Chapter 8 • Interfere with steps involved in protein

synthesis
Anti-infective Agents
• Interfere with DNA synthesis
Development of Anti-infective Therapy
• Alter the permeability of the cell
• 1920s
membrane to
– Paul Ehrlich worked on developing a
allow essential cellular components to leak
synthetic chemical effective against out

infection-causing cells only Anti-infective Activity

– Scientists discovered penicillin in a mold • Anti-infectives vary in their effectiveness

against
sample
invading organisms
• 1935
• Some are selective: they are effective only
– The sulfonamides were introduced for a small number of organisms
Anti-infective agents • Bactericidal: kill the cell
• Drugs that are designed to act selectively • Bacteriostatic: prevent reproduction of the
on cell, some are not as aggressive against
foreign organisms that have invaded & invading

infected the body of a human host. organism they just interfere w/ the ability of
the cells to reproduce or divide
• They possess selective toxicity- the ability
to Narrow Spectrum vs Broad Spectrum

affect certain CHONs or enzyme systems • Narrow spectrum of activity

that are used by the infecting organism but – Effective against only a few
microorganisms
not by human cell.
with a very specific metabolic pathway or
Mechanisms of Action
enzyme
• Interfere with biosynthesis of the bacterial
cell • Broad spectrum of activity

wall ( penicillins work in this way) – Useful in treating a wide variety of

infections
• Prevent the cells of the invading organism
from Human Immune Response

using substances essential to their growth • Goal of anti-infective therapy is reduction

and of the

development population of the invading organism

• Drugs that eliminate all traces of any •HELP !!!!
invading
•Immunocompromised patients
pathogen might be toxic to the host as well
cope with infections

• Immune response is a complex process

•Prevention of infection
involving
•Proper nutrition
chemical mediators, leukocytes,
lymphocytes, Resistance
antibodies, and locally released enzymes • Anti-infectives act on a specific enzyme
and chemicals system or biological process; many
microorganisms that
Chemical mediator
do not act on a specific system are not
-Mast cells release histamines when the
affected by the particular drug
allergen is encountered
• This is considered natural or intrinsic
HUMAN IMMUNE RESPONSE
resistance to that drug
•When this response is completely
Acquired Resistance
functional & all of the necessary
• Microorganisms that were once sensitive
proteins, cells, and chemicals are to the

being produced by the body, it can particular drug have begun to develop
acquired resistance
isolate & eliminate foreign CHONs,
• This results in serious clinical problems
including bacteria, fungi & viruses.
Ways Resistance Develops
Problems With Treating Infections in
• Producing an enzyme that deactivates the
Immunosuppressed Patients
antimicrobial drug
• Anti-infective drugs cannot totally eliminate
the •Changing cellular permeability to prevent
the drug from entering the cell or altering
pathogen without causing severe toxicity in
transport systems to exclude the drug from
the
active transport into the cell.
host
•Altering transport systems to exclude
• These patients do not have the immune
the drug from active transport into the
response
cell
in place to deal with even a few invading
•Altering binding sites on the
organisms
membranes or ribosomes, which then
Immunosuppressed patients
no longer accept the drug • Along with a culture, identifies the
pathogen and appropriate drug for
•Producing a chemical that acts as an
treatment
antagonist to the drug
Factors Affecting Prescribing
Preventing Resistance
Anti-infective Agents

• Identification of the correct pathogen

• Limit the use of antimicrobial agents to the
• Selection of the right drug
treatment of specific pathogens sensitive to
– One that causes the least complications
the drug being used
for that particular patient
• Make sure doses are high enough, and
– One that is most effective against the
the duration of drug therapy long enough
pathogen involved
• Be cautious about the indiscriminate use
of anti-infectives Combination Therapy

•The duration of drug use is critical to • Use of a smaller dosage of each drug
ensure that the microbes are completely,
• Some drugs are synergistic powerful when
not partially, eliminated & are not given the
given in combination
chance to grow & develop resistant strains.
• In infections caused by more than one
Identification of the Pathogen
organism, each pathogen may react to a
• Identification of the infecting pathogen is different anti-infective agent
done by culture
• Sometimes, the combined effects of the
• A culture of a tissue sample from the
different drugs delay the emergence of
infected area is done
resistant strains –vital in the tt of TB,
– A swab of infected tissue is allowed to
grow on an agar plate malaria & some bacterial infection.
– Staining techniques and microscopic • However, resistant strains seem more
likely to emerge when fixed combinations
examination identify the bacterium
are used over time
• Stool can be examined for ova and
• Individualizing the combination seems to
parasites
be more effective in destroying the
Sensitivity of Pathogen pathogen w/o allowing time for the
emergence of strains that are resistant to
• Shows which drugs are capable of
the drugs
controlling the particular microorganism
Adverse Reactions to
• Important to be done for microorganisms
that have known resistant strains Anti-infective Therapy

