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Antiviral Agents Flashcards

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1
Q

What are viruses that respond well to antiviral therapy?

A

-influenza A and some respiratory viruses
-herpes viruses
-cytomegalovirus (CMV)
-HIV that causes acquired-immune deficiency syndrome (AIDS)
-hepatitis B and C

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2
Q

Antivirals across the lifespan of children

A

-More severe reactions expected
-No proven safety for many; extreme caution should be used
-Doses should be calculated by weight
-Monitor closely

particularly vulnerable to the effects on the kidneys, bone marrow, and liver

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3
Q

Antivirals across the lifespan of adults

A

-Antibiotics won’t work for viral infections
-Drugs do not cure the disease (no cure for HIV)
-Caution in pregnancy
-Advise childbearing women to use contraceptives

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4
Q

Antivirals across the lifespan of older adults

A

-More susceptible to adverse effects; monitor closely
-Hepatic/renal dysfunction may be worsened by these medications
-Dose may need to be lowered

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5
Q

What are the Agents used for Influenza A and Respiratory Viruses?

A

● Amantadine - influenza A, West Nile virus, and Parkinson’s disease
●Oseltamivir - influenza A & B ( can reduce severity if taken shortly after symptoms begin)
●Peramivir - acute influenza (IV med for patients who cannot take oral antiviral meds)
●Rimantadine - influenza A
●Zanamivir - Influenza A & B (inhaled med)

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6
Q

Agents for Influenza A and Respiratory Viruses
What are the indications?

A

Treatment and reduction of severity of respiratory viruses and influenza

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7
Q

Agents for Influenza A and Respiratory Viruses
What are the actions?

A

prevents viral replication

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8
Q

Agents for Influenza A and Respiratory Viruses
What are the contraindications?

A

Allergy, renal impairment, pregnancy, or lactating

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9
Q

Agents for Influenza A and Respiratory Viruses
What are the adverse effects?

A

Dizziness, insomnia, nausea, orthostatic hypotension and urinary retention; peramivir associated with Stevens-Johnson Syndrome

these influenza agents have an effect on dopamine levels - so they can cause some disturbances and mood and sleep patterns

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10
Q

Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Assessment:

A

-Assess for contraindications or cautions (asking pts for any liver or kidney problems)
-Perform a physical assessment
-Assess for orientation and reflexes; vital signs; urinary output; and skin
-Monitor renal and hepatic function tests
-Assess mood, anxiety, sleep
-Monitor BP for orthostatic hypotension

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11
Q

Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Nursing diagnoses:

A

-Impaired comfort related to GI, CNS, or GU effects of the drug
-Altered sensory perception (kinesthetic) related to CNS effects of the drug
-Knowledge deficit regarding drug therapy

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12
Q

Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Implementation:

A

-Start the drug regimen as soon after exposure to the virus as possible, usually within 2 days of the start of symptoms
-Administer influenza A vaccine before the flu season begins, if at all possible
-Administer the full course of the drug
-Provide safety provisions if CNS effects occur
-Instruct the patient about the appropriate dosage-scheduling regimen; safety
precautions

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13
Q

Nursing considerations for patients receiving agents for influenza A and respiratory viruses
Evaluation:

A

-Monitor patient response to the drug (prevention of respiratory flulike symptoms, alleviation of flulike symptoms).
-Monitor for adverse effects (changes in orientation and affect, blood pressure, urinary output, skin changes, and/or liver or renal function test changes).
-Determine the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to help to avoid or minimize adverse effects.
-Monitor the effectiveness of comfort and safety measures and adherence to

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14
Q

Agents for Herpes and Cytomegalovirus
Drug names/ suffixes?

A

(-clovir)
●Acyclovir - genital herpes, cold sores, chicken pox and shingles
●Ganciclovir - cytomegalovirus (CMV) (organ transplant, HIV, AIDS pts)
●Valacyclovir - genital herpes, cold sores and shingles
●Valganciclovir - treat and prevent cytomegalovirus (CMV) (organ transplant, HIV, AIDS pts)

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15
Q

Agents for Herpes and Cytomegalovirus (-clovir)
What are the actions/ indications?

A

Inhibit viral DNA replication; treatment of HSV and CMV

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16
Q

Agents for Herpes and Cytomegalovirus (-clovir)
What are the contraindications?

A

-Known allergy, highly toxic in pregnancy and lactation and renal disease, severe CNS disorders (Alzheimer’s, stroke, Parkinson’s, multiple sclerosis, or epilepsy should not take these drugs)

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17
Q

Agents for Herpes and Cytomegalovirus (-clovir)
What are the adverse effects?

