ACYCLOVIR BRAND NAME: Alti-acyclovir, Avirax, Zovirax GENERIC NAME: acyclovir (acycloguanosine) CLASSIFICATION: Antiviral, Purine nucleoside analogue

MOA: Antiviral activity; inhibits viral DNA replication. INDICATIONS: Initial and recurrent mucosal and cutaneous HSV 1 and 2 and varicella zoster infections in immunocompromised patients; severe initial and recurrent genital herpes infections in selected patients; herpes simplex encephalitis; treatment of neonatal HSV infections; acute treatment of herpes zoster (shingles) and chickenpox CONTRAINDICATIONS: Contraindicated with allergy to acyclovir, seizures, CHF, renal disease, lactation. SIDE EFFECTS: Nausea, vomiting, loss of apetite, diarrhea; headache, dizziness.

ADVERSE EFFECTS: Headache, vertigo, depression, tremors, encephalophatic changes; inflammation or phlebitis at injection sites, rash, hair loss, nausea, vomiting, diarrhea, anorexia, crystalluria with rapid IV administration, hematuria, transient burning at site of application. NURSING RESPONSIBILITIES: Assessment: History: Allergy to acyclovir, seizures, CHF, renal disease, lactation Physical: Skin color, lesions; orientation; BP, P, auscultation, perfusion, edema; R, adventitious sounds; urinary output; BUN, creatinine clearance Implementation: Systemic Administration: Ensure that the patient is well hydrated. Topical Administration Start treatment as soon as possible after onset of signs and symptoms. Wear a rubber glove or finger cot when applying drug.

REFAMPIN BRAND NAME: Rifadin, Rimactane, Rofact GENERIC NAME: refampin CLASSIFICATION: Antituberculotic, Antibiotic MOA: Inhibits DNA-dependent RNA polymerase activity in susceptible bacterial cells. INDICATIONS: Treatment of pulmonary TB in conjunction with at least one other effective antituberculotic. CONTRAINDICATIONS: Contraindicated with allergy to any rifamycin, acute hepatic disease, lactation. SIDE EFFECTS: Reddish-orange coloring of body fluids (tears, sweat, saliva, urine, feces, sputum), nausea, vomiting, epigastric distress; skin rashes, or lesions; numbness, tingling, drowsiness, fatigue.

ADVERSE EFFECTS: Headache, drowsiness, fatigue, dizziness, inability to concentrate, mental confusion, generalized numbness, ataxia, muscle weakness, visual disturbances, exudative conjunctivitis, rash, prurities, urticaria, pain in extremities, osteomalasia myopathy, fever, flulike syndrome. NURSING RESPONSIBILITIES: Assessment History: Allergy to any rifamycin, acute hepatic disease, pregnancy, lactation Physical: Skin color, lesions; T; gait, muscle strength; orientation, reflexes, ophthalmologic examination; liver evaluation; CBC, liver and renal function tests, urinalysis Implementation Administer on an empty stomach, 1 h before or 2 h after meals. Administer in a single daily dose. Consult pharmacist for rifampin suspension for patients unable to swallow capsules. Prepare patient for the reddish-orange coloring of body fluids (urine, sweat, sputum, tears, feces, saliva); soft contact lenses may be permanently stained; advise patients not to wear them during therapy. Arrange for follow-up of liver and renal function tests, CBC, ophthalmologic examinations.

Teaching points: Take drug in a single daily dose. Take on an empty stomach, 1 h before or 2 h after meals. Take this drug regularly; avoid missing any doses; do not discontinue this drug without first consulting your physician. The following side effects may occur: reddish-orange coloring of body fluids (tears, sweat, saliva, urine, feces, sputum; stain will wash out of clothing, but soft contact lenses may be permanently stained; do not wear them); nausea, vomiting, epigastric distress; skin rashes or lesions; numbness, tingling, drowsiness, fatigue (use caution if driving or operating dangerous machinery; use precautions to avoid injury). Have periodic medical checkups, including an eye examination and blood tests, to evaluate the drug effects. Report fever, chills, muscle and bone pain, excessive tiredness or weakness, loss of appetite, nausea, vomiting, yellowing of skin or eyes, unusual bleeding or bruising, skin rash or itching.

ISONIAZID BRAND NAME: Isotamine, Nydrazid GENERIC NAME: isoniazid (isonicotinic acid hydrazide, INH) CLASSIFICATION: Antituberculotic MOA: Bactericidal: Interferes with lipid and nucleic acid biosynthesis in actively growing tubercle bacilli. INDICATIONS: Tuberculosis, all forms in which organisms are susceptible; prophylaxis in specific patients who are tuberculin reactors or household members of recently diagnosed tuberculars or who are considered to be high risks (patients with HIV and drugs users). CONTRAINDICATIONS: Contraindicated with allergy to isoniazid, isoniazid-associated hepatic injury or other severe adverse reactions to isoniazid , acute hepatic disease. SIDE EFFECTS: Nausea, vomiting, epigastric distress, (take drug with meals); skin rashes or lesions; numbness, tingling, loss of sensation (use caution to prevent injury or burns).

