Shared Flashcard Set

Details

Immune System
Immune System Modulators, Antineoplastics
172
Pharmacology
Post-Graduate
04/08/2010

Additional Pharmacology Flashcards

 


 

Cards

Term

 

 

 

hepatitis B vaccine

(Engerix-B, Recombivax HB)

 

Mechanism of Action

Definition

Immune System Modulators- Immunization Agents (MC)-

Vaccines (SC)

 

Vaccine contains suspension of inactivated hepatitis B surface antigen (HBsAg)

 

Provides active immunity against the hepatitis B virus

 

Part of current immunization schedules

 

For individuals at high risk for exposure

Term

 

 

hepatitis B vaccine

(Engerix-B, Recombivax HB)

 

A/T/A/T

Definition

Immune System Modulators- Immunization Agents (MC)-

Vaccines (SC)

 

IM: 3-dose series

adults-deltoid muscle preferred

neonates-anterolateral thigh

shake vial well to assure inuform suspension

document lot # after administration

 

Contraindications: active infection or fever, immunocompromised state, compromised CV status, pregnancy

Term

 

 

 

hepatitis B vaccine

(Engerix-B, Recombivax HB)

 

A/T/A/T

Definition

Immune System Modulators- Immunization Agents (MC)-

Vaccines (SC)

 

Serologic confirmation of antibody production recommended/required


+ titer


85% protected against hepatitis B infection after second dose, 90% after third

Term

 

 

 

hepatitis B vaccine

(Engerix-B, Recombivax HB)

 

A/T/A/T

Definition

Immune System Modulators- Immunization Agents (MC)-

Vaccines (SC)

 


Local: mild tenderness at injection site, local inflammatory reaction


Systemic: fever, fatigue, malaise, headache


Be prepared for more severe allergic response

Term

 

 

 

hepatitis B vaccine

(Engerix-B, Recombivax HB)

 

A/T/A/T

Definition

Immune System Modulators- Immunization Agents (MC)-

Vaccines (SC)

--Explain risks of contracting vaccine-preventable diseases

--Explain current CDC recommendations for immunizations (adult and child)

--Females of CB age must avoid pregnanct for a month after receiving vaccination

--Provide patiend with ecidence of immunization

--Provide date for next vaccination

--Discuss common side effects

--Discuss symptoms to immediately report to healthcare provider

Term

 

 

 

interferon alfa-2a

(Roferon-A)

 

Mechanism of Action

Definition

Immune System Modulators- Immunostimulants (MC)-

Interferons (SC)

 

Interferon normally produced by lymphocytes & macrophages within 4-6 hours after viral infection

 

Enhances immune system to remove antigens; inhibit virus replication (antiviral)

 

Suppresses cancer cell growth

Term

 

 

 

interferon alfa-2a

(Roferon-A)

 

A/T/A/T

Definition

Immune System Modulators- Immunostimulants (MC)-

Interferons (SC)

 

SQ/IM (SQ if bleeding risk)

baseline vitals, weight, mental status

baseline labs: CBC, platelet count, liver & renal fn

patient should be well hydrated before use

 

Contraindications: renal or liver dz, neonates/infants, pregnancy, other forms of hepatitis, blood dyscrasias, cardiac/pulmonary dz, neuropsychiatric disorders

Term

 

 

 

interferon alfa-2a

(Roferon-A)

 

A/T/A/T

Definition

Immune System Modulators- Immunostimulants (MC)-

Interferons (SC)

 

Increase immune system response - decreased viral infection

 

Labs: WBCs improved

 

Others related to decrease viral infection

-Hepatitis: improved liver fn test

Term

 

 

 

interferon alfa-2a

(Roferon-A)

 

A/T/A/T

Definition

Immune System Modulators- Immunostimulants (MC)-

Interferons (SC)

 

Most common: flu-like sx (50%) - fever, chills, fatigue, dizziness

 

CV: hypotension, dysrhythmias

 

More severe: myelosupression, hepatotoxicity, neurotoxicity, mental status changes: depression, psychosis

 

GI: N/V/D/A

Term

 

 

 

interferon alfa-2a

(Roferon-A)

 

A/T/A/T

Definition

Immune System Modulators- Immunostimulants (MC)-

Interferons (SC)

 

Take as directed - proper injections technique

Contraception

Avoid: ETOH

Report adcerse effects immediately

Report s/sx infection, bleeding

Follow-up labs: CBC, liver & kidney function tests

Monitor weight & report decrease PO intake

May take other meds for treating minor adverse effects

Term

 

 

 

Immunosuppressants

Mechanism of Action &

Pharmacotherapeutics

Definition

 

 

Inhibit immune system

 

All subclasses suppress some aspect of T-cell funtion

 

Prevent transplant rejection

 

treat autoimmune diseases - e.g. rheumatoid arthritis, Chrohn's dz

Term

 

 

 

cyclosporine

(Sandimmune, Neoral)

 

A/T/A/T

Definition

Immune System Modulators- Immunosuppressants (MC)-

Calcineuria Inhibitors (SC)

 

PO/IV - slow IV for first 30 mins

Neoral (PO) & Sandimmune (IV) - not interchangeable with dosing

Baseline labs: CBC, kidney/liver fn tests, electrolytes

PO - mix with diluent; NO GRAPEFRUIT JUICE

 

Contraindications: renal or liver dz, pregnanct/lactation, individuals recently inoculated with live vaccine (esp. viral), blood dyscrasias

Term

 

 

 

cyclosporine

(Sandimmune, Neoral)

 

A/T/A/T

Definition

Immune System Modulators- Immunosuppressants (MC)-

Calcineuria Inhibitors (SC)

 

Absence of s/sx of organ rejection - graft tenderness or fever

 

Depending on transplanted organ, other labs or diagnostic tests

 

Check serum level of cyclosporine

Term

 

 

 

cyclosporine

(Sandimmune, Neoral)

 

A/T/A/T

Definition

Immune System Modulators- Immunosuppressants (MC)-

Calcineuria Inhibitors (SC)

 

Nephrotoxicity (75% of patients) -dose-dependent --> High BUN, Cr.

Infection (74%) - fever, sore throat

CV - HTN

Neuro - tremors

Hirsutism

Lymphomas - fixing one condition caused another

Less common: hepatotoxicity

Term

 

 

 

cyclosporine

(Sandimmune, Neoral)

 

A/T/A/T

Definition

Immune System Modulators- Immunosuppressants (MC)-

Calcineuria Inhibitors (SC)

 

--Take as directed - same time qd

--Take with food to reduce GI upset

--Enhance palatability of oral solution by mixing with milk, chocolate milk, or orange juice;use a glass versus plastic container

--avoid grapefruit juice

--contraception

--report adverse effects immediately: infection; change urinary status

--infection and injury prevention

Term

 

 

 

cyclosporine

(Sandimmune, Neoral)

 

Mechanism of Action

Definition

Immune System Modulators- Immunosuppressants (MC)-

Calcineuria Inhibitors (SC)

 

 

Binds to colcineurin (intracellular messenger/enzyme that promotes synthesis of interleukin and other cytokines) to disrupt T-cell function, specifically, helpter T-cells --> supresses prodection of interleukins, interferons, and other cytokines

Term

 

 

 

cyclophosphamide

(Cytoxan)

 

Definition

 