A

Nausea, vomiting, headache, rash, and hair loss, paresthesias, neuropathy and renal dysfunction

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18
Q

Agents for Herpes and Cytomegalovirus (-clovir)
What are the drug-drug interactions?

A

Nephrotoxic drugs, zidovudine

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19
Q

Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Assessment:

A

-Assess for contraindications and cautions (renal or neurological disorders)
-Perform a physical assessment
-Assess orientation and reflexes
-Examine skin (color, temperature, and lesions)
-Evaluate renal function tests

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20
Q

Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Nursing diagnoses:

A

-Impaired comfort related to GI, CNS, or local effects of the drug
-Impaired sensory (kinesthetic) perception related to CNS effects of the drug
-Knowledge deficit regarding drug therapy

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21
Q

Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Implementation:

A

-Administer the drug ASAP after the diagnosis has been made
-Ensure good hydration (reduce risk of kidney damage)
-Ensure that the patient takes the complete course of the drug regimen
-Wear protective gloves when applying the drug topically
-Provide safety precautions
-Warn the patient that GI upset, nausea, and vomiting can occur
-Monitor renal function tests periodically during treatment
-Provide patient teaching

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22
Q

Nursing Considerations for Patients Receiving Agents for Herpes Virus and CMV
Evaluation:

A

-Monitor patient response to the drug (alleviation of signs and symptoms of herpes or CMV infection).
-Monitor for adverse effects (orientation and affect, GI upset, and renal function).
-Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects.
-Monitor the effectiveness of comfort and safety measures and
adherence to the regimen

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23
Q

Agents for HIV and AIDS
What are the drugs in this class?

A

●Nonnucleoside reverse transcriptase inhibitors
- Delavirdine, Efavirenz, Nevirapine

●Nucleoside reverse transcriptase inhibitors (NRTIs)
-Abacavir, Emtricitabine, Lamivudine, Tenofovir, Zidovudine

●Protease inhibitors
-Darunavir, Fosamprenavir, Lopinavir, Ritonavir, Tipranavir

●Fusion inhibitors
-Enfuvirtide

●CCR5 coreceptor antagonists
-Maraviroc

●Integrase strand transfer inhibitors
-Dolutegravir, raltegravir

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24
Q

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)
What drugs are in this class?

A

●Delavirdine
●Efavirenz
●Nevirapine

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25
Nucleoside Reverse Transcriptase Inhibitors (NRTIs) What drugs are in this class?
●Abacavir ●Emtricitabine ●Lamivudine ●Tenofovir ●Zidovudine
26
Protease Inhibitors (-navir) What drugs are in this class?
●Darunavir ●Fosamprenavir ●Lopinavir ●Ritonavir ●Tipranavir
27
Fusion Inhibitors What drugs are in this class?
Enfuvirtide
28
CCR5 Coreceptor Antagonist What drugs are in this class?
Maraviroc
29
Integrase Strand Transfer Inhibitors (-gravir) What drugs are in this class?
●Dolutegravir, raltegravir
30
Drug class: NNRTI What are the actions/indications?
Action/Indications – Bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent DNA polymerase activities
31
Drug class: NNRTI What are the contraindications?
Allergy, pregnancy and lactation
32
Drug class: NNRTI What are the adverse effects?
dry mouth, abdominal pain, n/v, constipation, diarrhea, dizziness, blurred vision, headache, flu-like syndrome
33
Drug class: NNRTI What are the drug-drug interactions?
Too many to list consult a resource before adding any new meds to pts regimen
34
Drug class: NRTI What are the actions/indications?
Action/Indications – Compete with naturally occurring nucleosides within the cell that the virus would use to build the DNA chain. (For HIV) *preferred method f treatment for pregnancy*
35
Drug class: NRTI What are the contraindications?
Allergy, lactation
36
Drug class: NRTI What are the cautions?
hepatic dysfunction, renal impairment, bone marrow suppression
37
Drug class: NRTI What are the adverse effects?
hypersensitivity, pancreatitis, hepatomegaly, neurological problems, bone marrow suppression *very serious, even deadly allergic reactions have been reported with these meds*
38
Drug class: NRTI What are the drug-drug interactions?
Many- refer to resource before adding meds to pts regimen
39
Drug class: Protease Inhibitors (-Navir) What are the actions/indications?
Action/Indications – Block protease activity within the HIV virus
40
Drug class: Protease Inhibitors (-Navir) What are the contraindications?
Lactation and hepatic dysfunction *preferred during pregnancy*
41
Drug class: Protease Inhibitors (-Navir) What are the adverse effects?
GI effects, changes in liver function, elevated cholesterol and triglyceride levels, redistribution of fat, Stevens-Johnson syndrome
42
Drug class: Protease Inhibitors (-Navir) What are the drug-drug interactions?
Many- do not combine with other hepatotoxic meds (increased risk for liver damage)
43
Drug class: Fusion Inhibitors What are the actions/indications?
Action/Indications – Prevents the fusion of the virus with the human cellular membrane
44
Drug class: Fusion Inhibitors What are the contraindications?
Allergy, lactation
45
Drug class: Fusion Inhibitors What are the cautions?
lung disease and pregnancy *can exacerbate respiratory problems due to the potential side effects of cough and pneumonia *
46
Drug class: Fusion Inhibitors What are the adverse effects?
Insomnia, depression, peripheral neuropathy, nausea, diarrhea, pneumonia, injection site reactions
47
Drug class: Fusion Inhibitors What are the drug-drug interactions?
No reported drug interactions
48
Drug class: CCR5 Coreceptor Antagonist What are the actions/indications?
Action/Indications – Blocks the receptor site on the cell membrane to which the HIV virus needs to interact to enter the cell
49
Drug class: CCR5 Coreceptor Antagonist What are the contraindications?
Hypersensitivity, nursing mothers and liver disease
50
Drug class: CCR5 Coreceptor Antagonist What are the adverse effects?
Dizziness and changes in consciousness, URIs; BBW severe hepatotoxicity
51
Drug class: CCR5 Coreceptor Antagonist What are the drug-drug interactions?
Many
52
Drug class: Integrase Strand Transfer Inhibitors (-gravir) What are the actions/indications?
●Action/Indications –inhibit the activity of the virus-specific enzyme integrase, an encoded enzyme needed for viral replication. Treatment of HIV
53
Drug class: Integrase Strand Transfer Inhibitors (-gravir) What are the contraindications?
Hypersensitivity
54
Drug class: Integrase Strand Transfer Inhibitors (-gravir) What are the cautions?
rhabdomyolysis, myopathy, pregnancy
55
Drug class: Integrase Strand Transfer Inhibitors (-gravir) What are the adverse effects?
Headache, dizziness, insomnia, weight gain, liver failure, renal impairment, and suicidal ideation
56
Drug class: Integrase Strand Transfer Inhibitors (-gravir) What are the drug-drug interactions?
decreased serum levels of either drug if combined with rifampin
57
Drug class: Integrase Strand Transfer Inhibitors (-gravir) What are the drug-drug interactions?
decreased serum levels of either drug if combined with rifampin
58
Nursing Considerations for Patients Receiving Agents for HIV and AIDS Assessments:
-Assess for contraindications and cautions -Perform a physical assessment (skin, CNS, GI, renal, and hepatic) -Assess level of orientation and reflexes -Examine the skin (color, temperature, and lesions) -Check temperature -Evaluate CBC, hepatic and renal function tests. ALT/AST, creatinine, and BUN
59
Nursing Considerations for Patients Receiving Agents for HIV and AIDS Nursing diagnoses:
-Impaired comfort related to GI, CNS, or dermatological effects of the drugs -Altered sensory (kinesthetic) perception related to CNS effects of the drugs -Malnutrition related to GI effects of the drugs -Injury related to CNS effects of the drugs -Knowledge deficit regarding drug therapy 28
60
Nursing Considerations for Patients Receiving Agents for HIV and AIDS Implementation:
-Monitor renal and hepatic function before and periodically during therapy -Ensure that the patient takes the complete course of the drug regimen and takes all drugs included in a particular combination -Administer the drug around the clock, if indicated -Monitor nutritional status -Stop drug if severe rash occurs -Provide safety precautions -Teach the patient that these drugs do not cure the disease -Provide patient teaching
61
Nursing Considerations for Patients Receiving Agents for HIV and AIDS Evaluation:
-Evaluate drug effects (relief of signs and symptoms of AIDS and ARC stabilization of helper T-cell levels) = monitoring CBCs -Monitor for adverse effects (GI alterations, dizziness, confusion, headache, fever) -Monitor for drug–drug interactions as indicated for each drug -Evaluate effectiveness of patient teaching plan, comfort and safety measures
