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378 Cards in this Set

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Bacteriocidal
Kills organisms, more effective during log growth
Bacteriostatic
Prevent bacterial growth, less desired clinically
Dose Adjustment Factor
1/F(kf-1) + 1
Sulfonamide MOA
Bacteriostatic; compete with PABA to be incorporated in folic acid
Antifolate MOA
Inhibit dihydrofolate reductase
Sulfonamide Adverse Effects
-hypersensitivity
-acute hemolytic anemia
-bone marrow depression
-thrombocytopenia, granulocytopenia
-agranulocytosis
-GI effects
-Hepatitis
-Crystalluria, toxic nephrosis
-CNS toxicity
-Stevens-Johnson Syndrome
-Vitamin K deficiency
Antifolate Adverse Effects
-GI
-Hematologic
-Nausea, vomiting
-Leukopenia
-Granulocytopenia
-Megaloblastic anemia
Sulfonamide Uses
-Urinary infection
-Nocardiosis
-Chlamydia
-Trachoma
-Shigellosis
-Acute toxoplasmosis
-Ulcerative cholitis
-Rheumatoid arthritis
-Chronic burn lesions
Antifolate Uses
-Recurrent UTI
-Acute otitis media
-Chronic bronchitis
-Pneumonitis
-Shigellosis
-Malaria
-Toxoplasmosis
DNA Synthesis Inhibitors
Quinolones
Nalidixic Acid
Cinoxacin
Fluroquinolones
Norfloxacin
Ciprofloxacin
Ofloxacin
Levofloxacin
DNA Synthesis Inhibitor Uses
-UTI
-General bacterial infection
-Prostatitis
-Bone and soft tissue infection due to staph and gram (-) organisms
Urinary Tract Infection Sulfa Drug
Sulfisoxazole
Nocardiosis Sulfa Drug
Sulfadiazine
Sulfisoxazole
Triple sulfonamide
Shigellosis Treatment
Sulfadiazine
Succinylsulfathiazole
Acute Toxoplasmosis Treatment
Sulfadiazine
Ulcerative Cholitis TX
Sulfasalazine
Rhemuatoid Arthritis TX
Sulfasalazine
Chornie Burn Lesion TX
Mafedine Acetate HCl
Prontosil Use
Staph infection
Sulfadiazine Use
Nocardiosis, Shigellosis, Acute toxoplasmosis
Sulfasoxazole Use
UTI, topical in eye, nose, ear, vagina
Sulfamethoxazole Use
UTI
Succinylsulfathiazole Use
Ulcerative cholitis
Bacillary dysentry
Bowel sterilization
Salicylaxosulfapyridine Use
Ulcerative cholitis
Bacillary dysentery
Bowel sterilization
Mefedine Use
Chronic burn lesions
Trimethoprim use
Recurrent UTI
Tremiethoprim-sulfamethoxazole Use
Acute otitis media
Acute exacerbation of chronic bronchitis
Methotrexate Uses
Pneumonitis
Shigellosis
Malaria
Toxoplamsosis
Norfloxacin Uses
UTi
General bacterial infection
Ciprofloxacin uses
UTI, prostatits, staph, gram - infections
3 Ways to Organize Microbes
Organism
Infectious process
Epidemilogic process
Pseudomonas Aeruginosa
Pulmonary infection
Primary skin infections
Catheter related UTI
Otitis externa
Eye infection
Bacteremia
Coxsackie B
Mild upper respiratory infection
Pleurodynia
Meningitis
Myocarditis
Myositis
Type 1 Diabetes Mellitus
Candida Albicans
Esophageal infection
Vulvovaginitis
Cystitis
Peritoniitis
Endocarditis
Meningitis
Fungemia
Microsproridia
-Encephalitozoan
-Nosema
-Microsporidium
Debilitating diarrhea
Ocular pain, vision loss
Neurologic disturbances
Hepatatis
Pneumonia Causes
Streptococcus pneumoniae
Staphylococcus aureus
H. influenzae
Mycoplasma pneumoniae
Chlamydophlia pneumoniae
Chlamydophila psittaci
Pseudomonas aeruginosa
Legionella
RSV, parainfluenza, metapneumovirus, measeles, CMV
Aspergillus, cryptococcus neoformans, Histoplasma capsulatum, Blastomyces dermatitidis, Coccidoies immites, Pneumocystis jiroveci
Ascaris lumbricoides, Stronglyoides stercoralis, Toxoplasma gondii
Gastroenteritis Causes
Campylobacter jejuni, Slamonella, Shigella, Vibrio cholerae, Vibrio parahaemolyticus, Yersinia enterocolitis, E. Coli
Rotavirus A, adneovirus 40/41, Norovirus, calcivirus, astrovirus, reovirus
Entamoeba histolytica, giardia lambia, microsporidia, cyrptososporidum parvum, cyclospora catetenesis, isospora beii, schistosoma mansoni, stronglyodies stercoralis, trichuris trichiura
Cellulitis Causes
Group A strep, S. aureus, H. influenzae
Rash causes
Varicella-Zoster, measles, rubella, pravovirus B19
Superficial and cutaneous infections
Tricophyton, Microsproum, Candida, Malassezia
Ulcerative
leishmania, dracunculus
UTI causes
E. coli, Proteus mirabilis, Staph saprophyticus, Adneovirus, BK virus, Candida, Cryptococcus neoformans, Schistoma haemotobilum
Sexually Transmitted Infections
Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae
HPV, HSV, CMV, HBV, HCV, HDV, HIV, HTLV-1
Candida albicans
Trichomonas vaginalis
Arthropod-borne Infections
Borrelia burgdorferi, Coxiella burnetti, Ehrlichia inaffensis, Rickettsia rickettsii, Yersinia pestis
EEEV, WEEV, SLV, WNV, CEV, LCEV, YFV, Dengue, Colti virus
Plasmodium, babesia, Wuchereia
Food-borne infections
Camplyobacter jejuni, Slamonella, Shigella, Vibrio cholerae, Vibrio parahemolyticus, Yersinia enterocolitica, E. coli, Bacillus cereus, Listeria monocytogenes, Brucella
Norovirus, astrovirus, calcivirus, Hepatitis A virus
Mycotoxins
Trichinella psiralis, cyclosproa cayetanensis, Taenia
Nosocomial Infection
