Upgrade to remove ads
Terms in this set (88)
general principles of virology
a virus cannot replicator on its own
it must attach to and enter a host cell
it then uses the host cell's energy to synthesize protein, DNA, and RNA
viruses are difficult to kill because they live inside the cells
-any drug that kills a virus may also kill cells
respiratory infections (coronaviruses, rhinoviruses)
gastroenteritis (rotaviruses, Norwalk-like viruses)
most viral illnesses are bothersome but survivable
effective vaccines have prevented some illnesses
effective drug therapy is available for a small number or viral infections
kill or suppress the virus by destroying visions or inhibiting the ability of viruses to replicate; controlled by current antiviral therapy
immunoglobulins are concentrated antibodies that can attack and destroy viruses
viruses controlled by current antiviral treatment:
key characteristics of antiviral drugs:
able to enter the cells infected with virus
interfere with viral nucleic acid synthesis, regulation, or both
some drugs interfere with ability of virus to bind to cells
some drugs stimulate the body's immune system
best response to antiviral drugs are in patients with competent immune systems
a healthy immune system works synergistically with the drug to eliminate or suppress viral activity
-occur in immunocompromised patients
-would not normally harm an immunocompetent person
-require long-term prophylaxis and antiinfective drug therapy
-can be other viruses, fungi, bacteria, or protozoa
-used to treat infections caused by viruses other than HIV
-used to treat infections caused by HIV, the virus that causes AIDS
An 82-year-old woman is unable to take the influenza vaccine because of allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her?
a. She should receive the flu vaccine as soon as possible.
b. She should receive zanamivir (Relenza) in the inhalation form.
c. She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin.
d. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
Correct answer: D
Rationale: Oseltamivir (Tamiflu) is the only one indicated for prophylaxis of influenza infection. Both oseltamivir and zanamivir can be used to treat active influenza illness. Treatment with oseltamivir and zanamivir ideally should begin within 2 days of symptom onset.
herpes simplex and varicella zoster virus infections
-HSV2 (genital): highly transmissible, "neonatal" herpes
-chickenpox (HHV-3 or VZV): varicella virus vaccine
-shingles (HHV-3 or VZV): painful (opioids for pain control), postherpetic neuralgias, acyclovir may speed recovery; best results are generally seen when the antiviral drug is started within 72 hours of symptom onset, Zostavax
-Human herpesviruses 6 and 7 are not especially clinically significant; immunocompromised patient
-Kaposi's sarcoma (HHV-8)
mild, without symptoms or chronic hepatitis or liver failure and death
transmission occurs through blood and body fluid exposure
transmission to infancts
antiviral drug therapy: lamivudine, tenofovir, and telbivudine, and alfa-interferon
leading cause of liver failure leading to liver transplantation
transmission: infected blood and sexual contact
alcoholic disease can lead to development
treatment: interferon, ribavirin, simeprevir, and sofosbuvir
antiviral drugs (non-HIV)
mechanism of action:
most of the current antiviral drugs work by blocking the activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes
used to treat non-HIV viral infections:
vary with each drug
healthy cells are often killed also, resulting in serious toxicities
synthetic nucleoside analog
used to suppress replication of HSV-1, HSV-2, VZV
drug of choice for treatment of initial and recurrent episodes of these infection
oral, topical, parenteral forms
***oseltamivir (Tamiflu) and zanamivir (Relenza)
active against influenza types A and B
reduce duration of illness
oseltamivir: causes n/v
zanamivir: causes diarrhea, nausea, sinusitis
treatment should begin within 2 days of influenza symptom onset
synthetic nucleoside analog
given orally, or by oral or nasal inhalation
inhalation form (Virazole) used for hospitalized infants with RSV infections
Before beginning therapy, thoroughly
assess underlying disease and medical history, including allergies.
Assess baseline vital signs and nutritional status.
Assess for contraindications, conditions
that may indicate cautious use, and potential drug interactions.
Be sure to teach proper application technique for ointments, aerosol powders, and so on.
Emphasize hand washing before and after administration of medications to prevent site contamination and spread of infection.
Instruct patients to wear a glove or finger cot when applying ointments or solutions to affected areas.
