PHARMACOLOGY NURSING

ANTI INFECTIVES Antibiotic Therapy

➢ Goal: To reduce bacterial load so the immune system can handle

ANTI – BACTERIAL AGENTS the infection.

➢ Culture and sensitivity tests determine the appropriate antibiotic.
➢ Also known as antibacterials, are medications that destroy or slow
➢ Avoid overuse to prevent resistance.
down the growth of bacteria.
➢ Powerful medicines that fight certain infections and can save lives
when used properly. Gram Stain:

Bacteria ➢ Gram Positive: Bacteria that retain Gram’s stain, often

associated with respiratory and soft tissue infections (e.g.,
➢ are everywhere:
Streptococcus pneumoniae).
• soil, water, air, and the bodies of every person and
➢ Gram Negative: Bacteria that lose Gram’s stain, often
animal.
causing urinary and GI infections (e.g., E. coli).
➢ Bacteria do not have a membrane enclosing their nucleus (part
containing DNA) Bacteria and Oxygen:
➢ Virus invades plant or animal cell
➢ Aerobic: Require oxygen to survive.
➢ Bacteria reproduce on their own
➢ Anaerobic: Do not require oxygen (e.g., bacteria causing
Spread of diseases gangrene).

➢ Ways: CLASSES OF ANTIBIOTICS

• contaminated water
1. Aminoglycosides:
• food
➢ Used to treat serious infections caused by gram-negative
• sexual contact
aerobic bacteria (e.g., Pseudomonas aeruginosa, E. coli,
• Air Proteus species).
• when infected people sneeze or cough ➢ Poorly absorbed from the GI tract, but well absorbed after
• animal contact or contact with infected people. IM injection.
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➢ Contraindications: Allergies, renal or hepatic disease, ➢ Pharmacokinetics: Absorbed from the GI tract, excreted in
hearing loss, pregnancy. urine and feces.
➢ Adverse effects: Neurotoxicity, ototoxicity, nephrotoxicity, GI ➢ Contraindications: Pregnancy, children under 18, renal
and cardiac effects. dysfunction, seizures.
2. Carbapenems: ➢ Adverse effects: CNS symptoms (dizziness, insomnia), GI
➢ Broad-spectrum antibiotics effective against gram-positive effects, tendinitis, tendon rupture.
and gram-negative bacteria. 5. Penicillins:
➢ Used for serious infections, including respiratory and intra- ➢ Effective against streptococcal, staphylococcal, and other
abdominal infections. infections.
➢ Contraindications: Allergies, seizure disorders, lactation, ➢ Some bacteria produce penicillinase, an enzyme that
pregnancy. inactivates penicillin.
➢ Adverse effects: Pseudomembranous colitis, diarrhea, ➢ Pharmacokinetics: Rapidly absorbed from the GI tract and
superinfections, headache, dizziness. excreted unchanged in the urine.
3. Cephalosporins: ➢ Contraindications: Allergies, renal impairment, pregnancy.
➢ Bactericidal and bacteriostatic, depending on the dose. ➢ Adverse effects: GI upset, hypersensitivity reactions,
➢ Used for a variety of infections including respiratory, urinary, anaphylaxis.
and skin infections. 6. Sulfonamides:
➢ Pharmacokinetics: well absorbed from the GI tract or after ➢ Inhibit folic acid synthesis in bacteria.
IM/IV administration. ➢ Used for infections caused by gram-negative and gram-
➢ Contraindications: Allergies to cephalosporins or penicillins, positive bacteria.
renal/hepatic impairment. ➢ Pharmacokinetics: Absorbed from the GI tract, excreted in
➢ Adverse effects: GI upset, CNS effects, nephrotoxicity. urine.
4. Fluoroquinolones: ➢
➢ Broad-spectrum antibiotics affecting DNA replication in ➢ Contraindications: Allergies, pregnancy, lactation, renal
bacteria. disease.
➢ Used for urinary, respiratory, and skin infections.
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➢ Adverse effects: GI upset, renal issues (crystalluria), CNS • Isoniazid (Nydrazid)