 

Cancer Tx- Antineoplastics (MC)- Alkylating Agents (SC)

Term

 

 

 

methotrezate

(Folex, Mexate)

 

Definition

 

 

Cancer Tx- Antineoplastics (MC)- Antimetabolites (SC)

Term

 

 

 

doxorubicin

(Adriamyein)

 

Definition

 

 

Cancer Tx- Antineoplastics(MC)- Antitumor Antibiotics(SC)

Term

 

 

 

Vincristine Sulfate

(Oncovin)

 

Definition

 

 

Cancer Tx- Antineoplastics (MC)- Natural Products (SC)

Term

 

 

 

tamoxifen

(Nolvadex)

 

Definition

 

 

Cancer Tx- Antineoplastics (MC)- Hormones/Hormone Antagonists (SC)

Term

 

 

 

 

Principles of Cancer Therapy

Definition

--Growth fraction: ratio of replicating cells to resting cells

--Chemotherapy most successful against rapidly dividing cells or those with high growth fraction

--Cancer cells - several have high growth fraction

--Normal cells with high growth fraction: hair follicles, bone marrow, and GI tissue have high growth fraction-explains many adverse effects

--Cure outcome dependent on: every malignant cell must be removed or killed

--even 1 cell can reproduce

--immune system eliminates very small number of cancer cells

--combination therapy: affect different stages in cell cycle; different mechanisms of action to increase cell killing

--combinations allow for lower doses --> reduce toxicity, slow development of resistance

--Specific dosing schedules: depend on type of tumor, stage of dz, overall condition; given as single dose or several doses; may be given within days or after several weeks; sometimes optimum dose must be delayed

Term

 

 

 

Antineoplastics

 

A/T/A/T

Definition

Pre-Chemo Assessment - Labs: CBC, renal function, electrolytes, uric acid

 

Pre- and Post-hydration

 

Routes: primarily PO/IV (can also give intravesically)

IV: long-term venous access decices - PICC, Hichman cath, infusaports

 

Pre-medications often ordered: antipyretic, antihistamine, antianxiety, antiulcer

Term

 

 

 

Antineoplastics

 

A/T/A/T

Definition

 

 

 

Depends on type of malignancy being treated

 

Tests to evaluate size of tumor

Term

 

 

 

 

Antineoplastics

 

A/T/A/T

 

Definition

Hematologic Effects: BMD *test*

- Anemia: safety, iron supplements, blood transfusions

- Thrombycytopenia: safety, bleeding precautions, transfusions

- Leukopenia: infection precautions, protective isolation; early  

  detect s/sx infection

GI effects:

- N/V - antiulcers, antiemetics ATC, Diet modification, strict I/O, weights

Oral mucosa:

- Thrush: antifungal

- Stomatitis: oral rinses/meds for pain (e.g. viscous lidocaine)

- Eat soft, bland, cold, non-acid foods

Hair/alopecia: Support for body image; scarves, hats, wigs

Renal Status:

- BUN, Cr, Diuretics, Follow hydration orders, strict I/O

- Antigout meds for increased uric acid levels

Others: Cardiotoxicity, Pulmonary effects, Hepatotoxicity

Term

 

 

 

Antineoplastics

 

A/T/A/T

Definition

 

 

Good nutrition

Good personal hygiene

Safety to decrease bleeding risks

Wats to decrease infection risks

Contraception - avoid pregnancy for at least 6 mo after therapy

Follow up labs as indicated

Support Groups

Term

 

 

 

 

What is the general mechanism of action for antiinfectives/antimicrobial agents?

Definition

Stops microorganism spread by interfering with genetic components and/or replication/reproductive growth:


1. Inhibit cell wall synthesis      

2. Inhibit protein synthesis - necessary for cell walls and other structures  

3. Disrupt cell membranes         

4. Inhibit reproduction - inhibit RNA or DNA synthesis             

5. Inhibit cell metabolism and growth - block necessary components -                                                                                antimetabolite


Goal: kills enough of the organism or slows its growth enough so the antural body defenses can overcome invading agent.

Term

 

 

 

 

What are the nontoxic adverse effects of antiinfectives/antimicrobial agents in general

and what do you do to check for them?

Definition

NONTOXIC ADVERSE EFFECTS       HOW TO CHECK FOR EFFECTS

1.   Hypersensitivity                                       

          - rash/hives/pruritis           - skin -- rash

          - fever, chills                   - temp -- fever

          - anaphylaxis                   - resp/cardic -- distress

2.   superimposed/secondary/       - look for new signs of infection:

      opportunistic infections            check oral mucous membranes,

                                                 skin folds, GI/GU and resp. tracts

3.   GI upset: N/V/A/D  (PO)         - I/O, GI upset

4.   Resistance                    

Incidence of adverse effects increases with renal insufficiency,

liver disease and in older adults

Term

 

 

 

 

What are the toxic adverse effects of antiinfectives/antimicrobial agents in general

and what do you do to check for them?

Definition

 

TOXIC ADVERSE EFFECTS          CHECKING FOR ADVERSE EFFECTS

1.   Nephrotoxicity                   - BUN, Cr. I/O

2.   Neurotoxicity                     - LOC and hearing

         · D LOC

         · ototoxicity

3.   Hepatotoxicity                   - ALT, AST

4.   BMD – blood dyscrasias       - CBC (anemia, thrombocytopenia,

                                              leukipenia)


Incidence of adverse effects increases with renal insufficiency,

liver disease, and in older adults

Term

 

 

 

What general teaching is involved

with antiinfectives/antimicrobial agents?

Definition

TEACHING


1.  Take entire course of meds (don’t share or save).

2.  Take at regular intervals

3.  Report signs of hypersensitivity

4.  Stress good nutrition and personal hygiene.

5.   Take probiotic supplements or cultured dairy products

6.   Use contraception (alternative to BCPs)

 

Term

 

 

 

What are the general administration

guidelines for antiinfectives/antimicrobials?

Definition

ADMINISTRATION

1.  Check MAR for identification of any drug allergies.

2.   Send specimen of probable infection source for culture and sensitivity ( C & S) before starting therapy when possible.

3.  Administer on time and at appropriate intervals to provide optimal blood levels.

3.   Give in deep muscle for IM injections

4.  Be aware of IV incompatibilities when administering > 1 antiinfective agents.

5.  Oral agents are usually given on an empty stomach to enhance absorption.

6.  Contraindications:  pregnancy/lactation (Categories B-X)

 

Term

 

 

 

What are the general pharmacotherapeutics

for antiinfectives/antimicrobial agents and how

do you check for therapeutic effect?

