Antimalarials, Anthelmintics, and Peptides

Antimicrobial Peptides
- Apply the nursing process for people taking antimicrobial peptides.
- Summarize the side effects and adverse reactions of peptides used as microbials, including:
- Colistimethate
- Polymyxins
- Bacitracin
- Metronidazole
- Discuss effects of peptides on antibiotic-resistant bacteria.
Anthelmintic Drugs
- Apply the nursing process for people receiving anthelmintic drugs, including patient teaching on protective measures during self-management.
- Correlate transmission with prevention in people with helminthic infections.
- Identify the side effects and adverse reactions of anthelmintic drugs.
- Describe the transmission of helminths in people infected with cestodes and nematodes.
Antimalarial Drugs
- Apply the nursing process, including patient teaching on the route and side effects for people receiving antimalarial drugs.
- Identify side effects and adverse reactions in people responding to antimalarial drugs.
- Explain the two-phase parasitic process in the transmission and action of antimalarial drugs in people with malaria.

Pathogens: Protozoan parasites, including:
- P. malariae
- P. ovale
- P. vivax
- P. falciparum

Tissue Phase:
- Invasion of body tissue.
- Symptoms: None initially.
Erythrocytic Phase:
- Invasion of red blood cells (RBCs).
- Symptoms include:
- Fever
- Chills
- Sweating
- Flu-like symptoms

Treatment Regimen:
- Combinations used for drug-resistant malaria.
Prophylactic Measures:
- Chloroquine, primaquine, mefloquine.
Malaria Eradication Methods:
- Prophylaxis
- Treatment for acute attack
- Prevention of relapse.
Side Effects/Adverse Reactions:
- Visual disturbances
- Dizziness
- Gastrointestinal (GI) distress
- Hypokalemia
- Eighth cranial nerve and retinal damage
- Ototoxicity
- Cardiovascular effects
- Nystagmus
- Wheezing
- Renal and hepatic impairment
- Hemolytic anemia.

Concept:
- Infection, nutrition, immunity.
Assessment:
- Assess if the patient has traveled to a malaria-endemic area.
- Obtain a patient history of malaria and antimalarial drugs usage.
Patient Problems:
- Decreased immunity
- Decreased visual acuity.
Planning:
- The patient will take antimalarial drugs at the prescribed times and dosages.
Nursing Interventions:
- Monitor renal and liver function by checking urine output and liver enzymes.
- Monitor for impaired consciousness, headache, or seizures.
- Monitor patients returning from malaria-endemic areas for malarial symptoms.

Definition: Parasitic worms.
Types of Helminths:
- Cestodes (tapeworms)
- Trematodes (flukes)
- Intestinal Nematodes (roundworms)
- Extraintestinal Tissue-Invasive Nematodes (e.g., trichinosis, filariae).

Transmission occurs in conditions of poor sanitation and hygiene via:
- Contaminated food
- Bites of carrier insects
- Direct penetration of skin.
Sites Affected:
- Intestine
- Lymphatic system
- Blood vessels
- Liver.

Action: Destroys parasitic worms.
Examples:
- Ivermectin.
Administration: Usually given for 1 to 3 days.
Side Effects/Adverse Reactions:
- Dizziness
- Drowsiness
- Headache
- Weakness
- GI distress (anorexia, nausea, vomiting, occasionally diarrhea or stomach cramps).

Concept:
- Infection, nutrition.
Assessment:
- Assess for anal itching/abdominal discomfort.
- Assess travel history to other countries.
- Obtain a history of the patient's dietary habits and food preparation.
Patient Problems:
- Coping issues, decreased immunity.
Planning:
- The patient will demonstrate handwashing before eating.
- The patient will explain proper food preparation methods to avoid recurrence.
Nursing Interventions:
- Monitor for adverse effects.
- Educate on the importance of handwashing before eating and after working in soil or with animals.

Colistimethate: Treats infections caused by Pseudomonas aeruginosa, CRE, Klebsiella, and Shigella.
Polymyxins: Effective against Pseudomonas aeruginosa, Escherichia coli, Klebsiella, and Shigella.
Bacitracin: Treats most gram-positive and some gram-negative bacteria.
Metronidazole:
- Class: Nitroimidazole
- Treats Trichomonas vaginalis, amebiasis, giardiasis, Helicobacter pylori, and rosacea.
- Often combined with peptide drugs to prevent resistance.

Concept:
- Immunity, infection.
Assessment:
- Health history
- Prior use of antibiotics
- Renal function.
Patient Problems:
- Nausea/Vomiting (N/V)
- Fluid and electrolyte imbalance
- Skin integrity issues.
Planning:
- The patient’s skin will remain intact without pruritus, swelling, or rash.
- The patient will identify the dosage and explain how to properly take the prescribed drug.
- The patient will describe the side effects and adverse reactions that require notification of a health care provider.
Interventions:
- Monitor fluid and electrolytes.
- Monitor intake/output (I/O).
- Teach the patient to read all instructions before taking medication.
- Discuss possible side effects and adverse reactions.

Determine if patient can be treated without antibiotics.
Encourage the patient to complete antibiotics as prescribed.
Instruct the patient to:
- Use antibiotics correctly.
- Not skip doses.
- Avoid self-medicating with someone else’s medication.
Reinforce self-management skills in personal hygiene.

Drug Classes and Drugs
- Knowledge necessary for the exam.
Antimalarials:
- Chloroquine as a key drug.
- Apply the nursing process, including patient education on route and side effects for people receiving antimalarial drugs.
Anthelmintics:
- Ivermectin as a primary drug.
- Apply the nursing process for people receiving anthelmintic drugs, including patient education on protective measures.
Peptides:
- Apply the nursing process for people taking antimicrobial peptides.
- Understand the indication of the drug, its mechanism of action, side effects/adverse effects, and necessary nursing interventions.