Pharmacology Highlights

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Micro drugs that block cell wall synthesis by inhibiting peptidoglycan cross-linking:

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* 'cillins, imipenam, aztreonam, cephalosporins

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Micro drugs that block peptidoglycan synthesis:

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* Bacitracin, vancomycin

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Micro drugs that disrupt bacterial cell membranes:

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* Polymxins

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Micro drugs that block nucleotide synthesis:

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* Trimethoprim and Sulfonamide

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Micro drug that blocks DNA topoisomerases:

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* Quinolones

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Micro drug that blocks mRNA synthesis:

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* Rifampin

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Micro drugs that blocks protein synthesis at 50s ribosomal subunit:

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* Chloramphenicol, Clindamycin, Erythromycin (Macrolides), Lincomycin, Linezolid, and Streptogramins (quinupristin and dalfopristin)

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Micro drugs that block protein synthesis at the 30s ribosomal subunit:

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* Tetracyclines (doxy is safe for renally impaired) and Aminoglycosides (Gentamycin, Tobramycin, etc.)

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Bacteriocidal (kill the organism) drugs are:

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* Vanco, Fluoroquinolones, Penicillin, Aminoglycosides, Cephalosporins, Metronidazole

("Very Finely Proficient At Cell Murder")

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2 drugs that can cause C. diff:

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* Ampicillin and Clindamycin

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The anti-pseudomonal drugs:

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* TCP "Takes care of Pseudomonas"

Ticarcillin, Carbenicillin, Piperacillin -- extended spectrum, work like penicillin

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What is Aztreonam best used for?

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* Penicillin allergic pt's and those with renal insufficiency who can't tolerate aminoglycosides for a gram neg infection

Mech: Inhibits cell wall synthesis

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Drug of choice for enterobacter infection:

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* Impenem/Cilistatin combo (inhibitor of dehydropeptidase I)

SE: CNS (seizure) at high levels

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Main use for vancomycin:

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* Serious gram (+) infections usually with Staph A. or Clostridium diff

Vanco resistance: when a bug changes its wall for D-ala D-ala to D-ala D-lac

SE: Nephro, Ototoxic, Thrombophlebitis-- give slow IV otherwise "red man" syndrome

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Aminoglycosides (30s) are best for:

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* Aerobic gram (-) rod infections -- bacteriocidal but needs O2 for uptake, thus ineffective against anaerobes

SE: Nephro, Ototoxic, Teratogen

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How do the tetracyclines work?

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* Bind 30s and prevent attachment of amino-tRNA

Note: Don't take with milk or antacids

Causes discolored teeth and inhibited bone growth in kids, causes photosensitivity, DON'T TAKE IF PREGNANT

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Tetracycline that is an ADH antagonist:

Tetracycline that is fecally excreted and thus safe for the renally impaired:

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* ADH antagonist = demococycline

Renally safe = Doxycycline

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How do the macrolides work?

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* Inhibit protein synthesis, bind to 23s of the 50s ribosomal unit

USES: URIs, STD's, pneumonia, Mycoplasma, Leionella, Chlamydia, Neisseria

SE: Acute cholestatic hepatitis, increases serum theophylline and oral anticoagulants (warfarin)

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Chloramphenicol works how?

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* Inhibits 50s peptidyl transferase activity

USES: meningitis (Hib, Neisseria, Strep pneumo)

SE: Gray baby syndrome, Aplastic anemia, anemia

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Best drug to treat anearobes above the diaphragm:

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* Clindamycin

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How does sulfonamide work?

How does trimethoprim work?

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* Sulfa = inhibits dihydropeptidase

Trimeth = inhibits dihydrofolate reductase

(Sulfa inhibits PTERO, Trimeth inhibits FOLATE)

Combo treats pneumo jirovecii infection

SE: Photosensitivity, Nephrotoxic, Kernicterus in infants, hemolysis in G6PD deficient pt's

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People with sulfa allergies shouldn't be given these drugs:

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* FASTS (Furosemide, Acetazolamide, Sulfa, Thiazide--hctz, Sulfonylureas)

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How do the fluoroquinolones work?

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* Inhibit DNA gyrase (topo II)

USES: Gram neg rods of urinary and GI tract (pseudomonas and neisseria)

SE: hurts kids bones, don't give to anyone under 18, damages cartilage, cause arthralgias

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How does metronidazole work?

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* Forms toxic metabolites in bacterial cell that damages DNA-- 'cidal

USES: antiprotozoal, anaerobes, h.pylori infection

SE: Disulfiram reaction with EtOH

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How do polymixins work?

