Nizoral

Angela Earhart, MD

• Division of Maternal Fetal Medicine
• Department of Obstetrics and Gynecology
• The Methodist Hospital-Houston
• Houston, Texas

When exposed to gastric acid fungus hives generic nizoral 200 mg mastercard, pepsinogen is converted to pepsin antifungal on lips order nizoral with a visa, an active enzyme that is proteolytic and promotes digestion anti fungal wall paint buy nizoral 200 mg overnight delivery. Tell the patient that antacids or other medications affecting stomach acidity or gastrointestinal motility should be discon tinued topical antifungal yeast infection quality 200 mg nizoral, if possible fungus gnats harmful order nizoral online now, for at least 48 hours before collection fungus gnats boiling water order nizoral with visa. After skin anesthesia is performed, a large-bore pericar diocentesis needle is placed on a 50-mL syringe and introduced into the pericardial sac 34). Some patients who have recurring cardiac tamponade may require placement of an indwelling pericardial catheter. Note the following possibilities: Usually the fluid is taken to the chemistry laboratory, where the color, turbidity, glucose, albumin, protein, and lactic dehydrogenase levels are obtained. When catecholamine levels are excessive (norepinephrine >2000pg/mL), the diagnosis is easily made. However, when basal levels are not significantly elevated, it is difficult to differentiate essential hypertension from a functioning pheochromocytoma. Clonidine is normally a potent suppressor of catecholamine production, yet it has little to no effect on catecholamines in patients with pheochromocytoma. The terms phosphorus and phosphate are used interchangeably throughout this and other discussions. It is the inorganic phosphate that is measured when one requests a phosphate, phosphorus, inorganic phosphorus, or inorganic phosphate. The absorption is very efficient, and only rarely is hypophosphatemia caused by gastrointestinal malabsorption. Abnormal findings Decreased blood levels Hypertension Preeclampsia notes 710 plasminogen plasminogen (Fibrinolysin) Type of test Blood Normal findings 2. This fibrinolytic system is a normal part of the balance between coagulation and fibrinolysis. Plasminogen levels are occasionally measured during fibrinolytic therapy (for coronary and peripheral arterial occlusion) and are diminished with full fibrinolysis. Because plasminogen is made in the liver, patients with cirrhosis or other severe liver diseases can be expected to have decreased levels. Inflammatory conditions may have mild elevations of plasminogens, which are acute-phase reactant proteins. Abnormal findings Increased levels Decreased levels Acute coronary syndrome Bleeding disorders Coronary artery disease Restenosis after coronary angioplasty Infection Inflammation Trauma Diabetes mellitus Insulin resistance syndrome Pregnancy notes P 714 platelet aggregation test platelet aggregation test Type of test Blood Normal findings Dependent on the platelet agonist used Test explanation and related physiology Platelet aggregation is an important part of hemostasis. After this step, the normal coagulation factor waterfall occurs (see Figure 10, p. Congenital syndromes, uremia, myeloproliferative disorders, and certain drugs are associated with abnormal platelet aggregation. If blood is passed through a heart-lung or dialysis pump, platelet injury can occur and aggregation can be reduced. Antibodies directed to platelets cause early destruction of the platelets and subsequent thrombocytopenia. The diagnosis is suspected based on clinical symptoms, recent heparin administration, and low platelet counts. It is performed on patients who develop petechiae (small hemorrhages in the skin), spontaneous bleeding, or increasingly heavy menses. Common associative diseases with thrombocytosis are iron deficiency anemia and malignancy (leukemia, lymphoma, or solid tumors, such as those involving the colon). In a platelet function analyzer, anticoagulated whole blood is passed over membranes at a standardized flow rate, creating high shear rates that result in platelet attachment, activation, and aggregation on the membrane. This is one of several aspirin resistance tests that are performed to determine the effectiveness of aspirin on inhibiting platelet aggregation and thereby protecting the patient from vascular thromboembolic disease (Table 28). Elevated values are associated with an increased risk of acute ischemic stroke and myocardial infarction. Effective aspirin therapy should reduce the level of this metabolite in the urine. This test requires one normal extremity against which the other extremities may be compared. Arterial plethysmography is performed by applying three blood pressure cuffs to the proximal, middle, and distal parts of an extremity. A reduction in amplitude of a pulse wave in any of the three cuffs indicates arterial occlusion immediately proximal to the area where the decreased amplitude is noted. A positive result is reliable evidence of arteriosclerotic peripheral vascular occlusion. Nicotine creates constriction of the peripheral arteries and alters the test results. It is also performed when chest imaging indicates a pleural-based tumor, reaction, or thickening. The