Antimicrobials Part 2 Flashcards
acyclovir (Zovirax) MOA
inhibits viral replication by suppressing synthesis of viral DNA
acyclovir (Zovirax) indications
- topical for HSV
- PO for HSV and VZV
- IV for immunocompromised pts
acyclovir (Zovirax) AEs
- generally well-tolerated
- phlebitis with IV therapy
- nephrotoxicity
- neurotoxicity
acyclovir (Zovirax) nursing considerations
- 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
ganciclovir (Cytovene) MOA
inhibits viral replication by suppressing synthesis of viral DNA
ganciclovir (Cytovene) indications
prevention and treatment of CMV infection in immunocompromised pts
ganciclovir (Cytovene) AEs
- granulocytopenia
- thrombocytopenia
- teratogenic
ganciclovir (Cytovene) nursing considerations
- monitor CBC for changes in WBC and PLT
- coadmin with CSF
- admin PO with food
- education on contraception
Interferon Alfa MOA
- blocks viral entry into cells
- blocks synthesis of viral messenger RNA and viral proteins
- blocks viral assembly and release
Interferon Alfa indications
HCV and HBV
Interferon Alfa administration
- conventional therapy: SQ/IM 3x/week
- long term therapy: SQ 1/week
Interferon Alfa AEs
- most common = flu-like symptoms
- neuropsychiatric
- bone marrow suppression with long term
Interferon Alfa nursing considerations
- acetaminophen PRN for flu-like s/s
- monitor mental status
- monitor CBC
- monitor hepatitis s/s and liver enzymes
ribavirin (Rebetol) MOA
unclear; but increases pt response to interferon alfa
ribavirin (Rebetol) indications
combination therapy with interferon alfa
ribavirin (Rebetol) AEs
- interferon alfa s/s
- hemolytic anemia
- fetal injury
ribavirin (Rebetol) nursing considerations
- monitor mental status
- monitor CBC
- monitor hepatitis s/s and liver enzymes
- extended use of contraception due to prolonged half-life
glecaprevir/pibrentasvir (Mavyret) MOA
inhibit viral protease, the enzyme needed for HCV replication, as well as NS5A, which is needed to RNA replication and virion assembly
glecaprevir/pibrentasvir (Mavyret) indications
combination treatment for HCV genotypes 1-6 with or without cirrhosis
glecaprevir/pibrentasvir (Mavyret) AEs
- most common = GI upset, HA
- possible reactivation of HBV, causing further hepatic injury/failure
glecaprevir/pibrentasvir (Mavyret) nursing considerations
- 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
oseltamivir (Tamiflu) MOA
inhibits neuraminidase to prevent viral replication and prevents newly formed viral particles from spreading to other cells
oseltamivir (Tamiflu) AEs
- generally well-tolerated
- most common = N/V
- hypersensitivity and neuropsychiatric s/s are rare
oseltamivir (Tamiflu) nursing considerations
- 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
abacavir (Ziagen) MOA
NRTI that inhibit HIV replication by suppressing synthesis of DNA by acting as substrates for reverse transcriptase
abacavir (Ziagen) indications
HIV
abacavir (Ziagen) AEs
- lactic acidosis and hepatic stenosis r/t mitochondrial toxicity
- possible evidence for increased risk for MI
- hypersensitivity
abacavir (Ziagen) nursing considerations
- 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
efavirenz (Sustiva) MOA
NNRTI that inhibit HIV replication by suppressing synthesis of DNA through binding to active center of reverse transcriptase enzyme
efavirenz (Sustiva) indications
HIV
efavirenz (Sustiva) AEs
- CNS symptoms common
- rash
- teratogenicity
efavirenz (Sustiva) nursing considerations
- numerous drug interactions, including those for HIV
- taking med at hs on empty stomach can reduce CNS symptoms
- educate on CNS symptoms and rash
lopinavir/ritonavir (Kaletra) MOA
- lopinavir inhibits protease, an enzyme needed for HIV virion maturation, leaving the virus immature and noninfectious
- ritonavir helps boots lopinarvir’s effects
lopinavir/ritonavir (Kaletra) indications
HIV
lopinavir/ritonavir (Kaletra) AEs
- most common is diarrhea
- hyperglycemia and new-onset diabetes
- lipodystrophy and hyperlipidemia
- prolonged PR and QT interval
lopinavir/ritonavir (Kaletra) nursing considerations
- 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
raltegravir (Isentress) MOA
inhibit integrase, an enzyme needed for HIV replication, by preventing insertion into host DNA
raltegravir (Isentress) indications
HIV
raltegravir (Isentress) AEs
- generally well-tolerated
- elevated liver enzymes
- skin hypersensitivity rxns are rare
- viral medication resistance is more common
raltegravir (Isentress) nursing considerations
- assess for hepatic injury
- instruct pt to report skin manifestations and stop meds immediately
- other first-line INSTI is dolutegravir
enfuvirtide (Fuzeon) MOA
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
enfuvirtide (Fuzeon) indications
HIV
enfuvirtide (Fuzeon) AEs
- SQ injection site rxns
- pneumonia s/s
- hypersensitvity rxns
maraviroc (Selzentry) MOA
CCR5 antagonist that blocks HIV entry into CD4 T cells by binding with CCR5 a co-receptor needed for entry
