IRIS E.

FRANCHE
BSN 2-C

Classificatio Medication Therapeutic Actions/ Common Adverse Nursing Responsibilities

n Indication Effects

Anti - Penicillins THERAPEUTIC ACTIONS:
Infective - May act on the cells of
invading organisms in several
different ways. The goal of
therapy is interference with the
normal function of the invading
organism to prevent it from
reproducing and to cause cell
death without affecting host
cells.
- Narrow-spectrum
anti-infectives are agents that
are so selective in their action
that they are effective against
only a few microorganisms.
- Broad-spectrum
anti-infectives are agents that
interfere with biochemical
reactions in many different kinds
of microorganisms.
- Anti-infectives that can cause
cell death are said to have
bactericidal effects.
- Anti-infectives that can
interfere with the ability of the
cells to reproduce or divide are
said to have bacteriostatic
effects.
INDICATIONS:
Children
- Use with caution as early
exposure can lead to early
sensitivity.
Kidney damage: Drugs
like aminoglycosides
have direct toxic effect on
the fragile cells in the
kidney and can cause
conditions ranging from
renal dysfunction to
full-blown renal failure.
GI toxicity:
Many anti-infectives have
direct toxic effects on the
cells lining the GIT
causing nausea,
vomiting, stomach upset,
and diarrhea. Some
drugs have toxic effects
on the liver causing
hepatitis and even liver
failure.
Neurotoxicity:
Some anti-infectives can
damage or interfere with
the function of nerve
tissue, usually in areas
where drugs tend to
accumulate in high
concentrations. For
example, aminoglycoside
antibiotics collect in the
8th cranial nerve and can
cause dizziness, vertigo,
and loss of hearing.
Chloroquine, a drug for
treatment of malaria can
accumulate in the retina
and optic nerve and
cause blindness.
(1) The nurse must
assess for
contraindications or
cautions:
➢ History of allergy
➢ History of liver
dysfunction
➢ History of renal
dysfunction
(2) The nurse must
perform a physical
assessment to
establish a baseline
date for evaluating
the effectiveness of
the drug and the
occurrence of any
adverse effects
related with drug
therapy
(3) The nurse must
assess for
orientation and
reflexes to evaluate
any CNS effects of
the drugs.

- Use of antibiotics in pediatric Hypersensitivity

ear infections (which might be a
viral infection) may contribute to
development of drug resistance.
- Children are susceptible to
gastrointestinal (GI) and
nervous system effects of
anti-infectives so it is important
to monitor their hydration and
nutritional status carefully.
Reactions:
Most agents are protein
bound for transfer
through the
cardiovascular system
and are able to induce
antibody formation in
susceptible people. With
next exposure,
immediate or delayed
 IRIS E. FRANCHE
BSN 2-C

allergic responses may

occur.

Adults Superinfections:
-This age group tends to Broad-spectrum
demand quick cure to various anti-infectives can
signs and symptoms. Therefore, destroy normal flora.
drug allergies and emergence Superinfections are
of resistant strains can be a big infections that occur
problem with this group. when opportunistic
pathogens that were kept
- Extra caution is exercised in in check by normal flora
pregnant and lactating women bacteria have the
because many of these agents opportunity to invade
have teratogenic effects to the tissues. Common causes
fetus and can cross into breast of superinfections are
milk. Proteus and
Pseudomonas.
Older adults
- They present with
manifestations that are different
from younger age groups so
culture and sensitivity tests are
important to determine the type
and extent of infection.
- They are susceptible to severe
GI, renal, and neurological
effects and must be monitored
for nutritional status and
hydration during drug therapy.
- Their liver function should
always be taken in
consideration when planning for
anti-infective therapy.

Antibiotics Aminoglycoside THERAPEUTIC ACTION: CNS: ototoxicity, (1) The nurse must
s Exert bactericidal effect through irreversible deafness, assess for the
inhibition of protein synthesis in vestibular paralysis, mentioned cautions
susceptible strains of confusion, depression, and
gram-negative bacteria. disorientation, contraindications
Specifically, they bind to a unit numbness, tingling, (e.g. drug allergies,
of the bacteria ribosomes and weakness CNS depression,
cause misreading of the genetic CV disorders, etc.)
code leading to cell death. Renal: renal failure to prevent any
Hematology: bone untoward
INDICATION: marrow depression, complications.
Children: This age group is leading to (2) The Nurse must
very sensitive to GI and CNS immunosuppression and perform a thorough
adverse effects of antibiotics. resultant superinfections physical
Therefore, it is important to assessment (other
monitor their nutritional and GI: nausea, vomiting, medications taken,
hydration status while on diarrhea, weight loss, CNS, skin,
therapy. Oral candidiasis as a stomatitis, hepatotoxicity respirations, and
 IRIS E. FRANCHE
BSN 2-C

