anti-infectives

Question 1

sulfonamides (action, use, adverse reactions, interactions, administration)

Answer 1

ACTION: They slow or retard the multiplication of bacteria (bacteriostatic)
USE: Often used to control urinary tract infections caused by certain bacteria (ex. E. coli)
ADVERSE REACTIONS: Hematologic changes (Agranulocytosis—decrease in granulocytes, a type of white blood cell, Thrombocytopenia—decrease in platelets, Aplastic anemia—anemia due to deficient red
blood cell production in the bone marrow, Leukopenia—decrease in the number of white
blood cells), allergic reactions (Stevens-Johnson syndrome)
INTERACTIONS: Administered with… oral anticoagulant—the action of the anticoagulant may be enhanced, methotrexate—risk of bone marrow suppression, hydantoin—the serum hydantoin level may be increased
ADMINISTRATION: Take with water and no food (except sulfasalazine, taken w/ food)

Question 2

Penicillins (action, use, adverse reactions, interactions, administration)

Answer 2

ACTION: Prevents bacteria from using a substance that is necessary for the maintenance of the bacteria’s outer cell wall. Penicillins can be bactericidal (destroy bacteria) or bacteriostatic.
USE: treat bacterial infections due to susceptible microorganisms, can be used as a prophylaxis (prevention) against potential secondary bacterial infections that may occur in a patient with a viral infection
ADVERSE REACTION: Mild reactions (nausea, vomit, fever, etc.), allergic reactions, superinfections (secondary infection occurring during antibiotic treatment), hematopoietic changes
INTERACTIONS: Interferes w/ the effectiveness of birth control, decreased effectiveness of penicillin when it is administered w/ tetracyclines, large doses of penicillin increase bleeding risks of patients taking anticoagulant agents, oral penicillins administered w/ beta-adrenergic blocking drugs may be at increased risk for an anaphylactic reaction
ADMINISTRATION: Don’t give w/ food, wait 1 to 2 hours (exceptions: bacampicillin, penicillin V, amoxicillin)

Question 3

Cephalosporins (action, use, adverse reactions, interactions, administration)

Answer 3

ACTION: Usually bactericidal, defect cell walls to make them unstable (3 generations of Cephalosporins, progression from 1st - 3rd: more effective against gram-negative bacteria, less effective against gram-positive), similar to the action of Penicillin
USE: Treats infections caused by susceptible microorganisms, may be used preoperatively (around the time of surgery) to prevent infections from surgeries on a contaminated or potentially contaminated area (ex. GI tract, vagina)
ADVERSE REACTIONS: Most common are gastrointestinal disturbances (ex. nausea, vomiting, diarrhea), severe (Stevens-Johnsons syndrome) to mild allergic reactions, hepatic & renal dysfunction, aplastic anemia, epidermal necrolysis
a patient allergic to Penicillin is also most likely allergic to Cephalosporin
INTERACTIONS: Risk of nephrotoxicity increases when administered w/ the aminoglycosides, risk of bleeding increases when taken w/ oral anticoagulants, disulfiram-like reaction when taken within 72 hours of alcohol consumption, severe reactions like arrhythmias and unconsciousness
ADMINISTRATION: Taken w/ food when given orally (exception: Cefdinir, disregard to food), IV, IM

Question 4

Tetracyclines (action, use, adverse reactions, interactions, administration)

Answer 4

ACTION: Inhibits bacterial protein synthesis, which is a process necessary for their reproduction, the effect is that bacteria are either destroyed or the multiplication rate is slowed. Tetracyclines are bacteriostatic
USE: Treats infections caused by a wide range of gram-negative and gram-positive microorganisms (susceptible microorganisms).
Tetracyclines are used in infections caused by Rickettsiae (Rocky Mountain spotted fever, typhus fever, and tick fever) and in situations where penicillin is contraindicated
ADVERSE REACTIONS: GI reactions (ex. nausea, vomiting, diarrhea, etc.), Skin rashes, photosensitivity reaction, not given to children under 9 as it results in permanent yellow-gray-brown discoloration of the teeth, long term use may result in bacterial overgrowth
INTERACTION: Antacids containing aluminum, zinc, magnesium, bismuth salts, and foods high in calcium impair absorption of tetracyclines, may increase the effects of anticoagulants when taken w/ them, less effective on women when given orally (don’t give to pregnant), reduce insulin requirements (monitor blood glucose levels carefully)
ADMINISTRATION: Empty stomach, no dairy (exception: doxycycline & minocycline), clindamycin w/ food, troleandomycin & clarithromycin without regard to meals

