Part 7 Flashcards
B lactam antibiotics mechanism of action
Disrupt bacterial cell wall causing them to take up water and burst through inhibiting transpeptidases that catalyze cell wall formation and activation of autolysins that cleave bonds in wall by binding Penicillin binding proteins
B-lactamases definition
Coded for by a plasmid between bacteria to promote synthesis of proteins that release into the space around them to cleave certain PCNs
PCN drug interactions (3 to know)
1) probenecid - delay excretion
2) aminoglycosides - inhibed by PCNs and need to be administered separately
3) Bacteriostatic antibiotics - PCNs work best on fast dividing
Anti pseudomonal penicillin name
-Piperacillin
1st -5th gen cephalosporins trend (3)
- 1st gen most susceptible to B lactamases, 5th is highly resistant
- Increased activity against gram - bacteria
- increased ability to reach csf
List example 1st-5th gen cephalosporins
1) cephalexin (keflex)
2) Cefaloxin
3) ceftazidime, cefdinir (omnicef), or ceftriaxone (roecephin)
4) cefipime
5) ceftaroline (effective gainst MRSA)
Disulfiram like reaction can occur with metronidazole. What other drug class can it possibly occur with?
Cephalosporins (apparently)
Carbapenems drug class and MOA
B-lactam antibiotis that like penicillins and cephalosporins, inhibit bacterial cell wall synthesis, have very broad antimicrobial spectrum
Vancomycin adverse effects (3)
- Renal failure (dose related)
- Ototoxicity
- Red man syndrome (histamine release resulting in rashes, flushing, potential to go into shock)
These two antibiotic classes should never share an IV bag
PCNs and aminoglycosides
What is the broadest spectrum aminoglycoside
Amikacin
Tetracyclines mechanism of action
Broad spectrum antibiotics that inhibit protein synthesis at the ribosome 30s subunit after being transported via energy dependent processes
Tetracycline absorption
Via GI, but form insoluble chelates with cations preventing absorption and thus require administration 1-2 hours after ingestion of a chelate
Tetracycline common side effects (3)
- GI upset
- bones and teeth coloraion
- photosensitivity
Macrolides mechanism of action
Broad spectrum antibiotics that act by inhibiting bacterial protein synthesis, bind 50S ribosome and are bacteriostatic
Macrolide common adverse effects (2)
-GI effects
-QT prolongcatoin which can precipitate torsades de pointes
Chloramphenicol MOA and why is it not commonly used? What is it drug of choice for? What is another condition this is linked to?
Similar to a macrolide, not commonly used because has adverse effect of aplastic anemia requiring close monitoring, is still sometimes used as drug of choice in eye infections and typhoid or meningitis. In pediatrics, this is linked to gray baby syndrome which is where it builds up to toxic levels causing abdominal distension, gray coloration of skin, possibly shock and death
Fluorquinolones mechanism of action
Passive diffusion, inhibit DNA replication on bacterial gyrase and toposioromase, rapidly bactericidal
3 common B-lactamase inhibitors to be combined with penicillinase sensitive PCN
1) clavulanic acid
2) tazobactam
3) sulbactam
IV calcium gluconate with ceftriaxone injection
contraindicated due to calcium precipitate formation
Teicoplanin
Similar action and structure to vancomycin, but largely devoid of any ADRs
Fosfomycin
Similar action and structure to vancomyscin, often used in uncomplicated UTI
Telavancin
Similar action and structure to vancomycin, treats complex skin infections and causes taste disturbance and foamy urine
4 tetracyclines available
1) tetracycline (short acting, no food)
2) denecocycline (medium acting, no food)
3) doxyxcline(long acting, no food)
4) minocycline (long acting, food okay)
Fanconi syndrome
A type of Ingestion of proximal renal tubular acidosis sometimes due to ingestion of outdated tetracycline can cause proximal renal tubular dysfunction leading to renal failure
Name the 3 macrolides
1) erythromycin
2) azithromycin
3) clarithromycin
Clarithromycin and azithromycin are often prescribed over erythromcyin because of one distinct advantage
They do not typically cause nausea and diarrhea
Clindamycin mechanism of action
Inhibition of the 50S ribosome to prevent protein synthesis
Clindamycin ADR
Can cause psudomembranous colitis from Cdiff
Dalflopristin/Quinipristin mechanism of action and what do they treat?
