Dispensing; Exam 3 - Miscellaneous (Top 200 Anti-Infective)

Front 1

What has been reported with nearly all antibiotics?

Back 1

Pseuduomembranous colitis has been reported with nearly all antibiotics and may range from mild to life threatening. It is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents. Although many antibiotics cause gastrointestinal distress and diarrhea, Pseudomembranous colitis is a specific syndrome caused by Clostridium difficile enterotoxins.
Treatment with antibiotics alters the normal flora of the colon and may permit overgrowth of Clostridium difficile. Mild cases of pseudomembranous colitis usually respond to discontinuation of the antibiotic. In more severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation, and treatment with an antibiotic against Clostridium difficile.

Front 2

Penicillins

Back 2

Penicillins are indicated for treatment of infections caused by penicillin-sensitive microorganisms. Penicillins are bactericidal; they inhibit bacterial cell wall synthesis. All penicillins share cross allergenicity.

Front 3

ampicillin

Back 3

The spectrum of activity of amoxicillin and ampicillin are essentially identical. Pharmacists should instruct patients to take ampicillin on an empty stomach because food decreases bioavailability.

Front 4

amoxicillin

Back 4

Amoxicillin may be taken without regard to meals. Amoxicillin oral suspension maintains potency for 14 days when stored under refrigeration or at room temperature.

Front 5

Augmentin

Back 5

Augmentin oral suspension must be stored under refrigeration to maintain potency. Pharmacists may not substitute two Augmentin 250 mg tablets for one Augmentin 500 mg tablet because the patient would receive a double-dose of potassium clavulanate. Potassium clavulanate is a beta-lactamase inhibitor. The beta-lactamases are a group of enzymes produced by certain bacteria that inactivate beta-lactam antibiotics (penicillins and cephalosporins). Potassium clavulanate broadens the spectrum of activity of amoxicillin.

Front 6

Penicillinase

Back 6

Penicillinase is an enzyme produced by certain bacteria that converts penicillin to an inactive product. Penicillinase is a type of beta-lactamase.

Front 7

penicillin G potassium

Back 7

Penicillin G potassium may be administered either intravenously or intramuscularly, however, the intravenous route is preferred because intramuscular administration is uncomfortable.

Front 8

penicillin G procaine

Back 8

Procaine is an anesthetic utilized to reduce burning on administration and to increase the duration of action of penicillin G.

Front 9

penicillin G benzathine

Back 9

Benzathine is an anesthetic utilized to reduce burning on administration and to increase the duration of action of penicillin G.

Front 10

parenteral penicillin G

Back 10

Serious medication errors have occurred with parenteral penicillin G. The most devastating errors have resulted from intravenous administration of penicillin G procaine or penicillin G benzathine. Intravenous administration of these suspensions may result in fatal embolism.

Front 11

Tetracyclines

Back 11

Tetracyclines are bacteriostatic antibiotics active against a wide range of gram-positive and gram-negative organisms. Tetracyclines form non-absorbable complexes with divalent/trivalent cations (Zn, Al, Mg, Ca, Fe) contained in substances such as antacids, milk, foods and vitamin/mineral products.

Front 12

Tetracyclines adverse effect

Back 12

Tetracyclines are associated with phototoxicity. Pharmacists should counsel patients to wear sunscreen whenever outdoors and to avoid tanning beds while taking tetracycline antibiotics. Use of systemic tetracyclines during pregnancy or in infants and children under 8 years of age may cause permanent discoloration of teeth. This is most common with long-term use, but has occurred with repeated short-term courses. Tetracyclines are FDA Pregnancy Risk Factor Category D medications. Pharmacists should never dispense outdated tetracycline products due to the nephrotoxicity associated with decomposition products.

Front 13

Doxycycline unapproved indication

Back 13

Doxycycline is used to prevent travelers diarrhea caused by E. coli. This is not an approved FDA indication.

Front 14

Macrolide

Back 14

Macrolide antibiotics have similar antibacterial spectrums, mechanisms of action, and resistance. The ketolides are structurally related to the macrolides.

Front 15

Zithromax

Back 15

Zithromax 250 mg tablets are available in a unit-of-use package known as Z-Pak. Zithromax 500 mg tablets are available in a unit-of-use package known as Tri-Pak. Azithromycin tablets and oral suspension may be taken without regard to meals. Zithromax powder for oral suspension (single 1 gram packet) is indicated for treatment of the sexually transmitted organism Chlamydia trachomatis. The powder should be mixed with approximately 60 mL of water and administered immediately after mixed.

