Anti-Infective Therapy and Immune Response Notes (Pages 12-24)

ANTI INFECTIVE ACTIVITY

• Goal of anti-infective therapy: reduce invading organisms to a point where the human immune response can take care of the infection.
• Spectrum: effectiveness against invading organisms
  • Narrow Spectrum: selective in their action; for that specific medication, it only kills a specific bacteria.
  • Example: spectinomycin (Trobicin) kills Neisseria gonorrhoeae; penicillin and erythromycin kill gram-positive bacteria.
  • Broad Spectrum: useful in treatment of a wide variety of infections; one medication can kill two or more bacteria.
  • Example: tetracycline and cephalosporins kill both gram-positive and gram-negative bacteria.
• BACTERICIDAL: causes death of cells (suicidal action).
• BACTERIOSTATIC: interferes with the ability of cells to reproduce or divide (stops reproduction but does not kill the bacteria).
• ACQUIRING RESISTANCE
  • Resistance: natural or acquired; ability over time to adapt to an anti-infective drug and produce cells not affected by a particular drug.
  • Importance: follow prescribed timing to prevent resistance; finish full course of antibiotics (e.g., 7 days).
  • Acquiring Resistance mechanisms:
  • Producing an enzyme that deactivates the antimicrobial (e.g., Penicillinase, beta-lactamase).
  • Changing cellular permeability to prevent drug entry.
  • Altering binding sites on membranes or ribosomes.
  • Producing a chemical that acts as an antagonist to the drug.
• COMMON RESISTANCE BACTERIA IN THE AREA:
  • MRSA: Methicillin-resistant Staphylococcus aureus; resistant to methicillin, oxacillin, penicillin, amoxicillin.
  • Common in ER; spread via direct contact; handwashing critical.
  • VRE: Vancomycin-resistant Enterococci; affects severely ill, immunocompromised in ICUs and some cancer units.
• PREVENTING RESISTANCE
  • Limit use of antimicrobial agents.
  • Doses should be high enough and duration long enough; around-the-clock dosing (e.g., same timing, q8h).
  • Do not use a prescribed drug to treat other infections; culture first to identify pathogen.
  • Do not use a more powerful drug when a less potent one may be effective.
  • IDENTIFICATION OF PATHOGEN: Culturing infected area.
  • SENSITIVITY OF THE PATHOGEN: perform sensitivity testing to determine which drug controls the microorganism.
  • COMBINATION THERAPY: in some cases, two or more drugs are more effective.
• ADVERSE REACTIONS (general)
  • Kidney damage (nephrotoxicity): drugs metabolized by kidney (e.g., aminoglycosides).
  • Gastrointestinal toxicity: direct toxic effects on GI lining; triggers CTZ.
  • Neurotoxicity: e.g., aminoglycosides cause dizziness, vertigo, hearing loss; chloroquine may cause blindness.
  • Hypersensitivity reactions: immediate or delayed; cross-sensitivity (penicillin, cephalosporins).
  • Superinfections: due to destruction of normal flora (e.g., candidiasis; yeast infections).
• PROPHYLAXIS
  • Prevention of infection in postoperative or invasive procedures; antibiotics given to prevent infection.
• GLOSSARY (selected terms)
  • Antibiotic: natural substances produced by microorganisms that kill other microorganisms.
  • Anti-Infective: medication effective against pathogens.
  • Beta-lactam: structure that interferes with bacterial cell wall synthesis; beta-lactamase enzymes can inactivate these drugs.
  • Beta-lactamase inhibitors: block beta-lactamase enzymes; help preserve bacterial cell wall synthesis.
  • Pathogen: organism that can cause disease.
  • Pathogenicity: ability of microorganism to cause infection.

DESCRIBING AND CLASSIFYING BACTERIA

• Gram Stain
  • Positive: staphylococci, streptococci, enterococci (often respiratory infections).
  • Negative: E. coli, Klebsiella, Pseudomonas, Salmonella (often GI infections).
• Morphology: rod (bacilli), spiral (spirilla), spherical (cocci).
• Oxygen use:
  • Aerobic: requires O₂.
  • Anaerobic: does not require O₂.

