Pharmacology Antivirals

Front 1

Acyclovir (Zovirax)

Back 1

-suppresses synthesis of viral DNA
-treat infections caused by herpes simplex viruses (genitalia, mouth, face, etc) and varicella-zoster virus (shingles, chickenpox)
-caution in pts with dehydration or renal impairment or in those taking other nephrotoxic drugs
-topical-apply with a finger cot or rubber glove to avoid viral transfer to other body sites or other people
-give IV by slow infusion and never by bolus, but over an hour or more
-with h s genitalis-decreases symptoms and not eliminate virus or cure; cleanse area with soap and water 3-4 times daily, dry thoroughly; avoid all sexual contact while lesions present and use a condom even when lesions are absent
-nephrotoxicity-IV can precipitate in renal tubules and cause reversible damage-infuse slowly and ensure adequate hydration during infusion and 2 hours after

Front 2

Amantadine (symmetrel)

Back 2

-prophylaxis and treatment of Influenza type A virus; also Parkinson's
-MOA not fully understood
-CNS effects-exercise caution in hazardous activities
-Cardiovascular effects-orthostatic hypotension, HF-therefore caution in those with HF or peripheral edema
-no preggos unless outweigh
-can increase peripheral and CNS effects of anticholinergic drugs (psychotic rxns like atropine poisoning)
-resistance can develop rapidly

Front 3

Zanamivir (relenza)

Back 3

-oral inhalation
-treatment of acute uncomplicated influenza at least 7 yro and prophylaxis of influenza in at least 5 yro; H5N1
-neuraminidase inhibitor-enzyme for viral reproduction; active against influenza A and B
-reduce duration of symptoms, incidence of complications requiring antibacterial drugs
-cough/throat irritation since dry powder
-not recommended in those with underlying airway disease because may cause severe bronchospasm and respiratory decline; bronchodilator first

Front 4

Influenza vaccine – patient teaching

Back 4

-protection begins 1-2 weeks; 6 months or less for elderly
-inactivated influenza vaccine-first timers may have fever, myalgia, malaise lasting 1-2 days; GBS
-live, attenuated influenza vaccine-anaphylaxis, GBS, Bell's palsy; runny nose, cough, headache in kids and adults
-6 mons to 18 yro and older than 50 yro; those at high risk of complications from flu-preggos, nursing homes, children who take long-term aspirin therapy (at risk for Reye's syndrome if get flu); weakened immune system; muscle or nerve disorders like CP or seizure disorders that could lead to breathing or swallowing problems' long-term health problems; who can transmit flu to others at high risk for complications-healthcare and household members of kids up to 5 and people over 50; travelers, dorms, people who provide essential community services
-NOT to those who have a a severe allergy to chicken eggs, who have had a severe rxn to flu vaccine before, who have experienced GBS, who have a moderate or severe illness with a fever-wait until symptoms abate

Front 5

AZT, ZDV Zidovudine (retrovir)

Back 5

-NRTI=nucleoside/nucleotide reverse transcriptase inhibitors; competitive and not allow adding of more bases by enzyme so DNA strand not grow
-maximal and durable suppression of viral load, restoration and or preservation of immune fxn, improvement of quality of life, reduction of HIV-related morbidity and mortality and prevention of HIV transmission
-baseline data: assess pt's clinical status and get a plasma HIV RNA level and CD4 T-cell count, hemoglobin value and granulocyte count
-risk of hematologic toxicity is increased by a low granulocyte count; low levels of hemoglobin, vitamin B12, or folic acid; and concurrent use of drugs that are myelosuppressive, nephrotoxic or toxic to circulating blood cells
-instruct pt to adhere closely to prescribed dosing schedule
-IV is slowly over one hour; dont mix solution with biologic or colloidal fluids like blood products or protein solutions; give within 8 hours if not refrigerated or within 24 hours if refrigerated

Front 6

AZT, ZDV Zidovudine (retrovir)

