Drugs Pharmacology

Anti Hypertensive Drugs
Diuretics - DOC x HTN monotherapy

plasma volume ECFV VR CO MAP/BP TPR (Reflex) PRA CO a maintained lowered TPR; 1) intravascular volume and 2) vascula
responsiveness by Na and Ca++
Drug Drug
Name MOA Pharmacology Toxicities/SDFX Reflex Contraindications Administration Misc
Interactions
Sexual Dysfunction, Along w tx HTN

hypovolemia, w Quinidine=Torsade de Diuretics (in
Work on Distal Hypokalemia/alkalosis, Pointes; w Digoxin= Dig Elderly or dehydrated or may need K general) are good
Thiazides
convoluted Tubule Hypomanesemia, Toxicity; w supplements; in K for Edema,
(Hydrochlorothiazide/Hy Brain other RxRx interactions;
(descending loop of Hypercalcemia, Cotricosteroids= Na BP and Dyspnea; Thiazides
droDiuril/H2TZ) DM, Hypokakemia
Henle?) Hyperuricemia, arrythmias are good x Severe
Retention; w Li= Plasma
Hyperlipidemia, Renal Impairment
[Li]; w Warfarin=
Hyperglycemia w HTN
effectiveness; w
NSAIDS=HTN
Thiazide-like
(Chlorthalidone/Hygroto DM, Hypokalemia
n)
blocks Na/2Cl-/K on good x tx of HTN w

Hearing Loss (just like
Ascending Loop of Renal Impairment
Loop (Furosemide/Lasix) aminoglycosides), DM, Hypokalemia
Henle so they stay in even morese than
Hypocalcemia
lumen Thiazides
NSAIDS, blockers and

K-Sparring Aldosterone receptor Estrogenid
ACE inhibitors good x tx of HTN w
(Spironolactone, antagonist; Reduce SDFX/Gynecomastia b/c
Hyperkalemia; may lead Hypkalemia
Eplerenone/inspra) aldosterone levels? of steroid like sx of drug;
to cardiac arrest
RAAS Ihibiting Drugs

Drug Drug
Interactions
Captorpril causes rash;

hpotension, Na
depletion; Dry cough
Little sex dysfx
A-II prodx TPR compliance,
SDFX; help
and aldosterone and Hyperkalemia bc K not
manage DM;
Block A I: A II conversion Na excretion; ACE excreted bc aldosterone
ACE Inibitors (end in Great Results If mortality if prior
in lung endothelial cells; breaks down bradykinin, is inhibited; Angioedema w NSAIDS = HTN
-pril eg Captopril) Used w Thiazides MI; only
Bradykinin so if it's blocked the (esp if black); Renal
antihypertensive
bradykinin can stick Failure due to GFR,
mx w/o sexual
around longer Proteinuria, rashes
dysfx
(captopril) fever,
pancytopenia, BM
depression
Angiotensin II Receptor
Blockers/ARB's (end in Block AII type I receptors
"-sartan"; Losartan, aldosterone bradykinin
Valsartan, Irbersartan, relaease and vaeesel angioedema
Candesartan, relaxation
Telmisartan, Eprosartan)
Aldosterone Receptor
Blocker (Spironolactone,
Eplerenone)
Sympathoplegic Agents
CNS 2 Agonists; Ganglionic Blockers; Neurotransmitter Depletors; , , Blockers
Drug Drug
Interactions
some orthostatic
hypotension; Dry Mouth,
2 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
blockers (Doxazosin, Doxazosin were
end in "-sin") 25% more likely to
have hrt falu
Bronchospasm (esp Esp good in white

nonselective), Hrt Failr; ppl w hyperkinetic
Blockers (end in "-ol",
CO via HR and CF; Bradycardia; AV block; hearts; Esp good
Nadolol, Propranolol, response TPR NonSelective blockers
CNS; RAAS (no Peripheral Vascular Diss for Ventricular
Timolol, Atenolol, and VR; Atenolol TPR - Asthma, Vascular
compensatory volume esp in Raynauds: Ectopies, Angina,
Bisoprolol, Metoprolol, (reflex) Disease
expansion Depression (not as bad Sinus Tachycardia
Labetalol)
as Reserpine); Vivd and Dissecting
Dreams; Sex Dysfx Aneurysm
TPR, HR, CO, VR Orthostatic Hypotension,

blocker-Labetolol 1, 2, 1 blocker (basically Bradycardia, Heart no reflex tachycardia DM, Asthma, CHF
sympathetics) block, CF
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
Ca++ Channel Blockers

SDFX = TPR (all), HR (V,D>>N), CF (V>>D,N)
Drug Drug
Interactions
constipation,
Hypotension, some HA,
Phenylalkylamine 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 blockers safest Ca channel
(Diltiazem)
block (nyeh) blocker
Hypotension, HA, highest affintiy x
Dihydropyridines Peripheral Edema w blockers HR sublingual, short heart of other Ca
Tachycardia 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).
Dyslipidemia Drug Therapy
Drug Drug
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
serum TG, Use x pts w TH esp good x Type III
HDL; plasma
extrahepatic LPL, w Statins = chance of >750mg/dL, esp hyperlipidemia; Not
Fibrates (Gemfibrozil) fibrinogen levels :: Type I hyperlipidemia
aplipoprotein synths, Rhabdomyolysis good if pt is Type III good x pts w Type
Gallstones, chance of
HDL? (elevated IDL) phtyp I; Ppl use x in
arrythmias, Nausea,
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
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
irreversibly inhibits ADP Bleeding of

ADP Inhibitors DOC x preventing
prehibiting platelet hemorrhage, easy
(Clopidogril) 2ndary stroke or MI
aggregation burising, GI, Intracranial
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
Anticoagulants (prevent fibrin scaffold formation after platelet aggregation)

Drug Drug
Interactions
Spontaneous
hemorrhage, alopecia,
HMW Heparin binds to HSS, fever, skin ncrosis Does not cross
pts w religious wishes
Binds to Antithrombin III AT III bound to factor Iia osteoporosis/sponatneo Do NOT Give BBB or placenta.
against pork (it comes
Heparin thus preventing or Xa. LMW heparin us bone brkg @ chronic Orally. Do NOT Treat spontaneous
from pig
inactivation of thrombin. binds to ATIII bound to doses, dangerous lvls Give IM. hemorrhage w
glycosaminoglycans)
XA only of AT III, protamine sulfate
thrombocytopenia,
antiplatelet AB's
by inhibiting Factor Iia it

stops fibrin from being
made, and prevents
scaffold formation;
Direct Thrombin Lepirudin/Hirudin is used
Inhibit Thrombin (Factor prolongs PTT (so does Lepirudin is derived
Inhibitors (Hirudin to replace Heparin in
Iia) Heparin) from leech saliva
Argatroban) Heparin-Induced
Thrombocytopenia;
Argatroban is used to tx
Heparin induced
Throbocytopenia
DOC x DVT prevention

Enoxaparin
after hip surgery
Warfarin activity if in
Reduced vit K is crucial conjunction w Cimetidine
x turning Preprothrombin (OTC H2 blocker) via
into Prothrombin thus warfarin 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 Aspirin = Platelet fx:: cyto 450
Stops the reduction of vit (crosses BBB and bioavailability.
Warfarin/Coumadin the platelets. -wiki; Warfarin activity if in metabolization;
K. causes fetal death birth Dose is calculated
Warfarin is used to tx A conjunction w binds to prots.
defects) by finding INR PT
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
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
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)
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
Interactions
Dilates the Sublingual to

Mimics endogenous NO
viens>>coronary bypass liver, Oral,
the cGMP pathway Flushing of face neck,
aa>>peripheral aa. Topical (ointment ? Keep away from air,
which relaxes myosin. Pulsating HA due
Used to tx Effort Angina. looks like light. Tolerance
Effort angina - preload, dilation of meninges
Venous Flow toothpaste?) develops to low
Nitrates (Nitroglycerin, SV MVO2; Variant (esp if topical) , Postural
Preload LVEDV/P Dispensed in doses @ 4 wks.
ISDN, ISMN) angina- coronary flow Hypotension due to
Ventricular stretch Lactose to prevent Stagger w drug free
by relieving coronary antagonism of SAS,
Systole time combustion. Should periods to avoid
spasm; Mixed angina - Halitosis,
Stroke Volume have burning tolerance
coronary blood flow Methemoglobinemia
MVO2/Cardiac work sensation when
MVO2
Venous Return placed in tongue
Bronchospasm (esp
maybe: LVEDV
nonselectives), Heat
Heart size duration
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/ 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 blokrs and contractility and HR as No Orthostatic Vasodilation - N, V;
flow; Ditiazem - HR Constipation, AV block, use w 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 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
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
upstroke of AP; K No evidence shows
bind to open/active Na
Ia Disopyramide flow; phase 2, and AP it works. Ia and Ic
channel
depolarization kill ppl.
Mouth numbness,
Tinnitus, slurred speech,
confusion,
bind to inactive/closed K flow, APDl and somnolescence, sxrs, toxicity w Propranolol,
Ib Lidocaine IV Not as deadly as Ia
Na channel phase 2 CNS depression; Verapamil Cimetidine
activates K channels
AP duration from
hyperpolarization
bind to inactive/closed K flow, APD and
Ib Tocainide AP duration from oral Not as deadly as Ia
Na channel phase 2
hyperpolarization
bind to inactive/closed K flow, APD and
Ib Mexiletine AP duration from oral Not as deadly as Ia
Na channel phase 2
hyperpolarization
Death via Hypotension,
Cardiac Failure, Asystole
esp in old ppl,
bind to inactive/closed K flow, APD and Teratogenesis, Gingival
Ib Phenytoin oral Not as deadly as Ia
Na channel phase 2; Hyperplasia, Hirsutism;
AP duration from
hyperpolarization
upstroke of AP BIG
Ic Flecanide Just as deadly as Ia
TIME
Ic Moricizine Just as deadly as Ia
Ic Propafenone Just as deadly as Ia
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 - Blockers
Drug Drug
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)
& blockers
(Labetolol)
Class II - Blockers are GREAT x Tachyarrhthmias
Class III K+ Blockers
Drug Drug
Interactions
Pulmonary Fibrosis
(fatal), Irreversible Liver
damage, Constipation,
Good x ischemic tissue bluish discoloration, w blocker inhibition
Delays repolarization;
Amiodarone (also Ia Na and during V Tachy to thyroid dysfx (from I's) of both; w 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 use x Atrial
Torsades de Pointes
blocker) Tachyarrhythmias
Class IV Ca Antagonists (Nifedipine Is NOT an Antiarrhthmic agent)
Drug Drug
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
Interactions
SA automaticity; Tx toxicity w K (to

