chamberlain universityFNP NR Pharmacology STUDY GUIDE

INTRO TO PHARMACOTHERAPEUTICS Prescription Writing Need at least 2 patient identifiers: Name, DOB, Address, Date of Rx, Prescriber name, address, license number, DEA number if applicable, Info for supervising MD, Drug: ...

INTRO TO PHARMACOTHERAPEUTICS Prescription Writing Need at least 2 patient identifiers: Name, DOB, Address, Date of Rx, Prescriber name, address, license number, DEA number if applicable, Info for supervising MD, Drug: name/strength/dose/route/QTY/refills, Signature JC “Do Not Use” List • U: write out “unit” • IU: write out “international units” • Q.D., Q.O.D.: write out daily or every other day • Trailing/leading zeros • MS, MSO4, MgSO4: write morphine sulfate or magnesium sulfate • µg: write mcg • H.S.: write half-strength or at bedtime • T.I.W.: write three times weekly or 3 times weekly • S.C. or S.Q.: write Sub-Q or subQ or subcutaneously • D/C: write discharge • c.c.: write mL • AS, AD, AU, OS, OD, OU: write out, e.g., both eyes or left ear ANTIBIOTICS Class Drug MOA Uses/Coverage ADR/DDI Education/Other PCN: 1st Gen Pen G (IV) Inhibit cell wall synthesis, Bactericidal Pneumococcal pneumonia Benzathine penicillin (IM) Syphilis, strep throat Pen VK (PO) Gram + coverage and Treponema pallidum PCN: 2nd Gen Nafcillin (IM/IV) Cloxacillin (PO) Antistaphylococcal, MSSA Dicloxacillin (PO) PCN: 3rd Gen Ampicillin (PO) Extended-spectrum: G(+) PLUS some G(-); Amoxicillin (PO) OM, URI Augmentin (amox + clavulanate) Diarrhea, Good for beta-lactamase: H.Flu, M.Cat PCN: 4th Gen Zosyn (piperacillin + tazobactam) (IV) Broad spectrum, covers Pseudomonas, many G(-) Cephalosporin: 1st Gen Cefazolin (IM, IV) Inhibit cell wall synthesis good Gram + coverage, NO MRSA coverage Cross-sensitivity with PCNs Cephalexin (PO) Cephalosporins: 2nd Gen Cefaclor Not as good G+ but some G(-); OM, Strep Cefuroxime (IM, IV, PO) pharyngitis Cephalosporins: 3rd Gen Ceftriaxone (IM, IV) better G- but lower G+ coverage, High risk w/ some for ESBL resistance Ceftriaxone good for gonorrhea d/t single dose Cefotaxime (IM, IV) Cefixime (PO) Cephalosporins: 4th Gen Cefepime (IM/IV) Good G+ and G- coverage, Pseudomonas Covers Cephalosporins: 5th Gen Ceftaroline (IV) G- as 3rd-gen plus MRSA coverage Carbapenems Doripenem Inhibit cell wall synthesis Broader than other BL-abx All IV, IM, saved for very broad coverage May have cross-sensitivity to PCNs Ertapenem Ertapenem: not good Pseudomonas coverage Imipenem & cilastatin Meropenem Monobactam Aztreonam: IM, IV, inhale Inhibit cell wall G- ONLY, Covers Pseudomonas Never use for empiric tx, 1synthesis Good for PCN-allergic Vancomycin IV Inhibit cell wall synthesis Mainly for G+ and MRSA IV ADR: dose-related ototoxicity & nephrotoxicity; Red man (infusion NOT allergy) Dose for renal fxn, monitor serum levels Vancomycin PO For C. diff. colitis Telavancin Inhibit cell wall synthesis Alternative to vancomycin Covers G+ and MRSA ADR: Teratogenic and QT prolongation No drug monitoring Macrolides Erythromycin Inhibit protein synthesis, bind to 50s ribosomal subunit G+, G-, and atypicals, Often used to treat G+ in pen-allergic patients; Enzyme inhibitor: E > C >> A Must watch with: CBZ, warfarin, statins, etc. Allergic reactions are rare! Clarithromycin ADR: n/v, metallic taste Improved H.Flu vs. E-mycin Azithromycin Long 1/2 life, good for Chlamydia, other atypicals Tetracyclines Doxycycline Inhibit protein synthesis, bind to 30s ribosomal subunit Coverage very broad: G+, G-,aerobic and anaerobic, spirochetes, mycoplasmas, rickettsiae, chlamydiae, some protozoa, MRSA PO High levels of resistance CI: Avoid with chelating agents (MVI, antacid, milk, iron), Avoid in pregnancy and small children (<8) – Binds Ca and will stain teeth Minocycline ADR: n/v, liver disease, phototoxicity Tigecycline IV Derivative of minocycline MRSA, MDRSp, VRE, ESBL-producing G-, many anaerobes, NOT for Pseudomonas; for Complicated SSTIs, intraabdominal ifxn, CAP Aminoglycoside Amikacin Inhibit protein synthesis, bind to 30s ribosomal subunit G- including Pseudomonas Monitor renal function and serum drug levels! Gentamicin ADR: ototoxicity, nephrotoxicity Tobramycin Clindamycin Inhibit protein synthesis, bind to 50s ribosomal subunit Mainly for anaerobic coverage PO or IV and in some topicals, MRSA PO ADR: rashes and high rate of C.diff. Linezolid (Zyvox) Inhibit protein synthesis, bind to 50s ribosomal subunit PO & IV Use for resistant organisms: MRSA, VRSA, VRE, penicillin-resistant Strep. pneumo Caution for Serotonin Syndrome Might offer benefit when transitioning to outpatient Fluoroquinolones Ciprofloxacin Inhibit nucleic acid synthesis – inhibit topoisomerase UTI, GI, Pseudomonas broad G-, respiratory FQs with improved G+ coverage ADR: C.diff colitis!! CNS: seizure, dizziness; Cardiac: QT prolong; MS: tendon, cartilage; Endo: glycemic control; Skin: photosensitivity, rash DDI: antacids, Fe, Ca, Zn Levofloxacin UTI, GI, LRI, URI, skin Moxifloxacin LRI, URI, GI, skin (no UTI!!) Others PO, otic, ophthalmic Folate Antagonist TMP-SMX (Bactrim, Septra) Broad with G+ and G-, NO Pseudomonas Common for UTI, MRSA PO ADRs: rash (simple to SJS), photosensitivity, crystalluria (need to counsel) Dose based on TMP (more important in PO liquid) Miscellaneous Metronidazole Covers protozoa, anaerobes **DOC: C.diff. colitis Trichomoniasis; Various infections of: skin, bone, CNS, GYN, GI, LRI, endocarditis ADR: Avoid with EtOH. Metallic taste Nitrofurantoin unclear, thought to inhibit several enzyme pathways and possibly Use in simple UTI treatment and prophylaxis NOT pyelonephritis or complicated cystitis CI: ClCr <60 mL/min; Do not use in renal impairment Warnings/Caution: Hepatic disease, Elderly 2cell wall synthesis