Antimicrobial patho

General Characteristics of Antimicrobials

• Invade, attach to cells, multiply, and assault tissues

• Initiates an inflammatory/immune response

• Adapt to survive

• Inflammatory/immune response may be sufficient in some cases

• Pathogens may have adapted to increase survival within the host – in these cases, antimicrobial
  therapy is utilized

Bacteria

• A single-celled microorganisms without nuclei that reproduce by fission or splitting

• Single-celled, without nuclei

• Aerobic or anaerobic

• Gram-positive or gram-negative

• Shape [rod, cocci…]

• Treat with antibiotics

Virus

• Are intracellular parasites that survive only in living tissues.

• Invade and replicate inside cells

• Classified according to structure or origin [e. g., adenovirus, retrovirus…]

• Treat symptoms only or with antivirals

Fungi

• Are plantlike microorganisms that live as parasites on living tissue or as saprophytes on decaying organic matter

• Plant-like

• May be treated with antifungals

Parasites

• From the animal kingdom – infect other animals [e. g., protozoa, helminths, arthropods]

Colonization

• Presence and growth of microorganisms on host tissues.

• Does not necessarily cause injury or elicit an immune response

Normal Microbial Flora

• Most parts of the body are sterile [organs and fluids]

• Some parts of the body contain microorganisms that do not cause any harm or injury to the host – known as normal flora

• Examples of normal flora in the human body

- Gut/Gi Tract, Mouth, Upper respiratory, Skin

• Intestinal Flora synthesizes Vitamin K and Vitamin B complex

• Intestinal Flora aids in digestion

• Plays a role in preventing overgrowth from other pathogens

How is Normal Flora helpful to the body?

Infection

What happens if flora (microorganisms) that is normal to one tissue type enters another tissue type?

Opportunistic infection - immune suppressed

Impaired vitamin k synthesize, over growth of pathogen,

Overgrowth of pathogens, particulary yeast or C.diff

What happens if normal flora is killed by antibiotics?

Host Defense Mechanisms

• Examples: skin, mucous membranes, secretions, coughing, immune system, inflammation (WBC)

• Factors that increase risks of pathogenic invasion:
  o Advanced age
  o Break in integument (break in the skin)
  o DM / other chronic diseases
  o Impaired blood supply
  o Malnutrition
  o Neutropenia or other decrease in WBCs
  o Poor personal hygiene
  o Presence of tubes/catheter devices
  o Suppression of normal flora

• Proliferation of microbial pathogens causes harm to host, manifestations of an infectious process; infectious process

Opportunistic Infection

• SERIOUS; LIFE-THREATNING

• Microorganisms that do not normally cause infections in host with an intact immune system

• These microorganisms are usually normal endogenous, environmental flora, and
  nonpathogenic but become pathogenic in hosts whose defense mechanisms are
  impaired/immunosuppressed; enters someone with compromised immune system

• HIV/AIDS

• Burn patinets

• Chemo patients

What populations are most at risk for acquiring an opportunistic infection?

Superinfection

• Emergence of a new or an additional infection that appears during the course of
  treatment for a primary infection due to depletion of immune cells and/or depletion of normal flora

• Difficult to treat

Serology

• Identifies pathogens indirectly; a measure of antibodies (titer) in a specimen/infected host

• “Measurs how many antibodies in the human that are preset for a specific pathogen”

Polymerase Chain Reaction (PCR)

• Detection of antigens

Microscopic Examination

• Helps with visualization

• Gram Stain (dye) assists in differentiating microorganisms

Culture and Sensitivity

• Process of growing microorganisms (sample) in a lab for the purpose of identifying a specific organism; 48 hrs later

• “S” = susceptible

• “R” = resistant

• “MIC” = lowest concentration of antibiotic that prevents growth of a microorganism

• ALWAYS COLLECT CULTURE & SENSITIVITY SPECIMEN FIRST

Community Acquired Infection

• Infection that the host contracted outside of the hospital setting

• Easier to treat

• Diagnosed ≤ 48 hours of admission (first 48 hrs)

• Common type: community-aquired pneumonia (inflection of lungs, does not aquired in healthcare facility, leading cause of morbidity/mortality).

