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

1.

monobactam aztreonam

2.
3.

4.

-LACTAM:
PENICILLINS
Bacteriocidal

Penicillin V (oral) &

Penicillin G
(IV/injection)

Same

Penicillin G
Streptococci
S pneumo - resistance
Meningococci
Treponema pallidum
Actinomyces

Penicillinase a type of
lactamase

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

Hemolytic anemia

Use penicillins for

prophylaxis of
endocarditis with surgical
or dental procedures

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

-lactamase-resistant
penicillins
Anti-psuedomonals

lactamase inhibitors

Oxacillin
Nafcillin
Dicloxicillin
Methicillin
Ticarcillin
Piperacillin

Same

Clavulanic acid
Sulbactam

Suicide inhibitors of lactamase

they irreversibly inhibit the

Same

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
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.

Tazobactam

LACTAM CEPHALOSPORINS
Bacteriocidal

enzyme to protect penicillins

Mainly due to lactamases, but

changed PBPs and
changed porin
structures are possible

Less susceptible to penicillinases

than penicillins

1st generation

Cefazolin
Cephalexin

Do not enter CNS

2nd generation

Cefoxitin
Cefaclor
Cefuroxime

Most dont enter CNS

Gram positive cocci and some

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

3rd generation

Ceftriaxone
Cefotaxime
Ceftazidime

4 generation

Cefepime

5th generation

Ceftaroline

th

Most enter CNS!

Important for empiric management
of meningitis and sepsis

Resistant to most beta lactamases

Bugs not covered by

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

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

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.
Use for serious gram negative
infections resistant to other
lactams
Even broader spectrum!
activity against pseudomonas
and gram positive bugs
Broad coverage of gram
positives and gram negatives
MRSA but not pseudomonas

Broad range of hypersensitivity

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

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

Doesnt cover
psuedomonas

CARBAPENEMS
Bactericidal
IV ONLY

MONOBACTAMS
Bactericidal
IV ONLY

INHIBITORS OF
PEPTIDOGLYCAN
SYNTHESIS
VANCOMYCIN
Bactericidal

PROTEIN SYNTHESIS
INHIBITORS 30S
SUBUNIT
AMINOGLYCOSIDES
Bactericidal

TETRACYCLINES
Bacteriostatic

Imipenem
Meropenem
Ertapenem
Doripenem

Wide spectrum
Gram positive cocci
Gram negative rods - including
pseudomonas (ertapenem has
pseudomonas coverage)
Risk of seizures limits use to life- Anaerobes
threatening infections

Aztreonam

Same as penicillin. Resistant to

beta lactamases.

Vancomycin

Inhibits cell wall peptidoglycan

Only gram positives. Serious,
formation by binding D-ala D-ala
multi-drug resistant bugs:
portion of cell wall precursors
MRSA
cant elongate the peptidoglycan Enterococci
chain.
Clostridium difficil (oral dose
for pseudomembranous colitis)
S pneumo if resistant penicillins
Doesnt enter CNS

Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin

Tetracycline
Doxycycline
Minocycline

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

CLINDAMYCIN

Chloramphenicol
Not 1st line for
anything in
developed countries!
Clindamycin

Gram negative rods

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.

Limited CNS penetration

PROTEIN SYNTHESIS
INHIBITORS 50S
SUBUNIT
CHLORAMPENICOL
Bacteriostatic

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.

Bind to PBPs just like penicllins,

but are not -lactams and are
resistant to beta lactamases.

Severe gram-negative rod

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

No cross-allergenicity with
penicillins or cephalosporins!

Resistance is rare, but is

emerging in staph
(VRSA) and enteroccal
(VRE) strains
Amino acid
modification D-ala Dala D-ala D-lactate

Drug inactivation by
acetylation,
phosphorylation, or
adenylation

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

Nephrotoxicity especially when

mixed with cephalosporins
Neuromuscular blockade
Ototoxicity
Teratogen

Streptomycin is used for TB and

is 1st line for bubonic plague
and tularemia.

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

Important in hospitals for

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

Renal elimination

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

uptake or efflux out GI distress

Discoloration of teeth & inhibition of
of bacterial cells by
bone growth in kids
plasmid-encoded
Photosensitivity
transport pumps
Contraindicated in pregnancy
Superinfections candidiasis, colitis
Doxycycline has fecal elimination

Blocks peptidyltransferase,

which transfers amino acid from A

site to P site and catalyzes peptide
bond. Acts at the 50s subunit

Meningitis H influenza, N
meningitidis, S pneumo
Rocky mountain spotted fever
(Rickettsia rickettsi)

Drug inactivation by
acetyltransferase
encoded by plasmids

Inhibits translocation of the

Anaerobes above the

Cross resistance for

Anemia (dose dependent)

Aplastic anemia dose
independent
Gray baby syndrome in preemies
because they lack liver UDPglucuronyl transferase
Psuedomembranous colitis from C

Divalent cations limit

absorption - dont mix
with milk (ca2+) or
antacids (ca2+ or mg2+) or
iron containing
preparations
Use demeclocycline to
block ADH receptor in
SIADH

Limited usefulness b/c of

toxicities but still used in
developing countries
because of cost
Best for lung abscesses

Bacteriostatic

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

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

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

Metronidazole for
anaerobes below the
diaphragm

Gram positive cocci (S

pyogenes). Sometimes used for
osteomyelitis high
concentration in bone

MACROLIDES
Bacteriostatic

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

from aspiration! Although

klebsiella can cause such
infections, mixed
anaerobic bugs are most
common.

