Anti-Virals Flashcards
What are the key characteristics of antiviral drugs?
- able to enter the cells infected with a virus
- interfere with viral nucleic acid synthesis, regulation, or both
- some drugs interfere with the ability of a virus to bind to cells
- some drugs stimulate the body’s immune system
What are some common patient teachings for most antivirals?
- taking a missed dose as soon as the patient remembers unless time for the next dose (DO NOT DOUBLE DOSE)
- patient should not share medication
- the patient should notify the HCP of all medications (prescription or not) being taken
What are two types of Herpes Simplex Virus?
HSV1- perioral blisters
HSV2- genital blisters
How is Herpes Simplex Virus contagious?
highly transmissible through close physical contact
What are the symptoms of Herpes Simplex Virus?
Periods of latency and painful outbreaks
How can you treat Herpes Simplex Virus?
- No cure, but meds can speed up the process of remission (especially if started early)
- Ongoing low dose for prophylaxis of outbreaks
What is Varicella Zoster?
- Herpes virus that causes chickenpox; acute infectious disease
- Common childhood illness
– illness may be more severe for adults - highly contagious viral infection
What are the symptoms of Varicella Zoster?
Causes an itchy, blister-like rash
How can you prevent Varicella Zoster?
By a vaccine
Do you need a varicella zoster vaccine after having chicken pox?
No, because after a person has had chickenpox, the varicella-zoster virus can remain inactive in the body for many years
What is Herpes Zoster caused by?
the reactivation of varicella
What are the symptoms of Herpes Zoster?
- Skin lesions follow nerve tracts
- Painful lesions (often requiring narcotics)
- Postherpetic neuralgias (long-term nerve pain)
How to treat Herpes Zoster?
Must give medication w/in 72 hours of symptom onset
How to treat HSV1, HSV2, VZV, & Herpes Zoster?
acyclovir
What is acyclovir?
- Antiviral; synthetic nucleoside analogue
- Used to suppress HSV1, HSV2, VZV, Herpes Zoster
- Drug of choice for both initial and recurrent episodes of viral infections of herpes simplex virus
How is acyclovir administered?
- PO- Recurrent genital herpes infection; localized cutaneous herpes zoster infections (shingles) and varicella (chickenpox)
- IV- Severe episodes of genital herpes in non-immunocompromised clients, mucosal or cutaneous herpes simplex in immunocompromised clients, herpes simplex encephalitis, and neonatal herpes simplex infection
What is a contraindication of acyclovir?
hypersensitivity to acyclovir or valacyclovir
What are some adverse effects of acyclovir?
- GI: N/V/D
- Local: burning sensation/pain when applied topically
Which drug does acyclovir have drug interactions with?
zidovudine: increased risk for neurotoxicity
What to educate the patient about acyclovir?
- medication is not a cure, virus will lie dormant in the ganglia
- will not prevent spread to others (use condoms)
- women with genital herpes should get yearly pap smears b/c of the likelihood of developing cervical cancer
What is hepatitis B?
a liver infection caused by the hepatitis B virus
How is Hep B contagious?
when blood, semen, or other body fluids from a person infected w/ the virus enters the body of someone who is not infected
- sexual contact
- sharing needles
- during pregnancy or delivery
How to prevent Hep B?
vaccine
How to treat Hep B?
tenofovir alafenamide
What is tenofovir alafenamide?
- Nucleoside reverse transcriptase inhibitor (NRTI)
- Indicated for chronic Hep B
What is a contraindication of tenofovir alafenamide?
- end-stage renal disease (ESRD)
- liver impairment
- use cautiously in pregnancy, only if the benefit outweighs the risk
What are some adverse effects of tenofovir alafenamide?
- Fluid & Electrolyte: lactic acidosis
- GI: hepatomegaly w/ steatosis, abdominal pain, increased liver enzymes
- GU: renal failure
Which drugs do tenofovir alafenamide have drug interactions with?
acyclovir and valacyclovir
- may increase tenofovir levels and toxicity
- avoid if possible
What to educate the patient about tenofovir alafenamide?
- the client should be tested for HIV infection before starting medication
- avoid missing doses
- advise patients to take non-hormonal methods of birth control
- patients should notify HCP immediately of symptoms of lactic acidosis and if pregnancy or breastfeeding is planned
What is Hepatitis C?
A liver infection caused by the hepatitis C virus
- can be short term but half of people develop chronic hep C causing cirrhosis and liver cancer
How is Hep C contagious?
