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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Antiviral Agents Chapter 10
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Page 1: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antiviral AgentsAntiviral Agents

Chapter 10

Page 2: Ppt 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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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stages of Virus ReplicationStages of Virus Replication

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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 7: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Respiratory VirusesCommon Respiratory Viruses

• Influenza A

• Influenza B

• Respiratory Syncytial Virus

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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 9: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 10: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Considerations for Respiratory Antiviral Therapy

Nursing Considerations for Respiratory Antiviral Therapy

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation

Page 11: Ppt chapter 10

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Prototype of Respiratory Antiviral AgentsPrototype of Respiratory Antiviral Agents

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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

Tell whether the following statement is true or false.

Treatment of a viral infection is difficult without serious toxic effects for the host.

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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.

Page 14: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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.

Page 16: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 17: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 20: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Signs and Symptoms of HIV/AIDS (cont.)Signs and Symptoms of HIV/AIDS (cont.)

• Secondary Infections – Pneumocystis carinii, disseminated herpes simplex

Page 21: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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.

Page 22: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drugs Used to Treat HIV/AIDSDrugs Used to Treat HIV/AIDS

• Reverse Transcriptase Inhibitors

• Protease Inhibitors

• Nucleosides

• Fusion Inhibitors

Page 24: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 25: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 28: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents

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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents

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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents

Page 31: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents

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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents

Page 33: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prototype of HIV/AIDS Antiviral AgentsPrototype of HIV/AIDS Antiviral Agents

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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

Page 35: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 36: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 37: Ppt chapter 10

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

Page 38: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 39: Ppt chapter 10

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Prototype of Hepatitis B Antiviral AgentsPrototype of Hepatitis B Antiviral Agents

Page 40: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Page 41: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Considerations for Locally Active Antiviral Agents

Nursing Considerations for Locally Active Antiviral Agents

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation

Page 42: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

Which antiviral drugs are not absorbed systemically?

A. Anti-hepatitis B agents

B. Locally Active Antiviral Agents

C. Nucleoside Agents

D. Fusion Inhibitors

Page 43: Ppt chapter 10

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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.