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Medication Review Anti-Infective Drugs

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Medication Review, Anti-Infectant Drugs

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Medication Review Anti-Infectant Drugs

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Definitions Ketolide Urinary Anti-Infectives Tetracyclines Antibiotics Glycylcyclines Penicillins Antiparasitic Agents Cephalosporins Antitubercular Agents Quinolones Antiviral Agents Macrolides

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PassAssured's Pharmacy Technician Training Program

Medication Review Anti-Infectant Drugs

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Definitions

Bacteriostatic  Allows the body's natural defense mechanisms to have time to destroy the microorganisms by inhibiting bacterial growth

Bactericidal  Kills the microorganisms

Therapeutic Classes

Antibacterials

 Unlike antibiotics, antibacterials are not synthesized from microorganisms.  Usually bacteriostatic, but some are considered bactericidal

Side Effects  Photosensitivity - protect from the sun  Allergy

Antibacterial sulfonamides (Sulfa Agents) Sulfacetamide (Sulamyd®) - Legend Drug Sulfamethoxazole (Gantanol®) - Legend Drug

Other antibacterials Acetic Acid (VoSol®) - Legend Drug Povidone - Iodine (Betadine®, Medicated douches) - OTC Product Hexachlorophen (pHisoHex®) - OTC Product

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Urinary Anti-Infectives

 Concentrated in the urine and are used for urinary tract infections (UTI's)

Examples: Nirofurantoin (Macrodantin, Macrobid®) - Legend Drug- take with food, drink plenty of fluid Norfloxacin (Noroxin®) - Legend Drug - take on empty stomach and drink plenty of fluids

Note: Pyridium (Phenazopyridine) - Legend Drug - is often given with urinary anti-infectives for urinary pain, may discolor urine and should have auxiliary label "May Discolor Urine Red".

Antibiotics

 Synthesized by microorganisms - grown  Can be bacteriostatic or bactericidal

Patient Information  Most are taken on an empty stomach (one hour before or two hours after a meal) to ensure proper absorption  Should be taken for the full course of therapy

 Certain liquid antibiotics (procaine penicillin G for injection Bicillin L-A) need refrigeration and certain powders need to be reconstituted. Once reconstituted, some of these products should have 10 – 14 day expirations.

Mechanism of action

 Prevents bacteria from growing

Examples: Pencillins, Cephalosporins - Legend Drug

Penicillins

Side Effects  Allergy  Nausea/vomiting/diarrhea p4 ______© PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems

Examples: Penicillin (Pen-VK®) - Legend Drug Amoxicillin (Amoxil®) - Legend Drug Ampicillin (Amcill®) - Legend Drug Cloxacillin (Tegopen®) - Legend Drug Dicloxacillin (Dynapen®) - Legend Drug Nafcillin (Nafcil®) - Legend Drug Piperacillin (Pipracil®) - Legend Drug Ticarcillin (Ticar®) - Legend Drug

Cephalosporins

Side Effects  Allergy  Nausea/vomiting/diarrhea

First generation cephalosporins are moderate spectrum agents. They are effective alternatives for treating staphylococcal and streptococcal infections and; therefore, are alternatives for skin and soft-tissue infections, as well as for streptococcal pharyngitis.

Examples First Generation:

Cephalexin (Keflex®) - Legend Drug Cefadroxil (Duricef®) - Legend Drug Cefazolin (Ancef®) - Legend Drug

The second generation cephalosporins have a greater gram-negative spectrum while retaining some activity against gram-positive bacteria. They are also more resistant to beta-lactamase. They are useful agents for treating upper and lower respiratory tract infections, sinusitis and otitis media.

Examples Second Generation:

Cefaclor (Ceclor®) - Legend Drug Cefoxitin (Mefoxin®) - Legend Drug Cefprozil (Cefzil®) - Legend Drug

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Cefuroxime (Ceftin®) - Legend Drug Cefotetan (Cefotan®) - Legend Drug Cefmetazole (Zefazone®) - Legend Drug

Third generation cephalosporins have a broad spectrum of activity and further increased activity against gram-negative organisms.