Question 5

Macrolides (action, use, adverse reactions, interactions, administration)

Answer 5

ACTION: Effective against a wide range of pathogenic bacteria, particularly infections in the respiratory and genital tract, bacteriostatic or bactericidal –> bind to cell membrane & cause changes to protein functions
USE: effective against many gram-positive and gram-negative microorganisms, acne vulgaris & skin infections, use with sulfonamides to treat upper respiratory infections caused by Hemophilus influenza, prophylaxis when patients are allergic to penicillin
ADVERSE REACTIONS: GI reactions (nausea, vomiting, diarrhea, abdominal pain), allergic reactions, and mild to life-threatening pseudomembranous colitis (this risk comes with all anti-infectives)
INTERACTIONS: Increases serum levels of digoxin
& the effects of anticoagulants, antacids decrease absorption of macrolides, shouldn’t be administered with clindamycin, lincomycin, or chloramphenicol (decrease in the therapeutic activity of macrolides), concurrent administration of the macrolides w/ theophylline may increase serum theophylline levels.
ADMINISTRATION:
Clarithromycin: w/ no regard to meals, may be taken w/ milk
Azithromycin: tablet given w/ no regard to meals, suspension is not given with meals (1 hour before, 2 hours after)
Dirithromycin: w/ food or within 1 hour of eating
Erythromycin: empty stomach (similar to Azithromycin suspension) with 180mL-240mL of water

Question 6

Lincosamides (action, use, adverse reactions, interactions, administration)

Answer 6

ACTION: Act by inhibiting protein synthesis in
susceptible bacteria, causing death.
USE: Infections caused by gram-negative and gram-positive microorganisms, high toxicity potential-used only for the treatment of serious infections (used in conjunction w/ other antibiotics) where penicillin or erythromycin (a macrolide) is not effective
ADVERSE REACTION: Abdominal pain, esophagitis, nausea, vomiting, diarrhea, skin rash, blood dyscrasias, and mild to life-threatening pseudomembranous colitis
INTERACTIONS: Decreased absorption of lincosamides when administered w/ kaolin or aluminum, administration with neuromuscular blocking drugs enhances their actions (can lead to severe and profound respiratory depression)
ADMINISTRATION: Food impairs the absorption of lincomycin, patients should take nothing by mouth (except water) for 1 to 2 hours before and after (exception: Clindamycin)

Question 7

Fluoroquinolones (action, use, adverse reactions, interactions, administration)

Answer 7

ACTION: Bactericidal, interferes with DNA
gyrase (enzyme) which is needed by bacteria for DNA synthesis
USE: Treatment against gram-positive & gram-negative organisms
Primary: lower respiratory infections, infections of the skin, urinary tract infections, and sexually transmitted diseases
Other: administered ophthalmic forms for eye infections
ADVERSE REACTIONS: Fungal superinfections, pseudomembranous colitis, allergic reactions, photosensitivity reaction, regular mild adverse reactions (nausea, dizziness, etc.)
INTERACTIONS: Use of fluoroquinolones w/ theophylline increases serum theophylline levels, administered w/ cimetidine may interfere with the elimination of the fluoroquinolones, use of fluoroquinolones with an oral anticoagulant may increase the effects of the oral coagulant, administration w/ antacids, iron salts, or zinc will decrease the absorption of the fluoroquinolones, there is a risk of seizures if fluoroquinolones are given with the NSAIDs, risk of severe cardiac arrhythmias when the fluoroquinolones gemifloxacin & moxifloxacin are administered w/ drugs that increase the QT interval
ADMINISTRATION:
Increase fluid intake
Empty Stomach: norfloxacin & enoxacin are given on an empty stomach
No regard to meals: Ciprofloxacin & lomefloxacin (manufacturer recommends drug to be given
2 hours after a meal)
Moxifloxacin is given once a day
IV: ciprofloxacin, gatifloxacin, and ofloxacin
IM: the rest

Question 8

Aminoglycosides (action, use, adverse reactions, interactions, administration)

