Pharmacology 181

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• Pharmacology 181
• Anti-Infective Drugs
• Chapter 17
• Dr. Jay Shahed

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Procedure

• Acquire a sample
• Culture sensitivity test.
• Incubate
• Give a broad - spectrum while waiting
• If resistanceD/C Med
• Check with CDC for resistant Antibodies.
• Check for side effects

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• Select anti- infective drug
• Check for
• liver status
• Age of patient
• Pregnancy
• Resistance

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Adverse reactions

• Allergic hypersensitivity
• care D/C Med
• Direct toxicity
• Direct tissue damage
• Ototoxicity, Nephrotoxicity, hepatotoxicity
• Action D/C Med
• Indirect toxicity ( Superinfection)
• The destruction of the normal flora when using a
  broad spectrum
• Diarrhea, Vaginitis, Stomatitis
• Action D/C Med

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Aminoglycosides

• Examples
• Amikacin ( Amikin )
• Gentamicin ( Garamycin )
• Tobramycin ( Nebcin )
• Indication
• Gram NEG Bacteria
• Escherichia Coli ( E- Coli )
• Pseudomonas
• Salmonella
• Gram POS.. bacteria
• Staphylococcus Aureus

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• Side effects
• Nephrotoxicity
• Ototoxicity
• Neuromuscular blocking
• Respiratory paralysis
• CNS Symptoms
• Headache, tremor, lethargy, numbness, seizures
• Blurred vision
• Rash or Uticaria
• Septicemia

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• Contraindication
• Patients with
• Tinnitus, vertigo, hearing loss
• Reduced renal function
• Dehydration
• Pregnant or nursing woman
• Infants

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• Interactions
• Other Ototoxic drugs
• Amphotericin B
• Cephalosporins
• Polymixin B
• Bacitricin
• Vancomycin
• Anesthetics
• Succinylcholine
• Curare ( can cause respiratory paralysis).
• Antiemetics
• Mask symptoms of vestibular ototxicity

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Cephalosporins

• Semisynthetic antibiotics derivatives produced by
  a fungus
• Related to Penicillin
• Broad spectrum
• Classified into !st, 2nd and 3rd generation
  according to the type of bacteria

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• First generation
• e.g Cephalexin ( Keflex )
• G bacteria
• Pneumonia, UTI
• Second generation
• e.gCefaclor ( Ceclor )
• G - and G bacteria
• Influenza
• Third generation
• e.g Ceftriaxone ( Rocephin )
• Cefazolin ( Kefzol, Ancef )
• Strongest mainly against G -
• STDs

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• Side effects
• Hypersensitivity
• Blood Dyscrasias
• Increase bleeding time
• Mild hepatic dysfunction
• Nausea, vomiting, diarrhea.
• Phlebitis ( IV administration)
• Respiratory distress

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• Contraindication
• Renal impairment
• Allergies to PCN
• Superinfections-colitis
• Pregnant or nursing mothers
• Children-mild hearing loss reported
• Interaction
• Increased effectiveness with Probenecid
• Disulfiram- like reactions with alcohol ingestion
  ( Flushing, tachycardia, shock)

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Chloramphenicol

• Chloromycetin
• Indication
• Treat serious infections by susceptible organisms
• typhoid fever
• Meningitis
• Hemophilic influenza
• Rickettsial infections
• Rocky Mountain spotted fever

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• Used for patients that did not response to other
  antibiotics
• Very toxic
• Patients should be hospitalized to monitor
  levels.

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• Side effects
• Bone marrow depression
• leading to bleeding and infection
• Aplastic anemia ( Fatal )
• Circulatory collapse ( Fatal )
• Visual disturbances
• Neuritis, headaches, confusion
• Hypersensitivity reactions

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• Contraindications
• Infants
• Pregnant women
• Impaired renal or hepatic function
• Interactions
• Potentiation of
• Dicumarol ( anticoagulant)
• Phenytoin ( anticonvulsant)
• Tolbutamide ( antidiabetic)
• Antagonistic response
• Vitamin B12
• Folic acid
• Iron

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Erythromycin

• E - Mycin, Ilosone, EES, ERYC
• Clarithromycin Biaxin
• Indication
• Respiratory infections
• Skin conditions
• Acne
• STDs
• Least toxic Ab used in the treatment of sensitive
  patients.
• Streptococcus A is resistant to E.E.S

