NPLEXCombinationReviewChapter10–Immunology自然療法醫(yī)師注冊考試復(fù)習(xí)10章結(jié)合–免疫學(xué)課件

NPLEXCombinationReview

Immunology/ToxicologyPaulS.Anderson,NDMedicalBoardReviewServicesCopyrightMBRSNPLEXCombinationReview

Immun1LaboratoryTestingMethodologiesPCR:PolymeraseChainReactionELISA(EnzymeLinkedImmunosorbantAssay)–MeasuresIgG/M/A…UsedindiseasedetectionandAllergenidentification.RASTQuantifiesIgEantibodies.IntradermaltestingPositivereactiondemonstrateserythemaatpointofinjection.BloodimmunoglobinsIgG–Delayedhypersensitivityreactiontoantigen.IgE–Immediatehypersensitivityreactiontoantigen.ElectrodermalallergytestEAVisappropriateexample.LaboratoryTestingMethodologi2IDImmunology:GeneralCulturesTaketimeSomethingsgrow,somedon’tAntibodyTestingGoodforeffectSomebetterthanothersDNA(PCR)TestingDetectsDNAofthesubjectoftheprobeNoneedforgrowingacultureNoneedforIginterpretationCangetQuantitative(viralload)testsIDImmunology:GeneralCultures3AntibodyTestingSerumtests.Serummustbeseparatedfromclot/SSTGelwithin1hour!PipetteserumintoaplastictransporttubeExcessiveexposuretothegelintheSSTwillbindantibodies,causingfalsenegativetests.Usedforallergytesting,Autoimmunetesting,ExposureIg(Immunoglobulin)Types:IgG:Longtermexposure,Delayedreactions(ie.Foodallergy).IgGlastsalongtime,andisamarkerofEXPOSURE,notsuccessfultreatment.IgM:Acutephasereactions.Indicatesrecentinfectionorre-exposure.IgA:SecretoryIg.Showsmucosalresponse,andisagoodmarkerofsuccessfultreatment.Canbemeasuredintheserum,stoolandsalivaIgE:Anaphylaxis.(Type-1Reaction).TotalIgEinserumisatestforgeneralallergiclevelinthepatientTraditionallythemarkerusedforfoodandInhalantallergy,althoughIgGismorehelpfulwithmostfoodreactions.AntibodyTestingSerumtests.4AntibodyTesting-2HighIgG,LowIgMorIgAProbablepastinfection/exposure.Inactiveorcured.InfoodallergytestingIgGisalwaysconsideredactive,butdelayedresponseallergy.LowIgG,HighIgMNewinfection/ExposureHighIgG,HighIgMReactivatedinfection/ExposureHighIgG,LowIgM,HighIgACurrentimmuneresponse(mucosal)thatispasttheinitialIgMresponsewindow.(Ongoingproblem).AntibodyTesting-2HighIgG,5AutoimmuneDisordersAnti-nuclearantibody(ANA)Titerlevelisimportant:>1:160“positive”Screeningtestforconnective-tissuediseases:RA,SLE,Lupus,MCTD,CRESTSyndrome,Scleroderma,andPolymyositis.UseconfirmatoryANAsub-testingtoconfirmspecificdiseaseDx.OftenorderedasANA+Reflex(7or9values)runifANAAispositiveErythrocyteSedimentationRate(ESR)NonspecificmeasureofinflammationDiagnosticinveryfewconditions(Giantcellarteritis)CanalsoindicatecancerouseffectC-reactiveprotein(CRP)Screeningfornondescriptiveinflammatoryandinfectiondiseaseprocesses.AlsousedfordiscriminatingamongDDXandmonitoringdiseaseprocessCRPelevation:RA,Reiter’s,vasculitis,rheumaticfever,neonatalandpost-operativeinfections,pyelonephritis,MIandembolism.AutoimmuneDisordersAnti-nucle6AutoimmuneDisordersRheumatoidfactor(RF)UsedinthediagnosisandevaluationofRAandotherCTD;HighestinRA,butalsoelevatedinCVD,MI,renaldisease,malignancy,thyroidandliverdisease,SLE,sclerodermaandpolyarteritisnodosa.ParvoB-19viralassayConsiderinRFNegativewomannursingorcaringforayoungchildwhopresentswithRAlikesymptoms.Humanleukocyteantigen(HLA)HLAB-27mostcommon.Glycoproteinsthatmaybeserologicallydetermined;usuallyperformedfortransplantationmatchesbutalsoelevatedinAS,Reiter’sSyndrome,MS,chronicactivehepatitis,gluten-sensitiveenteropathy,SLE,DMandhemochromatosis.ConsiderChlamydiatesting(Reiter’s)AutoimmuneDisorders7AutoimmuneDisordersAnti-thyroidantibody(AntiMicrosomalorTPOAb)Usedindiagnosisandclassificationofinflammatoryandautoimmunethyroiddisease.MarkerforHashimoto’sthyroiditis,atrophicthyroiditis,andGrave’sDisease.AntithyroglobulinAntibody(AntiTG)Detectandconfirmautoimmunethyroiditis,HashimotothyroiditisThyroid-StimulatingImmunoglobulin

