Drug Class

INHIBITORS OF
PEPTIDOGLYCAN
CROSS LINKING

Names
-lactams
penicillins,
cephalosporins,
carbapenems

Mechanism
Bind PBPs (transpeptidases),
block cross-linking of
peptidoglycan activation of
autolytic enzymes. Bactericidal

Bugs

Resistance

Toxicity
Hypersensitivity with a range of
manifestations urticarial skin rash is
common, but anaphylaxis is possible
1. IgE mediated rapid onset,
anaphylaxis, angioedema,
laryngospasm
2. IgM and IgG antibodies fixed to
cells vasculitis, neutropenia,
positive Coombs test
3. Immune complex formation
vasculitis, serum sickness (fever,
urticaria, proteinuria, arthralgia,
lymphadenopathy 5-10 days after
starting the drug), interstitial
nephritis
4. T cell mediated urticarial and
maculopapular rashes, Sevens
Johnson syndrome

Notes
Most are eliminated
through the kidney
except nafcillin and
oxacillin are eliminated in
bile (N and O say NO to
the kidney!)

Same

Penicillin G
Streptococci
S pneumo - resistance
Meningococci
Treponema pallidum
Actinomyces

Penicillinase a type of
lactamase

Hemolytic anemia

Use penicillins for

prophylaxis of
endocarditis with surgical
or dental procedures

monobactam aztreonam

-LACTAM:
PENICILLINS
Bacteriocidal

Penicillin V (oral) &

Penicillin G
(IV/injection)

Jarisch Herxheimer reaction in

syphilis looks like sepsis

Penicillin G for syphilis

prophylaxis

Penicillin V
Streptococci and oral
pathogens

Amino-penicillins =
-lactamase-sensitive
penicillins

Ampicillin
Amoxicillin better
oral bioavailability

Same
HELPSS kill enterococci!

Gram positives
Gram postive cocci not
staph
Listeria (ampicillin)
Enterococci

Oral penicillin for

prophylaxis of strep
pharyngitis in a kid with a
history of rheumatic fever
Penicillinase

Psuedomembranous colitis (broad

spectrum)
Maculopapillar rash is common with
ampicillin

More gram negatives

H Influenza
E coli
Proteus
Salmonella & shigella

-lactamase-resistant
penicillins
Anti-psuedomonals

Oxacillin
Nafcillin
Dicloxicillin
Methicillin
Ticarcillin
Piperacillin

Same

Same

Amoxicillin can be used for

lyme disease and as part of
combined therapy for H pylori
Staph aureus that has
penicillinase. Dont use for
MRSA bug now has altered
PBP sites.
Works for most enteric gram
negative rods including
psuedomonas and anaerobes
(e.g., bacterioides).

MRSA has altered

penicillin binding protein
target site
Penicillinase. Use with
lactamase inhibitors.

Methicillin interstitial nephritis

Nafcillin commonly used

for skin and soft tissue
infections, unless MRSA is
suspected
Synergy with
aminoglycosides against
pseudomonas and
enterococci.

 lactamase inhibitors

Clavulanic acid
Sulbactam
Tazobactam

LACTAM CEPHALOSPORINS
Bacteriocidal

Suicide inhibitors of lactamase

they irreversibly inhibit the
enzyme to protect penicillins

Mainly due to lactamases, but

changed PBPs and
changed porin
structures are possible

Less susceptible to penicillinases

than penicillins

Bugs not covered by

cephalosporins are
LAME
Listeria,
Atypicals
(chlamydia,
mycoplasma),
MRSA (except
ceftaroline),
Enterococci
1st generation

Cefazolin
Cephalexin

Do not enter CNS

Gram positive cocci and some

gram negatives (1st gen drugs
PEcK at gram negatives)
Proteus
E coli
Klebsiella.

2nd generation

Cefoxitin
Cefaclor
Cefuroxime

Most dont enter CNS

3rd generation

Ceftriaxone
Cefotaxime
Ceftazidime

Most enter CNS!

