Pharmacology- Antitubercular and Antivirals Drugs- EXAM 3

what is tuberculosis?

-infectious disease caused by bacillus mycobacterium tuberculosis

-AIRBORNE! only need one single micro droplet to contract it

-occurs mainly in lungs but can spread to other organs

-primarily affects lungs (can spread to kidneys, spine, brain)

what is latent tuberculosis?

-someone who is infected but do not have an active infection

-occurs during reactivation of dormant bacilli

*ONLY people with active tb can spread the infection to others

what are the antimycobacterials for TB?

-isoniazid

-pyrazinamide

-ethambutol

what is isoniazid (INH)?

-a TB drug that kills actively growing mycobacteria outside the cells and inhibits the growth of dormant bacteria

-used for both active and latent TB and is typically first line for latent TB

-bacteriocidal and tx is a 6-9 months (daily pills)

how does isoniazid work for latent TB?

-only isoniazid used daily for 6-9 months

-isoniazid with rifapentine taken once weekly for 3months

how does isoniazid work for active TB?

-several anti-mycobacterial drugs (to decrease resistance)

-usually four-drug regimen (often including isoniazid and rifapentine)

what is pyrazinamide?

-a TB drug that can effectively kill organisms residing within the very acidic environment

-increases uric acid

what is ethambutol?

-a TB drug that inhibits bacterial RNA synthesis

-side effects: can lead to blindness so any complaints of visual disturbances NEED TO BE followed up

what are the complications of isoniazid?

-peripheral neuropathy

-hepatotoxicity

-neuritis (aka inflammation of the nerves)

what supplement helps reduce symptoms of neuritis in patients taking isoniazid?

B6 supplements

in what population is isoniazid contraindicated in?

-patients with liver disease

*must monitor LFT's before and during medication and educate patient to be on the look out for liver damage symptoms

can patients on TB drugs drink any alcohol?

-absolutely NOT no alcohol at all!

what are the interactions of isoniazid?

-isoniazid inhibits metabolism of phenytoin

-concurrent use of tyramine food (aged cheese, cured meats), alcohol, rifampin, pyrazinamide INCREASES RISK OF HEPATOXICITY

what are the nursing administration factors for antimycobacterials?

-usually given PO

-if IM, warm to room temperature and inject deeply into a large muscle like vastus lateralis or ventricular glutealis

-for active, direct observation is done to ensure adherence (DOT) + must be started at the very beginning of therapy

what are patient education factors for antimycobacterials?

-consider a second form of birth control

-take isoniazid 1hr before or 2 hr after meals with full glass of water

-isoniazid is best on a empty stomach but can be taken with food to mitigate GI distress

-complete full course

what is rifampin?

-a TB drug that kills slower growing organisms

-bactericidal as a result of inhibition of protein synthesis

-can expect an orange-reddish staining of the skin and fluids

how do we use rifampin for treating TB?

-given in combination with at least one other antitubercular drug to help prevent antibiotic resistance

what are the complications associated with rifampin?

-discoloration of body fluids (red/orange color)

-hepatoxicity

-mild GI discomfort

-pseudomembranous colitis aka CDIFF

what are the contraindications/precautions for rifampin?

-use cautiously in patients who have liver dysfunction

-non-hormonal form of birth control should be used

-cannot use contacts while on rifampin

what are the drug interactions of rifampin?

-rifampin accelerates metabolism of warfarin, oral contraceptives, and NNRTI's used as tx for HIV

-concurrent use with isoniazid and pyrazinamide INCREASES RISK of hepatotoxicity

what are the nursing administration factors for rifampin?

-administer PO or by IV route

-PO- 1 hr before or 2 hr after meals with full glass of water

-monitor kidney and liver function prior to and during treatment

what are patient education factors for rifampin?

-use non-hormonal contraception

-body fluids may have a red-orange color (expected and non-harmful)

-complete full course

-avoid alcohol (increase risk of liver damage)

how do we evaluate medication effectiveness for TB antimycobacterials?

-improvement of tuberculosis manifestations like clear breath sounds, no night sweats, increased appetite, no afternoon rises of temperature

-three negative sputum cultures for tuberculosis (usually takes 3-6 months to achieve because these cultures need to have time apart)

-chest x-ray

what is RIPES?

-guideline for major TB drugs (antimycobacterials)

what are antivirals?

-most act by altering viral reproduction

-only effective during viral replication

-ineffective when virus is dormant

- used to treat herpes/ Varicella and Influenza

what is acyclovir?

-antiviral used to herpes simplex and varicella

-prevents the reproduction of viral DNA and interrupt cell replication

-all antivirals end in -vir

what are the complications associated with acyclovir?

-phlebitis and inflammation at the site of infusion

-nephrotoxicity

-nausea, HA, diarrhea

-gingival hyperplasia

what are nursing administration factors for acyclovir?

-administer IV slowly over 1 hr or longer

-healed herpetic lesions should continue to use condoms

-we want to start treatment as early as possible to give the virus less time to replicate

-ensure to rotate IV sites

what is oseltamivir (tamiflu)?

-antiviral that shortens flu symptoms and decreases the release of the virus from infected cells

-should be taken 24-48 hours within getting flu like symptoms

what are the complications of oseltamivir?

-N/V/D

-self-injury and delirium (BLACK BOX WARNING) we try not to use these in pediatrics

what are the nursing administration factors for oseltamivir?

-should be taken within 48 hours of flu symptoms

-not substitute for influenza vaccines just helps prevent serious complications associated with the flu