03 Others

Trimethoprim/sulfamethoxazole

  • Panda: PABA - intermediate in folate synthesis (foliage for folate)

  • 2 leaves on first step: dihydrofolic acid

  • 4 leaves on second step: tetrahydrofolic acid

  • Rotten sulfa eggs: sulfamethoxazole (SMX)

  • Panda dropping: SMX is a PABA analog that blocks dihydropteroate synthase

  • Toilet paper: trimethoprim (TMP)

  • 2 leaves ducking: TMP blocks dihydrofolate reductase

  • bacteriocidal when together

  • Bladder cup: first line treatment for UTI

  • Egg down pants: treats acute prostatitis

  • Zombie guts: treats gastroenteritis caused by gram negative bacteria (e.g. Shigella, Salmonella)

  • Red porta potty: activity against gram negative GI and urinary tract bacteria

  • No mercy pharaoh: activity against MRSA

  • Card dealing cowboy: activity against nocardia

  • Purple fence: activity against gram positive bacteria

  • Old ping pong man in PJs: treats Pneumocystis jirovecii pneumonia (PJP) (old man: cane for inmmunocompromised)

  • Address 200: PJP prophylaxis for CD4 < 200

  • Address 100: toxoplasmosis prophylaxis with TMP/SMX for CD4 <100

  • Empty pan: pancytopenia

  • Red fireworks: megaloblastic anemia

  • Tarantula: teratogen in 1st trimester - antifolate effects cause neural tube defects

  • Sweaty itchy red devil: sulfa allergy - fever, urticaria, rash

  • Bite and seeds: bite cells and Heinz bodies seen in RBCs

  • Broken G6PD-free fruit: hemolytic anemia in G6PD deficiency

  • Red mask sloughing off: Stevens-Johnson syndrome

  • Mad scientist with 4 tubes of acid: Type IV renal tubular acidosis (RTA)

  • K shape: Type IV RTA leads to hyperkalemia

  • Kidney bag with little blue candies: interstitial nephritis

  • Flash photo: photosensitivity

  • Yellow candy corn: kernicterus in neonate (sulfonamide use in last month of pregnancy) (displace bilirubin bound to albumin, increase free unconjugated bilirubin)

  • Bloody: warfarin displaced from albumin causes over- anticoagulation and bleeding

  • Vandalized chrome bumper: inhibition of cytochrome P450

  • Werewolf: drug induced lupus

  • Ghandi cat: treat toxoplasmosis caused by Toxoplasma gondii

  • Dyed sulfur eggs: sulfadiazine

  • Pyramid witch hat: pyrimethamine. Good for malaria and toxoplasmosis because inhibits parasite DHFR

Fluoroquinones

  • Flowers: fluoroquinolones

  • unwinding braid: inhibit bacterial topoisomerases (e.g. DNA gyrase)

  • bacterialcidal because inhibit transcription

  • Red bladder cup: treat gram negative UTIs (e.g. E. coli, Proteus)

  • Mona Lisa elevating and sipping from bladder cup: levofloxacin and ciprofloxacin treat UTI caused by Pseudomonas

  • Milky kidney flask: empiric treatment for pyelonephritis

  • Flower bulb down pants: treat acute prostatitis

  • Gastrointestinal feast: treat gram negative bacterial causes of gastroenteritis (e.g. Shigella, Salmonella, E. coli, Campylobacter

  • Salmon: treat Salmonella gastroenteritis

  • Fish bones: treat gram negative osteomyelitis

  • Sickle: sickle cell patients are at increased risk of Salmonella osteomyelitis

  • Lung axe: treat anthrax caused by Bacillus anthracis

  • Rusty chest plate: respiratory quinolones treat community acquired pneumonia (e.g. levofloxacin, moxifloxacin

  • Cold walking snowshoer: respiratory quinolones treat atypical “walking” pneumonia caused by Mycoplasma pneumoniae (e.g. levofloxacin, moxifloxacin)

  • Legion of ships: respiratory quinolones treat atypical “walking” pneumonia caused by Legionella pneumophila (e.g. levofloxacin, moxifloxacin)

  • Medals: divalent and trivalent cations (e.g. calcium, iron, magnesium) decrease absorption

