Antiviral Agents Flashcards
What is Acquired immunodeficiency
syndrome (AIDS)?
Condition is caused by HIV. Number of T-cells decrease to a certain point and the decreased immunity allow for opportunistic infections and cancers.
What is AIDS-related complex (ARC)?
A group of symptoms that occur in individuals who are HIV positive but don’t meet the criteria for an AIDS diagnosis. The helper T-cell count has not reached the cutoff for it to be considered AIDS.
What is CCR5 coreceptor antagonist?
A type of drug that blocks the receptor site that HIV binds to in healthy cells. This prevents the spread of the infection.
What is Coronavirus?
A group of RNA viruses that mostly causes respiratory problems. Corona-19 is type of coronavirus.
What is Cytomegalovirus (CMV)?
A DNA virus that affects all ages and often remains dormant after initial infection. Mostly infects lungs, eyes and liver.
What is Fusion inhibitor?
Drug that stops HIV from binding to cell membranes, this decreases the spread of the infection.
What is Helper T cell?
A Lymphocyte that helps kick off immune response.
What is Hepatitis B?
A virus that infects the liver and may be fatal. Transferred through blood.
What is Hepatitis C?
A virus that infects the liver, yet not as severe as Hep. B. Patients may however need a liver transplant over time.
What is Herpes?
A DNA virus that causes chickenpox or varicella zoster. Causes genital herpes, cold sores and can cause encephalitis (rare but serious condition that causes inflammation of the brain)
What is Human immunodeficiency virus (HIV)?
The virus that destroys helper T-cells which leads to AIDS & ARC.
What is Influenza A?
The common cold or flu.
What is Integrase strand transfer inhibitor?
A drug that blocks integrase, which is a vital part of virus replication.
What is Interferon?
A hormone that is released by the tissues when there is a viral replication and this stop it further replicating.
What is Nonnucleoside reverse transcriptase inhibitors?
Drugs that bind to reverse transcriptase which is responsible for breaking down cell DNA. This stops DNA replication.
What is Nucleoside reverse transcriptase inhibitors?
Drugs that bind to the reverse transcriptase that is responsible for inserting viral DNA into cell DNA, this stops replication.
What is Protease inhibitors?
Drugs that inhibit the protease enzyme in HIV which prevents immature HIV cells from becoming fully mature infective HIV cells.
What is Virus?
A tiny bit of DNA or RNA protected by a protein coat. It lives by hijacking other cells to do its bidding. There are several viruses that do respond to antiviral therapy, but not all viruses do.
What are Viruses That Respond to Antiviral Therapy?
●Influenza A and some respiratory viruses (seasonal flu)
●Herpes viruses (chickenpox, shingles, genital herpes)
●Cytomegalovirus (CMV)
●Human immunodeficiency virus (HIV) that causes acquired- immune deficiency syndrome (AIDS)
●Hepatitis B and C
● Warts and eye infections.
What are some Characteristics of Common Viruses?
●A virus cannot replicate on its own and rely on other cells to reproduce. They’re strands of DNA/RNA code in a shell.
●It must attach to and enter a host cell.
●It then uses the host cell’s energy to synthesize protein, DNA, and RNA.
●Viruses are difficult to kill because they live inside our cells.
●Any drug that kills a virus may also kill our cells
Explain the stages of virus replication
1) Virus attaches to the cell wall in the cell of a host.
2) Enters cell and releases RNA/DNA fragments.
3) Using the cell’s own hardware the virus replicates the fragments and protein shells.
4) New virions get released to infect other cells.
What are some lifespan considerations that we need to keep in mind with children and antivirals?
Children are more sensitive to drugs and more severe reactions expected.
Particularly vulnerable to effects on kidneys, bone marrow and liver.
No proven safety for many; extreme caution should be used
Doses should be calculated by weight
Monitor closely
What are some lifespan considerations that we need to keep in mind with adults and antivirals?
