VICK SIDHUS DRUG OF CHOICE LIST BLOCK 2 PHARMACOLOGY

1. DRUG OF CHOICE FOR CLOSURE OF PATENT DUCTUS ARTERIOSIS INDOMETHACIN (PGE2 MAINTAINS THE PDA), ASA CAN BE USED. 2. DRUG OF CHOICE IN ACS ANTIPLATELET EFFECT - ASA 3. DRUG OF CHOICE FOR PEDIATRIC VIRAL FEVER - ACETAMINOPHEN (NOT ASA - REYES SYNDROME) 4. DRUG OF CHOICE FOR OSTEOARTHRITIS PAIN - ACETOMINOPHEN 5. DRUG OF CHOICE FOR ACETOMINOPHEN OVERDOSE - N-ACETYLCYSTEINE 6. DRUG OF CHOICE (DMARD) FOR RA - METHOTREXATE, HYDROXYCHLOROQUINE, SULFASALAZINE, STEROIDS, gold salts, penicillamine. 7. DRUG OF CHOICE FOR ACUTE GOUTY ARTHRITIS - INDOMETHACIN, COLCHICINE (any non-salycilate NSAID) 8. DRUG THAT IS METABLIZED TO PABA AND NEEDS HIGHER SULFONAMIDE DOSE - PROCAINE 9. BUPIVACAINE IS MORE CARDIOTOXIC THAN LIDO AND OTHER LAS - BLOCK NA CHANNELS AND CONDUCTION DELAYS AND BRADY - CONTRACTILITY ALSO DECREASED, BUT IS THE DOC IN OBS /GYN 10. DRUG OF CHOICE IN ENT SURGERY - COCAINE 11. DRUG OF CHOICE FOR PRE-ANESTHETIC REMOVAL OF SECRETIONS GLYCOPYROLATE (anesth---> parasymp----> secretions) 12. INHALATIONAL ANESTHETIC OF CHOICE FOR RAPID ONSET AND RECOVERY WITH LOWEST AIR-BLOOD CO-EFFICIENT - N2O (++analgesic) 13. INHALED ANESTHETIC OF CHOICE - FOR MOST POTENT (LOW MAC, HIGH OIL GAS CO-EFF) - HALOTHANE (fulminant hepatitis, malignant hyperthermia, prolongation of labour) 14. DRUG OF CHOICE FOR INHALED ANESTHESIA IN KIDS - SEVOFLURAINE 15. DRUG OF CHOICE FOR INHALED ANESTHESIA FOR SURGICAL DAYCARE DESFLURANE. (airway irritation) 16. DRUG OF CHOICE FOR INHALED ANESTHESIA IN CARDIAC / NEUROSURGERY - ISOFLURANE (coronary dilation) 17. (SAFEST) INHALATIONAL ANESTHETIC - N2O 18. INHALATIONAL ANESTHETIC FOR ASTHMATICS - HALOTHANE 19. DRUG OF CHOICE FOR IV INDUCTION / prolonged SEDATION - PROPOFOL 20. DRUG OF CHOICE FOR IV INDUCTION IN HEMODYNAMICALLY UNSTABLE PTS - ETOMIDATE (can suppress steroid production) 21. DRUG OF CHOICE FOR BURN DRESSING, DISSOCIATIVE AMNESIA, GOOD ANALGESIC EFFECT - KETAMINE. (C/I IN ELEVATED ICP) 22. DRUG OF CHOICE FOR BZD IV CONT. INFUSION FOR ANESTHESIA MIDAZOLAM 23. DRUG OF CHOICE FOR PERIOPERATIVE ANALGESIA - FENTANYL / ketorolac

24. DRUG OF CHOICE FOR ACUTE MORPHINE / HEROIN OD REVERSAL NALOXONE 25. DRUG OF CHOICE FOR LONGER ACTING REVERSAL - NALTREXONE 26. DRUG OF CHOICE FOR PAIN / ANXIETY RELATED TO MI - MORPHINE 27. DRUG OF CHOICE FOR ANTITUSSIVE IN NONINFECTIVE / NONPRODUCTIVE COUGH - CODEINE (some ppl lack enzyme to convert to active morphine-no effect) 28. DRUG OF CHOICE FOR OPIOD WITHDRAWAL (LONG TERM) - METHADONE 29. DRUG OF CHOICE FOR ACUTE OPIOD WITHDRAWAL - CLONIDINE (ALPHA 2 AGONIST) 30. OBSTETRICAL OPIOD OF CHOICE - MEPERIDINE 31. DRUG OF CHOICE TO DIAGNOSE OPIOD DEPENDANCE - NALOXONE 32. DRUG OF CHOICE TO AMELIORATE POSITIVE AND NEGATIVE SCHIZOPHRENIC SYMPTOMS - ATYPICAL ANTIPSYCHOTICS(CLOZAPINE) 33. DRUG OF CHOICE FOR EPS MANAGEMENT - GIVE ANTIMUSCARINIC -BENZTROPINE 34. DRUG OF CHOICE FOR TARDIVE DYSKINESIA - D/C TYPICALS!!! D/C ANTIMUSCARINICS 35. DRUGS THAT CAUSES AGRANULOCYTOSIS - CLOZAPINE / CHLORPROMAZINE 36. DRUG THAT CAUSES CHOLESTATIC JAUNDICE/ CORNEA/ LENS DEPOSITS CHLORPROMAZINE 37. DRUG THAT CAUSES RETINOPATHY AND RETINAL DEPOSITS THIORIDAZINE (torsade de pointe) 38. (1ST LINE) ATYPICAL ANTIPSYCHOTIC OF CHOICE - RESPIRIDONE 39. DRUG THAT CAUSES WEIGHT GAIN - OLANZAPINE / clozapine / mirtazipine 40. DRUGS THAT CAUSE QT PROLONGATION - QUETIAPINE, ZIPRASIDONE 41. MAOI + SSRI = SEROTONIN SYNDROME 42. MAOI + TYRAMINE (FOOD) = CHEESE RXN => HYPERTENSIVE CRISIS ETC.. 43. DRUGS OF CHOICE FOR DEPRESSION - SSRIS (lower efficacy than TCAs, but fewer side effects- ANORGASMIA) 44. DRUG OF CHOICE FOR DEPRESSION / ANXIETY / QUIT SMOKING BUPROPION. 45. DRUG (ANTIEPILEPTIC) THAT CAN CAUSE PANCREATITIS - VALPROATE 46. DRUG OF CHOICE FOR ABSENCE SEIZURES - ETHOSUXAMIDE 47. DRUG THAT CAUSES CLEFT LIP / PALATE - PHENYTOIN 48. DRUG THAT CAUSES CLEFT AND SPINA BIFIDA - CARBAMAZAPINE / valproate 49. DRUG OF CHOICE FOR ADJUNCT TO LEVODOPA - CARBIDOPA** OR BENSERAZIDE (do not cross BBB) peripheral decarboxylase enzyme inhibitors. 50. DRUG THAT DECREASES THE EFFICACY (causes peripheral breakdown) - & IS CONTRAINDICATED WITH LEVODOPA THERAPY - VITAMIN B6 (PYRIDOXINE) 51. MOST COMMON SIDE EFFECT OF LEVODOPA - (N+V IN 80%***USE NON PNENOTHIAZINE ANTIEMETICS) AND TACHARRYTHMIAS / AF FROM

