Antivirals Acyclovir (Zovirax)

2. AntiviralsAcyclovir (Zovirax) • Inhibit viral DNA reproduction • H. zoster & H simplex • Oral, IV • Initial and recurrent episodes

3. Acyclovir (Zovirax) • Must be started asap • Reduces viral shedding • Decreases: • Symptoms • Severity • Duration

4. AntiretroviralsHighly Active Antiretroviral Therapy (HAART) • Nucleoside Reverse Transcriptase Inhibitors • Non-Nucleoside Reverse Transcriptase Inhibitos • Protease Inhibitors

5. Monotherapy or 2 agentsis not recommended • Rapid development of resistance • Antiviral activity is inferior to combinations of 3 or more

6. NRTIZidovidine • Substitutes for thymidine • Inhibits reverse transciptase • Prevention • Slows progression

8. NRTI • Faulty version of building block • Without building block, HIV cannot copy • HIV uses NRTI=Viral replication is stalled

9. AntiretroviralsHighly Active Antiretroviral Therapy (HAART) • Nucleoside Reverse Transcriptase Inhibitors • Non-Nucleoside Reverse Transcriptase Inhibitos • Protease Inhibitors

10. Monotherapy or 2 agentsis not recommended • Rapid development of resistance • Antiviral activity is inferior to combinations of 3 or more

11. NRTI • Faulty version of building block • Without building block, HIV cannot copy • HIV uses NRTI=Viral replication is stalled

12. Adverse Effects • Bone marrow suppression • Anemia • Nuetropenia • Dose limiting effects

13. Non-nucleoside Reverse Transcriptase InhibitorsNivirapine (Viramune) • Treat advanced disease • Used for synergistic effect • Bind to and disable Reverse Transcriptase • Inhibit viral replication • Pg 586

14. Protease InhibitorIndinavir (Crixivan) • Pg 586 • Drug interactions pg 587 • PI’s disable protease • Virus is unable to make copies

15. St. Johns Wort • Used as an anti-depressant • Decreases blood levels of Protease Inhibitors • Decreases blood levels NNRTI’s

16. Recommendation for Newly Acquired Infections

17. Anti-Tubercular Drugs The World Health Organization estimates that in the next decade 300 million more people will become infected, that 90 million people will develop the disease, and 30 million people will die from it. TB currently kills more adults each year than AIDS, malaria and tropical diseases combined, and almost 170,000 children (see the WHO Report on Global Tuberculosis Control).  

18. Prevention • Reduces incidence 54-88% • 12 month course of medication • Prevent progression to clinical disease

19. Multi-drug regimen Treatment

20. TreatmentIsoniazid (INH) • Give with B6 • Single daily dosing • Empty stomach if possible • 6-9 months

21. TreatmentRifampin • Reddish discoloration • Rifampin and INH in combination eliminate TB from sputum and produce clinical improvement • Take on empty stomach

22. Assess Adverse Effects • N & V & diarrhea • Neurotoxicity 8th cranial nerve (575) • Hepatotoxicity • Hypersensitivity

23. Fungal Infections Treatment of Fungal Infections Candidiasis·Oral

24. Fungal Infections • Candidiasis • Vaginal discharge, itching, burning • Penile discharge, urinary frequency

25. Fungal Infections Lesions of the Skin/Nails ·Warm moist areas of the body

26. Fungal Infections Lungs·Fever, malaise, cough

27. Prototype Drug for FungusNystatin (Mycostatin) • Swish for several minutes THEN swallow

28. Nursing AssessmentFungus • Obese people need teaching about skin protection

29. Nursing Actions Fungus • Universal Precautions • Nystatin (Mycostatin)  • Oral Hygiene • Nonacidic Foods • Soft bland food

30. Antiprotozoal & Antifungals • Amebiasis • Giardiasis NO • Malaria NO • Pneumocystosis NO • Toxoplasmosis NO • Trichomoniasis • Helminthiasis NO • Scabies and Pediculosis NO

31. AmebicidesMetronidazole (Flagyl) • Kills the amebia that causes intestinal and extraintestinal amebiasis

32. AmebicidesMetronidazole (Flagyl) • Kills the ameba that causes trichomoniasis

33. Nursing Assessment • Determine exposure to parasite by history or lab report • Environment • Travel • Sex

34. Nursing Assessment • Identify signs and symptoms • N/V • Diarrhea • Abdominal cramping • Weakness

35. NURSING INTERVENTIONS • Give Metronidazole(Flagyl) with food • Common side effects • N/V • Diarrhea • Observe for adverse effects especially neurological • Convulsions • Paresthesias • Vertigo

36. Patient Teaching Metronidazole (Flagyl) • Take Flagyl with or after meals • DO NOT drink Alcohol products • Cramps • Nausea • Vomiting • Headaches • flushing

37. Drug to Drug InteractionsMetronidazole (Flagyl) • Decrease effectiveness • Phenobarbital • Phenytoin • Increase effectiveness • Cimetidine (Tagamet)

38. Patient Teaching • Prevention • Clean environment • Travel precautions • Handwashing • Undercooked meat/fish • Condom use

39. Test Question You are going to give a client Amoxicillin clavulanate (Augmentin). Which of the following nursing interventions are most important? • Check allergies • Assess pain level • Observe respirations • Evaluate blood pressure

40. A Always Check Allergies prior to administering any medication!!

41. Test Question • You are about to give a client Cephalexin (Keflex). The client states he is allergic to penicillin. What is the appropriate nursing action? • Check all vital signs carefully • Hold drug until physician notified • Give drug after making an allergy bracelet • Tell client allergic responses will be assessed

42. B Speak to the physician and remind him/her of the allergy…sometimes there is a cross over between these drug families.

43. Test Question • Which of the following clients is most likely to be treated with Gentamicin (Garamycin)? • 56 yr old deep wound infection • 42 yr old neuromuscular disorder • 19 yr old chronic pain from auto accident • 91 yr old post op urinary tract infection

44. A This is a potent antibiotic

45. Test Question • You are told to do a peak blood level on a client who has been treated with Gentamicin (Garamycin). What nursing action is correct? • Hold medication until pulse rate is assessed • Assess blood pressure before giving medication • Run blood sample after medication is given • Draw blood immediately before medication is due

46. C Peaks are drawn After the medication is given.