Front 16

Zmax

Back 16

Zmax provides a full course of antibacterial therapy in a single oral dose. The microspheres should be mixed with 60 mL of water and consumed as one dose within 12 hours on an empty stomach.

Front 17

Biaxin

Back 17

Biaxin oral suspension maintains stability for 14 days when stored at room temperature – the reconstituted suspension should not be stored under refrigeration.

Front 18

Prevpac

Back 18

Biaxin is used in combination products with other medications in the treatment of Helicobacter pylori, a bacteria associated with duodenal ulcers.

Front 19

Cephaloporins

Back 19

Cephaloporins are structurally and pharmacologically related to penicillins. They are classified by generation based on their spectrum of activity. In general, progression from first to third generation increases activity against gram-negative organisms, decreases activity against gram-positive organisms, and increases efficacy against resistant organisms. Cephalosporin cross-reactivity is approximately 3 to 7% in patients with a documented history of penicillin allergy. Cephalosporins should be administered with caution to penicillin sensitive individuals. Most of these medications are available in both solid and powder for oral suspension dosage forms. Most cephalosporin oral suspensions should be stored under refrigeration (except Omnicef, which is stored at room temperature). Cephalosporin oral suspensions are available in a wide variety of flavors.

Front 20

Omnicef

Back 20

Omnicef oral suspension should be stored at room temperature. It will maintain stability for 10 days. Cefdinir oral suspension may cause orange or red stools. This may be caused by an interaction between cefdinir and dietary iron.

Front 21

Nitrofurantoin

Back 21

Nitrofurantoin is an antibiotic indicated for treatment of urinary tract infections. Therapeutic concentrations of nitrofurantoin are achieved only in the urine. The presence of food increase the bioavailability of both forms of nitrofurantoin.

Front 22

Macrodantin

Back 22

Macrodantin capsules may also be prescribed as a single daily dose for long term suppressive therapy. If single dose therapy is prescribed, patients should be instructed to take the medication at bedtime.

Front 23

Macrobid

Back 23

Nitrofurantoin monohydrate is in a blend of powders, which, upon exposure to gastric and intestinal fluids, forms a gel matrix that releases nitrofurantoin over time.

Front 24

Fluoroquinolones

Back 24

Fluoroquinolones are broad spectrum, bactericidal antibiotics, and active against a wide range of gram-positive and gram-negative organisms. The emergence of bacterial resistance to fluoroquinolones, and of cross-resistance within the class, is becoming a significant clinical concern worldwide. The World Health Organization recommends that prescribing practices for antimicrobial agents be modified to reflect this growing concern.
Fluoroquinolones are not recommended for use in patients less than 18 years of age. This age group was not included in clinical trials because fluoroquinolones caused lameness in immature dogs due to permanent cartilage lesions. This class of anitbiotcs has also been associated with rupture of the Achilles tendon. Increased intracranial pressure and seizures have occurred with fluoroquinolones. These medications should be cautiously prescribed to patients with epilepsy or other CNS disorders that may predispose to seizures.
Patients allergic to one fluoroquinolone may be allergic to other fluoroquinolones.

Front 25

Cipro

Back 25

Each package of oral suspension contains microcapsules of ciprofloxacin along with a diluent consisting of sucrose, water, and flavoring. The microcapsules are added to the diluent prior to dispensing. Water should not be used to form the suspension. Cipro oral suspension is stable for 14 days when stored under refrigeration or at room temperature. Cipro oral suspension is not indicated for patients under 18 years of age.

Front 26

Levaquin

Back 26

Levaquin 750 mg tablets are also available in a unit-of-use package under the trade name Leva-pak. Leva-pak contains five tablets to be administered once daily

Front 27

Bactroban

Back 27

Impetigo is a contagious staphylococcal or streptococcal skin infection characterized by vesicles, pustules, and yellowish crusts. When Bactroban Ointment is applied to extensive open wounds or burns, the possibility of absorption of the polyethylene glycol vehicle, resulting in renal toxicity, should be considered.

