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NRS 230 Pharm 1 - MHCC > Drugs Need to Know: Anti-Infective/Antibiotic/Antiprotozoal > Flashcards

Drugs Need to Know: Anti-Infective/Antibiotic/Antiprotozoal Flashcards

1
Q 
trimethoprim/sulfamethoxazole
trade name(s)
A 
Bactrim
Bactrim DS
Septra
Septra DS
Sulfatrim 
Sulfatrim DS
Sulfatrim Pediatric
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2
Q

trimethoprim/sulfamethoxazole

Therapeutic Class

A

anti-infectives

antiprotozoals

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3
Q

trimethoprim/sulfamethoxazole

Pharm Class

A

folate antagonists

sulfonamides

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4
Q

trimethoprim/sulfamethoxazole

Indications

A

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.
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5
Q

trimethoprim/sulfamethoxazole

Action

A

Combination inhibits the metabolism of folic acid in bacteria at two different points

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6
Q

trimethoprim/sulfamethoxazole

Therapeutic Effects

A

Bactericidal action against susceptible organisms
>Many gram+positive aerobic pathogens
>Many gram-negative aerobic pathogens

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7
Q

trimethoprim/sulfamethoxazole

Contraindication

A

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

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8
Q

trimethoprim/sulfamethoxazole

Precautions

A

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).

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9
Q

trimethoprim/sulfamethoxazole

Adverse Effects

A 
ERTHEMIA MULTIFORM
STEVENS-JOHNSONS
TOXIC EPIDERMAL NECROLYSIS
C.DIFF ASSOC. DIARRHEA
HEPATIC NECROSIS
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10
Q

trimethoprim/sulfamethoxazole

Side Effects

A 
rash
nausea
vomiting
headache
fatigue
hallucinations
hyperkalemia
hypoglycemia
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11
Q

trimethoprim/sulfamethoxazole

Drug-Drug Reactions

A

> 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)

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12
Q

trimethoprim/sulfamethoxazole

Assessment

A

> 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.

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13
Q

trimethoprim/sulfamethoxazole

Patient Teaching

A

> 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

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14
Q

trimethoprim/sulfamethoxazole

Routes

A

PO, IV

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15
Q

Ampicillin

Trade Names

A

Omnipen
Amcill
Polycillin
Principen

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16
Q

Ampicillin

Therapeutic Class

A

anti-infectives

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17
Q

Ampicillin

Pharm Class

A

aminopenicillins

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18
Q

Ampicillin

Indications

A 
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.
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19
Q

Ampicillin

Action

A

Binds to a bacterial cell wall, resulting in death.

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20
Q

Ampicillin

Therapeutic Effects

A

Bactericidal action, broader spectrum that penicillin

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21
Q

Ampicillin

Contraindication

A

Penicillin hypersensitivity

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22
Q

Ampicillin

Precautions

A

> 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.

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23
Q

Ampicillin

Adverse Effects

A

SEIZURES (High Doses)
C.DIFF
ANAPHYLAXIS
SERUM SICKNESS

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24
Q

Ampicillin

Side Effects

A 
Diarrhea
rash
superinfection
nausea
vomiting
urticaria
blood dyscrasias
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25
Q

Ampicillin

Drug-Drug Reactions

A

> 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.

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26
Q

Ampicillin

Assessment

A

> 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

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27
Q

Ampicillin

Patient Teaching

A

> 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

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28
Q

Ampicillin

Routes

A

PO, IM, IV

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29
Q

Cefazolin

Trade Names

A

Previously, Ancef

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30
Q

Cefazolin

Therapeutic Class

A

anti-infectives

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31
Q

Cefazolin

Pharm Class

A

first generation cephalosporin

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32
Q

Cefazolin

Indications

A

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.
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33
Q

Cefazolin

Action

A

Binds to bacterial cell wall membrane, causing cell death

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34
Q

Cefazolin

Therapeutic Effects

A

Bactericidal action against susceptible bacteria.
>Against many gram + cocci
>Against some gram - rods

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35
Q

Cefazolin

Contraindications

A

Hypersensitivity to cephalosporins

serious hypersensitivity to penicillins

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36
Q

Cefazolin

Precautions

A

> 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.

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37
Q

Cefazolin

Adverse Effects

A 
SEIZURES (High Doses)
CDIFF
STEVENS-JOHNSONS
ANAPHYLAXIS
SERUM SICKNESS
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38
Q

Cefazolin

Side Effects

A 
diarrhea
nausea
vomiting
rash
pain at IM site
Phlebitis at IV site
thrombocytopenia
neutropenia
leukopenia
cramps
pruritis
urticaria
superinfection
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39
Q

Cefazolin

Drug-Drug Reactions

A

Probenicid decreases excretion and increases blood levels of renally excreted cephalosporins

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40
Q

Cefazolin

Route

A

IM, IV

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41
Q

Cefazolin

Assessment

A

> 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

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42
Q

Cefazolin

Patient Teaching

A

Report signs of superinfection

Notify immediately of rash, fever, or diarrhea occurs

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43
Q

Doxycycline

Trade Names

A 
Acticlate
Doryx
Doryx MPC
Doxy
Oracea
Vibramycin
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44
Q

Doxycycline

Therapeutic Class

A

anti-infectives

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45
Q

Doxycycline

Pharm Class

A

tetracyclines

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46
Q

Doxycycline

Indications

A

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.

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47
Q

Doxycycline

Action

A

Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome.
Low-dose products used in the management of periodontitis inhibit collagenase.

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48
Q

Doxycycline

Therapeutic Effects

A 
Bacteriostatic action against susceptible bacteria
>some gram + pathogens
   >anthrax
>some gram - pathogens
>other pathogens
   >mycoplasma
   >Treponema pallidum
   >Chlamydia,
   >Rickettsia,
   >Borrelia burgdorferi.
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49
Q

Doxycycline

Contraindications

A

Hypersensitivity
Avoid alcohol products and bisulfites
Pregnancy in last half

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50
Q

Doxycycline

Precautions

A

Pregnancy
Breastfeeding
Children <8

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51
Q

Doxycycline

Adverse Affects

A 
DRESS
ERYTHEMA MULTIFORM
EXFOLIATIVE DERMATITIS
STEVENS-JOHNSONS
TOXIC EPIDERMAL NECROLYSIS
CDIFF
HEPATOTOXICITY
PANCREATITIS
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52
Q

Doxycycline

Side Effects

A 
photosensitivity
hypersensitivity
superinfection
n/v/d
intercranial hypotension
headache
rash
dysphagia
esophagitis
glossitis
phlebitis at IV site
blood dyscrasias
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53
Q

Doxycycline

Drug-Drug Reactions

A

> 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.

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54
Q

Doxycycline

Drug-Food Reactions

A

Calcium in food or dairy products decrease absorption by forming insoluble compounds

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55
Q

Doxycycline

Routes

A

PO, IV

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56
Q

Doxycycline

Assessment

A

> 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

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57
Q

Doxycycline

Patient Teaching

A

> 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

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58
Q

Gentamicin

Trade Names

A

Garamycin

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59
Q

Gentamicin

Therapeutic Class

A

anti-infectives

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60
Q

Gentamycin

Pharm Class

A

aminoglycosides

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61
Q

Gentamycin

Indications

A

> 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.

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62
Q

Gentamicin

Action/Therapeutic Effects

A

Bactericidal action, inhibits protein synthesis in bacteria at 30S ribosome.

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63
Q

Gentamicin

Contraindications

A

> Hypersensitivity to gentamicin or other aminoglycosides
bisulfate intolerance
Pregnancy
Neonates

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64
Q

Gentamicin

Precautions

A 
>Renal impairment
>Hearing impairment
>Neuromuscular diseases
>Neonates
>Geriatric
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65
Q

Gentamicin

Adverse Reactions/Side Effects

A 
Ototoxicity (vestibular & cochlear)
nephrotoxicity
ataxia
vertigo
hypersensitivity
muscle paralysis (high IV doses)
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66
Q

Gentamicin

Drug-Drug Interactions

A

> 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.

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67
Q

Gentamicin

Routes

A

IM, IV, IT(intrathecal)

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68
Q

Gentamicin

Assessment

A

> 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

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69
Q

Gentamicin

Teaching

A

> Report hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating
Drink lots of fluids
Notify of pregnancy planned or suspected

70
Q

Azithromycin

Trade Names

A

Zithromax

71
Q

Azithromycin

Therapeutic Class

A

agents for atypical mycobacterium

anti-infectives

72
Q

Azithromycin

Pharm Class

A

Macrolides

73
Q

Azithromycin

Indications

A

> 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

74
Q

Azithromycin

Action/Therapeutic Effects

A

Inhibits protein synthesis at 50S bacterial ribosome
Bacteriostatic action
Active against some gram negative and some gram positive aerobic bacteria.
NOT active against MRSA

75
Q

Azithromycin

A

ROUTE ONSET PEAK DURATION
PO rapid 2.5–3.2 hr 24 hr
IV rapid end of infusion 24 hr

76
Q

Azithromycin

Contraindications

A

> 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.

77
Q

Azithromycin

Precautions

A

> 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).

78
Q

Azithromycin

Adverse Reactions

A 
>Torsades De Pointes
>Acute generalized exanthematous pustulosis
>DRESS
>Stevens-Johnsons Syndrome
>Hepatotoxicity
>Hypersensitivity
>CDAD
79
Q

Azithromycin

Side Effects

A 
>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
80
Q

Azithromycin

Drug-Drug Interactions

A

> 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.

81
Q

Azithromycin

Routes

A

PO, IV

82
Q

Azithromycin

Assessment

A

> 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.

