DRUG

CLASSIFICATION

INDICATION Treatment of pulmonary tuberculosis that is not responsive to first-line antituberculosis agents but is sensitive to capreomycin in conjunction with other antituberculosis agents. Treatment in active pulmonary and extra pulmonary (including renal) TB that is not responsive to firstline antituberculotics in conjunction with other antituberculotics.

capreomycin Antituberculotic (Capastat Sulfate) (third line) Antibiotic

Dosage:

1 g/10 mL
Route:

IM,IVTT

MECHANISM OF ACTION Polypeptide antibiotic; mechanism of action against Mycobacterium tuberculosis unknown.

SIDE EFFECTS/ NURSING CONSIDIRATION ADVERSE EFFECTS Ototoxicity, Hepatic Administer this drug only impairment, when other forms of Nephrotoxicity, therapy have failed. Leukocytosis, Administer only in leukopenia, conjunction with other eosinophilia, antituberculitics to which hypokalemia, the Mycobacteria is uticaria, rashes, susceptible. fever, pain, induration at injection sites and sterile abscesses.

PATIENTS TEACHING Teach patient that this drug should be taken regularly. Avoid missing doses. The patient must not discontinue this drug without first consulting the health care provider. Tell patient to report any side effects that will be encountered.

cycloserine (Seromycin)
Dosage:

Antituberculotic (third line) Antibiotic

Capsule: 250mg
Route:

IM, PO

Inhibits cell wall synthesis in susceptible strains of gram-negative bacteria ad in Mycobacterium tuberculosis, causing cell death.

Drowsiness, Use cautiously in patients Warn patient to avoid somnolence, with impaired renal alcohol, which may cause headache, tremor, function; these patients serious neurologic vertigo, confusion, need reduced dosage. reactions. rash, elevated Obtain specimen for Advice patient not to serum transaminase culture and sensitivity perform hazardous levels, headache, tests before therapy activities if drowsiness shaking, confusion begins and then occurs. and dizziness. periodically to detect Tell patient to report possible resistance. adverse reactions Monitor serum cycloserine promptly; dosage may need levels periodically, to be adjusted or other especially in patients drugs prescribed to relieve receiving high doses (over adverse reactions. 500 mg daily) because toxic reactions may occur with blood levels above 30 mcg/ml. Observe patient receiving doses more than 500 mg daily for signs and symptoms of CNS toxicity, such as seizures, anxiety, and tremor. Monitor results of hematologic tests and

ethambutol HCL Antituberculotic (Etibi, Myambutol) Dosage: Tablets: 100 mg 400 mg Route: P.O.

Treatment of pulmonary TB in conjunction with at least one other antituberculotic.

Inhibits the synthesis of metabolites in growing mycobacterium cells, impairing cell metabolism, arresting cell multiplication, and causing cell death

renal and liver function studies. Observe patient for psychotic symptoms, hallucination, and possible suicidal tendencies. Monitor patient for hypersensitivity reactions, such as allergic dermatitis. Give pyridoxine, anticonvulsant, tranquilizer or sedative to relieve adverse reactions. Optic neuritis, Use cautiously in patients fever, malaise, with impaired renal headache, dizziness, function, cataracts, thrombocytopenia, recurrent eye anorexia, nausea, inflammation, gout, or vomiting, toxic diabetic retinopathy. epidermal Perform visual acuity and necrolysis, color discrimination tests anaphylactoid before and during therapy. reactions. Obtain AST and ALT levels before therapy and monitor this level every 34 weeks. Anticipate dosage reduction in patients with impaired renal function. Always give ethambutol with other antituberculotics to prevent development of resistant organisms. Monitor serum uric acid level; observe patients for signs and symptoms of gout.

Reassure patient that visual disturbances usually disappear several weeks to months after drug is stop. Optic neurisis is related to dose and duration of treatment Inform patient that drug is given with other antituberculotics Stress importance of complains with drug therapy.

dapsone Antituberculotic (Avlosulfont, dapson) Dosage: 25 mg 100 mg

Treatment for multibacillary leprosy, Paucibacillary leprosy and dermatitis herpetiformis.

May inhibit folic acid biosynthesis in susceptible organisms.