Gram positive cocci and more

gram negatives (2nd gen is a
HEN - PecKS at gram
negatives)
H. Influenza
Enterobacter aerogenes
Neisseria
Proteus
E coli
Klebsiella
Serratia marcescens
Wider spectrum:
Gram positive cocci
Gram-negative cocci, many
rods.

th

4 generation

Cefepime

5th generation

Ceftaroline

Important for empiric management

of meningitis and sepsis

Resistant to most beta lactamases

Use for serious gram negative

infections resistant to other
lactams
Even broader spectrum!
activity against pseudomonas
and gram positive bugs
Broad coverage of gram

Broad range of hypersensitivity

Vitamin K deficiency
Assume penicillin allergy applies to
cephalosporins
For gram +, consider macrolides
For gram -, consider aztreonam
nephrotoxicity of aminoglycosides

Renal clearance, with

active secretion blocked
by probenecid. Except
cefoperazone and
ceftriaxone, largely
eliminated in bile.

Often used before

surgery to prevent S.
aureus infections

Ceftriaxone meningitis,
gonorrhea, and
community acquired
pneumonia. Largely
elimated in bile.
Ceftazidime
pseudomonas

Doesnt cover

positives and gram negatives

MRSA but not pseudomonas
CARBAPENEMS
Bactericidal
IV ONLY

Imipenem
Meropenem
Ertapenem
Doripenem

Bind to PBPs just like penicllins,

but are not -lactams and are
resistant to beta lactamases.
Risk of seizures limits use to lifethreatening infections

MONOBACTAMS
Bactericidal
IV ONLY

INHIBITORS OF
PEPTIDOGLYCAN
SYNTHESIS
VANCOMYCIN
Bactericidal

TETRACYCLINES
Bacteriostatic

No cross-allergenicity with
penicillins or cephalosporins!

Gram negative rods

Vancomycin

Inhibits cell wall peptidoglycan

formation by binding D-ala D-ala
portion of cell wall precursors
cant elongate the peptidoglycan
chain.

Only gram positives. Serious,

multi-drug resistant bugs:
MRSA
Enterococci
Clostridium difficil (oral
dose for pseudomembranous
colitis)
S pneumo if resistant
penicillins

Resistance is rare, but is

emerging in staph
(VRSA) and enteroccal
(VRE) strains

Severe gram-negative rod

infections but not effective
against anaerobes. (Mean
GNATS cannot kill anaerobes)

Drug inactivation by
acetylation,
phosphorylation, or
adenylation

Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin

Tetracycline
Doxycycline
Minocycline

1. Binds to the 30s subunit to

block formation of the
initiation complex (A initiates
the alphabet) bacteriostatic.
(like linezolid at 50s)
2. Also causes misreading of
mRNA and blocks
translocation bacteriocidal.
Requires oxygen for uptake!
Binds to the 30s subunit and
prevents attachment of
aminoacyl-tRNA to the A site.
(like streptogramins at 50s)

Doxycycline > tetracycline

Elimination in renal disease

GI distress
Drug fever (cross-allergenicity
with penicillins),
CNS effects seizures with
imipenem in overdose or renal
dysfunction. Meropenem is less
risky.

Same as penicillin. Resistant to

beta lactamases.

Limited CNS penetration

PROTEIN SYNTHESIS
INHIBITORS 50S
SUBUNIT
CHLORAMPENICOL
Bacteriostatic

Wide spectrum
Gram positive cocci
Gram negative rods including pseudomonas
(ertapenem has
pseudomonas coverage)
Anaerobes

Aztreonam

Doesnt enter CNS

PROTEIN SYNTHESIS
INHIBITORS 30S
SUBUNIT
AMINOGLYCOSIDES
Bactericidal

psuedomonas

Chloramphenicol

Blocks peptidyltransferase,
which transfers amino acid from A
site to P site and catalyzes peptide

Amino acid
modification D-ala Dala D-ala D-lactate

Streptomycin is used for TB and

is 1st line for bubonic plague
and tularemia.

