Pharmacology - Nursing Flashcards
This article is the last to cover immune system medications, focusing on tuberculosis (TB) medications, antifungal medications, and antiviral medications.
The Nursing Pharmacology video series follows along with our Pharmacology Second Edition Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
Antituberculars (TB medications)
Antituberculars are medications used to treat tuberculosis. These include rifampin, isoniazid, pyrazinamide, ethambutol.
Patients being treated for TB are likely to be taking several different antibiotics, possibly all four of these, and they may be taking them for a prolonged amount of time, sometimes between six months and a year, until they have cleared themselves of TB.
Don’t get TIPSY when taking TB meds. Think of a RIPE orange to remember TB meds (and the color of your secretions when using rifampin).
Also: “RIPE” refers to the first letter of each of these medications.
Mode of action of antitubercular medications
Antituberculars work by stopping the growth of the bacteria that causes TB (Mycobacterium tuberculosis). They are bactericidals (they kill the bacteria) and/or bacteriostatics.
Side effects of antitubercular medications
All four of these medications carry a black box warning for hepatotoxicity (damage to the liver). That means the patient should not drink alcohol, as these medications are already causing stress on the liver.
Side effects of rifampin
In addition to hepatotoxicity, rifampin will cause orange discoloration of the patient’s secretions, as well as GI upset. Rifampin decreases the effectiveness of oral contraceptives, so the patient will need to use an alternative form of birth control while they’re taking rifampin.
Side effects of isoniazid
In addition to hepatotoxicity, isoniazid can cause neuropathy.
Side effects of pyrazinamide
In addition to hepatotoxicity, pyrazinamide can cause arthralgia (joint pain).
Side effects of ethambutol
In addition to hepatotoxicity, ethambutol can cause issues with the eyes and with vision. Remember it this way: E for ethambutol, E for eyes. Advise the patient to report any issues they are having with their vision when they’re taking this medication and encourage them to get regular screening for their vision.
Nursing care for patients receiving antituberculars (and their families)
Note that, because of the increased risk for hepatotoxicity, it is important to monitor the patient’s liver function throughout therapy and to look for signs of liver damage.
Sputum samples need to be collected every 2 – 4 weeks. Remember, the patient is only considered no longer to be infectious after three negative sputum cultures.
Patients with active TB need to wear masks in public.
Finally, the patient's family members will need to be tested for TB because it is an extremely contagious disease.
Antifungals (systemic)
Systemic antifungal agents include amphotericin B, ketoconazole, and fluconazole. These medications are used for systemic fungal infections as opposed to topical fungal infections. We’ll explore agents for topical infections when we cover medications for the integumentary system.
Amphotericin B will “terrorize” your body (i.e., it is very toxic).
Mode of action of systemic antifungal agents
Systemic antifungal agents disrupt ergosterol in the fungal cell membrane.
Side effects of action of systemic antifungal agents
Although none of these carries a black box warning, all three of these systemic antifungals carry the risk for hepatotoxicity. Patients should not drink alcohol, and their liver function should be closely monitored.
Side effects of amphotericin B (Fungizone)
Amphotericin B is particularly toxic. This medication should only be used for life-threatening fungal infections. In addition to hepatotoxicity, amphotericin B carries a side effect of nephrotoxicity (rapid deterioration of the liver and kidney functions), phlebitis, fever, chills, and nausea and vomiting.
Side effects of ketoconazole
Ketoconazole carries the risk for hepatotoxicity as well as GI upset and arrhythmias (irregular heartbeat).
Side effects of fluconazole (Diflucan)
Fluconazole carries the risk for hepatotoxicity as well as GI upset and rash.
Nursing care for patients receiving systemic antifungals
If giving amphotericin B, first administer a test dose to see if there is a patient reaction.
For all three of these medications, monitor for liver dysfunction. Signs and symptoms include pale stools, dark urine, nausea and vomiting, fatigue, and jaundice (yellowing of the skin or whites of the eyes).
Antivirals
Systemic antiviral agents treat viruses and include acyclovir, ganciclovir, oseltamivir, and zanamivir. These medications inhibit viral replication. Note that most end in -vir, which is how you know they are used to treat “vir”al infections.
It is also important to note that these medications do not cure conditions.
Acyclovir (Zovirax), valacyclovir (Valtrex)
Acyclovir is used to treat herpes and varicella-zoster viruses, such as shingles (a viral infection that causes a painful rash).
Side effects of acyclovir
The side effects of acyclovir include phlebitis, GI upset, and nephrotoxicity.
Ganciclovir (Cytovene)
Ganciclovir is used to treat cytomegalovirus.
Side effects of ganciclovir
The side effects of ganciclovir include phlebitis, GI upset, nephrotoxicity, and bone marrow suppression (anemia, neutropenia, thrombocytopenia).
Oseltamivir (Tamiflu), zanamivir (Relenza)
Oseltamivir and zanamivir are antivirals that are used to treat influenza A and B.
Side effects of oseltamivir and zanamivir
The side effects of oseltamivir and zanamivir include GI upset and headache.
Nursing care for patients receiving oseltamivir and zanamivir
When treating influenza, it is vital to start oseltamivir and zanamivir within 48 hours of the onset of symptoms. If a patient has been having symptoms for longer than that, these medications will not be as effective.