Pharm - Infection and Immune

Infection and Immune Medications

Heather Miller, RN, MSN

Objectives

• Explain the expected therapeutic effects of immune system and infection medications.

• Summarize the pharmacological action of immune system and infection medications.

• Monitor for common adverse effects of immune system and infection medications.

• Apply the concept of safe medication administration and dosage calculation when administering immune system and infection medications.

• Reinforce client education regarding immune system and infection medications.

• Determine if the immune system and infection medications is appropriate for the client.

• Monitor for potential interactions that can cause adverse or life-threatening effects when administering immune system and infection medications.

• Types of immunity

  • Active-artificial - vaccines

  • Active-natural - infection

  • Passive-natural - maternal

  • Passive-artificial - monoclonal antibodies

Immune System

• Child - Dtap; MMR; Polio; Varicella; Hep B; Hep A; Hib; Meningitis; PCV13; RV

• Adult - Varicella; Tdap; Pneumonia (65+); Shingles (50+)

• Flu, COVID-19 recommended starting at 6mo +

• HPV recommended in teen years

• Administration techniques - calm, minimize discomfort (pacifier w/sucrose sln, blanky), fun bandage; IM is vastis lateralis and SQ outer upper arm

Disease Prevention - Immunizations

Childhood Schedule

Adult Schedule

DTap

• Diphtheria, tetanus, pertussis

• Administer 5 doses: 2, 4, 6, 15-18 mo; 4-6yrs

• Redness, swelling; inconsoloable crying for 3+hrs; acute encephalopathy

• Caution - Guillain-Barré, seizures, shock with previous dose

IPV

• Inactivated poliovirus vaccine

• Administer 4 doses: 2, 4, 6-18mo; 4-6yrs

• Tenderness at injection site

• Contraindicated with anaphylaxis with neomycin, streptomycin, or polymyxin B

• Caution with pregnancy

MMR

• Measles, mumps, rubella

• Administer 2 doses - 12-15mo; 4-6yrs

• Localized reaction; joint pain/stiffness; deafness, seizures

• Caution with thrombocytopenia; anaphylaxis with eggs, gelatin, neomycin

Varicella

• Chicken pox

• Administer 2 doses: 12-15mo; 4-6yrs

• Injection site reaction; seizures; pneumonia

• Contraindicated in pregnancy, anaphylaxis to neomycin or gelatin

Hepatitis B

• Protection from liver infection with virus Hepatitis B

• Administer 3 doses: 12-24hr after birth; 1-2mo; 6-18mo

• Injection sites reaction

• Contraindicated with allergy to yeast

Hepatitis A

• Infection of the liver with the virus Hepatitis A

• Administer 2 doses: 12-23mo; 6mo later

• Headache, malaise

• Caution with pregnancy

Flu

• Seasonal

• Start at 6mo old (inactivated)

• At 2yr, receives live-attenuated nasal

  • Contraindicated 2-17yr receiving ASA products, 2-4yr with asthma

  • Option for those allergic to eggs

• Body aches, increased risk of Guillain-Barré, seizures

Adult Vaccines

• Herpes Zoster - shingles

  • At age 50

  • 2-doses, 2-6mo apart

• Varicella

  • 2-doses without immunity evidence

  • Not for pregnant, allergic to neomycin or gelatin, HIV, or immunosuppressed

Multiple Select

What are two vaccines that protect children from multiple diseases?

• MMR

• Varicella

• DTap

• Hep B

Match

Match the following types of immunity with their correct descriptions.

• Passive-natural Immunity

• Active-natural Immunity

• Active-artificial Immunity

Immunity acquired by a child through mother's milk

Immunity that occurs when a person's own immune system produces antibodies in response to the presence of a pathogen when a person gets sick

Immunity that occurs through vaccines

• Immunity acquired by a child through mother's milk

• Immunity that occurs when a person's own immune system produces antibodies in response to the presence of a pathogen when a person gets sick

• Immunity that occurs through vaccines

Multiple Choice

A nurse is reinforcing teaching with a group of new parents on immunizations. Which of the following vaccines is not started until after the first birthday?

• Pneumococcal

• Meningococcal

• Varicella

• Rotavirus

Antimicrobial Therapy

• Narrow-spectrum - only a few

• Broad-spectrum - wide variety

• Bactericidal - directly kills, destroys cell wall

• Bacteriostatic - slows the growth, disrupts protein synthesis

• Identifying the "bug" - gram stain, cultures

• Host Factors - age, site, immune system, comorbidities

Multiple Choice

A nurse is caring for a client with an infection in a wound. Which of the following actions should the nurse place priority?

