Philip Jacobson

@PhilipJacobson_

P4 Pharmacy Student | South Dakota State University ‘20 | Passionate about learning and understanding the why |

Vrijeme pridruživanja: studeni 2019.

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  1. Prikvačeni tweet
    11. sij

    1/ Aminoglycosides have poor activity against gram-positive organisms. So why can they be used in combination with a beta-lactam for some gram-positive infections? “Synergy” has always been my justification, but I’ve never understood the true mechanism….

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  2. 3. velj

    The use of daptomycin for infections caused by viridans group streptococci is NOT recommended 🛑 VGS can rapidly develop resistance to daptomycin despite in vitro susceptibility 🦠

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  3. 21. sij

    The presence of Cushing’s Triad (below) is a sign of increased intracranial pressure. - Bradycardia - Decreased, irregular respirations - Systolic hypertension (wide pulse pressure)

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  4. 15. sij
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  5. 15. sij

    Hypercapnia in COPD patients receiving oxygen is NOT due to decreased respiratory drive 🤯 Rather, it’s due to ventilation-perfusion mismatch and the Haldane effect.

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  6. 11. sij

    6/ 
 Unfortunately, the synergistic mechanism for viridans group strep and staphylococci is not well understood.

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  7. 11. sij

    5/ When used on their own, neither antibiotic is ideal for IE due to enterococci. Gentamicin has poor entry across the cell membrane and ampicillin is bacteriostatic. In combination, ampicillin helps facilitate intracellular uptake of gentamicin for a rapid bactericidal effect.

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  8. 11. sij

    4/ Is gentamicin improving the activity of ampicillin or vice versa? From what I found, the mechanism of aminoglycoside synergy has only been described for enterococci.

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  9. 11. sij

    3/ While it may not be preferred in some instances, it’s still an option. In this case, synergy implies that the combination of a beta-lactam and an aminoglycoside (ampicillin + gentamicin) is more effective than either on their own.

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  10. 11. sij

    2/ In my (limited) experience, the combination is most commonly used in endocarditis. The IDSA endocarditis guidelines list a gentamicin-containing regimen for the treatment of IE caused by enterococci, viridans group strep, and (prosthetic valve) staphylococci.

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  11. 9. sij

    Lastly, Gulf War Illness may be present in a substantial amount of Veterans who fought in the Gulf War. Up to 1/3 of Gulf war veterans (~250,000) show symptoms of Gulf War Illness.

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  12. 9. sij

    The cause of Gulf War Illness is still debated. Here are some of the proposed causes: - Low-level exposure to sarin gas - The use of pyridostigmine as an anti-nerve gas agent - Pesticide exposure

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  13. 9. sij

    Gulf War Illness is due to chronic CNS inflammation. Symptoms are largely non-specific and may include tremor, memory issues, fatigue, headache, and more.

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  14. 9. sij

    I recently heard about Gulf War Illness for the first time. As a VA pharmacy intern, I had learned a lot about Agent Orange exposure, but never Gulf War Illness. Here’s what I learned!

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  15. 2. sij

    Cefiderocol has activity against resistant gram-negative organisms including pseudomonas and carbapenemase-producing organisms. It is INACTIVE against gram positives and anaerobes. Lastly, it should be reserved for patients with no alternative treatment options.

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  16. 2. sij

    Cefiderocol (Fetroja®) is an IV cephalosporin recently approved for complicated UTI, including pyelonephritis. It's mechanism of entry into bacterial cells is very unique! As a siderophore, it binds to iron and uses the bacterial iron transport system for entry.

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  17. 13. pro 2019.

    Lastly, GPA did NOT have a statistically significant association for invitation to a pharmacy residency interview.

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  18. 13. pro 2019.

    Cannabis has multiple drug interactions. Pharmacokinetic drug interactions are related to CBD, while pharmacodynamic drug interactions are related to THC. Renal clearance increases in obesity. However, the increase is not proportional to the increase in body weight.

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  19. 13. pro 2019.

    High dose cefepime may cause neurotoxicity. Despite its labeling contraindication, propofol is likely safe in patients with egg allergies. At high doses, ketamine activates opioid receptors. However, its pain-relieving effects are not reversed by naloxone.

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  20. 13. pro 2019.

    Voriconazole displays non-linear kinetics. For posaconazole and itraconazole, oral and liquid dosage forms are NOT bioequivalent. Shock Index (SI) may be used to assess blood loss and degree of shock. SI = HR/SBP

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