Pharmacology Student Activity Sheet PDF

Pharmacology STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session 1 LESSON TITLE: INTRODUCTION TO PHARMACOLOGY...

Pharmacology STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session 1 LESSON TITLE: INTRODUCTION TO PHARMACOLOGY Materials: LEARNING OUTCOMES: Notebook, pens ,paper and index card At the end of the lesson, the nursing student can: References: 1. Differentiate the three phases of drug action; Kee, Joyce LeFever, Hayes, Evelyn R. & 2. Describe the four processes of pharmacokinetics; McCuistion E. Pharmacoloy A Nursing 3. Discuss the four types of drug interaction. Process Approach 6th edition.. Singapore: Elsevier Saunders Company. SUBJECT ORIENTATION & GETTING TO KNOW EACH OTHER ACTIVITY (20 minutes) You will now take note everything about the subject orientation 1. Calendar of activities 2. Classroom rules and regulations 3. Computation of grades 4. Grading of modules 5. Election of officers 6. Requirements – Drug study per period/ term MAIN LESSON (45 minutes) THREE PHASES OF DRUG ACTION I. Pharmaceutic Phase o Disintegration – is the breakdown of tablet into smaller particles o Dissolution - dissolving of the smaller particles in the GI fluid before absorption o 1st phase of drug action o Rate limiting – time it takes for the drug to disintegrate and dissolve to become available for the body to absorb it. II. Pharmacokinetic Phase  o Is the process of drug movement to achieve drug action o 2nd phase of drug action o What the body does to the drug- refers to the study of how the body processes drugs o It includes the 4 basic components of : 1. Absorption 2. Distribution 3. Metabolism (Biotransformation) 4. Excretion 1. Absorption – the movement of drug particles from the G.I. tract to body fluids by : a. Passive absorption b. Active absorption c. Pinocytosis a. Passive absorption o Movement of a drug from the site of administration into the bloodstream. o Absorption determines how long it takes for a drug to take effect. o Usually the more rapid the absorption, faster the drug works o Drugs can be absorbed through plasma primarily by: Diffusion (movement from higher concentration to lower concentration) o Does not require energy to move across the membrane. b. Active absorption o Requires a carrier such as an enzyme or protein o Energy is required for active absorption c. Pinocytosis o Process by which cells carry drug across their membrane by engulfing the drug paticles Factors Affecting Absorption o Surface area o Contact time with surface o Circulation o Solubility (water soluble vs lipid soluble) o Ionization (weak versus strong acid/base) o Drug form & drug concentration o Bioavailability ( after first pass thru liver) o Route of administration (enteral & parenteral) o Additives: alter the location of disintegration of drugs as well as increase or decrease the rate of absorption o Enteric coating allows a drug to dissolve only in an alkaline (pH greater than 7.0) environment such as the small intestine. o Sustained release drugs:allow drugs to be released slowly over time, rather than quickly, like conventional tablets. o Size of drug particles: smaller the particle, faster the onset. Drug Absorption varies by form Liquids, elixirs, syrups Fastest Suspension solutions Powders Capsules Tablets Coated tablets Enteric-coated tablets Slowest 2. Distribution: the transport of drugs from the blood to the site of action. A drug must be distributed to its site of action to have an effect  o Drugs are also distributed to tissues where it has no effect. Competition for drug binding sites affects the amount of drug available for action in the body. o Volume of Distribution (Vd) - The degree of distribution of a drug into various body compartments and tissue Factors Affecting Distribution 1. Perfusion Rate 2. Permeability of Membranes 3. Protein binding 4. Tissue Localization 5. Blood Brain Barrier 6. Placenta 3. Metabolism (breakdown of the drug) o Biotransformation: process by which the body changes the chemical structure of a drug to another form called a metabolite. o Metabolite: a more water soluble compound that can be easily excreted. The major organ for this process is the liver o First Pass Phenomenon - Drugs are first absorbed through the small intestine then arrive at the liver via the portal circulation o There they undergo considerable biotransformation before entering the systemic circulation. o There will be less active drug available for action in the body cells after this first Pass through the Liver Variations in Metabolism o Pharmacogenetics - hereditary influences on drug responses, refers to variations in which individuals metabolize drugs. o Circadian Rhythms - the rate of drug absorption, hepatic clearance, half-life and duration of action, have all been shown to differ depending upon the time of day a drug is administered. o Effects of Gender and Age Elimination of the drug from the body is directly influenced by age. Newborns and elderly experience the effects of drugs for longer and the drug takes a lot longer to be eliminated from the body. Newborns : When babies are born to term, their renal function is very quick to establish similar levels to adults wi thin one week after birth. If the baby is born prematurely it can take 8 weeks or more to reach the level of enzymes necessary. If drugs are given before the renal function is at this level, the drug elimination from the body takes a lot longer and so do the effects of the drugs. Elderly : Renal filtration rate begins to decline at 20 years of age and by 50 years of age it has declined by 50%. This again will affect the elimination of drugs from the body. 4. Excretion: process where drugs are removed from the body. Kidneys are the major organs of excretion. o Lungs excrete gaseous drugs. o Biliary excretion (bile & feces) is important for a few drugs. These drugs may be reabsorbed when passing through the intestines from the liver ( enterohepatic re-circulation ). o Intestines, sweat, saliva and breast milk constitute minor routes of drug excretion o Clearance of drugs - elimination of drugs from circulation by all routes. It affects the time a drug remains in the body and the dosage required. Renal Clearance Hepatic clearance PLASMA HALF-LIFE o The elimination half-life of a drug is a pharmacokinetic parameter that is defined as the time it takes for the concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. In other words, after one half-life, the concentration of the drug in the body will be half of the starting dose. o Drugs with short half-lives are quickly eliminated from the body. ( Ex: analgesics : given several X per day ) o Drugs with longer half-lives stay in the body longer (Ex: Digoxin given once a day ) III. PHARMACODYNAMIC PHASE o What a drug does to the body- refers to the study of the mechanism of drug action on living tissue.  o Drugs may increase, decrease or replace enzymes, hormones or body metabolic functions. o Chemotherapeutic drugs alter an abnormal parasite or growth on the body such as bacteria, viruses or neoplastic tissue. examples: antibiotics and antineoplastic drugs. Effects of Drugs Therapeutic / Desired effect a. curative (cures a disease or condition) b. supportive (supports a body function until other treatments or the body's response can take over c. substitutive (replaces body fluids or substances) d. chemotherapeutic (destroys malignant cells) e. restorative (returns the body to health) Adverse drug reaction (ADR) is an unwanted or harmful reaction experienced following the administration of a drug or combination of drugs under normal conditions of use and is suspected to be related to the drug. An ADR will usually require the drug to be discontinued or the dose reduced. Adverse event is harm that occurs while a patient is taking a drug, irrespective of whether the drug is suspected to be the cause. Side-effect is any effect caused by a drug other than the intended therapeutic effect, whether beneficial, neutral or harmful. The term ‘side-effect’ is often used interchangeably with ‘ADR’ although the former usually implies an effect that is less harmful, predictable and may not even require discontinuation of therapy (e.g. ankle oedema with vasodilators). Drug toxicity describes adverse effects of a drug that occur because the dose or plasma concentration has risen above the therapeutic range, either unintentionally or intentionally (drug overdose). Drug abuse is the misuse of recreational or therapeutic drugs that may lead to addiction or dependence, serious physiological injury (such as damage to kidneys, liver, heart), psychological harm (abnormal behavior patterns, hallucinations, memory loss), or death. Hypersensitivity / allergy: exaggerated adverse reaction to drug CASE SCENARIO You will read and analyze the case scenario. Answer all the questions based on the data presented in the scenario. Patient Background: Mary, a 65-year-old woman, presents to her primary care physician with complaints of insomnia. She reports difficulty falling asleep and frequent awakenings throughout the night. Mary has no significant medical history and takes no regular medications. Phase 1: Absorption Mary's physician prescribes her a sedative-hypnotic medication to help improve her sleep. Mary takes the medication orally as directed before bedtime. 1. Describe the process of absorption of the sedative-hypnotic medication taken by Mary. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Phase 2: Distribution The sedative-hypnotic medication reaches Mary's brain, where it acts on GABA receptors to promote sedation and sleep. 2. Explain the process of distribution of the sedative-hypnotic medication within Mary's body, including its passage to the brain. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Phase 3: Metabolism After a restful night's sleep, Mary's liver metabolizes the sedative-hypnotic medication to facilitate its elimination from her body. 3. Describe the process of metabolism of the sedative-hypnotic medication in Mary's body. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________  Phase 4: Excretion Mary's kidneys filter the metabolites of the sedative-hypnotic medication from her bloodstream into her urine for elimination from her body. 4. Explain the process of excretion of the metabolites of the sedative-hypnotic medication from Mary's body. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ CHECK FOR UNDERSTANDING (20 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not allowed. You are given 25 minutes for this activity: Multiple Choice 1. What is pharmacokinetics? a. The study of biological and therapeutic effects of drugs b. The study of absorption, distribution, metabolism and excretion of drugs c. The study of mechanisms of drug action d. The study of methods of new drug development ANSWER: RATIO: 2. The interaction of one drug increased by the presence of a second drug is known as: a. Potentiation b. Addictive effects c. Antagonism d. Synergism ANSWER: RATIO: 3. Considering the absorption of medications during administration, which of the following routes would yield the quickest response? a. Oral Medications b. Subcutaneous injections c. Intravenous medications d. Topical medications ANSWER: RATIO: 4. Which of the following best defines the process of pharmacokinetics? a. The effect of medication on the body b. The effect of the body on medication c. The study of medications d. The preparation of medications for administration ANSWER: RATIO: 5. When performing an assessment about medication drug history should include which of the following? a. Complete vital signs b. Reason for medication c. Client’s goal therapy d. Administration of OTC medications ANSWER: RATIO: 6. When considering the pharmacotherapeutic effects of drugs administered to clients, the nurse considers which property of most Importance: a. Efficacy b. Potency c. Interaction with other drugs d. Toxicity ANSWER: RATIO: 7. Safety of a drug is determined by the degree between which of the following? a. Therapeutic and toxic doses b. Potency and efficacy c. Subtherapeutic and toxic levels d. Side and adverse effects ANSWER: RATIO: 8. The nurse is monitoring the therapeutic drug level for a client on vancomycin (Vancocin) and notes that the level is within the acceptable range. What does this indicate to the nurse? Select all that apply. a. The drug should cause no toxicities or adverse effects b. The drug level is appropriate to exert therapeutic effects c. The dose will not need to be changed for the duration of treatment d. the nurse will need to continue monitoring because each client response to a drug is unique ANSWER: RATIO: 9. When a drug is 50% protein bound it means that: a. 50% of the drug destroys protein b. A drug not bound to protein is an active drug c. 50% of the dose is at work d. Protein must be restricted in the diet ANSWER: RATIO: 10. When reviewing the patient’s medication regimen, the nurse understands that the interval of drug dosage is related to what? a. Half-life b. Biotransformation c. Metabolism d. Therapeutic effect ANSWER: RATIO: 11. It is important for the nurse to be aware of the four sequential processes of the pharmacokinetic phase. What are these processes? a. Distribution, metabolism, excretion, absorption b. Biotransformation, excretion, absorption, metabolism c. Absorption, distribution, metabolism, excretion d. Metabolism, distribution, absorption, excretion ANSWER: RATIO: 12. The nurse is teaching the client about newly prescribed medication. Which statement made by the client would indicated the need for further medication education? a. "the liquid form of the drug will be absorbed faster than the tablets." b. "If I take more, I'll have a better response" c. "taking this drug with food will decrease how much gets into my system." d. "I can consult my health care provider if i experience unexpected adverse effects" ANSWER: RATIO: 13. The nurse is caring for several clients. Which client will the nurse anticipate is most likely to experience an alteration in drug metabolism? a. A 3 day old premature infant b. A 22 year old pregnant female c. A 32 year old man with kidney stones d. A 50 year old executive with hypertension ANSWER: RATIO: 14. A client is being discharged from the hospital with a nebulizer for self-administration of inhalation medication. Which statement made by the client indicates to the nurse that the client education has been successful? a. "Inhaled medications should only be taken in the morning." b. "Doses for inhaled medications are larger than those taken orally" c. "Medicines taken by inhalation produce a very rapid response." d. "Inhaled drugs are often rendered inactive by hepatic metabolism reaction” ANSWER: RATIO: 15. The Nurse is caring for a client with hepatitis and resulting in hepatic impairment. The nurse would expect the duration of action for most medications to: a. Decrease b. Improve c. Be unaffected d. Increase ANSWER: RATIO: RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: RATIO: 2. ANSWER: RATIO: 3. ANSWER: RATIO: 4. ANSWER: RATIO: 5. ANSWER: RATIO: _ 6. ANSWER:  RATIO: 7. ANSWER:  RATIO: 8. ANSWER: RATIO: 9. ANSWER: RATIO: 10. ANSWER: RATIO: 11. ANSWER: RATIO: 12. ANSWER: RATIO: 13. ANSWER: RATIO: 14. ANSWER: RATIO: 15. ANSWER: RATIO: LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. Muddiest Point In today’s session, what was least clear to you? For next session, review Principles of Drug Administration, Dosage Calculations  Pharmacology STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session 2 LESSON TITLE: PRINCIPLES OF DRUG ADMINISTRATION/ Materials: DOSAGE CALCULATIONS Book, pen, notebook and index card LEARNING OUTCOMES: At the end of the lesson, the nursing student can: References 1. Discuss the drug administration safety guidelines. Hayes, Evelyn R. Pharmacology: A Nursing 2. Describe how different dosages affect the absorption, Process Approach: 6th Edition. Singapore: onset and duration of drug action. Elsevier Saunders Company. 3. Calculate intravenous infusion and medication using the Karch, Amy M. Focus on Nursing Pharmacology correct formula. 5th edition. Philedelphia: Lippincott William and Wilkins Kozier, Barbara, et.al. Fundamentals of Nursing Concepts, Process and Practice: 8th Edition. New Jersey: Pearson Hall. LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY PRE TEST (15 minutes) PRE TEST You may now answer the 20 items pretest. Please follow instructions. Use black ballpen and No erasures. You are given 15 minutes to answer. I. IDENTIFICATION. Fill each blank with the correct answer. Write your answers on the space provided.  9. is the most common form of drug. 10. are medications and fluids administered directly into the bloodstream and are immediately available for use by the body. II. Convert the given measures to new units. Write your answers on the space provided for each number. No erasures. 1. 1 kg = lb 2. 1 tsp = mL 3. 1 L = mL 4. 1 kg = g 5. 1 oz = mL 6. 1 g = mg 7. 1 mg = mcg 8. 1 tbsp = mL 9. 1 cup = fl oz 10. 1 pint = cups 11. 12 inches = foot 12. 1 tbsp = tsp 13. 1 cc = mL 14. 8 oz = mL 15. 1 tsp = gtt MAIN LESSON (40 minutes) Principles of Drug Administration To provide safe drug administration, the nurse should practice the “rights” of drug administration. They are: 1. The right client 2. The right drug 3. The right dose 4. The right time 5. The right route Experience indicates that five additional rights are essential to professional nursing practice: 1. The right assessment 2. The right documentation 3. The client’s right to education 4. The right evaluation 5. The client’s right to refuse I. The right client needs to be ensured by checking the wrist band, and by checking a second piece of identification. This could be a picture on the chart, or a case number that is both on his chart and wristband. This must be done before any medication is administrated. II. The right drug means that the client receives the drug that was prescribed by a physician (MD), dentist (DDS), podiatrist (DPM), or an advanced practice nurse with the license to write prescriptions (APRN). The use of computerized systems to record medications has helped to decrease medication errors, because nurses are not trying to read written forms of the prescriptions. Dr.’s can electronically add a new medication order to a pt. chart from any location. If there is a phone order or verbal order it must be cosigned by the prescribing physician within 24 hours. The components of a drug order are as follows: − Date and time the order is written − Drug name (generic is preferred) − Drug dosage − Route of administration − Frequency and duration of administration (e.g, x 7 days, x 3 doses) − Any special instructions for withholding or adjusting dosage based on nursing assessment, drug effectiveness, or laboratory results  − Physician or other health care provider’s signature or name if TO or VO − Signatures of licensed practitioners taking TO or VO. * If any of these components are missing, the entire order is incomplete and the medication should not be given. To avoid error, the nurse must check the bottle against the order for the medication three different times. 1. at the time of contact with bottle or container 2. before pouring the drug, and 3. after pouring the drug. Drugs given for the first dose, one-time or PRN medication should always be checked against the original order. Beware of medications that sound alike, and read the labels carefully. 