DRUG

Metronidazole
Ceftriaxone
Paramomycin

Doxycycline (tetracycline)
Penicillin G
Chloramphenicol

Ampicillin/Amoxicillin

Dexamethasone

Acyclovir

Dapsone

Rifampin
Clofazime

Amphotericin B
Flucytosine
Fluconazole

Melarsoprol
Praziquantel

Albendazole

Penciclovir

Ganciclovir

Riluzole (Rilutek)

Azithromycin/Erythryomycin (Macrolides)
Natamycin

Ivermectin

Diethylcarbamazine

Donepezil (Aricept)

Rivastigmine (Exelon)

Mematine (Namenda)
Quetiapine

Clozapine

Sodium Oxybate

ANTI E

Phenytoin

Carbamazepine

Lamotrigine

Lacosamide
Ethosuxomide

Valproic acid

Gabapentin

Pregabalin

Diazepam, Lorazepam, Midazolam

Clonazepam
Phenobarbital
Vigabatrin

Felbamate
Rufinamide

Tigabine

Toprimate

Mechanism of Action

Nitrogen species reduced intracellularly

3rd Gen cephalosprin: beta-lactam
16s ribosomal RNA, inhibits protein synthesis.
Bind to 30s subunit of bacterial ribosome, blocking binding of
aminoacyl-tRNA to the acceptor site complex, preventing addition
of amino acids to growing peptide.
Beta-lactam, IV version, rapid renal clearance (half life 30 mins).
Hypersensitivity, rash, seizure.
Binds to 50s ribosomal subunit preventing bacterial protein
synthesis.
Beta-lactams with greater acitivity against gram negatives, can
add beta-lactamase inhibitors.
Long acting glucocorticoid: anti-inflammatory effects: reduce
concentration, distribution and function of peripheral leukocytes
and suppress inflammatory cytokines and chemokines and other
mediators of inflammation.
Requires three phosphorylation steps for activation, first
phosphorylated by virus-specific thymidine kinase, and then to di
and tri phosphate by host cell enzymes. Competes with
deoxyGTP for viral DNA polymerase and chain termination
following incorpation into viral DNA.

Inhibits folate synthesis.

Binds to beta subunit of bacterial DNA-dependent RNA

polymerase, inhibiting RNA synthesis.
Phenazine dye, alternative to Dapsone. Unknown MOA, may
involve DNA binding.

Binds to ergosterol, pokes holes in the cell membrane of fungi.

Interferes with DNA and RNA synthesis selectively in fungi
Blocks fungal p450 enzymes and interferes with ergosterol
synthesis
Trivalent-arsenic compound delivered in propylene glycol through
slow infusion.
Increases permeability of trematode and cestode cell membranes
to calcium, resulting in death.
Inhibits microtubule synthesis in nematodes, also has larvicidal
effects and ovicidal effects.

Inhibits viral DNA polymerease and chain termination following

incorpation in viral DNA.

Phosphorylated by CMV viral kinase, UL 97, inhibiting CMV DNA

polymerase.
Blocks TTX-sensitive sodium channels associated with damaged
neurons. Possibly directly inhibits kainate and NMDA receptors
and accelerates glutamate clearance from the synapse.

Binds to a small region of 23s rRNA of the 50s ribosomal subunit

near the peptidyl transferase active center, all are bacteriostatic.
Binds to ergosterol, pokes holes in the cell membrane of fungi.
Similar to amphotericin B and Nystatin.
Potentiates both glutamate-gated chloride channels in nematode
cell membranes and release of GABA from presynaptic terminals
leading to hyperpolarization of neuromuscular cells and
pharyngeal paralysis. Cannot cure human host of O.volvus
infections.
Postulated to stimulate innate immune system, inhibit
microtubule polymerization, and inhibit arachidonic acid
metabolism.

Cholinesterase inhibitor, reversible

Cholinesterase inhibitor, pseudo-irreversible inhibitor of AChE and

BuChE (butyrylcholinesterase inhibitor).
Noncompetitive NMDA receptor antagonist indicated in dementia
due to Alzheimer's disease. Indicated because excitotoxicity from
excessive glutamate release has been implicated in the
presentation of dementia. NMDA receptors mostly located in
spinal cord, hippocampus and cerebral cortex.
Atypical antipsychotic: Combined antagonist properties at
dopamine D2 and serotonin 5-HT2 receptors.
Atypical antipsychotic: Combined antagonist properties at
dopamine D2 and serotonin 5-HT2 receptors. Also binds to
muscarinic receptors.
Mechanism of action unknown. Similar to gammahydroxybutyrate (GHB). Binds to GABA-B receptor.

ANTI EPILEPSY DRUGS

Inhibits electrical tranmission by use-dependent block of neuronal
voltage-gated sodium channel.
Sodium channel blocker. Active metabolite (10,11oxycarbmazepine) also is anti-epileptigenic. Drug of choice for
focal seizures.

Sodium channel blocker, also other unstudied effects, making it

useful for absence seizures.

Sodium Channel blocker.

