Week 2 - Chemotherapy Infectious Diseases III Flashcards
TB - Antimycobacterial Agents; Misc Antibacterial Drugs; Antifungals; ANTIViral Agents
What causes tuberculosis?
Mycobacterium tuberculosis
How is tuberculosis primarily transmitted?
Airborne via inhaling infected sputum aerosolized by cough or sneeze
What is a common characteristic of tuberculosis infections?
In most cases, the infected individual has no symptoms
What diagnostic methods are used for tuberculosis?
- Microscopic examination of sputum smears
- Culturing of sputum samples
What is the definition of multidrug-resistant tuberculosis (MDR-TB)?
TB resistant to isoniazid and rifampin
What is extensively drug-resistant tuberculosis (XDR-TB)?
Resistant to isoniazid, rifampin, all fluoroquinolones, and at least one injectable second-line anti-TB drug
What is the standard treatment approach for tuberculosis?
Always contains two or more drugs to which the infecting organism is sensitive
What is the preferred minimum initial treatment for active TB?
Isoniazid, rifampin, pyrazinamide, and ethambutol for 8 weeks, then isoniazid and rifampin for 18 weeks
What is directly observed therapy (DOT)?
Oral administration of medications observed by a healthcare employee
How is the evaluation of tuberculosis treatment conducted?
- Clinical symptoms at each clinic visit
- Sputum tests evaluated every 2-4 weeks initially, then monthly after cultures become negative
What is latent TB and how is it treated?
Latent TB is treated with isoniazid or isoniazid and rifapentine after ruling out active TB
What is the action of isoniazid?
Kills tubercle bacilli at concentrations 10,000 times lower than those needed to affect gram + and gram - bacteria
What are common adverse effects of isoniazid?
- Hepatotoxicity
- Peripheral neuropathy
What is the primary action of rifampin?
Inhibits bacterial DNA-dependent RNA polymerase, suppressing RNA synthesis
What is a common side effect of rifampin?
Discoloration of body fluids (red-orange urine, sweat, saliva, and tears)
What are the most hepatotoxic first-line TB drugs?
Pyrazinamide
What are the common side effects of ethambutol?
- Optic neuritis
- Allergic responses
- GI upset
What is a common treatment regimen for Mycobacterium Avium Complex (MAC) infection?
- Azithromycin or clarithromycin
- Ethambutol
- Rifampin or rifabutin
What is the drug class of ciprofloxacin?
Fluoroquinolones
What are the primary adverse effects of ciprofloxacin?
- GI disturbances
- Tendon rupture
- Photo toxicity
What is the action of metronidazole?
Lethal to anaerobic organisms and used for protozoal infections
What is the primary use of amphotericin B?
Treatment of systemic fungal infections
some protozoal infections
Tx is 6-8 weeks and up to 3-4 onths
What are common adverse effects of amphotericin B?
- Infusion reactions
- Nephrotoxicity
- Hypokalemia
What are azoles used for?
Treatment of systemic mycoses with less toxicity than amphotericin B
What is the action of acyclovir?
Inhibits viral replication by suppressing synthesis of viral DNA
What is the best time to vaccinate for influenza?
October or November
What is the recommended treatment for influenza if symptoms begin?
Oseltamivir (Tamiflu) must begin no later than 2 days after symptom onset
What is the most common place TB infects?
Lungs
can infect other body organs and systems
How long does it take to get lab results (culture) from a sputum sample for possible TB?
culturing takes 2-6 weeks for results
Is TB difficult to treat?
Yes
Takes a long time - months
2 or more meds
Before you get results back from your culture (which can take up to 6 weeks) - How does the initial treatment begin?
Based on evidence of patterns of drug resistance in the community and immunocompetence of the patient
How many drugs are needed to treat ACTIVE TB?
4 drug therapy
can include as many as 7
What two drugs do you ALWAYS start with when treating TB?
Isoniazid & Rifampin
What is the standard of care by health care employee for adherence and oral administration for TB?
Directly Observed Therapy
(DOT)
How many meds for Latent TB?
2+ meds
What organ do TB drugs affect?
Liver
What is the Drug Interactions for Isoniazid?
Phenytoin dose should be reduced because it can increase phenytoin levels.
So - MONITOR LEVELS
What is an adverse effect of rifampin?
Hepatotoxic
What happens to oral contraceptives when on rifampin?
renders oral contraceptives ineffective
use alternate method
What other use for Rifampin?
Leprosy (Hansen Disease)
What are ADVERSE effects of Fluoroquinolone?
TENDON RUPTURE of Achilles tendon - usually over 60 years - taking glucocorticoids
pregnancy
seizures, prolong QT
Dizziness, confusion
Photosensitivity
What history of disease in a patient would you NOT give Ciprofoxacin?
Myasthenia Gravis
Genetic disorder
voluntary muscles
Face
swallowing
weakness
When to discontinue Ciprofloxacin - what signs/symptoms?
First sign of tendon pain,
Swelling
Inflammation in ankle/foot (sore ankle)
Daptomycin - class “Cyclic Lipopeptides”
what does it kill?
gram + bacteria
MRSA
What is the route for Amphotericin B?
Usually IV
go SLOW
What do you use to treat and infuse reaction from Amphotericin B?
(3 drugs)
Tx - Tylenol, Aspirin, diphenhydramine
Nephrotoxicity happens in ALL patients on Amphotericin B.
What would you do on days that the drug is infused to minimize this?
Infusing 1 liter of fluids on days drug is given.
If plasma creatinine rises above 3.5 take action
When taking amphotericin B – drug interactions you would avoid using with …?
nephrotoxic agents
What are the adverse effects of Itraconazole?
Cardio suppression
Liver injury
What would you educate your patient on when taking Itraconazole - when to call DR?
Persistent N/V
Fatigue
Jaundice
Dark Urine
Pale stools
Think - Liver
Superficial Mycosis are treated locally
Tinea Capitis =
Ringworm of the scalp
Superficial Mycosis are treated locally
Tinea Pedis =
athletes foot
Superficial Mycosis are treated locally
Tinea Corporis =
Ringworm of the body
Superficial Mycosis are treated locally
Tinea Cruris =
Jock Itch
Superficial Mycosis are treated locally
Candidiasis =
vulovaginal
Oral = thrish
Superficial Mycosis are treated locally
Onychomycosis
nail fungus
Class =
-cyclovir
Antiviral
Acyclovir uses:
Herpes virus family:
Herpes simplex
Varicella Zoster
Shingles
Chicken pox
What are the side effects of Acyclovir?
reversible nephrotoxicity
(greater risk when dehydrated)
give slow over 1 hour and increase hydration during infusion and 2 hours after
When should you defer a flu vaccine?
Acute febrile illness
Contraindications of Flu shot?
allergy to eggs
Best time to vaccinate for the flu?
October or November
