This document provides information on various classes of drugs used to treat different types of infections and diseases. It discusses narcotics and their uses, side effects, and nursing considerations. It also summarizes several classes of antibiotics like aminoglycosides, carbapenems, cephalosporins, quinolones, penicillins, sulfonamides, tetracyclines, and macrolides. Additionally, it covers drugs used to treat tuberculosis, leprosy, HIV/AIDS, and antifungal drugs.

1. CLASS 3

2. Narcotics Narcotic=Greek word=STUPOR Opium, Opium derivatives like heroin, morphine

4. Narcotic Use TREATPAIN

5. Narcotic Use TREAT COUGH

6. Narcotic Use Alleviate Diarrhea

7. Narcotic Use Induce Anesthesia

8. Modes of Administration Orally Transdermally Injected Suppositories Abused by smoking, sniffing, injecting

9. Narcotic Effects euphoria

10. Narcotic Effects Decreased GI activity

11. Narcotic Effects pupil construction

12. Narcotic Effects Nausea and Vomiting Flushing of Face and Neck

13. Narcotic Effects Dependence Addiction Tolerance

14. Narcotic Effects MOST SERIOUS: Respiratory depression

16. Nursing Care of Patient on Narcotics

17. Narcotic Withdrawal

18. Suboxone

19. Antimicrobial Drugs

20. Chapter 8

22. Antibiotic-Resistant Microorganisms

23. Indications for Use Empirical--most likely organism Prophylactic therapy

29. Aminoglycosides

30. Aminoglycosides

31. Aminoglycosides

33. Aminoglycosides renal failure [high peaks] ototoxicity [high troughs]

34. Drug Levels Gentamycin levels peak 5-10; trough <2 Amikacin Peak 20-35; trough <5 Tobramycin Peak 5-10; trough <2

35. Carbapenems Imipenem/cilastatin-Primaxin Doripenem-Doribax Ertapenem-Invanz Is NOT

36. Monobactam Aztreonman

37. Cephalosporins Broad-spectrum gram + and – First generation Second generation Third generation Fourth generation

38. Cephalosporins

39. First Generation Ancef Kefzol

40. Second GenerationCephalosporins Mefoxin

41. Third GenerationCephalosporins Cefixime - Suprax] Cefdinir - Omnicef Cefpodoximine - Vantin Ceftriaxone - Rocephin

42. Fourth Generation Cephalosporin Cefepime (Maxipime) Cefditoren – Spectracef

43. Nursing Care of Patient Taking Cephalosporins Side/Adverse Effects: N/V/Diarrhea Psuedomembranous colitis CNS Symptoms Nephrotoxicity Superinfections

44. Pseudomembranous Colitis

45. Disulfiram

46. Examples of Quinolones ciprofloxacin enoxacin lomefloxacin norfloxacin ofloxacin levofloxacin

47. Side EffectsQuinolones CNS HA, dizziness, fatigue, depression, & restlessness GI N/V/D, constipation, inc. LFTs, & thrush DERM rash, pruritis, photosensitivity, & flushing Other fever, chills, blurred vision, & tinnitus, tendon rupture

48. Adverse Reactions Hypersensitivity anaphylaxis Serum sickness Skin rash Urticaria Nephrotoxicity Neurotoxicity Coagulation disorders

49. How Penicillin works

50. Beta-Lactam Antibacterials Beta-lactamring

51. Penicillins Effective, Safe Excreted Kidnes Risk of hypersensitivity Gram + bacteria Contraindications—hypersensitivity or allergic reactions; potential for cross-sensitivity with cephalosporins and carbapenems

52. Examples of Penicillins Dicloxacillin (Dynapen) Penicillin G Penicillin V (Pen-Vee K) Piperacillin (Pipracil)

53. Aminopenicillins Ampicillin Amoxicillin

54. Extended-Spectrum PCN (Antipseudomonal) Carbenicillin, ticarcillin, mezlocillin, and piperacillin—broad-spectrum PCN/beta-lactamase inhibitor combinations Unasyn Augmentin Timentin Zosyn

55. Cephalosporins and Penicillin

56. Common Side Effects PCNs N/V/D ; anxiety, and abdominal pain less common convulsions, inc. LFT’s, & increase in bleeding time

57. Nursing Implications Penicillins: Empty stomach Cephalosporins

58. Sulfonamides Broad spectrum, bacteriostatic Gram + and - Contraindicated Hypersensitivity to sulfonamides, thiazides, sulfonylureas; renal failure; pregnancy, lactation; children <2 mos

