top 100: Infectious Disease Medications Part 2

what medications are classified as a lincosamide?

Clindamycin (antibiotic)

clindamycin formulations

1. capsules

2. solution for injection

3. granules for oral solution

4. topical pledget

5. topical gel

6. topical lotion

7. topical solution

8. topical foam

9. vaginal cream

10. vaginal suppositories

clindamycin indications

1. bacterial infections such as

- orally for skin infections and abdominal infections

- topical for bacterial vaginosis or acne

- prevention of infections during dental procedures

clindamycin MOA

binds to 50S ribosomal subunit to inhibit protein synthesis

clindamycin brand name

Cleocin

common side effects of clindamycin

1. NVD

2. abdominal pain

3. rash

serious side effects with clindamycin

1. Clostridium DIfficile colitis*****

2. increased liver function tests

3. erythema multiforme

4. SJS

5. TEN

6. agranulocytosis

what antibiotic is most likely to cause C DIFF in patients?

clindamycin

clindamycin boxed warnings

possible severe colitis which might result in fatality

colitis

inflammation of the colon

clindamycin contraindications

hypersensitivity

clindamycin counseling (all forms)

1. finish all, store properly, stop & report allergic reaction

2. may cause NVD**

3. report severe diarrhea**

4. take with a full glass of water to avoid esophageal irritation

clindamycin counseling (topical)

may cause dryness or skin irritation

clindamycin counseling (vaginal forms)

may decrease effectiveness of barrier contraceptives, use another form of birth control for up to 5 days following treatment

what medications are classified as a nitrofuran?

Nitrofurantoin

Nitrofurantoin name brands

Macrobid and Macrodantin

formulations of Macrodantin

capsule

formulations of Macrobid

monohydrate capsules

other formulations of nitrofurantoin

oral suspension

nitrofurantoin MOA

cell wall synthesis inhibitor via inhibiting acetyl-coenzyme-A and therefore interfering with bacterial carbohydrate metabolism

nitrofurantoin common side effects

1. NVD, rash

2. headache

3. loss of appetite

4. discoloration of urine (dark yellow/orange/brown) **

nitrofurantoin serious side effects

1. hepatotoxicity

2. hemolytic anemia

3. peripheral neuropathy

4. pulmonary fibrosis

**more likely to happen in treatment w/ longer duration

nitrofurantoin boxed warnings

none

nitrofurantoin contraindications

1. CrCL < 60 ml/min

2. pregnancy @ term

3. hepatic dysfunction w/ previous use

4. hypersensitivity

nitrofurantoin counseling (all formulations)

1. finish all, store properly, stop & alert if reaction occurs

2. may cause NVD or rash 7 report severe diarrhea

3. may cause dark or discolored urine**

4. report breathing difficulty if taking for > 6 months**

5. take w/ food**

what medications are classified as a nitroimidazole

metronidazole

what classes and their respective medications are antibiotics?

lincosamides: clindamycin

nitrofuran: nitrofurantoin

nitroimidazole: metronidazole

what classes and their respective medications are antifungals?

azole antifungal: fluconazole

what classes and their respective medications are antivirals?

guanosine nucleoside analog: acyclovir & valacyclovir

neuraminidase inhibitor: oseltamivir

what classes and their respective medications are used for symptom management?

antitussive: benzonatate

antitussive/expectorant combo: codeine-guaifenesin

what medication is classified as a nitroimidazole?

metronidazole

metronidazole brand name

Flagyl

metronidazole formulations

1. tablets and capsules

2. ER tablets

3. topical cream

4. topical gel

5. vaginal gel

6. injectable solution

metronidazole indications

can be used for bacterial and protozoal infections:

- bacterial vaginosis, trichomoniasis, giardiasis, amebiasis

****Clostridium Difficile infection******

metronidazole MOA

free radical formation (cytotoxic reduced form) --> breakage of helical DNA --> protein breakage --> cell death

metronidazole common adverse effects

1. NVD, rash

2. headache, dizziness

3. abnormal taste

4. yeast infection

5. vaginitis

6. Jarisch Herxheimer Reaction

metronidazole serious side effects

1. SJS, TEN

2. seizures

3. neuropathies

4. aseptic meningitis

5. ototoxicity

metronidazole boxed warnings

carcinogenic in mice and rats

metronidazole contraindications

1. use of disulfiram in the last two weeks

2. use of alcohol-containing products during therapy and within 72 hours of discontinuation

- both linked to causing severe/ extreme nausea and vomiting

3. 1st trimester pregnancy

metronidazole counseling (all formulations)

1. finish all, store properly, stop & alert if reaction develops, may cause NVD and rash, report severe diarrhea

2. may cause metallic taste**

3. report any abnormal nerve sensations **

4. AVOID ALCOHOL --> including alcohol based mouth wash and cough syrups**

metronidazole counseling (topical)

1. may cause dryness or irritation

2. avoid contact w/ eyes**

metronidazole counseling (vaginal)

1. may cause yeast infections

2. may cause itching and increased menstrual cramping

what medications are classified as an azole antifungal?