BETA-LACTAM INHIBITORS: PENICILLIN

• History: Sir Alexander Fleming (1920s).
• Four subgroups based on structure and spectrum:
  • Natural penicillins.
  • Aminopenicillins.
  • Extended spectrum antibiotics.
  • Penicillinase-resistant penicillins.
• SAMPLE MEDICATIONS (NARROW vs BROAD)
  • Narrow spectrum (effective against ONE type of organism): Penicillin G (Benzylpenicillin), Penicillin V.
  • Broad spectrum (kill both gram-positive and gram-negative): Amoxicillin (Amoxil), Ampicillin (Ampicin), Bacampicillin (Penglobe).
  • Penicillinase-resistant penicillins: Cloxacillin, Oxacillin, Dicloxacillin, Nafcillin, Methicillin.
  • Extended-spectrum penicillins: Piperacillin + Tazobactam (TAZOCIN, VIGOCID); Amoxicillin/clavulanic acid (Augmentin); Ticacillin/clavulanic acid (Timentin); Ampicillin/sulbactam (Unasyn).
• MODE OF ADMINISTRATION: PO, IV.
• PHARMACOKINETICS
  • Absorbed in GI tract; peak levels in ~1 hour.
  • Excreted unchanged in urine.
  • Can cross into breast milk; breastfeeding is a contraindication for penicillin in some contexts.
• DRUG-DRUG INTERACTIONS
  • Tetracyclines reduce penicillin effectiveness.
  • Aminoglycosides inactivated when given with penicillin.
  • Penicillins may interfere with estrogen-containing birth control.
  • Beta-blockers may increase risk for anaphylaxis.
• MECHANISM OF ACTION
  • Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins; causes unstable cell walls and lysis.
• INDICATIONS (typical examples) – broadly: streptococcal infections, pneumococcal infections, tonsillitis, endocarditis, syphilis, septicemia, UTI, diphtheria, anthrax, etc. (tailor to patient case).
• CONTRAINDICATIONS
  • Hypersensitivity to penicillins and cephalosporins.
  • Caution in renal disease, pregnancy (category C), lactation.
• ADVERSE REACTIONS
  • N/V, diarrhea, abdominal pain, glossitis, stomatitis, gastritis, furry tongue, taste alterations.
  • Superinfection (glossitis, stomatitis, candidiasis, etc.).
  • Hypersensitivity (rash, urticaria, anaphylaxis).
  • Bone marrow depression (thrombocytopenia, leukopenia, anemia, granulocytopenia).
  • IM: pain at injection site; IV: phlebitis.
• NURSING PROCESS
  • Pre-administration assessment: allergy history; infection symptoms; vital signs; infected area characteristics; labs (CBC, renal/hepatic function, cultures).
  • Ongoing assessment: daily response, signs of improvement, drainage changes.
  • PROMOTING OPTIMAL RESPONSE TO THERAPY: shake vials; oral penicillin best on empty stomach (1 hour before or 2 hours after meals); some penicillins may be taken with meals (e.g., bacampicillin, penicillin V, amoxicillin, co-amoxiclav).
  • MONITORING ADVERSE REACTIONS: manage minor hypersensitivity with antihistamines; major reactions require epinephrine, corticosteroids; diarrhea monitoring for C. difficile; skin care for hypersensitivity; treat superinfections; counsel about IV site care and speed of administration.
  • PATIENT EDUCATION: complete full course; take at prescribed times; take with water; refrigerate suspensions; avoid alcohol if advised; report adverse reactions.
• CRITICAL THINKING ITEMS (examples simulated in exams)
  • Administration timing for Penicillin V (e.g., 1 hour to 2 hours after meals vs with meals vs around the clock).
  • Interpret culture and sensitivity results: if sensitive to Penicillin, Penicillin will be effective; allergy is not inferred from sensitivity result.

CEPHALOSPORINS

• GENERATIONS & SPECTRUM
  • 1st Generation: largely gram-positive; limited gram-negative activity (Proteus mirabilis, E. coli, Klebsiella pneumoniae) [PEcK]; examples: cefadroxil, cefazolin, cephalexin; administration often parenteral.
  • 2nd Generation: less active against gram-positives; enhanced against gram-negatives (Haemophilus influenzae, Enterobacter aerogenes, Neisseria, PECK) [HENPEcK]; examples: cefaclor, cefamandole, cefonizid, cefotetan, cefoxitin, cefmetazole, cefprozil, cefuroxime.
  • 3rd Generation: less active against gram-positives; most potent against gram-negatives (HEN PECK, Serratia marcescens); examples: cefdinir, cefixime, cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftriaxone, ceftibuten.
  • 4th Generation: broader spectrum including gram-positives; more resistant to beta-lactamases; example: cefepime (common), cefditoren, ceftaroline.
• MODE OF ADMINISTRATION: Parenteral (for many cephalosporins; some are oral like cefalexin, etc.).
• PHARMACOKINETICS
  • Primarily metabolized in the liver; excreted in urine.
  • Cross placenta and enter breast milk; well absorbed from GI tract.
• DRUG-DRUG INTERACTIONS
  • Cephalosporins with aminoglycosides increase nephrotoxicity risk; monitor BUN/creatinine.
  • Oral anticoagulants: increased bleeding risk; monitor.
  • Alcohol: disulfiram-like reaction; avoid for at least 72 hours.
  • Uricosuric drugs (probenecid) reduce excretion of certain cephalosporins (e.g., cefaclor).
• ACTION
  • Bactericidal and bacteriostatic; attach to penicillin-binding proteins to inhibit cell wall synthesis.
• INDICATIONS
  • Respiratory infections, otitis media, bone/joint infections, genitourinary infections, perioperative prophylaxis.
• CONTRAINDICATIONS
  • Allergy to penicillin; caution in renal failure and bleeding/hepatic disease.
• ADVERSE EFFECTS
  • GI: N/V, diarrhea, anorexia, abdominal pain, flatulence.
  • Pseudomembranous colitis (Clostridium difficile).
  • Superinfection; hypersensitivity reactions; potential for aplastic anemia, toxic epidermal necrolysis.
  • CNS: headache, dizziness; neuropathies.
  • Nephrotoxicity; phlebitis at IV site; local injection discomfort.
• NURSING CONSIDERATIONS
  • Round-the-clock dosing to maintain blood levels.
  • Most can be taken with meals to reduce GI upset; some require without regard to meals (e.g., cefdinir can be with food; others better on empty stomach).
  • Suspensions refrigerated; shake well; watch for poop changes and superinfections.
  • Monitor for adverse reactions; ensure full course; culture/sensitivity as needed; promote hydration.

CARBAPENEMS

• BROAD-EST ACTION; reserved for complicated infections (body cavities/tissues).
• COMMON AGENTS: Imipenem + cilastatin (Tienam), Ertapenem (Invanz), Meropenem (Merrem).
• ACTION: Bactericidal; very resistant to beta-lactamase; essential for a wide spectrum.
• INDICATIONS: Gram-positive and Gram-negative; aerobic bacteria including Pseudomonas; bone, joint, skin infections; endocarditis; pneumonia; UTI; intra-abdominal and pelvic infections; septicemia.
• NURSING INTERVENTIONS: Imipenem contains lidocaine (CI if allergy to lidocaine); monitor seizures (rare, esp. with higher doses or in elderly/renally impaired).
• PHARMACOKINETICS: Rapidly absorbed if given IM; peak levels at end of IV infusion; excreted unchanged in urine.
• INTERACTIONS: Valproic acid decreases; cyclosporine, ganciclovir increase ADR; avoid unmonitored combo with CNS-active drugs.

MONOBACTAM: AZTREONAM (AZACTAM)

• MODES: IM, IV.
• PHARMACOKINETICS: Excreted unchanged in urine; crosses placenta and breast milk.
• ACTION: Disrupts bacterial cell wall synthesis, causing leakage of cellular contents.
• INDICATIONS: Modestly severe systemic infections; intra-abdominal and gynecological infections; E. coli, enterobacter, serratia, proteus, Salmonella, pseudomonas, Neisseria, Klebsiella; UTI; skin infections; septicemia.
• CONTRAINDICATIONS: Allergy to aztreonam.
• CAUTION: History of acute allergy to penicillins or cephalosporins; renal/hepatic dysfunction; pregnant/lactating women.
• ADR: N/V, diarrhea, GI upset.

