comp 6

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comp 6
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comp 6
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  1. causes of infections
    micro-organisms: bacteria, viruses, fungi, protozoa, parasitic worms
  2. barriers of infection
    Host defenses- skin, mucous membranes. gastric acid, immune factors
  3. Risk for infection
    • -advanced age
    • -diseases that suppress, the immune system (CA, HIV)
    • -impaired blood supply
  4. bactriostatic
    inhibits the growth of bacteria
  5. Bactericidal
    kills the bacteria
  6. antibacterial therapy mechanisms of action
    • -inhibit cell wall synthesis
    • -after membrane permeability
    • -inhibit protein synthesis
    • -inhibit synthesis of RNA & DNA
    • -interferes with metabolism
  7. antibacterial drugs- pharmacokinetics/pharmacodynamics
    -must penetrate the bacterial cell wall sufficiently & bind to sites on bacterial cell
  8. drug concentration
    Minimum effective concentration (MEC)
  9. Helps determine abx
    • -Duration of time of antibacterial agent
    •  *type of pathogen
    •  *site of infection
    •  *immunocompetence
  10. body defenses to infections
    • -age
    • -nutrition
    • -immunoglobulins
    • -circulation
    • -WBCs
    • -organ function
  11. Antibacterial Resistance
    • -inherent resisitance (natural)
    • -acquired resistance
    • -inappropriate use of abx
    • -nosocomial infections
    • -cross-resistance-resistant to many drugs
    • -abx combinations
  12. how do we know which abx will work the best
    culture and sensitivity
  13. Microbial infections
    • *Bacterial infections
    •  -Gram Stain
    •   -gram positive (turns purple)
    •   -gram negative

    •  -Bacterial shape
    •   -Bacilli- elongated or rod shaped
    •   -Cocci- spherical
  14. narrow spectrum abx
    work on a few different infections
  15. broad spectrum abx
    work on more than a few infections
  16. sign & symptoms of infection
    fever, chills, sweats, redness, pain, swelling, fatigue, weight loss, increase WBC, pus formation
  17. antibacterial therapy assessment before
    vs, where infection, drug interactions
  18. antibacterial therapy assessment during
    VS, SE, nutrition, hydration
  19. antibacterial therapy assessment after
    VS, effectiveness, s/sx resolved
  20. empiric therapy
    abx selected is one that can best kill the microorganism known to the most common cause
  21. prophylactic therapy
    giving an abx to prevent infection
  22. therapeutic response
    decrease in specific s/sx of infections
  23. subtherapeutic response
    when s/sx of infection do not improve
  24. why do s/sx of infection not improve
    • -wrong abx used
    • -course of therapy not long enough
    • -wrong dose
    • -bacterial resistance
  25. 3 major adverse reactions to antibacterial therapy
    • -allergic reactions
    • -superinfection
    • -organ toxicity
  26. anaphylactic reaction fact
    have mild reaction can have serious reaction later
  27. general adverse reactions-ALLERGIC
    • *mild allergic reaction
    •  -rash, pruritus, hives
    • *severe allergy: anaphylactic shock
    •  -bronchospasms, laryngeal edema, vascular collapse, cardiac arrest
    • *tx: epinepherial, antihistamine, bronchodilator
  28. General adverse reaction- SUPERINFECTION
    • *secondary infection (ex. thrush)
    • *sites: mouth, skin, respiratory tract, vagina, intestines
    • *usually occur when treated more than one week
  29. general adverse reactions-ORAGAN TOXICITY
    • *Liver: monitored with liver profile
    • *kidney: monitored with BUN, CR- kidney fx test
  30. CLASSIFICATIONS of antibiotic therapy
    • *penicillins
    • *cephalosporins
    • *macrolides
    • *tetracyclines
    • *aminoglycosides
    • *fluorquinolones
    • *sulfonamides
    • *miscellaneous
  31. structure of penicilins
    beta-lactam ring
  32. Basic penicillins
    • -introduced to kill staphylococcus
    • -inhibit bacterial cell wall synthesis
    • -NARROW SPECTRUM
    • -ex: penicillin G Na/K, penicillin G procaine, penicillin V
    • -given PO, IM, IV
  33. Broad spectrum penicillin
    • -bactericidal
    •  -ex: amoxicillin (amoxil), ampicillin (omnipen)
  34. Penicillinase- resisitant penicillin
    • -Bactericidal
    •  -ex: dicloxacillin (dynapen)
  35. extended-spectrum penicillins
    • -Bactericidal
    •  -ex: piperacillin (pipracil), ticarcillin (ticar), carbenicillin (geopen)
  36. Beta-lactamase inhibitors
    • -are not given alone
    • -Examples: clavulanic acid (amoxicillin & clav acid: augmentin)
    •                  sulbactam (ampicillin & sulb= unasyn)
    •                  tazobactam (pipercillin & tazo= zosyn)
  37. purpose of beta-lactamase inhibitors
    make the abx more effective against some bacteria (two meds together)
  38. penicillin SE
    • *common-nausea, vomiting, diarrhea
    • *hypersensitivity (allergic reactions)
    •  -rash------------>anaphylaxis
    • *superinfection
  39. penicillin drug interactions
    • *aspirin
    • *oral contraceptives
    • (broad spectrum PCNs)
  40. penicillin nrsg interventions
    • *____ before drugs given
    • *monitor closely during first dose
    • *take with meals
    • *assess for side effects
    • *use alternate form of birth control if on oral contraceptives until new cycle starts after completion of abx
  41. cephalosporins
    • *inhibit bacterial cell wall synthesis
    • *bactericidal
    • *treats:
    •  -respiratory, urinary, skin, bone, joint and genital infections
    • *given PO, IV, IM
  42. cephalasporins 1st generation
    cefazolin, cefadroxil, cephalexin, cephradine

