Test Review 3 ( antibiotics/antifungals-TB/anativiral/antparasistic

what is Narrow specturm

Drugs that are only active againsta few species

• safter and better since they target things more specifically

what does broad spectrum mean

drugs that are active agsinst a wide variety of microbes

what are the two kinds of defense/resistance principles

• Innate(natural)

• Acquired over time

  • may become less ensteiv to a drug or lose sensitivity

  • antibitotic resistance can develop to sevreal drugs

  • ass. w/ extended hospitalizations( morbitity and mortality)

what is antimicrobial stewardship

a multifaceted approach aimed at optimizing the use of antimicrobials (antibiotics, antifungals, and antivirals) to ensure their effectiveness and safety for patients while minimizing the risk of antimicrobial resistance

What is the process for selecting antibiotics

1. identify the infecting organism

2. think about drug sensivity of the infecting organsim

3. infestin site and status of host defenses

4. consider any allergies. inability of the drug to penetrate infection site and suscepibility of pt to have risk of frisrt choice drug toxicity

How do we idenifty the infectiing organsim

• a gram-stained preperation of blood, urine, exudate, sputum, etc.

• Polymerase chain rxns(PCR): detect low bacteria/virus titers

  • genertates thousands of DNA?RNA copies of the infecting microbe

  • more specific than a gram stain

what are gram-posative bacteria

its cell wall contains a thick layer of peptidoglycan and stains blue or purple after a Gram stain

what are gram negative bacteria

are bacteria that have a thin peptidoglycan layer and an outer membrane containing lipopolysaccharides.

• more harmful and harder to kill because of the extra outer membrane

what are the 3 kinds of selective toxicty

• bacterial cell wall disruption

• inhibits bacterial enzymes

• disrupts protein synthesis

what are the misuses of antibacterial therapy(5)

• attempted treatment of viral inf

• treatment of fever of unkown origin

• improper dosing

• treatment in the absense of adequate bacteriologic info.

• omission of surgical darinage

what assessments are needed proir and during therapy

Prior:

• Assess inf. ( vital , wound appearance, sputum, urine, & stool)

• Obtain history to determine allergies or previous reactions

• C & S PRIOR to therapy

During:

• WBC mointored

• Observe pt for s/s of anaphylaxis- d'c drug IMMEDIATELY and call rapid response (if in-pt) or 911 (outpt). Will likely need epinephrine & antihistamine

• Monitor bowel function. Report diarrhea, abd cramping, fever, bloody stools, and s/s of clostridioides difficile associated diarrhea (CDAD

what kind of pt education is important during antibiotic treatment

• Instruct to take medications around the clock and finish medications as directed (even if feeling better)

• Advise to report about super infections (black, furry tongue overgrowth; vaginal itching or discharge; loose/foul smelling stools) and allergies

• Advise not to treat diarrhea w/o consulting provider

• Most antibiotics DO NOT affect contraceptive drug therapy except the rifampicin family

what are the diff types antibiotic drug rxns

what drugs can pateint be allergic too if they are allergic to penicillin

• Cephalosporins have cross sensitvity

what drugs weakned the bacterial cell wall

B-lactams

• penicillins

• cephalosporins

• carbapenems

Vancomyocin

what are the 5 generations cephalosprins

• There are five generations of cephalosporins34 .

• As we progress from 1st to 5th generation, there is increasing activity against gram-negative bacteria and anaerobes, increasing resistance to destruction of β-lactamases, and increasing ability to reach the CSF

what drugs are in the 1st generations of cephalosprins(6)

• cefazolin

• cefadroxil

• cephalexin

• cephalothin

• cephaprin

• cephradine

what drugs are in the 2nd generations of cephalosprins(4)

• cefoxitin

• cefotetan

• cermetazole

• cefprozil

what drugs are in the 3nd generations of cephalosprins(6)

• ceftraixone

• ceftibuten

• cefotaximie

• ceftazidime

• cedpodoxime

• cefixime

what are the 4 generation cephalosprins(2)

• Cefepime

• Cefpirome

what are the 5th generation cephalosproins(2)

• ceftaroline

• ceftobiprole

what drugs inhibits protein synthesis

• tetracylines

• macrolides

• aminoglycosides

what are 3 beta-Lactams

• penicillins

• cephalosporins

• Crabapenems

what is the action of penicillins

 target penicillin-binding proteins (PBPs) when bacteria are growing, disrupting cell wall synthesis

