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