-抗感染因子(英文)Anti課件

AntiinfectiveagentsChapters37,38,39&41Antibiotics:DefinitionMedicationsusedtotreatbacterialinfectionsIdeally,beforebeginningantibiotictherapy,thesuspectedareasofinfectionshouldbeculturedtoidentifythecausativeorganismandpotentialantibioticsusceptibilitiesAntibiotics:ClassesSulfonamides

Penicillins CephalosporinsTetracyclinesMacrolidesAminoglycosidesQuinolonesFigure37-1Bacterialmorphologies.(FromMurray,P.R.,Rosenthal,K.S.,Kobayashi,G.S.,&Pfaller,M.A.(2002).Medicalmicrobiology.St.Louis,MO:Mosby.)Figure37-3Gram-stainmorphologyofbacteria.ThecrystalvioletofGramstainisprecipitatedbyGramiodineandistrappedinthethickpeptidoglycanlayeringram-positivebacteria.Thedecolorizerdispersesthegram-negativeoutermembraneandwashesthecrystalvioletfromthethinlayerofpeptidoglycan.Gram-negativebacteriaarevisualizedbytheredcounterstain.(FromMurray,P.R.,Rosenthal,K.S.,Kobayashi,G.S.,&Pfaller,M.A.(2002).Medicalmicrobiology.St.Louis,MO:Mosby.)Figure37-4Gram-positiveandgram-negativebacteria.Agram-positivebacteriumhasathicklayerofpeptidoglycan

(left).Agram-negativebacteriumhasathinpeptidoglycanlayerandanoutermembrane(right).Structuresinparenthesesarenotfoundinallbacteria.(FromMurray,P.R.,Rosenthal,K.S.,Kobayashi,G.S.,&Pfaller,M.A.(2002).Medicalmicrobiology.St.Louis,MO:Mosby.)AntibioticTherapyEmpirictherapy:treatmentofaninfectionbeforespecificcultureinformationhasbeenreportedorobtainedProphylactictherapy:treatmentwithantibioticstopreventaninfection,asinintraabdominalsurgeryAntibioticTherapy(cont’d)TherapeuticresponseDecreaseinspecificsignsandsymptomsofinfectionarenoted(fever,elevatedWBC,redness,inflammation,drainage,pain)SubtherapeuticresponseSignsandsymptomsofinfectiondonotimproveAntibioticTherapy(cont’d)FourcommonmechanismsofactionInterferencewithcellwallsynthesisInterferencewithproteinsynthesisInterferencewithDNAreplicationActingasametabolitetodisruptcriticalmetabolicreactionsinsidethebacterialcellActionsofAntibioticsBactericidal:killbacteriaBacteriostatic:inhibitgrowthofsusceptiblebacteria,ratherthankillingthemimmediately;willeventuallyleadtobacterialdeathAntibiotics:SulfonamidesOneofthefirstgroupsofantibioticssulfadiazineSulfamethoxazole(Bactrim)sulfisoxazoleSulfonamides:

MechanismofActionBacteriostaticactionPreventsynthesisoffolicacidrequiredforsynthesisofpurinesandnucleicacidDonotaffecthumancellsorcertainbacteria—theycanusepreformedfolicacidSulfonamides:IndicationsTreatmentofUTIscausedbysusceptiblestrainsof:Enterobacterspp.,

Escherichiacoli,Klebsiellaspp.,Proteusmirabilis,Proteusvulgaris,StaphylococcusaureusNocardiosisPneumocystiscariniipneumonia(PCP)UpperrespiratorytractinfectionsOtherusesSulfonamides:

CombinationProductstrimethoprim/sulfamethoxazoleUsedtotreatUTIs,PCP,otitismedia,otherconditionserythromycin/sulfisoxazoleUsedtotreatotitismediasulfisoxazoleUsedtotreatotitismedia,UTIs,otherconditionsBeta-LactamAntibioticsPenicillinsCephalosporinsCarbapenemsMonobactamsPenicillinsNaturalpenicillinsPenicillinase-resistantpenicillinsAminopenicillinsExtended-spectrumpenicillinsPenicillins(cont’d)NaturalpenicillinspenicillinG,penicillinVpotassiumPenicillinase-resistantpenicillinsCloxacillinAminopenicillinsamoxicillin,ampicillin,pivamicillinAnti-pseudomonalpenicillins