ventricular Delayed After lvl @ 5 mEq/dL),
Depolarization (DAD); Lidocaine to
SA Bradycardia, SVT, AV
Excitability bc depolarize hyperpolarize, Dig
use x Atrial Block, Jxal Tachycardia,
Digoxin/Digitoxin? membr pot; Toxic doses Fab Fragments, DO
Tachyarrhythmias V Tach, V Fib (20% of
have adverse effect.; NOTUSE
pts have SDFX)
Conduction velocity in PADDLES,
atria, in AV node, in VERAPAMIL or
ventricles at toxic doses BRETYLIUM
cAMP, gK,
Flushing, SOB,
automaticity of SA node;
Bronchospasm, HA,
Adenosine Conduction velocity in DOC x PVST Heart Transplant
Hypotension, Nausea,
atria (vagomimetic), in
Paraesthesia
AV node
Atrial Tachyarrhythmias - Tx w Propanolol, Dofetilide, Sotalol, Digoxin or Verapamil

SVT - DOC=Adenosine (but may cause asthma attack) Vagal Maneuvers, Digoxin, Phenylephrine ( TPR vagal RE), blockers, Verapamil (IV): Prophylaxis via Verapamil, blocker (NOT Esmolol) AVOID CAFFIENE
CIGARETTES
Wolf Parkinson White (WPW) Syndrome (a ventricular pre excitation thing) - AV Node via Vagal Maneuvers, Verapamil Digoxin, Propranolol; Accessory (kent bundle) w Amiodarone QPD Flecanide Propanlolol
V Tach - tx w Lidocaine ( V automaticity, Rapid depolarization in nml, Bidirectional block in Ischemic), Procainamide ( phase 0, ADP, ERP, V automaticity), Propranolol, Bretylium ( ADP, ERP) DC Cardioeversion
(the paddles)::: None of these incr survival. HA!
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
aureusdamn
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
created to overcome the loses activity if + gentamycin penicillinase; NOT active

Broad Given w Na so watch Na
Carbenicillin Narrow Spectr of PNC G. (pseuodmonas, proteus) b/c chem rxn so give poor absorption vs Klebsiella or injection
Spectrum levels
Not much used anymore staggered Pseudomonas
Staph aureus starting to Narrow B lactamase

Oxacillin oral
become resistant Spectrum resistant :-)

Nafcillin injection

Cloxacillin
Dicloxacillin
Amox+Clavulinic acid (B
oral (better vs
Amoxicillin lactamx inhibtr) x incr
Ampicillin)
efficacy
prodrug (ampicilin is active
Bacampicillin Metabolized to Ampicillin Oral
compound
Geocillin (Carbenicillin
Derivative of carbenicillin klebsiella
Inodyl)
Ticarcillin Pseudomonas klebsiella
Pseudomonas (best vs
Narrow
Azlocillin Psuedomonas of PNCs), klebsiella
Spectrum, G-
G-
Pseudomonas AND
Mezlocillin/Pipercillin
klebsiella G-
Not an
D Penicillamine Chelates Copper Wilsons Disease
Antibacterial
disrupts erasamase at
stage 2 of cell wall synths;
erasamase converts L-
D-Cycloserine (2ry tx of TB (1 of 4))
alanine to D-alanine so it
disrupts the bact cell wall
synths
Cephalosporins
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;
Cephalothin 1st Genertion G+ (staph endocarditis) Nephrotoxic synergistic w AG IM/IV
Cefazolin 1st Genertion G+ (E. coli, Klebsiella) IM/IV
Cephalexin 1st Genertion G+ (klebsiella) oral
Cefadroxil 1st Genertion G+ (UTI) oral
Broad MTT causes bleeding. GIVE

alternative if allergic to
Cefamandole 2nd Generation Spectrum G+ (ear infx, sinusitis) W VITAMIN K; disulfram IM/IV
ampicillin or amoxicillin
some G- reaction
Broad
MTT causes bleeding. GIVE W
Cefoxitin 2nd Generation Spectrum G+ (anaerobes) IM/IV
VITAMIN K; disulfram reaction
some G-
Broad
Cefaclor 2nd Generation Spectrum G+ oral
some G-
Broad
Cefuroxime 2nd Generation Spectrum G+ (meningitis)
some G-
Broad
Cross BBB (good if you have
Cefotaxime 3rd Generation Spectrum oral
CNS infections)
more G-
Broad
Ceftizoxime 3rd Generation Spectrum oral
CNS infections)
more G-
Broad
Ceftriaxone 3rd Generation Spectrum
CNS infections)
more G-
Broad
Cefixime 3rd Generation Spectrum oral
CNS infections)
more G-
Broad
Cefpodoxime Proxetil 3rd Generation Spectrum oral
CNS infections)
more G-
Broad
Cefepime 4th Generation Spectrum (pseudomonas)
CNS infections)
Good G-
Broad
Cefpirome 4th Generation Spectrum (pseudomonas)
CNS infections)
Good G-
Other Beta Lactam Drugs
or Combos
Broad
(anaerobes, UTI, LRI, GI, must give w cilastatin to kidney enzx inactivates so
Carbapenem Imipenem Spectrum -
Gyn infxs) inhibit kidny metabolism must give w inhibitor
anaerobes
Broad
Carbapanem (anaerobes, UTI, GI, Gyn
Spectrum - does not need inhibitor
Meropenem infxs)
anaerobes
NO PNC cross
Monobactam G- rods ONLY superinfx may occur lactamase resistant :-)
hypersensitivity :-)
Clavulanic Acid + Ticarcillin or

Beta Lactamase
inhibit beta lactamase (no Amoxicillin; Sulbactam +
Inhibitors (Clavulanic
antibacterial activity by Ampacillin; Tazovactam +
acid, Sulbactam,
themselves) Pipercillin/Mezclocillin
Tazobactam)
(combos needed x activity)
Red Man SSx, (hives, HoTN,

flushing, rush, chest pain); IV (IM) via slow infusion
(staph aureus, C. diff, Bact chg the D-ala D-ala
cell wall sythesis inhibtr ototoxic, injx site irritation,, rash, AG + vanc = Synergistic to avoid Red Man SSx,
Vancomycin G+ commonly used x PNC so drug has nowhere to
via binding D-ala D-ala chest pain, hypotension, Nephrotoxicity oral x gut bact (e.g C.
resistant drugs) bind
synergistic w Nephrotoxic diff)
drugs (AG)
(staph infx that don't RE topical

Nephrotoxic if given IV (less so Synergistic w other
Bacitracin cell wall synthesis inhibitor to PNC meth, oxa naf or intrathecal/pleural
if given orally) nephrotoxc drugs
cloxacillins) (IV/IM)
detergent, cell membr

Polymixin B G- infx Nephrotoxic if given IV topica (ophthalmic/otic)
disruption
detergent, cell membr Circumoral paresthesias if IV,
Colistin Sulfate G- infx
disruption nephrotoxic
AntiFolates
Sulfonamides
or Combos
incr warfarin activty (wfn is gluc6phos DH defx (NADPH

compeltes with paba for good distribution, bound to
bumped off plasma prot by is depleted and can't reduce
coupling enzyme so bact StvJonSSx (from long lasting plasma prot making it
none but alt x (UTI, sulfmds causing unwanted G6PDH-causes hemolytic
Broad Spec can't make vit. B9. free sulf Rx), decr vit K synth(by difficult to metabolize, renal decreased permeability,
nocardiosis, shigella, bleeding); hydantoin (same anemia), AIDS, kernicterus
GENERALLY (G+ cocci, G- drug is active drug; pH wiping out gut bact), excretion (unchanged), coupling enzyme pills, orally, cheap :D
trachoma, chlamydia, as wfn but is an (new borns; bumps off
cocci/rods dependant (will crystalize hypoglycemia/GI, hepatitis, acetylation in liver loses changes, paba prodx incr.
pneumocystis jirovechi) anticonvulsant), incr T1/2 bilirubin and causes mental
out at low pH so drink lots crytalluria, CNS-rare-, activity but retains toxicity,
Phenytoin (competes x retardation), allergic to SO2
of water T1/2 depends on kidny fx
micrsomal enzx), (e.g. Celexa)
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
Inhibit folate synths sulfa w trimethoprim (UTI,

(Folate to FH2; or FH2 to StvJonSSx, hypersensitivity, prostatitis, otitis med, chronic
Depends on
Small Molec Antifolates thymine derivatives THF4) Thymine (malaria) GI, megaloblastic anemia, N/V, bronchitis, pneumocystis prodrug incr folate reductase
R1, R2
Derivative, some are anemia, incr serum creatinine jirovechi (not AIDS pts)
prodrugs shigellosis, toxoplasmosis
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 Synthesis Inhibitors

Quinilones
or Combos
(STD, UTI, GI infx, URI,
DNA gyrase - SSTI, bone/joint infx
GENERALLY topoisomerase II (G-) or IV {better vs sulfa}, TB,
(G+) mycobacterium avium
cmplx)
(STD, UTI, GI infx, URI,

DNA gyrase - SSTI, bone/joint infx
Nalidixic Acid topoisomerase II (G-) or IV {better vs sulfa}, TB,
(G+) mycobacterium avium
cmplx)
DNA gyrase -
Cinozacin topoisomerase II (G-) or IV
(G+)
Fluoroquinilones
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,
Liver metabzd, Excreted in

