Q2Grp1 Flashcards
Acyclovir
Brand: Zovirax
Class: Viral DNA Polymerase Inhibitor
MOA: {Nucleoside Analogue Prodrug that competitively inhibits Viral DNA Polymerase.}
acyclic nucleoside analogue of deoxyguanosine that is selectively phosphorylated by the virus-encoded thymidine kinase to its monophosphate form. Cellular enzymes then convert the monophosphate to the active antiviral acyclovir triphosphate, which competitively inhibits viral DNA synthesis by inactivation of viral DNA polymerase and incorporation into and termination of viral DNA replication.
Indication: Genital Herpes, Shingles, Chickenpox, Cold Sores
Contraindication: Hypersensitivity to acyclovir or valacyclovir.
Black Box: N/A
Preg Cat: N/A
Counsel Pts: {Finish completely, Hydrate, Start ASAP, Improve 2-3 days, if worse: call doc}
Complete full course of therapy. Ensure adequate hydration. For HSV, initiate treatment as soon as possible at first sign of lesion (treatment most effective if initiated within 24 h of lesion onset). For VZV, treatment should begin within 24 h of appearance of rash. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP. If using for prophylaxis or suppression of infection, this medication should reduce the number of breakouts. Maintain adequate hydration during therapy.
Amiodarone
Brand: Cordarone
Class: Antiarrhythmic
MOA: {Type 3 Antiarrhythmic that reduces K+ channel activity}
Type III antiarrhythmic that prolongs the effective refractory period of atrial and ventricular tissue by blocking potassium conductance.
Indications: Secondary prophylaxis of ventricular arrhythmias.
Contraindications: Hypersensitivity, severe bradycardia, severe sinus node dysfunction, 2nd- or 3rd-degree AV block, and cardiogenic shock
Black Box: Arrhythmias, hepatotoxicity, proarrhythmic effects, pulmonary toxicity
Preg Cat: Contraindicated with pregnancy X
Counsel Pts: {Use sunscreen. Report changes in heart, lungs, liver. Multiple drug interactions. With food but avoid grapefruit.}
Use sunscreen; avoid tanning beds and prolonged sun exposure. Report signs/symptoms of cardiac arrhythmias, pulmonary toxicity, or liver toxicity. Multiple drug interactions so inform providers about all medications you are taking. Take consistently with regard to meals but avoid taking with grapefruit or grapefruit juice. Patient medication guide must be dispensed with this medication
Amoxicillin
Brand: Amoxil
Class: β-Lactam Antibiotic
MOA: {Gram positive can’t make cell wall.}
Penicillin derivative that inhibits the biosynthesis of bacterial cell wall mucopeptide. Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae.
Indications: Acute otitis media, Lower respiratory tract infection, Pharyngitis, tonsillitis, Streptococcal pharyngitis, Ear, nose, and throat infection, infection of skin and/or subcutaneous tissue, infection of genitourinary system, H. pylori GI tract infection.
Contraindications: Hypersensitivity
Black Box: N/A
Preg Cat: Risk in 1st/3rd trimester
Counsel Pts: {Finish course, shake well before use, refrigerate when not in use, short expiration after mix, with food, if worse: talk to doc, decreases oral contraceptive effectiveness.}
Complete full course of therapy. For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution. Can take with food if causes upset stomach. Avoid mixing suspension with food or beverages and use with measuring device that comes with prescription. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner. May decrease effectiveness of oral contraceptives; encourage patients to use backup contraceptive method (eg, condom).
Amoxicillin/Clavulanate
Brand: Augmentin
Class: β-Lactam Antibiotic
MOA: {Amox, Clav: β-Lactamase destroy Amox and clavalunate inhibits that.}
a semisynthetic penicillin derivative. Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae. Amoxicillin is not effective against β-lactamase–producing bacteria. Clavulanate, a β-lactamase inhibitor, has weak antibacterial activity but is a potent inhibitor of plasmid-mediated β-lactamases and protects amoxicillin from degradation by β-lactamases
Indications: Acute otitis media (Ear Infections), Community-acquired pneumonia, Lower respiratory tract infection, Sinusitis, infection of skin or subcutaneous tissue, infectious disease of genitourinary system, Urinary tract infection, acute cystitis/pyelonephritis.
