Infection Drugs Flashcards

RACHE PARTY: Drugs for Infection

Key Concepts

• Goal of Anti-infective Therapy: Reduce the invading organism to a point where the human immune response can eliminate the infection.
• Action of Anti-infectives:
  • Bactericidal: Destroy the infective pathogen.
  • Bacteriostatic: Prevent the pathogen from reproducing.
• Effectiveness of Anti-infectives:
  • Narrow Spectrum: Effective against a small group of pathogens.
  • Broad Spectrum: Effective against many pathogens.

Toxicities of Anti-infectives

• Kidney: Some anti-infectives can cause renal dysfunction or renal failure. Monitor kidney function and urine output in patients taking nephrotoxic drugs.
• GI: Very common; anti-infectives directly affect GI cells, causing nausea, vomiting, and diarrhea. The death of microorganisms can release toxins, triggering the chemoreceptor trigger zone (CTZ), causing more nausea and vomiting.
• Liver: Some anti-infectives can cause hepatitis and liver failure (e.g., many cephalosporins). Monitor liver function.
• Neuro: Some anti-infectives can damage nerve tissue due to accumulation in those tissues (e.g., aminoglycosides collecting in cranial nerves, causing dizziness, vertigo, or hearing loss, even hallucinations).
• Allergy: Immediate or delayed allergic responses, including anaphylaxis, may occur. Monitor for a history of allergy and the type of response the patient had. Differentiate between a true allergy and a common adverse effect (e.g., N/V/D).
• Superinfection: Opportunistic pathogens invade tissues that are now susceptible after healthy bacteria are wiped out by another antibiotic.

Mechanism of Action of Anti-infectives

• Cell Wall Biosynthesis Interference: Some anti-infectives interfere with the biosynthesis of the pathogen cell wall (e.g., penicillins).
• Essential Substance Prevention: Some anti-infectives prevent cells of the invading organism from using substances essential to growth/development, causing an inability to divide, leading to death (e.g., sulfonamides, some antimycobacterials).
• Protein Synthesis Interference: Many anti-infectives interfere with steps involved in protein synthesis, which is necessary for cell division (e.g., aminoglycosides and macrolides).
• DNA Synthesis Interference: Some anti-infectives interfere with DNA synthesis, impairing division leading to death (e.g., fluoroquinolones).
• Cell Membrane Permeability Change: Some anti-infectives change the permeability of the cell membrane to allow leakage, leading to death (e.g., some antibiotics, antifungals, and antiprotozoals).

Penicillins

• Introduction: Penicillin was the first antibiotic introduced for clinical use in the 1920s.
• Development: Subsequent versions have been developed to decrease adverse effects and modify against resistant bacteria.
• Resistance: Increased use of penicillin has led to more bacteria synthesizing the enzyme "penicillinase" to counteract the effects of penicillin.
• Action: Bactericidal.
• Unique Property: Has a beta-lactam ring in the molecular structure.
• Mechanism: Interferes with the ability of bacteria to build their cell walls when dividing, which leads to swelling and bursting from pressure in the cell.
• Indications:
  • Streptococcal infections (e.g., pharyngitis, tonsillitis, scarlet fever, endocarditis).
  • Pneumococcal infections.
  • Staphylococcal infections.
  • Fusospirochetal infections.
  • Rat-bite fever.
  • Diphtheria.
  • Anthrax.
  • Syphilis.
  • Uncomplicated gonococcal infections.
  • High doses can treat meningococcal meningitis.
  • Aminopenicillins can treat more gram-negative infections.
  • Antipseudomonal penicillins have the widest spectrum of activity and can treat gram-positive and gram-negative bacteria.

