med essentials
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7/27/2019 Med Essentials
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chloramphenicol50 s wide spectrum including h influenzae. N meningitis
bacteroides, rickettsia and salmonella
plasmid mediated acetyltransferases that inactivate the drug
toxicities
gray baby syndrome. decreased glucoronyl transferase in neonates and
aplastic anemia, bone marrow suppression, gi irritation
alcohol substance abuse] 10% are problem drinkers
accounts for 50% autoaccident deaths
leading cause of mental retardation
medical complications
cirrhosis,alcoholic hepatitis
pancrreatitis
gastric or duodenal ulcer\esophageal varices/middle age onsetof diabetes
GI cancer
hypertension
peripheral neuropathies
myopathies.cardiomyopathy,cerebral vascular accidents
erectile dysfunction
gout.vitamin deficiencies
pernicious anemia
brain disorders including wernicke KORSAKOFF syndrome
chronic user can develop alcohol withdrawal syndrome, upon discontinuation
of ethanol consumption
symptoms include,anxiety,tremor,insomnia, delerium tremens,and lifethreatening seizures,arrythmia,NV and diarrhea can occur
coccaine
crack is smokable form
blocks DA, NE, 5HT uptake,
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effects euphoria, hypervigilance,anxiety,stereotyped behaviour,
grandiosity,tachycardia, pupillary dilation , decreased appetite
toxicity cardiac arrythmias, myocardial infarction, stroke,hallucination,
paranoia, hyperthermia,seizures and death
withdrawal' craving, depression, fatigue, increased sleep time,increased
appetite
amphetamine]releases DA, NE, 5HT, weak MAO Inhibitor,
CNS depressents
benzodiazepine increased frequency oF gaba channel opening
efect]light to moderate CNS depression
toxicity/ impaired judgement, slurred speech, uncoordination, unsteady gait,
stupor, respiratory depression,death
withdrawal\anxiety. delirium,insomnia,possible l ife threatening seizures
treat long acting BZD.to suppress acute symptoms,taper dose
exposure
simple phobias
treated by forced exposure to feared object
exposure maintained until feaar response is extinguished
aversive conditioning
properties of original stimulus are changed to produce aversive response
can help reduce deviant behaviours
systemic desensitization often used to treat anxiety and phobias
hierarchy of stimuli \technique of muscle relaxation taught
patient relaxes in presenceof each stimulus on hierarchy
works by replacing anxiety with relaxation an incompatible response
ON THE BASIS OF OPERANT CONDITIONINGS
SHAPING
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shaping achieves target behavior b y reinforcing sucessive approximations of
desired response reinforcement gradually modified to move behaviours from
general responses to specific responses desired
EXTINCTION
discontinuing the reinforcement maintaining an undesired behaviour
time out with children or for test anxiety
STIMULUS CONTROL
sometimes stimuli are inadverently acquire Control over behavior , when this
is true. removal of that stimulus can extinguish response
example an insomniac only permitted in bed when he/she so tired that sleep
comes almost at once
BIOFEDBACK
using external feedback to modify internal physiologic states often used
electronic devices to present physiologic information
eg heart monitor to show heart rate
FADING
gradually removing the reinforcement, while
1 without the subject, discerning the difference
2 maintaining desired response
brain growth spurt
critical period of great vulnerability to environmental influence\
extends from last trimester of pregnancy through first 14 postnatal months
size of cortical cells and complexity of cell interconnections undergo their
most rapid increase
stranger anxiety
distress in presence of unfamiliar people
appears in 6 months.reaches peak at 8 months then disappears after 12
months
separation anxiety
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distress of infant after separation from caretaker
appears at 8-12 months
begins to disappear at 20-24 months
separation anxiety disorder failure to resolve separation anxiety
treatment focuses on child's interaction with parents.not on activities in
school
glioblastoma multiforme
most common primary brain tumor\highly malignany/usually lethal at 8-12
months
