Antiviral Drugs Flashcards
Acyclovir
Chemical Classification
Purine nucleoside analog
Acyclovir
Functional Classification
Antiviral
Acyclovir
Mechanism of Action
Interferes with DNA synthesis by conversion to acyclovir triphosphate, thereby causing decreased viral replication
Acyclovir
Uses
Mucocutaneous herpes simplex virus, herpes genitalis (HSV-1, HSV-2), varicella infections, herpes zoster, herpes simplex encephalitis
Acyclovir
Contraindications
Hypersensitivity to this product, valacyclovir
Acyclovir
Side Effects
CNS: tremors, confusion, lethargy, hallucinations, SEIZURES, dizziness, headache, encephalopathic changes
EENT: gingival hyperplasia
GI: nausea, vomiting, diarrhea, increased ALT/AST, abdominal pain, glossitis, colitis
GU: OLIGURIA, PROTEINURIA, HEMATURIA, vaginitis, moniliasis, GLOMERULONEPHRITIS, ACUTE RENAL FAILURE, changes in menses, polydipsia
HEMA: THROMBOTIC THROMBOCYTOPENIA PURPURA, HEMOLYTIC UREMIC SYNDROME (immunocompromised patients)
INTEG: rash, urticaria, pruritus, pain or phlebitis at IV site, unusual sweating, alopecia, STEVENS-JOHNSON SYNDROME
MS: joint pain, leg pain, muscle cramps
Acyclovir
Nursing Considerations
ASSESS:
- Signs of infection, anemia
- TOXICITY: ANY PATIENT WITH COMPROMISED RENAL SYSTEM BECAUSE PRODUCT IS EXCRETED SLOWLY WITH POOR RENAL SYSTEM FUNCTION; TOXICITY MAY OCCUR RAPIDLY
- HEPATIC, RENAL STUDIES: AST, ALT, URINALYSIS, PROTEIN, BUN, CREATININE, CCr, WATCH FOR INCREASING BUN AND SERUM CREATININE OR DECREASED CCr; I&O RATIO; REPORT HEMATURIA, OLIGURIA, FATIGUE, WEAKNESS; MAY INDICATE NEPHROTOXICITY; CHECK FOR PROTEIN IN URINE DURING TREATMENT
- Blood studies: WBC, RBC, Hct, Hgb, bleeding time; blood dyscrasias may occur product should be discontinued
- C&S before product therapy; product may be taken as soon as culture is taken; repeat C&S after treatment; determine the presence of other infections
- Bowel pattern, before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued
- Skin eruptions: rash, urticaria, itching
- Allergies before treatment, reaction of each medication; place allergies on chart in bright red letters
- Neurologic status with herpes encephalitis
PERFORM/PROVIDE:
-adequate intake of fluids (2L) to prevent deposits in kidneys
Acyclovir
Overdose Treatment
Discontinue product, hemodialysis, resuscitate if needed
Ganciclovir
Functional Classification
Antiviral
Ganciclovir
Chemical Classification
Synthetic Nucleoside Analog
Ganciclovir
Mechanism of Action
Inhibits replication of herpesviruses; competitively inhibits human CMV DNA polymerase and is incorporated, resulting in termination of DNS elongation
Ganciclovir
Uses
Cytomegalovirus (CMV) retinitis in immunocompromised persons, including those with AIDS, after indirect ophthalmoscopy confirms diagnosis; prophylaxis for CMV in transplantation
Ganciclovir
Contraindications
Hypersensitivity to acyclovir, ganciclovir, famciclovir, penciclovir, valacyclovir, valganciclovir
Ganciclovir
Side Effects
CNS: Fever, chills, COMA, Confusion, abnormal thoughts, dizziness, bizarre dreams, Headache, psychosis, tremors, somnolence, Paresthesia, Weakness, SEIZURES, peripheral neuropathy
CV: dysrhythmia, hypo/hypertension
EENT: retinal detachment in CMV retinitis, ocular hypertension, ocular pain, conjunctival scarring, cataracts
GI: Abnormal LFTs, Nausea, Vomiting, Anorexia, Diarrhea, Abdominal Pain, HEMORRHAGE, PERFORATION, PANCREATITIS
GU: HEMATURIA, Increased Creatinine, BUN
HEMA: GRANULOCYTOPENIA, THROMBOCYTOPENIA, IRREVERSIBLE NEUTROPENIA, ANEMIA, EOSINOPHILIA, PANCYTOPENIA
INTEG: Rash, alopecia, Pruritus, urticaria, pain at site, phlebitis
RESP: dyspnea
Ganciclovir
Nursing Considerations
ASSESS:
- CMV RETINITIS: culture should be completed before starting treatment (urine, blood, throat), ophthalmic exam
- INFECTION: increased temp, sore throat, chills, fever; report to prescriber
- LEUKOPENIA/NEUTROPENIA/THROMBOCYTOPENIA: CBC, WBCs, platelets q2days during 2x/day dosing and then q1wk for leukopenia with daily WBC count in patients with prior leukopenia with other nucleoside analogs or for whom leukopenia counts are /=q2wk, BUN; LFTs; ophthalmic exam
- For seizures, dysrhythmias
Idinavir
Functional Classification
Antiretroviral
Idinavir
Chemical Classification
Protease Inhibitor
Idinavir
Mechanism of Action
