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AntiinfectiveagentsChapters37,38,39&41AntiinfectiveagentsChapters1Antibiotics:DefinitionMedicationsusedtotreatbacterialinfectionsIdeally,beforebeginningantibiotictherapy,thesuspectedareasofinfectionshouldbeculturedtoidentifythecausativeorganismandpotentialantibioticsusceptibilitiesAntibiotics:DefinitionMedicat2Antibiotics:ClassesSulfonamidesPenicillins CephalosporinsTetracyclinesMacrolidesAminoglycosidesQuinolonesAntibiotics:ClassesSulfonami3Figure37-1Bacterialmorphologies.(FromMurray,P.R.,Rosenthal,K.S.,Kobayashi,G.S.,&Pfaller,M.A.(2002).Medicalmicrobiology.St.Louis,MO:Mosby.)Figure37-1Bacterialmorpholo4Figure37-3Gram-stainmorphologyofbacteria.ThecrystalvioletofGramstainisprecipitatedbyGramiodineandistrappedinthethickpeptidoglycanlayeringram-positivebacteria.Thedecolorizerdispersesthegram-negativeoutermembraneandwashesthecrystalvioletfromthethinlayerofpeptidoglycan.Gram-negativebacteriaarevisualizedbytheredcounterstain.(FromMurray,P.R.,Rosenthal,K.S.,Kobayashi,G.S.,&Pfaller,M.A.(2002).Medicalmicrobiology.St.Louis,MO:Mosby.)Figure37-3Gram-stainmorphol5Figure37-4Gram-positiveandgram-negativebacteria.Agram-positivebacteriumhasathicklayerofpeptidoglycan(left).Agram-negativebacteriumhasathinpeptidoglycanlayerandanoutermembrane(right).Structuresinparenthesesarenotfoundinallbacteria.(FromMurray,P.R.,Rosenthal,K.S.,Kobayashi,G.S.,&Pfaller,M.A.(2002).Medicalmicrobiology.St.Louis,MO:Mosby.)Figure37-4Gram-positiveand6AntibioticTherapyEmpirictherapy:treatmentofaninfectionbeforespecificcultureinformationhasbeenreportedorobtainedProphylactictherapy:treatmentwithantibioticstopreventaninfection,asinintraabdominalsurgeryAntibioticTherapyEmpiricther7AntibioticTherapy(cont’d)TherapeuticresponseDecreaseinspecificsignsandsymptomsofinfectionarenoted(fever,elevatedWBC,redness,inflammation,drainage,pain)SubtherapeuticresponseSignsandsymptomsofinfectiondonotimproveAntibioticTherapy(cont’d)The8AntibioticTherapy(cont’d)FourcommonmechanismsofactionInterferencewithcellwallsynthesisInterferencewithproteinsynthesisInterferencewithDNAreplicationActingasametabolitetodisruptcriticalmetabolicreactionsinsidethebacterialcellAntibioticTherapy(cont’d)Fou9ActionsofAntibioticsBactericidal:killbacteriaBacteriostatic:inhibitgrowthofsusceptiblebacteria,ratherthankillingthemimmediately;willeventuallyleadtobacterialdeathActionsofAntibioticsBacteric10Antibiotics:SulfonamidesOneofthefirstgroupsofantibioticssulfadiazineSulfamethoxazole(Bactrim)sulfisoxazoleAntibiotics:SulfonamidesOneo11Sulfonamides:

MechanismofActionBacteriostaticactionPreventsynthesisoffolicacidrequiredforsynthesisofpurinesandnucleicacidDonotaffecthumancellsorcertainbacteria—theycanusepreformedfolicacidSulfonamides:

MechanismofA12Sulfonamides:IndicationsTreatmentofUTIscausedbysusceptiblestrainsof:Enterobacterspp.,Escherichiacoli,Klebsiellaspp.,Proteusmirabilis,Proteusvulgaris,StaphylococcusaureusNocardiosisPneumocystiscariniipneumonia(PCP)UpperrespiratorytractinfectionsOtherusesSulfonamides:IndicationsTreat13Sulfonamides:

CombinationProductstrimethoprim/sulfamethoxazoleUsedtotreatUTIs,PCP,otitismedia,otherconditionserythromycin/sulfisoxazoleUsedtotreatotitismediasulfisoxazoleUsedtotreatotitismedia,UTIs,otherconditionsSulfonamides:

CombinationProd14Beta-LactamAntibioticsPenicillinsCephalosporinsCarbapenemsMonobactamsBeta-LactamAntibioticsPenicil15PenicillinsNaturalpenicillinsPenicillinase-resistantpenicillinsAminopenicillinsExtended-spectrumpenicillinsPenicillinsNaturalpenicillins16Penicillins(cont’d)NaturalpenicillinspenicillinG,penicillinVpotassiumPenicillinase-resistantpenicillinsCloxacillinAminopenicillinsamoxicillin,ampicillin,pivamicillinAnti-pseudomonalpenicillins

piperacillinsodium Penicillins(cont’d)Naturalpe17Penicillins(cont’d)Firstintroducedinthe1940sBactericidal:inhibitcellwallsynthesisKillawidevarietyofbacteriaAlsocalled“beta-lactams”Penicillins(cont’d)Firstintr18Penicillins(cont’d)BacteriaproduceenzymescapableofdestroyingpenicillinsTheseenzymesareknownas

beta-lactamasesAsaresult,themedicationisnoteffectivePenicillins(cont’d)Bacteriap19Penicillins(cont’d)Chemicalshavebeendevelopedtoinhibittheseenzymes:Clavulanicacid(Clavulin)TazobactamSulbactamThesechemicalsbindwithbeta-lactamaseandpreventtheenzymefrombreakingdownthepenicillinPenicillins(cont’d)Chemicals20Penicillins:

MechanismofActionPenicillinsenterthebacteriaviathecellwallInsidethecelltheybindtopenicillin-bindingproteinOncebound,normalcellwallsynthesisisdisruptedResult:bacteriacellsdiefromcelllysisPenicillinsdonotkillothercellsinthebodyPenicillins:

MechanismofAc21Penicillins:IndicationsPreventionandtreatmentofinfectionscausedbysusceptiblebacteria,suchas:Gram-positivebacteriaStreptococcus,Enterococcus,Staphylococcusspp.Penicillins:IndicationsPreven22Penicillins:AdverseEffectsAllergicreactionsoccurin0.7%to8%ofcasesUrticaria,pruritus,angioedema10%ofallergicreactionsarelifethreatening10%ofthesearefatalPenicillins:AdverseEffectsAl23Penicillins:SideEffectsCommonsideeffectsNausea,vomiting,diarrhea,abdominalpainOthersideeffectsarelesscommonPenicillins:SideEffectsCommo24CephalosporinsFirstgenerationSecondgenerationThirdgenerationFourthgenerationCephalosporinsFirstgeneration25Cephalosporins(cont’d)SemisyntheticderivativesfromafungusStructurallyandpharmacologicallyrelatedtopenicillinsBactericidalactionBroadspectrumDividedintogroupsaccordingtotheirantimicrobialactivityCephalosporins(cont’d)Semisyn26Cephalosporins:FirstGeneration cephalexin(Keflex) cefazolin(Ancef) cefadroxil(Duricef)Goodgram-positivecoveragePoorgram-negativecoverageCephalosporins:FirstGenerati27Cephalosporins:

FirstGeneration(cont’d)Usedforsurgicalprophylaxis,URIs,otitismediacefazoline:IVorPO(Ancef)cephalexin:PO(Keflex)Cephalosporins:

FirstGenerat28Cephalosporins:

SecondGenerationGoodgram-positivecoverageBettergram-negativecoveragethanfirstgenerationcefaclorcefprozilcefoxitincefuroximecefotetan

Cephalosporins:

SecondGener29Cephalosporins:

SecondGeneration(cont’d)cefoxitin:IVandIMUsedprophylacticallyforabdominalorcolorectalsurgeriesAlsokillsanaerobescefuroxime:POSurgicalprophylaxisDoesnotkillanaerobesCephalosporins:

SecondGener30Cephalosporins:

ThirdGenerationMostpotentgroupagainstgram-negativeLessactiveagainstgram-positivecefiximecefotaximeceftizoximeceftriaxoneceftazidimeCephalosporins:

ThirdGenera31Cephalosporins:

ThirdGeneration(cont’d)cefiximeOnlyoralthird-generationagentBestofavailableoralcephalosporinsagainstgram-negativeTabletandsuspensionceftriaxoneIVandIM,longhalf-life,once-a-dayadministrationEasilypassesmeningesanddiffusedintoCSFtotreatCNSinfectionsCephalosporins:

ThirdGenera32Cephalosporins:

FourthGenerationcefepimeNewestcephalosporinagentsBroaderspectrumofantibacterialactivitythanthirdgeneration,especiallyagainstgram-positivebacteriaCephalosporins:

FourthGener33Cephalosporins:SideEffectsSimilartopenicillinsCephalosporins:SideEffectsSi34MacrolideserythromycinazithromycinclarithromycinMacrolideserythromycin35Macrolides:

MechanismofActionPreventproteinsynthesiswithinbacterialcellsBacteriawilleventuallydieMacrolides:

MechanismofActio36Macrolides:IndicationsStrepinfectionsStreptococcuspyogenes

(groupAbeta-hemolyticstreptococci)MildtomoderateURIHaemophilusinfluenzaeSpirochetalinfectionsSyphilisandLymediseaseGonorrhea,Chlamydia,MycoplasmaMacrolides:IndicationsStrepi37Macrolides:SideEffectsGIeffects,primarilywitherythromycinNausea,vomiting,diarrhea,hepatotoxicity,flatulence,jaundice,anorexiaNeweragents,azithromycinandclarithromycin:fewersideeffects,longerdurationofaction,betterefficacy,bettertissuepenetrationMacrolides:SideEffectsGIeff38TetracyclinesdemeclocyclineoxytetracyclinetetracyclinedoxycyclineminocyclineTetracyclinesdemeclocycline39Tetracyclines(cont’d)NaturalandsemisyntheticObtainedfromculturesofStreptomycesBacteriostatic—inhibitbacterialgrowthInhibitproteinsynthesisStopmanyessentialfunctionsofthebacteriaTetracyclines(cont’d)Natural40Tetracyclines(cont’d)BindtoCa2+andMg2+andAl3+ionstoforminsolublecomplexesThus,dairyproducts,antacids,andiron

saltsreduceabsorptionoftetracyclinesTetracyclines(cont’d)Bindto41Tetracyclines:IndicationsWidespectrumGram-negative,gram-positive,protozoa,Mycoplasma,Rickettsia,Chlamydia,syphilis,LymediseasedemeclocyclineisalsousedtotreatSIADH,andpleuralandpericardialeffusionsTetracyclines:IndicationsWide42Tetracyclines:SideEffectsStrongaffinityforcalciumDiscolorationofpermanentteethandtoothenamelinfetusesandchildrenMayretardfetalskeletaldevelopmentiftakenduringpregnancyTetracyclines:SideEffectsStr43Tetracyclines:SideEffects(cont’d)Alterationinintestinalfloramayresultin:Superinfection(overgrowthofnonsusceptibleorganismssuchasCandida)DiarrheaPseudomembranouscolitisTetracyclines:SideEffects(c44Tetracyclines:SideEffects(cont’d)Mayalsocause:VaginalmoniliasisGastricupsetEnterocolitisMaculopapularrashTetracyclines:SideEffects(c45AminoglycosidesgentamicinneomycinstreptomycintobramycinamikacinAminoglycosidesgentamicin46Aminoglycosides(cont’d)NaturalandsemisyntheticProducedfromStreptomycesPoororalabsorption;noPOformsPotentantibioticswithserioustoxicitiesBactericidal;preventsproteinsynthesisKillmostlygram-negative;some

gram-positivealsoAminoglycosides(cont’d)Natura47Aminoglycosides:IndicationsUsedtokillgram-negativebacteriasuchasPseudomonasspp.,E.coli,Proteusspp.,Klebsiellaspp.,Serratiaspp.OftenusedincombinationwithotherantibioticsforsynergisticeffectAminoglycosides:IndicationsUs48Aminoglycosides:

Indications(cont’d)AllaminoglycosidesarepoorlyabsorbedthroughtheGItract,andgivenparenterallyException:neomycinGivenorallytodecontaminatetheGItractbeforesurgicalproceduresAlsousedasanenemaforthispurposeAminoglycosides:

Indications49Aminoglycosides:AgentsThreemostcommon(systemic):gentamicin,tobramycin,amikacinCauseserioustoxicitiesNephrotoxicity(renalfailure)Ototoxicity(auditoryimpairmentandvestibular[eighthcranialnerve])MustmonitordruglevelstopreventtoxicitiesAminoglycosides:AgentsThreem50Aminoglycosides:SideEffectsOtotoxicityandnephrotoxicityarethemostsignificantHeadacheParesthesiaNeuromuscularblockadeDizziness

