Drugs & Bugs For Exam I

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Permethrin

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Mechanism of Action:
Inhibits sodium ion influx through nerve cell membrane channels in parasites resulting in delayed repolarization and thus paralysis and death of the pest
Indications for Use:
Single-application treatment of infestation with Pediculus humanus capitis (head louse) and its nits or Sarcoptes scabiei (scabies); indicated for prophylactic use during epidemics of lice
Contraindications:
Hypersensitivity to pyrethyroid, pyrethrin, chrysanthemums, or any component of the formulation; lotion is contraindicated for use in infants <2 months of age
Adverse Reactions: Dermatologic: Pruritus, erythema, rash of the scalp
Local: Burning, stinging, tingling, numbness or scalp discomfort, edema
No known interactions.

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Lindane

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Mechanism of Action:
Directly absorbed by parasites and ova through the exoskeleton; stimulates the nervous system resulting in seizures and death of parasitic arthropods
Indications:
Treatment of Sarcoptes scabiei (scabies), Pediculus capitis (head lice), and Phthirus pubis (crab lice); FDA recommends reserving lindane as a second-line agent or with inadequate response to other therapies
Contraindications:
Hypersensitivity to lindane or any component of the formulation; uncontrolled seizure disorders; crusted (Norwegian) scabies, acutely-inflamed skin or raw, weeping surfaces or other skin conditions which may increase systemic absorption
Adverse Reactions:
Cardiovascular: Cardiac arrhythmia
Central nervous system: Ataxia, dizziness, headache, restlessness, seizure, pain
Dermatologic: Alopecia, contact dermatitis, skin and adipose tissue may act as repositories, eczematous eruptions, pruritus, urticaria
Gastrointestinal: Nausea, vomiting
Hematologic: Aplastic anemia
Hepatic: Hepatitis
Local: Burning and stinging
Neuromuscular & skeletal: Paresthesia
Renal: Hematuria
Respiratory: Pulmonary edema
Monitoring:
Nursing mothers should interrupt breast-feeding, express and discard milk for at least 24 hours following use.
No interactions, toxicity

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Ivermectin

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Mechanism of Action
Ivermectin is a semisynthetic antihelminthic agent; it binds selectively and with strong affinity to glutamate-gated chloride ion channels which occur in invertebrate nerve and muscle cells. This leads to increased permeability of cell membranes to chloride ions then hyperpolarization of the nerve or muscle cell, and death of the parasite.
Indications:
Treatment of the following infections: Strongyloidiasis of the intestinal tract due to the nematode parasite Strongyloides stercoralis. Onchocerciasis due to the immature form of the nematode parasite Onchocerca volvulus.
Off label use: Pediculus humanus capitis, Pediculus humanus corporis,
Adverse reactions:
Miscellaneous: Mazzotti-type reaction (with onchocerciasis): Pruritus (28%), fever (23%), skin involvement (23%; including edema/urticarial rash), lymph node tenderness (1% to 14%), lymph node enlargement (3% to 13%), arthralgia/synovitis (9%)
Monitoring:
Skin and eye microfilarial counts, periodic ophthalmologic exams; follow up stool examinations
Interactions: BCG: Antibiotics may diminish the therapeutic effect of BCG. Risk X: Avoid combination.Vitamin K Antagonists (eg, warfarin): Ivermectin may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy. Enhances the effects of alcohol p high fat meal.

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Hydroxyzine

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Mechanism of Action:
Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract. Possesses skeletal muscle relaxing, bronchodilator, antihistamine, antiemetic, and analgesic properties.
Indications: Treatment of anxiety; preoperative sedative; antipruritic
Contraindications:
Hypersensitivity to hydroxyzine or any component of the formulation; early pregnancy; SubQ, intra-arterial, or I.V. administration of injection
Adverse reactions:
Central nervous system: Dizziness, drowsiness, fatigue, hallucination, headache, nervousness, seizure
Dermatologic: Pruritus, rash, urticaria
Gastrointestinal: Xerostomia
Neuromuscular & skeletal: Involuntary movements, paresthesia, tremor
Ocular: Blurred vision
Respiratory: Thickening of bronchial secretions
Miscellaneous: Allergic reaction
Monitoring:
Relief of symptoms, mental status, blood pressure
Interactions:
Anticholinergics: May enhance the adverse/toxic effect of other Anticholinergics
Acetylcholinesterase Inhibitors (Central): Anticholinergics may diminish the therapeutic effect of Acetylcholinesterase Inhibitors
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol and other CNS depressants