advantage of an open procedure is that a larger piece of pleura can be obtained. After the presence of fluid has been determined by the thoracentesis technique, the skin overlying the biopsy site is anesthetized and pierced with a scalpel blade. The inner needle is removed, and a blunt-tipped, hooked biopsy trocar attached to a three-way stopcock is inserted into the cannula. The cannula and biopsy trocar are withdrawn while the hook catches the parietal wall and takes a specimen with its cutting edge. In most forms of porphyria, increased levels of porphyrins and porphobilinogens are found in the urine. Heavy metal (lead) intoxication is also associated with increased porphyrins in the urine. They are accurate, however, in screening for porphyria, especially the intermittent variety. These assays are predominantly used to differentiate the various forms of congenital porphyrias. Interfering factors Drugs that may alter test results include aminosalicylic acid, barbiturates, chloral hydrate, chlorpropamide, ethyl alcohol, griseofulvin, morphine, oral contraceptives, phenazopyridine, procaine, and sulfonamides. P Certain radioactive chemical compounds provide specific information depending on the information required and the organ being evaluated. These composite views, which allow the information from two different studies to be digitally correlated and superimposed onto one image, lead to more precise 732 positron emission tomography information and accurate diagnoses. Epilepsy, Parkinson disease, and Huntington disease are identified as localized areas of increased metabolic activity indicating rapid nerve firing. These agents bind to the beta-amyloid plaques that are increased in patients with Alzheimer disease. These images are used to detect areas of abnormal bone growth associated with tumors. The uptake of 18F NaF in the skeleton reflects sites of increased blood flow and bone remodeling associated with bone injury or metastatic disease. If the patient is anxious, sedatives can be administered 30 minutes before testing. Instruct patients with diabetes to take their pretest dose of insulin at a meal 3 to 4 hours before the test. Extraneous auditory and visual stimuli are minimized by a blindfold and ear plugs. If the chest is being scanned, instruct the patient to breathe in a shallow manner until the middle of the chest is reached. Abnormal findings Myocardial infarction Huntington disease Coronary artery disease Dementia Cerebrovascular accident Alzheimer disease Epilepsy Malignant tumor Parkinson disease notes 736 potassium, blood potassium, blood (K) Type of test Blood Normal findings Adult/elderly: 3. Intracellular K concentration is approximately 150mEq/L, whereas normal serum K concentration is approximately 4mEq/L. Symptoms of hyperkalemia include irritability, nausea, vomiting, intestinal colic, and diarrhea. Instruct the patient to avoid opening and closing the hand after a tourniquet is applied. Drugs that may cause increased levels include diuretics, gluco corticoids, and salicylates. Test explanation and related physiology Prealbumin is one of the major plasma proteins. However, prealbumin is secondary to thyroxine-binding globulin in the transportation of triiodothyronine (T3) and thyroxine (T4). Because prealbumin levels in serum fluctuate more rapidly in response to alterations in synthetic rate than do those of other serum proteins, clinical interest in the quantification of serum prealbumin has centered on its usefulness as a marker of nutritional status. Because prealbumin has a short half-life, it is a sensitive indicator of any change affecting protein synthesis and catabolism. Prealbumin is also a negative acute phase reactant protein; serum levels decrease in inflammation, prealbumin 741 malignancy, and protein-wasting diseases of the intestines or kidneys. Increased levels of prealbumin occur in Hodgkin disease and chronic kidney disease. Drugs that may cause increased levels include anabolic ster oids, androgens, and prednisolone. Drugs that may cause decreased levels include amiodarone, estrogens, and oral contraceptives. However, in Down-affected pregnancy, serum levels are half that of unaffected pregnancies. This test is commonly used in conjunction with other pregnancy and maternal screening tests (p. Assist the patient in scheduling and obtaining more accurate diagnostic testing if the results are positive. Hormone assays for urinary pregnanediol are primarily used today to monitor progesterone supplementation in patients with an inadequate luteal phase. Drugs that may cause decreased levels include oral contracep tives and progesterones. Abnormal findings Increased levels Decreased levels Ovulation Threatened abortion Pregnancy Fetal death Luteal cysts of ovary Toxemia of pregnancy Arrhenoblastoma of ovary Amenorrhea Hyperadrenocorticalism Ovarian hypofunction Choriocarcinoma of ovary Placental failure Adrenocortical hyperplasia Preeclampsia Ovarian neoplasm Breast neoplasm notes P 746 progesterone assay progesterone assay Type of test Blood Normal findings <9 years: <20 ng/dL 10-15 years: <20 ng/dL Adult male: 10-50ng/dL Adult female Follicular phase: <50 ng/dL Luteal: 300-2500 ng/dL Postmenopausal: <40 ng/dL Pregnancy First trimester: 