Instruct patients to consult their prescribers before taking any other medication, including over-the-counter medications.
Emphasize the importance of good hygiene.
Inform patients that antiviral drugs are not cures but do help to manage symptoms.
Instruct patients on the importance of taking these medications exactly as prescribed and for the full course of treatment.
Instruct patients to start therapy with antiviral drugs at the earliest sign of recurrent episodes of genital herpes or herpes zoster.
Monitor for adverse effects:
-Effects are varied and specific to each drug.
Monitor for therapeutic effects:
-Effects vary depending on the type of viral infection.
-Effects range from delayed progression of AIDS and other viruses to a decrease in flulike symptoms, decrease in frequency of herpes-like flare-ups, or crusting over of herpetic lesions.
When teaching patients about treatment of viral infection with Acyclovir (Zovirax), which of the following statements will the nurse include?
a. The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV.
b. Acyclovir (Zovirax) is only effective for initial viral infections.
c. Acyclovir (Zovirax) is available in topical form only.
d. Acyclovir (Zovirax) is taken once daily.
Correct answer: A
Rationale: Acyclovir (Zovirax) is a synthetic nucleoside analogue that is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. Acyclovir is considered the drug of choice for the treatment of both initial and recurrent episodes of these viral infections. Acyclovir is available in oral, topical, and injectable formulations. Acyclovir (Zovirax) is taken five times daily.
When reviewing the antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza) used for treatment of the flu, which of the following statements should the nurse include?
a. These drugs are effective only for influenza A.
b. These drugs decrease the effects of the flu by 12 hours.
c. Zanamivir is currently indicated only for treatment of active influenza.
d. The most commonly reported adverse events with oseltamivir are diarrhea, nausea, and sinusitis.
Correct answer: C
Rationale: Zanamivir is currently indicated only for treatment of active influenza. These drugs are active against influenza virus types A and B. They have been shown to reduce the duration of influenza infection by several days. The most commonly reported adverse events with oseltamivir are nausea and vomiting.
Which of the following drugs does the nurse include when teaching caregivers about treatment of neonates with RSV?
a. Telbivudine (Tyzeka)
b. Sofosbuvir (Solvald)
c. Ganciclovir (Cytovene)
d. Ribavirin (Virazole)
Correct answer: D
Rationale: Telbivudine (Tyzeka) is a nucleoside analogue RTI indicated for chronic hepatitis B. Sofosbuvir (Solvald) is the first-in-class RNA polymerase inhibitor for the treatment of chronic hepatitis C. Ganciclovir (Cytovene) is indicated for the treatment of infections caused by CMV. The inhalational form (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV.
Which statement should the nurse include when teaching the patient about Indinavir (Crixivan) therapy?
a. The drug must be taken with food.
b. Patients taking the drug should be encouraged to drink at least 48 ounces of liquid daily.
c. This drug is best absorbed in an alkaline environment.
d. Indinavir decreases CD4 cell counts.
Correct answer: B
Rationale: Patients who take indinavir are encouraged to drink at least 48 oz of liquids every day to maintain hydration and help avoid nephrolithiasis. This drug is best dissolved and absorbed in an acidic gastric environment, and the presence of high-protein and high-fat foods reduces its absorption. Therefore, it is recommended that it be administered in a fasting state. Indinavir therapy produces increases in CD4 cell counts and significant reductions in viral load.
chapter 40 key points
viruses are difficult to kill and to treat because they live inside human cells, and most antiviral drugs work by inhibiting replication of the virus. in this chapter, antiviral drugs are categorized as either non-HIV antivirals or HIV antivirals (antiretrovirals)
non-HIV antivirals include amantadine, rimantadine, acyclovir, ganciclovir, oseltamivir, zanamivir, and ribavirin. HIV antivirals include enfuvirtide, indinavir, maraviroc, nevirapine, raltegravir, tenofovir, and zidovudine
administer antiretroviral drugs only after the prescriber's orders are read and understood and after performing a thorough nursing assessment that includes a review of the patient's nutritional status, weight, baseline vital signs, and renal and hepatic functioning as well as an assessment of heart sounds, neurologic status, and GI tract functioning
comfort measures and supportive nursing care are to accompany drug therapy. patients need to drink plenty of fluids and to space medications around the clock, as ordered, to maintain steady blood levels of the drug
During treatment with zidovudine, the nurse needs to monitor for which potential adverse effect?