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Acyclovir

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Mechanism of Action:
Acyclovir is converted to acyclovir monophosphate by virus-specific thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes. Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA.
Indications:
Treatment of genital herpes simplex virus (HSV), herpes labialis (cold sores), herpes zoster (shingles), HSV encephalitis, neonatal HSV, mucocutaneous HSV in immunocompromised patients, varicella-zoster (chickenpox)
Contraindications:
Hypersensitivity
Adverse reactions:
>10%: Central nervous system: Malaise (≤12%). <2% headache
Monitoring:
Urinalysis, BUN, serum creatinine, liver enzymes, CBC
Interactions:
can decrease the therapeutic effect of zoster vaccine
Mycophenolate- incr serum conc
Tenofovir: decr excretn of
Zidovudine: enhance CNS depressant effect of

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Valacyclovir

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Mechanism of Action:
Valacyclovir is rapidly and nearly completely converted to acyclovir by intestinal and hepatic metabolism. Acyclovir is converted to acyclovir monophosphate by virus-specific thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes. Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA.
Indications:
Treatment of herpes zoster (shingles) in immunocompetent patients; treatment of first-episode and recurrent genital herpes; suppression of recurrent genital herpes and reduction of heterosexual transmission of genital herpes in immunocompetent patients; suppression of genital herpes in HIV-infected individuals; treatment of herpes labialis (cold sores); chickenpox in immunocompetent children
Contraindications:
Hypersensitivity
Adverse reactions:>10%:
Central nervous system: Headache (13% to 38%)
Gastrointestinal: Nausea (5% to 15%), abdominal pain (1% to 11%)Hematologic: Neutropenia (≤18%)
Hepatic: ALT increased (≤14%), AST increased (2% to 16%)
Respiratory: Nasopharyngitis (≤16%)
Monitoring:
Urinalysis, BUN, serum creatinine, liver enzymes, and CBC
Interactions:
can decrease the therapeutic effect of zoster vaccine
Mycophenolate- incr serum conc
Tenofovir: decr excretn of
Zidovudine: enhance CNS depressant effect of

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Terbinafine (Lamisil)

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Mechanism of Action:
Synthetic allylamine derivative which inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell wall and results in fungal cell death.
Indications:
Antifungal for the treatment of tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm)
Contraindications:
Hypersensitivity
Adverse reactions:(in 1-10%)
Dermatologic: Burning, contact dermatitis, dryness, exfoliation, irritation, pruritus, rash
Local: Irritation, stinging
Monitoring: It is excreted in breastmilk but has limited systemic abs. when used topically
Drug Interactions:
no known

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Ketoconazole (Nizoral)

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Mechanism of Action:
Alters the permeability of the cell wall by blocking fungal cytochrome P450; inhibits biosynthesis of triglycerides and phospholipids by fungi; inhibits several fungal enzymes that results in a build-up of toxic concentrations of hydrogen peroxide; also inhibits androgen synthesis
Indications:
Systemic: Treatment of susceptible fungal infections, including candidiasis, oral thrush and many others
Topical: Cream: Treatment of tinea corporis, tinea cruris, tinea versicolor, cutaneous candidiasis, seborrheic dermatitis
Foam, gel: Treatment of seborrheic dermatitis
Shampoo: Treatment of dandruff, seborrheic dermatitis, tinea versicolor
Contraindications:
Hypersensitivity and CNS fungal infections
Adverse Reactions: systemic: itching, nausea. Topical: itching, burning, stinging, swelling etc
Monitoring: LFT's
Interactions: many many drugs A-Z

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Calcipotriene (Dovonex)

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Mechanism of Action
Synthetic vitamin D3 analog which regulates skin cell production and proliferation
Indications: Treatment of plaque psoriasis; chronic, moderate-to-severe psoriasis of the scalp
Contraindications: hypersensitivity, pts with demonstrated hypercalcemia/vit D tox, pts with acute eruptions on scalp
Adverse reactions:
>10%: Dermatologic: Burning, itching, rash, skin irritation, stinging, tingling. Skin atrophy, hyperpigmentation, folliculitis, and hypercalcemia
Monitoring: Serum calcium
Interactions: orlistat (may decr serum conc of fat sols) and vitamin D analogs
Toxicity: may cause hypercalcemia

