Week 4 Antiviral/fungal/protozoa/elmintic Flashcards
Antiviral Drug Category Example and MOA/Indication
Oseltamivir
MOA: stops the shedding of the virus’s protein coat
Indication: Tx and reduction of influenza
-is only given to high risk pt, (COPD, immunocompromised)
Antiviral Oseltamivir
SE/AE
SE/AE Dizzy, insomnia, nausea and vomiting, orthostatic, hypotension and urinary retention
Oseltamivir Nsg implications
Tx needs to start within 2 days of the flu symptoms
immunocompromised children/adults may be given oseltamivir if they show symptoms
Herpes Antivirals
Example, MOA, Indication
Acyclovir (can be PO, IV, Topical)
MOA: inhibit viral DNA replication by competing with viral substrates to form shorter non-effective DNA chains.
Indication: herpes simplex AND Varicella Zoster
Herpes Antivirals Acyclovir SE AE
NEPHROTOXICITY , headache, paresthesia’s (pins and needles sensation)
Herpes Antiviral Acyclovir
Interactions Contraindications
Interactions: aminoglycosides, NEPHROTOXIC DRUGS
Contraindications:
Highly toxic in pregnancy/lactation, Renal disease (due to nephrotoxicity)
Herpes Antiviral acyclovir Nsg Implications pt edu
Topical route: apply gloves because it causes burning sensations
IV: admin slowly/over 1 hour to decrease AE, gives the body a chance to properly eliminate the acyclovir
Pt Edu:
-use as prescribed
-using barrier contraception (toxic fetal effects)
-gloves: prevent “burning” and infections (STI )
-Avoid sex while lesions are present,
-Keep area clean, soap/water 3-4x a day
Antivirals used for HIV/AIDS (3 examples)
-zidovudine AZT
-raltegravir
-enfuvirtide
antiviral for HIV/AIDS zidovudine MOA, Indication, Nsg, SE/AE
zidovudine
-reduces HIV by stopping DNA synthesis
Indication: First tx of HIV
SE/AE: headache, N/V, rash, chills, diarrhea, flu-like, BONE MARROW SUPPRESSION
Nsg: zidovudine CAN be given to preg women to stop viral infection to baby
Notify if rash develops (all)
Raltegravir HIV/AID antiviral
MOA/Indication
integrase inhibitor: raltegravir
MOA: inhibits enzymes integrase needed for viral replication
indication: first-line tx of HIV, cocktailed with 2-3 antiretroviral drugs
Antiviral HIV/AID enfuvirtide
MOA Indication
MOA: prevents FUSION of virus and human host cell
Indication: is used when HIV tx is not responding to other antiretrovirals cocktails
FOR ALL Antiviral HIV/AIDS
notify provider if rash develops
(watch for bone marrow suppression in zidovudine)
Hep B and prevention
-can be mild or result in chronic hepatitis/liver failure/death
-transmitted through blood/body fluid exposure
-transmitted to baby
-Hep B vax to prevent HBV
Hep B Tx and Nsg considerations
Tx: lamivudine, tenofovir, and telbivudine
and alfa-interferon
Nsg: LFT’s and RENAL function test, assess for jaundice and LOC or level of consciousness
LOC is impacted by bilirubin
Hep C
-leading cause of liver failure, will need a liver transplant
-transmitted by blood and sexual contact
-alcoholics may develop Hep C!
Prevention : avoid exposure
Tx: interferon, ribavirin, simeprevir, and sofosbuvir
Antifungals 4 examples
nystatin
amphotericin B
terbinafine
fluconazole
Nystatin antifungals
Indication SE AE
-suspension, lozenge (dissolve in mouth) or troche
Indication: treats candidiasis
What are the SE/AE of antifungals?
Interactions?
SE N/V is MOST common, diarrhea, dizzy, HA
AE- HEPATOXICITY, NEPHROTOXICITY,
-is teratogenic, causes peripheral neuropathy, tinnitus
Interactions: will increase the effects of anticoagulants
Antifungals terbinafine will treat?
onychomycosis
fluconazole antifungal can treat what?
yeast infections, meningitis
As a nurse what should you know about antifungals?
antifungal have hepatic and nephrotoxicity,
monitoring kidney/renal function is vital
monitor I&O, k levels
lozenge- instruct not to chew or swallow, let it dissolve
suspension- swish and swallow/sip
Diflucan 1 dose for yeast infections
amphotericin B-pretreat with antipyretic, fever reducer, Tylenol
administer antiemetics, and corticosteroids to lower infusion-related rxns.
Antifungals
nystatin, amphotericin, terbinafine, fluconazole evaluations, and pt edu
-ease infection symptoms
-improve energy
-homeostasis
pt edu
-report any odd bleeding/ bruising (indicates liver problems!)