(ThytrophinReceptorAb)DetectGrave’sDz.OrderwhenGrave’sSn/SxandTPOelevationAutoimmuneDisordersAnti-thyro8THYROIDHORMONESYNTHESISTHYROIDHORMONESYNTHESIS9InfectiousDiseaseTestingAnti-Streptolysin-Otest(ASO)(>200iu/ml)Elevationintitersreflectimmunologicresponsetostreptococcus;ASOtitersclinicallyusefulifserumisobtainedin2-3weekintervals.Chlamydiaantibody(IgG,IgM)PresenceofIgGAbindicateschlamydialinfectioninthepast;highlysensitivebuthaslowspecificity.PresenceofIgMor4-foldincreasefromacute–convalescence=recentinfection.CytomegalovirusPCRCytomegalovirus(CMV-IgG,IgM)PresenceofIgMor4-foldincreaseinIgG=recentinfectionInfectiousDiseaseTestingAnti10InfectiousDiseaseTestingEpstein-BarrVirus(EBV)Monospot:ScreeningtestperformedwithsymptomaticPt.(falsenegativeinadults10%).MeasuresIgMheterophilantibodies.Positivewindow:4-21daysPCRforEBV:MostsensitivetestisQuantitative(viralload)PCRUsedinChronicreactivatingcasesEBVPanel: Earlyphase–IgM:anti-VCAAcuteillness–IgG:anti-VCAAcuteillness–IgGanti-EAConvalescence–Anti-EBNA(IndicatespastinfectionORChronicreactivationinrecurrentEBVpatients).InfectiousDiseaseTestingEpst11E.coliO157-H7specificassayStoolGiardiaStoolassayinsymptomaticpatientHelicobacterpyloriMultiplemethodologies:Nitrogenbreathtest(Sensitiveforpresenceofdzandtx)SerumIgG:(SensitiveforPASTinfection–butwillnotdecreasewithsuccessfultx.)SerumIgM:(Sensitiveforcurrentinfectionbutwilldecreasein2-4weeksregardlessofinfection.)Serum,SalivaryorStoolIgA:(Riseswithpresenceofinfxn/fallswitheffectivetx.)StoolIgAispreferredtestnowbyIDSAE.coli12Hepatitis(A,B,C,D,E)virusHAV:IgMtitersreflectacuteinfection.IgGtitersidentifiedyearsafteracuteillness.HBV:HbsAg:detected1–4monthspost-infection.Patientswiththisantigenpresent>6monthsexhibitchronichepatitis.ANTI-HBsAb:PatientswiththisAbareconsideredprotectedagainsttheHBVinfectionHbcAg–IgMmostusefulmarkertodeterminethe“window”:(HbsAgdisappearsandANTI–HbsAgappears;usuallydemonstratespresentinfection.)ThepresenceofANTI–HbcAg

