Real Time Pharmacology

Discharge Diagnoses:  1. Gram negative septic shock, E.coli  2. Hypotensive syncope, GLF, C2 fx, rib fx  3. C2 cervical fracture due to GLF/syncope due to hypotension/shock  4. Metabolic Encephalopathy 5. Atrial fibrillation with RVR  6. Right heart failure  7. Pulmonary hypertension  8. Urinary tract infection, present on admission  9. Hyperkalemia  10. Rib fractures, right 6-8  11. Acute kidney injury  12. Aortic stenosis, Mild  13. Mitral stenosis, Mild  14. Scalp laceration  15. Oral thrush  16. Cellulitis of left foot  My input: Would it have been better to prescribe Macrobid 100 mg because of DD interaction of bactrim with warfarin, (Her INR went up from 2.4 to 2.6 in one day) informed the ID doctor about the possibility of switching the medication. Will look in to sensitivtiy labs Little bit about Kionex: FDA use:  Hyperkalemia   Hyperkalemia Adult Dose Average dosage, 15 to 60 g/day given a...

Current vaccines were developed targeting initial SARS-CoV-2 that emerged in 2019.  Spike protein mutations present new challenges for mAb therapy and threaten the protective efficacy of current vaccines.  Recent emergence of new SARSCoV-2 variants B.1.1.7 in the UK. and B.1.351 in South Africa is of concern. South African variant B.1.351 is markedly more resistant to neutralization by convalescent plasma (~11-33 fold) and vaccine sera (~6.5-8.6 fold).  .   B.1.351 contains 9 spike mutations in addition to D614G, including a cluster of mutations (e.g., 242-244del & R246I) in NTD, three mutations (K417N, E484K, & N501Y) in RBD, and one mutation (A701V) near the furin cleavage site  Many of the mutations reside in the antigenic supersite in NTD or in the ACE2-binding site (also known as the receptor binding motif—RBM) that is a major target of potent virus-neutralizing antibodies.  Vaccinee Sera  Sera were obtained from 1 2 participants of a Phas...

  Known safety profile: inactivated vaccines better known than protein subunit and nucleic acid and these two are better than viral vector Whole virus vaccines use a weakened (attenuated) or deactivated form of the pathogen that causes a disease to trigger protective immunity to it.  There are two types of whole virus vaccines.  1. Live attenuated  vaccines use a weakened form of the virus, which can still grow and replicate, but does not cause illness. 2.  Inactivated vaccines  contain viruses whose genetic material has been destroyed by heat, chemicals or radiation so they cannot infect cells and replicate, but can still trigger an immune response. Both are known, tried and tested vaccination strategies, which form the basis of many existing vaccines – including those for yellow fever and measles, shingles (live attenuated vaccines), or seasonal influenza and hepatitis A (inactivated vaccines).  ADVANTAGES AND DISADVANTAGES OF LIVE ATTENUATED VACCI...

  Entering a Cell After injection, the vaccine particles bump into cells and fuse to them, releasing mRNA. The cell’s molecules read its sequence and build spike proteins. The mRNA from the vaccine is eventually destroyed by the cell, leaving no permanent trace. Spike protein coming outside the cell and bumping into antigen presenting cell Helper T cell being activated Helper T cell bumping in to B cell and B cell producing antibodies The S protein is made up of 1,160 to 1,400 amino acids, depending upon the type of virus. I n addition to its role in penetrating cells, the S protein of viruses, particularly the SARS-CoV-2 virus, is a major inducer of neutralizing antibodies  (NAbs). NAbs are protective antibodies that are naturally produced by our humoral immune system. Functional S protein ALLOWS viruses like the novel SARS-CoV-2 to interact with receptors of potential host cells. As a result, the S protein represents an ideal target for vaccine and antiviral drug discovery. ...

Current Hospital Diagnosis: Woman-76 year old 1. Upper GI bleed  2. Acute blood loss anemia  3. Gastric hemorrhage due to gastric antral vascular ectasia (GAVE)  4. Acute‐on‐chronic kidney injury ‐‐‐‐‐Improving with diuresis  5. Congestive heart failure‐‐acute on chronic  6. Right‐sided heart failure ‐‐‐‐‐Continue diuresis.  7. OSA (obstrucve sleep apnea) ‐‐Continue CPAP  8. Tricuspid regurgitaon 9. S/P bioprosthec MVR (mitral valve replacement) on 10. Atrial fibrillaon s/p MAZE and excision of le atrial appendage No anticoagulation right now given bleeding 11. Hypercoagulable state, secondary  12. Malnutrion ‐‐Moderat...