pharm 4 anti-infectives
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Drugs for TB are used for _____ or ______ disease.
Ppl at increased risk for TB?
healthcare, prison workers, immunocompromised
What TB meds can cause optic neuritis?
- 1. isoniazid
- 2. ethambutol
5 meds used for TB?
- Isoniazid (INH)
3 circumstances where prophylaxis for TB is indicated?
- 1. in immunocompromised ppl who have induration with PPD of >5mm
- 2. in high-risk workers who have induration >10mm
- 3. in anyone who has induration >15mm
What are the 4 first-line drugs for TB?
Why are these first line?
- You could catch TB on a crowded PIER:
they are effective with manageable toxicities
Which med may be used for TB or leprosy?
How are TB meds given?
combination therapy to prevent resistance
If a pt is taking fluconazole & there is no indication of a candidiasis infection what should nurse do?
check if they are immunocompromised for some reason
Precautions with TB pt?
When is a pt able to go home from hospital after TB infection?
after 3 negative sputum tests
5 second-line drugs for TB?
- 1. aminoglycosides
- 2. cycloserine
- 3. ethionamide
- 4. fluroquinolones
- 5. para-aminosalicylic acid
Test results in a pt that will receive TB prophylactic Tx?
will have positive PPD & negative chest X-ray
Length of therapy for TB prophylaxis? (not active disease)
6 to 9 months in normal pt
12 months in immunocompromised
What drug has multiple drug interactions esp. with HIV meds?
rifampin - IV drug users inject amp -> HIV
EX of immunocompromised pt?
AIDS, steroid use (arthritis pt)
3 test that confirm active TB?
- 1. PPD
- 2. AFB - sputum smear test
- 3. chest X-ray
Drug therapy for pt with active or reactivated TB?
multi drug therapy required for 6 to 24 months
2 phases in the Tx of active TB & their goal?
- 1. induction phase - get sputum to test negative/non-infectious
- 2. continuation phase - eliminate all intracellular bacilli
Therapy during the induction phase of active TB Tx?
will get 3 or 4 drugs
Standard of care for induction phase of TB Tx determined by?
DOTS - Direct Observed Tx: short course
Therapy during the continuation phase of TB Tx?
minimum of 2 drugs
Memory help for isoniazid/INH?
- I - Interactions with tyramine & histamine
- N - Neuropathy (peripheral & optic)
- H - Hepatotoxicity
- no antacid
& take on empty stomach
What is the most common cause of multi-drug resistant TB (MDR-TB)?
inadequate drug therapy due to pt non-adherence
What should be assessed prior to the admin of isoniazid?
- 1. liver function tests
- 2. Hx of liver disease or alc/drug use
Action of isoniazid?
disrupts cell wall synthesis
Route of admin for isoniazid?
IM, oral, IV
When is isoniazid used for TB?
always included in Tx regimen unless there is a resistance to it
Isoniazid bactericidal or bacteriostatic?
Black box warning for isoniazid?
2 common AE of isoniazid?
- 1. hepatotoxicity
- 2. peripheral neuropathy
4 important nursing responsibilities with isoniazid?
- 1. prevent liver damage
- 2. prevent peripheral neuropathy
- 3. prevent food/drug interactions
- 4. assess for pre-existing conditions
3 ways to minimize the potential for hepatitis with isoniazid use?
- 1. assess for pre-existing hepatic disease
- 2. assess for drug/alcohol use
- 3. baseline liver function tests (LFTs) & serial LFTs during Tx
What is the cause of peripheral neuropathy in isoniazid pt?
isoniazid increases excretion of vitamin B6/pyridoxine -> peripheral neuropathy
3 ways to prevent peripheral neuropathy in isoniazid pt?
- 1. teach pt to report s/s
- 2. give vitamin B6/pyridoxine supplement
- 3. routine eye exams for optic neuritis
Interactions with isoniazid?
tyramine foods & histamine foods
Foods that contain histamine?
Education for pt taking isoniazid?
- 1. take u.d. & why important to adhere
- 2. explain alc/diet restrictions
- 3. s/s of hepatotoxicity & peripheral neuropathy
- 4. importance of eye exams
2 considerations for admin of isoniazid?