-report yellowing of eyes or skin, (jaundice and liver function)
-preventing reinfection
RECAP name for antifungals and their purpose
nystatin-candidiasis
amphotericin B-systemic infections
terbinafine-onychomycosis
fluconazole- yeast infections, meningitis
Antiprotozoals
examples (2)
hydroxychloroquine
metronidazole
antiprotozoal hydroxychloroquine
MOA
Indication
Hydroxychloroquine works by attacking the parasite during its development
Indication: prophylactic (prevention) of malaria, systemic lupus erythematosus, and off label autoimmune disorders.
hydroxychloroquine antiprotozoal
SE AE
Nsg
SE/AE: N/V, diarrhea, anorexia, abdominal pains, VISUAL disturbances
NSG
to prevent malaria etc, the drug should be taken 1-2 weeks prior to exposure and 4-8 weeks after leaving
-take the med with 8oz water
-WILL NEED eye exams every 6-12 months
metronidazole
MOA
Indication
MOA: inhabits DNA of protozoa
Indication: trichomoniasis and giardiasis (dirty water), C-diff, H, pylori.
Metronidazole SE/AE
Interactions
Contraindications
SE/AE dizzy, metallic taste, N/V, diarrhea, peripheral neuropathy
Interactions: alcohol, anticoagulants
Contraindications: Hepatic diseases
NSG Implications of metronidaxole
AVOID Alcohol ETOH
Trichomoniasis infections should have partner treated as well
avoid driving until effects are known
Anthelmintic agents
example
mebendazole
mebendazole
MOA
Indication
SE/AE
MOA: interferes with worms normal function
Indication: used against pinworms, round/whip/hookworms
SE/AE: abdomen hurts, headache dizzy
mebendazole anthelmintic
contraindications
nsg implications
contraindicated by pregnancy, hepatic and renal disease
Nsg implications: stool culture for ova and parasites- BEFORE Tx
Assess hgb and hct (may be decreased)
Infection control
short nails
hand hygiene
AM shower
Cleanings linens
toilet disinfections
Carbapenems
-penem
Imipenem
What is carbapenems MOA and treatment for?
Imipenem
MOA inhibits cell membrane synthesis killing the bacteria
severe infection/bacterial pneumonia
Carbapenems imipenem
SEAE
imipenem
C-diff,
Superinfections-thrush, vaginal yeast
N/V
What is the possible interactions/contraindications of imipenem?
What food helps with nausea and vomiting due to carbapenem? What should you do before administering the drug?
-cross-sensitivity to PCN or Cephalosporins,
-harmful in pregnancy cat D
Nursing implications
Probiotic yogurt can help with N/V.
ASSESS C&S, PCN allergies, pregnancy always!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Cephalosporins
cephalexin PO
cefazolin IV
cefaclor PO
ceftriaxone IV
Cephalosporins
cephalexin, cefazolin, cefaclor, ceftriaxone MOA and Indication
MOA-stop cell wall building in bacteria, -cidal and static
Indication: UTI, prevention of post-op infections
Cephalosporins
Cephalexin cefazolin cefaclor ceftriaxone
SE/AE
GI-TRACK BLEEDING!
Rash, renal function decreases, bleeding
Cephalexin cefazolin cefaclor ceftriaxone
Interactions/contraindications
Allergies to PCN, hepatic/renal impaired, ETOH, aminoglycosides, PCN
for cephalexin cefazolin cefaclor ceftriaxone, what would you asses as a nurse?
What would be the pt edu?
ASESS C&S, renal function
Creatine: should be (0.5-1.1)
liver function ALT is (10-55)
Pt edu
- because of the harsh effect/metabolized in liver, avoid Alcohol,
Alcohol + Cephalosporin= Antabuse/disulfiram effect!
-give the med w/ food to ease any upset
PCN: examples
Penicillin G or V obsolete
Amoxicillin
can be combo with clavulanate -PO
Piperacillin/ tazobactam
PCN MOA and indications
MOA: messes up the bacterial cell wall
Indication: strep throat, prevention of endocarditis (dental), sinus infections, peritonitis, Zosyn
PCN SE/AE outside of allergic rxns?
Anaphylaxis, then…
angioedema, itching, renal impairment,
hyperkalemia, dysthymias, hypernatremia
What contraindicates pcn?
What interacts with pcn?
allergies, renal disease
cephalosporins, NSAIDS, oral contraceptives, warfarin
it will reduce Vit K
Warfarin interaction and Vit K reduction = blood too thin
PCN nsg implications pt edu
assess allergies to cephalosporins and PCN
Take 1 hr before, or 2hr after food, with 8oz of water. No juice, the juice will inhibit drug effect
report s/s of allergic rxns, Dyspnea, hives
watch for 30min p admin
use additional birth control
Sulfonamides
Sulfadiazine
sulfamethoxazole
Sulfonamides
Sulfadiazine
sulfonamides
MOA
indication
sulfadiazine : inhibit folic acid synthesis required for synthesis of purine and nucleic acid , a static
indication: UTI, E.coli, klebsiella, Staph CA MRSA
Sulfonamides SE.AE/ interactions contraindications, nsg
photosensitivity, steven Johnson syndrome skin peeling and blistering, N/V, diarrhea, renal effects
Interactions/contra: thiaside diuretics, oral hypoglycemic
sulfonamides will lower blood sugar
drink 8-10 glasses of h2o
-renal damage, minimizes crystal formation in urine
tetracycline
tetracycline
doxycycline
minocycline
How does tetracycline treat the patient and what is is used to treat?
