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penicillin G and pencillin V
- pencillinase-sensitive penicillin
- inhibit peptidoglycan xlinking cell wall. Bactericidal (mostly on g+)
- Strep pneumo, strep pyog, actinomyces
- Neis meningitidis (g-), Trep pallidum
- G is IV and IM; V is oral
- beta lactam ring
- cleaved by beta lactamase
- Hypersensitivity, direct Coombs hemolytic anemia
-
ampicllin
- penicillinase-sensitive extended spectrum penicillin
- inhibit peptidoglycan xlinking cell wall. Bactericidal (extended to more g-)
- Strep pneumo, strep pyog, actinomyces, List monocytogenes
- Neis meningitidis, H pylori, E coli, Proteus mirabilis, Salmonella, Shigella (g-), Trep pallidum
- beta lactam ring
- cleaved by beta lactamase unless claculanic acid
- Hypersensitivity, pseudomembranous colitis
- amp HHELPSS kill enterococci
-
amoxicillin
- penicillinase-sensitive extended spectrum penicillin
- greater oral bioavalability than ampicillin, otherwise same
- inhibit peptidoglycan xlinking cell wall. Bactericidal (extended to more g-)
- Strep pneumo, strep pyog, actinomyces, List monocytogenes
- Neis meningitidis, H pylori, E coli, Proteus mirabilis, Salmonella, Shigella (g-), Trep pallidum
- beta lactam ring
- cleaved by beta lactamase unless claculanic acid
- Hypersensitivity, pseudomembranous colitis
- amo HHELPSS kill enterococci
-
dicloxacillin
- penicillinase-resistant penicillin narrow spectrum
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- Methycillin sensitive staph aureus (not MRSA!)
- beta lactam ring with bulky R group
- NOT cleaved by beta lactamase
- Hypersensitivity, interstitial nephritis
- NO Degradation (d for dicloxacillin)
-
nafcillin
- penicillinase-resistant penicillin narrow spectrum
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- Methycillin sensitive staph aureus (not MRSA!)
- beta lactam ring with bulky R group
- NOT cleaved by beta lactamase
- Hypersensitivity, interstitial nephritis
- NO Degradation (n for naf)
-
oxacillin
- penicillinase-resistant penicillin narrow spectrum
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- Methycillin sensitive staph aureus (not MRSA!)
- beta lactam ring with bulky R group
- NOT cleaved by beta lactamase
- Hypersensitivity, interstitial nephritis
- NO Degradation (o for oxacillin)
-
piperacillin
- antipseudomonal penicillinase-sensitive extended spectrum penicillin
- inhibit peptidoglycan xlinking cell wall. Bactericidal (extended to pseudomonas and g-)
- Strep pneumo, strep pyog, actinomyces, List monocytogenes
- Neis meningitidis, H pylori, E coli, Proteus mirabilis, Salmonella, Shigella, Pseudomonas (g-), Trep pallidum
- beta lactam ring
- use with claculanic acid to prevent beta lactamase
- Hypersensitivity
-
ticarcillin
- antipseudomonal penicillinase-sensitive extended spectrum penicillin
- inhibit peptidoglycan xlinking cell wall. Bactericidal (extended to pseudomonas and g-)
- Strep pneumo, strep pyog, actinomyces, List monocytogenes
- Neis meningitidis, H pylori, E coli, Proteus mirabilis, Salmonella, Shigella, Pseudomonas (g-), Trep pallidum
- beta lactam ring
- use with claculanic acid or sulbactam or tazobactam to prevent beta lactamase
- Hypersensitivity
-
calvulanic acid
- beta lactamase inhibitor
- add to penicillins
- CAST for penicillins (Calvulanic Acid, Sulbactam, Tazobactam)
-
sulbactam
- beta lactamase inhibitor
- add to penicillins
- CAST for penicillins (Calvulanic Acid, Sulbactam, Tazobactam)
-
tazobactam
- beta lactamase inhibitor
- add to penicillins
- CAST for penicillins (Calvulanic Acid, Sulbactam, Tazobactam)
-
cefazolin
- 1st gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- staph, strep, Proteus mirabilis, E coli, Klebsiella pneumoniae
- prior to surgery to prevent staph
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- Don't phal for/be fazed by the 1st gen. They ain't worth a PEcK (proteus, e coli, klebsi)
- Faze 1 of surgery
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
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cephalexin
- 1st gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- staph, strep, Proteus mirabilis, E coli, Klebsiella pneumoniae
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- Don't phal for/be fazed by the 1st gen. They ain't worth a PEcK (proteus, e coli, klebsi)
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
