Categories
Chemotherapeutic Agents Nursing Pharmacology

Vaccines and Sera

Vaccines and Sera

Biologicals—Actions

  • Stimulate the production of antibodies
  • Provide preformed antibodies to facilitate an immune reaction
  • React specifically with the toxins produced by an invading pathogen

Types of Immunity

  • Active immunity
    • The body recognizes a foreign protein and begins producing antibodies to react with it
  • Passive immunity
    • Occurs when preformed antibodies are injected into the system and react with a specific antigen

Immunization

  • Definition
    • The process of artificially stimulating active immunity
    • Exposes the body to weakened or less toxic proteins associated with specific disease-causing organisms
  • Goal
    • To cause an immune response without having the patient suffer the full course of a disease

Childhood Vaccinations

  • Diphtheria, pertussis, and tetanus
  • Haemophilus B
  • Hepatitis B and hepatitis A
  • Chickenpox
  • Polio
  • Measles, mumps, and rubella

Vaccines—Indications

  • Stimulate active immunity in people who are at risk
  • The vaccine needed depends on the exposure the person will have to pathogens
  • Vaccines are thought to provide lifelong immunity

Vaccines—Contraindications

  • In the presence of immune deficiency
  • During pregnancy
  • Known allergies to any of the components of the vaccine
  • Patients who receive immune globulin or who have received blood or blood products within the last 3 months
  • Caution with history of febrile convulsions or cerebral injury, conditions in which high fever would be dangerous, and during acute infection

Vaccines–Adverse Effects

  • Fever
  • Rash
  • Malaise
  • Chills
  • Fretfulness
  • Drowsiness
  • Anorexia
  • Vomiting
  • Irritability
  • Pain, redness, and swelling at the injection site

Site of Action of Vaccines, Immune Sera, and Antitoxins

Site of Action of Vaccines, Immune Sera, and Antitoxins
Site of Action of Vaccines, Immune Sera, and Antitoxins

Immune Sera

  • Definition
    • Sera that contain antibodies to specific bacteria or viruses
  • Types
    • Antitoxin and antivenom
      • Immune sera have antibodies to specific toxins that might be released by invading pathogens, or to venom from spider or snake bites

Immune Sera and Antitoxins—Indications

  • Provide passive immunity to a specific antigen or disease
  • Used as prophylaxis against specific disease after exposure
  • May lessen the severity of a disease

Immune Sera and Antitoxins

  • History of severe reaction to any immune sera
  • Use with caution:
    • Pregnancy
    • Coagulation defects
    • Previous exposure to the immune sera
    • Rash
    • Nausea
    • Vomiting
    • Chills
    • Fever
  • Allergic reaction
    • Chest tightness, decreased blood pressure, and difficulty breathing
  • Local reaction
    • Swelling, tenderness, pain, and muscle stiffness at the injection site

Biological Weapons

Biological Weapons
Biological Weapons

Use of Biologicals Across the Lifespan

Use of Biologicals Across the Lifespan
Use of Biologicals Across the Lifespan

Adult Immunization Schedule

Adult Immunization Schedule
Adult Immunization Schedule

Childhood Immunization Schedule

Childhood Immunization Schedule
Childhood Immunization Schedule

Prototype Vaccine

Prototype Vaccine
Prototype Vaccine

Prototype Immune Sera

Prototype Immune Sera
Prototype Immune Sera

Nursing Considerations for Vaccines

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Immune Sera and Antitoxins

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Immune Modulators

Immune Modulators

 

Sites of Actions of Immune Modulators

  • Immune modulators
    • Modify the actions of the immune system
  • Immune stimulants
    • Energize the immune system when it needs help fighting a specific pathogen
  • Immune suppressants
    • Block the normal effects of the immune system in organ transplantation and autoimmune disorders

Immune Stimulants

  • Interferons
    • Naturally released from human cells in response to viral invasion
  • Interleukins
    • Communicate between lymphocytes, stimulate cellular immunity, and inhibit tumor growth
  • T and B cell modulator (levamisole)
    • Restores immune function and activity

Interferon

  • Actions
    • Prevents virus particles from replicating inside other cells
    • Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
    • Inhibits tumor growth and replication
  • Pharmacokinetics
    • Absorbed well after subcutaneous or intramuscular injection
    • Broken down in the tissues
    • Excreted in the kidneys
    • May be teratogenic
  • Contraindications
    • Known allergy
    • Pregnancy and lactation
    • Use with caution in cardiac disease, myelosuppression, and with central nervous system dysfunction
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, anorexia, nausea, headache, dizziness, and bone marrow depression
  • Drug-to-drug interactions

