Pharma

Which of the following protozoa is responsible for causing malaria?

Plasmodium falciparum

What is the primary mode of transmission for Giardia lamblia?

Contaminated water or food

Which protozoal infection is associated with congenital defects when acquired during pregnancy?

Toxoplasma gondii

Treatment and chemoprophylaxis of infection with sensitive parasites

Chloroquine

Treatment of infection with cholorquine-resistant P falciparum strains and in fixed combination with artesunate

Amodiaquine

Treatment of P Falciparum infection in fixed combination with dihtdroartemisinin

Piperaquine

Oral and intravenous treatment of P falciparum infections

Quinine

Chemoprphylaxis and treatmen of infections with P falciparum

Mefloquine

Radical cure and terminal prophylaxis of infections with P vivax and P ovale; alternative chemoprophylaxis for all species

Primaquine and/or Tafenoquine

Drug prevention for malaria area without resitant P-falciparum

Chloroquine

Drug prevention for malaria area WITH resitant P-falciparum

Malarone or Mefloquine

Drug prevention for malaria area with Multi-drug resistant P falciparum

Doxycycline

Terminal prophylaxis of P vivax and P ovale infections; alternative for primary prevention

Primaquine or Tafenoquine

Concentrating in parasite food vacuoles and preventing biocrystallization of heme into hemozoin

Chloroquine

common side effect of Chlorquine

Pruritus

Rare but serious side effect of Chlorquine

Hemolysis in G6PD-deficient patients Seizures Psychosis

Contraindication of Chlorquine

Psoriasis or porphyria Retinal, visual or muscular disorder

Widely used for malaria treatment due to its low cost and effectiveness against some chloroquine-resistant P. falciparum strains

Amodiaquine

as a first-line therapy for uncomplicated P. falciparum malaria

Artesunate + amodiaquine a

Produces free radical damaging malaria parasites

Artemisinin

r eradication of dormant liver forms of P. vivax and P. ovale.

PRIMAQUINE

Acts by interfering with the electron transport chain in parasite and also known to generate ROS

PRIMAQUINE

5,6 ortho quinone tafenoquine → redox cycled by P. falciparum which are upregulated in gametocytes and liver stages

TAFENOQUINE

first-line therapy for Babesia microti infections.

Quinine + clindamycin

antacids decrease quinine absorption

Aluminum-containing

Drugs to not combine with Mefloquine

Quinine, Quinidine, HAlofantrine

for eradication of dormant liver forms of P. vivax and P. ovale

Primaquine

Radical Cure of Acute P. vivax & P. ovale Malaria

Primaquine and/or Tafenoquine

an alternative treatment for mild-to-moderate pneumocystosis

Primaquine + clindamycin

What drug/s is contraindicated to pregnant women

Primaquine and Tafenoquine

Used in the fixed combination Malarone for malaria treatment and prevention.

ATOVAQUONE

For mild to moderate P. jirovecii pneumonia

ATOVAQUONE

Used in some immunocompromised patients with toxoplasmosis

ATOVAQUONE

ATOVAQUONE

MOA: Disrupts mitochondrial electron transport in plasmodia

MOA: Pyrimethamine & Proguanil

Inhibit plasmodial dihydrofolate reductase (folate synthesis)

MOA: Sulfonamide and Sulfones

Inhibit dihydropteroate synthase (synergistic effect)

First-line therapy for P. jivorecci infection

TMP-SMX

Alternative therapies for intestinal amebiasis

Tetracycline & Erythromycin

Which of the following antimalarial drugs acts by inhibiting heme detoxification in the food vacuole of Plasmodium species?

Chloroquine

Which drug is required to eradicate dormant liver stage (hypnozoites) of Plasmodium vivax and Plasmodium ovale?

Primaquine

What is the preferred first-line intravenous drug for treating severe Plasmodium falciparum malaria?

Artesunate + amodiaquine a

drug can cause QT prolongation

IV quinidine

: first-line therapy for Babesia microti infections.

Quinine + clindamycin

Used primarily for extraluminal amoebiasis

Metronidazole

Drug for Giardiasis and Trichomoniasis

Metronidazole

Used as a luminal amebicide

Paromycin

Contraindicated in iodine intolerance

IODOQUINOL

Effective luminal amebicide but lacks activity against trophozoites

DILOXANIDE FUROATE

Which of the following is the first-line drug for the treatment of invasive Entamoeba histolytica infections (intestinal or extraintestinal, including liver abscess)?

Metronidazole

Which of the following drugs is used as a luminal amebicide to eliminate Entamoeba histolytica cysts in asymptomatic carriers or after treatment of invasive amoebiasis?

