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ARVS
NRTIs names?
NNRTIs names?
PIs names?
- Nukes- AZT, 3tC, DDI, D4T
- Non Nukes- EFV, NVP (Nevirapine)
- Protease Inhibitors-Lopinavair, Ritonavir
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How do nukes work?
grab DNA reverse transcriptase is trying to build
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How do non nukes work?
hook reverse transcriptase itself to keep it from working
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How do PIs work?
prevent final assembly of virus
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Who needs ARVs?
- Depends on CD4 count (WHO stage II w CD4 count below 350mm3
- clinical sx (opportunistic infections)
- do they want to
- WHO stage 3 of HIV disease regardless of CD4 count
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ARV tx success?
by 24 weeks less than 400 copies/mL
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HIV SEs
drug adverse effects
anorexia, sore dry mouth, swallowing difficulties, constipation/diarrhea, n/v/altered taste, depression tiredness lethargy
Lactic acidosis, hepatox, pancreatitis, peripheral neuropathy, fat accumulation, hyperlipidemia, premature CAD, hyperglycymie, insulin resistance/DM, bone disorders, osteoperosis, bone marrow suppression, hypersensitivity reactions, skin rashes
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What ABs can cause renal toxicity?
aminoglycosides and sulfanamides, flouroquinalones
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What abs can cause thrombocytopenia
penicillins and cephalosporins
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ABs and weird side effects in kids
weight bearing joint effects?
ototoxicity and nephrotoxicity?
blacken teeth
liver and kidney monitoring in babies?
- flouroquinalones
- aminoglycosides
- tetracyclines
- clindamycin
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which ABs alter membrane perm?
PCNs, cephalo, vanco
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which ABs inhib protein sybnth
EES, tetracyclines, clindamycin, aminoglycosids
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Which ABs inhibit nucleic acid syth?
flouroquinalones, HIV anti retrovirals
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Which AB inhibits cell metab and growth?
sulfanamides
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Which ABs effect bacterial cell walls?
- Penicillins
- Cephalosporins-cefotaxime
- Vancomycins-vancomycin
- Carbapenems-meropenem
- Monobactam
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Which ABs have beta lactam?
penicillins, cephalosporins, carbapenems
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broad spectrum ABs
- cephalosporins
- Carbapenems
- Tetracyclines
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ABs w AEs other than nvd and allergies
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cephalosporins
don't give if
- pt is allergic to penicillins
- Oral—Keflex (cephalexin); Ceclor (cefaclor), Lorabid (lorcarbef); Omnicef (cefdinir)
- Parenteral—Ancef (kefzol); Mefoxin (cefoxitin); Claforan (cefotaxime), Fortaz (ceftazidime), Rocephin (ceftriaxone); Maxipime (cefepime)
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Carbapenems (meropenem, primaxin)
how given?
all parenteral
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Monobactam (azactam, aztreonam)
- has beta lactams, but stable in presc of beta lactamase
- active against g- bacteria, lots of resistant strains
- preserves normal g pos and anaerobic flora
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ABs affecting protein synthesis
- aminoglycosides- gentamycin
- tetracyclines-tetracycline
- macrolide antibiotics-erythromycin
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Narrow spectrum ABs
Aminoglycosides
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Bacteriocidal ABs
Aminoglycosides/gentamycin (G- orgs), flouroquinalones (cipro)
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Aminoglycosides
what do they do? How? spectrum?
AEs
How do you check therapeutic levels?
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cidal G-, G+, narrow spect
- protein synth inhibitors
- pneumonia, MRSA, some URIs, endocarditis, bacteremia, sepsia, skin infections, UTIs
- accumulate in kidneys and ears
- ototox, nephrotox
- Peak and trough
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Bacteriostatic ABs
Sulfas, Tetracyclines
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What AB do they give for chlamydia, mycoplasma, protozoa?
tetracyclines
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What AB causes renal and phototoxicity and kid's teeth blue?
tetracyclines
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What do macrolides (erythromycin, Zithromax (azithromycin), Biaxin (clarithromycin), and Dynabac (dirithromycin) work against?
what kind of tox is risk?
DDIs with
- G+ cocci like Neisseria, terponema, mycoplasma, bacteroides, clostridia, corynebacterium
- liver/hepatic
- coumadin, theophylline, prednisone, norpace, lanoxin, tegretol, alfenta, parlodel (dopamine agonist)
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What ABs are contraindicated in liver disease?
flouroquinalones, macrolides
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photosensitivity
Fucking terrible sunburn
flouroquinalones, macrolides, sulfanamides
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Vancomycin
often treats
- MRSA
- G + only, hypotension, flushing, rash
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Cleocin (clindamycin)
- G+ cocci
- good for acne and BV
- can cause colitis
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Flagyl
- good against clostridium and protozoa like giardis, amebiasis, trich
- topically for rosacea, BV
- avoid ETOH
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Aminoglycoside DDIs
amphocerin, vancomycin, cephalosporins, loop ds, neuro blocking agents can inc effects
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What are sulfas used for
UTIs, pneumocystis carinii
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Which ABs can cause bone marrow depression, folic acid def, and cholestatic jaundice?
may cause crystalluria, tx ulcerative colitis and RA
Sulfonamides
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silver sulfadiazine is useful in_____
burns
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Antifungals
- fluconazole (Diflucan)
- Nystatin (P), (Mycostatin)
- may be used orally, topically or vaginally
- generally well tolerated
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Acyclovir is a_________
for?_________
AEs
- antiviral
- HSV, Herpes zoster
- lightheadedness, anorexia, n/v, HA
- confusion, tremors, sz
- IV may be nephrotoxic
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