Pesudomas aeruginosa, S. aureas, RSV, Rotavirus, Candida, Cryptosporidium parvum
Lower respiratory tract infection
Newborn: chlamydia trachmatis, RSV
Infact: H. influenzae, Streptococcus pneumoniae, RSV, parainfluenza ivrus, metpneumovirus
Children: H. influenzae, S. pneumoniae, parainfluenzae virus, metapneumovirus
Young adults: mycoplasma pneumoniae, chlamydophila pneumoniae, adenoviruses
Mature adults: chlamdyphila pneumoniae, S. pneumoniae, Lengionella, influenza virus
Older adults: H. influenzae, S. pneumoniae, influenza viruses, RSV
Penicillin Toxicities
Nephritis
Hematuria
Hemolytic anemia
GI distress
Hypersensitivity
Penicillins
PCN G
Ampicillin
Amoxicillin
Bacampicillin
Carbenicillin
Ticarcillin
Azlocillin
Mezlocillin
Diperacillin
Penicillin and Cephalosporin MOA
Interfere with cell wall synthesis by competitively inhibiting transpeptidation
Cephalosporin Toxicities
Superinfection
Renal necrosis
Vitamin K metabolism is reduced
1st Generation Cephalosporins
Cephalothin
Cefazolin
Cephalexin
Cefadroxil
2nd geneartion Cephalosporins
Cefaclor
Cefaroxine
Efoxitin
Cefamandole
3rd generation Cephalosporins
Cefotaxime
Cefoperazone
Cefepime
Beta-lactam Antibiotics
Carbapenems
Clavulanic Acid
Sulbactam
Taxobactam
Monobactams
Non beta-lactam Antibiotics
Cycloserine
Vancomycin HCl
Bacitracin
Polymyxin B sulfate
Colistin sulfate
Ampicillin Uses
Gram +
Listeria monocytogenes
E. Coli
Bordetella pertussis
H. influenza
Shigella
Proteus mirabilis
Salmonella
Ampicillin Pharmacokinetics
Renal and biliary excretion
Ampicillin Side Effects
Cross-allergy
Skin rash
GI disturbances
Azlocillin Uses
Pseudomonas
Methicillin Uses
Penicillinase resistant organisms
B-lactamase producing staph, strep, pneumococci
Mezlocillin Uses
Klebsiella
Pseudomonas
Penicillin G Uses
Diplococcus pneumoniae
Streptococus pyogenes, viridans
Staphylococcus aureas
Neisseria gonorrhea, meningitidis
Clostridium perfringens, tetani
Corynebacterium diphtheriae
Bacillus anthracis
Treponema pallidum
Leptospira
Actinomyces israeilii
Listeria monocytogenes
Pencillin Kinetics
Absorption depends on pH, tubular excretion
Ticarcillin Uses
Pseudomonas aeurginosa
Piperacilliin
Klebsiella, psuedomonas
Cefadroxil Uses
1st generation
UTI
Cefazolin Uses
1st generation
E. Coli, Klebsiella, surgical prophylaxis
Cephalexin Uses
1st generation
Cephalothin Uses
1st generation
Staph infection (endocarditits)
Interstitial nephritis
Ceflaclor Uses
2nd generation
Lower respiratory infxn, UTI, skin infection
Cefoxitin
2nd generation
Mixed anaerobic infxns (peritonitis, diverticulitis)
Cefuorxime
2nd generation
Passes BBB
Meningitis
Cefixime
3rd generation
Cefoperazone
3rd generation
Cefotaxime
3rd generation
Gram negative bacilli
Cefepime
4th generation
Meningitis
Carbapenems
-Cilastin
-Imipenem
pseudomonas, actinetobacter, Bacteriodes fragilis
Monobactam
-Axtreonam
Gram negative bacilli
Resistant to b-lactamases
Clavulanic Acid
-Sulbactam
-Tazobactam
B-lactamase inhibitors
Cycloserine
Inhibits racemase in cell wall synthesis
Vacomycin HCl MOA
inhibits cell wall synthesis
inhibits peptidoglycan synthesis by interfering with transfer from membrane lipid carrier to cell wall acceptor
Vancomycin Hcl Uses
Severe infections caused by S. aureus
Strep, pneumo, entero, coryne, colstridia, spirochetes
Vancomycin Toxicity
Ototoxic
Phlebitis
Peripheral neuropathy
Bacitracin MOA
inhibits pyrophosphatase reaction, releases lipid carrier
Bacitracin Uses
Topical for staph infection
bacitracin toxicity
Neprhotoxic
Eosinophilia
Polymyxin B sulfate MOA
disorients protein an dlipid
Polymyxin B uses
topical for gram negative bacilli, pseudomonas
Polymyxin Toxicity
Curare-like
Pain
Nephrotoxic
Colistin sulfate Uses
pseudomonas, aerobacter, klebsiella, e.coli, proteus, severe systemic infection
Colistin sulfate toxicity
circumoral paresthesia, slurred speech, visual disturbances, fever
Macrolides MOA
bind to 50s subunit where it blocks the translocation step in which the peptidyl tRNA is shifted from A to P site
Lincosamide MOA
binds 50s subuint of 70s ribosome and inhibits peptidyl transferase reaction and or prevents translocation of tRNA from acceptor to donor site
Tetracycline MOA
inhibits protein synthesis by binding to 30s portion and prevents attachment of aminoacyl-tRNA toA site; also inhibits attachment of N-formyl methinonine tRNA to 30s
Tigecycline MOA
binds to 30s subuint and blocks amino acyl-tRNAs from binding to ribosome
Chloramphenicol MOA
inhibits protein syntehsis by preventing mRNA from binding to 50s subunti; prevents conversion of polysomes to single ribosomes; inhibits mitochondrial peptidyltransferase
Macrolide Pharm
gram + infections
bacteriostatic
well absorbed
inactivated by acid
little changed drug exreted in urine
excreted in feces
Lincosamide Pharm
gram + infections
rapidly and ocmpletey absorbed orally
shorter half life
