Anti-Infective – Antivirals

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Outline

Overview

  1. Overview
    1. Classes of DNA viruses / 14 classes of RNA viruses
    2. Mechanism of Action
      1. Kill or suppress viruses – inhibiting replication
      2. Blocking the activity of a polymerase enzyme
    3. Subclass – Immunoglobins
      1. Concentrated antibodies that can attack and destroy viruses
        1. Nonspecific (human gammaglobulin)
        2. Specific (rabies immunoglobulin, varicella-zoster immunoglobulin)
    4. Types
      1. Acyclovir
      2. Valacyclovir
      3. Famciclovir
      4. Ganciclovir
      5. Oseltamivir
      6. Zanamivir
      7. Didanosine
      8. Idoxuridine
      9. Lamivudine
      10. Stavudine
      11. Trifluridine
      12. Zalcitabine
      13. Amantadine
      14. Ribavirin
      15. Foscarne
  2. Indications
    1. Smallpox (poxviruses)
    2. Sore throat and conjunctivitis (adenoviruses)
    3. Warts (papovaviruses)
    4. Influenza (ortho-myxoviruses
    5. Respiratory infections (coronaviruses, rhinoviruses)
    6. Gastroenteritis (rotavirus, Norwalk-like viruses)
    7. HIV/AIDS (retroviruses)
    8. Herpes (herpesviruses)
    9. Hepatitis (hepadnaviruses)

III. Contraindications
A.    Amantadine

1.     Lactating women

2.     Children younger than 12 months of age

B.    Cidofovir

1.     Compromised renal function

C.     Ribavirin

1.     Hemoglobinopathies (sickle-cell anemia)

IV. Interactions
A.    Acyclovir

1.     Interferon – increased antiviral effects

2.     Zidovudine – increased risk of neurotoxicity

B.    Amantadine

1.     Anticholinergic drugs – increase anticholinergic effects

2.     CNS stimulants – increases CNS stimulant effects

C.     Didanosine

1.     Antacids – increase antiviral effects

2.     Itraconazole / Ketoconazole – decrease antifungal absorption

3.     Quinolones – decrease quinolones effects

4.     Tetracyclines – decrease tetracycline effects

D.    Ganciclovir

1.     Imipenem – increased risk for seizures

V. Side Effects
A.    Acyclovir

1.     N / V / D

2.     Headache

B.    Amantadine

1.     Insomnia

2.     Nervousness

C.     Rimantadine

1.     Lightheadedness

2.     Anorexia

D.    Didanosine

1.     Pancreatitis

2.     Peripheral neuropathies

3.     Seizures

E.     Foscarnet

1.     Seizures

2.     Hypocalcemia

3.     Hypokalemia

4.     Renal failure

5.     Bone marrow suppression

6.     N / V/ D

F.     Ribavirin

1.     Rash

2.     Conjunctivitis

3.     Anemia

G.    Zidovudine

1.     Bone marrow suppression

2.     Nausea

3.     Headache

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Transcript

Welcome back and today we are going to discuss antivirals.

Antiviral meds work by killing or suppressing viruses by inhibiting viral replication. They do this by blocking polymerase enzyme which creates new viral components.

Immunoglobulins are a subclass of antiviral medications and are made of concentrated antibodies that can attack and destroy viruses.  They may be nonspecific (e.g., human gammaglobulin) or specific (e.g., rabies immunoglobulin, varicella-zoster immunoglobulin) in their activity.

Antivirals types are plentiful but don’t get overwhelmed, focus on the endings… -CLOVIR, -AMIVIR and -DINE. Antivirals go on and go, memorizing the full generic names will cause madness, again focus on the endings only.

Indications for antivirals meds focus all forms locations of viral infections – systemic, throat, optic, STI, respiratory, GU, HIV/AIDS and hepatic. Again, they cover each and all body systems, don’t let the list overwhelm you. Focus on general concepts.

Contraindications focus in the word CAR and include CIDE-OFF-O-VIR (increases risk of renal failure), A-MAN-TA-DINE (causes teratogenic effects), RIB-A-VI-RIN (anemias can lead to heart attack).

