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Angiotensin II Receptor
Blockers/ARB's (end in Block AII type I
"-sartan"; Losartan, receptors → ↓ ↑ bradykinin →
Valsartan, Irbersartan, aldosterone relaease angioedema
Candesartan, and vaeesel relaxation
Telmisartan, Eprosartan)
Aldosterone Receptor
Blocker (Spironolactone,
Eplerenone)
Sympathoplegic Agents
CNS α2 Agonists; Ganglionic Blockers; Neurotransmitter Depletors; α, β, Blockers
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
some orthostatic
hypotension; Dry Mouth,
α2 Agonists (Clonidine, Drowsiness, Depression;
Guanabenz) Sexual Dysfx; Withdrawl
Supersensitivity;
Pseudotolerance
Orthostatic
Ganglionic Blockers Hypotension; Sexual
Vasodilation w/o
(Trimthapham ↓ HR, VR, TPR, CF Dysfx; Paralytic Ileus, none :)
reflexes (cool)
Camsylate) Urinary Retention (esp
old men)
Reserpine: Suicide,
depression, ↓
sypmathetic action.
Guanethidine:
Retrograde
Sympatholytic Agents Ejaculation. Orthostatic OTC decongestants; pts
Reserpine is cheap
(Reserpine, Deplete adrenergic Hypotension, Fluid w hypokalemia (b/c
↓ HR, VR, TPR, CF and effective but as
Guanethidine, neurotransmitters Retention, Sexual Dysx; diarrhea causes K loss);
HORRIBBLE SDFX
Guanadrel) Parasympathetic Reserpine depression
Predominace (Nasal
Stuffiness, GI acid
secretion, Diarrhea,
Bradycardia);
Supersensitivity
pts using
α blockers (Doxazosin, Doxazosin were
end in "-sin") 25% more likely to
have hrt falu
↑ K channel efflux → ↓
Hydralazine SLE esp in excitability → ↓ arterial
Vasodilators ↓ TPR Hydralazine
slow acetylators ≤ reactivity/constriction; ↑
(Hydralazine, Minoxidil, Minoxidil Diazoxide: ↓ Nitroprusside (IV
200mg/day, Rapid Drop blood volume, ↓ in Angina
Diazoxide; TPR and VR only); Others oral
in TPR → angina; venous capcitance; ↑
Nirtoprusside)) Nitroprusside
Minoxidil Hair growth TPR, ↑ HR, ↑
contractility
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
constipation,
Hypotension, some HA,
Phenylalkylamine β blockers; Cardiac
Peripheral Edema (no
(Verapamil) Failure
RE to diuretics), AV
block, some CHF
a little hypotension, considered the
Benzothiazipine
peripheral edema, AV OK to use w β blockers safest Ca channel
(Diltiazem)
block (nyeh) blocker
Hypotension, HA, highest affintiy x
Dihydropyridines Peripheral Edema w β blockers → ↓ HR sublingual, short heart of other Ca
Tachycardia β blockers
(Nefedipine et al) (does not RE to THIS IS BAD! duration chnl blkrs; good in
diuretics) ER situation
All antihypertensive mx cause ↑ in RAAS (via: ↓ BP and CO → ↓ blood flow to kidney → ↑ RAAS), ↑ chance of Orthostatic Hypotension (via ↓ contractilty, volume or CF).
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Reduces esterificationof
TG in liver, May reduce
hepatic cholesterol
formation, Reduces Flushing, Pruitis
VLDL, TH and LDL, ↑ (itching), Abdominal
Poor pt
HDL, Effective vs pains, Dyspepsia Peptic Give w Aspirin; Use
Nicotinic Acid/Niacin Inhibits adipose Lipase compliance; Use in
Hyperlipidemia Types II- ulcers (at first), Hepatic in pts w ↑ ↑ TGs
pt w ↑ ↑ TGs
V, Cho-ol levels reduced dysfx (jaundice, ↑
≈ 25% @ 3gm/day. ↓ transaminase levels)
clotting via ↑ tissue
plasminogen factor and
↓ plasma fibrinogen
↑ extrahepatic
lipoptotein lipase (LPL),
Indicated x pts w
↓ aplopotrotin syths, ↓
TG>750 mg/dL;
serumTG, ↓ VLDL, kinda Use x pts w TH
↓ serum TG, ↑ esp good x Type III
↑ HDL; ↓ plasma >750mg/dL, esp
extrahepatic LPL, ↓ w Statins = ↑ chance of hyperlipidemia; Not
Fibrates (Gemfibrozil) fibrinogen levels :: Type I hyperlipidemia good if pt is Type III
aplipoprotein synths, ↑ Rhabdomyolysis good x pts w Type
Gallstones, ↑ chance of (elevated IDL)
HDL? I; Ppl use x ↑ in
arrythmias, Nausea, phtyp
surviival w/o
Cramps, Bleeding due to
evidence.
↓ platelet adhesiveness
→ bleeding
Chlestipol &
Colesevelan are
Binds bile acid which are Absorbs other drugs as
newer and more
Bile Acid Sequestrants precursors to cholesterol Major Constipation, well as bile acids so Stagger
↓ LDL, Not absorbed in potent w less SDFX
(Cholestyramine, which shifts bile acid impaction, abd cramps, Cholestyramine will also administration of
GI tract, and help ↓ CHD
Colestipol, Colesevelan) prodx instead of Hemrrhoid aggrevation bind vitamins, digoxin other drugs
mortality and ↓
cholesterol etc
major coronary
events
Diarrhea, Hepatic
↓ cholesterol absorption
Cholesterol Absorption insuffx; These SDFX are
from guy → ↓
Inhibitor (Ezetimibe) mild/more tolerable vs
cholesterol, ↓ TG
BASeqeuestrants
Good Compliance
inhibit HMG CoA Works in liver, ↓
HMG CoA Reductase Myalgias, NEVER USE IN but Expensive;
Reductase → ↓ cholesterol, ↓ LDL, ↑
Inhibitors ("Statins") rhabdomyolysis (rare) PREGNANT WOMEN Must Perform LFT
cholesterol synths HDL
bf and after tx
ANTICOAGULANTS
Antithrombotics
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Aspirin is used to
help prevent
thrombus
Stroke, Hemorrhage,
formation; used to
Aspirin Bleeding, GI Distress,
help prevent 2nd
ulcers
stroke. NOT useful
to prevent 1st
seizure
Used during
invasive cardiac
GP Iib/IIIa Inhibitors IV ONLY
procedures CABG,
PTA
Inhibit fibrinopen
receptor on platelets to Bleeding, immune
ABCIXIMAB GP Iib/IIIa Inhibitors IV ONLY
inhibit fibrin binding and reaction
scaffold forming
Inhibit fibrinogen
receptor on platelets to Bleeding immune
EPTIFIBATIDE GP Iib/IIIa Inhibitors IV ONLY
inhibit fibrin binding and reaction
scaffold forming
Inhibit fibrinogen
receptor on platelets to
Tirofiban GP Iib/IIIa Inhibitors Bleeding, IV ONLY
inhibit fibrin binding and
scaffold forming
↑ Warfarin activity if in
conjunction w
Reduced vit K is crucial
Cimetidine (OTC H2
x turning Preprothrombin
blocker) via ↓ warfarin
into Prothrombin thus
metabolism, w
the Ca++ on gamma
Phenylbutazone via ↓ Oral (good good
Carboxyglutamic acid
binding to prots, w pregnant women thing) w 100%
can't bind FIIa or FIXa to cyto 450
Stops the reduction of vit Aspirin = ↓ Platelet fx:: ↓ (crosses BBB and bioavailability.
Warfarin/Coumadin the platelets. -wiki; metabolization;
K. Warfarin activity if in causes fetal death birth Dose is calculated
Warfarin is used to tx binds to prots.
conjunction w defects) by finding INR PT
A fib, Prevent
Cholestyramine due to ↓ so that PT ≈ 2.