Answer 8

ACTION: Bactericidal, blocks a step in protein synthesis that is necessary for bacteria multiplication, disrupts the functional ability of cell membrane causing cell death
USE: Infections caused by gram-negative microorganisms, oral aminoglycosides are poorly absorbed so they are helpful in suppressing GI bacteria. Oral aminoglycosides kanamycin & neomycin are used preoperatively to
reduce the number of bacteria present in the intestines. Kanamycin, neomycin, and paromomycin are used orally in the management of hepatic coma (liver failure results in an elevation of blood ammonia levels) to help temporarily reduce symptoms by reducing the number of ammonia-forming bacteria in the intestines (lowers ammonia blood levels)
ADVERSE REACTIONS: Nephrotoxicity, ototoxicity, neurotoxicity (along w/ their numerous symptoms), fungal superinfections, pseudomembranous colitis, allergic reactions, nausea, anorexia, urticaria, rash
INTERACTIONS: Administration w/ cephalosporins increases the risks of nephrotoxicity, administration w/ loop diuretics increases the risk of cytotoxicity (irreversible hearing loss), there is an increased risk of neuromuscular blockage (paralysis of the respiratory muscles) if the aminoglycosides are given shortly after general anesthetics (neuromuscular junction
blockers)
ADMINISTRATION: Oral aminoglycosides can be given without regard to meals, can all be given IM (except paromomycin), can all be given IV (except paromomycin & streptomycin)

Question 9

Chloramphenicol (action, use, adverse reactions, interactions, administration)

Answer 9

ACTION: Interferes/inhibits protein synthesis, necessary for microorganism reproduction, bacteriostatic
USE: Potentially dangerous drug so its use is limited to serious infections (when less dangerous drugs cannot be used)
ADVERSE REACTIONS: Blood dyscrasias, superinfection, allergic reactions, nausea, vomiting,
& headache
INTERACTIONS: Increased effects of oral hypoglycemic drugs, oral anticoagulants, & phenytoin when administered with chloramphenicol. Phenobarbital or rifampin
may decrease chloramphenicol blood levels.
ADMINISTRATION:
Oral: empty stomach, however, if there is GI distress, may eat with food
IV: administered around the clock to maintain therapeutic blood levels of the drug.

Question 10

Linezolid (action, use, adverse reactions, interactions, administration)

Answer 10

ACTION: Bacteriostatic & bacteriocidal, an
oxazolidinone, binds to a site on a specific ribosomal RNA and prevents the formation of a component necessary for the bacteria replication
USE: Treatment of vancomycin-resistant enterococcus (VRE), nosocomial (hospital-acquired), and community-acquired pneumonia, pneumonia, and in the treatment of skin and skin structure infections
ADVERSE REACTIONS:
Common: nausea, vomiting, diarrhea, headache, insomnia.
Other: fatigue, depression, nervousness, photosensitivity
Most serious: Pseudomembranous colitis & thrombocytopenia
INTERACTIONS: Administration w/ antiplatelet drugs increases the risk of bleeding and thrombocytopenia, administration w/ the MAOIs (type of antidepressants) decreases their effect, there is a risk of severe hypertension if linezolid is combined w/ food containing lots of tyramine
ADMINISTRATION:
Oral: everyone 12 hrs, w/ or without food
IV: Infused during a period of 30 to 120 minutes, protect the drug from light, monitor the patient for 2 weeks (blood platelets count)

Question 11

Meropenem (action, use, adverse reactions, interactions, administration)

Answer 11

ACTION: Inhibits synthesis of the bacterial cell wall & causes the death of susceptible cells
USE: intra-abdominal infections, bacterial meningitis
ADVERSE REACTIONS: The common effects, flatulence, rash, superinfections, abscess or
phlebitis at the injection site, tissue sloughing
INTERACTIONS: Administration w/ probenecid inhibits the excretion of meropenem
ADMINISTRATION: IV only, every 8 hrs, given over a span of 15 to 30 min if the drug is diluted, 3 to 5 min as a bolus injection (5 - 20mL)

Question 12

Metronidazole (action, use, adverse reactions, interactions, administration)

Answer 12

ACTION: Not well understood (!), thought to disrupt DNA and protein synthesis in susceptible organisms
USE: Treatment of serious infections caused by anaerobic (able to live without oxygen) microorganisms
ADVERSE REACTIONS: GI tract reactions (nausea, anorexia, diarrhea, vomiting), central nervous system (CNS) reactions (seizures and
numbness of the extremities), allergic reaction, Thrombophlebitis may occur from IV
INTERACTIONS: Metabolism of metronidazole may decrease when administered w/ cimetidine, Effectiveness of metronidazole may
decrease when administered w/ phenobarbital, the effectiveness of warfarin is increased when administered w/ metronidazole
ADMINISTRATION:
Oral: w/ meals, avoid drinking alcoholic beverages for at least 1 day after
IV: powdered form, after reconstitution the solution should be clear to pale yellow to pale green (do not use if it is cloudy/contains particulates), use within 24 hrs