Inhibits human immunodeficiency virus (HIV-1) protease; this prevents the maturation of the virus
Idinavir
Uses
HIV-1 in combination with at least 2 other antiretrovirals
Idinavir
Contraindications
Hypersensitivity, breastfeeding
Idinavir
Side Effects
CNS: Headache, Insomnia, dizziness, somnolence
GI: Diarrhea, Abdominal Pain, Nausea, Vomiting, anorexia, dry mouth
GU: nephrolithiasis
INTEG: rash
MS: Pain
OTHER: asthenia, INSULIN-RESISTANT HYPERGLYCEMIA, hyperlipidemia, KETOACIDOSIS, lipodystrophy
Idinavir
Nursing Considerations
ASSESS:
- Complaints of lower back, flank pain; indicates kidney stones
- Signs of infection, anemia, presence of other sexually transmitted diseases
- Blood/hepatic studies: ALT, AST; total bilirubin, amylase, blood glucose, serum cholesterol/lipid profile, may be elevated
- Plasma HIV RNA, viral load, CD4 during treatment
- Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
- Skin eruptions; rash, urticaria, itching
- Allergies before treatment, reaction of each medication; place allergies on chart
Nevirapine
Functional Classification
Antiretroviral
Nevirapine
Chemical Classification
Nonnucleoside reverse transcriptase inhibitor (NNRTI)
Nevirapine
Mechanism of Action
Binds directly to reverse transcriptase and blocks RNA, DNA, thus causing a disruption of the enzyme’s site
Nevirapine
Uses
HIV-1 in combination with other highly active antiretroviral therapy (HAART)
Nevirapine
Contraindications
Hypersensitivity, hepatic disease
Nevirapine
Side Effects
CNS: Paresthesia, Headache, Fever, Peripheral Neuropathy
GI: Diarrhea, abdominal pain, Nausea, Stomatitis, HEPATOTOXICITY, HEPATIC FAILURE
HEMA: NEUTROPENIA, ANEMIA, THROMBOCYTOPENIA
INTEG: Rash, TOXIC EPIDERMAL NECROLYSIS
MISC: STEVENS-JOHNSON SYNDROME, ANAPHYLAXIS
MS: pain, myalgia, RHABDOMYOLYSIS
Nevirapine
Nursing Considerations
ASSESS
- Resistance testing before therapy and when therapy fails
- Signs of infection, anemia, hepatotoxicity, immune reconstitution syndrome; hepatitis B or C, liver toxicity may occur
- HIV: blood studies during treatment: ALT, AST, viral load, CD4, plasma HIV RNA, renal studies; if LFTs elevated significantly, product should be withheld; glucose levels in diabetic patients
- RHABDOMYOLYSIS: pain, tenderness, weakness, edema; product should be discontinued
- Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
- STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, allergies before treatment, reaction to each medication; skin eruptions; rash, urticaria, itching; if rash is severe or systemic symptoms occur, discontinue immediately
Zidovudine (Retrovir)
Functional Classification
Antiretroviral
Zidovudine (Retrovir)
Chemical Classification
Nucleoside reverse transcriptase inhibitor (NRTI)
Zidovudine (Retrovir)
Mechanism of Action
Inhibits replication of HIV-1 virus by incorporating into cellular DNA by viral reverse transcriptase, thereby terminating the cellular DNA chain
Zidovudine (Retrovir)
Uses
Used in combination with at least 2 other antiretrovirals for HIV-1 infection
Zidovudine (Retrovir)
Contraindications
Hypersensitivity
Zidovudine (Retrovir)
Side Effects
CNS: Fever, Headache, Malaise, diaphoresis, Dizziness, Insomnia, paresthesia, somnolence, chills, tremor, twitching, anxiety, confusion, depression, lability, vertigo, loss of mental acuity, SEIZURES, malaise
EENT: taste change, hearing loss, photophobia
GI: Nausea, Vomiting, Diarrhea, Anorexia, cramps, Dyspepsia, Constipation, dysphagia, Flatulence, rectal bleeding, mouth ulcer, abdominal pain, HEPATOMEGALY
GU: dysuria, polyuria, urinary frequency, hesitancy
HEMA: GRANULOCYTOPENIA, ANEMIA
INTEG: Rash, acne, pruritus, urticaria
MS: myalgia, arthralgia, muscle spasm
RESP: dyspnea
SYST: LACTIC ACIDOSIS
Zidovudine (Retrovir)
Nursing Considerations
ASSESS:
- Blood counts q2wk; watch for decreasing granulocytes, Hgb; if low, therapy may have to be discontinued and restarted after hematologic recovery; blood transfusions may be required; viral load, CD4 counts, LFTs, plasma HIV RNA, serum creatinine/BUN at baseline and throughout treatment
- LACTIC ACIDOSIS, SEVERE HEPATOMEGALY WITH STEATOSIS: Obtain baseline liver function tests, if elevated, discontinue treatment; discontinue even if liver function tests are normal but lactic acidosis, hepatomegaly are present; may be fatal
