Penicillin-Toxicity: low level for all penicillins-ADR: Allergy – wear allergy bracelet if anaphylactic*-DON’T: mix with aminoglycosides + pcn inactivates-Requires: adjustment if renal impairment – levels will get to high and at risk for seizures (renal filtration<50)*Name Use ADR Teaching/Monitoring1st GenerationPCN VK – oralPCN GK, PCN G SodiumPharyngitissyphillusPCN GK+ PCN G Sodium – monitor Na/K respectively (IV)*PCNBenzathine, procain – long acting - IM – never IV (slow absorption)2nd GenerationDicloxcillin (dynapen)Nafacillin/oxacillinCellulitisNon MRSA staphDynapen – empty stomach for absorption3rd Generation Otitis, resp*, skin infections Really upsets the stomach Ampicillin – Amoxicillin (amoxil)Amoxicillin/ clavulante (augmentin)All cause diarrhea – eat food!4th Generation AntipseudomonalTx serious infectionsZoysn – monitor Na*-monitor renal-BP incease – htn/ bp ptsMonitor weight (edema)-resp s/s: SOB, no sleepCephalosporins *** (all start with cef or ceph)Cross sensitivity with PCN – normally give erythromyocinADRs: Allergies, prone to thrombophlebitis(rotate site), nausea(give them food to help)Name Use Monitoring/ADR1st Generationcefazolin(Ancef)cephalexin (keflex)Ancef- surgical prophlyaxisKeflex – primarily skin infections2nd Generation1)cefotetan (cefotan)2) Cefuroxime (cefitin) + cofactor (ceclor)1- GI/ GU infections2- resp tract infections / children with ear infections1- prothrombinlevels, no vitamin k – results in bleeding3rd GenerationCeftriaxone (rocephin)Meningitis, pneumonia, UTI, gonorrhea *rocephin and Ca+ can cause precipitates in neonates lungs and Baby will die!! – Don’t mixNo w/in 48 hours of another-pain at injection site (pre treat with lidocaine)4th Generation Cefepime (maxipime)Serious infection including pneumonias -similar to zoysn w/o sodium effects-assess for poor renal fxnTetracyclines (pt teaching and monitoring)- More ADRs than pcn and ceph- Resistance: can develop over time- ADR: photosensitivity – sever sunburn – wear protective clothing / injury to bone (teeth staining) (don’t give before 8)avoid pregnancy, overgrowth of yeast- GI/Hepatic: hepatotoxicity: ALT, AST, LFT increased - DDI: avoid calcium – binds with drug and decreases absorption, avoid iron- Uses: acne, lyme disease, rocky mtn spotted fever, pneumonia, Chlamydia, ulcers- Names:1) Tetracycline (sumycin) – empty stomach2) ooxycycline(vibramycin) – with food3) minocycine (minocin) – vestibular damage (headache)Administration: 1 hour before food or two hours after foodImipenem (Primaxin) – very broad spectrum antibiotic**(primaxin)cross sensitivity with OCN and Ceph- ADRs: good, most common- GI, allergy rxn, suprainfections, adjust dose in renal pts, decrease dose (avoid seizures)- Positives: well tolerated for mixed infections = well tolerated in most ptsMacrolides – all the myocins- DDI: increases the drug level of Coumadin(increases bleeding time), increased lvls of tegratol, increased lvls of theophyline- increase INR: increase bleeding – decrease Coumadinmust measure peak (30 min after), and trough(no more than 30 minutes before next dose)- ADRs: GI common (food), QT prolongation – ventricular dysrhythmia- Use: sub for PCN, 1st line defense for diphtheria, Chlamydia, mycoplasm, pneumonia- Names:o Erythromycino Clarithromycin (Biaxin) Less GI, less dosing DDI, same as erythro More expensiveo Azithromycin (Zithromax) Once a day, less GI Fewer DDI More expensiveAminoglycosides- Examples: gentamyocin/ tobramyocin/ amikacin. neomycin- Monitoring: peaks and troughs, BUN, serum creatine, I&O- DDIs: Loops (ototoxicity) amp b (nephrotoxicity) skeletal muscle relaxants (worsens paralysis)- ADRs: renal toxicity, ototoxicity (tinnitus – cochlear) vestibular damage+ headaches, renal (contributes to dys) - Other Information: Do not mix it with PCN (PCN will inactivate it), not good for staph/ strepVancomycin – absorption from gut poor – usually IV- Treatment for:o Great for MRSAo C. Difficile (pseudomembranous collitis)- Great For: Staph/ MRSA, people with PCN allergies- ADRs: Red Mans syndrome- infusion rxn(slow infusion), ototoxicity(tinnitus)- Monitoring: peaks and troughs / trough associated with efficacy ~opposite of aminoglycosidesSulfonamides- ADRs: rash(SJS+ ST OP), monitor blood abnormalities(leucopenia – anemia- bleeding (decrease in hemoglobin)), hemolytic anemia, photosensitivity, SJS, Kernicterus none< 2 months of life– increase bilirubin, renal damage (increase fluids)- DDI: Warfarin- increase INR, bleeding, phenytoin (dilantin) – ataxia, drowsiness, nystagmus- Combination: Bactrim+Septrum –tx UTIs, sinus/ear infections, pneumonia (PCP)Fungal InfectionsA) Systemic – treats blood, central nervous system, and deep tissues1) Amphotericin B-IV (only given IV) – *NEVER GIVE AS A BOLUS!- Use: drug of choice- MOA: Cell leaking- Spectrum: broad- ADRs: Renal toxicity(everyone- even otherwise healthy individuals), hypokalemia, infusion rxns (fever, chills, rigor, HA-can pre-medicate)- Monitor: BUN and serum Creatine (we would see decrease with both) Always start with a test dose to see if they can tolerate it2) Azoles : - Use: systemic + superficial infections- MAO: cell leaking- Spectrum: broad- ADR: N/HA/Hepatotoxicity*- Examples: requires acidic environment o Ketoconazole (nizoral)o Itracazole (diflucan) – treats yeast infectionsCoumadin(bleeding) – monitor INR for increaseB) Superficial ADRs associated with topical creams: itching, irritation, burning1) Griseofulvin (PO)– Give with fatty meal = increase absorption - MAO: disrupts the mitosis of fungus- Use: fungus of the skin, hair, and nails- ADRs: HA, liver disease- Monitor: AST, LFT2) Nystatin - Use: Candida(Yeast infection) - used to treat thrush in babies- Administration:o PO: Intestinal fungal infectiono Topical: skin, mouth, esophagus, vagina- ADRs: PO- n/v/d –local irritation / topical: burning, itching, irritation - GI irritation- **used for thrush in infants3) Terbinafine (Lamisil) - MAO: no synthesis of ergosterol (cell membrane)- Uses: skin infections, topical OTC, nail infection (PO)- ADRs with oral: HA, and Diarrhea *liver damage - hepatotoxicityMetronidazole (Flagyl)- Use: GI/ GU infections, PUD, pseudomembranous colitis- ADRs: metallic taste common – N/V/D : take with food- DDI: disulfiram rxn with