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NRSG Pharm CH 37
Viral infections
| Question | Answer |
|---|---|
| Viral infection | Intercellular parasites, must be in host cell to replicate, many specific to host cells. Most self-limiting, req no pharm. Ex rhinovirus that causes common cold. Some req aggressive therapy, ex HIV, herpes viruses |
| Challenges to antiviral therapy | Mutate rapidly -> drug becomes ineffective, difficult for drug to find virus w/o injuring normal cells, each antiviral specific to one particular virus |
| Replication of HIV | Targets CD4 receptor on T lymphocyte using reverse transcriptase, makes viral DNA from RNA |
| Rep of HIV | Virions bud from host cell, Enzyme protease enables virion to infect other CD4 Result = grad destruction of immune system |
| HIV retrovirus because? | Reverse synthesis process (DNA from RNA) |
| HAART | Highly Active Antiretroviral Therapy Aggressive treatment w/ multiple drugs concurrently Simultaneous use of several drugs to reduce probability of resistance |
| HAART goals | Reduce plasma level of HIV RNA (Viral load) - undetectable level or less than 50 copies than 50/mL Restore and preserve immunologic function (absolute CD4 count), reduce morbidity, inc quality of life, prevent transmission |
| Treatment barriers | Pt nontolerance of adverse, nonadherence to complex regimen, resistant strains, genetic variability therapy always changing - stay current |
| HAART 5 drugs | 1. NtRTI, 2. NNRTI 3. PI 4. Entry Inhibitors 5. Intergrade inhibitors and other misc. antivirals |
| 1. NtRTI | Nucleotide reverse transcriptase inhibitors (NtRTI) - resemble natural building blocks of DNA |
| 2. NNRTI | Nonnucleoside reverse transcriptase inhibitors NNRTI - target enzyme needed for reverse transcriptase |
| 3. Protease inhibitor | Protease inhibitor - PI - Block viral enzyme protease, inhibiting final assembly of HIV virions |
| 4. Entry inhibitors | Fusion inhibitors and CCR5 antagonists - block entry of viral nucleic acid into CD4 |
| 5. Integrase inhibitors and other misc antivirals | Integrase inserts it's viral DNA strand into human chromosome |
| First HIV regimen inc: | two NRTIs + an INSTI + an NNRTI or a PI boosted with cobicistat (Tybost) or ritonavir (Norvir) |
| Cobicistat (Tybost) or ritonavir (Norvir) HAART actions | increase effectiveness of PI drug |
| zidovudine (Retrovir, AZT) classes, action | Antiretroviral, nucleoside reverse transcriptase inhibitor (NRTI) Virus uses drug, creates defective DNA strand. Used for HIV infusion in combo w/ other antiretroviral, used for PEP in healthcare. Prevention of transmission of HIV mom-> fetus |
| zidovudine (Retrovir, AZT) admin alerts | Admin on empty stomach, full glass of water, do not admin with fruit juice, preg cat C |
| zidovudine (Retrovir, AZT) considerations | Most tx guidelines do not include zidovudine as a drug of first choice due to resistance potential |
| zidovudine combos | Combivir (zidovudine and lamivudine) Trizivir (zidovudine, lamivudine, and adacavir) |
| zidovudine (Retrovir, AZT) adverse | fatigue, gen weakness, anorexia, N/D, Headache, |
| Zidovudine (Retrovir, AZT) black box | fatal lactic acidosis with hepatomegaly and steatosis reported. Bone marrow suppression may result in neutropenia or severe anemia. Myopathy may occur w/ long term use. |
| zidovudine (Retrovir, AZT) labs | WBC, Hgb may dec due to neutropenia and anemia - bone marrow suppression |
| Iopinavir w/ ritonavir (Kaletra) actions | Inhibit HIV protease, (PI), ritonavir inhibits hepatic breakdown of Iopinavir, permitting serum levels to increase |
| Iopinavir with ritonavir (Kaletra) side/adverse | Gen well tolerated, N/V/D, Abd pain, Hyperglycemia Inc in total cholesterol and triglycerides rare: pancreatitis Preg cat C |
| Herpesvirus infections | Fam of virus cause repeated blister-like lesions on skin, genitals, mucosal surfaces antivirals lower freq/intensity of acute disease relieve acute s/sx, prevent reoccurance DOES NOT CURE |
| acyclovir (Zovirax) classes, actions | Antiviral for herpesviruses, nucleoside analog Most effective against HSV1 and HSV2 Prevents viral DNA synthesis. Effective only at high dose against CMV and varicella Zoster 5% ointment topical for active lesions, oral for prophylaxis, IV severe |
| acyclovir (Zovirax) adverse | Topical: burning, pruritis PO: N/V, diarrhea, headache IV: nephrotoxicity, neurotoxicity -> hypotension, confusion |
| acyclovir (Zovirax) lab tests | Kidney function! BUN (blood urea nitrogen), serum creatinine - both may increase |
| Considerations for HAART | Care is similar for NtRTIs, NNRTIs, PI, s/s of opportunistic infection Bone marrow suppression, liver tox, Stevens-Johnson syndrome Teach pt to practice blood and bodily fluids |
| LABS for HAART | plasma HIV RNA (viral load), CD4 counts, CBC, liver/renal profiles, BGL |
| Antiviral Therapy nurse roles | Extreme caution in pt w/ preexisting renal or hepatic disease Judicious use warranted during pregnancy Emphasize compliance with antiviral therapy Some drugs cause digestive distress and should be taken with food |
Created by:
kmulla
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