Contraindications: Hypersensitivity to penicillins; extended release products are contraindicated in patients on dialysis or severe renal dysfunction, history of cholestatic jaundice or hepatic dysfunction with amoxicillin/clavulanate therapy
Black Box: N/A
Preg Cat: 1st/3rd Trimester risk
Counsel Pts: {Finish course, with food, shake well before use, refrigerate when not in use, short expiration date after mix, 2-3 d improve, decrease effectiveness of oral contraceptives, if worse: talk to doc}
Complete full course of therapy. Take dose with food to ensure proper absorption. For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution of 10 d. Avoid mixing suspension with food or beverages. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner. May decrease effectiveness of oral contraceptives; encourage patients to use backup contraceptive method (eg, condom).
Apixaban
Brand: Eliquis
Class: Factor Xa
MOA: selective inhibitor of factor Xa. By inhibiting factor Xa, apixaban decreases thrombin generation and thrombus development.
Indications: Atrial fibrillation(nonvalvular), Hip or knee replacement surgery, Deep Vein Thrombosis or Pulmonary Embolism
Contraindications: Hypersensitivity, active bleeding
Black Box: Premature discontinuation increases risk of thrombotic events; increased risk of spinal hematoma with spinal puncture or neuraxial anesthesia
Preg Cat: No human data (suggested toxicity)
Counsel Pt: {Food doesn’t matter, Don’t stop before talking to doc (increase risk of stroke), interrupt 1-2 d to dental/surgery. Avoid OTC NSAIDS/Aspirin (bleeding risk), stop if you have bleeding or trouble breathing.}
Seek medical attention if any unexpected bleeding or trouble breathing. Take with or without food. Do not stop taking apixaban without talking with your HCP; stopping early may increase the risk of stroke, especially in patients with atrial fibrillation. Apixaban should be interrupted 24-48 h prior to dental and surgical procedures and re-started after hemostasis. Avoid OTC NSAIDs and high-dose aspirin; they increase the risk of bleeding
Azithromycin
Brand: Zithromax
Class: Macrolide Antibiotic
MOA: {Hits both gram but better against negative, binds to bacterial ribosomes}
slightly less active than erythromycin against gram-positive bacteria but substantially more active against M. (B.), Haemophilus sp., Legionella sp., Neisseria sp., Bordetella sp., Mycoplasma sp., and C. trachomatis. Azithromycin binds to the 50S ribosomal subunit, thus interfering with microbial protein synthesis.
Indications: Acute infective exacerbation of COPD, skin or tissue infection, Bacterial sinusitis, Chancroid, nongonococcal cervicitis, nongonococcal urethritis, Community-acquired pneumonia, Sexually transmitted infections, Streptococcal pharyngitis
Contraindications: Hypersensitivity to macrolide or ketolide antibiotic (azithromycin or erythromycin)
Black Box: N/A
Preg Cat: N/A
Counsel Pt: {Finish course, food doesn’t matter but upset stomach take with food, 2-3 improvement, if worse talk to doc}
Complete full course of therapy. Take tablets with or without food, although some patients report increased tolerability when given with food. Avoid mixing suspension with food or beverages, but food can be taken afterward. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with healthcare practitioner.
Cefdinir
Brand: Omnicef
Class: Third-Generation Cephalosporin
MOA: {Hit both grams via blocking cell wall buildup and letting bacterial autolytic cell wall enzymes lyse the bacteria.}
Activity against a number of gram-positive and gram-negative bacteria including β-lactamase–producing strains.
Indication: Acute otitis media, pharyngitis, tonsillitis, Bronchitis, acute, secondary bacterial infection, Community-acquired pneumonia, uncomplicated skin, and/or subcutaneous tissue infection, acute exacerbation of COPD, Streptococcal pharyngitis, group A (alternative agent for mild, nonanaphylactic, penicillin allergy)
Contraindication: Hypersensitivity to cephalosporin
Black Box: N/A
Preg Cat: N/A
Counsel Pts: {Finish course, shake well before use, room temp, short expiration date, with food, 2-3 d improve, if worse talk to doc, separate antacids/iron/vitamins by 2h}
Complete full course of therapy. For the suspension, shake well and can be stored at room temperature. Note 10 d expiration after reconstitution. Avoid mixing suspension with food or beverages, but food can be taken afterward. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP. Separate administration of antacids, iron, and vitamins by 2 h.
Cephalexin
Brand: Keflex
Class: First-Generation Cephalosporin
MOA: {hits gram + mostly by preventing cell wall synthesis and letting autolytic enzymes lyse the bacteria}
inhibits bacterial wall synthesis of actively dividing cells by binding to ≥1 penicillin-binding proteins (PBPs). Most gram-positive bacteria, including non–penicillinase- and penicillinase-producing staphylococci and streptococci. Activity against gram-negative bacteria is less than that observed with the 2nd- and 3rd-generation cephalosporins and is primarily restricted to E. coli, Klebsiella, and Proteus mirabilis.
