Module 12 Antiviral Agents

Question 1

Viruses That Respond to

Antiviral Therapy

Answer 1

Influenza A and some respiratory viruses
Herpes viruses
Cytomegalovirus (CMV)
Human immunodeficiency virus (HIV) that causes acquired-immune deficiency syndrome (AIDS)
Hepatitis B and C
Some viruses that cause warts and certain eye infections

Question 2

Characteristics of Common

Viruses

Answer 2

A virus cannot replicate on its own.
It must attach to and enter a host cell.
It then uses the host cell’s energy to synthesize protein, DNA, and RNA.
Viruses are difficult to kill because they live inside our cells.
Any drug that kills a virus may also kill our cells.

Question 3

Antivirals Across the Lifespan

Children ,adult, older adults

Answer 3

Children
◦ More severe reactions expected
◦ No proven safety for many; extreme caution
should be used
◦ Doses should be calculated by weight
◦ Monitor closely
Adults
◦ Antibiotics won’t work for viral infections
◦ Drugs do not cure the disease
◦ Caution in pregnancy
◦ Advise child bearing women to use
contraceptives
Older adults
◦ More susceptible to adverse effects; monitor
closely
◦ Hepatic/renal dysfunction may be worsened by
these medications
◦ Dose may need to be lowered

Question 4

Common Respiratory Viruses

Answer 4

Influenza A
Influenza B
Respiratory Syncytial Virus (RSV)

Question 5

Agents for Influenza A and

Respiratory Viruses

Answer 5

Amantadine
Oseltamivir
Peramivir
Ribavirin
Rimantadine
Zanamivir

Question 6

Agents for Influenza A and
Respiratory Viruses
Indications –

Contraindications –

Adverse Effects–

Drug-Drug Interactions –

Answer 6

Indications – Prevent shedding of the viral protein coat

Contraindications – Allergy, renal impairment, pregnancy, or lactating

Adverse Effects– Dizziness, insomnia, nausea, orthostatic hypotension and urinary retention
peramivir associated with Stevens-Johnson Syndrome

Drug-Drug Interactions – Primarily anticholinergic agents

Question 7

Nursing Considerations for Patients Receiving. Agents for Influenza A and Respiratory Viruses
ADPIE

Answer 7

Assessment
◦ History and physical exam
◦ Allergy; liver or renal dysfunction; pregnancy and lactation
◦ Assess orientation and reflexes; VS; urinary output
◦ Monitor appropriate labs

Nursing Diagnoses
◦ Acute pain related to GI, CNS, or GU effects of the drug
◦ Disturbed sensory perception (kinesthetic) related to CNS effects of the drug
◦ Deficient knowledge regarding drug therapy

Implementation
◦ Start the drug regimen as soon after exposure to the virus as possible, usually within 2 days of the start of
symptoms
◦ Administer influenza A vaccine before the flu season begins, if at all possible
◦ Administer the full course of the drug
◦ Provide safety provisions if CNS effects occur
◦ Instruct the patient about the appropriate dosage-scheduling regimen; safety precautions

Evaluation
◦ Monitor patient response to the drug (prevention of respiratory flu-like symptoms, alleviation of flu-like symptoms)
◦ Monitor for adverse effects (changes in orientation and affect, blood pressure, urinary output, skin changes, liver or
renal function test changes)
◦ Determine the effectiveness of the teaching plan
◦ Monitor the effectiveness of comfort and safety measures and compliance with the regimen

Question 8

Agents for Herpes and

Cytomegalovirus (-clovir)

Answer 8

Acyclovir
Ganciclovir
Valacyclovir
Valganciclovir

Question 9

Agents for Herpes and
Cytomegalovirus
Indications –

Contraindications –

Adverse Effects–

Drug-Drug Interactions –

Answer 9

Indications – Inhibit viral DNA replication by competing with viral substrates to form shorter,
non-effective DNA chains

