Top 200 Exam 3 (Anit-Infective)

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aerobic

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requiring oxygen

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ageusia

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absence of taste

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anaerobic

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not requiring oxygen

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anosmia

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absence of the sense of smell

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cystitis

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inflammation of the bladder

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dyspepsia

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impaired digestion

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emesis

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vomiting

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glossitis

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inflammation of the tongue

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gynecomastia

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breast enlargement in males

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hematuria

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blood in the urine

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hemoptysis

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the expectoration of blood or of blood-stained sputum. The term expectorate means eject from the throat or lungs by coughing.

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Herpes labialis

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cold sores

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Herpes zoster

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shingles

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lethargy

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a lowered level of consciousness marked by listlessness, somnolence, and apathy

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myalgia

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pain in a muscle or muscles. A synonym for this term is myodynia.

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nosocomial

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an infection originating in a hospital

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nystagmus

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involuntary, rapid, rhythmic movement of the eyeball

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ophthalmagra

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pain in the eye

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paresthesia

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sensation of burning or tingling on the skin

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pediculicide

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agent that destroys lice

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pediculosis

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infested with lice

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pustule

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collection of pus under the skin

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somnolence

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drowsiness

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stomatitis

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inflammation of the oral mucosa

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tinnitus

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a ringing or roaring noise in the ears

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varicella

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chickenpox

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vesicle

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blister

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virulent

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disease causing

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Psuedomembranous colitis

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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 GI distres and diarrhea, Pseudomembranous colitis is a specific syndrome caused by Clostridium dificile enterotoxins.

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Clostridium dificile

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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 give to management with fluids and electrolytes, protein supplementation, and treatment with an antibiotic effective against Clostridium difficile.

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Penicillins

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Indicated for treatment of infections caused by penicilin sensitive microorganisms. They are bactericidal and inhibit cell wall synthesis. All penicillins share cross allergenicity.

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Penicillin categories

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1. Natural penicillins - penicillin G, penicillin V
2. Aminopenicilins - ampicilin amoxicillin (Amoxil, Trimox), amoxicillin/potassium clavulanate (Augmentin)
3. Penicillinase resistant penicillins - dicloxacillin, nafcillin, oxacillin
4. Extended spectrum penicillins - carbenicillin (Geocillin), piperacillin, ticarcillin

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Oral dosage penicillins

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Penicillin V, amoxicillin, amoxicillin/potassium clavulanate, carbenicillin, and dicloxacillin

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Parenteral dosage penicillins

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Penicillin G, piperacillin, nafcillin, ticarcillin

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Both oral and parenteral penicillins

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Ampicillin, oxacillin

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Ampicillin

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should be taken on empty stomacy

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amoxicillin info

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capsule (250,500mg)
tablet (500,875mg)
chewable tablet
powder for oral suspension - maintains potency for 14 days when stored under refrigeration or at room temp

Amoxicillin is usually administered 2 or 3 times a day.

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Augmentin

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Generic name: amoxicillin, potassium clavulanate

TC: Antibiotic (aminopenicillin, beta-lactamase inhibitor)

Indications: bacterial infections

Dosage form: tablet (250,125) (500,125) (875,125) (1000,62.5) - this last strenght is trade name Augmentin XR and administered BID
chewable tablet
powder for oral suspension - The 600mg/5ml strength is available under the trade name Augmentin ES-600
NOTE: Each chew tab and oral suspension product contains different strengths of potassium clavulanate.

Other information: Oral suspension must be stored in fridge. Pharmacists may not substitute 2 Augmentin 250mg tabs for one 500mg tab b/c patient would receive a double dose of potassium clavulanate

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Potassium clavulanate

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beta-lactamase inhibitor. Beta-lactamases are a group of enzymes producd by certain bacteria that inactivate beta-lactim antibiotics (penicillins and cephalosporins). It broadens the spectrum of activity of amoxicillin.

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3 types of parenteral penicillin G

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penicillin G Aqueous (Pfizerpen)
penicillin G procaine (Wycillin)
penicillin G benzathine (Bicillin LA)

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Bicillin CR

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trade name product contaning both penicillin G procaine and n=penicillin G benzathine

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penicillin G Aqueous

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Better known as penicillin G potassium. May be administered IV or IM. IV is preferred b/c IM administration is uncomfortable.

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penicillin Gs administered IM, not IV

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penicillin G procaine
penicillin G benzathine

Both of these are suspensions. They are anesthetics utilized to reduce burning on administration and to increase DOA of penicillin G.

IV ADMINISTRATION OF THESE SUSPENSIONS MAY RESULT IN FATAL EMBOLISMS.

