Final Guide for Midterm PDF

**Final guide for Midterm** Antiviral drugs **Types:** 1. **Antiviral drugs (non-HIV)** - Used to treat infections caused by [non-HIV] infections. (influenza, herpes, CMV- cytomegalovirus, and hepatitis) 2. **Antiretroviral drugs (HIV)** - Used to treat infections...

**Final guide for Midterm** Antiviral drugs **Types:** 1. **Antiviral drugs (non-HIV)** - Used to treat infections caused by [non-HIV] infections. (influenza, herpes, CMV- cytomegalovirus, and hepatitis) 2. **Antiretroviral drugs (HIV)** - Used to treat infections caused by [HIV], the virus that causes AIDS **MOA:** Antiviral drugs mainly **inhibit viral replication**, often by blocking enzyme polymerase, which limits the virus and allows the immune system to fight it. **Adverse effects:** vary with each drug. Healthy cells can be killed by antiviral drugs, leading to significant toxicities. **[Antiviral drugs Non-HIV]** **Contraindications:** - [Amantadine:] Narrow antiviral spectrum. Lactating women, children under 12 months, patients with eczematous rash, [active only against influenza A] but no longer recommended due to resistance. - **CNS: insomnia, nervousness, light-headedness** - **GI: anorexia, nausea, others** - **CV: Orthostatic hypotension** **Common Antiviral Drugs** *"ROZA"* - **Acyclovir (Zovirax)**: Synthetic, treats HSV 1, HSV 2, and VZV. Available in oral, topical, and parenteral forms. - **Oseltamivir** (Tamiflu) & **Zanamivir** (Relenza): Combination med, effective against influenza A and B. Reduce its duration. - oseltamivir phosphate: oral use only; causes nausea and vomiting - zanamivir: inhalation drug; causes nausea, diarrhea, and sinusitis - **[Treatment should begin within 2 days of influenza symptom onset or cant give it anymore.]** - Delayed progression of HIV infection **HIV and AIDS** - HIV is treated with antiretrovirals, which target retrovirus enzymes: reverse transcriptase and integrase to prevent viral replication. - Retroviruses (bad) use **[reverse transcriptase]** to create complementary DNA *"mirror image"*, and **[integrase]** facilitates the integration of this viral DNA into the host\'s DNA. *\"Mirror image\" describes how the newly synthesized DNA strand complements the original RNA template, ensuring accurate copying of genetic information (A, T, C, G) for replication.* Antibiotics +-----------+-----------+-----------+-----------+-----------+-----------+ | **Antibio | **Mechani | **Indicat | **Contrai | **Adverse | **Example | | tic | sm | ions** | ndication | Effects** | s** | | Class** | of | | s** | | | | | Action** | | | | | +===========+===========+===========+===========+===========+===========+ | 1. **Pen | Disrupts | Infection | Known | n/v, | Penicilli | | icillins | cell wall | s | allergy, | diarrhea, | n | | 💣** | synthesis | caused by | specific | abdominal | G, V | | | , | [gram | reactions | pain. | ,Amoxicil | | | leading | +ve]{.und | to | [Interact | lin, | | | to | erline} | penicilli | s | | | | bacterial | bacteria | ns | with oral | Pipera**c | | | lysis | (e.g., | | contracep | illin** | | | | Strepto[c | | tives | | | | | occus]{.u | | **(this | | | | | nderline} | | one | | | | | ) | | higher | | | | | -- part | | affinity) | | | | | of normal | | **]{.unde | | | | | flora. | | rline}, | | | | | | | decrease | | | | | | | efficienc | | | | | | | y, | | | | | | | warfarin | | | | | | | interecti | | | | | | | on. | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 2. **Mac | Inhibits | [Strep | Known | [Neurotox | Erythromy | | rolides🌱* | protein | infection | drug | icity, | cin\*, | | * | synthesis | s, | allergy | GI | Azithromy | | | /growth | **STDs**] | | effects | cin, | | **[ba | | {.underli | | (with | Clari**th | | cteriosta | | ne} | | erythromy | romycin,* | | tic]{.und | | (e.g., | | in),]{.un | * | | erline}** | | syphilis, | | derline} | | | | | gonorrhea | | cardiac | [Fidaxomi | | | | ) | | arrhythmi | cin | | | | | | as | (Dificid) | | | | | | [(QT]{.un | -]{.under | | | | | | derline} | line} | | | | | | prolongat | new, for | | | | | | ion) | C diff | | | | | | | diarrhea, | | | | | | | narrow | | | | | | | spectrum | +-----------+-----------+-----------+-----------+-----------+-----------+ | 3. **Ami | Disrupts | [For the | Known | **[Nephro | Genta**mi | | noglycosi | bacterial | most | allergy | toxicity] | cin**, | | des** | cell wall | serious | | {.underli | Strepto** | | | synthesis | infection | | ne}** | mycin**, | | **💣** | and px | s]{.under | | 5-25% of | | | | growth | line} | | p[t, | Amikacin | | | | (mostly | | (check | | | | | gram -ve) | | creatinin | | | | | [very | | e), | | | | | potent]{. | | **Ototoxi | | | | | underline | | city.