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1、NPLEXCombinationReviewImmunology/ToxicologyPaulS.Anderson,NDMedicalBoardReviewServicesCopyright MBRSNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Laboratory Testing MethodologiesPCR: Polymerase Chain ReactionELISA(EnzymeLinkedImmunosorbantAssay)MeasuresIgG/M/AUsedindiseasedetectionand
2、Allergenidentification.RASTQuantifiesIgEantibodies.Intradermal testingPositivereactiondemonstrateserythemaatpointofinjection.Blood immunoglobinsIgGDelayedhypersensitivityreactiontoantigen.IgEImmediatehypersensitivityreactiontoantigen.Electrodermal allergy testEAVisappropriateexample.NPLEXCombination
3、ReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学IDImmunology:GeneralCulturesTaketimeSomethingsgrow,somedontAntibodyTestingGoodforeffectSomebetterthanothersDNA(PCR)TestingDetectsDNAofthesubjectoftheprobeNoneedforgrowingacultureNoneedforIginterpretationCangetQuantitative(viralload)testsNPLEXCombinationRe
4、viewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntibodyTestingSerumtests.Serum must be separated from clot / SST Gel within 1 hour!PipetteserumintoaplastictransporttubeExcessiveexposuretothegelintheSSTwillbindantibodies,causingfalsenegativetests.Usedforallergytesting,Autoimmunetesting,ExposureIg(Immunog
5、lobulin)Types:IgG:Longtermexposure,Delayedreactions(ie.Foodallergy).IgGlastsalongtime,andisamarkerofEXPOSURE,notsuccessfultreatment.IgM:Acutephasereactions.Indicatesrecentinfectionorre-exposure.IgA:SecretoryIg.Shows mucosal response, and is a good marker of successful treatment.Canbemeasuredintheser
6、um, stool and salivaIgE:Anaphylaxis.(Type-1Reaction).TotalIgEinserumisatestforgeneralallergiclevelinthepatientTraditionallythemarkerusedforfoodandInhalantallergy,althoughIgGismorehelpfulwithmostfoodreactions.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntibodyTesting-2HighIgG,LowIgM
7、orIgAProbablepastinfection/exposure.Inactiveorcured.InfoodallergytestingIgGisalwaysconsideredactive,butdelayedresponseallergy.LowIgG,HighIgMNewinfection/ExposureHighIgG,HighIgMReactivatedinfection/ExposureHighIgG,LowIgM,HighIgACurrentimmuneresponse(mucosal)thatispasttheinitialIgMresponsewindow.(Ongo
8、ingproblem).NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Autoimmune DisordersAnti-nuclear antibody (ANA)Titerlevelisimportant:1:160“positive”Screeningtestforconnective-tissuediseases:RA,SLE,Lupus,MCTD,CRESTSyndrome,Scleroderma,andPolymyositis.UseconfirmatoryANAsub-testingtoconfirmspe
9、cificdiseaseDx.OftenorderedasANA+Reflex(7or9values)runifANAAispositiveErythrocyte Sedimentation Rate (ESR)NonspecificmeasureofinflammationDiagnosticinveryfewconditions(Giantcellarteritis)CanalsoindicatecancerouseffectC-reactive protein (CRP)Screeningfornondescriptiveinflammatoryandinfectiondiseasepr
10、ocesses.AlsousedfordiscriminatingamongDDXandmonitoringdiseaseprocessCRPelevation:RA,Reiters,vasculitis,rheumaticfever,neonatalandpost-operativeinfections,pyelonephritis,MIandembolism.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Autoimmune DisordersRheumatoid factor (RF)Usedinthediagn
11、osisandevaluationofRAandotherCTD;HighestinRA,butalsoelevatedinCVD,MI,renaldisease,malignancy,thyroidandliverdisease,SLE,sclerodermaandpolyarteritisnodosa.Parvo B-19 viral assayConsiderinRFNegativewomannursingorcaringforayoungchildwhopresentswithRAlikesymptoms.Human leukocyte antigen (HLA) HLA B-27 m
12、ost common.Glycoproteinsthatmaybeserologicallydetermined;usuallyperformedfortransplantationmatchesbutalsoelevatedinAS,ReitersSyndrome,MS,chronicactivehepatitis,gluten-sensitiveenteropathy,SLE,DMandhemochromatosis.Consider Chlamydia testing (Reiters)NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试
13、复习10章结合免疫学Autoimmune DisordersAnti-thyroid antibody (Anti Microsomal or TPO Ab)Usedindiagnosisandclassificationofinflammatoryandautoimmunethyroiddisease.MarkerforHashimotosthyroiditis,atrophicthyroiditis,andGravesDisease.Antithyroglobulin Antibody (Anti TG)Detectandconfirmautoimmunethyroiditis,Hashi
