Brand: Amoxil
Class: Antibiotic; aminopenicillin (beta-lactam)
Indications: Ear, nose and throat, lower respiratory, skin and GU infections; H. pylori eradication with other drugs
Action: Binds penicillin-binding proteins and blocks bacterial cell wall synthesis (bactericidal)
Adverse Effects: Anaphylaxis, severe skin reactions, C. difficile diarrhea, rash (common with mononucleosis), nausea
Contraindications: Prior serious hypersensitivity to amoxicillin or another beta-lactam (penicillins, cephalosporins)
Interactions: Probenecid (raises levels), allopurinol (more rash), warfarin (INR may rise), oral contraceptives (less effective)
Nursing Considerations: Ask about prior beta-lactam reactions before the first dose; watch for anaphylaxis; assess for watery or bloody diarrhea
Patient Teaching: Finish the full course; report hives, swelling or trouble breathing; report severe or bloody diarrhea, even weeks later
Plain amoxicillin is destroyed by bacterial beta-lactamase, which is why it is often paired with clavulanate.
Card 2
piperacillin-tazobactam
Answer
Brand: Zosyn
Class: Antibiotic; extended-spectrum penicillin plus beta-lactamase inhibitor
Indications: Intra-abdominal, skin and female pelvic infections; hospital-acquired and moderate community-acquired pneumonia
Action: Piperacillin blocks cell wall synthesis; tazobactam protects it from many beta-lactamases
Adverse Effects: Anaphylaxis, SJS/TEN, C. difficile diarrhea, AKI in critically ill, seizures in renal impairment, bleeding, leukopenia
Contraindications: Prior allergic reaction to any penicillin, cephalosporin or beta-lactamase inhibitor
Interactions: Vancomycin (more AKI), aminoglycosides (inactivated; give separately), methotrexate, probenecid, anticoagulants
Nursing Considerations: Draw cultures before the first dose when possible; monitor creatinine and urine output, especially with vancomycin; check potassium
Patient Teaching: Report rash, itching or trouble breathing; report diarrhea, unusual bleeding or bruising
Antipseudomonal coverage is what makes it a common empiric choice for sepsis from an abdominal or hospital-acquired source.
Card 3
penicillin G benzathine
Answer
Brand: Bicillin L-A
Class: Antibiotic; long-acting natural penicillin
Indications: Syphilis and other treponemal infections, mild to moderate strep upper respiratory infection, rheumatic fever prevention
Action: Slowly released from an IM depot; blocks bacterial cell wall synthesis
Adverse Effects: Boxed: not for IV use, inadvertent IV use linked to cardiorespiratory arrest and death; anaphylaxis, Jarisch-Herxheimer reaction
Contraindications: History of hypersensitivity to any penicillin
Nursing Considerations: Deep IM only (dorsogluteal or ventrogluteal); never IV or near an artery or nerve; inject slowly and steadily; watch for anaphylaxis
Patient Teaching: Fever and aches within hours of syphilis treatment are usually a Jarisch-Herxheimer reaction; report hives or trouble breathing
L-A means long-acting: the deep IM depot releases penicillin slowly for weeks, which is exactly why it must never enter a vein.
Card 4
cefazolin
Answer
Brand: None (Ancef discontinued)
Class: Antibiotic; first-generation cephalosporin
Indications: Perioperative prophylaxis; serious respiratory, urinary, skin, biliary, bone and joint infections, septicemia, endocarditis
Action: Binds penicillin-binding proteins and blocks bacterial cell wall synthesis
Adverse Effects: Anaphylaxis, C. difficile colitis, seizures with high doses in renal impairment, low prothrombin activity, positive Coombs test
Contraindications: Known allergy to cephalosporins
Interactions: Probenecid (raises levels), anticoagulants (monitor PT), false-positive urine glucose with copper reduction tests
Nursing Considerations: Time prophylaxis to the pre-incision window per protocol; ask about beta-lactam allergy and reaction type; adjust for renal function
Patient Teaching: Report rash, hives or trouble breathing; report watery or bloody diarrhea, even after the course ends
First-generation cephalosporins are strongest against gram-positive skin flora, which is why cefazolin is the standard for preventing surgical-site infection.
