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61 Cards in this Set
- Front
- Back
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NRTI
Mechanism Names Side Effects |
Nucleoside Analogs (chain terminator)
Names: (-dine) zidovdine (AZT), Stavidine, Didanosine, Lamivudine, Emtricitabine, Abacavir, Tenofovir Side Effects: mitochondrial tox- peripheral Neuropathy, acidosis, pancreatitis, liver steatosis, lipodytrophy AZT- anemia/neutropenia ABC- hypersensitivity TDF- renal tox * D- can't go together and D4T can't go with AZT! |
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praziquantel (Biltricide)
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Schistosoma hematobium
resistant- Fasciola hepatica |
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Ivermectin (Stromectol)
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Strongyloides
filariasis and scabies |
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primaquine
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Liver Hypnozoites-
Plasmodium ovale Plasmodium vivax Side Effects- G6PD Hemolytic anemia |
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Mebendazole
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pinworm Enterobius vermicularis
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Oseltamivir and zanamivir
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"Tamiflu"
neuraminidase (NA) inhibitors and hemagglutinin (HA)- inhibit newly formed virus from release work on Influenza A and B |
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Valacyclovir/Acyclovir
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HSV 1 and 2 and VZV
reduces duration/Fz of outbreak doesn't prevent infection/shedding Side Effects- Crystilline Kidney |
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Foscarnet
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inorganic pyrophosphate analogue treatment of ganciclovir-resistant CMV nephrotoxicity
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Famciclovir/Penciclovir
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HSV 1 and 2 and VZV
less potent than Acyclovir |
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Cidofovir
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ganciclovir-resistant CMV
acyclovir-resistant HSV |
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ganciclovir
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First line CMV
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Ribavirin
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Nucleoside analog
Combo with Interferon in HCV |
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Interferon
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enhances cytokine release
Combo with Ribavirin in HCV and in HBV Tx Side Effects- hemolytic anemia, depression, and thyroid abnormalities |
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Adefovir
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HBV
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lamivudine
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HBV and HIV
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Amphotericin B
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binds Ergosterol
Use- broad spectrum antifungal- systemic or meningitis (in combo with 5-flucytosine) Side Effects- Nephrotoxic and anaphylaxis |
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Bone Marrow Suppressor Drugs
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AZT-Zidovudine- NRTI for HIV
Ganciclovir- NRTI for CMV Ribavirin- NRTI for HCV |
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3 indications for bactericidal Antibiotics
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Bacterial meningitis
Endocarditis neutropenic patient Include: aminoglycosides, cell wall inhibitors, quinolones, and rifampin |
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Reasons for Combo Therapy
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Fear of resistance (ex TB)
Limiting Toxic dose (ex PI for HIV) Synergy (ex Gentamicin + Ampicillin/Vancomycin * does increase the risk of hypersensitivity Rxn |
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Protein Inhibitor Antibiotics
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50S: Macrolides, streptogramins, clindomycin and chloramphenicol
30S: Tetracyclines, Aminoglycosides * All bacteriostatic except Aminoglycosides |
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fluoroquinolones
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DNA gyrase and inhibit topoisomerase IV
Ciprofloxin- EEK ESP- UTI/Prostatitis, Legionellapneumonia, and nosocomial pneumonias to cover *pseudomonas, Mycoplasma, Chlamydia, Anthrax, Mycobacteria, Rickettsiae, Brucella, Levofloxin- "respiratory"- CAP |
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penicillin resistance
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b-lactamase production plasmid encoded or chromosomal (harder to overcome)
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sulfonamide resistance
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“Bypass” pathway in folic acid metabolism
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Macrolides resistance
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methylation of the 23s segment of the ribosome, altering target
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Vancomycin resistance
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cleave d-Ala-d-Ala and replace it with d-Ala-d-Lac
VRE |
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Quinolone resistance
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mutations in DNA gyrase and topoisomerase, efflux pumps
Campylobacter, Salmonella, E. coli, Pseudomonas, and Staph. aureus |
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Perioperative antimicrobial prophylaxis
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1.started just before surgery to ensure adequate serum concentrations
2. Coverage of Staph. aureus from the skin, or gram negative anaerobes if the bowel 3. Only need 1 dose with longer 1/2 life *Use cephalosporins |
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Antimicrobial prophylaxis Indications
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1. following a cat>human>dog bite
2. in a close contact to someone with meningococal meningitis 3. before dental work in a patient with an abnormal heart valve. 4. Pneumocystis pneumonia in AIDS pt 5. Latent TB (esp in HIV pt) |
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Antibiotics OK in Pregnancy
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1. Penicillins
2. Erythromycin (without esolate) |
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Antibiotics BAD in Pregnancy
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1. Tetracyclines - staining and dysplasia of developing teeth and bone
2. Quinolones- cartilage abnormalities 3. Bactrim/Sulfonamides- kernicterus(yellow brain) |
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Nafcillin
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"Anti-Staph" Pencillin
Bulky side chain that blocks B-Lactamase activity *too bulky for Gram -, only use with Gram + |
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MRSA resitance mechanism
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altered PBP proteins- resistant against all B-Lactam antibiotics
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Aztreonam (Monobactam)
