prototype drugs

penicillin G

• beta-lactam, Gram +, limited gram -

• Use: strep throat, syphilis, meningitis

• MOA: binds to PBP - inhibiting cell wall synthesis

• ADR: hives, anaphylaxis, hyperkalemia

• dont: allergy, renal impairment, hyperkalemia

• considerations: monitor allergic reactions, renal function,

• education: advise to complete full course.

• admin: IV or IM because orally it is inactivated

Ampicillin

• beta-lactam, broad

• MOA: cell wall inhibitor

• ADR: rash, anaphylaxis, diarrhea (risk of c. diff)

• Use: sinusitis, otitis media, UTIs

• dont: allergy, renal impairment, hypersensitivity

• considerations: take on empty stomach, montior for diarrhea and renal function

• education: advise to complete full course of therapy

Cefazolin

• 1st gen - cell wall inhibitors

• ADR: nephrotoxicity, rash, C diff.

• don’t: allergy, chronic kidney disease or renal impairment

• Use: res infections, UTI, skin infections

• considerations: monitor renal function, superinfection, allergies,

• education: report diarrhea, rashes or allergic reactions

Imipenem-cilastatin

• carbapenem - cell wall inhibitor

• MOA: cilastatin prevent renal degradation of imipenem

• ADR: nausea, seizure, c. diff

• Use: severe or MDRO infections, complicated UTI, pneumonia

• dont: allergy, caution in renal impairment

• considerations: watch for CNS (seizures), monitor renal function, align with IV infusion recommended time

• education: report diarrhea, rash, complete full course

Vancomycin

class: glycopeptide

MOA: binds to dala dala to inhibit cell wall synthesis

Use: severe gram+ infections: skin and tissue infections, C. diff (Oral- first-line), MRSA(IV),

ADR: nephro and ototo toxicity, red man syndrome, nausea

dont: hypersensitivity and renal impairment

considerations: monitor peak and trough levels, infusion Iv for at least 60 minutes, check renal function

education: report hearing loss, ringing, and reduced urine. take for the full course to prevent resistance

Tetracycline

• bind to 30s ribosomes, stops translation to prevent making proteins

• BROAD: for gram+ and gram- and atypical pathogens (rickets and lyme)

• other: doxycycline

• USE: res and GI infections, chlamydia, H. pylori ulcers, lyme

• don’t: pregnancy (D), children under 8, throat disorders

• ADR: PHOTOSENSITIVITY, upset GI, diarrhea, SJS, hepatotoxicity

• consid: avoid with food, dairy, antacids and iron supplements, and take on empty stomach (1 hour before or 2 hours after eating) with water!, avoid excessive sunlight, shouldn’t really lay down after taking

Erythromycin

class: macrolide, protein synthesis inhibitor

USE: res, skin, tiss infections, chlamydia and group A strep

MOA: 50s - short ½ life

ADR: NVD, abdominal pain, QT PROLONGATION, TORSADES DE POINTES, hepatoxicity

consid: take with food, monitor for heptox, assess EKG for QT, educate to take full course

Gentamicin

aminoglycoside

USE: serious gram+ (pseudomonas, klebsiella) often used in combination with beta-lactams

MOA: 30s

ADR: NV, fatigue, otot, nephro, neur tox - BLACK BOX WARNING (hearing loss and kidney damage) - GETA away from this drug

dont: chronic kidney diease, pregnacy (D), hearing loss

consid: renal function and TROUGH levels, assess for oto tox, adminster IV to reduce tox, hydrate to minize nephro tox

Clindamycin - linda has…..

