Hepatitis B Vaccine

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Interferon alfa-2b
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Ibuprofen (Motrin)
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Prednisone
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Acetaminophen (Tylenol)
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Penicillin G
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Gentamicin (Garamycin)
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Trimethoprim-Sulfamethoxazole (Bactrim DS)

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Isoniazid (INH)
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Cefazolin (Ancef)
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Vancomycin (Vanocin)
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Fluconazole (Diflucan)
Therapeutic Classification Antifungal Use: Pharmacologic Classification Inhibitor of fungal cell membrane synthesis; -azole

Action: Interferes w/ the synthesis of ergosterol. Rapidly and completely absorbed when given orally is particularly effective against Candida albicans. Can penetrate most to reach infections in the CNS, bone, eye, urinary tract and respiratory tract. Admin Alerts: Do not mix IV fluconazole w/ other drugs. Preg = C.

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AEs: N/V/D at high doses. Pts w/ hepatic impairment should be monitored carefully for hepatotoxicity. Stevens-Johnson syndrome have been reported in pts w/ immunosuppression. Nursing Actions: Interactions:

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Amphotericin B (Fungizone)
Therapeutic Classification Pharmacologic Classification Antifungal (systemic type) Polyene Use: Broad spectrum use against most of the fungi pathogenic to humans. Preferred drug for many systemic mycoses. Porphylactic antifungal therapy for pts w/ severe immunosuppression. Action: Binds to ergosterol in fungal cell membranes, causing them to become permeable or leaky. Admin Alerts: Infuse slowly b/c cardiovascular collapse may result if the med is infused too rapidly. Admin premedication, such as acetaminophen, antihistamines, and corticosteroids, to decrease the risk of hypersensitivity reactions. Withhold the drug if the BUN exceeds 40 mg/dL or serum creatinine rises above 3 mg/dL. Preg = B. AEs: Fever, chills, vomiting, h/a, nephrotoxicity, hypokalemia, cardiac arrest, hypoTN, dysrythmias. Phlebitis w/ IV therapy. Nursing Actions: Can cause ototoxicity: assess for hearing loss, vertigo, unsteadying gait & tinnitus. Contraindicated b/c of hypersensitivity. Caution w/ pts w/ renal impairment. Increases values of serum creatinine, alkaline phosphatase, BUN, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). May decrease values for serum potassium, calcium, and magnesium. Interactions: Use w/ corticosteroids, muscle relaxants, and thiazloe may potentiate hypokalemia. Use w/ digoxin cause digoxin toxicity in pts with pre-existing hypokalemia. OD can cause cardiorespiratory arrest.

Metronidazole (Flagyll)
Therapeutic Classification Pharmacologic Classification Anti-infective, antiprotozoan Drug that disrupts nucleic acid synthesis Use: Tx for most forms of amebiasis. Preffered drug for giardiasis and trichomoniasis. Tx against anaerobic bacteria and used to treat a number of respiratory, bone, skin and CNS infections. Tx of rosacea. Off-label use for pseudomembranous colitis & Crohns disease. Action: Disrupts DNA & protein synthesis in susceptible organisms. Bactericidal, thrichomonacidal, or amebicidal action. Admin Alerts: The extended-release form must be swallowed whole and taken on an empty stomach. Metronidazole is contraindicated during the 1st trimester of pregnancy. Preg = B.

AEs: Anorexia, nausea, diarrhea, dizziness, and headache. Dry mouth, metallic taste. Rarely causes bone marrow suppression. Black Box Warning: Carcinogenic in laboratory animals and should be used only for approved indications Nursing Actions: May decrease values for AST and ALT. Contraindicated in pts w/ trichomoniasis during 1st trimester of pregnancy & those w/ hypersensitivity to the drug. Can cause bone marrow suppression contraindicated in pts w/ blood dyscrasias. Interactions: Interacts w/ oral anticoagulants to potentiate hypoprothrombinemia. Use w/ ETOH may elicit a disulfiram reaction. In pts who are taking lithium, may elevate lithium levels.

Chlorquine (Aralen)
Therapeutic Classification Pharmacologic Classification Antimalarial drug Heme complexing agent Use: Drug of choice for prophylaxis and tx of malaria. Effective for the erythrocytic stage but no activity against latent Plasmodium. Off-label use for tx of rheumatic & inflammatory disorder: lupus erythematosus & rheumatoid arthritis. Prevents malaria by being administer 2 weeks before the pt enters an endemic are. Action: Concentrates in the food vacuoles of Plasmodium residing in RBCs. Once there, it prevents the metabolism of heme and then builds to toxic levels w/in the parasite. Admin Alerts: Pediatric dosage should be monitored closely; b/c children are susceptible to OD. Aspirate to prevent irritating effects to tissues when admin IM. Preg = C. AEs: N/D, confusion, convulsions, reduced reflexes, hypoTN and dysrhythmias. . At higher doses, CNS & cardiovascular toxicity may be observed. Can cause retinal toxicity, including blurred vision, photophobia and difficulty focusing. Resistance to chlorquine is common.

Zidovudine (Retrovir, AZT)

Therapeutic Classification Pharmacologic Classification Antiretroviral Nuceloside reverse transcriptase inhibitor (NRTI) Use: Used in combination w/ other antiretrovirals for symptomatic and asymptomatic pts who are infected w/ HIV as well as for postexposure prophylaxis in health care workers who have been exposed to HIV. An important indication is reduction of the reisk of transmission rate of HIV from a mother who is HIV+ to her fetus. Action: Structurally resembles thymidine, one of four nucleoside building blocks of DNA. As the reverse transcriptase enzyme begins to synthesize viral DNA, it mistakenly uses zidovudine as one of the nucleosides, thus creating a defective DAN strand. Admin Alerts: Admin on empty stomach w/ water only. Avoid administering w/ fruit juice. Preg = C. AEs: H/A, fatigue, generalized weakness, anorexia, N/D and other CNS effects. Black Box Warning: Fatal lactic acidosis w/ hepatomegaly and steatosis have been reported. Bone marrow suppression may result in neutropenia or severe anemia. Myopathy may occur w/ long-term use. Nursing Actions: Hypersensitivity is the only contraindication. Use w/ caution in pts w/ pre-existing anemia or neutropenia. Monitor blood counts & other blood tests to prevent hematologic toxicity. Renal dosing. Interactions: Avoid other drugs that suppress bone marrow function. Use w/ other antiretroviral agents may cause lactic acidose and severe hepatomegaly w/ steatosis. WBC & Hgb may decrease due to neutropenia & anemia. Use w/ caution w/ herbal supplements (St. Johns wort). May increase AZT toxicity: atovaquone, amphotericin B, aspirin, doxorubicin, fluconazole, methadone, and valporic acid.

Nursing Actions: Contraindicated in pts w/ renal impairment and those w/ hypersensitivity to the drug. Interactions: Antacids & laxatives containing aluminum and magnesium can decrease chloroquine absorption & must not be given within 4 hrs of each other. May interfere w/ the response to rabies vaccine. OD may be fatal.

Acyclovir (Zovirax)
Therapeutic Classification Pharmacologic Classification Antiviral for herpesviruses Nucleoside analog Use: Drug of choice for herpesviruses. Most effective against HSV-1 and HSV-2 or at high doses against CMV and varicella zoster. Action: Prevents viral DNA synthesis and thus decreases the duration and severity of acute herpes episodes. Prophylactic tx may decrease the frequency of herpes appearance but does not cure the pt. Admin Alerts: IV may cause painful inflammation of vessels at the site of infusion. Admin around the clock, even if sleep is interrupted. Admin w/ food. Preg = C. AEs: Few AE when admin topically or orally. Nephrotoxicity and neurotoxicity are possible when med is given IV. Resistance has developed to the drug, particularly in pts with HIV-AIDS. Nursing Actions: Contraindicated in pts w/ hypersensitivity to drugs in this class. BUN and serum creatinine levels may increase. Interactions: Avoid concurrent use w/ nephrotoxic agents. Probenecid decrease acyclovir elimination and sidovudine may cause increased drowsiness and lethargy.

Oseltamivir Phosphate (Tamiflu)

Therapeutic Classification Pharmacologic Classification Antivirals Neuramidase inhibitors Use: Tx of uncomplicated acute illness d/t influenza infection in adults and children >1 yr who have had symptoms for <2 days. Prevention of influenza in pts >1. Action: Inhibits the enzyme neuraminidase, which may alter virus particle aggregation and release. Reduced duration or prevention of flu-related symptoms.

Admin Alerts: Use correct oral dosing device for measuring oral solution to prevent med errors. AEs: Seizures, abnormal behavior, agitation, confusion, delirium, hallucinations, insomnia, nightmares, vertigo, bronchitis, N/V. Nursing Actions: Admin w/ food or milk to minimize GI irritation. Monitor influenza symptoms (sudden onset of fever, cough, h/a, fatigue, muscular weakness, sore throat). Interactions: May decrease the therapeutic effect of influenza virus vaccine avoid use 2 days prior to and 2 weeks after vaccine administration.

Generic Name (Trade Name)

Therapeutic Classification Use: Action: Pharmacologic Classification

Generic Name (Trade Name)

Therapeutic Classification Use: Action: Pharmacologic Classification

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