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NURS 3303 > Antimicrobials Part 2 > Flashcards

Antimicrobials Part 2 Flashcards

1
Q

acyclovir (Zovirax) MOA

A

inhibits viral replication by suppressing synthesis of viral DNA

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2
Q

acyclovir (Zovirax) indications

A
  • topical for HSV
  • PO for HSV and VZV
  • IV for immunocompromised pts
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3
Q

acyclovir (Zovirax) AEs

A
  • generally well-tolerated
  • phlebitis with IV therapy
  • nephrotoxicity
  • neurotoxicity
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4
Q

acyclovir (Zovirax) nursing considerations

A
  • viral resistance to therapy
  • monitor renal function and fluid status
  • monitor neuro status
  • only decreases s/s in genitals: avoid sexual contact when lesions present and use protection
  • use finger cot/rubber glove with topical
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5
Q

ganciclovir (Cytovene) MOA

A

inhibits viral replication by suppressing synthesis of viral DNA

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6
Q

ganciclovir (Cytovene) indications

A

prevention and treatment of CMV infection in immunocompromised pts

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7
Q

ganciclovir (Cytovene) AEs

A
  • granulocytopenia
  • thrombocytopenia
  • teratogenic
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8
Q

ganciclovir (Cytovene) nursing considerations

A
  • monitor CBC for changes in WBC and PLT
  • coadmin with CSF
  • admin PO with food
  • education on contraception
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9
Q

Interferon Alfa MOA

A
  • blocks viral entry into cells
  • blocks synthesis of viral messenger RNA and viral proteins
  • blocks viral assembly and release
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10
Q

Interferon Alfa indications

A

HCV and HBV

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11
Q

Interferon Alfa administration

A
  • conventional therapy: SQ/IM 3x/week
  • long term therapy: SQ 1/week
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12
Q

Interferon Alfa AEs

A
  • most common = flu-like symptoms
  • neuropsychiatric
  • bone marrow suppression with long term
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13
Q

Interferon Alfa nursing considerations

A
  • acetaminophen PRN for flu-like s/s
  • monitor mental status
  • monitor CBC
  • monitor hepatitis s/s and liver enzymes
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14
Q

ribavirin (Rebetol) MOA

A

unclear; but increases pt response to interferon alfa

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15
Q

ribavirin (Rebetol) indications

A

combination therapy with interferon alfa

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16
Q

ribavirin (Rebetol) AEs

A
  • interferon alfa s/s
  • hemolytic anemia
  • fetal injury
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17
Q

ribavirin (Rebetol) nursing considerations

A
  • monitor mental status
  • monitor CBC
  • monitor hepatitis s/s and liver enzymes
  • extended use of contraception due to prolonged half-life
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18
Q

glecaprevir/pibrentasvir (Mavyret) MOA

A

inhibit viral protease, the enzyme needed for HCV replication, as well as NS5A, which is needed to RNA replication and virion assembly

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19
Q

glecaprevir/pibrentasvir (Mavyret) indications

A

combination treatment for HCV genotypes 1-6 with or without cirrhosis

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20
Q

glecaprevir/pibrentasvir (Mavyret) AEs

A
  • most common = GI upset, HA
  • possible reactivation of HBV, causing further hepatic injury/failure
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21
Q

glecaprevir/pibrentasvir (Mavyret) nursing considerations

A
  • monitor hepatitis s/s and liver enzymes
  • all pts must be tested for both HBV and HCV prior to initiation of treatment
  • promoted medication adherence due to a longer medication regimen for 8 weeks or greater
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22
Q

oseltamivir (Tamiflu) MOA

A

inhibits neuraminidase to prevent viral replication and prevents newly formed viral particles from spreading to other cells

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23
Q

oseltamivir (Tamiflu) AEs

A
  • generally well-tolerated
  • most common = N/V
  • hypersensitivity and neuropsychiatric s/s are rare
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24
Q

oseltamivir (Tamiflu) nursing considerations

A
  • rapid flu testing possibly before confirming diagnosis
  • carefully assess for vaccination hx and s/s onset
  • educate pts to monitor allergic rxn s/s especially w/ integumentary system
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25
Q

abacavir (Ziagen) MOA

A

NRTI that inhibit HIV replication by suppressing synthesis of DNA by acting as substrates for reverse transcriptase

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26
Q

abacavir (Ziagen) indications

A

HIV

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27
Q

abacavir (Ziagen) AEs

A
  • lactic acidosis and hepatic stenosis r/t mitochondrial toxicity
  • possible evidence for increased risk for MI
  • hypersensitivity
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28
Q

abacavir (Ziagen) nursing considerations

A
  • genetic testing for HLA-B*5701
  • monitor cardiac and LA s/s
  • use of safe practices to prevent transmission
  • other first-line NRTI include lamivudine, tenofovir, and entricitabine
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29
Q

efavirenz (Sustiva) MOA

A

NNRTI that inhibit HIV replication by suppressing synthesis of DNA through binding to active center of reverse transcriptase enzyme

