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\author{kjaniskevich}
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  /Title (pharm250-the-immune-system.pdf)
  /Creator (Cheatography)
  /Author (kjaniskevich)
  /Subject (PHARM250 the Immune system Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{PHARM250 the Immune system Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{kjaniskevich} via \textcolor{DarkBackground}{\uline{cheatography.com/132444/cs/27496/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}kjaniskevich \\
  \uline{cheatography.com/kjaniskevich} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 13th April, 2021.\\
   Updated 13th April, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Fever - classes of medication}}  \tn
% Row 0
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\seqsplit{Acetaminophen} & {\bf{Mechanism of action}}: acts at hypothalamus to cause peripheral vasodilation, which enables sweating and allows body to rid excess heat \{\{nl\}\} No anti-inflammatory action \{\{nl\}\} {\bf{Primary use}}: fever, mild to moderate pain, osteoarthritis \tn 
% Row Count 9 (+ 9)
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NSAID's & Same mechanism of action as acetaminophen (for fever)\{\{nl\}\} Because of acetaminophen's safety record (few drug interactions and side effects), it is first-line for fever\{\{nl\}\} NSAID could be more appropriate if inflammation is also present (ibuprofen \textgreater{} ASA)\{\{nl\}\} ASA is contraindicated in children  Reye's Syndrome (ASA + virus + fever in child) \tn 
% Row Count 21 (+ 12)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adverse effects}}  \tn
% Row 0
\SetRowColor{LightBackground}
NSAID & nausea, dyspepsia, ulcer with long-term use, potential anti-platelet action, hypertension, increased risk of cardiac event with long-term use \{\{nl\}\} Take with food \{\{nl\}\} Caution in kidney disease, cardiovascular disease, GI conditions \tn 
% Row Count 12 (+ 12)
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\mymulticolumn{2}{x{5.377cm}}{Corticosteroids} \tn 
% Row Count 13 (+ 1)
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Acetominophen & very rare liver toxicity (max dose of 4g/24hours), avoid alcohol, interacts with warfarin \{\{nl\}\} (but doesn't ↑ bleeding on its own) \tn 
% Row Count 20 (+ 7)
% Row 3
\SetRowColor{white}
1st-Generation Antihistamines & Significant sedation \tn 
% Row Count 22 (+ 2)
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\mymulticolumn{2}{x{5.377cm}}{2nd-Generation Antihistamines} \tn 
% Row Count 23 (+ 1)
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Intranasal Corticosteroids & nasal irritation, dryness and bleeding (epistaxis), bad taste, loss of smell \tn 
% Row Count 27 (+ 4)
% Row 6
\SetRowColor{LightBackground}
Decongestants\{\{nl\}\}{\emph{Phenylephrine, pseudoephedrine}} & oral – hypertension, anxiety, insomnia; \{\{nl\}\}intranasal – nasal irritation, rebound congestion, rarely systemic effects \tn 
% Row Count 34 (+ 7)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
% Row 7
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Penicillin & anaphylaxis, diarrhea, nausea, vomiting, pain at injection site, superinfections, some (minor) drug interactions \tn 
% Row Count 6 (+ 6)
% Row 8
\SetRowColor{white}
Cephalosporins \{\{nl\}\}{\emph{Cefotaxime}} (3rd Gen.) & hypersensitivity, rash, itching, anaphylaxis, diarrhea, vomiting, nausea, pain at injection site, some (minor) drug interactions\{\{nl\}\} Must be given IV or IM (not orally) \tn 
% Row Count 15 (+ 9)
% Row 9
\SetRowColor{LightBackground}
Tetracyclines & diarrhea, yeast infections, nausea, vomiting, epi-gastric burning, yellow-brown teeth discolouration in young children (we don't prescribe for kids), photosensitivity \{\{nl\}\} Can potentially interfere with oral contraceptives (recommend backup method) \{\{nl\}\} Higher chance of superinfections because it is broad-spectrum \tn 