Important in hospitals for

empiric use in severe, lifethreatening infections
Renal elimination. Give
imipenem with
cilistatatin to inhibit rapid
renal metabolism
IV only

Nephrotoxicity
Ototoxicity
Hypotension
Thrombophlebitis
Red man syndrome diffuse
flushing. Prevent with antihistamines
and slow infusion rate

Renal elimination

Nephrotoxicity especially
when mixed with
cephalosporins
Neuromuscular blockade
Ototoxicity
Teratogen

Synergistic with
lactams for enterococci
(penicillin G or ampicillin)
and pseudomonas
(extended spectrum)
Neomycin for bowel
surgery

Borrelia burdorferi
Mycoplasma pneumonia
Rickettsia and chlamydia
(reaches high intracellular
concentrations)
Acne
Doxycycline prostatitis,
reaches high concentrations
Minocycline
meningococcus carrier
states

uptake or efflux out

of bacterial cells by
plasmid-encoded
transport pumps

Meningitis H influenza, N
meningitidis, S pneumo
Rocky mountain spotted

Drug inactivation by
acetyltransferase
encoded by plasmids

GI distress
Discoloration of teeth & inhibition
of bone growth in kids
Photosensitivity
Contraindicated in pregnancy
Superinfections candidiasis,
colitis

Divalent cations limit

absorption - dont mix
with milk (ca2+) or
antacids (ca2+ or mg2+) or
iron containing
preparations

Doxycycline has fecal elimination

Use demeclocycline to
block ADH receptor in
SIADH

Anemia (dose dependent)

Aplastic anemia dose
independent

Limited usefulness b/c of

toxicities but still used in
developing countries

CLINDAMYCIN
Bacteriostatic

Not 1st line for

anything in
developed countries!
Clindamycin

bond. Acts at the 50s subunit

Inhibits translocation of the
peptidyl-tRNA from the A site to
the P site ribosome cant move
in 5 to 3 direction on mRNA. Acts
at the 50s subunit

fever (Rickettsia rickettsi)

Anaerobes above the
diaphragm - aspiration
pneumonia, lung abscesses,
and oral infections
(bacteroides, clostridium
perfringens, peptostreptococcus,
fusobacterium, prevotella)

Cross resistance for

staph with
erythromycin if
erythromycin resistant,
will quickly gain
resistance to
clindamycin!

Gray baby syndrome in

preemies because they lack liver
UDP-glucuronyl transferase
Psuedomembranous colitis from
C difficile
Fever
Diarrhea

Azithromycin
Clarithromycin
Erythromycin

Same as clindamycin
(macroslides). Bind to the 23S
rRNA of the 50s subunit

Atypical pneumonias
mycoplasma (including
avium), chlamydia, legionella
STDs chlamydia
Gram positive cocci
streptococcal infections in
patients allergic to penicillin

Best for lung abscesses

from aspiration! Although
klebsiella can cause such
infections, mixed
anaerobic bugs are most
common.
Metronidazole for
anaerobes below the
diaphragm

Gram positive cocci (S

pyogenes). Sometimes used for
osteomyelitis high
concentration in bone

MACROLIDES
Bacteriostatic

because of cost

Methylation of target
site on 23S rRNA
prevents drug binding

MACRO:
Motility issues
Arrhythmia by QT
Acute cholestatic hepatitis
Rash
eOsinophilia
serum concentration of
theophyllines, oral anticoagulants
Can cause serotonin syndrome

Clarithromycin
combine with
metronidazole and PPI in
triple therapy for H pylori
Azithromycin
prophylaxis in AIDS for
Mycobacterium avium
(CD4 < 50)

LINEZOLID
Bacteriostatic (usually)

Linezolid

Binds to the 50s subunit to block

assembly of the initiation
complex (like 50s version of
aminoglycosides)

