Ch. 32 - Antituberculars, Antifungals, Peptides, Metronidazole

Question 1

Tuberculosis (TB) (1):

Answer 1

(Mycobacterium tuberculosis)

1.) Thrives in organs with good O2 supply

2. ) Dormant stage: 
   - Resistance to immune defenses & drugs

Question 2

Tuberculosis (TB) (2):

Answer 2

3. ) May become active at any time

4. ) Slow growing dug therapy for prolonged periods

Question 3

Drug Therapy:

Answer 3

• Prophylactic therapy

- Treat active infection

Question 4

Prophylactic Tx: (1):

Answer 4

1. ) Close contact with clients with active TB

2. ) Positive HIV test & positive TB skin test

Question 5

Prophylactic Tx: (2):

Answer 5

Isoniazid (INH) = drug of choice (Tuberculocidal effect)

Question 6

Active Infection – Tx (1):

Answer 6

Multiple - drug therapy recommended (2-3 drugs)

-D/t chance of developing resistance to anti-tubercular drugs

Question 7

Active Infection – Tx (2):

Answer 7

First - line drugs (1st choice)

Second - line drugs (2nd choice)

Question 8

First - line Drugs (1):

Answer 8

• More effective

- Less toxic

Question 9

First – line Drugs (2):

Answer 9

Combination:

• isoniazid (INH)
• Rifampin

INH & Rifampin = classic

Question 10

Second- line drugs:

Answer 10

• Not as effective as 1st – line drugs

- May be combined w/ 1st- line drugs

Question 11

Side effects/Adverse reactions (1):

Answer 11

Isoniazid (INH):

1. ) Skin rashes, hepatotoxicity
2. ) Peripheral neuropathy

Question 12

Peripheral Neuropathy:

Answer 12

-d/t deficiency of pyridoxine (Vit B6)

• S/S:
  
  • Numbness, tingling extremties

Pyridoxine supplements

Question 13

Side effects/Adverse reactions (2):

Answer 13

Rifampin:

1. ) Body secretions may turn orange
2. ) May permanently discolor soft contant lenses
3. ) Hepatotoxicity

Question 14

Contraindications:

Answer 14

Severe hepatic disease

Question 15

Nursing Interventions (1):

Answer 15

isoniazid (INH) = 1 hr before or 2 hrs after meals:
-Food decreases absorption rate

• Give pyridoxine with isoniazid (INH)
  
  • To prevent peripheral neuropathy

Question 16

Nursing Interventions (2):

Answer 16

• Monitor serum level enzymes

- Compliance

Question 17

Client Teaching (1):

Answer 17

1. ) Take on empty stomach
2. )No antacids = decrease drug absorption
3. ) Avoid alcohol
4. ) Avoid direct sunlight
5. ) Body fluids may turn orange

Question 18

Client Teaching (2):

Answer 18

Report:

-Numbness, tingling, of hands and feet

Question 19

Antifungal Drugs (1):

Answer 19

Infection caused by fungus:
-Mycosis

Superficial
Systemic

Question 20

Antifungal Drugs (2):

Answer 20

Superficial infection:
-Integumentary system

Systemic:
-Lungs, CNS, abdomen

Question 21

Antifungal Drugs (3):

Answer 21

More difficult to tx than bacterial infections:
-Cell structure similar to human cells

Fungistatic or fungicidal

Question 22

Classifications:

Answer 22

Polyenes
Azoles
Antimetabolites
Echinocandins
Antiprotozoals

Question 23

Polyenes:

Answer 23

Amphotericin B – to treat:

• Severe systemic fungal infection
• Not absorbed in GI tract
• IV

Question 24

Amphotericin B: Side effects;

Answer 24

1. ) Flushing
2. ) fever, chills
3. ) n/v
4. ) Hypotension

Question 25

Amphotericin B (1):

Answer 25

HIGHLY TOXIC! =

• Nephrotoxicity
• Electrolyte imbalance

Question 26

Amphotericin B (2):

Answer 26

Monitor:

• Urinary output
• Kidney functioning

Question 27

nystatin (Mycostatin):

Answer 27

Tx: candidal infection

Topical:
-Creams, ointment, vaginal supp

Oral suspension: 

• Candidal infection of mouth (thrush) – in babies/newborns
  
  • Common form

Question 28

Azoles:

Answer 28

Tx: systemic & local infections:
-fluconazole (Diflucan)

Tx: systemic & vaginal candidiasis

PO/IV/Vaginal

Question 29

fluconazole (Diflucan):

Answer 29

SE:

1. ) Po: anorexia, n/v, diarrhea, rash
2. ) Vaginal: rash, burning

Question 30

Azoles cont….

Answer 30

1. ) miconazole
2. ) ketoconazole (Nizoral)
   
   • Topical or systemic
   • Take with food
   • Avoid antacids

Question 31

metronidazole (Flagyl) (1):

Answer 31

Tx: protozol infection
*Disorders assoc w/ GI tract

i.e. Helicobacter pylori = peptic ulcers

Question 32

metronidazole (Flagyl) (2):

Answer 32

Tx:

1. ) Protozoal infections
2. ) Intestinal amebiasis
3. ) Inflammatory bowel disease
4. ) Trichomoniasis
5. ) Bacterial vaginosis

Question 33

Side Effects:

Answer 33

1. ) Dizziness, HA
2. ) Dark or reddish/brown urine
3. ) Dry mouth, metallic/bitter taste
4. ) GI distress

Question 34

Teach Client:

Answer 34

Avoid alcohol & meds containing alcohol = drug interaction