Transcript Ch. 34-Drugs Used to Treat Infectionsx

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microorganism (microbe): small living plant or animal,
only seen with microscope, they are everywhere
some are harmful and cause infections, these are called
pathogens
non-pathogens usually do NOT cause infection
normal flora: microbes that live and grow in a certain
area (ie: certain microbes are in intestines others are
on skin)
they are non-pathogens when they are in/on a natural
reservoir.
when a non-pathogen is transmitted from its natural site
to another site or host, it becomes a pathogen (ie:
Escherichia coli, E. Coli, is found in colon, if enters
urinary system an infection can occur)
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immune system protects the body from disease and
infection (box 34-1 p. 4o5, The Immune System:
Structure and Function)
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infection: a disease state resulting from the invasion and
growth of microbes in the body
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local infection: is in a body part
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systemic infection: involves whole body
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signs/symptoms of infection listed in box 34-2 p. 406
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see box 34-2 on pg. 406 for Common Infections
Focus on Older Persons:
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changes occur in immune system with aging
when older person has an infection they may not show signs
and symptoms listed in box 34-2
person may have only slight fever, or no fever at all
redness, swelling may be very slight, person may not complain
of pain. Confusion and delirium may occur
an infection can become life-threatening before older person
has obvious sign/symptoms
you must be alert to the most minor changes in a person’s
behavior or condition
report any concerns to nurse at once
older persons are at risk for infection
healing takes longer than in younger persons, therefore
rehabilitation can take longer
the person’s independence and quality of life are affected
Anti-Microbial Agents
anti-microbial agents: chemicals that eliminate
pathogens
 antibiotics: anti-microbials, derived from living organisms
ie: penicillin was first derived from mold
 most antibiotics are harvested from large colonies of
microbes
 they are purified and chemically modified into semisynthetic anti-microbial agents
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anti-microbials are classified according to
type of pathogen to be destroyed:
› bacteria- anti-bacterial agents: bacteria are one-
celled plant life that multiply rapidly, often called
germs, to classify them they are stained
 gram-negative bacteria: have pink color when stained
 gram-positive bacteria: have violet color when stained
› fungi- anti-fungal agents: fungi are plants that live
on other plants/animals. Mushrooms, yeast and
molds are common fungi. Than can infect mouth,
vagina, skin, feet and other areas
› viruses- anti-viral agents: viruses are microbes that
grow in living cells, they cause many diseases. The
common cold, herpes, AIDS and hepatitis are
examples
anti-bacterials are further classified into drug
classes, ie: penicillins, tetracyclines
 anti-bacterial ordered depends on pathogen
present
 goal of anti-microbial therapy is to eliminate
the infection, sometimes secondary
infections develop
 secondary infection: caused by a microbe
that follows the first infection, they first
infection was caused by a different
microbe
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Delegation Guidelines
Anti-Microbial Agents:
Some drugs used to treat infections are given
parenterally- by intramuscular or intravenous
injection. Because you do NOT give such dose
forms, they are NOT included in this chapter.
Should a nurse delegate the administration of
such to you, you must:
- remember that parenteral dosages are often
very different from dosages other routes
-Refuse the delegation. Make sure to explain
why. Do NOT just ignore the request. Make sure
the nurse knows that you cannot give drug and
why
Promoting Safety and Comfort
Anti-microbial Agents:
safety
-always check for allergies any time you give an anti-microbial, closely
observe all persons for allergic reaction to drug. Persons with history of
allergies, asthma or rhinitis are at risk, so are persons taking many drugs
-everyone should be observed carefully for at least the first 20-30 minutes
after drug is given. Some reactions may NOT occur for several days.
Should a reaction occur tell nurse immediately, do not give next dose
until nurse directs you to
-a serious allergic reaction may occur with first dose, repeated exposures
can be life-threatening. Notify nurse if person shows any signs of allergic
reaction:
- swelling, redness or pain at injection site
- hives
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-rash
-wheezing
-nausea
-fever
-itching
-nasal congestion
-severe respiratory distress
-dyspnea
-vomiting
-diarrhea
-malaise
-follow nurses directions, you may be asked to:
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activate agency’s rapid response team
bring the emergency cart (crash cart) to persons bedside
provide CPR
comfort - anti-microbials are given at regular intervals to maintain blood
levels of drug. Ie: drug given every 6 hours, you may have to wake
person to give the dose
Drug Class: Amino-Glycosides:
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antibiotics that kill bacteria by inhibiting protein synthesis
used against gram-negative microbes that cause the
following:
› UTIs (ch 30)
› meningitis- infection/inflammation of membranes covering spinal
cord
› wound infections
› septicemia- systemic infection in which pathogens are present in
blood, can be caused by spread of infection from any body part
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most drugs in this class are given IM or IV
neomycin (Neo-Fradin) is given orally
Assisting With the Nursing Process
neomycin (Neo-Fradin):
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output, observe for hearing loss
PLANNING: oral dose forms: 500mg tablets or 125mg/5mL
bottle
IMPLEMENTATION: usually adult oral dose: 4-12g daily in 4
divided doses
EVALUATION: report and record:
 dizziness, tinnitus(ringing in ears), signs of hearing loss:
drug can cause hearing damage
 decreasing urinary output, bloody or smoky-colored
urine: these signal kidney toxicity
 see Promoting Safety and Comfort: anti-microbial agents
Drug Class: Cephalo-Sporins:
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inhibit cell wall synthesis in bacteria
drugs are related to penicillins
may be used for persons allergic to penicillins
used for:
› UTIs
› respiratory tract infections
› abdominal infections
› bacteremia ( presence of bacteria in blood)
› meningitis
› osteo-myelitis (infection of bone and bone marrow)
Assisting With the Nursing Process
cephalo-sporins:
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output
PLANNING: see table 34-1 (pg. 410) for “oral dose forms”
IMPLEMENTATION: see table 34-1 (pg. 410) “Adult Dosage Range”
EVALUATION: report and record:
 diarrhea: normal flora of GI are altered, observe
signs/symptoms of dehydration if diarrhea is severe or does not
resolve
 genital/anal itching, vaginal discharge, thrush (fungal infection
of mouth): signals secondary infections, remind person of need
for good oral and personal hygiene
 bleeding, easy bruising, bleeding gums, nosebleeds: signal
changes in platelets
 changes in alertness and orientation to persons, time and
place, confusion, muscle cramps, nausea: may signal
electrolyte imbalance
 see promoting safety and comfort: anti-microbial agents p.
409
Drug Class: Ketolides:
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prevents bacteria from synthesizing new proteins
used to treat:
› acute bacterial sinusitis
› bronchitis
› pneumonia
Assisting With the Nursing Process
telithromycin (Ketek):
ASSESSMENT: ask about signs/symptoms, measure vital signs, measure
intake/output, ask about GI symptoms, ask about vision problems
PLANNING: oral dose forms 300 and 400mg tablets
IMPLEMENTATION: usual dose is 800mg daily for 5, 7, 10 days, length
depends on infection.
EVALUATION: report and record:
 diarrhea, nausea, vomiting: most common side effects, usually mild
and tend to resolve
 dizziness: tends to resolve, provide for safety
 blurred vision, difficulty focusing, double vision: may occur after 1st or
2nd dose, may last for several hours, provide for safety
 see promoting safety and comfort: anti-microbial agents, p. 409
Drug Class: Macrolides:
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inhibit protein synthesis in susceptible bacteria
kill bacteria or prevent bacteria from multiplying
often used when drugs in other classes can’t be used
used for:
› respiratory infections
› GI infections
› skin infections
› soft tissue infections
› sexually transmitted diseases (STDs)
Assisting With the Nursing Process
macrolides:
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output, ask about GI symptoms
PLANNING: see table 34-2 p. 411 for “Oral Dose Forms”
IMPLEMENTATION: see table 34-2 p. 411 for “Adult Dosage
Range”
EVALUATION: report and record:
 diarrhea, nausea, vomiting, abnormal taste: most
common side effects, usually mild and resolve
 see promoting safety and comfort: anti-microbial agents,
p. 409
Drug Class: Penicillins:
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were the first true antibiotics
remain one of the most widely used classes of antibiotics
interfere with bacterial cell wall synthesis
resulting cell wall is weak because of a defective structure,
bacteria are destroyed
most effective against bacteria that spread rapidly
many bacteria that are sensitive to penicillin develop a protective
mechanism against the drug, they can cause penicillin
resistance
penicillins are used to treat:
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middle ear infections
pneumonia
meningitis
UTIs
syphilis
penicillins also ordered before surgeries and dental procedures
goal is to prevent infection in persons with history of rheumatic fever,
rheumatic fever may affect heart, brain, joints, skin or
subcutaneous tissues
Assisting With the Nursing Process
penicillins:
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output
PLANNING: see table 34-3 p. 412 for “Oral Dose Forms”
IMPLEMENTATION: see table 34-3 p. 412 for “Adult Dosage
Range”
EVALUATION: report and record:
 diarrhea: penicillins alter the normal flora of the GI tract,
observe for signs/symptoms of dehydration is diarrhea is
severe or does not resolve
 changes in alertness, orientation to person, time and
place; confusion; muscle cramps; nausea: may signal
electrolyte imbalance
 see promoting safety and comfort: anti-microbial agents,
p. 409
Drug Class: Quinolones:
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prevent bacteria from reproducing
effective in treating initial and re-current UTIs
a new class- the fluoro-quinolones- inhibit the activity of
enzyme needed for bacteria to multiply
drugs in this class work against both gram negative and
gram positive bacteria, this includes some anaerobes
anaerobes: microbes that live and grow in absence of
oxygen
aerobes: microbes that live and grow in the presence of
oxygen
Assisting With the Nursing Process
quinolones:
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output
PLANNING: see table 34-4 p. 413 for “Oral Dose Forms”
IMPLEMENTATION: see table 34-4 p. 413 for “Adult Dosage Range”
EVALUATION: report and record:
 nausea, vomiting, diarrhea, GI discomfort: usually mild and
resolve
 dizziness, light-headedness: tend to be self-limiting: provide for
safety
 photo-sensitivity: sensitivity to sunlight, UV light, person should
avoid exposure, should apply sunscreen, wear longsleeves, hat and sunglasses, sunburn needs medical
attention
 tinnitus(ringing in ears), headache, dizziness, depression,
drowsiness, confusion: nervous system effects, provide for
safety
 see promoting safety and comfort: anti-microbial agents,
p. 409
Drug Class: Sulfonamides:
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highly effective anti-bacterial agents
inhibit bacteria from making folic acid, causing bacterial
death (folic acid needed for cell growth and
reproduction)
drugs used to treat:
› UTIs
› otitis media
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may be used to treat infections in persons allergic to
penicillin
Assisting With the Nursing Process
sulfonamides:
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output, ask about GI symptoms
PLANNING: see table 34-5 p. 414 for “Oral Dose Forms”
IMPLEMENTATION: see table 34-5 p. 414 for “Adult Dosage
Range”, person should drink water several times a day
EVALUATION: report and record:
 nausea, vomiting, diarrhea, GI discomfort: usually mild and
resolve
 photo-sensitivity: sensitivity to sunlight, UV light, person should
avoid exposure, should apply sunscreen, wear long-sleeves,
hat and sunglasses, sunburn needs medical attention
 sore throat, fever, jaundice, weakness: may signal changes in
read and white blood cells
 tinnitus(ringing in ears), headache, dizziness, depression,
drowsiness, confusion: nervous system effects, provide for
safety
 see promoting safety and comfort: anti-microbial agents,
p. 409
Drug Classes: Tetracyclines:
effective against gram-negative and gram-positive
bacteria
 inhibit bacteria cells from making protein
 drugs often used in person allergic to penicillin to treat:
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› certain STDs
› UTIs
› upper respiratory infections
› pneumonia
› meningitis
› acne
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tetracyclines may stain the teeth if taken during teeth
development- last half of pregnancy through 8 years of
age, drugs are secreted in breast milk, nursing mothers
should feed infants formula or cow’s milk
Assisting With the Nursing Process
tetracyclines:
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output, ask about GI symptoms
PLANNING: see table 34-6 p. 415 for “Oral Dose Forms”
IMPLEMENTATION: see table 34-6 p. 415 for “Adult Dosage
Range”, give drug 1 hour before or 2 hours after the person
ingests antacids, milk or other dairy products, or products
containing calcium, aluminum, magnesium, or iron.
EVALUATION: report and record:
 nausea, vomiting, diarrhea, GI discomfort: usually mild and
resolve
 photo-sensitivity: sensitivity to sunlight, UV light, person should
avoid exposure, should apply sunscreen, wear long-sleeves,
hat and sunglasses, sunburn needs medical attention
 see promoting safety and comfort: anti-microbial agents,
p. 409
Drug Class: Anti-Tubercular Agents:
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tuberculosis (TB) is described in box 34-3 p. 407
these drugs are used in the treatment of TB:
› ethambutol (Myambutol)
› isoniazid (INH)
› rifampin (Rifadin)
ethambutol (Myambutol):
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inhibits bacterial growth
used with other anti-tubercular agents to prevent the development
of resistant organisms
goal of therapy: eliminate TB
Assisting With the Nursing Process
ethambutol (Myambutol):
ASSESSMENT: ask about signs/symptoms, measure vital signs, measure
intake/output, ask about GI symptoms, observe level of alertness and
orientation to person, time and place
PLANNING: Oral Dose: 100 and 400mg tablets
IMPLEMENTATION: dosage based on persons body weight, drug given
once/day with food or milk
EVALUATION: report and record:
 nausea, vomiting, diarrhea, abdominal cramps: usually mild and
resolve, give drug with food or milk
 confusion, hallucinations: provide for safety
 blurred vision, red-green vision changes: provide for safety
 see promoting safety and comfort: anti-microbial agents, p. 409
isoniazid (INH):
appears to disrupt the bacteria’s cell wall and inhibits the
cell from multiplying
 used to prevent and treat TB
 if TB is active, then used with other anti-tubercular agents
 goals of therapy:
 prevent TB in persons who test positive for disease
 eliminate TB in persons with active TB
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Assisting With the Nursing Process
isoniazid (INH):
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output, ask about GI symptoms
PLANNING: Oral Dose: 50, 100, and 300mg tablets and 50mg/5mL
syrup
IMPLEMENTATION: dosage based on persons body weight, drug is
usually a single daily dose, may be in divided doses. Give drug
on empty stomach
EVALUATION: report and record:
 tingling and numbness of hands and feet: these are common
and dose related, observe for signs of skin breakdown, test
water temperature to prevent burns
 nausea, vomiting: common and dose related
 dizziness, ataxia (staggering gait, imbalance, poor
coordination): provide for safety during ambulation
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 see promoting safety and comfort: anti-microbial agents, p.
409
rifampin (Rifadin):
drug blocks key pathways needed for cells to grow and
multiply
 used with other drugs to treat TB
 also used to eliminate certain bacteria in the nasopharynx of carriers showing no symptoms
 carrier: human or animal that is a reservoir for microbes
but does not have the signs/symptoms of infection
 such bacteria are:
 N. meningitidis: may cause septicemia or meningitis
 H. influenzae type B (Hib disease): may cause meningitis,
pneumonia, joint or bone infections, throat
inflammations. Hib disease mainly affects kids in first 5
years of life
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Assisting With the Nursing Process
rifampin (Rifadin)
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output, ask about GI symptoms
PLANNING: Oral Dose: 150 and 300mg capsules
IMPLEMENTATION: usual adult dose is 600mg once/day, drug is
given 1 hour before or 2 hours after a meal
EVALUATION: report and record:
 reddish-orange secretions: urine, feces, saliva, sputum, sweat
and tears may be tinged reddish-orange, harmless and
resolves
 nausea, vomiting: mild and resolve
 nausea, vomiting, fever, chills, muscle or bone pain, bruising,
yellowish color of skin or eyes: person needs further medical
attention
 see promoting safety and comfort: anti-microbial agents, p.
409
Drug Class: Other Antibiotics:
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other antibiotics used to treat infections include:
› clindamycin (Cleocin)
› metronidazole (Flagyl)
› tinidazole (Tindamax)
› vancomycin (Vancocin)
clindamycin (Cleocin):
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inhibits bacteria from making protein
used against:
› gram-negative aerobes
› gram-positive anaerobes
› gram-negative anaerobes
Assisting With the Nursing Process
clindamycin (Cleocin):
ASSESSMENT: ask about signs/symptoms, measure vital signs, measure
intake/output, ask about bowel elimination patterns
PLANNING: Oral Dose: 75, 150 and 300mg capsules, 75mg/5mL
suspension
IMPLEMENTATION: usual adult oral dose is 150-450 mg every 6 hours. Do
not refrigerate suspension, it is stable at room temperature for 14
days
EVALUATION: report and record:
 diarrhea: usually mild and tends to resolve
 severe diarrhea: signaled by 5 or more stools/day
 blood or mucus in stool: person needs further medical attention
 see promoting safety and comfort: anti-microbial agents, p. 409
metronidazole (Flagyl):
kills bacteria and some protozoa
 protozoa: one-celled animals (can infect blood, brain,
intestines, and other body areas
 drug used to treat:
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› trichomoniasis: vaginal infection
› giardiasis: diarrhea usually caused by water contaminated with
feces, aka: traveler’s diarrhea
› amebic dysentery: inflammation of the intestine, person has
frequent loose stools with flecks of blood and mucus, liver
may be involved
› anaerobic bacterial infections
Assisting With the Nursing Process
metronidazole (Flagyl):
ASSESSMENT: ask about signs/symptoms, measure vital signs,
measure intake/output, ask about GI symptoms, observe level
of alertness and orientation to person, time and place
PLANNING: Oral Dose: 250 and 500mg tablets, 375 and 500mg
capsules, 750mg extended-release tablets
IMPLEMENTATION: dosage depends on the infection needing
treatment, person should avoid alcohol and drugs containing
alcohol (cough meds, mouth wash)
EVALUATION: report and record:
 nausea, vomiting, diarrhea: usually mild and tends to resolve
 dizziness: provide for safety
 confusion, seizures: provide for safety, follow care plan for
seizure precautions
 see promoting safety and comfort: anti-microbial agents, p.
409
tinidazole (Tindamax):
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similar to metronidazole, used to treat:
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trichomoniasis in men/women
giardiasis
amebic dysentery
amebic liver abscess
Assisting With the Nursing Process
tinidazole (Tindamax):
ASSESSMENT: ask about signs/symptoms, measure vital signs, measure
intake/output, ask about GI symptoms, observe level of alertness and
orientation to person, time and place
PLANNING: Oral Dose: 250 and 500mg tablets
IMPLEMENTATION: dosage depends on the infection needing treatment,
person should avoid alcohol and drugs containing alcohol (cough
meds, mouth wash)
EVALUATION: report and record:
 nausea, vomiting, diarrhea: usually mild and tends to resolve
 dizziness: provide for safety
 confusion, seizures: provide for safety, follow care plan for seizure
precautions
 see promoting safety and comfort: anti-microbial agents, p. 409
vancomycin (Vancocin):
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drug prevents cell walls from forming
effective against gram-positive bacteria
has severe adverse effects
reserved for people with potentially life-threatening infections who can NOT be
treated with penicillins or cephalo-sporins
Assisting With the Nursing Process
vancomycin (Vancocin):
ASSESSMENT: ask about signs/symptoms, measure vital signs, measure
intake/output, observe for hearing loss
PLANNING: Oral Dose: 125 and 250mg capsules
IMPLEMENTATION: usual adult dose is 500mg every 6 hours or 1g every 12
hours
EVALUATION: report and record:
 dizziness, tinnitus(ringing in ears), signs of hearing loss: drug can cause
hearing damage
 decreasing urinary output, bloody or smoky-colored urine: signals
kidney toxicity
 genital and anal itching, vaginal discharge, thrush: signal secondary
infections, remind person of need for good oral and personal
hygiene
 see promoting safety and comfort: anti-microbial agents, p. 409
Drug Class: Topical Anti-Fungal Agents
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anti-fungal agents change cell membranes
proteins and electrolytes can leak from cells, cells cannot
take the nutrients needed for their growth
topical agents are used to treat:
› athlete’s foot
› jock itch
› ring worm
› thrush
› diaper rash
› vaginal yeast infection
Assisting With the Nursing Process
topical anti-fungal agents:
ASSESSMENT: ask about signs/symptoms
PLANNING: see 34-7 for “Topical Dose Forms”
IMPLEMENTATION: see table 34-7 for Adult Dosage Range, for -athletes foot: person should change cotton socks 2-3x/day
-jock itch: person should wear clothing that fits well, and is wellventilated
-eye contact: eye contact with drug should be avoided,
wash eyes at once if contact occurs
EVALUATION: report and record:
 vaginal applications: vaginal or perineal burning, itching,
discharge, soreness, swelling: usually mild and resolve
 redness, swelling, blistering, oozing: may signal allergic reaction
 see promoting safety and comfort: anti-microbial agents, p.
409
Drug Class: Systemic Anti-fungal Agents:
fluconazole(Diflucan):
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interferes with cell well formation
used for:
› fungal infections affecting:
› meninges
› mouth and pharynx
› esophagus
› vagina
› to prevent fungal infections in:
› bone marrow transplant patients who are receiving radiation or
chemo
› persons w/ HIV
› persons with weakened immune system
Assisting With the Nursing Process
fluconazole (Diflucan):
ASSESSMENT: ask about signs/symptoms, measure vitals,
measure intake/output, ask about GI symptoms
PLANNING: Oral Dose Form: 50, 100, 150, 200mg tablets, 10
and 40mg/mL
IMPLEMENTATION: usual adult dose is 100-400mg daily,
dosage depends on the infection being treated
EVALUATION: report and record:
 nausea, vomiting and diarrhea: usually mild and tend to
resolve
 anorexia, nausea, vomiting, jaundice: may signal liver
toxicity
 see promoting safety and comfort: anti-microbial agents,
p. 409
flucytosine (Ancobon):
thought to prevent cell from making protein, used to fight fungal
infections affecting:
-blood
-heart
-urinary tract
-meninges
-lungs
Assisting With the Nursing Process
flucytosine (Ancobon):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, ask about GI symptoms, observe level of alertness and
orientation to person, time and place
PLANNING: Oral Dose Form: 125 and 250mg tablets
IMPLEMENTATION: dose depends on body weight, drug is given every 6
hours
EVALUATION: report and record:
 nausea, vomiting and diarrhea: usually mild and tend to resolve
 rash, sore throat, fever, jaundice, weakness: may signal changes in
red/white blood cells
 decreasing urinary output, bloody or smoky colored urine: may signal
kidney toxicity
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 see promoting safety and comfort: anti-microbial agents, p. 409
systemic anti-fungal agents cont….
griseofulvin (Fulvicin and Grifulvin):
drugs stop cell division and new cell growth, used to treat ringworm of scalp, body,
nails and feel!
Assisting With the Nursing Process
griseofulvin (Fulvicin, Grifulvin):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure intake/output, ask
about GI symptoms
PLANNING: Oral Dose Form: 125, 250, 500mg tablets, 125mg/5 mL
IMPLEMENTATION: dose depends on the microbe and location of infections usually
500mg to 1g in 1 dose or in divided doses, high-fat meal may increase drug
absorption
EVALUATION: report and record:
 nausea, vomiting, anorexia, abdominal cramps: usually mild and tend to resolve
 confusion: provide for safety
 dizziness: provide for safety
 genital and anal itching, vaginal discharge, thrush: signal secondary infection,
remind person of need for good oral and perineal hygiene
 photo-sensitivity: sensitivity to sunlight and UV light, avoid exposure, wear
sunscreen, long sleeves, hats and sunglasses. Sunburn needs medical attention
 sore throat, fever, jaundice, weakness: may signal changes in red/white blood
cells
 decreasing urinary output, bloody or smoky-colored urine: signal kidney toxicity
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 see promoting safety and comfort: anti-microbial agents, p. 409
systemic anti-fungal agents cont….
itraconazole (Sporanox)
drug interferes with the cell wall, cell contents leak out of the cell
Assisting With the Nursing Process
itraconazole (Sporanox):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, ask about GI symptoms, observe for
signs/symptoms of heart failure (ch 21)
PLANNING: Oral Dose Form: 100mg capsules, 10mg/mL oral
solution in 150mL container
IMPLEMENTATION: 100-400mg daily, doses greater than 200mg
are given in 2 divided doses, give the drug with a full meal
EVALUATION: report and record:
 nausea, vomiting: usually mild and tend to resolve
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 dyspnea, chest pain, fatigue, edema, syncope(fainting),
palpitations: signs of heart failure
 see promoting safety and comfort: anti-microbial agents, p.
409
systemic anti-fungal agents cont….
ketoconazole (Nizoral)
drug interferes with the cell wall, cell contents leak out of the cell
Assisting With the Nursing Process
ketoconazole (Nizoral):
ASSESSMENT: ask about signs/symptoms, measure vitals,
measure intake/output, ask about GI symptoms
PLANNING: Oral Dose Form: 200mg tablets
IMPLEMENTATION: 200-400mg once daily, give drug at least
2 hours before giving drugs that reduce stomach acidity,
give the drug with food, avoid alcohol or products
containing alcohol
EVALUATION: report and record:
 nausea, vomiting: usually mild and tend to resolve
 anorexia, nausea, vomiting, jaundice: may signal liver
toxicity
 see promoting safety and comfort: anti-microbial agents,
p. 409
systemic anti-fungal agents cont….
terbinafine (Lamisil)
drug affects enzymes that cells need to live, used to treat fungal
infections affecting toenails and fingernails
Assisting With the Nursing Process
terbinafine (Lamisil):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, ask about GI symptoms
PLANNING: Oral Dose Form: 250mg tablets
IMPLEMENTATION: fingernail infection: 250mg daily for 6 weeks
toenail infections: 250mg daily for 12 weeks
EVALUATION: report and record:
 decreasing urinary output, bloody or smoky-colored urine:
signal kidney toxicity
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 see promoting safety and comfort: anti-microbial agents,
p. 409
Drug Class: Anti-Viral Agents:
acyclovir (Zovirax):

drug prevents viral cells from multiplying, used to treat genital herpes
Assisting With the Nursing Process
acyclovir (Zovirax):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure intake/output,
observe level of alertness and orientation to person, time and place
PLANNING: Oral Dose Form: 200, 400, 800mg tablets, 200mg/5mL suspension,
topical: 5% ointment
IMPLEMENTATION: topical: apply to each lesion every 3 hours, 6x/day for 7 days.
Wear gloves and practice hand hygiene. Oral: initial treatment: 200mg
every 4 hours while awake, total daily dosage is 1000mg for 10 days.
Suppressive therapy: 400mg 2-5x/day for up to 12 mos. Intermittent therapy:
200mg every 4 hours while awake, total daily dosage is 1000mg for 5 days,
drug is started at earliest sign of symptoms
EVALUATION: report and record:
 sweating: follow care plan for fluid intake
 decreasing urinary output, bloody or smoky-colored urine: signal kidney
toxicity
 hypotension: BP is measured in the supine and standing positions, provide for
safety
 confusion: provide for safety
 see promoting safety and comfort: anti-microbial agents,
p. 409
famciclovir (Famvir):


drug prevents the virus cell from multiplying
used to treat: recurrent genital herpes, herpes zoster (shingles)
Assisting With the Nursing Process
famciclovir (Famvir):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, GI symptoms, observe level of alertness and
orientation to person, time and place
PLANNING: Oral Dose Form: 125, 250, 500mg tablets
IMPLEMENTATION: for genital herpes: 125mg 2x/day for 5 days, therapy
should be started within 6 hours of first sign/symptom
herpes zoster: 500mg every 8 hours for 7 days, therapy should be
started within 72 hours of onset
EVALUATION: report and record:
 nausea, vomiting, headache: usually mild and resolve with
continued therapy
 confusion: provide for safety
 see promoting safety and comfort: anti-microbial agents,
p. 409
valacyclovir (Valtrex):

