Antivirals

Question 1

What does varicella-zoster (a herpes virus) cause?

Answer 1

Shingles (in adults) and chickenpox (in children, teens, and young adults)

Question 2

What is the key thing to remember about antivirals, specifically when they work?

Answer 2

They only work during the replication process of the virus, not when it is dormant.

Question 3

Does taking an antiviral when a virus is dormant have any effect of the virus?

Answer 3

NO NO NO

Question 4

What is the therapeutic response of antivirals?

Answer 4

Prevent viral replication resulting in relief or suppression of symptoms; DOES NOT CURE

Question 5

Even when taking an antiviral, for something like herpes 1 & 2 (cold sores and genital herpes), can the virus still be transmitted?

Answer 5

YES YES YES

Question 6

What is the suffix to know antivirals by?

Answer 6

vir

Question 7

What is acyclovir (Zovirax) commonly used for?

Answer 7

The suppression of herpes viruses including varicella-zoster

Question 8

What are some nursing considerations for antiviral medications?

Answer 8

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)

Question 9

What are some nursing considerations for antiviral administration?

Answer 9

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)

Question 10

What are some patient teaching points for antivirals?

Answer 10

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)

Question 11

Is there a single drug used to treat HIV?

Answer 11

No, it is a combination drug therapy

Question 12

What is the goal of using a combination of drugs?

Answer 12

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

Question 13

What is the name for the combination drug therapy for HIV?

Answer 13

HAART (highly active anti-retroviral therapy)

Question 14

How many medications are usually used in HAART?

Answer 14

3-4

Question 15

Why is HAART more beneficial to a patient for treatment of HIV?

Answer 15

Able to use lower dosages of each

Reduce adverse effects of each

Reduce resistance of virus by attacking it in multiple ways

Question 16

Does HAART have a lot of drug-drug interactions?

Answer 16

YES YES YES

THERE ARE TOO MANY TO MEMORIZE

CHECK FOR INTERACTIONS BEFORE PRESCRIBING OTHER MEDICATIONS, WATCH OUT FOR OTC MEDICATIONS, HERBAL REMEDIES

Question 17

Why is treatment failure common with HAART?

Answer 17

The treatment is very expensive

lots of adverse effects

lifelong administration of a lot of medications

BASICALLY COMPLIANCE IS A BIG ISSUE

Question 18

What do Nucleoside Reverse Transcriptase Inhibitors (NRTIs & NNRTIs) do (HAART)?

Answer 18

stop viral replication

zidovudine (Retrovir) NRTI

delavirdine (Rescriptor) NNRTI

NNRTI - non-nucleoside reverse transcriptase inhibitor

Question 19

What do protease inhibitors do (HAART)?

Answer 19

inhibit enzymes needed for viral replication

Ritonavir (Norvir)

Question 20

What do fusion/entry inhibitors do (HAART)?

Answer 20

blocks virus from attaching to CD4 cells

enfuvirtide (Fuzeon)

Question 21

How is enfuvirtide (Fuzeon), a fusion/entry inhibitor, administered?

Answer 21

subcutaneous injection

Question 22

How does the HIV virus replicate?

Answer 22

reverse transcriptase (it makes DNA from RNA)

Question 23

What is the main challenge about treating HIV?

Answer 23

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

Question 24

What is the one symptom that all of the HAART medications discussed can cause?

Answer 24

flu-like symptoms (chills, malaise, fever) - patient and nurse should report these (compliance concern, may be opportunistic infection)

Question 25

What are some adverse effects/nursing considerations of NRTIs?

Answer 25

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)

Question 26

What are some adverse effects/nursing considerations of protease inhibitors?

Answer 26

flu-like symptoms (chills, malaise, fever)

bone marrow suppression (monitor CBC, report signs of opportunistic infections)

Question 27

What are some adverse effects/nursing considerations of fusion/entry inhibitors?

Answer 27

flu-like symptoms (chills, malaise, fever)

rash (report)

bacterial pneumonia (report respiratory infections)

Question 28

What are some adverse effects of NNRTIs?

Answer 28

flu-like symptoms (chills, malaise, fever)

rash (report)

Question 29

What is concerning about the bone marrow suppression caused by protease inhibitors and NRTIs?

Answer 29

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.

Question 30

Are respiratory infections a typical opportunistic infection from HAART therapy and HIV?

Answer 30

YES YES YES

HIV patients have higher incidences of TB, which is an opportunistic infection

Question 31

What are some main patient teaching points for HIV antivirals (antiretrovirals)?

Answer 31

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)