First Aid--Pharmacology--Antimicrobials
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- Penicillin
-
-Penicillin G (IV form), Penicillin V (oral)
Mech:
1. Binds PBPs
2. Blocks transpeptidase cross-linking of cell wall
3. Activates autolytic enzymes
Clinical Use:
Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, and spirochetes.
Tox:
Hypersensitivity, hemolytic reactions - Methicillin
-
Group with nafcillin and dicloxacillin
Mech:
Same as penicillin. Narrow spectrum; penicillinase resistant because of bulkier R group.
Clin:
S. aureus
Tox:
Hypersensitivity reactions; interstitial nephritis (unlike the others in this group) - nafcillin
-
Group with methicillin and dicloxacillin
Mech:
Same as penicillin. Narrow spectrum; penicillinase resistant because of bulkier R group.
Clin:
S. aureus
Tox:
Hypersensitivity reactions - Dicloxicillin
-
Group with methicillin and nafcillin
Mech:
Same as penicillin. Narrow spectrum; penicillinase resistant because of bulkier R group.
Clin:
S. aureus
Tox:
Hypersensitivity reactions - Ampicillin, amoxicillin
-
Mech: Same as penicillin. Wider spectrum; penicillinase sensitive. Also combine with clavulanic acid (penicillinase inhibitor) to enhance spectrum. AmOxicillin has greater Oral bioavailability than ampicillin.
Clin: Extended-spectrum penicillin--certain gram-positive bacteria and gram-negative rods
"HELPS enterococci": H. influenzae, E. Coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci
Tox: Hypersensitivity reactions; ampicillin rash; pseudomembranous colitis - Carbenicillin
-
Mech: Same as penicillin, Extended spectrum.
Clin: Pseudomonas and gram-negative rods; susceptible to penicillinase; use with clavulanic acid.
Tox: Hpyersensitivity reactions - piperacillin
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Group with carbenicillin and ticacillin
Mech: Same as penicillin, Extended spectrum.
Clin: Pseudomonas and gram-negative rods; susceptible to penicillinase; use with clavulanic acid.
Tox: Hypersensitivity reactions - ticarcillin
-
Group with Carbenicillin and piperacillin
Mech: Same as penicillin, Extended spectrum.
Clin: Pseudomonas and gram-negative rods; susceptible to penicillinase; use with clavulanic acid.
Tox: Hypersensitivity reactions - Cephalosporins
-
Mech: beta-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases; bactericidal.
1st gen: "PEcK"--gram-positives plus Proteus Mirabilis, E. Coli, Klebsiella
2nd gen: "HEN PEcKS"--Haemophilus, Enterobacter aerogenes, Neissseria, Proteus Mirabilis, E. Coli, Klebsiella, Serratia Marcescans
3rd gen: serious gram-negative infections resistant to other beta-lactams; to treat meningitis b/c most penetrate the blood brain barrier. Examples: ceftazidime for pseudomonas; gftriaxone for gonorrhea.
4th gen: increased activity against pseudomonas and gram-positive organisms.
Tox: Hypersensitivity reactions, increases nephrotoxicity of aminoglycosides, disulfirim-like reaction with ethanol (incephalosporins with a methylthiotetrazole group, e.g., cefamandole). - Name a good drug to treat gonorrhea
- ceftriazone, a 3rd gen. cephalosporin
- name a cephalosporin to treat pseudomonas
- cephtazidime--3rd gen.
- Name a cephalosporin that can cause a disulfiram-like reaction
- cefamandole
- Aztreonam
-
Mech:
A monobactam resistant to beta-lactamases. Inhibits cell wall synthesis (binds to PBP3). Synergistic with aminoglycosides. No cross-allergenicity with penicillins.
Clin: Gram-negative rods--Klebsiella, Pseudomonas, Serratia. No activity against gram-positives or anaerobes. Great choice for penicillin-allergic patients and those with renal insufficiency whp cannot tolerate aminoglycosides
Tox: occasional GI upset - Imipenem/Cilastatin
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Mech: Imipenem is a broad-spectrum beta-lactamase resistant carbapenem. "With imipenem, the kill is LASTIN' with ciLASTATIN!", i.e. always administered with cilastatin (inhibitor of renal dihydropeptidase I) to prevent inactivation in renal tubules
Clinical use: Gram-positive cocci, gram-negative rods, and anaerobes. Drug of choice for Enterobacter.
Tox: GI distress, skin rash, and CNS toxicity (seizures) at high plasma levels - Vancomycin
-
Mech: Inhibits cell wall mucopeptide formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal. Resistanceoccurs with amino acid change of D-ala D-ala to D-ala D-lac.
