| Question | Answer |
| -Generalized tonic-clonic seizures and partial seizures.
-low toxicity and low cost
-metabolized by the hepatic microsomal system,
MOA: (sedation) GABAA receptors.
(Anticonvulsant): Ca++ channel inhibition /decreases excitatory transmitter release. | Phenobarbital |
| - Generalized Tonic-clonic and partial seizures.
-efficacy is due both to drug and active metabolites (Phenobarbital).
-two active metabolites, phenobarbital and phenylethylmalonamide (PEMA) | Primidone (Mysoline) |
| - Generalized tonic-clonic, simple, and complex-partial seizures.
- trigeminal (tic douloureux) , glossopharyngeal neuralgias and manic-depressive affective disorder( resistant to lithium) pain associated with multiple sclerosis
-Hepatic metabolism | Carbamazepine (Tegretol) |
| -epilepsy, mood disorders, anxiety
-analog of carbamazepine
- active metabolite (10-hydroxycarbazepine) that is equipotent to carbamazepine
- fewer SE’s that carbamazepine
- hyponatremia
-anticholinergic activity
- synergistically with nmb | Oxcarbazepine (Trileptal) |
| -central agent in treating absence seizures.
- More effective in managing absence seizures than trimethadione
SE : euphoria, anemia
Bone marrow depression, Stevens-Johnson syndrome
-Tegretol decreases levels.
- Isoniazid increases levels. | Ethosuximide (Zarontin) |
| -alone or in combination to treat partial and generalized seizures, bipolar disorder and depression
- sodium channel antagonist and high voltage dependent Ca++ channels
-decrease the release of aspartate and glutamate
-met. by liver
-hep enzyme induc | Lamotrigine (Lamictal) |
| -used to treat partial sz in adults and neuropathic pain
-mono- or adjunctive therapy
-bind to synaptic vesicles decreasing release of NT
-SE h/a, anxiety, CNS depression ,initial sedation, depression , hallucinations
-no liver met or protein binding | Levetiracetam (Keppra) |
| DOC for status epilepticus
also used for status epilepticus, other sz
- interaction with GABAA ionophore to increase the duration of GABA binding and -increase chloride flux leading to hyperpolarization
- low toxicity
- used as anesthesia adjuvant | Benzodiazepines
Diazepam (Valium)
Lorazepam (Ativan) |
| -May also be used in combination with other drugs to tx:
akinetic sz, absence sz refractory to succinimides or valproic acid (Depakene), infantile spasms
-MOA: benzo-mediated enhancement of GABA-induced ^ in Cl- conductance (hyperpolarization). | Clonazepam (Klonopin) |
| - Partial and tonic-clonic sz but NOT absence sz
- widely used
- Hep microsomal system.
SE: status epilepticus the most apparent toxic sign is cardiac arrhythmia
cerebellar and vestibular disturbances, hirsuitism
-Etoh decreases efficacy. | Phenytoin (Dilantin) |
| -a Phenytoin prodrug used by injection for status epilepticus (5 day max use, only if Phenytoin not usable)
-more water soluble and metabolized to formic acid | Fosphenytoin
(Generic) |
| - Partial, generalized seizures and absence seizures
-extensively protein bound and conjugated
- MOA d/t ^^ recovery time of voltage activated Na+ channels.
-Can cause serum phenobarbital to increase by 40%. | Valproic Acid (Depakene) |
| -adjunct for partial and generalized seizures, obesity, migraines and Parkinson’s disease
-acts at GABAA receptor to enhance GABA binding
- blocks voltage-gated T-type calcium channels
-metabolism can be inhibited by ketoconazole, carbamazepine(Tegreto | Zonisamide (Zonegran) |
| -adjunct for partial sz, anxiety disorders (panic attacks), and neuropathic pain
- inhibits GABA neuronal reuptake
-^^ duration of GABA interaction at receptor zone
- ^^ neuronal inhibition
-use may actually trigger sz in non-epileptics | Tiagabine (Gabitril) |
| -tx partial, generalized, absence sz, bulimia, migraine h/a, tremors
-structurally a monosaccharide r/t fructose
- inhibit voltage gated Na and Ca channels
- enhances GABA Cl ion flux
-inhibits glutamate induced neuronal excitation
- SE kidney ston | Topamax |
| -no longer the clinical agent of choice for absence seizure due to toxicity.
MOA: Similar to ethosuximide (Zarontin)
-inhibits T-type Ca++ currents.
