WK 2 - Pharm slides Flashcards
MDR - TB
TB is resistant to which drugs?
isoniazid
rifampin
the most effective anti-TB drugs
What are the most effective anti-TB drugs?
isoniazid & rifampin
XDR-TB
Resistant to which drugs?
- isoniazid & rifampin
- All fluoroquinolones
- at least one injectable second line anti-tb drug
TB always contains how many drugs minimum?
two or more
which the organism is sensitive to
How do you determine sensitivity for drug for TB?
sputum culture
takes 6 weeks
While waiting for sputum culture for TB how do you begin treatment?
what is it based on?
patterns of drug resistance in the community and immunocompromised patient
Active TB is how many drug therapy?
4
Which two drugs are always used to start treatment of TB?
isoniazid & rifampin
can include as many as 7 drugs
If the organism is not resistant to isoniazid & rifampin - what is the treatment protocol?
isoniazid & rifampin & pyrazinamide &
ethambutol – for 8 weeks
Then isoniazid & rifampin for 18 weeks
minimum for active TB
Who gets involved when there is a diagnosis of TB?
What agency gets notified?
Public Health
What is the standard of care for TB when it comes to adherence?
DOT
Direct Observation Therapy
Healthcare employee watch patient take PO meds
How often is a TB evaluated -
Clinical symptoms?
Sputum tests?
After cultures become negative?
Clinical symptoms - each clinic visit
Sputum tests - every 2-4 weeks
After cultures become negative - monthly
What is Latent TB treated with?
2 options:
- Isoniazid
- Isoniazid & rifampin (12 years or older; HIV infection Not taking antiretroviral drugs
What are the clilnical symptoms of TB
fever
malaise
anorexia
cough
Areas that are high risk for TB?
Prisons, jails
nursing homes
hospitals
homeless shelters
How many drugs for Latent vs Active TB?
Active 4+
Latent 2+
Adverse effects of Isoniazid?
Hepatoxicity (no ETOH)
Peripheral neuropathy
what does isoniazid treat?
active and latent TB
Isoniazid interacts adversely with what drug causing a need to monitor that drug’s levels?
Phenytoin. (seizure med)
Rifampin has what common side effect that is normal but alarming to see?
Discoloration of bodily fluids - urine, sweat, saliva, tears
turn a reddish orange color
What is the drug of choice for pulmonary TB?
Rifampin and other TB drugs
Also - rifapentine (a long acting rifampin)
Adverse effects of Rifampin?
Hepatoxicity
Reddish orange bodily fluids
What does rifampin do to oral contraceptives?
renders them ineffective
use alternative
In HIV patients, what drug is preferred over rifampin?
rifabutin
What is the most hepatotoxic of all first line drugs for TB?
Pyrazinamide
What are the side effects of Pyrazinamide?
polyarthralgias (joint pain)
hyperuricemia
GI disturbances
Rash
Photosensitivity
Is ethambutol bactericidal or bacteriostatic?
bacteriostatic
inhibits growth - does not kill all
What is the most common side effect of ethambutol?
Optic Neuritis
What are two other uses for TB drugs?
Leprosy (Hansen Disease - Rifampin)
MAC - MycobacteriumAvium Complex Infection
MAC - MycobacteriumAvium Complex Infection – commonly found where?
food, water, soil
What are uses for Fluoroquinolone drugs?
- eye infections
- TB
- Respiratory Infections
- Infections of bone, joints & soft tissue
- UTIs, STDs
Are Fluoroquinolones bactericidal or bacteriostatic?
bactericidal -
cell death
Adverse effects of Fluoroquinolones are:
- Tendon Rupture (<18 cartilage)
- QT prolong
- Pregnancy
- Seizures
- Dizziness, confusion
- Photosensitivity
What class are Ciprofloxacin?
fluoroquinolones
Ciproflaxin used for…
Respiratory infections
UTI
bone/joint infections
Ciprofloxacin side effects
Tendon Rupture
diarrhea
C-diff & Candida (super infection)
Photosensitivity
When taking ciprofloxacin should not be given with patients with…
Myasthenia Gravis
Ciprofloxacin reacts with milk and calcium - how to administer with those items?
med 6 hours before calcium, milk
or
2 hours after calcium milk
Use this mnemonic for nursing considerations:
F
L
O
X
A
C
I
N
S
F -fluid intake - 8 oz glass and 2L/day
L -long QT intervlas
O -older adults - DTR rupture - achiles
X -Don’t administer Cations - calcium, iron.
A -avoid in kids
C -C-diff
I -interactions with cafeine, pheno, warfarin, theophyline
N - neuromuscular - MYASTHENIA GRAVIS
S -sunscreen
what kills gram + and MRSA?
Daptomycin - cyclic lipopeptides
Amphotericin B, ketoconazole, fluconazole, are what class fo drugs?
Antifungals
treat systemic fungal infections
Amphotericin B treat ?
systemic fungal infections
some protozoal infections
What route is Amphotericin B given and how?
IV and slow
What are four adverse effects of Amphotericin B?
Infusion reactions
Nephrotoxicity
Hypokalemia - kidney damage
bone marrow suppression - monitor RBCs
Avoid using what type of drugs when using amphotericin B?
nephrotoxic drugs
When taking Amphotericin B - everyone gets nephrotoxicity (kidneys) - how can you minimize this?
by infusing 1 liter of fluid on days drug is given
if creatinine >3.5 take action
how can you reduce infusion reactions form amphotericin B?
pretreat with?
Diphenhydramine + Acetaminophen
ASA can also help but increases nephrotoxicity (kidneys)
AZOLES - what organ effect toxic
hepatotoxicity
liver
What is an alternative to amphotericin B -
Azoles
less toxic and can be given by mouth
Superficial Mycosis are treated locally
Tinea…
Tinea Pedis = athlete’s foot
Tinea corporis = ringworm of the body
Tinea Curis = jock itch
Candidiasis = vaginal or oral thrush
Onychomycosis =
nail fungus and hard to treat
Tinea Capitis =
ringworm of the scalp and hard to treat
Tinea Pedis =
athlete’s foot
Tinea corporis =
ringworm of the body
Tinea Curis =
jock itch
Candidiasis =
vaginal or oral thrush
Acyclovir are used for…
antiviral
herpes
varicella-zoster viruses
both shingles and chicken pox
Acyclovir adverse effects…
reversible nephrotoxicity (greater risk of dehydrated)
contraindicated with pregnancy
ACYCLOVIR - When would use
IV ?
PO ?
IV = acute outbreak - extreme case
PO = prevent outbreak
What are the contraindications for the influenza vaccine?
Guillain-Barre syndrome
egg allergy
acute febrile illness (fever) - hold until better
When is the best time to vaccinate?
October or November
What is a treatment for the flu?
Oseltamivir (Tamiflu)
Influenza A & B
within 48 hours (2 days)
