med essentials

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,



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



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



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



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



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



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

med essentials

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