Chapter 30 : Antituberculars, Antifungals, And Antivirals Flashcards
What’s the bacteria that causes tuberculosis?
Mycobacterium tuberculosis
How is TB spread?
Person to person via droplets
Airborne
What an example of droplets?
Coughing
Sneezing
Talking
Who are at risk of getting TB?(4)
Immunocompromised
Living/working in high risk residential
Injecting illegal drugs
Health care works with these pts
What are common side effects of tuberculosis? (3)
Cough
Fever
Night sweats !!
Gi distress
Weight loss!!
Positive acid fast bacilli in the sputum or blood sputum !!
Notes
Tuberculosis
Prophylaxis recommended for those
- close contact with active TB
- HIV positive/ immunosuppressive
- conversion from negative to pos
- latent TB infection
- injection drug users
- recent immigrants
Are you gonna get TB when someone behind you coughs at the grocery school?
No
Are you gonna get TB when you live with someone who has TB?
Yes
What is latent TB?
When you’ve been exposed to TB and it’s in your body
But you’re not sick
But you have zero symptoms
You can’t spread it
Can you spread latent TB?
No
So let’s say you have latent TB, however you become sick, weak, immunocompromised, what happens?
You’re more likely to develop active TB
What percentage are you at when you have latent TB to develop active TB?
10%
What do we as nurses do to help latent tb patients?
This helps how?
Treat them for TB
Destroying that myobacterium in their lung
To avoid active TB
With latent TB, how is the skin test ?
You are negative for years and then suddenly you get positive
Overall latent TB
Are you sick?
are you contagious?
Nope!
What’s the vaccine for TB?
BCG vaccine
Is latent TB easy to treat?
And how long?
Yes
3 months
What is active TB?(4)
Positive skin & blood test
Symptoms
X-ray
Contagious
What’s the biggest problem with treating TB is what? (3)
Drug resistant
Drug toxicity
Patient no adherence
Since TB is a highly drug resistance bacteria, how do we treat active TB? (3)
Take multiple medications
For at least 9 months
Multiple times a day
Notes
Effectiveness depends on
- types of infections
- adequate dosing
- sufficient duration of treatment
- adherence to drug regimen
- selection of an effective drug combination
TB medications are so strict to the point that people are paid to go to houses to what?
Watch them take it
To avoid resistance !!
What’s the first thing to do when someone has TB? Like labs or tests wise?
Cultures
Usually what other tests can we use to see TB?
Skin test
X ray test
Blood test
If we suspect a patient who has TB what do we do?
Immediately start on antitubercular drugs and isolation
Problems with successful therapy occur because of patient ??
Nonadherencd to drug therapy
What are the 4 first line antitubercular drugs ?
Isoniazid
Rifampin
Purazinamide
Ethambutol
When taking antitubercular drugs, we usually have to do what?
Combine multiple of these medications because of how bad resistance is with TB
What is the initial phase of medication of TB?
How long and how many drugs?
2 months
4 drugs
What is the continuation phase for TB drugs?
How long and how many drugs?
4-7 months
2 drugs
How long does it take for a culture for TB to come back?
2 months
When the culture hasn’t come back how many drugs will they be on?
Then after it comes back?
4 drugs
2 drugs
What is the biggest thing of all TB drugs? Causes?
Hepatotoxicity!!
When a patient has TB drug and since it causes hepatotoxicty ( liver problem ), what do we do?
Monitor LFTS
Before and monitor
What is isoniazid (INH)
Route : (2)
Oral & IM
How do you take isoniazid ?
Empty or full stomach?
And when?
Empty
Before 1 hour
2 hour after meals
What are side effects of isoniazid (INH)(5)
Photosensitivity
Tinnitus
Peripheral neuropathy
Heptotoxicty
Blurred vision
How do we treat peripheral neuropathy in the TB drug INH?
How does this aid ?
Vitamin B6 ( pyridoxine )
Stops those parathesia feeling
Usually we don’t wait for patients to have that numbness in tingling instead we?
Tell them to take vitamin b6 !
What does ethambutol do?
Damage eyes!!
Blurred or changed vision
Normally when a patient who just got TB and is not taking ethambutol and INH, we usually do what?
Do a visual exam
( baseline )
Since it causes changes in vision!
What is rifampin so different?? (2)
Everything comes out orange
Fluids orange
Sweat, semen, salvia
Decrease birth control
Again, every TB medication has what?