Clin: Used for serious, gram-positive multidrug-resistance organisms, including MRSA and Claustridium difficile (pseudomembranous colitis).
Tox: "Does NOT cause many problems" well, maybe a few...Nephrotoxixity, Ototoxicity, Thrombophlebitis; also, "red man syndrome"(diffuse flushing); otherwise generally well tolerated -
30S Inhibitors
50S Inhibitors -
"Buy AT 30...
Aminoglycosides (bactericidal)
Tetracyclines (bactericidal)
...CELL at 50"
Chloramphenichol
Erythromycin
Lincomycin
cLindamycin
(see picture on p.293 for mechanisms) - Gentamicin
-
-an aminoglycoside (like neomycin, amikacin, tobramycin, streptomycin)
Mech: Bactericidal; inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake; therefore ineffective against anaerobes.
Clin: Use for severe gram-negative rod infections. Synergistic with beta-lactam antibiotics.
Tox: Nephrotoxicity (especially when used with cephalosporins), Ototoxicity (especially when used with loop diuretics), a teratogen. - Neomycin
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-an aminoglycoside (like gentamicin, amikacin, tobramycin, streptomycin)
Mech: Bactericidal; inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake; therefore ineffective against anaerobes.
Clin: Use for severe gram-negative rod infections. Synergistic with beta-lactam antibiotics. Neomycin particularly used for bowel surgery.
Tox: Nephrotoxicity (especially when used with cephalosporins), Ototoxicity (especially when used with loop diuretics), a teratogen. - amikacin
-
-an aminoglycoside (like neomycin, gentamicin, tobramycin, streptomycin)
Mech: Bactericidal; inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake; therefore ineffective against anaerobes.
Clin: Use for severe gram-negative rod infections. Synergistic with beta-lactam antibiotics.
Tox: Nephrotoxicity (especially when used with cephalosporins), Ototoxicity (especially when used with loop diuretics), a teratogen. - tobramycin
-
-an aminoglycoside (like neomycin, amikacin, gentamicin, streptomycin)
Mech: Bactericidal; inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake; therefore ineffective against anaerobes.
Clin: Use for severe gram-negative rod infections. Synergistic with beta-lactam antibiotics.
Tox: Nephrotoxicity (especially when used with cephalosporins), Ototoxicity (especially when used with loop diuretics), a teratogen. - streptomycin
-
-an aminoglycoside (like gentimicin, neomycin, amikacin, tobramycin)
Mech: Bactericidal; inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake; therefore ineffective against anaerobes.
Clin: Use for severe gram-negative rod infections. Synergistic with beta-lactam antibiotics. Streptomycin specifically can be used as an anti-TB agent.
Tox: Nephrotoxicity (especially when used with cephalosporins), Ototoxicity (especially when used with loop diuretics), a teratogen. - Tetracyclines
-
-anything "-cycline," i.e. tetracycline, doxycycline, demeclocycline, and minocycline
Mech: Bacteriostatic; bind to the 30S and prevent attachment of amino-acyl tRNA; limited CNS penetration. Doxycycline is fecally eliminated and can be used in patients with renal failure, but must not take with milk, antacids, or iron-containing preparations because divalent cations inhibit it's absorption in the gut.
Clin: "BaRT, VACUUM!!!" Borrelia, Rickettsia, Tularemia, Vibrio cholerae, Acne, Chlamydia, Ureaplasma Urealyticum, Mycoplasma
Tox: GI distress!, discoloration of teeth and inhibition of bone growth in children, Fanconi's syndrome (kidney tubule malfunction), photosensitivity - Erythromycin
-
-a macrolide (along with azithromycin and clarithromycin)
Mech: Inhibit protein synthesis by blocking translocation; binds to 23S RNA of the 50S ribosomal subunit. Bacteriostatic.
Clin: URIs, pneumonias, STDs--gram-positive cocci (streptococcal infections in patients allergic to penicillin), Mycoplasma, Legionella, Chlamydia, and Neisseria
Tox: GI discomfort (most common cause of non-compliance), acute cholestatic hepatitis, eosinophilia, skin rashes. - azithromycin
-
-a macrolide (along with erythromycin and clarithromycin)
Mech: Inhibit protein synthesis by blocking translocation; binds to 23S RNA of the 50S ribosomal subunit. Bacteriostatic.
