anti-infective medications Flashcards
1
Q
tuberculosis antitubercular drugs
A
- isoniazid (INH)
- rifampin (RIF, ridadin)
2
Q
isoniazid (INH) indications
A
- anti-tb drug
- used alone or in combo to treat latent TB
- must be given in combo to treat active TB
3
Q
isoniazid (INH) bbw
A
- severe and sometimes fatal hepatitis may occur usually within the first 3 months or later
- risk increases with chronic liver disease or daily etoh use
4
Q
isoniazid (INH) cautions
A
- peripheral neuroptahy from deficiency of pyridoxine
- poor blood glucose control in diabetes
- pts with seizures, especially those on benzodiazepines or phenytoin due to risk of toxicity
5
Q
isoniazid (INH) implications
A
- monitor ast & alt and stop drug if 3x above normal
- educate to avoid tyramine foods due to risk for hepatotoxicity
- educate on s/s of hepatotoxicity: jaundice, fatigue, anorexia, malaise, nausea
- educate to eat food high in b6 or take a supplement
- may require DOT
- take on empty stomach unless GI upset
- dont take acetaminophen
- dont drink
6
Q
rifampin (RIF, rifadin) indications
A
- tuberculosis but is used for other conditions also
- synergistic with INH, produces improvement faster than any other drug
- can be used alone for latent tb
- must be used in combo to treat active tb
7
Q
rifampin (RIF, rifadin) implications
A
- given once, twice, or 3x weekly
- monitor liver enzymes prior to treatment then monthly
- diminishes effects of warfarin, oral contraceptives, HIV treatment therapy, and methadone (may need dosage changes)
- causes harmless red-orange discloration of urine, sweat, tears, and other body fluids
- take on empty stomach unless GI upset
- feels better after 2 weeks biut needs to be taken for 6 more months
8
Q
antiviral medications
A
- inhibit viral production but doesn’t eliminate the virus from the tissue
- protection only lasts while the drug is being taken
- prevention is the best action
- once infected, we can often only offer symptomatic treatment
9
Q
drugs for herpesvirus infections
A
- acyclovir
- ganciclovir
10
Q
acyclovir indications
A
- herpes simplex (HsV-1, HSV-2)
- varicella-zoster
- doesnt eliminate the inactive virus in the body or prevent recurrence of disease
11
Q
acyclovir caution
A
- may become less effective with prolonged use, especially in immunocompromised patients
- renal sufficiency
- iv administration can result in phlebitis
12
Q
acyclovir implications
A
- infuse iv dose over one hour due to risk of renal damage. hydrate with 2-3L fluids per 24 hours
- topical: wash hands prior to admin and wear gloves
- therapy should begin as soon as symptoms present
- wash lesions with soap and water, keep dry
- can cause gingival hyperplasia
13
Q
ganciclovir implications
A
- cmv treatment in immunocompromised patients (AIDS, post transplant)
- IV: treats CMV retinitis (no contact use), prevention of CMV in transplant pt
- oral: prevention of CMV in advanced HIV or at risk for development
14
Q
ganciclovir cautions and contraindications
A
- risk of renal impairment, encourage hydration
- contraindication for neutrophil <500 or platelet count <25,000
- contraindicated for IM, IVP, SUBQ
15
Q
ganciclovir BBW
A
- granulocytopenia (neutropenia), anemia, thrombocytopenia. DISCONTINUE IF SEVERE BONE MARROW DEPRESSION OCCURS
- Female and male patients of childbearing age must maintain contraceptive precautions during therapy and MINIMUM OF 90 DAYS AFTER THERAPY
16
Q
ganciclovir implications
A
- give IV over one hour, rapid admin results in toxicity
- dialysis pt should receive meds post dialysis
- hazardous material, dont allow to touch skin
- monitor BUN and Cr
17
Q
drugs for respiratory syncytial virus
A
ribavirin
18
Q
ribavirin indications
A
- in children with severe RSV of lower respiratory tract
- off label for immunocompromised RSV+ adults with hemapoietic cell, heart, or lung transplants
- also used in hepatitis c treatment, off label use for influenza
