Immune System Medications

Immunizations

Action: stimulates production of antibodies to prevent illness

Side Effects: DTaP, Tdap

• fever

• irritability

• seizures

Contraindications: DTaP, Tdap

Occurrence of seizures within 3 days of vaccine

Side Effects: Hib

• low-grade fever

Contraindicated: Hib

Age younger than 6 weeks

Side Effects: Rotavirus

• irritability

• diarrhea

• vomiting

• intussusception

Contraindicated: Rotavirus

• History of intussusception

• Maximum age for the final dose is: 8 months, 0 days

Side Effects: IPV

Anaphylactic reaction to:

• neomycin

• streptomycin

• polymyxin B

Side Effects: MMR

• joint pain

• anaphylaxis

• thrombocytopenia

Contraindication: MMR

• allergy to eggs, gelatin, or neomycin

• immunocompromised, pregnancy

Side Effects: Varicella

• vesicles on skin

• pruritus

Contraindication: Varicella

• pregnancy

• allergy to gelatin and neomycin

• immunocompromised

Side Effects: Seasonal Flu

• fever

Contraindication: Seasonal Flu

• Nasal spray contraindicated for children younger than 2, adults older than 50 years, and clients who are immunocompromised

• History of Guillain-Barre

Side Effects: Hepatitis A, B

• anaphylaxis

Contraindication: Hepatitis A, B

• Hep A: pregnancy

• Hep B: allergy to yeast

Contraindication: Meningococcal vaccine

History of Guillain-Barre

Contraindication: HPV—up to age 26

• pregnancy

• allergy to yeast

Tetanus boost

Every 10 years

MMR

1 or 2 doses at ages 19 to 49

Varicella

2 doses if no history of disease

Pneumococcal (PPSV)

once after age 65

recommended for immunocompromised, COPD, living in long-term care facility

Hepatitis A

two doses for high-risk clients

Hepatitis B

3 doses for high-risk clients

Seasonal influenza

annually

Meningococcal vaccine

• students entering college

• adults over than 56 years

• repeat every 5 years for high-risk clients

Herpes Zoster

over age 60

Nursing Interventions and Client Edu: Immunization

• consult CDC guidelines for schedule of administration

• educate clients about the purpose of immunization and keeping records

• instruct parents to avoid administration of aspirin for management of adverse effects in children

• instruct clients regarding side/adverse effects and management

Antimicrobes

Action: Inhibit growth, destroy, or otherwise control replication of microbes

Aminoglycosides Medications

• Amikacin

• Gentamicin sulfate

• Streptomycin

Therapeutic Use: Aminoglycosides

Septicemia, meningitis, pneumonia

Precautions: Aminoglycosides

• high risk for ototoxicity, nephrotoxicity

• monitor creatinine and BUN

• monitor trough levels

Cephalosporins Medications

• Cephalexin

• Cefaclor

• Cefotaxime

Therapeutic Use: Cephalosporins

• upper respiratory, skin, urinary infection

• used as prophylaxis for clients at risk

Precautions: Cephalosporins

• cross-sensitivity with penicillins

• monitor for signs of C. Diff

Fluoroquinolones Medications

• Ciprofloxacin

• Levofloxacin

Therapeutic Use: Fluoroquinolones

• bronchitis

• chlamydia

• gonorrhea

• PID

• UTI

• pneumonia

• prostatitis

• sinusitis

Precautions: Fluoroquinolones

Caution with hepatic, renal, or seizure disorder

Macrolides Medications

• Azithromycin

• Clarithromycin

• Erythromycin

Therapeutic Use: Macrolides

• upper respiratory infections

• sinusitis

• Legionnaires’ disease

• whooping cough

• acute diphtheria

• chlamydia

Precautions: Macrolides

• used for clients who have penicillin allergy

• administer with meals

Therapeutic Use: Nitrofurantoin

UTI

Precautions: Nitrofurantoin

• broad-spectrum

• contraindicated in renal dysfunction

• urine will have brown discoloration

Penicillins Medications

• amoxicillins

• ampicillins

Precautions: Penicillins

Hypersensitivity with possible anaphylaxis

Sulfonamides Medications

Trimethoprim/sulfamethoxazole

Therapeutic Use:n Sulfonamides

UTI, bronchitis, otitis media

Precautions: Sulfonamides

• consume at least 3 L/day of fluid

• use backup contraceptives

• avoid sun exposure

Tetracyclines Medications

• doxycyclines calcium

• tetracycline HCI

Therapeutic Use: Tetracycline

fungal, bacterial, protozoal, rickettisal infections

Precautions: Tetracycline

• consume at least 3 L/day of fluid

• use backup contraception

• avoid sun exposure

• permanent tooth discoloration if given to children younger than 8 years

Glycopeptide Medications

Vancomycin

Therapeutic Use: Glycopeptide

MRSA, bacterial, C. difficile infections

Precautions: Glycopeptide

• contraindication: allergy to corn

• caution: ototoxicity, nephrotoxicity

• monitor trough levels

• administer over 1 hr IV to prevent red man syndrome

Antifungal Medications

Fluconazole

Therapeutic Use: Antifungal

Candidiasis infections

Precautions: Antifungal

• monitor hepatic and renal function

• refrigerate suspensions

• increased risk of bleeding for clients taking anticoagulants

Antimalarials Medications

• hydroxychloroquine

• quinine sulfate

Therapeutic Use: Antimalarials

• prevent malarial attacks, rheumatoid arthritis

• systemic lupus

Precaution: Antimalarials

• increased risk of psoriasis

• monitor for drug-induced retinopathy

Antiprotozoal Medication

Metronidazole

Therapeutic Use: Antiprotozoal

• trichomoniasis and giardiasis

• clostridium Difficile

• amebic dysentery

• PID

• vaginosis

Precautions: Antiprotozoal

• take with food

• do not consume alcohol during therapy or 48 hr after completion of regimen

Antituberculars Medications

• Isoniazid (INH)

• Rifampin

Therapeutic Use: Antituberculars

• prevention and treatment of TB

• latent TBH INH: 6 to 9 months

• active TB: multiple therapy up to 24 months

Precautions: Antituberculars

• risk of neuropathies and hepatotoxicity

• consume foods high in vitamin B6

• avoid foods with tyramine (INH)

• increased risk of phenytoin (INH)

• avoid alcohol

• discoloration or urine, saliva, sweat, and tears (rifampin)

Antiretrovirals Medications

• Acyclovir

• Valacyclovir HCI

• Zidovudine

Therapeutic Use: Antiretrovirals

Genital herpes, shingles, HIV

Precautions: Antiretrovirals

• acyclovir and valacyclovir: administer with food

• increase fluid intake

• begin therapy with first onset of symptoms

Nursing Interventions and Client Edu: Antiretrovirals

1. assess history of medications allergy

2. monitor for signs of medication reactions

3. monitor for signs of secondary infections

4. administer medications at appropriate time intervals to maintain therapeutic effects

5. if C&S is prescribed, perform test before initiating therapy

6. instruct client to complete entire medication regimen