Antimictobials, Antibacterial, Antifungal, Antiviral, Antiprotozoal, Antihelminths Flashcards by Rhaizza Mae Guerra

BacteriCIDAL Antibiotics

"Very Finely Proficient At Murder"
vancomycin
fluoroquinolones
Penicillins
Aminoglycosides
Metronidazole

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BacterioSTATIC Antibiotics

"we're ECSTaTic about bacteriostatics"
erythromycin
clindamycin
sulfamethoxazole
trimethoprim
tetracycline
chloramphenicol

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[penicillin]
narrow spectrum penicillin
SE: hypersensitivity, GI upset

Pen G (inject)
Pen V (oral) "vunganga"

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[penicillin]
penicillinase-resistant penicillins
SE: interstitial nephritis, neutropenia

methicillin

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[penicillin]
extended-spectrum penicillins
SE: pseudomembranous colitis

ampicillin (most likely to cause rash)
amoxicillin

AMPicillin- AMPed up penicillin
amOxicillin- greater Oral bioavailability

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[penicillin]
antipseudomonal penicillins
SE: hypertension, hypervolemia, bleeding

piperacillin

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[penicillin]

used for staph

nafcillin

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Amoxicillin HELPS kill enterococci

Amoxicillin "HELPS" kill enterococci
Haemophilus influenzae
Escherichia coli
Listeria monocytogenes
Proteus mirabilis
Salmonella spp.
Enterococci

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Takes Care of Pseudomonas

“TCP” Takes Care of Pseudomonas
ticarcillin
carbenicillin
piperacillin

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1st generation cephalosporin, 
high bone penetration, 
surgical prophylaxis,
greatest gram-positive coverage
SE: hypersensitivity reaction

cefazolin

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2nd generation cephalosporin,
added gram negative coverage
SE: disulfiram reaction

cefamandole

cefotetan

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3rd generation cephalosporin, pseudomonas coverage

SE: disulfiram reaction

cefoPERAzone

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most efficacious cephalosporin for pseudomonas aeruginosa

ceftaziDIME

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4th generation cephalosporin, broad spectrum activity (gram positive and gram negative)

cefepime

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which cephalosporin has the best penetrance to the BBB?

ceftriaxone

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microbes covered by 1st gen cephalosporins

microbes covered by 1st gen cephalosporins
"PEKs first"
Proteus mirabilis
escherichia coli
klebsiella pneumoniae

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1st generation cephalosporins

1st generation cephalosporins "PH, FAD, FAZ"
ceFADroxil
ceFAZolin
cePHalothin
cePHapirin
cePHradine
cePHalexin

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microbes covered by 2nd gen cephalosporins

HEN has KEPS
haemophilus influenzae
enterobacter aerogenes
neisseria spp.
klebsiella pneumoniae
escherichia coli
proteus mirabilis
serratia marcescens

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2nd generation cephalosporins

2nd generation cephalosporins
"fox, fur, for, fam, teta, fon, fac, lora, pro, azole"
ceFOXitin
ceFURoxime
ceFORanide
ceFAMandole
cefoTETAN
ceFONicid
ceFAClor
LORAcarbed
cefPROzil
cefmetAZOLE

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cephalosporins causing disulfiram reaction

cephalosporins causing disulfiram reaction
"man, azole, teta, pera"
cefaMANdole
cefmetAZOLE
cefoTETAn
cefoPERAzone

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most commonly used against Bacteroides

ceftizoxime

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most active cephs against penicillin-resistant streptococcus pneumoniae

ceftriaxone

cefotaxime

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has a very good action on pseudomonas

ceftazidime

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best CNS penetrance

ceftriaxone

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has good activity against B. fragilis and thus used for abdominal and pelvic infections

cefotetan | cefoxitin

3rd generation cephalosporins

``` "FEnge PO PERA to FIX my TTTTTV" (about money) ceFEtamet cefPOdoxin cefoPERAzone ceFIXime cefTRIAxone cefTaziDIME cefoTAXime cefoTIZOxime cefTibuten ```

anti-pseudomonal cephalosporins

ceftaziDIME ceFEPime cefoPERAzone

silver bullet agains gram negative bacteria, no gram-positive activity, with anti-pseudomonal coverage

aztreonam

beta-lactamase inhibitor | SE: cholestatic jaundice

"CAST" clavulonic acid sulbactam tazobactam

treatment for MRSA | SE: red man syndrome

vancomycin

drug of last resort, broad spectrum of activity | SE: CNS toxicity (confusion, encephalopathy, seizures)

imipenem-cilastatin

Drugs of last resort