Penicillin Administration and Considerations

• Administration: Take on an empty stomach to ensure absorption.
• Excretion: Excreted in urine (monitor kidney function).
• Breast Milk: Enters human milk (can cause diarrhea and superinfection in the infant).
• Contraindications:
  • History of allergy to penicillins, cephalosporins, or imipenem.
  • Cautious use in kidney disease.
• Adverse Effects:
  • GI: N/V/D, abdominal pain, glossitis, stomatitis, gastritis, sore mouth, furry tongue (mostly due to loss of normal bacterial flora).
  • Superinfections: Common (mostly due to loss of normal bacterial flora).
  • Allergy, including anaphylaxis.
• Key Nursing Considerations:
  • Allergies can develop anywhere from 2 hours to several weeks after taking penicillins.
  • Question patients with any renal impairment.
  • Monitor kidney function and I/Os.
  • Monitor potassium and EKG for dysrhythmias (high doses of penicillin G can cause hyperkalemia).
  • Monitor sodium (IV ticarcillin-clavulanate can cause hypernatremia).
• Nursing Administration:
  • Report signs of allergic reaction (dyspnea, oral swelling, rash, itching, hives).
  • Careful administration if given IM (extremely painful).
  • Finish ALL the medication even if feeling better.
  • Use contraceptives, as antibiotics render birth control useless.

Penicillins Cross Reactivity Chart

• Antibiotics that are known to be cross-reactive have a (+) in the cell.
• Antibiotics with similar R1 side chains have an (X) in the cell.
• Blank cells imply there is no known cross-reactivity or R1 structure similarities.

Aminoglycosides

• Bactericidal - Inhibit protein synthesis
• Primarily treat aerobic gram-negative bacilli
• Lots of adverse effects
• Crosses placenta and human milk
• Synergistic bactericidal effect when given with penicillins or cephalosporins
• Do not give with loop diuretics (increased ototoxicity)
• Can cause bone marrow depression

Aminoglycosides Complications

• Ototoxicity (SEVERE): Vestibular apparatus toxicity - hearing loss and loss of balance
  • Nursing Considerations: Monitor for tinnitus, headache, hearing loss, nausea, dizziness, vertigo. Do baseline hearing tests or screen for preexisting hearing loss. Educate patients to monitor for the development of hearing problems.
• Nephrotoxicity (SEVERE): Acute Tubular Necrosis
  • Nursing Considerations: Monitor for proteinuria, urine casts, dilute urine, elevated BUN and creatinine. Monitor I/Os, BUN, creatinine. Monitor for hematuria/cloudy urine.
• Intense Neuromuscular Blockade: When combined with anesthetics or NMBs – increased risk of paralysis
  • Nursing Considerations: Close monitoring of patients for changes with muscular strength or evidence of paralysis.
• Hypersensitivity
  • Nursing Considerations: Monitor for rash, pruritus, paresthesia of hands/feet, urticaria.
• Neurological Complications (Streptomycin): Peripheral neuritis, optic nerve dysfunction
  • Nursing Considerations: Have patient report any neurological findings

Carbapenems

• Bactericidal
• Inhibit cell membrane synthesis
• Broad spectrum
• Beta-lactam antibiotic (possible cross-sensitivity to those with penicillin allergy)
• Effective against gram-positive and gram-negative
• Caution during pregnancy and lactation
• Therapeutic Uses:
  • Reserved for serious infections
  • Serious intra-abdominal, urinary, skin, bone, joint, gynecological infections

Carbapenems Complications

• Allergy:
  • Potential for cross-allergy with other beta-lactams
• Kidney:
  • Can be nephrotoxic – must monitor kidney function
• GI:
  • Commonly cause toxic GI effects. Pseudomembranous colitis, C. diff diarrhea, N/V can lead to serious dehydration and electrolyte imbalances
• Superinfection
  • Can occur with ANY of the carbapenems. Monitor for indications of colitis (diarrhea), oral thrush, vaginal yeast infection
• CNS:
  • HA, dizziness, altered LOC. Seizures have been reported when combined with patients taking valproic acid d/t causing subtherapeutic levels of valproic acid

Cephalosporins

• Beta-lactam antibiotic – very similar to penicillins in structure and activity
• Originally introduced in the 1960s, and many generations have been developed, all with different activity
• Both bactericidal and bacteriostatic, depending on the dose and drug
• Rule of Thumb: As the generations increase, the medication is MORE likely to:
  • Reach the CSF
  • Be LESS susceptible to beta-lactamase destruction
  • Be MORE effective against gram – organisms.
• 1st Gen: Effective against select gram-positive and select gram-negative bacteria
• 2nd Gen: Effective against all 1st gen bacterias + plus 3 others
• 3rd Gen: Effective against all 1st and 2nd gen bacterias, but less activity against gram + bacteria with more activity against gram – bacilli
• 4th Gen: 1 single drug. Effective against gram – and gram +
• Most are excreted in the urine, but ceftriaxone is eliminated in the liver
• Crosses the placenta and enters human milk