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30
Q

efavirenz (Sustiva) indications

A

HIV

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31
Q

efavirenz (Sustiva) AEs

A
  • CNS symptoms common
  • rash
  • teratogenicity
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32
Q

efavirenz (Sustiva) nursing considerations

A
  • numerous drug interactions, including those for HIV
  • taking med at hs on empty stomach can reduce CNS symptoms
  • educate on CNS symptoms and rash
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33
Q

lopinavir/ritonavir (Kaletra) MOA

A
  • lopinavir inhibits protease, an enzyme needed for HIV virion maturation, leaving the virus immature and noninfectious
  • ritonavir helps boots lopinarvir’s effects
34
Q

lopinavir/ritonavir (Kaletra) indications

A

HIV

35
Q

lopinavir/ritonavir (Kaletra) AEs

A
  • most common is diarrhea
  • hyperglycemia and new-onset diabetes
  • lipodystrophy and hyperlipidemia
  • prolonged PR and QT interval
36
Q

lopinavir/ritonavir (Kaletra) nursing considerations

A
  • monitor heart rhythm on telemetry
  • virus less resistant to the drug combination
  • stable at room temp for short-term; put in refrigerator for long-term
  • educate pts on glucose and lipid control
37
Q

raltegravir (Isentress) MOA

A

inhibit integrase, an enzyme needed for HIV replication, by preventing insertion into host DNA

38
Q

raltegravir (Isentress) indications

A

HIV

39
Q

raltegravir (Isentress) AEs

A
  • generally well-tolerated
  • elevated liver enzymes
  • skin hypersensitivity rxns are rare
  • viral medication resistance is more common
40
Q

raltegravir (Isentress) nursing considerations

A
  • assess for hepatic injury
  • instruct pt to report skin manifestations and stop meds immediately
  • other first-line INSTI is dolutegravir
41
Q

enfuvirtide (Fuzeon) MOA

A

blocks HIV entry into CD4 T cells by preventing fusion of the HIV lipid bilayer through binding of medication to glycoprotein in the HIV envelope

42
Q

enfuvirtide (Fuzeon) indications

A

HIV

43
Q

enfuvirtide (Fuzeon) AEs

A
  • SQ injection site rxns
  • pneumonia s/s
  • hypersensitvity rxns
44
Q

maraviroc (Selzentry) MOA

A

CCR5 antagonist that blocks HIV entry into CD4 T cells by binding with CCR5 a co-receptor needed for entry

45
Q

maraviroc (Selzentry) AEs

A
  • hepatic injury
  • possible increased risk for CV events, including MI
46
Q

maraviroc (Selzentry) nursing considerations

A
  • educate and assess for liver injury
  • assess CV status
  • CCR5 tropism assay is performed first to determine if use is appropriate
47
Q

cabotegravir/rilpilvirine (Cabenuva) MOA

A

inhibits HIV intergrase by binding to the integrase active site and blocking the strand transfer step of retroviral DNA integration that is essential for the HIV replication cycle

48
Q

cabotegravir/rilpilvirine (Cabenuva) indications

A

complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 yrs of age and older

49
Q

cabotegravir/rilpilvirine (Cabenuva) AEs

A
  • hypersensitivity rxns
  • post injection rxns
  • hepatotoxicity
  • depressive disorders
50
Q

cabotegravir/rilpilvirine (Cabenuva) nursing considerations

A
  • administer each injection at separate gluteal injection sites
  • a complete dose requires 2 injections
  • allow 15 minutes for the medicine to become room temp
  • may remain in syringe for 2 hrs
  • pt education on adverse rxns and s/s
51
Q

BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) MOA

A

after delivery of lipid nanoparticle, RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity

52
Q

BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) AEs

A
  • injection site soreness
  • fever, chills, fatigue, HA, lymphadenopathy with 24-48 hrs
  • anaphylaxis, very rarely; milder allergic rxns
53
Q

BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) nursing considerations

A
  • pt education, including duration of protection and time between doses
  • careful preparation to maximize doses per vial and appropriate amount of diluent depending on pt population and formulation
  • once reconstituted, must be within 6 hrs for purple cap and 12 hrs for gray cap
  • IM injection soreness can be treated with OTC analgesics
  • monitor pt for 15 min post-admin
54
Q

mRNA-1273 (Moderna COVID-19 vaccine) MOA

A

after delivery of lipid nanoparticle, RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity

55
Q

mRNA-1273 (Moderna COVID-19 vaccine) AEs

A
  • injection site soreness
  • fever, chills, fatigue, HA, myalgia, arthralgia
  • anaphylaxis, very rarely; milder allergic rxns also reported
56
Q

mRNA-1273 (Moderna COVID-19 vaccine) nursing considerations

A
  • pt education, including duration of protection and time between doses
  • care prep of maximize doses per vial
  • follow storage instructions after opening
  • IM injection soreness can be treated with OTC analgesics
  • monitor pts for 15 min post-admin
57
Q

Ad26.COV2.S (Janssen/J&J COVID-19 Vaccine) MOA

A

recombinant, replication-incompetent adenovirus vector that expresses SARS-CoV-2 spike antigen without virus propagation to elicit immune response