superinfection is common in this laboratory tests like

age group which makes eating CV: palpitations, renal functions tests
and drinking difficult. hypotension, and complete blood
Fluoroquinolones are hypertension count or CBC) to
associated with damage to establish baseline
developing cartilage and are not Hypersensitivity data before drug
recommended for growing reactions: purpura, rash, therapy begins, to
children. In addition to this, urticaria, exfoliative determine
pediatric dosages should be dermatitis effectiveness of
double-checked to decrease the therapy, and to
risk for adverse effects. Most of evaluate for
all, parent education is occurrence of any
important in cutting down the adverse effects
unnecessary use of antibiotics associated with drug
in children. therapy.
(3) The Nurse must
perform culture and
sensitivity tests at
Adults: This age group has the the site of infection
tendency to cure simple to ensure
manifestations with antibiotics. appropriate use of
Therefore, it is important to the drug.
educate them that antibiotics (4) The Nurse must
are effective only for certain conduct orientation
bacteria and not for simple and reflex
manifestations like common assessment, as well
colds, which may be viral. as auditory testing
Storage of unused pills for to evaluate any
future infections and sharing CNS effects of the
antibiotics with symptomatic drug
friends should be avoided and (aminoglycosides).
emphasized in health teachings.

Older adults: Assessing the

problem and obtaining
appropriate specimens for
culture is especially important
with this population. Older
patients may be more
susceptible to adverse effects of
antibiotic therapy.

Antiviral influenza A and THERAPEUTIC ACTION: CNS: adverse effects (1) The Nurse must
respiratory Unknown. However, the belief is that may be related to assess for the
viruses drugs that these agents prevent possible effects of mentioned cautions
shedding of the viral protein dopamine levels in the and
coat and entry of the virus into brain, like contraindications
the cell. This prevents light-headedness, (e.g. drug allergies,
replication and therefore causes dizziness, insomnia hepatorenal
impairment,
CV: orthostatic pregnancy and
hypotension lactation, etc.) to
IRIS E. FRANCHE
BSN 2-C

viral death. prevent any

GU: urinary retention untoward
complications.
(2) The nurse must
INDICATION: Children: This perform a thorough
age group is very sensitive to physical
the effects of most antivirals and assessment (other
therefore more severe reactions medications taken,
can be expected. - In orientation and
addition, many antivirals do not reflexes, vital signs,
have proven safety and efficacy etc.) to establish
in children. - Caution must be baseline data before
applied and smaller doses are drug therapy begins,
given for children. to determine
effectiveness of
therapy, and to
evaluate for
occurrence of any
Adults: This age group should
adverse effects
be educated about the dangers
associated with drug
of using antibiotics for viral
therapy.
diseases. - Emphasis is given
on patients with HIV about the
limitations of antiviral drugs with
regards to the curative aspect of
the disease.

Pregnant women: Generally,

pregnant women are not given
antivirals unless the benefits
clearly outweigh the risks to the
fetus or neonate. - Women of
childbearing age should be
advised to use barrier
contraceptives if they take any
of these drugs.
- The Centers for Disease
Control and Prevention (CDC)
advises that women with HIV
infection should not breast-feed
to protect the neonate from the
viruses.

Older adults- Older patients

are more susceptible to adverse
effects of antiviral therapy,
particularly those with hepatic
and renal dysfunctions.
 IRIS E. FRANCHE
BSN 2-C
Antifungal THERAPEUTIC ACTION: ● GI: liver toxicity
Azole ● Either binding to sterols ● Severe effects
Antifungals and causing cell death
or interfering with cell
replication.
● Ketoconazole,
fluconazole, and
itraconazole block the
activity of a sterol in a
fungal wall. Therefore,
they may also block the
activity of human
steroids such as
testosterone and
cortisol.
● Posaconazole, a new
drug, inhibits the
synthesis of ergosterol
leading to inability of
the fungus to form cell
walls.
● Terbinafine blocks the
formation of ergosterol.
INDICATIONS:
Children
● This population is more
sensitive to the effects
of antifungals so more
severe adverse
reactions may be
expected from them.
● Only fluconazole,
ketoconazole,
terbinafine, and
griseofulvin have
established pediatric
doses.
● Topical agents are
avoided on open or
draining areas to avoid
systemic absorption.
Also, occlusive
(1) The nurse must
assess for the
mentioned cautions
on a fetus or a and
nursing babies contraindications
(e.g. known history
of allergy to
antifungals, liver
and kidney
dysfunction,
pregnancy and
lactation, etc.) to
prevent any
untoward
complications.
(2) The Nurse must
perform a thorough
physical
assessment (other
medications taken,
orientation and
reflexes, skin color
and lesions, etc.) to
establish baseline
data before drug
therapy begins, to
determine
effectiveness of
therapy, and to
evaluate for
occurrence of any
adverse effects
associated with drug
therapy.
(3) The Nurse must
obtain a culture of
the infected area to
make an accurate
determination of the
type and
responsiveness of
the fungus.
(4) The Nurse must
evaluate renal and
hepatic function
tests and complete
blood count to
determine baseline
 IRIS E. FRANCHE
BSN 2-C