Definition

PHARMACOTHERAPEUTICS

1.   Treat actual infections

2.   Prevent infections (prophylaxis)


    Consider factors that increase a person’s risk of infection:

           immuno compromised, age extremes, neutropenia, malnutrition, impaired

           circulation (DM), invasive procedures, other chronic illnesses


THERAPEUTIC EFFECT:

 

1.  Monitor systemic indicators of infection:

         ·  WBC

         ·  Temp at least every shift

2.  Monitor actual site of infection – repeat cultures

3.  Monitor peak & trough levels, esp. for agents with narrow spectrum

 

Term

 

 

 

penicillin G

(Pentids)

 

A/T/A/T

Definition

Antiinfectives - Antibacterial (MC) - Penicillins (SC)

 

 


Check for history of allergies; most common for drug-induced anaphylaxis


Take with full glass of water; do NOT drink acidic juice

Term

 

 

 

penicillin G

(Pentids)

 

A/T/A/T

Definition

Antiinfectives - Antibacterial (MC) - Penicillins (SC)

 

 

observe for allergic responses (focus)

check electrolytes, esp. Na+ and K+ (more FYI)

 

Hypersensitivity

Resistance

GI distress (PO agents)

Blood dyscrasias (rare)

Term

 

 

 

penicillin G

(Pentids)

 

A/T/A/T

Definition

Antiinfectives - Antibacterial (MC) - Penicillins (SC)

 

 

follow-up labs especially if h/o renal or CV disease


Drug-drug interactions:

oral anticoagulants - PCN interferes with platelet aggregation

BCP - PCN decreases efficacy

Diuretics - use with caution

Term

 

 

 

cefotaxime

(Claforan)

 

A/T/A/T

Definition

Antiinfectives - Antibacterials (MC) - Cephalosporins (SC)

 

 

 

Check for history of allergies - cross sensitivity to PCN

Term

 

 

 

cefotaxime

(Claforan)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Cephalosporins (SC)

 

 

 

Hypersensitivity - cross-sensitivity to penicillins

Monitor for allergic responses

GI: Antibiotic-associated pseudomembranous colitis (AAPMC)

Nephrotoxicity if preexisting renal dz -check urine output; BUN & Cr.

observe for frequent loose stools and other GI effects (AAPMC)


Term

 

 

 

cefotaxime

(Claforan)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Cephalosporins (SC)

 

Follow-up labs especially if h/o renal disease

 

Report adverse effects, especially diarrhea, changes in urinary output

 

No ETOH - disulfiram-like effect

 

Drug-drug interactions:

     oral anticoagulants - decrease prothrombin

     (decrease vit. K metabolism)

Term

 

 

cefotaxime

(Claforan)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Cephalosporins (SC)

 

 

High spectrum of gm (-) and gm (+) organisms

 

Resistant strains

 

longer duration of action

Term

 

 

 

tetracycline HCL

(Achromysin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Routes: PO, IM, topical

Frequency: QID - Short T1/2

 

Do not give with: milk prodects, iron, Mg++ containing laxatives/antacids, antilipiemics (all decrease drug absorption)

            Wait ~2 hours after taking meds to take antacids

 

Contraindications: 2nd half pregnancy, whildren <8y/o (teeth), severe renal or liver disease

Term

 

 

 

tetracycline HCL

(Achromysin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Resistance

GI: N/V/D

Photosensitivity - sun burn easily in direct sunlight

Yello-brown discoloration of teeth if given to patients <8y/o

Category D

Term

 

 

 

tetracycline HCL

(Achromysin)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Broad spectrum - Bacteriostatic


Alternate for PCN resistance


Due to resistance, use limited to: chlamydial infections, Lyme's Disease, Rocky Mountain spotted fever, H. pylori


Long-term treatment of acne vulgaris

Term

 

 

 

tetracycline HCL

(Achromysin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Take as directed - full glass of water

Avoid sun exposure - use suncreen

Report adverse effects

Other drug-drug interactions: decreases effectiveness of BCPs

Do NOT use expired meds - high risk of nephrotoxicity

Do not give with: milk prodects, iron, Mg++ containing laxatives/antacids, antilipiemics (all decrease drug absorption)

            Wait ~2 hours after taking meds to take antacids

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

Mechanism of Action

 

 

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Alternative to PCN allergies; broad spectrum

Low doses = bacteriostatic; high doses = bacteriocidal

Most gram (+) and many gram (-)

Variety of strep infections (resp, skin)

Legionnaire's disease

Pertussis prophalaxis

H. influenza

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

 

Take with full glass of water

 

shake/mix suspensions thoroughly

 

Do not give with fruit juices

 

 

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

GI: N/V/D/abdominal pain

     monitor PO intake and stools

 

Check liver enzymes: AST, ALT

 

Hypersensitivity

 

Rare: Hepatotoxicity

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

 

Report adverse effects


Drug-drug interactions:

- Anesthetics & Antiseizure agents - increased risk of drug toxicity

- Cyclosporine - increased risk of nephrotoxicity

- Increased effects of oral anticoagulants

 

 

Term

 

 

 

gentamicin

(Garamycin)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Aminoglycosides (SC)

 

Narrow Spectrum

 

Aerobic gram (-) bacteria systemic infections

 

Some enterococci infections

 

Sterilize bowel prior to surgery

 

Parasitic infections

Term

 

 

 

gentamicin

(Garamycin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Route: IM/IV/PO (for bowel prep)

 

Baseline renal function tests and hearing screening (for toxicity)

 

Contraindications: neuromuscular disease (e.g. myasthenia gravis, Parkinson's) - AMG (aminoglycosides) cause N-M blockage

 

 

Memory Aid: HIGH risk of toxicity = gentamicin = Not a gentleman = mean

Term

 

 

 

gentamicin

(Garamycin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Nephrotoxicity - check BUN, Cr, UA during treatment

 

Ototoxicity

 

Peak and Trough levels *TEST*

 

Monitor hearing, tinnitus, dizziness, ataxia

 

Monitor neuro status - LOC

Term

 

 

 

gentamicin

(Garamycin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Take as directed - with full glass of water; drink adequate fluids

 

Report adverse effects - hearing changes/loss; decrease in urinary fn

 

Follow up labs: BUN, Cr, hearing, peak/trough levels

 

Drug-drug interactions:

      other drugs causing ototoxicity (i.e. Lasix, ASA, ampho B)


Term

 

 

 

ciprofloxacin

(Cipro)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

Route: PO/IV

 

Do not take with antacids or mineral supplements (iron)

 

Advantage: longer-acting; can take once or twice daily

 

Contraindications: neuro conditions, alcoholism

Term

 

 

 

ciprofloxacin

(Cipro)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

Variety of gm (+) and gm (-) infections (resp, GI and GU tracts, soft tissue & skin)

 

MDR - TB

 

anthrax

Term

 

 

 

ciprofloxacin

(Cipro)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

GI status: N/V/D, hepatotoxicity (ALT, AST tests)

 

CNS: dizziness, HA, sleep disturbances

 

Photosensitivity - sunburns

 

CV: dysrhythmias

 

M-S: tendonitis; tendon rupture

Term

 

 

 

ciprofloxacin

(Cipro)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

Avoid antacids/mineral supplements (iron) - take 4 hrs apart

 

Report adverse effects


Follow-up labs as indicated - liver


function tests, ECG (depends on underlying conditions)


Limit sun exposure; wear sun screen

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

Gram (+) & gram (-) - bacteriostatic

 

UTIs - E. Coli Proteus, Klebsiella (aka urinary antiseptics)

 

pneumocystis carini pneumonia

 

topical agent burns

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

 

Route: PO/topical

 

Give with full glass of water

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

 

Resistance

Renal insufficiency due to crystaluria - check for changes in UO

GI: N/V/A

Heme: blood dyscrasias - blocks folic acid synthesis

Hypersensitivity (Stevens-Johnson syndrome) - check skin after sun exposure; check skin for rashes

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

Take with full glass of water; increase PO fluid intake unless contraindicated

 