Hospital Acquired Infection

• Infection that originated in the hospital setting

• Most difficult to treat and more costly

• More likely to be drug-resistant

• Diagnosed ≥ 48 hours of admission (before 48 hrs)

Antibiotic-Resistant Microorganisms

• Major Public Health Issue

• Microorganisms that are able to survive despite antibiotic treatment/therapy

• May require lengthy hospitalizations and the administration of more toxic medications

• COSTLY

• EX: Penicillin-Resistant Streptococcus pneumoniae (pneumococci), vancomycin-resistant enterococci, methicillin-resistant and vancomyic intermediate/vancomycin-resistant staphylococcus species

• Make sure to see if there is any improvement 24-36 hrs, if not, notify provider

Causes of Antibiotic-Resistant Microorganisms

• OVERUSE OF ANTIBIOTICS – overprescribing , patients not taking antibiotic as prescribed, poor hygiene/sanitation, poor infection control in hospitals, use of antibiotics in agriculture

• At risk populations: hospitalized patients, critically ill

• *Patients who do not demonstrate improvement within 24-36 hours of receiving antibiotics may have an antibiotic-resistant pathogen

Drug Therapy

• Purpose: Treat or prevent an infection as a result of tissue invasion by a microorganism

• Goal: get rid of the invading pathogen and restore the host to a state of wellness

• Role of Nurse: Monitor the patient’s response

• The immune system of the host plays a role in the overall treatment/recovery

• The most widely used group of medication

Broad Spectrum Antibiotics

• Are effective against a wide range of bacteria (e.g., both gram-positive and gram-negative bacteria)

Narrow Spectrum Antibiotics

• Are effective against a limited range or a specific type of bacteria.

• Is preferred/initial choice when possible because broad-spectrum drugs are more likely to kill some normal flora, which disrupts the microbial balance.

Bactericidal

• KILLS the bacteria

Bacteriostatic

• INHIBITS GROWTH of the bacteria
  

Antibacterial Drug Therapy

• Are toxic to microbes but harmless to host

• Typically work by:

- Disrupting bacterial cell wall
- Blocking an enzyme unique to bacteria
- Disrupting bacterial protein synthesis
- Disrupting bacterial synthesis of RNA / DNA

Factors to choosing an Antibiotic

• Identify the organism

• Drug sensitivity

• Host factors such as:
  1. Status of health (immune system, renal/liver function…etc.
  2. Site of infection
  3. Allergies
  4. Age
  5. Pregnancy, may cross the placenta

  
  

Guidelines of Antimicrobial Drug Therapy

• DO NOT USE antibacterial agents to treat viral infections

• Use only if bacterial infection diagnosed or strongly suspected OR indication for prophylaxis

• Narrow-spectrum is preferred over broad-spectrum and should be used initially if appropriate

• Avoid antimicrobials for fever unless manifestations and/or diagnostic tests indicate infection

• Practitioners should follow CDC guidelines for prevention/treatment; particularly with drug-resistant organisms

• May be necessary to consult an infectious disease specialist

• Obtain cultures for C&S and gram stain BEFORE administering 1st dose of antibiotics (if cultures are ordered)

Empiric Therapy

• Drug therapy undertaken prior to obtaining a definite diagnosis

• Beginning antimicrobial therapy while waiting for C&S results (if done)

Example of Empiric Therapy

Patient has Manifestations of Infection

• Order antimicrobial

• Start antimicrobial (empiric therapy)

• Monitor for therapeutic response

OR

• Order a C&S and antimicrobial

• Collect C&S

• Start antimicrobial (empiric therapy)

• Review C&S results in 48-72 hours; adjust antimicrobial therapy as applicable

• monitor for therapeutic response

What should a nurse do to monitor a patients response to antibiotic therapy?

