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Pharm Exam 3

Terms in this set (76)

What are they key characteristics of antiviral drugs
-able to enter cells infected with the virus
-interfere with the viral nucleic acid synthesis and/or regulation
-(some) drugs interfere with the ability of the virus to bind to cells
-(some) drugs stimulate the bodys immune response
How do antiviral drugs work?
They kill/ suppress the virus by destroying virions/ inhibiting the ability of the virus to replicate. controlled by current antiviral therapy

Ig (from animals or humans) are concentrated antibodies that can attack and destroy viruses
What are the current viruses controlled by current antiviral therapy?
-Cytomegalovirus (CMV
-Hepatitis viruses
-Herpes viruses
-HIV
-the flu
-Respiratory syncytial virus (RSV)
A healthy immune system works __________with the drug to eliminate or suppress viral activity
synergistically
What do opportunistic infections need?
prophylaxis and antiinfective drug therapy
Opportunistic infections can be...?
-viruses
-fungi
-bacterie
-protozoa
Types of herpes simplex virus
HSV-1 and HSV-2
Types of human herpes virus CZH
-Chicken pox/ shingles (HHV-3 or (VZV)
-Epstein-Barr (HHV-4)
-Cytomegalovirus (HHV-5)
-Kaposi's sarcoma (HHV-8) cancer inducing in aids patients
What do antiviral drugs treat?
(infections other than HIV)
-HSV
-VZV
CMV
-HAV, HBV, HCV
What do antiretroviral drugs treat?
Used to treat infections caused by AIDS- the virus that causes AIDS
Whats the major issue with antiviral drugs?
They also kill healthy cells
Amantadine (Symmetrel)

Class
Indications
Antiviral/ non HIV

Antiviral/ Parkinsons

Narrow antiviral spectrum, only active against influenza A

Most recent guidelines advise against use
Amantadine (Symmetrel)

CNS effects

GI effects
Antiviral/ non HIV

CNS: nervousness, insomnia, light headedness

GI: anorexia, nausea, others
Rimantadine (Flumadine)

indications
effects compared to (what other drug)
Antiviral/ non HIV

Same spectrum of activity, mechanism of action, and indications as amantadine

Fewer CNS adverse effects

CNS: Dizziness, blurred vision
Causes GI upset
What are the neuraminidase antiviral inhibitors?

Indication?
- oseltamivir (Tamiflu)
- zanamivir (Relenza)

Active against flu A and B
Action of oseltamivir (Tamiflu) and zanamivir (relenza)

when should treatment begin?
Reduces duration of illness (flu A and B)

within 2 days of symptom onset
oseltamivir (Tamiflu) adverse effects
Nausea and vomiting
zanamivir (Relenza) adverse effects
nausea, diarrhea, sinusitis
acyclovir (Zovirax)

Class
Indication
synthetic nucleoside analog

Used to suppress replication of HSV1, HSV2, VZV
acyclovir (Zovirax)

adverse effects
CNS: headache
GI: GI upset
Other: swealling of hands and feet, burning with topical forms
Precaution with acyclovir (Zovirax) parenteral

all the forms it comes in?
infuse at least 1hr to avoid kidney damage

Oral, topical, parenteral
What drug is used to treat CMV (cytomegalovirus- CMV retinitis)
ganciclovir (Cytovene)
What types of human herpes virus is cancer inducing for a patient with AIDs
Kaposi's sarcoma
ganciclovir (Cytovene)

forms
Oral, parenteral, opthalmic surgically inserter (Vitraset)
ganciclovir (Cytovene)

adverse effects
Bone marrow toxicity, seizures, nausea, vomiting, headache
ganciclovir (Cytovene)

nursing interventions and why
Since a serious AE is bone marrow toxicity we want to test the RBC, WBC, platelets
What drugs are used to treat CMV?
ganciclovir, foscarnet, cidofovir

foscarnet used to treat CMV in patients with AIDs
foscarnet, cisofovir

Adverse effect

Nursing interventions
Renal toxicity, edema, anemia

NI: assess BUN and creatine levels, monitory I&O, assess K and Na
How does foscarnet/ cisofovir cause anemia in AE?
Renal toxicity- Kidneys produce hormone that helps produce RBCs (erythropoetin)
What is the drug of choice to treat HSV1, HSV2, VZV
acyclovir (Zorirax)
Whats the normal range for BUN and creatinine?
BUN: 10-20
Creatinine: 0.6-1.2
Signs of hyperkalemia
Dizziness, weakness, cardiac irregularities, muscle cramps, diarrhea, nausea.
Signs of hypokalemia
weakness, dysrhymias, increased cardiac sensitivity of digoxin, ileus, Flat T wave
signs of hypernatremia
you are FRIED

Fever
Restless
Increased BP
Edema
Decreased urinary output
Signs of hypoatremia
...
Ribavirin Indications
hospitalized infants & young children with severe lower respiratory tract infections caused by RSV

Bronchiolitis
Pneumonia
at risk for developing severe lower respiratory tract disease
very contagious
Ribavirin adverse effects
Rash, conjunctivitis, anemia, mild bronchospasm

