NSG 215 – Pharmacotherapeutics III Viral, Fungal, Parasitic Infections Drug & Prototype Treatment of Viruses *** Antiviral acyclovir (Zovirax) *** Antiviral ganciclovir *** Antiviral ribavirin Indications & Contraindications Clinical Manifestations & Nursing Considerations Herpes CMV (cytomegalovirus) infection of the eyes in those who are immunosuppressed; includes people with acquired AIDS RSV *** Monoclonal antibody palivizumab RSV *** Influenza (not often used) Adamantane amantadine hcl **Treatment of Parkinson’s *** Influenza Endonuclease inhibitor baloxavir Nucleoside analogs lamivudine Hepatitis B Polymerase inhibitors sofosbuvir Hepatitis C Heals skin lesions; (this is NOT a cure) #/severity/length of future outbreaks Take @ 1st S/S ? renal fx IV or PO WBC, plt ? depression, anxiety, aggressive behavior ? homicidal or suicidal ideation/attempts Ø split/crush pills Ø double dose if you miss Risk for infection, risk for impaired gas exchange Only given IM Only in children < 2 years ? anaphylactic reaction PO only S/E: orthostatic hypotension, dizziness, mottling, insomnia, seizures, or suicidal thoughts/attempts Do not crush/split! Symptomatic for < 48 hrs PO only Avoid dairy ( absorption) PO only ? redistribution of body fat S/E: anorexia, MS pain, malaise, or cough S/E: myalgia, pruritis, rash, or anemia PO only **Negative pregnancy test!!! NSG 215 – Pharmacotherapeutics III Viral, Fungal, Parasitic Infections Antiretrovirals Various HIV NRTIs zidovudine (Retrovir) **know general action of medication/class HIV NNRTIs efavirenz (Sustiva) **know general action of medication/class HIV Protease inhibitors - PIs saquinavir (Invirase) **know general action of medication/class Treatment of Fungal Infection *** Polyenes *amphotericin B; nystatin - deoxycholate formulation - lipid formulations (tox) *** Azoles fluconazole (Diflucan) *** Echinocandins caspofungin *** *nephrotoxic Fungal/yeast infections Candida infections PO or IV Ø breast feeding S/E: granulocytopenia, weakness, abdominal pain, pancreatitis, hepatomegaly, or seizures PO only May cause rash, nausea, suicidal thoughts/behaviors, hepatotoxicity, or long QT High fat meals may increase digestion – Do NOT have one! Have on an empty stomach Risk for infection, noncompliance No longer available in the United States PO only May cause abdominal discomfort, liver enzymes, QT interval prolongation, torsade des pointes, or seizures Monitor ECG Have pt avoid grapefruit/ garlic May cause hyperglycemia Risk for infection High alert medication! S/E: CP, chills, BP, bilirubin, liver damage Frequent V/S PO, IV S/E: torsades de pointes, hepatotoxicity, hypersensitivity IV only ? TEN Ø pregnant/breast feeding PO only NSG 215 – Pharmacotherapeutics III Viral, Fungal, Parasitic Infections Miscellaneous griseofulvin Scalp/nail infections *** Pyrimidine analog flucytosine Candida Cryptococcus Meningitis Endocarditis Pulmonary infections UTIs S/E: H/A, dizzy, Toxic epidermal necrolysis (TEN), serum sickness, erythema multiforme, hepatotoxicity Absorption is by fatty foods – take with or after meals to minimize GI irritation Photosensitivity reaction wear sunscreen Possible cross-sensitivity to penicillin Risk for impaired skin integrity, risk for infection, deficient knowledge PO only RBC/WBC, vomiting, aplastic anemia, or seizures Risk for infection, risk for deficient fluid volume, deficient knowledge Use sunscreen – may cause photosensitivity reactions Treatment of Parasitic Infection *** Amebicide metronidazole (Flagyl) bacterial & parasitic infections giardiasis *** Antibacterial tetracycline; doxycycline *antibiotic* Infections from bacteria *antibiotic* *** Antimalarial Kills the organism that cause malaria and amebiasis ? cause aseptic meningitis, encephalopathy, abdominal pain, anorexia, or seizures Take with food/milk to avoid GI irritation (prn) Do NOT crush! Avoid alcohol – N/V, HR, facial flushing PO only S/E: photosensitivity, N/V/D Calcium in foods/dairy products absorption – have with 1 glass of liquid after meals/1 hr before bed Risk for infection, deficient knowledge, noncompliance efficacy of birth control Old tetracycline may be toxic! Throw it away PO only S/E: N/V, rash, H/A, dizzy NSG 215 – Pharmacotherapeutics III Viral, Fungal, Parasitic Infections chloroquine; quinine Prevention: taken weekly (same day each week) Treatment: loading doses followed by dosing multiple times/day. *** Antihelmintic mebendazole ivermectin Treats infections caused by worms (helminths) *** Scabicide/Pediculicide permethrin (Rid, Nix) Scabies: live 1-2 months vs 48-72 hours (on a person) (without host) Lice: 32-35 days TEN, agranulocytosis, aplastic anemia, leukopenia, seizures Avoid foods that acidify urine - will decrease effectiveness Monitor CBC throughout therapy Risk for infection, chronic pain, deficient knowledge Take with food (prn) PO only S/E: N/V/D, tarry stools, weakness, cough, fever, hives, angioedema, seizures Risk for infection, impaired home maintenance, deficient knowledge Teach hygiene Topical only Impaired home maintenance & bathing/hygiene/self-care deficit Avoid getting the cream in the eye Wash clothes or bedding in hot water Massage thoroughly into the skin A second treatment often is necessary on day 9 to kill newly hatched lice before they can produce new eggs. **TEN - a life-threatening skin disorder characterized by a blistering and peeling of the skin. This disorder can be caused by a drug reaction—often antibiotics or anticonvulsives.