19
Q
ribavirin route
A
- inhaled
- peak 60-90 minutes
20
Q
ribavirin bbw
A
drug causes significant teratogenic effects, pregnant women or those who plan to become pregnant should not care for children receiving inhalation therapy in the room while it is being administered
21
Q
ribavirin implications
A
-monitor for bronchospasm, respirations, o2, auscultate
22
Q
amantadine hydrochloride indications
A
- influenza
- not recommended for influenza A bc of resistance developement
- not effective against influenza B
23
Q
amantadine hcl adverse effects
A
- cns effets
- orthostatic hypotension
- peripheral edema
- livedo reticularis and discoloration of the skin, resolves when med is d/c
- anticholinergic effects
24
Q
amantadine hcl implications
A
-first dose early in the am, second dose in early evening, 12 hours part with full glass of water or with food to help prevent disruptive sleep
25
neuraminidase inhibitors drugs
-oseltamivir
26
oseltamivir indications
-influenza a or b
27
oseltamivir implications
- begin treatment if pt has been symptomatic for 2
- can be used in children <1 year and adults prophylactically
- don't use in breastfeeding mothers
- dont take 48 hours prior to flu vaccine or 2 weeks after vaccine
- can cause epistaxis and conjuncitivitis
28
oseltamivir qsen alert
- take with food to prevent gi upset
| - adult capsules can be opened and powder mixed and sweetened liquid
29
nucleoside analogs drugs
lamivudine
30
lamivudine indications
- treats chronic hepatitis b with evidence of hepatitis b viral replication and active inflammation of the liver
- can be used with hiv when multi-drug regimen is necessary
- goal: reduce risk of transmission, prevent long-term complications (reduce malaise, myalgia, loss of appetite, and abdominal pain
31
lamivudine adverse effects
pancreatitis (particularly in pediatrics)
32
lamivudine bbw
- lactic acidoses and severe hepatomegaly with steatosis
| - will see hyperventilation with lactic acidosis
33
fungal infections
-most severe and invasive in immunocompromised hosts
-increased in incidence due to HIV, immunosuppresant drugs in pts with cancer or organ transplants,
long term PICC, implantation of prosthetic devices, widespread use of broad-spectrum abx
-most antifungal therapies produce potentially serious toxicities and drug interactions
34
antifungal polyene: amphotericin drugs
-amphotericin b deoxycholate
35
Amphotericin B deoxycholate
| indications
only used for serious fungal infections (progressive and potentially fatal) due to toxicity
36
Amphotericin B deoxycholate bbw
not recommended for use in non invasive disease
37
Amphotericin B deoxycholate implication
- can only be given with 5% dextrose flush before and after
- separate iv line preferred
- in line filter
- monitor iv site for phlebitis
- pre-treat with asa, antihistamine, antiemetics
- nephrotoxic, hydrate with 1L sodium chloride
38
Amphotericin B deoxycholate adverse effects
- multiple organ failure
- respiratory arrest
- cardiac arrest
- hypokalemia, hyponatremia
39
antifungal azoles: fluconazole
fluconazole
40
fluconazole indications
- localized candidal infections (uti, thrush)
- prevention in pt receiving bone marrow transplants
- resistive strains develop with extensive use
41
fluconazole routes
oral or iv
42
fluconazole ae
- hepatotoxicity (mild to death) can be reversed if meds stopped
- alopecia with long term use (pt with aids)
- renal toxicity
- skin rash
- high dosing associated with miscarriage
43
fluconazole implications
-stop if alt, ast levels are 3x normal
44
antifungals echinocandins
caspofungin
45
caspofungin ae
- fever
- ha
- GI sx
- phlebitis
- can cause histamine response
46
caspofungin route
iv
47
caspofungin implications
- dont admin with mannitol and dextrose
- monitor liver, renal, electrolytes, CBC
- decreased wbc, HH
- increased potassium and liver enzymes
- assess for weight gain and peripheral edema in pt with cardiac disease
