1) BacteriostaticInhibitorsofProteinSynthesis

a) Tetracyclines
i) Broadspectrumantibiotics
(1) Suppressbacterialgrowthbyinhibitingproteinsynthesis
(2) Rickets,chlamydia,mycoplasmapneumoniae,Lymedisease,h.pylori,acne,periodontaldisease
(3) Decreasedabsorptionwithfood(1hr.beforeor2hr.aftermeals)
(4) Dontadministerwithcalcium,milkproducts,iron,magnesiumlaxativesorantacids
(5) Contraindicated:
(6) severerenalimpairment
(a) Longactingagents(doxycycline)drugofchoiceinpatientwithrenalimpairment*
(b) pregnancy/breastfeeding
(c) childrenunder8y/o(d/tstainedteeth)
(7) GastrointestinalIrritation(burning,cramps,n/v/d)*avoiddosingatbedtime
(8) Superinfection(c.diff,candidaalbicans)
(9) Hepatoxicity(lethargyandjaundice)
(10) Renaltoxicity
(a) Highdosecauseseverliverdamage,esp.inpregnantandpostpartum
(11) Photosensitivity(teachsunburn)

b) Macrolides
i) Inhibitsproteinsynthesis
ii) Erythromycin(big)preferred
iii) Firstchoicetx.andalternativetopenicillinGallergy
iv) Pertussis,diphtheria,chlamydia,pneumonia
v) Fooddecreasesabsorption
vi) QTDRUG
vii) AdverseEffects:
(1) GI(pain,n/v/d)
(2) QTprolongation&suddencardiacdeath

c) Clindamycin
i) CDADbiggestrisk
ii) Alternativetopenicillin
iii) Drugofchoiceforstreptococcal,gasgangrene,abdominalandpelvicinfections
iv) AdverseEffects:
(1) C.diff(CDAD)profuse,waterydiarrhea
(2) Opioidsandanticholinergicsmayworsensymptoms
(3) Promptlyreportanydiarrhea

d) Linezolid(Zyvox)
i) Usefulformultidrugresistantbacteria,VREandMRSAreservedfortheseinfections
ii) AdverseEffects:
(1) Diarrhea,nausea,headache
(2) ReversibleMyelosuppression(anemia,leukopenia,thrombocytopenia,pancytopenia)
(a) *WEEKLYBLOODCOUNTS
(3) Neuropathy(rare)
iii) DrugInteractions:
(1) InhibitsMAO(hypertensivecrisis)
 (2) SSRI(serotoninsyndrome)

e) Chloramphenicol
i) Inhibitsproteinsynthesis
ii) Fatalaplasticanemiaandgraysyndrome
(1) Graysyndrome:graycoloration,abdominaldistention,vomiting,cyanosis=discontinue
immediately!
(2) ReversibleBonemarrowsuppression:(CBCbefore&q.2daysafter)
(3) AplasticAnemia:fatal,weekstomonthsaftertx.
iii) Crossesbloodbrainbarrier
iv) Decreasedosewithliverimpairment
v) Lifethreateninginfectionsonly

2) Aminoglycosides:
a) Narrowspectrum,primarilyaerobicgramnegativebacteria
b) Disruptproteinsynthesis,causingrapidbacterialdeath
c) Seriousinjurytoinnerearsandkidneys
i) Damagetocochlea,disruptionofbalance
ii) Firstsign=highpitchedtinnitus,followedbyheadache
iii) Irreversible
d) Poorlyabsorbedorally,betterparentally
e) Bactericidal,concentrationdependent
f) Postantibioticeffect
g) E.coli
h) Reducedosewithrenalimpairment
i) Dosingmustbeindividualized
i) Monitorserumlevels(peakhigh,troughlow)
j) Nephrotoxicity
i) MonitorcreatinineandBUN
k) Neuromuscularblockade
i) Flaccidparalysisandpotentiallyfatalrespiratorydepression
ii) ReversewithIVcalcium
l) Oftenprescribedwithpenicillinstoenhancekill
i) NevermixtogetherinsameIVsolution,penicillincaninactivateaminoglycosides
(i) Gentamicin
1. Combinationwithvancomycinorpenicillin
2. Toxictokidneyandears