• all PCNs have a β-lactam ring joined to a second ring which is essential for antibacterial actions

what is the actions for cephalosproins

Disrupt cell wall synthesis & activate autolysins causing bacterial cell death

what is the action for carbpenems

what are the side effects for penicillin

• Lots of GI upset like nausea, vomiting and dirrhea

• rash

• Urticaria

what are the side effects for fluroquinolone

• Aortic aneurysm

• photosensitivity,

• rash

• hepatotoxicity

• C-diff

• abd pain (n/d)

• increased liver enzymes

• arthralgia

• myalgia tendonitis

• tendon rupture

• CNS- agitation( confusion, dizziness, drowsiness, ha, insomnia, paranoia)

Black Box Warning Tendon Rupture: Disrupts extracellular matrix of cartilage in immature animals increasing r/f tendon rupture (young/older age, solid organ tx, and taking glucocorticoids)

Black Box Warning Myasthenia Gravis: can exacerbate muscle weakness and should not receive this drug.

what are the side effects for cephalosporin

• C. Diff

• diarrhea

• pain with IM site

• phlebitis at IV site

• Rarely- neutropenia, agranulocytosis, eosinophilia, lymphocytosis, thrombocytopenia, thrombocytosis

what are the side effects of amphotecicin B

• Cerebral palsey

• hypotension

• n/v/d

• hyperbilirubinemia

• increase liver enzymes

• nephrotoxicity

• chills/fever

• phlebitis (these are all common!)

what are the side effects for Fluconazole

• QT interval prolongation

• SJS

• hepatoxicity

• n/v/d

Vancomycin

inhibits cell wall synthesis, promoting bacterial lysis and death

• only for gram posative organism

• used for MRSA, C-Diff, seroius inf.

what are some side effects of vancomyocin

• renal impairment(esp w/ other renal toxic meds), ototoxicty, and phlebitis

what is the therapeutic level for vancomyocin

10-20mg/L

what are some important things to note about vancomyocin

• assess the 8th cranial nerve by audiometry

• watch vanc levels for toxicty( under 10= subtherapeutic, and over 15-20= toxicty)

• monitor Iv sites cosley for any tissue ncrosiis or severe pain w/ extravastion

• educate pt on reporting any tinnitus, vertigo and hearing loss

what are tetracylines

broadspectrum drugs, that suppress bacterial growth by inhibiting protein synthesis by binding to 30S ribosomal subunit and inhibit the RNA transfer to the messenger RNA ribosome complex. This prevents additional amino acids to the growing peptide chain.

what are the side effects of tetracyclines

• GI (n/v/d, esophagitis, hepatotoxicity), nephrotoxicity, photosensitivity

what are some important things to note about tetracyclines

• avoid bedtime dosing

• avoid w/ calcium/dairy, antacids, mag-containing meds, sodium bicarb, iron supplements w/i 1-3 hrs of tetracyclines (chelates-decreases absorption)

• Educate pts on reporting any superinfection, use sunscreen & protective clothing, discard outdated prescriptions- toxic

what is Uncomplicated Acute cystitis (UTI)

• Mostly women of childbearing age

• E.coli is principle organism (80%), then S. saprophyticus, and enterococcus faecalis

• S/S: dysuria, urinary urgency, urinary frequency, suprapubic discomfort, pyuria, & bacteriuria (>100,000 urine bacteria)

what are the 1st and 2nd line of defense for treating UTI’s

First line tx: trimethoprim/sulfamethoxazole and nitrofurantoin

Second line tx: fluroquinolones and Fosfomycin

what is sulfonamide( actiona nd side effects)

a medication used to treat UTI’s, Inhibit synthesis of tetrahydrofolate (folate derivative). Bacteria will be unable to synthesize DNA, RNA, & proteins

S/E:

• hypersensitivity

  • drug fever

  • rash [Stevens-Johnson syndrome]

  • photosensitivity

• blood dyscrasias

  • agranulocytosis

  • leukopenia

  • aplastic anemia

  • thrombocytopenia)

• kernicterus (newborns)

• renal damage

what is Trimethoprim(action and S/E)

a medication used to treat UTI’s, Inhibit dihydrofolate reductase (enzyme that converts dihydrofolate to its active form: tetrahydrofolate (folate derivative). Bacteria will be unable to synthesize DNA, RNA, & proteins

• active aginst most gram neg bacilli and some gram-pos.

S/E:

• altered taste, epigastric discomfort, glossitis, n/v, pruritis, rash

Sulfamethoxazole (SMZ) and Trimethoprim (TMP)( pt education)

• used togtheor to treat UTI’s, broad spectrum, less microbial resistance

• need to assess for infection, IV site for phlebitis, allergies to sulfonamides, renal function, increase fluid intake (1-1.5 L/day), rash (SJS), may cause hypoglycemia, monitor CBC, potassium bilirubin, renal labs, alk phos

• Use sunscreen/protective clothing, notify HCP for skin rash, fever, mouth sores, bleeding/bruising. May cause fetal harm (use multiple BC methods)

what are Sulfamethoxazole (SMZ) and Trimethoprim (TMP) contraindicated

• Severe hepatic or renal impairment

• hypersensitivity to sulfonamides or trimethoprim

• drug-induced thrombocytopenia from SMZ or TMP

• children < 2 (kernicterus)

What is Nitrofurantoin(action and S/E)

the first drug of choice, a broad spectrum bacteriostatic at low concentrations and bactericidal at high concentrations. Injures bacteria by damaging DNA. Becomes concentrated in the urine

S/E: GI (anorexia, n/v/d, hepatoxicity, c-diff), rust/brown urine discoloration, photosensitive, blood dyscrasias, hypersensitivity, pulmonary fibrosis

what are some contraindications for Nitrofuratonin

Oliguria, anuria, signif renal impairment, pregnancy near term and infants < 1 month.

what are some important points for nitrofuratoin

• assess for S/S UTI, I/O, bowl function (c-diff), pulmonary reactions (cough, fever, chills, dyspnea). Monitor LFTs, renal function, CBC periodically

• administer w food to decrease GI irritation. DO NOT CRUSH tablets or open capsules. Urine discoloration is not significant, watch for adverse effects

what are some TB drug principles

• it needs twio phase active TB treatment

  • initial is to eliminate dividing bacilli

    • 2 months of 4 daily drugs( rifampin, isoniazid, pyrazinamide, ethambutol)

  • Continuation phase

    • 4 months w/ 2 daily drugs( Isoiazid, Rifampin)

what kinds of drugs are used to treat TB

• rifampin

• isoniazid

• pyrazinamide

• ethambutol

Rifampin action

Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms

Rifampin side effects and considerations

S/E:

• HEPATOTOXICITY,

• STEVEN JOHNSON SYNDROME

• red discoloration of tears & urine

• abd pain

• n/v/d

• flatulence

Nursing Considerations:

• Assess liver function

• Educate: S/S hepatitis or thrombocytopeni

• may decrease oral contraceptive effectiveness;

• saliva, sputum, teeth, sweat, tears, urine feces may become red-orange-brown (soft contact lenses may become permanently stained)\

• Avoid alcohol!

• Do not confuse w/ rifaximin or rifamate

what is the action for Isoniazid

Action-inhibits mycobacterial cell wall synthesis & interferes w/ metabolism.

what are the side effects and considerations for isoniazid

S/E:

• HEPATOTOXICITY, Pancreatitis, peripheral neuropathy

Nursing considerations:

• Assess liver function

  Educate: S/S hepatitis

  Avoid alcohol!

what are some actions for Pyrazinamide

converted to pyrazinoic acid in suspectable strains of Mycobacterium which lowers the environmental pH

what are the side effects and nursing considerations for Pyrazinamide

S/E:

• HEPATOTOXICITY, hyperuricemia

Nursing Considerations:

• Assess liver function & uric acid

• Educate: S/S hepatitis, may precipitate acute gout

• Avoid alcohol!