PERIPHERALLY PRODUCED DOPAMINE, DYSKINESIAS, behavioral / psychological, ON / OFF PHENOMENON. (off treated with - apomorphine) 52. DRUG THAT IS A COMPT INHIBITOR THAT CAUSES HEPATOTOXICITY TOLCAPONE - reduces peripheral L-dopa breakdown. 53. DRUG MAO-B INHIBITOR - SELEGILINE (helps by prolonging dopamine effect in the brain and slows disease by reducing ROSs) - SHOULD NOT BE USED WITH SSRI, TCA, MEPERIDINE. WHY? ---> SEROTONIN SYNDROME 54. DRUG OF CHOICE FOR DRUG INDUCED PARKINSONISM ANTICHOLINERGICS LIKE BENZTROPINE, TRIHEXIPHENIDYL, DIPHENHYDRAMINE, PROCYCLIDINE 55. DRUG OF CHOICE FOR ANTISPASTIC IN MS - BACLOFEN (GABAb AGONIST) 56. DRUGS ALSO USED IN MS - PREDNISONE AND INTERFERON BETA 1b 57. NSAID OF CHOICE FOR JOINT PAIN (ARTHRITIS) THAT HAS GOOD SYNOVIAL FLUID PENETRATION - DICLOFENAC 58. DRUG OF CHOICE FOR SELECTIVE COX-2 INHIBITION - CELECOXIB 59. DRUG OF CHOICE (NSAID) FOR POST OPERATIVE PAIN - KETOROLAC 60. DRUG OF CHOICE FOR IRREVERSIBLE BLOCKING PLATELETS FROM MAKING TXA2 - ASA 61. MOST COMMON A/E OF NSAIDS - PEPTIC ULCER (COX1) CAN LEAD TO GI BLEED SECONDARY TO PERFORATION. 62. DRUG OF CHOICE TO PROTECT GASTRIC MUCOSA WHEN PT ON ASA/NSAIDS - MISOPROSTOL (MOST EFFECTIVE), PPIS AND H2 BLOCKERS. 63. HOW DO NSAIDS REDUCE THE EFFICACY OF DIURETICS AND ACE INHIBITORS? - BLOCKING PGS LEADS TO DECREASE RBF AND GFR. 64. DRUG THAT IS CONTRAINDICATED IN GOUT - ASA (LOW DOSE) / ETOH 65. DRUG TO USE CAUTIOUSLY IN BRONCHIAL ASTHMA - ASA (SHUNTS AA TO LIPOXYGENASE FORMING MORE LEUKOTRIENES --> BRONCHOCONSTRICTION 66. DRUG OF CHOICE FOR PEDIATRIC VIRAL FEVER - ACETOMINOPHEN. WHAT IS ASA GIVEN? - REYES SYNDROME (LIVER DYS., ENCEPHALOPATHY, CEREBRAL EDEMA) 67. DRUG OF CHOICE FOR ASA OD - NO ANTIDOTE, BUT USE NaHCO3- / ACETAZOLAMIDE (TO ALKALIZE URINE) 68. DRUG OF CHOICE FOR CHRONIC INFLAMMATORY CONDITIONS (LONG ACTING WITH MORE COX2 - EASY ON GI) - MELOXICAM 69. DRUG OF CHOICE FOR CANCER BONE PAIN / DENTAL WITH NO ANTIPYRETIC EFFECT (NO BBB PENETRATION) - DIFLUNISAL 70. DRUG OF CHOICE FOR ACETAMINOPHEN OVERDOSE - NAC 71. DRUGS OF CHOICE FOR STANDARD DUAL THERAPY FOR RA METHOTREXATE AND ETANERCEPT (RECOMBINANT TNF RECEPTOR) 72. DRUG FOR RA - IL1 RECEPTOR ANTOGONIST (RECOMB) - ANAKINRA 73. DRUGS OF CHOICE FOR ACUTE GOUT ATTACKNSAIDS/COLCHICINE/STEROIDS 74. DRUG OF CHOICE (NSAIDS) FOR GOUT - INDOMETH, NAPROXEN, SULINDAC

