Drug quiz 1 with Counseling Points

Flagyl, Metrogel, Metrocream, Nuvessa, Vandazole, metronidazole (Antibacterial, Antiprotozoal)

Common Indications: bacterial vaginosis, trichomoniasis, etc. BBW: Possibly carcinogenic based on animal data Contraindications: Pregnancy (1st trimester), use of alcohol or propylene glycol-containing products during treatment or within 3 days of treatment discontinuation (disulfiram reaction) Side Effects: Metallic taste, darkened urine, nausea Drug Interactions: Can increase INR in patients taking warfarin (weak CYP2C9 inhibitor) Notes: Take IR tablets with food to decrease GI upset.

Diflucan, fluconazole (azole derivative, antifungal)

Common Indications: Yeast infections (ex. oral, esophageal, vaginal), nail bed infections (onychomycosis), oral thrush, oral candidasis Warnings: Hepatotoxicity, not recommended in pregnancy Side effects: Elevated LFTs, QT prolongation, rash/pruritis, headache, hair loss Drug Interactions: CYP450 inhibitor - a lot of drug interactions Notes: Vaginal candidiasis dose - 150 mg PO x 1 dose, renal dose adjustment required

Nizoral, ketoconazole (imidazole antifungal)

Common Indications: Mainly used topically BBW: Severe hepatotoxicity (has led to transplant and/or death), QT prolongation, oral use is considered last-line for antifungal therapy Side Effects: Same as fluconazole Drug Interactions: CYP450 inhibitor - a lot of drug interactions Notes: Shampoo can cause altered hair texture

Nystop, Mycostatin, nystatin (antifungal)

Common Indications: Mild, localized Candida infections (ex. Thrush) Dosage forms: Suspension, tablet Suspension Counseling Points: Shake well before using; Swish in the mouth and retain for as long as possible (seven minutes) before swallowing

Lamisil, terbinafine (Antifungal, topical)

Common Indications: Dermatophytes (nail bed infection) Dosage Forms: Tablet & topical Warnings: Hepatotoxicity Side Effects: Headache, elevated LFTs, skin rash, pruritus Notes: For nail bed infection treatment, may take several months after treatment continuation to see benefit due to the time it takes for nails to grow

Zovirax, acyclovir (antiviral)

Common Indications: Herpes simplex virus, varicella zoster virus (chicken pox), herpes zoster (shingles) herpes simplex labialis (cold sores) Dosage Forms: Capsule, tablet, buccal tablet, suspension, injection, topical Warnings: Caution in renal impairment, geriatrics, concomitant nephrotoxic medications Dosing for Herpes labialis: Apply topically 5 times daily for 4 days (can be used on genital sores) Dosing for Herpes zoster: 800 mg PO 5x daily for 7 or 10 days Counseling: Does not cure herpes infections - use proper contraception methods during sexual intercourse to avoid transmission; start treatment within 24 hours of symptom onset, maintain adequate hydration

Valtrex, valcyclovir (Antiviral)

Common Indications: Same as acyclovir - valacyclovir is a pro-drug of acyclovir, it is more expensive but less frequent dosing, may be a beneficial in patients with poor adherence Dosage Forms: Tablet Warnings: Same as acyclovir Dosing for Herpes Zoster: 1 gram PO TID for 7 days Counseling: Does not cure herpes infections - use proper contraception methods during sexual intercourse to avoid transmission; start treatment within 24 hours of symptom onset, maintain adequate hydration

Keflex, cephalexin ( Cephalosporin antibiotic 1st gen)

Common Indications: Skin infections (MSSA), strep throat Warnings: Cross-sensitivity with penicillin allergy Side Effects: GI upset, diarrhea, serious skin reactions (SJS/TEN) Dosing: 250-500 mg PO Q6-12H

Ceftin, cefuroxime axetil (Cephalosporin antibiotic 2nd gen)

Common Indications: Acute otitis media, community-acquired pneumonia (CAP) Warnings/Side Effects: Same as cephalexin Drug Interactions: Separate by 2 hours from short-acting antacids; avoid PPIs & H2RAs

Omnicef, cefdinir (Cephalosporin antibiotic 3rd gen)

Common Indications: Acute otitis media Warnings/Side Effects: Same as cephalexin

Cipro, ciprofloxacin (fluoroquinolone antibiotic)

Common Indications: Antipseudomonal (pneumonia) BBW: Tendon inflammation &/or rupture; peripheral neuropathy; CNS effects (seizures), use caution in patients with CNS disorders or are taking seizure-causing medications Warnings: QT prolongation (moxifloxacin > levofloxacin > ciprofloxacin); hypo/hyperglycemia; psychiatric disturbances; photosensitivity Counseling: Oral suspension - shake vigorously for 15 seconds before each dose; avoid sun exposure; separate from polyvalent cations; monitor blood glucose; avoid in pregnancy/breastfeeding

Levaquin, levofloxacin (fluoroquinolone antibiotic)

Common Indications: "Respiratory fluoroquinolone" The rest is the same as ciprofloxacin

Avelox, moxifloxacin (Fluoroquinolone antibiotic)

Common Indications: Only fluoroquinolone that cannot be used for UTI The rest is the same as ciprofloxacin

Zithromax, Z-Pak, azithromycin (macrolide antibiotic)

Common Indications: Community-acquired respiratory tract infections, COPD exacerbations, Chlamydia (in pregnant patients), severe traveler's diarrhea Warnings/Precautions: QT prolongation (erythromycin > azithromycin > clarithromycin); hepatotoxicity (use caution in patients with liver disease) Side Effects: GI upset (diarrhea, abdominal pain, cramping), taste perversion Drug Interactions: Fewer drug interactions than other macrolides Dosing: Z-Pak - 500 mg on day 1, 250 mg on days 2-5

Biaxin, clarithromycin (macrolide antibiotic)

Common Indications:  H. pylori treatment regimens Contraindications: Contraindicated to take with simvastatin or lovastatin Warnings/Precautions: QT prolongation, hepatotoxicity (use caution in patients with liver disease), Use caution in patients with coronary artery disease Side Effects: GI upset (diarrhea, abdominal pain, cramping), taste perversion Drug Interactions: Use caution with other QT prolonging drugs, Simvastatin and lovastatin are contraindicated (due to increased risk of muscle toxicity)

Clindagel, Cleocin, Cleocin T, clindamycin (lincosamide antibiotic)

Common Indications: Purulent and non-purulent skin infections, beta-lactam alternative for dental abscesses, surgical prophylaxis & infective endocarditis prophylaxis BBW: Colitis (C. difficile) Side Effects: Nausea, vomiting, diarrhea (N/V/D) Dosage Forms: Topical, injection, capsule, suspension

Macrobid, Macrodantin, nitrofurantoin (Nitrofuran antibiotic)

Common Indications: Drug of choice for uncomplicated UTI (cystitis only) Contraindications: Renal impairment (CrCl < 60 mL/min) Warnings: Hemolytic anemia Side Effects: GI upset (take with food), brown urine discoloration (harmless) Dosing: Macrobid is 100 mg BID for 5 days

Amoxil, amoxicillin (penicillin antibiotic)

Common Indications: First-line treatment for acute otitis media; prophylaxis for infective endocarditis prior to dental procedures Contraindications: Severe renal impairment (CrCl < 30 mL/min) - do not use extended release formulation Side Effects: Seizures (with accumulation when not renally adjusted), GI upset, diarrhea, rash, hemolytic anemia Dosage Forms: Tablet, capsule, chewable, suspension Notes: Avoid in patients with beta-lactam allergy

Augmentin, amoxicillin/clavulanate (penicillin antibiotic)

Common Indications: First-line treatment for acute otitis media & bacterial sinusitis (if antibiotics are indicated) Contraindications: Severe renal impairment (CrCl < 30 mL/min) - do not use extended release formulation or 875 mg strength Side Effects: Same as amoxicillin Dosage Forms: Tablet, chewable, suspension Notes: Use lowest dose of clavulanate to decrease diarrhea; avoid in patients with beta-lactam allergy

Pen-Vee K, penicillin V potassium (penicillin antibiotic)

Common Indications: First-line treatment for strep throat and nonpurulent skin infections (no abscess) Contraindications: Severe renal impairment (CrCl < 30 mL/min) Side Effects: Same as amoxicillin Dosage Forms: Tablet, suspension Notes: Take on an empty stomach

Septra, Septra DS, Bactrim, Bactrim DS, sulfamethoxazole/trimethoprim (sulfonamide antibiotic)

Common Indications: CA-MRSA skin infections, UTI, Pneumocystis pneumonia (PCP) Dosing: Dose based on the trimethoprim (TMP) component; SMX:TMP ratio = 5:1 Contraindications: Sulfa allergy Warnings: Skin reactions (SJS/TEN, thrombotic thrombocytopenic purpura) G6PD deficiency (hemolysis risk) Side Effects: Photosensitivity, elevated K levels, hemolytic anemia, crystalluria Counseling: Avoid in pregnancy and sulfa allergy; take with a full glass of water

