Pharma 2820 Infection, Pain, End-of-Life Drugs - PDF

Antiinfections PATHOGENS  Bacteria : TB, PNA, cellulitis, bronchitis, most STDs, UTI, traveler’s diarrhea, URI  Virus :Hepatitis, HIV, Shingles, flu, Covid, norovirus, herpes simplex(cold sores)  Fungi : candidiasis, pneumocystis pneumonia, histoplasmosis...

Antiinfections PATHOGENS  Bacteria : TB, PNA, cellulitis, bronchitis, most STDs, UTI, traveler’s diarrhea, URI  Virus :Hepatitis, HIV, Shingles, flu, Covid, norovirus, herpes simplex(cold sores)  Fungi : candidiasis, pneumocystis pneumonia, histoplasmosis  Parasites: tapeworms, lice, mosquitos, bedbugs, scabies Antiinfection agents can either kill the pathogen or stop its reproduction  SEPSIS TRIGGERS Elevated WBC Fever, chills, weakness, fatigue lactic acid elevation hypotension tachycardia 100 rule??? Temp>100 hypercapnic HR >100 BP They target bacterial cell wall ❑ Tetracyclines ; Doxycycline, Tetracycline. > they interfere with bacterial protein synthesis = broad spectrum. Watch for superinfection, teeth color, photosensitivity ❑ Cephalosporins : work like pcns; Cephalexin ( Keflex), Cefepime, Ceftrioxone ❑ Fluoroquinolones ( quinolones) ; BS usually for adults; Ciprofloxacin ( Cipro), Levofloxacin ( Levaquin) ❑ Sulfonamides : Bactrim, Septra, Sulfasalazine  Treating Tuberculosis Mycobacterium tuberculosis > Slow growing Usually invades through the lung Treatment involves the intensive and continuation phases. Latent: 9 months Isoniazid(INH) Requires 6-12 months antibiotic treatment Intensive phase usually lasts 2 months and involves daily taking Isoniazid, Rifampin, pyrazinamide, and ethambutol Continuation phase: 4 months INH and rifampin DX: Mantoux skin test, Quantiferon tests, sputum 8 culture, CXR  Isoniazid (INH)  Route: PO, IM (rare)  Administration: Do not give within 2 hours of antacid (aluminum)  Adverse Effects: Peripheral numbness and tingling, hepatotoxicity  Contraindications: Concurrent use of disulfiram  Considerations: Consider concurrent administration of pyridoxine (vit.B6), monitor liver enzymes regularly during treatment, complete full treatment course 9  ADVERSE EFFECTS OF ABX  Severe allergic reaction that results in difficulty breathing, facial, shock, swelling (lips, tongue, throat, face) =Anaphylaxis  Severe watery or bloody diarrhea; Clostridium difficile infection  Stomach cramps  Yeast infections in the mouth or vagina (white discharge and severe itching in the vagina or mouth sores or white patches in your mouth or on your tongue 10  nursing care when pt is on ABX  Verify allergies before initiation  2 hour monitor if first dose, adverse reaction can occur within minutes  Vital signs check especially temp  Push fluids unless contraindicative  Teach pt to take entire dose as ordered/ schedule  Offer probiotics for oral abx i.e lactobacillus, yogurt  Confirm sensitivities. may seek switching abx if not effective  Teach ABX effect on contraceptives, OTC, INR… 11  Classes of Antiretrovirals  Nucleoside/Nucleotide reverse transcriptase inhibitors ( NRTIs) abacavir(ziagen), Trizivir, Biktarvy  Non-nucleotide reverse transcriptase inhibitors > efavirenz, etravirine,nevirapine  Protease inhibitors > atazanavir, lopinavir, Norvir  Entry inhibitors >Maraviroc ( selzentry)  Integrase inhibitors = Biktarvy ( Bictegravir/tenofovir alafenamide/emtritabine) Patients infected with HIV will need combination therapy For example, Dolutegravir (integrase inh.) + abacavir (NRTI) + lamivudine (NRTI) 12 Pharmacotherapy with Antiretroviral Regimens  Establish baseline CBC, BMP, CD4, viral load, liver and kidney studies  Monitor for concurrent infections  Regularly monitor for hepatic, renal, and neuro toxicity  Monitor for pancreatitis  Monitor glucose and lipid levels  Emphasize importance of compliance with drug regimen  Assess for body image disturbance Therapy goal is to reduce the viral load and prevent opportunistic infections 13 NRTIs force the HIV virus to use faulty versions of building blocks so infected cells cannot make more HIV  Abacavir or ABC Ziagen  Emtricitabine or FTC Emtriva)  Lamivudine or 3TC Epivir  Zidovudine or ZDV Rotrovir Nucleoside reverse transcriptase inhibitors block the enzyme that HIV needs to make copies of itself AKA“NUKES”  PROTOTYPE DRUG: ACYCLOVIR  Therapeutic Class: Antiviral for herpesviruses  Pharmacologic Class: Nucleoside analog Tx shingles  Actions and Uses  oneof the first antiviral drugs, acyclovir is limited to pharmacotherapy for herpesviruses, for which it is a drug of choice. Prevents viral D N A synthesis, acyclovir decreases the duration and severity of acute herpes episodes. When given for prophylaxis, it may decrease the frequency of herpes appearance, but it does not cure the patient.  