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320 Pharmacology > Anti-Infectives > Flashcards

Anti-Infectives Flashcards

1
Q

List the Antitubercular drugs.

A
  • isoniazid (INH)​
  • rifampin​
  • ethambutol​
  • pyrazinamide (PZA)​

Remember: IREP

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2
Q

Patient education that is common among antitubercular drugs?

A
  • Take missed dose as soon as remembered unless its almost time for the next dose; DO NOT DOUBLE UP ON MISSED DOSES
  • Emphasize the importance of regular f/u exams to monitor progress and to check for side/adverse effects
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3
Q

How is isoniazid administered?

A
  • Available in PO (most common) and IM​
  • Black box warning for possible hepatitis​
  • Give pyridoxine (vit. B6) concurrently
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4
Q

Isoniazid indication?

A

First-line therapy of active TB; in combination w/ other agents; prevention of TB in clients exposed to active disease (monotherapy)

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5
Q

Isoniazid contraindications?

A

Hypersensitivity, acute liver disease, hx of hepatitis from previous use

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6
Q

Adverse effects of isoniazid?

A
  • EENT: blurred vision
  • GI: drug-induced hepatitis
  • Neuro: peripheral neuropathy (that’s why the need pyridoxine [vit B6])
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7
Q

Isoniazid drug interactions?

A
  • Additive CNS effects w/ other antituberculars
  • Aluminum containing antacids (may decrease absorption)
  • Increased risk of hepatotoxicity w/ other hepatoxic agents (including, ETOH, acetaminophen, and rifampin)
  • Isoniazid may decrease blood levels and effectiveness of ketoconazole
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8
Q

Describe nursing considerations and specific client education for isoniazid.

A
  • Liver enzymes should be evaluated prior to and monthly throughout therapy
    ~ Increased AST, ALT, and serum bilirubin may indicate drug-induced hepatitis
  • Advise client to notify HCP promptly if cues of hepatitis or peripheral neuritis occur
  • Advise client to take pyridoxine (vit B6) concurrently with drug to prevent neuropathy
  • Any changes in visual acuity, eye pain, or blurred vision should be reported immediately.
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9
Q

How is rifampin administered?

A

Available in both PO and parenteral forms​

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10
Q

Rifampin indication?

A

Active TB (w/ other drugs)

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11
Q

Rifampin contraindication?

A
  • Hypersensitivity
  • Use cautiously in clients w/ a hx of liver disease and/or concurrent use of other hepatotoxic drugs (increased risk of hepatotoxicity), chronic liver disease, poor nutritional status
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12
Q

Rifampin adverse effects?

A
  • EENT: red/orange discoloration of tears
  • GI: hepatotoxicity, abd pain, N/V/D, flatulence, heartburn, discoloration of saliva
  • GU: discoloration of urine
  • Hem: thrombocytopenia, hemolytic anemia
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13
Q

Rifampin drug interactions?

A
  • Significantly decreased levels and effectiveness of sofosbuvir and zidovudine (avoid concurrent use)
  • Absorption may be decreased by antacids; administer rifampin >/= 1 hr prior to antacids
  • Significantly decreases levels and effectiveness of hormonal contraceptives; use non hormonal birth control during rifampin therapy
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14
Q

Describe nursing considerations and specific client education for rifampin.

A
  • Advise client to report and cues of hepatitis
  • May use vitamin K supplementation in clients at risk for vit K deficiency
  • Cause clients to avoid ETOH during therapy; it can increase the risk of hepatotoxicity
  • Inform client that saliva, sputum, teeth, sweat, tears, urine, feces may become red-orange, to red-brown and that soft contact lenses may become permanently discolored
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15
Q

How is pyrazinamide administered?

A

ONLY available in generic PO form​

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16
Q

Pyrazinamide indication?

A

Used in combination w/ other drugs in the tx of active TB

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17
Q

Contraindication of pyrazinamide?

A
  • Hypersensitivity, cross-sensitivity with isoniazid, niacin, and severe liver impairment
  • Use cautiously in clients with gout, renal failure, and diabetes mellitus
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18
Q

Adverse effects of pyrazinamide?

A
  • GI: hepatoxicity
  • Metabolic: hyperuricemia
  • Derm: acne, pruritis, photosensitivity, rash
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19
Q

Pyrazindamide drug interactions?

A
  • Concurrent use of rifampin may result in life-threatening hepatoxicity and should be avoided
  • Maybe decrease effectiveness of antigout drugs
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20
Q

Describe nursing considerations and specific client education for pyrazinamide.