Card 5
cephalexin
Answer
Brand: None (Keflex discontinued)
Class: Antibiotic; first-generation cephalosporin (oral)
Indications: Respiratory, otitis media, skin, bone and GU infections including acute prostatitis
Action: Binds penicillin-binding proteins and blocks bacterial cell wall synthesis
Adverse Effects: Anaphylaxis, C. difficile diarrhea, hemolytic anemia with positive Coombs test, seizures in renal impairment, prolonged PT
Contraindications: Known hypersensitivity to cephalexin or other cephalosporins
Interactions: Metformin (levels rise), probenecid (not recommended), false-positive urine glucose with Benedict or Fehling tests
Nursing Considerations: Ask about prior beta-lactam reactions; expect a lower dose in renal impairment; monitor glucose on metformin; assess for diarrhea
Patient Teaching: Take doses evenly spaced, with or without food, and finish the course; report rash, swelling or severe diarrhea
Cephalexin is the oral first-generation cephalosporin, a common step-down from IV cefazolin for skin infections.
Card 6
meropenem
Answer
Brand: None (Merrem discontinued)
Class: Antibiotic; carbapenem (beta-lactam)
Indications: Complicated skin and intra-abdominal infections, bacterial meningitis in children 3 months and older
Action: Binds penicillin-binding proteins and blocks cell wall synthesis; resists many beta-lactamases
Adverse Effects: Anaphylaxis, severe skin reactions, seizures (CNS disease, renal impairment), C. difficile diarrhea, thrombocytopenia, rhabdomyolysis
Contraindications: Hypersensitivity to carbapenems, prior anaphylaxis to any beta-lactam
Interactions: Valproic acid (levels drop, breakthrough seizures; generally avoid), probenecid (not recommended)
Nursing Considerations: Ask about beta-lactam allergy; flag any valproate order to the provider; expect renal dose adjustment; seizure precautions if high risk
Patient Teaching: Report rash, diarrhea or muscle pain; do not drive until you know whether it causes confusion or tingling
Carbapenems are among the broadest beta-lactams, so stewardship teams save them for resistant gram-negative infections.
Card 7
vancomycin
Answer
Brand: Vancocin, Firvanq (oral forms)
Class: Antibiotic; glycopeptide
Indications: IV: serious MRSA and other gram-positive infections, endocarditis; oral: C. difficile diarrhea, staph enterocolitis
Action: Binds cell wall precursors and blocks bacterial cell wall synthesis
Adverse Effects: Nephrotoxicity, ototoxicity, infusion reaction (flushing, rash, hypotension) if infused fast, SJS/TEN/DRESS, neutropenia
Contraindications: Hypersensitivity to vancomycin
Interactions: Aminoglycosides, piperacillin-tazobactam and other nephrotoxic drugs; anesthetics (more infusion reactions)
Monitoring: Trough or AUC levels per protocol; creatinine, urine output; hearing and CBC on long courses
Nursing Considerations: Infuse over at least 60 min, no faster than 10 mg/min; if flushing starts, stop or slow it and notify; watch the site (necrosis)
Patient Teaching: Report itching or flushing during the infusion; report ringing in the ears, hearing change or less urine
Oral vancomycin is barely absorbed, so it treats C. difficile in the colon but cannot treat infection anywhere else.
Card 8
gentamicin
Answer
Brand: None (Garamycin discontinued)
Class: Antibiotic; aminoglycoside
Indications: Serious gram-negative infections (Pseudomonas, E. coli, Klebsiella, Proteus), neonatal and adult sepsis, some staph
Action: Binds the 30S ribosomal subunit, causing faulty protein synthesis (bactericidal)
Adverse Effects: Boxed: nephrotoxicity, usually irreversible ototoxicity (hearing, balance), neurotoxicity, fetal harm; neuromuscular blockade
Contraindications: Hypersensitivity; a prior serious reaction to another aminoglycoside may contraindicate use
Interactions: Loop diuretics (avoid), vancomycin and other nephrotoxic or ototoxic drugs, neuromuscular blockers
Monitoring: Peak and trough levels, kidney function, hearing and balance
Nursing Considerations: Time peak and trough draws per protocol; keep well hydrated; ask daily about tinnitus, hearing loss and dizziness
Patient Teaching: Report ringing in the ears, hearing loss, dizziness or less urine
Aminoglycosides injure the ears and kidneys, and ear damage is usually permanent, so new tinnitus or vertigo needs prompt reporting.
