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Counseling pearls for common Antibiotics??

Discussion in 'Pharmacy' started by Me_Gusta_Drugs, Jul 15, 2008.

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  1. Me_Gusta_Drugs

    Me_Gusta_Drugs Junior Member

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    Im on a retail rotation, and am trying to learn how to counsel (Antibiotics especially because they are so common).
    My questions....
    How important is this take with or without food business (which are important and which are no biggie) Which abx will cause the most GI upset? If anyone can help out...with any other counseling pearls....chime in


    What Im pretty sure of:
    No antacids, vitamins, calcium, milk with the Quinolones, Tetracyclines, and Azithromycin.
    No alcohol...especially with metronidazole and ketoconazle
    Emphasize full course of therapy
    Tetracyclines should be taken with a full glass of water or else....esophagitis
    Take without food (unless GI upset): Only Tetracyclines and Ampicillin???
    Take with food: nitrofurantoin
    Doesnt matter: All the rest??



    On a side note, I asked the pharmacist how to counsel insulins. He said "Use as directed and keep refrigerated" He said the patients coming in w/ insulin have already been thoroughly counseled on what to do by the nurse or doctor and "could tell us pharmacists a few things". Is he right on the money....Is this all thats needed to counsel insulins typically
  2. UofMN2010

    UofMN2010 Hockey is life

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    augmentin- take with food
    mostly just rifampin and tetracycline(s)- decreased effectiveness of BC
    Last edited: Jul 15, 2008
  3. Me_Gusta_Drugs

    Me_Gusta_Drugs Junior Member

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    So for Rifampin and Tetracyclines....they should use another form of BC for that month

    Most the other antibiotics your safe to tell patients they dont need another form of BC?
  4. Aznfarmerboi

    Aznfarmerboi Senior Member

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    With liquid antibiotics, refrigeration is a big thing. Be sure to remind your patients to throw them out after 14 days. For patients who finished their therapy too early due to not using calibrated devices, it is okay most of the time as long as they finish it.

    With FQ and tetracyclines, keep in mind of photosensitivity. If one of those rare things were to happen. . it would be this. In real case scenarios, maybe 5 out of 1000 patients might get it. In any case, it doesnt hurt to protect from sunlight or tanning salons.

    For females on birthcontrol pills, its nice to warn them about using back ups during and after (although in my clinical opinion is not necessary). Better to be safe than sorry though.

    With metro, it is important to counsel on diarrhea. With all antibiotics.. . diarrhea is a major problem. However with this one, it can be a sign of a superinfection.

    Yeast infection counseling should also be recommended for appropriate antibiotics.

    These are all the ones I can think of right now.
  5. Me_Gusta_Drugs

    Me_Gusta_Drugs Junior Member

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    possible superinfection with metro??....are you referring to pseudomembranous colitis (as in what clindamycin is notorious for)
  6. njac

    njac Senior Member

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    and flagyl is used to treat...
  7. Me_Gusta_Drugs

    Me_Gusta_Drugs Junior Member

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    k we'll just pretend i didnt say that last part....moving on
  8. njac

    njac Senior Member

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    no, I was supporting you there.

    Clinda can cause pseudomembranous colitis, as well as allowing c.diff to take over. We'll treat that with flagyl/metronidazole.
  9. aboveliquidice

    aboveliquidice No sacrifice - No victory Moderator Emeritus

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    Pen VK & Amoxicillin (without BLI) are taken on empty stomachs.

    And I can echo the insulin consultation... The only thing that I would add is to ask how often the patient is checking blood glucose. Once that is confirmed, ask them if they are keeping a journal. When patients go back to the physician, having a journal of readings can be very instrumental for accurate dosing per MD.

    Just some more pearls...

    ~above~
  10. pion

    pion

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    I often hear pharmacists counsel bactrim to be taken with plenty of water (not necessarily at the same time as the tablet, just in general while on the med). Why is this?
  11. rxlynn

    rxlynn Senior Member

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    I haven't had ID yet, so there may be some more specific reason that I don't know about BUT bactrim is often given for UTI, so the patients need to be drinking a lot of fluids to help treat the underlying condition.
  12. BMBiology

    BMBiology on maternity leave

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    Because bactrim can cause kidney stones. That is why you should take with 1.5-2.0L/d of water.
  13. ItsOverZyvox

    ItsOverZyvox Retired

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    I would tell them Zpak Sux...
  14. dezokitty

    dezokitty

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    For the insulin, it kinda depends on what you're comfortable with... The MD/nurse may know what they prescribed the patient, but it's still good to check to see if they have any compliance issues... Also, see if they're checking their blood glucose regularly, and also see if they have any issues with hypoglycemia. If they are, you can talk about glucose tabs/tubes. And it doesn't hurt to recommend a glucagon kit if they don't currently have one. Plus, it's always good to ask how they're doing with their meds in general; see if they have questions for you that they didn't bring up with their doctor :)
  15. pharmagirl

    pharmagirl

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    Someone mentioned this already, but the photosensitivity thing is a big one...
  16. BMBiology

    BMBiology on maternity leave

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    I am only including the main drugs:

    Photosensitivity: fluoroquinolones, tetracyclines, bactrim, tigeycyline

    Change urine color: metronidazole, nitrofurantoin, rifampin, phenazopyridine

    Avoid cations (antacids): fluoroquinolones, tetracyclines, azithromycin, cefdinir, isoniazid

    Stain teeth: tetracyclines, tigecycline

    Avoid EtOH: linezolid, isoniazid, metronidazole, cefamendole, cefmetazole, ceoperazone, cefotetan

    Avoid in children: fluoroquinolone (cipro is approved <18 yr old), tetracyclines, tigecycline, nitrofurantoin (not < 1 mo), bactrim (not <2 mo), pediazole (not < 2 mo)

    Avoid in pregnancy: fluoroquinolone, clarithromycin, metronidazole (1st trimester), nitrofurantoin (>38 wks), bactrim preg cat D at term

    Take with plenty water: tetracycline, bactrim, clindamycin, linezolid

    Take with food: augmentin, clarithromycin XL, nitrofurantoin

    Avoid tyramine food: linezolid, isoniazid
  17. Me_Gusta_Drugs

    Me_Gusta_Drugs Junior Member

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    Great information!
    Thanks
  18. GatorRxGirl

    GatorRxGirl

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    Now who's gonna go the extra mile and make a printable handout?
  19. FruitFly

    FruitFly Moderator Emeritus

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    I volunteer GatorRxGirl :smuggrin:
  20. GatorRxGirl

    GatorRxGirl

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    That's a negative, Ghostrider.
  21. FruitFly

    FruitFly Moderator Emeritus

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    Roger that. Over n out.
  22. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    ...the pattern is full.:laugh:
  23. SpirivaSunrise

    SpirivaSunrise Go Gators! Lifetime Donor

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    Hah! Definitely one of my faves...

    Uh oh...do I see this turning into a which SDN pharm member = which Top Gun castmember thread?
  24. FruitFly

    FruitFly Moderator Emeritus

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    Not gonna work. There's only like 1 chick in the whole movie. :laugh:
  25. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    Its on you...start a new thread.....
  26. GatorRxGirl

    GatorRxGirl

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    Hmm....I see a lot of the guys fighting over who can be Maverick.
  27. iphetamine

    iphetamine

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    wow, my thoughts exactly!!
    i have thought of doing one as a reference before scrolling to your post. :p
  28. tootoo30

    tootoo30 Account Closed!

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    A little off topic, but does bactrim cause birth defects? I asked the physician but she told me should would have to find out. WTF
  29. Glycerin

    Glycerin Commercially Unavailable Moderator Emeritus

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    There's a new FDA warning on FQs that came out in the last couple of weeks regarding ruptured tendons, so I'd probably tell the patients to report any unexplained leg/tendon pain.
  30. nsxiboi

    nsxiboi Member

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    wow these are helpful. I have an infectious disease final next week, along with 3 other finals. Then i go on rotations!! woohoo!! Gotta pass.
  31. nsxiboi

    nsxiboi Member

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    Bactrim causes neural tube defects because it inhibits the production of folate
  32. bananaface

    bananaface Pharmacy Supernerd Staff Member Administrator SDN Senior Moderator Lifetime Donor

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    I would tell them bananaface. They might not be able to read my nametag.
  33. FAMUPharmD09

    FAMUPharmD09 Pharm.D.

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    Rifampin changes urine color to orange
  34. iphetamine

    iphetamine

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    Riboflavin, vitamin B12 changes urine color to blue-green fluorescence.
  35. GatorRxGirl

    GatorRxGirl

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    Tears too...kind of like those old Gatorade commercials.
  36. iphetamine

    iphetamine

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  37. GatorRxGirl

    GatorRxGirl

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    Good job...way to go above and beyond. This will be very helpful for lots of people. It'd be a good idea to print it small so it can go in a coat pocket or small reference notebook.

    :D
  38. FruitFly

    FruitFly Moderator Emeritus

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    Affirmative
  39. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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  40. iphetamine

    iphetamine

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    THanks!

    How small you want it to be? I think you could print it as an option on 1/4 of an A4 paper.
  41. GatorRxGirl

    GatorRxGirl

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    Yeah that's probably the best option.

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