This document provides information on various classes of drugs used to treat different types of infections and diseases. It discusses narcotics and their uses, side effects, and nursing considerations. It also summarizes several classes of antibiotics like aminoglycosides, carbapenems, cephalosporins, quinolones, penicillins, sulfonamides, tetracyclines, and macrolides. Additionally, it covers drugs used to treat tuberculosis, leprosy, HIV/AIDS, and antifungal drugs.
51. Penicillins Effective, Safe Excreted Kidnes Risk of hypersensitivity Gram + bacteria Contraindications—hypersensitivity or allergic reactions; potential for cross-sensitivity with cephalosporins and carbapenems
52. Examples of Penicillins Dicloxacillin (Dynapen) Penicillin G Penicillin V (Pen-Vee K) Piperacillin (Pipracil)
61. Prototype Sulfa Preps Sulfamethoxazole Azo Gantanol Bactrim azo gantanol combo phenazopyridine and sulfa as a Antibiotic for UTI Bactrim combo trimethoprim and sulfa Antibiotic for UTI, PCP, ear infections, gonorrhea, etc. Sulfasoxazole Azogantrisin Pediazole azogantrisin combo phenazopyridine and sulfa for UTI’s Pediazole sulfisoxazole and erythromycin for otitis media
66. Macrolides and Ketolides May be bacteriostatic or bacteriocidal Erythromycin Telithromycin (Ketek)
67. Macrolides first intro in early 1950’s [erythromycin] inhibit growth of bacteria = bacteriostatic four main macrolides: erythromycin (many names) Azithromycin (Zithromax) Clarithromycin (Biaxin) troleandomycin
68. MACROLIDE: Indications for Use Widely used for respiratory tract and skin/soft tissue infections Used as penicillin substitute Used in newborns (ophthalmic)
69. Therapeutic EffectsMacrolides Strep infections Streptococcus pyogenes(group A beta-hemolytic) mild to moderate URTI Hemophilus influenza spirochetal infections syphilis & Lyme disease gonorrhea, chlamydia, and mycoplasma
70. Miscellaneous Metronidazole—effective against anaerobic bacteria, some gram+, and protozoa Quinupristin/dalfopristin— belongs to class streptogramins; bacteriostatic and bacteriocidal Spectinomycin—treatment of gonococcal exposure Vancomycin—active against gram+ Chloramphenicol—broad spectrum, bacteriostatic, active against gram+ and gram– Clindamycin—bacteriostatic, effective against gram+, some anaerobes Linezolid—member of new class oxalidinone; effective against aerobic gram+
71. Principles of Therapy Culture and sensitivity studies reviewed to treat with “right drug for right bug” Erythromycin interferes with the elimination of several drugs Monitor clients closely
72. Zithromax Loading dose of 500 mg Daily dose of 250 mg for total of 5 days therapy Given up t 10 days for CAP (community acquired pneumonia)
77. Tuberculosis (TB) Infectious disease that usually affects the lungs May infect lymph nodes, pleurae, bones, joints, kidneys, and GI tract Caused by Mycobacterium tuberculosis Multiplies slowly and remains dormant for years Natural history of TB Transmission Primary infection Latent tuberculosis infection (LTBI) Active tuberculosis
78. TB Principle organ affected is lungs Caused by Mycobacterium tuberculosis Transmission Primary infection Latent (LTBI)-Active TB
80. Chapter 34Drugs for Tuberculosis and Mycobacterium avium Complex (MAC) Disease
81. What does a positive PPD mean? Positive reaction is Induration NOT redness Low risk >15 mm >10 mm high risk >5mm persons at highest risk, HIV
82. Primary Antitubercular Drugs Rifapentine (Priftin)—used with at least one other drug; less frequent administration (1-2X/wk) Ethambutol (Myambutol)—part of 4-drug regimen Pyrazinamide—used with INH and rifampin for 2 mos Streptomycin—used in 4-drug regimen Isoniazid (INH)—most commonly used; bacteriocidal, inexpensive, and nontoxic Rifampin—works synergistically with INH Rifabutin (Mycobutin)—used in patients with HIV with MAC; longer half-life than rifampin
83. Secondary Antitubercular Drugs Para-aminosalicylic acid (PAS) Capreomycin (Capastat) Cycloserine (Seromycin) Ethionamide (Trecator SC) Indicated for clients when other agents are contraindicated or drug resistant
84. Other Drugs Used in Multidrug-Resistant Tuberculosis Aminoglycosides (amikacin and kanamycin) May be component of 4- to 6-drug regimen Fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, and sparfloxacin) may be used
85. Resistant TB For INH-resistant TB—rifampin, pyrazinamide, and ethambutol for 6 mos