Paromomycin

1st effective oral drug for visceral leishmaniasis

MILTEFOSINE

Parenteral treatment for visceral leishmaniasis

PAROMOMYCIN SULFATE

, is effective for cutaneous leishmaniasis

Paromomycin

Effective against trypanosomatid protozoans and P. jirovecii

PENTAMIDINE

Prophylaxis against P. jirovecii pneumonia

inhaled pentamidine

Common toxicities of Pentamidine

Pancreatic dysfunction

First line tx for Early East African Trypanosomiasis

SURAMIN

First line tx for Advanced CNS East African Trypanosomiasis

MELARSOPROL

First line tx for Advanced West African Trypanosomiasis

EFLORNITHINE

First oral tx of early and advanced West African Trypanosomiasis

FEXINIDAZOLE

Eliminates parasites and prevents progression when used in acute infection of chagas disease

BEZNIDAZOLE

Treats Giardia lamblia and Cryptosporidium parvum

NITAZOXANIDE

effective against metronidazoleresistant protozoa

NITAZOXANIDE

inhibits pyruvate-ferredoxin oxidoreductase pathway

NITAZOXANIDE

A 28-year-old traveler returns from sub-Saharan Africa and presents with fever and chills. He is diagnosed with Plasmodium falciparum malaria. Which of the following is the most appropriate first-line treatment?

Artemether-lumefantrine

How do artemisinin-based combination therapies (ACTs) primarily act against Plasmodium falciparum?

Generate free radicals toxic to the parasite

A 35-year-old HIV-positive patient presents with headache and is diagnosed with cerebral toxoplasmosis. Which of the following is the best initial pharmacologic therapy?

Pyrimethamine + Sulfadiazine + Folinic acid

Which of the following is a significant toxicity associate with pyrimethamine therapy for toxoplasmosis?

Bone marrow suppression

Instruction to patients while taking metronidazole

Avoid Alcohol Intake 24 hours, before and 48 hr after intake of drug

A 35-year old bank manager with history of myocardial infarction and maintained on warfrain develops amoebic dysentery. which of the following would pontetate the anti-effect of coumarin type anti-coagulant

Metronidazole

WHich of the following anti-marial drug belong to 8-aminoquinol

Primaquine

A gorup of student travelign to a country known to have a chlorquine-resitant malaria. which of the following can be used for prevention and treatment of malaria?

Atovaquone with proguanil

AFter the actue infection which of the followng medication is given to treat asymptomatic colonization of E. coli

IODOQUINOL

Which of the following drugs is used to reverse cholorquine resistance

Chlorpheniramine

Which of the following drug is the first line therapy for early hemolymphatic east afrcan trypanosomiasis

Suramin

Metronidazole is not effective in the treatment of

P. Jirovecii

Drug is used to reverse chloroquine resitance

Verapamil

1st line therapy in combination with clindamycin treatment for infection with babesia microti

quinine

Antimalarial contraindicated epilepsy

Mefloquine

prophylaxis anitbiotic for unruptured appendicitis

Cefazolin

prophylaxis anitbiotic for RUPTURED appendicitis

Cefoxitin

Surgical prophylactic antibiotic

Cefazolin

Anaeorbic drug for surgical antibiotic

Cefoxitin

Abdominal Prophlyactic antibiotic

Cefoxitin

Antibiotic fo hospital acquire meningococcemia

Rifampicin

PROPHYLAXIS IN PATIENTS AT HIGH RISK OF INFECTIVE ENDOCARDITIS

Amoxicillin: For dental procedures

Alternative antibiotic for Porphylaxis Infective endocarditits

 IV Ampicillin or Ceftriaxone  Macrolide or Clindamycin

POST-EXPOSURE PROPHYLAXIS Meningococcal meningitis

Rifampicin, Ceftriaxone, Quinolone

Post-exposure prophylaxis for HIV

Tenofovir + Emtricitabine + Raltegravir or Dolutegravir

pre-exposure Prophylaxis for HIV

Tenofovir + Emtricitabine

Non-Surgical Prophylaxis for: Anthrax

Cirpofloxacin or Doxycycline

Non-Surgical Prophylaxis for: Cholera

Tetracycline

Non-Surgical Prophylaxis for: Diptheria

Penicillin or Eryhtromycin

Non-Surgical Prophylaxis for: Herpes

Acyclovir

Non-Surgical Prophylaxis for: Haemophilus influenzae type B infection

Rifampin

Prophylaxis for HIV infection

Tenofovir/emtricitabine+Raltegravir

for Recurrent Bacterial otitis media

Amoxicillin

Prophylaxis for Rheumatic heart fever

Penicillin G

Recurrent UTI

TMP/SMX

Is used as a substitute for universal prophylaxis and as early targeted therapy in high-risk patients who already have a laboratory or other rest indicating an asymptomatic patient is infected