Back 6

-success indicated by reduction in plasma HIV RNA-decline to 10% of baseline within 2-8 weeks; after 16-20 weeks, should reach its minimun=ideally undectable; as viral load decreases, CD4 T-cell counts may rise which indicates some restoration of immune function
-anemia, neutropenia-baseline and at least 4 weeks after; lactic acidosis with hepatic steatosis-symptoms=nausea, vomiting, abdominal pain, malaise, fatigue, anorexia, hyperventilation-instruct to report ASAP
-reduction of plasma HIV RNA may give a false sense of safety-even though HIV RNA may not be detectable, they are still infectious and should avoid behaviors that can transmit HIV
-drugs that are myelosuppressive, nephrotoxic or directly toxic to circulating blood cells can increase risk of hematologic toxicity
-giving a combination of NRTIs to preggos may increase risk or lactic acidosis and hepatic steatosis-avoid these combinations

Front 7

efavirenz (sustiva)

Back 7

-non-nucleoside reverse transcriptase inhibitor-HIV-1; binds directly to HIV reverse transcriptase
-maximal and durable suppression of viral load, restoration and or preservation of immune fxn, improvement of quality of life, reduction of HIV-related morbidity and mortality and prevention of HIV transmission
-baseline data: assess pt's clinical status and get a plasma HIV RNA level and CD4 T-cell count, liver fxn test and pregnancy test
-instruct pt to adhere closely to prescribed dosing schedule
-with or without food but not a high-fat meal
-rash-start with lower dose and see if tolerate (mild to severe rash)
-hepatoxicity-baseline tests and periodically thereafter
-CNS symptoms like dizziness, insomnia, impaired consciousness, drowsiness, vivid dreams, nightmares-typically resolve in 2-4 weeks and take at bedtime to reduce effects-if severe symptoms occur, withdrawn

Front 8

efavirenz (sustiva)

Back 8

-teratogenic-oral and barrier
-competes with other drugs for metabolism by P450 and thereby increase their levels; accelerate metabolism of other drugs-not use with saquinavir; st. John's wort induces P450 and reduce levels so not use
-success indicated by reduction in plasma HIV RNA-decline to 10% of baseline within 2-8 weeks; after 16-20 weeks, should reach its minimun=ideally undectable; as viral load decreases, CD4 T-cell counts may rise which indicates some restoration of immune function
-empty stomach
-reduction of plasma HIV RNA may give a false sense of safety-even though HIV RNA may not be detectable, they are still infectious and should avoid behaviors that can transmit HIV

Front 9

opinavir (kaletra)

Back 9

-protease inhibitor
-bind to active site of HIV protease and prevent it from cleaving polyproteins-therefore the structural proteins and enzymes of HIV cant function and the virus remains immature and noninfectious
-with food-mix oral solution with chocolate milk, Ensure or Advera within 1 hour of administration to improve taste; refrigerate and protect from light
-maximal and durable suppression of viral load, restoration and or preservation of immune fxn, improvement of quality of life, reduction of HIV-related morbidity and mortality and prevention of HIV transmission
-baseline data: assess pt's clinical status and get a plasma HIV RNA level and CD4 T-cell count, measure serum transaminases and blood glucose
-instruct pt to adhere closely to prescribed dosing schedule
-success indicated by reduction in plasma HIV RNA-decline to 10% of baseline within 2-8 weeks; after 16-20 weeks, should reach its minimun=ideally undectable; as viral load decreases, CD4 T-cell counts may rise which indicates some restoration of immune function

Front 10

opinavir (kaletra)

Back 10

-reduction of plasma HIV RNA may give a false sense of safety-even though HIV RNA may not be detectable, they are still infectious and should avoid behaviors that can transmit HIV
-hyperglycemia/diabetes-pt to report symptoms-polydipsia, polyphagia, polyuria
-fat maldistribution-on waist, stomach, breasts, back of neck and loss from face, arms, buttocks, legs (face-reduce with Sculptra)
-hyperlipidemia-elevate cholesterol and triglycerides which pose a risk of cardiovascular events and pancreatitis; monitor Q 3-4 months-not give lovastatin and simvastatin
-increased bleeding in those with hemophilia
-increased transaminase levels-caution with those who have chronic liver disease-measure serum transaminases before and periodically thereafter
-may promote bone loss-adequate intake of calcium and vit D
-inhibit cytochrome P450-increase levels of other drugs
-powerful inhibitor of P450, so combined often with other PIs to raise their blood levels and boost antiviral effects
-rifampin induces P450 and reduce PIs levels so not use with PIs
-alternative form than oral birth control because can reduce levels of ethinyl estradiol
-st John's wort induces P450 can reduce levels of PIs so not use