75. DRUG OF CHOICE FOR GOUT IF NSAID C/I - COLCHICINE (DIARRHEA - 80%) -C/I IN PREGNANCY (colchicine prevents tubulin polymerization) 76. DRUG OF CHOICE FOR GOUT / NORMAL URINARY URIC ACID EXCRETIONS URICOSURIC AGENTS (PROBENEZID, SULFINPYRAZONE) - BLOCK PROX TUB. REABSORPTION. 77. DRUG OF CHOICE (CHRONIC GOUT) URIC ACID SYNTHESIS INHIBITOR ALLOPURINOL (FOR PT WITH PREVIOUS URIC ACID STONES OR RENAL INSUF. 78. DRUGS THAT NEED DOSE ADJUSTING WHEN ON ALLOPURINOL MERCAPTOPURINE AND AZATHIOPRINE 79. DRUG OF CHOICE FOR END STAGE PARKINSONS - DOPAMINE RECEPTOR AGONISTS - BROMOCRIPTINE 80. DRUG OF CHOICE FOR MILD EARLY PARKINSONS AND FOR DRUG INDUCED PARKINSONS - ANTICHOLINERGICS - BENZTROPINE 81. ANTIVIRAL (AMANTIDINE) INCREASES DOPAMINE IN PARKINSONS / ANTIMUSCARINIC - ADVERSE EFFECT = LIVEDO RETICULASRIS 82. DRUG OF CHOICE FOR ALS (NA CHANNEL BLOCKER) - RILUZOLE 83. MOST ADDICTIVE DRUG KNOWN TO MAN - CAFFEINE, FOLLOWED BY NICOT. 84. DRUG THAT BLOCKS COX IN CNS BUT NOT PERIPHERALLY ACETAMINOPHEN 85. DRUGS OF ABUSE THAT DO NOT PRODUCE DEPENDANCE AND ADDICTION PCP & LSD 86. DRUG OF CHOICE FOR ABUSE IN USA - MARIJUANA 87. MOST ABUSED OPIOD - HEROIN 88. TRIAD OF ACUTE OPIOD TOXICITY - RESP DEPRESSION, PIN POINT PUPILS, COMA 89. DRUG OF CHOICE FOR SUBSTITUTION THERAPY FOR OPIOD DEPENDENCEMETHADONE, BUPRENORPHINE 88. DRUG OF CHOICE TO PREVENT MIGRAINES - PROPRANOLOL 89. DRUG FOR MIGRAINES THAT IS A 5HT2 RECEPTOR ANTAGONIST WHICH CAN CAUSE RETROPERITONEAL, PLEURAL AND CARDIAC FIBROSIS METHYSERGIDE (6MONTH THERAPY MAX) 90. DRUG OF CHOICE (FIRST LINE) FOR ACUTE MIGRAINES - TRIPTANS (5HT 1D/1B RECEPTOR AGONISTS) - *****coronary vasospasm**** 91. DRUG OF CHOICE FOR DIARRHEA PREDOMINANT IBS - ALOSETRON 92. DRUG OF CHOICE FOR CONSTIPATION PREDOMINANT IBS - TEGADEROD 93. DRUG OF CHOICE FOR ETOH DETOX - LONG TERM - BZD CHLORDIAZEPOXIDE 94. DRUG OF CHOICE ETOH AVERSION THERAPY - ANTABUSE, NALTREXONE. (antabuse blocks acetaldehyde dehydrogenase) 95. DRUG OF CHOICE FOR METHANOL POISONING - FOMIPEZOLE, ETOH IV 96. DRUG OF CHOICE FOR BZD OD (antidote) - FLUMAZENIL 97. DRUG CAUSING MEMORY LAPSE / AGGRESSIVENESS - TRIAZOLAM 98. DRUG OF CHOICE SLEEP ONSET INSOMNIA - ZOLPIDEM, ZALEPLON

111. 112. 113. 114. 115. 116.

99. DRUG OF CHOICE FOR TONIC / CLONIC SZ - PHENYTOIN / CARBAMAZAPINE 100. DRUG OF CHOICE FOR ABSENCE SZ - ETHOSUXAMIDE 101. DRUG CAUSING DILUTIONAL HYPONATREMIA - CARBAMAZAPINE 102. DRUG OF CHOICE FEBRILE SZ - DIAZEPAM 103. DRUG OF CHOICE FOR STAUS EPILEPTICUS - IV LORAZ / DIAZ - IV PNEYTOIN 104. DRUG OF CHOICE FOR SIMPLE OR COMPLEX SZ - PHENYTOIN / CARBAMAZEPINE 105. DRUGS THAT CAUSE AGRANULOCYTOSIS - CLOZAPINE / CLORPROMAZINE 106. SIDE EFFECT OF COLCHICINE - DIARRHEA 107. DRUG OF CHOICE FOR TRIGEMINAL NEURALGIA - CARBAMAZAPINE 108. SIDE EFFECTS OF VALPROATE - ALLOPECIA, PANCREATITIS, SPINA BIFIDA, HEPATOTOX, THROMBOCYTOPENIA 109. SUCCS CAUSES HYPERKALEMIA --> POST OP MUSCLE PAIN 110. DRUG - GENERAL ANESTHETIC WHICH INCREASES BP / HR - KETAMINE DOPA DECARBOXYLASE AKA AROMATIC L -AMINOACID DECARBOXYLASE (AAA) DRUG THAT REACTIVATES TB - ETENERCEPT DRUG THATS CONTRAINDICATED IN PORPHYRIA - THIOPENTAL (SAFE IN HEAD TRAUMA - REDUCES ICP) SERIOUS SIDE EFFECT OF MEPERIDINE - SZ / HALLUCINATIONS OPIOD USED AS A TRANSDERMAL PATCH - FENTANYL OPIOD THAT IS CONTRAINDICATED IN MI - PENTAZOCINE PRIMIDONE?? PRO DRUG FOR CARBAMAZAPINE DEPRESSION + INSOMNIA = MIRTAZIPINE DEPRESSION + SCHIZOPHRENIA = AMOXAPINE DEPRESSION + PAIN = DULOXETINE ONLY TOPICAL - BENZOCAINE ABORTIVE MIGRAINE - TRYPANS ERGOTIMINE LEFLUNAMIDE - RA - ALLOPECIA - DECREASE T CELL. METHESIRGIDE / PROPRANOLOL / - PROPHYLACTIC FOR MIGRAINES (5HT2 ANT) - FIBROSIS TOPIRAMATE - MEMORY DYSFNX ramelteon - jet lag DEFEROXAMINE - fe overdose (chelator)