- 1. take on empty stomach - 1 h before or 2 h after a meal
- 2. avoid taking with antacids
Memory help for rifampin?
pin = my fam
they all drink/do drugs- hepatotoxiciy & multiple drug interactions
Marisa has contact lenses and Leanne takes pyridium b/c she has UTI (discolors contacts & bodily fluids)
they take ABX wrong so there is increased risk for mult. drug resistance
Action of rifampin?
inhibits RNA synthesis
2 uses for rifampin?
TB & leprosy
AE of rifampin?
similar to isoniazid/INH esp hepatotoxiciy
Teaching for pt taking rifampin?
can discolor body fluids & stain contact lenses
What antifungal med is extremely nephrotoxic?
Why is rifampin ass. with many drug interactions?
inducer of P450 enzyme system
determine other drug therapy regimens esp. HIV meds
Risk ass. with use of rifampin?
risk of MDR-TB r/t pt non-adherence
Potential adverse effects of ethambutol?
Ethambutol - Ethan has bad eyesight
Assessment/monitoring for ethambutol pt?
- 1. need eye exams
- 2. monitor for change in vision color or acuity
3 types of systemic fungal infections?
- 1. aspergillosis
- 2. cryptococcosis
- 3. histoplasmosis
Where is aspergillosis?
Who gets it more often?
soil or water
Where can cryptococcosis infect?
CNS/meningitis, lungs, disseminated
Where does histoplasmosis infect?
Where does is come from?
lungs usually but can be other organs
flu-like s/s, chest pain, fever, weight loss
What med can cause peripheral edema when given IV?
2 types of superficial myoces?
- 1. dermatophytic
- 2. mucous membrane
2 types of mucous membrane superficial myoces?
6 polyene antifungal drugs?
nnihilate A N
- Amphotersin B
What will usually be in the name of a polyene antifungal drug?
How is nystatin taken?
swish and swallow qid
Amphotercin B memory help?
otercin = ampho-terrible
- Golden Poison Dart Frog
- Ampho found a poisonous frog while picking mushrooms. The terrible frog bit her in an artery. Its poison damaged her kidneys and liver & she bled so much from her artery that she got electrolyte imbalances and pancytopenia. At the hospital she received meds through a central line via pump but still experienced an infusion reaction so the nurse brought her a blanket.
Med that should not be taken with grapefruit juice, pomegranate juice, or alcohol?
4 types of fungal infections that may be Tx with amphotercin B?
- 1. aspergillisus
- 2. candida
- 3. cryptococcus
- 4. histoplasma
Action of amphotericin B?
causes fungal cell permeability (punches holes in it) -> causes fungal cell death
also damages host cells
Amphotericin B is used to treat ______ & potentially _____ systemic infections.
5 potential adverse effects of amphotericin B?
- 1. hepatotoxicity
- 2. nephrotoxicity
- 3. electrolyte disturbances
- 4. pancytopenia - leukocytopenia, anemia, & thrombocytopenia
- 5. infusion reactions
Interventions for infusion reactions caused by amphotericin B?
warm blankets & diversions
What is the best way to give amphotericin B parenteral?
give through central line with filter via pump!
How should amphotericin B be given if central line is not an option?
should have at least 2 IV's & rotate sites with each admin
Nursing assessments/monitoring for pt on amphotericin B?
- 1. pancytopenia - CBC, H&H, s/s of bleeding or infection
- 2. monitor drug interactions
- 3. kidney damage - I&O, creatinine, hydration
- 4. electrolytes
- 5. liver function & s/s of liver damage
Coadministration of amphotericin B?
avoid coadmin if possible
What should be done prior to the first dose of amphotericin B?
admin a test dose & monitor for infusion reaction
When will infusion reaction with amphotericin B usually occur?
w/in first 15 min of admin
Nursing interventions for pt taking amphotericin B?
- 1. blankets/diversions for infusion reactions
- 2. maintain hydration
- 3. Educate pt about reaction potential
How should ALL antifungals be admin?
VERY SLOW over 2 to 6 h
What antifungal drug is similar in structure to amphotericin B?
Uses for nystatin?
