antibiotics/antivirals 4

• weaken cell wall
• change cell wall permeability
• alter protein synthesis
• interfere with nucleic acid synthesis(can't reproduce)
• Interfere with folic acid synthesis

Alters or hinders growth or replication, control infection so immune system can eradicate it

Destroys the bacteria

effective against many bacteria

effective against one or a few bacteria

• MRSA- methcillin resistant Staph. Aureus
• VRE- vancomycin resistant enteritis

• Hypersensitivities: from rash to anaphylaxis
• Most common with penicillins & derivatives
• Drug fever- hard to differentiate from infection--late onset
• Delayed hypersensitivity reactions:
• Steven-Johnson syndrome, erythema multiforma, toxic epidermal necrolysis
• **Observe for 'bull's eye' lesions and STOP DRUG
• Get a good allergy hx on all pts

Caused partly by indiscriminate use of antibiotics

• Bactericidal
• Resistance due to wide use
• Narrow spectrum (gram pos, strep, staph)
• Broad spectrum Penicillins include some gram neg (Ampicillin, Amoxicillin)

• Adverse Effects:
• allergy common
• cross-sensitivity w/ other PCN's
• rash most common, angioedema, anaphylaxis less common
• diarrhea--c.diff
• IV prep have high sodium- caution in pts w/CHF
• cleared renally so lower dose for pts w/renal disease

• Same mechanism as penicillins--can be broad spectrum
• ~10% cross-sensitivity to PCN's--especially w/ severe allergy

• Adverse Reactions
• resistance, diarrhea- c.diff, impaired renal function in high doses, bad reaction to ETOH- teach not to drink, 
• Nursing
• check allergies, if allergic to PCN monitor pt first few doses, if reaction to PCN is severe question order
• Push PO fluids
• monitor for diarrhea

• Bacteriostatic- interferes w/folic acid synthesis
• broad spectrum

• Uses:
• UTI's, URI (upper respiratory infection), pneumonia, infectious diarrheas
• Adverse Effects:
• allergic reactions common, rashes&stevens-johnson syndrome (most common w/HIV infection), crystalluria--can lead to renal failure, risk w/dehydration--push fluids, rare anemia

• Broad spectrum
• less resistance
• (not a sulfa-- a folic acid antagonist)
• synergistic w/sulfamethoxazole
• similar adverse effects (ie: rashes, crystalluria)
• Push fluids to prevent crystalluria!!
• Report rashes!!

• Narrow spectrum- primarily aerobic gram neg
• bactericidal- dose dependent
• inhibit protein synthesis
• primarily parenteral (IV)
• Adverse Reactions:
• low incidence of allergy, nephrotoxicity, ototoxicity-(tinnitus, hearing loss, HA, vertigo, N/V, may be irreversible), neuromuscular blockade--can cause paralysis w/OD
• high risk of hypocalcemia

• Monistor peak & trough blood levels- calculate dose & interval based on weight, renal function, then adjust based on peak & trough
• Nursing responsibility
• keep meds on schedule
• draw blood at peak & trough, if delayed report to lab&MD
• Monitor:
• BUN, creatinine, I&O, signs of hearing loss
• push fluids

• Narrow spectrum- gram pos, MRSA, c.diff
• inhibits cell wall synthesis
• reserved for severe infections
• resistance-VRE

PO or IV well diluted 

• Adverse:
• flushing reaction- red man syndrome (face, neck, chest, hypotension)
• nephrotoxicity
• hypersensitivity
• ototoxicity

• Bactericidal- alter DNA synthesis
• Broad spectrum--gram neg & gram pos
• *Drug of choice for community acquired Pneumonia

• Adverse
• GI-nvd
• CNS- dizziness, HA, confusion
• Rare seziures
• rashes
• effects growing cartilage--not for children >18! or pregnancy
• reduce dose for impaired renal functions

• Nursing
• well absorbed PO
• No dairy products or grapefruit juice
• Dilute well IV

