CASE 4 All Notes
CASE 4 All Notes
CASE 4 All Notes
COMBINED PILL
‘mini-pill’. Needs to be taken at the same time everyday because it stops working as soon as you
miss one and it doesn’t prevent ovulation as effectively
o This means NO WITHDRAWAL BLEED
o Works by thickening the cervical mucous, reduce fallopian tube’s cilia activity to prevent egg
from travelling from the ovary
o If pill is stopped, mucous changes are quickly reversed -> not very efficient
3 hour pill
o Levonorgestrel or norethisterone
o If one is missed, needs to be taken within 3 hours
12 hour pill
o Desogestrel
o If one is missed, needs to be taken within 12 hours
Prescribed to people who have just given birth or are breastfeeding
Used to delay menstruation – especially in women who have irregular periods due to menopause
EMERGENCY CONTRACEPTION
INTRAUTERINE DEVICES
Combined
o Patch – 1 patch a week, 3 patches then break. Might fall off and cause skin irritation
o Vaginal ring – lasts 21 days, works in diarrhoea, can come out but easily reinserted, works
straight away if started witing day 5 of cycle
Progesterone only
o Subdermal implant – under the skin and lasts 3 years, CONTRAINDICATED – liver disease,
heart disease, stroke or breast cancer
o Injection – lasts 8-13 weeks, might take up to a year for menstrual cycle to return to normal
after stopping, not affected by other medicine
BARRIER METHODS
STERILISATION
Pharmacology of antibiotics
Antibiotic – can be used to treat bacterial infection and cancer and sometimes some fungi/ protozoa.
Synthesised in vivo by bacteria or fungi
Chemotherapeutic – used to treat bacterial infection and cancer. Synthesised in a lab
TARGETS FOR ANTIMICROBIALS
Inhibitors of cell wall synthesis – -Lactams (penicillin and cephalosporins) – mainly for GRAM
POSITIVE infections
o Glycopeptides - Vancomycin – different MOA – treatment for MRSA (gram positive)
BACTERICIDAL effect
o Cephalosporin – Neisseria Gonorrhoea (gram negative) treatment as Gonorrhoea is
completely resistant to penicillin
o Gonorrhoea and chlamydia tend to have co-infection (together), so cephalosporins and
azithromycin (to treat chlamydia intracellularly) are used in combination
This is helpful because it helps reduce the chance of gonorrhoea developing
resistance to cephalosporins.
In addition, some gonorrhoea phagocytosed by neutrophils can also be killed quicker
as azithromycin penetrates cell wall
o Penicillin - BACTERICIDAL effect
Penicillin binds to penicillin binding proteins (PBP)
This prevents cross-linking of peptides within the peptidoglycan cell wall
Prevention of resistance
In serious infection
Infection with more than 1 microorganism
Unknown microorganism
Enhanced efficacy – SYNERGISM
SYNERGISM - this means the net effect of using the two antibiotics at the same time is bigger than the
additive effect (e.g aminoglycoside (protein synthesis inhibitor) used with penicillin (cell wall synthesis
inhibitor)- penicillin weakens cell wall and allows aminoglycosides to enter an effectively kill bacteria)
Selective toxicity: antimicrobials can affect bacteria without major effects on host mammalian cells.
However, at higher concentrations, the drug can cause side effects by affecting human cells
Therapeutic index: difference between effectiveness and toxicity
Mycoplasma/ urea plasma – don’t have a cell wall, so no penicillin binding protein
Bacteria may have polymorphism – slightly different sequence of penicillin binding protein
Inaccessible – e.g. chlamydia where the bacteria grows intracellularly
Bacteria can naturally express Beta lactamase (S. Aureus)
o Beta lactamase can cleave the beta-lactam ring in penicillin and cephalosporins, therefore
making them inactive
o This resistance can be overcome by clavulanic acid – mimics beta lactam antibiotics and
inhibits beta lactamase in bacteria
o Clavulanic acid has no antibiotic activity itself, therefore this is NOT synergism
o Co-amoxiclav – combination of amoxicillin (penicillin) and clavulanic acid
Acquired – genetic shift – transfer or resistance between strains, acquired beta lactamase
expression
Lipid soluble – body fats, cells, CSF In meningitis, BBB is broken down, so it
o Well absorbed, well distributed is easier for penicillin (hydrophilic) to
Polar drugs (extracellular – plasma and tissue) enter the CSF and reach therapeutic
o Can’t cross BBB, can’t get into cells levels. Over time uptake of penicillin is
o Low volume of distribution reduced as BBB has recovered
o pH dependent
POLYPHARMACY
Competition for metabolic pathway -> shortage of enxymes, slower metabolism, accumulation of
toxic products
Inhibition of the function of the liver (fluroquinolones, macrolides)
o This is problematic is patient is on warfarin
o If warfarin increases, patient starts bleeding
Activation of the function of the liver – rifampicin – TB treatment
o Increases metabolism of the oral contraceptive pill -> reduced half life of contraceptive pill ->
increased risk of pregnancy
A given agent can be bacteriostatic and bactericidal in different conditions – depends on dosage of drug
and target of bacteria
Determined by
o Hydrostatic pressure
o Oncotic pressure
o Properties of the barrier (basement membrane)
GFR = K(f) x net filtration pressure
o K(f) determined by hydraulic properties and surface area
CREATININE
Ureter enters the bladder at angle, so that when the bladder muscle contract, a ‘valve’ is created
and the increased pressure doesn’t cause the urine to back up into the kidneys
o If this is impaired, a pool of urine collects in the bladder/ ureter, increasing risk of infection
PRIMARY VUR – resolves as patient grows older
o Incompetent ureterovesical junction
o Shortening of intravesical ureter
o Spontaneous resolution of growth
SECONDARY VUR
o High pressure bladder
o Dysfunctional voiding or neurogenic bladder (e.g. spina bifida)
Radiology tutorial
Ionising radiation – CT and radiographs and urethrogram
No ionising radiation – ultrasound and MRI and barium
Ultrasound
Air is white
Fluid is black
Solid structures are shades of grey