06 - 06:50 AM
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| leen
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thanks cool guy ....
can u pl tell from which site u have taken this picture ...it seems very helpful
thanks
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| tolito
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BIOTIN
vit b7 or vit h. cofactor for co2 transfer in carboxylase actions.
pyr carboxylase
ac co a carboxylase
methiyl crotonyl co a carboxylase
propionyl co a carboxylase
deficiency from eating raw eggs over a long period (months/years). MECH, raw egg contains avidin which binds biotin irreversibly and prevents its absorbtion from gut.
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| tyler
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Cool!
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| cool_guyp4u
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Guys,
Keep this thread alive and please contribute atleast one post per day?
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