USMLE Step 2 Review 19 05 Drugs of Choice Chloramphenicol

USMLE Step 2 Review 19 05 Drugs of Choice Chloramphenicol

 

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Begin 19 05 Drugs of Choice Chloramphenicol Transcription

Finally, what is the antibiotic which is highly effective for life-threatening H. flu meningitis, but which many physicians are reluctant to use due to a very rare but fatal side effect in infants, and a much more common and fatal side effect in neonates?

  • Chloramphenicol.

What is the very rare but fatal side effect in infants?

  • Irreversible aplastic anemia.

What is the more frequent and fatal side effect in neonates?

  • Gray baby syndrome with circulatory collapse.

What is distinctive about neonates that makes them susceptible to this side effect of Chloramphenicol?

  • The neonate liver has not yet developed adequate gluroronyl transferase activity in order to clear excess Chloramphenicol.

What is the other name for the facial pain syndrome of trigeminal neuralgia?

  • This is also called Tic douloureux.

This is thought to be caused by what process?

  • Microvascular compression of trigeminal nerve roots.

Nerve roots of what part of the trigeminal nerve?

  • Usually the second and third divisions- the Maxiilary and Mandibular divisions.

Because treatment with a particular drug usually causes remission of symptoms within 24 hours, what drug is considered almost diagnostic for trigeminal neuralgia or tic douloureux?

  • Carbamazepine.

Trade name for Carbamazepine?

  • Tegratol.

What is the occasional side effect of Carbamazepine that the physician should be aware of in this instance?

  • Blood dyscrasia.

And what is the alternative drug, especially for treating the acute attack of tic douloureux or trigeminal neuralgia?

  • Phenytoin IV.

Trade name?

  • Dilantin.

What is the Vinca alkaloid used in MOP, COP, and CHOP cancer therapies?

  • Vincristine.

And which letter in MOP, COP, and CHOP stands for Vincristine?

  • The O.

What trade name for Vincristine does the O stand for?

  • Oncovene.

IV Acyclovir/Zovirax is the drug of choice in immunocompromized patients with herpes simplex fever blisters, however, in large ulcers, Acyclovir resistant strains of herpes simplex are common. What is the systemic alternative IV drug which will work to eradicate the ulcer, but not the infection against the acyclovir resistant strains?

  • Foscarnet IV.

And trade name for Foscarnet?

  • Foscavir.

The problem with Foscarnet/Foscavir is that the Acyclovir resistant strains of herpes simplex will usually recur after treatment is discontinued, at about 6 weeks.

What topical treatment has been reported to be successful on large herpes simplex ulcers with acyclovir resistant strains?

  • Trifluridine topical.

And the trade name for Trifluridine topical?

  • Viroptic.

What is the primary indication for Trifluridine topical/Viroptic?

  • Herpes simplex keratitis.

Viroptic is an ophthalmic solution. What is the ophthalmic ointment that is also a drug of choice for treating herpes simplex keratitis?

  • Vira-A.

And what is the generic drug in Vira-A?

  • Vidarabine.

In adult advanced cardiac life support, what is the drug of choice for persistent or recurrent ventricular fibrillation or ventricular tachycardia, after the first series of defibrillatory shocks have failed to stop it?

  • Epinephrine.

We’re going to look at ecclampsia a little more. Again, what was the drug of choice for pregnancy induced hypertensive crisis?

  • Hydralazine.

Trade name?

  • Apresoline.

What class of drug is Hydralazine/Apresoline?

  • A direct arteriolar dilator.

Now, Hydralazine/Apresoline is cleared slowly by about 50% of the population. It is cleared through what organ?

  • The kidneys.

It is renally cleared in the acetylated form, so renal insufficiency slows clearance. what is the metabolic characteristic of this 50% of the patients that causes slow clearance in the absence of kidney disease?

  • These people are slow acetylators. The liver is slower at acetylation in these people.

What is the alternative drug of choice for pregnancy-induced hypertensive crisis?

  • Labetalol.

And what are 2 trade names for Labetalol?

  • Normodyne, Trandate.

What class of drug is Labetalol/Normodyne/Trandate?

  • It is a cardioselective alpha 1 blocker and a non-selective beta blocker. In both cases, a competitive inhibitor.


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