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Pharmacology > antimicrobials pt 2 > Flashcards

antimicrobials pt 2 Flashcards

1
Q

Acyclovir (Zovirax) MOA

A

inihibits viral replication by suppressing synthesis of viral DNA

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2
Q

Acyclovir (Zovirax) indications

A

Topical for HSV
PO for HSV and VZV
IV for immunocompromised patients

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3
Q

Acyclovir (Zovirax) adverse effects

A

Generally well tolerated
Phlebitis with IV therapy
Nephrotoxicity- BUN, CREAT
Neurotoxicity- LOC

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4
Q

Acyclovir (Zovirax) nursing considersation

A

Viral resistance to therapy
Monitor renal function & fluid status
Monitor neuro status
Only decreases s/s in genitals; avoid sexual contact when lesions present and use protection
Use finger cot/rubber glove with topical

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5
Q

Ganciclovir (Cytovene) MOA

A

inhibits viral replication by suppressing synthesis of viral DNA

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6
Q

Ganciclovir (Cytovene) indications

A

prevention and treatment of CMV infection in immunocompromised pts

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7
Q

Ganciclovir (Cytovene) adverse effects

A

granulocytopenia
thrombocytopenia
teratogenic

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8
Q

Ganciclovir (Cytovene) nursing considerations

A

watch CBC for changes in WBC and PLT
coadmin with CSF, admin with food
education on contraception

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9
Q

Interferon Alfa MOA

A

blocks viral entry into cell
blocks synthesis of viral messenger RNA
blocks viral assembly and release

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10
Q

Interferon Alfa indications

A

HCV and HBV

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11
Q

Interferon Alfa adverse effects

A

flu like symptoms
neuropsychiatric - depression
bone marrow suppression

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12
Q

Interferon Alfa nursing considerations

A

acetaminophen PRN for flu-like s/s
monitor mental status
monitor CBC
monitor hepatits s/s and liver enzymes

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13
Q

Ribavirin (Rebetol) MOA

A

unclear but increases patient response to interferon alfa

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14
Q

Ribavirin (Rebetol) indications

A

hepatitis

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15
Q

Ribavirin (Rebetol) adverse effects

A

interferon alfa s/s
hemolytic anemia
fetal injury

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16
Q

Ribavirin (Rebetol) nursing considerations

A

monitor mental status
monitor CBC
monitor hepatitis s/s and liver enzymes
extended use of contraception due to prolonged half-life

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17
Q

Glecaprevir/Pibrentasvir (Mavyret) MOA

A

inhibit viral protease and NS5A

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18
Q

Glecaprevir/Pibrentasvir (Mavyret) indications

A

combination treatment for HCV genotypes 1-6 with or without cirrhosis

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19
Q

Glecaprevir/Pibrentasvir (Mavyret) adverse effects

A

nausea, fatigue, and headache
possible reactivation of HBV causing more liver injury

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20
Q

Glecaprevir/Pibrentasvir (Mavyret) nursing considerations

A

monitor hepatitis s/s and liver enzymes
pt must be tested for HBV and HCV before treatment
promote medication adherence since its a long regimen

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21
Q

oseltamivir (Tamiflu) MOA

A

prevents viral replication and prevents new viral particles from spreading to other cells

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22
Q

oseltamivir (Tamiflu) indications

A

flu

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23
Q

oseltamivir (Tamiflu) adverse effects

A

well tolerated
most common is n/v
hypersensitivity and neuropsychiatri s/s are rare

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24
Q

oseltamivir (Tamiflu) nursing considerations

A

rapid flu test (if theyve had flu for a couple days it wont work)
carefully assess for vaccination hx and onset of s/s
educate pt to monitor allergic rx

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25
Q

Abacavir (Ziagen) MOA

A

inhibit HIV replication by suppressing DNA synthesis

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26
Q

Abacavir (Ziagen) indications

A

HIV

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27
Q

Abacavir (Ziagen) adverse effects

A

Lactic acidosis & hepatic steatosis r/t mitochondrial toxicity
Possible evidence for increased risk for MI
Hypersensitivity

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28
Q

Abacavir (Ziagen) nursing considerations

A

Genetic testing for HLA-B*5701
Monitor cardiac and LA s/s
Use of safe practices to prevent transmission
Other first-line NRTI include lamivudine, tenofovir, & emtricitabine

