Handout 3A-2 PDF

Laoag City, Ilocos Norte Drugs Affecting the Systems: OTHER DRUGS CHEMOTHERAPEUTIC AGENTS A. ANTI-INFECTIVE/ANTIBACTERIAL DRUGS Substance that inhibit the growth of or kill bacteria. BACTERIOSTATIC – inhibit the growth of bacteria. BACTERICIDA...

Laoag City, Ilocos Norte Drugs Affecting the Systems: OTHER DRUGS CHEMOTHERAPEUTIC AGENTS A. ANTI-INFECTIVE/ANTIBACTERIAL DRUGS Substance that inhibit the growth of or kill bacteria. BACTERIOSTATIC – inhibit the growth of bacteria. BACTERICIDAL – drugs kill the bacteria. MECHANISM OF ANTIBACTERIAL ACTION 1. Inhibition of bacterial cell wall synthesis 2. Alteration of membrane permeability 3. Inhibition of protein synthesis 4. Interference with metabolism within the cells RESISTANCE TO ANTIBACTERIALS 1. NATURAL/INHERENT RESISTANCE Occurs without previous exposure to the antibacterial drug. Ex: Pseudomonas aeroginosa- resistant to Penicillin G 2. ACQUIRED RESISTANCE Is caused by prior exposure to the antibacterial. ✓ To determine the effect of antibacterial drugs have on specific microorganism, culture and sensitivity test is performed. NARROW AND BROAD SPECTRUM ANTIBIOTICS NARROW SPECTRUM- primarily effective against one type of organism Ex: penicillin and erythromycin- used to treat infections caused by gram (+) bacteria. Pharmacology Page 1 of 20  Laoag City, Ilocos Norte BROAD SPECTRUM – effective against both gram + and gram – organisms. Frequently used to treat infections when the offending microorganism has not been identified by C and S. Ex: Tetracycline, Cephalosporins GENERAL ADVERSE REACTIONS TO ANTIBACTERIALS 1. ALLERGY OR HYPERSENSITIVITY EFFECT Mild reactions – rash, pruritus, hives Severe reactions – anaphylactic shock (vascular collapse, laryngeal edema, bronchospasm and cardiac arrest) 2. SUPERINFECTION Occurs when the normal microbial flora of the body are disturbed during antibiotic therapy. Happens when the drug administered for less than a week. Usually occurs with the used of broad-spectrum antibiotics. 3. ORGAN TOXICITY Toxic to liver and kidneys- metabolism and excretion Ex: Aminoglycosides CLASSIFICATION OF ANTIBACTERIALS 1. PENICILLINS Natural antibacterial agent obtained from the mold of genus penicilluim and was introduced to the military during WWII and considered to have saved many soldier’s lives. Labeled as “miracle drug.” TYPES OF PENICILLIN a. PENICILLIN Penicillin G o Poorly absorbed orally- 1/3 of the dose is absorbed o First penicillin administered orally and IV Penicillin V o Less potent than G Benzathine Penicillin G Pharmacology Page 2 of 20  Laoag City, Ilocos Norte o Long acting when given by injection o Prophylaxis for rheumatic fever. Procaine Penicillin G o Milky in color- produced to extend drug’s activity o Procaine- decreases the pain related to injection of this medication – can be given IM b. BROAD SPECTRUM PENICILLINS Used to treat both gram + and gram – bacteria. Costlier than penicillin Examples Ampicillin – 1st broad spectrum penicillin; 20% protein bound Ampicillin-Sulbactam (Unasyn) Amoxicillin (Amoxil) Amoxicillin- Clavulanic Acid (Augmentin) o Clavulanic acid- an agent that promotes the breakdown of amoxicillin, intensifies the effect of amoxicillin. Bacampicillin Cyclacillin PK: Amoxicillin is well absorbed from the GIT; 20% protein bound; short half life; excreted in the urine. c. PENICILLINASE-RESISTANT PENICILLINS/ Antistaphylococcal Penicillins Used for treating penicillinase-producing staph.Aureus. Not effective against gram – bacteria Examples Cloxacillin Dicloxacillin Methicillin Nafcillin Oxacillin PK: Cloxacillin is 90% protein bound, excreted in the bile and urine. PD: Interfere with bacterial cell wall synthesis causing cell lysis. DRUG INTERACTIONS When taking aspirin with amoxicillin or cloxacillin- serum antibacterial levels may be increased. Pharmacology Page 3 of 20  Laoag City, Ilocos Norte Erythromycin/tetracycline with amoxicillin and cloxacilllin- decreased effect of the later 2 antibacterial drug (amox and cloxa) d. ANTIPSEUDOMONAL PENICILLINS Effective against PSEUDOMONAS