Antibiotics won’t work for viral infections
Drugs do not cure HIV - it will slow progression of the disease. There is no cure for HIV.
Caution in pregnancy - antivirals have been used to prevent the mother from passing infection on to the fetus.
Advise childbearing women to use barrier-contraceptives
HIV can be transferred through breastmilk so alternative feeding measures should be used.
What can possibly happen if patients use antivirals to attempt to treat bacterial infections?
Antivirals are ineffective in treating bacterial infections, however more importantly, doing this may create a mutated virus that is drug resistant to both antivirals and antibiotics.
What are some lifespan considerations that we need to keep in mind with older adults and antivirals?
○More susceptible to adverse effects; monitor closely
○Hepatic/renal dysfunction may be worsened by these medications
○Dose may need to be lowered
Name 3 Common Respiratory Viruses.
●Influenza A
●Influenza B
●Respiratory Syncytial Virus (RSV) - leading cause of respiratory infections in infants and may often result in bronchiolitis or pneumonia.
What are the 5 Agents for Influenza A and Respiratory Viruses that we need to know?
●Amantadine - influenza A, West Nile virus and Parkinson’s disease.
●Oseltamivir - influenza A & B (reduces duration & severity, but need to be shortly after symptoms occur)
●Peramivir - acute influenza (IV for patients who cannot take PO meds)
●Rimantadine - influenza A (prevent and treat)
●Zanamivir - Influenza A & B (inhaled)
What are the indications for using Agents for Influenza A and Respiratory Viruses?
Treatment of influenza and other respiratory infections.
Which patients are most likely to use antiviral medications?
Patients who are already immunocompromised, as an acute viral infection will be harder to fight of and may cause severe complications.
What are the MOA’s for the Agents for Influenza A and Respiratory Viruses?
Prevents viral replication by inhibiting an enzyme that allow the cell to release viral particles which slows the progression of the infection.
What are the contraindications of Agents for Influenza A and Respiratory Viruses
Allergy, renal impairment, pregnancy, or lactating.
What are the known adverse reactions of Agents for Influenza A and Respiratory Viruses
Influenza agents have and effect on dopamine levels and may cause mood disturbances and changes in sleep pattern.
Orthostatic hypotension r/t vasodilation by altering smooth muscle tone and body’s ability to regulate blood flow.
Dizziness, nausea, and urinary retention.
Peramivir associated with Stevens-Johnson Syndrome due to hypersensitivity or allergy to the drug.
What assessments should we be doing prior to giving patients Agents for Influenza A and Respiratory Viruses?
Assess for contraindications or cautions (pre-existing liver or kidney problems, pregnant or lactating or previous reaction to an influenza agent)
Perform a physical assessment : Orientation (pre-existing CNS), consciousness or cognitive function and strength and coordination.
Observe for mood anxiety levels, unusual behavior r/t dopamine levels.
Monitor BP/
Assess for orientation and reflexes; vital signs; urinary output; and skin
Monitor renal and hepatic function tests
What nursing diagnoses can be made prior to giving patients Agents for Influenza A and Respiratory Viruses?
○Impaired comfort related to GI, CNS, or GU effects of the drug
○Altered sensory perception (kinesthetic) related to CNS effects of the drug
○Knowledge deficit regarding drug therapy
What implementations should we be prepared to make when giving patients Agents for Influenza A and Respiratory Viruses?
○Start the drug regimen as soon after exposure to the virus as possible, usually
within 2 days of the start of symptoms
○Administer influenza A vaccine before the flu season begins, if at all possible
○Administer the full course of the drug
○Provide safety provisions if CNS effects occur
○Instruct the patient about the appropriate dosage-scheduling regimen; safety precautions.
What evaluations should we be doing once we’ve started a patient on Agents for Influenza A and Respiratory Viruses?
Monitor BP for orthostatic hypotension.
Monitor their eyes for possible urinary retention which could be caused by kidney impairments.
