IMMUNE SYSTEM

• The immune system consists of specialized cells and structures that defend the body
against invasion by harmful organisms or chemical toxins.

HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

• Medications and their mechanism of action

o Nucleoside-nucleotide reverse transcriptase inhibitors
▪ Damage HIV’s DNA interfering with ability control host DNA
o Non-nucleoside reverse transcriptase inhibitors
▪ Prevent conversion of HIV RNA into HIV DNA
o Protease inhibitors
▪ Inhibits HIV protease preventing virus maturation
o Fusion inhibitors
▪ Work by inhibiting the binding of human immunodeficiency virus to cells.
• Standard treatment consists of using three or four medications in regimens known as highly
active antiretroviral therapy (HAART)
• This therapy is not curative but can delay or reverse loss of immune function, preserve
health, and prolong life. 1
• The client with HIV or AIDS is at high risk for the development of opportunistic infections.
• Nontherapeutic effects
o Anorexia, nausea and vomiting, diarrhea, headache, dizziness, vaginitis, moniliasis
o Additional effects depending on drug
▪ Confusion, skin eruptions, allergic response, neuropathies, nephrotoxicity,
blood dyscrasias, hepatotoxicity, CNS depression
• Nursing care
o Explain that gastrointestinal complaints and insomnia resolve after 3-4wk of
treatment
o Encourage sexual abstinence or use of safer sex practices
o Encourage routine medical supervision; blood studies every two months
o Refer to manufacturer’s insert about need to take with or without food and what to
do if a dose is missed
o Take medications exactly as prescribed; avoid over-the-counter medications;
compliance of 95% necessary to prevent resistance
o Assess for sign and symptoms of opportunistic infections
 o Assess for sign and symptoms of nephrotoxicity, hepatotoxicity, and blood
dyscrasias

MEDICATIONS FOR HIV AND AIDS

ANTIVIRALS
NUCLEOSIDE -NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIS)
Abacavir (Ziagen)
Nursing care
Abacavir; lamivudine
(Epzicom)
Didanosine (Videx)
Emtricitabine (Emtriva)
Emtricitabine; tenofovir
(Truvada)
Lamivudine (Epivir)
Lamivudine; zidovudine
(Combivir)
Lamivudine; zidovudine;
abacavir (Trizivir)
Stavudine (d4t, Zerit)
Tenofovir (Viread)
Zalcitabine (ddC, Hivid)
Zidovudine (Retrovir,
azidothymidine, AZT,
ZDV)
NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTI S)
Delavirdine (Rescriptor)
Efavirenz (Sustiva)
NON-THERAPEUTIC EFFECT
• Can cause nausea
• Monitor for hypersensitivity reaction, including fever,
nausea, vomiting, diarrhea, lethargy, malaise, sore throat,
shortness of breath, cough, and rash.
• Same with Abacavir non-therapeutic effect
• Hypersensitivity reactions, lactic acidosis, and severe
hepatomegaly.
• Nausea, diarrhea, peripheral neuropathy, hepatotoxicity,
and pancreatitis
• Headache, diarrhea, nausea, rash, hyperpigmentation of
the palms and soles, lactic acidosis, and severe
hepatomegaly 2
• Same with Emtricitabine non-therapeutic effect
• Lactic acidosis and severe hepatomegaly
• Nausea and nasal congestion
• Anemia and neutropenia and lactic acidosis with
hepatomegaly
• Hypersensitivity reactions, anemia, neutropenia, lactic
acidosis, and severe hepatomegaly can occur.
• Peripheral neuropathy and pancreatitis.
• Nausea and vomiting
• Oral ulcers, peripheral neuropathy, hepatotoxicity, and
pancreatitis
• Nausea, vomiting, anemia, leukopenia, myopathy,
fatigue, and headache
• Rash, liver function changes, and pruritis
• Rash, dizziness, confusion, difficulty concentrating,
 dreams, and encephalopathy
Etravirine (Intelence) • Rash, gastrointestinal disturbances, headache,
hypertension, and peripheral neuropathy
Nevirapine (Viramune) • Rash, Stevens- Johnson syndrome, hepatitis, and
increased transaminase levels
PROTEASE INHIBITORS (PIS)
Amprenavir; vitamin E • Nausea, vomiting, headache, altered taste sensations,
(Agenerase) perioral paresthesia, rashes, and increased results of liver
function studies.
Caution
• Oral solution contains an alcohol that can interact with
metronidazole (Flagyl); can cause feelings of inebriation.
Atazanavir (Reyataz) • Nausea, headache, infection, vomiting, diarrhea,
drowsiness, insomnia, fever, hyperglycemia,
hyperlipidemia, and increased bleeding in clients with
hemophilia
Fosamprenavir (Lexiva) • Same with Amprenavir non-therapeutic effect
• Nausea, vomiting, headache, altered taste sensations,
3
perioral paresthesia, rashes, and altered liver function
Indinavir (Crixivan) • Nausea, diarrhea, hyperbilirubinemia, nephritis, and
kidney stones
Lopinavir-ritonavir • Nausea, diarrhea, altered taste sensations, circumoral
combination (Kaletra) paresthesia, and hepatitis
Nelfinavir (Viracept) • Nausea, flatulence, and diarrhea
Ritonavir (Norvir) • Nausea, vomiting, diarrhea, altered taste sensations,
circumoral paresthesia, hepatitis, and increased
triglyceride levels
Saquinavir (Invirase) • Nausea, diarrhea, photosensitivity, and headache
Tipranavir (Aptivus) • Hepatotoxicity (liver damage); can also cause nausea,
vomiting, diarrhea, headache, and fatigue
INTEGRASE INHIBITOR
Raltegravir (Isentress) Mechanism of actions
• Stops HIV replication and is used in combination with
other antiretroviral medications
Side effects
• Nausea, diarrhea, fatigue, headache, and itching.
 CHEMOKINE RECEPTOR 5 (CCR5) ANTAGONIST
Maraviroc (Selzentry) Mechanism of action
• Binds with CCR5 and blocks viral entry
Side effect
• Cough, dizziness, pyrexia, rash, abdominal pain,
musculoskeletal symptoms, and upper respiratory tract
infections; liver injury, and cardiovascular events have
occurred in some clients.
FUSION INHIBITOR
Enfuvirtide (Fuzeon) • Skin irritation at injection site, fatigue, nausea, insomnia,
and peripheral neuropathy.
ANTI-INFECTIVE AND ANTI - INFLAMMATORY MEDICATIONS
Bactrim Indication
• Used to treat opportunistic infections such as
Pneumocystis jiroveci pneumonia; Toxoplasma
encephalitis is treated with sulfamethoxazole-
trimethoprim
ANTIFUNGAL MEDICATIONS
• Amphotericin B Indication
(Fungizone) • Used to treat candidiasis, cryptococcal meningitis 4