VertigoSkinrashFeverSuperinfectionsAminoglycosides:SideEffectsO51QuinolonesciprofloxacinnorfloxacinofloxacinlevofloxacingatifloxacinQuinolonesciprofloxacin52Quinolones(cont’d)ExcellentoralabsorptionAbsorptionreducedbyantacidsFirstoralantibioticseffectiveagainst

gram-negativebacteriaQuinolones(cont’d)Excellento53Quinolones:

MechanismofActionBactericidalEffectiveagainstgram-negativeorganismsandsomegram-positiveorganismsAlterDNAofbacteria,causingdeathDonotaffecthumanDNAQuinolones:

MechanismofAct54Quinolones:IndicationsLowerrespiratorytractinfectionsBoneandjointinfectionsInfectiousdiarrheaUrinarytractinfectionsSkininfectionsSexuallytransmitteddiseasesAnthraxQuinolones:IndicationsLowerr55Quinolones:IndicationsLowerrespiratorytractinfectionsBoneandjointinfectionsInfectiousdiarrheaUrinarytractinfectionsSkininfectionsSexuallytransmitteddiseasesAnthraxQuinolones:IndicationsLowerr56Quinolones:SideEffectsBodySystem

EffectsCNS Headache,dizziness, fatigue, depression,restlessnessGI Nausea,vomiting, diarrhea,constipation, thrush, increasedliverfunction studiesQuinolones:SideEffectsBodyS57Quinolones:SideEffects(cont’d)BodySystem

EffectsIntegumentary Rash,pruritus,urticaria, flushing,photosensitivity (withlomefloxacin)Other Fever,chills,blurred vision, tinnitusQuinolones:SideEffects(cont58OtherAntibioticsclindamycin(MRSA)Metronidazole(anaerobes)nitrofurantoin(uncomplicatedUTI)OtherAntibioticsclindamycin(59OtherAntibiotics(cont’d)vancomycinNatural,bactericidalantibioticDestroyscellwallTreatmentofchoiceforMRSA,andothergram-positiveinfectionsMustmonitorbloodlevelstoensuretherapeuticlevelsandpreventtoxicityMaycauseototoxicityandnephrotoxicityOtherAntibiotics(cont’d)vanc60OtherAntibiotics(cont’d)vancomycin(cont’d)Shouldbeinfusedover60minutesMonitorIVsitecloselyRedman’ssyndromemayoccurDecreasedBP,flushingofneckandfaceAntihistaminemaybeorderedtoreducetheseeffectsEnsureadequatehydration(2Lfluids/ 24hr)ifnotcontraindicatedtopreventnephrotoxicityOtherAntibiotics(cont’d)vanc61Antibiotics:NursingImplicationsBeforebeginningtherapy,assessdrugallergies;hepatic,liver,andcardiacfunction;andotherlabstudiesBesuretoobtainthoroughclienthealthhistory,includingimmunestatusAssessforconditionsthatmaybecontraindicationstoantibioticuseorthatmayindicatecautioususeAssessforpotentialdruginteractionsAntibiotics:NursingImplicati62NursingImplicationsItisrecommendedtoobtainculturesfromappropriatesitesBEFOREbeginningantibiotictherapyNursingImplications63NursingImplications(cont’d)Clientsshouldbeinstructedtotakeantibioticsexactlyasprescribedandforthelengthoftimeprescribed;theyshouldnotstoptakingthemedicationearlywhentheyfeelbetterAssessforsignsandsymptomsofsuperinfection:fever,perinealitching,cough,lethargy,oranyunusualdischargeNursingImplications(cont’d)C64NursingImplications(cont’d)Forsafetyreasons,checkthenameofthemedicationcarefullybecausetherearemanyagentsthatsoundalikeorhavesimilarspellingsNursingImplications(cont’d)F65NursingImplications(cont’d)EachclassofantibioticshasspecificsideeffectsanddruginteractionsthatmustbecarefullyassessedandmonitoredThemostcommonsideeffectsofantibioticsarenausea,vomiting,anddiarrheaAlloralantibioticsareabsorbedbetteriftakenwithatleast180to240mLofwaterNursingImplications(cont’d)66NursingImplications(cont’d)EachclassofantibioticshasspecificsideeffectsanddruginteractionsthatmustbecarefullyassessedandmonitoredThemostcommonsideeffectsofantibioticsarenausea,vomiting,anddiarrheaAlloralantibioticsareabsorbedbetteriftakenwithatleast180to240mLofwaterNursingImplications(cont’d)67NursingImplications(cont’d)EachclassofantibioticshasspecificsideeffectsanddruginteractionsthatmustbecarefullyassessedandmonitoredThemostcommonsideeffectsofantibioticsarenausea,vomiting,anddiarrheaAlloralantibioticsareabsorbedbetteriftakenwithatleast180to240mLofwaterNursingImplications(cont’d)68NursingImplications(cont’d)SulfonamidesShouldbetakenwithatleast2000mLoffluidperday,unlesscontraindicatedDuetophotosensitivity,avoidsunlightand