Thromboemboli stroke,
absorption,
acute MI, Venous
Phenobarbital by
Thromnosis and
inducing cyt450, w
Pulmonary embolism.
Phenytoin by inducing
cyt450
How to treat SDFX: Mild bleeding w dose Reduction; Severe Bleeding w stopping regimen and give Vit k; BAD bleeding via all of the above w concentration or plasma
Thrombolytic Agents
Dissolve clots by activating the conversion of plasminogen to plasmin that hydrolyzes fibrin. Therapeutic window 2-6 hrs after ssx usu IV
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Bleeding
Thereapeutic window 2-
(antidote=AminoCaproic t1/2=23 mins; NOT
Streptokinase Activates Plasminogen 6hrs after ssx. Used x Thrombo-Embolic Stroke IV ONLY
Acid), Immune Rxn, an enzx
DVT, Acute MI
Fever, Anaphylaxis
Thereapeutic window 2-
6hrs after ssx. Used to
tx MI (not better vs
Alteplase repidly streptokinase),
Tissue Plasminogen activates plasminogen Thromboembolic
Activator (Alteplase, bound to fibrin Strokes(not that great); GI and intracranial
IV
Reteplase, inthrombus (low affinity Alteplase is good @ bleeding
Tenecteplase) for free plasminogen); treating MI (90 min
Urokinase window), Massive
pulmonary embolism,
Ischemic stroke (3 hr
window)
Thereapeutic window 2-
Desmoteplase
6hrs after ssx. IV
inhibits plasminogen maybe intravascular
Aminocaproic Acid Used to tx bleeding
activation thrombus
HSS, Dyspnea,
Protamine Sulfate antagonizes heparin Used to tx bleeding
Flushing, Bradycardia
Vitamin K Used to tx bleeding
Antianginal Drugs
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Bronchospasm (esp
maybe: ↑ LVEDV → ↑
nonselectives), Heat
Heart size → ↑ duration
β Blockers (Nadolol, failure, Bradycardia, AV
Use to tx Effort angina of systole → ↓ coronary
Propranolol, Timolol, ↓ HR & CF → ↓ CO & Block, Peripheral
and Acute MI. Not that perfusion → ↓ O2
Atenolol, Bisoprolol, MVO2 Vascular Disese,
great x Variant angina delivery → ↑ O2 demand
Metoprolol) Raynaud's, Depression,
→ reflex ↑ CF or HR.
"Vivid" dreams, Sexual
damn…
Dysfx.
Used to tx Prinzmetal
block voltage gated Ca Ditiazem - AV block,
angina; Effort angina Coronary
channels esp in aa>>vv; Hypotension; Verapamil
refractory to NO's/ β Vasodialtion - D, V,
Verapamil - ↓ HR, CF - Hypotension, HA,
Calcium Channel blockers, or pts w bad Nifedipine has ↑ Oral, prot bound, N); Peripheral
TPR and ↑ coronary Periph Edema, only Ditiazem is safe to
Blockers (Verapamil, SDFX to β blokrs and contractility and ↑ HR as No Orthostatic Vasodilation - N, V;
flow; Ditiazem - ↓ HR Constipation, AV block, use w β blockers
Ditiazem, Nifedpiine) NO's. Only Verapamil reflexes Hypotension Contractility - N ↑
TPR & coronary flow; CHF; Nifedipine -
and Ditiazem are (reflex), V ↓; HR - D
Nifedipine - ↓ TPR & ↑ Hypotension, HA, Perip
indicated x pure effort ↓, N ↑ (reflex) , V ↓
coronary flow Edema
angina.
Aspirin
Thromblytics
Fatty Acid Oxidation
Ranolazine
Inhibitor (pFOXI)
Effort angina + HTN? Treat w Ca Channel Blockers or β blockers. Effort Angina + Asthma/COPD? Treat w Ca Channel Blocker. Variant angina + HTN + Sinus Bradycardia? Treat w Nifedipine
Antiarrhythmic Agents
Class I Na Channel Blockers (Impede Diastolic Depolarization at some point?)
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Fever, Rash,
AntiNuclrAntibodies, K
channel blocking, widen
↑ upstroke of AP
QRS cmplx, widen QT ↑ toxicity w Amiodarone No evidence shows
bind to open/active Na duration (APD); ↓ K flow;
Ia Procainamide intervals; ≈ 20% Cimetidine Ranitidine IV it works. Ia and Ic
channel ↑ phase 2, and AP
converted to NAPA in Procaine kill ppl.
depolarization
liver so watch x NAPA
toxicity, Lupus in slow
acetylaters
All Class I antiaryhthmics ↓ Excitability, Responsiveness, and ischemia; also, by ↑ phase 2 they stop the cells from becoming prematurely "ready"/primed? for another contration. (except for lidocaine). Quinidine (Ia) just tells
all the cells to STFU so it can reset the rhythm
Class II - β Blockers
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Bronchospasm, Hrt
Failure, Bradycardia AV
Non-selective Propanolol - use x Block, Raynauds,
(Propanolol, Sotalol, Atrial Depression, Sex Dysfx:
Timolol) Tachyarrhythmias see above*: Sotalol may
cause Torsades de
Pointes
Atenolol DOC x
something; ↓ Esmolol is new It
Cardio-Selective automaticity by ↓ SAS; ↓ looks like Ach,
(Atenolol, Metoprolol, SAS related blocks the AV node
Esmolol) responsiveness of and then is
ischemic tissue; ↓ AV destroyed.
nodal conduction
ISA (Acebutolol)
α & β blockers
(Labetolol)
Class II - β Blockers are GREAT x Tachyarrhthmias
Class III K+ Blockers
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Pulmonary Fibrosis
(fatal), Irreversible Liver
damage, Constipation,
Good x ischemic tissue bluish discoloration, w β blocker → inhibition
Delays repolarization;
Amiodarone (also Ia Na and during V Tachy to thyroid dysfx (from I's) of both; w α blocker → ↓
marked ↑ in APDuration Has a 30 day half
channel blocker and Ca slow down excitability Hz yellow discoloraton of conduction velocity in all
and ERP (effective life (bad)
channel blocker) by ↑ prolonging AP eyes, Torsade de cardiac tissue; ↑ Toxicity
refractory period)
duration Pointes Fatal arrhthmias w Procaine
but these are rare. Life
saving prop's far
outweigh.
Torsades de Pointes;
Prolongs QT interval
Ibutilide use x A Fib/Flutter;
when acting as K
channel blocker
use x Atrial
Torsades de Pointes,
Dofetilide Tachyarrhythmias, A orally BID
Prolongs QT interval
Fib;
Sotalol (oooh also a β use x Atrial
Torsades de Pointes
blocker) Tachyarrhythmias
Class IV Ca Antagonists (Nifedipine Is NOT an Antiarrhthmic agent)
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
↓ SA automaticity; ↓ AV
use x Atrial Don't use w Propranolol
Verapamil nodal conduction AV SA Dysfx, Asystole
Tachyarrhythmias or Disopyramide
velocity
↓ SA automaticity; ↓ AV
Diltiazem nodal conduction
velocity
Not Nifedipine Not Nifedipine Not Nifedipine Not Nifedipine Not Nifedipine Not Nifedipine Not Nifedipine Not Nifedipine Not Nifedipine
Class V Cardiac Glycosides
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Torsades de Pointes - Stabilize w MgSO4 (DOC) remove causative agents (eg quinidine, amiodarone), give K to ↑ serum K lvls to 5+/- .5mEq/L
Paroxysmal Ventricular Tacnycardia (PVST) - DOC is Adenosine
Beta Lactam Antibiotics
Penicillins
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
no metabolism, drug
Anaphylaxis (immediate, Oral contraceptives lose excreted in the urine; picks
cell wall synthesis inhibitor destroying, drug can't
accelerated, delayed), epilepsy, activity if + PNC b/c gut bact up protein at lactam ring
GENERALLY @ transpeptidase enzx; Staph Strep?? penetrate, mutation,
nephritis, hematuria, hemolytic activate BCPs; lose activity if creating a hapten leading to
activation of autolytic enzx bioch indux, conjgx,
anemia (rare), GI, incr Na+ + TTCCL allergic rxn
transdx, transposition
Penicillin A
Penicillin F
combine w Probenicid (weak
acid) to compete for
excretion; Add procain
Narrow (charged) to decrease short T1/2 (<60 mins), renal injection b/c not acid
Penicillin G
Spectrum G+ absorption and incr T1/2; add excretion stable
phenoxyacetic acid to make
acid stable and thus available
orally
Narrow
Penicillin V penicillinase penicillinase oral
Spectrum G+
B lactamase
Narrow
Methicillin not used all too much staph aureus Nephrotoxic resistant :-); staph oral
Spectrum
aureus…damn
Ampcl+Sulbactam (B lactamx
penicillinase; NOT active
created to overcome the Broad inhibtr) x incr efficacy; BCP
Ampicillin shigella vs Klebsiella or oral
Narrow Spectr of PNC G Spectrum lose contraceptive activity w
Pseudomonas
Ampcln
Cephalosporins
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
More toxic vs PNC esp 1st gx;
same as PNC, cell wall
Broad (proteus, E. coli, irritation at IM inj site; Synergistic w other less susceptible to B
GENERALLY synths inhibition, auto lysis excreted in the urine cross rxn w PNC allergy oral?