BLOCK 4 LIST - ANTIBIOTICS****

DOC FOR CDIFF COLITIS - METRONIDAZOLE (THEN VANCO) DOC FOR MRSA - VANCO DOC FOR VANCO RESISTANT STAPH OR VRE- LINEZOLID DOC FOR SYPHILIS - PEN G (THEN 3RD GEN) DOC FOR STREP PNEUMO PNEUMONIA - PEN G DOC FOR LISTERIA (MENINGITIS IN KIDS / I/C) - AMPICILLIN (WITH AMINOGLYCOSIDES) DOC FOR CHLAMYDIA / RICKETTSIAE / MYCOPLASMA - DOXYCYCLINE DOC FOR AMEBIASIS - METRONIDAZOLE DSOC OF CHOICE FOR BACTERIAL MENINGITIS EMPIRIC TX - AMP, VANCO, 3RD GEN. CEPHALOSPORIN. (CEFTRIAXONE) DRUGS USED FOR PROSTATITIS - DOXYCYCLINE (ERYTHRO, CIPRO) WHAT ARE CEPHALOSPORINS NOT ACTIVE AGAINST? LAME. LISTERIA, ATYPICALS (CHLAMYDIA, MYCOPLASMA), MRSA, ENTEROCOCCI. SYNDROMIC TREATMENT OF STDS - DOXY AND 3RD GEN DOC FOR ACNE PROPHYLAXIS - TETRACYCLINES DOC FOR CHLOROQUINE RESISTANT MALARIA- TETRACYCLINES (doxy) OR QUININE** DOC FOR PREOP SURGICAL PROPHYLAXIS - CEFAZOLIN (1ST GEN) DOC FOR SIADH (ADH RECEPTOR BLOCKER) - DEMECLOCYCLINE DOC FOR NEPHROGENIC DI - THIAZIDE DIURETICS DOC FOR NEONATAL OR CHILDHOOD MENINGITIS - CEFTRIAXONE (COVERS STREP AGALACTEA (GROUP B), E COLI, H. FLU, NISSERIA MENINGITIDIS, STREP PNEUMO) 3RD GEN CEPH ACTIVE AGAINST PSEUDOMONAS - CEFTAZIDIME DOC FOR TYPHOID FEVER - CIPRO (OR 3RD GEN CEPH)

DOC FOR ENTEROBACTER - CARBAPENEMS DOC FOR USE WITH IMIPENEM - CILASTATIN DOC FOR H PYLORI - CLARITHROMYCIN AND AMOXICILLIN AND PPI DRUGS THAT BLOCK 50 S - CHLORAMPHENICOL, MACROLIDES, LINEZOLID. AND CLINDA DRUGS THAT BLOCK 30 S - AMINOGLYCOSIDES, TETRACYCLINES MACROLIDE OF CHOICE FOR URTIS (GOOD H.FLU COVERAGE)AZITHROMYCIN (CAP) DOC FOR DIPTHERIA - ANTI TOXIN AND ERYTHRO PROKINETIC MACROLIDE? ERYTHROMYCIN DOC FOR CHLAMYDIA IN PREGNANCY - (TETRACYCLINE C/I) - ERYTHRO FOR 7 DAYS OR AZITHROMYCIN SINGLE DOSE. DRUG THAT CAUSES CHOLESTATIC JAUNDICE - ERYTHROMYCIN ESTOLATE (HSR) DRUGS THAT CAUSE CDIFF COLITIS - CLINDA, TETRACYCLINES, AMPICILLIN (CEFALOSPORINS??) ABX THAT CAUSES CHEESE REACTION - LINEZOLID ABX THAT CAN CAUSE SZ - IMIPENEM, PEN G IN HIGH DOSE, NALIDIXIC ACID, FQS. DOC SALMONELLA TYPHI - CIPROFLOXACIN DOC IN GONNHOREA - 3RD GEN CEPH DOC FOR UTIS - CIPRO, NORFLOX, OFLOX FLUOROQUINALONE OF CHOICE FOR RESP INFECTIONS - GATIFLOXACIN DOC FOR ANTHRAX - CIPRO DRUGS TO TREAT BACTEROIDES FRAGILIS - ANAEROBES (INTRA-ABDOMINAL SEPSIS, BOWEL PERF, GSW, BRAIN ABSCESS) - 2ND GEN CEPH, METRONIDAZOLE, CLINDAMYCIN. PROSTATITIS - CIPRO OR DOXYCYCLINE DRUGS THAT ARE ACTIVE AGAINST GRAM -VE AEROBES - AMINOGLYCOSIDES DOC FOR BUBONIC PLAGUE AND TULEREMIA - STREPTOMYCIN AG WITH MOST ACTIVITY AGAINST P. AERUGINOSA - TOBRAMYCIN (SYNERGISTIC WITH PIPERICILLIN) DRUGS THAT CAUSE BONE DEFORMATIES AND TOOTH DYSPLASIAS TETRACYCLINES. DOC FOR WALKING PNEUMONIA (MYCOPLASMA) - TETRACYCLINE DOC FOR BORRELIA BURGDORFERI (LYME DISEASE) - DOXYCYCLINE DOC FOR NORCARDIAL INFECTIONS - COTRIMOXAZOLE DOC FOR PCP PNEUMONIA - TMP/SMX DOC FOR CANDIDAL CYSTITIS - FLUCONAZOLE AZOLE OF CHOICE FOR CRYPTOCOCCUS MENINGITIS - FLUC DOC FOR INVASIVE ASPERGILLOSIS - VORICONAZOLE DOC FOR TX OF DERMATOPHYTIC INFECTIONS OF THE NAILS - TERBINAFINE DOC FOR CMV INFECTIONS / RETINITIS - GANCYCLOVIR

