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Transcript of Ppt chapter 10
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antiviral AgentsAntiviral Agents
Chapter 10
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Viruses That Respond to Antiviral TherapyViruses That Respond to Antiviral Therapy
• Influenza A and some respiratory viruses
• Herpes viruses
• Cytomegalovirus (CMV)
• Human immunodeficiency virus (HIV) that causes acquired-immune deficiency syndrome (AIDS)
• Some viruses that cause warts and certain eye infections
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Antivirals Across the LifespanAntivirals Across the Lifespan
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Characteristics of Common VirusesCharacteristics of Common Viruses
• A virus cannot replicate on its own.
• It must attach to and enter a host cell.
• It then uses the host cell’s energy to synthesize protein, DNA, and RNA.
Viruses are difficult to kill because they live inside our cells.
• Any drug that kills a virus may also kill our cells.
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Stages of Virus ReplicationStages of Virus Replication
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Characteristics of Antiviral DrugsCharacteristics of Antiviral Drugs
• Able to enter the cells infected with virus
• Interfere with viral nucleic acid synthesis and/or regulation
• Some agents interfere with ability of virus to bind to cells
• Some agents stimulate the body’s immune system
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Common Respiratory VirusesCommon Respiratory Viruses
• Influenza A
• Influenza B
• Respiratory Syncytial Virus
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Signs and Symptoms of Respiratory Viruses
Signs and Symptoms of Respiratory Viruses
• Cough
• Fever
• Inflammation of the nasal mucosa
• Inflammation of the mucosa of the respiratory track
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Influenza A and Respiratory VirusesInfluenza A and Respiratory Viruses
• Action – Prevent shedding of the viral protein coat
• Pharmacokinetics – Administered oral, excreted unchanged in the urine
• Contraindications – Allergy, pregnancy, or lactating
• Adverse Reactions – Dizziness, insomnia, nausea, orthostatic hypotension
• Drug-to-Drug Interactions – Anticholinergic agents
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Nursing Considerations for Respiratory Antiviral Therapy
Nursing Considerations for Respiratory Antiviral Therapy
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Prototype of Respiratory Antiviral AgentsPrototype of Respiratory Antiviral Agents
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QuestionQuestion
Tell whether the following statement is true or false.
Treatment of a viral infection is difficult without serious toxic effects for the host.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
True
Rationale: A virus must enter a human cell to survive, making it difficult to treat without serious toxic effects for
the host.
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Signs and Symptoms of Herpes VirusSigns and Symptoms of Herpes Virus
• Painful vesicles that often occur in clusters on skin, cornea, or mucous membranes.
• Usual course of primary disease is two weeks
• Duration of recurrences varies
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Signs and Symptoms of CMVSigns and Symptoms of CMV
• May be asymptomatic
• Fatigue
• Nausea
• Jaundice
• If contracted during pregnancy can result in stillbirth, brain damage, or birth defects.
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Herpes and CytomegalovirusHerpes and Cytomegalovirus
• Action – Inhibit viral DNA replication by competing with viral substrates to form shorter, non-effective DNA chains
• Pharmacokinetics – Administered oral, IV or topically, excreted unchanged in the urine
• Contraindications – Pregnancy and lactation
• Adverse Reactions – Nausea, vomiting, headache, rash, and hair loss
• Drug-to-Drug Interactions – Nephrotoxic drugs, zidovudine
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Prototype of Herpes and Cytomegalovirus Agents
Prototype of Herpes and Cytomegalovirus Agents
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Nursing Considerations for Herpes Virus and Cytomegalovirus
Nursing Considerations for Herpes Virus and Cytomegalovirus
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Signs and Symptoms of HIV/AIDSSigns and Symptoms of HIV/AIDS
• Attach helper T-cells
• Acute Infection – Fever, rash, myalgia
• Asymptomatic Infection – Follows acute infection duration varies
• Persistent Generalized Lymphadenopathy – Adenopathy persists more than 3 months
• Constitutional Symptoms: Fever lasting more than a month, involuntary weight loss, chronic fatigue.
• Neurological Disease – Dementia
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Signs and Symptoms of HIV/AIDS (cont.)Signs and Symptoms of HIV/AIDS (cont.)
• Secondary Infections – Pneumocystis carinii, disseminated herpes simplex
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QuestionQuestion
You are caring for a patient that has been diagnosed with herpes simplex and are given a prescription. What should you teach this patient about taking their medication?