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Tetracyclines

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bacteriostatic ab active against a wide range of gram-positive and gram-negative organisms. They form nonabsorbable complexes with divalent/trivalent cations (Zn, Al, Mg, Ca, Fe) contained in substances such as antacids, mild, foods and vitamin/mineral products.

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Examples of tetracyclines

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doxycycline (Vibramycin, Vibratabs, Doryx)
minocycline (Dynacin, Minocin)

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Tetracycline info

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They are associated with phototoxicity. Patients should be counseled to wear sunscreen whenever outdoors and to avoid tanning beds. Use of systemic tetracyclines during pregnancy or in infants & children under 8 may cause permanent discoloration of the teeth (most common with long term use). Tetracyclines are FDA Pregnancy Category D meds. Never dispense outdated tetracyclines due to the nephrotoxicity associated with the decomposition products.

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Doxycycline use

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Used to prevent travelers diarrhea caused by E. coli. This is not an FDA indication.
FDA approved med for travelers diarrhea is Xifaxan (rifaxamin). It is available in a 200mg tablet and is administered TID for 3 days.

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Macrolide antibiotics

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azithromycin (Zithromax)
clarithromycin (Biaxin)
erythromycin

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Erythromycin salt forms

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erythromycin ethylsuccinate (E.E.S.)
erythromycin stearate (Erythrocin)
erythromycin base (Eryc, Ery-Tab)

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Erythromycin opthalmic ointment

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Ilotycin

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Ketek

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Generic name: telithromycin

Dosage Strength: 400mg tab

Ketek is a member of the ketolide class of antibiotics. They are structurally related to the macrolides

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Biaxin

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Generic name: clarithromycin

TC: Antibiotic (macrolide)

Indications: bacterial infection

Dosage form: tablet (250,500mg)
ER tab (500mg) - Biaxin XL
granules for oral suspension-oral suspension maintains stability for 14 days when stored at room temp. The reconstituted suspension should not be stored under refrigeration.

Dosing interval: tab and granules for oral suspension - BID
ER tablet - once daily

Other information: Biaxin is used in combination with other medications in the treatment of Helicobacter pylori, a bacteria associated with duodenal ulcers. One trade name product indicated for treatment of H. pylori is Prevpac. Prevpac contains 500mg of clarithromycin, 30mg lansoprazole (Prevacid), and 500mg of amoxicillin. These meds are administered together BID for 14 days.

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Zithromax

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Generic name: azithromycin

TC: antibiotic (azalide) - azalides are a subclass of the macrolides

Indications: bacterial infection

Dosage form: tablet (250,500mg) 250s are available in a unit-of-use package known as a Z-Pak and 500s in one known as a Tri-Pak.
powder for oral suspension
powder for oral suspension (1g single dose)
ER microspheres for oral suspension (2g single dose) - trade name Zmax

Other information: Take without regard to meals.
Zithromax powder for oral suspension (single 1 gram packet) is indicated for the treatment of the sexually transmitted organism Chlamydia trachomatis. Powder should be mixed w/ 60mL of water and administered immediately after mixing.
Zmax provides a full c ourse of antibacterial therapy in a single oral dose. The microspheres should be mixed w/ 60mL of water and consumed as one dose within 12 hours on an empty stomacy.

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Cephalosporins

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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. Cross-reactivity is approximately 3-7% in patients with a documented history of penicillin allergy. Cephalosprins should be administered with caution to penicillin sensitive individuals.

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1st generation cephalosporins

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cefadroxil (Duricef)
cephradine
cephalex (Keflex)

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2nd generation cephalosporins

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cefaclor (Ceclor)
cefprozil (Cefzil)
cefuroxime (Ceftin)

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3rd generation cephalosporins

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cefdinir (Omnicef)
cefpodoxime (Vantin)
cefditoren (Spectracef)

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Miscellaneous cephalosporin info

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Most of these meds are available in both solid and powder for oral suspension dosage forms. Most cephalosporin oral suspensions should be stored under refrigeration. Omnicef oral suspension, however, should be stored at room temp. Cephalosporin oral suspensions are available in a wide variety of flavors.

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Omnicef

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Generic name: cefdinir

TC: Antibiotic (3rd generation cephalosporin)

Indications: bacterial infection

Dosage form: capsule (300mg)
powder for oral suspension (125mg/5mL, 250mg/5mL). Omnicef oral suspension will maintain stability for 10 days when stored at room temp. The reconstituted suspension should not be stored under refrigeration.

Other information: Cefdinir oral suspension may cause orange or red stools. This may be caused by an interaction between cefdinir and dietary iron.

