alright welcome to chapter 4 immune there's 40 some medications here so I
just wrote it up I put one group out of order my hand cramped from writing all of
this so I'll just tell you which one's out of order but we'll get to that in a
bit so the first thing I want to do is I want to start with 4 OTC medications
neomycin polymyxin B and bacitracin this -mycin stem you may
have seen before it just means that it's from the streptomyces bacteria but it
doesn't necessarily tell you that it's exactly an antibacterial but neomycin,
polymyxin B, bacitracin, this is Neosporin so we're going to do
is we're going to go through antibacterials, antifungals, antivirals
with these four medications in that order and then through the big list
we're also going to go antibacterial, antifungal, antivirals. So the antifungal
over-the-counter so you might know Lotrimin Ultra we use for athlete's
foot things like that it's butenafine okay then influenza vaccine so again
using the prophylactic something that's trying to prevent infection before we
use something acute docosanol so influenza vaccine has one of its brand
names as Fluzone and when you see flu and a brand name that means influenza
but if you see -flu- in the generic name except for obviously the word influenza
like fluoxetine, Prozac or another one's escaping me now but that means a
fluorine atom so be careful about using -flu- to mean for the flu or for influenza.
docosanol it's Abreva I had no idea why anybody paid 20 bucks for this but
it'll make your cold sore go away much faster but think about docosanol so
you can go to the ball or you can go to the prom that's I guess why you would
spend 20 bucks on something like that but it abbreviates the amount of time
that that cold sore lasts so Abreva let's start with the first
antibiotic or antibacterial section so I had a little piece of tape here on the
board so we put penicillin over here but we have one penicillin antibiotic but
something unusual about it we start with amoxicillin which is Amoxil and this has
the -cillin stem and so amoxicillin, penicillin,
methicillin, these are all penicillin antibiotics we see that from the stem
but Amoxil is the brand name you just took out the -ic- and then the -lin- but
what's this clavulanate? So sometimes the bacteria can
secrete an enzyme which can make the antibiotic ineffective. That beta
lactamase enzyme can destroy the amoxicillin but if you add this
clavulanate you can augment and you see that word augment in Augmentin the
brand name this amoxicillin. The cephalosporins are related to the
penicillins they work on cell walls as well so I'm not going to get too much
into mechanism of action that's all in the book this is just review the archaic
one with C-E-P-H and I think they got rid of this because ceph- means brain or head
if you're talking about medical terminology and its brand name is Keflex
but this is first generation what that means is that a first generation drug
has three properties that a third or fourth generation wouldn't or the other
way around third and fourth have properties that first wouldn't so a
third and fourth generation would increase gram-negative coverage would
increase the ability to prevent beta lactamase attack just like the
clavulanate does with the amoxicillin ceftriaxone and cefepime a third
generation and fourth generation drug both do the same thing and then these
two have better penetration into the cerebral spinal fluid if there's some kind
of infection there but again the stem is cef-, C-E-F so the importance with putting
vancomycin here when it doesn't seem to relate at all is that vancomycin also
affects the cell wall. This -mycin stem again isn't
really going to help you too much but vancomycin is a glycopeptide and it works a
little bit differently against methicillin-resistant Staph aureus
something like that but these are all grouped together this is where I kind of
mixed it up the tetracyclines should be before the macrolides but you can see
tetracyclines doxycycline from the c-y-c-l-i-n-e
and minocycline from c-y-c-l-i-n-e the reason they're called tetracyclines is because
they have four rings so the game Tetris was actually the Tetra for four and
tennis so the person who invented it just combine those two together so we're
just naming this class after the four rings in it and then Doryx for
doxycycline is the brand name and then minocycline's brand name is Minocin
then we have the macrolides that macro- comes from just being a big molecule
that's why they're named that way. This is an interesting one where we see the
-mycin but we also see something very similar in the middle the T-H-R-O and
this might be an infix I'm not exactly sure but -thromycin you see that they
all have that and that's one way to think that these three are macrolides
now do all macrolides have -thromycin? No but this is a little bit helpful okay
so azithromycin is a z-pack the way that I order it is that you only take
that one once daily clarithromycin you take it twice daily so once daily then
twice daily so Biaxin twice daily and then erythromycin is taken four times
daily so the way that i put this in was to put it in number of doses a patient
would have to take per day one two and four. So we're actually
continuing on to the next with some other antibiotics
clindamycin which is Cleocin you see this used a lot topically because it can
cause some severe side effects severe diarrhea so clindamycin a lot of times
we'll see used for penicillin allergic patients and dentistry the
oxazolidinone, linezolid and you can kind of see the classification in the name
the -zolid stem again here puts it in that class but Zyvox is very solid or
'zolid' against MRSA and vancomycin-resistant enterococci
amikacin and gentamicin both have those the -kasin and -micin stems tell you
the -micin doesn't tell you it's an aminoglycoside but these two are related
in that way so Amikin and Garamycin. The two dihydrofolate reductase
inhibitors so sulfa- and -prim are both a prefix sulfa- so let's you know it's a
sulfa medication and trimethoprim the -prim lets you know that it's a
dihydrofolate reductase inhibitor what does that mean? Well bacteria need folic
acid just like we do but they have to make their own so if you block them from
