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penicillin G K
Natural Penicillin
Primarily used for streptococcal infections
dosed in million units except oral dosage form

avoid potassium load in selected patients
penicillin G Na
Natural Penicillin
Primarily used for streptococcal infections
dosed in million units except oral dosage form

avoid sodium load in selected patients
penicillin G procaine
Natural Penicillin
Primarily used for streptococcal infections
dosed in million units except oral dosage form

allergy to procaine sometimes confused with pen allergy
penicillin G benzathine
Natural Penicillin
Primarily used for streptococcal infections
dosed in million units except oral dosage form

used primarily for syphilis
penicillin VK
Natural Penicillin
oral dosage form (dosed in milligrams)
amoxicillin
Amoxil and various
Aminopenicillin
better absorbed than ampicillin, caused less diarrhea
Indication: alternative for otitis media, URIs, UTI's, and some pneumonia
amoxicillin/clavulanate
Augmentin
Aminopenicillin
clavulanate is a beta-lactamase inhibitor
Indication: alternative for otitis media, URIs, UTI's, and some pneumonia
ampicillin
Aminopenicillin
diarrhea and rash are common
Indication: alternative for otitis media, URIs, UTI's, and some pneumonia
ampicillin/sulbactam
Aminopenicillin
sulbactam is a beta-lactamase inhibitor
Indication: alternative for otitis media, URIs, UTI's, and some pneumonia
nafcillin
Semi-synthetic penicillins (anti-Staphylococcal)
Some activity against other organisms
but used almost exclusively for activity against Staphylococci
oxacillin
Semi-synthetic penicillins (anti-Staphylococcal)
Some activity against other organisms
but used almost exclusively for activity against Staphylococci
dicloxacillin
Semi-synthetic penicillins (anti-Staphylococcal)
Some activity against other organisms
but used almost exclusively for activity against Staphylococci
piperacillin
Extended-spectrum penicillins (anti-Pseudomonal)
broad-spectrum including Pseudomonas
piperacillin/tazobactam
Extended-spectrum penicillins (anti-Pseudomonal)
broad-spectrum including Pseudomonas

tazobactam is a beta-lactamase inhibitor
cefazolin
1st generation cephalosporins
Primarily used against strep and staph species
often used for surgical prophylaxis
cephalexin
1st generation cephalosporins
Primarily used against strep and staph species
often used for surgical prophylaxis
cefuroxime sodium
2nd generation cephalosporins
added activity against some Gram-neg organisms comapared to 1st generations
cefoxitin
2nd generation cephalosporins
added activity against some Gram-neg organisms comapared to 1st generations
ceftriaxone
3rd generation cephalosporins
added activity against some Gram-neg organisms comapared to 2nd generations

once-daily dosing
ceftazidime
3rd generation cephalosporins
added activity against some Gram-neg organisms comapared to 2nd generations

activity against Pseudomonas
cefepime
4th generation cephalosporins
called a 4th generation because of enhanced activity against some resistant Gram-neg organisms
ceftaroline
5th generation cephalosporin
called a 5th generation because of enhanced activity against methicillin-resistant Staphylococcus aureus (MRSA) - discussed in class with agents for Gram-positive infections
cefaclor
Oral cephalosporins with an expanded spectrum
You simply need to know that these are oral cephalosporins that cover more organisms than does cephalexin
ceftibuten
Oral cephalosporins with an expanded spectrum
You simply need to know that these are oral cephalosporins that cover more organisms than does cephalexin
cefdinir
Oral cephalosporins with an expanded spectrum
You simply need to know that these are oral cephalosporins that cover more organisms than does cephalexin
cefditoren
Oral cephalosporins with an expanded spectrum
You simply need to know that these are oral cephalosporins that cover more organisms than does cephalexin
cefuroxime axetil
Oral cephalosporins with an expanded spectrum
You simply need to know that these are oral cephalosporins that cover more organisms than does cephalexin
cefixime
Oral cephalosporins with an expanded spectrum
You simply need to know that these are oral cephalosporins that cover more organisms than does cephalexin
cefprozil
Cefzil
You simply need to know that these are oral cephalosporins that cover more organisms than does cephalexin
aztreonam
Monobactams
usually no risk of an allergic reaction in penicillin-allergic patients

Active against Gm (-) rods including Pseudomonas
PCN Allergy/Renal Dysfn.
imipenem/cilastatin
Carbapenems
broad-spectrum agents, increased chance of seizures

Indication: Intra-abdominal sepsis in ICU, Gm (-)/noscomial pneumonia, Febrile neutropenia
meropenem
Carbapenems
broad-spectrum agents, increased chance of seizures

