Tips Chapter 12- biochemistry Carbohydrate biochemistry Catabolism- breaking down of molecules- it is anerobic and requires energy- examples

y- examples are glycoylsis when glucose or pyruvate from glycolysis is converted to carbon dioxide and water Annabolism- formation of molecules- it doesnt require energy for example formation of the porphyrin ring in hemeFermentation is a reaction in which ethanol or lactate are fromed from glucose. It is anaerobic Carboydrate metabolism include- glycogenesis, glycogenolysis, gylcolysis, glucogenesis. Glycogenesis- formation of glycogen Glycolysis- break down of glucose Glucogenesois- formation of glucose Glycogenolysis break down of glycogen In anaerobic conditions glycolysis occurs in cells without mitochondria- and glucose is converted to lactic acid Citric acid cycle is the krebs cycle and is break down or synthetic purposes occurs in the mitochondria In aerobic conditions = pyruvate from glycolysis enters the krebs cycle and then it is oxidized to water and carbon dioxide if there is not enough 02 pyruvate is converted to lactate

Protein biochemistry Amino acids are building blocks of proteins. Proteins are formed from a polymerization reaction between two amino acids and cause a bonding (peptide bond) Essential amino acids are those that can not be synthesized in the body and need to be gotten from the diet- (PVT TIMHALL) Essential Aminoacds Phenylalanine Valine Trypthophan Theorine Isoleucine Methionine Histidine (infants) Argenine (infants) Leucine Lysine

Amino acid derivatives PhenylalanineTyrosine dopadopamine norepherine ephedrine Enzymes-> Tyrosine hydroxylase dopa decarboxylasedopamine b hydorxylase phenlethanolamine n methyl transferase Dopamelanin Tryptophan 5 hydroxytryoptopham 5 hydroxy triptamine Tryptophan niacin Tryptophan melanonin Glycine porphyrin ring heme Arginine NO vasodilator Arginine urea Arginine creatinine Glutamate GABA Amino acids- acidic side chain- aspartic acid and glutamic acid Amino Acids basic side chain- argine. Lysine, histadine Amino Acids- Polar and non ionic- Glycine, serine cystine Amino Acids non polar and hydrophobic- Alanine, Valine, Leucine, Methionine, Trypthophan, Phenylamine, Leucine, Isoleucin

Amino acids are zwitterions- this means that they have no net charge as they are made up of +ve and Ve ions. 50% is dissociated and they have 2 titration curves. Isoelectric point (pl) is the point in which there is no net charge pH>pl (-ve charge) PH<pl (+ve charge) There are four structuresprimary structure: sequence of amino acids- location of disulfide bonds Secondary structure- arrangement of proteins in an alpha helix or beta sheath Tertirary- 3d structure

Quatanery- arrangement of individual subunit chains into a complex molecue Simple proteins- are naturally occurring proteins and hydrolysis yields only alpha amino acds eg albumin, prolamine glutelin Conjugated proteins- classified on the nature of their prosthetic groupsDerived proteins- are formed from primary or conjucated proteins by the actions of an acidalkali- heat water-alcohol or an enzyme. They differ in chemical and physical properties of the primary or secondary derived protein. Protein Denaturation When the structure of the protein is unfolded and the structure gets disorganized due to the base pairs being broken. Proteins not denatured by hydrolysis but denatured by heat, ph, alcohol or enzymes. The process is usually irreversaible Globular and Fibrous proteins Globular proteins- Heme protens are specialized proteins- and they contain tightly bound prosthetic groups- Haemoglobin and myoglobin are the most common heme proteins in humans. They bind to oxygen reversaibly and they have a high affinity to carbon monoxide Haemoglobin- is a complex ring- of porphyrin and of ferrous ion (fe2+) It transports oxygen in the blood- and CO and CO2 bind reversailby with haemoglobin Myoglobin- is a complex of prorpyrin ring and Fe2+- transports oxygen in the tissues and the muscles and skeletal muscles Hemoglobinopathies- eg for thalsemia and for sickle cell anemia

4 pyrol rings make this porphyrin ring in Haemoblobin and myoglobin Methamoglobin (fe3+) can not bind to oxygen and is converted to haemoglobin by methamoglobin reductase.

Fats and lipids In fatty acid synthesis- the end product is Palmitate It is associated with Hexose monophosphate shunt,

Lipids are divded into 5 classes due to their structure Glycolipids -known as cerbrosides -Isolated from the brain -in hydrolysis they yield fatty acid, galactose and sphingosine -Known as galactolipids due to presence of galactose- such as phrenosin and kerasin

Sphingolipids- formed from palmitoyl CoA and serine- Sphingosine forms a ceramic backbone when joined to fatty acidsSphingosine + (sugars, choline phosphate, sialic acid)= cerborsides or shingomyelin found in nerve tissues and membrane. Phospholipids- known as phosphatides- they are esters that consist of fatty acid and phosphoric acid eg lethicin- form part of membranes Sterols (steroids) the sterols are alcohols and structurally related to steroids They have 3 cyclohexane ring and 1 cyclopentane ring The steroids are converted to compounds such as bile, vitamin D and are not broken down completely

Waxes High molecular weight esters Made up of monohydric alcohol and fatty acids eg spermaceti Fixed oils and fats- Esters of glycerol and fatty acids fixed oil solid at room temperature is called fat Essential Fatty acids -Linoleic acid, arachiondinc acid, and these are broken down by acetyl co a and enter the krebs cycle- very rapid break down causes ketoacidosis in diabetes

Fatty acid synthesis is cytosolic and the end product is palamitic acid. Acetly co A is the substrateCholesterol synthesis- the RLS is 3 hydroxy- 3 methylglutaryl co A reductase Acetyl co A 3 hydoxy 3 melthyl glutraly co A HMG Co A - melvanonate melvanoate isoprene 6 xIsoprene squalene Squalene lanosterol Lanosterol cholesterol

Essential trace elements Copper- Deficiency Wilkinsons disease leucopenia, neutropenia, mimic (cu2+) defect present in cytochrome oxidase Iron -most abundant metal in the body -microcytic/hyopchonic anemia is deficiency -Hemochromatosis- in high doses Zinc Children- poor growth Adults sexual defiecincy Selinium- Deficincy causes cardiomyopathy Chromium- impaired glucose tolerance Molybendum- present in xanthine oxidase needed to convert purine to uric acid Iodine- deficiency can cause goiter disease (diffuse toxic goiture , toxic non glodular goiter)

TIPS Nitric oxide is derived from arginine Arginine also gives creatinine and urea