maraviroc (Selzentry) AEs
- hepatic injury
- possible increased risk for CV events, including MI
maraviroc (Selzentry) nursing considerations
- educate and assess for liver injury
- assess CV status
- CCR5 tropism assay is performed first to determine if use is appropriate
cabotegravir/rilpilvirine (Cabenuva) MOA
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
cabotegravir/rilpilvirine (Cabenuva) indications
complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 yrs of age and older
cabotegravir/rilpilvirine (Cabenuva) AEs
- hypersensitivity rxns
- post injection rxns
- hepatotoxicity
- depressive disorders
cabotegravir/rilpilvirine (Cabenuva) nursing considerations
- 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
BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) MOA
after delivery of lipid nanoparticle, RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity
BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) AEs
- injection site soreness
- fever, chills, fatigue, HA, lymphadenopathy with 24-48 hrs
- anaphylaxis, very rarely; milder allergic rxns
BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) nursing considerations
- 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
mRNA-1273 (Moderna COVID-19 vaccine) MOA
after delivery of lipid nanoparticle, RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity
mRNA-1273 (Moderna COVID-19 vaccine) AEs
- injection site soreness
- fever, chills, fatigue, HA, myalgia, arthralgia
- anaphylaxis, very rarely; milder allergic rxns also reported
mRNA-1273 (Moderna COVID-19 vaccine) nursing considerations
- 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
Ad26.COV2.S (Janssen/J&J COVID-19 Vaccine) MOA
recombinant, replication-incompetent adenovirus vector that expresses SARS-CoV-2 spike antigen without virus propagation to elicit immune response
Ad26.COV2.S (Janssen/J&J COVID-19 Vaccine) AEs
- hypersensitivity rxns, including anaphylaxis
- injection site pain and swelling
- systemic rxns, including fatigure, fever, myalgia, and nausea
- thrombosis and thrombocytopenia
- GBS
Ad26.COV2.S (Janssen/J&J COVID-19 Vaccine) nursing considerations
- 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
nirmatrelvir & ritonavir (Paxlovid) MOA
nirmatrelvir acts as protease inhibitor, with ritonavir increasing nirmatrelvir plasma concentrations via metabolism inhibition
niramtrelvir & ritonavir (Paxlovid) AEs
- HTN
- diarrhea, impaired or altered sense of taste
- myalgia
- rebound COVID-19 infection
niramtrelvir & ritonavir (Paxlovid) nursing considerations
- 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
molnupiravir (Lageviro) MOA
once metabolized and phosphorylated, it is incorporated into viral genome errors and replication inhibition
molnupiravir (Lageviro) AEs
- erythema, rash, uticaria
- hypersensitivity, including anaphylaxis and angioedema
molnupiravir (Lageviro) nursing considerations
- 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
remdesevir (Veklury) MOA
inhibits RNA polymerase, which is necessary for viral replication, by acting as ATP analog which results in delayed chain terminations during replication
remdesevir (Veklury) indication
COVID-19 infection requiring hospitalization and supplemental oxygen in adult and pediatric pts
remdesevir (Veklury) AEs
- potentially severe bradycardia
- elevated ALT and AST levels
- hypersensitivity rxns resulting in anaphylaxis, angioedema, rash, etc.
- prolonged prothrombin time
remdesevir (Veklury) nursing considerations
- 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
dexamethasone (Decadron) MOA
decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability
dexamethasone (Decadron) indications
off-label use in COVID-19 infection requiring hospitalization, O2 supplementation, MV/ECMO for up to 10 days as monotherapy or with other agents
dexamethasone (Decadron) AEs
- adrenal suppression
- apathy/depression
- Cushingoid features
- GI effects
- hyperglycemia
- infection
dexamethasone (Decadron) nursing considerations
- 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
JYNNEOS (Monkeypox and Smallpox vaccine) MOA
attenuated, live, non-replicating smallpox and monkeypox vaccine that elicits humoral and cellular immune response to orthopoxviruses
JYNNEOS (Monkeypox and Smallpox vaccine) indications
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
JYNNEOS (Monkeypox and Smallpox vaccine) AEs
- allergic rxn: hives, swelling of face and throat, difficulty breathing
- vaccine rxn: redness, soreness, swelling, itching at injection site
- fatigue, HA, muscle pain
JYNNEOS (Monkeypox and Smallpox vaccine) nursing considerations
- 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
maraviroc (Selzentry) indications
HIV
cabotegravir/rilpilvirine (Cabenuva) indications
complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 yrs of age and older
cabotegravir/rilpilvirine (Cabenuva) indications
complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 yrs of age and older