  • Torsades strip: risk of prolonged Q-T interval

  • GI side effects, diarrhea

  • Old king gnawing on tendon: risk of tendon and cartilage damage in the elderly

  • Moon facies shield: risk of tendon and cartilage damage with chronic steroid use

  • Tarantula: teratogenic - damage to growing cartilage

  • Child gnawing cartilage: not recommended for children <10 years old - damage to growing cartilage

RIPE

  • RIPE: Combination of rifampin, isoniazid, pyrazinamide, and ethambutol used to prevent development of resistance

  • 2 phases of treatment: 4 drugs for 2 months followed by 2 drugs (i.e. isoniazid and rifampin) for 4 months

  • Liver spot: hepatotoxicity associated with all RIPE therapy drugs

INH

  • The Isolated Ranger: isoniazid (INH)

  • Mycobacteria cowboy shot off wall: INH acts on the mycobacterial cell wall by inhibiting mycolic acid production

  • Aggravating G tailed cat: INH is activated by a catalase-peroxidase (KatG)

  • Middle lobe bullet hole: primary TB (often presents as middle lobe cavity

  • Sleeping: INH can be used alone to treat latent TB infections

  • Silenced G tailed cat: resistance to INH by downregulating Kat G

  • Bandit in stockings and gloves: INH may cause peripheral neuropathy

  • Slow acetyl-gunslinger: INH metabolized by the liver enzyme N- acetyltransferase - slow acetylators have higher risk of side effects

  • Pair of dice (sixes): pyridoxine (vitamin B6) - INH promotes excretion

  • Ungloved hand holding dice: coadministration of INH and pyridoxine prevents peripheral neuropathy

  • Wolf: INH may cause drug induced lupus

  • MUD PILES: INH may cause anion gap metabolic acidosis

  • Broken chrome bumper: INH inhibits cytochrome P450

  • Motion lines: INH may cause seizures

  • Can also trigger hemolytic anemia in G6PD deficient patients

Rifampin

  • The Rifle: rifampin

  • Shot RNA track switch: rifampin binds bacterial DNA dependent RNA polymerase

  • Rifampin prophylactic monotherapy in close contacts exposed to Haemophilus influenzae or Neisseria meningitidis

  • Meningitis mohawk: Neisseria meningitidis

  • H plane: Haemophilus influenzae

  • Rifampin may produce orange body fluids

  • Speeding chrome bumper: rifampin activated cytochrome P450

Ethambutol

  • Ethel the Horse Whisperer: ethambutol

  • Arabian horse at the carbohydrate wall: ethambutol blocks arabinosyl transferase, inhibiting carbohydrate formation at the cell wall

  • Halt!: ethambutol is bacteriostatic

  • Red-green blinders: optic neuritis (loss of visual acuity, red-green color blindness)

Pyrazinamide

  • The Pyro: pyrazinamide

  • Needles: pyrazinamide may cause hyperuricemia and needle- shaped uric acid crystal formation

  • Yarn ball on toe: pyrazinamide may precipitate gout attacks

Leprosy

  • Immunocompromised cane: MAC is a common cause of disseminated disease in AIDS patients

  • Caged mockingbird: Mycobacterium avium complex (MAC) (Mycobacterium avium, Mycobacterium intracellulare)

  • crows: a macrolide (e.g. azithromycin or clarithromycin) combined with ethambutol treat MAC infections

  • Shariff Ethel: ethambutol (MAC treatment)

  • Speed limit 50: macrolide prophylaxis for MAC when CD4 < 50

  • Buttes: rifabutin (may be added as a third agent in treatment of MAC infection)

  • Rifle: rifampin (related to rifabutin)

  • Speeding chrome bumper: rifampin and rifabutin activate cytochrome P450; not as strong of an activator as driver brings cart to a halt

  • Leaping armadillo: Mycobacterium leprae(causative agent of leprosy)

  • Deputy zone: dapsone(used to treat leprosy)

  • Multi-lobed sand timer: dapsone can cause agranulocytosis and methemoglobinemia

  • Bite and seeds: bite cells and Heinz bodies seen in RBCs

  • Broken G6PD-free fruit: dapsone can cause hemolytic anemia in G6PD deficiency

  • Cloth: clofazimine (treats lepromatous leprosy)

  • Rifle: rifampin (used to treat leprosy)

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