Spectrum klebsiella) thrombophlebitis @ IV; nephrotoxc drugs lactamase vs PNC
induction, and …
hypersensitivity; superinfx;
AntiFolates
Sulfonamides
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
5aminocyclocyclic acid is
sulfasalazine Reum. Arth, colitis
cleaved off (active part)
Inhibit folate synths
Acute Lymph Leuk,
(Folate to FH2; or FH2 to GI ulcers, bone marrow
choriocarcinoma, Burkitts treat toxicites w folinic
THF4) | Cancer-MTX depression, hepatic toxicity, HA,
lymphoma, Psoriasis, pregnant fem, fem trying to acid (cancer) or folic
Methotrexate large molec antifolate cancer forms complx w pulmonary, renal,
immunosuppres (x organ get preg. acid (psoriasis RA); IM,
polyglutamate and is pseudolymphoma. (Tx x toxicity
transplants). TOO IV, IT
trapped inside cell to incr = Folinic acid or folic acid)
TOXIC x antibact
activity
metablized to
Prontosil Sulfonamide sulfanilamide (active prodrug
cmpd)
incr [creatine], StvJonSSX,
UTI, prostatitis,otitis
Slufamethoxazole/Trimet displaces drugs bound to
Bactrim (Septra) media, shigella, AIDS
hoprim combo plasma prot causing incr lvls
toxoplasmosis
e.g. warfarin
b9 defx, macrocytic
inhibit dihydrofolate suppression of chlorq normochromic anemia,
plasmodia,
Pyrimethamine small molecule antifolate reductase inhibiting folate resist falciparum sp usu megaloblastic bone marrow; synergism w sulfa drugs oral
sporozites
synths in combo w other TB mx leukopenia, granulocytopenia
rare StvJonSSX
inhibit dihydrofolate
Trimethoprim small molecule antifolate reductase inhibiting folate NVD synergism w sulfa drugs prodrug oral
synths
DNA gyrase -
Cinozacin topoisomerase II (G-) or IV
(G+)
Fluoroquinilones
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
STD, TB (2ry), SSTI, GI, cartilege growth inhibition Liver metabzd, Excreted in
urine/bile (depends on better than sulfa
GENERALLY mycobacterium infx; (in children), cardiac arrythmias, children, preg Fem
which) acid pH decr activity, drugs
better than sulfa drugs crystalluria (drink lots of water) rapidly absorbed,
Mycoplasma
pneumonia, Legionella, ERTHX + Clindamycin is
Diphtheria, also used to antagonistic; ERTHX + PNC
Induced resistance, 50S
G+, tx bacterial bronchitis, estolate form - cholestatic = syng renal damage; decr must coat tablet to
Binds to 50S ribosomal ribosome mutation, efflux
Bacteriostatic otitis media, hepatitis (GI pain, cytochrome P450 activity protect it from stomach
subunit, inhibits concentrated in the liver, pumps, hydrolysis/destrx
Erythromycin Macrolides (cidal @ high acne(topical). Prophylax hepatomegaly, incr bilirubin, so other Rx/herbs have Liver/kidney damage pH, so it dissolves in
translocation step and bile excretion of Rx; cross resistance to
doses but w endocarditis colon/oral eosinophlia; reversible); free more activity duodenum; good body
inhibsc cmplx formation other macrolides and
toxicities surgx [2ry Staph Strep, (active) form- N/V/D Chloramphenicol+Erythromyc distr
clindamycin
tetanus, chlamydia, lyme; in=antagonism by 50S
some G- N. Meningitidis, competition
H. flu, B. pertussis]
(mycobacterium avium,
Binds to 50S ribosomal
Toxoplasmosis
Broad subunit, inhibits
Azithromycin Macrolides encephalitis, chlamydia
Specturm translocation step and
urethritis) Erythromycin
inhibsc cmplx formation
1st
anaerobic infx
G+,
(bacterioides fragiles),
Bacteriostatic Pseudomembaranous cross resistance w
50S inhibition, strep pyogenes, diplo antagonize metabzd in liver, excreted
Clindamycin Lincosamides (cidal @ high enterocolitis (can be fatal so erithromycin, ribosomal oral (w or w/o food :-)
translocation inhibition pneumoniae, staph macrolides/erythromycin by kidneys
doses but w change to vancomycin) mutations
aureus; 2ry choice if
toxicities
allergic to PNC
Broad
30S inhibition previnting t- oral not so good
Minocycline Tetracycline Specturm G+, Lyme teeth discoloration not good for UTIs
aminoacyl binding absorption, IM/IV
G-
not good for UTIs;
Carbamazepine + doxy =
Broad
30S inhibition previnting t- decr doxy lvls via induction;
Doxycycline Tetracycline Specturm G+, Lyme teeth discoloration oral good absorption
aminoacyl binding PHB + doxy = decr levels via
G-
induction; PHT + doxy =
ditto;
Broad
Tigecycline (not 30S inhibition previnting t- Do NOT use to tx
Tetracycline Specturm G+, ssti, intra-abdominal infx GI, N/V/D IV ONLY
important) aminoacyl binding Proteus/Pseudomonas
G-
superinfx, hypersensitivity,
irreversible delayed aplastic not good w TTCCL,
prevents 50S from binding Salmonella typhosa liver glucuronidation or
anemia Gray Baby SSx (renal Polymyxin B, vancomycin,
to mRNA, inhibits (rickettsia, mycoplasma, hydroxylation inactivates,
Broad damage, cardiac collapse), hydrocortisone b/c of R factor transmits gene
Chlorapmphenicol peptidyltransferase (also lymphogranuloma). NOT inactive drug excreted by lower dose if liver disease oral
Spectrum good diffusion to CNS, and antagoinism; x acetylation
inhibits euka cells w diff USED FOR TRIVIAL kidny, incr plasma lvls if
inner eye (good thing), Chloramph+Erythromycin=an
mechanism) INFX liver disfxing
pancytopenia (rare/severe), GI, tagonism by 50S competition
neuro sdfx, superinfx,
Aminoglycosides
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
Kanamycin 2ry TB
E. coli, Proteus,
Shigellae,, Klebsiella; NOT effective x
Broad Nephrotoxic ototoxic, contact
Neomycin Aminoglycosides prophylactic x bowel Pseudomonas or topical oral x gut infx,
Spectrum dermatits
surgx (staph Bacterioides
enterocolitis)
Tobramycin Aminoglycosides bacteremia
Parommycin Aminoglycosides
VR E. faecium,
bactremia, URI caused
joint muscle pain, decr R factor transmits binding
Quinupristin streptogramin G+ 50S inhibitor by MRStaph/Strep PNC combo drug w Dalopristin oral
cytoP450 site mutation
resistant Strep
pneumoniae
multi-drug resistant
Linezolid Oxazoladinone G+ GI, HA, MAOI inhibition poor people
organisms
Netilmycin Oxazoladinone
Antifungal Drugs
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
Polyenes
Candida albicans;
Moniliasis (oral or topical)
(Cryptococcus,
none unless given systemically
binding to ergsterol Histoplasma, topical, oral (excreted
yeasts and (oral - mild N/V, diarrhea; IV -
