Download Textbook of Basic Nursing, Rosdahl and Kowalski

Introduction to Clinical
Pharmacology
Chapter 11Antiviral Drugs
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Antivirals: Actions
• Combat viral infections
• Interfere with the virus’s ability to reproduce
in a cell
• Can be toxic to human cells
• Are more difficult to develop
– Herbal Alert: St. John’s Wort
•Used for depression and as antiviral
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Antivirals: Uses
• **Labeled Uses: CMV in transplant patients;
HSV 1 and 2 (genital) and herpes zoster;
HIV; influenza A and B; RSV; hepatitis B and
C (see display 11-1)
• Unlabeled Uses: CMV and HSV infections
after transplantation procedures and
varicella pneumonia; CMV retinitis in
immunocompromised patients; ribavirin for
influenza A and B; herpes genitalis, and
measles
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Antivirals: Adverse Reactions
• Gastrointestinal Reactions
– Nausea, vomiting; diarrhea
• Other Reactions
– Headache; rash; fever; insomnia
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Antivirals: Contraindications and
Precautions
• Use during pregnancy and lactation only
when the benefit outweighs the risk to the
fetus or child
• *Used cautiously in patients:
– Renal impairment; low blood cell
counts; history of epilepsy; history of
respiratory disease
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Antivirals: Interactions
• Probenecid: Increased serum levels of the
antivirals
• Cimetidine: Increased serum levels of antiviral
valacyclovir
• Anticholinergic agents: With amantadine onlyincreased adverse reactions of anticholinergic
agent
• Theophylline: with acyclovir only-increased serum
level of theophylline
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antiretrovirals: Actions
• Retroviruses: Highly active antiretroviral
therapy (HAART)
– Protease inhibitors
– Reverse transcriptase inhibitors
– Attachment and fusion inhibitors
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antiretrovirals: Uses and Adverse
Reactions
• Used in the treatment of HIV and AIDS
• Adverse reactions:
– Gastrointestinal Reactions: Nausea,
vomiting; diarrhea; altered taste
• Other Reactions: Headache; fever; chills;
rash
– *numbness and tingling in the circumoral
area (around the mouth) or peripherally
(peripheral neuropathy) or both
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antiretrovirals: Contraindications and
Precautions
• Contraindicated in patients:
– Who are taking cisapride, pimozide,
triazolam, midazolam or an ergot
derivative
– Ritonavir is contraindicated if pt. is taking
buproprion (Wellbutrin), zolpidem
(Ambien) or an antiarrythmic drug
• Used cautiously in patients:
– With diabetes mellitus; impaired hepatic
function; pregnancy; hemophilia
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antiretrovirals: Interactions
• Anticoagulant, anticonvulsant, antiparasitic
agents: Decreased effectiveness when taking
ritonavir
• Interleukins: Risk of antiretroviral toxicity
• Fentanyl: Increased serum level of fentanyl
• *Oral contraceptives: Decreased
effectiveness of the birth control agent
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Preadministration assessment:
– Determine the patient’s general state of
health and resistance to infection
– Record vital signs, symptoms and
complaints
– Additional assessments may be necessary
in certain types of viral infections
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Nursing Process: Assessment (cont’d)
• Ongoing assessment:
– Monitor for and report any adverse
reactions from the antiviral drug
– Inspects the IV site several times a day
for redness, inflammation, or pain and
report any signs of phlebitis
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Nursing Process: Nursing Diagnosis
• Risk for imbalanced nutrition: Less than
body requirements
• Risk for impaired skin integrity
• Risk for injury
• Body image disturbance
• Acute pain
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Nursing Process: Planning
• *The expected outcome includes an optimal
response to therapy:
– *Management of adverse drug reactions
– *Understanding of and compliance with
the prescribed treatment regimen
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Nursing Process: Implementation
• Promoting an optimal response therapy:
– Allow the patient and family members time
to talk and ask questions
– *Amantadine: Observe the patient for
adverse effects-hypotension & insomnia
– Ribavirin: Discard and replace the solution in
the SPAG-2 aerosol generator every 24
hours; monitor respiratory function closely
throughout therapy-sudden respiratory
deterioration could occur in infants receiving
ribavirin is a pregnancy category X drug
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and managing patient’s need
– Risk for injury
• Monitor acutely ill patients carefully; place call
lights in a convenient place for the patient;
plan activities so as to provide adequate rest
periods; watch for signs of peripheral
neuropathy
– Body image disturbance
• Spend time with patients, encouraging them
to verbalize their feelings regarding any
change in appearance
• May have fat redisribution-weigh daily!!!!
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Nursing Process: Implementation
• Educating the patient and family
– Explain the dosage regimen and advise to take
the drug as prescribed only
– Instruct pt. to report any symptoms of infection
(temp, ST, dyspnea, weakness, lethargy)
– some drugs may cause photosensitivity
– Increased risk when suldenafil/Viagra and
antiretroviral drugs taken together-Rxn’shypotension, visual distrubances, prolonged
penile erection
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Nursing Process: Evaluation
• The therapeutic effect is achieved;
symptoms of the disease process subside or
diminish
• Adverse reactions are identified, reported,
and managed
• Patient and family demonstrate
understanding of the drug regimen
• Patient verbalizes the importance of
complying with the prescribed therapeutic
regimen
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