SPACE / ENTER TO ADVANCE
strudel med
PENICILLINS*
Let's start with **penicillin**, in the **IV**,
if you want it **PO**, you need **Pen V**.
All these **beta-lactams**, attach to **PBPs**,
Strep and a **SNAP**, **Syphilis** another,
Now let's start this rap, I'm here with my brother
AMINOPENICILLINS
Now we got **aminos**, pulling up in El Caminos,
**Amp** by **IV**, **Amox** by **PO**,
Keep their flow low, don't need no hysteria,
**H flu**, **E coli**, **Proteus**, **Listeria**.
BETA-LACTAMASE INHIBITORS*
Add a new pal, **amox** and **clav**.
Stopping the malaise, **beta-lactamase**.
ANTI-STAPH*
Now last but not least, we got **Naf** for **Staph**,
**M-S-S-A**, we attack this track
CEPH GEN 1*
you might think they boring,
but on boards they're important.
**Cephalosporins**, yeah you need to record them.
Generation **one**, a **faz** and a **flex**.
Before surgery, give them a **PEcK**!
CEPH GEN 2*
Generation **two**, **Fox** and its **fur**,
Add a **HEN** to **PEcK** and coverage occurs.
CEPH GEN 3*
Generation **three**,
An absolute win
When you see **SHIN** you know where to begin
CEPH GEN 4*
Generation **four**, changes the onus,
Choose **cefepime** and you'll cover **Pseudomonas**.
CEPH GEN 5*
Generation **five** takes a little dive,
Covers **MRSA** but **Pseudomonas** survives
CARBAPENEMS*
Last **beta-lactams** are our **carbapenems**,
To **negatives**, **anaerobes**, **carbapenems** venom
**ESBLs** fall, but **seizures** be pendin'.
Remember this verse then all is forgiven!
VANCOMYCIN*
I got another rhyme, let's talk about **MRSA**,
let's start with **IVs**, let's start this verse ya,
**Vancomycin** first line, 'fore **MRSA mercs ya**.
But watch the time, **kidney's** online
give it too quick and you'll **turn red**,
but that's still better than dead
DAPTOMYCIN*
No time for rest, **Daptomycin's** next,
Sold in a **vial**, impactin' the **myo**,
While in the **lung**, **surfactant** says no.
Dose too high and **muscles pay the prices**, crisis,
**Rhabdomyolysis**, **kidneys** roll the dices. AYYYY
LINEZOLID*
If you need more, God forbid open the door,
**Linezolid**, now catch your breath,
Rock the moment,
Block **fifty S** but watch **serotonin**!
PO MRSA*
Now let's take it slow and go to **PO**,
**Bactrim**, **Clinda**, **Doxy** let's go!
PROTEIN SYNTHESIS*
That's a perfect segue to our next topic,
**Protein synthesis** now on the docket.
**Aminoglycosides**, **gram negatives** can mop it
Moxie with **doxy**, **atypicals** knock it, rock it,
now we're getting nerdy, I'll tell you something nifty, thrifty,
**Buy at thirty** and **sell at fifty**!
**Buy at thirty** and **sell at fifty**!
FLUOROQUINOLONES*
Now to buy those you might need a loan,
So we turn now to **fluoroquinolones**.
They run their zone through,
that's **topo four and two**,
Cover **negatives** and **Pseudomonas** too.
Remember **side effects**, don't forget:
**Tendons** unmet, **QT** stretched,
sun's a mess, **GI's** a wreck!
METRONIDAZOLE*
Before we head off, gotta find a ride,
So let's get **GAP** at the **metro** and slide.
Head below the **diaphragm** where **anaerobes** are slicker,
No **liquor** on this ride where **disulfiram** sicker.
OUTRO
Now you memorize and spread the vibes.
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MNEMONICS*
PENICILLINS
SNAP = Sulfonamides, Nocardia, Actinomyces, Penicillins. Pen G is IV, Pen V is oral.
BETA-LACTAMASE INHIBITORS
Clav = clavulanate, a beta-lactamase inhibitor often co-administered with amoxicillin (brand name Augmentin)
ANTI-STAPH
Nafcillin is interchangeable with oxacillin. Works for MSSA (methicillin-sensitive staph aureus), not MRSA.
CEPH GEN 1
"faz and flex" = ceFAZolin + cephaLEXin. PEcK = Proteus, E. coli, Klebsiella. Gen 1 = gram positives mostly, surgical prophylaxis.
CEPH GEN 2
"Fox" = ceFOXitin, "fur" = ceFURoxime. "hen to peck" = HEN (H flu, Enterobacter, Neisseria) added to gen 1 PEcK coverage.
CEPH GEN 3
SHIN = Strep pneumo, H influenzae (the I), Neisseria. All encapsulated organisms. Gen 3 = serious gram negative infections, meningitis.
CEPH GEN 4
Gen 4 = everything in gen 3 plus Pseudomonas coverage.
CEPH GEN 5
Only cephalosporin that covers MRSA. Trades away Pseudomonas coverage.
CARBAPENEMS
"venom" = broadest beta-lactam spectrum. ESBLs (extended-spectrum beta-lactamases) can't break carbapenems. "seizures be pendin'" = imipenem lowers seizure threshold.
VANCOMYCIN
"turn red" = Red Man Syndrome from fast infusion (histamine release). "kidney's online" = nephrotoxic, monitor troughs.
DAPTOMYCIN
"surfactant says no" = inactivated in lungs, never use for pneumonia. "muscles pay" = check CPK for rhabdomyolysis.
LINEZOLID
"fifty S" = blocks 50S ribosomal subunit. "watch serotonin" = MAO inhibitor, risk of serotonin syndrome with SSRIs.
PO MRSA
Oral MRSA options. Bactrim = TMP-SMX, Clinda = clindamycin, Doxy = doxycycline.
PROTEIN SYNTHESIS
"Buy AT 30, CCEL at 50." 30S inhibitors: Aminoglycosides, Tetracyclines. 50S inhibitors: Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linezolid.
FLUOROQUINOLONES
"topo 4 and 2" = topoisomerase IV (gram+) and II/gyrase (gram-). Side effects: tendon rupture, QT prolongation, photosensitivity, GI upset.
METRONIDAZOLE
GET GAP at the Metro(nidazole). G = Giardia, E = Entamoeba histolytica, T = Trichomonas, G = Gardnerella vaginalis, A = Anaerobes (Bacteroides, C. diff), P = H. pylori (with PPI + clarithromycin). Use for anaerobes below the diaphragm (vs clindamycin above). AE: disulfiram-like reaction with alcohol.