Term
| 2nd generation quinolones / 1st generation fluoroquinolones |
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Definition
gram-neg rod coverage & some gram pos coverage active against "atypicals" (not 100% so not 1st choice) |
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Term
2nd generation quinolones/1st generation fluoroquinolones: example |
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Definition
ciprofloxacin (Cipro) best gram-neg coverage |
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Term
| 3rd generation quinolones/2nd generation fluoroquinolones |
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Definition
broad spectrum (not good for atypicals) gram-neg coverage as above greater gram-pos coverage |
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Term
3rd generation quinolones/2nd generation fluoroquinolones: example |
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Definition
levofloxacin (Levaquin) very expensive |
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Term
| 4th generation quinolones/3rd generation fluoroquinolones |
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Definition
very broad specturm: gram neg coverage & greater gram-pos coverage so, not often used |
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Term
| pharmacodynamics of quinolones & fluoroquinolones |
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Definition
interfere w/ bacterial DNA synthesis bactericidal post antibiotic effect (may not see effects for 12 days) |
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Term
| pharmacotherapeutics of quinolones/fluoroquinolones |
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Definition
active against a wide range of gram-neg & gram-pos bacteria used to treat infections involvoing the respiratory, urinary & GI tracts, infections of the sinus, skin, soft tissue, bones, joints & prostate; anthrax, infections, diarrhea & STDs |
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Term
| contraindications of quinolones/fluorquinolones |
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Definition
contraindicated in pregnancy, during lactation & in kids under 18 yrs of age (can cause cartilage erosion) use w/ caution in those w/ CNS disorders or predisposed to seizures use w/ caution in pts w/ known prolongation of the QT interval, pts w/ uncorrected hypokalemia & those receiving class 1A antiarrhythmics |
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Term
| adverse effects of quinolones/fluoroquinolones |
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Definition
GI (common) - nausea, emesis, abdominal discomfort HAs, dizziness, insomnia, depression, confusion rash photosensitivity superinfections seizures tendonitis & achilles tendon rupture (advese effects will disappear after d/c of drug) antacids, iron supplements &MVIs w/ minerals such as Zn & Ca can bind w/ and decreased oral bioavailability of quinolone antibiotics by as much as 90% cimetidine may increase levels of some agents |
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Term
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Definition
infectious diseases caused by fungi many common mycotic infections are superficial & only involve skin; fungi may also penetrate skin, causing subcutaneous infections systemic mycoses - most difficult to treat, antifungals are needed in high doses to reach the site to be effective; often life-threatening opportunistic: cryptococcal meningitis, aspergillosis; occur in immunosuppressed people (AIDS, cancer, transplant pts) non-opportunistic: endemic mycoses; blastomycosis, coccidioidomycosis, histoplasmosis; problem in some geographic locations |
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Term
antifungal agents: amphotericin B |
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Definition
binds w/ sterol in the fungal cell membrane, altering cell permeability & allowing intracellular components to leak out fungicidal or fungistatic, depending on the organism & conc of the drug tx of serious & ptotentially fatal systemic fungal infections (Candida, cryptococcus) |
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Term
| pharmacokinetics of amphotericin B |
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Definition
must be given IV; not absorbed from the GI tract poor penetration into CNS (if needed, given intrathecally) very long half-life |
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Term
| adverse effects of amphotericin B |
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Definition
highly toxic; its use is limited to pts w/ a definitive diagnosis of life-threatening infections; administered only to hospitalized pts under close medical supervision - fever & chills (>50% of pts) subside w/ subsequent admin of the drug; premedication helps prevent the problem (tylenol, benedryl)
- nephrotoxicity (80% of pts) despite the low levels of the drug being excreted in the urine, pts may experience decrease in glomerular filtration rate & tubular function; creatine clearnace drops & K is lost; can be permanent
- hypotension: shock-like fall in BP accompanied by hypokalemia (so, monitor pt)
- neurological effects: veritigo, tinnitus, blurred vision, seizures
- electrolyte imbalances (esp K)
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Term
