NEET MDS Lessons
Pharmacology
Structure of the CNS
The CNS is a highly complex tissue that controls all of the body activities and serves as a processing center that links the body to the outside world.
It is an assembly of interrelated “parts”and “systems”that regulate their own and each other’s activity.
1-Brain
2-Spinal cord
The brain is formed of 3 main parts:
I. The forebrain
• cerebrum
• thalamus
• hypothalamus
II. The midbrain
III. The hindbrain
• cerebellum
• pons
• medulla oblongata
Different Parts of the Different Parts of the CNS & their functions CNS & their functions
The cerebrum(cerebral hemispheres):
It constitutes the largest division of the brain.
The outer layer of the cerebrum is known as the “cerebral cortex”.
The cerebral cortex is divided into different functional areas:
1.Motorareas(voluntary movements)
2.Sensoryareas(sensation)
3.Associationareas(higher mental activities as consciousness, memory, and behavior).
Deep in the cerebral hemispheres are located the “basal ganglia” which include the “corpus striatum”& “substantianigra”.
The basal gangliaplay an important role in the control of “motor”activities
The thalamus:
It functions as a sensory integrating center for well-being and malaise.
It receives the sensory impulses from all parts of the body and relays them to specific areas of the cerebral cortex.
The hypothalamus:
It serves as a control center for the entire autonomic nervous system.
It regulates blood pressure, body temperature, water balance, metabolism, and secretions of the anterior pituitary gland.
The mid-brain:
It serves as a “bridge”area which connects the cerebrum to the cerebellum and pons.
It is concerned with “motor coordination”.
The cerebellum:
It plays an important role in maintaining the appropriate bodyposture& equilibrium.
The pons:
It bridges the cerebellum to the medulla oblongata.
The “locus ceruleus”is one of the important areas of the pons.
The medulla oblongata:
It serves as an organ of conduction for the passage of impulses between the brain and spinal cord.
It contains important centers:
• cardioinhibitory
• vasomotor
• respiratory
• vomiting(chemoreceptor trigger zone, CTZ).
The spinal cord:
It is a cylindrical mass of nerve cells that extends from the end of the medulla oblongata to the lower lumbar vertebrae.
Impulses flow from and to the brain through descending and ascending tracts of the spinal cord.
Second Generation Cephalosporins
Prototype drug is CEFUROXIME (IV) and CEFUROXIME AXETIL (oral). CEFOXITIN has good activity vs. anaerobes.
1. Expanded activity against gram negative bacilli. Still have excellent activity against gram positive (Staph. and Strep.) bacteria.
Activity for Gram negative bacteria
Neisseria sp. (some gonococci resistant)
H. influenzae (including some ampicillin-resistant strains)
Moraxella catarrhalis (some resistance esp. to cefaclor)
E. coli
Proteus mirabilis
Indole + Proteus (some strains resistant)
Morganella morganii (some strains resistant)
Klebsiella pneumoniae
Serratia sp. (many strains resistant)
2. Anaerobic infections - CEFOXITIN & CEFOTETAN only
Moderate activity against Bacteroides fragilis group.
Good activity for other Bacteroides sp., Peptostreptococcus, Fusobacterium, Clostridium sp
Uses
1. Community-acquired pneumonia - Cefuroxime is widely used for empiric therapy. Has activity vs. many ampicillin-resistant H. influenzae strains.
2. Skin and soft tissue infection
3. Urinary tract infections
4. Upper respiratory tract infections (otitis media, sinusitis). Some resistance to H.influenzae to cefaclor (20-30%).
5. Mixed aerobic & anaerobic infections - Cefoxitin & Cefotetan. Resistance to B.fragilis is increasing.
6. Surgical prophylaxis - Cefoxitin or cefotetan are widely used in cases where mixed aerobic & anaerobic infections may occur, esp. intra-abdominal, colorectal, and gynecologic operations. For cardiovascular and orthopedic procedures, cefuroxime and others may be used, but cefazolin is cheaper and appears to work well.
Isoflurane (Forane) MAC 1.3%, Blood/gas solubility ratio 1.4
- Better muscle relaxation than with the other halogenated anesthetic agents.
- Isoflurane markedly potentiates the action of the neuromuscular blocking agents.
