Drugs Causing Disulfiram-Like Rxns Metronidazole

MOA

Indications

Toxicity

1.Forms free radical toxic metabolites in bacterial cell damages DNA 2. Bactericidal 3.Anti-protozoal 1.Alkylating agent (DNA ss breaks or cross-linking) 2.Antineoplastic chemo agent

Procarbazine

1.Giardia, Entamoeba, Trichomonas, Gardnerella 2.Anaerobes (Bacteroides, C. diff) anaerobic infections below diaphragm 3.Part of triple therapy against H. pylori metronidazole + PPI + clarithromycin 1.HL 2.GBM

1.Disulfiram-like rxn w/alcohol headache, metallic taste

1st-gen Sulfonylureas (Tolbutamide, Chlorpropamide)

Cephalosporins

1.Close K+ channel in B-cell membrane (pancreas) depolarization of cell increased Ca2+ influx triggers insulin release 2.Indirectly decrease release of glucagon 1.B-lactams inhibit cell wall synthesis 2.Less susceptible to PCNases 3.Bactericidal

1.DM type 2 stimulate release of endogenous insulin 2.Not for DM type 1 require some islet fn

1.Disulfiram-like rxn w/alcohol 2.BM suppression 7-14 days after tx 3.Vesicant properties 4.Exacerbated by DNA repair deficits 1.Disulfiram-like rxn w/alcohol

1.1st gen (Cefazolin, Cephalexin) gram + cocci, Proteus mirabilis, E. coli, Klebsiella 2.Cefazolin surgical prophylaxis to prevent S. aureus wound infections 3.2nd gen (Cefoxitin, Cefaclor, Cefuroxime CNS) gram + cocci, H. flue, Enterobacter aerogenes, Neisseria, Proteus mirabilis, E. coli, Klebsiella, Serratia, anaerobes; for intra-abd infections 4.3rd gen (reach CNS; Ceftriaxone, Cefotaxime, Ceftazidime) serious gram infections res to other B-lactams; Lyme disease/B. bergdorferi, meningitis, gonorrhea (Ceftriaxone); Pseudomonas (Ceftazidime) 5.4th gen (Cefepime) increased activity against Pseudomonas & gram + bugs

1.Disulfiram-like rxn w/alcohol (certain 2nd & 3rd gen) 2.HSR rxns 3.Vit K def 4.Low cross-reactivity w/PCNs 5.Increased nephrotoxicity of aminoglycosides 6.Phlebitis 7.Biliary sludging when rapidly infused (Ceftriaxone) 8.Safe in neonates Cefotaxime 9.C/I in neonates Ceftriaxone