Serotonin is produced by tryptophan Tryptohan- 5-hydoxy trypophan5 hydroxy triptamine (serotonin) Phenylketanuria- is excessive phenylalanine in the urine Carbon monoxide has affinity Haemoglobin, myoglobin and cytochrome oxidase Carboxyhaemoglobin- Carbon monoxide and oxy haemoglyobin Iron in haemoglobin is in the ferrous state Rate limiting step in cholesterol synthesis is HMG CO A reductase Essential fatty acids- lineloic and linelonic (omega 3 and omega 6) Eiconosaids are prostaglanids Basic amino acid is arginine also is histamine and lycine Amino acid with a negative and positive charge- zwitter ion They have 2 tituration curves Ph>pl - -ve charge Ph <pl- positive charge Energy stored in the body in glycogen Starch made up of glucose Leithicins are phospholipids Sphingolipids contain sphinogsne and are glycolipids End product of anaerobic glycoyisi- lactate lactic acid End product of aerobic glycosis is pyruvic acid

Krebs cycle in the mitochondria Gylcolysis occurs in the cycoplasm End product or purine is uric acid Interstitial fluid surrounds the cells so the ion that is most extracellular is sodium, calcium and chloride- if inside the cell most abundant is potassium, magnesium and phosphate

Lineloic acid (omega 6-) above is lineloic acid as the c=c is on 6 carbon atom! Linolic acid (omega 3)

13- Clinical Biochemistry Renal Function test- Crcl and BUN(blood urea nitrogen) Liver function test- LDH, AST, ALT, ALP Cardiac enzymes- TROPIONINS, CREATINE KINASE Urine analysis- KETONE BODIES, PH , SPECIFIC GRAVITY Blood works- CBC, Anticoagulants- INR- WARFARIN (2-3 INR), HEPARIN (APTT), LMWH Thyroid test: SERUM TSH (0.5-5MU/L) TT4, FT4, TT3, FT3 Blood urea nitrogen is an end product of protein metabolism- it is produced In the liver and excreted by the kidneys- in normal conditions the urea clearance is 60% GFR. BUN increase indicates renal disease. Normal values for BUN- 8mg/dL to 18mg/dL (3 to 6.5mmol/L) the concentration of the BUN reflects renal function- because the urea nitrogen in the blood is filtered completely at the glomeruli of the kidney. Then it is absorbed and tubuar secreted within the nephron. Increase in BUN indicated acute renal failure. The BUN decrease may indicate a terminal liver disease- as the liver only produces BUN. Increase in BUN is due to azetomia. Serum creatinine- the creatinine is a metabolic product of muscle creatine phosphate- it is a more sensitive indicator for renal damage than BUN indicators. Normal values are 50-120mmol/l or 0.6-1.2mg/dl Serum creatinine will double by 50% with decrease in GFR. A decrease in GFR leads to an increase in CrCl so renal failure is indicated

Serum creatinine decreases in the elderly Crcl is the rate at which creatinine is removed from the blood by the kidney. Normal is 80-120 and if and if its less than 50- it indicates renal disease

Liver function test- LDH- ALP- AST- ALT LDH- lactate dehydrogenaseLDH1 and LDH2- heart LDH 3 lungs LDH4 and LDH5 liver and skeletal muscle ALP- alkaline phosphate AST- Aspartate aminotransferase ALT Alanine aminotransferase LDH- this is a glycocyitc enzyme catalyeses interconversion of lactate and pyruvate in most tissues. LDH present in high concentration in the liver, heart, kidney, lung and skeletal muscles - LDH is quickly liberated by the liver when diagnosed by trauma, infection or ischemia. So it is useful for MI, hepatic disease and Lung disease ALP- Alkaline phosphate- produced from the liver and the bones sensitive to partial to moderate bile obstruction AST- Aspartate aminotransferase- also known as SGPT- found in the heart, liver tissues, skeletal muscles and renal tissues. ALT sensitive to cell damage and less sensitive than AST.

Cardiac Enzymes Cardiac Troponins (Tn) Troponin C T and I are compex proteins that mediate the calcium mediated interactions of actin and myosin Troponin T is in cardiac and skeletal muscles Troponin I is only in cardiac muscle Troponin C is present in two isoforms in cardiac and skeletal muscle Troponin T and I are more careful indicators in myocardial injury They are used to assist in the diagnosis of acute MI

Troponin is a primary diagnostic test for MI Serum bilirubin (bile)

Breakdown product of rbc and is formed in the reticulocytes and then transported into the blood Bile is bound to serum albumin When bilirubin arrives in the liver at the sinusoidal surface of the liver cells the free fraction is rapidly taken up by the liver and converted to bilirubin diglucorinde and monoglucorinide (conjugated bilirubin)- This is then released into the intestine. Most is destroyed in the freaces but some is absorbed in the blood and the liver. Increase of bilirubin indicates jaundice.

Causes of increased bilirubin : -increase hemolysis urine colour not changed -biliary obstruction- bile in urine and kidney stones and dark urine, chlorpromazine gives intra hepatic cholestatsis -liver cell necrosis- viral hepatitis- dark urine colour and bile in the urine Serum proteins (blood proteins) These are albumins and globulins (alpha beta and gamma) Albumin is the major glycoprotein in the blood- it binds to acidic drugs it is produced by the liver levels are decreased in liver disease e Albumin contributes of 80% colloidal osmotic pressure and hence hypoalbumineia is associated with edema and ECF. Hypoalbuminea decrease in essential amino acids due to malnutrition can lead to hypoalbuminea It can be lost directy from the blood because of haemorrge and burns Hyperalbuminemia Increase in this can cause shock or volume depletion

Condition Renal failure Hepatic failure arthiritis burns

albumin Decrease decrease decrease decrease

Alpha glycoprotein Increase Increase Increase -

pregnancy Stress/trauma

decrease decrease

Increase

Globulins ( alpha, beta or gamma) They are the same as Ig opposite effect to albumin Bind to basic drugs

Urinalysis provides basic information regarding renal infection and function and UTI

Normal urine- clear, pale yellow or golden yellow Red- usually indicates blood in the urine- or can be drugs such as -phenolphtalein- laxative Brownish yellow- bile- jaundice Orange red- rifampicin Dark urine- metrondiazole and metformine Blue urine- triamterine Pyuria and bacteruia are UTI and are normally symptomless. Drugs that discolour urine Rifampicin- red/orange and alos body fluids Metronidazole (dark) Tetracycline Riboflavin Pyrinzinamide Trimaterin Nitrofuration Phenolphatin Pyrivium pamoate

