Transcript Drug List - Grand Saline ISD

Chapter 4
Antibiotics
Chapter 4 Topics
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Bacteria
How Antibiotics Work
Classes of Antibiotics
Antibiotics Independent of Classes
Adjunct in Treating Sepsis
Discussion Questions
Learning Objectives
• Identify the major types of antibiotics by drug
class.
• Know which auxiliary labels to use when
dispensing major types of antibiotics.
• Define therapeutic effects, side effects, and
administration routes of major antibiotics.
• Use antibiotic and general drug terminology
correctly in written and oral communications.
Fighting Bacterial Infections
• Bacteria: microorganisms that cause
infection
• Bactericidal agent: kills the invading
organism
• Bacteriostatic agent: inhibits the growth or
multiplication of bacteria
Types of Bacteria
• Aerobic bacteria
• Anaerobic bacteria
Types of Bacteria
• Aerobic bacteria
needs oxygen to survive
• Anaerobic bacteria
survives in the absence of oxygen
Bacteria Shapes
(a) Round cocci
(b) Rod-like bacilli
(c) Spiral-shaped spirochetes
Gram’s Stain Results and Related
Diseases
Shape
Gram’s
Stain
Bacteria
Related
Disease
rods
gram-positive
Corynebacteria
endocarditis
gram-negative
E. Coli
UTI
Gram’s Stain Results and Related
Diseases
Shape
Gram’s Stain
Bacteria
Related Disease
cocci
gram-positive
Staphylococcus
toxic shock
syndrome
gram-negative
Neisseria
gonorrhea
Gram’s Stain Results and Related
Diseases
Shape
Gram’s Stain
Bacteria
Related Disease
curved or
spiral rods
gram-negative
Campylobacter
septicemia
spirochetes
gram-negative
Treponema
palladium
syphilis
How Antibiotics Work
• Block protein formation
How Antibiotics Work
• Block protein formation
– Macrolides
– Tetracyclines
– Aminoglycosides
How Antibiotics Work
• Block protein formation
• Inhibit cell wall formation
How Antibiotics Work
• Block protein formation
• Inhibit cell wall formation
– Penicillins
– Cephalosporins
How Antibiotics Work
• Block protein formation
• Inhibit cell wall formation
• Interfere with DNA formation
How Antibiotics Work
• Block protein formation
• Inhibit cell wall formation
• Interfere with DNA formation
– Nalidixic acid
How Antibiotics Work
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Block protein formation
Inhibit cell wall formation
Interfere with DNA formation
Prevent folic acid synthesis
How Antibiotics Work
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Block protein formation
Inhibit cell wall formation
Interfere with DNA formation
Prevent folic acid synthesis
– Sulfonamides
Antibiotic Dispensing Issues
Warning!
• Mix exactly as directed by manufacturer
• Swab counting tray with alcohol between
drugs to prevent cross-contamination
Antibiotic Side Effects
• Most antibiotics should be taken on an
empty stomach to attain faster absorption
Antibiotic Side Effects
• Most antibiotics should be taken on an
empty stomach to attain faster absorption
• Examples of exceptions
– nitrofurantoin (Macrobid, Macrodantin)
– cefuroxime (Ceftin, Zinacef)
Antimicrobial Resistance
• Developing largely because of
–overuse
–misuse
Antimicrobial Resistance
• Developing largely because of
– overuse
– misuse
• The Pharmacy Technician’s role
– Place an label on antibiotics advising the
patient to take all of the medication
Discussion
How might the widespread use of
antibacterial soaps affect the
population?
Classes of Antibiotics
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Sulfonamides
Penicillins
Cephalosporins
Tetracyclines
Macrolides
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Ketolides
Quinolones
Streptogramins
Aminoglycosides
Cyclic Lipopetides
Sulfonamides
• AKA “sulfa drugs”
• Effective against a broad range of
microorganisms
• Block specific step in biosynthetic pathway
of folic acid
• Interfere with PABA and folic acid
formation, thereby destroying bacteria
Drug List
Sulfonamides and
Related Drugs
• nitrofurantoin (Macrobid, Macrodantin)
• sulfamethoxazole-trimethoprim (Bactrim
DS, Septra DS)
• sulfisoxazole (Gantrisin)
Sulfonamides
• If patient is allergic to sulfa….
Sulfonamides
• If patient is allergic to sulfa….
nitrofurantoin (Macrobid, Macrodantin)
Therapeutic Uses of Sulfonamides
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Urinary tract infections (UTIs)
Otitis media
Ulcerative colitis
Lower respiratory infections
Prophylaxis in Pneumocystis carinii
pneumonia in immunocompromised
patients
Sulfonamides’ Side Effects
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Rash
Nausea
Drug fever
Vomiting
Jaundice
Blood complications
Kidney damage
Sulfonamides’ Dispensing Issues
• Avoid the sun
• Maintain adequate fluid intake
Penicillins
• Low toxicity
• Effective derivatives created from
manipulating drug’s basic molecular
structure
• Kills bacteria by preventing them from
forming the rigid cell wall
• Because human cells do not have cell walls,
they are not affected
Drug List
Penicillins
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amoxicillin (Amoxil, Trimox)
amoxicillin-clavulanate (Augmentin)
ampicillin (Principen)
ampicillin-sulbactam (Unasyn)
carbenicillin (Geocillin)
Drug List
Penicillins
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dicloxacillin
nafcillin
oxacillin
penicillin G (various)
penicillin V (Veetids)
piperacillin
Drug List
Penicillins
• piperacillin-tazobactam (Zosyn)
• ticarcillin (Ticar)
• ticarcillin-clavulanate (Timentin)
Therapeutic Uses of Penicillins
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Abscesses
Beta-hemolytic streptococcus
Meningitis
Otitis media
Pneumonia
Respiratory infections
Tooth and gum infections
Venereal diseases (syphilis and gonorrhea)
Endocarditis due to streptococci
Penicillins’ Side Effects
• Diarrhea
• Allergies in 7% to 10% of population
Penicillins’ Dispensing Issues
• Take on an empty stomach
– Food slows absorption
– Acids in fruit juices or colas could
deactivate the drug
Penicillin Resistance
• Penicillinase-resistant penicillins
work against gram-positive aerobes
• Extended-spectrum penicillins are
more resistant to gram-negative
bacteria
• Penicillin combinations improve
effect
Cephalosporins
• Have a mechanism of action similar to
penicillins
• A person allergic to penicillin, about 10%
chance of being allergic
Cephalosporins
Warning!
Alert the Pharmacist if a patient
allergic to penicillins is receiving
a cephalosporin prescription.
Cephalosporins
• First-generation
Cephalosporins
• First-generation
– Similar to penicillinase-resistant penicillins
with greater gram-negative coverage
– Used for
• community-acquired infections
• mild to moderate infections
Cephalosporins
• Second-generation
Cephalosporins
• Second-generation
– Increased activity, especially against
Haemophilus influenzae
– Used for
• Otitis media in children
• Respiratory infections
• UTIs
Cephalosporins
• Third-generation
Cephalosporins
• Third-generation
– Active against a wide spectrum of gramnegative organisms
– Long half-life, so once-a-day dosing for some
– Used for
• Ambulatory patients
• Children (dosing before or after school)
Cephalosporins Side Effects
• Share side effects of penicillin
• Few may initiate unique toxic reactions
• Lower frequency of toxicity than many
other antibiotics
Cephalosporins
Warning!
All of the cephalosporins look
alike when written in the generic
form. Watch for dosing and
indications for use.
Drug List
Cephalosporins
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cefaclor (Ceclor)
cefadroxil (Duricef)
cefazolin (Ancef)
cefdinir (Omnicef)
cefditoren (Spectracef)
cefepime (Maxipime)
Drug List
Cephalosporins
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cefotaxime (Claforan)
cefotetan (Cefotan)
cefoxitin (Mefoxin)
cefpodoxime (Vantin)
cefprozil (Cefzil)
ceftazidime (Fortaz)
ceftibuten (Cedax)
Drug List
Cephalosporins
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ceftizoxime (Cefizox)
ceftriaxone (Rocephin)
cefuroxime (Ceftin, Zinacef)
cephalexin (Keflex)
cephradine (Velosef)
Tetracyclines
• Broad-spectrum bacteriostatic antibiotics
• Inhibit protein synthesis in bacteria by
binding to ribosomes
• Suppress the infection and require
phagocytes to complete the eradication of
the bacteria
Therapeutic Uses of Tetracyclines
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Acne
Chronic bronchitis
Lyme disease
Mycoplasma pneumoniae infection
Rickettsia infection
Some venereal diseases, such as Chlamydia
infection
• Traveler’s diarrhea
Tetracyclines’ Side Effects
• Gastrointestinal upset with nausea and
vomiting
Tetracyclines’ Dispensing Issues
• Avoid antacids to avoid chelation with
minerals
• Photosensitization
• To be avoided by pregnant women and
children
• Expired drugs are dangerous
Drug List
Tetracyclines
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demeclocycline (Declomycin)
doxycycline (Vibramycin)
minocycline (Minocin)
tetracycline (Sumycin)
Macrolides
• Inhibit protein synthesis by combining with
ribosomes
• Used primarily to treat pulmonary
infections
Macrolides
Drugs of choice for the following illnesses
and specific bacteria:
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Chlamydia
Group A beta-hemolytic streptococcus
H. influenzae
Legionnaire’s disease
M. pneumoniae
S. pneumoniae
Macrolides’ Dispensing Issues
Although most antibiotics should be taken on
an empty stomach, erythromycins usually
cause severe GI distress, so should be taken
with food
Macrolides
Warning!
