Anti-infective agents

Question 1

acyclovir

Answer 1

Brand - Zovirax

Class - Viral DNA Polymerase Inhibitor

Indication - Varicella/Chickenpox and Herpes Zoster/Shingles, Cold Sores/Genital herpes simplex

Counseling - Complete full course of therapy and ensure adequate hydration. Most effective if initiated within 24 hours of rash onset, should improve within 2-3 days.

MoA - Inhibits viral DNA synthesis

Question 2

amoxicillin

Answer 2

Brand - Amoxil

Class - Beta-Lactam Antibiotic

Indication - Ear, nose, or throat infection, skin/sq tissue, genitourinary system, acute otitis media, lower respiratory tract infection, pharyngitis tonsillitis, streptococcal pharyngitis

Pregnancy: Risk

Counseling - Complete full course of therapy, shake and store in fridge, can take with food if upset stomach; use condom/may decrease birth control effectiveness.

MoA - Semisynthetic penicillin derivative that inhibits the synthesis of bacterial wall mucopeptide; active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae.

Question 3

amoxicillin / clavulanate K+

Answer 3

Brand - Augmentin

Class - Beta-Lactam Antibiotic

Indication - Acute otitis media, Community-acquired pneumonia, Lower respiratory tract infection, Sinus, infection of skin/sq tissue, genitourinary/UTI

Pregnancy: Risk (amoxicillin)

Contraindication: No extended release products for patients with a history of jaundice/hepatic dysfunction

Counseling - Complete full course of therapy, shake and store in fridge, can take with food if upset stomach; use condom/may decrease birth control effectiveness.

MoA - Clavulanate is a β-lactamase inhibitor that protects amoxicillin from degradation by β-lactamases, amoxicillin is a semisynthetic penicillin derivative that inhibits the synthesis of bacterial wall mucopeptide; active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae.

Question 4

azithromycin

Answer 4

Brand - Zithromax

Class - Macrolide Antibiotic

Indication - Acute infective exacerbation of COPD, skin or tissue infection, Bacterial sinusitis, Chancroid, community acquired pneumonia, Sexually transmitted infections, Streptococcal pharyngitis

Counseling - Complete full course of therapy, can take with food if upset stomach

MoA - Binds to the 50S ribosomal subunit, thus interfering with microbial protein synthesis

Question 5

cefdinir

Answer 5

Brand - Omnicef

Class - (3rd Gen) cephalosporin Antibiotic

Indication - Acute otitis media, Bronchitis, Community-acquired pneumonia, COPD, Streptococcal pharyngitis

Counseling - Complete full course of therapy, store at room temperature, separate administration of antacids, iron, and vitamins by 2 h.

MoA - Activity against a number of gram-positive and gram-negative bacteria including β-lactamase–producing strains

Question 6

cephalexin

Answer 6

Brand - Keflex

Class - (1st Gen) cephalosporin Antibiotic

Indication - Infection of skin and/or subcutaneous tissue, Osteomyelitis, Otitis media, respiratory tract infection, Streptococcal pharyngitis, Impetigo, ecthyma, Cellulitis (nonprulent, erysipelas)

Counseling - Seek medical attention if rash develops, complete full course of therapy, store in fridge.

MoA - Inhibits bacterial wall synthesis of actively dividing cells by binding to ≥1 penicillin-binding proteins (PBPs)

Question 7

chlorhexidine

Answer 7

Brand - Peridex, Paroex, Hibiclens

Class - Antibacterial cleansing agent

Indication - Gingivitis, Skin/wound cleansing, periodontitis

Counseling - Follow vehicle admin directions (rinse vs topical)

MoA - Cation binds to - bacterial walls (gram + & -) and yeast - antiseptic depending on concentration

Question 8

ciprofloxacin (oral)

Answer 8

Brand - Cipro

Class - Fluroquinolone Antibiotic

Indication - Anthrax, Bacterial prostatitis, Bronchitis, lower respiratory tract infection, UTI

Pregnancy: Contraindicated

Contraindication: Concomitant tizanidine

Black Box: May exacerbate muscle weakness, tendon inflammation/rupture, peripheral neuropathy, CNS effects, cardiac, dermatologic and hypersensitivity reactions, aortic dissection and rupture, hypoglycemia, mental health adverse effects

Counseling - Take with/without food, but not with milk or other dairy products. Take ciprofloxacin at least 2 h before or 6 h after antacids, sucralfate, or mineral supplements and multivitamins with calcium, iron, or zinc. Seek medication if decreased urination, yellowing of eyes, blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath or chest pain, tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion or hallucinations

MoA - Inhibits bacterial DNA gyrase (transcription). It is highly active against aerobic, gram-negative bacilli.

