Drugs Need to Know: Anti-Infective/Antibiotic/Antiprotozoal Flashcards
(172 cards)
1
Q
trimethoprim/sulfamethoxazole trade name(s)
A
Bactrim Bactrim DS Septra Septra DS Sulfatrim Sulfatrim DS Sulfatrim Pediatric
2
Q
trimethoprim/sulfamethoxazole
Therapeutic Class
A
anti-infectives
antiprotozoals
3
Q
trimethoprim/sulfamethoxazole
Pharm Class
A
folate antagonists
sulfonamides
4
Q
trimethoprim/sulfamethoxazole
Indications
A
Treatment of:
Bronchitis, Shigella enteritis, Otitis media, Pneumocystis jirovecii pneumonia (PCP), Urinary tract infections, Traveler's diarrhea. Prevention of PCP in HIV-positive patients.
Unlabeled Use(s): Biliary tract infections, osteomyelitis, burn and wound infections, chlamydial infections, endocarditis, gonorrhea, intra-abdominal infections, nocardiosis, rheumatic fever prophylaxis, sinusitis, eradication of meningococcal carriers, prophylaxis of urinary tract infections, and an alternative agent in the treatment of chancroid. Prevention of bacterial infections in immunosuppressed patients.
5
Q
trimethoprim/sulfamethoxazole
Action
A
Combination inhibits the metabolism of folic acid in bacteria at two different points
6
Q
trimethoprim/sulfamethoxazole
Therapeutic Effects
A
Bactericidal action against susceptible organisms
>Many gram+positive aerobic pathogens
>Many gram-negative aerobic pathogens
7
Q
trimethoprim/sulfamethoxazole
Contraindication
A
Hypersensitivity to sulfonamides or trimethoprim;
History of drug-induced immune thrombocytopenia due to sulfonamides or trimethoprim
Megaloblastic anemia secondary to folate deficiency;
Severe hepatic or renal impairment;
Pregnancy, lactation, or children <2 mo
8
Q
trimethoprim/sulfamethoxazole
Precautions
A
Use Cautiously in:
Mild to moderate hepatic or renal impairment (dose ↓ required if CCr <30 mL/min);
Genetic implication Glucose–6–phosphate dehydrogenase deficiency (↑ risk hemolysis);
HIV-positive patients (↑ incidence of adverse reactions);
Concurrent use with other products containing propylene glycol (IV only) (↑ risk of lactic acidosis).
9
Q
trimethoprim/sulfamethoxazole
Adverse Effects
A
ERTHEMIA MULTIFORM STEVENS-JOHNSONS TOXIC EPIDERMAL NECROLYSIS C.DIFF ASSOC. DIARRHEA HEPATIC NECROSIS
10
Q
trimethoprim/sulfamethoxazole
Side Effects
A
rash nausea vomiting headache fatigue hallucinations hyperkalemia hypoglycemia
11
Q
trimethoprim/sulfamethoxazole
Drug-Drug Reactions
A
> May ↑ half-life, ↓ clearance, and exaggerate folic acid deficiency caused by phenytoin.
May ↑ effects of sulfonylureas, pioglitazone, rosiglitazone, repaglinide, phenytoin, digoxin, and warfarin.
May ↑ toxicity of methotrexate.
↑ risk of thrombocytopenia from thiazide diuretics (↑ in geriatric patients).
↓ levels of and ↑ risk of nephrotoxicity with cyclosporine.
Concurrent use with >ACE inhibitors may ↑ risk of hyperkalemia
May ↓ the effects of tricyclic antidepressants.
Concurrent use with leucovorin may result in treatment failure and ↑ risk of death (avoid concurrent use)
12
Q
trimethoprim/sulfamethoxazole
Assessment
A
> assess for infection
Obtain specimen for culture and sensitivity before initiating therapy
Inspect IV site, Phlebitis common.
