Lecture Part 1 - 9.13.

23
Wednesday, September 13, 2023 08:52

Week 1
Pharmacodynamics = what drug does to body; aka MOA
• Drug-receptor interaction
○ Activation or inhibition
§ Agonist
§ Antagonist
○ 4 diff ways drug works in body
§ Full agonist = drug that starts/helps/stimulates cell receptor and tells cel
it's doing
§ Partial agonist = drug that stimulates cell but just a little bit---not to full ca
§ Antagonist = drug that stops/blocks cell receptor from doing something t
happen
□ Ex: BB = antagonist
§ Biochemical/Physicochemical properties = no receptor involvement; Che
how it works; when med breaks down and it just works on its own; doesn
□ Ex:
® TUMS
® Carafate = coating of stomach lining
◊ Dissolves and creates protective lining for stomach
◊ Used for gastritis
® Chelating agents
◊ Used for heavy metal poisoning

• Dose response relationship

○ As dose increases, response goes up (most of the time)
○ Sometimes with drugs, there is an opposite effect
§ As dose increases, response goes down
○ Ex:
§ seroquel
□ for sleep = 25-100 mg
® At low dose, you are not getting psych effects but will get sleep
□ for schizo = 400-600 mg
® At higher dose, you are not getting sleepiness effect but will ge
• Drug potency and efficacy

Types of Drug Interactions

ll to do more of what

apacity
that is supposed to

emistry of medicine is
n’t work on receptors

piness effect

et more psych effects

 ® At low dose, you are not getting psych effects but will get sleep
□ for schizo = 400-600 mg
® At higher dose, you are not getting sleepiness effect but will ge
• Drug potency and efficacy

Types of Drug Interactions

• Effects of a drug are CHANGED by the presence of another factor
○ Drug-drug pharmacokinetic
§ Ex:
□ Distribution
® 2 lipophilic drugs --> they will compete for fats
® 2 protein bound drugs --> whichever has higher affinity --> pr
□ Metabolism
® CYP450 inducers/inhibitors
◊ Drugs are trying to be metabolized in liver at the same ti
○ Drug-drug pharmacodynamics
§ One drug is competing with another drug for the same receptor or doing t
another drug
§ Ex
□ Cocaine and BB
® Coke stimulates beta receptors and BB is blocking beta recept
◊ Same receptors, opposite actions on those receptors
□ Narcan and opioids
○ Drug-food
§ Ex:
□ Grapefruit with other liver meds
□ Milk/dairy products can neutralize how things are absorbed
□ Coumadin and dark leafy greens (have massive amounts of vit k)
® Coumadin blocks vitamin k to work
○ Drug-disease
§ When you see contraindications and cautions, it is bc of a drug-disease int
□ ex
□ Liver failure with prodrugs
□ Dialysis with kidney excretion drugs
□ COPD/asthma + BB
® BB causes smooth relaxation of dilation in body but smooth m
the lungs
◊ BB are contraindications of COPD/asthma
□ Kidney disease/renal failure + contrast and NSAIDs (ibuprofen)
□ Sudafed + HTN
® Sudafed causes vasoconstriction
Prescribing Issues
• 50% of patients don’t take meds correctly
○ Make sure you're not leaving patients to figure it out themselves--teach them!
○ Make sure they understand
 piness effect

et more psych effects

rotein bound

ime

the opposite of

tors

teraction

muscle constriction in
 □ Sudafed + HTN
® Sudafed causes vasoconstriction
Prescribing Issues
• 50% of patients don’t take meds correctly
○ Make sure you're not leaving patients to figure it out themselves--teach them!
○ Make sure they understand
• What is the therapeutic objective?
○ Big 2
§ Cure
□ Ex: antibiotic to cure infection
§ Management
□ Ex: give HTN meds to decrease
® give HTN meds to decrease BP (managing chronic condition)
® Synthroid for hypothyroidism
§ Symptom relief
□ Ex: you have a cold and take cough medicine--just given to make peo
® Nothing will cure the cold--just need to manage symptoms to m
○ Some patients don't know what the therapeutic objective is--need to tell them
• Must consider cost
• Must consider patient factors
○ Functional ability
○ Age
§ Ex fluroquinolones can cause tendon tears (black box warning)
○ Allg
§ Make sure it's an actual allergy---not an ADR
□ Ex of actual allergy:
® Hives
® Swelling
® Angioedema
® Itching
○ PMH
○ Pregnancy
§ If you have a female in front of you, they are pregnant until you have data
□ Ask
® when was your last period?
® Do you have an IUD?
® Have you had a hysterectomy?
○ Financial status
§ Do they have insurance?
§ Can they afford?
• Informed consent
○ Never lie about what meds do
○ Need to sign informed consent if they are taking opioid (can only use one provi
ADRs)
ople feel better
make you feel better

a that says otherwise

ider/pharmacy,
 §
§ Can they afford?
• Informed consent
○ Never lie about what meds do
○ Need to sign informed consent if they are taking opioid (can only use one provi
ADRs)