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29
Q

Efavirenz (Sustiva) MOA

A

inhibit HIV replication by suppressing synthesis of DNA

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30
Q

Efavirenz (Sustiva) indications

A

HIV

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31
Q

Efavirenz (Sustiva) adverse effects

A

CNS symptoms are common
Rash
Teratogenicity

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32
Q

Efavirenz (Sustiva) nursing consideration

A

Numerous drug interactions, including those for HIV
Taking med at hs on empty stomach can reduce CNS symptoms
Educate on CNS symptoms and rash

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33
Q

Lopinavir/Ritonavir (Kaletra) MOA

A

inhibition of protease leaving the virus immature and noninfectious

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34
Q

Lopinavir/Ritonavir (Kaletra) indications

A

HIV

35
Q

Lopinavir/Ritonavir (Kaletra) adverse effects

A

Most common is diarrhea
Hyperglycemia and new-onset diabetes
Lipodystrophy (redistribution of fat) and hyperlipidemia
Prolonged PR and QT interval

36
Q

Lopinavir/Ritonavir (Kaletra) nursing considerations

A

Monitor heart rhythm on telemetry
Virus less resistant to the drug combination
Stable at room temperature for short-term; put in the refrigerator for long-term
Educate patients on glucose & lipid control

37
Q

Raltegravir (Isentress) MOA

A

inhibit integrase

38
Q

Raltegravir (Isentress) indication

A

HIV

39
Q

Raltegravir (Isentress) adverse effects

A

Generally well tolerated
Elevated liver enzymes
Skin hypersensitivity reactions rare
Viral medication resistance is more common

40
Q

Raltegravir (Isentress) nursing considerations

A

Assess for hepatic injury and trend LFT
Instruct patients to report skin manifestations and stop meds immediately
Other first-line INSTI is dolutegravir

41
Q

Enfuvirtide (Fuzeon) MOA

A
42
Q

Enfuvirtide (Fuzeon) indications

A

Blocks HIV entry into CD4 T cells

43
Q

Enfuvirtide (Fuzeon) adverse effects

A

SQ injection site reactions
Pneumonia s/s
Hypersensitivity reactions

44
Q

Enfuvirtide (Fuzeon) nursing considerations

A

Medication administration technique
Monitor respiratory and integumentary systems

45
Q

Maraviroc (Selzentry) MOA

A

blocks HIV entry into CD4 T cells

46
Q

Maraviroc (Selzentry) indications

A

infections resistant to other initial treatments

47
Q

Maraviroc (Selzentry) adverse effects

A

Hepatic injury
Possible increased risk for CV events, including MI

48
Q

Maraviroc (Selzentry) nursing considerations

A

Educate and assess for liver injury
Assess CV status
CCR5 tropism assay is performed first to determine if use is appropriate

49
Q

Cabotegravir/Rilpilvirine (Cabenuva) MOA

A

inhibits HIV integrase

50
Q

Cabotegravir/Rilpilvirine (Cabenuva) indication

A

indicated as a complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 years of age and older

51
Q

Cabotegravir/Rilpilvirine (Cabenuva) adverse effects

A

Hypersensitivity reactions
Post injection reactions
Hepatotoxicity
Depressive disorders

52
Q

Cabotegravir/Rilpilvirine (Cabenuva) nursing considerations

A

Administer each injection at separate gluteal injection sites
A complete dose requires 2 injections
Allow 15 minutes for the medicine to become room temperature.
May remain in a syringe for 2 hours.
Patient education on adverse reactions and signs and symptoms

53
Q

Pfizer vaccine MOA

A

RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity

54
Q

Pfizer vaccine indication

A

covid 19

55
Q

Pfizer vaccine adverse effects

A

Injection site soreness
Fever, chills, fatigue, headache, & lymphadenopathy within 24-48 hours
Anaphylaxis, very rarely; milder allergic reactions

56
Q

Pfizer vaccine nursing considerations

A

Patient education, including duration of protection and time between doses
Careful preparation to maximize doses per vial and appropriate amount of diluent depending on patient population and formulation
Once reconstituted, must be used within 6 hours for purple cap and 12 hours for gray cap
Intramuscular injection soreness can be treated with OTC analgesics
Monitor patients for 15 minutes post-administration

57
Q

Moderna vaccine MOA

A

RNA is translated to express full-length spike protein to elicit a systemic immune response to produce immunity

58
Q

Moderna vaccine indication

A

covid 19

59
Q

Moderna vaccine adverse effects

A

Injection site soreness
Fever, chills, fatigue, headache, myalgia, arthralgia
Anaphylaxis, very rarely; milder allergic reactions also reported

60
Q

Moderna vaccine nursing considerations

A

Patient education, including duration of protection and time between doses
Careful preparation to maximize doses per vial
Follow storage instructions after opening
Intramuscular injection soreness can be treated with OTC analgesics
Monitor patients for 15 minutes post-administration

