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What are the DDIs for Macrolides?
Erythromycin, clarithromycin = CYP450 inhibitors
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What are the counseling pearls for Macrolides?
- Finish entire prescription
- May take with food to decrease stomach upset
- Potential for drug-drug interactions: antiarrhythmics, cyclosporine, digoxin, theophylline, diltiazem, verapamil
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What are the AE of Fluoroquinolones?
- Nausea, dyspepsia
- Photosensitivity
- Headache, dizziness, insomnia
- Confusion, hallucinations (elderly, renal dysfunction)
- Seizures (rare, dose-related)
- QTc prolongation (dose-related) (Moxifloxacin, levofloxacin > ciprofloxacin)
- Blood glucose fluctuations (hypo/hyperglycemia)
- Arthralgias, Achilles tendon rupture (rare, elderly)
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What are the counseling pearls for Fluoroquinolones?
- Do not take with calcium, iron, zinc, antacids, milk or multivitamins
- Potential for drug-drug interactions: warfarin, theophylline, antiarrhythmics
- Might want to caution any patient on warfarin about antibiotics because of changes in flora effect Vitamin K levels
- May cause increased sensitivity to sunlight
- Contact prescriber if tendon inflammation or pain develops
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What is the spectrum for Tetracyclines?
- Large Range of Effect
- Atypicals – Mycoplasma, Chlamydia, Legionella
- T. pallidum, B. burgdoferi (Lyme disease), H. pylori
- Streptococcus pneumoniae
- CA-MRSA, P. acnes
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What are the common uses for Tetracyclines?
- Community-acquired pneumonia
- Bronchitis, sinusitis
- Skin and soft tissue infections (CA-MRSA)
- H. pylori eradication (tetracycline)
- Chlamydia (doxycycline)
- Tick borne diseases
- Acne
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What are the AE for Tetracyclines?
- Nausea, diarrhea, esophageal irritation
- Photosensitivity
- Tooth discoloration (children) -Avoid in pregnant women and children ≤ 8 years of age
- Dizziness, vertigo (minocycline) – not really a problem with doxycycline
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What are the Counseling pearls for Tetracyclines?
- Do not take with calcium, iron, zinc, antacids, milk or multivitamins
- May cause increased sensitivity to sunlight – do not use tanning equipment
- Take with a full glass of water, remain upright for 30 minutes - To prevent esophageal irritation
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What is the spectrum for Trimethoprim/Sulfamethoxazole?
- MSSA, CA-MRSA
- E. coli, Salmonella, Shigella
- Stenotrophomonas maltophilia
- Pneumocystis jirovecii (PCP)
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What are the common uses for Bactrim?
- PCP prophylaxis and treatment
- Skin and soft tissue infections (CA-MRSA)
- Urinary tract infections - Common
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What are the AE for Trimethoprim/Sulfamethoxazole?
- Allergic or hypersensitivity reactions – More common than other classes - Rash, toxic epidermal necrolysis, Stevens-Johnson syndrome
- Photosensitivity
- Bone marrow suppression (high doses) – tends to take a long time for this to develop
- Crystalluria, hyperkalemia
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