Pharm antiinfectives Flashcards
1
Q
antibiotic resistant - a bacterium that releases several toxins that cause severe & foul-smelling diarrhea.
A
Clostridium difficile (C. difficile)
2
Q
C diff caused by
A
abx, fecal-oral, contaminated fomites
dont take unnecessary or incomplete antibiotics
3
Q
carbapenems, cephalosporins, isoniazid, penicillin’s, vancomycin
A
Cell wall synthesis inhibitors:
4
Q
aminoglycosides, ketolides, macrolides, streptogramins, tetracyclines
A
Protein synthesis inhibitors:
5
Q
sulfonamides
A
Antimetabolites:
6
Q
fluoroquinolones
A
DNA synthesis inhibitors
7
Q
rifampin
A
RNA synthesis inhibitors
8
Q
medications that kill the bacteria
A
bactericidal
9
Q
medication that slows growth of bacteria
A
bacteriostatic
10
Q
free to grow, and the patient develops an infection that is resistant to conventional drug therapy. The bacteria is resistant, not the patient
A
acquired resistance
11
Q
An individual with an infection that is resistant to certain antibacterial drugs can transmit the resistant bacteria to others through:
A
poor hygiene, poor sanitation, poor infection control, close proximity
12
Q
The longer an abx is used and the more often it is prescribed
A
the larger percentage of resistant strains occur
13
Q
antibiotic resistance - infection in the intestines, lungs, urinary tract, wound, blood
A
Carbapenem-resistant Enterobacteriaceae (CRE)
14
Q
antibiotic resistant: intestines; most common HAI; very contagious
A
Clostridium difficile (C. difficile)
15
Q
antibiotic resistant - gram positive bacteria; skin, surgical wounds, bloodstream, lungs, urinary tract
A
Methicillin-resistant Staphylococcus aureus (MRSA)
16
Q
antibiotic resistant - wide range of infections, blood, UTI, intestines, wounds
A
Vancomycin-resistant enterococci (VRE
17
Q
given antibiotic to prevent infection
A
prophylactic
18
Q
a specimen of urine, stool, spinal fluid, sputum, blood, purulent wound drainage is collected per sterile technique and sent to the lab for organism identification and sensitivity to a drug
A
Culture & Sensitivity (C&S)
19
Q
how long for results of culture
A
2-3 days
20
Q
given after cultures are drawn
before results come back
A
broad spectrum antibiotics
21
Q
a secondary infection resistant to the treatment of the original infection. Normal floral of the body is destroyed
A
Superinfections
22
Q
CM of superinfections
A
fever
leukocytosis
diarrhea
bladder pain
dysuria
vaginal discharge
23
Q
The most important factors for abx therapy:
A
-Selecting the appropriate abx that kills the bacteria
-Regarding the host factors that can influence drug therapy: nutritional status, pregnancy, comorbidities
24
Q
how the immune system functions
A
Host defenses
25
the infection site, CNS and blood-brain barrier, poor circulation, excessive pus blocks drugs from reaching their target
Local tissue conditions
26
obtained on admission; avoid all drugs in the chemical class
Allergy history
27
doses of antibiotics are low to very young and very old because
unable to metabolize/excrete
28
pregnancy status effects from abx
tetracyclines discolor teeth in utero; aminoglycoside affect infant's hearing
29
genetics effect from abx
some patients have genetic absence of certain enzymes needed to metabolize abx
30
inhibit bacterial cell wall synthesis; bactericidal
Penicillins (PCNs)
31
Penicillinase-Resistant PCNs: narrow spectrum MOA and ex
Effective against gram-positive bacteria
Penicillinase-producing Staphylococcus aureus
Other Staphylococcus species
Treats endocarditis, meningitis, bacteremia, skin, and respiratory infections
dicloxacillin (Dynapen, Dycill)
nafcillin (Unipen)
oxacillin (Bactocil)
32
Natural PCNs: narrow spectrum MOA and ex
penicillin G benzathine (Bicillin); penicillin G potassium (Pfizerpen); penicillin G procaine; penicillin V
Effective against gram-positive and a few gram-negative bacteria
Streptococcus and Clostridium species
Neisseria and Staphylococcus species