Card 9
azithromycin
Answer
Brand: Zithromax
Class: Antibiotic; macrolide
Indications: Community-acquired pneumonia, bacterial COPD flare, sinusitis, strep pharyngitis, skin infection, chlamydial urethritis and cervicitis
Action: Binds the 50S ribosomal subunit and blocks bacterial protein synthesis
Adverse Effects: QT prolongation and torsades, hepatotoxicity, anaphylaxis and SJS, C. difficile diarrhea, myasthenia flare, pyloric stenosis in newborns
Contraindications: Allergy to any macrolide; prior cholestatic jaundice or liver dysfunction with azithromycin
Interactions: Other QT-prolonging drugs, warfarin (INR may rise), aluminum or magnesium antacids (not at the same time), nelfinavir
Nursing Considerations: Check QT, potassium and magnesium if at risk; avoid other QT drugs; watch for jaundice; infuse IV over 60 min or more, never bolus or IM
Patient Teaching: Report palpitations, fainting, yellow skin or dark urine; separate from aluminum or magnesium antacids
A long tissue half-life is why azithromycin courses can be as short as one to five days.
Card 10
doxycycline
Answer
Brand: Acticlate, Doryx MPC (Vibramycin discontinued)
Class: Antibiotic; tetracycline
Indications: Rickettsial infections, chlamydia and other STIs, Mycoplasma pneumonia, anthrax, malaria prophylaxis, adjunct for severe acne
Action: Binds the 30S ribosomal subunit and blocks bacterial protein synthesis (bacteriostatic)
Adverse Effects: Esophageal ulcers, photosensitivity, permanent tooth staining (late pregnancy to age 8), intracranial hypertension, C. difficile diarrhea
Contraindications: Hypersensitivity to any tetracycline
Interactions: Antacids, iron, calcium, magnesium (less absorption); anticoagulants; isotretinoin; penicillins; oral contraceptives
Nursing Considerations: Give with plenty of fluid, not at bedtime; separate from minerals and antacids; avoid in pregnancy and age 8 or under unless severe
Patient Teaching: Take with a full glass of water and do not lie down right after; use sunscreen and limit sun; report severe headache or blurred vision
Doxycycline is still first-line for suspected Rocky Mountain spotted fever at any age, because delayed treatment is deadlier than the tooth risk.
Card 11
ciprofloxacin
Answer
Brand: Cipro
Class: Antibiotic; fluoroquinolone
Indications: UTI and pyelonephritis, lower respiratory, bone and joint, infectious diarrhea, typhoid, inhalational anthrax, plague
Action: Inhibits bacterial DNA gyrase and topoisomerase IV, blocking DNA replication
Adverse Effects: Boxed: disabling, possibly irreversible tendon rupture, neuropathy, CNS effects; myasthenia flare; aortic aneurysm, dysglycemia, long QT
Contraindications: Hypersensitivity to any quinolone, use with tizanidine
Interactions: Tizanidine, theophylline, multivalent cations (antacids, iron, calcium, zinc, sucralfate), warfarin, sulfonylureas, QT drugs
Nursing Considerations: Avoid in myasthenia gravis; tendon risk is highest over 60, on steroids or after transplant; check glucose in diabetes
Patient Teaching: Stop and call for tendon pain, tingling, confusion or mood change; take 2 h before or 6 h after antacids, iron, calcium or zinc
For uncomplicated cystitis, sinusitis and bronchitis flares, the boxed warning says to reserve fluoroquinolones for patients with no other option.
