PAPD Fall 2022 Quiz 1

Amoxicillin/Clavulanate Brand name - ANSWER Augmentin Amoxicillin/Clavulanate Common FDA indications - ANSWER Acute otitis media, Community-acquired pneumonia, Lower respiratory tract infection, Sinusitis, infection o ...

Amoxicillin/Clavulanate Brand name - ANSWER Augmentin Amoxicillin/Clavulanate Common FDA indications - ANSWER Acute otitis media, Community-acquired pneumonia, Lower respiratory tract infection, Sinusitis, infection of skin or subcutaneous tissue, infectious disease of genitourinary system, Urinary tract infection, acute cystitis, Urinary tract infection, pyelonephritis Amoxicillin/Clavulanate Dosing - ANSWER (Tablet) 250 mg/125 mg, 500 mg/125 mg, 875 mg/125 mg; (Tablet, Extended Release) 1000 mg 62.5 mg; (Tablet, Chewable) 200 mg/28.5 mg, 400 mg /57 mg; (Suspension) 125 mg/31.25 mg/5 mL, 200 mg/28.5 mg/5 mL, 250 mg/62.5 mg/5 mL, 400 mg/57 mg/5 mL, 600 mg/42.9 mg/5 mL Amoxicillin/Clavulanate Mechanism of Action - ANSWER Amoxicillin is a semisynthetic penicillin derivative. Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae. Amoxicillin is not effective against β-lactamase-producing bacteria. Clavulanate, a β-lactamase inhibitor, has weak antibacterial activity but is a potent inhibitor of plasmid-mediated β-lactamases and protects amoxicillin from degradation by β-lactamases Amoxicillin/Clavulanate Dose adjustment Renal - ANSWER CrCl 10-30 mL/min, increase interval to q12h; CrCl <10 mL/min, increase interval to q24h; avoid 875 mg tablet and extended release tablet for those on hemodialysis or CrCl <30 mL/min Amoxicillin/Clavulanate Dose adjustment Hepatic - ANSWER Consider dose adjustment in severe impairment Amoxicillin/Clavulanate Drug interactions - ANSWER Methotrexate, Venlafaxine, Warfarin, Typhoid vaccine, BCG (intravesical), cholera vaccine, Sodium picosulfate Amoxicillin/Clavulanate Contraindications - ANSWER Hypersensitivity to penicillins; extended release products are contraindicated in patients on dialysis or severe renal dysfunction, history of cholestatic jaundice or hepatic dysfunction Amoxicillin/Clavulanate Adverse reactions - ANSWER Nausea, diarrhea, Skin rash, vomiting, mycosis, candidiasis, Severe hypersensitivity, renal failure, hepatic failure, pancytopenia Amoxicillin/Clavulanate Key counseling points - ANSWER Complete full course of therapy. Take dose with food to ensure proper absorption. For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution of 10 d. Avoid mixing suspension with food or beverages. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner. May decrease effectiveness of oral contraceptives; encourage patients to use backup contraceptive method (eg, condom) Amoxicillin/Clavulanate Clinical pearls - ANSWER There is cross-hypersensitivity between penicillin and cephalosporin; use with caution in cephalosporin-allergic patients. Incidence of diarrhea is higher than with amoxicillin alone Amoxicillin/Clavulanate Black box warnings - ANSWER None Cefuroxime Brand name - ANSWER Ceftin, Zinacef Cefuroxime Common FDA indications - ANSWER Acute infective exacerbation of COPD, uncomplicated skin and/or subcutaneous tissue infection, acute bacterial maxillary sinusitis, uncomplicated UTI, Acute otitis media, Bronchitis, acute, secondary bacterial infection, Gonorrhea, Pharyngitis, tonsillitis, acute uncomplicated cystitis, acute simple cystitis, Bite wound, prophylaxis Cefuroxime Dosing - ANSWER (Oral Tablet) 125 mg, 250 mg, 500 mg Cefuroxime Mechanism of Action - ANSWER A 2nd-generation cephalosporin whose activity is better than cefazolin but less than cefotaxime, against H. influenzae, including β-lactamase-producing strains. The activity of against S. aureus is slightly less than that of cefazolin. Its activity against anaerobes is poor, similar to the 1st-generation cephalosporins. Cefuroxime Dose adjustment Renal - ANSWER CrCl = 10-30 mL/min, administer full dose every 24 h; CrCl ≤10 mL/min, administer full dose every 48 h, administer after dialysis Cefuroxime Dose adjustment Hepatic - ANSWER Not required Cefuroxime Drug interactions - ANSWER Ethinyl estradiol and other estrogen-based birth control products, Cefuroxime Contraindications - ANSWER Hypersensitivity to cephalosporins, Sodium picosulfate, Antacids, proton pump inhibitors, Vitamin K antagonists (eg, warfarin) Cefuroxime Adverse reactions - ANSWER Diarrhea, Nausea and vomiting, vaginitis, increased liver enzymes, diaper rash, local thrombophlebitis, Stevens-Johnson syndrome, hepatotoxicity, severe hypersensitivity, anemia, neutropenia, pancytopenia, seizure Cefuroxime Key counseling points - ANSWER Seek medical attention if a rash develops. Complete full course of therapy. For the suspension, shake well and store in the refrigerator. Note 10 d expiration after reconstitution. Avoid mixing suspension with food or beverages, but food can be taken afterward. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with a health-care practitioner. Cefuroxime Clinical pearls - ANSWER May resume normal activities after 24 h of antibiotics if afebrile. Approximately 10% of patients allergic to penicillins are also allergic to cephalosporins; use with caution in penicillin-allergic patients. Suspension formulation discontinued by brand-name manufacturer and no generic suspension available for over 2 years. Also available in injectable formulation. Cefuroxime Black box warnings - ANSWER None Erythromycin Brand name - ANSWER Erythrocin Erythromycin Common FDA indications - ANSWER Bacterial infections Erythromycin Dosing - ANSWER (Capsule) 250 mg; Tablet: 250 mg, 400 mg, 500 mg; (Tablet Delayed Release) 250 mg, 333 mg, 500 mg; (Suspension) 200 mg/5 mL, 400 mg/5 mL Erythromycin Mechanism of Action - ANSWER Binds to the 50S ribosomal subunit and inhibits RNA-dependent protein synthesis Erythromycin Dose adjustment Renal - ANSWER Not required Erythromycin Dose adjustment Hepatic - ANSWER Not required Erythromycin Drug interactions - ANSWER Typhoid vaccine, BCG (intravesical), cholera vaccine, Sodium picosulfate, CYP3A4/5 inducers/inhibitors/substrates, Ergot alkaloids Erythromycin Contraindications - ANSWER Hypersensitivity, concurrent ergotamine, terfenadine, astemizole, lovastatin, simvastatin, cisapride Erythromycin Adverse reactions - ANSWER Diarrhea, Nausea and vomiting, vaginitis, QTc prolongation, arrhythmias, Stevens-Johnson syndrome, hepatotoxicity, severe hypersensitivity, anemia, neutropenia, pancytopenia, seizure Erythromycin Key counseling points - ANSWER Seek medical attention if a rash develops. Complete full course of therapy. For the suspension, shake well. Some formulations require refrigeration. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner Erythromycin Clinical pearls - ANSWER May resume normal activities after 24 h of antibiotics if afebrile. Major inhibitor of CYP3A4/5 with potential for severe drug interactions, especially if substrates also have QTc prolonging effects. Also available in injectable formulation