PREEMPTIVE THERAPY

Class I: Exposure of TB (prophylaxis)

Isoniazid for 3 months

Class II: Infection of TB (pre-emptive)

Isoniazid for 9 months or Rifampicin for 6 months

Class III: Disease

Start definitive therapy

Antimicrobial agents are frequently used before the pathogen responsible for a particular illness or the susceptibility to a particular antimicrobial agent is known

EMPIRIC THERAPY

Proper antimicrobial doses and dose schedules are crucial to maximizing efficacy and minimizing toxicity. In addition, the duration of therapy should be as short as is necessary. Unnecessarily prolonged therapies lead to the emergence of resistance.

DEFINITIVE THERAPY

The suppressive therapy is eventually discontinued if the patient’s immune system improves

POSTTREATMENT SUPPRESSIVE THERAPY

First line of Drugs for TB

HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol)

antibiotic for ruptured appendicitis

Cefazolin + metronidazole

Antimalarial drugs fixed combination

Atovaquone-proguanil and artemetherlumefantrine

Bacteriostatic Agents

Chloramphenicol, Clindamycin, Ethambutol, Macrolides, Nitrofurantonin, Novobiocin Oxazolaidinodes, Sulfonamides,Tetracyclines, Tigecycline, Trimethoprim

TIME-DEPENDENT ANTIBIOTICS

beta-lactams and vancomycin

Persistent suppression of bacterial growth after limited exposure to an antimicrobial agent

POST-ANTIBIOTIC EFFECT

Which do you think would be more effective? Is it the dotted line or continuous line?

Dotted line

Which of the following parameters is used to predict the efficacy of timedependent antibiotics?

Time above the MIC (T>MIC)

Antibacterial agent with in vitro post antibiotic effects of more than 1.5 hrs against Gram-negative Bacilli

Aminoglycoside Carbapenem Chloramphenicol Rifampin Tetracycline Tigecycline

Drugs for Ameobiasis

Metronidazole

Which antibacterial agent appears to be the safest to use in the pregnant patient?

The mother has community-acquired pneumonia and the drug of choice that covers for mycoplasma and chlamydia would be a macrolide, which drug would you prescribe?

Antimicrobial drugs contracindicated in Pregnancey

Sulfo, Aminogly, Fluoroqui, Eryhtro, Metronida, Tetra, Rbaivrin, Griseofluvin, Chloramphenicol

A hospitalized AIDS patient is receiving antiretroviral drugs but no antimicrobial prophylaxis. He develops sepsis with fever, suspected to be caused by a gram-negative bacillus. Antimicrobial treatment of this severely immune-depressed patient should not be initiated before

Specimens have been taken for laboratory tests and examination

If amikacin is used in the treatment of this patient, monitoring of serum drug level may be advised because the drug

b. Has a narrow therapeutic window

Which antibiotic is typically recommended for prophylaxis against infective endocarditis at high-risk patients prior to dental procedures?

Amoxicillin

For adults undergoing surgery for which infection risk is high, such as orthopedic surgery, which of the following is the most advisable prophylactic antibiotic choice?

Cefazolin

Which of the following is a common indication for antibiotic prophylaxis in patients undergoing surgical procedures?

b. Patients with prosthetic heart valves

A 50-year-old woman is undergoing hip replacement surgery. Her surgeon placed her on a broad-spectrum antibiotic prior to surgery. What is the goal of his antibiotic use?

a. Prophylaxis

Which antibacterial agent appears to be the safest to use in the pregnant patient?

Azitrhomycin

Which antibiotic is known to be bacteriostatic?

c. Clindamycin

Which of the following antibiotics is bactericidal?

c. Ciprofloxacin

The elimination half-life of many beta-lactam antibiotics is prolonged by which?

Probenecid

Which antibiotic is classified as bactericidal and is commonly used to treat tuberculosis?

Isoniazid

Which of the following is classified as bacteriostatic?

Erythromycin

Which antibiotic is known to be time-dependent?

c. Beta-lactam

7. Which of the following is concentration dependent?

c. Aminoglycosides

Which of the following is not bactericidal?