Contraindications – Known allergies to antiviral agents, highly toxic in pregnancy and lactation
and renal disease, severe CNS disorders

Adverse Effects– Nausea, vomiting, headache, rash, and hair loss, paresthesias, neuropathy and
renal dysfunction

Drug-Drug Interactions – Nephrotoxic drugs, zidovudine

Question 10

Nursing Considerations for Patients

Receiving Agents for Herpes Virus and CMV

Answer 10

Assessment
◦ History and physical exam
◦ Allergy; renal dysfunction; severe CNS disorders; pregnancy or lactation
◦ Assess orientation and reflexes; examine skin
◦ Monitor appropriate labs
Nursing Diagnoses
◦ Acute pain related to GI, CNS, or local effects of the drug
◦ Disturbed sensory perception (kinesthetic) related to CNS effects of the drug
◦ Deficient knowledge regarding drug therapy

Implementation
◦ Administer the drug as soon as possible after the diagnosis has been made
◦ Ensure good hydration
◦ Ensure that the patient takes the complete course of the drug regimen
◦ Wear protective gloves when applying the drug topically
◦ Provide safety precautions
◦ Warn the patient that GI upset, nausea, and vomiting can occur
◦ Monitor renal function tests periodically during treatment
◦ Provide patient teaching

Evaluation
◦ Monitor patient response to the drug (alleviation of signs and symptoms of herpes or CMV infection).
◦ Monitor for adverse effects (orientation and affect, GI upset, and renal function).
◦ Evaluate the effectiveness of the teaching plan
◦ Monitor the effectiveness of comfort and safety measures and compliance with the regimen

Question 11

Agents for HIV and AIDS

Answer 11

Nonnucleoside reverse transcriptase inhibitors
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors
Fusion inhibitors
CCR5 coreceptor antagonists
Integrase inhibitors

Question 12

Nonnucleoside Reverse

Transcriptase Inhibitors

Answer 12

Delavirdine
Efavirenz
Nevirapine

Question 13

Nonnucleoside Reverse
Transcriptase Inhibitors

Indications –

Contraindications –
Adverse Effects –
Drug-Drug Interactions -

Answer 13

Indications – Bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent
DNA polymerase activities
Contraindications – Pregnancy and lactation
Adverse Effects – GI-related, dizziness, blurred vision, headache
Drug-Drug Interactions - numerous

Question 14

Nucleoside Reverse

Transcriptase Inhibitors

Answer 14

Abacavir
Emtricitabine
Lamivudine
Tenofovir
Zidovudine

Question 15

Nucleoside Reverse
Transcriptase Inhibitors

Indications –

Contraindications –

Adverse Effects –

Drug-Drug Interactions –

Answer 15

Indications – Compete with naturally occurring nucleosides within the cell that the virus would
use to build the DNA chain
Contraindications – pregnancy (except zidovudine), hepatic dysfunction, renal impairment, bone
marrow suppression
Adverse Effects – Signs of hypersensitivity, pancreatitis, hepatomegaly, neurological problems,
bone marrow suppression
Drug-Drug Interactions – numerous

Question 16

Protease Inhibitors (-vir)

Answer 16

Darunavir
Fosamprenavir
Lopinavir
Ritonavir
Tipranavir

Question 17

Protease Inhibitors

Indications –

Contraindications –

Adverse Effects-

Drug-Drug Interactions-

Answer 17

Indications – Block protease activity within the HIV virus
Contraindications – Pregnancy and lactation and mild to moderate hepatic dysfunction
Adverse Effects- GI effects, changes in liver function, elevated cholesterol and triglyceride levels
may occur as well as Stevens-Johnson syndrome risk
Drug-Drug Interactions- numerous

Question 18

Fusion Inhibitors
Enfuvirtide

Indications –

Cautions –

Adverse Effects–

Drug-Drug Interactions –

Answer 18

Indications – Prevents the fusion of the virus with the human cellular membrane
Cautions – lung disease and pregnancy
Adverse Effects– Insomnia, depression, peripheral neuropathy, nausea, diarrhea, pneumonia,
injection site reactions
Drug-Drug Interactions – No reported drug interactions

