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PHCY220 - M1 Test With
Complete Solution
The legislation - Answer Medicines act 1981 Medicines reguations 1984 Miuse of drugs act 1975 Miuse of drugs regulation 1977 Pathogenesis of a fever from infection - Answer It is a response to LPS which is an endotoxin AKA exogenous pyrogen which stimulate the immune system to release soluble mediators Red flags of a fever - Answer Pale/mottled/ashen/blue colour of the skin No response to social cues, does not wake if roused or does not stay awake, weak, high pitched continuous cry for babies Age below 3 months Temperature above 38 Neck stiffness Non blanching rash Characteristics of bacteria that are selective drug targets - Answer Folate pathway Bacterial cell wall Folate pathway as a drug target for bacteria - Answer Humans get folic acid from diet but bacteria make their own. We need folic acid to make DNA. This synthesising pathway is only found in bacteria What is empiric therapy - Answer Medical treatment or therapy based on experience and more specifically therapy begun on the basis of a clinical educated guess in the absence of complete or perfect information MOA of trimethoprim - Answer Inhibits key enzyme in folate synthesis Never used in pregnancy MOA of quinolones - Answer Inhibit DNA gyrase in gram negative bacteria and inhibit topoisomerase IV in gram positive bacteria
MOA of tetracyclines - Answer Bind to 30S inhibit binding of aa-tRNA Avoid in children and pregnancy MOA of aminoglycosides - Answer Irreversible inhibition of 30S subunit MOA of macrolides - Answer Reversible binding to 50S ribosomal subunit MOA of glycopeptides - Answer Prevent addition of murein monomers to peptide chain Bacteriostatic drugs - Answer Trimethoprim Tetracyclines Macrolides Bactericidal drugs - Answer Quinolones Aminoglycosides Penicillins Glycopeptides Time dependent drug classes - Answer Beta lactamases - penicillins, monobactams, cephalosporins and carbapenems Macrolides Tetracyclines Concentration dependent drug classes - Answer Aminoglycosides Fluoroquinolones MOA of triazoles - Answer Inhibit microsomal CYP which then impairs ergosterol synthesis that is the key component in plasma membrane of fungal cells Avoid during pregnancy MOA of amphotericin B - Answer Binds to ergosterol in the fungal membrane Forms pores or channels which leads to increased permeability and leakage MOA of echinocandins - Answer Inhibit synthesis of 1, 3 beta D glucans which decreases structural integrity causing cell death Fungistatic antifungals - Answer Triazoles Fungicidal antifungals - Answer Echinocandins Terbinafine
Unwanted effects of monobactams - Answer Generally well tolerated and is similar to other beta lactams
Unwanted effects of glycopeptides - Answer Nephrotoxicity Hypersensitivity and rashes SJS or TEM Red man syndrome
What is a method that can be used to achieve more than 40% cover of a dose of penicillins - Answer Constant infusion This is relatively uncommon but may be done in clinical practice either in hospital or at home in a few cases
What is AMR - Answer To optimise the use of antimicrobial agents in the prevention and treatment of infections and minimise the potential harms that may result from their use including AMR, ADR and excessive healthcare costs
Steps to the WHO global action plan - Answer Improve awareness and understanding of antimicrobial resistance Strengthen the knowledge and evidence base Reduce the incidence of infection Optimise the use of antimicrobial medicines Develop an economic case for sustainable investment
NZ AMR action plan - Answer Awareness and understanding Surveillance and research Infection prevention and control Antimicrobial stewardship
Governance, collaboration and investment
AMS intervention categories - Answer Broad higher level activities Specific ground level activities
Broad interventions - Answer Guideline and clinical pathway development and review Antimicrobial restrictions Auditing
Specific interventions - Answer IV to PO switch Dose optimisation Eliminate duplicates De-escalation Duration Interactions Allergy warnings Document indication on chart or script
Pathogenesis of staph aureus - Answer Damage to epithelial barrier and colonisation of bacteria in the tissue or blood Phagocytosis of bacteria by macrophages where the activated macrophages then attract neutrophils which secrete mediators
What are polyenes - Answer Naturally occurring antifungals produced by particular strains of bacteria
Unwanted effects of triazoles - Answer Generally mild Nausea
Histamine - Answer Mediator of immediate allergic and inflammatory conditions Also has a role in gastric acid secretion and functions as a NT and neuromodulator Most histamine is stored in granules within mast cells or basophils and are complexed with a protein
How is histamine released - Answer By exocytosis during an inflammatory or allergic reaction after a stimuli triggers its release Causes itching swelling and redness
Role of T helper cell subsets - Answer Provide protection to pathogens and destroy transformed cells but can also cause tissue destruction, remodelling, DNA mutation and cancer
Pathogenesis of acne - Answer Inflammation of the sebaceous gland Hyperseborrhoea and abnormal follicular keratinisation Bacterial proliferation and inflammation
Hyperseborrhoea - Answer Androgens which play a crucial role in pathogenesis does not develop in their absence They stimulate the growth of sebaceous glands and stimulate sebum production
Dermatitis - Answer Chronic allergic hypersensitivity disease, immune dysfunction Immune mediators TH2 to allergens
Pathogenesis of AD - Answer Acute involves the allergens entering via damaged skin and stimulate the release of inflammatory mediators from granulocytes Chronic involves being driven by cytokines released by T cells and keratinocyte dysfunction
Pathogenesis of urticaria - Answer Mediated by mast cell degranulation Causes include a one off or idiopathicy. Physical triggers such as pressure, heat, cold or chemical contact or allergies
Pathogenesis of psoriasis - Answer Damaged KC release danger molecules that activate DC and then go to the lymph node and activate T cells
Mechanisms involved in the regulation of cortisol secretion - Answer Diurnal variation Stress which can be physical or psychological Negative feedback
GC MOA as an immunosuppressant - Answer Activated GR complex upregulates the expression of anti inflammatory proteins Activated GR complex decreases the expression of pro inflammatory proteins
GC MOA as an anti inflammatory - Answer Our body cells release arachidonic acid and then uses enzymes to produce leukotriene, prostaglandins, thromboxane and prostacyclines. For this to occur, we need phospholipase A2 and GC stop this from occurring therefore blocking pro inflammatory mediators.
Classification of GC and MC receptors - Answer Type 1 receptors are specific for MC but have a high affinity for GC Type 2 receptors are specific for GC and are expressed in virtually all cells
Tuberculoid leprosy - Answer Non infectious Paucibacillary Small defined dry scaly lesions Slow growing and hair loss Systemic nerve damage
Cytokines as a method for alternative therapy - Answer Soluble messengers of the immune system Proteins therefore they have to be given by injection Most act short range from cell to cell They act at low concentrations and have short half lives
Limitations of antibodies - Answer Short term effect Anaphylaxis Unwanted activities
Limitations of cytokines - Answer Toxicity Lack of specificity Effects on pathogens Short half life BA Cost
What so pattern recognition receptors do - Answer PRR on cells of innate immune system recognise conserved patterns from microbes
Anti microbial peptides as a method for alternative therapy - Answer Can be isolated from both eukaryotes and prokaryotes Issues with BA and stability Activity is related to aa composition and properties such as positive net charge, flexibility, size, hydrophobicity
Phage therapy as a method of alternative therapy - Answer Viruses of bacteria Specific host ranges
Advantages and limitations of phage therapy - Answer Can kill bacteria very quickly Very specific and easy to grow and isolate with little toxicity They are also self replicating and self limiting with good biodistribution Bacteria can develop resistance and the immune response to phages are limitations