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B-Lactam
* Ok with PNC allergy Use Gram - aerobes (EEK) |
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Imipenem (Carbapenem)
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B-Lactam
*Use as a last resort drug- esp for pseudomonas- very broad spectrum Use- antibiotic-resistant gram - bacilli, nosocomial infections, infections with multiple microbes |
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Third generation cephalosporins
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ceftazidime and ceftriaxone
Use Gram - aerobes (EEK + ES), meningitis |
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Active TB treatment
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RIPE - 4 drug combo Tx
1. Isoniazid 2. Rifampin 3. Pyrazinamide 4. Ethambutol plus pyridoxine (vitamin B6) if no cavitation or + culture after 2 months reduce to first 2 and shorten Tx- if not change drugs and keep on with Tx Always try to get an HIV test- affects HARRT therapy (no rifamipin) |
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Rifamipin
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Mainly TB- first line
*resistance alone is high inhibitor of DNA-dependent RNA polymerase Side Effects- hepatotoxicity, immune-mediated reactions, numerous drug interactions, and orange secretions * CYT P450 inducer- can't be used with Protease Inhibitors women need back up contraceptive methods |
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TB Hepatotoxcicity
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isoniazid, rifampin, and pyrazinamide, levofloxacin, or amikacin
NOT ethambutol |
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isoniazid
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TB- first line
interferes with mycolic acid synthesis Side Effects: hepatotoxicity, hypersensitivity reactions, peripheral neuropathy and CNS complaints |
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pyrazinamide
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TB- RIPE
converted by bacterial enzymes to pyrazinoic acid- Toxic Side Effects- hepatotoxicity, arthralgias, hyperuricemia, and GI |
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ethambutol
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TB- RIPE
blocks arabinosyl transferases Side Effects: optic neuritis |
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latent TB infection (LTBI) Treatment
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9 months of isoniazid or 4 months of rifampin therapy if HIV negative
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metronidazole (Flagyl)
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metabolites damage bacterial DNA
Use- “below the diaphragm” anaerobes- 1st and 2nd line treatment against C. difficle and brain abcesses, and antiparasitic activity against Trichomonas, E. histolytica, and Giardia- * bad with oral/pulmonary infections Side Effects- CNS toxicities, peripheral neuropathy, neutropenia, dark urine, N/D, metallic taste |
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trimethoprim-sulfamethoxazole (Bactrim)
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Folate pathway inhibitor
Use- UTI’s, prostatitis, listerial meningitis in PCN-allergic, and PCP Side Effects- Nephrotoxic, HyperKlemia, aseptic meningitis |
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aminoglycosides
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30S Ribosome- -cidal Protein Inhibitor
* Use as combination therapy with b-lactam drugs- Synergy Ex. gentamicin Use- aerobic gram-negative bacilli (EEK ESP)- osteomyelitis, enterococci, Combo Tx for staph, strep, and pseudomonas Side Effects- Nephrotoxic and Ototoxic |
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Amantadine/Rimantadine
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M2 membrane protein to prevent uncoating of the virus
* Only Influenza A Resistance is high |
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NNRTI- Non-Nuc
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Reverse transcriptase inhibitor
Names: Efavirenz, Nevirapine, Delavirdine Side Effects: drug interations |
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PI- Protease Inhibitor
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Block viral packaging
Names: -navir Side Effects: GI, Lipid dysfxn, osteopenia, insulin resistance Ritonavir- too toxic at therapeudic dose, give to booster effects of other PI |
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Fusion Inhibitor
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blocks HIV capsid from binding gp41
Names: Enfuvirtide Side Effects: hypersensitivity, baterial pneumonia, pain at injection site |
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HAART Therapy
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HIV regimin begun at low CD4 or high viral load (>100000)
2NRTI + 1NNRTI or 1 PI |
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Fluconazole
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Inhibit Ergosterol synthesis
Use- Candida, meningitis |
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Caspofungin
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block glucan synthetase, inhibiting fungal cell wall biosynthesis
Use- systemic aspergillosis |
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Griseofulvin
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blocking spindle formation- cell division
Use- dermatophytes |
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Vancomycin
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Bind D-ALA D-ALA to block cell wall synthesis
Use- beta-lactam- resistant gram-positive organisms- MRSA and Enterococcus |
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Clindomycin
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50S Protein Inhibitor
Use- Anaerobes- lung abscesses, intraabdominal and pelvic infections, GAS skin and soft tissue infections, diabetic foot ulcers, and odontogenic infections * causes C difficile |
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Gram + (versus Gram -)
Cellular features |
Gram + have NO outer cell membrane- easier for drugs to enter
* stain blue due to thick peptidiglycan cell wall |
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Chloramphenicol
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50S Ribosome- Protein Inhibitor
Side Effects- Aplastic anemia-Bone marrow suppression, and gray baby syndrome |
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Piperacillin/tazobactam
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extended spectrum penicillin + B-Lactamase inhibitor
Use-DOC for Pseudomonas |
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Macrolide
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50S Ribosome- Protein Inhibitor
Erythro, Azithro, Clarithromycin (disseminated MAC) Beta-hemolytic streptococci, pneumococci, staphylococci and enterococci, mycoplasma, mycobacteria, some rickettsia and chlamydia. |
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Quinupristin/Dalfopristin (Synercid)
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gram positive pathogens including E. faecium form of VRE, but not the E. faecalis form
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Linezolid
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blocks the formation of 70S initiation complex
Use- MRSA and VRE |