A
  • Evaluate liver enzymes before and w2-4 weeks during therapy
  • Monitor serum acid concentrations during therapy; may cause increased levels resulting in precipitations of an acute gout flare up
  • Usually given concurrently with isoniazid
  • Advise client if any cues of hepatotoxicity are present
  • Advise client to use sunscreen and protective clothing to prevent photosensitivity reactions
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21
Q

How is ethambutol administered?

A

PO only

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22
Q

Ethambutol indications?

A

Active TB (w/ at least one other drug)

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23
Q

Ethambutol contraindications?

A
  • Hypersensitivity, optic neuritis
  • Use cautiously in renal and severe hepatic impairment (dosage reduction required)
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24
Q

Ethambutol adverse effects?

A
  • EENT: optic neuritis
  • GI: hepatitis
  • MSK: joint pain
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25
Q

Ethambutol drug interactions?

A
  • Neurotoxicity may be increased with other neurotoxic drugs
  • Aluminum hydroxide (antacid) may decrease absorption (space 4 hours apart)
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26
Q

Describe nursing considerations and specific client education for ethambutol.

A
  • Assessments of visual function should be made frequently during therapy
  • Monitor renal and liver enzymes, CBC and uric acid levels routinely
  • Administer w/ food or milk to minimize GI irritation
  • Tablets may be crushed and mixed with apple juice or sauce. Advise clients to take medication as directed and not to skip a dose
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27
Q

What are the two types of fungi?

A
  • Yeasts (single-celled fungi) that reproduce by budding​
  • Molds (multicellular; characterized by long, branching filaments)​
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28
Q

Define mycosis.

A

An infection caused by a fungus

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29
Q

List the four general types of mycotic infections.

A
  1. Systemic (e.g.sepsis/fungemia)​
  2. Cutaneous​
  3. Subcutaneous​
  4. Superficial (tinea pedis [athlete’s foot],tinea cruris [jock itch], and tinea corporis[ringworm])
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30
Q

List the four classes of antifungal drugs.

A
  1. Polyenes​
  2. Imidazole​​
  3. Triazoles​
  4. Echinocandins​

Rememeber: PITE

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31
Q

What are two examples of POLYENES antifungal drugs?

A
  • Amphotericin B (systemic)​
  • Nystatin (superficial)​
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32
Q

What is an example an IMIDAZOLE antifungal drug?

A

Ketoconazole

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33
Q

What are three examples of TRIAZOLE antifungal drugs?

A

Fluconazole, Voriconazole, Posaconazole​

34
Q

What is an example of an ECHINOCANDINS antifungal drug?

A

Caspofungin

35
Q

Describe the drug profile of amphotericin B?

A
  • Lots of adverse effects when given IV
    ~ Symptom management (pre-med) w/ antipyretics, antihistamines, antiemetics, and corticosteroids to decrease the severity of infusion-related reactions​
  • Use cautiously in patients with bone marrow suppression or renalimpairment​
  • Often a 1 mg test dose is given over 20-30 minutes to see if the patient will tolerate the drug
36
Q

amphotericin B indications?

A

Tx of progressive, potentially fatal fungal infections (such as aspergillosis)

37
Q

amphotericin B contraindications?

A
  • Hypersensitivity; potential for distribution into breast milk and toxicity in infant; DC nursing
  • Use cautiously in renal impairments
38
Q

amphotericin B adverse effects?

A
  • CV: chest pain, cardiac dysrhythmias
  • CNS: Neurotoxicity, tinnitus, visual disturbances, hand or feet numbness or tingling
  • GI: N/V/D, abd pain, elevated liver enzymes, hyperbilirubinemia,
  • GU: nephrotoxicity, hypokalemia, hypomagnesemia
  • Misc: hypersensitivity reactions/acute infusion reactions, chills, fever
39
Q

amphotericin B drug interactions?

A
  • Concurrent use w/ zidovudine may increase the risk of nephrotoxicity
  • Combined used of ‘azole’ antifungals may increase fungal resistance
40
Q

Describe nursing considerations and specific client education for amphotericin B.

A

KEY: IV
- Check provider orders for pre-medications
- If administering through an existing IV line, flush line w/ D5W before infusion or use a separate line
- Do not dilute or mix w/ saline solution, other medications, or solutions containing bacteriostatic drugs
- Explain to the client the need for long-term IV therapy

41
Q

How is nystatin administered?

A
  • Not available in a parenteral form, but does come in several oral and topical formulations​
42
Q

nystatin indications?

A
  • PO suspension: local tx of oropharyngeal candidiasis
  • PO tablet: Tx of non-esophageal mucus membrane GI candidiasis
43
Q

nystatin contraindications?

A

Hypersensitivity

44
Q

nystatin adverse effects?

A
  • GI: Abd pain (in large doses), N/V/D
  • Derm: Rash, urticaria (hives)
45
Q

Describe nursing considerations and specific client education for nystatin.