SULFONAMIDES

• MECHANISM: Bacteriostatic; inhibits folic acid synthesis by antagonizing para-aminobenzoic acid (PABA).
• INDICATIONS: UTIs, otitis media, meningitis; broad spectrum infections; chancroid; bronchitis; Pneumocystis jirovecii pneumonia (PJP); duodenal ulcers; burns (mafenide, silver sulfadiazine for wound care).
• MODES: PO, IV.
• PK: Absorbed from GI; metabolized in liver; excreted in urine; teratogenic; distributed into breast milk.
• DRUG-DRUG INTERACTIONS: Hypoglycemia risk with certain sulfonylureas; warfarin toxicity; cyclosporine nephrotoxicity; phenytoin toxicity; some interactions with warfarin.
• ADVERSE EFFECTS: GI symptoms; crystalluria, hematuria, proteinuria; CNS effects (headache, dizziness, vertigo, ataxia, seizures); hematologic effects (agranulocytosis, thrombocytopenia, anemia, leukopenia, hemolytic anemia); hypersensitivity; photosensitivity; kernicterus risk in neonates; orange urine color with sulfasalazine; skin and mucous membrane reactions; hepatic toxicity; Stevens-Johnson syndrome risk; dermatologic discoloration.
• IMPLEMENTATION/ADMINISTRATION: Burn care with mafenide and silver sulfadiazine; application thickness ~1/16 inch; avoid drafts; inform about stinging;
• MONITORING: CBC, renal function, hydration; monitor urinary output; assess for leukopenia, thrombocytopenia; monitor for crystalluria and stone formation; manage diarrhea with hydration and stool monitoring; assess for superinfections; monitor liver enzymes; monitor skin reactions.
• PATIENT EDUCATION: Take as prescribed; take with full glass of water; take on empty stomach except certain meds; avoid alcohol when advised; monitor urine color changes; refrigerate suspensions; discard after 14 days.

TETRACYCLINES

• SAMPLE MEDICATIONS: Tetracycline, Oxytetracycline, Doxycycline, Minocycline, etc. Common uses: acne, ophthalmia neonatorum prophylaxis, traveler’s diarrhea, periodontal disease, STD.
• MODE OF ADMINISTRATION: PO.
• PK: Incomplete GI absorption; absorption affected by food, iron, calcium; concentrated in liver; excreted unchanged in urine; crosses placenta and into breast milk; can stain teeth and bones if used in young patients.
• DRUG-DRUG INTERACTIONS: Decreases penicillin effectiveness; oral contraceptives reduced effectiveness; increases digoxin toxicity; dairy products reduce absorption; many ions (Ca, Mg, Zn, Al, Fe, bismuth) reduce absorption; avoid in pregnancy and children under 8 due to dental enamel effects; hepatic/renal impairment risk; topical/or ocular preparations contraindicated for ocular infections that require normal flora.
• MECHANISM: Inhibits protein synthesis by binding to 30S ribosomal subunit; prevents tRNA binding to mRNA; bacteriostatic.
• INDICATIONS: M. pneumoniae, Borrelia recurrentis, H. influenzae; psittacosis; ornithosis; lymphogranuloma venereum; granuloma inguinale; acne; uncomplicated GU infections by C. trachomatis; rickettsial diseases; intestinal amebiasis.
• CONTRAINDICATIONS & CAUTIONS: Allergy to tetracycline; pregnancy and lactation; caution in children <8 due to tooth discoloration; hepatic/renal disease; ophthalmic preparations contraindicated for non-ocular infections; photosensitivity.
• ADR: N/V, diarrhea, abdominal pain, glossitis, staining of teeth; hepatotoxicity; skeletal effects; photosensitivity; bone marrow suppression; superinfections; ocular discomfort with topical use; intracranial hypertension risk.
• NURSING CONSIDERATIONS: Take on empty stomach; avoid dairy; take with full glass of water; avoid sunlight; monitor for GI upset; ensure full course; monitor hepatic/renal function.

MACROLIDES

• SAMPLES: Erythromycin, Azithromycin, Clarithromycin, Dirithromycin.
• MODE OF ADMINISTRATION: PO; some parenteral.
• PK: Absorption; drug interactions with digoxin, anticoagulants; interactions with theophylline, carbamazepine, corticosteroids; some macrolides reduce the effectiveness of oral contraceptives; some inhibit absorption with antacids.
• MECHANISM: Inhibits protein synthesis by binding to 50S ribosomal subunit; bactericidal at high concentrations; bacteriostatic at lower concentrations.
• INDICATIONS: Listeria (food handling); PID (N. gonorrhoeae); URIs; ocular infections; acne; GI infections; prophylaxis for endocarditis in GABHS infections; broad range including some STI.
• CONTRAINDICATIONS & CAUTIONS: Allergy to macrolides; ocular preparations caution for non-bacterial ocular infections; hepatic dysfunction; caution in myasthenia gravis; lactation.
• ADR: GI upset; hepatotoxicity; CNS effects (confusion, abnormal thoughts); hypersensitivity; potential for superinfections; rare QT prolongation with some agents.
• NURSING CONSIDERATIONS: On an empty stomach for most, with a full glass of water; some can be given with food (clarithro/azithro vary); monitor liver tests; assess allergies; monitor for liver damage.

