immunity Flashcards
two major categories of antiviral drugs
antivirals = a general term used for those medications used to treat infections and viruses other than HIV antiretrovirals = indicated specifically for the treatment of infections cause by HIV
antiviral drug mechanism of action
blocks the activity of the polymerase enzyme
antiviral drug contraindications
most well tolerated with a few exceptions
amantadine
ribavirin
antiviral drug interactions
arise when administered IV or orally
less incidence when topical
antiretroviral agents in adults and adolescents with HIV 5 drug classifications
Fusion Inhibitor Entrance Inhibitors Reverse Transcriptase Inhibitor (combination medications) Nucleoside RTI (NRTIs)-Zidovudine Nucleotide RTI (NrRTI)- Tenofovir Non-nucleotide RTI (NNRTIs)- Efavirenz Integrase Inhibitor- Enfuvirtide Protease Inhibitor- Atazanavir
antiretroviral contraindications
known severe drug allergy
intolerable toxicity
antiretroviral prescribing considerations
ART protocols require a combination: two nRTIs + a third agent such as a NNRTI or Protease Inhibitor or an Integrase inhibitor
Drug therapy for HIV/AIDS is NOT curative
Drug therapy to control the virus is lifelong- daily adherence
an initial antiretroviral regimen generally consists of
2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) in combination with a third active drug from one of the following classes: nonnucleoside reverse transcriptase inhibitor (NNRTI), protease inhibitor, or integrase strand transfer inhibitor (INSTI).
protease inhibitors adverse effects
Lipid abnormalities, including lipodystrophy, or redistribution of fat stores under the skin:
Hump at the base of the neck and abdomen, and skeletonized(bony) appearance of the face and limbs
Dyslipidemias and hyper-triglyceridemia
Insulin resistance
long term antiretroviral consequences
Bone demineralization and possible osteoporosis
Treatment includes: Calcium replacement, Vitamin D, and Bisphosphonates
Guidelines for the Use of Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV
Licensed by Health Canada in Feb, 2016; Publicly funded for individuals with coverage
Recommended for the following people:
Men who have sex with men (MSM) and transgender women (TGW) that fall into high risk category
Heterosexual men and women that fall into high risk for acquiring HIV
Persons who inject drugs (PWID)
assessment for PrEP
Confirm negative HIV antigen/antibody (Ag/Ab) test within 15 days before starting PrEP medication
For heterosexual women, determine if there are immediate plans to become pregnant, or if the woman is currently pregnant or breastfeeding, as this may alter the risk/benefit ratio for PrEP1.
Screen for hepatitis B and C as well as other STI’s (gonorrhea, chlamydia, syphilis)
Confirm adequate renal function: calculated creatinine clearance or estimated glomerular filtration rate (eGFR) ≥60 mL/minute, and absence of proteinuria on urinalysis and/or quantitative test
Review current medication list
nursing considerations when teaching about PrEP
The time taken to reach these levels is not certain, however there are estimates for how long (or how many doses) it can take PrEP to reach maximum drug concentration levels within certain tissues:
Seven doses to reach maximum drug concentration in rectal tissues (for receptive anal sex)
Twenty doses to reach maximum concentration in vaginal (or frontal hole) tissues (for receptive vaginal or frontal sex).
Twenty doses to reach maximum concentration as it relates to preventing HIV infection through injection drug use.
guidelines for post-exposure prophylaxis (PEP)
Goal: To reduce the risk of HIV transmission to persons following exposure to blood or body fluids.
Risk Assessment completed with determination to 1 of 2 paths:
1. Significant Risk of HIV Transmission Initiate PEP starter kit: Tenofovir DF 300 mg once a day Lamivudine 150 mg twice a day Raltegravir 400 mg twice a day
2. Negligible Risk of HIV Transmission PEP not recommended
The schedule for HIV testing has been updated, both in the context of receiving and not receiving PEP. Individuals receiving PEP should have HIV testing at baseline, and 3 weeks, 6 weeks, and 3 months after completing PEP. Individuals not receiving PEP should have HIV testing at baseline, and 3 weeks, 6 weeks, and 3 months after the exposure
nursing considerations when teaching about teaching as prevention (TasP)
Key Recommendations to integrate TasP (New Guidelines as of December, 2019):
Providers should inform persons with HIV that maintaining HIV RNA levels <200 copies/mL with ART prevents HIV transmission to sexual partners.
Persons starting ART should use another form of prevention with sexual partners for at least the first 6 months of treatment and until an HIV RNA level of <200 copies/mL has been documented. Many experts recommend confirming sustained suppression before assuming that there is no risk of sexual HIV transmission.
