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Anti infective
 

Anti infective

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    Anti infective Anti infective Presentation Transcript

    • Anti-infective
    •  Acyclovir  Cefepime Albendazole  Cetriaxone Amantadine  Ciprofloxacin Amoxicillin-clavulanate  Clindamycin Amphotericin B  Doxycycline Azithromycin  Efavirenz Aztreonam  Enfuvirtide Caspofungin  Erythromycin Cefazolin  Ethambutol
    •  Foscarnet  Linezolid Fosfomycin  Mefloquine Ganciclovir  Metronidazole Gentamicin  Mupirocin Griseofulvin  Nafcillin Imipenem-cilastatin  Nitrofurantoin Isoniazid  Oseltamivir Itraconazole  Paromomycin Ivermectin  Penicillin G Levofloxacin
    •  Pentamidine  Rifampin Piperacillin-tazobactam  Ritonavir-lopinavir Praziquantel  Streptomycin Primaquine  Terbinafine Pyrimethamine  Trifluridine Pyrantel  TMP-SMX Quinine  Vancomycin Quinpristein-dalfopristin  Zidovudine Ribavirin
    • Acyclovir Antiviral  Dizziness Nucleoside analogue  Diarrhea  N Converted to acyclovir  Nephrotoxicity triphosphate by viral & host cell kinases  Probenecid ↑ serum levels Incorporated into DNA by viral DNA polymerase causing DNA chain termination  HSV2  Herpes zoster • Shingles • Chickenpox – varicella  ↓ viral shedding, pain, & healing time
    • Albendazole Antihelmintic  GI distress Benzimidazole  Constipation or diarrhea  Hepatitis & hematologic toxicity w/ high doses Binds & inhibits polymerization of tubulin dimmers to form cytoplasmic microtubules  Impairs glucose uptake & deplete glycogen stores  Intestinal nematode infections • Hookworm • Pinworm • Whipworm • Ascariasis • Capillariasis  Trichinosis • Use w/ corticosteroid  Cysticercosis & echinococcus  Microsporidiosis
    • Amantadine Anti-influenza,  Ataxia antiparkinson  Dizziness Tricyclic amine  Insomnia  Skin mottling & livedo reticularis Inhibits influenza-A M2 proton channel &  Blurred vision acidification of virus  Dry mouth particle  Prevents viral protein- protein dissociation & uncoating of viral particles  Influenza A
    • Amoxicillin-clavulanate β-lactam ABX  Diarrhea Extended spectrum aminopenicillin  Superinfection & β-lactamase inhibitor  Pseudomembranous colitis  Allergic rxn Amoxicillin • Rash • Serum sickness  Binds PBP • anaphylaxis • Inhibits cross-linking of cell wall peptidoglycan Clavulanate  Probenecid inhibits renal tubular  Inhibits class-A β-lactamase excretion • ↑ serum levels • Protects amoxicillin from destruction  NOT antimicrobial by itself  Respiratory tract infections • Otitis, sinusitis, pneumonia  Skin or skin structure infections • Bite wounds
    • Amphotericin B Antifungal  Chills Polyene ABX  Fever  Diarrhea  N, V Binds ergosterol & ↑  Nephrotoxicity membrane permeability  Hypokalemia  Leakage of cell contents  ↑ toxicity w/ cyclosporine,  Candidiasis antineoplastics  Cryptococcal meningitis  Thiazides, &  Aspergillosis corticosteroids ↑ hypokalemia  Blastomycosis  Coccidioidomycosis  Histoplasmosis  Mucormycosis
    • Azithromycin Macrolide Protein synthesis inhibitor Binds 50s ribosome Prevents peptide elongation & translocation from acceptor site to peptidyl site  Respiratory infections d/t strep, pneumo, H. influenzae, Legionella • Otitis media, sinusitis  Single-dose Tx for chlamydial urethritis, chancroid, MAI infections
    • Aztreonam β-lactam ABX  Thrombophlebitis Monobactam  Allergic rxn Binds PBP including transpeptidase Inhibits cross-linking of cell wall peptidoglycan  Drug resistant gram (-) infections including Pseudomonas aeruginosa & Enterobacteriaceae
