shosh: antibiotics

Inhibits transpeptidase cross-linking of bacterial cell wall

• Methicillin
• Nafcillin
• Oxacillin

Use for staph aureus (except for MRSA)

• Ampicillin and amoxicillin
• Use with clavulanic acid or sulbactam to protect against penicillinase

Ampicillin or amoxicillin

Ticarcillin, piperacillin, carbenicillin + clavulanic acid, sulbactam, or tazobactam

• Cefazolin, cephalexin
• Use for surgical prophylaxis, due to their long half lives

• Cefotaxime, ceftazidime, ceftriaxone
• Use to treat gonorrhea, sepsis, and meningitis (can cross the BBB)

• Listeria--penicillin
• Atypicals--macrolides
• MRSA--vancomycin
• Enterococci--amoxicillin

• Inhibits cell wall synthesis
• Synergistic with aminoglycosides
• No cross-allergenicity with penicillin--can be used as an alternative in patients with penicillin allergy
• ONLY works on gram negative rods

Cilastatin, to inhibit renal inactivation

Seizures

• Inhibits D-ala D-ala in bacterial cell walls
• Use for bad gram positives (S. aureus, clostridium)

Risk of ototoxicity

Vancomycin

Gentamycin, neomycin, amikacin, tobramycin, streptomycin

• Inhibit formation of the initiation complex, block mRNA translation
• Require oxygen for uptake, so don't work against anaerobes

• Nephrotoxicity
• Ototoxicity (especially when used with furosemide)
• Teratogenic

Aminoglycosides (streptomycin, neomycin, amikacin, gentamycin, tobramycin)

Binds to 30S subunit, blocks binding of aminoacyl-tRNA

• Tetracycline binds to divalent cations in the gut, which inhibits its absorption (and absorption of the cations)
• Inhibition of Ca absorption can cause dysplastic changes to teeth and bones

Doxycycline

A tetracycline that acts as an ADH antagonist. Used to treat SIADH, not used as an antibiotic

• Bind to 50S subunit, block translocation
• (names all end in ...thromycin)
• Use for atypicals (mycoplasma, legionella, chlamydia, MAC)

• Prolongation of QT interval
• GI discomfort, due to activation of motilin receptors
• Acute cholestatic hepatitis
• Increased concentration of oral anticoagulants

Chloramphenicol

Clindamycin--good for osteomyelitis because has good penetrance into bone, but DOES NOT WORK against gram negative osteomyelitis (i.e. salmonella)

Telithromycin

• Quinupristin, dalfopristin--bind to 50S ribosomal subunit
• Linezolid--blocks initiation complex formation

Dihydropteroate synthetase

TMP-SMX

Nifurtimox (arsenic)

Fluoroquinolones

• Bismuth
• Metronidazole
• Amoxicillin/tetracycline

Disulfiram like reaction with alcohol

Pyrazinamide

Ethambutol

Primaquine

• Neurotoxicity, due to similarity with B6, and impaired B6 absorption
• B3, niacin, deficiency, since B6 is needed to make B3
• Hepatotoxicity
• DI lupus

• Binds to ergosterol, causes pores to form in cell membrane
• Use for systemic mycoses (coccidioidomycosis, blastomycosis, aspergillosis, candida, mucor)

• Binds to ergosterol, disrupts fungal membranes
• Use for oral candida (too toxic for systemic use)

• Inhibit P450 14alpha demethylase, block sterol synthesis
• Use for systemic mycoses
• (Drug of choice in invasive aspergillosis)

Mebendazole (disrupts glucose uptake and microtubule structure)

Opens Ca channels in helminth cell membranes

• Inhibits RNA synthesis by conversion to 5-FU and incorporation into RNA change, inhibits DNA synthesis by inhibition of thymidine synthase
• Use of systemic fungal infections

Inhibits synthesis of beta glucans, blocks cell wall formation

• Inhibits squalene epoxidase
• Use to treat dermatophytoses

• Deposits in keratin-rich tissues, inhibits microtubule function
• Use for dermatophyte infection
• Disulfiram-like reaction

• Blocks viral penetration and uncoating
• Causes release of DA from nerve terminals
• Used to treat influenza A and Parkinson's

• Inhibits influenza neuraminidase
• Side effects are flu-like symptoms. Heehee.

• Inhibits IMP dehydrogenase, blocks synthesis of gaunine nucleotides.
• Use to treat CMV and chronic hep C, in combo with alpha interferons

Hemolytic anemia

• A prodrug that is activated by bacterial thymidine kinase and causes chain termination.
• Use for HSV, VZV, and EBV

• A prodrug that is activated by human cellular kinases and inhibits viral DNA polymerase
• First line treatment for CMV

BMS

• Inhibits viral DNA polymerase. Not a prodrug.
• Use to treat CMV retinitis when gancyclovir doesn't work

• Nephrotoxicity
• Hypocalcemia, due to Ca chelation--can be life threatening if patient is also on pentamidine, for PCP

• Squinavir, indinavir, ritonavir
• Ritonavir has lots of interactions with other drugs
• All protease inhibitors cause insulin resistance and lipodystrophy (buffalo hump, central obesity)

Causes less hyperglycemia and lypodystrophy than most protease inhibitors

• Nevirapine
• Efavirenz
• Delaviridine

Insomnia, nightmares

• NRTI
• Severe allergic reactions

Enfuvirtide

Maraviroc

Raltegravir