DNA gyrase - urine/bile (depends on
Ciprofloxacin ANTHRAX NVD, HA, abnml LFTs,
which) acid pH decr activity,
children, preg Fem
topoisomerase II (G-) or IV
(G+) rapidly absorbed,
DNA gyrase -
Levaquin/Levafloxacin topoisomerase II (G-) or IV NVD, HA, abnml LFTs, children, preg Fem
(G+)
DNA gyrase -
Norfloxacin topoisomerase II (G-) or IV
(G+)
DNA gyrase -
Ofloxacin topoisomerase II (G-) or IV
(G+)
NOT a quinolone, but

Nitrofurantoin damages DNA. unk UTI RARE-liver, lung, GI, skin pts w severe renal insfx
Protein Synthesis Inhibitors
or Combos
stop ribosomal complex
G+, G-, Broad
GENERALLY from moving, disrupt aa depends on geography conjugation oral
Spectrum
binding
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]
Binds to 50S ribosomal

H. flu, mycobacterium decr cytochrome P450
Broad subunit, inhibits
Clarithromycin Macrolides avium (AIDS pts usu), H. activity so other Rx/herbs
Specturm translocation step and
pylori have more activity
inhibsc cmplx formation
(mycobacterium avium,
Binds to 50S ribosomal
Toxoplasmosis
Broad subunit, inhibits
Azithromycin Macrolides encephalitis, chlamydia
Specturm translocation step and
urethritis) Erythromycin
inhibsc cmplx formation
1st
too toxic to use, 50S

Lincomycin (not used 50S inhibition,
Lincosamides Broad inhibition, blocks antagonize macrolides oral (w/ food?)
anymore) translocation inhibition
Specturm translocation step
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
Gradual reisistance via R

factor and efflux,
Chelates heavy metals (Ca, overuse. Cross
GI (staph enteritis could cause
Mg) which reduces Lower dose if kidney disfx. resistance w
Brucella Bacteroides superinfx), hypersstvy,
Broad 30S inhibition previnting t- absorption; TTCCL Excretion depends on GFR streptomycin,
(Lyme, spirochetes, photosenstvy, liver damage, oral not so good
Tetracycline Tetracycline Specturm G+, aminoacyl binding; inhibits decreases activity of BCPs (except for minocycline and erythromycin, ampicillin,
mycoplasmas amebae, renal damage, dizzy/vertgo, absorption, IM/IV
G- fMet tRNA from binding via killing gut bact needed for doxycycline); kids <10 preg chloramphenicol,
cholera, STDs); SIADH damage to teeth/bones causes
BCP activation; fem oxacillin, and
discolored teeth
PNC+TTCL=antagonistic cephalosporins. G- usu
have cross resistance w
chloramphenicol (not G+)
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;
Broad Carbamazepine + doxy =
30S inhibition previnting t-
Doxycycline Tetracycline Specturm G+, Lyme teeth discoloration decr doxy lvls via induction; oral good absorption
aminoacyl binding
G- PHB + doxy = decr levels via
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
or Combos
resistance via R factor

transfor; mutation of 30S
unchgd excreted form by subU; adenylation in
CN VIII damage, renal kidny via GFR; short T1/2, kanamycin streptomycin,
prot synths inhibition; cell damage allergic dermatitis low TI, dosing schedule is renal disfx incr plasma lvls so gentamycin, tobramycin; IM, subQ, oral (x gut
Narrow (G- rods causing ototoxicy if +Ethacrynic
GENERALLY Aminoglycosides membr damage via; binds (topical), neuromuscular jx tricky so instead of lots of lower dose; synergistic renal phosphorylation in infx; bad absorption in
Spectrum G- meningitis) acid
to 30S ribosome blocker, vertigo, dysmetria, small doses Rx is a few tox w other renal toxic drugs kanamycin, streptomycin; gut), intrathecal, topical
+Romberg sign heavy doses instead of lots acetylation in kanamycin,
of small doses neomycin, tobramycin,
amikacin, gentamycin
strreptoycin
Must combo w other TB

vestibular system disruption,
inhibits fMet binding; drugs; strpmcn + PNC to tx
hearing loss if high doses,
inhibits translocation step enterococci; DO NOT GIVE
peripheral neuritis, facial
Streptomycin Aminoglycosides (aminoacyl binding to TB (must combo); plague ALONE b/c resistance mutation of 30S subU IM (no CSF distribution)
paresthesia, NMJ blocked in
tRNA); require O2 for develops quickly; synergistic
high doses, rash/hives, kidny
transport thru cell walll activity w Erhthromycin to tx
damage
Strep faecalis endocarditis
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
Genta + Carbenicillin = decr

genta activity via chemical
Pseudomonas resistant
rxn; Genta + Cephalothin =
to Polymyxin
synergistic nephrotoxicity via
B(Klebsiella, Proteus , Nephrotoxic, vestibular intrathecal (CNS
Gentamicin Aminoglycosides G- tubular necrosis; Genta + Renal excretion via GFR
G- rods causing ototocicity, CNS toxicities toxicities)
Polymyxin B = synerg
meningitis; E. coli, );
nephrotoxicity and NMJ
Plague
block; Genta + Kanamycin =
synerg ototoxic effects;
Viomycin Aminoglycosides 2ry choice x TB arises quickly
pain at injx site, hives, N/V,

gonorrhea in urethra,
insomnia, dissiness; rare- pts sensitive to PNC usu Ineffective in extragenital
Spectinomycin Aminocyclotol 30S subU inhibitor prostate or cervix if N. IM
renal/liver damage, incr BUN, tolerate spectomycin gonorrhea/syhp
gonorrhea is susceptible
decr clearance, incr LFTs
Streptogramins
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
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),
Use only in hospital w fatally

ill pts and make sure pt is
VERY TOXIC: NEPHROTOXIC, "healthy" enough to take th
.3 mg <MIC< hypersensitivity, chills, fever, Rx. Daily dose not to exceed
severe deep fungal infx DO NOT EXCEED 4g else
1 mg. Dose is binding to sterol causes phlebitis, HA, anemia, anorexia, 1.5 mg/kg; AmphoB allows topical, IV (low doses
Amphtericin B Polyene (e.g. meningitis, bone, renal damage, do LFT's, N/A
2x MIC that cell membrane leakage decr renal fx HoTN, hepatic Rifampicin (usu bact Rx) to long time, .5mg/kg)
pnemonia); topical renal fx test b/f tx
lab gives you. failur, jaundice, hepatocullular penetrate fungal cell wall and
disfx, kill fungi, but is toxic to host);
intrathecal administration
causes chemical meningits
Imidazoles/Triazoles
topical, oral (being

Keto + antacids decr keto
systemic infx replaced by
inhibits cytchrP450 (disrupts activity b/c keto needs acid
Inhibition of ergosterol (coccidiomycosis, itraconazole and
Broad steroid hormone metbz and environment to be
Ketoconazole syths causing membr paracoccidiomycosis, vriconazole; voricon
Spectrum other drug metabz), elevates soluable/active; keto +
disruption histoplasmosis-formally does not inhibit P450
LFT's cyclosporine incr cyclosp lvls;
txd w Amph B as much which is good
keto decr steroid metablzm
for polypharmacy)
Deaminated to 5fluoracil
(active cmpd) which
replaces U in mRNA
Usefulness lmtd b/c cytopls
Candida resulting in screwy
membr not permeable to
albicans peptides. Also converted Fatal Bone Marrow
Candida albicans 5Flu, so AmphoB HIGH lots of things
5-Flucytosine (Cryptococcus to Depression, diarrhea, AIDS pts prodrug oral (good absorption)
(Cryptococcus) potentiates 5-flu become resistant
, Torulopsis, 5fluorodeoxyriboseMonoP have trouble tolerating
effectiveness (tx x Candida
Aspergillus) hos. Which inhibits
& cryptococcus infx)
thymidylate synthase.
Basically commits
suicide
binds to cell membr,

skin and nail infx, Gris + PHB decr Gris lvls
kills(?) growing fungi by
athletes foot. by decr absorption; Gris +
disrupting mitotic spindle. oral (good absorption if
(Microsporum, warfarin decr warfarin activity
Binds to host keratin mild; HA (gone in a few days), eaten w fats), IV. Up to
Griseofulvin fungastatic trichophyton, by induction; Gris induces N/A
creating an environment memory probs, GI 12 mos to treat
Epidermophyton; athletes prophyrin synths causing
where fungi can't grow dermatophytes
foot and stuff): (systemic porphyria attack to those pts
and the fungi is shed w
x candida albicans) w porphyrias
natural shedding process
Tinea pedis, cruris,

Inhibition of ergosterol synergistic with coumadin
Broad vesicolor (vulvovaginal systemic - arrythmias, phlebitis, low vit K, pts taking topical, not given
Miconazole syths causing membr (anticoagulate), use if
Spectrum candidasis) HA anticoagulants systemically
disruption AmphoB not an option
coccidiomycosis
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)

or Combos
Tinea pedis, cruris,

Undecylenic Acid Fatty acid? ??? GI topical
vesicolor, ringworm
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)
Inhibits beta 1-3 glucan Aspergillosis after

Caspofungin Echinocandin Aspergillosis nyeh, GI, incr LFT
syths AmphoB has failed
Anti TB Drugs
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
Seizures (esp if predisposed), ppl w seizures, depression

Cycloserine 2ry must be given w B6
peripheral neuorapothy (exacerbated)
Ethionamide GI, HoTN, liver toxicities

Levofloxacin
Viomycin AG 2ry prot syths inhibitor 2ry TB ototoxicity
Kanamycin AG 2ry prot syths inhibitor 2ry TB ototoxic nephrotoxic
Amikacin AG
must combo; maybe can

use AmphoB to let rifampin
into fungal infx; Rifampin +
AminosAcid block the
TB combo, active
absorption of the other from
systemic TB, TB
gut (bad thing); INH + INH+Rifampin have additive
inhibits RNA polymease mingitis,eradication of reare hepatitis, turns host
Rifabutin/Rifampin 1ry Rifampin + Pyraz + induces P450 liver toxicity <-toxicity; causes from RNA pol mutation
(initiation step) meningiococcal carrier fluids orange, flu like ssx
Ehambutol or Streptomycin is loss of BCP activity
state; Mycobacterium
standard 4 Rx tx. use INH +
avium
Rifampin + pyrazinamide
(lose pyr after 2 mos); INH
+Rifam+Ethambutol is safe x
preg fem
2ry agent
ototoxicity, renal toxicity (not as
Capreomycin peptide when 1ry no
bad as AG)
longer useful
Rifampin + AminosAcid block

the absorption of the other
2ry b/c of GI bad diarrhea b/c of high dose
Aminosalicyclic acid folic acid synths from gut (bad thing); BCPs requires 8g per day
probs (8g)
lose effectiveness; induction
of liver;
Ciprofloxacin