partly metabolized in liver
excreted in free form and glucuronides in urine and bile
Tetracycline Pharm
bacterostatic at low dose
bacteriocidal at high dose
gram + and -
excrete din feces
can cross placenta
chelates metals
cleared by glomerular filtration
Tigecycline Pharm
Gram + and Gram -
Chloramphenicol Pharm
bacteriostatic
gram + and -
well absorbed
hepatic metabolism
diffuses into CNS
Macrolide Drug Interactions
interferes with cytochrome P450 and increases activity of other drugs metabolized by these enzymes
Erythomycin-Clindamycin reaction
antagonistic, competition for 50S subunit
Erythromycin-Penicillin
syngerisitc, antagonistc
-bacteriostatic prevents bacteriocidal
Doxycyline-Carbamazepine
45% reduction in doxycyline half lief, induces liver enzymes by CBZ
Doxycyline-Phenobarbital
reduced serum lvels, reduced half life, and reduced urinary excretion
-induction o fhepatic microsomal enzymes
Doxycyline-Phenytoin
decreased half-life
induction of microsomal enzymes
chlortetracycline-penicillin
antagonizes bactericidal action of PCN
Tetracycline-Aluminum Hydroxide
decrseaed absorption of tetracycline
-TCN forms relatively insoluble chelates with divalent and trivalent metallic ions
Tetracycline-Cimetidine
reducction in mean peak tetracyline plasma concentration and excretion
Tetracycline-Oral contraceptives
antibiotic destroys gut flora and prevents steroid reabsorption
Chloramphenicol-peniclllin
bacteriostatic prevents bactericidal
Erythomycin Uses
When patient sensitive to PCn
Syphilis
Prophylaxis for rheumatic fever
Diphtheria carrier state, Legionnaires, Chlamydia, pertussis, tetanus, strep, staph, mycoplasma pneumonia, amebiasis
H influenza, mycobacterium-avium intracellulare
H. pylori
Azithromycin Uses
Mycobacterium avium intracellulare
Toxoplasmosis encephalitis
Uncomplicated nongonoccal urethritis
Clindamycin Uses
anaerobes (bacteriodes fragilis)
pneumococci, streptococci, staphlycocci
PCN allergy
Tetracycline Uses
chronic pulmonary problems
UTIs
rickettsiae, mycoplasma, cholera, lymphogranuloma
alternatives for actinomyscosis, norcardia, amebiasis
Tigecycline Uses
complicated skin and soft tissue infections
ulcers, burns, wound infections, abscesses
complication intra-abdominal infections
appendicitis, cholecystis, diverticulitis, perforation, absesses, peritonitis
Chloramphenicol Uses
atlerative for rickettsial infxn
pstittacosis, inclusion conjuncivitis
Aminoglycoside MOA
affect protein synthesis in bacterial cell
Streptomycin MOA
inhibit PS
damage bacterial cell membranes
block energy production
Spectinomycin MOA
inhibits PS at 30S subunit
Aminoglycosides Pharm
poorly absorbed from GI tract
excreted unchanged by kidney (glomerular filtration)
greatere effect in alkaline environment
difficlty passing to CSF
Aminoglycosides Toxicity
ototoxic (vertigo, past pointing, positive Romberg sign, tinnitus, loss of hearing)
nephrotoxic (increased levels of creatinine and BUN)
Peripheral neuritis
Facial and peripheral paresthesias
NMJ blockade
Hypersensitivity
Gentamicin-Carbenicillin
Semisynthetic PCNs chemically interact with aminoglycosides to form biologically inactive amides
Gentamicin-Cephalothin
incrased nephrotoxicity and acute renal failure, additive effects
Gentamicin-Polymyxin B
Nephrotoxicity and NMJ blockade
aminoglycoside and polypeptide may produce reversible NMJ blockade
Gentamicin/Kanamycin - Ethracrynic acid
increased ototoxic effets
synergistic
Streptomycin-PCN/Erythromycin
syngergistic tx of strep faccalis
Streptomycin Uses
Primary TB, miliary, meningitis, pyelonephritis, peritonis, osteomyelitis
Endocarditis
Plague, tulremia, brucellosis
Neomcyin Uses
GI tract
E. Coli, Proteus, Shigalla, Klebsiella, Pyoderma
Tobramycin Uses
Bacteremia caused by gram neg bacilli
Amikacin Uses
Infection caues by bacterial strains resistant to gentamicin or tobramycin
Viomycin Uses
2nd line for Tb
Spectinomycin
Acute gonococcal urethritis, proctitis, cervicitis when due to Neisseria gonorrhea
Netilmicin Uses
aerobic gram neg bacilli
Staphyloccous Aureus Clinical Manifestations
folliculitis, furuncles, carbuncles, cellulitis, impetigo, wound infection
pyomyostitis, osetomyelitis, septic arthritis
pneumnoia, bacterima, sepsis
endocarditis, device-related
toxic mediated
suppurative foci
post viral pneumonia
Group A Skin Disease (B-he
moltyic strep)
Erysipleas, pyodrema, cellulitis, lymphangitis, necrotizing fascitiis, myostitis
Group A Scarlet Fever
Pharyngitis with rash
Strawberry tongue
Scarlantiform rash
Desquamination of hands, feat, axillae
Group B
Sepsis, meningitis, pneumonia, pelvic infection
Diabetes mellitus, chornic edema, cirrhosis
Endocarditis, cellultis
Complications of Group A Streptococcus Pharyngitis
Suppurative, peritonsilar or retropharyngeal abscess
Sinusitis or otitis media, meningitis, endocarditis, pneumonia
Non-supprative: acute rhemuatic fever, post-streptococcal glomerulonephritis