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Tacrolimus (Protopic)

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Mechanism of Action:
Suppresses cellular immunity (inhibits T-lymphocyte activation), by binding to an intracellular protein, FKBP-12 and complexes with calcineurin dependant proteins to inhibit calcineurin phosphatase activity
Indications: Oral/injection: Prevention of organ rejection in heart, kidney, or liver transplant recipients Topical: Moderate-to-severe atopic dermatitis otherwise unresponsive/or tx inappropriate
Contraindications: Hypersensitivity
Adverse reactions: multiple for organ txplant pts in multiple organ systems. Topica: flu like symptoms, headache, skin burning, increased cough (children)
Monitoring: systemic admin should monitor kidney, liver function. breastmilk.
Interactions: multiple A-Z

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Imiquimod (Aldara)

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Mechanism of Action
Precise mechanism is unknown; Toll-like receptor 7 agonist that induces cytokines, including interferon-alpha and others
Indications:
Treatment of external genital and perianal warts/condyloma acuminata; nonhyperkeratotic actinic keratosis on face or scalp; superficial basal cell carcinoma (sBCC) with a maximum tumor diameter of 2 cm located on the trunk, neck, or extremities (excluding hands or feet)
Contraindications: None
Adverse reactions: application sites reactions are common. burning, erosion, edema, weeping, crusting, flaking, itching, induration, scabbing, vesicles, etc.
Monitoring: reduction in lesion size is indicative of med working. pts should be monitored for signs of sensitivity
Interactions: vaccines, immunosuppressants, echinacea
Toxicity: don't use in eyes/nose/mouth, don't use in immunocompromised

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Etanercept (Enbrel)

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Mechanism of Action
Etanercept is a recombinant DNA-derived protein composed of tumor necrosis factor receptor (TNFR) linked to the Fc portion of human IgG1. Etanercept binds tumor necrosis factor (TNF) and blocks its interaction with cell surface receptors. TNF plays an important role in the inflammatory processes and the resulting joint pathology of rheumatoid arthritis (RA), polyarticular-course juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS), and plaque psoriasis.
Indications: Treatment of moderately- to severely-active rheumatoid arthritis (RA); moderately- to severely-active polyarticular juvenile idiopathic arthritis (JIA); psoriatic arthritis; active ankylosing spondylitis (AS); moderate-to-severe chronic plaque psoriasis
Contraindications: Hypersensitivity, pts with sepsis
Adverse reactions: CNS headache, GI abdominal pain/vomiting, injection site reaction, respiratory tract infection
Monitoring: Signs & symptoms of infection, TB screen before tx
Interactions: enhances effects of immunosuppressants, enhances toxicity of multiple drugs, vaccines ineffective

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Methotrexate

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Mechanism of Action:
Methotrexate is a folate antimetabolite that inhibits DNA synthesis. Methotrexate irreversibly binds to dihydrofolate reductase, inhibiting the formation of reduced folates, and thymidylate synthetase, resulting in inhibition of purine and thymidylic acid synthesis. Methotrexate is cell cycle specific for the S phase of the cycle. MOA unknown for RA. In psoriasis it is thought to target rapidly proliferating cells in skin. has anti-inflammatory effect for Crohn's.
Indications: Oncology &
Nononcology uses: Treatment of psoriasis (severe, recalcitrant, disabling) and severe rheumatoid arthritis (RA), including polyarticular-course juvenile rheumatoid arthritis (JRA)
Adverse reactions: many many.
subacute toxicity can occur. reactions much less when used for RA.
Interactions: aceretin enhances toxicity of. Many ABx: increases serum conc of. Enhances effects of immunosuppressants. NSAIDS increase excretion of. Penicillins decr excretion of metroxte. Diminish tx effects of vaccines.
Toxicity: ARF, & multiple organ systems affected

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Tretinoin (Retin-A)
-topical

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Mechanism of Action:
Keratinocytes in the sebaceous follicle become less adherent which allows for easy removal; inhibits microcomedone formation and eliminates lesions already present
Indications: Treatment of acne vulgaris; photodamaged skin; palliation of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin as part of a comprehensive skin care and sun avoidance program
Off-label:some skin CA
Contraindications: hypersensitivity
Adverse reactions: dermatologic: erythema, excessive dryness, scaling, pruritus
Interactions: contraceptives, may decr serum conc of.
For external use only, avoid abraded skin.