Report adverse effects, especially rash, urinary difficulty

 

Follow-up labs as indicated - renal function tests, CBC

 

Limit sun exposure - sunscreen

Term

 

 

 

imipenem

(Primaxin)

 

Mechanism of Action

Definition

Antiinfectives-Antibacterial (MC)-Misc. Antibacterials(SC)

Carbapenems (Sub SC)

 

PCN-resistant organisms


broad-spectrum - bacteriocidal


mixed with cilastatin - to maintain drug levels

(decreased inactivation before excretion)

 

 

Term

 

 

 

imipenem

(Primaxin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Misc. Antibacterials (SC)

Carbapenems (Sub SC)

 

 

Check for allergies

 

Route: IV

Term

 

 

 

imipenem

(Primaxin)

 

A/T/A/T

Definition

Antiinfectives-Antibacterial (MC)-Misc. Antibacterials(SC)

Carbapenems (Sub SC)

 

(Similar to PCN. but only given IV and can be used for more serious infections)

 

observe for allergic responses (focus)

check electrolytes, esp. Na+ and K+ (more FYI)

Hypersensitivity

Resistance

GI distress (PO agents)

Blood dyscrasias (rare)

Term

 

 

 

imipenem

(Primaxin)

 

A/T/A/T

Definition

Antiinfectives-Antibacterial (MC)-Misc. Antibacterials(SC)

Carbapenems (Sub SC)

 

(Similar to PCN. but only given IV and can be used for more serious infections)

 

follow-up labs especially if h/o renal or CV disease


Drug-drug interactions:

oral anticoagulants - PCN interferes with platelet aggregation

BCP - PCN decreases efficacy

Diuretics - use with caution

Term

 

 

 

nitrofurantoin

(Macrodantin)

 

Mechanism of Action

 

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

 

Treat or prevent lower UTIs

 

Low doses = bacteriostatic

high doses = bacteriocidal

Term

 

 

 

nitrofurantoin

(Macrodantin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

 

Route: PS

 

Contraindications: hematologic disorders, renal dysfunction

Term

 

 

 

nitrofurantoin

(Macrodantin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

GI: N/V/A/D

hypersensitivity

blood dyscrasias

neurotoxicity - peripheral neuritis - muscle weakness, tingling/numbness

allergies - monitor for pulmonary sx

check urinary status - change in UO

CBC - watch for other infections, bleeding


Term

 

 

 

nitrofurantoin

(Macrodantin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

Maintain adequate PO fluid intake unless contraindicated

 

Report adverse effects, especially rash, urinary difficulty, bleeding

 

Report neuro changes - safety precautions

 

Follow-up labs as indicated - renal function tests, CBC

Term

 

 

 

vancomycin

(Vancocin)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

Monocactams (Sub SC)

 

alternative to PCN allergies

 

gram (+) - MRSA

 

pseudomembraneous colitis (oral)

 


Term

 

 

 

vancomycin

(Vancocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

Monobactams (Sub SC)

 

 

Route: IV/PO

 

Baseline tests: hearing, renal function tests

 

CDC 'limits' use due to VRA (Vanco resistant entercocci)

Term

 

 

 

vancomycin

(Vancocin)

 

A/T/A/T

Definition

Antiinfectives-Antibacterials (MC)-Misc. Antibaterials(SC)

Monobactams (Sub SC)

 

Nephrotoxicity - BUN, Cr, UA

Ototoxicity - check for hearing changes, tinnitus, dizziness, ataxia

Peak/Tough levels

"Red-man" syndrome - run IV slowly - observe skin for slushing, hypotension, muscle pain

 

(Memory Aid: similar to aminogly - mean; vanco - vicious!)


Term

 

 

 

vancomycin

(Vancocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

Drink adequate fluids

 

Report adverse effects - hearing changes/loss; decrease in urinary fn

 

Follow-up labs: BUN, Cr, hearing, peak/trough levels

 

Drug-drug interactions: other drugs causing ototoxicity

Term

 

 

 

isoniazid

(INH)

 

Principles of Drug Therapy

 

 

 

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

Long term tx: avg 6-12 mo; up to 24 mo for immunocompromised pts or resistant strains; tuberculocidal


Multi-drug tx: at least 2, sometimes 3-4 agents given concurrently

Due to resistance, slowly-growing nature of organism


Prophylactic use - new (+) TB test; Not used alone unless prophylacticly *Test*


First-line drugs - safer, more effective


Second-line drugs - more toxic, less effective; used when resistance occurs with first-line agents

Term

 

 

 

isoniazid

(INH)

 

A/T/A/T

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

Route: PO/IM; qD

Direct observation therapy (DOT) - to ensure compliance

Give Vit B6 pyridoxine concomitantly (combo with INH)

Duration

-prophylaxis: daily for 6 mo.

-active infection: ex) for non-HIV: 4 first-line drugs for 4 mo. (IR); longer for resistant strains

 

Contraindications: liver disease

Term

 

 

 

isoniazid

(INH)

 

A/T/A/T

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

Hepatotoxicity - AST, ALT


GI: N/V

 

Blood Dyscrasias: CBC - note RBC, H&H for anemia

 

check neuro status - muscle weakness, peripheral neuropathy

 

+ red-orange discoloration of body fluids

Term

 

 

 

isoniazid

(INH)

 

A/T/A/T

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

 

--Non-pharmacologic to increase host resistance: balanced diet, rest, sunshine,

   fresh air

--Decrease spread - cover mouth, dispose of tissues; maintain respiratory isolation  

  (FYI - neg. pressure room), handwashing

--Follow strict drug regimen for full duration - Compliance is Key!

--Follow-up tests: liver enzymes, CBC, CXR, sputum specimen

--Report adverse effects, esp GI

--Avoid: ETOH

--If taking rifampin combo will have red tears, urine, sweat, saliva

--Drug-Drug interactions: phenytoin

Term

 

 

 

amphotericin B

(Funfizone)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Route: IV

 

Baseline labs: BUN, Cr, AST, ALT, electrolytes

 

Often premedication is needed to offset s/sx with onset of tx (fever, chills, N/V) --> Antipyretic, antiemetic

 

Influse IV very slowly - monitor vitals during infusion

 

Term

 

 

 

amphotericin B

(Funfizone)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Can be VERY toxic

Hypersensitivity

Onset of tx: N/V, chills, fever, HA (transient)

Nephrotoxicity - BUN, Cr

Hepatotoxicity - AST, ALT

Electrolyte imbalances - hypokalemia

CV: cardiac arrest, hypotension, dysrhythmias

BMD: Blood Dyscrasias - CBC - thrombocytopenia, anemia, leukopenia - develop other infections, bleeding tendencies

Term

 

 

 

amphotericin B

(Funfizone)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Take premeds to decrease initial N/V, fever, chills
Follow-up labs as indicated to ID toxicities

Report: decreased UO & increased FV, increased GI sx

Maintain good fluid intake

AVOID: ETOH

Report infusion problems - IV site pain

Multiple drug-drug interactions - speak to MD re: any OTC, herbal tx

         --(too many to mention)

Term

 

 

 

amphotericin B

(Funfizone)

 

Mechanism of Action

 

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

 

Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out

Term




nystatin

(Mycostatin)