Ehambutol or Streptomycin is prodrug (active cmpd is
isonicotinic acid uses up
INH metabolit causes toxicity standard 4 Rx tx. use INH + converted by catalase to oral good absorption;
causing OH buildup in cell; mutation of catalase TB
1ry TB tx, NO B6 defx, peripheral neuropathy; Rifampin + pyrazinamide isonicotinic acid); LONG Treat <20yos. DO NOT prophylaxis x 9 mos if
Isoniazid interferes w mycolic acid TB combo has high mutation rate so
G-/+ activity liver toxicity esp w EtOH (lose pyr after 2 mos); INH T1/2 you can give; TREAT if >35yos evidence of expossed
synths causing cell wall selectivity is common :(
(death); szr if prone; +Rifam+Ethambutol is safe x acetylation inactivates; (only prophylaxic tx
damage
preg fem; give w B6; INH P450 metabolism
inhibits metbz of Phenytoin

Ehambutol or Streptomycin is
TB combo, retrobulbar neuritis @ high standard 4 Rx tx. use INH +
1ry TB tx, NO mycolic acid inhibition ro
Ethambutol mycobacterium avium doses (decr visual acuity, red Rifampin + pyrazinamide excreted in urine/feces DO NOT use in kids oral
G-/+ activity RNA syths inhibtion
cmplx green color blindness) (lose pyr after 2 mos); INH
preg fem
Ehambutol or Streptomycin is
standard 4 Rx tx. use INH +
Liver Toxicity TOXICITY HIGH if tx w/o other
Pyrazinamide 1ry reinfection Rifampin + pyrazinamide
MANDATES hospitalization drugs
(lose pyr after 2 mos); INH
preg fem
Dapsone Leprosy use 3-4 leprosy mx to start

Clofazimine Leprosy use 3-4 leprosy mx to start
Amithiozone Leprosy use 3-4 leprosy mx to start
pregnant women (day 20-50
Thalidomide Leprosy teratogen use 3-4 leprosy mx to start
cuases seal limbs in fetus)
Ethionamide 2ry Leprosy use 3-4 leprosy mx to start
AntiViral Drugs
or Combos
do not use w bactrim, NOT USED

Amantadine and nervousness, depression,
prophylactic tx of Flu antihistamines (causes CURRENTLY B/C OF decr dose in elderly b/c
Rimantadine (better Blocks binding to cell epilepsy esp if prone to decr dose in geratric pts
A2 in elderly (parkinson) neurotoxicity; esp in older RESISTANCE IN ALL of decr renal fx
mx) psychosis
ppl, hmmm) STRAINS OF FLU
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
(herpes keratitis from

herpes type I, if at high doses stops host DNA
(DNA viruses systemic - allopurinol + vida topical, (systemic-
replaces adening to stop idoxuridine not available); synths (polymerase); deamination causes
Vidarabine purine via decr causes decr activity of gout HARDLY); acyclovir is
DNA synths chicken pox, herpes carcinogen, teratogen, inactivity; prodrug
synthesis) mx better
encephalitis via systemic; mutagen
ocular herpes infx
neurotoxic, flu like ssx usu

inhibit virus binding by Chronic Hepatitis (B, C)
resolves in days, bone marrow
Interferon alpha binding to virus; inhibit at (Karposis sarcoma, must be taken for 1 yr
suppresion, exacerbate
all steps of virus rep melanoma)
depression/suicide
inhibits viral DNA

Herpes (all kinds and inactivated if taken w
Acyclovir purine polymerase; syths prodrug
manifestations) allopurinol
inhibition
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

constantly turning over via mt combo prodrug concerted to
Lamivudine NRTI termination and slow replx prophylaxis x exposure @ low lvls or monothpy
toxicity; lactose acidosis, liver Lamivudine+Zidovudine nucleotide
transcriptase

constantly turning over via mt combo Tenofovir + prodrug concerted to
Emtricitabine NRTI termination and slow replx prophylaxis x exposure @ low lvls or monothpy
toxicity; lactose acidosis, liver Emricitabine nucleotide
transcriptase
incorporation into DNA damage tissue that are

causing early DNA HIV @ all stages; constantly turning over via mt
combo Tenofovir +
Tenofovir NRTI termination and slow replx prophylaxis x exposure toxicity; lactose acidosis, liver NOT prodrug @ low lvls or monothpy
Emricitabine
by blocking reverse and newborn failure low platelets, renal
transcriptase insfx
nonompetetive inhibitor of
Efavirenz NNRTI HIV @ all stages; teratogen cytP450 indux preg fem, liver disfx @ low lvls or monothpy
reverse transcriptase
HIV @ all stages;

inhibit final prot metabz of long lasting DM, combo w low dose Ritonavir, @ low lvls or monothpy;
Atazanavir Protease inhibitor prophylaxis x exposure
HIV prot hyperlipidemia, diarrhea then combo w NRTI cross resistance
and newborn
HIV @ all stages;
Fosamprenavir Protease inhibitor prophylaxis x exposure
and newborn
HIV @ all stages;
Lopinavir Protease inhibitor prophylaxis x exposure
and newborn
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
painful injx; incr chance of bact @ low lvls or monothpy;

Enfuvirtide Fusion inhibitor; peptide binds to gp41 HIV @ all stages don't give if allergic injx
pneumonia cross resistance
AntiParasitic Drugs
AntiMalarial
or Combos
DNA replication disruption;
GENERALLY sulfa drugs, trimethoprim,
B9 syths inhibition
quinolones
as prophylactic tx must
Excreted in tears absorbed if Plasmodium sp can't
be given x 6 mos
by corneal epithlm causing concentrate in cell then
use during erythrocytic Coadministration w straight after leaving
Binding to DNA inhibits GI, HA, malaise, vertigo, blurry edema and opacifications mx won't work;
Chloroquine Aminoquinolone phase of maria cycle; Primaquine is required to endemic area.; as
nucleic acid synths vision. of cornea (retinal aa constrx falciparum is chloroquine
schizonticide; tx /prevent relapse; suppressive therapy
causes retinal ischemia and resistant and reqs
2.5 g orally w/in 3 days,
visual impairment) cinchona and anti-folates
IM if necessary;
blood schizonts of P prophylactic vs
interference with w fine not active vs P falciparum;
blood falciparum, vivax, chloroquine resistant
Mefloquine coordination and spatial pts w epilepsy or on
schizonticide Prophylactic ovale, falciparum, ovale,
discrimination psychiatric mx; pregn
malariae vivax;
Hydroxychloroquine
injx site irritation, retinal

ischemia, hearing loss, ringing
in ears, dizziness, N/V/D;
gamete of all Severe-blindness, deafness, usu given w anti-folates,
Plasmodium Binding to DNA inhibits Chloroquine resistant vertigo, HoTN; pyrimethamine + no resistance and we IV/IM? as blood
Quinine Cinchona alkaloid
sp EXCEPT nucleic acid synths falciparum sp thrombocytopenia, purpura, sulfadiazine/dapsone (x don't know why schizonticide; oral
falciparum hemolytic anemia, choroq resist falciparum)
agranulocytosis, blackwater
fever (hemolysis, clotting, renal
failure uremia, death)
Chloroquine must be given w

tissue
Exoerythrocytic P vivax well tolerated; acute hemolytic Prima for complete tx; + no resistance and we
Primaquine 8-Aminoquinolone schizonticide; ppl w Gluc 6 P DH defx
and P ovale anemia 4aminoquinolone x don't want any
gametocidal
prophylaxis
Chloroquanide
b9 defx, macrocytic
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
plasmodia,
Trimethoprim reductase inhibiting folate resist falciparum sp usu megaloblastic bone marrow;
sporozites
synths in combo w other mx leukopenia, granulocytopenia
rare
GI, N/V/D, dermatitis,

Diaminodiphenyl Folic acid inhibition b/c it is crystalluria, hematuria,
ppl w Gluc 6 P DH defx
Sulfone (DDS) a paba analog hemolytic/aplastic anemia,
granulocytopenia
Sulfa
Trimethoprim +
Bacrim+Amant=neurotoxicitie pts taking amantadine, old
Sulfamethoxazole
s in geriatric pts pts
(bactrim)
Amebicides, AntiProtozoal Drugs

or Combos
Metronidazole teratogenic
Diloxanide furoate
Iodoquinol
Emetine
Dehydroemetine
Chloroquine
Suramin Na
Melarsoprol
Na Stibogluconate
Pentamidine
Isethionate
Nifurtimox
Quinacrine
Atovaquone

or Combos
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
75% of cases in Males unk reasons. Nocardiosis-Pulmonary inf as

50% of cases to immunocompr, transitory or chronic, rarely
Nocardia asteroides AIDS, EtOHics, cancer, chrnc necrtizing, w/ many large abscesses.
pulmonary inf. Orgsms are wrdwde, 2)May disseminate to organs w/
soil and aquatic. predilection to brain
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
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
Teponema pertenue Children, Warm tropics Yaws-looks like warts on skin.

