Chapter 7
Antiinfectives:
Antiviral Drugs
Understanding Pharmacology, 3rd ed.
Workman
Learning Objectives—Lesson 7.1
1. Explain the names, actions, usual adult dosages,
possible side effects, and adverse effects of the
various types of nonretroviral drug therapies.
2. Describe priority actions to take before and after
giving any of the various types of nonretroviral drug
therapies.
3. Prioritize essential information to teach patients who
take any of the various types of nonretroviral drug
therapies.
Intracellular, submicroscopic
parasites that must infect a
living cell to reproduce
Viruses Two types:
Common viruses
(nonretroviruses)
Retroviruses
Virustatic: Reduces the number of viruses
Intended responses:
•Shorten the duration or intensity of an existing viral
Antiviral
disease
•Prevent reactivation of a dormant viral infection
•Prevent a viral infection from multiplying to the
Drug point of disease
Therapy Allergic reactions always possible
•More serious reactions occur when given
intravenously
Teaching priorities:
•Antiviral drugs must be taken exactly as
prescribed; must take drug long enough to work
Drugs for Herpes Simplex
Infections
Slow viral reproduction
Most effective against genital herpes infections,
Epstein-Barr virus, cytomegalovirus, varicella-zoster virus
Side effects: Headache, dizziness, nausea, diarrhea
Adverse effects: Reduced kidney function, leading
to kidney damage and failure; pain/irritation at
injection site; reduced efficacy of antiseizure drugs
Teaching priorities: Same as general antiviral drugs
Life span considerations: Weigh benefits against risks
in pregnancy; not recommended during lactation
Baloxavir, oseltamivir,
peramivir, zanamivir
Drugs for Side effects:
Common
• Headache, nausea/vomiting,
Respiratory diarrhea, dizziness
Viral
Infections Adverse effects:
• Vary by specific drug
• May include acute confusion,
delirium, hallucinations,
elevated liver enzymes
Administering Drugs for Common Respiratory
Viral Infections
Check before: Check after: Teaching priorities:
Ask about drug allergies For IV drugs, assess Take drug exactly as
Do not administer patient every 15 minutes prescribed
peramivir with other Teach patients taking
drugs zanamivir how to use a
dry powder inhaler
Ribavirin suppresses viral
action and reproduction
Used for viral infections
that do not respond to
other antiviral agents
Ribavirin Nausea/vomitin
g, diarrhea,
fever,
headache, rash,
conjunctivitis,
Side effects: muscle pain,
fatigue,
dizziness, runny
nose, injection
site pain or
irritation
Teratogenic
Prolonged use
Adverse may impair
functioning of
effects: liver, kidneys,
heart, ears. May
lead to some
forms of cancer.
Check before:
• Hearing; cardiac, respiratory,
neurologic, kidney, liver
functioning
• Blood counts and vital signs
• Ask about other drugs the
Administering patient may be taking
Ribavirin • Wear a mask when giving
aerosolized form
Check after:
• Monitor closely for side effects or
organ toxicity
• Review lab values daily
• Assess hearing daily
Pregnancy and lactation:
Do not use during pregnancy
Life Span or breastfeeding!
Considerations Use two forms of contraception
for Ribavirin while taking the drug, and 1
month after discontinuing the
drug
Inhibits viral proteins and enzymes
important to virus replication and
reproduction
Side effects:
Drugs for
Chronic •Headache, GI discomfort, rashes, fatigue
Hepatitis Adverse effects:
C •Elevated liver enzymes, jaundice, bone marrow
Infection
suppression, angioedema, drug interactions
Teaching priorities:
•Avoid alcohol
•Women should use two forms of contraception
•Report signs of allergic reaction or jaundice
Limits replication and reproduction of
HBV; may be used for months to
years
Side effects:
Fatigue, headache, fever, rash,
muscle aches
Adverse effects:
Drugs for
Peginterferon: Psychiatric
Chronic disorders worsen, bone marrow
suppression
Hepatitis B Entecavir: liver toxicity, lactic
acidosis, shallow breathing
Infection Teaching priorities:
Avoid alcohol; women use two
forms of contraception
Report new feelings of
depression
Report signs of allergic reaction
or jaundice
Pregnancy and lactation:
Life Span
Studies have not been
Considerations
performed
for Drugs for Strong likelihood of peginterferon
Chronic causing pregnancy loss
Hepatitis B Peginterferon and entecavir
contraindicated during
Infection pregnancy and breastfeeding
Retroviruses
Always use RNA as Allow high Human immune
their genetic efficiency of cellular deficiency virus
material infection (HIV)
HIV attacks the immune system
Most severe form of immune deficiency
disease caused by HIV infection is acquired
immune deficiency syndrome (AIDS)
HIV/AIDS Everyone with AIDS has HIV infection
Not everyone with HIV infection has AIDS
Opportunistic infections
Nucleoside analog reverse
transcriptase inhibitors (NRTIs)
Non-nucleoside analog
reverse transcriptase inhibitors
Seven (NNRTIs)
Classes of Protease inhibitors (PIs)
Antiretroviral Fusion inhibitors
Drugs CCR5 antagonists
Integrase strand transfer
inhibitors (INSTIs)
Attachment inhibitors
Virustatic
Drug resistance common;
related to missed drug doses
New combination therapy is
easier to manage (1-3 pills per
day)
Antiretroviral Be alert to allergic reactions
Therapy Intended response: suppression
of viral reproduction, delay
progression to later stages,
prevent transmission
Measured by “viral load” and
decreased opportunistic
infections; immune function
improved
Common Side Effects and Adverse Effects of
Combination ART
Side effects: Adverse effects:
Rash, nausea, vomiting, Elevated liver enzymes,
abdominal pain, headache, jaundice, increased risk of birth
fatigue, weight gain, difficulty defects, many interactions with
sleeping, vivid dreams or other drugs
nightmares
Priority Actions for Combination ART
Check patient for liver problems, glucose levels (if diabetic)
Lifelong treatment; ensure appropriate, in-depth education
Obtain a list of all drugs patient is currently taking
Teaching priorities:
• Take drugs exactly as prescribed, be aware of signs of liver toxicity, do not
change other drugs without discussing with a provider
Life Span Considerations for
Combination ART
Pediatric considerations:
Not approved for use in children
Pregnancy and lactation:
Not approved; HIV positive mothers are instructed not
to breastfeed.
Older adults:
Be careful of drug interactions
Drugs for Preexposure
Prophylaxis of HIV Infection
Prevent sexual transmission of HIV
Combination drugs emtricitabine and tenofovir for HIV-1
negative patients with a partner who is HIV-1 positive
Does not replace safer sex practices