• Kidney damage - aminoglycosides

• Gastrointestinal (GI) tract toxicity direct
effect on the cell lining of the GIT
(n/v,stomache upset or diarrhea
• Neurotoxicity some anti-infectives can
damage or interfere w/ the function of nerve
tissue (aminoglycosides collect in the 8th
CN & can cause dizziness, vertigo &
hearing loss
• Hypersensitivity reactions
• Superinfections destriction of the normal
flora
Prophylaxis of Anti-infective Agents
• People traveling to areas where malaria is
endemic
• Patients who are undergoing
gastrointestinal or genitourinary surgery
• Patients with known cardiac valve disease,
valve
replacements, and other conditions
requiring invasive procedures
Chapter 9
Antibiotics
• Antibiotics are defined as:
– Chemicals that inhibit specific bacteria
Types of Antibiotics
• Bacteriostatic
– Substances that prevent the growth of
bacteria
• Bactericidal
– Substances that kill bacteria directly
Signs of Infection
• Fever • Lethargy • Slow-wave sleep
induction • Classic signs of inflammation
(redness, swelling, heat, and pain)
Goal of Antibiotic Therapy
• Decrease the population of the invading
bacteria to a point where the human
immune system can effectively deal with the
invaders
Selecting Treatment
• Identification of the causative organism
• Based on the culture report, an antibiotic is
chosen that is known to be effective at
treating the invading organism
Bacteria Classification
• Gram-positive
– The cell wall retains a stain or resists
decolorization with alcohol
• Gram-negative
– The cell wall loses a stain or is
decolorized by alcohol
• Aerobic
– Depend on oxygen for survival
• Anaerobic
– Do not use oxygen
Aminoglycosides
• A group of powerful antibiotics used to
treat serious infections caused by gram-
negative aerobic bacilli
• Common medications:
– Amikacin (Amikin)
–Gentamicin (Garamycin)
– Kanamycin (Kantrex)
– Neomycin (Mycifradin)
– Streptomycin neuromuscular blockade w/ paralysis is
possible
– Tobramycin (Nebcin, Tobrex)
Cephalosporins
• Bactericidal
• Similar to penicillin in structure and activity
• Indications: treatment of serious infections
caused by susceptible bacteria • Action

• Action: inhibit protein synthesis in – Interfere with the cell-wall–building ability

susceptible strains of gram-negative of bacteria when they divide
bacteria causing cell death
• Indication
• Pharmacokinetics
– Treatment of infection caused by
– Poorly absorbed from the GI tract but susceptible bacteria
rapidly
• Pharmacokinetics
absorbed after IM injection, reaching peak
– Well absorbed from the GI tract
levels within 1 hour
– Metabolized in the liver, excreted in the
– Widely distributed throughout the body,
urine
crossing the placenta and entering breast
milk • Contraindications
– Excreted unchanged in the urine and have – Allergies to cephalosporins or penicillin
an average half-life of 2 to 3 hours
• Adverse effect
– Depend on the kidney for excretion and
are toxic to the kidney – GI tract

• Contraindications • Drug-to-drug interactions

– Known allergies, renal or hepatic disease, – Aminoglycosides, oral anticoagulants, and

ETOH
and hearing loss
Fluoroquinolones
• Adverse effects
• Relatively new class of antibiotics with a
– Ototoxicity and nephrotoxicity are the broad spectrum of activity
most significant
• Indications: treat infections caused by
Drug-to-drug interactions susceptible strains of gram-negative
bacteria, including urinary tract, respiratory
Diuretics and neuromuscular blockers
tract, and skin infections
• Combined w/ potent diuretics- incidence of
• Actions: interferes with DNA replication in
ototoxicity,nephrotoxicity & neurotoxicity
susceptible gram-negative bacteria,
increases.
preventing cell reproduction
• Combined w/ anesthetics- nondepolarizing
• Pharmacokinetics
neuromuscular blockers, succinylcholine, or
citrate anticoagulated blood, increased – Absorbed in the GI tract
– Metabolized in the liver • Action

– Excreted in the urine and feces – Similar to macrolides

• Contraindications • Indications

– Known allergy, pregnancy, and lactation – Severe infections

• Adverse effects • Pharmacokinetics

– Headache, dizziness, and GI upset – Well absorbed from the GI tract or IM

• Drug-to-drug interactions – Metabolized in the liver and excreted in

the urine and feces
– Antacids, quinidine, and theophylline
• Contraindications
Macrolides
– Hepatic or renal impairment
• Antibiotics that interfere with protein
synthesis in susceptible bacteria • Adverse effects

– GI reactions

• Indications: treatment of respiratory, Monobactams

dermatologic, urinary tract, and GI infections
• Unique structure with little cross-resistance
caused by susceptible strains of bacteria
• Action
• Actions: bind to cell membranes causing a
change in protein function and cell death; – Disrupts bacteria cell wall synthesis,
can be bacteriostatic or bactericidal which promotes the leakage of cellular
content and cell death
• Pharmacokinetics
• Indications
– Absorbed from the GI tract
– Treatment of infections caused by
– Metabolized in the liver, excreted in the
susceptible bacteria; UTI, skin, intra-
bile to feces
abdominal, and gynecologic infections
• Contraindications
• Pharmacokinetics
– Allergy and hepatic dysfunction
– Well absorbed from the IM injection
• Adverse effects
– Excreted unchanged in the urine
– GI symptoms
• Contraindications
• Drug-to-drug interactions
– Allergy
– Digoxin, oral anticoagulants, theophylline,
• Adverse effects
and corticosteroids
– GI and hepatic enzyme elevation
Lincosamides
Penicillin’s
• Similar to macrolides but more toxic
• First antibiotics introduced for clinical use
• Action
– Inhibit synthesis of the cell wall in
susceptible bacteria, causing cell death
• Indications
– Treatment of infections caused by
streptococcal, pneumococcal,
staphylococcal, and other susceptible
bacteria
• Pharmacokinetics
– Well absorbed from the GI tract
– Excreted unchanged in the urine
• Contraindications
– Allergy
– Caution in patients with renal disease
• Adverse effects
– GI effects
• Drug-to-drug interactions
– Tetracyclines and aminoglycosides
Sulfonamides
• Drugs that inhibit folic acid synthesis
• Action
– Interfere with the cell-wall–building ability
of dividing bacteria
• Indications
– Treatment of infections caused by gram-
negative and gram positive-bacteria
• Pharmacokinetics
– Well absorbed from the GI tract
– Metabolized in the liver and excreted in
the urine
• Contraindications
– Allergy and pregnancy
• Adverse effects
– GI symptoms and renal effects related to
the filtration of the drug
• Drug-to-drug interactions
– Cross sensitivity with thiazide diuretics
– Sulfonylureas
Tetracyclines
• Developed as semisynthetic antibiotics
based on the structure of a common soil
mold
• Action
– Inhibit protein synthesis in susceptible
bacteria, preventing cell replication
• Indications
– Treatment of various infections caused by
susceptible strains of bacteria and acne,
and when penicillin is contraindicated for
eradication of susceptible organisms
• Pharmacokinetics
– Adequately absorbed from the GI tract
– Concentrated in the liver and excreted
unchanged in the urine
• Contraindications
– Allergy, pregnancy, and lactation
• Adverse effects
– GI, skeletal: damage to bones and teeth
• Drug-to-drug interactions
– Penicillin G, oral contraceptive therapy,
methoxyflurane, and digoxin
Antimycobacterials
• Contain pathogens causing tuberculosis —Antimycobacterial
and leprosy
• Assessment and history
• Action
• Nursing diagnosis
– Act on the DNA of the bacteria, leading to
• Implementation
lack of growth and eventual bacterial death
• Evaluation
• Indication
Chapter 10
– Treatment of acid-fast bacteria
Antiviral Agents
• Pharmacokinetics
virus
– Well absorbed from the GI tract
• is a small infectious agent that can
– Metabolized in the liver and excreted in
replicate only inside the living cells of
the urine
organisms.
• Contraindications
•Viruses infect all types of organisms, from
– Allergy and renal or hepatic failure animals & plants to bacteria & archaea.

• Adverse effects Interferons

– CNS effects and GI irritation
• Drug-to-drug interactions
– Rifampin and INH can cause liver toxicity
• Interferons (IFNs) are proteins made and
released by host cells in response to the
presence of pathogens—such as viruses,
bacteria, or parasites—or tumor cells.

Antibiotic Use Across the Lifespan • They allow for communication between
cells to trigger the protective defenses of the
• Pediatric population • Adult population immune system that eradicate pathogens or
• Geriatric population tumors.

Nursing Considerations Interferons

—Aminoglycosides •Are released by the host in response to

viral invasion of a cell & prevent the
—Cephalosporins replication of that particular virus.
—Fluoroquinolone Viruses That Respond to Antiviral
—Macrolides & Lincosamides Therapy

—Monobactam • Influenza A and some respiratory viruses

—Penicillins • Herpes viruses

—Sulfonamides • Cytomegalovirus (CMV)

—Tetracyclines
• Human immunodeficiency virus (HIV) that • Inflammation of the mucosa of the
causes acquired immune deficiency respiratory tract
syndrome (AIDS)
Signs and Symptoms of Herpes Virus
• Some viruses that cause warts and certain
• Painful vesicles that often occur in clusters
eye infections
on skin, cornea, or mucous membranes
Characteristics of Common Viruses
• Usual course of primary disease is 2 week
• Viral replication
• Duration of recurrences varies
– A virus cannot replicate on its own
Signs and Symptoms of CMV
▪ It must attach to and enter a host cell
• May be asymptomatic
▪ It then uses the host cell’s energy to
• Fatigue
synthesize protein, DNA, and RNA
• Nausea
• Viruses are difficult to kill because they live
inside our cells • Jaundice
– Any drug that kills a virus may also kill our • If contracted during pregnancy, can result
cells
in stillbirth, brain damage, or birth defects
Characteristics of Antiviral Drugs
Signs and Symptoms of HIV/AIDS
• Able to enter the cells infected with virus
• Attach helper T cells
• Interfere with viral nucleic acid synthesis
and/or regulation • Acute infection: fever, rash, and myalgia

• Some agents interfere with the ability of • Asymptomatic infection: follows acute
the virus to bind to cells infection; duration varies

• Some agents stimulate the body’s immune • Persistent generalized lymphadenopathy:

system adenopathy persists more than 3 months

Common Respiratory Viruses Influenza A & Respiratory Viruses

• Influenza A • Action: prevent shedding of the viral

protein coat
• Influenza B
• Pharmacokinetics: administered orally and
• Respiratory syncytial virus
excreted unchanged in the urine
Signs & Symptoms of Respiratory Viruses
• Contraindications: allergy, pregnancy, and
• Cough lactation
• Fever • Adverse reactions: dizziness, insomnia,
nausea, orthostatic hypotension
• Inflammation of the nasal mucosa
• Drug-to-drug interactions: anticholinergic
agents
• Constitutional symptoms: fever lasting
more than a month, involuntary weight loss,
chronic fatigue
• Neurologic disease: dementia
• Secondary infections: pneumocystis carinii
and disseminated herpes simplex
Herpes & Cytomegalovirus
• Action: inhibit viral DNA replication by
competing with viral substrates to form
shorter, noneffective
DNA chains
• Pharmacokinetics: administered orally, IV,
or topically; excreted unchanged in the urine
• Contraindications: pregnancy and lactation
• Adverse reactions: nausea, vomiting,
headache, rash, and hair loss
• Drug-to drug-interactions: nephrotoxic
drugs and zidovudine
Drugs Used to Treat HIV/AIDS
• Reverse transcriptase inhibitors
• Protease inhibitors
• Nucleosides
• Fusion inhibitors
Reverse Transcriptase Inhibitors
• Action: bind directly to HIV reverse
transcriptase, blocking both RNA- and DNA-
dependent DNA polymerase activities.
• They prevent the transfer of information
that would allow the virus to replicate &
survive
• Pharmacokinetics: given orally,
metabolized in the liver, and excreted in the
urine
•Contraindications: pregnancy and lactation
•Adverse reactions: headache, nausea,
vomiting, rash, chills, fever, and diarrhea
Protease
•A protease (also termed peptidase or
proteinase) is any enzyme that conducts
proteolysis, that is,begins protein catabolism
by hydrolysis of the peptide bonds that link
amino acids together in the polypeptide
chain forming the protein.
Hydrolysis
• Hydrolysis is a chemical process in which
a water molecule is added to a substance
resulting in the split of that substance into
two parts. One fragment of the target
molecule (or parent molecule) gains a
hydrogen ion (H+) from the split water
molecule. The other portion of the target
molecule collects the hydroxyl group (OH−)
of the split water molecule. In effect an acid
and a base are formed
Protease Inhibitors
• Action: block protease activity within the
HIV virus
• Pharmacokinetics: agents are teratogenic
except for saquinavir
• Contraindications: pregnancy and lactation
Nucleosides
• Action: interfere with HIV replication by
inhibiting cell protein synthesis
• Pharmacokinetics: given orally or IV,
metabolized in the liver, and excreted in the
urine
• Adverse reactions: HA, insomnia,
dizziness, nausea, diarrhea, fever, and rash
Fusion Inhibitors
• Action: prevent the fusion of the virus with
the human cellular membrane
• Pharmacokinetics: given sub-q,
metabolized in the liver, recycled in the
tissues, and not excreted
• Contraindication: no true contraindication
• Adverse reactions: HA, dizziness, myalgia,
nausea, vomiting, and diarrhea
• Drug-to-drug interactions: pimozide,
rifampin, triazolam, midazolam, and oral
contraceptives
Locally Active Antiviral Agents
• Action: act on viruses by interfering with
normal viral replication and metabolic
processes
• Pharmacokinetics: not absorbed
systemically
• Contraindication: allergy to the drug
• Adverse reactions: local burning, stinging,
and discomfort
Nursing Considerations for Respiratory
Antiviral Therapy, Nursing
Considerations for Herpes Virus and
Cytomegalovirus, Nursing
Considerations for HIV/AIDS Antiviral
Therapy, Nursing Considerations for
Locally Active Antiviral Agents
• Assessment (history and physical exam)
• Nursing diagnosis • Implementation
• Evaluation
Chapter 11
Antifungal Agents
What Is a Fungus?
• Fungus
– Composed of a rigid cell wall made up of
chitin and various polysaccharides, and a
cell membrane containing ergosterol
– Protective layers of the fungal cell make
the organism resistant to antibiotics
Patients Susceptible to Fungal Infections
• Patients with AIDS and AIDS-related
complex (ARC)
• Patients taking immunosuppressant drugs
• Patients who have undergone
transplantation surgery or cancer treatment
• Members of growing elderly population no
longer protected from environmental fungi
Culture
• Culture is needed prior to prescribing
antifungal agents
• Patients on antifungal agents are immuno-
compromised at onset
Amphotericin B Indications
• Aspergillosis • Leishmaniasis
• Cryptococcosis • Blastomycosis
• Moniliasis • Coccidioidomycosis
• Histoplasmosis • Mucormycosis
• Candida infections (topically)
Amphotericin B
• Indications: progressive, potentially fatal
fungal infections
• Pharmacokinetics: IV form, excreted in the
urine
• Contraindication: kidney disease
• Adverse reaction: kidney failure
Systemic Antifungal Agents
• Caspofungin (Cancidas) (IV)
– Approved for the treatment of invasive
aspergillosis in patients who are refractory
to other treatments
• Flucytosine (Ancobon) (oral)
– Less toxic drug used for the treatment of
systemic infections caused by Candida or
Cryptococcus
• Nystatin (Mycostatin, Nilstat) (oral)
– Used for the treatment of intestinal
candidiasis; also available in a number of
topical preparations
Voriconazole & Terbinafine
• Newer agents
• Voriconazole (Vfend)
– Available in oral and IV forms
– Treats invasive aspergillosis and serious
infections caused by Scedosporium
apiospermum and Fusarium species
• Terbinafine (Lamisil)
– Blocks the formation of ergosterol
– Inhibits a CYP2D6 enzyme system
– Oral drug for the treatment of
onychomycosis of the toenail or fingernail
Azoles
• Newer class of drugs used to treat
systemic fungal infections
• Less toxic than amphotericin B
• Less effective than amphotericin B
Ketoconazole (Nizoral)
• Used orally to treat many of the same
mycoses as amphotericin B
• Works by blocking the activity of a steroid
in the fungal wall
• Has side effect of blocking the activity of
human steroids, including testosterone and
cortisol
• Pharmacokinetics: absorbed from the GI
tract, metabolized in the liver, excreted in
the feces
• Contraindications: not drug of choice for
patients with endocrine or fertility problems
• Adverse reaction: hepatic toxicity
• Drug-to-drug interactions: many
Fluconazole (Diflucan)
• Not associated with the endocrine
problems seen with ketoconazole
• Used to treat candidiasis, cryptococcal
meningitis, and other systemic fungal
infections
• Prophylactic agent for reducing the
incidence of candidiasis in bone marrow tr•
Pharmacokinetics: available in oral and IV
preparations, excreted unchanged in the
urine
• Contraindications: renal dysfunction
• Adverse reactions
• Drug-to-drug interactions: inhibits CYP450
and may be associated with drug-to-drug
interactions
Itraconazole (Sporanox)
• An oral agent used for the treatment of
assorted systemic mycoses
• Associated with hepatic failure
• Slowly absorbed from the GI tract, it is
metabolized in the liver by the CYP450
system
• Excreted in the urine and feces
Overall Contraindications to Systemic
Antifungal Agents
• Anyone with a known allergy
• Pregnant or lactating women (with the
exception of terbinafine for life-threatening
infections)
• Patients with renal or liver disease
– Drug metabolism or excretion may be
altered, or condition may worsen as a result
of the actions of the drug
Overall Adverse Reactions to Systemic
Antifungal Agents
• CNS effects
– Headache, dizziness, fever, shaking, and
chills
• GI effects
– Nausea, vomiting, dyspepsia, and
anorexia
• Hepatic dysfunction
• Dermatologic effects
– Rash and pruritus associated with local
irritation
• Renal dysfunction
Topical Antifungal Infections
• Caused by dermatophytes
• Tinea infections (ringworm)
– Athlete’s foot (tinea pedis)
– Jock itch (tinea cruris)
• Candida
– Yeast infections of the mouth and vagina
• Action
– Work to alter the cell permeability of the
fungus, causing prevention of replication
and fungal death
• Indication
– Indicated only for local treatment of
mycoses, including tinea infection
• Contraindication/caution
– Limited to known allergy to any antifungal
agent
• Adverse effects
– Local effects include irritation, burning,
rash, and swelling
– When taken as a suppository or troche,
nausea, vomiting, hepatic dysfunction,
urinary frequency, burning, and change in
sexual activity can occur
• Drug-to-drug interactions
– None reported
Nursing Considerations for
Systemic Antifungal Agents
• Assessment (history and physical exam)
• Nursing diagnosis
• Implementation
Nursing Considerations for
Topical Antifungal Agents
• Assessment (history and physical exam)
• Nursing diagnosis
• Implementation
• Evaluation
Chapter 12
Antiprotozoal Agents – Treatment of plasmodial malaria in
combination with other drugs
Causes of Protozoal Infections
• Hydroxychloroquine (Plaquenil)
• Insect bites
– Treatment of plasmodial malaria in
– Malaria
combination with other drugs (particularly
– Trypanosomiasis primaquine)

