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DRUG THERAPY FOR

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

DRUGS THERAPY FOR


VIRAL INFECTIONS
CHAPTER 21

METHODS VIRUSES SPREAD


Secretions from infected
persons
Ingestion of
contaminated food or
water
Breaks in skin or mucous
membranes
Sexual contact
Pregnancy/Breastfeeding
Organ transplantation

THERAPY FOR
VIRAL INFECTIONS
Most self-limiting; require no
pharmacotherapy
Example: rhinovirus that causes common cold

Some viruses cause serious disease


and require aggressive therapy
Example: HIV is fatal if left untreated
Example: herpes viruses can cause significant
pain and disability if left untreated

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

DRUGS FOR HIV


Enzyme Inhibitors
Nucleoside Reverse Transcriptase Inhibitor (NRTI),
Nonnucleoside Reverse Transcriptase Inhibitor
(NNRTI)
Protease Inhibitors (PI)
Integrase Strand Transfer Inhibitors

Viral Entry Blockers


Fusion Protein Inhibitors
CCR5 Antagonists

VIRAL ENTRY BLOCKERS

Entry & Fusion Inhibitors

Treat advanced
disease

CCR5
Antagonists

Particular type of
HIV

ENZYME INHIBITORS
Nucleoside Reverse
Transcriptase Inhibitor (NRTI)

Used for maternal HIV


Side effects:
Ha, Malaise
Bone Marrow
Suppression
GI- N&V, anorexia
CNS depression
Nursing interventions?

Nonnucleoside Reverse
Transcriptase Inhibitor
(NNRTI)

Side effects:
CNS-dizziness, HA,
insomnia

Rash can develop into


Stevens Johnson
GI
Liver damage
Contraindicated BF
Nursing
Interventions?

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

THERAPY FOR HIV/AIDS


Usually includes at least 3 medications
When used in combination, lower doses are
possible thus decreasing toxicities
Also decreases viral resistance
Goals: maintain/increase CD4 counts and
decrease viral load
Increase in CD4 = decrease in viral load= ability
to fight a viral infection

TREATMENT FAILURES
Common with antiretroviral therapy

Client non-tolerance of adverse effects


Client non-adherence to complex regimen
Emergence of resistant strains
Genetic variability

Therapy always changingstay


current with latest treatments

DRUG THERAPY GENERAL


INSTRUCTIONS
Assess for symptoms of HIV and any
opportunistic infections
Monitor plasma HIV RNA (viral load)
assays, CD4 counts
Many drugs have specific instructions
regarding food/ drug interactions

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

DRUGS FOR HERPES VIRUSES


HSV 1 & HSV - 2
Oral antiviral
therapy given for 5
to 10 days
Topical forms of
several antivirals
are available
Most drugs are well
tolerated!

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

DRUGS FOR INFLUENZA


Vaccination is best
approach
Antivirals available to
prevent influenza
Most useful when
combined with vaccines

2 classes:
Adamantanes (no longer
used)

Neuramindase
Inhibitor

DRUGS FOR INFLUENZA


Neuroaminidase
Inhibitors
Influenza A or B
virus
Prototype
Oseltamivir
phosphate (Tamiflu)
Shorten discomfort
period for influenza
symptoms

Have limited
efficacy
MUST BE
STARTED WITH
IN 48 HOURS
OF SYMPTOMS
Shortens length
of symptoms

DRUGS FOR HEPATITIS


Nucleoside Analogs
Viral hepatitis caused by:

Hepatitis A (HAV) & Hepatitis B (HBV)


Best prevented through vaccination
Hep B (3 dose vaccination)
Only a few medications available for
post-exposure treatment

Immunoglobulins sometimes used to confer passive


immunity