- Produces rapid onset and recovery of anesthesia.
- Does not sensitize the heart to catecholamines.
- Produces respiratory depression, but produces less cardiovascular depression
- than does halothane.
- It has an extremely low degree of metabolism and is apparently relatively
- nontoxic.
Griseofulvin
- Griseofulvin is an antifungal drug. It is used both in animals and in humans, to treat ringworm infections of the skin and nails. It is derived from the mold Penicillium griseofulvum.
- It is administered orally.
Etomidate -Intravenous Anesthetics
- A nonbarbiturate anesthetic used primarily to induce surgical anesthesia.
- It does not produce analgesia.
- Etomidate has minimal effect on the cardiovascular system and respiration during induction of anesthesia.
- Like the barbiturates, etomidate decreases cerebral blood flow, cerebral metabolic rate and intracranial pressure.
- No changes in hepatic, renal or hematologic function have been reported.
- Myoclonic muscle movements are relatively common.
- Postoperative nausea and vomiting are more common with etomidate than with barbiturates.
Flucloxacillin, important even now for its resistance to beta-lactamases produced by bacteria such as Staphylococcus species. It is still no match for MRSA (Methicillin Resistant Staphylococcus aureus).
The last in the line of true penicillins were the antipseudomonal penicillins, such as ticarcillin, useful for their activity against Gram-negative bacteria
Immunosuppressive drugs are essential in managing various medical conditions, particularly in preventing organ transplant rejection and treating autoimmune diseases. They can be classified into five main groups:
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Glucocorticoids: These are steroid hormones that reduce inflammation and suppress the immune response. They work by inhibiting the production of inflammatory cytokines and reducing the proliferation of immune cells. Common glucocorticoids include prednisone and dexamethasone. Their effects include:
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Mechanism of Action: Glucocorticoids inhibit the expression of genes coding for pro-inflammatory cytokines (e.g., IL-1, IL-2, TNF-α).
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Clinical Uses: They are used in conditions like rheumatoid arthritis, lupus, and to prevent transplant rejection.
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Side Effects: Long-term use can lead to osteoporosis, weight gain, diabetes, and increased risk of infections.
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Cytostatic Drugs: These agents inhibit cell division and are often used in cancer treatment as well as in autoimmune diseases. They include:
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Examples: Cyclophosphamide, azathioprine, and methotrexate.
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Mechanism of Action: They interfere with DNA synthesis and cell proliferation, particularly affecting rapidly dividing cells.
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Clinical Uses: Effective in treating cancers, systemic lupus erythematosus, and other autoimmune disorders.
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Side Effects: Can cause bone marrow suppression, leading to increased risk of infections and anemia.
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Antibodies: This group includes monoclonal and polyclonal antibodies that target specific components of the immune system.
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Types:
- Monoclonal Antibodies: Such as basiliximab and daclizumab, which target the IL-2 receptor to prevent T-cell activation.
- Polyclonal Antibodies: These are derived from multiple B-cell clones and can broadly suppress immune responses.
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Clinical Uses: Used in organ transplantation and to treat autoimmune diseases.
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Side Effects: Risk of infections and allergic reactions due to immune suppression.
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Drugs Acting on Immunophilins: These drugs modulate immune responses by binding to immunophilins, which are proteins that assist in the folding of other proteins.
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Examples: Cyclosporine and tacrolimus.
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Mechanism of Action: They inhibit calcineurin, a phosphatase involved in T-cell activation, thereby reducing the production of IL-2.
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Clinical Uses: Primarily used in organ transplantation to prevent rejection.
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Side Effects: Nephrotoxicity, hypertension, and increased risk of infections.
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Other Drugs: This category includes various agents that do not fit neatly into the other classifications but still have immunosuppressive effects.
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Examples: Mycophenolate mofetil and sirolimus.
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Mechanism of Action: Mycophenolate inhibits lymphocyte proliferation by blocking purine synthesis, while sirolimus inhibits mTOR, affecting T-cell activation and proliferation.
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Clinical Uses: Used in transplant patients and in some autoimmune diseases.
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Side Effects: Gastrointestinal disturbances, increased risk of infections, and potential for malignancies.
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