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  • 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