c. Kaposi's sarcoma
d. bone marrow suppression
After giving an injection to a patient with HIV infection, the nurse accidentally received a needlestick from a two-full needed disposal box. Recommendations for occupational HIV exposure may include the use of which drug(s)?
b. lamivudine and enfuviritied
c. emtricitabine and tenofovir
When the nurse is teaching a patient who is taking acyclovir for genital herpes, which statement by the nurse is accurate?
a. This drug will help the lesions to dry and crust over
b. acyclovir will eradicate the herpes virus
c. this drug will prevent the spread of the virus to others
d. be sure to give this drug to your partner too
A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education?
a. I will be monitored for side effects and improvements while I'm taking this medicine
b. Test drugs do not eliminate the HIV, but hopefully the amount of virus in my body will be reduced
c. There is no cure for HIV
d. These drugs will eventually eliminate the virus from my body
After surgery for organ transplantation, a patient is receiving ganciclovir, even though he does not have a viral infection. Which statement best explains the rationale for this medication therapy?
a. ganciclovir is used to prevent potential exposure to the HIV virus
b. this medication is given to prophylactically prevent influenza A infection
c. ganciclovir is given to prevent CMV infection
d. the drug works synergistically with antibiotics to prevent super infections
The nurse is reviewing the use of multi drug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (SATA)
a. the combination of drugs has fewer associated toxicities
b. the use of multiple drugs is more effective against resistant strains of HIV
c. effective treatment results in reduced T-cell counts
d. the goal of this treatment is to reduce the viral load
e. this type of therapy reduces the incidence of opportunistic infections
b, d, and e
The nurse notes in the patient's medication history that the patient is taking sofosbuvir (Solvald) with ribavirin. Based on this finding, the nurse interprets that the patient has which disorder?
b. genital herpes
c. chronic hepatitis C
The nurse is obtaining a medication history from a client diagnosed with genital herpes. Which drug would the nurse expect this client to be prescribed?
a. Ribavirin (Virazole)
b. Acyclovir (Zovirax)
c. Zidovudine (Retrovir)
d. Amantadine (Symmetrel)
Acyclovir is the drug of choice to treat herpes simplex infections, which includes the virus type 2 that causes genital herpes. Ribavirin is effective against respiratory syncytial virus, zidovudine against human immunodeficiency virus (HIV), and amantadine against Haemophilus influenzae type A.
To assess for the dose-limiting toxicity of ganciclovir (Cytovene), the nurse will monitor which laboratory test result?
a. Blood urea nitrogen
b. Liver function tests
c. Complete blood count (CBC)
d. Creatine phosphokinase
Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, the CBC should be monitored.
Medications used to treat HIV infections are more specifically classified as what type of drugs?
HIV is a member of the retrovirus family; therefore, drugs used to treat this virus are classified as antiretroviral drugs. Although antiretroviral drugs also fall under the broader category of antiviral drugs in general, their mechanisms of action are unique to the acquired immune deficiency syndrome virus. So, they are more commonly referred to by their subclassification as antiretroviral drugs.
How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated?
a. Viral load
c. Lymphocyte counts
d. Red blood cell counts
All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.
Which client statement regarding his or her diagnosis of HIV infection indicates a need that further teaching is necessary?
a. "I must take these medications exactly as prescribed for the rest of my life."
b. "I don't need to use condoms as long as I take my medication as prescribed."
c. "I will notify my health care provider immediately if I bruise or bleed more easily than normal."
d. "I should remain upright for 30 minutes after taking my zidovudine to prevent esophageal ulceration."
Antiretroviral drugs do not stop the transmission of HIV, and clients need to continue standard precautions and safe sex practice, including condom use. Potential serious adverse effects of zidovudine are bone marrow suppression and esophageal ulceration.
When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B?
a. Indinavir (Crixivan)
b. Enfuvirtide (Fuzeon)
c. Oseltamivir (Tamiflu)
d. Ganciclovir (Cytovene)
Oseltamivir (Tamiflu) and zanamivir (Relenza) are active against influenza virus types A and B and have been shown to reduce the duration of influenza infection by several days.