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• Side effects
• Anorexia
• N/V/D
• Rash
• Superinfections
• Contraindication
• Liver dysfunction
• Alcoholism

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• Interactions
• May cause toxicity when given with the following
  drugs
• carbamazepine ( Tegretol ).
• Ataxia, dizziness, drowsiness
• Cyclosporine
• Immunosuppressant
• Theophylline
• Terenadine ( Seldane) or Astemizole ( Hismanal)
• Cardiac problems

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• Triazolam ( Halcion )
• Potentiate sedation
• Warfarin
• Prolong PT and BT
• Digoxin
• patients Directions
• Dont take with other drugs
• Take 1 hr ac or 2 h pc with a full glass of water

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Penicillin

• Source
• Fungus species
• organisms
• Streptococcus
• Some Staphylococcus
• Meningococcus

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Types

• Narrow Spectrum
• Penicillin G ( Procaine )
• Penicillin V
• Benzathine
• Nafcillin
• Methicillin
• Broad spectrum
• Amino - Penicillin
• Amoxicillin, Ampicillin, Augmentin
• Amoxillin
• Carbencillin ( Geopen, Geocillin )
• Ticarcillin

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• Indication
• Respiratory infection
• Intestinal infection
• Rheumatic fever
• Endocarditis
• STDs
• Gonorrhea ( some organisms are resistant )
• Syphilis
• Peptic ulcer disease
• combined with Omeprazole ( Prilosec )
• Helicobacter pylori

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• Serious side effects
• Hypersensitivity
• Fatal anaphylaxis
• Superinfections
• ( Ampicillin)
• N/V/D
• Blood Dyscrsias
• Renal and Hepatic disorders
• CSF effects
• Confusion, anxiety, seizures,

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• Contraindications
• Hx of allergies
• Impaired renal function
• Interactions
• Potentiation
• Probenecid
• anti-inflammatory
• Antagonistic
• Delayed absorption
• Food or anti-acids
• Antagonistic
• with other anti infective drugs
• Estrogen

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Quinolones

• A new anti-infective drug
• Example
• Ciprofloxacin ( Cipro )
• Indication
• Adults
• UTI
• Lower RTI
• GI tract Skin
• Bones and joints

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• Side effects
• GIN/V/D, Abdominal pain, Colitis
• CNS Headache, dizziness, confusion,
  irritability, seizures, anxiety
• Crystalluria Increase crystals
• Drink much water
• Superinfection
• Rash
• Phototoxicity - Severe sun burn

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• Contraindications
• Elderly with GI diseases or arteriosclerosis
• Children
• Pregnancy and lactation
• Severe renal impairment
• Seizures

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• Interactions
• Theophylline
• Can Potentiate serious or fatal CNS effects
• cardiac arrest
• Respiratory failure
• Probenicid ( Anti gout )
• Increases the blood level of Cipro
• Antiacids
• Decreases absorption
• Coumarin
• Increase risk of bleeding

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Tetracycline

• Broad spectrum
• Indication
• Uncommon bacteria
• Rickettia
• Chlamydia
• Rocky Mountain spotted fever
• Atypical pneumonia
• STD
• Acne

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• N/V/D
• Superinfections ( Vaginitis, Stomatitis )
• Photosensitivity
• Discolored teeth in fetus or young children.
• Retarded bone growth
• Hepatic disease
• renal disease
• CNS ( vertigo, Cerebral edema) uncommon
• Thrombophlebitis
• Allergic reactions

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• Contraindications
• Pregnancy/ Lactation/ Children under 8 Y/O
• Patient exposed to constant sunlight
• Patient with liver and renal disease
• Interactions
• Antiacids, Calcium supplements, Magnesium
  laxatives.
• Iron preparations
• Antidiarrheal agents
• Dairy products

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Antifungals

• Amphotericin B ( Fungizone )
• Indications
• Systemic fungal infections
• Given IV
• AIDS
• Side effects
• Headaches, Chills/Fever, Hypotension, Tachypnea
• Malaise, muscle and joint pain and weakness
• Anorexia, Nausea, vomiting, cramps
• Nephrotoxicity
• Anemia Hypokalemia