DOC FOR PCP PNEUMONIA - TMP / SMZ DOC FOR DENTAL PROCEDURE PROPHYLAXIS IN HEART MURMUR - ORAL AMOXICILLIN DOC FOR CHLOROQUINE RESTISTANT MALARIA - QUININE DOC FOR SYPHILLIS - PEN G DOC FOR LISTERIA - AMPICILLIN (PROBABLY WITH AG) - DIARRHEA DRUGS THAT CAUSE CDIFF - AMPICILLIN, CLINDA, EMPRIC THERAPY FOR BACT. MENINGITIS - AMP, VANCO, 3RD GEN CEPH WHAT AZOLE CROSS THE BBB - FLUCONAZOLE MOA OF AMPHOTERICIN B - BINDS ERGOSTEROL MOA AZOLES - PREVENTS ERGOSTEROL SYNTHESIS DOC FOR THE PROPHYLAXIS AND SUPPRESSION OF CRYPTOCOCCAL MENINGITIS - FLUCONAZOLE DOC FOR SEVERE SYSTEMIC MYCOSES - AMPHOTERICIN B DOC FOR SYNERGY WITH AMPHOTERICIN B - FLUCYTOSINE DRUGS THAT ACT LIKE DISULFIRAM - METRONIDAZOLE, HIV DRUG THAT REDUCES VERTICAL TRANSMISSION BY 50% - NEVIRAPINE HIV DRUG THAT CAUSES NIGHTMARES - EFAVIRENZ CARBAPENEM THAT CAUSES SZ - IMIPENEM CELL WALL INHIBITOR THAT IS ONLY USED IV FOR aerobic GM-VE RODS AZTREONAM (GOOD FOR PSEUDOMONAS FOR PTS ALLERGIC TO PENS) DOC FOR TULEREMIA AND PLAGUE - STREPTOMYCIN AG OF CHOICE FOR PSEUDOMONAS - TOBRAMYCIN DRUG THAT CAUSES GREY BABY SYNDROME - CHLORAMPHENICOL DOC FOR GANCYCLOVIR RESISTANT CMV - FOSCARNET DOC FOR HEPATIC ENCEPHALOPATHY - NEOMYCIN po ISONIAZID SLOW AND FAST ACETYLATORS - SLOW PERIPHERAL NEUROPATHY, FAST GET HEPATITIS ABX AND MOTILITY AGENT - ERYTHROMYCIN DOC FOR PINWORMS - MEBANDEZOLE DRUGS THAT CAUSE NEUROMUSCULAR BLOCKADE - AMINOGLYCOSIDES MACROLIDE THAT DOESNT INHIBIT CYP450 - AZITHRO DOC FOR CHLAMYDIA IN PREGNANCY- ERYTHRO OR AZITHRO NAME 3 ANAEROBES - BACTEROIDES, TOXOPLASMA, CLOSTRIDIUM DOC FOR STAPH INDUCED OSTEOMYELITIS - CLINDA DRUGS THAT CAUSE PHOTOSENSITIVITY - TETRACYCLINES, FLUROQUINOLONES, SULFONAMIDES DRUGS THAT BLOCK DIHYDROFOLATE REDUCTASE - METHOTREXATE, TRIMETHOPRIM AND PYRIMATHAMINE DOC FOR NOCARDIA - COTRIMOXAZOLE (BACTRIM) ABX THAT CAUSES CHEESE RXN - LINEZOLID DRUGS THAT CAUSE STEVENS JOHNSON SYNDROME - SULFONAMIDES

ADVERSE EFFECTS OF ISONIAZID***SLIDE 258 AND KETOCONAZOLE 320 DOC FOR SEVERE REFRACTORY CMV RETINITIS - FOMIVERSEN (AFTER GANCYCLOVIR AND FOSCARNET HAVE FAILED) DOC FOR LATENT MALARIA - PRIMAQUINE DOC FOR RSV BRONCHIOLITIS AND PNEUMONIA - RIBAVARIN DOC FOR HEP C - RIBIVARIN AND INTERFERON ALPHA 2B DOC FOR CYSTICERCOSIS AND NEUROCYSTICERCOSIS - ALBENDAZOLE DOC FOR ONCHOCERCIASIS / STRONGYLOIDES - IVERMECTIN DOC FOR PHILARIASIS, LOA LOA - DIETHYLCARBAMAZINE (MODIFIES SURFACE PROTEINS SO HOST IMMUNE CAN KILL) DOC FOR FLUKES (TREMATODES) CHINESE FLUKES AND CYSTODES PRAZIQUANTEL (INCREASED CALCIUM INFLUX) ANTI-HIV THAT SHOULDNT BE ADDED TO AZT - STAVUDINE DRUG THAT COVERS ENTAOMEBA HISTOLITICA, GIARDIA AND TRICHOMONAS VAGINITIS - METRONIDAZOLE (AND ANAEROBES, CDIFF, HPYLORI) when treating trichamonas with flagyl, treat both partners DOC FOR MOD--> SEVERE TISSUE AMEBIASIS (INTEST / LIVER) - METRONODAZ. DOC FOR TRICHOMONAS AND GIARDIA - METRONIDAZOLE] DRUG THAT CAUSES METALLIC TASTE AND DISULFIRAM TYPE - METRONIDAZ. LUMINAL AMEBICIDE THAT CAUSES FLATULENCE AND CRAMPING DILOXANIDE FUOARATE DOC FOR TOXOPLASMOSIS - PYRIMETHAMINE AND SULFADIAZINE DOC FOR TX AND PROPHYLAXIS OF T. GONDII IN AIDS - PYRIMETHAMINE AND SULFADIAZINE. (can cause megaloblastic anemia and folate def AND stevens johnson syndrome) DOC FOR ACUTE TRYPANOSOMA CRUZI (CHAGAS) AMERICAN SLEEPING SICKNESS - NIFURTIMOX DOC FOR ADVANCED / CNS AFFECTED AFRICAN TRYPANSOMIASIS DOC FOR LESHMENIASIS - SODIUM STIBOGLUCONATE (pentamidine / amphotericin B) MALARIA DRUG FOR PROPHYLAXIS IN CHLOROQUIN RESISTANT AREAS MEFLOQUINE RADICAL CURE MALARIA VIVAX AND OVALE- PRIMAQUINE DOC FOR ALL SENSITIVE PLASMODIUM INFECTIONS - CHLOROQUINE ADVERSE EFFECTS OF CHLOROQUINE - GI, CINCHONISM (GI + VERTIGO / TINNITUS), PRURITIS, RETINOPATHY, WIDE QRS, HEMOLYSIS(G6PD), ARREST IN RAPID IV PUSH). DOC FOR SEVERE CEREBRAL P. FALCIPARUM - QUININE / QUINIDINE