• Fluconazole
(Diflucan)
• Ketoconazole
(Nizoral)
ANTIVIRAL MEDICATIONS
• Acyclovir (Zovirax) Indication
• Foscarnet (Foscavir) • Used to treat cytomegalovirus retinitis, herpes simplex,

• Ganciclovir varicella-zoster virus

(Cytovene)

IMMUNOSUPPRESSANTS

• Mechanism of action
o Suppress the immune response and alter antibody formations.
• Indication
o Used in the treatment of clients with rheumatoid arthritis, multiple sclerosis.
o Used for transplant recipients to prevent organ or tissue rejection.
 o Treat autoimmune disorders such as systemic lupus erythematosus.
• Contraindication
o Contraindicated in clients with GI disorders, infection, bone marrow depression,
cancer, impaired liver or kidney function, and hyperlipidemia.
• Adverse effect
o Leukopenia, thrombocytopenia, nephrotoxicity, chest pain, dyspnea, wheezing,
fluid retention, vomiting, nausea, and diarrhea.
• Nursing care
o Practice isolation precautions to protect client from infection.
o Monitor vital signs, intake, and output.
o Assess for signs and symptoms of infection which can be fatal.
• Client teaching
o Encourage client to avoid crowds and to report any signs or symptoms of infection.
o Instruct client to use contraception while on immunosuppressant therapy.
o Flowers, plants, fresh fruit, and raw vegetables should be discouraged because of
infection risk.
o Emphasize importance of medication compliance.
5
IMMUNOSUPPRESSANTS
CALCINEURIN INHIBITORS
• Cyclosporine Indication
(Sandimmune, • Used for prevention of rejection following allogenic

Gengraf, Neoral) organ transplantation

Adverse effect
• Nephrotoxicity, infection, hypertension, and hirsutism.
Nursing care
• Usually administered with a glucocorticoid and another
immunosuppressant
• Tacrolimus Indication
(Prograf) • Used for prevention of rejection following liver or kidney
transplantation
Adverse effect
• Nephrotoxicity, neurotoxicity, gastrointestinal effects,
hypertension, hyperkalemia, hyperglycemia, hirsutism,
and gum hyperplasia.
 CYTOTOXIC MEDICATIONS
• Azathioprine Indication
(Imuran) • Used with renal transplant recipients
Caution
• Can cause neutropenia and thrombocytopenia
• Cyclophosphamide Indication
(Cytoxan, Neosar) • Used for its immunosuppressant action to treat
autoimmune disorders
Caution
• Can cause neutropenia and hemorrhagic cystitis
• Methotrexate Indication
(Rheumatrex, • Used for its immunosuppressant action to treat

Trexall) autoimmune disorders

Caution
• Can cause hepatic fibrosis and cirrhosis, bone marrow
suppression, ulcerative stomatitis, and renal damage
• Mycophenolate Indication
mofetil (CellCept) • Used to prevent rejection following kidney, heart, and

