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61 Cards in this Set

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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!
praziquantel (Biltricide)
Schistosoma hematobium
resistant- Fasciola hepatica
Ivermectin (Stromectol)
Strongyloides
filariasis and scabies
primaquine
Liver Hypnozoites-
Plasmodium ovale
Plasmodium vivax
Side Effects- G6PD Hemolytic anemia
Mebendazole
pinworm Enterobius vermicularis
Oseltamivir and zanamivir
"Tamiflu"
neuraminidase (NA) inhibitors and hemagglutinin (HA)- inhibit newly formed virus from release
work on Influenza A and B
Valacyclovir/Acyclovir
HSV 1 and 2 and VZV
reduces duration/Fz of outbreak
doesn't prevent infection/shedding
Side Effects- Crystilline Kidney
Foscarnet
inorganic pyrophosphate analogue treatment of ganciclovir-resistant CMV nephrotoxicity
Famciclovir/Penciclovir
HSV 1 and 2 and VZV
less potent than Acyclovir
Cidofovir
ganciclovir-resistant CMV
acyclovir-resistant HSV
ganciclovir
First line CMV
Ribavirin
Nucleoside analog
Combo with Interferon in HCV
Interferon
enhances cytokine release
Combo with Ribavirin in HCV and in HBV Tx
Side Effects- hemolytic anemia, depression, and thyroid abnormalities
Adefovir
HBV
lamivudine
HBV and HIV
Amphotericin B
binds Ergosterol
Use- broad spectrum antifungal- systemic or meningitis (in combo with 5-flucytosine)
Side Effects- Nephrotoxic and anaphylaxis
Bone Marrow Suppressor Drugs
AZT-Zidovudine- NRTI for HIV
Ganciclovir- NRTI for CMV
Ribavirin- NRTI for HCV
3 indications for bactericidal Antibiotics
Bacterial meningitis
Endocarditis
neutropenic patient
Include: aminoglycosides, cell wall inhibitors, quinolones, and rifampin
Reasons for Combo Therapy
Fear of resistance (ex TB)
Limiting Toxic dose (ex PI for HIV)
Synergy (ex Gentamicin + Ampicillin/Vancomycin
* does increase the risk of hypersensitivity Rxn
Protein Inhibitor Antibiotics
50S: Macrolides, streptogramins, clindomycin and chloramphenicol
30S: Tetracyclines, Aminoglycosides
* All bacteriostatic except Aminoglycosides
fluoroquinolones
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
penicillin resistance
b-lactamase production plasmid encoded or chromosomal (harder to overcome)
sulfonamide resistance
“Bypass” pathway in folic acid metabolism
Macrolides resistance
methylation of the 23s segment of the ribosome, altering target
Vancomycin resistance
cleave d-Ala-d-Ala and replace it with d-Ala-d-Lac
VRE
Quinolone resistance
mutations in DNA gyrase and topoisomerase, efflux pumps
Campylobacter, Salmonella, E. coli, Pseudomonas, and Staph. aureus
Perioperative antimicrobial prophylaxis
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
Antimicrobial prophylaxis Indications
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)
Antibiotics OK in Pregnancy
1. Penicillins
2. Erythromycin (without esolate)
Antibiotics BAD in Pregnancy
1. Tetracyclines - staining and dysplasia of developing teeth and bone
2. Quinolones- cartilage abnormalities
3. Bactrim/Sulfonamides- kernicterus(yellow brain)
Nafcillin
"Anti-Staph" Pencillin
Bulky side chain that blocks B-Lactamase activity
*too bulky for Gram -, only use with Gram +
MRSA resitance mechanism
altered PBP proteins- resistant against all B-Lactam antibiotics
Aztreonam (Monobactam)
B-Lactam
* Ok with PNC allergy
Use Gram - aerobes (EEK)
Imipenem (Carbapenem)
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
Third generation cephalosporins
ceftazidime and ceftriaxone
Use Gram - aerobes (EEK + ES), meningitis
Active TB treatment
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)
Rifamipin
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
TB Hepatotoxcicity
isoniazid, rifampin, and pyrazinamide, levofloxacin, or amikacin
NOT ethambutol
isoniazid
TB- first line
interferes with mycolic acid synthesis
Side Effects: hepatotoxicity, hypersensitivity reactions, peripheral neuropathy and CNS complaints
pyrazinamide
TB- RIPE
converted by bacterial enzymes to pyrazinoic acid- Toxic
Side Effects- hepatotoxicity, arthralgias, hyperuricemia, and GI
ethambutol
TB- RIPE
blocks arabinosyl transferases
Side Effects: optic neuritis
latent TB infection (LTBI) Treatment
9 months of isoniazid or 4 months of rifampin therapy if HIV negative
metronidazole (Flagyl)
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
trimethoprim-sulfamethoxazole (Bactrim)
Folate pathway inhibitor
Use- UTI’s, prostatitis, listerial meningitis in PCN-allergic, and PCP
Side Effects- Nephrotoxic, HyperKlemia, aseptic meningitis
aminoglycosides
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
Amantadine/Rimantadine
M2 membrane protein to prevent uncoating of the virus
* Only Influenza A
Resistance is high
NNRTI- Non-Nuc
Reverse transcriptase inhibitor
Names: Efavirenz, Nevirapine, Delavirdine
Side Effects: drug interations
PI- Protease Inhibitor
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
Fusion Inhibitor
blocks HIV capsid from binding gp41
Names: Enfuvirtide
Side Effects: hypersensitivity, baterial pneumonia, pain at injection site
HAART Therapy
HIV regimin begun at low CD4 or high viral load (>100000)
2NRTI + 1NNRTI or 1 PI
Fluconazole
Inhibit Ergosterol synthesis
Use- Candida, meningitis
Caspofungin
block glucan synthetase, inhibiting fungal cell wall biosynthesis
Use- systemic aspergillosis
Griseofulvin
blocking spindle formation- cell division
Use- dermatophytes
Vancomycin
Bind D-ALA D-ALA to block cell wall synthesis
Use- beta-lactam- resistant gram-positive organisms- MRSA and Enterococcus
Clindomycin
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
Gram + (versus Gram -)
Cellular features
Gram + have NO outer cell membrane- easier for drugs to enter
* stain blue due to thick peptidiglycan cell wall
Chloramphenicol
50S Ribosome- Protein Inhibitor
Side Effects- Aplastic anemia-Bone marrow suppression, and gray baby syndrome
Piperacillin/tazobactam
extended spectrum penicillin + B-Lactamase inhibitor
Use-DOC for Pseudomonas
Macrolide
50S Ribosome- Protein Inhibitor
Erythro, Azithro, Clarithromycin (disseminated MAC)
Beta-hemolytic streptococci, pneumococci, staphylococci and enterococci, mycoplasma, mycobacteria, some rickettsia and chlamydia.
Quinupristin/Dalfopristin (Synercid)
gram positive pathogens including E. faecium form of VRE, but not the E. faecalis form
Linezolid
blocks the formation of 70S initiation complex
Use- MRSA and VRE