In infants, RSV is an important cause of lower respiratory tract diseases such as bronchiolitis and pneumonia. RSV is also an important cause of otitis media in young children.
In older children and young, healthy adults, RSV causes respiratory tract infections such as the common cold and bronchitis. However, in the elderly (people older than 65 years of age) and in adults with chronic cardiopulmonary diseases, RSV can cause severe lower respiratory tract disease, including pneumonia.

The reason why the severity of RSV infection is reduced with age (except for the elderly) is that IgA respiratory antibody reduces the frequency of RSV infection as a person ages.

virtually everyone has been infected by RSV by the age of 3 years.
RSV also causes outbreaks of respiratory infections in hospitalized infants; these outbreaks can be controlled by handwashing and use of gloves, which interrupt transmission by hospital personnel.

Why is it called a "syncytial" virus?
Because it makes cells fuse and clump together and become one huge multi-nucleated cell (called syncytium).

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The fusion protein is present on RSV surface. It causes cells to fuse, forming multinucleated giant cells (syncytia), which give rise to the name of the virus.

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#التمريض

Streptococcus bacteria

Anti-epileptic drugs for treatment of absence seizures:
• Ethosuximide (1st-line).
• Lamotrigine.

We avoid giving valproic acid (depakine) for women of childbearing age because of risk of teratogenicity.

CYP450 Inhibitors:

Antibiotics/virals/fungal agents:
• Macrolides (except azithromycin)
• Ciprofloxacin
• TMP/SMX
• INH
• Azole antifungals (including metronidazole)
• HIV antivirals (especially protease-inhibitors)

Cardiovascular drugs:
• Non-dihydropyridine CCBs (verapamil, diltiazem)
• Amiodarone
• Carvedilol
• Metoprolol

Neuropsychiatric drugs:
• Fluoxetine
• Bupropion
• Duloxetine
• Sertraline
• Amitriptyline
• Codeine
• Tramadol
• Valproate

Miscellaneous:
• Cimetidine
• Cyclosporine
• Grapefruit juice

CYP450 Inducers:

Steroids:
• Dexamethasone
• Combined oral contraceptives (contain estradiol & gestodene)

Anti-epileptics:
• Phenytoin
• Phenobarbital
• Carbamazepine

Miscellaneous:
• Rifampin
• Lumacaftor (for cystic fibrosis)
• Tobacco

Interestingly, tobacco is an inducer of CYP1A2 which metabolizes caffeine

ذني مهمات لأن بيهن interactions وطيحان حظ

طبعًا السالفة بيها تفاصيل أكثر؛ أكو تقريبًا 57 إنزيم ضمن الـ cytochrome system بس عدنا منهن 6 كلش مهمات، لأنهن مسؤولات عن أيض العديد من الأدوية، وكل إنزيم من ذني الـ 6 يتأثر بعدة أدوية ومواد كيميائية، قسم منها يحفزنّه inducers، قسم يثبطنّه inhibitors، وقسم هنّ ركائز substrates يشتغل عليهن الإنزيم.

The 6 most essential CYP450 enzymes with their inducers, inhibitors, and substrates.

The coagulation cascade is intricate and cross-linked that it's better to call it the coagulation network, since it doesn't proceed like a cascade from point A to point B, rather, point A affects both points B and C which subsequently affect point A,... etc.