By Joshua O. Benditt, et al. American College of Chest Physicians
Directly from the ACCP severe Care medication Board evaluate 2009 path, this article covers each subject in a concise, easy-to-use structure. Use as a self-study source to organize for the severe care drugs subspecialty board exam.
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Additional info for ACCP Critical Care Medicine Board Review, 20th Edition
The rifamycins (eg, rifampin and rifabutin) accelerate the metabolism of protease inhibitors through induction of hepatic P450 cytochrome oxidases. Rifabutin has comparable antituberculous activity but with less hepatic P450 cytochrome enzymeinducing effect than rifampin. 34 Two clinically relevant trends related to TB deserve comment. 36 Some recent attention has focused on measures that foster type 1 immunity as a means of treating patients with TB, including those who may not have responded to initial therapy.
49 Trimethoprim-sulfamethoxazole is often used because of its convenient IV dosing; however, it has not been definitively proven that the combination is synergistic at the drug ratios that usually are achieved in serum or CSF. 44 Neonates and pregnant women are also at risk, and the infection occurs with increased frequency with cirrhosis. About one third of patients in some series have no known risk factor, and Listeria has only recently been considered a cause of febrile GI illness in immunocompetent persons.
These lead to proteolytic cleavage of C3 to generate C3b, and this mechanism can lead to immediate opsonization. In addition to its opsonizing ability and its initiation of the membrane attack complex of complement, C3b can be joined by factors B and D to form a C3 convertase, which is highly labile. When bound by properdin, the C3 convertase is stabilized and can then cleave more C3 to generate more C3b, with a resultant amplification of the alternative complement pathway. 22 There are four clinically relevant situations within the category of defective humoral immunity: (1) disorders of immunoglobulin production; (2) asplenia or hyposplenic states; (3) hypocomplementemia; and (4) impaired neutralization of toxins.
ACCP Critical Care Medicine Board Review, 20th Edition by Joshua O. Benditt, et al. American College of Chest Physicians