14、motothyroiditisThyroid-Stimulating Immunoglobulin(Thytrophin Receptor Ab)DetectGravesDz.OrderwhenGravesSn/SxandTPOelevationNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学THYROID HORMONE SYNTHESISNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Infectious Disease TestingAnti
15、-Streptolysin-O test (ASO) (200iu/ml)Elevationintitersreflectimmunologicresponsetostreptococcus;ASOtitersclinicallyusefulifserumisobtainedin2-3weekintervals.Chlamydia antibody (IgG, IgM)PresenceofIgGAbindicateschlamydialinfectioninthepast;highlysensitivebuthaslowspecificity.PresenceofIgMor4-foldincr
16、easefromacuteconvalescence=recentinfection.Cytomegalovirus PCRCytomegalovirus (CMV- IgG, IgM)PresenceofIgMor4-foldincreaseinIgG=recentinfectionNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Infectious Disease TestingEpstein-Barr Virus (EBV)Monospot:Screeningtestperformedwithsymptomatic
17、Pt.(falsenegativeinadults10%).MeasuresIgMheterophilantibodies.Positivewindow:4-21daysPCRforEBV:MostsensitivetestisQuantitative(viralload)PCRUsedinChronicreactivatingcasesEBVPanel:Early phaseIgM:anti-VCAAcute illnessIgG:anti-VCAAcute illnessIgGanti-EAConvalescenceAnti-EBNA(IndicatespastinfectionORChr
18、onicreactivationinrecurrentEBVpatients).NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学E. coliO157-H7 specific assayStoolGiardiaStool assay in symptomatic patientHelicobacter pyloriMultiple methodologies:Nitrogen breath test (Sensitive for presence of dz and tx)Serum IgG: (Sensitive fo
19、r PAST infection but will not decrease with successful tx.)Serum IgM: (Sensitive for current infection but will decrease in 2-4 weeks regardless of infection.)Serum, Salivary or Stool IgA: (Rises with presence of infxn / falls with effective tx.)Stool IgA is preferred test now by IDSANPLEXCombinatio
20、nReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Hepatitis (A,B,C,D,E) virusHAV:IgMtitersreflectacuteinfection.IgGtitersidentifiedyearsafteracuteillness.HBV:HbsAg:detected14monthspost-infection.Patientswiththisantigenpresent6monthsexhibitchronichepatitis.ANTI-HBsAb:PatientswiththisAbareconsideredprotec
21、tedagainsttheHBVinfectionHbcAgIgMmostusefulmarkertodeterminethe“window”:(HbsAgdisappearsandANTIHbsAgappears;usuallydemonstratespresentinfection.)ThepresenceofANTIHbcAg IgG indicatespreviousHBVinfectionandpersistsindefinitely.HCVAbPatientswiththisAbhavefour-foldincreaseforHCCHCVPCRisavailableaswell.H
22、DV-co-exists with hepatitis b infection.MakedHep-Bmoredeadly.Worstinpregnancy.HEVNotgenerallytestedfor:casesoutofU.S.Testifforeigntravelinthepast60daysNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Herpes simplex virus (HSV-1; HSV-2)Antibodies:IgMCurrentinfection.IgGInfectioninthepast.
23、IgG/MType(1or2)specificserologyisbestDDXPCRisavailableVirusisolation(Tzank smear)isOLDmethodtoconfirmanHHVinfection:CanhavefalsepositivesifotherHHVinfectionispresentNOTspecifictoHHV1or2Generally* HSV1abovewaistwhileHSV2affectsbelowwaist.Butthisisnotalwaysthecase.NPLEXCombinationReviewChapter10Immuno
24、logy自然疗法医师注册考试复习10章结合免疫学Human Immunodeficiency Virus (HIV)Standardmethodfordiagnosis:ELISAmeasuredanti-HIVtiters.ConfirmedbyWesternBlotAnalysis.(MAY TAKE 6 MONTHS TO SERO-CONVERT)DecreasedCD4/CD8ratioNewlydiagnosedcondition:T-Cellsubset(CD3,CD4,CD8).Earliest diagnosis: PCR for HIVHuman Papilloma Vir
25、us (6,11,16,18,31,33)HPV16,18,31,33arecommoncausesforcervicalcancer.AvailableasPCRonPapsampleHPV6,11commoncausesforplantarandgenitalwarts.NOT generally cancerous or pre-cancerousNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Rubella titerPresenceofIgMand/orfour-foldincreaseinIgG=presen
26、tinfection.Syphyllis (VDRL / RPR)Nontreponemaltestsusedprimarilyfordetectionofprimarysyphiliticinfection.TuberculosisIntradermalskintest:Read48-72hoursforinduration.BCG:PostID;checkserologyresults.Lyme disease ( 250 antibody reaction units)Skin,blood,synovialorCSF.ELISAorWesternblotcheckingforantibo
27、dydetection.PCRNowavailableNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntimicrobialandDermatologicPharmacologyNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Antifungal,helminthicandprotozoalPharmacologyNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Antif