Streptogamins, together become bactericidal, treat VRE and MRSA
Linezolid mechanism of action, what does it treat and what is an ADR
Binds 23s portion of 50s subuinit of ribosome, cross resistance therefore unlikely, treates VRE and MRSA, myelosupression
Metronidazole spectrum
Protozoa or anaerobic bacteria, DOC for Cdiff, amoeba, and trichomonas vaginalis
Metronidazole mechanism of action
Taken up passively, converted to active form in anaerobic bacteria, break up DNA helical structure
Metronidazole ADRs (3)
Neurologic effect, urine darkening, disulfarim like rxn
Sulfonamides mech of action
Inhibition of synthesis of folic acid by binding where PABA does to be bacteriostatic
Sulfonamide spectrum
Broad, gram + including MRSA and some gram neg, DOC for acute UTI
Sulfonamide ADRs (5)
- Photosensitivity
- drug fever
- Steven Johnson syndrome (widespread lesions)
- acute hemolytic anemia
- Kernicterus (bilirubin buildup in newborn brain
Osteon/Haversion canal definition
Hollow tubes in cortical bone that serves as passage for the vessels to supply the structure
Lamella definition
One of the layers of an osteon/havarsion system that radiate outward from the canal center
Lacunae definition
A hole in hydroxapatite matrix that stores osteocytes (inactive form of osteoblasts)
Osteoblast
Functionally lay down hydroxapatite matrix forming cortical bone, stimulated by calcitonin and inhibited by PTH
Osteoclast
Functionally remove hydroxapatite matrix by removing cortical bone via phagocytosis, inhibited by calcitonin
Low blood calcium causes release of ____, high blood calcium causes release of ______
PTH, calcitonin
Osteomalacia (rickets disease in children)
Caused by inadequate vit. D intake (and treated with supplement), causes weakness and bone pain
Ligament definition and function
Attachment of tissue from bone to bone, function to stabilize the joint and to facilitate the desired motion set by the ligament’s orientation
Sacrotuberous ligament insertion and function
Insertion: Sacrum to ischial tuberosity
Function: Houses a nerve, intertwined with the sacrospinous ligament
Sacrospinous ligament insertion and function
Insertion: Sacrum to ischial spine
Function: Anterior to the sacrotuberous ligament, forms the greater sciatic foramen, functionally prevents the ileum from sliding posterior to sacrum, intertwined with sacrotuberous ligament
Sacroiliac ligament (SI joint) insertion and function
Insertion: Sacrum to Iliac
Function: Tightly intermingle the sacrum with the ileum
Acetabular labrum insertion and function, does it often cause symptoms if torn?
Insertion: Femur head to acetabolum of pelvic bone
Function: Tightly wrap around the ball and socket joint of the femur with the pelvic girdle.
It does not often cause symptoms when torn.
