PHWC Session Guides PDF

2/10/25, 11:28 PM OneNote Tuesday 2/11 Thursday, February 6, 2025 1:12 PM Session Guide: A-5-3: Face Dissection Lab (MM Lab) Tuesday, 02/11/2025 at 8:00 AM - 9:50 AM & 10:00 AM - 11:50 AM...

2/10/25, 11:28 PM OneNote Tuesday 2/11 Thursday, February 6, 2025 1:12 PM Session Guide: A-5-3: Face Dissection Lab (MM Lab) Tuesday, 02/11/2025 at 8:00 AM - 9:50 AM & 10:00 AM - 11:50 AM Assignment Info for Students (if none, leave blank) Submission Instructions, Due Date, and Time Graded-Yes or No Osmosis Playlist https://www.osmosis.org/playlist/yI-9RDLJcJk Includes videos related to the QoD RAP Educational Objectives Session Objective RAP Educational Objectives Answer # Assigned Student 06-4230 Identify the features of the THIS PDF HAS ALL OF THIS INFORMATION + FEW MORE PICTURES: Ashleigh Gilligan external surface of the skull, Exter and the structures (nerves, nalFeatu vessels, muscles) related to resofthe each feature Skull_Ha ndout.p df ExternalFeat uresoftheSku 1. IDENTIFY THE FEATURES OF THE EXTERNAL SURFACE OF THE SKULL: The individual bones of the skull: https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 1/24 2/10/25, 11:28 PM OneNote Sutures https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 2/24 2/10/25, 11:28 PM OneNote 2. External features of each bone of the skull & what structures pass through and what attaches/articulates to https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 3/24 2/10/25, 11:28 PM OneNote https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 4/24 2/10/25, 11:28 PM OneNote FORAMINA/APERTURES OF CRANIAL FOSSAE AND CONTENTS: Table 8 https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 5/24 2/10/25, 11:28 PM OneNote 06-4231 Trace the trigeminal nerve *PSA: It would be helpful to familiarize yourself with key external landmarks of the skull before learning the Moizzah Ahmad (CN V) and facial nerve (CN VII) from the brain to their For CN V (Trigeminal): orbit, middle superior orbital fissure, foramen rotundum, pterygopalatine fossa peripheral distributions, with For CN VII (Facial): Features of the temporal bone (including internal acoustic meatus, facial canal, a attention to the functional modalities of their neurons, clinical testing, and the The trigeminal nerve (CN V) is the fifth paired cranial nerve. It emerges from the lateral aspect of the pon consequences of common the principal general sensory nerve for the head (face, teeth, mouth, nasal cavity, and dura of the cranial c lesions expands into the trigeminal ganglion. This ganglion has the cell bodies of the sensory nerves, and the gang and mandibular. These are each color coded red, blue and green respectively in the images provided. Nerve Pathway (1st , 2nd picture) Innervation Ophthalmic Exits the cranial cavity via the superior orbital fissure General sensory ONLY to: into the upper orbit of the eye. Forehead, nose, eyelids After innervating the orbit, it exits and goes to the Conjunctiva/cornea forehead and medial/upper part of the nose. Ethmoidal air sinuses Dura mater Maxillary Passes through the foramen rotundum to leave the General sensory ONLY to: cranial cavity, and goes into the pterygopalatine fossa. Face (cheek, lateral forehead) From the pterygopalatine fossa, the fibers go to the Nasal cavities and other paranasal sinuses lower orbit, mid-face, nasal cavity, palate, and upper Palate and upper teeth jaw. Dura mater Mandibular It leaves the skull via foramen ovale and enters the General sensory to: infratemporal fossa. Face (temporal region, lower jaw, chin) From the infratemporal fossa, it enters the lower jaw Anterior 2/3rd of the tongue and lower teet and the lower face. Dura mater Motor (branchiomotor) to: Recall that the mandibular division of the t comes from the 1st Pharyngeal arch! Hence innervation is to: Muscles of mastication (temporalis, massete lateral pterygoids) Anterior digastric and mylohyoid mm https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 6/24 2/10/25, 11:28 PM OneNote Tensor tympani m Tensor Veli palatini m Auxillary function of the trigeminal nerve: One of the functions of the trigeminal nerve is to “shuttle” the this can be seen with the lingual branch of the trigeminal nerve, and the parasympathetic branch from CN target the salivary glands. En route to the salivary glands, they will merge their fibers for a short period with glands, they will diverge and become independent again. In this way the trigeminal nerve helps