• Mycophenolic acid liver transplantation

Caution 6
(Myfortic)
• Diarrhea, vomiting, neutropenia, sepsis.
• Increased risk of infection and malignancies, especially
lymphomas
ANTIBODIES
• Basiliximab Indication
(Simulect) • Used to prevent rejection following kidney

• Daclizumab transplantation
Caution
(Zenapax)
• Severe acute hypersensitivity reactions, including
anaphylaxis
• Lymphocyte Indication
immune globulin • Used to prevent rejection following kidney, heart, liver,

• Antithymocyte and bone marrow transplantation

Side effects
globulin (equine)
• Fever, chills, leukopenia, and skin reactions.
Caution
• Can cause anaphylactoid reactions
• Muromonab-CD3 Indication
(Orthoclone OKT3) • Used to prevent rejection following kidney, heart, and
liver transplantation
Side effects
• Fever, chills, dyspnea, chest pain, nausea, and vomiting.
Caution
• Can cause anaphylactoid reactions
• Rho(D) immune Indication
globulin (RhoGAM) • To prevent isoimmunization in Rh-negative clients who
are exposed or potentially exposed to Rh-positive red
blood cells by transfusion, termination of pregnancy,
amniocentesis, chorionic villus sampling, abdominal
trauma, or bleeding during pregnancy or the birth
process.
Contraindication
• Contraindicated for Rh-positive clients
• Contraindicated in clients with a history of systemic
allergic reactions to preparations containing human
immunoglobulins 7
• Not administered to a newborn
Adverse effect
• Elevated temperature
• Tenderness at the injection site
Nursing care
• Rho(D) immune globulin (RhoGAM) is of no benefit
when the client has developed a positive antibody titer to
the Rh antigen
• Administer to the client by the intramuscular injection at
28 weeks’ gestation and within 72 hours after delivery.
• Never administer by intravenous route.
• Monitor for temperature elevation.
• Monitor injection site for tenderness.
OTHER
• Sirolimus Indication
(Rapamune) • Used to prevent renal transplant rejection
Caution
• Increases the risk of infection; raises cholesterol and
 triglyceride levels; can cause renal injury
Side effects
• Rash, acne, anemia, thrombocytopenia, joint pain,
diarrhea, and hypokalemia.

IMMUNIZATION

• Children who began primary immunizations at the recommended age but failed to receive
all the required doses do not need to begin the series again; they need to receive only the
missed doses.
• Recommended age for beginning primary immunizations of infants is at birth.
• If there is suspicion that the parent will not bring the child to the pediatrician or health
care clinic for follow-up immunizations, any of the recommended vaccines can be
administered simultaneously.
• Contraindications and precautions
o Contraindicated if the child experienced an anaphylactic reaction to a previously
administered vaccine or a component in the vaccine.
o Live virus vaccines generally are not administered to individuals with severely 8
deficient immune systems, individuals with a severe sensitivity to gelatin, or
pregnant women.
o A vaccine is administered with caution to an individual with a moderate or severe
acute illness, with or without fever.
o Children born prematurely should receive the full dose of each vaccine at the
appropriate chronological age.

VACCINES
VACCINES DESCRIPTION
Hepatitis B vaccine (HepB) Indication
• Protects against hepatitis B
Contraindications
• Severe allergic reaction to previous dose or vaccine
component (components include aluminum
hydroxide, yeast protein)
Precautions
• An infant weighing less than 2000 g or an infant with
moderate or severe acute illness with or without fever.
 Nursing care
• Administered by the intramuscular route
• The birth dose can be delayed in rare circumstances
if the infant’s mother tests negative for hepatitis B
surface antigen [HBsAg].
• Monovalent HepB or a combination vaccine containing
hepatitis B may be used to complete the series.
• HBsAg-positive mothers
o Infant should receive HepB vaccine and
hepatitis B immunoglobulin (HBIG) within 12
hours of birth.
o Infant should be tested for HBsAg and
antibody to HBsAg after completion of HepB
series (9 to 18 months of age).
• Mother whose HBsAg status is unknown
o Infant should receive the first dose of hepatitis
vaccine series within 12 hours of birth.
o Maternal blood should be drawn as soon as
9
possible to determine the mother’s HBsAg
status.
o If the mother’s HBsAg test result is positive,
the infant should receive HBIG as soon as
possible (no later than 1 week of age).
Rotavirus vaccine (RV) Description
• RotaTeq • Cause of serious gastroenteritis and is a nosocomial

