Anti-Infectives Flashcards
List the Antitubercular drugs.
- isoniazid (INH)
- rifampin
- ethambutol
- pyrazinamide (PZA)
Remember: IREP
Patient education that is common among antitubercular drugs?
- 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
How is isoniazid administered?
- Available in PO (most common) and IM
- Black box warning for possible hepatitis
- Give pyridoxine (vit. B6) concurrently
Isoniazid indication?
First-line therapy of active TB; in combination w/ other agents; prevention of TB in clients exposed to active disease (monotherapy)
Isoniazid contraindications?
Hypersensitivity, acute liver disease, hx of hepatitis from previous use
Adverse effects of isoniazid?
- EENT: blurred vision
- GI: drug-induced hepatitis
- Neuro: peripheral neuropathy (that’s why the need pyridoxine [vit B6])
Isoniazid drug interactions?
- 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
Describe nursing considerations and specific client education for isoniazid.
- 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.
How is rifampin administered?
Available in both PO and parenteral forms
Rifampin indication?
Active TB (w/ other drugs)
Rifampin contraindication?
- 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
Rifampin adverse effects?
- 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
Rifampin drug interactions?
- 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
Describe nursing considerations and specific client education for rifampin.
- 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
How is pyrazinamide administered?
ONLY available in generic PO form
Pyrazinamide indication?
Used in combination w/ other drugs in the tx of active TB
Contraindication of pyrazinamide?
- Hypersensitivity, cross-sensitivity with isoniazid, niacin, and severe liver impairment
- Use cautiously in clients with gout, renal failure, and diabetes mellitus
Adverse effects of pyrazinamide?
- GI: hepatoxicity
- Metabolic: hyperuricemia
- Derm: acne, pruritis, photosensitivity, rash
Pyrazindamide drug interactions?
- Concurrent use of rifampin may result in life-threatening hepatoxicity and should be avoided
- Maybe decrease effectiveness of antigout drugs
Describe nursing considerations and specific client education for pyrazinamide.
- 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
How is ethambutol administered?
PO only
Ethambutol indications?
Active TB (w/ at least one other drug)
Ethambutol contraindications?
- Hypersensitivity, optic neuritis
- Use cautiously in renal and severe hepatic impairment (dosage reduction required)
Ethambutol adverse effects?
- EENT: optic neuritis
- GI: hepatitis
- MSK: joint pain
Ethambutol drug interactions?
- Neurotoxicity may be increased with other neurotoxic drugs
- Aluminum hydroxide (antacid) may decrease absorption (space 4 hours apart)
Describe nursing considerations and specific client education for ethambutol.
- 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
What are the two types of fungi?
- Yeasts (single-celled fungi) that reproduce by budding
- Molds (multicellular; characterized by long, branching filaments)
Define mycosis.
An infection caused by a fungus
List the four general types of mycotic infections.
- Systemic (e.g.sepsis/fungemia)
- Cutaneous
- Subcutaneous
- Superficial (tinea pedis [athlete’s foot],tinea cruris [jock itch], and tinea corporis[ringworm])
List the four classes of antifungal drugs.
- Polyenes
- Imidazole
- Triazoles
- Echinocandins
Rememeber: PITE
What are two examples of POLYENES antifungal drugs?
- Amphotericin B (systemic)
- Nystatin (superficial)
What is an example an IMIDAZOLE antifungal drug?
Ketoconazole
What are three examples of TRIAZOLE antifungal drugs?
Fluconazole, Voriconazole, Posaconazole
What is an example of an ECHINOCANDINS antifungal drug?
Caspofungin
Describe the drug profile of amphotericin B?
- 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
amphotericin B indications?
Tx of progressive, potentially fatal fungal infections (such as aspergillosis)
amphotericin B contraindications?
- Hypersensitivity; potential for distribution into breast milk and toxicity in infant; DC nursing
- Use cautiously in renal impairments
amphotericin B adverse effects?
- 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
amphotericin B drug interactions?
- Concurrent use w/ zidovudine may increase the risk of nephrotoxicity
- Combined used of ‘azole’ antifungals may increase fungal resistance
Describe nursing considerations and specific client education for amphotericin B.
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
How is nystatin administered?
- Not available in a parenteral form, but does come in several oral and topical formulations
nystatin indications?