62
Anti-Hepatitis B Agents What are the drugs in this class?
●Adefovir; entecavir
63
Anti-Hepatitis B Agents What are the actions/indications?
Action/Indications- Inhibits reverse transcriptase in the hepatitis B virus and causes DNA chain termination
64
Anti-Hepatitis B Agents What are the contraindications?
Known allergy, lactation
65
Anti-Hepatitis B Agents What are the adverse effects?
Most significant are headache, dizziness, nausea, diarrhea, and elevated liver enzymes, renal impairment, lactic acidosis
66
Anti-Hepatitis B Agents What are the drug-drug interactions?
increased risk of renal toxicity if these drugs are taken with other nephrotoxic drugs
67
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents Assessment:
-Assess for contraindications or cautions (renal or hepatic impairment) -Perform a physical assessment -Assess body temperature -Assess level of orientation and reflexes -Evaluate renal and liver function tests
68
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents Nursing diagnoses:
-Impaired comfort related to the CNS and GI effects of the drug -Malnutrition related to the GI effects of the drug -Knowledge deficit regarding drug therapy
69
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents Implementation:
-Monitor renal and hepatic function prior to and periodically during therapy -Withdraw the drug and monitor the patient if he or she develops signs of lactic acidosis or hepatotoxicity -Caution patient to not run out of this drug -Advise women of childbearing age to use barrier contraceptives -Advise women who are breastfeeding to find another method of feeding the baby -Advise patients that there is still a risk of transferring the disease -Provide patient teaching 33
70
Nursing Considerations for Patients Receiving Anti–Hepatitis B Agents Evaluation:
-Monitor patient response to the drug (decreased viral load of HBV). -Monitor for adverse effects, including liver or renal dysfunction, headache, nausea, and diarrhea. -Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to avoid adverse effects. -Monitor the effectiveness of comfort and safety measures and adherence to the drug regimen.
71
Anti-Hepatitis C Agents What are drugs in this class?
●velpatasvir-sofosbuvir; ledipasvir-sofosbuvir; glecaprevir- pibrentasvir; elbasvir-grazoprevir
72
Anti-Hepatitis C Agents What are the actions/indications?
●Action/Indications- alters viral replication; used in combination to treat chronic hepatitis C *Hep C can be cured*
73
Anti-Hepatitis C Agents What are the contraindications?
Known allergy, pregnancy, lactation
74
Anti-Hepatitis C Agents What are the cautions?
Several liver disease
75
Anti-Hepatitis C Agents What are the adverse effects?
Most common HA, fatigue, nausea, diarrhea, rash, and severe skin reactions
76
Anti-Hepatitis C Agents What are the drug-drug interactions?
protease inhibitors; St. John’s wort
77
Anti-Hepatitis C Agents What are the drug-drug interactions?
protease inhibitors; St. John’s wort
78
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents Assessment:
-Assess for contraindications or cautions (allergy or liver impairment) -Perform a physical assessment -Assess body temperature -Assess level of orientation and reflexes -Evaluate liver function
79
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents Nursing diagnoses:
-Impaired comfort related to the CNS and GI effects of the drug -Malnutrition related to the GI effects of the drug -Knowledge deficit regarding drug therapy
80
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents Implementation:
-Monitor hepatic function prior to and periodically during therapy -Advise women of childbearing age to use barrier contraceptives -Advise women who are breastfeeding to find another method of feeding the baby -Advise patients that these drugs do not immediately cure the disease (8-12 weeks to work) -Provide patient teaching
81
Nursing Considerations for Patients Receiving Anti–Hepatitis C Agents Evaluation:
-Monitor patient response to the drug (decreased viral load of hepatitis C). -Monitor for adverse effects, including liver dysfunction, headache, nausea, diarrhea, and rash. -Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to avoid adverse effects. -Monitor the effectiveness of comfort and safety measures and adherence to the drug regimen.
82
Locally Active Antiviral Agents What are the drug names in this class?
●Docosanol; ganciclovir; penciclovir, acyclovir
83
Locally Active Antiviral Agents What are the actions/indications?
Action/Indications – Act on viruses by interfering with normal viral replication and metabolic processes; for specific, local viral infections
84
Locally Active Antiviral Agents What are the contraindications?
Allergy to the drug
85
Locally Active Antiviral Agents What are the adverse effects?
Local burning, stinging, and discomfort
86
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents Assessment:
-Assess for history of allergy -Perform a physical assessment -Assess the infected area, including location, size, and character of lesions -Evaluate for signs of inflammation at the site of infection
87
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents Nursing diagnoses:
-Impaired comfort related to local effects of the drug -Knowledge deficit regarding drug therapy
88
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents Implementation:
-Ensure proper administration of the drug (don’t apply on open wounds) -Stop the drug if severe local reaction occurs or if open lesions occur near the site of administration -Instruct the patient about the drug being used -Teach that these drugs do not cure the disease -Encourage the patient to report severe local reaction or discomfor
89
Nursing Considerations for Patients Receiving Locally Active Antiviral Agents Evaluation:
-Monitor patient response to the drug (alleviation of signs and symptoms of viral infection). -Monitor for adverse effects, including local irritation and discomfort. -Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, the dosage, proper administration technique, and adverse effects to watch for and report to a health care provider. -Monitor the effectiveness of comfort and safety measures and adherence to the regimen.

Pharm Final (15 decks)

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