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HIV & medications (pharm test) Flashcards

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1
Q

Pathophysiology of Infection

A

-Bacteria
Single-cell microorganisms
Gram +, gram –
Aerobic and anerobic
Bacilli: rod-shaped
Spirilla: curved or spiral
Cocci: spherical
-Viruses
Smallest pathogen
-Fungi
Yeasts or molds, infect skin or subcutaneous tissue

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2
Q

Antibacterial Drugs

A

Treats Bacterial Infection
-Caused by bacteria: bacilli, cocci, spirilla
-Bacteria release toxins: cause cell lysis
-Antibacterials/antibiotics
-Bacteriostatic drugs: inhibit the growth of bacteria
-Bactericidal drugs: kill bacteria

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3
Q

Mechanisms of Actions of Antibacterial Drugs

A

-Inhibit bacterial cell wall synthesis
-Inhibit nucleic acid synthesis
-Inhibit protein synthesis
-Disrupt cell membrane permeability
-Work as an anti-metabolite
-Inhibit bacterial enzymes

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4
Q

Antibiotic Resistance

A

-From overuse of antibiotics
-Antibiotics in food
-Meat & dairy products
-Clostridium difficile (C. difficile)
-One major cause is the use of antibiotics
-Antibiotics destroy helpful bacteria, allowing C-diff to take over (opportunistic pathogen

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5
Q

“Superbug”

A

-A “Superbug” is an organism that shows significant antibiotic resistance, usually to two or more classes of antibiotics
-Superbugs include:
MRSA, VRSA
VRE
PRP
-MDR anything:
(MDR) Klebsiella
(MDR) Acinetobacter

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6
Q

Factors affecting the use of antibacterial drugs

A

Resistance to antibacterials:
-Natural or inherent resistance
-Acquired resistance
-Cross-resistance (ALWAYS DO C&S FIRST)

Use of antibiotic combinations:
-Effects: additive, potentiates

Nosocomial infections:
-Ex: C-diff, candidiasis

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7
Q

General adverse reactions to antibacterials:

A

-Allergic (Mild: rash or Severe: anaphylactic shock)
-Secondary and opportunistic infections
-Organ toxicity

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8
Q

Narrow-spectrum and broad-spectrum antibiotics:

A

-Narrow spectrum: some penicillins, erythromycin
-Broad spectrum: tetracycline, cephalosporins

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9
Q

Beta-Lactam Antibacterials

A

-Have beta-lactam ring in cell structure
-Inhibit synthesis of bacterial cell walls
-Defective cell wall allows leakage of contents
-Mainly bactericidal
-Drug classes:
Penicillins
Cephalosporins
Carbapenems
Monobactams

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10
Q

ampicillin

A

-Classification: pencillin (PCN), beta-lactam antibiotic
-Can be combined with a beta-lactamase inhibitor to decrease chance of resistance
-Ex: Ampicillin-sulbactram (Unasyn)
-Action: inhibits cell wall synthesis

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11
Q

ampicillin (2)

A

-Uses
Anthrax, endocarditis, tonsillitis, etc.
-Contraindications and Caution:
-Adverse effect: Hypersensitivity reaction
N/V/D
Abdominal pain, gastritis
-Contraindications (CI):
Known hypersensitivity
Renal impairment

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12
Q

Ampicillin Nursing Interventions

A

-Check for Allergies
-Review C&S before giving med
-Monitor for S&S of allergic reaction
Hives, redness, difficulty breathing, chest pain, swelling
-High doses of PCN may decrease platelet aggregation leading to bleeding
-Medi-alert bracelet
-Increase fluid intake and monitor urine output
-Take most without food if can tolerate

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13
Q

Cephalosporins

A

-Broad Spectrum: gram +, gram– (depends on the generation)
There are 5 generations at present

-Prototype: Cefazolin (Kefzol, Ceclor)
First generation

-Indications:
surgical prophylaxis, respiratory, urinary, skin, bone, joint, brain and spinal cord infections