IgG

indicatespreviousHBVinfectionandpersistsindefinitely.HCV–Ab–PatientswiththisAbhavefour-foldincreaseforHCCHCVPCRisavailableaswell.HDV-co-existswithhepatitisbinfection.MakedHep-Bmoredeadly.Worstinpregnancy.HEV–Notgenerallytestedfor:casesoutofU.S.Testifforeigntravelinthepast60daysHepatitis(A,B,C,D,E)virus13Herpessimplexvirus(HSV-1;HSV-2)Antibodies:IgM–Currentinfection.IgGInfectioninthepast.IgG/MType(1or2)specificserologyisbestDDXPCRisavailableVirusisolation(Tzanksmear)isOLDmethodtoconfirmanHHVinfection:CanhavefalsepositivesifotherHHVinfectionispresentNOTspecifictoHHV1or2

Generally**HSV–1abovewaistwhileHSV–2affectsbelowwaist.Butthisisnotalwaysthecase.Herpessimplexvirus(HSV-1;H14HumanImmunodeficiencyVirus(HIV)Standardmethodfordiagnosis:ELISAmeasuredanti-HIVtiters.ConfirmedbyWesternBlotAnalysis.(MAYTAKE6MONTHSTOSERO-CONVERT)DecreasedCD4/CD8ratioNewlydiagnosedcondition:T-Cellsubset(CD3,CD4,CD8).Earliestdiagnosis:PCRforHIVHumanPapillomaVirus(6,11,16,18,31,33)HPV16,18,31,33arecommoncausesforcervicalcancer.AvailableasPCRonPapsampleHPV6,11commoncausesforplantarandgenitalwarts.NOTgenerallycancerousorpre-cancerousHumanImmunodeficiencyVirus(15RubellatiterPresenceofIgMand/orfour-foldincreaseinIgG=presentinfection.Syphyllis(VDRL/RPR)Nontreponemaltestsusedprimarilyfordetectionofprimarysyphiliticinfection.TuberculosisIntradermalskintest:Read48-72hoursforinduration.BCG:Post–ID;checkserologyresults.Lymedisease(>250antibodyreactionunits)Skin,blood,synovialorCSF.ELISAorWesternblotcheckingforantibodydetection.PCRNowavailableRubellatiter16Antimicrobial

and

Dermatologic

PharmacologyAntimicrobial

and

Dermatolog17Antifungal,helminthicandprotozoalPharmacologyAntifungal,helminthicandpro18AntifungalsMOAUsesAdverseEffectsOtherNystatinDisruptsfungalcellwallIntestinal,cutaneous,vaginalandmucocutaneousinfectionscausedbyCandidaContactdermatitisPoorlyornotabsorbed.Goodtopicalagent/GIAgent.MiconazoleDisruptsfungalcellwallTineapedis,cruris,versicolor,corporis,cutaneouscandidainfectionandvulvovaginalcandidiasisPruritus,skinirritation,burning,contactdermatitisClotrimazoleDisruptsfungalcellwall“Nausea,vomiting,vaginalburningorirritationwithapplication,erythema,pruritus,increasedliverfunctiontestsGriseofulvinFungicidalTineapedis,tineaunguiumAlsoTineacorporis,capitisandcrurisHeadache,dizziness,GIupset,nausea,vomiting,rash,urticaria,hepatictoxicTeratogenicBoricAcidFungastaticagentVaginalcandidiasisLocalirritationGentianVioletFungicidalOralCandidaMouthrinse,maystainskinorclothingDonotuseonulcerativewoundsonthefaceAceticAcid[VoSolOtic]InhibitsordestroysbacteriaintheearOticsolutionforexternalearinfectionsEarirritation,urticariaAntifungalsMOAUsesAdverseEffe19ANTIFUNGAL