Card 12
sulfamethoxazole-trimethoprim
Answer
Brand: Bactrim, Bactrim DS (Septra discontinued)
Class: Antibiotic; sulfonamide plus folate antagonist
Indications: UTI, Pneumocystis pneumonia treatment and prevention, shigellosis, traveler's diarrhea, pediatric otitis media
Action: Blocks two sequential steps of bacterial folic acid synthesis
Adverse Effects: SJS/TEN, DRESS, hyperkalemia, thrombocytopenia and other blood dyscrasias, hypoglycemia, crystalluria, hemolysis in G6PD deficiency
Contraindications: Sulfa or trimethoprim allergy, folate-deficiency anemia, infants under 2 months, marked liver damage, dofetilide
Interactions: Warfarin (INR rises), phenytoin, methotrexate, ACE inhibitors and other potassium-raising drugs, sulfonylureas
Nursing Considerations: Encourage fluids to prevent crystalluria; hold at the first rash and notify; monitor potassium, CBC and renal function; check INR
Patient Teaching: Drink plenty of fluids; stop and call for any rash, sore throat, fever or unusual bruising
Trimethoprim blocks potassium excretion like a potassium-sparing diuretic, so potassium can climb fast in older adults on ACE inhibitors.
Card 13
metronidazole
Answer
Brand: Flagyl
Class: Antibacterial and antiprotozoal; nitroimidazole
Indications: Trichomoniasis, amebiasis, serious anaerobic infections (intra-abdominal, gynecologic, skin, bone, CNS)
Action: Reduced inside anaerobes and protozoa to products that damage their DNA
Adverse Effects: Boxed: carcinogenic in mice and rats, avoid unnecessary use; encephalopathy, peripheral neuropathy, seizures, metallic taste
Contraindications: Nitroimidazole allergy, disulfiram within 2 weeks, alcohol or propylene glycol use, first-trimester use for trichomoniasis
Interactions: Warfarin (INR rises), lithium (toxicity), busulfan, alcohol and propylene glycol (disulfiram-like reaction)
Nursing Considerations: Check INR on warfarin and lithium level on lithium; ask about numbness, tingling, confusion or unsteady gait and report
Patient Teaching: No alcohol during therapy and for at least 3 days after; urine may darken; report numbness, tingling, confusion or seizures
The alcohol reaction (flushing, vomiting, headache) is why the 3-day rule after the last dose matters as much as during treatment.
Card 14
clindamycin
Answer
Brand: Cleocin
Class: Antibiotic; lincosamide
Indications: Serious anaerobic infections; serious strep, pneumococcal and staph infections when a penicillin is not appropriate
Action: Binds the 50S ribosomal subunit and blocks bacterial protein synthesis
Adverse Effects: Boxed: C. difficile infection up to fatal colitis, reserve for serious infections; anaphylaxis, SJS/TEN/DRESS, AKI
Contraindications: Hypersensitivity to clindamycin or lincomycin
Interactions: Neuromuscular blockers (enhanced), strong CYP3A4 inhibitors (raise levels), inducers such as rifampin (lower levels)
Nursing Considerations: Assess stools every shift; hold and notify for significant diarrhea; not for meningitis (poor CSF entry); monitor renal function
Patient Teaching: Take capsules with a full glass of water, 30 min before lying down; call for watery or bloody diarrhea, even 2 months later
Clindamycin's boxed warning is about the colon, not an organ toxicity: it is one of the antibiotics most linked to C. difficile.
Card 15
nitrofurantoin
Answer
Brand: Macrobid, Furadantin (Macrodantin discontinued)
Class: Urinary antibacterial; nitrofuran
Indications: Urinary tract infection, mainly acute uncomplicated cystitis; not for pyelonephritis
Action: Reduced by bacteria to reactive products that damage ribosomes, DNA and other targets
Adverse Effects: Acute and chronic lung reactions, hepatitis, peripheral neuropathy, hemolytic anemia (G6PD deficiency), C. difficile diarrhea
Contraindications: CrCl under 60 mL/min, pregnancy at term or in labor, infants under 1 month, prior nitrofurantoin liver injury
Interactions: Magnesium trisilicate antacids (less absorption), probenecid and sulfinpyrazone (less urinary effect, more toxicity)
Nursing Considerations: Check creatinine clearance first; give with food; watch for fever, cough or dyspnea (acute lung reaction); assess for numbness
Patient Teaching: Take with food; brown urine is harmless; report cough, shortness of breath, tingling, yellow skin or dark urine
Nitrofurantoin only reaches useful levels in the bladder, so it cannot treat kidney or bloodstream infection.
