UNIT 3 EXAM Flashcards
(158 cards)
1
Q
Microbiology
A
Study of microscopic organisms
2
Q
Bacteria
A
Single-celled, prokaryotic organisms
3
Q
Normal Flora
A
Good bacteria that is found in the GI tract, nose, mouth, and on skin that keeps us healthy
4
Q
Pathogen
A
An organism that produces an infection or disease
5
Q
Defense Mechanisms
A
Our body’s response to something foreign (white blood cells, skin, immune response) that prevents/protects from infection
6
Q
Antibiotics
A
drugs (or chemicals) that interfere with the life-process of a pathogen, making them incapable of reproducing and, in some cases, killing.
7
Q
Staphylococcus aureus
A
often cause skin infections
8
Q
Streptococcus pyogenes
A
causes strep (a disease that results in a sore throat (pharyngitis)
9
Q
Streptococcus pneumoniae
A
bacterium that causes infections: otitis media, sepsis, and community-acquired pneumonia, and meningitis
10
Q
Cocci
A
spherical bacteria
11
Q
Bacilli
A
rod-shaped bacteria
12
Q
Spirilla
A
Curved-rods
13
Q
Strepto
A
Chains
14
Q
Staphylo
A
clusters
15
Q
Diplo
A
Pairs
16
Q
Gram positive
A
retain blue stain from crystal violet (purple)
17
Q
Gram negative
A
retain red stain from safranin (red)
18
Q
Antibiotic Sensitivity
A
ID the bacteria to identify which antibiotics will be effective;
response to antibiotic therapy varies with different types of bacteria
19
Q
Culture and Sensitivity
A
test performed to ID bacteria and determine antibiotic susceptibility;
take a specimen/sample;
add antibiotics to medium to determine what antibiotics are effective;
newer technologies give faster results for some organisms
20
Q
Empiric Therapy
A
initiate drug therapy before ID;
use a broad spectrum antibiotic;
may change drug choice after ID and sensitivity are detrmined
21
Q
Antibacterial Agents
A
Bacteriostatic;
Bactericidal
22
Q
Bacteriostatic Agents
A
inhibit reproduction and growth of bacteria;
elimination of bacteria is more dependent on the immune system (leukocytes, macrophages)
23
Q
Bactericidal Agents
A
drugs that kill bacteria
24
Q
Antibiotics NOT EFFECTIVE
A
fungal infection,
virus,
parasites
25
Antibiotics EFFECTIVE
bacteria;
cancer
26
Bacterial Resistance
antibiotic becomes ineffective as bacteria resist its actions;
may occur:
1) bacteria produce enzymes that inactivate the antibiotic
ex: penicillinase, cephalosporinase
2) antibiotic cannot penetrate cell wall of bacterium; bacterium alters cell wall
27
Penicillinase
destroy penicillins
28
Cephalosporinase
destroys cephalosporins
29
Chemoprophylaxis
use of antibiotics before a bacterial infection has developed;
i.e. prior to abdominal surgery, gunshot wound, knee/hip replacement, history of heart valve replacement, exposure to TB or other contagious disease
30
Superinfection
Overgrowth of bacteria over a earlier one not treated by the medication administered initially;
could be caused by the elimination of normal flora;
ex: diarrhea, oral thrush, vaginal yeast
31
Common Antibiotic Side Effects
N/V/D and photosensitivity
32
Serious Antibiotic Side Effects
ototoxicity (temporary or permanent);
nephrotoxicity;
hepatotoxicity
33
Allergic Reactions
skin rash/hives;
pruritis (itching);
pyrexia (fever);
shortness of breath;
edema;
anaphylaxis (airway swells, multi-organ failure; give EPI)
34
Four Basic MOA (Antibiotics)
Cell Wall Synthesis Inhibitors
Protein Synthesis Inhibitors
Folate Biosynthesis Inhibitors
Nucleic Acid Synthesis Inhibitors
35
Antibiotics: Cell Wall Synthesis Inhibitors
Penicillins
Beta Lactamase Inhibitors
Penicillin Combo Drugs
Cephalosporins
36
Penicillin
bactericidal;
mold;
MOA: beta lactam ring binds to and inhibits bacterial enzymes to work in cell wall synthesis;
loss of osmotic pressure, cell lysis, loss of nutrients, and cell death
USES: strep, staph, UTI, upper and lower respiratory infections, otitis media
