Mycobacterial infections, Pain, Analgesic, and Anesthesia Medications

Rifampin

treats mycobacterial infections

MOA: Inhibits bacterial RNA synthesis by binding to bacterial RNA polymerase, preventing transcription

ADRs: GI upset, hepatotoxicity, red-orange body fluids (normal), strong CYP450 inducer, decrease use of oral contraceptives

Contraindicated w/ HIV

Monitor LFTs, DDIs, educate about body fluid discoloration

Isoniazid (INH)

treats mycobacterial infections

MOA: inhibits mycolic acid synthesis —> no formation of mycobacteria cell wall

ADRs: Fever, rash, neurotoxicity, hepatotoxicity, peripheral neuropathy

Monitor LFTs, give 25-50 mg daily of vitamin B6 to prevent neuropathy, report numbness and tingling, no alcohol

Pyrazinamide

treats mycobacterial infections

MOA: Disrupts the cell membrane potential and inhibits bacterial repair mechanisms

ADRs: Hepatotoxicity, hyperuricemia (may cause gout), GI discomfort, arthralgia (non-inflammatory joint pain)

Monitor LFTs and any pain in joints, hydrate to prevent uric acid buildup

Ethambutol

treats mycobacterial infections

MOA: Inhibits arabinosyl transferase (enzyme involved in cell wall synthesis in mycobacteria)

ADRs: Optic neuritis, hyperuricemia, arthralgia (non-inflammatory joint pain), GI upset

Monitor visual acuity, renal fcn, and educate patients to report blurred vision or color changes

Dapsone

treats leprosy and mycobacterial infections

MOA: inhibits folic acid synthesis —> decreasing mycobacterial growth

ADRs (bad): nausea, vomiting, hemoptysis, methemoglobinemia (oxidizes blood causing cyanosis), SJS/TENS, agranulocytosis, GI bleeding, hepatotoxicity

Monitor CBC, LFTs, and renal fcn

Aspirin

Nonselective NSAID

MOA: blocks COX1, COX2, **and** thromboxane A

ADRs: GI bleeding (verrrry serious), tinnitus, renal effects, Reyes synd (kids)

Take w food, do NOT take before surgery bc of bleeding risk

Caution w anticoagulants and contraind w kids < 18 bc it causes Reyes snyd (esp when taken w other drugs)

Watch for drug-virus interactions and combo products for overdose

Toxicity: treat w sodium bicarbonate to alkalinize the urine to pee aspirin out

Ibuprofen (Advil)

Nonselective NSAID

MOA: blocks COX1 and COX2

ADRs: GI irritation and bleeding, nephrotoxicity, hypertension, hypersens

Take w food; avoid in high risk GI/CV pts, anticoagulants, steroids, and late pregnancy

Celecoxib

Selective NSAID

MOA: blocks COX 2 only

**thus… less GI effect so preferred for those w gastic ulcers

ADRs: increase cardiovascular risk w clotting (MI, stroke), hypertension, nephrotoxic

Take w food, monitor for all effects (esp cardio and BP)

Caution w sulfa allergy bc could be cross-reactivity rxns

Prednisone

Steroidal anti-inflamm drug

MOA: inhibits phospholipase a —> cannot make arachidonic acid —> decrease prostaglandins and leukotrienes

Completely suppress inflammation (no cytokines, immune response, etc)

ADRs: increased infection risk/poor wound healing, hyperglycemia, fluid retention/hypertension (could lead to weight gain and edema)

Long term ADRs: osteoporosis, adrenal suppression (learns to make less steroids over time), psychiatric effects (increased energy or psychosis)

Take w food, monitor blood glucose and infection risk, TAPER DOSES

Acetaminophen

Antipyretics (fever-reducer)

MOA: blocks COX 1 and COX 2 in CNS to reset hypothalamic temperature set point

ADRs: hepatotoxicity!

Monitor total daily dose - max = 4k mg/day (4 extra strength tablets a day)

Avoid alcohol

Could be given IV or oral

Toxicity: liver failure —> use N-acetylcysteine (NAC) or activated charcoal (1st thing to give)

Morphine

Opioid agonist prototype; most commonly given opioid for pain; mimics endorphins

MOA: binds to opioid receptors (mu/kappa) in CNS to alter pain perception

ADRs: respiratory depression, sedation, constipation, nausea

**BBW for Sched II - give extended release or patches only for opioid tolerant clients (not opioid-naive)

Oral, IV (give slowly), subcutaneous

Monitor for respiratory depression and tolerance

Toxicity: give naloxone

Fentanyl

Opioid agonist; VERY POTENT

MOA: binds to mu/kappa opioid receptors

50-100x more powerful than morphine; fast onset, short ½ life

Reserved for severe pain, not surgery

ADRs: resp depression, bradycardia, hypotension

Ensure airway support, monitor for resp depression, titrate carefully

BBW for Sched II - high abuse potential

Change patch every 3 days if given transdermal, also IV or lozenge

Tramadol

Weak opioid agonist

MOA: binds to mu receptor, inhibits norepi/serotonin uptake

ADRs: dizziness, fatigue, CNS stimulation, seizures, SSRI synd, sudden death if combo w ethanol

Contraind if history of seizures bc it lowers threshold

Sched IV ctrled sub