Question 13

Pentamidine Isethionate (action, use, adverse reactions, interactions, administration)

Answer 13

ACTION: not fully understood (!)
USE: Treatment (parenteral form) or prevention (aerosol form) of Pneumocystis carinii pneumonia, seen in those with acquired immunodeficiency syndrome (HIV/AIDS)
ADVERSE REACTIONS: More than half of patients that receive this drug through the parenteral form have side effects; leukopenia, hypoglycemia, thrombocytopenia, hypotension, and other common ones. The aerosol form can lead to fatigue, a metallic taste in the mouth, shortness of breath, and anorexia.
INTERACTIONS: Nephrotoxicity develops when administered w/ nephrotoxic drugs, bone marrow depression occurs when administered w/ antineoplastic drugs or when the patient has received radiation therapy recently
ADMINISTRATION:
IV: infuse drug over 1 hour
Aerosol: use a special nebulizer (Respirgard II) and delivers the drug until the chamber is empty, the patient should be lying down

Question 14

Spectinomycin (action, use, adverse reactions, interactions, administration)

Answer 14

ACTION: Chemically related to but different from aminoglycosides, interferes with bacterial protein synthesis
USE: Treatment of gonorrhea (a sexually transmitted disease)
ADVERSE REACTIONS: Soreness at the injection site, urticaria (hives), dizziness, rash, chills, fever, and allergic reactions
INTERACTIONS: none known (:skull:)
ADMINISTRATION: single or multiple doses, IM, all sexual contact need to receive treatment

Question 15

Vancomycin (action, use, adverse reactions, interactions, administration)

Answer 15

ACTION: against susceptible gram-positive bacteria, inhibits bacterial cell wall synthesis and increases cell wall permeability (allows stuff to pass through)
USE: against susceptible gram-positive microorganisms that do not respond to treatment of other anti-infectives, can be used to treat treating anti-infective–associated pseudomembranous colitis caused by Clostridium difficile
ADVERSE REACTIONS: Nephrotoxicity, ototoxicity, nausea, chills, fever, urticaria, sudden fall in blood
pressure with parenteral administration, and skin rashes
INTERACTIONS: When administered with other ototoxic and nephrotoxic drugs, additive effects may be seen
ADMINISTRATION: orally, intermittent IV infusion, unused portions of reconstituted oral suspensions and parenteral solutions are stable for 14 days when refrigerated after reconstitution.

Question 16

Antitubercular Drugs (action, use, adverse reactions, interactions, administration)

Answer 16

ACTION: Most are bacteriostatic (isoniazid is bactericidal, with rifampin and streptomycin having some bactericidal activity) against the M. tuberculosis bacillus, which inhibits bacterial cell wall synthesis, which slows the multiplication rate of the bacteria
USE: Combine w/ other antitubercular drugs (except isoniazid which is used alone) to treat active tuberculosis. Isoniazid is used w/ other antitubercular drugs to prevent those close in contact w/ the patient from getting tuberculosis
ADVERSE REACTION:
ETHAMBUTOL: Optic neuritis (dose-related), dermatitis, pruritus, anaphylactoid reactions, joint pain, anorexia, nausea, and vomiting, reddish-orange discoloration of body fluids
ISONIAZID: Allergic reactions, jaundice, hematologic changes, fever, skin eruptions, nausea,
vomiting, epigastric distress, hepatitis, Peripheral neuropathy is the most common symptom
of toxicity.
PYRAZINAMIDE: Hepatotoxicity + its symptoms
RIFAMPIN: Nausea, vomiting, epigastric distress, heartburn, fatigue, dizziness, rash, hematologic changes, renal insufficiency, a reddish-orange discoloration of body fluids
STREPTOMYCIN: Nephrotoxicity, ototoxicity, numbness, tingling, tinnitus, nausea, vomiting, vertigo, circumoral paresthesia, soreness at the injection site
INTERACTIONS:
ETHAMBUTOL: none stated
ISONIAZID: Alcohol may lead to drug-related hepatitis, aluminum salts may reduce the oral
absorption of isoniazid, anticoagulants may be enhanced when taken w/ isoniazid, increased serum levels of phenytoin when used w/ isoniazid, an exaggerated sympathetic-type response can occur when administered w/ foods containing tyramine
PYRAZINAMIDE: Pyrazinamide decreases the effects of allopurinol, colchicines, and probenecid
RIFAMPIN: Isoniazid & rifampin administered concurrently causes a higher risk of hepatotoxicity than when either drug is used alone, use w/ oral anticoagulants or oral hypoglycemics may decrease the effects of the anticoagulant or hypoglycemic drug, decrease in the effect of the oral contraceptives, chloramphenicol, phenytoin, and verapamil when used w/ rifampin
STREPTOMYCIN: Administration w/ ethacrynic acid, furosemide, and mannitol increases the ototoxic adverse reactions.
ADMINISTRATION:
ETHAMBUTOL: Once every 24 hours (same time each day), w/ food
ISONIAZID: Empty stomach, may take with food if GI upset, no/less alcohol, can prescribe 6 to 50 mg pyridoxine (to prevent vitamin B) daily
PYRAZINAMIDE: Once daily w/ food, an alternative is to give twice per week for outpatients, DOT (for outpatients)
RIFAMPINL: Once daily on an empty stomach
STREPTOMYCIN: Administered daily w/ IM injection, the preferred site is the upper outer quadrant of the buttock or the mid-lateral thigh, deltoid can also be used if it is developed, drug dosage is reduced in those over 60 years of age (avoid toxicity)

