ID ADE and counseling Flashcards
PCN
- Complete entire course of therapy
- Drink ample fluids
- Report persistent diarrhea (Concern for pseudomembranous colitis)
- Pregnancy category B
- ADE: nausea, diarrhea, HIVES, RASH
Veetids
• Take on empty stomach with water
Pfizerpen-G
• Pearls: Very short half-life, so must dose frequently or give by continuous infusion
Dicloxacillin
• Take on empty stomach with water
Nafcillin
• Pearls: Short half-life; q4h dosage interval, largely eliminated by the liver
Amoxil
- Take extended release formulation within 1 hour of finishing a meal
- Shake suspension well before use; may be mixed with formula, milk, fruit juice, or other cold drinks
Augmentin/XR/ES
- Take with food to decrease GI effects
- Drink water after chewable tablets
- Augmentin ES suspension does not taste very good
- ADE: diarrhea, hepatic dysfunction
Cephalosporins
- Complete entire course of therapy
- Drink ample fluids
- Report persistent diarrhea (Concern for pseudomembranous colitis)
- Pregnancy category B
- ADE: Nausea, diarrhea, RASH
Ancef (cefazolin)
• Pearl: Good alternative to anti-staphylococcal penicillins (i.e. nafcillin), except in CNS infections
Keflex (cephalexin)
• Take on empty stomach
Ceftin (cefuroxime)
- Take the suspension with food
- Bitter taste
- Tablets are without regard to meals
Omnicef (cefdinir)
- Avoid antacids / iron within 2 hours
* ADE: Discolored stools (red)
Rocephin (ceftriaxone)
- Pearls: Dosed once daily except for meningitis and enterococcal endocarditis (q12 hours), High biliary elimination, so no renal dose adjustment needed
- ADE: Biliary sludging, Hyperbilirubinemia in infants / neonates
Maxipime (cefepime)
• Pearl: Often used as an alternative to piperacillintazobactam in cases of mild penicillin allergy when anti-pseudomonal activity is needed
Teflaro (ceftaroline)
• Dose adjust for CrCl < 50 ml/min
Carbapenems
• Will all need renal adjustments
• ADE: GI, rash, SEIZURES (imipenem greatest risk)
- Risk factors for seizures- renal impairment, CNS disease
• Pregnancy category B except for imipenem which is a category C
Primaxin (imipenem / cilastatin)
- Renally adjust for CrCl < 90 mL/min
- Cilastatin inhibits dehydropeptidase and keeps the toxic product from forming (imipenem gets metabolized to nephrotoxic product in the kidney by dehydropeptidase)
- ADE: Most likely carbapenem to cause seizures
Invanz (ertapenem)
- Renally adjust for CrCl <= 30 mL/min
* Once daily dosing convenient for home infusion therapy
Merrem (meropenem
- Renally adjust for CrCl < 50 mL/min
* Pearl: Extended interval dosing (3 hour infusion) may be used for extremely resistant Gram (-) organisms
Macrolide
• Complete entire course of therapy
• Although erythromycin and azithromycin best absorbed on empty stomach, take with food or milk if GI upset
• Pregnancy category B
• ADE: GI UPSET, nausea, cramping, diarrhea, Rare hepatotoxicity (mostly telithromycin), QTc prolongation
- For QTc prolongation, Erythromycin (worst) > clarithromycin > azithromycin (least likely)
Erythromycin / Ery-tab
- Food or milk if GI upset
* Swallow delayed release capsule and enteric coated tablet whole
Biaxin / Biaxin XL (clarithromycin)
- Take XL dosage form with food to increase absorption
* Regular tablets without regard to food
Zithromax / Zmax (azithromycin)
- Take without regard to meals
* Pearl: Biliary excretion / long half-life
Ketek (telithromycin)
- Report severe / persistent diarrhea or fainting
* ADE: diarrhea, nausea
Fluoroquinolones
• Complete entire course of therapy
• Drink ample fluids to maintain urine flow
• Avoid antacids and iron products within hours prior to or after administration
• ADE: Nausea, diarrhea, headache, sun photosensitivity, QTc prolongation
- For QTc prolongation, Moxifloxacin (worst) > levofloxacin > ciprofloxacin (least)
Baxdela (delafloxacin)
- IV dose adjustment for CrCl < 30 mL/min
* No effects on QTc interval observed in study of 51 healthy subjects
Tetracyclines
- Take on empty stomach; food decreases absorption; can take with food if cannot tolerate taking it on an empty stomach
- No antacids, iron or dairy within 2 hours
- Avoid prolonged sunlight (except with minocycline)
- Pregnancy category D (avoid unless benefit > risk)
