Term
hepatitis B vaccine
(Engerix-B, Recombivax HB)
Mechanism of Action |
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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
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Term
hepatitis B vaccine
(Engerix-B, Recombivax HB)
A/T/A/T |
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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
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Term
hepatitis B vaccine
(Engerix-B, Recombivax HB)
A/T/A/T |
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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 |
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Term
hepatitis B vaccine
(Engerix-B, Recombivax HB)
A/T/A/T |
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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 |
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Term
hepatitis B vaccine
(Engerix-B, Recombivax HB)
A/T/A/T |
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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
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Term
interferon alfa-2a
(Roferon-A)
Mechanism of Action |
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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 |
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Term
interferon alfa-2a
(Roferon-A)
A/T/A/T |
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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
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Term
interferon alfa-2a
(Roferon-A)
A/T/A/T |
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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
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Term
interferon alfa-2a
(Roferon-A)
A/T/A/T |
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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
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Term
interferon alfa-2a
(Roferon-A)
A/T/A/T |
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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
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Term
Immunosuppressants
Mechanism of Action &
Pharmacotherapeutics |
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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
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Term
cyclosporine
(Sandimmune, Neoral)
A/T/A/T |
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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
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Term
cyclosporine
(Sandimmune, Neoral)
A/T/A/T |
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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
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Term
cyclosporine
(Sandimmune, Neoral)
A/T/A/T |
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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
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Term
cyclosporine
(Sandimmune, Neoral)
A/T/A/T |
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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
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Term
cyclosporine
(Sandimmune, Neoral)
Mechanism of Action |
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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 |
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Term
cyclophosphamide
(Cytoxan)
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Definition
Cancer Tx- Antineoplastics (MC)- Alkylating Agents (SC) |
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Term
methotrezate
(Folex, Mexate)
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Definition
Cancer Tx- Antineoplastics (MC)- Antimetabolites (SC) |
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Term
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Definition
Cancer Tx- Antineoplastics(MC)- Antitumor Antibiotics(SC) |
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Term
Vincristine Sulfate
(Oncovin)
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Definition
Cancer Tx- Antineoplastics (MC)- Natural Products (SC) |
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Term
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Definition
Cancer Tx- Antineoplastics (MC)- Hormones/Hormone Antagonists (SC) |
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Term
Principles of Cancer Therapy |
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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
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Term
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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
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Term
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Definition
Depends on type of malignancy being treated
Tests to evaluate size of tumor
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Term
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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
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Term
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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
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Term
What is the general mechanism of action for antiinfectives/antimicrobial agents? |
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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. |
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Term
What are the nontoxic adverse effects of antiinfectives/antimicrobial agents in general
and what do you do to check for them? |
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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
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Term
What are the toxic adverse effects of antiinfectives/antimicrobial agents in general
and what do you do to check for them? |
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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 |
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Term
What general teaching is involved
with antiinfectives/antimicrobial agents? |
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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)
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Term
What are the general administration
guidelines for antiinfectives/antimicrobials? |
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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)
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Term
What are the general pharmacotherapeutics
for antiinfectives/antimicrobial agents and how
do you check for therapeutic effect? |
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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
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Term
penicillin G
(Pentids)
A/T/A/T |
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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 |
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Term
penicillin G
(Pentids)
A/T/A/T |
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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)
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Term
penicillin G
(Pentids)
A/T/A/T |
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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 |
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Term
cefotaxime
(Claforan)
A/T/A/T |
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Definition
Antiinfectives - Antibacterials (MC) - Cephalosporins (SC)
Check for history of allergies - cross sensitivity to PCN |
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Term
cefotaxime
(Claforan)
A/T/A/T |
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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)
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Term
cefotaxime
(Claforan)
A/T/A/T |
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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)
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Term
cefotaxime
(Claforan)
Mechanism of Action |
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Definition
Antiinfectives- Antibacterial (MC)- Cephalosporins (SC)
High spectrum of gm (-) and gm (+) organisms
Resistant strains
longer duration of action
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Term
tetracycline HCL
(Achromysin)
A/T/A/T |
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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
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Term
tetracycline HCL
(Achromysin)
A/T/A/T |
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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
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Term
tetracycline HCL
(Achromysin)
Mechanism of Action |
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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 |
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Term
tetracycline HCL
(Achromysin)
A/T/A/T |
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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 |
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Term
erythromycin
(E-Mycin, Erythrocin)
Mechanism of Action
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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
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Term
erythromycin
(E-Mycin, Erythrocin)
A/T/A/T |
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Definition
Antiinfectives- Antibacterial (MC)- Macrolides (SC)
Take with full glass of water
shake/mix suspensions thoroughly
Do not give with fruit juices
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Term
erythromycin
(E-Mycin, Erythrocin)
A/T/A/T |
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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
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Term
erythromycin
(E-Mycin, Erythrocin)
A/T/A/T |
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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
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Term
gentamicin
(Garamycin)
Mechanism of Action |
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Definition
Antiinfectives- Antibacterial (MC)- Aminoglycosides (SC)
Narrow Spectrum
Aerobic gram (-) bacteria systemic infections
Some enterococci infections
Sterilize bowel prior to surgery
Parasitic infections
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Term
gentamicin
(Garamycin)
A/T/A/T |
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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
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Term
gentamicin
(Garamycin)
A/T/A/T |
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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
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Term
gentamicin
(Garamycin)
A/T/A/T |
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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)