Cephalosporins Adverse Effects

• Allergy
  • Cross-sensitivity to penicillin. Heightened monitoring in these patients
• GI:
  • Most common including N/V/D, anorexia, abd pain, flatulence
  • Pseudomembranous colitis has been reported, including C. diff
• CNS:
  • HA, dizziness, lethargy, paresthesia
• Kidney:
  • Nephrotoxicity is possible, particularly in those with preexisting kidney dz
  • Increased risk of nephrotoxicity with concurrent use of aminoglycosides; monitor kidney function
• Bleeding:
  • Do not use in patients with bleeding disorders or those using anticoagulants such as warfarin
  • Observe for bleeding
  • Monitor coagulation labs
  • Thrombophlebitis with IV infusion
  • Always dilute
  • Administer slowly (over 3 to 5 minutes) if bolus
  • Cholecystitis – with ceftriaxone
  • Monitor for referred left shoulder pain or abdominal tenderness
  • No, no, no, no alcohol

Cephalosporins Nursing Administration

• Complete ALL medication
• Do not combine ceftriaxone with calcium (forms precipitate)
• Take oral doses with food
• Store liquid suspensions in a refrigerator
• Promote taking a probiotic to discourage superinfections!

Fluoroquinolones

• Synthetic class
• Bactericidal
• Broad spectrum
• Enter bacterial cell by passive diffusion through channels in the cell membrane and then interfere with the action of DNA enzymes necessary for reproduction and growth = cell death
• Gram + and gram –
• Therapeutic uses: urinary, respiratory, skin infections, and prevention/treatment of anthrax
• Metabolized in the liver, excreted in urine and feces
• Crosses placenta and enters human milk
• This class has many boxed warnings d/t potential serious adverse effects
• Not recommended for the treatment of uncomplicated infections

Fluoroquinolones Adverse Effects

• Common:
  • HA, dizziness, insomnia, depression d/t CNS effects
  • GI effects include N/V/D, dry mouth, possibly d/t CTZ stimulation
• More Serious:
  • Tendinitis, tendon rupture
  • Achilles tendon rupture (specifically, however, can also cause extreme muscle pain, joint and nerve pain, and other nervous system disturbances)
  • Risk increases when fluoroquinolones are combined with corticosteroids
  • Evaluate for pain, swelling, tenderness, redness near the Achilles tendon
  • Tell patients to stop the medication and avoid any exercise, and notify the provider
  • Peripheral neuropathy, CNS effects
  • Cardiac:
    • Prolonged QT interval, palpitations, and dysrhythmias
  • C. diff – Increased risk with Cipro
  • Superinfection – thrush, vaginal yeast infection
  • Immunological:
    • Bone marrow depression (likely d/t drug effects on cells of the bone marrow)
  • Other:
    • Severe Phototoxicity – even with sunscreen
    • Fever, rash, and other severe skin reactions
• Contraindications
  • Do not administer to children under 18 d/t increased risk of Achilles tendon rupture unless treatment is for E. coli UTI or anthrax

Fluoroquinolones Interactions

• Minerals
  • Avoid calcium, aluminum-magnesium antacids, iron salts, sucralfate, dairy
  • Separate doses by 4 hours if necessary
• Cardiac:
  • If taken with any other drugs that increase the QT interval, severe to fatal cardiac reactions are possible
• Bleeding:
  • Increased plasma levels of warfarin
  • Monitor INR and for signs of bleeding
• CNS
  • NSAIDS with fluoroquinolones increase the risk of CNS stimulation
  • Monitor for SZ, dizziness, HA

Fluoroquinolones Nursing Administration

• Educate patients to immediately report joint/tendon pain or CNS disturbances like psychosis and confusion

Sulfonamides (Sulfa)

• Inhibit folic acid synthesis (precursors of RNA and DNA)
• Effective against gram – and gram +
• Therapeutic Uses
  • UTIs typically caused by E. coli
  • Chlamydia trachomatis
  • Nocardia
  • H. flu
  • E. coli
  • P. mirabilis
• Passes into human milk
• HIGHLY TERATOGENIC
• Metabolized in the liver and excreted in urine

Sulfonamides Contraindications

• Allergy to sulfonamides, sulfonylureas, thiazide or loop diuretics (cross-sensitivity)
• Pregnancy (kernicterus – see below)
• Lactation (kernicterus, diarrhea, rash in the infant)
• Folate deficiency (increased risk of megaloblastic anemia)
• Kidney DZ or kidney stones (give lower dose)
• Cautious use for patients >65 d/t increased risk of thrombocytopenia, hyperkalemia, folate deficiency
• Cautious use in patients who take ACEI or ARBs or potassium-sparing diuretics d/t increased risk of hyperkalemia
• Patients taking antidiabetic agents concurrently have an increased risk of hypoglycemia (must reduce dose of antidiabetic drug)

Sulfonamides Adverse Effects

• GI
  • N/V/D, abd pain, anorexia, stomatitis, hepatic injury
• Kidney
  • Crystalluria – collection of crystalline in the kidneys/ureters/bladder causing irritation/obstruction developing into AKI
  • Hematuria, hyperkalemia, proteinuria ---> can progress to nephrotic syndrome and toxic nephrosis
  • Nursing Consideration
    • Encourage at least 8 – 8oz glasses of water each day
    • Monitor urine output (minimum 1200ml/day)
• CNS
  • HA, dizziness, vertigo, ataxia, convulsions, depression
• Blood dyscrasias
  • Hemolytic anemia, aplastic anemia, thrombocytopenia, leukopenia, agranulocytosis
  • Nursing Considerations
    • Obtain blood sample for baseline CBC count
    • Monitor and educate for bleeding, bruising, sore throat, and pallor
  • Allergy (can be fatal)
    • Dermatological
      • Photosensitivity
      • Most severe is Stevens-Johnson syndrome (photos on next slide – rare and severe skin and mucus membrane reaction)
      • Nursing Considerations
        • Monitor for any sign of rash (stop administration immediately)
• Kernicterus
  • Jaundice, increased bilirubin levels, neurotoxic to newborns
  • Nursing Considerations
    • Do not give to pregnant women, breastfeeding women, or infants <2 months
    • Hyperkalemia
      • Elevated potassium
      • Nursing Considerations
        • Monitor electrolyte labs (specifically potassium)
        • Monitor for EKG changes, dysrhythmias, or palpitations

Sulfonamides Nursing Administration

• Assess for allergy
• Take on empty stomach with a full glass of water
• Finish all medication
• Evaluate for improvement of infection

Tetracyclines

• Semisynthetic based on common soil mold
• Bacteriostatic
• Broad-spectrum
• Inhibits organism growth by preventing protein synthesis, and bacteria cannot multiply (can affect human cells in high concentrations)
• Therapeutic Uses (gram – and gram +), (Good ABX for patients allergic to PCNs)
  • Acne vulgaris
  • Dental disease
  • Rickettsial infections (typhus fever, rocky mountain spotted fever)
  • Chlamydia
  • Brucellosis
  • PNA (specifically for mycoplasma pneumonia)
  • Lyme DZ
  • Anthrax
  • H. pylori

Tetracyclines Contraindications

• Allergy
• Pregnancy
  • Crosses placenta and enters human milk
  • Negative effect on developing bones and teeth: will stain baby teeth (deciduous) and can cause skeletal defects
• Children up to 8 years – can potentially damage developing bones and teeth

Tetracyclines Interactions

• Forms nonabsorbable chelates, reducing absorption rendering the ABX ineffective when taken with food or:
  • Milk products
  • Calcium and iron supplements
  • Laxatives with magnesium
  • Antacids
  • Oral Contraceptives – need backup
  • Digoxin – when taken concurrently can raise digoxin levels causing toxicity