Interleukins

  • Definition
    • Chemicals produced by T cells to communicate between leukocytes
  • Types of preparations
    • Aldesleukin (Proleukin)
      • Human interleukin produced by recombinant DNA technology using Escherichia coli bacteria
    • Oprelvekin (Neumega)
      • A newer agent produced by DNA technology
  • Actions
    • Increase the number of natural killer cells and lymphocytes
    • Activate cellular immunity and inhibit tumor growth
  • Indications
    • Aldesleukin: specific renal carcinomas and possible treatment of AIDS and AIDS-related disorders
    • Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy
  • Pharmacokinetics
    • Rapidly distributed after injection
    • Cleared by the kidneys
    • Teratogenic
  • Contraindications
    • Known allergy, pregnancy, and lactation
    • Caution with renal, liver, or cardiovascular impairment
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, fatigue, fever, and respiratory difficulties

T and B Cell Modulators

  • Action/Indication
    • Levamisole stimulates B cells which in turn stimulate antibody formation, enhancing T cell activity
    • Used in the treatment of Duke’s stage C colon cancer
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peaks in 1.5 to 2 hours
    • Metabolized in the liver and excreted in the urine
    • T½ of 16 hours
  • Contraindications
    • Known allergy, pregnancy, and lactation
  • Adverse reactions
    • Headache, dizziness, ataxia, nausea, vomiting, and diarrhea
  • Drug-to-drug interactions
    • Disulfiram-type reaction
    • Increased phenytoin levels

Types of Immune Suppressants

  • T and B cell suppressors
  • An interleukin receptor antagonist
  • Monoclonal antibodies
    • Produced by a single clone of B cells that react with specific antigens

T and B Cell Suppressors

  • Azathioprine (Imuran): prevents rejection in renal hemotransplants; treats rheumatoid arthritis
  • Cyclosporine (Sandimmune): suppresses rejection in a variety of transplants; treats rheumatoid arthritis and psoriasis
  • Glatiramer acetate (Copaxone): reduces number of relapses in multiple sclerosis in adults
  • Mycophenolate mofetil (CellCept): prevents rejection after renal or heart transplant in adults
  • Sirolimus (Rapamune): prevents rejection after renal transplantation
  • Tacrolimus (Prograf): prevents rejection after liver transplantation
  • Action
    • Inhibit DNA synthesis
  • Contraindications
    • Known allergy, pregnancy, CNS disease, and hepatic disease
  • Drug-to-drug interactions

T and B Cell Suppressor Adverse Effects

  • Increased risk for infection and development of neoplasms
  • Hepatotoxicity
  • Renal toxicity and renal dysfunction
  • Pulmonary edema
  • Possible headache, tremors, and secondary infections such as acne, GI upset, diarrhea, and hypertension

Interleukin Receptor Antagonists

  • Actions
    • Used to treat rheumatoid arthritis
    • Block activity of interleukin-1
  • Pharmacokinetics
    • Given subcutaneously
    • Reach peak in 3 to 7 hours
    • Metabolized in the tissues
    • T½ of 4 to 6 hours
  • Contraindications
    • Known allergy, pregnancy, lactation, and renal impairment
  • Adverse reactions
    • Headache, sinusitis, nausea, and diarrhea
  • Drug-to-drug interaction
    • Etanercept may cause severe and even life- threatening infections

Monoclonal Antibodies

  • Action
    • Antibodies attach to specific receptors
  • Pharmacokinetics
    • Must be injected
  • Contraindications
    • Known allergy and fluid overload
  • Adverse reactions
    • Pulmonary edema, fluid retention, flu-like symptoms
  • Drug-to-drug interaction
    • Severe immune suppression can occur

Use of Immune Modulators Across the Lifespan

Use of Immune Modulators Across the Lifespan
Use of Immune Modulators Across the Lifespan

Prototype Immune Stimulants

Prototype Immune Stimulants
Prototype Immune Stimulants

Prototype Interleukins

Prototype Interleukins
Prototype Interleukins

Prototype T and B Cell Suppressors

Prototype T and B Cell Suppressors
Prototype T and B Cell Suppressors

Prototype Monoclonal

Prototype Monoclonal
Prototype Monoclonal

Nursing Considerations for Immune Stimulators

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Immune Suppressants

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Antineoplastic Agents

Antineoplastic Agents

Neoplasm Cancer—Mechanisms of Growth

  • Anaplasia
    • Cancerous cells lose cellular differentiation and organization and are unable to function normally
  • Autonomy
    • Cancerous cells grow without the usual homeostatic restrictions that regulate cell growth and control
    • This allows the cells to form a tumor
  • Metastasis
    • Cancer cells travel from the place of origin to develop new tumors in other areas of the body
  • Angiogenesis
    • Abnormal cells release enzymes to generate blood vessels and supply oxygen and nutrients to the cells, generating growth
    • Cancerous cells rob the host cells of energy and nutrients and block normal lymph

