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Precautions and monitoring effects (1) the most common adverse effects of isoniazid are skin rash medications you cant drink alcohol purchase epivir-hbv 150mg line, fever treatment ind purchase epivir-hbv 100mg with visa, jaundice, and peripheral neuritis. Signs and symptoms include insomnia, restlessness, hyperreflexia, and convulsions. Significant interactions (1) With concurrent phenytoin therapy, blood levels of both phenytoin and isoniazid may increase, possibly causing toxicity. Therapeutic uses (1) In recommended combinations for treatment of active tuberculosis (2) Prophylactic rifampin is effective when administered to carriers of N. Precautions and monitoring effects (1) Serious hepatotoxicity may result from rifampin therapy. The newer rifamycins, rifabutin (Mycobutin) and rifapentine (Priftin) may be substituted for rifampin in special situations, for example, intolerance or serious drug interactions. Rifabutin (Mycobutin) is an antimycobacterial agent that is similar to rifampin, with activity against both tubercular and nontubercular mycobacterial, and offers no clear advantage over rifampin. The use of rifabutin has resulted in mild elevation of liver enzymes and thrombocytopenia. The concentrations of the following drugs may be reduced while taking rifabutin: cyclosporine, zidovudine, prednisone, digitoxin, quinidine, ketoconazole, protease inhibitors, propranolol, phenytoin, sulfonylureas, and warfarin. Rifapentine (Priftin) is a long-acting rifamycin-derivative and has a similar profile of microbiological activity to rifampin. Rifapentine should always be used in conjunction with 1 other antituberculosis drug to which the isolate is susceptible. Concomitant use of rifapentine with these drugs may decrease plasma concentrations, and dosage adjustments may be required. This drug is bactericidal and/or bacteriostatic, depending on the cell concentration achieved. Pyrazinamide is used as a primary agent with isoniazid and rifampin for at least 2 months, followed by isoniazid and rifampin. This agent may result in hepatotoxicity and, rarely, hepatic necrosis resulting in death. Second-line drugs are mainly substituted or added to preferred therapy owing to intolerance or drug resistance. These agents are less effective, more toxic, and are used in combination with primary agents. Aminosalicylic acid is bacteriostatic; it probably inhibits the enzymes responsible for folic acid synthesis. Cycloserine can be bacteriostatic or bactericidal, depending on its concentration at the infection site; it impairs amino acid use, thereby inhibiting bacterial cell wall synthesis. The mechanism of action of capreomycin (bacteriostatic), ethionamide (bactericidal), and pyrazinamide (bactericidal) is unknown. Second-line antitubercular agents are active against various microorganisms, including M. These agents generally are reserved for patients with extensive extrapulmonary or drug-resistant disease or for patients who need retreatment. Adverse effects of aminosalicylic acid include leukopenia, agranulocytopenia, thrombocytopenia, hemolytic anemia, mononucleosis-like syndrome, malaise, joint pain, fever, and skin rash. Capreomycin and streptomycin are ototoxic and nephrotoxic; they should not be administered together. Ethionamide may induce nausea, vomiting, orthostatic hypotension, metallic taste, epigastric distress, and peripheral neuropathy. A combination of rifampin 120 mg, isoniazid 50 mg, and pyrazinamide 300 mg in one tablet is used in patients expected to have low compliance with tuberculosis drug therapy. One disadvantage is that many patients are required to take as many as five to six tablets daily, which may reduce compliance. Levofloxacin is usually used in combination with other tuberculosis agents for active treatment. Because viruses lack independent metabolic activity and can replicate only within living host cells, antiviral agents tend to injure host as well as viral cells. Hence, a common mechanism of resistance is a deficiency or structural alteration in viral thymidine kinase (Table 36-5).

