Pathopharm Drugs for Viral Infections

•Worms will be expelled in stool •Take showers rather than baths •Change undergarments, linens, and towels daily

Antihelminthic Drugs What are ways to educate patient on nature of worm infestation?

Vaccination

Best way to approach Influenza A is to prevent it How do we do this?

Cytomegalovirus Candidiasis of trachea, lungs, esophagus [NOT the mouth], Kaposi sarcoma (soft tissue cancer) Histoplasmosis Encephalopathy TB Pneumocystis jiroveci and carinii (yeast-like fungi)

CD4 cells eventually die (we diagnose someone with AIDS when they test positive for HIV AND EITHER have a CD4 count less than 200 OR they develop one or more of the AIDS-defining diseases) What are 7 big AIDs defining diseases?

Fluconazole

Drug for Systemic Fungal Infections Side/adverse effects of hepatotoxicity and nephrotoxicity Don't take with warfarin

AIDs

ELISA is a screening test for what disease?

Rash on the face is common (self-limiting)

For Fifth disease, what is common?

No, we control them, but don't cure them (minimize s/s, prevent reoccurrences)

For herpes virus infections, is it curable?

Rheumatic fever scars the valves of the heart, forcing this vital organ to work harder to pump blood. Rheumatic heart disease, which can eventually cause the heart to fail

For patients with Strep Throat, what can rhuematic fever eventually lead to?

Follows nerve distribution in the body (dermatomal distribution) In line

For shingles, what do the blisters follow on the body? Are they in line or all over the body?

Yes, to prevent the spread of infection

For shingles,do we cover the blisters?

HIV invades CD4 cells and turns them into virus producing cells (how virus replicates)

HIV invades what type of cell in the body? What happens to this cell after it's invaded?

Central nervous system symptoms (dizziness, insomnia, drowsiness)

HIV-AIDS Antiretrovirals Classification What are the side/adverse effects of Non-nucleoside reverse transcriptase inhibitors (NNRTIs)? Efavirenz

Anemia and neutropenia from bone marrow suppression GI upset Peripheral neuropathy

HIV-AIDS Antiretrovirals Classification What are the side/adverse effects of Nucleoside/Nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)? Lamivudine Zidovudine Stavudine

Hyperglycemia, hyperlipidemia, fat maldistribution, pancreatitis

HIV-AIDS Antiretrovirals Classification What are the side/adverse effects of Protease inhibitors (PIs)? Lopinavir

Doing a rapid antigen detection test to identify if the bacteria is group A beta-hemolytic streptococci

How can we identify strep throat? (test wise)

Caused from from a bite by a tick carried by several species of deer

How do people get Lyme Disease?

Higher fever (up to 104 F) Tender anterior cervical lymph nodes Large inflamed tonsils Gray-white exudate

How do we identify strep throat? (assessment wise)

3- to 4-week course of oral antibiotic therapy is recommended during the beginning of the disease.

How do we treat Lyme Disease?

Early antibiotic treatment

How do we treat strep throat?

Clothing and linens should be washed and dried on the hottest settings

How do you prevent reinfection of scabies?

Western blot test (confirms HIV)

If the ELISA test is positive (blood test), what test do we need to do next and why?

Cardiac toxicity

If we administer amphotericin B, what happens if we give it too fast?

No, a negative ELISA test result is not considered accurate immediately after exposure This is because ELISA is positive within 3 weeks to 3 months following infection.

Is ELISA accurate immediately after exposure? Why?

Ringworm

Is a skin infection caused by a fungus. It leads to red, scaly, blistered rings on the skin or scalp that grow outward as infection spreads. The fungus is easily spread by sharing hair care instruments and hats or via towels, linens, clothing, and sports equipment

Salicylates

Salts derived from salicylic acid found in plants and used in many pain relievers

Interferon alfa

This is the first line medication for chronic Hepatitis B and C Boosts immune system function but can produce flu-like symptoms as a side effect

Oseltamivir

This medication can treat Influenza infections in patients Only slightly shortens the duration of symptoms Reported to shorten the normal 7-day of duration of influenza symptoms to 5 days

After 4-6 weeks of the bite

To test for Lyme disease, when would the test have a valid result?

Symptomatic therapy - stay hydrated, saline gargles, bedrest Pseudoephredrine (nasal decongestant - don't use or more than 3-4 days) Analgesics (ibuprofen, acetaminophen) dextromethorphan or codeine for cough NO ASPIRIN for people under 18 yo [Reye's Syndrome])

Treatment for URIs involve what kind of therapy? What drugs do we give and what drugs do we avoid? Why would we avoid this certain drug?