% Row Count 32 (+ 17)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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Macrolides\{\{nl\}\}{\emph{Erythromycin}} & : significant nausea, vomiting, diarrhea (take with food), some important drug interactions \{\{nl\}\} Warfarin, cyclosporine, anticonvulsants (all via CYP450 inhibition/induction)\{\{nl\}\} Fidaxomicin – new; for treatment of c. difficile; not absorbed, stays in GI tract nausea, constipation, vomiting \tn 
% Row Count 15 (+ 15)
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Aminoglycosides\{\{nl\}\}{\emph{Gentamicin}} & ototoxicity, nephrotoxicity \tn 
% Row Count 17 (+ 2)
% Row 12
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Fluoroquinolones \{\{nl\}\} {\emph{Ciprofloxacin}} & nausea, diarrhea (can take with food), photosensitivity \{\{nl\}\} Separate from minerals like calcium, iron, magnesium, aluminum (including supplements and antacids) by 2h\{\{nl\}\}Serious adverse effects associated with fluoroquinolones: Tendinitis or tendon rupture (1.3-5.6 in 10,000)\{\{nl\}\} Cardiac arrhythmias (15-57 in 100,000)\{\{nl\}\} CNS effects  seizures, tremors, altered mental state \{\{nl\}\} Peripheral neuropathy \tn 
% Row Count 38 (+ 21)
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Sulfonamides \{\{nl\}\}{\emph{Sulfamethoxazole-Trimethoprim (SMZ-TMP, Septra®, Bactrim®, -DS)}} & nausea, vomiting, skin rashes, photosensitivity, anemia, crystalluria\{\{nl\}\} Drink lots of water to prevent crystalluria\{\{nl\}\} Monitor for: painful urination, abdominal pain, blood in urine, fever \tn 
% Row Count 10 (+ 10)
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Carbapenems \{\{nl\}\}{\emph{ertapenem, imipenem, meropenem}} & skin reactions, inflammation at injection site, diarrhea, nausea, vomiting \tn 
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Clindamycin & High risk of superinfection (GI) \tn 
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Nitrofurantoin & Changes urine to orange colour \{\{nl\}\} Must take with food \tn 
% Row Count 19 (+ 3)
% Row 17
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Metronidazole & Disulfiram reaction – flushing, tachycardia, shortness of breath, severe nausea \& vomiting, throbbing headache, visual disturbance, confusion, dizziness\{\{nl\}\} Occurs \textasciitilde{} 5-10 minutes after intake, lasts 30 mins  several hours \tn 
% Row Count 31 (+ 12)
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Vancomycin & Ototoxicity and nephrotoxicity \tn 
% Row Count 2 (+ 2)
% Row 19
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Linezolid & lactic acidosis, myelosuppression (↓WBC and platelets), peripheral and optic neuropathy, serotonin syndrome, diarrhea, \{\{nl\}\}  Major drug interaction with any serotonergic drug, may need to discontinue until course of treatment finished, also inhibits MAO \tn 
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% Row 20
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Rifampin (RMP) & Rashes, blood dyscrasias, GI disturbances, liver damage, nephrotoxicity \{\{nl\}\} Secretions coloured a reddish-orange (sweat, urine, sputum, tears) \tn 
% Row Count 23 (+ 8)
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Amphotericin B & fever \& chills during infusion, vomiting, headache, phlebitis, nephrotoxicity, hypokalemia, ototoxicity \tn 
% Row Count 29 (+ 6)
% Row 22
\SetRowColor{LightBackground}
Azole Antifungals\{\{nl\}\}{\emph{fluconazole, itraconazole, ketoconazole, miconazole, voriconazole}} & Rare hepatotoxicity – avoid alcohol, watch for jaundice, monitor liver enzymes \tn 
% Row Count 34 (+ 5)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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Nystatin & Oral thrush – swish and swallow oral suspension four times daily (works topically) (needs Rx) \tn 
% Row Count 5 (+ 5)
% Row 24
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Classic Immuno-suppressant & Increased risk of infections, Increased risk of cancers such as lymphomas, cysts, and polyps \{\{nl\}\}Frequency increases with intensity and duration of treatment, Kidney impairment, hepatic impairment, Hypertension, hyperlipidemia,\{\{nl\}\} CNS: tremor, headache, skin prickling sensation,\{\{nl\}\} GI: nausea, vomiting, abdominal pain, diarrhea, gingival hyperplasia,\{\{nl\}\} MSK: Muscle cramps, myalgia\{\{nl\}\} Endocrine: Menstrual disturbances, gynecomastia, Hypertrichosis (abnormal amount of hair growth over body), Fatigue \tn 
