1. 1 Chapter 33 Antivirals, Antimalarials, and Anthelmintics Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

2. 2 Viruses  Viruses  Method of transmission Coughing, sneezing  Process of replication of itself (virus)  Common viral infections include influenza, herpes virus infections, and viral hepatitis infections.  General signs and symptoms Headache, fever, cough Nausea, vomiting, diarrhea Fatigue, muscular pain Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

3. 3 Influenza  Influenza (“the flu”)  Highly contagious viral infection that affects the nose, throat, and lungs  Seasonal and more prevalent from fall to spring  Three antigen types: A, B, and C Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

4. 4 Herpes Viruses  Herpes simplex virus type 1 (HSV-1)  Herpes simplex virus type 2 (HSV-2)  Varicella-zoster viruses (HSV-3 or VZV), more commonly known as chickenpox and shingles  Epstein-Barr virus (HSV-4 or EBV)  Cytomegalovirus (HHV-5 or CMV) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

5. 5 Hepatitis B (HBV)  Hepatitis B (HBV): Serious liver infection caused by the hepatitis B virus  Transmission: Needlestick, intimate sexual contact, or childbirth  HBV is found in all body fluids, including blood, semen, and vaginal fluid.  Signs and symptoms of HBV: Anorexia, vomiting, diarrhea, jaundice, malaise, and myalgia Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

6. 6 Vaccines  Vaccines  Influenza virus vaccine Changes yearly Promotes antibody production Composition: eggs  Success rate Healthy children and adults have 65% to 90% success rate. Older adults, vaccines are effective 60% of the time, but less than 60% if an older adult has multiple health problems. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

7. 7 Diagnostic Tests for Influenza  Influenza A: Directigen Flu A  Both influenza A and B vaccines:  Flu OIA  QuickVue Influenza Test  ZstatFlu Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

8. 8 Antiviral Non-HIV Drugs  Nonclassified antivirals  Amantidine (Symmetrel)  Cidofovir (Vistide)  Foscarnet (Foscavir)  Rimantadine HCl (Flumadine)  Vidarabine (Vira-A)  Telbivudine (Tyzeka)  Adefovir dipivoxil (Hepsera)  Entecavir (Baraclude) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

9. 9 Antiviral Non-HIV Drugs (Cont.)  Purine Nucleosides  Acyclovir (Zovirax)  Famciclovir (Famvir)  Ganciclovir sodium (Cytovene)  Ribavirin (Virazole)  Valacyclovir HCl (Valtrex)  Valganciclovir (Valcyte) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

10. 10 Antiviral Non-HIV Drugs (Cont.)  Neuraminidase Inhibitors  Oseltamivir phosphate (Tamiflu)  Zanamivir (Relenza)  Topical Non-HIV Antivirals  Penciclovir (Denavir)  Trifluridine (Viroptic)  Idoxuridine (Herplex Liquifilm) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

11. 11 Nursing Process: Antiviral: Acyclovir  Assessment  Nursing diagnoses  Planning  Nursing interventions  Patient teaching  Cultural considerations  Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

12. 12 Antimalarials  Malaria  Protozoan disease  Incubation period 10 to 35 days  Etiology  Protozoan parasites, P. malariae, P. ovale, P. vivax, and P. falciparum  Phases  Tissue phase: no symptoms  Erythrocytic phase: fever, chills, sweating, flulike symptoms Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

13. 13 Antimalarials (Cont.)  Treatment regimen  Combinations used for drug-resistant malaria  Prophylactic measures  Prevent malaria; prevent relapse  Drugs  Chloroquine HCl (Aralen HCl)  Hydroxychloroquine sulfate (Plaquenil sulfate)  Mefloquine HCl (Lariam)  Primaquine phosphate (Primaquine)  Pyrimethamine (Daraprim)  Quinine sulfate (Qualaquin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

14. 14 Antimalarials (Cont.)  Side effects/adverse reactions  Plaquenil GI distress Mood or mental changes, blurred vision Blood dyscrasias  Quinine GI distress, vision changes, dizziness Confusion, delirium, seizures Eighth cranial nerve involvement, tinnitus Renal impairment, blood dyscrasias Cardiovascular collapse, decreased respirations Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

15. 15 Nursing Process: Antimalarials  Assessment  Nursing diagnoses  Planning  Nursing interventions  Patient teaching  Cultural considerations  Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

16. 16 Antimalarials (Cont.)  Nursing interventions  Monitor kidney and liver function.  Take drug with meals to prevent GI distress.  Report vision changes.  Avoid alcohol.  Advise individuals traveling to endemic countries to take prophylactic drug. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

17. 17 Anthelmintics  Helminths (parasitic worms)  Four groups of helminths  Cestodes (tapeworms)  Trematodes (flukes)  Intestinal nematodes (roundworms)  Tissue-invading nematodes (tissue roundworms) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

18. 18 Anthelmintics (Cont.)  Bithionol (Bitin, Lorothidol)  Diethylcarbamazine (Hetrazan)  Ivermectin (Stromectol)  Praziquantel (Biltricide)  Pyrantel pamoate (Pin-X) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

19. 19 Anthelmintics (Cont.)  Usually given 1 to 3 days  Side effects/adverse reactions  GI upset, dizziness, drowsiness, HA, weakness  Nursing interventions  Give after meals to prevent GI distress.  Encourage good hygiene.  Warn against driving motor vehicles. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

20. 20 Nursing Process: Antihelminics  Assessment  Nursing diagnoses  Planning  Nursing interventions  Patient teaching  Cultural considerations  Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

21. 21 Practice Question #1 Which is the most appropriate nursing intervention for a patient who is taking mefloquine and hydroxychloroquine (Plaquenil)? A.Collect a stool specimen. B.Assess the patient’s hearing. C.Advise the patient to take showers, not baths. D.Encourage female patients to have a Pap test every 6 months. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

22. 22 Practice Question #2 Travelers visiting malaria-infested countries are instructed to A.avoid mosquitoes in these countries. B.receive immunizations before travel. C.visit these countries only while in good health. D.take prophylactic antibiotics before traveling. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

23. 23 Practice Question #3 Which is a side effect associated with amantadine (Symmetrel) therapy? A.Hypertension B.Constipation C.Slurred speech D.Orange-colored urine Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

24. 24 Practice Question #4 Which nursing intervention is the priority when a patient is receiving antiviral agents? A.Promoting hydration B.Enhancing bowel function C.Increasing tidal volume D.Promoting circulation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

25. 25 Practice Question #5 A patient treated with acyclovir (Zovirax) for genital herpes should be instructed that A.breast cancer is more common in patients with a history of genital herpes. B.antiviral medications provide a cure for genital herpes. C.oral hygiene should be performed several times a day. D.the medication must be taken on an empty stomach. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

26. 26 Practice Question #6 Before administration of the influenza vaccine to a patient, it is most important for the nurse to ask the patient if they are allergic to A. peanuts. B. eggs. C. penicillin. D. lidocaine. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

27. 27 Practice Question #7 Which information will the nurse include when teaching a patient about anthelmintic therapy? A.Take the medication 1 hour before meals. B.Take a bath at least once a day. C.Change your sheets every other day. D.Be aware that drowsiness may occur. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.