Examples Third Generation:

Cefdinir (Omnicef®) - Legend Drug Cefixime (Suprax®) - Legend Drug Cefpodoxime (Vantin®) - Legend Drug Ceftriaxone (Rocephin® -) Legend Drug Cefotaxime (Claforan®) - Legend Drug Ceftibuten (Cedax®) - Legend Drug Ceftazidime (Fortaz®, Ceptaz®) - Legend Drug

Fourth generation cephalosporins are extended spectrum agents with similar activity against gram-positive organisms as first generation cephalosporins. They also have a greater resistance to beta-lactamases than the third generation cephalosporins. Many can cross blood brain barrier and are effective in meningitis.

Examples Fourth Generation:

Cefepime (Maxiprime®) - Legend Drug

Quinolones

 Have many drug interactions - antacids decrease the absorption and should be given 2 to 4 hours apart.  Cimetidine (Tagamet®) - OTC Drug - increases the effect  Caffeine clearing from the body is reduced  Theophylline levels are increased

Side Effects  GI upset  Headache

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Examples: Ciprofloxacin (Cipro®) - Legend Drug Ofloxacin (Floxin®) - Legend Drug Norfloxacin (Noroxin®) - Legend Drug Levofloxacin (Levaquin®) - Legend Drug Cinoxacin (Cinobac®) - Legend Drug Nalidixic Acid (NegGram®) - Legend Drug Moxifloxacin (Avelox®) - Legend Drug considered a drug of last resort when all other antibiotics have failed.[ Lomefloxacin( Maxaquin®) - Legend Drug Gemifloxacin mesylate (Factive®) - Legend Drug

Macrolides

Side Effects  GI upset  Diarrhea

Examples: Erythromycin (EES®, Eryc®) - Legend Drug Azithromycin (Zithromax®) - Legend Drug Clarithromycin (Biaxin®) - Legend Drug Dirithromycin (Dynabac®) - Legend Drug

Ketolide

Side Effects  Diarrhea

 Nausea

 Abdominal pain

 Vomiting Example Telithromycin (Ketek®) - Legend Drug

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Tetracyclines

Side Effects  Photosensitivity

CAUTION: Binds to Ca products (dairy products), binds to aluminum and magnesium. Use protection in sunlight.

Examples: Tetracycline (Achromycin®, Sumycin®) - Legend Drug Doxycycline (Vibra-Tabs®) - Legend Drug Minocycline (Minocin®) - Legend Drug Demeclocycline (Declomycin®) - Legend Drug

Glycylcyclines

Glycylcyclines are a new class of antibiotics derived from tetracycline. These tetracycline analogues are specifically designed to overcome tetracycline resistance bacteria.

Side Effects  GI upset  Diarrhea Example Tigecycline (Tygacil ®) - Legend Drug Aminoglycosides - Used in Hospitals

Side Effects  Kidney damage  Ototoxicity

Examples: Gentamicin (Garamycin®) - Legend Drug Tobramycin (Nebcin®) - Legend Drug Amikacin (Amikin®) - Legend Drug Neomycin (Mycifradin Sulfate®) - Legend Drug Streptomycin - Legend Drug

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Miscellaneous: Vancomycin (Vancocin®) - Legend Drug - Used in serious or severe infections not treatable with other antimicrobials Clindamycin (Cleocin®) - Legend Drug - Use: anaerobes - serious respiratory infection, GI infection Sulfamethoxazole and Trimethoprim (Bactrim®, Septra®, Cotrim®, SMZ-TMP®) – Legend Drugs Imipenem and Cilastatin (Primaxin®) - Legend Drugs - For I.V. use Chloramphenicol - Legend Drug Bacitracin - Legend Drug Metronidazole (Flagyl®) - Legend Drug

Antifungals

Use  To treat topical and systemic fungal infections

Patient Information  Many of these need to be protected from light and heat.  Most need to be taken with meals to help with stomach upset.

