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178 Cards in this Set
- Front
- Back
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Penicillin, ampicillin, ticarcillin, piperacillin, imipenem, aztreonam, cephalosporins
MOA |
Block cell wall synth by inhibiting peptidoglycan cross linking
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Bacitracin, Vancomycin
MOA |
Block peptidoglycan synth
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Polymyxins
MOA |
Disrupt bacterial cell membranes
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Sulfonamindes
Trimethoprim MOA |
block nucleotide synth
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Fluroquinolones
MOA |
Block DNA topoisomerase
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Rifampin
MOA |
block mRNA synth
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Chloraemphenicol, macrolides, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid
MOA |
block protein synth at 50s ribosome
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Aminoglycosides, tetracyclines
MOA |
block protein synth at 30s ribosome
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Bacteriostatics
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we're ECSTaTiC about bacteriostatics
Erythromycin Clindamycin Sulfamethoxazole Trimethprim Tetracycline Chloramphenicol |
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Batcericidials
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Very Finely Proficient At Cell Murder
Vancomycin Fluoroquinolones Penicillin Aminoglycosides Cephalosporins Metronidazole |
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prototype for b-lactams
(2) |
penicillin G (IV), pen V (oral)
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Drug that is bactericidal for
-S. pneumo -S. pyogenes -N. meningitides -Treponema pallidum (syphillis) -Pasteurella multocida -Listeria -Actinomyces israelii a. drug? b. MOA c. toxicity |
a. penicillin G (IV), V (oral)
b. binds and blocks transpeptidase cross linking, activates autolytic enzymes c allergy (bronchospasm, rash, shock), rash, Pseudomembranous colitis (C. diff) |
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Drug I would use for a patient with strep throat caused by S. pyogenes
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Penicillin V
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3 Penicillinase-resistant penicillins
what makes them penicillinase-resistant |
METhicillin, NAfcillin, diclOXacillin
I MET a NAsty OX bulkier R group |
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Infection with S. aureus (but not MRSA)
a. drug to treat b. toxicity |
a. penicillinase-resistant penicillins (methicillin, nafcillin, dicloxacillin)
b. hypersensitivity methcillin - interstitial nephritis |
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What makes MRSA methicillin-resistant
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altered penicilllin binding protein (transpeptidase) binding site
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What would I use for an s. aureus infection causing
-cellulitis -endocarditis -sepsis |
nafcillin
"use NAF for STAPH" |
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spectrum compared to pen G
a. penicilinase-resistant pens b. aminopens c. antipseudomonals |
a. narrower
b. wider c. wider |
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2 aminopenicillins
how do they compare in general with penicillins regarding coverage |
ampicillin (IV) , amoxicillin (oral)
better coverage of gram negs |
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class of drug used to treat
-H. influenzae -E. coli -Listeria -Proteus -Salmonella -Enterococci a. 2 drugs b. toxicity |
ampicillin (IV), amOxacillin (Oral)
hypersensitivity, ampicillin rash, pseudomembranous colitis |
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Drug I would use for outpatient bronchitis, otitis media, sinusitis, or Listeria infection
what makes it good as an outpatient drug |
amoxacillin
oral |
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drug combined with gentamycin to provide broad gram neg. coverage
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ampicillin
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Aminopenicillins
a. sensitive to penicilinase? b. how can you enhance their spectrum |
a. yes
b. give clauvulanic acid, protects against penicillinase destruction |
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Triple therapy for H. pylori infection involving an aminopenicllin
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amoxacilin, bismuth, metronidazole
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3 antipseudomonals
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ticarcillin, carbenicillin, piperacillin
James Bond uses 3 tools to kill the nasty pseudomonas 1. TICk 2. CAR 3. PIPE bomb |
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Treatment for pseudomonas and gram negative rods
a. what should you use it with to extend the spectrum b. toxicity |
ticarcillin, carbenicillin, piperacillin
a. give with clauvulanic acid (sensitive to penicillinase) b. hypersensitivity |