3) SulfonamidesandTrimethoprim
i) Sulfonamides
b) SulfonamidesprimarytreatmentagainstUTI
i) E.Coli
c) Inhibitfolicacid(folate)requiredbycellstomakeDNA,RNA&proteins
d) Hypersensitivityreactions
i) Rash,drugfever,photosensitivity
(1) Wearsunscreen&protectiveclothing
ii) StevenJohnsonssyndrome*mostseverehypersensitivityreaction
 (1) lesionsofskinandmembranes,fever,malaise,toxemia(highBP,swellingofhands&feet,protein
inurine)
(2) Discontinueimmediatelywithanyrash
e) HemolyticAnemiainpt.withG6deficiency
i) Fever,pallor,jaundice
ii) Agranulocytosis,leukopenia,thrombocytopenia
f) Kernicterus
i) Depositionofbilirubininnewbornbrain
ii) Neveruseinpt.under2mo.old/pregnancyorbreastfeeding
g) Renaldamagefromcrystalluria
i) 8to10glassesofwaterperday

ii) Trimethoprim/sulfamethoxazole
(1) UTItreatment,esp.goodforHIVpt.
(2) Hyperkalemia
(3) Birthdefects
(4) UTIprophylaxiswithlowdosetherapy

4) Fluoroquinolones
a) DisruptDNAreplicationandcelldivision
b) InhibitDNAgyraseandtopoisomerase
c) Tendinitisandtendonrupture*usuallyAchillestendon
i) Ciprofloxacin(Cipro)
(1) Respiratorytract,urinarytract,GItract,joints,skin,softtissueinfections
(2) Preferreddrugforpreventinganthrax
(3) Candidamaydevelopfromtreatment
(4) CNSeffectsinolderadults(confusion,visualdisturbances)
(5) 60+,transplants,glucocorticoids=highriskfortendonrupture
(a) stopimmediatelyifpain,swelling,orinflammation
(b) dontexerciseuntiltendinitisisruledout
(6) phototoxicity
(a) avoidsunlightandsunlamps
(7) MyastheniaGravis
(a) Exacerbatemuscleweakness
(8) Absorptiondecreasedbycationicsubstances
(a) 6hoursbetweenmilkproducts(calcium),antacids,iron,zincsalts&sucralfate

5) AntimycobacterialAgents:DrugsforTB
a) Antituberculosisregimensmustalwayscontaintwoormoredrugstowhichtheinfectingorganismis
sensitive
b) Fourtosevendrugregimenfor6monthsto2+years
c) Directobservationtherapytoensureadherance
d) Inductionphase:eliminateactivelydividingextracellulartuberclebacillimakesputumuninfectious
i) 2months
ii) isoniazid,rifampin,pyrazinamide,andethambutol
e) Continuousphase:eliminateallleftoverbacteria
i) 4months
ii) isoniazidandrifampin
 (1) Rifampim
(a) Broadspectrumantibiotic
(b) SupressesRNAandproteinsynthesis
(c) Takeonanemptystomachformaximumabsorption
(d) AdverseEffects:
(i) Hepatotoxicity:
1. Jauniceorhepatitis
2. Monitorforincreaseinliverenzymesbeforetreatmentandq.24weeksafter
(ii) Discolorationofbodyfluids:
1. Redorangecoloredurine,sweat,salivaandtears
(2) Isoniazid
(a) Primaryagentfortx.andprophylaxisofTB
(b) Inhibitsgrowthofmycolicacid(specifictoTB)
(c) AdverseEffects:
(i) Hepatotoxicity
1. Injuryandnecrosis
2. Monitorforanorexia,fatigue,nausea,jaundice
3. Greatestriskfactorisadvancingage
4. Stopimmediately

(ii) PeripheralNeuropathy
1. Mostcommon
2. Tingling,numbness,burningpainofhandsandfeet
3. Causedbypyridoxine(B6)deficiency
4. Eliminatealcoholintake

(3) Pyrazinamide
(a) AdverseEffects:
(i) Hepatotoxicity
1. Hepatitisornecrosis
2. ElevationinASTand/orALT
3. Monitorbeforetreatmentandq.2weeks
(ii) NongoutyPolyarthalgias
1. Paininmultiplejoints
2. TreatmentwithNSAIDS
(4) Ethambutol
(a) AdverseEffects:
(i) OpticNeuritis
1. Doserelated
2. Blurredvision,constrictionofvisualfield,disturbanceofcolordiscrimination
3. Assessvisionbeforeandq.monthafter
6) MicellaneousAntibacterialDrugs:Metronidazole
a) Metronidazole(Flagyl)
i) Protozoalinfectionandobligateanaerobicbacterialinfections
ii) InfectionsofCNS,abdominalorgans,bones&joints,skinandsofttissues,GUtract
iii) Prophylaxisforcolorectal,abdominalorgynecologicsurgery
 iv) UsedincombinationtherapyforH.pyloriassociatedPUD