tanningbedsTheseagentsreducetheeffectivenessof

oralcontraceptivesOralformsshouldbetakenwithfoodormilktoreduceGIupsetNursingImplications(cont’d)S69NursingImplications(cont’d)PenicillinsAnyclienttakingapenicillinshouldbecarefullymonitoredforanallergicreactionforatleast30minutesafteritsadministrationTheeffectivenessoforalpenicillinsisdecreasedwhentakenwithcaffeine,citrusfruit,colabeverages,fruitjuices,ortomatojuiceNursingImplications(cont’d)P70NursingImplications(cont’d)CephalosporinsOrallyadministeredformsshouldbegivenwithfoodtodecreaseGIupset,eventhoughthiswilldelayabsorptionSomeoftheseagentsmaycauseadisulfiram-likereactionwhentakenwithalcoholNursingImplications(cont’d)C71NursingImplications(cont’d)MacrolidesTheseagentsarehighlyprotein-boundandwillcausesevereinteractionswithotherprotein-bounddrugsTheabsorptionoforalerythromycinisenhancedwhentakenonanemptystomach,butbecauseofthehighincidenceofGIupset,manyagentsaretakenafteramealorsnackNursingImplications(cont’d)M72NursingImplications(cont’d)TetracyclinesMilkproducts,ironpreparations,antacids,andotherdairyproductsshouldbeavoidedbecauseofthechelationanddrug-bindingthatoccursAllmedicationsshouldbetakenwith180to240mLoffluid,preferablywaterDuetophotosensitivity,avoidsunlightand

tanningbedsNursingImplications(cont’d)T73NursingImplications(cont’d)AminoglycosidesMonitorpeakandtroughbloodlevelsoftheseagentstopreventnephrotoxicityandototoxicitySymptomsofototoxicityincludedizziness,tinnitus,andhearinglossSymptomsofnephrotoxicityincludeurinarycasts,proteinuria,andincreasedBUNandserumcreatininelevelsNursingImplications(cont’d)A74NursingImplications(cont’d)QuinolonesShouldbetakenwithatleast3Loffluidperday,unlessotherwisespecifiedIntakeofalkalinefoodsanddrugs,suchasantacids,dairyproducts,peanuts,andsodiumbicarbonateshouldbelimited NursingImplications(cont’d)Q75UnderstandingVirusesViralreplicationAviruscannotreplicateonitsownItmustattachtoandenterahostcellItthenusesthehostcell’senergytosynthesizeprotein,DNA,andRNAUnderstandingVirusesViralrep76Figure38-1Virusreplication.Somevirusesintegrateintohostchromosomeswithdevelopmentoflatency.(ModifiedfromBrody,T.M.,Larner,J.,&Minneman,K.P.(1998).Humanpharmacology:moleculartoclinical(3rded.).St.Louis,MO:Mosby.)Figure38-1Virusreplication.77UnderstandingViruses(cont’d)Virusesaredifficulttokillbecausetheyliveinsidehumancells Anydrugthatkillsavirusmayalsokill humancellsUnderstandingViruses(cont’d)78ViralInfectionsCompetentimmunesystem:BestresponsetoviralinfectionsAwell-functioningimmunesystemwilleliminateoreffectivelydestroyvirusreplication