% Row Count 31 (+ 26)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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Chemotherapy & {\bf{short term}} \{\{nl\}\} Nausea/vomiting, Diarrhea or constipation, \seqsplit{Mucositis/stomatitis}, Myelosuppression, Hair growth alterations, Weight gain / weight loss, Taste alterations, Fatigue, Hepatic and renal changes, Cardiac function changes, Rash / skin changes / nail changes, High blood pressure \{\{nl\}\}{\bf{Long term}}\{\{nl\}\}Infertility, Secondary malignancies, Heart failure, Osteoporosis, Pulmonary fibrosis, Cataracts, Peripheral neuropathy, Hearing loss, Fatigue, Endocrine abnormalities \tn 
% Row Count 25 (+ 25)
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Inflammation mediators}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{Histamines} \tn 
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\mymulticolumn{1}{x{5.377cm}}{Leukotrienes} \tn 
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\mymulticolumn{1}{x{5.377cm}}{Interleukins} \tn 
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\mymulticolumn{1}{x{5.377cm}}{Prostaglandin} \tn 
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Inflammation classes of medication}}  \tn
% Row 0
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{\bf{Non-steroidal anti-inflammatories}} \{\{nl\}\} {\bf{{\emph{NSAID}}}} & Inhibit cyclo-oxygenase (COX), which reduces prostaglandin synthesis therefore inhibiting inflammation \{\{nl\}\}Also have analgesic and antipyretic properties\{\{nl\}\} For mild to moderate inflammation \tn 
% Row Count 10 (+ 10)
% Row 1
\SetRowColor{white}
COX-1 & – In all tissues, stomach lining (mucosa), involved in platelet aggregation \tn 
% Row Count 14 (+ 4)
% Row 2
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COX-2 & more specific for inflammation \tn 
% Row Count 16 (+ 2)
% Row 3
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{\emph{Ibuprofen}} & mild to moderate inflammation, fever, mild to moderate pain, dysmenorrhea, musculoskeletal pain, arthritis \tn 
% Row Count 22 (+ 6)
% Row 4
\SetRowColor{LightBackground}
{\bf{Corticosteroids}}\{\{nobreak\}\} & Mimic endogenous cortisol, attempting to bring body back to homeostasis after a fight-or-flight response\{\{nl\}\} Anti-inflammatory and immuno-suppressive\{\{nl\}\} For severe inflammation\{\{nl\}\} Serious systemic adverse effects limit use to emergencies and severe inflammation (multiple sclerosis, rheumatoid arthritis, auto-immune diseases)\{\{nl\}\} Local administration, short-term use preferred whenever possible \tn 
% Row Count 43 (+ 21)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Antibiotics - Classes of medication}}  \tn
% Row 0
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{\bf{Penicillins}} \{\{nl\}\} {\emph{-cillin}} & Disrupt bacterial cell walls, Bactericidal\{\{nl\}\} Penicillin-binding protein: a protein only in bacterial cell walls that penicillin binds to which weakens the cell wall, allows fluid to enter and destroys the cell\{\{nl\}\} Penicillins contain a beta-lactam ring in its structure necessary for activity\{\{nl\}\} Many bacteria produce beta-lactamase (penicillinase) that is a natural defense to penicillin – it breaks the beta-lactam ring, leaving it ineffective therefore penicillin resistance \tn 
% Row Count 25 (+ 25)
% Row 1
\SetRowColor{white}
{\emph{Amoxicillin + Clavulanic Acid (Amoxiclav)}} & Clavulanic acid inhibits β–lactamases (penicillinases) of some microorganisms to allow amoxicillin to be active against it  \{\{nl\}\}  Synergistic relationship \tn 
% Row Count 33 (+ 8)
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{\emph{Penicillin G Potassium (Pen G)}} & Drug of choice against streptococci, pneumococci, staphylococci, gonorrhea and syphilis (given IV or IM) \tn 
% Row Count 6 (+ 6)
% Row 3
\SetRowColor{white}
{\bf{Cephalosporins}} \{\{nl\}\} {\emph{-ce(f)ph}} & Related to penicillins (1st gen. also have beta-lactam ring)\{\{nl\}\} Also inhibit cell wall synthesis, Bactericidal\{\{nl\}\} Classified according to "generation" (1 - 4)\{\{nl\}\} {\bf{General Rules}} \{\{nl\}\} 1st generation not effective against bacteria producing beta-lactamase \{\{nl\}\} More potent as go up in generation \{\{nl\}\} Fewer similarities with penicillins as go up in generation\{\{nl\}\} Higher generations reserved for known resistant infections \tn 
% Row Count 29 (+ 23)
% Row 4
\SetRowColor{LightBackground}
{\emph{Cefotaxime (3rd Gen.)}} & Has broad-spectrum activity against gram-negative organisms; for serious infections of lower respiratory tract, CNS, genitourinary system, bones, blood, and joints \tn 
% Row Count 38 (+ 9)
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{\bf{Tetracyclines}} \{\{nl\}\} {\emph{doxycycline, minocycline, tetracycline}} \{\{nl\}\}{\emph{-cycline}} & Inhibit bacterial protein synthesis, Bacteriostatic\{\{nl\}\} Broad-spectrum (both gram-positive and negative)\{\{nl\}\} Usually given orally (PO)\{\{nl\}\} Should not be given at the same time as iron, calcium, magnesium (ions bind to drug so it can't absorb) – separate by 2h \tn 
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{\emph{Tetracycline}} & Used for Rocky Mountain spotted fever, h.pylori infections, acne vulgaris, chlamydia \tn 
% Row Count 19 (+ 5)
% Row 7
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{\bf{Macrolides}} \{\{nl\}\} {\emph{azithromycin, clarithromycin, erythromycin, fidaxomicin}} \{\{nl\}\} {\emph{-thromycin}} & Inhibit bacterial protein synthesis, Some are bactericidal, some bacteriostatic\{\{nl\}\} No structural similarities to penicillin – zero chance of cross-reactivity \tn 
% Row Count 28 (+ 9)
% Row 8
\SetRowColor{white}
{\emph{Erythromycin}} & Used for upper and lower respiratory tract infections, whooping cough, diphtheria, or for other infections in patients who cannot take penicillins \tn 
% Row Count 36 (+ 8)
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{\bf{Aminoglycosides}} \{\{nl\}\} {\emph{amikacin, gentimicin, streptomycin, tobramycin}} \{\{nl\}\} {\emph{-mycin OR -micin}} & Inhibit bacterial protein synthesis and cause abnormal protein synthesis, Dose-dependent bactericidal\{\{nl\}\} Very effective, usually reserved for serious infections (like tuberculosis) or when other antibiotics have failed\{\{nl\}\} Require therapeutic drug monitoring – levels must be in specific range to be effective, but not toxic\{\{nl\}\} Injection or topical \tn 
% Row Count 18 (+ 18)
% Row 10
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{\emph{Gentamicin}} & Used for serious (life-threatening) infections or when other antibiotics have failed (also topically as eye drops and creams/ointments – this would not require therapeutic drug monitoring) \tn 
% Row Count 28 (+ 10)
% Row 11
\SetRowColor{LightBackground}
{\bf{Fluoroquinolones}} \{\{nl\}\} {\emph{besifloxacin, ciprofloxacin, gatifloxocin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin}} \{\{nl\}\} {\emph{-floxacin}} & Affect bacterial DNA synthesis, Bactericidal Most often used orally (also ear, eye)\{\{nl\}\} Absorption is affected by minerals (calcium, iron, magnesium) and need to be separated (\textasciitilde{}2h)\{\{nl\}\}Generally not used in children – affects cartilage development \tn 
% Row Count 41 (+ 13)
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{\emph{Ciprofloxacin}} & Used commonly for respiratory, urinary, ophthalmic, gastrointestinal, and gynecological infections – high usage in \seqsplit{community/out-patient} \tn 
% Row Count 7 (+ 7)
% Row 13
\SetRowColor{white}
{\bf{Sulfonamides}} \{\{nl\}\} {\emph{sulfacetamide, sulfamethoxazole, sulfapyridine}} \{\{nl\}\}{\emph{Sulfa-}} & Suppress bacterial growth by inhibiting essential folic acid needed within the cell, Bacteriostatic \{\{nl\}\} Broad spectrum, older class  more resistance seen \{\{nl\}\} Orally and topically (acne)\{\{nl\}\} "Sulfa" is also a common "allergy" \tn 
% Row Count 20 (+ 13)
% Row 14
\SetRowColor{LightBackground}
{\emph{Sulfamethoxazole-Trimethoprim (SMZ-TMP, Septra®, Bactrim®, -DS)}} & Both drugs inhibit essential folic acid synthesis; work synergistically (a pharmacodynamic interaction)\{\{nl\}\} Used to treat urinary tract infections \tn 
% Row Count 28 (+ 8)
% Row 15
\SetRowColor{white}
{\bf{Carbapenems}} \{\{nl\}\} {\emph{ertapenem, imipenem, meropenem}} \{\{nl\}\} {\emph{-penem}} & Relatively new-ish \{\{nl\}\} Contain beta-lactam ring and inhibit cell wall synthesis (like penicillins)\{\{nl\}\} The beta-lactam ring is very resistant to destruction by penicillinase\{\{nl\}\} Broad spectrum – and very effective; as a newer class, they are being reserved for resistant infections (like MRSA, etc.) \tn 
% Row Count 44 (+ 16)
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% Row 16
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\mymulticolumn{2}{x{5.377cm}}{{\bf{ Miscellaneous VIPs}}} \tn 
% Row Count 1 (+ 1)
% Row 17
\SetRowColor{white}
{\emph{Clindamycin}} & protein synthesis inhibitor; bacteriostatic \{\{nl\}\} Used topically (acne), oral or IV for serious systemic infections \{\{nl\}\} High risk of superinfection (GI) \tn 
% Row Count 9 (+ 8)
% Row 18
\SetRowColor{LightBackground}
{\emph{Nitrofurantoin}} & inhibits protein, RNA, DNA, and cell wall synthesis; bactericidal \{\{nl\}\} Excreted unchanged through the kidney (no metabolism), therefore used only for urinary tract infections \{\{nl\}\} Changes urine to orange colour \{\{nl\}\} Must take with food \tn 
% Row Count 22 (+ 13)
% Row 19
\SetRowColor{white}
{\emph{Metronidazole}} & destroys bacterial DNA; bactericidal \{\{nl\}\} For anaerobic bacteria \{\{nl\}\} NO ALCOHOL USE (even small amounts present in cough syrup or mouthwash) \tn 
% Row Count 30 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Antibiotics - Classes of medication (cont)}}  \tn
% Row 20
\SetRowColor{LightBackground}
{\emph{Vancomycin}} & inhibits cell wall synthesis; bactericidal (through different mechanism than aminoglycosides)\{\{nl\}\} Reserved for severe infections that are resistant to anything else  usually only used in hospital \seqsplit{(methicillin-resistant} staph. aureus - MRSA)\{\{nl\}\} Injection or oral \{\{nl\}\} If IV given too quickly  Red Man Syndrome (flushing, red face, hypotension)  slow down infusion \{\{nl\}\} Therapeutic drug monitoring required (like aminoglycosides) \tn 
% Row Count 23 (+ 23)
% Row 21
\SetRowColor{white}
{\emph{Linezolid}} & inhibits bacterial protein synthesis \{\{nl\}\} Use to treat \seqsplit{vancomycin-resistant} enterococcus (VRE), pneumonia or skin infections caused by MRSA \{\{nl\}\} i.e. Severe infections resistant to other antibiotics \tn 
% Row Count 34 (+ 11)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Allergies- Classes of Medication}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Antihistamines}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
1st-Generation Antihistamines & Block H1 receptors \{\{nl\}\} Shorter acting, cause more drowsiness, and work faster  than 2nd Generation\{\{nl\}\} Used mostly to treat allergic response\{\{nl\}\} {\emph{Diphenhydramine}} and {\emph{chlorpheniramine}} most common \{\{nl\}\} Have anticholinergic effects \{\{nl\}\} Significant sedation – some use as a sleep aid \tn 
% Row Count 16 (+ 15)
% Row 2
\SetRowColor{LightBackground}
2nd-Generation Antihistamines \{\{nl\}\}{\emph{Cetirizine (Reactine®), loratidine (Claritin®), desloratidine (Aerius®), fexofenadine (Allegra®)}} & \{\{nl\}\}{\emph{Cetirizine (Reactine®), loratidine (Claritin®), desloratidine (Aerius®), fexofenadine (Allegra®)}} \tn 
% Row Count 23 (+ 7)
% Row 3
\SetRowColor{white}
{\bf{Intranasal Corticosteroids}} & To reduce inflammation in nasal mucous membranes, and local immunosuppression\{\{nl\}\} Used daily to prevent symptoms\{\{nl\}\} Can take up to 2 weeks for full effect\{\{nl\}\} Local administration prevents systemic side effects \tn 
% Row Count 34 (+ 11)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Allergies- Classes of Medication (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
{\bf{Decongestants}} \{\{nl\}\}{\emph{Phenylephrine, pseudoephedrine}} & Sympathomimetics – stimulants – cause vasoconstriction and reduction of mucous production\{\{nl\}\} For immediate relief of nasal congestion – oral or intranasal\{\{nl\}\} Short term-use only – rebound congestion if longer than 3-5 days (intranasal) \tn 
% Row Count 13 (+ 13)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Drugs for Anaphylaxis}}} \tn 
% Row Count 14 (+ 1)
% Row 6
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Epinephrine & Stimulates both α and β adrenergic receptors \{\{nl\}  Via α–receptors: counters the high vascular permeability that occurs during anaphylaxis that leads to loss of intravascular fluid and hypotension \{\{nl\}\} Via β–receptors: causes bronchial smooth muscle relaxation and relieves bronchospasm, dyspnea, and wheezing\{\{nl\}\} Also alleviates pruritus, urticaria, and angioedema \tn 
% Row Count 33 (+ 19)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Anti-fungals - Classes of medication}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Amphotericin B }} & Binds to fungal cell membranes, making them leaky, Given IV \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Azole Antifungals }} \{\{nl\}\}{\emph{fluconazole, itraconazole, ketoconazole, miconazole, voriconazole}} & Alter fungal cell membranes by depleting ergosterol\{\{nl\}\} Used orally, topically, injection; fluconazole available OTC\{\{nl\}\} Safer than amphotericin B\{\{nl\}\} Most often for vaginal candidiasis, athlete's foot, or thrush \{\{nl\}\}metronidazole is NOT an azole antifungal \tn 
% Row Count 17 (+ 14)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Miscellaneous}}} \tn 
% Row Count 18 (+ 1)
% Row 3
\SetRowColor{white}
{\emph{Ciclopirox}} & topical med used for fungal nail or scalp infections (nail polish or shampoo) \tn 
% Row Count 22 (+ 4)
% Row 4
\SetRowColor{LightBackground}
{\emph{Terbinafine}} & oral med for fungal nail infections \tn 
% Row Count 24 (+ 2)
% Row 5
\SetRowColor{white}
{\emph{Nystatin}} & cream available without prescription for many topical fungal infections (ringworm, diaper rash) \tn 
% Row Count 29 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Anti-Virals -Classes of medication}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{HIV}} & Because of antiretroviral drugs, HIV patients are able to live symptom-free for much longer with very low counts of the retrovirus \{\{nl\}\} Antiretroviral drugs block the HIV replication cycle \{\{nl\}\} \tn 
% Row Count 10 (+ 10)
% Row 1
\SetRowColor{white}
HAART – highly active antiretroviral therapy & Goal is to reduce plasma HIV to its lowest possible level - HIV still remains in the lymph nodes \{\{nl\}\} Blood and lymph are separate rivers that cross occasionally \{\{nl\}\} Use different classes of antiretrovirals at same time to reduce resistance \{\{nl\}\} Each class 'attacks' different step of replication cycle \tn 
% Row Count 26 (+ 16)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Herpes Infections}}} \tn 
% Row Count 27 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{HSV1: oral cold sores} \tn 
% Row Count 28 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{HSV2: genital ulcerations} \tn 
% Row Count 29 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Zoster: shingles (due to previous varicella-zoster infection)} \tn 
% Row Count 31 (+ 2)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Anti-Virals -Classes of medication (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
{\emph{Acyclovir, famciclovir, valacyclovir}} & Mostly controlled by oral therapy of antivirals – taken at first sign of outbreak, continued for short term \{\{nl\}\} These antivirals prevent viral DNA synthesis \{\{nl\}\} Very well tolerated – take with food \tn 
% Row Count 11 (+ 11)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Over the Counter medications for Herpes}}} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
{\emph{Lipactin®}} - heparin + zinc & can reduce pain, may speed healing\{\{nl\}\} Mechanism does not match pathophysiology \tn 
% Row Count 17 (+ 5)
% Row 9
\SetRowColor{white}
{\emph{Abreva®}} - docosanol & prevents viral entry into cells, stops spread if caught early (can reduce duration of cold sore by \textasciitilde{}1 day) \tn 
% Row Count 23 (+ 6)
% Row 10
\SetRowColor{LightBackground}
{\bf{Influenza}} \{\{nl\}\}{\emph{ Amantadine, and neuraminidase inhibitors (oseltamivir and zanamivir) }} & BEST PROTECTION = VACCINATION \{\{nl\}\} Antiviral drugs may decrease severity of symptoms of influenza and may shorten symptom time by a couple days IF taken within first 48 hours \{\{nl\}\} Generally used only in patients at high risk of complications from influenza \tn 
% Row Count 36 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Immunosuppression - Classes of Medication}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Calcineurin Inhibitors }} \{\{nl\}\} {\emph{Cyclosporine, tacrolimus, pimecrolimus (topical)}} & "Classic" immuno-suppressants used for transplants (or topically for psoriasis)\{\{nl\}\} Disrupt T-cell function by binding to calcineurin \{\{nl\}\} They are not specific – suppress the ENTIRE immune system  patient is very susceptible to any other infection \{\{nl\}\} Extensive monitoring for detailed WBC counts and signs of infection (see slide on monitoring) \tn 
% Row Count 19 (+ 19)
% Row 1
\SetRowColor{white}
{\bf{Corticosteroids}} & Anti-inflammatory and  	immunosuppressant activity \{\{nl\}\} Often used to control exacerbations of condition such as asthma, rheumatoid arthritis, MS, etc. \{\{nl\}\} Pulse therapy (very high doses, gradual taper) to minimize side effects \{\{nl\}\} Many, many side effects \tn 
% Row Count 33 (+ 14)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Immunosuppression - Classes of Medication (cont)}}  \tn
% Row 2
\SetRowColor{LightBackground}
{\bf{Biologics }} & medications produced using biological processes in living organisms such as yeast and bacteria \{\{nl\}\}  Have active pharmaceutical ingredients that cannot reasonably be synthesized by chemical means (too complicated)\{\{nl\}\} Are complex, large molecules derived from living sources and produced through a number of intricate steps\{\{nl\}\}Biologics can be immunosuppressant or immunostimulant (very specifically) or replace a substance that is missing (insulin) \tn 
% Row Count 23 (+ 23)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Vaccines, Blood products, Hormones \& growth factors, Enzymes Gene therapy, Cancer treatments} \tn 
% Row Count 25 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Chemotherapy }}} \tn 
% Row Count 26 (+ 1)
% Row 5
\SetRowColor{white}
{\emph{Cytotoxic drugs}} & traditional; interfere with or damage DNA, causing apoptosis (programmed cell death) \tn 
% Row Count 31 (+ 5)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Immunosuppression - Classes of Medication (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
{\emph{Hormonal therapy }} & not cytotoxic; effects mediated through hormonal receptors (deprivation) – for hormone-responsive cancer (breast, prostate, etc.) \tn 
% Row Count 7 (+ 7)
% Row 7
\SetRowColor{white}
{\emph{Immunotherapy }} & monoclonal antibodies, vaccines; non-specifically boost immune system to help eradicate cancer (interferon alfa) \tn 
% Row Count 13 (+ 6)
% Row 8
\SetRowColor{LightBackground}
{\emph{Targeted agents}} & monoclonal antibodies, tyrosine-kinase inhibitors (TKIs); the future of treatment – to target cancer cells only \tn 
% Row Count 19 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.29402 cm} x{3.68298 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Tuberculosis medications}}  \tn
% Row 0
\SetRowColor{LightBackground}
Rifampin (RMP) & Most potent anti-TB drug available \{\{nl\}\} Good bactericidal activity, prevents acquired drug resistance and is very important in preventing relapse \{\{nl\}\} Current doses are based on studies performed in the 1960s, when the lowest effective dose was used because of the high cost of the drug; concerns now that dose is too low -\textgreater{} current trials -\textgreater{} dosing recommendations may change \tn 
% Row Count 14 (+ 14)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}