1. Antivirals, Antiretrovirals, and Antifungal Medications
Chapter 10
Antivirals, Antiretrovirals, and Antifungal Medications
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

2. ANTIVIRALS Acyclovir (Zovirax) Ganciclovir (Cytovene) Therapeutic Uses
Acyclovir herpes simplex and varicella
Ganciclovir prevention of cytomegalovirus (CMV) (in HIV/AIDS, organ transplants)
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

3. Acyclovir Complications
ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU
Phlebitis and inflammation site Rotate IV injection sites.
of infusion Monitor IV sites for swelling and redness.
Nephrotoxicity Administer acyclovir infusion slowly over 1 hr.
adequate hydration during infusion
increasing oral fluid
Mild discomfort Observe for manifestations
associated with oral therapy notify the provider.
(nausea, headache, diarrhea)
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

4. Ganciclovir Complications
ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU
Suppressed bone marrow Obtain baseline CBC and platelet count.
frequently during treatment
Fever, headache, nausea, diarrhea Report these findings.
Teratogenic and embryotoxic Warn clients to prevent pregnancy and
(Suppresses sperm production) possible sterility.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

5. Other ANTIVIRALS
Interferon alfa-2b (Intron A) hepatitis B and C Lamivudine (Epivir) hepatitis B and C Oseltamivir (Tamiflu) influenza A and B. Ribavirin (Rebetol) influenza Amantadine influenza Boceprevir (Victrelis) hepatitis C virus
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

6. Antivirals Nursing Administration
Acyclovir
Topical administration (rubber gloves to avoid transfer of virus)
Administer IV infusion slowly over 1 hr or longer.
Expect symptom relief but not cure.
Wash affected area 3-4 times/day, keep the lesions dry
Refrain from sexual contact while lesions present.
Condoms for healed herpetic lesions
Review the Nursing Process (ADPIE) as it applies to patients receiving antiviral medications.
Patient teaching is always an essential component of any medication regimen.
Patients and significant family members must be taught not only the action and uses of specific medication but also how to store and administer the product.
Why is bottled water recommended for immunocompromised patients? (Because they are at greater risk for further infections. Using bottled water, if it is available, avoids potential pathogens in untreated or poorly treated water supplies.)
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

7. Antivirals Nursing Administration
Ganciclovir
Administer IV infusion slowly, infusion pump, over 1 hr.
Administer oral medication with food and encourage extra fluid intake during therapy.
Administer intraocular for CMV retinitis.
Instruct clients to complete the prescribed course of antimicrobial therapy, even though manifestations might resolve before the full course is completed.
Review the Nursing Process (ADPIE) as it applies to patients receiving antiviral medications.
Patient teaching is always an essential component of any medication regimen.
Patients and significant family members must be taught not only the action and uses of specific medication but also how to store and administer the product.
Why is bottled water recommended for immunocompromised patients? (Because they are at greater risk for further infections. Using bottled water, if it is available, avoids potential pathogens in untreated or poorly treated water supplies.)
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

8. Acquired Immunodeficiency Syndrome (AIDS)
Viral disease
High mortality rate
High-risk populations include:
Homosexual and bisexual men
Intravenous drug users
People in prison
Female sexual partners of people in high-risk groups
Children born to mothers at risk
AIDS is caused by a retrovirus (currently named human immunodeficiency virus, or HIV). Retroviruses are viruses that contain ribonucleic acid (RNA) rather than deoxyribonucleic acid (RNA) as their genetic material.
More than 98% of patients with the severest form of AIDS die within 5 years of diagnosis. However, advances in treatment have significantly prolonged patient lifespan.
Today, AIDS is a disease that affects the world in epidemic proportions.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

9. Antiretrovirals FUSION/ENTRY INHIBITORS
enfuvirtide (Fuzeon)
Therapeutic Use
HIV that is unresponsive to other antiretrovirals
ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU
Localized reaction injection site Rotate injection sites.
Monitor for swelling and redness.
Bacterial pneumonia Monitor breath sounds
Observe for fever, cough, or SOB
Systemic reaction
(fever, chills, rash, hypotension) Monitor for reaction. Discontinue and
notify the provider.
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

10. Antiretrovirals CCR5 ANTAGONISTS
maraviroc (Selzentry) Therapeutic Use (HIV infection) ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU Cough and URI report respiratory findings. CNS effects move carefully from lying or sitting (dizziness, paresthesias) Hepatotoxicity stop maraviroc and notify provider (jaundice, RUQ pain, nausea) (preceded by hives, rash)
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced.

11. Antiretrovirals NRTIs
zidovudine (Retrovir)
Therapeutic Use (HIV infection)
ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU
●● Other Medications
◯◯ Didanosine (Videx)
◯◯ Stavudine (Zerit)
◯◯ Lamivudine (Epivir)
◯◯ Abacavir (Ziagen)
●● Combination Medications: fixed medication dosages in one tablet or capsule
◯◯ Abacavir, lamivudine, zidovudine (Trizivir)
◯◯ Abacavir, lamivudine (Epzicom)
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced.

12. Antiretrovirals NRTIs
ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU Bone marrow suppression Monitor CBC, platelets. monitor bleeding, easy bruising, sore throat, fatigue. Lactic acidosis Monitor: hyperventilation, nausea, abd pain. (Pregnancy increases risk) N/V/D Take with food Monitor fluids and electrolytes. Hepatomegaly/fatty liver Monitor liver enzymes.
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced.