28、ungalsMOAUsesAdverse EffectsOtherNystatinDisruptsfungalcellwallIntestinal,cutaneous,vaginalandmucocutaneousinfectionscausedbyCandidaContactdermatitisPoorlyornotabsorbed.Goodtopicalagent/GIAgent.MiconazoleDisruptsfungalcellwallTineapedis,cruris,versicolor,corporis,cutaneouscandidainfectionandvulvovag
29、inalcandidiasisPruritus,skinirritation,burning,contactdermatitisClotrimazoleDisruptsfungalcellwall“Nausea,vomiting,vaginalburningorirritationwithapplication,erythema,pruritus,increasedliverfunctiontestsGriseofulvinFungicidalTineapedis,tineaunguiumAlsoTineacorporis,capitisandcrurisHeadache,dizziness,
30、GIupset,nausea,vomiting,rash,urticaria,hepatictoxicTeratogenicBoricAcidFungastaticagentVaginalcandidiasisLocalirritationGentianVioletFungicidalOralCandidaMouthrinse,maystainskinorclothingDonotuseonulcerativewoundsonthefaceAceticAcidVoSolOticInhibitsordestroysbacteriaintheearOticsolutionforexternalea
31、rinfectionsEarirritation,urticariaNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学ANTIFUNGAL DRUGS - 2AmphotericinI.V.Only(unlesscompounded)TwotypesStrong/Highpotentialsideeffectprofile(I.V.)TriazoleclassFluconazole(Diflucan)InhibitsFungalp-450,degradingfungalcellwallKetoconazole(Nizora
32、l)Itraconazole(Sporonox)Voriconazole(V-Fend)Terbinafine(Lamisil)TopicalandOralformsNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学NystatinMultipleformaavailable.TopicalkillevenintheGItract.GIInfections:500,0001MillionUnitspotidNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免
33、疫学FluconazoleAbsorbssomoresystemickillandmoresystemicsideeffect.PrimarysiteofactivityLiverDosingstrategiesvarywidelybasedonimmunocompetenceandtypeofinfection.Maybeaslowas150-200mginasingledoseforuncomplicatedfungalvulvovaginosistoasmuchas200mgbidforlongterm(2-4weeks),or100mgdailyformonths.Ifusingitl
34、ongtermInormallytreatona5dayson/2daysoffrotation.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学TerbinafineFingernailonychomycosis:250mgqdfor6weeksToenailonychomycosis:250mgqdfor12weeksNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学ANTIPARASITIC DRUGSTopicalMOAUsesAdverse
35、 EffectsOtherLindaneKwellPenetratesexoskeletoninducingseizuresanddeathofarthropodsScabies,pediculosisSeizures,irritation,CNSdisturbancePermethrinElimite / NixCausesparalysisbydisruptingsodiumcurrentintheparasiteScabies,pediculosisPruritus,edema,rash,burning,orstingingAntihelminthicsMOAUsesAdverse Ef
36、fectsOtherMebendazoleVermoxIrreversiblyinhibitsnutrientuptakebyhelminthesPinworms,roundworms,hookwormsAbdominalpain,diarrhea,feverNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学MebendazolePinworm:100mgpoasasingledose.Repeatin2-3weeksRoundworm,Whipworm,Hookworm:100mgpobidX3daysRepeatin3
37、weeksNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntiprotozoalMOAUsesAdverse EffectsOtherMetronidazoleInhibitsDNAsynthesisinmicroorganismcausingcelldeathAmoebas,trichomoniasis,giardiaGIdistress,seizures,ataxia,cramping,rash,jointpain.*Do not take with ETOH (acts like Antabuse)Potent
38、atesdrugsmetabolizedbyP450system;AntimalarialMOAUsesAdverse EffectsOtherChloroquineUnknownMalaria,extraintestinalamebiasisHeadache,dizziness,pruritus,neuropathy,seizures,retinalchangesandototoxicQuinineUnknownMalariaExtremelytoxic,cinchonism,shockANTIPARASITIC DRUGSNPLEXCombinationReviewChapter10Imm
39、unology自然疗法医师注册考试复习10章结合免疫学AmebicideIodoquinolMetronidazole(Flagyl)Paromomycinsulfate(Humatin)AntiPneumocystisAtovaquone(Mepron)Pentamidineisethionate(Pneumopent)ANTIPARASITIC DRUGSNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学MetronidazoleIntestinalamebiasis750mgpobid5-7days,theniodo
40、quinolRx.Trichomoniasis750mgpotidX7daysOR1grampobidX1day:RepeatthisdoseRxin4-6weeks.Bacterialvaginosis500mgpobidX7daysNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntibioticPharmacologyNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntibioticclassesandTargetsBactericida
41、lantibioticsthattargetbacterialcellwall;penicillins,cephalosporinsorcellmembrane;polymixinsorinterferewithessentialbacterialenzymes;quinolones,sulfonamidesusuallyBacteriostaticABXarethosewhichtargetproteinsynthesis;aminoglycosides,macrolidesandtetracyclinesAdapted from: Finberg RW, Moellering RC, Ta
42、lly FP, et al (November 2004). The importance of bactericidal drugs: future directions in infectious disease. Clin. Infect. Dis. 39 (9): 131420. doi:10.1086/425009. PMID 15494908. NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学ANTIMICROBIAL OVERVIEW (Gent. / Tobra. & Streptomycin)(-flo
43、xacins) macrolides quinolonesNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学So,Letstalkaboutsideeffectsandantibioticprescriptions:NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Antibiotics:GITractSymbioticbeneficialflorakillOvergrowthofflora-dysbiosisPseudomembranousColit
44、is(C.diff)KidneysMostABXarepolar.LotsofKiexcretionOfteninIVusetheycancauseKifailureifadministeredimproperlyLiverLivereffectpossible,butlesscommonthanKi“Superinfection”SystemicinfectionwithbacteriaorfungithatarenoteffectedbytheABXyouhavegivenlikeasystemicdysbiosis.NPLEXCombinationReviewChapter10Immun
45、ology自然疗法医师注册考试复习10章结合免疫学ABXand“GoodFlora”SupplementsABXgivenwithbeneficialflorasupplements(acidophilus,bifidus)willkillmanyofthosebugsaswell.SomewaittorepopulatethegutuntilaftertheRx.Ifyouareconcernedthatthepatientwillgettoobehind(ietoomuchgoodflorakill)youmaysupplementbeneficialfloraduringtheABXco
46、urse,ANDafter.IfdoingthisDONOThavethepatienttakethegoodflorasupplementwhiletheABXpillsareinthestomach.AlternatetimeofdosebetweenfloraandABX.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学PenicillinMOAUsesAdverse EffectsOtherP
47、enicillin(PenVee-K)Breakdown/InhibitbacterialcellwallsynthesisGram+cocci,anaerobicbacteria,syphilisNausea,vomiting,rash,seizures,anaphylaxis,neurotoxic,nephrotoxicNot effective against -lactamase producing organism or Gram anaerobesAmpicillinInhibitscellwallsynthesisSomeGram+andGramorganisms,prophyl
48、axisfordentalproceduresNausea,vomiting,diarrhea,seizures,rash,urticaria,anaphylaxisNot effective against -lactamase producing organismAmoxicillinInhibitscellwallsynthesisSomeGram+andGramorganisms,prophylaxisfordentalprocedures“AmoxicillinandClavulanateAugmentinInhibitscellwallsynthesisandClavulanate
49、 makes it effective against -lactamase producing organismsGram +, Gram -, and -lactamase producing organism“NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学NOTE:AllRxsareforthelongerterm(i.e.10dayinsteadof7day).SomeINDICATIONSREQUIREFEWERTxdaysseeSanfordGuideetc.AllareinAdultDosesunless
50、otherwisenoted.An“Adult”isa150PoundHumanNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Rx:Adult:PEN-VK500mgtablets#30Sig:1potidChild:Amoxicillin(OrAmox/Clav)80-90mg/kgoftheamoxicillincomponentindailydivideddoses.RxX7-10daysNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Ce
51、phalosporinsMOAUsesAdverseEffectsOtherCephalexinKeflex1stgenerationBactericidalbyinhibitingcellwallsynthesisURI,GIinfections,cutaneousinfections,softtissueinfectionsNausea,diarrhea,maculopapularrash,anaphylaxis,serumsickness,GIdistress10-15% of patients have cross allergy between penicillin and ceph
52、losporinsCefaclorCeclor2ndgeneration“UTI,URI,OM“CefiximeSuprax3rdgeneration“MoreresistanttoGram-lactamaseproducingorganism“CefepimeMaxipime4thgeneration“E.coli,Proteus,K.pneumoniae,Enterobacter,B.fragilis,Staph/Strep“IVDoseformNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Rx:Cefalexin
53、500mg#30Sig1poq-6-hCefaclor500mg#30Sig1poq-8-hNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学MacrolidesMOAUsesAdverse EffectsOtherErythromycinInterfereswithbacterialDNAsynthesisDrugsofchoiceforM.pneumonia,pertussis,neonatalC.pneumoniaStrepthroat,URI,Abdominal pain, nausea, diarrhea, vo
54、miting,anaphylaxisContraindicated in Pregnancy;cautionwithimpairedrenalfunctionClarithromycinBiaxin“BronchitisNon-gonococcalurethritis,cervicitis,chanroid“SAMEAzithromycinZithromax“LESS GI effect, Less medication needed to achieve effect.SAMENPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合