Specific gravity increase- indicated excessive blood sugar or protein in the urine decreased SG indicates diabetes insipidus Fixed SG- kidney loses ability to dilute or concentrate the urine Protein in the urine proteinurea- can be caused by UTI, renal infection, venous congestion Albuminurea- indicates glomerular permeability

microalbimurea- - albumin the the urine that is higher than normal but lower than the set standards- sign of renal nephritis Glycosuria- indicates diabetes Ketones They do NOT normally appear in the urine- and if there are no glucose stores then the fat stores start to metabolise to form ketones. Ketonuria is uncontrolled DM or starvation or zero or low carbohydrate diets Three types of ketone bodies: -Betahydroxy butyric acid (80%) -Acetoacetic acid (2o%) -acetone (trace amounts) URINE ANALYSIS Urine Ph- 4.5-9 Specific gravity- 1.010-1.025 Protein levels -50-80mg Glucose levels 180 Ketone do not appear in urine

Common serum enzymes CK or CPK is found in the heart and skeletal muscle CK transfers the high energy phosphate group in tissues that use a lot of energy Total CK- increases with excersise and IM injections of drugs irritating to tissues like diazepam Ck isoenzyme -Deep IM jnection can increase CK levels can use to diagnose MI or skeletal muscle damage

-CK-MM in skeletal muscle CK-BB- brain tissue CK MB in the heart for MI Blood work CBC Haemoglobin

Hct or PCV- this is the % of the RBC per volume of blood WBC RBC MCHC Platelet count, reticulocyte count and LDC do not usually need to be included in a CBC

Hct- this sit he percentage of the RBC per the volume of blood. Decrease in HCt is results from anaemia or bleeding or bone marrow depression. Chronic anaemia or hemolysis Increase can result from polycythemia WBC- 4000-11000 Neutrophils 55-75% Lympocytes 20-40% monocytes 0-7% eosionphos basophils -Bacterial infections indicate increase in neutrophil and drcrease in lymphocytes -Viral infection increase lymphocytes Allergic reaction- increase basophils (asthma) COPD- neutrophils increase AIDS- T cell decrease (lymphocytes decrease) TB- increase monocytes

Warfarin and anticoagulants

Warfarin Oral INR and PT

Heparin Iv or SC apTT

LMWH Sc Not monitored due to predictable reactions but monitor rash and bleeding and heparin assay

Normal INR 2-3

Heparin- apTT, heparin assay and PT

PT- prothrombin is syntheisied in the liver and then is converted into thrombin during the blood clotting process. -Thrombin is critical in the homeostatic process because it creates the fibrin monomers that form the mesh over the wound and activates the platelets -Clotting time is measured -PT- measures 2,7,9,10 factors -Normal value is 10-13 seconds Increase in PT (INR) can occur due to inadequate vitamin K in the diet or drugs that incrase PT- warfarin, heparin, LMWH, high dose of salicycates, and antibiotics. Higher the INR- more bleeding- thinner blood Decrase in PT (INR) due to increase in vitamin K- vegetables and supplements and can cause an increase in blood clots IF not bleeding and increase in INR- stop warfarin aPTT this measures the intrinsic clotting system which depends on the facors 2 7 9 10 measures the other clotting factors- 8,9,10,12,13 monitored for heparin therapy normal values are 21-45 seconds Increase in aPTT -liver dysfunction -inadequate vitamin K intake -poor or inadequate nutrition -increase in aPTT increases the risk of bleeding

INR>3- overdose of blood thinners warfarin, NSAIDS INR<2 oral contraceptives , vitamin K Normal lipoprotein level -Low density- (LDL) <2.2 -TCG<3.6

-HDL >0.9 -C.HDL 5mmol/L Thyroid function tests (serum) Normal Serum TSH 0.5-5 >5 hypothyroidism Serum TSH elevated Thyroid disease test free T4 and serum TSH Free T3 and T4 Replacement therapy for hypothyroidism is serum TSH, Free thyroxin index, resin TII uptake (Rt3U) and TT4 Free T3 and T4 FT4 is the mist reliable test for hyopthyroidsm and hyperthyroidism in contrast to: FT3 is expensive Total tt3 and tt4 TT3 and TT4 measure free and bound total serum t3 and t4 TT3 is useful in Graves disease TT3- not good for hypothyroidsm hyperthryroidsm <0.5 Serum TSH, Free T4 and T3

Dehydration BUN normal in mild Moderate increase BUN Sever increase BUN, increase Hb and low sucrose

TIPS Normal K level range is 3.5-5mmol/L Precursor of plasma cells B lymphocytes Leukopenia- reduced lycocytes Normal CrCL- 80-120ml/min Bilirubin is icnrased in jaundice and AST and ALT AST>ALT and AST more sensitive Alcholic hepitisi- AST >ALT (both elevated) INR is normal test for warfarin INR in warfarin patient should be between 2-3 LMWH- not monitored- monitor for rash bleeding and heparin assay INR >5 bleeding talk to dr stop warfarin aptT and PTt is heparin in MB- CK MB and LDH and Ti Troponin I is elevated after an MI Calcitionin opposes action of parathyroid hormone Hypothyroidism measured by TSH Hyperthyroidism TT3 and TT4 (free)

14- Nutrition Canada Health Food Guide -Carbohydrate 55% -Proteins 30% Fats <5% Fibre 30g/day Minerals and vitamins Water 8-10 glasses a day Salt <2g /day Allergens -milk- lactose Peanuts

Tartazine- colouring agent

Vitamins Water Soluble- B and C Fat Soluble ADEK

Vitamin short notes Vitamin B1- Thiamine Vitamin B2- Riboflavin Vitamin B3 niacin Vitamin B5- panththenic acid Vitamin B12- Cyconobalamin Vitamin C Ascorbic Acid Vitamin E- alpha tocopherol Vitamin K1- phylloquinone Vitamin K2 menaquninone Vitamin k3 synthetic menaquione

Vitamin B1- Thiamine

Contains a sulphur atom Made from pryrimidine and a thiazole and couple by the methylene bridge Rapidly converted to Thiamine pyrophosphate ad thiamine diphophosporansferase Usually in the diet but if not need to take thiamine Deficiency: Reduced capacity for the cells to release energy Can cause beri beri Wernicke korskaoff syndrome Found in chronic alcoholics so vit b1 supplement is needed

Vitamin B2- Riboflavin

-Precursor for co enzyme FMN and FAD -It decomposes when exposed to light -Can cause deficiencies in new born -Found in eggs, meat, cereal and milk -1.2-1.7 day Seen in alcoholics due to poor diet -Glossitis, stmatisis, photobhobia and sehorrhea is deficiency