Nystatin MOA
increase permeability of fngal membrane by disruption or causing a reorientation of sterol structure leading to leakage of intracellular components
Amphotericin B MOA
increase permeabiity of fungal membrane
Ketoconazole MOA
inhibits ergosterol synthesis
Griseofulvin MOA
alteration of biochemical functions; bound to cell lipids; bind to microtubules responsible for mitotic spindle formation
5-Flurocytosine MOA
Incorporated into mRNA in place of uracil; wrong amino acids inserted into proteins
Terbinafine MOAS
Inhibits formation of squalene epoxide
Nystatin Pharm
Absorption
Dosage
Application
Excretion
negligible from GI tract
Large dosage
Topical application
Excreted in feces
Amohotericin B Pharm
Absorption
Poor from GI tract
bound to plasma lipoporteins
Griseofulvin Pharm
Absorption
Application
absorption is enhanced by ultra fine particle form; increased with a fatty meal
oral application
5-FC Pharm
absorbed well
Alllyamines Pharm
Oral or topical
Well absorbed
Long half-life
Liver metabolism
Excreted in urine and feces
Nystatin Toxicity
mild, transitory nausea; vomiting; diarrhea; hemolytic anemia; kidney damage
Amphotericin B Toxicity
hypersensitivity; chills; fever; phlebitis; headache; anemia; anorexia; decreased renal function; hypotesnion
acute hepatic failure; nephrotoxic; depressed hematocrit
Griseofulvin Toxicity
Very safe; headache, memory lapse, impaired judgment
Skin rash, photosensitivity
Gi distress
5-FC Toxicity
severe diarrhea; bone marrow depression
Allylamines (Terbinafine) Toxicity
Headache, diarrhea, dyspepsia, abdominal pain, change in taste, increased liver enzymes
Ketoconazole - Aluminum Hydroxide
Decreaed peak Ketoconazole concentrations
Ketoconazole solubility decreases as pH increases
Ketoconazole - Cyclosporine
increased cyclosporine blood levels
Ketoconazole - Steroids
Ketoconazole inhibits steroid biosynthesis by inhibiting CP450 systems
Menstrual irregularities, gynecomastias, decreaesd libido, azoospermia, decreased plasam concentrations, suppressed androgen production, decreased cortisol in Chushing's disease
Grisofulvin - Phenobarbital
SErum levels of orally administered grisefofulvin are lowered due to decreased absorption
Griseofulvin - Warfarin
decrease in hypoprothormbinemic effects of warfarin due to induction of liver microsomal enzymes
Nystatin Uses
Candida infection of skin, mucous membranes, intestinal tract, moniliasis on skin or GI tract
Amphotericin B Uses
severe deep fungal infection, only with hospitalized patients
Ketoconazole Uses
Systemic fungal infections; coccidiodomycosis, paracocidiodomycosis, histoplasmosis
Flucystosine Uses
Candida albicans and cryptococcosis
Miconazole Uses
Tinea pedia, Tinea cruris, Tinea versicolor
Vulvovaginal candidiasis
Fluconazole Uses
Oral and esophageal candidiasis
Cryptococal Meningitis
Undecylenic Acid Uses
Tinea pedis
Tolnaftate Uses
Dermatophytic infections; Trichophyton rubrum
Terbinafine Uses
dermatophytes - Trichophyton, Epidermophyton, Micropsorum, Aspergillus, Sporothrix, Malassezia furfur
Capsofungin Uses
Invasive aspergillosis
Isoniazid Pharmacology
MOA: inhibits synthesis of mycolic acid
Very specific for mycobacteria, bactericidal
Spectrum: Mycobacterium tuberculosis
Absorption: well absorbed, diffuses freely
Metabolism: acetyling in liver, bowel, kidney
Excretion: urine
Toxicity: peripheral neuropathy, hypersensitivity, hepatic toxicity
Ethambutol
Moa: interfere with synthesis of RNA and/or mycolic acid
Selectivity: M. tuberculosis, M. bovis
Absorption: well
Excretion: urine and feces
Toxicity: reversible optic neuritis, allergy
Rifampin
MOA: inhibits DNA-dependent RNA-synthesis; interferes with RNA polymerase
Selectivity: no effect on mammalian cells
Spectrum: gram + bacteria, M. tuberculosis
Resistance: due to mutation in RNA polymerase
Peak levels: 2-4 hours
Excretion: urine and bile
Metabolism: deacetylation in liver, but still active
Toxicity: hepatitis, orange body fluids
Isoniazid - Rifampin
hepatotoxicity
Isoniazid - Alumninm Hydroxide
Decreased peak serum levels with decreased absorption of isoniazid, AlOH delays gastric emptying
Isoniazid - Disulfiram
adverse CNS effects; altered dopamine metabolism
Isoniazid - Prednisone
Isoniazid plasma levels are decrased; prednisone increases heaptic metabolism and or renal clearance
Rifamin - aminosalicylic acid
Aminosalicylic acid ganules decrease bioavailability of rifampin because rifampin adsborbs onto bentonite
Rifampin - oral contraceptives
Rifampin decreases elimination half life and reduces bioavaliablity; estrogens and progestogens are excreted in bile, gut flora are killed off, and steroids are not reabsorbed
Rifampin - Prednisone
Decreased corticosteriod activity due to rifampin's induction of hepatic metabolizing enzymes which leads to increased steroid metabolism
Isoniazid Uses