-metabolite Dimethadione. | Trimethadione (Tridione) |
| -Structural analog of GABA
-chronic pain therapy
-MOA: increase GABA synthesis,
-increase interaction with GABA receptors
-decrease GABA reuptake rate
-1/2 life 6 hours
No plasma protein binding | Gabapentin (Neurontin) |
| • Cross links DNA (cant divide).
• DLT is bone marrow dep
• Uses: Hodgkin’s lymphomas, leukemias, lung breas, ovarian ca, burkitt’s lymphoma
• agent for kids w/ neuroplastomas/ Retinoblastomas
• used in combo w/ methorexate + 5-fluorouracil for breast | Alkylating Agent:
Cyclosphoshamide (cytoxan) |
| • MOA: DNA crosslink
• Uses: CML and polycythemi vera
• DLT; Bone marrow dep.
• SE: alopecia, lung fibrosis, impotence
• causes myelosupression (granulocytes > plts, erythrocytes >pancytopenia
• no cytotoxicity to lymphoid tissue or GI epilthelium | Alkylating agent:
Busulfan (myleran) |
| • Inhibit topisomerase II
• Bind to DNA to inhibit DNA/RNA synthesis
• O2 radical production
• DLT for doxorubin and saunorubicin is CM (d/t O2 radicals)
• Bone marrow dep in 2 weeks, recovery in 4 weeks. More severe w/ dexrazoxane | Antibiotic anticancer agents:
Anthracyclines Doxorubicin, Daunorubicin, and others) |
| • Uses: soft tissue osteogenic an other sarcomas; lungs, bladder, ovarian, thyroid cancers; Hodgkin, lymphoma, acute leukemia
• If given to rapidly IV, erythematous streaking along proximal veins
• Chelates iron and other metals | Doxorubicin (adriamycin) |
| • uses: acute leukemias, some solid tumors in children.
• Daunoxome approven 1st line therapy for advance Karposi sarcoma | Daunorubicin (Daunomycin) |
| Cu-chelating glycopeptides, isolated from streptomyces
• MOA: breaks DNA strands >Free radicals
• DLT: Pulmonary fibrosis
• Uses: testicular tumors, skin cancers, lung, Kaposi’s sarc. lymphoma, Hodgkins
• SE: N/V fever, skin toxicity, anaphylactic rx | *Bleomycin
Antibiotic anti cancer agent |
| anaolog of folic acid.
• Uses ALL in kids, carc. of breast, head, neck, gastric, bladders. used in high doses for osteogenic sarcomas along w/ "rescue” of host toxicity by leucovorin (folinic acid, citrovorum fx).
• DLT is mucositis.
• TERATOGENIC | Anti metabolic anti cancer agent: *Methotrexate; |
| Analog of uraciil w/ flourine @ 5-position
• cells can be “rescue from high doses by giving uridine
• Methotrexate ^^ activity
• Use stomach, colon, bladder, prostate, breast, and ovarian ca,
• Warning of ^ dose= anorexia, nausea, > stomatitis & diar | *5-Fluorouracil |
| • Isolated from the periwinkle plant.
• MOA; spindle poisons, causes mitotic arrest at metaphase.
• May need allopurinol to prevent hyperuricemia
• Fatal if given intrathecally | Natural product anticancer Agents:
*Vincristine (oncovin)t1/2=85hr
Vinblastine (Velban)t1/2=25hr |
| from the Pacific and European Yew Tree (Bark fungus)
• MOA mitotic spindle poison.
• Uses; breast head, lung ca, Kaposi sarcoma & restinosis (taxus).
• Docetaxel & Carbazitaxel for prostate ca
• SE: N/V alopecia, neutropenia, anemia, thrombocytopenia | Natural product anticancer Agents:
Paclitaxel, Docetaxel (Taxotere), CArbazitaxel (Jevtana) |
| MOA: after hydrolysis, loses Cl & forms platinum species that reacts w/ DNA & protein to from cross link.
Use testicular tumors, ca. of bladder, neck, cervical, lung, esophagus, neuro & retinoblastomas
SE: n/V, ototox neurotox, anaphylaxis
DLT-nephrot | Natural product anticancer Agents:
Cisplatin (Platinol) |
| • Less nephrotoxic than cisplatin
• 2nd generation compound
• Uses: ovarian, head, neck and lung ca
• DLT: bone marrow depression
• Longer half life than cisplatin | Carboplatin. |
| • Ethyl or Isopropyl
• Iso more effective than Ethyl
• Antiseptic and disinfectant
• Bactericidal
• Repeated wiping increases efficacy
• Ineffective against fungal or viral organisms | . Alcohol |
| • Benzalkonium and Cetylpyridinium
• Effective against most bacteria, fungal and viruses. NOT mycobacterium tuberculosis
• Mixed with alcohol to increase efficacy
• Alters cell permeability
• Also used as preservatives and to sterilize surgical equip. | Quatenery ammonia compounds |
| Effective against bacterial, viral, and fungus
• Toxicity fairly low, but caution in allergic pts.