A new vaccination, Zostavax (Zoster Vaccine Live), has been approved to prevent the development of what condition in adults older than the age of 60 years?
a. Influenza A
b. Herpes zoster
c. Avian influenza
d. Herpes simplex
Zoster vaccine (Zostavax) is a vaccine for the prevention of herpes zoster. Herpes zoster, also known as shingles, is an extremely painful condition caused by the varicella-zoster virus that also causes chickenpox. The vaccine is approved for clients 60 years of age or older to prevent reactivation of the zoster virus that causes shingles, although clients as young as 50 years may receive it. Zostavax is a one-time vaccine.
The most significant drug interactions with use of antivirals occur when antivirals are administered via which route?
Significant drug interactions that occur with antiviral drugs arise most often when they are administered via systemic routes such as intravenously and orally. Many of these drugs are also applied topically to the eye or body, however, and the incidence of drug interactions associated with these routes of administration is much lower.
The nurse is aware that viruses can enter the body through various routes. Through which routes can viruses enter the body? (Select all that apply.)
a. Through an animal bite
b. Transplacentally from mother to infant
c. Inhalation through the respiratory tract
d. Localized allergic reaction to medication
e. Ingestion via the gastrointestinal (GI) tract
a, b, c, and e
Viruses can enter the body through at least four routes: (1) inhalation through the respiratory tract, (2) ingestion via the GI tract, (3) transplacentally via mother to infant, and (4) inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others). Viruses cannot enter the body through an allergic reaction caused by medication.
Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.)
a. Fusion inhibitors
b. Protease inhibitors
c. Neuraminidase inhibitors
d. Reverse transcriptase inhibitors
e. Nonnucleoside reverse transcriptase inhibitors
a, b, d, and e
Neuraminidase inhibitors are used in the treatment of the influenza virus.
Before administration of any antiviral medication, what nursing responsibilities would be performed? (Select all that apply.)
a. Baseline vital signs
b. History of medication use
c. Head-to-toe physical assessment
d. Documentation of known allergies
e. Monitor for medication adverse effects
a, b, c, and d
Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the client's nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered.
TB is caused by Mycobacterium tuberculosis
these drugs treat all forms of Mycobacterium (MTB)
TB is most commonly characterized by granulomas in the lungs: nodular accumulations of inflammatory cells that are delimited and have a center that has a cheesy or caveated consistency
Common infection sites:
lung (primary site)
brain (cerebral cortex)
bone (growing end)
passed from infected humans (most common), cows, and birds
tubercle bacilli are conveyed by droplets
droplets are expelled by coughing or sneezing, and they then gain entry into the body by inhalation
tubercle bacilli then spread to other body organs via blood and lymphatic systems
tubercle bacilli may become dormant, or walled off by calcified or fibrous tissue
very slow-growing organism
more difficult to treat than most other bacterial infections
first infectious episode: primary TB infection
reinfection: chronic form of the disease
dormancy: may test positive for exposure but are not necessarily infectious because of this dormancy process
TB infects one third of the world's population
MDR-TB that is resistant to both isoniazid (INH) and rifampin
XDR-TB: relatively rare type of MDR-TB, resistant to almost all drugs used to treat TB, including the two best first-line drugs, INH and rifampin, as well as to the best second-line medications
XDR-TB is of special concern for immunocompromised patients
2013: FDA granted accelerated approval for bed aquiline for the treatment of MDR-TB
Inhibits mycobacterial ATP synthase
first drug in 40 years to treat TB with a new mechanism of action
side effects: headache, chest pain, nausea, QT prolongation
first line anti tubercular drugs
INH: primary drug used
second line antitubercular drugs
para-aminosalicyclic acid (PAS)
anti tubercular drug therapy considerations
major effects of drug therapy: reduction of cough and, therefore, reduction of the infectiousness of the patient
normally occurs within 2 weeks of the initiation of drug therapy if TB strain is drug sensitive
most cases of TB can be cured
successful treatment: several antibiotic drugs for at least 6 months and sometimes for as long as 12 months
perform drug-susceptibility testing on the first Mycobacterium spp. that is isolated from a patient specimen to prevent the development of MDR-TB
even before the results of susceptibility tests are known, begin a regimen with multiple anti tubercular drugs to reduce the chances of development of resistance
adjust drug regimen after the results of susceptibility testing are known