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cefaclor
- 2nd gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- staph, strep, Proteus mirabilis, E coli, Klebsiella pneumoniae, H flu, Enterobacter aerogenes, Neisseria, Serratia marcescens
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- HENS PEcK at fake fox fur (HENS = H flu, Enterobacter aerogenes, Neisseria, Serratia marcescens) (fake = cefaclor) (hen = 2nd gen)
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
-
cefoxitin
- 2nd gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- staph, strep, Proteus mirabilis, E coli, Klebsiella pneumoniae, H flu, Enterobacter aerogenes, Neisseria, Serratia marcescens
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- HENS PEcK at fake fox fur (HENS = H flu, Enterobacter aerogenes, Neisseria, Serratia marcescens) (fox = cefoxitin) (hen = 2nd gen)
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
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cefuroximine
- 2nd gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- staph, strep, Proteus mirabilis, E coli, Klebsiella pneumoniae, H flu, Enterobacter aerogenes, Neisseria, Serratia marcescens
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- HENS PEcK at fake fox fur (HENS = H flu, Enterobacter aerogenes, Neisseria, Serratia marcescens) (fur = cefuroxime) (hen = 2nd gen)
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
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ceftriaxone
- 3rd gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- serious Neisseria (meningitis, gonorrhea) disseminiated Lyme
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- T.X., T.Z. are 3 (3rd gen) (ceftriaxone)
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
-
cefotaxime
- 3rd gen cephalosporin (same as ceftriaxone)
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- serious Neisseria (meningitis, gonorrhea) disseminiated Lyme
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- T.X., T.Z. are 3 (3rd gen) (cefotaxime)
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
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ceftazidime
- 3rd gen cephalosporin (same as ceftriaxone)
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- pseudomonas but not as good as cefepime
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- T.X., T.Z. are 3 (3rd gen) (ceftazidime)
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
-
cefepime
- 4th gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- staph, strep, Proteus mirabilis, E coli, Klebsiella pneumoniae, best for pseudomonas
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- Fep fell pseudomonas
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
-
ceftaroline
- 5th gen cephalosporin
- inhibit peptidoglycan xlinking cell wall. Bactericidal
- staph, strep, Proteus mirabilis, E coli, Klebsiella pneumoniae, H flu, Enterobacter aerogenes, Neisseria, Serratia marcescens MRSA but not pseudomonas
- beta lactam but less susceptible to beta lactamase
- resistance by penicillin binding protein change aka transpeptidase change
- hypersensitivity (penicillin allergy is a no go), direct Coombs hemolytic anemia, disulfram-esque (alcohol), Vit K deficiency, increase nephrotox of aminoglycosides
- Organisms not covered by gens 1-4 are LAME (listeria, atypicals (mycoplas and chlam), MRSA, Enterococci (group D "strep" E faecium, E faecalis)
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imipenem
- carbapenem
- inhibit peptidoglycan xlinking cell wall. Bactericidal broad sepctrum g+, g-, anaerobes
- beta lactam resistant
- bad adverse effects GI, skin rash, CNS tox (seizures), so only used when others fail or life threatening infection
- dehydropeptidase I in renal tubule inactivates drug
- cilastatin inhibits dehydropeptidase I to make the drug lastin
-
meropenem
- carbapenem
- inhibit peptidoglycan xlinking cell wall. Bactericidal broad sepctrum g+, g-, anaerobes
- beta lactam resistant
- bad adverse effects GI, skin rash, but decreased risk of CNS tox (seizures), only used when others fail or life threatening infection
- not degraded by dehydropeptidase I in renal tubule
- cilastatin not needed
-
ertapenem
- carbapenem
- inhibit peptidoglycan xlinking cell wall. Bactericidal broad sepctrum g+, g-, anaerobes
- beta lactam resistant
