Lab quiz 3

Acyclovir Drug Class

Viral DNA Polymerase Inhibitor

Acyclovir Brand Names

Zovirax

Acyclovir formulations

Capsule, Tablet, Suspension

Acyclovir Indications

Genital herpes simplex (Tx & suppression)

Herpes zoster (shingles)

Varicella (chickenpox)

Cold sores (orolabial HSV Tx)

Herpes simplex prevention (immunocompromised)

Acyclovir ADRs

Common: Malaise

Less: N/V/D/HA

Rare: Sev. Hypersensitivity, Renal failure, TTP

Acyclovir Counseling

• Adequate hydration

• Start within 24hr of lesions (HSV) or rash (VZV)

Acyclovir Clinical Pearls

• NOT indicated < 2yo

• Topical and parenteral available

Acyclovir monitoring

• Lesions subside within 2-3 days

• Seek medical attention if decreased urination, unusual bruising/bleeding, blistering skin rash, SOB, confusion, lethargy, seizures

Albendazole brand names

Albenza

Albendazole Drug class

Anthelmintic (destroy parasitic worms)

Albendazole Indication

Parenchymal neurocysticercosis

Off label

• round/hook/pin worm

• Giardiasis

• Chinese / Southeast asian liver fluke

• Dog/Cat hookworm

• Oesophagostomum bifurcum

• Toxocariasis

• Trichinellosis

Albendazole Pregnancy recommendation

Avoid during 1st trimester

Albendazole Drug interactions

Grapefruit juice (increase serum concentration)

Phenytoin/Carbamazepine/Phenobarbital (decrease [serum])

Albendazole ADRs

Common: HA, elevated LFTs

Less: N/V/D, abdom. Pain, dizziness, alopecia

Rare: Hepatic/Renal failure, Aplastic anemia, Agranulocytosis, Stevens-Johnson syndrome

Albendazole Monitoring

• Monitor fecal specimens for 3wks post Tx

• Ophthalmic examination in Neurocysticercosis

• Monitor LFTs & CBC beginning of each 28d cycle & q 2wks

Albendazole Counseling

• Take with high-fat meals or grapefruit juice

• Avoid pregnancy min. 1 month post Tx

• Tablets can be crushed or chewed

• Nematode infections should wash underwear and bedding often in hot water

Albendazole Clinical Pearls

• Single dose for Nematode infections

• Neurocysticercosis use concurrent corticosteroids & anticonvulsants

Brimonidine Tartrate brand names

Alphagan P

Lumify

Brimonidine Tartrate Drug class

Adrenergic agonist

Antiglaucoma agent

Brimonidine Tartrate Formulations

Ophthalmic solution

Brimonidine Tartrate Indications

Ocular HTN

Open-angle glaucoma

Ocular redness (OTC indication)

Off label: Capsulotomy

Brimonidine Tartrate ADRs

Common: Allergic conjunctivitis, Conjunctival discoloration, Drowsiness

Less: Burning eye sensation, HTN, Xerostomia, Visual disturbance, Dizzy, Fatigue, Follicular conjunctivitis, watery eyes

Rare: Syncope (lost consciousness via BP drop SEEK MEDICAL HELP), Arrhythmias, Bradycardia

Brimonidine Tartrate Couseling

• Wash hands & remove contact lenses before Tx application

• Reapply contacts after 15mins

• Separate other Ophthalmic agents by 5mins

Brimonidine Tartrate Clinical Pearls

• Topical available for Rosacea

• Can be combo with Timolol or Brinzolamide for Glaucoma

Cephalexin brand names

Keflex

Daxbia

Cephalexin Drug class

1st gen Cephalosporin

Cephalexin formulations

Capsule, Tablet, Suspension

Cephalexin Indication

FDA indication

• Skin/tissue infection

• Osteomyelitis

• Otitis Media / Respiratory tract infection / UTI

• Streptococcal pharyngitis

• Impetigo, Ecthyma

• Cellulitis (nonpurulent)

Off-label

• Bacterial endocarditis; Prophylaxis in high risk

• Prosthetic joint infection

• endocarditis prophylaxis

Cephalexin Drug interactions

Cholestyramine

Metformin

Typhoid vaccine, BCG (intravesical), Cholera vaccine

Sdoium picosulfate

Multivitamins, minerals

Cephalexin ADRs

Common: Nausea

Less: Vomiting

Rare: Stevens-Johnson syndr, Renal failure, Anemia, Neutropenia, Seizure

Cephalexin Monitoring

Seek medical attention if decreased urination, blistering skin rash, extreme fatigue, unusual bruising or bleeding, SOB, Rash

