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USMLE Antifungals And Antivirals

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amyhan's version from 2016-05-20 18:07

Antifungal and Antiparasitic

MoA

DrugQuestionAnswerNumberMnemonic
Amphotericin BMoABinds ergosterol/forms membrane pores that allow electrolyte leakage2AmphoTERicin TEARS holes
NystatinMoABinds ergosterol/forms membrane pores that allow electrolyte leakage2Molecular effect/cellular effect
AzolesMoAInhibits ergosterol synthesis via lanosterol 14-alpha-demethylase (P450 enzyme) inhibition (lanosterol to ergosterol)2Enzymatic effect/cellular effect
Flucytosine (5 flucytosine)MoAConversts to 5 fluorouracil by cytosine deaminase then inhibits RNA/DNA biosynthesis2MoA of Activation/cellular effect
CapsofunginMoAInhibits cell wall synthesis/inhibits B glucan synthesis2Molecular effect/cellular effect
MicafunginMoAInhibits cell wall synthesis/inhibits B glucan synthesis2Molecular effect/cellular effect
TerbinafineMoAInhibits fungal enzyme squalene epoxidase - inhibits ergosterol synthesis; accumulation of squalene is fungicidal1Molecular effect
GriseofulvinMoAInterferes with microtubule function/disrupts mitosis/deposits in keratin tissues3Molecular effect/cellular effect/other effect
ChloroquineMoABlocks detoxification of heme into hemozoin - heme toxic to plasmodia2Molecular effect/cellular effect
MebendazoleMoAImmobilize helminths - inhibits microtubule synthesis1N/A
Pyrantel pamoateMoAImmobilize helminths - targets nAChR, causing irreversible paralysis1N/A
IvermectinMoAImmobilize helminths - binds glutamate gated Cl- channel -> increased permeability to Cl- ions -> hyperpolarization of nerve and muscle cells and paralysis1N/A
DiethylcarbamazineMoAImmobilize helminths1N/A
PraziquentelMoAImmobilize helminths1N/A
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Organisms

DrugQuestionAnswerNumberMnemonic
Amphotericin BOrganismsSerious/systemic mycoses (Cryptococcus/Blastomyces/Coccidioides/Histoplasma/Candida/Mucor)6N/A
NystatinOrganismsCandidiasis (oral/diaper rash/vaginal)33 places of infection of one organism
AzolesOrganismsLocal/less serious systemic mycoses1N/A
FluconazoleOrganismsAll types of Candidal infections/chronic suppression of cryptococcal meningitis in AIDS2N/A
ItraconazoleOrganismsBlastomyces/Coccidioides/Histoplasma3N/A
ClotrimazoleOrganismsTopical fungal infections1N/A
MiconazoleOrganismsTopical fungal infections1N/A
FlucytosineOrganismsSystemic (especially Cryptococcus) in combo w/Ampho B3Type of infection/typical agent/combination
CapsofunginOrganismsInvasive aspergillosis/Candida2N/A
MicafunginOrganismsInvasive aspergillosis/Candida2N/A
TerbinafineOrganismsDermatophytoses (tinea/ringworm)/onychomycosis (finger/toenail)2N/A
GriseofulvinOrganismsDermatophytoses (tinea/ringworm)1N/A
PyrimethamineOrganismsToxoplasmosis1N/A
SuraminOrganismsTrypanosoma brucei1N/A
MelaroprolOrganismsTrypanosoma brucei1N/A
NufurtimoxOrganismsTrypanosoma cruzi1N/A
Sodium stibogluconateOrganismsLeishmaniasis1N/A
ChloroquineOrganismsNon falciparum plasmodia1Exception to genus treatment
Artemether/lumifantrineOrganismsPlasmodium falciparum1N/A
Atovaquone/proguanilOrganismsPlasmodium falciparum1N/A
MebendazoleOrganismsEnterobius1N/A
Pyrantel pamoateOrganismsAntihelminthic1N/A
IvermectinOrganismsStrongyloides/Onchocerca volvulus2N/A
DiethylcarbamazineOrganismsLoa loa/Wucheria bancrofti2N/A
PraziquentelOrganismsSchistosoma/Clonorchis sinensis/Paragonimus Westermani3N/A
Amphotericin BKey to UseIntrathecally for fungal meningitis/supplement K+ and Mg+ because of altered renal tubule permeability/hydration reduces nephrotoxicity/liposomal formulation reduces toxicity4N/A
NystatinKey to UseTopical for diaper rash or vaginal (b/c too toxic systemically)/swish and swallow for thrush2MoA of administration
FlucytosineKey to UseSystemic (especially Cryptococcus) in combo w/Ampho B1Combo use
GriseofulvinKey to UseOral treatment of superficial infections (dermatophytoses)1N/A
ChloroquineKey to UsePlasmodium falciparum has high frequency of resistance via membrane pump1N/A
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Toxicity

