Antifungal/viral/parasitic

Question 1

Polyenes

Answer 1

• Anti-fungal
• 4-12 weeks of treatment
• Systemic: amphotericin B, IV, only for severe infection
• Local: Nystatin; swish & swallow, topical, intravaginal
• Contraindication: lactation
• Educate on the importance of adherence to the treatment regimen
• Side effects: flushing, fever, chills, headache, phlebitis
• Should premedicate -> prevent febrile reactions (antipyretics), anaphylaxis (glucocorticoids) & shock
• Adverse effects: neurotoxicity, hepatotoxicity, nephrotoxicity, leukopenia, thrombocytopenia

Question 2

Azoles

Answer 2

• Anti-fungal
• IV,PO,intravaginal
• Systemic: fluconazole, ketoconazole
• Local: miconazole, clotriamazole
• Contraindication: lactation
• Educate on the importance of adherence to the treatment regimen
• Side effects: flushing, fever, chills, headache, phlebitis
• Should premedicate -> prevent febrile reactions (antipyretics), anaphylaxis (glucocorticoids) & shock
• Adverse effects: neurotoxicity, hepatotoxicity, nephrotoxicity, leukopenia, thrombocytopenia

Question 3

Amantadine

Answer 3

• Amantadine, rimantadine
• Antiviral
• Flu A specific, but mostly used for Parkinson’s**
• Side effect: nausea

Question 4

Oseltamivir & Zanamivir

Answer 4

• PO
• Flu A & B
• Flu A prophylactic; need to start within 48 hours of exposure
• Side effects: GI symptoms, self injury, delirium, renal failure

Question 5

Acyclovir & Valacyclovir

Answer 5

• For herpes
• MOA: Interrupts viral DNA synthesis (does not affect latent virus)
• PO,IV,topical
• Side effects: malaise, N/V/D, phlebitis, gingival hyperplasia, neuropathy, hepatotoxicity, CNS changes

Question 6

Lamivudine

Answer 6

• Indication: Hep B
• Side effects: neutropenia, myalgia, neuropathy
• Monitor liver function
• Discontinuing may cause return of acute hepatitis

Question 7

Sofosbuvir

Answer 7

• Indication: Hep C

Question 8

Remdesivir

Answer 8

• Nucleotide analog with broad spectrum antiviral activity
• Only used under EUA by FDA
• Indication: treatment of COVID-19 in hospitalized pts

Question 9

Hydroxychloroquine Sulfate

Answer 9

• Antimalarial

- Off label use: RA & lupus

Question 10

Mebendazole & Ivermectin

Answer 10

• Antihelminths
• Ivermectin also used for Arthropods (lice, mites)
• Side effects: GI upset, dizziness, drowsiness, weakness
• Nursing interventions: warn against driving because of dizziness & drowsiness, wash hands, shower, change bedding, towels, sleep along during treatment period
• All members of family are treated