ADVERSE EFFECTS OF QUININE. QUINIDINE - GI, CINCHONISM, HYPOGLYCEMIA, HYPOTENSION, QT LONG, HEMOLYSIS G6PD, HSR, BLOCK WATER FEVER (HSR, HEMOLYSIS AND HEMOGLOBINURIA) HALF LIFE OF MEFLOQUINE - 17 DAYS ADVERSE EFFECTS OF MEFLOQUINE - PSYCHIATRIC SX (AVOID IN PSYCH PTS / SZ) AND CARDIOTOXICITY (AVOID IN CONDUCTION DEFECTS) DOC FOR ROUND, PIN, HOOK AND WHIPWORMS - MEBENDAZOLE & ALBENDAZOLE DOC FOR CUTANEOUS / VISCERAL LARVA MIGRANS / GNATHOSTOMISIS, CYSTISERCOSIS, HYDATID CYST - ALBENDAZOLE DOC FOR ONCOCERCA VOLVULUS (RIVER BLINDENESS) AND STRONGYLOIDIASIS - IVERMECTIN (mazotti like rxn may occur - allergy to killed microfilariea) DOC FOR FILARIASIS FROM W. BANCROFTI, B MALAYI, B. TIMORI, ... LOA LOA, TROPICAL EOSINOPHILIA - DIETHYLCARBAMAZINE DOC IN FLUKES (TREMATODES) - SCHISTOSOMAIASIS, CHINESE FLUKE, LUNG FLUKE, CESTODES (TAPEWORMS) LIKE T SOLIUM (PORK), T SAGINATA (BEEF), DIPHYLLOBOTHRIUM LATUM (FISH), H NANA (DWARF) - PRAZIQUANTEL DOC FOR FASCIOLA HEPATICA (SHEEP LIVER FLUKE) - BITHIONOL BURN PTS - MAFENIDE, OR SILVER SULFADIAZIME DRSG. neveripine - nnrti, great for vertical transmission of HIV - can cause fulminant fatal hetatitis. monitor LFTs. Protease Inhibitors - reedistribution of fat -----(indinavir - nephrolithiasis - push fluids) flagyl - peripheral neuropathy, metalic taste, DIISULFIRAM LIKE RXN. diloxanide furoate - FLATULENCE (liminal ameba) toxoplasmosis doc - pyremethamine / sulfadiazine (slide 70 baskar review) Sodium stibogluconate**** DOC for leshmeniasis ovale and vivex eradication -primaquine

high dose chloroquine - cinchonism / retinopathy quinine / quinidine IV - chloroquine resistant malaria / cerebral malaria mefloquine - psychiatric problems / not for kids (<15kg), prolong QT artemisinin - free radicals (no resistance) primaquine - eradicate liver stage - look for G6PD -ivermectin - mazotti like reaction - give steroids diethyl

MECHANISM OF ACTIONS 1. PENICILLIN - BIND PBP AND INHIBIT CROSS LINKING (TRANSPEPTIDATION) OF BACTERIAL CELL WALL 2. CEPHALOSPORINS - BIND PBP AND INHIBIT CROSS LINKING (TRANSPEPTIDATION) OF BACTERIAL CELL WALL 3. AZTREONAM - SAME AS PEN / CEPHS 4. CARBAPENEMS - SAME AS PEN / CEPH - BETA LACTAMASE RESISTANT BUT NOT METALLO-B-LACTAMASE RESISTANT 5. VANCOMYCIN - BINDS D-ALA D-ALA AND INHIBITS TRANSGLYCOSYLATION THUS PREVENTING ELONGATION AND CROSSLINKING OF CELL WALL 6. AMINOGLYCOSIDES - BINDS 30S RIBOSOMAL SUBUNIT PREVENTING THE FORMATION OF INITIATION COMPLEX (STATIC) AND CAUSES MISREADING OF CODE (CIDAL) 7. LINEZOLID - BINDS 50S, BLOCKS INITIATION COMPLEX (70s formation) 8. TETRACYCLINE - BINDS 30S AND BLOCKS ATTACHMENT OF tRNA AT ITS ACCEPTOR SITE (AA INCORPORATION) 9. DALFOPRISTIN / QUINAPRISTIN - BINDS 50S AND BLOCKS THE ATTACHMENT OF t RNA AT ITS ACCEPTOR SITE (AA INCORPORATION) 10. CHLORAMPHENICOL - BINDS 50S, INHIBITS PEPTIDYLTRANSFERASE THUS PREVENTS PEPTIDE CHAIN ELONGATION 11. MACROLIDES - BINDS 50S AND BLOCKS TRANSLOCATION OF PEPTIDYL tRNA FROM ACCEPTOR TO DONOR SITE (translocation step) 12. CLINDAMYCIN - SAME AS MACROLIDES 13. QUINOLONES / FLUOROQUINOLONES - INHIBIT BACTERIAL DNA SYNTHESIS BY INHIBITING BACTERIAL DNA TOPOISOMERASE II (DNA GYRASE) AND TOPOISOMERASE IV