| drug interactions with amphotericin B |
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Definition
vancomycin & other mephrotoxic drugs: increased chance of renal impairment steroids: exacerbation of hypokalemia & increased risk of superinfection digoxin: increased risk for toxicity due to hypokalemia electrolyte solutions: inactivate amphotericin B when diluted in the same solution |
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Term
| nursing management for amphotericin B |
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Definition
dose varies w/ severity of infection, so no optimum dosage schedule is established therapy must continue for weeks to ensure effectiveness when amphotericin B is reconstituted, it may be added to 5% D5W; the infusion solution must contain no preservatives or electrolytes; saline should not be used to flush the amphotericin B IV line do not use an in-line filter, but when it is unavoidable, the pore diameter should be no less than 1micro. or the amount of the drug the client receives will be less protect IV solutions from light exposure, particularly when given over 8 hrs; drug should be infused slowly over a min of 6 hrs; long term therapy usually requires placement of central line premedicate the pt w/ acetaminophen, diphenhydramine & glucocorticosteroids to lessen fever & chills monitor for renal dysfunction, phlebitis |
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Term
antifungal agents: nystatin |
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Definition
too toxic for perenteral use used topically for Candida cutaneous infections & orally (not absorbed) for GI Candida ("swish & swallow") |
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Term
antifungal agents: flucytosine |
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Definition
only antimetabolite that acts as an anticmycotic; penetrates fungal cell where it's converted to its active metabolite - fluorouracil; it is incorported into the RNA of the fungal cells, altering their protein synth & causing cell death absorbed well from the GI tract; penetrates CSF well used predominantly in conjunction w/ amphotericin B; this combo therapy is the tx of choie for cryptococcal meningitis |
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Term
antifungal agents: azole antifungals |
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Definition
wide-spectrum antifungal drugs to which resistance rarely develops all have the same mechanism of action but different therapeutic indications their development provided a way to treat systemic infections orally mechanism: block synthesis of ergosterol by inhibiting P450 sterol synthesis; viable fungal membranes cannot be formed without ergosterol |
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Term
antifungal agents: ketoconazole (Nizoral) |
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Definition
tx of mucocutaneous candidiasis, histoplasmosis, dermatophytes PO & topical admin; GI absorption is impaired if gastirc pH is elevated (should not be taken w/ antacids, H2 blockers & PPIs; should be separated by 2 hrs) should be taken w/ food to minimize nausea major toxicities: gynecomastia & decreased libido due to inhibition of testosterone & cortisol synthesis |
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Term
antifungal agents: fluconazole (Diflucan) |
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Definition
greater activity & spectrum than others - including aspergillus lifetime maintenance anti-cryptococcal meningitis therapy in AIDS penetrates CSF - prophylaxis in immonocompromised pts available oral or IV (very safe, 2nd drug of choice for kids although no FDA approval) single dose possible (vaginal yeast) due to long half-life & high activity (drug of choice) |
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Term
antifungal agents: itraconazole (Sporanox) |
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Definition
injection is now available for the tx of potentially life-threatening fungal infections, including blastomycosis, histoplasmosis and aspergillosis in pts who are intolerant of or refractory to amphotericin B active against many of the same fungi as ketoconazole/fluconazole used for the tx of dermatophyte skin infections unresponsive to topical therapy; used in tx of onychomycosis need acidic envirnoment for best absorption (same as ketoconazole) adverse effects: nausea/vomiting, d iarrhea, and abdominal pain very expensive |
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Term
antifungal agents: miconazole/clotrimazole/terconazole |
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Definition
greates use as a topical tx: tinea corporis (ringworm) tinea cruris (in inguinal area) tinea pedis (athlete's foot) vulvovaginal candidiasis (yeast infection) miconazole & clotrimazole available OTC side effects: itching & burning |
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Term
antifungal agents: griseofulvin |
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Definition
- enters susceptible fungal cells & inhibits microtubule function; w/ long-term therapy (weeks to months), this drug accumulates in the newly synthesized stratum corneum, making these cells undesirable for fungal growth
- drug of choice for pediatrics; cheap and widely used w/ adults - but, huge problem w/ resistance now
