Immune System Medications

Question 1

Need to Knows

Answer 1

• Classes: “mycin, cillin, micin, oxacin…”
• If allergic to penicillin, patient needs a new class to prevent anaphylaxis.
• All ABX get a culture and sensitivity test before starting therapy.

Question 2

Aminopenicillins

Answer 2

Amoxicillin (Amoxil), Ampicillin (Unasyn), Amoxicillin/Clavulanate (Augmentin)

• Used for lower respiratory infection, sinus infection, pneumonia, ear infection, impetigo, skin infection, UTI, Peptic Ulcer (H. Pylori), GI/GU Infections
• Side effects: N/V/D, vaginitis, anemia, rash, abdominal pain, alkalosis, glossitis, fever
• Watch for penicillin allergy* (ANAPHYLAXIS)
• Can have oral, diaper, and/or vaginal candidiasis rash
• Watch for N/V/D

Question 3

Extended-Spectrum Penicillins

Answer 3

Piperacillin/Tazobactam (Zosyn)

• Used for appendicitis, peritonitis, skin infections, GYN infections, community-acquired nosocomial pneumonia
• s/e: seizures (higher doses), drug induced hepatitis, bleeding, pain, superinfection
• Watch for anaphylaxis
• Obtain Hx before therapy initiates
• Notify HCP if fever or diarrhea occur (esp pus, mucus, or blood is in stool)

Question 4

Potassium Clavulanate ER (Augmentin XR)

Answer 4

• Used for Lower RTI, sinus infection, pneumonia, ear infection, impetigo, skin infection, UTI
• Side effects:

Question 5

Cyclosporine

Answer 5

Sandimmune, Neoral, Restasis

• Used to prevent/tx organ rejection, graft-vs-host disease in bone marrow and transplant clients. Tx RA and psoriasis, inflammatory dry eye.
• s/e: seizures, confusions, abdominal discomfort, F/E imbalances
• This medicine is used for a lifetime.
• Cosmetic changes (hirsutism, acne) may occur
• Don’t take St. John’s wort (interferes with anti rejection properties)

Question 6

Immunomodulator

Answer 6

Pimecrolimus (Elidel)

• Used to tx atopic dermatitis
• s/e: headache, cough, redness/burning on application site
• Avoid Eyes; not for children <2 years
• Don’t apply occlusive dressing over site

Question 7

Salicylate (ASA)

Answer 7

Aspirin (ASA)

• Used to treat inflammatory disorders, mild to mod pain, fever.
• s/e: epigastric distress, increase bleeding time, anemia, heartburn, nausea
• Take with food or milk
• Report tinnitus (Toxicity level reached)
• Don’t take with other NSAIDs

Question 8

Antimetabolite

Answer 8

Methotrexate

• Used alone or with other tx modalities to tx carcinoma, leukemia, mycosis fungoides. Tx psoriasis and RA unresponsive to conventional therapy.
• s/e: headaches, anorexia, N/A, stomatitis
• Avoid alcohol (prevent GI Irritation), avoid vaccines without HCP advice
• Affects folic acid

Question 9

Tumor Necrosis Factor Blockers

Answer 9

Adalimumab (Humira), Certolizumab Pegol (Cimzia), Golimumab (Simponi), Infliximab (Remicade), Etanercept (Enbrel)

• Used to dec progress of RA, juvenile arthritis, etc. Also used in Crohn’s and UC.
• s/e: headache, URTI, abdominal pain, injection site reactions, Infections
• Don’t receive live vaccines during therapy and avoid sick people.
• Notify HCP of URI or other infections

Question 10

Synthetic Vitamin D₃ Analogue

Answer 10

Calcipotriene (Dovonex)

• Used to control skin cell development and production by acting as a synthetic form of Vit D
• s/e: itching, skin irritation, hypercalcemia, dry skin
• Apply a thin layer to affected skin 2x/day and rub in completely. Don’t cover.
• Regular lab tests done to monitor Ca+ concentrations
• Expect improvement in 2-8 weeks

Question 11

Colony-stimulating Factors

Answer 11

Filgrastim (Neupogen), Sargramostim (Leukin), Pegfilgrastim (Neulasta)

• Used to accelerate bone marrow recovery after chemo or transplant. Management of severe chronic leukopenia.
• s/e: weakness, diarrhea, bone pain, myalgia, SVT

*Notify HCP of dyspnea or palpitations

Question 12

Anti-Infective

Answer 12

Vancomycin (Vancocin)

