Antimicrobial, Fungal, etc.

Question 1

INH Adverse Effects

Answer 1

isoniazid (INH)

Adverse effects
Hepatotoxicity, peripheral neuropathy, and encephalopathy

Question 2

Rifampin Adverse Effects

Answer 2

Hepatitis, discoloration of urine, stools

Question 3

Adverse Effects: Amphotericin B

Answer 3

Transfusion-related: Fever, chills, rigors, HOTN, bronchospasm, N/V
Electrolyte disturbances (↓K, ↓Mg, ↓Cl, ↓Ca)
Anemia, Leukopenia, thrombocytopenia
Dysrhythmias (V-fib, cardiac arrest) w/ rapid infusion
Peripheral neuropathy, hypersensitivity, seizures
Numbeness, tingling, weakness
Nephrotoxicity (if pre-existing renal impairment)

To reduce the severity of the infusion-related reactions, pretreatment with an antipyretic (acetaminophen), antihistamines, antiemetics, and corticosteroid may be given

Drug of choice for the treatment of many severe systemic fungal infections is Amphotericin B

Question 4

acyclovir (Zovirax): Purine Nucleoside Analogue Drugs

Answer 4

Used to suppress replication of:
HSV-1, HSV-2
Drug of choice for treatment of initial and recurrent episodes of these infections

Adverse effects
Light-headedness, anorexia, nausea, vomiting, abdominal pain, and headache. Renal toxicity

Question 5

Cephalosporins

Answer 5

Orally administered forms should be given with food to decrease GI upset, even though this will delay absorption
Some of these drugs may cause a disulfiram (Antabuse)-like reaction when taken with alcohol

Adverse Effects: 
Similar to penicillins
N/V/D, anorexia, abdominal pain, flatulence 
Hypersensitivity reactions frequent 
Maculopapular rash
Psuedomembranous colitis w/ cefazolin
Violent, bloody diarrhea, abd pain
Potential cross-sensitivity with penicillins if allergies exist

Question 6

Aminoglycosides

Answer 6

Bactericidal; prevents protein synthesis

Very potent antibiotics with serious toxicities
Nephrotoxicity: renal damage
Ototoxicity: auditory impairment and vestibular [eighth cranial nerve]

Names end in -mycin

Question 7

Vancomycin

Answer 7

Bactericidal
Serious gram-positive infections, especially Clostridium difficile and methicillin-resistant Staphylococcus aureus.

Most common Adverse Effects
“Red man” syndrome resulting from histamine release
Fever, chills, tachycardia, pruritus, paresthesias, rash, or redness of the face, neck, upper body, arms, or back.
Most serious: Ototoxicity & nephrotoxicity

Question 8

fluconazole (Diflucan)

Answer 8

Adverse effects
Diarrhea, nausea, vomiting, abdominal pain, headache, rash, and dizziness

Minimizing adverse effects
Carefully screen patients for preexisting disorders, which may increase the risk of adverse reactions.

Question 9

Protease Inhibitors: saquinavir (Invirase)

Answer 9

Adverse effects
Nausea, diarrhea, stomach discomfort, insomnia, and headache

Maximizing therapeutic effects
Administer saquinavir tablets or capsules within 2 hours after eating a full meal.
Administer ritonavir with each dose of saquinavir.

Patient and family education
Explain the importance of periodic clinical and blood monitoring.
Teach patients the signs and symptoms of diabetes.

Ongoing assessment and evaluation
Patients who take saquinavir should have periodic examinations and blood monitoring.

Question 10

Enfurvitide (Fuzeon)

Answer 10

Contraindications and precautions
Hypersensitivity

Adverse effects
Injection site reaction, anorexia, nausea, weight loss, fatigue, anxiety, headache, insomnia, peripheral neuropathy, and infections

Patient and family education
Emphasize the importance of aseptic technique when reconstituting and administering enfuvirtide.
Explain the potential for injection-site reactions.

Ongoing assessment and evaluation
Assess the patient taking enfuvirtide for signs of infectious disorders, such as pneumonia, sinusitis, herpes simplex, influenza, and conjunctivitis.