>Monitor bowel function
>Assess for rash
>Monitor CBC and UA frequently for May produce ↑ serum bilirubin, ↑ potassium, creatinine, and alkaline phosphatase.
May cause hypoglycemia.
13
Q
trimethoprim/sulfamethoxazole
Patient Teaching
A
> Empty stomach, full galss of water, 1 hr before or 2hr after meals, may take with food if GI upset occurs
Take medicine as directed
Complete whole course
notify doctor if rash, sore throat, fever, mouth sores, or unusual bleeding or bruising occurs
Proper dilution, rate, and admin of drug and IV equipment
14
Q
trimethoprim/sulfamethoxazole
Routes
A
PO, IV
15
Q
Ampicillin
Trade Names
A
Omnipen
Amcill
Polycillin
Principen
16
Q
Ampicillin
Therapeutic Class
A
anti-infectives
17
Q
Ampicillin
Pharm Class
A
aminopenicillins
18
Q
Ampicillin
Indications
A
Treatment of the following infections: Skin and skin structure infections, Soft-tissue infections, Otitis media, Sinusitis, Respiratory infections, Genitourinary infections, Meningitis, Septicemia. Endocarditis prophylaxis.
Unlabeled Use(s): Prevention of infection in certain high-risk patients undergoing cesarean section.
19
Q
Ampicillin
Action
A
Binds to a bacterial cell wall, resulting in death.
20
Q
Ampicillin
Therapeutic Effects
A
Bactericidal action, broader spectrum that penicillin
21
Q
Ampicillin
Contraindication
A
Penicillin hypersensitivity
22
Q
Ampicillin
Precautions
A
> Severe renal insufficiency (dose ↓ required if CCr <10 mL/min);
Infectious mononucleosis, acute lymphocytic leukemia or cytomegalovirus infection (↑ incidence of rash);
Patients allergic to cephalosporins;
Lactation: Distributed into breast milk. Can cause rash, diarrhea, and sensitization in the infant.
23
Q
Ampicillin
Adverse Effects
A
SEIZURES (High Doses)
C.DIFF
ANAPHYLAXIS
SERUM SICKNESS
24
Q
Ampicillin
Side Effects
A
Diarrhea rash superinfection nausea vomiting urticaria blood dyscrasias
25
Ampicillin
| Drug-Drug Reactions
>Probenecid ↓ renal excretion and ↑ blood levels of ampicillin–therapy may be combined for this purpose.
>Large doses may ↑ the risk of bleeding with warfarin.
↑ risk of with concurrent allopurinol therapy.
>May ↓ the effectiveness of oral hormonal contraceptives.
26
Ampicillin
| Assessment
>Observe for anaphylaxis
>Keep epinephrine, antihistamine, and CPR equipment nearby when administering
>Monitor bowel function for diarrhea or bloody stools
>assess for rash, infection
>before therapy obtain history, and specimen for culture and sensitivity
27
Ampicillin
| Patient Teaching
>Take whole course as directed
>Report signs of infection or allergy
>Notify immediately for fever and diarrhea
>Use an alternate or additional form of nonhormonal birth control
28
Ampicillin
| Routes
PO, IM, IV
29
Cefazolin
| Trade Names
Previously, Ancef
30
Cefazolin
| Therapeutic Class
anti-infectives
31
Cefazolin
| Pharm Class
first generation cephalosporin
32
Cefazolin
| Indications
Treatment of the following infections due to susceptible organisms:
```
Skin and skin structure infections (including burn wounds),
Pneumonia,
Urinary tract infections,
Biliary tract infections,
Genital infections,
Bone and joint infections,
Septicemia,
Bacterial endocarditis prophylaxis for dental and upper respiratory procedures.
Perioperative prophylaxis.
```
33
Cefazolin
| Action
Binds to bacterial cell wall membrane, causing cell death
34
Cefazolin
| Therapeutic Effects
Bactericidal action against susceptible bacteria.
