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Step2 Review
Introduction to biostatistics
Types of data
Probability
Mean, median, and mode
Range, variance, and standard deviation
Standard error of the mean (Central limit theorem)
Normal distribution and z-scores
Paired t-test
Two-sample t-test
Hypothesis testing: One-tailed and two-tailed tests
One-way ANOVA
Two-way ANOVA
Repeated measures ANOVA
Correlation
Methods of regression analysis
Linear regression
Logistic regression
Spearman's rank correlation coefficient
Mann-Whitney U test
Kappa coefficient
Chi-squared test
Fisher's exact test
Kaplan-Meier survival analysis
Type I and type II errors
Sensitivity and specificity
Positive and negative predictive value
Test precision and accuracy
Incidence and prevalence
Relative and absolute risk
Odds ratio
Attributable risk (AR)
Mortality rates and case-fatality
DALY and QALY
Direct standardization
Indirect standardization
Study designs
Clinical trials
Disease causality
Selection bias
Confounding
Interaction
Prevention
Eczematous rashes: Clinical (To be retired)
Papulosquamous skin disorders: Clinical (To be retired)
Alopecia: Clinical (To be retired)
Hypersensitivity skin reactions: Clinical (To be retired)
Autoimmune bullous skin disorders: Clinical (To be retired)
Blistering skin disorders: Clinical (To be retired)
Hypopigmentation skin disorders: Clinical (To be retired)
Benign hyperpigmented skin lesions: Clinical (To be retired)
Skin cancer: Clinical (To be retired)
Immunodeficiencies: Clinical (To be retired)
Antihistamines for allergies
Glucocorticoids
Advanced cardiac life support (ACLS): Clinical (To be retired)
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Coronary artery disease: Clinical (To be retired)
Heart failure: Clinical (To be retired)
Syncope: Clinical (To be retired)
Pericardial disease: Clinical (To be retired)
Cardiomyopathies: Clinical (To be retired)
Hypertension: Clinical (To be retired)
Hypercholesterolemia: Clinical (To be retired)
Sympatholytics: Alpha-2 agonists
Adrenergic antagonists: Presynaptic
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Positive inotropic medications
Diabetes mellitus: Clinical (To be retired)
Hyperthyroidism: Clinical (To be retired)
Hypothyroidism and thyroiditis: Clinical (To be retired)
Parathyroid conditions and calcium imbalance: Clinical (To be retired)
Pituitary adenomas and pituitary hyperfunction: Clinical (To be retired)
Hypopituitarism: Clinical (To be retired)
Cushing syndrome: Clinical (To be retired)
Adrenal masses and tumors: Clinical (To be retired)
Adrenal insufficiency: Clinical (To be retired)
MEN syndromes: Clinical (To be retired)
Hyperthyroidism medications
Hypothyroidism medications
Insulins
Hypoglycemics: Insulin secretagogues
Miscellaneous hypoglycemics
Adrenal hormone synthesis inhibitors
Mineralocorticoids and mineralocorticoid antagonists
Esophageal disorders: Clinical (To be retired)
Esophagitis: Clinical (To be retired)
Gastroesophageal reflux disease (GERD): Clinical (To be retired)
Gastroparesis: Clinical (To be retired)
Malabsorption: Clinical (To be retired)
Inflammatory bowel disease: Clinical (To be retired)
Jaundice: Clinical (To be retired)
Cirrhosis: Clinical (To be retired)
Laxatives and cathartics
Antidiarrheals
Acid reducing medications
Fever of unknown origin: Clinical (To be retired)
Fat-soluble vitamin deficiency and toxicity: Pathology review
Anemia: Clinical (To be retired)
Microcytic anemia: Pathology review
Non-hemolytic normocytic anemia: Pathology review
Intrinsic hemolytic normocytic anemia: Pathology review
Extrinsic hemolytic normocytic anemia: Pathology review
Macrocytic anemia: Pathology review
Heme synthesis disorders: Pathology review
Leukemia: Clinical (To be retired)
Lymphoma: Clinical (To be retired)
Thrombocytopenia: Clinical (To be retired)
Bleeding disorders: Clinical (To be retired)
Thrombophilia: Clinical (To be retired)
Myeloproliferative neoplasms: Clinical (To be retired)
Plasma cell disorders: Clinical (To be retired)
Blood products and transfusion: Clinical (To be retired)
Anticoagulants: Heparin
Anticoagulants: Warfarin
Anticoagulants: Direct factor inhibitors
Antiplatelet medications
Thrombolytics
Hematopoietic medications
Ribonucleotide reductase inhibitors
Topoisomerase inhibitors
Platinum containing medications
Anti-tumor antibiotics
Microtubule inhibitors
DNA alkylating medications
Monoclonal antibodies
Antimetabolites for cancer treatment
Infective endocarditis: Clinical (To be retired)
Pneumonia: Clinical (To be retired)
Tuberculosis: Pathology review
Diarrhea: Clinical (To be retired)
Viral hepatitis: Clinical (To be retired)
Urinary tract infections: Clinical (To be retired)
Meningitis, encephalitis and brain abscesses: Clinical (To be retired)
Bites and stings: Clinical (To be retired)
Protein synthesis inhibitors: Aminoglycosides
Antimetabolites: Sulfonamides and trimethoprim
Antituberculosis medications
Miscellaneous cell wall synthesis inhibitors
Protein synthesis inhibitors: Tetracyclines