- effective only against dermatophytes
- absorbed well PO, especially w/ high-fat diet & distributed to the keratin-containing stratum corneum
- adverse effects: HAs, hepatotoxicity (only concerned if 2nd round of prescription), photosensitivity, GI irritation
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Term
antifungal agents: terbinafine (Lamisil) |
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Definition
similar spectrum as Griseofulvin PO & topical administration drug of choice for fingernal (8 wks PO) & toenail (12 wks PO) fungi - "onycomycosis" |
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Term
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Definition
- virus is an abligate intracellular parasit; its metabolic processes, such as synthesis of proteins & DNA depend on the host cell
- steps in viral replication:
- absorption & penetration of host cell
- synthesis of early nonstructural proteins, such as nucleic acid polymerases
- synthesis of RNA & DNA
- synthesis of late structural proteins
- assembly of virus particles
- most antiviral drugs enter the virus & prevent further replication of the virus by inhibiting one of these steps
- b/c of this action, the earlier in the disease the drug is given (preferably before symptoms are present), the better the outcome
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Term
| drugs used to treat herpesvirus infection |
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Definition
herpesvirus family: herpes simplex virus type 1 (cold sore) & 2 (genital) varicella-zoster virus cytomegalovirus (CMV) epstein-barr virus (mono) |
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Term
drugs used to treat herpesvirus infection: acyclovir (Zovirax) |
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Definition
- first effective, nontoxic, systemic antiviral drug
- halts HSV DNA replication; does not affect considerably the host cells
- has poor bioavailability (PO); only 20% of drug is absorbed after oral admin; in sufficiently large dose effective
- half-life short (2-3 hrs)
- excretion via the kidneys (this is the only thing we have to worry about)
- available in parenteral, oral & topical preps (can be given to neonates)
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Term
| nursing considerations of acyclovir (Zovirax) |
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Definition
advise the pt absorption is unaffected by food these drugs can only manage the disease; they can neither cure it nor keep it from spreading to others promote condom use during sex & abstinence while lesions are present instruct pt to report redness or pain in the eye; herpes eye infections can lead to blindness adverse effects: relatively safe & well tolerated: IV - renal dysfunction & neurotoxicity PO - diarrhea & HAs topical - local irritation |
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Term
drugs to treat herpesvirus infections: valacyclovir (Valtrex) |
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Definition
valine ester of acyclovir well-absorbed after oral admin, after which de-esterification releases free acyclovir; delivers higher blood levels of acyclovir w/ reduced dosing frequency (3-5x higher than oral acyclovir; comparable to IV acyclovir) - increased half-life & bioavail. absorption not affected by food can be used in preg (cat B) |
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Term
drugs to treat herpesvirus infections: penciclovir (Denavir) |
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Definition
very expensive poorly absorbed after PO available only in topical form; more effective than topical acyclovir, esp for herpes labialis |
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Term
drugs to treat herpesvirus infections: famciclovir (Famvir) |
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Definition
pro-drug ester of penciclovir enhanced bioavailability |
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Term
| drugs used to treat respiratory viruses |
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Definition
viral respiratory infections for which tx exists include: influenza A & B respiratory Syncytial Virus (RSV) immunization against influenza A is the preferred approach immunization against RSV is a lso indicated for those at risk (i.e. premature infants) |
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Term
drugs used to treat respiratory viruses: amantadine/rimantadine |
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Definition
inhibit viral uncoating: viruses enter cells through endosomes, which are membrane-bound vacuoles that surround the virus particle; acidification of the endosome is needed for the virus to uncoat & transfer its genetic material to the host cytoplasm; these drugs act as weak bases to prevent acidification of the endosome used mainly for influenza A prophylaxis in elderly & immunocompromised (can be admin. up to 48 hrs after symptoms) well absorbed orally adverse effects: insomnia, dizziness, ataxia (uncoordinated movements), less common w/ rimantadine b/c it does not cross the BBB |
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Term
drugs used to treat respiratory viruses: ribavirin |
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Definition
