June 18, 2021

Antibiotics that cover anaerobes

Anaerobic bacteria are bacteria that do not live or grow when oxygen is present. In humans, these bacteria are most commonly found in the gastrointestinal tract. ⁠ ⁠ πŸ”Ί They play a role in conditions such as appendicitis, diverticulitis, and perforation of the bowel so it is important to make sure we have adequate anaerobic coverage when empirically treating these infections. ⁠ ⁠ πŸ’Š There are several antibiotics that cover anaerobes in addition to other bacteria. ⁠

Antibiotics that cover Pseudomonas

Pseudomonas is a type of bacteria (bug) that is found commonly in soil and in water. Of the many different types of Pseudomonas, the one that most often causes infections in humans is called Pseudomonas aeruginosa, which can cause infections in the blood, lungs (pneumonia), or other parts of the body after surgery.⁠ ⁠ πŸ”Ί Pseudomonas aeruginosa treatment has become increasingly difficult as bacteria become more resistant to the available antibiotics on the market. If they develop resistance to several types of antibiotics, these germs can become multidrug-resistant.⁠

Antituberculosis Agents

Tuberculosis (TB) is caused by Mycobacterium tuberculosis (aerobic, non-spore forming bacillus). Active TB is transmitted by aerosolized droplets (sneezing, coughing, talking, etc.) and is highly contagious. ⁠ ⁠ Active disease treatment is divided into two treatment phases, initial and continuation. To avoid treatment failure due to resistance, the preferred initial treatment consists of a 4 drug regimen of rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE). ⁠ ⁠ These 4 drugs are taken for about 8 weeks during the initiation phase. In the continuation phase, the regimen is narrowed based on susceptibilities.

Asthma, Management of

πŸ“– Asthma is a common airway disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever.⁠
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πŸ’Š Medical management includes bronchodilators like beta-2 agonists and muscarinic antagonists (salbutamol and ipratropium bromide respectively) and anti-inflammatories such as oral or nebulized steroids. Theophylline was once popular but is rarely used due to its narrow therapeutic index and side effect profile. However, it is still important to note as there are patients still treated with it. ⁠
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πŸ’Š Patients with life-threatening asthma are managed with high flow oxygen inhalation, systemic steroids, back-to-back nebulizations with short-acting beta 2 agonists, and short-acting muscarinic antagonists, and intravenous magnesium sulfate.⁠
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πŸ’Š Antibiotics should only be used if an infection is suspected (positive CXR, symptoms of cough and purulent sputum production, fever, high WBC, etc.) and should be withheld if not, to reduce the rise of antimicrobial resistance. ⁠

Beta-1 Cardioselective Beta-Blockers

❀️ Cardioselective beta-blockers work on the beta-1 receptors. Beta-1 receptors primarily are found in cardiac tissues whereas beta-2 receptors are located in the lungs (remember: 1 heart, two lungs). ⁠
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❀️ Cardioselective beta-blockers exert their effect by binding to the beta-1 receptor sites selectively and inhibiting the action of epinephrine and norepinephrine on these sites. They are often preferred in patients with respiratory disease as they are less likely to cause constriction of airways or peripheral vasculature.⁠

Cholinergic Muscarinic Agonist Effects

πŸ‘‰πŸ» Cholinergic muscarinic agonists are drugs that bind to and activate muscarinic cholinergic receptors and increase the activity of the parasympathetic nervous system. They are most commonly used when it is desirable to increase smooth muscle tone, especially in the GI tract, urinary bladder, and eye. They may also be used to reduce heart rate. ⁠
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πŸ‘‰πŸ» Direct cholinergic agonists work by resisting acetylcholinesterase, thus preventing its breakdown. Drugs in this class include bethanechol, carbachol, and methacholine, and pilocarpine.⁠
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πŸ‘‰πŸ» Indirect cholinergic agonists work by inhibiting the acetylcholinesterase enzyme preventing the degradation of acetylcholine. Drugs in this class include neostigmine, physostigmine, galantamine, donepezil, and rivastigmine. ⁠

CYP450 Enzymes, Major Inducers of

πŸ‘‰πŸ» Drugs that are inducers increase CYP450 enzyme activity by increasing enzyme synthesis. ⁠
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πŸ‘‰πŸ» A drug also may be metabolized by the same CYP450 enzyme that it induces. Carbamazepine (Tegretol), a potent enzyme inducer, must be initiated at a low dose and then increased at weekly intervals as its half-life gradually decreases over time.⁠

CYP450 Enzymes, Major Inhibitors of

The CYP450 enzymes are essential for the production of numerous agents including cholesterol and steroids. Additionally, these enzymes are necessary for the detoxification of foreign chemicals and the metabolism of drugs.⁠
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Drugs that are CYP450 inhibitors block the metabolic activity of one or more of the CYP450 enzymes. The extent to which an inhibitor affects the metabolism of a drug depends upon factors such as the dose and the ability of the inhibitor to bind to the enzyme.⁠

