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4 drugs used to treat tuberculosis
- Pyrizinamide (P, PZA)
Treatment for TB begins with ________ treatment and then shifts to _________ treatment as _________ is established
- empiric treatment
- focal treatment
- drug sensitivity
Why would being immunocompromised make TB treatment with Ethambutol less effective?
It relies on intact host immunity (is bacteriostatic)
Which TB drug is the standard treatment, especially for latent, and why?
- relatively safe
Why is patient adherence difficult when treating TB? What treatment option promotes adherence?
- long term
- drugs are hard on system
- Direct Observation Therapy
Rifampin, Isoniazid and Pyrinamide are all bacterio_______; Ethambutol is bacterio______
Where are Rifampin, Isoniazid and Pyrinamide metabolized? What is the main adverse effect to worry about?
S/S of hepatoxicity to teach patients about for R, I, PZA
- Darkened urine
- Pale stools
What effect does Rifampin have on P450? What does this do to HIV treatment?
Induces it; makes HIV drugs less effective
Multi-drug resistant TB is resistant to which drugs? Extensively drug resistant TB?
- MDR-TB: I & R
- XDR-TB: I, R & others
AE's of Isoniazid and associated teachings
- hepatoxicity: assess baseline liver functions
- -older people at greatest risk
peripheral neuropathy: pins and needles
AE's of Rifampin and associated teachings
makes oral contraceptives ineffective: use alternate form
decreases levels of other drugs due to increased drug metabolism
discoloration of bodily fluids: may stain contacts
AE's of PZA
Rapid resistance: always question if prescribed alone
- Hyperurecemia with gouty arthritis
- (uric crystals)
AE's of Ethambutol
- optic neuritis
- -loss of central vision
- -impaired color differentiation
report changes in vision; assess vision before treatment starts and monthly
not given to children under 8
What drug treats herpes simplex, varicella-zoster virus and cytomegalovirus?
- Acyclovir (Zovirax)
when acyclovir is administered via IV, it may cause ______. How can this be avoided?
- adequate hydration during treatment and for two hours after
drugs used to treat Hepatitis (HCV and HBV)
Interferon Alpha (2a/2b)
when do you treat Hep C?
only when certain S/S are present:
- HCV viremia (virus enters bloodstream and accesses body)
- persistant elevated ALT
how does interferon alpha work?
affects viral replication
AE's of interferon alpha?
- Flulike symptoms
- hemolytic anemia
- thyroid disfunction
- bone marrow suppression
Why do anti-virals have such adverse effects?
virus replicates inside host cells so can't damage virus without damaging host
Primary management of influenza is _____
Secondary is _____
Drugs to treat influenza
two kinds of flu vaccine
- live, attenuated influenza vaccine (LAIV)
AE's of influenza vaccine
- pain at site of injection
- flu-like symptoms
protection from influenza begins when?
1-2 weeks after vaccination
nasal spray influenza vaccine (FluMist) lasts how long? who can get it?
what is the general overview of HIV diagnosis and treatment?
- it's very complicated to diagnose
- lots of drugs exist to treat it
- there are a lot of complications and interactions
What are NRTIs?
- Nucleoside Reverse Transcriptase Inhibitors
What are NNRTIs? Prototype?
- Non-Nucleoside Reverse Transcriptase Inhibitors
4 classes of drugs for treating HIV
- Protease Inhibitors
- Integrase Inhibitors
which class of HIV drugs are the most effective?
What's ART and HAART?
- Antiretroviral therapy
- Highly Active Antiretroviral Therapy
what's a retrovirus? how can it be stopped?
- uses RNA as genetic material
- transcribes RNA to DNA
stop replication by blocking enzymes
testing for efficacy of HIV treatment involves counts of what cell?
how do you treat HIV in pregnant women? which drug is preferred?
- Same principles
- "If you can save the mother, you can save the baby"
Retrovir is a ________ (drug class)
how does it work?
- suppresses synthesis of viral DNA
AE's of Retrovir
- N/V/D --very common
- abdominal pain
- insomnia myopathy
patient teachings for Retrovir
- adherence is important
- assess muscle changes
- -weakness, spasm, stiffness, cramps
Sustiva is a _______ (drug class)
How does it work?
- inhibits synthesis of viral DNA
Induces P450: accelerates drug metabolism
AE's of Sustiva and associated patient teachings
- CNS effects (in 50%) of patients: take at bedtime
- -avoid in patients with history of mental illness or substance abuse
Rash/Steven Johnson Syndrome: Stop treatment immediately
Oral contraceptives don't work
What's Steven Johnson Syndrome?
what drug is it associated with?
- skin sloughs off and changes color
- Sustiva (for HIV)
What is the prototype for Protease Inhibitors?
how does it work?
- stops protease from contributing to HIV maturing
AE's of Kaletra
causes other chronic conditions
cardiovascular: Prolongs PR & QT intervals
Fat redistribution (hyperlipidemia)
reduces bone density
increased bleeding in hemophilia
Teachings for Kaletra
beware of falls (hemophilia)
monitor glucose levels and for S/S of diabetes (i.e. polydipsia, polyurea)
Which two classes of HIV drugs can be most successfully combined to reduce viral load to undetectable levels?
Protease Inhibitors and NRTIs
HIV fusion inhibitor works how?
how is it given?
- blocks entry of HIV into cells
AE's of fusion inhibitors?
HIV Integrase Strand Inhibitors works how?
inhibit insertion of HIV DNA into cells
AE's for Isentress (Integrase Strand Inhibitor) and patient teachings/monitor
- Organ disfunction: monitor kidneys and liver
-rare but fatal
CCR5 Antagonists work how?
- only for certain strain of HIV
- blocks viral entry to cell
used with other HIV drugs
who can't take CCR5 antagonists?
patients under 16
AE/s of CCR5 antagonists and associated patient teachings/monitor?
myocardial ischemia, infarction: teach S/S to report
Hepatoxicity: monitor liver function