AERUGINOSA- a gram – bacillus that is difficult to eradicate. Used also against Klebsiella Pneumoniae Examples Azlocillin Carbenicillin Mezlocillin Piperacillin Ticarcillin SIDE EFFECTS AND ADVERSE REACTIONS Hypersensitivity Superinfection Rash n/v diarrhea 2. CEPHALOSPHORINS chemically and pharmacologically related to penicillins. They act by interfering with bacterial cell wall synthesis thereby altering the osmotic stability of the actively growing bacterial cell and resulting in its death. May exert either bactericidal or bacteriostatic effect depending on: a. susceptibility of the organism being treated b. dose of the drug used c. tissue concentration of the drug d. the rate at which the bacteria are multiplying GENERATIONS OF CEPHALOSPORINS a. FIRST GENERATION CEPHALOSPORINS Exhibit gram + and some gram – activity and are generally susceptible to beta-lactamase inactivation. Bactericidal action against susceptible bacteria. Pharmacology Page 4 of 20  Laoag City, Ilocos Norte Cephapirin Cephradine Cefadroxil PK: Well absorbed following oral administration, cefazolin- well absorbed following IM administration Widely distributed; crosses the placenta and enter breastmilk in low concentration Excreted entirely unchanged by the kidneys t ½ cephalexin- 50 to 80 mins; cefazolin – 90-150 mins b. SECOND GENERATION CEPHALOSPORINS exhibit a greater spectrum of gram – activity and less gram + activity. Some agents in this group are resistant to beta lactamases. Examples Cefaclor (Ceclor) Cafamandole (Mandol) Cefoxitin Cefonecid Cefuroxime PK: Well absorbed following oral and or IM administration They all cross the placenta and enter breastmilk in low concentration Penetration into CSF is poor but ADEQUATE for CEFUROXIME- used in treating meningitis. Excreted by the kidneys Pharmacology Page 5 of 20  Laoag City, Ilocos Norte T ½ cefaclor- 30 to 60 mins; cefoxitin 40-60 mins; cefuroxime 60- 120 mins c. THIRD GENERATION CEPHALOSPORINS Broader spectrum of gram – activity Generally drug cost is greater than 1st and 2nd generation drugs Examples Cefixime Cefotetan Cefotaxime Ceftazidime Ceftriaxone Cefoperazone PK: Well absorbed after oral administration Crosses the placenta and enters breastmilk in low concentration Ceftriaxone and Cefotaxime partly metabolized and partly excreted in the urine; cefixime- 50% excreted unchanged in the urine t 1/2 – cefotaxime 1-1.5 hours; ceftazidime 2 hours SIDE EFFECTS AND ADVERSE REACTIONS GI disturbances (n/v, diarrhea) Alteration in blood clotting time- increased bleeding with large doses Nephrotoxicity d. FOURTH GENERATION CEPHALOSPORIN ⚫ Cefepime ⚫ Good gram-positive & gram-negative coverage ⚫ Anti-Pseudomonal (including ceftazidime resistant isolates) ⚫ Penetrates CSF ⚫ Given parenterally ⚫ Excreted in the urine Pharmacology Page 6 of 20  Laoag City, Ilocos Norte e. FIFTH GENERATION CEPHALOSPORIN ◆ Ceftaroline fosamil is newly FDA approved prodrug formulation of ceftaroline ⚫ Effective against gram-positive bacteria, and retains the activity of later-generation cephalosporins with broad- spectrum activity against gram-negative bacteria ⚫ indicated for treating: ◼ ORSA ◼ skin & soft tissue infections ◼ community-acquired pneumonia 3. MACROLIDES, LINCOSAMIDES, VANCOMYCIN Discussed together because they have similar spectrums of antibiotic effectiveness to penicillin and used as penicillin substitute esp with individuals who are allergic to penicillin. a. MACROLIDES Are bacteriostatic antibiotics that act by inhibiting CHON synthesis in the bacterial cell. Used primarily for oral therapy of respiratory, GI, urinary, skin, soft tissue infection caused by gram + and some gram – organisms. Examples Erythromycin Clarythromycin Azithromycin PK: Erythromycin is well absorbed from the GIT Available IV but should be diluted in 100 ml of NSS or D5W to prevent phlebitis or burning sensations at the injection site. Pharmacology Page 7 of 20  Laoag City, Ilocos Norte Short half-life; moderate protein binding effect Excreted in the bile, feces and some degree in urine. SIDE EFFECTS GI