treatment of infections part 3 Flashcards
describe the etiology of viruses and viral infections
- intracellular viruses enter host cell
- mode of transmission varies
- all human cells do not have receptors for all viruses
what are soem clinical manifestations of viruses and viral infections
- may have no symptoms
- fever
- headache
- couhg
- malaise
- muscle aches
- N/V/D
- insomnia
- photophobia
describe drug therapy for viruses and viral infections
- vaccines
- antiviral agents prevent viral replication but are expensive and often toxic
PREVENTION IS KEY
name some herpes viruses
- herpes simplex (cold sores-HSV1 and genital sores HSV2)
- chickenpox (herpes varicella)
- shingles (herpes zoster)
- cytomegalovirus (CMV)
name some different topical antivirals for herpes
- docosanol (OTC)
- penciclovir
- trifluridine
name some systemic antivirals for herpes
- famciclovir
- acyclovir
- valacyclovir
what are some adverse effects of herpes antiviral drugs
- CNS: fatigue
- bone marrow suppression: especially in neonates, can cause anemia or leukopenia
- skin: thrombocytopenia purpura (rash)
- renal: hemolytic uremic syndrome (pallor, fatigue, blood in urine and shit)
what are some cautions for herpes antivirals
- renal dysfunction
- CNS disorders (bc seizure meds can become less effective)
- use caution in neonates, infants and children
what will you monitor for with herpes antivirals
- signs and symptoms of infection
- adverse reactions
what are some patient education considerations for herpes antivirals
- treatment of initial infection is longer than recurrence
- herpes is never cured and can spread even when dormant
- always use protections and no sexy time with active sores
describe cytomegalovirus and its symptoms
- herpes virus, opportunistic infection seen in immunocomprimised patients
- affects the eyes (retinitis), resp tract (pneumonitis), liver (hepatitis)
give an example of a drug for cytomegalovirus
ganciclovir
PO, IV, topical
what are some nursing considerations for ganciclovir
- monitor BUN/creatinine and CBC
- pregnancy test before and 3mo after
what are some adverse effects of ganciclovir
- CNS: fever and chills
- skin: severe pruritis (itching everywhere)
- renal: can cause dysfunction
- black box warnings: bone marrow supression and birth defects
what are some contraindications/cautions for ganciclovir
- pregnancy/lactating
- bone marrow supression
- renal dysfunction
what antiviral is given for the flu
oxeltamivir
tamiflu
what antiviral is given for RSV
ribavirin
what is the black box warning for ribavirn
significant teratogenic (cant even be in the same room when drug is given inhalation)
whats something to remember about oseltamivir
administer within 48hrs of onset of symptoms
what are you going to monitor when giving ribavirin or oseltamivir
- resp system
- also educate on vaccines and birth control
what drugs are used to treat hepatitis B and C
nucleoside analogs and pegylated interferon
what are some adverse effects of nucleoside analogs (hep B drug)
- can cause pancreatitis and referred pain to the back
- fever, vomiting, tachycardia
- black box warning for lactic acidosis and hepatomegaly (RUQ pain, jaundice)
what are drugs to treat HIV called?
antiretroviral treatment (ART)
describe patient education for viral hepatitis and HIV treatment
- prevent transmission
- closely adhere to treatment regimen (even missing one or two doses is pretty rough)
- regular blood tests
- practice safe sex
- use clean needles
with COVID, post vaccination, majority do not need…
hospitalization
what should you remember about available treatments for covid
- sx can come back and person may test positive again
- some are only used in inpatient setting bc they are IV only
which os the following is true regarding oseltamivir?
1) the drug should be started within the first 48hrs
2) it is used to treat UTIs
3) it can cause pancreatitis
4) patient may develop cdiff
1) drug should be started within the first 48hrs
describe fungal infection etiology
- range from athletes foot to fatal systemic infection
- rigid cell wall (similar to human cells)
- some are from the environment or the normal flora
what do the clinical manifestations of fungal infections depend on?