Pancreatitis, Use cautiously in patients hemolytic anemia, with chronic renal, hepatic, agranulocytosis, or CV diseases; refractory aplastic anemia, types of anemia and G6PD toxic erythema, deficiency. erythema Obtain baseline CBC. multiforme, toxic Monitor CBC weekly for epidermal first month, monthly for 6 necrolysis, months, and then erythema nodosum semiannually. and sulfone Reduce or temporarily syndrome. discontinue dapsone if hemoglobin falls below 9 g/dl, WBC count falls below 5,000 mm3, or RBC count falls below 2.5 million mm3 or remains low. If generalized diffuse dermatitis occurs, notify prescriber ad prepare to interrupt therapy. Give antihestamines to combat allergic dermatitis. Watch for signs and symptoms of erythema nodusum reaction, such as malaise, fever, painful inflammatory in duration in skin and mucosa, iritis, and neuritis, which may occur during therapy as a result of Mycobacterium leprae bacilli. In severe cases, stop therapy and give glucocorticoids cautiously. Watch for and report for signs and symptoms of sulfone syndrome, including fever, malaise, jaundice with hepatic

Instruct breast-feeding patient to immediately notify prescriber if cyanosis occurs in infant. Inform patient of need for long term therapy. Stress importance of compliance with drug therapy. Advice patient to avoid unprotected exposure to sunlight or sunlamps.

isoniazid (INH, Nydrazid, laniazid, isotamine PMS-Isoniazid. Dosage: Tablets: 100 mg 300 mg Syrup: 50mg/5 mL Injection: 100 mg/mL Route: IM, PO

Antitubercular

TB, all forms in which are organisms are susceptible Prophylaxis in specific patients who are tuberculin reactors for household members of recently diagnosed tuberculars or who are considered to be high risk (patients with HIV, IV drug users, recent converters [5 mm or more increased on skin test within 2 year in patients younger than 35 year or 15 mm or more increase in patients older than 35 yr] and children younger than 4 yr with 10 mm or more in duration or purified protein derivative tuberculin skin test).

nicrosis, lypmhadenopathy, methemoglobinemia and hemolytic anemia. Bactericidal: Peripheral Give on an empty interferes with neuropathy, stomach, 1 hr before or 2 lipid and nucleic nausea, vomiting, hr after meals; may be acid biosynthesis in epigastric distress, given with food if GI upset actively growing elevated AST, occurs. tubercle bacilli. hepatitis, Give in a daily single dose. thrombocytopenia, Reserve parenteral dose local irritation at IM for patients unable to take injection site oral medications. Decrease foods containing tyramine or histamine in patients diet. Consult with physician and arrange for daily pyridoxine in diabetic, alchoholic, or malnourished patients; also for patients who develop peripheral neuritis, and those with HIV. Discontinue drug and consult with physician if signs of hypersensitivity occur.

Instruct patient to take drug exactly as prescribed; warn against stopping drug without prescribers consent. Advice patient to take drug 1 hr before or 2 hrs after meals. Tell patient to notify prescriber immediately if signs and symptoms of liver impairment occur, such as anorexia, fatigue, malaise, jaundice, and dark urine. Advice patient to avoid alcoholic beverages while taking drug. Also tell him to avoid certain foods ( fish such as skipjack and tuna and products containing tyramine, such as aged cheese, beer, and chocolate) because drug has some MAO inhibitor activity. Encourage patient to comply fully with treatment which may take months or years.

pyrazinamide Antituberculotic (tebrazid, zinamide) Dosage: Tablets: 500 mg Route: P.O

Unlabeled used of 300-400 mg/day increased over 2 wk to 20 mg/kg/day, for improvement of severe tremor in patients with MS. Initial treatment of active TB in adults and children when combined with other antituberculotics. Treatment of active TB after treatment failure with primary drugs. Treatment of drug-resistant TB as part of an individualized regimen.

Bacteriostatic or bacteriocidal against mycobacterium tuberculosis

rifampin Antibiotic (Rifadin, Rimactane, Antituberculotic Rofact) Dosage: Capsules: 150 mg 300 mg Powder for injection:

Treatment of pulmonary TB in conjunction with at least one other effective antituberculotic.

Inhibits DNAdependent RNA polymerase activity in susceptible bacterial cells.

Hepatotoxity , Administer cautiously to nausea, vomiting, patients with CV disease, diarrhea, anorexia, diabetes mellitus, sideroblastic hyperthyroidism, increased anemia, IOP, hyoertensin, and to thrombocytopenia, patients older than 60 yr adverse effects on who may have increased clothing sensitivity to mechanisms or symphatomimetic amines. vascular integrity, Avoid prolonged use; hepatitis, arthralgia, underlying medical myalgia, rush and problems may be causing fever. the congestion. Do not cut, crush, or allow patient to chew ER tablets. Monitor CV effect carefully: hypertensive patients who take this drug may experience changes in BP because of the additional vasoconstriction. However if a nasal decongestant is needed, pseudoephideprine is the drug of choice. Pancreatitis, acute Use cautiously in patients renal failure, with liver disease. thrombocytopenia, Treatment with at least 1 transient other antituberculotic is leucopenia, recommended. hepatotoxicity, Give 1 hr before or 2 hrs headache, after meals for optimal drowsiness, fatigue, absorption; however, if GI

Inform patient that he/she must take drug together with other antituberculotics. Tell patient to report adverse reactions promptly, specially fever, and malaise, loss of apetite, nausea, vomiting, dark urine, yellow skin or eye discoloration, and pain or swelling of the joints. Stress importance of compliance with drug therapy. If daily therapy poses a problem, tell patient to ask prescriber about twice-weekly dosing.

Instruct patient who develops drug induced GI upset to take drug with meals. Warn patient about drowsiness and possible red-orange discoloration of urine, feces, saliva, sweat,

600 mg Route: IM, IVTT

dizziness, rash, heartburn, epigastric distress, fever and flulike symptoms.

rifapentine (Priftin) Dosage: Tablets: 150 mg Route: P.O

Antibiotic Antituberculotic

Treatment of Inhibits DNANeutropenia, pulmonary TB in dependent RNA leukopenia, conjunction with at polymerase activity hyperuricemia, least one other in susceptible strains headache, dizziness, effective of Mycobacterium pyuria, proteinuria, antituberculotic. tuberculosis. hematuria, Demonstrates hyperuricemia, and bactericidal activity reddish discoloration against the organism of body fluids. both intracellularly and extracellularly.

irritation occurs, patient may take rifampin with meals. Monitor hepatic function, hematopoietic studies, and serum uric acid levels. Drug systemic effects may cause asymptomatic elevation of liver function test results and serum uric acid level. Watch for and report to prescriber signs and symptoms of hepatic impairment. Drug may cause hemorrhage in neonates of rifampin-treated mothers. Rifampin alters standard serum folate and Vit. B12 asays. Rifampin may cause temporary retention of sulfobromophthalein in the liver excretion test. It may also interfere with contrast material in gallbladder studies and urinalysis based on spectrophotometry. Administer on an empty stomach, 1 hr before or 2 hrs after meals; if GI upset is severe, drug may be taken with food. Always use in combination with other antituberculotics. Prepare patient for the reddish orange coloring of body fluids (urine, sweat, sputum, tears, feces, saliva);soft contact lenses may be permanently

sputum and tears. Soft contact lenses may be permanently stained. Advice patient to avoid alcoholic during drug therapy.

Stress importance of strict compliance with this drug regimen and that of daily companion drugs, as well as necessary follow-up visits and laboratory tests. Advise a woman to use nonhormonal methods of birth control. Tell patient to take drug with food if nausea, vomiting, or GI upset occurs. Instruct patient to report

streptomycin sulfate Dosage: Injection: 1 g/2.5 mL ampules or 15 mg/kg/day Route: IM

Antibiotic Treatment of Antitubercular tularemia, plague, subacute bacterial endocarditis (if less toxic agents are not appropriate). Fourth drug in the treatment of TB

Inhibits protein synthesis by binding directly to the 30S ribosomal subunit. Generally bactericidal.

stained, patients should be fever, loss of appetite, advise not to wear them malaise, nausea, vomiting, during drug therapy. darkened urine, yellowish discoloration of skin and Recommend the use of eyes, pain or swelling of the barrier contraceptives joints, or excessive loose while using this drug; stools or diarrhea. hormonal contraceptives may be ineffective. Instruct patient to protect pills from excessive heat. Provide small, frequent meals if GI upset occurs. Tell patient that rifapentine can turn body fluids red Provide skin care if dermatologic effects occur. orange and permanently stain contact lenses. Tinnitus, dizziness in Obtain specimen for Instruct patient to report the ears, hearing culture and sensitivity adverse reaction promptly. loss, leucopenia, tests before giving first Encourage patient to thrombocytopenia, dose. Therapy may begin maintain adequate fluid hemolytic anemia, pending results. intake. apnea, anaphylaxis, Evaluate patients hearing Emphasize need for blood vomiting and before therapy and for 6 tests to monitor nausea. months afterward. streptomycin levels and Watch for signs and determine effectiveness of symptoms of therapy. superinfection, such as continued fever and other signs of new infection. Nephrotoxicity occurs less frequently with streptomycin than with other aminoglycosides. In primary treatment of tuberculosis, streptomycin is stopped when sputum becomes negative. Streptomycin can cause a false-positive reaction in copper sulfate tests for urine glucose such as Benedicts reagent or Diastix.

