Exam I: Study Flashcards!!

Natural Penicillin

PCN G/V, Procaine PCN, Benzathine PCN

AGAINST: Streptococcus spp. Staphylococcus spp syphillis

Ureidopenicillins

Piperacillin

AGAINST: pseudomonas

ALWAYS w/ tazobactam

Penicillase-Resistance Penicillin

oxacillin, nafcillin/ diclocillin

AGAINST: MSSA, GP staphococcal spp

β-Lactamase Inhibitors

sulbactam (ampicillin)/ tazobactam (piperacillin)/ clavulanic acid (amoxicillin)

INCR ACTIVITY: GN/GP Anaerobes (H.influ, M.cat, N.gonorr, B,Fragil)

Aminopenicillins

Amoxicillin/Ampicillin

AGAINST: naturals + enterococcus

Cephalosporins

.5-1% cross-sensitivity with pcn

NEVER w/ neonates w/ hyperbilirubinemia

Cefazolin/ Cephalexin, cefadroxil

1st Gen!!

strep/staph spp. for skin and soft tissue

Cefuroxime, cefaclor

2nd Gen Group 1!

Cefuroxime → menigitis (ok)

Strep (MSSA!)

Cephamycins: cefoxitin, cefotetan

2nd Gen Group 2!!

“dirty surgery” → Bacteroides spp.

NO anticoags (MTT)

Cefrazidime

ceftriaxone(IV)/cefpdoxime(PO)

3rd Gen!!

Ceftazidime: anti-pseudomonal!!

Ceftriaxone: menigitis!! (2/day)

renal/hepatic precautions

cefepime

4th Gen!! (~3rd)

BROAD + P. aeruginosa

Ceftaroline/ ceftobriprole

5th Gen!

roline: BROAD + MRSA

briprole: 2024 (++Pseudomonas)

Thiemycins (“penems”)

Meropenem: BROAD (+{Pseudomonas)

Ertapenem: BROAD (+ESBL)

Impenem/Cilastatin : lowers seizure threshold!!

• renal toxic metabolites

GP/GN/anaerobes (B. fragilis)

5-10% cross-sensitivity w/ pcn

Monobactams

Aztreonam: GN/Pseudomonas

Aminoglycodside SUB w/ toxicity subscep pt

GIVEN w/ lincosamides/macrolides

Glycopeptides

Vancomycin

• PO: C. diff

• IV: MRSA

Precau: Red Man’s Syndrome

Aminoglycosides

Gentamycin, Tobramycin, Amikamycin/ Streptomycin (IV)

• pseudomonas/ GN

Synergist /w PCN, AMP, Vanc

Precau: Nephro/OTOtoxic!!

• no preg

Tetracyclines

Doxycycline: MRSA (cellulitis), Lymes!!

Tetracycline/Minocycline: Nephro/Hepta Tox!!

• GN/P, Atyp

• Dist: Maxillary Sinus

Precautions

• Teeth staining/ Growth plates

  • NO MILK

  • NO PREG

• Esophageal Irritant (no HS)

• Hyper/Photosensitivity

Macrolides

Azitrhomycin/Clarithromycin

• MAC attackl

• Lung/sputum penetration

Erythromycin

• CYP 450 interactions!!

ATYP! GN (A>C>E) GP (E>C>A)

Precautions:

• QTc prolongation

Lincosamides

Clindamycin: ANAEROBES (head/neck); staph/strep (MRSA)

• bone

Precautions:

• pseudomonas colitis

• esophageal irritant

Fluoroquinolones

Moxifloxacin: MSSA (GP)

Levofloxacin: PO (100%) Pseudomonsa; MSSA (GN/P)

Ciprofloxacin: Pseudomonas (GN)

Bone Penetration

Precau:

• tendons

  • NO MILK

• Aortic aneurysm

• QTc prolongation

Sulfas

Trimethoprim/Sulfamethoxazole: PO MRSA (cellulitis) GN/GP

Precautions;

• crystallization in renal tubules

  • hyperkalemia

  • QTc prolongation

• Warfarin!!