Indication: Intra-abdominal sepsis in ICU, Gm (-)/noscomial pneumonia, Febrile neutropenia
ertapenem
Carbapenems
broad-spectrum agents, increased chance of seizures

used once daily, can be used for serious acquired community infections
doripenem
Carbapenems
broad-spectrum agents, increased chance of seizures

Indication: Intra-abdominal sepsis in ICU, Gm (-)/noscomial pneumonia, Febrile neutropenia
vancomycin
Glycopeptides
older antibiotic, resistance developing, VRE, VISA, VRSA

Used in Tx of MRSA and highly resistant Strep. species

ADE: Fevers, chills, phlebitis, Red Man Syndrome, Ototoxicity, Nephrotoxicity at higher doses
linezolid
Oxazolidinones
bacteriostatic, often used for pneumonia, IV and oral, MAO inhibitor, drug interaction with SSRIs

ADE: Thrombocytopenia
Community acquired pneumonia
MRSA and VRE infections
daptomycin
Lipopeptides
bactericidal, often used in bacteremia and endocarditis, doesn't work in pneumonia (surfactant), increases CPK levels (muscle)
tigecycline
Glycylcyclines
tetracycline derivative, activity against MRSA, VRE, anaerobes, some Gram-neg aerobes
gentamicin
Aminoglycosides
ototoxicity and nephrotoxicity are the major limitations to use

Use: UTI, Pneumonia, Bacteremia/Sepsis, Empiric for neutropenia, Intra-abdominal infections, DM foot infections
tobramycin
Aminoglycosides
ototoxicity and nephrotoxicity are the major limitations to use

Use: UTI, Pneumonia, Bacteremia/Sepsis, Empiric for neutropenia, Intra-abdominal infections, DM foot infections
amikacin
Aminoglycosides
ototoxicity and nephrotoxicity are the major limitations to use

Use: UTI, Pneumonia, Bacteremia/Sepsis, Empiric for neutropenia, Intra-abdominal infections, DM foot infections
neomycin
Aminoglycosides
ototoxicity and nephrotoxicity are the major limitations to use
non-absorbable agent

Use: UTI, Pneumonia, Bacteremia/Sepsis, Empiric for neutropenia, Intra-abdominal infections, DM foot infections
streptomycin
Aminoglycosides
ototoxicity and nephrotoxicity are the major limitations to use
used mainly for TB

Use: UTI, Pneumonia, Bacteremia/Sepsis, Empiric for neutropenia, Intra-abdominal infections, DM foot infections
azithromycin
Macrolides
used primarily for respiratory infections
fewer GI sides effects than erythromycin; better activity

clarithromycin
Macrolides
used primarily for respiratory infections
fewer GI sides effects than erythromycin; better activity

erythromycin
Macrolides
used primarily for respiratory infections
GI side effects

ADE: pts do not finish rx course, Jaundice, Ototoxicity at high doses, QT interval prolongation (torsades)

DDI: CYP450 oxidation, inc. serum conc. of theophylline, warfarin, digoxin, etc.
ciprofloxacin
Fluoroquinolones
used for respiratory infections, UTIs, others,

complexation reactions with oral use (antacids, metal cations), QTc prolongation, tendon damage
broad activity
levofloxacin
Fluoroquinolones
used for respiratory infections, UTIs, others,

complexation reactions with oral use, QTc prolongation, tendon damage
broad activity
moxifloxacin
Fluoroquinolones
used for respiratory infections, UTIs, others,

complexation reactions with oral use, QTc prolongation, tendon damage

Primarily Respiratory Infections
gemifloxacin
Fluoroquinolones
used for respiratory infections, UTIs, others,

complexation reactions with oral use, QTc prolongation, tendon damage

Primarily Respiratory Infections
trimethoprim/sulfamethoxazole or cotrimoxazole
Urinary anti-infectives
antifolate/sulfa combination, skin reactions, drug interactions with protein bound sulfa, used for MRSA skin infections in addition to UTIs

ADE:
Stevens Johnson Syndrome w/long acting sulfonamides
Hepatitis, Blood dyscrasias, GI, Skin Rxns
nitrofurantoin
Urinary anti-infectives
poor systemic levels so used only for UTIs, pulmonary fibrosis, GI side effects