Pinta-Looks like skin is peeling, or
Treponema carateum Children, Warm arid tropics
becoming unpigmented
Bejel/Endemic-Mouth lesions, skin
Treponema syphillis Children, Arid subtropical lesions, granulomatous lesions on
skin nasophrx, bones
Relapsing Fever Tick Born (B.
Borrelia recurrentis, recurrentis)-More relapses but less
hemsii, turicatae, severe. Louse born (B. hermsii,
parkerii turicatae, parkerii)-Usu only one
severe febrile episode
Lyme Disease 1)Primary stg-

Borrelia burgdoferi, Worldwide Reservoirs-Deer, mice erythema chronicum migrans
garinii, afzelii Vector-ticks 2)Secondary stg-rash, arthrits, neuro,
cardiac 3)Tertiary stg-arthritis
Leptospirosis-usu subclinical may

Leptospira interrogans,
Reservoirs-animals (e.g. cows) cause fevers, conjuctivitis, Icterus
biflexa
jaundice Kidney/Liver dss
More Notes:
Oral Microbiology
General features Bact of supragingiva is mostly G(+) sp. Bact of subgingiva is mostly G(-) sp. Disru
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 due to 1)Periodontal Disease-Gingivitis,
endotoxins of G(-) bact Periodontitis, Periodontosis,
2)Immunologial-allergic Periodontal Abscess, Drug
rxn of gingiva to induced gingival Hyperplasia,
mouthwash/toothpast, ANUG, Primary Herpetic
pemphigus vulgaris, stomatitis, Recurrent Herpetic
lichen planus, neoplastic Stomatitis, Herpetic Whitlow,
dss, carcinoma Aphthous Ulcers, Candidiasis,
3)Traumatic-blunt Hairy Tongue, Dry Socket
trauma, plaques, 2)Endodontic-Pulpitis
chemical (aspirin is
caustic to epithelial
tissue)
Legionella and Bartonella

General Features 1)Peru Ecuador, Colombia 2)G(-) rods fastidious (needs humidity w/ CO2) 3)
M>F 2:1, 50+yo, Summer, Smokers,

1)Legionairres dss-Flu like ss(x)
EtOHics, immcomrsd, pulmo dss
Legionella pneumophilia Fatal 2)Pontiac Fever-Flu-like ss(x)
Spread via aerosol e.g. swamp
Self-limiting
coolers
1)Bartonellosis-Acute anemia
1)Peru Ecuador, Colombia 2)G(-) verruga Anemia caused by removal
rods fastidious (needs humidity w/ of infd sensitized RBC's, HA Myalgia.
Bartonella bacilliformis
CO2) 3)Spread via sandfly Anemic phase ends when humoral
Phlebotomus RE induced Chronic Bartonellosis w/
cutaneous lesions1-2cm for years
1)"Trench Fever"-Fevers at 5day

1)Spread via human louse Pediculus intervals 2)Most commonly HA, xtrm
Bartonella quintana
humanus wkns tibial pain Varies fr ass(x) to
debilitating 3)Angiomatosis
1)Car Scrath Dss-Lymphadenopathy

Bartonella henselase at site of inf 2)SBE 3)Bacillary
Angiomatosis
Parasites
SubKingdom Protozoa
Reservoir: Only Humans thus

human-human transmission only via
1)Amoebic Dysentery-abd pain,
fecal contaminated H2O w/ cysts.
cramps, colitis w/ diarrheaBloody
Flying bugs can transport feces cysts
Entamoeba histolytica stools w/ 25poops/day. (R lobe of
from feces to food Common in
liver may be infrupturelung inf.
Tropics 1)Prot defx, Pregnant,
Length of illness days-yrs
immdfx InfDss, but may assx
carriers.
WrdWde Childrn<10yo e.g. daycare

centers Homosexual Males 1)Giardia-mild drrha to
Reservoir:dogs, muskrats, sheep, malabsorption syndrm, foul dirrha,
lakes, rivers aka "backpackers dss" abd cramps, farting, steatorrha
Giardia lablia
Transmission fecal-oral cyst is Malnutrition b/c G. lamblia absorbs
infective form Flying bugs can fat sol. stuff like beta carotene, B12
transport feces cysts from feces to exacerbating malabsorption syndrm
food
Balantidum coli
WrdWde, Fem Mosquito is vector.

Mosqo ingests diff sex sp., male
matures to magetes female into
macrogamete, fertilization forming
zygote/ookineate/oocyst, oocyst
1)Malaria-Early flu-like ss(x),
turns to haploid sporozites,
Plasmodium falciparum Nausea, vomiting drrha, HA fever
sporozites goto mosqo saliva glands,
convulsions, joint pain
inf humans. In humans sporozites
goto hepatocytes to become
merozoites, release, inf RBC's,
mature into trophozoites, merozoites,
rupture, release more merozoites
Coccidian parasite, Cat is vector and

reservoir. Immcprsd and pregnant
are at risk. Cat eats cyst, cyst turns 1)Toxoplasmosis-Acute:chills, fever,
Toxoplasma gondii into trophozit, trophozit turns to HA fatigue, lmphadenitis, myalgia
oocyst, cat poops, humans ingest Chronic:rash, encephlitis, myocarditis
oocyst, oocyst turns into sporozit, inf
and dss
Children under 5, Americas Kissing

bug is vector, inf but poops on
human skin causing irritation, human
scratches inf into skin, inf. 1)Chagas Disease-Inflamntn,
Trypomastigotes invade phagocytic swelling, facial rash/edema, death
Trypanosoma cruzi
cells, develp into amastigotes, bea CNS damage (esp in chldrn) and
multiply, ruputure, mature to myocarditis
trypomastigit form, inf new RBC's
(get picked up by new Kissing bug).
Many reservoirs.
Trypanosoma grucie g,
Africa Tse Tse fly is vector 1)African Sleeping Sickness
rhodosaiense
More Notes
SubKingdom Metazoa
General Features Phylum Nematodes
1)Found in 2/3 of world esp

1)Adult worms no acute ss(x) 2)GI
(sub)tropics and areas w/ sanitation
obstr, abdom pain oral expulsion
Ascaris lumbricoides 2)Most prevalent in Asia SthEast
3)Lung phase w/ pulmonary ss(x)
USA 3)4-14yos 4)Access to hlthcr,
(Ascaris coming out of anus?)
hygeine, soc.ec cond's also factors
1)Enterobiasis-usu ass(x) but ss(x)
1)Temperate climates 2)5-10yos = perianal pruritus at night, anorexia
Enterobius vermicularis 3)Adults inhabit cecum Most irritability abdom pain Sometimes
common helminthe inf in USA fem w/ vulvovaginitis or peritoneal
granulomas
1)Skin-Larva currens (fast

advancing skin lesion usu on
1)Indigenous to S.E. USA (KY, TN,
Stronyloides stercoralis perineum or trunk 2)GI-bloating,
FL LA etc) esp veterans
anorexia nausea 3)Pulmonary-
nonspcfc
1)inhabit lymph syst and subq tiss 1)ass(x) 2)Acute Lymphadenitis w/

Wucheria bancrofti
Larva is inf agent Tropical fever Elefantitis(?)
Phylum Platyhelminthes Class Trematodes

General Features Nutrient uptake via absorption Nonsegmente
Schistosoma mansoni hepslpleenomegally
Fasciolopsis buski Asia Metacercariae is inf agent
Class Cestodes
General Features Head w/ scolex suckers, hermaphroditic, no gut, nutrients via abos
1)T solium-passing of gravid

wrldwde Humans only definitve host
proglottids >13branches/glottid thus
T saginata no hooks Larval cyst in
Taenia solium major concern is develping
undercooked meat is inf agent High
cystercosis 2)cystercosis-depends
in Latin America/Africa low in USA
on where cyst is Neuro is fatal
1)T sagomata-abd pain, passing

wrdwde High in Latin america low in
proglottids 15-20branches/glottid
Taenia saginata USA T solium has hooks, Eggs of
2)cystercosis-depends on where cyst
undercooked beef are inf agents
is, Neurocyst can be fatal
WrdWde Egg causes inf Larva
Echinococcus causes dss Protoscolios inf dogs Cystic echinococcosis Hydatid Cysts
granulosus dogs poop eggs other wldlif/humans Can Be Found In Liver
infected
Rickettsia and Ehrlichia
I) Rickettiosis
A)Typhus Fever 1)Epidemic/Louse

Human/Rat Louse (or flea) bornTyphus-Fever HA myalgia, rash
(respectively) is vector/reservoir, on 4th day (1st on trunk then limbs
Rickettsia prowazekii Louse dies b/c of inf, Africa, S. usu not face), Maculopapular rash w/
America. No person-person petechia, CNS dsf(x)(stupor
transmission G(-) delerium), uremia Brill's Disease is
remanifestation usu mild w/o rash
2)Endemic Flea Born Typhus-

Same as Epidemic but less severe
R. typhi Texas G(-)
Rash first on appendages THEN
trunk
B)Spotted Fever 1)Rocky Mt.

E. USA, campers/hikers. Roden/Dog Spotted Fever-incubation x 5days,
ticks are vectors. Ticks are vecrtor HA fever myalgia, maculopapular
Rickettsia rickettsii
and reservoir. Ticks not killed by inf rash w/ petechia on 4th day on
G(-) hands feet then trunk face. Death via
circulatory collapse/kidney failure
2)Boutennese Fever milder form of

R. conoria G(-) RMSF Rash first on trunk then
appendages
Transmitted by mite bite of house 3)Rickettsialpox Rash first on trunk

R. akari
mouse G(-) then appendages
SE Asia, Australia. Transmitted by C)Scrub Typhi Rash first on trunk

Orienta tsutsugamushi
chigger G(-) then appendages
Farm/Rural area, Slaughterhouse D)Q Fever Rash first on trunk then

Cocellia burnetti
workers appendages
Ehrlichia ewingii Wisconsin, Minnesota E)HumanGranulocyticEhrlichiosis

omycetes
s too far away. Reason for removal is usu. Cosmetic
Key Diagnostics Treatment Notes
1)examin sputum, pus

tissue, cervical exudates
for granules and
1)PNC 2)tetracycline, Part of normal flora.
filaments >1mcmtr side.
clindamycin, Propylactics used by
2) Culture ID via morph,
sulfonamides. 3)surgery dentists and after
gram stain (+) and
to drain lesions trauma.Nonsporeforming
fimaments.
3)Facultative
anaerobes
20-30% fatal 1)Log phase

1)Distinguish from TB more virulent vs stationary
2)Exam sputum for G+ phase. Virulence due to
orgs 3)Culture ID via 1)SFM-TMP 2)surgery penetrating growing tip.
morph, Aerobic growth, Effect lysozome fx. Virulent
partial acid fast forms grow out of
macrophage
1)Long term antibx.