Mechanism of Action

Definition

Antiinfectives - Antifungals (MC) - no subclasses




Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out

Term

 

 

 

nystatin

(Mycostatin)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Topical - creams, ointment, powder - clean affected area first

 

P0 - swish and swallow liquid for oral thrush (2 min) and apply via oral swabs - usual dose is 4 ml

 

Avoid eating/drinking for 30 min after

Term

 

 

 

nystatin

(Mycostatin)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Topical: Skin irritation or rash (contact dermatitis)

           Check skin folds or wherever you apply

 

Oral: N/V/D

Term

 

 

 

nystatin

(Mycostatin)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Use only as directed

 

Good skin or oral care

 

Avoid tight-fitting clothes for skin infections

 

Report: rash, skin irritations

Term

 

 

 

fluconazole

(Diflucan)

 

Mechanism of Action

 

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out

Term

 

 

 

fluconazole

(Diflucan)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Route: PO/IV

 

Baseline labs: BUN, Cr, AST, ALT, electrolytes

 

Often premedication is needed to offset s/sx with onset of tx (fever, chills, N/V) --> Antipyretic, antiemetic

 

Influse IV very slowly - monitor vitals during infusion


Term

 

 

 

fluconazole

(Diflucan)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

GI: N/V/D

 

Hepatotoxicity

 

Reproductive: Menstrual abnormalities, gynecomastia, decreased libido

Term

 

 

 

fluconazole

(Diflucan)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Take as ordered

 

AVOID: ETOH, OTC meds

 

Report: persistent GI s/sx; reproductive disturbances

 

Maintain good fluid intake

 

Follow-up labs as indicated

Term

 

 

 

What are the factors that make

drug therapy difficult for malaria?

Definition

 

Requires multi-drug therapy

 

Prevention of relapse - tx latent forms due to complex life cycle of Plasmodium (it changes forms)

 

Prevention - before, during, and after treatment

 

Treatment - start as soon as sx appear

Term

 

 

 

What are the factors that contribute

to parasitic infections?

Definition

 

 

 

Overpopulated areas with poor sanitation

 

Children - poor hygienic practices

 

Immunocompromised patients

Term

 

 

 

chloroquine

(Aralen)

 

Mechanism of Action

Definition

Antiinfectives- Antiparasitics (MC)- Antiprotozoal (SC)

 

 

Malaria - acute stage, prophylaxis

Term

 

 

 

metronidazole

(Flagyl)

 

Mechanism of Action

Definition

Antiinfectives- Antiparasitics (MC)- Antiprotozoal (SC)

 

 

Non-malarial parasitic infections

 

Anaerobic bacterial infections

Term

 

 

 

mebendazole

(Vermox)

 

Mechanism of Action

Definition

Antiinfectives- Antiparasitics (MC)- Antihelminthic (SC)

 

 

 

 

Parasitic worms: round worm & pinworms

Term

 

 

 

 

Characteristics of Viruses

Definition

 

 

Has protein coat (capsid) surrounded by lipid envelope (compromised of glycoprotein & protein spikes) - triggers immune response.

 

Enters host cell & uses its genetic materials for replication with the help of enzymes - viruses must be inside host cell to cause infection

 

Difficult to eliminate virus without injuring normal cells

Term

 

 

 

Viral infections & Drug Therapy

(Implications)

Definition

 

Most self-limiting do not require pharmacotherapy e.g.rhinovifus

 

Some cause serious diseases: HIV, Herpesviruses

 

Challenges of antiviral therapy:

-rapid mutation

-difficult to avoid injuring normal cells

-each drug virus-specific

Term

 

 

zidovudine

(Retrovir, AZT)

 

Goals of Therapy

 

 

 

 

Definition

Antiinfectives - Antivirals (MC) - Antiretrovirals (SC)

 

Decrease HIV RNA load - marker of dz progression

 

Increase lifespan and quality of life

 

Decrease transmission from mother to baby

 

Decrease drug resistance (HAART - combos)

 

Tx initiated with CD4 under 200 or if symptoms appear

Term

 

 

 

nevirapine

(Viramune)

 

Goals of Therapy

Definition

Antiinfectives - Antivirals (MC) - Antiretrovirals (SC)

 

Decrease HIV RNA load - marker of dz progression

 

Increase lifespan and quality of life

 

Decrease transmission from mother to baby

 

Decrease drug resistance (HAART - combos)

 

Tx initiated with CD4 under 200 or if symptoms appear

Term

 

 

 

saquinavir mesylate

(Forovase, Invirase)

 

Goals of Therapy

Definition

Antiinfectives - Antivirals (MC) - Antiretrovirals (SC)

 

Decrease HIV RNA load - marker of dz progression

 

Increase lifespan and quality of life

 

Decrease transmission from mother to baby

 

Decrease drug resistance (HAART - combos)

 

Tx initiated with CD4 under 200 or if symptoms appear

Term

 

 

 

acyclovir

(Zovirax)

 

Goals of Therpy

Definition

Antiinfectives - Antivirals (MC) - Antiherpesvirals (SC)

 

 

Lessens severity and duration of acute herpes simplex symptoms

 

Prolongs latent period prevent recurrences

 

Does not cure

Term

 

 

 

 

What is the general mechanism of action for antiinfectives/antimicrobial agents?

Definition

Stops microorganism spread by interfering with genetic components and/or replication/reproductive growth:


1. Inhibit cell wall synthesis      

2. Inhibit protein synthesis - necessary for cell walls and other structures  

3. Disrupt cell membranes         

4. Inhibit reproduction - inhibit RNA or DNA synthesis             

5. Inhibit cell metabolism and growth - block necessary components -                                                                                antimetabolite


Goal: kills enough of the organism or slows its growth enough so the antural body defenses can overcome invading agent.

Term

 

 

 

 

What are the nontoxic adverse effects of antiinfectives/antimicrobial agents in general

and what do you do to check for them?

Definition

NONTOXIC ADVERSE EFFECTS       HOW TO CHECK FOR EFFECTS

1.   Hypersensitivity                                       

          - rash/hives/pruritis           - skin -- rash

          - fever, chills                   - temp -- fever

          - anaphylaxis                   - resp/cardic -- distress

2.   superimposed/secondary/       - look for new signs of infection:

      opportunistic infections            check oral mucous membranes,

                                                 skin folds, GI/GU and resp. tracts

3.   GI upset: N/V/A/D  (PO)         - I/O, GI upset

4.   Resistance                    

Incidence of adverse effects increases with renal insufficiency,

liver disease and in older adults

Term

 

 

 

 

What are the toxic adverse effects of antiinfectives/antimicrobial agents in general

and what do you do to check for them?

Definition

 

TOXIC ADVERSE EFFECTS          CHECKING FOR ADVERSE EFFECTS

1.   Nephrotoxicity                   - BUN, Cr. I/O

2.   Neurotoxicity                     - LOC and hearing

         · D LOC

         · ototoxicity

3.   Hepatotoxicity                   - ALT, AST

4.   BMD – blood dyscrasias       - CBC (anemia, thrombocytopenia,

                                              leukipenia)


Incidence of adverse effects increases with renal insufficiency,

liver disease, and in older adults

Term

 

 

 

What general teaching is involved

with antiinfectives/antimicrobial agents?

