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I was told that if you add gentamicin to ampillicin then the effect of ampillicin would increase. Does anyone know how or why?
Ampillicin + Gentamicin = Synergy
- Thread starter BME103
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Yes..I know how and why..but you need to find the answer on your own.
But I will tell you that Gent and Ampi can't be given together... you will also need to figure out why and how.
Hey there!
How's the new job??? Do you already have an agenda for those rogue dops???
Did you have a nice few weeks off??? Welcome back....for however long!
btw....do you think this was a "bait" question???
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Yo SDN!
Actually...I've been going at it full force... visited 6 hospitals past 2 weeks..meeting DOPs and clinical managers... got a list of agenda..will see if they can implement it. Been using the RV every weekend...realized we need a little fishing boat too!!
I'm not sure if it's a bait question... but I believe students should be able to find the answers to these simple pharmacology questions on their own instead of asking.
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I was under the impression that if you expect of early sepsis, you can add gent to amp and that would give a broad spectrum coverage (G+ and G-). I have a hard time finding the reason. Any hints as to why and how?
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if broad spectrum is what you desire... then why not just use a broad spectrum antibiotic... And if I'm having a septic episode..I sure wouldn't want ampi gent...
But you still can't give ampi and gent together...
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The mechanism of synergy between Beta Lactam and Aminoglycoside is not really well established except for Enterococci...gram positive strep prevalently resistant to beta lactams such as PCN or AMP..with high MIC and bacteriostatic with reduced susecptibility... but when AG is added to the regimen.. it somehow aids intracelluar uptake of AG.. thereby lowering the MIC of PCN... we call that Synergy.
This mechanism is not universal to all bugs.
Do a medline search.. Endocarditis, Aminoglycoside, Penicillin, Synergy.
This mechanism is not universal to all bugs.
Do a medline search.. Endocarditis, Aminoglycoside, Penicillin, Synergy.
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Thanks for the infor! I will look it up and see if there's more infor.
Agree with Zpak - if you need broad spectrum, off the cuff early antibiiotic coverage - use a drug which will give you this - don't cut & paste.
But...there is the whole pcn (& pcn cogener)-aminoglycoside interaction.
Its not clearly understood, but we do know that some pcn-like drugs can form complexes with aminoglycosides (look up piperacillin-gentamicin) which not only inactivate the aminoglycoside, but give compounds with unknown toxicities.
There are also reports which suggest that the two compounds give false readings when you do blood levels. Add to that comorbid factors like renal disease, chf, etc...you now have something you can't make heads or tails out of.
Why do it??? Choose a broad spectrum drug to start - wait for culture & sensitivity results & change as needed.
So....zpak - where have you taken the RV??? Do NOT tell me you pull into the parking lot at the hospital you have to consult on with that RV - how awful would THAT look!!!!
So...a small fishing boat???? How much can you tow??? I'm betting baby Zpak thinks this is all good fun - right? Can you get a life vest that small???
How is SarahSux doing with cooking in a little oven with a little fridge?? You're not taking up the whole space with you're beer are you????
Now - final question.......how did Little Miss Sux do on her science project with the - what were they - some fecal bug or such????
But...there is the whole pcn (& pcn cogener)-aminoglycoside interaction.
Its not clearly understood, but we do know that some pcn-like drugs can form complexes with aminoglycosides (look up piperacillin-gentamicin) which not only inactivate the aminoglycoside, but give compounds with unknown toxicities.
There are also reports which suggest that the two compounds give false readings when you do blood levels. Add to that comorbid factors like renal disease, chf, etc...you now have something you can't make heads or tails out of.
Why do it??? Choose a broad spectrum drug to start - wait for culture & sensitivity results & change as needed.
So....zpak - where have you taken the RV??? Do NOT tell me you pull into the parking lot at the hospital you have to consult on with that RV - how awful would THAT look!!!!
So...a small fishing boat???? How much can you tow??? I'm betting baby Zpak thinks this is all good fun - right? Can you get a life vest that small???
How is SarahSux doing with cooking in a little oven with a little fridge?? You're not taking up the whole space with you're beer are you????
Now - final question.......how did Little Miss Sux do on her science project with the - what were they - some fecal bug or such????
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I think I will take a stab at it. Amp binds and break down the bacteria cell wall while genti binds ribosome and inhibits protein synthesis. The reason why they are synergic is because amp helps genti get into the bacteria. As a result of resistence (to cell wall or/and ribosome binding), it's harder to kill the bacteria so what amp does is that it barely binds to the bacteria cell wall and makes a small hole and this just allow genti to come in and thus, binds to the ribosome and kill the bacteria. This is why they are synergic (increases the bacterialcidal affect and increases the rate of killing).