7) Antifungalagents
a) Drugsforsystemicmycoses
i) Fourclasses:polyeneantibiotics,azoles,echinocandins,pyrimidineanalogs
(1) AmphotericinB(polyeneantibiotic)
(a) Drugofchoiceforpotentiallyfatalinfections*
(b) Highlytoxic(infusionreactions&renaldamage)
(c) Increasepermeabilityofcellwallcausingleakageanddeath
(d) 68weekstreatment
(e) MustbeadministeredIV
(f) AdverseEffects:
(i) Infusionreactions:
1. Fever,chills,rigors(coldandsweating),nausea,headache
2. 13houraftertreatment&persistfor1hour
3. Pretreatmentwithdiphenhydramineplusacetaminophen
4. AdministerDantroleneifrigorsoccurs
(ii) Phlebitis
1. Common
2. ReducebychangingIVsitesoftenandpretreatwithheparin
(iii) Nephrotoxicity
1. Reversible
2. Minimizebyinfusing1Lofsalinewhenadministratingamphotericin
3. Avoidnephrotoxicdrugs
4. Kidneyfunctionq.34days
5. StrictI&O
6. Administerpotassiumsupplements
(iv) BoneMarrowSuppression
1. Anemia
2. MonitorCBS/Hematocrit*

(g) Ketoconazole(azole)
(i) Inhibitsynthesisofergosterol
(ii) AlternativetoamphotericinBforsystemicinfections
1. Muchlesstoxicandaseffective
(iii) Antacidswilldecreaseabsorption
(iv) GivedrugwithfoodtoavoidGIupset
(v) AdverseEffects:
1. Livernecrosis
a. Monitorbaselineandq.month
2. Sterility

(h) Flucytosine(pyrimidineanalog)
(i) seriousinfectionscausedbycandidaandc.neoformans
(ii) AlwaysincombinationwithamphotericinB
(iii) AdverseEffects:
 1. BoneMarrowSuppression:
a. Reversibleneutropeniaorthrombocytopenia
b. Plateletandleukocytecountq.week
2. Hepatotoxicity
a. Mildandreversibleliverdysfunction
b. Liverfunctionmonitoredq.week

b) Drugsforsuperficialmycoses
i) Nystatin(PolyeneAntibiotics)
(1) Drugofchoiceforintestinalcandidiasis
(2) Oralortopic

ii) Griseofulvin
(1) Oraltotreatsuperficialmycoses
(2) Depositedintokeratinofskin,hairandnails
(3) Dosewithafattymealtoenhanceabsorption

8) DrugsforTreatingParasites
a) Malaria:
i) MildtoModerateMalaria:oraltherapy;chloroquine3daycourseforclinicalcure
ii) SevereMalaria:parentaltherapyofquinidinegluconateplusantibiotic
iii) Prophylaxis:takeonceaweek
(1) Chloroquine
(a) Highlyactiveagainsterythrocyticformsofparasite
(b) Drugofchoiceformildmoderateandprophylaxis
(c) Notactiveagainstexoerythrocytic(liver)form
(d) AdverseEffects:
(i) GIeffects:(discomfort,nausea,diarrhea)*takewithmealtodecrease
(ii) Visualdisturbances
(iii) Pruritus
(iv) Headache

(2) Quinine
(a) Preferredtx.forchloroquineresistantmalaria
(b) Quinineoccursnaturallyinthebarkofcinchonatree
(c) Activeagainsterythrocyticforms;notliver
(d) Adjunctwithantibioticsbecauseitisnothighlyactive
(e) AdverseEffects:
(i) Cinchonism:tinnitus,headache,visionchanges,nausea,diarrhea
1. Contraindicatedinpt.withpreexistingopticneuritisortinnitus
(ii) Hemolysisinpt.withg6pddeficiency
1. Contraindicatedinpt.withthisgene
(iii) Quinidinelikeeffectsontheheart
1. Cautioninpt.witha.fib
(iv) Hypoglycemia
1. D/tstimulateofpancreaticbetacells,whichcauseshyperinsulinemia
 (f) PregnancyCategoryX
(i) Causesdeafnessinfetus