- ADE: Nausea, diarrhea, Photosensitivity (all except minocycline)
Minocin (minocycline)
• ADE: can cause vertigo
Bactrim
- Empty stomach with ample water (especially to prevent crystalluria)
- Avoid prolonged exposure to sunlight
- ADE: Photosensitivity, acute kidney injury (crystalluria), diarrhea, rash, hyperkalemia
Macrobid / Macrodantin (nitrofurantoin)
- Take with food (increases absorption and helps with nausea)
- May cause small incidence of urine discoloration (brown)
- ADE: NAUSEA, diarrhea, headache
- Rare: peripheral and optic neuropathy; hepatic rxns
Monurol (fosfomycin)
• ADE: headache, dizziness, GI upset
Flagyl (metronidazole)
- Take with food or milk (to help with GI upset)
- Avoid alcohol during and 24 hours after therapy
- ADE: Nausea, diarrhea, cramping, metallic taste, seizure risk
Metrogel-Vaginal (metronidazole)
- Avoid intercourse during therapy
- Avoid alcohol during and 24 hours after therapy
- ADE: Candida superinfection
Dificid (fidaxomicin)
- Emphasize adherence (typically takes 10 days to see effect)
- ADE: Nausea / GI discomfort
Rifampin
- Take 1 hour before or 2 hours after food (empty stomach)
- Soft contact lenses may become permanently stained
- ADE: Red / orange discoloration of secretions/urine, potential for hepatotoxicity
Bactroban (mupirocin)
- Apply small amount to affected area(s) but do not rub in
- Do not use nasal ointment with other nasal medications
- ADE: Topical irritation; nasal ointment may cause headache, rhinitis, congestion
Vancocin (vancomycin)
- ADE: Concern for nephro- and ototoxicity/phlebitis (IV)
* Monitor: Trough concentration 30 minutes before 4th dose
Vibativ (telavancin)
- Dose adjust for CrCl < 50 ml/min
- ADE: Potential for nephrotoxicity/increase in serum creatinine
- Infusion-related reactions similar to vancomycin
Cubicin (daptomycin)
- ADE: Myopathy / rhabdomyolysis
- Monitor: for myopathy, Creatine kinase (CK) concentrations weekly
- Pearl: Deactivated by pulmonary surfactant; therefore, CANNOT be used to treat pneumonia, Renal adjustments needed
Cleocin (clindamycin)
- Report diarrhea promptly to the physician
- Take with a full glass of water
- ADE: Nausea, abdominal pain, diarrhea
Zyvox (linezolid)
- ADE: Bone marrow suppression (> 2 weeks therapy), Peripheral and optic neuropathy (> 28 days therapy), Serotonin syndrome
- Monitor: Weekly CBC if on extended duration of therapy
Diflucan (fluconazole)
• ADE: nausea, hepatotoxicity, QTc prolongation
Sporanox (itraconazole)
- Take capsule / tablet with food and / or acidic beverage; avoid antacids
- Take solution on an empty stomach
- ADE: Nausea, rash, headache, edema, hepatotoxicity, QTc prolongation
Ketoconazole
- Take with food and/or acidic beverage; avoid antacids
- Surveillance for hepatic adverse effects
- ADE: nausea, skin irritation (if applied topically)
- Monitor: LFT’s
- Don’t bother learning dose on this one; will not test over it; we don’t use this often
Nystatin
- ADE: Local irritation, but generally well-tolerated
* DO know topical dosing for this
Griseofulvin
- Take with a fatty meal to increase absorption
- Renal, hepatic and blood cell monitoring may be needed for prolonged therapy (leukopenia can happen over time)
- ADE: Skin rash / urticaria, nausea, photosensitivity
Lamisil (terbinafine)
- Take with food
- Monitor: for signs of liver dysfunction or rash
- ADE: Diarrhea, dyspepsia; RASH (with oral use), Local irritation (topical)
Zovirax (acyclovir)
- Drink ample fluids
* ADE: Nausea, vomiting (oral administration), nephrotoxicity, CNS toxicity (seizure, confusion, etc)
Valtrex (valacyclovir)
- Drink ample fluids
* ADE: Headache, nausea, diarrhea, fatigue, CNS
Famvir (famciclovir)
- Drink ample fluids
* ADE: Headache, nausea, diarrhea, fatigue (causes headache and nausea more than the first two anti-virals)
Tamiflu (oseltamivir)
- Start within 2 days of symptom onset if used for treatment
* ADE: Nausea, vomiting, headache
Natroba (spinosad)
• How to apply:
- For topical application only
- Shake suspension well
- Cover dry scalp and dry hair
- Leave on for 10 minutes then rinse thoroughly with warm water
- Observe for additional live lice after 7 days
- Adjunct lice management information applies
• ADE: Application site redness / irritation