NiacIn Vitamin B3 Nicotinic acid and nicotinamide can serve the source for this Niacin is required for the synthesis of active form of vitamin B3 NAD and NADP are co factors for dehydrogenases Niacin can be derived from tryptophan and is not a true vitamin Nicotinic acid can be used in the diet but is not recommended in patients with gout or diabetes Glossitis, depression dementia, are the deficiency Can cause PELLAGRA- depression, diarrhea, Hartnup disease causes it too decrease in niacin can be caused by isonazid therapy for TB

Vitamin B5- Pathothenic Acid

It is formed from Beta alanine and panthtenci acid - can be gained from wholemeal grains, legumes and meat\ -Extremely rare

Vitamin B6- Pyridoxine- pyridoXAL

Used as a supplement for nausea and vomiting in pregnant women 0.6mg/day Drugs can reduce it like anti tb isonazaid, penicillamine for RA , avoid with levodopa- as vitamin b6 causes the conversion of levodopa to dopamine and can give nausea and vomiting Biotin this is co factor that is required by enzymes involved in carboxylation reactions- eg acetyl coA carboxylase and pyruvate carboxylase -Found in foods and synthesized in the bacteria -Can be got from excessive consumption of raw eggs-Antiboitics can cause decrease in biotin in the long run

Cyanocobalamin- Vitamin B12 Has a corrin ring and a tetrapyrolle ring structre has a cobalt ion in the center

It is absorbed in the ileum it is a co factor used in catabolism of fatty acids- and amino acids valine isoleucine and transcobalamin Megoblastic or pernicious anaemia can occur from the defficeicny due to the lack of the intrinsic factor that is produced to help it to be absorbed Should be given parentally- oral supplements are not effective Oral contraceptives, trifluperazine, KI metformin should not be taken at the same time Use in the elderly

Folic Acid COnjucated molecule and has a pteridine structure| it is linked to PABA Animals cant synthezise paba so it mst be got from folic or folate in the diet Yeast and leafy vegetables- are a good source Megoblastic anaemia and in preg can cause neural tube defect Conc decreased by- anticonvulsants, oral contraceptives, metformin, dapsone, 5-FU, sulfonamides

Vitamin C Ascorbic Acid

Wound healing- used in collagen synthesis Fruits and veg deficiency causes scurvy smokers are vit C deficient

Vitamin A Has 3 active molecules Beta carotene retinol retinal retinoic acid Retinol, retina and retinoic acid Beta carotene is precursor of vitamin A Rhodopsin is inactive form of vit A in vision B-carotene is two molecules than of retinal that are linked at their aldehyde ends also called pro vitamin A Good anti oxidants od vit A is toxic can cause bone pain- nausea diarrhea and hepatosplegenomy (enlarged liver and spleen) Def- xeroplhtalmia Night blindnessEarly symptoms- increased suspectivity to infection, cancer anaemaia prolonged- deterioration of the eye tissue- and progressive keratinzation of the cornea Accutaine- cis retinoic acid- oral only TTT Retin A trans retinoic acid- cream ov >2500IU

Retinol

Retinoia acid

Vitamin D Steroid hormone 1,25 dihyoxycolecalcferol is the active form deroved from ergosterol and prodced in the skin Chronic renal failure is a deficiency of vitamin D3 Milk- fish eggs liver oil rickets in children and oesteomalacia in adults Newborn should get vitamin D drops (oral)

Vitamin E Alpha tocopherol 0 is the strongest antioxidant Vitamin $E is a natural antioxidant Storage site is the adipose tissues Increased intake is needed in premature infants and persons with fat diet cause increase in blood cell fragility Vitamin K (Quinolone structre) K1(phylloquninone) green vegetables k2(menaquinone) interstinal bacteria K3 synthetic mendione- When administed it is alyklated to V2 maintain clotting 2 7 9 10 antidote for warfarin

Essential fatty acids These include lineloic acid (omega 3), arachdionic acid, eicosopentanoic acid,

EFA- need to be gained from the dietOmega 3 and omega 6 is from vegetable oil and fish oil provide eicosapentanoic acid- some EFA can be made from other EFA like araciondonic acid

TIPS Vitamin B12- commonly found in animal products PABA is a precursor of folic acid Vitamin D deficiency is common in Canada and USA D3 1,25 dihydroxycolecalciferol is the active form of vitamin D Supplement of folic acid in pregnancy reduces neural tube defect Storage form of vitamin D is D2 Skin exposed vitamin D is cholecalciferol ADEK absorption occurs in the small intestine All B compex washout except vitamin B12 Folic acid is used for DNA and RNA synthesis Vit A overdose causes toxicity Alcoholic patients deficient in vitamin B12 Chronic renal disease need vitamin D Deficincy in newborn treateted for hyperbilurimea by photo therapy riboflavin Niacin is not a true vitamin Pellagra is due to def of vitamin d3 Pteridine ring is in folic acid Scurvy is in vitamin C def B carotene is the precursor of Vitamin A Omega 6- lineloic acid Omega 3 linelonic acid act like aspirtin antiplatlet Vit E toxicity prevents vit C from working Vit B1 is beriberi and Wrnick Korsaff syndrome Vitamin D in chronic renal disease Vit b12 has cobalt center- cycobalamin Vitamin b2 riboflavin- pellagra

Chapter 15 Microbiology

Bacteria: Contain cell membrane and cell organs Bacterial shape- round(coccus) rod like (bacillus) spiral (spirochete) Bacterial nucleus is not surrounded by a cell membrane Bacterial ribosomes are 30s 50s and 70s Cell membrane consist of cytochrome, lipids and enzymes Mesosomes are invaginations of bacteria Plamid- circular piece of dna Endospore- is a inactive cell External layer is a capsule and is resistant to phagocytosis Cell wall- resistant to osmotic pressure Peptidoglycan cell wall present in gram positive and gram negative cells Mucopeptide is presnt in peptidoglycan Techoic acid- water soluble polymer- present in gram positive only Periplasmic space gram positive bacteria between cell memembrane and outer cell Outer membrane- grame nevative- phospholipid layer embedded proteins and prions Lipopolysaccharide- gram ve and consist of lipid A an endotoxin Glyocalyx is the external layer- slime layer and is adhesive Appendages- flagella/pilli/ ordinally pillae or sex pillae Bacteria growth cuvre- lag- increase in size and exponential is increase in numbers Decline is death phase Obligate aerobe- generate h202 are a bactericidal Superoxide dismustase- enzyme released to neturalise h202 Obligate anaerobe- has no superoxide dimusterase Facultative anerobe- most pathogenic- can switch from fermentative to respiratory metabolism Aero tolerant anerobes- similar to facultative and remain fementative Canophilic anaerobe- similar to facultative

