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Chapter 13 Antivirals, Antiretrovirals and Antifungal Medications Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 13 Lesson 13.1 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 2 Learning Objectives • Describe how antiviral and antiretroviral medications work • List common medications used in treating AIDS and AIDS-related fungal infections • Outline Standard Precautions the nurse takes in limiting exposure to AIDS Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 3 HIV Infection Acquired immunodeficiency syndrome (AIDS) – Viral disease – High mortality rate High-risk populations include: – – – – – Homosexual and bisexual men Intravenous drug users People in prison Female sexual partners of people in high-risk groups Children born to mothers at risk Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 4 Antivirals Action and Uses • Decrease symptoms of viral infection • Lessen the symptoms of viral illness in immunocompromised patients or adults and children at risk Adverse Reactions – Hepatotoxicity, nephrotoxicity, blood dyscrasias, peripheral neuropathies Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 5 Antivirals (cont.) Nursing Implications and Patient Teaching • • • • Medications do not cure Follow specific storage instructions Reporting adverse reactions Administration – Encourage immunocompromised clients in areas with impure water supplies to drink bottled water only Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 6 Antiretrovirals Action • Interfere with the ability of a retrovirus to reproduce or replicate • Two types: – Reverse transcriptase inhibitors • Act early in viral life cycle – Protease inhibitors • Act later in viral life cycle Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 7 Antiretrovirals (cont.) Uses – Slow advance of AIDS – Maintain immunity – Prevention of HIV in infants born to HIVinfected mothers – Prevention of HIV in healthcare workers exposed to HIV Drug Interactions Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 8 Antiretrovirals (cont.) Nursing Implications and Patient Teaching • Adherence is essential • Medications do not cure • Report all drugs and supplements used, including OTC and CAM • Signs and symptoms of pancreatitis • Signs and symptoms of peripheral neuropathy Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 9 Antiretrovirals (cont.) Nursing Implications and Patient Teaching (cont.) • Routes of disease transmission • Need for social and financial support Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 10 Antifungals Action – Fungistatic – Fungicidal Uses – Treat mycotic infections • Fungal-specific medications • Systemic medications Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 11 Antifungals (cont.) Common Antifungal Medications: Ketoconazole (Nizoral) • Broad-spectrum fungistatic and fungicidal action • Used to treat oral thrush, candidiasis, histoplasmosis Nystatin (Mycostatin) • Antibiotic with fungistatic and fungicidal action • Used to treat intestinal, vaginal, and oral fungal infections caused by Candida strains Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 12 Antifungals (cont.) Common Antifungal Medications (cont.) Amphotericin B (Amphotec) • Systemic drug Griseofulvin • Activity decreased with barbiturates Metronidazole (Flagyl) • Related drug for mixed fungal and bacterial or protozoa infections; interacts with alcohol Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 13 Antifungals (cont.) Nursing Implications and Patient Teaching • Take all the medication as ordered; do not stop when symptoms disappear • Avoid alcohol • Report nausea, vomiting, and diarrhea; watch for easy bruising, sore throat, rash, or fever • Nystatin must be shaken thoroughly before use • Intolerance to the sun (photosensitivity) can occur with griseofulvin therapy • Cleanliness of hair, skin and nails will limit spread Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 14