ANTIFUNGAL DRUG amphotericin B (Amphocin, Fungilin) Dosage: Injection: 50 mg Suspension for injection: 100 mg/20 mL Powder for injection: 50 mg, 100 mg/vial Route: IV CLASSIFICATION Anrtifungal INDICATION Treatment of any type of progressive fungal infection that does not respond to conventional therapy. MECHANISM OF ACTION Binds to sterols in the fungal cell membrane with a resultant change in membrane permeability, an effect that can destroy fungal cells and prevent their reproduction; fungicidal or fungistatic depending on concentration and organism. SIDE EFFECTS/ NURSING ADVERSE EFFECTS CONSIDIRATION Nausea, vomiting, Arrange for immediate dyspepsia, diarrhea, culture of infection malaise, seizures, but begins treatment arrhythmias, before lab results are asystole, phlebitis, returned. thrombophlebitis, Monitor injection sites anorexia, nausea, and veins for signs of vomiting, cramping, phlebitis. fever, chills, Amphotericin B generalized pain, products may cause weight loss and pain severe electrolyte at injection site. abnormalities, such as magnesium wasting. Monitor electrolytes more often. Monitor renal functions tests weekly; discontinue or decrease dosage of drug at any sign of increased renal toxicity. Monitor fluid intake and output. Headache, Culture infected area hypotension nausea prior to starting drug; and vomiting, drug can be started abdominal pain, before results are dyspepsia, elevated known, but liver enzymes, appropriate leucopenia, adjustments in neutropenia, rash, treatment should be uticaria, flushing and made when culture pruritus. results are evaluated. Periodically monitor LFTs to make sure hepatoxicity does not occur. PATIENTS TEACHING Warn patient of possible discomfort at IV site and other potential adverse reactions. Instruct patient to report signs and symptoms of hypersensitivity immediately. Inform patient that therapy may take several months. Stress importance of compliance and recommended follow-up.

anidulafungin (Eraxis) Dosage: Single-use vials: 50 mg 100 mg with diluent vial Route: IV infusion

Antifungal Echinocandin

Treatment of candidemia and other forms of candida infections (intra-abdominal abscess, peritonitis) Treatment for esophageal candidiasis

Inhibits glucan synthesis, an enzyme present in fungal cells but not human cells; this inhibition prevents fungal cell wall from forming and results in cell death.

Patient should not use this medication if allergic to anidulafungin, caspofungin (Cancidas), micafungin (Mycamine), or similar antifungal medicines. Instruct the patient before using

fluconazole (Diflucan) Dosage: Tablets: 50 mg, 100 mg, 150 mg, 200 mg Powder for oral suspension: 10 mg/mL 40 mg/mL Injection: 2 mg/mL Route: P.O, IV

Antifungal

Treatment of oropharyngeal, esophageal, vaginal, and systemic candidiasis, UTI and peritonitis caused by Candida. Treatment of cryptococcal meningitis

Binds to sterols in the fungal cell membrane, changing membrane permeability; fungicidal or fungistatic depending on concentration and organism.

anidulafungin, tell the physician has liver disease. Instruct the patient to use this medication for the full prescribed length of time. The symptoms may improve before the infection is completely cleared. Skipping doses may also increase the risk of further infection that is resistant to antibiotics. Headache, dizziness, Use cautiously in Tell patient to take nausea, vomting, patients drug as directed, abdominal pain, hypersensitive to even after he/she diarrhea, dyspepsia, other antifungal feels better. taste perversion, azole compounds; no Instruct patient to leucopenia, data exist regarding report adverse thrombocytopenia, cross-sensitivity. reactions rash and Serious promptly. anaphylaxis. hapatotoxicity has occurred in patients with underlying medical conditions. Periodically monitor liver function during prolonged therapy. If patient develops mild rash, monitor him closely. Discontinue drug if lesions progress, and notify prescriber. Risk of adverse reactions appears to be greater in HIV-

Suggest the use of contraceptive measures while using this drug.

flucytosine (Ancobon, Ancotil) Dosage: Capsules: 250 mg, 500 mg Route: P.O.

Antifungal

Treatment of serious infections caused by susceptible strains of Candida, Cryplococcus

Affects cell membranes of susceptible fungi to cause fungus death; exact mechanism of action is nit understood.

itraconazole (Sporanox) Dosage: Capsules: 100 mg Injection: 10 mg/ml Oral solution: 10 mg/ml Route: IV, P.O.