DRUGS-2AmphotericinI.V.Only(unlesscompounded)TwotypesStrong/Highpotentialsideeffectprofile(I.V.)TriazoleclassFluconazole(Diflucan)InhibitsFungalp-450,degradingfungalcellwallKetoconazole(Nizoral)Itraconazole(Sporonox)Voriconazole(V-Fend)Terbinafine(Lamisil)TopicalandOralformsANTIFUNGALDRUGS-2Amphoteric20NystatinMultipleformaavailable.Topicalkill–evenintheGItract.GIInfections:500,000–1MillionUnitspotidNystatinMultipleformaavailab21FluconazoleAbsorbs–somoresystemickillandmoresystemicsideeffect.Primarysiteofactivity–LiverDosingstrategiesvarywidelybasedonimmunocompetenceandtypeofinfection.Maybeaslowas150-200mginasingledoseforuncomplicatedfungalvulvovaginosistoasmuchas200mgbidforlongterm(2-4weeks),or100mgdailyformonths.IfusingitlongtermInormallytreatona5dayson/2daysoffrotation.FluconazoleAbsorbs–somores22TerbinafineFingernailonychomycosis:250mgqdfor6weeksToenailonychomycosis:250mgqdfor12weeksTerbinafineFingernailonychomy23ANTIPARASITICDRUGSTopicalMOAUsesAdverseEffectsOtherLindane[Kwell]PenetratesexoskeletoninducingseizuresanddeathofarthropodsScabies,pediculosisSeizures,irritation,CNSdisturbancePermethrin[Elimite]/[Nix]CausesparalysisbydisruptingsodiumcurrentintheparasiteScabies,pediculosisPruritus,edema,rash,burning,orstingingAntihelminthicsMOAUsesAdverseEffectsOtherMebendazole[Vermox]IrreversiblyinhibitsnutrientuptakebyhelminthesPinworms,roundworms,hookwormsAbdominalpain,diarrhea,feverANTIPARASITICDRUGSTopicalMOAU24MebendazolePinworm:100mgpoasasingledose.Repeatin2-3weeksRoundworm,Whipworm,Hookworm:100mgpobidX3daysRepeatin3weeksMebendazolePinworm:25AntiprotozoalMOAUsesAdverseEffectsOtherMetronidazoleInhibitsDNAsynthesisinmicroorganismcausingcelldeathAmoebas,trichomoniasis,giardiaGIdistress,seizures,ataxia,cramping,rash,jointpain.**DonottakewithETOH(actslikeAntabuse)PotentatesdrugsmetabolizedbyP450system;AntimalarialMOAUsesAdverseEffectsOtherChloroquineUnknownMalaria,extraintestinalamebiasisHeadache,dizziness,pruritus,neuropathy,seizures,retinalchangesandototoxicQuinineUnknownMalariaExtremelytoxic,cinchonism,shockANTIPARASITICDRUGSAntiprotozoalMOAUsesAdverseEf26AmebicideIodoquinolMetronidazole(Flagyl)Paromomycinsulfate(Humatin)AntiPneumocystisAtovaquone(Mepron)Pentamidineisethionate(Pneumopent)ANTIPARASITICDRUGSAmebicideANTIPARASITICDRUGS27MetronidazoleIntestinalamebiasis750mgpobid5-7days,theniodoquinolRx.Trichomoniasis750mgpotidX7daysOR1grampobidX1day:RepeatthisdoseRxin4-6weeks.Bacterialvaginosis500mgpobidX7daysMetronidazoleIntestinalamebia28Antibiotic

PharmacologyAntibiotic

Pharmacology29AntibioticclassesandTargetsBactericidalantibioticsthattargetbacterialcellwall;penicillins,cephalosporinsorcellmembrane;polymixinsorinterferewithessentialbacterialenzymes;quinolones,sulfonamidesusuallyBacteriostaticABXarethosewhichtargetproteinsynthesis;aminoglycosides,macrolidesandtetracyclinesAdaptedfrom:FinbergRW,MoelleringRC,TallyFP,etal(November2004)."Theimportanceofbactericidaldrugs:futuredirectionsininfectiousdisease".Clin.Infect.Dis.39(9):1314–20.doi:10.1086/425009.PMID15494908.AntibioticclassesandTargets30ANTIMICROBIALOVERVIEW(Gent./Tobra.&Streptomycin)(-floxacin’s)macrolidesquinolonesANTIMICROBIALOVERVIEW(Gent.31So,