The Body’s Immune System Response to Cancerous Cells

  • Can damage or destroy some neoplastic cells
  • T cells recognize the abnormal cells and destroy them
  • Antibodies form in response to parts of the abnormal cell protein
  • Interferons and tissue necrosis factor (TNF) play a role in the body’s attempt to eliminate the abnormal cells

Possible Causes of Cancer

  • Genetic predisposition
  • Viral infection
  • Constant irritation and cell turnover
  • Stress
  • Lifestyle factors
  • Environmental factors

Classifications of Tumors

  • Solid tumors
    • May originate in any body organ
    • Carcinomas (originate in epithelial cells)
    • Sarcomas (originate in the mesenchyma)
  • Hematologic malignancies
    • Leukemias and lymphomas that occur in the blood-forming organs

Mechanisms of Antineoplastic Drugs

  • Affect cell survival
  • Boost the immune system in its efforts to combat the abnormal cells

Goal of Cancer Treatment

  • To destroy cancer cells using the following methods:
    • Surgical removal
    • Stimulation of the immune system to destroy them
    • Radiation therapy to destroy them
    • Drug therapy to kill them during various phases of the cell cycle

Categories of Antineoplastic Agents

  • Alkylating agents
    • React chemically with portions of the RNA, DNA, or other cellular proteins
  • Antimetabolites
    • Have chemical structures similar to those of natural metabolites
  • Antineoplastic antibiotics
    • Not selective for bacterial cells only; toxic to human cells
  • Mitotic inhibitors
    • Drugs that kill cells as the process of mitosis begins
  • Hormones and hormone modulators
    • Used in cancers that are sensitive to estrogen stimulation
  • Cancer-cell–specific agents
    • Treat chronic myeloid leukemia (CML) and CD117-positive unresectable or metastatic malignant GI stromal tumors (GIST)

Sites of Action of Non-Cell-Cycle–Specific Antineoplastic Agents

Sites of Actions of Non-Cell-Cycle-Specific Antineoplastic Agents
Sites of Actions of Non-Cell-Cycle-Specific Antineoplastic Agents

 

 

Sites of Action of Cell-Cycle–Specific Antineoplastic Agents

Sites of Action Cell-Cycle-Specific Antineoplastic Agents
Sites of Action Cell-Cycle-Specific Antineoplastic Agents

Alkylating Agents

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Antimetabolites

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Antineoplastic Antibiotics

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Mitotic Inhibitors

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Hormones and Hormone Modulators

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Prototype Alkylating Agent

Prototype Alkylating Agent
Prototype Alkylating Agent

 

 

Prototype Antimetabolite Agent

Prototype Antimetabolite Agent
Prototype Antimetabolite Agent

 

 

Prototype Antineoplastic Antibiotics

Prototype Antineoplastic Antiboitics
Prototype Antineoplastic Antiboitics

 

 

Prototype Mitotic Inhibitors

Prototype Mitotic Inhibitors
Prototype Mitotic Inhibitors

 

Prototype Hormones and Hormone Modulators

Prototype Hormones and Hormone Modulators
Prototype Hormones and Hormone Modulators

 

 

Use of Antineoplastic Across the Lifespan

Use of Antineoplastic Across the Lifespan
Use of Antineoplastic Across the Lifespan

 

 

Nursing Considerations for Alkylating Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antimetabolites

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antineoplastic Antibiotics

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Mitotic Inhibitors

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Hormones and Hormone Modulators

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Anthelmintic Agents

Anthelmintic Agents

Two Types of Helminths Commonly Infecting Humans

  • Nematodes or roundworms
    • Pinworms, whipworms, threadworms, Ascaris, and hookworms
  • Platyhelminthes or flatworms
    • Cestodes (tapeworms) and flukes (schistosomes)

Measures to Control Infection

  • Keep nails short
  • Keep hands clean
  • Frequent handwashing
  • Shower in the morning
  • Change and launder undergarments, bed linens, and pajamas daily
  • Disinfect toilet seat daily
  • Handwashing after using the bathroom

Tissue-Invading Worms

  • Trichinosis
    • Caused by ingestion of the encysted larvae of the roundworm, Trichinella spiralis, in undercooked pork
  • Filariasis
    • Infection of the blood and tissues of healthy individuals by worm embryos, injected by insects
  • Schistosomiasis
    • Infection by a fluke that is carried by a snail

Life Cycle of Schistosoma

Life Cycle of Shistosomo
Life Cycle of Shistosomo

 