Oxygen requirement Facultative anerobe- most pathogenic can shift from fermanetative to respiratory Obligate aerobe has superoxide dismustase enzyme and releases h202 Obligage aerobe killed by 02 Aerotoelarnt anaerobe femain fermentative

Virus No cell structures Made of DNA RNA and protein All are harmful

Fungi cell membrane contain ergosterol layer made up of thread like structures called chitin Protozoa eg amoeba unicellular or single cell organisms- based on flagelletes-

Atypical bacteria Mycoplasma: have no cell wall Rickettsia- can be transported by ticks and mites Chlymaida- lack ATP synthesis Mycobacteria Cell membrane contain a mycolic layer acid fast test can detect it

Gram ve has more layers than gram +ve Gram +ve Stain blue or purple Techoic acid Peptidoglycan layer is thick Exotoxin is a metabolic product Exotoxin is thermoliable- and destroyed at high temperature. It is a high molecular weight protein Gram ve Stain pink or red LPs in the outer membrane Peptidoglycan layer is thin Endotoxin is metabolic product Endotoxin is complex and made of phospholipidpolysaccharide and protein

Gram positive Cocci- Streptococcus S pyogenes (A) S agalactiae (B) S bovis (D) S pneumonia S viridians Stapylococcus S aureus S epidermis S saprophyticus Enterococcus Baccili C. dipthariaie Listeria monocytogenes Norcardia Baccilus cerus Gram +ve and anaerobic Clostridium

Gram negative Gram ve cocci NISSERIA N gonorrhea N meningitis Moraxella catarrhalis

Rods E coli Klebesiella pneumonia Enterobacter

Shigella Proteus mirabilis Salmonella

S typi S eneridis Vibero cholarea P aeruginosa Hinflenza Y pestis Gram ve anaerobic Fusobacterium B fragilis Bacetiodies

C perfinges,

C difficile, C botilium, C tetana

Gram +ve cocci S aureus Catalase and coagulase positive

Beta hemolytic streptocci s pyogenes

S pneuomanae

Found on the skin and in the nose On boils Wound infections Toxic shock syndrome Tonsillitis, cellulits, septecaemia can occur in immue diease like rheumatic fever CAP, ototis media and menigitis

Penicillin g and penicillin v

Clarithromycin Azithromycin Erythromycin Penicillin G Amoxicillin otitis media Penicillin G Clarithromycin Azithromycin Penicillin G or amoxicillin

S viridians S epidermis Gram ve Cornyebacterium diptherai

Endocardiits and dental carries Instrument contaminationcathether infections UTI Diphtheria disased due to toxic production Tetanus Gas gangrene Botulinism P colitis Menigococcol meningitis- and shock of URT STI- always pathogenic

Erythromycin or penicillins Tetracycline Vancomycin or metronidazole

Cl tetani Cl perfugines CL botilium Cl dofficile Gram ve cocci Nessesieria menengitits Nesseria Gonorrhea Gram ve bacilli E coli Proteus klebsiella S typhi salmonella Shigella P aureginosa

Penicillin G Cephalosporins 2nd or 3rd generation or ciprofloxacin E coli (sulfa drugs) UTI E coli diahrrhea ciprofloxacin

UTI Travelers diahreaha Wound infection or sepsis Inhabitants of the gut Enteric fever, food poisoning, most Sp are animal pathogens and typi only infects man Dysentry Hospital acquired and opportunittic infections

Chloramphenicol and ciprofloxacin Ciprofloxacin Aminoglycosides 3rd gen cephalosporinscrefazidime or cefurtoxime Ampicillin Clarithromycin Azithromycin

H influenzae

Pneumonia, meningitis, otitis media

Amoxicillin Tetracycline

Acid fast bacill M tuberculosis

Tuberculosis- most common infectious cause of death world wide

M leprae Spiroches Treponema pallidum Borellie burgoferi

leprosy

Isonazaid Rifampicin Ethambutol Pyrazinamide Streptomycin Dapsone Rifampicin Doxycycline Penicillin G Tetracycline

Syphilis (STI) Lyme disease- tick bourne infection causing rash arthlagian and nerulogical signs- bull eye rash

Fungi

C. albicans

Have thick ergosterol containing walls- and grow in humans as budding yeast cellsand slender tubules hyphae Thrush , valvovaginitis, mucicutaneous infection Atheltes foot Ringworm

T Pedis Dermatophtes

Nystatin Clotrimoxazole Miconazole Clotrimoxazole Tolfinate Acquired from animals sometime Skin naiks hair

Aspergillus

Allergic reactions or opportunitsitc infections and is airbourne

C neoformans

Meningitis in immunocompromised= soil nd pigeon droppings

Protozoa Plasmodia

Malaria-

Chloroquine, mefloquine, primaquine, doxycylcine Metronidazole Metronidazole, Ciprofloxacin, Cotrimoxazole

g. lambalia E. Histolytica Viruses DNA virus Adenovirus Herpes simplex Herpes Zoster Cytomegalovirus Epstein BAR (EB virus)

Low grade GI diseasegiardiasis Dysentry- severe when it spreads to the liver

Conjunctivitis- sore throatHSV1 and HSV2 can cause oral and genital lesions. HSV 1 is cold sores and kertaoconjunctivitis HSV 2 is genital VZV can cause chicken poxshingles glandular fever rosella infantum (6th disease) Transmitted via sexual or bodily fluids Warts and cervical cancer Hamaerogic cysts Smallpox Influenza (flu)

Aciclovir Famciclovir Foscarnet Ganciclovir

Hepandavirus Hepatits B Papilliovirus Polyomaviurs Poxovirus Orthyomyxoviruses- Influenza A and B

Interferon Alpha Garadsil used for cervical cancer

Amatadine Neurominidase inhibitios Osetlamavir Zanamavir Rimantidine (influenza A )

Flavivirus- yellow feverhepititis Paramyxoviruses- EnterovirusRSv measles mumps Reterovirus Rotavirus Reterovirus HIV HTLV

Yellow fever chronic hepititis Resp infections Croup Rhinorrhea- hepatitis common cold gastroenteritis Aids T cell leukaimea Can be severe in infacnts Rhino- runny nose

