03 Others
- 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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