monitor patient compliance closely during therapy
problems with successful therapy occur because of patient non adherence to drug therapy and the increased incidence of drug-resistant organisms
anti tubercular drugs mechanism of action
-protein wall synthesis inhibitors: streptomycin, kanamycin, capreomycin, rifampin, rifabutin, others
-cell wall synthesis inhibitors: cyclosporine, ethionamide, INH
-other mechanisms of action: ethambutol, INH, PAS, ethionamide
anti tubercular therapy
effectiveness depends on:
type of infection
sufficient duration of treatment
adherence to drug regimen
selection of an effective drug combination
drug resistant organisms
drug of choice for TB
resistant strains of Mycobacterium emerging
metabolized in the liver thought acetylation (watch for slow acetylators)
used alone or in combination with other drugs
contraindicated with liver disease
***antabuse-like reaction with alcohol
adverse effects of TB drugs
INH: peripheral neuropathy, hepatotoxicity
ethambutol: retrobulbar neuritis, blindness
***rifampin: hepatitis; discoloration of urine, stools, and other body fluids
perform liver function studies in patients who are to receive INH or rifampin (especially in older patients and those who used alcohol daily)
patient education is critical
therapy may last for up to 24 months
take medications exactly as ordered at the same time every day
emphasize the importance of strict adherence to regimen for improvement of condition or cure
remind patients that they are contagious during the initial period of their illness - instruct in proper hygiene and prevention of the spread of infected droplets
patients should not consume alcohol while taking these medications or take other medications, including OTC, unless they check with their prescribers
rifampin causes oral contraceptives to become ineffective; another form of birth control is needed
***patients who are taking rifampin should be told that their urine, stool, saliva, sputum, sweat, or tears may become reddish orange; even contact lenses may be stained
pyridoxine may be needed to combat neurologic adverse effects associated with INH therapy
oral preparations may be given with meals to reduce GI upset even though recommendations are to take them 1 hour before or 2 hours after meals
monitor for adverse effects:
paresthesias of the extremities
loss of appetite
chapter 41 key points
all anti tubercular drugs are to be taken exactly as prescribed. emphasize adherence to the therapeutic regimen and long-term dosing combined with healthy living practices
therapeutic effects include resolution of pulmonary and extra pulmonary MTB infections
vitamin B6 is needed to combat the peripheral neuropathy associated with INH
counsel women taking oral contraceptive therapy who are prescribed rifampin on other forms of birth control because of the ineffectiveness of oral contraception when rifampin is taken
educate the patient about the importance of strict adherence to the drug regimen for improvement or cure of the condition. provide instructions in written and oral forms about drug interactions and the need to avoid alcohol while taking any of these medications
The nurse is teaching a patient who is starting anti tubercular therapy with rifampin. Which adverse effects would the nurse expect to see?
a. headache and neck pain
c. reddish brown urine
d. numbness or tingling of extremities
During anti tubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the relational for this second medication?
a. this vitamin will help to improve your energy levels
b. this vitamin helps to prevent neurologic adverse effects
c. this vitamin works to protect your heart from toxic effects
d. this vitamin helps to reduce GI adverse effects
The nurse is counseling a woman who is beginning anti tubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interaction?
a. you will need to switch to another form of birth control while you are taking the rifampin
b. your birth control pills will remain effective while you are taking the rifampin
c. you will need to take a stronger dose of birth control pills while you are on the rifampin
d. you will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy
When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious
a. during all phases of the illness
b. any time up to 18 months after therapy begins
c. during the postictal phase of TB
d. during the initial period of the illness and its diagnosis
While monitoring a patient, the nurse knows that a therapeutic response to anti tubercular drugs would be
a. the patient states that he or she is feeling much better
b. the patient's laboratory test results show a lower WBC count
c. the patient reports a decrease in cough and night sweats
d. there is a decrease in symptoms, along with improved chest x-ray and sputum culture results
The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include:
a. orange discoloration of sweat and tears
b. darkened urine
e. visual disturbances
b, d, and f
Bedaquiline (Sirturo) is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understanding of the instructions?
a. i will take this with food
b. i need to take this 1 hour before breakfast
c. i can stop this drug if the side effects bother me
d. it's okay to have a glass of wine while taking this drug
Before discharge, the nurse is reviewing a client's prescribed medication regimen for tuberculosis (TB). The client asks the nurse why pyridoxine (vitamin B6) has been prescribed while continuing to take isoniazid (Nydrazid) to treat TB. What is the nurse's best response?
a. "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria."
b. "You really should not be on that drug. I will check with the health care provider."
c. "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid."
d. "Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid."
Isoniazid can cause neurotoxicity. Pyridoxine, vitamin B6, is the drug of choice to prevent this adverse reaction. It is not an antiinfective drug and thus will not work to destroy the mycobacterium or prevent drug resistance.
What information should the nurse provide to a client prescribed rifampin (Rifadin)?
a. Oral contraception is the preferred method of birth control when using rifampin.
b. The patient will only need to take this medication for the prescribed 14-day period.
c. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces.
d. Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities.
Red-orange-brown discoloration of the skin, sweat, tears, urine, feces, sputum, saliva, and tongue as an adverse effect of the drug, but it is not harmful. Rifampin does not cause peripheral neuropathies (isoniazid does), but it does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long term to eradicate the slow-growing mycobacterium lying deep within the tissues.
Which client statement indicates to the nurse that the client understands the discharge teaching for ethambutol (Myambutol)?
a. "Constipation will be a problem, so I will increase the fiber in my diet."
b. "Dizziness and drowsiness are common adverse effects with this drug."
c. "I will need to have my vision checked periodically while I am taking this drug."
d. "This medication may cause my bodily secretions to turn red-orange-brown."
Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure?
a. Advise that these drugs will only need to be taken for 7 to 10 days.
b. Remind that sunscreen is not needed during outdoor activities.
c. Explain that isoniazid may decrease blood serum glucose in susceptible people.
d. Emphasize that oral contraceptives become ineffective when given with rifampin.
Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. These medications must be taken long term because mycobacterium is slow growing. They can cause photosensitivity, necessitating the use of sunscreen. Finally, isoniazid may increase, not decrease, serum glucose levels.
The nurse anticipates a prescription for vitamin supplementation for a client who is receiving isoniazid (Nydrazid) therapy. What vitamin supplement is usually prescribed with isoniazid?
c. Vitamin E
d. Vitamin B6
Pyridoxine (vitamin B6) is often given concurrently with isoniazid to prevent the adverse effect of isoniazid induced peripheral neuropathy associated with neurotoxicity.
When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.)
b. Uric acid levels
c. Sputum cultures
d. Liver function tests
e. Complete blood cell count
d and e
Rifamate can lead to impairment of liver function as well as hematologic disorders. Assessment of sputum cultures confirms the diagnosis but is not related to adverse effects. The drug does not affect uric acid levels or cholesterol.