PATIENT TEACHING/SIDE EFFECTS: N, D, rash, inflammation at injection site of given parenterally
37
Parenteral Drug Administration
IV, IM, Sub q
38
PENICILLINS
1) penicillin (Veetids)
2) amoxicillin (Amoxil)
3) ampicillin (Principen)
4) didoxacillin (Dynapen)
39
Four Generation of Penicillin
Generation 1: narrow spectrum; effective against gram positive bacteria; given orally and parenterally
Generation 2: spectrum is broader, covering more of the gram negative bacteria; given orally or parenterally
Generation 3: broader spectrum of activity than Generation 2; drugs given orally or parenterally
Generation 4: the widest spectrum of activity with the most potent effects; these are given parenterally; good for patients who are on Na+ restricted diets
40
Antibiotics: Beta-Lactamase Inhibitors
Bactericidal;
MOA: inhibit enzymes produced by bacteria called penicillinases that deactivate PCN and make it ineffective; also inhibit cell wall synthesis
USES: when bacteria are resistant to PCN; upper/lower respiratory infections, UTI, otitis media, strep, staph
PATIENT TEACHING/SIDE EFFECTS: N, D, rash, inflammation at the injection site, cannot take if allergic to PCN
41
Antibiotics: Beta-Lactamase Inhibitors
bactericidal;
clavulante + amoxicillin = Augmentin
sulbactam + ampicillin = Unasyn
tazobactam + piperacillin = Zosyn
42
Antibiotics: Caphalosporins
bactericidal;
MOA: inhibits cell wall synthesis of bacteria;
loss of osmotic pressure, cell lysis, loss of nutrients, and cell death
USES: strep, staph, upper/lower respiratory infections, otitis media, pneumonia, UTI, when a patient is allergic to penicillin, pre-op prophylaxis
PATIENT TEACHING/SIDE EFFECTS: 20% cross-sensitivity for allergy to penicillin and cephalosporins, GI upset, diarrhea, rash, some cause disulfiram reaction when alcohol is used, cefdinir (Omnicef) might cause bright red stools
43
CEPHALOSPORINS
1) cephalexin (Keflex)
2) cefotetan (Cefotan)
3) ceftriaxone (Rocephin)
4) cefador (Cedor)
5) cefixime (Suprax)
6) cefadroxil (Duricef)
7) cefdinir (Omnicef)
44
Four Generations of Cephalosporins
First Generation: active against some gram positive and negative bacteria.
Second Generation: broader than first generation; more potent.
Third Generation: broader than second generation.
Fourth Generation: greater resistance to beta-lactamase inactivating enzymes
45
Antibiotics: Protein Synthesis Inhibitors
1) Tetracyclines
2) Macrolides
3) Aminoglycosides
4) Lincosamides
46
Antibiotics: Tetracyclines
Bacteriostatic;
MOA: bind to ribosomes and interfere with protein synthesis of bacteria
USES: acne, lower respiratory tract infection, chlamydia, skin infections
PATIENT TEACHING/SIDE EFFECTS: N/V/D, photosensitivity, yellowing of teeth and deposits into growing bones - not recommended for children or women who are pregnant (Category D); do not take with dairy products , antacids and Fe+ tabs (decrease effectiveness), nephrotoxicity, hepatoxicity, superinfection, take 1 hour before meals and few hours after meals, do not take outdated drugs - Fanconi syndrome involving kidneys
47
ANTIBIOTICS: TERACYCLINES
bacteriostatic;
tetracycline (Achromycin)
doxycycline (Vibromycin)
minocycline (Minocin)
48
Antibiotic: Macrolides
mostly bacteriostatic;
MOA: inhibits protein synthesis;
USES: ear, nose, throat infections;
chlamydia;
pneumonia
PATIENT TEACHING/SIDE EFFECTS: GI disturbances, arithromycin (Z-Pak) has shown an elevation in LFTs and arrythmias, should have a gap between time of taking antacids and meds, clarithromycin (Biaxin) - metallic taste in the mouth, arithromycin (Z-Pak) loads on day 1 with 2 tabs
49
ANTIBIOTICS: MACROLIDES
erythromycin;
clarythromycin (Biaxin);
azithromycin (Zithromax, Z-Pak)
50
Antibiotics: Aminoglycosides
bactericidal;
MOA: diffuse through bacteria's cell membrane into cytoplasm, bind to bacterial ribosomes and inhibit protein synthesis;