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Acetyl-CoA Citrate Malonyl-CoA Malate Oxaloacetate When adipose tissue stores triglyceride arriving from the liver or intestine medicine 3605 buy discount epivir-hbv 100 mg on line, glycolysis must also occur in the adipocyte medicine quinine buy genuine epivir-hbv line. Which of the following products or intermediates of glycolysis is required for fat storage Glycerol Glucose 6-phosphate Pyruvate Acetyl-CoA Dihydroxyacetone phosphate Items 3 and 4 Abetalipoproteinemia is a genetic disorder characterized by malabsorption of dietary lipid, steatorrhea (fatty stools), accumulation of intestinal triglyceride, and hypolipoproteinemia. A patient with a history of recurring attacks of pancreatitis, eruptive xanthomas, and increased plasma triglyceride levels (2,000 mg/dL) associated with chylomicrons, most likely has a deficiency in A. He is given instructions for dietary modifications and a prescription for simvastatin. From a Lineweaver-Burk plot, the Km and Vmax of this rate-limiting enzyme were calculated to be 4 X 10-3 M and 8 X 102 mmol/h, respectively. If the above experiment is repeated in the presence of simvastatin, which of the following values would be obtained ApoB-l 00 formation is also impaired in these patients, but this would not explain the clinical symptoms described. The genetic defect would result in malabsorption of the three fatty acids listed, but only lin oleate is strictly essential in the diet. These are the clinical features of lipoprotein lipase deficiency (type Llipoproteinemia). The findings are indicative of heterozygous type lla familial hypercholesterolemia, an autosomal dominant disease. Free fatty acids are transported through the blood in association with serum albumin. Neither erythrocytes nor brain can use fatty acids and so continue to rely on glucose during normal periods of fasting. Erythrocytes lack mitochondria, and fatty acids do not cross the blood-brain barrier efficiently. Short-chain fatty acids (2-4 carbons) and medium-chain fatty acids (6-12 carbons) diffuse freely into mitochondria to be oxidized. Long-chain fatty acids (14-20 carbons) are transported into the mitochondrion by a carnitine shuttle (Figure 1-16-2) to be oxidized. Very long-chain fatty acids (>20 carbons) enter peroxisomes via an unknown mechanism for oxidation. Fatty Acid Entry Into Mitochondria Long-chain fatty acids must be activated and transported into the mitochondria. Fatty acylCoA synthetase, on the outer mitochondrial membrane, activates the fatty acids by attaching CoA. The fatty acyl portion is then transferred onto carnitine by carnitine acyltransferase-1 for transport into the mitochondria. Carnitine acyltransferase-1 transfers the fatty acyl group to carnitine (outer mitochondrial membrane). The carnitine transport system is most important for allowing long-chain fatty acids to enter into the mitochondria. Carnitine acyltransferase-1 is inhibited by malonyl-CoA from fatty acid synthesis and thereby prevents newly synthesized fatty acids from entering the mitochondria. Insulin indirectly inhibits ~-oxidation by activating acetyl-CoA carboxylase (fatty acid synthesis) and increasing the malonyl-CoA concentration in the cytoplasm. In a fasting state, the liver produces more acetyl-CoA from ~-oxidation than is used in the citric acid cycle. Much of the acetyl-CoA is used to synthesize ketone bodies (essentially two acetylCoA groups linked together) that are released into the blood for other tissues. Non-ketotic hypoglycemia should be strongly associated with a block in hepatic p-oxidation.

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Esmolol (Brevibloc) is used to treat supraventricular tachycardias; it possesses a very short (9 mins) half-life medicine 2410 order 150mg epivir-hbv, and has been used to control the ventricular response to atrial fibrillation or flutter during or after surgery medicine 72 epivir-hbv 100 mg otc. Acebutolol (Sectral) has been used in the management of ventricular arrhythmias; although not specifically listed within the recent guidelines, like esmolol and propranolol, the -adrenergic blockers were given a class I ranking for ventricular control in patients with atrial fibrillation. Propranolol (Inderal) may be given intravenously or orally when used as an antiarrhythmic. A loading dose of 500 mcg/kg/min is infused over 1 min, followed by a 4-min maintenance infusion of 50 mcg/kg/min. If a satisfactory response is not achieved within 5 mins, the loading dose is repeated and followed by a maintenance infusion of 100 mcg/kg/min. An oral dose of 400 mg is given by mouth daily up to a maximum of 1200 mg/day for the treatment of ventricular arrhythmias. An anticoagulant may be given before propranolol therapy begins to prevent this complication. Abrupt discontinuation in cardiac patients may exacerbate an angina attack or a more significant acute coronary syndrome. Propranolol (Inderal) (1) Severe vasoconstriction may occur with concomitant epinephrine administration. Sotalol (Betapace) is used to treat supraventricular and ventricular tachyarrhythmias. Sotalol antagonizes both 1- and 2-adrenergic receptors but also prolongs the phase 3 action potential. Ibutilide (Corvert) is used in the conversion of atrial fibrillation and flutter of recent onset (duration 30 days). In the most recent guidelines provided for the treatment of atrial fibrillation, ibutilide received along with dofetilide, a class I recommendation with "A" level of evidence for its use in the pharmacologic cardioversion of atrial fibrillation. Dofetilide (Tikosyn) is available in the United States under restricted access in the treatment of atrial fibrillation/flutter. As mentioned earlier, within the most recent guidelines provided for the treatment of atrial fibrillation, dofetilide received, along with ibutilide, a class I recommendation with "A" level of evidence for its use in the pharmacological cardioversion of atrial fibrillation. Available for both oral and intravenous use and should only be initiated in the hospital setting. Oral doses of 100 to 600 mg/day (usually 300 to 400 mg/day) for maintenance therapy in ventricular tachycardia and 100 to 200 mg/day for maintenance therapy for supraventricular tachycardias are given. Cardiac Arrhythmias 605 (3) Intravenous formulation is available for treatment and prophylaxis of recurrent ventricular fibrillation or hemodynamically unstable ventricular tachycardia in refractory patients. Recommended doses include a rapid loading infusion of 150 mg over 10 mins, followed by a slow infusion of 1. Sotalol (Betapace) is available commercially as an oral tablet, and therapy should be initiated within the hospital setting. Normal dosing of 80 mg twice daily initially and increasing doses at 2- to 3-day intervals to a maximum dose of 640 mg/day, given in two to three doses throughout the day. Normal doses for the conversion of recent-onset atrial fibrillation to normal sinus rhythm is a dose of 1 mg (0. Amiodarone (Cordarone) (1) Life-threatening pulmonary toxicity may occur during amiodarone therapy, especially in patients receiving 400 mg/day. Baseline as well as routine pulmonary function tests reveal relevant pulmonary changes. However, this reaction rarely causes visual disturbance, but the patient should be monitored with routine ophthalmological examinations. Therapeutic response may be delayed for weeks after oral therapy begins; adverse reactions may persist up to 4 months after therapy ends. Sotalol (Betapace) (1) Side effects of this drug are directly related to -blockade and prolongation of repolarization. Dofetilide (Tikosyn) (1) Patients need to be monitored closely for the subsequent development of ventricular arrhythmias with increasing doses of dofetilide or with declining renal status. In clinical trials, ventricular tachycardias, including TdP, are the most frequently occurring arrhythmias due to dofetilide. Amiodarone (Cordarone) (1) Amiodarone may increase the plasma levels of quinidine, procainamide, diltiazem, digitalis, and flecainide. Sotalol (Betapace) (1) Sotalol must be used cautiously in those patients receiving agents with cardiac-depressant properties.