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3 beta lactamase inhibitors
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Clauvulanic Acid
Sulbactam Tazobactam CAST |
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First generation cephalosporins
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CePHalexin
CeFAZolin they all have PH except ceFAZolin, so don't get "FAZed" by this |
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drug to treat gram positive cocci (staph or strep when patient is allergic to penicillin, or before surgery to prevent skin infection)
-Proteus -E.Coli -Klebsiella a. adverse efects |
1st gen cephalosporins (cefazolin, cephalexin)
-treat gram pos cocci + PEcK a. Hypersensitivity, delayed rash, c. difficile |
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Drug that treats gram pos. cocci +
-H. influenzae -Enterboacter -Neisseria -Proteus -E. Coli -Klebsiella -Serratia |
2nd gen cephalosporins (Cefoxitin, Cefaclor, Cefuroxime)
treat HEN PEcKS |
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If your patient has pneumonia, but you don't know what is causing it, what is a good agent to give broad coverage of the most likely pathogens
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Cefuroxime (2nd gen cephalosporin)
provides coverage of both S. pneumo and H. influenzae |
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2nd gen cephalosporin good for anaerobes
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cefoxitin
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3 second gen cephalosporins
toxicities (5) |
ceFOXitin, ceFAclor, ceFURoxime (FOX FAmily wears FUR)
1. hypersensitivity 2. C. diff 3. increases nephrotixicity of aminoglycosides 4. if ceph has a MMT sidechain, can interfere with alcohol metabolism --> buildup of acetaldehyde 5. vit K deficiency |
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3 third gen cephalosporins
what are they good for in general |
cefTRIaxone, cefoTaxime, cefTazidime
good for serious gram neg infections resisant to other b-lactams |
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patient has meningitis/gonorrheae that is resistant to other b-lactams
what should I try? |
ceftriaxone - good CSF penetration
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3rd gen cephalosporin used for pseudomonas
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ceftazidime
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Cephalosporins
5 adverse side effects |
1. hypersensitivty
2. cross-hypersensitivity with penicillins 3. nephrotoxic with aminoglycosides 4. if MTT side chain --> disulfride-like rxn with ethanol (nausea and vomiting from buildup of acetaldehyde) 5. vit K def |
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cephalosporin good for pseudomonas and gram pos.
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cefepime (4th gen)
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two cephalosporins that work against pseudomonas
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ceftazidime (3rd), cefepime (4th)
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Drug that is a magic bullet for gram negative rods, aerobic organisms in patients who are
-pen allergic -cannot tolerate aminoglycosides because they are pen allergic how should you take these to increase spectrum? |
aztreonam
used with a gram pos. killer like vancomycin or clindamycin |
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aztreonam
a. mechanism b. toxicity c. use |
a. monobactam (resists b-lactamase) that binds to PBP3 and inhibits cell wall synth
b. non-toxic, little cross reactivity with pens c. gram neg rods, used synergistically with aminoglycosides |
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Drug with the broadest spectrum
-gram pos cocci -gram neg rods (+pseudomonas) -anaerobes but it cannot cover MRSA drug? newer drug that is better? |
imipenem/cilastatin
meroprenem - don't need cilastatin b/c it is stable to dihydropeptidase |
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imipenem
what do you give with it to increase its lifespan and why |
cilastatin
b/c imipenem is broken down by dihydropeptidase (in kidney) |
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Drug that you can give in a trauma for the best overall general coverage (known as 'decerebrate antiobiotic')
negative side effects |
carbapenem class
1. GI distress 2. skin rash 3. seizures |
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beta lactams that are
a. resistant to beta lactamase (4) b. susceptible to beta lactamase (3) |
a. impinem, aztreonam, cephalosporins, pen-resistant pens
b. Penicillin, aminopenicillins, antipseudomonals |
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Drug that is used only for serious gram positive infections
-MRSA -C. diff -enterococci a. mechanism b. toxicity (4) |
a. inhibits cell wall peptidoglycan by binding D-ala D-ala side chain --> bacteriocidal
b. Nephrotoxic, Ototoxic, Thrombophlebitis, flushing generally NOT many problems |
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A bacteria has an amino acid change from D-ala D-ala to D-ala D-lac in its peptidoglycan