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Macrodantin

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Generic name: nitrofurantoin

TC: antibiotic

Indications: treatment of urinary tract infections

Dosage form: microcrystalline and macrocrystalline
capsules - may be prescribed as a single daily dose for long term suppressive therapy and patients should be instructed to take the medication at bedtime.
ready to use oral suspension (Furadantin) - contains 25mg nitrofurantoin per 5mL oral suspension

Dosing interval: microcrystalline and macrocrystalline - 50 - 100mg four times a day

Other information: The presence of food increases the bioavailability of both micro and macrocrystalline forms.

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Macrobid

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Generic name: nitrofurantoin monohydrate (75mg), nitrofurantoin macrocrystals (25mg)

TC: antibiotic

Indications: bacterial infection of the urinary tract

Dosage form: capsule (100mg)

Dosing interval: BID

Other information: 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.

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Fluoroquinolones

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Broad spectrum, bactericidal antibiotics, 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.

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Additional fluoroquinolone info

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They are not recommended for use in patients less than 18 years of age. This age group was not included in clinical trials b/c they caused lameness in immature dogs due to permanent cartilage lesions. This class of antibiotics has also been associated with rupture of the Achilles tendon. Increased intracranial pressure and seizures have occurred with fluoroquinolones. These meds should be cautiously prescribed to patients with epilepsy or other CNS disorders that may predispose to seizures.

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Available fluoroquinolones

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ciprofloxacin (Cipro)
oflaxacin
norfloxacin (Noroxin)
levofloxacin (Levaquin)
moxifloxacin (Avelox)
gemifloxacin (Factive)
gatifloxacin - opthalmic only

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Oral dosage fluoroquinolones

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norfloxacin
ofloxacin
gemifloxacin

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Oral/parenteral fluoroquinolones

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ciprofloxacin
levofloxacin
moxifloxacin

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Fluoroquinolone phototoxicity

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Pharmacists should counsel patients to use sunscreen when outdoors and to avoid tanning beds while taking fluoroquinolones due to the possibility of phototoxic reactions

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Ophthalmic fluoroquinolone products

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levofloxacin (Quixin)
ofloxacin (Ocuflox)
ciprofloxacin (Ciloxan)
gatifloxacin (Zymar)
moxifloxacin (Vigamox)

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Otic fluoroquinolone products

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ofloxacin (Floxin Otic)
ciprofloxacin with hydrocortisone (Cipro HC Otic)
ciprofloxacin with dexamethasone (Ciprodex)

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Avelox

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Generic name: moxifloxacin

TC: antibiotic (fluoroquinolone)

Indications: bacterial infection

Dosage form: tablet (400mg)

Dosing interval: once daily

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Levaquin

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Generic name: levofloxacin

TC: antibiotic (fluoroquinolone)

Indications: bacterial infection

Dosage form: tablet (250,500,750mg) Levaquin 750mg tabs are also available in a unit-of-use package under the trade name Leva-pak that contains five tabs to be administered once daily.

Dosing interval: once daily

Other information:

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Cipro

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Generic name: ciprofloxacin

TC: antibiotic (fluoroquinolone)

Indications: bacterial infection

Dosage form: tablet (250,500,750mg)
ER tab (500,1000mg)-Cipro XR
oral suspension (5,10%). Each pkg contains microcapsules of ciprofloxacin along with a diluent consisting of sucrose, water, and flavoring. The microcapsules are added to diluent prior to dispensing. Water should not be used to form the suspension. It is stable for 14 days when stored under refrigeration or at room temp. It is not indicated for patients under 18.

Dosing interval: BID

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Vigamox

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Generic name: moxifloxacin

TC: Ophthalmic antibiotic

Indications: ophthalmic bacterial infections

Dosage form: ophthalmic solution

Dosing interval: TID

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Zymar

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Generic name: gatifloxacin

TC: Ophthalmic antibiotic

Indications: ophthalmic bacterial infections

Dosage form: ophthalmic solution

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Ciprodex

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Generic name: ciprofloxacin, dexamethasone

TC: Otic antibiotic/Steriod combination

Indications: otic bacterial infections and inflammatory conditions

Dosage form: otic suspension

Dosing interval: BID

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Bactroban

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Generic name: mupirocin

TC: Topical antibiotic

Indications: impetigo

Dosage form: ointment (2%)
cream (2%)

Dosing interval: TID

Other information: 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.
Another product for treatment of impetigo is Altabax (retapamulin) Ointment. Altabax should be administered BID for 5 days.

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Benzamycin

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Generic name: erythromycin, benzoyl peroxide

TC: Topical antiacne agent

Indications: agent

Dosage form: gel

Dosing interval: BID

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

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BenzaClin

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Generic name: benzoly peroxide, clindamycin

TC: Topical antiacne agent

Indications: acne

Dosage form: gel

Dosing interval: BID

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

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Metrogel-Vaginal

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Generic name: metronidazole

TC: Vaginal antibiotic

Indications: bacterial vaginosis

Dosage form: vaginal gel

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Diflucan

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Generic name: fluconazole

TC: Antifungal (triazole)

Indications: oral and vaginal candidiasis

Dosage form: tablet (50,100,150,200mg)
powder for oral suspension (10mg/40mL) NOTE: Diflucan oral suspension will maintain potency for 14 days when stored at room temp.