making their own it would kill the bacteria or hurt the bacteria and then
if you take a couple letters out of the word bacterium you get Bactrim, the
brand name. This fluoroquinolone is interesting because of the -oxacin
suffix so the -oxacin is the suffix and then this -fl- is an infix and this
fluorine atom makes it a fluoroquinolone rather than just a quinolone and then
Cipro just got, you just cut off the -floxicin to make Cipro from
ciprofloxacin and then Levaquin and is like Levaquin except it's a
quinolone so the -quin for that. Antiprotozoal, metronidazole so
-nidazole is the stem and it's an amidazole antibiotic so you could see those
letters kind of similar together and this is flagyl. TB I use R-I-P-E as
the acronym or way to remember it when you think of that raised section that if
you would have a positive induration on a TB test I would think it's ripe like
it's a welt or swelling so rifampin - Rifadin, isoniazid - INH,
pyrazinamide - PZA, and ethambutol which is Myambutol
and there's clues in there that I mentioned in the book about how to
remember what the side effects are for those but again we're still in the
antibacterials and with all these medications and now we're going to move
over to the antifungals
so three antifungals a lot of times students will
try to be very efficient and they'll just try to remember the generic name
but amphotericin B doesn't really tell you much about what it does but Fungizone
own certainly tells you it's for fungus. Fluconazole the -conazole stem some
people get this wrong and they put that -azole stem in there and and -azole- is
just azole, it's just an organic chemistry group so you don't want to use
-azole because if you do that then you say fluconazole and omeprazole a proton
pump inhibitor in the same class and that's just not true. Nystatin so this
is Mycostatin so if you've had microbiology class you
know the myco- means some kind of fungus be careful with this -statin
so the -statin and nystatin and the -statin in MYcostatin, there's a class of HMG-CoA
reductase inhibitors that are anti cholesterol medications that have this
-statin stem and really the -vastatin is a better way to do that and I'll talk
about that when we get to cardio. Oseltamivir
so the -amivir is the stem here and these
brand names are great they tell you exactly what it's for oseltamivir you
tame the flu which is influenza and Zanamivir is Relenza make the
influenza relent so pretty good brand names there another antiviral for
herpes simplex virus and varicella zoster virus - acyclovir okay so the -cyclovir
is the stem and this again I didn't mention this -vir stem but
it's kind of a sub stem so -vir is the all-encompassing antiviral stem but -amavir
tells you it's for the influenza, -cyclvir tells you it's for HZV/VZV
and we have Zovirax, so zoster virus acts the zoster virus or wreak the virus so
you can see the val- from Valtrex and val- from valcyclovir are
similar so some similarities there I go over it all in the book. Palivizumab so
again we have a monoclonal antibody, m-a-b and this is for respiratory syncytial
virus so we've had a medication that's a biologic with this kind of naming for
asthma for ulcerative colitis and as an antiviral so this -mab doesn't tell you
what it's for but the -vizu- with the -mab helps you understand how it's
working within the body and then this is Synagis. All right so those are the
antifungals and then the non-HIV antivirals the next thing I'm going to
do is go over the HIV antivirals which so i haven't mentioned the top 200
there's going to be 200 drugs in this list the top 200 drugs tend to omit the
HIV medications but I think it's essential that we talk about them and
certainly how HIV works in the body so let's go to the HIV medicines
all right so what I did was I put them in an order that makes sense in
terms of how the HIV virus attacks the body so the first thing the HIV virus
tries to do it tries to fuse so we've got enfuvirtide and you can see the
-fu- from fuse but the -vir- stem (oops one in green) the -vir- stem and then the Fuseon
so something that's trying to fuse with the healthy cell then you've got
miraviroc which is a CCR-5 antagonist a cellular chemokine receptor
antagonist and again we're still outside the cell trying to get in and if you
look at the brand you see Selzentry so sans entry means no entry so that's one
way you can think of it that we don't want this virus to get in. Efavirenz
is a non-nucleoside reverse transcriptase inhibitor and it's paired
here with emtricitabine and tonofovir which comes to Atripla so
the trip, I have triplet daughters but this triple
makes three drugs in one medication and then the A surrounded so maybe against
AIDS or something like that. Efavirenz is a non-nucleoside reverse
transcriptase inhibitor, an NNRTI. Emtricitabine and tenofovir are
nucleoside nucleotide reverse transcriptase inhibitors or NRTI so a
mouthful certainly but hopefully a good way of remembering it that we're going
from fusion and CCR5 antagonist outside the cell now the cell, now this HIV virus
is trying to attack reverse transcriptase and then it's going to try
to attack integrase and then protease and so by stopping reverse
transcriptase by stopping integrase by stopping protease we can hopefully stop
the HIV so we have raltegravir and this is Isentress so again we see that
'entry' as one of the, as the brand name and then Darunavir
which also is Prezista so we're resisting the HIV virus with a protease inhibitor okay so you
kind of see the -tegrase T-E-G-R-A-V-I-R in raltegravir and darunavir, it's
really the brand name with Prezista that you see the protease inhibitor. But
the key is that by memorizing these five brand names and then you certainly
got the combination here so it's eight actual medicines but one two three four
five six seven, seven actual medicines let me do that one again okay so by
memorizing HIV medications and we have seven medications but five groups, five
different types here the key is that we're learning how does HIV go from this
to this to that to that and so these orders aren't just about memorizing it
but also memorizing the pathophysiology that goes along with understanding HIV