Definition

TEACHING


1.  Take entire course of meds (don’t share or save).

2.  Take at regular intervals

3.  Report signs of hypersensitivity

4.  Stress good nutrition and personal hygiene.

5.   Take probiotic supplements or cultured dairy products

6.   Use contraception (alternative to BCPs)

 

Term

 

 

 

What are the general administration

guidelines for antiinfectives/antimicrobials?

Definition

ADMINISTRATION

1.  Check MAR for identification of any drug allergies.

2.   Send specimen of probable infection source for culture and sensitivity ( C & S) before starting therapy when possible.

3.  Administer on time and at appropriate intervals to provide optimal blood levels.

3.   Give in deep muscle for IM injections

4.  Be aware of IV incompatibilities when administering > 1 antiinfective agents.

5.  Oral agents are usually given on an empty stomach to enhance absorption.

6.  Contraindications:  pregnancy/lactation (Categories B-X)

 

Term

 

 

 

What are the general pharmacotherapeutics

for antiinfectives/antimicrobial agents and how

do you check for therapeutic effect?

Definition

PHARMACOTHERAPEUTICS

1.   Treat actual infections

2.   Prevent infections (prophylaxis)


    Consider factors that increase a person’s risk of infection:

           immuno compromised, age extremes, neutropenia, malnutrition, impaired

           circulation (DM), invasive procedures, other chronic illnesses


THERAPEUTIC EFFECT:

 

1.  Monitor systemic indicators of infection:

         ·  WBC

         ·  Temp at least every shift

2.  Monitor actual site of infection – repeat cultures

3.  Monitor peak & trough levels, esp. for agents with narrow spectrum

 

Term

 

 

 

penicillin G

(Pentids)

 

A/T/A/T

Definition

Antiinfectives - Antibacterial (MC) - Penicillins (SC)

 

 


Check for history of allergies; most common for drug-induced anaphylaxis


Take with full glass of water; do NOT drink acidic juice

Term

 

 

 

penicillin G

(Pentids)

 

A/T/A/T

Definition

Antiinfectives - Antibacterial (MC) - Penicillins (SC)

 

 

observe for allergic responses (focus)

check electrolytes, esp. Na+ and K+ (more FYI)

 

Hypersensitivity

Resistance

GI distress (PO agents)

Blood dyscrasias (rare)

Term

 

 

 

penicillin G

(Pentids)

 

A/T/A/T

Definition

Antiinfectives - Antibacterial (MC) - Penicillins (SC)

 

 

follow-up labs especially if h/o renal or CV disease


Drug-drug interactions:

oral anticoagulants - PCN interferes with platelet aggregation

BCP - PCN decreases efficacy

Diuretics - use with caution

Term

 

 

 

cefotaxime

(Claforan)

 

A/T/A/T

Definition

Antiinfectives - Antibacterials (MC) - Cephalosporins (SC)

 

 

 

Check for history of allergies - cross sensitivity to PCN

Term

 

 

 

cefotaxime

(Claforan)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Cephalosporins (SC)

 

 

 

Hypersensitivity - cross-sensitivity to penicillins

Monitor for allergic responses

GI: Antibiotic-associated pseudomembranous colitis (AAPMC)

Nephrotoxicity if preexisting renal dz -check urine output; BUN & Cr.

observe for frequent loose stools and other GI effects (AAPMC)


Term

 

 

 

cefotaxime

(Claforan)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Cephalosporins (SC)

 

Follow-up labs especially if h/o renal disease

 

Report adverse effects, especially diarrhea, changes in urinary output

 

No ETOH - disulfiram-like effect

 

Drug-drug interactions:

     oral anticoagulants - decrease prothrombin

     (decrease vit. K metabolism)

Term

 

 

cefotaxime

(Claforan)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Cephalosporins (SC)

 

 

High spectrum of gm (-) and gm (+) organisms

 

Resistant strains

 

longer duration of action

Term

 

 

 

tetracycline HCL

(Achromysin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Routes: PO, IM, topical

Frequency: QID - Short T1/2

 

Do not give with: milk prodects, iron, Mg++ containing laxatives/antacids, antilipiemics (all decrease drug absorption)

            Wait ~2 hours after taking meds to take antacids

 

Contraindications: 2nd half pregnancy, whildren <8y/o (teeth), severe renal or liver disease

Term

 

 

 

tetracycline HCL

(Achromysin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Resistance

GI: N/V/D

Photosensitivity - sun burn easily in direct sunlight

Yello-brown discoloration of teeth if given to patients <8y/o

Category D

Term

 

 

 

tetracycline HCL

(Achromysin)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Broad spectrum - Bacteriostatic


Alternate for PCN resistance


Due to resistance, use limited to: chlamydial infections, Lyme's Disease, Rocky Mountain spotted fever, H. pylori


Long-term treatment of acne vulgaris

Term

 

 

 

tetracycline HCL

(Achromysin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Tetracyclines (SC)

 

Take as directed - full glass of water

Avoid sun exposure - use suncreen

Report adverse effects

Other drug-drug interactions: decreases effectiveness of BCPs

Do NOT use expired meds - high risk of nephrotoxicity

Do not give with: milk prodects, iron, Mg++ containing laxatives/antacids, antilipiemics (all decrease drug absorption)

            Wait ~2 hours after taking meds to take antacids

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

Mechanism of Action

 

 

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Alternative to PCN allergies; broad spectrum

Low doses = bacteriostatic; high doses = bacteriocidal

Most gram (+) and many gram (-)

Variety of strep infections (resp, skin)

Legionnaire's disease

Pertussis prophalaxis

H. influenza

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

 

Take with full glass of water

 

shake/mix suspensions thoroughly

 

Do not give with fruit juices

 

 

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

GI: N/V/D/abdominal pain

     monitor PO intake and stools

 

Check liver enzymes: AST, ALT

 

Hypersensitivity

 

Rare: Hepatotoxicity

Term

 

 

 

erythromycin

(E-Mycin, Erythrocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

 

Report adverse effects


Drug-drug interactions:

- Anesthetics & Antiseizure agents - increased risk of drug toxicity

- Cyclosporine - increased risk of nephrotoxicity

- Increased effects of oral anticoagulants

 

 

Term

 

 

 

gentamicin

(Garamycin)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Aminoglycosides (SC)

 

Narrow Spectrum

 

Aerobic gram (-) bacteria systemic infections

 

Some enterococci infections

 

Sterilize bowel prior to surgery

 

Parasitic infections

Term

 

 

 

gentamicin

(Garamycin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Route: IM/IV/PO (for bowel prep)

 

Baseline renal function tests and hearing screening (for toxicity)

 

Contraindications: neuromuscular disease (e.g. myasthenia gravis, Parkinson's) - AMG (aminoglycosides) cause N-M blockage

 

 

Memory Aid: HIGH risk of toxicity = gentamicin = Not a gentleman = mean

Term

 

 

 

gentamicin

(Garamycin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Nephrotoxicity - check BUN, Cr, UA during treatment

 

Ototoxicity

 

Peak and Trough levels *TEST*

 

Monitor hearing, tinnitus, dizziness, ataxia

 

Monitor neuro status - LOC

Term

 

 

 

gentamicin

(Garamycin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Macrolides (SC)

 

Take as directed - with full glass of water; drink adequate fluids

 

Report adverse effects - hearing changes/loss; decrease in urinary fn

 