piperacillinsodium

Penicillins(cont’d)Firstintroducedinthe1940sBactericidal:inhibitcellwallsynthesisKillawidevarietyofbacteriaAlsocalled“beta-lactams”Penicillins(cont’d)BacteriaproduceenzymescapableofdestroyingpenicillinsTheseenzymesareknownas

beta-lactamasesAsaresult,themedicationisnoteffectivePenicillins(cont’d)Chemicalshavebeendevelopedtoinhibittheseenzymes:Clavulanicacid(Clavulin)TazobactamSulbactamThesechemicalsbindwithbeta-lactamaseandpreventtheenzymefrombreakingdownthepenicillinPenicillins:

MechanismofActionPenicillinsenterthebacteriaviathecellwallInsidethecelltheybindtopenicillin-bindingproteinOncebound,normalcellwallsynthesisisdisruptedResult:bacteriacellsdiefromcelllysisPenicillinsdonotkillothercellsinthebodyPenicillins:IndicationsPreventionandtreatmentofinfectionscausedbysusceptiblebacteria,suchas:Gram-positivebacteriaStreptococcus,Enterococcus,Staphylococcus

spp.Penicillins:AdverseEffectsAllergicreactionsoccurin0.7%to8%ofcasesUrticaria,pruritus,angioedema10%ofallergicreactionsarelifethreatening10%ofthesearefatalPenicillins:SideEffectsCommonsideeffectsNausea,vomiting,diarrhea,abdominalpainOthersideeffectsarelesscommonCephalosporinsFirstgenerationSecondgenerationThirdgenerationFourthgenerationCephalosporins(cont’d)SemisyntheticderivativesfromafungusStructurallyandpharmacologicallyrelatedtopenicillinsBactericidalactionBroadspectrumDividedintogroupsaccordingtotheirantimicrobialactivityCephalosporins:FirstGeneration

cephalexin(Keflex)

cefazolin(Ancef)

cefadroxil(Duricef)Goodgram-positivecoveragePoorgram-negativecoverageCephalosporins:

FirstGeneration(cont’d)Usedforsurgicalprophylaxis,URIs,otitismediacefazoline:IVorPO(Ancef)cephalexin:PO(Keflex)Cephalosporins:

SecondGenerationGoodgram-positivecoverageBettergram-negativecoveragethanfirstgenerationcefaclorcefprozilcefoxitincefuroximecefotetan

Cephalosporins:

SecondGeneration(cont’d)cefoxitin:IVandIMUsedprophylacticallyforabdominalorcolorectalsurgeriesAlsokillsanaerobescefuroxime:POSurgicalprophylaxisDoesnotkillanaerobesCephalosporins:

ThirdGenerationMostpotentgroupagainstgram-negativeLessactiveagainstgram-positivecefiximecefotaximeceftizoximeceftriaxoneceftazidimeCephalosporins:

ThirdGeneration(cont’d)cefiximeOnlyoralthird-generationagentBestofavailableoralcephalosporinsagainstgram-negativeTabletandsuspensionceftriaxoneIVandIM,longhalf-life,once-a-dayadministrationEasilypassesmeningesanddiffusedintoCSFtotreatCNSinfectionsCephalosporins:

FourthGenerationcefepimeNewestcephalosporinagentsBroaderspectrumofantibacterialactivitythanthirdgeneration,especiallyagainstgram-positivebacteriaCephalosporins:SideEffectsSimilartopenicillinsMacrolideserythromycinazithromycinclarithromycinMacrolides:

MechanismofActionPreventproteinsynthesiswithinbacterialcellsBacteriawilleventuallydieMacrolides:IndicationsStrepinfectionsStreptococcuspyogenes