    • Caspofungin Antifungal  HA Echinocandin  Fever  Phlebitis Inhibits synthesis of cell  Abnormal LFTs wall component  β-1,3-D-glucan  Candida albicans  Invasive aspergillosis  IV admin • Not absorbed well by gut
    • Cefazolin β-lactam ABX  Rash 2nd generation cephalosporin  Diarrhea  Pseudomembranous colitis Binds PBP including  Superinfection transpeptidase Inhibits cross-linking of cell  Probenecid inhibits excretion wall peptidoglycan & ↑ serum levels  Surgical wound infections  Infections d/t • Staph, strep, E. coli, Klebsiella pneumoniae, Proteus mirabilis  NOT active against MRSA
    • Cefepime β-lactam ABX  Rash 4th generation  Diarrhea cephalosporin  Pseudomembranous colitis  Superinfection Binds multiple PBP Inhibits cross-linking of  Probenecid inhibits cell wall peptidoglycan excretion & ↑ serum levels Resistant to many β- lactamases  Drug-resistant gram (-) bacteria • Citrobacter • Enterobacter
    • Ceftazidime β-lactam ABX  Rash 3rd generation cephalosporin  Diarrhea  Pseudomembranous colitis Binds PBP including  Superinfection transpeptidase Inhibits cross-linking of cell  Probenecid inhibits excretion wall peptidoglycan & ↑ serum levels  Gram (+), gram (-), & anaerobics – Pseudomonas aeruginosa  Pneumonia, meningitis, UTI, skin structures, bones, jts
    • Cetriaxone β-lactam ABX  Rash 3rd generation cephalosporin  Diarrhea  Pseudomembranous colitis Binds PBP including  Superinfection transpeptidase Inhibits cross-linking of cell  Probenecid inhibits excretion wall peptidoglycan & ↑ serum levels  Infection d/t • Pneumococci, gonococci, meningococci, H. influenzae, Moraxella catarrhalis, Borrelia burgdorferi  Single IM injection Tx acute otitis media or gonorrhea
    • Ciprofloxacin Antibacterial  Insomnia Fluoroquinolone  Diarrhea  N Inhibits bacterial DNA topoisomerase type II (DNA  Absorption ↓ by cations gyrase) & type IV • Antacids Prevents DNA replication & • Iron separation of chromosomes • Zinc • bismuth  Urinary tract, prostate, intraabdominal w/ metronidazole, bone or jt, skin  Inhalational anthrax  Gonorrhea  Infectious diarrhea  Gram (+), gram (-), Pseudomonas aeruginosa
    • Clindamycin Aminosugar ABX  C. difficile superinfection Protein synthesis inhibitor  Diarrhea  Pseudomembranous colitis Binds 50s ribosome Prevents translocation of nascent peptide from acceptor site to peptidyl site  Strep, staph, gram (+)  Acne vulgaris  Anaerobes including Bacteroides
    • Doxycycline Tetracycline ABX  AVOID Protein synthesis inhibitor • Pregnancy & children > 8 y/ o • Outdated preparations are Binds 30s ribosome nephrotoxic Reversibly inhibits binding of transfer RNA to acceptor site  Permanent teeth discoloration  Rickettsia, Chlamydia,  Photosensitivity Mycoplasma, Borrelia  Diarrhea  Acne  N, V  Cholera  Gonorrhea & syphilis in PCN allergic pts  Brucellosis & ehrlichiosis
    • Efavirenz Antiretroviral  N Non-nucleoside reverse  Rash transcriptase inhibitor  Drowsiness  Depression Binds reverse transcriptase & disrupts catalytic site  HIV in combo w/ nucleoside reverse transcriptase inhibitor – synergistic  High fat meal ↑ absorption
    • Enfuvirtide Antiretroviral  Injection site rxn HIV fusion inhibitor • Rotate sites daily Binds HIV virus gp41 & blocks fusion of HIV w/ host cells CD4 Thelper lymphocytes  Drug-resistant HIV
    • Erythromycin Macrolide ABX  Activates motilin receptors causing uncoordinated Protein synthesis inhibitor peristalsis • Anorexia Binds 50s ribosome • N, V Prevents peptide elongation & translocation from acceptor site to peptidyl site  Pharyngitis, otitis media, sinusitis, pneumonia d/t • Strep, pneumococci, Mycoplasma, Chlamydia, Legionella, MAI