>Against many gram + cocci
>Against some gram - rods
35
Cefazolin
| Contraindications
Hypersensitivity to cephalosporins
| serious hypersensitivity to penicillins
36
Cefazolin
| Precautions
>Renal impairment (dose ↓ and/or ↑ dosing interval recommended if CCr <50 mL/min [adults] or <70 mL/min [children])
>Hepatic impairment
>History of GI disease, especially colitis
>OB: Half-life is shorter and blood levels lower during pregnancy; has been used safely.Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
>Geri: Dose adjustment due to age-related ↓ in renal function may be necessary in older adults.
37
Cefazolin
| Adverse Effects
```
SEIZURES (High Doses)
CDIFF
STEVENS-JOHNSONS
ANAPHYLAXIS
SERUM SICKNESS
```
38
Cefazolin
| Side Effects
```
diarrhea
nausea
vomiting
rash
pain at IM site
Phlebitis at IV site
thrombocytopenia
neutropenia
leukopenia
cramps
pruritis
urticaria
superinfection
```
39
Cefazolin
| Drug-Drug Reactions
Probenicid decreases excretion and increases blood levels of renally excreted cephalosporins
40
Cefazolin
| Route
IM, IV
41
Cefazolin
| Assessment
>Observe for anaphylaxis
>Observe for rash, discontinue if occurs.
>Monitor bowel function
>Observe for infection
>Monitor labs
>Before initiating therapy obtain history and specimens for culture and sensitivity
42
Cefazolin
| Patient Teaching
Report signs of superinfection
| Notify immediately of rash, fever, or diarrhea occurs
43
Doxycycline
| Trade Names
```
Acticlate
Doryx
Doryx MPC
Doxy
Oracea
Vibramycin
```
44
Doxycycline
| Therapeutic Class
anti-infectives
45
Doxycycline
| Pharm Class
tetracyclines
46
Doxycycline
| Indications
Treatment of various infections caused by unusual organisms, including:
Mycoplasma,
Chlamydia,
Rickettsia,
Borellia burgdorferi.
Treatment of inhalational anthrax (postexposure) and cutaneous anthrax.
Treatment of gonorrhea and syphilis in penicillin-allergic patients.
Prevention of exacerbations of chronic bronchitis.
Treatment of acne.
Treatment of inflammatory lesions associated with rosacea (Oracea only).
Malaria prophylaxis.
47
Doxycycline
| Action
Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome.
Low-dose products used in the management of periodontitis inhibit collagenase.
48
Doxycycline
| Therapeutic Effects
```
Bacteriostatic action against susceptible bacteria
>some gram + pathogens
>anthrax
>some gram - pathogens
>other pathogens
>mycoplasma
>Treponema pallidum
>Chlamydia,
>Rickettsia,
>Borrelia burgdorferi.
```
49
Doxycycline
| Contraindications
Hypersensitivity
Avoid alcohol products and bisulfites
Pregnancy in last half
50
Doxycycline
| Precautions
Pregnancy
Breastfeeding
Children <8
51
Doxycycline
| Adverse Affects
```
DRESS
ERYTHEMA MULTIFORM
EXFOLIATIVE DERMATITIS
STEVENS-JOHNSONS
TOXIC EPIDERMAL NECROLYSIS
CDIFF
HEPATOTOXICITY
PANCREATITIS
```
52
Doxycycline
| Side Effects
```
photosensitivity
hypersensitivity
superinfection
n/v/d
intercranial hypotension
headache
rash
dysphagia
esophagitis
glossitis
phlebitis at IV site
blood dyscrasias
```
53
Doxycycline
| Drug-Drug Reactions
>May ↑ effect of warfarin.
>May ↓ effectiveness of estrogen-containing oral contraceptives.
>Antacids, calcium, iron, and magnesium form insoluble compounds (chelates) and ↓ absorption of tetracyclines; this effect is least with doxycycline.
>Cholestyramine or colestipol ↓ absorption of tetracyclines.