NRTI NNRTI protease inhibitors Zoonotic infection

Rhabdovirus- rabies

rabies

Togavirus Rubella Alpha virus

German measles Encephilitis

Bacterial infections Stye- external hordeulu or internal hordelum Causes- S aurus Site of infection- edge of the eyelid- and head ruptures within a few days Treatment Warm compress and cloxacillin or flucloxacillin Inclusion and drainage are indicated and patient should be referred if they do not respond to the treatment Conjuncitivits Pink eye or red eye Viral- bacterial- chlyamidial Non infectious- foreign or allergy Treamtnet Oral tetracycline doxycline Erythromycin safe in pregnancy Azithromycn 1g as a single dose Amoxiciilin safe in pregnancy Ceftraixone- 1g IM single dose Genococcal conjuncitivits in adults Viral conjunctivitis Treatment is supportive- topical corticosteroid therapy is controversial Bacterial conjuncitivits Staphylococcus and strepoloccus H influenza in children New born conjunctivitis c.trachomitis or n gonnorhea chylamidia trachomonitis- erythromcycin n gonnherea- ceftriaxone Purleunt or mucopurleunt discharge is bacterial Viral non mucouperulent discharge Watery discharge can be due ti URTI or adenovirus Viral conjunctivitis is follicular reaction and prerucicula lympadenothpy

Children kept out of school for 2 weeks following onset of infection

Gentamicin or tobramcyin eye drops Fusicidic acid eye drops 2.5% povidone iodine is best for the propylaxis

Cannilcuitis Actimces Mechanical expression of exudative or granular material from the canculi and penicillin G Refer the patient for a definitive treatment Darocystitis Streptococci or s pneumonaie Infection of nasoscrlimal sac Acute- amoxicillin Chronic irrigation nd penicillin G Keratitis Bacteria fungi herpes simplex acanthameobea Sight threatening and so an emergency Herpes simplex keratitis HSV 1 Topical disease- acyclovir 5 times a day and continued 3 days after healing Trifluridine and hifluridine drops Stromal disease- antiviral and corticosteroids

Ear nose and thorat Common cold Sinusitis Pharngitis sore throat Pneumonia Bronchitis Otitis media Skin and soft tissues Cellulitis S pyrogens or s aureus Dermis Penicillin and flucolaxcillin Impetigo S aureus and S pyogenes Bullous crusted pustular eruption of the skin Due to invasion of local causative agent Penicillin or amox and fluclox Folliculitis (boil) S aureus Penicillin or amoxicillin

Rhinovirus Bacteria s pneumonia Virus adenovirus Bacteir s pyognees H pneuomina H influenza S pnenonia h influenza m catrrahlis

Acute spreading of the dermis- lesion is hot and red and swollen

Erysipelas- rapidly spreagind infection fo the skin S pyrgiens or s aureus Dermis of the face Penicillin or amoxic with or without fluclox Neroctising fasicits Inflammatory response of tissue below the dermis and spread along the facial planes and disrupt the blood supply and cause necrosis and gangrene S pyogenes (B haemolytic group) Benzyl penicillin and clinamycin with or without metrondizaole Gangrene Coliform or sterptococco (group A) Penicillin and celhaliposin beta lactam and qunilones can be used Pai fever systemic toxicity Viruses Papillonoma virus Molluscum contagiosum (pox virus) Pox virus from sheeps or goats

Common wart Fleshy papule Papovascular lesions with systemic spread like herpes simplex

Fungi Dermatophyte

Tinea pedis

Ring worm or skine lesions (keratin loving fungi) C neoformans, or Blastomyces dermtitidis Atheltlets foot clotrimazole miconazole tolnafate

CNS infections Neonatal (6 weeks) group B strep

Children > 3 months and adults S pneumonia N meningitis H influenza type B Eldery alcoholics immunocomprimesd E cloli S pneumonia Meningococcal infection N menignigitis Haemophilus influenza type B

E coli and other Ampicillin + gentamicin or ampicillin and cefrtiaxone Cefrtoixone or ampicillin and vancomycin Cefrtixione or ampicillin or vancomycin Respiratory route Affects 6 month to 5 year old children Hib vaccine spread Blood-> meninges Viral infection of the brain cns and cells HSV 1 is most common CMV rabies mumps

encepelitis

polio TB meningitis

Enterovirus Meningococcus Pneumoccus H influenza CNS Benzyp penicillin menicoccois Bezyl penicillin/cefotaxime or vancomycin if resistant for pneumoccus H influenza cefotaxime Prop meng rifampicin or ciprofloxacin whole family or close contacts

Respiratory infections CAP

Causative agent: S pneumonia (most common) Abulatory patients 18-40 year -M pneumonia (24%) -S pneumonia (5%) -Chlyamidia Pneumonia (2%) -H influenza (1%) -Legionella pneumophilia (1%) Requiring hospital administration S pneumonia (17%) M pneumonia(14%) Chylamidia pneumonia (10%) H influenza (7%) L pneumophilia (1%) Emergency treatment is penicillin V S pneumonia amoxicillin, penicillin G or macrolide H infleuzna 2nd or 3rd gen cephalosporin + clauvnate S aureusMethicillin susceptible- Cloxacillin Methicillin resistant Vancomycin M pneumonia and C pneumonia- Doxycylcine or macrolide Legionella- Fluroquinolones- marcolide rifampicin E coli- aerobic gram ve bacilli- 2nd or 3rd gen cephalosporins- initial therapy should be with cefoxitin pipercillin or tazobactum

Brochitis

Based on age group <1 year- RSV , parainfuenza , corona virus 1-10 years- parainfluzna , enterovirus rsv >10 years- influenza RSV adenovirus

Bacterial bronchitis Treatment

Chlyamidia pneumonia , mycoplasma pneumonaie ` Routine antibitict not recommended Atipyrectci or angalestic aciteomenophen Antiussive- dextromethorphan Beta agonist salbutamol `

Urinary Tract infection Lower UTI Upper UTI UTI most common agent is E coli Cystitis Urethritis

Cystitis and urethritis Polynephritis and uretitis

Pyleonephritis

Cotrimoxazole, or amoxicillin or ciprofloxacin Urea plasma and chlymidia infectiondoxycylcine during pregnancy use erythromycin Bacterial infection of kidney subustances Amoxicillin cephalosporins cortimoxazole or aminoglycosides

Sexually transmitted infections Causative agents Nisseria gonorrhea Chylamidia Lymphogranuloma Bacterial vaginosis AIDS Hepititis B and C Chancroid (syphilis) Genital herpes Genital Warts Candidia or yeast are not STI Candidia is not STI so no treatment and if the symptoms recur within two months then the partner would need treatment

Infectious Arthiritis Lyme diease Oseteomyleitis are all bone and joint infections Infectious arthiritis The gonococcus bacteria can cause different symptoms in males and females Women develop red sores on the hands and feet and severe pain in the wrist and ankles In men gonococcus only affects a single joint and most often the knee is affected. Arthiritis is due to gonococcus and oral ampicillin is the treatment Surgery doesnt really help

Lyme disease Is tick bourne and can cause arithirits and in severe cases heart and cns complications Spirochete (Boreli bergodorferi) Is transmitted to humans via deer tick and prevelant during summer months Oesteomylitis