Treats anthrax, tetanus, diphtheria, endocarditis, respiratory infections, syphilis
33
Broad spectrum PCNs MOA and examples
amoxicillin (Amoxil)
amoxicillin and clavulanate (Augmentin)
ampicillin (Omnipen)
ampicillin and sulbactam (Unasyn)
Effective against gram-positive and gram-negative bacteria
Escherichia coli, Haemophilus influenzae
Shigella dysenteriae
Proteus mirabilis and Salmonella species
Treats respiratory, skin, intraabdominal, urinary tract, gynecologic infections, otitis media, sinusitis
34
inhibit Gram positive bacteria & some Gram negative bacteria
Extended-Spectrum PCNs
35
Extended-Spectrum PCNs MOA and ex
piperacillin (Pipracil)
piperacillin and tazobactam (Zosyn)
ticarcillin and clavulanate (Timentin)
Effective against gram-negative bacteria
Pseudomonas aeruginosa
Proteus and Serratia species
Klebsiella pneumoniae
Enterobacter and Acinetobacter species
Treats respiratory, intraabdominal, and skin infections
36
Recap PCNs indications:
PNA, meningitis, skin/bone/joint infections, gastric infections, blood & heart valve infections, gas gangrene, tetanus, anthrax, sickle-cell anemia in infants
37
Adverse Effects of PCNs
Rash, pruritus, NV, fever, anaphylaxis symptoms, nephrotoxicity, including angioedema, circulatory collapse, cardiac arrest
38
penicillin G classes
Therapeutic Class: antibacterial
Pharmacologic Class: cell wall inhibitor, natural PCN
39
PCN G actions
Drug of choice against streptococci, pneumococci, staphylococci, gonorrhea, syphilis
40
PCN alerts
Observe for allergic reactions for 30 minutes, esp. after first dose
Do not mix PCN and aminoglycosides in same IV solutions; dampens effects of aminoglycosides. Give 1 hour apart
41
adverse effects and contraindications of PCN G
Adverse Effects
NVD
Anaphylaxis; monitor for late reactions…several weeks
Contraindications
Hypersensitivity
Use caution in patients with severe renal dz
42
Lab tests for PCN G
may give a positive Coombs test, a test to detect antibodies stuck to RBC surface
May give false positive urinary or serum proteins
43
largest antibiotic class
gram negative infections
cephalosporin
44
each cephalosporin generation has increasing
bactericidal activity
45
First Generation Cephalosporins MOA and ex
cefadroxil (Duricef), cefazolin (Ancef, Kefzol), cephalexin (Keflex)
Effective against mostly gram-positive and some gram-negative bacteria
Staphylococci, Streptococci
E. coli, Klebsiella, Proteus, Salmonella, and Shigella species
46
Second Generation Cephalosporins MOA and ex
cefaclor (Ceclor), cefotetan (Cefotan), cefoxitin (Mefoxin), cefprozil (Cefzil), cefuroxime (Zinacef), cefuroxime (Ceftin)
Effective against gram-positive and gram-negative bacteria
Staphylococci, Streptococci, E. coli
Klebsiella, Proteus, Salmonella, and Shigella species
Haemophilus influenza, Enterobacter species
Neisseria gonorrhoeae, Neisseria meningitidis
47
Third Generation Cephalosporins MOA and examples
cefdinir (Omnicef), cefditoren (Spectracef), cefixime (Suprax), cefotaxime (Claforan), cefpodoxime (Vantin), ceftazidime (Fortaz, Tazicef), ceftibuten (Cedax), ceftizoxime (Cefizox), ceftriaxone (Rocephin)
Effective against gram-positive and gram-negative bacteria
Has increased resistance to destruction by beta-lactamases
48
Fourth Generation Cephalosporin
MOA and examples
Effective against gram-positive and gram-negative bacteria
Staphylococci, Streptococci
E. coli, Klebsiella, and Proteus species
Pseudomonas aeruginosa
Highly resistant to destruction by beta-lactamases
49
Fifth Generation Cephalosporins
MOA and ex
ceftaroline (Telfaro), ceftolozane and tazobactam (Zerbaxa)
Effective against gram-positive and gram-negative bacteria
Staphylococci, MRSA, Streptococci, E. coli
Klebsiella and Proteus species, Pseudomonas aeruginosa
Highly resistant to destruction by beta-lactamase
50
Adverse Effects of cephalosporins
Anaphylaxis, superinfection
Mouth sores, headache, dysgeusia, GI distress
Clostridium difficile-associated diarrhea
Increased bleeding, seizures
