Pharm Parasiti/hiv/neuro

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Chloroquine

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antimalarial drug which increases blood ph, disrupts synthesis of RNA and DNA in the parasite

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Chloroquine side effects

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N/V/D abd. pain, hypotension

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Chloroquine use

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Acute malaria attacks, not effective for relapses. Discoid lupus erythematosus, RA

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Chloroquine Contraindications:

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Hypersensitivity, patients with preexisting eye conditions, hepatic disorders, blood dyscrasias, dental disease, GI disorders, and neurological disorders.

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Chloroquine serious adverse effects

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Blurred vision, difficulty focusing and changes in accommodation (retinopathy). Tinnitus and reduced hearing, seizures, blood dyscrasias, agranulocytosis, aplastic anemia, pancytopenia, neutropenia, thrombocytopenia. hair loss, hair bleaching

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Chloroquine teaching

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Teach your patient side effects and to move fast is not effective on all kinds of malaria. Delay dental work in blood dyscrasias, turn pee brown or red, eye exams and ear exams, avoid alcohol, 2 weeks prior as prophylaxis and 4-6 weeks after leaving area. Take on weekly basis.

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Metronidazole (flagyl) is for

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Inhibits DNA synthesis in bacteria

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Metronidazole (flagyl) pharmacokinetics

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Can be administered orally, IV, or topically

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Metronidazole (flagyl) is used for treatment in

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Trichomoniasis, amebiasis and giardiasis. antibacterial agent against anaerobic infections. Crohns disease, antibiotic associated diarrhea (CDIFF)

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Metronidazole (flagyl) Contraindications

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Drug crosses placenta into breastmilk and alcohol dependency. Stop drinking at least 1 day before use to prevent disulfiram-like interaction. use caution with compromised hepatic or bone marrow function

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Metronidazole (flagyl) common side effects

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N/V, xerostomia (dry mouth), altered sense of taste and abd. pain.

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Metronidazole (flagyl) serious side effects

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Blood dyscrasias, CNS toxicity: ataxia, mood changes, encephalopathy. IV formula has high sodium content and can exacerbate CHF.

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Metronidazole (flagyl) Nursing

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Treat both partners if std, adverse reaction with alcohol intake, ice chips and hard candies to moisten mouth, if iv infuse slow over 1 hour.

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Pentamidine (pentame 300) what is it?

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Interferes with nucleotide, phospholipid and protein synthesis of parasite.

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Pentamidine (pentame 300) Pharmacokinetics

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Inhaled and parental administration

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Pentamidine (pentame 300) USED FOR

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Prophylaxis and treatment of PCP pneumonia in patients unable to take SMZ-TMP who are at risk (high viral load, low T cell count)

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Pentamidine (pentame 300) Contraindications:

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Hypersensitivity, caution with asthma, hematologic disorder, hepatic and renal diseases and DM.

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Pentamidine (pentame 300) Common side effects

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Cough and bronchospasms

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Pentamidine (pentame 300) Serious adverse effects

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Severe hypotension, thrombocytopenia, leucopenia, anemia, tachycardia, and arrhythmias, severe hypoglycemia especially in DM patients.

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Pentamidine (pentame 300) nursing intervenetions:

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pt. laying down and resuscitation equip. available, monitor vs before, during and 2 hours after admin. Do not give IM injections cause bleeding, bruising, or hematomas, no bed time admin due to hypoglycemia, N/V/D that does not subside call doc. small freq. meals, use within 24 hours and keep out of light, s/s infection check liver enzymes, CBC, and EKG periodically.

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Acyclovir (zovirax) how does it work

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Must go phosphorylation, active drug is incorp. with DNA chain and terminates synthesis

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Acyclovir (zovirax): Pharmacokinetics

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Poorly absorbed GI, topical does not lead to systemic levels.

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Acyclovir (zovirax) use

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Antiviral herpes virus not active against HIV

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Acyclovir (zovirax): Contraindications

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Hypersensitivity, caution with renal disease, pre-existing neurological disorders (esp. seizures) caution in pregnant or breastfeeding.

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Acyclovir (zovirax): Common adverse

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Light-headedness, anorexia, nausea, vomiting, abd. pain and headache.

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Acyclovir (zovirax) Serious adverse

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Confusion, tremors, hallucinations, seizures or coma.

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Acyclovir (zovirax)Nursing

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Administer with full glass of water and regular intervals, causes nephrotoxicity real easy so hydrate, administer IV over 1 hours. monitor urine output 2 hours after infusion and call dr. if less than 500ml per gram of acyclovir, keep away from light and moisture,

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Acyclovir (zovirax) teach your patient

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Call doc if decreased urine output, increase in weight, tremors, confusion, hallucinations, coma. AND wear gloves with topical application/wash after.

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Xerostomia

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Dry mouth

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Permethrin (elmite): what is it?

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Disrupts parasites nerve cell membrane resulting in paralysis and death.

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Permethrin (elmite): Pharmockinetics

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Topical application may have small amount absorbed systemically.

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Permethrin (elmite): used for

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Lice, Scabies

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Permethrin (elmite): Contraindications

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Hypersensitivity to household insecticides

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Permethrin (elmite): common adverse effects

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Burning, itching, numbness, rash, redness, stinging or tingling of the scalp.

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Permethrin (elmite):Serious adverse effects

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Inhalation can aggravate bronchial asthma.

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Permethrin (elmite): nursing

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External use only, apply to scalp and leave in place for 10 minutes, apply second treatment 10 days, use nit comb to remove lice and nits, keep out of reach of children, apply as skin as ordered.

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Permethrin (elmite): what are you teaching your patient

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Wash all clothing, bedding etc. in very hot water, and by using hot dryer at least 20 minutes. clean house by vacuuming.

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Mebendazole (vermox): what does it do?

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Disrupts absorptive and secretory functions of cells essential to the heminths survival

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Mebendazole (vermox) Pharmacokinetics

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Chewable tablets, poorly absorbed with extensive first pass.

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Mebendazole (vermox) use:

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Anthelminithic drug effective against nematodes, worms such as whipworms, pinworms, hookworms, and giant roundworms, HELMINTH WORMS.

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Mebendazole (vermox) CONTRAINDICATIONS

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Hypersensitivity, inflammatory bowel disease or hepatic disease, pregnancy and breastfeeding.

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Mebendazole (vermox)Common adverse effects

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Rarely systemic toxicit due to poor absorption, abd. pain, diarrhea, dizziness, headache fever, rash and flushing.

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Mebendazole (vermox)Serious adverse effects

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Leukopenia, thrombocytopenia, eosinophilia, may elevate liver enzymes.

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Mebendazole (vermox) Nursing:

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Teach patient to monitor for sore throat, fatigue, and fever. blood dyscrasias, washing fruits and veggies, oatmeal bath to relieve itching, cbc and liver enzymges monitored.

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Amphotericin B (Fungizone): what is it?

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Binds to sterols in fungal cell, weakening the structure and causing cell leakage and death.

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Amphotericin B (Fungizone): pharmacokinetics

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pooly absorbed from GI, must be given intrathecal for CSF infections

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Intrathecal

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Inside an anatomical space, epidurals are given here.

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Amphotericin B (Fungizone): use:

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Antifungal agent for systemic fungal or protozoa infections. IV or topical ointments .1-5 mg/kg/day.

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Amphotericin B (Fungizone): Contraindications

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Administer cautiously in patients with hypokalemia, hypomagnesia, and anemia, this drug can exacerbate. Renal patients should be monitored for nephrotoxicity.

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Amphotericin B (Fungizone): Common adverse effects

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Infusion reactions, electrolyte imbalances, anemia.

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Amphotericin B (Fungizone): Serious adverse effects

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Nephrotoxicity seen as azotemia, renal tubular acidosis and renal failure.

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Amphotericin B (Fungizone): Nursing interventions

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Do not administer with other nephrotoxic drugs, keep pt. well hydrated, administer in acute care environ. CAT. B. do not reconstitute with a bacteriostatic agent. Can stop erythropoiesis, monitor renal labs, CBC, electrolytes.

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Fluconazole (Diflucan) What is it?

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Alters fungal cell membrane, leading to increased cellular permeability and leakage.

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Fluconazole (Diflucan): Pharmacokinetics

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Can be given IV or orally.

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Fluconazole (Diflucan) USE

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Esophageal or oropharyngeal candidiasis, candida vaginitis, disseminated candidiasis, cryptococcal meningitis (caused by fungus)

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Fluconazole (Diflucan) Contraindications

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Caution in pregnancy and exisiting hepatic and renal dysfunction.

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Fluconazole (Diflucan) Common adverse effects

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Diarrhea, nausea, and vomiting, elevation in AST, ALKP, BILIRUBIN

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Fluconazole (Diflucan) SERIOUS ADVERSE EFFECTS

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Steven Johnson syndrome

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Fluconazole (Diflucan) Nursing interventions

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Teach clients S/S of adverse effects and when to call provider, monitor renal and hepatic function prior to and during therapy. Taking with food if GI distress, do not ingest ETOH will increase hepatotoxicity, use aspirin instead of acetaminophen for discomforts due to Tylenol effects on liver.

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Zidovudine (AZT) what does it do?

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Inhibits reverse transcriptase a critical enzyme to HIV replication

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Zidovudine (AZT): Pharmacokintecs

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Oral or parental administration

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Zidovudine (AZT): USE

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HIV 1 in adults and children, prophylaxis in preventing transmission to fetus, Epstein barr

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Zidovudine (AZT) Contraindications:

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Hypersensitivity, breast feedings, existing lactic acidosis, clients with hepatic dysfunction, obesity have higher risk of lactic acidosis.

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Zidovudine (AZT)Common adverse effects:

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N/V/anorexia, abd.pain, headaches, seizures, parethesia, restlessness, insomnia, nail discoloration and alteration in taste.

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Zidovudine (AZT) Serious adverse effects

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Anemia, granulocytopenia, thrombocytopenia, bone marrow suppression, lactic acidosis, hepatomegaly with steatosis (fatty liver)

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Zidovudine (AZT) Nursing interventions

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Give 1 hour before meals, have pt. on low fat diet, give in 3 divided doses, no IM injections, monitor CBC, liver enzymges, teach pt. to monitor for sore throat, bleeding or bruising and fatigue. Treat headache with NSAIDS.

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Efavirenz (EFV): what does it do?

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Inhibits HIV reverse transcriptase, inhibits ability of virus to change viral RNA to DNA.

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Efavirenz (EFV) Pharmacokinetics

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Absorbed rapidly with oral administration

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Efavirenz (EFV) Use

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Treat HIV infection in combination with other antivirals, not effective in HIV 2.

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Efavirenz (EFV) Contraindications

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Hypersensitivity, patients taking midazolam, triazolam, ergots or voriconazole, use of alcohol or psychoactive drugs increase risk of CNS effects, use cautiously in clients with hepatic impairment or hep b or c.

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Efavirenz (EFV) Common adverse effects

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Dizziness, impaired concentration, hallucinations, rash and steven johnsons syndrome.

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Efavirenz (EFV) Serious adverse effects

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Steven Johnsons syndrome, lipodystrophy, hepatotoxicity, seizures and severe depression, paranoid or manic reactions. Insomnia, abnormal dreams.

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Efavirenz (EFV) nursing interventions.

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Administer on empty stomach, and at bedtime to decrease CNS effects, monitor liver function before and during therapy,

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Efavirenz (EFV) Patient teaching

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notify provider s/s toxicity fatigue jaundice, nausea or vomiting, depression or manic episodes, rash that becomes denuded. Educate pts. about physical changes that could develop secondary to lipodystrophy. Child bearing women use contraception other than hormonal contraceptives.

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Saquinavir (invirase): what does it do?

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Inhibits HIV proteqase enzyme required for HIV replication.

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Saquinavir (invirase) Pharmacokinetics

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Poor bioavailability, is combined with ritonavir to slow metabolism.

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Saquinavir (invirase) USE

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Treatment of HIV in adults, may combine with reverse transcriptase meds. Use for both HIV1 and HIV 2.

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Saquinavir (invirase) Contraindications

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Hypersensitivity, no 16 y/o, caution with pt. with liver impairments, caution with DM will cause hyperglycemia.

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Saquinavir (invirase) Common adverse effects

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N/D/ stomach discomfort, hyperglycemia, increased bone loss, headache.

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Saquinavir (invirase) Serious adverse effects

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Pancreatitis, lipodystrophy (fat redistribution)

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Saquinavir (invirase) Nursing interventions:

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Administer within 2 hours after eating a full meal, administer ritonavir with each dose, small frequent meals to decrease GI distress. Acetaminphen for HA.

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Enfuvirtide (Fuzeon): What does it do

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Binds to GP41 (protein) this inhibits HIV from entering the cell.

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Enfuvirtide (Fuzeon): Pharmacokinetics

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SQ injection which reaches peak in 8 hours.

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Enfuvirtide (Fuzeon): Use:

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Treatment for patients who experience treatment failure or do not tolerate treatment with existing anti-retrovirals.

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Enfuvirtide (Fuzeon): Contraindications

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Hypersensitivity, caution in predisposed to respiratory infections by such risk factor as smoking, pulmonary disfunction, low CD4 counts or high viral load.

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Enfuvirtide (Fuzeon): Common adverse effects

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Injection site reaction, itchy rash and red swollen puffy or hardened skin, nausea, weight loss, fatigue, anxiety.

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Enfuvirtide (Fuzeon): Serious adverse effects

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Bacterial pneumonia, lymphadenopathy.

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Enfuvirtide (Fuzeon): Nursing interventions

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Refridgerate unused medicine, reconstituted with sterile water allow to sit for 45 minutes, after adding dilutants tap vial and roll vial in hand, give SQ arms, abdomen, upper thigh, use aseptic technique, sq every 12 hours, avoid sites with increased risk of irritation. s/s of infection

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Propofol: what does it do

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Anesthetic used in management of general anesthesia, sedation inducting or maintenance, status elipticus.