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nusiel2's version from 2015-06-26 03:03

pregnancy

Question Answer
clarithormycinembryotoxic
sulfonamideskernicterus
aminoglycosidesototox
fluorquinolonescartilage damage
metronidazolemutagenic
tetracyclinediscolored teeth, inhibits bone growth
ribavirinteratogenic
griseofulvintertagoneic
chloramphenicolegray baby :(
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Section

Question Answer
ethambutol mech SEinhibits carb polymerization in mycobacterium cell wall by inhibiting arabinosyltransferase; red-green color blindness
isoniazid mechdecreases mycolic acid; metabolized to active via bacterial catalase peroxidase (Katg);
isoniazid SEhepatotox, lupus, neurotox; neuro and lupus prevented by b6
rifampin mech SE4 r's - inhibis DNA-depend RNA polymerase; red/orange fluids, revs up p450, rapid tolerance used alone
rifampin ppx formeningococcal, TB, H. flu
pyrazinamide mechinhibits mycolic acid synthesis - inhibts mycolic fatty acid synthase I; active in acid phagolysosome
pyrazinamide SEhepatotox, hyperuricemia
AIDS Ppx200 - TMP-SMX; 100 - TMP-SMX; 50 - azithromycin
empiric flu treatment - outpatient, in patient, ICUout-macrolide; in-fluoroquinolone; ICU: either + b-lactam
amphotericin B mech and SEbinds ergosterol, makes membrane pores - electrolyte leakage; fungi; intrathecal for meningitis (doesn't cross BBB), hypokalemia nd hypomagnesia - supplement
ampho B SEIV phlebitis, anemia, hypotension, arrhythmia, nephrotox, fevers/chills; hydration dec nephrotox; causes hypo- Mg and hypo-K so need to supplement!
nystatin mech, usesame mech as ampho B; oral candida, vaginosis, diaper rash- TOPICAL
azoles mech and SEinhibits p450 that metabolizes lanasterol to ergosterol; inhibits liver p450, steroid synthesis - gynecomastia; fever and chills
ketoconazole usesystemic fungi
miconazole; cloprimazole usetopical fungi
fluconazole useAIDS cryptococus; and all candida
flucytosine use and mechmetab via cytosine deaminase to 5-FU; SE BM suppression; used with amphoB for systemic fungi
caspofungininhibit synthesis of b-glucan and stops cell wall synthesis; flushing(histamine release), GI upset; invasive aspergillosis, candida
terbinafine mech and SEinhibit squalene epoxidase; dermatophytes-esp.onchomycoses(toe or nail); inc LFTs, visual disturbances
griseofulvin use; mechinterferes with microtubules, disrupts mitosis; deposits in keratin containing tissues; oral for superficial infection - ringworm, tinea
griseofulvin SEteratogenic, carcinogenic, confusion, HA, increases both p450 and warfarin metab.
pyramethamine usetoxoplasmosis
sodium stibogluconate useleishmaniasis
suramin & melarsprol uset. brucei
nifurtimox uset. cruzi
chloroquine mechblocks detoxification of heme to hemozoin so it accumulate and is toxic to plasmodia;not for p. falciparum(membrane pump decreases drug concentraton) use artemether/lumifantrine or atovaquone/proguanil.
quiniine or artisunate-life threatening malaria
chloroquine SEretinopathy
helminth tximmobilize helminth - ivermectin, diethylcarbamazine, praziquantel(flukes/trematodes), mebendazole, pyrantel palmoate
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Antiviral