• Rotarix (hospital-acquired) pathogen that is most severe in

children 3 to 24 months of age; children younger than
3 months have some protection because of maternally
acquired antibodies.
• Vaccine may be withheld if an infant is experiencing
severe vomiting and diarrhea; it is administered as
soon as the infant recovers
Administration
• Administered by the oral route because the vaccine
must replicate in the infant’s gut.
 Nursing care
• RotaTeq: three doses
o The first dose of the vaccine needs to be
administered at age 6 to 14 weeks
o The second is given 4 to 10 weeks after the
first dose
o The third is given 4 to 10 weeks after the
second dose (no later than 32 weeks of age).
• Rotarix: two doses
o The first dose of the vaccine needs to be
administered at age 6 to 14 weeks
o The second is given 4 weeks after the first
dose (series needs to be completed by 24
weeks of age).
Diphtheria, tetanus, Description
acellular pertussis (DTaP) • Tetanus toxoid; reduced diphtheria toxoid and
acellular pertussis vaccine (Tdap adolescent
preparation)
Indication 10
• Protect against diphtheria, tetanus, and pertussis
Contraindications
• Encephalopathy within 7 days of a previous dose or a
severe allergic reaction to a previous dose or to a
vaccine component.
Administration
• Intramuscular route
Complication
• Encephalopathy
Nursing care
• Td does not provide protection against pertussis.
• Td is used as a booster every 10 years after Tdap is
administered at 11 to 18 years of age.
Haemophilus influenzae Indication
type b conjugate vaccine • Protects against numerous serious infections caused

(Hib) by H. influenzae type b, such as bacterial meningitis,

epiglottitis, bacterial pneumonia, septic arthritis, and
sepsis
 Contraindications
• Severe allergic reaction to a previous dose or vaccine
component
Administration
• Intramuscular route
Nursing care
• Depending on the brand of Hib vaccine used for the
first and second doses, a dose at 6 months of age
(third dose) may not be needed.
• DTaP-Hib combination products should not be used
for primary immunization in infants at 2, 4, or 6
months of age, but can be used as the final dose in
children 12 months to 4 years of age.
Influenza vaccine Description
• Vaccine is recommended annually for children 6
months to 18 years of age.
Inactivated poliovirus Indication
vaccine (IPV) • IPV protects against polio
Contraindications
11
• Severe allergic reaction to a previous dose or vaccine
component; components may include formalin,
neomycin, streptomycin, or polymyxin B
Administration
• Subcutaneous route
• May also be given by the intramuscular route
Nursing care
• The last dose of the IPV should be administered on
or after age 4 years and at least 6 months after the
previous dose; additionally, if four doses are
administered before age 4 years, a fifth dose should
be administered at age 4 to 6 years.
Measles, mumps, rubella Indication
(MMR) vaccine • MMR protects against measles, mumps, and rubella.
Contraindications
• Severe allergic reaction to a previous dose or vaccine
component (gelatin, neomycin, eggs), pregnancy,
known immunodeficiency
 Caution
• If the child received immunoglobulin, the MMR vaccine
should be postponed for at least 3 to 6 months
(immunoglobulin can inhibit the immune response to
the MMR vaccine).
Administration
• Subcutaneous route
Nursing care
• Children who have not received the second dose
previously should complete the schedule at the 11- to
12-year-old pediatric or health care clinic visit.
Varicella vaccine Indication
• Varicella vaccine protects against chickenpox.
Contraindications
• Severe allergic reaction to a previous dose or vaccine
component (gelatin, bovine albumin, neomycin),
significant suppression of cellular immunity,
pregnancy
Administration
12
• Subcutaneous route
Nursing care
• Children 13 years old and older (who have not had
chickenpox or have not been previously vaccinated)
need two doses given at least 28 days apart.
• Children receiving the vaccine should avoid aspirin or
aspirin-containing products because of the risk of
Reye’s syndrome.
Pneumococcal conjugate Indication
vaccine (PCV) • Prevents infection with Streptococcus pneumoniae,
which may cause meningitis, pneumonia, septicemia,
sinusitis, and otitis media.
Administration
• Intramuscular route
Pneumococcal Recommended in addition to PCV for certain high-risk
polysaccharide vaccine groups, such as children with chronic illness specifically
(PPSV) associated with increased risk of pneumococcal disease or its
complications; anatomical or functional asplenia;
 hemoglobinopathies; nephrotic syndrome; cerebrospinal
fluid leaks; a cochlear implant; and conditions associated
with immunosuppression (PPSV is given at least 8 weeks
after the last dose of PCV).
Contraindications
• Severe allergic reaction to a previous dose or vaccine
component
Hepatitis A vaccine (HepA) Indication
• Vaccine protects against hepatitis A.
Contraindications
• Severe allergic reaction to a previous dose or vaccine
component.
Administration
• Intramuscular route
Meningococcal (MCV4) Indication
vaccine • Vaccine protects against Neisseria meningitidis.
Contraindication
• Children with a history of Guillain-Barre’ syndrome.
Administration
• Intramuscular route 13
Revaccination
• Recommended for children who remain at increased
risk after 3 years (if the first dose was administered at
age 2 to 6 years) or after 5 years (if the first dose was
administered at age 7 years or older).
Human papillomavirus Indication
vaccine (HPV) • Depending on the type of vaccine used (HPV2 or
HPV4), the HPV vaccine guards against diseases that
are caused by HPV types 6, 11, 16, and 18, such as
cervical cancer, cervical abnormalities that can lead to
cervical cancer, and genital warts.
Contraindication
• Individuals with a reaction to a previous injection and
in pregnant women.
Caution
• The vaccine can cause pain, swelling, itching, and
redness at the injection site; fever; nausea; and
dizziness.
• Reactions to a vaccine
o Local reactions
▪ Tenderness, erythema, swelling at injection site
▪ Low-grade fever
▪ Behavioral changes such as drowsiness, unusual crying, decreased appetite
▪ Nursing care to minimize local reactions
• Select a needle of adequate length to deposit vaccine deep into the
muscle or subcutaneous mass.
• Inject into the appropriate recommended site.
o Anaphylactic reactions
▪ Goals of treatment are to secure and protect the airway, restore adequate
circulation, and prevent further exposure to the antigen
▪ Nursing care
• Mild reaction with no evidence of respiratory distress or
cardiovascular compromise
o Subcutaneous injection of an antihistamine, such as
14
diphenhydramine (Benadryl), and epinephrine (Adrenalin)
may be administered.
• For moderate or severe distress
o Establish an airway
o Provide cardiopulmonary resuscitation if the child is not
breathing
o Elevate the head
o Administer epinephrine, fluids, and vasopressors as
prescribed
o Monitor vital signs
o Monitor urine output
• Guidelines for administration of vaccines
o Follow manufacturer’s recommendations for route of administration, storage, and
reconstitution of the vaccine.
o If refrigeration is necessary, store on a center shelf and not on the door; frequent
temperature changes from opening the refrigerator door can alter the vaccine’s
 potency.
o A vaccine information statement needs to be given to the parents or individual, and
informed consent for administration needs to be obtained.
o Check the expiration date on the vaccine bottle.
o Parenteral vaccines are given in separate syringes in different injection sites.
o Vaccines administered intramuscularly are given in the vastus lateralis muscle (best
site) or ventrogluteal muscle (the deltoid can be used for children 36 months and
older); the dorsogluteal site (buttocks) is avoided.
o Vaccines administered subcutaneously are given into the fatty areas in the lateral
upper arms and anterior thighs.
o Adequate needle length and gauge are as follows: intramuscular, 1 inch, 23-25
gauge; subcutaneous, ⅝ inch, 25 gauge (needle length may vary depending on the
child’s size).
o A topical anesthetic may be applied to injection site before the injection.
o For painful or red injection sites, advise the parent to apply cool compresses for the
first 24 hours, and then use warm or cold compresses as long as needed.
15
o An age-appropriate dose of acetaminophen (Tylenol) or ibuprofen (Motrin) may
be administered every 4 to 6 hours for vaccine-associated discomfort.
o Maintain an immunization record, document day, month, year of administration;
manufacturer and lot number of vaccines; name, address, title of person
administering the vaccine; and site and route of administration.
o A vaccine adverse event report needs to be filed and the health department needs
to be notified if an adverse reaction to an immunization occurs.
 • Priority nursing actions
o When administering a parenteral vaccine
1. Verify the prescription for the vaccine.
2. Obtain an immunization history from the parents to ensure that the
immunizations are up to date.
3. Assess for allergies because some vaccines contain components to which the
child may be allergic.
4. Provide information to the parents about the vaccine.
5. Obtain parental consent.
6. Check the lot number and expiration date and prepare the injection.
7. Select the appropriate site for administration.
8. Administer the vaccine.
9. Document the administration and site of administration and lot number and
expiration date of the vaccine.
10. Provide an updated vaccination record to the parents.

RECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATIONS IN THE US 16

AGE VACCINES
Birth Hepatitis B vaccine (HepB)
1 month HepB
2 months • Inactivated poliovirus vaccine (IPV)
• Diphtheria, Tetanus, acellular Pertussis (DTaP) vaccine
• Haemophilus influenzae type b conjugate vaccine (Hib)
• Pneumococcal conjugate vaccine (PCV)
• Rotavirus (RV)
4 months DTaP, Hib, IPV, PCV, RV
6 months DTaP, Hib, HepB, IPV, PCV, RV (dose may be needed
depending on type of vaccine used for first and second doses)
12-15 months • Hib
• Measles, mumps, rubella (MMR) vaccine
• PCV
• Hepatitis A, first dose (second dose is given 6 months
after the first dose)
• Varicella vaccine
15-18 months DTaP
18-21 months Hepatitis A, second dose (given 6 months after the first dose)
4-6 years • DTaP
• IPV
• MMR
• varicella vaccine
11-12 years • MMR (if not administered at 4-6 years)
• diphtheria, tetanus, acellular pertussis adolescent
preparation (Tdap)
• Meningococcal vaccine (MCV4)
• Human papillomavirus (HPV) (first dose to girls at age
11 to 12 years, second dose 2 months after first dose, and
third dose 6 months after first dose).

RECOMMENDED IMMUNIZATIONS IN THE PHILIPPINES

AGE VACCINES
Birth • Hepatitis B vaccine (HepB)
• BCG 17

• 1 ½ month Pentavalent vaccine

• 2 ½ month • DPT
• 3 ½ month • HepB
• Hib
• 1 ½ month Oral polio vaccine (OPV)
• 2 ½ month
• 3 ½ month
3 ½ month Inactivated polio vaccine (IPV)
• 1 ½ month Pneumococcal conjugate vaccine (PCV)
• 2 ½ month
• 3 ½ month
• 9 months Measles, mumps and rubella (MMR)
• 1 year
DIFFERENCE OF OPV AND IPV

DIFFERENCE OF OPV AND IPV

ORAL POLIO VACCINE (OPV) INACTIVATED POLIO VACCINE (IPV)
Composed of live, weakened viruses Composed of killed viruses
Given orally, by drops Given by injection
Given in 3 doses at 1½ months, 2½ months and Given in a one dose at 3½ months (14 weeks)
3½ months (6, 10 and 14 weeks) maximizes a child’s immunity when given in
addition to OPV
Provides immunity through the mucosa Provides immunity through the blood
(mouth and intestines)
Passes immunity from person-to-person Provides individual immunity only
Very low risk for Vaccine-Associated Paralytic No risk for VAPPs or cVDPVs
Poliomyelitis (VAPPs) or circulating Vaccine-
Derived Polioviruses (cVDPVs)

ANTIBIOTIC

• Mechanism of action
o Generally, work by being bactericidal (killing the bacteria) or bacteriostatic 18

(inhibiting bacterial growth).

• Considerations
o The type or kind of antibiotic is determined by the bacteria causing the infection.
o These medications do not work for illnesses caused by viruses or fungi.
• Indication
o Used to treat infections.
o Some antibiotics are considered broad-spectrum antibiotics because they can treat
a wide range of gram-negative and gram-positive organisms.
o Broad-spectrum antibiotics
▪ Used until the source of the infection is identified and then it is either
continued or the medication is switched to a bacteria-specific antibiotic.
• Caution
o Prolonged use of antibiotics can increase the client’s risk of superinfections, or
secondary infections
• Medications
o Penicillins (Amoxil, Timentin)
▪ Bind to cell wall leading to cell death
 o Cephalosporins (Keflex, Cefzil)
▪ Bind to cell wall causing cell death
o Aminoglycosides (Garamycin, Nebcin)
▪ Decreases protein synthesis
o Tetracyclines (Vibramycin, Terramycin)
▪ Inhibit bacterial protein synthesis
o Fluoroquinolones (Cipro, Levaquin)
▪ Decreases DNA synthesis
o Macrolides (Zithromax, Biaxin)
▪ Decreases protein synthesis
• Adverse effect
o Nausea, vomiting, and diarrhea.
• Nursing care
o Assess for allergies
o Specimen cultures should be obtained prior to antibiotic therapy
▪ First dose may be given while results are pending.
o Determine appropriate method of administration and provide instructions to the 19
client.
o Monitor intake and output.
o Encourage fluid intake (unless contraindicated).
o Initiate safety precautions because of possible central nervous system effects.
o Medication should be given around the clock to maintain a therapeutic blood level.
o Penicillins and cephalosporins may inactivate aminoglycosides and should be given
separately.
o Monitor kidney and liver function studies, because the kidneys and liver are where
most antibiotics are metabolized.
o Monitor for adverse effects and report to physician if any occur.
o Assess for signs of superinfection: Furry overgrowth on tongue, vaginal discharge,
foul-smelling stools
o Peak and trough levels should be monitored on the client receiving aminoglycosides.
o Do not crush/chew extended-release tablets
• Client teaching
o Emphasize the importance of completing the full prescribed course.
 o Women who are taking oral contraceptives should use an alternate method of
contraception (especially while taking any of the penicillin or tetracycline drugs.)
o Including yogurt in the diet can alleviate diarrhea caused by antibiotics.
o Avoid alcohol consumption during antibiotic therapy.