🞄 For example, Percocet contains oxycodone and acetaminophen. Percodan contains oxycodone and aspirin. Percodan should not be given to someone who has an adverse reaction to aspirin. Nursing implication includes the following: 1. Check that medication order is complete and legible 2. Know why the client is receiving the medication 3. Check the drug label three times before administration 4. Know the start date that the drug was ordered and the ending date The following are the four categories of drug orders: 1. Standing orders 2. One-time (single dose) 3. PRN 4. STAT (at once) III. The right dose is the dose prescribed for a particular client. The nurse is responsible for questioning any dose that looks too high or too low. Always consult a peer or pharmacist if the dosage appears incorrect. Beware of pediatric doses that are based on body weight. Weights can change daily so regular assessment of dosages is crucial. The nursing implications include the following: a. Calculate the drug dose correctly. For some medications, two nurses are needed to sign off on a new order such a heparin and insulin. b. Check the PDR, American hospital formulary, drug package inserts, or other drug references for recommended range of specific drug doses. IV. The right time is the time at which the prescribed dose should be administered. – Nursing implications include the following: 1. Administer drugs at the specified times. Drugs may be given 0.5 hour before or after the time prescribed if the administration interval is > 2 hours. 2. Administer drugs that are affected by foods, before meals (e.g. tetracycline). 3. Administer drugs that can irritate the stomach (gastric mucosa) with food such as aspirin or potassium. 4. The drug administration schedule can sometimes be flexible in order to accommodate the client’s activities for the day or preferences. 5. It’s the nurse’s responsibility to be aware of test’s or procedures that are taking place that may affect the medication administration. (e.g, fasting blood tests, endoscopy) 6. Check the expiration date on medications and return to pharmacy if expired. 7. Antibiotics need to be given evenly over 24 hours as opposed to T.I.D V. The right route is necessary for adequate or appropriate absorption. – The following are the nurse’s implications with regard to route: 1. Assess client’s ability to swallow before administering p.o. 2. Do not crush or mix medications into other substances before consultation with the pharmacy. Do not mix meds into sweetened juices for kids or add to formula for babies. Follow all med administration guidelines for that specific drug. 3. Use aseptic technique when administering drugs. Use sterile technique when administering parenteral meds. 4. Administer drugs to appropriate sites. 5. Stay with client until p.o meds have been swallowed. 6. If it’s necessary to combine a medication with another substance, explain this to the client. FORMS AND ROUTES FOR DRUG ADMINISTRATION Medication safety tips. 1. Avoid distractions. The hospital is full of interruptions and distractions. In fact, several studies have concluded that these factors account to around 45-50% of medication errors. Focus. Distractions during medication preparation and administration can cause errors. Distractions : From ringing telephones, alarming call bells to short-tempered patients, all of these things can easily disrupt your focus. Even your co-nurses and patients can take your mind off of what you’re doing. Because these factors are hard to eliminate altogether, reaching an agreement with your colleagues can help. You can ask them to handle patients’ concerns as you focus on preparing and administering the due medications. Once it’s their turn to administer, offer to attend to your patient’s other needs. 2. Know your Rs. The Rights of Drug Administration aren’t that hard to memorize. Putting them into practice, however, can be a different story particularly if it’s the first time you’re administering a medication. The anxiety, fear and tension can easily put you at risk of committing an error. Because of this vulnerability, certain hospitals implement policies to help new nurses hone their skills without risking the welfare of their patients. Know the 10 rights of drug administration. 3. Always ask and countercheck. More often than not, medication errors involve miscommunication and false assumptions. If you can’t read your doctor’s handwriting, there’s nothing wrong in verifying it with the doc. Getting shouted by an annoyed doctor is better than a dead patient. “…IT IS STANDARD PRACTICE TO FOR ANOTHER NURSE TO RECOMPUTE AND DOUBLE CHECK IT.” In case you are sure or unsure of your calculations, it is standard practice to for another nurse to recompute and double check it. Any miscalculation can lead to potentially debilitating effects on your patient. 4. Stay updated. With a very busy shift, it can be hard to keep up with every update doctors write on your patients’ charts. One of the best ways you can address this is through a process called Medication Reconciliation. It involves creating a complete list of medications your patient is receiving and constantly updating the list as transition of care happens or if there are any changes in his medication chart. 5. Label properly. Each hospital has its own policy when it comes to labeling medications. Generally, however, it’s a universal practice to keep every syringe, vial or container properly labeled to avoid medication error. Label your ports and medications. Make it a point to label every syringe or container that has medication in it. Even bowls, catheters and receptacles have labels on them just to make sure 6. Report. In case an error does happen, make it a point to report the incident. Notify all the members of the health team in charge of the patient’s care as well as the hospital safety committee. Depending on your institution’s policy, you may also need to inform the relatives of the patient as to what went wrong and how was the error managed. A research from the University of Michigan showed that the more the families are informed about an error, the less likely they are to react legally. 7. Check on antidotes. The wrong drug and route can pose fatal risks to your patients. Some incident can even lead to loss of lives, particularly if not handled correctly. This makes preparation and readiness critical. Aside from emergency drugs, have the basic antidotes on stock. Keeping them within easy reach will enable you to respond quicker to emergent cases. MEASURING SYSTEMS 1. Metric system 2. Apothecary system 3. Household system I. Metric System – is a decimal system based on the power of ten. The basic unit of measurement are: a. Gram for weight b. Liter for volume c. Meter for linear measurements or length II. Apothecary System o Solids: grain (gr) 60 gr = 1 dram (dr) 8 dr = 1 ounce (oz) o Liquids: minim (min) 60 minim = 1 fluidram (f dr) 8 f dr = 1 fluidounce (f oz) III. Household System o Solids: pound (lb) 1 lb = 16 ounces (oz) o Liquids: pint (pt) 2 pt = 1 quart (qt) 4 qt = 1 gallon (gal) 16 oz = 1 pt = 2 cups (c) 32 tablespoons (tbsp) = 1 pt 3 teaspoons (tsp) = 1 tbsp 60 drops (gtt) = 1 tsp Methods for Calculation / Drug Calculations Tablet Dosage Calculations This formula is used to calculate the number of tablets to be administered when given the required dose. Required Dose ------------------ = Number of tablets to be given Stock Dose Units for required dose and stock dose must be the same. Example 1: A client is ordered 150mg of aspirin. 300 mg aspirin tablets are available. How many tablets would you give? 150 mg 300 mg = 1/2 tablet Example 2: How many tablets containing 62.5 mcg will be required to give a dose of 0.125 mg? STEP 1: CONVERT TO SAME UNITS (Convert 0.125 mg to mcg) The decimal place is moved 3 places to the right. 0.125 mg = (0.125 * 1000 mcg) = 125 mcg STEP 2: CALCULATE 125 mcg = 2 tablets 62.5 mcg OR Convert 62.5 mcg to mg. The decimal place is moved 3 places to the left; 62.5 mcg = (62.5 * 0.001 mg) = 0.0625 mg STEP 3: CALCULATE 0.125 mg = 2 tablets 0.0625 mg Fluid Dosage Calculations This formula is used to calculate the amount of medication in solution for oral, intramuscular, intravenous or subcutaneous injection to be administered when given a dosage, stock dose and volume: Required Dose Stock Volume X = Volume to be given Stock Dose 1 Units for required dose and stock dose must be the same. Example1: A client is ordered 15mg of Stemetil. You have 2ml of solution on hand which contains 25 mg Stemetil. What volume of solution would you give?  15 mg 2 ml 30 X = = 1.2 ml 25 mg 1 25 Example 2: A dose of 75 mg of pethidine has been ordered. It is available in ampules containing 100 mg in 2 ml. How much are you going to administer ? 75 mg 2 ml 150 X = = 1.5 ml 100 mg 1 100 Intravenous Fluid Computation Intravenous fluid must be given at a specific rate, neither too fast nor too slow. The specific rate may be measured as ml/hour, L/hour or drops/min. To control or adjust the flow rate only drops per minute are used. The burette contains a needle or plastic dropper which gives the number of drops per ml (the drop factor). A number of different drop factors are available (determined by the length and diameter of the needle). Common drop factors are: 10 drops/ml (blood set), 15 drops / ml (regular set), 60 drops / ml (microdrop). To measure the rate we must know: a. the number of drops b. time in minutes. The formula for working out flow rates volume (ml) X drop factor (drops/ml) = drops / minute is: time (min) Example: 1500 ml IV Saline is ordered over 12 hours. Using a drop factor of 15 drops / ml, how many drops per minute needs to be delivered? 1500 (ml) X 15 (drops/ml) = 31 drops / minute 12 x 60 (gives us total minutes) 22,500 ml 720 min CASE SCENARIO You will read and analyze the case scenario. Answer all the questions based on the data presented in the scenario. DRUG ADMINISTRATION SAFETY GUIDELINES Part 1: Intravenous (IV) Antibiotic Administration Emily's physician orders ceftriaxone 1 gram IV every 12 hours for her infection. 1. Describe the safety guidelines that should be followed when administering ceftriaxone to Emily intravenously. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Part 2: Patient Education 2. Explain the importance of patient education regarding IV antibiotic therapy to Emily and provide examples of key points that should be included.  ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ MEDICATION ADMINISTRATION Part 1: Oral Medication Administration John's physician orders aspirin 81 mg orally once daily as part of his treatment plan. 1. Describe the principles of oral medication administration that should be followed when administering aspirin to John. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Part 2: Intravenous Medication Administration John's physician orders heparin 5,000 units intravenously every 6 hours for anticoagulation therapy. 2. Describe the principles of intravenous medication administration that should be followed when administering heparin to John. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ CHECK FOR UNDERSTANDING (30 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not allowed. You are given 25 minutes for this activity: Multiple Choice 1. The nursery nurse is putting erythromycin ointment in the newborn’s eyes to prevent infection. She places it in the following area of the eye: a. Under the eyelid b. On the cornea. c. In the lower conjunctival sac d. By the optic disc. ANSWER: RATIO: 2. Nursing responsibilities in the assessment phase of the nursing process include which responsibilities? (Select all that apply.) a. Identify side effects of drugs that are nonspecific b. Check peak and trough levels of drugs c. Advise client to avoid fatty foods prior to ingesting an enteric coated tablet d. Evaluate client's reaction to drug ANSWER: RATIO: 3. The nurse is aware of the many factors related to effective health teaching about the medication. The most essential component of the teaching plan is to do which? a. Provide written instructions. b. Establish a trust relationship. c. Use colorful charts. d. Review community resources. ANSWER: RATIO: 4. A medication health teaching plan is tailored to a specific client. Common topics for health teaching include which? (Select all that apply.) a. Importance of adherence to the prescribed regimen b. How to administer medication (s) c. What side/adverse effects to report to the health care provider d. Instruction of the client on what foods should be eaten ANSWER: RATIO: 5. The nurse educator on the unit receives a list of high-alert drugs. Which strategies are recommended to decrease the risk of errors with these medication? (Select all that apply.) a. Store medications alphabetically on their usual shelf. b. Limit access to these drugs. c. Use special labels. d. Provide increased information to staff. ANSWER: RATIO: 6. Nurse is preparing to administer a medication to a 13-year-old client. The nurse follows the six rights of medication administration for a pediatric client. After checking for the right client, the right dose, the right drug, the right time and the right route, what is the final item the nurse must check for this client? a. Right age b. Right Label c. Right Documentation d. Right strength ANSWER: RATIO: 7. When performing an assessment about medication, the drug history should include: a. Complete vital signs b. Client’s goal of therapy c. Reason for medication d. Administration of OTC medications ANSWER: RATIO: 8. The volume of SC medication must be no more than: a. 0.5 mL b. 1.0 mL c. 1.5 mL d. 3.0 mL ANSWER: RATIO: 9. Which of the following muscles is a possible site for IM injections? a. Outer aspect of the hip b. Shoulder c. Vastus gluteus d. Vastus lateralis ANSWER: RATIO: 10. When deciding on what time of day to give medications, the nurse pays closest attention to the client’s habits regarding: a. Eating b. Sleeping c. Elimination d. Activity ANSWER: RATIO: 11. Doctor’s Order: Tylenol supp 1 g pr q 6 hr prn temp > 101; Available: Tylenol supp 325 mg (scored). How many supp will you administer? a. 2 supp b. 1 supp c. 3 supp d. 5 supp ANSWER: COMPUTATION : 12. Doctor’s Order: Nafcillin 500 mg po pc; Available: Nafcillin 1 gm tab (scored). How many tab will you administer per day? a. 2.5 tabs b. 2 tabs c. 1.5 tabs d. 1 tab ANSWER: COMPUTATION : 13. Doctor’s Order: Synthroid 75 mcg po daily; Available: Synthroid 0.15 mg tab (scored). How many tab will you administer? a. 1 tab b. 0.5 tab c. 2 tabs  d. 1.5 tabs ANSWER: COMPUTATION : 14. Doctor’s Order: Diuril 1.8 mg/kg po tid; Available: Diuril 12.5 mg caps. How many cap will you administer for each dose to a 31 lb child? a. 2 caps b. 2.5 caps c. 3 caps d. 1.5 caps ANSWER: COMPUTATION : 15. Doctor’s Order: Cleocin Oral Susp 600 mg po qid; Directions for mixing: Add 100 mL of water and shake vigorously. Each 2.5 mL will contain 100 mg of Cleocin. How many tsp of Cleocin will you administer? a. 3 tsp b. 5 tsp c. 3.5 tsp d. 1 tsp ANSWER: COMPUTATION : RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: RATIO: 2. ANSWER: RATIO: 3. ANSWER: RATIO: 4. ANSWER: RATIO: 5. ANSWER: RATIO: 6. ANSWER: RATIO: 7. ANSWER: RATIO: 8. ANSWER: RATIO: 9. ANSWER:  RATIO: 10. ANSWER: RATIO: 11. ANSWER: RATIO: 12. ANSWER: RATIO: 13. ANSWER: RATIO: 14. ANSWER: RATIO: 15. ANSWER: RATIO: LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. 3-2-1 Three things you learned: 1. 2. 3. Two things that you’d like to learn more about: 1. 2. One question you still have: 1. For the next session review Anti-Infective Agents, Antibiotics  Pharmacology STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session 3 LESSON TITLE: ANTI-INFECTIVE AGENTS/ ANTIBIOTICS Materials: LEARNING OUTCOMES: Book, Notebook, pens & paper At the end of the lesson, the nursing student can: 1. Explain the mechanism of action of anti-infective References: agents. Hayes, Evelyn R. Pharmacology: A Nursing 2. Differentiate broad spectrum and narrow spectrum Process Approach: 6 th Edition. Singapore: drugs; Elsevier Saunders Company. 3. Discuss the use of antibiotics across lifespan. 4. Develop a drug study guide. (therapeutic action, Karch, Amy M. Focus on Nursing Pharmacology indication, contraindication, most common adverse 5th edition. Philedelphia: Lippincott William reaction and nursing responsibility which includes health and Wilkins teachings) of the different classes of antibiotics LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (10 minutes) ANAGRAM Rearrange the scrambled letters to form a word. Words are related to the lesson. 1. I T N B T I A I O C S 2. E L I N O G Y C O A M S I D S 3. P H N I C O R E A O L P S E 4. F Q U N O L O U I L O R O N E S 5. M I C R B A E O S L 6. C O S A L I N M D E I S 7. M A T C O M A S N B O 8. E N P I L N E C L I S 9. S A M U N I E L D F S O 10. T E N I E L S T C R C A Y MAIN LESSON (45 minutes) ANTI-INFECTIVE AGENTS Development of Anti-infective Therapy 1920s Paul Ehrlich worked on developing a synthetic chemical effective against infection-causing cells only. Scientists discovered penicillin in a mold sample  1935 The sulfonamides were introduced Mechanisms of Action 1. Interfere with biosynthesis of the bacterial cell wall 2. Prevent the cells of the invading organism from using substances essential to their growth and development 3. Interfere with steps involved in protein synthesis 4. Interfere with DNA synthesis 5. Alter the permeability of the cell membrane to allow essential cellular components to leak out Mechanism of Anti-infective Agents Anti-infective Activity 🞄 Anti-infectives vary in their effectiveness against invading organisms 🞄 Some are selective: they are effective only for a small number of organisms 🞄 Bactericidal: kill the cell 🞄 Bacteriostatic: prevent reproduction of the cell Narrow Spectrum vs Broad Spectrum 1. Narrow spectrum of activity - Effective against only a few microorganisms with a very specific metabolic pathway or enzyme 2. Broad spectrum of activity - Useful in treating a wide variety of infections Human Immune Response 1. Goal of anti-infective therapy is reduction of the population of the invading organism 2. Drugs that eliminate all traces of any invading pathogen might be toxic to the host as well 3. Immune response is a complex process involving chemical mediators, leukocytes, lymphocytes, antibodies, and locally released enzymes and chemicals Problems with Treating Infections in Immunosuppressed Patients Anti-infective drugs cannot totally eliminate the pathogen without causing severe toxicity in the host These patients do not have the immune response in place to deal with even a few invading organisms Resistance Anti-infectives act on a specific enzyme system or biological process; many microorganisms that do not act on a specific system are not affected by the particular drug This is considered natural or intrinsic resistance to that drug Acquired Resistance  Microorganisms that were once sensitive to the particular drug have begun to develop acquired resistance This results in serious clinical problems Ways Resistance Develops 1. Producing an enzyme that deactivates the antimicrobial drug 2. Changing cellular permeability to prevent the drug from entering the cell 3. Altering transport systems to exclude the drug from active transport into the cell 4. Altering binding sites on the membranes or ribosomes, which then no longer accept the drug 5. Producing a chemical that acts as an antagonist to the drug Preventing Resistance 1. Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used 2. Make sure doses are high enough, and the duration of drug therapy long enough 3. Be cautious about the indiscriminate use of anti-infectives Identification of the Pathogen 1. Identification of the infecting pathogen is done by culture 2. A culture of a tissue sample from the infected area is done o A swab of infected tissue is allowed to grow on an agar plate o Staining techniques and microscopic examination identify the bacterium 3. Stool can be examined for ova and parasites Sensitivity of Pathogen 1. Shows which drugs are capable of controlling the particular microorganism 2. Important to be done for microorganisms that have known resistant strains 3. Along with a culture, identifies the pathogen and appropriate drug for treatment Factors Affecting Prescribing Anti-infective Agents 1. Identification of the correct pathogen 2. Selection of the right drug –One that causes the least complications for that particular patient –One that is most effective against the pathogen involved Combination Therapy 1. Use of a smaller dosage of each drug 2. Some drugs are synergistic 3. In infections caused by more than one organism, each pathogen may react to a different anti-infective agent 4. Sometimes, the combined effects of the different drugs delay the emergence of resistant strains Adverse Reactions to Anti-infective Therapy 1. Kidney damage 2. Gastrointestinal (GI) tract toxicity 3. Neurotoxicity 4. Hypersensitivity reactions 5. Superinfections Prophylaxis of Anti-infective Agents People traveling to areas where malaria is endemic Patients who are undergoing gastrointestinal or genitourinary surgery Patients with known cardiac valve disease, valve replacements, and other conditions requiring invasive procedures ANTIBIOTICS Antibiotics are defined as: Chemicals that inhibit specific bacteria Types of Antibiotics 1. Bacteriostatic - Substances that prevent the growth of bacteria 2. Bactericidal - Substances that kill bacteria directly  Signs of Infection 1. Fever 2. Lethargy 3. Slow-wave sleep induction 4. Classic signs of inflammation (redness, swelling, heat, and pain) Goal of Antibiotic Therapy Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invaders Selecting Treatment Identification of the causative organism Based on the culture report, an antibiotic is chosen that is known to be effective at treating the invading organism Bacteria Classification 1. Gram-positive - The cell wall retains a stain or resists decolorization with alcohol 2. Gram-negative - The cell wall loses a stain or is decolorized by alcohol 3. Aerobic - Depend on oxygen for survival 4. Anaerobic - Do not use oxygen I. Aminoglycosides - A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli Common medications: – Amikacin (Amikin) – Gentamicin (Garamycin) – Kanamycin (Kantrex) – Neomycin (Mycifradin) – Streptomycin – Tobramycin (Nebcin, Tobrex) Bactericidal Indications: treatment of serious infections caused by susceptible bacteria Action: inhibit protein synthesis in susceptible strains of gram-negative bacteria causing cell death Pharmacokinetics – Poorly absorbed from the GI tract but rapidly absorbed after IM injection, reaching peak levels within 1 hour – Widely distributed throughout the body, crossing the placenta and entering breast milk – Excreted unchanged in the urine and have an average half-life of 2 to 3 hours – Depend on the kidney for excretion and are toxic to the kidney Contraindications: Known allergies, renal or hepatic disease, and hearing loss Adverse effects: Ototoxicity and nephrotoxicity are the most significant Drug-to-drug interactions: Diuretics and neuromuscular blockers II. Cephalosporins Similar to penicillin in structure and activity Action - Interfere with the cell-wall–building ability of bacteria when they divide Indication - Treatment of infection caused by susceptible bacteria Pharmacokinetics – Well absorbed from the GI tract – Metabolized in the liver, excreted in the urine Contraindications: Allergies to cephalosporins or penicillin Adverse effect: GI tract Drug-to-drug interactions: Aminoglycosides, oral anticoagulants, and ETOH III. Fluoroquinolones Relatively new class of antibiotics with a broad spectrum of activity Indications: treat infections caused by susceptible strains of gram-negative bacteria, including urinary tract, respiratory tract, and skin infections Actions: interferes with DNA replication in susceptible gram-negative bacteria, preventing cell reproduction Pharmacokinetics – Absorbed in the GI tract  – Metabolized in the liver – Excreted in the urine and feces Contraindications: Known allergy, pregnancy, and lactation Adverse effects: Headache, dizziness, and GI upset Drug-to-drug interactions: Antacids, quinidine, and theophylline IV. Macrolides Antibiotics that interfere with protein synthesis in susceptible bacteria Indications: treatment of respiratory, dermatologic, urinary tract, and GI infections caused by susceptible strains of bacteria Actions: bind to cell membranes causing a change in protein function and cell death; can be bacteriostatic or bactericidal Pharmacokinetics – Absorbed from the GI tract – Metabolized in the liver, excreted in the bile to feces Contraindications: Allergy and hepatic dysfunction Adverse effects: GI symptoms Drug-to-drug interactions: Digoxin, oral anticoagulants, theophylline, and corticosteroids V. Lincosamides Similar to macrolides but more toxic Action: Similar to macrolides Indications: Severe infections Pharmacokinetics: Well absorbed from the GI tract or IM – Metabolized in the liver and excreted in the urine and feces Contraindications: Hepatic or renal impairment Adverse effects: GI reactions VI. Monobactams Unique structure with little cross-resistance Action: Disrupts bacteria cell wall synthesis, which promotes the leakage of cellular content and cell death Indications: Treatment of infections caused by susceptible bacteria; UTI, skin, intra-abdominal, and gynecologic infections Pharmacokinetics: Well absorbed from the IM injection; Excreted unchanged in the urine Contraindications: Allergy Adverse effects: GI and hepatic enzyme elevation VII. Penicillins First antibiotics introduced for clinical use Action: Inhibit synthesis of the cell wall in susceptible bacteria, causing cell death Indications: Treatment of infections caused by streptococcal, pneumococcal, staphylococcal, and other susceptible bacteria Pharmacokinetics: Well absorbed from the GI tract; Excreted unchanged in the urine Contraindications: Allergy; Caution in patients with renal disease Adverse effects: GI effects Drug-to-drug interactions: Tetracyclines and aminoglycosides VIII. Sulfonamides Drugs that inhibit folic acid synthesis Action: Interfere with the cell-wall–building ability of dividing bacteria Indications: Treatment of infections caused by gram-negative and gram positive-bacteria Pharmacokinetics: Well absorbed from the GI tract; Metabolized in the liver and excreted in the urine Contraindications: Allergy and pregnancy Adverse effects: GI symptoms and renal effects related to the filtration of the drug Drug-to-drug interactions: Cross sensitivity with thiazide diuretics; Sulfonylureas IX. Tetracyclines Developed as semisynthetic antibiotics based on the structure of a common soil mold Action: Inhibit protein synthesis in susceptible bacteria, preventing cell replication  Indications: Treatment of various infections caused by susceptible strains of bacteria and acne, and when penicillin is contraindicated for eradication of susceptible organisms Pharmacokinetics: Adequately absorbed from the GI tract; Concentrated in the liver and excreted unchanged in the urine Contraindications: Allergy, pregnancy, and lactation Adverse effects: GI, skeletal: damage to bones and teeth Drug-to-drug interactions: Penicillin G, oral contraceptive therapy, methoxyflurane, and digoxin X. Antimycobacterials Contain pathogens causing tuberculosis and leprosy Action: Act on the DNA of the bacteria, leading to lack of growth and eventual bacterial death Indication: Treatment of acid-fast bacteria Pharmacokinetics: Well absorbed from the GI tract; Metabolized in the liver and excreted in the urine Contraindications: Allergy and renal or hepatic failure Adverse effects: CNS effects and GI irritation Drug-to-drug interactions: Rifampin and INH can cause liver toxicity CASE SCENARIO You will read and analyze the case scenario. Answer all the questions based on the data presented in the scenario. Case Scenario 1 Anti-infective Agents A student nurse has to administer a broad-spectrum anti-infective medication to a patient. The patient develops nausea, vomiting, and diarrhea while taking the medication. The student nurse has to teach the patient about the anti-infective medication. 1. What is the difference between a broad-spectrum and narrow-spectrum anti-infective medication. _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. The patient asks the student nurse what it means to develop resistance to antiinfectives. When the student nurse is teaching the patient about the antiinfective agent, it is important to include what general points to minimize bacterial resistance? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. Identify the three common adverse reactions associated with the use of antiinfectives. This patient is complaining of what common adverse reaction? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Case Scenario 2 The student nurse has to administer antibiotics to a patient who has developed a complicated GU infection. The antibiotics that the student nurse has to administer to the patient include ertapenem, cefaclor, and ciprofloxacin The clinical instructor asks the student nurse to explain how an antibiotic is selected for use in a particular clinical situation. 1. What should the student nurse tell the faculty member about how an antibiotic is selected? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. What are the common adverse effects of ertapenem, cefaclor, and ciprofloxacin that the student nurse needs to tell the patient about? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. What specific points should the student nurse include in patient teaching about ertapenem, cefaclor, and ciprofloxacin? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Case Scenario 3 Patient RM is a 26 y/o male was rushed to the emergency room with a very high fever low blood pressure, fast respiratory rate, disorientation and shortness of breath. Basic interventions were done in the ambulance, while the hospital is waiting for RM’s arrival. The Medical team takes over, and assessment and interventions were performed. Laboratory results come back and clinical indicators lead to RM’s diagnosis of Sepsis. Vancomycin 500mg every 6 hours was started. 1. What clinical presentation do you expect patient RM to display if Sepsis is suspected? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. What is important to health teaching about RM’s antibiotics? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. Develop a drug study guide on Vancomycin. CHECK FOR UNDERSTANDING (30 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not allowed. You are given 25 minutes for this activity: Multiple Choice 1. The nurse is administering an anti-infective that is considered to be a bacteriocidal. Before beginning therapy, the nurse should assess the client for: a. Any neurologic abnormalities. b. Cardiac history. c. Hypersensitivity. d. Respiratory conditions. ANSWER: RATIO: 2. The client asks the nurse why the physician didn't prescribe the same antibiotic that he always takes for an infection. The best response by the nurse would be: a. "It doesn't matter which antibiotic is taken." b. "Try this medicine, and if you're not better in 10 days, return to the office." c. "You don't want to take the same antibiotic all the time." d. "Bacteria can become resistant to some antibiotics. ANSWER: RATIO: 3. A nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention prior to administration regarding anti-infectives is: a. Obtaining the culture report before starting any medication. b. Performing a culture within 24 hours after starting the medication. c. Performing the culture for evidence before administering the first dose of the anti-infective. d. Administering medicine, and omitting performing cultures. ANSWER: RATIO: 4. A client has been on an antibiotic for two weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks the nurse why a superinfection is caused by this medication. The nurse responds: a. "This is a secondary infection due to "Candida." b. "The infection has developed immunity to the current drug." c. "The infection has become severe." d. "The infection has a restricted group of microorganisms." ANSWER: RATIO: 5. A client has been discharged with a prescription for penicillin. Discharge instructions includes which of the following? a. Penicillin can be taken while breastfeeding. b. The entire prescription must be finished. c. All penicillin can be taken without regards to eating. d. Some possible side effects include abdominal pain and diarrhea ANSWER: RATIO: 6. An antimicrobial medication that has selective toxicity has which characteristic? a. Ability to transfer DNA coding b. Ability to suppress bacterial resistance c. Ability to avoid injuring host cells d. Ability to act against a specific microbe ANSWER: RATIO: 7. The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? a. Resistant infection b. Superinfection c. Nosocomial infection d. Allergic reaction ANSWER: RATIO: 8. A client has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in stating that tetracycline: a. Is classified as a narrow-spectrum antibiotic. b. Is used to treat a wide variety of disease processes. c. Has been identified to be safe during pregnancy. d. Is contraindicated in children under 8 years of age. ANSWER: RATIO: 9. Important information to include in the client's education regarding taking aminoglycosides is that: a. The drug can cause discoloration of teeth. b. Fluid intake should be decreased to prevent retention. c. This drug primarily is given orally, because it is absorbed in the GI tract. d. A serious side effect is hearing loss. ANSWER: RATIO:  10. A client has been prescribed ciprofloxacin (Cipro). Important information that the nurse must know includes: a. This medicine must be taken on an empty stomach to increase absorption. b. This medicine is classified as an aminoglycoside and is given for systemic bacterial infections. c. This medicine should be given with an antacid to increase the absorption and effectiveness of the medicine. d. This medicine should not be given with the ordered multivitamin. ANSWER: RATIO: 11. A nursing intervention for administering sulfamethoxazole-trimethoprim (Bactrim) to a client is to: a. Have the client drink a full glass of water with the medicine. b. Have the client drink a glass of milk. c. Have the client take the medicine with solid foods. d. Have the client take the medicine on an empty stomach. ANSWER: RATIO: 12. This antibiotic can have an adverse effect of dizziness, vertigo, and loss of hearing. a. Chloramphenicol b. Aminoglycoside c. Vancomycin d. Fluoroquinolo nes ANSWER: RATIO: 13. A 60 year old male patient on fourth day of his antibiotic therapy complains of dizziness and nausea. Which is the most appropriate nursing action? a. Institute safety precaution and raise side rails. b. Collaborate with the doctor about antibiotic therapy’s dosage and duration. c. Provide comfort measures. d. Instruct client to inform you if symptoms get worse. ANSWER: RATIO: 14. A middle-aged woman came to the ER and complains of ringing in the ears, paresthesias of the extremities, and erythema of the back. She also noticed that she had decreased urine output. What history of drug intake should the nurse ask? a. Oral contraceptive pills (OCPs) b. Antifungals c. Vancomycin d. Trimethoprim-sulfamethoxa zole ANSWER: RATIO: 15. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is: a. Only the nurse’s—she should have checked the allergies before administering the medication. b. Only the physician’s—she gave the order, the nurse is obligated to follow it. c. Only the pharmacist’s—he should alert the floor to possible allergic reactions. d. The pharmacist, physician, and nurse are all liable for the mistake ANSWER: RATIO: RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: RATIO: 2. ANSWER: RATIO: 3. ANSWER: RATIO: 4. ANSWER: RATIO: 5. ANSWER: RATIO: 6. ANSWER: RATIO: 7. ANSWER: RATIO: 8. ANSWER: RATIO: 9. ANSWER: RATIO: _ 10. ANSWER: RATIO: 11. ANSWER: RATIO: 12. ANSWER: RATIO: 13. ANSWER: RATIO: 14. ANSWER: RATIO: 15. ANSWER: RATIO: LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. TWO ROSES AND A THORN Each student must note two topics or concepts he or she enjoyed learning about, and another they didn’t like or still have questions about. For the next session, review Antifungal & Antiprotozoal Drugs  Pharmacology STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session 4 LESSON TITLE: ANTIFUNGAL & ANTIPROTOZOAL Materials: DRUGS Notebook, Pharmacology book, drug handbook, LEARNING OUTCOMES: pens & paper At the end of the lesson, the nursing student can: References: 1. Discuss the mechanism of action of antifungal and Kee, Joyce LeFever, Hayes, Evelyn R. & antiprotozoal medications. McCuistion E. Pharmacoloy A Nursing 2. Describe the five antifungal drug classes. Process Approach 6th edition.. Singapore: 3. Develop an antifungal and antiprotozoal drug study guide Elsevier Saunders Company. LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (5 minutes) FOCUSED LISTING List the key ideas or concepts from assigned work. MAIN LESSON (50 minutes) ANTIFUNGAL What Is a Fungus? Composed of a rigid cell wall made up of chitin and various polysaccharides, and a cell membrane containing ergosterol Protective layers of the fungal cell make the organism resistant to antibiotics Patients Susceptible to Fungal Infections Patients with AIDS and AIDS-related complex (ARC) Patients taking immunosuppressant drugs Patients who have undergone transplantation surgery or cancer treatment Members of growing elderly population no longer protected from environmental fungi Culture Culture is needed prior to prescribing antifungal agents Patients on antifungal agents are immuno-compromised at onset Antifungals (Antimycotic drugs) are used to treat mycosis, or infections caused by fungi. Fungi are different from bacteria in the sense that their cell walls are made up of chitin and various polysaccharides rendering these organisms resistant to antibiotics. Common fungal infections  1. Athlete’s foot (tinea pedis) is a fungal infection that affects the skin on your feet, often between your toes. Typical symptoms of athlete’s foot include: itching, or a burning, stinging sensation between your toes or on the soles of your feet; skin that appears red, scaly, dry, or flaky; cracked or blistered skin 2. Jock itch (tinea cruris) is a fungal skin infection that happens in the area of your groin and thighs. It’s most common in men and adolescent boys. The main symptom is an itchy red rash that typically starts in the groin area or around the upper inner thighs. The rash may get worse after exercise or other physical activity and can spread to the buttocks and abdomen. The affected skin may also appear scaly, flaky, or cracked. The outer border of the rash can be slightly raised and darker. 3. Ringworm of the scalp (tinea capitis) This fungal infection affects the skin of the scalp and the associated hair shafts. It’s most common in young children and needs to be treated with prescription oral medication as well as antifungal shampoo. The symptoms can include: localized bald patches that may appear scaly or red associated scaling and itching associated tenderness or pain in the patches 4. Tinea versicolor sometimes called pityriasis versicolor, is a fungal/yeast skin infection that causes small oval discolored patches to develop on the skin. It’s caused by an overgrowth of a specific type of fungus called Malassezia, which is naturally present on the skin of about 90 percent of adults. These discolored skin patches most often occur on the back, chest, and upper arms. They may look lighter or darker than the rest of your skin, and can be red, pink, tan, or brown. These patches can be itchy, flaky, or scaly. Tinea versicolor is more likely during the summer or in areas with a warm, wet climate. The condition can sometimes return following treatment. 