Spread through contact with blood from an infected person
- Sharing needles or other equipment used to inject drugs
- Patients receiving hemodialysis are at high risk
How to treat Hep C?
sofosbuvir
What is sofosbuvir?
- First RNA polymerase inhibitor “breakthrough therapy”; 1st drug treatment
- Used in combo w/ other medications to treat Chronic Hep C
– ribavirin (makes it Category X)
What is a contraindicaton of sofosbuvir?
- severe renal impairment or ESRD
- concurrent use of St. John’s Wort and ribavirin
What are some adverse effects of sofosbuvir?
- Derm: pruritis (itchy)
- Neuro: fatigue, headache, insomnia, irritability
What to educate patient for sofosbuvir?
- a negative pregnancy test must be obtained before beginning therapy
- administer once daily w/o regard to food
How should patients who can’t swallow pills take sofosbuvir?
- sprinkle pellets on one or more spoonfuls of non-acidic soft foods (pudding, mashed potatoes) at or below room temperature
- take pellets within 30 minutes and do not chew pellets
How can HIV be contagious?
- sexual activity
- intravenous drug use
- perinatally from mother to child
What is HAART (highly active antiretroviral therapy)?
combo of 2 nucleoside analogues and a protease inhibitor
- reduce viral load by depressing HIV replication
How to treat HIV?
zidovudine
abacavir
raltegravir
What to educate patients about all HIV treatments and medications?
- does not cure HIV but does reduce transmission
- use nonhormonal methods of birth control
- patient must notify HCP if they plan or suspect pregnancy
What are the contraindications for HIV treatments and medications?
- not recommended for breastfeeding mothers with HIV
- hypersensitivity
What is zidovudine?
- First nucleoside reverse transcriptase inhibitor (NRTI)
- Safely used in pregnancy and in newborns
- Causes bone marrow suppression
- Oral (tablets, solution/syrup) or injectable (IV) forms
What is a contraindication of zidovudine?
- severe hepatic or renal disease
- bone marrow suppression
What are some adverse effects of zidovudine?
- Fluids/electrolytes: lactic acidosis
- GI: hepatomegaly with steatosis, abdominal pain, N/D
- Hem: anemia, granulocytopenia
- Neuro: headache, weakness
Which drugs do zidovudine have drug interactions with?
- acyclovir: Increased neurotoxicity
- other drugs that cause bone marrow suppression: Increased bone marrow suppression
What are some nursing considerations for zidovudine?
- monitor viral load and CD4 count before and during treatment
- monitor complete blood count
- when giving to neonates use a syringe with 0.1 mL graduations
What is abacavir?
- Nucleoside reverse transcriptase inhibitor (NRTI)
- Slows the progression of HIV infection
- Increases CD4 cell count and decreases viral load
- Oral only (solution and tablets)
What is a contraindication of abacavir?
- moderate to severe impairment
- use cautiously in patients with coronary heart disease
- concurrent use of antiviral combination products containing abacavir (toxicity risk)
What are some adverse effects of abacavir?
- CV: myocardial infarction
- Fluid & Electrolyte: lactic acidosis
- GI: hepatomegaly w/ steatosis, abdominal pain, N/V/D
Which drugs do abacavir have drug interactions with?
alcohol: Increased blood levels
What are some nursing considerations for abacavir?
- monitoring viral load and CD4 cell count regularly
- must always be used in combination with other antiretroviral drugs
What are some medications for HIV?
emtricitabine
tenofovir disproxil
What is emtricitabine?
- Nucleoside reverse transcriptase inhibitor (NRTI)
- Oral use only; used in combination with other agents
What is a contraindication of emtricitabine?
- Use cautiously in Hep B co-infection (can cause severe exacerbation of HBV)
What are some adverse effects of emtricitabine?
- Derm: rash
- Fluid & Electrolyte: lactic acidosis
- GI: hepatomegaly w/ steatosis, abdominal pain, N/D
- Neuro: dizziness, headache, insomnia, weakness
- Resp: cough
What are nursing considerations for emtricitabine?
- monitor for HBV, viral load, and CD4
- used in combination with other antiretroviral
What is tenofovir disproxil?
- Nucleoside reverse transcriptase inhibitor (NRTI)
- Used to treat HIV (and chronic Hep B)
- Oral use only
- Often used in combination with other agents
What is a contraindication of tenofovir disproxil?
- concurrent use of antiretroviral combination products containing tenofovir
- concurrent use of NSAIDs (increased risk of ARF)
What are some adverse effects of tenofovir disproxil?
Fluid & Electrolyte: lactic acidosis
GI: hepatomegaly w/ steatosis, abdominal pain, N/D
GU: ARF
MSK: bone pain
Neuro: depression, headache
What drugs do tenofovir disproxil have drug interactions with?
