Chapter 36 - Antiviral Drug Med Cards

Question 1

Zidovudine - Nucleoside and nucleotide reverse transcriptase inhibitor

Answer 1

Action - As the reverse transcriptase enzyme begins to synthesize viral DNA, it mistakenly uses zidovudine as one of the nucleosides, thus creating a defective DNA strand

Use - in combination with other antiretrovirals for both symptomatic and asymptomatic HIV-infected patients, as well as for post exposure prophylaxis in HIV-exposed health care workers
- an important indication is to reduce the transmission rate of HIV from an HIV-positive mother to her fetus

Contraindications - allergy to this product

Adverse Effects - fatigue, headache, anorexia, nausea, and diarrhea. More serious CNS effects have been reported

Patient teaching - GI complaints and insomnia resolve after 2-3 weeks of treatment

• This product does not cure AIDS
• The patient is still infective to others
• Product must be taken BID or TID
• • no longer first choice drug

Question 2

Efavirenz - Nonnucleoside reverse transcriptase inhibitor

Answer 2

Action - inhibit reverse transcriptase. It is always used in combination with other antivirals in treatment using HAART

Use - HIV-1 in combination with at least 2 other antivirals

Contraindications - Pregnancy, allergy, moderate/severe hepatic disease

Adverse Effects - CNS effects in at least 50% of patients when first initiating therapy, sleep disorders, nightmares, dizziness, reduced ability to concentrate, and delusions. These symptoms gradually diminish after 3 to 4 weeks of therapy. Rash is common.

Patient teaching - That product does not cure disease, it treats symptoms
- HIV can still be transmitted

• • increase chance of seizures in epilepsy patients

Question 3

Lopinavir with Ritonavir - Protease inhibitor

Answer 3

Action - To inhibit the viral enzyme protease, which is responsible for the final assembly of the HIV virions. Lopinavir is the active component, whereas ritonavir inhibits the breakdown of lopinavir, promoting higher serum levels of lopinavir

Use - in combination with other antiretrovirals for HIV-infected patients. It is the preferred drug for the initial therapy of HIV infection.

Contraindications - ???

Adverse Effects - It is well tolerated, but may lead to nausea, headache, vomiting, dyspepsia, and diarrhea. Hyperglycemia has been reported. Lipodystrophy syndrome occurs in many patients receiving long-term therapy. Pancreatitis is rare, but possible, serious side effect.

Patient teaching - Redistribution of body fat or accumulation of body fat may occur

• regular follow-up exams and blood work will be required
• Not a cure
• • take with food

Question 4

Acyclovir - Antiviral

Answer 4

Action - to prevent viral DNA synthesis

Use - limited to the herpes viruses, for which it is a drug of choice. It is most effective against HSV-1 and HSV-2, and is effective only at high doses against CMV and varicella zoster

Contraindications - allergy to this product, valacyclovir

Adverse Effects - Adverse effects are few when given topically or orally. When given IV, nephrotoxicity and neurotoxicity are possible. Resistance to the drug has developed

Patient teaching - Do not touch lesions to avoid spreading

• patient is still infective, this is not a cure
• seek dental care to avoid gingival hyperplasia
• women with mental herpes are more likely to develop cervical cancer; keep all GYN appointments
• • increase fluids