Letstalkaboutsideeffectsandantibioticprescriptions:So,

Letstalkaboutsideeffec32Antibiotics:GITractSymbiotic–beneficialflorakillOvergrowthofflora-dysbiosisPseudomembranousColitis(C.diff)KidneysMostABXarepolar.LotsofKiexcretionOfteninIVusetheycancauseKifailureifadministeredimproperlyLiverLivereffectpossible,butlesscommonthanKi“Superinfection”SystemicinfectionwithbacteriaorfungithatarenoteffectedbytheABXyouhavegiven–likeasystemicdysbiosis.Antibiotics:GITract33ABXand“GoodFlora”SupplementsABXgivenwithbeneficialflorasupplements(acidophilus,bifidus…)willkillmanyofthosebugsaswell.SomewaittorepopulatethegutuntilaftertheRx.Ifyouareconcernedthatthepatientwillgettoobehind(ietoomuchgoodflorakill)youmaysupplementbeneficialfloraduringtheABXcourse,ANDafter.IfdoingthisDONOThavethepatienttakethegoodflorasupplementwhiletheABXpillsareinthestomach.AlternatetimeofdosebetweenfloraandABX.ABXand“GoodFlora”Supplemen34NPLEXCombinationReviewChapter10–Immunology自然療法醫(yī)師注冊考試復(fù)習(xí)10章結(jié)合–免疫學(xué)課件35PenicillinMOAUsesAdverseEffectsOtherPenicillin(PenVee-K)Breakdown/InhibitbacterialcellwallsynthesisGram+cocci,anaerobicbacteria,syphilisNausea,vomiting,rash,seizures,anaphylaxis,neurotoxic,nephrotoxicNoteffectiveagainst-lactamaseproducingorganismorGram–anaerobesAmpicillinInhibitscellwallsynthesisSomeGram+andGram–organisms,prophylaxisfordentalproceduresNausea,vomiting,diarrhea,seizures,rash,urticaria,anaphylaxisNoteffectiveagainst-lactamaseproducingorganismAmoxicillinInhibitscellwallsynthesisSomeGram+andGram–organisms,prophylaxisfordentalprocedures“AmoxicillinandClavulanate[Augmentin]InhibitscellwallsynthesisandClavulanatemakesiteffectiveagainst-lactamaseproducingorganismsGram+,Gram-,and-lactamaseproducingorganism“PenicillinMOAUsesAdverseEffec36NOTE:AllRx’sareforthelongerterm(i.e.10dayinsteadof7day).SomeINDICATIONSREQUIREFEWERTxdays–seeSanfordGuideetc.AllareinAdultDosesunlessotherwisenoted.An“Adult”isa150PoundHumanNOTE:AllRx’sareforthelong37Rx: Adult:PEN-VK500mgtablets#30Sig:1potidChild:Amoxicillin(OrAmox/Clav)80-90mg/kgoftheamoxicillincomponentindailydivideddoses.RxX7-10daysRx: Adult:38CephalosporinsMOAUsesAdverseEffectsOtherCephalexin[Keflex]1stgenerationBactericidalbyinhibitingcellwallsynthesisURI,GIinfections,cutaneousinfections,softtissueinfectionsNausea,diarrhea,maculopapularrash,anaphylaxis,serumsickness,GIdistress10-15%ofpatientshavecrossallergybetweenpenicillinandcephlosporinsCefaclor[Ceclor]2ndgeneration“UTI,URI,OM““Cefixime[Suprax]3rdgeneration“MoreresistanttoGram--lactamaseproducingorganism““Cefepime[Maxipime]4thgeneration“E.coli,Proteus,K.pneumoniae,Enterobacter,B.fragilis,Staph/Strep“IVDoseformCephalosporinsMOAUsesAdverseE39Rx:Cefalexin500mg#30Sig1poq-6-hCefaclor500mg#30Sig1poq-8-hRx:Cefalexin500mg40MacrolidesMOAUsesAdverseEffectsOtherErythromycinInterfereswithbacterialDNAsynthesisDrugsofchoiceforM.pneumonia,pertussis,neonatalC.pneumoniaStrepthroat,URI,Abdominalpain,nausea,diarrhea,vomiting,anaphylaxisContraindicatedinPregnancy;cautionwithimpairedrenalfunctionClarithromycin[Biaxin]“BronchitisNon-gonococcalurethritis,cervicitis,chanroid“SAMEAzithromycin[Zithromax]“LESSGIeffect,Lessmedicationneededtoachieveeffect.SAMEMacrolidesMOAUsesAdverseEffec41Rx:Erythromycin333mg#30Sig1tid(IusethisasitislessGIupsettingthanthe500mgstrength–IgiveWITHfood)Erythromycin500mg#20Sig1bidAzithromycin250mg#6(“Z-Pak”)Sig2poDay-1,1poqddays2-5(Somesuggest#3(“3-Pak)inuncomplicateddz.)Rx:Erythromycin333mg42TetracyclineMOAUsesAdverseEffectsOtherTetracyclineInterfereswithbacteriaproteinsynthesisSusceptibleGram+andGram–organismsincludingchlamydiaandlymediseaseSebulytic(Acne)Intracranialhypertension,GIdistress,nausea,vomiting,diarrhea,rash,photosensitivity,increasedpigmentationNotforuseinchildrenunder9yearsoldbecauseofpermanentdiscolorationofteethenamelInterfereswithoralcontraceptiveeffectivenessDoxycyclineMinocycline“““LessnephrotoxicTetracyclineMOAUsesAdverseEff43DoxycyclineGeneraloralRx:Doxycycline100mgtabletsSig:1poq-12-hTreatfor7daysformostinfections(Acneprophylaxis50-100mg,qd-bid)DoxyisINEXPENSIVE.DoxycyclineGeneraloralRx:44MinocyclineGeneraloralRx:Minocycline100mgtabletsSig:1poq-12-hTreatfor7daysformostinfections(Acneprophylaxis50-100mg,qd-bid)Minocyclineis95%absorbedinthestomach,andhasaverylowGIflorakillrate.MinocyclineGeneraloralRx:45SulfonamidesMOAUsesAdverseEffectsOtherCo-trimoxazole/Trimethoprim/Sulfamethoxazole[Septra]/[Bactrim]Sulfisoxazole[Gantrisin]Sulfamethoxazole[Gantanol]Sulfadiazin[Coptin]InterferewithbacterialfolicacidsynthesisUTI,OM,URI,pneumocystiscarinii,traveler’sdiarrheaUTI,URINausea,vomiting,diarrhea,rash,seizures,toxicnephrosis,hepaticnecrosis,dermatitis,SJS/TEN,anaphylaxisMANYPotentialsideeffects.InterferewithoralcontraceptiveeffectivenessSulfonamidesMOAUsesAdverseEff46Nitrofurantoinmonohydrate/macrocrystals