Mebendazole (Vermox)

  • Most commonly used of all of the anthelmintics
  • Effective against pinworms, roundworms, whipworms, and hookworms
  • Available in the form of a chewable tablet
  • Few adverse effects
  • Not metabolized in the body; most is excreted unchanged in the feces
  • Should not be used during pregnancy

Pyrantel (Antiminth, Pin-Rid, Pin-X, Reese’s Pinworm)

  • Oral drug effective against pinworms and roundworms
  • Given as a single dose
  • Poorly absorbed; excreted unchanged in the feces
  • Not recommended for use during pregnancy and lactation
  • Safety not established for children age <2 years
  • Adverse effects may include GI side effects and diarrhea

Thiabendazole (Mintezol)

  • Treats roundworm, hookworm, and whipworm infections
  • Not the anthelmintic drug of choice (not as effective, more adverse effects)
  • Best drug for treatment of threadworm infections
  • Readily absorbed from the GI tract; reaches peak levels in 1 to 2 hours
  • Metabolized in the liver and excreted in the urine

Albendazole (Albenza)

  • Treats active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm
  • Serious adverse effects
  • Should be used only after causative worm is identified
  • Poorly absorbed from the GI tract; reaches peak levels in about 5 hours
  • Metabolized in the liver and primarily excreted in the urine
  • Should not be used during pregnancy and lactation

Ivermectin (Stromectol)

  • Effective against the nematode that causes onchocerciasis, or river blindness
  • Used to treat threadworm disease or strongyloidiasis
  • Readily absorbed from the GI tract; reaches peak plasma levels in 4 hours
  • Completely metabolized in the liver with a half-life of 16 hours; excreted through the feces
  • Should never be taken during pregnancy; used with caution during lactation

Praziquantel (Biltricide)

  • Very effective in the treatment of a wide number of schistosomes, or flukes
  • Taken in a series of three doses at 4- to 6-hour intervals
  • Has relatively few adverse effects
  • Rapidly absorbed from the GI tract; reaches peak plasma levels within 1 to 3 hours
  • Metabolized in the liver with a half-life of 0.8 to 1.5 hours
  • Excreted primarily through the urine

Anthelmintic Actions/Indications

  • Affects metabolic processes that are different in worms than in human hosts or are not found in humans
  • Causes death of the worm by interfering with normal functioning

Anthelmintic Contraindications

  • Presence of known allergy to any of these drugs
  • Lactation
  • Pregnancy (in most cases)
  • Caution should be used in the presence of renal or hepatic disease or severe diarrhea and malnourishment

Anthelmintic Adverse Effects

  • Abdominal discomfort
  • Diarrhea
  • Pain
  • Headache
  • Dizziness
  • Fever
  • Chills

Anthelmintic Drug-to-Drug Interactions

  • Theophylline = increased levels of theophylline
  • Albendazole with dexamethasone increases the overall effect of the drug

Sites of Action of the Anthelmintic Drugs

Sites of Action of the Anthelmintic Drugs
Sites of Action of the Anthelmintic Drugs

 

 

Use of Anthelmintic Agents Across the Lifespan

Use of Anthelmintic Agents Across the Lifespan
Use of Anthelmintic Agents Across the Lifespan

Prototype Anthelmintic Agent

Prototype Antelmintic Agent
Prototype Antelmintic Agent

Drug/Dosage/Indication

Drug/Dosage/Indication
Drug/Dosage/Indication

Nursing Considerations for Anthelmintic Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Antiprotozoal Agents

Antiprotozoal Agents

Causes of Protozoal Infections

  • Insect bites
    • Malaria
    • Trypanosomiasis
    • Leishmaniasis
  • Ingestion or contact with the causal organism
    • Amebiasis
    • Giardiasis
    • Trichomoniasis

Protozoal Parasites Identified as Causes of Malaria

  • Plasmodium falciparum
    • Considered the most dangerous type of protozoan
  • Plasmodium vivax
    • Milder form of the disease; seldom results in death
  • Plasmodium malariae
    • Endemic in tropical countries; mild symptoms
  • Plasmodium ovale
    • Rarely seen; in the process of being eradicated

Life Cycle of Plasmodium

Life Cycle of Plasmodium
Life Cycle of Plasmodium

Antimalarials

  • 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 transmission
    • Treatment of toxoplasmosis
  • Quinine (generic)
    • Treatment of chloroquine-resistant plasmodial infections

Antimalarials—Action

  • Interrupt plasmodial reproduction of protein synthesis
  • Agents that do not appear to affect the sporozoites are used for prophylaxis

Antimalarials—Contraindications

  • Known allergy
  • Liver disease
  • Alcoholism
  • Lactation
  • Cautions
    • Retinal disease or damage
    • Psoriasis

Antimalarials—Adverse Effects

  • Headache
  • Dizziness
  • Fever
  • Chills
  • Malaise
  • Nausea
  • Vomiting
  • Hepatic dysfunction

Antimalarials—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
    • Inhibit DNA synthesis
  • Contraindications
    • Known allergy, pregnancy, CNS disease, and hepatic disease
  • Adverse reactions
    • Headache, dizziness, ataxia, nausea, vomiting, and diarrhea

Malaria

  • Signs and symptoms
    • Related to the destruction of red blood cells and toxicity to the liver
  • Treatment
    • Aims at attacking the parasite at the various stages of its development inside and outside the human body

Other Protozoal Infections

  • Amebiasis
  • Leishmaniasis
  • Trypanosomiasis
  • Trichomoniasis
  • Giardiasis
  • Pneumocystis carinii

Risk Factors for Protozoal Infections

  • Unsanitary conditions
  • Poor hygienic practices

Prototype Antiprotozoal Agent

Prototype Antiprotozoal Agent
Prototype Antiprotozoal Agent

Prototype Antifungal Agent

Prototype Antifungal Agent
Prototype Antifungal Agent

Use of Antifungals Across the Lifespan

Use of Antifungal Across the Lifespan
Use of Antifungal Across the Lifespan

Common Antiprotozoal Agents

  • Atovaquone (Mepron)
    • Especially active against PCP
  • Metronidazole (Flagyl, MetroGel, Noritate)
    • Treats amebiasis, trichomoniasis, and giardiasis
  • Pentamidine (Pentam 300, NebuPent)
    • Treats PCP, trypanosomiasis, and leishmaniasis
  • Tinidazole (Tindamax)
    • Treats trichomoniasis, giardiasis, and amebiasis

Nursing Considerations for Antimalarial Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antiprotozoal Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Antifungal Agents

Antifungal Agents

What Is a Fungus?

  • 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

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

  • Newer agents
  • 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

  • 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

Sites of Action of Antifungal Agents

Sites of Action of Antifungal Agents
Sites of Action of Antifungal Agents

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

Topical Antifungal Infections

  • Caused by dermatophytes
  • Tinea infections (ringworm)
    • Athlete’s foot (tinea pedis)
    • Jock itch (tinea cruris)
  • Candida
    • Yeast infections of the mouth and vagina

Topical Antifungal Agents

  • Action
    • Work to alter the cell permeability of the fungus, causing prevention of replication and fungal death
  • Indication
    • Indicated only for local treatment of mycoses, including tinea infection
  • Contraindication/caution
    • Limited to known allergy to any antifungal agent
  • Adverse effects
    • Local effects include irritation, burning, rash, and swelling
    • When taken as a suppository or troche, nausea, vomiting, hepatic dysfunction, urinary frequency, burning, and change in sexual activity can occur
  • Drug-to-drug interactions
    • None reported

Prototype Antifungal Agent

Fluconazole
Fluconazole

Clotrimazole
Clotrimazole

Use of Antifungals Across the Lifespan

Drug Therapy Across the Lifespan
Drug Therapy Across the Lifespan

Nursing Considerations for Systemic Antifungal Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Topical Antifungal Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Antiviral Agents

Antiviral Agents

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

Antivirals Across the Lifespan

Antivirals Across the Lifespan
Antivirals Across the Lifespan

Characteristics of Common Viruses

  • Viral replication
    • A virus cannot replicate on its own
      • It must attach to and enter a host cell
      • 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
    • Any drug that kills a virus may also kill our cells

Stages of Virus Replication

Stages of Virus Replication
Stages 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 Herpes Virus

  • Painful vesicles that often occur in clusters on skin, cornea, or mucous membranes
  • Usual course of primary disease is 2 weeks
  • Duration of recurrences varies

Signs and Symptoms of CMV

  • May be asymptomatic
  • Fatigue
  • Nausea
  • Jaundice
  • If contracted during pregnancy, can result in stillbirth, brain damage, or birth defects

Signs and Symptoms of HIV/AIDS

  • Attach helper T cells
  • Acute infection: fever, rash, and myalgia
  • Asymptomatic infection: follows acute infection; duration varies
  • Persistent generalized lymphadenopathy: adenopathy persists more than 3 months
  • Constitutional symptoms: fever lasting more than a month, involuntary weight loss, chronic fatigue
  • Neurologic disease: dementia
  • Secondary infections: pneumocystis carinii and disseminated herpes simplex

