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 overanticoagulation 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 Nacetyltransferase - 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 needleshaped 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)