Drugs Need to Know: Anti-Infective/Antibiotic/Antiprotozoal Flashcards
trimethoprim/sulfamethoxazole trade name(s)
Bactrim Bactrim DS Septra Septra DS Sulfatrim Sulfatrim DS Sulfatrim Pediatric
trimethoprim/sulfamethoxazole
Therapeutic Class
anti-infectives
antiprotozoals
trimethoprim/sulfamethoxazole
Pharm Class
folate antagonists
sulfonamides
trimethoprim/sulfamethoxazole
Indications
Treatment of:
Bronchitis, Shigella enteritis, Otitis media, Pneumocystis jirovecii pneumonia (PCP), Urinary tract infections, Traveler's diarrhea. Prevention of PCP in HIV-positive patients.
Unlabeled Use(s): Biliary tract infections, osteomyelitis, burn and wound infections, chlamydial infections, endocarditis, gonorrhea, intra-abdominal infections, nocardiosis, rheumatic fever prophylaxis, sinusitis, eradication of meningococcal carriers, prophylaxis of urinary tract infections, and an alternative agent in the treatment of chancroid. Prevention of bacterial infections in immunosuppressed patients.
trimethoprim/sulfamethoxazole
Action
Combination inhibits the metabolism of folic acid in bacteria at two different points
trimethoprim/sulfamethoxazole
Therapeutic Effects
Bactericidal action against susceptible organisms
>Many gram+positive aerobic pathogens
>Many gram-negative aerobic pathogens
trimethoprim/sulfamethoxazole
Contraindication
Hypersensitivity to sulfonamides or trimethoprim;
History of drug-induced immune thrombocytopenia due to sulfonamides or trimethoprim
Megaloblastic anemia secondary to folate deficiency;
Severe hepatic or renal impairment;
Pregnancy, lactation, or children <2 mo
trimethoprim/sulfamethoxazole
Precautions
Use Cautiously in:
Mild to moderate hepatic or renal impairment (dose ↓ required if CCr <30 mL/min);
Genetic implication Glucose–6–phosphate dehydrogenase deficiency (↑ risk hemolysis);
HIV-positive patients (↑ incidence of adverse reactions);
Concurrent use with other products containing propylene glycol (IV only) (↑ risk of lactic acidosis).
trimethoprim/sulfamethoxazole
Adverse Effects
ERTHEMIA MULTIFORM STEVENS-JOHNSONS TOXIC EPIDERMAL NECROLYSIS C.DIFF ASSOC. DIARRHEA HEPATIC NECROSIS
trimethoprim/sulfamethoxazole
Side Effects
rash nausea vomiting headache fatigue hallucinations hyperkalemia hypoglycemia
trimethoprim/sulfamethoxazole
Drug-Drug Reactions
> May ↑ half-life, ↓ clearance, and exaggerate folic acid deficiency caused by phenytoin.
May ↑ effects of sulfonylureas, pioglitazone, rosiglitazone, repaglinide, phenytoin, digoxin, and warfarin.
May ↑ toxicity of methotrexate.
↑ risk of thrombocytopenia from thiazide diuretics (↑ in geriatric patients).
↓ levels of and ↑ risk of nephrotoxicity with cyclosporine.
Concurrent use with >ACE inhibitors may ↑ risk of hyperkalemia
May ↓ the effects of tricyclic antidepressants.
Concurrent use with leucovorin may result in treatment failure and ↑ risk of death (avoid concurrent use)
trimethoprim/sulfamethoxazole
Assessment
> assess for infection
Obtain specimen for culture and sensitivity before initiating therapy
Inspect IV site, Phlebitis common.
>Monitor bowel function
>Assess for rash
>Monitor CBC and UA frequently for May produce ↑ serum bilirubin, ↑ potassium, creatinine, and alkaline phosphatase.
May cause hypoglycemia.
trimethoprim/sulfamethoxazole
Patient Teaching
> Empty stomach, full galss of water, 1 hr before or 2hr after meals, may take with food if GI upset occurs
Take medicine as directed
Complete whole course
notify doctor if rash, sore throat, fever, mouth sores, or unusual bleeding or bruising occurs
Proper dilution, rate, and admin of drug and IV equipment
trimethoprim/sulfamethoxazole
Routes
PO, IV
Ampicillin
Trade Names
Omnipen
Amcill
Polycillin
Principen
Ampicillin
Therapeutic Class
anti-infectives
Ampicillin
Pharm Class
aminopenicillins
Ampicillin
Indications
Treatment of the following infections: Skin and skin structure infections, Soft-tissue infections, Otitis media, Sinusitis, Respiratory infections, Genitourinary infections, Meningitis, Septicemia. Endocarditis prophylaxis.
Unlabeled Use(s): Prevention of infection in certain high-risk patients undergoing cesarean section.
Ampicillin
Action
Binds to a bacterial cell wall, resulting in death.
Ampicillin
Therapeutic Effects
Bactericidal action, broader spectrum that penicillin
Ampicillin
Contraindication
Penicillin hypersensitivity
Ampicillin
Precautions
> Severe renal insufficiency (dose ↓ required if CCr <10 mL/min);
Infectious mononucleosis, acute lymphocytic leukemia or cytomegalovirus infection (↑ incidence of rash);
Patients allergic to cephalosporins;
Lactation: Distributed into breast milk. Can cause rash, diarrhea, and sensitization in the infant.
Ampicillin
Adverse Effects
SEIZURES (High Doses)
C.DIFF
ANAPHYLAXIS
SERUM SICKNESS
Ampicillin
Side Effects
Diarrhea rash superinfection nausea vomiting urticaria blood dyscrasias
Ampicillin
Drug-Drug Reactions
> Probenecid ↓ renal excretion and ↑ blood levels of ampicillin–therapy may be combined for this purpose.
Large doses may ↑ the risk of bleeding with warfarin.
↑ risk of with concurrent allopurinol therapy.
May ↓ the effectiveness of oral hormonal contraceptives.
Ampicillin
Assessment
> Observe for anaphylaxis
Keep epinephrine, antihistamine, and CPR equipment nearby when administering
Monitor bowel function for diarrhea or bloody stools
assess for rash, infection
before therapy obtain history, and specimen for culture and sensitivity
Ampicillin
Patient Teaching
> Take whole course as directed
Report signs of infection or allergy
Notify immediately for fever and diarrhea
Use an alternate or additional form of nonhormonal birth control
Ampicillin
Routes
PO, IM, IV
Cefazolin
Trade Names
Previously, Ancef
Cefazolin
Therapeutic Class
anti-infectives
Cefazolin
Pharm Class
first generation cephalosporin
Cefazolin
Indications
Treatment of the following infections due to susceptible organisms:
Skin and skin structure infections (including burn wounds), Pneumonia, Urinary tract infections, Biliary tract infections, Genital infections, Bone and joint infections, Septicemia, Bacterial endocarditis prophylaxis for dental and upper respiratory procedures. Perioperative prophylaxis.
Cefazolin
Action
Binds to bacterial cell wall membrane, causing cell death
Cefazolin
Therapeutic Effects
Bactericidal action against susceptible bacteria.
>Against many gram + cocci
>Against some gram - rods
Cefazolin
Contraindications
Hypersensitivity to cephalosporins
serious hypersensitivity to penicillins
Cefazolin
Precautions
> Renal impairment (dose ↓ and/or ↑ dosing interval recommended if CCr <50 mL/min [adults] or <70 mL/min [children])
Hepatic impairment
History of GI disease, especially colitis
OB: Half-life is shorter and blood levels lower during pregnancy; has been used safely.Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
Geri: Dose adjustment due to age-related ↓ in renal function may be necessary in older adults.
Cefazolin
Adverse Effects
SEIZURES (High Doses) CDIFF STEVENS-JOHNSONS ANAPHYLAXIS SERUM SICKNESS
Cefazolin
Side Effects
diarrhea nausea vomiting rash pain at IM site Phlebitis at IV site thrombocytopenia neutropenia leukopenia cramps pruritis urticaria superinfection
Cefazolin
Drug-Drug Reactions
Probenicid decreases excretion and increases blood levels of renally excreted cephalosporins
Cefazolin
Route
IM, IV
Cefazolin
Assessment
> Observe for anaphylaxis
Observe for rash, discontinue if occurs.