urine discoloration (brown)
dose adjustment for renal pts CN in pts. w/ CrCl <40
G6PD deficiency
monitor elderly
fosfomycin
Urinary anti-infectives
packet that must be mixed prior to use
clindamycin
Lincosamides
older anti-anaerobic agent, used also for MRSA skin infections, may be more likely to cause C. diff colitis than some other agents
doxycycline
Tetracyclines
used for a variety of infections including Rickettsial infections such as Rocky Mountain Spotted fever
most frequently used agent
minocycline
Tetracyclines
used for a variety of infections including Rickettsial infections such as Rocky Mountain Spotted fever
potent, but may cause dizziness
tetracycline HCl
Tetracyclines
used for a variety of infections including Rickettsial infections such as Rocky Mountain Spotted fever
not used as much anymore, others are used more frequently
colistin sulfate
Polymixins
nephrotoxicity is a limitation to use, being used now because of resistant Gram-negatives
rifampin
Rifamycins
metabolic enzyme inducers
used in TB regimens and to add activity against Staph in combo regimens, drug interactions (inducer)
rifabutin
Rifamycins
metabolic enzyme inducers
fewer drug interactions than rifampin
metronidazole
Misc.
anti-anerobic activity, peripheral neruopathies, disulfiram reaction
bacitracin
Misc.
mupirocin
Misc.
topical for elimination of nasal carriage of MRSA and for minor skin infections
rifaximin
Misc.
for traveler's diarrhea and C. diff infections
nitazoxanide
Misc.
for protozoal and helminthic infections/very promising for C. diff infections
fidaxomicin
Misc.
Oral drug with superior sustained response against C. difficile infections when compared to vancomycin
amphotericin B deoxycholate
Polyenes
broad-spectrum antifungal activity, bind ergosterol (toxicity thought to be related to binding cholesterol in humans
infusion-related toxicities and other longer term toxicities such as neprhotoxicity
amphotericin B lipid complex
Lipid based amphotericin products
designed to reduce the toxicity of amphotericin (especially nephrotoxicity)
amphotericin B cholesteryl sulfate complex
Lipid based amphotericin products
designed to reduce the toxicity of amphotericin (especially nephrotoxicity)
Liposomal amphotericin B
Lipid based amphotericin products
designed to reduce the toxicity of amphotericin (especially nephrotoxicity)
most frequently used of the lipid based amphotericin products because of range of indications
nystatin
Lipid based amphotericin products
designed to reduce the toxicity of amphotericin (especially nephrotoxicity)
topical use
fluconazole
Azoles
broad-spectrum antifungals, all are metabolic enzyme inhibitors to some extent, azole-resistant Candida becoming a problem
widely used for Candida infections
voriconazole
Azoles
broad-spectrum antifungals, all are metabolic enzyme inhibitors to some extent, azole-resistant Candida becoming a problem
advantage over fluconazole is activity against Aspergillus, has visual side effects
posaconazole
Azoles
broad-spectrum antifungals, all are metabolic enzyme inhibitors to some extent, azole-resistant Candida becoming a problem
slightly more potent than other azoles against Candida, may have fewer drug interactions
caspofungin
Echinocandins
Primarily used because they are active against azole-resistant Candida

aslo has an indication for treatment of Aspergillus infections, dosage adjustment with elevated Child-Pugh score
micafungin
Echinocandins
Primarily used because they are active against azole-resistant Candida

fewer drug interactions than caspofungin
anidulafungin
Echinocandins
Primarily used because they are active against azole-resistant Candida

fewer drug interactions than caspofungin
flucytosine
Misc.
used in combination for treatment of Cryptococcal meningitis, severe bone marrow toxicity, therapeutic drug monitoring usually done
acyclovir
Nucleosides used for Herpes Infections
require metabolism to active triphosphates, have activity against other herpes viruses but usually used for herpes simplex
valacyclovir
Nucleosides used for Herpes Infections
require metabolism to active triphosphates, have activity against other herpes viruses but usually used for herpes simplex

Prodrug of acyclovir
famciclovir
Nucleosides used for Herpes Infections
require metabolism to active triphosphates, have activity against other herpes viruses but usually used for herpes simplex

Prodrug of acyclovir
vidarabine
For herpetic ophthmalmic infections
Ointments and solutions used primarily for treatment of herpes simplex conjuntivitis and keratitis. All can cause irritation to the eye and patients may need to wear sunglasses because of photophobia
idoxuridine
For herpetic ophthmalmic infections
Ointments and solutions used primarily for treatment of herpes simplex conjuntivitis and keratitis. All can cause irritation to the eye and patients may need to wear sunglasses because of photophobia
trifluridine
For herpetic ophthmalmic infections
Ointments and solutions used primarily for treatment of herpes simplex conjuntivitis and keratitis. All can cause irritation to the eye and patients may need to wear sunglasses because of photophobia
ganciclovir
Primarily used for CMV Infections
may cause myelosuppression
valganciclovir
Primarily used for CMV Infections
Prodrug of ganciclovir, may cause myelosuppression