Dosing interval: once daily

Other information: Diflucan 150mg as a single oral dose is indicated for vaginal candidiasis. Fluconazole may be administered without regard to meals.

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Azole antifungals which are triazoles

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Sporanox (itraconazole)
Diflucan (fluconazole)
Vfend (voriconazole)
Noxafil (posaconazole)

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Azole antifungal that is an imidazole

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Nizoral (ketoconazole)

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these azoles are indicated for treatment of a variety of systemic fungal infections

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Oral ketoconazole, itraconazole, voriconazole, and posaconazole

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this azole is indicated for treatment of localized fungal infections such as oral or vaginal candidiasis

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fluconazole

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Ketoconazole dosage info

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cream - indicated for treatment of tinea pedis, tinea cruris, and tinea corporis.
shampoo - indicated for recuction of scaling due to dandruff.
tablets should be administered with food to minimize GI irritation.

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rare side effect of oral ketoconazole

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gynecomastia

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Sporanox

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Generic name: itraconazole

TC: antifungal (triazole)

Indications: oral candidiasis

Dosage form: ready-to-use oral solution-indicated for the treatment of oral candidiasis; to achieve max benefit, the patient should swish the oral solution (10mL at a time) in the mouth for several seconds and swallow.
capsules-Sporanox caps should be administered with food for maximum absorption.

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Noxafil

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administer with food for maximum absorption

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Vfend

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only administer on empty b/c food decreases absorption

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fluconazole(Diflucan)

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can be administered with or withoud food

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Vfend (voriconazole)

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should be administered without food b/c food decreases absorption

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Lamisil

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Generic name: terbinafine

TC: antifungal

Indications: onchomycosis, topical fungal infections

Dosage Form: tablet (250mg)
cream

Dosing interval: tablet -once daily
cream - BID

Other information: Treatment of onchomycosis (fingernail): one tab daily for 6 weeks. Treatment of onchomycosis (toenail): one tab 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 SALAD's have occurred between Lamisil and Lamictal (lamotrigine) tablets. Lamictal is an anticonvulsant.

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acyclovir

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oral forms - tablet, capsule, oral suspension
indicated for treatment and prophalyxis of genital herpes, treatment of herpes zoster and varicella
topical forms - cream, ointment
Oral acyclovir is more effective than topical in the treatment of genital herpes. Oral is most effective if started w/in 24 hours of the onset of symptoms. Mild pain, burning, or stinging may occur after topical application.

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Zovirax Oral Suspension

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ready to use suspension that maintains stability at room temperature. It contains 200mg of acyclovir per 5mL of suspension

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Zovirax Ointment

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5% acyclovir in a polyethylene glycol base. It is indicated for initial episodes of genital herpes.

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Zovirax Cream (5%)

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indicated for recurrent herpes labialis.

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Women with genital herpes

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May be at an increased risk of developing cervical cancer. Pap tests should be done yearly to detect early cervical changes.

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Pap test

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(named for Dr. George Papanicolaou)
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-endometrium)

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Denavir Cream

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penciclovir - topical antiviral indicated for treatment of herpes labialis

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Valtrex

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Generic name: valacyclovir

TC: antiviral

Indications: herpes zoster, genital herpes (recurrent)

Dosage Form: tablet

Other information: Herpes zoster - one gram TID for 7 days
Recurrent genital herpes - 500 mg BID for 3 days
Herpes labialis - 2 grams BID for 1 day
Patients allergic to Zovirax should not be prescribed Valtrex b/c valacyclovir is rapidly converted to acyclovir

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Famvir

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Generic name: famciclovir

TC: antiviral

Indications: herpes zoster, genital herpes (recurrent)

Dosage Form: tablet

Other information: Herpes zoster - 500mg TID for 7 days
Genital herpes - 125mg BID for 3 days
Herpes labialis - 1500mg as a single dose

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Tamiflu

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Generic name: oseltamivir

TC: antiviral

Indications: influenza treatment and prophylaxis

Dosage form: capsule (30,45,75mg)
powder for oral suspension (12 mg/mL)

Dosing interval: BID

Other information: The oseltamivir dose in patients 13 and older is 75mg. The dose in patients under 13 is based on the patients weight. Patients should be counseled to take oseltamivir w/ food to reduce the incidence of nausea. Tamiflu oral suspension should be stored under refrigeration and used w/in 10 days of preparation.