Monitor bowel function
Observe for infection
Monitor labs
Before initiating therapy obtain history and specimens for culture and sensitivity
Cefazolin
Patient Teaching
Report signs of superinfection
Notify immediately of rash, fever, or diarrhea occurs
Doxycycline
Trade Names
Acticlate Doryx Doryx MPC Doxy Oracea Vibramycin
Doxycycline
Therapeutic Class
anti-infectives
Doxycycline
Pharm Class
tetracyclines
Doxycycline
Indications
Treatment of various infections caused by unusual organisms, including:
Mycoplasma,
Chlamydia,
Rickettsia,
Borellia burgdorferi.
Treatment of inhalational anthrax (postexposure) and cutaneous anthrax.
Treatment of gonorrhea and syphilis in penicillin-allergic patients.
Prevention of exacerbations of chronic bronchitis.
Treatment of acne.
Treatment of inflammatory lesions associated with rosacea (Oracea only).
Malaria prophylaxis.
Doxycycline
Action
Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome.
Low-dose products used in the management of periodontitis inhibit collagenase.
Doxycycline
Therapeutic Effects
Bacteriostatic action against susceptible bacteria >some gram + pathogens >anthrax >some gram - pathogens >other pathogens >mycoplasma >Treponema pallidum >Chlamydia, >Rickettsia, >Borrelia burgdorferi.
Doxycycline
Contraindications
Hypersensitivity
Avoid alcohol products and bisulfites
Pregnancy in last half
Doxycycline
Precautions
Pregnancy
Breastfeeding
Children <8
Doxycycline
Adverse Affects
DRESS ERYTHEMA MULTIFORM EXFOLIATIVE DERMATITIS STEVENS-JOHNSONS TOXIC EPIDERMAL NECROLYSIS CDIFF HEPATOTOXICITY PANCREATITIS
Doxycycline
Side Effects
photosensitivity hypersensitivity superinfection n/v/d intercranial hypotension headache rash dysphagia esophagitis glossitis phlebitis at IV site blood dyscrasias
Doxycycline
Drug-Drug Reactions
> May ↑ effect of warfarin.
May ↓ effectiveness of estrogen-containing oral contraceptives.
Antacids, calcium, iron, and magnesium form insoluble compounds (chelates) and ↓ absorption of tetracyclines; this effect is least with doxycycline.
Cholestyramine or colestipol ↓ absorption of tetracyclines.
Adsorbent antidiarrheals may ↓ absorption.
Barbiturates, carbamazepine, or phenytoin may ↓ effectiveness.
Isotretinoin may ↑ risk of intracranial hypertension; avoid concomitant use.
Doxycycline
Drug-Food Reactions
Calcium in food or dairy products decrease absorption by forming insoluble compounds
Doxycycline
Routes
PO, IV
Doxycycline
Assessment
> Monitor bowel function
Assess for rash, discontinue if severe or fever also occurs
Assess IV site for thrombophlebitis
Assess for infection
Obtain culture and sensitivity before initiating therapy
Doxycycline
Patient Teaching
> Take whole course as directed
Notify immediately if rash or diarrhea, or signs of superinfection
Use sunscreen and protective clothing
Take calcium or iron 1-3 hours before or after doxycycline
Gentamicin
Trade Names
Garamycin
Gentamicin
Therapeutic Class
anti-infectives
Gentamycin
Pharm Class
aminoglycosides
Gentamycin
Indications
> Treatment of serious gram-negative bacterial infections and infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated.
In combination with other agents in the management of serious enterococcal infections.
Prevention of infective endocarditis.
Topical Ophth: Treatment of localized infections due to susceptible organisms.
Gentamicin
Action/Therapeutic Effects
Bactericidal action, inhibits protein synthesis in bacteria at 30S ribosome.
Gentamicin
Contraindications
> Hypersensitivity to gentamicin or other aminoglycosides
bisulfate intolerance
Pregnancy
Neonates
Gentamicin
Precautions
>Renal impairment >Hearing impairment >Neuromuscular diseases >Neonates >Geriatric
Gentamicin
Adverse Reactions/Side Effects
Ototoxicity (vestibular & cochlear) nephrotoxicity ataxia vertigo hypersensitivity muscle paralysis (high IV doses)
Gentamicin
Drug-Drug Interactions
> Inactivated by penicillins and cephalosporins when coadministered to patients with renal insufficiency.