58
Q

Ad26.COV2.S (Janssen/J&J COVID-19 Vaccine) AEs

A
  • hypersensitivity rxns, including anaphylaxis
  • injection site pain and swelling
  • systemic rxns, including fatigure, fever, myalgia, and nausea
  • thrombosis and thrombocytopenia
  • GBS
59
Q

Ad26.COV2.S (Janssen/J&J COVID-19 Vaccine) nursing considerations

A
  • CDC Advisory Committee on Immunization Practices has made preferential recommendation for mRNA over adenovirus vector vaccines
  • pt education, including duration of protection and time between doses
  • careful pre to maximize doses per vial
  • follow storage instructions after opening
  • IM injection site soreness can be treated with OTC analgesics
  • monitor pts for 15 min post-admin
60
Q

nirmatrelvir & ritonavir (Paxlovid) MOA

A

nirmatrelvir acts as protease inhibitor, with ritonavir increasing nirmatrelvir plasma concentrations via metabolism inhibition

61
Q

niramtrelvir & ritonavir (Paxlovid) AEs

A
  • HTN
  • diarrhea, impaired or altered sense of taste
  • myalgia
  • rebound COVID-19 infection
62
Q

niramtrelvir & ritonavir (Paxlovid) nursing considerations

A
  • pt education on medication regimen (twice daily x 5 days) and adherence
  • numerous drug interactions; thoroughly assess medication usage during pt interview
  • risk of HIV resistance if pt has an uncontrolled or undiagnosed infection
63
Q

molnupiravir (Lageviro) MOA

A

once metabolized and phosphorylated, it is incorporated into viral genome errors and replication inhibition

64
Q

molnupiravir (Lageviro) AEs

A
  • erythema, rash, uticaria
  • hypersensitivity, including anaphylaxis and angioedema
65
Q

molnupiravir (Lageviro) nursing considerations

A
  • alternative outpatient option for those who canno take Paxlovid
  • pt education on medication regimen (twice daily x 5 days) and adherence
  • not commercially available; current use if under EUA from AmerisourceBergen
  • capsules can be administered with or without food; do not crush, open, or break
66
Q

remdesevir (Veklury) MOA

A

inhibits RNA polymerase, which is necessary for viral replication, by acting as ATP analog which results in delayed chain terminations during replication

67
Q

remdesevir (Veklury) indication

A

COVID-19 infection requiring hospitalization and supplemental oxygen in adult and pediatric pts

68
Q

remdesevir (Veklury) AEs

A
  • potentially severe bradycardia
  • elevated ALT and AST levels
  • hypersensitivity rxns resulting in anaphylaxis, angioedema, rash, etc.
  • prolonged prothrombin time
69
Q

remdesevir (Veklury) nursing considerations

A
  • monitor CMP and RUQ s/s
  • although unlikely, monitor renal function for impairment for the duration of therapy
  • d/c infusion and provide appropriate interventions if hypersensitivity rxns occur
70
Q

dexamethasone (Decadron) MOA

A

decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability

71
Q

dexamethasone (Decadron) indications

A

off-label use in COVID-19 infection requiring hospitalization, O2 supplementation, MV/ECMO for up to 10 days as monotherapy or with other agents

72
Q

dexamethasone (Decadron) AEs

A
  • adrenal suppression
  • apathy/depression
  • Cushingoid features
  • GI effects
  • hyperglycemia
  • infection
73
Q

dexamethasone (Decadron) nursing considerations

A
  • typical regimen is 6mg daily x 10 days
  • alternative glucocorticoid equivalent may be used if not available
  • monitor labs and pt response closely
  • pt may require home glycemic control after d/c
74
Q

JYNNEOS (Monkeypox and Smallpox vaccine) MOA

A

attenuated, live, non-replicating smallpox and monkeypox vaccine that elicits humoral and cellular immune response to orthopoxviruses

75
Q

JYNNEOS (Monkeypox and Smallpox vaccine) indications

A

for prevention of smallpox and monkeypox disease in adults 18 years of age and older determined to be at high risk for small pox or monkeypox infection

76
Q

JYNNEOS (Monkeypox and Smallpox vaccine) AEs

A
  • allergic rxn: hives, swelling of face and throat, difficulty breathing
  • vaccine rxn: redness, soreness, swelling, itching at injection site
  • fatigue, HA, muscle pain
77
Q

JYNNEOS (Monkeypox and Smallpox vaccine) nursing considerations

A
  • pt education on duration of protection and time between doses
  • allow vaccine to thaw and reach room temp before use
  • swirl vial gently before use for at least 30 seconds
  • monitor pts for 15 min post-admin
78
Q

maraviroc (Selzentry) indications

A

HIV

79
Q

cabotegravir/rilpilvirine (Cabenuva) indications

A

complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 yrs of age and older

80
Q

cabotegravir/rilpilvirine (Cabenuva) indications

A

complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 yrs of age and older

NURS 3303 (10 decks)

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