(groupAbeta-hemolyticstreptococci)MildtomoderateURIHaemophilusinfluenzaeSpirochetalinfectionsSyphilisandLymediseaseGonorrhea,Chlamydia,MycoplasmaMacrolides:SideEffectsGIeffects,primarilywitherythromycinNausea,vomiting,diarrhea,hepatotoxicity,flatulence,jaundice,anorexiaNeweragents,azithromycinandclarithromycin:fewersideeffects,longerdurationofaction,betterefficacy,bettertissuepenetrationTetracyclinesdemeclocyclineoxytetracyclinetetracyclinedoxycyclineminocyclineTetracyclines(cont’d)NaturalandsemisyntheticObtainedfromculturesofStreptomycesBacteriostatic—inhibitbacterialgrowthInhibitproteinsynthesisStopmanyessentialfunctionsofthebacteriaTetracyclines(cont’d)BindtoCa2+andMg2+andAl3+ionstoforminsolublecomplexesThus,dairyproducts,antacids,andiron

saltsreduceabsorptionoftetracyclinesTetracyclines:IndicationsWidespectrumGram-negative,gram-positive,protozoa,Mycoplasma,Rickettsia,Chlamydia,syphilis,LymediseasedemeclocyclineisalsousedtotreatSIADH,andpleuralandpericardialeffusionsTetracyclines:SideEffectsStrongaffinityforcalciumDiscolorationofpermanentteethandtoothenamelinfetusesandchildrenMayretardfetalskeletaldevelopmentiftakenduringpregnancyTetracyclines:SideEffects(cont’d)Alterationinintestinalfloramayresultin:Superinfection(overgrowthofnonsusceptibleorganismssuchasCandida)DiarrheaPseudomembranouscolitisTetracyclines:SideEffects(cont’d)Mayalsocause:VaginalmoniliasisGastricupsetEnterocolitisMaculopapularrashAminoglycosidesgentamicinneomycinstreptomycintobramycinamikacinAminoglycosides(cont’d)NaturalandsemisyntheticProducedfromStreptomycesPoororalabsorption;noPOformsPotentantibioticswithserioustoxicitiesBactericidal;preventsproteinsynthesisKillmostlygram-negative;some

gram-positivealsoAminoglycosides:IndicationsUsedtokillgram-negativebacteriasuchasPseudomonas

spp.,E.coli,Proteus

spp.,Klebsiellaspp.,Serratiaspp.OftenusedincombinationwithotherantibioticsforsynergisticeffectAminoglycosides:

Indications(cont’d)AllaminoglycosidesarepoorlyabsorbedthroughtheGItract,andgivenparenterallyException:neomycinGivenorallytodecontaminatetheGItractbeforesurgicalproceduresAlsousedasanenemaforthispurposeAminoglycosides:AgentsThreemostcommon(systemic):gentamicin,tobramycin,amikacinCauseserioustoxicitiesNephrotoxicity(renalfailure)Ototoxicity(auditoryimpairmentandvestibular[eighthcranialnerve])MustmonitordruglevelstopreventtoxicitiesAminoglycosides:SideEffectsOtotoxicityandnephrotoxicityarethemostsignificantHeadacheParesthesiaNeuromuscularblockadeDizziness

VertigoSkinrashFeverSuperinfectionsQuinolonesciprofloxacinnorfloxacinofloxacinlevofloxacingatifloxacinQuinolones(cont’d)ExcellentoralabsorptionAbsorptionreducedbyantacidsFirstoralantibioticseffectiveagainst

gram-negativebacteriaQuinolones:

MechanismofActionBactericidalEffectiveagainstgram-negativeorganismsandsomegram-positiveorganismsAlterDNAofbacteria,causingdeathDonotaffecthumanDNAQuinolones:IndicationsLowerrespiratorytractinfectionsBoneandjointinfectionsInfectiousdiarrheaUrinarytractinfectionsSkininfectionsSexuallytransmitteddiseasesAnthraxQuinolones:IndicationsLowerrespiratorytractinfectionsBoneandjointinfectionsInfectiousdiarrheaUrinarytractinfectionsSkininfectionsSexuallytransmitteddiseasesAnthraxQuinolones:SideEffectsBodySystem

EffectsCNS Headache,dizziness, fatigue, depression,restlessnessGI Nausea,vomiting, diarrhea,constipation, thrush, increasedliverfunction studiesQuinolones:SideEffects(cont’d)BodySystem