– Leishmaniasis • Mefloquine (Lariam)

• Ingestion or contact with the causal – Prevention and treatment of plasmodial

organism malaria in combination with other drugs

– Amebiasis • Primaquine (generic)

– Giardiasis – Prevention of relapses of Plasmodium

vivax and Plasmodium malariae infections
– Trichomoniasis
– Radical cure of P. vivax malaria
Protozoal Parasites Identified as
• Pyrimethamine (Daraprim)
Causes of Malaria
– Prevention of plasmodial malaria in
• Plasmodium falciparum
combination with other agents to suppress
– Considered the most dangerous type of transmission
protozoan
– Treatment of toxoplasmosis
• Plasmodium vivax
• Quinine (generic)
– Milder form of the disease; seldom results
in death – Treatment of chloroquine-resistant
plasmodial infections
• Plasmodium malariae
Antimalarials—Action
– Endemic in tropical countries; mild
symptoms • Interrupt plasmodial reproduction of
protein synthesis
• Plasmodium ovale
• Agents that do not appear to affect the
– Rarely seen; in the process of being
eradicated sporozoites are used for prophylaxis

Antimalarials Antimalarials—Contraindications

• Chloroquine (Aralen) • Known allergy

– Prevention and treatment of plasmodial • Liver disease

malaria; treatment of extraintestinal
• Alcoholism
amebiasis
• Lactation
• Halofantrine (Halfan)
• Cautions
– Retinal disease or damage – Aims at attacking the parasite at the
various stages of its development inside
– Psoriasis
and outside the human body
Antimalarials—Adverse Effects
Other Protozoal Infections
• Headache
• Amebiasis
• Dizziness
• Leishmaniasis
• Fever
• Trypanosomiasis
• Chills
• Trichomoniasis
• Malaise
• Giardiasis • Pneumocystis carinii
• Nausea
Risk Factors for Protozoal Infections
• Vomiting
• Unsanitary conditions
• Hepatic dysfunction
• Poor hygienic practices
Antimalarials—Drug-to-Drug Interactions
Common Antiprotozoal Agents
• Quinine derivatives and quinine create risk
• Atovaquone (Mepron)
for cardiac toxicity
– Especially active against PCP
• Antifolate drugs with pyrimethamine can
increase risk of bone marrow suppression • Metronidazole (Flagyl, MetroGel, Noritate)