Positive Outcomes
• Knowledge deficit/patient perception
• Polypharmacy = 5-10 meds
• Measuring adherence
○ Count pills--mult left over?

FDA Approval
• Stage 1: animals
○ 1-3 years
• Stage 2: people
○ Determining toxic/therapeutic range
○ 2-10 years
• Stage 3: more people
• FDA review for 2 years
• Approved
• 8.5 years to get med approved from creation to people actually being able to take it

DEA
• Controlled substances = at risk for dependence
• Schedule 1-5
○ Sched 5 = least dependent
§ Gabapentin
§ Lomotil
§ Cough syrup with little bit of codeine in it
○ Sched 4
○ Sched 3
§ BENZOS MOVED TO HERE
§ Testosterone
○ Sched 2
§ Morphine
§ Cocaine
§ Amphetamines
§ All have to be WRITTEN prescriptions or called in--cannot e-scribe
§ Can prescribe 30 day, ZERO refills
□ Cannot prescribe refills!!
○ Sched 1
§ LSD
§ MJ
ider/pharmacy,
 § All have to be WRITTEN prescriptions or called in--cannot e-scribe
§ Can prescribe 30 day, ZERO refills
□ Cannot prescribe refills!!
○ Sched 1
§ LSD
§ MJ
§ Cocaine
• Need to have DEA # to prescribe
○ Need to apply for it
○ Very expensive
• Federal regulations but states give prescriptive authority

OTC Meds
• 42% of adults take OTC meds
• 49% report dietary supplement use
• Assume all pts have tried an OTC tx
• OTC drugs are approved/labeled by FDA to be safe to use OTC
• OTC must go through the new drug application process just as prescription drugs
• There are 80 therapeutic categories of OTC drugs
○ Some people will take multiple APAP for multiple things --> APAP tox
• Hazards
○ Inaccurate dosing
§ Toxic levels due to OD
○ APAP tox
§ Overuse
§ Combo meds
○ Decongestant meds in infants/young children
§ Infant drops removed from market
§ Relabeled not to use under age 4 years
○ Abuse
• ADRs--GET REST FROM NEW PPT!!
○ GI upset
--------------------------------------
Week 3
Gram + vs Gram -
• Gram + bact = can be stained with dye
○ Only has 2 walls
§ Inner membrane
§ Peptidoglycan layer
○ MUCH easier to kill/treat
○ Ex
§ Staph
□ We could touch a petri dish and grow staph
□ We live with this
□ Usually not pathogenic
○ MUCH easier to kill/treat
○ Ex
§ Staph
□ We could touch a petri dish and grow staph
□ We live with this
□ Usually not pathogenic
□ Ex:
® impetigo = staph that has penetrated skin
® Staph aureus = MC
◊ skin
® MRSA
◊ skin
® Staph saprophyticus = UTI, vagina
◊ Females with
§ Strep
□ We live with this
□ Usually not pathogenic
□ Ex:
® strep pyrogenes
◊ throat
® Strep PNA
◊ lungs
® Strep viridans
◊ Dental abscess
◊ Can travel to heart --> Endocarditis
® Strep agalactiae
◊ Group b
} Mom is not affected but if they have it they get ant
} Babies --> sick
§ Enterococcus
□ In GI system
□ We live with this
□ Usually not pathogenic
□ Ex:
® E. faecalis - urinary tract
® E. faecium - urinary tract
§ More rare
□ Clostridium
® Type of enterococcus
◊ Botulinum
} Botulism
} Anaerobic
◊ Tetani
} Tetanus
} anaerobic
tibx before delivery
 □ Ex:
® strep pyrogenes
◊ throat
® Strep PNA
◊ lungs
® Strep viridans
◊ Dental abscess
◊ Can travel to heart --> Endocarditis
® Strep agalactiae
◊ Group b
} Mom is not affected but if they have it
they get antibx before delivery
} Babies --> sick
§ Enterococcus
□ In GI system
□ We live with this
□ Usually not pathogenic
□ Ex:
® E. faecalis - urinary tract
® E. faecium - urinary tract
§ More rare
□ Clostridium
® Type of enterococcus
◊ Botulinum
} Botulism
} Anaerobic
◊ Tetani
} Tetanus
} anaerobic
◊ Difficile
} GIT
} Anaerobic
□ P acnes
□ Diphtheria
□ Anthrax
□ listeria
• Gram - bacteria are not stained
○ 3 Layers
§ Plasma membrane
§ Peptidoglycan layer
§ Outer layer = lipopolysaccharides + proteins
○ Has extra layer of protein + fats
○ Ex: everything that is not gram +
§ N. gonorrhea
§ N. meningitidis
 § Peptidoglycan layer
§ Outer layer = lipopolysaccharides + proteins
○ Has extra layer of protein + fats
○ Ex: everything that is not gram +
§ N. gonorrhea
§ N. meningitidis
§ E. coli
§ Shigella
§ Campylobacter
§ Salmonella
§ Pasturella
§ H flu
§ M cat
§ Proteus
§ Pseudomonas
§ Mycoplasma (atypicals)
□ Seen with walking PNA
§ Legionella (atypicals)
§ Chlamydia (atypicals)
○ NEVER normal--we don’t have this just living on/in us
○ ALWAYS pathogenic
• MOA of most antibx = destroying cell membrane
○ Do not memorize MOA for antibx
• Pick antibx based on bacteria
• Gram + or -
○ MRSA = +
○ MSSA = +
○ DRSP = +
• If pt had antibiotics in the last 90 days and is sick again, they prolly had h. flu
or m. cat (moraxella catarrhalis)
○ Always ask when they last took an antibx
○ If they still have it, the class of antibx that they took will not work
again---they have become resistant to it

