Ati Meds For Infection (Viral Infections, Hiv, Aids)

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antivirals

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acyclovir (Zovirax)
ganiciclovir (Cytovene)
other meds: interferon alfa-2b (Intron A)
lamivudine (Epivir)
Oseltamivir (Tamiflu)
ribavirin (Rebetol)
amantadine (Symmetrel)
boceprevir (Victrelis)
telaprevir (Incivek)

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antiviral MOA

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prevent reproduction of viral DNA and thus interrupts cell replication

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acyclivir (antiviral)

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treats herpes simplex and varicella zoster viruses

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ganciclovir (antiviral)

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treatment and prevention of cytomegaolvirus
prevention therapy using ganciclovir is also given for clients who have HIV/AIDS, organ transplants, and other immunocompromised states

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interferon alfa-2b and lamivudine

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used to treat hep b and c

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oseltamivir

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used to treat influenzae A and B

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ribvirin

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is used to treat respiratory syncytial virus and inflammation

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boceprevir and telaprevir

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used to treat hep C virus

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acyclovir adverse

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phlebitis and inflammation at site of infusion
nephrotoxicity
mild discomfort associated with oral terhapy

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gaciclovir adverse

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suppressed bone marrow, including leukocytes and thrombocytes
fever, headache, nausea, diarrhea

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acyclovir contraindications

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renal impairment, dehydration, nephrotoxic meds

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gaciclovir contraindications

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neutrophil count below 500 mm3 or platelet count less than 25000 mm 3
should be used cautiously in infants under 3 months, older adults, and clients who have dehydration, renal insufficiency, or malignant disorders

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gaciclovir interactions

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cytotoxic meds may increase toxicity

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acyclovir interactions

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probenecid may decrease elimination of acyclovir
concurrent use of zidovudine may cause drowsiness

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acyclovir admin

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put on rubber gloves to administer topical
administer IV infusion slowly over 1 hour or longer

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ganciclovir admin

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IV infusion slowly over at least 1 hr
administer oral med with food
intraocular for CMV retinitis
avoid getting ganciclovir solution or powder on skin

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antiviral effectiveness

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healed genital lesions, decreased inflammation or pain, improvement in vision

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antiretroviral- fusion/entry inhibitors

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proto: enfuvertide (Fuzeon)
subQ

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antiretroviral MOA

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decreases and limites the spread of HIV by blocking HIV from attaching to and entering CD4 T cell

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enfuvirtide (Fuzeon) uses

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treatment of HIV that is unresponsive to other antiretrovirals

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enfuvirtide (Fuzeon) adverse

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localized reaction at injection site
bacterial pneumonia
fever, chills, rash, hypotension

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enfuvirtide contrainidcations

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hypersensitivity

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enfuvirtide admin

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only administered subQ

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enfuvirtide effectiveness

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reduction of symptoms and remain free of opportunistic infection

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antiretroviral-CCR5 antagonist

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proto: maraviroc (selzentry)

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maraviroc MOA

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prevents HIV from entering lymphocytes by binding to CCR5 on cell membranes

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maraviroc use

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treats HIV infection in conjunction with other antiretroviral meds

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maraviroc adverse

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cough and upper respiratory tract infections
CNS effects
hepatotoxicity

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maraviroc contraindications

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first med to treat clients who have newly diagnosed HIV infection and also contraindicated with existing liver disease or during lactation
caution: existing cardiovascular disorders and older adults

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maraviroc interactions

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most protease inhibtors raise marviroc levels
rifampin, efavrienz, phenytoin, some anticonvulsants, St. John's Wort decreases maraviroc levels

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maraviroc effectiveness

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decrease in HIV manifestations and absence of opportunistic infection

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NRTIs (antiretroviral)

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zidovudine (Retrovir)

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zidovudine (NRTI) MOA

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reduces HIV symptoms by inhibiting DNA synthesis and thus viral replication

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zidovudine (NRTI) use

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first line antiretrovirals to treat HIV infection

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zidovudine (NRTI) adverse

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can cause suppressed bone marrow, resulting in anemia, agranulocytis, and thrombocytopenia
lactic acidosis
nausea, vomiting, diarrhea
hepatomegaly, fatty liver

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zidovudine NRTI contraindications

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liver disease, bone marrow depression

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zidovudine (NRTI) interactions

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probenecid, valproic acid, and methadone may increase zidovudine
ganciclovir
rifampin and ritonavir may reduce zidovudine levels
phenytoin may alter both med levels

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zidovudine (NRTI) admin

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monitor for bone marrow suppression
obtain baseline CBC and platelets at the start of therapy and monitor periodically as needed
anemia may be treated with epoetin alfa or infusions
neutropenia may be treated with colony-stimulating factors

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zidovudine effectiveness

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reduction of symptoms and remain free of opportunistic infection

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antiretrovirals (NNRTIs)

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proto: delavirdine (Rescriptor), efavirenz (Sustiva)
other: nevirapine (Viramune), etravirine, (Intelence)

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delavirdine (NNRTIs) MOA

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act directly on reverse transcriptase to stop HIV replication

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delaviridine use

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primary HIV-1 infection
used in combination with other antiretroviral agents to prevent med resistance

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delaviridine adverse

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rash, flulike symptoms, headache, fatigue, CNS manifestations
CNS manifestations, dizziness, drowsiness, insomnia, nightmares

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NNRTI (efavirenz) contraindications

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liver disease, hypersensitivity

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NNRTI interactions

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antacids may decrease absorption of delavirdine- allow one hour between medications
NNRTI may increase effects of benzodiazipines, antihistamines, calcium channel blockers, ergot alkaloids, quinidine, warfarin, and others
rifampin and phenytoin may cause decrease in levels of delavirine
didanosine may reduce both medicines absorption
NNRTIs may cause increase in slidenafil level

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NNRTI administration

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efavirernz must be given with a high-fat meal to increase absorption

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NNRTI effectiveness

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reduction of symptoms and remaining free of opportunistic infection

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Protease inhibitors

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ritonavir (Norvir)

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protease inhibitors MOA

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act against HIV 1 and HIV2 to alter and inactivate the virus by inhibiting enzymes needed for HIV replication

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protease inhibitor use

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HIV infections
ritonavir is usually given with other PIs to increase their effect

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protease inhibitor adverse

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bone loss-oseoporosis
DM-hyperglycemia
hypersensitivity
nausea and vomiting
elavated serum lipids
thrombocytopenia, leukocytopenia

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protease inhibitor contraindications

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liver disease
contraindicated in many medications

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protease inhibitor interactions

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raltegravir may be decreased with concurrent use of rifampin or the combination tipranavir/ritonavir

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protease administration

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raltegravir may decreased with concurrent use of rifampin or the combination tipranavir/ritonavir
raltegravir dosage may need to be increased

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Protease inhibitor effectiveness

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effectiveness may be evidenced by reduction of HIV manifestations and freedom of opportunistic infections