55、免疫学Rx:Erythromycin333mg#30Sig1tid(IusethisasitislessGIupsettingthanthe500mgstrengthIgiveWITHfood)Erythromycin500mg#20Sig1bidAzithromycin250mg#6(“Z-Pak”)Sig2poDay-1,1poqddays2-5(Somesuggest#3(“3-Pak)inuncomplicateddz.)NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学TetracyclineMOAUsesAdv
56、erse EffectsOtherTetracyclineInterfereswithbacteriaproteinsynthesisSusceptibleGram+andGramorganismsincludingchlamydiaandlymediseaseSebulytic(Acne)Intracranialhypertension,GIdistress,nausea,vomiting,diarrhea,rash,photosensitivity,increasedpigmentationNot for use in children under 9 years old because
57、of permanent discoloration of teeth enamelInterfereswithoralcontraceptiveeffectivenessDoxycyclineMinocycline“LessnephrotoxicNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学DoxycyclineGeneraloralRx:Doxycycline100mgtabletsSig:1poq-12-hTreatfor7daysformostinfections(Acneprophylaxis50-100mg
58、,qd-bid)DoxyisINEXPENSIVE.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学MinocyclineGeneraloralRx:Minocycline100mgtabletsSig:1poq-12-hTreatfor7daysformostinfections(Acneprophylaxis50-100mg,qd-bid)Minocyclineis95%absorbedinthestomach,andhasaverylowGIflorakillrate.NPLEXCombinationReviewC
59、hapter10Immunology自然疗法医师注册考试复习10章结合免疫学SulfonamidesMOAUsesAdverse EffectsOtherCo-trimoxazole / Trimethoprim/SulfamethoxazoleSeptra / BactrimSulfisoxazoleGantrisinSulfamethoxazoleGantanolSulfadiazinCoptinInterferewithbacterialfolicacidsynthesisUTI,OM,URI,pneumocystiscarinii,travelersdiarrheaUTI,URINau
60、sea,vomiting,diarrhea,rash, seizures,toxicnephrosis,hepaticnecrosis,dermatitis,SJS/TEN, anaphylaxisMANY Potential side effects.InterferewithoralcontraceptiveeffectivenessNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Nitrofurantoinmonohydrate/macrocrystalsTRADENAME:MacrobidSpecificUTII
61、ndicationCONTRAINDICATIONS:Anuria,oliguria,orsignificantimpairmentofrenalfunction(creatinineclearanceunder60mLperminuteorclinicallysignificantelevatedserumcreatinine)arecontraindications.Treatmentofthistypeofpatientcarriesanincreasedriskoftoxicitybecauseofimpairedexcretionofthedrug.Becauseofthepossi
62、bilityofhemolyticanemiaduetoimmatureerythrocyteenzymesystems(glutathioneinstability),thedrugiscontraindicatedinpregnantpatientsatterm(38-42weeksgestation),duringlaboranddelivery,orwhentheonsetoflaborisimminent.Forthesamereason,thedrugiscontraindicatedinneonatesunderonemonthofage.DOSAGE AND ADMINISTR
63、ATION:Macrobid capsules should be taken with food.Adults and Pediatric Patients Over 12 Years: One 100 mg capsule every 12 hours for seven days.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Fluoroquino-lonesMOAUsesAdverse EffectsOtherCiprofloxacinCiproAndallother“-floxs”GatifloxacinTe
64、quinLevofloxacinLevaquinLomefloxacinMoxifloxacinAveloxNorfloxacinNoroxinOfloxacinOcufloxTrovafloxacinTrovanEnoxacinBactericidalbyinterferingwithbacterialDNAsynthesisWidespectrum:URI,UTI,cutaneousinfections,boneorjointinfections,abdominalinfectionsRash,arthralgias,nausea,diarrhea,seizures,GIandCNSeff
65、ectsAchilles Tendon RuptureCan arrest growth plate in childrenDo not use under age 18NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Ciprofloxacin100-750mgPOq-12-hDosebasedonseverityofinfectionandcurrentindication.ThereissomevariabilityofeffectivenessamongthevariousFQagents.NPLEXCombina
66、tionReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AminoglycosidesMOAUsesAdverse EffectsGentamicin Garamycin Kanamycin KantrexNeomycin Mycifradin Netilmicin Netromycin Streptomycin Tobramycin Nebcin Paromomycin Humatin BactericidalbyinterferingwithbacterialDNAsynthesisUseforseriousinfectionsofEnteroba
67、cter,E.coli,K.pneumonia,PseudomonasPneumocystispneumoniaOtotoxic,nephrotoxic,seizures,anaphylaxis,neurotoxicSevere OtotoxicityNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Antituberculosis MOAUsesAdverse EffectsOtherIsoniazidRifampinRifabutinRifapentenePyrazinamideInhibitscellswallsyn
68、thesisinMycobacteriumtuberculosisImparesRNAsynthesisUNKNOWNTBTBTBTBTBAdditiveTx.Neuropathies,hepatotoxic,GIdisturbance,fever,rashMANY“All are HepatotoxicGive with B-6NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Topical AntibioticsMOAUsesAdverse EffectsOtherBacitracinBactinInhibitscel