Tetracyclines Complications

• GI distress (cramping, N/V/D, esophageal ulceration “pill esophagitis”)
  • Nursing Considerations – high risk for superinfection
  • Monitor for N/V/D, abd pain, glossitis, dysphagia
  • Monitor I/Os
• Doxy and Minocycline can be taken with food, but this will reduce absorption
• Do not take at bedtime to avoid esophageal irritation (and take with a full glass of water)
• Tooth and bone damage d/t accumulation, causing staining and pitting
  • Nursing Considerations
    • Do not administer to children under age 8 or pregnant women
• Hepatotoxicity – fatal has been reported
  • Nursing Considerations
    • Avoid administration of high daily IV doses
    • Monitor for lethargy and jaundice
• Severe rash and photosensitivity – even with sunscreen
  • Nursing Considerations
    • Educate patient to avoid the sun and wear protective clothing and sunscreen
• Superinfection – pseudomembranous colitis and thrush (mouth/pharynx/vagina/bowels)
  • Nursing Considerations
    • Monitor for diarrhea or evidence of overgrowth of yeast
• Dizziness (with minocycline)
  • Nursing Considerations
    • Monitor for dizziness
    • Instruct patients to change positions slowly

Tetracyclines Nursing Administration

• Instruct patients to take on an empty stomach with a full glass of water or 1 hour before or 2 hours after meals.
• Instruct patients to avoid milk products and antacids or not to consume within 2 hours of the medication
• Instruct patients to use an alternate form of birth control
• Take it in the daytime, or avoid taking it just before lying down (to avoid esophagitis)
• Complete all medication
• Monitor for resolution of infection
• Avoid sun exposure!

Lincosamides

• Bacteriostatic
• Interfere in protein synthesis of gram-positive bacteria… some anaerobic
• Metabolized in the liver and excreted in urine and feces
• Crosses placenta and enter human milk

Contraindications/Cautions:

• Liver
  • Cautious use in pt’s with pre-existing liver dz
  • Monitor liver function
• Adverse Effects
  • GI
    • Can be fatal… pseudomembranous colitis, abd pain
  • Other
    • Skin reactions and bone marrow depression

Lipoglycopeptides

• Semisynthetic, all based on the original drug: vancomycin
• Inhibit bacterial cell wall synthesis by interfering with polymerization and cross-linking of peptidoglycans
• Effective against susceptible strains of the gram + organism
• May cross the placenta and may pass into human milk
• Metabolism varies
• Excreted in urine and feces

Lipoglycopeptides Contraindications:

• Known allergy
• Cautious use in pregnancy and lactation
• Use contraceptive
• Adverse Effects
  • GI
    • N/V/D, taste alterations, loss of appetite, risk of C. diff
  • Kidney
    • Nephrotic
  • Transfusion reaction (red man syndrome)
    • Flushing, sweating, hypotension
  • Infusion pain
    • Pain and redness with infusion

Macrolides

• Expected Mechanism of Action
  • Bacteriostatic but bactericidal at high doses
  • Slows growth of organisms by inhibiting protein synthesis
• Therapeutic Uses
  • Useful for patients with a PCN allergy
  • Prophylaxis against rheumatic fever and bacterial endocarditis
  • Legionnaires’ DZ, pertussis, and acute diphtheria
  • Chlamydia
  • PNA due to Mycoplasma pneumoniae and strep

Macrolides Adverse Effects

• GI distress (N/V and epigastric pain, anorexia, diarrhea, pseudomembranous colitis)
  • Nursing Considerations
    • Give erythromycin with meals
    • Monitor for GI effects
• Prolonged QT Intervals (potential for dysrhythmias and possible sudden cardiac death)
  • Nursing Considerations
    • Evaluate patient for existing prolonged QT and do not administer if positive
• Ototoxicity with high dose
  • Nursing Considerations
    • Monitor for hearing loss, vertigo, tinnitus
• Neuro
  • Confusion, abnormal thinking, uncontrollable emotions
• Contraindications
  • Pregnancy – can cause adverse effects on developing fetus
  • Lactation – can cause superinfection and diarrhea in infant
  • Liver DZ – it’s metabolized in the liver (can lead to toxicity in patients with preexisting liver dz)
  • QT prolongation!
  • Any cardiac dysrhythmias!