Cell wall synthesis inhibitors: Penicillins
Miscellaneous protein synthesis inhibitors
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
DNA synthesis inhibitors: Fluoroquinolones
Integrase and entry inhibitors
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors
Hepatitis medications
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Neuraminidase inhibitors
Herpesvirus medications
Azoles
Echinocandins
Miscellaneous antifungal medications
Anthelmintic medications
Antimalarials
Anti-mite and louse medications
Hypernatremia: Clinical (To be retired)
Hyponatremia: Clinical (To be retired)
Hyperkalemia: Clinical (To be retired)
Hypokalemia: Clinical (To be retired)
Metabolic and respiratory acidosis: Clinical (To be retired)
Metabolic and respiratory alkalosis: Clinical (To be retired)
Toxidromes: Clinical (To be retired)
Medication overdoses and toxicities: Pathology review
Acute kidney injury: Clinical (To be retired)
Chronic kidney disease: Clinical (To be retired)
Nephritic and nephrotic syndromes: Clinical (To be retired)
Renal tubular defects: Pathology review
Renal tubular acidosis: Pathology review
Osmotic diuretics
Carbonic anhydrase inhibitors
Loop diuretics
Potassium sparing diuretics
Stroke: Clinical (To be retired)
Seizures: Clinical (To be retired)
Headaches: Clinical (To be retired)
Hyperkinetic movement disorders: Clinical (To be retired)
Hypokinetic movement disorders: Clinical (To be retired)
Muscle weakness: Clinical (To be retired)
Disorders of consciousness: Clinical (To be retired)
Spinal cord disorders: Pathology review
Sympathomimetics: Direct agonists
Muscarinic antagonists
Cholinomimetics: Direct agonists
Cholinomimetics: Indirect agonists (anticholinesterases)
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Nonbenzodiazepine anticonvulsants
Migraine medications
Anti-parkinson medications
Medications for neurodegenerative diseases
Asthma: Clinical (To be retired)
Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)
Diffuse parenchymal lung disease: Clinical (To be retired)
Venous thromboembolism: Clinical (To be retired)
Acute respiratory distress syndrome: Clinical (To be retired)
Pleural effusion: Clinical (To be retired)
Pneumothorax: Clinical (To be retired)
Lung cancer: Clinical (To be retired)
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Joint pain: Clinical (To be retired)
Rheumatoid arthritis: Clinical (To be retired)
Seronegative arthritis: Clinical (To be retired)
Systemic lupus erythematosus (SLE): Clinical (To be retired)
Sjogren syndrome: Clinical (To be retired)
Inflammatory myopathies: Clinical (To be retired)
Vasculitis: Clinical (To be retired)
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Opioid agonists, mixed agonist-antagonists and partial agonists
Antigout medications
Osteoporosis medications
Pregnancy
Routine prenatal care: Clinical (To be retired)
Hypertensive disorders of pregnancy: Clinical (To be retired)
Antepartum hemorrhage: Clinical (To be retired)
Premature rupture of membranes: Clinical (To be retired)
Stages of labor
Abnormal labor: Clinical (To be retired)
Vaginal versus cesarean delivery: Clinical (To be retired)
Postpartum hemorrhage: Clinical (To be retired)
Gestational trophoblastic disease: Clinical (To be retired)
Breastfeeding
Abdominal pain: Clinical (To be retired)
Puberty and Tanner staging
Amenorrhea: Clinical (To be retired)
Contraception: Clinical (To be retired)
Virilization: Clinical (To be retired)
Infertility: Clinical (To be retired)
Vulvovaginitis: Clinical (To be retired)
Sexually transmitted infections: Clinical (To be retired)
Menopause
Abnormal uterine bleeding: Clinical (To be retired)
Ovarian cysts, cancer, and other adnexal masses: Clinical (To be retired)
Endometrial hyperplasia and cancer: Clinical (To be retired)
Cervical cancer: Clinical (To be retired)
Vaginal cancer: Clinical (To be retired)
Vulvar cancer: Clinical (To be retired)
Estrogens and antiestrogens
Progestins and antiprogestins
Androgens and antiandrogens
Aromatase inhibitors
Uterine stimulants and relaxants
Newborn management: Clinical (To be retired)
Neonatal ICU conditions: Clinical (To be retired)
Congenital TORCH infections: Pathology review
Neonatal jaundice: Clinical (To be retired)
Perinatal infections: Clinical (To be retired)
Congenital disorders: Clinical (To be retired)
Congenital heart defects: Clinical (To be retired)
Autosomal trisomies: Pathology review
Miscellaneous genetic disorders: Pathology review
Disorders of carbohydrate metabolism: Pathology review
Disorders of fatty acid metabolism: Pathology review
Glycogen storage disorders: Pathology review
Lysosomal storage disorders: Pathology review
Mood disorders: Clinical (To be retired)
Anxiety disorders: Clinical (To be retired)
Schizophrenia spectrum disorders: Clinical (To be retired)
Dissociative disorders: Clinical (To be retired)
Eating disorders: Clinical (To be retired)
Obsessive compulsive disorders: Clinical (To be retired)
Trauma- and stressor-related disorders: Clinical (To be retired)