(3) QuinidineGluconate
(a) Onlyparenteraldrugformalaria
(b) Adjunctwithantibioticsbecauseitisnothighlyactive
(c) AdverseEffects:
(i) Hypotension
(ii) Circulatoryfailure
(iii) *diluteandinjectslowly
b) Worms
i) Mebendazole
(1) Drugofchoiceformostintestinalworms
(2) Preventsuptakeofglucosefromworms,paralyzesthemdeath

c) ProtozoalInfection
i) Pentamidine
(1) PneumocystisPneumonia(PCP)
(a) DisruptDNA,RNAandproteinsynthesis
(b) Inhalation:prophylaxistreatmentofPCPinpt.withHIV
(i) Hx.of1ormoreepisodesofPCP
(ii) CD4countbelow200
(iii) SideEffects:
1. Cough
2. Bronchospasm

(c) Parenteral:treatmentofactivePCP
(i) SideEffects:
1. Suddenandseverehypotension
2. Hypoglycemiaorhyperglycemia
a. Monitorb/gdaily
3. NecrosisatIMinjectionsite
4. Leukopenia,thrombocytopenia,acuterenalfailure,hypocalcemia,dysrhythmias

(2) WestAfricanSleepingSicknessand
(a) IMinjection

d) Ectoparasiticides(parasitethatliveonsurfaceofhost)
i) Pediculosis(infestationwithlice)
(1) HeadLice
(a) Pruritus(itching)
(b) Treatmentofchoice:permethrinandpyrethrinswithpiperonylbutoxide
(c) Nitsremovedwithfinetoothcomb
(d) Repeattreatmentasneeded
(2) BodyLice
(a) Liveonclothing/washanddrywithhighheat
 (b) Treatmentofchoice:permethrinandmalathion

ii) Scabies(infestationwithMites)
(1) Mitesburrowbeneaththeskinandlayeggs
(2) Smallridgesordottedlines
(3) Wrist,elbows,navel,genitalregionandwebsoffingers
(4) Pruritusaftergoingtobed
(5) Eradicatebycoveringentirebodysurfacewithtreatmentlotion
(6) Drugofchoice:permethrin

1. Permethrin(nix,elimite,acticin)
a. Paralysisinadults,ovaunaffected
b. Approvedforchildren2monthandup
c. Itchingmaypersistfor2+weeksaftertreatment
d. Sideeffects:
i. Erythemaandedema
ii. Burning,stinging,numbness

2. Malathion(Ovide)
a. Killsliceandtheirova
b. Approvedforchildren6y/oandup
c. Sideeffects:
i. Flammable**teaching

9) AntiviralAgents:DrugsforNonHIVViralInfections

a) HerpesSimplexVirusesandVaricellaZosterVirus
i) HSV:infectionofgenitalia,mouth,face,othersites
ii) VZV:chickenpoxandshingles
(1) ShinglesisreactivationofdormantVZV

1. Acylovir(Zovirax)
a. FirstchoiceforHSVandVZV
b. PrematureterminationofDNAstrandgrowth
c. CanbetakenprophylacticallytopreventHSVlesions
d. IVfortreatmentofchoiceforimmunocompromisedpatients
e. AdverseEffects:
i. Intravenoustherapy:Phlebitisandinflammation,nephrotoxicity,dehydration
ii. *monitorforelevationincreatinineandBUN
iii. *Ensureadequatenutritionbeforebeginningoftherapy
iv. *Monitorforagitation,tremors,delirium(neurotoxicity)

b) CytomegalovirusInfection
i) Herpes,Varicella,EpsteinBarVirus
ii) Virusremainsdormantforlife
iii) Highrisk:immunocompromisedpt.(HIV,cancertx.immunosuppressants)

(1) Ganciclovir
(a) OnlyforpreventionandtreatmentofCMVinimmunocompromisedhost
 (b) SuppressesreplicationofDNA
(c) AdverseEffects:
(i) GranulocytopeniaandThrombocytopenia
1. BoneMarrowSuppression
2. MorelikelywithIVtherapy
3. Reversible
4. CBSmonitored
(ii) ReproductiveToxicity
1. Teratogenicandembryotoxicupto90daysaftertreatment
2. InfertilityandSterility
c) Hepatitis
i) AcuteHepatitis:
(1) 6months
(2) liverinflammation,jaundice,elevationofALT
ii) ChronicHepatitis:
(1) Canleadtocirrhosis,hepatocellularcarcinoma,liverfailure
(2) B,CandD