mechanism of action is not clear used to treat infants & young kids infected w/ RSV not indicated for use in adults favorable responsese of acute Hep. A virus & influenza A/B infections have also been reported effective when admin PO, IV & by aerosol methods adverse effects: dose-dependent transient hemolytic anemia & elevated bilirubin; teratogenic |
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Term
| drugs used to treat HIV & AIDS |
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Definition
- HIV is a retrovirus; ater entering the host cell, it undergoes reverse transcription & is then incorporated into the host cell's DNA
- AIDS, caused by HIV, is characterized by a CD4 count of less than 200 (CD4 is the immune system cell targeted) & the presence of 2 opportunistic infections
- tx of HIV infections has been radically modified during the past 10 yrs by the introduction of powerful antiretroviral drugs & by the development of methods to determine the viral load in plasma
- introduction of HIV protease inhibitors & non-nucleoside reverse transcriptase inhibitors has made the breakthrough possible
- long-term benefits & saftely profiles of these agents are still being evaluated
- for all pts, regular monitoring of viral load & CD4 cell count should be used to guide therapy
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Term
nucleoside reverse transcriptase inhibitors antiretroviral (NRTIs) |
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Definition
- prevents viral DNA f rom replication; active inhibitors of reverse transcriptase - decrease or prevent HIV replication in infected cells
- exert a virustatic effect against retroviruses (drug mimics one of the nucleosides that the virus wants, so DNA prod is inactive)
- b/c of rapid mutation, the virus is a constantly moving target, thus the therapeutic response decreases w/ long-term usage, particularly in the later stage of the disease
- resistant strains can be transferred between individuals
- another factor that contributes to loss of drug efficacy includes incrased viral load resulting from a reduction in immune mechanisms
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Term
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Definition
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Term
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Definition
tx of HIV infection in adults or kids over 3 mo of age used in HIV-pos pregnant women during the 2nd & 3rd trimester & in newborns to decrease the risk of the baby being infected from 26% to 8% retroviral therapy should be started before immunodeficiency becomes evident: aim is to reduce plasma viral conc as much as possible & as long as possible NRTIs have greater effectiveness when used in combo of at least 3 drugs |
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Term
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Definition
- all can cause potentially fatal syndrome of lactic acidosis w/ hepatic failure probably due to mitrochorial toxicity; also, associated w/ peripheral lipoatrophy, central fat accumulation & hyperlipidemia
- zidovudine: anemia, neutropenia, HAs, fatigue, myalgia
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Term
| nucleotide reverse transcriptase inhibitor (NRTI) |
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Definition
nucleotides - phosphorylated nucleosides nucleosides & nucleotides: similar mech of action generally well tolerated, renal toxicity has been reported |
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Term
| non-nucleoside revrse transcriptase inhibitors antiretroviral (NNRTIs) |
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Definition
- bind to the active center of revrse transcriptase to block RNA & DNA polymerase activities
- this action causes a disruption of the enzyme's catalytic site & prevents replication of HIV virus
- used in tx of HIV in cobo w/ other antiviral agents
- retard progression of HIV & decrease complications
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Term
| adverse effects of NNRTIs: |
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Definition
- most common = rash, which can be benign or life-threatening, may be associated w/ fever, conjunctivitis, blistering, oral lesions & muscle/joint pain
- HAs, fatigue, drowsiness, n/v/d
- anemia & neutropenia (very low WBCs) may also occur
- may be given with or without food
- pt should withold drug and notify precribing heath care provider immediately when rash occurs
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Term
| protease inhibitors (PIs) |
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Definition
- asparate protease is an enzyme that is essential for the final step of retrovirus proliferation; it is encoded w/ the HIV genome & is absent in uninfected CD4 cells
- these agents interfere w/ HIV protease, thereby impending the viral replication & leading to the assembly of nonfunctional virions; prevent cleavage of protein precursors essential for HIV maturation
- used in tx of HIV in combo w/ other agents
- use led to marked clinical improvement & prolonged survival even in pts w/ advanced HIV
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Term
| adverse effects of protease inhibitors: |
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Definition