1)Examine pus for
PNC(Actinomyces),
granule and verify size,
Chloramphenicol
color, G+ w/ bact
Sulfonamides (Nocardia) inf by traumatic
filaments<fungal filmts
Streptomycin implantation
2)Culture ID via morph,
(Actinomadura,
cell wall composition,
Streptomyces)
use for verification
2)Amputation-last resort
ochetes
al shaped, Nonsporulating, Motile
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
Transmission via mouth-

mouth contact Usu not fatal
Borrelia in blood, stain Tick born is Endemic.

w/ Giemsa. Must take 1)Ttrcycln, Erythromycin Louse Born is Epidemic.
sample DURING febrile 2)JH rxn Relapses progressively
stage. milder. Death via CV probs
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
Only spirochete resistant to
envrnmnt outside body thus
is the only spirochete that
1)Long course antibx
1)Darkfield microsc can be cultivated.
2)Vaccinate livestock
Transmission via soil, H2O,
food, inf tissue,
congenital(rare)
crobiology
of subgingiva is mostly G(-) sp. Disruption of these proportions disease.
1)Caries excavation.
?
Restore missing s(x)
and Bartonella
astidious (needs humidity w/ CO2) 3)Spread via sandfly Phlebotomus
G(-) rods Stain better w/

silver stain Antiphagocytic
Antibodieskilling Cytotoxin
inhibits PMN respiratory
1)Flurosc antibody 1)Erythromycin 2)
bursts Macrophages may
staining 2)Culture fr lung Rifampin
kill Orgs produce B-
lactamase Two other
Legionella spp w/ diff DNA
but same ss(x)
Gentamycin 1)Can be found w/o dss.
1)Can be found w/o dss

Gentamycin
2)may cause SBE
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
Phylum Sarcomastigaphora
20m. 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 IngestionStomachHCl
paromomycin 3)Improve
dissemination 3)Ab to release trophozoites in
sanitation
testing, ELISA, PCR dudnemAttachment to
host cell and destruction
Phylum Sarcomastigaphora
1)Exmn stool x Class Mastigaphora
trophozits (fresh smple) Cyst*chlorine resistant*
usu billions of trophzits, IngestionStomachHCl
Smple at diff time to release trophozoites in
intervals b/c neg sample 1)Metronidazole, dudnem and
inf, Cysts are 11m furazolidine, quinacrine. jjnmtrophzits 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)Exmn RBC's for 1)Mefloquin-orally

rings 2)PCR or Ag Quinine-IV both to treat Phylum Apicomplexa
detction blood and liver
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
1)Thk/Thn blood films

for trypomastigotes
1)Nifurtimox (has little
2)Biopsy-of nodes,
affect on tissue inf) 2)Na
spleen, liver for Kissing bug eradication as
Stibogluconate w/
amastigotes control method
Meglumine
3)xenodiagnosis-inf
antimoniate
clean kissing bug w/ p(t)
blood
SubKingdom Metazoa
Phylum Nematodes
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 250m 1)Ivermectin or
2)worms don't need to
orgnsm=intestinal inf Thiabendazole, but usu
leave body to finish life
600m 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
blood/tisse parasite Mosqo

1)interruption of dss w vector
1)Microsc ID of
Albendazole+Ivermectin(
mcrofiliariae of blood
or Diethylcarmazine) for
sampls at night 2)ICT
5 yrs Alleviate/prevent-
for Ab-Ag rxn.
lymphedema mngnmt
s Class Trematodes
uptake via absorption Nonsegmented
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
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
1)worm inf dgx via eggs

in stool 3mos post inf ID 1)Praziquantel for worm
of progolittid for inf. 2)Albendazole or
speciation 2)cystercosis- Praziquantel for
cysts in involved organ cystercosis 3)Surgy to
Eggs in feces Ag-Ab remove calcified cysts
tests
Imaging Serological
tests should be used b/f Surgry w/ postop
invasive methds, Albendazole
Immunoassys
and Ehrlichia
kettiosis
Flea born Typhus-Rash

on arms/legs THEN 30%fatal Flea born Typhus
Ttcycl, Chloramphenicol
trunk Tick born-Rash is wrdwde Not fatal for
w/in 7 days onset
on trunk first then fleas. Fatal for louse
legs/arms, serology
w/in 7 days onset
inf in tick is everywhere,

<60%fatal w/o t(x).
Rickettsia live in nucl of cell
w/in 7 days onset
2 and 3 caused by diff sp
vs 1)
w/in 7 days onset
w/in 7 days onset
w/in 7 days onset
w/in 7 days onset
Severity of dss b/c of high
[endotoxin] Vector control
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
Black Piedra-Black gritty nodules
Pedraia hortai
in hair shaft
Temperate climates, sporadically in S. White Piedra-soft, mucilaginous,

Trichosporon beigelii
U.S. light colored nodules on hair
Tinea nigra-Chronic asymptomatic

Teenagers, female, U.S. Gulf Coast,
Exophiala werneckii infection of stratum corneum usu of
FL, warmth of Caribbean
palm
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
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 w/
M. audouinii children, worldwide scaling to inflammatory lesions of
glabrous skin
Tinea crurus (jock itch)-Lesions
usu males. Favors humidity are sharply demarcated raised
erythematous border
Most common, affects millions Tinea pedis (athletes foot)-often

Trichophyton
worldwide begins on 4th/5th digit
usu occurs w/ tinea pedis Tinea manum-infection of hand
Tinea unguium-nail infection
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
Sporotrichosis-4 clinical types: 1)

Found worldwide, endemic areas in cutaneous lymphatic-75% of
Brazil, Mxco, Zimbabwe. 75% of cases. Leads to necrotic lymph
Sporothrix schenckii cases male, in U.S. associated w/ nodules progressing along lymph
horticulture/gardening as occupational vessels 2) cutaneous non-
hazard. lymphatic-"fixed" form, found in
endemic areas
Mycetoma (Eumycetoma)-
localized, swollen, lesion with pus
1ly in males b/c of exposure.
on foot or hand. Pus contains
Pseudallescheria boydii Wolrdwide w/ endemic areas in
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
Aquatic parasite. Occurs in

Rhinosporidosis-looks like huge
Rhinosporidium seeberi children/young men > femes. Most
wart on/near nose
cases in Sri Lankan divers/fisherman
Lobomycosis-chronic inf may

Affects males, usu S. America. spread peripherally w/ verrucous
Loboa loboi
Dolphins may be resorvouir ulcerated lesions. Develops over
20-30 yrs
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
white females, immunocompromised Coccidiomycosis-1)1ry inf is

(AIDS). Disseminated form occurs in generally inapparent, benign (60%)
men w/ pigmentation and pregn or mild-severe URI. 2)2ry inf
femms (3rd trimester). Found in (a)benign chronic pulmonary-thin
Coccidioides immitus,
Sonoran Life Zone/Desert (e.g. El walled cavities or granulomas
Coccidioides posadasii
Paso) SW U.S., Mexico. C immitus in (b)progressive pulmonary form-
San Joaquin Valley. C posadassi may follow 1ry or from reactivation.
elsewhere. Thermly dimorphic mold- May disseminate to skin depending
soil. on health status
Incidence: Symptomatic pulmonary Histoplasmosis-1)pulmonary inf

disease 75% Men. 1:1 sex ration in 95%subclinical. Leaves cavitary
chldrn. Mildly chronic cases are 75- lesions in peeps w/ underlying lung
90%male. Immunocompromised p(x) probs 2)Disseminated disease may
at risk or mortatlity 70% dissemination leave lesions b/c infd retic.edoth
Histoplasmosis
and mortality in AIDS p(x). Sexual cells freely disseminate even in
capsulatum
bias in disease but not exposure ass(x) p(x). Oropharyngeal cancer
Geography: Worldwide, endemic due to mildly chronic disase
areas E of Misspi, incldng Rio Grande (recurrent over 10-20yrs). 3)African
areas. Mold-soil microconidia-irrittion Histoplasmosis disese of skin and
on inhalation. Animals as reservoir. bones
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
Incidence:most children in NY cty skin

test +, 1000cases/yr in nonAIDS pop.
Maybe 3:1 male:femms. 50%in
healthy peeps, 50% 2ry to DM, AIDS, Cryptococcosis-1)1ry Pulmonary
bone cancer, 4th most common inf usu ass(x) to mild ss(x) thus not
Cryptococcus
disease in AIDS p(x) often diagnosed 2)Disseminated
neoformans va grubii
Geography:worldwide types B-tropical, disease-meningitis in U.S.,
type C-S. Calif, type AandD-soil and skin/bone inf-Euro.
pigeon guano (pigeon as reservoir)
Yeast is inhaled and forms capsule
after infection
Opportunistic Infections
General Features 1)Inf of immunocompromised 2)becoming more frequent 3)pathogenic ones are ubiquitous 4)a
1)Nml flora of mouth, GI, vagina, skin