Drug Therapy with Beta-Lactam Antibacterial Agents

• Includes: penicillin, cephalosporins, carbapenems & monobactams

• This class of drugs binds to proteins on the cell membrane of bacteria and inhibits the synthesis of the bacterial cell wall
  - These types of drugs have a chemical structure called a “beta-lactam ring”
  - This “ring' must stay together in order for antibacterial effects
  - Some microorganisms produce enzymes [beta-lactamase] that break down this ring, thus making the drug ineffective; contributes to resistance to this class of med – therefore a chemical called clavulanic acid [beta-lactamase inhibitor] is added to some in this class to inhibit these enzymes
  - Generally safe with children
  - Safe with older adults except with renal impairment

Penicillins

• “cillin”

• Examples: PCN G, PCN V, ampicillin (P), oxacillin, nafcillin, amoxicillin, piperacillin,

• Extensively used; originates from mold and semisynthetic substances

• All forms of PCN are available for IM route; Pharmacokinetics:
  - Widely distributed
  - Excreted by kidneys

• Mechanism of Action [MOA]: binds to protein on cell wall of bacterial, weakens cell wall, inhibits cell wall synthesis, then causes cell to rupture (bactericidal); Does not damage/injure host cells

• Indications: bacterial infections – skin/soft tissue, pulmonary, GI, GU, endocarditis

• Contraindications: hypersensitivity/allergy to ANY PCN

Adverse Effects of Penicillin

• Hypersensitivity; 1-10% experience allergic response

• GI: N/V/D, gastritis, abdominal pain

• Superinfection

• Nephropathy

• CNS: confusion, lethargy, dysphagia, seizures, coma

• BBW: DO NOT ADMINISTER IV PCN G

Nursing Implications for Penicillin

• Generally safe for use in children and older adults

• Should be taken on an empty stomach to increase absorption – take with a full glass of H2O

• If patient experiences GI upset – may take with food but be aware that absorption will be impaired–

• Renal Excretion

• Hepatic Impairment:

• 1st dose – ALWAYS monitor for at least 30 minutes

• If given IM give deep in large muscle (painful/tissue irritation)

• Monitor for adverse effects and therapeutic response

QSEN: Be aware that PCN beta-lactamase inhibitor combinations contain PCN + clavulanate (clavulanic acid). Amoxicillin + clavulanate [Augmentin] is commonly used and each tablet contains a specified amount of amoxicillin and 125 mg of clavulanate. Therefore, a 500 mg tablet of Augmentin is NOT equal to two 250mg tablets

Cephalosporins

• “cef” “ceph”

• Originate from a fungus; related to PCN; Broad-spectrum, bactericidal

• MOA: similar to PCN; Most effective against cells undergoing division

• Indications: surgical prophylaxis, infections of the respiratory tract, skin/soft tissues, bones, joints, GU, brain/spinal cord, & sepsis

• Contraindications: hypersensitivity or previous anaphylactic reaction to PCN [chemically similar to PCN

Adverse Effects of Cephalosporins

• Hypersensitivity

• GI: Abd pain, diarrhea, gastritis, N/V

• Superinfection

Types of Cephalosporins

• NOTE: as the generations of cephalosporins progress, they have

• ↑ high ability against gram–bacteria and anaerobic bacteria

• ↑ high ability to resist destruction by beta-lactam enzymes

• ↑ high capacity to get to CSF

1st Generation Cephalosporins

• EX: Cefazolin (Ancef), Cephalexin (Keflex)

• Indications: Surgical prophylaxis; Rarely used

2nd Generation Cephalosporins

• EX: Cefaclor (Ceclor), cefprozil (Cefzil)

• Indications: Surgical prophylaxis (colorectal/gynecologic)

3rd Generation Cephalosporins

• Cefdinir (Omnicef), Ceftriaxone (Rocephin)

• Indications: Able to penetrate meninges and enter CSF; good choice for
  meningeal infections. Pseudomonas infections when used in combination with
  other antibacterials [to prevent drug resistance]

4th Generation Cephalosporins

• EX: cefepime (Maxipime)

• Indication: Broader spectrum, May be used with strains that have developed resistance to 3rd generation

5th Generation Cephalosporins

• EX: Ceftaroline (Teflaro)

