Faculty Patient Information Leaflets: Discussion of Zirthomax, Charlie C. Thomas, BPharm, RPh, FAPhA Rocephin, Doxycycline, State Pharmacy Director Erthromycin, Flagyl and Alabama Department of Public Health Bicillin L-A Amanda Holloway Satellite Conference and Live Webcast Pharm D Candidate Wednesday, January 20, 2010 Auburn University 8:00 - 9:00 a.m. Central Time Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division Objectives Objectives • Discuss the use of the Patient • Describe the importance of proper Information Leaflet (PIL) when patient counseling prior to DISPENSING medication in ADPH administering/dispensing medication Clinics • List conditions that may • Define the proper use of PILs when contraindicate medication dispensing medications in ADPH administered and/or dispensed by clinics ADPH nurses Objectives Azithromycin (Zithromax) • Identify medications that may • Azithromycin is a macrolide conflict with those antibiotic used to treat bacterial administered/dispensed from the infections, including those that are ADPH sexually transmitted • It has a half-life of 68 hours – Single dose stays in the body for an extended period (>3 days) 1 Azithromycin: What You Need Azithromycin: What You Need to Know About Your Patient to Know About Your Patient • History of • Is the patient pregnant or trying to – Kidney disease become pregnant? – Liver disease • Is the patient breastfeeding? – Irregular heart beat or heart disease – Allergic reaction to a previous dose of azithromycin, other macrolide antibiotics, foods, dyes, or preservatives Azithromycin: Important Ceftriaxone (Rocephin) Drug Interactions • Lincomycin • Magnesium • Ceftriaxone is a parenteral third- • Amiodarone • Nelfinavir generation cephalosporin antibiotic • Antacids • Phenytoin – Half-life is 6-9h • Cyclosporine • Warfarin • Digoxin • Ergotamine or Dihydroergotamine Ceftriaxone: What You Need Ceftriaxone: What You Need to Know About Your Patient to Know About Your Patient • History of • Pregnant or trying to get pregnant? – Any chronic illness – Bowel disease (colitis) • Breast-feeding? – Concurrent kidney and liver disease – Unusual or allergic reaction to ceftriaxone, other cephalosporin or penicillin antibiotics, foods, dyes or preservatives 2 Ceftriaxone: Important Doxycycline Drug Interactions (Monodox, Vibramycin) • Calcium • Doxycycline is a tetracycline – Do not take this medication with antibiotic Ceftriaxone • Half-life is 12-15 hours • Coumadin (Warfarin) • Alcohol • Some other antibiotics Doxycycline: What You Need Doxycycline: What You Need to Know About Your Patient to Know About Your Patient • History of • Do they plan to be out in the sun for – Severe liver disease long periods of time? – Unusual or allergic reaction to • Pregnant or trying to become doxycycline, tetracycline pregnant? antibiotics, other medicines, foods, • Breast-feeding? dyes, or preservatives – Bowel disease (ulcerative colitis or Crohn’s) Doxycycline: Important Erythromycin Base Drug Interactions • Antacids containing Ca, Mg, Al • Erythromycin is a macrolide • Vitamins containing iron or zinc antibiotic • Pepto-Bismol – Half-life is 1.5-2 hours • Seizure Medications (Phenytoin, Carbamazepine, Phenobarbital) • Coumadin (Warfarin) • Birth control pills • Other antibiotics 3 Erythromycin Base: What to Erythromycin Base: Know About Your Patient Important Drug Interactions • History of • DO NOT take Erythromycin with the following drugs – Severe liver disease – Chloroquine – Myasthenia Gravis – Cisapride – Unusual or allergic reaction to – Droperidol erythromycin, other medicines, foods, dyes, or preservatives – Eplerenone • Pregnant or trying to get pregnant? – Ergotamine/Dihydroergotamine – Methadone • Breast-feeding? Erythromycin Base: Erythromycin: Important Important Drug Interactions Drug Interactions • DO NOT take Erythromycin with the • Chloroquine, Cisapride, Droperidol & following drugs anti-arrhythmic drugs (Amiodarone, Dofetilide, Propafenone) – Fluoroquinolones • Eplerenone – Sirolimus • Methadone – Some cholesterol medications • Cholesterol lowering medications (statins, red yeast rice) (statins, red yeast rice) – Vinblastine • Digoxin Erythromycin: Important Metronidazole (Flagyl) Drug Interactions • Antibacterial and antiprotozoal agent • Warfarin that belongs to the nitroimidazole • Seizure medications (Phenytoin, Carbamazepine) class • Theophylline – Half-life is 8h • Bromocriptine • Cyclosporine and Tacrolimus 4 Metronidazole: What You Need Metronidazole: What You Need to Know About Your Patient to Know About Your Patient • History of – Alcohol consumption – Anemia or other blood disorders – Unusual or allergic reaction to • Pregnant or trying to become metronidazole, or other medicines, pregnant? foods, dyes, or preservatives – Disease of nervous system (seizure • Breast-feeding? or peripheral neuropathy) – Severe liver disease – Fungal or yeast infection Metronidazole: Important Penicillin G Benzathine Drug Interactions (Bicillin L-A) • Alcohol • Penicillin G Benzathine is a long • Disulfiram acting form of penicillin G • Ritonavir, Timpranivir, Amprenavir, Sertraline oral solutions • After injection, a depot forms in the tissue and slowly releases the drug • Cimetidine into the blood stream over several • Lithium days • Phenytoin • Phenobarbital – Serum levels can be detected up to • Warfarin 30 days after a single doses Bicillin L-A: What You Need Bicillin L-A: What You Need to Know About Your Patient to Know About Your Patient • History of • Pregnant or trying to become – Asthma pregnant? – Severe kidney disease • Breast-feeding? – Unusual or allergic reaction to penicillin G benzathine, any penicillin or cephalosporin antibiotic, other medicines, foods, dyes, or preservatives 5 Bicillin L-A: Allergy Considerations Important Drug Interactions • In addition to hypersensitivity • Aspirin, Indomethacin, probenacid, reactions to the active drug therapy, Ethacrynic acid, Phenylbutazone, patients may have an allergy to one diuretics (HCTZ, Lasix, etc.) of the inactive components of the • Birth control pills drug formulation • Methotrexate • All patients need to be asked if they • Typhoid vaccine have any medication, food, dye, or preservative allergies In Summary Resources • Dispensing medications requires • Clinical Pharmacology [database specific procedures according to laws, online]. Tampa, FL: Gold Standard, rules, and regulations Inc.;2009. URL: • Nurses should be aware of important http://www.clinicalpharmacology.com health conditions or disease states • Lexi-Comp [database online]. listed on the Patient Information Leaflets that may interact and what Hudson, OH: Lexi-Comp, Inc. actions they should take to resolve Copyright © 1978-2009. these interactions before dispensing http://www.crlonline.com/crlsql /servlet/crlonline medications in the health department Resources • Drug Facts and Comparisons. Electronic edition. St. Louis: Wolters Kluwer Health, May 2009. 6.