14. SULFONAMIDES - BLOCK BACTERIAL DNA SYNTHESIS VIA FOLATE BY BLOCKING DIHYDROPTEROATE SYNTHETASE. (PABA ANALOGUES) 15. TRIMETHOPRIM - BLOCKS DIHYDROFOLATE REDUCTASE 16. ISONIAZID - BLOCKS MYCOLIC ACID SYNTHESIS VIA INHIBITING THE ENZYMES RESPONSIBLE FOR THE CELL WALL PRODUCTION. KATG GENE --> CATALASE PEROXIDASE ENZYME ---> ISONIAZID ACTIVATION 17. RIFAMPIN - BLOCKS DNA DEPENDANT RNA POLYMERASE, THUS BLOCKS THE INITIATION OF RNA SYNTHESIS (NUCLEIC ACID SYNTHESIS INHIBITOR) 18. PYRAZINAMIDE - UNKOWN MECHANISM 19. ETHAMBUTOL - INHIBITS ARBINOSYL TRANSFERASE, THUS HAMPER THE SYNTHESIS OF ARABINOGLYCAN (COMPONENT OF MYCOBACTERIAL CELL WALL. 20. STREPTOMYCIN - AMINOGLYCOSIDE (30S) INITIATION COMPLEX 21. DAPSONE - INHIBIT DIHYROPTEROATE SYNTHASE SIMILAR TO SULFONAMIDES (LEPROSY) 22. AMPHOTERICIN B -POLYENE THAT BINDS / INTERACTS WITH ERGOSTEROL OF FUNGAL CELL WALL AND CAUSES PORE FORMATION 23. NYSTATIN - TOPICAL POLENE - SAME MOA AS AMPHOTERICIN B 24. FLUCYTOSINE - GIVEN WITH AMPHOTERICIN B (SYNERGY) - IS CONVERTED TO FdUMP WHICH INHIBITS THYMIDYLATE SYNTHETASE, THUS INHIBITS DNA SYNTHESIS. (CAUSES BONE MARROW SUPPRESSION IN HUMANS) 25. KETOCONAZOLE (AZOLES) - INTERFERES WITH ERGOSTEROL SYNTHESIS. 26. GRISEOFULVIN - BINDS MICROTUBULES AND PREVENTS SPINDLE FORMATION THUS INHIBITING MITOSIS (FUNGAL) 27. TURBINAFINE - INHIBITS FUNGAL SQUALENE EPOXIDASE THUS PREVENTING THE FORMATION OF ERGOSTEROL (HIGH LEVELS OF SQUALENE IS ALSO TOXIC TO THE FUNGAL CELLS) 28. CASPOFUNGIN - INHIBITS FUNGAL CELL WALL SYNTHESIS 29. ACYCLOVIR --> ACYCLOVIR MONOPHOSPHATE (BY VIRAL TK) ---> DIPHOSPHATE---> ACYCLOVIR TRIPHOSPHATE(active) (BY HOST KINASES). ACYCLOVIR TRIPHOSPHATE INHIBITS VIRAL DNA POLYMERASE AND WHEN INCORPORATED INTO THE DNA --> DNA CHAIN TERMINATOR. 30. VALACYCLOVIR - PRODRUG (TO INVCREASE BA) OF ACYCLOVIR 31. GANCYCLOVIR - ACTIVATED BY PHOSPORYLATION OF VIRAL ENZYME PHOSPHOTRANSFERASE (UL97) AND INHIBITS CMV (immunosupression) 32. VALGANCYCLOVIR - PRODRUG FOR GANCYCLOVIR 33. FOSCARNET - INORGANIC PYROPHOSPHATE THAT INHIBITS RNA POLYMERASE AND HIV REVERSE TRANSCRIPTASE (USED IN GANCYCLOVIR RESISTANT CMV**) 34. AMANTADINE / RIMANTADINE - INHIBITS M2 PROTEIN PROTON ION CHANNEL THUS VIRAL UNCOATING OF INFLUENZA A