Card 16
linezolid
Answer
Brand: Zyvox
Class: Antibiotic; oxazolidinone
Indications: Vancomycin-resistant Enterococcus faecium, hospital and community-acquired pneumonia, skin infections including MRSA
Action: Binds the 50S subunit and prevents formation of the 70S initiation complex
Adverse Effects: Myelosuppression, peripheral and optic neuropathy, serotonin syndrome, lactic acidosis, hypoglycemia, hyponatremia
Contraindications: Any MAOI now or within 2 weeks, hypersensitivity
Interactions: SSRIs, SNRIs and other serotonergic drugs; pseudoephedrine and vasopressors (BP rise); high-tyramine foods
Monitoring: CBC weekly; visual function on extended courses; BP with adrenergic drugs
Nursing Considerations: Screen the med list for serotonergic and adrenergic drugs; watch for agitation, fever, tremor or clonus; monitor glucose in diabetes
Patient Teaching: Avoid large amounts of aged cheese, cured meats and tap beer; report vision changes, tingling, bleeding or repeated vomiting
Linezolid is a weak nonselective MAO inhibitor, which explains its serotonin syndrome, tyramine and blood pressure warnings.
Card 17
isoniazid
Answer
Brand: None (Nydrazid discontinued)
Class: Antitubercular; isonicotinic acid hydrazide
Indications: Active TB with other drugs, preventive therapy for latent TB infection
Action: Inhibits mycolic acid synthesis in the mycobacterial cell wall
Adverse Effects: Boxed: severe, sometimes fatal hepatitis, higher with age, daily alcohol, liver disease, injection drug use; peripheral neuropathy
Contraindications: Prior isoniazid liver injury or severe reaction (drug fever, chills, arthritis), acute liver disease
Interactions: Phenytoin, carbamazepine (levels rise), acetaminophen, rifampin (liver injury), tyramine and histamine foods
Monitoring: Monthly symptom review; AST and ALT before and during therapy in patients 35 and older
Nursing Considerations: Give on an empty stomach; give pyridoxine as ordered; hold and report anorexia, nausea, dark urine, jaundice or fatigue
Patient Teaching: Avoid alcohol; report nausea, dark urine, yellow skin or tingling; aged cheese, wine or tuna can cause flushing
Isoniazid depletes vitamin B6, so pyridoxine is added to prevent its peripheral neuropathy.
Card 18
rifampin
Answer
Brand: Rifadin IV (Rifadin capsules discontinued)
Class: Antitubercular; rifamycin
Indications: All forms of TB with other drugs, clearing meningococci from the nose and throat of asymptomatic carriers
Action: Inhibits bacterial DNA-dependent RNA polymerase
Adverse Effects: Hepatotoxicity, flu-like hypersensitivity, severe skin reactions, thrombocytopenia, vitamin K-dependent bleeding
Contraindications: Rifamycin allergy; several HIV drugs (atazanavir, darunavir, saquinavir and others), praziquantel, lurasidone
Interactions: Strong inducer: lowers hormonal contraceptives, warfarin, azoles, digoxin, tacrolimus, cyclosporine; isoniazid (liver)
Nursing Considerations: Give oral doses 1 h before or 2 h after a meal; have pharmacy review every medication; monitor liver tests; watch for bleeding
Patient Teaching: Urine, sweat and tears turn orange-red and can permanently stain soft contacts; use nonhormonal birth control
Rifampin speeds the metabolism of so many drugs that starting or stopping it can undo a stable warfarin, contraceptive or transplant regimen.
Card 19
fluconazole
Answer
Brand: Diflucan
Class: Antifungal; triazole
Indications: Vaginal, oral, esophageal and systemic candidiasis, cryptococcal meningitis, Candida prophylaxis in marrow transplant
Action: Inhibits fungal CYP450 14-alpha-demethylase, blocking ergosterol synthesis
Adverse Effects: Hepatotoxicity, QT prolongation and torsades, anaphylaxis, exfoliative skin reactions, adrenal insufficiency, headache, nausea
Contraindications: QT-prolonging CYP3A4 substrates such as pimozide, quinidine and erythromycin; hypersensitivity
Interactions: Raises warfarin, sulfonylureas, phenytoin, tacrolimus, cyclosporine; statins (myopathy); rifampin lowers fluconazole
Nursing Considerations: Screen for QT and CYP interactions; check liver tests on long courses; monitor INR and glucose; avoid in pregnancy unless severe
Patient Teaching: Report yellow skin, dark urine, palpitations, fainting or rash; tell every prescriber and pharmacist you take it
Fluconazole inhibits human CYP enzymes as well as the fungal one, which is why it raises the levels of so many other drugs.