Nystatin Polyene causes cell membrane Blastomyces, N/A in feces) vaginal
fungi hemolytic anemia, kidny
leakage Trichophytion, tablets,
damage)
Epidermophyton,
Microsporum; sometimes
mycoplasma bact),
Imidazoles/Triazoles
oral/esophogeal
give antiemetic to counteract
Inhibition of ergosterol candidiasis in AIDS pts GI, vomiting. In AIDS pts -
vomiting; phenytoin lvls incr; teratogenic (don't give to
Fluconazole syths causing membr (cryptococcal meningitis; StvJon SSx, liver damage, Resistance
anticoagulant lvls incr if + preg fem)
disruption prevent relapse after thrombocytopenia, rash)
flucon
Amph B)
Squalene epoxidase
Tolnaftate Fatty acid? inhibitor (ergosterol syths Trichophyton rubrum GI topical
inhibition)
Trichophyton,
Epidermophyton,
fungicide by Squalene epoxidase HA, diarrhea, dyspepsia, abd T1/2=16 days, liver
Microsporum
Terbinafine Allylamine squalene inhibitor (ergosterol syths pain; chg in tast patterns; incr metabolizes, inactive cmpd oral, topical
(aspergillus, candida,
buildup inhibition) LFT (severe hepatotoxicity rare) excreted in feces kidny
sporothrix schenckii,
malassezia furfur)
Anti TB Drugs
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
INH + Rifampin + Pyraz +
inhibits fMet binding; Ehambutol or Streptomycin is
inhibits translocation step standard 4 Rx tx. use INH +
Ototoxicity, nephrotoxicity (all Start to see improvement of
Streptomycin Aminoglycosides 1ry (aminoacyl binding to Rifampin + pyrazinamide for all TB tx: oral;
AG do) morbidity in 2 weeks
tRNA); require O2 for (lose pyr after 2 mos); INH
transport thru cell walll +Rifam+Ethambutol is safe x
preg fem
2ry agent
ototoxicity, renal toxicity (not as
Capreomycin peptide when 1ry no
bad as AG)
longer useful
Ciprofloxacin
AntiViral Drugs
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
antimetabolite; DNA
synths inhibitor by
stopping DNA elongation;
(herpes keratitis from photosensitivity, edema causing
Idoxuridine (historical incorporated into DNA topical, (systemic-
herpes type I, if nothing lacrimal duct occlusion; slows prodrug teratogenic, carcinogenic,
significance only) causing DNA breakage, HARDLY)
else left) down healing process
muation rate incr;
selectivity due to rapid
rate of virus replication
Ganciclovir
Ribavirin
Cidofovir
Trifluridine
Foscarnet
HIV Drugs- 1PI + Ritonavir + 2NRTI (specific combo) = 4 drug Tx; or NRTI (combo)+ NNRTI = 3 Drug Tx
incorporation into DNA
damage tissue that are
causing early DNA HIV @ all stages;
constantly turning over via mt combo prodrug concerted to
Zidovudine NRTI termination and slow replx prophylaxis x exposure @ low lvls or monothpy
toxicity; lactose acidosis, liver Lamivudine+Zidovudine nucleotide
by blocking reverse and newborn
failure low platelets
transcriptase
nonompetetive inhibitor of
Efavirenz NNRTI HIV @ all stages; teratogen cytP450 indux preg fem, liver disfx @ low lvls or monothpy
reverse transcriptase
HIV @ all stages; long lasting DM, combo b/c incr T1/2 of other
inhibit final prot metabz of @ low lvls or monothpy;
Ritonavir Protease inhibitor prophylaxis x exposure hyperlipidemia, diarrhea drugs; but contraindicated if inhibits cytP450
HIV prot cross resistance
and newborn inhibits cytP450 pt taking other mx
AntiParasitic Drugs
AntiMalarial
Drug Drug Interactions
Name Class Spectrum MOA DOC Toxicities/SDFX Metabolism Contraindications Resistance Administration
or Combos
Chloroquanide
b9 defx, macrocytic
inhibit dihydrofolate suppression of chlorq normochromic anemia,
plasmodia,
Pyrimethamine reductase inhibiting folate resist falciparum sp usu megaloblastic bone marrow;
sporozites
synths in combo w other mx leukopenia, granulocytopenia
rare
b9 defx, macrocytic
inhibit dihydrofolate suppression of chlorq normochromic anemia,
plasmodia,
Trimethoprim reductase inhibiting folate resist falciparum sp usu megaloblastic bone marrow;
sporozites
synths in combo w other mx leukopenia, granulocytopenia
rare
Metronidazole teratogenic
Diloxanide furoate
Iodoquinol
Emetine
Dehydroemetine
Chloroquine
Suramin Na
Melarsoprol
Na Stibogluconate
Pentamidine
Isethionate
Nifurtimox
Quinacrine
Atovaquone
Piperazine Citrate
Thiabendazole
Mebendazole
Albendazole
Pyrantel Pamoate
Paromomycin
Praziquantel
Bithionol
Niclosamide
Quinacrine
Actinomycetes
General Features No Immune RE: b/c it's too far away. Reason for removal is
Etiology Epidemiology Manifestations
Actinomycosis-1)Cervicofacial-
most common, usu follows dental
caries and happens after trauma
2)Thoracic-pulmonary inf may be
Actionmyces israeli,
initiated by extentision or inspiration.
Propionibacterium M>F 2:1, 15-35yo, usu after loss of
Maybe spread to CNS 3)Abdominal-
propionicus, nml flora
usus due to perforation of intestinal
Actinomyces naeslundii
wall e.g. appdx rupture. ss(x) follow
infd organ. 4)Genital-common in
femms, usu w/ IUDs, ss(x) similar to
PID, usu subclinical
Actinomycetoma-SubQ inf
M>F b/c of more exposure.
1)Swollen lesion usu on foot/hand
Sub/tropical, Sudan, Mxco, usu soil
suppurating abscesses w/ grains
dwellers.
(same as eumycetoma)
Spirochetes
General Features Spiral shaped, Nonsporulating, Motile
Etiology Epidemiology Manifestations
Syphillis-1)Primary Stage-Hard
chancre nonpainful (genitals-males
cervix-fems) 2)Secondary Stage-Flu
like ssx, skin lesions, mucous
1)Modes of Inf-Passage through birth
membrane lesions 3)Latent Period
canal, infection in utero, contact
Treponema pallidum 4)Late Period/Tertiary Stage-
during manifestation, blood
Neurosyphilis:Asymptomatic or
transfusion 2)Adolescent to adults
Symptomatic-Meningovascular,
Parenchymatous (paresis, Tabes
Dorsalis). Late Benign Syph-Gumma
Formation
More Notes:
Oral Microbiology
General features Bact of supragingiva is mostly G(+) sp. Bact of subgingiva is mostly G(-) sp. Disr
Etiology Epidemiology Manifestations
Everybody everywhere is susceptible
(babies falling asleep w/ bottle, ↓
Dental Caries-Decalcification of
Streptococcus mutans, salivary rate, late weaning).
inorganic and organic portions of
Lactobacillus Brushing, Fluoride, Peridex (.12%
tooth via acids produced when bact
acidophilus chlorohexidine)etc etc. helps to
act on CHOs
prevent. ↑[L. acidophilus]≈[caries].