• Community-acquired pneumonia, MRSA, VRSA, skin infections

Nursing Implications for Cephalosporins

• Generally safe with children; cautious with neonates

• May need to decrease dose in older adults

• May impair Vitamin K synthesis in the intestinal tract which is pertinent for patients taking a specific type of anticoagulant [Anticoagulants will be covered in cardiac lecture]

• PO – take with food / milk

QSEN: If used for surgical prophylaxis, give 60 minutes before first incision so that the drug has time to reach therapeutic serum and tissue concentrations

Carbapenems

• Broad-spectrum, bactericidal, beta-lactam antimicrobials

• Imipenem-cilastatin (Primaxin) – parenteral

• Ertapenem (Invanz) – parenteral

Monobactam

• Bactericidal

• Aztreonam (Azactam) - parenteral

Aminoglycosides

• “micin, mycin”

• Examples: gentamicin (P), amikacin (Amikin), streptomycin

• Potent; Poorly absorbed from GI tract

• Widely distributed with parenteral administration

• MOA: Bactericidal – enters cell walls – attaches to specific ribosome and impairs ability of bacteria to synthesize proteins that are required for cellular function and reproduction

• Indications: serious systemic infections (septicemia); gram negative aerobic (aerobic-needs O2 to cross cell wall) pathogens (e.g. tuberculosis, osteomyelitis) in conjunction with other antibacterials for synergistic effect

Adverse Effects of Aminoglycosides

• BBW: NEPHROTOXICITY & OTOTOXICITY (EARS & KIDNEYS)

• Nephrotoxic

• Ototoxic such as vertigo, tinnitus

• Peripheral neuropathy

• Use cautiously with myasthenia gravis

• Contradtications: Hypersensitivity

Nursing Implications of Aminoglycosides

• Cautious use with neonates, children, and older adults

• Dosing
  (a) Conventional Dosing: multiple doses throughout the day
  (b) **Once daily dosing (ODA): once a day with higher doses

• Loading dose vs Maintenance dose

• Id patients at high risk for nephrotoxicity [renal impairment]

• Hydration [2-3L per day]

• Monitor therapeutic serum levels
  (a) Creatinine clearance (CrCl)
  (b) Peak and Trough serum laboratory values

Peak

• Highest serum level of drug

• Time: 0.5-1 hour after administration

Trough

• Lowest serum level of drug

• Immediately before the next schedules dose

Gentamicin 400 mg IV daily. The nurse will administer the ordered Gentamicin at 0830 over 1
hour. A peak and trough have been ordered?

• What time will the nurse draw the serum trough level?

• What time will the nurse draw the serum peak level?

Fluoroquinolones

• “floxacin”

• Examples: ciprofloxacin (P)(Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox)

• MOA: interferes with bacterial DNA replication; bactericidal; Cells/DNA of host are not affected;

• Indications: gram-negative aerobic pathogens; lower respiratory tract, bone/joint, GU, GI, skin/soft tissue, ciprofloxacin 1st line for anthrax

Adverse Effects of Fluoroquinolones

• Usually well tolerated, N/V, abd discomfort, photosensitivity

• BBW: tendinitis and tendon rupture, peripheral neuropathy, CNS/CV effects

• BBW: Myasthenia gravis – may exacerbate muscle weakness

• GI, HA, photosensitivity reactions

• Contradications: Hypersensitivity

Nursing Implcations of Fluoroquinolones

• Not routinely used in children except with complicated UTI, pyelonephritis, anthrax exposure

• Once a day dosing increases compliance

• Avoid taking with dairy products

• 2-3 L fluid each day if not contraindicated

• Cautious with severe liver disease

• May prolong QT interval

• Assess for therapeutic effects/adverse effects

Tetracyclines

• Examples: tetracycline (P), doxycycline (Vibramycin)

• MOA: Inhibit protein synthesis, thereby suppressing bacterial cell growth (bacteriostatic

• Indications: Lyme disease, select animal bites, some sexually transmitted infections (STI’s), acne, H pylori bronchitis

• Doxycycline is approved by FDA to treat anthrax after exposure

• Contraindications: hypersensitivity, renal failure, pregnant women, < 8 yrs age

• Should not be used in children less than 8 years of age or during pregnancy; deposits in bone- forming tissue

- < 8 years of age: may cause permanent discoloration to the teeth (yellow, gray, brown)
- Pregnancy: hepatotoxic to pregnant females; may interfere with fetal bone and skeletal development

Adverse Effects of Tetracyclines

• N/V, photosensitivity, GI symptoms, CNS, hepatotoxicity, renal toxicity, superinfections

• QSEN: Avoid taking expired tetracyclines; severe reactions including renal damage may occur due to alteration in the chemical structure after expiration

Nursing Implications of Tetracyclines

• Take on empty stomach

• Take with 8 oz H2O to reduce GI irritation

• Avoid milk products, Fe, and antacids within 2 hours of administration

• Avoid prolonged exposure to sunlight, tanning beds

• If on oral contraceptives – use another form of birth control

Sulfonamides (Sulfa Drugs)

• Examples: trimethoprim (TMP)/sulfamethoxazole (SMZ) (P) (Bactrim, Septra), silversulfadiazine (silvadene); “sulfa”

• MOA: inhibits synthesis of folic acid [necessary component for RNA/DNA synthesis], bacteriostatic; halt

• Do not harm host synthesis of folic acid

• Highly resistant – used less often

• Indications: UTI’s, burns (topical Silvadene), chronic bronchitis

• Contraindication: renal failure, hypersensitivity to this class or other sulfa based drugs, late pregnancy

Adverse Effects of Sulfonamides

• N/V/D, photosensitivity, kernicterus (newborn), renal damage, blood dyscrasias such
  as aplastic anemia, thrombocytopenia, leukopenia

• *Steven-Johnson Syndrome: rare hypersensitivity reaction; high mortality rate

Nursing Implications of Sulfonamides

• Drink at least 2 liters of fluid daily to avoid crystallization in urine

• May monitor pH of the urine alkaline urine better

• Give with glass of H2O

• Oral contraceptive effectiveness is decreased with TMP-SMZ

• Avoid prolonged exposure to sunlight, tanning beds

• Nitrofurantoin (Macrobid Macrodantin): An anti-infective agent used to treat and prevent UTI’s

SULF

• S = sunlight (photosensitivity)

• U = urine crystalization

• L = Liquid (2-3 L/day)

• F = Another Form of birth control

Macrolides

• (macro – “big molecules”)

• Examples: erythromycin (P), clarithromycin (Biaxin), azithromycin (Zithromax)

• MOA: interferes with bacterial protein synthesis

• May be bactericidal or bacteriostatic, depending on concentration of drug

• Erythromycin is administered as an ophthalmic ointment to newborns
  to prevent rheumatic fever, gonorrhea, syphilis, pertussis, and
  chlamydial conjunctivitis

• Contraindications: Hypersensitivity

Adverse Effects of Macrolides

• GI, (N/V/D, cramping, anorexia, hepatotoxicity, pseudomembranous colitis); use
  cautiously with liver disease (hepatic metabolism and excretion), CNS (reversible hearing loss), confusion, emotional lability

Miscellaneous Anti-Infective Agents

• Chloramphenicol, Clindamycin (Cleocin), Dalbavacin (Dalvance), Daptomycin (Cubicin), Linezolid (Zyvox), Metronidazole (Flagyl), Oritavancin (Kimyra), Quinupristin-Dalopristin (Synercid), Rfiaximin (Xifazan), Tedizolid (Sivextro), Televancin (Vibativ), Tigecycline (Tygacil) “thromycin” “ceph”

  
  

Vancomycin

• Rising incidence of Vancomycin Resistance Enterococcus (VRE), limited use is recommended, used for serious infections

• MOA: inhibits cell wall synthesis; bactericidal; gram positive only

• Poor GI absorption, mostly given intravenously

• Contrainfications: Hypersensitivity

Indications of Vancomycin

• Intravenous (IV) for MRSA, bacterial endocarditis, other serious systemic infections

• Oral is only used for pseudomembranous colitis caused by C. dificile and staphylococcal
  enterocolitis; oral administration does not absorbed from the GI tract, works directly within the bowel lumen

Adverse Effects of Vancomycin

• Nephrotoxicity (reversible)

