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ANTIVIRAL DRUGS

Understanding Viruses

Viral replication

 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
Understanding Viruses

Viruses are difficult to kill because they live


inside the cells

 Any drug that kills a virus may also kill cells


Viral Infections
Competent immune system:

 Best response to viral infections


 A well-functioning immune system will eliminate or effectively destroy virus
replication

Immunocompromised patients have frequent viral infections

 Cancer patients, especially leukemia or lymphoma


 Transplant patients, due to pharmacologic therapy
 AIDS patients, disease attacks immune system
Antivirals
Viruses controlled by current antiviral therapy

 Cytomegalovirus (CMV)
 Hepatitis viruses
 Herpes viruses
 Human immunodeficiency virus (HIV)
 Influenza viruses (the “flu”)
 Respiratory syncytial virus (RSV)
Antivirals
Key characteristics of antiviral drugs

 Able to enter the cells infected with virus

 Interfere with viral nucleic acid synthesis and/or regulation

 Some drugs interfere with ability of virus to bind to cells

 Some drugs stimulate the body’s immune system

 Best responses to antiviral drugs are in patients with competent immune


systems

 A healthy immune system works synergistically with the drug to eliminate


or suppress viral activity
Antivirals
Opportunistic infections

 Occur in immunocompromised patients

 Infections that would not normally harm an


immunocompetent person

 Require long-term prophylaxis and anti-infective drug


therapy

 Can be other viruses, fungi, bacteria, or protozoa


Antiviral Medications
 Antiviral drugs
 Used to treat infections caused by viruses other than HIV
 Antiretroviral drugs
 Used to treat infections caused by HIV, the virus that causes
AIDS
 Herpes-Simplex Viruses
 HSV-1 (oral herpes)
 HSV-2 (genital herpes)

 Varicella Zoster Virus


 Chickenpox
 Shingles
Antiviral Drugs: Nonretroviral
 Mechanism of action
 Inhibit viral replication
 Used to treat non-HIV viral infections
 Influenza viruses
 HSV (herpes simplex virus), VZV (vericella zoster virus)
 CMV (cytomegalovirus)
 Hepatitis A, B, C (HAV, HBV, NCV)
 Adverse Effects
 Vary with each drug
 Healthy cells are often killed also, resulting in serious
toxicities
Antivirals Drugs-Nonretroviral
Amantadine (Symmetrel)

 Narrow antiviral spectrumactive only against influenza A

 Used prophylactically when vaccine is not available or cannot be


given

 Therapeutic use can reduce recovery time

 CNS effects: insomnia, nervousness, lightheadedness

 GI effects: anorexia, nausea, others


Antivirals Drugs-Nonretroviral
Rimantadine (Flumadine)

 Same spectrum of activity, mechanism of action, and


indications as amantadine

 Fewer CNS adverse effects

 Causes GI upset
Antivirals Drugs-Nonretroviral
Acyclovir (Zovirax)

 Synthetic nucleoside analog

 Used to suppress replication of:


 HSV-1(oral herpes), HSV-2(genital herpes),
VZV (Varicella – chickenpox or shingles)

 Drug of choice for treatment of initial and recurrent


episodes of these infections

 Oral, topical, parenteral forms


Antivirals Drugs-Nonretroviral
Ganciclovir (Cytovene)

 Synthetic nucleoside analog

 Used to treat infection with cytomegalovirus (CMV)

 Oral, parenteral forms

 CMV retinitis
 Ophthalmic form surgically implanted
 Ocular injection (fomivirsen)
Antivirals Drugs-Nonretroviral
Dose-Limiting Toxicities

 ganciclovir and zidovudine


 Bone marrow toxicity

 foscarnet and cidofovir


 Renal toxicity
Antivirals Drugs-Nonretroviral
Neuraminidase Inhibitors

oseltamivir (Tamiflu) and zanamivir (Relenza)