- bad adverse effects GI, skin rash, CNS tox (seizures), so only used when others fail or life threatening infection
- dehydropeptidase I in renal tubule inactivates drug
- cilastatin inhibits dehydropeptidase I to make the drug lastin
-
doripenem
- carbapenem
- inhibit peptidoglycan xlinking cell wall. Bactericidal broad sepctrum g+, g-, anaerobes
- beta lactam resistant
- bad adverse effects GI, skin rash, CNS tox (seizures), so only used when others fail or life threatening infection
- dehydropeptidase I in renal tubule inactivates drug
- cilastatin inhibits dehydropeptidase I to make the drug lastin
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aztreonam
- monobactam
- inhibit peptidoglycan xlinking cell wall by binding penicillin binding protein 3. Bactericidal gram negative rods that are aerobes only (H flu, enterobacter, pseudomonas)
- synergistic with aminoglycosides
- Usually non toxic (no penicillin cross reactivity)
-
vancomycin
- binds D-ala D-ala to inhibit cell wall peptidoglycan formation. Bactericidal most tough g+ and bacteriostatic C diff (oral)
- Resistance if D-ala D-lac
- nephrotox, ototox, thrombophlebitis, red man syndrome (prevented with pretreat antihistamine and slow infusion)
- the fine print for the vanc account was NOT read (nephro/ototox, thrombophelbitis, red man) and now I lack a dolla lac and "D-ala"
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bacitracin
- inhibits cell wall peptidoglycan formation
- topical
- for beta hemolysis strep agalactiae is resistant; strep pyogenes is sensitive
- B-BRAS (bacitracin group B Resistant [agalctiae], group A Sensitive [pyogenes])
-
optochin
- for alpha hemolysis viridans strep (S mutans, mitis) is resistant; strep pneumoniae is sensitive
- OVeRPaSs (Optochin Viridans Resistant; Pneumonia Sensitive
-
novobiocin
- for coagulase negative staph staph saprophyticus is resistant; staph epidermidis is sensitive
- NO StRESs on the staph retreat (NOvobiocin Saprophyticus Resistant; Epidermidis Sensitive
-
aminoglycoside
- binds 30S subunit preventing initiation complex formation, misread mRNA, block xlocation. Bactericidal g- aerobes (O2 dependent uptake)
- synergy with beta lactam antibioitics
- bacteria acetylate, phosphorylate, adenylate drug (transferases) to inactivate
- buy AT 30 CeL 'eM for 50 (Aminoglycosides, Tetracyclines inhibit 30S subunit; Clindamycin/Chloramphenicol, Linezolid, Macrolides inhibit 50S subunit.
- A mean gent strept ami and neomi to bras. That's deafinitely bad for babies' and kids' idea of strong men (ototox, teratogen, nephrotox, neuromuscular block)
-
gentamicin (class/special?)
- aminoglycoside
- A mean gent strept ami and neomi to bras (a mean oglycoside, gentamicin, streptomycin, amikacin, neomycin, tobramycin)
-
streptomycin (class/special?)
- aminoglycoside
- 2nd line mycobacterium tuberculosis
- tinnitus, vertigo, ataxia, nephrotoxicity
- A mean gent strept ami and neomi to bras (a mean oglycoside, gentamicin, streptomycin, amikacin, neomycin, tobramycin)
-
amikacin (class/special?)
- aminoglycoside
- A mean gent strept ami and neomi to bras (a mean oglycoside, gentamicin, streptomycin, amikacin, neomycin, tobramycin)
-
neomycin (class/special?)
- aminoglycoside
- A mean gent strept ami and neomi to bras (a mean oglycoside, gentamicin, streptomycin, amikacin, neomycin, tobramycin)
-
tobramycin (class/special?)
- aminoglycoside
- A mean gent strept ami and neomi to bras (a mean oglycoside, gentamicin, streptomycin, amikacin, neomycin, tobramycin)
-
tetracyclines
- tetracycline, doxycycline, minocycline
- bind A site on 30S prevent new tRNA attach. Bacteriostatic borrelia burgdorferi, mycoplasma pneumoniae, rickettsia, chlamydia (good intracellular concentration), acne
- low CNS penetration. divalent cations prevent gut absorption (milk [Ca], antacids [Ca, Mg], iron)
- plasmid-encoded pump it out of bacteria
- GI, yellow teeth/inhibit bone growth in kids (teratogen), photosensitivity (think Peru)
- Had an upset stomach b/c yellow teeth and looked short in the photo (GI, yellow teeth, inhibit bone growth, photosensitivity
- buy AT 30 CeL 'eM for 50 (Aminoglycosides, Tetracyclines inhibit 30S subunit; Clindamycin/Chloramphenicol, Linezolid, Macrolides inhibit 50S subunit.
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minocycline (class/special?)
tetracycline
-
doxycycline (class/special?)