Ethambutol action

inhibits mycobacteria growth

what are the side effects and nursing considerations for Ethambutol

S/E:

• HEPATITIS, optic neuritis

Nursing considerations:

• Assess renal & liver function & uric acid

• Educate: S/S hepatitis, may precipitate acute gout

• Monitor color discrimination monthly

what are the 3 types of helmonthic infestations

• nemotoda

• trematoda

• cestoda

what is a intestinal nemotoda dn what is used to treat it

a roundworm that infects the intestines

• treated w/ albendazole and mebendazole

what is the actions for albendazole

inhibits tubulin polymerization=loss of cytoplasmic microtubules

• causes death ot affcected larvae

what are the side effects(3) and considerations for Albendazole

S/E:

• Increased LFTs

• PANCYTOPENIA

• headache

Nursing considerations:

• Verify neg pregnancy

• Monitor LFTs, WBC

• Administer w/ food (high fat)

• Use contraception during & at least 3 days after therapy

What is acylovir

An anti-herpes medication that doesn’t cure it but can help reduce signs/symptoms

• action: Intereferes w/ DNA Chain replication

what are the side effects and nursing consideration for Acyclovir

S/E:

• NEPHROTOXICITY (especially w IV), SEIZURES, STEVEN-JOHNSON SYNDROME, N/V/D, dizziness, headache, pain with IV-phlebitis

Nusring considerations:

• MEDICATION COMPLANCE lessens episodes. Start tx ASAP

• Avoid sexual contact with lesions present. Condoms to be used with sexual contact

• May feel fatigued when starting to take the medication

• Assess lesions and monitor renal function (BUN, serum creatinine, & CCr) before/during therapy

• USE GLOVES-assess lesions

• Disseminated VZV airborne and contact precautions

• Women w/ genital herpes-yearly Papanicolaou smears-increased r/f cervical cancer

what is malaria

a parasitic disease that is found mostly in the tropics and transmitted thru a mosquito bite

• treated w/ Artemisinin

artemisninin side effects

• dizziness

• fatigue

• HA

• weakness

• abd pain

• anorexia

• n/v

• muscle pain

what is the antiviral treatment used for COVID-19

Nirmatrelvir and ritonavir = Paxovid

what is Paxlovid

• Nirmatrelvir- Inhibits viral replication.

• Ritonavir is a pharmacokinetic enhancer with no activity against SARS-CoV-2 but inhibits CYP3A-mediated metabolism of nirmatrelvir resulting in increased nirmatrelvir plasma concentrations.

• Recommened to give w/in 5 days of symptoms

• can cause GI problesm like dirrhea or dysgesusia

what is dysgeusia

a taste disorder characterized by a distorted or altered sense of taste, where food or drinks may taste metallic, bitter, sour, or otherwise unpleasant, even when they should taste normal.

influenza antivral treatment

Oseltamivir( tamiflu)

what is Oseltamivir( tamiflu)

It is an anti-flu prevention and treatment for flu A and B

• inhibits neuraminidase , a viral enzyme required for replication to preevnt the release f virus from the infected cells

• can cause a headache

what are some nursing consideratiosn for Oseltamivir( tamiflu)

• Flu last 5-10 days, with days 3-5 being the worst w/ symptoms

• Not curable, but speeds up viral shedding

• Helps lessen the symptoms up to 3 days (if given within 12 hrs of onset)

• Only can be given within the first 48 hours of symptoms

what drugs are known to be nerphrotoxic

• Acyclovir (especially IV)

• aminoglycosides

• tetracyclines

• vancomycin (especially with other renal toxic medications)

• amphotericin B

• tenofovir disoproxil fumarate (TDF)

• Concurrent use of NSAIDs and other nephrotoxic drugs with TDF may increase the risk of acute renal failure1

what is HIV

a retrovirus (lack self-replication) targeting CD4 cells mainly T lymphocytes (also macrophages and microglia- but these are generally resistant to HIV destruction)

• Replicates rapidly during ALL infection stages & mutates rapidly

• Spread through infected body fluids: blood, breast milk, semen, vaginal fluids (NOT through urine, feces, saliva, tears)

• has 3 phases ( rapid replication, latency, AIDS)

what ae the two actions for drugs to treat HIV

• durgs that inhibit HIV enzymes

• Drugs that block HIV entry to cells

what are the 4 kinds of drugs that inhibit HIV enzymes

• Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

• Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Protease Inhibitors

• Integrase Strand Transfer Inhibitors (INSTIs)

what kinds of drugs block HIV entry into cells

• Attachment Inhibitors

• Fusion Inhibitors

• CCR5 Antagonists

what are the side effects for and main drug of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