S. mutans main cause of oral infs.
1)Microbial-brkdwn of
epithelial wall provides
entry, G(-) rods
increase, tissue damage
1)Periodontal Disease-Gingivitis,
due to endotoxins of
Periodontitis, Periodontosis,
G(-) bact
Periodontal Abscess, Drug
2)Immunologial-allergic
induced gingival Hyperplasia,
rxn of gingiva to
ANUG, Primary Herpetic
mouthwash/toothpast,
stomatitis, Recurrent Herpetic
pemphigus vulgaris,
Stomatitis, Herpetic Whitlow,
lichen planus, neoplastic
Aphthous Ulcers, Candidiasis,
dss, carcinoma
Hairy Tongue, Dry Socket
3)Traumatic-blunt
2)Endodontic-Pulpitis
trauma, plaques,
chemical (aspirin is
caustic to epithelial
tissue)
Parasites
↓↓↓SubKingdom Protozoa↓↓↓
Etiology Epidemiology Manifestations
Trypanosoma grucie g,
Africa Tse Tse fly is vector 1)African Sleeping Sickness
rhodosaiense
More Notes
↓↓↓SubKingdom Metazoa↓↓↓
General Features Phylum ↓↓Nematodes↓↓
Etiology Epidemiology Manifestations
↓↓Class Cestodes↓↓
General Features Head w/ scolex suckers, hermaphroditic, no gut, nutrients via abos
Etiology Epidemiology Manifestations
ochetes
al shaped, Nonsporulating, Motile
Key Diagnostics Treatment Notes
NonVenereal ss(x)-Yaws,
1)Direct exam
Pinta, Bejel Dg(x) via
2)Serologic tests-
demonstration of orgsm
NonspecificTrepanoma
T(x)=PNC (or Ttrcycl or
l Rapid Plasma Reagin
Erythrmc) 2)Virulence-
for cardiolipin, ELISA,
1)PNC, 2)Ttracycln, Outer membr prots for
Specific Trepanomal
Erythromycin, 3)Jarishc adherence, hyaluronidase
(hemaggltzn assay,
Herxheimer Rxn for tissue invasion,
fluoroscein antibody
fibronectin for mimic,
tests 3)Demonstration of
antiphagocytosis (reason
orgsm via drkfld exam,
for undetectable) 3)May
silver stain, tests under
cause still born or late
"2)"
abortion
Skin to skin
Skin to skin
1)Clinical
exam-"Bullseye 1)Early Inf-Doxycycline
Can lead to debilitating
erythema"(75% of p(t)) or Amoxycilin 2)Late-
arthritis
2)Serological tests Ceftriaxone
ELISA, Immunoflrsc Ab
crobiology
of subgingiva is mostly G(-) sp. Disruption of these proportions → disease.
Key Diagnostics Treatment Notes
1)Caries excavation.
…?
Restore missing s(x)
and Bartonella
astidious (needs humidity w/ CO2) 3)Spread via sandfly Phlebotomus
Key Diagnostics Treatment Notes
1)Blood ID esp in
immcmpr pts 2)Cultures
1)Now reduced in AIDS pts
NOT helpful b/c too few None
b/c of t(x) for M tb inf
orgs available due to cell
mdtd RE
asites
om Protozoa↓↓↓
Key Diagnostics Treatment Notes
Phylum Sarcomastigaphora
20μm. 1)Flask shaped Class Sarcodina NOT
1)Metronidazole (flagyl)
ulcers in intestine commensal, Amoebic cysts
follwd by iodoquinol
2)stool samples mcrscpy can form in liver maybe
2)t(x) for carriers w/
(watery-trophozoites w/ fatal, Reportable dss in Tx
luminal amoebiasis
ingst RBC solid-cysts)-- Asexual reprodx. Cyst
iodoquinol, furamide and
not helpful after Ingestion→Stomach→HCl
paromomycin 3)Improve
dissemination 3)Ab to release trophozoites in
sanitation
testing, ELISA, PCR dudnem→Attachment to
host cell and destruction
Phylum Sarcomastigaphora
1)Exmn stool x Class Mastigaphora
trophozits (fresh smple) Cyst*chlorine resistant*
usu billions of trophzits, Ingestion→Stomach→HCl
Smple at diff time to release trophozoites in
intervals b/c neg sample 1)Metronidazole, dudnem and
≠inf, Cysts are 11μm furazolidine, quinacrine. jjnm→trophzits attach to
long commonly found in T(x) of contacts intstn villi via ventral
solid samples and suckers and absorb
survive for ≈2wks semidigstd food through
2)String test, Ab test w/ body, usu encyst in colon,
98% accuracy onset of dss b/c of intstn
inflmmtn.
Phylum Ciliaphora
1)"Nml" pt-Clindamycin
2)AIDS pt- Prevention via good
1)Ab testing, IgM (not
Pyrimethamine w/ hygiene and women
found in AIDS p(x))
Trisulfapyrimadine avoiding cat litter
3)Pregnant-Spiramycin
↓↓↓SubKingdom Metazoa↓↓↓
Phylum ↓↓Nematodes↓↓
Key Diagnostics Treatment Notes
1)Albendazole PO
1)Fem > Male 2)15-35cm
(mebendazole later to
long Creamy white Cuticle
1)Microsc ID of eggs in treat whipworm),
w/ fine circular striations
stool 2)Poor growth Mebendazole avoid
3)Adult lives in upper sm
vermifuges 2)VitA to
intest
improve growth devl't
1)Albendazole PO
1)Nocturnal observation 1)F>M 2-13cm Yellow, Fem
(mebendazole later to
2)Scotch tape test of w/ pointed tail 2)Gravid fem
treat whipworm),
anal area and view migrates to anus to deposit
Mebendazole 2)treat
micrscp for eggs eggs 3)Hygeine
whole family and school
(≈50mcrmetrs) preventative
chums
1)Eosinophilia as
1)Symptoms can occur if
hallmark of helminthe inf
p(t) put on corticostrds
2)Larva in stool 250μm 1)Ivermectin or
2)worms don't need to
orgnsm=intestinal inf Thiabendazole, but usu
leave body to finish life
600μm orgnsm=hyperinf too late by the time p(t)
cycle Can also be free
3)Larva in sputum = seeks t(x)
living 3)↑ prodx of steroids
hyperinf 4)Culture in
→ ↑ virulence
beef broth
s Class ↓↓Trematodes↓↓
uptake via absorption Nonsegmented
Key Diagnostics Treatment Notes
Praziquantel (incr cell
vaccine dev'lt against Sm
membr permeability)
eggs w/ spine in feces p80 would be nice avoids
Oxamniquine no longer
inf via surf membr renewal
available in USA
elliptoid shaped eggs in Praziquantel (incr cell
stool or vomit membr permeability)
Cestodes↓↓
aphroditic, no gut, nutrients via abosrption aka Tapeworms
Key Diagnostics Treatment Notes
1)worm inf dgx via eggs cysticercosis ingestion can
in stool 3mos post inf ID 1)Praziquantel for worm happen in populations that
of progolittid for inf. 2)Albendazole or don't eat pork. b/c a carrier
speciation 2)cystercosis- Praziquantel for can contaminate the
cysts in involved organ cystercosis 3)Surgy to nonpork meal e.g. jews
Eggs in feces Ag-Ab remove calcified cysts eating food from a dirty
tests pork eater
Ttcycl, Chloramphenicol
w/in 7 days onset
Ttcycl, Chloramphenicol
w/in 7 days onset
Ttcycl, Chloramphenicol
w/in 7 days onset
Ttcycl, Chloramphenicol
w/in 7 days onset
Ttcycl, Chloramphenicol
w/in 7 days onset
Severity of dss b/c of high
[endotoxin] Vector control
Ttcycl, Chloramphenicol
important esp for human
w/in 7 days onset
lice and rats Vaccine
Key Diagnostics Treatment available Notes
Superficial Infections
General Features No Immune RE: b/c it's too far away. Reason for removal is usu. C
Etiology Epidemiology Manifestations
Black Piedra-Black gritty nodules
Pedraia hortai
in hair shaft
Pityriasis versicolor-Chronic,
Normal skin/scalp flora. Ds(x) hightest mildly asymptomatic non-
in tropics. Found equally in wo(men). inflammatory infection of stratum
Malassezia furfur Recurrent. Excess perspiration, corneum. Lesions covered w/
corticosteroids, malnutrition and sharply delineated furfuraceous
hydrophobic cmpds on skin. scales, w/ variable pigmentation,
may be single or coalesed.