• IV Use: Tx life-threatening infections (MRSA infections)
• PO Use: Tx of Staph enterocolitis, psuedomembraneous colitis from C. Diff
• s/e: hypotension, n/v, leukopenia, back and neck pain, superinfection
• Take oral form as directed
• Report tinnitus, rash, vertigo, hearing loss, flushing of skin, dizziness
• Admin IV over 60-90 mins to prevent “red-man syndrome”

Question 13

Nonsteroidal Anti-Inflammatory Agents (NSAIDs)

Answer 13

Indomethacin, Ibuprofen, Naproxen, Ketorolac

• Used to tx mild to mod musculoskeletal pains or dysmenorrhea.
• S/e: GI Bleeding, hepatitis, drowsiness, constipation
• Take with food or milk and remain upright for 30 mins to dec irritation
• Alcohol increases irritation
• Report abdominal/stomach pain or black-red stools
• Wear sunscreen and protective clothing

Question 14

Lincosamide Antibiotic

Answer 14

Clindamycin (Cleocin)

• Used to tx skin infections, RTI, septicemia, intra-abdominal infections, GYN infections, osteomyelitis
• s/e: dizziness, arrhythmias, hypotension, n/v/d
• Take medication until completed
• Notify HCP of diarrhea, abdominal cramping, fever, or bloody stools STAT

Question 15

Aminoglycosides

Answer 15

Gentamicin, Amikacin, Tobramycin

• Used to tx serious gram-negative bacterial infections and staph caused infections from penicillins (contraindicated)
• Prevention of infective endocarditis. Used with other anti-infectives for TB
• s/e: Ototoxicity, nephrotoxicity, ataxia, vertigo
• Drink plenty of fluids
• Report tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating

Question 16

Macrolides

Answer 16

Azithromycin (Zithromax), Clarithromycin (Biaxin), Erythromycin

• Used for mild to moderate Upper (Pharyngitis, Tonsillitis) and Lower Respiratory Infections (Pneumonia, MAC, exacerbation of COPD, Chlamydia)
• Used for bacterial STDs, ear infections, skin infections, GU infections, PUD
• Given PO or IV
• Side effects: Nausea, Diarrhea, Headache, Fatigue, Heartburn
• Watch for N/V/D, abdominal pain, superinfections
• Given in a 7 day dosage pack
• Report blood in stool

Question 17

Fluoroquinolones

Answer 17

Ciprofloxacin (Cipro), Levofloxacin (Levaquin), Moxifloxacin (Avelox), Gemifloxacin (Factive), Ofloxacin

• Used (PO, IV) to tx UTI, GYN infections, skin infections, bone/joint infections, infectious diarrhea, typhoid fever.
• s/e: vaginitis, drowsiness, headache, abdominal pain, hyper/hypoglycemia
• Take medication as directed
• Drink plenty of fluids daily (prevent kidney stones)
• Don’t take with antacids
• May cause dizziness and drowsiness
• Use sunscreen and protective clothing
• Report rash, tendon pain or bloody stools*

Question 18

Cephalosporins

Answer 18

• Used for Respiratory, GI/GU infections, Endocarditis, Meningitis
• Side effects: Rash, Anorexia, Hypersensitivity, GI Pain
• Contraindicated for Penicillin Allergy*

1st generation: For Gram Positive Staph/Strep. Examples: cefadroxil or cephalexin
2nd generation: For Gram-positive staph/strep and certain Gram-negative bacteria. Examples: cefuroxime, cefprozil, and cefaclor.
3rd generation: For Flu, Pneumonia, E.Coli. Examples: ceftriaxone and cefotaxime.
4th generation: Ex: Cefepime. Used for Gram-positive and Gram-negative bacteria.
5th generation: For MRSA, Penicillin-Resistant Strep, Ampicillin-susceptible and Enterococcus faecalis. Ex: Ceftaroline

*5th generation doesn’t work for Pseudomonas bacteria

Question 19

Tetracyclines

Answer 19

Doxycycline, Minocycline, Tetracycline

• Used to treat various infections caused by unusual organisms. Tx of inhaled anthrax, gonorrhea, syphilis (penicillin allergy), acne.
• Prevents exacerbations of chronic bronchitis

-s/e: esophagitis, photosensitivity, rashes, superinfection

• Avoid antacids and dairy products.
• Women should use non-hormonal contraception
• Watch for s/s of yeast infection