Tx topical, vaginal, & oral fungal infections
Why is nystatin not used for systemic fungal infections?
poor GI absorption & toxicity
Nystatin oral troches admin?
dissolved in mouth - don't chew or swallow
Antifungal drugs end with _____.
3 antifungal drugs?
- 1. fluconazole/Diflucan
- 2. itraconazole/Sporanox
- 3. ketoconazole/Nizoral
3 uses for fluconazole?
1. Tx esophageal, oropharyngeal, & vulvovaginal candidiasis
2. Tx systemic infections
3. prophylaxis for immunocompromised pt esp HIV with CD4 <200
3 potential adverse effects of fluconazole?
- 1. GI disturbances
- 2. HA & dizziness
- 3. mildly elevated liver enzymes
Conazole had the flu. She had GI upset & was throwing up
so hard she got a HA
& was very dizzy
. She took so much tylenol for her HA
that she had elevated liver enzymes
Action of acyclovir?
competes for position in DNA chain of herpes virus then terminates DNA synth.
Use for acyclovir?
- use for herpes viruses ONLY:
- 1. herpes simplex I & II
- 2. herpes zoster/shingles
- 3. epstein-barr virus
- 4. cytomegalovirus/CMV
2 routes of admin for acyclovir?
2 goals of acyclovir Tx?
- 1. shorten outbreak
- 2. extend time b/t outbreaks
What drugs should not be given with pre-existing eye diseases?
anti-malarials: hydroxychloroquine & chloroquine
Memory help for acyclovir?
She was riding her bicycle so long that she got dehydrated
. She ran her bike into a water
& landed on her head. She hit it so hard she had a seizure
. When she woke up her head & abd hurt
so bad she took 8
tylenol with 8 oz of water
which caused her to have liver and kidney damage
Med that can cause thrombophlebitis?
Why may nephrotoxicity occur with acyclovir?
- can cause crystallization
3 common AE of acyclovir?
- 1. HA
- 2. GI: NV, anorexia, abd pain
- 3. light headed
2 serious AE of acyclovir?
nephrotoxicity & neuro/seizures
Teaching for acyclovir pt?
- 1. 8 - 8 oz glasses of water per day
- 2. prevent spreading
- 3. Wear gloves & wash hands before & after application of topical
- 4. Protect from light & moisture - don't store in bathroom
OTC topical Tx for herpes simplex I/oral herpes
Rx Tx for herpes simplex II
requires multiple applications throughout the day: wear gloves & wash hands before and after admin
4 antivirals that Tx influenza?
What type of influenza does each Tx?
- 1. amantadine - A
- 2. rimantadine - A
- 3. tamiflu - A & B
- 4. Relenza - A & B
"dines" are A only
If a med has ivir at the end it is an _____ med.
Uses for tamiflu?
Tx & prophylaxis for influenza type A & B
give w/in 48 h of onset
4 AE of tamiflu?
- 1. N/V
- 2. bronchitis
- 3. insomnia
- 4. vertigo
fluenza had in
somnia b/c she was sick with bronchitis
. She took a lot of cold medicine that made her have vertigo
and she got very nauseated
Therapy for HIV & AIDS?
HAART - Highly Active AntiRetroviral Therapy
5 drugs that Tx HIV & AIDS?
- 1. Protease inhibitors
- 2. Entry inhibitors
- 3. Nucleoside Reverse Transcriptase Inhibitors
- 4. Nonnucleoside Reverse Transcriptase Inhibitors
- 5. Nucleoside Reverse Transcriptase Inhibitors
How are HAART drugs admin?
combo of 3 to 4 drugs
inhibit enzymes, replication, etc. to decrease progression
Action of retrovir?
inhibit reverse transcriptase
reverse transcriptase is an enzyme produced by HIV virus that allows it to form viral DNA w/in human cell
Route of admin for retrovir?
oral and parenteral
Retrovir memory help?
Retro is a hippy who likes to shoot up acid that he learned to make from milk (lactic acidosis) The milk in his blood is killing all of his blood cells (bone marrow suppression) & the fat from the milk is building up in his liver and making his pancreas very tired (liver damage/fatty liver, pancreatitis, fatigue). He is always running from his hallucinations so he has muscle pains & tingling (peripheral neuritis) & he is wasting away.
7 serious AE of retrovir?
- 1. lactic acidosis with hepatic steatosis
- 2. bone marrow suppression
- 3. hepatotoxicity
- 4. muscle pain/myopathy
- 5. peripheral neuropathy
- 6. wasting
- 7. pancreatitis
3 Black Box Warnings for retrovir?
- 1. hematologic toxicities r/t bone marrow suppression
- 2. myopathy
- 3. lactic acidosis
What causes lactic acidosis & pancreatitis with retrovir?
altered fat & protein metabolism
What type of drug is retrovir?
NRTI for HIV
4 things to educate retrovir pt about?
- 1. need low-fat diet
- 2. adherence to therapy & why important
- 3. warn about serious AE
- 4. follow up for blood monitoring
Admin of retrovir?
admin 1 h before meals - will get 600mg per day BID-TID
NNRTIs compared to NRTI/retrovir?
less powerful & less toxic
only effective against HIV-1
Action of NNRTIs?
inhibit reverse transcriptase enzyme
Admin of sustiva?
tk 1 time per day hs on an empty stomach
used as polytherapy
Common AE of sustiva?
- 1. dizziness
- 2. impaired concentration
- 3. insomnia
- 4. abnormal dreams
- 5. hallucinations
- sustiva- sustenance - When Sustiva takes adipex she does not want to take sustenance. Adipex gives her insomnia & abnormal dreams and she gets dizzy and has impaired concentration if she doesn't eat. She hallucinated that she saw a doughnut & ate poison which caused hepatotoxicity. When they gave her meds at the hospital she had a Stevens Johnson syndrome reaction.
When is sustiva admin?
give at night to decrease CNS s/s
Education for pt taking sustiva?
- should not drive until know how it affects them
- take hs
Most potent anti-HIV drugs?
protease inhibitors (PIs)
Activity and admin of protease inhibitors (PI)?
they have activity against both HIV I & II and are used as polytherapy
Prototype protease inhibitor drug (PI)?
Memory help for saquinavir?
- Saquinavir is an indian. She went riding on her buffalo (hump) & decided to eat some chocolate-covered bacon. She ate so much that she got sick to her stomach and developed insulin resistance. She felt so sick she fell off her buffalo and got a headache. She developed hyperlipidemia and even had fat deposits in her liver. She could not sleep because she was so upset about all the fat in her body, because she knew it would increase her risk for pancreatitis and cardiovascular problems so she got up and drank some grapefruit and pomegranate juice with vodka. (should not be taken with grapefruit or pomegranate juice or with alcohol)
Most common adverse effects of saquinavir?
- 1. deposits of fat/buffalo hump
- 2. GI upset
- 3. insulin resistance
- 4. HA
- 5. hyperlipidemia
- 6. fat deposits in liver
- 7. hepatotoxicity
- 8. insomnia
2 most serious AE of saquinavir?
- 1. cardiovascular problems
- 2. pancreatitis r/t fat probs
Pt education with saquinavir?
- 1. low-fat & chol. foods
- 2. limit alcohol consumption r/t liver damage
- 3. do not take with grapefruit or pomegranate juice or with garlic
- 4. Take with small frequent meals to help with GI upset.
Effect of taking garlic, grapefruit juice, or pomegranate juice with Saquinavir?
can lower med levels
Action of entry inhibitors/fusion inhibitors?
inhibits HIV from binding to, fusing with, & entering the human cell
Prototype entry/fusion inhibitor?
Admin of fuzeon?
SQ in 12 h intervals/bid
Most common AE of fuzeon admin?
injection site reactions
fuzeon - med fuses with the skin & irritates it
Most serious AE of fuzeon admin?
fuzeon - pneu-mon-ion
4 pt education for pt taking fuzeon?
- 1. rotate injection sites to increase absorption and decrease irritation
- 2. how to reconstitute & admin
- 3. use of asceptic technique
- 4. monitor for s/s of infection
Anti-parasitic drug that Tx protozoan infections?
6 things that may be Tx with metronidazole?