Nephrotoxicity
Stevens-Johnson syndrome
Elevated hepatic enzymes
Oral or vaginal candidiasis
51
percentage of patients showing cross sensitivity of cephalosporin
1-7%
52
ceph contraindication
patients with previously severe adverse reaction to PCN
53
reasonable alternative to PCN
Ceph
54
class of cefazolin
Therapeutic Class: antibacterial
Pharmacological Class: cell wall inhibitor; first generation cephalosporin
55
cefazolin actions
Treats for Gram-positive organisms in the respiratory tract, urinary tract, skin, biliary tract, bones, joints
Treats genital infections, septicemia, endocarditis
Not effective against MRSA
Used prophylactically preoperatively
56
adverse effects and contraindications of cefazolin
Adverse Effects
Rash, diarrhea, superinfections
Contraindications: hypersensitivity to cephalosporins or PCNs; use with caution in CKD
Drug-Drug Interactions: if used with nephrotoxic drugs (aminoglycosides/vancomycin ↑ risk of nephrotoxicity; anticoagulant effect of heparin & warfarin may be ↑ ; additive/synergistic effect with other abx (aztreonam, carbapenems, PNCs)
57
lab test of cefazolin
false positive on coombs test
58
Effective against gram-positive and gram-negative bacteria
Inhibit bacterial protein synthesis, slow microbial growth, exert bacteriostatic effect
tetracyclines (cycline)
59
tetracycline classes
Therapeutic Class; antibacterial
Pharmacologic Class: tetracycline; protein synthesis inhibitor
60
tetracycline actions
inhibits protein synthesis; bacterial resistance
Treats acne, anthrax, plague, gingivitis, cholera, gram +/- STIs, skin, and urinary and respiratory infections, Helicobacter pylori, MRSA
61
adverse effects of tetracycline
GI effects,
rash stinging/burning with topical applications, anaphylaxis,
secondary infections,
hepatotoxicity, ototoxicity, nephrotoxicity, permanent teeth discoloration in children
Increased mortality with tigecycline (Tygacil); should be reserved for infections not responsive to other antiinfectives
62
tetra alert
Administer antacids & tetracycline 1-3 hours apart
63
tetra labs
May ↑ blood urea nitrogen (BUN) aspartate aminotransferase (AST),
alanine
aminotransferase (ALT),
amylase,
bilirubin,
alkaline phosphatas
64
Inhibits protein synthesis by binding to the bacterial ribosome
macrolides
65
macrolides treat
whooping cough (pertussis), Legionnaires’ dz, streptococcus, H. influenza, & M. Pneumoniae, Listeria, Chlamydia, Neisseria
66
erythromycin classes
Therapeutic Class: antibacterial
Pharmacologic Class: Macrolide; protein synthesis inhibitor
67
erythromycin actions
for patients unable to take PCNs or have a PCN-resistant infection
Inactivated by stomach acids, made to dissolve in the small intestine (do not crush or chew)
Treats Bordetella pertussis, Legionella pneumophila, Mycoplasma pneumoniae, Corynebacterium diphtheriae
68
alerts fro erythromycin
Give on empty stomach with full glass of water. Food ↓ levels of drug in the body
Mix suspensions well
Do not give with milk or fruit juices
69
adverse effects of erythromycin
GI effects, hearing loss, vertigo/dizziness in high doses, high doses of IV may be cardiotoxic/fatal dysrhythmias
70
erythromycin labs
erythromycin interferes with AST; gives false urinary catecholamine values
71
More toxic than many other abx
Important for treatment of aerobic gram-negative bacteria, mycobacteria, protozoans
aminoglycosides
72
gentamicin classes
Therapeutic Class: antibacterial; bactericidal
Pharmacologic Class: aminoglycoside; protein synthesis inhibitor
73
actions of gentamicin
broad spectrum for serious urinary, respiratory, nervous, or GI infections
E. coli, Proteus, Pseudomonas, Serratia, Klebsiella, Citrobacter
74
alerts for gentamicin
Withhold if peak serum value is above normal range of 5-10 mcg/mL & advise HCP
75
adverse effects and contraindications of gentatmicin
Adverse Effects
Rash, GI effects, fatigue
Neurotoxicity, ototoxicity (tinnitus, vertigo, HA)
Neuromuscular blockade and respiratory paralysis