MOA: 50

USE: gram+ (staph and strep), without oxygen infections, skin and tissue infections

ADR: NVD, C.diff, SJS

dont: history of C. diff, GI diease, hypersensitivity

consid: watch for diarrhea, take with full glass of water, report severe diarrhea

Linezolid

MOA: prevents initiation of translation 50s

USE: resistant gram+ (MRSA, VRE), Hos Aq infec and ventilator-pneumonia

ADR: NVD, myelosuppression!!! (anemia (not enough RBCs), lactic acidosis, peripheral neuropathy

dont: hypersensitvity, avoid using with MAOI and serotonergic drugs

consideration: monitor RBC, assess for lactic acidosis, watch for serotonin syndrome, avoid high tyramine-containing foods, reporting tingling or numbness, complete full course

Ciprofloxacin

fluoroquinolone

USE: UTIs, pneumonia, infectious diarrhea, and skin infections

MOA: inhibits DNA replication

ADR: NVD, dizziness, phototoxicity, QT PROLONG, tendon rupture, toxic psychosis

BLACK BOX WARNING - don’t sip on this (increased tendon rupture)

contraindications: pregnancy (category C), CKD, seizure disorders

considerations: admin in IV over 60 minutes to prevent vein irritation, monitor ECG, avoid sunlight, avoid calcium, iron, and antacids

Rifamycin

• MOA: bactericidal against susceptible bacteria

• USES: FIRST LINE TREATMENT FOR TB, prophylaxis meningitis, adjunct therapy (MRSA)

• UNIQUE: Harmless orange discoloration of body fluids

• dont: hypersensitivity and hepatic impairment

• considerations: check liver function and monitor drug interactions, educate on orange fluid, adhere to TB, take on empty stomach

Metronidazole

Class: antibacterial, antiprotozoal

USE: Effective anaerobic bacterial infections (c diff), protozoal infections

MOA: disrupts DNA synthesis by forming toxic free radicals

ADR: NVD, metallic taste, confusion, seizures, neuropathy, dark urine

considerations: warn to avoid alcohol use and for 48 hours after, monitor CNS, admin with food,

Nitrofurantoin

• directly in the urine with limited systemic absorption, ideal for localized UTIs

• MOA: Bactericidal in the urine

• ADR: NVD, pulmonary toxicity, neuropathy

• dont: severe renal impairment, late pregnancy (38-42), hypersensitivtiy

• considerations: take with food/ milk, hydration, monitor, harmless dark yellow/urine

TMP-SMZ - Bactrim

• inhibits synthesis of dihydrofolic acid activation

• USE: UTIs, PJP, MRSA skin infec, Gi infec

• ADR: NV, Photosensitivty, SJS, TENS,

• dont: folate deficiency, pregnancy, renal/hepatic, sensitivity

• considerations: AVOID WITH G6PD deficiency due to risk of hemolysis, sunscreen, allergic reactions, fluid intake

Fidaxomicin

• inhibits RNA synthesis

• NARROW - targets C. Diff

• ADR: NV, stomach pain

• considerations: monitor improvement and advise on hydration

Clotrimazole

• inhibits ergosterol synthesis

• USE: superficial fungal (, cutaneous and mucosal candidasis(vag yeast, oral thrush, oropharyngeal candidiasis

• ADR: skin irritation, redness, burning, or itching, rare allergic reactions

• DONT: hypersensitivity

• consid: apply thin layer to clean, dry skin, for vag infections use intra vaginal cream

Nystatin

Binds to ergosterol in fungal
cell membranes and causes leakage of cellular contents.
• Indications: oral, vaginal, cutaneous, and GI candidiasis,
• Adverse Drug Reactions (ADR): Generally mild, including
skin irritation or mild GI upset

considerations:

• oral: Administer after meals to reduce GI upset.
  • Swish liquid in mouth for several seconds, then
  swallow.
  • Avoid eating/drinking for 30 minutes after use

• topical:

  • Creams, powders and ointments
    • Clean and dry affected area before applying.
    • Apply a thin layer to the affected area 2-3 times daily.
    • Monitor for skin irritation

Fluconazole

Inhibits synthesis of ergosterol in fungal cell membranes.
• Indications: candidiasis, invasive candidiasis, cryptococcosis, coccidioidomycosis

ADR: SJS, hepatotoxicity, QT pro, anaphlyaxis

dont: hypersensitivity, liver diseas, loe potassium, pregant

considerations: monitor liver function tests results, assess for signs of skin reactions