- BAT TAG
- Bacterial vaginosis
- Antibiotic-associated pseudomembranous colitis
Admin of metronidazole PO?
should give with meals to decrease GI s/s & bad taste ass. with med
Admin of metronidazole IV?
give slowly over 1 h
2 things to monitor when give metronidazole IV?
- 1. thrombophlebitis s/s
- 2. s/s of peripheral edema
Memory help with metronidazole?
Metronidazole - Metro-fell-in-a-hole
- Metro fell in a hole and hit her head and her stomach. (GI upset) She had a HA & was very dizzy from loss of blood (blood dyscrasias). She had a dry mouth so she began to drink some canadian mist she had in her purse even though she was pregnant. (no alcohol or pregnancy) When she was taken to the hospital they gave her IV fluids and some food, but the IV caused thrombophlebitis & peripheral edema & the food did not taste right so she didn't eat.
Common AE of metronidazole?
- 1. GI upset & anorexia
- 2. CNS: HA & dizziness
- 3. dry mouth
- 4. thrombophlebitis & peripheral edema with IV admin
- 5. altered taste
Serious AE of metronidazole?
Pt education with metronidazole?
- 1. no alcohol & make sure other products don't contain alcohol
- 2. can't use if pregnant
- 3. take with meals
- 4. s/s of blood dyscrasias
Antimalarial drugs end with ____.
2 antimalarial drugs?
- 1. chloroquine/Aralen
- 2. hydroxychloroquine/Plaquenil
Which antimalarial drug is less toxic?
3 uses for antimalarial drugs?
- 1. prophylaxis
- 2. Tx acute attack
- 3. prevention of relapse
2 things to consider when using antimalarials for prevention of relapse?
- 1. identity of species
- 2. geographic area of infection
Memory help for antimalarial drugs: chloroquine and hydroxychloroquine?
Hydroxy & chloroquine are twins. Hydroxy is blind(retinopathy), and she ran into chloroquine and broke her nose. Chloroquine bled so much she got anemic & her blood pressure dropped. Hydroxy was so upset about what she did that she thought she was going to throw up (GI upset), but she ate a meal(take with meals) and felt better.
Major contraindication for antimalarial drugs?
pre-existing eye disease like cataracts or retinopathy
Common AE of antimalarial drugs?
- 1. hypotension
- 2. GI upset
hydroxychloroquine sounds like hydrochlorothiazide & they both lower BP
2 serious AE of antimalarials?
- 1. retinopathy
- 2. aplastic anemia
What does nurse need to know prior to admin of antimalarial drugs?
Hx of eye disease or hypotension
Pt education with antimalarials?
- 1. change positions slowly r/t hypotension
- 2. admin med on same day each week
- 3. admin with meals to decrease GI effects
- 4. potential for eye probs
- 5. s/s of aplastic anemia
Admin of antimalarials for prophylaxis?
begin 1 to 2 wks before entering area & continue for 4 to 6 weeks after leaving the area
Mebendazole memory help?
Mebendazole climbed a tree (trematodes) & got infected with worms. Her stomach was hurting and she felt dizzy. She fell out of the tree and pooped her pants (diarrhea). She had a horrible HA and was bleeding everywhere (blood dyscrasias.
3 types of helminths Tx by mebendazole?
- 1. nematodes- round worms
- 2. trematodes- flukes
- 3. cestodes - tapeworms
Common AE of mebendazole/anti-helminths?
GI upset: abd pain, diarrhea, dizziness, & HA
Serious AE of mebendazole?
3 antihelminthics/mebendazole nursing considerations
- 1. Tx entire family at same time
- 2. encourage small, frequent meals to decrease GI effects
- 3. educate pt to wash clothing and bed linens etc at the same time family is being Tx
Prototype antiectoparasitic drug?
7 uses for permethrin?
- Many Fleas Like Biting My Tiny Cat
- Biting flies
Route of admin for permethrin?
Permethrin for Tx of lice?
Permethrin for Tx of scabies?
need to Tx the whole family !
2 common AE of permethrin?
- 1. skin irritation
- 2. pruritis
3 pt education for permethrin?
- 1. apply only u.t.
- 2. keep out of reach of children and do not let them admin med
- 3. do not leave on more than recommended time period
What would you like to do?
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