• Vancomycin Infusion Reaction (aka Redman Syndrome): hypotension, flushing, skin rash related to histamine release

Nursing Implications of Vancomycin

• IV administration slowly, over 1-2 hours to decrease risk of vancomycin infusion reaction

• Monitor renal function (renal excretion)

- [nasal administration of bactroban for prevention of staph sternal incision]

Review for Drugs for Tuberculosis

• Refer to the CDC for the most current evidence-based treatment for TB

• Mycobacterium tuberculosis

• Review pathology of TB independently to include C&S takes 4-6 weeks
  - Latent versus active TB
  - Manifestations of active TB

Drugs for Tuberculosis

• Drug resistance (secondary to mutations) is a major barrier to successful drug therapy for TB

• Multidrug-resistance tuberculosis (MDR-TB) is a public health issue because it is a type of TB that is resistant to at least one first-line antitubercular medication

• Multidrug therapy: ALWAYS TREAT TB WITH 2 OR MORE MEDICATIONS

- Latent TB = 3 drugs approved over 3-9 months
- Active TB = 10 drugs approved over 6-9 months
- Second-line antimicrobials may be used in combination with antitubercular medications when
there is drug resistance to one or more of the first-line antitubercular medications
[Ex: aminoglycosides, some fluoroquinolones]

• Isoniazid (INH)

• Rifampin (Rifadin)

What 2 antitubercular medications are used with latent TB?

Isoniazid (INH)

• Bactericidal

• Most commonly used; Affordable

• MOA: Inhibits cell wall synthesis

• Indications:
  - Latent TB: may be used alone or in combination with other antitubercular medications
  - Active TB: must be used in combination with other antitubercular medication

Adverse Effects of Isoniazid

• BBW: HEPATOTOXIC

• INH-induced peripheral neuropathy

• Prevention of INH-induced peripheral neuropathy: Pyridoxine, (B6) 25-50 mg daily

Nursing Implications of Isoniazid

• Monitor liver function tests (LFT); may need to discontinue if hepatotoxicity occurs

• Avoid ETOH

• Teaching to ensure compliance

• Home care nurse may use Direct Observation Therapy (DOT)

• Treatment of latent TB can be delayed until after delivery

• Several drug-drug interactions

• Take on an empty stomach with a full glass of water

Rifampin: Rifamycins (Rifadin)

• Bactericidal

• MOA: inhibits synthesis of RNA

• Synergistic effect with INH

• Enzyme inducer – interacts with many other drugs, including some antiretroviral agents

• Indications:
  - Latent TB: may be used alone or in combination with other antitubercular medications
  - Active TB: must be used in combination with other antitubercular medication
  - Staphylococcus infections

Adverse Effects of Rifampin

• GI, rash, liver dysfunction/hepatotoxicity, acute kidney injury

• Reddish-orange discoloration (harmless) to urine, saliva, tears, sputum, sweat

Nursing Implications for Rifampin

• Monitor LFT

• Avoid ETOH

• Take on an empty stomach

• If on oral contraceptives – use another form of birth control

• NOTE: Ethambutol is indicated for active TB and has an adverse effect of optic neuritis (inflammation of the optic nerve). Patients on this medication should be taught to notify the provider immediately of any visual changes. If visual changes arise, the medication should be discontinued.

  
  

Manifestations of hepatotoxicity

Antiviral Drugs

• Viruses reproduce inside the cell

• Viral infections induce the host to create antibodies (review antibody response of the immune system)

• Individuals with impaired/weak immune response are at greater risk with viral infections

• Most viral infections are self-limiting

• Several vaccines are available against viruses

• MOA: penetrate cell and inhibit viral DNA replication

• Because viruses replicate inside host tissues and utilize host cells for metabolic processes, most antiviral meds are likely to cause some harm to host

Drugs for COVID-19

• Remdesivir; administered in a healthcare facility

• Nirmatrelvir + Ritonavir (Paxlovid); outpatient management

• “vir”

Drugs for Herpes (simplex & zoster)

