3080 exam 5 viral, fungi, TB

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Which fungal infection is the only one that is transferred from person to person?

Tinea Pedis

Why are fungal infections not typically transferred from person to person?

Because fungi is slow growing

How long does a fungi culture take to come back?

2-3 weeks

Scalp, skin, nails and mucous membrane (oral, vaginal) are what type of fungal disease?

Superficial

Systemic fungal diseases include what organs?

Lungs, brain, and digestive organs

What are fungal infections called?

mycoses

What is the largest class of antifungal drugs that inhibits ergosterol biosynthesis, which causes the fungal plasma membrane to leak?

Azoles

What is the drug of choice for systemic or invasive fungal diseases and is usually given IV?

Amphotericin B

What are the Side effects of Amphotericin B?

Renal*hypokalemia*, nephrotoxicity, and ototoxicity

What are the nursing considerations with Amphotericin B?

Infuse slowly to avoid cardiovascular collapse, monitor renal function (I/O), monitor for hypokalemia and dysrhythmias

What drugs are contraindicated while taking Amphotericin B because they contribute to a decrease renal function?

Aminoglycosides, vancomycin, and corboplatin

Which azoles are commonly used for both systemic and superficial infections?

Fluconazole (Diflucan), Itraconazole (Sporanox), or Ketoconazole (Nizoral)

What is the main administration concern when administering Fluconazole (Diflucan) IV?

Do not mix with other drugs***

Fluconazole (Diflucan) has drug to drug interactions with what drugs?

Warfarin (increases chances of bleeding) and sulfonylureas

When Nystatin (Mycostatin) is administered orally, what are the nursing considerations?

Instruct patient to swish and swallow or swish and spit. No food or drink for 30 minutes after administration so it can absorb in the mouth and GI tract

When Nystatin (Mycostatin) is administered topically, what are the nursing considerations?

Don't cover with occlusive dressing

When Nystatin (Mycostatin) is administered vaginally, what are the nursing considerations?

Pt should remain in recumbent position for at least 15-30 minutes after administration.

What medication is indicated for mycoses of the hair, skin, and nails that are unresponsive to topical agents?

Fulvicin (Griseofulvin)

Before administering Fulvicin (Griseofulvin) what allergies should be assessed?

PCN

What instructions should be given to the patient taking Fulvicin (Griseofulvin)?

Take with or after meals, high fat meals increase absorption, drug may alter taste, txt may take weeks or months. Should have an alternative form of bc besides oral contraceptives.

What are the side effects of Fulvicin (Griseofulvin)?

Photophobia, headache and altered taste

What are the two types of Protozoal infections?

Malaria and Non-malarial - Giardia, tichomonas vaginalis

How is malaria primarily spread?

Through the anopheles mosquito

Malaria travels to the _____ where it multiplies and transforms into progeny called _______?

Liver; merozoites

The merozoites (Malaria) infect the _______ and cause what types of signs and symptoms?

RBC; fever and chills

What drug is used as prevention of relapse of Malaria?

Primaquine phosphate

What is the prototype drug for Malaria and is used as both prophylactic and in acute attacks?

Chloroquine (Aralen)

When and how should Chloroquine (Aralen) be administered?

Immediately before or after meals to decrease GI upset; If given IM give in large muscle

Chloroquine (Aralen) is not contraindicated in which patients?

Patients with G6PD deficiency and alcoholics since it is hepatotoxic

What are the nursing interventions for patients taking Chloroquine (Aralen)?

Monitor for vision changes (retinopathy), muscle weakness and decreased DTRs, may cause rusty discoloration of urine.

What is the drug of choice for nonmalarial protozoan infections?

Metronidazole (Flagyl)

What are the nursing considerations when administering Metronidazole (Flagyl)?

ER tabs must be taken whole, Give 1 hour or 2 hours after meals, if given IV...must be given SLOW*** (major incompatibilities).

What are the side effects of Metronidazole (Flagyl)?

N/V/D, dizziness, HA, and metallic taste

Metronidazole (Flagyl) should not be taken with what medications or substances?

Oral anticoagulants, lithium, or alcohol

How are the common Helminthic infections classified?

roundworms (nematodes), flukes (trematodes), or tapeworms (cestodes)

Roundworms primarily infect which group of people? Why?

Children aged 3 to 8 years old, because they are most likely to be exposed to contaminated soil without proper hand washing.

What is the drug of choice for helminthic infections?

Mebendazole (Vermox)

What are important nursing interventions for children with pinworms?