• Death w/ Stevens’Johnson syndrome

Imidazoles

Metronidazole: ANAEROBES (ALL)

Precautions

• Disulfaram reactions

• Warfarin

• Child-Pugh C (redu dose 50% /w severe hepatic impairment)

Oxazolindinones

Linezolid: VACN+ (Strep, Staph, Entero); Chlamydia, M. tuberculosis

NO dose adj renal/heptaic

Precaustions:

• Serotonin syndrome risk

Lipopetides

Daptomycin: VANC sub (Staph, Strep, Entero)

Precautions

• CK → Rhabdomyolosis risk

• pneumonia bugs NOT in lungs

Contact Signaling

via signaling molecules to plasma membrane-bound receptors

Ex: Paracrine (to other cells); Autocrine (to self); Hormonal (via blood to target); Neurohormone (via blood from neuron)

Isotonic

Same osmolality _285 mOsm/kg

ex: NSS/G5SS

Atrophy

response to decr in work/adv environmental factors: SMALLER SIZE

Hypertrophy

incr in work → L

Hyperplasia

Incr in # of cells

Metaplasia

Reversible change in which one cell type replaces another (may be precancerous)

• typ due to chronic inflammation

Dysplasia

deranged cell growth (Strong precursor to cancer)

Apoptosis

NORMAL, again cell deathNe

Necrosis

Pathological: unregulated enzymatic destruction → loss of cell membrane integrity → inflammatory response

Caseous Necrosis

TB infections

Combo of coagulative and liquefactive necrosis

Fat Necrosis

Breast, pancreas, other abd structures

action of lipases

Gangrenous Necrosis

Clinial for “greensih/black color change”

Dry (ischemia) AND Wet (infection)

Gass gangrene (Clostridium)

Coagulative Necrosis

Kidneys, Heart, and Adrenal Glands

• protein denaturation

• changes to protein albumin

Liquefactive Necrosis

Neurons and glial cells in BRAIN

• Hydrolytic enzymes form a liquid-filled cyst/pus

Autolysis

postmortem putrefactive changes associated with the release of enzymes and lytic dissolution

Pharmacodynamics

drug → body

Pharmacokinetics

Body → drug

Enteral

PO, SL, Buccal, PR

Parenteral

IV, SC/SQ, IM, INH, Top

Best Admin for Peds

Ill: Parenteral most reliable

• IV/IM/SC

BW/BSA Dosing

BW (body weight) most common

BSA: least frequent (use apps nomogram) BUT most accurate

Innate

NONspecific (w/in min) → via perforin and granzyme

PRRs

Macrophage, Dendritic Cells, Neutrophil, Eosinophil, Basophil, Mast cell, Complement

APC (antigen presenting cell)

Macrophage and Dedritic cells (#1 initial reponse to T-cell)

Adaptive

SPECIFIC response (~3 to become efficient)

B-cells (humoral)/ T-cells (cell-mediated)

B-cells

Antibody (humoral) mediated immunity (EXTRAcell → antibodies in fluid bind)

Mature into plasma cells in bone marrow to secrete cell surface receptor immunoglobulins (antibodies!!)

T-cells

Cell Mediated Immunity!! (intracell, CONTACT → phago/cytotox)

cell surface receptor = T-ell receptors

mature in thymus (CD markers+MHC)

• synth IL

PRR

TLR (surface of epithelial)

• cytokines → macrophages

C-type Lectic Receptors (MBL & dectin-1)

• MBL in FLUID bind to mannon; dectin-1 bind to β-glucan (yeast/fungus)

Nod-like Receptor

• recog peptidoglycan

RIG-1 helicase-like receptors

• w/in cytosol: recog virus dsRNA

cGAS cyclin GMP-AMP synthtase

• w/in cytosol: recog virus dsDNA

NK cells

ex (antigen-presenting cells (macro/mono), granulocytes (neutro/eos/baso), lymphocytes)

1: activate cells and recruit OTHER immune cells

2: infections STAYS local

3: repair damage!

Antigen-Presenting Cells

Innate! NK cells type!

EX: macrophages, monocytes (differentiate to macrophage, dendritic)

Func: phagocytosis, antigen presentation, cytokine production

Cytokines

Produ by Antigen-Presenting Cells!! (macro and mono → macro/dendritic)

INTERLEUKINS

ENHANCE inflammation → call others to action

ex: IL-8: CHEMOKINES - attract cells to site

TNF-alpha..

Complement

systemic cascade of proteins activate one another (INNATE)

ALL PATHWAYS → C3 END in Inflammation/ Opsonization/ MAC (lysis)N

Neutrophils

INNATE:

granulocyte #1 in blood

Chemotaxis (Cytokine, bacterial product)

Phagocytosis

Degranulation (antimicrobial proteins, enzymes, ROS)

NETosis

Secondary Lymphoid Organs

spleen, MALT (mucous associated lymph tissues), lymph nodes

T-cell Mature Types

CD4

• follicular helper cells (Tfh) - B cells

  • CD4 effector/helper T cells (Th) → leave and coordinate response in tissue

• CD4 regulatory cells (Treg) → suppress inflammation

CD8

• cytotoxis T cells (CTL) → kill virally infected cells VIA lymphocyte

Hypersensitivity Type I

IgE: allergen induces binding to mast cells and basophils (DEGRANU via histamine)