to carry (“s has a detailed list of numerous other examples as well if you are interested in looking. Now, moving on to the facial nerve: The Facial Nerve (Cranial Nerve VII) is a mixed nerve with motor, sensory, and parasympathetic functio junction. Then, it passes through the internal acoustic meatus of the temporal bone. After the internal ac canal and then exits the facial canal via stylomastoid foramen. The facial canal has a Geniculate Gang Nerve. At the geniculate ganglion, the facial nerve gives rise to three nerves: Nerve Type Pathway (Pre-Ganglionic → Synapse → Post-Ganglionic) Innervation Greater (Parasympathetic) Pre: It combines with the deep petrosal nerve to form the nerve of Parasympath Petrosal the pterygoid canal Nerve Synapse: Pterygopalatine ganglion Post: Fibers join zygomatic (CN V2) & lacrimal (CN V1) nerves Chorda Parasympathetic & Pre: travels as chorda tympani nerve and later joins lingual nerve Parasymp Tympani Sensory (Taste) (CN V3) Sensory (t Synapse: Submandibular ganglion Rem Post (2 possible pathways): sens https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 7/24 2/10/25, 11:28 PM OneNote Directly branches from the Submandibular Ganglion. These fibers does directly innervate the submandibular gland. and Some postganglionic fibers rejoin the lingual nerve and travel to sens the sublingual gland and innervate it. Nerve to Motor Direct branch from Facial Nerve (CN VII) within the facial canal. Motor inn Stapedius reducing s Recall tha and that s As the facial nerve exits the facial canal via stylomastoid foramen, deep to the parotid gland, it gives rise to auricular branch and the terminal motor branches. Nerve Type Innervation Posterior Auricular Nerve Sensory Sensory around the external ear Terminal Motor branches. These include: Motor (branchiomotor) Recall that CN VII (facial nerve) comes from Temporal Mm facial expression, stylohyoid m, posterior Zygomatic Zygomatic branch: Orbicularis Occuli, respons Buccal Mandibular Cervical Lesions of the Facial Nerve and their associated Clinical Significance: *follow along with the pictures from the ppt Lesion Location Symptoms Explanation of pt Presentation Prior to the internal auditory No lacrimation Eye dryness will result both from: meatus Hyperacusis (heightened Inability of the lacrimal gland to produce tear sensitivity to sound) Inability of the eye muscles to blink due to lo Complete ipsilateral facial Hyperacusis will result from non-functioning nerve paralysis Lesion in the facial canal Preserved lacrimation Lacrimation will be preserved as the greater petros Hyperacusis facial canal. facial paralysis Dry eyes will still be present, because despite tear p function of the zygomatic branch. Hyperacusis will result from a non-functioning nerv Lesion distal to Stylomastoid Preserved Lacrimation Both greater petrosal nerve and nerve to stapedius Foramen No Hyperacusis Facial paralysis present as terminal motor branches Facial Paralysis Lesion along the greater No Lacrimation Only results in loss of lacrimation as the facial nerve petrosal pathway No hyperacusis So, patients will still present with dry eyes, because No facial Paralysis lubrication. Lesions in Chorda Tympani Few presenting complaints (Remember that chorda tympani provides parasym well as taste sensation for anterior 2/3rd of the ton Posterior tongue’s taste buds and other salivary org And just one last thing, https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 8/24 2/10/25, 11:28 PM OneNote It is important to be able to distinguish between a peripheral motor lesion (LMN) and a central motor lesion (UMN) of the faci A peripheral motor lesion (LMN) of the facial nerve would result in an inability to move muscles on the IPSILATERAL sid ○ E.g Bell's Palsy, often reversible A central motor lesion (UMN) of the facial nerve would only result in paralysis of the lower face muscles on the CONTR This is because the upper face (forehead and eyelids) receives innervations from both sides of the brain - bilateral innerv receives signals from the opposite side of the brain - contralateral innervation. ○ E.g Stroked 06-4233 Describe the configuration of Chris Head structures in the face, including musculoskeletal and neurovascular features Muscles of Scalp and Face (required muscles of facial expression listed below) Note: (All Muscles innervated by the Facial Nerve (CN VII)) Frontalis Elevates eyebrows and wrinkles skin of forehead; protracts scalp Occipitalis