• Use as a skin antiseptic, but must be applied for 1-2 mins to assure good action
• Causes skin staining, beneficial notification of application | . Iodine |
| • Combination of an organic molecule carrier with iodine
• Povidine-iodine most common agent
• Free iodine concentration is low enough that little staining is observed
• Not as effective as iodine
• Used in handsoaps and surgical swabs | Iodophors |
| • No longer used d/t easy absorption and severe dermatological, neurological, and possible teratogenic effects
• Neonates especially susceptible
• Handwash effective against gram+ bugs
• Sticks to skin providing continued action
• Presscript only for | Hexachlorophene (pHisoHex) |
| • Used as a caustic astringent and antiseptic
• Bactericidal, and often used in eyes of newborns of mothers with gonococcal infections
• Used on burns and other wounds | Silver Nitrate |
| • Mercurochrome & Merthiolate (Thiomersal)
• Not used much now. Thiomersal used as preservative in a few vaccines
• Poor efficacy
• Allergic reactions and poisoning (oral) | Mercurous compounds |
| 1. Alcohol
2. Quatenery ammonia compounds
3. Iodine
4. Iodophors
5. Chlorahexidine (Hibiclens)
6. Hexachlorophene
7. Silver Nitrate
8. Mercurous compounds | Antiseptic |
| • Effective against bacterial, viral, and fungal organisms
• Glutaraldehyde more effective than formaldehyde
• Requires several hours exposure for maximum effectiveness
• Acts by precipitating proteins in the organism
• Reacts with any proteins, | Aldehydes |
| • Bactericidal against most organisms including Mycobacterium tuberculosis
• A phenol derivative, it causes burns to skin, therefore is only used as a disinfective | Cresol |
| • Used in Gas sterilization
• Requires a treatment chamber to hold instruments for the several hour contact period required
• Air-out plastic components sterilized by this method to allow ethylene oxide to out-gas from materila | Ethylene Oxide |
| Alcohol
Aldehydes
Cresol
Chlorine
Ethylene oxide
Heat | Disinfectants |
| Bind to 30S subunit of bacterial ribosome & inhibit PRO synthesis by blocking the binding of aminoacyl tRNA to acceptor site (A) on the mRNA-ribosome complexà AA can’t be added to the growing peptide | Tetracyclines |
| Irreversible inhibitors of PRO synthesis that bind to receptor PRO on 30S subunit à misreading of mRNA message
-Gentamicin, Tobramycin, Amikacin, Streptomycin, Neomycin (Combined with polymixin as Neosporin), Kanamycin | Aminoglycosides |
| Inhibits PRO synthesis & binds to the 30S subunit (doesn’t à misreading like AG’s do) | Spectinomycin (Trobicin) |
| PRO synthesis inhibitor that reversibly binds to site on 50S subunit & inhibits translocation step where peptidyl tRNA moves from A site on the ribosome to P site & reversibly blocks PRO synthesis. | Macrolides
- erythromycin (E-mycin), clarithromycin (Biaxin), azithromycin Zithromax) |
| binds reversibly to 50S subunit of bacterial ribosomes & inhibits PRO synthesis (like macrolides)
-lincomycin (Lincocin),clindamycin (Cleocin) | Lincosamides:
-lincomycin (Lincocin),clindamycin (Cleocin) |
| PRO synthesis inhibitor by reversibly binding to 50S subunit of bacterial ribosomes & inhibits transpeptidation by inhibiting peptidyl transferase. It prevents binding of AA end of aminoacyl tRNA to the acceptor site on 50S subunit. | Chloramphenicol |
| Inhibits PRO synthesis by binding to bacterial 23S ribosomal RNA of the 50S subunit thus px formation of a functional 70S initiation complex, an essential step (unique MOA & doesn’t show cross resistance to other antibx) | Oxazolidione
(Linezolid) |
| Bind to 23S RNA of the 50S subunit (like macrolides); do not induce the methylase enzyme (so not subject to MLS resistance?) | Streptogramins |