Highly resistant bugs MRSA

and VRE, drug resistant
S pneumo

Very rare

STREPTOGRAMINS
Bacteriostatic alone,
Bacteriocidal together

Quinupristin
Dalfopristin

Several mechanisms. Bind to 50s

and prevent interaction of
amino-acyl tRNA with the
acceptor site (like tetracyclines at
the 30s). Also block release of
completed polypeptide

VRSA and VRE, other drug

resistant gram-positive cocci

Inactivating enzymes,
efflux

Sulfamethoxazole
Sulfisoxazole
Sulfadiazine
Sulfasalazine

Block first step of folate

synthesis, which is PABA +
pteridine dihydropteroic acid.
Acts as antimetabolite of
dihydropterate synthase.

Altered enzyme,
uptake, or PABA
synthesis

Hypersensitivity
Hemolysis if G6PD deficient
Nephrotoxicity
tubulointerstitial nephritis
Photosensitivity
Displace bilirubin and other
drugs from albumin e.g.,
warfarin; kernicterus in infants
and pregnancy
Stevens Johnson syndrome

Sulfasalazine ulcerative
colitis

Altered dihydrofolate
reducatase

Give folic acid to avoid:

Megaloblastic anemia
Leukopenia
Granulocytopenia

Can give Bactrim for

prophylaxis w/ recurrent
UTIs

FOLIC ACID SYNTHESIS

SULFONAMIDES
Bacteriostatic

TRIMETHOPRIM
Bacteriostatic

Trimethoprim

Normally dihdropteroic acid

continues on to dihydrofolic acid
tetrahydrofolic acid purines,
thymidine, and methionine. Then
DNA and proteins, respectively.
Blocks bacterial dihydrofolate
reductase, acts as a folate
analog. Use in combo with
sulfonamides, causing sequential
block of folate synthesis

Gram positives
Gram negatives
Nocardia
Chlamydia
Triple sulfas or Bactrim for
UTI

Usually combined w/
trimethoprim to avoid resistance

Bactrim:
UTIs
Shigella and salmonella
Pneumocystis jirovecii
disc shaped yeast, causes
interstitial pneumonia in

Prophylaxis in AIDS for

AIDS
Pneumonia treatment and
prophylaxis
Toxoplasmosis
prophylaxis

pneumocystis pneumonia
(CD4 < 200)

DNA TOPOISOMERASES
FLOUROQUINOLONES
Bactericidal

Ciprofloxacin
Norfloxacin
Levofloxacin
Oflofloxacin
Sparfloxacin
Moxifloxacin
Gemifloxacin
Enoxacin

Inhibit DNA gyrase

(topoisomerase II) and
topoisomerase IV. TII relaxes
supercoiled DNA and TIV
separates replicated DNA during
cell division

Gram negative rods of

urinary & GI tracts
includes pseudomonas!
Neisseria
Some gram positives

Mutation in DNA
gyrase (topoisomerase
II) encoded by
chromosome.
Also plasmid encoded
resistance, efflux
pumps.

More common
GI upset
Superinfections
Skin rashes
Headache, dizziness

Ciprofloxacin is the drug

of choice for prophylaxis
of N. mengitidis
infections. Use rifampin for
children.

Rare
Tendonitis, tendon rupture (esp
> 60 yrs, taking prednisone), leg
cramps, myalgias
QT
Contraindicated in pregnant women,
nursing moms, and kids under 18 yrs
due to possible damage to cartilage

QUINOLONE

Nalidixic acid

DAMAGES DNA
METRONIDAZOLE
Bacteriocidal
Antiprotozoal

ANTIMYCOBACTERIAL
DRUGS
ISONIAZID

Metronidazole

Forms free radical toxic

metabolites damage DNA

Protozoa giardia,
entamoeba, trichomonas,
Gardnerella (gram variable
rod)
Use with PPI and
clarithromycin for triple
therapy against H Pylori
Anaerobes below the
diaphragm

Isoniazid

synthesis of mycolic acids.