fluconazole

fluconazole brand names

Diflucan

fluconazole formulations

1. tablets

2. powder for oral suspension

3. solution for injection

fluconazole indications

fungal or yeast infections like vaginal yeast infections

fluconazole MOA

"cell membrane synthesis inhibitor"

decreases ergosterol synthesis and inhibits cell membrane formation

fluconazole common side effects

NV

headache

fluconazole serious side effects

1. SJS, TEN

2. agranulocytosis

3. anaphylaxis

4. seizures

5. QT prolongation**

6. Torsades de pointes**

fluconazole boxed warnings

none

fluconazole contraindications

1. concomitant use with terfenadine in patients receiving multiple fluconazole doses

2. concomitant use with drugs metabolized by CYP3A4 that are known to prolong the QT interval (such as erythromycin or quinidine)***

3. hypersensitivity

fluconazole counseling

1. may cause NV, store properly, may cause headache, report any severe rash

2. report any abnormal feelings of heart rate**

what medications are classified as a guanosine nucleoside analog?

acyclovir and valacyclovir

acyclovir brand name

Zovirax

acyclovir formulations

1. capsules, tablets

2. oral suspension

3. solution for injection

4. topical cream

5. topical ointment

6. buccal tablet

valacyclovir brand name

Valtrex

valacyclovir formulations

tablets

acyclovir and valacyclovir indications

viral infections such as herpes zoster (shingles), recurrent herpes simplex labialis, genital herpes simplex

acyclovir and valacyclovir MOA

synthetic purine nucleoside which:

1. competitively inhibits viral DNA polymerase (enzyme)

2. incorporates into the chain

3. terminates DNA chain

4. inactivates viral DNA polymerase

acyclovir and valacyclovir common side effects

1. NVD, headache

2. malaise

3. contact dermatitis w/ topical formulation (itching)

acyclovir and valacyclovir serious side effects

1. thrombocytopenic purpura/hemolytic uremic syndrome

- red or purple spots under the skin related to low platelets

2. neutropenia

- decreased neutrophils

3. increased LFTs

4. increased SCr

valacyclovir and acyclovir boxed warnings

none

valacyclovir and acyclovir contraindications

hypersensitivity to prior use or milk protein (buccal form)

valacyclovir and acyclovir counseling (oral)

1. drink plenty of water to avoid renal complications**

2. may cause NVD, store properly

3. elderly patients may experience dizziness, confusion, and somnolence

acyclovir counseling (topical)

1. may cause itching, burning, dryness

2. only use on external parts of lips and face**

3. use rubber glove with application to avoid transmission**

what is the most important point to keep in mind about treatment of diseases when dispensing valacyclovir and acyclovir?

no form prevents reinfection or transmission of disease

what medications are classified as a neuraminidase inhibitor?

oseltamivir

oseltamivir brand name

Tamiflu

oseltamivir formulations

1. capsules

2. powder for oral suspension

oseltamivir indications

treatment and prophylaxis of influenza virus type A and B

oseltamivir MOA

inhibits viral neuraminidase which affects release of viral particles

oseltamivir common side effects

NVD and abdominal pain

oseltamivir serious side effects

1. abnormal behaviour, delirium, seizures

2. GI hemorrhage

3. SJS, TEN

oseltamivir boxed warnings

none

oseltamivir contraindications

hypersensitivity to prior oseltamivir use

tamiflu counseling

1. finish all, may cause NVD, store appropiately

2. report abnormal behavior or signs of delirium/hallucinations

3. take w/ food

4. skip missed dose if next dose is within 2 hours

5. begin treatment within 2 days of symptoms

-going to make cause of flu lighter and shorten duration

by around a day, but will not be a "miracle worker". Virus

will still have to run its course

6. capsules can be mixed with chocolate syrup, corn syrup, caramel topping, or light brown sugar dissolved in water

what medication is classified as an antitussive (cough suppressant) ?

benzonatate

benzonatate name brand

Tessalon Perles

benzonatate formulations

capsules

benzonatate indications

cough

benzonatate MOA

anesthetizes stretch to cough receptors of vagal afferent fibers located in alveoli; may also inhibit transmission of cough reflex at medulla

benzonatate common side effects

nausea

numbness of throat and tongue if capsules are broken or chewed

dizziness, headache, sedation

benzonatate boxed warnings

none

benzonatate contraindications

hypersensitivity to prior use with benzonatate

benzonatate counseling

may cause dizziness or sedation, may cause headache

do not break, crush, or chew capsule

what medication is classified as a antitussive/expectorant combination

codeine-guaifenesin

codeine-guaifenesin name brand

Robitussin AC

codeine-guaifenesin formulations

solution, syrup, and tablets

codeine-guaifenesin indications

cough

codeine-guaifenesin MOA

codeine: suppresses cough reflex in the cough center of medulla

guaifenesin: thins bronchial secretions and increase sputum volume

codeine-guaifenesin common side effects

NV, constipation, sedation

codeine-guaifenesin serious side effects

respiratory depression

orthostatic hypotension, syncope

seizures

codeine-guaifenesin boxed warnings

none

contraindications of codeine-guaifenesin

hypersentivity to either component

asthma

pediatric patients having adenoidectomy or tonsillectomy (increases risk of respiratory depression)

codeine-guaifenesin counseling

1. may cause sedation

2. do not drive or engage in activities requiring alertness

3. rise slowly from seated position

4. may cause NV and constipation

5. avoid use w/ alcohol

6. drink plenty of water to increase effectiveness of expectorant and loose mucous