    gram +/-
  43. cephalosporins 2nd generation
    cefaclor, cefuroxime, cefotetan, cefoxitin

    gram +/- broader spectrum
  44. cephalosporins 3rd generation
    cefixime, ceftazidime, ceftriaxone

    gram +/- broader spectrum less effect on gram +
  45. cephalosporins 4th generation
    cefepime, cefditoren

    gram +/- broad spectrum resistant to most beta lacatimase bacteria, broader spectrum gram + coverage than 3rd generation
  46. cephalosporins contraindications
    **Note Penicillin Allergy
  47. cephalosporin SE/AE
    • *GI disturbances: N&V, diarrhea, increased bleeding (large doses)
    • *Nephrotoxicity

    *INTERACTIONS: alcohol
  48. cephalosporins nrsg interventions
    • *assess for allergy
    • *C&S before therapy
    • *take with food/or 1hr before or 2hr after
    • *assess renal and liver function
    • *administer IV over 30-45 min
    • *monitor for superinfection
    • *VS
  49. Macrolides (antimicrobials)
    • -Erythromycin (E-mycin)
    • -Azithromycin (Zithromax-"Z pack")
    • -Clarithromycin (Biaxin)
  50. other Antimicrobials
    • -Clindamycin
    • -Vancomycin
  51. Macrolides: Erythromycin, Clarithromycin, Azithromycin

    Action/Route
    • -Broad Spectrum
    • -Bacteriostatic: low to moderate doses
    • -Bactericidal: high doses

    Route: Oral, IV
  52. Macrolides: Erythromycin, Clarithromycin, Azithromycin

    Uses
    • *Mild to Moderate infections
    •  -Respiratory, sinuses, GI tract, skin, and soft tissue infections, & select STDs
    • -Erythromycin used to tx mycolasmal pneumonia, legionnaires disease
  53. Macrolides: Erythromycin, Clarithromycin, Azithromycin

    SE/AE
    -GI distress, N&V, diarrhea, abdominal cramping (mostly w/ Erythromycin & Clarithromycin

    -Superinfection

    -Hepatotoxicity (when taken in high doses with other hepatotoxic drugs)
  54. Macrolides: Erythromycin, Clarithromycin, Azithromycin

    Drug Interactions
    • -Increase Serum levels of Warfarin, theophylline, carbmazepine
    • -Erythromycin levels increase with fluconazole (diflucan), ketoconazole (Nizoral), diltiazem (Cardizem)
    •  --risk of sudden death
    • -Azithromycin levels may be reduced by antacids
  55. Macrolides: Erythromycin, Clarithromycin, Azithromycin