TRADENAME:MacrobidSpecificUTIIndicationCONTRAINDICATIONS:Anuria,oliguria,orsignificantimpairmentofrenalfunction(creatinineclearanceunder60mLperminuteorclinicallysignificantelevatedserumcreatinine)arecontraindications.Treatmentofthistypeofpatientcarriesanincreasedriskoftoxicitybecauseofimpairedexcretionofthedrug.Becauseofthepossibilityofhemolyticanemiaduetoimmatureerythrocyteenzymesystems(glutathioneinstability),thedrugiscontraindicatedinpregnantpatientsatterm(38-42weeksgestation),duringlaboranddelivery,orwhentheonsetoflaborisimminent.Forthesamereason,thedrugiscontraindicatedinneonatesunderonemonthofage.DOSAGEANDADMINISTRATION:Macrobidcapsulesshouldbetakenwithfood.AdultsandPediatricPatientsOver12Years:One100mgcapsuleevery12hoursforsevendays.Nitrofurantoinmonohydrate/ma47Fluoroquino-lonesMOAUsesAdverseEffectsOtherCiprofloxacin[Cipro]Andallother“-flox’s”Gatifloxacin[Tequin]Levofloxacin[Levaquin]LomefloxacinMoxifloxacin[Avelox]Norfloxacin[Noroxin]Ofloxacin[Ocuflox]Trovafloxacin[Trovan]EnoxacinBactericidalbyinterferingwithbacterialDNAsynthesisWidespectrum:URI,UTI,cutaneousinfections,boneorjointinfections,abdominalinfections

