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95 Cards in this Set
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7 bacteriocidal agents
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beta lactams
aminoglycosides vancomycin fluorouinolones rifampin metronidazole isoniazid |
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6 bacteriostatic agents
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macrolides
chloramphenicol clindmycin tetracylcin sulfonamides ethambutol |
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inhibitors of cell wall synthesis
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beta lactams
vancomycin |
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beta lactams subtypes
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penicilllins
cephalosporins carbapenems monobactams |
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inhibitor of transpeptidation reaction
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beta lactams
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mechanisms of resistance to penicillin and cephalosporins
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autolytic enzyme deficiency
altered PBP productions of beta lactamase outer membrane |
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DOC for group a beta hemolytic strep, viridans strep, meningicoccus, treponema
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penicillin G
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penicillin A, D, M, E
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A: penicillin G acid labile, V stable
D: wide, low concentratio in prostate, eye, CSF, 60% protein bound M: not metablozid E: rapid renal clearance, high concentration in urine |
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side effects of penicillin
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skin rash, fever, bronchospasm, vasculiis, serum sickness, exf derm, steen johnson syndrom, anaphylaxis
all due hypersinsitivity antibodies against enicillinoic acid |
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penicillinase resistant penicillins (methicillin group)
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nafcillin
dicloxacillin |
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aminopenicillins
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ampicillin
amoxicillin |
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antipseudomonal penicililns
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carbenicillin
indanyl carbenicilin (orally active compound for UTI) |
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extended spectrum penicillin
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piperacillin
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what is augmentin?
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amoxicillin/clavulinic acid
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first generation cephalosporin
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cefazolin
cephalexin |
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first generation cephalosporins are used often for
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surgical prophylaxis (cefazolin)
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second generation ceph
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cefuroxime
cefuroxime axetil (orally active) |
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second generation ceph's are used for
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increased gram - actiity
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third generation ceph
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cefotaxime
ceftizoxime ceftriaxone |
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cephalosporins with broad gm - activity
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third generation
resistant to beta lactamases |
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ceftriaxone
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third gen ceph with long half life 8 hrs
good cns penetration used for meningitis, hospital cquired pneumonia, sepsis, outpt gonorrhea |
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cefepime
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4th generation ceph
reistant to some beta lactamase cleared by kidneys, excellent cns penetration NOT actie against MRSA b fragilis myco |
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ceftazidime
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third generation ceph
increased antipseudomonal activity |
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meropenem
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broad spectrum carbapenem
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particularly usefull against mixed infections of nosocomial organisms nd has excellent activity against anaerobes P. aeruginosa
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meropenem
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beta lacam with spectrum that resembles aminoglycoside (good against gm -, poor against gm + and anaerobes)
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aztreonem
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beta lactam not associated with hypersensitivity
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aztreonem
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meropenem administration
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IV, cilastatin (peptidase inhibitor) not required
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beta lactamase inhibitors
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tazobactam
sulbactam clavulinic acid |
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although both can be used for antibiotic associated colitis due to c dif, you would use metronidazole or vancomycin
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metronidazole to reduce appearance of vancomycin-resistant srains
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vancomycin s/e
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flushing
tach thrombophlepb ototoxicity |
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mechanism of resistance to vancomycin
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peptidoglycans wherein the pentapeptide terminates in d-ala-lactate and has lower affinity for vancomycin
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tetracylcin MOA
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enter bacteria by energy dependant process
act at A site of 30s ribosome prevent binding of tRNA |
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tetracyclin/doxycyclin A,D,M,E
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oral (30% T 100% D) but don't use dairy, antacids, or iron with T
binding to plasma proteins increases with inc lip sol excretion is both urin and feces (kidney for T, hepatic for D) |
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side effects of tetracyclin
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toxicity
photosensitivity renal insufficiency irritation fancony synrome super infections |
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MOA of CAM
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inhibits synthesis at 70s ribosome and halts translation elongation
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Chloramphenicol A,D,M, E
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oral
good penetration into CSF hepatic met |
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gray baby syndrome is associated with
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Chloramphenicol
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CAM can cause what blood disorders
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reversible bone marrow depression
rare aplastic anemia |
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DOC for typhoid
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CAM
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guidelines for cam use
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life threatining infection
never prophylactically or mild infection avoid prolonged use discontinue if lekopenia occurs |
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aminoglycosides
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gentamicin, tobramycin, amikacin
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MOA of aminoglycosides, A,D,M,E
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translational distortion or block based on concentration
poor oral availability, renal excretion, poor cns penetration |
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resistance to aminoglycosides
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intrinsic due to low ph, hyperosmolarit, divalent cations,
acquired: ribosomal, decreased uptake, ENZYMES (most common method) |
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which aminoglycoside has widest spectrum
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ami > tobra > genta
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S/E of aminoglycosides
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neurotoxicity
ototoxicity renal |