Most important drug in TB tx
Ethambutol Uses
Very effective management of TB tx failures
Rifampin Uses
Human TB, high salivary level
Meningococcal carrier state
Viruses (vaccinia, cowpox, adenovirus, trachoma)
Pyrazinamide Uses
Only in TB tx
Valuable in short courses as an adjunct to minimize local spread of infection
Secondary TB drugs
Cycloserine
Ethionamide
Levofloxacin
Viomycin
Kanamycin
Amikacin
Rifabutin
Ciprofloxacin
Capreomycin
Aminosalycylic Acid
Streptomycin TB uses
Primary TB agent
Mycobacterium Avium Complex TX
Rifabutin
Macrolides
Quinolones
Clofazimine
Amikacin
Rifampin
Thalidomide
Dapsone Pharmacology
Absorption: absorbed well from GI tract; retained in tissues
Metabolism: conjugated in liver
Exretion: urine
Toxicity: Gi and blood dyscrasisas
Dapsone Uses
Long term suppression of mycobacterium leprae
Amithizone Uses
Substitute for dapsone
Resistance develops after 2 years
Clofazimine Uses
Secondary when you can't use sulfones in leprosy tx
Stages of Viral Replication and INfectin
1. Attachment and Penetration
2. Uncoating
3. Components of virus are synthesized
4. Virus particles are assembled
5. Virus is released
Gamma Globulin MOA
Blocks penetration of virus into cell
Amantidine Hcl/Rimantidine MOA
Prevents viral uncoating after penetration
Idouridine MOA
Inhibits a number of enzymes involved in viral DNA synthesis
Vidarabine MOA
Inhibits viral DNA polymerase
Acyclovir MOA
inhibits replication by interfering with viral DNA polymerase
Ribavirin MOA
Antimetabolite activity; inhibits formation of viral mRNA
Trifluridine MOA
Inhibitor of viral DNA synthesis by incorporation into viral DNA
Foscarnet MOA
Inhibits RNA polymerases and reverse transcriptases
Amantidine/Rimantidine Pharmacology
completely absorbed from GI tract, 90% excreted in urine unmetabolized
Idoxuridine Pharm
Rapidly inactivated in liver; IV or topical
Vidarabine Pharm
IV or topical
Deaminated
Excreted in urine
Acyclovir Pharm
Excreted by kidney
Glomerular filtration
Ribavirin Pharm
Aerosl, little systemic absorption
Trifluridine Pharm
Only topial
Very little absorption
Foscarnet Pharm
Deposited into bone
Glomerular filtration and tubular secretion
Gamma globulin Toxicity
Anaphylactyoid attack
Amantidine Toxicity
CNS: nervousness, insomnia, dizziness, slurred speech, ataxia, inability to concentrate, emotional depression, feelings of detachment
Idoxuridine Toxicity
Irritation, edema, itching, photophobia
Stomatitis, marrow aplasia, hepatic degeneration
Teratogenic, carcinogenic
Vidarabine Toxicity
Teratogenic in animals
Anorexia, nauses, vomiting, diarrhea
CNS: dizziness, hallucinations, psychosis, ataxia
Lacrimation, burning, irritation, pain, photophobia
Interferon alfa Toxicity
Headache, weakness, fatigue, anemia, GI, CV, fever, neuropsychiatric problems
Acyclovir Toxicity
headache, nausea, vomiting, fever, hair loss, depression, fatigue, renal dysfunction
Ganciclovir Toxicity
Leukopenia, neutropenia, thrombocytopenia, reanl damage, seizures
Cidofovir Toxicity
Nephrotoxic
Ribavirin Toxicity
Death, decreased pulmonary function, CV problems (cardiac arrest, hypotension, bradycardia)
Conjunctivitis, anemia, chest soreness
Trifluridine Toxicity
Palpebral edeam, transient burning of eyes
Foscarnet Toxicity
Hypocalcemia, hypomagnesemia, renal insufficency
Fever, seizures, cardiac dysrhythmias
Myelosuppresion
Vidarabine - Allopurinol
Severe nephrotoxicity
Allopurinol increased blood levels of hypoxantine arabinoside
Acyclovir - Probenecid
Probenecid causes decrease in elimination rate of parenterally administered acyclovir
Blocks tubular secretion
Amantadine Uses
Influenza prophylaxis
Idoxuridine Uses
Herpes virus infection (herpetic keratitis, encephalitis)
Only approved by FDA for HSV infection of eyelid, conjunctive, cornea
Vidarabine Uses
Topical ophthalmic
HSV 1 and 2, Varicella-Zoster, Vaccinia
HSV Keratitis
Interferon alfa Uses
CMV
Herpes Zoster
HSV
Chornic hepatitis B and C
Genital warts
Kaposi's sarcoma
Hairy cell leukemia
Candyloma acuminatum
Acyclovir Uses
Topical HSV, encephalitis
Ganciclovir Uses
CMV
Ribavirin Uses
infants and chilren with severe lower respiratory infection due to RSV
Cidofovir Uses
CMV, HSV-1, HSV-2, VZV, EBV, HPV
Trifluridine Uses
Topical tx for epithelial keratitis caused by HSV 1 or 2
After idoxuridine has failed
Foscarnet Uses
CMV retinitis (IV)
Reverse Transcriptase Inhibitors
Zidovudine
Lamivudine
Emtrictabine
Tenotivr DF
Efavirenz
Protease Inhibitors
Atazanavir
Fosamprenavir
Lopinavir
Ritonavir
Fusion Inhibitors
Enfuvirtide
NRTI adverse effects
Lactic acidosis, liver failure
Bone marrow suppression
Renal insufficiency
NNRTI adverse effects
Potential teratoxicity
Increase transaminase levels (hepatic damage)
Stevens-Johnson syndrome
PI Adverse effects
Fat maldistribution
Hyperlipidemia, hyperglycemia
Increased bleeding
Astehnia
Elevated serum transaminase
GI intolerance
