Study Notes 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: 1 st 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: 2 nd Gen Nafcillin (IM/IV) Cloxacillin (PO) Antistaphylococcal, MSSA Dicloxacillin (PO) PCN: 3 rd Gen Ampicillin (PO) Extended-spectrum: G(+) PLUS some Amoxicillin (PO) G(-); OM, URI Augmentin (amox + clavulanate) Diarrhea, Good for beta-lactamase: H.Flu, M.Cat PCN: 4 th Gen Zosyn (piperacillin + tazobactam) (IV) Broad spectrum, covers Pseudomonas, many G(-) Cephalosporin: 1 st Gen Cefazolin (IM, IV) Inhibit cell wall synthesis good Gram + coverage, NO MRSA coverage Cross-sensitivity with Cephalexin (PO) PCNs 2 Cephalosporins: 2 nd Gen Cefaclor Not as good G+ but some G(-); OM, Strep pharyngitis Cefuroxime (IM, IV, PO) Cephalosporins: 3 rd 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: 4 th Gen Cefepime (IM/IV) Good G+ and G- coverage, Covers Pseudomonas Cephalosporins: 5 th 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 crosssensitivity to PCNs Ertapenem Ertapenem: not good Pseudomonas coverage Imipenem & cilastatin Meropenem Monobactam Aztreonam: IM, IV, inhale Inhibit cell wall synthesis G- ONLY, Covers Pseudomonas Never use for empiric tx, 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. Emycin 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>