antimicrobials pt 2 Flashcards
Acyclovir (Zovirax) MOA
inihibits viral replication by suppressing synthesis of viral DNA
Acyclovir (Zovirax) indications
Topical for HSV
PO for HSV and VZV
IV for immunocompromised patients
Acyclovir (Zovirax) adverse effects
Generally well tolerated
Phlebitis with IV therapy
Nephrotoxicity- BUN, CREAT
Neurotoxicity- LOC
Acyclovir (Zovirax) nursing considersation
Viral resistance to therapy
Monitor renal function & 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) adverse effects
granulocytopenia
thrombocytopenia
teratogenic
Ganciclovir (Cytovene) nursing considerations
watch CBC for changes in WBC and PLT
coadmin with CSF, admin with food
education on contraception
Interferon Alfa MOA
blocks viral entry into cell
blocks synthesis of viral messenger RNA
blocks viral assembly and release
Interferon Alfa indications
HCV and HBV
Interferon Alfa adverse effects
flu like symptoms
neuropsychiatric - depression
bone marrow suppression
Interferon Alfa nursing considerations
acetaminophen PRN for flu-like s/s
monitor mental status
monitor CBC
monitor hepatits s/s and liver enzymes
Ribavirin (Rebetol) MOA
unclear but increases patient response to interferon alfa
Ribavirin (Rebetol) indications
hepatitis
Ribavirin (Rebetol) adverse effects
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 and NS5A
Glecaprevir/Pibrentasvir (Mavyret) indications
combination treatment for HCV genotypes 1-6 with or without cirrhosis
Glecaprevir/Pibrentasvir (Mavyret) adverse effects
nausea, fatigue, and headache
possible reactivation of HBV causing more liver injury
Glecaprevir/Pibrentasvir (Mavyret) nursing considerations
monitor hepatitis s/s and liver enzymes
pt must be tested for HBV and HCV before treatment
promote medication adherence since its a long regimen
oseltamivir (Tamiflu) MOA
prevents viral replication and prevents new viral particles from spreading to other cells
oseltamivir (Tamiflu) indications
flu
oseltamivir (Tamiflu) adverse effects
well tolerated
most common is n/v
hypersensitivity and neuropsychiatri s/s are rare
oseltamivir (Tamiflu) nursing considerations
rapid flu test (if theyve had flu for a couple days it wont work)
carefully assess for vaccination hx and onset of s/s
educate pt to monitor allergic rx
Abacavir (Ziagen) MOA
inhibit HIV replication by suppressing DNA synthesis
Abacavir (Ziagen) indications
HIV
Abacavir (Ziagen) adverse effects
Lactic acidosis & hepatic steatosis 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, & emtricitabine
Efavirenz (Sustiva) MOA
inhibit HIV replication by suppressing synthesis of DNA
Efavirenz (Sustiva) indications
HIV
Efavirenz (Sustiva) adverse effects
CNS symptoms are common
Rash
Teratogenicity
Efavirenz (Sustiva) nursing consideration
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
inhibition of protease leaving the virus immature and noninfectious
Lopinavir/Ritonavir (Kaletra) indications
HIV
Lopinavir/Ritonavir (Kaletra) adverse effects
Most common is diarrhea
Hyperglycemia and new-onset diabetes
Lipodystrophy (redistribution of fat) 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 temperature for short-term; put in the refrigerator for long-term
Educate patients on glucose & lipid control
Raltegravir (Isentress) MOA
inhibit integrase
Raltegravir (Isentress) indication
HIV
Raltegravir (Isentress) adverse effects
Generally well tolerated
Elevated liver enzymes
Skin hypersensitivity reactions rare
Viral medication resistance is more common
Raltegravir (Isentress) nursing considerations
Assess for hepatic injury and trend LFT
Instruct patients to report skin manifestations and stop meds immediately
Other first-line INSTI is dolutegravir
Enfuvirtide (Fuzeon) MOA
Enfuvirtide (Fuzeon) indications
Blocks HIV entry into CD4 T cells
Enfuvirtide (Fuzeon) adverse effects
SQ injection site reactions
Pneumonia s/s
Hypersensitivity reactions
Enfuvirtide (Fuzeon) nursing considerations
Medication administration technique
Monitor respiratory and integumentary systems
Maraviroc (Selzentry) MOA
blocks HIV entry into CD4 T cells
Maraviroc (Selzentry) indications
infections resistant to other initial treatments
Maraviroc (Selzentry) adverse effects
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 integrase
Cabotegravir/Rilpilvirine (Cabenuva) indication
indicated as a complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 years of age and older
Cabotegravir/Rilpilvirine (Cabenuva) adverse effects
Hypersensitivity reactions
Post injection reactions
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 temperature.
May remain in a syringe for 2 hours.
Patient education on adverse reactions and signs and symptoms
Pfizer vaccine MOA
RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity
Pfizer vaccine indication
covid 19
Pfizer vaccine adverse effects
Injection site soreness
Fever, chills, fatigue, headache, & lymphadenopathy within 24-48 hours
Anaphylaxis, very rarely; milder allergic reactions
Pfizer vaccine nursing considerations
Patient education, including duration of protection and time between doses
Careful preparation to maximize doses per vial and appropriate amount of diluent depending on patient population and formulation
Once reconstituted, must be used within 6 hours for purple cap and 12 hours for gray cap
Intramuscular injection soreness can be treated with OTC analgesics
Monitor patients for 15 minutes post-administration
Moderna vaccine MOA
RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity
Moderna vaccine indication
covid 19
Moderna vaccine adverse effects
Injection site soreness
Fever, chills, fatigue, headache, myalgia, arthralgia
Anaphylaxis, very rarely; milder allergic reactions also reported
Moderna vaccine nursing considerations
Patient education, including duration of protection and time between doses
Careful preparation to maximize doses per vial
Follow storage instructions after opening
Intramuscular injection soreness can be treated with OTC analgesics
Monitor patients for 15 minutes post-administration
J&J vaccine MOA
J&J vaccine indications
covid 19
J&J vaccine adverse effects
Hypersensitivity reactions, including anaphylaxis
Injection site pain and swelling
Systemic reactions, including fatigue, fever, myalgia, & nausea
Thrombosis with thrombocytopenia
GBS
J&J vaccine nursing considerations
CDC Advisory Committee on Immunization Practices has made preferential recommendation for mRNA over adenovirus vector vaccines
Patient education, including duration of protection and time between doses
Careful preparation to maximize doses per vial
Follow storage instructions after opening
Intramuscular injection soreness can be treated with OTC analgesics
Monitor patients for 15 minutes post-administration
Nirmatrelvir & ritonavir (Paxlovid) MOA
Nirmatrelvir & ritonavir (Paxlovid) indications
symptomatic, nonsevere COVID-19 infection with risk factors for the development of severe COVID-19 infection
Nirmatrelvir & ritonavir (Paxlovid) adverse effects
Hypertension
Diarrhea, impaired or altered sense of taste
Myalgia
Rebound COVID-19 infection
Nirmatrelvir & ritonavir (Paxlovid) nursing considerations
Patient education on medication regimen (twice daily x 5 days) and adherence
Numerous drug interactions; thoroughly assess medication usage during the patient interview
Risk of HIV resistance if a patient has an uncontrolled or undiagnosed infection
Molnupiravir (Lageviro) MOA
incorporated into viral RNA polymerase resulting in viral genome errors and replication inhibition
Molnupiravir (Lageviro) indications
symptomatic, nonsevere COVID-19 infection with risk factors for development of severe COVID-19 infection
Molnupiravir (Lageviro) adverse effects
Erythema, rash, urticaria
Hypersensitivity, including anaphylaxis, angioedema
Molnupiravir (Lageviro) nursing considerations
Alternative outpatient option for those who cannot take Paxlovid
Patient education on medication regimen (twice daily x 5 days) and adherence
Not commercially available; current use is 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 inhibits viral replication
Remdesevir (Veklury) indications
COVID-19 infection requiring hospitalization & supplemental oxygen in adult and pediatric patients
Remdesevir (Veklury) adverse effects
Potentially severe bradycardia
Elevated ALT and AST levels
Hypersensitivity reactions 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
Discontinue infusion and provide appropriate interventions if hypersensitivity reactions occur
Dexamethasone (Decadron) MOA
Decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability
Dexamethasone (Decadron) adverse effects
Adrenal suppression
Apathy/depression
Cushingoid features
GI effects
Hyperglycemia
Infection
Dexamethasone (Decadron) nursing considerations
Typical regimen is 6 mg daily x 10 days
Alternative glucocorticoid equivalent may be used if not available
Monitor labs and patient response closely
Patient may require home glycemic control after d/c
Dexamethasone (Decadron) indications
for off-label use in COVID-19 infection requiring hospitalization, O2 supplementation, MV/ECMO for up to 10 days as monotherapy or with other agents
monkeypox and smallpox vaccine MOA
attenuated, live, non-replicating smallpox and monkeypox vaccine that elicits humoral and cellular immune responses to orthopoxviruses.
monkeypox and smallpox vaccine indications
moneypox and smallpox
monkeypox and smallpox vaccine adverse effects
An allergic reaction can occur after injection (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness)
monkeypox and smallpox vaccine nursing consideration
Patient education, including duration of protection and time between doses
Allow the vaccine to thaw and reach room temperature before use.
Swirl the vial gently before use for at least 30 seconds
Monitor patients for 15 minutes post-administration