Antifungaltriazole Parenteral and Oral: treatment of febrile neutropenic patients wth suspected fungal infections. Oral Solution: treatment of fungal, candidiasis infections of the esophagus or mouth

Binds to sterols in the fungal cell membrane, changing membrane permeability; fungicidal or fungistatic depending on concentration and organism.

infected patients. Monitor blood, liver and renal function studies frequently during therapy; obtain susceptibility tests weekly to monitor drug resistance. Administer capsules over 15 minutes to reduce adverse GI reactions. Monitor fluid intake and output; report marked changes. Headache, dizziness, Use cautiously in heart failure, nausea patients with and vomiting, hypochlorhydria; they diarrhea, abdominal may not absorb drug pain. Anorexia, readily. hepatic function Because abnormality, rash, hydrochlorydria can edema, fever, and accompany HIV malaise. infection, use cautiously in HIV infected patients. Use cautiously in patients receiving other highly bound drugs because drug and its metabolites are bound to plasma proteins. Perform baseline liver function tests and monitor results periodically. Rash, nausea and vomiting, diarrhea, anemia, leukopenia, thrombopenia, respiratory arrest, and shortness of breath.

Tell patient that therapeutic response may take weeks or months. Advice patient to report adverse reactions promptly. Instruct patient to take capsules over 15 minutes to reduce adverse GI reactions.

Teach patient to recognize and report signs and symptoms of liver disease. Tell the patient to take capsule with food to ensure maximal absorption. Instruct patient not to use oral solution interchangeably with itraconazole capsules. Tell patient that oral solution should be used 10 ml at a time. Advise patient to take solution without food and to take capsules with a full meal. Urge patient to tell prescriber about

all drugs he is taking to avoid potential drug interactions. ketoconazole (Nizoral) Dosage: Oral suspension: 100 mg/5 ml Tablets: 200 mg Route: P.O. Antifungal (imidazole) Treatment of systemic fungal infections: candidiasis, chronic mucocutaneous candidiasis, oral thrush, candiduria, nlastomycosis, coccidiodomycosis, paracoccidiomycosis. Treatment of dermatophytosis (recalcitrant infections not responding to topical or grisefulvin therapy) Topical Treatment of seborrheic dermatitis in patients older than 12 yr. Interferes with fungal cell-wall synthesis by inhibiting formation of ergosterol and increasing cell-wall permeability that makes the fungus susceptible to osmotic instability. Nausea and Use cautiously in vomiting, pruritus, patients with hepatic suicidal tendencies, disease and in those thrombocytopenia, who are taking other leucopenia, fatal hepatotoxic drugs. hepatotoxicity, fever Because of potential and chills. for serious hepatotoxicity, dont use ketoconazole for less serious conditions, such as fungal infections of skin or nails. Monitor patient for signs and symptoms of hepatoxicity, including elevated liver enzyme levels, nausea that doesnt subside, and unusual fatigue, jaundice, dark urine, or pale stool. Doses up to 800 mg/day can be used to treat fungal meningitis and intracerebral fungal lesions. Instruct patient with achlorydia to dissolve each tablet in 4 ml aqueous solution of 2.0 N hydrochloric acid, sip mixture through glass or plastic straw, and then drink glass of water because ketoconazole needs gastric acidity for dissolution and absorption. Instruct patient to wait at least 2 hours after dose before taking antacids. Make sure patient understands that treatment should be continued until all tests indicate that active fungal infection has subsided.

micafungin sodium (Mycamine) Dosage: Powder for injection: 50 mg

Antifungal Echinocandin

Treatment of patients with esophageal candidiasis Prevention of Candida infections in patients undergoing hematopoetic stem cell transplantation. Treatment of candidemia,

Inhibits the synthesis of components needed for the production of fungal cell walls, leading to cell

Headache, hemolytic anemia, potentially serious hypersensitivity reaction, rash, phlebitis, nausea and vomiting,

Establish baseline liver function, renal function, and CBC before beginning therapy. Use sterile technique in preparing solution

Route: IV infusion

acute disseminated candidiasis, Candida peritonitis and absesses.

death.

abdominal pain and changes in BP

for IV infusion, there are no bacteriostatic agents in the preparation. Monitor injection site for any signs of reaction or the development of phlebitis. Maintain life support equipment on hand when beginning therapy, potentially serious hypersensitivity has been reported. Advise the use of contraceptives during the therapy. Provide comfort measures and possible analgesics for headache and pain. Encourage frequent small meals if GI tract effects are uncomfortable. Tell the patient to take the full course of drug therapy even if symptoms improve. Continue during menstrual period even if vaginal route is being used. Long term use will be needed; beneficial effects may not be seen for several weeks.

miconazole nitrate (Monistat) Dosage: Vaginal Suppositories: 100 mg, 200 mg, 1200 mg Topical Cream: 2% Vaginal cream: 2% Topical powder: 2% Topical spray: 1%, 2% Topical ointment:

Antifungal

Local treatment of vulvovaginal candidiasis (moniliasis). Effectiveness in pregnancy has not been established. As miconazole nitrate is effective only for candidal vulvovaginitis, the diagnosis should be confirmed by KOH smear and/or cultures. Other pathogens commonly associated with vulvovaginitis (Trichomonas and Haemophi

Fungicidal: alters fungal cell membrane permeability, causing cell death; also may alter fungal cell DNA and RNA metabolism or cause accumulation of toxic peroxides intrecellularly.