 Active against influenza types A & B

 Use: Reduce duration of illness

 oseltamivir: causes nausea & vomiting

 zanamivir: causes diarrhea, nausea, sinusitis

 Treatment should begin within 2 days of influenza symptom


onset
Antivirals Drugs-Nonretroviral
Ribavirin

 Synthetic nucleoside analog

 Given orally, or oral or nasal inhalation

 Inhalation form (Virazole) used for hospitalized infants


with RSV (respiratory syncytialvirus) infections
HIV
Human immunodeficiency virus infection
 ELISA (enzyme-linked immunosorbent assay)
 Detects HIV exposure based on presence of human antibodies to the virus in the blood
 Retrovirus
 Transmitted by:
 Sexual activity, intravenous drug use, perinatally from mother to child

Five Stages of HIV Infection

 Stage 1: asymptomatic infection


 Stage 2: early, general symptoms of disease
 Stage 3: moderate symptoms
 Stage 4: severe symptoms, often leading to death

WHO model stages


Opportunistic Infections

 Protozoal
 Toxoplasmosis of the brain, others
 Fungal
 Candidiasis of the lungs, esophagus, trachea
 Pneumocystis jiroveci pneumonia, others
 Viral
 CMV disease, HSV infection, others
 Bacterial
 Various mycobacterial infections, others
 Extrapulmonary TB

 Opportunistic neoplasias
 Kaposi’s sarcoma, others
Antiretroviral Drugs

HAART - Highly active antiretroviral therapy

 Includes at least three medications


 “cocktails”

 These medications work in different ways to reduce


the viral load
Antiretroviral Drugs
 Reverse transcriptase inhibitors (RTIs)
 Block activity of the enzyme reverse transcriptase, preventing production of
new viral DNA
 Reverse transcriptase inhibitors (RTIs)
 Nucleoside RTIs (NRTIs)
 Nonnucleoside RTIs (NNRTIs)
 Nucleotide RTIs (NTRTIs)
 Examples
abacavir (Ziagen) delavirdine (Rescriptor)
didanosine (Videx) lamivudine (Epivir)
stavudine (Zerit) tenofovir (Viread)
Antiretroviral Drugs

 Protease inhibitors (PIs)


 Inhibitthe protease retroviral enzyme, preventing viral
replication
 Examples:

amprenavir (Agenerase) indinavir (Crixivan)


nelfinavir (Viracept) ritonavir (Norvir)
saquinavir (Invirase)
Antiretroviral Drugs

 Fusion inhibitors

 Inhibit viral fusion, preventing viral replication

 Newest class of antiretroviral drugs

 Example: enfuvirtide (Fuzeon)


Antiretroviral Drugs

 Combinations of multiple antiretroviral medications


are common

 Adverse effects vary with each drug and may be


severemonitor for dose-limiting toxicities

 Monitor for signs of opportunistic diseases


Antiretroviral Drugs:
Adverse Effects
 Numerous and vary with each drug

 Drug therapy may need to be modified because of


adverse effects

 Goal is to find the regimen that will best control the


infection with a tolerable adverse effect profile

 Medication regimens change during the course of


the illness
Nursing Implications

 Before therapy, assess underlying disease, history,


allergies

 Assess baseline VS and nutritional status

 Assess for contraindications, conditions that may


indicate cautious use, and potential drug interactions
Nursing Implications
Patient Education
 Consult their physician before taking other medication,
including OTCs

 Good hygiene

 Antiviral drugs are not cures but help manage symptoms

 Take these medications exactly as prescribed

 Take medications for the full course of treatment


Nursing Implications
Patient Education
 Teach each proper application for ointments, aerosol
powders

 Hand washing before and after administration of


medications

 Wear glove or finger cot when applying ointments

 Start therapy with antiviral drugs at the earliest sign


of recurrent episodes of genital herpes or herpes
zoster
Nursing Implications

Monitor for therapeutic effects


 Effects will vary depending on the type of viral
infection
 Effects range from delayed progression of AIDS and
other viruses to decrease in flu-like symptoms, decrease
in frequency of herpes-like flare-ups, or crusting over
of herpetic lesions

Monitor for adverse effects


 Effects are varied and specific to each drug

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