Cephalexin Counseling

• Refrigerate suspension & shake well

• Avoid mixing suspension with food/bev; can take food after

• Sx improve within 2-3d

Chlorhexidine brand names

Peridex, Paroex, Hibiclens, Periogard

Chlorhexidine Drug class

Antibacterial cleansing agent

Chlorhexidine Formulations

Liquid Oral Rinse

Topical Soln

External Patch

Chlorhexidine Indications

FDA

• Gingivitis

• Skin/Wound cleansing

Off-label

• Burn, prevention of nosocomial infection

• Oropharyngeal decontamination to reduce ventilator pneumonia

• Osteonecrosis of jaw

Chlorhexidine ADRs

Common: mouth/tongue irritation, tooth ache/discoloration

Less: GI irriation

Rare: allergic/skin irritation

Chlorhexidine Monitoring

Toxic: tooth discoloration, skin irritation

Chlorhexidine Counseling

• oral rinse with 15mL and swish for min. 30sec; do not swallow

  • Wait several hours after to eat or drink

  • Teeth discoloration can be removed by dental cleaning

• Topical only on unbroken skin

  • Avoid in eyes, ears, mouth, nose, genital/anal areas

• 70% alcohol & flammable

  • Apply in well ventilated space

• Do not cover treated area until completely dry

Chlorhexidine Clinical pearls

Not for children

Nonprescription products available

Ciprofloxacin (Otic) brand names

Cetraxal, Otiprio

Ciprofloxacin (Otic) Formulations

Otic soln., Suspension, Intratympanic

Ciprofloxacin (Otic) Indications

Acute Otitis Externa

Otitis Media with Effusion

Ciprofloxacin (Otic) ADRs

Common: application site pain/itching

Less: Fungal ear suprainfection

Ciprofloxacin (Otic) Monitoring

• Cultures if infection not improved within 1wk

• Ear pain, hypersensitivity, secondary fungal infections

Ciprofloxacin (Otic) Counseling

Warm up soln with hands for min. 1min before administering

Patient should lie down and maintain min. 1 min after instillation

Ciprofloxacin (Otic) Clinical Pearls

Not for < 1yo

Not for eyes

Injectable / Oral formulations avail

Intratympanic product only used during tympanostomy tube placement

Can combo w Hydrocortison otic (Cipro HC)

Clarithromycin brand names

Biaxin

Clarithromycin Drug class

Macrolide abx

Clarithromycin Formulations

Tab, Tab ER, Oral suspension

Clarithromycin Indication

FDA

• acute infective exacerbation of bronchitis

• CA- pneumonia, skin infection, sinusitis, pharngitis

• Disseminated infection, prophylaxis HIV

• H. Pylori GI tract infection

• Streptococcal pharyngitis

• COPD, acute exacerbation

Off-label

• Bacterial endocarditis prophylaxis for high risk

Clarithromycin Contraindications

Concomitant Colchicine, Cisapride, Pimozide, Astemizole, Terfenadine, Ergotamine, Dihydroergotamine, or HMG-CoA reuctase inhibitors metabolized by CYP3A4/5

Hx Cholestatic jaundice / liver dysfunction

Colchicine in renal/hepatic impairment

Clarithromycin Suffix

XL (don’t crush)

Clarithromycin ADRs

Common: taste disturbance

Less: N/V/D/HA, rash

Rare: QTc prolongation, Stevens-Johnson syndrome, anemia, neutro/thrombocyto-penia, myasthenic crisis, elevated LFTs, hallucinations, nephrotoxicity

Clarithromycin Monitoring

Seek medical attention if heart palpitations, yellowing skin/eyes, extreme fatigue, blistering skin rash, unusual bruising or bleeding

