Drug Therapy for Viral, Fungal, and Parasitic Infections

warts, common cold, flu, chickenpox, COVID-19, measles, monkeypox, mumps, HIV, HPV, hepatitis

what are some conditions that are caused by viruses? (11)

intracellular

viruses are ______

secretions, contaminated food/water, breaks in skin/mucous membranes, sexual contact, pregnancy, breast feeding, organ transplantation

what are some mode of transmission for viruses? (7)

not every human cell has a receptor for every virus

why do certain viruses effect certain parts of the body?

asymptomatic, fever, HA, cough, malaise, muscle aches, N/V/D, insomnia, photophobia

what are some common clinical manifestations of viruses? (9)

vaccines and antiviral agents

what are general drug therapy for viruses? (2)

prevent viral replication

how do antivirals work?

expensive and often toxic

what are the 2 main downsides to antivirals?

Herpes Simplex (HSV-1, HSV-2), Chickenpox (Herpes Varicella), Shingles (Herpes Zoster), Cytomegalovirus (CMV)

what are the 4 types of herpes viruses?

cold sores

what is HSV-1?

genital sores

what is HSV-2?

docosanol (OTC), penciclovir, trifluridine

what are 3 examples of topical meds for HSV-1?

famciclovir, acyclovir, valacyclovir

what are 3 examples of systemic medications for herpes?

FAV

what is the acronym for herpes systemic meds?

CNS effects (malaise, fatigue, seizure pt caution), bone marrow supression (esp in neonates), skin effects (thrombocytopenic purpura), renal effects (hemolytic uremic syndrome)

what are the adverse effects of herpes medications? (4)

rash caused due to a decrease in platelets

what is thrombocytopenic purpura?

hemolytic uremic syndrome

when the blood vessels in the kidney become inflammed and clots form clogging up the kidney

fatigue, pale, hematuria

what are the s/sx of hemolytic uremic syndrome (3)?

renal dysfunction, CNS disorders (seizure caution), use caution in neonates, infants, and children

what are the contraindications/use with caution for herpes medications? (3)

improvement in symptoms, rash, hematuria

what are things to watch for in someone taking herpes medications?

treatment lasts longer for initial infection than recurrence and herpes is never cured & can spread even when dormant (use protection, no sex when sores present, c-section during active infection)

patient education for herpes (2)

cytomegalovirus

this is an opportunistic herpes infection that is most common in immunocompromised patients such as HIV and chemo

eyes, respiratory tract, liver

what organs does cytomegalovirus effect? (3)

ganciclovir

what medication is used to treat cytomegalovirus?

PO, IV, topical

what are the pharmacokinetics for ganciclovir?

CNS effects (fever, chills), skin effects (intense pruritis), renal effects (increased BUN/Cr), bone marrow suppression (BBW), major birth defects (BBW) (contraception prior to and 3 months after therapy)

what are the adverse effects of ganciclovir? (5)

pregnancy/lactating, bone marrow suppression, renal dysfunction (caution)

contraindications/cautions for ganciclovir? (3)

monitor BUN/Cr & CBC, pregnancy test before and after

nursing notes for ganciclovir (2)

oseltamivir (tamiflu)

medication for the flu

ribavirin

medication for RSV

ribavirin

this medication is typically inhaled for children

teratogenic

what is the BBW for ribavirin?

oseltamivir

this medication must be administered within 48 hours of onset of symptoms

RR, SpO2, lung sounds, accessory muscle use

what are some things to assess for patients with flu/RSV? (4)

hepatomegaly and lactic acidosis

what are the BBW for hepatitis B (and C) medications? (2)

pancreatitis

what is the adverse effect for hepatitis B (& C) medications? (1)

fever, vomiting, tachycardia

what are some s/sx of pancreatitis? (3)

antiretroviral treatment (ART)

what are drugs to treat HIV called?

CD4

HIV attacks what cells?

1. prevent transmission

2. closely adhere to treatment regimen

3. regular blood tests (viral load, CD4, CBC, kidney/liver function)

4. practice safe sex

5. use clean needles

give me 5 bullets on patient education for viral hepatitis and HIV treatment?

A.

Which of the following is true regarding Oseltamivir?

A. the drug should be started within the first 48 hours
B. it is used to treat UTIs
C. it can cause pancreatitis
D. the patient may develop cdiff

environment or normal flora

what are the 2 most common places to get fungal infections from?

oral candidiasis

which clinical manifestation of a fungal infection is this?

white patches on tongue and throat

GI candidiasis

which clinical manifestation of a fungal infection is this?

diarrhea d/t loss of normal flora

vaginal candidiasis

which clinical manifestation of a fungal infection is this?

yellowish vaginal discharge, inflammation; caused by pregnancy, diabetes, oral contraceptives, and antibiotics

skin candidiasis

which clinical manifestation of a fungal infection is this?

red and macerated due to moist skin folds or dressing

systemic candidiasis

which clinical manifestation of a fungal infection is this?