725-4400ng/dL Second trimester: 1950-8250 ng/dL Third trimester: 6500-22,900ng/dL Test explanation and related physiology the major effect of progesterone is to induce the development of the secretory phase of the endometrium in anticipation of implantation of a fertilized ovum. Serum progesterone level is significantly increased during the second half of the ovulatory cycle. Normally, blood samples drawn at days 8 and 21 of the menstrual cycle show a large increase in progesterone levels in the latter specimen, indicating that ovulation has occurred. Progesterone levels should progressively rise during pregnancy because of placental production. Positive reactivity by immunohistochemistry is observed in the nuclei of the tumor cells. Interfering factors the use of such hormones as progesterone or estrogen may cause false-negative results. During sleep, prolactin levels increase twofold to threefold to circulating levels equaling those of pregnant women. It is elevated in patients with prolactin-secreting pituitary acidophilic or chromophobic adenomas. To a lesser extent, moderately high prolactin levels have been observed in women with secondary amenorrhea. In general, very high prolactin levels are more likely to be caused by pituitary adenoma than other causes. The prolactin level is helpful for monitoring the disease activity of pituitary adenomas. Drugs that may cause decreased values are clonidine, dopa mine, ergot alkaloid derivatives, and levodopa. After Inform the patient that no precautions need to be taken by others against radiation exposure because only tracer doses of radioisotopes are used. Ultrasound is very helpful in guiding the direction of a prostate biopsy 35) and in quantitating the volume of prostate cancer. When radiation therapy implantation is required for treatment, ultrasound is used to map the exact location of the prostate cancer. The depth of transmural involvement and presence of extrarectal extension can be accurately assessed. Significant barriers, such as prostate glandular tissue and vascular structure, are interposed between the prostatic lumen and the bloodstream. The major effect of albumin in the blood is to maintain colloidal osmotic pressure. Furthermore, albumin transports important blood constituents, such as drugs, hormones, and enzymes. Alpha2 globulins include serum haptoglobins (which bind hemoglobin during hemolysis), ceruloplasmin (which is a carrier for copper), prothrombin, and cholinesterase (which is an enzyme used in the catabolism of acetylcholine).

Story and science: How providers and parents can utilize storytelling to combat anti-vaccine misinformation fungus gnats bacillus thuringiensis effective nizoral 200 mg. How anecdotal evidence can undermine scientifc results: Why subjective anecdotes often trump objective data antifungal oral gel order nizoral 200 mg online. How trust in experts and media use afect acceptance of common anti-vaccination claims antifungal ointment for jock itch proven nizoral 200mg. Wellcome Global Trust Global Monitor: How does the world feel about science and health Exemplifcation in communication: the infuence of case reports on the perception of issues quince fungus purchase nizoral amex. Additional sections address prevalence antifungal research order nizoral with visa, mortality and morbidity antifungal talcum discount 200mg nizoral overnight delivery, caregiving and use and costs of health care and services. A Special Report discusses the financial and personal benefits of diagnosing earlier in the disease process, in the stage of mild cognitive impairment. The characteristic symptoms of causes of dementia are associated with distinct symptom dementia are difculties with memory, language, patterns and brain abnormalities, as described in Table 1 problem-solving and other cognitive skills that afect a (see page 6). These symptoms have brain abnormalities associated with more difculties occur because nerve cells (neurons) in parts 3-7 than one cause of dementia. For example, studies report of the brain involved in cognitive function have been that about half of people who had the brain changes damaged or destroyed. People in the fnal stages of the disease are In some cases, individuals have dementia-like symptoms bed-bound and require around-the-clock care. Common causes of dementia-like symptoms are depression, delirium, side effects from medications, thyroid problems, certain vitamin deficiencies and excessive use of alcohol. These symptoms reflect the degree of damage to neurons in different parts of the brain. The pace at which symptoms advance from mild to moderate to severe varies from person to person. In the mild stage, most people are able to function independently in many areas but are likely to require assistance with some activities to maximize independence and remain safe. This is called mixed pathology, and if recognized during life is called mixed dementia. Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, disorientation, confusion, poor judgment, behavioral changes and, ultimately, difficulty speaking, swallowing and walking. Vascular the brain changes of vascular dementia are found in about 40 percent of brains from individuals with dementia. In addition to changes in cognition, people with vascular dementia can have difficulty with motor function, especially slow gait and poor balance. Vascular dementia occurs most commonly from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain. When there is clinical evidence of two or more causes of dementia, the individual is considered to have mixed dementia. These features, as well as early visuospatial impairment, may occur in the absence of significant memory impairment. Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein in neurons. When evidence of more than one dementia is recognized during life, the individual is said to have mixed dementia. Nerve cells in the front (frontal lobe) and side regions (temporal lobes) of the brain are especially affected, and these regions become markedly atrophied (shrunken). The aggregates are thought to cause degeneration of the nerve cells that produce dopamine. Creutzfeldt this very rare and rapidly fatal disorder impairs memory and coordination and causes behavior changes. Jakob disease Results from a misfolded protein (prion) that causes other proteins throughout the brain to misfold and malfunction. A specific form called variant Creutzfeldt-Jakob disease is believed to be caused by consumption of products from cattle affected by mad cow disease. Normal pressure Symptoms include difficulty walking, memory loss and inability to control urination. Caused by impaired reabsorption of cerebrospinal fluid and the consequent buildup of fluid in the brain, increasing pressure in the brain. People with a history of brain hemorrhage (particularly subarachnoid hemorrhage) and meningitis are at increased risk. Can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid. These extensions and start having personality and behavioral changes, enable individual neurons to form connections with including suspiciousness and agitation. At such connections, called synapses, stage, individuals require help with basic activities of daily information flows in tiny bursts of chemicals that are living, such as bathing, dressing and using the bathroom. Because of damage to areas of the brain involved in movement, individuals become the accumulation of the protein fragment beta-amyloid bed-bound. Damage to areas of the brain that plaques are believed to contribute to cell death by control swallowing makes it difficult to eat and drink. Food particles may be deposited in the lungs and cause As the amount of beta-amyloid increases, a tipping point lung infection. This type of infection is called aspiration is reached at which abnormal tau spreads throughout pneumonia, and it is a contributing cause of death among the brain. Microglia try to clear the toxic proteins as well Instead, physicians (often with the help of specialists as widespread debris from dead and dying cells. Atrophy, or include the following: shrinkage, of the brain occurs because of cell loss. Several days In addition, treatments to prevent, slow or stop these or weeks may be needed for an individual to complete the changes are not yet available, although many are being required tests and examinations and for the physician to tested in clinical trials. Others include forgetting important dates or appointments, but remembering events, asking for the same information over and over, and increasingly needing to rely on memory them later. Challenges in planning or solving problems: Some people experience changes in their ability to develop Making occasional errors when and follow a plan or work with numbers. They may have trouble following a familiar recipe, keeping track balancing a checkbook. They may have difficulty concentrating and take much longer to do things than they did before. Sometimes, people have trouble driving to a familiar location, managing a the settings on a microwave or budget at work or remembering the rules of a favorite game. They may have difficulty reading, judging distance and determining color or glaucoma or age-related macular contrast, which may cause problems with driving. They may stop in the middle of a conversation and have no idea how to continue or the right word. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name. For example, they may use poor judgment when dealing with money, giving large amounts to in a while. They may have trouble keeping up with a favorite sports family and social obligations. Developing very specific ways of They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at doing things and becoming irritable work, with friends or in places where they are out of their comfort zones. A genetic mutation to the person affected and to family members and friends, is an abnormal change in the sequence of chemical but the individual is still able to carry out everyday activities. By age 40, most people with Down syndrome have Therefore, it is important that people experiencing significant levels of beta-amyloid plaques and tau tangles cognitive impairment seek medical help for diagnosis 26 in their brains. According to the the importance of older adults reporting their own National Down Syndrome Society, about 30 percent of experience of memory and thinking problems, without people with Down syndrome who are in their 50s have (or before) a formal examination by a doctor.