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Isotretinoin (Accutane)

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Mechanism:
Reduces sebaceous gland size and reduces sebum production; regulates cell proliferation and differentiation
Indications: Treatment of severe recalcitrant nodular acne unresponsive to conventional therapy
Contraindications: pregnancy & hypersensitivity
Adverse reactions: multiple organ systems; dermatologic: dry skin, angular chelitis, incr sunburn, brittle hair.
Monitoring: pregnancy tests before and during tx, CBC with differential and platelet count, baseline sedimentation rate, glucose, CPK; signs of depression, mood alteration, psychosis, aggression, severe skin reactions. Lipids, LFTs.
Interactions: alcohol enhances toxicity. Retinoids may lessen efficacy of contraceptives. Avoid vitamin A supplements.
Toxicity: severe teratogenic effects

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Benzoyl Peroxide

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Mechanism: Releases free-radical oxygen which oxidizes bacterial proteins in the sebaceous follicles decreasing the number of anaerobic bacteria and decreasing irritating-type free fatty acids
Indications: Treatment of mild-to-moderate acne vulgaris and acne rosacea
Contraindications: hypersensitivity
Adverse reactions: irritation, contact dermatitis, dryness, erythema, peeling
No known interactions.
May bleach towels,clothing, external use only.

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Azelaic Acid

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Mechanism of Action
Azelaic acid is a dietary constituent normally found in whole grain cereals; can be formed endogenously. Exact mechanism is not known. In vitro, azelaic acid possesses antimicrobial activity against Propionibacterium acnes and Staphylococcus epidermidis. May decrease microcomedo formation.
Indications: Topical treatment of inflammatory papules and pustules of mild-to-moderate rosacea; mild-to-moderate inflammatory acne vulgaris
Contraindications: hypersensitivity
Adverse reactions: pruritus, burning, stinging, itching.
Monitoring; use caution when using on nursing mom.
No interactions:
Toxicity: ? hypopigmentation reported. external use only.

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Staphylococcus aureus

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Morphology: Gram + Cocci (ball)
Metabolic: facultative anaerobic. Coagulase + test (fibrinogen turned into fibrin clot)
Medical Conditions:
Skin Infections (Cellulitis, Bollous Impetigo, Boils, Surgical woun, Furunculosis,Carbuncles)
Toxic Shock Syndrome, Meningitis Osteomyelitis (Children -Boys under 12 years)
Acute endocarditis, Septic arthritis, Bactermia/Sepsis
Urinary Tract Infection, Gastroenteritis,Pneumonia-Rare
Tx:
MSSA: Dicloxacillin or Nafcillin
MRSA: Vancomycin or Clindamycin
1st Generation IV Cephalosporins
Both: Mupirocin Ointment for skin

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Staphylococcus epidermis

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Morphology: Gram + Cocci
Metabolic: gives a + Catalase test
(diff. strep from staph)
Facultative anaerobe
Medical Conditions:
-Prosthetic Joints
-Prosthetic heart valves
-Sepsis from IV lines
-Urinary tract infections associated with foley catheters
-Frequent skin contaminate in blood cultures
Tx: Vancomycin + Rifampin
Rifampin + Bactrim
Fluoroquinolone

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Staphylococcus s saprophyticus

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Morphology: Gram + Cocci
Metabolic: facultative anaerobe. Novobiocin resistant, urease, lipase +,coagulase (-)
Medical: UTI's in sexually active women
Tx:Penicillin, Bactrim, Fluoroquinolones

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Streptococcus agalactiae

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Morphology: Gram + strepto coccus
Metabolic: mircroaerophilic beta-hemolytic. CAMP test important for ID'ing.
Medical: cause of meningitis and sepsis in newborns.
Tx: Penicillin & ampicillin