Nephrotoxicity: ↓ renal function (oliguria, proteinuria, ↑ BUN and creatinine levels). Be aware of patients with preexisting CKD
Contraindications
Hypersensitivity, impaired renal function, preexisting hearing loss
76
labs for gentamicin
Gentamicin ↑ serum bilirubin, serum creatinine, serum lactate dehydrogenase (LDH), BUN, AST, ALT
May ↓ values of serum calcium, sodium, or potassium
77
nursing interventions for aminoglycosides
Send a sample from the infected area to the lab for C&S to determine organism and its sensitivity
Check for hearing loss and renal function
Check that therapeutic drug monitoring has been ordered for peak and trough drug levels
Monitor for signs and symptoms of superinfection (fever, chills, dyspnea, cyanosis)
Encourage patient to increase fluids unless fluids are restricted
Monitor BUN (7-22) and creatinine (0.6-1.2)
78
Broad spectrum against gram-negative pathogens. Newer drugs are effective against gram-positive microbes
Well absorbed orally
fluroquinolones
79
ciprofloxacin classes
Therapeutic Class: antibacterial
Pharmacologic Class: fluroquinolone; bacterial DNA synthesis inhibitor
80
actions of ciproflaxin
Inhibits DNA replication and growth
Effective against gram-positive and gram-negative bacteria S. pneumoniae, S. aureus, H. influenza, P. aeruginosa, Salmonella, and Shigella species
Treats: anthrax, skin, soft-tissue, bone/joint, gynecologic, intraabdominal, urinary and respiratory tract infections
81
adverse effects of ciproflaxin
Anaphylaxis, superinfection
Photosensitivity, eye damage, visual disturbances GI distress, dysgeusia (taste disorder)
Tendinitis, tendon rupture (Achilles tendon common)
Clostridium difficile–associated diarrhea
Stevens-Johnson syndrome
May cause extreme weakness in patient with Myasthenia Gravis
82
lab changes from ciproflaxin
may ↑ AST, AST, BUN, creatinine levels
83
nursing interventions from fluroquinolones
Obtain a specimen from the infected site for C&S
Monitor theophylline levels (increases)
Monitor blood glucose (levofloxacin increases effects or oral hypoglycemics)
Teach to avoid antacids & calcium; they interfere with absorption
Monitor patients for increased affects of anticoagulants
Monitor intake and output
Check lab values for renal function
Check for signs and symptoms of superinfection
Encourage patient to report side effects
Advise patient to wear sunglasses, sun block, and protective clothing when in the sun
84
Only antibiotic not derived from biologic substances; comes from a sulfur-containing chemical
Folic acid inhibitors. Sulfonamides stop cells from using folic acid to make DNA
sulfonamides
85
trimethoprim-sulfamethoxazole actions
Inhibit bacterial synthesis of folic acid, which is essential for bacterial growth
Effective against gram-negative bacteria
Proteus, Klebsiella, E. coli, and Chlamydia
species
Pneumocystis carinii pneumonia, shigella
infections of the small intestine
Acute episodes of chronic bronchitis
Treats otitis media, meningitis, malaria, and
respiratory and urinary tract infections
86
adverse effects of trimethoprim-sulfamethoxasole
Anaphylaxis
Photosensitivity
GI distress, stomatitis
Insomnia, tinnitus
Crystalluria, renal failure
Blood dyscrasias
Stevens-Johnson syndrome
Vaginal itching/discharge (super infection)
87
overdose treatment for trimethoprim-sulfamethoxazole
increase acidification of the urine
5-15 mg leucovorin daily
88
trimethoprim-sulfamethoxazole pregnant and nursing mothers
crossed the placenta and excreted in breast milk
89
nursing intervention for sulfonamides
Administer sulfonamides with a full glass of water (increase fluid intake to avoid crystalluria)
Record vital signs and intake and output.
Observe the patient for hematologic reactions (bleeding, bruising)
Check for signs and symptoms of superinfection
Counsel patient not to take antacids with sulfonamides
Warn patient to wear sunglasses, avoid direct sunlight, use sun block, and wear protective clothing in the sun.