DrugQuestionAnswerNumberMnemonic
Amphotericin BToxicityFever/chills/hypotension/nephrotoxicity/arrhythmias/anemia/IV phlebitis7Grouped/2 on RoS/5 from CV to hematologic systems
AzolesToxicityTestosterone synthesis inhibition/gynecomastia/liver dysfunction/b/c P450 inhibition42 processes lead to 2 syndromes
FlucytosineToxicityBone marrow suppression1N/A
CapsofunginToxicityGI upset/flushing from histamine release2N/A
MicafunginToxicityGI upset/flushing from histamine release2N/A
TerbinafineToxicityAbnormal LFTs/visual disturbances2N/A
GriseofulvinToxicityTeratogenic/carcinogenic/confusion/headaches/P450 activation/Warfarin metabolism increase63 pairs/2 enzymatic/2 CNS/2 cellular growth related
ChloroquineToxicityRetinopathy1N/A
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Antiviral

MoA

DrugQuestionAnswerNumberMnemonic
AmantadineMoAInhibit M2 on Influenza A/inhibits viral uncoating1Molecular/cellular effects
RimantadineMoAInhibit M2 on Influenza A/inhibits viral uncoating1Molecular/cellular effects
ZanamivirMoAInhibit influenza neuraminidase/decrease progeny release2Molecular/cellular effects
OseltamivirMoAInhibit influenza neuraminidase/decrease progeny release2Molecular/cellular effects
RibavirinMoAInhibits guanine nucleotide synthesis/competitively inhibits IMP deH2ase2Molecular/cellular effects
AcyclovirMoAMonophosphorylated by HSV/VZV thymidine kinase/2nd phosphate from host enzymes/guanosine analog inhibitis viral DNA polymerase via chain termination3Activation steps/molecular effect
ValacyclovirMoAMonophosphorylated by HSV/VZV thymidine kinase/2nd phosphate from host enzymes/guanosine analog inhibitis viral DNA polymerase via chain termination3Activation steps/molecular effect
FamciclovirMoAMonophosphorylated by thymidine kinase/2nd phosphate from host enzymes/guanosine analog inhibitis viral DNA polymerase via chain termination3Activation steps/molecular effect
GanciclovirMoAMonophosphorylated by CMV thymidine kinase/2nd phosphate from host enzymes/guanosine analog inhibitis viral DNA polymerase via chain termination3Activation steps/molecular effect
ValganciclovirMoAMonophosphorylated by CMV thymidine kinase/2nd phosphate from host enzymes/guanosine analog inhibitis viral DNA polymerase via chain termination3Activation steps/molecular effect
FoscarnetMoAPyrophosphate analog/binds PP binding site of viral DNA polymerase2N/A
CidofovirMoADirectly inhibits viral DNA polymerase1N/A
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Antiparasite Treatment

