NUCLEOSDIE/NUCLEOTIDE REVERSE TRASCRIPTASE INHIBITORS- NRTI’S

·        HIV in adults and children

·        prophylaxis in preventing transmission to fetus

·        Epstein –Barr

Inhibit reverse transcriptase a critical enzyme to HIV replication.

·        hypersensitivity

·        breast feeding

·        existing lactic acidosis.

·        Clients with hepatic dysfunction, obesity have a higher risk of lactic acidosis.

·        nausea, vomiting, anorexia and abdominal pain.

·        headache, seizures, paresthesia, restlessness and insomnia.

·        nail discoloration and alteration in taste.

·        anemia

·        grantulocytopenia,

·        thrombocytopenia

·        bone marrow suppression

·        lactic acidosis

·        hepatomegaly with steatosis (fatty liver)

Give 1 hour before meals

Have patient on low fat diet

How is Zidovudine (AZT) given in 24 hrs

Zidovudine (AZT) can be given IM

True or False ?

False

No IM injections

What S/S and labs should the nurse assess for when the pt is on

Zidovudine (AZT)

Monitor CBC, Liver enzymes

monitor for sore throat,  bleeding or bruising and fatigue

What med is best to use for a HA if the pt is on Zidovudine (AZT)

NONNUCLEOSIDE REVERSE TRASCRIPTASE INHIBITORS- NNRTI’S

Treat HIV 1 infection in combination with other antivirals.

Not effective in HIV-2 infections.

·        Hypersensitivity

·        Patients taking midazolam, triazolam, ergots or voriconazole

·        Use of alcohol or psychoactive drugs increase risk of CNS effects

·        Use cautiously in clients with hepatic impairment or Hepatitis B or C

dizziness, impaired concentration, hallucinations

rash

·        Steven’s Johnson syndrome,

·        lipodystrophy,

·        hepatotoxicity

Seizures and severe depression, paranoid or manic reactions.

How should Efavirenz (EFV) be given in relation to food

Administer on an empty stomach

Administer at bedtime to decrease CNS effects

·        Monitor liver function tests before and during therapy. 

·         notify provider of s/s of toxicity such as fatigue, jaundice, nausea or vomiting.

A pt is on Efavirenz (EFV) and develops depretion and a rash. The nurse knows this is an expected side effect and educates the pt.

True or False

False

Teach clients to notify provider for depression or manic episodes, rash that becomes denuded.

Your pt is taking Efavirenz (EFV). What should you teach them regarding lipodystrophy

also called fat redistribution, is a

disturbance in the way your body produces, uses, and stores fat. 

Treatment of HIV in adults.  May combine with reverse transcriptase meds.

Use for both HIV 1 and HIV-2

·         Hypersensitivity

·         Not approved for use in individuals under 16 yrs.

·         Caution in patients with liver impairment

·         Caution in patients with diabetes will cause hyperglycemia

·        nausea, diarrhea, stomach discomfort,

·        Hyperglycemia

·        Increased bone loss

·         Headache

·        Pancreatitis

·        Lipodystrophy

Administer within 2 hours after eating full meal

administer ritonavir (antiviral medication, protease inhibitor.) with each does 

acetaminophen for HA

Treatment for patients who experience treatment failure or do not tolerate treatment with existing antiretrovirals.

Binds to gp41 (protein) This inhibits HIV from entering the cell

·        Hypersensitivity

·        Caution in clients predisposed to respiratory infections by such risk factors as smoking, pulmonary dysfunction, low CD4 counts or high viral load.

·        Injection site reaction:  itchy rash and red,swollen puffy or hardened skin.

·        nausea, weight loss, fatigue, anxiety

bacterial pneumonia

lymphadenopathy-swollen/enlarged lymph nodes

Teach patients to use aseptic technique with injections

Explain the potential for injection site reaction

Avoid sites with increased risk of irritation

Refrigerate unused medicine

Teach healthy lifestyle choices to avoid infection risks

Teach s/s of infection