Antiviral/Antifungal Drugs
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| Viruses | Difficult to treat because they invade the cell and use cell's DNA and RNA to reproduce more viruses.
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| Common viral infections | Herpes, influenza, cytomegalovirus (CMV), hepatitis
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| Antiviral drug | Used to prevent or delay spread of viral infection. Interfere with viral replication cell.
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| 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
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| Topical Antivirals | Used to treat herpes simplex viruses. Ex. Denavir, Viroptic, Herpes Liquifilm
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| 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***.
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| Gamma globulin | provides passive immunity with antibodies to block penetration of virus into cell
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| Purine nucleosides | Interfere with viral nucleic acid synthesis. Effective for HSV1, HSV2, zoster, varicella, CMV. Ex. Ribavin (virazole), Acyclovir (zorvirax).
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| Side Effects of Antivirals | GI disturbances, some cause CNS disturbances, bone marrow depression.
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| Antiviral teaching | how to prevent spread of infection. Signs of immunosuppression, infection. Safety r/t dizziness or weakness.
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| 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.
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| What are antivirals designed to do | decrease viral load, increase CD4 T cells, prevent resistance, prevent secondary infections and cancer
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| 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.
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| Antifungal Drugs | Also called antimycotic drugs. Used for fungal infections.
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| Fungi | Eukaryotes= similar in structure and metabolic function to human. Difference in steroid cell wall.
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| Are antibiotics useful for fungal infections? | Antibiotics useful for bacteria are not effective for fungal infections***
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| Superficial fungal infections | Fungal infections of skin and mucous membrane (athlete's foot). Ex. Candida, trichophyton.
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| Systemic Fungal infections | Candida, aspergilliosis, pneumoncystis. May require intensive and prolonged therapy. Drugs of choice: Amphotericin B (Fungizone, AmBisome). Fluconazole (Diflucan).
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| 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).
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| AmBisome | Amphotericin B combined with lipid. Less SE. Very expensive, use if can't tolerate regular preparation.
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| Nystatin | Oral, topical antifungal. Poorly absorbed from GI. Treats intestinal candida: Swish and swallow for oral candida to coat the oral membranes and esophagus.
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| Nystatin tx in immunosuppressed pts | Used as a prophylaxis for immunosuppressed (chemo pt) to prevent overgrowth of yeast
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| 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
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| 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****
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| 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****
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| 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
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| Bacitracin | Bacterial action- can cross blood brain barrier. Adverse reactions: renal dysfunction, blood dyscrasias, resp distress, allergic reactions (hives)
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| 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
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| Vancomycin for C. Difficile | Take orally b/c not absorbed from GI tract so treats local infection in intestine***
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| Vancomycin side effects | Nephrotoxicity** Ototoxicity**. Monitor drug levels
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| Red man Syndrome | Allergic reaction to Vancomycin but may be premedicated to decrease response***
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| Glycyclyclines | Synthetic analogs of the tetracyclines. Acts by blocking protein synthesis in bacterial cells. Bacteriostatic.
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| Glycyclyclines uses | Complicated skin infections. Intra-abdominal infection.
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| Tigercycline (Tygacil) | Given IV. SE: similar to tetracycline, photosensitivity, decreased oral contraceptive effectiveness
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| Nitrofurantoin (Furadantin) | Urinary Atiseptic. For UTI. Effective against gram+ and -. SE: GI upset, rash, pruritis, rust/brown urine, superinfection.
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| Urinary Tract infections (UTIs) | Acute cystitis, urethritis, prostatitis.
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| Common drug groups used to treat UTIs | Trimethoprim-sulfamethoxazole. Nitrofurantoin. Fluroquinolones (Cipro). Amoxicillin. Third generation cephalosporins.
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| 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
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| 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***.
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| 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).
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| Bethanechol | Urinary simulant. Cholinergic. Increase detrusor activity.
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