5. Cutaneous candidiasis is a skin infection that’s caused by Candida fungi. This type of fungi is naturally present on and inside our bodies. When it overgrows, an infection can happen. Candida skin infections occur in areas that are warm, moist, and poorly ventilated. Some examples of typical areas that can be affected include under the breasts and in the folds of the buttocks, such as in diaper rash. The symptoms of a Candida infection of the skin can include: a red rash, itching, small red pustules 6. Onychomycosis (tinea unguium) is a fungal infection of your nails. It can affect the fingernails or the toenails, although infections of the toenails are more common. You may have onychomycosis if you have nails that are: discolored, typically yellow, brown, or white, brittle or break easily & thickened Antifungals can be systemic and/or topical. Systemic antifungals are used to treat systemic mycoses and can be toxic to the host and not to be used indiscriminately. It is important to get a culture of the fungus causing the infection to ensure that the right drug is being used so that the patient is not put at additional risk from the toxic adverse effects associated with these drugs. Topical antifungals are used to treat a variety of mycoses of skin and mucous membranes. Some systemic antifungals have topical forms. Claasification of Antifungal Drugs and its Mechanism of Action 1. Polyenes: Act by binding to ergo sterol in the fungal cell membrane. This binding results in depolarization of the membrane. This binding results in depolarization of the membrane and formation of pores that increase permeability to proteins and monovalent and divalent cations, eventually leading to cell death. 2. Echinocandins: noncompetitively inhibit beta-1,3-D-glucan synthase enzyme complex in susceptible fungi to disturb fungal cell glucan synthesis. Beta-glucan destruction prevents resistance against osmotic forces, which leads to cell lysis. They have fungistatic activity against Aspergillus species 3. Antimetabolites: Inhibits fungal protein synthesis by replacing uracil with 5 fluro uracil in fungal RNA, also inhibit thymidilate synthetase via 5-flourodeoxy-uridine monophosphate and thus interferes with fungal DNA synthesis. 4. Allylamines: Inhibits ergo sterol synthesis by inhibiting the enzyme squaline epoxidase. 5. Azoles: Inhibition of cytochrome P450 14a-demethylase. This enzyme is in the sterol biosynthesis pathway that leads from lanosterol to ergo sterol. ANTIFUNGAL AGENTS Amphotericin B Indications Aspergillosis Leishmaniasis Cryptococcosis Blastomycosis Moniliasis Coccidioidomycosis Histoplasmosis Mucormycosis Candida infections (topically) Amphotericin B Indications: progressive, potentially fatal fungal infections Pharmacokinetics: IV form, excreted in the urine Contraindication: kidney disease Adverse reaction: kidney failure Systemic Antifungal Agents Caspofungin (Cancidas) (IV) : Approved for the treatment of invasive aspergillosis in patients who are refractory to other treatments Flucytosine (Ancobon) (oral) :Less toxic drug used for the treatment of systemic infections caused by Candida or Cryptococcus  Nystatin (Mycostatin, Nilstat) (oral): Used for the treatment of intestinal candidiasis; also available in a number of topical preparations Voriconazole & Terbinafine Voriconazole (Vfend) : Available in oral and IV forms. Treats invasive aspergillosis and serious infections caused by Scedosporium apiospermum and Fusarium species Terbinafine (Lamisil) : Blocks the formation of ergosterol, Inhibits a CYP2D6 enzyme system. Oral drug for the treatment of onychomycosis of the toenail or fingernail Azoles o Newer class of drugs used to treat systemic fungal infections. Less toxic than amphotericin B, Less effective than amphotericin B Ketoconazole (Nizoral) Used orally to treat many of the same mycoses as amphotericin B Works by blocking the activity of a steroid in the fungal wall Has side effect of blocking the activity of human steroids, including testosterone and cortisol Pharmacokinetics: absorbed from the GI tract, metabolized in the liver, excreted in the feces Contraindications: not drug of choice for patients with endocrine or fertility problems Adverse reaction: hepatic toxicity Drug-to-drug interactions: many Fluconazole (Diflucan) Not associated with the endocrine problems seen with ketoconazole Used to treat candidiasis, cryptococcal meningitis, and other systemic fungal infections Prophylactic agent for reducing the incidence of candidiasis in bone marrow transplant recipients Pharmacokinetics: available in oral and IV preparations, excreted unchanged in the urine Contraindications: renal dysfunction Adverse reactions: Drug-to-drug interactions: inhibits CYP450 and may be associated with drug-to-drug interactions Itraconazole (Sporanox) An oral agent used for the treatment of assorted systemic mycoses Associated with hepatic failure Slowly absorbed from the GI tract, it is metabolized in the liver by the CYP450 system Excreted in the urine and feces There is an increased incidence of fungal infections in immunocompromised patients (e.g., patients with AIDS, those taking immunosuppressants like organ transplant recipients, etc.). Overall Contraindications to Systemic Antifungal Agents Anyone with a known allergy Pregnant or lactating women (with the exception of terbinafine for life-threatening infections) Patients with renal or liver disease : Drug metabolism or excretion may be altered, or condition may worsen as a result of the actions of the drug Overall Adverse Reactions to Systemic Antifungal Agents CNS effects : Headache, dizziness, fever, shaking, and chills GI effects:Nausea, vomiting, dyspepsia, and anorexia Hepatic dysfunction Dermatologic effects :Rash and pruritus associated with local irritation Renal dysfunction ANTIPROTOZOAL AGENTS Antiprotozoals are agents used to treat protozoan infections. Protozoan infections are common in tropical areas. Protozoans are single-celled organisms that pass through several stages in their life cycles, including at least one phase as a human parasite. While protozoans thrive in tropical climate, they may also survive and reproduce in any area where people live in very crowded and unsanitary conditions. Causes of Protozoal Infections 1. Insect bites : Malaria, Trypanosomiasis, Leishmaniasis 2. Ingestion or contact with the causal organism : Amebiasis, Giardiasis, Trichomoniasis Protozoal Parasites Identified as Causes of Malaria 1. Plasmodium falciparum : Considered the most dangerous type of protozoan Plasmodium vivax : Milder form of the disease; seldom results in death 2. Plasmodium malariae : Endemic in tropical countries; mild symptoms 3. Plasmodium ovale : Rarely seen; in the process of being eradicated Life cycle of a Plasmodium Protozoal Diseases Malaria It is a disease characterized by a cycle of fever and chills transmitted through a bite of a female Anopheles mosquito. Identified causes include Plasmodium falciparum, vivax, malariae, and ovale. Malaria is endemic in many parts of the world. Sporozoites travel through bloodstream and become lodged in the liver and other tissues. Amebiasis It is an intestinal infection caused by Entamoeba histolytica. It is often known as amoebic dysentery. The disease is transmitted through fecal-oral route. Amebiasis is characterized by mild to fulminant diarrhea. In worst cases, it is able to invade extraintestinal tissue. Leishmaniasis Is a disease caused by a protozoan that is passed from sand flies to humans. It is characterized by serious lesions in the skin, viscera, and mucous membranes of host. Trypanosomiasis Is caused by Trypanosoma leading to African sleeping sickness and Chagas’ disease. African sleeping sickness is caused by T.brucei gambiense and is transmitted by tsetse fly. It is characterized by lethargy, prolonged sleep, and even death. Chagas’ disease is caused by T.cruzi and is passed to humans by common housefly. It is characterized by severe cardiomyopathy. Trichomoniasis Is caused by T.vaginalis, a common cause of vaginitis (reddened, inflamed vaginal mucosa, itching, burning, and yellowish-green discharge). It is usually transmitted through sexual intercourse.  Asymptomatic in men Giardiasis Is caused by G.lamblia, the most commonly diagnosed intestinal parasite in the United States. Transmission is through contaminated water or food, and trophozoites. Characterized by diarrhea, rotten egg-smelling stool, and pale and mucus-filled stool. Some patients experience epigastric pain, weight loss, and malnutrition. Commonly used oral antiprotozoal drugs can be generally classified into two main groups: antimalarial drugs and miscellaneous antiprotozoals. In addition to their use as antiprotozoals, some of them such as metronidazole and doxycycline are also used for treating bacterial infections Antimalarials: Antimalarials are agents used to attack Plasmodium at various stages of its life cycle. Through this, it becomes possible to prevent acute malarial reaction in individuals who have been infected by the parasite. These agents can be: o schizonticidal (acting against the red-blood-cell phase of the life cycle), o gametocytocidal (acting against the gametocytes), o sporontocidal (acting against the parasites that are developing in the mosquito), or o schizonts as prophylactic or antirelapse agent work against tissue t. Quinine (Qualaquine) was the first drug found to be effective in the treatment of malaria. Treatment of chloroquine- resistant plasmodial infections Chloroquine (Aralen): Prevention and treatment of plasmodial malaria; treatment of extraintestinal amebiasis Halofantrine (Halfan): Treatment of plasmodial malaria in combination with other drugs Hydroxychloroquine (Plaquenil): Treatment of plasmodial malaria in combination with other drugs (particularly primaquine) Mefloquine (Lariam): Prevention and treatment of plasmodial malaria in combination with other drugs Primaquine (generic): Prevention of relapses of Plasmodium vivax and Plasmodium malariae infections; Radical cure of P. vivax malaria Pyrimethamine (Daraprim) : Prevention of plasmodial malaria in combination with other agents to suppress Therapeutic Action of antimalarials is: Entering human red blood cells and changing the metabolic pathways necessary for the reproduction. Chloroquine, the mainstay of treatment, in addition to this main mechanism, is directly toxic to parasites and decreases the ability of the parasite to synthesize DNA. Interrupt plasmodial reproduction of protein synthesis Agents that do not appear to affect the sporozoites are used for prophylaxi Contraindications: Known allergy, Liver disease, Alcoholism, Lactation Cautions: Retinal disease or damage, Psoriasis Adverse Effects: Headache, Dizziness, Fever, Chills, Malaise, Nausea, Vomiting, Hepatic dysfunction Drug-to-Drug Interactions Quinine derivatives and quinine create risk for cardiac toxicity Antifolate drugs with pyrimethamine can increase risk of bone marrow suppression Other Antiprotozoal Drugs Actions: Inhibiting DNA synthesis in susceptible protozoa, interfering with cell’s ability to reproduce, subsequently leading to cell death Contraindications: Known allergy, pregnancy, CNS disease, and hepatic disease Adverse reactions: Headache, dizziness, ataxia, nausea, vomiting, and diarrhea CASE SCENARIO You will read and analyze the case scenario. Answer all the questions based on the data presented in the scenario. Case Scenario 1 After teaching a group of nursing students about candidiasis, the clinical faculty member asks the student nurses to present information about one of the current patient assignments. One of the student nurses states that the assigned patient has developed an oropharyngeal candidiasis and is being treated with clotrimazole and a topical antifungal. The student provides key information about the antifungal agents the patient is receiving. 1. What are the characteristics of a fungus?  ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 2. What is the therapeutic action of clotrimazole? ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 3. What are the most common adverse reactions of clotrimazole? ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 4. What are the nursing considerations for a patient receiving a topical antifungal? ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Case Scenario 2 A patient and two school-age children recently returned from 6 months abroad to several foreign countries. The patient is upset because the children have both been diagnosed with worms. 1. What are the common worms that can cause disease in humans? ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 2. What therapeutic actions are associated with the use of anthelmintic agents? ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 3. What patient teaching points need to be stressed for the children who are receiving an anthelmintic? ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ CHECK FOR UNDERSTANDING (30 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not allowed. You are given 25 minutes for this activity: Multiple Choice 1. A patient receiving topical antifungal complains of blisters in her perineum. Which is/are a possible explanation(s) for this? a. Fungal infection is not healing. b. Patient is allergic to the drug. c. Both A and B d. None of the above ANSWER: RATIO: 2. Which of the following will alert the nurse for possible adverse effect in patients receiving long-term itraconazole therapy? a. Central obesity b. Cataract c. Thickening of the skin d. Pathologic U wave ANSWER: RATIO: 3. An eight (8) month old infant is receiving antifungals. Which should be included in the nurse’s health teaching to the mother? a. Cover the area of lesions with diaper to prevent additional infection. b. Make sure area is free from occlusive dressings. c. Apply more topical cream on draining areas because it is where fungi are most d. Advise that redness and rashes are negligible side effects of antifungal therapy and should not be a cause of worry. ANSWER: RATIO: 4. Which of these antifungals can be used in pregnant women? a. Fluconazole b. Nystatin c. Ketoconazole d. Amphotericin B ANSWER: RATIO: 5. Arvic, a 16-year-old student, has acquired systemic fungal infection, he should be treated with: a. Amphotericin B b. Miconazole (Monistat IV) c. Ketoconazole d. Griseofulvin (Fulvicin) ANSWER: RATIO: 6. Which of the following must always be present before beginning antifungal therapy? a. Coagulation profile b. Confirmed diagnosis c. Biopsy of infected site d. Urinalysis ANSWER: RATIO: 7. A 32-year-old woman presents to her gynecologist with a 4 days history of perineal pruritus and a non-malodorous, thick, cheesy vaginal discharge. The only medication the woman is taking is an oral contraceptive. A wet preparation of vaginal secretion shows budding yeast cells and pseudohyphae. Which of the following drugs, given locally, would be appropriate for this patient? a. Mebendazole b. Metronidazole c. Miconazole d. Saquinavir ANSWER: RATIO: 8. The nurse sees a patient in the clinic who has been taking chloroquine for the treatment of malaria. While the nurse measures vital signs, the patient repeatedly rubs her eyes. When the nurse questions why, the patient says, "I guess it's time for a trip to the eye doctor. My glasses don't seem to work very well and I'm having trouble with my vision." What does the nurse suspect is happening with this patient? a. Adverse effect of medication b. Muscles controlling the eye are impacted by malaria c. Chemical actions of the medication are reducing aqueous humor d. Malaria infection is damaging optic tissue ANSWER: RATIO: 9. The nurse is caring for a patient taking antimalarials for prophylaxis while serving in the Peace Corps in Africa. The patient has taken the medication for 2 months and is continuing to lose significant weight due to the GI effects of the drug. What recommendations can the nurse make to reduce GI adverse effects and promote healthy nutrition for this patient? (Select all that apply.) a. Avoid alcohol. b. Add extra fat to diet for calories. c. Take the drug immediately after meals. d. Eat 5 to 6 small meals a day. ANSWER: RATIO: 10. An instructor is describing the action of primaquine. What would the instructor include? a. The drug blocks the use of folic acid. b. It changes the metabolic pathways for reproduction. c. The drug increases the acidity of plasmodial food vacuoles. d. It disrupts the mitochondria, killing the gametocytes. ANSWER: RATIO: RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER:  RATIO: 2. ANSWER: RATIO: 3. ANSWER: RATIO: 4. ANSWER: RATIO: 5. ANSWER: RATIO: 6. ANSWER: RATIO: 7. ANSWER: RATIO: 8. ANSWER: RATIO: 9. ANSWER: RATIO: 10. ANSWER: RATIO: LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. MINUTE PAPER Compose two to three sentences to explain what she/he has leaned using the key ideas listed in lesson review. For next session review antiviral and anthelmintic.  Pharmacology STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session 5 LESSON TITLE: ANTIVIRAL & ANTHELMENTIC DRUGS Materials: Notebook, Pharmacology book, drug handbook, LEARNING OUTCOMES: pens & paper At the end of the lesson, the nursing student can: 1. Describe how antiviral and antihelmintic medications References: work. Kee, Joyce LeFever, Hayes, Evelyn R. & 2. Identify antiviral and anthelmintic drug therapy health McCuistion E. Pharmacoloy A Nursing teachings; and, Process Approach 6th edition.. Singapore: 3. Create a drug study guide. (therapeutic action, indication, Elsevier Saunders Company. contraindication, most common adverse reaction And nursing responsibility ) of antiprotozoal and anthelmintic. LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (5 minutes) EVERYBODY WRITES How did the Pandemic (COVID 19) of 2020 affected you and your family? MAIN LESSON (50 minutes) ANTIVIRAL Antivirals are agents used to treat the diseases caused by viruses such as warts and common colds. Viruses are composed of a single DNA or RNA inside a protein coat. Viruses must enter a cell in order for them to carry on with their metabolic processes. Upon successful entry, viruses inject their DNA or RNA to the cell and the cell is altered in such a manner that it is now “programmed” to control the metabolic processes that the virus needs to survive. Because viruses are contained in the cells, researchers find it difficult to develop vaccines. However, viruses respond to some antiviral therapy including influenza A viruses, herpes viruses, CMV, HIV, hepatitis B and C viruses, and some viruses that cause warts and eye infections. Viruses That Respond to Antiviral Therapy Influenza A and some respiratory viruses Herpes viruses Cytomegalovirus (CMV) Human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS) Some viruses that cause warts and certain eye infections Characteristics of Common Viruses Viral replication: A virus cannot replicate on its own o It must attach to and enter a host cell o It then uses the host cell’s energy to synthesize protein, DNA, and RNA Viruses are difficult to kill because they live inside our cells o Any drug that kills a virus may also kill our cells Stage of Virus replication Characteristics of Antiviral Drugs Able to enter the cells infected with virus Interfere with viral nucleic acid synthesis and/or regulation Some agents interfere with the ability of the virus to bind to cells Some agents stimulate the body’s immune system Common Respiratory Viruses Influenza A Influenza B Respiratory syncytial virus Signs & Symptoms of Respiratory Viruses Cough, Fever, Inflammation of the nasal mucosa, Inflammation of the mucosa of the respiratory tract Signs and Symptoms of Herpe