Question 17

Leprostatic Drugs (action, use, adverse reactions, interactions, administration)

Answer 17

ACTION:
CLOFAZIMINE: Primarily bactericidal against Mycobacterium leprae, exact action is unknown
DAPSONE: Bactericidal and bacteriostatic against the same bacteria
USE:
CLOFAZIMINE: To treat leprosy
DAPSONE: Main used to treat leprosy, can also be used to help treat dermatitis herpetiformis ( a chronic, inflammatory skin disease)
ADVERSE REACTIONS:
CLOFAZIMINE: Pigmentation of skin, abdominal pain, diarrhea, nausea, & vomiting.
DAPSONE: Hemolysis (destruction of red blood cells), nausea, vomiting, anorexia, & blurred vision
INTERACTIONS:
CLOFAZIMINE: None that are significant
DAPSONE: None that are significant
ADMINISTRATION: Outpatient basis, may require many years, given orally w/ food

Question 18

Antiviral Drugs (action, use, adverse reactions, interactions, administration)

Answer 18

ACTION: Viruses can only reproduce within a living cell, they consist of DNA or RNA surrounded by a protein shell and are only capable of reproducing using the body’s cellular material. Most antiviral drugs inhibit viral DNA or RNA reproduction in the virus, causing virus death
USE: Effective only against a small number of specific viral infections (HSV, HIV, CMV, Genital herpes, Influenza A, RSV, Viral herpes infections), unofficial uses
ADVERSE REACTIONS: Giving systemically can result in GI disturbances, such as nausea, vomiting, diarrhea, and anorexia. Giving topically can result in transient burning, stinging, and pruritus at the application site.
ACYCLOVIR: Giving IV can cause phlebitis, lethargy, confusion, tremors, skin rashes, nausea, and crystalluria. Giving orally can cause nausea, vomiting, diarrhea, headache, dizziness,
and skin rashes. Giving topically can cause transient burning, stinging, and pruritus.
AMANTADINE: Nausea, vomiting, anorexia, asthenia, constipation, depression, visual disturbances, psychosis, urinary retention, and
orthostatic hypotension.
DIDANOSINE: Headache, peripheral neuropathy, rhinitis, cough, diarrhea, nausea, vomiting, anorexia, hepatotoxicity, and pancreatitis
RIBAVIRIN: Worsening of respiratory status, hypotension, ocular irritation (erythema, conjunctivitis, and blurred vision).
ZANAMIVIR: Common ones are headache, nausea, diarrhea, anorexia, rhinitis, and flu-like symptoms. Severe ones are respiratory effects and include severe bronchospasm that may lead to death.
ZIDOVUDINE: Headache, weakness, malaise, nausea, abdominal pain, diarrhea, hematologic changes including anemia and granulocytopenia.
INTERACTIONS:
ACYCLOVIR: Extreme w/ zidovudine, increased risk of nephrotoxicity w/ nephrotoxic drugs & amphotericin B, decrease in the renal excretion of acyclovir w/ probenecid (prolonging the effects of acyclovir and increasing the risk of drug toxicity).
AMANTADINE: Concurrent use of antihistamines, phenothiazines, tricyclic antidepressants, disopyramide, and quinidine may increase the anticholinergic effects (dry mouth, blurred vision, constipation) of amantadine.
DIDANOSINE: Decrease in the effectiveness of
dapsone in preventing Pneumocystis carinii pneumonia when didanosine is administered w/ it. Use w/ zalcitabine may cause additive neuropathy
RIBAVIRIN: Antagonize the effects & potentiate the hematologic toxic effects of zidovudine. Risk of digitalis toxicity increases when administered w/ it.
ZANAMIVIR: None that are significant
ZIDOVUDINE: Increased risk of bone marrow depression when administered w/ antineoplastic drugs, other drugs causing bone marrow depression, and in patients having/recently taken radiation therapy. Additive neurotoxicity may occur when administered w/ acyclovir. Clarithromycin decreases blood levels of zidovudine and lamivudine increases blood levels of zidovudine.
ADMINISTRATION:
ACYCLOVIR: Orally without regard to food (w/ food if GI disturbance occurs), nurses should use finger cot or glove when administrating topically (prevent the spread of infection), IV
AMANTADINE: Protect the capsules from moisture to prevent deterioration. When prescribed for influenza A, the drug should be given 24 to 48 hrs after symptoms begin.
DIDANOSINE: Empty stomach for patients w/ HIV or those that have experienced a decreased therapeutic effect w/ zidovudine, tablets are not swallowed whole (chew or crush w/ 1 oz of water), mix buffered powder w/ 4 oz of water and stir until dissolved and drink immediately
RIBAVIRIN: Inhalation
using a small particle aerosol generator, discard and replace the solution every 24 hours, treatment lasts for at least 3 days, but not more than 7, for 12 to 18 h/d.
ZANAMIVIR: Powder blister
for inhalation, the usual dose is 2 inhalations (one 5-mg blister per inhalation) administered w/ a
Diskhaler device started within
2 days’ onset of flu symptoms, taken every 12 hours
ZIDOVUDINE: Capsules and syrup should be protected from light.