it is now resistant to what drug |
vancomycin
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Why should you pre-treat with antihistamines and give a slow infusion rate of vancomycin
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prevent diffuse flushing (red man syndrome)
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30s inhibitors
static or cidal? |
AT
aminoglycosides (cidal) tetracycline (static) |
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50s inhibitors
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CCELL
Chlomramphenicol (static) Clindamycin (static) Erythromycin (static) Lincomycin (static) Linezolin (variable) |
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Only anti-ribosomal antibiotic that cannot be absorbed orally
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aminoglycosides
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Drug that has wide spectrum activity (gram pos, gram neg, anaerobes), used specifically with
-bacterial meningitis if patient is pen and cephalosporin allergic -Rickettsial infection (rocky mtn spotted fever) if patient is pregnant or a child |
Chloramphenicol
very wide spectrum - good overall coverage, but toxic, so only use if other drugs are contraindicated can't use tetracycline for rickettsia in a child or pregnant woman |
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Drug used to treat pen/cephalosporin-resistant meningitis
a. MOA b. toxicity |
chloramphenicol
a. inhibits 50s peptidyltransferase, bacteriostatic b. anemia (dose dep.), aplastic anemia (dose indep.), gray baby syndrome (baby lacks UDP-glucoronyl transferase) |
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Bacteria obtains a plasmid-encoded acetyltransferase
what drug is it resistant to now |
chloramphenicol
this drug inhibits peptidyltransferase in 50s ribosome (bacteriostatic) |
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Patient with poor dentition presents with
-wt loss -chronic fever -night sweats -foul-smelling sputum imaging shows lung abscess treat? |
clindamycin
in general, used for anaerobic infections above the diaphragm |
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Treatment of bacteroides or c. perfringens infection --> aspiration pneumonia or lung abscess
a. MOA b. toxicity |
clindamycin
MOA: blocks peptide bond formation at 50s subunit (static) Tox: pseudomembranous colitis, fever, diarrhea |
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treats anaerobic infections
a. above diaphragm b. below diaphargm |
a. clindamycin
b. metronidazole |
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aminoglycosides - which one is used for
a. added with penicillin for in-hospital infections b. pseudomonas c. broadest spectrum, good for resistant nosocomial infections d. broadest spectrum but lots of toxicity, topically for skin, bowel surgery |
a. gentamycin
b. tobramycin c. amikacin d. neomycin |
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Drug that is used with b-lactams to kill aerobic gram negative rods of the GI tract (like e.coli)
why use b-lactam |
aminoglycosides
-MEAN GNATS canNOT kill anaerobes Gentamycin, neomycin, amikacin, tobramycin, streptomycin these need to cross the cell wall to act, so beta lactams help by breaking down wall |
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a bacteria develops a transferase enzyme that allows it to acetylate, phosphorylate, or adenylate a drug
what drug is it now resistant to? what is its MOA? Toxicity? |
aminoglycosides
inhibits initiation complex formation on 30s (cidal), but needs Oxygen for uptake Nephrotoxic (esp w/cephalosporins), Ototoxic (esp w/ loop diuretics), Teratogen MEAN GNATS canNOT kill anaerobes |
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Drug used for
-Chlamydial VD -Mycoplasma pneumoniae -Rickettisia -H. pylori -Borrelia burgdorgeri 4 types |
Tetracycline, doxycycline, demeclocyline, minocycline
Picture a solider in the TET offensive: he has chlamydia from prostitutes, rickettsia from ticks, 'walking' pneumonia |
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Contraindications for tetracycline
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-pregnancy
-don't take with milk, antacids, or Fe-containing preps (chlates divalent cations --> inhibits absorption in the gut) |
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Tetracyclines
which tetracycline works better than the rest with food because it is a poor chelator of divalent cations how is it eliminated and why is this important |
doxycylcine
fecally eliminatd, can take in renal failure |
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Tetracycline
which can work as a diuretic in SIADH and why |
demeclocycline - ADH antagonist
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Alternative drug to erythromycin for treating walking pneumonia from mycoplasma pneumoniae
MOA? adverse? |
tetracycline
