HIV and AIDS Tx Flashcards
What does the abbreviation of HIV and of AIDS mean?
HIV:
human immunodeficiency virus (causative microorganisms of AIDS)
AIDS:
Acquired- immunodeficiency syndrome (end stage of chronic HIV infection)
What is the classification of meds used to tx HIV and AIDS?
Why are viruses hard to tx?
Antiretrovirals therapy (antivirals)(ART) and some experimental vaccines
Hard to tx bc need to enter the cell to replicate so meds need to be able to enter the cell to kill the disease (often kills the human cell as well)
What are the subclasses of antiretroviral (5)?
What are their prototypes?
- fusion inhibitors : enfuvirtide
- non-nucleoside reverse transcriptase inhibitors (NNRTIs) : nevirapine
- Nucleoside reverse transcriptase inhibitors (NRTIs) : zidovudine
- protease inhibitors: indinavir
- integrase inhibitors : Raltegravir
Which HIV antiretroviral drugs are considered safe in pregnancy?
Enfuvirtide (fusion inhibitor) and zidovudine (NRTI)
What is the major toxicity associated with enfuvirtide (fuzeon)?
An antiretroviral fusion inhibitor medication
The major toxicity associated with enfuvirtide is peripheral neuropathy and neurotoxicity
Can also cause hypersensitivity reactions and pneumonia and injection site reactions
How is enfuvirtide (fuzeon) administered?
Antiretroviral HIV fusion inhibitor medication
Injection SC only
What are some nursing implications and assessments needing to be done with enfuvirtide (fuzeon)?
Antiretroviral fusion inhibitor
- Assess liver and kidney function
- assess for signs of neurotoxicity (peripheral neuropathy: tingling and numbness of extremities)
- monitor therapeutic drug levels
- good hydration
- monitor VS
- good hygiene, safe sex
What are the main toxicities associated with zidovudine (Retrovir) PO?
NRTI antiretroviral HIV medication
- bone marrow suppression (leukopenia, anemia, thrombocytopenia) —> high risk of bleeding and infection
- hepatotoxicity
- pancreatitis
- lactic acidosis
- esophagitis
How should zidovudine (retrovir) be taken and what are some implications and monitoring to be done?
Antiretroviral NRTI HIV med
- teach pt about safety regarding risk of bleeds and infection
- can be taken with food to decrease GI upset
- remain upright for 30min post administration to avoid esophagitis or esophageal ulceration
- increase fluid intake 2-3L per day
- monitor CBC and clotting studies results
- monitor kidney and liver function tests
- monitor s&s of infections
What are some toxicities associated with nevirapine (viramune) PO?
Antiretroviral NNRTI HIV medication
- hepatotoxicity
- nephrotoxicity
- kidney stones (nephrolithiasis)
- GI upset
- generalized rash
What are some implications are monitoring needing to be made with nevirapine (viramune)?
HIV antiretroviral NNRTI
- increase fluid intake to prevent kidney stones
- monitor liver and kidney tests
- can be taken with food to decrease GI upset
What are the toxicities that need monitoring with Raltegravir ?
HIV integrase inhibitor antiretroviral
- myopathies
- breakdown of muscle cells
What are nursing implications and monitoring needing to be done with raltegravir tx regarding myopathies and muscle cells breakdown?
And some general ones?
Integrase inhibitor HIV antiretroviral
- baseline recordings of skeletal muscle functioning
- pain levels is crucial for pt safety
- increase hydration
- monitor liver and kidney tests
- monitor VS for signs of opportunistic infections
What are some toxicities or AE caused by Indinavir (crixivan)?
Protease inhibitors (PI) antiretroviral HIV drug
- lipid abnormalities (lipodystrophy, fat distribution problems, lipohypertrophy, lipoatrophy)
- insulin resistance causing diabetes type 2
- dislipidemia
- nephrolithiasis (kidney stones)
- taste changes
What are some pt teaching with indinavir (crixivan) PO?
- may cause taste changes
- can result in humps in the posterior base of neck or bone appearance of the face due to lipodystrophy
- limit caffeine and fruit juices
- take sugarless gum or hard candy to stimulate saliva
How should indinavir (crixivan) be taken PO?
Protease inhibitor HIV antiretroviral med
- increase hydration to avoid kidney stones ( at least 1.5L/day)
- best taken in fasting state bc high protein and high fat foods decrease absorption (2hrs after meal)
- limit caffeine, fruit juices
- take sugarless gum or hard sugarless candy to stimulate saliva
What are some important points to avoid medication resistance with antiretroviral tx for HIV and AIDS?
- should be taken at least 3 different types of ART drugs at a time (low CD4 and elevated viral load = maybe resistance)
- teach how to take the meds properly
- take as prescribed (all of them)
- assess for any interactions with other meds, OTC and herbs
- goal: latent viral load
- NOT A CURE, life long tx
What is the goal of tx with antiretrovirals for HIV and AIDS?