Possible respiratory paralysis after inhalation anesthetics or neuromuscular blockers.
↑ incidence of ototoxicity with loop diuretics.
↑ incidence of nephrotoxicity with other nephrotoxic drugs.
Gentamicin
Routes
IM, IV, IT(intrathecal)
Gentamicin
Assessment
> Assess for infection
Evaluate eighth cranial nerve by audiometry before and throughout
Monitor I&O
Obtain specimen for culture and sensitivity before therapy initiation
Monitor blood levels for toxicity
Gentamicin
Teaching
> Report hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating
Drink lots of fluids
Notify of pregnancy planned or suspected
Azithromycin
Trade Names
Zithromax
Azithromycin
Therapeutic Class
agents for atypical mycobacterium
anti-infectives
Azithromycin
Pharm Class
Macrolides
Azithromycin
Indications
> Treatment of
-upper respiratory tract infections
-lower respiratory tract infections
-acute otitis media
-skin/skin structure infections
-nongonococcal urethritis, cervicitis, gonorrhea, & chancroid
Prevention of Mycobacterium avium complex (MAC) infection in advanced HIV infected patients
Unlabeled uses
>Prevention of bacterial endocarditis
>treatment of cystic fibrosis
>Treatment and post-exposure prophylaxis of pertussis in infants
Azithromycin
Action/Therapeutic Effects
Inhibits protein synthesis at 50S bacterial ribosome
Bacteriostatic action
Active against some gram negative and some gram positive aerobic bacteria.
NOT active against MRSA
Azithromycin
ROUTE ONSET PEAK DURATION
PO rapid 2.5–3.2 hr 24 hr
IV rapid end of infusion 24 hr
Azithromycin
Contraindications
> Hypersensitivity to azithromycin, erythromycin, or other macrolide anti-infectives;
History of cholestatic jaundice or hepatic dysfunction with prior use of azithromycin;
QT interval prolongation, hypokalemia, hypomagnesemia, or bradycardia;
Concurrent use of quinidine, procainamide, dofetilide, amiodarone, or sotalol.
Azithromycin
Precautions
> Severe hepatic impairment (dose adjustment may be required);
Severe renal impairment (CCr <10 mL/min);
Myasthenia gravis (may worsen symptoms);
Geri: May have ↑ risk of QT interval prolongation;
OB: Use only if potential maternal benefit justifies potential fetal risk;
Lactation: Use during breast feeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Neonates (↑ risk of infantile hypertrophic pyloric stenosis at up to 42 days of life).
Azithromycin
Adverse Reactions
>Torsades De Pointes >Acute generalized exanthematous pustulosis >DRESS >Stevens-Johnsons Syndrome >Hepatotoxicity >Hypersensitivity >CDAD
Azithromycin
Side Effects
>abdominal pain (common) >diarrhea (common) >nausea (Common) >dizziness >seizures >drowsiness >fatigue >headache >chest pain >hypotension >palpitations >QT interval prolongation >photosensitivity >rash >ototoxicity >hyperkalemia >cholestatic jaundice > ↑ liver enzymes >dyspepsia >flatulence >melena >oral candidiasis >pyloric stenosis >nephritis >vaginitis >anemia >leukopenia >thrombocytopenia
Azithromycin
Drug-Drug Interactions
> Quinidine, procainamide, dofetilide, sotalol, and amiodarone may ↑ risk of QT interval prolongation; concurrent use should be avoided.
Aluminum- and magnesium-containing antacids ↓ peak levels.
Nelfinavir ↑ levels (monitor carefully); azithromycin also ↓ nelfinavir levels.
Efavirenz ↑ levels.
May ↑ the effects and risk of toxicity of warfarin and zidovudine.
Other macrolide anti-infectives have been known to ↑ levels and effects of digoxin, theophylline, ergotamine, dihydroergotamine, triazolam, carbamazepine, cyclosporine, tacrolimus, and phenytoin ; careful monitoring of concurrent use is recommended.
Azithromycin
Routes
PO, IV
Azithromycin
Assessment
> Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Notify health care professional immediately if these occur.
Assess patient for skin rash frequently during therapy. Discontinue azithromycin at first sign of rash; may be life-threatening. >Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.
Lab Test Considerations:
>May cause ↑ serum bilirubin, AST, ALT, LDH, and alkaline phosphatase concentrations.
