Charliethomas_edit.ppt

Patient Information Leaflets:
Discussion of Zirthomax,
Charlie C. Thomas, BPharm, RPh, FAPhA
Rocephin, Doxycycline,
State Pharmacy Director
Erthromycin, Flagyl and
Alabama Department of Public Health
Bicillin L-A
Amanda Holloway
Satellite Conference and Live Webcast
Pharm D Candidate
Wednesday, January 20, 2010
Auburn University
8:00 - 9:00 a.m. Central Time
Produced by the Alabama Department of Public Health
Video Communications and Distance Learning Division
Objectives
Objectives
• Discuss the use of the Patient
• Describe the importance of proper
Information Leaflet (PIL) when
patient counseling prior to
DISPENSING medication in ADPH
administering/dispensing medication
• List conditions that may
• Define the proper use of PILs when
contraindicate medication
dispensing medications in ADPH
administered and/or dispensed by
ADPH nurses
Objectives
Azithromycin (Zithromax)
• Identify medications that may
• Azithromycin is a macrolide
conflict with those
antibiotic used to treat bacterial
administered/dispensed from the
infections, including those that are
sexually transmitted
• It has a half-life of 68 hours
– Single dose stays in the body for
an extended period (>3 days)
Azithromycin: What You Need
Azithromycin: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Is the patient pregnant or trying to
– Kidney disease
become pregnant?
– Liver disease
• Is the patient breastfeeding?
– Irregular heart beat or heart disease
– Allergic reaction to a previous dose
of azithromycin, other macrolide
antibiotics, foods, dyes, or
preservatives
Azithromycin: Important
Ceftriaxone (Rocephin)
Drug Interactions
Lincomycin
Magnesium
• Ceftriaxone is a parenteral third-
Amiodarone
Nelfinavir
generation cephalosporin antibiotic
Antacids
Phenytoin
– Half-life is 6-9h
Cyclosporine
Warfarin
Ergotamine or Dihydroergotamine
Ceftriaxone: What You Need
Ceftriaxone: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Pregnant or trying to get pregnant?
– Any chronic illness
– Bowel disease (colitis)
• Breast-feeding?
– Concurrent kidney and liver
– Unusual or allergic reaction to
ceftriaxone, other cephalosporin or
penicillin antibiotics, foods, dyes
or preservatives
Ceftriaxone: Important
Doxycycline
Drug Interactions
(Monodox, Vibramycin)
• Calcium
• Doxycycline is a tetracycline
– Do not take this medication with
antibiotic
Ceftriaxone
• Half-life is 12-15 hours
• Coumadin (Warfarin)
• Alcohol
• Some other antibiotics
Doxycycline: What You Need
Doxycycline: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Do they plan to be out in the sun for
– Severe liver disease
long periods of time?
– Unusual or allergic reaction to
• Pregnant or trying to become
doxycycline, tetracycline
pregnant?
antibiotics, other medicines, foods,
• Breast-feeding?
dyes, or preservatives
– Bowel disease (ulcerative colitis or
Crohn’s)
Doxycycline: Important
Erythromycin Base
Drug Interactions
• Antacids containing Ca, Mg, Al
• Erythromycin is a macrolide
• Vitamins containing iron or zinc
antibiotic
• Pepto-Bismol
– Half-life is 1.5-2 hours
• Seizure Medications (Phenytoin,
Carbamazepine, Phenobarbital)
• Coumadin (Warfarin)
• Birth control pills
• Other antibiotics
Erythromycin Base: What to
Erythromycin Base:
Know About Your Patient
Important Drug Interactions
• History of
• DO NOT take Erythromycin with the
following drugs
– Severe liver disease
– Chloroquine
– Myasthenia Gravis
– Cisapride
– Unusual or allergic reaction to
– Droperidol
erythromycin, other medicines,
foods, dyes, or preservatives
– Eplerenone
• Pregnant or trying to get pregnant?
– Ergotamine/Dihydroergotamine
– Methadone
• Breast-feeding?
Erythromycin Base:
Erythromycin: Important
Important Drug Interactions
Drug Interactions
• DO NOT take Erythromycin with the
• Chloroquine, Cisapride, Droperidol &
following drugs
anti-arrhythmic drugs (Amiodarone,
Dofetilide, Propafenone)
– Fluoroquinolones
• Eplerenone
– Sirolimus
• Methadone
– Some cholesterol medications
(statins, red yeast rice)
• Cholesterol lowering medications
(statins, red yeast rice)
– Vinblastine
• Digoxin
Erythromycin: Important
Metronidazole (Flagyl)
Drug Interactions
• Antibacterial and antiprotozoal agent
• Warfarin
that belongs to the nitroimidazole
• Seizure medications (Phenytoin,
Carbamazepine)
• Theophylline
– Half-life is 8h
• Bromocriptine
• Cyclosporine and Tacrolimus
Metronidazole: What You Need
Metronidazole: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
– Alcohol consumption
– Anemia or other blood disorders
– Unusual or allergic reaction to
• Pregnant or trying to become
metronidazole, or other medicines,
pregnant?
foods, dyes, or preservatives
– Disease of nervous system (seizure
• Breast-feeding?
or peripheral neuropathy)
– Severe liver disease
– Fungal or yeast infection
Metronidazole: Important
Penicillin G Benzathine
Drug Interactions
(Bicillin L-A)
• Alcohol
• Penicillin G Benzathine is a long
• Disulfiram
acting form of penicillin G
• Ritonavir, Timpranivir, Amprenavir,
Sertraline oral solutions
• After injection, a depot forms in the
tissue and slowly releases the drug
• Cimetidine
into the blood stream over several
• Lithium
• Phenytoin
– Serum levels can be detected up to
• Phenobarbital
30 days after a single doses
• Warfarin
Bicillin L-A: What You Need
Bicillin L-A: What You Need
to Know About Your Patient
to Know About Your Patient
• History of
• Pregnant or trying to become
– Asthma
pregnant?
– Severe kidney disease
• Breast-feeding?
– Unusual or allergic reaction to
penicillin G benzathine, any
penicillin or cephalosporin
antibiotic, other medicines, foods,
dyes, or preservatives
Bicillin L-A:
Allergy Considerations
Important Drug Interactions
• In addition to hypersensitivity
• Aspirin, Indomethacin, probenacid,
reactions to the active drug therapy,
Ethacrynic acid, Phenylbutazone,
patients may have an allergy to one
diuretics (HCTZ, Lasix, etc.)
of the inactive components of the
• Birth control pills
drug formulation
• Methotrexate
• All patients need to be asked if they
have any medication, food, dye, or
• Typhoid vaccine
preservative allergies
In Summary
Resources
• Dispensing medications requires
• Clinical Pharmacology [database
specific procedures according to laws,
online]. Tampa, FL: Gold Standard,
rules, and regulations
Inc.;2009. URL:
• Nurses should be aware of important
http://www.clinicalpharmacology.com
health conditions or disease states
• Lexi-Comp [database online].
listed on the Patient Information
Leaflets that may interact and what
Hudson, OH: Lexi-Comp, Inc.
actions they should take to resolve
Copyright 1978-2009.
these interactions before dispensing
http://www.crlonline.com/crlsql /servlet/crlonline
medications in the health department
Resources
• Drug Facts and Comparisons.
Electronic edition. St. Louis: Wolters
Kluwer Health, May 2009.

Source: http://adph.org/ALPHTN/assets/012010ahandouts.pdf