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• Fluconazole ( Diflucan )
• Indication
• Severe Candidial infections
• Oral, esophageal, Urinary tract, Pneumonia
• Side effects
• GI disorder
• Rash
• Hepatic abnormalities
• Dizziness
• Headaches

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• Contraindications
• Children under 13
• Pregnant/ nursing women
• Seizure disorders
• Interactions
• Coumarin
• Can cause prolonged PT
• Astemizole ( Hismanal ).
• Terfenadine ( Seldane)
• Cardiac effects
• Oral antidiabetic agents
• Hypoglycemia

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• Griseofulvin( Grisactin )
• Indication
• Tinea ( ringworm, Tinea pedis)
• Side effects
• Headache
• Thirst
• Rash
• Photosensitivity
• Hepatic toxicity

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• Contraindication
• Children under 2
• Pregnancy
• Liver diseases
• Porphyria ( Increase porphyrin in blood
• Photosensitivity
• Interactions
• Alcohol
• Phenobarbital
• Coumarin
• Contraceptives

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• Nystatin ( Mycostatin )
• Indication
• Intestinal candidiases
• Diaper rash
• Mouth/vaginal thrush
• Side effects
• Rare V/N/D
• Caution with pregnancy.

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Antituberculosis

• Drugs
• Isoniazide ( INH )
• Ethambutol
• Rifampin
• Pyrainamide
• Streptomycin

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• CDC treatment regimen recommendation
• Asymptomatic patients
• PPD
• INH QD ( 6 - 12 months )
• Treat symptomatic patients
• Active TB
• INH Rifampin Pyrazinamide Ehambutol or
  Streptomycin QD ( 2 months )
• INH Rifampin QD or 2,3xwk ( 6 - 9 months )
• Pregnancy No streptomycin May cause fetal
  Ototoxicity.

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• Isoniazide ( INH ) and Rifampin
• Side effects
• 1st 5 wks
• N/V/D
• CNS symptoms
• Hepatic toxicity
• Hypersensitivity
• Orange color urine
• Contraindications
• Liver disease ( alcoholism )
• Renal failure
• Caution with children

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• Interactions
• Antagonism
• Hypoglycemic drugs
• Corticosteroids
• Digitalis
• Anticoagulants
• Estrogen
• Potentiation
• Dilantin ( Toxicity)

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• Ethambutol
• Side effects
• Optic neuritis
• Dermatitis, Pruritis, headache, mailaise
• GI disorders
• Contraindications
• Visual problems
• Impaired renal functions
• Diabetes ( retinopathy )
• Caution - pregnancy

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• Pyrainamide
• Side effects
• Hepatic toxicity
• Gout - increase Uric Acid
• Hypersensitivity
• GI disorders
• Contraindications
• Renal failure
• Diabetes
• Hepatic disorders
• Children
• Pregnant women

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• Streptomycin
• Side effects
• Ototoxicity
• Nephrotoxicity

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Miscellaneous Anti - Infective

• Clindamycin ( Cleocin )
• Derived from lincomycin
• Indication
• Severe URI
• Pneumocystis carinii
• Septicemia
• Osteomyelitis
• Side effects
• GI symptoms
• Rash

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• Caution
• Hx of GI disease
• Elderly
• Children
• Pregnancy

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• Vancomycin ( Vancocin )
• Indication
• Life threatening infections
• Staphylococcus Aureus
• Colitis
• Endocarditis
• Side effect
• Ototoxicity ( deafness, Tinnitus )
• Nephrotoxicity
• Rash
• Pseudomembranous colitis
• Caution
• Same as Clindamycin

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Antiviral

• Drugs
• Acyclovir
• ( Zovirax )
• Amantadine
• ( Symadine, Symmetral )
• Ribavirin
• ( Virasole )

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• Acyclovir ( Zovirax )
• Indication
• Herpes simplex
• herpes Zoster ( Shingles )
• Chicken pox ( Varicella zoster )
• Side effect
• Not common
• Impaired renal function
• Lethragy
• Tremors
• Confusion
• Headaches

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• Contraindication
• Children
• Pregnant women
• Renal and hepatic disorders
• Dehydration
• Neurological abnormalities

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• Amantadine ( Symadine, Symmetral )
• Indication
• Respiratory infections
• Influenza A virus only
• Parkinsonian syndrome
• Side effect
• CNS
• Bluish mottling of skin and Eczema
• Anorexia, nausea, constipation
• Hypotension, edema, urinary retention, Dyspnea
• Visual disturbances

