Real Time Pharmacology

 Stroke patient (69 year old) with low energy levels and tardive dyskinesia What is Co-Q 10? Ubiquinone or Co Q 10  is a vitamin like substance and is a cofactor of an enzyme. It is present in the mitocondrial membranes where it is involved in the energy production.  The most common Coenzyme Q in human mitochondria is Co Q 10 . 'Q'  represents quinone head and 10 refers to the number of isoprene repeats in the tail.  Dietary CoQ 10 -supplementation was associated with demonstrable benefits in CPZ-induced Parkinsonism-like changes in mice. Clinical effects have not been well studied in humans. Meat (10-120 mg/kg) and oils (10-280 mg/kg) are the richest sources of dietary Co Q 10 References: 1.  Onaolapo OJ, Odeniyi AO, Jonathan SO, Samuel MO, Amadiegwu D, Olawale A, Tiamiyu AO, Ojo FO, Yahaya HA, Ayeni OJ, Onaolapo AY. An Investigation of the Anti-Parkinsonism Potential of Co-enzyme Q 10  and Co-enzyme Q 10  /Levodopa-carbidopa Combination in ...

  West Nile virus (WNV) is most commonly spread to people by the bite of an infected mosquito. In humans, disease ranges from asymptomatic infection, seen frequently, to encephalitis/paralysis and death, seen rarely.  Symptoms No symptoms in most people.  Most infected individuals  (8 out of 10) do not experience any symptoms. Fever:  About 1 in 5 infected individuals have a fever with other mild symptoms such as rash, headache, body aches, joint pains, vomiting, and diarrhea Serious symptoms   About 1 in 150 infected individuals develop a severe illness affecting the central nervous system such as encephalitis (inflammation of the brain) or meningitis (inflammation of the membranes that surround the brain and spinal cord) About 1 out of 10  people who develop severe illness affecting the central nervous system die. Y ou can reduce your risk of WNV by wearing long-sleeved shirts, long pants, masks, gloves and goggles  to prevent mosquito b...

Acute Lacunar Infarct of PONS: A quarter of all ischaemic strokes (a fifth of all strokes) belong to lacunar type. Lacunar infarcts are  noncortical infarcts,   small infarcts (2–20 mm in diameter) in the deep cerebral white matter, basal ganglia, or pons,  caused by occlusion of a single penetrating branch of a cerebral artery. Female 75-year old

Molnupiravir   is a prodrug  of the synthetic nuceloside  derivative N4-hydroxycytidine,  currently tested in a Phase 2/3 trial against SARS-COV-2 that is set to be completed in May 2021. Big question: Molnupiravir is structurally similar to cytarabine, will it also have side effects similar to cytarabine? Cytarabine: References: 1. https://clinicaltrials.gov/ct2/show/NCT04405739 2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/071868s032lbl.pdf 3. https://www.biorxiv.org/content/10.1101/2020.03.30.016485v1.full.pdf

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...