Irritation, rash, Culture fungus headache, irritation, involved before burning, maceration, therapy. allergic contact Insert vaginal dertitis, sensitization suppositories high into or vulvovaginal the vagina; have burning and pelvic patient remain cramps recumbent for 10-15 min after insertion; provide sanitary napkin to protect clothing from stains. Monitor response; if none is noted, arrange

2% Spray powder or liquid: 2% Solution: 2% Route: Topical, Vaginal

lus vaginalis [Gardnerella]) should be ruled out by appropriate laboratory methods.

nystatin (Mycostatin, Nadostatin, Nilstat, Nystex) Dosage: Lozenges: 200,000 units Oral suspension: 100,000 units/ml powder: 50, 150 or 500 million units; 1,2 or 5 billion units

Antifungal

Oral: treatment of oropharyngeal candidiasis Troche: treatment of oral candidiasis Vaginal: local treatment of vaginal candidiasis (moniliasis) Topical applications: treatment of cutaneous or mucocutaneous mycotic infections caused by candida albcans and candida species.

Instruct patient to insert vaginal suppositories high into vagina. Instruct the patient to use hygiene measures to prevent reinfection or spread of infection. Advices the patient that this drug is for treating the fungus; do not self-medicate other problems with this drug. Advice the patient to refrain from sexual intercourse, or advise partner to use a condom to avoid reinfection. Advice the patient to report any adverse effects immediately. Fungicidal and Nausea and Nystatin isnt Instruct pt not to fungistatic: binds to vomiting, diarrhea, effective against chew or swallow the sterols in the GI distress, irritation, systemic infections. lozenge, but to cell membrane of vulvovaginal Vaginal tablets can be allow it to dissolve the fungus with a burning, and local slowly in mouth. used by pregnant pt. resultant change in irritation. up to six wks. Before Advise pt. to cont. membrane term to treat taking drug or permeability, maternal infection atleast two days allowing leakage of that may cause oral after s/s intracellular candidiasi in disappear. Consult components and neonates. prescriber for causing cell death. exact length of For treatment therapy. Of oral candidiasis :

for further cultures to determine causative organism. Apply lotion to intertriginous areas if topical application is required; if cream is used, apply sparingly to avoid maceration of the area. Ensure patient receives the full course therapy to eradicate the fungus and to prevent the recurrence. Discontinue topical or vaginal administration if rash or sensitivity occurs.

Tablets: 500,00 units Vaginal suppositories: 100,000 units. Route: P.O, Topical, Vagina

after the mouth is Instruct pt. to clean of food debris, cont. therapy have pt. hold during mens. suspension in mouth Explain that for several min. factors before swallowing, predisposing pt. to when treating infants vaginal infection swab med. On oral include use of mucosa. Prescriber antibiotics, oral may instruct contraceptives, immunosuppressed and pt. to stop on vaginal corticosteroids; tablets(100,000 diabetes; units) because this reinfection by provides prolonged sexual partner; contact with oral and tight-fitting mucosa. panty hose. Encourage pt. to use cotton underwear. Instruct women in careful hygiene for affected areas, including cleaning perineal area from front to bac . Advise pt. to report redness, swelling, or irritation. Tell pt. that over using mouth wash or wearing fitting dentures, especially in elderly pt. may promote infection. antifungal Treatment of serious cause by scedosporium apiospermum ,fusarium species in pt. intolerant of Inhibits fungal biosynthesis leading to cell membrane rupture Headache, visual Check pt. medication Tell pt to avoid disturbance, carefully for exposure to dizziness,tachycardia beginning drug sunlight while ,bp changes, nausea therapy; voriconazole using this drug.

Voriconazole (Vfend) Dosage:

Tablets:50,200 mg Powder for injection:200 mg to be reconstrituted to 10 mg/ml Powder for oral suspension:40mg/ ml Route: p.o and iv

or refractory to other therapy.

in cell death in susceptible fungi.

and vomiting, is associated with Tell pt not to use fever,chills,rash,anap many drug St. Johns wort hylactic reaction , interactions. while taking this stevens jhonson Monitor vision drug. syndrome. changes also. Advice patient not to drive at night or perform potentially hazardous tasks because of possible visual disturbances. Protect pt from exposure to strong sunlight while using this drug. Women of childbearing age should be advised to use barrier contraceptives while using this drug because of risk of fetal death or abnormalities. Arrange for frequent small meals if nausea and vomiting are a problem.