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Type of HIV-AIDS Antiretrovirals Classification Disrupts enzyme activity Target the enzyme needed for reverse transcriptase to function, so the enzyme is unable to construct viral DNA

Nucleoside/Nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs)

Type of HIV-AIDS Antiretrovirals Classification Inhibits HIV replication Chemically resemble the natural building blocks of DNA. In essence, reverse transcriptase is fooled by these drugs and inserts them into the viral DNA strand and the new viral DNA strand doesn't function correctly.

Protease Inhibitors (PIs)

Type of HIV-AIDS Antiretrovirals Classification Prevents maturtation of virus Prevent viral replication by selectively binding to viral proteases and blocking formation of protein precursors that are necessary for the production of infectious viral particles called virions

Hepatitis A

Type of Hepatitis Spread by oral-fecal route •Vaccination available - standard precautions unless fecal incontinence, then use contact precautions

Hepatitis C

Type of Hepatitis Transmitted through exposure to contaminated blood and body fluids

Hepatitis B

Type of Hepatitis Transmitted through exposure to contaminated blood and body fluids Vaccination available Most cases of this hepatitis do not progress to chronic disease

Influenza B Vaccine called Hib

Type of Influenza More commonly seen in children What is the vaccine for this Influenza called?

Influenza A

Type of Influenza Most common across a person's lifespan

Fifth disease

Type of disease ("slapped face," or erythema infectiosum) is a viral illness caused by the human parvovirus and affects mainly school-age children

Amphotericin B

Type of drug for systemic fungal infections Adverse effects: Nephrotoxicity, hepatotoxicity, ototoxicity, anaphylaxis, cardiac arrest, dysrhythmias, thrombocytopenia, leukopenia, anemia

Valacyclovir and Acyclovir

What 2 drugs do we use to treat Herpesvirus Infections?

Stage 1: Acute Infection

What HIV Stage is this? Fever, Lymph adenopathy, pharyngitis, rash, arthralgia/myalgia, HIV viral load high/may or may not test positive for antibodies, CD4 T cell count is > 500 cells; virus is transmissible to others- described as "worst flu ever"

Stage 2: Latency

What HIV Stage is this? Lymphadenopathy, but may be asymptomatic; will test positive for HIV antibodies; CD4 T cell count is between 200 and 499 cells

Stage 3: AIDs

What HIV Stage is this? •Opportunistic infections occur -Respiratory: pneumocystis carinii pneumonia, tuberculosis, Kaposi's sarcoma -GI: cryptosporidiosis, candida, cytomegalovirus (CMV), isosporiasis, Kaposi's sarcoma -Neuro: cytomegalovirus, toxoplasmosis, cryptococcosis, non-Hodgkin's lymphoma, varicella zoster (shingles), herpes simplex -Skin: shingles, herpes simplex, Kaposi's sarcoma

Lamivudine Zidovudine Stavudine

What are some examples of Nucelotide/Nucleoside reverse transcriptase inhibitors? (NRTIs)

Nausea, diarrhea CNS and cardiovascular toxicity at higher doses (convulsion, confusion, reduce reflexes, hypotension, dysrhythmias) Retinal toxicity (blurred vision, photophobia, difficulty focusing)

What are the adverse effects of Chloroquine?

Airway obstruction (from swollen lymph nodes around neck) Severe abdominal pain (spleen rupture) You hear stridor or "AB" concerns OR severe abdominal pain - CALL HCP

What are the medical emergencies of mononucleosis and should be reported immediately?

•Should be used cautiously in patients with renal disease •Monitor liver function test values; signs and symptoms of hepatotoxicity •Contraindicated with chronic alcoholism (toxic to liver) •Use with warfarin may increase risk for bleeding •Refrigerate suspensions

What are the nursing implications for Fluconazole?

•Infuse slowly (may lead to cardiovascular collapse if infused rapidly) •Administer pre-medications (acetaminophen, antihistamines, corticosteroids) to decrease the risk of hypersensitivity reactions •Hold the drug if the BUN and serum creatinine are high - Use cautiously with renal impairment patients •Monitor liver enzymes •Use with caution with patients that have bone marrow suppression •Assess for hearing loss, vertigo, dizziness, unsteady gait, and tinnitus (ototoxicity) •Interacts NEGATIVELY with many drugs

What are the nursing implications for amphotericin B?

People in close contact -Nursing homes -Day care -Prison

What are the populations at risk for scabies?

Non-compliance given the high frequency of dosing for Valacyclovir (Q8H) and Ayclovir (Q4H) Nephrotoxiticty (Increased serum creatitine and BUN)

What are the risks of Valacyclovir and Acyclovir?

Unilateral, linear pattern of fluid-filled blisters Pain Itching

What are the s/s of herpes zoster (shingles)?

Fatigue Fever Sore throat Splenomegaly Hepatomegaly Swollen lymph nodes

What are the s/s of mononucleosis?