Cutaneous Infections (Dermatophytosis)
usu caused by 1) Trichophyton (rubrum, tonsurans, mentagrophytes) 2) Epidermophyton floccosu
General Features audouinii). colonize keratized tissue. Found on humans, animals, and in soil. Inf fr nml flora are m
acute, more sensitive to t(x) and less likely to reoccur. same sp can cause more than one ss(x), m
Etiology Epidemiology Manifestations
Tinea capitus-1) Epidemic a. Grey
M. audouinii childhood disease. Spread frm Mexico patch caused by M. audouinii b.
to U.S. Black dot caused by T. tonsurans
T. tonsurans 2) Nonepidemic more severe
Tinea favosa-yellow cup shaped
common in Mediterranean
crusts called scutula
occurs in adult males, acquired from Tinea barbae-mild irritation to
animals folliculitis
Tinea corpus-ringworm on body
M. audouinii children, worldwide w/ scaling to inflammatory lesions
of glabrous skin
Tinea crurus (jock itch)-Lesions
usu males. Favors humidity are sharply demarcated raised
erythematous border
Transmission my contact, either fr soil, lesions, or indirect (pool, shower, comb, etc) Microsporum sp:m
More Notes: floccosum:macroconidia, Trichophyton sp:microconidia. Temp sensitive limits inf to surface. Fatty acid
patch to pre-puberty.
Subcutaneous Infections
General features Introduced via traumatic implantation. Some occur worldwide w/ endemic areas, Seve
Etiology Epidemiology Manifestations
Mycetoma (Eumycetoma)-
localized, swollen, lesion with pus
1ly in males b/c of exposure.
Pseudallescheria on foot or hand. Pus contains
Wolrdwide w/ endemic areas in
boydii grains. Looks like random lesions
Sudan, Mxco. Orgms usu live in soil.
on body with dark, crusty draining
blotches.
Chromo(blasto)mycosis-SubQ,
localized chronic inf of skin and
Fonsecaea pedrosoi, Worldwide, more in Tropics.
subq tissues leading to verrucoid,
Phialophora verrucosa, Males>Femes. Usu a soil orgnsm. Inf
ulcerated, crusted l(x)s. Starts as
Cladosporium carrionii via traumatic implantation
small red macule then black stuff
on skin, then HUGE swollen warts.
Phaeohyphomycosis cerebral-
Cladosporium
1)SubQ Phaeo is subQ cysts
trichoides, Fonsecaea
(1"x1") red, black 2)Cerebral Phae
pedrosio, Bipolaris
is cerebral inf w/ abscess, fatal
spicifera
3)inf of paranasal sinuses
Conidiobolus coronatus
Entomophthoromycosis (C/B?)
or Basidiolus ranarum
Systemic Infections
1)Occur in nml hlthy peeps, asymptomatic/subclinical 2)1ly pulmonary inf that may spread via blo
General Features
restricted or in endemic areas 6)localized outbrx from exposure to com
Etiology Epidemiology Manifestations
Blastomycosis-Inhalation of
Incidence: males>femms AfroAmrcns>
conidia → 1)Pulmonary inf w/
All ages but more in 30-50yo's In small
variety of ss(x). 2)Chronic
epidemics-no sex bias, mostly children
cutaneous disease is 80% of
Blastomyces inf, usu pulmonary inf. Geography:
presentation w/ 50% having
dermatitidis Thermally dimorphic, Africa, Mxco,
pulmonary ss(x) 3)Disseminated
Venzla, Israel, India, East U.S. Coast.
disease generalized w/ bone, UG
Lives in soil. Animals (dogs) as
tract, and CNS as extrapulmonary
reservoir.
sites.
Paracoccidiomycoses
1)Pulmonary inf asymptomatic, self
limiting, may become latent, few
Incidence:No sexual bias w/ 5-25% of develop ss(x) after exposure.
pop skin test +. Symptomatic disease 2)Chronic Progressive Inf occurs
are 90%male ag wrkrs. 11:1 following latency in 90% cases w/
Paracoccidioides
male:femm b/c estrogen inhibits mold dissemination to mucosal and
brasiliensis
to yeast morph. Geography:Central gingival srfcs, may have chronic
and S. Amrca. Avoids the Amazon pulmonary disease and some both
Thermally Dimorphic Dissemination to other organs also
observed 3)Acute progressive form
(10%of cases) in children and
adults fatal in weeks
Pneumocystitis jiroveci
Pneumonia-Diffuse pneumonia
1)debilitates infants w/ subtle
Immunocompr, AIDS p(x), Ubiquitous,
infant, Bcell and Lymphocyte
Worldwide, nml flora, animals as
Pneumocystitis jiroveci infiltration 2)immnocopmr p(x)
reservoir 30-40%mortality in infants,
manifest ofver several weeks w/
10% mortality in AIDS p(x)
fever, recurrent/breakthrough
tachypnea, massive # of orgnsms
invading alveolar spaces.
Nosocomial inf x2 fr 1980-1990 at 4/1000 discharge. Candida albicans 60%, Candida sp. 20%, Torulo
wound, pneumonia, fungemia, IV catheter most likely cause for inf. Infectious, and expensive. Other o
More Notes piedra), Geotrichum, Penicillium
ections
ar away. Reason for removal is usu. Cosmetic
Key Diagnostics Treatment Notes
1)Examine skin
scrapings for Topicals: miconazole, Can be confused
pigmented hyphae. ointment, sulfur soln's, with malignant
2)Culture for salicylic acid melanoma
verification
lipophilic,
Topicals: 1)SeSulfide
hypopigmentation
examine skin scales micon/ketocon(azole)
due to
for shory hyphae and Oral:
interference of
spherical cells ketocon/itracon/flucon(a
fungal melanin
zole)
synths
Dermatophytosis)
rophytes) 2) Epidermophyton floccosum or 3) Microsporum (canis, gypseum,
mals, and in soil. Inf fr nml flora are more chronic/mild. Inf fr soil/animals more
sp can cause more than one ss(x), more than one sp can cause same ss(x).
Key Diagnostics Treatment Notes
usu aquired fr
1)Topical nonRX- animals (dogs)
Undecylenic acid,
Tolnatrate, Miconazole,
Clotrimazole,
Terbinafine, Drying less common
USEFUL FOR MOST:
1)chronicity 2)reoccurence
cmps, keratolytic nowadays
3)severity 4)spread to agents. nonRx often
others 5)pets/animals used b/f seeing a
6)distinguish fr C.albicans. physician. 2)Topical Rx-
Some sp fluoresce so use
"wood's lamp". Examine Exonazole nitrate,
hair for spores Ketoconazole,
(endo/ecto(thrix). Skin/nail Oxiconazole,
scraping for hyphae. Sulconazole,
Culture ID via color, txtr,
topography etc) Ciclopiroxolamine (nail
may require
lacquer) Naftifine,
antibacterials for
Butenafine 3)Systemic-
2ndry inf
Griseofulvin,
Detoconazole,
Itraconazole.
nfections
ur worldwide w/ endemic areas, Several sp may cause same ss(x)
Key Diagnostics Treatment Notes
Spontaneous
resolution
ctions
pulmonary inf that may spread via blood 3)immunit to reinf 4)geographically
localized outbrx from exposure to common source
Key Diagnostics Treatment Notes
HIGHLY
INFECTIOUS.