61
Q

J&J vaccine MOA

A
62
Q

J&J vaccine indications

A

covid 19

63
Q

J&J vaccine adverse effects

A

Hypersensitivity reactions, including anaphylaxis
Injection site pain and swelling
Systemic reactions, including fatigue, fever, myalgia, & nausea
Thrombosis with thrombocytopenia
GBS

64
Q

J&J vaccine nursing considerations

A

CDC Advisory Committee on Immunization Practices has made preferential recommendation for mRNA over adenovirus vector vaccines
Patient education, including duration of protection and time between doses
Careful preparation to maximize doses per vial
Follow storage instructions after opening
Intramuscular injection soreness can be treated with OTC analgesics
Monitor patients for 15 minutes post-administration

65
Q

Nirmatrelvir & ritonavir (Paxlovid) MOA

A
66
Q

Nirmatrelvir & ritonavir (Paxlovid) indications

A

symptomatic, nonsevere COVID-19 infection with risk factors for the development of severe COVID-19 infection

67
Q

Nirmatrelvir & ritonavir (Paxlovid) adverse effects

A

Hypertension
Diarrhea, impaired or altered sense of taste
Myalgia
Rebound COVID-19 infection

68
Q

Nirmatrelvir & ritonavir (Paxlovid) nursing considerations

A

Patient education on medication regimen (twice daily x 5 days) and adherence
Numerous drug interactions; thoroughly assess medication usage during the patient interview
Risk of HIV resistance if a patient has an uncontrolled or undiagnosed infection

69
Q

Molnupiravir (Lageviro) MOA

A

incorporated into viral RNA polymerase resulting in viral genome errors and replication inhibition

70
Q

Molnupiravir (Lageviro) indications

A

symptomatic, nonsevere COVID-19 infection with risk factors for development of severe COVID-19 infection

71
Q

Molnupiravir (Lageviro) adverse effects

A

Erythema, rash, urticaria
Hypersensitivity, including anaphylaxis, angioedema

72
Q

Molnupiravir (Lageviro) nursing considerations

A

Alternative outpatient option for those who cannot take Paxlovid
Patient education on medication regimen (twice daily x 5 days) and adherence
Not commercially available; current use is under EUA from AmerisourceBergen
Capsules can be administered with or without food; do not crush, open, or break

73
Q

Remdesevir (Veklury) MOA

A

inhibits RNA polymerase which inhibits viral replication

74
Q

Remdesevir (Veklury) indications

A

COVID-19 infection requiring hospitalization & supplemental oxygen in adult and pediatric patients

75
Q

Remdesevir (Veklury) adverse effects

A

Potentially severe bradycardia
Elevated ALT and AST levels
Hypersensitivity reactions resulting in anaphylaxis, angioedema, rash, etc.
Prolonged prothrombin time

76
Q

Remdesevir (Veklury) nursing considerations

A

Monitor CMP and RUQ s/s
Although unlikely, monitor renal function for impairment for the duration of therapy
Discontinue infusion and provide appropriate interventions if hypersensitivity reactions occur

77
Q

Dexamethasone (Decadron) MOA

A

Decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability

78
Q

Dexamethasone (Decadron) adverse effects

A

Adrenal suppression
Apathy/depression
Cushingoid features
GI effects
Hyperglycemia
Infection

79
Q

Dexamethasone (Decadron) nursing considerations

A

Typical regimen is 6 mg daily x 10 days
Alternative glucocorticoid equivalent may be used if not available
Monitor labs and patient response closely
Patient may require home glycemic control after d/c

80
Q

Dexamethasone (Decadron) indications

A

for off-label use in COVID-19 infection requiring hospitalization, O2 supplementation, MV/ECMO for up to 10 days as monotherapy or with other agents

81
Q

monkeypox and smallpox vaccine MOA

A

attenuated, live, non-replicating smallpox and monkeypox vaccine that elicits humoral and cellular immune responses to orthopoxviruses.

82
Q

monkeypox and smallpox vaccine indications

A

moneypox and smallpox

83
Q

monkeypox and smallpox vaccine adverse effects

A

An allergic reaction can occur after injection (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness)

84
Q

monkeypox and smallpox vaccine nursing consideration

A

Patient education, including duration of protection and time between doses
Allow the vaccine to thaw and reach room temperature before use.
Swirl the vial gently before use for at least 30 seconds
Monitor patients for 15 minutes post-administration

Pharmacology (10 decks)

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