pharm class 9 pt 2

exam 4

moa of antifungal drugs

fungistatic, fungicidal

fungistatic

inhibits growth of fungus

fungicidal

kills fungus

fungal infections

systemic mycoses, superficial mycoses

systemic mycoses

spread out

superficial mycoses

local

2 categories of systemic mycoses

opportunistic, nonopportunistic

opportunistic infections occur in -

immunocompromised, sick

nonopportunistic infections occur in -

any patient

treating systemic mycoses can be -

difficult

aspergillosis occurs when fungi -

invades lungs and spreads to other organs

s/s of aspergillosis

sob, cp, fever, chills, cough, nosebleeds

aspergillosis can be life threatening if left -

untreated

superficial mycoses - candida

MMs, moist skin

chronic superficial mycoses that involve candida may involve -

scalp, skin, nails

superficial mycoses - dermatophytic infections

skin, hair, nails, tx topical/oral

types of candida infections with superficial mycoses

thrush, yeast infection

types of deramtophytic infections with superficial mycoses

athlete’s foot, ringworm, jock itch

tinea corporis

ringworm

tinea cruris

jock itch

tinea capitis

ringworm on head

onychomycosis

nail infection

4 classes of antifungal meds

polyenes, azoles, echinocandins, pyrimidine

polyene antibiotics

amphotericin b, nystatin

uses of ampho b

antifungal

drug of choice for most systemic mycoses

ampho b

ampho b moa

fungistatic or fungicidal

adverse effects of ampho b

infusion reactions, phlebitis, nephro, hypok, bone marrow supp

ampho b considerations

must be iv, no nephrotoxic drugs, no nsaids, monitor bun, cr, k, hgb, hct

nystatin uses

systemic, superficial mycoses

forms of nystatin

tab, topical

nystatin moa

fungistatic, fungicidal

adverse effects of nystatin

nvd, skin irritation

considerations with nystatin

swish in mouth before swallow

azoles

itraconazole, fluconazole

uses of azoles

broad antifungal, systemic/superficial mycoses

azoles moa

fungistatic

adverse effects of azoles

nvd, cardiac supp, liver injury

which azole causes yeast infections?

fluconazole

nursing considerations with azoles

cyp2a4 inhibited, can raise drug levels, assess liver failure

echinocandins

caspofungin

caspofungin uses

systemic mycoses

caspofungin moa

fungistatic, fungicidal

adverse effects of caspofungin

fever, phlebitis

caspofungin routes

iv only

nursing considerations with echocandins (caspofungin)

only iv, cyp450 inducers can lower caspofungin

pyrimidine analogs

flucytosine

flucytosine uses

systemic mycoses

flucytosine moa

fungicidal

adverse effects of flucytosine

bone marrow supp, liver dysfunction

what can you combine pyrimidine analogs (flucytosine) with for serious illness?

ampho b

pyrimidine analogs nursing consderations

narrow antifungal spectrum, low dose with renal

what should you monitor with pyrimidine analogs

platelets, leukocytes, lfts

what do pyramidine analogs inhibit?

drug metabolizing enzymes → toxicity

it is difficult to suppress viral replication without -

harming the host

hsv 1

cold sores, genital

hsv 2

genital infection

hsv s/s

none, painful blisters

varicella zoster can cause both -

chickenpox, shingles

s/s of varicella

maculopapular/vesicular lesions, fever, lost appetite,

s/s of vzv

neuro pain, blisters

first choice for shingles, chickenpox, herpes simplex

acyclovir

acyclovir use

herpes viruses

acyclovir moa

inhibits virus by supp viral dna

acyclovir adverse effects - iv

phlebitis, nephro, neurotoxicity

acyclovir adverse effects - oral

nvd, headache, vertigo

acyclovir adverse effects - topical

skin irritation

acyclovir nursing considerations

monitor bun, cr

valacyclovir uses

shingles, genital herpes, cold sores, varicella

valacyclovir adverse effects - immunocompromised pts

ttp/hus

valacyclovir adverse effects - non immunocompromised pts

nvd, headache, vertigo

cytomegalovirus spreads through -

body fluids

cytomegalovirus can remain _________ for entire life of patient

dormant

which patients with cytomegalovirus are at high risk for reactivation of dormant virus?

immunosuppressed

common sites of infection with cytomegalovirus

lungs, eyes, gi

ganciclovir uses

cmv in immunocompromised

ganciclovir moa

viral dna supp

ganciclovir adverse effects

bone marrow supp

ganciclovir nursing considerations

monitor cbc, pancytopenia risk

foscarnet uses

cmv retinitis in aids pts, acyclovir resistant hsv/vzv

foscarnet adverse effects

nephrotoxicity, hypoca, hypok, hypomg, hypo/hyperphos, fever, nvd, anemia, headache

foscarnet considerations

monitor bun, cr, avoid use of nephrotoxic drugs

viral hepatitis - acute

a → g, < 6 mo

acute viral hepatitis is characterized by -

liver inflamed, jaundice, high alt

viral hepatitis - chronic

b, c, d only

chronic viral hepatitis can lead to -

cirrhosis, carcinoma, liver failure

hepatitis c transmission

blood exchange

hepatitis c - s/s

jaundice, nausea, abd pain, myalgias

hep c is the leading reason for -

liver transplant

protease inhibitors

simeprevir

simeprevir use

hep c

simeprevir moa

inhibits protease, enzyme for hep c

simeprevir adverse effects

headache, nausea

interferon alfa and ribavirin

not part of hep c tx anymore

interferon alfa and ribavirin adverse effects

anemia, birth defects, bone marrow supp, flu, nvd

hepatitis b transmission

blood, semen

chronic hep b infections can be treated with -

interferon alfa

interferon alfa with hep b helps to normalize -

alt

flu transmission

droplet

s/s of flu

fever, cough, chills, sore throat