OrganismTreatmentNumber
Giardia lambliaMetronidazole1
Entamoeba histolyticaMetronidazole/iodoquinol for asymptomatic cyst passers2
CryptosporidiumPrevention (filter water)/nitazoxanide in immunocompetent2
Toxoplasma gondiiSulfadiazine and pyrimethamine2
Naegleria fowleriAmphotericin B1
Trypanosoma brucei/gambiense/rhodesienseSuramin for blood borne/malarsoprol for CNS2
PlasmodiumChloroquine/mefloquine for resistance/IV quinidine in life threatening3
Plasmodium vivax/ovaleChloroquine/add primaquine for hypnozoite2
BabesiaAtovaquone and azithromycin2
Trypanosoma cruziNifurtimox1
Leishmania donovaniSodium Stibogluconate1
Trichomonas vaginalisMetronidazole (and partner)1
Enterobius vermicularis (pinworm)Bendazoles/pyrantel pamoate2
Ascaris lumbricoides (giant roundworm)Bendazoles/pyrantel pamoate2
Strongyloides stercoralisIvermectin/albendazole2
Ancylostoma duodenale (hookworm)Bendazoles/pyrantel pamoate2
Necator americanus (hookworm)Bendazoles/pyrantel pamoate2
Dracunculus medinensisSlow extraction of worm1
Onchocerca volvulusIvermectin1
Loa loaDiethylcarbamazepine1
Wuchereria bancroftiDiethylcarbamazepine1
Toxocara canisAlbendazole/mebendazole2
Taenia solium/porkPraziquantel1
Taenia solium/eggsPraziquantel/bendazoles for neurocysticercosis2
Diphyllobothrium latumPraziquantel1
Echinococcus granulosusBendazoles1
SchistosomaPraziquantel1
Clonorchis sinensisPraziquantel1
Paragonimus westermaniPraziquantel1
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Viruses

DrugQuestionAnswerNumberMnemonic
AmantadineVirusesInfluenza A1N/A
RimantadineVirusesInfluenza A1N/A
ZanamivirVirusesInfluenza A/B2N/A
OseltamivirVirusesInfluenza A/B2N/A
RibavirinVirusesRSV/chronic HCV2N/A
AcyclovirVirusesHSV1/2/VZV/weak against EBV/none against CMV53 strong/1 weak/1 none (HHV1-3 strong/4 weak/5 none)
ValacyclovirVirusesHSV1/2/VZV/weak against EBV/none against CMV53 strong/1 weak/1 none (HHV1-3 strong/4 weak/5 none)
FamciclovirVirusesVZV Herpes Zoster1HHV3
GanciclovirVirusesCMV (especially immunocompromised)1HHV5
ValganciclovirVirusesCMV (especially immunocompromised)1HHV5
FoscarnetVirusesCMV retinitis in immunocomprised when ganciclovir fails/acyclovir resistant HSV2N/A
CidofovirVirusesCMV retinitis in immunocomprised/acyclovir resistant HSV2N/A
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Miscellaneous

DrugQuestionAnswerNumberMnemonic
RibavirinToxicityTeratogenic/hemolytic anemia2N/A
GanciclovirToxicityLeukopenia/neutropenia/thrombocytopenia/nephrotoxic4N/A
FoscarnetToxicityNephrotoxicity1N/A
CidofovirToxicityNephrotoxicity1N/A
ValacyclovirKey to UseProdrug w/better oral availability than acyclovir1better aVAiLability
FamciclovirResistanceMutated thymidine kinase1N/A
ValganciclovirKey to UseProdrug w/better oral availability than ganciclovir1better aVAiLability
GanciclovirResistanceMutated CMV DNA polymerase/lack of viral kinase2N/A
FoscarnetResistanceMutated DNA polymerase1N/A
CidofovirKey to UseCoadminister w/probenecid and IV saline to reduce toxicity22 things and why
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AntiHIV