stops protein syth susceptible bacteria preventing replication a static
Acne vulgaris, chlamydia, pneumonia, Lyme disease
tetracycline SEAE contra
N/V, diarrhea, superinfection, bone discoloration, photosensitive
Preg cat D, children under 8 or lactating women
-causes permanent tooth stain because the medicine binds to Ca of teeth
What would a tetracycline patient want to incorporate and avoid into there lifestyle and the way the administer the drug?
-use sun protection
-avoid dairy, iron preparations
antacids 2 hrs before —-admin because it inactivates tetracycline
-take with water 6-8oz
-food can help with stomach upset not dairy
-alt BC!
Macrolides 3 examples
Clindamycin
Erythromycin
Azithromycin
Macrolides
MOA-
Indication
MOA stop protein syth, cidal static bacterial
Indication: for patients with PCN allergy, strep, gonorrhea, chlamydia
macrolide mcyin drugs indications
clindamycin-
erythromycin-
azithromycin-
SE/AE
interactions/contra
Erythromycin: CNA and GI upset hepatoxicity, superinfections
Azithromycin: fewer GI AE longer duration of action and better efficacy
Clindamycin: c-diff
Inter/Contra: hepatic impairment, warfarin and digoxin
Aminoglycosides
Gentamin, neomycin, tobramycin
Aminoglycosides
gentamicin, neomycin, tobramycin
MOA
Indication
MOA: protein syth inhibition of gram negative bacteria, these bacteria cause serious toxicity
Indication: E. Coli, pseudomonas, klebsiella pneumonia
aminoglycosides gentamicin, neomycin, tobramycin
SE/AE (black box warning) (most common)
contraindications:
Interactions
Nsg/pt edu
SE/AE: OTOTOXICITY, NEPHROTOXICITY BLACK BOX WARNING
dizzy-most common
contraindicated by renal/hepatic disease, hearing loss
interactions: loop diuretics which increase ototox,
do not mix with PCN in the same IV solution
Nsg implications: Peak and trough
P=30min after IV
T=right before next does
-in order to prevent ototoxicity, perform renal function tests, hematuria, BUN and creatine
-drink plenty water, report tinnitus
As a nurse, what would you want to be sure/know pertaining to antibiotic use?
What would you want your patient to know?
get C&S before admin of therapy!!!!!
-Superinfections: yeast, c-diff (s/s of yeast: foul odor, redness in stomach folds, yellow on tongue)
-take as prescribed
-common AE is N/V, diarrhea
Therapeutic effect
-improved signs of infection, lowered WBC, normal vitals, negative C&S, no fever/lethargy, drainage, redness.
Monitor Adverse reactions/hypersensitivity
-SOB, hives, itching swelling
-drink plenty fluids! avoid kidney damage
-take as prescribed
-report hives, breathing problems, severe headache, changed urine output
Antitubular ppd and indication
PPD purified protein derivative
PPD Mantoux test
indication: screening for exposure to TB
antitubular drug
isoniazid*
rifampin*
rifabutin
pyrazinamide
rifapentine
isoniazid
rifampin
rifabutin
pyrazinamide
rifapentine
MOA Indication
act on DNA of bacteria
tx of TB
What are the SE/AE of antitubular drugs?
What are they contraindicated by
SEAE
*peripheral neuropathy, hepatoxicity
*Rifampin: orange-colored body fluid is normal
Contraindicated: by using both isoniazid and rifampin leading to hepatotoxicity and increase drug effects
isoniazid + phentoin= phenytoin
What should you know as a nurse about antitubular drugs?
What would you want to include in patient education?
Monitor therapeutic effect: decreased s/s of TB, C&S, improved chest XRT
pt edu
Rifampin-orange color in body fluid is normal
avoid alcohol (hepatotoxicity)
take med at the same time/day
report fever, diarrhea, peripheral neuropathy, or bloody stool/jaundice
Tx can last 12 months*
contagious initially
**use alternate BC! because it decreases the effectiveness.
purified protein derivative Mantoux
+ result is indicated by redness at site of injection
if the skin test is pos a chest x-ray needs to be completed, if the chest XR shows +, must obtain C&S of sputum
10mm tall bump
Bacille Calmette guerine BCG is a vaccine for TB can cause false positives
Retinoid and indication
isotretinoin /Acutane
severe nodulocystic acne vulgaris
isotretinoin inter/contra labs, nsg
contraindicated by pregnancy: Category X
females need 2 neg preg tests
Liver function tests, lipid panel, Complete Blood Count
Nsg
preg test each month before refills, use multi BC
watch for yellow skin jaundice
avoid alcohol, use sunscreen