>Adsorbent antidiarrheals may ↓ absorption.
>Barbiturates, carbamazepine, or phenytoin may ↓ effectiveness.
>Isotretinoin may ↑ risk of intracranial hypertension; avoid concomitant use.
54
Doxycycline
| Drug-Food Reactions
Calcium in food or dairy products decrease absorption by forming insoluble compounds
55
Doxycycline
| Routes
PO, IV
56
Doxycycline
| Assessment
>Monitor bowel function
>Assess for rash, discontinue if severe or fever also occurs
>Assess IV site for thrombophlebitis
>Assess for infection
>Obtain culture and sensitivity before initiating therapy
57
Doxycycline
| Patient Teaching
>Take whole course as directed
>Notify immediately if rash or diarrhea, or signs of superinfection
>Use sunscreen and protective clothing
>Take calcium or iron 1-3 hours before or after doxycycline
>
58
Gentamicin
| Trade Names
Garamycin
59
Gentamicin
| Therapeutic Class
anti-infectives
60
Gentamycin
| Pharm Class
aminoglycosides
61
Gentamycin
| Indications
>Treatment of serious gram-negative bacterial infections and infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated.
>In combination with other agents in the management of serious enterococcal infections.
>Prevention of infective endocarditis.
>Topical Ophth: Treatment of localized infections due to susceptible organisms.
62
Gentamicin
| Action/Therapeutic Effects
Bactericidal action, inhibits protein synthesis in bacteria at 30S ribosome.
63
Gentamicin
| Contraindications
>Hypersensitivity to gentamicin or other aminoglycosides
>bisulfate intolerance
>Pregnancy
>Neonates
64
Gentamicin
| Precautions
```
>Renal impairment
>Hearing impairment
>Neuromuscular diseases
>Neonates
>Geriatric
```
65
Gentamicin
| Adverse Reactions/Side Effects
```
Ototoxicity (vestibular & cochlear)
nephrotoxicity
ataxia
vertigo
hypersensitivity
muscle paralysis (high IV doses)
```
66
Gentamicin
| Drug-Drug Interactions
>Inactivated by penicillins and cephalosporins when coadministered to patients with renal insufficiency.
>Possible respiratory paralysis after inhalation anesthetics or neuromuscular blockers.
>↑ incidence of ototoxicity with loop diuretics.
>↑ incidence of nephrotoxicity with other nephrotoxic drugs.
67
Gentamicin
| Routes
IM, IV, IT(intrathecal)
68
Gentamicin
| Assessment
>Assess for infection
>Evaluate eighth cranial nerve by audiometry before and throughout
>Monitor I&O
>Obtain specimen for culture and sensitivity before therapy initiation
>Monitor blood levels for toxicity
69
Gentamicin
| Teaching
>Report hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating
>Drink lots of fluids
>Notify of pregnancy planned or suspected
70
Azithromycin
| Trade Names
Zithromax
71
Azithromycin
| Therapeutic Class
agents for atypical mycobacterium
| anti-infectives
72
Azithromycin
| Pharm Class
Macrolides
73
Azithromycin
| Indications
>Treatment of
-upper respiratory tract infections
-lower respiratory tract infections
-acute otitis media
-skin/skin structure infections
-nongonococcal urethritis, cervicitis, gonorrhea, & chancroid
>Prevention of Mycobacterium avium complex (MAC) infection in advanced HIV infected patients
Unlabeled uses
>Prevention of bacterial endocarditis
>treatment of cystic fibrosis
>Treatment and post-exposure prophylaxis of pertussis in infants
74
Azithromycin
| Action/Therapeutic Effects
Inhibits protein synthesis at 50S bacterial ribosome
Bacteriostatic action
Active against some gram negative and some gram positive aerobic bacteria.
