pharm antibiotics and antifungals

• used for very serious systemic fungal infections
• "Ampho-the-terrible"- causes high incidence of renal failure
• ADRs: renal toxicity- almost all pt get (monitor Scr, BUN, I & O, stay hydrated), hypokalemia (monitor K, look for cramps, weakness, palpiations, can premedicate w/K), Infusion Reaction-fever, HA, chills, rigors (can premedicate w/ tylenol and benedryl)
• *administer 1 mg test dose to see if they can tolerate and check for allergy
• Infuse over 2-4 hours
• try to avoid hyrocortisol

• tinea pedis- athletes foot
• tinea corporis- ring worm
• tinea capitis- ring worm of scalp
• vulvovaginal candidiasis- vaginal yeast infection
• onychomycosis- nails (no real threat just cosmestic reasons to cure)

Treats VRE MRSA

• used for antibiotic resistant bacteria
• ADRS: contipation, nausea, HA, myopathy( monitor CK, be careful w/statin)

• for antibiotic resistant bacteria only
• is a weak MAOI-avoid tryamine containing foods, and watch for Seratonin Syndrome

• used for serious infections such as C-diff
• Give IV unless c-diff (oral)
• ADRs: ototoxicity(rare), *"red-man" syndrome(infusion too fast-slow over 60 minutes)

• antibiotic and anti-protozoans or parasites
• ADRS: metallic taste, *disulfram reaction if taken w/ alcohol= NV, dizzy, increase HR, SOB (given to acoholics to keep them from drinking), Liver toxicity

• alteranative to PCN for certain serious infections
• ADRS: Anibiotic-associated psuedomembranous colitis (c-diff)= watery diarrhea w/blood and mucous
• (D/C med and give flagyl or vancomycin)

• end in "floxacin"
• ADRS: NVD, CNS-dizzy, confused, HA, seizures (decrease dose in elderly), photosensitivity(hat, sunscreen), tendon rupture/damage to growing cartilage (*dont give to kids<18), liver abnormalities, black box warning
• Interactions: warfarin(increase INR=bleeding), Fe, milk/dairy, antacids (give at different time)

• begins with sulf (ex include bactrim + septra-UTIS)
• ADRS: rash(stop-stephen johnsons syndrome), blood abnormalties(CBC), Hemolytic anemia (CBC), photosensitivity (sunscreen, hats, etc), Kernicterus (dont give to kids <2 mo-is a build up of bilirubin), crystals in urine-renal damage(drink alot of water)
• Interactions: warfarin (increases INR-bleeding, Dilantin, oral hypoglycemic

• end in "cin"
• Give for serious infections (sepsis)
• narrow TI range **monitor peak and trough
• Theraputic level= 4-12, if more serious higher, if less lower
• Cant mix in IV w/PCN
• Interations: Loops ( ototoxicity + renal failure ** if trough >2=toxicity), amphotericin B (renal failure), skeletal muscle relaxants
• ADRS: renal toxicity (check Scr clearance norm=.6-1.2), ototoxicity- cochlear=tinnitus, vestivular=HA

• end in "thromycin"
• dont give with Coumadin (increase INR-bleeding), Tegretol(increase levels), Theo-Dur(increase levels)
• ADRS: GI upset, prolonged QT interval (ventricular dysrhythmia)
• Erythromycin-cheap, many ADRS, 4x a day, many Drug-drug interactions
• Clarithromycin-expensive, some drug-drug, less GI SEs, 2x a day,
• Azithromycin-expensive, fewer drug-drug, 1xa day,

• end in cycline
• dont give to kids under 8 y/o (injure developing bones and teeth), or pregnant pts
• ADRS: photosensitivity (burn easy)(sunscreen, hat, etc.), injur developing bones and teeth (noone under 8 and pregnant), GI/hepatic SEs if long term (monitor LFT), yeast infections (supra-infection b/c broad), decrease effects of BC pills
• Tetracylcine-take on empty stomach
• Doxyxline- take w/ food
• **cant take with any kind of metal (Fe, Al, etc.), Ca foods, antacids (take 1 hr before ingesting these, or 2 hrs after)

• End in Penem
• Very broad! (can cause supra- infections)
• has beta lactam
• ADRS: well tolerated, GI upset, allegry, supra infections,
• **Seizures in renal impairement if dose not adjusted (decreased)

• start with "ceph" or "cef"
• contain beta lactam ring
• cant give to pt. who hv severeallergy to penicllin or Carbapenems
• ADRS: Nausea (give w/food), thrombophlebitis (rotate INJ site), pain at INJ site(ceftriaxone) (mix w/litocaine)
• as generation increases- becomes broader

• Monitor NA
• careful in HF and HTN

• Causes Diarrhea-take with food
• Dicloxacillin (Dynapen), Nafcillin, Oxacillin
• MRSA resistant to these
• take Dicloxacillin on an empty stomach

• Long acting, 2-3wks
• Suspension- released over time= give IM

• Give IV
• Monitor K, and Na
• Careful in pt with HF and HTN

Oral

anti-fungals

systemic and superficial fungal infections

ex: Diflucan (fluconazole)- used primarily for yeast infections, interacts w/warfarin-increase INR

ADRS: nausea, HA, Liver toxicity (monitor LFT, ALT, AST), topical may cause burning, itching, irritation, 

for fungal infections of hair, nails, or skin

ADR: transient HA

Contraindicated in liver disease

Absorbed well w/ high fatty meal

For superficial fungal infection

drug of choice 4 intestional fungal infections-PO

Topical-4 skin, mouth(suspension), esophagus, vagina, etc

ADRS: local irritation from topical use, GI irritation-po

for superficial fungal infections

usually for nail infections but can be for skin also

ADRS w/ oral: HA, D, liver damage (monitor LFT, AST, ALT)