Peptides
DRUG bacitracin (Altracin) Dosage: Powder for injection: 50,000 units Ophthalmic ointment: 500 units/g Topical ointment: 500 units/g Route: IM, PO, Ophthalmic CLASSIFICATION Antibiotic INDICATION Topical ointment: prophylaxis of minor skin abrasions. Tx of all superficial infections of the skin caused by susceptible staphylococci. IM: pneumonia and empyema caused by susceptible strains of staphylococci in infants. MECHANISM OF ACTION Antibacterial; inhibits cell wall synthesis of susceptible bacteria, primarily staphylococci, causing cell death. SIDE EFFECTS/ NURSING ADVERSE EFFECTS CONSIDIRATION Nausea and vomiting, For topical nephrotoxicity, application: irritations, burning, cleansed the area stingning, itching, before applying the blurring of vision and ointment. super infection. For IM use: reconstitute 50,000 unit vial with 9.8 ml 0.9% of NaCl injection with 2% procane HCL; reconstitute the 10,000 unit vial with 2 ml of diluents. Facial flashing, irritation, blurring of vision, fever, dizziness, ataxia, drowsiness, paresthesias, rush, super infection and uticuria. Monitor the pt renal function carefully. Be aware that neurotoxicity can result in respiratory paralysis. For ophthalmic use: reconstitute powder with 20-50 ml of diluents. Monitor renal function test during therapy. Do not use IM route routinely because severe pain may occur at injection site. PATIENTS TEACHING Tell pt to report rash or skin lesions; change in urinary voiding pattern, changes in vision, severe stinging or itching.

polymyxin B Sulfate (Sterile) Dosage: Injection: 5000,000 units/vial Ophthalmic soln: 500,000 units Route: IV, IM, Intrathecal, Ophthalmic

Antibiotic

Acute infections caused by susceptible strains of pseudomonas aeroginosa, escheria colli, haemophilus influenza. When less toxic drug is ineffective or contraindicated.

Bactericidal: has surfactant activity that allows it to penetrate and disrupt the cell membranes of susceptible gram negative bacteria, causing cell death, not effective against proteus species.

Tell pt to report DOB, rash or skin lesions, pain at injection site or IV site, change in urinary voiding patterns, fever, flulike symptoms, changes in vision, severe itching or stinging.

DRUG atovaquone (Mepron) Dosage: Suspension: 750 mg/5 ml Route: oral

CLASSIFICATION antiprotozoal

METRONIDAZOLE INDICATION MECHANISM OF ACTION Prevention and acute oral Directly inhibits treatment of mild to moderate enzyme for nucleic P.carinii pneumonia(PCP) in pt. acid and ATT intolerant to synthesis in trimethoprimsulfamethoxazole. protozoa: effective against P. carinii.

Pentamidine isethionate (NebuPent) Dosage: Aerosols, injection: 300-mg vial Route: IM, IV

antiprotozoal

Treatment of P.carinii peumonia, especially in pt. do not responds to therapy with the less toxic TMPSMZ combination (injection).

Antiprotozoal activity in susceptible P.carinii pneumonia:

SIDE EFFECTS/ NURSING PATIENTS TEACHING ADVERSE EFFECTS CONSIDIRATION Dizziness,insomnia, Drug has appeared Instruct pt. to take headache, rash in breastmilk used drug with meals ,sweating, diarrhea, cautiously in because food nausea and vomiting breastfeeding pt. significantly , fever and elevated Because drug is inhances liver enzymes absorption period. bound to plasma protein, used cautiously with other highly protein-bound drugs, and assess pt. for toxicity when used together. Because of risk of concurrent pulmonary infc. Monitor pt. closely during therapy. Hypotension, Used Instruct pt. nausea, anorexia, cautiously in to used the headache, fatigue, breastfeedin aerosol pain and abscess at g pt. devise until injction site, fever, the chamber Give aerosol rash, dizziness and is empty, form only by drowsiness. which may respirgard 2, take up to nebulizer. 45mins. In pt. with Warn pt. AIDS that IM pentamidine injection is may painful. produce less severe Instruct pt. adverse to complete reaction the full than cocourse of trimoxazole. pentamidine therapy,even if feeling better.