- fecal-elimination tetracycline, safe in renal failure
- doodoo cycle
-
chloramphenicol
- blocks peptidyl transferase at 50S subunit. Bacteriostatic meningitis (H flu, N mening, S pneumo), rickettsia rickettsii (rocky mtn spotted fever)
- anemia, anaplastic anemia, gray baby (premies lack UDP-glucuronyl transferase). rarely used in US (tox)
- takes the cholor out of you (anemia, gray baby)
- buy AT 30 CeL 'eM for 50 (Aminoglycosides, Tetracyclines inhibit 30S subunit; Clindamycin/Chloramphenicol, Linezolid, Macrolides inhibit 50S subunit.
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clindamycin
- block translocation at 50S. Bacteriostatic anerobic above diaphragm (metro below)(aspiration pneumonia [bacteroides, clostridium perfinges], lung abscess, oral infection, invasive strep pyog, gardnerella vag (so it can be used below too)
- buy AT 30 CeL 'eM for 50 (Aminoglycosides, Tetracyclines inhibit 30S subunit; Clindamycin/Chloramphenicol, Linezolid, Macrolides inhibit 50S subunit.
- pseudomembranous colitis, fever, diarrhea
- Good above diaphragm bad below (C diff)
-
linezolid
- oxazolidinone
- bind to 50S preventing binding to 30S. Bacteriostatic/cidal g+ (including MRSA and VRE)
- 50S ribosomal RNA point mutation resistance
- bone marrow suppression, peripheral neuropathy, serotonin syndrome
- Not lyin' when I say marrowage makes my toes tingle and my heart pound (marrow suppression, peripheral neuropathy, serotonin syndrome)
-
macrolides
- bind to 23S rRNA of 50S blocking translocation. Bacteriostatic atpyical pneumonia (mycoplasma, chlamydia, legionella), bordatella pertusis, strep (when penicillin allergy), STIs (chlamydia)
- methylation of 23S rRNA resistance
- GI motility, long QT, cholestatic hepatitis, rash, eosinophilia
- MACRO side effects (Motility, Arrhythmia, Cholestatic hepatitis, Rash, eOsinophilia)
- macaroni is clear az air without cheese (clarithromycin, azithromycin, erythromycin)
-
clarithromycin (class/special?)
- macrolide
- macaroni is clear az air without cheese (clarithromycin, azithromycin, erythromycin)
- inhibit P-450
- embryotoxic
-
azithromycin (class/special?)
- macrolide
- macaroni is clear az air without cheese (clarithromycin, azithromycin, erythromycin)
- does NOT inhibit P-450 (erythromycin, clarithromycin are)
-
erythromycin (class/special?)
- macrolide
- macaroni is clear az air without cheese (clarithromycin, azithromycin, erythromycin)
- inhibit P-450
-
sulfonamides
- sulfamethoxazole (SMX), sulfisoxazole (NOT -azoles!), sulfadiazine
- inhibit dihydropeteroate (PABA+pteridine->dihydropteroic acid), part of folate synthesis, reducing THF (purines, thymidine for DNA, and methionine for protein). Bacteriostatic g+, g-, nocardia, chlamydia. Bacteriocidal with trimethoprim
- resistance by altered dihydropteroate synthase, reduced uptake, increased PABA synthesis
- hypersensitivity, G6PD def hemolysis, nephrotox (tubulointerstitial nephritis), photosens, kernicterus in infants, displace warfarin/others from albumin
- SulTry is folly (sulfa inhibit 1st step in folate pathway)
- I sulled (sold) kids photos of baby corn to buy favabean war rashions (sulfonamides, nephrotox, infant kernicterus, G6PD hemolysis, albumin, hypersensitivity)
-
sulfamethoxazole (class/special?)
-
sulfisoxazole (class/special?)
sulfonamide
-
sulfidiazine (class/special?)
