Antitb, Antifungal, Antiviral

• Amphotericin B


  Highly toxic antifungal drug
• Mechanism of action of Amphotericin B

  Binds to the fungal cell membrane to form open channels that increase cell permeability and leakage of intracellular components, especially potassium
• Pre-treatment for Amphotericin B infusion

  1. Antihistamine (Benadryl)

  2. Acetaminophen (Tylenol)

  3. Glucocorticoid (Hydrocortisone)
• Amphotericin B administration


  • IV ONLY, High incidence of phlebitis so monitors the IV site, Change IV site (central line is preferred)
• Nursing interventions for Amphotericin B

  1. Monitor: BUN/CR, GFR, K+

  2. Monitor: I&O

  3. Avoid NSAIDS, aminoglycosides

  4. Monitor: liver labs

  5. Change IV sites

  6. Monitor: infusion-related reactions

  7. Premedicate with antipyretics, antihistamines, antiemetics, and steroids 30 to 60 minutes prior to administration

  8. Monitor CBC (toxic to bone marrow)

  9. Hydrate patient with 1L NSS to help reduce nephrotoxicity, monitor LFT and potassium
• Polyenes


  Class of antifungal drugs including Amphotericin B and nystatin
• Administration of oral polyene suspension

  Swish in the mouth and either spit out or swallowed (if candida infection goes down the esophagus), Don't eat/drink for 2 hours after
• Influenza vaccine


  Protection begins 14 days after administration
• Live nasal spray flu vaccine

  Approved for use in healthy non-pregnant people, 2 through 49 years old, Do not give to immunocompromised people
• Fluzone High-Dose Quadrivalent vaccine

  Contains four times the antigen as standard dose flu vaccines, Recommended for people 65 years of age and older
• Flublok Quadrivalent recombinant flu vaccine

  Does not require an egg-grown vaccine virus and does not use chicken eggs in the production process, Recommended for people allergic to the regular one (eggs)
• Fluad Quadrivalent flu vaccine


  Standard dose inactivated influenza vaccine
• First generation influenza antivirals

  Amantadine and Rimatidine, Active against type A but not type B, Viruses develop resistance easily, Side effects: Nervousness, anxiety, agitation, insomnia, difficulty in concentrating, and exacerbations of pre-existing seizure disorders and psychiatric symptoms in patients with schizophrenia or Parkinson's disease
• Second generation influenza antivirals

  Oseltamivir (Tamiflu) and Zanamivir (Relenza), Active against Type A and B, More effective & better tolerated - decrease viral spread, Shorten the duration of signs and symptoms, Side effects: dizziness, headache, insomnia, fatigue, and GI distress (LESS!!)
• Antiviral drugs


  Don't kill viruses, Decrease the ability of virus to replicate (decreases viral load), Difficult to suppress viral replication without harming host
• Hepatitis B treatment


  All children should get vaccine before entering school, 5 drugs used to treat chronic hepatitis: 1 alpha interferons (Peg alfa-2a), 4 nucleoside analogs (Lamivudine, Adefovir, Entecavir, Tenofovir), Shown to delay the progression to liver disease, Side effects: Mild to life-threatening - CNS, Endocrine, GI, Hepatic, Musculoskeletal, Renal, Lactic acidosis, blood dyscrasias
• Hepatitis C treatment


  No vaccine but we have treatment that cures it, Peginterferon alfa-2a and -2b, Protease inhibitors (simeprevir, paritaprevir), NS5A inhibitors (daclatasvir, ledipasvir, ombitasvir), Polymerase inhibitors (dasabuvir, sofosbuvir), Many of these antivirals are prepackaged as combination therapy, Ledipasvir (NS5A Inhibitor)/sofosbuvir (polymerase inhibitors) - Brand/Trade Name - Harvoni, Once a day dosing for 8-12 weeks, CURES type 1 Hepatitis C, Watch for drug interactions, Side effects: CNS, GI, Musculoskeletal, Respiratory