Retracts scalp; increasing effectiveness of frontal belly Orbicularis oculi Closes eyelids: palpebral part does so gently; orbital part tightly (winking) corrugator supercilii Draws eyebrow medially and inferiorly, creating vertical wrinkles above nose procerus Depresses medial end of eyebrow; wrinkles skin over dorsum of nose orbicularis oris Tonus closes oral fissure; phasic contraction compresses and protrudes lips (kissing) or resists distens zygomaticus major Part of dilators of mouth; elevate labial commissure—bilaterally to smile (happiness); unilaterally to s https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 9/24 2/10/25, 11:28 PM OneNote (Draws angle of mouth superiorly and posteriorly) levator labii superioris Part of dilators of mouth; retract (elevate) and/or evert upper lip; deepen nasolabial sulcus depressor anguli oris Part of dilators of mouth; depresses the angle of the mouth buccinator Presses cheek against molar teeth; works with tongue to keep food between occlusal surfaces and ou “kissing muscle” platysma Depresses mandible; tenses skin of inferior face and neck Sensory innervation primarily Trigeminal CN V; Motor innervation primarily Facial Nerve CN VII. Muscles of Mastic V. Trigeminal ganglion—the large sensory ganglion of CN V—form the ophthalmic nerve (CN V1), the maxillary nerve ( nerve (CN V3). These nerves are named according to their main regions of termination: the eye, maxilla, and mandi CN V1 and CN V2 = sensory CN V3 = largely sensory but also motor fibers from the motor root of CN V Major Cutaneous Branches of Trigeminal Nerve (CN V) 1. Opthalmic CNV1: Lacrimal, supra-orbital, supratrochlear, infratrochlear, and external nasal nerves 2. Maxillary CNV2: Infra-orbital, zygomaticotemporal, and zygomaticofacial nerves 3. Mandibular CNV3: Auriculotemporal, buccal, and mental nerves 06-4234 Explain the divisions of the The external ear and middle ear are mainly concerned with the transfer of sound to the internal ear, whi Zayna Hasan ear (external, middle, internal) based on location, content, sensory innervation and general function(s) https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 10/24 2/10/25, 11:28 PM OneNote External ear: Composed of Shell-like auricle (pinna): collects sound External acoustic meatus (ear canal): conducts sound to the tympanic membrane Auricle Composed of an irregularly shaped plate of elastic cartilage that is covered by thin skin Concha: deepest depression Helix: Elevated margin of auricle Lobe: fibrous tissue, fat, and blood vessels Tragus: projection overlapping the opening of the external acoustic meatus Arterial supply: mainly from the posterior auricular and superficial temporal arteries Innervation: great auricular and auriculotemporal nerves ○ Great auricular nerve: supplies the cranial (medial) surface (commonly called the “back of the lobule) of the lateral surface (“front of ear”) ○ Auriculotemporal nerve: supplies the skin of the anterior aspect of the lateral surface of the au and tragus ○ Skin of concha is is mostly innervated by the auricular branch of the vagus External acoustic meatus Ear canal that leads inward through the tympanic part of the temporal bone from the auricle to the Lateral third is cartilaginous and medial two thirds is bony Tympanic membrane Forms a partition between the external acoustic meatus and the tympanic cavity of the middle ear Responds to airborne sound waves, converting them to vibrations transmitted by the solid medium Innervation to external acoustic meatus and tympanic membrane: The skin of the superior and anterior walls of the external acoustic meatus and the supero-anterior two membrane are supplied mainly by the auriculotemporal nerve, a branch of CN V3. The skin of the posterior and inferior walls of the meatus and postero-inferior third of the external surfac auricular branch of the vagus (CN X). The internal surface of the tympanic membrane is supplied by t Middle ear https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 11/24 2/10/25, 11:28 PM OneNote Contents Auditory ossicles (malleus, incus, and stapes) Stapedius and tensor tympani muscles Chorda tympani nerve, a branch of CN VII Tympanic plexus of nerves Tympanic cavity Narrow air-filled chamber in the petrous part of the temporal bone Two parts: tympanic cavity proper, the space directly internal to the tympanic membrane, and th membrane Pharyngotympanic tube: joins middle ear to nasopharynx Equalizes pressure