``` "I AM your Last Shot at Victory" imipenem amikacin meropenem linezolid streptogramins vancomycin ```

[protein synthesis inhibitors] binds to 50S subunit SE: aplastic anemia, gray baby syndrome

chloramphenicol - inhibits peptidyl transferase

[protein synthesis inhibitors] binds to 30S subunit SE: tooth enamel discoloration, photosensitivity

tetracycline

[protein synthesis inhibitors] binds to 50S subunit DOC for penicillin-allergic patients SE: diarrhea, cholestatic jaundice, QT prolongation

``` Macrolides: erythromycin azithromycin clarithromycin telithromycin roxithromycin ```

used for macrolide-resistance

telithromycin

macrolide with highest Vd (volume distribution) and slowest elimination, single dose administration; binds to 50S subunit

azithromycin

all macrolides inhibit CYP450 except

azithromycin

binds to 50S subunit, anaerobic coverage | SE: pseudomembranous colitis

Lincosamide: clindamycin lancomycin

binds to 50S subunit, vancomycin-resistance

Oxazolidinone (linezolid, tedizolid) | streptogramins (quinupristin, dalfopristin)

blocks attachment of T-RNA to acceptor site

tetracyclines

for anaerobic infections ABOVE the diaphragm

clindamycin

for anaerobic infections BELOW the diaphragm

metronidazole

[aminoglycosides] | has lowest therapeutic index

amikacin

``` [aminoglycosides] bactericidal binds to 30S subunit treatment if endocarditis SE: nephrotoxicity, ototoxicity ```

gentamicin

[aminoglycosides] | treatment of ocular infections

tobramycin

[aminoglycosides] | treatment of tuberculosis

streptomycin

[aminoglycosides] | treatment of drug-resistant gonorrhea

spectinomycin

[aminoglycosides] | widest spectrum of activity, pseudomonas coverage, narrow therapeutic window

amikacin

[aminoglycosides] | treatment of hepatic encephalopathy

neomycin

Mean GiANTS canNOT kill anaerobes

``` Mean GiANTS canNOT kill anaerobes gentamicin amikacin neomycin tobramycin streptomycin nephrotoxicity ototoxicity teratogen (aminOglycosides require O2 for transport)` ```

[sulfonamides] | blocks dihydropteroate synthase

sulfamethoxazole | dapsone

[sulfonamides] | blocks dihydrofolate reductase

trimethoprim

[sulfonamides] sequential blockade in folate synthesis, urinary tract infections SE: hypersensitivity (SJS, TEN), kernicterus, hemolysis in patients with G6PD

TMP-SMX | trimethoprim suilfonamides

[sulfonamides] | treatment of burn infections that can cause neutropenia

sulfadiazine

[sulfonamides] | treatment of burn infections that can cause metabolic acidosis

mafenide acetate

[fluoroquinolone] 2nd generation quinolone, treatment of urinary tract infections and GIT infections SE: tendinitis, tendon rupture, QT prolongation

ciprofloxacin

[fluoroquinolone] | 3rd generation quinolone, treatment of pulmonary infections

levofloxacin