Question 9

ciprofloxacin (otic)

Answer 9

Brand - Cetraxal, Otiprio

Class - Fluroquinolone Antibiotic

Indication - Otitis externa or media w/ effusion

Pregnancy: Weigh risks/benefits

Counseling - Warm solution in hands, lie w/ ear upwards, maintain position for 1 min after drops

MoA - Inhibits bacterial DNA gyrase (transcription). It is highly active against aerobic, gram-negative bacilli.

Question 10

clarithromycin

Answer 10

Brand - Biaxin

Class - Macrolide Antibiotic

Indication - Acute infective exacerbation of bronchitis, community-acquired pneumonia, disseminiated infection due to M. avium group, H. pylori GI infection (w/ amox and PPI), Strep pharyngitis (group A), COPD

Contraindication: Concomitant colchicine, cispride, pimozide, astemizole, terfenadine, ergotamine, dihydroergotamine, or statins metabolized by CYP3A4/5, history of cholesaatic jaundice/hepative dysfunction, renal impairment

Counseling - Complete full course of therapy, if symptoms don’t improve in 2-3 days seek follow up w/ HCP

MoA - Inhibits RNA-dependent protein synthesis by binding to the 50S subunit of the 70S ribosome

Question 11

clindamycin (oral)

Answer 11

Brand - Cleocin

Class - Lincosamide Antibiotic

Indication - Bacterial infectious disease, Infection of skin and/or subcutaneous tissue, Infection of disease of abdomen, Lower respiratory tract infection, Pelvic inflammatory disease, Septicemia, Osteomyelitis, Diabetic foot infection

Black Box: Colitis

Counseling - Tk w full glass of water and remain upright for 30 minutes after dose to minimize risk of GI ulceration; complete full course of therapy

MoA - Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; it is bactericidal or bacteriostatic depending on the concentration, organism, and inoculums.

Question 12

clindamycin (topical)

Answer 12

Brand - Cleocin T, Clindagel

Class - Lincosamide Antibiotic

Indication - Acne vulgaris, Bacterial vaginosis

Counseling - Apply to cleansed, dry face, avoiding eyes/mucous membranes/cuts. Alcohol is flammable.

MoA - Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; it is bactericidal or bacteriostatic depending on the concentration, organism, and inoculums. Gram - aerobes are resistant, so are enterococci and C difficile

Question 13

doxycycline

Answer 13

Brand - Vibramycin

Class - Tetracycline Antibiotic

Indication - Acinetobacter infection, Acne vulgaris, Gonorrhea, Staphylococcal infection, Pneumonia

Pregnancy: Contraindicated

Counseling - Take with water, do not take with calcium foods, may cause photosensitivity (wear sunscreen and avoid UV), discontinue at sign of skin redness.

MoA - Broad-spectrum bacteriostatic compound that inhibits protein synthesis at the 30S ribosomal subunit

Question 14

erythromycin

Answer 14

Brand - Erythrocin

Class - Macrolide Antibiotic

Indication - Bacterial infections

Contraindication: Concomitant cispride, astemizole, terfenadine, ergotamine, lovastatin, simvastatin

Counseling - Seek medical attention iif rash develops. Complete full course of therapy, if symptoms don’t improve in 2-3 days seek follow up w/ HCP

MoA - Inhibits RNA-dependent protein synthesis by binding to the 50S subunit

Question 15

fluconazole

Answer 15

Brand - Diflucan

Class - Imidazole Antifulgal

Indication - Candidal vulvo, Candidal vulvovaginitis, Cryptococcal meningitis, Oropharyngeal candidiasis

Pregnancy: Risk (>400 mg/d)

Contraindication: Concurrent ergot alkaloids, CYP3A4/5 substrates that prolong QTc

Counseling - If weekly dose, take at same time, many OTC meds interact w/ fluconazole, consult your PCP or Pharmacist first.

MoA - Inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability

Question 16

hydroxychloroquine

Answer 16

Brand - Plaquenil

Class - Aminoquinoline

Indication - Lupus erythematosus, Malaria, Rheumatoid arthritis

Contraindication: Retinal/visual field changes from prior use; long-term use in children

Counseling - If weekly dose, take at same time w/ food.

MoA - Effective in treating P vivax, P malariae, and susceptible strains of P falciparum.