dressings, including function of these

tight diapers, should be organs and to
avoided over the assess possible
affected areas. toxicity during drug
therapy.

Adults

● This age group widely

use over-the-counter
antifungals and it
should be emphasized
to them that antifungals
can be very toxic so
usage is only justified
when a causative
organism is identified.

● Pregnant and lactating

women should be
advised that usage of
this drug should only be
in situations where the
benefits clearly
outweigh the risks.

● As for women of
childbearing age,
barrier contraceptives
should be employed.
Lastly, antifungals
should not be used over
open or draining areas
as this can facilitate
systemic absorption.

Older adults

● They are more

susceptible to the
adverse effects of the
drug, especially those
with hepatic and renal
dysfunction. In such
cases, doses are
needed to be lowered.

Antiprotozoal Leishmaniasis THERAPEUTIC ACTION ● CNS: headache, (1) The nurse must
dizziness assess for the
● Immunological: mentioned cautions
IRIS E. FRANCHE
BSN 2-C

● Entering human red fever, shaking, and

blood cells and chills, malaise contraindications
changing the metabolic ● GI: nausea, (e.g. drug allergies,
pathways necessary for vomiting, hepatorenal
the reproduction. dyspepsia, impairment,
Chloroquine, the anorexia, hepatic pregnancy and
mainstay of treatment, dysfunction lactation, visual
in addition to this main ● Dermatological: disturbances, etc.)
mechanism, is directly rash, pruritus, to prevent any
toxic to parasites and loss of hair untoward
decreases the ability of associated with complications.
the parasite to changes in (2) The nurse must
synthesize DNA. protein synthesis perform a thorough
● Eyes: visual physical
changes, assessment (other
possible medications taken,
INDICATIONS blindness reflexes and muscle
Children ● Ears: ototoxicity strength, skin color,
● This age group is very related to nerve temperature,
sensitive to the effects damage texture, etc.) to
of most antiprotozoals ● Cinchonism establish baseline
and therefore more (nausea, data before drug
severe reactions can be vomiting, tinnitus, therapy begins, to
expected. and vertigo) may determine
● In addition, many occur with high effectiveness of
antivirals do not have levels of quinine therapy, and to
proven safety and or primaquine. evaluate for
efficacy in children. occurrence of any
adverse effects
Adults associated with drug
● This age group should therapy.
be well advised about (3) The nurse must
the need for prophylaxis perform ophthalmic
against various and retinal
protozoal infections and examinations and
the need for immediate auditory screening
treatment if disease is to determine the
contracted. need for cautious
● Administration of drug administration and
in pregnant and nursing to evaluate changes
women is only justified that occur as a
if benefits clearly result of drug
outweigh the risk. therapy.
● Women of childbearing (4) The nurse must
age are advised to use assess the patient’s
barrier contraceptives liver function,
when any antiprotozoal including liver
drug is being taken. function tests to
determine
Older adults appropriateness of
● Older patients are more therapy and to
susceptible to adverse monitor for toxicity.
effects of antiprotozoal (5) The nurse must
therapy, particularly obtain blood culture
those with hepatic and to identify the
 IRIS E. FRANCHE
BSN 2-C
renal dysfunctions.
Anthelmintic THERAPEUTIC ACTION: ● GI: abdominal
s ● They act on metabolic
pathways present in the
invading worm but are
absent or significantly ● CNS: headache,
different in the human
host.
● Immunologic:
INDICATION:
Children
● Culture of the
suspected worm is ● Albendazole is
important before
beginning any drug
therapy.
● Albendazole,
ivermectin, and
praziquantel are more
toxic so they are
avoided in children.
Instead, a chewable
preparation of
mebendazole is usually
given.
● Children may develop
serious GI effects
during therapy so
nurse’s focus must be
on nutritional status and
hydration.
Adults
● This age group might
be repulsed by the idea
that they have a worm
infestation, and they
may be reluctant to
discuss the needed
causative
Plasmodium
species and ensure
appropriate use of
the drug.
(1) The nurse must assess
discomfort, for the mentioned cautions
diarrhea, pain and contraindications (e.g.
known allergies, hepatorenal
dysfunction, pregnancy and
dizziness, lactation, etc.) to prevent
any untoward complications.
(2) The nurse must perform
fever, shaking, a thorough physical
chills, malaise, assessment (other
rash, pruritus, medications taken, reflexes
loss of hair and muscle strength, skin
color, temperature, texture,
etc.) to establish baseline
associated with data before drug therapy
severe bone begins, to determine
marrow effectiveness of therapy, and
depression and to evaluate for occurrence of
renal failure. any adverse effects
associated with drug
therapy.
(3) The nurse must assess
the patient’s liver function,
including liver function tests
to determine
appropriateness of therapy
and to monitor for toxicity.
(4) The nurse must obtain a
culture of stool for ova and
parasites to determine the
infecting worm and establish
appropriate treatment.
(5) The nurse must assess
the abdomen to evaluate for
any changes from baseline
related to the infection,
identify possible adverse
effects, and monitor for
improvement.
 IRIS E. FRANCHE
BSN 2-C