DrugQuestionAnswerNumberMnemonic
LopinavirMoAPrevent HIV-1 aspartate protease from cleaving polypeptide products into mature products1PI
AtazanavirMoAPrevent HIV-1 aspartate protease from cleaving polypeptide products into mature products1PI
DarunavirMoAPrevent HIV-1 aspartate protease from cleaving polypeptide products into mature products1PI
FosamprenavirMoAPrevent HIV-1 aspartate protease from cleaving polypeptide products into mature products1PI
SaquinavirMoAPrevent HIV-1 aspartate protease from cleaving polypeptide products into mature products1PI
RitonavirMoAPrevent HIV-1 aspartate protease from cleaving polypeptide products into mature products1PI
IndinavirMoAPrevent HIV-1 aspartate protease from cleaving polypeptide products into mature products1PI
TenofovirMoALack 3' OH group/competitively bind reverse transcriptase/early terminate DNA chain3NRTI (molecular structure/2 steps of action)
EmtricitabineMoALack 3' OH group/competitively bind reverse transcriptase/early terminate DNA chain3NRTI (molecular structure/2 steps of action)
AbacavirMoALack 3' OH group/competitively bind reverse transcriptase/early terminate DNA chain3NRTI (molecular structure/2 steps of action)
LamivudineMoALack 3' OH group/competitively bind reverse transcriptase/early terminate DNA chain3NRTI (molecular structure/2 steps of action)
ZidovudineMoALack 3' OH group/competitively bind reverse transcriptase/early terminate DNA chain3NRTI (molecular structure/2 steps of action)
DidanosineMoALack 3' OH group/competitively bind reverse transcriptase/early terminate DNA chain3NRTI (molecular structure/2 steps of action)
StavudineMoALack 3' OH group/competitively bind reverse transcriptase/early terminate DNA chain3NRTI (molecular structure/2 steps of action)
NRTIMnemonichaVUDINEd with my NUCLEAR family (vudine/nucleoside analog)1NRTI
PIMnemonicNAVIR tease a PROTEASE1PI
NevirapineMoABind to reverse transcriptase/different site from NRTIs1NNRTI
EfavirenzMoABind to reverse transcriptase/different site from NRTIs1NNRTI
DelavirdineMoABind to reverse transcriptase/different site from NRTIs1NNRTI
RaltegravirMoAInhibits HIV genome integration into host cell at HIV integrase1II
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Misc

DrugQuestionAnswerNumberMnemonic
Protease InhibitorsToxicityHyperglycemia/GI intolerance (nausea/vomiting)/lipodystrophy/nephropathy4PI
RitonavirToxicityHyperglycemia/GI intolerance (nausea/vomiting)/lipodystrophy/nephropathy/P450 inhibitor5PI+1
IndinavirToxicityHyperglycemia/GI intolerance (nausea/vomiting)/lipodystrophy/nephropathy/hematuria5PI+1
Nucleoside Reverse Transcriptase InhibitorsToxicityBone marrow suppression/peripheral neuropathy/lactic acidosis/rash4NRTI
Zidovudine (ZDV formerly AZT)ToxicityBone marrow suppression/peripheral neuropathy/lactic acidosis/rash/anemia5NRTI+1
Nucleoside Reverse Transcriptase InhibitorsKey to UseMust be activated (Tenofovir excluded)2Rule of action/exception
Non Nucleoside Reverse Transcriptase InhibitorsKey to UseNeed not be activated1Rule of action
Non Nucleoside Reverse Transcriptase InhibitorsToxicityBone marrow suppression/peripheral neuropathy/lactic acidosis/rash4NNRTI
RaltegravirToxicityHypercholesterolemia1N/A
HAART TherapyKey to Use2 NRTI plus NNRTI or PI or II4N/A
INF alphaWhen to useChronic HBV/HCV/Kaposi's sarcoma3N/A
IFN betaWhen to useMS1N/A
IFN gammaWhen to useNADPH oxidase deficiency1N/A
IFN allToxicityNeutropenia/myopathy2N/A
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AKA

DrugAbbreviation
TenofovirTDF
EmtricitabineFTC
AbacavirABC
Lamivudine3TC
ZidovudineZDV/formerly AZT
DidanosineddI
Stavudined4T
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