Question 19

Antifungal Drugs (action, use, adverse reactions, interactions, administration)

Answer 19

ACTION: Fungicidal or fungistatic.
Amphotericin B (most effective to treat systemic fungal infections), miconazole, nystatin, and ketoconazole are thought to have an effect on the cell membrane of the fungus, resulting in a fungicidal or
fungistatic effect.
Fluconazole is fungistatic through the depletion of sterols (a group of substances related to fats) in the fungus cells.
Griseofulvin is deposited in keratin precursor cells, which are then
gradually lost (due to the constant shedding of top skin cells), and replaced by new, noninfected cells.
Flucytosine is not clearly understood.
Clotrimazole binds with phospholipids in the fungal cell membrane, increasing the permeability of the cell and resulting in the loss of intracellular components.
USES: Treat superficial and deep fungal infections
ADVERSE REACTIONS:
AMPHOTERICIN B: Fever, shaking, chills, headache, malaise,
anorexia, joint, muscle pain, abnormal renal function, nausea, vomiting, and anemia
FLUCONAZOLE: Nausea, vomiting,
headache, diarrhea, abdominal pain, skin rash, abnormal liver functions
FLUCYTOSINE: Nausea, vomiting, diarrhea, rash, anemia, leukopenia, thrombocytopenia, renal impairment (elevated blood urea nitrogen (BUN), serum creatinine levels)
GRISEOFULVIN: Symptoms that are similar to allergic reactions (rash, urticaria), nausea, vomiting, oral thrush, diarrhea, headache
ITRACONAZOLE: Common ones are nausea, vomiting, and diarrhea. Severe hypokalemia may occur in patients receiving 600 mg or more daily. Hepatotoxicity is a
possibility with itraconazole administration.
KETOCONAZOLE: Nausea, vomiting, headache, dizziness, abdominal pain, pruritus
may be seen (most are mild and transient), hepatic toxicity
MICONAZOLE: Irritation, Aensitization, vulvovaginal burning. Skin irritation may result in redness, itching, burning, or skin fissures. Other reactions with miconazole include cramping, nausea, and headache
INTERACTIONS:
AMPHOTERICIN B: Severe
hypokalemia may occur w/ corticosteroids, increased
risk of digitalis toxicity w/ digoxin, increased risk of nephrotoxicity w/
nephrotoxic drugs, decreases the
effects of miconazole.
FLUCONAZOLE: Increased effect of the oral hypoglycemic when administered w/ them, decrease the metabolism of phenytoin
and warfarin.
FLUCYTOSINE: Risk of flucytosine toxicity increases w/ amphotericin B.
GRISEOFULVIN: Anticoagulant effect may be decreased w/ warfarin, the effect of griseofulvin may be decreased w/ barbiturates, decrease in the effects of oral contraceptives may occur with griseofulvin therapy, causing breakthrough bleeding, pregnancy, or amenorrhea. Blood salicylate concentrations may be decreased when administered w/ griseofulvin.
ITRACONAZOLE: Elevates blood concentrations of digoxin and cyclosporine, phenytoin decreases blood levels of itraconazole and alters the metabolism of phenytoin. Histamine antagonists, isoniazid, and rifampin decrease plasma levels of itraconazole. Increased anticoagulant effect w/ warfarin
KETOCONAZOLE: Absorption of the drug is impaired when taken w/ histamine antagonists and antacids, enhances the anticoagulant effect of
warfarin and causes an additive hepatotoxicity w/ other hepatotoxic drugs and alcohol, may decrease the blood levels of ketoconazole w/ rifampin or isoniazid
MICONAZOLE: None stated
ADMINISTRATION:
AMPHOTERICIN B: Daily or every other day for several months, sterile water is used for reconstitution, IV infusion immediately after reconstitution for 6+ hrs, protected from light, patients swish drug in the mouth for several minutes & swallow for oral administration, an oral solution may be used for 2 weeks.
FLUCONAZOLE: Oral or IV, initial dose is 200 - 400 mg, followed by 100 - 200 mg per day for 14+ days. When given as a continuous infusion, the drug is infused at a maximum rate of 200 mg per hour. Do not remove IV overwrap until ready to use
FLUCYTOSINE: Orally, 2 to 6 capsules/dose, taken a few at a time during a 15-minute period (avoid nausea + vomit)
GRISEOFULVIN: Orally as a single dose or in 2 - 4 divided doses, prolonged therapy to completely remove infection
ITRACONAZOLE: Oral w/ food, Iv infusion over 60 min, doses greater than 200 mg are given in 2 divided dosages
KETOCONAZOLE: W/ food, tablets may be crushed, absorbed best in an acid environment, do not administer antacids, anticholinergics, or histamine blockers until at least 2 hours after ketoconazole is given.
MICONAZOLE: Self-administered on an outpatient basis