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structural analog of folic acid and competes with FAH
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trimethoprim
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structural analog of p amino benzoic acid PABA
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sulfonamide
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treat nocardia
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sulfonamide (in combo with ampicillin)
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treat protozoal infections including p falciparum, toxoplasma, pneomcystic carinii
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sulfonamides
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drug of choice for leprosy
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dapsone
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sulfonamide A,D,M, E
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good oral absorbpion, wide distribution including CNS, acetylted andproduct remains toic, can precipitate in urine
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cotrimaxazole
(cotrimazole) |
combo of sulfamethoxazle with FAH2 inhibitor trimethoprim used fr UTI
not effective against pseudomonas |
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trimethoprim A,D,M,E
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well absorbed from gut
blood levels higher than other tissues acetylated in liver and appears in urine |
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theoretical side effect of SMZ/TMP
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megaloblastic anemia in folate deficient patient
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inhibit topoisomerase IV and DNA gyrase
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fluoroquinolones
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second gen fuoroquinolone
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ciprofloxicin
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third generation fluoroquinolone
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levofloxacin
moxifloxacin |
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resistance to fluoroquionolone
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chromosomal mutation in DNA gyrase or topoisomerase genes or
increased efflux plasmid mediated |
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fluoroquionlone A,D,M,E
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orally available
excellent tissue peneration, bone and prostate (CSF low, brain parenchyma high) some excreted through urine unchanged (Levo), others undergo extensive hepatic met |
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meningococcal prophylaxis DOC
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ciprofloxicin
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macrolides
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erythromycin
clarithromycin azithromycin |
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binds 50s subunit of ribosome, inhibits protein translocation step
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erythromycin
m |
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mot often used to treat mycoplasm pneuomniae
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erythromycin
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penicillin allergic individuals cn use this for strep and pneumococcal infections
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erythromycin
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DOC for C diptheriae
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erythromycin
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DOC for legionella
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Erythromycin
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erythromycin A,D,M,E
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orally available, but acid labile
diffuses well into most body spaces except CSF unless inflamed concentrated by liver excreted in bile |
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ilosone
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acid resistant form of erythromycin
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S/E of erythromycin
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GI upset,, ilosone can cause cholestatic hepatitis, potentiation of other drugs by interfereing with cytochrome p45
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more effective than erythromycin against H flu
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claryithromycin or azithromycin
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partitions into acidic compartmens, such as acidic vesicle in phagocytic cells
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azithromycin
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anaerobes, anaerobes, anaerobes
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metronidizole
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effective against virtually al anaerobic gram - bacteria, including bacteriodes, nicararophilic protozoa, but ineffective agaisnt aerobic and facultative anaerobic
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metronidazole
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MOA of metronidazole
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interrupts electron transport process-- mutagen
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metronidazole A,D,M,E
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oral, 8 hour half life, vol of distribution is total body water, unchanged and oxidized are excreted in urine and penetrates all tissues
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furry tongue, head ache, nausea, contraindicated with CNS disease, glossitis, stomatitis
disulfiram like effect |
metronidazole
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anaerobe coverage best compounds
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metro, meropenem, CAM, amp/calv, ticarcilin/sulbactam, piperacillin/tazobacam
NOT CLINDAMYCIN |
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anti mycobacerial
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isoniazid, rifampin, pyrasinamide, ethambutol
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inhibits synthesis of mycolic acids
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isoniazid
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isoniazid A,D,M,E
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well absorbed from gut, well distrubted, acetylated and appears in urine, there are fast acetylaters and slow acetylaters that are determined geneticaly
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toxic effects of isoniazid
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hepatotoxicity, optic neuritis
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inh therapy includes administration of what to prevent symptoms of excitabillity (neurotoxicity)
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pyridoxine
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interacts with phenytoin to cause toxicity, lethargy, incoordination
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isoniazid
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binds to beta subunit of bacterial RUNA polymerase
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rifampin
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rifampin A,D,M,E
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well absorbed from gut, distributes widely, deacylated in liver, only 20% in uirne, cautin with compromised hepatic function
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why is rifampin no good for grm -
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doesn't penetrate outer membrane
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can be used for H flu prophylaxis
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rifampin, cipro is better
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rifampin side effects
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hepatotoxicity
inducer cyp3a4 (cyt p450 enzyme |
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pyrazinamide
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bacericidal for tubercle bacillus
absorbed from gut, widel distributed, excvreted by kidne |
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important part of short term 6 month TB treatment
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pyrasinamidr
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side effects of pyrazinamidr
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hepatotoxicity
hyperuricemia |
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drug is taken up by diviiding mycobacteria and is tuberculostatic after 24 hrs
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ethambutol
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ethambutol
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well absorbed from gi tract, distributes widely, renal excretion
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s/e of ethambutol
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retrocular neuritis
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