Penicillin

Narrow - Pfizerpen, Bicillin, Veetids

Broad - Augmentin, Principen

Antistaph - Unipen

Antipsuedomonas - Timentin, Zosyn

Weaken bacterial cell wall

Adverse: Renal Impairment, Anaphylaxis

Hyperkalemia (Pfizerpen), Hypernatremia (Timentin)

Penicillin inactivates: aminoglycosides if mixed in IV

Probenecid delays penicillin excretion

Cross allergies with and cephalosporins and imipenem

Veetid and Augmentin with Food, the rest 1hr before and 2hr after food with full glass of water

Cephalosporins (begin with cef)

 1 - Keflex, Ancef, 2 - Ceclor, Cefotan, 3 - Rocephin, Calaforan,  4 -  Maxipime

4 is safest from beta lactamase and more likely to reach CSF and more effective against gram neg

destroy bacterial cell walls

Adverse Effects: pseudomembranous colitis (diarrhea - notify provider and dc med), Thrombophlebitis @ IV site

Rocephin and Cefotan - watch for bleeding

Ancef, Cefotan, Cefoperazone - AVOID ALCOHOL

Take with food

Carbapenems

imipenem-cilastatin (Primaxin)

Meropenem (Merrem IV)

beta lactam - destroy bacterial cell walls

Adverse: GI (N/V, diarrhea), Suprainfection

Causes decreased blood lvls of Depakote resulting in breakthrough seizures

Other Inhibitors

Vancomycin (Vancocin)

Axtreonam (Azactam)

Fosfomycin (Monurol)

destroys bacterial cell wall

Adverse: Ototoxicity, thrombophlebitis, Renal toxicity

Vancomycin - Increased risk for Ototoxicity with other Ototoxic drugs (loop diuretics and aminolycosides)

-admin slowly to prevent infusion reaction (rashes, flusing, tachycardia, hypotension)

Don't use with corn allergy

Tetracyclines

Doxycycline (Vibramycin)

minocycline (Minocin)

demeclocycline (Declomycin)

broad spectram - inhibits growth by inhibiting protein synthesis (bacteriostatic)

Adverse:

GI (N/V, diarrhea, ulcers, cramping) - Don't take at bed time to prevent ulcers

tooth dicoloration, hypoplasia of tooth enamal - avoid admin to kids under 8 and pregnant women

hepatotoxicity, photosensitivity, suprainfection of bowel

Reduced absorption: admin within 1hr before to 3hr after of calcium, magnesium, or iron

oral contraceptives don't work

increased risk of digoxin toxicity

Macrolides (-romycin)

erythromycin (E-Mycin)

azithromycin (Zithromax)

Good for Pt with Penicillin Allergy

slows growth by inhibiting protein synthesis (bacteriostatic) can be cidal at high doses

Adverse:

GI (N/V, epigastric pain) - take with meals

prolonged QT (dysrhythmias, sudden cardiac arrest)

Ototoxicity - high dose only

Avoid: prolonged QT, liver disease

Interactions:

Inreased risk of these drugs toxicity: antihistamines, theophylline, carbamazepine, warfarin, digoxin

Erythromycin toxicity risk with: verapamil, diltiazem, HIV protease inhib., antifungl medicaations, nefzodone

Aminoglycosides

Amikacin (Amikin)

Tobramycin

Streptomycin

Neomycin (Mycifradin)

Paromomycin

bactericidal - disrupting protein synthesis

Adverse:

Ototoxicity - stop with manifestations (balance & hearing)

Nephrotoicity - Report hematuria (BUN, creatinene)

Stronger neuromuscular blockade in muscle relaxants

 - resp. depression

Neurologic disorder (neuritis, tingling, numbness)

 Nephroxic drugs to avoid: amphotericin B, cephalosporins, vancomycin

neuromuscular blocking agents to avoid: tubocurarine

Ototoxic drugs to avoid: ethacrynic acid, loop diuretics, salicylates

Sulfonamides

Sulfamethoxazole

Sulfadiazine

 (Trimethoprim)

Sulfa Allergies extend to: Loop diuretics, tolbutamide, microzide (thiazide diuretics) 

kills bacteria by preventing synthesis of folic acid

Adverse:

SJS, blood dyscrasias, crystalluria, kernicterus, photosensitivity

Increase effects of coumadin, dilantin, sulfa hypoglycemics, orinase

Contraindication:

folate deficiency, renal dysf, old people taking ACE I. or ARBs bc hyperkalemia

take on empty stomach with water

Urinary Tract Antiseptics

nitrofurantoin (Furadantin, Novo-Furan)

nitrofurantoin macrocrystals (Macrodantin, Macrobid)

Methenamine (Hiprex, Urex)

bacteriostatic/cidal by damaging DNA

GI discomfort (admin with milk/meals)

Hypersensitivity - Pulmonary manifestations

blood dyscrasias

peripheral neuropathy

HA, drowsiness,dizziness

Toxicity with creatinine clearance less than 40

urine will be brown

avoid crushing - teeth staining

not when pregnant

Fluoroquinolones

Ciprofloxacin (Cipro)

ofloxacin (Floxin

moxifloxacin (Avelos)

levofloxacin (Levaquin)

Norfloxacin (Noroxin

bactericidal by inhibiting enzyme necessary for DNA replication

Adverse:

GI issues, Achilles tendon rupture(no admin to ppl <18)

Suprainfection, phototoxicity

 CNS effects: dizziness, HA, restlesssness, confusion

Contraindications:

increased risk for C. Diff,

Cationic compounds (aluminum-magnesium antacids, iron salts, sucralfate, dairy) decrease absorption

Plasma levels of theophylline and coumadin can increase with cipro use

Urinary Tract Analgesic

phenazophyridine (PYridiate, Pyridium, Urogesic)

azo dye that functions as a local anesthetic on the mucosa of the urinary tract

urine goes orange

contraindicated for ppl with kidney injury or disease

Antimycobacterial (Antituberculosis)

isoniazid (INH, Nydrazid)

Pyrazinamide (PZA)

Ethambutol (Myambutol)

Rifapentine (Priftin)

specific for mycobacteria

Adverse: Peripheral neurophathy (B12 def-pyridoxine), hepatotoxicity, Hyperglycemia, phenytoin toxicity

Avoid Alcohol, inject deep muscle,

Antituberculosis

Rifampin (Rifadin)

bactericidal - inhibition of protein synthesis

Adverse: orange body fluids, hepatotoxicity, mild GI discomfort

may need incrased dose of HIV meds, watch PT/INR, oral contraceptives unaffective, avoid alcohol

1 hr before-2 hr after meal admin

AntiProtozoals

metronidazole (Flagyl)

bactericidal against anaerobic micro-organisms

Gi discomfort (n/v, dry mouth, metallic taste)

darkening of urine, CNS: ataxia, seizures, numbness

Avoid alcohol, watch PT/INR, Don't give to ppl with CNS disorders, blood dyscrasias, lactating

Antifungals

amphotericin B (fungizone)

ketoconazole (Nizoral)

flucytosine (ancobon)

Nystatin (mycostatin)

miconazole (Monistat)

Clotrimazole (lotrimin)

Terbinafine (Lamisil)

Fluconazole (diflucan)

Griseofulvin (Grifulvin)

acts on fungal cell membranes

infusion reaction (fever, chills, rigors, HA 1-3 hrs after)

THrombophlebitis, Nephrotoxicity, hypokalemia, Bone marrow supression

Ketoconazole - heptotoxicity, sex hormones (males - gynecomastia, decreased libido, erectile dysf, females - irregular menstrual flow)

Anti Virals

Acyclovir (Zovirax)

Granciclovir (Cytovene)

Interferon alfa-2b (Intron A)

Lamivudine (Epivir)

Oseltamivir (Tamiflu)

Ribavirin (rebeetol)

Amantadine (symmetrel)

Boceprevir (Victrelis)

Telaprevir (Incivek)

prevent the reproduction of viral DNA

Acyclovir - phlebitis at IV site, Nephrotoxicity , nausea, diarrhea, HA

used with zidovudine-drowsyness, probenecid - decreased elimination

Ganciclovir - bone marrow supression, fever, HA, nausea, diarrhea

Antiretroviral (HIV)

Fusion/Entry Inhibitor

enfivirtide (fuzeon) subQ

bacterial pneumonia

hypersensitivity -  fever, chills, rash, hypotension, localized reaction at site

Antiretroviral

CCr5 antagonist

maraviroc Selzentry

cough, URI

dizziness, paresthesias

hepatotoxicity

Antiretroviral -NRTIs

zidovudine (retrovir)

bone marrow suprresion

lactic acidosis

N/V diarrhea

fatty liver

AntiretroviralsNNRTIs

efavirenz (Sustiva)

rash-SJS

flulike symtoms

dizziness, drowsiness, insomnia,nightmares

Antiretrovirals - Protease Inhibitors

ritonavir (Norvir)

bone loss/osteoporosis

DM/hyperglycemia

Allergic Reaction

N/V

hyperlipidemia

thrombocytopenia, leukpenia

Antiretroviral INSTI

raltegravir (Isentress)

HA, insomnia, SJS, Liver injury

not for under 16