Iliofemoral ligament
Insertion: Anterior inferior iliac spine to femur
Function: Strongest ligament in the body, Y ligament, helps us remain upright while walking
Ischiofemoral ligament insertion (no function given)
Insertion: Ischium to femur
Function: Not much to say
Pubofemoral ligament insertion and function
Insertion: Superior ramus of the pubis to the femur
Function: prevents hyper-abduction at the hip joint (god help when you do the splits yo)
Anterior cruciate ligament insertion and function
Insertion: Femur to tibia, crossing anteriomedially over the PCL
Function: limit anterior displacement of tibia
Posterior cruciate ligament insertion and functiom
Insertion: femur to tibia, crossing posteriolaterally behind the ACL
Function: limit posterior displacement of tibia
Medial collateral ligament insertion and function
Insertion: Medial femur to tibia
Function: prevent medial directed force on the tibia and femur
Lateral collateral ligament insertion and function
Insertion: lateral femur to lateral fibula
Function: prevent lateral directed force on fibula and femur
Medial/Lateral Meniscus insertion and function
Insertion: between tibia and femur
Function: Shock absorber, provide stability
Anterior tibiofibular ligament insertion (no function listed)
Insertion: anterior face of inferior space between tibia and fibula
Function: mmmk
Anterior talofibular ligament insertion and function
Insertion: Lateral malleolus to anterior talus
Function: Most commonly injured in an ankle sprain, prevents foot from sliding forward during a sprain
Calcaneofibular ligament insertion (no function listed)
Insertion: Lateral malleolus to calcaneous posterioinferiorally
Function:
Posterior talofibular ligament insertion (no function listed
Insertion: Lateral malleolus to posterior talus
Function:
Posterior tibiofibular ligament insertion (no function listed)
Insertion: posterior face of inferior space between tibia and fibula
Function
Acromioclavicular ligament insertion and function
Insertion: Lateral clavicle to acromion
Function: 1 of 2 attachments between clavicle and scapula
Coracoclavicular ligament insertion and function
Insertion: Inferior clavicle to coracoid process
Function: 1 of 2 attachmentts between clavicle and scapula
Coracoacromial ligament insertion and function
Insertion: Coracoid process to acromion
Function: Forms a roof over the humerus attachment, has passage underneath
inferior/anterior/posterior glenohumoral ligaments insertion and function
Insertion: Space around glenoid fossa to humerus
Function: limit movement, none exists superiorally allowing for reach amirite
Glenoid labrum insertion and function
Insertion: Glenoid fossa to humerus head
Function: Increase bony contact area
Radial collateral ligament insertion and function
Insertion: Proximal radius to distal humerus
Function: resist lateral directed force on the elbow joint
Ulnar collateral ligament insertion and function
Insertion: proximal ulna to distal humerus
Function: resist medial directed force on elbow joint
Annular ligament insertion and function
Insertion: Radius to ulna proximally
Function: protect integrity of radius in radial notch of the ulna but allow for supination and pronation
FRISBE acronym for critically evaluating a study
Follow up - were patients outcomes accounted for at end of study
Randomization - Equal chance being assigned to experimental or control group
Intention to treat analysis - are the results analyzed based on intended original treatment
Similar baseline characteristics - did patients have characteristics that could cause even outocome distribution
Blinding - study blinded
Equal treatment - controlling for any other confounding variables not being tested
Case control study characteristics
Analysis of a patient with the disease (case) and without (control) to analyze effect of known risk factors with specific outcome, study rare conditions
Cohort study characteristics
Dividing up of patient with one characteristic versus another who all already have a disease to follow them to see differences in outcome to determine cause and effect of characteristic
Randomized clinical trial characteristics
Often used to study intervention or cure of disease state, highest level of causality because can be blind
Systematic review definition
Belongs to synthesis 5S model. Seeks to answer a specific clinical question by analyzing all the findings from an entire body of primary research regarding the topic. Involves several experts collaborrating over a long time
Type I and type II error
A false positive and false negative
Retrospective cohort study definition
Study medical records of a group of similar individuals in order to determine which factors are related to a certain outcome
Meta analysis definition
statistical procedure for combining data from multiple studies
Superficial clots require work up as sometimes they are treated if they are in close proximity to a….