Tetracycline is the drug of choice

Bone infection of the marrow and caused by S aureus

G I infections Stomach

H pylori is the common infection and is associated with peptic ulcer disease and gastric cancer Large intesting 99% anaerobes Bactersisides- Bifidobacterium clostridium anerobic cocci and anaerobes Anerobes enterobacaea- e coli enterococci proteus Dysentry travelers diaorrhea Travelers diahrea Eggs meat poultry and travelers diarrhea P colitis Meat poisingig and travelers diarrhea Meat mayonnaise custard Actue gastroenteritis and reheated dishes Diarrhea in hospitalized patients Ameobiasis

Food poisoning Shigella C jejuni Salmonella C difficile E coli S aureus c. perfigines Norwalk virus Entomebea

B cerus V parahemolyticus Listeria

Reheated rice Contaminated sea food Meat

TIPS

Beta haemolytic bacteria- Sterp. Pyogenes ( Group A strep_ Toxic shock syndrome- S aureus Lyme disease is borrelia burgodorferi Techoic acid- is in gram positive bacteria S pneumonaia, S aureus Encephelitis is a brain infection caused by: -Viral alpha viruses- the ones that cause rubella or rabies virus HSV virus -bacterial- N meningitis Chylamidia in new more is C trachomitisNon gonococcal infections that cause UTI is E coli and chylamidia Diphtheria- Corynebacterium diphteriae, URTI Sypiliis- Treponema palladium Anthrax- bacillus anthraics E coli- gram negative anaerobic cocci The bacteria that degrades h202 is obligate anaerobe S aureus- s epidermis does not Live vaccines- MMR, sabine, small pox, VZ, yellow fever Killed vaccine- polio, influzna rabies Viral diarrhea- rota virus CAP- S pneumonia ambulatory patients M pneumonia. And Hospital admission is S pneumonia Sub acute endocaritis- s aureas and s viridians Syphillis Tropenem Pallidum Gram +ve bacilli= B diarrhea- C jejuni, E colli shigella Otitis externa- pseudomonas Aspiration of ear is in middle ear infection Encephalitis HSV Gram +ve bacilli C diptheri Sinusitis H pneumonia, H inflenze M carttharalis Nocosomial infections S aureus and Pseudomonas Shingles herpes zoster Herpes- HSV 1 HSV 2 VZV CMV Epistein barr Tuberculosis: caused by Menigicococcus, Pneumoccocus, H influenza Menigcoccus- benzyl penicillin Pneumococcus- benzyl penicillin/ cefotaxime/ vancomycin if resistant

H influanzae- Cefotaxime (start with penicillin + cefotaxime) Propylaxsis- Rifampicin or ciprofloxacin Pneumonia emergency treatment- Penicillin V S pneumonia- Penicillin G- amox or macrolide High level resistant- quinolines and 3rd gen cephalosporins H influenza- 2nd 3rd generation cephalosporins or amoxicillin and clavanate S aureus- Methicillin Susceptible- Cloxacillin and meth resistant vancomycin M pneunonae or C pneumonia- Doxycycline or macrolide Legionella florquniolines macrolide and rifampicin Ecoli- 2nd nd 3rd cephalosporins- initial therapy- cefoxtin or piperacollin and tazobactum

16 - Cell and molecular Biology DNA replication This first occurs by separating the double stranded DNA molecules and then each new strand then serves as a template onto which new bases are paired upon in complementary base pairing. The same thing is done in transcription from DNA t RNA. The RNA is the intermediate between the DNA and the protein. Cell organelles ER membranes that extend throughout the cytoplasm . only in eukaryotic cells. Cytochrome P450 is present in ER RER- helps in protein synthesis SER- helps in lipid synthesis Golgi bodies contain sacs help in protein and lipid synthesis lysosomes help in digestion Genome- complete set of DNA in the organism Gene expression- gene is DNA sequence that encodes a protein or RNA molecules

Nucleotide- Base+sugar+phosphate pentose sugar- ribose or deoxyribise phosphate 5 carbon nirotgenous base

Nitrogen bases Purine bases adenine and guanine Pyrimidine bases- thiamine- uracil- cytosine at (2 base pair) cg (3 ) Au Purine 2 bonds and pyrimidine 1 bond cDNA- complementary DNA that is syntheisezed from RNA rather than from DNA template used in cloning or to locate specific probes\ RNA differences has Uracil instead of Thiamine, single stranded, has ribose instead of deoxyribose RNA polymerases- enzymes help in the synthesis of rRNA tRNA and mRNA 3 types of RNA based on their functions: rRNA- ribosomal = 80% is syntheisie in ribosome in cells tRNA- 15% of tota- tRNA amino acid carries the specific amino acid to the site of protein synthesis and it contains an anticodon that recongnizes al codons on mRNA mRNA- 5% carries the genetic information from DNA to cytosol in protein synthesis Codon present in MRNA nd is have a set of 3 bases- there are 64 combinations but 20 common amino acids UAG UAA UGA- dont code for anthing When UA UGA UAG is reahed its nonsense codon and it stops Step 1-> transcription Step 2 -> translation DNa mrnatrna rrna protein Transcription 1st process of protein synthesis and DNA is copied into mRNA from mrna to dna s reverse transcriptase Translation- mrna is brought to the ribosme by the trna and then under goes complimentary base pairing catalysed by amino acyl trna synthase- and then it keeps going until a stop codon is reached. After which there is post translational modification glycoslyation sulfation etc splicing of exons Intron and exons

Coding reigon of a eukaryotcyte gene is introns and exons- intron is a segment of a gene that is suited between exons. It is not responsible for the coding of a protein- so they wud be spliced out of the mRNA- the exon is a nucleotide seuqnece in DNA that carries the code for the final mRNA molecule- and so defines the amino acid sequence Remoiving introns is called splicing-

DNA recombinant technology Cloning Duplicating DNA and it is identical using a vector Insert the DNA into a plasmid vector- it is usually an antibiotic resistant getna and recombinant molecule is formed. Plasmids and DNA fragments must have compatible RE ends for ligation by DNA ligase- The ends are joined together to form the circular DNA product . Once the Recombinnt (circular DNA ) is formed- it is then inserted into a host cell like E coli and allowed to replicate and then the memebrane of the cells are made permeable with shock treatment of calcium ions to allow the cells to take up the DNA pieces So the cells are grown in an antibiotic medium and only the resistant cells will grow Select the cells with the DNA x and the antibiotic resistant cell use beta galactosidase to get cells with the DNA x and not the vector due to unsuccessful ligation. Kill the cells and extract the DNA X Eg Cystic fibrosis etc