69、lwallsynthesisofbacteriaTopicalinfectionsSkinrash,allergicdermatitisNeomycinNeosporinDisruptsbacterialproteinsynthesisTopicalbacterialinfectionsContact dermatitis, rash,maybenephrotoxicorototoxicMupirocinBactrobanBacterialRNAinhibitionImpetigo,MRSAprophylaxisLowExpensiveNPLEXCombinationReviewChapter
70、10Immunology自然疗法医师注册考试复习10章结合免疫学MupirocinMupirocinRx:#1-15gramtubeSig:ApplytoaffectedareasbidNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntiviralPharmacologyNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学AntiviralsMOAUsesAdverse EffectsOtherAcyclovirZoviraxValacyclovi
71、rValtrexFamcyclovirFamvirInhibitsviralmultiplicationbyinterferingwithDNAsynthesisHSVtypesI&II,Varicella,Herpesencephalitis(MolleretsSyndrome)Val. and Fam. both metabolize to Acyclovir in the body, but require lower dosing.Nausea,vomiting,headache,seizures,coma,rashNPLEXCombinationReviewChapter10Immu
72、nology自然疗法医师注册考试复习10章结合免疫学AcyclovirGenitalherpesInitial:200mgq-4-hor400mgq-8-hRecurrent:200mgq-4-h(5Xdaily)(IoftenaddanrxforAcyclovircreambid)Suppressivetxforrecurrentgenitalherpes400mgpobidVaricella-Zoster800mgpoq-4-h(5Xdaily)for7-10daysNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学V
73、alacyclovirGenitalherpesInitial:1grampobidX10daysRecurrent:500mgpobidX5daysSuppressivetxforrecurrentgenitalherpes9orfeweroutbreaks/year:500mgqd9:1gramqdVaricella-Zoster1grampotidX5-7daysNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学FamcyclovirOralherpes1500mgasasingledoseGenitalherpes
74、Initial:NodataRecurrent:1000mgbidX1daySuppressivetxforrecurrentgenitalherpes250mgbidVaricella-Zoster500mgq-8-hX7daysNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学ANTIVIRAL THERAPY - 2HumanHerpesVirus17(except CMV)Acyclovir,Valcyclovir,FamcyclovirCMVCidofovir,Foscarnet,GancyclovirHepat
75、itisB&CInterferonalpha,PegylatedInterferonRibavirinLamivudine(3tc)HepatitisBInfluenzaZanamivirOseitamivirNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学ANTIVIRAL THERAPY HIVNucleosideReverse-transcriptaseInhibitors(NRTI)TypeA:Zidoiudine (ZDV), Stavudine (d4T)TypeB:Dianosine (ddl), Zalc
76、itabidine (ddc), Lamivudine (3tc)Other:AbacavirNonNucleosideReverse-transcriptaseInhibitors(NNRTI)NeuirapineDelaviridineEfavirenzProteaseInhibitorsSaquinavirIdinavirRitonavirNelafavirAmprenavirTripleTherapy:2 NRTIs and P.I. or NNRTINPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Biologi
77、csandImmuneModulatingDrugsNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学EICOSANOIDSMEMBRANE PHOSPHOLIPIDARACHADONATELEUKOTRIENESPROSTAGLANDINS /THROMBOXANESLipoxygenaseCyclooxygenasePhospholipase A2Stimulated by: Angiotensin - 2 / Bradykinin / Epinephrine / ThrombinInhibited by: CORTI
78、COSTEROIDSInhibited by:NSAIDSNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学LeukotrienereceptorantagonistPharmacologyBindstocysteinylleukotrienereceptor1intheupperandlowerairwaystopreventleukotriene-mediatedeffectsassociatedwithasthmaandallergicrhinitis.IndicationsandUsageProphylaxisan
79、dchronictreatmentofasthmainpatients12moofageandolder;reliefofsymptomsofseasonalallergicrhinitisinpatients2yrofageandolder;reliefofsymptomsofperennialallergicrhinitisinpatients6moofageandolder.Preventionofexercise-inducedbronchoconstriction(EIB)inpatients15yrofageandolder.UnlabeledUsesChronicurticari
80、a,atopicdermatitis.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学LeukotrienereceptorantagonistAdverseReactionsCardiovascularCardiac complications, palpitations (postmarketing).CNSHeadache (18%); asthenia/fatigue, dizziness (2%); abnormal dreams, depression, drowsiness, hallucinations,
81、 insomnia, paraesthesia/hypoesthesia, psychomotor hyperactivity (including agitation, aggressive behavior, irritability, restlessness, and tremor), seizures (postmarketing).DermatologicAtopic dermatitis, dermatitis, eczema, skin infection, urticaria (at least 2%); rash (2%); vasculitic rash (postmar