Influenza A & Respiratory Viruses

  • Action: prevent shedding of the viral protein coat
  • Pharmacokinetics: administered orally and excreted unchanged in the urine
  • Contraindications: allergy, pregnancy, and lactation
  • Adverse reactions: dizziness, insomnia, nausea, orthostatic hypotension
  • Drug-to-drug interactions: anticholinergic agents

Herpes & Cytomegalovirus

  • Action: inhibit viral DNA replication by competing with viral substrates to form shorter, noneffective DNA chains
  • Pharmacokinetics: administered orally, IV, or topically; excreted unchanged in the urine
  • Contraindications: pregnancy and lactation
  • Adverse reactions: nausea, vomiting, headache, rash, and hair loss
  • Drug-to drug-interactions: nephrotoxic drugs and zidovudine

Drugs Used to Treat HIV/AIDS

  • Reverse transcriptase inhibitors
  • Protease inhibitors
  • Nucleosides
  • Fusion inhibitors

Reverse Transcriptase Inhibitors

  • Action: bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent DNA polymerase activities
  • Pharmacokinetics: given orally, metabolized in the liver, and excreted in the urine
  • Contraindications: pregnancy and lactation
  • Adverse reactions: headache, nausea, vomiting, rash, chills, fever, and diarrhea

Protease Inhibitors

  • Action: block protease activity within the HIV virus
  • Pharmacokinetics: agents are teratogenic except for saquinavir
  • Contraindications: pregnancy and lactation

Nucleosides

  • Action: interfere with HIV replication by inhibiting cell protein synthesis
  • Pharmacokinetics: given orally or IV, metabolized in the liver, and excreted in the urine
  • Adverse reactions: HA, insomnia, dizziness, nausea, diarrhea, fever, and rash

Fusion Inhibitors

  • Action: prevent the fusion of the virus with the human cellular membrane
  • Pharmacokinetics: given sub-q, metabolized in the liver, recycled in the tissues, and not excreted
  • Contraindication: no true contraindication
  • Adverse reactions: HA, dizziness, myalgia, nausea, vomiting, and diarrhea
  • Drug-to-drug interactions: pimozide, rifampin, triazolam, midazolam, and oral contraceptives

Locally Active Antiviral Agents

  • Action: act on viruses by interfering with normal viral replication and metabolic processes
  • Pharmacokinetics: not absorbed systemically
  • Contraindication: allergy to the drug
  • Adverse reactions: local burning, stinging, and discomfort

Prototype of Respiratory Antiviral Agents

Rimantadine
Rimantadine

Prototype of Herpes and Cytomegalovirus Agents

Acyclovir
Acyclovir

Prototype of HIV/AIDS Antiviral Agents

Nevirapine
Nevirapine

 

Zidovidine
Zidovidine

Nursing Considerations for Respiratory Antiviral Therapy

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Herpes Virus and Cytomegalovirus

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for HIV/AIDS Antiviral Therapy

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Locally Active Antiviral Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Antibiotics

Antibiotics

Antibiotics

  • Antibiotics are defined as:
    • Chemicals that inhibit specific bacteria

Types of Antibiotics

  • Bacteriostatic
    • Substances that prevent the growth of bacteria
  • Bactericidal
    • Substances that kill bacteria directly

Signs of Infection

  • Fever
  • Lethargy
  • Slow-wave sleep induction
  • 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

  • Gram-positive
    • The cell wall retains a stain or resists decolorization with alcohol
  • Gram-negative
    • The cell wall loses a stain or is decolorized by alcohol
  • Aerobic
    • Depend on oxygen for survival
  • Anaerobic
    • Do not use oxygen

