> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/antimicrobials/03-others.md). # 03 Others ## Trimethoprim/sulfamethoxazole ![](https://f001.backblazeb2.com/file/wikiFiles/5XGsQLW.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/5XGsQLW.jpg) * 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) ![](https://f001.backblazeb2.com/file/wikiFiles/5XGsQLW.jpg) * Address 200: PJP prophylaxis for CD4 < 200 * Address 100: toxoplasmosis prophylaxis with TMP/SMX for CD4 <100 ![](https://f001.backblazeb2.com/file/wikiFiles/5XGsQLW.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/sNmuIJJ.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/5XGsQLW.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/6VwAAW7.jpg) * Flowers: fluoroquinolones * unwinding braid: inhibit bacterial topoisomerases (e.g. DNA gyrase) * bacterialcidal because inhibit transcription ![](https://f001.backblazeb2.com/file/wikiFiles/6VwAAW7.jpg) * 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) ![](https://f001.backblazeb2.com/file/wikiFiles/6VwAAW7.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * 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) ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * Middle lobe bullet hole: primary TB (often presents as middle lobe cavity * Sleeping: INH can be used alone to treat latent TB infections ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * Silenced G tailed cat: resistance to INH by downregulating Kat G ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/HkOUx2l.jpg) * 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 ![](https://f001.backblazeb2.com/file/wikiFiles/HkOUx2l.jpg) * 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)