• Tenofovir

SE-rash, depression, HA (TDF only)

what are the side effects for and main drug of Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Efavirenz

• rash and psychiatric/neurological complains (decreased concentration, strange dreams, delusions, mania, increased suicide rates (HR 2.6)

what are the side effects for and main drug of Protease Inhibitors

• ritonavir

• Lipodystrophy (but also seen with HIV who have never been treated w/ this med), nausea, fatigue, paresthesia, dyslipidemia

what are the side effects for and main drug of CCr 5 Antagonists

• Maraviroc

• Generally, WELL tolerated. Some have cough, fever, rash, MS problems, abdominal pain, dizziness

• Limited impact on lipid levels

what does Hepatitis B treatment look like

• The therapy goal for Hepatitis B virus (HBV) is HBV DNA suppression and loss of HBeAG and HBsAG24.

• No cure

• Recommend to start with tenofovir alafenamide 25 mg daily (low drug-resistance & potent)

• 6 drugs to treat chronic HBV

  • Alfa-interfreons( interferon alfa-2b & peginterferon alfa-2a)

  • nuceleoside analogs(lamivudine, adefovir, entecavir, tenofovir)

what are the two formulatiosn for tenofovir

tenofovir disoproxil fumarate & tenofovir alafenamide

Tenofovir alafenamide(TAF)

• 1st line agent

• Can be used as first line therapy in treatment-naïve patients, prior exposure, or drug resistance to other nucleoside analogs

• Better option for renal impairment or osteoporosis

Tenofovir disoproxil fumarate (TDF)

• Disrupts DNA synthesis

• No resistance has been identified in clinical trials

what is alfa-interferons(action and S/E)

• Action: multiple viral replication cycle effects-binds to host cell membrane receptors- blocks viral cell entry, synthesis of viral messenger RNA & proteins, and viral assembly/release

  • used to treat Hepatitis B

• Side Effects: flu-like s/s, fatigue, neutropenia, depression, alopecia, n,v,d, anorexia

• Black Box Warning: May cause or worsen autoimmune, infectious, and ischemic conditions. Serious neuropsychiatric conditions have occurred (suicide and suicidal ideations)

what are the hepatitis C treatment concepts

• The treatment goal for Hepatitis C (HCV) is cure, indicated by undetectable HCV-RNA levels22 .

  • after 12 months of treatment ALT normalizes in up to 50% of pateints

  • HCV-RBNA levels are undetectable in up to 40% of pateints= cured

• combination therapy

  • Recommended Naïve Patient with or without Cirrhosis Regimens: Glecaprevir 300mg/pibentasivir 120 mg x 8 weeks (PROTOTYPE); or sofobuvir 400mg/velpatasivr 100 mg x 12 weeks - (without cirrhosis)

  • Obtain HCG test prior to tx

what is Glecaprevir

• a protease inhibitor

• needs to be used in combinatiopn w/ another anti-HCV drug

• need to be taken w/ food to enhance absorption

• can cause hepatotoxicty

what is Pibrentasvir

• NS5A inhibiotor, used to treat HCV

• Pibrentasvir is combined with glecaprevir (NS3/4A protease). Trade name- Mavyret

  • Treats genotypes 1-6

  • Contraindicated with moderate to severe hepatic impairment

what are some nursing consideratiosn when treating HCV

• HCV one-time screening for US asymptomatic adults w/o liver disease ages 18-79

• Record current medications (including OTC/dietary supplements), monitor & educate about drug-drug interactions (especially with HIV co-infection)

  Educate about proper medication administration, ADHERENCE, prevention of reinfection

• Assess labs (prior and throughout treatment): CBC, INR, hepatic function (albumin, total/direct bilirubin, alanine aminotransferase [ALT], aspartate aminotransferase [AST]), eGFR, HCV RNA (viral load), HIV antigen/antibody, Hep B surface antigen, HCV genotype, serum pregnancy test, HCV genotype

• avoid alcohol

what are the s/s for hepatotoxicty

• jaundice (yellowing of the skin and eyes)

• fatigue

• nausea/vomiting,

• abdominal pain

• dark urine, and pale stools

what are the labs for liver toxicty

alanine aminotransferase (ALT), aspartate aminotransferase (AST), total and direct bilirubin, alkaline phosphatase (ALP), and liver function tests (LFTs)