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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Concepts Covered:

  • Basics of NCLEX
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  • Studying
  • Fundamentals of Emergency Nursing
  • Developmental Considerations
  • Developmental Theories
  • Communication
  • Concepts of Mental Health
  • Health & Stress
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  • Emotions and Motivation
  • Pregnancy Risks
  • Cardiac Disorders
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  • Childhood Growth and Development
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  • Respiratory Disorders
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  • Lower GI Disorders
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  • Disorders of the Adrenal Gland
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  • Disorders of the Thyroid & Parathyroid Glands
  • Central Nervous System Disorders – Brain
  • Central Nervous System Disorders – Spinal Cord
  • Peripheral Nervous System Disorders
  • Immunological Disorders

Study Plan Lessons

Overview of the Nursing Process
Nursing Process – Assess
Nursing Process – Diagnose
Nursing Process – Plan
Nursing Process – Implement
Nursing Process – Evaluate
Critical Thinking
Thinking Like a Nurse
The Nurse Routine
Prioritization
Triage
Cultural Awareness and Influences on Development
Developmental Considerations for the Hospitalized Individual
Family Structure and Impact on Development
Kohlberg’s Theory of Moral Development
Erikson’s Theory of Psychosocial Development
Piaget’s Theory of Cognitive Development
Body Image Changes Throughout Development
Nurse-Patient Relationship
Therapeutic Communication
Defense Mechanisms
Self Concept
Patients with Communication Difficulties
Maslow’s Hierarchy of Needs in Nursing
Nutrition Assessments
Nutrition (Diet) in Disease
Specialty Diets (Nutrition)
Developmental Stages and Milestones
Cultural Awareness and Influences on Development
Environmental and Genetic Influences on Growth & Development
Growth & Development – Late Adulthood
Developmental Considerations for End of Life Care
Growth & Development -Transitioning to Adult Care
ABGs Nursing Normal Lab Values
ABG (Arterial Blood Gas) Interpretation-The Basics
ROME – ABG (Arterial Blood Gas) Interpretation
ABGs Tic-Tac-Toe interpretation Method
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic Alkalosis
ABG (Arterial Blood Gas) Oxygenation
Lactic Acid
Base Excess & Deficit
Fluid & Electrolytes Course Introduction
Fluid Compartments
Fluid Pressures
Fluid Shifts (Ascites) (Pleural Effusion)
Isotonic Solutions (IV solutions)
Hypotonic Solutions (IV solutions)
Hypertonic Solutions (IV solutions)
Potassium-K (Hyperkalemia, Hypokalemia)
Sodium-Na (Hypernatremia, Hyponatremia)
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Chloride-Cl (Hyperchloremia, Hypochloremia)
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Phosphorus-Phos
Calcium Acetate (PhosLo) Nursing Considerations
Epoetin (Epogen) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Epoetin Alfa
Acute Renal (Kidney) Module Intro
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care and Pathophysiology of Renal Calculi (Kidney Stones)
Chronic Renal (Kidney) Module Intro
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Dialysis & Other Renal Points
Peritoneal Dialysis (PD)
Hemodialysis (Renal Dialysis)
Continuous Renal Replacement Therapy (CRRT, dialysis)
Anesthetic Agents
Anesthetic Agents
Epidural
Patient Controlled Analgesia (PCA)
Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
Clindamycin (Cleocin) Nursing Considerations
Proton Pump Inhibitors
Atenolol (Tenormin) Nursing Considerations
Captopril (Capoten) Nursing Considerations
Amlodipine (Norvasc) Nursing Considerations
Azithromycin (Zithromax) Nursing Considerations
Cephalexin (Keflex) Nursing Considerations
Ampicillin (Omnipen) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Acyclovir (Zovirax) Nursing Considerations
Anti-Infective – Antivirals
Anti-Infective – Antifungals
Cefdinir (Omnicef) Nursing Considerations
Cefaclor (Ceclor) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Hematology Module Intro
Thrombocytopenia
Ferrous Sulfate (Iron) Nursing Considerations
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Iron Deficiency Anemia
Hemophilia
Hemoglobin (Hbg) Lab Values
Hematocrit (Hct) Lab Values
Platelets (PLT) Lab Values
Diabetes Mellitus (DM) Module Intro
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Diabetes Management
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hypoglycemia
Addisons Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Insulin Drips
Antidiabetic Agents
Thrombolytics
Iodine Nursing Considerations
Propylthiouracil (PTU) Nursing Considerations
Glucagon (GlucaGen) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care and Pathophysiology for Appendicitis
Hiatal Hernia
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
GERD (Gastroesophageal Reflux Disease)
Gastritis
Bariatric Surgeries
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Ulcerative Colitis(UC)
Nursing Care and Pathophysiology for Hemorrhoids
Nursing Care and Pathophysiology for Crohn’s Disease
Appendicitis
Pantoprazole (Protonix) Nursing Considerations
Omeprazole (Prilosec) Nursing Considerations
Pancrelipase (Pancreaze) Nursing Considerations
Ondansetron (Zofran) Nursing Considerations
Vasopressin
Proton Pump Inhibitors
Parasympatholytics (Anticholinergics) Nursing Considerations
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Parkinsons
Essential NCLEX Meds by Class