Pharm exam 4: Antibiotics, Antifungals + Antivirals

What are the 5 principles of antibiotic therapy

1. Hypersensitivity(1(anaphylaxis) + 4(SCAR)) reactions (allergies)

2. Super Infection (antibiotics kill bad and good bacteria)

3. Finish ENTIRE therapy

4. Interactions(contraceptives(-), warfarin(+))

5. S/s of infections

s/s of anaphylaxis?

Urticaria, Hives, Oxygen gone, Hypotension, Angioedema

s/s of Infection?

WBC^, TEMP^, Bacteria-present in cultures/samples

What is Penicillin G used for?

Group B strep prevention

Syphilis

What are Ampicillin and Amoxicillin used for

Upper respiratory infection - acute otitis media

Dental use to prevent endocarditis in high risk cardiac patients

What drugs should you avoid while specifically on Penicillins?

Hormone-based contraceptives

Warfarin

Probenicid

What 2 antibiotics can you not mix in the same syringe

Penicillins and Aminoglycosides

Penicillin G Potassium adverse?

Hyperkalemia!

Penicillin G benzathine/procaine adverse?

syphilis

NEVER GIVE AS IV

What kind of Amoxicillin suspensions should be shaken before administration

IV suspension

What antibiotics are included in Beta-Lactam allergies/cross sens.

Penicillins, Cephalosporins, Carbapenems and Monobactams

What treats Staphylococcus aureus?

Penicillin

Why is MSSA resistant to Penicillin

Penicillinase causes the breakdown of penicillin, rendering it ineffective.

What treats MSSA?

Methicillin or Cephalexin

What is Tazobactam?

Beta Lactamase Inhibitor

What is Clavulanate

Beta Lactamase Inhibitor

What is Cefalozin

Cephalosporin

What is Ceftriazone

Cephalosporin

What is Meropenem?

Carbapenem

What is Impenem

Carbapenem

What is Ertrapenem

Carbapenem

What is Doripenem

Carbapenem

What is Aztreonam used for?

IV + Inhaled antibiotic

What is Vancomycin used for?

MRSA + C.Diff antibiotic

What is Azithromycin

Macrolide

What is Clarithomycin

Macrolide

What is Erythromycin

Macrolide

Which subclass does ACE acronym work for?

Macrolides

Azithromycin, Clarithomycin, Erythromycin

What is Gentamicin?

Aminoglycoside

What is Tobramycin

Aminoglycoside

What is Neomycin

Aminoglycoside

What is Amikacin

Aminoglycoside

What is Levofloxacin

Fluoroquinolone

What is Ciprofloxacin

Fluoroquinolone

What is Phenazopyridine used for?

Local Anesthetic for UTIs + other Genitourinary post-procedural pain

What is Sulfamethaxole-Trimethoprim used for?

Bacteriostatic used to treat UTIs and Lung Infections

What is Cefazolin used for?

Cefazolin is first gen, used preoperatively for Gram + and some Gram - bact.

What is Ceftriaxone used for?

Ceftriaxone is 3rd gen and used for UTIs, ^CSF penetration

Adverse effects of Cephalosporins?

Disulifram-like reaction with alcohol

Precipitant may form if used with IV calcium

What are Carbapenem’s used for?

SEVERE infections!!

Broad coverage of majority Gram ± bacterias

Avoid usage to prevent resistance

Adverse effects of Carbepenems

SEIZURE + CNS confusion

Can lower levels of seizure medications

What is Aztreonam used for?

Aerobic gram negative bacteria

What are adverse of Vancomycin?

Ototoxicity, Neprotoxicity + Red Man Syndrome

What is Red Man Syndrome

Histamine release in response to Vancomycin infusion

Itchy, Red, Rashes, Tachycardia and HYPOTENSION

What should the speed of Vancomycin infusion be to prevent Red Man Syndrome?

1g per hour max (DILUTED)

What does high trough level of Vancomycin indicate?

Toxicity/Nephrotoxicity

What does it mean if the trough is 10-20 for Vancomycin?

Therapeutic range

What does low trough level of Vancomycin indicate?

Subtherapeutic levels and increased risk of treatment failure.

What are Macrolides used for?

Alternative to amoxicillin(allergies)

Used in combination with Ceftriaxone for CAP

Adverse of Macrolides?

QT prolongation + Dysrhythmias

Ototoxicity

N/V/D

Increase levels of other drugs(inhibitor PACMAN)

Should you take Macrolides with food?