``` [fluoroquinolone] 3rd generation quinolone broad spectrum of activity, anaerobic coverage, treatment of ocular infections ```

moxifloxacin

[fluoroquinolone] 3rd generation quinolone SE: diabetes mellitus

gatifloxacin

[fluoroquinolone] 3rd generation quinolone SE: cardiotoxicity

grepafloxacin

[fluoroquinolone] 4th generation quinolone SE: hepatotoxicity

trovafloxacin

[fluoroquinolone] | most active agent against gram (-) organisms esp pseudomonas

ciprofloxacin fluoroquinolone MOA: inhibits DNA replication by binding to DNA gyrase and topoisomerase IV; cidal

inhibits cartilage development

fluoroquinolones "FluoroquinoLONES hurt attachment to your BONES (cartilage damage)"

antimicrobial with anaerobic and antiprotozoal coverage, treatment of pseudomembranous colitis SE: disulfiram reaction, metallic taste, neurotoxicity

metronidazole

antimicrobial for treatment of urinary tract infections | SE: pulmonary fibrosis

nitrofurantoin

[Anti-mycobacterial agents] Cidal; inhibits mycolic acid synthesis SE: neurotoxicity, hepatotoxicity, sideroblastic anemia, drug-induced lupus, Potent CYP450 INHIBITOR

isoniazid

[Anti-mycobacterial agents] Cidal; inhibits DNA-dependent RNA polymerase SE: red orange urine, hepatotoxicity, CYP450 INDUCER

rifampicin

used in patients with PTB

rifabutin

used in patients with traveller's diarrhea

rifaximin

[Anti-mycobacterial agents] Static; inhibits arabinoglactan sythesis SE: visual dysfunction (retrobulbar neuritis, color blindness)

ethambutol

[Anti-mycobacterial agents] Static but Cidal on actively dividing MTB SE: hyperuricemia, hepatotoxicity (most)

pyrazinamide

[Anti-mycobacterial agents] Cidal; binds to 30S, IM SE: nephrotoxicity, ototoxicity

streptomycin

Mnemonic: | INH Injures Neurons and Hepatocytes

INH Injures Neurons and Hepatocytes

``` Mnemonic: R= Rifampicin RNA polymerase inhibitor Red-orange body fluids Rapid development of resistance Revs up cytochrome P450 (inducer) ```

[drugs for leprosy] most active drug against M. leprae; inhibits folate synthesis SE: methemoglobinemia, hemolysis in G6PD deficient patients

dapsone

[drugs for leprosy] inhibits DNA-dependent RNA polymerase SE: red-orange urine, delays onset of dapsone resistance

rifampicin

[drugs for leprosy] phenazine dye, binds to guanine bases SE: skin discoloration

clofazimine

[antifungals] most efficacious antifungal drug, forms artificial pores SE: nephrotoxicity (RTA), infusion-related reactions

amphotericin B

[antifungals] topical treatment of dermatophytosis and candidiasis SE: gynecomastia, CYP450 inhibitor

ketoconazole

[antifungals] | DOC for treatment and secondary prophylaxis of cryptococcal meningitis

fluconazole

[antifungals] interferes with fungal microtubules; potent CYP450 inducer

griseofulvin

[antifungals] | treatment of candidiasis (oropharyngeal, esophageal, vaginal), swish and swallow or suppository preparations

nystatin

inhibits DNA polymerase | SE: nephrotoxicity

antivirals

[antivirals] treatment of HSV and VZV; requires activation by viral thymidine kinase SE: crystalluria

acyclovir

[antivirals] treatment of CMV; requires activation by viral thymidine kinase

ganciclovir

[antivirals] treatment of HSV, VZV and CMV; does not require viral thymidine kinase activation

foscarnet, cidofovir

[antivirals] prevents viral uncoating, influenza A coverage SE: cerebellar dysfunction, livedo reticularis

amantadine

[antivirals] neuramminidase inhibitor; DOC for influenza

oseltamivir

[antivirals] | treatment of hepatitis B infection

lamivudine

[antivirals] | treatment of hepatitis C and RSV infection

ribavirin

mnemonics: [AMANTADINE] A man to dine takes off his coat Amantidine prevents uncoating

[antivirals] nucleoside reverse transcriptase inhibitor (NRTI), requires phosphorylation, primary drug for HIV, prevents vertical transmission of HIV SE: lactic acidosis, bone marrow suppression

zidovudine

[antivirals] non-nucleoside reverse transcriptase inhibitor (NNRTI), no phosphorylation required SE: hepatotoxicity

delavirdine

[antivirals] protease inhibitor; SE: fat redistribution syndrome, hyperlipidemia, insulin resistance

"-navir" | Ritonavir

[antivirals] | fusion inhibitor, binds gp41 subunit

enfuvirtide

[antivirals] | binding inhibitor, CCR5 antagonist

maraviroc

