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Antibacterials, Antituberculars and Antiprotozoals

1. Penicillins - “mold”: Penicillium notatum

2. Cephalosporins – “fungus” Cephalosporium acremonium

- inhibit the bacterial enzyme necessary for bacterial cell wall


synthesis

3. Macrolides – fungus like bacteria: Streptomyces erythreus

- bind to the 50S ribosomal subunits & inhibit protein synthesis

4. Lincosamides – inhibit bacterial protein synthesis

5. Vancomycin – “glycopeptides”: Inhibit bacterial cell wall


synthesis

6. Ketolides – Block protein synthesis

7. Tetracycline – Streptomyces aureofaciens: inhibit bacterial


protein synthesis

8. Glycylcyclines – Synthetic tetracycline analogue : block protein


synthesis

9. Aminoglycosides – inhibit bacterial protein synthesis

10. Fluoroquinolones – interfere with enzyme DNA gyrase needed


for bacterial DNA synthesis

11. Sulfonamides – “coal tar derivatives” inhibit bacterial synthesis


of folic acid

12. Metronidazole – Impair DNA function of susceptible bacteria

Inhibit bacterial cell wall synthesis

1. Penicillins
2. Cephalosporins

3. Vancomycin

Inhibit bacterial protein synthesis

1. Lincosamides

2. Tetracyclines

3. Aminoglycosides

Blocks protein synthesis

1. Ketolides

2. Glycylcyclines – Ex. Tigecycline “ photosensitivity”

Bactericidal Bacteriostatic

1. Vancomycin 1. Tetracyclines

2. Cephalosporins 2. Glycylcyclines

3. Aminoglycosides 3. Sulfonamides

4. Fluoroquinolones

Bactericidal and Bacteriostatic

1. Penicillins

2. Macrolides

3. Lincosamides

4. Ketolides

5. Metronidazole
1. Penicillins – Ex. Amoxicillin, Ampicillin, Co – Amoxiclav and
Cloxacillin ( Penicillinase resistant antibiotics )

- Check for bleeding

- High doses: decrease platelet aggregation

- 1 hour before or two hours after meals

- Watch out for superinfection: mouthulcers, discharges from


genital area, stomatitis and black furry tongue.

- Ingest buttermilk of yogurt to prevent superinfection of intestinal


flora with long term use of penicillins or cephalosporins

- Keep epinephrine available for allergic reaction

2. Cephalosporins – Ex. Cephalexin, ceftazidime and cefepime

- Check for bleeding

- Decreases blood clotting time

- No alcohol during drug therapy: it causes flushing or dizziness

- With meals

- Watch out for superinfection

3. Macrolides – Ex. Clarithromycin, Erythromycin and


Azithromycin

- Hepatotoxic

- Monitor for liver damage: Jaundice, Increase liver enzyme

- 1 hour before or 2 hours after meals

- Give with a full glass of water

- No IM route
4. Lincosamides – Ex. Clindamycin and Lincomycin

- Watch out for leukopenia and thrombocytopenia

- Decreases WBC and Platelet count

- Give with a full glass of water

- May cause Pseudomembranous colitis

- Maintain adequate hydration and report if Diarrhea occurs

5. Vancomycin

- Ototoxic

- Report presence of Tinnitus

- Monitor for: REDMAN or REDNECK SYNDROME: sudden


decrease in BP, fever and chills with paresthesia and erythema of
neck and back

6. Tetracyclines – Ex. Doxyclycline and Minocycline

- Drug becomes toxic when expose to light and extreme heat

- Accumulate, weaken and cause staining and pitting of teeth and


bones

- Photosensitivity

- Use sunblock & protective clothing

- Can cause discoloration of permanent teeth of children 8 years


old and below

- No milk and milk products, Iron, calcium and antacids

- 1 hour before and 2 hours after meals with a full glass of water

7. Aminoglycosides – Ex. Streptomycin ( IM ), Gentamycin( IV ),


Tobramycin ( topical/IV) and Neomycin ( oral : use as pre operative
drug to decrease bacterial count in the intestine for client pre GIT
surgery