disturbances- n/v, diarrhea, abdominal cramping b. LINCOSAMIDES Inhibit bacterial CHON synthesis and have both bacteriostatic and bactericidal action. Examples Clindamycin Lincomycin o Clindamycin is considered to be more effective than lincomycin and has fewer toxic effects. o Clindamycin is absorbed better thru GIT than lincomycin SIDE EFFECTS GI Irritation- n/v Stomatitis ADVERSE REACTIONS: Colitis and anaphylactic shock c. VANCOMYCIN Glycopeptides bactericidal antibiotic, was widely used in the 1950s to treat staphylococcal infections. ADVERSE REACTIONS: Nephrotoxicity and Ototoxicity Pharmacology Page 8 of 20  Laoag City, Ilocos Norte 4. TETRACYCLINES First broad spectrum antibiotics effective against gram + and gram – bacteria and many other organisms such as mycobacteria, rickettsiae. Act by inhibiting bacterial CHON synthesis and have a bacteriostatic effect. Not effective against Staph Aureus and pseudomonas Frequently prescribed for oral use although they are available for IM and IV. Should not be taken with Mg-Aluminum preparations, milk products containing calcium or iron-containing drugs- all of these substances bind with tetracycline and prevent absorption of the drug. Examples Tetracycline (Achromycin) Oxytetracycline (Terramycin) Demeclocycline (Declomycin) Doxycycline (Vibramycin) Minocycline (Minocin) o Except doxycycline and minocycline, all tetracyclines can be taken on an empty stomach 1 hour before or 2 hours after meal. SIDE EFFECTS n/v diarrhea photosensitivity (sunburn reaction) ADVERSE REACTIONS pregnant women should not take it during the 1st trimester- possible teratogenic effects women in last trimester and children younger than 8 y/o should NOT take it because it irreversibly discolors the permanent teeth. Minocycline- can cause damage to the vestibular part of the inner ear- difficulty maintaining balance. Nephrotoxicity- if given in high doses Superinfection- disrupt the microbial flora of the body 5. AMINOGLYCOSIDES Act by inhibiting bacterial protein synthesis. Used against gram – bacteria such as E. coli and pseudomonas. Examples Amikacin (Amikin) Pharmacology Page 9 of 20  Laoag City, Ilocos Norte Gentamicin (Garamycin) Tobramycin (Nebcin) Netilmicin (Netromycin) – one of the latest aminoglycosides that is effective against gram – bacteria and has fewer side effects. Streptomycin – 1st aminoglycoside (1944) used with the treatment of tuberculosis; t ½ is 2.5 hours Neomycin – decreases bacteria in the bowel and is used as a preoperative bowel antiseptic. PD: Pregnancy category D for aminoglycosides. Onset of action- IM and IV immediately Peak concentration time 0.5-1.5 hours Not readily absorbed through the GIT IV line is flushed for each antibiotic has been administered to ensure that it is completely delivered. ADVERSE REACTIONS Ototoxicity and Nephrotoxicity Superinfection 6. QUINOLONES/FLOUROQUINOLONES Interfere with the enzyme DNA gyrase which is needed for the synthesis of bacterial DNA. It is bactericidal; effective against both gram + and gram – organisms. Use in the treatment of UTI, lower respiratory tract infections, skin, soft tissue, bones and joint infection. Examples Cinoxacin Pharmacology Page 10 of 20  Laoag City, Ilocos Norte Ciprofloxacin Norfloxacin Ofloxacin PK: Ciprofloxacin is 70% absorbed from the GIT It has a low protein binding effect; t ½ is 3-4 hours ½ of the drug is excreted unchanged in the urine. PD: Should be taken before meals since food slows the absorption rate. Onset of action 0.5-1 hour, peak 1-2 hours; duration UNKNOWN DRUG INTERACTION: Should not be given together with antacid- decreases the absorption rate of quinolones. 