A. When applying the drug topically be sure to use absorbent pads to decrease risk of exposure to the drug.
B. Warn the patient that GI upset, nausea, and vomiting are to be expected.
C. Start taking the medicine as soon as possible to improve effectiveness of antiviral activity.
D. Be sure to take most of the medication prescribed to improve effectiveness of antiviral activity.
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AnswerAnswer
C. Start taking the medicine as soon as possible to improve effectiveness of antiviral activity.
Rationale: Administer the drug as soon as possible after the diagnosis has been made to improve effectiveness of the antiviral activity.
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Drugs Used to Treat HIV/AIDSDrugs Used to Treat HIV/AIDS
• Reverse Transcriptase Inhibitors
• Protease Inhibitors
• Nucleosides
• Fusion Inhibitors
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Reverse Transcriptase InhibitorsReverse Transcriptase Inhibitors
• Action – Bind directly to HIV reverse transcriptase blocking both RNA and DNA dependent DNA polymerase activities
• Pharmacokinetics – Given orally, metabolized in the liver, excreted in the urine
• Contraindications – Pregnancy and lactation
• Adverse Reactions – Headache, nausea, vomiting, rash, chills, fever, diarrhea
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Protease InhibitorsProtease Inhibitors
• Action – Block protease activity within the HIV virus
• Pharmacokinetics
• Contraindications – Pregnancy and lactation
• Adverse Reactions
• Drug-to-Drug Interactions
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NucleosidesNucleosides
• Action – Interfere with HIV replication by inhibiting cell protein synthesis
• Pharmacokinetics – Given orally or IV; metabolized in the liver and excreted in the urine
• Contraindications
• Adverse Reactions – HA, insomnia, dizziness, nausea, diarrhea, fever, rash
• Drug-to-Drug Interactions
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Fusion InhibitorsFusion Inhibitors
• Action – Prevents the fusion of the virus with the human cellular membrane
• Pharmacokinetics – Given sub-q; metabolized in the liver it is recycled in the tissues it is not excreted
• Contraindications – No true contraindication
• Adverse Reactions – HA, dizziness, myalgia, nausea, vomiting, and diarrhea
• Drug-to-Drug Interactions – Pimozide, rifampin, triazolam, midazolam, oral contraceptive
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Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents
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Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for HIV/AIDS Antiviral Therapy
Nursing Considerations for HIV/AIDS Antiviral Therapy
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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QuestionQuestion
You are caring for a patient with HIV. A nursing diagnosis for this patient is acute pain related to GI, CNS, or dermatological effects of the drugs. What type of drug is this patient taking?
A. Integrase Inhibitor
B. Nucleoside
C. Reverse Transcriptase Inhibitor
D. Protease inhibitor
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AnswerAnswer
A. Integrase Inhibitor
Rationale: Nursing diagnoses related to drug therapy might include: Acute Pain related to GI, CNS, or dermatological effects of the drugs
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anti-Hepatitis B Agents Anti-Hepatitis B Agents
• Therapeutic Actions and Indications
• Pharmacokinetics
• Contraindications and Cautions
• Adverse Effects
• Clinically Important Drug–Drug Interactions
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Nursing Considerations for Receiving Agents for Hepatitis B
Nursing Considerations for Receiving Agents for Hepatitis B
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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Prototype of Hepatitis B Antiviral AgentsPrototype of Hepatitis B Antiviral Agents
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Locally Active Antiviral AgentsLocally Active Antiviral Agents
• Action – Act on viruses by interfering with normal viral replication and metabolic processes
• Pharmacokinetics – Not absorbed systemically
• Contraindications – Allergy to the drug
• Adverse Reactions – Local burning, stinging, and discomfort
• Drug-to-Drug Interactions
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Nursing Considerations for Locally Active Antiviral Agents
Nursing Considerations for Locally Active Antiviral Agents
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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QuestionQuestion
Which antiviral drugs are not absorbed systemically?
A. Anti-hepatitis B agents
B. Locally Active Antiviral Agents
C. Nucleoside Agents
D. Fusion Inhibitors
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AnswerAnswer
B. Locally Active Antiviral Agents
Rationale: Locally active antiviral drugs are not absorbed systemically, but caution must be used in patients with known allergic reactions to any topical drugs.