    NRG interventions
    • -C&S before therapy
    • -Monitor liver enzymes during therapy
    • -Advise client to report SE & take full course of antibacterial agent as prescribed
    • -administer antacids 2hrs before or after macrolides
    • -Give Azithromycin 1hr before or 2hrs after meals w/ full glass of water
  56. other: Clindamycin
    • ACTION:
    •   -Inhibit bacterial protein synthesis
    •   -bacteriostatic and bactericidal
    •     -dependent upon dosage

    • SE/AE:
    •   -GI distress, rash, colitis, anaphylactic shock

    • DRUG INTERACTION
    •   -Aminophylline, phenytoin (Dilantin), barbiturates, ampicillin

    NRG INTERVENTIONS
  57. Vancomycin
    • ACTION:
    •   -inhibits cell wall synthesis

    BACTERICIDAL

    • INDICATIONS
    •   -serious infections of bone, skin, lower respiratory tract, MRSA

    • CONTRAINDICATIONS
    •   -Use cautiously w/ kidney dysfunction or hearing loss
  58. Vancomycin SE/AE & ROUTE
    • -rash, N&V
    • -ototoxicity & nephrotoxicity
    • -Redman syndrome (redneck syndrome)
    •   -red blotchy face, neck, chest (toxic effect)
    •   -caused by rapid injection
    • -Pseudomembranous colitis

    ROUTES: oral & IV
  59. Vancomycin NRG interventions
    • -C&S prior to therapy
    • -Monitor vancomycin levels
    •   -peak
    •   -trough
    • -monitor BP, renal function, superinfection, hearing, IV site
    • -Infuse over 60 min or greater
    • -increase fluids (decrease nephrotoxicity)
  60. Aminoglycosides
    • ACTION:
    •  -inhibit bacterial protein synthesis
    •  -Bactericidal

    • DRUGS:
    •  -gentamicin (Garamycin), Tobramycin (nebcin), Neomycin (Mycifradin), Amikacin (Amikin)

    • ROUTE:
    •  -IM, IV
    •  -Neomycin->PO or IM
  61. Aminoglycosides SE/AE & DRUG Interactions
    • SE/AE:
    • -photosensitivity
    • -superinfection
    • -ototoxicity
    • -Nephrotoxocity (liver & kidney)
    • -other->GI disturbances, HA, parasthesias, skin rash, fever

    • DI:
    •  -anticoagulants->increase bleeding
    •  -use with other nephrotoxic drugs increase toxic effects
  62. Aminoglycosides NRG INTERVENTIONS
    • -C&S
    • -monitor renal function
    • -monitor hearing loss
    • -warn to use sunblock & wear protective clothing
    • -monitor for superinfection
    • -monitor peak & trough levels
  63. other Antibiotics similar to Macrolides
    • *Ketolides
    •  -telithromycin (Ketek)
    •  -used to treat community acquired pneumonia

    • *Lipopeptides
    •  -daptomycin
    •  -used to tx complicated skin infections
  64. Tetracyclines
    • ACTION:
    • -inhibits protein synthesis--Bacteriostatic
    • -broad spectrum

    USES: fights Helicobacter [ylor, treats acne oral, topical), chlamydia, mycoplasma, lyme disease

    ROUTE: Oral**, IM, IV
  65. Tetracyclines
    • *short acting
    •  -tetracycline (aachromycin)
    • *intermediate acting
    •  -demeclocycline (declomycin)
    • *long acting
    •  -minocycline (minocin)
    •  -doxycycline (vibramycin)
    •   -may be taken with milk products & food
  66. tetracycline SE/AE
    • -GI distress, photosensitivity, stomatitis
    • -discolors teeth, damages inner ear
    •  -do not give to children under age of 8
    • -blood dyscrasis
    •  -thrombocytopenia & hemolytic anemia
    • -superinfection
    •  -pseudomembranous colitis
    • -CNS toxicity
    • -Hepatotoxicity
    • -nephrotoxocity
  67. Tetracyclines DRUG-FOOD Interactions & contraindications
    • D-F interactions
    • -antacids, Milk products (except Doxycycline), iron, preparations
    • -decreases effects of oral contraceptives
    • -digoxin absorption is increased, leading to toxicity
    • -increases effect of nephrotoxicity

