Ch. 35-39 Flashcards
What are the three modes of transmission of the AIDS virus?
Injection of infected blood, sexual contact, and maternal-fetal
How does HIV spread through the body?
Lymphoid system
What forces the single strand HIV-RNA to be converted to HIV-DNA?
Reverse transcriptase
What is the HIV virus attracted to in the body?
CD4 + T-lymphocytes
What is clinical latency and how long is it with HIV infection?
Symptom free period after infection; 8-12 years
What is HAART?
Highly active antiretroviral therapy; Current treatment recommendation
What does HAART utilize? What are the acronyms for?
2 NRTI’s and 1 NNRTI. Nucleoside/nucleotide reverse transcriptase inhibitor. Non-nucleotide reverse transcriptase inhibitor
What is a major side effect of NRTI use? How can you avoid it?
Stomach upset. Take with food, except didanosine
What are the goals of HAART?
To preserve and increase the number of CD4+ T-cells, decrease viral load, prevent resistance and secondary infections/cancers, have client in good clinical condition
What are the potential benefits of delayed therapy?
Avoid negative effects of therapy, delay drug resistance, maintain treatment options
What are the potential risks of delayed therapy?
Irreversible immune damage, difficulty in suppressing replication later, transmission risks, opportunistic infections
Why use 2 classes of drugs together?
Reduces risk of resistence
Name 3 NRTI’s. Which 2 also work for Hep B?
Epivir, Emtriva, Retrovir. The “E’s”
Will side effects (nausea, diarrhea, abdominal pain) increase over time? What can be done to help?
No, they decrease. BRAT diet
How do NNRTI’s work?
Attach to reverse transcriptase so RNA to DNA doesn’t occur
Name a NNRTI. What are it’s side effects?
Sustiva. Neuro-disturbing dreams, insomnia, lack of concentration, mood changes
What is the most potent type of AIDs drug? What side effects are common?
Protease inhibitors. Hyperlipidemia, hyperglycemia, GI upset
Name 3 protease inhibitors and which one is used for prego women?
Atazanavir (Reyataz), darunavir (Prezista) and Kaletra. Kaletra
How do entry inhibitors work? Are these used in combo or alone?
Prevents fusion of HIV and CD4 cells. Only in combo
What is the biggest drawback to entry inhibitors? What is another drawback?
Expensive! BID injection. Local RXN at site
Name a common entry inhibitor combination drug?
Combivir (Epivir and Retrovir)
What is a major concern for HIV patients taking these drugs? What are the consequences?
Adherence to the regimen. Viral replication, increased viral load, deterioration of immune system, development of resistant strains
What conditions increase the need to start a drug regimen?
CD4s such as cryptosporidiosis, pregnancy, Hep-B co-infection that requires treatment
What are the most common HIV related opportunistic infections?
Bacterial-TB and MAC, pneumonia, septicemia. Fungal-PCP, candidiasis. Viral-cytomegalo virus, herpes simplex, herpes zoster. Malignancies-Kaposi’s sarcoma, lymphoma, squamous cell carcinoma
What is the drug of choice for a pregnant woman with HIV? What is done for the baby?
Retrovir. Retrovir dosing begins 8-12 hrs after birth and continues for 6 weeks. HIV will be undetectable after regimen
How should PEP for health care workers be implemented?
Combivir BID initiated ASAP and continued for 4 weeks. Institution specific
What is the most common side effect of Emtriva?
Hyperpigmentation of palms and soles
What is the difference between Active and passive immunity?
Active-body produces antibodies from exposure to disease or live virus vaccine. Passive-Mother/baby or from antibody vaccine
What immunizations are recommended for children by the CDC?
DTaP, TD, IPV, varicella, MMR, HIB, HEP-A&B, pneumococcal, meningococcal, HPV, rotavirus
What immunizations are recommended for adults by the CDC?
TDaP, TD, flu, pneumococcal polysaccharide, HPV, MMR, varicella, Zoster
What do HPV and Hep B vaccines have in common?
3 doses
How often do you need a TD booster?
Every 10 years
How and when is the Zoster vaccine given?
A single dose at age 60 or over
When is HPV given?
For adults, ages 22-26. Kids can start as young as 9, but 11-12 is the recommendation
What are the 2 main types of anti-cancer drugs?
Cell-cycle non-specific and cell-cycle specific
What 2 vaccines are usually given for foreign travel?
Typhoid and yellow fever
What are the 4 influences on cancer?
Dietary, environmental, genetic, infective
What drug classes are cell-cycle non-specific?
Alkylating agents, antitumor antibiotics, hormones
What drug classes are cell-cycle specific?
Antimetabolites and mitotic inhibitors
Why is combination drug therapy beneficial for HIV?
Decreases drug resistance and drug toxicity
How do alkylating agents work? When are they most effective?
They prevent cells from dividing. G0 phase
Does cell-cycle specific work on any stage of cancer?
No. The cycle-cell non-specific drugs work on any stage. Alkylating agents, antitumor antibiotics, and hormones
What kind of tumors do alkylating agents work best on?
Solid tumors (lung, breast, bladder), leukemia’s, lymphomas
What kind of gloves and gown should be worn when administering chemo?
Powder-free gloves (nitrile, polyurethane, neoprene), gown (disposable, impermeable, lint free)
What are some nursing considerations to be aware of for alkylating agents?
Hydration, anti-emetics, lab values
What are some side effects of alkylating agents?
N/V/D, weight loss, alopecia
What are some adverse effects of alkylating agents?
Thrombocytopenia (bleeding precautions), leukopenia (avoid sick people), hemorrhagic cystitis (lots of fluids)
Name an alkylating agent.
Cyclophosphamide (Cytoxan)
When are antiemetics given if an alkylating agent has been prescribed?
30-60 minutes prior
How do antimetabolites work?
Halt cell growth by acting as a decoy metabolite, which interferes with DNA production/tumor growth
How do antimetabolites work?
Halt cell growth by acting as a decoy metabolite, which interferes with DNA production/tumor growth
What are the three modes of transmission of the AIDS virus?
Injection of infected blood, sexual contact, and maternal-fetal
What is hemorrhagic cystitis?
Bleeding bladder
How can hemorrhagic cystitis be prevented?
Have the patient drink plenty of fluids
What cancers are antimetabolites used for?
Acute leukemia, breast cancer, head and neck cancer, an osteosarcoma
What are the side effects for antimetabolites?
Photosensitivity, N/V/D
What are the adverse effects of antimetabolites?
Bone marrow suppression, so check RBC’s/WBC’s and platelets
What hormonal agents are used to treat cancer?
Corticosteroids and sex hormones.
How do steroids work on cancers?
Slows inflammatory process associated with tumor growth
What are the side effects of steroids?
Fluid retention, hyperglycemia, infection
How do sex hormones work on tumors?
Slows the growth of hormone-dependent tumors such as prostate and breast
Name 1 drug used for prostate cancer and 1 used for breast cancer.
Tamoxifen for breast and Faslodex for prostate
What are neutropenic precautions? Name some.
To keep a cancer patient from picking up a secondary infection due to low WBC’s. There is a list of precautions to take but they are common sense, except avoid anyone who has had a live vaccine in the last 3 weeks and rinse mouth out with warm water
What are some chemo precautions in the clinical setting?
PPE, wash hands frequently, avoid contact with bodily fluids for 48 hrs after, flush twice, wash soiled linens in hot water separately, use condoms, and < 14 can’t visit
Can a patient receiving chemo get pregnant?
Yes, but they need to wait for 3-4 months after chemo ends
Can LPN’s give cancer meds?
No
What else can chemo patients NOT have in their rooms?
No live flowers or fresh fruit (can contain bacteria)
What are biologic response modifiers?
Drugs that enhance host immunologic functions to destroy or interfere with tumor activities and promote differentiation of stem cells
Why are biologic response modifiers used in conjunction with chemo?
Decreases length of post-chemo neutropenia and allows for higher doses of chemo drugs
Name 2 biologic response modifiers. What do they do?
Epoetin alfan (Procrit) and darbepoetin alfa (Aranesp). Stimulate RBC production
What are biologic response modifiers used for?
Anemia secondary to chemo, renal failure, HIV, Zidovudine patients
How are Epoetin alfan (Procrit) and darbepoetin alfa (Aranesp) administered?
IV push and subQ
What blood level must be met in order to administer an erythropoietin stimulating agent? Side effects?
Hgb greater than 10 g/dL. HA, HTN, thrombosis, arthalgias
What do granulocyte colony-stimulating factors do? Name 2
Regulates production of neutrophils in bone marrow. Filgrastim (Neupogen) and Pegfilgrastim (Neulasta)
How are granulocyte colony-stimulating factors administered? What is the major side effect and how do you treat it?
IV & subQ. Bone pain - Non-narcotic analgesics, fatigue - give at bedtime
What are the adverse reactions for granulocyte colony-stimulating factors?
Splenic rupture. LUQ or shoulder tip pain
What adult vaccines are done in 2 doses?
Varicella, Hep A. MMR and pneumococcal may be 1 or 2 doses
What drug helps with the pain of herpes zoster?
Neurontin
How is pneumococcal given if you are over 65?
1 dose, and the 1 more after 10 years
How old does a child have to be to get the influenza vaccine?
At least 6 months old
The CDC recommends TDaP instead of TD for what 3 groups?
Pregnant women over 20 weeks, adults in close contact with children under 1 yr old, and health care providers
When should the pneumococcal vaccine be given to those under 65?
Chronic lung disease, immunocompromised, nursing home, liver/kidney disease, adults who smoke cigarettes
What are interferons?
Proteins that regulate the immune system
What is a major side effect of interferon?
Flu-like symptoms
A drug not often used in the clinical setting because of it’s serious side effects, must be administered IV, what is it?
Interleukin-2
What is a myelosuppression and what is its main symptom?
Suppression of bone marrow activity, resulting in fewer RBC’s, WBC’s and platelets. Fever