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Expectations for these presentations summarized below: October 9 antifungal young living essential oils order nizoral 200 mg on-line, 10 fungus gnats h2o2 cheap nizoral 200mg with visa, 16 anti fungal salve recipe buy discount nizoral, 17: Present your background and methods in PowerPoint format in no more than 10 minutes anti fungal balanitis order 200mg nizoral visa. The methods presented should be the culmination of modifications to your proposal made following feedback from primary project preceptors fungus gnats lavender oil order nizoral now. Slides should succinctly present the purpose of the project antifungal uk nizoral 200 mg, how objectives you have selected align with this purpose, and how selected primary and secondary outcomes relate to these objectives. You should also present a plan for identifying patients, the number of patients you wish to , data elements you plan to collect, and a basic plan for data analysis. Feedback from the Research Workgroup will focus on optimizing the presented methods to suit the purpose of the project and maximize the likelihood of useful results. March 5, 11, 12, 18, 19: Present background, methods, and results in PowerPoint format in no more than 10 minutes. This presentation should include enough background information and succinct methodology to orient those in attendance to the project (similar to the expectations for platform presentation). The Research Workgroup will focus feedback on optimizing the presentation of results. Data collection and analysis must be complete prior to your scheduled presentation date. Presentations will be delivered without interruption by the audience, timed to ensure they are appropriate length, and should be practiced and polished. Direct questions regarding appropriate methodology, data collection, and data analysis to your primary project preceptors. Site: University of Virginia Health System Status: Active Required Description: Each resident will conduct a residency project. The residents will be provided with a suggested list of topics early in the residency year. Residents will work with a pharmacist preceptor team to complete the project by all of the assigned deadlines. The project methodology and results will be written in manuscript format suitable for submission to a peer reviewed biomedical journal. The project write-up will be submitted to the preceptor, residency program director, and department director. Project results may also be presented to institutional committees, if appropriate. The resident will assume responsibility for the design, implementation and completion of the project. Appropriate planning and adherence to predetermined presentation deadlines will prevent project-related emergencies. Expected progression of resident responsibility on this learning experience Day 1: Resident Research Committee to review learning activities and expectations with resident. Quarter 1: the resident will design their project with the coaching from their preceptor/ research team. Quarters 2-4: the resident will take responsibility for all required elements of the project with facilitation by the preceptor/ project team. Evaluation PharmAcademic will be used for documentation of scheduled evaluations (see chart below). Preceptor and Learning Experience evaluations must be completed by the last day of the learning experience. Identify the key stakeholders (departmental and organization) who must provide approval for project. Evaluated Demonstrates appropriate assertiveness in presenting pharmacy concerns, solutions, and interests to external stakeholders. Effectively communicates any changes in medication formulary, medication usage, or other procedures to appropriate parties. Accurately assess the impact, including sustainability if applicable, of the project. Evaluated Is prepared for all project team/ preceptor and Research Committee meetings. Introduction (bold, 12-point) the introduction should include background information on the project. Methods this section should begin with a statement that the project was approved by the Institutional Review Board. Results A summary of results should be included in this section, followed by figures and tables. Bar graphs should be in black and white only and not contain gray shading as filler or background; distinctive fillings should be used instead (eg, white or solid black, stripes, cross-hatching, dots). This section should be a written expansion of the results presented at Eastern States Conference, ie, results should not be copied and pasted from presentation slides or posters. Discussion Include interpretation of your results and how your findings apply to practice. Additionally, elaborate on the similarities and differences between your study design and results compared to other studies. Put the work that you did into perspective, assess generalizability, and consider its clinical implications. Site: University of Virginia Health System Status: Active Required Description: Each resident will conduct a quality project. Residents will work with a pharmacist preceptor to complete the project by all of the assigned deadlines. The project write-up will be submitted to the preceptor, residency program director, and Chair/ Secretary of the appropriate institutional committee. The resident will assume responsibility for the design, implementation and completion of the quality project. Expectation of Learners: Preceptor Interaction Project preceptor and resident will meet as needed to support project development and progression. Each resident will also receive support from the Research Committee regarding project design and poster development. E-mail: Residents are expected to read e-mails regularly for ongoing communication. Appropriate planning and adherence to predetermined project deadlines will prevent project-related emergencies. Expected progression of resident responsibility on this learning experience: Day 1: Resident Research Committee to review learning activities and expectations with resident. This will be further enforced by the specific project preceptor on the first resident-preceptor meeting following project selection. Quarter 1: the resident will design their project proposal and data collection form with the coaching from their preceptor. Quarter 2: With preceptor facilitation, the resident will independencly complete the majority of the project including data collection, result analysis, and poster development. Follows timeline and milestones established with preceptor/ project team Gains necessary commitment and approval for implementation Implements the project as specified in