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    Ppt chapter013 Ppt chapter013 Presentation Transcript

    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical Pharmacology Chapter 13- Antifungal and Antiparasitic Drugs
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antifungal Drugs: Actions and Uses • Fungicidal OR Fungistatic: Action is related to their concentration in body tissues • Used prophylactically to prevent fungal infection in immunocompromised patients • Used to treat: Superficial and deep fungal infections; systemic infections; superficial infections of nail beds, oral, anal and vaginal areas
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Helminthic, Protozoal, and Amebiasis • Helminthic infections: invasion of body by parasitic worms. – Anthelmintic drugs kill the parasites. • Protozoal infections: single-cell parasites. – Antiprotozoal drugs work to inhibit DNA synthesis, effectively killing the organism. – Amebiasis is a parasitic gastrointestinal disorder.
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antifungal Drugs: Adverse Reactions • Topical administration: Integumentary reactions – Irritation and burning sensation; redness, stinging; abdominal pain (vaginal preparations) • Systemic administration – Headache; rash; nausea, vomiting, diarrhea; anorexia and malaise; abdominal, joint, or muscle pain
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antifungal Drugs: Contraindications, Precautions and Interactions • Contraindicated in patients: With a history of allergies to the drug; during pregnancy and lactation • Contraindications for antifungal drugs: Griseofulvin; Voriconazole; Itraconazole • Used cautiously in patients: With renal dysfunction and/or hepatic impairment • Interactions: Possible depend on the individual drugs, and many interactions can occur
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment • Preadministration assessment: – Assess for signs of the infection before giving the first dose; take and record vital signs – Inspect superficial fungal infections of the skin or skin structures and record – Ask about pain and to describe white plaques or sore areas of the oral or perineal areas and any vaginal discharge
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment (cont’d) • Ongoing assessment: – Carefully observe the patient every 2 to 4 hours for adverse drug reactions – If administered topically, instruct the patient to look for signs of improvement and adverse reactions both minor and severe
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Nursing Diagnosis • Impaired comfort-related to IV administration of amphotericin B • Risk for Ineffective tissue perfusion: Renal RT adverse reactions of antifungal drugs
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Planning • The expected outcome depend on the reason for administering the antifungal drug but includes an optimal response to therapy: – Patient relates to the management of adverse reactions, and an understanding of and compliance with the prescribed treatment regimen
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response therapy: – Amphotericin B: Protect IV solution of from exposure to light; administer immediately after the drug is reconstituted; renal damage is the most serious adverse reaction to the use of amphotericin B – hence serum creatinine levels and BUN levels are checked frequently
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response therapy (cont’d): – Topical antifungal infection preparations: Inspect the area at the time of each topical application; If administered vaginally, question the patient regarding any discomfort or other sensations experienced; evaluate and chart the patient’s response to therapy daily
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient’s need: – Impaired comfort: Medication administration •Use precautions when administering amphotericin B intravenously; inform before the drug is given that the side effects can be uncomfortable; provide warm blankets; reassure that the medications administered before the antifungal are to help ease the reaction
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient’s need (cont’d): – Risk for ineffective tissue perfusion: Renal •Carefully monitor fluid intake and output, serum creatinine levels and BUN levels •Gerontological alert: Fluconazole
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family: – For topical antifungal drugs include the importance of cleanliness and using the correct ointment amount in the prescribed frequency in the teaching plan – For ringworm infections advise keeping towels and facecloths used for bathing separate from those of other family members
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family (cont’d): – Teach drug-specific points for the following drugs •Flucytosine; Griseofulvin; Ketoconazole; Itraconazole; Miconazole
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Evaluation • The therapeutic effect is achieved; signs and symptoms of infection improve; optimal skin integrity is maintained • Adverse reactions are identified, reported, and managed • Patient and family demonstrate understanding of the drug regimen • Patient verbalizes the importance of complying with the prescribed therapeutic regimen
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiparasitic Drugs • Anthelmintic Drugs-used against invasion of parasitic worms (Helminthiasis) • Antiprotozoal Drugs-used against invasion of single celled parasites