• bronchospasm (smooth muscle contraction), vasodilation, incr capillary permeability (leukocytes enter)

  • anaphylaxis: severe bronchospasm and hypotension

Hypersensitivity Type II

CYTOTOX IgG antigens bind to Tfh & B cells

• complement mediated lysis/ autoimmune hemolytic anemia

  • MOTHER-BBY

Hypersensitivity Type III

Mult. Antibodies: Tfh & Bcell activation

• antibody immune complexs + antigen

  • neutrophils via complement → lysosomal enzymes

Hypersensitivity Type IV

DELAYED ( T-cell mediated)

CD4/CD8 Tcells bind to antigen’s proteinds

• release cytokines on 2ND exposure (inflammation/macrophages)II

IgG

Highest

Start Memory

Mommy → Baby natural passive immunity

Opsonization

fixes complement (IgM)

IgA

Mucosal Membranes

IgM

antigen receptor (Bcell surface!!)

Long term memory cell

fixes complement (IgG)

IgD

unknown; found on B cell

IgE

ALLERGY antigen (mediates mas/basophils)

Degranulation eosinophils for WORM infections

Multiple Sclerosis

demyelation of brain white mattter (T-cell)

Chronic Thyroiditis

Hashimoto’s: antibodies agaisnt thyroidglobulin & thyroidperoxidase

Anemias, Thrombocytopenias, Granulocytopenias

antibodies → cell surfaces→ cell destruction

T1DM

T-cells → islet cells of pancreas

Pemphigas

antibodies → desmogelin (epthelial)

Celiac Disease

antibodies → gliadin (wheat, rye, barley)

IBS (Crohn’s & Ulcerative colitis)

Th-1 & Th-17 attack normal intestinal flora

IgA Nephrophathy

Glomerulonethisitis!!

IgA containing immune complexes → glomerulli (ESRD)

Psoriasis

inflammatory infiltrate

Staphylococcus Aureus

GP, Catalase +, Coag -

nosocomial: pneumo, septicemia, surg-wound infection

abscess, food poisoning, toxic shock syndrome

Strep Pyognes

GP, catalase -, β complete hydrolysis, Bacitracin sensitive

pharyngitis, cellulitis

Clostridium spp

GP rod, anaerobic, spore-forming

perfinges (gas ganrene, blood poisoning)

difficile (pseudomembranous colitis)

tetani (tetnus)

botulinum (botulism)

Trepenoma

spirochete

syphilis (benzathiene pcn)

Borrelia

spirochete

lyme disease (doxycycline)

Herpesvirus

bud from nuclear membrane

cause lifelong latent infections - w/ inciting agent or immunosuppression → reactivation of virus replication and disease

HSV type 1: above waist

• acute gingivostomatitis (cold sores), keratitis, encephalitis

HSV type 2: below waist

• genitalis, neonatal encephalitis, etc aseptic meningitis

Protozoa

Intestinal: giardia

urogenital: trichomonas

blood: plasmodium

tissue: toxoplasma

AGS Beers

guideline/criteria ID risks of medications

Anticholinergic Medications (confusion, drowsiness, blurred vision, diff urinating, dry mouth, constipation)

Cardiovascular Medication: Alpha 1 Blockers, Alpha agonists, Antiarrhythmics…

• orthostatic hypotension, CNS

• Decreased elimination of digoxin

• Higher risk of hyperkalemia (spironolactone)

Benzodiazepines (incr sensitivity (slow metabolism, neurocog sim to alc); incr risk of fall/fracture/cog/impairment/delirium)

Sedative-Hypnotics: (sim to benzodia: delirium, falls, sleep)

Anitpsy (dementia risk, QTc prolong, abnormal mvmts)

Pain Meds: (GI bleeding/ peptic ulcer disease, …)

P-glycoprotein

efflux transporter: keep it in intestinal lumen

Neoplasm

tumor

Benign Tumore

Adenoma, Lipoma, Hemangioma, Neuroma

polyp

fibroid

Carcinoma

epithelial cancer (#1 80-90%)

ex. adenocarcinoma (glands), ductal carcinoma, squamous cell carcinoma

Sarcomas

mesenchymal cells (1%)

lymphoma

lymphocytes (breast) 5%

Leukemias

Bone Marrow Cells (2.5%)

TNM System

T: Tumor size

N: Lymph Node Status

M: Metastasis

TP53

tumor suppressor gene

Mutations cause ~50-60% of cancers

proto-oncogenes

gene that encodes receptors that growth factors bind to

mutations → oncogenes, overexpression

Warburg effect

cancer req more glucose (use glycolysis)

What PET scans read

VEGF

vascular endothelial growth factor - induce angiogenesis