Doxycycline

Which of the following is not bacteriostatic?

c. Metronidazole

Which of the following is a characteristic of concentrationdependent antibiotic?

c. Exhibit a post-antibiotic effect

Which of the following antibiotics is a bactericidal?

c. Penicillin

Bactericidal antibiotics are particularly useful in:

b. Immunocompromised patients

Amoxicillin

How does micro-organism have resistance to Beta-lactams

- (1) Inactivation of antibiotic by β-lactamase - (2) Modification of target PBPs - (3) Impaired penetration of drug to target PBPs - (4) Antibiotic efflux

essential for the biologic activity of these compounds for beta lactams

Structural integrity of the 6-aminopenicillanic acid nucleus

MoA of Beta-Lactams

interfering with the transpeptidation reaction of bacterial cell wall synthesis.

The only Penicillins can be taken with food

Amoxicillin

irritation and local pain from intramuscular injection of large doses.

PENICILLIN G

Effective in the treatment of syphilis

benzathine penicillin (IM once weekly)

The only penicillin cleared by biliary excretion

Nafcillin

Mild to moderate localized staphylococcal infections

- Cloxacillin - Dicloxacillin

Serious systemic staphylococcal infections

-Oxacillin -Naficillin

Adverse effect of Nafcillin

Neutropenia

Adverse effect of Oxacillin

Hepatitis

Adverse effect of Methicillin

Interstitial nephritis

1st gen Cephalosporin

Cefazolin, Cefadroxil, Cephalexin, Cephalothin, Cephapirin, and Cephradine

2nd Gen Cephalosporin

Cefaclor, Cefamandole, Cefonicid, Cefuroxime, Cefprozil, Loracarbef, and Ceforanide, Cefoxitin, Cefmetazole, and Cefotetan

3rd Gen Cephalosporin

Cefoperazone, Cefotaxime, Ceftazidime, Ceftizoxime, Ceftriaxone, Cefixime, Cefpodoxime Proxetil, Cefdinir, Cefditoren Pivoxil, Ceftibuten, And Moxalactam

4th gen

Cefepime

5th gen

Ceftaroline

Which one is not a 1st Gen Cephalosporin

Cefaclor

Which one is not a 2nd Gen Cephalosporin

Cefotaxime

Primarily gram-positive coverage with limited gramnegative activity.

FIRST-GENERATION Cephalosporin

The only IV First Gen Cephalosphorin

Cefazolin

Expanded gram-negative activity while retaining grampositive coverage.

SECOND-GENERATION

Greater gram-negative activity but reduced gram-positive coverage.

THIRD-GENERATION

Broadest spectrum, covering both gram-positive and gramnegative bacteria effectively, and Pseudomonas aeruginosa

FOURTH-GENERATION

Has Methicillin-resistant Staphylococcus aureus (MSRA) coverage

FIFTH-GENERATION

Drug of choice for surgical prophylaxis

Cefazolin

2nd Gen Cephalosporin available in IV and Oral

Cefuroxime

Exhibit activity against anaerobes also available in IV

Cefoxitin, Cefmetazole, and Cefotetan

SECOND-GENERATION CEPHALOSPORINS are excreted via ?

All are renally

FIRST-GENERATION CEPHALOSPHORINS Excretion is mainly by

by glomerular filtration and tubular secretion

patients with renal failure or impairement should be ____ for cephalosphorin

Dosage Adjustment

2nd gen cepholosphohrin for Community Acquired Pneunomia

Cefuroxime

SECOND-GENERATION CEPHALOSPORINS for: -plus anaerobes - Peritonitis - Diverticulitis - Pelvic inflammatory disease

(Cephamycins) Cefoxitin Cefmetazole Cefotetan

Only IV 3rd gen Cehp that can't penetrate body fluids and tissue

Cefoperazone

Oral 3rd Gen Ceph

Cefixime Cefdinir Ceftibuten Cefpodoxime

3rd gen Ceph Treatment of Meningitis

Ceftriaxone 2g q12h

- Serious infections caused by organisms - Bacterial Meningitis

Ceftriaxone Cefotaxime

Febrile Neutropenia

Ceftazidime

What organism 3rd gen cehpalosporin is contra indcated

Enterobacter, serratia, C, Freundii, Hafnia, Aeromonoas, Proteus, Providencia, Morganella Morgann

What gen of Cephalosphorin can penetrate well into CSF

4th gen

Treatment of enterobacter infections

Cefepime

First Beta-lactam antibiotic with activity against methicillin resistant staphylococci (MRSA)

CEFTAROLINE

Patients with documented penicillin anaphylaxis have an increased risk of reacting to

cephalosporins

beta-lactam that only covers for gram-negative organisms

AZTREONAM

AZTREONAM shares structural similarities to

ceftazidime

Bacterial Coverage of aztreonam

aerobic gramnegative rods (including Pseudomonas aeruginosa)