USES: before/after abdominal/intestinal surgery;
conjunctivitis;
otitis media;
bronchitis;
Staph infections ;
serious gram negative bacilli
PATIENT TEACHING/SIDE EFFECTS: when administered parenterally: ototoxicity and nephrotoxicity, tinnitus is a sign of ototoxicity, hearing loss may be permanent or temporary, N/V/D, may interfere with renal - oliguria
51
ANTIBIOTICS: AMINOGLYCOSIDES
bactericidal;
streptomycin;
gentamicin (Garamycin);
tobramycin (Tobrex)
52
Antibiotics: Lincosamides
bacteriostatic;
MOA: inhibit protein synthesis;
USES: deep tissue infections, acne;
DRUGS: clindamycin (Cleocin);
PATIENT TEACHING/SIDE EFFECTS: diarrhea, allows overgrowth of C. diff (that causes diarrhea and colitis), pseudomembranous colitis (a severe inflammation of inner lining of large intestine)
53
Antibiotics: Sulfonamides
bacteriostatic;
MOA: inhibit the synthesis of folic acid -> inhibit growth
USES: burns, skin infections, acne
PATIENT TEACHING/SIDE EFFECTS: N/V/D, photosensitivity, crystalluria - crystals in urine causing cell damage, must have adequate fluid intake to prevent crystalluria , blood in the urine, reduced urine output;
blood disorders: anemia, leukopenia, thrombocytopenia, meds commonly have an odor, monitor for rash/Stevens-Johnsons syndrome, increases effects of coumadin (Warfarin) and hypoglycemia drugs
54
ANTIBIOTICS: SULFONAMIDES
bacteriostatic;
sulfamethoxazole/trimethoprin (Azulfidine);
sulfasalazine (Ganstrin);
sulfisoxazole (Silvadene);
silver sulfadiazine (Sulamyd)
55
Antibiotics: Nucleic Acid Synthesis Inhibitors
Fluoroquinolones (bactericidal)
56
Antibiotics: Fluoroquinolones
bactericidal;
MOA: inhibits an enzyme needed for synthesis of bacterial DNA and bacterial replication;
USES: UTI, GI, respiratory, soft tissue, bone and joint infections, anthrax, conjunctivitis
PATIENT TEACHING/SIDE EFFECTS: dizziness, HA, photosensitivity, crystalluria, drowsiness or anxiety, GI disturbances, rash, tendon rupture/tendinitis, if patient is over 60 and on steroids/increases the risk of tendon rupture, avoid iron, zinc, antacids several hours before and after dozing
NEW WARNINGS: black box warning - in a black box,
mental health effects - disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium,
hypoglycemic effects, severe joint pain, and debilitating musculoskeletal effects, peripheral neuropathy, and rupture of aneurysms, do not use in patients with history of blockages or aneurysms
57
ANTIBIOTOCS: FLUROQUINOLONES
ciprofloxacin (Cipro);
levofloxacin (Levaquin);
moxifloxacin (Avelox)
58
Antibiotic: vancomycin (Vancocin)
bactericidal;
MOA: inhibits cell wall synthesis;
USES: last resort - superbugs, Methicillin Resistant Staph Aureus (MRSA), enterococcal infections, pseudomembranous colitis
PATIENT TEACHING/SIDE EFFECTS: vancomysin-flushing syndrome - flushing of neck and upper body due to histamine release, ototoxicity, nephrotoxicity, fever, chills, phlebtis (inflammation of a vein) at injection site
59
Antibiotic: metronidazole (Flagyl)
bactericidal;
MOA: binds to bacterial DNA and breaks it apart
USES: bacterial and protozoa infections (intestinal and vaginal), Clostridium difficile, skin infections
PATIENT TEACHING/SIDE EFFECTS: GI upset, metallic taste, dizziness, ataxia, disulfiram type reaction with alcohol (N/V and severe HA)
60
Antibiotics: Urinary Tract Agents
Urinary Tract Antiseptic;
Urinary Tract Analgesic
61
Antibiotic: Urinary Tract Antiseptic
nitrofurantoin (Macrodantin);
bactericidal;
MOA: damages bacterial DNA;
PATIENT TEACHING/SIDE EFFECTS: adequate hydration
62
Urinary Tract Analgesic
phenazopyridine (Pyridium);
USE: combo drug therapy with antibiotic for UTIs, provides pain relief;
PATIENT TEACHING/SIDE EFFECTS: changes color of urine to orange, hydrate
63
Preventing Infections
Antiseptics;
Disinfectants
64
Antiseptics