Candidasis-Thrush, Vaginitis,
2)immunocompromised, trauma
Intertrigginous, Onychomycosis,
experience e.g. burn, leukemias,
Diaper rash 2)Systemic inf 4th
endocrine factors e.g. DM/DI, AIDS
most common nosocomial blood
are all predisposing factors. Also
stream inf and is life threatening.
iatrogenic 3)Plaque made of
Candida albicans, and 3)Endocarditis 4)Recurrent Eye inf
(an)aerobe leading to
other sp 5)Random skin rashes/lesions after
microenvironment. Deep seated
sepsis 7)UTI 8)chronic
plaque required physical scraping for
mucocutaneous candidiasis
removal. Biofilm helps colony grow.
involved cell mediated immunity.
Abiotic surfaces e.g. dentures, help
epithelial lesions are verrucous and
biofilm adhesion and device
warty
deterioration
Aspergillosis-1)Allergic RE (IgE)
as asthma, allergic
bronchopulmonary aspergillosis
(most common RE), IgG RE for
nonatopic inf 2)noninvasive
colinization-aspergilloma in
Adults, males-unkown sex bias
preexisting cavity e.g. pulmonary
2)similar predisposing factors as
Aspergillus fumigatus pleura, asymptomatic may lead to
Candida. 3)Worldwide in soil-mold,
and other sp. fatal hemmorrage, nonpulmonary
decaying vegetation, can be
colonization in head cavities w
aerosolized
ss(x) of otitis, sinusitis etc.
3)Invasive disease occurs as 1ry
pulmonary inf of compromised host
seen as a fatal necrotizing
pneumonia, dissemination may
spread to GI, liver kidney etc
Predisposing factors: Acidosis-

rhinocerbral inf, Leukemia Steroids Muromycosis-1)Cerebral form
Rhizopus orysae,
Immunosupprsant-thoracic form looks like bells palsy, death w/in 1
Absidia, Rhizomucor,
Geography:Worldwide on decaying week if untreated 2)Thoracic form
Mucor
vegetation-mold, soil, H2O. Produce is usu pulmonary inf.
sporangiospores (conidia)
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
Direct exam shows

hair shaft w/ nodules. These are types
Hair cut (or Terbinifine)
Under scope shows of Piedra
fungi
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).
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,
Ciclopiroxolamine (nail
topography etc) may require
lacquer) Naftifine,
antibacterials for
Butenafine 3)Systemic-
2ndry inf
Griseofulvin,
Detoconazole,
Itraconazole.
shower, comb, etc) Microsporum sp:macroconidia, Epidermophyton

ensitive limits inf to surface. Fatty acids on scalp after puberty help limit grey
nfections
ur worldwide w/ endemic areas, Several sp may cause same ss(x)
1) looks like cysts

Lesions along
on skin following
lymphatics is
lymphatics 2)
pathognomonic.
Orally-KI (in milk), looks like you put
Direct exam for cigar
Itraconazole Topical- your skin through
shaped yeast.
Amphotericin B (for a meat grinder.
Culture ID of thermally
lymphatic relapse or 1ry Dissemination is
dimorphic (grows as:
pulmonary inf, Heat rare. Pulmonary
mold in soil, yeast at
inf is becoming
37. Serology not
common in
helpful
hospitals
Direct exam of pus for

granule of certain 1)Longterm antib(x):
size, color, filaments Ampho B, topical Actinomycetoma
>1mcromter. Culture Nystatin, KI (all w/ little is due to bact.
for verification based success). 2)Surgery to yeast grows faster
on morphology and clean abscess. vs mold
asexual conidial 3)Amputation.
formation
Direct exam reveals

pigmented branching
1)Surgery successful if
hyphae w/ sclerotic
early 2)Itraconazole
bodies (spore).
3)Antibacterials for 2ry
Culture ID of dark
inf 4)AmphoB-partial
pigmented colonies
cure w/ relapse
looking for asexual
reproduction
Direct exam of tissue

shows pigmented
Drugs w/ variable Cerebral Phaeo
fungal elements
success. Surgery for diagnosed after
Culture ID via
certain manifestations death.
morphology and
conidial formation
6-330 mcrmtr
sporangium (filled w/ 1) Surgery 2) various
endospores) No drugs tried
culture available
Direct exam of tissue

for chain of bout 4
Similar to
lemon shaped cells Surgery
chromomycosis
bout 9micrmeters. No
culture
Spontaneous
resolution
ctions
pulmonary inf that may spread via blood 3)immunit to reinf 4)geographically
localized outbrx from exposure to common source
HIGHLY
INFECTIOUS.
Skin test. Differentiate
Possible terrorist
from other URI's. Take
agent. Virulence
travel h(x). Direct
due to protease,
exam of sputum for 1)bed rest for 1ry ss(x)
estrogen binding
sporangia or 2)disseminated w/
prot, Tcell
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
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^
Undecyclin Griseofulvin Echinocandin

Haloprogin 5-flurocytosine Miconazole*^
Clioquinol Nikkomycin Z Fluconazole*^
Triacetin Ketoconazole*+ Voriconazole+^
Ciclopiroxolamine Fluconazole*^ Amphotericin B*^
Squalene 2.3, Itraconazole
epoxidase
inhibitors
(tolnaftate, naftifine,
terbinafine,
butenafine)
Allyl Ammines are Voriconazole+^
part of the Squalene
2,3 epixidase
inhibitors
(Terbinafine,
Naftitine,
Butenafine)
Polyenes* (Nystatin,
Amphotericin B*^)
Azoles*+^
(Clotrimazole,
Econazole,
Ketoconazole *+,
Miconazole *^,
Butoconazole,
Oxiconazole,
Sulconazole,
Terconazole,
Tioconazole)
Drugs for
Drugs for Superficial Drugs for Cutaneous SubCutaneous
Infections Infections Infection
cell wall synths cell wall f(x) DNA syns
Allylamines of the Azoles Polyenes
Squalene 2,3
epoxidase inhibitors
Naftifine Clotrimazole* Nystatin
Terbinafine Econazole* Amphotericin B*^
Butenafine Fluconazole*^
Itraconazole
Ketoconazole*
Miconazole*^
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
Poxviridae Herpesviridae Hepadnaviridae Adenoviridae Papillomaviridae Polyomaviridae Parvoviridae *ssDNA
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
(+) RNA (-) RNA
NonSegmented Nonsegmented Segmented
Naked Enveloped Enveloped Enveloped
Picorividae Noroviridae Togaviridae Flaviviridae Coronaviridae Retroviridae Parmyxoviridae Filoviridae Rhabdoviridae Arenaviridae Bunyaviridae Orthomyxoviridae
Coxackie Virus A West Nile

Rhinovirus Poliovirus Echovirus and B Hepatitis A Norwalk Calciviridae Rubella EEV WEV VEV Yellow Fever virus Dengue Virus St. Louis virus virus Corona SARS HIV, HTLV 1 and 2 Parinfluenza Measles Mumps RSV Ebola Marburg Rabies VSV LSV TCV LCV CLEV Hanta virus Influenza A, B, C
Table 8-4. Transmission and Distribution of Pathogenic Parasites
Organism Infective Form Mechanism of Spread
Intestinal Protozoa
Entamoeba histolytica Cyst/trophozoite Indirect (fecal-oral)
Direct (venereal)
Giardia lamblia Cyst Fecal-oral route
Dientamoeba fragilis Trophozoite Fecal-oral route
Balantidium coli Cyst Fecal-oral route
Isospora belli Oocyst Fecal-oral route
Cryptosporidium Oocyst Fecal-oral route
species
Enterocytozoon bieneusi Spore Fecal-oral route
Urogenital Protozoa
Trichomonas vaginalis Trophozoite Direct (venereal) route
Blood and Tissue Protozoa
Naegleria and Cyst/trophozoite Direct inoculation, inhalation
Acanthamoeba species
Plasmodium species Sporozoite Anopheles mosquito
Babesia species Pyriform body Ixodes tick
Toxoplasma gondii Oocysts and tissue cysts Fecal-oral route, carnivorism
Leishmania species Promastigote Phlebotomus sandfly
Trypanosoma cruzi Trypomastigote Reduviid bug
Trypanosom brucei Trypomastigote Tsetse fly
Nematodes
Enterobius vermicularis Egg Fecal-oral route
Ascaris lumbricoides Egg Fecal-oral route

Toxocara species Egg Fecal-oral route
Trichuris trichiura Egg Fecal-oral route
Ancylostoma duodenale Filariform lava Direct skin penetration from
contaminated soil
Necator americanus Filariform larva Direct skin penetration,
autoinfection
Strongyloides Filariform larva Direct skin penetration,
autoinfection
Trichinella spiralis Encysted larva in tissue Carnivorism
Wuchereria bancrofti Third-stage larva Mosquito
Brugia malayi Third-stage larva Mosquito
Loa loa Filariform larva Chrysops fly
Mansonella species Third-stage larva Biting midges or black flies
Onchocerca volvulus Third-stage larva Simulium black fly
Dracunculus medinensis Third-stage larva Ingestion of infected cyclops
Dirofilaria immitis Third-stage larva Mosquito
Trematodes
Fasciolopsis buski Metacercaria Ingestion of metacercaria
encysted on aquatic plants
Fasciola hepatica Metacercaria Metacercaria on water plants
Opisthorchis Metacercaria Metacercaria encysted in
(Clonorchis) sinensis freshwater fish
Paragonimus Metacercaria Metacercaria encysted in
westermani freshwater crustaceans
Schistosoma species Cercaria Direct penetration of skin by free-
swimming cercaria
Cestodes
Taenia solium Cysticercus, embryonated egg Ingestion of infected pork;
or proglottid ingestion of egg (cysticercosis)
Taenia saginata Cysticercus Ingestion of cysticercus in meat

Diphyllobothrium latum Sparganum Ingestion of sparganum in fish
Echinococcus Embryonated egg Ingestion of eggs from infected
granulosus canines
Echinococcus Embryonated egg Ingestion of eggs from infected

multilocularis animals, fecal-oral route
Hymenolepsis nana Embryonated egg Ingestion of eggs; fecal-oral route
Hymenolepsis diminuta Cysticercus Ingestion of infected beetle larvae
in contaminated grain products
Dipylidium caninum Cysticercus Ingestion of infected fleas
ogenic Parasites
Distribution
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
Worldwide
North America, Europe
Worldwide
Worldwide
Tropical and subtropical areas

North America, Europe
Worldwide
North, Central, and South America
Africa
Worldwide
Areas of poor sanitation

Worldwide
Worldwide
Worldwide
Africa
Africa and Central and South America
Africa and Central and South America
Africa, Asia
Japan, Australia, United States
China, Southeast Asia, India
Worldwide
China, Japan, Korea, Vietnam
Asia, Africa, India, Latin America
Africa, Asia, India, Latin America
Pork-eating countries: Africa,

Southeast Asia, China, Latin America
Worldwide
Worldwide
Sheep-raising countries: Europe,
Asia, Africa, Australia, United States
Canada, Northern United States, Central

Europe
Worldwide
Worldwide
Worldwide
Nephritic = Blood + HTN + Oliguria + Azotemia + Edema
PSGN - Follows group A 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 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)
FSGS - glomerular sclerosis frm persistent glomerular vasodilation

Hypercellular
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
Membranoproliferative Glomerulonephritis/MPGN - basement membrane alterations, glomerular cell

proliferation, WBC infiltration,Tram Track appearance due to GBM duplication
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
IgA Nephropathy/Berger Disease - IgA deposits in medangium, recurrent hematuria
Amyloidosis - large kidneys, low BP, congo red stain positive
Hypertensive Nephrosclerosis - Black ppl w uncontrolled HTN, proteinuria

Anticonvulsants
Drugs That Work On Na+ Channels
Drug MOA SDFX Source T(x) For
Phenytoin Nystagmus, Diplopia, Ataxia, Anticonvulsant
(Fosphenytoin is Decrease Influx. Increase Efflux of Na+, Ca2+ Hirsuitism, Coarsening of Facial (Partial and
Website
broken down into and K+ channels in open state Features, Mild Peripheral General
Phenytoin) Neuropathy Tonic/Clonic Szr)
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
Agranulocytosis, Thrombocytopenia, antineuralgic,
paroxysmal depolarizing shift
StvJohnson Sx antidiuretic, muscle
relaxant and
antiarrhythmic
Metabolized to active cmpd 10, 11Dihydro-10 Same as CBZ

Oxcarbazepine Same as CBZ but less frequency notes
Hydroxy-5H Dibenz[b,f]azepine5Carboxamide Partial Szr
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
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
At low conc. Blocks voltage Na+ channels.