Question 19

CCR5 Coreceptor Antagonist
Maraviroc

Indications –

Contraindications –

Adverse Effects–

Drug-Drug Interactions-

Answer 19

Indications – Blocks the receptor site on the cell membrane to which the HIV virus needs to interact to
enter the cell
Contraindications –Hypersensitivity to any component of the drug, nursing mothers and liver disease
Adverse Effects– Dizziness and changes in consciousness; BBW severe hepatotoxicity
Drug-Drug Interactions- numerous

Question 20

Integrase Inhibitors
Dolutegravir, raltegravir

Indications –

Contraindications –

Cautions-

Adverse Effects–
Drug-Drug Interactions –

Answer 20

Indications –inhibit the activity of the virus-specific enzyme integrase, an encoded enzyme needed for viral
replication.
Contraindications –Hypersensitivity to any component of the drug and nursing mothers
Cautions- rhabdomyolysis, myopathy, pregnancy
Adverse Effects– Headache, dizziness, and an increased risk for the development of rhabdomyolysis and
myopathy
Drug-Drug Interactions – decreased serum levels of either drug if combined with rifampin

Question 21

Nursing Considerations for
Patients Receiving Agents for
HIV and AIDS
ADPIE

Answer 21

Assessment
◦ History and physical exam
◦ Allergy; renal or hepatic dysfunction; any medication or herbal substances; pregnancy or lactation
◦ Assess level of orientation and reflexes; examine the skin; check temperature
◦ Monitor appropriate labs
Nursing Diagnoses
◦ Acute pain related to GI, CNS, or dermatological effects of the drugs
◦ Disturbed sensory perception (kinesthetic) related to CNS effects of the drugs
◦ Imbalanced nutrition: Less than body requirements related to GI effects of the drugs
◦ Risk for injury related to CNS effects of the drugs
◦ Deficient knowledge regarding drug therapy

Implementation
◦ Monitor renal and hepatic function before and periodically during therapy
◦ Ensure that the patient takes the complete course of the drug regimen and takes all drugs included in a
particular combination
◦ Administer the drug around the clock, if indicated
◦ Monitor nutritional status
◦ Stop drug if severe rash occurs
◦ Provide safety precautions
◦ Teach the patient that these drugs do not cure the disease
◦ Provide patient teaching
Evaluate
◦ Evaluate drug effects (relief of signs and symptoms of AIDS and ARC stabilization of helper T-cell levels)
◦ Monitor for adverse effects (GI alterations, dizziness, confusion, headache, fever)
◦ Monitor for drug–drug interactions as indicated for each drug
◦ Evaluate effectiveness of patient teaching plan, comfort and safety measures

Question 22

Anti-Hepatitis B Agents
Adefovir; entecavir; telbivudine

Indications-

Contraindications-

Adverse Effects-

Drug-Drug Interactions-

Answer 22

Indications- Inhibits reverse transcriptase in the hepatitis B virus and causes DNA chain termination
Contraindications- Known allergy, pregnancy, lactation and known renal and liver dysfunction
Adverse Effects- Most significant are headache, dizziness, nausea, diarrhea, and elevated liver
enzymes
Drug-Drug Interactions-increased risk of renal toxicity if these drugs are taken with other
nephrotoxic drugs

Question 23

Nursing Considerations for
Patients Receiving Anti–Hepatitis
B Agents
ADPIE

Answer 23

Assessment
◦ History and physical exam
◦ Allergy; renal dysfunction; severe liver impairment; pregnancy and lactation
◦ Assess body temperature; level of orientation and reflexes
◦ Monitor appropriate labs
Nursing Diagnoses
◦ Acute pain related to the CNS and GI effects of the drug
◦ Imbalanced nutrition: Less than body requirements related to the GI effects of the drug
◦ Deficient knowledge regarding drug therapy

