Antifungal, Antiviral, and Immunizing Agents UNIT 16 Antifungal, Antiviral, and Immunizing Agents

Key Terms Adenovirus Antibody Antigen Candida Cryptococcosis Cytomegalovirus Epidemiological HSV/HIV (continues)

Key Terms Histoplasmosis Immunocompetence Immunodeficiency Phagocytosis Retrovirus Varicella Volar

Antifungal Agents Systemic, skin, and mucous membrane infections Histoplasmosis Candida Cryptococcosis Athlete’s foot Tinea (continues)

Antifungal Agents Special considerations Wear gloves when applying topical medication Do not contaminate medication container Refrain from sexual intercourse while being treated for vaginal fungal infections Keep area clean and dry (continues)

Antifungal Agents Contraindications Hypersensitivity Bone marrow depression Impaired renal function Cautious use during pregnancy or lactation

OTC Antifungals FDA guidelines May contain only one active ingredient, limited to a specific list Must have label warning against use on scalp or nails, or in children younger than 2 years of age May not contain certain specified ingredients due to ineffectiveness

Antiviral Agents Synthetic drugs Developed to combat specific viral diseases HSV Influenza Herpes zoster

Drugs for Herpes Simplex or Herpes Zoster Acyclovir Trifluridine Famciclovir Penciclovir (continues)

Drugs for Herpes Simplex or Herpes Zoster These drugs Do not cure herpes Dosage varies with drug Type of herpes treated varies with drug

Special Considerations Always wear gloves when applying topical or ophthalmic medications Care should be taken to not touch eye with applicator of ophthalmic medications

Drugs for Influenza Amantadine hydrochloride Rimantadine Oseltamivir phosphate Zanamivir

Special Considerations Antiviral drugs do not cure influenza Flumadine used for prevention and treatment in adults, but only for prevention in children Amantadine hydrochloride also used to treat Parkinson’s disease (continues)

Special Considerations Oseltamivir phosphate and Zanamivir are used for those with uncomplicated influenza, who have been symptomatic no more than 2 days Oseltamivir phosphate and Zanamivir are NOT substitutes for the flu vaccine

Warning! Zanamivir (Relenza) carries the risk of the following adverse reactions: Bronchospasm: discontinue Relenza Allergic reaction: discontinue Relenza, seek appropriate treatment Neuropsychiatric events: monitor for signs of abnormal behavior and seek treatment as needed

Antiretroviral Agents Used to treat HIV infection Four classes NRTIs NNRTIs PIs FIs

NRTIs Interrupt early stage of virus replication Slow spread of HIV Delay onset of opportunistic infections Do NOT prevent transmission to others

NNRTIs Inhibit HIV production Prevent conversion of RNA to DNA

PIs Interrupt virus replication at later step in life cycle Prevent HIV from being assembled and released from CD41T cells

FIs Prevent HIV from entering healthy T-cells Reserved for patients who have failed initial regimens

HAART Combination of antiretroviral drugs Success lies in ability to disrupt HIV at different stages of replication Use of at least three antiretroviral agents has shown significant effect Decrease in morbidity and mortality rate

Severe Adverse Effects Neutropenia Anemia Pancreatitis Peripheral neuropathy

Special Considerations Treatment does not cure HIV infection Virus may not be detectable after treatment, but is still present and may still be spread Combination therapy is very expensive Virus may “rebound” if regimen discontinued (continues)

Special Considerations HIV drugs may interact with other common drugs HIV drugs may prompt or worsen diabetes May experience weight redistribution May increase risk of stroke or heart attack

HIV in Children Can be passed during pregnancy, delivery, or breastfeeding Risk of HIV-infected woman having infected baby is 25% for each pregnancy Immunizations should be given at regular intervals Child should be protected from infection (continues)

HIV in Children Discussion Question: Who are some children who would be at risk for HIV infection?

Mother-to-Child Transmission (MTCT) of HIV Antiretroviral drugs help prevent May occur during pregnancy, during birth, or through breastfeeding C-section helps reduce risk Treatment of baby with antiretroviral drugs reduces risk Abstaining from breastfeeding reduces risk

Hemophilia and AIDS Approximately 20,000 hemophiliacs in the United States 50% infected with HIV More than 2,000 have developed AIDS 65% of those with AIDS have died (continues)

Hemophilia and AIDS Of 2,000 who have AIDS, 179 are younger than age 13 Of 65% who died, 97 were children Today, clotting factors are heat treated and should not carry HIV Cost for patient can be as high as $100,000 per year

HIV and the Older Adult 10% of AIDS patients are older than 50 years Incidence rising faster than in younger age groups Immune function diminishes with age Acquired in same way as younger people (continues)

HIV and the Older Adult Discussion Question: How would you teach an older adult about HIV prevention?

Symptoms of AIDS in Older Adults HIV/AIDS dementia or confusion EPS Ataxia, leg tremors Peripheral neuropathy Opportunistic infections Tuberculosis AIDS-related cancers PCP HPV

Immunization Active Passive Administration of vaccine or toxoid Temporary, through administration of antitoxins or antibodies

Immunizing Agents Vaccine Toxoid Immune globulin Specific immune globulin Antitoxin (continues)

Immunizing Agents Discussion Questions: What might be some reasons that a parent would not get their child vaccinated? What are possible repercussions of failure to vaccinate children?

Special Considerations Check for allergy to any components of vaccine Live, attenuated-virus vaccines should not be given to those with immunosuppression or those in their immediate family (continues)

Special Considerations Vaccines should be deferred during severe febrile illnesses Live, attenuated-virus vaccines should be avoided during pregnancy NO evidence of fetal risk with inactivated virus vaccines

Recommendations for Hepatitis B Vaccine Health care workers Those with high-risk sexual practices Illicit injectable drug users Military personnel with increased risk Morticians and embalmers Blood bank workers Prisoners (continues)

Recommendations for Hepatitis B Vaccine Did You Know? Many states are now requiring Hepatitis B vaccine for school children. Prior to giving vaccines to a minor, you must obtain written consent from the parent or guardian.

H1N1 Vaccine Inactivated vaccine Children younger than 9 years require two doses Intramuscular route recommended LAIV Intranasal administration only Not for use in children younger than 2 years or adults older than 49 years