Fustion Inhibitor Adverse Effects
Injection site reaction
Hypersensitivity
Bacterial pneumonia
NNRTI-Based Therapy
Efavirenz
Lamivudine + Zidovudine
Emtricitabine + Tenofovir
NNRTI-Based Therapy Advantages
High efficacy
Easier than PIs (fewer drug interactions
NNRTI-Based Therapy Disadvantages
Resistance
-limited number of mutations needed
PI-Based Therapy
Atazanavir, fosamprenavir OR lopinavir
Ritonavir boosting
Lamivudine + Zidovudine OR
Emtricitabine + Tenotovir
PI Based Therapy Advantages
High efficacy
Less resistance
Avoid NNRTI adverse effects
PI Based Therapy disadvantages
Difficult
Long term side effects
Induction of cytoP450 enzymes cauess drug intreactions
Resistance to multiple PIs
NRTIs
Emtricitabine
Lamivudine
Tenofovir
Zidovudine
NNRTIs
Efavirenz
PIs
Atazanavir
Fosamprenavir
Lopinavir
Ritonavir
FIs
Enfuvirtide
4-aminoquinolones
Chloroquine
Mefloquine
Chlorquine Congeners
Chlorquine Pharm
MOA: Schizonticidae
Bind to native DNA and inhibits nucleic acid synthesis
Toxicity: GI, malaise, transient headache, vertigo, blurred vision, uritcaria, pruritis
Ocular toxicity, skin changes, edema, and opacifications of corneal epithelium
Retinal ischemia --> visual impairment
Chlorquine Uses
Suppressive prophylaxis of malaria
Acute malaria
Management of relapsing malaria
Mefloquine Toxicity
Epilepsy, psychiatric disorders, cardaic conduction drugs, pregnancy, fine coordination, spatial discrimation problems
Mefloquine Uses
Malaria prophylaxis
Chlorquine Congeners Toxicity
vomitng, diarrhea, vertigo
Chlorquine Congeneres Uses
Overt malarial attacks and suppression
Chincona Alkaloids (quinine) MOA
binds to double stranded DNA, inhibits DNA synthesis
Quinine Toxicity
local irritant, anusea, pain
Cinchonism: ototoxicity, retinal ischemia, tinnitus, dizziness, nausea, vomiting, diarrhea, disturbed vision, deafness, vertigo, dysryhmia, hypotension
Thrombocytopenia purpura, hemoltyic anemia, agranulocytosis
Blackwater fever: hemolysis, hemoglobinuria, azotemia, clotting, rneal failure, uremia
Quinine Uses
Suppressive therapy of malaria
Coadministered with antifolate for resistant types
8-Aminoquinolones (Primaquine) MOA
binds to DNA
Primaquine Toxicity
GI upset, headache, visual disturbance, pruritis, leukopenia, metehemoglobenimia, cyanosis, acute hemolytic anemia
NNRTIs
Efavirenz
PIs
Atazanavir
Fosamprenavir
Lopinavir
Ritonavir
FIs
Enfuvirtide
4-aminoquinolones
Chloroquine
Mefloquine
Chlorquine Congeners
Chlorquine Pharm
MOA: Schizonticidae
Bind to native DNA and inhibits nucleic acid synthesis
Toxicity: GI, malaise, transient headache, vertigo, blurred vision, uritcaria, pruritis
Ocular toxicity, skin changes, edema, and opacifications of corneal epithelium
Retinal ischemia --> visual impairment
Chlorquine Uses
Suppressive prophylaxis of malaria
Acute malaria
Management of relapsing malaria
Mefloquine Toxicity
Epilepsy, psychiatric disorders, cardaic conduction drugs, pregnancy, fine coordination, spatial discrimation problems
Mefloquine Uses
Malaria prophylaxis
Chlorquine Congeners Toxicity
vomitng, diarrhea, vertigo
Chlorquine Congeneres Uses
Overt malarial attacks and suppression
Chincona Alkaloids (quinine) MOA
binds to double stranded DNA, inhibits DNA synthesis
Quinine Toxicity
local irritant, anusea, pain
Cinchonism: ototoxicity, retinal ischemia, tinnitus, dizziness, nausea, vomiting, diarrhea, disturbed vision, deafness, vertigo, dysryhmia, hypotension
Thrombocytopenia purpura, hemoltyic anemia, agranulocytosis
Blackwater fever: hemolysis, hemoglobinuria, azotemia, clotting, rneal failure, uremia
Quinine Uses
Suppressive therapy of malaria
Coadministered with antifolate for resistant types
8-Aminoquinolones (Primaquine) MOA
binds to DNA
Primaquine Toxicity
GI upset, headache, visual disturbance, pruritis, leukopenia, metehemoglobenimia, cyanosis, acute hemolytic anemia
NNRTIs
Efavirenz
PIs
Atazanavir
Fosamprenavir
Lopinavir
Ritonavir
FIs
Enfuvirtide
4-aminoquinolones
Chloroquine
Mefloquine
Chlorquine Congeners
Chlorquine Pharm
MOA: Schizonticidae
Bind to native DNA and inhibits nucleic acid synthesis
Toxicity: GI, malaise, transient headache, vertigo, blurred vision, uritcaria, pruritis
Ocular toxicity, skin changes, edema, and opacifications of corneal epithelium
Retinal ischemia --> visual impairment
Chlorquine Uses
Suppressive prophylaxis of malaria
Acute malaria
Management of relapsing malaria
Mefloquine Toxicity
Epilepsy, psychiatric disorders, cardaic conduction drugs, pregnancy, fine coordination, spatial discrimation problems
Mefloquine Uses
Malaria prophylaxis
Chlorquine Congeners Toxicity
vomitng, diarrhea, vertigo
Chlorquine Congeneres Uses
Overt malarial attacks and suppression
Chincona Alkaloids (quinine) MOA
binds to double stranded DNA, inhibits DNA synthesis
Quinine Toxicity
local irritant, anusea, pain