7. SULFONAMIDES Bacteriostatic, acting by inhibiting bacterial synthesis of folic acid. They are used in treating urinary and ear infections. THREE (3)CATEGORIES ACCDG TO THEIR DURATION OF ACTION a. SHORT-ACTING- t ½ 4-8 hours Rapid absorption and excretion rate. Examples Sulfisoxazole Sulfacytine Sulfadiazine Sulfamethizole b. INTERMEDIATE-ACTING- t ½- 8 to 12 hours Moderate to slow absorption and a slow excretion rate. Examples Sulfamethoxazole Trimethoprim- Sulfamethoxazole (Bactrim) (Co-Trimoxazole) c. LONG ACTING Very slow excretion rate. Examples Pharmacology Page 11 of 20  Laoag City, Ilocos Norte Sulfamethoxypyridazine Sulfameter PK: Cotrimoxazole is well absorbed from the GIT; moderately CHON bound; excreted in the urine. Many of sulfonamides are for oral use since they are absorbed readily by the GIT. Well distributed to body tissues and the brain Liver metabolizes the drug and kidneys excrete it. Mostly are highly protein bound and displace other drugs. SIDE EFFECTS AND ADVERSE REACTIONS GIT disturbances- anorexia, n/v Skin rash and itching Anaphylaxis is not common Photosensitivity Crystalluria- insoluble in acid urine Hematuria Prolonged use and high doses – can cause blood dyscrasias such as hemolytic anemia and aplastic anemia. 8. UNCLASSIFIED ANTIBACTERIALS a. CHLORAMPHENICOL Has a bacteriostatic action by inhibiting bacterial CHON synthesis. Used only for treatment of serious infections. Effective against gram – and gram + bacteria. ADVERSE EFFECT: Blood dyscrasias related to bone marrow suppression b. SPECTINOMYCIN HCl (Trobicin) Introduced in 1971 Used against Neisseria gonorrhea Prescribed for persons allergic to penicillins, cephalosporins or tetracycline, Administered IM as a single dose. c. IMIPENEM with CILASTATIN Na (Primaxin) Introduced in 1986 Effective against gram + bacteria including staph and pseudomonas. Pharmacology Page 12 of 20  Laoag City, Ilocos Norte NURSING RESPONSIBILITIES ON ANTIBACTERIAL THERAPY 1. Check for signs and symptoms of superinfection especially in clients taking high doses of antibiotic for a prolong time. 2. Assess for allergic reaction, may be mild (rash and urticaria) or severe (anaphylactic shock). Discontinue and notify physician. 3. Dilute antibiotic for IV use in an appropriate amount of solution as indicated. 4. Instruct the client to complete the prescribed course of antibiotic therapy, usually 5- 10 days. SPECIFIC NURSING RESPONSIBILITIES: a. PENICILLIN Administer oral penicillin 1 hour before or 2 hours after meals to reduce destruction by gastric acid and delay in drug absorption. Advise clients who are allergic to penicillin to wear a medic alert bracelet or necklace that indicates the allergy. b. MACROLIDES Monitor the client for liver damage due to prolonged use and high dosage. c. AMINOGLYCOSIDES Monitor for signs of ototoxicity and nephrotoxicity. Report/notify the physician. Encourage the client to increase intake of fluid. d. CEPHALOSPORINS Administer IV over 30-45 mins to prevent venous irritation. e. TETRACYCLINES Check lab values for liver and kidney function. Instruct client to store out of light and extreme heat. It decomposes in light and extreme heat causing it to become toxic. Instruct the client to use sunblock lotion during sun exposure- photosensitivity is a common side effect. f. SULFONAMIDES Administer the drug with extra fluids to increase urine output thus decreasing the risk for crystalluria and stone formation. Observe the client for hematologic reaction that may lead to life-threatening anemias. Check all drugs the client is taking for drug interactions. Most sulfonamides are highly CHON bound and compete for protein sites. Advise pregnant woman to avoid during the last trimester of pregnancy. Advice to avoid direct sunlight to decrease the risk of photosensitivity. Instruct the client not to take antacids with sulfonamides because antacids decrease absorption rate. Pharmacology Page 13 of 20  Laoag City, Ilocos Norte B. ANTIVIRAL DRUGS Are used to destroy, prevent, or delay the spread of a viral infection. The purpose is to prevent the replication of the virus by inhibiting one of the steps of viral replication thus preventing it from reproducing. Examples 1. AMANTIDINE HCl Effective against the virus that causes influenza A. Not effective against influenza B Excreted unchanged in the urine. SIDE EFFECTS AND ADVERSE REACTIONS CNS- insomnia, depression, anxiety, confusion, ataxia, dizziness, slurred speech GIT – anorexia, n/v, diarrhea 2. ANTIVIRAL ANTIMETABOLITES a. VIDARABINE Exerts an antiviral effect against herpes simplex type I, herpes zoster and cytomegalovirus. SIDE EFFECTS GIT disturbances- n/v, diarrhea CNS disturbances- weakness, malaise, tremor and confusion ADVERSE REACTIONS Decrease in Hgb, WBC and platelets, thrombophlebitis b. ACYCLOVIR Was introduced as an antineoplastic and later found out to be effective against genital herpes simplex I and II, herpes zoster (shingles), and CMV. Interferes with the virus synthesis of DNA thereby short-circulating its replication. 