That's my reasoning. Any comments?
That's my reasoning. Any comments?
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EDIT: Damn, someone responded 3 minutes before I could get this up....
WVU - you do not have enough to do!!!
Where is Mrs WVU????? Why are you spending time drawing these funny pictographs???? (I don't even know how you can do this on a computer!)
Shouldn't you be studying for the state board or some such nonsense???
Where is Mrs WVU????? Why are you spending time drawing these funny pictographs???? (I don't even know how you can do this on a computer!)
Shouldn't you be studying for the state board or some such nonsense???
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Sadly, this is true. I played Gears of War for 4 hours tonight, then watched WVU lose it's basketball game, then played on the internet...bringing me to now.
Playing Elebits on Wii.
Hey, just trying to help...
Start---->All Programs---> Accessories---> Paint
Actually, that's not a bad idea.....
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EDIT: Damn, someone responded 3 minutes before I could get this up....
Pharm students love this crap (I mean that in the kindest sense). You should consider academia (provided you move beyond Paint).
Actually, I really mean that. Some of the best professors I've had are the most unconventional. The point gets across all the quicker.
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EDIT: Damn, someone responded 3 minutes before I could get this up....
What do you think, next SDN T-shirt perhaps?
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(provided you move beyond Paint).
The fact that it's made with 1995 technology makes it that much better.
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now as far as the PCN and AG forming that complex - I thought that was only at concentrations achieved if they were in the same bag or something. Can they be run simultaneously, do they need seperate lines or do you stagger the dosing?
They definitely require separate lines (always a source of error when both are ordered since you don't KNOW the nurses will use separate lines).
But, research suggests staggered dosing to allow for tissue distribution out of the intravascular compartment. It really is still unclear exactly what these complexes are in vivo, what their toxicities are & if they have any therapeutic value or if then diminish therapeutic value.
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EDIT: Damn, someone responded 3 minutes before I could get this up....
love it!
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yep.
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I grant SDN the rights to reproduce the picture. As long as I get a t-shirt for free.
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We've been scoping out many beautiful state parks here in Texas...almost every weekend. Haven't parked the RV on the hospital Lot yet..but I am taking notes where I can park it. baby Zpak is happy and content staying in the RV all day and night... and Sarah is loving the cozy kitchen..and the fridge is much larger than the one I had in Pharmacy School... haven't had a beer in 3 months and it's dung beetle...due in April. And the RV can tow about 5000lb..but I won't be towing a boat with the RV.. can you see the big arse RV going into the water to pull the boat out? It'll drown my engine which is in the most rear of the RV!
How's CA?
We just reserved a 35ft RV lot at the Tuolumne Meadows Camping ground today...for July for a week!!! Sarah had to get on the phone at 6:55 PST and kept dialing to get through...
Aaaah Tuolumne Meadows - beautiful. I haven't been there in years, but I've got fond memories. Its a great place to take the kids. Some nice, easy hikes to falls, Tenaya Lake, evening campfire programs. You can also take your fishing poles, but you might not catch much. Kids don't care - they just like to do it. Are you coming over the Tioga or from the southern entrance? Not much snow this year, so the Tioga will probably be open early.
CA is good. We've gots lots of changes professionally here. Recently tech check tech for pyxis (thats one thing I gave up when I went part-time
) & lots of movement toward expanded practices in the outpt setting. There was a lot of push toward expanding hospital & retail communication, but we've had a number of really bad drug errors in some local hospitals, so they need to get their stuff in order first. Lots more emphasis right now on credentialling in both practice settings.MSII is now MSIII & is studying for Step I. She called a bit frantically since she couldn't remember the Type I antiarrhythmics
. I gave her my old mnemonic (knowing encainide was off the market), but it is hard to remember them when she hasn't seen them in real patients with real ekgs that correlate with physical signs. It will all come soon enough - she's got lots of clinical years ahead.Have you ever done the Oregon coast? That's our next trip - if you can believe, we've never done that one!
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Aaaah Tuolumne Meadows - beautiful. I haven't been there in years, but I've got fond memories. Its a great place to take the kids. Some nice, easy hikes to falls, Tenaya Lake, evening campfire programs. You can also take your fishing poles, but you might not catch much. Kids don't care - they just like to do it. Are you coming over the Tioga or from the southern entrance? Not much snow this year, so the Tioga will probably be open early.
