med agents final

• most potent FQ against GM- bacteria
• limited activity vs strep and anareobes
• UTI=GM- =cipro but resistance with monotherapy
• BID dosing t1/2=5 hours
• first broad spec

• GM+ anaerobe
• upper respieratory tract
• active vs pen presistant and macrolide resistant strep pneumo and pseudomonasaeruginosa
• 5x more soluble than oflox

• gm + anaerobe
• upper respiratory tract
• improved activity vs strep pneumoniae
• resaonable anaerobic activity
• mainly metbaolized by conjugation
• NO URINARY EXCRETION
• longest t/12
• dont need to adjust in renal failure
• watch interaction with antiarrhythmics
• active for MDRTB

• first FQ
• low bioavailability

• racemate has 1/2 the activity of LEVOfloxacin
• opthlamic available
• IV/PO
• generic available

• DOC chlamydia trachomatis (7d) borellia, anaplasma, ehrlichia and rickettsia
• bronchitis,
• CAP--not atypicals
• broad spec gm + gm - atypical organisms tick borne pathogens
• take on an empty stomach avoid vitamins do not lay down x30 minutes

• very broad spec MRSA and VRE and nosocimial enterobacteriaciae
• IV only
• NAUSEA 40%
• photosensitivity

• metabolized
• somewhat more lipophilic at physiological pH reaches higher concentrations in tears and saliva --useful for meningococcal carrier state

• not for pseudomonas auerginosa (76%R) okay for serratia (93%)
• good for gram negative
• mixture of drugs
• inactivated by 2' adenylation and acetylation at the 2'6'and 3' positions

• good for pseudomonas aerginosa (95%) not for serratia(79%)
• good for gram - infections
• less renal dysfunction
• inactivated by 2' adenylation and acetylation at the 2'6'and 3' positions

• synthetic AG analog
• used for infections resistant to other AG
• not good for pseudomonas
• exellent gm -
• only inactivated by 6'acetylation and is resistant to other inactiviating enzymes

neomycin>gentamicin=amkikacin= netilmicin>tobramycin>streptomycin

streptomycin =kanamyin > amikcacin=gentamicin = tobramycin>netlimycin

• combines with cytoplasmic membran sterols
• broad specturm of ctivity versus a variety of funagl pathogens TOXIC
• first line for cryptococcus neoformans, histoplasma capsulatim blastomyces
• highest concentrations in liver > spleen = kidneys> lungs>heart = muscles>bone
• LOW RENAL not UTI
• adverese effects--RENAL TOXICITY, binds renal sterols, GI problems, hypokalemia, phlebitis, thrombophlebitis at injection site
• give APAP 500 mg 30 min prior to to prevent rigors

amphotericin B, toxicity effects, 0.5mg/kg/dose

amphotericin B lipid complex,

more effective less toxic than fungizone, $$$$$

• candida albicans--UTIs
• cryptococcal meningitis first line
• if fail azoles
• PO
• well distrubited reaches joints, CSF levels high
• 80-90% renally eliminated

• water soluble triazole, PO and IV
• tx thrush, candida albicans esophagitis cryptococcus
• paritally effective for inital teatment of cryptococcal meningitis in AIDS to prevent candida infections
• achieve adequate CFS concentrations preferred for meningitis
• adjust in renal failure
• best tolerated

• broad spec not as efective as amb for serious systemic fungal injfections
• highly protein bound ery lipophilic go to fat, liver kidney and skin
• primarily metabolized--excreted in bile

• broad spec
• expanded spec including ASPERGILLUS
• primary indications--blastomycosis pumonary and extrapulmonary and histoplasmosis DOC sporotrix schenkii, toenail infections $$
• hepatic metabolized--almost entirely, active metabolite hydroxyitraconazole
• Take with food
• highly protein bound

• second generation triazole enhanced activity vs flucoanzole resistnat C Krusei and grabrata IV and PO
• GOLD STANDARD FOR ASPERGILLUS
• ideal po to IV switch
• LARGE volume of distribution
• almost completley metabolized--saturable, CYP2C19 drug interactions!!
• VISUAL DISTURBANCES

• ORAL PROPHYLAXIS FOR ASPERGILLOSIS
• auc 4 x higher when given with fatty meal vs fatty state
• large volume of distrubution
• PROLONG QTC interval

• AZOLES=INHIBITORS!!DRUGS HAVE INCREASED LEVEL!! therefore you will need to redraw levels of cyclosproin, HIV protease inhibitors tacrolimus (keto) phenytoin, warfarin (fluc)-- rifampin decreaesd auc of fluc 25%
• itraconazole---tacrolimus, cyclosporin, warfarin
• VORICONAZOLE--antiregctuoin drug, rifabutin increased 331% 3A4 substrate!!
• posaconazole--inhibits rifabutin but induces metabolism of rifampin.

echinocandin--aspergillus not first line , long half life and large volume of distrubution. load dose