83
Q

Azithromycin

Patient Teaching

A

> 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

84
Q

Ciprofloxacin

Trade Names

A

Cipro

Cipro XR

85
Q

Ciprofloxacin

Therapeutic Class

A

Anti-infectives

86
Q

Ciprofloxacin

Pharm Class

A

Fluoroquinolones

87
Q

Ciprofloxacin

Indications

A
88
Q

Ciprofloxacin

Action/Therapeutic Effects

A
89
Q

Ciprofloxacin

Contraindications

A
90
Q

Ciprofloxacin

Precautions

A
91
Q

Ciprofloxacin

Adverse Reactions

A
92
Q

Ciprofloxacin

Side Effects

A
93
Q

Ciprofloxacin

Drug-Drug Interactions

A
94
Q

Ciprofloxacin

Routes

A
95
Q

Ciprofloxacin

Assessment

A
96
Q

Ciprofloxacin

Patient Teaching

A
97
Q

Vancomycin

Trade Names

A
98
Q

Vancomycin

Therapeutic Class

A
99
Q

Vancomycin

Pharm Class

A
100
Q

Vancomycin

Indications

A
101
Q

Vancomycin

Action/Therapeutic Effects

A
102
Q

Vancomycin

Contraindications

A
103
Q

Vancomycin

Precautions

A
104
Q

Vancomycin

Adverse Reactions

A
105
Q

Vancomycin

Side Effects

A
106
Q

Vancomycin

Drug-Drug Reactions

A
107
Q

Vancomycin

Routes

A
108
Q

Vancomycin

Assessment

A
109
Q

Vancomycin

Patient Teaching

A
110
Q

Metronidazole

Trade Names

A
111
Q

Metronidazole

Therapeutic Class

A
112
Q

Metronidazole

Pharm Class

A
113
Q

Metronidazole

Indications

A
114
Q

Metronidazole

Action/Therapeutic Effects

A
115
Q

Metronidazole

Contraindications

A
116
Q

Metronidazole

Precautions

A
117
Q

Metronidazole

Adverse Reactions

A
118
Q

Metronidazole

Side Effects

A
119
Q

Metronidazole

Drug-Drug Interactions

A
120
Q

Metronidazole

Routes

A
121
Q

Metronidazole

Assessment

A
122
Q

Metronidazole

Patient Teaching

A
123
Q

Zosyn

Trade Names

A
124
Q

Zosyn

Therapeutic Class

A
125
Q

Zosyn

Pharm Class

A
126
Q

Zosyn

Action/Therapeutic Effects

A
127
Q

Zosyn

Contraindications

A
128
Q

Zosyn

Precautions

A
129
Q

Zosyn

Adverse Reactions

A
130
Q

Zosyn

Side Effects

A
131
Q

Zosyn

Drug-Drug Reactions

A
132
Q

Zosyn

Routes

A
133
Q

Zosyn

Assessment

A
134
Q

Zosyn

Patient Teaching

A
135
Q

Fluconazole

Trade Names

A
136
Q

Fluconazole

Therapeutic Class

A
137
Q

Fluconazole

Pharm Class

A
138
Q

Fluconazole

Indications

A
139
Q

Fluconazole

Action/Therapeutic Effects

A
140
Q

Fluconazole

Contraindications

A
141
Q

Fluconazole

Precautions

A
142
Q

Fluconazole

Adverse Reactions

A
143
Q

Fluconazole

Side Effects

A
144
Q

Fluconazole

Drug-Drug Interactions

A
145
Q

Fluconazole

Routes

A
146
Q

Fluconazole

Assessment

A
147
Q

Fluconazole

Patient Teaching

A
148
Q

Ceftriaxone

Trade Names

A
149
Q

Ceftriaxone

Therapeutic Class

A
150
Q

Ceftriaxone

Pharm Class

A
151
Q

Ceftriaxone

Action/Therapeutic Effects

A
152
Q

Ceftriaxone

Contraindications

A
153
Q

Ceftriaxone

Precautions

A
154
Q

Ceftriaxone

Adverse Reactions

A
155
Q

Ceftriaxone

Side Effects

A
156
Q

Ceftriaxone

Drug-Drug Interactions

A
157
Q

Ceftriaxone

Routes

A
158
Q

Ceftriaxone

Assessment

A
159
Q

Ceftriaxone

Patient Teaching

A
160
Q

Meropenem

Trade Names

A
161
Q

Meropenem

Therapeutic Class

A
162
Q

Meropenem

Pharm Class

A
163
Q

Meropenem

Indications

A
164
Q

Meropenem

Action/Therapeutic Effects

A
165
Q

Meropenem

Contraindications

A
166
Q

Meropenem

Precautions

A
167
Q

Meropenem

Adverse Reactions

A
168
Q

Meropenem

Side Effects

A
169
Q

Meropenem

Drug-Drug Interactions

A
170
Q

Meropenem

Routes

A
171
Q

Meropenem

Assessment

A
172
Q

Meropenem

Patient Teaching

A

NRS 230 Pharm 1 - MHCC (23 decks)

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