Drugs for Viral Infections

1
Drugs for Viral Infections

• Chapter 36

2
Virus vs. Bacteria

• Compare and contrast structural components of
  bacteria and viruses
• Describe a viron.
• Identify indications for viral infection
  pharmacotherapy.

3
Challenges of Anti-Viral Therapy

• Rapid mutation
• Intracellular nature of virus
• Drugs have narrow spectrum of activity

4
HIV vs. AIDS

• Discuss the difference between a virus and a
  retrovirus.
• Differentiate between HIV infection and AIDS.
• Describe the replication of HIV.

5
Pharmacotherpy for HIV-AIDS

• Identify the therapeutic goals of therapy.
• Classifications
• Nucleoside reverse transcriptase inhibitors
  (NRTI)
• Nonnucleoside reverse transcriptase inhibitors
  (NNRTI)
• Protease Inhibitors
• Neucleotide reverse transcriptase inhibitor
  (NtRTI)
• Fusion (entry) inhibitor

6
HIV-AIDS Pharmacotherapy

• Compare and contrast the mechanism of action of
• Reverse transcriptase inhibitors
• Protease inhibitors
• Fusion inhibitors
• Identify reasons treatment failures occur.

7
Antiretrovirals NCs

• Drug is not a cure
• Prior to RX assess for sx of HIV, opportunistic
  infection, use of herbals
• Monitor viral load
• Verify ordered combination drugs
• Common side effects
• Fatigue, headache, GI disturbances
• Other side effects dependent upon specific drug

8
Antiretrovirals NCs

• Most contraindicated pregnancy, lactation
• Side effects can influence ADLs
• NRTIs cautiously pancreatitis, PVD, neuropathy,
  kidney or liver disorders, cardiac disease,
  alcohol abuse
• NNRTIs judiciously use in liver impairment, CNS
  disease
• PIs potential risks if sensitive to
  sulfonamides, liver disorders, renal insufficiency

9
Antiretrovirals NCs

• Variations in administration instructions
• NRTIs empty stomach, water only, no fruit juice
• Nevirapine (Viramune) and saquinavir (Invirase)
  take with food to decrease GI upset
• Contact HCP before taking any OTC med or
  supplement

10
Antiretrovirals Client Teaching

• NRTIs report fever, skin rash, abd pain, n/v,
  numbness or burning of hands/feet
• NNRTIs report fever, chills, rash, blistering or
  reddening of the skin, muscle or joint pain
• PIs report rash, abd pain, headache, insomnia,
  fever, constipation, cough, fainting, visual
  changes

11
Antiretrovirals Client Teaching

• Wash hands frequently avoid crowds
• Increase fluid intake empty bladder frequently
• Abstinence or barrier contraception
• Do not share needles
• Take medications as ordered
• Sufficient rest and sleep healthy diet
• Keep all scheduled appts and lab visits

12
Perinatal HIV Transmission

• Discuss pharmacotherapy for the prevention of
  perinatal transmission.

13
Occupation Exposure

• Identify risk factors for occupational exposure
  to HIV.
• Describe post HIV exposure prophylaxis.

14
Herpesvirus Infections

• HSV-1
• HSV-2
• CMV
• VZV
• EBV
• Herpesvirus 6
• Children roseola
• Immunocompromised hepatitis or encephalitis

15
Herpesvirus Infections

• Triggering events
• Immunosuppression
• Physical challenges
• Emotional stress
• Pharmacologic goals
• Relieve acute symptoms
• Prevent recurrences

16
Antivirals NCs

• Baseline VS, wt, CBC, viral cultures, LFTs, RFTs
• Cautiously pre-exisiting renal or liver
  dysfunction
• Judiciously pregnancy
• Routes IV, oral, topical, inhalation
• instruct re proper technique
• Emphasize compliance

17
Antivirals NCs

• Generally well tolerated
• Take with food if GI upset
• Severe adverse reactions
• Renal Failure, Thrombocytopenia
• More frequently side effects
• Headache
• Fatigue
• Dizziness

18
Antivirals Client Teaching

• Meds do not prevent transmission
• avoid activities that may transmit
• Immediately report hematuria, bruising,
  jaundice, fever, chills, confusion, nervousness,
  dizziness, nausea, vomiting
• Complete full course of treatment
• Keep scheduled appts and lab visits

19
Antivirals Client Teaching

• Caution while performing hazardous activities
• No other prescription, OTC, herbals or
  supplements without HCP approval
• Apply topicals with applicator or glove
• No other creams, ointments, or lotions to
  infected sites

20
Influenza

• Describe the characteristics of influenza.
• Differentiate between primary and secondary
  pharmacotherapy for influenza infections.
• Differentiate between antiviral and
  neuroaminidase inhibitor therapy.

21
Viral Hepatitis

• Caused by several different viruses with unique
  clinical features
• All cause inflammation and necrosis of liver
  cells
• Acute
• Fever, chills, fatigue, anorexia, nausea,
  vomiting
• Chronic
• Prolonged fatigue, jaundice, liver cirrhosis,
  hepatic failure

22
Viral Hepatitis

• Differentiate between Hepatitis A, Hepatitis B,
  and Hepatitis C.
• Compare and contrast pharmacotherapy for
  Hepatitis A, Hepatitis B, and Hepatitis C.

23
Viral Hepatitis Exposure

• Compare and contrast post-exposure prophylaxis
  for Hepatitis A, Hepatitis B, and
  Hepatitis C.