Clin: URIs, pneumonias, STDs--gram-positive cocci (streptococcal infections in patients allergic to penicillin), Mycoplasma, Legionella, Chlamydia, and Neisseria
Tox: GI discomfort (most common cause of non-compliance), acute cholestatic hepatitis, eosinophilia, skin rashes. - Clarithromycin
-
-a macrolide (along with erythromycine and azithromycin)
Mech: Inhibit protein synthesis by blocking translocation; binds to 23S RNA of the 50S ribosomal subunit. Bacteriostatic.
Clin: URIs, pneumonias, STDs--gram-positive cocci (streptococcal infections in patients allergic to penicillin), Mycoplasma, Legionella, Chlamydia, and Neisseria
Tox: GI discomfort (most common cause of non-compliance), acute cholestatic hepatitis, eosinophilia, skin rashes. - Chloramphenicol
-
Mech: Inhibits 50S peptidyltransferase. Bacteriostatic.
Clin: Meningitis (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae)
Tox: Bad ones. Anemia (dose-dependant), Aplastic anemia (dose-independant), gray baby syndrome (in premature infants because they lack the UDP-glucuronyl transferase). - Clindamycin
-
Mech: Blocks peptide bond formation at 50S ribosomal subunit. Bacterostatic.
Clin: Use to treat anaerobes above the diaphragm (e.g. Bacteroides fragilis, Clostridium perfringens)
Tox: Pseudomembranous colitis, fever, diarrhea - Sulfonamides
-
-Sulfamethoxazole, sulfisoxazole, triple sulfas, sulfdiazine.
Mech: PABA antimetabolites inhibit dihydropteroate synthase. Bacterostatic.
Clin: gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas of SMX for simple UTI.
Tox: Hypersensitivity reactions, hemolysis if G6PD deficient, nephrotoxicity (tubulointerstitial nephritis), kernicterus in infants, displace other drugs from albumin (e.g. warfarin). - Trimethoprim
-
Mech: Inhibits bacterial dihydrofolate reductase. Bacteriostatic. Used in combination with sulfonamides (trimethoprim-sulfamethoxazole [TMP-SMX]), causing sequential block of folate synthesis. Combination used for recurrent UTIs, Shigella, Salmonella, PCP.
Tox: "TMP --> Treats Marrow Poorly" Megaloblastic anemia, leukopenia, granulocytopenia. (May alleviate with supplemental folic acid) - Floroquinolones
-
-ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin (fluoroquinolones), nalidixic acid (a quinolone).
Mech: Inhibit DNA gyrase (topoisomerase II). Bactericidal.
Clin: Gram-negative rods of the urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms.
Tox: GI upset, superinfections, skin rashes, headache, dizziness. "FluoroquinoLONES hurt attachments to your BONES." i.e. contraindicated in pregnant women and in children because animal studies show damage to cartilage, and it causes tendonitis and tendon rupture in adults. - Metronidazole
- Giardiasis, amebic dysentary (Entamoeba histolytica), bacterial vaginitis (Gardnerella vaginalis), Trichomonas
- Polymyxins
-
-Polymyxin B, Polymixin E
Mech: Bind to cell membranes of bacteria and disrupt their osmotic properties. Polymyxins are cationic, basic proteins that act like detergents.
Clin: Resistant gram-negative infections
Tox: Neurotoxicity, acute renal tubular necrosis. - Isoniazid (INH)
-
Mech: Decreases synthesis of mycolic acids; half-lives differ depending on speed of acetylation.
Clin: Mycobacterium tuberculosis. The only agent used as solo prophylaxis against TB.
Tox: Hemolysis if G6PD deficient, "INH Injures Neurons and Hepatocytes." neurotoxicity (can be prevented by pyridoxine aka vit. B6), hepatotoxicity, SLE-like syndrome. - Rifampin
-
4 R's of Rifampin
1) RNA polymerase inhibitor
2) Revs up microsomial P-450
3) Red/orange body fluids
4) Rapid resistance to dapsone if used alone
Mech: Inhibits DNA-dependant RNA polymerase.
Clin: Mycobacterium tuberculosis; delays resistence to dapsone when used for leprosy. Used for meningococcol prophylaxis and chemoprophylaxis in contacts of children with Haemophilus influenzae type B.