ADVERSE EFFECTS: Peripheral neuropathy, seizures, toxic encephalopathy, optic neuritis and atrophy, memory impairment, toxic psychosis, nausea, vomiting, epigastric distress, bilirubinemia, bilirubinuria, elevated AST, ALT levels, jaundice, hepatitis, agranulocytis, haemolytic or aplastic anemia, thrombocytopenia, eosinophilia, pyridoxine deficiency, pellagra, hyperglycemia, metabolic acidosis, hypocalcemia, hypophostanemia due to altered vitamin D metabolism. NURSING RESPONSIBILITIES: Assessment History: Allergy to isoniazid, isoniazid-associated adverse reactions; acute hepatic disease; renal dysfunction; lactation Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensitivity, bilateral grip strength; ophthalmologic examination; R, adventitous sounds; liver evaluation; CBC, liver and kidney function tests, blood glucose Implementation Give on an empty stomach, 1 h before or 2 h after meals; may be given with food if GI upset occurs. Give in a single daily dose.

Decrease tyramine-containing and histamine-containing food in diet. Consult with physician and arrange for daily pyridoxine in diabetic, alcoholic, or malnourished patients; also for patients who develop peripheral neuritis. Discontinue drug, and consult with physician if signs of hypersensitivity occur.

Teaching points: Take this drug in a single daily dose. Take on an empty stomach, 1 h before or 2 h after meals. If GI distress occurs, may be taken with food. Take this drug regularly; avoid missing doses; do not discontinue without first consulting with your prescriber. Do not drink alcohol, or drink as little as possible. There is an increased risk of hepatitis if these two drugs are combined. Avoid tyramine-containing foods; consult a dietician to obtain a list of tyramine-containing and histamine-containing foods. The following side effects may occur: nausea, vomiting, epigastric distress (take drug with meals); skin rashes or lesions; numbness, tingling, loss of sensation (use caution to prevent injury or burns). Have periodic medical check-ups, including an eye examination and blood tests to evaluate the drug effects.

Report weakness, fatigue, loss of appetite, nausea, vomiting, yellowing of skin or eyes, darkening of the urine, numbness or tingling in hands or feet.

ETHAMBUTOL BRAND NAME: Etibi, Myambutol GENERIC NAME: ethambutol hydrochloride CLASSIFICATION: Antituberculotic MOA: Inhibits the synthesis of metabolites in growing mycobacterium cells, impairing cell metabolism, arresting cell multiplication, and causing cell death. INDICATIONS: Treatment of pulmonary tuberculosis in conjunction with at least one other antituberculotic. CONTRAINDICATIONS: Contraindicated with allergy to ethambutol; optic neuritis. SIDE EFFECTS: Nausea, vomiting, epigastric distress; skin rashes or lesions, visual changes, disorientation, confusion, drowsiness, dizziness. ADVERSE EFFECTS: Optic neuritis (loss of visual acuity, changes in color perception), fever, malaise, headache, dizziness, mental confusion, disorientation, hallucinations, peripheral neuritis, anorexia, nausea, vomiting, GI upset, abdominal pain, transient liver impairment, allergic

reactions-dermatitis, pruritus, anaphylactoid reaction, toxic epidermal necrolysis, thrombocytopenia, joint pain, acute gout. NURSING RESPONSIBILITIES: Assessment History: Allergy to ethambutol, optic neuritis, impaired renal function Physical: Skin color, lesions; T, orientation, reflexes, ophthalmologic examination; liver evaluation, bowel sounds; CBC, liver and renal function tests Implementation Administer with food if GI upset occurs. Administer in a single daily dose; must be used in combination with other antituberculous agents. Arrange for follow-up of liver and renal function tests, CBC, ophthalmologic examinations.

Teaching points: Take drug in a single daily dose; it may be taken with meals if GI upset occurs. Take this drug regularly; avoid missing doses. Do not discontinue this drug without first consulting your physician. The following side effects may occur: nausea, vomiting, epigastric distress; skin rashes or lesions; disorientation, confusion, drowsiness, dizziness (use caution if driving or operating dangerous machinery; use precautions to avoid injury). Arrange to have periodic medical checkups, which will include an eye examination and blood tests.

Report changes in vision (blurring, altered color perception), skin rash.

FLUCONAZOLE BRAND NAME: Diflucan GENERIC NAME: fluconazole CLASSIFICATION: Antifungal MOA: Binds sterols in the fungal cell membrane, changing membrane permeability; fungicidal or fungistatic depending on concentration and organism. INDICATIONS: Treatment of oropharyngeal, vaginal, and systemic candidiasis; treatment of cryptococcal meningitis; prophylaxis of candidiasis in bone marrow transplants. CONTRAINDICATIONS: Contraindicated with hypersensitivity to fluconazole, lactation. SIDE EFFECTS: Headache (analgesics may be ordered), nausea, vomiting, diarrhea (frequent small meals may help). ADVERSE EFFECTS: Confusion, hallucinations, headache, sedation, vertigo,chest pain, rash, nausea, vomiting, diarrhea, anemia, leukopenia, thrombopenia, elevation of liver enzymes, BUN and creatinine, respiratory arrest, shortness of breath.

NURSING RESPONSIBILITIES: Assessment

History: Hypersensitivity to fluconazole, renal impairment, lactation Physical: Skin color, lesions; T; injection site; orientation, reflexes, affect; bowel sounds; renal function tests; CBC and differential; culture of area involved Implementation Culture infection prior to therapy; begin treatment before lab results are returned. Decrease dosage in cases of renal failure. Infuse IV only; not intended for IM or SC use. Do not add supplement medication to fluconazole. Administer through sterile equipment at a maximum rate of 200 mg/h given as a continuous infusion. Monitor renal function tests weekly, discontinue or decrease dosage of drug at any sign of increased renal toxicity.

Teaching points: Drug may be given orally or IV as needed. The drug will need to be taken for the full course and may need to be long term. Use hygiene measures to prevent reinfection or spread of infection. Arrange for frequent follow-up while you are on this drug. Be sure to keep all appointments, including blood tests. The following side effects may occur: nausea, vomiting, diarrhea (small frequent meals may help); headache (analgesics may be ordered). Report rash, changes in stool or urine color, difficulty breathing, increased tears or salivation.

METRONIDAZOLE BRAND NAME: Noritate, Protostat, Metrogel, Nidagel GENERIC NAME: metronidazole CLASSIFICATION: Antibiotic, antibacterial, amebicide, antiprotozoal MOA: Bactericidal: Inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoal-trichomonacidal, amebicidal: Biochemical mechanism of action is not known. INDICATIONS: Acute infection with susceptible anaerobic bacteria; acute intestinal amoebiasis, amebic liver abscess, trichomoniasis (acute and partners of patients with acuteinfection); preoperative prophylaxis for patients undergoing colorectal surgery; treatment of inflammatory papules, pustules, and erythema of rosacea; prophylaxis, for patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn's disease; antibiotic-associated pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (use recommended by CDC). CONTRAINDICATIONS: Contraindicated with hypersensitivity to metronidazole; pregnancy (do not use for trichomoniasis in first trimester).

SIDE EFFECTS: Dry mouth with strange metallic taste (frequent mouth care, sucking sugarless candies may help), nausea, vomiting, diarrhea (eat frequent small meals). ADVERSE EFFECTS: Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures, peripheral neuropathy, fatigue, unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, crapms, dysuria, incontinence, darkening of urine, thrombophlebitis (IV), redness burning, dryness, and skin irritation. NURSING RESPONSIBILITIES:

PYRAZINAMIDE BRAND NAME: PMS-Pyrazinamide GENERIC NAME: pyrazinamide CLASSIFICATION: Antituberculous

(CAN), Tebrazid (CAN)

drug

MOA: Bacteriostatic or bacteriocidal against Mycobacterium tuberculosis; mechanism of action is unknown. INDICATIONS: Initial treatment of active TB in adults and children when combined with other antituberculous agents; Treatment of active TB after treatment failure with primary CONTRAINDICATIONS: Contraindications: allergy to pyrazinamide, acute hepatic disease, pregnancy, lactation.Use cautiously with gout, diabetes mellitus, acute intermittent porphyria. SIDE EFFECTS/ ADVERSE EFFECTS: loss of appetite, nausea, vomiting (take drug with food); skin rash, sensitivity to sunlight (avoid exposure to the sun).

NURSING RESPONSIBILITIES: Assessment History: Allergy to pyrazinamide, acute hepatic disease, gout, diabetes mellitus, acute intermittent porphyria, pregnancy, lactation Physical: Skin color, lesions; joint status; T; liver evaluation; liver function tests, serum and urine uric acid levels, blood and urine glucose, CBC Implementation Administer only in conjunction with other antituberculous agents. Administer once a day. Arrange for follow-up of liver function tests (AST, ALT) prior to and every 2---4 wk during therapy. Discontinue drug if liver damage or hyperuricemia in conjunction with acute gouty arthritis occurs.

Teaching points: Take this drug once a day; it will need to be taken with your other TB drugs.

Take this drug regularly; avoid missing doses. Do not discontinue this drug without first consulting your prescriber. The following side effects may occur: loss of appetite, nausea, vomiting (take drug with food); skin rash, sensitivity to sunlight (avoid exposure to the sun). Have regular, periodic medical checkups, including blood tests to evaluate the drug effects. Report fever, malaise, loss of appetite, nausea, vomiting, darkened urine, yellowing of skin and eyes, severe pain in great toe, instep, ankle, heel, knee, or wrist.