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Pharm > Ch 27 > Flashcards

Ch 27 Flashcards

1
Q

tuberculosis causative agent? aka?

A

a. Caused by acid-fast bacillus Mycobacterium tuberculosis

b. aka tubercle bacillus

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2
Q

tuberculosis how many affected?

A

c. One of world’s major health problems, killing more persons than any other infectious disease, including AIDS
d. Affects more than 1.5 million people with 8 million new cases each year

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3
Q

who is more susceptible to TB?

A

f. alcoholics, AIDS, and debilitative conditions

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4
Q

antitubercular drugs

A

a. Isonizaid (INH): first drug demonstrating effectiveness against the tubercle bacillus
b. prophylaxis
e. Different combination of drugs can be used as multidrug therapy is more effective
f. If multidrug resistance develops other antibacterial agents can be used

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5
Q

what is recommended for individuals who have been in close contact with persons with TB, or who test positive for HIV, or a positive TB skin test?

A

prophylaxis

c. If a person is diagnosed with TB, family members may be given prophylactic doses of isoniazid for 6 months to 1 year

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6
Q

when are patients considered noninfectious for TB?

A

Considered noninfectious when patient meets ALL (3) criteria

i. Three consecutive negative AFB sputum smears collected in 8- to 24-hour intervals (one should be an early morning specimen)
ii. Compliant with treatment regimen for two weeks or longer
iii. Symptoms have improved clinically (are coughing less and no fever)

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7
Q

isoniazid (INH) type of drug? mechanism of action?

A

antitubercular drug - inhibits bacterial cell wall synth.

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8
Q

antifungal drugs

A

nystatin
azole group
polyenes

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9
Q

Amphotericin B - risk, PT, PD, Adv, NI

A

(polyene) (amphoterrible) (IV only)
1. Monitored closely: risk of toxicity - nephrotox, electrolytes(hypokalemia/hypomagenesemia)
2. Effective against numerous fungal diseases (mostly for severe fungus)
3. binds to fungal cell membrane, forming open channels increasing cell permeability: leakage of intracellular components
5. Must watch urine output closely and renal function closely, an electrolytes

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10
Q

why are pregnant women at risk with TB?

A

can cross placenta.

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11
Q

nystatin route, PD, effect, PT, NI, pt ed

A

PK: PO or topical: suspension, cream, ointment, vaginal tablets. (Most common = oral suspension)
PD: Increases permeability of the fungal cell membrane: fungal cell becomes unstable
b. Fungistatic and fungicidal
PT: Candida
NI: Assess mucous membrane, oral cavity prior to administration
PT ED: Patient must swish the medication in their mouth > spit it out

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12
Q

azole group PD, forms it is used in

A

i. Inhibit cytochrome P450 in fungal cells, interfering with formation of ergosterol, a major sterol in fungal cell membrane > increased cell permeability and leakage
ii. Used in topical preparations, vaginal tablet, cream, ointment, and solution

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13
Q

fluconazole(Diflucan) PD, PT, prec, SE, D/F/L, NI, pt ed

A

PD: inc permeability of fungal cell membrane
PT: Candida, cryptococcal meningitis
Prec: pregnant
no adv known
SE: vaginal rash/burning, anorexia, n/v/d, stomach cramps, rash, headache
DFL: ^PT w/warfarin, ^hypoglycemia w/sulfonylureas, ^seizure meds, dec level with cimedtidine and rifampin
NI: assess renal/hepatic prior (ci), obtain culture first, monitor urine.
Pt ed: no alc/driving

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14
Q

viruses

A

more difficult to eradicate than most bacteria.

obligate intracellular organisms: must reside in living host cell to survive/reproduce

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15
Q

viral infections

A 
influenza
hepatitis B
herpesviruses
a.	HSV-1: herpes simplex virus
b.	HSV-2: herpes simplex virus
c.	HSV-3: varicella zoster virus
d.	HSV-4: Epstein-barr
e.	HHV-5: Cytomegalovirus
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16
Q

vaccines used to? against what examples?

A

a. Pharmacologic preparations developed to provide immunity against and prevent diseases such as
i. Smallpox
ii. Chickenpox
iii. Mumps
iv. Rabies
v. Influenza

17
Q

why does flu vax change every yr? what is used in vax?