Drug Names #1

There are a plethora of drug facts to memorize for school, but it is definitely helpful when their names hint at what they are used for, their mechanism of action, frequency, or duration.
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πŸ’Š Lasix: short for ‘last six hours’ because of the 6-hour duration of action. Try not to administer this diuretic to patients after 4 pm to decrease nighttime awakenings.⁠
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πŸ’Š Macrobid: this formulation of Macrodantin is given BID (twice a day). Macrodantin is recommended to be given 4 times a day. Ensure you are using the right formulation for the right frequency. ⁠
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πŸ’Š Protonix: Protonix belongs to a class of proton pump inhibitors. Its brand name, Protonix, tells you that it is used to ‘nix protons’ or acid and is used to treat GERD and acid-reflux disorders. ⁠
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πŸ’Š Lopressor: brand name for metoprolol, a beta-blocker that is used for high blood pressure. The brand name, lo-pressor, tells you that it is used to help ‘lower pressures’. ⁠
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πŸ’Š Flonase: brand name for fluticasone nasal spray. Its name, Flonase, sounds an awful lot like ‘flow nasal’ which tells you that it is used to treat allergies that commonly cause nasal congestion. ⁠
πŸ’Š Ambien: AM is the sig for morning and Bien means good in Spanish. It is a sleeping aid medication that translates into ‘good morning’. ⁠

Drug Names #2

Part 2 of It’s all in the name! Hope these mnemonics make it easier for you to memorize these medications.
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πŸ’Š Flomax: brand name for tamsulosin, a medication used to treat urinary retention or benign prostatic hyperplasia (BPH). Its name tells you that it is used to ‘maximize flow’. ⁠
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πŸ’Š Lunesta: a sleep aid medication whose root word Luna means moon in Latin. ⁠
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πŸ’Š Xarelto: brand name for rivaroxaban, an oral anticoagulant. Its name hints at its mechanism of action, inhibiting factor Xa in the clotting cascade. ⁠
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πŸ’Š Fosamax: brand name for alendronic acid, it is a medication used to treat osteoporosis or bone weakening. Its name means os = bone, and max = great in Latin. ⁠
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πŸ’Š Prevacid: brand name for lansoprazole, it belongs to a class of proton pump inhibitors. Its name tells you that it ‘prevents acid’ and is used to treat GERD and acid-reflux disorders. ⁠
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πŸ’Š Glucophage: brand name for metformin. It is a medication used to treat type 2 diabetes. Its name derives from the Greek words gluco= glucose and phage = eat or consume. ⁠This helps you remember metformin’s mechanism of action is to increase uptake of glucose by cells in the body to be used as energy (or in other words increase insulin sensitivity). ⁠

Drug Names #3

πŸ’Š Vicodin is the brand name for hydrocodone/acetaminophen. Its component hydrocodone is approximately 6 times (VI) times as potent as codeine (codin). ⁠
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πŸ’Š Levitra is the brand name for vardenafil, a medication used to treat erectile dysfunction. The article ‘Le’ is used to describe masculine nouns in French (‘La’ is used with feminine nouns) and vitra is similar to the word vitality. So together, the name masculine vitality will help you remember the indication for Levitra. ⁠
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πŸ’Š Actigall is the brand name for ursodiol, a medication used to dissolve certain types of gallstones. It sounds a lot like “ACTS ON THE GAL-bladder” to help you remember what it is used for. ⁠

Drug Names #5

πŸ’Š Cisplatin is a chemotherapy medication used to treat a number of different cancers. Its name tells you that it is an isomer of a platinum-containing compound. ⁠
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πŸ’Š Maalox is used to treat heartburn, acid indigestion, sour stomach, and upset stomach. The name is an acronym that refers to the solution’s compositional elements: MAgnesium and ALuminum Oxide.⁠
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πŸ’Š Sonata is the brand name of Zaleplon, a sedative used to treat insomnia. The prefix Sona means ‘sleepy’ in Portuguese to help you remember its indication. ⁠

Drug Names #4

πŸ’Š Bactroban is the brand name of mupirocin, an antibiotic ointment that works to inhibit the growth of bacteria, hence the name ‘ban bacteria’ or Bactroban. ⁠
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πŸ’Š Emend is the brand name of aprepitant, an anti-nausea medication indicated to prevent nausea and vomiting caused by chemotherapy. The name emend has the components of ‘end emesis’ in it. ⁠
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πŸ’Š Morphine is an opioid pain medication. The drug was named after Morpheus, the Greek god of dreams because in addition to its long-lasting analgesic effects, it would also induce sleep. ⁠