Nephrotoxicity Hepatotoxicity Ototoxicity Anaphylaxis Cardiac arrest Dysrhythmias Thrombocytopenia Leukopenia Anemia (respiratory system is safe) Easy way to remember: amphoTERRIBLE

What are the severe adverse effects for amphotericin B?

Can produce flu-like symptoms

What are the side effects of interferon alfa?

N/V Abdominal pain Diarrhea (when given in high doses) Steven-Johnson Syndrome in patients with immunosuppression Nephrotoxicity Hepatotoxicity

What are the side/adverse effects of Fluconazole?

Vaccinations (when virus has a vaccine) Give antivirals (drugs that interrupt an aspect of the virus's replication cycle)

What are ways we can approach viruses in terms of management?

Can cause a rash

What can happen if you give amoxicillin to someone with mononucleosis?

Rheumatic fever S/S of rheumatic fever are... Fever Muscle aches Swollen and painful joints Some cases a red rash St. Vitus dance (Sydenham's chorea) -Rapid, jerky, involuntary movements (can be entire body)

What can strep throat lead to? And what are the signs and symptoms of this?

Pre-medicate (corticosteriods, acetaminphen, antihistamines) before we adminster to minimize allergic reactions

What do we usually do before we administer amphotericin B and why?

Mebendazole

What drug do we use to treat pinworms (antihelminthic drug)?

Miconazole (also have cream form for skin fungal infections)

What drug treats vaginal infections?

Bananas, kiwis, pineapple, tomato, chestnuts Tropical fruits*

What food allergies are associated with ALSO having a latex allergy?

Ring-like rash occurring 3 to 4 weeks after a bite (not all patients develop this)

What happens in the early stages of Lyme Disease?

Flulike symptoms Arthralgias (joint pain) Neurological deficits Cardiac abnormalities, and enlarged and inflamed joints

What happens in the late stages of Lyme Disease?

Efavirenz

What is an example of a non-nucleoside reverse transcriptase inhibitor? (NNRTI)

Lopinavir

What is an example of a protease inhibitor? (PI)

103 and above

What is considered a high grade fever?

In the 100's

What is considered a low grade fever?

Epstein-Barr virus

What is the cause of mononucleosis?

Caused by a mite spread by direct person-to-person contact

What is the cause of scabies?

Nystatin (lots of formulations depending on where the infection is-cream, powder, oral liquid)

What is the drug we use for candida infections?

Chloroquine

What is the prototype antimalarial drug??

Fecal-oral

What is the route of transmission for Hepatitis A?

Percutaneous and permucosal

What is the route of transmission for Hepatitis B?

Percutaneous and permucosal

What is the route of transmission for Hepatitis C?

Percutaneous and permucosal

What is the route of transmission for Hepatitis D

Fecal-oral

What is the route of transmission for Hepatitis E?

Due to the varicella zoster virus turning into herpes zoster virus (VZV)

What is the source of the shingles infection?

Management of symptoms (hydration, rest, control of pain, reducing fever) Sore throat is treated with saline gargles of anesthetic lozenges (•benzocaine/menthol lozenges) •Ibuprofen or acetaminophen is appropriate treatment to control pain and manage fever in the child with mononucleosis

What is the treatment for mononucleosis?

5% permethrin

What is the treatment for scabies?

Diphenhydramine (or any antihistamines) Corticosteroids Acetaminophen

What kind of meds would we premedicate with for amphotericin B?

Test positive for HIV and either have... CD4 count less than 200 (they die off) OR They develop one or more of the AIDs-defining diseases (S10)

When figuring out how to diagnose a patient with AIDs, what characteristics do they need to test positive for?

Patients who go through... Corticosteroid therapy Chemotherapy AIDS/HIV Transplant recipient

Who are considered immunocompromised people?

Clients 6 months-2 years old Clients with chronic conditions Immunocompromised clients Health care workers Clients 65 and up Pregnant clients

Who does the CDC (Centers for Disease Control and Prevention) especially recommend getting vaccinated?

Children

Who should get a culture (pharyngeal swab) for strep throat even if rapid antigen detection test is negative?

Protein in the body start to fall apart (denature)

Why is a fever of 105 dangerous?

Aspirin causes Reye syndrome -s/s of Reye Syndrome is encephalopathy and hepatic dsyfunction Give alternative fever-reducing (anti-pyretic) medication

Why should you not give aspirin to children for fever caused by Influenza? What are the s/s of this? What would you give instead?

Naw

if ANY drug is hepatotoxic...do you think we should give it to patients who are alcoholics or have liver damage?

MMR Varicella

•Severely immunocompromised children (e.g., corticosteroid therapy, chemotherapy, AIDS/HIV, transplant recipient) generally should not receive live vaccines What are 2 live vaccines that you should avoid?