deep vein
Subclavian artery derived from and empties to and path
Derived from: brachiocephalic trunk on the right side, aortic arch on the left
Empties into: axillary artery
Travels along and passes under the clavicle where it will change names
Axillary artery is derived from and empties into and path
Derived from: subclavian artery
Empties into: brachial artery
Travels across the axillary region, has thoracoacromial trunk branch most medial, then lateral thoracic, then posterior and anterior humeoral circumflex, then subscapular before finally changing names into brachial artery
Posterior and anterior humoral circumflex arteries derived from and course
Derived from: axillary artery
Travel around the surgical and anatomical neck of the humerus (respectively) and anastamose together
Lateral thoracic artery derived from and course
Derived from: axillary artery
Travels along the chest wall before dipping around to supply the lats
Subscapular artery derived from and course
Derived from: axillary artery
Travels around to supply the posterior shoulder and eventually the lats
Brachial artery derived from and empties into and course
Derived from:axillary artery
Empties into: radial and ulnar arteries
Travels from name change of the axillary artery at the beginning of the arm, has a branch profunda brachial artery coming off, continues into the cubital fossa and the forearm where it divides into radial and ulnar arteries
Profunda brachial artery derived from and course
Derived from: brachial artery
Travels deep to supply the posterior arm
Radial artery derived from and empties into and course
Derived from: brachial artery
Empties into: deep palmar arch artery
Travels from the brachial artery to supply along the radius, can be palpated, empties into the deep palmar arch artery
Ulnar artery derived from empties into and course
Derived from: brachial artery
Empties into: superficial palmar arch artery
Travels from brachial artery to supply along the ulna, empties into superficial palamr artery
Superficial and deep palmar arteries derived from and course
Derived from: ulnar and radial arteries respectively
Travel along the palmar face of the hand and anastamose together for recurrent blood supply of the hand
Cephalic vein course
Travels on the superficial anterior face of the forearm, has a branch in the cubital fossa of the median cubital vein, then travels up the arm over the beceps brachii before turning 90 degrees and draining into the axillary vein
Basilic vein course
Travels along the medial face of the forearm, has a branch in the cubital fossa of the median cubitla vein, then travels up the medial arm before draining into the border between brachial and axillary veins
Muculocutaneous nerve derivation and course
Derived from: lateral cord of the brachial plexus,
Travels to innervate the anterior arm
Axillary nerve derived from and course
Derived from: posterior cord of the brachial plexus
Travels to innervate deltoids and teres minor
Radial nerve derived from and course
Derived from: posterior cord of the brachial plexus
Travels to innervate the posterior arm and deep next to the profunda brachii artery before moving anteriolaterally around the lateral epicondyle of the humerous through the cubital fossa to then supply the dorsum of the forearm and dorsum of hand up to digit four
Median nerve derived from and course
Derived from: Lateral and medial cords of the brachial plexus
Travels deep in the anterior arm alongside profunda brachii artery into the cubital fossa, it continues into the anterior forearm to supply most of that bad boy and travels through the carpal tunnel to supply the palmar hand up to digit four
Ulnar nerve derived from, course
Derived from: the medial cord of the brachial plexus
Travels posteriomedially down the arm, through the medial epicondyle (where it can be easily struck), and then down the medial forarm (only supplying the flexor carpi ulnaris muscle) before reaching the hand to supply the 5th and part of the 4th digit dorsally and palmar
Globe definition
Surface of the eyeball proper
Orbit definition
Bony cavity housing the eye
7 bones that comprise the orbit
1) lacrimal
2) maxilla
3) frontal
4) zygomatic
5) sphenoid
6) ethmoid
7) palatine
Vision falls within the spectrum of 400nm to 750nm. Anything below 400 nm ____ the cells while anything above 750 nm ____ the cells
Kills, doesn’t carry enough energy to cause a photochemical reaction
Medial and lateral in regards to the eye
Nasal and temporal
Conjunctiva definition
Clear coating that covers the anterior sclera of the eye and eyelid (continuous so nothing can get trapped behind the eye)
Medial and lateral commissure/canthus definition
Skin areas outside the eye where the corners meet
Lacrimal caruncle definition
The red area of the nasalmost portion of the eye
Orbicularis oculi muscle
Surrounds the eye allowing for closure of eyelid
Tarsal/meibomian glands
Holocrine glands on the tarsal plate that secrete an oily substance to reduce tear evaporation in the eye
Tarsal plate definiiton
The superior and inferior connective tissue that form the inside of the eyelid
Bulbar vs palpebral conjunctiva
Palpebral covers the inside of the eyelid, bulbar covers the sclera
Levator pallpebrae superioris muscle function and innervation
Functions to lift the eyelid, CN III
3 tunics of eyeball and features
Tunica fibrosa - sclera and cornea
Tunica vasculosa - choroid, ciliary body and iris
tunica interna - retina and optic nerve
Ciliary body definition
Functions to produce aqueous humor that flows from the posterior to anterior chamber through the pupil where it is reabosrbed into canal of schlemm
Failure of aqeuous humor to drain into canal of schlemm can lead to what pathology?
