ANTI-TUBURCULAR [Publish Date]

ANTI-FUNGAL/ANTIVIRAL

Anti-Tubercular
These drugs are found throughout the world, mostly in
underdeveloped nations they are mostly used to treat tuberculosis.
• Tuberculosis is a Highly communicable (spreadable) disease caused by
mycobacterium it mainly effects the lungs and also bones bladder and kidneys or
other body parts It’s a respiratory infection that causes inflammation and bacteria
within the lung tissue and it is spread through aerosol transmission by
humans ,cows, and birds this infection Requires N95 Mask when treating clients.
Culture and sensitivity test must be done also a chest x-ray in order to diagnose.
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Remember the patient’s room should always be a negative pressured room.
Some people are exposed to it but due to a strong immune system they’re body
only recognizes it builds a wall and doesn’t let it in these people will show a
positive tb result this type of infection is called latent it is inactive, not contagious
and has no symptoms. If they’re immune system weakens they are still able to get
secondary tb.
Active= Infected showing signs (more seen in underdeveloped countries)
Symptoms-night sweats and chills, productive cough, bloody/rusty sputum
Latent= Inactive dormant no signs
Symptoms- none not contagious shows nothing on scan Treatment for 2-10
weeks may still be necessary.

Active TB RISK FACTORS ARE

• Those in constant, frequent
contact with a person with active
untreated TB • Those with immune dysfunction or
infection with human immune
deficiency virus • People who live in crowded areas
(long-term care facilities, prisons,
mental health facilities) • Older adults and homeless people • Abusers of injection drugs
or alcohol.
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ANTI-FUNGAL/ANTIVIRAL

NOTES:
THERE ARE 4 ANTITUBERCULAR DRUGS USED IN COMBO TO TREAT &
PREVENT ACTIVE TB THAT IS UNCOMPLICATED…
THESE ARE CALLED 1ST LINE DRUGS & TREATMENT LAST 6 MONTHS OR
LONGER
WHILE RECEIVING THERAPY AND SYMPTOMS ARE FREE PATIENTS’ MAY NO
LONGER BE INFECTIOUS TO OTHERS

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THE 1ST FOUR DRUGS ARE ISONIAZID(INH), RIFAMPIN,PYRAZINAMIDE &

ETHAMBUTOL THEY ARE GIVEN FOR 8 WEEKS THEN INH&RIFAMPIN THE LAST
18 WEEKS

Susceptibility tests are required because usually those who have caught tb due to
drug use get MDR-TB meaning multi drug resistant organisms are present when 2
of the 4 first line drugs do not work this is usually why. In this case 2nd line drugs
are introduced such as 2nd line oral Fluoroquinolone and
2nd line injectables, amikacin, kanamycin & capreomycin
The most rare TB is XDR-TB this is resistant to isoniazid rifampin and
fluoroquinolones and the 2nd line injectables ** patients usually have poor
outcomes**
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ANTI-FUNGAL/ANTIVIRAL

1ST LINE DRUGS ROUTE:PO

ISONIAZID,RIFAMPIN,PYRAZINAMIDE,ETHAMBUTOL
ASSESSMENT: It is highly important that the patient is on
board with TB treatment and consistent w meds.
USED FOR: 1st line treatment/prevention
ACTION: Stops mycobacterium spread, and new cell walls being built by killing and
then suppressing symptoms
They are Bactericidal, Bacteriostatic and Chemoprophylaxis( used to prevent
disease) HAVE INTRA AND EXTRACELLULAR EFFECTS
NO ALCOHOL NO ANTACIDS/ACETAMINOPHEN WITH THESE DRUGS AND
SUNSCREEN IS ENCOURAGED WHILE AVOIDING SUN
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ISONIAZID -KILLS mycobacterium & stops dormant growth halting replication for
latent tb bactericidal. PO/IM
ADVR’S: GI, Hepatotoxicity, tingling n numbness, dizziness, ataxia hepatic labs
need to be done.
CONSIDERATIONS/TEACHING: no antacids/acetaminophen, take on empty
stomach 1hr ac/2 hrs aftermeal to absorb well. Take vitamin B this drug
depletes it causing the numbness/tingling. Report any yellowing bruising, or
dark urine liver toxicity risk
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RIFAMPIN -KILLS slow dormant growth alters cell rna to treat
ADVR’S: Hepatitis (Jaundice, GI, tenderness in RUQ)
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ANTI-FUNGAL/ANTIVIRAL

CONSIDERATIONS/TEACHING: Orange body fluid discoloration may occur

contacts can be stained, check glucose levels fluctuations can occur, IV if no PO
and doses should be mixed and given slowly to prevent shock.
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PYRAZINAMIDE-KILLS organisms in acidic isolated dormant environments slows
growth (this one is used in combo)
ADVR’S: acidic so GI upset,
CONSIDERATIONS/TEACHING: Sunscreen, 8oz of water, check for gout, no
alcohol and report dark urine &yellowing of skin or eyes also check for bleeding
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ETHAMBUTOL-STOPS rna synthesis by suppression its very slow acting
bacteriostatic and( must be used in combo w anti-TB drugs