Side Effects  Kidney damage with systemic antifungals

Examples: Amphotericin B (Fungizone®) - Legend Drug - must protect from light. Ketoconazole (Nizoral®) - Legend Drug Miconazole (Monistat®) - Legend Drug Fluconazole (Diflucan®) - Legend Drug Nystatin (Mycostatin®) - Legend Drug Clotrimazole (Lotrimin®, Mycelex®, Gyne-Lotrimin®) - OTC Drug/Legend Drugs Griseofulvin (Fulvicin P/G®) - Legend Drug Intraconozole (Sporanox®) - Legend Drug Terbinafine (Lamisal®) – cream: OTC Drug/ tablets: Legend Drug Voriconazole (VFEND) - Legend Drug - is generally used to treat serious, invasive fungal infections.

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Antiparasitic Agents

Use  To treat parasitic infections (parasites are organisms which need a host to complete their life cycle)

Patient Information  Many of these agents can cause stomach upset, so they need to be taken with food.

Antihelminthics - Worm Infections

Side Effects  Stomach upset nausea/diarrhea

Examples: Mebendazole (Vermox®) - Legend Drug - Used to treat worms, whipworms, pinworms, roundworms, hookworms Pyrantel Pamoate (Antiminth®) - Legend Drug - Used to treat roundworms, pinworms Albendazole (Albenza®) - Legend Drug - tapeworms Piperazine (Vermizine®) - Legend Drug - pinworms, roundworms Praziquantel (Biltricide®) - Legend Drug - effective against flatworms Ivermectin (Stromectol ®) - Legend Drug - broad-spectrum antiparasitic agent (treat worms)

Amebicides - Amoeba Infections

Side effects - same as Antibuse  Avoid alcohol due to a vomiting reaction

Examples: Metronidazole (Flagyl®) - Legend Drug Chloroquine (Aralen®) - Legend Drug - indication; treatment of extraintestinal amebiasis.

Antitubercular Agents

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Use  To treat tuberculosis  Combination therapy with several agents is usually required to avoid resistance  Purified protein derivative is an agent used to detect tubercular infections

Examples: Rifampin (Rifadin®) - Legend Drug - side effect: red urine Isoniazid (INH®) Legend Drug - side effect: liver damage Ethambutol (Myambutol®) - Legend Drug - side effect: optic neuritis Pyrazinamide - Legend Drug- side effect: liver damage, gout

Antiviral Agents

Use  To treat viral infections

Antivirals for treatment influenza

Amantadine (Symmetrel®) - Legend Drug Rimantadine (Flumadine®) - Legend Drug Zanamivir (Relenza®) - Legend Drug Oseltamivir (Tamiflu®) - Legend Drug

Side Effects  Nausea  CNC effects

Antivirals for the Herpes Virus

Acyclovir (Zovirax®) - Legend Drug Famciclovir (Famvif®) - Legend Drug Valacyclovir (Valtrex®) - Legend Drug

 Side effects include nausea/vomiting

Antivirals used for HIV and AIDS

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Protease inhibitors Side Effects:

 Nausea/vomiting

 Muscle weakness

Examples: Indinavir (Crixivan®) - Legend Drug Nelfinavir (Viracept®) - Legend Drug Ritonavir (Norvir®) - Legend Drug Saquinavir (Invirase®) - Legend Drug

Non-nucleoside reverse transcriptase inhibitors Nevirapine (Viramune®) - Legend Drug Delavirdine (Rescriptor®) - Legend Drug

Reverse transcriptase inhibitors: Side Effects:  Nausea/diarrhea  Anemia  Headache  Insomnia  Fatigue  Peripheral neuropathy

Examples: Zidovudine (AZT®, Retrovir®) - Legend Drug Didanosine (Videx®) - Legend Drug Lamivudine (Epivir®) - Legend Drug Stavudine (Zerit®) - Legend Drug

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