Anti-Fungals, Tb Drugs & Antivirals

Front 1

Antifungals: Prototype

Back 1

Amphotericin B

Front 2

Amphotericin B: Action

Back 2

Fungicidal or fungistatic. Very toxic

Front 3

Amphotericin B: Therapeutic Uses

Back 3

1. Effective against systemic severe fungal infections
2. Examples: Valley Fever Crytococcosis, Histoplasmosis, Coccidiomycoses/ Aspergillosis / Candida

Front 4

Amphotericin B: Adverse Effects

Back 4

1. Almost all get Sx
2. Headache, chills, fever, malaise, muscle/joint pain (avoid by premedicating 30min before ie, with Aspirin or Benadryl)
3. Sever thrombophlebitis!!! (Best given through central line)
4. Nephrotoxicity
5. Anemia

Front 5

Amphotericin B: Dosage

Back 5

1. Start with IV test dose to see if pt tolerates w/o allergic reaction
2. Infused very slowly (4-6 hrs)
3. Long treatment
4. Dilute w/ D5W (NOT SALINE) and only use infusion pump to safely deliver.

Front 6

Amphotericin B: Nursing Implications

Back 6

1. Light sensitive drug; must be covered w/ light (ie foil)
2. Watch closely for side effects and toxicity. Take temp
3. Watch serum blood levels (RBC) for anemia as well as KIDNEY tests
4. Check K+ level - may need supplemental K+

Front 7

Antivirals: Prototype

Back 7

Acyclovir

Front 8

Acyclovir: Action

Back 8

1. Prevents replication of viral DNA (preferentially taken up by herpes virus cells)
2. Not a cure; simply a treatment

Front 9

Acyclovir: Therapeutic Uses

Back 9

1. Primarily against Herpes Simplex Viruses 1 8 2 & Herpes Zoster (Shingles); also, Flu, West Nile Virus, SARS, Pertussis
2. Topical, parenteral, oral forms (oral is absorbed poorly/slowly)
-Immunocompromised (ie AIDS pts) usually use IV

Front 10

Acyclovir: Adverse Effects

Back 10

Few

Front 11

Acyclovir: Nursing Implications

Back 11

Use topically with gloves so don't spread. Teach pt that it is a treatment, not a cure: episodes may reoccur. Most antivirals are expensive.

Front 12

Other antivirals?

Back 12

Virazole or Ribaviran for Respiratory Syncytial Virus (RSV) in new babies

Front 13

Anti-Helminthic Drugs: Therapeutic Uses

Back 13

Worms (helminths); ie pinworms; ⅓ of world population is infected - often if poor sanitation & may show no clinical symptoms.

Front 14

Anti-Helminthic Drugs: Nursing Implications

Back 14

1. Worms easily spread through family, so all may need treatment
2. Sanitation Teaching
- Meticulous handwashing, esp after disposal of feces and urine, and before and after eating
- Change bed linens, night clothes, and towels daily
- Keep fingernails short
- Toilet disinfection

Front 15

Anti-Malarial Drugs: Prototype

Back 15

Chlorquine.

Another is Quinine, used for leg cramps

Front 16

Chloroquine: Action

Back 16

Inhibit DNA enzymes essential to protein synthesis by parasite cells

Front 17

Chloroquine: Therapeutic Uses

Back 17

1. Kill Plasmodium organisms (parasite that cause malaria)
2. Should start Rx 1-2 weeks prior to going to endemic area and continue for 6-8 weeks after leaving.

Front 18

Chloroquine: Contraindications

Back 18

Allergy - rule this out first. Might require reduced dosages

Front 19

Chloroquine: Adverse Effects

Back 19

1. GI Upset - nausea, stomach pain, anorexia, vomiting
2. Retinopathy (vision disturbance)
3. May bleach scalp and body hair after several mos. of use
4. May exacerbate psoriasis

Front 20

Chloroquine: Nursing Implications

Back 20

OVERDOSE can cause death; common with children

If this occurs, induce vomiting

Front 21

Anti-Amebicide: Prototypes

Back 21

Metroniazole (Flagyl) & Pentamidine.

Front 22

Metroniazole: Generic Name

Back 22

Flagyl

Front 23

Metroniazole: Action

Back 23

Interferes with microbial DNA synthesis

Front 24

Metroniazole: Therapeutic Uses

Back 24

Rx for Trichomonas (STD) or Giardiasis (intestinal parasite) effective for Gm (-) & anaerobes. Often used with aminoglycosides to treat mixed aero and anaerobic organisms (bowel surgeries) DOSAGE/ROUTE: 60-80% absorbed from GI tract; PO or IV

Front 25

Metroniazole: Interactions

Back 25

1. Alcohol - avoid!!
2. Phenobarb (sedative)
3. Anticoagulants
4. Cimetidine (anti-ulcer med)

Check before giving together.

Front 26

Metroniazole: Adverse Effects

Back 26

Nausea, overgrowth of other super-infections (Candida or thrush); may get dizzy, metallic taste in mouth

Front 27

Metroniazole: Nursing Implications

Back 27

1. Pt may want to suck on hard candy if metallic taste
2. Patient teaching: how to watch for superinfection, don’t stop or interrupt schedule without asking Dr
3. Warn pt not to drink alcohol - including in Elixirs and OTC meds!

Front 28

Pentamidine: Action

Back 28

Inhibits protein and nucleic acid synthesis

Front 29

Pentamidine: Therapeutic Uses

Back 29

Treat various protozoal infections; or Pneumocystis Carinii (AIDS patients at risk)

Front 30

Pentamidine: Routes

Back 30

IM, IV, or nebulized (fine particle dispersion inhaled)

Front 31

Pentamidine: Adverse Effects

Back 31

May lower BP and cause nephrotoxicity

Front 32

Pentamidine: Nursing Implications

Back 32

1. Avoid nebulized exposure if pregnant
2. If IM route: change site daily to avoid abscesses

Front 33

Tuberculosis

Back 33

Bacterial infection caused by Mycobacterium tuberculosis. Infection occurs primarily in lungs, but can also be in brain, abdomen (peritoneum) or GU tract.

Long treatment, often multiple drugs. = The organism has poor blood supply and encapsulates; rapidly becomes resistant to ABX

Front 34

Tuberculosis Symptoms

Back 34

Coughing bloody sputum, night sweats, persistent cough, anorexia

Front 35

INH (Isoniazid): Action

Back 35

Bactericidal that kills the mycobacteria by disrupting cell wall synthesis

Front 36

INH (Isoniazid): Therapeutic Uses

Back 36

1. Treatment of active TB (most widely used drug) w/ other antituberculars
2. Prophylaxis as single drug (ie for family members)
3. Well absorbed in GI tract

Front 37

INH (Isoniazid): Contraindications

Back 37

1. Acute liver disease
2. Genetic factors may affect absorption

Front 38

INH (Isoniazid): Adverse Effects

Back 38

Peripheral neuropathy / neuritis (numb feet) lead to clumsiness, pain in hands and feet; liver toxicity; GI irritation

Front 39

Rifampin: Action

Back 39

Broad-spectrum bactericidal drug - inhibits protein synthesis

Front 40

Rifampin: Therapeutic Uses

Back 40

Prevention of TB, or for Methicillin resistant Staph Aureus (Staph A)

Front 41

Rifampin: Contraindications

Back 41

Renal dysfunction

Front 42

Rifampin: Adverse Effects

Back 42

1. Headache, drowsiness, visual disturbances, fever
2. Red/orange color to sweat, tears, urine (not harmful and not a reason to stop the drug)

Front 43

Rifampin: Nursing Implications

Back 43

Many drug interactions - check! This includes birth control pills

Discolors contact lenses- do not wear

Front 44

Pyrazinamide: Therapeutic Uses

Back 44

To treat the peripheral neuropathies (ie, feet go numb) associated with INH therapy. Used with at least one other TB drug.

Front 45

Pyrazinamide: Adverse Effects

Back 45

Hepatotoxicity (dose related)
--> Elevated uric acid, so pts may get GOUT attacks