Card 20
nystatin
Answer
Brand: None (Mycostatin discontinued)
Class: Antifungal; polyene
Indications: Oral candidiasis (suspension), cutaneous and mucocutaneous candidiasis (topical forms)
Action: Binds ergosterol in the fungal cell membrane, causing leakage of cell contents
Adverse Effects: Oral irritation, nausea, vomiting, diarrhea; rare hypersensitivity and Stevens-Johnson syndrome
Contraindications: Hypersensitivity to any component
Interactions: None clinically significant; GI absorption is negligible
Nursing Considerations: Not for systemic infection; place half the dose in each side of the mouth; continue 48 h after symptoms clear; dentures may need soaking
Patient Teaching: Hold the suspension in your mouth as long as possible before swallowing; keep using it at least 48 h after symptoms clear
Nystatin is barely absorbed, so it treats thrush on contact but does nothing for a systemic fungal infection.
Card 21
amphotericin B
Answer
Brand: AmBisome (Fungizone discontinued)
Class: Antifungal; polyene
Indications: Life-threatening fungal infection (Aspergillus, Candida, Cryptococcus), febrile neutropenia (liposomal), visceral leishmaniasis
Action: Binds ergosterol and forms pores in the fungal cell membrane
Adverse Effects: Boxed (conventional): not for noninvasive infection such as thrush, never over 1.5 mg/kg; infusion rigors, nephrotoxicity, low K and Mg
Contraindications: Hypersensitivity, unless the infection is life-threatening and only amphotericin B will treat it
Interactions: Other nephrotoxic drugs, corticosteroids (more hypokalemia), digoxin (toxicity with low K), flucytosine
Monitoring: Kidney function, potassium, magnesium, CBC, liver function
Nursing Considerations: Verify product and dose (forms are not interchangeable mg for mg); premedicate as ordered; check vitals often early in the infusion
Patient Teaching: Chills and fever during the infusion are common; report trouble breathing, chest pain or less urine
Nicknamed amphoterrible for its rigors and kidney injury; lipid formulations cause less of both but are dosed differently.
Card 22
acyclovir
Answer
Brand: Zovirax cream and ointment (oral Zovirax discontinued)
Class: Antiviral; nucleoside analog (guanosine)
Indications: Oral: shingles, genital herpes, chickenpox; IV: HSV encephalitis, neonatal herpes, HSV or VZV in immunocompromised
Action: Inhibits viral DNA polymerase and terminates the growing viral DNA chain
Adverse Effects: Kidney injury from crystals, encephalopathy (confusion, hallucinations), TTP/HUS in immunocompromised, phlebitis, severe skin reactions
Contraindications: Prior significant hypersensitivity to acyclovir or valacyclovir
Interactions: Other nephrotoxic drugs, probenecid (raises levels)
Nursing Considerations: Infuse IV over at least 1 h, never bolus, IM or subcut; ensure hydration and urine output; monitor creatinine; watch for confusion
Patient Teaching: Start at the first sign of an outbreak; drink plenty of fluids; it does not cure herpes, so avoid contact while lesions are present
Acyclovir is activated by viral thymidine kinase, so it works mainly in infected cells and spares healthy ones.