50% passes in the CSF, 10-30% is CHON bound t ½ is 2-3 hours Excreted unchanged in the urine. SIDE EFFECTS GIT disturbances- n/v, diarrhea CNS disturbances- headache, dizziness, insomnia, depression Pharmacology Page 14 of 20  Laoag City, Ilocos Norte Hematuria Hypotension Increase BUN and Creatinine c. RIBAVIRIN Used to treat respiratory syncytial virus (RSV) in children and respiratory infections caused by influenza A and B virus in the aged. Administered by aerosol. d. ZIDOVUDINE Thought to suppress the replication of the HIV by allowing the T4 (helper) lymphocytes to increase initially to destroy any free virus in the system. Given to prolong the life of the person with HIV and AIDS. NURSING RESPONSIBILITIES 1. Monitor the clients CBC. Report abnormal results such as leucopenia, thrombocytopenia and decrease hemoglobin. 2. Instruct the client having dizziness due to orthostatic hypotension to arise slowly from a sitting position to a standing position. 3. Advise the client to ensure an adequate fluid intake to ensure adequate hydration. 4. Instruct the client with genital herpes to avoid spreading the infection by sexual abstinence or the use of a condom. Women should have a Pap smear done every 6 months or as indicated. 5. Instruct client taking Zidovudine to have blood counts monitored. C. ANTIFUNGAL DRUGS Also called ANTIMYCOTIC DRUGS Used to treat 2 types of fungal infections. o Superficial fungal infections – skin or mucous membrane o Systemic fungal infection- lungs or CNS CLASSIFICATIONS 1. POLYENES a. AMPHOTERICIN B Introduced in 1956. Effective against numerous systemic fungal diseases including histoplasmosis and candidiasis. PK: Not administered for the GIT- administered IV I low doses for treating systemic infections. Highly protein bound, long t ½, 5% is excreted in the urine SIDE EFFECTS Flushing hypotension Pharmacology Page 15 of 20  Laoag City, Ilocos Norte Fever paresthesias Chills thrombophlebitis n/v ADVERSE EFFECTS Neprhrotoxicity Electrolyte imbalance b. NYSTATIN (Mycostatin) Administered orally or topically to treat candida infection. Available in suspensions, cream, ointment and vaginal tablets. Poorly absorbed via the GIT however the ORAL tablet form is used for intestinal candidiasis. Oral suspension is for the candida infection in the mouth- “swish and swallow” PK: poorly absorbed orally, CHON binding power and t ½ is unknown Drug is excreted unchanged in feces. PD: Increases permeability of the fungal cell membrane, thus causing the fungal cell to become irritable and to discharge the content. Has fungistatic and fungicidal action. Onset of action for both suspension and tablet is rapid. Onset of action for vaginal tablet/cream- approximately 24 hours or more/ 2. IMIDAZOLE GROUP Effective against candidiasis (superficial and systemic), histoplasmosis and others. a. KETOCONAZOLE (Nizoral) 1st effective antifungal drug that is absorbed orally. 90% CHON bound, t ½ is 8 hours Treatment could last 1-6 months for systemic infections. b. MICONAZOLE (Monistat) For IV and topical use. Topical – frequently used in the treatment of vaginitis. IV- used to treat bladder infections and fungal meningitis. 95% CHON bound; t ½ is 24 hours Pharmacology Page 16 of 20  Laoag City, Ilocos Norte c. FLUCONAZOLE (Diflucan) Used to treat cryptococcal meningitis in AIDS clients. 3. ANTIMETABOLITES a. FLUCYTOSINE Well absorbed from the GIT Used in combination with other antifungal drugs such as amphotericin B. Fungal resistance occurs if the drug is given alone. NURSING RESPONSIBILITIES 1. Assess for side effects such as headache, phlebitis, s/sy of electrolyte imbalance and nephrotoxicity. 