Antivirals Flashcards
What does varicella-zoster (a herpes virus) cause?
Shingles (in adults) and chickenpox (in children, teens, and young adults)
What is the key thing to remember about antivirals, specifically when they work?
They only work during the replication process of the virus, not when it is dormant.
Does taking an antiviral when a virus is dormant have any effect of the virus?
NO NO NO
What is the therapeutic response of antivirals?
Prevent viral replication resulting in relief or suppression of symptoms; DOES NOT CURE
Even when taking an antiviral, for something like herpes 1 & 2 (cold sores and genital herpes), can the virus still be transmitted?
YES YES YES
What is the suffix to know antivirals by?
vir
What is acyclovir (Zovirax) commonly used for?
The suppression of herpes viruses including varicella-zoster
What are some nursing considerations for antiviral medications?
Nephrotoxicity
Causes inflammation or phlebitis at injection sites
Usually there arent any side effects unless given IV (can also be given as cream or pill), the patient is immunosuppressed, or has a really bad outbreak (particularly shingles)
What are some nursing considerations for antiviral administration?
Nephrotoxicity & phlebitis or inflammation - When IV, administer slowly over 1 hour and encourage fluids during and after therapy.
Wear gloves for topical application (decrease spread of virus)
What are some patient teaching points for antivirals?
Make sure that the patient knows the antiviral is not a cure for the virus.
Wash area and keep area dry (promote healing)
Take medication as directed
avoid sexual activity (genital herpes)
Is there a single drug used to treat HIV?
No, it is a combination drug therapy
What is the goal of using a combination of drugs?
the goal is to reduce plasma HIV to the lowest possible level (each drug attacks the virus in different ways), by reducing the amount of viral replication the immune system can be preserved
What is the name for the combination drug therapy for HIV?
HAART (highly active anti-retroviral therapy)
How many medications are usually used in HAART?
3-4
Why is HAART more beneficial to a patient for treatment of HIV?
Able to use lower dosages of each
Reduce adverse effects of each
Reduce resistance of virus by attacking it in multiple ways
Does HAART have a lot of drug-drug interactions?
YES YES YES
THERE ARE TOO MANY TO MEMORIZE
CHECK FOR INTERACTIONS BEFORE PRESCRIBING OTHER MEDICATIONS, WATCH OUT FOR OTC MEDICATIONS, HERBAL REMEDIES
Why is treatment failure common with HAART?
The treatment is very expensive
lots of adverse effects
lifelong administration of a lot of medications
BASICALLY COMPLIANCE IS A BIG ISSUE
What do Nucleoside Reverse Transcriptase Inhibitors (NRTIs & NNRTIs) do (HAART)?
stop viral replication
zidovudine (Retrovir) NRTI
delavirdine (Rescriptor) NNRTI
NNRTI - non-nucleoside reverse transcriptase inhibitor
What do protease inhibitors do (HAART)?
inhibit enzymes needed for viral replication
Ritonavir (Norvir)
What do fusion/entry inhibitors do (HAART)?
blocks virus from attaching to CD4 cells
enfuvirtide (Fuzeon)
How is enfuvirtide (Fuzeon), a fusion/entry inhibitor, administered?
subcutaneous injection
How does the HIV virus replicate?
reverse transcriptase (it makes DNA from RNA)
What is the main challenge about treating HIV?
It replicates within CD4 cells, which play a big role in our immune response, the virus literally destroys our immune system while it is replicating
What is the one symptom that all of the HAART medications discussed can cause?
flu-like symptoms (chills, malaise, fever) - patient and nurse should report these (compliance concern, may be opportunistic infection)
What are some adverse effects/nursing considerations of NRTIs?
flu-like symptoms (chills malaise, fever)
lactic acidosis (monitor for rapid breathing, nausea, abdominal pain)
fatty liver/hepatotoxic (monitor liver enzymes)
bone marrow suppression (monitor CBC, report symptoms of opportunistic infections)
What are some adverse effects/nursing considerations of protease inhibitors?
flu-like symptoms (chills, malaise, fever)
bone marrow suppression (monitor CBC, report signs of opportunistic infections)
What are some adverse effects/nursing considerations of fusion/entry inhibitors?
flu-like symptoms (chills, malaise, fever)
rash (report)
bacterial pneumonia (report respiratory infections)
What are some adverse effects of NNRTIs?
flu-like symptoms (chills, malaise, fever)
rash (report)
What is concerning about the bone marrow suppression caused by protease inhibitors and NRTIs?
Not only does it decrease WBC, RBC, and platelet counts, but the virus itself also attacks CD4 cells which impairs our immune system as well.
This makes the body vulnerable to opportunistic infections, the main two being thrush (oral candidiasis) and yeast infections. Not only that, but some opportunistic infections can feel like flu-like symptoms (chills, fever, malaise). So flu-like symptoms are not only an adverse effect of all of the medications for HAAR, but the bone marrow suppression from protease inhibitors and NRTIs can cause opportunistic infections that present with flu-like symptoms.
Are respiratory infections a typical opportunistic infection from HAART therapy and HIV?
YES YES YES
HIV patients have higher incidences of TB, which is an opportunistic infection
What are some main patient teaching points for HIV antivirals (antiretrovirals)?
report symptoms - make sure they know the main adverse symptoms
report signs of opportunistic infections - flu-like symptoms, pneumonia, skin rashes, thrush, yeast infections
avoid crowds (bone marrow suppression, weak immune system
good hand washing
protect sexual partners, dont share needles
take med as ordered
get sufficient rest (immune system health)
keep scheduled appointments/OTCs and other medications (like st. johns wort) unless discussed with HCP – (some may decrease effectiveness of HAART medications)