82、keting).EENTConjunctivitis, ear pain, myopia, otitis, pharyngitis, rhinorrhea, sinusitis, tonsillitis (at least 2%); nasal congestion (2%); epistaxis (at least 1%).GIDiarrhea, dyspepsia, gastroenteritis, laryngitis, nausea, tooth infection (at least 2%); dental pain, infectious gastroenteritis (2%);
83、 pancreatitis, vomiting (postmarketing).Hematologic-LymphaticBruising, eosinophilia, increased bleeding tendency (postmarketing).HepaticCholestatic hepatitis, hepatocellular liver-injury, mixed-pattern liver injury (postmarketing).Lab TestsALT/AST increased (2%); pyuria (1%).MusculoskeletalArthralgi
84、a, myalgia (including muscle cramps) (postmarketing).RespiratoryInfluenza (4%); cough (3%); acute bronchitis, pneumonia, upper respiratory tract infection, wheezing (at least 2%); worsening of pulmonary symptoms (postmarketing).MiscellaneousAbdominal pain (3%); fever, varicella, viral infection (at
85、least 2%); trauma (1%); edema, hypersensitivity (including anaphylaxis, hepatic eosinophilic infiltration, pruritus, and urticaria) (postmarketing).NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学LeukotrienereceptorantagonistMontelukastSodiumSingulair-Tablets10mg-Tablets,chewable4mg-Tab
86、lets,chewable5mg-Granules4mg/packetDoseinadults:10mgQDALSO:Zafirlukast(za-FIR-loo-kast)AccolateZileutonExtended-ReleaseTabletsZyfloCRExtended-ReleaseTabletsZyfloCRNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学InterferonAnyofagroupofproteinsproducedbycellsinthebodyinresponsetoanattackb
87、yavirus.Acellinfectedbyavirusreleasesminuteamountsofinterferons,whichattachthemselvestoneighboringcells,promptingthemtostartproducingtheirownprotectiveantiviralenzymes.Theresultisimpairmentofthegrowthandreplicationoftheattackingvirus.Interferonhasalsobeenshowntohavesomeantitumorproperties.Thereareth
88、reeknownclassesofinterferons:alpha-,beta-,andgamma-interferons.Althoughtheywerediscoveredinthe1950s,themedicaluseofinterferonswasimpracticaluntiltherecombinantDNAtechniquesofgeneticengineeringmadeitpossibletomassproducethem.Interferonsusedasdrugsincludealpha-interferon,forhepatitisBandC,humanpapillo
89、mavirus,hairy-cellleukemia,andKaposissarcoma,andbeta-interferon,formultiplesclerosis.The Columbia Encyclopedia. Copyright 2001-08 Columbia University Press. All rights reserved.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学GENERIC:InterferonBRAND NAMES:Roferon-A,Intron-A,Rebetron,Alfe
90、ron-N,Peg-Intron,Avonex,Betaseron,Infergen,Actimmune,PegasysClasses:Alpha,betaandgamma.Actions:directtheimmunesystemsattackonviruses,bacteria,tumorsandotherforeignsubstancesthatmayinvadethebody.Used in:Leukemia,HepatitisB,C,GenitalWartsThebetainterferonshavebeenfoundusefulinmanagingMSAdverse Effects
91、:Flu-likesymptomsfollowingeachinjectionoccurwithallinterferons.Depressionandsuicidearepossible,butnotcommonHYPOTHYROIDISMOthersideeffectswithallinterferons(maybecausedbyhigherdoses)Fatiguediarrhea,nausea,vomiting,abdominalpain,anorexiajointaches,backpainanddizziness.congestion,increasedheartrate,con
92、fusion,lowwhitebloodcellcount,lowplateletcount,lowredbloodcellcount,increaseinliverenzymes,increaseintriglycerides,NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Immune Cell LinesBone Marrow:Hemocytoblast Lymphoid Stem CellsB-CellsNK CellsPeripheral Tissues:Cell Mediated Immunity Ab (H
93、umoral) Immunity Immunological SurveillanceThymus:Lymphoid Stem CellsT-Cell LinesNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学TacrolimusPharmacologySuppressescell-mediatedimmunereactionsandsomehumoralimmunity,butexactmechanismisnotknown.Themechanismofactioninatopicdermatitisisnotknow
94、n.IndicationsandUsagePOandIVProphylaxisoforganrejectioninpatientsreceivingallogenicliver,kidney,orhearttransplants.Usedinconjunctionwithadrenalcorticosteroids.TopicalAssecond-linetherapyfortheshort-termandnoncontinuouschronictreatmentofmoderatetosevereatopicdermatitis.UnlabeledUsesPOandIVProphylaxis
95、ofrejectionforpatientsreceivingbonemarrow,pancreas,pancreaticislandcell,andsmallboweltransplantation.TopicalTreatmentofvitiligoinchildren;facial,flexural,andintertriginouspsoriasis.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学TacrolimusDosage and AdministrationProphylaxisofOrganRejec