in the middle ear with the atmospheric pressure, thereby allowing free moveme and leave the tympanic cavity, this tube balances the pressure on both sides of the membrane. Arterial supply: pharyngotympanic tube are derived from the ascending pharyngeal artery, a bran meningeal artery and artery of the pterygoid canal, branches of the maxillary artery Innervation: tympanic plexus, which is formed by fibers of the glossopharyngeal nerve (CN IX pterygopalatine ganglion Auditory ossicles: form a mobile chain of small bones across the tympanic cavity from the tympanic me Malleus ○ Attaches to the tympanic membrane ○ Transmits vibrations from the eardrum Incus ○ Located between the malleus and the stapes and articulates with them Stapes ○ Sends vibrations to inner ear The auditory ossicles increase the force but decrease the amplitude of the vibrations transmitted from th internal ear Muscles associated with auditory ossicles Tensor tympani ○ Tenses the tympanic membrane, reducing the amplitude of its oscillations ○ The tensor tympani is supplied by the mandibular nerve (CN V3) Stapedius ○ Reduces vibrations of sound waves, which helps protect inner ear from damage. Also preven ○ Nerve to the stapedius arises from the facial nerve (CN VII) Internal Ear Innervated by the vestibulocochlear nerve (CNVIII) Contains the vestibulocochlear organ concerned with the reception of sound and the maintenance of Consists of the sacs and ducts of the membranous labyrinth Fluids are involved in stimulating the end organs for balance and hearing Bony labyrinth Cochlea ○ Transforms sound into electrical signals sent to the brain Vestibule of bony labyrinth ○ Helps maintain balance and equilibrium by sensing head movement and acceleration. Semicircular canals (anterior, posterior, lateral) ○ Balance and sense head position Membranous labyrinth Fluid-filled sacs and ducts inside in the bony labyrinth. Plays a role in balance and hearing. Has en (similar to extracellular fluid) https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 12/24 2/10/25, 11:28 PM OneNote ○ Vestibular labyrinth: ▪ Helps detect movement and head position ○ Cochlear labyrinth ▪ Converts sound into nerve signals ▪ Semicircular ducts ○ Detects rotational movements of the head ○ Hair cells of the crests stimulate primary sensory neurons of the vestibular nerve, whose ce ▪ Cochlear duct ○ Converts sound waves into electrical impulses of nerve cells ○ Hair cells of the spiral organ are innervated by the cochlear division of the vestibulocochlear n ▪ Internal acoustic meatus ○ The facial nerve (CN VII), the vestibulocochlear nerve (CN VIII) and its divisions, and blood v divides near the lateral end of the internal acoustic meatus into two parts: a cochlear nerve an Session Objectives Session Objective # Session Objectives Facilitator Notes 4241 * Apply anatomical knowledge to clinical concepts that relate to the face 12457 * Differentiate anatomical structures from dissection of the Michael Melillo structures of the face and scalp that includes musculature, vasculature, nervous, and glandular structures. https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 13/24 2/10/25, 11:28 PM OneNote https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 14/24 2/10/25, 11:28 PM OneNote 13217 * Differentiate between the anatomical structures within the Differentiate between the anatomical structures within the external, m Mary Sabatino external, middle, and internal ear. External ear Auricle: helix, antihelix, tragus, concha, lobule of the auricle ○ External acoustic meatus (external auditory canal) Middle ear Walls of tympanic cavity Tympanic membrane https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 15/24 2/10/25, 11:28 PM OneNote Oval window Round window Promontory Auditory (eustachian tube) Internal ear Bony labyrinth Cochlea Vestibule Semicircular canals 13218 * Apply anatomical knowledge of neuromuscular structures of the Injury to the facial nerve (CN VII) or its branches produces paralysis of som Vanessa Arias face to the clinical concepts pertaining to the Question of the Day the eyeball). Thus, lacrimal fluid is not spread over the cornea, preventing and Clinical Themes. This makes the cornea vulnerable to ulceration. A resulting corneal scar ca displacement of the mouth (drooping of its corner) is produced by contrac whistle or blow a wind instrument. They frequently dab their eyes and mo https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 