DNA recombinant technology Plasmid circular piece of DNA used in recominbation and cloning Endonuclease enzymes- Restriction enzymes are a set of enzymes that are bacterial and they cut the DNA at specific sites called the restriction sites- by breaking the phospohidester bonds- between the nucleotides- to form the single stranded DNA they are isolated from bacterial species- and break foreign DNA Lyase and lygase are the enzymes Lyase- splits DNA on specific sites Lygase- joins the DNA on specific sites

TIPS

Nucleic acid- DNA and RNA Building blocks are nucleotides Purine bases are adenine and guanine Pyrimidine bases are thiamine cytocine and uracil Base only in RNA uracil All genetic information in an organism is called as genome DNA sequence that encodes a protein or a DNA is a gene Fist step in protein synthesis is transcription Segment of gene between exons is intron Split DNA on specific sigte DNA lyase Join DNA DNA ligase Small circular chromosome of DNA is plasmid Genetic disease with chromosome X is haemophilia Geneome all the genes etc Microtubule in cell division- centrosomes Prokaryotes- have cell membrane Eukaroycte- have cell wall Nucleotide is sugar phosbate and base DNA- A G C T RNA A G C U Complementary- AT CG AU Transcription is DNa to mRNA Translation is mRNA to tRNa Andicodon on tRNA cDNA is complementart DNA syntheisized fromm RNA rather than DNA rRNA- 80% virus have single stranded DNA RNA polymerase is in transcription mRNA DNA transferase cataylses moving of specific functional grouos such as phosphate DNA isomerase- isomeraisation DNA lyase- cutting apart DNA ligase joining together Reverse transcriptase is used to make DNa from rna it is a RNA dependent DNA polymerase NNRTI- reverse transcriptase inhibitiors and it is a virus DNA synthesis by reverse ranscriptase- inhibits by AZT Hapten is a low MW compound that act as an immunogen by chemically complexing to a large molecue at the cell surface

PCR is used to make a bigger DNA chain or to amplify it- can be used in finger printing 1st step is denaturation and the DNA heated o 96 0C to break it up done for 9 minutes and oly used in DNa that need heat activation Denaturation is then used heating to 96-98 degrees for 20 -30 mins so DNA double strand is broken and as hydrogen bonds are broken Annealing step- lower the temp to 50-60 degrees to allow the bonds to reform between the base pairs Elongation depends on the tem and Taq polymerase is usedExtension/elongation step: The temperature at this step depends on the DNA polymerase [12][13] used; Taq polymerase has its optimum activity temperature at 7580 C, and commonly a temperature of 72 C is used with this enzyme. At this step the DNA polymerase synthesizes a new DNA strand complementary to the DNA template strand by adding dNTPs that are complementary to the template in 5' to 3' direction, condensing the 5'-phosphate group of the dNTPs with the 3'-hydroxyl group at the end of the nascent (extending) DNA strand. The extension time depends both on the DNA polymerase used and on the length of the DNA fragment to be amplified. As a rule-of-thumb, at its optimum temperature, the DNA polymerase will polymerize a thousand bases per minute. Under optimum conditions, i.e., if there are no limitations due to limiting substrates or reagents, at each extension step, the amount of DNA target is doubled, leading to exponential (geometric) amplification of the specific DNA fragment. Final elongation- is the single step and performed at the end to ensure the last DNA is fully extended done at 70-74oC for 15 mins Final hold: This step at 415 C for an indefinite time may be employed for short-term storage of the reaction _______________________________________________________________________

Chapter 17- Pharmacogenetics This is when genetic differences in individuals can affect the way that the drugs work or are metabolized in their bodies and the drug response This allows drugs to be made that are customized to each persons genetic mark up and they used for cytochrome enzymes that are responsible for drug interactions. The first step is a detailed analysis of teach of the genes un a single nucleotide polymorphism SNP- single nucleotide polymorphism- is used when one base pair on a nucleotide replaces another- A single base differences exist between individuals- this is the most commogenetic variation In DNA. Defective splicing- is which an internal polypeptide segment is abnormally removed and the ends are then joined.

Gene therapy This is the use of genes to cure diseases by altering a single defective gene like in cystic fibrosis Eg drugs used are HER2 receptor genes and traszumatab used for breast cancerHER2 Rna inhibitor

Immunology In organ transplant rejection due to infiltration of T cells Most common antibody is IgG Munorab ad Monoclonal antibody attack CD4 igM first produced when exposed to an antigen igE activated in asthma patients acute graft rejection is type 2 tuberculin test is type 4 infliximab is for RA and chrons disease hapten is low molecular weight molecule that covalently binds to a larger molecule infliximab is iv hashimoto is hypothyroidism and is type 2- organ specific autoimmune diease acute graft rejection is type 2 igE mediates type 1 poison ivy is type 4 neutrophil- respond to bacterial and fungal infection monocytes hightest cell in the body basophils not mast cells penicillin hypersensitivity type 1 lupus drugs HIPP MCQ- hydralazine- isonazid- procanamide- penicillamine- methyldopachlorpromazine qunidine SLE is type 3 non organ specific autoimmune rd Steven Johnson- od of pshycotics or TCA- rash- photosensitivity feverer 3 degree burns SASPAN- sulphonamides phenytoin allopurinol nsaids sulfoxazole Red man syndrome vancomycin Gluten in wheat and rye ____________________________________________________________________________

Immunization High risk for flu jab- 6month- 2 year kids, egg allergy, asthma, cvd, pregnancy and seniors Who should not take- < 6 month- egg allergy and flu symptoms Live vaccines not given to pregnant and immunocompromised Live vaccine eg MMR, varciella, yellow fever, small pox- sabine polio Flu vaccine is killed vaccine and effective against influenza a and b Killed vaccine- flu, hepatitis A and B, thypoid, cholera Travellers should take Hep A and B Hep C is chronic hepatitis Hep B vaccine protects against Hep D Dukoral oral vaccine is for E coli and cholera- - two doses one week apart and the last one a week before you travel- High risk latin America- south east asia and Africa ( basically poor countries) Giadardisil is used for papilloma virus Biotechnology -Anameia with chemotherapy- chronic renal disease- erythropoietin -anaemia for cancer chemotherapy and chronic dialyisis and AZT- epoeitn alph and darpoeitn -Neutropenia associated with chemotherapy- filgristim -TNF alpha and beta- enterecept -Graft rejection- muromonab -Chrons and ra is infliximab -haemophilia A def of clotting factor 8 -muromonab attacks CD4 cells Vaccnes Ascorbic acid can detoxify the urine Conjcation reaction is the one that causes acetominphen toxicity