EffectsIntegumentary Rash,pruritus,urticaria, flushing,photosensitivity (withlomefloxacin)Other Fever,chills,blurred vision, tinnitusOtherAntibioticsclindamycin(MRSA)Metronidazole(anaerobes)nitrofurantoin(uncomplicatedUTI)OtherAntibiotics(cont’d)vancomycinNatural,bactericidalantibioticDestroyscellwallTreatmentofchoiceforMRSA,andothergram-positiveinfectionsMustmonitorbloodlevelstoensuretherapeuticlevelsandpreventtoxicityMaycauseototoxicityandnephrotoxicityOtherAntibiotics(cont’d)vancomycin(cont’d)Shouldbeinfusedover60minutesMonitorIVsitecloselyRedman’ssyndromemayoccurDecreasedBP,flushingofneckandfaceAntihistaminemaybeorderedtoreducetheseeffectsEnsureadequatehydration(2Lfluids/ 24hr)ifnotcontraindicatedtopreventnephrotoxicityAntibiotics:NursingImplicationsBeforebeginningtherapy,assessdrugallergies;hepatic,liver,andcardiacfunction;andotherlabstudiesBesuretoobtainthoroughclienthealthhistory,includingimmunestatusAssessforconditionsthatmaybecontraindicationstoantibioticuseorthatmayindicatecautioususeAssessforpotentialdruginteractionsNursingImplicationsItisrecommendedtoobtainculturesfromappropriatesitesBEFOREbeginningantibiotictherapyNursingImplications(cont’d)Clientsshouldbeinstructedtotakeantibioticsexactlyasprescribedandforthelengthoftimeprescribed;theyshouldnotstoptakingthemedicationearlywhentheyfeelbetterAssessforsignsandsymptomsofsuperinfection:fever,perinealitching,cough,lethargy,oranyunusualdischargeNursingImplications(cont’d)Forsafetyreasons,checkthenameofthemedicationcarefullybecausetherearemanyagentsthatsoundalikeorhavesimilarspellingsNursingImplications(cont’d)EachclassofantibioticshasspecificsideeffectsanddruginteractionsthatmustbecarefullyassessedandmonitoredThemostcommonsideeffectsofantibioticsarenausea,vomiting,anddiarrheaAlloralantibioticsareabsorbedbetteriftakenwithatleast180to240mLofwaterNursingImplications(cont’d)EachclassofantibioticshasspecificsideeffectsanddruginteractionsthatmustbecarefullyassessedandmonitoredThemostcommonsideeffectsofantibioticsarenausea,vomiting,anddiarrheaAlloralantibioticsareabsorbedbetteriftakenwithatleast180to240mLofwaterNursingImplications(cont’d)EachclassofantibioticshasspecificsideeffectsanddruginteractionsthatmustbecarefullyassessedandmonitoredThemostcommonsideeffectsofantibioticsarenausea,vomiting,anddiarrheaAlloralantibioticsareabsorbedbetteriftakenwithatleast180to240mLofwaterNursingImplications(cont’d)SulfonamidesShouldbetakenwithatleast2000mLoffluidperday,unlesscontraindicatedDuetophotosensitivity,avoidsunlightand

tanningbedsTheseagentsreducetheeffectivenessof

oralcontraceptivesOralformsshouldbetakenwithfoodormilktoreduceGIupsetNursingImplications(cont’d)PenicillinsAnyclienttakingapenicillinshouldbecarefullymonitoredforanallergicreactionforatleast30minutesafteritsadministrationTheeffectivenessoforalpenicillinsisdecreasedwhentakenwithcaffeine,citrusfruit,colabeverages,fruitjuices,ortomatojuiceNursingImplications(cont’d)CephalosporinsOrallyadministeredformsshouldbegivenwithfoodtodecreaseGIupset,eventhoughthiswilldelayabsorptionSomeoftheseagentsmaycauseadisulfiram-likereactionwhentakenwithalcoholNursingImplications(cont’d)MacrolidesTheseagentsarehighlyprotein-boundandwillcausesevereinteractionswithotherprotein-bounddrugsTheabsorptionoforalerythromycinisenhancedwhentakenonanemptystomach,butbecauseofthehighincidenceofGIupset,manyagentsaretakenafteramealorsnackNursingImplications(cont’d)TetracyclinesMilkproducts,ironpreparations,antacids,andotherdairyproductsshouldbeavoidedbecauseofthechelationanddrug-bindingthatoccursAllmedicationsshouldbetakenwith180to240mLoffluid,preferablywaterDuetophotosensitivity,avoidsunlightand

tanningbedsNursingImplications(cont’d)AminoglycosidesMonitorpeakandtroughbloodlevelsoftheseagentstopreventnephrotoxicityandototoxicitySymptomsofototoxicityincludedizziness,tinnitus,andhearinglossSymptomsofnephrotoxicityincludeurinarycasts,proteinuria,andincreasedBUNandserumcreatininelevelsNursingImplications(cont’d)QuinolonesShouldbetakenwithatleast3Loffluidperday,unlessotherwisespecifiedIntakeofalkalinefoodsanddrugs,suchasantacids,dairyproducts,peanuts,andsodiumbicarbonateshouldbelimited UnderstandingVirusesViralreplicationAviruscannotreplicateonitsownItmustattachtoandenterahostcellItthenusesthehostcell’senergytosynthesizeprotein,DNA,andRNAFigure38-1Virusreplication.Somevirusesintegrateintohostchromosomeswithdevelopmentoflatency.(ModifiedfromBrody,T.M.,Larner,J.,&Minneman,K.P.(1998).Humanpharmacology:moleculartoclinical(3rded.).St.Louis,MO:Mosby.)UnderstandingViruses(cont’d)Virusesaredifficulttokillbecausetheyliveinsidehumancells Anydrugthatkillsavirusmayalsokill humancellsViralInfectionsCompetentimmunesystem:BestresponsetoviralinfectionsAwell-functioningimmunesystemwilleliminateoreffectivelydestroyvirusreplication

ViralInfections(cont’d)Immunocompromisedclientshavefrequentviralinfections Cancerclients,especiallyleukemiaor lymphoma Transplantclients,duetopharmacological therapy AIDSclients,diseaseattacksimmunesystemAntiviralsViruseskilledbycurrentantiviraltherapyCytomegalovirus(CMV)HepatitisvirusesHerpesvirusesHumanimmunodeficiencyvirus(HIV)Influenzaviruses(the“flu”)Respiratorysyncytialvirus(RSV) Antivirals(cont’d)KeycharacteristicsofantiviraldrugsAbletoenterthecellsinfectedwithvirusInterferewithviralnucleicacidsynthesisand/orregulationSomeagentsinterferewithabilityofvirus

tobindtocellsSomeagentsstimulatethebody’simmunesystemAntiviralMedicationsAntiviralagentsUsedtotreatinfectionscausedbyvirusesotherthanHIVAntiretroviralagentsUsedtotreatinfectionscausedbyHIV,thevirusthatcausesAIDSAntiviralAgents:NonretroviralMechanismofactionInhibitviralreplicationUsedtotreatnon-HIVviralinfectionsInfluenzavirusesHSV,VZV(anotherherpesvirus)CMVHepatitisA,B,C(HAV,HBV,HCV)HIVHumanimmunodeficiencyvirusinfectionELISA(enzyme-linkedimmunosorbentassay)DetectsHIVexposurebasedonpresenceofhumanantibodiestothevirusinthebloodRetrovirusTransmittedby:Sexualactivity,intravenousdruguse,perinatallyfrommothertochildNaturalHistoryofHIVInfectionPrimaryacuteinfectionAsymptomaticinfectionEarlysymptomaticinfectionAdvancedimmunodeficiencywithopportunisticcomplicationsOpportunisticInfectionsProtozoalToxoplasmosisofthebrain,othersFungalCandidiasisofthelungs,esophagus,tracheaPCP,othersViralCMVdisease,HSVinfection,othersOpportunisticInfections(cont’d)BacterialVariousmycobacterialinfections,othersOpportunisticneoplasiasKaposi’ssarcoma,othersOthersAntiretroviralAgents(cont’d)Reversetranscriptaseinhibitors(RTIs)Blockactivityoftheenzymereversetranscriptase,preventingproductionofnewviralDNAProteaseinhibitors(PIs)Inhibittheproteaseretroviralenzyme,preventingviralreplicationFusioninhibitorsInhibitviralfusion,preventingviralreplicationAntiretroviralAgents:

SideEffectsNumerousandvarywitheachagentDrugtherapymayneedtobemodifiedbecauseofsideeffectsGoalistofindtheregimenthatwillbestcontroltheinfectionwithatolerablesideeffectprofileMedicationregimenschangeduringthecourseoftheillnessAntivirals:NursingImplicationsBeforebeginningtherapy,thoroughly

assessunderlyingdiseaseandmedicalhistory,includingallergiesAssessbaselineVSandnutritionalstatusAssessforcontraindications,conditions

thatmayindicatecautioususe,andpotentialdruginteractionsNursingImplicationsBesuretoteachproperapplicationtechniqueforointments,aerosolpowders,etc.EmphasizehandwashingbeforeandafteradministrationofmedicationstopreventsitecontaminationandspreadofinfectionClientsshouldwearagloveorfingercotwhenapplyingointmentsorsolutionstoaffectedareasNursingImplications(cont’d)Instructclientstoconsulttheirphysicianbeforetakinganyothermedication,includingOTCsEmphasizetheimportanceofgoodhygieneInformclientsthatantiviralagentsarenotcuresbutdohelptomanagesymptomsNursingImplications(cont’d)InstructclientsontheimportanceoftakingthesemedicationsexactlyasprescribedandforthefullcourseoftreatmentMonitorforsideeffectsEffectsarevariedandspecifictoeachagentNursingImplications(cont’d)MonitorfortherapeuticeffectsEffectswillvarydependingonthetypeofviralinfectionEffectsrangefromdelayedprogressionofAIDSandARCtodecreaseinflulikesymptoms,decreasedfrequencyofherpes-likeflare-ups,orcrustingoverofherpeticlesionsAntituberculousAgentsTuberculosis(TB)CausedbyMycobacteriumtuberculosisAntituberculousagentstreatallformsofMycobacteriumTuberculosisTuberculosis(abbreviatedasTBforTubercleBacillusisacommonanddeadlyinfectiousdiseasecausedbythemycobacteriumtuberculosisSymptomsincludeaproductive,prolongedcoughofmorethanthreeweeksduration,chestpain,andcoughingupblood.Systemicsymptomsincludefever,chills,nightsweats,appetiteloss,weightloss,paling,andthoseafflictedareofteneasilyfatiguedMycobacteriumInfectionsCommoninfectionsitesLung(primarysite)BrainBoneLiverKidneyMycobacteriumInfections(cont’d)AerobicbacillusPassedfrominfected:HumansCows(bovine)Birds(avian)MycobacteriumInfections(cont’d)TuberclebacilliareconveyedbydropletsDropletsareexpelledbycoughingorsneezing,thengainentryintothebodybyinhalationTuberclebacillithenspreadtootherbodyorgansviabloodandlymphaticsystemsTuberclebacillimaybecomedormant,orwalledoffbycalcifiedorfibroustissueAntituberculousAgentsFirst-LineAgentsisoniazid*INHethambutolpyrazinamide(PZA)rifampinstreptomycin*MostfrequentlyusedSecond-LineAgentscapreomycincycloserineethionamidekanamycinpara-aminosalicyclicacid(PAS)MechanismofActionThreegroupsProteinwallsynthesisinhibitors(streptomycin,kanamycin,capreomycin,rifampin,rifabutin)Cellwallsynthesisinhibitors(cycloserine,ethionamide,isoniazid)OthermechanismsofactionIsoniazid(INH)DrugofchoiceforTBResistantstrainsofMycobacteriumemergingMetabolizedintheliverthroughacetylation—watchfor“slowacetylators”UsedaloneorincombinationwithotheragentsIndicationsUsedfortheprophylaxisortreatmentofTBAntituberculousTherapyEffectivenessdependsupon:TypeofinfectionAdequatedosingSufficientdurationoftreatmentDrugcomplianceSelectionofaneffectivedrugcombinationAntituberculousTherapy(cont’d)ProblemsDrug-resistantorganismsDrugtoxicityClientnoncomplianceSideEffectsINH

