20:07:11 [hutals] ok, ready to get started on antimicrobials?
20:07:12 [Lorena] do you want to start now?
20:07:18 [Lorena] yes
20:07:41 [kmonica26] yes
20:08:03 [jwls29] yes
20:08:55 [hutals] i'm trying to find a diagram on net, but cant. anyway, a previous question had pic with most common type pathway of transmission, which is transduction...
20:09:30 [hutals] they asked what was mech of action?
20:09:59 [Lorena] MOA of transduction?
20:10:50 [hutals] yes, sorry, that is what i meant.....the real question had a diagram of it rather than the word, but you had to know what it was and the mech of action of how its transferred
20:11:16 [Lorena] a donor bacteria or male gives ssome genetic material to a recipient -a female bacteria- by a F factor
20:12:12 [hutals] i think this is the one that is transferred from once cell to another via a phage
20:12:26 [Lorena] thats conjugation ...ops
20:12:51 [Lorena] yes, via a phage-the phage is the "transductor"
20:13:11 [hutals] and i remember something about transFormation being F-ree cells
20:14:00 [hutals] i guess that is more of a micro question, but i happen to have it written in this part of my notes
20:14:08 [Lorena] good one
20:14:51 [hutals] the part that got me was that they wanted you to recognize transduction from a pic?? so try to go over those at some point
20:15:07 [Lorena] ok
20:15:14 [jwls29] ty hutals
20:16:23 [Lorena] antibiotics that can cause crystalluria?
20:16:44 [jwls29] sulfonamides
20:17:05 [hutals] ethylene glycol
20:17:15 [Lorena] yes, very good jwls
20:18:20 [hutals] which drugs develop resistance by beta lactamase cleavage of beta lactam ring?
20:19:29 acestep1 enters this room
20:19:39 [hutals] hey ace
20:19:47 [Lorena] hi ace
20:20:03 [hutals] penicillincs and cephalosporins develop resistance in this manner....another previous real question
20:20:09 [jwls29] hi ace
20:20:14 [kmonica26] pencillin, caphalosporins
20:20:16 [Lorena] organisms have developed resistance to penicillins and cephalosporins
20:20:20 [acestep1] hi hutals n lor . how r u guys
20:20:34 [Lorena] hi ace, good and you?
20:20:35 [acestep1] hey jwls
20:20:41 [hutals] good, how bout u?
20:21:00 [acestep1] im good as well
20:21:06 [hutals] how does erythromycin develop resistance? (q bank question)
20:21:33 [kmonica26] methytranferase formation
20:22:06 [acestep1] agree
20:22:25 [hutals] yep, methylation of base in RNA
20:22:49 [Lorena] thanks
20:23:48 [Lorena] drugs that can cause disulfiram reactions?
20:24:10 [jwls29] metronidazole
20:24:32 [acestep1] metronida, chllorpropa, cefoteetan n pefperazone
20:24:33 [hutals] metro
20:24:41 [hutals] cefotetan
20:24:45 [hutals] cefamandole
20:24:48 [acestep1] oops sorry imean cefperazone
20:25:01 [hutals] cefoperazone
20:25:30 [acestep1] i think moxalactam as well
20:25:35 [hutals] chlorpropamide
20:25:38 [Lorena] metronidazole, cefotetan, cefoperazone, cefamandole, moxalactam, ketoconazole .....god job
20:25:59 [hutals] 65 yo female presents with prod cough, fever, lobar pneumonia seen on x-ray. what is the drug of choice? (another q bank question)
20:26:36 [acestep1] pen /eph
20:26:55 [kmonica26] amoxicillin..strep pneumo
20:27:10 [Lorena] she has typical neumonia....penicillins or cephalosporins
20:27:10 [acestep1] imean penicillin s or cephlosporins ( 1st or 2nd gen
20:27:37 [Lorena] agree with ace, 1st or 2th generation
20:27:40 [hutals] this patient most likely has community aquired pneumonia, which is most commonly caused by strep pneumo. despite resistance, penicillin is still the drug of choice for the boards. in real life this is not the case
20:27:43 [jwls29] agree with pcn or cephalo
20:28:12 [acestep1] lol. agree
20:28:18 [hutals] ceph is 2nd choice for boards and #1 for real life
20:28:46 [Lorena] patient with gonorrhea , allergic to penicillins...tx?
20:28:48 [acestep1] . k
20:29:19 [hutals] aztreonam
20:29:36 [acestep1] ideally its ceftriazone but since hes allergic i think erythro?
20:30:05 [jwls29] erythro?
20:30:25 [kmonica26] I think erythro or azithro
20:30:29 [acestep1] erythormycin
20:31:02 [Lorena] yes, erythro, azythro or fluoroquinolones
20:31:30 [acestep1] k
20:31:39 [Lorena] aztreonam probably too but it is only IV
20:31:52 [hutals] this was also a real question given as a young girl who developed UTI and allergic to penicillin. the common factor is that they are both gram neg (gonorrhea and e.coli for UTI). according to kap, a pt with gram neg who is allergic to pens should be given aztreonam to specifically cover gr neg
20:32:45 [Lorena] very good everybody
20:33:23 [acestep1] ic . ididnt know tht hutals
20:33:33 [hutals] azithromycin will cover gr -, but clarith will not cover gonorrhea
20:33:33 [Lorena] what if the patient is pregnant, gonorrhea+ allergy to penicillin?
20:34:18 [kmonica26] azithro is safe
20:34:26 [kmonica26] in preganancy
20:34:48 [hutals] i'm not sure if can give with pregnancy? i know you can give azith with pregnancy, so probably best choice
20:34:56 [acestep1] i still go for erythro
20:35:08 [Lorena] excellent monica
20:35:11 [acestep1] k
20:35:31 [Lorena] and hutals
20:35:31 [kmonica26] thanks
20:36:00 [Lorena] erythromycin too but not in the estolate form because it can cause cholestasis specially dangerous in pregnancy
20:36:28 [acestep1] yes . i forgot abt tht
20:36:31 [Lorena] only erythromycin base or ethylsuccinate
20:36:55 [acestep1] yes. agree
20:37:22 [hutals] what drug most commonly causes C. diff? what treatment?
20:37:51 [kmonica26] clindamycin...treat with vanco or metronidazole oral
20:38:05 [Lorena] clindamycion, lyncomycin, ampicillin but [practically all broad spectrum antibiotics. Tx is metronidazole and vanncomycin is back up
20:38:06 [acestep1] amphicllin
20:38:19 [jwls29] agree
20:38:22 [acestep1] agree with lor
20:38:50 [hutals] C diff caused MC by clindamycin and ampicillin, treat with metro first....vanco if drug resistance
20:39:19 [Lorena] what drug has the infamous side effect of interstitial nephritis?
20:39:37 [jwls29] methicillin
20:39:40 [kmonica26] methicillin
20:39:42 [acestep1] methicillin
20:39:51 [hutals] agree
20:39:58 [acestep1] i think even nsaids n sulfonamides
20:40:00 [Lorena] good!
20:40:37 [kmonica26] which drugs cause phototoxicity?
20:40:40 [hutals] what drug gives "red man syndrome"? what other side effects for this drug?
20:40:41 [Lorena] yes, very probably
20:40:48 [acestep1] sorry sorry we r discussing antibiotics only
20:40:52 [jwls29] tetracycline
20:41:02 [jwls29] vancomycin
20:41:04 [hutals] fluoroquins
20:41:08 [hutals] tetracycline
20:41:15 [kmonica26] vanco for hutals
20:41:15 [jwls29] for red man sdme
20:41:30 [acestep1] i think sulfonamides n tetra n quinolones
20:41:44 [acestep1] tht was for monica
20:41:46 [kmonica26] and yes answer is sulphonaamides, tetracyclies and fluoroq
20:41:55 [Lorena] red man sx is for vanco
20:42:03 [acestep1] for read man - vanco
20:42:35 [Lorena] release of histamine so flushing and hypotension
20:42:48 [hutals] yes, red man is vanco. also ototox, nephrotox, hypersensitivity
20:42:52 [acestep1] agree
20:43:14 [hutals] very good all
20:44:17 [Lorena] tx for syphilis in penicillin allergy?
20:44:23 [hutals] real question had MOA of antifungals (amphotericin or nystatin)?
20:44:57 [acestep1] tetracyclines
20:45:07 [kmonica26] ergosterol interction and makes pores there
20:45:16 [acestep1] oops sorry imean erythro
20:45:25 [jwls29] amphotericin
20:45:27 [Lorena] agree with monica
20:45:30 [acestep1] agree with monica
20:45:50 [hutals] Patients with penicillin allergy can be treated with alternative regimens if they have primary or secondary syphilis. Penicillin is the only effective drug for neurosyphilis; oral desensitization should be accomplished before treatment of penicillin-allergic patients.
20:46:22 [acestep1] ic
20:46:40 [acestep1] from where did u get this
20:46:50 [Lorena] ver good hutals , tetracyclines is also a choice
20:47:10 [hutals] http://www.aafp.org/afp/990415ap/2233.html
20:47:16 [Lorena] it is in k a pl an , at the end of the chapter in q's and asnwers too
20:47:47 [acestep1] k . thnx both of u
20:47:54 [kmonica26] 16-year-old female patient presents with complaints of a
20:48:13 [kmonica26] non-productive cough, low-grade fever, and a headache. The
20:48:23 [Lorena] yw ace
20:48:26 [kmonica26] physician also notes a non-purulent otitis media. She is
20:48:36 [kmonica26] treated with an antibiotic that inhibits the translocation
20:48:49 [kmonica26] of the growing peptide chain along the mRNA. The antibioti
20:49:01 [kmonica26] c the patient was given was
20:49:23 [hutals] erythromycin??
20:49:42 [kmonica26] yep correct
20:49:45 [jwls29] azithromycin?
20:49:48 [acestep1] tetracyclines?
20:50:25 [hutals] sounds like atypical pnemonia where the macrolides are the drug of choice
20:50:34 [kmonica26] MOA of Macrolides...basically another way of asking
20:50:46 [acestep1] k
20:50:50 [kmonica26] yes U r absolutely right
20:50:56 [kmonica26] hutals
20:51:15 [hutals] good one because the boards can never seem to ask a straight forward question anymore
20:51:43 [kmonica26] tru
20:51:51 [kmonica26] true
20:51:58 [hutals] what is the DOC for anaerobes?
20:52:17 [jwls29] clindamycin?
20:52:30 [kmonica26] clinda?
20:52:37 [acestep1] metronida?
20:53:12 [Lorena] i would go for metro
20:53:23 [hutals] DOC for anaerobes is Metronidazole....at least according to q bank. clinda i think is #2 (like in alcoholic because of disulfuram reaction )
20:53:59 [acestep1] k . thnx
20:54:13 [Lorena] DOC for ulcerative colitis?
20:54:23 crusher enters this room
20:54:30 [acestep1] i think even k aplan mentions it as doc in metro
20:54:47 [acestep1] sulfasalazine
20:54:54 [Lorena] hi crush
20:54:57 [acestep1] hi crush
20:55:09 [jwls29] sulfasalazine
20:55:15 [jwls29] hi crusher
20:55:18 [kmonica26] agree with jwls
20:55:20 [hutals] Corticosteroids
20:55:37 [acestep1] ic
20:55:49 [crusher] hello all
20:55:53 [acestep1] yes could b
20:56:03 [hutals] hey crush
20:56:17 [Lorena] yes, very good, sulfasalazine when cleaved in the intestin by bacteria , it forms a compound that has local antiinflamatory properties ...also steroids ...very good!
20:56:35 [acestep1] k
20:57:12 [hutals] so sulfasalazine is first choice for UC? thanks
20:57:19 [hutals] didnt know that one
20:58:10 [Lorena] yes, the compound is 5-aminosalicylic acid...sounds antiinflamatory
20:58:29 [hutals] ah yes, that one sounds familiar
20:58:39 [acestep1] yup plus sulfadiazine
20:59:28 [hutals] why can't they just call it ulcerative colitis....azine, or ol, or something easier to remember
20:59:50 [acestep1] lol
21:00:05 [acestep1] ok s/e of aminoglycosides
21:00:07 [Lorena] sulfadiazine+pyrimethamine , what is this combo used for?
21:00:38 [acestep1] toxoplasmosis?
21:00:43 [Lorena] aminoglycosides are nephrotoxic specially if combined with loops, also ototoxic
21:01:08 [acestep1] v gd
21:01:12 [hutals] PCP, salmonella
21:02:00 [acestep1] aslo they r neuromuscular blker so when given with anesthetics they act synergistically
21:02:16 [hutals] what drug can cause hemolysis in G6PD def pts and is also is contraindicated in pregnancy because causes kernicterus from inc unconjugated bilirubin?