Question 20

Anthelmintic Drugs (action, use, adverse reactions, interactions, administration)

Answer 20

ACTION:
ALBENDAZOLE: Interferes with the synthesis of the parasite’s microtubules, resulting in the death of susceptible larva.
MEBENDAZOLE: Blocks the uptake of glucose by the helminth, resulting in a depletion of the helminth’s own glycogen, which results in a decreased
formation of adenosine triphosphate (helminth needs for reproduction and survival).
PYRANTEL: Paralyzes the helminth, causes it to release its grip on the intestinal wall, it is then excreted in the feces.
THIABENDAZOLE: Appears to suppress egg/larval production, therefore may interrupt the life cycle of the helminth
USE: Treat helminthiasis
ALBENDAZOLE: Treat larval forms of pork tapeworm and liver, lung, and peritoneum disease caused by the dog tapeworm.
MEBENDAZOLE: Treat whipworm, pinworm, roundworm, American hookworm, & the common hookworm.
PYRANTEL: Treat roundworms and pinworms
THIABENDAZOLE: Threadworms
ADVERSE REACTIONS:
ALBENDAZOLE: Doesn’t say
MEBENDAZOLE: Transient abdominal pain and diarrhea.
PYRANTEL: GI side effects (nausea, vomiting, abdominal cramps, or diarrhea).
THIABENDAZOLE: Allergic reactions, drowsiness, and dizziness.
INTERACTIONS:
ALBENDAZOLE: Effects increased w/ dexamethasone and cimetidine.
MEBENDAZOLE: Reduced plasma levels w/ the hydantoins and carbamazepine.
PYRANTEL: Pyrantel & piperazine are antagonists and should not be given together.
THIABENDAZOLE: Plasma level of the xanthine may increase to toxic levels w/ Xanthine derivatives.
ADMINISTRATION:
ALBENDAZOLE: Tablets, twice a day with meals for 8 to 30 days
MEBENDAZOLE: Chew, swallow whole, or mix the tablets w/ food. Take w/ foods high in fat to increase absorption.
PYRANTEL: Anytime without regard to meal or time of day, may take the drug w/ milk or fruit juices.
THIABENDAZOLE: Take w/ food to minimize GI upset/distress

Question 21

Antimalarial Drugs (action, use, adverse reactions, interactions, administration)