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Term
ciprofloxacin
(Cipro)
A/T/A/T |
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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
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Term
ciprofloxacin
(Cipro)
Mechanism of Action |
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Definition
Antiinfectives- Antibacterial (MC)- Fluoroquinolones (SC)
Variety of gm (+) and gm (-) infections (resp, GI and GU tracts, soft tissue & skin)
MDR - TB
anthrax
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Term
ciprofloxacin
(Cipro)
A/T/A/T |
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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
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Term
ciprofloxacin
(Cipro)
A/T/A/T |
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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 |
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Term
TMP-SMZ
(Bactrim, Septra)
Mechanism of Action |
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Definition
Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)
Gram (+) & gram (-) - bacteriostatic
UTIs - E. Coli Proteus, Klebsiella (aka urinary antiseptics)
pneumocystis carini pneumonia
topical agent burns
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Term
TMP-SMZ
(Bactrim, Septra)
A/T/A/T |
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Definition
Antiinfectives- Antibacterial (MC)- Sulfonamides (SC)
Route: PO/topical
Give with full glass of water
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Term
TMP-SMZ
(Bactrim, Septra)
A/T/A/T |
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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 |
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Term
TMP-SMZ
(Bactrim, Septra)
A/T/A/T |
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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
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Term
imipenem
(Primaxin)
Mechanism of Action |
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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)
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Term
imipenem
(Primaxin)
A/T/A/T |
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Definition
Antiinfectives- Antibacterial (MC)- Misc. Antibacterials (SC)
Carbapenems (Sub SC)
Check for allergies
Route: IV
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Term
imipenem
(Primaxin)
A/T/A/T |
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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) |
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Term
imipenem
(Primaxin)
A/T/A/T |
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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 |
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Term
nitrofurantoin
(Macrodantin)
Mechanism of Action
|
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Definition
Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)
Treat or prevent lower UTIs
Low doses = bacteriostatic
high doses = bacteriocidal
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Term
nitrofurantoin
(Macrodantin)
A/T/A/T |
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Definition
Antiinfectives- Antibacterials (MC)- Misc. Antibaterials(SC)
Route: PS
Contraindications: hematologic disorders, renal dysfunction
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Term
nitrofurantoin
(Macrodantin)
A/T/A/T |
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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
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Term
nitrofurantoin
(Macrodantin)
A/T/A/T |
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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
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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)
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Term
vancomycin
(Vancocin)
A/T/A/T |
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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)
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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
|
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
|
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
|
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)
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Term
vancomycin
(Vancocin)
A/T/A/T |
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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)
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Term
vancomycin
(Vancocin)
A/T/A/T |
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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!)
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Term
vancomycin
(Vancocin)
A/T/A/T |
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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
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Term
isoniazid
(INH)
Principles of Drug Therapy
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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 |
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Term
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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
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Term
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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
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Term
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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
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Term
amphotericin B
(Funfizone)
A/T/A/T |
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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
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Term
amphotericin B
(Funfizone)
A/T/A/T |
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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 |
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Term
amphotericin B
(Funfizone)
A/T/A/T |
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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)
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Term
amphotericin B
(Funfizone)
Mechanism of Action
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Definition
Antiinfectives - Antifungals (MC) - no subclasses
Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out |
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Term
nystatin
(Mycostatin)
Mechanism of Action |
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Definition
Antiinfectives - Antifungals (MC) - no subclasses
Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out |
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Term
nystatin
(Mycostatin)
A/T/A/T |
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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
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Term
nystatin
(Mycostatin)
A/T/A/T |
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Definition
Antiinfectives - Antifungals (MC) - no subclasses
Topical: Skin irritation or rash (contact dermatitis)
Check skin folds or wherever you apply
Oral: N/V/D |
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Term
nystatin
(Mycostatin)
A/T/A/T |
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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
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Term
fluconazole
(Diflucan)
Mechanism of Action
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Definition
Antiinfectives - Antifungals (MC) - no subclasses
Fungicidal - increase permeability of fungal cell membrane --> allows intracellular contents to leak out |
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Term
fluconazole
(Diflucan)
A/T/A/T |
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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
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Term
fluconazole
(Diflucan)
A/T/A/T |
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Definition
Antiinfectives - Antifungals (MC) - no subclasses
GI: N/V/D
Hepatotoxicity
Reproductive: Menstrual abnormalities, gynecomastia, decreased libido
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Term
fluconazole
(Diflucan)
A/T/A/T |
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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
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Term
What are the factors that make
drug therapy difficult for malaria? |
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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 |
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Term
What are the factors that contribute
to parasitic infections? |
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Definition
Overpopulated areas with poor sanitation
Children - poor hygienic practices
Immunocompromised patients
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Term
chloroquine
(Aralen)
Mechanism of Action |
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Definition
Antiinfectives- Antiparasitics (MC)- Antiprotozoal (SC)
Malaria - acute stage, prophylaxis |
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Term
metronidazole
(Flagyl)
Mechanism of Action |
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Definition
Antiinfectives- Antiparasitics (MC)- Antiprotozoal (SC)
Non-malarial parasitic infections
Anaerobic bacterial infections
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Term
mebendazole
(Vermox)
Mechanism of Action |
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Definition
Antiinfectives- Antiparasitics (MC)- Antihelminthic (SC)
Parasitic worms: round worm & pinworms |
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Term
Characteristics of Viruses |
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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
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Term
Viral infections & Drug Therapy
(Implications) |
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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
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Term
zidovudine
(Retrovir, AZT)
Goals of Therapy
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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
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Term
nevirapine
(Viramune)
Goals of Therapy |
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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 |
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Term
saquinavir mesylate
(Forovase, Invirase)
Goals of Therapy |
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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 |
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Term
acyclovir
(Zovirax)
Goals of Therpy |
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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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