Skin test. Differentiate
Possible terrorist
from other URI's.
agent. Virulence
Take travel h(x).
due to protease,
Direct exam of 1)bed rest for 1ry ss(x)
estrogen binding
sputum for sporangia 2)disseminated w/
prot, Tcell
or spherules. Thermly AmphoB or Fluconazole
mediated RE in
dimorphic grows as (use Fluc in AIDS p(x))
reinf,
spherule-tiss. Culture 3)cavities removed
alkalinazation of
ID for arthrospores in surgcly
phagosomeallergi
filament (also
es to 1ry inf is
exoantigen and DNA
good b/c it
probe)
indicates immune
RE.
1)Direct exam of
moderate chronic
sputum, biopsy, blood
1ry Pulmonary-treat disseminated
for intracellular yeast.
ss(x) only. Acute cases disease fatal if
Culture ID takes 28
use AmphoB or untreated (6-12
days shows spores w/
Itraconazole w/ mos) Fulminant
spikes. Use DNA
Ketoconazole and disease may
probe nstead
fluconazole as occur in infants
2)animal inoculation
alternatives. Surgery to and adults.
to obtain tissue for ID.
remove pulm lesions Resistant to
Blood test also helpful
oxidative burst
for d(x) and pr(x)
1)Direct exam of
sputum, biopsy, pus,
1)AmphoB Itrazonazole virulenc factors:
for broad based
2)2hydorxystilbamine morphogenesis,
budding yeast
3)Ketoconazole-mixed cell wall, anti
2)Culture ID yeast-
results 4)Itraconazole macrophage
tissue mold-nature
for HIV suppression adhesion
3)DNA test,
exoantigen
Skin test shows
1)Direct exam of
no sex bias for
mucosal scrapings for
1)Sulfa drugs x 3-5yrs symptomatic
"pilots wheel" yeast
2)Imidazoles, oral disease Virulence
2)Culture ID mold-
kitoconazole (possiblity factors:morphoge
nature yeast-tissue,
of relapse) Itraconazole nesis, estrgn
ID via yeast form
3)AmphoB for inpatient binding prot, cell
3)serolgy for
wall, immune
diagnosis/prognosis
suppression
1)only fungus w/
1)Direct exam of capsule
sputum or CSF in 2)Meningitis fatal
1)AmphoB 2)Combo
India ink for capsule if untreated
AmphoB+5-
2)Culture ID-cells 3)Virulence
Fluorocytosine
examined for capsule factors:Mating
3)Fluconazole (esp in
Phenol oxidase test type, growth at 37
AIDS p(x) to prevent
used for ID degr, capsule is
relapse)
3)Serologic test for antiphagocytic,
capsular antigen. immune
suppression
nfections
3)pathogenic ones are ubiquitous 4)any fungus or shroom may cause inf
Key Diagnostics Treatment Notes
1)can be
1)Direct exam of 1)Topicals for acute/chronic,
sputum, pus, tissue Cutaneous-Nystatin, disseminated/sup
for yeasts, Miconazole, erficial/deepseate
pseudohyphae Clotrimazole(OTC x d 2)Concern of
2)Culture ID looks for vaginitis), esophigitis in
germ tubes, Ketoconazlole. 2)Thrush AIDS 3)Virulenc
chlamydospores. t(x) lozenges Factors:yeast
Yeast ID via physio 3)Esophegitis AmphoB, morph chgs,
rxns 3)Isolation from Fluconazole 4)Systemic- protease
skin/vaginal mucosa AmphoB, Fluconazole, phospholipase,
to confirm. Ketoconazole adhesins, laminin
Significance in urine (sometimes combo w/ collagen,
'pends on other Miconazole IV and 5- macrophage
factors Isolation fr Flurocytosine 5)t(x) of evasion, immune
sterile site significant. predisposing factors supression, Th1
4)Serology ineffective helps in t(x) response and Th2
susceptibility
1)Direct exam of
sputum, biopsy for
1)ubiquitous so
septate hyphaew/
may be
acute angle branching
1)Treat allergy ss(x) contaminate in
2)Culture ID based on
2)AmphoB w/ culture so
colonial morphology
5Fluorocytosine or repeated cultures
and pattern. Fast
surgery for Aspergilloma used.
growth (white center,
3)Must treat invasive 2)Virulence:protea
green cortex) +blood
disease aggressively b/c se phospholipase,
culture should be
it's fatal. AmphoB or adhesins laminin,
considered significant
Itraconazole gliotoxin
since even invasive
(immunosuppresa
cultures can be -
nt) endotoxin
Serologic test best in
noninvasive disease
1)Direct exam of
sputum, biopsy for
NON-septate hyphae, Disease fatal w/o t(x).
usu few to see 50% w/ t(x) 1)AmphoB
2)Culture ID via 2)surgical debridement
colony morphgy and
sporangial formation
Fungus related to
ascomycetes.
1)Direct exam-Infant Atypical chrtcs,
looks emaciated, X- used to be
1)Acute t(x)
rays show diffuse lung thought as
Trimethoprim-
cavity 2)sputum, parasite.
sulfamethozoasole
Biobsy (for asci, Virulence:adhesin
2)Propylaxis for AIDS
spores ameboid s to Type I
via TMP-SMX.
shaped yeast, 3)No pneumocytes,
culture available disruption of
blood-air barrier
(lung)
lbicans 60%, Candida sp. 20%, Torulopsis, Aspergillus.Inf of UTI, surgical
inf. Infectious, and expensive. Other opportunistic sp: Trichosporon (see white
Topicals* Orals+ IV^
Oxiconazole*
Sulconazole*
Terbinifine*+
Terconazole*
Tioconazole
Voriconazole+^
Drugs for
Drugs for Systemic Opportuinistic
Infection Infection
squalene epoxidase
DNA syns competition for subst
inhibitors
DNA Viruses
Enveloped Naked
Variola Vaccinia Monkeypox Molluska contagiosum HSV VZV EBV CMV HHV Hebatitis B Adenovirus HPV JC BK Simian Parvovirus B19 Adenoassociated virus
RNA Viruses
ss RNA
Picorividae Noroviridae Togaviridae Flaviviridae Coronaviridae Retroviridae Parmyxoviridae Filoviridae Rhabdoviridae Arenaviridae Bunyaviridae Orthomyxoviridae
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
Tropical and subtropical areas
Tropical and subtropical areas
Africa
Africa and Central and South America
Africa and Central and South America
Africa, Asia
Japan, Australia, United States
Worldwide
China, Japan, Korea, Vietnam
Worldwide
Worldwide
Sheep-raising countries: Europe,
Asia, Africa, Australia, United States
Worldwide
Nephritic = Blood + HTN + Oliguria + Azotemia + Edema
PSGN - Follows group A β hemolytic strep infx, usu due to bad hygiene, ↓ C3, ASO or antiDNAse B
positive, shows "lumpy bumpy" on subepithelium w IF, large hypercellular glom
RPGN - Crescents → deposition of fibrin in bowman space, monocytes, large pale kidneys
Type I - Anti GBM IgG complexes → complex deposits on GBM → smooth linear appearance on
immunofluroscence. e.g Goodpasteurs
Type II - Immune complex mediated → "lumpy bympy" glomerular BM on immunofluorescence. e.g.
Bergers Disease
Type III - ANCA associated aka Pauci immune shows nothing on GBM w immunofluorescence but
PMNs have either c-ANCA or p-ANCA. Usu a RE to Wegener Granulomatosis or vasculitis'.