86. Resistant TB For rifampin-resistant TB—INH and ethambutol for 18 mos or INH, pyrazinamide, and streptomycin for 9 mos
88. Resistant TB For intermittent schedules, healthcare providers administer or directly observe therapy (DOT)
89. Resistant TB During pregnancy—3-drug regimen of INH, rifampin, and ethambutol used with close monitoring of LFT
90. Mycobacterium Avium Complex Disease (MAC) Mycobatcteriumavium and Mycobacterium intracellulare are grouped together as MAC Found in water and soil; transmitted by inhalation of droplets Opportunistic infection of immunocompromised Main drugs used—macrolides, azithromycin and clarithromycin, and rifabutin Prophylactic therapy life-long 3-drug regimen—macrolide, rifabutin, and ethambutol
91. TB drugs first line agents ethambutol isoniazid pyrazinamide rifampin streptomycin second line agents paraaminosalicylate sodium (PAS) capreomycin cycloserine ethionamide kanamycin
92. Drugs used to Treat TB INH-Isoniazid Most common least expensive 300 mg/day or 900 mg 2x/week Adverse effects: Hepatotoxicity Peripheral neuropathy (Give B6-pyridoxine 25 to 50 mg daily)
93. Rifampin and Rifabutin Metabolized in liver SE: RED BODY FLUIDS GI irritation, hepatitis, Numerous drug interactions
94. Ethambutol Major adverse effect is optic neuritis Moniter visual acuity and red/green discrimination OK to give with food
95. Miscellaneous Drugs Chloramphenicol-Chloromycetin Used in serious infections Toxicity-life threatening blood dyscrasias Therapeutic levels 10-20mcg/mL “Gray baby syndrome” (cardiovascular collapse in newborns) Frequent CBC monitoring
96. Clindamycin (Cleocin) Rx Severe Infection Topical use - acne Diarrhea serious SE Persistent, bloody stools (>5 stools a day)—stop drug, assess for presence of C. Diff.
97. Vancomycin Gram + Used in serious infections Primarily IV PO for Rx of C.difficile Rx of MRSA Emergence of VRE IV – give slowly over 1-2 hrs to avoid RED MAN Syndrome
98. Viruses Viruses spread by secretions, ingestion, breaks in skin and mucous membranes, blood transfusions, sexual contact, pregnancy, breast-feeding, and organ transplantation Viral replication is parasitic in nature Viruses induce antibodies and immunity
99. Antiviral Drugs Few drugs inhibit viruses without being excessively toxic to host tissues Most antivirals inhibit viral replication but do not eliminate viruses from tissues Available drugs are expensive, relatively toxic, and effective in a limited number of infections
100. Drugs for Herpesvirus Infections Acyclovir, famciclovir, and valacyclovir Penetrate virus-infected cells, become activated by an enzyme, and inhibit viral DNA reproduction Treatment of herpes simplex and herpes zoster infections Cidofovir, foscarnet, ganciclovir, and valganciclovir Inhibit viral reproduction Treat cytomegalovirus (CMV) retinitis most commonly seen in AIDS Foscarnet treats acyclovir-resistant herpes simplex
101. Drugs for Influenza A Amantadine and rimantadine inhibit replication of the influenza A virus Oseltamivir (Tamiflu) and zanamivir (Relenza) approved for influenza A or B Seasonal prophylaxis used in high-risk patients Treat early and may shorten illness length
102. Drug for Respiratory Syncytial Virus (RSV) Ribavirin used to treat bronchiolitis or pneumonia caused by RSV Used in hospitalized infants and young children Given by inhalation with Viratek small particle aerosol generator
104. Drugs for HIV and AIDS (Antiretrovirals) See Handout in Class
105. Antifungal Drugs Mechanism of action is to disrupt the structure and function of various fungal cell components Polyenes and azoles act on ergosterol to disrupt fungal cell membranes Echinocandins or glucan synthesis inhibitors are a new class of antifungals that disrupt cell walls rather than cell membranes
106. Azoles Ketoconazole (Nizoral) given orally and is less toxic; little absorption occurs topically Disadvantage is there are many drug–drug interactions Fluconazole (Diflucan) Synthetic broad-spectrum agent that may be used long-term Increases effect of several drugs Itraconazole (Sporanox) Synthetic broad-spectrum agent similar to fluconazole May be used in long-term suppression of histoplasmosis Voriconazole (Vfend) Broad-spectrum activity
107. Polyenes Amphotericin B Highly toxic to humans and recommended only for serious, potentially fatal infections Nystatin Used topically only; too toxic for systemic use