Glaucoma
Components of the forebrain (3)
Telencephalon, diencephalon, and retina
Fovea definition
Region of the macula that is most dense with only cones,
Blind spot definitnion
Area of the eye where the optic disk lies (where the optic nerve and vessels exit the posterior face of the eyeball) often filled in by the brain
A large cup to disk ratio implies…
…glaucoma or other pathology
Ectopic pupil definition
When a pupil does not form at the center of the iris
The near response
- Constriction of pupil
- Contract ciliary muscle and relax suspensory ligaments to relax lens into more convex shape
- Convergence of eyes
- increased refraction
The far response
- Relaxation of pupil
- Relax ciliary muscle and contract suspensory ligament to tighten lens into more straight shape
- no convergence of eyes
- decreased refraction
Hyperopia definition
Farsighted, eyeball too short
Myopia definition
Nearsighted, eyeball too long
Rods have ____, cones have ____
rhodopsin, iodopsin
Rods of the eye mech of action
Produce steady ion flow in dark that causes inhibitory post synaptic potential that produces no signal in the optic nerve, upon light the dark current ceases so excitatory post synaptic potential occurs in the optic nerve
Auricular hematoma definition
Collection of blood underneath perichondrium of ear often leading to deformity known as cauliflower ear
distal 1/3rd of external ear is ____, proximal 2/3rd is ____ and is painful when touched
cartilage with ceruminous glands and hair follicles, temporal bone painful when touched
Umbo definition
Where the malleus bone attaches to the tympanic membrane
Cone of light definition
Reflected light on the anterior inferior quadrant of the tympanic membrane when viewed via otoscope, points at the umbo and if distorted could indicate ottitis media
Ossicles order
- Tympanic membrane
- Malleus
- Incus
- stapes
- oval window
Tympanic reflex
Protect the cochlea in response to loud noises via the tensor tympani and stapedius muscles, does not protect against prolonged loud noises only building noise like thunder
Tensor tympani and stapedius muscle functions
stapedius - reduces mobility of stapes
Tensor tympani - pull eardrum inward tightening it
3 parts of the inner ear
Vestibule
Cochlea
semicircular canals
Vestibule definition
Central cavity of bony labrynth containing the utricle and saccule
Utricle and Saccule definition
Hold equilibrium receptor regions within the vestibule that respond to the pull of gravity and the changes in head position in a straight line
Semicircular canals definition
Part of the bony labyrinth that have an ampula on one end that respond to movements of the head in rotational movement
Otolith definition
Free moving ear stone that moves linearly in the utricle and saccule to stimulate hair cells to detect linear acceleration
Ampulla definition
Located on the end of a semicircular canal and houses a cupula
Cupula definition
Cap where hair cells are located within an ampula within a semicircular canal that contains endolymph and hair cells stimulated to detect rotational acceleration
Cochlea definition
Part of the bony labrynth that houses the organ of corti and extends in a spiral shape from the oval window to the round window, with a varying basalr membrane on the floor throughout that is stimulated by different frequencies
Hearing mechanism
- Sound hits tympanic membrane
- tympanic membrane vibrates ossicles
- Ossicles fibrate oval window
- fluid wave stretches the basilar membrane at a certain frequency
- Basilar membrane oscillates
- Organ of corti hair cells at that frequency locus bend
- Hair cells send an ap down cochlear nerve
Organ of corti definition
Sensory organ of hearing, spans width of the cochlea, is vibrated by the basilar membrane at varying frequency loci to send an AP interpreted as sound to the brain
Ala nasi definition
Wing like protrusions at the base/entrance of the nose
Nasal conchae/turbinates definition
Scroll shaped bony elements that increase the surface area of the nose and allow for humidifaction and cleansing of bacteria
Olfactory mucosa definiton
Lines the roof of the nasal fossa at the cribiform plate of the ethmoid bone to allow for olfaction
Wharton’s duct definition
Opening of the submandibular salivary gland under the tongue near the frenulum
Stenson’s duct definition
Opening of the parotid duct on the inner cheek near the 2nd molar
3 intrinsic salivary glands of the mouth
Parotid
Submandibular
Sublingual
Facial nerve provides taste on the…
…anterior 2/3 of the tongue
Glossopharyngeal nerve provides taste on the….
…posterior 1/3 of the tongue
