pharm antibiotics and antifungals

  1. Ampotericin B
    • 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
  2. Superficial infections
    • 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)
  3. Dalfopristin/Quinupristin (synercid)
    Treats VRE MRSA
  4. Daptomycin (Cubicin)
    • used for antibiotic resistant bacteria
    • ADRS: contipation, nausea, HA, myopathy( monitor CK, be careful w/statin)
  5. Linezolid (Zyvox)
    • for antibiotic resistant bacteria only
    • is a weak MAOI-avoid tryamine containing foods, and watch for Seratonin Syndrome
  6. Vancomycin
    • 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)
  7. Flagyl
    • 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
  8. Clindamycin (cleocin)
    • 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)
  9. Fluoroquinolones
    • 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)
  10. Sulfonamides:
    • 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
  11. Aminoglycosides
    • 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
  12. Macrolides
    • 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,
  13. Tetracycline
    • 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)
  14. Carbapenem
    • 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)
  15. Cephalosporins
    • 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
  16. Ticarcillin, Timetin, Piperacillin, Zosyn
    • Monitor NA
    • careful in HF and HTN
  17. Ampicillin, Amoxicillin, Augmentin
    • Causes Diarrhea-take with food
    • Dicloxacillin (Dynapen), Nafcillin, Oxacillin
    • MRSA resistant to these
    • take Dicloxacillin on an empty stomach
  18. Penicillin Benzarhine, Penicillin Procaine
    • Long acting, 2-3wks
    • Suspension- released over time= give IM
  19. Penicillin GK, Penicillin G Sodium
    • Give IV
    • Monitor K, and Na
    • Careful in pt with HF and HTN
  20. Penicillin VK
  21. Azoles

    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, 
  22. Griseofulvin
    for fungal infections of hair, nails, or skin

    ADR: transient HA

    Contraindicated in liver disease

    Absorbed well w/ high fatty meal
  23. Nystatin
    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
  24. Terbinafine (Lamisil)
    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)
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pharm antibiotics and antifungals