Yes

What are tetracyclines used for?

ACNE

Lyme disease

Anthrax

Adverse of Tetracyclines?

GI issues —> ulcers?

Photosensitivity

Tooth discoloration(calcium binds to tetracyclines)

Bone growth suppression in infants

Tips on Tetracycline administration?

Drink with water, NOT at night, NEVER laying down

DONT TAKE WITH CALCIUM, Mg + Al products!(lots of laxatives)

Are tetracyclines safe for children and pregnant patients?

NO!

What are amino glycosides used to treat?

Pseudomonas Aeruginosa

Adverse of Aminoglycosides?

Nephrotoxicity, Ototoxicity

PRECIPITANT FORMATION IF MIXED WITH PENICILLIN

When are trough levels drawn?

30-60min BEFORE next dose

When are peaks drawn?

30-60 min AFTER administration

What are Fluoroquinolones for?

E.Coli, Pseudomonas and Anthrax

E.Coli—> UTIs

Adverse of Fluoroquinolones?

TENDON RUPTURE/TENDONITIS

QT prolongation

Photosensitivity

What products should you avoid if taking Fluoroquinolones

Zinc, Iron, Mg, Calcium, Al

What is Phenazopyridine

Local Anesthetic for UTI + urinary pain relief(post-procedural)

What is the adverse of Phenazopyridine?

Orange-Reddish stained urine(harmless)

Adverse of Sulfamethoxazole-Trimethoprim?

Pancytopenia(blood dycriasis)

Bilirubin accumulation in newborns(kernicterus/brain damage)

Renal Crystallization

Hyperkalemia

Photosensitivity, Rash/Fever, SCAR

How many drugs usually used in Induction phase, Continuation and Latent Tuberculosis?

Induction: 4 (8 weeks)

Continuation: 2 (18 weeks)

Latent: 1-2 (3-9 months)

What do all RIPE drugs carry risk of?

Hepatotoxicity! GI distress(take 1hr-2hr before meals)

Adverse of Rifampin?

Red/Orange discoloration

Rapid Metabolizes other drugs

Adverse of Isoniazid?

Peripheral Neuropathy(give B6 to help)

Adverse of Pyrazinamide

Joint pain (increases Uric Acid—> Gout flare)

Adverse of Ethambutol?

Optic Neuritis

What is Acyclovir?

Anti-viral —> herpes

What is Valacyclovir?

Anti-viral —> herpes

What is Oseltamivir?

Anti-viral —> influenza

Adverse of IV Herpes Antivirals?

Nephrotoxicity

Phlebitis(site reaction)

Adverse of topical Herpes Antivirals?

Burning, itching of site (wear gloves, wash soap+ water 3-4x/day)

Adverse of Oseltamivir

N/V (take w/ food)

What is important nursing consideration for Oseltamivir?

MUST GIVE WITHIN 48 HOURS OF SYMPTOM ONSET

What class is Amphotericin B?

Polyene Antifungal

What class is Nystatin?

Polyene Antifungal

What class is Fluconazole?

Azole Antifungal

What class is Itraconazole

Azole Antifungal

What class is Ketoconazole

Azole Antifungal

What class is Clotrimazole?

Azole Antifungal

What is Amphotericin B used for?

SERIOUS systemic fungal infections

Adverse of Amphotericin B

Highly TOXIC

(BUN)Nephrotoxicity

(BMS)Bone marrow supression

(Brazil Nuts)Hypokalemia + (Banana)Hypomagnesemia

What are some examples of Potassium rich foods

Potatoes w/ skin, spinach, bananas, fruit juices(citrus), avacado

What are some examples of Magnesium rich foods

nuts, seeds, beans, dark chocalate, avacados

What should your premedicate patients scheduled to take Amphotericin B?

Diphenhydramine and Tylenol

What is Nystatin used for?

Superficial Fungal Infection (Oral Thrush)

What is Ketoconazole for?

Dandruff

What is Fluconazole for?

Vaginal yeast infection

What is Clotrimazole used for?

topical cream for skin/surface fungal

What is Itraconazole for?

systemic and superficial fungal infections

What is important to know about Azole-antifungals?

They are Liver Inhibitors(toxicity)

Adverse of Fluconazole?

GI upset, take with foodA

Adverse of Itraconazole?

QT-Prolongation —> HF risk

GI upset(take with food)