prevents attachment of aminoacyl-tRNA to 30s ribosome (static), limited CNS penetration GI distress, discolored teeth, inhibits bone growth in kids, photosensitivity (phototoxic dermatitis), renal and hepatotoxic (picture soldier in TET offensive who is irritable (GI), has yellow teeth, works in the dark (photosensitive), has shrapnel in kidney and liver, and breaks kids' bones) |
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MOA of tetracycline
resistance conferred when... |
prevents aminoacyl-tRNA attachment to 30s ribosome (Static)
resistance when bacteria gets plasmid-encoded efflux pumps that decrease uptake into cells or increase efflux out of cells |
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Rickettisial infection - treat
a. adults b. kids/pregnant women |
a. tetracycline (can accumulate intracellularly)
b. chloramphenicol (can't use tetracycline with kids and pregnant people) |
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Drug that treats
-atypical pneumonias (mycoplasma, chlamydia, legionella) -Legionairre's disease -gram positives (strep infections in paitents allergic to pen) -URIs - otitis, sinusitis, bronchitis -STDs -Neisseria |
Macrolides: erythromycin, azithromycin, clarithromycin
(Picture cross (gram pos.) over a wreat (erythromycin) that commemorates a french legionnaire (legionella)) |
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Patient has Legionairre's disease
go to drug? MOA? Tox? |
Macrolide - erythromycin, clarithromycin, azithromycin
MOA: blocks translocation on 50s ribosome - inhibits protein synth (static) Tox: -long QT (avoid if arrhythmias) -GI discomfort (peristalsis) -acute cholestatic hepatitis (blocked bile duct) -eiosinophilia, skin rash -increases serum conc. of theophyllines, oral anticoags |
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Bacteria has a methylated 23s binding site
what drug is it resistant to |
Macrolides - eryth, azith, clarithromycin
these drugs bind to 23s subunit of 50s ribosome, inhibit translocation of growing polypeptide |
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Drug to that treats UTIs that you should NEVER use with warfarin
why |
TMP-SMX
displaces warfarin from albumin --> increases serum warfarin --> high risk of bleeding |
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3 sulfonamide drugs
MOA |
sulfamethoxazole, sulfisoxazole, sufladizine
Inhibits Dihydropteroate synthetase --> inhibits THF production -> can't make purines, thymine, or proteins |
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Hypersensitivity
Hemolysis (if G6PD deficient) Tubulointerstitial nephritis Photosensitivity Kernicterus in infants Warfarin interaction which drug? what does it treat? |
sulfonamides
Gram pos, gram neg, nocardia, chlamydia |
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Bacteria gets altered dihydropteroate synthetase or upregulates PABA synthesis
what drug is it resistant to |
sulfonamides
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Trimethoprim
MOA TOX |
inhibits bacterial DHF reductase
megaloblastic anemia, leukopenia, granulocytopenia (can help by giving folic acid) |
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Drug that treats
-Strep pneumo or h. influenza induced otitis, bronchitis, sinusitis, pneumonia -Shigella, salmonella, e.coli induced diarrhea -Enterics (e.coli) induced UTI, urethritis, prostatitis -PCP, toxoplasmosis, Isospora syndromes in AIDS patients |
TMP-Smx
T - (respiratory) Tree - M - mouth (GI) P - pee (GU) S - systemic (AIDS) |
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I have a sulfa allergy
which 8 drugs must I avoid |
-sulfonamindes
-sulfasalazine -sulfonylurea -thiazide diuretics -acetazolamide -furosemide -celecoxib -probenicid |
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Drug that covers
-pseudomonas in CF patients -aerobic enterics (ETEC, slamonella, shigella, campylobacter) -complicated UTIs (enterobacteriae) -pneumonia from intracellular organisms (Legionella, mycobact, salmonella) -s.aureus chronic osteomyelitis |
fluroquinolones
cipro, noro, oflo, sparflo, moxi, gat "floxacins" nalidixic acid |
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patient with CF has pseudomonas infection
drug? MOA? toxicity? |
fluroquinolones - cipro
inhibits DNA gyrase (cidal) -GI upset -C. diff colitis -pregnant and children - cartilage damage -tendon rupture -myalgias in kids |
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patient has chronic s. aureus osteomyelitis
drug? when is it contraindicated? what should you avoid taking it with? |
fluorquinolones
contra in pregnancy and children (cartilage damage, tendon damage, myalgias) "fluorquinoLONES hurt attachments to BONES" Don't take with antacids |
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bact has point mutation in DNA gyrase
what drug is it resistant to |
fluoroquinolones
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How do moxifloxacin and gatfloxacin differ from ciprofloxacin
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fluoroquinolones
moxi and gati have more anaerobic coverage, strep pneumo coverage |
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Drug good for aeorbic enterics, complicated UTIs, community acquired pneumonia from legionella or mycobact.