its design. Failing to meet parameters early in admission is associated with increased length of stay. At the University of Virginia Health System we have observed variation in the methods of hydration and urine alkalization both prior to and during high-dose methotrexate administration. Variation exists between both treatment plans and primary oncology/hematology provider. One possible result due to this variation is patients may have difficulty meeting urine output and alkalization parameters. Both of these outcomes result in increased length of stay, worse patient outcomes, and increased cost to the health system and the patient. Plan to develop the protocol with input from hematology, neurology, nephrology, pharmacy and nursing. Decide on who the official decision makers will be for the adjustments (nurse, pharmacy or fellow driven protocol). Evaluate the clinical outcomes after implementation and make adjustments as needed. Rank lists will be highly considered, but are not the sole deciding factor in project assignment. Data collection and analysis should be complete by this point as results and conclusions are expected to be included in your abstract. Anticipate several iterations of poster edits prior to final submission at the end of November. Additional dates are not included in this timeline and expectations should be discussed with your specific project preceptors. Workgroup Thursday, March 12 Wednesday, March 18 the Research Committee will focus feedback on optimizing Thursday, March 19 the presentation of results. Data collection and analysis will need to be complete prior to your scheduled presentation date to make the most of these sessions. The manuscript should be formatted in a manner appropriate for submission to the target journal for publication. This deadline is for a complete draft of the manuscript, as all data collection, analysis, and conclusions should be complete. Though this is the initial manuscript deadline on this list, recognize that sections can/should be completed longitudinally with other project deadlines (purpose/background, methods, results/conclusions). Consider creating your own timeline to avoid attempting to write the entire manuscript at once to meet this deadline. Presentations will be preceptors/staff Thursday, May 14 delivered without interruption by the audience, timed to ensure they are of appropriate length, and should be practiced and polished. All residents should attend (even if not scheduled to present) to support each other and hear feedback that may apply to projects apart from the one being presented. It is the responsibility of the resident to communicate with their advisor when they are expected to present to the research committee and ensure that their advisor is able to participate. If their advisor is not able to participate and/or they have a conflict with their assigned date, they need to schedule time with the research committee chairs and their advisor to discuss options for alternative dates/times. Each resident will be provided with an individualized schedule that identifies their shift and practice area. Through this commitment, residents work independently in pharmacist shifts to support the patient care mission of the Department of Pharmacy Services and the University of Virginia Medical Center. This individual routinely meets with the resident and solicits feedback from all pharmacists and technicians who work with the residents during their service commitment for completion of the required evaluations. Expectation of Learners: During the learning experience, the resident will focus on the goals and objectives outlined below by performing the activities that are associated with each objective. Preceptor Interaction Daily: Residents will with technician and pharmacist colleagues in their assigned areas (see pharmacy schedule for shifts). Service colleagues will provide feedback to the resident as needed and to the designated preceptor at least quarterly. Daily times: Residents work with pharmacists, technicians, and supervisory staff to prioritize questions and problems related to their assigned duties. For problems/ questions that cannot be answered by on-site staff, residents shall the departmental Help Chain to assist with resolution. E-mail: Residents are expected to read applicable staffing-related e-mails each day at a minimum for ongoing communication. Pager: If directed by on-site personnel, residents should utilize the Help Chain for urgent/emergency situations pertaining to patient care D. Thereafter: the resident assumes responsibilities as the pharmacist in the assigned area. Residents are always assigned to work with other team members who can model/ coach/ or facilitate optimal practice standards. Residents will identify a pharmacist preceptor for presentation dependent upon the topic selected. More specific information and deadlines can be found in the Presentation Guidelines. The resident will assume responsibility for the development and execution of the presentations. E-mail: E-mails are appropriate for routine, non-urgent questions and problems Residents are expected to routinely read e-mails for ongoing communication. Appropriate planning and adherence to predetermined presentation deadlines will prevent presentation-related emergencies. Expected progression of resident responsibility on this learning experience Day 1: Presentation guidelines, learning activities and expectations are shared with the resident. In the first month of the residency, presentation dates are selected by the collective group of residents. At least 60 days before the first scheduled presentation: the resident will identify a topic and appropriate preceptor. Includes accurate citations and relevant references, and adheres to applicable copyright laws. Selects content that is relevant, thorough, evidence based (using primary literature where appropriate), and timely, and reflects best practices. Provide presentations that are clear, grammatically correct, and free from slang and dialects. Residents must identify a pharmacist preceptor for each presentation (seminar and tech talk). The purpose of the seminar presentation is to critically evaluate the literature, answering a specific question or clinical controversy. Residents are encouraged to avoid seminar topics that have been presented in the department in the previous 12-18 months, unless new or emerging literature exists. At least 60 days before your scheduled presentation, identify your topic and preceptor. Pharmacist Objectives: Using the template below, develop 3-5 objectives for your presentation o Discuss the new treatment options/ standards of care for patients.