Doryx, Oracea, Vibramycin, doxycycline (tetracycline antibiotic)

Common Indications:  First-line treatment for Lyme disease and Rocky Mountain Spotted Fever, community acquired pneumonia, COPD exacerbations, bacterial sinusitis, chlamydia, acne, CA-MRSA skin infections Contraindications: Warnings/Precautions: Caution in children <8 years old, pregnancy, and breastfeeding (permanent teeth discoloration) Side Effects: Nausea, vomiting, diarrhea, photosensitivity Drug Interactions: Separate from antacids and polyvalent cations (at least 1-2 hours before or 4 hours after the chelating drug) Counseling: Sit upright for at least 30 minutes after the dose to prevent esophageal irritation, take with at least 8 oz of water

Minocin, minocycline (tetracycline antibiotic)

Common Indications:  CA-MRSA skin infections, acne Warnings/Precautions: Caution in children <8 years old, pregnancy, and breastfeeding (permanent teeth discoloration); drug induced lupus erythematosus (DILE) Side Effects: Nausea, vomiting, diarrhea, photosensitivity Drug Interactions: Same as doxycycline

Bactroban, mupirocin (topical antibiotic)

Common Indications:  Elimination of MRSA colonization of the nares Side Effects: Headache, burning, localized irritation, rhinitis, pharyngitis

Tamiflu, oseltamivir (antiviral against influenza)

Common Indications:  Influenza Dosage Forms: capsule, suspension Warnings/Precautions: Neuropsychiatric events, serious skin reactions (SJS/TEN), anaphylaxis Side Effects: Headache, nausea, vomiting, diarrhea, abdominal pain Dosing: Treatment >12 years old:  75 mg BID x 5 days. Prophylaxis >12 years old: 75 mg QD x 10 days. Pediatrics: weight based. Notes:Most effective when started within 48 hours of symptom onset

Plaquenil, hydroxychloroquine ( aminoquinoline antimalarial, disease modifying antirrheumatic DMARD)

Common Indications:  Rheumatoid arthritis, Lupus Warnings/Precautions: Can cause irreversible retinopathy, myopathy and neuropathy, cardiomyopathy, QT prolongation Side Effects: Nausea, vomiting, diarrhea, abdominal pain, rash, pruritis, headache, vision changes (dose related), bone marrow suppression, hepatotoxicity Notes: Causes hemolysis in patients with G6PD deficiency

Peridex, PerioGard, chlorhexidine gluconate (antibacterial oral rinse)

Common Indications:  Gingivitis, periodontitis Side Effects: Dental discoloration, dysgeusia, mouth irritation Counseling points: Swish and spit 15 mL BID

Descovy, emtricitabine/tenofovir/alafenamide (Nucleoside reverse transcriptase inhibitor NRTI)

Common Indications: HIV PrEP BBW: Post-treament exacerbation of acute Hepatitis B; Risk of drug resistance with use for pre-exposure prophylaxis Warnings/Precautions: immune reconstitution syndrome (IRIS); lactic acidosis; renal toxicity (TAF less severe than TDF); hepatomegaly Side Effects: Hyperlipidemia; Weight gain, renal impairment, decrease in bone mineral density (TAF); Nausea, diarrhea, Hyperpigmentation of the palms of the hands or soles of the feet (emtricitabine) Drug Interactions: Check for drug interactions! Counseling points: Do not stop taking or skip doses of HIV medications without speaking to your doctor. This medication does not cure HIV - use safe sex practices and do not share needles.

Biktarvy, bictegravir/emtrivitabine/tenofovir alafenamide (Integrase inhibitor / Nucleoside reverse transcriptase inhibitor NRTI)

Common Indications: HIV Treatment BBW: Post-treament exacerbation of acute Hepatitis B Warnings/Precautions: immune reconstitution syndrome (IRIS); lactic acidosis Side Effects: Weight gain, increase in serum creatinine, N/V; renal impairment (TAF); Avoid with multivalent cations (bictegravir); Hyperpigmentation of the palms of the hands or soles of the feet (emtricitabine) Drug Interactions: Check for drug interactions! Significant! Counseling points: Do not stop taking or skip doses of HIV medications without speaking to your doctor. This medication does not cure HIV - use safe sex practices and do not share needles.