    • Ethambutol Antitubercular  Dose-related Synthetic butanol retrobulbar optic neuritis derivative  Impaired red-green color discrimination Bacteriostatic against • Monitor pts color mycobacteria discrimination regularly Inhibits RNA synthesis  Gouty arthritis  M. tuberculosis  MAI
    • Foscarnet Antiviral  HA Pyrophosphate  Diarrhea  V  Renal failure Blocks pyrophosphate-  Hypocalcemia binding site on viral  Hypokalemia DNA polymerase  Hypomagnesemia  Prevents attachment of  Anemia nucleotide precursors to DNA  Arthralgia  Myalgia  CMV retinitis in HIV pts  Acyclovir-resistant HSV  Pentamidine causes life- in immunocompromised threatening hypocalcemia
    • Fosfomycin ABX Cell wall synthesis inhibitor Inhibits enopyruvyl transferase & addition of phosphenolpyruvate to N- acetylglucosamine to form N-acetylmuramic acid  Cystitis d/t E. coli or Enterococcus faecalis  Single dose Tx for UTI
    • Ganciclovir Antiviral  ↓ visual acuity  Neutropenia Nucleoside analogue  Thrombocytopenia  Anemia Converted to ganciclovir triphosphate  Inhibits viral DNA polymerase  CMV infection in immunocompromised & transplants
    • Gentamicin Aminoglycoside ABX  Nephrotoxicity Protein synthesis inhibitor  Ototoxicity • Vestibular & cochlear • ↑ w/ loop diuretics Binds 30s ribosome Prevents initiation of protein synthesis  Misreading of genetic code  Gram (-) bacilli including Enterobacteriaceace & P. aeruginosa  Strep, enterococcal, & staph infections  Monitor serum levels
    • Griseofulvin Antifungal  HA Fungistatic ABX  Induces CYP450 • Reduces plasma Deposits in keratin levels warfarin & precursor cells of skin, OCP hair, & nails Disrupts microtubules & mitotis of dermatophytes  Dermatophyte infections  NOT Candida
    • Imipenem-cilastatin β-lactam ABX  Allergic rxns Carbapenem ABX &  Diarrhea dehydropeptidase inhibitor  V  Seizures Imipenem • ↑ risk w/ ganciclovir or cyclosporine  Binds PBP & inhibits cross- linking cell wall peptidoglycan  Probenecid inhibits secretion & ↑ serum levels Cilastatin  Inhibits renal dehydropeptidase & degradation of imipenem  Endocarditis, pneumonia, UTI, pelvic, abdominal d/t aerobic & anaerobic
    • Isoniazid Antitubercular  Hepatitis Nicotinic acid derivative • Toxic metabolite acetyl- hydrazine  Peripheral neuropathy Reduces catalase- • Vit. B6 deficiency peroxidase  Inhibits synthesis of mycolic acid component of cell wall  TB  Bimodal distribution d/t fast & slow acetylation  Inactivates vit. B6
    • Itraconazole Antifunal  GI distress Synthetic triazole  Rash  Hepatitis Inhibits 14-α-demethylase  CYP450 enzyme that converts lanosterol  ergosterol  Blastomycosis, candidiasis, coccidioidomycosis, histoplasmosis  Onychomycosis – nail beds
    • Ivermectin Antiparasitic  Vertigo Antihelmintic ABX  Sedation Activates glutamate-gated Cl ion channel  Pharyngeal m. hyperpolarization & paralysis  Strongyloidiasis  Cutaneous larva migrans  Onchocerciasis filiariasis • W. bancrofti
    • Levofloxacin Antibacterial Fluoroquinolone Inhibits bacterial DNA topoisomerase type II (DNA gyrase) & type IV Prevents DNA replication & separation of chromosomes  Community-acquired pneumonia  UTI  Gynecologic & skin infections  Gram (+), gram (-), P. aeruginosa, Mycoplasma, Mycobacterium
    • Linezolid Antibacterial  Inhibits MAO Oxazolidinone protein synthesis inhibitor Binds 23s ribosomal RNA of 50S subunit  Prevents formation of 70s initiation complex  VRE, MS/MRSA, PCN-sensitive pneumococci