Answer 21

ACTION: Interferes w/ the life cycle of the plasmodium, primarily
when it is present in the red blood cells. Destruction at this stage prevents the development of the male and female forms of the plasmodium which keeps the mosquito (when the mosquito bites an infected individual) from ingesting male and female forms of the plasmodium, thus effectively ending the plasmodium life cycle.
USES:
1. Suppression—the prevention of malaria
2. Treatment—the management of a malarial attack
CHLOROQUINE: Also used to treat
extraintestinal amebiasis
DOXYCYCLINE: Also used to treat bacterial infections when penicillin is contradicted
QUININE: Also may be used for the
prevention/treatment of nocturnal leg cramps.
ADVERSE REACTIONS:
CHLOROQUINE: hypotension, electrocardiographic changes, visual disturbances, headache, nausea, vomiting, anorexia, diarrhea, abdominal cramps.
DOXYCYCLINE: Is a tetracycline, adverse reactions include photosensitivity, anorexia, nausea, and vomiting.
QUININE: Cinchonism (symptoms include quinine, including tinnitus, dizziness, headache, GI disturbances, visual disturbances) at full therapeutic doses, usually disappears when the dosage is reduced. Other adverse reactions include hematologic changes, vertigo, and skin rash.
INTERACTIONS:
CHLOROQUINE: Increased risk of hepatotoxicity w/ other hepatotoxic drugs.
DOXYCYCLINE: Decreased absorption w/ antacids or iron, decrease in the therapeutic effects w/ barbiturates, phenytoins, and carbamazepine. Increased
risk of digoxin toxicity w/ digoxin.
QUININE: Absorption is delayed w/ antacids containing aluminum, plasma digitalis levels may increase w/ digitalis preparations, plasma levels of warfarin are
increased when administered w/ quinine.
ADMINISTRATION:
CHLOROQUINE: (for suppression) begins 2 weeks before exposure and continues for 6 - 8 weeks after the client leaves the area where
malaria is prevalent. Prental injection is avoided (IV, IM), must change to oral route, eat w/ food or milk and avoid foods that acidify the urine
QUININE: Initial treatment is parental, well diluted and
administered slowly for IV, w/ food or immediately after a meal, do not chew or open tablet/capsule

Question 22

Amebicides Drugs (action, use, adverse reactions, interactions, administration)

Answer 22

ACTIONS: Amebicidal (kill amebas)
USES: Kill both intestinal (in intestine) and extraintestinal (outside of intestine, liver) amebas
CHLOROQUINE: Treat extraintestinal amebiasis when oral therapy is not feasible
IODOQUINOL: Treat intestinal amebiasis
METRONIDAZOLE: Treat intestinal amebiasis, infections caused by susceptible microorganisms (previous flash card)
PAROMOMYCIN: Aminoglycoside w/ amebicidal activity and is used
to treat intestinal amebiasis
ADVERSE REACTIONS:
CHLOROQUINE: Hypotension, electrocardiographic changes, headache, nausea, vomiting, anorexia, diarrhea, abdominal cramps, psychic stimulation
IODOQUINOL: Various types of skin eruptions, nausea, vomiting, fever, chills, abdominal cramps, vertigo, and diarrhea
METRONIDAZOLE: Convulsive seizures, headache, nausea, and peripheral neuropathy
PAROMOMYCIN: Nausea, vomiting, diarrhea, nephrotoxicity, and ototoxicity
INTERACTIONS:
CHLOROQUINE: Increased risk of hepatotoxicity w/ other hepatotoxic drugs.
IODOQUINOL: May interfere with the results of thyroid function tests.
METRONIDAZOLE: Metabolism of metronidazole is decreased w/ cimetidine, metabolism is increased w/ phenobarbital and possibly causing a decrease in the
effectiveness of metronidazole. Increases the effects of warfarin.
PAROMOMYCIN: High doses and prolonged therapy causes the drug to be absorbed in large amounts by patients with bowel disease, causing ototoxicity and renal impairment.
ADMINISTRATION:
CHLOROQUINE: (for suppression) begins 2 weeks before exposure and continues for 6 - 8 weeks after the client leaves the area where
malaria is prevalent. Prental injection is avoided (IV, IM), must change to the oral route, eat w/ food or milk and avoid foods that acidify the urine
IODOQUINOL: 210 mg & 650 mg tablets, usual dose is 650 mg three times a day for 20 days, after a meal.
METRONIDAZOLE: w/ food, no alcohol until treatment is done
PAROMOMYCIN: 3 times a day w. meals