>May cause ↑ creatine phosphokinase, potassium, prothrombin time, BUN, serum creatinine, and blood glucose concentrations.
>May occasionally cause ↓ WBC and platelet count.
Azithromycin
Patient Teaching
> Take 1 hour before or 2 hours after meals
Take as directed and take whole course
Do not take with antacids or food
May cause drowsiness or dizziness
Use sunscreen/protective clothing, photosensitivity
Immediately Report chest pain, palpitations, yellowing of skin or eyes, sign of superinfection, rash, fever, or diarrhea especially with blood, mucus, or pus in it.
If for urethritis or cervicitis, sexual partners should also be treated.
Notify provider if symptoms do not improve
Notify provider if pregnancy is planned, suspected, or breastfeeding
If breastfeeding, monitor infant for rash, diarrhea or vomiting
Ciprofloxacin
Trade Names
Cipro
Cipro XR
Ciprofloxacin
Therapeutic Class
Anti-infectives
Ciprofloxacin
Pharm Class
Fluoroquinolones
Ciprofloxacin
Indications
Ciprofloxacin
Action/Therapeutic Effects
Ciprofloxacin
Contraindications
Ciprofloxacin
Precautions
Ciprofloxacin
Adverse Reactions
Ciprofloxacin
Side Effects
Ciprofloxacin
Drug-Drug Interactions
Ciprofloxacin
Routes
Ciprofloxacin
Assessment
Ciprofloxacin
Patient Teaching
Vancomycin
Trade Names
Vancomycin
Therapeutic Class
Vancomycin
Pharm Class
Vancomycin
Indications
Vancomycin
Action/Therapeutic Effects
Vancomycin
Contraindications
Vancomycin
Precautions
Vancomycin
Adverse Reactions
Vancomycin
Side Effects
Vancomycin
Drug-Drug Reactions
Vancomycin
Routes
Vancomycin
Assessment
Vancomycin
Patient Teaching
Metronidazole
Trade Names
Metronidazole
Therapeutic Class
Metronidazole
Pharm Class
Metronidazole
Indications
Metronidazole
Action/Therapeutic Effects
Metronidazole
Contraindications
Metronidazole
Precautions
Metronidazole
Adverse Reactions
Metronidazole
Side Effects
Metronidazole
Drug-Drug Interactions
Metronidazole
Routes
Metronidazole
Assessment
Metronidazole
Patient Teaching
Zosyn
Trade Names
Zosyn
Therapeutic Class
Zosyn
Pharm Class
Zosyn
Action/Therapeutic Effects
Zosyn
Contraindications
Zosyn
Precautions
Zosyn
Adverse Reactions
Zosyn
Side Effects
Zosyn
Drug-Drug Reactions
Zosyn
Routes
Zosyn
Assessment
Zosyn
Patient Teaching
Fluconazole
Trade Names
Fluconazole
Therapeutic Class
Fluconazole
Pharm Class
Fluconazole
Indications
Fluconazole
Action/Therapeutic Effects
Fluconazole
Contraindications
Fluconazole
Precautions
Fluconazole
Adverse Reactions
Fluconazole
Side Effects
Fluconazole
Drug-Drug Interactions
Fluconazole
Routes
Fluconazole
Assessment
Fluconazole
Patient Teaching
Ceftriaxone
Trade Names
Ceftriaxone
Therapeutic Class
Ceftriaxone
Pharm Class
Ceftriaxone
Action/Therapeutic Effects
Ceftriaxone
Contraindications
Ceftriaxone
Precautions
Ceftriaxone
Adverse Reactions
Ceftriaxone
Side Effects
Ceftriaxone
Drug-Drug Interactions
Ceftriaxone
Routes
Ceftriaxone
Assessment
Ceftriaxone
Patient Teaching
Meropenem
Trade Names
Meropenem
Therapeutic Class
Meropenem
Pharm Class
Meropenem
Indications
Meropenem
Action/Therapeutic Effects
Meropenem
Contraindications
Meropenem
Precautions
Meropenem
Adverse Reactions
Meropenem
Side Effects
Meropenem
Drug-Drug Interactions
Meropenem
Routes
Meropenem
Assessment
Meropenem
Patient Teaching