Question Answer
amantadineblocks viral uncoating/viral penetration (M2 PROTEIN); influenza a; also increases dopa release; influenza a PPX, parkinson's
amantadine SEataxia, slurred speed, DZ; rimantadine - fewer CNS SE
amantadine resistancemutated M2 protein; 90% influenza A resistant, so not used
oseltamivr, zanamavirinfluenza A and B, blocks neuraminidase - release of progeny
ribavirin use; mechanismRSV, HEP C; blocks Guanine synthesis by blocking IMP dehydrogenase
ribavirin SEvery teratogenic and hemolytic anemia
acyclovirguanosine analog; monophos- by viral thymidine kinase; rest by cell enzymes; inhibits DNA polymerase HSV/VSV/EBV, HSV - mucocutaneous and oral lesions, encephalitis; few SE; ppx in immunocomp; no effect against latent viruses
acyclovir resistno viral thymidine kinase
valacyclovirprodrug; better oral availability
ganciclovirCMV kinase monosphosphorylates, cell enzymes triphosphorylate, inhibits DNA polymerase ; use as ppx esp in immunocomp; SE leukopenia, neutropenia, thrombocytopenia, renal tox; more toxic to host enzymes than acyclovir;
valganciclovirprodrug; better oral availability,
ganciclovir resistanceCMV DNA polymerase or no viral kinase
foscarnetpyrophoshate analog blocks viral DNA polymerase ; nephrotox; use for CMV retinitis or HSV resistant to other meds
cidofovirinhibits viral DNA polym; use for CMV retinitis in immunocomp or HSV-resistant; long half life; nephrotox(coadminister w/ probenecid and IV saline to reduce toxicity)
-navir'sprotease inhibitors; lipodystrophy; hyperglycemia; GI intolerance; nephropathy, hematuria (indinavir). inhibit p450(ritonavir)
neVIRapine efaVIRenz, delaVIRdineNNRTIs; bind reverse transcriptase at different site, no phos for activation; same SE as NRTIs
tenofovirNRTI, nucleotide analog. does not have to be activated, rest are nucleosides need phosphorylation to be active
emtricitabineNRTI
abacavirNRTI
lamivudineNRTI
zidovudineNRTI
didanosineNRTI
stavudineNRTI
NRTIsmust be phosphorylated by thymidine kinase; no 3'-OH group, so bind to reverse transcriptase and terminate DNA prolong.; SE periph neuropathy; BM suppression (reverse with epo or GM-CSF)
zidovudineuse as ppx and pregnancy; megaloblastic anemia
NNRTisrash, periph neuropathy, BM suppression - reverse with erythropoietin or GM-CSF
raltegravirintegrase inhibitor; reversible inibitor!; hypercholesterolemia
interferonsGlycoproteins ysnthesized by virus infected cells, block DNA&RNA viruses; neutropenia, myopathy
IFN alphachronic hep B, kaposi sarcoma
IFN betaMS
IFN gammaNADPH oxidase deficiency
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Penicillins

Question Answer
penicillinG and V, binds PBP, blocks transpeptidase, enables autolytic enzymes; bacteriocidal to g+rods, g+cocci, g-coccis, spirochetes; SE - hypersens., hemolytic anemia
penicillin resistanceB-lactamase cleaves lactam ring
penicilinase-resistantdiclox-, naf-, oxa-, meth- ; due to bulky R group SE hypersens., interstitial nephritis; just staph!
methicillininterstitial nephritis
ampicillin, amoxacillinwider spectrum, same mech, amox- better oral availability, SE- pseudomembranous colitis, hypersensetivity
ampicillin SErash
ampi/amox- useHELPSS enterococci; h. flu, e.coli, listeria, proteus, salmonella, shigella, enterococci
antipseudomonalsticaricillin, pipericillin, carbenicillin; pseudomans and g-rods, use with clavulanic acid; SE-hypersens.
b-lactamase inhibitorssulbactam, tazobactam, clavulanic acid
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cephalosporin

Question Answer
mechanisminhibts cell wall synth.; more resistant to b-lactam
1st gencephalexin, cephalozolin(use prior to surgery staph aureus) gram + cocci , PEcK
2nd genfac fox fur ;gram + cocci HEN PeCKS
HEN PeCKSh. influenzae, enterobacter, neisseria, proteus, ecoli, klebsiella, serratia marcescen,
3rd genserious g-; neisseria (ceftriaxone) and pseudomonas (ceftasidime)
4th gencefipimine; g+ and pseudomonas
SEhypersens, vit K def, increase aminoglycoside nephrotox, disulfiram like with ethanol, cross-reactivity with PCN in 5-10%
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other