13. Antiretrovirals NNRTIs
Delavirdine (Rescriptor) Efavirenz (Sustiva) Nevirapine (Viramune) Etravirine (Intelence) Therapeutic Uses Primary HIV-1 infection ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU Rash Monitor for rash, diphenhydramine, if prescribed (Stevens-Johnson syndrome) Notify provider for fever/blistering. Flulike symptoms Monitor for adverse reactions. (headache, fatigue) Encourage rest/oral fluid intake. CNS manifestations Should decrease after first few weeks of therapy. (dizziness, drowsiness, Do not drive or operate machinery insomnia, nightmares)
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced.

14. Antiretrovirals PROTEASE INHIBITORS
ritonavir (Norvir) Saquinavir (Invirase) Indinavir (Crixivan) Fosamprenavir (Lexiva) Nelfinavir (Viracept) Lopinavir/ritonavir combination (Kaletra) Therapeutic Uses HIV infections ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU Osteoporosis ^ calcium/vitamin D. DM/hyperglycemia monitor for increased thirst and urine output. Monitor glucose. Adjust diet, antidiabetic medications Hypersensitivity reaction Monitor for rash. Notify the provider if rash develops. N+V Take with food Elevated serum lipids Monitor hyperlipidemia. Adjust diet. Thrombocytopenia, leukopenia Monitor CBC. Monitor for infection (fever, sore throat). Monitor for bleeding (blood in stool, bruising).
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced.

15. Antiretrovirals INTEGRASE INHIBITORS (INSTIs)
raltegravir (Isentress) Therapeutic Use – first-line for HIV when combined with 2-3 two other meds ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU Headache/difficulty sleeping notify provider Skin rash Notify provider Liver injury Monitor liver function tests. (anorexia, nausea, RUQ pain, jaundice) Notify provider
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced.

16. Antifungals
Amphotericin B (Amphotec) Ketoconazole Therapeutic Uses Systemic fungal infection (Candidiasis, Aspergillosis, Cryptococcosis, Mucormycosis) Dermatophytic infections (tinea pedis [ringworm of the foot], tinea cruris [ringworm of the groin]); candida infections of the skin and mucous membranes, fungal infections of the nails (Onychomycosis).
Fungi are plants that produce yeastlike or moldlike diseases called mycotic infections in humans. These can be either superficial infections or systemic infections.
Because fungi are found almost everywhere, they pose a risk for immunocompromised patients, including those taking corticosteroids.
Many opportunistic infections in AIDS patients are fungal in nature.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

17. Antifungals Complications
Amphotericin B
ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU
Infusion reactions Give test dose
(fever, chills, rigors, HA) Pretreat (diphenhydramine and acetaminophen).
Thrombophlebitis Observe infusion sites for erythema, swelling, pain.
Rotate injection sites.
Administer in large vein
Nephrotoxicity baseline and weekly kidney function (BUN and creatinine)
Monitor I&O.
›› Infuse 1 L saline on the day of amphotericin B infusion.
›› Hypokalemia ››Monitor electrolyte levels, especially potassium.
›› Administer potassium supplements accordingly.
›› Bone marrow suppression ››Obtain baseline CBC and hematocrit, and monitor weekly.
Ketoconazole
›› Hepatotoxicity (anorexia, nausea,
vomiting, jaundice, dark urine, and
clay‑colored stools)
››Obtain baseline liver function studies, and monitor liver
function monthly.
›› If manifestations occur, notify provider and discontinue
medication.
›› Effects on sex hormones
≫≫In males, gynecomastia (enlargement
of breast), decreased libido,
erectile dysfunction
≫≫In females, irregular menstrual flow
Fungi are plants that produce yeastlike or moldlike diseases called mycotic infections in humans. These can be either superficial infections or systemic infections.
Because fungi are found almost everywhere, they pose a risk for immunocompromised patients, including those taking corticosteroids.
Many opportunistic infections in AIDS patients are fungal in nature.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

18. Antifungals Complications
Amphotericin B ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU Hypokalemia Monitor electrolytes (potassium) Administer potassium supplements Bone marrow suppression Baseline and weekly CBC/hematocrit
Fungi are plants that produce yeastlike or moldlike diseases called mycotic infections in humans. These can be either superficial infections or systemic infections.
Because fungi are found almost everywhere, they pose a risk for immunocompromised patients, including those taking corticosteroids.
Many opportunistic infections in AIDS patients are fungal in nature.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

19. Antifungals Complications
Ketoconazole ADVERSE EFFECTS NURSING INTERVENTIONS/CLIENT EDU Hepatotoxicity Baseline and Qmo liver function studies (anorexia, nausea, vomiting, Notify provider, discontinue med jaundice, dark urine, clay‑colored stools) Sex hormones effect M: gynecomastia (enlargement of breast), decreased libido, erectile dysfunction F: irregular menstrual flow
Fungi are plants that produce yeastlike or moldlike diseases called mycotic infections in humans. These can be either superficial infections or systemic infections.
Because fungi are found almost everywhere, they pose a risk for immunocompromised patients, including those taking corticosteroids.
Many opportunistic infections in AIDS patients are fungal in nature.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.