Clarithromycin Counseling

Sx improve within 2-3 days, otherwise seek help

Clarithromycin Clinical pearls

Caution in severe renal / hepatic/ cardiac disease

ER and IR not interchangeable

Children max 1g/day

Clindamycin (topical) brand names

Cleocin T

Clindagel

Clindesse

Evoclin

Clindamycin (topical) drug class

Lincosamide abx

Clindamycin (topical) Formulations

Topical foam/soln/gel/swab/lotion/cream

Vaginal suppository

Clindamycin (topical) Indications

Acne vulgaris

Bacterial vaginosis

Off-label

• Acneiform eruptions

• Rosacea

Clindamycin (topical) Suffix

T

Clindamycin (topical) ADRs

Common: dry skin

Less: itching, pruritis, rash

Clindamycin (topical) Monitoring

Seek medical help if blistering skin rash

Clindamycin (topical) Counseling

Wash & dry face

Avoid eyes & mucous membraes

Avoid cut/broken skin

Shake well

Flammable liquid

Avoid smoking while applying or heat/flame exposure

Apply foam to tissue for application

Clindamycin (topical) Clinical pearls

May increase sun sensitivity, use sunscreen (1-2hr after topical soln)

Injectable available

Combo w Benzoyl peroxide for mild acne

Combo w Topical retinoid or systemic antibacterial for mod-sev acne

Erythromycin brand names

Erythrocin

Erythromycin Drug class

Macrolide Abx

Erythromycin Formulations

Tab, Tab DR

Cap DR

Suspension

Erythromycin Indications

Bacterial infections

Chlamydia trachomatis

Nongonococcal urethritis

Erythromycin Contraindications

Concurrent Ergotamine, Terfenadine, Astemizole, Lovastatin, Simvastatin, Cisapride

Erythromycin Crushing indirections

Do not crush or chew ER tabs

Erythromycin ADRs

Common: DIarrhea

Less: N/V, Vaginitis

Rare: QTc prolongation, arrhythmias, SJ syndrome, Hepatotoxicity, Anemia, Neutro/Pancyto-penia, Seizure

Erythromycin Monitoring

Yellowing of eyes, Blistering skin rash (seek help) or extreme fatigue, SOB, Unusual bruising or bleeding

Erythromycin Counseling

Some formulations need refrigeration

Sx resolve within 2-3d

Erythromycin Clinical Pearls

Major CYP3A4/5 inhibitor , beware of substrates also QTc prolongation

Fidaxomicin brand names

Dificid

Fidaxomicin Drug class

Macrolide Abx

Fidaxomicin Formulations

Tab, suspension

Fidaxomicin Indication

C.diff

Fidaxomicin ADRs

Common: nausea

Less: Abdom. Pain, Vomiting, Anemia, Neutropenia

Rare: Bowel obstruction, GI hemorrhage

Fidaxomicin Monitoring

Signs of blood in stool or bowel obstruction

Fidaxomicin Counseling

Can give w or w/o food

Fidaxomicin Clinical pearls

Expensive alternative to metro or vanco for C.diff management

Metronidazole brand names

Flagyl

Metronidazole Drug class

Nitroimidazole abx

Antiprotozoal

Metronidazole Formulations

Cap & Tab

Metronidazole indication

FDA

• Anaerobic abscess

• Amebic dysentery, acute

• Bacterial vaginosis

• Trichomoniasis

Off-label

• C.diff, + pseudomembranous colitis

• H. Pylori GI infection

• Giardiasis

Metronidazole BOX WARNING

Carcinogenic

Metronidazole Contraindication

1st trimester of pregnancy

Metronidazole ADRs

Common: N/HA

Less: Diarrhea, Dizzy, Neuropathy, Abnormal taste

Rare: Seizures, Ototoxicity, Dark urine, SJ syndrome, Neutro/thrombocyto-penia

Metronidazole Monitoring

• Seek medical help if Severe diarrhea, Dark urine, Yellowing skin/eyes, unusual bruising/bleeding, blistering skin rash, SOB

• CBC repeatedly, Neurologic Sx

Metronidazole Counseling

• Avoid alcohol during medication Tx & 3d after

• May cause Disulfram-like rxn

• Can take w food to minimize stomach upset

Metronidazole Clinical Pearls

Alternative for C.diff (AFTER Vanco & Fidaxomicin)

Injectable and topicals avail

Mupirocin brand names

Bactroban

Mupirocin Drug class

Topical antibacterial

Mupirocin Formulations

Topical ointment/cream

Nasal ointment

Mupirocin Indications

Impetigo

Secondary skin infections

Eradication of nasal colonization of MRSA

Off-label

• Surgical prophylaxis in MRSA

Mupirocin Suffix

AT Nasal

Mupirocin ADRs

Less: HA, Pruritis, Burning, Stinging, Rhinitis

Rare: C.diff diarrhea