ANTIBIOTICS
ANTIBIOTICS ADVERSE EFFECTS
Aminoglycosides • Ototoxicity
• Amikacin (Amikin) • Confusion, disorientation
• Gentamicin (Garamycin) • Renal toxicity
• Kanamycin (Kantrex) • Gastrointestinal irritation
• Neomycin (Neo-Fradin) • Palpitations, blood pressure changes
• Streptomycin • Hypersensitivity reactions
• Tobramycin (Nebcin)
Cephalosporins • Gastrointestinal disturbances
• Cefaclor (Ceclor) • Pseudomembranous colitis
• Cefadroxil (Duricef) • Headache
• Cefazolin (Ancef, Kefzol) • Dizziness
• Cefdinir (Omnicef) • Lethargy 20
• Cefditoren (Spectracef) • Paresthesias
• Cefepime (Maxipime) • Nephrotoxicity
• Cefotaxime (Claforan) • Superinfections
• Cefotetan (Cefotan)
• Cefoxitin (Mefoxin)
• Cefpodoxime (Vantin)
• Cefprozil (Cefzil)
• Ceftazidime (Ceptaz, Fortaz,
Tazicef)
• Ceftibuten (Cedax)
• Ceftizoxime (Cefizox)
• Ceftriaxone (Rocephin)
• Cefuroxime (Ceftin)
• Cephalexin (Keflex)
• Loracarbef (Lorabid)
Fluoroquinolones • Headache
• Ciprofloxacin (Cipro) • Dizziness
 • Gatifloxacin (Tequin)
• Gemifloxacin (Factive)
• Levofloxacin (Levaquin)
• Lomefloxacin (Maxaquin)
• Moxifloxacin (Avelox)
• Norfloxacin (Noroxin)
• Ofloxacin (Floxin)
• Trovafloxacin (Trovan)
Macrolides
• Azithromycin (Zithromax)
• Clarithromycin (Biaxin)
• Dirithromycin (Dynabac)
• Erythromycin
Lincosamides
• Clindamycin (Cleocin)
• Lincomycin (Lincocin)
Monobactam
• Aztreonam (Azactam)
Penicillins
• Amoxicillin (Amoxil)
• Ampicillin (Principen)
• Carbenicillin (Geocillin)
• Penicillin G (Bicillin L-A,
Permapen, Pfizerpen,
Wycillin)
• Penicillin V (Veetids)
• Piperacillin
• Ticarcillin (Ticar)
Penicillinase-Resistant Penicillins
• Dicloxacillin
• Nafcillin
• Oxacillin
Sulfonamides
• Sulfamethoxazole
• Insomnia
• Depression
• Gastrointestinal effects
• Bone marrow depression
• Fever
• Rash
• Photosensitivity
• Gastrointestinal effects
• Pseudomembranous colitis
• Confusion, abnormal thinking
• Superinfections
• Hypersensitivity reactions
• Gastrointestinal effects
• Pseudomembranous colitis
• Bone marrow depression
• Gastrointestinal effects
• Hepatotoxicity 21
• Allergic reactions
• Gastrointestinal effects, including sore mouth
and furry tongue
• Superinfections
• Hypersensitivity reactions, including
anaphylaxis
• Gastrointestinal effects
• Hepatotoxicity
 • Sulfadiazine • Nephrotoxicity
• Sulfasalazine • Bone marrow depression
• Sulfisoxazole • Dermatological effects
• Trimethoprim o Hypersensitivity and photosensitivity
• Sulfamethoxazole (TMP- • Headache, dizziness, vertigo, ataxia, depression,
SMZ; Bactrim, Cotrim, seizures
Septra)
Tetracyclines • Gastrointestinal effects
• Demeclocycline • Hepatotoxicity
(Declomycin) • Teeth (staining) and bone damage
• Doxycycline (Vibramycin) • Superinfections
• Minocycline (Minocin) • Dermatological reactions,
• Oxytetracycline o Rash and photosensitivity
(Terramycin) • Hypersensitivity reactions
• Tetracycline (Sumycin)
Antimycobacterials • Gastrointestinal effects
• Antituberculosis agents • Neuritis
Leprostatics
• Dizziness 22
• Clofazimine (Lamprene) and
• Headache, malaise, drowsiness
dapsone
• Hallucinations

ANTIFUNGAL MEDICATION

• Mechanism of action
o Work by altering permeability of fungal cell membranes and either killing the cell
or inhibiting growth by preventing reproduction of the cell.
• Indication
o Used in the treatment of systemic or topical fungal infections, such as ringworm
and Candida infections.
• Medication
o Topical
▪ Mechanism of action
• Disrupt fungal cell wall and metabolism
▪ Medications
• Amphotericin B (Amphocin, Fungizone)
• Clotrimazole (Lotrimin)
 • Ketoconazole (Nizoral)
• Nystatin (Mycostatin)
▪ Nontherapeutic effects
• Burning, irritation
o Systemic
▪ Mechanism of action
• Impair fungal plasma membrane
▪ Medications
• Clotrimazole (Gyne-Lotrimin, Mycelex)
• Fluconazole (Diflucan)
• Nystatin (Mycostatin)
▪ Nontherapeutic effects
• Renal, liver, and ototoxicity, teratogenic, fluid and electrolyte
imbalance, nausea and vomiting, diarrhea, rash, fever
• Nursing care
o Specimens for culture and sensitivity need to be obtained prior to starting
antifungal therapy. 23
o Administer medication around the clock to achieve therapeutic level.
o Monitor renal and liver function studies with systemic antifungal medications due
to the risk of toxicity.
o Amphotericin B should be infused via infusion pump and with close monitoring of
the client.
o Systemic
▪ Monitor for nephrotoxicity, hepatotoxicity, ototoxicity
▪ Complete entire regimen
▪ Prevent pregnancy
▪ Monitor for hypoglycemia in clients with DM
o Topical
▪ Monitor for irritation
▪ Clean skin with tepid water before application
▪ Teach how to use/insert medication and to abstain from intercourse
• Client teaching
o Take this medication for the prescribed time even if you are feeling better or
 symptoms have disappeared.
o Do not cover infected area with an occlusive dressing.