What could patients do to mitigate some of the adverse reactions r/t Agents for Influenza A and Respiratory Viruses?
Keeping hydrated
Standing up slowly, making sure environment is safe (no tripping hazards)
Take medication with food to avoid nausea.
What are the name /suffix(es) of the agents used to treat Herpes and Cytomegalovirus (CMV) ?
(-clovir)
●Acyclovir - genital herpes, cold sores, chicken pox and shingles
●Ganciclovir - cytomegalovirus (CMV)
●Valacyclovir - genital herpes, cold sores and shingles
●Valganciclovir - treat and prevent cytomegalovirus (CMV)
Which agents for Herpes and Cytomegalovirus are particularly good for immune compromised patients, such as organ transplant patients and HIV/AIDS patients?
Ganciclovir and Valganciclovir
What are the MOA’s for the Herpes and Cytomegalovirus agents?
Interrupting the making of viral DNA. The DNA becomes too short (not full code) to be replicated and therefore cannot make more viruses. This hurts the virus without damaging human cells.
What are the known contraindications to giving a patient Herpes and Cytomegalovirus agents?
Known allergy.
Highly toxic in pregnancy and lactation and renal disease (benefit must outweigh risk).
Serious hypersensitivity reactions may occur - assess for previous reaction.
Severe CNS disorders (Alzheimer’s, Parkinson’s, MS, epilepsy) should not take as diseases may be exacerbated.
What are some known adverse reactions to Herpes and Cytomegalovirus agents?
Nausea & vomiting,
headache, paresthesia, neuropathy (CNS effect)
rash, and hair loss,
renal dysfunction -due to the nephrotoxic effect of the drug.
Are there any known drug-drug interactions with Herpes and Cytomegalovirus agents, and if so, what are they?
Nephrotoxic drugs (increases effect)
Zidovudine; a retroviral drug used for treatment of HIV & AIDS (increased drowsiness)
What should we be assessing prior to giving patients Herpes and Cytomegalovirus agents?
○Assess for contraindications and cautions : Renal or Neurological diagnoses. Pregnant or lactating.
○Perform a physical assessment : Skin orientation and cognitive assessment & renal and hepatic labs.
■Assess orientation and reflexes
■Examine skin (color, temperature, and lesions)
○Evaluate renal function tests
What nursing diagnoses should anticipate prior to giving patients Herpes and Cytomegalovirus agents?
○Impaired comfort related to GI, CNS, or local effects of the drug
○Impaired sensory (kinesthetic) perception related to CNS effects of the drug
○Knowledge deficit regarding drug therapy
What nursing implementations should we be prepared to make when giving patients Herpes and Cytomegalovirus agents?
○Administer the drug as soon as possible after the diagnosis has been made (most effective at beginning of infection)
○Ensure good hydration (reduces kidney damage)
○Ensure that the patient takes the complete course of the drug regimen (reduce medication resistance)
○Wear protective gloves when applying the drug topically
○Provide safety precautions (fall risk due to CNS effect)
○Warn the patient that GI upset, nausea, and vomiting can occur
○Monitor renal function tests periodically during treatment
○ Patients treated for genital herpes should avoid sexual activity during an outbreak.
○Provide patient teaching
What are the 6 categories of drugs used to slow the progression of HIV and AIDS?
●Nonnucleoside reverse transcriptase inhibitors
●Nucleoside reverse transcriptase inhibitors (NRTIs)
●Protease inhibitors
●Fusion inhibitors
●CCR5 coreceptor antagonists
●Integrase strand transfer inhibitors
What type of virus is HIV?
Retrovirus. This is a type of virus that has RNA instead of DNA?
What happens once HIV has infected a T-cell?
The T-cell can no longer perform its immune function to stimulate an immune response. This means that the virus can keep reproducing as well as enabling other infectious agents introduced to the body to replicate without an immune response from the body.
HIV can mutate and lay dormant for years without any symptoms.