CA is good. We've gots lots of changes professionally here. Recently tech check tech for pyxis (thats one thing I gave up when I went part-time
MSII is now MSIII & is studying for Step I. She called a bit frantically since she couldn't remember the Type I antiarrhythmics
Have you ever done the Oregon coast? That's our next trip - if you can believe, we've never done that one!
We're going up the Tioga.. will load up with Diesel and grocery in Lee Vining. I'll run the generator so I'll need a lot of diesel..and may need a solar panel. We'll cook ...and will have plenty of propane. Won't need to run the AC I don't think...but we'll be there a week and will do some fly fishing.
I have traveled the Oregon coast every September for the past 7 years. We do a week long golf outing.. Oregon coast is beautiful... went crabbing one year and caught over 300 dungeneous crabs.. kept 36, limit 12 per person.
Sand dunes are beautiful and the scenery is just awesome.
We traveled heavily from Bandon up to Florence...because 5 of our buddies live in Coos Bay Oregon. We love it ... but wouldn't want to live there.
What the heck is an Encainide? j/k
No - no need for AC in Yosemite - but on the Lee Vining side - especially if you visit Mono Lake (which you should - it has changed tremendously since you've been there....but needs AC & lots & LOTS of water in July). There also used to be a great burger joint in Lee Vining - if its still there - you'll find it. The whole d*#n town is 1 block long.
Don't forget the spinning rods for baby Zpack & little Miss Dung Beetle Award Winning Zpak (I know, I know - I'm premature - but, I KNOW these things - I've LIVED these things!). They won't get the hang of fly fishing, but they get great joy out of smaking that spinning rod into the river (go far, far away from the serious fisherman lest they kill you - I'm thinking more Colorado or Wyoming).
Thanks for the Oregon coast tips - we'll look into them!
Have a great trip!
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give us the pneumonic for the anti arrythmics z-pack...
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If you ask SDN nicely she may forgive confusing her with Z, she might also give the mnemonic.
If you ask SDN nicely she may forgive confusing her with Z, she might also give the mnemonic.
Did that guy confuse me with Zpak?
You can tell us apart from a mile away!!!I'm the one with the short (albeit not tooo short) skirt, great legs & a white coat - Zpaks that old guy who used to wear scrubs (when he was a dop) - now you can find him in a zipper RV jumpsuit
No worries....I think Zpak is out getting a matching jumpsuit for Sarah for Mother's Day, so I'll give you the mnemonics I used (remember - I'm OLD
!)"A Doubtful Quality Product Bought To Preserve Little Money Can Fabricate Enough Problems"
A = 1A
D = Disopyriamide
Q = Quinidine
P = Procainamide
B = 1B
T = Tocainamide
P = Phenytoin
L = Lidocaine
M = Mexiletine
C = 1C
F = Flecainamide
E = Encainamide (now off the market)
P = Propafenone
To remember the "P's" - there are 3 of them - they start & end with Pr & the Prs go in alaphebetical order....so...first P is the first alphabetic Pr "procainamide"....second P is "phenytoin" (the only non-Pr - it is surrounded by Pr when it comes to P's) ....the last P is the last alphabetic Pr "propanfenone". (You should have paid attention when your mother told you to watch your Ps & Qs!!!
).There are others, but you have to know the groups.
"Quaker Preachers Discuss Sobriety" = Quinidine, Procainamide, Disopyramide, Sodium channel blocade (Class 1A)
"People Like Salty Mexican Tacos" = Phenytoin, Lidocaine, Sodium channel blockade, Mexilitine, Tocainide (Class 1B)
"Flea Encrusted People" = Flecainamide, Encainide (off the market), Propafenone (Class 1C) - (not to be taken literally about those with arrhythmias requiring Class 1C drugs!!!!)
Anyway, these were the ones I used & worked for me. There are a zillion others & I'm sure Zpak has the "official" USC version - if he remembers..
Good luck!
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Did that guy confuse me with Zpak?
I'm the one with the short (albeit not tooo short) skirt, great legs & a white coat - Zpaks that old guy who used to wear scrubs (when he was a dop) - now you can find him in a zipper RV jumpsuit
No worries....I think Zpak is out getting a matching jumpsuit for Sarah for Mother's Day, so I'll give you the mnemonics I used (remember - I'm OLD
"A Doubtful Quality Product Bought To Preserve Little Money Can Fabricate Enough Problems"
A = 1A
D = Disopyriamide
Q = Quinidine
P = Procainamide
B = 1B
T = Tocainamide
P = Phenytoin
L = Lidocaine
M = Mexiletine
C = 1C
F = Flecainamide
E = Encainamide (now off the market)
P = Propafenone
To remember the "P's" - there are 3 of them - they start & end with Pr & the Prs go in alaphebetical order....so...first P is the first alphabetic Pr "procainamide"....second P is "phenytoin" (the only non-Pr - it is surrounded by Pr when it comes to P's) ....the last P is the last alphabetic Pr "propanfenone". (You should have paid attention when your mother told you to watch your Ps & Qs!!!
There are others, but you have to know the groups.
"Quaker Preachers Discuss Sobriety" = Quinidine, Procainamide, Disopyramide, Sodium channel blocade (Class 1A)
"People Like Salty Mexican Tacos" = Phenytoin, Lidocaine, Sodium channel blockade, Mexilitine, Tocainide (Class 1B)
"Flea Encrusted People" = Flecainamide, Encainide (off the market), Propafenone (Class 1C) - (not to be taken literally about those with arrhythmias requiring Class 1C drugs!!!!)
Anyway, these were the ones I used & worked for me. There are a zillion others & I'm sure Zpak has the "official" USC version - if he remembers..
Good luck!
We at USC do not deal with antiarrythmics..we can't spell it..nor does it make that much of a big financial impact..since Cordarone has gone generic!!
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We got on some Crappie over the weekend...spring break..some friends and we were at a state park camping..fished off the pier and one of the kids (not mine...Dung Beetle Zpak already got her first fish last year...little large mouth bass and a blue gill) got her first and 2nd fish...
Oh - I hope you had cameras!!
We (well - Dr sdn & the kids) were fishing off a pier at Twin Lakes when they were little. (Twin Lakes is up out of Bridgeport - a bit farther up 395 from Lee Vining - though you can get there thru Ebbits Pass from Lake Alpine)
Anyway....they were fishing for crappie....MSIII (she was about 6 at the time) had just hooked a fish & in our son's (what should I call him - graphic sdn???) enthusiasm (he was 3) to see the fish - he knocked over dr sdn's tackle box right into the lake.
It wasn't the "full" tackle box - since a true dad fisherman has a box with those things which he needs & another box with those things which are needed when taking the children (I didn't know that then - silly me
) - so not too much was lost. But - he was not of a mind to go down & try to get it & I certainly was not going either.A fun memory!!! So - make up an extra tackle box in case baby Zpak takes off & tips it over.
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There were 6 of us going out on Lake Oachita in Arkansas. Never let a kid cast in front of you. I was about 7, got hooked by a wayward cast. Luckily just in the finger, but I've been scarred for life. I rarely go fishing. I'll bring myself to do it for the kids, but it won't be the big family past-time.
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I once got a fishhook in my finger on a church fishing trip. Some old dude pulled it out, took some chewing "backy" out of his cheek and stuck it on there. Miraculously, it seemed to make it better. *shrugs*
Gross.
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Huh. Well...it might have caused some vasoconstriction....
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I know, right? Nasty! I was about 7 at the time and I remember telling people, "He put his 'chaw' on my finger!"
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I know, right? Nasty! I was about 7 at the time and I remember telling people, "He put his 'chaw' on my finger!"
As long as you didn't suck on it afterwards.
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I still haven't gotten my damned free shirt yet.
What gives?
...
Also, for the mods, have there actually been people nerdy enough to have bought one of these? And if so, where are they from and what do they do? I can't even imagine the type of person that would wear a shirt depicting a cartoon of how antibiotics work...
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Yes.
Until the end of the month. Then off to the wonderful land of a Washington DC bedroom community.
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EDIT: Damn, someone responded 3 minutes before I could get this up....
I love it.
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Wrong.
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Nope, not wrong. An AG and b-Lactam can be used in therapy for synergy yet recommended adminstered 2 hours apart.
Different B-lactams can inactivate different AG.
Go study some more dummy.
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Mkay. I did not know that. You are right, I am wrong. I thought you were saying they are not used together in practice because broad-spectrums are preferred.
I have since found that amp+gent has been given right after one another as long as the lines are flushed in between. It seems the recommendation to wait is based mostly on in vitro studies and some hospital policy allows for immediate admin as they report no complications. But yes, never at the same time as you say.
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I forgot how much I love Mike's drawings. You should submit them to the editors of DiPiro to replace their factually accurate yet boring illustrations.