35. OSELTAMIVIR / ZANAMIVIR - NEURAMINIDASE ENZYME INHIBITOR OF INFLUENZA A AND B, THUS INHIBITS VIRAL REPLICATION AND RELEASE. 36. RIBIVARIN - PHOSPHORYLATED TO TRIPHOSPHATE FORM AND INHIBITS RNA DEPENDENT RNA POLYMERASE. (tx of RSVbronch / pneumonia) 37. NUCLEOSIDE REVERSE TRANSCRIPTION INHIBITORS (NRTIS) PHOSPHORYLATED DRUG COMPETITIVELY INHIBITS HIV-1 REVERSE TRANSCRIPTASE (RNA DEPENDANT DNA POLYMERASE) (lactic acidosis / hepatomegaly) 38. NON NUCLEOSIDE REVERSE TRANSCRIPTION INHIBITORS (NNRTIS) SYNERGIST TO NRTIS, NON COMPETITIVE, NOT PHOSPHORYLATED, NOT USED IN MONOTHERAPY - CAN CAUSE STEVENS-JOHNSON SYNDROME 39. PROTEASE INHIBITORS - (VIRS) - INHIBITS HIV PROTEASE ENZYME. THIS ENZYME CONVERTS PRECURSOR PROTEINS TO FINAL ACTIVE VIRAL PROTEINS. (NO MONOTHERAPY) 40. HIV INTEGRASE INIHIBITOR - BLOCKS HIV INTEGRASE ENZYME THUS VIRAL DNA CANNOT INTEGRATE INTO HOST DNA - PREVENTS HIV INFECTING NEW CELLS. GIVEN IN ++ RESISTANCE TO OTHER DRUGS 41. FUSION / ENTRY INHIBITORS BLOCK VIRAL ENTRY INTO CD4 CELLS - GIVEN IN ++ REFRACTORY HIV (blocks CCR5 receptors) 42. INTERFERONS - INHIBIT VIRAL TRANSCRIPTION, TRANSLATION, PS AND MATURATION. - MC ADVERSE EFFECT - ACUTE FLU LIKE ILLNESS 43. CHLOROQUINE - INHIBITS HEME POLYMERASE - THUS ACCUMULATION OF FREE HEME in food vacuoles WHICH IS TOXIC TO PARASITES (RESISTANCE MUTATION IN PfCRT TRANSPORTER EFFLUXES THE DRUG FROM PARASITE) 44. BENZIMIDAZOLES (ANTIHELMINTHICS) - DAZOLES - INHIBIT THE POLYMERIZATION OF TUBULIN DIMERS THUS NO MICROTUBULES, INHIBIT NEMATODE GLUCOSE UPTAKE. 45. PYRANTEL PALMOATE (ANTIHELMINTHIC) - DEPOLARIZING NEUROMUSCULAR BLOCKADE IN (SPASTIC PARALYSIS) OF NEMATODE 46. PIPERAZINE CITRATE - PARASITIC PARALYSIS BY BLOCKING ACH AT NMJ 47. IVERMECTIN - ENHANCE GABA MEDIATED TRANSMISSION AND CLPERMIABILITY - PARALYSIS. 48. PRAZIQUANTEL - INCREASES CALCIUM PERMIABILITY - CONTRACTURE /PARALYSIS OF MUSCLE - DEATH. 49. DIETHYLCARBAMAZINE - MODIFY SURFACE PROTEINS AND DISPLACE FROM TISSUES - PARASITE THEN MORE SUSCEPTIBLE TO HOST IMMUNITY.

Infection

DRUG OF CHOICE

Backup Drug If Methicillin resistant staph aureus: treat with VANCOMYCIN (although carbapenems are broad spectrum antibiotics, they are ineffective against MRSA) If VANCOMYCIN resistant staph: treat with Linezolid, Quinupristine/ Dalfopristine

Other Special Cases

Staphylococcal Antistaph penicillins: Infection Nafcillin, Cloxacillin Methicillin (not used)

Gonococcal Infection

Ceftriaxone: Single I/M injection

Ciprofloxacin

Toxoplasma Gondii

Pyrimethamine + sulfadiazine

Spectinomyci n: for patients who are allergic to penicillins/cephal osporins, who are infected with Fluoroquinolone resistant gonorrhea Spiramycin: During the first trimester of pregnancy

Legionella (Legionairres Disease Pneumonia) Lysteria monocytogene s

Azithromycin

Fluoroquinolones (Cipro/Levo/Ofloxacin ) Co-trimoxazole is also effective in treating septicemia and meningitis caused by Listeria Cephalosporin s NOT effective (remember LAME)

Ampicillin (IV) : (given along with Aminoglycoside for synergy)

Actinomycosis Penicillin G Haemophilus For Non-beta lactamase producing H. Influenzae: influenzae Ampicillin Beta-lactamase producing (around 30%): Amoxicillin + Clavulanic acid

Beta-lactamase producing (around 30%): Ceftriaxone/cefotaxi me Or Azithromycin/Clarithr omycin Or FQs (Cipro or Levo) (not in pregnant women and children) Backup Drug Other Special Cases

Infection

DRUG OF CHOICE

Pseudomonal Infections

Piperacillin/tazobact am, Ticarcillin/clavulanic acid Aztreonam (monobactam) : when the patient is allergic to penicillins

Ceftazidime/cefopera zone/cefipime Imipenem/cilastatin, Meropenem Aminoglycoside: Tobramycin, Amikacin, Gentamicin (betalactam antibiotics are usually administered along with AGs for synergistic effect and to prevent resistance development Ciprofloxacin/Levoflo xacin/Ofloxacin Azithromycin (Single dose treatment for Cervicitis, Pelvic inflammatory disease; alternative to Erythromycin) Ofloxacin (not in pregnant lady)

Chlamydial Infections

Doxycycline Erythromycin: drug of choice when the patient is pregnant

Anthrax

Ciprofloxacin

Doxycycline Amoxicillin Gentamicin Doxycycline: for Prophylaxis

Plague

Streptomycin given With Doxycycline Streptomycin

Tularemia

Gentamicin Doxycycline (alternative)

Corynebacteri Antitoxin Rifampin/clindamyci um Diphtherae Procaine Penicillin G/ n Erythromycin (to eradicate the carrier state) Pertussis Whooping Cough Macrolides (Erythromycin/Clarithro/ Azithro) For macrolides allergic patients: Cotrimoxazole

Clostridium Perfringens and Tetanus

Penicillin G + Clindamycin

In tetanus: Tetanus toxoid Anti-tetanus serum Backup Drug Vancomycin Other Special Cases

Infection

DRUG OF CHOICE

Clostridium Metronidazole difficile (Pseudomembr anous Colitis) Syphillis Penicillin G (Treponema Doxycycline (If the pallidum) patient is allergic to penicillins; but not in pregnancy) Enterococcal AGs (Genta/strepto) Infections + Ampicillin AGs (Genta/strepto) + Vancomycin

Erythromycin (If the patient is allergic to penicillins; but no longer recommended ) For VREs (Vancomycin resistant Enterococcal infection) Linezolid Quinupristine/Dalfopr istine Ciprofloxacin Chloramphenicol Azithromycin/clarithr omycin FQs (Levo/Gati/Moxi)

During pregnancy in pen sensitive patients, desensitizatio n is recommended

Rickettsia Mycoplasma

Doxycycline Doxycycline or Erythromycin