#3 Unit 4 NS10 Anti Tuberculars Fungals Virals Helmintics Vaccines (Pt 2)LT 8.27.23 (2).pptx

Unit 4 Antituberculars, Antifungals, Antivirals, Antimalarials, Antihelmintics, Immunizations Lynnette Taylor, MSN/Ed, RN Ventura College School of Nursing 1 Objectives 01 02 03 Explain Differentiate Apply Explain the mechanism of action of antituberculars, fungals, -virals, malarials, helminthics D...

Unit 4 Antituberculars, Antifungals, Antivirals, Antimalarials, Antihelmintics, Immunizations Lynnette Taylor, MSN/Ed, RN Ventura College School of Nursing 1 Objectives 01 02 03 Explain Differentiate Apply Explain the mechanism of action of antituberculars, fungals, -virals, malarials, helminthics Differentiate between the different drug classifications Apply the nursing process to patients receiving these drugs including patient teaching 2 Antituberculars 3 Tuberculosis Etiology Mycobacterium tuberculosis Acid-fast bacillus Transmission Person to person via droplets Coughing, sneezing Patients at risk Alcohol-addicted, debilitated Immunocompromised Patients with AIDS 4 Antitubercular Drugs Drug combinations Single-drug therapy Ineffective Multidrug therapy Decreases bacterial resistance to drug Treatment duration decreased With TB, drug treatment compliance is closely monitored by Public Health 5 Antitubercular Drugs (Cont.) Drug selection First-line drugs Isoniazid, rifampin, ethambutol, streptomycin More effective, less toxic than second-line Second-line drugs Para-aminosalicylic acid, kanamycin, cycloserine, ethionamide, capreomycin, pyrazinamide, and others Less effective; More toxic Treatm ent usually takes 6-12 months 6 Isoniazid (INH) Route: Oral, IM Used as prophylaxis Adverse reactions GI distress, constipation Blurred vision, photosensitivity Tinnitus, dizziness Peripheral neuropathy (paresthesias) Psychotic behavior, seizures Blood dyscrasias, hepatotoxicity 7 Isoniazid (INH) Patient teaching Many drug interactions (phenytoin, alcohol) Empty stomach; avoid antacids Must follow complete regimen Collect sputum specimen in early morning Take pyridoxine (vitamin B6) to prevent peripheral neuropathy; report numbness, tingling, burning Check liver enzymes, CBC Need frequent eye examinations 8 9 Streptomycin, Rifampin, Ethambutol Streptomycin Monitor ototoxicity Monitor renal function Rifampin Warn patient that body fluids may be red-orange Contact lenses may be affected Ethambutol Take single daily dose to avoid visual disturbances ANTIFUNG ALS 10 Antifungal s Fungal infections (mild to severe) Superficial infections: skin, mucous membranes Topical, oral, vaginal Nystatin, miconazole (Monistat) Systemic infections: lungs, CNS IV, IM Fluconazole (Diflucan), Amphotericin B (most severe cases) 11 Nystatin (Mycostatin) Antifungals Oral candidiasis Methods of administration: oral, topical Patient teaching Administrat ion: Swish and swallow Gargle if throat affected 12 Antifungals Amphotericin B Treats severe fungal infections Side effects/adverse reactions Flushing, fever, chills, headache, dyspnea Hypotension, hypertension, tachycardia GI distress, pseudomembranous colitis Seizures, paresthesia, thrombophlebitis High doses: nephrotoxicity, electrolyte imbalances, ototoxicity 13 ANTIVIRALS 14 Antiviral Viruses Method of transmission Coughing, sneezing Ex: influenza, HSV, and viral hepatitis infections General signs and symptoms Headache, fever, cough Nausea, vomiting, Examples : Acyclovir, Amantadi ne, Ribavirin, Interfero n, Tamiflu 15 Antivirals for Influenza Influenza A Amantidine (Symmetrel) Rimantadine (Flumadine) Side effects: Insomnia, depression, anxiety, confusion, ataxia, orthostatic hypotension, weakness, dizziness, slurred speech Influenza A and B Zanamivir (Relenza) Oseltamivir (Tamiflu) Inhibits viral replication if given within 48 hours of symptoms 16 Influenza Vaccine 17 Other Antivirals Purine Nucleosides Effective against various herpes viruses, CMV Examples: Acyclovir (Zovirax) Side effects/adverse reactions GI distress, headache, confusion, depression, tremors, lethargy, increased bleeding, hematuria, blood HAAR T for HIV 18 Antivirals Acyclovir Extremely nephrotoxic Typically an IV bolus of fluids is recommended prior to infusing IV acylovir Delivered IV over 1 hour (crystalline nephropathy) PO forms, must drink plenty of fluids 19 ANTIMALARIALS 20 Antimalarials Treatment regimen Combinations used for drugresistant malaria Prophylactic measures Prevent malaria—abx prior to travel; prevent relapse Medications don’t provide a cure for the disease Drugs Hydroxychloroquine (Plaquenil) Quinine (Quinamm) Mefloquine (Lariam) 21 Antimalarials Nursing interventions Monitor kidney and liver function. Take drug with meals to prevent GI distress. Report vision, mood, other changes. Avoid alcohol. Advise individuals traveling to endemic countries to take prophylactic drug. 22 ANTHELMINTICS 23 Anthelmintics Helminths are parasitic worms Tape Worms 24 Anthelmintic Usually given for 1 to 3 days Adverse reactions (rare due to short duration of med) GI upset, dizziness, drowsiness, H/A, weakness Nursing interventions Give after meals to prevent GI distress. Encourage good hygiene. Pin Worms IMMUNIZATIONS 25 Immunity Active immunit y Body produces antibodies Passive immunit y Receives antibodies from another source Commun ity immunit y Exposed to antigen Natural immunity 26 1 Vaccination: Antigen given to stimulate immune response but does not typically produce the disease 2 Attenuated virus: Live, weakened microorganisms 3 Toxoids: Inactivated toxins that stimulate antitoxin formation but can’t produce disease Vaccines 27 Examples of Vaccine Preventable Diseases Anthrax Pertussis Diphtheria Pneumococcal disease Haemophilus influenzae type B Poliomyelitis Hepatitis A Hepatitis B Human papillomavirus Rabies Rotavirus Rubella Smallpox Influenza Tetanus Japanese encephalitis Tuberculosis Measles Typhoid Meningococcal disease Varicella Mumps Yellow fever Herpes Zoster 28 29 Vaccination Recommendatio ns Centers for Disease Control and Prevention (CDC) Vaccine Safety Reporting diseases and adverse reactions Mild reactions: Injection site swelling, low-grade fever Contraindications: Moderate or severe illness Anaphylaxis 30 31 Knowled ge Test! Question A middle-aged adult is diagnosed with tuberculosis. Which of the following is true of treatment for this diagnosis? a) Treatment may take about 10 days to 2 weeks. b) Usually two to three agents are needed. c) The bacteria is usually resistant to treatment therapy. d) Treatment for tuberculosis is usually without side effects. 