A

KEY: PO suspension / mucous membrane
- Inspect oral mucus membranes before and frequently during therapy
- PO suspension should be administered by swish, gargle, and swallow
- Advise client to report increased irritation of mucous membranes or lack of therapeutic response to the HCP
- For clients that wear dentures- dentures require soaking in nystatin suspension

46
Q

Describe the drug profile of fluconazole.

A
  • Great coverage against many fungi, less adverse effects than amphotericin B​
  • Available in both PO and parenteral forms​
47
Q

fluconazole indication?

A

Usually only 1 PO dose is needed for the tx of vaginalcandidiasis infections

48
Q

fluconazole contraindication?

A
  • Hypersensitivity; Pregnant clients (may cause fetal harm)- use only if benefit justifies potential fetal risk
  • Use cautiously in: renal impairment, underlying liver disease, structural heart disease, electrolyte abnormalities, or concurrent use of other QT prolongating medication
49
Q

fluconazole adverse effects?

A
  • CV: torsade de pointes, QT prolongation, dizziness
  • GI: hepatotoxicity
  • MISC: hypersensitivity reactions (including anaphylaxis)
50
Q

flucanazole drug interactions?

A
  • Rifampin and isoniazid: decrease blood levels of fluconazole
  • May antagonize effects of amphotericin B
  • May increase voriconazole levels; avoid concurrent use
51
Q

Describe nursing considerations and specific client education for fluconazole.

A
  • Obtain specimens for cx (culture) before instituting therapy; therapy may be started before results are obtained
  • May cause fetal harm
52
Q

Describe the drug profile of voriconazole.

A
  • Indicated for invasive aspergillosis
  • Contraindicated in patients w/ known drug allergy
  • Available in PO and parenteral forms​
53
Q

voriconazole indication?

A

Invasive aspergillosis

54
Q

voriconazole contraindication?

A
  • Severe hepatic impairment, pregnancy (may cause fetal harm)
  • Concurrent use in St. John’s wort, rifampin (causes voriconazole to be broken down rapidly)
  • Use cautiously in hepatic & renal impairment, QT prolongation, HF, sinus bradycardia, hypokalemia
55
Q

voriconazole adverse effect?

A
  • CV: changes in BP, peripheral edema, QT prolongation, tachycardia
  • EENT: visual disturbances, photophobia
  • GI: hepatoxicity, N/V
56
Q

voriconazole drug interactions?

A
  • Fluconazole may increase levels of voriconazole; avoid concurrent use
  • St. John’s wort may significantly decrease levels and effectiveness; concurrent use is contraindicated
57
Q

Describe nursing considerations and specific client education for voriconazole.

A

KEY: monitor labs
- Monitor for cues of fungal infections prior to and during therapy
- Monitor visual function
- Monitor liver enzymes (AST, ALT, and bilirubin) prior to starting, then weekly during first month
- Monitor renal function (serum creatinine) during therapy
- Correct any electrolyte abnormalities (hypokalemia, hypomagnesemia) prior to starting therapy

58
Q

Describe the drug profile of caspofungin.

A
  • First echinocandin antifungal drug​
  • Indicated for invasive aspergillosis refractory to or intolerant of other therapies
  • Dosages need to be reduced in patients with impaired liver function​
  • Available in parenteral form ONLY
59
Q

caspofungin indication?

A
  • invasive aspergillosis
  • candidemia esophageal candidiasis
60
Q

caspofungin contraindication?

A
  • Hypersensitivity, concurrent use with cyclosporine (increased risk of hepatotoxicity), and pregnancy (may cause fetal harm)
  • Use cautiously in hepatic impairment; use while breast feeding only if the potential maternal benefit justifies potential risk to the infant
61
Q

caspofungin adverse effects?

A
  • CV: hypotension, tachycardia, peripheral edema
  • Derm: rash, flushing, pruritis
  • GI: hepatoxicity, N/V/D
  • Hem: decreased H/H, leukopenia, anemia
  • Misc: Hypersensitivity reactions (including anaphylaxis and angioedema)
62
Q

caspofungin drug interactions?

A

Blood levels and effectiveness may be decreased by rifampin

63
Q

Describe nursing considerations and specific client education for caspofungin.

A

KEY: monitor for anaphylaxis

  • Assess for skin rash frequently during therapy; DC at first sign of rash
  • Monitor client for cues of anaphylaxis during therapy. If any cues of anaphylaxis STOP THE INFUSION IMMEDIATELY
  • Monitor liver enzymes
64
Q

Describe the drug profile of terbinafine.

