Antimicrobials Flashcards
Enfurvitide (Fuzeon/T20) Misc
Injection only
Trimethoprim Class
Antimetabolite (DHFR Inhibitor)
Sulfamethoxazole Class
Antimetabolite (Dihydropterate synthase inhibitor)
Isoniazid (INH) Class
Antitubercular antimetabolite
Rifampin Class
Antitibuercular antimetabolite
Pyrazinamide Class
Antitubercular antimetabolite
Ethambutol Class
Antitubercular antimetabolite
Acyclovir (Zovirax) Class
Purine analog (guanosine)
Ganciclovir (Zirgan) Class
Purine analog (guanine)
Foscarnet (Foscavir) Class
Pyrophosphate congener
Oseltamivir (Tamiflu) Class
Neuraminidase inhibitor
Zidovudine (Retrovir/AZT) Class
NRTIs
Efavirenz (Sustiva/EFV) Class
NNRTIs
Ritonavir (Norvir/RTV) Class
Protease inhibitors
Enfurvitide (Fuzeon/T20) Class
Fusion inhibitors
Raltegravir (Isentress) Class
HIV integrase inhibitor
Amphotericin B Class
Polyene / Cell membrane inhibitor
Nystatin Class
Polyene / Cell membrane inhibitor
Clotrimazole (lotrimin); Fluconazole (diflucan) Class
Azole / Cell wall synthesis inhibitor
Tolnaftate; Terbinafine (lamisil) Class
Allylamine / Cell wall synthesis inhibitor
Capsofungin (Cancidas) Class
Echinocandin / Cell wall synthesis inhibitor
Flucytosine (Ancobon) Class
Nucleic acid synthesis inhibitor
Trimethoprim MOA
inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in sequential inhibition of enzymes of the folic acid pathway
Sulfamethoxazole MOA
interferes with bacterial folic acid synthesis and growth via inhibition of dihydrofolic acid formation from paraaminobenzoic acid (PABA)
Isoniazid (INH) MOA
binds to and inhibits enzymes necessary for mycobacterium cell wall synthesis
Rifampin MOA
inhibits mRNA synthesis in bacteria
Pyrazinamide MOA
unknown; it is known to be bacteriocidal when used in combination with IHN, rifampin, and ethambutol
Ethambutol MOA
inhibits enzyme that is involved with mycobacterium cell wall synthesis
Acyclovir (Zovirax) MOA
Binding to enzymes produce inactive compounds, which stop nucleic acid synthesis
Ganciclovir (Zirgan) MOA
Binding to enzymes produce inactive compounds, which stop nucleic acid synthesis
Foscarnet (Foscavir) MOA
Binding to enzymes produce inactive compounds, which stop nucleic acid synthesis; highly ionized (no oral utility, renal excretion)
Oseltamivir (Tamiflu) MOA
Prevent viral release from host cells
Zidovudine (Retrovir/AZT) MOA
Inhibits reverse transcriptase
Efavirenz (Sustiva/EFV) MOA
bind directly to reverse transcriptase and inhibit its action
Ritonavir (Norvir/RTV) MOA
bind within active pocket of protease, inhibiting binding of virus
Enfurvitide (Fuzeon/T20) MOA
prevents fusion of virus into host cell
Raltegravir (Isentress) MOA
necessary for insertion of viral DNA into human genomic DNA
Amphotericin B MOA
drug binds to ergosterol in fungal plasma membrane –> forms pores that disrupt fungal membrane –> reuslts in fungal cell death
Nystatin MOA
Pores are formed in the fungal cell membrane, allowing leakage of K+ and Mg+
Clotrimazole (lotrimin); Fluconazole (diflucan) MOA
Inhibit ergosterol synthesis by inhibiting lanosterol demethylase
Tolnaftate; Terbinafine (lamisil) MOA
Inhibit ergosterol synthesis by inhibiting squalene epoxidase
Capsofungin (Cancidas) MOA
Inhibits glucan synthase complex
Flucytosine (Ancobon) MOA
Prodrug converted by fungal enzyme to analog inhibitor of pyrimidine nucleotide synthesis
Trimethoprim Therapies
Uncomplicated UTIs; Pneumocystis pneumonia & Toxoplasmosis infections in immunocompromised patients
Sulfamethoxazole Therapies
Uncomplicated UTIs; Pneumocystis pneumonia & Toxoplasmosis infections in immunocompromised patients
Isoniazid (INH) Therapies
TB
Rifampin Therapies
