Antimalarial, Antiprotozoal, and Antihelmintic Drugs Flashcards
Chloroquine
Chemical Classification
Synthetic 4-amino-quinoline derivative
Chloroquine
Functional Classification
Antimalarial
Chloroquine
Mechanism of Action
Inhibits parasite replication, transcription of DNA to RNA by forming complexes with DNA of parasite
Chloroquine
Uses
Malaria of Plasmodium vivax, P. malariae, P. ovale, P. falciparum (some strains) amebiasis
Chloroquine
Contraindications
Hypersensitivity, retinal field changes
Chloroquine
Side Effects
CNS: headache, stimulation, fatigue, SEIZURES, psychosis, hallucinations, insomnia
CV: hypotension, HEART BLOCK, ASYSTOLE WITH SYNCOPE, ECG changes, cardiomyopathy
EENT: Blurred Vision, Corneal Changes, Retinal Changes, Difficulty Focusing, tinnitus, vertigo, deafness, photophobia, corneal edema
GI: Nausea, Vomiting, Anorexia, diarrhea, cramps
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, HEMOLYTIC ANEMIA, LEUKOPENIA
INTEG: pruritus, pigmentary changes, skin eruptions, lichen-planus-like eruptions, eczema, EXFOLIATIVE DERMATITIS
Chloroquine
Nursing Considerations
ASSESS:
- INFECTION: resistance is common, not to be used for P. falciparum acquired in areas of resistance or where prophylaxis has failed
- Ophthalmic test if long-term treatment or dosage of >150mg/day
- Blood studies: CBC, since blood dyscrasias occur
- ECG during therapy; watch for depression of T waves, widening of QRS complex
- ALLERGIC REACTIONS: pruritus, rash, urticaria
- BLOOD DYSCRASIAS: malaise, fever, bruising, bleeding (rare)
- FOR OTOTOXICITY (tinnitus, vertigo, change in hearing); audiometric testing should be done before, after treatment
- FOR TOXICITY: blurred vision; difficulty focusing; headache; dizziness; decreased knee, ankle reflexes; seizures, CV collapse; product should be discontinued immediately and IV fluids given
Chloroquine
Overdose Treatment
Administer barbiturate (ultrashort-acting), vasopressor; tracheostomy may be necessary
Hydroxychloroquine (Plaquenil)
Functional Classification
Antimalarial, antirheumatic (DMARDS)
Hydroxychloroquine (Plaquenil)
Chemical Classification
4-Aminoquinoline derivative
Hydroxychloroquine (Plaquenil)
Mechanism of Action
Impairs, complement-dependent antigen-antibody reactions
Hydroxychloroquine (Plaquenil)
Uses
Malaria caused by susceptible strains of Plasmodium vivax, P. malariae, P. ovale, P. falciparum (some strains); SLE, rheumatoid arthritis
Hydroxychoroquine (Plaquenil)
Contraindications
Hypersensitivity to the product or chloroquine; retinal field damage
Hydroxychloroquine (Plaquenil)
Side Effects
CNS: headache, stimulation, fatigue, irritability, SEIZURES, bad dreams, dizziness, confusion, psychosis, decreased reflexes
CV: hypotension, heart block, ASYSTOLE WITH SYNCOPE
EENT: Blurred Vision, Corneal Changes, Retinal Changes, Difficulty Focusing, tinnitus, vertigo, deafness, photophobia, corneal edema
GI: Nausea, Vomiting, Anorexia, diarrhea, cramps
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, APLASTIC ANEMIA
INTEG: pruritus, pigmentation changes, skin eruptions, lichen-planus -like eruptions, eczema, EXFOLIATIVE DERMATITIS, alopecia, STEVENS-JOHNSON SYNDROME, photosensitivity
Hydroxychloroquine (Plaquenil)
Nursing Considerations
ASSESS:
- SLE, MALARIA SYMPTOMS: before treatment and daily
- RHEUMATOID ARTHRITIS: pain, swelling, ROM, temp of joints
- Ophthalmic exam at baseline and q6mo if long-term treatment or product dosage >150mg/day
- Hepatic studies q wk: AST, ALT, bilirubin if patient receiving long-term treatment
- BLOOD DYSCRASIAS: blood studies: CBC, platelets; WBC, RBC, platelets may be decreased; if severe product should be discontinued; assess for malaise, fever, bruising, bleeding (rare)
- For decreased reflexes: knee, ankle
- ECG during therapy: watch for depression of T waves, widening QRS complex
- ALLERGIC REACTIONS: pruritus, rash, urticaria
- FOR OTOTOXICITY (tinnitus, vertigo, change in hearing); audiometric testing should be done before, after treatment