Treat everyone in the family with one dose of Mebendazole (Vermox) at the same time.

Mebendazole (Vermox) is most effective when administered how?

When chewed and taken with fatty meals which increases absorption.

Mebendazole (Vermox) may be potentiated by which drugs?

Tegretol or Dilantin

Mebendazole (Vermox) should be used cautiously in which patients?

Patients with IBD and children under 2 years

What is the preferred target of the HIV virus once it enters the body?

The CD4 receptor on T4 lymphocytes***

What is unique about the replication of the HIV virus?

HIV uses reverse transcriptase to construct DNA from RNA; all living organisms make RNA from DNA.*****

What is the best lab test to determine when drug therapy should be initiated in patients with HIV?

HIV RNA - which is an estimate of how rapidly the virus is replicating.

What is the nonnucleoside reverse transcriptase inhibitor (Antiretroviral) prototype for HIV?

Efavirenz (Sustiva) - blocks RNA and DNA activities.

What are the side effects of Efavirenz (Sustiva)?

Hepatotoxic**, Stevens-Johnson syndrome**, paresthesia, myalgia, fever, and GI distress

What prototype drug is a nucleoside reverse transcriptase inhibitor used to prevent perinatal mother to fetus transfer of HIV?

Zidovudine (Retrovir, AZT)

How and when is Zidovudine (Retrovir) given to a HIV mother and baby?

Used during pregnancy weeks 14-34, given IV during labor, and given to the infant for 6 weeks.

Frequent lab test should be performed when taking Zidovudine (Retrovir) to detect what?

Hematologic toxicity

What is the MOA for Zidovudine (Retrovir)?***

As the reverse transcriptase enzyme begins to synthesize viral DNA, it mistakenly uses zidovudine as one of the nucleosides, thus creating a defective DNA strand.***

What prototype drug is a protease inhibitor that prevents the cleavage of viral polyproteins (final step in HIV maturation) and is used in advanced HIV infections?

Lopinavir with Ritonavir (Kaletra)

What are the adverse effects of Lopinavir with Ritonavir (Kaletra)?

Hepatotoxic, nephrotoxic, and GI distress

HSV 1 primarily causes infections in what areas?

Eye, mouth, and lips

HSV 2 primarily causes infection in what area?

Genital infections

What virus affects multiple body systems in immunosuppressed patients?

Cytomegalovirus (CMV)

Varicella-zoster virus (VZV) causes what two viruses?

Shingles (zoster) and chicken pox (Varicella)

What virus causes mononucleosis and Burkitt's lymphoma?

Epstein-Barr virus

Herpesvirus - 6 causes what 3 viruses?

Roseola in children and hepatitis or encephalitis in immunosuppressed patients.

What is the prototype drug used to treat herpesviruses?

Acyclovir (Zovirax)

What are some important nursing considerations when administering Acyclovir (Zovirax) via IV?

It may cause painful inflammation of vessels at the site of infusion and may cause nephrotoxicity.

Which antiviral drug is indicated for unvaccinated individuals during a confirmed outbreak of influenza A and is continued for 10 days?

Amantadine (Symmetrel)

Which antiviral drug is used for influenza A or B symptomatic patients?

Oseltamivir (Tamiflu) - for 2 days

How is hepatitis A spread?

By the oral-fecal route

How are hepatits B and C spread?

Primarily through exposure to contminated blood and body fluids.

What is the main HBV pharmacotherapy and how is it administered?

Interferon alfa - SQ

What are the signs and symptoms of interferon alfa?

Flu-like symptoms, rash, and cough

In order for medications to reach the tuberculosis microorganisms isolated in the tubercles, therapy must continue for how long?

6 - 12 months.

In order to treat tuberculosis effectively how many antibiotics should be administered concurrently?

2 - 4 antibiotics

What are the primary first line drugs used to treat tuberculosis?

Isoniazid (INH), Rifampin (Rifadin), and Streptomycin

What test is required for a definite diagnosis of tuberculosis?

Sputum cultures

What is the prototype drug used to treat a positive skin test for tuberculosis?

Insoniazid (INH)

What are the common side effects of Insoniazid (INH)?

Parathesias to the hands and feet....overdose can be fatal

What can be administered to decrease the effects of parathesias while taking INH?

Vitamin B-6

The patient taking INH should be instructed to avoid which food and drinks?

Foods taking tyramine, aged cheese, beer, red wine, and chocolate.

What is one of the main problems in patients taking INH?

Non-compliance with medication regimen.

What are the main drug to drug interactions when taking INH?

Don't take antacids or alcohol.

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