Antiviral Agents Flashcards
What are viruses that respond well to antiviral therapy?
-influenza A and some respiratory viruses
-herpes viruses
-cytomegalovirus (CMV)
-HIV that causes acquired-immune deficiency syndrome (AIDS)
-hepatitis B and C
Antivirals across the lifespan of children
-More severe reactions expected
-No proven safety for many; extreme caution should be used
-Doses should be calculated by weight
-Monitor closely
particularly vulnerable to the effects on the kidneys, bone marrow, and liver
Antivirals across the lifespan of adults
-Antibiotics won’t work for viral infections
-Drugs do not cure the disease (no cure for HIV)
-Caution in pregnancy
-Advise childbearing women to use contraceptives
Antivirals across the lifespan of older adults
-More susceptible to adverse effects; monitor closely
-Hepatic/renal dysfunction may be worsened by these medications
-Dose may need to be lowered
What are the Agents used for Influenza A and Respiratory Viruses?
● Amantadine - influenza A, West Nile virus, and Parkinson’s disease
●Oseltamivir - influenza A & B ( can reduce severity if taken shortly after symptoms begin)
●Peramivir - acute influenza (IV med for patients who cannot take oral antiviral meds)
●Rimantadine - influenza A
●Zanamivir - Influenza A & B (inhaled med)
Agents for Influenza A and Respiratory Viruses
What are the indications?
Treatment and reduction of severity of respiratory viruses and influenza
Agents for Influenza A and Respiratory Viruses
What are the actions?
prevents viral replication
Agents for Influenza A and Respiratory Viruses
What are the contraindications?
Allergy, renal impairment, pregnancy, or lactating
Agents for Influenza A and Respiratory Viruses
What are the adverse effects?
Dizziness, insomnia, nausea, orthostatic hypotension and urinary retention; peramivir associated with Stevens-Johnson Syndrome
these influenza agents have an effect on dopamine levels - so they can cause some disturbances and mood and sleep patterns
Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Assessment:
-Assess for contraindications or cautions (asking pts for any liver or kidney problems)
-Perform a physical assessment
-Assess for orientation and reflexes; vital signs; urinary output; and skin
-Monitor renal and hepatic function tests
-Assess mood, anxiety, sleep
-Monitor BP for orthostatic hypotension
Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Nursing diagnoses:
-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
Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Implementation:
-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
Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Evaluation:
-Monitor patient response to the drug (prevention of respiratory flulike symptoms, alleviation of flulike symptoms).
-Monitor for adverse effects (changes in orientation and affect, blood pressure, urinary output, skin changes, and/or liver or renal function test changes).
-Determine the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to help to avoid or minimize adverse effects.
-Monitor the effectiveness of comfort and safety measures and adherence to
Agents for Herpes and Cytomegalovirus
Drug names/ suffixes?
(-clovir)
●Acyclovir - genital herpes, cold sores, chicken pox and shingles
●Ganciclovir - cytomegalovirus (CMV) (organ transplant, HIV, AIDS pts)
●Valacyclovir - genital herpes, cold sores and shingles
●Valganciclovir - treat and prevent cytomegalovirus (CMV) (organ transplant, HIV, AIDS pts)
Agents for Herpes and Cytomegalovirus (-clovir)
What are the actions/ indications?
Inhibit viral DNA replication; treatment of HSV and CMV
Agents for Herpes and Cytomegalovirus (-clovir)
What are the contraindications?
-Known allergy, highly toxic in pregnancy and lactation and renal disease, severe CNS disorders (Alzheimer’s, stroke, Parkinson’s, multiple sclerosis, or epilepsy should not take these drugs)
Agents for Herpes and Cytomegalovirus (-clovir)
What are the adverse effects?
Nausea, vomiting, headache, rash, and hair loss, paresthesias, neuropathy and renal dysfunction
Agents for Herpes and Cytomegalovirus (-clovir)
What are the drug-drug interactions?
Nephrotoxic drugs, zidovudine
Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Assessment:
-Assess for contraindications and cautions (renal or neurological disorders)
-Perform a physical assessment
-Assess orientation and reflexes
-Examine skin (color, temperature, and lesions)
-Evaluate renal function tests
Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Nursing diagnoses:
-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
Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Implementation:
-Administer the drug ASAP after the diagnosis has been made
-Ensure good hydration (reduce risk of kidney damage)
-Ensure that the patient takes the complete course of the drug regimen
-Wear protective gloves when applying the drug topically
-Provide safety precautions
-Warn the patient that GI upset, nausea, and vomiting can occur
-Monitor renal function tests periodically during treatment
-Provide patient teaching
Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Evaluation:
-Monitor patient response to the drug (alleviation of signs and symptoms of herpes or CMV infection).
-Monitor for adverse effects (orientation and affect, GI upset, and renal function).
-Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects.
-Monitor the effectiveness of comfort and safety measures and
adherence to the regimen
Agents for HIV and AIDS
What are the drugs in this class?
●Nonnucleoside reverse transcriptase inhibitors
- Delavirdine, Efavirenz, Nevirapine
●Nucleoside reverse transcriptase inhibitors (NRTIs)
-Abacavir, Emtricitabine, Lamivudine, Tenofovir, Zidovudine
●Protease inhibitors
-Darunavir, Fosamprenavir, Lopinavir, Ritonavir, Tipranavir
●Fusion inhibitors
-Enfuvirtide
●CCR5 coreceptor antagonists
-Maraviroc
●Integrase strand transfer inhibitors
-Dolutegravir, raltegravir
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)
What drugs are in this class?
●Delavirdine
●Efavirenz
●Nevirapine
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
What drugs are in this class?
●Abacavir
●Emtricitabine
●Lamivudine
●Tenofovir
●Zidovudine
Protease Inhibitors (-navir)
What drugs are in this class?
●Darunavir
●Fosamprenavir
●Lopinavir
●Ritonavir
●Tipranavir
Fusion Inhibitors
What drugs are in this class?
Enfuvirtide
CCR5 Coreceptor Antagonist
What drugs are in this class?
Maraviroc
Integrase Strand Transfer Inhibitors (-gravir)
What drugs are in this class?
●Dolutegravir, raltegravir
Drug class: NNRTI
What are the actions/indications?
Action/Indications – Bind directly to HIV reverse transcriptase,
blocking both RNA- and DNA-dependent DNA polymerase activities
Drug class: NNRTI
What are the contraindications?
Allergy, pregnancy and lactation
Drug class: NNRTI
What are the adverse effects?
dry mouth, abdominal pain, n/v, constipation,
diarrhea, dizziness, blurred vision, headache, flu-like syndrome
Drug class: NNRTI
What are the drug-drug interactions?
Too many to list consult a resource before adding any new meds to pts regimen
Drug class: NRTI
What are the actions/indications?
Action/Indications – Compete with naturally occurring nucleosides within the cell that the virus would use to build the DNA chain. (For HIV)
preferred method f treatment for pregnancy
Drug class: NRTI
What are the contraindications?
Allergy, lactation
Drug class: NRTI
What are the cautions?
hepatic dysfunction, renal impairment, bone marrow suppression
Drug class: NRTI
What are the adverse effects?
hypersensitivity, pancreatitis, hepatomegaly, neurological
problems, bone marrow suppression
very serious, even deadly allergic reactions have been reported with these meds
Drug class: NRTI
What are the drug-drug interactions?
Many- refer to resource before adding meds to pts regimen
Drug class: Protease Inhibitors (-Navir)
What are the actions/indications?
Action/Indications – Block protease activity within the HIV virus
Drug class: Protease Inhibitors (-Navir)
What are the contraindications?
Lactation and hepatic dysfunction
preferred during pregnancy
Drug class: Protease Inhibitors (-Navir)
What are the adverse effects?
GI effects, changes in liver function, elevated cholesterol and triglyceride levels, redistribution of fat, Stevens-Johnson syndrome
Drug class: Protease Inhibitors (-Navir)
What are the drug-drug interactions?
Many- do not combine with other hepatotoxic meds (increased risk for liver damage)
Drug class: Fusion Inhibitors
What are the actions/indications?
Action/Indications – Prevents the fusion of the virus with the human cellular membrane
Drug class: Fusion Inhibitors
What are the contraindications?
Allergy, lactation
Drug class: Fusion Inhibitors
What are the cautions?
lung disease and pregnancy
*can exacerbate respiratory problems due to the potential side effects of cough and pneumonia *
Drug class: Fusion Inhibitors
What are the adverse effects?