Adverse Effects There are few adverse effects from acyclovir when it is administered topically or P O. Nephrotoxicity and neurotoxicity are possible when the medication is given I V. Resistance has developed to the drug, particularly in patients with H I  Nursing consideration during antiretroviral therapy  Monitor kidney and liver function tests, heart function  For PO take with food unless contraindicated  Manage side effects: skin rash, weight gain, fever, fatigue, joints pain, headache, swelling of eyes  Teach patient to take all meds as prescribed  Teach patients drugs do not cure HIV, they reduce viral load ;Symtuza( darunavir)  Genetic testing prior initiation especially NRTIs such as Trizivir and Ziagen  Non-Nucleoside Reverse Transcriptase inhibitors ( NNRTIs) such as doravirine have side effect of vivid dreams, anxiety and depression should not be given to patients with mental illness  Parasites  Protozoa: malaria, dysentery, giardiasis Malaria is a serious disease worldwide causing significant morbidity and mortality Atovaquone-proguanil  Helminths: wormlike creatures like tapeworms and roundworms. Ex. Enterobius vermicularis (pinworm) Pinworm is most common helminthic infection in the US Pyrantel pamoate (available OTC)  Arthropods: ticks and ectoparasites like lice (pediculosis [capitus, corporus, pubis], mites (scabies) Ectoparasites may be vectors for more serious diseases (bubonic plague) 17 Pharmacotherapeutic management of pain ❑ Pain is unpleasant experience –sensory or emotional related to potential or confirmed tissue damage ❑ Opioids and non-opioids analgesic ❑ Acetaminophen > for mild-mod. Pain and fever. Watch for liver failure pts ❑ Nonsteroidal anti-inflammatory drugs ( NSAIDS) > ASA, Ibuprofen, Naproxen ❑ Antidepressants: duloxetine and Amitriptyline for tx of neuropathic pain ❑ Antiepileptics : Gabapentin, Pregabalin( Lyrica) for neuropathy, fibromyalgia ❑ Local anesthetics; lidocaine patch ❑ Opioids : morphine, codeine, hydrocodone, fentanyl, oxycodone, methadone, tramadol,  some side effects of pain meds ❖ Opioids: resp. suppression, sedation, mental instability, abnormal EKG ❖ NSAIDS: G.I upset ❖ Lidocaine : arrhythmias, seizure, loss of consciousness ❖ Duloxetine : serotonin syndrome, tachycardia, seizure, coma ❖ Acetaminophen : OD can cause liver damage = activated charcoal  Medication for end -of -life ❑ Goal is palliative and comfort. To manage anxiety and pain Morphine sulphate po, IV, SL > for pain, and shortness of breath Acetaminophen : for pain, fever > po or PR Haloperidol ; agitation and restlessness Lorazepam, for anxiety, restlessness ,insomnia agitation and nausea ; IV, PO, SL Atropine sulfate/ scopolamine : secretion > death rattle Bisacodyl ( Dulcolax) po/PR Antidepressants ABX, IVF, and none death related medications are usually stopped END –OF LIFE QUIZ KNOW THE MEDS THEY WILL NEED Febrile actively dying patient will need ? A.Acetaminophen PR B.Acetaminophen po Haloperidol ( Haldol) is helpful in ? Agitation and anxiety Impending death can be a source of great anxiety. Patient can benefit from ? A.Lorazepam ( Ativan) B.Diazepam ( Valium) C.Xanax ( alprazolam) D.Clonazepam ( Klonopin) ALL THE ABOVE Valium, Xanax, Ativan, Klonopin  For gurgling breathing sounds this sublingual drops may help Atropine gtts Death rattle can be minimized by using this patch  Dyspnea and air hunger can cause severe discomfort and pain in the dying. This can be managed by using which of these controlled substances A.Morphine sulfate ( Roxanal) B.Iron sulfate C.Calcium sulphate D.Potassium sulfate A.Morphine sulfate ( Roxanal) Nausea is common in the dying. It can be managed by the following except? A.Ondansetron ( Zofran) B.Prochlorpezine ( Compazine) C.Metoclopramide ( Reglan) D.Dronabinol ( marinol) ALL THE ABOVE Which of the following is the most comfortable laxative for the actively dying A.Bisacodyl Supp B.Milk of magnesia C.Lactulose D.Senna s A.Bisacodyl Supp Which of the following is true regarding use of IV fluids for the actively dying A.It is helpful to dehydrate the dying B.It should be isotonic C.It should be hypertonic D.It is contraindicative, it may prolong suffering