8 NAPLEX study: Antibiotic counseling points

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Acyclovir (Zovirax) - Antiviral counseling points

Take at first sign of outbreak;
Take with or without food; Drink plenty of fluids

Acyclovir (Zovirax) common side effects

Headache, Nausea, Upset stomach

Topical Acyclovir side effects include:

dry/cracked lips, burning, stinging, flaky skin. If these side effects persist or worsen tell your doctor or pharmacist immediately.

Amoxicillin counseling points

Take with a meal or snack; See a doctor right away if rash or allergic reaction develops; Suspensions may be refrigerated (Augmentin MUST be refrigerated)

Amoxicillin common side effects

GI upset, Rash, Allergic reaction (see MD right away for rash or allergy)

Azithromycin (Zithromax) counseling points

Take with or without food (XR suspension should be taken on an empty stomach); Suspension does not require refrigeration

Azithromycin (Zithromax) common side effects:

Nausea or abdominal discomfort

Clarithromycin (Biaxin) counseling points

Take with or without food (Biaxin XL should be taken with food); Liquid suspension should not be refrigerated; Watch for drug interactions

Clarithromycin (Biaxin) common side effects:

Diarrhea, Abdominal pain, Nausea, Abnormal (metallic) taste

Ciprofloxacin (Cipro) counseling points:

Use sunscreen/avoid sun, Report any pain, swelling or inflammation of tendons immediately, Do not use with Tizanidine (Zanaflex); Take 2 hours before, or 4-6 hours after antacids, MVI, Mg, Ca, Fe, Zn, Dairy, bismuth subsalicylate, sucralfate, didanosine

Ciprofloxacin (Cipro) side effects

Common: Nausea, Diarrhea, Rash, Dizziness, Photosensitivity, Bone and joint problems in <18 year olds
Rare: Seizures (Do not use with history of seizure), Tendon Rupture (more common in elderly, patients on corticosteroids or transplant patients)

Levofloxacin (Levaquin) counseling points:

Use sunscreen/avoid sun; Report any pain, swelling or inflammation of tendons immediately; Do not use with Tizanidine (Zanaflex); Take with or without food (take suspension on empty stomach); Drink plenty of fluids to prevent crystalluria; May increase INR; May cause hypoglycemia in DM; Take 2 hours before, or 4-6 hours after antacids, MVI, Mg, Ca, Fe, Zn, Dairy, bismuth subsalicylate, sucralfate, didanosine

Levofloxacin (Levaquin) side effects

Common: Nausea, Diarrhea, Rash, Dizziness, Photosensitivity, Bone and joint problems in <18 year olds; Increased INR with warfarin; Hypoglycemia in DM, Crystalluria
Rare: Seizures (Do not use with history of seizure), Tendon Rupture (more common in elderly, patients on corticosteroids or transplant patients)

Doxycycline (Doryx, etc) counseling points:

Use sunscreen/avoid sun; Drink plenty of fluids; Take 2 hours before, or 4-6 hours after antacids, MVI, Mg, Ca, Fe, Zn, Dairy, bismuth subsalicylate, sucralfate, didanosine; Contact MD immediately if serious stomach pain, yellowing of skin/eyes, vision changes, mental/mood changes

Doxycycline (Doryx, etc) common side effects:

Stomach upset; Mild diarrhea, Nausea, HA, Vomiting; Photosensitivity
Rare: Hepatotoxiciy

Erythromycin (EES) counseling points:

Chew tablet thoroughly before swallowing; Take with food to reduce GI irritation (but may be taken with or without food); Liquid suspension combination with sulfisoxazole (Pediazole) should be refrigerated; There are many DDIs

Erythromycin (EES) common side effects:

Nausea, Abdominal pain, Cramping, Diarrhea

Fluconazole (Diflucan), Ketoconazole (Nizora) and Itraconazole (Sporanox) - antifungal counseling points:

Contact MD righ away if brown or dark-colored urine, pale stools, more tired than usual, yellow skin or eyes; Contact MD right away if rash develops; Decrease dose in renal disase; Many DDIs; Ketoconazole and Itraconazole require an acidic environment for absorption

Fluconazole (Diflucan), Ketoconazole (Nizora) and Itraconazole (Sporanox) - antifungal common side effects:

HA, Nausea, Abdominal pain
Serious/rare: hepatotoxicity, serious skin rash

Clindamycin (Cleocin) counseling points:

Contact MD immediately if serious diarrhea (this could occur up to a couple weeks after completing the medication); Take with or without food; Take with full glass of water; Liquid suspension should not be refrigerated