NOT active against MRSA
75
Azithromycin
ROUTE ONSET PEAK DURATION
PO rapid 2.5–3.2 hr 24 hr
IV rapid end of infusion 24 hr
76
Azithromycin
| Contraindications
>Hypersensitivity to azithromycin, erythromycin, or other macrolide anti-infectives;
>History of cholestatic jaundice or hepatic dysfunction with prior use of azithromycin;
>QT interval prolongation, hypokalemia, hypomagnesemia, or bradycardia;
>Concurrent use of quinidine, procainamide, dofetilide, amiodarone, or sotalol.
77
Azithromycin
| Precautions
>Severe hepatic impairment (dose adjustment may be required);
>Severe renal impairment (CCr <10 mL/min);
>Myasthenia gravis (may worsen symptoms);
>Geri: May have ↑ risk of QT interval prolongation;
>OB: Use only if potential maternal benefit justifies potential fetal risk;
>Lactation: Use during breast feeding only if potential maternal benefit justifies potential risk to infant;
>Pedi: Neonates (↑ risk of infantile hypertrophic pyloric stenosis at up to 42 days of life).
78
Azithromycin
| Adverse Reactions
```
>Torsades De Pointes
>Acute generalized exanthematous pustulosis
>DRESS
>Stevens-Johnsons Syndrome
>Hepatotoxicity
>Hypersensitivity
>CDAD
```
79
Azithromycin
| Side Effects
```
>abdominal pain (common)
>diarrhea (common)
>nausea (Common)
>dizziness
>seizures
>drowsiness
>fatigue
>headache
>chest pain
>hypotension
>palpitations
>QT interval prolongation
>photosensitivity
>rash
>ototoxicity
>hyperkalemia
>cholestatic jaundice
> ↑ liver enzymes
>dyspepsia
>flatulence
>melena
>oral candidiasis
>pyloric stenosis
>nephritis
>vaginitis
>anemia
>leukopenia
>thrombocytopenia
```
80
Azithromycin
| Drug-Drug Interactions
>Quinidine, procainamide, dofetilide, sotalol, and amiodarone may ↑ risk of QT interval prolongation; concurrent use should be avoided.
>Aluminum- and magnesium-containing antacids ↓ peak levels.
>Nelfinavir ↑ levels (monitor carefully); azithromycin also ↓ nelfinavir levels.
>Efavirenz ↑ levels.
>May ↑ the effects and risk of toxicity of warfarin and zidovudine.
>Other macrolide anti-infectives have been known to ↑ levels and effects of digoxin, theophylline, ergotamine, dihydroergotamine, triazolam, carbamazepine, cyclosporine, tacrolimus, and phenytoin ; careful monitoring of concurrent use is recommended.
81
Azithromycin
| Routes
PO, IV
82
Azithromycin
| Assessment
>Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
>Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
>Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Notify health care professional immediately if these occur.
>Assess patient for skin rash frequently during therapy. Discontinue azithromycin at first sign of rash; may be life-threatening. >Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.
Lab Test Considerations:
>May cause ↑ serum bilirubin, AST, ALT, LDH, and alkaline phosphatase concentrations.
>May cause ↑ creatine phosphokinase, potassium, prothrombin time, BUN, serum creatinine, and blood glucose concentrations.
>May occasionally cause ↓ WBC and platelet count.
83
Azithromycin
| Patient Teaching
>Take 1 hour before or 2 hours after meals
>Take as directed and take whole course
>Do not take with antacids or food
>May cause drowsiness or dizziness
>Use sunscreen/protective clothing, photosensitivity
>Immediately Report chest pain, palpitations, yellowing of skin or eyes, sign of superinfection, rash, fever, or diarrhea especially with blood, mucus, or pus in it.
>If for urethritis or cervicitis, sexual partners should also be treated.