gets into bloodstream and can affect brain, heart, kidneys, and eyes; can be fatal

opportunistic infections

coccidiodomycosis, cryptococcosis, histoplasmosis, sporotrichosis, and pneumocystis jiroveci are all types of…

polyenes

this is a drug class that acts on ergosterol to disrupt the fungal cell membrane

azoles

this is a drug class that binds to an enzyme that is required to synthesize ergosterol

echinocandins

this is a drug class that disrupts the fungal cell wall and is less toxic (because the cell wall is one thing that differentiates human and fungal cells)

amphotericin B and nystatin

what are the two polyenes that we learned about?

amphotericin B

this medication is highly toxic — for serious fungal infections only

must be given IV over 4-12 weeks; lipid option for patients with renal dysfunction

what are the pharmacokinetics for amphotericin B? (2)

multiple organ failure (BBW), respiratory arrest (BBW), cardiac arrest (BBW), GI effects, GU effects (hypokalemia, azotemia, renal failure (non lipid form)), hematologic effects (bone marrow suppression)

what are the adverse effects of amphotericin B? (6)

azotemia

high levels of nitrogen waste in blood

allergy, renal impairment, lactating (can pass)

contraindications/cautions for amphotericin B (3)

aminoglycosides, barbiturates, benzodiazepines, antiHTN

what are medications that amphotericin B interacts with? (4)

D5W; 2-6 hours

amphotericin B must be infused with ____ over _____

aspirin, antihistamines, and antiemetics

what are some medications we should administer prior to giving Amphotericin B? (3)

assess for phlebitis

what is a nursing note for amphotericin B?

nystatin

this is a polyene used for oral, intestinal, and vaginal cnadidiasis (swish oral); toxic when given IV

PO, IV, shampoo, topical cream

what are the pharmacokinetics for azoles (4)

clotrimazole, miconazole

what are two OTC topical azoles? (not super worried about knowing)

fluconazole, ketoconazole

what are the two main systemic azoles?

liver toxicity, GI effects (N/V/D), CNS effects (HA), skin effects (rash, alopecia)

what are the adverse effects of azoles (4)?

hepatic/renal dysfunction, endocrine/fertility problems

what are the contraindications for azoles? (2)

caspofungin and micafungin

what are the two echinocandins we need to know?

highly bound to plasma albumin

pharmacokinetics for echinocandins

CNS effects (fever, HA, nausea), skin effects (rash), GI effects (vomiting), GU effects (increased BUN/Cr), bone marrow supression

adverse effects for echinocandins (5)

infants <3 months

what is the contraindication for echinocandins?

must be with patient for first 15 minutes of admin, incompatible with any IV meds except saline, assess CBC/CMP

what are the nursing notes for echinocandins? (3)

terbinafine

this is a broad spectrum antifungal used as oral therapy for onychomycosis

hepatotoxicity

what is the BBW for terbinafine?

C.

The nursing student is preparing to administer Amphotericin B. When looking at the patient’s medication list, which of the following would the student question?

A. Diltiazem
B. Insulin
C. Aminoglycosides
D. Macrolides

protozoal, helminths, scabies, pediculi

parasitic infections are caused by… (4)

insecticide, surveillance process, drug therapy

how do we prevent parasitic infections? (3)

insect bites or ingested/contact organisms

protozoal infections are caused by…

malaria

example of an insect bite protozoal infection

amebiasis, giardiasis, trichomoniasis

3 examples of protozoal infections caused by ingested/contact organisms

amebiasis

this is contracted from food with feces that have amebic cysts; s/sx diarrhea; can be fatal?

giardiasis

symptoms of this are rotten egg smelling stool, pale mucus filled stool, epigastric distress, weight loss, and malnutrition

trichomoniasis

GU infection that is typically asymptomatic in men but then sexually transmitted to women where they have symptoms such as reddened, inflamed vaginal tissue, itching, burning, yellowish green discharge

malaria

parasitic disease that killed millions, is endemic, and transmitted through the bite of the Anopheles female mosquito

False

True or False: mosquitoes and malaria have no resistance and are easy to avoid

1-2 weeks prior and 4 weeks after

when should antimalerials be given for travel?

chloroquine phosphate, hydroxychloroquine, mefloquine

what are 3 examples of antimalarials

antimalarials

these drugs inhibit prostaglandins, making them useful for autoimmune diseases as well as the reason we discussed

retinal toxicity and EKG changes

adverse effects of antimalarials (2)

metronidazole

what example of amebicide do we need to know?

metronidazole

this med is used to treat amebiasis, trichomoniasis, bacterial vaginosis, and diverticulitis (off label)

watch liver function, carcinogenicity found in rats (BBW), contra in pregnancy, avoid alcohol (during & 2 days after)

what are the nursing notes for metronidazole? (4)

helminth infection

this affects about 1 billion people, is the most common of all diseases, more common in tropical areas, and increased presence due to world travel

hookworm, pinworm, roundworm, tapeworm, threadworm, trichinosis, whipworm

give me 7 examples of helminths

stool specimen for ova & parasites (O&P)

how to get diagnosis for intestine invading worm infections

handwashing, laundering bed linens/undergarments, disinfection of bathroom/toilet, good personal hygiene

how to prevent reinfection/spread of intestine invading worms (4)

mebendazole

antihelminth that can cause hepatitis, should avoid alcohol, and recheck stool sample in 3 weeks

scabies & pediculosis

2 parasitic infections of the skin

permethrin

topical treatment for scabies/pediculicides

chrysanthemum allergy

contraindication for permethrin