Advise patient with allergy to one sulfonamide to avoid all sulfonamide preparations
90
Bactericidal. Contain a beta-lactam ring & kill bacteria by inhibiting cell wall synthesis
The ring is resistant to destruction by beta-lactamase
carbapenems
91
common allergic reaction to vancomycin, caused by degranulation of mast cells & basophils that result in histamine release
RMS -Red Man Syndrome
92
To prevent Red Man Syndrome
To prevent Red Man Syndrome: run IV no faster than 10 mg/min; at least over 60 min (whichever is longer)
Stop the infusion & notify provider
93
sometimes given to help prevent RMS
diphenhydramine (Benadryl)
94
therapeutic trough of benadryl
10-20 mcg/mL
95
metronidazole (flagyl)
Therapeutic Class: antiinfective; antiprotozoan
Pharmacologic Class: disrupts nuclei acid synthesis
96
actions of metronidazole (flagyl)
Disrupts DNA and protein syntheses in bacteria and protozoa
Antimicrobial amebicide
Effective against H. pylori, Clostridium, Giardia, Gardnerella, Prevotella, Peptococcus bacteria species, and Trichomonas vaginalis protozoa
Treats Clostridium difficile-associated diarrhea; amebiasis; giardiasis; trichomoniasis; bacterial vaginosis; acne; meningitis; and gynecologic, skin, intraabdominal, and respiratory infections
97
alerts for metronidazole (Flagyl)
extended release must be swallowed whole & taken on empty stomach
Contraindicated in first trimester of pregnancy (risk for birth defects)
98
adverse effects of metronidazole (Flagyl)
GI effects,
dizziness,
HA,
dry mouth,
metallic taste
99
lab changes from metronidazole (Flagyl)
↓ AST & ALT values
100
first and second line drug for Tubercular, Fungal, Protozoan, & Helminthic Infections
First-Line Drugs
ethambutol (Myambutol): tuberculosis (TB)
isoniazid (INH); rifampin (Rifadin): latent & active TB
pyrazinamide (PZA): TB
rifabutin (Mycobutin): prevents Mycobacterium dz in HIV patients
Second-Line Drugs
amikacin (Amikin)
aminosalicyclic (Paser)
ciprofloxacin (Cipro)
kanamycin (Kantrex)
ofloxacin (Floxin)
streptomycin
101
isoniazid (INH)
Therapeutic Class: antituberculosis drug
Pharmacologic Class: mycolic acid inhibitor
102
actions of isoniazid (INH)
Most effective therapy for TB
Used alone or in combination with other anti-TB drugs for treating the active dz
103
adverse effects and contras of isoniazid
Adverse Effects
Numbness of hands/feet, rash, fever, optic neuritis, hearing loss, memory loss, psychoses
Hepatotoxicity: monitor for ↑ liver enzymes, for jaundice, fatigue, loss of appetite, avoid ETOH
Contraindications
Hypersensitivity, severe hepatic impairment
104
labs for isoniazid
may increase AST and ALT
105
nursing interventions for anti-TB drugs
Administer INH 1 hour before or 2 hours after meals.
Give pyridoxine (vitamin B6) as prescribed with INH to prevent peripheral neuropathy
Monitor hepatic function tests: hepatotoxic
Emphasize importance of complying with drug regimen
106
86% of all human fungal infections are caused by
Candida albicans (single- or multicell organisms)
107
bind to fungal cell membrane to form open channels that increase cell permeability & leakage of K+
Ex:
Polyenes
amphotericin B (Abelcet), nystatin (Mycostatin)
108
inhibit fungal synthesis, interfering with the formation of ergosterol
Ex:
Azoles
fluconazole (Diflucan)
ketoconazole (Nizoral)
posaconazole (Noxafil)
109
selectively penetrate fungal cell and disrupts fungal DNA/RNA synthesis
Ex:
Antimetabolites
flucytosine (Ancobon)
110
inhibit biosynthesis of essential component of the fungal cell wall
Ex:
Echinocandins
caspofungin (Cancidas)
111
amphotericin B (Fungizone) classes
Therapeutic Class: antifungal (systemic)
Pharmacologic Class: polyene
112
actions of amphotericin B (fungizone)
Treats severe, systemic fungal infections
Binds to fungal cell membranes, causing cell permeability, and leakage of cellular contents
Not absorbed from the GI tract; given IV
113
alerts for amphotericin B (Fungizone)
Reactions usually begin 1-3 hours after initiating drug
Avoid reactions: pretreat 30-60 minutes before drug with: acetaminophen, diphenhydramine, hydrocortisone, or antiemetics
Infuse slowly to avoid cardiovascular collapse
Withhold drug if BUN > 40 mg/dL or creatinine > 3 mg/dL. Use with caution with CKD
Normal ranges: BUN (7-22) and creatinine (0.6-1.2)
114