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fluoroquinolones
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Drug that treats
-Giardia -Entamoeba -Trichomonas -Gardnerella vaginalis -Anaerobes (below diaphragm) -h. Pylori MOA adverse? |
Metronidazole (GET GAP)
Forms free radical toxic metabolite--> damages DNA (cidal) Disulfiram-like rxn with alcohol headache metallic taste teratogen |
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Drug to use in resistant gram negative infections that bind to cell membranes and disrupt their osmotic properties
2Toxicity |
Polymyxins (polymyxin B, colistimethate)
-Neurotoxic -acute renal tubular necrosis |
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M. tuberculosis
a. prophylaxis b. treatment |
a. isoniazid
b. RIPE = rifampin, isoniazid, pyrazinamide, ethambutol |
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T. avium-intracellulare
a. prophylaxis b. treat |
a. azithromycin
b. azithromycin, rifampin, ethambutol, streptomycin |
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mycobacterium leprae
treatment? |
dapsone, rifampin, clofazimine
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Patient has TB
a. first line therapy b. second line therapy |
a. Isoniazid (INH), Streptomycin, Pyrazinamide, Rifampin, Ethambutol (RIPES)
b. cycloserine |
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Ethambutol
MOA Side effect |
MOA = decreases carb polymerazation of myocobact. cell wall by blocking arabinosyltransferase
side effect: optic neuropathy (red green color blindness) |
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Pyrazinamide
use? MOA? |
use: first line TB
Effective in acidic pH of phagolysosomes, where mycobact engulfed by macrophages live |
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If active TB
treatments and how long |
1. 4 for 2 (RIPE for 2 months)
2. 2 for 4 (RI for 4 months) If potts or meningitis from TB, treat longer! |
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Only agent used for solo prophylaxis for TB
MOA? Toxicity? |
Isoniazid
Decreases synth of mycolic acids, but needs to be converted to active form by bacterial catalase peroxidase -inhibits Cyp 450 -different half lives for fast and slow acetylators! -Neurotox (peripheral neuropathy), lupus - give B6 to prevent these -Hepatototoxic |
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Drug used for
-first line TB -given with dapsone in leprosy to delay resistance -meningococcal prophylaxis and chemoprophylaxis in contacts of children w/ H. influenzae B Mechanism? Tox |
Rifampin
Inhibits DNA-dependent RNA Pol Drug interaction (increases activity of P450), orange body fluids (non toxic) |
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4 Rs of rifampin
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RNA polymerase in hibitor
Revs up P450 Red/orange body fluids Rapid resistance if used alone |
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Drug interactions with rifampin
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upregulates P450, so it decreases effect of these drugs
-coumadin (blood thinner) -oral contraceptives -oral hypoglycemics, corticosteroids -anti-seizure (phenytoin) |
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Nonsurgical antimicrobial prophylaxis
Meningococcal infection |
rifampin (first choice)
minocycline |
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Nonsurgical antimicrobial prophylaxis
Gonorrhea |
ceftriaxone
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Nonsurgical antimicrobial prophylaxis
Syphilis |
Benzathine, pen G
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Nonsurgical antimicrobial prophylaxis
History of recurrent UTIs |
TMP-SMX
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Nonsurgical antimicrobial prophylaxis
PCP |
TMP-SMX (first)
aerosolized pentamidine |
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Nonsurgical antimicrobial prophylaxis
Endocarditis with surgical or dental procedures |
Penicillins
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Nonsurgical antimicrobial prophylaxis
Mycobacterium avium-intracellulare |
Azithromycin
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Treat MRSA
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Vancomycin
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Treat VRE
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Linezolid and streptogramins (quinupristin/dalfoprisitne)
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Antifungals
2 drugs that disrupt membrane by forming artificial pores |
amphtericin
nystatin |
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Antifungals
drug for serious, systemic mycoses -crypto, blasto, coccidioides, aspergillus, histoplasma, candida, mucormycoses MOA |
amphotericin B
Binds to ergosterol, forms pores that allow electrolytes to leak (amphotericin TEARS membrane) |
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Fungal meningitis
drug? how is it given? |
amphotericin B
give intrathecally because it does not cross BBB |
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Patient has systemic aspergillus infection
drug? toxicity? how can you reduce toxicity |
amphotericin B
-Fever/chills (shake and bake) -Nephrotoxicity (keep track of BUN, Cr) -Hypotension -Arrhythmias -Anemias -IV phlebitis (inflamm of vein) hydration to reduce nephrotoxicity, liposomal amphotericin reduces toxicity |
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drug for
-oral candidiasis -diaper rash -vaginal candidiasis MOA? |
Nystatin
same as amphotericin B, but too toxic so only use topically |
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Drug for cryptococcal meningitis in AIDS, candida infections
MOA |
Fluconazole (can cross BBB)
Inhibits P450 that converts lanosterol to ergosterol --> cannot make ergosterol --> cannot make fungal membrane |
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Drug for systemic infections of (less serious?)