–Peripheralneuritis,hepatotoxicityEthambutol

–Retrobulbarneuritis,blindnessRifampin

–Hepatitis,discolorationofurine,stoolsNursingImplicationsObtainathoroughmedicalhistoryandassessmentPerformliverfunctionstudiesinclients

whoaretoreceiveisoniazidorrifampin

(especiallyinelderlyclientsorthosewhousealcoholdaily)Assessforcontraindicationstothevariousagents,conditionsforcautioususe,andpotentialdruginteractionsNursingImplications(cont’d)ClienteducationiscriticalTherapymaylastforupto24monthsTakemedicationsexactlyasordered,

atthesametimeeverydayEmphasizetheimportanceofstrictcompliancetoregimenforimprovementofconditionorcureNursingImplications(cont’d)Clienteducationiscritical(cont’d)Remindclientsthattheyarecontagiousduringtheinitialperiodoftheirillness—instructinproperhygieneandpreventionofthespreadofinfecteddropletsEmphasizetoclientstotakecareofthemselves,includingadequatenutritionandrestNursingImplications(cont’d)Clientsshouldnotconsumealcoholwhileonthesemedicationsortakeothermedications,includingOTC,unlesstheycheckwiththeirphysicianDiabeticclientstakingINHshouldmonitorbloodglucoselevelsbecausehyperglycemiamayoccurINHandrifampincauseoralcontraceptivestobecomeineffective;anotherformofbirthcontrolwillbeneededNursingImplications(cont’d)Clientswhoaretakingrifampinshouldbetoldthattheirurine,stool,saliva,sputum,sweat,ortearsmaybecomereddishorange;evencontactlensesmaybestainedPyridoxinemaybeneededtocombatneurologicsideeffectsassociatedwithINHtherapyOralpreparationsmaybegivenwithmealstoreduceGIupset,eventhoughrecommendationsaretotakethem1hourbeforeor2hoursaftermealsNursingImplications(cont’d)MonitorforsideeffectsInstructclientsonthesideeffectsthatshouldbereportedtothephysicianimmediatelyTheseincludefatigue,nausea,vomiting,numbnessandtinglingoftheextremities,fever,lossofappetite,depression,jaundiceNursingImplications(cont’d)MonitorfortherapeuticeffectsDecreaseinsymptomsofTB,suchascough

andfeverLaboratorystudies(cultureandsensitivitytests)andCXRshouldconfirmclinicalfindingsWatchforlackofclinicalresponsetotherapy,indicatingpossibledrugresistanceAntifungalAgents:DefinitionDrugsusedtotreatinfectionscausedbyfungi Systemic TopicalFungiLargeanddiversegroupofmicro-organismsBrokendownintoyeastsandmouldsFungalinfectionsalsoknownasmycosisSomefungiarepartofthenormalfloraoftheskin,mouth,intestines,vaginaYeastsSingle-cellfungiReproducebybuddingCanbeusedforBakingAlcoholicbeveragesMouldsMulticellularCharacterizedbylong,branchingfilamentscalledhyphaeMycoticInfectionsFourgeneraltypesCutaneousSubcutaneousSuperficial,mostSystemic**Canbelifethreatening*UsuallyoccurinimmunocompromisedhostMycoticInfections(cont’d)CandidaalbicansDuetoantibiotictherapy,antineoplastics,orimmunosuppressants(corticosteroids)MayresultinovergrowthandsystemicinfectionsInthemouthOralcandidiasisorthrushNewborninfantsandimmunocompromisedclientsVaginalcandidiasis“Yeastinfection”Pregnancy,diabetesmellitus,oralcontraceptivesAntifungalAgentsSystemicamphotericinB,fluconazole,ketoconazole,itraconazoleTopicalExamples:clotrimazole,miconazole,nystatinIndicationsSystemicandtopicalfungalinfectionsAgentofchoiceforthetreatmentofmanyseveresystemicfungalinfectionsisamphotericinBChoiceofagentdependsontypeandlocationofinfectionSideEffects:AmphotericinBFeverHeadache Malaise Hypotension MuscleandjointpainLoweredpotassiumlevels

Mainconcerns:RenaltoxicityNeurotoxicity:seizuresandparesthesiasChills

Dysrhythmias

NauseaAnorexia“Shakeandbake”AntifungalAgents:

SideEffects(cont’d)FluconazoleNausea,vomiting,diarrhea,stomachpainIncreasedliverfunctionstudiesGriseofulvinRash,urticaria,headache,nausea,vomiting,anorexia,othersNursingImplicationsFollowmanufacturer’sdirectionscarefullyforreconstitutionandadministrationMonit