• Administer antibiotic

• Obtain wound culture

• Monitor for superinfection

• Reinforce wound care teaching

• Tetracycline

• Aminoglycosides

• Penicillins

• Cephalosporins

• Vancomycin

Antibiotics

Penicillins

• Bactericidal

• Treats: strep - meningitis, pneumonia; syphilis

• Amoxicillin - broad-spectrum

• Piperacillin/tazobactam - antipseudomonal (extended)

• Anaphylaxis; renal impairment

• Decreases oral contraceptive efficacy; complete entire course of therapy; caution with IM

Cephalosporins

• Bactericidal; high therapeutic index, treats wide variety of infections

• Cephalexin (1st gen)

• Ceftriaxone (3rd gen) - eliminated largely by liver

• Cross-sensitivity to PCN

• Contraindicated with bleeding disorders

• Risk for C-Diff

Vancomycin

• Bactericidal; MRSA, CDiff

• Poor absorption in GI tract

• Ototoxic - monitor peak & trough

• Red man syndrome - rash, itching, flushing, tachycardia; d/t IV infusion too fast

• Renal toxicity - monitor I&O, BUN, creatinine

Tetracyclines

• Bacteriostatic; treats acne, STI, pneumonia, H-pylori, UTI

• Tetracycline; Doxycycline

• Discolored teeth; hepatotoxicity; photosensitivity; superinfection

• Not recommended for <8y/o

• Empty stomach; water; additional contraception

• Bacteriostatic; block reproduction of bacteria

• Azithromycin - treats pertussis, diphtheria, chlamydial infections, pneumonia

• Can prolong QT interval; nausea, vomiting, superinfection

• Teratogenic; contraindicated with QT prolongation

• No intercourse until finished; on empty stomach, with 8oz water; monitor liver function

Macrolides

Aminoglycosides

• Bacteriostatic; treats e-coli, klebsiella; prophylactic colorectal surgery

• Narrow-spectrum - narrow therapeutic index

• Nephrotoxicity - monitor BUN, creatinine, I&O

• Ototoxicity - monitor peak & trough

• Contraindicated - pregnancy; kidney impairment; use of loop diuretics

• Do not mix with PCN; complete entire course of therapy

Multiple Choice

Which of the following symptoms should the client report to the provider while on antibiotic therapy?

• Sensitivity to the sun

• Odorous diarrhea

• Symptom resolution

• Sinusitis

Multiple Choice

Which medication should be avoided if a patient has a sulfa allergy?

• Bactrim

• Cipro

• Zosyn

• Rocephin

• Bacteriostatic; inhibits growth by preventing folic acid synthesis

• Trimethoprim/sulfamethoxazole

• Treats UTI, cystitis, otitis media

• Avoid if allergic to sulfa drugs, trimethoprim, or COX-2 inhibitors (celecoxib); pregnant

• Blood dyscrasias, hyperkalemia, kernicterus

  • Monitor CBC, potassium, liver enzymes

• Take with 8oz water; complete entire course of therapy

UTI Treatment

Fluoroquinolones

• Bacteriostatic; treats Klebsiella, UTI, URI

• Ciprofloxacin - broad-spectrum

• Take with food; limit caffeine

• Achilles tendon rupture; phototoxicity; suprainfection (yeast)

• Broad-spectrum; prevents bacterial RNA synthesis

• Rifampin

• Discolored body fluids; hepatotoxicity

• Accelerates metabolism of warfarin, PO contraception, NNRTIs

  • Monitor PT/INR; adjust med dosage

• Take on empty stomach; avoid alcohol

Antimycobacterial

• Causes cell death; treats fungal infections (candidiasis, tinea)

• Amphotericin B, nystatin, miconazole

• Thrombophlebitis; nephrotoxicity; localized hypersensitivity

• Apply directly to infection; complete entire course; take PO at least 2hr before PPI or H2

Antifungal

• Alter viral reproduction

• Acyclovir - HSV, varicella-zoster

• Phlebitis - rotate inj sites; monitor sites

• Nephrotoxicity - hydrate; administer IV slowly; monitor BUN, creatinine

Antivirals

• Inhibits DNA synthesis & viral replication

• Zidovudine (NRTI) - first-line treatment for HIV for short-term care

  • Recommended for pregnant clients with HIV

• Suppressed bone marrow, fatigue, hyperventilation

  • Monitor CBC, platelets; lactic acid

• Nephrotoxicity - hydrate; administer IV slowly; monitor BUN, creatinine

Antiretrovirals

Multiple Choice

Which of the following information should the nurse teach the client about regarding the use of antiretrovirals and resistance?

• Adherence to med regimen decreases resistance

• Taking only one medication minimizes resistance

• Take the medication at the same time daily

• Changing regimen often minimizes resistance