• inhibit protein synthesis
• bacteriostatic low dose, bactericidal high dose

• Uses
• URI (upper resp. infec.)
• pneumonia
• chlamydia, gonorrhea
• gram pos
• substitute for PCN

• Adverse
• allergies uncommon
• GI upset w/PO less w/IV
• take w/food if needed
• high dose IV-reversible hearing loss
• thrombophlebitis--slow IV infusion

• Inhibit protein synthesis
• Bacteriostatic, broad spectrum
• Well absorbed PO
• Uses: acne, chlamydia, rickettsia, Lyme dx, h.pylori
• Adverse
• Rare allergy
• Photosensitivity common
• GI upset common- take with food
• Diarrhea--c.diff

• Dont use in pregnancy or kids under 8
• Dont take with dairy or antacids- will inactivate drug
• Can aggregate renal failure, monitor

Antibiotic against anaerobic bacteria, antiprotozoal, amebicide, bacteroids, c.diff, gardneralla, giardia, trichomonas, h.pylori

• Adverse 
• NVD
• HA, metallic taste in mouth
• Disulfiram reaction w/ETOH
• Interacts w/Coumadin and lithium

PO, IV, topical

• Nursing
• Teach not to take w/ETOH
• Report adverse effects

• Isoniazid
• Rifamycin
• Pyrazinamide
• Ethambutol

• Inhibit cell wall synthesis
• Resistance uncommon
• Uses
• Treat active TB
• Post exposure prophylaxis
• Positive PPD, no active disease
• Teach need for long term use

• Uses-- TB
• Prophylaxis formeningococcal and h.influenza meningitis
• Adverse
• GI irritation, colors body fluids orange, hepatotoxicity
• Immune reaction w/intermittent use (flu like sx, vnd, myalgia to acute renal failure)
• Teach
• Plan for body fluid stain,contact lenses
• Do Not Miss a dose
• Monitor hepatic enzymes

• Bacteriastatic or bactericidal
• Used for TB
• Adverse
• Inhibits urate excretion- gout- check uric acid
• Rare jaundice- monitor hepatic enzymes

• Bacteriostatic-- used for TB
• Adverse
• Visual changes- may need to dc drug
• GI upset
• Confusion, HA
• Teach to report visual changes- blurring, color blindness
• Combination therapy results lower doses fewer adverse fewer resistance
• Therapy lasts 3-6 months, 9 w/HIv
• Major challenge=compliance

• Alternative to vaccination
• Reduces severity and length of symptomatic period
• Resistance from seasonal influenza, bit not from H1N1
• Blocks replication of virus

• Inhibit viral replication
• Only effective in influenza A, many resistances
• *must be taken when first flu symptoms identified (1st 2 days)
• Adverse
• Anxiety, insomnia, confusion

• Inhibit DNA synthesis 
• Widely distributed in body fluids, including breast milk and placenta
• Adverse
• Skin irritation w/topical application
• NVD, HA, rash
• High doses CNS symptoms- HA, confusion
• Renal toxicity

Chronic use for genital herpes for up to 10 years

• Also used for RSV in children
• Pregnancy category X
• Aerosol for RSv can cause eye irritation

• Adverse
• Fatigue, malaise, nausea, anorexia, HA, insomnia.  Typically resolves in firstfew weeks
• Uses
• Treatment of HIV
• Prevent mother to child transmission
• Post exposure prophylaxis

• Treats HIV, reduce death rate  of those seriously ill w/HIV
• Adverse
• NVD, abd pain, HA, altered taste, increased liver enzymes

Long term effects- redistributed body fat

Protease inhibitor or non-nrti combined w/ 2 nrti drugs

Combined agents affect virus at different stages of life span

Goal- reduce viral load

• Hypersensitivity, HA, NV, low BP
• Confusion, joint/muscle pain
• Nephrotoxicity

• Antifungal
• Suppresses glucocorticoid production, can be used to treat cushings syndrome
• PO, IV
• Many drug interactions, hepatotoxicity

• For the nails up to 3 months
• Adverse- hepatotoxicity

Anti fungal treats candidiasis