Other Antiprotozoal Drugs – Treats amebiasis, trichomoniasis, and

giardiasis
• Actions
• Pentamidine (Pentam 300, NebuPent)
– Inhibit DNA synthesis
– Treats PCP, trypanosomiasis, and
• Contraindications
leishmaniasis
– Known allergy, pregnancy, CNS disease,
• Tinidazole (Tindamax)
and hepatic disease
– Treats trichomoniasis, giardiasis, and
• Adverse reactions
amebiasis
– Headache, dizziness, ataxia, nausea,
Nursing Considerations for Antimalarial
vomiting, and diarrhea
Agents
Malaria
• Assessment (history and physical exam)
• Signs and symptoms
• Nursing diagnosis
– Related to the destruction of red blood
Nursing Considerations for
cells and toxicity to the liver
Antiprotozoal Agents
• Treatment
• Assessment (history and physical exam)
• Nursing diagnosis • Schistosomiasis

• Implementation • Evaluation – Infection by a fluke that is carried by a

snail
Chapter 13
Mebendazole (Vermox)
Anthelmintic Agents
• Most commonly used of all of the
Two Types of Helminths Commonly
anthelmintics
Infecting Humans
• Effective against pinworms, roundworms,
• Nematodes or roundworms
whipworms, and hookworms
– Pinworms, whipworms, threadworms,
• Available in the form of a chewable tablet
Ascaris, and hookworms
• Few adverse effects

• Platyhelminthes or flatworms
• Not metabolized in the body; most is
– Cestodes (tapeworms) and flukes
excreted unchanged in the feces
(schistosomes)
• Should not be used during pregnancy
Measures to Control Infection
Pyrantel (Antiminth, Pin-Rid, Pin-X,
• Keep nails short
Reese’s Pinworm)
• Keep hands clean
• Oral drug effective against pinworms and
• Frequent handwashing roundworms

• Shower in the morning • Given as a single dose

• Change and launder undergarments, • Poorly absorbed; excreted unchanged in

the feces
bed linens, and pajamas daily
• Not recommended for use during
• Disinfect toilet seat daily pregnancy and lactation
• Handwashing after using the bathroom • Safety not established for children age <2
Tissue-Invading Worms years

• Trichinosis • Adverse effects may include GI side

effects and diarrhea
– Caused by ingestion of the encysted
larvae of the roundworm, Trichinella spiralis, Thiabendazole (Mintezol)
in undercooked pork • Treats roundworm, hookworm, and
• Filariasis whipworm infections

– Infection of the blood and tissues of • Not the anthelmintic drug of choice (not as
healthy individuals by worm embryos, effective, more adverse effects)
injected by insects
• Best drug for treatment of threadworm
infections
• Readily absorbed from the GI tract;
reaches peak levels in 1 to 2 hours
• Metabolized in the liver and excreted in
the urine
Albendazole (Albenza)
• Treats active lesions caused by pork
tapeworm and cystic disease of the liver,
lungs, and peritoneum caused by dog
tapeworm
• Serious adverse effects
• Should be used only after causative worm
is identified
• Poorly absorbed from the GI tract; reaches
peak levels in about 5 hours
• Metabolized in the liver and primarily
excreted in the urine
• Should not be used during pregnancy and
lactation
Ivermectin (Stromectol)
• Effective against the nematode that
causes onchocerciasis, or river blindness
• Used to treat threadworm disease or
strongyloidiasis
• Readily absorbed from the GI tract;
reaches peak plasma levels in 4 hours
• Completely metabolized in the liver with a
half-life of 16 hours; excreted through the
feces
• Should never be taken during pregnancy;
used with caution during lactation
Praziquantel (Biltricide)
• Very effective in the treatment of a wide
number of schistosomes, or flukes
• Taken in a series of three doses at 4- to 6-
hour intervals
• Has relatively few adverse effects
• Rapidly absorbed from the GI tract;
reaches peak plasma levels within 1 to 3
hours
• Metabolized in the liver with a half-life of
0.8 to 1.5 hours
• Excreted primarily through the urine
Anthelmintic Actions/Indications
• Affects metabolic processes that are
different in worms than in human hosts or
are not found in humans
• Causes death of the worm by interfering
with normal functioning
Anthelmintic Contraindications
• Presence of known allergy to any of these
drug
• Lactation
• Pregnancy (in most cases)
• Caution should be used in the presence of
renal or hepatic disease or severe diarrhea
and malnourishment
Anthelmintic Adverse Effects
• Abdominal discomfort
• Diarrhea
• Pain
• Headache
• Dizziness
• Fever
• Chills
Anthelmintic Drug-to-Drug Interactions
• Theophylline = increased levels of
theophylline
• Albendazole with dexamethasone
increases the overall effect of the drug
– Cancerous cells rob the host cells of
energy and nutrients and block normal
lymph
The Body’s Immune System Response to
Cancerous Cells