ViralInfectionsCompetentimmu79ViralInfections(cont’d)Immunocompromisedclientshavefrequentviralinfections Cancerclients,especiallyleukemiaor lymphoma Transplantclients,duetopharmacological therapy AIDSclients,diseaseattacksimmunesystemViralInfections(cont’d)Immun80AntiviralsViruseskilledbycurrentantiviraltherapyCytomegalovirus(CMV)HepatitisvirusesHerpesvirusesHumanimmunodeficiencyvirus(HIV)Influenzaviruses(the“flu”)Respiratorysyncytialvirus(RSV) AntiviralsViruseskilledbycu81Antivirals(cont’d)KeycharacteristicsofantiviraldrugsAbletoenterthecellsinfectedwithvirusInterferewithviralnucleicacidsynthesisand/orregulationSomeagentsinterferewithabilityofvirus

tobindtocellsSomeagentsstimulatethebody’simmunesystemAntivirals(cont’d)Keycharact82AntiviralMedicationsAntiviralagentsUsedtotreatinfectionscausedbyvirusesotherthanHIVAntiretroviralagentsUsedtotreatinfectionscausedbyHIV,thevirusthatcausesAIDSAntiviralMedicationsAntiviral83AntiviralAgents:NonretroviralMechanismofactionInhibitviralreplicationUsedtotreatnon-HIVviralinfectionsInfluenzavirusesHSV,VZV(anotherherpesvirus)CMVHepatitisA,B,C(HAV,HBV,HCV)AntiviralAgents:Nonretrovira84HIVHumanimmunodeficiencyvirusinfectionELISA(enzyme-linkedimmunosorbentassay)DetectsHIVexposurebasedonpresenceofhumanantibodiestothevirusinthebloodRetrovirusTransmittedby:Sexualactivity,intravenousdruguse,perinatallyfrommothertochildHIVHumanimmunodeficiencyviru85NaturalHistoryofHIVInfectionPrimaryacuteinfectionAsymptomaticinfectionEarlysymptomaticinfectionAdvancedimmunodeficiencywithopportunisticcomplicationsNaturalHistoryofHIVInfecti86OpportunisticInfectionsProtozoalToxoplasmosisofthebrain,othersFungalCandidiasisofthelungs,esophagus,tracheaPCP,othersViralCMVdisease,HSVinfection,othersOpportunisticInfectionsProtoz87OpportunisticInfections(cont’d)BacterialVariousmycobacterialinfections,othersOpportunisticneoplasiasKaposi’ssarcoma,othersOthersOpportunisticInfections(cont88AntiretroviralAgents(cont’d)Reversetranscriptaseinhibitors(RTIs)Blockactivityoftheenzymereversetranscriptase,preventingproductionofnewviralDNAProteaseinhibitors(PIs)Inhibittheproteaseretroviralenzyme,preventingviralreplicationFusioninhibitorsInhibitviralfusion,preventingviralreplicationAntiretroviralAgents(cont’d)89AntiretroviralAgents:

SideEffectsNumerousandvarywitheachagentDrugtherapymayneedtobemodifiedbecauseofsideeffectsGoalistofindtheregimenthatwillbestcontroltheinfectionwithatolerablesideeffectprofileMedicationregimenschangeduringthecourseoftheillnessAntiretroviralAgents:

SideEf90Antivirals:NursingImplicationsBeforebeginningtherapy,thoroughly

assessunderlyingdiseaseandmedicalhistory,includingallergiesAssessbaselineVSandnutritionalstatusAssessforcontraindications,conditions