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.

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

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

Usually combined w/
trimethoprim to avoid resistance

Bactrim:
UTIs
Shigella and salmonella
Pneumocystis jirovecii disc
shaped yeast, causes interstitial
pneumonia in AIDS
Pneumonia treatment and
prophylaxis
Toxoplasmosis prophylaxis

Prophylaxis in AIDS for

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

Metronidazole

Forms free radical toxic

metabolites damage DNA

Isoniazid

synthesis of mycolic acids.

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

RIFAMYCINS

Rifampin
Rifabutin

Inhibits DNA-dependent RNA

polymerase

PYRAZINAMIDE

Pyrazinamide

Acidifies intracellular
environment by conversion to
pyrazinoic acid effective in
acidic pH of phagolysosome,
where TB engulfed by

ANTIMYCOBACTERIAL
DRUGS
ISONIAZID

Protozoa giardia, entamoeba,

trichomonas,
Gardnerella (gram variable rod)
Use with PPI and clarithromycin
for triple therapy against H
Pylori
Anaerobes below the
diaphragm
Used only for TB the only
agent that is ever used solo for
TB

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
menginococcal prophylaxis)
TB

Disulfiram like reaction with

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

Mutations in KatG gene INH Injures Neurons & Hepatocytes

for catalase-peroxidase Drug-induced lupus
no activation of
isoniazid.
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.

Enzyme alteration

Rapid resistance if used

solo

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

Hyperuricemia
Hepatotoxicity

Clindamycin for anaerobes

above the diaphragm

Different half lives in fast

vs. slow acetylators

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

ETHAMBUTOL

Ethambutol

macrophages is found
carbohydrate polymerization
of mycobacterium cell wall by
blocking arabinosyltransferase

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

Nystatin

TRIAZOLES

Fluconazole
Ketoconazole
Clotrimazole
Miconazole
Itraconazole
Voriconazole

PYRIMIDINES

Flucytosine

ECHINOCANDIN
S

Caspofungin
Micafungin
Anidulafungin
Terbinafine

TERBINAFINE
Dermatophytes
GRISEOFULVIN
Dermatophytes

Griseofulvin

Liposomal form has toxicity

Topical form of amphotericin B

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

Candidiasis oral, diaper, vaginal

Inhibit fungal ergosterol synthesis by

Local and less serious systemic
inhibiting the cytochrome P450 enzyme that
mycosis
converts lanosterol to ergosterol
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
Inhibits DNA and RNA synthesis by
Systemic fungal infections conversion to 5-flourouracil by cytosine
especially cryptococcal meningitis
deaminase. 5-flourouracil directly messes
in combo w/ amphotericin. Can also
up RNA and also messes up the conversion
combine therapy for candida.
of dUMP to dTMP for DNA.
Inhibit cell wall synthesis by inhibiting
Invasive aspergillosis, candida
synthesis of glucan, a component of the
fungal cell wall
Inhibits fungal squalene epoxidase in
Dermatophytoses especially
dermatophytes only (think squamous
onychomycosis = fungal infection of
finger/toe nails
cells) ultimately results in ergosterol
Interferes with microtubule formation
(grease the MTs), disrupts mitosis. Deposits
in keratin-containing tissues (e.g., nails)

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

Oral treatment of superficial

infections, inhibits growth of
dermatophytes (tinea, ringworm)

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
GI upset
Flushing from histamine release
GI upset
Headaches
Hepatotoxicity
Taste disturbance
Teratogenic
Carcinogenic
Confusion
warfarin and P450 metabolism

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

Foscarnet
Cidofovir
Inhibit viral
protein
synthesis

Interferon

Like acyclovir, etc.

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

Viral DNA polymerase inhibitor binds to

1. CMV retinitis in immune
pyrophosphate binding site of the enzyme. Doesnt need
compromised patients
activation by viral kinase!
2. HSV resistant to acyclovir
Like foscarnet but maybe a different binding site
Same as foscarnet
Binds to receptors on cell surface to protein synthesis. 1. Chronic Hep B and Hep C
2. Condyloma acuminatum
Normally made by virus-infected cells. Exhibits wide
3. Kaposi sarcoma
range of antiviral and anti-tumor properties
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)
The nucleosides need to be phosphorylated for activity, tenofovir
doesnt.

Use
Toxicity
CHOOSE 2 for part 1 Bone marrow suppression reverse
of triple therapy
with G-CSF and EPO!
Peripheral neuropathy
Nucleosides lactic acidosis
Nucleotides rash
Zidovudine anemia
Didanosine - pancreatitis

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

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

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