``` mnemonic [NNRTIs] Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) Never Ever Deliver Nucleosides Nevirapine Efavirenz, Etravirine Delavirdine ```

mnemonic [Protease inhibitors] All protease inhibitors end with -navir NAVIR (never) tease a proTEASE

[anti-malarial] primary drug for malaria, prevents heme polymerization into hemozoin SE: retinal damage, hearing loss

chloroquine

[anti-malarial] chloroquine-resistance, severe malaria, DOC for pregnant patients with malaria SE: hypoglycemia, blackwater fever, cinchonism

quinine (class 1a)

[anti-malarial] | eradication of hypnozoites of P. vivax and ovale

primaquine

[anti-malarial] | chemoprophylaxis (chloroquine-resistant areas)

mefloquine, | malarone

[anti-malarial] | chemoprophylaxis (multi-drug resistant areas)

doxycycline

[anti-malarial] | DOC for malaria in the Philippines (P. falciparum)

artemether/ lumefantrine | co-artem

[anti-protozoal drugs] asymptomatic cyst carries of E. histolytica SE: flatulence

diloxanide furoate

[anti-protozoal drugs] amebic dysentery, trichomoniasis, bacterial vaginosis; SE: disulfiram reaction

metronidazole (forms free radicals)

[anti-protozoal drugs] | cryptosporidium parvum infection

nitrazoxanide

[anti-protozoal drugs] | pneumocystitis jiroveci pneumonia

Trimethoprim/Sulfamethoxazole

[anti-protozoal drugs] | toxoplasmosis

pyrimethamine-sulfadiazine

[anti-protozoal drugs] | african sleeping sickness (T. bruceii)

malarsoprol +- suramin | "sure mellow sleep"

``` [anti-protozoal drugs] Chagas disease (T. Cruzi) ```

nifurtimox

[anti-protozoal drugs] | leishmaniasis

sodium stibogluconate

[anti-helminthic drugs] inhibits helminthic microtubules; ovicidal

mebendazole | any but not albendazole

[anti-helminthic drugs] inhibits helminthic microtubules, ovicidal and larvicidal. DOC for hydatid disease (echinococcosis)

albendazole

[anti-helminthic drugs] DOC for filaria and loa loa SE: filarial fever

diethylcarbam

[anti-helminthic drugs] DOC for strongyloides and onchocerca SE: mazzotti reaction (cause flaccid paralysis)

ivermectin

[anti-helminthic drugs] | DOC for enterobium (cause spastic paralysis)

pyrantel pamoate

[anti-helminthic drugs] | DOC for trichinosis

thiabendazole

[anti-helminthic drugs] DOC for trematodes and cestodes except echinococcosis

praziquantel | albendazole for echinococcosis

[anti-helminthic drugs] | back-up drug to praziquantel

niclosamide

[anti-fungal] | Broadest spectrum triazole (the only azole with activity against Rhizopus sp/ mucormycosis)

Posaconazole

[anti-fungal] | Can increase levels of cyclosporine and tacrolimus

Micafungin

Adverse effects of aminoglycoside

“NON” Nephrotoxicity Ototoxicity Neuromuscular blockade

Is given for pre-exposure prophylaxis to reduce HIV acquisition in homosexuals, heterosexuals and IV drug users

Tenofovir + Emtricitabine

Is indicated for acyclovir resistant HSV and VZV in immunocompromised individuals

Foscarnet

Antiviral agent that prevent vertical transmission at the onset of labor

Nevirapine

First line Antiviral agent that prevent vertical transmission

Zidovudine

Prevents vertical transmission of HBV when given in the last 4 weeks of gestation

Lamivudine

A patient with Hepatitis B and co-infected with HIV is best treated with

Lamivudine

Antiviral agent that does not cause termination of chain elongation because of the presence of 3-OH group

Penciclovir