cidofovir
Primarily used for CMV Infections
nephrotoxicity
foscarnet
Primarily used for CMV Infections
does not need to be phosphorylated, may cause alterations in calcium and phosphate levels
fomivirsen
Primarily used for CMV Infections
used for CMV retinitis
amantadine
Anti-influenza agents (earlier agents)
active only against influenza A, CNS side effects
rimantadine
Anti-influenza agents (earlier agents)
active only against influenza A, CNS side effects

more active and has fewer side effects than amantadine
zanamivir
Anti-influenza agents--Neurominadase inhibitors
inhibit release of newly formed virus from the infected cell surface, active against influenza A and B strains

given by inhaler
oseltamivir
Anti-influenza agents--Neurominadase inhibitors
inhibit release of newly formed virus from the infected cell surface, active against influenza A and B strains

given orally
interferon alfa
Agents used primarily for hepatitis treatment
other interferons made, but interferon alpha used for hepatitis, many adverse effects including neuropsychiatric effects
Pegylated interferon alpha
Agents used primarily for hepatitis treatment
PEG added to slow the elimination so that fewer doses could be used, still has side effect profile of interferons, used with ribavirin in the treatment of hepatitis C
ribavirin
Agents used primarily for hepatitis treatment
used in combo with pegylated interferon for treatment of hepatitis C, causes hemolytic anemia
adefovir
Agents used primarily for hepatitis treatment
Primarily used for hepatitis B, causes nephrotoxicity
lamivudine (3TC)
Agents used primarily for hepatitis treatment
Used also for HIV infection
telaprivir
Agents used primarily for hepatitis treatment
a protease inhibitor, increased virologic response when added to peginterferon + ribavirin for treatment of Hep C
bocepravir
Agents used primarily for hepatitis treatment
a protease inhibitor, increased virologic response when added to peginterferon + ribavirin for treatment of Hep C
ribavirin
Miscellaneous
used by inhalation for treatment of respiratory syncytial virus (RSV), a infection usually seen in children
zidovudine (AZT)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria
stavudine (D4T)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria
didanosine (DDI)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria

contains buffer, so potentially decreased absorption of other agents that require acidic stomach pH
tenofovir disoproxil fumarate (TDF)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria

produrg of tenofovir, tenofovir is actually a nucleotide analogue and does not require activation (phosphorylation)
zalcitabine (DDC)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria
emtricitabine (FTC)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria
lamivudine (3TC)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria

also used to treat hepatitis
abacavir (ABC)
Nucleoside reverse transcriptase inhibitors (NRTIs)
competitive inhibitors of reverse transcriptase, competes with natural pyrimidines or purines, must be phosphorylated to generate active nucleotide analogues, cause lactic acidosis because of effects on mitochondria

increased blood levels with ethanol, do not rechallenge if patient experiences hypersensitivity reaction
neviripine (NVP)
Non-nucleoside reverse transcriptase inhibitors (NRTIs)
noncompettitive inhibitors of reverse transcriptase (diffferent site than with NRTIs), binds to enzyme and changes conformation, these drugs are not given alone, major side effects are rash, hepatotoxicity, and CNS side effects
delavirdine (DLV)
Non-nucleoside reverse transcriptase inhibitors (NRTIs)
noncompettitive inhibitors of reverse transcriptase (diffferent site than with NRTIs), binds to enzyme and changes conformation, these drugs are not given alone, major side effects are rash, hepatotoxicity, and CNS side effects
efavirenz (EFV)
Non-nucleoside reverse transcriptase inhibitors (NRTIs)
noncompettitive inhibitors of reverse transcriptase (diffferent site than with NRTIs), binds to enzyme and changes conformation, these drugs are not given alone, major side effects are rash, hepatotoxicity, and CNS side effects
saquinavir (SQV)
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
ritonavir (RTV)
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)

potent CYP3A4 inhibitor (this is used so that ritonavir can boost blood levels of other antiretrovirals
indinavir (IDV)
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
nelfinavir (NFV)
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
amprenavir (APV)
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
fosamprenavir (908)
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
atazanavir
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
tiprinavir
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
darunavir
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)
lopinavir
Protease inhibitors
prevents proteolytic cleavage of a final product necessary for assembly and release of the virus, all cause GI distress, potential for increased bleeding, insulin resistance, hyperlipidemias, altered distribution of fat, potentially hepatotoxicity, many CYP450 interactions (theyare metabolized that way and they are inhibitors (mainly 3A4 and 2D6)

ritonavir added to boost lopinavir
enfuvirtide
Other Drugs for Treatment of HIV
fusion inhibitor
maraviroc
Other Drugs for Treatment of HIV
CCR5 receptor antagonist
raltegravir
Other Drugs for Treatment of HIV
integrase strand inhibitor