DOC: Generalized
Valproic Acid (GABA High conc slows influx of Ca++. Increases
Hepatic Toxicity Epilepsy Sx.
synth inducer) activity of GABA making enzm (glutamic acid
Absence Szr
decarbxlylse) and inhibits GABA metabolism.
DOC: Petit Mal;
Reduces Ca++ currents in thalamus so that the
Ethozuximide Alternative to
thalamus is the discharge pacemaker.
Valproic acid
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
Absent szr Partial

Clobazam
Szr
Binds to GABA receptor increase Cl- DOC for infants

Phenobarbital current, Blocks AMPA receptor, Blocks L and N Sedating Absent szr Partial
type Ca++ currents and inhibits Na+ channels Szr
Primidone (metabolized Partial Szr Absent

Metabolized to PHB Sedating, Dizziness, Nausea
to Phenobarbital) szr
GABA Reuptake Inhibitors

Nipecotic
Adjunct thpy x
Dizziness, Asthenia, Nrvsness,
Partial and
Tiagabine Inhibits GABA transporter 1 Tremor, Depression, Emotional notes
secondary gen.
Labile
szr
DOC x Infantile
Absence status drowsiness, (rarely:
spasm Used as an
Vigabatrin Inhibits GABA transaminase depression agitation, confusion &
adjunct x refactory
psychosis)
partial szrs
GABA Synthesis Inducers
Partial Szr Adjunct

Generalized Tonic
GABA analog, Decreases GABA metabolism,
Gabapentin (Neurontin) notes Clonic Szr
Inhibits Reuptake
(Neuropathic pain,
Periperal Neuralgia
Second line adjunct

Pregabalin Incr. GABA in neurons and glial cells notes
x Partial Szr
At low conc. Blocks voltage Na+ channels.

Generalized
Valproic Acid (GABA High conc slows influx of Ca++. Increases
Hepatic Toxicity notes Epilepsy Sx.
synth inducer) activity of GABA making enzm (glutamic acid
Absence Szr
decarbxlylse) and inhibits GABA metabolism.
GABA Synthesis Inducers
Partial Szr 3rd line

Felbamate Blocks NMDA receptors Aplastic anemia, SEVERE Hepatitis notes
x refractory cases
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

Increases GABA channel conductivity,
Progesterone notes
Attenuates glutamate excitatory RE:
PROconvulsant via decreases Cl- flux, and
Estradiol notes
NMDA agonist in hippocampus
Increases intracellular [H+] causing K+ to move
CarbonicAnhydrase out, hyperpolarization increasing the
notes
Inhibitors threshold. (Topiramate, Zonisamide and
Acetazolamide)
Leveritacetum notes
Hypnotics/Anxiolytics
BZDs

Daytime sedation; Rebound
Zolpidem GABA receptor agonist (Hypnotic) notes Insomnia
Insomnia (low);
Zaleplon GABA receptor agonist (Hypnotic) Low incidence of rebound insomnia notes Insomnia
Chloral Hydrate Metabolized to Trichloroethanol Tolerance/Dependance notes
Anxiety (Atpyical
Buspirone 5HT1a and DA2 AntAg
Anxiolytic)
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
Well Tolerated dizziness, HA,

Fluvoxamine SSRI in CNS
insomnia, nervousness, somnolence
ADD/ADHD
Methylphenidate DA reuptake inhibitor many PDR
Dextroamphetamine DA and NE reuptake inhibitor Severe, but in few pts PDR
Atomoxetine
NE reuptake inhibitor, Adenyl cyclase
Desipramnie desinsitization, Beta adrenergic receptor
downregulation, 5HT receptor downregulation
Antidepressant
Buproprion 5HT & NE reuptake inhibitor
Smoking cessation
Venlafaxine (and
5HT & NE reuptake inhibitor
metabolite)
CNS Alpha2 adrenergic Agonist (activating ADD, HTN,
Clonidine
inhibitory pthwys, reducing symp outflow, ) Depression
Guanfacine A2 agonist HTN
Mood Disorders
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
Test + TP (++) FP (-+)
Test - FN (--) TN (+-)
Disease Healthy
+ Risk Diseased Pts Healthy Pts

Factor Exposed (++) Exposed (-+)
Disease Pts
No Risk Health Pts Not
Not Exposed
Factor - Exposed (+-)
(--)
Syphillis
Stage Duration ClinicalDisease ActivityofTreponemapallidum
Incubation 2to6weeks(most None Spirochetesactively

often3to4weeks) proliferateatentrysite,
spreadoverbody
Primary 8to12weeks 1.Chancrepresent Chancreteemingwiththem

atinoculationsite
2.Regional
lymphadenopathy
Primary 4to8weeks None Inconspicuous
Latent
Secondary Variableoverperiod 1.Skinand Skinandmucosallesions

of5years(Latent mucosallesions richinspirochetes(highly
periodswith 2.Generalized infectious)
recurrences) lymphadenopathy
Latent Fewmonthstoa None Inconspicuous
lifetime(average6to
7years)
Tertiary Variablerestof Relatedtoorgan Paucityofspirochetesin
patientslife systemdiseased classiclesion
Diagnosis TissueChange
IdentificationofT. Chancreappearsat
pallidum inoculationsite
a)Darkfield
microscopy
b)Fluorescentantibody
1.Darkfield Chancrepresent
microscopyofchancre
2.STSpositive
STSPositive Nonedemonstrable;
Chancrehashealed
withlittlescarring
1.Darkfield 1.Infectionactive
microscopy
2.STSPositive 2.Resolution
spontaneous
STSPositive
1.STSpositiveor 1.Gumma
negative
2.Specialsilverstains 2.Healing
3.Scarring
4.Tissuedistortion
Actinomycetes
General
filaments>1mcmtr. Cell wall w/ peptidoglycan, a.a. Streptomyces-are large family of bact. found in soil, H2O, organic debris-primary source
Features
Etiology Epidemiology Manifestations Treatment Key Diagnostics Notes
Actinomycosis Normal flora of GI tract, oral cavity.
Cutaneous Infections (Dermatophytosis)

Subcutaneous Infections
Systemic Infections
Opportunistic Infections
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

Drugs Pharmacology

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Anti Hypertensive Drugs

Diuretics - DOC x HTN monotherapy

Sexual Dysfunction, Along w tx HTN

blocks Na/2Cl-/K on good x tx of HTN w

NSAIDS, blockers and

RAAS Ihibiting Drugs

Captorpril causes rash;

Bronchospasm (esp Esp good in white

TPR, HR, CO, VR Orthostatic Hypotension,

Ca++ Channel Blockers

Dyslipidemia Drug Therapy

irreversibly inhibits ADP Bleeding of

Anticoagulants (prevent fibrin scaffold formation after platelet aggregation)

by inhibiting Factor Iia it

DOC x DVT prevention

Dilates the Sublingual to

Ic Propafenone Just as deadly as Ia

SA automaticity; Tx toxicity w K (to

Atrial Tachyarrhythmias - Tx w Propanolol, Dofetilide, Sotalol, Digoxin or Verapamil

created to overcome the loses activity if + gentamycin penicillinase; NOT active

Staph aureus starting to Narrow B lactamase

Staph aureus starting to Narrow B lactamase

Staph aureus starting to Narrow B lactamase

Cephalothin 1st Genertion G+ (staph endocarditis) Nephrotoxic synergistic w AG IM/IV

Cefazolin 1st Genertion G+ (E. coli, Klebsiella) IM/IV

Cephalexin 1st Genertion G+ (klebsiella) oral

Cefadroxil 1st Genertion G+ (UTI) oral

Broad MTT causes bleeding. GIVE

Clavulanic Acid + Ticarcillin or

Red Man SSx, (hives, HoTN,

(staph infx that don't RE topical

detergent, cell membr

incr warfarin activty (wfn is gluc6phos DH defx (NADPH

Inhibit folate synths sulfa w trimethoprim (UTI,

DNA Synthesis Inhibitors

(STD, UTI, GI infx, URI,

Liver metabzd, Excreted in

NOT a quinolone, but

Binds to 50S ribosomal

too toxic to use, 50S

Gradual reisistance via R

resistance via R factor

Must combo w other TB

Genta + Carbenicillin = decr

pain at injx site, hives, N/V,

Use only in hospital w fatally

topical, oral (being

binds to cell membr,

Tinea pedis, cruris,

Drug Drug Interactions

Tinea pedis, cruris,

Inhibits beta 1-3 glucan Aspergillosis after

Seizures (esp if predisposed), ppl w seizures, depression

Ethionamide GI, HoTN, liver toxicities

must combo; maybe can

Rifampin + AminosAcid block

INH + Rifampin + Pyraz +

INH + Rifampin + Pyraz +

Dapsone Leprosy use 3-4 leprosy mx to start

do not use w bactrim, NOT USED

(herpes keratitis from

neurotoxic, flu like ssx usu

inhibits viral DNA