59. Examples of Sulfonamides Sulfamethoxazole Trimethoprim AKA BACTRIM and SEPTRA

60. Side Adverse Effects photosensitivity

61. Prototype Sulfa Preps Sulfamethoxazole Azo Gantanol Bactrim azo gantanol combo phenazopyridine and sulfa as a Antibiotic for UTI Bactrim combo trimethoprim and sulfa Antibiotic for UTI, PCP, ear infections, gonorrhea, etc. Sulfasoxazole Azogantrisin Pediazole azogantrisin combo phenazopyridine and sulfa for UTI’s Pediazole sulfisoxazole and erythromycin for otitis media

62. Urinary Antiseptics Bactericidal Not used in systemic infections EXAMPLE: Phenazopyridine PYRIDIUM or AZO

63. Tetracyclines Contraindicated in pregnancy, children <8 yrs, and renal failure

64. Examples of tetracyclines demeclocycline oxytetracycline tetracycline doxycycline minocycline

65. Taking Tetracyclines: NO:

66. Macrolides and Ketolides May be bacteriostatic or bacteriocidal Erythromycin Telithromycin (Ketek)

67. Macrolides first intro in early 1950’s [erythromycin] inhibit growth of bacteria = bacteriostatic four main macrolides: erythromycin (many names) Azithromycin (Zithromax) Clarithromycin (Biaxin) troleandomycin

68. MACROLIDE: Indications for Use Widely used for respiratory tract and skin/soft tissue infections Used as penicillin substitute Used in newborns (ophthalmic)

69. Therapeutic EffectsMacrolides Strep infections Streptococcus pyogenes(group A beta-hemolytic) mild to moderate URTI Hemophilus influenza spirochetal infections syphilis & Lyme disease gonorrhea, chlamydia, and mycoplasma

70. Miscellaneous Metronidazole—effective against anaerobic bacteria, some gram+, and protozoa Quinupristin/dalfopristin— belongs to class streptogramins; bacteriostatic and bacteriocidal Spectinomycin—treatment of gonococcal exposure Vancomycin—active against gram+ Chloramphenicol—broad spectrum, bacteriostatic, active against gram+ and gram– Clindamycin—bacteriostatic, effective against gram+, some anaerobes Linezolid—member of new class oxalidinone; effective against aerobic gram+

71. Principles of Therapy Culture and sensitivity studies reviewed to treat with “right drug for right bug” Erythromycin interferes with the elimination of several drugs Monitor clients closely

72. Zithromax Loading dose of 500 mg Daily dose of 250 mg for total of 5 days therapy Given up t 10 days for CAP (community acquired pneumonia)

73. BIAXIN

74. Side EffectsMacrolides GI N/V/D, hepatotoxicity, flatulence, jaundice, & anorexia primarily involve erythromycin newer macrolides [azithromycin & clarithromycin] less SE’s, longer action, better efficacy, & better tissue penetration

75. Drugs to Treat Leprosy DAPSONE AND THALIDOMIDE

76. Other Antibiotics Clindamycin(Cleocin) Daptomycin (Cubicin) Linezolid(Zyvox) Metronidazole (Flagyl) Quinupristin/dalfopristin (Synercid) Vancomycin (Vancocin)

77. Tuberculosis (TB) Infectious disease that usually affects the lungs May infect lymph nodes, pleurae, bones, joints, kidneys, and GI tract Caused by Mycobacterium tuberculosis Multiplies slowly and remains dormant for years Natural history of TB Transmission Primary infection Latent tuberculosis infection (LTBI) Active tuberculosis

78. TB Principle organ affected is lungs Caused by Mycobacterium tuberculosis Transmission Primary infection Latent (LTBI)-Active TB

79. How TB is spread

80. Chapter 34Drugs for Tuberculosis and Mycobacterium avium Complex (MAC) Disease

81. What does a positive PPD mean? Positive reaction is Induration NOT redness Low risk >15 mm >10 mm high risk >5mm persons at highest risk, HIV

82. Primary Antitubercular Drugs Rifapentine (Priftin)—used with at least one other drug; less frequent administration (1-2X/wk) Ethambutol (Myambutol)—part of 4-drug regimen Pyrazinamide—used with INH and rifampin for 2 mos Streptomycin—used in 4-drug regimen Isoniazid (INH)—most commonly used; bacteriocidal, inexpensive, and nontoxic Rifampin—works synergistically with INH Rifabutin (Mycobutin)—used in patients with HIV with MAC; longer half-life than rifampin

83. Secondary Antitubercular Drugs Para-aminosalicylic acid (PAS) Capreomycin (Capastat) Cycloserine (Seromycin) Ethionamide (Trecator SC) Indicated for clients when other agents are contraindicated or drug resistant

84. Other Drugs Used in Multidrug-Resistant Tuberculosis Aminoglycosides (amikacin and kanamycin) May be component of 4- to 6-drug regimen Fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, and sparfloxacin) may be used