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• Contraindication
• patients with Mental disorder
• Seizures disorder
• Cardiovascular
• Renal impairment
• Elderly
• Pregnant

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• Ribavirin ( Virasole )
• Indication
• Oral inhalation
• Children
• LRI
• Lassa fever
• Hantavirus
• Side effect
• Respiratory complications
• Hypotension
• cardiac arrest
• Anemia
• Rash, conjunctivitis

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• Contraindication
• Pregnancy/ lactation
• Interactions
• Digitalis
• Diuretics
• Zidovudine ( AZT )

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HIV/AIDS Infections

• Drugs
• Zidovudine ( AZT ) ( Retrovir )
• Zalcitabine ( ddc ) HIVid
• Co - trimoxazole ( Bactrim, Septra )
• Clindamycin ( Cleocin )
• Foscarnet ( Foscavir )
• Ganciclovir ( Cytovine )
• Pentamidine ( NebuPent ) ( Pentam )
• Trimetrexate ( NeuTrexin )
• Interferon ( Roferon A, Intron A )

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• Zidovudine ( AZT ) ( Retrovir )
• Indication
• Initial treatment
• CD4 lt 200, lt 500, Seropositive HIV patients
• Side effect
• Anemia/ Granulocytopenia
• Headache, insomnia, lethargy, fatigue
• N/V/D
• Muscle pain
• Cautions
• Close supervision to patients with Renal and
  Hepatic disorders.
• Interactions
• Probenecid - flu like symptoms
• Acetaminophen - Increase risk of Granulocytopenia

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• Zalcitabine ( ddc ) HIVid
• Indication
• Must be administered with AZT
• Advanced AIDS CD4 lt300
• Side effect
• Peripheral neuropathy
• Rash
• Oral Ulcers
• Cautions
• Patients with pancreatic, renal or hepatic
  disorders

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• Co - trimoxazole ( Bactrim, Septra )
• Indication
• UTI
• Enteritis
• Otitis media
• Pneumocystis carinii
• Toxoplasmosis
• Side effect
• Skin disorders
• GI
• Hepatic
• Renal

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• Contraindications
• Impaired hepatic function
• Impaired renal
• Blood Dyscrasias ( Severe damage of blood
  component)
• Pregnancy
• Interactions
• Anticoagulants ( Potentiation)
• Local anesthetics ( Antagonism )

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• Foscarnet ( Foscavir )
• Indication
• Toxoplasmosis
• Side effect
• Nephrotoxicity
• N/V/D
• Electrolyte imbalance
• Coughing
• Dyspnea

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• Ganciclovir ( Cytovine )
• Indication
• Toxoplasmosis
• Side effect
• Blood Dyscrasias
• Neutropenia, Thrombocytopenia
• Headaches, confusion, Seizures
• Hepatic/ Renal effects

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• Pentamidine ( NebuPent ) ( Pentam )
• Indication
• Pneumocystis carinii
• Side effect
• Nephrotoxicity
• Cough and Bronchospasm
• Contraindication
• Pregnancy/ lactation

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• Trimetrexate ( NeuTrexin )
• Indication
• Folate antagonist
• Counteract myelosuppression
• Side effect
• Myelosuppression
• Liver enzymes elevation, fever, rash
• Renal/ GI effect.
• Contraindications
• Pregnancy/Lactation
• Children under 18
• Interactions
• Zidivudine - must D/C if administered
• E.E.S, Rifampin, Fluconazole, Cimetadine,
  Acetaminophen.

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• Interferon ( Roferon A, Intron A )
• Indication
• Kaposi sarcoma
• Hepatitis B
• Leukemia

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Urinary Anti - Infective

• Nitrofuantoin ( Macrodantin, Furadantin)
• Timethoprim ( Proloprim )
• Indication
• Initial or recurrent UTIs
• Side effect
• N/V ( Give with milk to avoid )
• Numbness
• Headache , dizziness
• Weakness of muscles
• Respiratory distress
• Brown Urine Anemia

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• Contraindication
• Renal impairment
• Anemia
• Diabetes
• electrolyte abnormalities
• Asthma
• Pregnancy
• Children under 12
• Interaction
• Probenecid ( Benemid)
• Magnesium
• Antiacids