usually well tolerated GI distress, hepatotoxicity is most common HAs, alopecia, dizziness, rash, dry skin, fatigue, cough, back pain, hyperglycemia & paresthesias around the mouth serious but rare effects: renal dysfunction, hepatic failure & Stevens-Johnson syndrome (abrupt development of mucocutaneous lesions) |
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Term
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Definition
after HIV binds to host cell surface, a conformational change occurs in the transmembrane glycoprotein subunit of the viral envelope, facilitating fusion of the viral & host cell membranes & entry of the virus into the cell fusion inhibitors bind to the glycoprotein subunit & prevent the conformational change |
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Term
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Definition
amebicides: destroy amebae used to treat: Giardiasis (an intestinal disorder, which is spread by water and food contaminated by feces; also found in untreated well water), Trichomoniasis vaginalis (STD), and amebiasis or amebic dysentery (not a problem in western society) |
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Term
antiparasitic agents: amebicides: metronidazole (Flagyl) |
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Definition
- for infections caused by obligate anaerobic bacteria (gram neg) - Gardiasis, trichomoniasis, H. pylori infection, C. diff, bacterial vaginosis
- well tolderated, only a few minor side effects: nausea & emesis, metallic taste in mouth, occasional hypersensitivity reactions, throbophlebitis when given IV
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Term
pharmacokinetics of metronidazole (Flagyl) amebicide |
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Definition
- admin PO, IV, or topical (ointment, vaginal prep)
- widely distributed in most body tissue & fluids, including CSF (can be used for brain abscess due to anaerobes)
- intravaginally admin. can be absorbed systemically; however, peak serum conc after this admin.are generally <2% of the levels acheived w/ standard 500mg oral doses
- topical preps are only minimally absorbed; detectable serum levels are about 100x lower than the peak concs of a single 250mg oral dose (so, topical used a relief but not cure)
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Term
| nursing considerations for amebicides (metronidazole) |
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Definition
ETOH ingestion along w/ metronidazole may produce antabuse-like effect (flushing, tachycardia, n/v, HA) & hypotension may produce metallic taste & discolored urine use during 1st trimester contraindicated; use in 2nd/3rd trimesters may be acceptable if other tx have failed (may cause premature labor/miscarriage in 1st) |
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Term
antiparasitic drugs: anthelminitics |
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Definition
destroy parasitic worms by disrupting ther nervous systems used to treat infestations w/ the following parasites: flatworms, flukes, pinworms, roundworms, tapeworms everyone who is in close contact w/ the pt should be treated |
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Term
antiparasitic agents: antimalarials |
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Definition
active against the parasites that cause malaria (not a problem in US except for travel, which may require preventive measures) should be started 1-2 wks before any travels to areas where malaria is endemic monitor for CBC for neutropenia admin. antimalarials w/ food to decrease GI distress if pt comes from another part of the world w/ high fever, malaria considered until proven otherwise Cholroquine (Aralen), Hydroxycholoroquine (Plaquenil), Quinine sulfate (Quinamm) |
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Term
antiparasitic agents: antiprotozoal |
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Definition
drugs that destroy protozoa Pentamidine: used to treat pneumocystosis, an accute pneumonia-like lung infection, which is caused by the parasite protozoa & is an opportunisitic infection in AIDS toxoplasmosis: in many mammals & birds; spread by contact w/ feces (don't clean cat's litter box of eat fish > 1x/week if preg) |
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Term
antiparasitic agents: pediculicides |
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Definition
pediculosis capitis, corporis, pubis (LICE) TX: rx of choice = Permethrin (NIX) 1% creme rinse - shampoo, towel dry, blow dry; apply to slightly damp hair & rinse after 10-20 min; may retreat in 1 wk b/c f nits; safe in kids >2mo of age, treat household members if necessary vinegar prior to back-combing gamma benzin hexocholoride (Kwell) - used in past; many neurological adverse effects |
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Term
antiparasitic agents: scabidides |
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Definition
- scabies: infestation w/ the mite Sarcoptes scabei humani (can survive 6mo on sewn edges)
- tx: rx of choice = 5% permethrin (Elimite) - left on for 8-14 hrs, may need 2nd tx; treat close contacts & use environmental decontamination w/in 3 days of contact w/ person b/c mite can only survive this long w/o human contact
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