ANTIVIRAL MEDICATIONS

• Viruses are microorganisms that can only reproduce inside a host cell.
• Mechanism of action
o By halting reproduction of virus inside the host cell, the concentration of the virus
becomes small enough that the client’s immune system can eliminate it from the
body.
• Indication
o Antiviral medications are used to treat viral disorders such as herpes simplex,
shingles, chickenpox (varicella), influenza A and B, cytomegalovirus, and HIV.
• Medication
o Acyclovir (Zovirax)
▪ Mechanism of action
• Decrease viral DNA synthesis
▪ Indication
• Herpes viruses: simplex, genitalis, zoster, varicella 24
o Amantadine (Symmetrel)
▪ Mechanism of action
• Stopping growth of the flu virus
▪ Indication
• Prevent or treat a certain type of flu (influenza A)
o Zidovudine (AZT Retrovir)
▪ Mechanism of action
• Inhibiting the enzyme reverse transcriptase that HIV uses to make
DNA and therefore decreases replication of the virus
▪ Indication
• Antiretroviral medication used to prevent and treat HIV/AIDS
o Oseltamivir (Tamiflu)
▪ Mechanism of action
• Decrease entry of virus into host
▪ Indication
• Influenza type A
 o Ganciclovir (Cytovene)
▪ Mechanism of action
• Decrease viral DNA synthesis
▪ Indication
• Cytomegalovirus
• Nontherapeutic effects
o Anorexia, nausea and vomiting, diarrhea, headache, dizziness, vaginitis, moniliasis
o Depending on drug
▪ Confusion, skin eruptions, allergic response, neuropathies, nephrotoxicity,
hepatotoxicity, blood dyscrasias, CNS depression
• Nursing care
o Obtain C&S before starting therapy
o Take medication exactly as ordered to maintain therapeutic blood levels
o Avoid over-the-counter medications
o Assess for sign and symptoms of nephrotoxicity, hepatotoxicity, and blood
dyscrasias
o Assess for sign and symptoms of opportunistic infections
25
o Oseltamivir
▪ Begin treatment as soon as sign and symptoms appear
▪ Give at least 4hr before hours of sleep to decrease insomnia
o Acyclovir, valacyclovir
▪ Take for pain/pruritus, which usually occurs before eruptions
▪ Increase fluids to 3L per day
▪ Herpes genitalis
• Increase risk for cervical cancer,
• Avoid sexual activity during exacerbations
o Ganciclovir
▪ Give with food
▪ Assess for neutropenia, thrombocytopenia, photosensitivity, decrease visual
acuity
▪ Ensure regular ophthalmological exams
▪ Avoid pregnancy during and for 90 d after treatment (teratogenic)
▪ May cause infertility
o Administer IV mixtures by infusion pump.
 o Monitor renal and liver function studies for possible nephrotoxicity and
hepatoxicity.
o If treating lesions, assess daily for resolution.
o Maintain adequate fluid intake.
o Antiviral medications do not prevent the transmission of the viruses so universal
precautions should be practiced.
• Client teaching
o Teach proper medication administration technique.
o Teach client infection control methods to prevent the transmission of the virus to
others.

ANTIPARASITIC MEDICATIONS

• Parasiticidal
o Mechanism of action
▪ Directly absorbed into parasites and eggs (for scabies and lice)
o Medication
▪ Lindane (Kwell)
26
▪ Nontherapeutic effects
• CNS toxicity and seizures
▪ Permethrin (Nix)
▪ Nontherapeutic effects
• Pruritus, tingling
• Anthelmintic
o Mechanism of action
▪ Prevents worm growth and reproduction (for pinworms)
o Medication
▪ Mebendazole (Vermox)
▪ Nontherapeutic effects
• Hypersensitivity (rash, anaphylaxis) abdominal pain
• Nursing care
o Wash bedding, clothes, etc., in hot water and dryer
o Vacuum carpets/furniture
o Seal nonwashables in plastic bags for two weeks
o Treat all family members
o Pediculosis/scabies
▪ Use gown, gloves, hair cap when giving care
▪ Scrub body with soap and water, dry, apply medication
▪ Avoid wounds, mucous membranes, face, eyes
o Pinworms
▪ Obtain specimen via cellophane tape test in AM
▪ Monitor perianal condition and for GI distress
▪ Teach handwashing before meals and after toileting
o Head lice
▪ Shampoo for 5min
▪ Use fine-tooth comb to remove eggs

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