NEET MDS Lessons
Pharmacology
Aminoglycoside
Aminoglycosides are a group of antibiotics that are effective against certain types of bacteria. They include amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, and tobramycin. Those which are derived from Streptomyces species
Aminoglycosides work by binding to the bacterial 30S ribosomal subunit, causing misreading of t-RNA, leaving the bacterium unable to synthesize proteins vital to its growth.
Aminoglycosides are useful primarily in infections involving aerobic, Gram-negative bacteria, such as Pseudomonas, Acinetobacter, and Enterobacter. In addition, some mycobacteria, including the bacteria that cause tuberculosis, are susceptible to aminoglycosides. Streptomycin was the first effective drug in the treatment of tuberculosis, though the role of aminoglycosides such as streptomycin and amikacin have been eclipsed (because of their toxicity and inconvenient route of administration) except for multiple drug resistant strains.
Infections caused by Gram-positive bacteria can also be treated with aminoglycosides, but other types of antibiotics are more potent and less damaging to the host. In the past the aminoglycosides have been used in conjunction with penicillin-related antibiotics in streptococcal infections for their synergistic effects, particularly in endocarditis.
Because of their potential for ototoxicity and renal toxicity, aminoglycosides are administered in doses based on body weight. Blood drug levels and creatinine are monitored during the course of therapy.
There is no oral form of these antibiotics: they are generally administered intravenously, though some are used in topical preparations used on wounds.
Aminoglycosides are mostly ineffective against anaerobic bacteria, fungi and viruses.
Doxycycline
Commonly prescribed for infections and to treat acne. treat urinary tract infections, gum disease, and other bacterial infections such as gonorrhea and chlamydia., as a prophylactic treatment for infection by Bacillus anthracis (anthrax). It is also effective against Yersinia pestis and malaria.
Metabolism
Hepatic Drug-Metabolizing Enzymes: most drug metabolism in the liverperformed by the hepatic microsomal enzyme system.
Therapeutic Consequences of Drug Metabolism
- Accelerated Renal Drug Excretion: The most important consequence of drug metabolism is the promotion of renal drug excretion. Metabolism makes it possible for the kidney to excrete many drugs that it otherwise could not.
- Drug Inactivation
- Increased Therapeutic Action: Metabolism may increase the effectiveness of some drugs.
- Activation of Prodrugs: A prodrug is a compound that is inactive when administered and made active by conversion in the body.
- Increased or Decreased Toxicity
Factors that influence rate of metabolism:
- Age: Hepatic maturation doesn't occur until about a year old.
- Induction of Drug-Metabolizing Enzymes: Some drugs can cause the rate of metabolism to increase, leading to the need for an increased dosage. May also influence the rate of metabolism for other drugs taken at the same time, leading to a need for increased dosages of those drugs as well.
- First-Pass Effect: Hepatic inactivation of certain oral drugs. Avoided by parentaral administration of drugs that undergo rapid hepatic metabolism.
- Nutritional Status
- Competition between Drugs
Seizure classification:
based on degree of CNS involvement, involves simple ( Jacksonian; sensory or motor cortex) or complex symptoms (involves temporal lobe)
1. Generalized (whole brain involved):
a. Tonic-clonic:
Grand Mal; ~30% incidence; unconsiousness, tonic contractions (sustained contraction of muscle groups) followed by clonic contractions (alternating contraction/relaxation); happens for ~ 2-3 minutes and people don’t breathe during this time
Drugs: phenytoin, carbamazepine, Phenobarbital, lamotrigine, valproic acid
Status epilepticus: continuous seizures; use diazepam (short duration) or diazepam + phenytoin
b. Absence:
Petit Mal; common in children; frequent, brief lapses of consciousness with or without clonic motor activity; see spike and wave EEg at 3 Hz (probably relates to thalamocorticoreverburating circuit)
Drugs: ethosuximide, lamotrigine, valproic acid
c. Myoclonic: uncommon; isolated clinic jerks associated with bursts of EEG spikes;
Drugs: lamotrigine, valproic acid
d. Atonic/akinetic: drop seizures; uncommon; sudden, brief loss of postural muscle tone
Drugs: valproic acid and lamotrigine
2. Partial: focal
a. Simple: Jacksonian; remain conscious; involves motor or sensory seizures (hot, cold, tingling common)
Drugs: carbamazepine, phenytoin, Phenobarbital, lamotrigine, valproic acid, gabapentin
b. Complex: temporal lobe or psychomotor; produced by abnormal electrical activity in temporal lobe (involves emotional functions)
Symptoms: abnormal psychic, cognitive, and behavioral function; seizures consist of confused/altered behavior with impaired consciousness (may be confused with psychoses like schizophrenia or dementia)
Drugs: carbamazepine, phenytoin, laotrigine, valproic acid, gabapentin
Generalizations: most seizures can’t be cured but can be controlled by regular administration of anticonvulsants (many types require treatment for years to decades); drug treatment can effectively control seizures in ~ 80% of patients
Cephalosporins
Produced semisynthetically by chemical attachment of side chains to 7-aminocephalosporanic acid. Same mode of action , same resistance mech.
But tend to be more resistant than penicillins to certain beta –lactamases .
GENERATION BASED ON :
-- BACTERIAL SUSCEPTIBILITY PATTERNS
-- RESISTANCE TO BETA –LACTAMASES
--NOT EFFECTIVE AGAINST -MRSA , L. MONOCYTOGENES , C. DIFFICLE , ENTEROCOCCI
First Generation
Parentral
- CEPHALOTHIN
- CEFAZOLIN
Oral
- CEPHALEXIN
- CEPHRADINE
- CEFADROXIL
Second Generation
Parentral
CEFUROXIME
CEFOXITIN
Oral
CEFACLOR
CEFUROXIME AXETIL
Third Generation
Parentral
CEFOTAXIME
CEFTIZOXIME
CEFTRIAXONE
CEFTAZIDIME
CEFOPERAZONE
Oral
CEFIXIME
CEFPODOXIME
CEFDINIR
CEFTIBUTEN
Fourth Generation
Parentral
CEFEPIME
CEFPIROME
Anesthesia agents
1. Inhalation anesthetics (volatile anesthetics)
- gases : N2O, xenon
- Fluids (vaporisers)
2. Intravenous anesthetics
- Barbiturans : thiopental
- Others : propofol, etomidat
3. Pain killers
- Opioids: fentanyl, sufentanil, alfentanil, remifentanil, morphine
- Non Steroid Anti Inflamatory Drugs: ketonal, paracetamol
4. Relaxants
- Depolarising : succinilcholine
- Non depolarising : atracurium, cisatracurium, vecuronium, rocuronium
5. adiuvants
-benzodiazepins: midasolam, diazepam
Sulfonylureas
1st generation
tolbutamide
chlorpropamide
2nd generation
glyburide
glimepiride
glipizide
Mechanism
glucose normally triggers insulin release from pancreatic β cells by increasing intracellular ATP
→ closes K+ channels → depolarization → ↑ Ca2+ influx → insulin release
sulfonylureas mimic action of glucose by closing K+ channels in pancreatic β cells
→ depolarization → ↑ Ca2+ influx → insulin release
its use results in
↓ glucagon release
↑ insulin sensitivity in muscle and liver
Clinical use
type II DM
stimulates release of endogenous insulin
cannot be used in type I DM due to complete lack of islet function
Toxicity
first generation
disulfiram-like effects
especially chlorpropamide
second generation
hypoglycemia
weight gain