Counseling pearls for common Antibiotics??

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Me_Gusta_Drugs

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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
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augmentin- take with food
mostly just rifampin and tetracycline(s)- decreased effectiveness of BC
 
Last edited:
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?
 
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Me_Gusta_Drugs said:
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
Click to expand...

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.
 
possible superinfection with metro??....are you referring to pseudomembranous colitis (as in what clindamycin is notorious for)
 
Me_Gusta_Drugs said:
possible superinfection with metro??....are you referring to pseudomembranous colitis (as in what clindamycin is notorious for)
Click to expand...

and flagyl is used to treat...
 
Me_Gusta_Drugs said:
k we'll just pretend i didnt say that last part....moving on
Click to expand...

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.
 
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~
 
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?
 
pion said:
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?
Click to expand...

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.
 
pion said:
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?
Click to expand...

Because bactrim can cause kidney stones. That is why you should take with 1.5-2.0L/d of water.
 
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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 :)
 
Someone mentioned this already, but the photosensitivity thing is a big one...
 
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
 
Now who's gonna go the extra mile and make a printable handout?
 
That's a negative, Ghostrider.
 
Hmm....I see a lot of the guys fighting over who can be Maverick.
 
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
 
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.
 
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.
 
tootoo30 said:
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
Click to expand...

Bactrim causes neural tube defects because it inhibits the production of folate
 
Riboflavin, vitamin B12 changes urine color to blue-green fluorescence.
 
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
 
THanks!

How small you want it to be? I think you could print it as an option on 1/4 of an A4 paper.
 
Yeah that's probably the best option.
 
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