** | | | | | } | | ]{.underl | | | | | | | ine}**Poo | | | | | | | r | | | | | | | oral | | | | | | | absorptio | | | | | | | n, | | | | | | | IV/IM | | | | | | | only** | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 4. **Sul | [**Broad* | UTIs | Allergy, | [Allergic | Sulfa | | fonamides | * | | [pregnanc | reactions | (not | | ** | spectrum] | | y, | to | always) | | | {.underli | | infants | "sulfa",] | | | **💣** | ne}, | | \< 2 | {.underli | Septra | | | [inhibits | | months]{. | ne} | (Sulfamet | | | bacterial | | underline | hematolog | hoxazole/ | | | growth by | | } | ical | Trimethop | | | interferi | | | issues, | rim) | | | ng | | | **[photos | [combinat | | | with | | | ensitivit | ion]{.und | | | Folate]{. | | | y]{.under | erline} | | | underline | | | line}**, | | | | } | | | GI issues | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 5. **Flu | Alters | [Complica | Known | Photosens | Ciproflox | | oroquinol | bacterial | ted | drug | itivity, | acin, | | ones** | DNA, | UTIs]{.un | allergy | [tendonit | Levofloxa | | | causing | derline}, | | is/ruptur | cin, | | **💣 | cell | respirato | | e]{.under | Moxiflo** | | by | death. | ry | | line} | xacin** | | 🧬** | [Potent | infection | | (d/t | | | | **broad** | s | | affinity | | | | spectrum, | | | to | | | | good oral | | | connectiv | | | | absoption | | | e | | | | ]{.underl | | | tissue). | | | | ine} | | | Excellent | | | | | | | oral | | | | | | | absorptio | | | | | | | n | | +-----------+-----------+-----------+-----------+-----------+-----------+ - **Bacteriostatic** antibiotics **[inhibit the growth]** or replication of bacteria but don\'t kill them outright. They essentially [\"stall\" bacterial growth], allowing the immune system to eliminate the bacteria. - **Bactericidal** antibiotics **[kill bacteria directly]**, leading to bacterial cell death. - Mostly all bacteriocidal, just one bacteriostatic -\>macrolides SULFAS: **\*If a patient comments that they have an allergy to "sulphas", ask the patient more information about the allergic reaction** **often combined with other antibiotics, making chances of allergic reaction greater** - Bacteria are highly adaptive & mutate which can lead to drug resistance important patients complete antibiotic treatments **Miscellaneous Abx:** +-----------------------------------+-----------------------------------+ | **Metronidazole (Flagyl®) FYI** | \- **Mechanism**: Interferes with | | | microbe DNA synthesis | +===================================+===================================+ | **🧬** | \- **Uses**: Intra-abdominal and | | | gynecological infections | +-----------------------------------+-----------------------------------+ | | \- **Contraindications**: | | | Pregnancy (first trimester), | | | **[avoid alcohol]** | | | (causes cramps, n/v, h/a) | +-----------------------------------+-----------------------------------+ | | \- **Adverse Effects**: | | | Dizziness, h/a, GI pain, | | | reversible neutropenia or | | | thrombocytopenia | +-----------------------------------+-----------------------------------+ | | \- **Drug Interactions**: many, | | | ex. increased toxicity with | | | lithium, benzodiazepines, | | | cyclosporine, calcium channel | | | blockers, warfarin | +-----------------------------------+-----------------------------------+ | **Nitrofurantoin (MacroBID®) | \- **Mechanism**: Disrupts | | FYI** | bacterial wall and interferes | | | with enzymes regulating bacterial | | | metabolism | +-----------------------------------+-----------------------------------+ | **💣** | \- **Primarily used for**: | | | Urinary tract infections (UTIs) | +-----------------------------------+-----------------------------------+ | | -**Contraindications[:]{.underlin | | | e}** | | | [severe renal | | | impairment], | | | otherwise kidneys can't excrete | | | it | +-----------------------------------+-----------------------------------+ | | \- **Form**: Only available | | | orally; take with [food or | | | milk] to minimize GI | | | upset | +-----------------------------------+-----------------------------------+ | | \- **Adverse Effects**: GI pain, | | | dizziness, h/a, skin reactions; | | | very rare fatal hepatotoxicity | +-----------------------------------+-----------------------------------+ | **Vancomycin hydrochloride | \- **Mechanism**: Bactericidal by | | (Vancomycin)** | binding to and destroying | | | bacterial cell wall | +-----------------------------------+-----------------------------------+ | **💣** | \- **Uses**: Treatment of choice | | | for MRSA; oral vancomycin for | | | antibiotic-induced colitis (C. | | | difficile) | +-----------------------------------+-----------------------------------+ | | \- **Adverse Effects**: | | | Nephrotoxicity (particularly with | | | other nephrotoxic drugs), **red | | | man syndrome** (if IV dose given | | | too quickly), thrombophlebitis | | | (burning- d/t its potency). | | | Flushing or itching of: head, | | | neck, face, and upper body | | | | | | Causes thrombophlebitis (burning) | | | -\> b/c VERY potent antibiotic | +-----------------------------------+-----------------------------------+ | | \- **Monitoring**: Must monitor | | | blood levels (troughs) to ensure | | | therapeutic levels and prevent | | | toxicity; use cautiously in renal | | | impairment. [Lab will test around | | | 4-5 day before the schedule dose | | | for that day to see how the | | | kidneys are doing]. | +-----------------------------------+-----------------------------------+ [Before starting abx therapy:] obtain a culture assess renal, liver and cardiac function 💡 Very commonly: n/v and diarrhea -- risk for dehydration Take with at least 180 mL of water & food with them too [Monitor:] - Rupture of tendons or tendonitis = fluroquinolones - Nephrotoxicity & red man syndrome = vancomycin - Nephrotoxicity & ototoxicity = aminoglycosides - Metronidazole (Flagyl) works against anaerobes and widely used to treat abdominal and gynecological infections - Nitrofurantoin (MacroBid) primarily used to treat UTI