• Acyclovir (Zovirax) (P) – PO, topical, IV

• Famciclovir (Famvir) - PO

• Valacyclovir (Valtrex) – PO

• Docosanol (Abreva) – OTC

• Monitor for liver and renal impairments; “vir”

Drugs for Cytomegalovirus (CMV)

• Ganciclovir (P) – PO, IV

- Monitor for bone marrow suppression – thrombocytopenia/ granulocytopenia. Do not
administer with neutropenia/thrombocytopenia

• Foscarnet - IV

• Cidofovir – IV

• “vir”

Drugs for Respiratory Syncytial Virus (RSV)

• Antiviral: Ribavirin (Virazole) (P)
  - BBW: Teratogenic

• Monoclonal antibodies such as

- Palivizumab (Synagis)

- Nirsevimab-alip (Beyfortus) [FDA approved July 2023

Drugs for Influenza

• Amantadine (Symmetrel) (P)

• Oseltamivir (Tamiflu)

• Peramivir (Rapivab)

Drugs for HIV / AIDS

• **Refer to the CDC for the most current evidence-based treatment for HIV

• Remember – NO CURE

• MOA: prevents or inhibits viral reverse transcriptase (synthesis of DNA); inhibits protease enzyme

• Individuals with HIV should begin treatment as soon as possible.

Antiretroviral Therapy (ART)

• GOAL: Reduce the viral load (amount of HIV), preserve the immune system, prevent illness

• Classifications:

- Nucleoside Reverse Transcriptase Inhibitors (NRTI’s)
- Non-Nucleoside Reverse Transcriptase Inhibitors (NNTRI’s)
- Protease Inhibitors
- Fusion Inhibitors
- CCR5 Antagonist
- *Combination Therapy is A MUST*

• Zidovudine (AZT) (P) a NRTI, is the drug of choice for pregnant women who are HIV positive to prevent maternal-fetal HIV transmission during labor; administered at the onset of labor or before a C-section

• AZT = A Zero Transmission

Combination HIV Therapies

Dovato:

• Integrase inhibitor

• Reverse transcriptase inhibitor

• Nucleoside

• Preferred for pregnant women who are HIV + as long as viral load is controlled

Truvada

• Nucleoside reserve transcriptive Inhibitors

• Nucleotide reserve transcriptive Inhibitors

General Nursing Implications for Antiretroviral Drugs

• Prevention such as handwashing, vaccinations, sexual precautions, clean needles if IV drug abuser

• Take as prescribed

• Stress Reduction

• Observe for therapeutic effects

• Monitor CD4 count, viral load, CBC

• Adverse Effects: anorexia, N/V/D, fever, HA, bone marrow depression, renal impairment

• HIV Pre-Exposure and Post-Exposure Prophylaxis

Antifugal Drugs

• Molds and yeasts

• Fungal cells are very much like human cells; therefore, antifungal drugs may induce serious adverse effects to host

• Fungal infections are more severe, serious in individuals who are immunocompromised

• Used for local and systemic fungal infections (vaginal, oral, skin, candida)

Amphotericin B (Fungizone)

• Given for serious systemic fungal infections

• IV infusion, with IV pump, use an in-line filter

• Nephrotoxic

• Monitor liver function

• Pre-medicate with antipyretic, antiemetic, and antihistamine to reduce side effects of chills, hypotension, tachycardia, malaise, muscle pain, joint pain

• BBW: should only be used for potentially fatal fungal infections due to adverse effects and risk of toxicity

Azoles

• Fluconazole (Diflucan) (P), ketoconazole; “azole”

• Indicated for local and systemic fungal infections such as candida

• Nursing Implications
  - Avoid exposure, especially if an impaired immune system
  - Monitor liver and renal function

Antiparasitics

• Living organisms that survives at the expense of the host

• Examples of medications used for various parasitic infestations

- Metronidazole (Flagyl) (P), used for intestinal parasites
- Tetracycline/doxycycline – intestinal parasites
- Chloroquine (Aralen) – antimalarial
- Mebendazole (Vermox) – hookworms, pinworms, roundworms, whipworms, tapeworms
- Permethrin (Nix) - pediculosis scabies
- Malathion (RID) – lice