    • Mefloquine Antimalarial  Neuropsychiatric syn 4-quinolone methanol • Hallucination derivative • Anxiety • Confusion • Seizure Inhibits erythrocytic • Coma schizogony Inhibit nucleic acid synthesis  Malaria  Chloroquine- susceptible/resistant trains of P. falciparum & P. vivax  Perform CBC during chronic prophylactic Tx
    • Metronidazole Antiprotozoal  GI pain Nitroimidazole  Anorexia  N Reduced by  Dizziness pyruvate:ferredoxin to form nitro-free radicals  Alcohol causes that attack DNA & disulfiram-like effect proteins  Amebiasis, giardiasis, trichomoniasis  Balantidium coli, C. difficile, B. fragilis
    • Mupirocin ABX Protein synthesis inhibitor Competes w/ isoleucine for binding bacterial isoleucyl tRNA synthetase Prevents addition of isoleucine during protein synthesis  Impetigo by staph or strep  Eradicate nasal colonization of MRSA  Infected traumatic skin lesions
    • Nafcillin β-lactam ABX  Diarrhea Antistaphylococcal,  Superinfection penicillinase-resistant  Pseudomembranous colitis penicillin  Allergic rxn • Rash Binds PBP • Serum sickness  Inhibits cross-linking of • Anaphylaxis cell wall peptidoglycan  Probenecid inhibits renal  Methicillin-sensitive tubular secretion & ↑ penicillinase producing serum levels staph • Bone, jt, UTI, respiratory, skin, endocarditis, meningitis
    • Nitrofurantoin Urinary tract  Anorexia antibacterial  N, V Nitrofuran  Neurotoxicity  Pneumonitis Inhibits bacterial enzymes  Probenecid inhibits urinary excretion  UTI • E. coli, S. saprophyticus
    • Oseltamivir Antiviral Neuraminidase inhibitor Inhibits influenza A & B neuraminidase  Prevents release & spreading of viral particles  Influenza A & B
    • Paromomycin Antiprotozoal  Nephrotoxic & Aminoglycoside ABX ototoxic if given IV Inhibits protein synthesis  Intestinal amebiasis  Cryptosporidiosis in immunocompromised pts
    • Penicillin G β-lactam ABX  Diarrhea Narrow-spectrum  Superinfection penicillin  Pseudomembranous colitis  Allergic rxn Binds PBP • Rash  Inhibits cross-linking • Serum sickness of cell wall • Anaphylaxis peptidoglycan  Probenecid inhibits  Strep, pneumococcal, renal tubular secretion meningococcal  Syphilis
    • Pentamidine Antiprotozoal  Nephrotoxic Amidino-pentane  Hematologic toxicity derivative  Hypoglycemia  Allergic rxn • Anaphylaxis Disrupts nucleic acid synthesis in protozoa  Erythromycin ↑ fatal arrhythmias  P. carinii  Early stage African trypanosimiasis – sleeping sickness
    • Piperacillin-tazobactam β-lactam ABX  Diarrhea Antipseudomonal penicillin  Superinfection & β-lactamase inhibitor  Pseudomembranous colitis  Allergic rxn • Rash Piperacillin • Serum sickness  Binds PBP • Anaphylaxis • Inhibits cross-linking of cell wall peptidoglycan  Probenecid inhibits renal Tazobactam tubular secretion  Inhibits class A β-lactamases  Gram (-) bacilli, P. aeruginosa
    • Praziquantel Antihelmintic  Malaise Isoquinoline derivative  Anorexia  Drowsiness ↑ Ca permeability of  dizziness schistosome tegument  Contraction & exposing antigens to host immunity  Schistosomiasis  Chinese liver fluke  Lung fluke  Cestodes – tapeworms
    • Primaquine Antimalarial  Hemolytic anemia in 8-aminoquinoline G6PD deficiency  methemoglobinemia Converted to oxidizing quinoline-quinone intermediates  Eradicate exo- erythrocytic forms of P. vivax & P. ovale
    • Pyrimethamine Antiprotozoal  N Folate reductase inhibitor  Anorexia  Hypersensitivity rxn Inhibits folate reductase Folate deficiency in protozoa  Malaria in combo w/ sulfadoxine  Toxoplasmosis in combo w/ sulfadoxine  NOT effective against P. vivax