Antibacterial spectrum combination is determined by the companion penicillin, not the beta-lactamase inhibitor

BETA-LACTAMASE INHIBITORS

Amoxicillin can be paired with

Clavulanic acid

Ampicillin can be paired with

Sulbactam

Tazobactam can be paired with

Piperacillin

Ertapenem has no coverage for

Pseudomonas aeruginosa

Adverse Effects of Carbapenem

-low platelets -Drug fever -Seizure (imipenem-Cilastatin)

Imipenem is inactivated by

dehydropeptidases

Excessive levels of imipenem in patients with renal failure will cause

Seizures

Adverse effect of vancomycin

Phlebitis

Adverse effect of vancomycin

Red man syndrome

- Very similar to vancomycin in mechanism of action and antibacterial spectrum - It can be given IM or IV - Permitting once-daily dosing - Long half-life (45 – 70 hours)

TEICOPLANIN

Approved for treatment of complicated skin and soft tissue infections and hospital-acquired pneumonia

TELAVANCIN

alternative Vancomycin Allows for once-weekly IV administration

DALBAVANCIN AND ORITAVANCIN

Novel cyclic lipopeptide fermentation product of Streptomyces roseosporus

DAPTOMYCIN

Treatment of uncomplicated lower urinary tract infections in women

FOSFOMYCIN

Suppression of mixed bacterial flora in surface lesions of the skin, in wounds, or mucous membranes

BACITRACIN

- Used almost exclusively to treat tuberculosis caused by Mycobacterium tuberculosis strains resistant to first-line agents - Second-line agent for PTB

CYCLOSERINE

inhibit the synthesis of folate, which is crucial for bacterial growth and survival.

Sulfonamides

Toxoplasmosis

Pyrimethamine + Sulfadiazine

UTI

- TMP-SMX - Sulfisoxazole 2-4 g initially, followed by 1-2 g orally QID x 5-10 days

used in ulcerative colitis, enteritis, and other inflammatory bowel disease

Sulfasalazine

used topically but can be absorbed from burn sites

mafenide acetate

used as a second-line drug for the treatment of malaria

Pyrimethamine + Sulfadoxine

P. jirovecii pneumonia (in patients who are immunodeficient such as those with HIV)

Sulfonamide + Trimethoprim

Adverse effect of Sulfonamides

hemolytic anemia (esp. in G6PD deficiency), leukopenia

THERAPEUTIC USES OF TRIMETHOPRIM-SULFAMETHOXAZOLE

o Urinary Tract Infections o Respiratory Infections o Otitis Media o Pneumocystis jirovecii

ADVERSE EFFECTS of TMP-SMX

- Megaloblastosis - Leukopenia - Thrombocytopenia

MOA of fluoroquinolones

Inhibit DNA gyrase and topoisomerase IV

DNA Gyrase Inhibition

Gram NeGative

Topoisomerase IV inhibition

Gram posiTive

Fluoroquinolones that are not excreted by the kidney

Moxifloxacin Delafloxacin and Gemifloxacin

2nd generation quinolone

- Lomefloxacin (Maxaquin) - Enoxacin (Penetrex) - Ofloxacin (FLoxin) - Ciprofloxacin (Cipro) - Levofloxacin (Levaquin)

Quinolone coverage for Gram-negative organisms (but not Pseudomonas species)

1st gen - Nalidixic acid (NegGram) - Cinoxacin (Cinobac) - Norfloxacin (Noroxin)

Prostatitis:

Norfloxacin, Ciprofloxacin, Ofloxacin x 4–6 weeks

PRIMARY ANTI-TB DRUGS

- H – Isoniazid - R – Rifampin/Rifampicin - Z – Pyrazinamide - E – Ethambutol

used to treat active tuberculosis to prevent the emergence of resistance during therapy

H – ISONIAZID & R – RIFAMPIN

CATEGORY I oF TB

2HRZE/4HR

CATEGORY IA of TB

2HRZE/10HR

CATEGORY II

2HRZES/1HRZE/5HRE

CATEGORY IIA

2HRZES/1HRZE/9HRE

Most active drug for the treatment of tuberculosis caused by susceptible strains

ISONIAZID

Inhibits synthesis of mycolic acids, which are essential components of mycobacterial cell walls

ISONIAZID

BASIS OF RESISTANCE of ISONIAZID

- Overexpression of inhA - Mutation or deletion of the katG gene - Promoter mutations resulting in overexpression of ahpC - Mutations in kasA