very large and diverse group of microorganisms, including yeasts and molds
fungal infections also known as mycoses
some fungi are part of the normal flora of the skin, mouth, intestines, and vagina
systemic, cutaneous, subcutaneous, and superficial
cutaneous, subcutaneous, and superficial: infections of various layers of the integumentary system (skin, hair, and nails)
fungi that cause integumentary infections are known as dermatophytes
reproduce by budding
can be used for baking and alcoholic beverages
characterized by long, branching filaments call hyphae
four general types:
systemic: can be life threatening (usually occurs in immunocompromised host)
may follow antibiotic therapy, antineoplastics, or immunosuppressants (corticosteroids)
may result in overgrowth and systemic infections
growth in the mouth is called thrush or oral candidiasis
common in newborn infants and immunocompromised patients
pregnancy, women with diabetes mellitus, women taking oral contraceptive
drugs used to treat infections caused by fungi
antifungal drugs mechanism of action
polyenes: amphotericin B and nystatin
bind to sterols in cell membrane lining
result: fungal cell death
do not bind to human cell membranes or kill human cells
immunocompromised patients are at a higher risk of fungal infection
small test dose (allergic reaction)
***monitor vital signs
better tolerated at a slower rate
thrush (or vaginal)
suspension and lozenges
imidazoles and triazoles: ketoconazole, fluconazole, itraconazole, voriconazole
inhibit fungal cell cytochrome P-450 enzymes, resulting in cell membrane leaking
result: altered cellular metabolism and fungal cell death
***check WBC and platelets (CBC)
treats nail fungus
anti fungal drug indications
systemic and topical fungal infections
drug of choice for the treatment of many severe systemic fungal infections is amphotericin B
choice of drug depends on type and location of infection
fluconazole: passes into the CSF and inhibit the growth of cryptococcal fungi, effective in the treatment of cryptococcal meningits
antifungal drug contraindications
most common: drug allergy, liver failure, kidney failure
itraconazole: contraindicated treatment of onychomycoses in patients with sever cardiac problems
amphotericin B adverse effects
neurotoxicity; tinnitus; visual disturbances; hand or feet numbness, tingling, or pain; convulsions
renal toxicity, potassium loss, hypomagnesemia
fever, chills, headache, nausea, occasional hypotension, GI upset, anemia
prescribers commonly order various premedications: antiemetics, antihistamines, antipyretics, and corticosteroids
prevent or minimize infusion-related reactions
***likelihood of such reactions can also be reduced by using longer-than-average drug infusion times
antifungal drugs adverse effects
increased liver enzymes
use with caution in patients with renal and liver dysfunction
antifungal drug interactions
many antifungal drugs are metabolized by the cytochrome P-450 enzyme system
coadministartion of two drugs that are metabolized by this system may result in competition for these enzymes and thus higher levels of one of the drugs
antifungal drugs nursing implications
to reduce the severity of the infusion-related reactions, pretreatment with an antipyretic, antihistamines, antiemetics, and corticosteroids may be given
use IV infusion pumps and the most distal veins possible
check if med should be given with meals or on empty stomach
mystatin given as an oral lozenge or troche should be slowly and completely dissolved in the mouth (not chewed or swallowed whole)
nystatin suspension should be swished thoroughly in the mouth as long as possible before swallowing
chapter 42 key points
fungi are a very large and diverse group of microorganisms and consist of yeasts and molds. yeasts are single-celled fungi that may be harmful or helpful. molds are multicellular and are characterized by long, branching filaments called hyphae
candidiasis is an opportunistic fungal infection caused by C. albicans and occurs in patients taking broad-spectrum antibiotics, antineoplastics, or immunesuppressants, as well as in immunocompromised persons when candidiasis occurs in the mouth, it is commonly called oral candidiasis or thrush. oral candidiasis is more commonly seen in newborns or immunocompromised person
vaginal candidiasis is a yeast infection and occurs most commonly in individuals with diabetes mellitus, women taking oral contraceptives, pregnant women, and post-antibiotic therapy
antifungals may be administered either systemically or topically. some of the most common systemic antifungals are amphotericin B and fluconazole; an example of a topical antifungal is nystatin
before administering antifungals, thoroughly assess for allergies as well as interactions with other drugs patients are taking, including prescription drugs, OTCs and herbals
amphotericin B must be properly diluted according to manufacturer guidelines and administered using and IV pump. tissue extravasation of fluconazole at the IV infusion site leads to tissue necrosis; therefore, check the site hourly and document the assment
The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern?
a. endocrine disease
b. hepatic disease
c. cardiac disease
d. pulmonary disease
While monitoring a patient who is receiving IV amphotericin B, the nurse expects to see which adverse effect?
c. fever and chills
d. diarrhea and stomach cramps
When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's
a. history of cardiac disease
b. history of gallbladder surgery
c. ethnic background
d. cytochrome P-450 enzyme system
During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects?
a. forcing of fluids during the infusion
b. infusing the medication quickly
c. infusing the mediation over a longer period of time
d. stopping the infusion for 2 hours after half of the bag has infused, then resuming 1 hour later
When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct?