-blastomyces -coccidioides -histoplasma -candida -hypercortisolism Toxicity? |
Ketoconazole
-inhibits hormone synth (gynecomastia) -liver dysfunction (inhibits P450) -fever, chills |
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Drugs for topical fungal infections that can cause gyencomastia and liver dysfunction
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ketoconazole
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Drug used in systemic fungal infections, combined to amphotericin B
MOS? tox? |
flucytosine
converted to 5-FU --> inhibits thymidylate synthase --> inhibits DNA synth -bone marrow suppression -nausea, vomiting, diarrhea (effects rapidly dividing GI and Bone marrow cells) |
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Drug for invasive aspergillosis
MOA Tox |
Caspofungin
Inhibits b-glucan --> inhibits fungal cell wall synth GI upset, flushing |
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Drug to treat onychomycosis (fungal infection of finger or toe nails)
MOA |
terbinafine
inhibits fungal enzyme squalene epoxidase --> can't make ergosterol |
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drug that is oral treatment for superficial fungal infections
also inhibits growth of dermatophytes (tinea, ringworm) MOA Tox |
Griseofulvin
MOA: interferes with microtubule formation, disrupts mitosis; deposits in keratin containing tissues Tox: teratogen, carcinogen, confusion, headache, increases P450 and warfarin metabolism |
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Patient with HIV was cleaning cat litter, presents with 1 month of
-LN enlargement, fever, aches dx? What drug should you use with sufladiazine? MOA of drug? |
Toxoplasmosis
Pyrimethamine Inhibits plasmodial DHF reductase |
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Patient in Africa has constant, irregular episodes of
-extreme fever, shaking and chills -drenching sweats -hepatosplenomegaly 0brain, lung, kidney damage dx? treat? MOA of drug? |
malaria from p. falciparum (constant, irregular episodes differentiate from other bugs that cause malaria)
pyrimethamine selectively inhibits DHF reductase of plasmodiaum falciparum |
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Patient bitten by a Tse Tse fly has
-fever, headache, joint pain, itching -swollen LN at back of neck (Winterbottom's sign) -anemia dx? treat? MOA? |
Sleeping sickness from a Trypanosoma infection (hemolymphatic stage)
Treat with suramin Inhibits enzymes involved in energy metabolism |
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Drug used to treat African sleeping sickness
limitations of this drug |
suramin - inhibits enzymes involved in energy metabolism
no CNS involvement |
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Patient bitten by a Tse Tse fly had
-fever, headache, winterbottom's sign now has -altered sleep cycle -confusion treat? MOA |
african sleeping sickness from trypanosoma (neuro phase)
melarsoprol, which inhibits sulfhydryl groups in parasite enzymes Has CNS involvment |
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African sleeping sickness treatment
a. hemolymphatic stage b. neuro stage |
a. suramin
b. melarsoprol |
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Patient in S. America has
-dilated cardiomyopathy -magacolon -megaesophagus on blood smear, you see motile trypomastigotes a. dx b. bug c. treat d. MOA of treat |
Chigas disease
Tyrpanosoma Cruzi Nifurtimox Forms intracellular oxygen radicals, which are toxic to organism |
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Patient is bitten by a sandfly, has
-spiking fevers -hepatosplenogmegaly -pancytopenia macrophages show up containing amastigotes (lacking flagella) a. dx b. bug c. treat d. MOA of treat |
a. Visceral leishmaniasis
b. leishmania donovani c. Sodium stiogluconate d. inhibits glycolysis at PFK reaction |