21:02:18 [Lorena] yes toxo...good
21:02:28 [acestep1] i thought pcp- cotrimoxazole
21:02:48 [crusher] sulfa drugs .?
21:02:53 [Lorena] sulfadiazines, SMX/TMP
21:03:05 [jwls29] sulfa
21:03:21 [acestep1] agree
21:03:55 [hutals] oops, i got mixed up on lor's question, i thought it said cotrimoxazole which is trimethoprim and sulfamethoxazole
21:04:27 [hutals] anyway, thats the answer to my question, and also happens to be used for PCP and salmonella
21:04:48 [hutals] aka TMP SMX
21:04:53 [hutals] or bactrim
21:05:20 [Lorena] ok, thanks
21:05:27 [acestep1] k. np
21:05:35 [hutals] you all got it right....very good
21:06:04 [Lorena] gray baby syndrome? signs and symptoms , drug that caused?
21:06:06 [hutals] and its a sulfa drug, so thats correct as well
21:06:19 [jwls29] chloramphenicol
21:06:25 [acestep1] chroampheicol
21:06:30 [hutals] is it choramphenicol??
21:06:44 [Lorena] yes
21:06:45 [crusher] cholampenicol
21:06:48 [acestep1] i think it interferes with mitochondria
21:07:37 [Lorena] i just ask for signs and symptoms becausethey will probably just decribe the baby ...and ask what drug caused it
21:07:50 [hutals] i dont remember exact signs, but baby looks a bit gray
21:07:56 [acestep1] agree
21:08:15 [acestep1] i think diff in breathing n cynosis
21:08:16 [Lorena] abdominal distention, vomiting, cyanosis, irregular respiration, hypothermia, CV colapse
21:08:46 [acestep1] so basically all s/s of ischemia
21:09:14 [Lorena] yes, so i think you are right and it interferes with mitochondria-
21:09:33 [acestep1] k
21:09:33 [hutals] i think the cyanosis is the part that produces the "gray" appearance....right?
21:09:58 [Lorena] yes
21:10:20 [acestep1] ya n then in teh end cuz of damage 2 brain n dec atp u have cvs collpase n dec temp
21:10:49 [hutals] ""Gray syndrome" occurs if newborns (especially premature babies) are given chloramphenicol for a bacterial infection. Babies this young do not have the necessary enzymes that allow the liver to metabolize this drug appropriately. The chloramphenicol accumulates in the baby's blood stream, causing
21:10:53 [hutals] hypotension (low blood pressure), cyanosis (blue coloring of lips, nail beds, and skin from lack of oxygen in the blood), and often death."
21:10:54 [acestep1] i think cvs collpase with all od n also resap diff
21:11:35 [acestep1] ok . i thing is it exc by glucoronidation?
21:12:00 [acestep1] n i think mostly was given for h.influenza infections
21:12:13 [crusher] if someone is allergic topenecillin can take cephalosporin?if yes why if not why?
21:12:31 [hutals] good point lorena because they wont be nice enough to say "gray baby" in the question
21:12:31 [kmonica26] But the commonest side effevt of chloramphenicol is dose dependent BOne marrow suppression..I remmeber seeing a question where it was asked
21:12:38 [acestep1] no - cuz bothr b lactams
21:12:56 [Lorena] no, because cross allergy
21:13:21 [jwls29] agree
21:13:27 [crusher] good.no cos both pen n cepholo has samw moa
21:13:29 [Lorena] thanks hutals
21:13:39 [acestep1] yes monica but this bms is much less than bms with other drugs eg czrbemezapine
21:13:45 [hutals] choramphenicol is also cause of aplastic anemia (parvo is other cause of this)
21:14:05 [kmonica26] agree ace
21:14:08 [acestep1] agree
21:14:28 [Lorena] ok
21:15:15 [acestep1] guys im really sleepy
21:16:00 [acestep1] i guess ill read the transcript
21:16:20 [hutals] ok, good nite ace
21:16:23 [crusher] whts the mechanismof resistance of penicillin
21:16:34 [acestep1] ill see u guys tom . tc
21:16:40 [Lorena] see you tomorrow ace
21:16:46 [kmonica26] beta lactum production
21:16:48 [acestep1] gn all of u
21:16:56 [kmonica26] sory lactamase
21:17:00 [hutals] beta lactamase
21:17:01 [Lorena] good morning to you
21:17:06 [kmonica26] good note ace
21:17:25 [acestep1] i think 3 - b lactamase, dec permeability
21:17:29 [crusher] good nite ace
21:17:39 [acestep1] ya . lol . its morning
21:17:58 [acestep1] gn all of u.