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14
Q

Generations of Cephalosporins

A

-First-generation
Gram + bacteria: E. coli, Klebsiella
-Second-generation
Gram + and –: Neisseria gonorrhorae, Haemophilus influenzae, Neisseria meningitis
-Third-generation
Gram + and –: Pseudomonas aeruginosa
Less effective against gram +
-Fourth-generation
Gram + and –: Streptococci, staphylococci
-Fifth Generation:
Gram + and –
Unlike other cephalosporins, can be used for MRSA and VRSA

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15
Q

Cephalosporin Nursing Interventions

A

-Some cross sensitivity to PCN
-Secondary infections: take full prescription, eat/drink foods with probiotics (yogurt, buttermilk)
-Can cause nephrotoxicity in clients with known renal disease
-Take with food to help prevent GI upset
-Educate about decreased effectiveness of birth control

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16
Q

gentamicin

A

-Classification: Aminoglycoside
-Action: inhibits protein synthesis
-Uses: gram neg aerobic microorganisms; severe systemic infections (not responsive to other drugs)
-E. coli, Proteus pseudomonas
-Adverse effects: N/V, rash, peripheral neuropathy, tinnitus, ototoxicity, nephrotoxicity

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17
Q

gentamicin (cont’d)

A

-Contraindications and caution: renal impairment, neuromuscular disorders, pregnancy & hypersensitivity
-Nursing:
Check C&S
Monitor peak/trough
Monitor urine output, BUN, and Creatinine
Give IM or IV
Administer IV slowly

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18
Q

ciprofloxacin (Cipro)

A

-Classification: Fluoroquinolone (quinolone)
-Action: interferes w/ enzymes needed for synthesis of bacterial DNA
-Uses: gram neg; some gram pos
Bone & joint infections
Bronchitis & pneumonia
Gastroenteritis
UTI
Anthrax

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19
Q

ciprofloxacin (Cipro) (cont’d)

A

-Adverse effect: N/V, rash, urticaria, tendonitis, photosensitivity, secondary infection (yeast, Clostridium difficile)
-Contraindications: Renal impairment, pregnancy & hypersensitivity
-Increased incidence of resistance due to overuse
-Nursing Interventions:
Need to stay hydrated, monitor I&O
No antacids for 2 hrs before or 6 hrs after oral dose
Instruct client to report s/s of thrush/yeast or C. difficile
Report any Achilles tendon pain or edema, especially when walking
Wear sunscreen & protective clothing when in the sun

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20
Q

tetracycline hydrochloride (Sumycin)

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A

-Classification: Tetracycline
-Action: Inhibits microbial growth by preventing protein synthesis
-Uses: gram pos, gram neg (some resistance)
Fights Helicobacter pylori
Treats acne (oral, topical)
-Common: doxycycline (Vibramycin)
-AE: n/v/d, rash, urticaria, esophagitis, photosensitivity, hepatotoxicity, secondary infection (yeast, C. difficile)
-CI: liver disease, pregnancy, hypersensitivity, renal impairment (for some tetracyclines)

21
Q

Tetracycline Nursing Interventions

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A

-Wear sunscreen and protective clothing when out in the sun
-Oral contraceptives rendered less effective
-Avoid giving to children under 8 due to permanent teeth discoloration or in pregnancy due to baby teeth discoloration of fetus
-Instruct client to report any s/s of a secondary infections
-Yeast/thrush
-C-diff

22
Q

sulfamethoxazole-trimethoprim (Bactrim)

Study These Flashcards
A

-Classification: Sulfonamide
-Action
-Inhibit bacterial synthesis of folic acid (folate antagonist)
Bacteriostatic (topical for burn related infections is bactericidal)
-Uses
Fights gram neg, gram pos bacteria
Klebsiella, E. coli, Shigella enteritis
UTI’s, respiratory infections, otitis media
Treat infection r/t 2nd and 3rd degree burns (topical)
-CI: renal impairment, hypersensitivity, pregnancy