can cross midline via corpus callosum, areas of necrosis surrounded by rows
of neoplastic cells([pseudopalisading necrosis)
astrocytoma benign tumor of children and young adults, usually in posterior
fossa in children
rosenthal fibers immunostaining with GFAP
oligodendroglia slow growing,long survival average 5-10 yrs fried egg
appearance,perinuclear Halo
ependymoma , ependymal origin, can arise in 4th ventricle and lead to
hydrocephalus, rosettes and pseudorosettes
meningioma second most common primary brain tumor dural convexities,
parasaggital region, attaches to dura compresses underlying brain without
invasion , microscopic psammoma bodies
schwannoma third most primary brain tumor mostly cn 8 location
most frequent location CN 8 AT Cerebellopontine angle, hearing loss, tinnitus,
good prognosis after surgical resection
ANTONI A And B areas, a hypercellular and B hyocellular, bilateral acoustic
schwannomas, pathognomonic for neurofibromatosis 2
medulloblASTOMA
HIGHLY malignant cerebellar tumor,a type of primitive neuroectodermal
tumors PNET
BLUE small round cell with pseudorosettes
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retinoblastoma sporadic unilateral
familial bilateral associated with osteosarcoma
small round blue cells , may have rosettes
craniopharyngioma derived from odontogenic epithelium usually childrenand adult, remnants of rathke pouch.often calcified. symptoms due to
encroachment on pituitary stalk or optic chiasm\benign but may recur.
histology resembles adamanthinomamost common tumor of tooth
characteristic cross sectional studies case control studies cohort studies
time one time point retrospecti ve
prospective
incidence no no
yes
prevalence yes no
no
causality no yes
yes
role of disease measure disease begin with disease end
with disease
assesses association of risk factor and disease many risk
factors for single
disease single risk
factor affecting many disease
chi square to assess association odds ratio to
estimate risk relative
and attributable
risk to estimate risk
chylomicrons transport dietary triglyceride and cholesterol from intestine to
tissues
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apo B 48 , apo C 2 , apo E
Secreted by epithelial cells. activate lipoprotein lipase, uptake by liver
VLDL
trnsport triglyceride fron liver to tissues.
apo B100, apo C 2, apo E
secreted by liver, activates lipoprotein lipase , uptake of remnants by liver
LDL
delivers cholesterol into cells
Apo B100
uptake by liver and other tissues via LDL receptor
apo b100 receptor
IDL
picks up cholesterol from HDL,to become LDL
brain growth spurtcritical period of great vulnerability to environmental
influence
extends from last trimester of pregnancy through first 14 postnatal month
projection at ributing inner feeling to others paranoid behavior
denial saying it isnot so\substance abuse ,reaction to death
splitting world composed of opposites
borderline personality good vs evil
blocking. transient inability to remember
displacement source remain same but target changes
repression , foregetting is not retrievable
disulfiram, inhibits aldehyde dehydrogenase, decreases alcohol consumption,
produces symptoms chest pain,hyperventilation,tachycardia vomitting,
effective fr short term treatment
bzd help prevent alcohol related seizures
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acamprosate help prevent relapse hypothesized
to decrease glutamate receptor sensitivity
social phobia treatment paroxetine
obsessive compulsive, fluoxetine, fluvoxamine
imprtant benzodiazpine
panic anxiety alprazolam
chlodiazepoxide alcohol detoxification
clonazepam panic anxiety ,seizures
diazepam , anxiety insomnia, pre op sedation, muscle relaxation
flurazepam insomnia
lorazepam anxiety alcohol related seizureas
midazolam anesthesia
oxazepam alcohol detoxification
temazepam insomnia
triazolam
, insomnia
immunoglobulin are glycoprotein produced by B cells, they consist 2 light
chain linked by disulphide bonds and 2 heavy polypeptide chains
amphotericin B
binds ergosterol in fungal membrane blocking synthesis, systemic fungal
infection, fungal meningitis
griseofulvin interfe with microtubule function arrsting mitotic activity
systemic drug for tinea infecx
nystatin ,destroy fungal membrane
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