Follow up labs: BUN, Cr, hearing, peak/trough levels

 

Drug-drug interactions:

      other drugs causing ototoxicity (i.e. Lasix, ASA, ampho B)


Term

 

 

 

ciprofloxacin

(Cipro)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

Route: PO/IV

 

Do not take with antacids or mineral supplements (iron)

 

Advantage: longer-acting; can take once or twice daily

 

Contraindications: neuro conditions, alcoholism

Term

 

 

 

ciprofloxacin

(Cipro)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

Variety of gm (+) and gm (-) infections (resp, GI and GU tracts, soft tissue & skin)

 

MDR - TB

 

anthrax

Term

 

 

 

ciprofloxacin

(Cipro)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

GI status: N/V/D, hepatotoxicity (ALT, AST tests)

 

CNS: dizziness, HA, sleep disturbances

 

Photosensitivity - sunburns

 

CV: dysrhythmias

 

M-S: tendonitis; tendon rupture

Term

 

 

 

ciprofloxacin

(Cipro)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)

 

Avoid antacids/mineral supplements (iron) - take 4 hrs apart

 

Report adverse effects


Follow-up labs as indicated - liver


function tests, ECG (depends on underlying conditions)


Limit sun exposure; wear sun screen

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

Gram (+) & gram (-) - bacteriostatic

 

UTIs - E. Coli Proteus, Klebsiella (aka urinary antiseptics)

 

pneumocystis carini pneumonia

 

topical agent burns

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

 

Route: PO/topical

 

Give with full glass of water

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

 

Resistance

Renal insufficiency due to crystaluria - check for changes in UO

GI: N/V/A

Heme: blood dyscrasias - blocks folic acid synthesis

Hypersensitivity (Stevens-Johnson syndrome) - check skin after sun exposure; check skin for rashes

Term

 

 

 

TMP-SMZ

(Bactrim, Septra)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)

 

Take with full glass of water; increase PO fluid intake unless contraindicated

 

Report adverse effects, especially rash, urinary difficulty

 

Follow-up labs as indicated - renal function tests, CBC

 

Limit sun exposure - sunscreen

Term

 

 

 

imipenem

(Primaxin)

 

Mechanism of Action

Definition

Antiinfectives-Antibacterial (MC)-Misc. Antibacterials(SC)

Carbapenems (Sub SC)

 

PCN-resistant organisms


broad-spectrum - bacteriocidal


mixed with cilastatin - to maintain drug levels

(decreased inactivation before excretion)

 

 

Term

 

 

 

imipenem

(Primaxin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterial (MC)- Misc. Antibacterials (SC)

Carbapenems (Sub SC)

 

 

Check for allergies

 

Route: IV

Term

 

 

 

imipenem

(Primaxin)

 

A/T/A/T

Definition

Antiinfectives-Antibacterial (MC)-Misc. Antibacterials(SC)

Carbapenems (Sub SC)

 

(Similar to PCN. but only given IV and can be used for more serious infections)

 

observe for allergic responses (focus)

check electrolytes, esp. Na+ and K+ (more FYI)

Hypersensitivity

Resistance

GI distress (PO agents)

Blood dyscrasias (rare)

Term

 

 

 

imipenem

(Primaxin)

 

A/T/A/T

Definition

Antiinfectives-Antibacterial (MC)-Misc. Antibacterials(SC)

Carbapenems (Sub SC)

 

(Similar to PCN. but only given IV and can be used for more serious infections)

 

follow-up labs especially if h/o renal or CV disease


Drug-drug interactions:

oral anticoagulants - PCN interferes with platelet aggregation

BCP - PCN decreases efficacy

Diuretics - use with caution

Term

 

 

 

nitrofurantoin

(Macrodantin)

 

Mechanism of Action

 

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

 

Treat or prevent lower UTIs

 

Low doses = bacteriostatic

high doses = bacteriocidal

Term

 

 

 

nitrofurantoin

(Macrodantin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

 

Route: PS

 

Contraindications: hematologic disorders, renal dysfunction

Term

 

 

 

nitrofurantoin

(Macrodantin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

GI: N/V/A/D

hypersensitivity

blood dyscrasias

neurotoxicity - peripheral neuritis - muscle weakness, tingling/numbness

allergies - monitor for pulmonary sx

check urinary status - change in UO

CBC - watch for other infections, bleeding


Term

 

 

 

nitrofurantoin

(Macrodantin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

Maintain adequate PO fluid intake unless contraindicated

 

Report adverse effects, especially rash, urinary difficulty, bleeding

 

Report neuro changes - safety precautions

 

Follow-up labs as indicated - renal function tests, CBC

Term

 

 

 

vancomycin

(Vancocin)

 

Mechanism of Action

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

Monocactams (Sub SC)

 

alternative to PCN allergies

 

gram (+) - MRSA

 

pseudomembraneous colitis (oral)

 


Term

 

 

 

vancomycin

(Vancocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

Monobactams (Sub SC)

 

 

Route: IV/PO

 

Baseline tests: hearing, renal function tests

 

CDC 'limits' use due to VRA (Vanco resistant entercocci)

Term

 

 

 

vancomycin

(Vancocin)

 

A/T/A/T

Definition

Antiinfectives-Antibacterials (MC)-Misc. Antibaterials(SC)

Monobactams (Sub SC)

 

Nephrotoxicity - BUN, Cr, UA

Ototoxicity - check for hearing changes, tinnitus, dizziness, ataxia

Peak/Tough levels

"Red-man" syndrome - run IV slowly - observe skin for slushing, hypotension, muscle pain

 

(Memory Aid: similar to aminogly - mean; vanco - vicious!)


Term

 

 

 

vancomycin

(Vancocin)

 

A/T/A/T

Definition

Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)

 

Drink adequate fluids

 

Report adverse effects - hearing changes/loss; decrease in urinary fn

 

Follow-up labs: BUN, Cr, hearing, peak/trough levels

 

Drug-drug interactions: other drugs causing ototoxicity

Term

 

 

 

isoniazid

(INH)

 

Principles of Drug Therapy

 

 

 

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

Long term tx: avg 6-12 mo; up to 24 mo for immunocompromised pts or resistant strains; tuberculocidal


Multi-drug tx: at least 2, sometimes 3-4 agents given concurrently

Due to resistance, slowly-growing nature of organism


Prophylactic use - new (+) TB test; Not used alone unless prophylacticly *Test*


First-line drugs - safer, more effective


Second-line drugs - more toxic, less effective; used when resistance occurs with first-line agents

Term

 

 

 

isoniazid

(INH)

 

A/T/A/T

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

Route: PO/IM; qD

Direct observation therapy (DOT) - to ensure compliance

Give Vit B6 pyridoxine concomitantly (combo with INH)

Duration

-prophylaxis: daily for 6 mo.

-active infection: ex) for non-HIV: 4 first-line drugs for 4 mo. (IR); longer for resistant strains

 

Contraindications: liver disease

Term

 

 

 

isoniazid

(INH)

 

A/T/A/T

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

Hepatotoxicity - AST, ALT


GI: N/V

 

Blood Dyscrasias: CBC - note RBC, H&H for anemia

 

check neuro status - muscle weakness, peripheral neuropathy

 

+ red-orange discoloration of body fluids

Term

 

 

 

isoniazid

(INH)

 

A/T/A/T

Definition

Antiinfectives-Antituberculars (MC)-1st-line agents (SC)

 

 

--Non-pharmacologic to increase host resistance: balanced diet, rest, sunshine,

   fresh air

--Decrease spread - cover mouth, dispose of tissues; maintain respiratory isolation  

  (FYI - neg. pressure room), handwashing

--Follow strict drug regimen for full duration - Compliance is Key!