Things to Consider
• What is most likely bug/bacteria that you are trying to kill? = #1 question
• Where is the bug?
○ In
§ GI (deep)?
§ Skin (superficial)?
§ external ear canal (give drops) vs internal ear canal (give pills)?
§ Bladder vs urethra
• Where does the drug concentrate?
• What is the best method of administration?
○ Ex
 § Skin (superficial)?
§ external ear canal (give drops) vs internal ear canal (give pills)?
§ Bladder vs urethra
• Where does the drug concentrate?
• What is the best method of administration?
○ Ex
§ Ears = drops
§ Eye = drops
§ Bone = IV
• Has the patient been on recent antibx (last 90 days)?
○ Will be resistant to previous class
• Pt specific factors
○ Pregnancy
○ Allg
○ Cost

Resistance vs Coverage
• Resistance = bacteria exposed to antibx previously and developed methods
to protect itself against a specific antibx
• Sanford guide gives resistance guidance

Antibx Stewardship
• Set of coordinated strategies to improve use of antimicrobial meds with goal
of enhancing pt health outcomes, reducing resistance to antibx, and

Beta-lactam
• Antibx with a beta-lactam ring
• Attached to any PCN or cephalosporin
○ PCN = pentagon
○ Cephalosporin = hexagon
• What is a beta lactamase?
○ -ase = enzyme
○ Enzyme that bacteria produces that eats away at beta lactam ring
§ PCN/cephalosporins cannot work without beta lactam ring
□ This is one way bacteria can be resistant to
PCN/cephalosporin
• Cannot give amox and cephalosporin within 90 days of each other
• Allergies
○ 90% of people allergic to amox is actually allergic to the pentagon--will
not be allergic to hexagon
§ This means that they can still take cephalosporin
○ 10% of people are allergic to the beta-lactam ring so they are allergic
to PCN and cephalosporin
○ If severe reaction (hives, anaphylaxis) to PCN = allergic to both
PCN/cephalosporin
 not be allergic to hexagon
§ This means that they can still take cephalosporin
○ 10% of people are allergic to the beta-lactam ring so they are allergic
to PCN and cephalosporin
○ If severe reaction (hives, anaphylaxis) to PCN = allergic to both
PCN/cephalosporin
○ If mild reaction (itching, rash that goes away) to PCN = you can give
cephalosporin
• Multi-billiform(?) rash = more common in kids when getting antibx (PCN)
for viral infection
○ Can try cephalosporin