adverse effects of amphotericin (fungazone)
Flushing, fever, chills, headache, tachypnea
Dizziness, ototoxicity, hypotension, GI distress
Paresthesia, thrombophlebitis
High doses: nephrotoxicity, hypokalemia, hypomagnesemia
115
lab changes from amphotericin (fungizone)
May ↑ serum BUN & creatinine, alkaline phosphatase, AST, ALT
May ↓ serum potassium, calcium, magnesium
116
azole antifungals
Consist of 2 different chemical classes: imidazoles; triazoles
117
azole antifungals action
Broad spectrum
Increases permeability of fungal cell membrane by inhibiting ergosterol synthesis to impair fungal growth
118
Systemic Azoles
Adverse Effects
- fluconazole, ketoconazole are for systemic & topical infections
-NV, anaphylaxis, rash, may affect glycemic control in patients with DM, hepatotoxic
119
Topical Azoles:
Adverse Effects:
- clotrimazole(Mycelex) for skin, vaginal, oral fungal infections
fluconazole (Diflucan) for oral candidiasis
- burning/irritation at application sites
120
fluconazole (Diflucan) classes
Therapeutic Class: antifungal
Pharmacologic Class: inhibitor of fungal cell membrane synthesis
121
fluconazole (diflucan) actions
Increases permeability of fungal cell membrane by inhibiting ergosterol synthesis to impair fungal growth
Completely absorbed when given orally (PO)
Effective against Candida albicans
Able to penetrate most body membranes to reach infections in the CNS, bone, eye, urinary tract, resp tract
Narrow spectrum
122
adverse effects of fluconazole (diflucan)
Headache, rash, GI distress
Hypokalemia, dysrhythmias
Hepatotoxicity, nephrotoxicity
Stevens-Johnson syndrome in the immunocompromised patient
123
drug-drug interactions of fluconazole (diflucan)
Fluconazole with warfarin ↑ risk for bleeding
Hypoglycemia if given concurrently with oral hypoglycemics
Levels of the drug may be ↓ with concurrent use of rifampin
Effects of fentanyl (Sublimaze), alfentanil (Alfenta), methadone (Dolophine) may be prolonged
124
lab changes for fluconazole (diflucan)
AST, ALT, & alkaline phosphatase may be ↑
125
Topical application for superficial mycoses
nystatin (Mycostatin, Nystop)
terbinafine (Lamisil)
tolnaftate (Tinactin)
126
Prototype Drug nystatin (Mycostatin, Nystop) classes
Therapeutic Class: superficial antifungal
Pharmacological Class: polyene
127
action of nystatin
Binds to sterols causing loss of intracellular potassium and other cell contents
128
application of nystatin
Swish for at least 2 minutes, then swallow…swish and swallow
Apply with a swab in infants/children
129
adverse effects of nystatin
contact dermatitis, N-V-D
130
nursing intervention for antifungals
Monitor renal/liver function studies; urine output, CBC, electrolytes
Advise the patient to take drugs as prescribed
Advise the patient not to consume alcohol
Encourage the patient to report side effects
131
single-celled organisms that inhabit water, soil, animal hosts
Protozoa
132
thrive in condition where sanitation & personal hygiene are poor & population density is high
drug resistant if cysts occur inside host
Protozoa
133
from fecal-contaminated water = dysentery symptoms: severe diarrhea
Amebiasis/Entamoeba histolytica
134
from fecal-contaminated water
Cryptosporidiosis/Cryptosporidium parvum
Giardiasis/Giardia lamblia:
135
from female Anopheles mosquito
Malaria/Plasmodium
136
congenital transmission or cat feces
Toxoplasmosis/Toxoplasma gondii
137
through sexual contact
Trichomoniasis/Trichomonas
138
from kissing bug (America) Chagas’ dz, tsetse fly (African)
Trypanosomiasis/Trypanosoma
139
the second most common fatal infectious dz in the world
Almost all occur in infected immigrants or travelers bringing the dz from endemic areas
malaria
140
Lifecycle of Plasmodium
Malaria begins with a bite form an infected female Anopheles mosquito, a carrier of the parasite
Plasmodium travels to the liver, then to the bloodstream
A mosquito bites the animals/humans and becomes infected
The cycle begins again
141
Prevention of malaria
Prophylactic antimalarial drugs before travel to infested areas
When infection is confirmed, initiate drug therapy ASAP
Prevention of relapse: drugs are given to eliminate the dormant forms of Plasmodium that reside in the liver
Mosquito netting
Protective clothing
142
treats the acute stage of malaria . It interferes with protein synthesis
chloroquine (Aralen)
143
Side effects/adverse reactions of chloroquine (aralen)
Visual disturbances, dizziness
GI distress: A-N-V-D, abdominal cramps
Seizures, confusion, HA, psychosis
Ototoxicity
Renal impairment, hepatomegaly
Hemolytic anemia
Cardiovascular effect
144
teaching for malaria drugs
Prophylaxis does can be taken before, during, after trip to malaria-endemic countries
Take with food
Report vision changes immediately
Avoid large quantities of ETOH
145
nursing interventions for antimalarials
Monitor renal and liver function by checking urine output, BUN, creatinine, and liver enzymes
Monitor the patient for impaired consciousness, headache, or seizures
Monitor patients returning from malaria-endemic areas for malarial symptoms
146
the drug of choice for nonmalarial protozoan infections
metronidazole (Flagyl)
147
treats trichomoniasis, giardiasis, amebiasis
tinidazole (Tindamax)
148
helminths and types
parasitic worms
Four groups of helminths
Cestodes (tapeworms)
Trematodes (flukes)
Intestinal nematodes (roundworms)
Tissue-invading nematodes (tissue roundworms)
149
helminths trasmission and sites affected
Transmission
Entry from infected soil to humans via:
Contaminated food
Bites of carrier insects
Direct penetration of skin
Sites affected
Intestine, lymphatic system
Blood vessels, liver
150
mebendazole (Vermox) classes
Therapeutic Class: drug for worm infections
Pharmacologic Class: anthelminthic
151
mebendazole (vermox)
Broad spectrum drug for mixed helminth infections, common in regions with poor sanitation
Effective against adult & larval stages of the parasites
Absorbed systemically
For pinworms, 1 dose is sufficient; others require 3 consecutive days of treatment
152
adverse effects of mebendazole (vermox)
As worms die, may have abdominal pain, distention & diarrhea
153
least effective of all anti-infectious agents
antivirals
154
means of viral transmission
Droplets: coughing, sneezing, talking
Contact: infected lesions/secretions
Process of replication of itself
155
There are 3 basic strategies used for antiviral pharmacotherapy
Prevent viral infections through vaccinations
Treat active infections with drugs, such as acyclovir (Zovirax) that interrupt the replication cycle
For prophylaxis to boost the person’s immune response; viruses should remain dormant/latent with the person being symptom-free of the virus
156
replicates itself by first reverse-coding its genes into the DNA of the cells it infects. It does this with an enzyme called reverse transcriptase.1
retrovirus
157
profound immunosuppression that leads to opportunistic infections & malignancies
Acquired Immune Deficiency Syndrome (AIDS)
158
slow the growth of the causative agent for AIDS, the Human Immunodeficiency Virus (HIV), by several mechanisms
Antiretroviral drugs
159
drugs for HIV/AIDS
Drugs cost $40,000 - $60,000 per year & may produce serious adverse effects that lower quality of life (QOL)
160
therapeutic goal for HIV drugs
Reduce HIV-related morbidity & prolong survival
Improve QOL
Restore & preserve immune function
Suppress plasma HIV viral load to the maximum extent possible
Prevent HIV transmission
161
Most important indicator of how the virus is replication in the body
viral load
162
drugs that target specific phases of the HIV replication cycle
Antiretroviral therapy (ART)
163
zidovudine (Retrovir, ZDV, formerly AZT) classes
Therapeutic Class: antiretroviral
Pharmacologic Class: Nucleoside reverse transcriptase inhibitors (NRTI)
164
actions of zidovudine (Retrovir, ZDV, formerly AZT)
Creates a defective DNA strand
Treatment of HIV in combination with other antiretrovirals
Prevention of HIV from mother to fetus or neonate
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adverse effects of zidovudine (Retrovir, ZDV, formerly AZT)
Fatigue, generalized weakness, GI symptoms, HA, serious CNS effects have been reported
Fatal lactic acidosis with hepatomegaly and fatty liver dz
Bone marrow suppression resulting in neutropenia or severe anemia
Myopathy with long-term use
166
labs for zidovudine (Retrovir, ZDV, formerly AZT)
Mean corpuscular volume (MCV) may be ↑, WBC & Hgb may ↓ due to neutropenia & anemia
167
efavirenz (Sustiva) classes
Therapeutic Class: antiretroviral
Pharmacologic Class: Nonnucleoside reverse transcriptase inhibitors (NNRTI)