Requires bacterial catalaseperoxidase (encoded by KatG)
to convert INH to active metabolite

Used only for TB the only

agent that is ever used solo for
TB

Mutations in KatG gene

for catalase-peroxidase
no activation of
isoniazid.

Disulfiram like reaction with

alcohol (severe flushing,
tachycardia, hypotension)
Headache
Metallic taste

Clindamycin for anaerobes

above the diaphragm

INH Injures Neurons &

Hepatocytes
Drug-induced lupus

Different half lives in fast

vs. slow acetylators

Similar in structure to Vitamin B6

competes with B6 in synthesis of
nucleotides (including GABA)
defective end products. Also renal
excretion of B6. Prevent
neurotoxicity and lupus w/ B6.

RIFAMYCINS

Rifampin
Rifabutin

Inhibits DNA-dependent RNA

polymerase

TB
Leprosy delays
resistance to dapsone
Can use for prophylaxis
with Neisseria meningitidis
or exposure to kids with H
influenza. But ciprofloxacin
is the drug of choice for

Enzyme alteration

Minor hepatotoxicity and drug

interactions ( P450)
Orange body fluids (not
dangerous)
In HIV, rifabutin is better because
< P450 stimulation rifAMPin
amps up P450s but rifaBUTin
does not

4 Rs of Rifampin
1. RNA polymerase
inhibitor
2. Ramps up microsomal
P450
3. Red/orange body fluids
4. Rapid resistance if
used alone

menginococcal prophylaxis)
PYRAZINAMIDE

Pyrazinamide

ETHAMBUTOL

Ethambutol

Acidifies intracellular
environment by conversion to
pyrazinoic acid effective in
acidic pH of phagolysosome,
where TB engulfed by
macrophages is found
carbohydrate polymerization
of mycobacterium cell wall by
blocking arabinosyltransferase

TB

Rapid resistance if used

solo

Hyperuricemia
Hepatotoxicity

TB

Rapid resistance if used

solo

Optic neuropathy red/green color

blindness, visual acuity, central
scotoma

Antifungal Drugs
Drug Class
POLYENES

Names
Amphotericin
B

Mechanism
Binds ergosterol and forms membrane
pores leakage of electrolytes.
Unfortunately also binds cholesterol to a
lesser degree toxicity
Poor penetration into CNS combine w/
flucytosine for cryptococal meningitis

Use
Serious, systemic mycoses
Cryptococcus neoformans,
candida +/- flucytosine for
meningitis
Mucor
Aspergillis
Blastomyces, coccidiodes
histoplasma

Resistance
Low ergosterol
content in cell
membranes

Liposomal form has toxicity

Nystatin

Topical form of amphotericin B

Candidiasis oral, diaper, vaginal

TRIAZOLES

Fluconazole
Ketoconazole
Clotrimazole
Miconazole
Itraconazole
Voriconazole

Inhibit fungal ergosterol synthesis by

inhibiting the cytochrome P450 enzyme that
converts lanosterol to ergosterol

PYRIMIDINES

Flucytosine

ECHINOCANDIN
S

Caspofungin
Micafungin
Anidulafungin
Terbinafine

Inhibits DNA and RNA synthesis by

conversion to 5-flourouracil by cytosine
deaminase. 5-flourouracil directly messes
up RNA and also messes up the conversion
of dUMP to dTMP for DNA.
Inhibit cell wall synthesis by inhibiting
synthesis of glucan, a component of the
fungal cell wall
Inhibits fungal squalene epoxidase in
dermatophytes only (think squamous
cells) ultimately results in ergosterol

Local and less serious systemic

mycosis
Fluconazole in AIDS, use for
chronic suppression of
Cryptococcus neoformans
meninigitis and candida of all
kinds
Itraconazole blasto, coccidio,
histo, sporo
Clotrimazole and miconazole
for topical fungal infections
Systemic fungal infections especially cryptococcal meningitis
in combo w/ amphotericin. Can also
combine therapy for candida.