Implementation
◦ Monitor renal and hepatic function prior to and periodically during therapy
◦ Withdraw the drug and monitor the patient if he or she develops signs of lactic acidosis or
hepatotoxicity
◦ Caution patient to not run out of this drug
◦ Advise women of childbearing age to use barrier contraceptives
◦ Advise women who are breastfeeding to find another method of feeding the baby
◦ Advise patients that these drugs do not cure the disease, and there is still a risk of transferring the
disease
◦ Provide patient teaching

Evaluation
◦ Monitor patient response to the drug (decreased viral load of hepatitis B)
◦ Monitor for adverse effects (liver or renal dysfunction, headache, nausea, diarrhea)
◦ Evaluate the effectiveness of the teaching plan
◦ Monitor the effectiveness of comfort and safety measures and compliance with the drug regimen

Question 24

Anti-Hepatitis C Agents
Daclatasvir; simeprevir; sofosbuvir

Indications-

Contraindications-
Caution-
Adverse Effects-

Drug-Drug Interactions-

Answer 24

Indications- used in combination with ribavirin or ribavirin and peginterferon or other hepatitis C drugs
to treat chronic hepatitis C in patients with compromised liver function
Contraindications- Known allergy, pregnancy, lactation
Caution- severe liver disease
Adverse Effects- Most common fatigue, nausea, diarrhea, and rash
Drug-Drug Interactions- protease inhibitors or other antivirals; St. John’s wort

Question 25

Nursing Considerations for
Patients Receiving Anti–Hepatitis
C Agents
ADPIE

Answer 25

Assessment
◦ History and physical exam
◦ Allergy; severe liver impairment; pregnancy and lactation
◦ Assess body temperature; level of orientation and reflexes
◦ Monitor appropriate labs
Nursing Diagnoses
◦ Acute pain related to the CNS and GI effects of the drug
◦ Imbalanced nutrition: Less than body requirements related to the GI effects of the drug
◦ Deficient knowledge regarding drug therapy

Implementation
◦ Ensure that this patient is also receiving peginterferon and ribavirin or other hepatitis C drugs
◦ Monitor hepatic function prior to and periodically during therapy
◦ Advise women of childbearing age to use barrier contraceptives
◦ Advise women who are breastfeeding to find another method of feeding the baby
◦ Advise patients that these drugs do not cure the disease
◦ Provide patient teaching

Evaluation
◦ Monitor patient response to the drug (decreased viral load of hepatitis C)
◦ Monitor for adverse effects (liver dysfunction, headache, nausea, diarrhea, rash)
◦ Evaluate the effectiveness of the teaching plan
◦ Monitor the effectiveness of comfort and safety measures and compliance with the drug regimen

Question 26

Locally Active Antiviral Agents

Answer 26

Docosanol; ganciclovir; penciclovir
Indications – Act on viruses by interfering with normal viral replication and metabolic processes
Contraindications – Allergy to the drug
Adverse Effects – Local burning, stinging, and discomfort

Question 27

Nursing Considerations for
Patients Receiving Locally Active
Antiviral Agents
ADPIE

Answer 27

Assessment
◦ History and physical exam
◦ Allergy
◦ Assess the infected area, including location, size, and character of lesions
Nursing Diagnoses
◦ Acute pain related to local effects of the drug
◦ Deficient knowledge regarding drug therapy

Implementation
◦ Ensure proper administration of the drug
◦ Stop the drug if a severe local reaction occurs or if open lesions occur near the site of administration
◦ Instruct the patient about the drug being used
◦ Teach that these drugs do not cure the disease

Evaluation
◦ Monitor patient response to the drug (alleviation of signs and symptoms of viral infection)
◦ Monitor for adverse effects (local irritation and discomfort)
◦ Evaluate the effectiveness of the teaching plan
◦ Monitor the effectiveness of comfort and safety measures and compliance with the regimen

Question 28

The End