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TUBERCULOSIS
CHAPTER 20
TUBERCULOSIS
Commonly invades lung
but can also effect the
bone, lymph nodes, blood,
kidney as well as other
body systems
Drug therapy is
more complex than
that of other
infections
6 24 months
Multidrug therapy
Prevention
ANTITUBERCULOSIS THERAPY
Isoniazid (INH),
avoid foods
containing Tyramine
Rifamycins
interacts with oral
contraceptives
Use alternate form of
birth control
ISONIAZID (INH)
Side Effects
GI symptoms
Peripheral neuropathy
Vitamin B-6 can be helpful
CNS
Hepatotoxicity liver damage
ADMINISTRATION
Liver enzymes prior to beginning
administration and then monthly
thereafter
Oral dose is given on an empty
stomach
Given with other drugs to treat
active TB
Given alone for latent TB
Alcohol increases the risk of toxicity
RIFAMYCINS:
RIFAMPIN, RIFAPENTINE, RIFABUTIN
Side Effects
Liver toxicity
Red-orange secretions
GI
best if taken on empty stomach
but can take with food if GI side
effects are problematic
ANTITUBERCULAR AGENTS
Category 1 - Isoniazid (INH), Rifampin,
Pyrazinamide
First-line Oral drugs
Most effective
Well tolerated
Hepatitis most serious adverse effect
Category 2 Aminoglycosides, Fluoroquinolones,
Oral bacteriostatic agents
Second-line drugs
Injectable agents
Less effective
More toxic
Used when resistance develops
THERAPY FOR
VIRAL INFECTIONS
Most self-limiting; require no
pharmacotherapy
Example: rhinovirus that causes common cold
CHALLENGES OF ANTIVIRAL
THERAPY
Viruses mutate rapidly, and drug
becomes ineffective
Difficult for drug to find virus without
injuring normal cells
Each antiviral drug specific to one
particular virus
HIV PHARMACOTHERAPY
No cure yet
but many new
drugs developed
Some therapeutic
successes
People live symptomfree longer.
Rates of transmission
from mother to
newborn reduced
70% decline in death
rate in US
Incidence of infections
still very high in African
nations
THERAPEUTIC GOALS
Prevent or delay
progression from
HIV to AIDS
Reduce HIV RNA
load in the blood
To undetectable
level or < 50
copies/mL
& increase CD4
levels
Increased lifespan
Higher quality of
life
Decreased risk of
transmission from
mother to child
INITIATION OF
PHARMACOTHERAPY
Pharmacotherapy may be initiated
In acute phase (symptomatic)
In chronic (asymptomatic) phase
Advantages/Disadvantages
INITIATION OF PHARMACOTHERAPY
Acute phase
(symptomatic)
Advantage:
Severe sx of AIDS can
rapidly lead to death
Always initiated when
AIDS defining symptoms
become apparent
CD4 T-cell count falls
below 200 cells/mcL
Chronic phase
(asymptomatic)
Advantage:
viral load or burden can
be reduced
Early tx will delay the
onset of acute sx
Delay progression of AID
Disadvantage:
Expensive
Adverse effects; lower
quality of life
Viral resistance
Treat advanced
disease
CCR5
Antagonists
Particular type of
HIV
ENZYME INHIBITORS
Nucleoside Reverse
Transcriptase Inhibitor (NRTI)
Nonnucleoside Reverse
Transcriptase Inhibitor
(NNRTI)
Side effects:
CNS-dizziness, HA,
insomnia
ENZYME INHIBITORS
Protease Inhibitors
Side effects:
Hypertension/
Hypotension
CNS
Pruritus, rash,
eczema
Thrombocytopenia,
anemia
Integrase Inhibitors
Side Effects
HA, dizziness, N &V,
abdominal pain
Hyperglycemia
Decreased Bone
density
Increase in
cholesterol &
triglyceride
Liver toxicity
TREATMENT FAILURES
Common with antiretroviral therapy
GENERAL INSTRUCTIONS
Assess for side effects specific to the
category
Client should not drive or perform
hazardous activities until medication
reactions are known
Be aware of conditions and drugs that are
problematic with antiretroviral therapy
Teach clients how to practice blood and
body-fluid precautions
SPECIAL CIRCUMSTANCES
Pregnancy/New
born
Post exposure
prophylaxis
DRUGS FOR
HERPES VIRUSES
Need to Know:
Acyclovir
(Zovirax)
Lessen severity of
acute herpes
simplex infections
Prolong latent
period of disease
Herpes Virus
infections:
Herpes simplex (HSV):
types 1 and 2
Varicella-zoster (VZV)shingles(zoster) &
chicken pox(varicella),
Cytomegalovirus
(CMV)
NO CURE
Recurrent herpes
treatment started
within 24 hrs may
shorten and
decrease severity
of break out
NURSING CARE
FOR HERPES VIRUSES
Assess for hypersensitivity
Assess for the healing of lesions,
decreased pain
Side effects of IV administration
Neurotoxicity
Renal toxicity
Administer IV over 1 hour
Thrombophlebitis
SIDE EFFECTS
DRUGS FOR HERPES VIRUSES
Topical:
can cause
localized
burning,
stinging or
itching
Oral:
GI
With or without
food
Vertigo
Headache
2 classes:
Adamantanes (no longer
used)
Neuramindase
Inhibitor
Have limited
efficacy
MUST BE
STARTED WITH
IN 48 HOURS
OF SYMPTOMS
Shortens length
of symptoms