A
  • Classified as an allylamine antifungal; only drug in its class​
  • Available in topical cream, gel, and spray for treating superficial dermatologic infections (athlete’s foot, jockitch, ringworm)​
  • PO form is also available for the systemic use and is used primarily to treat onychomycoses of the fingernail and toenail
65
Q

terbinafine indication?

A

onychomycoses (fungal nail infection)

66
Q

terbinafine drug interactions?

A
  • ETOH and other hepatoxic agents (may increase risk of hepatoxicity)
  • Rifampin- may decrease effectiveness
  • Fluconazole- may increase levels of terbinafine
67
Q

terbinafine contraindication?

A

Hypersensitivity, chronic or active liver disease, HF or left ventricular dysfunction

68
Q

Describe the drug profile of metronidazole.

A
  • An antiprozoal drug that also has fairly broad abx activity as well
  • Contraindicated in the first trimester of pregnancy​
  • May cause metallic taste in mouth
  • Advise client to not drink ETOH- disulfiram type reaction (copious vomiting among other things)
  • Available in PO, parenteral, and topical forms
69
Q

terbinafine adverse affects?

A
  • CV: Worsens HF in clients w/ HF
  • CNS: headache, dizziness
  • Derm: rash, pruritis
  • GI: hepatotoxicity, drug-induced hepatitis, N/V/D, anorexia, abd pain
  • Hem: neutropenia, pancytopenia (if given longer than 6 weeks)
70
Q

Describe nursing considerations and specific client education for terbinafine.

A
  • Monitor CBC; medication should be DC’d if values are abnormal
  • Monitor liver enzymes; medication should be DC’d if values are abnormal
  • Instruct patient to notify HCP for cues of liver dysfunction
  • May cause disturbance to taste and smell; blurred vision
71
Q

metronidazole indications?

A
  • Antibiotics:
    ~ Clostridium difficile (not commonly used anymore)​
    ~ H.pylori​
    ~ Anaerobic bacteria​
    ~ Used in surgeries for GI/GU (abdominal, colorectal, vaginal)​
  • Antiprotozoal:
    ~ Trichomoniasis​
    ~ Giardiasis
72
Q

metronidazole contraindications?

A
  • hypersensitivity; 1st trimester of pregnancy
  • Use cautiously in client’s w/ blood dyscrasia, severe hepatic impairment, if client is breast feeding
73
Q

metronidazole adverse effects?

A
  • EENT: blurred vision, sore throat, dry mouth, metallic taste, glossitis​
  • GI: anorexia, vomiting, diarrhea, constipation​
  • GU: can cause the urine to darken, dysuria, cystitis,​
  • Hem: leukopenia
  • Derm: rash, pruritis, urticaria
  • Misc: super infection (it is also an abx!)
74
Q

metronidazole drug interactions?

A
  • Rifampin- may decrease levels & effectives of metronidazole
  • Disulfiram-like reaction may occur with ETOH ingestion
  • Action of warfarin may be increased (risk for bleeding)
75
Q

Describe nursing considerations and specific client education for metronidazole.

A
  • Assess for infection
  • Obtain specimens for culture and sensitivity BEFORE initiating therapy. First dose may be given before receiving results
  • PO- administer on an empty stomach (or can be given w/ food or milk to minimize GI upset)
  • Instruct clients to not skip or double up on doses
76
Q

Describe the drug profile of hydroxychloroquine.

A
  • PO only
  • COVID-19​ use:
    ~ Cardiac issues; clients reporting heart palpitations​[revoked]
77
Q

hydroxychloroquine indication?

A

prophylaxis of malaria and tx of uncomplicated malaria

78
Q

hydroxychloroquine contraindications?

A
  • Hypersensitivity to hydroxychloroquine or chloroquine; previous visual damage from hydroxychloroquine or chloroquine, and psoriasis
  • Use cautiously in concurrent use of hepatoxic drugs, hepatic impairment or alcoholism
79
Q

hydroxychloroquine adverse effects?

A
  • GI: N/V/D
  • CNS: dizziness, headache, seizure, personality changes
  • Derm: rash, pruritis
  • Misc: alopecia
80
Q

hydroxychloroquine drug interactions?

A
  • Concurrent use of other QT prolongation drugs
  • May increase the risk of hepatoxicity when administered w/ hepatoxic drugs
  • Antacids my bind to and decrease the absorption of hydroxychloroquine
81
Q

Describe nursing considerations and specific client education for hydroxychloroquine.

A

KEY: minimize mosquitos / monitor QT prolongation
- For malaria prophylaxis, medication should be started 2 weeks prior to potential exposure and continued for 4-6 weeks after leaving the area
- Educate client on minimizing exposure to mosquitos
- Monitor ECG/EKG for cardiomyopathy and QT prolongation
- Monitor liver enzymes

320 Pharmacology (36 decks)

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