Tox: Minor hepatotoxicity and it activates P-450. - Ethambutol
-
-an anti-TB drug (part of RESPIre: Rifampin, Ethambutol, Streptomycin, Pyrazinamide, Isoniazid (INH))
2nd line--Cycloserine
Tox: Hepatotoxic - Most common mechanism of resistance to penicillins/cephalosporins
- beta-lactamase cleavage of beta-lactam ring
- Most common mechanism of resistance to aminoglycosides
- Modification via acetylation, adenylation, or phosphorylation
- Most common mechanism of resistance to vancomycin
- Terminal D-ala of cell wall component replaced with D-lac, decreasing affinity
- Most common mechanism of resistance to chlormaphenicol
- Modification by acetylation
- Most common mechanism of resistance to macrolides
- Methylation of rRNA near erythtromycin's ribosome-binding site
- Most common mechanism of resistance to Tetracyclines
- increased transport out or decreased uptake into the cell
- Most common mechanism of resistance to sulfonamides
- Altered enzyme (bacterial dihydropteroate synthase), decreased uptake, or increased PABA synthesis
- Drug used for prophylaxis for meningococcal infection
- Rifampin (drug of choice), minocycline
- Drug used for prophylaxis for gonorrhea
- ceftriaxone
- Drug used for prophylaxis for syphilis
- Benzathine penicillin G
- Drug used for prophylaxis in an individual who has a history of recurrent UTIs
- TMP-SMX
- Drug used for prophylaxis for PCP
- TMP-SMX (drug of choice), aerosolized pentamidine
- Amphotercin B
-
Mech: Binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes and disrupt homeostasis "AmphoTERcin TEARS holes in the fungal membrane forming pores"
Clin: Used for a wide spectrum of systemic mycoses: Cryptococcus, Blastomyces, Coccidiodes, Aspergillis, Histoplasma, Candida, Mucor (systemic mycoses). Itrathecally for fungal meningitis; does not cross BBB.
Toxicity: Fever/chills ("shake and bake"), hypotension, nephrotoxicity, arrythmias ("amphoterrible"). - Nystatin
-
Mech: Binds to ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes and disrupt homeostasis.
Clin: "Swish and swallow" for oral candidiasis (thrush) - Fluconazole
-
-one of the azoles: fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole
Mech: Inhibits fungal ergosterol synthesis by inhibiting Lanosterol --> Ergosterol step.
Clin: Systemic mycoses. cryptococcal meningitis in AIDS patients and candidal infections of all types (i.e. yeast infections).
Tox: Hormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cytochrome P-450), fever, chills - Ketoconazole
-
-one of the azoles: fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole
Mech: Inhibits fungal ergosterol synthesis by inhibiting Lanosterol --> Ergosterol step.
Clin: Systemic mycoses. Blastomyces, Coccidiodes, Histoplasma, Candida albicans; hypercortisolism
Tox: Hormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cytochrome P-450), fever, chills - clotrimazole
-
-one of the azoles: fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole
Mech: Inhibits fungal ergosterol synthesis by inhibiting Lanosterol --> Ergosterol step.
Clin: Systemic mycoses. hypercortisolism.
Tox: Hormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cytochrome P-450), fever, chills - miconizole
-
-one of the azoles: fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole
Mech: Inhibits fungal ergosterol synthesis by inhibiting Lanosterol --> Ergosterol step.
Clin: Systemic mycoses. hypercortisolism.
Tox: Hormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cytochrome P-450), fever, chills - Flucytocine
-
Mech: inhibits DNA synthesis by conversion to fluorouracil, which competes with uracil.
Clin: systemic fungal infections (e.g. Candida, Cryptococcus)
Tox: Nausea, vomiting, diarrhea, bone marrow suppression - Caspofungin
-
Mech: Inhibits cell wall synthesis
Clin: Invasive aspergillosis
Tox: GI upset, flushing - Terbinafine
-
Mech: Inhibits the fungal enzyme squalene epoxidase
Clin: Used to treat dermatophytoses (especially onychomycosis). - Griseofulvin
-
Mech: Interferes with microtubule function; disrupts mitosis. Deposits in keratin-containing tissues (e.g. nails).
Clin: Oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm).
Tox: Teratogenic, carcinogenic, confusion, headaches, increased warfarin metabolism - Amantadine (and Rimantidine)
-
Mech: Blocks viral penetration/uncoating; may buffer pH of endosome. Also causes the release of dopamine from intact nerve terminals.
Clin: Prophylaxis for influenza A; Parkinson's disease.
Tox: Ataxia, dizziness, slurred speech Rimantidine is a derivative with fewer CNS side effects.