>Notify provider if symptoms do not improve
>Notify provider if pregnancy is planned, suspected, or breastfeeding
>If breastfeeding, monitor infant for rash, diarrhea or vomiting
84
Ciprofloxacin
| Trade Names
Cipro
| Cipro XR
85
Ciprofloxacin
| Therapeutic Class
Anti-infectives
86
Ciprofloxacin
| Pharm Class
Fluoroquinolones
87
Ciprofloxacin
| Indications
88
Ciprofloxacin
| Action/Therapeutic Effects
89
Ciprofloxacin
| Contraindications
90
Ciprofloxacin
| Precautions
91
Ciprofloxacin
| Adverse Reactions
92
Ciprofloxacin
| Side Effects
93
Ciprofloxacin
| Drug-Drug Interactions
94
Ciprofloxacin
| Routes
95
Ciprofloxacin
| Assessment
96
Ciprofloxacin
| Patient Teaching
97
Vancomycin
| Trade Names
98
Vancomycin
| Therapeutic Class
99
Vancomycin
| Pharm Class
100
Vancomycin
| Indications
101
Vancomycin
| Action/Therapeutic Effects
102
Vancomycin
| Contraindications
103
Vancomycin
| Precautions
104
Vancomycin
| Adverse Reactions
105
Vancomycin
| Side Effects
106
Vancomycin
| Drug-Drug Reactions
107
Vancomycin
| Routes
108
Vancomycin
| Assessment
109
Vancomycin
| Patient Teaching
110
Metronidazole
| Trade Names
111
Metronidazole
| Therapeutic Class
112
Metronidazole
| Pharm Class
113
Metronidazole
| Indications
114
Metronidazole
| Action/Therapeutic Effects
115
Metronidazole
| Contraindications
116
Metronidazole
| Precautions
117
Metronidazole
| Adverse Reactions
118
Metronidazole
| Side Effects
119
Metronidazole
| Drug-Drug Interactions
120
Metronidazole
| Routes
121
Metronidazole
| Assessment
122
Metronidazole
| Patient Teaching
123
Zosyn
| Trade Names
124
Zosyn
| Therapeutic Class
125
Zosyn
| Pharm Class
126
Zosyn
| Action/Therapeutic Effects
127
Zosyn
| Contraindications
128
Zosyn
| Precautions
129
Zosyn
| Adverse Reactions
130
Zosyn
| Side Effects
131
Zosyn
| Drug-Drug Reactions
132
Zosyn
| Routes
133
Zosyn
| Assessment
134
Zosyn
| Patient Teaching
135
Fluconazole
| Trade Names
136
Fluconazole
| Therapeutic Class
137
Fluconazole
| Pharm Class
138
Fluconazole
| Indications
139
Fluconazole
| Action/Therapeutic Effects
140
Fluconazole
| Contraindications
141
Fluconazole
| Precautions
142
Fluconazole
| Adverse Reactions
143
Fluconazole
| Side Effects
144
Fluconazole
| Drug-Drug Interactions
145
Fluconazole
| Routes
146
Fluconazole
| Assessment
147
Fluconazole
| Patient Teaching
148
Ceftriaxone
| Trade Names
149
Ceftriaxone
| Therapeutic Class
150
Ceftriaxone
| Pharm Class
151
Ceftriaxone
| Action/Therapeutic Effects
152
Ceftriaxone
| Contraindications
153
Ceftriaxone
| Precautions
154
Ceftriaxone
| Adverse Reactions
155
Ceftriaxone
| Side Effects
156
Ceftriaxone
| Drug-Drug Interactions
157
Ceftriaxone
| Routes
158
Ceftriaxone
| Assessment
159
Ceftriaxone
| Patient Teaching
160
Meropenem
| Trade Names
161
Meropenem
| Therapeutic Class
162
Meropenem
| Pharm Class
163
Meropenem
| Indications
164
Meropenem
| Action/Therapeutic Effects
165
Meropenem
| Contraindications
166
Meropenem
| Precautions
167
Meropenem
| Adverse Reactions
168
Meropenem
| Side Effects
169
Meropenem
| Drug-Drug Interactions
170
Meropenem
| Routes
171
Meropenem
| Assessment
172
Meropenem
| Patient Teaching