21:18:19 [crusher] b ,lactamase (penicillinase) break lactam ring
21:18:23 [Lorena] agree beta lactamase
21:18:42 [hutals] what is DOC for CMV?
21:19:01 [Lorena] ganciclovyr
21:19:06 [kmonica26] ganciclovir
21:19:10 [crusher] acylovir..
21:19:10 [jwls29] ganciclovir
21:19:24 [crusher] oops yes gan
21:19:52 [hutals] gancyclovir is DOC. acyclovir is the distractor
21:20:23 [Lorena] tx of CMV resistant to ganciclovir?
21:20:44 [crusher] foscarnet
21:20:46 [hutals] foscarnet
21:20:56 [kmonica26] foscaret?
21:21:04 [Lorena] yes
21:21:14 [jwls29] agree
21:21:22 [Lorena] good everybody
21:21:50 [hutals] forcarnet is given to AIDS pts who often get CMV retinitis. what AIDS drug is contraindicated with foscarnet?
21:22:12 [crusher] moa of amantadine
21:22:13 [Lorena] pentamidine
21:22:19 [hutals] and why is it contraindicated?
21:23:02 [hutals] amantadine interferes with attachment, penetration and uncoating of virus
21:23:05 [Lorena] because increases renal toxicity
21:23:37 [kmonica26] and hypocalceamia
21:23:49 [Lorena] agree with hutals , thats why it is only for prophylaxis
21:23:53 [crusher] or uncoating
21:24:22 [crusher] yes good it prevent viral pentration n uncoating
21:24:33 [hutals] yes dont give with pentamidine because renal tox and hypocalcemia
21:25:06 [hutals] AZT should not be given with ganglyclovir because both are neutropenic
21:25:13 [Lorena] jus to remember , mention the anti parkinsonian effects of amantadin
21:26:41 [hutals] also used for prevention of influenza A (amantadine)
21:27:48 [crusher] moa of acyclovir
21:27:57 [hutals] what is DOC for RSV?
21:28:04 [crusher] moa of acylovir
21:28:18 [Lorena] inhibits viral DNA polymerase
21:28:30 [Lorena] RSV gets Rivabirin
21:28:33 [hutals] inhibits viral DNA polymerase
21:29:21 [hutals] yep Ribavirin which inhibits RNA polymerase.....dont confuse with DNA polymerase of acyclovir
21:29:39 [crusher] very good all
21:30:04 [crusher] wht about moa of ziminavir/
21:30:29 [Lorena] R-ivabirin- R-sv - R-na polymerase
21:30:46 [hutals] good one lor
21:30:56 [jwls29] thanks lore
21:31:26 [Lorena] yw
21:32:01 [Lorena] inhib neuraminidase?
21:32:13 [hutals] i think all the "avir" drugs inhibit aspartate protease
21:32:55 [Lorena] oh ok
21:33:04 [crusher] yes lor..it inhibit neroamidases
21:33:46 [Lorena] oh good, i was guessing
21:33:50 [hutals] i thought it was a protease inhibitor like the other avirs
21:34:38 [crusher] chek out caplan 214 page very good summary of moa
21:35:50 [crusher] about the reverse transcriptase what is major s/e ofzalcitabine?
21:36:27 [kmonica26] pancreatitis,perphercal neuropathy
21:36:35 [hutals] neuropathy
21:37:20 [Lorena] i just know the s/e of RTI's in gral.: hematotoxic, neuropathy, lactic acidosis
21:37:38 [crusher] yes zalcitabine majoe s/e isperipheral neuropathy
21:38:09 [crusher] add onemore lor pancreatitis fpr diadinosine
21:38:18 [hutals] pancreatitis also, and neutorpenia, GI effects
21:38:33 [Lorena] ok, thanx
21:39:09 [crusher] zidovudinefamous one=====hematotoxic
21:39:49 [Lorena] side effects of PI's?
