Antivirals
Acyclovir (Zovirax)

Inhibit viral DNA reproduction

H. zoster & H simplex

Oral, IV

Initial and recurrent episodes

Acyclovir (Zovirax)

Must be started asap

Reduces viral shedding

Decreases:

Symptoms

Severity

Duration

Antiretrovirals
Highly Active Antiretroviral Therapy (HAART)

Nucleoside Reverse Transcriptase Inhibitors

Non-Nucleoside Reverse Transcriptase Inhibitos

Protease Inhibitors

Monotherapy or 2 agents
is not recommended

Rapid development of resistance

Antiviral activity is inferior to combinations of 3 or more

NRTI
Zidovidine

Substitutes for thymidine

Inhibits reverse transciptase

Prevention

Slows progression

 

NRTI

Faulty version of building block

Without building block, HIV cannot copy

HIV uses NRTI=Viral replication is stalled

Adverse Effects

Bone marrow suppression

Anemia

Nuetropenia

Dose limiting effects

Non-nucleoside Reverse Transcriptase Inhibitors
Nivirapine (Viramune)

Treat advanced disease

Used for synergistic effect

Bind to and disable Reverse Transcriptase

Inhibit viral replication

Pg 586

Protease Inhibitor
Indinavir (Crixivan)

Pg 586

Drug interactions pg 587

PI’s disable protease

Virus is unable to make copies

St. Johns Wort

Used as an anti-depressant

Decreases blood levels of Protease Inhibitors

Decreases blood levels NNRTI’s

Recommendation for Newly Acquired Infections

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).  

Prevention

Reduces incidence 54-88%

12 month course of medication

Prevent progression to clinical disease

Treatment

Multi-drug regimen

Treatment
Isoniazid (INH)

Give with B6

Single daily dosing

Empty stomach if possible

6-9 months

Treatment
Rifampin

Reddish discoloration

Rifampin and INH in combination eliminate TB from sputum and produce clinical improvement

Take on empty stomach

Assess Adverse Effects

N & V & diarrhea

Neurotoxicity 8^th cranial nerve (575)

Hepatotoxicity

Hypersensitivity

Fungal Infections
 

Treatment of Fungal Infections
Candidiasis
·  Oral

Fungal Infections

Candidiasis

Vaginal discharge, itching, burning

Penile discharge, urinary frequency

 

 

Fungal Infections
    

Lesions of the Skin/Nails

·       Warm moist areas of the body

 

 

 

Fungal Infections
    

Lungs
·       Fever, malaise, cough
 

Prototype Drug for Fungus
Nystatin (Mycostatin)
 

Swish for several minutes THEN swallow

 

Nursing Assessment
Fungus
 

Obese people need teaching about skin protection
 

Nursing Actions 
Fungus

Universal Precautions

Nystatin (Mycostatin) 

Oral Hygiene

Nonacidic Foods

Soft bland food

Antiprotozoal & Antifungals

Amebiasis

Giardiasis NO

Malaria NO

Pneumocystosis NO

Toxoplasmosis NO

Trichomoniasis

Helminthiasis NO

Scabies and Pediculosis NO

Kills the amebia that causes intestinal and extraintestinal amebiasis

 

Kills the ameba that causes trichomoniasis

 

Determine exposure to parasite by history or lab report

Environment

Travel

Sex

 

Identify signs and symptoms

N/V

Diarrhea

Abdominal cramping

Weakness

 

Give Metronidazole(Flagyl) with food

Common side effects

N/V

Diarrhea

Observe for adverse effects especially neurological

Convulsions

Paresthesias

Vertigo

 

Patient Teaching Metronidazole (Flagyl)

Take Flagyl with or after meals

DO NOT drink Alcohol products

Cramps

Nausea

Vomiting

Headaches

flushing

Drug to Drug Interactions
Metronidazole (Flagyl)

Decrease effectiveness

Phenobarbital

Phenytoin

Increase effectiveness

Cimetidine (Tagamet)

Prevention

Clean environment

Travel precautions

Handwashing

Undercooked meat/fish

Condom use

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

 

 

A

Always Check Allergies prior to administering any medication!!

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

 

 

 

B

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

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

 

 

A

This is a potent antibiotic

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

 

 

 

 

 

C

Peaks are drawn After the medication is given.