- Photosensitivity, ototoxic, nephrotoxic and neurotoxic ( Peripheral


neuritis

- Oral form: after meals

- Increase water intake

- Monitor CR, BP, Intake & output

8. Fluoroquinolones – Ex.Ciprofloxacin, Ofloxacin and Levofloxacin

- Causes drug related dizziness

- Avoid caffeinated products

- Photosensitivity & Crystalluria

- Increase water intake 2 liters and above

- MIO, nephrotoxic

- With food and full glass of water

- Monitor Blood sugar level: increases effects of hypoglycemic drugs

9. Chloramphenicol: chloromycetin ( Oral, IV, Opthalmic and Otic )

- Causes GRAY SYNDROME in neonates and premature babies:


Abdominal distention, pallid cyanosis, vasomotor collapse and
irregular respiration

- Agranulocytosis: report sorethroat, tiredness and flulike


symptoms

- give on empty stomach

- Bone marrow suppressions


10. Sulfonamides – Ex. Cotrimoxazole (bactrim), Sulfisoxazole
(gantrisin), Sulfasalazine (azulfidine): use to treat ulcerative colitis
and crohn’s disease, for rheumatoid arthritis, a sulfapyridine that is
carried by A.S.A. and release in the colon

- Photosensitivity, Crystalluria, red orange urine

- Kidney stone formation, Nephrotoxic, blood dyscrasias: decrease


RBC, WBC and Platelet

- MIO, increase water intake

- Before meals

11. Metronidazole – 500 mg tablet, 500mg IV per 100 ml for


intestinal amoebiasis and post abdominal surgery

- Disulfiram type reaction: flushing, dizziness, hypotension, N/V


severe headache and palpitation

- Report severe GI upset

- Metallic taste in the mouth

- Red brownish Urine

- No Alcoholic drinks, cologne, after shave lotion, bath splashes

- Adjunct therapy for H. pylori infection

12. Antitubercular drugs

A. Rifampicin

- Hepatotoxic

- Increases Uric acid level

- Empty stomach

- No Alcohol ingestion during therapy


- RED ORANGE discoloration of urine, feces, saliva, sweat, sputum
and tears

B. Isoniazid INH

- Hepatotoxic

- Peripheral Neuropathy: report numbness and tingling sensationof


lower extremities

- Give with vitamin B6

- Agranulocytosis

- No alcohol ingestion

- Increases blood sugar level, visual disturbances

C. Pyrazinamide PZA

- Hepatotoxic

- Increases uric acid level

- Monitor for joint pain due to acute gout

D. Ethambutol

- Acute gout, Increases uric acid level

- Visual disturbance, blurred vision

Fungus

- Cellular organism with a hard cell wall that contains chitin and
polysaccharides and a cell membrane that contains ergosterol

Mycosis

- Any infection with a fungus


I. Systemic antifungals

- Alter the cell permeability of the fungus, leading to cell death


and prevention of replication

1. Polyenes – Amphoterecin B ( hypotension ), Nystatin ( swish


and Swallow)

Azoles - Fluconazole

= bind to ergosterol to open pores in the cell membranes

2. Azoles – Ketoconazole

- Impair the synthesis of ergosterol allowing increased cell


permeability and leakage of cellular components leading to death

3. Antimetabolites – Flucytosine

- Penetrate fungal cell, convert it into fluororacil that disrupts


fungal DNA and RNA synthesis

4. Echinocandins – Caspofungin

- Inhibit biosynthesis of fungal cell wall which interfere growth and


reproduction

= Headache, dizziness, sleepiness, lethargy and visual changes

= avoid alcohol consumption

II. Topical antifungals

- Alter the cell permeability of the fungus causing prevention of


replication and fungal death
- Too toxic to be use systemically
1. Gentian violet – cannot be use near active lesions
2. Econazole
3. Miconazole
4. Ketoconazole

Side effects
1. Local ( cream, lotion, spray )

- Irritation, burning, rash & swelling

2. Suppository or troche

- N/V, Hepatic dysfunction

3. Vaginal suppository

- Urinary frequency and burning sensation

Helminths

- Worms that cause disease by invading the human body

Anthelmintics

- Agents that destroys worm


- Given for a short period (1 – 3 days )

1. Mebendazole

- Inhibits uptake of glucose and other nutrients of helminthes

2. Pyrantel pamoate

- Blocks neuromuscular action, paralyzing the worm and causing


its expulsion by normal peristalsis

3. Albendazole

- Powerful drug, can cause renal failure and bone marrow


suppression

= Anorexia, N/V, stomach cramps: Give with food

= Dizziness, headache, drowsiness

- Avoid alcohol intake, avoid operating car or machinery, no


abrupt or sudden change of position