21:40:07 [hutals] lamivudine will not have peripheral neuropathy, so good alternative to avoid that particular SE
21:40:29 [crusher] indinavir .nephrolithoasis
21:40:54 [kmonica26] disordered lipid metabolism
21:40:54 [hutals] headache?
21:41:18 [crusher] alsoinhib of p450
21:41:54 [Lorena] very good
21:42:57 [Lorena] DOC for back packer's diarrhea?
21:43:16 [hutals] ritonavir acutally induces one p450 enz, but inhibits 2 other p450 enzymes....i have enuf trouble remembering which ones induce and inib...now they have combos?!?
21:43:34 [Lorena] lol
21:43:39 [crusher] metro
21:44:14 [Lorena] yes, the bug is giardia lamblia
21:44:20 [hutals] agree metro
21:45:01 [hutals] i was trying to figure out what bug causes back packers diarrhea....but metro covers many bugs
21:45:06 [hutals] so good choice
21:45:42 [Lorena] i didnt know the diarrhea by giardia lamblia was called like that before
21:45:59 [crusher] prophylaxix tx hiv of needle stick
21:46:15 [hutals] i didnt know until you just brought it up....thanks
21:47:05 [kmonica26] azt+3tc
21:47:13 [hutals] azt??
21:47:25 [Lorena] agree
21:47:41 [jwls29] agree with azt
21:48:21 [crusher] AZt +3Tc for i month n in high risk for 3 month
21:48:30 [hutals] good point to use in combo with 3tc, especially since it covers hep B
21:48:45 [hutals] they also work synergistically
21:49:38 [hutals] anything else to cover tonight?
21:49:50 [kmonica26] How about in Pregnancy? What dg used in HIV + mother?
21:49:57 [Lorena] i think we covered a lot
21:50:16 [crusher] azd in prgnant
21:50:24 [hutals] azt again would be my guess
21:50:47 [kmonica26] yes hutal and crusher
21:51:23 [crusher] but only in 2nd n 3rd trimester
21:51:25 [hutals] just for micro review....what percent of newborns of moms with HIV will have + HIV Abs at birth?
21:51:59 [crusher] n for neonat also ADv =6 week cos of verticle transmission
21:52:15 [kmonica26] 20% guessing
21:52:42 [crusher] i guess its high!
21:52:56 [Lorena] me too, very high
21:53:21 [hutals] this is a trick question. 100% of newborns will have HIV Abs at birth because the moms Ig pass to child.....but not all will become infected.
21:53:43 [kmonica26] interesting
21:54:01 [Lorena] thanx hutals
21:54:12 [hutals] after 6 months to a check you can recheck....without AZT i think it is 20% and with AZT i think goes down to 5 %
21:54:18 [hutals] or you can do PCR
21:54:21 [crusher] that support the ans of my q,s neonat azd for 6 week
21:54:23 [Lorena] ok, i have to go. See you guys tomorrow
21:54:32 [jwls29] i'm gonna go too
21:54:37 [jwls29] i'm sleepy
21:54:37 [hutals] but that was way back in micro, so dont quote me on that
21:54:41 [kmonica26] Me too
21:54:45 [kmonica26] Bye guys
21:54:51 [hutals] good nite all
21:54:55 [crusher] good night lorena and kmonica
21:54:55 [jwls29] bye
21:55:03 [Lorena] thanks for the great chat
21:55:04 [jwls29] i won't be here tomorrow
21:55:06 [crusher] good bbye all
21:55:14 [jwls29] we are still on for sat at 8?
21:55:41 [Lorena] yes, i will come on saturday
21:55:49 [hutals] me too
21:55:58 [jwls29] ok
21:56:06 [jwls29] c ya on saturday
21:56:10 [jwls29] bye
21:56:12 [hutals] lorena, are you posting chat?
21:56:36 [Lorena] yes, are you guys leaving too?
21:57:10 [hutals] i am, i was supposed to leave an hour ago....i'm late
21:57:41 [Lorena] i will post it ....oh yes, i forgot...thanks for staying hutals, we all apreciate it
21:58:10 [hutals] i learned alot in the last hour so it was worth it for me too......thanks and good nite
21:58:21 [Lorena] good night all
21:58:29 hutals exits from this room