Hepatotoxicity!!!
How do we know that a patient is having liver problems?
Jaundice!!!
Yellow everything
What are the big nursing considerations regarding TB? (6)
Assess liver functions
( monitor LFTS!)
Take orderly
INH & ethambutol = eye exams
No alcohol!
Rifampin = orange everything
Pyridoxine = INH & amingoclysides = treatment of neurotoxicity
Special populations
Pregnancy
- latent TB 9 months
HIV
- latent TB
- aggressive treatment
Pediatrics
- latent TB 9 months
Now onto antifungal medications !!
Normally fungal infections are local, which means?
Examples ?
Like on the skin, mucous membranes, nails, hair
Thrush, yeast infection
However if a patient has a system. Infection it’s more likely they have?
Examples?
Immunosuppression
Fungal lung infection or fungal meningitis
What’s more severe local or systemic ?
Systemic
What are the fungal drugs we are gonna talk about? (2)
Polyenes
Azoles
Polyenes, what’s the medication we need to know for this group of antifungal ?
Amphotericin B
When do we normally give amphotericin B?
Usually never unless it’s like nothing else works
Last resort type of med
What are the 3 big side effects of amphotericin B ( Polyenes )?
Thrombophlebitis
Nephrotoxicity
Hypokalemia
Since Polyenes, amphotericin B causes thrmobophlebitis, what is the nurse going to do?
We are gonna assess the IV site for any inflammation/redness
Try to avoid small vein, use big one
What is another drug that causes hypokalemia??
So what we need to monitor ?
Side effects
Palpitations
Heart skipping a beat
We check potassium
Digoxin
Telemetry
Amphotericin B
Usually we give an infusion but they can experience flushing fever and chills
However we can prevent this but giving 1-3 hours before this infusion what 3 drugs?
Tylenol Benadryl corticosteroid
Is Amphotericin B highly protein bound?
If we give this to another highly protein bound what happens??
Yes!
Toxic!!
How long is the half life for Amphotericin B?
If they had an allergy reaction, how long will it take to get rid of it?
15 days
15 days!!!
Amphotericin B causes bone marrow suppression, so we need to monitor what as well?
CBC
How do you give azoles?
Oral, IV, vaginal or topical
What treatment come from using azoles?
Athletes foot
Yeast infections
Thrush
What does oral antifungal medications interact with this? (3)
Warfarin
Digoxin
Statins
What are some side effects of azoles? (2)
Hepatotoxicity
Nephrotoxicity
What’s the biggest drug interaction with azoles? And what does it cause?
Fluconazole
Increase PT with warfarin
Hypoglycemia with sulfa drugs
We usually use oral azole medications are first given since it’s less toxic than what?
Amphotericin B
What is the super fetal drug that induced what for azoles?
Ketoconazole
Hepatitis
Azoles can affect diabetics how?
Glycemic levels
Do we give azoles to pregnant woman?
No
Cause menstrual abnormalities
Overall we want to avoid what with antifungal since it causes Hepatotoxicity?
Alcohol!!
Now onto viruses!
Does antibacterials kill viruses?
Nope!
What are examples of virus ?
Hepatitis
Herpes
HIV
Flu
RSV
COVID
What are some examples of influenza medications? (2)
Tamiflu and relenza
What does the antiviral tamiflu and relenza do to the body?
Decrease the viral spread
It doesn’t go away
Just shortens your symptoms !!
Shorten the infection
Or prevent the infection
What are the big side effects of tamiflu and relenza ! (2)
Abnormal behavior !!!!!!
Nausea and vomiting
Dizziness & headache
When is influenza antiviral medications most effective?
48 hours of onset of illness
What’s the common herpes antiviral medication?
Acyclovir ( Zovirax )
What’s the biggest 4 side effects of herpes antivirals?
Leukopenia
Thrombocytopenia
Low hemoglobin
Hematocrit
Do we do a culture of herpes? Why?
Yes
Before we give medication cause it’s gonna help aid symptoms
Patients who take herpes medication for like 5 days do we need CBC ?
What about 5 months?
No
Yes
What’s the biggest thing to know about cytomegalovirus ?(2)
Bone marrow suppression and toxicity !!
Noyes
Flu medications
Take medications 48 before, since it’s too much virus in the body
So you need to take it early
Not candidates for the medications !!
Hepatitis antivirals
What do you need do know ? (2)
Hepatotoxity & bone marrow suppression !!!