PCN
• MOA: inhibit bacterial cell wall synthesis
• ADRs
○ May cause serious immediate allg rxn
§ Rxns occur within 2-30mins of admin
○ Desensitization therapy
○ Rash = maculopapular rash occurs 9% of the time that is not allergic in
origin; appears 7-10 days into tx
○ GI
§ Diarrhea
§ n/v
§ Addition of clavulanate increases risk of diarrhea
§ GI upset
○ Fungal overgrowth
§ Always a risk with antibx
§ Women on antibix more at risk for vaginal yeast infection
§ Kids on antibx more at risk for thrush
§ Men with DM on antibx more at risk for jock itch
○ C diff colitis
• Most are preg category b
○ Can be taken
• Ex
○ Ampicillin
○ Amox
○ Penicillin g/k
• Treats gram + but not staph
○ Used to treat strep
• Drug of choice for strep
• NOT beta lactamase---do not use with beta lactamase producers
○ Do not give twice within 90 day period
• Safe in kids and preggos

Extended spectrum PCN

 • Drug of choice for strep
• NOT beta lactamase---do not use with beta lactamase producers
○ Do not give twice within 90 day period
• Safe in kids and preggos

Extended spectrum PCN

• Ex
○ Amox/clavulanic acid (augmentin)
○ Piperacillin/tazobactam (zosyn)
• Treats
○ Gram+ and -
○ Beta lactamase producers
○ NOT mrsa
○ NOT atypical mycoplasma
• If taken amox in last 90 days, you CAN take augmentin or zosyn
○ If started with augmentin and get sick in 90 days, you cannot move
backwards --> move to another class
§ Start with MOST specific antibx you can choose--do NOT start
with broad spectrum
□ Ex of broad spect:
® Zosyn
® Augmentin
® Vanc
§ You should have started with amox first

• Good for bites

• Clavulanate assoc with diarrhea

1st gen Cephalosporins

• Ex
○ Cephalexin (Keflex)
○ Cefadoxil (Duricef)
• Treats
○ Gram +
○ Staph and strep
○ Think skin infections

2nd gen cephalosporin

• ex
○ Cefuroxime (ceftin)
○ Cefaclor
○ Cefprozil
• Treats
○ Gram + and -
○ Staph and stre
 ○ Cefuroxime (ceftin)
○ Cefaclor
○ Cefprozil
• Treats
○ Gram + and -
○ Staph and stre
○ H flu
○ E coli
○ Proteus
• Good coverage of + and - but NOT beta lactamase producing bact

3rd gen cephalosporin

• ex
○ Ceftibuten
○ Cefixime
• Treats
○ Gram + (weak)
○ Gram -
○ Beta lactamase
○ Strep
○ NOT staph
○ H flu
○ M cat
○ E coli
○ Klebsiella
○ Salmonella
○ Shigella
• Good for 90 day reinfection and smokers (at risk for h flu and m cat)

Extended spect 3rd gen cephalosporin

• ex
○ Ceftriaxone (rocephin)
○ Cefdinir (omnicef)
○ Cefpodoxime
○ Cefditoren
• BROAD sepctrum
• Treats
○ Gram +/-
○ Beta lactamase
○ Strep
○ Staph
○ H flu
○ M cat
 ○ Beta lactamase
○ Strep
○ Staph
○ H flu
○ M cat
○ E coli
○ Proteus
○ Salmonella
○ Shigella
• Gonorrhea
○ Resistant to so much---cannot treat with 1st-3rd gen ceph
§ Need to start with rocephin at 500 mg (high dose!!)

Tetracyclines
• MOA= inhiit bact protein synthesis
• Pharmacokin
○ Food decreases absorption
○ Milk and calcium REALLY decrease absorption
○ Take on empty stomach
• Precautions/contraindications--MEMORIZE
○ Do not prescribe to preggos, lactating women, or kids <8y/o
○ Can permanently stain bones/teeth under 8y/o
• Ex
○ Doxycycline
○ Minocycline
• Treats
○ Gram -
○ Atypicals
§ #1 recc for chlamydia
○ MRSA
○ P acnes
○ Some h pylori regimens
• Good for atypical pathogens and lower RT pathogens
• Tick borne illnesses
○ Ex
§ rickettsia
§ lyme = #1 tx for lyme
• NOT in preggos or kids <8 y/o
• Causes photosensitivity