Insomnia, depression, peripheral neuropathy, nausea, diarrhea, pneumonia, injection site reactions
Drug class: Fusion Inhibitors
What are the drug-drug interactions?
No reported drug interactions
Drug class: CCR5 Coreceptor Antagonist
What are the actions/indications?
Action/Indications – Blocks the receptor site on the cell membrane to which the
HIV virus needs to interact to enter the cell
Drug class: CCR5 Coreceptor Antagonist
What are the contraindications?
Hypersensitivity, nursing mothers and liver disease
Drug class: CCR5 Coreceptor Antagonist
What are the adverse effects?
Dizziness and changes in consciousness, URIs; BBW severe hepatotoxicity
Drug class: CCR5 Coreceptor Antagonist
What are the drug-drug interactions?
Many
Drug class: Integrase Strand Transfer Inhibitors (-gravir)
What are the actions/indications?
●Action/Indications –inhibit the activity of the virus-specific enzyme integrase, an encoded enzyme needed for viral replication. Treatment of HIV
Drug class: Integrase Strand Transfer Inhibitors (-gravir)
What are the contraindications?
Hypersensitivity
Drug class: Integrase Strand Transfer Inhibitors (-gravir)
What are the cautions?
rhabdomyolysis, myopathy, pregnancy
Drug class: Integrase Strand Transfer Inhibitors (-gravir)
What are the adverse effects?
Headache, dizziness, insomnia, weight gain, liver failure, renal impairment, and suicidal ideation
Drug class: Integrase Strand Transfer Inhibitors (-gravir)
What are the drug-drug interactions?
decreased serum levels of either drug if combined with rifampin
Drug class: Integrase Strand Transfer Inhibitors (-gravir)
What are the drug-drug interactions?
decreased serum levels of either drug if combined with rifampin
Nursing Considerations for Patients Receiving Agents for HIV and AIDS
Assessments:
-Assess for contraindications and cautions
-Perform a physical assessment (skin, CNS, GI, renal, and hepatic)
-Assess level of orientation and reflexes
-Examine the skin (color, temperature, and lesions)
-Check temperature
-Evaluate CBC, hepatic and renal function tests. ALT/AST, creatinine, and BUN
Nursing Considerations for Patients Receiving Agents for HIV and AIDS
Nursing diagnoses:
-Impaired comfort related to GI, CNS, or dermatological effects of the drugs
-Altered sensory (kinesthetic) perception related to CNS effects of the drugs
-Malnutrition related to GI effects of the drugs
-Injury related to CNS effects of the drugs
-Knowledge deficit regarding drug therapy 28
Nursing Considerations for Patients Receiving Agents for HIV and AIDS
Implementation:
-Monitor renal and hepatic function before and periodically during therapy
-Ensure that the patient takes the complete course of the drug regimen and takes all drugs included in a particular combination
-Administer the drug around the clock, if indicated
-Monitor nutritional status
-Stop drug if severe rash occurs
-Provide safety precautions
-Teach the patient that these drugs do not cure the disease
-Provide patient teaching
Nursing Considerations for Patients Receiving Agents for HIV and AIDS
Evaluation:
-Evaluate drug effects (relief of signs and symptoms of AIDS and ARC stabilization of helper T-cell levels) = monitoring CBCs
-Monitor for adverse effects (GI alterations, dizziness, confusion, headache, fever)
-Monitor for drug–drug interactions as indicated for each drug
-Evaluate effectiveness of patient teaching plan, comfort and safety
measures
Anti-Hepatitis B Agents
What are the drugs in this class?
●Adefovir; entecavir
Anti-Hepatitis B Agents
What are the actions/indications?
Action/Indications- Inhibits reverse transcriptase in the hepatitis B virus and causes DNA chain termination
Anti-Hepatitis B Agents
What are the contraindications?
Known allergy, lactation
Anti-Hepatitis B Agents
What are the adverse effects?