TERBINAFINE
Dermatophytes
GRISEOFULVIN
Dermatophytes

Griseofulvin

Interferes with microtubule formation

(grease the MTs), disrupts mitosis. Deposits
in keratin-containing tissues (e.g., nails)

Toxicity
Caused by cholesterol binding:
Fever & chills
Hypotension
Nephrotoxicity because GFR - w/
hydration
Hypomagnesemia, hypokalemia in
most pts altered permeability of renal
tubules
Arrhythmias
Anemia - renal EPO
IV phlebitis

Inhibit testosterone synthesis

gynecomastia (especially ketoconazole)
Liver dysfunction inhibits P450s

Resistance is
fast if used solo

Bone marrow suppression not reversible

with leukovorin. 5 fluorouracil is an
antimetabolite used in cancer treatment. If
overdose, can rescue with uridine

Invasive aspergillosis, candida

GI upset
Flushing from histamine release

Dermatophytoses especially
onychomycosis = fungal infection of
finger/toe nails

GI upset
Headaches
Hepatotoxicity
Taste disturbance
Teratogenic
Carcinogenic
Confusion
warfarin and P450 metabolism

Oral treatment of superficial

infections, inhibits growth of
dermatophytes (tinea, ringworm)

Notes
Give intrathecally for fungal
meningitis
Give w/ K+ and Mg2+

Also used in Thayer-martin

media (VPN) to grow
Neisseria inhibits
competition from fungus
Can use ketoconazole to
treat PCOS (also
spironolactone). But
gynecomastia and
amenorrhea

Drug Class
Inhibit
release of
viral progeny

Name
Zanamivir
Oseltamivir

Mechanism
Inhibit influenza neuraminidase to release of progeny
virus

Use
Influenza A and B
(orthomyxyviruses)

Inhibit nucleic
acid
synthesis

Ribavarin

Inhibits synthesis of guanine nucleotides by

competitively inhibiting inosine monophosphate
dehydrogenase, which converts IMP GMP GTP.
Virus cant make RNA.
Guanosine analog that selectively inhibit viral DNA
polymerase. Get monophosphorylated by HSV/VSV
thymidine kinase selective for infected cells. Then
Drug-MP Drug-TP via cellular enzymes, and inhibits
viral DNA polymerase via chain termination.

RSV
Chronic Hep C

Acyclovir
Famcyclovir
Valacyclovir

Gancicyclovi
r

Inhibit viral
protein
synthesis

Like acyclovir, etc.

Foscarnet

Viral DNA polymerase inhibitor binds to

pyrophosphate binding site of the enzyme. Doesnt need
activation by viral kinase!

Cidofovir

Like foscarnet but maybe a different binding site

Interferon

Binds to receptors on cell surface to protein synthesis.

Normally made by virus-infected cells. Exhibits wide
range of antiviral and anti-tumor properties

1. HSV oral/genital ulcers

and encephalitis. If
resistant, try foscarnet
or cidofovir
2. VZV use famciclovir
for zoster (in older
FAMily members)
3. Weak activity against
EBV
CMV especially in immune
compromised

1. CMV retinitis in
immune compromised
patients
2. HSV resistant to
acyclovir
Same as foscarnet
1. Chronic Hep B and Hep
C
2. Condyloma
acuminatum
3. Kaposi sarcoma
4. Renal cell carcinoma,
hairy cell leukemia,
malignant melanoma

Resistance

Virus mutates thymidine

kinase no
monophosphorylation of
drug.

Toxicity

Hemolytic anemia
Severe teratogen makes sense
b/c human cells use IMP
dehydrogenase to make GMP
Must be adequately hydrated!
Risk of obstructive crystalline
nephropathy and acute renal
failure!