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* Disrupt membrane osmotic properties--detergent-like

SE: Neurotoxic and Nephrotoxic (Acute tubular necrosis)

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Best drug to treat a myco leprae infection:

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* Dapsone (inhibits dihydrofolic acid)

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How does isoniazid work?

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* Inhibits mycolic acid synthesis

Pyridoxine (B6) can prevent seizures/convulsions

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How does Rifampin work?

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* Inhbits DNA-dependent RNA-polymerase

Note: turns body fluids orange and interferes with Birth control

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Best to treat a Vanco-resistant enterococcus:

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* Linezolid + Streptogramin (quinpristin/Dalfopristin)

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Best for treatment of gonorrhea:

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* Ceftriaxone

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Best treatment for an AID's pt with diarrhea:

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* Azithromycin (Myco Avium infection)

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How do the polyene antifungals work?

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* Ampho B and Nystatin act as detergents and tear holes in the membrane

Nystatin is TOPICAL -- used for oral candidiasis "swish and swallow"

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How do the azole antifungals work?

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* Inhibit fungal ergosterol synthesis

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Azole that is best for cryptococcus meningitis cause it crosses the BBB:

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* Fluconazole (inhibits liver P450's)

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Best azole for blasto/coccidio/histoplasma/candidal infections:

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* Ketoconazole (can cause gynecomastia)

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Azoles best for topical fungal infections:

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* Clotrimazole and Miconazole

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How does flucytosine work?

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* Inhibits DNA synthesis by conversion to fluorouracil which COMPETES with uracil

USE: Candida (germ tube and pseudohyphae) and Cryptococcal infection

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Best drug for an invasive aspergillosis infection:

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* Capsofungin (inhibits cell wall synthesis)

"Lets CAP this aspergillus (45 degree angles)"

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Drug to treat RSV and Chronic Hep C:

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* Ribavirin (inhibits synthesis of guanine by inhibiting IMP)

SE: Anemia, SEVERE TERATOGEN

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Antiviral that prevents viral uncoating, also used to treat parkinsons:

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* Amantadine

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Used for influenza A/B infection:

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* Oseltamivir/Zanamivir (inhibits neuraminidase which prevents VIRAL RELEASE)

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How does Acyclovir work?

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* Inhibits viral DNA polymerase

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Treats CMV infection in the immunocompromised:

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* Gangcyclovir (inhibits DNA polymerase)

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Used for acyclovir resistant HSV or for CMV retinitis:

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* Foscarnet

SE: Nephrotoxic

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Interferon used to treat hepatitis B, C, and Kaposi's sarcoma:

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* Inteferon-alpha

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Antibiotics to avoid if pregnant:

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* SAFE Moms Take Really Good Care

(Sulfa, Aminoglycosides, Fluorquins, Erythromycin, Metronidazole, Tetracycline, Ribavirin, Griseofulvin, Chloramphenicol)

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Drugs that are ADH antagonists (can cause diabetes insipidus):

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* Lithium and demecocycline

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Drug that can cause Fanconi's syndrome (causes type 2 proximal renal tubular acidosis ph < 5.5 treat with HCTZ):

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* Expired tetracycline

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Drugs that can cause torsades de pointes:

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* Sotalol (III), quinidine (Ia), and cisapride

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Causes a DILATED cardiomyopathy:

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* Doxorubicin (intercalates DNA)

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Causes a direct positive coomb's test:

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* Methyldopa (used for pregnant women with HTN)

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Drugs that can cause pulmonary fibrosis (restrictive):

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* Bleomycin, Busulfan, amiodarone

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Can cause acute cholestatic hepatitis:

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* Macrolides (Erythromycin, etc.)

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Can cause hepatic necrosis/hepatitis:

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* Halothane, Valproic acid, Isoniazid

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Can cause gingival hyperplasia:

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* Phenytoin (blocks Na+ channels, IB antiarrythmic)

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Can cause gout:

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* Furosemide, Thiazides

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Can cause photosensitivity:

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* SAT (Sulfonamide, Aminoglycosides, Tetracyclines)

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Can cause SLE-like syndrome:

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* its not HIPP to have lupus

(Hydralazine, Isoniazid, Procainamide, Phenytoin)

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Can cause hemolysis in G6PD pt's:

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* hemolysis IS PAIN

(Isoniazid, Sulfa, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin)

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Killed vaccines:

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* Salk polio, Rabies, Influenza, HAV

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Live attenuated vaccines:

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* MMR, SABIN (is alive) Polio, VZV, yellow fever, smallpox

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Drugs that can cause seizure:

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* Buproprion (wellbutrin) and Imipenem/cillistatin