Rash,arthralgias,nausea,diarrhea,seizures,GIandCNSeffectsAchilles'TendonRuptureCanarrestgrowthplateinchildrenDonotuseunderage18Fluoroquino-lonesMOAUsesAdvers48Ciprofloxacin100-750mgPOq-12-hDosebasedonseverityofinfectionandcurrentindication.ThereissomevariabilityofeffectivenessamongthevariousFQagents.Ciprofloxacin100-750mgPOq49AminoglycosidesMOAUsesAdverseEffectsGentamicin[Garamycin]

Kanamycin[Kantrex]Neomycin[Mycifradin]Netilmicin[Netromycin]

StreptomycinTobramycin[Nebcin]Paromomycin[Humatin]BactericidalbyinterferingwithbacterialDNAsynthesisUseforseriousinfectionsofEnterobacter,E.coli,K.pneumonia,PseudomonasPneumocystispneumoniaOtotoxic,nephrotoxic,seizures,anaphylaxis,neurotoxicSevereOtotoxicityAminoglycosidesMOAUsesAdverse50AntituberculosisMOAUsesAdverseEffectsOtherIsoniazidRifampinRifabutinRifapentenePyrazinamideInhibitscellswallsynthesisinMycobacteriumtuberculosisImparesRNAsynthesisUNKNOWNTBTBTBTBTBAdditiveTx.Neuropathies,hepatotoxic,GIdisturbance,fever,rashMANY“““AllareHepatotoxicGivewithB-6AntituberculosisMOAUsesAdvers51TopicalAntibioticsMOAUsesAdverseEffectsOtherBacitracin[Bactin]InhibitscellwallsynthesisofbacteriaTopicalinfectionsSkinrash,allergicdermatitisNeomycin[Neosporin]DisruptsbacterialproteinsynthesisTopicalbacterialinfectionsContactdermatitis,rash,maybenephrotoxicorototoxicMupirocin[Bactroban]BacterialRNAinhibitionImpetigo,MRSAprophylaxis…LowExpensiveTopicalAntibioticsMOAUsesAdve52MupirocinMupirocinRx:#1-15gramtubeSig:ApplytoaffectedareasbidMupirocinMupirocinRx:53AntiviralPharmacologyAntiviralPharmacology54AntiviralsMOAUsesAdverseEffectsOtherAcyclovir[Zovirax]Valacyclovir[Valtrex]Famcyclovir[Famvir]InhibitsviralmultiplicationbyinterferingwithDNAsynthesisHSVtypesI&II,Varicella,Herpesencephalitis(Mollerets’Syndrome)Val.andFam.bothmetabolizetoAcyclovirinthebody,butrequirelowerdosing.Nausea,vomiting,headache,seizures,coma,rashAntiviralsMOAUsesAdverseEffec55AcyclovirGenitalherpesInitial:200mgq-4-hor400mgq-8-hRecurrent:200mgq-4-h(5Xdaily)(IoftenaddanrxforAcyclovircream–bid)Suppressivetxforrecurrentgenitalherpes400mgpobidVaricella-Zoster800mgpoq-4-h(5Xdaily)for7-10daysAcyclovirGenitalherpes56ValacyclovirGenitalherpesInitial:1grampobidX10daysRecurrent:500mgpobidX5daysSuppressivetxforrecurrentgenitalherpes9orfeweroutbreaks/year:500mgqd>9:1gramqdVaricella-Zoster1grampotidX5-7daysValacyclovirGenitalherpes57FamcyclovirOralherpes1500mgasasingledoseGenitalherpesInitial:NodataRecurrent:1000mgbidX1daySuppressivetxforrecurrentgenitalherpes250mgbidVaricella-Zoster500mgq-8-hX7daysFamcyclovirOralherpes58ANTIVIRALTHERAPY-2HumanHerpesVirus1–7(exceptCMV)Acyclovir,Valcyclovir,FamcyclovirCMVCidofovir,Foscarnet,GancyclovirHepatitisB&CInterferonalpha,PegylatedInterferonRibavirinLamivudine(3tc)[HepatitisB]InfluenzaZanamivirOseitamivirANTIVIRALTHERAPY-2HumanHer59ANTIVIRALTHERAPY–HIVNucleosideReverse-transcriptaseInhibitors(NRTI)TypeA:Zidoiudine(ZDV),Stavudine(d4T)TypeB:Dianosine(ddl),Zalcitabidine(ddc),Lamivudine(3tc)Other:AbacavirNonNucleosideReverse-transcriptaseInhibitors