effects, photosensitivity. • Rifampin (Rifadin)
7. Tetracyclines: • Pyrazinamide
➢ Inhibit protein synthesis, preventing bacterial replication. • Ethambutol (Myambutol)
➢ Used for infections like pneumonia, syphilis, and acne. • Streptomycin
➢ Pharmacokinetics: Absorbed from the GI tract, excreted • Rifapentine (Priftin)
unchanged in urine.
Leprostatic Drugs:
➢ Contraindications: Pregnancy, children under 8 (due to
effects on bones and teeth). ➢ Leprosy, also known as Hansen’s disease, is caused by
➢ Adverse effects: GI issues, photosensitivity, sperinfections, Mycobacterium leprae. It leads to disfiguring skin lesions
bone marrow depression. and destructive effects on the respiratory tract.
➢ Dapsone has long been the mainstay of treatment for
ANTI MYCOBACTERIAL AGENTS
leprosy, though resistant strains are emerging.
➢ Mycobacteria are a group of bacteria known for causing ➢ These drugs act on the DNA and RNA of mycobacteria,
diseases such as tuberculosis (TB) and leprosy. preventing growth and leading to bacterial death.
➢ These bacteria are characterized by their ability to hold a
Pharmacokinetics of Leprostatic Drugs:
stain, even in the presence of a destaining agent like acid.
Hence, they are referred to as acid-fast bacteria. ➢ These drugs are usually administered orally and are
metabolized in the liver, with excretion occurring through
Anti-Tuberculosis Drugs:
urine.
➢ Tuberculosis is a serious infectious disease primarily ➢ They can cross the placenta and enter breast milk, posing a
affecting the lungs, but it can also spread to the risk to the fetus or nursing child.
genitourinary tract, bones, and the meninges.
Contraindications and Cautions:
➢ Due to the slow-growing nature of Mycobacterium
tuberculosis, treatment can last from 6 months to 2 years. ➢ Contraindicated in patients with allergies to these agents,
➢ First-line drugs for TB treatment: renal or hepatic failure, and severe CNS dysfunction.

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➢ Use caution during pregnancy due to potential adverse ➢ Pharmacokinetics: Absorbed orally or parenterally, excreted
effects on the fetus. through kidneys.
➢ Contraindications: Pregnancy, renal disease, severe CNS
Adverse Effects:
disorders.
➢ Common CNS effects: Neuritis, dizziness, headache, drowsiness, ➢ Adverse effects: Nausea, vomiting, renal dysfunction, hair
and hallucinations. loss.
➢ GI effects: Nausea, vomiting, stomach upset, and abdominal pain.
Agents for HIV AND AIDS:
➢ Rifampin, Rifabutin, and Rifapentine can cause discoloration of
body fluids, such as urine, sweat, and tears. ➢ HIV (Human Immunodeficiency Virus) attacks the immune system,
particularly helper T cells (CD4 cells).
ANTI VIRAL AGENTS
➢ The virus is an RNA strand that enters helper T cells and uses
➢ Antiviral drugs treat viral infections by inhibiting the reverse transcriptase to convert its RNA into viral DNA.
replication of viruses. ➢ The viral DNA enters the host cell’s nucleus and integrates into the
host DNA, which alters the cell’s processes to produce more viral
Agents for Influenza A and Respiratory Viruses:
particles.
➢ Amantadine, oseltamivir, and zanamivir are used to prevent ➢ Loss of helper T cell function results in AIDS (Acquired Immune
viral replication in influenza. Deficiency Syndrome) and AIDS-related complex (ARC),
➢ Pharmacokinetics: Absorbed from the GI tract or respiratory characterized by the emergence of opportunistic infections and
tract, excreted in urine. cancers due to a weakened immune system.
➢ Contraindications: Renal impairment, pregnancy.
CLASSES OF HIV AGENTS:
➢ Adverse effects: Light-headedness, dizziness, nausea,
urinary retention. 1. Non-Nucleoside Reverse Transcriptase Inhibitors

Agents for Herpes and Cytomegalovirus (CMV): (NNRTIs):

➢ Acyclovir, famciclovir, and valacyclovir are used to inhibit ➢ Action: Directly bind to HIV reverse transcriptase, blocking

viral DNA replication. RNA- and DNA-dependent DNA polymerase activities,

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which inhibits the formation of viral DNA. As a result, the • Tenofovir: Peak levels within 45-75 minutes, excreted
virus cannot reproduce. in urine.
➢ Common Drugs: Delavirdine, Efavirenz, Nevirapine, ➢ Adverse Effects:
Etravirine, Rilpivirine. • Serious-to-fatal hypersensitivity (e.g., Abacavir).
➢ Pharmacokinetics: • Pancreatitis, hepatomegaly (e.g., Didanosine).
• Delavirdine: Rapid absorption with peak levels in 1 • Severe hepatomegaly with steatosis (e.g.,
hour, metabolized by the liver, excreted in urine. Emtricitabine, Tenofovir).
• Efavirenz: Peak levels in 3-5 hours, metabolized in • Lipodystrophy: Fat redistribution from the limbs and
the liver, half-life 52-76 hours. face to the trunk and neck.
• Nevirapine: Absorbed with peak effect in 4 hours,
3. Protease Inhibitors (PIs):
half-life 45 hours.
➢ Adverse Effects: ➢ Action: Block the activity of HIV protease, an enzyme
• GI issues: nausea, diarrhea, abdominal pain. essential for the maturation of infectious viral particles.
• CNS effects: dizziness, blurred vision, headache. Without functional protease, the virus remains immature and
• Flu-like symptoms: fever, muscle aches, fatigue. non-infectious.
➢ Common Drugs: Ritonavir, Saquinavir, Indinavir, Darunavir,
2. Nucleoside Reverse Transcriptase Inhibitors (NRTIs):
Atazanavir.
➢ Action: Compete with natural nucleosides used by the virus ➢ Pharmacokinetics: All taken orally.
to synthesize DNA. These nucleosides lack the chemical ➢ Adverse Effects:
structure needed to extend the DNA chain, causing • GI issues: nausea, vomiting, diarrhea.
termination of viral DNA synthesis. • Metabolic issues: Elevated cholesterol and
➢ Common Drugs: Zidovudine, Lamivudine, Tenofovir, triglycerides.
Abacavir, Emtricitabine. • Dermatological: Rashes, pruritus, Stevens-Johnson
➢ Pharmacokinetics: syndrome (rare but severe).
• Zidovudine: Absorbed rapidly, peak levels within 30-
75 minutes, half-life of 1 hour.
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4. Fusion Inhibitors: ➢ Pharmacokinetics: Rapid absorption from the GI tract,

metabolized in the liver, half-life 3 hours.
➢ Action: Prevent HIV from fusing with the host cell
➢ Adverse Effects: Headache, dizziness, increased risk of
membrane, blocking entry of the virus into the cell.
rhabdomyolysis and myopathy.
➢ Drug: Enfuvirtide (Fuzeon).
➢ Pharmacokinetics: Administered via subcutaneous ANTI FUNGAL AGENTS
injection, peak effects in 4-8 hours, recycled in tissues, half-
Systemic Antifungals:
life 3.2-4.4 hours.
➢ Adverse Effects: ➢ Azoles (e.g., fluconazole, ketoconazole) treat systemic
• Insomnia, depression, peripheral neuropathy. fungal infections.
• Injection-site reactions (pain, redness). ➢ Pharmacokinetics: Absorbed from the GI tract, metabolized
in the liver.
5. CCR5 Coreceptor Antagonist:
➢ Contraindications: Liver dysfunction, pregnancy, lactation.
➢ Action: Blocks the CCR5 receptor on host cells, preventing ➢ Adverse effects: Liver toxicity, GI issues, potential for severe
the virus from binding and entering the cell. fetal harm.
➢ Drug: Maraviroc (Selzentry).
Echinocandin Antifungals:
➢ Pharmacokinetics: Absorbed from the GI tract, metabolized
in the liver, half-life 14-18 hours. ➢ Caspofungin and micafungin inhibit fungal cell wall
➢ Adverse Effects: Severe hepatotoxicity, often preceded by synthesis.
allergic reactions. ➢ Pharmacokinetics: Administered via IV, excreted in urine.
➢ Contraindications: Hepatic impairment, pregnancy.
6. Integrase Inhibitors:
➢ Adverse effects: Hepatotoxicity, hypersensitivity, bone
➢ Action: Inhibit integrase, an enzyme that HIV uses to insert marrow suppression.
its viral DNA into the host cell’s genome, preventing viral
Topical Antifungals:
replication.
➢ Drug: Raltegravir (Isentress). ➢ Used for local fungal infections like ringworm.
➢ Common agents: Clotrimazole, miconazole, terbinafine.
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➢ Pharmacokinetics: Not absorbed systemically. other tissues in the body. The most common helminths that
➢ Adverse effects: Local irritation, burning, rash. infect humans include:
• Nematodes (roundworms)
ANTI PROTOZOAL AGENT
• Platyhelminths (flatworms), which cause intestine-
Antimalarials: invading and tissue-invading worm infections.