Sulfonamides
• MOA: block synthesis of folic acid by bact --> inhibits bacterial replicatoni
• ADRs
○ GI
 • Causes photosensitivity

Sulfonamides
• MOA: block synthesis of folic acid by bact --> inhibits bacterial replicatoni
• ADRs
○ GI
§ Anorexia
§ n/v
§ Diarrhea
§ Stomatitis
○ Rash
○ Increased hypersensitivity (like stevens johnsons syndrome (SJS) =
skin peels off)
○ Photosensitivity
○ CNS
§ HA
• Ex: tmp-smx (bactrim, septra)
• Treats
○ Gram -
○ Kills MRSA--first line
○ E coli = resistant (25%)
§ No longer 1st line for UTI
• Do NOT use in preggos

Macrolides
• MOA: binds to 50S subunit of susceptible organisms sand prevents bact
protein synth
• Precautions/contra
○ Most are safe in preggos and kids
• ADRs
○ Dose-related GI
§ n/v
§ Abd pain
§ Cramping
§ Diarrhea
○ Skin
§ Urticaria
§ Bullous eruptions
§ Eczema
§ SJS
• Early generation
○ Ex: erythromycin
○ Treats
§ Atypicals (mycoplasma, legionella)
§ P acnes (erygel)
 § SJS
• Early generation
○ Ex: erythromycin
○ Treats
§ Atypicals (mycoplasma, legionella)
§ P acnes (erygel)
○ NOT
§ Strep
§ Staph
§ Enterococcus
○ A lot of resistance!
○ Poorly tolerated d/t GI s/s--diarrhea
○ Drug interactions
• Later generation
○ Ex: azithromycin (z-pack), clarithromycin (biaxin)
§ Do not prescribe statin with biaxin
□ Or make sure you say not to eat grapefruit
□ Metallic taste
○ Treats
§ Atypicals (mycoplasma, legionella, pertussis [1st line])
§ Staph
§ STDs
§ Atypical PNAs
○ NOT
§ Strep
§ Enterococcus
○ Drug interactions
§ Clarithromycin - liver
○ A lot of resistance!

Fluroquinolones
• MOA: inhibit action of dna gyrase which is essential for organism to
replicate
• Pharmacokin
○ Well-absorbed
○ Take on empty stomach for best absorption
○ Avoid dairy and MVTs
• ADRs
○ Black box: tendonitis/tendon rupture
§ Elderly and athletes at higher risk
§ Can have developed onset (120 days to mos after admin)
○ GI
§ Pseudomembranous colitis
§ Hypoglycemia
 ○ Black box: tendonitis/tendon rupture
§ Elderly and athletes at higher risk
§ Can have developed onset (120 days to mos after admin)
○ GI
§ Pseudomembranous colitis
§ Hypoglycemia
○ CNS
§ Sleep disorders
§ Dizziness
§ Acidosis
○ Renal/hepatic failure
○ CVD
§ Angina
§ Atrial flutter
§ QT prolong (esp with moxifloxacin)
□ Do not give to pt with dysrhythmias
○ Psych
• Avoid in preg
• Do NOT rx to kids <18 y/o bc of tendon stuff

Fluroquinolones 2nd gen

• Ex: ciprofloxacin
• Treats
○ Gram -
○ Atypicals (mycoplasma, m cat)
○ Staph
• NOT
○ Strep
○ Resp use
○ In preg
○ Kids < 18 y/o
• Topical forms work above belt
• PO forms work below belt
• Used to be 1st line for pyelonephritis

Resp Fluroquinolones--3rd gen

• Ex: levofloxacin
• Treats
○ Gram +/-
○ Atypicals
○ DRSP
○ Aerobes and anaerobes
• NOT
○ In preg or kids <18 y/o
 ○ Atypicals
○ DRSP
○ Aerobes and anaerobes
• NOT
○ In preg or kids <18 y/o

Resp Fluroquinolones--4th gen

• ex
○ Moxifloxacin
○ Gemifloacin
○ Gatifloxacin
• Treats
○ Gram+/-
○ Atypicals

Glycopeptides/Lipopeptides
• Ex: vanc
• MOA: block construct of cell wall
• Treats
○ Gram+
○ Anaerobes
• Can treat c diff (anaerobe) with oral vanc bc it concentrates in the GI system
○ IV wont work for GI infections
• Recommended that IV for complicated skin infections, bloodstream
infections, bone/joint infections, endocarditis, and meningitis c/b MRSA
• Blood levels may be measured to determine the correct dose
○ Look at peaks and troughs
• Common SE
○ Pain at area of infection
○ Allergic rxns
○ Occasionally
§ Hearing loss
§ hypoTN
§ Bone marrow suppression
○ Safety in preg not clear
§ No harm evidence
§ Safe for breast feeding

