Antituberculars
INH SE and how to prevent
Interferes with absorption of vitamin B6 = Peripheral Neuropathy (Report numbness/tingling in extremities)
Used for Latent to prevent TB
SE: hepatotoxicity (REPORT IMMEDIATELY) = dark urine, yellowing of sclera, fatigue, elevated liver enzymes
Prevention = Vaccine, goo hygiene
TB S/S and Risk Factors
S/S = Cough (Blood tinged), night sweats, anorexia, chest pain and fever
Risk factors
- Immunocompromised, Persons in close contact, and health care employees
Antifungal patient Education
Have pt report skin rash, abdominal pain, diarrhea or fever
The patient should take the full medication regimen even if their s/s improve
Tamiflu (Oseltamivir and Zanamivir)
Given within 48 hours of start of S/S
SE = dizziness, insomnia, vertigo, fatigue, GI disturbances
Action = Decreases release of virus from infected cells
- Decreases viral spread
REPORT any self injury or delirium
Take FULL med regimen
TB treatment regimen
DO'S
- Take meds as directed
- Meds last 6-12 months, take on empty stomach w 8 oz of water
AIRBORNE precautions, N95
Sputum samples done every 2-4 weeks until you have 3 negative cultures = no longer infectious
- however, still continue the med regimen AFTER 3 neg cultures
TB with special populations
HIV = Longer Tx, Leading cause of death of people co infected with HIV latent TB
Peds = Treated with first lines
Pregnant = Benefits of tx outweigh the baby risk
Medications that cause nephrotoxicity
Amphotericin B
Flucytosine
Cyclosporine
Loop Diuretics
Allopurinol
Aminoglycosides
NSAIDS
Rifampin
Methotrexate
Vancomycin
Quinolones
Antivirals and pregnancy
Acyclovir has not been associated with birth defects so therefore it is SAFE to use as well as Tamiflu
Rifampin SE
SE include: Red and Orange tears, urine and sweat
- Wear glasses instead of contacts due to the discoloration of tears
- Oral contraceptives become ineffective
- No Alc due to liver tox
Pyrazinamide SE
Will increase LFTs and uric acid levels
SE: photosensitivity, thrombocytopenia, joint pain, and Liver Tox
Labs: Uric acid, CBC, LFTs
Nystatin (Polyene)
Tx : oral candidiasis
- Shake well with liquid suspension
- Swish in mouth several times then swallow, then check mucus membranes for any irritation later
Influenza Vaccine
Contraindications: Chicken eggs allergy
Active infection, Previous hypersensitivity, Children younger than 6 mo
FEVER
Guillain Barre Syndrome: immune system attacks your peripheral nervous system (Triggered by viral and bacterial infection)
Mist is CONTRAINDICATED in pregnancy
Latent TB treatment
Isoniazid is used for tx of latent TB
Latent TB = TB w/o s/s, want to use preventative measures to prevent TB from occurring
- Vaccine
Amphotericin B (Polyene) SE
SE include: Severe renal Injury
- Creatinine levels high
- Urine is less than 30 ml per hour or less
- Oliguria = Low urine
Phlebitis, fever, chills, vomiting
Important Labs: Potassium, Creatinine, CBCs (Hematocrit)
Azoles (Flucytosine and Caspofungin)
Flucytosine = Well absorbed in GI, causes renal and hepatic impairment
Caspofungin = Inhibits biosynthesis of the cell wall
- SE: Injection reactions, Elevated hepatic enzymes, histamine mediated reactions
Antimalarial drug SE
Drugs = Chloroquine, Quinine sulfate, Mefloquine, Hydroxychloroquine
SE: GI upset, retinal damage, 8th cranial nerve damage (vestibulocochlear), renal impairment, CV effects
Ethambutol SE
E = Eye so eye problems
- Blurred vision, color changes
- Report to physician / Baseline eye exams are a necessity
Contraindications
- Children less than 13 and pts with optic neuritis
Amphotericin B nursing interventions / Monitoring
Monitor Labs such as potassium, creatinine, and hematocrit levels
Monitor strict Is/Os
Ensure proper hydration and obtain baseline vitals
ONLY USE IN LIFE THREATENING FUNGAL EMERGENCIES
Antiviral Labs to monitor
CBCs, LFTs, Renal function labs and tests
Viral loads
Tx to malaria prior to travel
Doxycycline prophylaxis 1-2 days before travel
Preventative measures such as bug spray, bug nets, clothing, tents