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Anthelmintic Drugs: Actions and Uses • Albendazole: Interferes with synthesis resulting in death of larva; used to treat- larval forms of pork tapeworm; liver, lung, and peritoneum disease caused by dog tapeworm • Mebendazole: Blocks glucose uptake by helminth; used to treat- whipworm, pinworm, roundworm, American hookworm, and common hookworm • Pyrantel: Ability to paralyze helminth; used to treat- roundworm; pinworm • Thiabendazole: Interrupts the lifecycle of the helminth; used to treat- threadworm
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Anthelmintic Drugs: Adverse Reactions • Generalized adverse reactions: – Drowsiness, dizziness, nausea, vomiting, abdominal pain and cramps, diarrhea • Serious adverse effects: – Rash
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Anthelmintic Drugs: Contraindications and Precautions • Contraindicated in patients: – With a history of hypersensitivity; during pregnancy • Used cautiously in patients: – With hepatic or renal impairment; during lactation; with malnutrition or anemia
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Anthelmintic Drugs : Interactions Interactant drug Effect of interaction Dexamethasone Increased effectiveness of albendazole Cimetidine Interferes with elimination of albendazole Hydantoins and carbamazepine Lower levels of mebendazole Xanthine derivatives Increased serum level, possible toxic effects of the xanthines
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiprotozoal Drugs: Actions and Uses • Action: – Interfere with life cycle of the plasmodium – Prevents development of plasmodium – Prevents the mosquito from ingesting the plasmodium • Used for the treatment of: – Malaria
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiprotozoal Drugs: Adverse Reactions • Gastrointestinal reactions: – Vomiting; anorexia; abdominal cramping; diarrhea; and nausea • Other body system reactions: – Headache; dizziness; visual disturbances; hypotension; photosensitivity; cinchonism
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiprotozoal Drugs: Contraindications and Precautions • Contraindicated in patients: – With known hypersensitivity; during pregnancy • Used cautiously: – With children; lactating patients; with hepatic or renal disease or bone marrow depression • Quinine not prescribed for: – Patient with myasthenia gravis
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiprotozoal Drugs: Interactions Interactant drug Effect of interaction Antacids, Iron Decreased absorption of the antimalarial Digoxin Increased risk of digoxin toxicity Barbiturates, phenytoins, and carbamazepine Decreased effectiveness of doxycycline Warfarin Increased risk of bleeding
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiparasitic Drugs- Nursing Process: Assessment • Preadministration assessment: – Diagnosis of helminth infection- examination of stool; weigh patient to determine drug dosage • Ongoing assessment: – Save and transport all stools passed after intake of drug to laboratory – Acutely ill – monitor vital signs; record fluid intake/output every 4 hours – Observe patient for adverse reactions
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Anitparasitic Drugs Nursing Process: Nursing Diagnosis • Diarrhea-related to parasitic invasion of body • Risk for deficient fluid volume-related to parasitic invasion of body • Imbalance nutrition: less than body requirements-adverse reaction to drug therapy • Risk for impaired respiratory function- adverse reaction to drug therapy
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiparasitic Drugs-Nursing Process: Planning • Depends on the patient and the type of helminth infection • Outcome- reduction of anxiety, optimal response to therapy, management of adverse reaction, understanding compliance of prescribed therapeutic regimen
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiparasitic Drugs- Nursing Process: Implementation • Promoting optimal response to therapy: – Patient and family - explain treatment and future preventive measure; discuss concerns and questions – Based on the hospital policy, linen precaution necessary
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiparasitic Drugs- Nursing Process: Implementation • Monitoring and managing patient’s needs: – Diarrhea and risk of fluid body volume deficit: monitor fluid intake and output, IV fluid and electrolyte replacement may be necessary – Risk for imbalanced nutrition: Gastrointestinal: upset causing nausea, vomiting, abdominal pain, and diarrhea; Consider patient’s food preference and encourage intake of nutritious balanced meal – Risk for impaired respiratory function: with inhaled treatments of pentamidine, bronchodilator may be prescribed, instruct patient and family on use
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiparasitic Drugs- Nursing Process: Implementation • Educating patient and family member: – Instruction about taking the drugs as well as the household precautions to be followed till helminth is eliminated – Prepare the education plan to be followed
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiparasitic Drugs- Nursing Process: Evaluation • Therapeutic effect achieved; adverse reaction identified, reported, and successfully managed; stool specimen negative for parasites; patient verbalizes an understanding of the therapeutic regimen modalities and the importance of continued follow-up testing, and complying with the prescribed regimen and preventive measures
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation