NATURAL ANTICOAGULANTS:

       1. PGI-2.

       2. Antithrombin.

       3. Protein-C.

       4. TFPI.

       5. Heparin.

       6. Fibrinolytic system.

ANTIBIOTICS

Chemotherapy: Drugs which inhibit or kill the infecting organism and have no/minimum effect on the recipient.

Antibiotic these are substances produced by microorganisms which suppress the growth of or kill other micro-organisms at very low concentrations.

Anti-microbial Agents: synthetic as well as naturally obtained drugs that attenuate micro-organism.

SYNTHETIC ORGANIC ANTIMICROBIAL DRUGS

Sulfonamides

Trimethoprim-sulfamethoxazole

Quinolones – Ciprofloxacin

ANTIBIOTICS THAT ACT ON THE BACTERIAL CELL WALL

Penicillins

Cephalosporins

Vancomycin

INHIBITORS OF BACTERIAL PROTEIN SYNTHESIS

Aminoglycosides - Gentamicin

Antitubercular Drugs: Isoniazid & Rifampin

Tetracyclines

Chloramphenicol

Macrolides – Erythromycin, Azithromycin

Clindamycin

Mupirocin

Linezolid

 ANTIFUNGAL DRUGS

Polyene Antibiotics (Amphotericin B, Nystatin and Candicidin)

Imidazole and Triazole Antifungal Drugs

Flucytosine

Griseofulvin

ANTIPROTOZOAL DRUGS

Antimalarial Drugs – Quinine, Chloroquine, Primaquine

Other Antiprotozoal Drugs – Metronidazole, Diloxanide, Iodoquinol

 ANTIHELMINTHIC DRUGS

Praziquantel

Mebendazole

Ivermectin

ANTIVIRAL DRUGS

Acyclovir

Ribavirin

Dideoxynucleosides

Protease inhibitors

Indomethacin

commonly used to reduce fever, pain, stiffness, and swelling. It works by inhibiting the production of prostaglandins, molecules known to cause these symptoms.

Indications

ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, juvenile arthritis, psoriatic arthritis, Reiter's disease, Paget's disease of bone, Bartter's disease, pseudogout, dysmenorrhea (menstrual cramps), pericarditis, bursitis, tendonitis, fever, headaches, nephrogenic , diabetes insipidus (prostaglandin inhibits vasopressin's action in the kidney)

Indomethacin has also been used clinically to delay premature labor, reduce amniotic fluid in polyhydramnios, and to treat patent ductus arteriosus.

Mechanism of action

Indomethacin is a nonselective inhibitor of cyclooxygenase (COX) 1 and 2, enzymes that participate in prostaglandin synthesis from arachidonic acid. Prostaglandins are hormone-like molecules normally found in the body, where they have a wide variety of effects, some of which lead to pain, fever, and inflammation.

Prostaglandins also cause uterine contractions in pregnant women. Indomethacin is an effective tocolytic agent, able to delay premature labor by reducing uterine contractions through inhibition of PG synthesis in the uterus and possibly through  calcium channel blockade.

Indomethacin easily crosses the placenta, and can reduce fetal urine production to treat polyhydramnios. It does so by reducing renal blood flow and increasing renal vascular resistance, possibly by enhancing the effects of vasopressin on the fetal kidneys.

Adverse effects

Since indomethacin inhibits both COX-1 and COX-2, it inhibits the production of prostaglandins in the  stomach and intestines which maintain the mucous lining of the

gastrointestinal tract. Indomethacin, therefore, like other nonselective COX inhibitors, can cause ulcers.

Many NSAIDs, but particularly indomethacin, cause lithium retention by reducing its excretion by the kidneys.

Indomethacin also reduces plasma renin activity and aldosterone levels, and increases

sodium and potassium retention. It also enhances the effects of vasopressin. Together these may lead to:

edema (swelling due to fluid retention)

hyperkalemia (high potassium levels)

hypernatremia (high sodium levels)

hypertension (high blood pressure)

Sulindac:  Is a pro‐drug closely related to Indomethacin. 

Converted to the active form of the drug. 

Indications and toxicity similar to  Indomethacin

Neomycin

used as a topical preparation

Neomycin is not absorbed from the gastrointestinal tract, and has been used as a preventative measure for hepatic encephalopathy and hypercholesterolemia. By killing bacteria in the intestinal tract, it keeps ammonia levels low and prevents hepatic encephalopathy, especially prior to GI surgery. It is not given intravenously, as neomycin is extremely nephrotoxic (it causes kidney damage), especially compared to other aminoglycosides.

Ketoconazole

synthetic antifungal drug

used for infections such as  athlete's foot, ringworm, candidiasis (yeast infection or thrush), jock itch.

Ketoconazole is used to treat eumycetoma, the fungal form of mycetoma.

MOA: Ketoconazole is imidazole structured, and interferes with the fungal synthesis of  ergosterol, the main constituent of cell membranes, as well as certain enzymes. It is specific for fungi, as mammalian cell membranes contain no ergosterol.

Sensitive fungi Ketoconazole inhibits growth of  dermatophytes and  yeast species (such as Candida albicans).

Codeine

Codeine is methyl morphine, with a methyl substitution on the phenolic hydroxyl group of morphine. It is more lipophilic than morphine and thus crosses the blood–brain barrier faster.

• classified as a simple, or mild analgesic, codeine is often used in low doses as an oral analgesic has a much better oral/parenteral absorption ratio than morphine.
• Effective for mild to moderate pain.
• Constipation occurs
• Dizziness may occur in ambulatory patients.
• More potent histamine-releasing action than does morphine.
• Should not be administered by IV injection.
• Extremely effective antitussive agent and is used therapeutically for suppressing cough.
• In contrast to morphine, codeine overdose can occasionally lead to the production of seizures.
• Seizures can be treated with barbiturates.
• Respiratory depression can be counteracted with Naloxone.
• orally, 30 mg of codeine is equi-analgesic to 600 mg of aspirin, however, the effects of the two are additive, and occasionally synergistic