Most significant are headache, dizziness, nausea, diarrhea, and elevated liver enzymes, renal
impairment, lactic acidosis
Anti-Hepatitis B Agents
What are the drug-drug interactions?
increased risk of renal toxicity if these drugs are taken with other nephrotoxic drugs
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents
Assessment:
-Assess for contraindications or cautions (renal or hepatic impairment)
-Perform a physical assessment
-Assess body temperature
-Assess level of orientation and reflexes
-Evaluate renal and liver function tests
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents
Nursing diagnoses:
-Impaired comfort related to the CNS and GI effects of the drug
-Malnutrition related to the GI effects of the drug
-Knowledge deficit regarding drug therapy
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents
Implementation:
-Monitor renal and hepatic function prior to and periodically during therapy
-Withdraw the drug and monitor the patient if he or she develops signs of lactic acidosis or hepatotoxicity
-Caution patient to not run out of this drug
-Advise women of childbearing age to use barrier contraceptives
-Advise women who are breastfeeding to find another method of feeding the baby
-Advise patients that there is still a risk of transferring the disease
-Provide patient teaching 33
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents
Evaluation:
-Monitor patient response to the drug (decreased viral load of HBV).
-Monitor for adverse effects, including liver or renal dysfunction, headache, nausea, and diarrhea.
-Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to avoid adverse effects.
-Monitor the effectiveness of comfort and safety measures and adherence to the drug regimen.
Anti-Hepatitis C Agents
What are drugs in this class?
●velpatasvir-sofosbuvir; ledipasvir-sofosbuvir; glecaprevir-
pibrentasvir; elbasvir-grazoprevir
Anti-Hepatitis C Agents
What are the actions/indications?
●Action/Indications- alters viral replication; used in combination
to treat chronic hepatitis C
Hep C can be cured
Anti-Hepatitis C Agents
What are the contraindications?
Known allergy, pregnancy, lactation
Anti-Hepatitis C Agents
What are the cautions?
Several liver disease
Anti-Hepatitis C Agents
What are the adverse effects?
Most common HA, fatigue, nausea, diarrhea, rash, and severe skin reactions
Anti-Hepatitis C Agents
What are the drug-drug interactions?
protease inhibitors; St. John’s wort
Anti-Hepatitis C Agents
What are the drug-drug interactions?
protease inhibitors; St. John’s wort
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents
Assessment:
-Assess for contraindications or cautions (allergy or liver impairment)
-Perform a physical assessment
-Assess body temperature
-Assess level of orientation and reflexes
-Evaluate liver function
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents
Nursing diagnoses:
-Impaired comfort related to the CNS and GI effects of the drug
-Malnutrition related to the GI effects of the drug
-Knowledge deficit regarding drug therapy
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents
Implementation:
-Monitor hepatic function prior to and periodically during therapy
-Advise women of childbearing age to use barrier contraceptives
-Advise women who are breastfeeding to find another method of feeding the baby
-Advise patients that these drugs do not immediately cure the disease (8-12 weeks to work)
-Provide patient teaching
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents
Evaluation:
-Monitor patient response to the drug (decreased viral load of hepatitis C).
-Monitor for adverse effects, including liver dysfunction, headache, nausea, diarrhea, and rash.
-Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to avoid adverse effects.
-Monitor the effectiveness of comfort and safety measures and adherence to the drug regimen.
Locally Active Antiviral Agents
What are the drug names in this class?
●Docosanol; ganciclovir; penciclovir, acyclovir
Locally Active Antiviral Agents
What are the actions/indications?
Action/Indications – Act on viruses by interfering with normal viral replication and metabolic processes; for specific, local viral infections
Locally Active Antiviral Agents
What are the contraindications?
Allergy to the drug
Locally Active Antiviral Agents
What are the adverse effects?
Local burning, stinging, and discomfort
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents
Assessment:
-Assess for history of allergy
-Perform a physical assessment
-Assess the infected area, including location, size, and character of lesions
-Evaluate for signs of inflammation at the site of infection
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents
Nursing diagnoses:
-Impaired comfort related to local effects of the drug
-Knowledge deficit regarding drug therapy
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents
Implementation:
-Ensure proper administration of the drug (don’t apply on open wounds)
-Stop the drug if severe local reaction occurs or if open lesions occur near the site of administration
-Instruct the patient about the drug being used
-Teach that these drugs do not cure the disease
-Encourage the patient to report severe local reaction or discomfor
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents
Evaluation:
-Monitor patient response to the drug (alleviation of signs and symptoms of viral infection).
-Monitor for adverse effects, including local irritation and discomfort.
-Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, the dosage, proper administration technique, and adverse effects to watch for and report to a health care provider.
-Monitor the effectiveness of comfort and safety measures and adherence to the regimen.