lifestyle adjustments
and treatment plans.
● Pregnant and nursing
women should not use
these drugs unless the
benefits clearly
outweigh the risks.
Potential risks must be
communicated to the
patients.

Older adults

● Older patients are more

susceptible to GI and
CNS adverse effects of
Anthelmintics therapy
particularly those with
hepatic and renal
dysfunctions.

Antineoplasti Carboplatin THERAPEUTIC ACTION: (1) The nurse must assess

c ●
● Protein tyrosine
kinase inhibitors act
on specific enzymes
that are needed for
protein building by
specific tumor cells.
Blocking of these
enzymes inhibits tumor
cell growth and division.
● Epidermal growth
factor inhibitors are
drugs that act on
epidermal growth factor
receptors which are
found in both normal ● Gefitinib:
and cancerous cells but
are more abundant on
the latter.
● Proteasome inhibitors
are drugs indicated for
inhibition of proteasome ● Pazopanib: some
Imatinib: GI for the mentioned cautions
upset, muscle and contraindications (e.g.
cramps, heart drug allergies, hepatorenal
failure, fluid impairment, bone marrow
retention, skin suppression, pregnancy and
rash. Severe lactation, etc.) to prevent
adverse effects any untoward complications.
of traditional (2) The nurse must perform
antineoplastic a thorough physical
therapy (severe assessment (other
bone marrow medications taken,
depression, orientation and reflexes, vital
alopecia, severe signs, bowel sounds, etc.) to
GI effects) do not establish baseline data
occur. before drug therapy begins,
to determine effectiveness
potentially of therapy, and to evaluate
severe interstitial for occurrence of any
lung disease and adverse effects associated
various eye with drug therapy.
symptoms (3) The nurse must monitor
result of laboratory tests
bone marrow such as CBC with
IRIS E. FRANCHE
BSN 2-C

in human cells, a large depression, differential to identify

protein complex that diarrhea, possible bone marrow
works to maintain cell hypertension, suppression and toxic drug
homeostasis and and liver effects and establish
protein production. impairment, appropriate dosing for the
change in hair drug; and liver and renal
color function tests to determine
● Lapatinib: need for possible dose
diarrhea, liver adjustment and identify toxic
INDICATIONS: impairment, drug effects.
altered heart
● Imatinib, the first drug function
approved protein ● Erlotinib and
tyrosine kinase inhibitor, bortezomib:
is given orally and is cardiovascular
approved to treat events,
chronic myelocytic pulmonary
leukemia (CML). It toxicity
selectively inhibits the ● Bortezomib:
Bcr-Abl tyrosine kinase peripheral
created by the neuropathy, liver
Philadelphia and kidney
chromosome impairment
abnormality in CML.
● Bortezomib is used for
the treatment of multiple
myeloma in patients
whose disease had
progressed after two
standard therapies.

References

https://nurseslabs.com/anti-infective-agents/
https://nurseslabs.com/antibiotics/
https://nurseslabs.com/antiviral-drugs/
https://nurseslabs.com/antifungals/
https://nurseslabs.com/antiprotozoal-drugs/
https://nurseslabs.com/antiprotozoal-drugs/
https://nurseslabs.com/anti-infective-agents/
https://nurseslabs.com/anthelmintics/
https://nurseslabs.com/antineoplastic-agents/