Secondary (reactive) thrombocytosis What 2 laboratory tests may Fibrinogen and C-reactive protein help differentiate reactive levels are often elevated with reactive thrombocytosis from thrombocytosis because they are essential thrombocythemia What are some of the causes Acute infection or other inammatory of reactive thrombocytosis What are the presenting Hyperviscosity causes headache fungus gnats traps homemade buy nizoral paypal, blurred symptoms in patients with vision fungus gnats root aphids discount nizoral 200 mg fast delivery, dizziness fungus zybez 200mg nizoral, vertigo antifungal for yeast infection discount nizoral 200 mg with mastercard, paresthesias fungus gnats plants 200 mg nizoral with mastercard, polycythemia vera What physical ndings are Splenomegaly fungus gnats cider vinegar cheap 200 mg nizoral with mastercard, plethora, and macroglossia common in patients with polycythemia vera What is the major cause of Thrombosis or, less frequently, death in polycythemia vera What does the bone marrow Megakaryocyte hyperplasia and clustering show in essential thrombo cythemia Ectopic cal ndings in myelobrosis myeloid metaplasias are localized collec with myeloid metaplasia What is the differential Other myeloproliferative disorders, diagnosis for myelobrosis metastatic carcinoma, lymphoma, hairy with myeloid metaplasia For example, anemia results in weakness, neutropenia results in infection, and thrombocytopenia results in bleeding. Increased splenic function associated with splenomegaly, including sequestration of blood cells, leading to neutropenia, thrombocytopenia, and anemia What are the common 1. Direct inltration by pathogens (mycobacterial, fungal, or staphylococ cal infections) 3. Patients with type B antibodies are responsible blood have anti-A antibodies, and those for severe hemolysis after with type A blood have anti-B antibodies. What are the symptoms and Fever, nausea, and back or chest pains, signs of acute transfusion also wheezing, vomiting, hemoglobinuria, reaction Chapter 6 / Hematology 373 What is a febrile A temperature increase of 1 C with nonhemolytic transfusion shaking chills and no other cause for the reaction How does the administration these injected antibodies bind to of Rh immune globulin Rh-positive fetal cells, clearing them and work Platelet Function Disorders What is Glanzmann throm An autosomal recessive inherited defect basthenia What conditions predispose Malignancy, chronic inammatory a patient to venous conditions, postoperative period, thrombosis What enzyme is responsible Plasmin, which is activated from for the degradation of plasminogen by tissue-type plasminogen brin Many of these autoantibodies are antiphospholipid antibodies transient and appear to carry little or no have an increased risk of risk of thrombosis. When are antiphospholipid In the setting of a thromboembolic event antibodies clinically or recurrent miscarriage; if the antiphos meaningful Antithrombotic and thrombolytic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Antithymocyte-globulin and cyclosporine for severe aplastic anemia: association between hematologic response and long-term outcome. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Rituximab therapy for chronic and refractory immune thrombocytopenic purpura: a long term follow up analysis. Some bacteria retain the crystal violet even after a decolorizer is added (gram-positive; stain purple). Those with a high lipid content lose the purple color and pick up the counterstain (safranin). What is different about the Heat is used to pretreat the organisms Ziehl-Neelsen stain What temperature method is A cold method in which detergent is used used for the Kinyoun stain How is the Tzanck stain A vesicle suspected of containing virus is performed and what is it unroofed, its base is scraped, and the used for For the various cultures that can be obtained, How sensitive is a throat 90% sensitive for streptococcal pharyngitis culture for strep If a catheter is in place, disinfect the tubing and collect directly with a sterile needle and syringe. In general, how many blood Draw 2 sets (of 2) to avoid obtaining cultures should be obtained Are there special considera Use special transport media if the tions for viral cultures Measure acute and convalescent sera to detect a 4-fold increase in titer (synonymous with recent infection). To treat polymicrobial infections To treat single infections with uncertain susceptibility To create synergy To protect the antibiotic. When the combined effect is greater than the sum of the independent effects What is antagonism Consideration of individual organism and local resistance patterns is needed to select appropriate antimicrobial therapy. Added activity against some gram-negative rods; however, signicant resistance has been seen with Haemophilus inuenzae and Escherichia coli. It is recom cross-reactivity of allergy mended that patients with a history between penicillins and of immediate hypersensitivity reaction cephalosporins Which generation(s) of Cross-reactivity greatest among the rst cephalosporins has the and second-generation cephalosporins highest reactivity Chapter 7 / Infectious Diseases 389 What is the antimicrobial Streptococci, methicillin-sensitive spectrum of rst-generation Staphylococcus