Alport Disease - mutation of α 5 Type IV collagen → nephritis, nerve deafness, and ocular problems
and splitting of lamina densa
Nephrotic = Proteinuria +Hypoalbuminemia + Edema + Hyperlipidemia +
Lipiduria
MCD/MN/nil disease/Lipoid Nephrosis - Fused/absent podocytes (epithelial foot processes)
Perihilar
Collapsing
Tip Lesion
Membranous Glomurlonephropathy/MN/Membranous Nephropathy/MGN - subepithelial immune
complex disease vs GBM but NO Ig's in ciruculation, epimembranous spike and dome
appearance, Autoimmune states or heavy metals can predispose
Type I - Subendothelial IgG and complements, Prominent Tram Track appearance, ↑ mesangial
cells, ganular complement deposits w IF, Ig complexes circulating
Type II - Dense Deposit Disease shows some tram trac appearance, C3 next to dense deposists, ↓
serum C3, no Ig's in BM complexes, IgG vs C3 convertase, ribbon like deposits w/in capillary,
nephrotic and nephritic ssx both present
Diabetic Nephropathy - Early stage has large kidneys (later has small granular kidneys), EM shows
thick holey GBM, thin lamina rara interna and externa, tubular atrophy
Lupus Nephropathy
Type I - no ssx
Type II - IgGs and C3 in mesangial matrix, Proteinuria, hematuria. Just uncomfortable
Type III - Focal Proliferative has extenseive damage, ↓ complement, few pts w nephrotic ssx,
segmental necrosis, mesangial deposits
Type IV - Diffuse Proliferative is most severe form, combo of nephritic and nephrotic ssx, 100%
glomeruli involved, scarring, wire loop abnormalities, subendothelial depostis of Ig's and C3 and
Fibrin
Type V - Looks just like MG
HIV Associated Nephropathy - Black Drug users affected, Tamm Horsfall prots
DOC:
Anticonvulsant
Dizzines, diplopia, nausea, ataxia, (Partial Szr),
Slows recovery rate of inactive Na+ Channels, blurred vision. Aplatstic anemia, Anticholinergic,
Carbamazepine preventing the PDS. Metabolite also active. Website
paroxysmal depolarizing shift
Agranulocytosis, Thrombocytopenia, antineuralgic,
StvJohnson Sx antidiuretic, muscle
relaxant and
antiarrhythmic
Monotherapy in
Dizziness, HA, Diplopia, Nausea, Partial Seizures
Somnolence, Skin Rash (may (also in adjunct to
Lamotrigine Inactivates Voltage gated Na+ channels progress to StvnJohnson Sx). notes Valproate acid);
Increased risk of cleft palate if used Absence &
during pregn. Myoclonic szrs in
children
Drugs That Work On T-type Ca++ Channels
Drug MOA SDFX Source T(x) For
Adjunct thpy for
Blocks Na+ channels & decreases Cl- flux via StvnJohns Sx, Contraindicated in ppl Partial Szrs as
Zonisamide notes
T-type Ca++ channels w/ allergies to sulfonamid AB induction NOT long
term use
Drugs That Work Via GABA Agonists via increasing GABA prodx, decreasing GABA brkdwn, blocking GABA reuptake, GABA-A
agonists
Short TermPartial
Szr As IV to
Lorazepam GABA-A agonist in CNS Dizzines, atazia, drowsiness Website terminate szr b/f
use of long term
AED Absent szr
As IV to terminate
szr b/f use of long
Diazepam GABA-A agonist in CNS Dizzines, atazia, drowsiness Website term AED Absent
szr (Short
TermPartial Szr
DOC x Myocloninc
Szr & Subcortiical
Dizzines, atazia, drowsiness
Enhances GABA in Reticular Nucl. Inhibits T- Myoclonis 4th
Clonazepam Withdrawl may trigger status Website
type Ca+ channel currents DOC x Absent szr
epilepticus
Partial Szr, Panic
d/o
Adnunct x Partial
Inhibits Na+channels from inactive state, incr Acute myopia, secondary closed Szr & Primary Gen
Topiramate Cl- flux thru GABA receptors (diff from BZD angle Glaucoma, Oligohydrosis, notes TonClon Szr. Szrs
binding site) Hyperthermia frm LemoxGastut
Sx
Other AED's
Hypnotics/Anxiolytics
BZDs
Barbs
DOC x Myocloninc
Szr & Subcortiical
Dizzines, atazia, drowsiness
Enhances GABA in Reticular Nucl. Inhibits T- Myoclonis 4th
Clonazepam (BZD) Withdrawl may trigger status Website
type Ca+ channel currents DOC x Absent szr
epilepticus
Partial Szr, Panic
d/o
Mood Disorders
Drug MOA SDFX Source T(x) For
Buproprion (similar strx Antidepressant
DA, 5HT & NE reuptake inhibitor notes
to amphetamine) Smoking cessation
TCA alpha2 adrenergic receptor antagonist sedation, INCREASED appetite (wt
Mirtazapine Antidepressant
causing incr NE, 5HT in synapse gain)
liver failure (death; not used so much
Nefazodone SSRI (little affinity x alpha adrenergic receptors Antidepressant
anymore)
SNRI (venlagaxine, Antidepressant,
5HT & NE reuptake inhibitor
duloxetine) usu more effective
alters ion channel leading to decr in NE, 5HT
Li effective 50-60% of time Bipolar
reuptake
Divalporex stabilize temporal lobe Bipolar
Bipolar reduces
cycling and
Lamotrigine depression
NOTHING for
mania
Topiramate not effective for most ppl Bipolar
Oxacarbamaepine Bipolar
Antidepressant
DOC:
Hepatic induction leading to need for
Anticonvulsant
MASSIVE dosages. Dizzines,
Slows recovery rate of inactive Na+ Channels, (Partial Szr),
diplopia, nausea, ataxia, blurred
Carbamazepine preventing the PDS. Metabolite also active. Website Anticholinergic,
vision. Aplatstic anemia,
paroxysmal depolarizing shift antineuralgic,
Agranulocytosis, Thrombocytopenia,
antidiuretic, muscle
StvJohnson Sx
relaxant and
antiarrhythmic
Gr+
Cocci
Anaerobes
aerotolerant
Strep
Enterococcus
Staph
obligate
Peptostreoptococcus
Bacilli
Anaerobes
aerotolerant
nonsporforming
Lactobacillus
Corynebacterium
Propionibacterium
Actinomycetes
Arachnia
Bacterionema
obligate
sporeforming
Clostridium
Aerobes
aerotolerant
Rothia
Gr-
Cocci
Aerobes
Neisseria-flavens,
mucosa, subflava,
meningitidis, sicca
Anaerobes
Viellonella
Bacilli
Anaerobes
aerotolerant
nonsporeforming
Haemophilus
Actinobacillus
Eikenella
Capnocytophaga
obligate
Bacteroides
Fusobacterium
Leptotrichia
Wolinella
Selenomonas
spiral/curved
Anaerobes
aerotolerant
Campylobacter
Spirochetes
Anaerobes
obligate
Treponema
Borrelia
Disease Healthy
Disease Healthy
Disease Pts
No Risk Health Pts Not
Not Exposed
Factor - Exposed (+-)
(--)
Syphillis
Stage Duration Clinical Disease Activity of Treponema pallidum
2. Regional
lymphadenopathy
Primary 4 to 8 weeks None Inconspicuous
Latent
Secondary Variable over period 1. Skin and Skin and mucosal lesions
of 5 years (Latent mucosal lesions rich in spirochetes (highly
periods with 2. Generalized infectious)
recurrences) lymphadenopathy
Latent Few months to a None Inconspicuous
lifetime (average 6 to
7 years)
Tertiary Variable-rest of Related to organ Paucity of spirochetes in
patients life system diseased classic lesion
Diagnosis Tissue Change
2. STS positive
Subcutaneous Infections
Etiology Epidemiology Manifestations Treatment Key Diagnostics Notes
Systemic Infections
Etiology Epidemiology Manifestations Treatment Key Diagnostics Notes
Opportunistic Infections
Etiology Epidemiology Manifestations Treatment Key Diagnostics Notes
mal flora of GI tract, oral cavity.
Seizures
Generalized
General
Tonic Atonic Tonic Clonic Myoclonic Absent
Clonic
http://pediatricneurology.com/seizure_intro.htm
Partial
Simple- Complex-
No LOC + LOC