Teratogenic
Ribavirin administration routes
Orally or Nasal inhalation

Inhalation - Virazole (for hospitalized infants with severe RSV infections)
An 82-year-old woman is unable to take the influenza vaccine due to allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. What action should be taken?
Patient should begin oral oseltamivir (Tamiflu) therapy as soon as possible
What drug is used for infants who are hospitalized with severe RSV infections?
Ribavirin
How does HIV spread?
sexual intercourse, IV drug use, mother to child, sharing needles
How do you treat an accidental needle-stick injury?
Prophylactic therapy for accidental exposure. Post-exposure prophylactics. HBIG
What are the stages of HIV infection
1. Asymptomatic infection
2. Early, general symptoms of disease
3. Moderate symptoms
4. Severe symptoms, often leading to death
What symptoms are associated with stage 3 of HIV
weight loss, fever, diarrhea, see dropping rate of helper T cells CD4 <500 (normal 500-1000)
What symptoms are associated with stage 4 of HIV
chronic diarrhea, fever, opprotunistic infections, EB, fungal, TB pneumonia, other viral: carpris, sarcoma, herpes MRSA

<200 CD4
A patient with HIV infection is seen in the clinic. The nurse notes the patient is experiencing weight loss, chronic diarrhea, fever, and dropping CD4 counts. The nurse anticipates the patient is in which stage of HIV infection?
Stage 3
Protozoal opportunistic infections
Toxoplasmosis of the brain (abscess)
Fungal opportunistic infections
- Candidiasis of the lungs, esophagus, trachea
- Pneumocystis jirovecii pneumonia
- others
Viral opportunistic infections
- CMV disease
- HSV infection
- others
Bacterial opportunistic infections
- Various mycobacterial infections
- Extrapulmonary TB
HIV wasting syndrom opportunistic infections

effects
Cachexia, stage 4

Major weight loss, chronic diarrhea, chronic fever
What is HAART?
highly active antiretroviral therapy, at least 3 medications "cocktails", work in different ways to reduce viral load
Action of Reverse transcriptase inhibitors (RTI's)
Block activity of the enzyme reverse transcriptase, preventing production of new viral DNA
Action of protease inhibitors (PI's)
Inhibit the protease retroviral enzyme, preventing viral replication
Action of Fusion inhibitors
Inhibit viral fusion, prevent viral replication
maraviroc (Selzentry)

Class
Adverse effects
Pt education/ NI
CCR5 antagonist

hepatotoxicity
Administer Phenytoin (antiseizure) to decrease the effects of maraviroc

*epileptic pt might not benefit
HIV integrase strand transfer inhibitors
Raltegravir
Indinavir (Crixivan)

Class
Adverse effects
Pt education
Protease inhibitor

Nephrolithiasis - kidney stones

Advise patient to drink atleast 48oz of fluids to prevent this condition

*HIV infected person complains, hold drug and call prescriber
Tenofovir (Viread)

Class
Adverse effects
Pt education/ NI
Lactic acidosis, severe

hepatomegaly

Hold drug it patient experiences muscle pain and weakness
Zidovudine (AZT Retrovir)

Class
Adverse effects
pt education/ NI
NRTI

Bone marrow suppression

Safely used in pregnancy and newborns, increase the risk of neurotoxicity (tingly numbness in hands, fingers, toes, feet) when administered along with acyclovir

Check RBC, WBC, platelets if bone marrow issue
what drug administered when HIV+ mother has a baby
zidovudine (AZT Retrovir)

give to newborn for 6 weeks
pregnant for 14-34 weeks of gestation
A patient with active HIV has been taking zidovudine (AZT Retrovir). Which potential adverse effect may limit the length of time this medication can be taken?
Hepatomegaly

Check RBC, WBC, Platelets
The nurse administers maraviroc (Selzentry) to a patient with HIV infection. It is most important for the nurse to monitor?
Liver function tests
Zidovudine - acyclovir interaction
increase neurotoxicity, tingling/ numbness in extremities
zidovudine - gancilclovir/ ribavin interaction
antagonizes antiviral action of zidovudine
zidovudine - interferon beta interaction
increase serum levels of zidovudine, causing toxic effects

*bone marrow suppression, check RBC, WBC, platelets
zidovudine - cytotoxic drug interactions
increase risk of hematologic toxicity
zidovudine - didanosine interactions
additive/ synergistic effects against HIV
Adverse effects of amantadine
CNS: nervousness, insomnia, lightheadedness
GI: anorexia, nausea
other: hypotension, blurred vision
Adverse effects of ganciclover
bone marrow toxicity, nausea, vomiting, headache, seizures
Adverse effects of foscarnet/ cidofovir
Renal toxicity, edema, headache, seizure, electrolyte imbalance. bone marrow suppression, NVD
Adverse effects of Acyclovir
GI upset, headache, swelling at hands/ feet, burning with topical
Adverse effects retrovir
Bone marrow suppression, nausea, headache
Drugs that act on flu A
amantadine
drugs that act on flu A and B
oseltamivir (tamiflu), zanamivir (relenza)
Patient education for oseltamivir (tamiflu)
- dont take after 3 days of symptom onset

- take within 2 days of symptom onset to reduce duration

*Elder take oseltamivir before symptoms start, take soon as they've came in contact with someone who has had the flu
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