Macrolides, Tetracyclines, FQ's

Question 1

Azithromycin brand name

Answer 1

Zithromax, Zmax

Question 2

Azithromycin indications, bugs, and doses

Answer 2

L/URTI, skin/skin structure infections caused by H. influenzae, M. catarrhalis, S. pneumo, S. pyogenes, S. aureus, S. agalactiae: 500mg on day 1 followed by 250mg daily for 4 days (ZPAK)
Mild/Moderate COPD exacerbations: 500mg daily x3 days or ZPAK
AOM: 10mg/kg on day 1, 5mg/kg on days 2-5
pharyngitis/tonsilitis: 12mg/kg daily x5 days
MAC prevention in HIV:1200mg weekly
CAP caused by C. pneumo, H. flu, L. pneumo, M. cat, M. pneumo, S. aureus, or S. pneumo: 500mg IV x2 days, then 250mg daily x7-10 days
Pelvic Inflammatory Disease due to C. trach, N. gon, or M. hominis: 500mg IV x2 days, then 250mg daily x7-10 days (same as CAP)

Question 3

Azithromycin mechanism

Answer 3

macrolide

binds to 50S ribosomal subunit of susceptible bacteria, suppressing protein synthesis

Question 4

Azithromycin distribution

Answer 4

most body tissues EXCEPT CSF

Question 5

Azithromycin excretion

Answer 5

excretion through bile as unchanged drug

Question 6

Azithromycin drug interactions

Answer 6

antacids slow absorption
food decreases absorption
nelfinavir increases (x2) serum concentrations of Azithromycin
caution with drugs that prolong QT interval

Question 7

Azithromycin CI/precautions

Answer 7

CI: hypersensitivity to macrolides or ketolides
caution: hepatic dysfunction, prolonged QT interval, low serum K or Mg, and bradycardia. patients being treated for arrhythmias
colitis/secondary infections have occurred, contact physician with persistent diarrhea
DO NOT USE FOR complicated pneumonia, gonorrhea, or syphilis

Question 8

Azithromycin pregnancy category

Answer 8

B

Question 9

Azithromycin ADR’s

Answer 9

DIARRHEA, nausea, vomiting, abdominal pain

IV: pain at injection site and local inflammation

Question 10

Azithromycin patient education

Answer 10

prefer to be taken with food, except ZMAX should be taken on empty stomach
do not take antacids within 1 hour of administration
report severe persistent diarrhea

Question 11

Ciprofloxacin brand name

Answer 11

Cipro (XR)

Question 12

Ciprofloxacin indication/dosage

Answer 12

infectious diarrhea
UTI’s
uncomplicated pyelonephritis
LRTI, SSTI, and bone and joint infections
Typhoid fever: all ~500mg BID for 7-10 days
gonorrhea: 250mg once
uncomplicated cystitis: 100mg q12h for 3 days
aerosolized anthrax: 500mgorally or 400mg IV q12h for 60 days

Question 13

Ciprofloxacin mechanism

Answer 13

prevents synthesis of bacterial DNA

Question 14

Ciprofloxacin coverage

Answer 14

wide range of activity against Gram- and Gram_ bacteria

Question 15

Ciprofloxacin drug interactions

Answer 15

Antacids and iron salts decrease bioavailibility
Probenicid increases serum levels by decreasing excretion
NSAIDs may lower seizure threshold (mostly important for levofloxacin)
THEOPHYLLINE coadmin may lead to elevated plasma concentrations of theophylline

Question 16

Ciprofloxacin CI/precautions

Answer 16

CI: hypersensitivity. discontinue at first sign of rash or other allergic reaction, may be fatal
Do not use in patients receiving theophylline
caution: known or suspected CNS disorders, esp predisposed to seizures
Convultions, ICP, and psychosis have been reported
May rupture shoulder, hand, or Achilles tendon muscles, discontinue immediately

Question 17

Ciprofloxacin pregnancy category

Answer 17

C

may cause permanent lesions in weight-bearing joints in children and adolescents, do not use in pregnant women

Question 18

Ciprofloxacin ADRs

Answer 18

nausea, diarrhea, sun sensitivity, dizziness, RASH, MUSCLE RUPTURE

Question 19

Ciprofloxacin patient education

Answer 19

avoid prolonged sun exposure
take full course
discontinue if rash develops or tendon rupture occurs
take with full glass of water, without regard to meal
do not take antacids during therapy, or iron/calcium supplements within 2 hours before or 6 hours after
suspension can be stored at room temp, discard after 14 days
may cause dizziness or lightheadedness
do not chew, crush, or split XR tabs

Question 20

Clarithromycin brand name

Answer 20

Biaxin (XL)

Question 21

Clarithromycin indication/dosage

Answer 21

mild/mod pharyngitis or tonsilitis (S. pyogenes), mild/mod maxillary sinusitis (S. pneumo), Chronic bronchitis exacerbation (S. pneumo, M. cat, H. flu), pneumonia, CAP, uncomplicated SSTI, etc.
General dosing: 1000mg daily for 7-14 days

Question 22

Clarithromycin mechanism

Answer 22

inhibits protein synthesis by binding to 50S ribosomal subunit.

Question 23

Clarithromycin drug interactions

Answer 23

may increase serum theophylline and carbamazepine levels

Erythromycin may increase digoxin, warfarin, ergotamine, and triazolam, unsure if clarithromycin does too

Question 24

Clarithromycin CI/precautions

Answer 24

CI: hypersensitivity to macrolides
C. diff has been associated with use
caution or decrease dose in severe renal impairment

Question 25

Clarithromycin pregnancy category

Answer 25

C

caution in pregnant and nursing women

Question 26

Clarithromycin ADRs

Answer 26

nausea, DIARRHEA, disruption in taste, dyspepsia, abdominal pain, headache

Question 27

Clarithromycin patient education

Answer 27

take XL with food, IR does not matter with food or not
complete full course!
Report worsening diarrhea
store suspension at room temp, discard unused after 14 days. Follow each dose with liquid to rinse from mouth