Cinchonism: ototoxicity, retinal ischemia, tinnitus, dizziness, nausea, vomiting, diarrhea, disturbed vision, deafness, vertigo, dysryhmia, hypotension
Thrombocytopenia purpura, hemoltyic anemia, agranulocytosis
Blackwater fever: hemolysis, hemoglobinuria, azotemia, clotting, rneal failure, uremia
Quinine Uses
Suppressive therapy of malaria
Coadministered with antifolate for resistant types
8-Aminoquinolones (Primaquine) MOA
binds to DNA
Primaquine Toxicity
GI upset, headache, visual disturbance, pruritis, leukopenia, metehemoglobenimia, cyanosis, acute hemolytic anemia
NNRTIs
Efavirenz
PIs
Atazanavir
Fosamprenavir
Lopinavir
Ritonavir
FIs
Enfuvirtide
4-aminoquinolones
Chloroquine
Mefloquine
Chlorquine Congeners
Chlorquine Pharm
MOA: Schizonticidae
Bind to native DNA and inhibits nucleic acid synthesis
Toxicity: GI, malaise, transient headache, vertigo, blurred vision, uritcaria, pruritis
Ocular toxicity, skin changes, edema, and opacifications of corneal epithelium
Retinal ischemia --> visual impairment
Chlorquine Uses
Suppressive prophylaxis of malaria
Acute malaria
Management of relapsing malaria
Mefloquine Toxicity
Epilepsy, psychiatric disorders, cardaic conduction drugs, pregnancy, fine coordination, spatial discrimation problems
Mefloquine Uses
Malaria prophylaxis
Chlorquine Congeners Toxicity
vomitng, diarrhea, vertigo
Chlorquine Congeneres Uses
Overt malarial attacks and suppression
Chincona Alkaloids (quinine) MOA
binds to double stranded DNA, inhibits DNA synthesis
Quinine Toxicity
local irritant, anusea, pain
Cinchonism: ototoxicity, retinal ischemia, tinnitus, dizziness, nausea, vomiting, diarrhea, disturbed vision, deafness, vertigo, dysryhmia, hypotension
Thrombocytopenia purpura, hemoltyic anemia, agranulocytosis
Blackwater fever: hemolysis, hemoglobinuria, azotemia, clotting, rneal failure, uremia
Quinine Uses
Suppressive therapy of malaria
Coadministered with antifolate for resistant types
8-Aminoquinolones (Primaquine) MOA
binds to DNA
Primaquine Toxicity
GI upset, headache, visual disturbance, pruritis, leukopenia, metehemoglobenimia, cyanosis, acute hemolytic anemia
Primaquine Uses
Radical cure of P. vivax and relapsing forms
Prophylaxis of P. falciparum
Folic Acid Synthesis INhibitors
Biguanides
Diaminopyrimidines
Folic Acid Syntehsis Inhibitors MOA
Inhibit dihydrofolate reductase
FAS Inhibitors Toxicity
Folic acid deficiency, macrocytic normochromic anemia, megaloblastic bone marrow, leukopenia, granulocytopenia
FAS Inhibitors Uses
Prophylaxis, suppression of malaria in combo with other drugs
Sulfones and Sulfonamides MOA
Competitive inhibitors of PABA in folic acid synthesis
Sulfones and Sulfonamides Toxicity
Nausea, diarrhea, vomiting, exfoliative dermatitis, urinary tract complications, hemolytic or aplastic anemia, granulocytopenia
Metronidazole MOA
Nitro radical anion disrupts replication and transcription of DNA
Metronidazole Toxicity
Metallic taste, furred tongue, nausea, dark urine, weakness, skin rash, ataxia, paresthesias, avoid alcohol
Metronidazole Uses
Ameba invading gut wall or other tissue sites
Amebiasis, trichonomiasis, Leishmaniasis, Giardiasis
Indirectly Acting Luminal Amebicides
Tetracyclines
Paromomycin
Erythromycin
Direct Acting Luminal Amebicides
Iodoquinol
Luminal Amebicides Toxicity
GI, pruritis ani, headache, malaise, thryoid enlargement
Emetine/dehydroemetine MOA
Tissue amebicides; eradication of bowel wall and liver parasites
Emetine/dehydroemetine Toxicity
Renal decompensation, precordial pain, EKG abnormalities, tachycardia, gallop, hypotension, cardiac dilatation, CHF, muscular weakness, tenderness, aching, tremor, headache, dizziness, GI stress
Chloroquine Use
Hepatic amebiasis
Chloroquine Toxicity
GI upset, lenticular opacifications, renal ischemia, skin lesions, toxic psychosis, cardiac arrhythmias
Suramin Sodium MOA
Antiprotozoan; trypanocidal, forms protein complexes
Suramin Sodium Toxicity
Nausea, vomiting, shock, unconsiousness, acute urticaria, hyeresthesia, agranulocytosis, hemolytic anemia
Pentamidine MOA
Antiprotozoan; Leischmaniasis, Trypanosomiasis, Pneumonia prophylaxis, T. cruzi, P. carinii
Pentamidine Toxicity
Dyspnea, tachycardia, fainting, vomiting, rapid hypotension
Melarsoprol Use
CNS Trypanosomes
Melarsoprol Toxicity
Irritating, dealyed reactive encephalopathy, vomiting, abdominal colic
Sodium Stibogluconate
Leishmani, Kalaazar
Sodium Stibugluconate Toxicity
GI, fever, rash, hemolytic anemia, liver, renal, and heart damage
Nifurtimox Use
Chaga's disease (T. cruzi)
Nifurtimox Toxicity
convulsive episodes if predisposed
Quinacrine Use
Antimalarial, Giardiasis
Quinacrine MOA
Intercalates with DNA
Quinacrine Toxicity
Headache, dizziness, vomiting, blood dyscrasias, exfloiative dermatitis, psychoses
Atovaquone Use
P. carinii
Metronidazole Use
Urogenital trichomoniasis, Giardiasis, Bulantidiasis, Gardnerella vaginilis, Bacteriodes fragilis and clostridia