Front 28

Benzamycin

Back 28

Benzamycin Gel is supplied in a package containing benzoyl peroxide gel and a plastic vial containing erythromycin powder. Prior to dispensing, 3 mL of ethyl alcohol should be added to the erythromycin, which is then mixed with the gel. The final produce should be stored under refrigeration. The effectiveness of benzoyl peroxide is primarily attributable to its antibacterial activity.

Front 29

BenzaClin

Back 29

BenzaClin Gel is supplied in a package containing benzoyl peroxide gel and a plastic vial containing clindamycin powder. Prior to dispensing, 5 mL of purified water should be added to the clindamycin, which is then mixed with the gel. The final product may be stored at room temperature for 10 weeks.

Front 30

Azole antifungals

Back 30

Azole antifungals are chemically classified as either triazole or imidazole antifungals. Oral ketoconazole, itraconazole, voriconazole, and posaconazole are indicated for a variety of systemic fungal infections, while fluconazole is indicated for treatment of localized fungal infections such as oral and vaginal candidiasis.

Front 31

Nizoral

Back 31

Nizoral tablet should be administered with food to minimize GI irritation. A rare side effect of oral ketoconazole is gynecomastia.

Front 32

Sporanox

Back 32

In order to achieve the maximum benefit, the patient should swish the oral solution (10 mL at a time) in the mouth for several seconds and swallow. Sporanox capsules should be administered with food to achieve maximum absorption.

Front 33

Diflucan

Back 33

Fluconazole may be administered with or without food. Diflucan oral suspension will maintain potency for 14 days when stored at room temperature. Diflucan as a single oral dose is indicated for vaginal candidiasis.

Front 34

Vfend

Back 34

Vfend should be administered on an empty stomach because food decreases absorption.

Front 35

Noxafil

Back 35

Should be administered with food for maximum absorption

Front 36

Lamisil

Back 36

Treatment of onychomycosis (fingernail) – one tablet daily for 6 weeks. Treatment of onychomycosis (toenail) – one tablet daily for 12 weeks. The optimal clinical effect is usually seen months after cessation of treatment. This is related to the period required for outgrowth of healthy nail. Oral terbinafine may be administered without regard to meals. Topical terbinafine is indicated for tinea cruris, tinea pedis, and tinea corporis. Numerous look-alike, sound-alike mixups have occurred between Lamisil and Lamictal (lamotrigine) tablets. Lamictal is an anticonvulsant. Pharmacists must use precaution when dispensing these medications.

Front 37

genital herpes

Back 37

Women with genital herpes may be at increased risk of developing cervical cancer. Pap tests should be done yearly to detect early cervical changes. The Pap test (named for Dr. George Papanicolaou) is a staining procedure for detection and diagnosis of various conditions, particularly malignant and premalignant conditions of the female genital tract such as cancer of the cervix or mucous membrane of the uterus (clinical term for uterus is endometrium).

Front 38

Zovirax

Back 38

Oral acyclovir is more effective than topical acyclovir in the treatment of genital herpes. Oral acyclovir is most effective if started within 24 hours of the onset of symptoms.

Front 39

Zovirax Oral Suspension

Back 39

Zovirax Oral Suspension is a ready-to-use suspension that maintains stability at room temperature.

Front 40

Zovirax Ointment

Back 40

The ointment is in a polyethylene glycol base. Mild pain, burning, or stinging may occur after topical application.

Front 41

Indication of Denavir Cream

Back 41

treatment of herpes labialis

Front 42

Valtrex

Back 42

Treatment for herpes zoster is one gram three times daily for 7 days. Treatment for recurrent genital herpes is 500 mg twice daily for 3 days. Treatment for herpes labialis is 2 grams twice daily for 1 day. Patients allergic to Zovirax should not be prescribed Valtrex because valacyclovir is rapidly converted to acyclovir.

Front 43

Famvir

Back 43

Treatment for herpes zoster is 500 mg three times daily for 7 days. Treatment for genital herpes is 125 mg twice daily for 5 days. Treatment for herpes labialis is 1500 mg as a single dose.

Front 44

Tamiflu

Back 44

The oseltamivir dose in patients 13 years of age and older is 75 mg. The dose in patients under 13 is based on the patient’s weight. Patients should be counseled to take oseltamivir with food to reduce the incidence of nausea. Tamiflu oral suspension should be stored under refrigeration and used within 10 days of preparation.