"Amantidine blocks influenza A and rubellA and causes problems with the CerebellA" - Zanamivir
-
Mech: Inhibits influenza neuramidase
Clin: for both influenza A and B - Ribavirin
-
Mech: Inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase
Clin: RSV
Tox: Hemolytic anemia. Severe teratogen. - Acyclovir
-
Mech: Preferentially inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase
Clin: HSV, VSV, EBV. Mucocutaneous and genital herpes lesion. Prophylaxis in immunocompromised patients.
Tox: Delirium, tremor, nephrotoxicity - Ganciclovir
-
DHPG (dihydroxy-2-propoxymethyl guanine)
Mech: Phosphorylation by viral kinase; preferentially inhibits CMV DNA polymerase.
Clin: CMV, especially in immunocompromised patients.
Tox: Leukopenia, neutropenia, thrombocytopenia, renal toxicity. More toxic to host enzymes than acyclovir. - Foscarnet
-
"FOScarnet = pyroFOSphate analog"
Mech: Viral DNA polymerase inhibitor that binds to the pyrophosphate binding site of the enzyme. Does not require activation by viral kinase.
Clin: CMV retinitis in immunocompromised patients when ganciclovir fails.
Tox: Nephrotoxicity - Protease inhibitors
-
-protease inhibitors--all "-navir": saquinavir, ritonavir, indinavir, nelfinavir, amprenavir
Mech: Inhibit assembly of new virus by blocking protease enzyme.
Tox: GI intolerance (nausea, diarrhea), hyperglycemia, lipid abnormalities, thrombocytopenia (indinavir only) - Zidovudine
-
-AZT; a reverse transcriptase inhibitor of the nucleoside variety (includes zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), abecavir)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, lactic acidosis, megaloblastic anemia (AZT only)
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. AZT is used during pregnancy to reduce risk of fetal transmission. - Didanosine
-
-ddI; a reverse transcriptase inhibitor of the nucleoside variety (includes zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), abecavir)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, lactic acidosis
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - zalcitabine
-
-ddC; a reverse transcriptase inhibitor of the nucleoside variety (includes zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), abecavir)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, lactic acidosis
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - stavudine
-
-d4T; a reverse transcriptase inhibitor of the nucleoside variety (includes zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), abecavir)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, lactic acidosis
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - lamivudine
-
-3TC; a reverse transcriptase inhibitor of the nucleoside variety (includes zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), abecavir)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, lactic acidosis
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - abacavir
-
-a reverse transcriptase inhibitor of the nucleoside variety (includes zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), abecavir)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, lactic acidosis
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - nevirabine
-
a reverse transcriptase inhibitor of the non-nucleoside variety (includes nevirapine, delavirdine, and efavirenz)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, rash
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - delavirdine
-
a reverse transcriptase inhibitor of the non-nucleoside variety (includes nevirapine, delavirdine, and efavirenz)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, rash
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - efavirens
-
a reverse transcriptase inhibitor of the non-nucleoside variety (includes nevirapine, delavirdine, and efavirenz)
Mech: Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of viral genome into host DNA.
Tox: Bone marrow suppression (neutropenia, anemia), peripheral neuropathy, rash
Clin: Highly active antiretroviral therapy (HAART) generally entails combination therapy with protease inhibitors and reverse transcriptase inhibitors. Initiated when patients have low CD4 counts (<500 cells/mm3) or high viral load. - Interferons (as an antiviral)
-
Mech: Glycoproteins from human leukocytes that block various stages of viral RNA and DNA synthesis
Clin: Chronic hepatitis B and C, Kaposi's sarcoma
Tox: Neutropenia - Ivermectin
- Onchocerciasis (rIVER blindness treated with IVERmectin)
- Mebendazole/thiabendazole
- Nematode/roundworm (e.g. pinworm, whipworm) infections
- Pyrantel pamoate
- Giant roundworm (Ascaris), hookworm (Necator/Ancylostoma), pinworm (Enterobius).
- Praziquantel
- Trematode/fluke (e.g. schistosomes, Paragonimus, Clonorchis) and cysticercosis.
- Niclosamide
- Cestode/tapeworm (e.g. Diphyllobothrium latum, Taenia species) infections except cysticercosis
- Pentavalent antimony
- Leishmaniasis
- Chloroquine
- malaria
- quinine
- malaria
- mefloquine
- malaria
- atovaquone
- malaria
- proguanil
- malaria
- Primaquine
- Latent hypnozoite (liver) forms of malaria (Plasmodium vivax, Plasmodium ovale)
- Pantamidine
- PCP prophylaxis
- Nifurtimox
- Chagas' disease, American trypanosomiasis (T. cruzi)
- Suramin
- African trypanosomiasis (sleeping sickness).