    • Pyrantel Antihelmintic  Abdominal cramps Pyrimidine analogue  Anorexia  Diarrhea Activates cholinergic  V nicotinic receptors in somatic m. of nematodes Produces depolarizing NM blockade  Ascariasis  Hookworm & pinworm
    • Quinine Antimalarial  Abdominal cramps 4-aminoquinoline  Diarrhea  V Binds plasmodial DNA & prevents replication &  Cinchonism transcription during • Tinnitus erythrocytic schizogony • Blurred vision  Metabolism  Chloroquine-resistant • Cimetidine inhibits malaria • Rifampin induce  Admin w/ doxycycline or pyrimethamine- sulfadoxine
    • Quinupristin-dalfopristin Streptogramin ABX  Infusion site rxn Protein synthesis inhibitor Binds 50s ribosomal subunit Quinupristin  Inhibits aminoacyl tRNA synthesis & addition of AA Dalfopristin  Inhibits peptidyl transferase  VRE, MS/MRSA
    • Ribavirin Broad-spectrum antiviral  Anemia Guanosine analogue  Hypotension  Cardiac arrest Converted to ribavirin triphosphate Depletes guanosine triphosphate Inhibits viral RNA & protein synthesis  RSV in infants or children  Chronic hepatitis C  Viral hemorrhagic fever – Lass fever
    • Rifampin Antitubercular  Red discoloration of tears, Rifampin derivative urine, saliva, sweat  Abdominal pain  V Inhibits DNA-dependent RNA polymerase  Diarrhea  Hepatitis  TB  Leprosy  Induces CYP450  Prophylaxis meningococcal  ↓ levels meningitis & H. flu B • Warfarin infections • Theophylline • Itraconazole • Steroids • Opioids • Phenytoin • Verapamil
    • Ritonavir-lopinavir Antiretroviral  Anorexia HIV protease inhibitor  V  Altered taste Inhibits HIV protease  Abnormal thinking & conversion of gag-pol  Hyperlipidemia polyprotein to  Hyperlgycemia functional proteins Ritonavir  ↑ lopinavir levels  HIV in combo w/ nucleoside reverse transcriptase inhibitor
    • Streptomycin Aminoglycoside  Nephrotoxic Protein synthesis inhibitor  Ototoxic • ↑ w/ loop diuretics Binds 30s ribosome Prevents initiation of protein synthesis  Misreading of genetic code  Drug-resistant TB  Plague  Tularemia  IV admin
    • Terbinafine Antifungal  Itching Allylamine  Rash  Diarrhea Inhibits squalene  Anorexia oxygenase & formation of squalene epoxide during  Metabolism fungal membrane • Cimetidine inhibits ergosterol synthesis • Rifampin induce  Topical • Tinea corporis, cruris, pedis, versicolor  Oral • Onychomycosis – fungal nail infection
    • Trifluridine Antiviral  Ocular irritation Thymidine analogue • Redness • Itching Inhibits HSV DNA polymerase  Herpetic keratitis  Keratoconjunctivitis  Topical ocular admin
    • Trimethoprim-sulfamethoxazole Antibacterial  N, V Folate antagonist  Rash  Stevens-Johnson syn  Allergic rxn Sulfamethoxazole  Anemia  Inhibits folate synthesis • Hemolytic anemia Trimethoprim • Megalobalstic anemia  Inhibits folate reduction  Leukopenia  Thrombocytopenia  UTI, traveler’s diarrhea  Crystalluria  Shigella enteritis  P. carinii & Nocardia  Added folate deficiency w/ pneumonia phenytoin or MTX
    • Vancomycin Glycopeptide ABX  Red man syn Cell wall synthesis • Extensive rate of infusion inhibitor • Erythematous rash on face & upper body Binds D-alanyl-D-alanine  Ototoxicity portion of peptidoglycan • Vestibular & cochlear Prevents cross-linking of D-alanine & pentaglycine chain  MRSA, penicillin-resistant enterococci, C. difficile
    • Zidovudine Antiretroviral  Anemia Nucleoside reverse transcriptase inhibitor Activated nucleotide triphosphate incorporated into DNA causing chain termination  HIV  Prevent maternal-fetal HIV transmission  1st line Tx for HIV infections • Zidovudine w/ lamivudine or emtricitabine & efavirenz or lapinavir- ritonavir