LINCOSAMIDES

• Medications: Clindamycin (Cleocin), Lincomycin (Lincocin).
• MODE OF ADMINISTRATION: PO, IM; crosses placenta; excreted in urine and feces, metabolized by liver.
• MECHANISM: Bacteriostatic by inhibiting protein synthesis; can be bactericidal at high concentrations.
• INDICATIONS: Broad gram-positive coverage; common in serious infections.
• CONTRAINDICATIONS & CAUTIONS: Hypersensitivity; avoid in minor viral infections; caution in pregnancy, lactation, hepatic/renal disease; neuromuscular blockade risk with myasthenia gravis.
• ADR: Severe pseudomembranous colitis; hepatotoxicity; GI upset; skin and bone marrow suppression; rash.
• NURSING CONSIDERATIONS: Monitor GI activity; fluid balance; stop for severe bloody diarrhea; assess for allergy.

TETRACYCLINE, MACROLIDE & LINCOSAMIDES NURSING PROCESSES

• Tetracycline: take on empty stomach; no dairy; with full glass of water (except certain forms).
• Macrolides: Clarithromycin and Azithromycin may be taken without regard to meals; Dirithromycin with meals; Azithromycin suspension 1 hour or 2 hours after meals; Erythromycin on empty stomach with water.
• Lincosamides: Food impairs absorption; take 1-2 hours before meals or after meals; Clindamycin can be taken without regard to meals.

PARENTERAL ROUTES AND EDUCATION

• ROTATE injection sites; discontinue if phlebitis occurs.
• EDUCATION: Take drug at prescribed times; drink full glass of water; avoid OTCs; avoid alcohol; warn about photosensitivity (tetracyclines); inform if infection worsens after 5 days; pregnancy contraception considerations when using antibiotics; discuss missed doses.

FLUOROQUINOLONES

• INDICATIONS: Ciprofloxacin (anthrax, respiratory, skin, intra-abdominal infections, UTI, STI); Norfloxacin (UTI, prostatitis, STDs); Levofloxacin (URIs, UTI, prophylaxis for urinary and prostatic procedures); Moxifloxacin (CAP, respiratory, skin, anaerobic infections).
• PK/DOSE: Absorbed from GI tract; hepatic metabolism; excreted in urine and feces; crosses placenta and breast milk.
• DRUG-DRUG INTERACTIONS: Iron, calcium, magnesium, zinc, aluminum, iron, sucralfate, antacids reduce absorption; theophylline increases levels; NSAIDs increase CNS stimulation risk; cimetidine alters elimination; QT prolonging drugs increase risk of arrhythmias; warfarin interactions increase bleeding risk; avoid chocolate-colored foods to avoid mistaken bleeding cues.
• ACTION: Inhibits DNA gyrase (topoisomerase II) and topoisomerase IV; prevents DNA replication and transcription; bactericidal.
• INDICATIONS: Gram-negative organisms including E. coli, Proteus, Pseudomonas; UTIs, RTIs, STIs, skin, bone and joint infections.
• CONTRAINDICATIONS & CAUTIONS: Allergy to fluoroquinolones; category C in pregnancy; caution in renal dysfunction, diabetes, seizure history.
• ADR: CNS (headache, dizziness, insomnia, confusion); GI; bone marrow suppression; photosensitivity; tendonitis/tendon rupture; blood glucose alterations.
• NURSING CONSIDERATIONS: Not routinely used in under 18; avoid sun exposure; encourage fluids to prevent crystalluria; monitor for CNS symptoms; avoid antacids around dosing (give 4 hours before or 8 hours after).
• EXAM-FRIENDLY TIP: If given with antacids, dosing timing matters to maintain absorption.