➢ Quinine, chloroquine, and mefloquine are used to treat Types of Helminthic Infections:
malaria.
➢ Trichinosis: A disease caused by ingesting larvae of the
➢ Pharmacokinetics: Absorbed from the GI tract, excreted
roundworm Trichinella spiralis in undercooked pork. These
slowly in urine.
larvae can penetrate skeletal muscle and lead to
➢ Contraindications: Liver disease, lactation, pregnancy.
inflammation in the heart and brain, potentially causing fatal
➢ Adverse effects: CNS effects (headache, dizziness), GI
conditions like pneumonia, heart failure, and encephalitis.
issues, visual changes, ototoxicity.
➢ Filariasis: Caused by thread-like worms (filariae)
Other Protozoal Infections: transmitted by insect bites. The worms invade the lymphatic
system, causing severe inflammation and swelling, leading
➢ Metronidazole, pentamidine, and tinidazole are used to
to conditions such as elephantiasis.
treat infections like giardiasis and trichomoniasis.
➢ Schistosomiasis: An infection caused by platyhelminths
➢ Pharmacokinetics: Well absorbed orally, excreted in urine.
transmitted through freshwater snails. Chronic infection may
➢ Contraindications: Pregnancy, renal dysfunction, CNS
lead to abdominal pain, diarrhea, and blockage of blood flow
disease.
to the liver, lungs, and CNS.
➢ Adverse effects: GI upset, CNS issues, superinfections.
COMMON ANTI HELMINTHIC DRUGS
ANTI HELMINTHIC AGENTS
Anti-helminthic drugs act by interfering with the metabolic processes of
Helminthic Infections:
worms, which are different or absent in humans. Key drugs include:
➢ Helminthic infections refer to infections caused by parasitic
worms, which can affect the gastrointestinal (GI) tract or

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➢ Albendazole (Albenza): Poorly absorbed from the GI tract, ➢ Lactation: These drugs can be toxic to infants.
metabolized in the liver, and excreted in urine. Used for ➢ Renal or Hepatic Disease: Due to the potential for altered
infections caused by various worms. metabolism and excretion.
➢ Ivermectin (Stromectol): Readily absorbed from the GI
• Caution is also advised for individuals with severe diarrhea and
tract, metabolized in the liver, with excretion through feces.
malnutrition, as these conditions can affect drug efficacy.
➢ Mebendazole (Vermox): Available in chewable tablets and
used in short courses. Very little is absorbed systemically, Adverse Effects:
and it is excreted mostly unchanged in the feces.
➢ Mebendazole and Pyrantel, which are not absorbed
➢ Praziquantel (Biltricide): Rapidly absorbed from the GI
systemically, may cause abdominal discomfort, diarrhea, or
tract, metabolized in the liver, and excreted through urine.
pain but generally have few side effects.
➢ Pyrantel (Antiminth, Pin-Rid, Pin-X, Reese's Pinworm):
➢ Systemically absorbed drugs may cause:
Poorly absorbed and mostly excreted unchanged in the
• Headache and Dizziness
feces.
• Fever, Chills, Malaise: Often due to an immune
Pharmacokinetics: reaction to the death of the worms.
• Rash and Pruritus
➢ Albendazole: Reaches peak plasma levels in about 5
• Renal Failure and severe bone marrow depression,
hours, primarily excreted in urine.
particularly with Albendazole.
➢ Ivermectin: Metabolized in the liver, excreted through feces,
with a half-life of 16 hours.
➢ Praziquantel: Peaks within 1 to 3 hours, with a half-life of
0.8 to 1.5 hours, excreted primarily in urine.
➢ Pyrantel: Poorly absorbed and excreted mostly unchanged.

Contraindications and Cautions:

Anti-helminthic drugs are generally contraindicated in:

➢ Pregnancy: Due to potential risks to the fetus.

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