Readily absorbed from the gastrointestinal tract optimally on an empty stomach

ISONIAZID

Adverse reaction of Isoniaizid

Drug-induced systemic lupus erythematosus

2nd most active drug for TB

RIFAMPIN

Resitance to Rifampin

Mutation in rpoB

LATENT TUBERCULOSIS Single agent alternative to Isoniazid dosage is 600 mg/day for 4 months

Rifampin

Latent Tuberculosis of 9 months

Isoniazid

Rifampin combination therapy for serious staphylococcal infections such as:

o Osteomyelitis o Prosthetic joint infections o Prosthetic valve endocarditis

Adverse reaction of Rifampin

Imparts a harmless orange color to urine, sweat, and tears

Inhibits mycobacterial arabinosyl transferases, which are encoded by the embCAB operon.

ETHAMBUTOL

retrobulbar neuritis, resulting in loss of visual acuity and red-green color blindness.

ETHAMBUTOL

MAJOR ADVERSE EFFECTS of Pyrazinamide

HEPATOTOXICITY

MECHANISM OF ACTION of pyrazinamide

Pyrazinamide is converted to pyrazinoic acid (the active form of the drug) by mycobacterial pyrazinamidase, which is encoded by pncA

DRUGS USED IN LEPROSY

Combination of Dapsone, Rifampin, and Clofazimine

May also be used to prevent and treat Pneumocystis jiroveci pneumonia (PJP) in AIDS patients.

DAPSONE

Acyclic Guanosine derivative

Ganciclovir

Drug of choice for CMV infections

Ganciclovir

Dual therapy for more effective delaying progression of retinitis in patients with AIDS

Foscarnet and ganciclovir

1st generation of tetracycline

Tetracycline

2nd generation of tetracycline

(DM 2) Doxycycline and mino Cycline

3rd generation of tetracycline

(TOE 3) tigecycline, Omadacyline and Eravcycline

MOA of tetra cycline

reversible Inhibits portein synthesis at the 30s Subunit

Tetracycline is best against....

anaerobes, rickettsiae, chlamydia and mycoplasmas

tetracyclines effective agaisnt TetAE efflux pump

3rd gen tetra TOE3

tetracyclines effective agaisnt TetK

3rd gen + Doxy

tetras effective against multidrug efflux pump

3rd gens

Tetracyclines that are well absorbed

2nd Gen DM2 95-100%

Tetracycline that are moderately absorbed

1st Gen tetracycline, Demeclocylcline

tetra poorly absorbed

3rd gen tigecycline,Eravacycline poorly Omadacycline = 35%

Tetra cycline that can be administered with food

2nd Gen

- Tetracyclines are distributed widely to tissues and body fluids except for

Cerebro spinal fluid

Tetra that are slowing excreted

2nd Gen

What gen of tetracyclin that are: effective against multidrug efflux pump poorly absorbed effective against TetK

3rd gen

what gen of tetracycline that are Well absorbed Slowly Excreted Can be administerd with food

2nd Gen

Drug of Choice for: Rickettsiae Borellia Rocky MOuntain spotted fever Lyme Disease

Tetracycline

Excellent drugs for treatment of: Myoplasma pneumoniae Chlyamydia Spirochetes

Tetracycline

Adverse effect of tetracyclines

Alters the normal GI flora Nausea,vomiting and diarrhea it can bound to calcium in newly formed bones Impairs hepatic funciton

Combination with beta lactam in serious infection with gram-negative

Aminoglycosides (mycin)

Three mechanisms of resitance to tetracycline analogs

Impaired influx or increase reflux Ribosome protection Enzymatic inactivation

MOA of Aminoglycoside

Irreverisbile inhibits protein synthesis

Mechanism of resistance of Aminoglycoside

Production of a trasferase Enzyme Imapired entry 30s receptor is altered or deleted

Usual route of administered of aminogylcoside

Adverse effect of Aminoglycosides

Ototoxic Nephrotoxic

Aminoglycoside that can cause auditory damage

Neomycin Kanamycin Amikacin

Aminoglycoside that are most vestibulotoxic

Streptomycin Gentamycin

Aminogylcoside that is most nephrotoxic

Neomycin Tobramycin Gentamycin

Protein Synthesis inhibitor is mostly used agaisnt aerobic gram-negative bacteria

Aminoglycosides (mycin)

Second line for TB good for Tularemia, Brucellosis with penicilin effective for enterococcal endocarditis

Streptomycin

Meningitis caused by gram negative bacteria has been treated by the intrathecal injection

Gentamicin

the antibiotic that comes in eyedrop form.