sulfonamide
-
dapsone
- same as sulfonamide antibiotics, different structure
- inhibit dihydropeteroate (PABA+pteridine->dihydropteroic acid), part of folate synthesis, reducing THF (purines, thymidine for DNA, and methionine for protein). Leprosy (lepromatous and tuberculoid), pneumocystis jirovecii prophylaxis
- hemolysis if G6PD deficient
-
trimethroprim
- aka TMP
- inhibits bacterial dihydrofolate reductase (dihyrofolic acid->THF), reducing purines, thymidine for DNA, and methionine for protein. Further down than sulfonamides/dapsone in folate pathway. Bacteriostatic combo with sulfonamides for UTI, shigella, salmonella, pneumocystis jirovecii (tx and prophylaxis), toxoplasmosis prophylaxis
- megaloblastic anemia, leukopenia, granulocytopenia (give with folinic acid)
- sultry is folly (trimethoprime ihibit last step in folate metabolism)
-
fluoroquinolones
- ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin
- inhibit prokaryotic topoisomerase II (DNA gyrase) and IV. Bactericidal g- of UTI and GI (including pseudomonas), neisseria, some g+
- chromosome mutation in DNA gyrase, plasmid-encoded pump out
- GI upset, superinfections, skin rash, headache, dizziness, long QT (some), leg cramp/myalgia, damage growing cartilage (contraindicated pregnant, nursing, under 18), tendonitis/rupture in over 60 pop. or with prednisone
- flox of 2 and 4 tangled flouers (topoisomerase II and IV)
- fluoroQTbones (long QT, cartilage for kids, tendon for old/steroids)
-
enoxacin (class)
fluoroquinolone
-
daptomycin
- disrupts cell membrane of g+ staph aureus (esp MRSA), bacteremia, endocarditis, VRE (vanc resistant enterococci)
- surfactant in lungs inactivates it, can't tx pneumonia
- myopathy, rhabdomyolysis
- lungs and muscle adapt when running (no pneumonia coverage, myopathy/rhabdomyolysis, daptomycin)
-
metronidazole
- forms ROS damage DNA. Bactericidal anerobic below diaphragm (clinda above) bacteroides, Clostridium difficile, H pylori (triple therapy w/ PPI and clarithromycin), gardnerella vag. Antiprotazoal giardia, entamoeba, trichomonas
- disulfram-like, headache, metalic taste
- GET pro radicals off the metro (Giardia, Entamoeba, Trichomonas [protozoa], free radicals, metronidazole)
- The alcohol I bought on the metro had a metalic taste and gave me a headache (disulfram-like, metronidazole, metalic taste, headache)
-
rifamycins
- inhibit RNA polymerase, reducing mRNA synthesis. Mycobacterium tuberculosis, delay dapsone leprosy resistance, meningococcal prophylaxis for contact of child w/ H flu B
- rifampin is P-450 inducer; rifabutin is not, orange body fluid(both)
- RifAMPin ramps up P-450 but rifaBUTin does not
- RNA polymerase mutation, rapid resistance if monotherapy
- orange tipped rifle only hated by the NRA (orange fluid, rifamycin, don't use alone, RNA inhib)
- TB is RIPE for treatment (Rifamycins, Isoniazid, Pyrazinamide, Ethambutol)
-
rifampin (class/special?)
- rifamycin
- P-450 inducer
- RifAMPin ramps up P-450 but rifaBUTin does not
- TB is RIPE for treatment (Rifamycins, Isoniazid, Pyrazinamide, Ethambutol)
-
rifabutin (class/special?)
- rifamycin
- NOT a P-450 inducer (rifampin is), favored over rifampin for HIV patient
- RifAMPin ramps up P-450 but rifaBUTin does not
- TB is RIPE for treatment (Rifamycins, Isoniazid, Pyrazinamide, Ethambutol)
-
isoniazid
- aka INH
- decrease synthesis of mycolic acids (2nd layer of cell wall), converted to activce form by KatG encoded catalase peroxidase. Mycobacterium tuberculosis (tx and monotx prophylaxis/latent TB)
- resistance by mutation reduces KatG
- inhibits P-450, drug-induced lupus, hepatoxcitiy, halflife altered by slow/fast acetylators, induces vit B6 deficiency (sideroblastic anemia, peripheral neuropathy [mito iron bulidup])
- INHA6 isoniazid (Inhibit P-450, Nduced lupus, Hepatotox, Acetylators, b6 def)
- TB is RIPE for treatment (Rifamycins, Isoniazid, Pyrazinamide, Ethambutol)
-
pyrazinamide
- mech uncertain (intracellular prodrug) works best in acid (host phagolysosome). Mycobacterium tuberculosis
- hyperurecemia, hepatotoxicity
- TB is RIPE for treatment (Rifamycins, Isoniazid, Pyrazinamide, Ethambutol)
-
ethambutol
- inhibit arabinogalactan synthesis (3rd layer of cell wall) by blocking arabinosyltransferase to reduce carbohydrate polymerization. Mycobacterium tuberculosis
- red-green color blind
- ethan hunt snipes arabs (ethambutol, optic neuropathy, arabinogalactans)
- TB is RIPE for treatment (Rifamycins, Isoniazid, Pyrazinamide, Ethambutol)
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