(a) InterferonAlfa
(i) Parenteraladministrationonly
(ii) Blocksviralentryintocells
(iii) SideEffects:
1. Flulikesyndrome
a. Fever,fatigue,myalgia,headacheandchills
2. Depression
a. Suicidalideationandsuicide
b. Administerantidepressantdrugs
3. Alopecia,GIaffects,thyroiddysfunction,bonemarrowsuppression

(b) Ribavirin(Oral)
(i) Noteffectivewhenusedalone
(ii) Combinationwithinterferonalfa
(iii) AdverseEffects:
1. Hemolyticanemia
a. Hemoglobinbelow10
b. Onset12weeksafterstartingtreatment
c. MonitorHgBbeforetreatment,24weeksafterstartandmonthlyafter
2. Fetalinjury
a. Ruleoutpregnancybeforestartingtreatment
b. Testq.6months
c. 2barriercontraceptivemethods;oralcontraceptiveswontwork
d) Influenza
i) Spreadbydropletsproducedbycoughorsneeze
ii) Symptoms24daysafterexposure,last56days
iii) AnnualVaccinationisbestprotectionforeveryone6monthsandolder

(1) Oseltamivir(Tamiflu)
 (a) Preventionandtreatmentinpt.1y/o+
(b) Treatment:nolaterthan2daysafteronsetofsymptoms
(c) Inhibitsviralenzymeneededforreplication
(d) Sideeffects:
(i) Severehypersensitivityreactions(rare):
1. Anaphylaxis
2. StephenJohnsonsSyndrome
a. Stopimmediately*

10) AntiviralAgents:DrugsforHIVInfectionandRelatedOpportunisticInfections

a) Zidovudine(Retrovir)
i) TreatmentofHIV
ii) Nucleotidereversetranscriptaseinhibitor
iii) Decreaseviralload,increaseCD4counts,delayonsetofdisease/decreasesymptoms
iv) Alwayscombinedwithanotherantiretroviralmedication
v) AdverseEffects:
(1) BoneMarrowSuppression
(a) Severeanemiaandneutropenia
(i) Deficiencyinb12adfolicacid
(ii) HgBandneutrophilcountbeforeandq.24weeks

(2) LacticAcidosiswithHepatomegaly
(a) Liverenlargementandfattydegenerationoftheliver
(b) Nausea,vomiting,abdominalpain,hyperventilation(blowingoffcarbondioxidecanreduce
acidosis)
(c) ABG
(3) Myopathy

b) Efavirenz(sustiva)
i) TreatmentofHIV
ii) AdverseEffects:
(1) CNSsymptoms
(a) Dizziness,insomnia,vividdreams,nightmares
(b) Resolvewithin2to4weeks
(2) Rash
(a) StephenJohnsonSyndrome
(3) Teratogenic
(a) Avoidgettingpregnant
iii) Druginteractions:
(1) CytochromeP450
(2) Hormonalcontraceptives
(3) St.JohnsWart
c) Saquinavir
i) HIV
ii) ProlongsQTinterval

d) Raltegravir
i) HIV
 ii) AdverseEffects:
(1) Toxicepidermalnecrolysis
(2) Rhabdomyolysis
(a) breakdownofmuscletissuethatreleasesadamagingproteinintotheblood.
(3) StephenJohnsonssyndrome

e) Enfuvirtide
i) HIVthatisresistanttoothertreatments
ii) BlocksentryofHIVintoCD4cells
iii) Twicedailysubcutaneousinjections
iv) AdverseEffects:
(1) Injectionsitereactions:
(a) Occursinallpatients
(b) Painandtenderness,erythema,nodulesorcysts,ecchymosis
(c) Rotateinjectionsitestoprevent
(2) Pneumonia
(a) Cough,fever,breathingdifficulties
(3) HypersensitivityReactions
(a) Rash,fever,vomiting,chills,rigors(cold,shivering,increaseintemp.)

f) Maraviroc(selzentry)
i) HIV
ii) BlocksHIVentry
iii) AdverseEffects:
(1) Cough,dizziness,pyrexia,rash,abdominalpain,musculoskeletal,Upperrespiratoryinfections
(2) Liverinjury
(a) Precededbysignsofallergicreaction(eosinophilia,rash,evelatedigE)
(3) CardiovascularEvents