AMINOGLYCOSIDES

• INDICATIONS: Gentamicin (Pseudomonas), Tobramycin (serious infections), Amikacin (serious gram-negative infections), Streptomycin (TB in combination), Kanamycin (hepatic coma), Neomycin (hepatic coma, topical infections, GI flora suppression).
• MODE OF ADMINISTRATION: IM, IV.
• MECHANISM: Inhibit protein synthesis (30S) leading to disruption of cell membrane and cell death; bactericidal.
• PK: Rapidly absorbed after IM; excreted unchanged in urine.
• ADR/TOXICITY:
  • Ototoxicity (auditory/vestibular): tinnitus, deafness; monitoring required.
  • Nephrotoxicity: monitor renal function; urine output.
  • Neuromuscular blockade risk; respiratory depression possible with certain combos.
• CONTRAINDICATIONS & CAUTION: Allergy to aminoglycosides; renal/hepatic disease; pre-existing hearing loss; active herpes/mycobacterial infections; myasthenia gravis; pregnancy category C&D.
• NURSING INTERVENTIONS: Baseline hearing tests; monitor respiratory status; monitor IV site; monitor urine output; careful dosing in elderly/renal impairment; watch for CNS symptoms; ensure hydration; avoid co-administration with other nephrotoxic or ototoxic drugs.
• INTERACTIONS: Diuretics and cephalosporins increase nephro- and ototoxicity risk; anesthesia and certain neuromuscular blockers increase paralysis risk; citrate anticoagulated blood interactions.

ANTIVIRAL THERAPY OVERVIEW (HIV, HEPATITIS, HERPES, INFLUENZA)

• HIV/AIDS
  • Viral load (RNA) measures severity; goals include reducing HIV RNA < 50,000 copies/mL, increasing lifespan and quality of life, reducing mother-to-child transmission with timely treatment.
  • Therapeutic approaches include: Reverse Transcriptase Inhibitors (NRTIs and NNRTIs), Protease Inhibitors, Nucleoside analogs, Fusion inhibitors, etc.
  • Major classes and examples: NRTIs (e.g., abacavir, lamivudine, tenofovir, zidovudine), NNRTIs (e.g., efavirenz), Protease inhibitors (e.g., ritonavir, lopinavir), Fusion inhibitors (e.g., enfuvirtide).
  • Still require monitoring of viral load, CD4 counts, and adherence due to resistance and adverse effects.
• HEPATITIS B
  • Agents: Reverse transcriptase inhibitors that target HBV replication (e.g., adefovir, entecavir).
• HERPES & CMV
  • Agents inhibit viral DNA replication by thymidine kinase inhibition or DNA polymerase inhibition; examples: acyclovir, ganciclovir, famciclovir, valacyclovir, valganciclovir.
  • Important notes: IV acyclovir should be infused over 60 minutes; avoid IV push; monitor renal function; ensure hydration.
• INFLUENZA A
  • Neuraminidase inhibitors (oseltamivir, zanamivir) prevent viral replication and spread; Adamantanes (amantadine, rimantadine) prevent uncoating.
• THERAPY CONSIDERATIONS
  • Begin antiviral therapy soon after exposure or onset of symptoms for best outcomes.
  • Vaccination should occur prior to flu season where applicable.
• GENERAL NURSING CONSIDERATIONS
  • Adherence, monitoring for adverse effects (hepatic, renal, CNS, rash), and protection of others from exposure as needed.

DRUGS FOR TUBERCULOSIS (RIPES + DOT)

• Mycobacterium tuberculosis: droplet/airborne transmission; treatment for active disease and prophylaxis.
• RIPES (Common TB drugs):
  • R - Rifampin (Rifadin, Rimactane): alters DNA/RNA activity; reddish-orange body fluids; hepatotoxicity risk; monitor liver function.
  • I - Isoniazid: inhibits cell wall synthesis; causes peripheral neuropathy; give pyridoxine (B6) to prevent neuropathy; hepatotoxicity risk.
  • P - Pyrazinamide: active metabolite pyrazinoic acid creates acidic environment; risk of hyperuricemia; hepatotoxicity.
  • E - Ethambutol: optic neuritis; monitor visual acuity.
  • S - Streptomycin: ototoxicity and nephrotoxicity; injectable.
• DOT (Directly Observed Treatment): periodic visits to ensure medications are swallowed; 3-4x per week.
• Adverse effects (RIPES): Rifampin—red-orange secretions; INH—peripheral neuropathy; PZA—hyperuricemia; Ethambutol—optic neuritis; Streptomycin—ototoxicity/nephrotoxicity.
• NURSING CONSIDERATIONS: DOT adherence; monitor liver function; educate about side effects; barrier contraception; small frequent meals; hydration; avoid antacids with some regimens; report difficulty breathing, numbness, tingling, fever.