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Peroxidase Enzymes that symptoms yellow eyes discount epivir-hbv 100 mg amex, together with hydrogen peroxide medicine ketoconazole cream discount 100mg epivir-hbv mastercard, catalyze the oxidation of certain organic compounds. Pesticides are often applied to crops to control weeds and to reduce predation by insects or pathogenic microorganisms. Phenotype An observable feature or set of traits that is determined by a gene or combination of genes of an organism. Phenylalanine ammonia lyase An enzyme that converts phenylalanine to cinnamic acid and tyrosine to p-coumaric acid. This enzyme is central to the synthesis of phenylpropanoids, precursors of a range of phenolic compounds, including lignin, in plants. Phenylketonuria An autosomal recessive disorder in humans that is due to the lack of the liver enzyme phenylalanine hydroxylase and that causes phenylalanine to accumulate. Phosphodiester bond the linkage of a phosphate group to the 3 carbon of one nucleotide and the 5 carbon of another nucleotide; the linkage between nucleotides of the same nucleic acid strand. Phosphoramidite A chemically modified nucleoside used in the synthesis of short oligonucleotides. Phosphorothioate linkage the linkage between nucleotides after a sulfur group replaces an available oxygen of a phosphodiester linkage. In the manufacture of some microarrays, the oligonucleotide probes are synthesized directly on a solid surface using multiple rounds of addition of modified nucleotides followed by exposure to light to stimulate joining of the nucleotide to a growing oligonucleotide chain. Nucleotide addition is prevented in some positions by shielding them from the light. Photosynthetic Able to convert atmospheric carbon dioxide into organic compounds by using energy from sunlight. Phylogeny A prediction of evolutionary relationships among organisms that is determined from the comparison of molecular sequences and/or morphological characteristics. Physical map A map of the positions of chromosome sites, such as restriction endonuclease recognition or sequencetagged sites, on a chromosome. Phytase An enzyme able to break down phytate (phytic acid), a complex compound (inositol hexaphosphate) that is the major (60 to 80%) chemical form of phosphorus within cereal grains, oilseeds, and their byproducts. Many animals cannot digest and utilize the phosphorus within phytate, because they lack phytase in their digestive systems. The free inositol that is released upon digestion of phytate can chelate minerals such as iron, thereby facilitating its uptake. Phytoextraction the absorption and concentration of metals from the soil into the roots and shoots of plants. Phytohormone A substance that stimulates growth or other processes in plants; a plant hormone. Phytopathogen An organism, such as a fungus, bacterium, or virus, that causes disease in plants. Phytoremediation the use of plants to remove or detoxify environmental contaminants, metals, or organic compounds. Phytostabilization the use of plants to reduce the spread of metals in the environment. Phytostimulation the stimulation of microbial biodegradation of organic compounds in the rhizosphere, the area around the roots of plants. Phytotransformation the absorption and degradation of organic compounds by a plant. Phytovolatilization the uptake by a plant of compounds from the environment and subsequent release into the atmosphere of volatile materials, such as mercury- or arsenic-containing compounds. Plaque A clear area that is visible in a bacterial lawn on an agar plate and is due to lysis of the bacterial cells by bacteriophage. Pollination the transfer of pollen to the female reproductive organ of a plant, enabling fertilization to take place. Polyclonal antibody A serum sample that contains antibodies that bind to different antigenic determinants of one antigen. Polyhedron the combination of baculovirus nucleocapsids embedded in a matrix protein (polyhedrin). Polyhydroxyalkanoate Biodegradable polymers produced by microorganisms as a carbon and energy storage material.

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