Nursing Considerations for Anthelmintic • Can damage or destroy some neoplastic

Agents cells

• Assessment (history and physical exam) • T cells recognize the abnormal cells and
destroy them
• Nursing diagnosis
• Antibodies form in response to parts of the
• Implementation
abnormal cell protein
• Evaluation
• Interferons and tissue necrosis factor
Chapter 14 (TNF) play a role in the body’s attempt to
eliminate the abnormal cells
Antineoplastic Agents
Possible Causes of Cancer
Neoplasm Cancer—Mechanisms of Growth
• Anaplasia • Genetic predisposition

– Cancerous cells lose cellular • Viral infection

differentiation and organization and are
• Constant irritation and cell turnover
unable to function normally
• Stress
• Autonomy
• Lifestyle factors
– Cancerous cells grow without the usual
• Environmental factors
homeostatic restrictions that regulate cell
Classifications of Tumors
growth and control
• Solid tumors
– This allows the cells to form a tumor
– May originate in any body organ
• Metastasis
– Carcinomas (originate in epithelial cells)
– Cancer cells travel from the place of origin
to develop new tumors in other areas of the – Sarcomas (originate in the mesenchyma)
body
• Hematologic malignancies
• Angiogenesis
– Leukemias and lymphomas that occur in
– Abnormal cells release enzymes to
the blood-forming organs
generate blood vessels and supply oxygen
and nutrients to the cells, generating growth Mechanisms of Antineoplastic Drugs

• Affect cell survival

• Boost the immune system in its efforts to • Actions
combat the abnormal cells
• Pharmacokinetic
Goal of Cancer Treatment
• Contraindication
• To destroy cancer cells using the following
• Adverse reactions • Drug-to-drug
methods: interactions

– Surgical removal Antimetabolites

– Stimulation of the immune system to • Action

destroy them
• Pharmacokinetic
– Radiation therapy to destroy them
• Contraindications
– Drug therapy to kill them during various
• Adverse reaction • Drug-to-drug
phases of the cell cycle interactions

Categories of Antineoplastic Agents Antineoplastic Antibiotics

• Alkylating agents • Actions

– React chemically with portions of the • Pharmacokinetic

RNA, DNA, or other cellular proteins
• Contraindications
• Antimetabolites
• Adverse reactions • Drug-to-drug
– Have chemical structures similar to those interactions
of natural metabolites
Mitotic Inhibitors
• Antineoplastic antibiotics
• Actions
– Not selective for bacterial cells only; toxic
to human cells • Pharmacokinetic
• Mitotic inhibitors • Contraindications
– Drugs that kill cells as the process of • Adverse reactions • Drug-to-drug
mitosis begins interactions
• Hormones and hormone modulators Hormones and Hormone Modulators
– Used in cancers that are sensitive to • Actions
estrogen stimulation
• Pharmacokinetic
• Cancer-cell–specific agents
• Contraindications
– Treat chronic myeloid leukemia (CML)
and CD117-positive unresectable or • Adverse reactions • Drug-to-drug
metastatic malignant GI stromal tumors interactions
(GIST) Nursing Considerations for Alkylating
Alkylating Agents Agents
• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation • Evaluation

Nursing Considerations for

Antimetabolites

• Assessment (history and physical exam

• Nursing diagnosis

• Implementation • Evaluation

Nursing Considerations for

Antineoplastic Antibiotics

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation • Evaluation

Nursing Considerations for Mitotic

Inhibitors

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation • Evaluation

Nursing Considerations for Hormones

and Hormone Modulators

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation