Transcript 12 - Quia

Introduction to Clinical
Pharmacology
Chapter 12Antifungal and Antiparasitic
Drugs
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Antifungal Drugs: Actions and Uses
• Fungicidal OR Fungistatic: Action is related
to their concentration in body tissues
• Used prophylactically to prevent fungal
infection in immunocompromised patients
• Used to treat: Superficial and deep fungal
infections; systemic infections; superficial
infections of nail beds, oral, anal and vaginal
areas
• Tea tree oil and garlic are antifungal herbs
used to tx skin infections
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Antifungal Drugs: Adverse Reactions
• Topical administration: Integumentary
reactions
– Irritation and burning sensation; redness,
stinging; abdominal pain (vaginal
preparations)
• Systemic administration
– Headache; rash; nausea, vomiting,
diarrhea; anorexia and malaise;
abdominal, joint, or muscle pain
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Antifungal Drugs: Contraindications,
Precautions and Interactions
• Contraindicated in patients: With a history of
allergies to the drug; during pregnancy and
lactation
• Contraindications for antifungal drugs:
Griseofulvin; Voriconazole; Itraconazole
• Used cautiously in patients: With renal
dysfunction and/or hepatic impairment
• Interactions: See Table 12-3 for Amphotericin
B and digoxin
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Nursing Process: Assessment
• Preadministration assessment:
– Assess for signs of the infection before
giving the first dose; take and record vital
signs
– Inspect superficial fungal infections of the
skin or skin structures and record
– Ask about pain and to describe white
plaques or sore areas of the oral or
perineal areas and any vaginal discharge
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Nursing Process: Assessment (cont’d)
• Ongoing assessment:
– Carefully observe the patient every 2 to 4
hours for adverse drug reactions
– If administered topically, instruct the
patient to look for signs of improvement
and adverse reactions both minor and
severe
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Nursing Process: Nursing Diagnosis
• Impaired comfort-related to IV
administration of amphotericin B
• Risk for Ineffective tissue perfusion: Renal
RT adverse reactions of antifungal drugs
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Nursing Process: Planning
• The expected outcome depend on the
reason for administering the antifungal drug
but includes an optimal response to therapy:
– Patient relates to the management of
adverse reactions, and an understanding
of and compliance with the prescribed
treatment regimen
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Nursing Process: Implementation
• Promoting an optimal response therapy:
– **Amphotericin B: Protect IV solution of
from exposure to light; administer
immediately after the drug is
reconstituted; renal damage is the most
serious adverse reaction to the use of
amphotericin B – hence serum creatinine
levels and BUN levels are checked
frequently
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Nursing Process: Implementation
• Monitoring and managing patient’s need:
– Impaired comfort: Medication administration
• **Use precautions when administering
amphotericin B intravenously; inform
before the drug is given that the side
effects can be uncomfortable; provide
warm blankets; nausea, vomiting,
hypotension, tachypnea, fever, and chills
may occur within 15-20 minutes of the
beginning of the IV-adverse reaction may
be serious!!
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Nursing Process: Implementation
• Monitoring and managing patient’s need
(cont’d):
– Risk for ineffective tissue perfusion: Renal
•Carefully monitor fluid intake and
output, serum creatinine levels and
BUN levels
•Gerontological alert: Fluconazole
•Monitor kidney function –creatinine
clearance test
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Nursing Process: Implementation
• Educating the patient and family:
– For topical antifungal drugs include the
importance of cleanliness and using the
correct ointment amount in the
prescribed frequency in the teaching
plan
– **For ringworm infections advise
keeping towels and facecloths used for
bathing separate from those of other
family members
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Implementation
• Miconazole
– If administered vaginally, insert the drug high in the
vagina using the applicator provided
– Teach to prevent recurrent infections-avoid tight
fitting garments
– If no improvement in 5-7 days, stop using the drug
and consult the MD
– If abdominal pain, pelvic pain, rash, fever or
offensive smelling vaginal drainage occurs-consult
MD
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Nursing Process: Evaluation
• The therapeutic effect is achieved; signs and
symptoms of infection improve; optimal skin
integrity is maintained
• Adverse reactions are identified, reported,
and managed
• Patient and family demonstrate
understanding of the drug regimen
• Patient verbalizes the importance of
complying with the prescribed therapeutic
regimen
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Parasitic Infections
• Helminthic infections: invasion of body by
parasitic worms.
– Anthelmintic drugs kill the parasites.
• Protozoal infections: single-cell parasites.
– Antiprotozoal drugs work to inhibit DNA
synthesis, effectively killing the organism.
– Amebiasis is a parasitic gastrointestinal
disorder.
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Drugs
• Anthelmintic Drugs-used against invasion of
parasitic worms (Helminthiasis)
– **Roundworms, pinworms, whipworms,
hookworms and tapeworms
• Antiprotozoal Drugs-used against invasion of
single celled parasites
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Anthelmintic Drugs: Actions and Uses
• Albendazole: Interferes with synthesis resulting in
death of larva; used to treat- larval forms of pork
tapeworm; liver, lung, and peritoneum disease
caused by dog tapeworm
• Mebendazole: Blocks glucose uptake by helminth;
used to treat- whipworm, pinworm, roundworm,
American hookworm, and common hookworm
• Pyrantel: Ability to paralyze helminth; used to
treat- roundworm; pinworm
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Anthelmintic Drugs: Adverse Reactions
• **Generalized adverse reactions:
– Drowsiness, dizziness
– nausea, vomiting
– abdominal pain and cramps,
diarrhea
• Serious adverse effects:
– *Rash when taking pyrantel (OTC) med
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Anthelmintic Drugs: Contraindications
and Precautions
• Contraindicated in patients:
– With a history of hypersensitivity;
during pregnancy
• Used cautiously in patients:
– With hepatic or renal impairment; during
lactation; with malnutrition or anemia
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Anthelmintic Drugs : Interactions
Interactant drug
Effect of interaction
Dexamethasone
Increased effectiveness of
albendazole
Cimetidine
Interferes with elimination
of albendazole
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Antiprotozoal Drugs: Actions and Uses
• Action:
– Plasmodium falciparum causes malaria.
•Transmitted by certain mosqitoes
Other more common protozoans are
transmitted through contaminated food
or water
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**USES
– Malaria
– Giardiasis
– Toxoplasmosis
– Intestingal amebiasis
– STI-trichomoniasis
– PCP
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Antiprotozoal Drugs: Adverse Reactions
• Gastrointestinal reactions:
– Vomiting; anorexia; abdominal cramping;
diarrhea; and nausea
• Other body system reactions:
– Headache; dizziness; visual
disturbances; hypotension; cinchonism
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Antiprotozoal Drugs: Contraindications
and Precautions
• Contraindicated in patients:
– With known hypersensitivity; during
pregnancy except metronidazole, history of
ETOH dependence
• Used cautiously:
– With children; lactating patients; with hepatic
or renal disease or bone marrow depression
• Quinine not prescribed for:
– Patient with myasthenia gravis
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Antiprotozoal Drugs: Interactions
Interactant drug
Effect of interaction
Antacids, Iron
Decreased absorption of
the antimalarial
Digoxin
Increased risk of digoxin
toxicity
Decreased effectiveness
of doxycycline
Barbiturates, phenytoins,
and carbamazepine
Quinine &
Warfarin
Increased risk of
bleeding
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Antiparasitic Drugs- Nursing Process:
Assessment
• Preadministration assessment:
– Diagnosis of helminth infection- examination of
stool; weigh patient to determine drug dosage,
instruct parent to take specimens from anal areaearly in am prior to pt. getting OOB
• Ongoing assessment:
– Save and transport all stools passed after intake of
drug to laboratory
– Acutely ill – monitor vital signs; record fluid
intake/output every 4 hours
– Observe patient for adverse reactions
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Anitparasitic Drugs Nursing Process:
Nursing Diagnosis
• Diarrhea-related to parasitic invasion of body
• Risk for deficient fluid volume-related to
parasitic invasion of body
• Imbalance nutrition: less than body
requirements-adverse reaction to drug
therapy
– May require small, frequent meals
• Risk for ineffective airway clearance r/t
adverse effects of drug therapy
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Antiparasitic Drugs-Nursing Process:
Planning
• Depends on the patient and the type of
helminth infection
• Outcome- reduction of anxiety, optimal
response to therapy, management of
adverse reaction, understanding compliance
of prescribed therapeutic regimen
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Antiparasitic Drugs- Nursing Process:
Implementation
• Promoting optimal response to therapy:
– Patient and family - explain treatment
and future preventive measure; discuss
concerns and questions
– Based on the hospital policy, linen
precaution necessary
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Antiparasitic Drugs- Nursing Process:
Implementation
• Educating patient and family member:
– Daily bathing/shower is recommended
– Disinfect toilets daily
– Disinfect shower/tub immediately after
bathing
– Wash hands thoroughly after urinating or
defecating and before preparing and
eating food
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Antiparasitic Drugs- Nursing Process:
Evaluation
• Therapeutic effect achieved; adverse
reaction identified, reported, and
successfully managed; stool specimen
negative for parasites; patient verbalizes an
understanding of the therapeutic regimen
modalities and the importance of continued
follow-up testing, and complying with the
prescribed regimen and preventive measures
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