Viruses, Fungi, Parasites Flashcards
What are herpesviruses
Herpes simplex virus are fever blisters or cold sores on lips, mouth, face.
Genital herpes
There’s also cytomegalovirus which manifests as cytomegalovirus retinitis and patient may have blurry vision
What is the prototype for a herpesvirus drug?
Acyclovir
MOA for acyclovir
Interrupts viral DNA replication
Uses for acyclovir
Herpes simplex virus
Genital herpes
How does acyclovir help a patient with genital herpes?
Decreases duration and pain
It helps with viral shedding which means it decreases the risk of transmission
Nursing considerations for acyclovir
Apply topical with gloved hand
IV form but it associates with encephalopathy
What is the antiviral for CMV
Ganciclovir
MOA for ganciclovir
Inhibits viral DNA synthesis
Uses for ganciclovir
Cytomegalovirus (CMV) retinitis
Nursing considerations for ganciclovir
Use cautiously with patients who have renal impairment
Adverse effects of ganciclovir
2 BBW
- Granulocytopenia (neutropenia),
Thrombocytopenia - Maintain contraceptive precautions during and 90 days after therapy because it can cause birth defects
What is the oral formulation for ganciclovir
Valganciclovir
Nursing considerations for valganciclovir
Same BBW as ganciclovir
Take with high fat meal to increase absorption
What is respiratory syncytial virus (RSV)?
Respiratory illness that is more severe in babies causing cyanosis
Adults and healthy children can carry the disease with just common cold symptoms
What is the prototype drug for RSV
Ribavirin
MOA for ribavirin
Interferes with DNA and RNA replication
Uses for ribavirin
RSV in children
Nursing considerations for ribavirin
Given via inhalation
Monitor for signs of respiratory distress such as nasal flaring
Adverse effects of ribavirin
BBW for severe teratogenic effects
Antiviral to treat influenza?
Oseltamivir phosphate
MOA for oseltamivir phosphate?
Does not allow new viruses to escape cell
Uses for oseltamivir phosphate
Influenza in patients over 1 year old
Nursing considerations for oseltamivir phosphate
May take prophylactically
Adverse effects of oseltamivir phosphate
Some side effects are similar to flu symptoms
Take with food to decrease GI upset
What is the result of hepatitis?
Severe liver damage if not properly treated
Hep C can lead to cirrhosis, liver cancer, liver failure
How do you get Hep A?
Fecal- oral route, or close contact with infected person
How do you get Hep B?
Contaminated blood, other bodily fluids
Prototype for hepatitis
Lamivudine
MOA for lamivudine
Incorporates into the viral DNA and terminates it
Uses for lamivudine?
Chronic Hep B
HIV (off- label)
Adverse effects of lamivudine
*Can cause pancreatitis which presents as severe upper abdominal pain
Hepatomegaly with steatosis which is basically an enlarged or fatty liver.
*BBW
Lactic acidosis which presents as musculoskeletal pain (think pain after a workout)
What is human immunodeficiency virus (HIV)
Retrovirus
Binds to, and eventually destroys CD4+ cells (ex T lymphocytes)
CD4+ cells normally help regulate immune function
Can progress to acquired human immunodeficiency syndrome (AIDS)
What is the initial phase of HIV
Presents with flu like symptoms, lasting several weeks
What is the immune response of HIV
Decrease in viral reproduction
Asymptomatic, but infectious
What is the immune system damaged phase in HIV
Increased viral production
Illness progresses to aids phase in HIV
Once viral load reaches high levels
Serious opportunistic infections
What is pre exposure prophylaxis (PrEP)
A way for people who do not have HIV, but are at very high risk of getting HIV to prevent HIV infection by taking a pill every day
And that pill is Truvada (tenofovir and emtricitabine)
How does PrEP work?
When taken daily, lowers risk of HIV infection:
From sex by about 99%
From injections by about 74%
If not taken consistently, not as effective
What are the antivirals for HIV
Nucleoside reverse transcriptase inhibitors (NRTIs)
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
Prototype for NRTIs?