Tobramycin

It is resistant to many enzymes that inactivate gentamicin and tobramycin.

AMIKACIN

is generally limited to topical and oral use due to toxicity associated with parenteral use

Neomycin

Very nephrotoxic if given IV

Neomycin

antidotes for Aminglycocide adverse reaction

Calcium gluconate and neostigmine

Newest aminoglycoside to gain FDA approval for treatment of complicated urinary tract infections (cUTI).

PLAZOMICIN

used almost solely as an alternative treatment for drugresistant gonorrhea or gonorrhea in penicillin allergic patients.

SPECTINOMYCIN

50S subunit blockers

o Macrolides o Clindamycin o Chloramphenicol o Streptogramins o Oxazolidinones

Protoype drug of macrolides

Eryhtromycin

inhibits the formation of the 50S ribosomal subunit

Erythromycin

Destroyed by stomach acid and must be administered with enteric coating

Erythromycin

is not removed by dialysis.

Erythromycin

Adverse effect of Erthromycin

Anorexia

more active against Mycobacterium avium complex. than erythromycin

Clarithromycin

A minimally absorbed macrolide used to treat Clostridioides difficile

FIDAXOMICIN

Macrolide does not inactivate cytochrome P450 enzyme.

AZITHROMYCIN

Doesn't interact with erythro and clarithro

Azithromycin

Can prolong QT interval

Azithromycin

Enterococci and gram-negative aerobic organisms are resistant

CLINDAMYCIN

Rapidly bactericidal for most susceptible organisms except Enterococcus faecium

STREPTOGRAMINS

a combination of two streptogramins:

Quinupristindalfopristin

MLSB type resistance

STREPTOGRAMINS

Quinupristindalfopristin is approved for treatment of infections caused by:

Staph and strep

a member of the oxazolidinone class of synthetic antimicrobials

Linezolid

100% bioavailable after oral administration

Oxazolidinone

Approved for: o Vancomycinresistant E. faecium infections o Health care-associated pneumonia o Communityacquired pneumonia,

Oxazolidinone

Thrombocytopenia is the most common manifestation of this drug

Oxazolidinone

Most common adverse effect of intravenous ganciclovir treatment

Myelosuppression

Adverse reaction of Valganciclovir

Bone Myelosuppression

Non-nephrotoxic antiviral alternative

Foscarnet

to be non nephrotoxicity foscarnet must be given

titrated

Helps prevent nephrotoxicity of foscarnet

Saline preloading

Genital ulceration is caused by

high levels of ionized drug in the urine

Cytosine nucleotide analog

Cidofovir

Competitively inhibiting DNA synthesis and becoming incorporated into the viral DNA chain

Cidofovir

Treatment of CMV Retinitis

IV Cidofivir

IV cidofivir primary adverse effect ?