Macrolides Interactions

• MANY DRUG-DRUG INTERACTIONS!
• Inhibits the metabolism of the following, leading to toxicity (if unavoidable, monitor LFT labs)
  • Carbamazepine
  • Oral Anticoagulants
  • Digoxin

Macrolides Nursing Administration

• Administer on an empty stomach with a full glass of water
• Administer erythromycin IV form only for severe infections or those who cannot tolerate PO form
• Complete all the medication
• Monitor coagulation labs if given concurrently with warfarin
• Monitor LFT labs for any therapy >2 weeks
• Monitor for resolution of infection

Monobactam

• Medication Names
  • Aztreonam (IM or IV) – Bactericidal (MONOBACTAM), possible cross-sensitivity to PCNs
  • Effective against gram – enterobacteria and has no effect on gram + or anaerobic bacteria

Expected Mechanism of Action – Not necessarily broad-spectrum

• Destroys bacterial cell walls, destroying the organism

Therapeutic Uses

• Serious infections
  • MRSA – methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, streptococcal infections
  • C. diff - Antibiotic-associated pseudomembranous colitis due to Clostridium difficile
  • Crosses placenta and enters human milk

Monobactam Contraindications

• Contraindications/Cautions
  • Allergy
  • Cautious use in patients with allergy to penicillins or cephalosporins
  • Patients with pre-existing renal dz
  • Adverse Effects
    • GI
      • N/V/D, gi upset
    • Liver
      • May elevate LFTs
      • Monitor for liver toxicity
    • Infusion site
      • Inflammation, phlebitis, discomfort
      • Must be administered slowly – usually over 90 minutes
    • Interactions
      • Increased risk for ototoxicity when vancomycin is taken concurrently with loop diuretics or other aminoglycosides
      • Assess for hearing loss

Other Cell Wall Synthesis Inhibitors

• Linezolid/Zyvox
  • Bacteriostatic/bactericidal depending on concentration
  • Tx: Methicillin-resistant staphylococcus aureus (MRSA)
    • IV initially, convert to p.o. in 5 days
  • Caution: use of MAOI or SSRIs
  • Adverse: Thrombocytopenia

Other Cell Wall Synthesis Inhibitors

• Quinupristin/dalfopristin (Synercid)
  • Bacteriostatic/bactericidal depending on concentration
  • Tx: Vancomycin-resistant Enterococcus facecium (VRE) infection
  • Adverse: hepatotoxicity
  • Report: burning/pain at IV site, joint and muscle pain

Medications for Tuberculosis and Leprosy

• Mycobacteria is the pathogen that causes tuberculosis and leprosy
• Can hold a stain even when a “destaining” agent is applied, which is why it’s called “acid-fast” bacteria.
• Mycobacteria is hard to kill and can live a long time and is very slow-growing

Antimycobacterials

• Key point: Antimycobacterials are typically effective against bacteria; they are ALWAYS used in combination to deter resistance
• Metabolized in liver and excreted in urine
• Cross placenta and enter human milk
• Many CNS adverse effects
  • Neuritis (peripheral neuropathy), dizziness, HA, malaise, drowsiness, hallucinations
• Many GI adverse effects
  • N/V, anorexia, stomach upset, abd pain, rarely pseudomembranous colitis
• Unique issues:
  • Rifampin, rifabutin, and rifapentine cause orange/copper-tinted discoloration of body fluids

Antimycobacterials Toxicity

• Hepatotoxicity
  • Increased when combined with isoniazid, ribampin, pyrazinamide
• Histamine reaction
  • When eating foods containing tyramine + isoniazid, a histamine reaction can happen, including HA, diaphoresis, or flushing
• Reduced medication effectiveness
  • Rifampin reduces the effectiveness of warfarin, oral contraceptives

Medications for Parasitic Infections

• Medication Name:
  • Metronidazole/Flagyl
  • MOA: Broad-spectrum antimicrobial, bactericidal, for anaerobic microorganisms

Therapeutic Uses:

• Prophylactic for procedures in “dirty” anaerobic areas (colorectal, vaginal, abdominal)
• Protozoal infections (intestinal amebiasis, giardiasis, trichomoniasis)
• Anaerobic bacterial infections (antibiotic-induced C. diff, Gardnerella vaginalis)
• Alternative treatment for H. pylori (combined with a tetracycline and Pepto Bismol)

Antiprotozoals Expected Side Effects:

• GI Distress – N/V, dry mouth, metallic taste
  • Nursing Considerations – Inform patient this medication can be taken with food to minimize GI distress
• Urine Discoloration
  • Nursing Considerations – benign and expected. Inform patient to expect urine may change to amber or brown
• Adverse Effects:
  • Neurotoxicity – Negative CNS effects: extremity numbness, ataxia, seizures
    • Nursing Considerations – Must notify provider, discontinue promptly
  • Pseudomembranous colitis – Bloody stool/diarrhea, abd pain, fever
    • Nursing Considerations – Notify the patient to inform the provider of any development to r/o colitis

Antiprotozoals Contraindications & Cautions

• Do not give to patient with active CNS disorders/problems
• Do not give to patient with blood dyscrasias
• Do not give to lactating mother
• Do not give during 1st trimester of pregnancy

Cautions:

• Use CAUTIOUSLY with patient who have kidney, cardiac, fungal, or candida infections or seizure disorders
• Use CAUTIOUSLY in 2nd or 3rd trimester of pregnancy
• Use CAUTIOUSLY in elderly

Antiprotozoals Interactions

• ETOH!!! – Any alcohol will cause a disulfiram–like reaction (facial flushing, vomiting, dyspnea, tachycardia)
  • Nursing considerations: Advise patient NOT to drink alcohol!!
• Metronidazole INHIBITS INACTIVATION of: Warfarin, phenytoin, and lithium
  • Nursing considerations: Monitor labs (PT, PTT, INR), and blood levels of phenytoin and lithium.
  • Dosages may need to be adjusted

Antiprotozoals Nursing Considerations

• Administer via PO or IV
• Complete full coarse unless adverse effects arise
• Use contraception
• If the indicated use is for trichomoniasis, advise patient about transmission of STD and using barrier contraception to prevent transmission
• Monitor for effectiveness of treatment:
  • Resolution of bloody and/or mucus-laden diarrhea
  • Formed stools
  • Negative stool cultures
  • Resolution of vaginal/urethral discharge
  • Negative anaerobic blood cultures

Medications For Fungal Infections

• Medication Names:
  • Amphotericin B – MOA: -cidal (highly toxic, reserved for life-threatening fungal infections)
  • Ketoconazole
  • Nystatin
  • Clotrimazole
  • Fluconazole

MOA

• Dose-dependent – low dose is fungistatic, and high dose is fungicidal

Therapeutic Uses

• Systemic fungal infection (candidiasis, aspergillosis, cryptococcosis, mucormycosis)
• Superficial fungal infection (ringworm, candida, onychomycosis)

Antifungals Adverse Effects:

• Thrombophlebitis
  • Nursing considerations:
    • Rotate injection site, large vein only
    • Observe for erythema, swelling, pain at site
• Nephrotoxicity
  • Nursing considerations:
    • Monitor weekly kidney function tests/labs
    • Monitor I/Os
• Electrolyte imbalance
  • Nursing considerations:
    • Potassium can fluctuate, monitor electrolyte levels (CMP/BMP)
    • Oral supplements can help
• Bone marrow suppression
  • Nursing considerations:
    • Get baseline CBC, HCT
    • Monitor weekly

Antifungals Adverse Effects

Adverse Effects specific to Amphotericin B

• Infusion Reactions – Fever/chills/rigors/headache 1 to 3 hours post initiation of med
  • Nursing consideration:
    • Give 1ml test dose over 5-10 min
    • Pretreat with diphenhydramine and acetaminophen
    • Given meperidine, dantrolene, or hydrocortisone for rigors
• Nephrotoxic
  • Give 1L 0.9% NS daily prior to or after amphotericin B

Adverse Effects specific to Ketoconazole

• Hepatotoxicity – Anorexia, N/V, jaundice, amber urine, clay-colored stool
  • Nursing considerations:
    • Get baseline LFTs
    • Monitor LFTs monthly
    • Inform patients to notify provider if any symptoms develop, stop ketoconazole
• Sex Hormone Imbalance
  • Male patients: gynecomastia, decreased libido, erectile dysfunction
  • Female patients: Irregularities with menstrual flow/cycles
  • Notify patients to monitor and inform provider if symptoms develop

Antifungals Contraindications and Interactions

Contraindications:

• Do not give to patients with impaired kidney function
• Do not give to patients with anemia/bone marrow depression/electrolyte imbalances
• Do not give Fluconazole to pregnant or lactating women

Interactions:

• Aminoglycos