Nitroimidazoles
• ex
○ Metronidazole (flagyl)
§ Treats both parasitical and bacterial infections
○ Tinidazole
• Treats
Nitroimidazoles
• ex
○ Metronidazole (flagyl)
§ Treats both parasitical and bacterial infections
○ Tinidazole
• Treats
○ Anaerobes only
○ Clostridium
○ Fungal infections
• Active against trich, entamoeba histolytica, h pylori, c diff, bacterial
vaginosis
• Used to treat inside vaginal canal bc of anaerobic properties
• Contraindications/cautions
○ Hypersens
○ Alcohol use during and x3 days after tx
§ NO ALCOHOL WITH FLAGYL --> antabuse rxn
§ Rxn: horrible n/v d/t lactic acid production
§ Drug-food interaction
○ Propylene glycol-containing product use during and x3 days after tx
○ Disulfiram (antabuse) use within 14 days

Urinary Antiseptics
• Ex
○ Nitrofurantoin (macrobid)
• MOA = inhibits DNA/RNA/prtein/cell wall synthesis
• Treats
○ Urinary pathogens (MSSA, E coli)
• Concentrates in the bladder
• Does NOT work for MRSA bc cant concentrate in skin
• Requires normal creat clearance
• Category b: good for preggos
○ except at term (38-42 weeks) bc of premature rupture membrane risk

Lincosamides
• MOA = binds to 50S ribosomal subunit --> inhibits protein synthesis
• Ex
○ Clindamycin
○ Lincomycin
• Treats
○ Gram +
○ Aerobes and anaerobes
○ MRSA
• Contra: UC (irritates GI system)
• Common cause of c diff
 ○ Gram +
○ Aerobes and anaerobes
○ MRSA
• Contra: UC (irritates GI system)
• Common cause of c diff

MRSA works with

• Sulfa
• Vanc
• Clindamycin
• Fluroquinolones

Oxazolidinones
• Ex
○ Linezolid (zyvox)
• Treats
○ Gram +
○ Vanc resistant enterococcus
• Linezolid is used to treat diff types of bacteirl infections
○ PNA
○ Skin infections
○ Infections that are resistant to other antibx
• Rational drug selection
○ Ex: zyvox used to be v expensive--now generic

Top Med List slide--don’t memorize

Quick Facts---NEED TO MEMORIZE!

• HIV+ = high risk of being allergic to bactrim
• Use of PCN if pt has mono (or another mono infection) often causes
morbiliform rash--unknown mechanism
• Bactrim = 1st line for MRSA
○ Doxycycline 2nd line for MRSA
• Pertussis tx = use macrolides
• Ateypical PNA choose macrolide or doxycycline
• Strep pna = most common
○ Choose
• SCD = get prophylactic PCN until 6 y/o
• 4 most common causes of c diff
○ Clindamycin
○ Fluro
○ PCN
○ Cephalo
 • 4 most common causes of c diff
○ Clindamycin
○ Fluro
○ PCN
○ Cephalo

Antibmicrobial Resistance
• Every antibx class has organisms that are resistant
• Local resistance patterns can be identified by monitoring antibiogram of
local lab
○ Diff places have diff resistances
• Vaccines with pneumo vaccine has decreased resistance
• Fluro has increasing resistance

Antifungal agents
• MOA alter cell wall perm
• Ex: azoles, nystatin, griseofulvin, micafungin, butenafine, terbinfine
○ Diflucan = 1 dose for vag yeast infection
• ADRs
○ Liver probs
○ Interactions with other meds
• Most are topical
• Fungal infections are WORSE with hyperglycemia

Antivirals
• MOA: inhibits vial DNA synthesis --> inhibits dna rep
• Made for specific virus
○ Ex: paxlovid = specifically for covid
○ Many diff choices for antibx, but not so much for antivirals
• Ex:
○ -vir drugs
○ Tamiflu specifically for influenza
○ Ribavirin
○ Lamivudine/zidovudine
• Dz processes
○ Influenza
○ Varicella
○ Shingles
○ HSV
○ HIV
○ Hepatitis
○ HPV warts
○ COVID