ADVR’S: GI upset, anorexia, abdominal cramps Confusion,

hallucination, blurred vision, red-
green vision changes

CONSIDERATIONS/TEACHING: Take w food (gi upset) drink with 8oz of water to

prevent acid precipitation worsening gout /kidneys, report any vision issues
immediately (optic neuritis risk) Check for gout the uric acid in it worsens it
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Antifungals
Usually end in azoles
Fungal infections are called mycosis or mycotic infections they can happen due to
inhalation or ingestion this infection can easily grow on skin and nails and can be
localized, or invasive…..EX: athletes’ foot is localized & (specific to an area) but
candidiasis is invasive (caused by yeast and systemically spread) these infections
are opportunistic and take over the immune system these drugs used are fungal
specific and will be prescribed specifically for yeast or mold.
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ANTI-FUNGAL/ANTIVIRAL

RISK ARE INCREASED DUE TO: PREGNANCY, BIRTH CONTROL, CORTICOSTEROIDS,

WOMAN TAKING ANTIBIOTICS, NEWBORNS & TRANSPLANT

DRUGS:
Ketoconazole (Nizoral) A Broad-spectrum fungistatic and fungicidal action
USED FOR: oral thrush, candidiasis, histoplasmosis

Nystatin (Myostatin) An Antibiotic with fungistatic and fungicidal action COMES IN

CREAM /POWDER FORM
USED FOR: intestinal, vaginal, and oral fungal infections caused by
Candida strains
**Nystatin must be shaken thoroughly before use.

FLAGYL (METRONIDAZOLE)
Used for mixed fungal and bacterial infections

Fluconazole (Diflucan)
• Action: Chemically related to ketoconazole and itraconazole; inhibits certain
metabolic pathways in fungi comes in oral form
• Uses: Treatment of
meningitis, candidiasis,
systemic candidiasis
• Common adverse effects:
Nausea, vomiting, diarrhea
• Serious adverse effects:
Rash, hepatotoxicity
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ANTI-FUNGAL/ANTIVIRAL

Amphotericin B (Aphotic) (iv daily for months)

• Action: This antifungal agent disrupts
fungal cell membrane, breaks the cell.
• Use: Treatment of systemic life-
threatening fungal infection
• Common adverse effects: Malaise, fever,
chills, headache, nausea, vomiting,
thrombophlebitis (infection to veins) alternate sites to prevent and push slowly
• Serious adverse effects: Nephrotoxicity,
electrolyte imbalance
Secondary infections usually occur …..monitor bun, GFR, hepatic levels
Griseofulvin
• USED FOR: ringworm (most commonly)
ADVRS: GI, abdominal cramps, urticaria, rash, pruritus, photosensitivity,
confusion, dizziness, nephrotoxicity, hepatotoxicity.
CONTRAINDICATIONS: Effect decreased with barbiturates.
• Metronidazole (Flagyl)
• Related drug for mixed fungal
and bacterial or protozoa
infections; interacts with
alcohol.
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ANTIFUNGAL CONSIDERATIONS/TEACHING
Take all the drug as ordered; do not stop when symptoms
disappear.
Avoid alcohol.
Report nausea, vomiting, and
diarrhea; watch for easy
bruising, sore throat, rash, or
fever. Intolerance to the sun (photosensitivity) can occur with griseofulvin
therapy. Cleanliness of hair, skin, and nails will limit spread.
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ANTI-FUNGAL/ANTIVIRAL

Antiprotozoal Drugs
Protozoa have a relationship to traveling infection sites in the body

Action:
To destroy and invade ameba
USED FOR: Treatment of intestinal and extraintestinal amebiasis
Drug choice depends on location.

ADVR’S: Nausea, vomiting, anorexia, diarrhea, GI

distress, hepatic abscess
Drug-specific adverse reactions
Overdose
INTERACTIONS:
Alcohol will produce severe headache, flushing, cramps, nausea, and vomiting.
• Nursing implications and patient teaching • No alcohol
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Anthelmintics
• Helminthiasis: Infestation by worms
• Common infestations:
• Pinworms
• Roundworms
• Hookworms
• Tapeworms
• Whipworms
• Action is drug-specific.
• Drugs used
• Thiabendazole
• Niclosamide and paromomycin
• Piperazine and pyrantel pamoate
• Diethylcarbamazine citrate
• Mebendazole
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Adverse reactions
• Drug-specific
• Allergic reaction due to dead microfilaria
• Drug interactions
• Anthelmintic drugs
work against each
other if they are given
together.