23
Q

sulfamethoxazole-trimethoprim (Bactrim) (cont’d)

Study These Flashcards
A

-Adverse effects
Anorexia, N/V/D, rash, pruritis hyperkalemia, fatigue, crystalluria & photosensitivity

-Adverse Reaction
Life-threatening: leukopenia, thrombocytopenia, increased bone marrow depression, aplastic anemia, Stevens-Johnson syndrome & renal failure

24
Q

Nursing Interventions for Sulfonamides

Study These Flashcards
A

-Increase fluid intake to at least 2000 mL/day
-Check I & O
decreased risk of crystalluria
-Monitor CBC and renal function
-Monitor for rash, secondary infection
-Avoid during third trimester
-Effectiveness of contraceptives may be decreased
-Wear sunscreen and protective clothing in the sun

25
erythromycin (Erythrocin)
-Classification: macrolide -Common: azithromycin (Zithromax, Z-Pak) -Action: inhibits protein synthesis Bacteriostatic: low to moderate doses Bactericidal: high doses -Uses Respiratory infection; skin, soft tissue infection, chlamydia Ointment: newborns to prevent chlamydial conjunctivitis
26
erythromycin (Erythrocin) (cont’d)
Contraindications -hypersensitivity, hepatic dysfunction, pregnancy, lactation -Adverse Effects N/V/D, anorexia, abd cramps, rash, tinnitus & pruritis -Adverse reaction Secondary infections (c-dif), hearing loss, anaphylaxis, hepatotoxicity -Contraindications hypersensitivity, hepatic dysfunction, lactation
27
Nursing Interventions for Macrolides
-Check for allergies -Check liver enzymes -Report changes in skin color (jaundice) -Can give antacids 2 hrs before or 6 hrs after med, not with the med -Can give with food if GI upset -Contraceptives may have decreased effectiveness -Report s/s of secondary infection
28
vancomycin (Vancocin)
-Class: Glycopeptide -Action: inhibits cell wall and RNA synthesis, fights gram + -Uses oral for bacterial colitis—not absorbed from the GI tract, acts within the bowel lumen -IV for serious infections Bone Skin Lower respiratory tract MRSA
29
vancomycin (cont’d)
-Adverse Effects Chills, dizziness, fever, rashes, N/V, thrombophlebitis at inj. Site -Adverse Reactions Ototoxicity Nephropathy Stevens-Johnson syndrome Severe hypotension Tachycardia Cardiac arrest Red man syndrome or red neck syndrome (occurs with too rapid infusion- histamine release) -CI hypersensitivity, previous hearing loss (caution: impaired kidney function & renal failure)
30
Acquired Immune Deficiency Syndrome (AIDS)
Caused by human immunodeficiency virus (HIV) -Retrovirus: virus that has an enzyme capable of making a complementary DNA copy of the viral RNA, which then is integrated into a host cell’s DNA, so that host cell will replicate the virus for it -Transmitted by blood to blood or secretion contact
31
Phases of HIV/AIDS
1. Primary infection 2. Latency Phase 3. AIDS phase
32
HIV Transmission
-Infectious fluids: blood, semen, rectal & vaginal fluids, breast milk -Especially in the early & late phases of the disease -Breaks or abrasions in the skin allow the virus into the host -Modes of transmission: Sexual contact Infected needles Infected blood products Blood to open mucus membrane Maternal fetal transmission/childbirth Breastfeeding
33
HAART
Highly active antiretroviral therapy (HAART) is a combination therapy that is the current treatment recommendation Goals of HAART: -Decrease VL to undetectable levels -Preserve and increase number of CD4+ T cells -Prevent resistance -Have client in good clinical condition -Prevent opportunistic infections and cancers
34
HAART (cont’d)
Types of Antiretroviral Agents: Fusion Protein Inhibitors Integrase Inhibitors CCR5 Antagonist NRTIs NNRTIs PI
35
CCR5 Antagonist
