inhibits phosphoenol pyruvate, halts muramic acid synth

single dose for cystitis

effective against Ecoli: used in enterococcal UTIs

cyclic lipopeptide-> pore formation and disruption of peptidoglycan synthsis

(similar to polyenes action on fungi)

only gram+ cocci

VRSA, VRE ???

rhabdo

inhibits ergosterol synth by inhibiting lanosterol demethylase

imidazoles: toxicity except ketoconazole

triazoles: less tox

allylamines: terbinafine, tolnaftate (top), naftifine

dermatophytes (not candida) 

terbinafine oral vs onycho

azoles:

imidazoles: troche for candida, not systemic- micon, clotrim

triazoles: systemic, flucon, itracon, voricon

some p450

nystatin and ampho

cause pores->ion loss

nystatin (only topical, not good for dermatophytes) 

amphoB

renal, K/Mg wasting, tubular acidosis, normoytic anemia

produced by gram+ bacteria against gram-

severe toxicity

maybe usefull in severe resistance

gentamicin, streptomycin

requires O2 for uptake

only -cidal ribosomal inh

codon misread

gram-

rapid -cidal, prolonged post-kill ->sepsis

synergy w/b-lactam/ceph

hydrolysis-> poor oral, 100% renal

poor organ penetration (except kidneys)

neuromuscular blockade

require energy for uptake

prevents acces of tRNA to acceptor site

reasonable for pneumonia (high mycoplasma and 90% strep pneumo)

intracellulars, MRSA

skin sensitivity

not in kids or prego

constipating...need to use with magnesium laxatives

t: milk-alkali, nephrocalc, rebound acidity, digitalis antagonism

induces systemic alkalosis...rarely used

enhanced effects of amphetamine, quinidine, cinchophen

high sodium

abosrbed...may cause mg tox in renal dz

diarr, hypoK, hyperMg, iron defic

makes aluminum phosphate...may have protective effect on GI

constipation, phosphate depletion....waeakness anemia, tetany apnea, fecaloma, encephalopathy, impaired absorption

PE2 agonist...decrease acid production, increase mucous and bicarb secretion

 less effect than H2 antag

use in NSAID ulcers

bismuth salt

ppi/h2 ant

tetracycline or amoxicillin, metronidazole, maybe clarithromycin

metochlopramide - dopamine antagonist

cisapride- serotonin agonist

domperidone - dopamine antagonist

phenothiazine antiemetic

dopamine receptor antagonist

extra-pyramidal side- torticollis

trimethobenzamide- unknown mech on CRTZ

metocchlopramide- dopamine ant

ondansetron (zofran)

granesitron

dolasetron

headaches, dizziness, somnolence

relax small bowel smooth muscle

antidiarrh

opiod agonist (immodium)

increases rectal tone and disrupts peristalsis

lomotil

contractation of circular muscle->segmentation

also codeine sulfate

delayed 5 amino-salicylic acid

sulfasalazine: active portion

olsalazine- dimer...same as sulfa w/less tox

azathioprine -  puirne antimetabolite

infliximab- monoclonal to TNFa

cyclosporine- suppresses T suppressor and CD4 T

methi

oxa - parenteral

cloxa

diclox - oral

naf

add ecoli/proteus/heamophilus/moraxella

ampi- parenteral

amox - oral

(sinusitis)

extended spectrium

adds klebsiella, serratiam, pseudomonas, enterobacter

adds Staph aureus, gut anaerobes and all haemophilus to amino and ext spectrum

par: ampicillin/sulbactam, piperacillin/tazo

oral: amox/clavulanate

t: immune mediated thrombocytopenia

Staph aur (not MRSA)

strep except entero

ecoli, proteus, klebsiella

mouth anaerobes

oral:cephalexin

par: cefazolin

No neuro penetration

add haemophilus and abov/below diaphr anaerobes

or/par: cefuroxime

less gram pos, adds some pneumococcus

retains pleomorph, adds more gram-

2 splits: anti-pseudomonals (no staph)

non-psuedomonals (some staph)

antipseudo: ceftazadime

non: ceftriaxone

orals (variable pseudo): cefixime

GOOD CNS PEN

4th gen: cefepine: no sign difference

broadest b-lactam coverage

not MRSA

needs cilastin

imipenam (IV)

cumulative dose-dependent toxicity->seizure

only use in extreme resistance (ICU)

all gram- bacilli

no gram+/anaerobes

aztreonam (IV)

cipro/levo:  gram- enterobacteraciae

urinary pathogens resistant to sulfas/b-lactams

dose dependant CNS, QT lengthening

50s, blocks peptide bond formation at A site

MRSA (75%) MSSA (100%)

strep

anaerobes

no gram-

aspiration pneumo, anaerobe in bowel perf, b-lactam anaphylaxis

blocks translocation (50s)

strep, staph aureus, mycoplasma, pleomorph, chlamydia

used in allergic patients with suspected gram+

azithro- high tissue...long t1/2

t: p450, dd gi hypermotility

50s, site near peptidyl transferase

VRSA/MRSA

t: bone marrow suppression?

trimethoprim

pyrimethamine- used with dapsone as alt to TMP/SMX in parasites

prodrug- inhibits nucleic acid and cell wall synth

t: centrolobular hepatitis

neuro - prevented by pyridoxine

p450

TB inhibits RNA pol

t: centrolobular hepatitis, usually underlying liver dz

p450

TB static (metabolite accumulation)

centrolob hep

incr uric acid levles

TB inh arabinosyl transf in cell wall synth

dose dependent red-green optic tox

incr uric acid levels

pyrimidine analog

more against VZV than HSV

non-nucleoside analog (pyrophosphate congener)

acyclovir resistant VZV/HSV

some CMV, HIV

ionized-no oral, only renal

HPV

enhances interferon production

can be topical

HPV

cytosine analog, also other DNA viruses

topicals available

prevent relase from cells

seasonal prophylaxis

post-exposure for family members

if used within 1-2 days, reduces transm

oseltamivir- oral

zanuma- inh

perami- IV

2 NRTIs- abacavir, lamivudine (h, n/v, neutropen, pancr), combivir, didanosine (pancreas, neuro), stavudine (pancreas/neuro), zidovudine (granulo, n/v)

1 NNRTI (p450)- nevirapine, delaviridine, efavirenz, etravirine,

1 Protease inh -navir (lipdystrophy)

saquinavir- poor oral, well tol

ritonavir- p450 but usually given in a low dose to boost availability of saquinavir

indinavir- nephrolithiasis

Fusion inhbitors (used in resistance)

efuvirtide, maraviroc

CD4, CCR5 interaction (possible susceptibility)

1/2: ifn/ribavarin standard

3: boceprevir and telaprevir - HCV specific protease inhibitors (used as triple therapy)

caspofungin

systemic, less toxic than amphoB

resistant candida/aspergillus

confusion, opthalmoplegia, gait ataxia

korsakoff's- coma, amnesia

sugar depletes thiamine