ANTIVIRALS DRUG acyclovir (Zovirax) Dosage: Tablets: 400,300 mg Capsules: 200 mg Suspension: 200 mg/ 5 ml Route: IV, PO, Topical CLASSIFICATION Antiviral INDICATION Severe initial and recurrent genital herpes infections in immunocompromis e patients. Tx of neonatal HSV infections. Acute tx of herpes zoster (shingles) and chicken pox (varicella) MECHANISM OF ACTION Antiviral activity; inhibits viral DNA replication. SIDE EFFECTS/ NURSING PATIENTS TEACHING ADVERSE EFFECTS CONSIDIRATION Headache, vertigo, Use cautiously in Tell pt to take drugs depression, tremors, patients w/ as prescribed, even rash, hair loss, nausea neurologic after he/she feels and vomiting, problems, renal better. anorexia and disease, or Tell patient that diarrhea. dehydration and in drug is effective in those receiving managing herpes nephrotoxic drugs. infection that Dont administer IM doesnt eliminate or or SubQ. cure it. Warn pt that acyclovir wont prevent spread of infection to others. Tell patient to avoid sexual contact while visible lesions are present. Headache, insomnia, Use cautiously in pt Inform pt that long malaise, dizziness, with renal term effects of anorexia, vomiting, GI impairment. lamivudine are pain, nausea and unknown. Pt should diarrhea. discontinue Stress importance of breastfeeding if taking lamivodne lamivodine is exactly as prescribed. prescribed. Monitor pt CBC, Teach parents the platelet count, renal s/s of pancreatitis. and liver fx studies. Advice them to report s/s Report immediately. abnormalities.

lamivudine (Epivir) Dosage: Tablets: 100,150,300mg Oral soln: 500 mg/ml Route: PO

Antiviral

Treatment of HIV infection in combination with other anti retroviral drugs. Tx of chronic hepatitis B with active liver inflammation

Nucleosite analog inhibitor of HIV reverse transcriptase via DNA viral chain termination and HBV polymerase.

ANTIMALARIALS DRUG chloroquine phosphate (Aralen phosphate) Dosage: Tablets: 250, 500 mg Route: P.O. CLASSIFICATION Antimalarials INDICATION Tx. Of extraintestinal amebiasis . Prophylaxis and tx. Of acute attacks of malaria cause by susceptible strains plasmodia. MECHANISM OF ACTION Inhibits protozoal and protin synthesis. Mechanismof anti inflammatory action in rheumatoid arthritis is not known. SIDE EFFECTS/ ADVERSE EFFECTS Visual disturbances, hypotension. Pruritus, hair loss, nausea and vomiting, loss of appetite, diarrhea, abdominal pain. NURSING PATIENTS TEACHING CONSIDIRATION Administer Advise pt. to with meals if take full GI upset force of drug occurs. therapy. Take drug Schedule with meals if weekly, sameGI upset day therapy occurs. on a calendar. Advise the Double check pt. to make pediatric an doses: arrangement children are about susceptible to ophthalmolo over dosage. gic Arrange for examination ophthalmologi if long term c examination use is during long-ter indicated. m therapy. Tell pt. to report blurring of vision, loss of hearing, ringing in the ears, muscle weakness and fever. Adverse drug Instruct pt. reaction to take drug related to with meals sulfadiazine is Inform pt. similar to with sulfonamides. toxoplasmosi When used to s of treat importanace toxoplasmosis of frequent AIDS, therapy laboratory

pyrimethamine (Daraprim) Dosage: Tablet: 25mg Route: P.O

antimalarias

Malaria prophylaxis and transmission control

Inibits the enzyme dihydrofolate reductase, thereby impeding reduction of dihydrofolic acid. Sulfadoxin competitively inhibits use of PABA.

Seizures, headache, anorexia, vomiting, utecaria,pruritus, photosensitivity,

may be lifelong.

study. Warn pt. taking pyrimethami ne with sulfadoxin to stop drug and notify prescriber at first sign of rash, soar throat or glossitis.

ANTHELMINTIC DRUG mebendazole (Vermox) Dosage: Chewable tablets: 100 Mg Route: P.O CLASSIFICATION Anthelmintic MECHANISM OF ACTION Treatment of trichuris Irreversibly blocks trichuira (whipworm), glucose uptake by enterobius vermicularis susceptible (pinworm), ascaris helminthes, depleting lumbrecoides (round glycogen store worm), Ancylostoma needed for survival duodenale (common and reproduction of Hookworm), Necator helminths Americanus (American Hookworm) INDICATION SIDE EFFECTS/ ADVERSE EFFECTS Fever, transient abdominal pain, diarrhea NURSING CONSIDIRATION Culture for ova and parasites. Administer drug with food; tablets may be chewed, swallowed whole, or crushed and mix with food. Treat all family members for pin worm infestation. PATIENTS TEACHING Tell the patient to chew or swallow whole or crushed and mix with food. Discuss to the patient that pinworms are easily transmitted. Tell the patient that he/she may experience these side effects: nausea, abdominal pain and diarrhea.