a. chew the lozenge carefully before swallowing
b. dissolve the lozenge slowly and completely in your mouth
c. dissolve the lozenge until it is half the original size, and then swallow it
d. these lozenges need to be swallowed whole with a glass of water
When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (SATA)
a. blood dycrasias
c. pulmonary infiltrates
a, b, and e
blood dyscrasia = abnormal cellular elements
The nurse notes in a patient's medication history that the patient is taking terbinafine (Lamisil). Based on this finding, the nurse interprets that the patient has which disorder?
a. vaginal candidiasis
b. cryptococcal meningitis
c. invasive aspergillosis
What is the MOST common drug used to treat oral candidiasis?
a. Oseltamivir (Tamiflu)
b. Nystatin (Mycostatin)
c. Amantadine (Symmetrel)
d. Griseofulvin (Fulvicin P/G)
Nystatin is an antifungal drug that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet.
What is the MOST important action for the nurse to complete before administration of intravenous (IV) amphotericin B?
a. Assess for nausea and vomiting.
b. Monitor for cardiac dysrhythmias.
c. Check for premedication prescriptions.
d. Monitor IV site for signs of phlebitis.
Almost all clients given IV amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. The other choices are appropriate nursing actions after the IV infusion has begun.
Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections?
a. Voriconazole (Vfend)
b. Nystatin (Mycostatin)
c. Fluconazole (Diflucan)
d. Caspofungin (Cancidas)
Fluconazole is an antifungal drug that does not cause the major adverse effects of amphotericin when given intravenously. It is also very effective against vaginal yeast infections, and a single dose is often sufficient to treat vaginal infections.
A client visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse MOST likely instruct the client to take to treat this condition?
a. Terbinafine (Lamisil)
b. Voriconazole (Vfend)
c. Caspofungin (Cancidas)
d. Amphotericin B (Amphocin)
Terbinafine (Lamisil) is classified as an allylamine antifungal drug and is currently the only drug in its class. It is available in a topical cream, gel, and spray for treating superficial dermatologic infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).
The nurse needs to know that major adverse effects are MOST common by which drug?
a. Fluconazole (Diflucan)
b. Ketoconazole (Nizoral)
c. Griseofulvin (Fulvicin P/G)
d. Amphotericin B (Amphocin)
The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in clients receiving other antifungal drugs, but the IV administration of amphotericin B is associated with a multitude of adverse effects.
The nurse would question a prescription for voriconazole (Vfend) if the client was taking which medication?
b. Prednisone (Deltasone)
c. Captopril (Capoten)
d. Clindamycin (Cleocin)
The nurse would question a prescription for quinidine because both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.
The nurse has provided education to a client about fungal skin infections. Further client teaching is necessary when the client includes which condition in the discussion of fungal skin infections?
c. Athlete's foot
d. Vaginal yeast infection
Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the client included this in the discussion, further teaching is needed. All other skin infections listed are fungal and would be treated with antifungal medications.
What are important for the nurse to monitor in a client receiving an antifungal medication? (Select all that apply.)
b. Daily weights
c. Mental status
d. Intake and output
e. Blood urea nitrogen
a, b, d, and e
Nursing interventions appropriate to clients receiving antifungal drugs vary depending on the particular drug. However, it is important for the nurse to monitor all clients for indications of possible medication-induced renal damage so that prompt interventions can occur to prevent further dysfunction. Monitoring intake and output amounts, daily weights, and renal function tests will help prevent such damage.
What conditions are considered contradictions for use of antifungal medications? (Select all that apply.)
a. Heart failure
b. Liver failure
c. Kidney failure
d. Pancreatic failure
e. Respiratory failure
b and c
Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs.
THIS SET IS OFTEN IN FOLDERS WITH...
Chapter 40 Antiviral Drugs
Pharmacology Ch. 37: Cardiac Glycosides, Antiangin…
Chapter 40: Antiviral Drugs
Pharmacology Chapter 26-Antibacterials
YOU MIGHT ALSO LIKE...
Antiviral Drugs- Ch 40
Anti- Infectives: Antitubercular and Antifungal Dr…
chapter 40 antiviral
Pharm drugs for TB
OTHER SETS BY THIS CREATOR
Ch. 9: Intervention in Groups
GI Conditions (Test 2)