(NNRTI)NeuirapineDelaviridineEfavirenzProteaseInhibitorsSaquinavirIdinavirRitonavirNelafavirAmprenavirTripleTherapy:2NRTI’sandP.I.orNNRTIANTIVIRALTHERAPY–HIVNucleos60Biologicsand

ImmuneModulatingDrugsBiologicsand

ImmuneModulati61EICOSANOIDSMEMBRANEPHOSPHOLIPIDARACHADONATELEUKOTRIENESPROSTAGLANDINS/THROMBOXANESLipoxygenaseCyclooxygenasePhospholipaseA2Stimulatedby:Angiotensin-2/Bradykinin/Epinephrine/ThrombinInhibitedby:CORTICOSTEROIDSInhibitedby:NSAID’SEICOSANOIDSMEMBRANEPHOSPHOLIP62LeukotrienereceptorantagonistPharmacologyBindstocysteinylleukotrienereceptor1intheupperandlowerairwaystopreventleukotriene-mediatedeffectsassociatedwithasthmaandallergicrhinitis.IndicationsandUsageProphylaxisandchronictreatmentofasthmainpatients12moofageandolder;reliefofsymptomsofseasonalallergicrhinitisinpatients2yrofageandolder;reliefofsymptomsofperennialallergicrhinitisinpatients6moofageandolder.Preventionofexercise-inducedbronchoconstriction(EIB)inpatients15yrofageandolder.UnlabeledUsesChronicurticaria,atopicdermatitis.Leukotrienereceptorantagonis63LeukotrienereceptorantagonistAdverseReactionsCardiovascularCardiaccomplications,palpitations(postmarketing).CNSHeadache(18%);asthenia/fatigue,dizziness(2%);abnormaldreams,depression,drowsiness,hallucinations,insomnia,paraesthesia/hypoesthesia,psychomotorhyperactivity(includingagitation,aggressivebehavior,irritability,restlessness,andtremor),seizures(postmarketing).DermatologicAtopicdermatitis,dermatitis,eczema,skininfection,urticaria(atleast2%);rash(2%);vasculiticrash(postmarketing).EENTConjunctivitis,earpain,myopia,otitis,pharyngitis,rhinorrhea,sinusitis,tonsillitis(atleast2%);nasalcongestion(2%);epistaxis(atleast1%).GIDiarrhea,dyspepsia,gastroenteritis,laryngitis,nausea,toothinfection(atleast2%);dentalpain,infectiousgastroenteritis(2%);pancreatitis,vomiting(postmarketing).Hematologic-LymphaticBruising,eosinophilia,increasedbleedingtendency(postmarketing).HepaticCholestatichepatitis,hepatocellularliver-injury,mixed-patternliverinjury(postmarketing).LabTestsALT/ASTincreased(2%);pyuria(1%).MusculoskeletalArthralgia,myalgia(includingmusclecramps)(postmarketing).RespiratoryInfluenza(4%);cough(3%);acutebronchitis,pneumonia,upperrespiratorytractinfection,wheezing(atleast2%);worseningofpulmonarysymptoms(postmarketing).MiscellaneousAbdominalpain(3%);fever,varicella,viralinfection(atleast2%);trauma(1%);edema,hypersensitivity(includinganaphylaxis,hepaticeosinophilicinfiltration,pruritus,andurticaria)(postmarketing).Leukotrienereceptorantagonis64LeukotrienereceptorantagonistMontelukastSodiumSingulair

-Tablets10mg

-Tablets,chewable4mg

-Tablets,chewable5mg

-Granules4mg/packet

Doseinadults:10mgQDALSO:Zafirlukast(za-FIR-lo