type of infection and whether the patient is immunocompromised
fungal infection clinical manifestations
oral
white patches on tongue and throat
fungal infection clinical manifestations
GI
diarrhea d/t loss of normal flora
fungal infection clinical manifestations
vaginal
yellowish vaginal discharge, inflammation
fungal infection clinical manifestations
skin
red, macerated, smells like shit
fungal infection clinical manifestations
systemic
can affect brain, heart, kidneys, eyes
may be fatal
what are the three main drug therapies for fungal infections
- polyenes (act on ergosterol to disrupt the fungal cell membrane)
- azoles (bind to an enzyme that is required to synthesize ergosterol)
- echinocandins (disrupt the fungal cell wall and are less toxic)
describe amphotericin B and its pharmacokinetics
- polyene
- highly toxic - for serious fungal infections only
- must be given IV over 4-12 weeks
- lipid form higher concentration in diseased tissues, for patient with renal dysfunction, more expensive
what are some adverse effects of amphotericin B
- GI effects
- GU: hypokalemia and renal failure(only for nonlipid version)
- hematologic effects (bone marrow suppresion)
- fever, chills, hypotension
black box warning: multiple organ failure, respiratory arrest, cardiac arrest
only given in situations where if we dont, patient will “expire”
what are some cautions/contrainidcations of amphotericin B
- allergy
- renal impairment (unless using the lipid form)
what are some nursing considerations for amphotericin B
- prevent interactions (aminoglycosides)
- must infuse with dextrose and flush before and after with dextrose
- administer aspirin, antihistamines, and antiemetics prior
- assess for phlebitis
describe nystatin
- polyene
- used for oral, intestinal, and vaginal candidiasis
- oral - swish swish swish
name some azoles
OTC topicals: clotrimazole, miconazole
systemic: fluconazole, ketoconazole
these come in many formulations like PO, IV, shampoo, and topical cream
what are some adverse effects of azoles
- liver toxicity
- GI
- CNS: headache
- skin: rash/alopecia
what are soem contraindications/cautions for azoles
- hepatic/renal dysfunction
- endocrine/fertility probs
name some echinocandins
- caspofungin
- micafungin
fungins
describe the pharmacokinetics of echinocandins
highly bound to plasma albumin
what are some adverse effects of echinocandins
- CNS: fever, headache
- skin: rash
- GI
- GU: mild increase in BUN and Cr
- bone marrow suppression
contraindicated in infants <3months
what are some nursing considerations for echinocandins
- assessment during first 15mins of administration
- incompatible with any IV meds except normal saline
- assessment includes CBC and CMP
describe terbinafine
- broad spectrum antifungal
- oral therapy for onychomycosis (fungal infection of the nails)
- black box warning: can cause hepatotoxicity
which of the following are drug interactions with amphotericin B?
1) anti-diabetic meds
2) insulin
3) aminoglycosides
4) macrolides
3) aminoglycosides
amphotericin B has drug iteractions with aminoglycosides, barbituates, benzos, and antihypertensives
parasitic infections can be caused by…
- protozoal
- helminths (wormy worms)
- scabies
- pediculi (lice)
are there vaccines for parasitic infections?
no ma’am
prevention is key on this one
(insecticide use, surveillance process, and drug therapy)
what are protozoal infections caused by?
- insect bites (malaria)
- ingested/contact organisms (amebiasis, giardiasis, trichomoniasis)
describe amebiasis
happens from ingesting food with human shit in it
you get tons of diarrhea
describe giardiasis
honestly cant remember but also comes from shit
you get rotten egg smelling shit, weight loss, and malnutrition
describe trichomoniasis
men are asymptomatic then pass it on to the ladieas who are symptomatic
causes red/inflamed vaginal tissue, itching, burning, and some fucked up discharge
describe malaria
- parasitic disease that has killed millions and is transmitted through the bite of a specific mosquito
- the mosquito has developed resistance to pesticides and there are resistant strains developed to antimalarial drugs
name some types of drug therapy for malaria
- chloroquine phosphate
- hydroxychloroquine
- mefloquine
these inhibit prostaglandin effects
what are some adverse effects of antimalarials
- retinal toxicity
- ekg changes
give two examples of amebicides
- metronidazole
- tinidazole
what are some nursing considerations for amebicides
- watch liver function
- black box warning to only be used when needed
- contraindicated in pregnancy
- avoid alcohol for a couple days (flushing, sweating, N/V)
describe helminth infections
- most common of all diseases, more common in tropical areas, increased due to world travel
- lots of different types
- most oftne found in GI tract
- difficult for patients to accept the diagnosis -> causes intense itching around the asshole
how do you diagnose a helminth infection
stool specimen for ova and parasites
how do you treat helminth infection
antihelmintic drugs
family members may also be treated
describe prevention of reinfection and spread of helminth infection
- handwashing
- laudering items/undies
- disinfection of bathroom/toilet
- separate bathroom/toilet
- good personal hygiene
name and describe an antihelminitic
mebenazole
- can cause hepatitis
- avoid alcohol
- re-check stool. sample in three weeks
can also cause abdoinal pain, anorexia, diarrhea, N/V
scabies and pediculosis are parasitic infestations of the…
skin
name and describe drugs for scabies/pediculosis
permethrin
- topical
- assess for chrysanthemum allergy
lindane
- topical
- second line treatment bc of black box warning for CNS toxicity
- can cause seizures
the patient is receiving mefloquine. wich of the following assessment findings is the most concerning?
1) nausea
2) diarrhea
3) muscle aches
4) changes in EKG
4) changes in EKG
mefloquine is an antimalarial, asverse effects are EKG changes and retinal toxicity