Inhibit low-threshold, T-Type calcium channels found in thalamus.
Inhibits low-thershold T-type calicum channels, use-dpendent
block of sodium channels, increases activity of glutamic acid
decarboxylase (enzyme that makes GABA), decreases GABA
breakdown

Inhibit high-voltage-activated Calcium channel

Inhibit high-voltage-activated Calcium channels

Increase the affinity of GABA receptor for GABA and therby
increasing chloride current through channel, increased inhibition.
Act specifically at GABA-A receptors in the reticular nucleus to
"turn off" transmission in the nucleus, inhibiting GABA-mediated
hyperpolarization of the thalamus and indirectly inactivating the
T-type calcium channel.
Binds to GABA receptor and potentiates the action of endogenous
GABA by increasing duration of chloride influx.
Indirectly enhances GABA activity via inhibiton of GABA
breakdown.

Inhibits glycine binding site of NMDA receptor-ionophore complex,

resulting in supression of seizure activity.
Prolongs sodium channel inactivation and may inhibit mGluR4
glutamate receptors.

unknown MOA

May inhibit sodium channel, may potentiate GABA activation of

GABA-a, may antagonize AMPA receptor.

Indications

Protozoal infections/ Clostridium species

Pneumonia, meningitis, pyelonephritis, gonorrhea
Protozoal infections such as Entamoeba histolytica.

mycoplasma, chlamydiae, rickettsiae, spirochetes (LYME)

Strep infections, meningococcal infections, neurosyphillis.
RARE USE BECAUSE OF TOXICITIES

Prevent hearing loss in children with bacterial meningitis.

IV: Herpes simplex encephalitis, neonatal HSV infection, serious HSV

or VZV infections.
Oral: Genital herpes (HSV-2), Chicken Pox, Zoster
Topical: Herpes labialis, recurrent herpes labialis

Long-term treatment of leprosy

TB first line, atypical myobacerial infections (leprosy), eradication of

meningococcal colonization, staphylococcal infections.
Sulfone-resistant leprosy or when patients are intolerant to sulfones.

Localized and systemic candidemia, cryptococcus, histoplasma,

blastomyces, coccidoides, aspergillus
Cryptococcus and chromoblastomycosis
FUNGAL MENINGITIS
First line for advanced CNS East African trypanosomiasis and second
line after eflornithine for advanced West African trypanosomiasis.
Tanenia solium

Neurocysticercosis

Herpes zoster and recurrent genital herpes

CMV life-threatening pneumonia or sight threatening retinitis

Only medication approved for ALS.

Corynebacterium acnes, legionella pneuophila, treponema pallidum

(syphillis), mycoplasma pneumoniae, CHLAMYDIA. Azithryomycin
has increased activity against H.influenza and Moraxella catarrhalis.
Fusarium occular infections

Onchocerciasis by Onchocerca volvulus, lymphatic filariasis,

strongyloidiasis, scabies and cutaneous larva migrans.

Filiarisis, Loa Loa eye infection.

Treatment of mild, moderate, or SEVERE dementia related to

Alzheimers, Lewy-Body Diffuse Dementia, Parkison's disease with
associated dementia; traumatic brain injury; cognitive impairment
associated with multiple sclerosis and schizophrenia.

Treatment of mild to moderate dementia, also for dementia

related to Parkinson's.

Mild to moderate dementia related to Alzheimer's disease.

Psychotic disorders (schizophrenia); bipolar disorder.
Schizophrenia refractory to other antipsychotics, has not been used
as a first line agent because of a small but significant risk of
agranulocytosis.
Improves nighttime sleep in patients with narcolepsy and reduces
daytime sleepiness and cataplexy.

Focal and secondary generalized, status epilepticus, nonepileptic

seizures
Focal and tonic-clonic seizures, trigeminal neuralgia. Half life of
carbamazepine is reduced in chronic usage due to induction of P450
system. Linear metabolism, ideal for patients with potential drug
interactions.

Alternative to phenytoin and carbamazepine for focal and tonicclonic seizures. Third line for treatment of absence seizures.

Adjuct therapy for focal seizures.

Absence seizures. First line therapy for uncomplicated absence
seizures.

Tonic-clonc seizures, absence seizures, atypical seizures, focal

seizures
Focal seizures (not very good at this), diabetic peripheral
neuropathy, prophylaxis of migraine

Adjuct for focal seizures, used more for postherpetic neuralgia and
diabetic peripheral neropathy and fibromyalgia.

Terminate acute seizures.

Fourth drug of choice in treatment of absence seizures after

ethosuximide, valproic acid, lamotrigine.
Alternative drug in treatment of focal seizures and tonic-clonc
seizures.
Focal epilepsy (Refractory or adjunct therapy), infantile spasms.

Refractory epilepsy, especially focal and tonic-clonic subtypes.

Focal seizures. Drop attacks associated with Lennox-Gastaut
syndrome in children.

Focal and tonic-clonic seizures (adjunctive therapy).