Zidovudine
MOA for Zidovudine
Incorporates into viral DNA and terminates
Uses for Zidovudine
Prevents HIV transmission from mother to fetus
Adverse effects of Zidovudine
BBW
Granulocytopenia, pancytopenia
Lactic acidosis, hepatomegaly
Prototype for NNRTIs?
Efavirenz
MOA for Efavirenz
Similar to NRTI
Has synergy
Uses for Efavirenz
HIV
Adverse effects of Efavirenz
Not for patients with hepatic impairment
Stevens-Johnson syndrome
CNS effects
Take at night
Prototype of the polyenes
Amphotericin B deoxycholate
MOA for amphotericin B deoxycholate
Disrupts the membrane of fungal cells and stops reproduction
Uses for amphotericin B deoxycholate
BBW: reserved for potentially fatal infections
Adverse effects of amphotericin B deoxycholate
Renal impairment common
Keep hydrated with IV sodium chloride
Organ failure, cardiac arrest, respiratory arrest
Premeditate
Separate IV line (have its own IV line) and it should use an inline filter when administered
What’s special about the lipid formulation of amphotericin B deoxycholate
Less terrible
Less nephrotoxic
Do not use inline filter!
Prototype for the anti fungal Azoles
Fluconazole
Usually ends in -conazole
MOA for fluconazole
Disrupts membrane permeability
Uses for fluconazole
Drug of choice for candida infections
Adverse effects for fluconazole
Half dose if poor renal failure
Hepatotoxicity
Enzyme inhibitor
Watch for drug interactions
What’s an enzyme inhibitor?
Enzyme inhibitor = decreased drug metabolism= increased effects of some drugs= increased risk of toxicity
Prototype for pyrimidine analog?
Flucytosine
MOA for Flucytosine
Affects cell membrane, resulting in cell death
Uses for Flucytosine
Adjunct with AMP B for candida and cryptococcus
Adverse effects of Flucytosine
BBW: caution in renal impairment
Hepatotoxicity and bone marrow toxicity
But those things are dose dependent.. so.. Monitor labs closely to adjust dose
Prototype for amebicides
Metronidazole
MOA for Metronidazole
Diffuses across cell membrane, resulting in cell death
Uses for Metronidazole as an anti parasitic
Intestinal amebiasis
Trichomoniasis
Adverse effects of Metronidazole
Metallic taste, dark urine
Avoid alcohol during treatment and 3 days after
If taken with alcohol, can cause disulfiram reaction which presents as tachycardia, nausea, flushing, vomiting
Nursing considerations for anti parasitic Metronidazole
Assess stools for less diarrhea
Prototype for the antimalarials
Chloroquine phosphate
Usually ends with -quine
MOA for Chloroquine phosphate
Interferes with parasite DNA, RNA, and metabolism
Uses for Chloroquine phosphate
Treatment and prophylaxis of malaria
Nursing considerations for Chloroquine phosphate
Visual disturbances
Electrocardiogram changes
Take weekly (same day) for ppx; and daily for treatment
Prototype for anthelmintics
Mebendazole
MOA for Mebendazole
Blocks glucose uptake
Uses for Mebendazole
Worms (pinwork, hookworm, roundworm, whipworm)
Nursing considerations for Mebendazole
Chew/crush and swallow
Teratogenic
What is the main pinworm?
Enterobius vermicularis
What are the symptoms of Enterobius vermicularis
Perianal itching
What should you do if infected with Enterobius vermicularis
Disinfect toilets after use
Clean clothes, sheets, towels daily
Treat family members.. very contagious
Wash hands
Prototype for scabicides and pediculicides
Permethrin
MOA for permethrin
Stops influx of sodium, thus paralyzes and kills the parasites
Uses for permethrin
Lice and scabies
How do you apply permethrin to kill lice
Wash hair, apply cream, let it sit for 10 minutes, rinse with water, use lice comb
Repeat in 1 week if still present but this time keep drug on hair overnight
How to use permethrin for scabies
Apply head to toe and leave on for 8 to 14 hours
What are the main parasitic infections
Amebiasis
Malaria
Helminthiasis (worms)
Pediculosis (lice)
Scabies