32 Answer Answer: b Rationale: Single drug therapy with isoniazid proved ineffective in treating tuberculosis, because resistance to the drug developed in a short time. It was discovered that when a combination of antitubercular drugs was used, bacterial resistance did not occur, and the duration of treatment was reduced from 2 years to 6 to 9 months. Side effects do occur with 33 treatment for tuberculosis. Question When teaching a patient about isoniazid and rifampin drug therapy, which statement will the nurse include? a) Take isoniazid with meals. b) Double the amount of vitamin C in your diet to prevent the peripheral neuropathy associated with isoniazid therapy. c) Notify the primary healthcare provider immediately if your urine turns a red-orange color. d) Avoid exposure to direct sunlight. 34 Answer Answer: d Rationale: Isoniazid should be taken 1 hour before or 2 hours after meals for better absorption, Vitamin B6 prevents peripheral neuropathy associated with isoniazid therapy, and rifampin may turn urine, feces, saliva, sputum, sweat, and tears a harmless red-orange color. 35 Question Which of the following nursing interventions is the priority when a patient is receiving antiviral agents? a) Promoting hydration b) Enhancing bowel function c) Increasing tidal volume d) Promoting circulation 36 Answer Answer: a Antiviral drugs can affect renal function. Patients taking antiviral drugs should be advised to maintain adequate fluid intake to ensure sufficient hydration for drug therapy and increase urine output. 37 Before administration of the influenza vaccine to a patient, it is most important for the nurse to ask the patient if they are allergic to Question A. peanuts. B. eggs. C. penicillin. D. lidocaine. 38 Answer Answer: B Rationale: Eggs are used to produce the flu vaccine; therefore, any allergies to eggs should be determined before flu vaccine is administered to the patient. 39 Question Travelers visiting malaria-infested countries are instructed to a) Avoid mosquitoes in these countries. b) Receive immunizations before travel. c) Visit these countries only while in good health. d) Take prophylactic antibiotics before traveling. 40 Answer Answer: D Rationale: patients traveling to malariainfested countries should receive prophylactic doses of antimalarial drug before leaving, during the visit, and upon return. There are no immunizations available for malaria. 41 Question Newborns receive immunities via the transfer of maternal antibodies across the placenta. This is known as A. natural, passive immunity. B. acquired, passive immunity. C. natural, active immunity. D. acquired, active immunity. 42 ANS: A Passive immunity occurs when an individual receives antibodies against a particular pathogen from another source. Newborn infants naturally receive passive immunity via the transfer of maternal antibodies across the placenta. Passive immunity may also be acquired through the administration of antibodies pooled from several human or animal sources that have been exposed to diseasecausing pathogens. 43 Question Which statement about herpes zoster vaccine does the nurse identify as being true? Herpes zoster vaccine a) is indicated for the treatment of patients at age 40 years. b) is a live attenuated vaccine. c) should be administered every other year. d) prevented zoster in 90% of the people who received the vaccine. 44 ANS: B Zostavax is a live attenuated vaccine. Zostavax is licensed for use as a onetime injection in adults age 50 years and older. The vaccine has been shown to boost VZV immunity among vaccine recipients. In clinical trials, Zostavax prevented zoster in about 50% of people who received the vaccine. Effectiveness appears to decrease with increasing age of the vaccine recipient. In those who received the vaccine yet went on to develop zoster, the duration of pain was 45 reduced. Question Which is the first vaccine developed to prevent cancer? a) Rotavirus b) Pneumococcal disease c) Meningococcal disease d) Human papillomavirus 46 ANS: D Gardasil, the human papillomavirus (HPV) vaccine, has been called the first vaccine designed to prevent cancer. Prevnar is the first pneumococcal conjugate vaccine, which provides protection against seven serotypes of pneumococci. Menhibrix, a combination vaccine for infants and children age 6 weeks through 18 months, is used for prevention of invasive disease caused by Neisseria meningitides and Haemophilus influenza type b. Rotavirus is a leading cause of severe acute gastroenteritis in infants and young children. RotaTeq, a live oral vaccine containing five strains of rotavirus, is effective in protecting against severe gastroenteritis and significantly reduces the need for hospitalization among infected children. 47 References McCuistion, L. E., Vuljoin-DiMaggio, K., Winton, M. B., & Yeager, J. J. (2023). Pharmacology: A patient-centered nursing process approach (11th ed.). St. Louis, MO: Elsevier. 48