aureus, some community cephalosporins What is the antimicrobial Expanded activity against gram-negative spectrum of third rods. Ceftazidime has even less activity against gram-positive cocci but is an excellent antipseudomonal agent. What is the antimicrobial the rst fourth-generation cephalosporin spectrum of fourth is cefepime. What is the antimicrobial Most gram-positive and gram-negative spectrum of the aerobic and anaerobic pathogens carbapenems (imipenem except for Burkholderia cepacia, and meropenem) What is the antimicrobial Activity against aerobic gram-negative rods spectrum of aztreonam What is the antimicrobial Aerobic and facultative gram-negative spectrum of aminoglycosides How can aminoglycoside Careful monitoring of blood levels, serial toxicity be avoided Rocky Mountain spotted fever, ehrlichiosis, and Chlamydia infections; Borrelia burgdorferi and Mycoplasma sp. What are the major Discoloration of teeth and bones in toxicities of tetracyclines Chapter 7 / Infectious Diseases 391 What toxicities are Reversible bone marrow depression in associated with adults receiving 4 g or more per day and chloramphenicol As 1 of several agents for mycobacterial infections As part of combination therapy with erythromycin in severely ill patients with legionellosis Occasionally as combination therapy for severe gram-positive infections What is the antimicrobial Anaerobes (strict anaerobes), although spectrum of metronidazole Erythromycin, clarithromycin, and azithromycin What is the antimicrobial Most gram-positive pathogens (including spectrum of erythromycin Streptococcus pneumoniae [although resistance is rapidly increasing], Strepto coccus pyogenes, and Corynebacterium diphtheriae), Bordetella pertussis, Legionella pneumophila, Mycoplasma sp. There is resistance in up to 50% of gram-positive organisms, thus limiting the role of this agent in empiric treatment of respiratory tract infections. What is the antimicrobial Aerobic gram-negative rods; Haemophilus activity of older quinolones sp. These quinolones are not the therapy of choice for infections caused by staphylococci and streptococci. Chapter 7 / Infectious Diseases 393 What is the antimicrobial Enhanced gram-positive activity and activity of newer quinolones therefore indicated for empiric respiratory. What is the antimicrobial Specic gram-negative rods only, including activity of colistin What are the major adverse Ototoxicity (particularly vestibular distur effects of streptomycin Possible hepatotoxic drugs are reintroduced 1 at a time to identify the offending agent. What are the second-line Capreomycin, kanamycin, amikacin, antimycobacterial agents Cryptococcus neoformans), dimorphic fungi (including Blastomyces dermatitidis, Histoplasma capsulatum, Coccidioides sp. Chapter 7 / Infectious Diseases 395 How are acute reactions to Premedication with acetaminophen, amphotericin minimized What are the advantages Similar efficacy with less renal toxicity and disadvantages of but at a considerably higher dollar cost, lipid-encapsulated and some forms do not cross into the amphotericin B What is the antimicrobial In vitro and in vivo activity has been spectrum of voriconazole What is the indication for Invasive Aspergillus infections, the use of voriconazole What is the antimicrobial Most candida species as well as molds spectrum of posaconazole If treatment is begun within 24 hours after a varicella zoster rash rst appears, it decreases the severity of varicella in children and adults. If begun within 2 days of the onset of illness, they may decrease the duration of symptoms. What are the uses of the Also available for treatment of inuenza A other neuraminidase and, unlike rimantadine and amantadine, inhibitors, oseltamivir and also active against inuenza B zanamivir What are the common side Renal toxicity, which is usually reversible effects of foscarnet Unicellular organisms (prokaryotes) What is the difference Structural differences in the cell wall of between gram-positive and bacteria, so the staining properties on gram-negative bacteria Gram staining are different How can bacteria be further As aerobes or anaerobes classied What are the common organisms and the common syndromes that go with each of the following: Organism: Gram-positive cocci Staphylococci (S. Diarrhea, skin and soft-tissue infections, bacteremia Gardnerella Bacterial vaginosis, endometritis Haemophilus spp. Bacteroides, Prevotella, and Fusobacterium How do anaerobic infections Anaerobes gain access to usually sterile occur What are the spirochetes Treponema pallidum (syphilis), Leptospira, and their associated Borrelia (Lyme disease, relapsing fever), diseases They produce multisystem general diseases that they disease, with most organisms producing a cause Zoster results from reactiva tion of latent virus in dorsal root ganglia; it does not require new contact. Bacterial superinfection of lesions, encephalitis, cerebellar ataxia, and pneumonitis. Chapter 7 / Infectious DiseasesChapter 6 / Hematology 403403 How can Ramsay-Hunt Immunocompromised patients exposed syndrome be prevented Varicella vaccine is available and indicated in nonimmune children older than 12 months and in adults. What is the time course or use for the following virus specic antibodies: Viral capsid antigens