And what might indicate medication resistant?
Goal: having an undetectable viral load, so an increase in CD4 counts and decrease in viral load
Indication of resistance: high viral load and low CD4
A pt who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the pt reflects a need for more education?
A. “I will be monitored for AE and improvements while I’m taking this medicine.”
B. “These drugs do not eliminate the HIV, but hopefully the amount of virus in my body will be reduced.”
C. “There is no cure for HIV.”
D. “Thèse drugs will eventually eliminate the virus in my body.”
D.
There is no cure for HIV
The nurse is reviewing the use of multi drug therapy for HIV with a pt. Which statements are correct regarding the reason for using multiple drugs to tx HIV? Select all that apply.
A) the combination of drugs have fewer associates toxicities.
B) the use of multiple drugs is more effective against resistant strains of HIV.
C) effective tx results in reduced T cell counts
D) the goal of this tx is to reduce the viral load.
E) this type of therapy reduces the incidence of opportunistic infections.
B, D, E
Which statement about metabolic AE of ART is true? Select all that apply?
A) “thèse are annoying symptoms that are ultimately harmless”
B) ART-related body changes include central fat accumulation and peripheral wasting.
C) lipid abnormalities include increases in try glide rides and decreases in high density cholesterol
D. Insulin resistance and hyperlipidemia can be treated with meds to control glucose and cholesterol.
E. Insulin resistance and hyperlipidemia are more difficult to treat in HIV- infected clients than in y infected people.
B, C, D
Which information should the nurse include when teaching the pt about indinavir (crixivan) therapy?
A) the medication must be taken with food.
B) pts taking the drug should be encouraged to drink at least 1.5L of liquid daily
C) this medication is best absorbed in an alkaline environment
D) indinavir decreases CD4 cell counts
B
What is the General nursing process with antiretrovirals?
Assessments, implementation and teaching tips
Assessment:
- nutrition status
- weight
- VS
- kidney and liver function
- neurological status
- GI functioning
Implementation:
- monitor for infections
- take with food except indinavir
- dont crush pills
- encourage hydration
- encourage daily mouth care
- might cause orthostatique hypotension
Pt teaching tips:
- safe sex
- take meds as prescribed
- interactions
- hydration
- AE to report
- Pap smear
How to promote health with HIV?
- nutritional support to maintain a lean body mass and ensure appropriate levels of vitamins and micronutrients
- moderate or elimination of alcohol, smoking and drug use
- adequate rest and exercise
- reduce stress
- avoid infectious agents
- mental health counseling
- support groups
How to manage nausea or anorexia?
- prepare foods and meals you enjoy
- avoid nausea triggers
- avoid spicy foods or too hot
- protein and caloric dense
- small frequent meals
- drink between meals
- don’t lay down after eating
- premeds
- maybe boost of some nutrients
What are signs of malnutrition?
- weight loss
- dry skin
- brittle and thin hair
- loss of muscle mass
- brittle nails
- weakness
- bone and joint pain
- fatigue
What is cachexia related to cancer, HIV and AIDS?
Cachexia: ongoing muscle mass that’s is not entirely reversed with nutritional supplements.
Caused by underlying diseases.
May be caused at first by: anorexia, changes in metabolism, malabsorption of nutrients, or catabolism and fat distributions
What are some food elements that should be avoided with HIV antiretroviral therapy?
- limit caffeine
- limit fruit juices
- avoid echinacea
- avoid St. John wort
- avoid greasy foods
- avoid cheese and yogourts
- avoid alcohol
- avoid foods that are spicy or too flavoured
- popsicles, smoothies and jello may help with nausea
What is the best food elements to eat for prs on those tx?
High carb diet and high protein
Which HIV antiretroviral is the only one to be taken without food?
Indinavir (crixivan)
Which HIV antiretroviral causes lipid abnormalities?
Indinavir (crixivan)
What are the AE of indinavir (crixivan) the protease inhibitor HIV antiretroviral?
- lipid abnormalities
- taste changes
- insulin resistance causing type 2 diabetes
- nephroliathiasis (kidney stones)
Which antiretroviral should be taking with at least 1.5L of fluid?
Indinavir (crixivan)
Which antiretroviral needs to be taken and then the pt needs to remain upright for 30min after administration?
Zidovudine (Retrovir) due to risk of ulceration
What are the AE of zidovudine (retrovir)?
- ulceration
- myelosuppression
- pancreatitis
- hepatotoxicity
- lactic acidosis
Should the HIV antiretrovirals be taken with food?
Yes, EXCEPT indinavir (crixivan) the protease inhibitor HIV antiretroviral