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Antiprotozoan drug that is a prophylaxis for P. falciparum and p. malarieae
used with primaquine for P. vivax and P. ovale MOA |
Chloroquine
Blocks plasmodium heme polymerase --> accumulation of toxic Hb breakdown products --> destroys plasmodium |
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A first line prophylaxis for malaria and treatment for acute malaria (P. falciparum) resistant to chloroquine
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mefloquine
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Treatment for chloroquine-resistant species of p. falciparum when used in combo with pyrimethamine/sulfonamide
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Quinine
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Treatment for intestinal nematodes
MOA |
MeBENDazole (worms are BENDy)
Inhibit glucose uptake and microtubule synth |
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Alternative to mebendazole for ascaris, necator (hookworm), and enterobius (pinworm)
MOA |
Pyrantel pamoate
stimulates nicotnic receptors at NMJ --> contraction --> depolarization-induced paralysis (does not affect tapeworms or flukes) |
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Treatment of choice for onchocerca volvulus (river blindness) and intestinal nematodes
MOA effect on humans |
Ivermectin
Intensifies GABA neuroransmission --> immobilization Does not cross BBB --> no effect on humans |
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Drug used for
1. extra-intestinal nematodes (wucheria bancroti, brugia malayi, loa loa, oncocercia (2nd line)) 2. toxocariasis (visceral larval migrans) 3. tropical pulmonary eosinophilia |
Diethylcarbamazine
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Drug for
1. trematodes (flukes) - schistosomes 2. Cestodes (tapeworms) - Teania and diphyllobatum, latum 3. Taenia solium (cysticercosis) MOA |
Praziquantel
Increases membrane permeability to Ca --> contraction and paralysis of tapeworms and flukes |
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Drug for HSV, VZV, EBV
BUT NOT CMV why not CMV? |
acyclovir
needs to be monphosphorylated by thymidine kinase, which CMV does not have |
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Drug used for
-HSV - mucocutaneous and genital lesions, encephalitis -VZV infection involving eye -prophylaxis in immunocompromised patients a. drug b. structure of drug c. MOA of drug d. toxicity |
a. acyclovir
b. guanosine analog c. monphosphorylated by thymidine kinase --> triphosphate form made --> inhibits viral DNA polymerase by chain termination d. well tolerated |
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A virus that lacks thymidine kinase is resistant to...
one example |
acyclovir
CMV |
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Drug used for
1. CMV infection in AIDS patients -retinitis -pneumonitis -esophagitis 2. CMV pneumonitis in bone marrow transplant patients MOA |
Ganciclovir
5' monophosphate form by CMV viral kinase or VZV/HSV thymidine kinase --> triphosphate form of guanosine analog --> inhibits viral DNA pol |
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Ganciclovir
Toxicity |
Leukopenia, neutropenia, thrombocytopenia
renal toxicity (more toxic than acyclovir) |
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A CMV has mutated DNA polymerase or lacks viral kinase
what drug is it resistant to |
ganciclovir
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Drug for CMV retinitis when gancicovir fails or acyclovir-resistant HSV
MOA Toxicity |
Foscarnet
Binds to viral DNA pol pyrophosphate binding site, inhibits (does not need viral thymidine kinase) Nephrotoxic |
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Foscarnet resistance
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Mutated DNA pol
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When should HAART therapy be initiated in AIDS patient?