chemicals applied to only living tissue, without killing or harming tissue
i.e. alcohol (rubbing), Hibiclens, Betadine
65
Disinfectants
chemicals used on non-living objects (equipment and countertops)
i.e. Formaldehyde
helps prevent nosocomial infections: hospital acquired
66
Preventing Infections and Resistance
use good handwashing;
cover your mouth when coughing (using the bend of the arm; keep your hands clean);
take antibiotics as prescribed;
don't share medications;
take the entire regimen; don't save half for next time you get sick
67
Fungus
yeast or mold;
plant-like;
found in soil, air, contaminated foods
68
Mycotic infection
fungal infection;
symptoms: itching, redness, blisters, broken skin, inflammation of scalp, burning/discomfort
69
Fungal Infections
System Infections;
Dermatophytic Infections;
Candidiasis
70
System Infections
may involve multiple organs; invasive;
may involve blood, heart, lungs, GI tract, urinary tract, common in immunocompromised patients (HIV, chemo, neutropenic patients, etc) and patients in ICU
71
Dermatophytic Infections
skin, hair, nails (athlete's foot, ringworm); immune system blocks penetration to other tissue layers
72
Candidiasis
superficial infections of skin and mucous membranes (vaginal yeast, thrush - oral yeast); may be a result from elimination of normal flora from antibiotic use or inhaled corticosteroids (must always rinse after)
73
Antifungals
treat mycotic infection;
selective spectrum of activity: fungicidal and fungistatic
74
Antifungal: amphotericin B (Fungizone)
systemic agent;
usually fungicidal;
MOA: binds to ergosterol which is needed for fungal cell membrane integrity; electrolytes leak out due to the formation of pores
PATIENT TEACHING/SIDE EFFECTS: chills, fever, muscle spasms, HA, V, hypotension;
may be given pretreatment meds t help with side effects (NSAID, steroids or diphenhydramine);
given IV-invasive for administration; monitor blood, liver, kidney functions (hypokalemia, hypomagnesemia)
75
Antifungal: griseofulvin (Grisactin)
used for dermatophytic infections;
fungicidal
MOA: binds to keratin so fungi cannot utilize or infect it, bind to lipids of actively growing fungi and inhibits cell reproduction
PATIENT TEACHING/SIDE EFFECTS: treatment is 4-6 weeks for hair/scalp infections, 3-4 months for fingernail treatments, 6 months for toenail infections; NVD, photosensitivity, HA, rash
76
azoles
fungistatic or fungicidal depending on dosage, treats candidiasis ad dermatophytic infections, can be alternative to amphotericin B;
MOA: prevent formation of ergosterol which is needed for fungal cell membrane integrity, nutrients leak out to fungal cell destruction
PATIENT TEACHING/SIDE EFFECTS: GI upset, fever, rash, skin peeling, hepatoxicity, photosensitivity, arrhythmias
77
Strep throat/streptococcal pharyngitis
a bacterial infection that may cause a sore, scratchy throat, swollen glands and fever;
generally transmitted by direct contact with the mucus or sores of someone else with strep
78
Antifungals: Azoles
ketoconazole (Nizoral);
miconazole (Monistat);
fluconazole (Diflucan);
clotrimazole (Lotrimin)
79
Antifungal: nystatin (Mycostatin)
USES: candidiasis of skin and mucous membranes (vaginal, intestinal, oral yeast - especially in peds), safe for use during pregnancy
MOA: binds to ergosterol which is needed for fungal cell membrane integrity, changes the fungal cell permeability, electrolytes leak out due to formation of pores
PATIENT TEACHING/SIDE EFFECTS: N/V/D
80
DRUG OF CHOICE (Systemic Infection)
amphotericin B (Fungizone IV)
81
DRUG OF CHOICE (Dermatophytic Infection)
griseofulvin (Grisactin)
82
DRUG OF CHOICE (Candidiasis Infection)
fluconazole (Diflucan)
83
DRUG OF CHOICE (Oral Thrush in Peds)
nystatin (Mycostatin)
84
Malaria
infectious disease of the circulatory system and liver;
widespread in Africa, Asia, and South America;