Indication: Infection of skin and/or subcutaneous tissue, Osteomyelitis (bone swelling), Otitis media (ear infection), respiratory tract infection, Streptococcal pharyngitis, Impetigo (skin sores), ecthyma (deep impetigo), Cellulitis (nonpurulent), erysipelas (skin infection)
Contraindication: Hypersensitivity to Cephalosporins
Black Box: N/A
Preg Cat: N/A
Counsel Pts: {Finish course, shake well before use, store in fridge, short expiration date after mix, 2-3 d improve, if worse talk to doc}
Seek medical attention if rash develops. Complete full course of therapy. For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution. Avoid mixing suspension with food or beverages, but food can be taken afterward. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner.
Ciprofloxacin
Brand: Cipro
Class: Fluoroquinolone Antibiotic
MOA: Inhibits bacterial DNA gyrase. It is highly active against aerobic, gram-negative bacilli.
Indication: Anthrax, Bacterial prostatitis, Bronchitis, lower respiratory tract infection, infection of bone, skin, or soft tissue, sinusitis, Urinary tract infectious disease.
Contraindication: Hypersensitivity to ciprofloxacin or other quinolones, concomitant tizanidine
Black Box: May exacerbate muscle weakness in patients with myasthenia gravis, tendon inflammation and rupture, peripheral neuropathy, CNS effects, cardiac, dermatologic and hypersensitivity reactions, aortic dissection and rupture, hypoglycemia, mental health adverse effects.
Preg Cat: X
Counsel Pts: {W/wo food but avoid dairy, 2h before and 6h after antacids, supplements, vitamins, shake well before use, room temp, report less urination, rash, yellow eyes, usual bruises/bleeding, muscle weakness, prickling sensation, numbness, hallucinations}
Seek medical attention 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. Take with or 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. If using the suspension, shake well before use; suspension may be stored at room temperature.
Clindamycin
Brand: Cleocin
Class: Lincosamide Antibiotic
MOA: {Binds to bacterial 50s ribosome. Hits mostly gram+ and anaerobic gram -}
A semisynthetic 7-chloro-7-deoxylincomycin derivative that is active against most gram-positive organisms except enterococci and C. difficile. Gram-negative aerobes are resistant, but most anaerobes are sensitive. It inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; it is bactericidal or bacteriostatic depending on the concentration, organism, and inoculums.
Indication: Bacterial infectious disease, susceptible infections due to anaerobic organisms, staphylococci, streptococci, pneumococci, Infection of skin and/or subcutaneous tissue, Infectious disease of abdomen, Lower respiratory tract infection, Pelvic inflammatory disease, Septicemia, Osteomyelitis, Diabetic foot infection.
Contraindication: Hypersensitivity
Black Box: Colitis
Preg Cat: N/A
Counsel Pts: {Finish course, 2-3 d improve, take with full glass of water, remain 30 mins upright to reduce GI ulceration risk, if worse talk to doc}
Complete full course of therapy. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP. Take with full glass of water. Remain upright for 30 min after dose to minimize risk of GI ulceration.
Clopidogrel Bisulfate
Brand: Plavix
Class: Platelet Aggregation Inhibitor
MOA: {permanently stops platelet aggregation, till new ones are formed.}
An antiplatelet agent that prevents platelet aggregation by direct inhibition of ADP binding to receptor sites, inhibiting subsequent activation of the glycoprotein IIb/IIIa complex. This action is irreversible; therefore, platelets exposed to clopidogrel are inhibited for their lifespans.
Indication: Acute ST segment elevation MI managed medically (without PCI), non–ST segment elevation MI, Thrombosis prevention
Contraindication: Hypersensitivity and active bleeding.
Black Box: Reduced CYP2C19 function
Preg Cat: B
Counsel Pts: {Don’t stop without talking to doc (abrupt stop = re-thrombosis), report bleeding}
Report signs/symptoms of bleeding, especially if used concomitantly with anticoagulant therapy. Do not stop therapy abruptly without first talking with prescriber to minimize the risk of re-thrombosis, particularly after stent placement.