Question 17

ketoconazole (topical)

Answer 17

Brand - Nizoral

Class - Imidazole Antifulgal

Indication - Pityriasis versicolor, Seborrheic dermatitis (skin or dandruff), Tinea corpois/cruis/pedis

Counseling - Apply thin layer to intact skin, do not wash for at least 3 h, avoid mucous membranes, wait 20 min before sunscreen or cosmetics, alcohol vehicles are flammable

MoA - Inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability

Question 18

levofloxacin

Answer 18

Brand - Levaquin

Class - Fluroquinolone Antibiotic

Indication - Bacterial prostatitis/sinuitis, Bronchitis, Community acquired pneumonia, Infection of skin and/or SQ tissue, Pyelonephritis

Pregnancy: Contraindicated

Contraindication: Concomitant tizanidine

Black Box: Myasthenia gravis, tendon inflammation and rupture, peripheral neuropathy, CNS effects, cardiac dermatologic and hypersensitivity reactions, aortic dissections and ruptures

Counseling - Take with/without food, but not with calcium-containing or dairy products. Take ciprofloxacin at least 2 h before or 6 h after antacids, sucralfate, or mineral supplements and multivitamins with calcium, iron, or zinc. Seek medication if decreased urination, yellowing of eyes, blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath or chest pain, tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion or hallucinations.

MoA - Inhibits bacterial DNA gyrase (transcription). It is highly active against aerobic, gram-negative bacilli.

Question 19

metronidazole

Answer 19

Brand - Flagyl

Class - Nitroimidazole Antibiotic

Indication - Abscess, Amebic dysentery, Bacterial vaginosis, Trichomoniasis

Contraindication: 1st trimester of pregnancy, then low risk

Black Box: Carcinogenic

Counseling - Avoid alcohol while taking this medicaiton and for 3 days after, may cause severe disulfiram-like reaction, tk w food if GI upset, complete full course

MoA - Active against T. vaginalis (trichomoniasis), E. histolytica (amebiasis), and G. lamblia (giardiasis); it is bactericidal against nearly all obligate anaerobic bacteria including B. fragilis

Question 20

muprocin

Answer 20

Brand - Bactroban

Class - Topical antibiotic

Indication - Impetigo, Secondary Skin infections, Eradication of nasal colonization of MRSA during institutional outbreaks

Counseling - Instruct patients on proper application technique, avoid drug exposure to open wounds, burns, or eyes.

MoA - Active against a wide range of gram-positive bacteria (including methicillin-resistant Staphylococcus aureus) and certain gram-negative bacteria. Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase. Because of this unique mode of action, it demonstrates no in vitro cross-resistance with other classes of antimicrobial agents.

Question 21

nitrofurantoin

Answer 21

Brand - Macrobid, Macrodantin

Class - Nitrofuran Antibiotic

Indication - UTI

Pregnancy: Risk (hemolytic anemic, anuria, or oliguria)

Counseling - Makes urine brown, complete full course, shake and store at room temp

MoA - Inactivates bacterial ribosomes and is bactericidal in urine at therapeutic doses. It is active against most bacteria that cause UTIs except nearly all strains of Pseudomonas are resistant.

Question 22

oseltamivir (PO4^3-)

Answer 22

Brand - Tamiflu

Class - Antiviral, Neuraminidas Inhibitor

Indication - Influenza virus types A and B

Pregnancy: maternal benefit > embryo-fetal risk

Counseling - Complete full course of therapy, instruct oral syringe, tk w food to minimize GI upset.

MoA - Inhibitor of influenza virus neuraminidase, which prevents viral progeny detaching from the cellular envelope

Question 23

sulfamethoxazole / trimethoprim

Answer 23

Brand - Bactrim, Septra

Class - Antibiotic

Indication - UTI, Traveler’s Diarrhea, HIV infection, Acute infective COPD

Contraindication: < 2 months age, nursing mothers/near term pregnancy

Counseling - Makes urine brown, complete full course, shake and store at room temp

MoA - Sulfonamides are structural analogs and competitive antagonists of PABA, which prevent normal bacterial utilization of PABA for synthesis of folic acid, which is required for bacterial DNA synthesis

Question 24

valacyclovir

Answer 24

Brand - Valtrex

Class - Viral DNA Polymerase Inhibitor

Indication - Varicella/Chickenpox and Herpes Zoster/Shingles, Cold Sores/Genital herpes simplex

Counseling - Ensure adequate hydration. Seek medical attention if decreased urination, unusual bruising or bleeding, blistering skin rash, or shortness of breath.

MoA - Prodrug of acyclovir > Inhibits viral DNA synthesis