Card 23
oseltamivir
Answer
Brand: Tamiflu
Class: Antiviral; neuraminidase inhibitor
Indications: Influenza A and B treatment within 48 h of symptoms (age 2 weeks and older), prophylaxis (age 1 year and older)
Action: Blocks viral neuraminidase so new virus particles cannot be released from infected cells
Adverse Effects: Nausea and vomiting, serious skin and hypersensitivity reactions, delirium and abnormal behavior (mainly children)
Contraindications: Known serious hypersensitivity to oseltamivir
Interactions: Intranasal live flu vaccine (avoid from 2 weeks before to 48 h after); inactivated vaccine can be given any time
Nursing Considerations: Start as soon as possible after symptom onset; expect renal dose adjustment; monitor children for abnormal behavior
Patient Teaching: Take with food to reduce nausea and finish the course; it does not replace the yearly flu shot; report confusion or unusual behavior
Neuraminidase is the viral scissors that cuts new virus free from the cell; block it and the virus stays stuck.
Card 24
bictegravir-emtricitabine-tenofovir alafenamide
Answer
Brand: Biktarvy
Class: Antiretroviral; integrase inhibitor plus two nucleoside reverse transcriptase inhibitors
Indications: Complete regimen for HIV-1 infection in adults and children weighing at least 14 kg
Action: Bictegravir blocks HIV integrase; emtricitabine and tenofovir block reverse transcriptase
Adverse Effects: Boxed: severe hepatitis B flare after stopping in HIV-HBV coinfection; renal impairment, lactic acidosis, immune reconstitution
Contraindications: Dofetilide, rifampin
Interactions: Al/Mg antacids (2 h before or 6 h after), calcium or iron (with food), St. John's wort, rifabutin, phenytoin, carbamazepine
Monitoring: Hepatitis B test before starting; creatinine, urine glucose and protein
Nursing Considerations: Confirm HBV testing before the first dose; screen OTC antacids and supplements; reinforce daily adherence
Patient Teaching: Take one tablet daily and never stop without your provider; separate antacids, iron and calcium as instructed
One daily tablet covering two drug classes makes this a first-line regimen, because adherence is what prevents HIV resistance.
Card 25
methotrexate
Answer
Brand: Trexall, Xatmep, Jylamvo, Rasuvo
Class: Antimetabolite and DMARD; folic acid antagonist
Indications: Rheumatoid arthritis, polyarticular JIA, severe psoriasis, ALL and other cancers
Action: Inhibits dihydrofolate reductase, blocking DNA synthesis in rapidly dividing cells
Adverse Effects: Boxed: embryo-fetal toxicity, hypersensitivity, serious reactions and death; myelosuppression, liver and lung toxicity, mucositis
Contraindications: Pregnancy (non-cancer use), prior severe hypersensitivity to methotrexate
Interactions: NSAIDs, PPIs, probenecid, penicillins, sulfamethoxazole-trimethoprim (raise levels); live vaccines
Antidote: Leucovorin; glucarpidase for toxic levels with kidney impairment
Monitoring: CBC, liver and kidney function
Nursing Considerations: Confirm a once-weekly order for arthritis or psoriasis, never daily; verify pregnancy status; give folic acid as ordered
Patient Teaching: Take only on your one set day each week; limit alcohol (heavy use raises liver risk); use contraception; report fever, mouth sores or cough
Taking the weekly rheumatoid arthritis dose every day has killed patients, so always confirm the single dosing day.
Card 26
tacrolimus
Answer
Brand: Prograf, Envarsus XR, Astagraf XL
Class: Immunosuppressant; calcineurin inhibitor
Indications: Preventing rejection after kidney, liver, heart or lung transplant, with other immunosuppressants
Action: Binds FKBP-12 and inhibits calcineurin, blocking T-cell activation and IL-2 production
Adverse Effects: Boxed: serious infections and malignancies; nephrotoxicity, neurotoxicity (tremor, PRES), high K, hypertension, new diabetes
Contraindications: Hypersensitivity to tacrolimus; castor oil derivative allergy (IV form)
Interactions: CYP3A inhibitors (azoles, macrolides, grapefruit) raise levels; inducers (rifampin) lower them; live vaccines
Monitoring: Trough levels, kidney function, potassium, glucose, BP
Nursing Considerations: Never swap immediate- and extended-release forms; draw troughs just before a dose; watch for anaphylaxis with IV
Patient Teaching: Take at the same times daily; avoid grapefruit and live vaccines; report fever or infection signs; limit sun exposure
A narrow therapeutic range plus heavy CYP3A metabolism means one new antibiotic or antifungal can push tacrolimus into the toxic range.