Question Answer
aztreonamb-lactamase R; monobactam inhibits cell wall synth. binds PBP3; no cross reactivity with PCN; g- RODS ONLY, for renal insufficiency (no aminoglyc) or PCN allergic; SE - sometimes GI upset
imepenam/cilastatin, meropenembroad spectrum, b-lactamase R; g+ rods, g- cocci, anaerobes; only life-threatening infections; SE - SZ, severe GI distress, rash
cilastaininhibits dihydropeptidase I in renal tubules, breaks down imepenem
meropenemresistant to dihydropeptidase I, less SZ
vancomycin mech/usebinds d-al-dala preventing mucopeptide cell wall precursor formation; g+ only, serious infections
vancomycin SESE - nephrotox, ototox, thrombophlebitis, red-man syndrome
vancomycin resistanced-ala d-ala --> d-ala d-lac
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protein synthesis inhibitors

Question Answer
Aminoglycosides"GNATS" gentomycin, neomycin, amikacin, tobramycin, streptomycin; binds 30s and stop mRNA synthesis; need O2 for uptake; g+ rods (aerobes); SE: nephro (with cephalo), ototox (with loop diuretics), teratogenic
aminoglycoside resistanceadenylation, phosphorylation, acetylation
neomycincolon surgery
tetracylinesdoxycycline, tetracycline, demeclocycline, minocycline ; binds 30s inhibiting aminoacyl-tRNA attachment; don't take with iron supplement, lactose prod, antacids; use- borrelia, chlamydia, rickettsia, m. pnumonia because it stores intracell; SE- teeth discoloration, stops bone growth iin children, GI, photosens
tetracycline resistancedecrease influx or increased efflux via plasmid
macrolidesclarithromycin, azithromycin, erythromycin; bacteriostatic; binds 50s ihibiting translocation; SE- GI distress, prolonged QT, eosinophilia, acute cholestatic hep, skin rash, increased blood conc. of oral anticoag and theophyllines
marcolide useatypical pneumonia! ; STD, URI, G+ cocci, neisseria
macro resistance23rRNA methylation
chloramphenicolbacteriostatic; prevents peptide form. at 50s; meningitis - h.flu, neisseria, strep pneumo; anemia (dose dep), aplastic anemia (dose indep.), gray baby syndrome
chlormphenicol resistance plasmid - acetylation
gray baby syndromechloramphenicol due to low liver UDP glucoronyl transferase
clindamycinbacteriostatic; blocks peptide fromation in 50s subunit; anaerobic for lung aspiration or lung abscess; c.diff, diarrhea, fever
anaerobic above vs below diaphragmabove = clindamycin, below = metronidazole
sulfonamidesPABA antimetabolite inhibits dihydropteorate synthetase; bacetriostatic; g+, g-, nocardia, chlamydia; SE - G6PD, hypersens, nephrotox (tubulointerstitial nephritis), kernicterus in baby, photosens,, displaces drugs from albumin-warfarin
sulfa resistanceincreased PABA, enzyme mut, dec uptake
trimethroprimblocks dihydrofolate reductase; used with sulfas; UTIs, shigella, salmonella, PCP; megaloblastic anemia, granulcytopenia-, leukopenia;
stop TMP SEsupplement folate/folinic acid
nalidixic acidfluoroquinolone, a quinolone
enoxacinfluoroqinolone
fluoroquinolonebactericidal; floxacins, enoxacin, nalidixic acid; blocks DNA Gyrase/toposiomerase II; g- rods urinary and GI, neisseria, some g +; SE - HA, DZ, rash, superinfection!, GI, bone problems (more)
fluoroquinolone and bonescontra in pregnancy, children due to cartilage damage; tendonitis/rupture in adults; leg cramps/myalgia in children
fluoroquinolone restanceDNA gyrase mut
metronidazolebactericidal; forms free radicals in bacteria-kills DNA; GI, metallic taste, disulfiram-like; GET GAP- giardia, entamoeba, trichimonas, gardenerella, anaerobes, h.pylori,
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