Erythromycin and azithromycin
can be misread, but the dosing
should help.
Drug List
Macrolides
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azithromycin (Zithromax, Z-PAK)
clarithromycin (Biaxin)
dirithromycin (Dynabac)
erythromycin base (Eryc, Ery-Tab)
erythromycin ethylsuccinate (E.E.S., EryPed)
erythromycin lactobionate (Erythrocin)
erythromycin stearate (Erythrocin)
erythromycin-sulfisoxazole (Pediazole)
Ketolides
• Block protein synthesis by binding to ribosomal
subunits
• May inhibit the formation of newly forming
ribosomes
• Bacteria resistant to macrolides, lincomycin
derivatives, and streptogramins are also resistant
• Used to treat bacterial infections in the lungs and
sinuses
Drug List
Ketolides
• telithromycin (Ketek)
Quinolones
• Strong, rapid bactericidal action against
most gram-negative and many grampositive bacteria
• Antagonize the enzyme responsible for
coiling and replicating DNA, causing DNA
breakage and cell death
Therapeutic Uses of Quinolones
• Bone and joint infections caused by gramnegative organisms
• Infectious diarrhea
• Ophthalmic infections
• Some sexually transmitted diseases
• Upper respiratory infections
• UTIs
Quinolones’ Side Effects
• Primarily gastrointestinal, with nausea and
vomiting
• Dizziness
• Unpleasant taste
• Can cause joint problems such as swelling
and malformations
• Patients taking them have a tendency to
injure tendons
Quinolones’ Dispensing Issues
• Not to be given with theophylline
• Antacids interfere with absorption
• Avoid exposure to sun
Drug List
Quinolones
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ciprofloxacin (Ciloxan, Cipro)
gatifloxacin (Tequin)
gemifloxacin (Factive)
levofloxacin (Levaquin)
moxifloxacin (Avelox, Vigamox)
norfloxacin (Noroxin)
ofloxacin (Floxin, Ocuflox)
Streptogramins
• Inhibit protein synthesis within the bacterial
ribosomes
• Alternative to vancomycin
• Side effects similar to quinolones
nausea and vomiting
joint swelling
dizziness
Drug List
Streptogramins
• quinupristin-dalfopristin (Synercid)
Aminoglycosides
• Treat serious infections
• Inhibits bacterial protein synthesis by
binding to ribosomal subunits
Aminoglycosides’ Side Effects
• Nephrotoxicity, destructive to kidney
• Ototoxicity
– Tinnitus
– Permanent deafness
– Equilibrium problems
• Neuromuscular blockade
Aminoglycosides
• Less frequent dosing may help reduce
toxicity
– Less drug accumulates in the kidney and ear
– Simplified drug monitoring
• Levels should be checked prior to
administration of second dose to confirm
drug elimination
Drug List
Aminoglycosides
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amikacin
gentamicin (Garamycin, Genoptic)
kanamycin (Kantrex)
neomycin (Myciguent, Neo-Fradin)
streptomycin (none)
tobramycin (Nebcin)
Cyclic Lipopetides
• Bind bacterial membranes and cause the
cell membrane to depolarize
• Leads to
– Inhibition of DNA and RNA synthesis
– Bacterial death
Drug List
Cyclic Lipopetides
• daptomycin (Cubicin)
Warning!
Do not take with statins.
Antibiotics Independent of Classes
These antibiotics are independent of other
classes and each other due to structural
differences.
Drug List
Antibiotics Independent
of Classes
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chloramphenicol (Chloromycetin)
clindamycin (Cleocin)
linezolid (Zyvox)
metronidazole (Flagyl)
pentamidine (NebuPent, Pentam)
vancomycin (Vancocin)
Antibiotics Independent of Classes
vancomycin (Vancocin)
Warning!
Bacterial resistance is increasing
due to overuse.
Antibiotics Independent of Classes
Uses of clindamycin (Cleocin)
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Acne
Alternative to penicillin in dental prophylaxis
Anaerobic pneumonia
Bone infections
Bowel infections
Female genital infections
Intra-abdominal infections
Antibiotics Independent of Classes
clindamycin (Cleocin)
Warning!
If patient develops diarrhea, the
drug must be discontinued.
Antibiotics Independent of Classes
metronidazole (Flagyl)
Place a do not drink alcohol warning sticker
on this medication.
Adjunct in Treating Sepsis
• Sepsis is a life-threatening result of serious
infections.
• Properties of drotrecogin alfa (Xigris)
– Anticoagulant
– Anti-inflammatory
Drug List
Adjunct in Treating Sepsis
• drotrecogin alfa (Xigris)
Discussion
Why is resistance developing to
antibiotics? Is this a problem? What
role can the pharmacy technician play
in regards to this problem?