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

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

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

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

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

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

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

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

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

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

Antibiotic Use Across the Lifespan

  • Pediatric population
  • Adult population
  • Geriatric population

Comparison of Prototype Antibiotics

Drug/ Classification Indication Action Route Onset Peak Pharmacokinetics Adverse Effects
Gentamicin/ Aminoglycosides Treatment of serious infections caused by susceptible bacteria Inhibits protein synthesis in susceptible strains of gram negative bacteria IM Rapid 30-90 min T½  – 2-3 h Sinusitis, dizziness, rash, fever, risk of nephrotoxicity
IV Metabolized in the liver,
excreted in the urine
Cefaclor/ Cephalosporins Treatment of respiratory, dermatological, urinary tract, and middle ear infections Inhibits synthesis of bacteria cell wall Oral 30-60 min 8-10 h T ½ 30-60 min Nausea, vomiting, diarrhea, rash, superinfections, bone marrow suppression, risk for pseudomembranous colitis
Excreted unchanged in the urine
Ciprofloxacin/ Fluoroquinolones Treatment of respiratory, dermatological, urinary tract, ear, eye, bone, and joint infections Interferes with DNA replication in susceptible gram negative bacteria Oral Varies 4-5 h T ½  – 3.5-4 h Headache, dizziness, hypotension, nausea, vomiting, diarrhea, fever, and rash
IV 10 min 4-5 h Metabolized in the liver,
excreted in bile and urine
Erythromycin/ Macrolides Treatment of respiratory, dermatological, urinary tract, and GI infections Binds to cell membrane causing change in protein function and cell death Oral 1-2 h 1-4 h T ½ – 3-5 h Abdominal cramping, vomiting, diarrhea, rash, superinfections, liver toxicity, potential for hearing loss
IV Rapid 1h Metabolized in the liver, CONTINUED ON NEXT SLIDE
excreted in bile and urine
Treatment of serious infections caused by susceptible strains of bacteria Inhibits protein synthesis in susceptible bacteria Oral Varies 1-2 h T ½ – 2-3 hours Nausea, vomiting, diarrhea, pseudomembranous colitis, bone marrow suppression, hypotension, cardiac arrest
IV Immed. Min Metabolized in the liver, excreted in bile and urine
IM 20-30 min 1-3 h
Aztreonam/ Treatment of lower respiratory, dermatological, urinary tract, intra-abdominal, and GYN infections Interferes with bacterial cell wall synthesis IM Varies 60-90 min T ½ – 1.5-2 h Nausea, vomiting, diarrhea, rash, superinfections, anaphylaxis, local discomfort at injection site
Monobactams IV Immed. 30 min Excreted in unchanged urine
Amoxicillin/ Treatment of infections caused by susceptible strains of bacteria Inhibits synthesis of the cell wall, causing cell death Oral Varies 1 h T ½  – 1-1.4 h Nausea, vomiting, diarrhea, glossitis, stomatitis, bone marrow suppression, rash, fever, lethargy
Penicillins Excreted unchanged in urine
Sulfasalazine/ Treatment of rheumatoid arthritis, arthritis, and ulcerative colitis Clindamycin/ Oral Varies 1.5-6 h T ½ – 5-10 h Nausea, vomiting, hepatocellular necrosis, hematuria, Stevens-Johnson syndrome, rash, photophobia, fever
Sulfonamides Lincosamides 6-24 h – metab. Metabolized in the liver, excreted in urine
Tetracycline/ Treatment of various infections caused by susceptible bacteria Inhibits protein synthesis in susceptible bacteria Oral Varies 2-4 h T ½ – 6-12 h Nausea, vomiting, diarrhea, discoloration of teeth, bone marrow suppression, photosensitivity
Tetracyclines Excreted unchanged in urine
Isoniazid/ Treatment of tuberculosis Interferes with lipid and nucleic acid synthesis in actively growing tubercle bacilli Oral Varies 1-2 h T ½  – 1-4 h Peripheral neuropathies, nausea, vomiting, hepatitis, bone marrow suppression, fever, gynecomatia, lupus syndrome
Antimycobacterials Metabolized in the liver, excreted in urine

Nursing Considerations—Aminoglycosides

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Cephalosporins

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Fluoroquinolones

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations— Macrolides & Lincosamides

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Monobactam

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Penicillins

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Sulfonamides

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Tetracyclines

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Antimycobacterials

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Anti-infective Agents

Anti-infective Agents

Drug Therapy Across the Lifespan

Drug Therapy Across the Lifespan
Drug Therapy Across the Lifespan

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

  • Interfere with biosynthesis of the bacterial cell wall
  • Prevent the cells of the invading organism from using substances essential to their growth and development
  • Interfere with steps involved in protein synthesis
  • Interfere with DNA synthesis
  • Alter the permeability of the cell membrane to allow essential cellular components to leak out

Mechanism of Anti-infective Agents

Mechanism of Anti infective Agents
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

  • Narrow spectrum of activity
    • Effective against only a few microorganisms with a very specific metabolic pathway or enzyme
  • Broad spectrum of activity
    • Useful in treating a wide variety of infections

Human Immune Response

  • Goal of anti-infective therapy is reduction of the population of the invading organism
  • Drugs that eliminate all traces of any invading pathogen might be toxic to the host as well
  • 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

  • Producing an enzyme that deactivates the antimicrobial drug
  • Changing cellular permeability to prevent the drug from entering the cell
  • Altering transport systems to exclude the drug from active transport into the cell
  • Altering binding sites on the membranes or ribosomes, which then no longer accept the drug
  • Producing a chemical that acts as an antagonist to the drug

Preventing Resistance

  • Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used
  • Make sure doses are high enough, and the duration of drug therapy long enough
  • Be cautious about the indiscriminate use of anti-infectives