| Same as other B-lactam antibx: Disrupts synthesis of peptidoglycan layer of bacterial cell wall. Inhibits final stage of cell wall synthesis that involves peptide crosslinking by transpeptidases; structural analog of d-ala d-ala | Penicillins |
| Parenterals: methicillin and Nafcillin,
Oral: Isoxazolyls | Penicillinase-Resistant Penicillins |
| Carboxypenicillins (ticarcillin disodium(Timentin – with clavulanic acid) , Ureidopenicillins (piperacillin) | Antipseudomonal |
| Same as other B-lactam antibx: Disrupts synthesis of peptidoglycan layer of bacterial cell wall. Includes 1st, 2nd, 3rd, and 4th generations | Cephalosporins |
| Oral:Cephalexin (Keflex),Cefadroxil Parenteral: Cefazolin (Ancef, Kefzol) | 1st gen. Cephalosporins |
| Oral:Cefaclor (Ceclor, Raniclor),Cefuroxime axetil (Ceftin),Cefprozil Parenteral:Cefoxitin (Mefoxin) Cefuroxime sodium (Zinacef) Cefotetan (contains N-methylthiotetrazole group) | 2nd gen. Cephalosporins |
| Oral: Cefixime (Suprax) Cefpodoxime proxetil Ceftibuten (Cedax) Parenteral: Cefotaxime (Claforan) Ceftriaxone (Rocephin) Ceftazidime (Fortaz) | 3rd gen. Cephalosporins |
| Cefepime (Maxipime) | 4th. Gen. Cephalosporins |
| Inhibition of cell wall synthesis
-Imipenem (available with cilastatin as Primaxin), Meropenem (Merrem), Doripenem (Doribax), Ertapenem (Invanz) | Carbapenems |
| Same as other B-lactam antibx: Disrupts synthesis of peptidoglycan layer of bacterial cell wall. Begins with Mono. | Monobactam |
| Inhibits cell wall synthesis (peptidoglycan synthesis) by irreversibly binding to the pair of d-ala molecules of cell wall precursor units | Vancomycin |
| Inhbits cell wall synthesis by binding to a precursor of cell wall& forming unusable complex; acts 1 step before the one inhibited by vancomycin | Bacitracin |
| Inhibits early stage of cell wall synthesis; inhibits enolpyruvyl transferase & irreversibly blocks condensation of UDP-N-actely glucosamine w/p-enolpyruvate; inhibits bacterial adherence to uroepithelial cells | Fosfomycin Tromethamine
(Monurol) |
| PABA analog that competitively inhibits DHPS which is required for folic acid synthesis; it only affects bacteria that synthesize own folic acid | Sulfonamides
(Sulfamethoxazole, Sulfisoxazole, Sulfadiazine,Sulfacetamide, Sulfamylon, Silvadene
Trimethoprim-Sulfamethoxazole (Bactrim, Septra) |
| Nitro group activated by intracellular electron transport PRO in anaerobic organism to chemically reactivate intermediates that react with DNA & can> ↑ degradation of existing DNA, altered DNA helical structure, ↑ strand breaks, & inhibition of DNA syn. | Metronidazole
(Flagyl) |
| anoxic or hypoxic condition is required for formation of cytotoxic metabolites) | Metronidazole
(Flagyl) |
| Surface active agents that disrupt osmotic properties and transport mechanisms of cell membranes in gram – bacteria only; also binds & inactivates endotoxins | Polymixins |
| Reversibly binds to bacterial isoleucyl-tRNA synthase & blocks PRO synthesis | Mupirocin
(Bactroban) |
| Inhibits DNA gyrase which is a topoisomerase responsible for breaking & rejoining DNA strands necessary for DNA replication
-ciprofloxacin ophthalmic (CILOXAN), ofloxacin , etc | Fluoroquinolones
ciprofloxacin (CIPRO) ophthalmic (CILOXAN), ofloxacin ophthalmic (OCUFLOX), norfloxacin (NOROXIN),lomefloxacin, Levofloxacin (LEVAQUIN), Gatifloxacin (Zymar - ophthalmic), Moxifloxacin (Avelox) |
| Similar to the Macrolides, keto group a 3 position instead of a hydroxyl group and removal of a sugar group, binds to the 50s bacterial ribosomal subunit
-Telithromycin (Ketek) (oral tablets) | Ketolides |
| Hydrolyzed in acidic urine to formaldehyde and ammonia, Formaldehyde is bactericidal in urine ph < 5.5, Used for chronic lower UTIs. Activity is higher in acid urine, Primarily used to px UTIs and to px bacteriuria after prostatectomy, urinary analgesic | Urinary tract Antiseptics:
Methenamine (Hiprex), Nitrofurantoin (Furadantin), Hemolytic anemia (if G6PD-deficient) |
| Not DOC for anything (alone) | Sulfa |
| DOC for prevention of burn infections | Silver Sulfadiazine |
| DOC for empiric treatment of acute UTI, Nocardia, moraxella catarrhalis, H. flu, Yersinia enterocolitica | Trimethoprim + sulfamethoxazole (Bactrim, Septra)
5:1 SMZ:TMPà [blood] ratio of 20:1 |
| Listeria monocytogenes | Ampicillin |
| Proteus mirabilis, Eikenella corrodens | AminoPCN (ampicillin, amoxicillin) |
| 1 of DOC for pseudomonas aeruginosa | Ticarcillin + aminoglycoside |
| DOC for syphilis | PCN |
| Antbx for Rheumatic recurrence | Use Pen V or benzathine Pen G |
| DOC Endocarditis prevention if valvular disease undergoing dental/surgical procedures | PO DOC= amoxicillin 1 hour before procedure
Parenteral DOC= ampicillin 30 min before procedure |
| Typhoid fever DOC | ceftriaxone |
| Gonorrhea DOC | Ceftriaxone or cefixime |
| DOC for enterobacteriaceae (E. coli, Klebsiella, Proteus, Providencia stuartii, Serratia | 3rd gen. Cephalosporins |
| Drug used for H. flu meningitis | Ceftriaxone or cefotaxime |
| Drugs used for Surgical Prophylaxis | Cefazolin- ‘clean’ surgery
Cefoxitin or cefotetan- colorectal surgery, appendectomy, hysterectomy, or ‘dirty’ surgery |
| DOC for Enterobacter, Citrobacter freundi, Acinetobacter, C. fetus | Imipenem |
| Reserved for very serious gram- infections resistant to less expensive drugs | Azactam |
| DOC for mycoplasma pneumo (or a TCN), legionella pneumophila (+ rifampin), bordetella pertussis, corynebacterium diptheriae, campylobacter jejuni (if fluoroquino are c/i)
DOC valvular heart disease undergoing dental/surgical procedures & allergic to PCN | Macrolides |
| DOC for helicobacter pylori (TCN+ flagyl+ bismuth subsalicylate). Also useful for rickettsial, mycoplasmal, spirochetal, chlamydial. | tetracyclines |
| DOC for UTI due to pseudomonas aeruginosa | ciprofloxacin (fluoroquinolone) |
| DOC for campylobacter jejuni, shigella, salmonella, | Fluoroquinolones |
| DOC for rickettsial disease (Rocky Mountain spotted fever) if unable to take TCN (↓ renal fxn, pregnant, peds), glanders (w/streptomycin), N. Meningitis & H. influenzae meningitis if PCN allergic | Chloramphenicol |
| DOC w/TCN for glanders (pseudomonas mallei) | Streptomycin |
| Used to tx vancomycin resistant enterococcus faecium, community acquired pneumonia d/t staph aureus, streptococcus penumoniae, & skin infections (even those d/t MRSA) | Zyvox |
| DOC for MRSA | Vancomycin |
| DOC for giardiasis (anaerobic protozoa); DOC for C. difficile & H. pylori (PO form only); DOC for gardnerella vaginalis | Flagyl |
| Bacteriocidal antibiotics | PCN, cephalosporins, carbapenems, fluoroquinolones, flagyl, monobactam, aminoglycosides, fosfomycin |
| Bacteriostatic | sulfamides, macrolides, lincosamides, tetracyclines, chloramphenicol, Zyvox, Vancomycin, spectinomycin |
| SE:
-metallic taste & neurotoxicity (neuropathies, dizziness, convulsions, vertigo)à c/I in active CNS disease
-disulfram like rxn with ETOH
-Reddish brown urine, reversible neutropenia
-may potentiate warfarin; may potentiate lithium toxicity | Flagyl |
| SE:
-rapid infusion à ‘red neck’ syndrome = flushing over upper chest, urticarial rash, tachycardia, hypotension d/t histamine release
-ototoxicity & nephrotoxicity- especially if renal impairment | Vancomycin |
| -it’s a weak MAOI (avoid tyramine rich foodsà HTN crisis) | Zyvox |
| -all s/e are dose-dependent except hypersensitivity (which is rare)
-ototoxicity (its irreversible b/c sensory hair cells do not regenerate)
*auditory toxicity: can lead to deafness
*vestibular toxicity: h/a, n/v, vertigo, ataxia | aminoglycosides |
| SE:
-nephrotoxicity: ↑BUN & Crt; its reversible since proximal tubular cells can regenerate