Disruptive, impulse-control and conduct disorders: Clinical (To be retired)
Personality disorders: Clinical (To be retired)
Sleep disorders: Clinical (To be retired)
Somatic symptom disorders: Clinical (To be retired)
Sexual dysfunctions: Clinical (To be retired)
Paraphilic disorders: Clinical (To be retired)
Substance misuse and addiction: Clinical (To be retired)
Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review
Psychiatric emergencies: Pathology review
Preoperative evaluation: Clinical (To be retired)
Postoperative evaluation: Clinical (To be retired)
General anesthetics
Local anesthetics
Neuromuscular blockers
Esophageal surgical conditions: Clinical (To be retired)
Gastrointestinal bleeding: Clinical (To be retired)
Peptic ulcers and stomach cancer: Clinical (To be retired)
Appendicitis: Clinical (To be retired)
Diverticular disease: Clinical (To be retired)
Hernias: Clinical (To be retired)
Bowel obstruction: Clinical (To be retired)
Colorectal cancer: Clinical (To be retired)
Abdominal trauma: Clinical (To be retired)
Anal conditions: Clinical (To be retired)
Gallbladder disorders: Clinical (To be retired)
Pancreatitis: Clinical (To be retired)
Breast cancer: Clinical (To be retired)
Benign breast conditions: Pathology review
Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Breast
Valvular heart disease: Clinical (To be retired)
Chest trauma: Clinical (To be retired)
Anatomy clinical correlates: Thoracic wall
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Mediastinum
Dizziness and vertigo: Clinical (To be retired)
Thyroid nodules and thyroid cancer: Clinical (To be retired)
Neck trauma: Clinical (To be retired)
Nasal, oral and pharyngeal diseases: Pathology review
Traumatic brain injury: Clinical (To be retired)
Brain tumors: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Eye conditions: Inflammation, infections and trauma: Pathology review
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Burns: Clinical (To be retired)
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Kidney stones: Clinical (To be retired)
Renal cysts and cancer: Clinical (To be retired)
Urinary incontinence: Pathology review
PDE5 inhibitors
Peripheral vascular disease: Clinical (To be retired)
Leg ulcers: Clinical (To be retired)
Aortic aneurysms and dissections: Clinical (To be retired)
Echinocandins
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Ursula Florjanczyk, MScBMC
Evan Debevec-McKenney
Echinocandins are a novel class of medications used to treat mycoses, or fungal infections.
Mycoses can be localized skin infections, or develop into systemic infections in immunodeficient patients.
Antifungals work either through fungistatic action, meaning that they inhibit fungal growth, or through fungicidal action, meaning they kill the fungi.
Now, most fungi have a protective cell wall made of different carbohydrate molecules.
Some fungal species have beta glucans which are polysaccharide polymers that are cross linked with other carbohydrate molecules to make a strong fungal cell wall.
Beta glucans are produced by an enzyme on the cell membrane called beta-1,3-D-glucan synthase.
This enzyme is not found in human cells which makes it a good target for antifungal medications.
Now, echinocandins are a type of medication that noncompetitively bind to and inhibit beta-1,3-D-glucan synthase.
This weakens the cell wall and prevents it from being repaired.
The cell wall gradually deforms more and more until it ruptures, causing the cell to die.
Echinocandins are only available via IV since they are not well absorbed through the GI tract.
Medications in this class include anidulafungin, micafungin, and caspofungin.
They are only effective against fungal species that have beta-1,3-D-glucan synthase, but it’s extremely rare for these organisms to have resistance to these medications.
Because of this, echinocandins are often used to treat fungal infections that are resistant to the more common antifungal medications like amphotericin-B and the “azole” medications like fluconazole.
Echinocandins are used to treat mucocutaneous candidiasis, which affect the skin, nails, and oral mucosa, or disseminated candidiasis, where the infection spreads to multiple organ systems through the blood, causing endocarditis, endophthalmitis, and osteomyelitis.
Echinocandins are a class of antifungals, mainly used to treat infections caused by candida species and aspergillus species. They work by disrupting the formation of the fungal cell wall, leading to cell death. They inhibit eta-1,3-D-glucan synthase, an enzyme necessary for the synthesis of major fungal cell components known as Beta glucans. Echinocandins are generally well-tolerated and have a low risk of serious adverse effects.
The most common side effects are facial flushing, nausea, vomiting, and skin rash. Rare but serious side effects include anaphylaxis (a life-threatening allergic reaction) and Stevens-Johnson syndrome (a severe skin reaction).
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