96、tion,LiverTransplantsAdultsPO0.1to0.15mg/kg/dayin2divideddailydosesevery12hnosoonerthan6haftertransplantation.IV0.03to0.05mg/kg/dayascontinuousinfusion.ChildrenPO0.15to0.2mg/kg/dayin2divideddailydosesevery12h.IV0.03to0.05mg/kg/dayascontinuousinfusion.TopicalDermatitisAdultsTopicalApplythinlayerof0.0
97、3%or0.1%toaffectedskinareastwicedaily;rubingentlyandcompletely;continuefor1wkafterclearingofatopicdermatitis.Children(2yrofageandolder)TopicalApplythinlayerof0.03%toaffectedskinareastwicedaily;rubingentlyandcompletely;continuefor1wkafterclearingofatopicdermatitis.General AdviceDonotuseocclusivedress
98、ingswithtopicaluse.NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学TacrolimusPronouncation:(tak-ROE-li-mus)Trade Names:Prograf- Capsules 0.5 mg- Capsules 1 mg- Capsules 5 mg- Injection 5 mg/mLTrade Names:Protopic- Ointment 0.03%- Ointment 0.1%NPLEXCombinationReviewChapter10Immunology自然疗
99、法医师注册考试复习10章结合免疫学PimecrolimusDosageForm:Cream1%TRADE NAME: ElidelFOR DERMATOLOGIC USE ONLYNOT FOR OPHTHALMIC USEElidel (pimecrolimus) Cream 1% contains the compound pimecrolimus, the immunosuppressant 33-epi-chloro-derivative of the macrolactam ascomycin.NPLEXCombinationReviewChapter10Immunology自然疗法
100、医师注册考试复习10章结合免疫学PimecrolimusIndicationsandUsageforElidelElidel(pimecrolimus)Cream1%isindicatedassecond-linetherapyfortheshort-termandnon-continuouschronictreatmentofmildtomoderateatopicdermatitisinnon-immunocompromisedadultsandchildren2yearsofageandolder,whohavefailedtorespondadequatelytoothertopica
101、lprescriptiontreatments,orwhenthosetreatmentsarenotadvisable.ElidelCreamisnotindicatedforuseinchildrenlessthan2yearsofage(seeWARNINGS,boxedWARNING,andPRECAUTIONS,PediatricUse).NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学LOCAL AND SURFACE ACTING DRUGSProtectantsMOAUsesAdverse Effects
102、OtherPetroleumOtherocclusiveproductsMoisturizingskinprotectantApplytoskinsurroundingwartbeforeremovingTopical analgesicsMOAUsesAdverse EffectsOtherCapsaicinZostrixLikelydepletessubstancePTopicalforpainassociatedwithHSV,neuralgia,diabeticneuropathiesOA,RAStingingorburningpainuponapplication,mayirrita
103、terespiratorypassagesExternaluseonlyNEVERonmucusmembranes/eyes!NPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学Anti-inflammatoryMOAUsesAdverse EffectsOtherHydrocortisoneUnknown;chemicalidenticaltothatofcortisolInflammation,antipruritic,vasoconstictive,antiproliferativeAtrophy,pruritus,i
104、rriation,similareffectsoforalsteroidsWeaklyactive!TriamcinoloneBetamethasoneEtcLongeracting,MUCHmorepotentthanhydrocortisone“Inhaled&intranasalversionforasthmaticsCalcipotriene(Dovonex)NiacinamideointmentTretinoin(Retin-A)Isotretinoin(Accutane)Vit.D3analogVitB-3RetinoicAcidORAL DRUGPsoriasisAcneAcne
105、SevereAcneInflammationFewReboundinflammationTeratogenicPseudotumorcerebri3-5%ConcentrationMusthavenegativePGtestConsentneededNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学MiscellaneousNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学NPLEXCombinationReviewChapter10Immunolog
106、y自然疗法医师注册考试复习10章结合免疫学Chelators:MOAUsesAdverse EffectsOtherPenicillamineChelatesheavymetals,esp.copperWilsonsDisease,RA,mercuryorleadpoisoningOpticneuritis,GIdistress,stomatitis,nephroticsyndrome,GN,leukopenia,skinrash,arthralgiaEDTANa-EDTACa-EDTAChelatesmetals,lead,calcium,aluminum(LongIVformat)(Sho
107、rterIVformat)Lead poisoning,hypercalcemiaexcessive doses: renal failure,tubularnecrosisHypocalcemia , HypercalcemiaHeadacheandjointpainfromdetoxificationprocessDMPSGenerallyIVform.Usedforprovocativeheavymetaltesting.CanbeusedforTx.Chelatesmercury,andsomeotherheavymetals.MercurypoisoningHypomagnesmei
108、aHeadaches,depressionandsuicidalthoughtsusuallyduetothemercurypoisoningDetoxingaffectstheendocrinesystem:watchforfatigue,anger,mood-swings;Supplementwithwaterand detoxsupplements.DMSAChemetOralpharmaceuticalforMercury,heavymetalandleaddetoxification.Lead,mercury,orotherheavymetalpoisoningSameasDMPSScheduleandcantakeyear(s)dependingontheindividualNPLEXCombinationReviewChapter10Immunology自然疗法医师注册考试复习10章结合免疫学