168
efavirenz (Sustiva) actions
Inhibits reverse transcriptase & is approved for children 3 moths or older
Advantage of once-daily dosing & penetration into the cerebrospinal fluid (CSF)
Resistance to NNRTIs can develop, & cross resistance of drugs in this class can occur
High-fat meals ↑ absorption by 50% and may cause toxicity
169
efavirenz (Sustiva) adverse effects
CNS effects: sleep disorders, nightmares, dizziness, ↓ ability to concentrate, delusions, rash
170
contraindications of efavirenz (Sustiva)
Teratogen (birth defects): neural tube defects (NTDs)
Pregnancy
Teach birth control
171
efavirenz (Sustiva) lab changes
may give false-positive for marijuana, may ↑ serum lipid values
172
dolutegravir (DTG, Tivicay)
Therapeutic Class: antiretroviral
Pharmacologic Class: integrase strand transfer inhibitor
173
dolutegravir (DTG, Tivicay) actions
Blocks the strand transfer of retroviral DNA & interrupts the HIV replication cycle
Fewer drug interactions & greater barriers to resistance than other INSTIs
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administration alerts for dolutegravir (DTG, Tivicay)
↑ risk of NTDs in mothers who took drug during first trimester
Only in pregnancy when benefits outweigh risks
175
adverse effects of dolutegravir (DTG, tivicay)
Insomnia, fatigue, HA
May ↑ blood cholesterol & triglycerides
Depression, suicidal ideation, anxiety
176
lab changes for dolutegravir (DTG, Tivicay)
total cholesterol & triglycerides may ↑
177
HIV-infected patients can transmit the virus during
pregnancy, labor, delivery, and breastfeeding
178
Postexposure prophylaxis regimens (PEP)
PEP regimen should be initiated within
the most common reactions
within 72 hours of the event and continued for 4 weeks
most common reactions being nausea, malaise, and fatigue
179
DNA viruses that cause repeated blister-like lesions on the skin, genitals, & other mucosal surfaces
Herpes Viruses
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spread by close contact
Causes
Herpes simplex virus type 1 (HSV-1)
cold sores
181
spread by close contact
causes
Herpes simplex virus type 2 (HSV-2)
lesions on genitalia, and also can be caused by simplex type 1
182
spread by close contact
Causes
Varicella-zoster viruses (HSV-3 or VZV chickenpox and shingles
183
transmitted by body fluids (saliva)
Causes
Epstein-Barr virus (HHV-4 or EBV)
Causes mononucleosis
184
transmitted by body fluids
Causes
Causes
Cytomegalovirus (HHV-5 or CMV)
Causes weakened immune system
Causes chickenpox and mononucleosis
185
herpesvirus acyclovir (zovirax) classes
Therapeutic Class: antiviral for herpesviruses
Pharmacologic Class: nucleoside analog
186
herpesvirus acyclovir (zovirax) actions
Interferes with the steps of viral nucleic acid (DNA) synthesis to ↓ the duration/severity of acute herpes episodes
Most effective against HSV-1 & HSV-2
Effective only at high doses against CMV & varicella zoster
187
herpesvirus acyclovir (zovirax) adverse effects
Nephrotoxicity & neurotoxicity are possible per IV route
Resistance has developed to the drug, particularly in patients with HIV-AIDS
188
herpesvirus acyclovir (zovirax) lab changes
may ↑ BUN & creatinine levels
189
zanamivir (Relenza)
Blocks function of viral neuraminidase protein by stopping the release of viruses from infected cells to health cells
Treats influenza A & B
Take bronchodilators before zanamivir
Administered via inhalation
190
zanamivir side effects
HA, N-V-D, dizziness, weakness
191
Decreases the release of the virus from infected cells by inhibiting activity of neuraminidase to decrease viral spread and shorten duration of symptoms
Treats and prevents influenza A and influenza B
oseltamivir (Tamiflu)
192
oseitamivir (tamiflu) treatment should begin within
48 hours of flu symptoms - treat for 10 days
193
oseitamivir (tamiflu) side effects
N-V-D, dizziness/vertigo HA, insomnia
Monitor closely for abnormal behavior (delirium, hallucinations)
194
transmission of viral hepatitis
Needlestick, intimate sexual contact, or childbirth (HCV)
Blood-borne pathogens spread via blood and body fluids
195
hepatitis CM
Fatigue, malaise
Nausea, abdominal pain
Jaundice
196
vaccines for hepatitis
A and B
197
drug therapy for hep C
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