Ex: mannitol

can be used to draw water from the tissues and excrete it in the kidneys

20% soln administered as a bolus of 1 g/kg

repeat at 0.25 - 0.5 g/kg every 4-6 hours

effects peak in 1 hr, and last for 4-24 hrs

Beware of rebound

Uses: prophylaxis of acute renal failure, glaucoma, opthalmologic procedures, cerebral edema

Possible side effects: pulmonary edema (esp. in pts w/ cardiac decompensation), HA, NV, convulsions, hypokalemia

K⁺ diuretics that work on the principal cells

Ex: sprionolactone (aldosterone antagonist), triamterene, amiloride (NaCl channel blockers, reduce H⁺ secretion)

↑ lumen negative transepithellial voltage

↑ NH₃ synthesis

↑ H⁺ pump & Cl^-/CHO₃^- exchanger

Uses: mild edema, hyperaldosteronism, hypokalemia

Side effects: hyperkalemia, metabolic acidosis, impotence, ginecomastic

Ex: furosemide (lasix), bumetanide

inhibition of salt reabsorption (including Mg²⁺) in thick ascending limb Na⁺/K⁺/2 Cl^-

induce a compensatory ↑ in NaCl reabsorption in the distal tubule

Uses: edema (including pulmonary HTN), hyperccalcemia, prophylaxis of ARF

Side effect: hypovolemia, hypokalemia, metabolic alkalosis, Ca²⁺ & Mg²⁺ depletion

Ex: HCTZ, chlorthalidone, metalozone

inhibition of NaCl reabsorption in the early distal tubule

binds to the Cl^- spot on NaCl transporter

↑ Ca²⁺ reabosption

Uses: edema, HTN, Hypercalciuria/lithiasis, osteporosis,

Side effects: hypovolemia, hypokalemia, metabolic alkalosis, hyponatermia, hypercalcemia

streptogamin

"drug of last resort" against MRSA

glycopeptide binds to Gly and inhibits cell wall synthesis

PRF B

penicillins, cephalosporins, carbapenem, monobactams

can be used syntergistically with aminoglycosides, however, do not place in the same bag (inactivation in solution)

cross into CSF and bone only when inflamed 

excreted by kidneys (except nafcillin → biliary, excretion inhibited by probenecid)

safest to use during pregnancy

gentamicin (IM/IV), neomycin (topical), amikacinn (IM/IV), trobramycin (IM/IV) streptomycin (IM), kanamycin, paromomycin

inhibition of protein synthesis

can be used syntergistically with PCNs, however, do not place in the same bag (inactivation in solution)

can cause ototoxicity, especially if used with loop diuretics 

PRF D

inhibits protein synthesis, bacteriostatic

also inhibits mitochondrial protein synthesis in mammalian cells

PRF C, causes gray baby syndrome

secreted in urine

vancomycin, teicoplanin

inhibit cell wall synthesis

Ciprofloxacin, levofloxacin, trovafloxacin, moxifloxacin, ofloxacin (CSF)

interfere with bacterial DNA replication and transcription by inhibiting DNA gyrase, broad spectrum aerobic 

DOC for anthrax

causes cartilage weakening

contraindicated in myasthenia gravis patients

linezlid, posizolid, tedizolid, cycloserine

inhibit protein synthesis, bacteriostatic

metronidazole (Flagyl), tindazol, nimorazole

used to treat anaerobic and parasitic infections

tigecycline

very new, developed in 2005

daptomycin, surfactin

disruption of cell membrane

pristinamycin IIA and IA

inhibit protein synthesis

geldanamycin, rifampin, rifamycin, naphthomycin

inhibit RNA synthesis

azithromycin - IV, DOC for Mycoplasma pneumoniae  and Legionnaires' disease, preferred for Chlamydia trachomatis, distributes in all fluids except CSF), may cause arrhythmias 

erythromycin - both excreted in bile

clarithromycin - DOC for intracellular infections, excreted by both liver and kidneys

inhibit protein synthesis, aggressively bateriostatic

interacts with P-450 system

tetracycline (PO, short acting), doxycycline (safe for renal insufficiency IV/PO), limecycline, oxytetracycline, demeclocycline (also used for SIADH), tigecycline (IV, long acting)

inhibits protein synthesis by binding to 30S ribosome, bacteriostatic, broad spectrum

absorption impaired by cations (found in dairy products, antacids, salts)

excreted in urine (exp dox, which is excreted in bile)

not safe for pregnant women or young children (bind to tissue undergoing calcification)

↓ efficacy of birth control

GI upset common

prontosil, sulfanilamide, sulfadiazine, sulfisoxazole

folate antagonist, bacteriostatic, penetrates CSF

PRF D, causes kernicterus

can cause crystalluria

PCN G - DOC for syphillis, effective against cocci, G⁺ bacillli, spirocetes, and streptococcal, penumococcal, & menigococcal infecctions

PCN V - similar spectrum, administered orally, acid stable

β-lactams

1^st gen - cefazolin (ancef), good against G⁺ , and PEcK Proteus, E. coli, K. pneumo, 

also cephalexin (keflex) 

2^nd gen - eg. cefoxitin (mefoxin, also covers anaerobic bacteria), also covers HEN

Haemophilus inf, Enterobacter aerogenes, Neisseria

3^rd gen - ceftriaxone (rocephin, DOC for meningitis, and gonorrhea), ceftaxime (claforan, DOC for meningitis), mostly against G^-, some anaerobic activity, penetrate CSF

4th and 5th gen also exist

ineffecctive against MRSA, Listeria monocytogenes, Clostridium difficle, and Enterococci

Nafcilllin - injected

Oxacillin, dicloxacillin - orally for chronic infections (eg. osteomylitis) or parenterally for serious infections

ampicillin (PO/IM/IV, DOC for Listeria monocytogenes) & amoxicillin (PO, lyme disease)

not active against Pseudomonas or Klebsiella 

Augmentin: amoxicillin-clavulanate (a β-lactamase inhibitor)

β lactam monobactam targeting only G^- rods

Binds penicillin binding protein 3 to prevent peptidoglycan cross-linking

lincosamide, narrow spectrum against anaerobic infection such as Bf 

can lead to pseudomembranous colitis (C. diff)

DOC of protozoals and C. diff

not safe for pregnant women or alcoholics