drug inhibits the viral cell from multiplying, used to treat herpes
zoster (shingles), also treats or suppresses genital herpes
Assisting With the Nursing Process
valacyclovir (Valtrex):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output
PLANNING: Oral Dose Form: 500mg and 1g capsules
IMPLEMENTATION: herpes zoster: 1g 3x/day for 7 days
genital herpes: 500mg 2x/day for 7 days
EVALUATION: report and record:
sweating: follow care plan for fluid intake
decreasing urinary output, bloody or smoky-colored urine: signal kidney
toxicity
 hypotension: BP is measured in the supine and standing positions, provide for
safety
 confusion: provide for safety
 see promoting safety and comfort: anti-microbial agents,
p. 409


abacavir (Ziagen)


drug prevents the viral growth, used with other anti-viral agents to :
slow progression of HIV, reduce frequency of opportunistic infections
opportunistic infection: caused by non-pathogens in a person with
weakened immune system; risk factors: diabetes, HIV, cancer, urinary
catheterization
Assisting With the Nursing Process
abacavir (Ziagen):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, GI symptoms
PLANNING: Oral Dose Form: 300mg tablets, 20mg/mL oral solution in
240mL bottles
IMPLEMENTATION: usual adult dose: 300mg 2x/day, given with other
anti-viral agents
EVALUATION: report and record:
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 see promoting safety and comfort: anti-microbial agents, p. 409
atazanavir (Reyataz):



drug prevents the virus cell from multiplying
immature virus celss are not infectious,
drug is used with other anti-viral agents to:
 slow progression of HIV
 reduce frequency of opportunistic infections
Assisting With the Nursing Process
atazanavir (Reyataz)
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output
PLANNING: Oral Dose Form: 100, 150, 200, 300mg capsules
IMPLEMENTATION: usual adult dose is 400mg once/day with food
EVALUATION: report and record:
 jaundice: reverses when drug is discontinued
 rash: usually resolves in 1-2 weeks
 severe rash, blisters, fever: person needs medical attention
 signs/symptoms of hyperglycemia: ch. 27
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 see promoting safety and comfort: anti-microbial agents,
p. 409
didanosine (Videx):


drug prevents cells from multiplying
used to: slow progression of HIV, reduce frequency of opportunistic
infections
Assisting With the Nursing Process
didanosine (Videx):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure intake/output,
GI symptoms
PLANNING: Oral Dose Form: 25, 50, 100, 150, 200mg chewable tablets
125, 200, 250, 400mg delayed-release capsules
10mg/mL powder for oral solution after reconstitution
IMPLEMENTATION: chewable tablets: 125mg every 12 hours for persons<132lbs
and 200mg every 12 hours for persons>132 lbs, tablets must be thoroughly
chewed, crushed tablets should be dispersed in at least 1oz of water
delayed-release capsules: 250mg once/day for persons <132 lbs, 400mg
once/day for persons >132lbs
powder: 167mg every 12 hours for persons <132lbs, 250mg every 12 hours for
persons >132lbs, prepared by pharmacist, drink ordered dose immediately,
do not mix powder with liquids containing acid
give ALL drug forms on an empty stomach
EVALUATION: report and record:
 diarrhea: most common with powder form
 abdominal pain, nausea, vomiting: may signal pancreatitis
 numbness, tingling, pain in feet/hands: signal nervous system involvement
 see promoting safety and comfort: anti-microbial agents, p. 409
efavirenz (Sustiva):

drug prevents HIV from multiplying, used with other agents to: slow
progression of HIV, reduce frequency of opportunistic infections
Assisting With the Nursing Process
efavirenz (Sustiva):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, GI symptoms
PLANNING: Oral Dose Form: 50, 100, 200mg capsules, 600mg tablets
IMPLEMENTATION: usual adult dose is 600mg once/day with other antiviral agents, drug should be taken on empty stomach at bedtime,
food increases absorption and risk of toxic effects. Women who are
or may become pregnant should NOT take this drug, fetal deaths
associated with drug
EVALUATION: report and record:
 drowsiness, dizziness, impaired concentration, vivid dreams,
depression, delusions: may improve after 2-4 weeks of therapy
 rash: this usually resolves within 1 month of therapy
 severe rash, blisters, fever: person needs medical attention
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 see promoting safety and comfort: anti-microbial agents, p. 409
emtricitabine (Emtriva):

drug prevents HIV from multiplying, used with other agents to: slow
progression of HIV, reduce frequency of opportunistic infections
Assisting With the Nursing Process
emtricitabine (Emtriva):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, GI symptoms
PLANNING: Oral Dose Form: 200mg capsules, 10mg/mL solution
IMPLEMENTATION: usual adult dose is 200mg capsule once/day, 240mg
oral solution once/day, dosage reduced for those with impaired
kidney function
EVALUATION: report and record:
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 malaise, muscle pains, respiratory distress, hypotension: signal a buildup of lactic acid in blood (lactic acidosis, ch. 27)
 changes in skin color: may occur on palms and soles of feet
 diarrhea, nausea, rhinitis, rash, weakness, cough, headache
 see promoting safety and comfort: anti-microbial agents, p. 409
lamivudine (Epiver and Epivir-HBV):

drug prevents HIV and the hepatitis B virus (HBV) from multiplying, used to:
slow progression of HIV when used with zidovudine (Retrovir), slow
progression of HBV infection and reduce frequency of opportunistic
infections
Assisting With the Nursing Process
lamivudine (Epiver and Epivir-HBV):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, GI symptoms, ask about numbness, tingling and pain
in hands/feet
PLANNING: Oral Dose Form: 100, 150, 300mg tablets, 5 and 10 mg/ML
oral solution in 240mL bottles
IMPLEMENTATION: for HIV: 150mg 2x/day with zidovudine (Retrovir)
for HBV: 100mg once/day
EVALUATION: report and record:
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 malaise, muscle pains, respiratory distress, hypotension: signal a buildup of lactic acid in blood (lactic acidosis, ch. 27)
 abdominal pain, nausea, vomiting: may signal pancreatitis
 numbness, tingling, pain in feet/hands: signal nervous system
involvement
 see promoting safety and comfort: anti-microbial agents, p. 409
stavudine (Zerit and Zerit XR):


drugs are used with other anti-virals in the treatment of HIV infection
goals of therapy: slow progression of HIV infection, reduce frequency of
opportunistic infections
Assisting With the Nursing Process
stavudine (Zerit and Zerit XR):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure intake/output,
GI symptoms, ask about numbness, tingling and pain in hands/feet
PLANNING: Oral Dose Form: 15, 20, 30, 40 mg capsules, 37.5, 50, 75, 100mg
extended-release capsules, 1mg/mL powder for oral solution
IMPLEMENTATION: capsules: <132lbs: 30mg every 12 hours, >132lbs 40mg every
12 hours for
extended-release capsules: <132lbs 75mg once/day, >132lbs 100mg
once/day
EVALUATION: report and record:
 anorexia, nausea, vomiting, jaundice: may signal liver toxicity
 malaise, muscle pains, respiratory distress, hypotension: signal a build-up of
lactic
acid in blood (lactic acidosis, ch. 27)
 abdominal pain, nausea, vomiting: may signal pancreatitis
 numbness, tingling, pain in feet/hands: signal nervous system involvement
 see promoting safety and comfort: anti-microbial agents, p. 409




amantadine hydrochloride (Symmetrel)
acts against the influenza A virus
also used to treat Parkinson's disease
discussed in ch. 14
oseltamivir (Tamiflu):


drug inhibits an enzyme on viral cell coat, enzyme needed for cell
production and spread of viral cell particles
drug used to reduce flu symptoms- nasal congestion, sore throat,
cough, muscle aches, fatigue, headache, chills, sweats
Assisting With the Nursing Process
oseltamivir (Tamiflu):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output, GI symptoms
PLANNING: Oral Dose Form: 75 mg capsules, 12mg/mL oral suspension
IMPLEMENTATION: usual adult dosage: 75mg 2x/day for 5 days,
treatment should begin within 2 days of flu symptom onset, give drug
with food/milk
EVALUATION: report and record:
 nausea, vomiting: give drug with food/milk
 cough, yellow or green sputum, sore throat, fever, continuing
symptoms: person needs further medical attention
 see promoting safety and comfort: anti-microbial agents, p. 409
zanamivir (Relenza):



drug inhibits an enzyme on viral cell coat, enzyme needed for cell
production and spread of viral cell particles
drug used to reduce flu symptoms- nasal congestion, sore throat,
cough, muscle aches, fatigue, headache, chills, sweats
drug may prevent a secondary infection of pneumonia
Assisting With the Nursing Process
zanamivir (Relenza):
ASSESSMENT: ask about signs/symptoms, measure vitals, measure
intake/output
PLANNING: Oral Dose Form: 5mg blisters of powder for inhalation
IMPLEMENTATION: usual adult dosage: 2 inhalations (one 5mg blister per
inhalation for a total of 10mg) every 12 hours for 5 days; treatment
should begin within 2 days of flu symptom onset; inhaled broncodilators should be taken before this drug
EVALUATION: report and record:
 asthma, broncho-spasm, shortness of breath, chest soreness: person
must stop taking drug and seek medical attention
 cough, yellow or green sputum, sore throat, fever, continuing
symptoms: person needs further medical attention
 see promoting safety and comfort: anti-microbial agents, p. 409
ribavirin (Rebetol):

drug inhibits viral activity. for adults its used with other
drugs in treatment of hepatitis C (see box 34-3)
Assisting With the Nursing Process
ribavirin (Rebetol):
ASSESSMENT: ask about signs/symptoms, measure vitals,
measure intake/output, ask about GI symptoms
PLANNING: Oral Dose Form: 200mg capsules
IMPLEMENTATION: for persons <165lbs: 400mg in AM and
600mg in PM
for persons >165lbs: 600mg in AM and 600mg in PM
EVALUATION: report and record:
 fatigue, dizziness, headache, pallor, dyspnea on exertion:
may signal changes in red blood cell production
 see promoting safety and comfort: anti-microbial agents,
p. 409