--Follow-up tests: liver enzymes, CBC, CXR, sputum specimen

--Report adverse effects, esp GI

--Avoid: ETOH

--If taking rifampin combo will have red tears, urine, sweat, saliva

--Drug-Drug interactions: phenytoin

Term

 

 

 

amphotericin B

(Funfizone)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Route: IV

 

Baseline labs: BUN, Cr, AST, ALT, electrolytes

 

Often premedication is needed to offset s/sx with onset of tx (fever, chills, N/V) --> Antipyretic, antiemetic

 

Influse IV very slowly - monitor vitals during infusion

 

Term

 

 

 

amphotericin B

(Funfizone)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Can be VERY toxic

Hypersensitivity

Onset of tx: N/V, chills, fever, HA (transient)

Nephrotoxicity - BUN, Cr

Hepatotoxicity - AST, ALT

Electrolyte imbalances - hypokalemia

CV: cardiac arrest, hypotension, dysrhythmias

BMD: Blood Dyscrasias - CBC - thrombocytopenia, anemia, leukopenia - develop other infections, bleeding tendencies

Term

 

 

 

amphotericin B

(Funfizone)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Take premeds to decrease initial N/V, fever, chills
Follow-up labs as indicated to ID toxicities

Report: decreased UO & increased FV, increased GI sx

Maintain good fluid intake

AVOID: ETOH

Report infusion problems - IV site pain

Multiple drug-drug interactions - speak to MD re: any OTC, herbal tx

         --(too many to mention)

Term

 

 

 

amphotericin B

(Funfizone)

 

Mechanism of Action

 

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

 

Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out

Term




nystatin

(Mycostatin)


Mechanism of Action

Definition

Antiinfectives - Antifungals (MC) - no subclasses




Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out

Term

 

 

 

nystatin

(Mycostatin)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Topical - creams, ointment, powder - clean affected area first

 

P0 - swish and swallow liquid for oral thrush (2 min) and apply via oral swabs - usual dose is 4 ml

 

Avoid eating/drinking for 30 min after

Term

 

 

 

nystatin

(Mycostatin)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Topical: Skin irritation or rash (contact dermatitis)

           Check skin folds or wherever you apply

 

Oral: N/V/D

Term

 

 

 

nystatin

(Mycostatin)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Use only as directed

 

Good skin or oral care

 

Avoid tight-fitting clothes for skin infections

 

Report: rash, skin irritations

Term

 

 

 

fluconazole

(Diflucan)

 

Mechanism of Action

 

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out

Term

 

 

 

fluconazole

(Diflucan)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Route: PO/IV

 

Baseline labs: BUN, Cr, AST, ALT, electrolytes

 

Often premedication is needed to offset s/sx with onset of tx (fever, chills, N/V) --> Antipyretic, antiemetic

 

Influse IV very slowly - monitor vitals during infusion


Term

 

 

 

fluconazole

(Diflucan)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

 

GI: N/V/D

 

Hepatotoxicity

 

Reproductive: Menstrual abnormalities, gynecomastia, decreased libido

Term

 

 

 

fluconazole

(Diflucan)

 

A/T/A/T

Definition

Antiinfectives - Antifungals (MC) - no subclasses

 

Take as ordered

 

AVOID: ETOH, OTC meds

 

Report: persistent GI s/sx; reproductive disturbances

 

Maintain good fluid intake

 

Follow-up labs as indicated

Term

 

 

 

What are the factors that make

drug therapy difficult for malaria?

Definition

 

Requires multi-drug therapy

 

Prevention of relapse - tx latent forms due to complex life cycle of Plasmodium (it changes forms)

 

Prevention - before, during, and after treatment

 

Treatment - start as soon as sx appear

Term

 

 

 

What are the factors that contribute

to parasitic infections?

Definition

 

 

 

Overpopulated areas with poor sanitation

 

Children - poor hygienic practices

 

Immunocompromised patients

Term

 

 

 

chloroquine

(Aralen)

 

Mechanism of Action

Definition

Antiinfectives- Antiparasitics (MC)- Antiprotozoal (SC)

 

 

Malaria - acute stage, prophylaxis

Term

 

 

 

metronidazole

(Flagyl)

 

Mechanism of Action

Definition

Antiinfectives- Antiparasitics (MC)- Antiprotozoal (SC)

 

 

Non-malarial parasitic infections

 

Anaerobic bacterial infections

Term

 

 

 

mebendazole

(Vermox)

 

Mechanism of Action

Definition

Antiinfectives- Antiparasitics (MC)- Antihelminthic (SC)

 

 

 

 

Parasitic worms: round worm & pinworms

Term

 

 

 

 

Characteristics of Viruses

Definition

 

 

Has protein coat (capsid) surrounded by lipid envelope (compromised of glycoprotein & protein spikes) - triggers immune response.

 

Enters host cell & uses its genetic materials for replication with the help of enzymes - viruses must be inside host cell to cause infection

 

Difficult to eliminate virus without injuring normal cells

Term

 

 

 

Viral infections & Drug Therapy

(Implications)

Definition

 

Most self-limiting do not require pharmacotherapy e.g.rhinovifus

 

Some cause serious diseases: HIV, Herpesviruses

 

Challenges of antiviral therapy:

-rapid mutation

-difficult to avoid injuring normal cells

-each drug virus-specific

Term

 

 

zidovudine

(Retrovir, AZT)

 

Goals of Therapy

 

 

 

 

Definition

Antiinfectives - Antivirals (MC) - Antiretrovirals (SC)

 

Decrease HIV RNA load - marker of dz progression

 

Increase lifespan and quality of life

 

Decrease transmission from mother to baby

 

Decrease drug resistance (HAART - combos)

 

Tx initiated with CD4 under 200 or if symptoms appear

Term

 

 

 

nevirapine

(Viramune)

 

Goals of Therapy

Definition

Antiinfectives - Antivirals (MC) - Antiretrovirals (SC)

 

Decrease HIV RNA load - marker of dz progression

 

Increase lifespan and quality of life

 

Decrease transmission from mother to baby

 

Decrease drug resistance (HAART - combos)

 

Tx initiated with CD4 under 200 or if symptoms appear

Term

 

 

 

saquinavir mesylate

(Forovase, Invirase)

 

Goals of Therapy

Definition

Antiinfectives - Antivirals (MC) - Antiretrovirals (SC)

 

Decrease HIV RNA load - marker of dz progression

 

Increase lifespan and quality of life

 

Decrease transmission from mother to baby

 

Decrease drug resistance (HAART - combos)

 

Tx initiated with CD4 under 200 or if symptoms appear

Term

 

 

 

acyclovir

(Zovirax)

 

Goals of Therpy

Definition

Antiinfectives - Antivirals (MC) - Antiherpesvirals (SC)

 

 

Lessens severity and duration of acute herpes simplex symptoms

 

Prolongs latent period prevent recurrences

 

Does not cure

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