Antiviral interactions include DAGA and include DI-DAN-O-SEEN, A-CY-CLO-VIR, GAN-CY-CLO-VER, A-MAN-TA-DINE. Again, big list of words, focus more in CRITICAL interactions such as neurotoxicity, ABX interactions and seizures risk increase. As a nurse, you focus on what can severely harm the patient or make drugs ineffective. Dianosine when given with itraconazole, ketoconazole or tetracyclines will decrease absorption sho should be given 2 hours apart. Acyclovir, when given with Zidovudine, will increase neurotoxicity risk. Ganciclovir, when given with Imipenem, will increase in seizures risks. And lastly, amantadine, when given with anticholinergic or CNS stimulants drugs, will increase their effects.

Alright, antiviral side effects are plentiful and extensive but I want you to focus on four systems, GI, CNS, hematologic and renal. Let’s review the possible side effects. Nausea, vomiting, diarrhea. pancreatitis. Headache, nervousness, seizures. Bone marrow suppression, anemia. Hypocalcemia, hypokalemia and renal failures.

Nursing concepts for antivirals include infection control and pharmacology.  

The key points for antivirals include types: CLOVIR, -AMIVIR and -DINE. Indications for antivirals meds focus all forms locations of viral infections – systemic, throat, optic, STI, respiratory, GU, HIV/AIDS and hepatic. Again, they cover each and all body systems, don’t let the list overwhelm you. Focus on general concepts. Contraindications focus in the word CAR and include CIDE-OFF-O-VIR (increases risk of renal failure), A-MAN-TA-DINE (causes teratogenic effects),, RIB-A-VI-RIN (anemias can lead to heart attack). Antiviral interactions include DAGA and include DI-DAN-O-SEEN, A-CY-CLO-VIR, GAN-CY-CLO-VER, A-MAN-TA-DINE. Again, big list of words, focus more in CRITICAL interactions such as neurotoxicity, ABX interactions and seizures risk increase. As a nurse, you focus on what can severely harm the patient or make drugs ineffective. Side effects cover many body systems and include GI, CNS, hematologic and renal systems.

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Exam 2

Concepts Covered:

  • Infectious Disease Disorders
  • Infectious Respiratory Disorder
  • Microbiology
  • EENT Disorders
  • Respiratory Disorders
  • EENT Disorders
  • Cardiovascular Disorders
  • Medication Administration
  • Noninfectious Respiratory Disorder
  • Sexually Transmitted Infections
  • Neurologic and Cognitive Disorders
  • Shock
  • Pregnancy Risks
  • Liver & Gallbladder Disorders
  • Integumentary Disorders
  • Upper GI Disorders
  • Urinary Disorders

Study Plan Lessons

Influenza – Flu
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Antiviral Agents for Treatment
Flu Symptoms Nursing Mnemonic (FACTS)
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Asthma
Anti-Infective – Antivirals
Pneumonia
Nursing Care and Pathophysiology for Influenza (Flu)
Respiratory Infections Module Intro
Nursing Care and Pathophysiology of Pneumonia
Nasal Disorders
Rheumatic Fever
Nursing Care Plan (NCP) for Rheumatic Fever
Guaifenesin (Mucinex) Nursing Considerations
Bronchodilators
Albuterol (Ventolin) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Salmeterol (Serevent) Nursing Considerations
Corticosteroids
Fluticasone (Flonase) Nursing Considerations
Anti-Infective – Tetracyclines
Alveoli & Atelectasis
Gentamicin (Garamycin) Nursing Considerations
Anti-Infective – Antitubercular
Anti-Infective – Glycopeptide
Acyclovir (Zovirax) Nursing Considerations
Rifampin (Rifadin) Nursing Considerations
Nystatin (Mycostatin) Nursing Considerations
Histamine 1 Receptor Blockers
Diphenhydramine (Benadryl) Nursing Considerations
Promethazine (Phenergan) Nursing Considerations
Histamine 2 Receptor Blockers
Famotidine (Pepcid) Nursing Considerations
Asthma for Certified Emergency Nursing (CEN)
Influenza for Certified Emergency Nursing (CEN)
Amoxicillin (Amoxil) Nursing Considerations
Mechanisms of Antimicrobial Agents
Anti-Infective – Antifungals
Isoniazid (Niazid) Nursing Considerations
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care Plan (NCP) for Tuberculosis
Anti-Infective – Penicillins and Cephalosporins
Parasympatholytics (Anticholinergics) Nursing Considerations
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Nursing Care Plan for Nasal Disorders