Amphotericin B

binds to ergosterol in fungal cell membranes, creating pores that lead to cell death

use: invasive (systemic) candidiasis, aspergillosis, cryptococcosis, histoplasmosis, coccidiomycosis,
blastomycosis

dont: Nephrotoxicity, hypokalemia

ADR: nephro, cardio, hepa, hema, neuro tox

consid: monitor for nephro and cardiac effects - hydrate before admini

Chloroquine

• antimalarial

• MOA: inhibits heme polymerization causing toxic heme accumulation

• ADR: CNS and cardiac toxicity at high doses, ocular toxicity

• dont: allergy, ckd, G6PD deficiency

• considerations: monitor ECG, check liver and kidney function, monitor vision, monitor hemolysis,

Pyrimethamine

• anti-protozoan

• MOA: inhibits the synthesis of folic acid

• USE: treating malaria and toxoplasma gondii (toxoplasmosis)

• ADR: folate deficiency, bone marrow suppression, anemia

• dont: preexisting megalobastic anemia, folate deficiency, caution in pregnancy

• consid: monitor blood count, leucovorin rescue therapy, monitor liver function

Metronidazole

• antibacterial, antiprotozoal, inhibits dna synthesis

• USE: protozoal infections, effective for anaerobic bactieral infections

• MOA: disrupts bacterial DNA and RNA synthesis by forming toxic free radicals

• ADR: metallic taste, confusion, seizures, neuropathy, dark. urine, NVD

• considerations: AVOID ALCOHOL use during and 48 hours after, monitor for CNS effects, adminster with food to minimize GI

Mebendazole

anti-helminthic

MOA: inhibits glucose transport and uncouples energy metabolism in parasites

ADR: stom pain, distension, diarrhea, seizures

dont: hypersensitivity, serious hepatic imairment

consid: chew tablet and monitor side effects

Ivermectin

causes parasite paralysis

ADR: dizziness, fatigue, anaphylaxis, hypotension, liver toicity, vision changes

DDI: cyp450 substrate inhibitors (keto, rit) can increase levels, inducers (phen) can decrease effectiveness

dont: hypersensitivity, pregnancy, breastfeeding

consid: scabies: single dose, head lice: single dose, watch for dizziness, headache, GI symptoms

Permethrin

anti-parasitic

MOA: disrupts the nerve cell membrane

ADR: itching burning, stinging

dont: hypersensitviity

consid: apply permthrin cream or lotion, permethrin shampoo

isoniazid

• anti-tuberculosis

• inhibits synthesis of mycolic acid (component of mycobacterial cell wall)

• ADR: hepatox, peripheral neuropathy, neurotoxicity, fever, rash

• dont: allergy, history of liver diease, seizure disorder

• consid: moniot rliver function tests, admin vitamin B6 (pyroxidine) 25-50mg daily to prevent peripheral neuropathy, take full length and avoid alcohol

rifampin

• anti-tuberculosis

• inhibits bacterial RNS synthesis

• ADR: hepatoxicity, red-orange pee, sweat, and tears

• dont: allergy, use with HIV medications, history of liver dieasse

• consid: monitor liver function tests, educate of red-orange discoloration, assess for drug ineractions

pyrazinamide

• anti-tuberculosis

• disrupts cell membrane and inhibits bacterial repair

• ADR: hepatox, hyperuricemia, GI discomfort

• dont: liver diease, acute gout, sensitvities

• consid: monitor liver function test, hydrate to prevent uric acid buildup, advise to report joint pain, swelling, or redness

ethambutol

• anti-tuberculosis

• MOA: inhibits arabinosyl transferase - cell wall inhibits

• ADR: optic neuritis, hyperuricemia, joint pain, GI upset

• dont: optic neuritis, renal impairment, allergy

• consid: monitor visual aqcity(difficult seeing red or green colors), renal function,

dapsone

• anti-leprosy

• MOA: inhibits folic acid metabolism

• ADR: dose-related hemolysis, photosensitivity, bone and joint pain, methemoglobinemia, hematological issues, nished vision, reddish-
  brown discoloration of skin, cornea, conjunctiva, and
  body fluids.

• dont: blood disorders, sensitivities, liver dysfunction

• consid:

  • monitor blood count, liver func test, renal func

  • look for signs of hemolysis and methe

  • educate on photo and discoloration of bodily fluids