TB
Pyrazinamide Therapies
TB
Ethambutol Therapies
TB
Acyclovir (Zovirax) Therapies
HSV, VZV (requires higher dose than HSV)
Ganciclovir (Zirgan) Therapies
Treatment & prophylaxis of CMV retinitis in HIV
Foscarnet (Foscavir) Therapies
Broad spectrum (HSV/VZV/CMV, and RNA viruses (including HIV))
Oseltamivir (Tamiflu) Therapies
Influenza A, influenza B, H1N1 (treat within 1-2 days of symptoms to speed functional recovery, decrease viral shedding duration)
Zidovudine (Retrovir/AZT) Therapies
HIV
Efavirenz (Sustiva/EFV) Therapies
HIV
Ritonavir (Norvir/RTV) Therapies
HIV
Enfurvitide (Fuzeon/T20) Therapies
HIV
Raltegravir (Isentress) Therapies
HIV
Amphotericin B Therapies
life threatening systemic infections
Nystatin Therapies
Topically (powder) against superficial fungal infections (candidiasis only)
Clotrimazole (lotrimin); Fluconazole (diflucan) Therapies
Workhorses for candidiases and dermatophytes (troche dosage form very useful due to mucosal contact time)
Tolnaftate; Terbinafine (lamisil) Therapies
Topical dermatophytes (limited utility against candida)
Capsofungin (Cancidas) Therapies
Life-threatening fungal infections unresponsive to older agents (especially candida, aspergillus)
Flucytosine (Ancobon) Therapies
Used in combo with amphotericin B in life threatening fungal infections in immunocompromised patients
Trimethoprim SE
rash (SJS), bone marrow suppression
Sulfamethoxazole SE
rash (SJS), bone marrow suppression
Isoniazid (INH) SE
peripheral neuritis (most common); hepatitis and hepatotoxicity (most severe)
Rifampin SE
nausea, vomiting, rash
Pyrazinamide SE
hepatitis, acute gout
Ethambutol SE
optic neuritis (most common)
Acyclovir (Zovirax) SE
malaise, HA, N/V/D, Low toxicity (CNS side effects if improper dosage in context of renal failure)
Ganciclovir (Zirgan) SE
Neutropenia, thrombocytopenia; adverse CNS effects
Foscarnet (Foscavir) SE
Dose-dependent renal, electrolyte/metabolic abrnormalities, and CNS toxicities
Oseltamivir (Tamiflu) SE
Neuropsychiatric toxicity has been reported
Zidovudine (Retrovir/AZT) SE
Granulocytopenia; N & V; anemia
Efavirenz (Sustiva/EFV) SE
CNS symtpoms, vivid dreams, drowsiness, teratogenic
Ritonavir (Norvir/RTV) SE
Lipodystrophy syndrome (hyperglycemia, hyperlipidemia, fat distribution)
Enfurvitide (Fuzeon/T20) SE
local injection sight reaction, increased rate of bacterial pneumonia
Raltegravir (Isentress) SE
nausea, HA, diarrhea, myopathy & rhabdomyolysis
Amphotericin B SE
fever, chills, kidney failure, hypotension, andemia, hypomagensemia, hypokalemia
Nystatin SE
Clotrimazole (lotrimin); Fluconazole (diflucan) SE
Hepatotoxicity (rarely); inhibits CYP450
Tolnaftate; Terbinafine (lamisil) SE
Hepatotoxicity (rarely)
Capsofungin (Cancidas) SE
very few side effects, hepatotoxicity (rarely)
Flucytosine (Ancobon) SE
Sloughing of GI mucosa; centrolobular hepatitis; bone marrow cytopenias
Trimethoprim Misc
usually given as combo with sulfamethoxazole (Bactrim)
Sulfamethoxazole Misc
Usually given as combo with trimethoprim (Bactrim)
Foscarnet (Foscavir) Misc
Used for invasive HSV/VZV infections from acyclovir resistant strains; alternative to ganciclovir for CMV
Oseltamivir (Tamiflu) Misc
Prophylaxis considered if in high-risk confined populations (nursing homes) or post-exposure prophylaxis for family members at high risk for severe disease
Enfurvitide (Fuzeon/T20) Misc
injection only
Nystatin Misc
Not use against dermatophytes
Clotrimazole (lotrimin); Fluconazole (diflucan) Misc
Clotrimazole = topical; fluconazole = systemic
Tolnaftate; Terbinafine (lamisil) Misc
Terbinafine (effective against onychomycoses); tolnaftate (oral only; weak agent)