protozoan parasite Plasmodium: carried by the Anopheles mosquito and injected directly into human bloodstream when bitten;
invade liver and RBCs (causing RBCs to rupture)
85
Symptoms of Malaria
shivering/chills
fever
sweating
a decrease in RBCs (anemia and weakness)
Jaundice
86
Antimalarials
drugs used for prophylaxis, for an acute attack, and to cure by eradicating all parasites from the body;
no vaccine
87
Antimalarials
protozoa-cidal;
prophylaxis and treatment of malaria
DRUGS: hydroxychloroquine (Plaquenil)
mefloquine (Lariam)
chloroquine (Aralen)
88
Antimalarial: hydroxychloroquine (Plaquenil)
protozoa-cidal;
MOA: acts on DNA inhibiting enzyme-activity;
anti-inflammatory tx for lupus and RA
PATIENT TEACHING/SIDE EFFECTS: stomach pains, HA, N, retinopathy, take one week before travel, weekly during travel, and 4 weeks after leaving the endemic area
89
Antimalarial: mefloquine (Lariam)
protozoa-cidal;
MOA: acts on erythropatic stages of Plasmodium (not hepatic stages)
PATIENT TEACHING/SIDE EFFECTS: dizziness, difficulty sleeping, anxiety, vision disturbances, not be taken with other cardiac drugs - cardiotoxicity, Stevens-Johnson syndrome, taken once a week starting two weeks before travel/during travel/and take 4 weeks after leaving the endemic area
90
Antimalarial: chloroquine (Aravel)
protozoa-cidal;
MOA: accumulates in parasites, binds to critical metabolic substances, breaks down Plasmodia membranes and kills the organisms;
also treats amoebic dysentery, leg cramps, lungs, and RA
PATIENT TEACHING/SIDE EFFECTS: N, D, blurred vision, HA, vertigo, can cause anemia and leukopenia, take one week before travel/during travel/and 4 weeks after leaving the endemic area
91
Anthelmintics
work on parasitic worms in intestines; usually contracted by contaminated food or soil ingested;
Symptoms: D,V, loss of appetite, itching - anal, abdominal cramps, weight loss
92
Anthelmintics
facilitate elimination of parasitic worms;
DRUGS: mebendazole (Vermox)
thiabendazole (Mintezol)
MOA: paralytic; combo with laxative
PATIENT TEACHING/SIDE EFFECTS: N, D, fever, HA, cramps
93
Tuberculosis (TB)
leading infectious killer on earth (about 2 million people die from TB yearly);
caused by mycobacterium tuberculosis;
affects the lungs, but can also affect the brain, spinal cord and kidneys;
can lie dormant for years;
increase in bacterial resistance to ANTI-TB drugs;
contacted by contaminated droplets from an infected individual who has sneezed or coughed
94
Tuberculosis (TB) Symptoms
weight loss, fever/chills, malaise, night sweats, persistent cough (sometimes produces blood); loss of apetite
95
Tuberculosis Diagnosis
Mantoux Test and Blood Tests (Quantiferon or T-SPOT)
Chest X-Ray
Sputum Test
96
Mantoux Test
used to diagnose tuberculosis;
purified protein derivative,
skin test;
measures induration (soft tissue becomes harder and thicker due to inflammation);
return in 48-72 hours for reading;
two-step test - return for a second test in 1-3 weeks
97
BCG vaccine
for TB;
not widely used in the US, given to high-risk individuals;
can cause a false positive skin test
98
Treatment for TB (4-drug regimen)
isoniazid (INH, Nydrazid)
rifampin (Rifadin)
pyrazinamide (Tetrazide)
ethambutol (Myambutol)
USE: TB tx and prophylaxis
PATIENT TEACHING/SIDE EFFECTS: can cause flu-like symptoms, GI upset, take the full regimen
99
isoniazid (INH, Nydrazid)
inhibits bacterial cell wall synthesis;
can cause hepatitis and peripheral neuritis (numbness in hands - vitamin B6 helps prevent neuritis), avoid alcohol
1 of the 4 drugs (TB regimen)
100
rifampin (Rifadin)
inhibits RNA synthesis of bacteria;
stains urine, tears and body fluids orange (avoid wearing contacts)
1 of 4 TB drugs (regimen)
101
pyrazinamide (Tebrazide)
inhibits bacterial replication;
can cause hyperuricemia and symptoms of gout
1 of 4 TB drugs (regimen)
102
ethambutol (Myambutol)
inhibits bacterial cell wall synthesis;
can cause optic neuritis;
eye exams before and after treatment
103
Drug Resistance with TB
if shown, do not complete the full course of treatment;
occurs if healthcare providers prescribe the wrong tx (wrong dose or length of time);
drugs are not available;
drugs are of poor quality;
patients do no take all of their drugs;
develop TB after previously treated;
patients come from areas in the world where drug-resistant TB is common;
have spent time with someone who is TB resistant
104
Virus
small infectious agent;
invades a living cell to survive;
cannot reproduce without a host;
contain genetic material (DNA or RNA) and an outside lipid layer;
use cell host to replicate itself;
can cause influenza A & B, chicken pox, mononucleosis, cold sores, common cold, pneumonia, GI illness, HIV-AIDS
105
HIV
Human Immunodeficiency Virus;
RNA virus/retrovirus;
contains reverse transcriptase (reverses normal cell processes and reproduces by transcribing in DNA);
infects the T-helper cells (CD4) and the macrophages of the immune system; immunosuppression;
no vaccine (research continues), rapidly replicates and mutates so frequently that it becomes unrecognizable to host immune cells;
contains single strand RNA to double strand DNA to make more retroviruses;
contains integrase;
allows viral DNA t enter host nuclei and chromosomes
106
HIV Transmission
person to person by sexual contact (vaginal or anal intercourse), contaminated blood via transfusion, fetal infection in utero, sharing contaminated needles (IV drug use) or accidental needle stick
107
HIV Per CDC
40,000 new cases per year in the US
108
HIV Diagnosis
antigen, antibody, and/or virus in blood or oral fluid;
no cure;
after infection, usually acute illness followed by clinical latency (may last 3 to 10 years)
109
Signs and Symptoms of HIV
altered mental status, adenopathy/lymphadenopathy, cough, D, difficulty swallowing, fatigue, fever, HA, numbness, oral, retinal, skin lesions, shortness of breath, sweating, vision changes, weakness, weight loss
110
AIDS Diagnosis
caused by HIV;
when CD4 helper cell count (T-lymphocytes) drops to less than 200;
presence of opportunistic disease
111
Opportunistic Disease
diseases that would not affect a healthy individual (severe immunosuppression);
include herpes, candida, Cytomegalovirus (CMV) - herpes virus causing hepatitis and encephalitis;
Pneumocystis jirovecii pneumonia (PCP) - fungal;
Toxoplasmosis - parasitic infection, infected meat or in cat litter;
TB
112
Treatment of HIV/AIDS
no definitive cure, but have seen cure in some patients undergoing chemotherapy followed by stem cell transplants and patients with undetected viral loads on antiretrovirals;
improve quality of life and immune function
113
ART (Antiretroviral therapy)
polypharmacy;
attack different stages of viral life cycle
114
6 Antiretroviral Agents (Anti-HIV)
Nucleotide Reverse Transcriptase Inhibitors;
Non-Nucleotide Reverse Transcriptase Inhibitors;
Protease Inhibitors;
Fusion Inhibitors;
Entry Inhibitors;
HIV Integrase Strand Transfer Inhibitors
115
The HIV life cycle
Binding (attachment)
Fusion
Reverse Transcription
Integration
Replication
Assembly
Budding
116
Antiretroviral Agents: Nucleotide Reverse Transcriptase Inhibitors (NRTI)
MOA: compete for a spot in DNA chain; inhibits reverse transcriptase and viral synthesis
PATIENT TEACHING/SIDE EFFECTS: peripheral neuropathy, bone marrow suppression, GI upset, monitor kidney and liver function
117
Antiretroviral Agents: Nucleotide Reverse Transcriptase Inhibitors (NRTI) drugs
zidovudine (AZT; Retrovir)
didanosine (ddl) (Videx)
starudine (d4T) (Zerit)
lamivudine (3TC) (Epivir)
emtricitabine (FTC) (Emtrivia)
tenofovir disoproxil fumarate (TDF) (Viread)
118
Antiretroviral Agents: Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI)
MOA: bind to enzyme reverse transcriptase, inhibiting protein synthesis without harming human DNA activity
PATIENT TEACHING SIDE EFFECTS: monitor kidney and liver function
119
Antiretroviral Agents: Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI) drugs
clelavirdine (Rescriptor)
nevirapine (Viramune)
efavirenz (Sustiva)
120
Antiretroviral Agents: Protease Inhibitors
MOA: inhibit HIV protease (enzyme needed for protein synthesis)
PATIENT TEACHING/SIDE EFFECTS: GI upset, weakness, HA
121
Antiretroviral Agents: Protease Inhibitors drugs
saquinavir (Fortovase)
ritonavir (Norvir)
indinavir (Crixivan)
nelfinavir (Viracept)
122
Antiretroviral Agents: Fusion Inhibitors
MOA: interferes with entry of virus into the host cell by preventing the HIV fusion sequence
DRUG: enfuvirtide (T-20; Fuzeon)
PATIENT TEACHING/SIDE EFFECT: GI upset, HA, muscle/joint pain, monitor liver function
123
Antiretroviral Agents: Entry Inhibitors
MOA: blocks HIV attachment to host cell and prevents it from penetrating host cell
DRUG: maraviroc (Selzentry)
PATIENT TEACHING/SIDE EFFECTS: cough, GI upset, muscle/joint discomfort, respiratory infections
124
Antiretroviral Agents: HIV Integrase Strand Transfer Inhibitors
MOA: blocks enzyme produced by the retrovirus that enables its genetic material to be integrated into host DNA
DRUG: raltegravir (Isentress)
PATIENT TEACHING/SIDE EFFECTS: GI upset, fatigue, HA, dizziness, insomnia
125
Monitoring of HIV
Viral Load (plasma HIV RNA)
-the lower, the better
CD4 count
-the higher, the better
126
Virus: Influenza
Flu virus;
A&B;
head and chest congestion, fever, muscle/body aches, cough, rhinorrhea, sneezing;
spread by contact to mouth or inhaling contaminated droplets into respiratory tract;
secondary infections: bacterial, otitis media, pneumonia, bronchitis
127
Herpes Simplex Virus
painful, viruses are found in fluid-filled blisters
HSV-1 mostly oral, fever blisters, cold sores (can cause genital blisters - less common)
HSV-2 genital blisters
avoid kissing/sharing utensils if oral; avoid intercourse if genital (can affect method of childbirth)
128
Antivirals
acyclovir (Zovirax)
valacyclovir (Valtrex)
amantadine (Symmetrel)
oseltamivir (Tamiflu)
zanamivir (Relenza)
PATIENT TEACHING/SIDE EFFECTS: GI upset, HA, joint/muscle pain, monitor kidney and liver function (acyclovir and valacyclovir)
129
Antiviral: acyclovir (Zovirax)
tx of HSV1 (usually oral) and HSV 2 (genital)
MOA: inhibits herpes replication, blocks nucleic acid synthesis
130
Antiviral: valacyclovir (Valtrex)
tx of HSV1 and HSV2
MOA: inhibits herpes replication
131
Antiviral: amantadine (Symmetrel)
treats influenza A
MOA: prevents virus from releasing DNA into host cell
132
Antiviral: oseltamivir (Tamiflu)
oral, influenza B, swine flu
MOA: causes viruses to aggregate/clump together, unable to connect with host cell to invade and replicate
133
Antiviral: zanamivir (Relenza)
inhaled, influenza B, swine flu
MOA: causes viruses to aggregate/clump together, preventing replication and spread
134
Cancer
development and reproduction of abnormal cells;
cell reproduction is rapid (uncontrolled);
structural alteration of cells and loss of function;
cells rob normal cells of vital nutrients
135
Tumor or Neoplasm
groups of cells without function
1) Malignant: bad, cancerous
2) Benign: noncancerous, bur can still cause complications
136
Primary Site
origination/ original location of tumor
137
Metastasis
cancer spreads to other locations in the body (circulatory or lymphatic)
138
Tumors
solid (breast, lungs)
diffuse (leukemia, Hodgkin's disease)
139
Antineoplastics
drugs used to inhibit tumor growth or cell reproduction;
cannot differentiate healthy cells from cancer cells; healthy cells get destroyed as well;
can be very toxic to the body
140
Chemotherapy
drugs used to kill cancer (also used for autoimmune conditions);
commonly given in cycles to allow a resting period for normal cells to recover
141
Hematologists
specialized doctors who research, diagnose, treat, and help prevent blood-related conditions and disease
142
Oncologist
doctor who has special training in diagnosing and treating cancer
143
Types of cancer
carcinomas, sarcomas, leukocytes, and lymphocytes
144
Carcinomas
stomach: gastric adenocarcinoma
liver: hepatocellular carcinoma
breast: carcinoma of the breast
kidney: renal cell carcinoma
skin: basal or squamous cell carcinoma
145
Sarcomas
bone: osteosarcoma; Ewing's sarcoma
fat: liposarcoma
lymph and blood vessels : angiosarcoma
146
Cancer Statistics
2nd leading death in the US
1 in 3 people develop some type of cancer in their lives
147
Two Types of Cancer Drugs
Cell Cycle Nonspecific Agents
Cell Cycle Specific Agents
148
Cell Cycle Nonspecific Agents (CCNS)
cytotoxic at any phase of cell cycle;
alkylating
149
Cell Cycle Specific Agents (CCS)
cytotoxic during a specific phase of cell cycle;
Antimetabolites, Plant Extracts/Mitotic Inhibitors, Cytotoxic Antibiotics
150
Antineoplastics: Alkylating Drugs
MOA: bind irreversibly to RNA, DNA and proteins; cell dies from inability to maintain metabolic and reproductive functions, CCNS
151
Antineoplastics: Alkylating Drugs
busulfan (Myleran) - leukemia
PATIENT TEACHING/SIDE EFFECTS: pulmonary fibrosis
cisplatin (Plantinol) - testicular, breast, ovarian, lung cancer
PATIENT TEACHING/SIDE EFFECTS: nephrotoxicity, ototoxicity
cyclophosphamide (Cytoxan) - breast, ovarian, leukemia
PATIENT TEACHING/SIDE EFFECT: cystitis, pre-drug hydration for prevention
mechlorethaminel (Mustargen) - lymphomas, leukemia
carboplatin (Paraplatin) - breast, lung, ovarian, bladder cancer
PATIENT TEACHING/SIDE EFFECTS (4,5): N, V, ulcers of skin/GI tract, alopecia
152
Antineoplastics: Antimetabolites
MOA: taken up by normal and cancerous cells and incorporated into the metabolic pathway for DNA synthesis;
functions antimetabolite that inhibits enzymes essential for RNA and DNA synthesis; most effective in the S phase of CCS
DRUGS: mercaptopurine (Purinethol) - leukemia
PATIENT TEACHING/SIDE EFFECTS: hyperuricemia
methotrexate (Folex) - leukemia
PATIENT TEACHING/SIDE EFFECT: mucositis, administer folic acid/leucovorin for overdose
153
CCS: Cytotoxic Antibiotics
MOA: kills cells by inhibiting nucleic acid and proteins synthesis, mostly active during G 2 phase, CCS
DRUGS: bleomycin (Bleoxane) - head/neck, testicular, ovarian
doxorubicin (Adriamycin) - lymphoma, breast cancer
PATIENT TEACHING/SIDE EFFECTS: cardiac toxicity, hepatotoxicity
154
CCS: Plant Extracts/Mitotic Inhibitors
MOA: inhibits mitosis during metaphase by binding to microtubules, most effective during M phase;
DRUGS: vincristin (Onvocin) - leukemia; lymphoma
PATIENT TEACHING/SIDE EFFECTS: neurotoxicity
vinblastine (Velban) - lymphoma
etoposide (Toposar) - testicular, lung cancers
paclitaxel (Taxol) - ovarian, breast, lung cancer
docetaxel (Taxotere) - breast, lung, prostate cancer
PATIENT TEACHING/SIDE EFFECTS: myelosuppression, peripheral neuropathy
155
Hormonal Antagonists
MOA: block hormones from binding to receptors on cancer cells, prevent cancer cell growth, do not kill cells directly
USES: adjunct therapy following surgery, radiation, chemotherapy (usually given for several years following cancer treatment)
DRUGS: anti-estrogens
anti-androgens
156
Hormonal Antagonists; Anti-estrogens
tamoxifen (Nolvadex) - breast cancer
raloxifene (Evista) - breast cancer, prevents osteoporosis
PATIENT TEACHING: similar to menopause , increases risk for thromboembolismH
157
Hormonal Antagonists: Anti-Androgens
bicalutamide (Casodex) - prostate cancer;
flutamide (Eulexin) - prostate cancer
PATIENT TEACHING: gynecomastia, impotency, hot flashes, liver complications
158