thatmayindicatecautioususe,andpotentialdruginteractionsAntivirals:NursingImplicatio91NursingImplicationsBesuretoteachproperapplicationtechniqueforointments,aerosolpowders,etc.EmphasizehandwashingbeforeandafteradministrationofmedicationstopreventsitecontaminationandspreadofinfectionClientsshouldwearagloveorfingercotwhenapplyingointmentsorsolutionstoaffectedareasNursingImplicationsBesureto92NursingImplications(cont’d)Instructclientstoconsulttheirphysicianbeforetakinganyothermedication,includingOTCsEmphasizetheimportanceofgoodhygieneInformclientsthatantiviralagentsarenotcuresbutdohelptomanagesymptomsNursingImplications(cont’d)I93NursingImplications(cont’d)InstructclientsontheimportanceoftakingthesemedicationsexactlyasprescribedandforthefullcourseoftreatmentMonitorforsideeffectsEffectsarevariedandspecifictoeachagentNursingImplications(cont’d)I94NursingImplications(cont’d)MonitorfortherapeuticeffectsEffectswillvarydependingonthetypeofviralinfectionEffectsrangefromdelayedprogressionofAIDSandARCtodecreaseinflulikesymptoms,decreasedfrequencyofherpes-likeflare-ups,orcrustingoverofherpeticlesionsNursingImplications(cont’d)M95AntituberculousAgentsTuberculosis(TB)CausedbyMycobacteriumtuberculosisAntituberculousagentstreatallformsofMycobacteriumAntituberculousAgentsTubercul96TuberculosisTuberculosis(abbreviatedasTBforTubercleBacillusisacommonanddeadlyinfectiousdiseasecausedbythemycobacteriumtuberculosisSymptomsincludeaproductive,prolongedcoughofmorethanthreeweeksduration,chestpain,andcoughingupblood.Systemicsymptomsincludefever,chills,nightsweats,appetiteloss,weightloss,paling,andthoseafflictedareofteneasilyfatiguedTuberculosisTuberculosis(abbr97MycobacteriumInfectionsCommoninfectionsitesLung(primarysite)BrainBoneLiverKidneyMycobacteriumInfectionsCommon98MycobacteriumInfections(cont’d)AerobicbacillusPassedfrominfected:HumansCows(bovine)Birds(avian)MycobacteriumInfections(cont99MycobacteriumInfections(cont’d)TuberclebacilliareconveyedbydropletsDropletsareexpelledbycoughingorsneezing,thengainentryintothebodybyinhalationTuberclebacillithenspreadtootherbodyorgansviabloodandlymphaticsystemsTuberclebacillimaybecomedormant,orwalledoffbycalcifiedorfibroustissueMycobacteriumInfections(cont100AntituberculousAgentsFirst-LineAgentsisoniazid*INHethambutolpyrazinamide(PZA)rifampinstreptomycin*MostfrequentlyusedSecond-LineAgentscapreomycincycloserineethionamidekanamycinpara-aminosalicyclicacid(PAS)AntituberculousAgentsFirst-Li101MechanismofActionThreegroupsProteinwallsynthesisinhibitors(streptomycin,kanamycin,capreomycin,rifampin,rifabutin)Cellwallsynthesisinhibitors(cycloserine,ethionamide,isoniazid)OthermechanismsofactionMechanismofActionThreegroup102Isoniazid(INH)DrugofchoiceforTBResistantstrainsofMycobacteriumemergingMetabolizedintheliverthroughacetylation—watchfor“slowacetylators”UsedaloneorincombinationwithotheragentsIsoniazid(INH)Drugofchoice103IndicationsUsedfortheprophylaxisortreatmentofTBIndicationsUsedfortheprophy104AntituberculousTherapyEffectivenessdependsupon:TypeofinfectionAdequatedosingSufficientdurationoftreatmentDrugcomplianceSelectionofaneffectivedrugcombinationAntituberculousTherapyEffecti105AntituberculousTherapy(cont’d)ProblemsDrug-resistantorganismsDrugtoxicityClientnoncomplianceAntituberculousTherapy(cont’106SideEffectsINH

–Peripheralneuritis,hepatotoxicityEthambutol

–Retrobulbarneuritis,blindnessRifampin

–Hepatitis,discolorationofurine,stoolsSideEffectsINH

–Peripheraln107NursingImplicationsObtainathoroughmedicalhistoryandassessmentPerformliverfunctionstudiesinclients

whoaretoreceiveisoniazidorrifampin

(especiallyinelderlyclientsorthosewhousealcoholdaily)Assessforcontraindicationstothevariousagents,conditionsforcautioususe,andpotentialdruginteractionsNursingImplicationsObtainat108NursingImplications(cont’d)ClienteducationiscriticalTherapymaylastforupto24monthsTakemedicationsexactlyasordered,

atthesametimeeverydayEmphasizetheimportanceofstrictcompliancetoregimenforimprovementofconditionorcureNursingImplications(cont’d)C109NursingImplications(cont’d)Clienteducationiscritical(cont’d)Remindclientsthattheyarecontagiousduringtheinitialperiodoftheirillness—instructinproperhygieneandpreventionofthespreadofinfecteddropletsEmphasizetoclientstotakecareofthemselves,inc

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