AGENTS FOR INFLUENZA A

• ACTION: Neuraminidase inhibitors prevent viral release and spread; Adamantanes prevent uncoating.
• MEDICATIONS: amantadine, oseltamivir, ribavirin, rimantadine, zanamivir.
• NURSING CONSIDERATIONS: Start early after exposure; vaccinate prior to season when applicable.

AGENTS AGAINST HERPES AND CMV

• ACTION: Inhibit viral DNA replication by thymidine kinase inhibition; incorporate into viral DNA causing nonfunctional chains.
• COMMON MEDICATIONS: acyclovir, cidofovir, famciclovir, foscarnet, ganciclovir, valacyclovir, valganciclovir.
• NURSING CONSIDERATIONS: Administer IV acyclovir over 60 minutes; monitor vitals; hydration; avoid IV push; monitor renal function; ensure complete course; protective gloves for topical use; caution GI upset; avoid sexual activity during active genital herpes; PAP smear every 6 months for genital herpes management.

DRUGS USED TO TREAT HEPATITIS B

• ACTION: Inhibit reverse transcriptase in HBV to terminate DNA chain and reduce viral replication.
• MEDICATIONS: adefovir, entecavir.
• NURSING CONSIDERATIONS: Monitor renal/hepatic function; educate adherence; barrier contraception; avoid antacids with certain regimens; watch for drowsiness; report dyspnea, numbness, tingling, fever.

IMMUNE RESPONSE & INFLAMMATION (BODILY DEFENSES)

• BARRIER DEFENSES: Skin, mucous membranes, gastric acid; major histocompatibility complex (MHC) for self/non-self identification.
• CELLULAR DEFENSES:
  • Neutrophils: digest foreign materials.
  • Basophils: release mediators for inflammatory response.
  • Eosinophils: proteins and reactions at allergic sites.
  • Macrophages: remove foreign materials, promote healing, release inflammatory mediators.
  • Lymphoid tissues: sites of immune activity.
• INFLAMMATORY RESPONSE: designed to protect against injury and pathogens; involves various chemical mediators; anti-inflammatory agents generally block or alter chemical reactions associated with inflammation.

KEY POINTS TO REMEMBER (REVIEW)

• Distinguish bactericidal vs bacteriostatic actions and their clinical implications.
• Understand the rationale for culture and sensitivity testing prior to antibiotic therapy.
• Know major drug classes, their general mechanisms, primary indications, and key adverse effects.
• Practice safe antibiotic administration: complete courses, awareness of interactions, and monitoring for adverse effects.
• In TB, DOT improves adherence and success rates; RIPES components and common adverse effects explained.
• For viral infections, understand that antivirals target specific viral replication steps (reverse transcriptase, protease, neuraminidase, entry/fusion) and that adherence is crucial.
• Basic immune defense concepts underpin infectious disease pharmacotherapy and infection control.

SUMMARY OF FORMULAS/NOTABLE EXPRESSIONS

• Dosing concepts: around-the-clock dosing to maintain bloodstream levels; example scheduling often noted as q8h (every 8 hours) in hospital settings.
• Drug interactions with antibiotics often involve enzymatic induction/inhibition or pharmacokinetic changes; e.g., penicillin interacts with beta-lactamase inhibitors to overcome resistance, and tetracyclines may reduce penicillin effectiveness due to altered microbiota and resistance patterns.
• Notation for classification schemes (helpful for exams):
  • Penicillin ends with "-illin"; Cephalosporin starts with "ceph"; Carbapenem ends with "-enem"; Monobactam ends with "-am"; Aminoglycoside ends with "-mycin" or "-cin"; Sulfonamide ends with "-zine" or "-zole"; Tetracycline ends with "-cycline"; Macrolides end with "-mycin"; Lincosamides end with "-mycin"; Fluoroquinolone ends with "-xacin".

NOTE

• This set of notes covers content from pages 12–24 of the transcript and consolidates key concepts, mechanisms, indications, adverse effects, nursing considerations, and practical nursing actions related to anti-infective therapy, antibiotic classes, TB/hepatitis/ HIV/HSV/Influenza antivirals, and basic immune/inflammatory physiology as described in the transcript. If you’d like, I can reorganize these notes into topic-specific cheat-sheets or a quick-reference table for exam drills.