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CD4 < 350 or high viral lode or AIDS-defining illness
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What does the HAART regimen consist of (2)
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1. 2 NRTIs + 1 protease inhibitor
2. 2 NRTIs + 1 NNRTI |
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HAART
5 protease inhibitors |
SaquiNAVIR
Ritonavir Indinavir Nelfinavir Amprenavir NAVIR TEASE a proTEASE |
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HAART
4 NRTIs |
Zidovudine (ZDV)
Didanosine (ddI) Zacitabine (ddC) Stavudine (d4T) "have YOU DINED (zidovUDINE) with my NUCLEAR (nucleosides) family?" |
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HAART
3 NNRTIs |
Nevirapine
Efavirenz Declaviridine Never Ever Deliver nucleosides |
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HAART
1 fusion inhibitor |
EnFUvirtide
FUsion inibitior |
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HAART
Mechanism of protease inhibitors |
prevent maturation of new viruses by preventing HIV-1 protease (pol) from cleaving HIV polypeptides into functional proteins
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Drugs that inhibit viral penetration
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gamma globulins
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Drugs that inhibit viral uncoating
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amantadine
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Drugs that inhibit viral nucleic acid synth
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purin and pyrimdine analogs
Reverse transcriptase inhibitors |
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Drugs that block late protein synth and processing (viral
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protease inhibitors
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Drugs that block viral protein packaging and assembly
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rifampin (vaccine()
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Drug that is used for treatment of influenza A, Parkinson's disease
MOA toxicity |
Amantadine
Blocks viral penetration, unCOATing (M2), release of dopamine from nerve terminals (picture A MAN getting ready TO DINE by taking off his COAT) Ataxia, dizziness, slurred speech "Amantadine causes problems with the cerebellA" |
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a virus has a mutated M2 protein
What drug does it resist |
amantadine
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Drug with fewer CNS side effects than amantadine, used for influenza A only
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Rimantadine
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Drug for both Influenza A and B
MOA |
Zanamavir, Oseltamivir
Inhibits influenza neuraminidase --> decreases release of progeny virus |
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Drug to treat RSV, chronic Hep C
MOA tox |
Ribavirin
Competitively inhibits IMP dehydrogenase --> disrupts guanine nucleotide synth Hemolytic anemia, teratogen |
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Saquinavir
Ritonavir Indinavir Nelfinavir Amprenavir class? use? toxicity? |
protease inhibitors
HAART Hyperglycemia GI intolerance Lipdystrophy Thrombodytopenia (indinavir) |
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Zidovudine (ZDV)
Didanosine (ddI) Zacitabine (ddC) Stavdine (d4T) class? use? MOA? |
NRTI
HAART, prophylaxis in pregnancy (ZDV) when phosphorylated by viral thymidine kinase, they competitively inhibit nucleotide binding to reverse transcriptase -> chain termination (they lack a 3'OH group) |
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Zidovudine (ZDV)
Didanosine (ddI) Zacitabine (ddC) Stavdine (d4T) adverse |
-bone marrow suppression (reversed by G-CSF and erythropoietin)
-peripheral neuropathy (ddI, ddC, d4T) -lactic acidosis (nucelosides) -rash (non-nucleosides) -megaloblastic anemia (ZDV) |
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Nevirapine
Efavirenz Declaviridine class? use? MOA |
NNRTI
HAART Bind to reverse transcriptase (at a different site than NRTIs, do not require phosphorylation) |
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NNRTI
adverse |
same as NRTI
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Enfuviritide
class? use? adverse? |
fusion inhibitor - binds gp41 and inhibits fusion with CD4 T cells
HAART - used in patients with persistent viral replication desite antiretroviral therapy -Hypersensitivity at injetion site -increased risk of bacterial pneumonia |
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Interferons
MOA adverse |
Induce the production of glycoproteins by virus infected cells that block replication of virus
Neutropenia |
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Drug for chronic hepatitis B and C, Kaposi's sarcoma
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IFN-alfa
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Drug for MS
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IFN-beta
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Drug for NADPH oxidase deficiency
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IFN-gamma
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combo therapy to treat hep C
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ribavirin + IFN-a
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Antibiotics to avoid in pregnancy
(mnemonic) (8) |
SAFE Moms Take Really Good Care
Sulfonamides Aminoglycosides Fluoroquinolones Erythromycin Metrnidazole Tetracycline Ribavirin Griseofulvin Chloramphenicol |
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Antibiotics to avoid in pregnancy
causes kernicterus (damage to baby brain caused by unconjugated bilirubin) |
Sulfonamides
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Antibiotics to avoid in pregnancy
Causes ototoxicity |
Aminoglycosides
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Antibiotics to avoid in pregnancy
Cartilage damage |
Fluoroquinolones
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Drug that causes
Acute cholestatic hepatitis |
Macrolide
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Antibiotics to avoid in pregnancy
Mutagenesis |
Metronidazole
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Antibiotics to avoid in pregnancy
Discolored teeth, inhibits bone growth |
tetracycline
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Antibiotics to avoid in pregnancy
Teratogenic (2) |
Ribavirin (antiviral)
Griseofulvin (anti-fungal) |
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Antibiotics to avoid in pregnancy
gray baby |
chloremphenicol
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