Focal and tonic-clonic seizures (adjuct)

Contraindication

DISULFIRAM RXN

GI upset, hepatotoxicity, photosensitivity, deposition

in bones and teeth.
Allergen
Dose related anemia, idiosyncratic aplastic anemia,
gray baby syndrome

Nausea, diarrhea, IV infusion with reversible renal or

neurologic toxicity. Probenecid and cimetidine
decrease acyclovir clearace and increase exposure.
Somolence and lethargy in patient receiving
zidovudine and acyclovir.

Hemolysis, especially with G-6-P dehydrogenase

deficiency. Methemoglobinemia is common. GI
introlerance, fever, pruritus, rashes.
Potent cytochrome p450 inducer, turns body fluids
orange, rash, nephritis, thrombocytopenia,
cholestasis, flu-like syndrome with intermittent
dosing.
Skin discolortion from red-brown to black. GI
intolerance.

IV for systemic use, intrathecal for fungal meningitis.

Infusion reactions, renal impairment.
Myelosuppresion

EXTREMELY TOXIC. Fever, vomiting, abdominal pain,

arthralgias. Reactive encephalopathy that appears
within first week of treatment.
Corticosteroids are commonly used in conjunction.
Should not be given to those with cirrhosis. Blood
counts and liver function studies should be
monitored during long-term therapy.
Penciclovir is topical form, more efficiently activated
by HSV and FZF thymidine kinase than acyclovir, but
less selective inhibitor of the DNA polymerase.
Famciclovir is prodrug form that can be taken orally.
More toxic than acyclovir, causes bone marrow
suppression neutropenia. Valganciclovir is a prodrug
with better oral bioavailability (valine ester of
Ganciclovir).

Liver toxicity issues.

Acute cholestatic hepatitis, ototoxicity, fulminant
hepatic necrosis (rare, telithromycin). GI distrubance.
Can lead to toxic levels of cyclosporine,
carbamazepine, warfarin and theophylline (with
concomittant use).

Doesn't cross the CNS, but causes headaches,

ataxia, coma when the blood-brain barrier is
hyperpermeable as in meningitis.
Excreted by kidneys, consider dose adjustment in
individuals with kidney issues.

Metabolized by liver, 100% bioavailability, available

as Oral Disintegrating Tablet (ODT). Somewhat
selective for CNS AChE, most common adverse
effects related to perpheral cholinomimetic effects on
GI tract (nausea, vomitting, anorexia, flatulence,
loose stools, diarrhea and abdominal cramping). May
increase the risk of syncope. Contraindicated in
patients with unstable or severe cardiac disease,
uncontrolled epilepsy, or active peptic ulcer disease.
Similar adverse effects profile to Donepizil. Lower
oral bioavailability, but transdermal patch is mostly
used. Transdermal patch has issues with skin
irritation, redness, or rash at the site of application.

Hypertension, constipation, dizziness, headache.

Hypersensitivity has been documented. Primarily
reserved as second line treatment for dementia
related to AD.
Mild extrapyramidal symptoms. Anticholinergic
symptoms, sedation, weight gain.
Agranulocytosis, mild extrapyramidal symptoms,
anticholinergic symptoms, sedation, weight gain.
Narrow safety margin, addictive potential. Date-rape
drug.

Ataxia, nystagmus, diplopia. Steven Johnson's

syndrome. Can induce increased metabolism of
other drugs, noteably cyclosporine, doxycycline,
lemotrigine, levodopa, methadone, oral
contraceptives, quinidine and warfarin.

Stevens-Johnson Syndrome, aplastic anemia, blood

pressure issues, confusion, nystagmus, blurred vision

Stevens-Johnsons syndrome, ataxia, somnlence,

blurred vision.
Dizziness, ausea, headache, fatigue, ataxia. No
severe interactions with other drugs. Dosedepdendent adverse effects occur in 10% of patients
taking lowest therapeutic dose. Use with caution in
patients with known cardiac conduction problems or
severe cardiac disease.
GI disturances (nausea, vomitting, pain). StevenJohnson syndrome.
Most effective for treatment of generalized epilepsy
syndromes having mixed seizure types. Also drug of
choice for patients with idiopathic generalized
seizures. For treatment of absence seizures that do
not respond to ethosuximide.
Stevens-Johnson syndrome, sedation, dizziness,
ataxia, fatigue, GI irritation. Not very effective drug.
More potent than gabapentin, used for treatment of
focal seizures in patients with hepatic
dysfunction.Peripheral edema, tremor, blurred vision,
diplopia, euphoria. Angioedema.
Ataxia, dizziness, somnolence, fatigue.
Contraindicated in glaucoma.

Similar to other benzos.

Steven-Johnson Syndrome, sedation, ataxia,
confusion, dizziness, depression.
Liver failure, vision loss, suicidial thoughts.
Aplastic anemia, bone marrow depression, hepatic
failure, Stevens-Johnson syndrome. Potent and lacks
sedative effects. Fatal aplastic anemia associated,
reserved for refractory epilepsy.
Dizziness, fatigue, nausea, vomiting, diplopia,
somnolence.
May enhance GABA activity by blocking GABA
reuptake into presynaptic neurons.Unexplained
sudden death, confusion, sedation, depression,
psychosis.

Sedation, psychomotor slowing, fatigue, speech or

language problems. RENAL STONES.