Persons with HIV who rely on ART for prevention need to maintain high levels of ART adherence. They should be informed that transmission is possible during periods of poor adherence or treatment interruption.
Providers should inform patients that maintaining an HIV RNA level of <200 copies/mL does not prevent acquisition or transmission of other sexually transmitted infections.
antiretroviral medications and pregnancy
Comprehensive care of HIV infected women and their infant
ART indicated for all pregnant women living with HIV to prevent mother-to-child HIV
Hyperemesis gravidarum and potential risks associated with teratogenicity should not be considerations to not initiate therapy
ART should be administered even after post-partum due to risks of breastfeeding and interruption to treatment
Breastfeeding
Breastfeeding results in about 50% of new HIV perinatal transmissions worldwide
Recommended exclusive formula feeding for all HIV infected mothers
antiretroviral medications and pediatric population
All HIV exposed infants should be offered antiretroviral prophylaxis regardless of maternal antenatal or intrapartum antiretroviral therapy, viral load, or mode of delivery:
Infants born to an HIV infected mother who took combination antiretroviral therapy (cART) in pregnancy and has a viral load <1000 copies/mL near delivery are offered oral zidovudine (AZT) for six weeks
Infants born to an HIV infected mother who has a known or projected viral load >1000 copies/mL or who did not receive antepartum antiretroviral therapy should receive a 3-drug combination antiretroviral for the first 2 weeks of life, followed by zidovudine until 6 weeks of age.
For mothers with unknown HIV status at delivery, a rapid (point-of-care) HIV antibody test is recommended. Starting the infant on a 3-drug regimen is recommended until maternal HIV test results are available
Infant Follow-Up:
Infants born to HIV infected mothers are considered vulnerable and require diligent follow-up in order to reach their full health potential
nursing considerations for antiviral and antiretroviral therapy
Take oral antivirals with meals to help minimize GI upset
Store capsules at room temperature, do not crush or break
Encourage adequate hydration and nutritional intake; monitor for wasting syndrome
Antiviral therapy must be taken for the entire course of therapy- if the patient misses a dose, take the dose as soon as it is remembered
If there are anticholinergic effects, suck on a sugarless candy or chew gum
Encourage daily mouth care and hygiene for dry mouth
Orthostatic hypotension may occur with some antiviral medication
Use safe handling and special administration of medication
Patients living with HIV should supplement their diet with a multivitamin mineral
Goal of therapy is to find the regimen that provides the best control for the patient.
lab values to monitor in patients taking ART
CBC: Hgb (anemia), Plt (thrombocytopenia), and WBC (neutropenia)
Kidney Function: creatinine, BUN, and creatinine clearance (nephrotoxicity(
Liver Function Tests: AST, ALT, GGT, Alk Phos, Bili (due to metabolization of medication in the liver)
Serum calcium levels (monitor for osteoporosis and bone density changes)
Serum cholesterol levels, triglycerides and blood glucose levels (increased cholesterol levels and insulin intolerance)
primary prevention of HIV
Teaching and education related how the virus is transmitted, reducing stigma associated with patients living with HIV, testing
Risk assessment of a patient’s behaviors, including sexual partners, IVDU, PrEP
Health Literacy
care for patient once infected with HIV
Collaborative holistic care is imperative
Teaching and education related to ART, drug adherence, keeping the viral load as low as possible for as long as possible
Maintain or restore a functioning immune system
Improve the patient’s quality of life
Reduce the potential for transmission of the virus
Reduce HIV-related diseases, disability, and death
Prevent reinfection
nursing interventions with patient with HIV
Assist the patient to adhere to drug regimens
Promote a healthy lifestyle
Prevent opportunistic infections and treat early
Protect others from HIV
Maintain of develop healthy, supportive relationships
Maintain activities and productivity
Come to terms with issues related to disease, death, and spirituality,
Cope with the frequent symptoms caused by HIV and its treatments
Monitor for nutritional inadequacies weight loss, diet, intake
Promote skin integrity
Prevent infection and risks of opportunistic infections
HIV health promotion
Prevention of HIV
Decrease risks related to sexual intercourse
Decreasing risks related to substance misuse
Decreasing risks of perinatal transmission
Decreasing risks at work
HIV testing and counseling
HIV acute intervention
Early intervention Initial response to diagnosis ART Adherence Health Promotion Acute Exacerbations Ongoing Care Disease and Drug Adverse Effects End of Life Care
HIV ambulatory and home care
Education about treatment options Empowerment Continue physical care for disease process Supporting patient, family, and friends Promote health maintenance End of life Care/ Palliative Care
immunosuppressant therapy mechanism of action
suppression of certain T lymphocyte cell lines
