NURS 317 Unit 7 Pharm Chapter 10 Flashcards
A client with HIV has had a CCR5 coreceptor antagonist added to the antiretroviral regimen. What assessment should the nurse prioritize?
A) Liver function
B) Kidney function
C) Cardiac monitoring
D) Respiratory function
A) Liver function
Rationale:Severe hepatotoxicity has been reported with maraviroc, a CCR5 coreceptor antagonist. For this reason, liver function should be monitored closely and is likely a priority over heart, kidney, and lung function.
The nurse is caring for a client with a new diagnosis of HIV. The client underwent testing as a screening process and is currently asymptomatic. The healthcare provider orders a combination of antiviral medications to prevent progression of the disease to AIDS. What points should the nurse include in the teaching plan for this client? Select all that apply.
A) Reporting nausea, vomiting, and diarrhea immediately
B) The importance of seeing the health provider regularly
C) Scheduling medications to allow for 8 hours of uninterrupted sleep
D) Avoiding driving or operating heavy machinery initially
E) The schedule for when to take medications
B) The importance of seeing the health provider regularly
D) Avoiding driving or operating heavy machinery initially
E) The schedule for when to take medications
Rationale:Having just learned of an HIV diagnosis, this client is likely to be very anxious, so it is important to draw up a written schedule of when each medication will be taken. Stress the importance of regular visits to the doctor in order for medication effectiveness to be monitored through lab studies and adverse effects to be managed. A client who is asymptomatic may be noncompliant with medications if adverse effects of the drugs are bothersome, so helping to reduce the negative effects can increase compliance. Instruct the client to avoid driving or operating heavy equipment until evaluating the effects the medication has on him or her because each client will respond differently. If no CNS effects occur, the client can return to normal driving habits. Nausea, vomiting, and diarrhea are likely to occur, so the client should be instructed on strategies to manage these symptoms and should call the doctor only if they cannot be managed or become acute. Medications should be taken around the clock if necessary to maintain therapeutic effects.
A client has been diagnosed with herpes and has been prescribed acyclovir 8 mg/kg IV q8h. The client weighs 143 lbs. What will the client’s daily dose of acyclovir be? Provide your answer in mg.
_______________mg
1560mg
Rationale:The client’s weight must first be converted to kilograms by dividing by 2.2: 143 ÷ 2.2 = 65 kg. The client is to receive 8 mg/kg: 8 mg × 65 kg = 520 mg. The client receives this dose q8h, so multiplying by 3 yields the daily (24h) dose of 1,560 mg.
A client is receiving a nonnucleoside reverse transcriptase inhibitor. Why should the nurse caution the client to avoid the concurrent use of St. John’s wort?
A) The risk for atropine-like effects is increased.
B) Life-threatening interactions are possible.
C) The risk for renal toxicity is increased.
D) Antiviral effects may be reduced.
D) Antiviral effects may be reduced.
Rationale:St. John’s wort should not be used because a decrease in antiviral effects may occur. Life-threatening effects can occur when nonnucleoside reverse transcriptase inhibitors are taken with antiarrhythmics, clarithromycin, calcium channel blockers, antituberculosis drugs, warfarin, quinidine, indinavir, saquinavir, or dapsone. The risk for renal toxicity may be increased if the agent is combined with another drug that affects the kidneys. Nonnucleoside reverse transcriptase inhibitors are not associated with atropine-like effects.
Locally active antiviral agents can be applied to open lesions to control severe symptoms.
A) FALSE
B) TRUE
A) FALSE
Rationale:Locally active antiviral agents should not be applied to open wounds.
The nurse is caring for a client who is receiving antiviral medications to treat HIV. What laboratory study should the nurse monitor most closely to determine the effectiveness of the medications?
A) P24 antigen test
B) CBC with differential
C) CD4 count
D) Liver function studies
C) CD4 count
Rationale:HIV attacks the helper T cells (CD4 cells) within the immune system. Monitoring T-cell count would indicate how effective the drug is at controlling the virus. CBC with differential does not include a T-cell count. P24 antigen tests confirm the presence of the virus but do not indicate the severity of the disease; it is either positive or negative. Liver function studies are not indicated unless liver function is damaged by the disease.
Drugs used to combat influenza and respiratory viruses act to inhibit viral DNA replication.
A) FALSE
B) TRUE
A) FALSE
Rationale:The exact mechanism of action of drugs to treat influenza and respiratory viruses is not known.
The nurse is providing health education to a client who has recently been diagnosed with HIV and will soon begin antiretroviral therapy. What teaching point should the nurse prioritize?
A) The need to adhere rigidly to the prescribed drug schedule
B) The incidence and prevalence of hypersensitivity reactions
C) The pathophysiology of the human immunodeficiency virus and its link to drug treatment
D) The need to report diarrhea or nausea to the provider immediately
A) The need to adhere rigidly to the prescribed drug schedule
Rationale:Strict adherence is absolutely vital to the success of HIV treatment. The client should learn about the possibility of hypersensitivity, but the exact incidence and prevalence is unimportant. Similarly, the client must learn about adverse effects, but adherence to the drug regimen is more important than the client’s response to diarrhea or nausea. Pathophysiology is not a priority teaching point for most clients.
When describing the action of an integrase inhibitor, the nurse understands that this class of drug acts by what mechanism?
A) Preventing the growth of viral DNA chain and its insertion into the host DNA
B) Blocking the activity of an enzyme in HIV leading to an immature HIV particle
C) Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication
D) Blocking the receptor site that HIV needs to interact with to enter the cell
C) Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication
Rationale:Integrase inhibitors inhibit the activity of a virus-specific enzyme, integrase, an encoded enzyme needed for viral replication. Nucleoside reverse transcriptase inhibitors prevent the growth of the viral DNA change and prevent it from inserting itself into the host DNA. Protease inhibitors block the activity of the enzyme protease, which is essential for the maturation of the infectious virus. CCR5-co-receptor antagonists block the receptor site HIV needs to interact with in order to enter the cell.
A client with HIV is frustrated by the size and complexity of the current medication regimen. What should the nurse teach the client about combination therapy for the treatment of HIV?
A) The client’s immune response is enhanced with multiple drugs.
B) Use of multiple drugs ensures sensitivity to various viral forms.
C) One drug combats the virus while the others are prescribed to diminish the adverse effects.
D) Use of combination therapy attacks the virus at different stages of the life cycle
D) Use of combination therapy attacks the virus at different stages of the life cycle
Rationale:Because HIV mutates over time, combination therapy is effective in attacking the virus at various points in the life cycle to achieve maximum therapeutic effect with the least amount of toxicity. Sensitivity is not a reason for using combination therapy. The use of combination therapy can increase the client’s risk for adverse effects