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Streptococcus pneumonia

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Morphology: gram + diplococci
Metabolic: aerotolerant anaerobe, alpha-hemolytic,sensitivity to lysis by bile
Medical: Pneumonia MC in adults ,Meningitis MC bacteria meningitis in adults
Sepsis,Otitis media in children (49%)
Tx:
OM: HD Amoxicillin or Augmentin or 2nd or 3rdgen. Cephalosporin
Pneumonia: Azithromycin or Doxycycline or Fluoroquinolones
Meningitis: Ceftriaxone+Vancomycin+Dexamethasone
(Premature) Ampicillin+Cefotaxime

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Streptococcus pyogenes

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Morphology: gram + cocci, group A strep.
Metabolic: facultative anaerobe
needs blood agar/growth medium
Medical: Pharyngitis
Skin Infection:Follicullitis, Cellulitis,Impetigo, Necrotizing fascitis, Scarlet Fever, Toxic Shock, Rheumatic Fever - Antibody mediated
Tx:Penicillin V or G
Cephalosprin 2nd or 3rdgeneration, Macrolides
Skin: Mupirocin Ointment
Necrotizing fascitis and Toxic Shock: add Clindamycin
Prophylactic antibiotic or prior to dental

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Listeria monocytogenes

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Morphology: gram + bacilli, has a flagellum
Metabolism: facultative anaerobe
catalase (+) oxidase (-)
Medical: Meningitis in immuno-suppressed and patients > 50
Septicemia in pregnant women
Neonatal meningits (rare)
Tx: Ampicillin
Bactrim

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Moraxella catarrhalis

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Morphology: gram(-) diplococcus
Metabolism: aerobic, oxidase +
Medical: Otitis media in children
URI – bronchitis, sinusitis, pneumonia
COPD exacerbations
Tx: OM: HD Amoxicillin or Augmentin or 2nd gen. Cephalosporin
Macrolide
COPD: HD Amoxicillin or Augmentin + Azithromycin

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Neisseria gonorrhoeae

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Morphology: gram (-) cocci, coffee bean shaped w/ pilli
Metabolic: grow on chocolate agar w/ CO2, grown on Thayer-martin agar, oxidase (+)
Medical: Urethritis
Cervical – PID, Ophthalmia neonatorum
Bacteremia, Septic arthritis
Tx: Ceftriaxone
Cefixime
Cefpodoxime
Azithromycin
Spectinomycin
ALSO: treat for Chlamydia
Azithromycin or Doxycycline

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Neisseria meningitidis

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Morphology: gram (-) cocci
Metabolism: chocolate agar plate,
+oxidase & + catalase, ferments CHO
Medical: Meningitis, Septicemia
Tx: Pencillin G
Ceftriaxone
Cefuroxime
Cefotaxime

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Campylobacter jejuni

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Morphology: enteric gram (-) rod, helical shaped
Metabolism: microaerophilic, oxidase/catalase (+), glucose neg. charcoal based agar.
Medical: Secretory or bloody diarrhea
Tx:
Azithromycin
Erythromycin
Ciprofloxacin

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Escherichia coli

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Morphology: enteric gram (-) rod
Metabolism:facultative anaerobe ferment lactose readily
Medical: Urinary tract infections
Diarrhea
Gram negative sepsis debilitated hospital patients
Newborn meningitis
Tx:
UTI: Bactrim + Pyridium
Nitrofurantoin
Ciprofloxacin or Levofloxacin
Diarrhea: self limited if not Ciprofloxacin or Levofloxacin
Meningitis: Ampicillin + Cefotaxime

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Helicobacter pylori

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Morphology: gram (-) Rod , spiral shaped, native to stomach
Metabolism: microaerophilic
+urease, +catalase, +oxidase
Medical: Duodenal ulcers
Chronic gastritis
Tx:
Rabeprazole + Amoxicillin (followed by)
Rabeprazole + Clarithromycin + Tinidazole
Bismuth + Tetracycline + Metronidazole + Omeprazole

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Salmonella

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Morphology: enteric gram (-) rods, motile/nonmotile phase
Metabolism: facultative anaerobes, grow on ferrous sulfate media
Medical: Gastroenteritis, Sepsis
Osteomyelitis in sickle cell
Chronic carrier
Paratyphoid fever
SALMONELLA TYPHI uncommon in the US
Enteric Fever
Tx: Usually no treatment
Ciprofloxacin
Azithromycin

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Shigella

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Morphology: gram (-) rod
Metabolism: no gas w/ glucose, do not ferment lactose
Medical: Dysentery
Diarrhea-bloody with mucus and pus
Tx:
Usually no treatment unless culture obtained
Ciprofloxacin (adults)
Azithromycin (children)

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Haemophilus influenzae

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Morphology: gram (-) rod
Metabolism: aerobe, anaerobe,
+catalase/oxidase tests, chocolate agar w/ additives (CO2)
Medical: Otitis media (29%)
Pneumonia
COPD exacerbation with pneumonia
Acute epiglottitis
Sepsis
Meningitis
Septic arthritis
Tx:
Augmentin
Cephalosporin 2nd and 3rd generation
Bactrim
Macrolide
Meningitis, Sepsis or Acute epiglottitis
Cefotaxime
Ceftriaxone

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Haemopilus ducreyi

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Morphology: gram (-) rod
Metabolism: difficult to grow, chocolate agar
Medical: Chancroid in developing world/tropics
Tx:
Azithromycin
Ceftriaxone
Ciprofloxacin
Erythromycin

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Legionella pneumophila

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Morphology: gram (-) rod, flagellated
Metabolism: aerobic, (-) urease, (-) fermentation
Medical: Legionnaires’ Disease
Pontiac Fever, no human/human transmission
Tx:
Fluoroquinolone
Azithromycin
Erythromycin + Rifampin
Clarithromycin

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Pasteruella multocida

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Morphology: gram (-) rod
Metabolism: penicillin sensitive
Medical: Dog or Cat bite
Augmentin
Alernative for Cat bite
Doxycycline
Cefuroxime
Alternative for Dog bite
Clindamycin + Fluoroquinolone (adults)
Clindamycin + Bactrim

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Pseudomonas aeruginosa

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Morphology: gram (-) rod, motile
Metabolism: aerobic, produces water soluble pigments, + oxidase
Medical: Pneumonia in Cystic fibrosis and immuno-compromised ,Osteomyelitis
Nail through tennis shoe
Post internal fixation
Burn wound infections
Sepsis
Urinary tract infections (per culture)
Endocarditis (IVDA)
Corneal infections in contact lens wearers
Malignant external otitis
Tx:
Tobramycin + Piperacillin or Ticarcillin, Osteomyelitis: nail in tennis shoe Ciprofloxacin
Osteomyelitis: long bone Vancomycin + Ceftaz
Burns: Vancomycin + Amikacin + Piperacillin

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Clostridium difficile

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Morphology: gram + rods,
Metabolism: anaerobic, spore forming, produces toxins
Medical: Pseudomembranous enterocolitis
Tx:
Metronidazole
Vancomycin
Terminate use of antibiotics

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Treponema pallidum

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Morphology: spirochete, seen only with immunofluoresence
Metabolism: difficult to subculture
Medical:Syphilis
Tx:
Penicillin G
Doxycycline

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Mycoplasma pneumoniae

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Morphology: Pleomorphic, lacks cell wall so cannot be stained
Metabolism: can be isolated but grows slowly (>1wk), serologic tests used for dx
Medical:Tracheobronchitis
Atypical pneuomonia
"Walking Pneumonia"
Tx:
Amoxicillin + Clarithromycin
Amoxicillin + Doxycycline

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Ureaplasma urealyticum

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Morphology: Pleomorphic
Metabolism: needs 10% urea for growth
Medical: Non-gonococcal urethritis
Tx:
Metronidazole +Erythromycin

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Chlamydia pneumoniae

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Morphology: gram (-) obligate intracellular parasite
Metabolism: dx made by serologic tests/culture, but not routinely available
(also infects koalas, snakes)
Medical: Atypical pneumonia
Tx:
Amoxicillin + Clarithromycin
Amoxicillin + Doxycycline or Erythromycin

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Chlamydia trachomatis

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Morphology: gram (-) obligate intracellular parasite
Metabolism: fails to grow in artificial media
Medical: Inclusion Conjuctivitis
Ophthalmia neonatorum
Infant pneumonia
Urethritis, cervicitis, PID
Tx:
Doxycycline or Azithromycin
Erythromycin