85. Resistant TB For INH-resistant TB—rifampin, pyrazinamide, and ethambutol for 6 mos

86. Resistant TB For rifampin-resistant TB—INH and ethambutol for 18 mos or INH, pyrazinamide, and streptomycin for 9 mos

87. Resistant TB MDR-TB—5- to 6-drug regimen individualized according to susceptibility reports

88. Resistant TB For intermittent schedules, healthcare providers administer or directly observe therapy (DOT)

89. Resistant TB During pregnancy—3-drug regimen of INH, rifampin, and ethambutol used with close monitoring of LFT

90. Mycobacterium Avium Complex Disease (MAC) Mycobatcteriumavium and Mycobacterium intracellulare are grouped together as MAC Found in water and soil; transmitted by inhalation of droplets Opportunistic infection of immunocompromised Main drugs used—macrolides, azithromycin and clarithromycin, and rifabutin Prophylactic therapy life-long 3-drug regimen—macrolide, rifabutin, and ethambutol

91. TB drugs first line agents ethambutol isoniazid pyrazinamide rifampin streptomycin second line agents paraaminosalicylate sodium (PAS) capreomycin cycloserine ethionamide kanamycin

92. Drugs used to Treat TB INH-Isoniazid Most common least expensive 300 mg/day or 900 mg 2x/week Adverse effects: Hepatotoxicity Peripheral neuropathy (Give B6-pyridoxine 25 to 50 mg daily)

93. Rifampin and Rifabutin Metabolized in liver SE: RED BODY FLUIDS GI irritation, hepatitis, Numerous drug interactions

94. Ethambutol Major adverse effect is optic neuritis Moniter visual acuity and red/green discrimination OK to give with food

95. Miscellaneous Drugs Chloramphenicol-Chloromycetin Used in serious infections Toxicity-life threatening blood dyscrasias Therapeutic levels 10-20mcg/mL “Gray baby syndrome” (cardiovascular collapse in newborns) Frequent CBC monitoring

96. Clindamycin (Cleocin) Rx Severe Infection Topical use - acne Diarrhea serious SE Persistent, bloody stools (>5 stools a day)—stop drug, assess for presence of C. Diff.

97. Vancomycin Gram + Used in serious infections Primarily IV PO for Rx of C.difficile Rx of MRSA Emergence of VRE IV – give slowly over 1-2 hrs to avoid RED MAN Syndrome

98. Viruses Viruses spread by secretions, ingestion, breaks in skin and mucous membranes, blood transfusions, sexual contact, pregnancy, breast-feeding, and organ transplantation Viral replication is parasitic in nature Viruses induce antibodies and immunity

99. Antiviral Drugs Few drugs inhibit viruses without being excessively toxic to host tissues Most antivirals inhibit viral replication but do not eliminate viruses from tissues Available drugs are expensive, relatively toxic, and effective in a limited number of infections

100. Drugs for Herpesvirus Infections Acyclovir, famciclovir, and valacyclovir Penetrate virus-infected cells, become activated by an enzyme, and inhibit viral DNA reproduction Treatment of herpes simplex and herpes zoster infections Cidofovir, foscarnet, ganciclovir, and valganciclovir Inhibit viral reproduction Treat cytomegalovirus (CMV) retinitis most commonly seen in AIDS Foscarnet treats acyclovir-resistant herpes simplex

101. Drugs for Influenza A Amantadine and rimantadine inhibit replication of the influenza A virus Oseltamivir (Tamiflu) and zanamivir (Relenza) approved for influenza A or B Seasonal prophylaxis used in high-risk patients Treat early and may shorten illness length

102. Drug for Respiratory Syncytial Virus (RSV) Ribavirin used to treat bronchiolitis or pneumonia caused by RSV Used in hospitalized infants and young children Given by inhalation with Viratek small particle aerosol generator

103. How HIV Drugs work

104. Drugs for HIV and AIDS (Antiretrovirals) See Handout in Class

105. Antifungal Drugs Mechanism of action is to disrupt the structure and function of various fungal cell components Polyenes and azoles act on ergosterol to disrupt fungal cell membranes Echinocandins or glucan synthesis inhibitors are a new class of antifungals that disrupt cell walls rather than cell membranes

106. Azoles Ketoconazole (Nizoral) given orally and is less toxic; little absorption occurs topically Disadvantage is there are many drug–drug interactions Fluconazole (Diflucan) Synthetic broad-spectrum agent that may be used long-term Increases effect of several drugs Itraconazole (Sporanox) Synthetic broad-spectrum agent similar to fluconazole May be used in long-term suppression of histoplasmosis Voriconazole (Vfend) Broad-spectrum activity

107. Polyenes Amphotericin B Highly toxic to humans and recommended only for serious, potentially fatal infections Nystatin Used topically only; too toxic for systemic use