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Antiviral/Antifungal Drugs

Viruses Difficult to treat because they invade the cell and use cell's DNA and RNA to reproduce more viruses.
Common viral infections Herpes, influenza, cytomegalovirus (CMV), hepatitis
Antiviral drug Used to prevent or delay spread of viral infection. Interfere with viral replication cell.
Nonclassified antivirals Amantadine and Rimantadine initially used to treat influenza A and Parkinson's disease. Foscarnet (foscar) used to treat HIV retinitis and herpes simplex in pt with HIV. Zanzvir (Relenza) and oseltamivir (Tamiflu) are approved to treat influenza
Topical Antivirals Used to treat herpes simplex viruses. Ex. Denavir, Viroptic, Herpes Liquifilm
Neuraminidase Inhibitors Decrease release of virus from infected cells. Given to prevent viral invasion for example after a dirty needle stick, exposure to body fluids of high risk pt***.
Gamma globulin provides passive immunity with antibodies to block penetration of virus into cell
Purine nucleosides Interfere with viral nucleic acid synthesis. Effective for HSV1, HSV2, zoster, varicella, CMV. Ex. Ribavin (virazole), Acyclovir (zorvirax).
Side Effects of Antivirals GI disturbances, some cause CNS disturbances, bone marrow depression.
Antiviral teaching how to prevent spread of infection. Signs of immunosuppression, infection. Safety r/t dizziness or weakness.
HAART: Highly active antiretroviral therapy Consists of at least 3 drugs to treat HIV. Uses combination of different types of antiviral drugs. Has extended life expectancy and quality of life for HIV infected pt.
What are antivirals designed to do decrease viral load, increase CD4 T cells, prevent resistance, prevent secondary infections and cancer
Nursing Responses Promote adherence/compliance (many pills must be taken at same time, several times a day, cause nausea, etc). Encourage increased fluids up to 2400 ml/day. Monitor lab for CD 4 count. Refer for nutritional support.
Antifungal Drugs Also called antimycotic drugs. Used for fungal infections.
Fungi Eukaryotes= similar in structure and metabolic function to human. Difference in steroid cell wall.
Are antibiotics useful for fungal infections? Antibiotics useful for bacteria are not effective for fungal infections***
Superficial fungal infections Fungal infections of skin and mucous membrane (athlete's foot). Ex. Candida, trichophyton.
Systemic Fungal infections Candida, aspergilliosis, pneumoncystis. May require intensive and prolonged therapy. Drugs of choice: Amphotericin B (Fungizone, AmBisome). Fluconazole (Diflucan).
Amphotericin B Antifungal Drug. Highly toxic, esp to renal**. Can cause electrolyte imbalance*** (K, Mg). Highly protein bound, must be given IV--give as total dose over days***. May need to premedicate (rigors, fever).
AmBisome Amphotericin B combined with lipid. Less SE. Very expensive, use if can't tolerate regular preparation.
Nystatin Oral, topical antifungal. Poorly absorbed from GI. Treats intestinal candida: Swish and swallow for oral candida to coat the oral membranes and esophagus.
Nystatin tx in immunosuppressed pts Used as a prophylaxis for immunosuppressed (chemo pt) to prevent overgrowth of yeast
Azole type Deplete fungal cell of ergosterol. Can be oral or parenterally for topical or systemic. Ex. Fluconazole (Diflucan). Clotrimazole (Mycelex): tx skin, vaginal, oral infections
Metronidazole (Flagyl) Treatment for: Intestinal amebiasis, bacterial vaginosis, inflammatory bowel disease, anaerobic infections, prophylaxis in colorectal surgery; Helicobacter pylori (H. pylori) peptic ulcer; prophylaxis in portal hypertension****
Cautions/Side Effects with Metronidazole (Flagyl) Avoid during first trimester of pregnancy. Must be slow IV***. SE: GI discomfort, seizures, metallic taste, cardiovascular collapse if too fast IV. Antabuse type reaction (violent vomiting) if taken with ETOH****
Polymyxins; colistin and polymyxin B Adverse reactions: high doses and serum levels; nephrotoxicity, neurotoxicity. Client teaching: check BUN, serum creatine; check for numbness and tingling of extremities
Bacitracin Bacterial action- can cross blood brain barrier. Adverse reactions: renal dysfunction, blood dyscrasias, resp distress, allergic reactions (hives)
Vancomycin Bacteriostatic or bacteriocidal. Used for drug resistant S. aureus (MRSA)***. PCN allergy. Not absorbed from GI tract, so cannot be used to treat systemic infection or infection outside of GI tract*** Must be given IV
Vancomycin for C. Difficile Take orally b/c not absorbed from GI tract so treats local infection in intestine***
Vancomycin side effects Nephrotoxicity** Ototoxicity**. Monitor drug levels
Red man Syndrome Allergic reaction to Vancomycin but may be premedicated to decrease response***
Glycyclyclines Synthetic analogs of the tetracyclines. Acts by blocking protein synthesis in bacterial cells. Bacteriostatic.
Glycyclyclines uses Complicated skin infections. Intra-abdominal infection.
Tigercycline (Tygacil) Given IV. SE: similar to tetracycline, photosensitivity, decreased oral contraceptive effectiveness
Nitrofurantoin (Furadantin) Urinary Atiseptic. For UTI. Effective against gram+ and -. SE: GI upset, rash, pruritis, rust/brown urine, superinfection.
Urinary Tract infections (UTIs) Acute cystitis, urethritis, prostatitis.
Common drug groups used to treat UTIs Trimethoprim-sulfamethoxazole. Nitrofurantoin. Fluroquinolones (Cipro). Amoxicillin. Third generation cephalosporins.
Methenamine Mandelate Used for chronic UTIs. Caution: not to be taken with sulfonamides. Client teaching: urine needs to be acid for bactericidal action (cranberries, plums, etc)***. Increase fluids to 1500-2000 ml/day
Action of antimuscarinics tolterodine tartrate (Detrol) Purpose: to control an overactive bladder-decrease detrusor muscle activity. Side Effects: Similar to anticholinergics***. Caution: avoid taking tolerodine if glaucoma, GI dysmotility***.
Urinary Analgesics Phenazopyridine (Pyridium). Purpose: relieve pain, burning sensation, and frequency and urgency of urination. SE: GI upset, nephron-and hepato-toxicity. Client teaching: urine will be a harmless reddish-orange color (dye in drug).
Bethanechol Urinary simulant. Cholinergic. Increase detrusor activity.
Created by: senmark



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