- PO suspension: local tx of oropharyngeal candidiasis
- PO tablet: Tx of non-esophageal mucus membrane GI candidiasis
nystatin contraindications?
Hypersensitivity
nystatin adverse effects?
- GI: Abd pain (in large doses), N/V/D
- Derm: Rash, urticaria (hives)
Describe nursing considerations and specific client education for nystatin.
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
Describe the drug profile of fluconazole.
- Great coverage against many fungi, less adverse effects than amphotericin B
- Available in both PO and parenteral forms
fluconazole indication?
Usually only 1 PO dose is needed for the tx of vaginalcandidiasis infections
fluconazole contraindication?
- 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
fluconazole adverse effects?
- CV: torsade de pointes, QT prolongation, dizziness
- GI: hepatotoxicity
- MISC: hypersensitivity reactions (including anaphylaxis)
flucanazole drug interactions?
- Rifampin and isoniazid: decrease blood levels of fluconazole
- May antagonize effects of amphotericin B
- May increase voriconazole levels; avoid concurrent use
Describe nursing considerations and specific client education for fluconazole.
- Obtain specimens for cx (culture) before instituting therapy; therapy may be started before results are obtained
- May cause fetal harm
Describe the drug profile of voriconazole.
- Indicated for invasive aspergillosis
- Contraindicated in patients w/ known drug allergy
- Available in PO and parenteral forms
voriconazole indication?
Invasive aspergillosis
voriconazole contraindication?
- 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
voriconazole adverse effect?
- CV: changes in BP, peripheral edema, QT prolongation, tachycardia
- EENT: visual disturbances, photophobia
- GI: hepatoxicity, N/V
voriconazole drug interactions?
- Fluconazole may increase levels of voriconazole; avoid concurrent use
- St. John’s wort may significantly decrease levels and effectiveness; concurrent use is contraindicated
Describe nursing considerations and specific client education for voriconazole.
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
Describe the drug profile of caspofungin.
- 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
caspofungin indication?
- invasive aspergillosis
- candidemia esophageal candidiasis
caspofungin contraindication?
- 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
caspofungin adverse effects?
- 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)
caspofungin drug interactions?
Blood levels and effectiveness may be decreased by rifampin
Describe nursing considerations and specific client education for caspofungin.
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
Describe the drug profile of terbinafine.
- 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
terbinafine indication?
onychomycoses (fungal nail infection)
terbinafine drug interactions?
- ETOH and other hepatoxic agents (may increase risk of hepatoxicity)
- Rifampin- may decrease effectiveness
- Fluconazole- may increase levels of terbinafine
terbinafine contraindication?
Hypersensitivity, chronic or active liver disease, HF or left ventricular dysfunction
Describe the drug profile of metronidazole.
- 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
terbinafine adverse affects?
- 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)
Describe nursing considerations and specific client education for terbinafine.
- 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
metronidazole indications?
- Antibiotics:
~ Clostridium difficile (not commonly used anymore)
~ H.pylori
~ Anaerobic bacteria
~ Used in surgeries for GI/GU (abdominal, colorectal, vaginal) - Antiprotozoal:
~ Trichomoniasis
~ Giardiasis
metronidazole contraindications?
- hypersensitivity; 1st trimester of pregnancy
- Use cautiously in client’s w/ blood dyscrasia, severe hepatic impairment, if client is breast feeding
metronidazole adverse effects?
- 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!)
metronidazole drug interactions?
- Rifampin- may decrease levels & effectives of metronidazole
- Disulfiram-like reaction may occur with ETOH ingestion
- Action of warfarin may be increased (risk for bleeding)
Describe nursing considerations and specific client education for metronidazole.
- 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
Describe the drug profile of hydroxychloroquine.
- PO only
- COVID-19 use:
~ Cardiac issues; clients reporting heart palpitations[revoked]
hydroxychloroquine indication?
prophylaxis of malaria and tx of uncomplicated malaria
hydroxychloroquine contraindications?
- 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
hydroxychloroquine adverse effects?
- GI: N/V/D
- CNS: dizziness, headache, seizure, personality changes
- Derm: rash, pruritis
- Misc: alopecia
hydroxychloroquine drug interactions?
- 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
Describe nursing considerations and specific client education for hydroxychloroquine.
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