Proximal tubular nephrotoxicity

blocks active tubular secretion and decrease nephrotoxicity of Cidofivir

high-dose probenecid

Indicated for CMV prophylaxis in adult CMV

Letermovir

Neuraminidase inhibitor available in the philippines

Oseltamivir

Adminstered diretly via inalation and not available in the philippines

Zanamir

Adverse effect of anti-influenza agents

Coughm bronchospasm

Active against influenza A only

Amantadine and Rimantadine

against HBV and HCV infection

Interferon

May used for condylomata acuminata

Interferon

good for HCV infection with interferon alfa

Ribavirin

prevetion of RSV infection in high-risk infant and children

Palivizumab

Topical treatment of external genital and perianal warts

Imiquimod

Anti-covid drug that sue for mild to moderate risk of severe Covid

Remdesivir

Oral treatment of genital herpes

Acyclovir

For varicella-zoster 3x a day

Valcyclovir

for recurrent herpes labialis

Penciclovir

Boost innate immunity to reduce viral replication and promote immune clearance

Interferon-alpha

Adverse effect of interferon

Flu-like symptoms

Adenine nucelotide analaog

Adefovir

Guanosine nucloeside analog

Entecavir

Cytosine nucleoside analog

Lamivudine

Thymidine nucleoside analog

Telbivudine

adenosine nucleotide analog

Tenofovir

Traditional Treatment of Hep C

Peggylated interferon alfa in combination with daily oral ribavirin

Nucleotide analog that inhibits the HCV

Polymerase inhibitor Sofosbuvir

Cornerstone of management of patient with HIV infection

cART aka HAART

NNRTI

-vir- in the midle

Protease Inhibitor

Navir

Integrase strand transfer inhibitor

Gravir

First line of regiment on antiretroviral therapy

2 NRTI + 1 NNRTI Tenofovir+ lamivudine + efavirenz

Need to test HLA*B5701 before iniating therapy

Abacavir

Didanosine adverse effect

pancreatitis

drug of choice of INSTI

Doletegravir

Teonfovir can cause

Fanconi syndrome

Primary Anti-TB Drugs

HRZE Isoniazid Rifampin/Rifampicin Pyrazinamide Ethambutol

prevered treatment of TB in the philippines

2HRZE/4HRs

Gene that indicate of Rifampicin resistance

rpoB

most active drug for TB

Isoniazid

MoA of Isoniazid

Inhibits synthesis of mycolic acid

Isoniazid must be taken at what time

before breakfast

Internaional duration of treatment of Isoniazid

9 months (locally 6 months)

Adverse reaction of Isoniazid

Drug-induced SLE Fever and skin rashes

What needs to be monitored during anti-TB medication

Liver function test

Most common major toxic effect of isoniazid

Hepatitis

2nd most active drug of anti-TB

RIfampin

what given to reverse neuropathy of Isoniazid

Pyridoxine (b6)

Rifampicin is excreted through ?

liver into bile

what Anti-TB drug has an activity against the biofil from the prosthetic material

RIfampicin

Drug that changes the urine,sweat and tears to orange

Rifampicin

MoA of Rifampicin

bind to beta sub unit of bacteria DNA

MoA of Ethambutol

Inhibiys mycobacterial arabinosyl transferases

What Anti-TB drug can cause loss of visual acuity

Ethambutol

The only anti-TB drug only use for TB

Pyrazinamide

Resitance of pyrazinamide is due to

mutations in pncA

what anti-TB drug requries doses adjustment in renal failure

Pyrazinamide and Ethambutol

anti-TB drug that can cause nephritis

Rifampin

Adverse effects of Pyrzainamide

Hepatoxicity Hyperuricemia Nausea Vomiting Photosensitivity

resitance of streptomycin is due to mutation in

rpSL gene or rrs gene

Durgs used in leprosy

Dapsone, Rifampin and Cofazimine

what is the drug that is only effective against fungi in the GI lumen

Amphotericin B

MoA of Ampotericin B

Binds to ergosterol and alter permiabilit of the cell

Low water Solubility azoles

Keto, Itra, Posca (KIP)

what azole is not excreted by renally

Fluconazole

Treatment for Dermatophytosis and candidiasis topically

Ketoconazole

Treatment for vulvovaginal candidiase

Clotrimazole or Miconazole

a carrier molecule to enhance solubility and bioavailibity of triazole

Cyclodextran

Preferred azole for treating diseases caused by dimorphic fungi

Itraconazole

This organism can resist fluconazole

Candida glabrata, kruseii, auris

Fungal coverage of Fluconazole

Cryptococcus Candida spp Coccidioides immitis

What drug to give on fluconazole resistant drugs

Voriconazole

Boradest-spectrum azole

Posaconazole

azole that is improved when taken with meals with high in fat

Posaconazole

Echinocandin

fungin

MoA of Echinocandin

Inhibit the synthesis of B(1-3)-glucan

Echinocandin are active against....

Candida and Aspergillus

treatment of choice for invasive aspergilossis and some enviromental molds

Voriconazole

Prophylaxis of fungal infection in leukemia patients

Posaconazole

also an alternative agent recommended by the Centers for Disease Control and Prevention for Primary and Secondary Syphilis

Doxycycline

Drug of choice for o Rickettsiae o Borrelia spp.

TETRACYCLINE

When to discontinue Tetracycline

When patient is vomiting, nausea and diarrhea

mainly used as a second line agent for treatment of tuberculosis.

Streptomycin

most serious toxic effect with streptomycin

o Vertigo o Loss of balance

treatment of complicated urinary tract infections (cUTI).

PLAZOMICIN

Active in vitro against many gram-positive and gramnegative organisms, but it is used almost solely as an alternative treatment for drugresistant gonorrhea or gonorrhea in penicillin allergic patients.

SPECTINOMYCIN

o Certain corynebacterial infections (eg, diphtheria and erythrasma) o Respiratory, neonatal, ocular, or genital chlamydial infections.

ERYTHROMYCIN

Erythromycin is not removed by

dialysis

Adverse effect of Erythromycin

Anorexia

A minimally absorbed macrolide used to treat Clostridioides difficile (formerly Clostridium difficile) infections.

FIDAXOMICIN

gray baby syndrome

CHLORAMPHENICOL

Rapidly bactericidal for most susceptible organisms except Enterococcus faecium, which is killed slowly.