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

2. Key Terms Adenovirus Antibody Antigen Candida Cryptococcosis
Cytomegalovirus
Epidemiological
HSV/HIV
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3. Key Terms Histoplasmosis Immunocompetence Immunodeficiency
Phagocytosis
Retrovirus
Varicella
Volar

4. Antifungal Agents Systemic, skin, and mucous membrane infections
Histoplasmosis
Candida
Cryptococcosis
Athlete’s foot
Tinea
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5. 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
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6. Antifungal Agents Contraindications Hypersensitivity
Bone marrow depression
Impaired renal function
Cautious use during pregnancy or lactation

7. 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

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

9. Drugs for Herpes Simplex or Herpes Zoster
Acyclovir
Trifluridine
Famciclovir
Penciclovir
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10. Drugs for Herpes Simplex or Herpes Zoster
These drugs
Do not cure herpes
Dosage varies with drug
Type of herpes treated varies with drug

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

12. Drugs for Influenza Amantadine hydrochloride Rimantadine
Oseltamivir phosphate
Zanamivir

13. 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
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14. 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

15. 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

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

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

18. NNRTIs
Inhibit HIV production
Prevent conversion of RNA to DNA

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

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

21. 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

22. Severe Adverse Effects
Neutropenia
Anemia
Pancreatitis
Peripheral neuropathy

23. 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
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24. 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

25. 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
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26. HIV in Children Discussion Question:
Who are some children who would be at risk for HIV infection?

27. 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

28. 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
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29. 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

30. 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
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31. HIV and the Older Adult Discussion Question:
How would you teach an older adult about HIV prevention?

32. 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

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

34. Immunizing Agents Vaccine Toxoid Immune globulin
Specific immune globulin
Antitoxin
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35. 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?

36. 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
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37. 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

38. 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
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39. 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.

40. 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