    • Contraindication:
    • -avoid during pregnancy & in children under 8
  68. Tetracyclines NRG INTERVENTIONS
    • -obtain C&S prior to drug
    • -administer 1hr before or 2hr after meals
    • -monitor kidney & liver function (if on high doses)
    • -store out of light & extreme heat
    • -advise client to use sun block
    • -teach client to report superinfection
    • -warn client to avoid milk*, iron, antacids
    • -tell client to use effective oral hygiene
  69. Fluoroquinolones (Quinolones)
    • ACTION:
    •  -broad spectrum: bactericidals

    • USES:
    •  -Streptococcus, pneumonia, pseudomonas, salmonella
    • -treat UTi, bone & joint infections, bronchitis, pneumonia, gonorrhea, gastroenteritis
  70. Fluoroquinolones (Quinolones)
    ROUTES: oral, IV

    • DRUGS:
    •  -Ciprofloxacin (Cipro)
    •  -levofloxacin (levaquin)
    •  -Norfloxacin (Noroxin)

    • SE/AE:
    •  -GI upset, rash, urtucaria, tinnitus, photosensitivity
    • -superinfection
    • -hematuria, crystalluria
    • -pseudomembranous colitis
    • -increase AST & ALT
  71. Fluoroquinolones (quinolones)
    • DRUG INTERACTIONS:
    • -antacids decrease absorption rate
    • -levofloxacin increases effect of oral hypoglycemic, theophylline, caffeine
    • -increase bleeding Coumadin (warfarin)

    • NRG INTERVENTIONS
    • -C&S
    • -infuse IV over 60-90 min
    • -increase fluid intake to >2000 ml/d *if not contraindicated*
    • -check for superinfection
    • -photosensitivity
    • -monitor labs
  72. Sulfonamides
    • ACTION:
    •  -inhibit bacterial synthesis of folic acid
    •  -bacteriostatic

    • USES:
    •  -UTIs, prostatitis, gonorrhea
    •  -otitis media, respiratory infections

    • ROUTE:
    •  -Oral, IV, topical, ophthalmic
  73. Types of Sulfonamides
    • *short acting
    •  -sulfadiazine (microsulfon)

    • *intermediate acting
    •  -sulfasalazine (azuifidine)
    •  -sulfamethoxazole (gantanol)
  74. Trimethoprim (sulfonamides)
    • -interferes w/ bacterial folic acid synthesis
    • -urinary tract antiinfective
    • -combined w/ sulfamethazole
    •  -prevent bacterial resistance
  75. TMP/SMZ (trimethoprim/sulfamethoxazole (Bactrim)) (Sulfonmamide)
    • -blocks bacterial protein synthesis
    • -bactericidal effect
    • -treats UTI, otitis media, intestinal infections, lower resp tract infections, prostatitis, gonorrhea

    ROUTE: oral, IV
  76. TMP/SMZ (sulfonamide) DRUG INTERACTIONS
    • -warfarin (Coumadin)
    •  -increase anticoagulant effect
    • -oral hypoglycemic 
    •  -increase hypoglycemia
  77. Sulfonamides SE/AE
    • -delayed _______ reactions
    • -GI distress
    • -photosensitivity
    • -crytstalluria
    • -renal failure
    • -blood dyscrasias
    •  -anemia; decrease WBC, decrease platelets
    • -superinfection
  78. TMP/SMZ NRG INTERVENTIONS
    • -administer w/ full glass of H2O 1hr before meals or 2hrs after meals
    • -increase fluid intake
    • -monitor sore throat, bruising, bleeding
    • -monitor CBC
    • -check for superinfection
    • -advise client not too take with antacids
    • -tell client to avoid direct sunlight
  79. ANTIBIOTICS: critical assessments/pt teaching
    • *Critical assessments
    •  -allergies
    •  -route (if more than one IVPB check compatibility)

    • *patient teaching
    •  -take abx prescription as ordered
    •  -use alternative form of birth control *for select abx*
    • -wear a medical alert bracelet if allergic
    • -use sunscreen (sulfa & tetracycline, fluoroquinolones)
    • -report significant side effects
    • -beware of drug interactions
  80. Drugs for URINARY TRACT DISORDERS
    • *UTI
    •  -abx
    •   -Nitrofurantoin (Macrodantin)
    •    -bacteriostatic/Bactericidal
    •    -SE: may turn urine brown
    •    -teaching: inc fluids, vit C (keeps urine acidic)

    • *Urinary Analgesics
    •  -Phenazopyridine (Pyridium)
    •   -SE: may turn urine reddish orange

    • *Urinary Stimulants
    •  -bethanechol (Urecholine)-parasympathomimetic

    • *Urinary Antispasmodics
    •  -gotta go gotta go gotta go
    •  -anticholinergic effects
  81. TUBERCULOSIS
    • *Etiology
    •  -mycobacterium tuberculosis
    •   -acid fast bacillus

    • *Transmission:
    •  -person to person via drops
    •   -coughing, sneezing

    • *Clients at risk
    •  -alcohol addicted, debilitated conditions, immuncompromised

    • *Symptoms
    •  -anorexia, cough, sputum, fever, night sweats, weight loss
    •  -positive acid fast bacilli (AFB)

    • *Phrophylaxis (6mo-1yr)
    •  -close contact w/ diagnosed TB client
    • -HIV w/ +TB test
    • -converted from negative to +TB test

    **contraindicated in liver disease
  82. TB: ANTITUBULAR DRUGS
    • *Drug combinations
    •  -single therapy
    •   -ineffective for treating TB

    •  -Multidrug therapy
    •   -determine bacterial resistance to drug
    •   -treatment duration decreased
  83. TB: antitubular drugs: Treatment Regimen
    • -divided into 2 phase
    •  -Phase 1: duration: 2 months
    •  -Phase 2: duration: 4-7 months
  84. TB: antitubular drugs: Drug Selection
    • *First line drugs
    •  -isoniazid (INH), rifampin, ethambutol, streptomycin, rifapentine
    •  -more effective than second line
    •  -less toxic than second line

    • *Second line drugs
    •  -Capreomycin, cycloserine, ethionamidem kanamycin, amikacin, ciprofloxacin, pyrazinamide
    •  -less effective
    •  -more toxic
  85. isoniazid (INH), rifampin, streptomycin (antitubular drugs)

    COMMON SE/AE TO ALL
    -GI distress, HA, blood dyscrasias, parasthesias, ___ , ocular toxicity
  86. Antitubular drugs specific SE/AE
    • *Isoniazid (INH)
    •  -____, hyperglycemia, hyperkalemia, hypophosphatemia, hypocalcemia

    • *Rifampin
    •  -turns body fluids orange

    • *Streptomycin
    •  -ototoxicity
  87. Antitubula drugs NRG PROCESS
    • *Assessment
    •  -note history of liver problems
    •  -assess for SE of meds

    • *Interventions
    •  -give INH 1hr before or 2hr after meals
    •  -monitor liver enzymes
    •  -collect sputum specimen for acid fast bacilli early in morning
  88. antitubular drugs NRG Process: client teaching
    • -must follow complete regimen
    • -take pyridoxine (vit B6) to prevent peripheral neuropathy
    • -need frequent eye exams
    • report numbness, tingling, burning
    • -avoid antacids
    • -avoid alcohol
  89. FUNGAL INFECTIONS
    • *also called 'mycosis'
    •  -yeast infections also called Candidiasis

    • *Contracted by different routes
    •  -ingested, implanted under skin after injury, inhaled

    • *general types
    •  -superficial: affects skin, hair, nails, mucous membranes
    •  -systemic
  90. ANTIFUNGALs
    • *fungal infections
    •  -treats superficial infections
    •   -skin, mucous membranes
    •   -mild

    •  -systemic infections
    •   -lungs, CNS
    •   -severe
  91. ANTIFUNGAL DRUG GROUPS
    • *Polyenes
    •  -Amphotericin B, nystatin

    • *Azoles
    •  -fluconazole (diflucan), miconazole (monistat), clotrimazole (lotrimin)

    • *Antimetabolites
    •  -Flucytosine (Ancobon)
    •  
    • *Antiprotozoals
    •  -atovaquone (mepron)

    • *Echinocandins
    •  -Caspofungin (cancidas)
  92. amphotericin B (antifungal)
    *treatment of severe fungal infections

    *route: IV over 2-6hrs

    *considered HIGHLY TOXIC

    • *SE/AE
    •  -flushing, fever, chills, N&V, Hypotension, GI distress, pseudomembranous colitis, parasthesis, thrombophlebitis, nephrotoxicity, electrolyte imbalances
  93. amphotericin B (antifungal) NRG INTERVENTIONS
    • -give slowly
    • -monitor VS every 30 min
    • -prevent febrile reactions, anaphylaxis
    •  -antipyretics, antihistamines, corticosteriods
    • -increase fluids
    • -monitor urine output & weight
    • -monitor electrolytes, BUN, CR, AST, ALT, bilirubin 
  94. Nystatin (mycostatin) (antifungal)
    ROUTE: oral, topical

    • ACTION:
    •  -increase permeability of fungal cell membrane
    •  -fungistatic, fungicidal

    • CLIENT TEACHING
    •  -administration: orally or topically
    •    gargal if throat affected
  95. Fluconazole (diflucan) (antifungal)
    *use: serious systemic fungal infections, other fungal infections, single dose treatment for vaginal acandidiasis

    *better SE profile than Amphotericin B

    *Route: PO & IV (parental)

    *SE/AE: N&V, diarrhea-common

    *interactions: anticoagulants, oral antidiabetic agents, cyclosporine, phenytoin
  96. Miconazole (monistat); Clotrimazole (lotrimin)
    (antifungal)
    *uses: vaginal yeast infections

    • *patient teaching:
    •  -take medication as prescribed-complete the full course
    •  -avoid from sexual intercourse until tx is completed
    •  -continue tx during menstruation
  97. PEPTIDES: POLYMYXIN B (aerosporin)
    -Treat pseudomonas aeruginosa, E.coli, klebsiella, shigella

    -route: slow IV

    -AE: nephrotoxicity, neurotoxicity
  98. PEPTIDES: BACITRACIN (bactrin)
    -treat meningitis

    -route: IM, topical

    -AE: GI distress, renal damage
  99. Metronidazole (Flagyl)
    *uses: GI, GU, skin, respiratory infections

    • *SE: -
    •   -HA, dizziness, GI distress, metallic taste
    •   -avoid alcohol
    •    -disulfiram-type reaction: N&V, facial flushing, sweating, severe HA, slurred speech
    •    -dark urine or reddish brown: high doses
    •    -metallic or bitter taste
  100. general principles: Antivirals
    *Infection with viruses: difficult to eradicate

    *Viral replication: can only replicate inside the cell of the host
  101. Viral illnesses & tx OVERVIEW
    • *Prominent viral illness
    •  -small pox (pox virus)
    •  -sore throat & conjuctunctivitis (adenovirus)
    •  -warts (papovirus)
    •  -respiratory infections (coronavirus & rhinovirus)
    •  -gastroenteritis (rotavirus, norwalk virus)
    •  -cytomegalovirus (CMV)
    •  -influenza (orthomyxovirus)
    •  -Hepatitis B (HBV)
    •  -HIV/AIDS (retroviruses)
    •  -Herpes (herpes virus)
  102. Vaccines-Viral
    **Prevent disease such as: small pox, chicken pox, measles, mumps, rubella

    • -influenza virus vaccine
    •   -changes yearly
    •   -promotes antibody production
    •   -composition: eggs**
    • -Success rate
    •   -65-90%
    • -Diagnosing influenza
  103. Viral treatment- Antiviral agents
    • -Viruses controlled by antiviral agents
    •  -influenza viruses
    •  -cytomegalovirus (CMV)
    •  -hepatitis viruses
    •  -herpes viruses
    •  -respiratory synctial virus (RSV)

    -Antiretroviral  agents (for HIV)
  104. Antivirals
    • *Amantidine (Symmetrel)
    • *Rimantadine (flumadine)
    •  -SE: Insomnia, ataxia, dizziness, orthostatic hypotension, depression, anxiety, confusion, weakness, slurred speech
    • *Zanamavir (Relenza)
    • *Oseltamiver (Tamiflu)
    •  -SE: N&V
    •  -Special considerations
    •   -tx should begin within 48hrs of influenza symptom onset
  105. Topical Antivirals
    -Used for herpes simplex viruses

    • -examples:
    •   -idoxuridine (herpes liquifilm)
    •   -penciclovir (denavir)
    •   -trifluridine (viroptic)
    •   -acyclovir (zovirax)
  106. Antivirals
    • *ribavirin (Virazole)
    • *famciclovir (famvir)
    • *ganciclovir (cytovene)
    • *valacyclovir (valtrex)
    • *acyclovir (zovirax)

    • *indications:
    •  -HSV-1 & HSV-2, including genital herpes, herpes zoster- shingles, chicken pox (VZV)
  107. Antiviral Route/SE/AE/Interventions
    *Route of administration:


    *SE/AE: N&V, HA, diarrhea, lethargy, increase bleeding, orthostatic hypotension, hematuria, nephrotoxicity, transient burning when topically apllied

    • *interventions:
    •  -monitor labs
    •  -teaching re: spread of infection
    •  -interventions to deal with SE
    •  -infuse IV slowly
  108. HIV & Antoretroviral agents
    • *Human Immunodeficiency Virus (HIV)
    •  -member of the "retro virus family"
    •      -frequent genetic mutations which results in viral strains resistant to medications & the patients immune system
    •  
    • -routes of transmission: 
    •     -sexual transmission
    •     -direct contact with infected blood
    •     -maternal fetal transmission

    -stages of HIV infection
  109. HIV & AIDS Labs/Diagnostics
    • *CD4 T-Cell counts aka T-cells
    •   -normal counts= 800-1200 cells/mm3

    • *viral load (VL)
    •   -measures the status of persons immune system...how much HIV is in blood
    •      -used to evaluate effect of therapy
    •      -monitors changes in HIV infection
    •      -guides treatment choice
  110. HIV & antiviral agents Indications
    • -symptomatic clients wiht HIV
    • -asymoptomatic clients with CD4+ T cells decrease to <350
    • -clients with CD4 counts >350 based on comorbidities
  111. most common HIV-related opportunistic infections/diseases
    *Bacterial: TB, Mycobacterium Avium complex (MAC), pneumonia, septicemia

    *Protozoal: PCP, toxoplasmosis, cryptosporidosis, leishmaniasis

    *Fungal: Candidiasis, cryptococcosis

    *viral: cytomegalovirus, herpes simplex, herpes zoster

    *HIV associated malignancies: kaposis sarcoma, lymphoma, squamous cell carcinoma
  112. HAART
    *Highly active antretroviral therapy (HAART)

    • *Goals of HAART
    •  -suppress viral replicatin to slow decline of CD4 cells
    •  -suppress VL to undetectable levels
    •  -decrease incidence of opportunistic infections
    •  -minimize adverse effects
    •  -improve qualilty of life
    •  -improve survival & reduce mortality
  113. Classes of Antiviral Agents
    *reverse transcriptase inhibitors

    *Protease inhibitors

    *entry inhibitors

    • *CCR5 antagonists
    •  
    • *integrase inhibitors
  114. Reverse Transcriptase inhibitors (antiretroviral agents)
    • *Nucleosides reverse transcriptase inhibitors (NRTIs)
    •  -Zidovudine (AZT), didanosine, stavudine, lamivudine, abacavir, tenofovir, entricitabine
    •  
    • *Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
    •  -efavirenz, delvirdine, nevirapine, etravirine

    *mechanism of action: blocks activity of the enzyme reverse transcriptase (RNA does not synthesize into DNA)
  115. Protease inhibitors (Pls)- 10 drugs (antiretroviral)
    • *mechanism of action
    •  -inhibits the protease retroviral enzyme (promotes the breakup of chains of protein molecules which stops viral replication)
  116. *Entry inhibitors- 1 drug (antiretroviral)
    -enfuviritide-fuzeon 