A

due to the genetic changes to its structure
i. Promotes production antibodies by the immune system, despite viruses’ varying genetic structures
ii. After influenza vaccine, most individuals develop high antibody titer levels providing protection against similar circulating viral strains
iii. Eggs are used to produce the vaccine, therefore contraindicated with allergies to eggs
details from CDC.

18
Q

dx tests for flu

A

a. Directigen Flu A has been available for many years to detect influenza A, but does not detect type B
b. ZstatFlu, QuickVue, and Flu OIA are diagnostic for both type A and B
i. Use throat and nasal swabs, or nasal aspiration
ii. Results are available within 10-20 minutes

19
Q

antiviral non HIV drugs used to what? how? 4 types?

A

a. Used to prevent or delay spread of a viral infection
b. Inhibit viral replication by interfering with viral nucleic acid synthesis in the cell
1. nonclassified antivirals
2. neuraminidase inhibitors
3. gamma globulin (immune globulin)
4. purine nucleosides

20
Q

amantadine hydrochloride, rimantadine hydrochloride

A

i. First two related antivirals
a. Used to treat influenza type A, and classified as non-classified antivirals (antiviral non HIV drugs)
b. Not effective for type B

21
Q

neuraminidase inhibitors

A

i. Group of drugs that decrease the release of the virus from infected cells>decrease viral spread and shorten duration of flu symptoms

22
Q

zanamivir (Relenza) and oseltamivir (Tamiflu)

A

Two neuraminidase inhibitors that should be taken within 48 hours of flu symptoms
Inhibit activity of neuraminidase, a viral glycoprotein. effective against type A and B influenza
Not substitutes for the flu shot

23
Q

gamma globulin (immune globulin)

A

i. Rich in antibodies found in the blood
ii. passive form of viral immunity: blocks penetration of the virus into the host cell
iii. Administered during the early stage to prevent a viral invasion in the body

24
Q

purine nucleosides

A

i. Effective with interfering with the steps of viral nucleic acid (DNA) synthesis

25
Q

acyclovir (Zovirax) class, PD, PT

A

purine nucleoside
PD: interferes w/viral synth of DNA
PT: HSV1, HSV2 (genital)

26
Q

tuberculosis increased risk is? transmission route is?

A

e. Result of increased crowded living conditions in urban areas
g. Transmitted by droplets dispersed in the air through coughing and sneezing

27
Q

isoniazid CI and D/F/L?

A

CI: renal/hep dx, ALCOHOLISM, DM RETINOPATHY
DFL: inc alc, rifampin, cyclosporine, phenytoin. dec GI absorption w/aluminum antacid. inc liver labs.

28
Q

INH adv/SE?

A

adv: psychosis, peripheral neuropathy, VIT B6 def, hyperglycemia
life thrt: BLOOD DYSCRASIAS, SEIZURES, thrombocytopenia, agranulocytosis, hepatotox
SE: tremor, PHOTOSENS, TINNITUS, dry mouth, rash, blurry

29
Q

INH nursing implications/pt ed?

A

assess TB test and cxr.
take 1-2 hr post meal (IM or PO) (food dec absorpt).
sputum samples early morning 3 days.
report burning hands (neuropathy) - take b6 to prevent.
urine may turn RED orange.

30
Q

Gamastan route, a singe dose can?

A

iv. Human immune globulin (Gamastan) is administered IM
gamma globulin
1. A single dose can protect for approximately 2 to 3 weeks, and can be repeated 2 to 3 weeks following the first dose

31
Q

acyclovir CI, prec

A

CI: renal/hep/allergy
prec: electrolyte, dehydration, moms, kids

32
Q

acyclovir Adv, SE

A

adv: urticaria, crystalluria, paresthesias, anemia, neuropathy, penias
SE: agitation, bleeding time, phlebitis, ortho hypo

33
Q

acyclovir NI, PT ed

A

monitor urine.
maintain enough fluids.
avoid spreading: abstinence or condoms.
women get routine paps (cervical cancer).
oral hygiene often because gingival hyperplasia may happen

Pharm (20 decks)

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