-MOA: prevents the interaction of HIV-1 and CCR5 that is needed for HIV to enter the cell -Prototype: Maraviroc (Selzentry) -May lead to drug-induced hepatoxicity after one month of use -Used in combination with other meds
36
CCR5 Antagonist (cont’d)
-AE: cough, fever, rash, HTN, dizziness, anxiety, depression -CI: liver and kidney impairment -Nursing Interventions: -High fat food enhances absorption -Monitor liver enzymes, BUN, CrCl
37
Fusion Protein Inhibitors
-MOA: inhibits fusion of the virus to the host cell which prevents HIV cell entry -Prototype: enfuvirtide (Fuzeon) -Expensive -Used in combination with 3-5 other agents -AE: inj site reactions (sub-q), rash, fatigue, diarrhea, nausea -Nursing Interventions: -Administer subcutaneously -Can use upper arm, abdomen, or thigh
38
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
-MOA: block reverse transcriptase needed for viral replication -Uses: slow progression, prevent transmission to fetus -Prototype NRTI: zidovudine (Retrovir) Used in combination with 2 or more antiretrovirals
39
Nucleoside Reverse Transcriptase Inhibitors (NRTIs) (cont’d)
-AE: anemia, neutropenia, n/v/d, headache, malaise, hepatomegaly -Adv. Reaction: lactic acidosis -Nursing Interventions: Monitor CBC & liver enzymes Monitor for lactic acidosis Monitor for opportunistic infections
40
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
-MOA: Prevent viral replication by binding with reverse transcriptase -Given in combination with other antiretrovirals -Major Disadv: prevalence of NNRTI-resistant viral strains & low genetic barrier of NNRTIs for development of resistance -Prototype: efavirenz (Sustiva)
41
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
-AE: dizziness, headache, depression, fever, fatigue, skin rash -Adv Reaction: Steven-Johnson Syndrome -CI: liver impairment, hypersensitivity, pregnancy (cat. D) -Nursing Interventions: Monitor for rash Monitor liver enzymes
42
INTEGRASE INHIBITORS
-MOA: blocks integrase to prevent virus replication -Prototype: Raltegravir (Isentress) -Must be used in conjunction with HAART for patients with resistance to other regimes -AE: n/v/d, headache, fever, abdominal pain
43
INTEGRASE INHIBITORS (cont’d)
-Adverse Reaction: rhabdomyolysis -Cautious use in patients taking medications that can cause muscle problems, such as, “statins”. Increases risk of rhabdomyolysis -Rhabdomyolysis can cause myoglobinuria which can lead to renal failure
44
Protease Inhibitors
-MOA: inhibit HIV protease, results in noninfectious immature HIV particles -Prototype: Saquinivir mesylate (Invirase) -Often used in combination with 2 NRTIs -C/I: use with ergot alkaloids can cause ergot toxicity, hepatic impairment, & conditions that cause QT prolongatio
45
Protease Inhibitors (cont’d)
-AE: N/V/D, peripheral neuropathy, depression, anxiety, rash, pancytopenia, chest pain, hyperglycemia (in diabetics) -Nursing Interventions: Monitor liver enzymes & CBC -Monitor ECG for QT prolongation -Give with meals to improve absorption
46
Adherence
-Adherence to regimen is major concern -Causes of nonadherence: Financial concerns/resources Life-long treatment commitment Multi-medication schedule (pill burden) -Nonadherence results in: Viral replication, increased VL Deterioration of the immune system Development of resistant viral strains
47
Antiretroviral Therapy: Pregnancy, Labor, Newborn
-Zidovudine (Retrovir) -Pregnant women – to prevent mother to baby transmission in HIV -Start during pregnancy -If mother did not receive during pregnancy, start during labor -Newborns -Given Retrovir for 4-6 weeks after birth
48

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