Medical Review. Anti-Infective Drugs. Pharmacy Technician Training Systems PassAssured, LLC
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1 Medical Review Anti-Infective Drugs Pharmacy Technician Training Systems PassAssured, LLC
2 Medical Review: Anti-Infectant Drugs PassAssured's Pharmacy Technician Training Program Medical Review Anti-Infectant Drugs Click Here for Glossary Index! (Internet Access is Required for this Feature) Click Here to Print Topic Help File,.pdf (Internet Access is Required for this Feature) Definitions Antibacterials Urinary Anti-Infectives Antibiotics Antifungals Antiparasitic Agents Antitubercular Agents Antiviral Agents PassAssured, LLC, Pharmacy Technician Training Systems Copyright PassAssured, LLC, Web Site - -o- p2
3 PassAssured's Pharmacy Technician Training Program Medical Review Anti-Infectant Drugs Click Here for Glossary Index! (Internet Access is Required for this Feature) Click Here to Print Topic Help File,.pdf (Internet Access is Required for this Feature) Medical Review: Anti-Infectant Drugs 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 Photosensitivity - protect from the sun Allergy Antibacterial sulfonamides (Sulfa Agents) p3
4 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 Urinary Anti-Infectives Concentrated in the urine and are used for urinary tract infections (UTI's) 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, 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 day p4
5 expirations. Mechanism of action Prevents bacteria from growing Pencillins, Cephalosporins - Legend Drug Penicillins Allergy Nausea/vomiting/diarrhea Penicillin (Pen-VK ) - Legend Drug Amoxicillin (Amoxil ) - Legend Drug Ampicillin (Amcill ) - Legend Drug Dicloxacillin (Dynapen ) - Legend Drug Nafcillin (Nafcil ) - Legend Drug Piperacillin (Pipracil ) - Legend Drug Ticarcillin (Ticar ) - Legend Drug Cephalosporins 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. p5
6 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. Second Generation: Cefaclor (Ceclor ) - Legend Drug Cefoxitin (Mefoxin ) - Legend Drug Cefprozil (Cefzil ) - Legend Drug 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. 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 Cefditoren (Spectracef ) - Legend Drug Fourth generation cephalosporins are extended spectrum agents with similar activity against gram-positive organisms as first p6
7 generation cephalosporins. They also have a greater resistance to beta-lactamases than the third generation cephalosporins. Many can cross the blood brain barrier and are effective in meningitis. Fourth Generation: Cefepime (Maxiprime ) - Legend Drug Ceftaroline (Teflaro ) - 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 GI upset Headache Ciprofloxacin (Cipro ) - Legend Drug Ofloxacin (Floxin ) - Legend Drug Norfloxacin (Noroxin ) - Legend Drug Levofloxacin (Levaquin ) - Legend Drug Moxifloxacin (Avelox ) - Legend Drug considered a drug of last resort when all other antibiotics have failed. Gemifloxacin mesylate (Factive ) - Legend Drug Macrolides GI upset p7
8 Diarrhea Erythromycin (EES, Eryc ) - Legend Drug Azithromycin (Zithromax ) - Legend Drug Clarithromycin (Biaxin ) - Legend Drug Fidaxomicin ( Dificid ) - Legend Drug Daptomycin (Cubicin)- Legend Drug Ketolides Are antibiotics belonging to the macrolide group that are modified, giving them a much broader spectrum than other macrolides. Diarrhea Nausea Abdominal Pain Vomiting Example Telithromycin (Ketek ) - Legend Drug Tetracyclines Photosensitivity CAUTION: Binds to Ca products (dairy products), binds to aluminum and magnesium. Use protection in sunlight. Tetracycline (Achromycin, Sumycin ) - Legend Drug p8
9 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. GI upset Diarrhea Example Tigecycline (Tygacil ) - Legend Drug Aminoglycosides Used in Hospitals Kidney damage Ototoxicity Gentamicin (Garamycin ) - Legend Drug Tobramycin (Nebcin ) - Legend Drug Amikacin (Amikin ) - Legend Drug Neomycin (Mycifradin Sulfate ) - Legend Drug Streptomycin - Legend Drug Miscellaneous: p9
10 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 - treatment bacterial infections Bacitracin topical - Legend Drug- A broad spectrum antibiotic Metronidazole (Flagyl ) - Legend Drug - used particularly for anaerobic bacteria and protozoa 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 Kidney damage with systemic antifungals 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 p10
11 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. Posaconazole (Norafil )-Legend Drug-used to prevent serious fungal infections in people with a weakened ability to fight infection 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 Stomach upset nausea/diarrhea 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 p11
12 antiparasitic agent (treat worms) Amebicides - Amoeba Infections Side effects - same as Antibuse Avoid alcohol due to a vomiting reaction Metronidazole (Flagyl ) - Legend Drug Chloroquine (Aralen ) - Legend Drug - indication; treatment of extraintestinal amebiasis. Iodoquinol (Yodoxin ) Legend Drug-treatment of intestinal amebiasis Antitubercular Agents 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 Red urine Liver damage Optic neuritis Rifampin (Rifadin ) - Legend Drug Isoniazid (INH ) Legend Drug p12
13 Ethambutol (Myambutol ) - Legend Drug Pyrazinamide - Legend Drug- Aminosalicylic Acid (Paser ) Legend Drug Bedaquiline (Sirturo ) Legend Drug Ethionamide (Trecator ) Legend Drug Antiviral Agents Use To treat viral infections Antivirals for treatment of influenza Amantadine (Symmetrel ) - Legend Drug Rimantadine (Flumadine ) - Legend Drug Zanamivir (Relenza ) - Legend Drug Oseltamivir (Tamiflu ) - Legend Drug Nausea CNS effects Antivirals for the Herpes Virus Acyclovir (Zovirax ) - Legend Drug Famciclovir (Famvif ) - Legend Drug Valacyclovir (Valtrex ) - Legend Drug Side effects Nausea/ vomiting Antivirals used for HIV and AIDS p13
14 Protease inhibitors : Nausea/ vomiting Muscle weakness Indinavir (Crixivan ) - Legend Drug Nelfinavir (Viracept ) - Legend Drug Ritonavir (Norvir ) - Legend Drug Saquinavir (Invirase ) - Legend Drug Atazanavir (Reyataz ) - Legend Drug Darunavir (Prezista ) - Legend Drug Fosamprenavir (Lexiva ) - Legend Drug Non-nucleoside reverse transcriptase inhibitors Nevirapine (Viramune ) - Legend Drug Delavirdine (Rescriptor ) - Legend Drug Reverse transcriptase inhibitors: : Nausea/ diarrhea Anemia Headache Insomnia Fatigue Peripheral neuropathy Zidovudine (AZT, Retrovir ) - Legend Drug Didanosine (Videx ) - Legend Drug Lamivudine (Epivir ) - Legend Drug p14
15 Stavudine (Zerit ) - Legend Drug PassAssured, LLC, Pharmacy Technician Training Systems Copyright PassAssured, LLC, Web Site - -o- p15
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