Notes
Amantidine and rimantidine
used to inhibit influenza
uncoating no longer used
b/c of resistance

No effect on latent virus

(only targets replicating
virus)
Valacyclover

Lack of viral kinase or

mutated viral DNA
polymerase.
Try foscarnet

DNA polymerase can

mutate

Renal toxicity
More toxic to host enzymes than
acyclovir:
Leukopenia
Neutropenia
Thrombocytopenia
Nephrotoxicity

Nephrotoxicity coadminister with

probenicid and IV saline to
Neutropenia
Myopathy

Valgancyclovir is a prodrug
with better

Drug class
Nucleoside
Reverse
Transcriptase
Inhibitors

Drug Names
Nucleosides:
Lamivudine
Stavudine
Zidovudine
Emtricitabine
Didanosine
Abacavir

Mechanism
Competitive inhibition of nucleotide binding to reverse
transcriptase terminates DNA chain (lacks 3 OH group)

Use
CHOOSE 2 for part 1
of triple therapy

Toxicity
Bone marrow suppression
reverse with G-CSF and EPO!
Peripheral neuropathy
Nucleosides lactic acidosis
Nucleotides rash
Zidovudine anemia
Didanosine - pancreatitis

Rash
Hepatotoxicity
Efavirenz CNS symptoms and rash,
avoid in pregnancy
Delavirdine avoid in pregnancy
Hyperglycemia
GI intolerance nausea, diarrhea
Lipodystrophy

The nucleosides need to be phosphorylated for activity, tenofovir

doesnt.

Notes
Choose 2, then use with 2 out of 3:
NNRT, protease inhibitor, integrase
inhibitor

Nucleotide:
Tenofovir
Non-nucleoside
Reverse Transcriptase
Inhibitors

Efavirenz
Nevivirapine
Delavirdine

Bind to reverse transcriptase at a site different from NRTIs. Dont

need phosphorylation to be active and dont compete with
nucleotides

CHOOSE 1 for part 2

or 3 of triple therapy

Protease
Inhibitors
-navir

Atazanavir
Darunavir
Fosamprenavir
Indinavir
Lopinavir
Ritonavir
Saquinavir

Normally viral aspartate protease cleaves HIV protein into its

functional parts assembly of virions. Protease inhibitors block
this process.

CHOOSE 1 for part 2

or 3 of triple therapy

Integrase
Inhibitor

Raltegravir

Blocks HIV integration into host cell by reversibly inhibiting HIV

integrase

Fusion
Inhibitor

Enfuvirtide
Maraviroc

Enfuvirtide binds gp41 to block fusion

Nephropathy
Hematuria - idinavir

Maraviroc binds CCR-5 on T cells/monocytes to block

interaction with gp120

CHOOSE 1 for part 2

or 3 of triple therapy

Hypercholesterolemia

Skin reaction at injection sites

Viral pol gene codes for protease,

integrase, and reverse transcriptase

Psuedomonas

Bug

Treatment
Ticarcillin, pipercillin, cefepime 4th generation, ceftazidime 3rd
generation, aminoglycosides, others?

MRSA

Vanco, daptomycin, linezolid, tigecycline, ceftaroline

VRE

Linezolid and streptogramins (quinupristin, dalfopristin) keep these

drugs pristine for hugely serious infections

Notes

PROTOZOA
Toxoplasmosis

Pyrimethamine inhibits protozoal dihydrofolate reductase

Trypanosoma brucei

Suramin and melarsoprol

Trypanosoma cruzi

Nifurtimox

Leishmaniasis

Sodium stibogluconate

PLASMODIA
Plasmodium vivax, ovale, malariae

Chloroquine.
If life threatening quinidine in the US, quinine elsewhere, or artesunate

Plasmodium falciparum

Artemether/lumefantrine or atovaquone/proguanil
If life threatening quinidine in the US, quinine elsewhere, or artesunate

HELMINTHS
Nematodes (round worms): Enterobius vermicularis (pinworm), ascaris
lumbricoides (giant roundworm), ancylostoma duodenale

Mebendazole, albendazole, bendazole, pyrantel pamoate, ivermectin,

diethylcabamazine, praziquantel

Trematodes (flukes): schistosoma, clonorchis sinesis

Praziquantel

10

Plasmodium falciparum is resistant to chloroquine membrane pump

intracellular concentration