Get Blueprints Series: Surgery PDF

By Seth J. Karp MD, James P.G. Morris MD

ISBN-10: 1405103329

ISBN-13: 9781405103329

Greater than simply Board assessment for USMLE, Steps 2 & three, Blueprints surgical procedure, third version may help in the course of clerkship rotations and subinternship. the recent version has been up to date with assistance from citizens to take care of a student-to-student method. good points contain:

Concise, exact, scientific high-yield content material overlaying all you want to understand for the USMLE and rotations

USMLE kind questions with complete causes supplied within the solutions

Key issues in each part highlighting crucial, high-yield details for every subject

Color-enhanced layout to extend the usefulness of figures and tables

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Known polymorphisms in these enzymes require a drug dosage adjustment. If 2 drugs are metabolized by the same CYP isozyme, they can interfere with each other’s normal route or rate of metabolism, and a drug interaction may decrease or increase plasma drug concentrations. An example is interaction between fluoxetine (a selective serotonin reuptake inhibitor) and St John’s wort. 31 BASIC PRINCIPLES Pharmacokinetics Drug or other factors increase synthesis or reduce degradation of enzyme INDUCTION Drug Decreased levels of all drugs metabolized by enzyme Other drugs metabolized by same CYP CYP450 enzyme Increased metabolites Metabolites CYP Inducers Inhibitors 1A2 Smoking, charbroiled foods, cruciferous vegetables, insulin, modafinil, nafcillin, omeprazole, phenobarbital, primidone, rifampin Amiodarone, anastrozole, cimetidine, ciprofloxacin, diltiazem, enoxacin, erythromycin, fluoroquinolones, fluvoxamine, grapefruit (juice), mexiletine, norfloxacin, ritonavir, tacrine, ticlopidine 2A6 Dexamethasone, phenobarbital Methoxsalen, ritonavir, tranylcypromine 2B6 Cyclophosphamide, dexamethasone, phenobarbitol, phenytoin, primidone, rifampin Efavirenz, nelfinavir, orphenadrine, ritonavir, thiotepa, ticlopidine 2C8/9 Dexamethasone, primidone, rifampin, secobarbital Anastrozole, amiodarone, cimetidine, diclofenac, disulfiram, fluconazole, fluvoxamine, flurbiprofen, fluvastatin, isoniazid, ketoprofen, lovastatin, metronidazole, omeprazole, paroxetine, phenylbutazone, ritonavir, sertraline, sulfinpyrazone, sulfonamides, sulfamethoxazole, trimethoprim, troglitazone, zafirlukast 2C19 Barbituates, rifampin Cimetidine, ketoconazole, modafinil, omeprazole, oxcarbazepine, ticlopidine 2D6 Dexamethasone, quinidine, rifampin Amiodarone, buproprion, celecoxib, chlorpromazine, chlorpheniramine, cimetidine, clomipramine, cocaine, doxorubicin, fluoxetine, fluphenazine, fluvoxamine, haloperidol, lomustine, metoclopramide, methadone, norfluoxetine, paroxetine, perphenazine, propafenone, quinidine, ranitidine, ritonavir, sertindole, sertraine, terbinafine, thioridazine, venlafaxine, vinblastine, vinorelbine 2E1 Acetone, ethanol, isoniazid Disulfiram, ritonavir 3A4 Barbituates, carbamazepine, dexamethasone, efavirenz, macrolides, glucocorticoids, modafinil, nevirapine, oxcarbazepine, phenobarbital, phenylbutazone, pioglitazone, phenytoin, primidone, rifabutin, rifampin, St John’s wort, sulfinpyrazone, troglitazone Amiodarone, anastrozole, chloramphenicol, cimetidine, ciprofloxacin, clarithromycin, clotrimazole, danazol, delavirdine, diltiazem, erythromycin, fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, mibefradil, miconazole, nefazodone, nelfinavir, nevirapine, norfloxacin, norfluoxetine, omeprazole, paroxetine, propoxyphene, quinidine, ranitidine, ritonavir, saquinavir, sertindole, troglitazone, troleandomycin, verapamil, zafirlukast, zileuton INHIBITION Drug Inhibition of enzyme Increased levels of all drugs metabolized by enzyme Other drugs metabolized by same CYP CYP450 enzyme Decreased metabolites Metabolites Figure 1-31 Metabolic Enzyme Induction and Inhibition Multiple factors, including drugs, can either increase or decrease metabolic enzyme activity.

Nuclear Protein Receptor Phospholipase C ␣ ATP R R Inactive PKA 2B. G Protein–Coupled Receptor Receptor ␣ Adapter protein P P P P P P Monomeric G protein MAP kinase Transcription factors Effect mRNA Protein synthesis Nitric oxide synthase NOS Arg GTP NO N O SGC Soluble guanylate cyclase cGMP Effect Figure 1-13 Second-Messenger Pathways Signal transduction commonly occurs by means of several general mechanisms: (1) ligand-gated ion channels modulate the influx or outflow of ions that alter transmembrane potential or modulate intracellular biochemical reactions (eg, the calciumcalmodulin system); (2) ligand binding to GPCRs modulates enzyme activity (eg, adenylyl cyclase or phospholipase C); (3) ligand binding activates a catalytic portion of the receptor (eg, tyrosine kinase activity); (4) a ligand enters the cell nucleus and alters protein (receptor) synthesis; and (5) a ligand amplifies or attenuates nitric oxide synthesis and the subsequent production of cGMP.

31 BASIC PRINCIPLES Pharmacokinetics Drug or other factors increase synthesis or reduce degradation of enzyme INDUCTION Drug Decreased levels of all drugs metabolized by enzyme Other drugs metabolized by same CYP CYP450 enzyme Increased metabolites Metabolites CYP Inducers Inhibitors 1A2 Smoking, charbroiled foods, cruciferous vegetables, insulin, modafinil, nafcillin, omeprazole, phenobarbital, primidone, rifampin Amiodarone, anastrozole, cimetidine, ciprofloxacin, diltiazem, enoxacin, erythromycin, fluoroquinolones, fluvoxamine, grapefruit (juice), mexiletine, norfloxacin, ritonavir, tacrine, ticlopidine 2A6 Dexamethasone, phenobarbital Methoxsalen, ritonavir, tranylcypromine 2B6 Cyclophosphamide, dexamethasone, phenobarbitol, phenytoin, primidone, rifampin Efavirenz, nelfinavir, orphenadrine, ritonavir, thiotepa, ticlopidine 2C8/9 Dexamethasone, primidone, rifampin, secobarbital Anastrozole, amiodarone, cimetidine, diclofenac, disulfiram, fluconazole, fluvoxamine, flurbiprofen, fluvastatin, isoniazid, ketoprofen, lovastatin, metronidazole, omeprazole, paroxetine, phenylbutazone, ritonavir, sertraline, sulfinpyrazone, sulfonamides, sulfamethoxazole, trimethoprim, troglitazone, zafirlukast 2C19 Barbituates, rifampin Cimetidine, ketoconazole, modafinil, omeprazole, oxcarbazepine, ticlopidine 2D6 Dexamethasone, quinidine, rifampin Amiodarone, buproprion, celecoxib, chlorpromazine, chlorpheniramine, cimetidine, clomipramine, cocaine, doxorubicin, fluoxetine, fluphenazine, fluvoxamine, haloperidol, lomustine, metoclopramide, methadone, norfluoxetine, paroxetine, perphenazine, propafenone, quinidine, ranitidine, ritonavir, sertindole, sertraine, terbinafine, thioridazine, venlafaxine, vinblastine, vinorelbine 2E1 Acetone, ethanol, isoniazid Disulfiram, ritonavir 3A4 Barbituates, carbamazepine, dexamethasone, efavirenz, macrolides, glucocorticoids, modafinil, nevirapine, oxcarbazepine, phenobarbital, phenylbutazone, pioglitazone, phenytoin, primidone, rifabutin, rifampin, St John’s wort, sulfinpyrazone, troglitazone Amiodarone, anastrozole, chloramphenicol, cimetidine, ciprofloxacin, clarithromycin, clotrimazole, danazol, delavirdine, diltiazem, erythromycin, fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, mibefradil, miconazole, nefazodone, nelfinavir, nevirapine, norfloxacin, norfluoxetine, omeprazole, paroxetine, propoxyphene, quinidine, ranitidine, ritonavir, saquinavir, sertindole, troglitazone, troleandomycin, verapamil, zafirlukast, zileuton INHIBITION Drug Inhibition of enzyme Increased levels of all drugs metabolized by enzyme Other drugs metabolized by same CYP CYP450 enzyme Decreased metabolites Metabolites Figure 1-31 Metabolic Enzyme Induction and Inhibition Multiple factors, including drugs, can either increase or decrease metabolic enzyme activity.

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Blueprints Series: Surgery by Seth J. Karp MD, James P.G. Morris MD


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