Clindamycin (Cleocin) common side effects:

Diarrhea, Abdominal pain, Nausea, Abnormal taste
Serious: Clostridium difficile

Metronidazole (Flagyl) common side effects:

Nausea, HA, Loss of appetite; Severe interaction with alcohol

Metronidazole (Flagyl) counseling points:

Do ingest alcohol products for at least 1-2 days after stopping the medication; Take with food, water or milk to reduce upset stomach

Oseltamivir (Tamiflu) - antiviral common side effects:

N/V
Rare/Serious: Rash

Oseltamivir (Tamiflu)- antiviral counseling points:

Start within 2 days of onset of influenza symptoms; Tx = 5 days, Prophy = 10 days; Take with or without food (food reduces N/V); Reduces effectiveness of intranasal influenza vaccine (within 2 weeks of administration); Contact MD if rash; Children and adolescents at risk for strange behavior, confusion or self injury

Nitrofurantoin (Macrodantin, Macrobid) common side effects:

Nausea, HA, Dark urine
Rare/Serious: hepatotoxicity, Pulmonary toxicity, Clostridium difficile

Nitrofurantoin (Macrodantin, Macrobid) counseling points:

Swallow whole; Mg antacids may decrease absorption; Report Dark brown urine, persisten N/V, stomach/abdominal pain, yellowing of eyes/skin, tiredness, fast/pounding heart, eye pain, vision changes, mental/mood changes, persistent/severe HA, new sign of infection, easy bruising/bleeding, persistent cough, chest pain, SOB/trouble breathing, joint/muscle pain, bluish lips/skin, severe diarrhea immediately; Not for use in severe renal impairment

Sulfamethoxazole and Trimethoprim (Bactrim, Septra) common side effects:

Nausea, Rash, Crystalluria, Photosensitivity, Allergy

Sulfamethoxazole and Trimethoprim (Bactrim, Septra) counseling points:

Do not use if allergy to sulfa; Take with full glass of water; Take with or without food (food decreases nausea); Wear sunscreen/avoid sun; Report rash immediately; Suspension should be kept at room temperature

Terbinafine (Lamisil) - antifungal common side effects:

Diarrhea, Stomach upset, Temporary change or loss of taste
Severe: Hepatotoxicity

Terbinafine (Lamisil) counseling ponts:

Take with or without food; It may take several months to work; Tell MD immediately if signs of new infection or vision changes or persistent nausea, loss of appetite, severe stomach/abdominal pain, dark urine, yellowing of eyes/skin, pale stools

Valacyclovir (Valtrex) - antiviral common side effects:

HA, Nausea, Stomach pain, Vomiting, Dizziness
Serious/Rare: Kidney failure, CNS problems

Valacyclovir (Valtrex) - antiviral counseling points:

Use daily and follow safer sex practices to decrease transmission; Does not cure herpes; Take with or without food; Store suspension in fridge for up to 28 days; Contact MD immediately if aggressive behavior, unsteady movement, shaky movement, confusion, hallucinations, seizures, coma, lack of urine.

Voriconazole (VFEND) - antifungal common side effects:

eyesight changes, rash, vomiting, nausea, diarrhea, HA, chills, fever, Photosensitivity, Allergy
Severe/Rare: Hepatotoxicity

Voriconazole (VFEND) - antifungal counseling points

Avoid night driving; Avoid sunlight; Tablets contain Lactose, suspension contains Sucrose; Take on empty stomach (at least 1 hour before or 1 hour after meals); Many DDIs; Do not use if pregnant or breastfeeding; Contact MD immediately if rash, difficulty breathing, persistent nausea, loss of appetite, severe stomach/abdominal pain, dark urine, yellowing of eyes/skin, pale stools

(True/False) Patients may stop taking meds treating infection at first signs of improvement

False. Finish ALL medication even if feeling 100% better.

What should patients do if they start to feel worse while on antibiotics?

Contact their physician immediately. May require change in therapy.

(True/False) All beta-lactams may cause rash

True. Patient should contact MD at signs of rash

(True/False) Patients may use household spoons to dispense suspensions

Kitchen teaspoons may not be 5mL. Use measuring devices supplied by pharmacy.

(True/False) Diarrhea associated with antibiotics may be treated with loperimide

False. May use probiotics or yogurt with separate administration times. Drink plenty of fluids. Take with food. Severe diarrhea may be a sign of Clostridium difficile, patient should contact MD immediately.

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