Viral Infections - Ch. 37 Flashcards
HIV
Targets the CD4 receptor on the T4 helper lymphocyte
THERAPY IS INITIATED WHEN CD4 IS UNDER 200 cells/mcl or WHEN SYMPTOMS APPEAR
HAART (Highly Active Antiretroviral Therapy)
Use of drugs from several classes reduces the probability the HIV will becomes resistant of treatment
**Treatment - failures are common with antiretroviral therapy **Patients have nontolerance of adverse effects, they do not adhere to the complex regiment, resistant strains can emerge, and genetic variability is a factor
NRTI, NNRTI, and PI THERAPY
Establish a trusting, non-judgmental relationship with the patient and his or her lifestyle
Assess - patient’s understanding of the HIV disease process
Monitor - Plasma HIV RNA (viral load) assays, CD4 counts, complete blood count, liver and renal profiles, blood-glucose levels throughout antiretroviral therapy
Teach - Patients how to practice blood and body-fluid precautions
Pharmacotherapy for HIV/AIDS - IMPLEMENTATION
Monitor - Vital signs, especially temperature if fever, blood glucose
Nucleoside and Nucleotide Reverse Transcriptase Inhibitors: Zidovudine (Retrovir, AZT)
Action - Inhibits viral DNA replication
**Important Indications - **Reduce the transmission of HIV from an HIV-Positive to her fetus
Side Effects - Fatigue, N/V/D, Anemia, Headache, Serious CNS Effects
Nursing - Monitor bone marrow suppression
BBW - LACTIC ACIDOSIS; BONE MARROW SUPPRESSION
Drug - Drugs that suppress bone marrow
Labs - CBC
Sustiva (Nonnucleoside Reverse Transcriptase Inhibitor: Efavirenz)
Action - Inhibits viral replication
Adverse Effects - RASH (COMMON), CNS effects when first initiating therapy, sleep disorders, nightmares, dizziness, reduced ability to concentrate, flulike SX
SX gradually diminish after 3 to 4 weeks of therapy
Nursing - EMPTY STOMACH AT HS; **TAKE WITH HIGH FAT MEAL
Drug - Monitor anti-epileptic drug levels…may increase incidence of seizures; increased CNS effects with psychotropic meds or ETOH; decreases effects of oral contraceptives
Kaletra (Protease Inhibitors: Lopinavir with Ritonavir)
Action - Prevents viral replication; LOPINAVIR IS THE ACTIVE COMPONENT, whereas RITONAVIR INHIBITS THE BREAKDOWN OF LOPINAVIR, promoting higher serum levels of lopinavir
Primary Use - With other antiretrovirals for HIV-Infected patient; PREFERRED DRUG FOR THE INITIAL THERAPY OF HIV INFECTION
Side Effects - N/V/D, Hyperglycemia, Osteoporosis
Long-term therapy - Lipodystrophy syndrome (Arms, Legs, Face Loss of fat distribution; Increased fat to abdomen, breasts, neck
Nursing - No Grapefruit
Drugs - Avoid statins
Labs - MAY INCREASE CHOLESTEROL, TGL
Zovirax (Acyclovir - Agent for Herpesviruses)
Action - Prevents DNA replication
Adverse - Effects - Few when given topically or orallyl IV; nephrotoxicity and neurotoxicity - dizzy, drowsy
Nursing - IV is an irritant, monitor for decrease in pain; ensure-safety, rise slowly from lying or sitting to standing; teach patient to refrain from sexual contact
Labs - BUN & Creatinine, TCP