16/24 2/10/25, 11:28 PM OneNote Session Guide: A-5-3: Pharmacology Antifungals, Antivirals, & Protein Synthesis Inhibitors (Classroom-based iLab) Tuesday, 02/11/2025 a Assignment Info for Students (if none, leave blank) Submission Instructions, Due Date, and Time Graded-Yes or No Osmosis Playlist https://www.osmosis.org/playlist/Y8RY8hqQP2v RAP Educational Objectives Session Objective RAP Educational Objectives Answer # Assigned Student 4308 Describe the pharmacology (drug names, mechanisms of action, side effects, Sofia Saari and mechanisms of drug resistance) of the drug classes that inhibit bacterial cell wall synthesis. https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 17/24 2/10/25, 11:28 PM OneNote Principles of Cell Wall Targeting Human cells lack cell walls, making bacterial cell walls a selective target for ant Both Gram-positive and Gram-negative bacteria have cell walls but with differen Cell wall structure consists of sugar backbone (NAG-NAM) connected by tetrap β-Lactam Antibiotics General Characteristics Named after β-lactam ring structure Four main families: Penicillins, Cephalosporins, Monobactams, Carbapenems Mechanism: Inhibits transpeptidases, leading to bacterial cell death through aut Common resistance: β-lactamases that cleave the β-lactam ring Penicillins Types and Characteristics: 1. Prototype Penicillins (G and V) Natural penicillins Active against Streptococci, some Gram-negative bacteria 2. Penicillinase-Resistant (Oxacillin, Dicloxacillin, Nafcillin) Developed for penicillin-resistant staphylococci Limited to methicillin-sensitive S. aureus 3. Amino-Penicillins (Ampicillin, Amoxicillin) Enhanced Gram-negative activity Active against H. influenza, H. pylori 4. Antipseudomonal Penicillins (Piperacillin, Ticarcillin) Broad spectrum including Pseudomonas Used with β-lactamase inhibitors Cephalosporins Five generations with progressively increased Gram-negative activity Later generations (3rd-5th) safe for patients with penicillin allergy Notable members: 1st gen: Cephalexin, Cefazolin 2nd gen: Cefaclor, Cefuroxime 3rd gen: Ceftriaxone, Cefotaxime 4th gen: Cefepime 5th gen: Ceftaroline (effective against MRSA) Carbapenems Include Imipenem, Meropenem, Doripenem, Ertapenem Broad spectrum activity Reserved as last resort for serious infections Imipenem requires cilastatin co-administration Monobactam Aztreonam: Gram-negative specific No cross-allergenicity with penicillins Useful for patients with penicillin allergy Other Antimicrobials Vancomycin Inhibits cell wall synthesis by binding to D-Ala-D-Ala Effective against Gram-positive bacteria Primary use: MRSA infections Side effects include nephrotoxicity and red-man syndrome Daptomycin Lipopeptide antibiotic Forms membrane pores leading to cell death Active against vancomycin-resistant organisms Used for complicated skin infections and bacteremia Side effect: myopathy Metronidazole Mechanism: Forms reactive nitro radicals damaging DNA Active against anaerobes and certain protozoa Notable side effects: metallic taste, disulfiram-like effect with alcohol Resistance Management Use of β-lactamase inhibitors (Clavulanic acid, -bactam compounds) Development of new β-lactam structures resistant to β-lactamases Strategic use of last-resort antibiotics Adverse Effects Hypersensitivity reactions common with penicillins Cross-allergenicity between penicillins and early-generation cephalosporins Specific monitoring needed for nephrotoxicity and ototoxicity with certain agents 4309 Describe the pharmacology (drug names, mechanisms of action, side effects, Protein Synthesis Inhibitors: Emma Rohrs most important mechanisms of drug resistance, and interaction with P450, if Emma Rohrs applicable) of protein synthesis inhibitors. Drug Name MOA + Drug Resistance https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 18/24 2/10/25, 11:28 PM OneNote Aminoglycosides (30s *MOA is based largely on streptomycin, we assu Subunit) similarly Streptomycin Neomycin Aminoglycosides = IRREVERSIBLE inhibitor Kanamycin Amikacin 1. Passive diffusion via porin channels Gentamicin 2. Transported into cytoplasm (this is an oxyg Tobramycin process) Sisomicin a. Transmembrane gradient supplies en Netilmicin b. Coupled to proton pump Plazomicin c. Issues can arise if low extracellular p Spectinomycin conditions (structurally related i. These situations inhibit transp but mainly used for ii. Pairing with another drug can gonorrhea not 3. Once inside it will bind to the 30S-subunit available in US) 4. Protein synthesis can then be inhibited by simultaneously: a. Interfering with initiation complex fo b. Misread of mRNA (wrong AA gets ad protein) c. Polysome breakdown into monosom nonfunctional) 5. All three of these process are irreversible a cell death (bactericidal!!!). For my visual learners: Three paths to resistance: 1. Organism produces a transferase enzyme a. This enzyme causes inactivation thro acetylation or phosphorylation b. This is the most common type of res 2. Organism mutates porin protein or deletes the aminoglycoside from getting inside a. Can also utilize growth conditions (li conditions anaerobic, so that the oxy transport into cell can't happen) 3. Receptor on 30s-subunit can become alte Tetracyclines (30s- *Broad spectrum antibiotics, bacteriostatic subunit): Doxycycline 1. Enter via passive diffusion Minocycline 2. Bind reversibly to the 30s-subunit Tigecycline a. Blocks the binding of aminoacyl-tRNA Omadacycline b. Preventing addition of amino acids t Eravacycline And more! Visual: the C and M triangles represent other ant T triangle represents tetracyclines, note the loca and how it is going to block the red charged tRNA amino acid. https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 19/24 2/10/25, 11:28 PM OneNote Resistance in three ways: 1. Influx/efflux of the tetracycline is impacte protein pump a. This is the most important mechanis b. Example: Gram negative species exp efflux pump are resistant to older te newer ones 2. Ribosome "protection" a. Proteins are produced that prevent t 3. Enzymes are inactivated Macrolides (50s- 1. Macrolides bind to the 50S subunit subunit): a. This blocks the polypeptide exit chann Erythromycin b. Peptidyl-tRNA dissociates away from r Clarithromycin 2. Erythromycin will also inhibit formation of t Azithromycin Ketolides ○ Solithromycin (not yet approved) Same image as before but focus on the Resistance: 1. Usually plasmid encoded a. Reducing cell membrane permea b. Hydrolyzation of the macrolides c. Changing the ribosome binding s bind (via mutation or methylase *the efflux and methylase mechanisms positive bacteria Clindamycin (50S): Same MOA as macrolides! (M triangle) Lincomycin Enterococci and gram-negative aerobic bacte derivative clindamycin Resistance to clindamycin: similar to macrol 1. Ribosome site mutation 2. Receptor modification 3. Enzyme inactivation Streptogramins (50s): *Same binding site as macrolides and clindamyci Quinupristin- This combination is bactericidal for most o dalfopristin ○ Combination Resistance occurs due to: of two Modification of binding site for Quinuprist streptogramin Efflux s Enzyme inactivates dalfopristin Chloramphenicol (50s): *Broad spectrum antibiotic Bacteriostatic for 1. Binds reversibly to 50s subunit most organisms https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 20/24 2/10/25, 11:28 PM OneNote Now looking at the C triangle! Low-level resistance: Mutations to being less permeable to c Significant Resistance: Chloramphenicol acetyltransferase ○ Inactivates the drug, is plasmid e Oxazolidinones (50s): *active against gram positive organisms Linezolid 1. Prevents the formation of the ribosome co Tedizolid 2. Binds to 23s of the 50s subunit Resistance: Occurs when the bacteria gain a mutation Pleuromutilin's (50s): *approved in 2019 for Pneumonia treatment in h Lefamulin 1. Binds to the 50s ribosome ○ Novel, 2. Unique because the binding pocket enclos approved in a. This prevents bacterial tRNA from bi 2019 b. Bactericidal for LRI organisms ○ Was previously *lacks activity against: only used in Enterococcus Faecalis veterinary Pseudomonas aeruginosa medicine Acinetobacter Baumannii ○ Right now Enterobacteriaceae group only approved for adult cases of CAP *resistance seems to be low *these were not *mutations observed in vitro mentioned in the previous *need more info on clinical resistance pre-record we had on *likely mechanisms antimicrobials, but it is in Target site alteration the textbook reading so I Efflux am including them, not sure if we will be tested on them though. 03-4305 Describe the drugs used to treat each of the three groups of fungal infections 3 Groups of Fungal Infections: Brigid O'Brien according to location of infection, signs, symptoms and most common Superficial/mucocutaneous causative species. ○ Superficial mycoses/Dermatophytes: ▪ Location: skin, hair nails ▪ Signs & symptoms: pruritic (itchy) rash and erythema ▪ Most common species: Epidermophyton, Microsporum, Tric ▪ Examples: Tina pedis (athlete's foot), tinea capitis (ringworm ○ Mucocutaneous mycoses: ▪ Location: mouth, axilla, groin, gluteal folds, vagina ▪ Signs & symptoms: rash, itching, scaling, erythema ▪ Most common species: yeasts - Candida albicans and other Subcutaneous ○ Location: dermis, subcutaneous connective tissue, muscle ○ Signs & symptoms: most commonly caused by puncture wounds c ○ Most common species: Sporothrix ○ Examples: chromomycosis, pseudallescheriases, sporotrichosis Systemic ○ Location: internal organs, tissues, skin, muscle, joints ○ Signs & symptoms: variety of symptoms based on what system th ○ Most common species: Aspergillus, Blastomyces, Candida, Coccidi ○ Examples: UTIs, pneumonia, meningitis, esophageal infections, se https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 21/24 2/10/25, 11:28 PM OneNote 03-4306 Describe the drug names, mechanisms of action, important side effects and Drugs Mechanisms of Action Pano Gentis effects on the P450 system of seven classes of antifungal drugs. Flucytosine Cytosine deaminase converts flucytosine (Inhibitor of Fungal Nucleic Acid Subsequent reactions convert 5-FU to 5-f Synthesis) monophosphate (5-FdUMP), which is a po of thymidylate synthase. Inhibition of thy in inhibition of DNA synthesis and cell div Griseofulvin Inhibits fungal mitosis by binding to tubu (Inhibitor of Fungal Mitosis) associated protein and thereby disrupting spindle. The drug is also reported to inhib synthesis. Allylamines and Benzylamines Squalene is converted to lanosterol by the (Inhibitors of Squalene epoxidase. Inhibitors of squalene epoxida Epoxidase) of lanosterol, which is a precursor for erg promote accumulation of the toxic metab fungal cell, making them fungicidal under Imidazoles and Triazoles Inhibit fungal 14α-sterol demethylase. D (Inhibitors of 14α-Sterol synthesis and accumulation of 14α-methy Demethylase) fungal membranes. Destabilization of the to dysfunction of membrane-associated e the electron transport chain, and may ult Polyenes Amphotericin B, nystatin, and natamycin (Inhibitors of Fungal Membrane binding to ergosterol and disrupting funga Stability) Echinocandins Caspofungin, micafungin, and anidulafun (Inhibitors of Fungal Wall wall synthesis by noncompetitively inhibi Synthesis) (1,3)-D-glucans. Disruption of cell wall int stress, lysis of the fungal cell, and ultimate Ciclopirox Mechanism of action is poorly understood (Chelator of Polyvalent Cations) the drug chelates the polyvalent cations of these ions inhibits numerous metal-de responsible for electron transport, DNA a production, catalase activity, and peroxid fungal cells. https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 22/24 2/10/25, 11:28 PM OneNote 03-4307 Describe the drug names, mechanism of action, and side effects of antivirals Antiherpesvirus Nucleoside and Nucleotide Analogues Nick Nakasian used for the treatment of HSV, VZV, HCMV, and influenza virus. Drugs Virus Treated Acyclovir, Valacyclovir HSV and VZV Penciclovir, Famciclovir HSV, Shingles Ganciclovir, Valganciclovir HCMV Cidofovir (only nucleotide analogue) HCMV Retinitis (commonly patie with HIV/AIDS) Nonnucleoside DNA Polymerase Inhibitors Drugs Virus Treated MOA Foscarnet HSV and HCMV Inhibits viral DNA polymera by mimicking the pyrophosp *Used when virus is product of DNA polymerizat resistant to initial acyclovir or ganciclovir treatment Inhibitors of Viral Uncoating – no longer used in US but included in obj Drugs Virus Treated MOA Amantadine, Influenza A only Inhibit influenza A uncoating Rimantadine blocking M2, a proton chann acidifies the interior of the v Acidification is necessary for dissociation of viral matrix p from the viral ribonucleopro Inhibitors of Viral Release Drugs Virus Treated MOA Zanamivir. Influenza A and B Inhibit influenza virus Oseltamivir neuraminidase, causing newly *must be used within 48 synthesized virions to remain hours of symptom attached to host cell onset *Neuraminidase normally perm release of influenza virus so it c spread https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 23/24 2/10/25, 11:28 PM OneNote *Neuraminidase inhibitors reduce the duration of flu symptoms in most be quite meaningful to the “flu” sufferer) requires that the drugs be tak Session Objectives Session Objective # Session Objectives Facilitator Notes Read https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 24/24