Drug: dose or duration (streptomycin least nephrotoxic, gentamicin most nephrotoxic)
Patient: age extremes, & critically ill pts | Aminoglycosides |
| -Neuromuscular blockade: inhibits presynaptic Ach release @ NMJ & ↓ postsynaptic receptor sensitivity; characterized as respiratory depression; patients with myasthenia gravis or hypocalcemia > susceptible; potentiation w/NMBD | Aminoglycosides |
| SE:
-Most adverse effects d/t inhibitory effect on PRO synthesis in mitochondria
-Bone marrow disturbances
*toxic erythroid bone marrow depression- (dose related) usually have complete recovery after d/c’d | Chloramphenicol |
| SE:
aplastic anemia- (not dose related) irreversible & fatal
-Gray Baby Syn.- 40% fatality; turns skin ash gray - use w/caution in babies & limit dose
-irreversible inhibition of liver microsomal P450 enzymes > ↑t1/2 warafin, phenytoin, etc. | Chloramphenicol
|
| -rare & infrequent s/e
-cartilage deterioration (arthropathy) in young animals so c/I in kids < 18y/o or during pregnancy or nursing
-Ofloxacin (Floxin) may potentiate anticoagulant activity of warfarin | fluoroquinolones |
| -GI effects (take with food and a full glass of H2O)
-superinfections much more common d/t broad spectrum
-Hepatotoxicity (especially if pregnant- so c/I during pregnancy)
-Renal toxicity (r/t TCN used, dose, duration, & extent of renal damage before u | tetracyclines |
| -binds to Ca2+ deposits in new forming bone & teeth à permanent brown discoloration of teeth in kids <8y/o & depression of bone growth (so c/i in pregnancy and peds)
-Vestibular toxicity with minocycline (abates after d/c’d) | tetracyclines |
| -Benign intracranial HTN in adults (pseudotumore cerebri) manifested as H/A, blurred vision, bulging fontanels
-Can ↓ prothrombin activity (so may need to decrease dose of anticoagulants)
-↓ effectiveness of oral contraceptives | tetraclyclines |
| -High incidence of diarrhea & pseudomembranous colitis not r/t dose or route (caused by necrotizing endotoxin) | lincosamides |
| -Inhibits cytochrome P450 enzymes>↑ effects of drugs such as anticoagulants, carbamazepine, cyclosporine, ergotamine, triazolam, lovastatin, theophylline
-Cholestatic jaundice in adults may be d/t hypersensitivity to estolate ester (dont use if pregnant | macrolides |
| -high doses> transient reversible hearing impairment
-rare reports of ventricular arrhythmias in patients w/ prolonged QT interval | macrolides |
| T or F. The Monobactam, Azactam is ok to use if PCN allergic; can >gram+ superinfections | True |
| T or F. -If PCN allergic, consider also allergic to imipenem
Can cause seizures: especially if elderly, predisposed to seizures, or high doses with renal impairment (meropenem least likely) | True |
| -Cefotetan & Cefoperazone: contain N-methylthiotetrazole group that can be cleaved & inhibit Vit K metabolism & aldehyde dehydrogenase > hypoprothrombinemia, bleeding disorders, & disulfiram-like rxn | Cephalosporins |
| -Pseudomembranous colitis & superinfections (especially with 3rd generation); candidiasis is common | Cephalosporins |
| -CarboxyPCN: high Na+ content > CHF
-Carbenicillin: abnormal platelet aggregation & bleeding
-Intrathecal PCN: epileptogenic (never give IT) | PCN |
| -Toxic concentrations of all PCN possible if patient renally impaired > seizures
-Ampicillin rash: not a hypersensitivity rxn
-Jarisch-Herxheimer rxn: if used in patients with secondary syphilis | PCN |
| -may be antagonized by LA with are esters of PABA (procaine)
-toxic epidermal necrolysis & Stevens-Johnson syndrome if hypersensitivity rxn occurs | Sulfa |
| SE:
-hepatic necrosis
-blood dyscrasias (agranulocytosis, aplastic anemia, hemolytic anemia)
-Mafenide: metabolic acidosis d/t inhibition of carbonic anhydrase
-Bactrim or Septra: CNS toxicity in AIDS patients | sulfa |