Identification of the Pathogen

  • Identification of the infecting pathogen is done by culture
  • A culture of a tissue sample from the infected area is done
    • A swab of infected tissue is allowed to grow on an agar plate
    • Staining techniques and microscopic examination identify the bacterium
  • Stool can be examined for ova and parasites

Sensitivity of Pathogen

  • Shows which drugs are capable of controlling the particular microorganism
  • Important to be done for microorganisms that have known resistant strains
  • Along with a culture, identifies the pathogen and appropriate drug for treatment

Factors Affecting Prescribing Anti-infective Agents

  • Identification of the correct pathogen
  • 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

  • Use of a smaller dosage of each drug
  • Some drugs are synergistic
  • In infections caused by more than one organism, each pathogen may react to a different anti-infective agent
  • Sometimes, the combined effects of the different drugs delay the emergence of resistant strains

Adverse Reactions to Anti-infective Therapy

  • Kidney damage
  • Gastrointestinal (GI) tract toxicity
  • Neurotoxicity
  • Hypersensitivity reactions
  • 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
Categories
Chemotherapeutic Agents Nursing Pharmacology

Introduction to Cell Physiology

Introduction to Cell Physiology

Chemotherapeutic Agents

  • Alter cellular function or disrupt cellular integrity, causing cell death
  • Prevent cellular reproduction, eventually leading to cell death

Chemotherapeutic Drugs

  • Destroy organisms that invade the body
    • Bacteria, viruses, parasites, protozoa, fungi
  • Destroy abnormal cells within the body
    • Neoplasms and cancers

Parts of a Human Cell

  • Nucleus
  • Cell membrane
  • Cytoplasm

Structure of a Cell

Stucture of a Cell
Stucture of a Cell

Cell Nucleus

  • Contains genetic material
    • Necessary for cell reproduction
    • Regulates cellular production of proteins
  • Each cell is “programmed” by the genes for the production of specific proteins
    • Allows the cell to carry out its function
    • Maintains cell homeostasis or stability
    • Promotes cell division

Cell Membrane

  • Surrounds the cell
  • Separates the intracellular fluid from the extracellular fluid
  • Essential for cellular integrity

Structure of a Lipid Cell Membrane

Structure of a Lipid Cell Membrane
Structure of a Lipid Cell Membrane

Organelles of the Cytoplasm

  • Mitochondria
  • Endoplasmic reticulum
  • Free ribosomes
  • Golgi apparatus
  • Lysosomes

Components of Cell Membrane

  • Cell membrane is made up of lipids and proteins
  • Several lipids make up the cell membrane
    • Phospholipids
    • Glycolipids
    • Cholesterol
  • Lipid layer provides a barrier for the cell and maintains homeostasis of the cell

Receptor Sites

  • Found on the cell membrane
  • Specific receptor sites allow interaction with various chemicals

Identifying Markers

  • Surface antigens
  • Important in the role of cellular immunity
  • Histocompatibility proteins allow for self-identification
  • The body’s immune system recognizes these proteins and acts to protect self-cells and to destroy non–self-cells

Channels

  • Channels or pores allow for the passage of substances into and out of the cell
  • Some drugs are designed to affect certain channels within the cell

Cell Properties

  • Endocytosis
    • Involves incorporation of material into the cell
    • Pinocytosis and phagocytosis occur
  • Exocytosis
    • Allows a cell to move a substance to the cell membrane and secrete the substance outside the cell
    • Hormones, neurotransmitters, and enzymes are excreted into the body by this process

Homeostasis of the Cell

  • Passive transport
    • Happens without the expenditure of energy and can occur across any semipermeable membrane
    • Occurs by diffusion, osmosis, and facilitated diffusion
  • Active transport
    • Energy-requiring process
    • Movement of particular substances against a concentration gradient
    • Important in maintaining cell homeostasis

Passive Transport

  • Diffusion
    • Does not require energy
    • The movement of solutes from a region of high concentration to a region of lower concentration across a concentration gradient
  • Osmosis
    • Does not require energy
    • Movement of water from an area low in solutes to an area high in solutes

Phases of the Cell Cycle

  • G0 phase
    • Resting phase
  • G1 phase
    • Gathering phase
  • S phase
    • Synthesizing phase
  • G2 phase
    • Last substances needed for division are collected and produced
  • M phase
    • Actual cell division occurs, producing two identical daughter cells

Cell Cycle

Cell Cycle
Cell Cycle

Cell Physiology

  • May alter the cell membrane, causing the cell to rupture and die
  • May deprive the cell of certain nutrients, altering the proteins that the cell produces and interfering with normal cell functioning and cell division
  • May affect the normal cells of patients to some extent