    • -mechanism of action  
    •   -works by inhibiting viral fusion
  117. HIV & Antiretroviral agents SE/AE
    *NRTIs: lactic acidosis, peripheral neuropathy, pancreatitis, lipatrophy, N&V, bone marrow suppression

    *NNRTIs: rash, fatigue, peripheral neuropathy, dizziness, insomnia, N&V

    *PI: hyperglycemia, increase bilirubin, HA, N&V

    *EI: N&V, rash, hypotension

    *CCR5: URI, cough, rash, fever, dizziness

    *integrase Inh: N&V, HA, diarrhea, fatigue
  118. HIV & antiretroviral agents-INTERVENTIONS
    • -increase fluids
    • -monitor labs: CD4 counts, VL, CBC
    • -teaching re: modes of transmission
    • -avoidance contact with others who have communicable diseases
    • -teaching & assessing for side effects
    • -health promoting activities
    • -adherence
  119. Adherence
    *Adherence to regimen is major concern

    • *Nonadherence  results in:
    •  -viral replication
    •  -increased VLs (viral load)
    •  -developement of resistant viral strains
    •  -deterioration of the immune system
  120. suggestions to promote client adherence
    • -client understanding of each medications purpose
    • -food &fluid restrictions
    • -recommended food choices
    • -storage of medications
    • -appropriate recording sheet
    • -contact person for questions
  121. HIV/AID related drugs NRG interventions/special considerations
    • NRS intervention:
    •  -assess barriers to adherence
    •   -medication organizers
    •   -written schedule
    •   -financial resources

    •  -assess support systems
    •   -AIDS network

    • Special Considerations:
    •  -does not eradicate the infectin, but slows the progression
  122. Antiretroviral therapy
    • *pregnancy
    •  -maternal
    •  -neonatal

    • *postexposure prophylaxis (PEP) for health care workers
    •  -risk- 0.3% form percutaneous injury, 0.9% from mucocutaneous injury
    •  -management should be initiated within hours of the event and continued for 4 weeks- usually a 2 drug regimen (see table 35-4)
  123.  Antimalarials
    • *malaria
    •  -protozoan disease
    •  -incubation period 10-35 days

    • *etiology
    •  -protozoan parasites, plasmodium spp

    • *phases
    •  -tissue phase (invasion of body tissue); no symptoms
    •  -erythrocytic phase (invasion of the red blood cells): fever, chills, sweating, flulike symptoms
  124. antimarials
    • *treatment regimen:
    •  -combinations used for drug resisitant malaria

    • *prophylactic measures
    •  -prevent malaria, prevent relapse
    •  -prophylaxis: take with food-start before exposure, during & 6-8 weeeks after leaving the region
    • *drugs
    •  -hydroxychloroquine (plaquenil), quinine (quinamm), chloroquine (aralen)
    •  -inhibit growth by interfering with protein synthesis
  125. Antimarials SE/AE
    • *chloroquine or hydroxychloroquine
    •  -GI distress, N&V, diarrhea, cramping, blurred vision, blood dyscrasias

    • *quinine
    •  -GI distressm vision changes, dizziness, confusion, delirium, seizures, tinnitus, reanl impairment, cardiocvascular effects
  126. antimarials NRG interventions
    • -monitor kidney and liver function
    • -take drug with meals to prevent GI distress
    • -report vision changes
    • -avoid alcohol
    • -may cause ototoxicity
    • -advise individuals traveling to endemic countries to take prophylactic drug
  127. anthelmintics
    *Helminths (parasitic worms)

    • *four groups of helminths
    •  -cestode:
    •    -tapeworms
    •  -trematodes
    •    -flukes
    •  -intestinal nematodes
    •   -round worms
    •   -pin worms
    •     -treat the whole family
    •  -tissue invading nematodes
    •   -pork roundworm
  128. anthelmintics
    • -usually given 1-3 days. may require longer treatment
    • -very specific in their action

    • SE/AE
    •  -GI upset, dizziness, drowsiness, HA, weakness

    • NRSG interventions
    •  -give after meals to prevent GI distress
    •  -encourage good hygiene
    •  -warn against driving moter vehicles

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