shouldnt take within 2 6 hr w antacids sucralfate iron preparation sevalamer

Shouldnt take within 2 6 hr w antacids sucralfate

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shouldn’t take within 2-6 hr w/ antacids, sucralfate, iron preparation, sevalamer, zinc salts; photosensitivity or phototoxicity; dizziness or light-headedness Lincosamides MOA Clindamycin—chlorine-substituted derivative of lincomycin and other drug in this class; suppress protein synthesis, the same as the receptor for macrolides; bacteriostatic Spectrum of activity In primary care, used for infections associated w/ anaerobic pathogen & G (+) cocci; treating secondary infection to staphy or strep in PCN allergic pts; decrease toxin production in septic shock caused by strep, staphy, clostridium (CDI is resistant to clindamycin) Resistanc e Commonly cross-resistance to macrolides Pharmaco -kinetics Complete absorption regardless of gastric acid or food, distribute to pleural & peritoneal fluids; metabolized by the liver to active and inactive metabolites; excreted in bile & urine Contra- indication Caution in pt w/ history of asthma, significant allergies; hypersensitivity; severe renal/hepatic impairment; pregnancy B; use it for serious infection in children and infant only ADRs GI: N/V, bitter or metallic taste; serious risk—CDI (should consider if developing diarrhea) Clinical use & dosing First line Tx for serious infections, MRSA (if resistance is low) in pediatric population; second line for G (+) cocci (limited use is recommended) Infections in PCN allergy pt: endocarditis prophylaxis; pneumococcal pn;
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skin & tissue infection Drug-resistance pneumococcal infections: second or third line for upper & lower resp. infection (Bacterial vaginosis), malaria, protozoal infections in (pregnant pt), children, and pt unable to tolerate first line therapy Odontogenic infections: first line tx—300mg-450mg qid for 3-5 d Monitorin g Cytotoxin assays or PCR testing for CDI; sitting or standing for 30 min d/t esophageal irritation Education For mild diarrhea, use attapulgite-containing antidiarrheal at least 2 h before or 3-4 hr after taking Macrolides, Azalides, Ketolides Pharmaco- dynamics Inhibits ribonucleic acid (RNA)-dependent protein synthesis; Macrolides—weak bases, activity increases in alkaline media; active against G (+) and Streptococcus, MSSA, Corynebacterium; atypical and intracellular organisms commonly resistant to beta- lactam antibiotics are often susceptible. Cross-resistance to all in class Azithromycin, Clarithromycin, Dirithromycin, Erythromycin, Telithromycin Pharmaco- kinetics Well-absorbed from duodenum-empty stomach increases absorption except telithromycin Partially metabolized in liver—Erythromycin, Telithromycin via CYP 3A4; excreted in mainly in bile & urine Contra- indication D/t inhibition of CYP 3A4, prolonged QT intervals, Torsades; hepatotoxicity— telithromycin; Exacerbation of Myasthenia gravis—erythromycin & Telithromycin; suspected or potential bacteremia contraindicates use of dirithromycin d/t serum levels are not adequate to provide coverage Azithromycin excreted via liver—cautious use needed; Clarithromycin excreted in liver & kidney—dosage adjustment not required for hepatic impairment with normal renal function;
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  • Spring '14
  • Henrikson,J
  • Clostridium difficile, Renal function

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