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Myocbacterium tuberculosis

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Morphology: acid fast bacteria, high lipid content in its walls
Metabolism: obligate anaerobes, selective media required, get energy from oxidation of C-compounds
Medical: Tuberculosis
Tx:
Isoniazid (INH)
Rifampin
Pyrazinamide
Ethambutol
Streptomycin
Rifabutin

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hydorcortisone
group 7 (least potent)

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Mechanism of Action: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability
Indications: relief of inflammation of corticosteroid-responsive dermatoses (low and medium potency topical corticosteroid)
Contraindications: hypersensitivity to drug
Adverse Reactions: Topical:
>10%: Dermatologic: Eczema (12.5%) others pruritus
Monitoring: BP, wt, 'lytes. is excreted in breastmilk. there is a therapeutic range but not for topical
Interactions: decr antineplastic effect of aldesleukin, Conivaptan -incr serum conc of CYP3A4 Substrates; Corticorelin- decr effects of, Deferasirox - enhances effect of, Tocilizumab - decr serum conc of
Clinical Pres of Interactions: GI bleeding with Deferasirox

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triamcinolone
group 2-6 (potent to low potency)

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Mechanism: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity and volume of the lymphatic system
Indications:Topical: Inflammatory dermatoses responsive to steroids
Contraindications: hypsersensitivity, fungal/viral infex
Adverse reactions: Dermatologic: Acneiform eruptions, allergic contact dermatitis, dryness, folliculitis,, hypertrichosis, hypopigmentation, itching, miliaria, perioral dermatitis, skin atrophy, skin infection (secondary), skin maceration, striae Endocrine: HPA axis suppression; metabolic effects Burning, irritation
Interactions:Aldesleukin: diminish the antineoplastic effect of Aldesleukin. Risk X:
Corticorelin: decr effect of Deferasirox: enhance the adverse/toxic effect of Deferasirox (GI bleeding)Monitor therapy
Pregnancy contraindicated. Monitor for infection.

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fluocinonide
groups 1-3 very super potent to potent

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High Potency
Mechanism: anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions (not well defined)
Indications: Anti-inflammatory, antipruritic; treatment of plaque-type psoriasis (up to 10% of body surface area)
Contraindications: hypersensitivity, fungal/viral infex
Adverse reactions: Cardiovascular: Intracranial hypertension Dermatologic: Acne, allergic dermatitis, contact dermatitis, dry skin, folliculitis, hypertrichosis, hypopigmentation, maceration of the skin, miliaria, perioral dermatitis, pruritus, skin atrophy, striae, telangiectasia
Endocrine & metabolic: Cushing's syndrome, growth retardation, HPA suppression, hyperglycemia
Local: Burning, irritation
Renal: Glycosuria
Interactions: Aldesleukin: decrs antineoplastic effect of Aldesleukin. Risk X.
Corticorelin: decr effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by . Risk C: Monitor. Deferasirox- enhance toxic effct of: GI bleed
Risk C; monitor tx.
systemic effects

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betamethasone
groups 1-6
very ultra super potent to low potency

Back 48

Mechanism: Controls the rate of protein synthesis; depresses the migration of polymorphonuclear leukocytes, fibroblasts; reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation
Indications: Inflammatory dermatoses such as seborrheic or atopic dermatitis, neurodermatitis, anogenital pruritus, psoriasis, inflammatory phase of xerosis
Contraindications: hypersensitivity, sys. fungal infx.
Adverse reactions: Dermatologic: Acneiform eruptions, allergic dermatitis, burning, dry skin, erythema, folliculitis, hypertrichosis, irritation, miliaria, pruritus, skin atrophy, striae, vesiculation
Endocrine and metabolic effects have occasionally been reported with topical use.
Interactions: multiple A-Z, same as the other 3 steroids. also Warfarin, alcohol, thiazide diuretics, NSAIDs, immunosuppressants, fluconazole, estrogen etc.
All should be monitored.
Toxicity? Adrenal suppression, immunosupression, Kaposi's sarcoma, myopathy, psychiatric disturbances, skin reactions