Doxycycline
Brand: Vibramycin
Class: Tetracycline Antibiotic
MOA: {Broad-spectrum antibiotic that blocks bacteria 30s ribosomal subunit, hits everything if not resisted to.}
Broad-spectrum bacteriostatic compound that inhibits protein synthesis at the 30S ribosomal subunit. Activity includes gram-positive, gram-negative, aerobic, and anaerobic bacteria, as well as spirochetes, mycoplasmas, rickettsiae, chlamydiae, and some protozoa. Many bacteria have developed plasmid-mediated resistance
Indication: Acinetobacter infection, Acne vulgaris, Gonorrhea, Staphylococcal infection of skin, community-acquired pneumonia.
Contraindication: Hypersensitivity to doxycycline or concurrent retinoic acid derivatives
Black Box: N/A
Preg Cat: Contraindicated in 2nd/3rd trimester
Counsel Pts: {Finish course, non calcium food, 2-3 d improve, wear sunscreen, glass of water, stop if erythema (reddening of skin)}
May take with food that does not contain calcium. Complete full course of therapy. Symptoms should improve within 2-3 d. May cause photosensitivity; discontinue at first sign of skin erythema. Wear sunscreen and avoid prolonged exposure to sunlight and ultraviolet light. Administer with 240 mL of water.
Fluconazole
Brand: Diflucan
Class: Imidazole Antifungal
MOA: {Stops ergosterol (fungal cell wall) synthesis}
Inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability.
Indication: Candidal vulvovaginitis, Candidiasis, Cryptococcal meningitis,
Contraindication: Hypersensitivity, concurrent ergot alkaloids, CYP3A4/5 substrates that prolong QTc (heart beat).
Black Box: N/A
Preg Cat: C
Counsel Pts: {Don’t take new meds without talking to doc, take on same day each week}
Many medications, including OTC medications, interact with fluconazole. Do not take any new medications without consulting your doctor or pharmacist. If taking a weekly dose, take on same day and time each week.
Isosorbide Mononitrate
Brand: Imdur
Class: Long-Acting Nitrate, Antianginal
MOA: {Converted to NO which activates Guanylate Cyclase which increases cGMP which decreases intracellular Ca2+ to relax vascular smooth muscle).
Active 5-mononitrate metabolite of isosorbide dinitrate. Nitroglycerin and other organic nitrates are converted to NO by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle
Indication: Angina
Contraindication: Hypersensitivity to nitrates, concurrent use with PDEIs, concurrent use with riociguat
Black Box: N/A
Preg Cat: C
Counsel Pts: {Take on empty stomach with 1/2 glass of water, swallow ER tablet whole, headaches are a sign it’s working, use acetaminophen to relieve head ache, talk to doc if severe, can cause dizziness, avoid heavy machinery, stand up slowly, don’t stop abruptly, avoid concomitant use of PDEI’s (viagra/cialis) (hypotension risk), no alcohol, Immediate release should be spaced 7h apart.}
take this medicine on an empty stomach with at least half a glass of water. Swallow the extended-release tablet whole. Do not break, crush, or chew it. This medicine can cause headaches, which is a sign that the medicine is working. Acetaminophen may be used to relieve the headache. Talk with your doctor if the headache is severe. This medicine can cause dizziness. Avoid driving, using machines, or doing anything else that could be dangerous if not alert. Stand up slowly if this medicine causes light-headedness from orthostatic hypotension. Do not stop using this medicine suddenly without asking a health-care provider. The dose may need to be slowly decreased before stopping it completely. Avoid concomitant use of PDEIs (viagra/cialis) as this may increase risk of severe hypotension. Avoid drinking alcohol while taking this drug. Scored tablets may be split. Doses of immediate release formulation should be taken at least 7 h apart.
Ketoconazole (Topical)
Brand: Nizoral
Class: Imidazole Antifungal
MOA: {Stops ergosterol synthesis (fungal cell wall)}
Inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability.
Indication: Candidiasis of skin, Dandruff, Pityriasis versicolor (colored yeast overgrowth), Seborrheic dermatitis (stubborn dandruff), Tinea corporis/cruris/pedis
Contraindication: Hypersensitivity
Black Box: N/A
Preg Cat: N/A
Counsel Pts: {Apply a thin layer to affected area, No contact with eyes, nose, mouth, vagina. Don’t wash for at least 3 hours after application, cosmetics at least 20 minutes, flammable}
Apply thin layer to affected area of skin. Skin should be intact. Do not get it in your eyes, nose, mouth, or vagina. Do not wash the areas where you applied this medicine for at least 3 h after application. Cosmetics (makeup or sunscreens) may be put on the affected areas 20 min after application. Topical products are alcohol based and flammable immediately after application.