- acyclovir- blood levels may be increased
- NSAIDs- increased risk for ARF
What to educate patients on for tenofovir disproxil?
- may cause hyperglycemia (patient should check for increased thirst, unexplained weight loss, increased urination)
- patient should monitor for lactic acidosis (weakness, fatigue, unusual muscle cramps)
What is raltegravir?
- Integrase Inhibitor
- PO
What is a contraindication of raltegravir?
- Use cautiously when patient’s taking other medications that can cause rhabdomyolysis and/or myopathy
What are some adverse effects of raltegravir?
GI: diarrhea
Hem: anemia, neutropenia
MSK: rhabdomyolysis, myopathy
Neuro: suicidal thoughts, headache
What drugs do raltegravir have drug interactions with?
Administration w/ antacids containing magnesium or aluminum decreases absorption of raltegravir
What to educate patients about on raltegravir?
- advise patient to report any signs of rhabdomyolysis (unexplained muscle pain, tenderness, weakness) or any signs of depression or suicidal thoughts
- condoms should be used
What does Pre-exposure prophylaxis do (PrEP)?
highly effective at preventing HIV
What are two PrEP medications?
- Truvada
- Descovy
What is Post-exposure prophylaxis (PEP)?
- Emergency tx taken w/in 72 hours of exposure to HIV
- Must be HIV negative (will test before & after tx)
When should you take PEP?
PEP is taken for 28 days after potential exposure
What are two PEP medications?
Raltegravir and Truvada
What treats influenza?
oseltamivir
What is oseltamivir?
- Neuraminidase inhibitor
- Active against influenza types A and B
- Reduce the duration of illness
What is a contraindication of oseltamivir?
- Hypersensitivity
- ESRD (End-Stage Renal Disease)
- not receiving dialysis
What are some adverse effects of oseltamivir?
GI: N/V
What drugs do oseltamivir have drug interactions with?
- may decrease the therapeutic effect of influenza vaccine
- avoid use 2 days prior to and 2 weeks after vaccine administration
What are nursing considerations for oseltamivir?
- may be administered w/ food or milk to minimize GI irritation
- use correct oral dosing for measuring oral solution, if not available, capsules can be opened and mixed with food
- take oseltamivir as soon as influenza symptoms appear
- not a substitute for the influenza vaccine
What can treat COVID-19?
remdesivir
What is a contraindication of remdesivir?
- hypersensitivity and severe renal impairment (eGFR < 30 mL/min)
- safety is not established in pregnant clients or children < 12 or weighing < 40 kg
What are some adverse effects of remdesvir?
- GI: increased liver enzymes, nausea
- Misc: Infusion reactions and anaphylaxis
What drugs do remdesvir have drug interactions with?
Hydroxychloroquine/chloroquine: may decrease antiviral activity
What are nursing considerations for remdesivir?
- IV administration only
- reconstitute powder
- solution should be clear and colorless; discard meds that are cloudy, discolored, or contain particulate matter
What treats RSV?
ribavirin
What is ribavirin?
- antiviral; synthetic nucleoside analogues
- nasal inhalation
- caution with pregnant and child-bearing aged health care workers
What is a contraindication of ribavirin?
- hypersensitivity
- patients receiving mechanically assisted ventilation
- significant CV disease
- hemoglobinopathies
- concurrent use of zidovudine
- pregnant women (may cause fetal harm)
What are some adverse effects of ribavirin?
- EENT: blurred vision, photosensitivity
- Hem: hemolytic anemia
What drugs do ribavirin have drug interactions with?
Zidovudine: decreased antiretroviral action of zidovudine
What are nursing considerations and patient education for ribavirin?
- ECG/EKG in patients w/ pre-existing cardiac disease
- treatment should begin w/in the first 3 days of RSV infection
- inform that ribavirin may cause blurred vision and photosensitivity
What treats CMV?
ganciclovir
What is ganciclovir?
- antiviral; synthetic nucleotide analogue
- oral, parenteral forms
- dose limiting toxicity = bone marrow suppression
What is a contraindication of ganciclovir?
- hypersensitivity to ganciclovir or acyclovir
- bone marrow suppression
- immunosuppression
What are some adverse effects of ganciclovir?
Hem: neutropenia, thrombocytopenia
What are nursing considerations for ganciclovir?
- assess for cues of infection and bleeding
- monitor neutrophils and platelet counts
- ganciclovir is not a cure for CMV
- frequent follow-up exams to monitor blood counts