2. Check the clients liver enzyme tests and BUN and creatinine levels. 3. Monitor urine output since many of antifungal drugs may cause nephrotoxicity. 4. Instruct the client to take the drugs as prescribed. Compliance is important since discontinuing the drug too soon may result in a relapse. 5. Advise the client to avoid driving or operating any hazardous equipment when taking amphotericin B, ketoconazole or flucystine because these drugs may cause visual changes, sleepiness, dizziness or lethargy. Pharmacology Page 17 of 20  Laoag City, Ilocos Norte D. ANTIPROTOZOAL DRUGS Used to treat infections caused by protozoa. Destroys protozoa or inhibits their growth and ability to reproduce. COMMON TYPES OF PROTOZOAL INFECTIONS 1. MALARIA Transmitted by the bite of infected mosquitoes in tropical and sub tropical areas of the world. 2. GIARDIASIS Intestinal infection which usually found in areas with poor sanitation and unsafe water. Infection occurs by swallowing contaminated water, eating contaminated food or through contact with infected person. 3. TRICHOMONIASIS Protozoal infection acquired through sexual contact Manifestations in FEMALE – vaginal itchiness, odorous yellow vaginal discharge Manifestation in MALE – painful urination, purulent urethral discharge TWO (2) MAIN GROUPS OF ANTIPROTOZOAL 1. ANTIMALARIAL DRUGS They kill or inhibit the growth of protozoa by affecting different stages of the parasitic life cycle. Examples Mefloquine Chloroquine Proguanil with Atovaquone Doxycycline SIDE EFFECTS n/v, diarrhea. Abdominal pain headache, dizziness, visual disturbances rashes, pruritus insomnia and vivid dreams (mefloquine and Proguanil) depression cause yellow teeth and teeth disfigurement if taken during teeth development (doxycycline) Pharmacology Page 18 of 20  Laoag City, Ilocos Norte 2. MISCELLANEOUS ANTIPROTOZOALS a. METRONIDAZOLE more common treatment for trichomoniasis and giardiasis b. TINIDAZOLE C. NIFURATEL SIDE EFFECTS n/v unpleasant metallic taste easy or excessive bruising and bleeding (nifuratel) NURSING RESPONSIBILITIES 1. Complete the recommended course of treatment and take the correct dose as instructed. 2. Advise patient not to have sexual intercourse while being treated for trichomoniasis as she may become reinfected. 3. Antiprotozoal can interact with other medicines, advise patient to inform or notify the physician. 4. Oral antiprotozoals should not be taken by women who are pregnant or breastfeeding. E. ANTI-HELMINTHICS drugs used to treat parasitic worm infection. Drug treatment is very specific to the organism- VERY IMPORTANT to IDENTIFY the CAUSATIVE WORM. TYPES OF CAUSATIVE WORM 1. Cestodes – tapeworms 2. Nematodes – round worms 3. Trematodes – flukes 4. Platyhelminthes- flat worm Examples a. DIETHYCARBAMAZINE (hetrazan) Inhibits rate of embryogenesis of nematodes. b. THIABENDAZOLE (mintezol) Exhibits the helminth-specific enzyme (fumarate reductase). Used for nematodes c. PYRANTEL (antiminth) Pharmacology Page 19 of 20  Laoag City, Ilocos Norte Blocks acetylcholine at the nureomuscular junction resulting in paralysis of the worms which are then expelled through the GIT. Used for nematodes d. PRAZIQUANTEL Used against trematodes and cestodes but not nematodes. Rapidly taken by the susceptible worms and causes leakage of the intracellular Ca- contracture and paralysis- then loss of intestinal mucosal grip- expelled SIDE EFFECTS Bitter taste Nausea, abdominal pain Headache, dizziness and sedation e. NICLOSAMIDE Highly effective against cestodes Intereferes with anaerobic generation of ATP in tapeworm. SIDE EFFECTS Malaise Light headedness Pruritus NURSING RESPONSIBILITIES 1. Before therapy, thorough health history and medication history. 2. Collect specimens before beginning drug therapy. 3. Administer all drugs as ordered and for the prescribed length of time. 4. Most drugs should be taken with food to reduce GI upset. Pharmacology Page 20 of 20