- FOR TOXICITY: blurred vision, difficulty focusing, headache, dizziness, knee, ankle reflexes; product should be discontinued immediately
Hydroxychloroquine (Plaquenil)
Overdose Treatment
Induce vomiting; gastric lavage; administer barbiturate (ultrashort acting), vasopressor, ammonium chloride; tracheostomy may be necessary
Metronidazole (Flagyl)
Functional Classification
Antiinfective-miscellaneous
Metronidazole (Flagyl)
Chemical Classification
Nitroimidazole derivative
Metronidazole (Flagyl)
Mechanism of Action
Direct-acting amebicide/trichomonacide binds and disrupts DNA structure, thereby inhibiting bacterial nucleic acid synthesis
Metronidazole (Flagyl)
Uses
Intestinal amebiasis, amebic abscess, trichomoniasis, refractory trichomoniasis, bacterial anaerobic infections, giardiasis, septicemia, endocarditis; bone joint, lower respiratory tract infections; rosacea
Metronidazole (Flagyl)
Contraindications
Pregnancy 1st trimester, breastfeeding, hypersensitivity to this product
Metronidazole (Flagyl)
Side Effect
CNS: Headache, Dizziness, confusion, irritability, restlessness, ataxia, depression, fatigue, drowsiness, insomnia, paresthesia, peripheral neuropathy, SEIZURES, incoordination, depression, encephalopathy, ASEPTIC MENINGITIS
CV: flattening of T waves
EENT: blurred vision, sore throat, retinal edema, dry mouth, metallic taste, furry tongue, glossitis, stomatitis, photophobia, optic neuritis
GI: Nausea, Vomiting, Diarrhea, epigastric distress, Anorexia, constipation, Abdominal Cramps, PSEUODMEMBRANOUS COLITIS
GU: darkened urine, vaginal dryness, polyuria, ALBUMINURIA, dysuria, cystitis, decreased libido, NEPHROTOXICITY, incontinence, dyspareunia, candidiasis
HEMA: LEUKOPENIA, BONE MARROW, DEPRESSION, APLASIA, THROMBOCYTOPENIA
INTEG: rash, pruritus, urticaria, flushing, STEVENS-JOHNSON SYNDROME
Metronidazole (Flagyl)
Nursing Considerations
ASSESS:
- INFECTION: WBC, wound symptoms, fever, skin or vaginal secretions; start treatment after C&S; for opportunistic fungal infections; superinfection: fever, monilial growth, fatigue, malaise
- Stools during entire treatment: should be clear at end of therapy; stools should be free of parasites for 1yr before patient considered cured (amebiasis)
- Vision by ophthalmic exam during, after therapy; vision problems often occur
- NEUROTOXICITY: peripheral neuropathy, seizures, dizziness, uncoordination, pruritus, joint pain; product may be discontinued
- ALLERGIC REACTION: fever, rash, itching, chills; product should be discontinued if these occur
- Renal, reproductive dysfunction: dysuria, polyuria, impotence, dyspareunia, decreased libido, I&O; weight daily
- SECONDARY MALIGNANCY: used only when indicated; avoid unnecessary use
Primaquine
Functional Classification
antimalarial
Primaquine
Chemical Classification
Synthetic 8-aminoquinolone
Primaquine
Mechanism of Action
Unknown; thought to destroy exoerythrocytic forms by gametocidal action
Primaquine
Uses
Malaria caused by Plasmodium vivax; in combination with clindamycin for Pneumocystis jiroveci pneumonia
Primaquine
Contraindications
Lupus erthematosus, rheumatoid arthritis; hypersensitivity to this product or idoquinol
Primaquine
Side Effects
CNS: headache, dizziness
CV: hypertension, dysrhythmias
EENT: Blurred Vision, Difficulty Focusing
GI: Nausea, Vomiting, Anorexia, cramps
HEMA: AGRANULOCYTOSIS, GRANULOCYTOPENIA, LEUKOPENIA, HEMOLYTIC ANEMIA, LEUKOCYTOSIS, mild anemia, METHEMOGLOBINEMIA
INTEG: pruritus, skin eruptions, pallor, weakness
Primaquine
Nursing Considerations
ASSESS:
- Ophthalmic test if patient receiving long-term treatment or product dosage of >/= 150mg/day
- Hepatic studies weekly: AST, ALT, bilirubin if patient receiving long-term therapy
- Blood studies: CBC; blood dyscrasias occur
- Allergic reactions: pruritus, rash, urticaria
- Blood dyscrasias: malaise, fever, bruising, bleeding (rare)
- Renal status: dark urine, hematuria, decreased output
- HEMOLYTIC REACTION: chills, fever, chest pain, cyanosis; product should be discontinued immediately