Metronidazole MOA
Penetrates necrtoic tissue
Folic acid inhibitors Uses
Toxoplasmosis
Piperazine Citrate Use
Ascariasis, enterobiasis
Piperzine MOA
Paralyzes roundworm musculature, blocks cholinergic myoneural junction, alteres permeability
Piperzine Toxicity
mild GI upset, muscular weakness, vertiog, headache, uritcarial reaction, seizures
Thiabendazole Use
Strongyloides stercoralis, cutaneous larva migrans, visceral larva migrans, pseudo-hookworm (trichostrongyloides), enterobiasis ascariasis, trichinella spiralis, hookworms, tricharis
Thiabendazole Toxicity
Nausea, vomiting, dizziness, headache, drowsiness, systemic and skin allergic reactions, tinnitus, bradycardia, hypotension, hyperglycemia, enuresis
Mebendazole Uses
A. lumbricoides, Tricharis trichiura, pinworm, trichinosis, ascaris, hookworm
Mebendazole MOA
partially metabolized, excreted;
impairs glucose uptak by inhibiting microtubule syntehsis in nematodes
Mebendazole Toxicity
Mild nausea, diarrhea, vomiting, pain
Albendazole Use
pinworm, ascariasis, tricheriasis, strongyloidiasis, hookworm, hydatid, cysticercosis
Albendazole Toxicity
epigastric distress, nausea, diarrhea, dizziness, lassitude, insomnia, alopecia, leukopenia
Pyrantel Pamoate Uses
Trichuriasis, ascaris, pinworm, trichostrongyloides orientalis, hookworm
Pyrantel Pamoate Toxicity
Nausea, diarrhea, abdominal cramps, vomiting, dizziness, sleepiness, headache, insomnia, weakness, increased liver enzymes
Praziquantel
Cestocide, schistosomidal, Clonorchiasis (liver fluke), fascioliasis, hymenolepiasis, metagoniimiasis, opisthorchiasis, paragonimiasis, taeniasis
Praziquantel MOA
increase permeability of cell membrane, loss of intracellular calcium, paralysis of trematode
Praziquantel Toxicity
carcinogenic, mutagneic, pregnancy, breast fedding, abdominal cramps, dizziness, drwosiness, fever, headache, nausea or vomiting, sweating, loss of appetite, skin rash, hives, itching
Bithionol Use
Paragonimus westermani, Clonocrchis sinesis, Fasciola hepatica
Bithionol Toxicity
GI upset, diarrhea, photosensitivity, skin reactions, urticaria, hypertension, ventricular extrasysteole, AV conduction defects, jaundice, blood dyscrasias
Nicolosamide Use
D. latum, H. diminuta, T. saginata, T. solium
Nicolosamide MOA
Releases scloex, inhibition of mitochondrial oxidative phosphorylation
Nicolosamide Toxicity
nausea, vomiting, abdominal pain
Quinacrine Uses
large tapeworm, T. solium, T. saginata, D. latum, H. nana
Quinacrine Toxicity
dizziness, headache, vomiting, psychosis, blood dyscrasia, allergic skin reaction, yellowing, nail pigmentation, ocular toxicity, liver damage
Quinacrine MOA
Does not kill worm, just detaches scolex
Paromomycin Uses
T. saginata, D. latum, T. solium, H. nana
5 Major Human Pathogens of Herpes Infection
1. HSV
2. Varicella-Zoster
3. CMV
4. EBV
5. HHV
Clinical Manifestations of Primary HSV Infections
Infectious virus comes into contact with mucosal surface
Asymptomatic
Local pain, vesicular rash, lymphoadenopathy
Sytemic fever, malaise
Clinical Manifestations of Recurrent HSV Infections
Stress, sunlight, fever
Grouped vesicles (orolabial vermillion border or genital)
Hyperesthesia
Asymptomatic viral shedding
Varicella (Chickenpox) manifestations
Primary infection
Children, young adults
Disseminated cutaneous disease (centripetal distribution, macules, vesicles, and crusts)
Close contact, airborne droplets
Mores severe in adults
Herpes Zoster (Shingles) Manifestations
Reactivation of dormant virus in those with waning immunity (advanced age, altered cell-mediated immunity)
Prodrome of pain and paresthesias for 1-3 days
Vesicular eruption (single dermatome, does not cross midline, crops of vesicles on erythematous base, pain)
Herpes Zoster Ophthalmicus
CN V1, forehead, pericoular, nose, keratitis, iritis, episcleritis, delayed contralteral hemiparesis
Ramsay-Hunt
geniculate ganglion, facial paralysis, anterior 1/3 taste loss, ear pain, vesicular eruption in auditory canal, tongue, palate
Treatment of HSV, VZV
Acyclovir
Valacyclovir
Famciclovir
Corticosteroids-shingles (decresae pain)
CMV Mononucleosis
Parimary infection of adults
Fever, malaise, fatigure, lymphoadenopathy, sore throat
Atypical lymphocytosis, abnormal antibodies
EBV Mononucleosis
Acquired through close contact
Oropharyngeal epithelial cells (exudative pharyngitis)
Fever, malaise, lymphoadenopathy, sore throat
Acute splenic congestion
Heterophile antibodies
Atypical lymphocytes
Lymphocytosis
To Prevent Nosocomial Infections
Vaccinate
Get catheters out
To Diagnose and Treat Nosocomial Infections
Target the pathogen
Access the experts
Use of antimicrobials
1. practice control
2. use local data
3. treat infection not contamination
4. treat infection not colonization
5. know when to say "no" to vancomycin
6. stop treatment when cured
Prevent transmission
isolate pathogen
break the cahin