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 4

Concepts Covered:

  • Hematologic Disorders
  • Hematologic Disorders
  • Labor Complications
  • Respiratory Disorders
  • Proteins
  • Oncologic Disorders
  • Oncology Disorders
  • Cardiac Disorders
  • Medication Administration
  • Immunological Disorders
  • Renal Disorders
  • Eating Disorders
  • Liver & Gallbladder Disorders
  • Substance Abuse Disorders
  • Intraoperative Nursing
  • Infectious Respiratory Disorder
  • Pregnancy Risks
  • Upper GI Disorders
  • Microbiology
  • Shock
  • Postpartum Complications
  • Studying
  • Shock
  • Disorders of the Posterior Pituitary Gland
  • Emergency Care of the Trauma Patient
  • Integumentary Disorders
  • Central Nervous System Disorders – Brain
  • Neurological Trauma
  • Respiratory Emergencies
  • Emergency Care of the Cardiac Patient
  • Acute & Chronic Renal Disorders
  • Endocrine and Metabolic Disorders
  • Urinary System
  • Urinary Disorders

Study Plan Lessons

Sickle Cell Anemia
Nursing Care and Pathophysiology for Sickle Cell Anemia
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Blood Transfusions (Administration)
Anti-Infective – Antivirals
Blood Transfusions (Administration)
Hemoglobin (Hbg) Lab Values
Hemoglobin (Hbg) Lab Values
Hemoglobin and Myoglobin
Red Blood Cell (RBC) Lab Values
Red Blood Cell (RBC) Lab Values
Nursing Care Plan (NCP) for Sickle Cell Anemia
Sickle Cell Anemia
Nursing Care Plan (NCP) for Sickle Cell Anemia
Leukemia Case Study (60 min)
Nursing Care Plan (NCP) for Leukemia
Leukemia
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Nursing Care Plan (NCP) for Leukemia
Leukemia
Leukemia
Antimetabolites
Alkylating Agents
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Neutropenia
Hematocrit (Hct) Lab Values
Platelets (PLT) Lab Values
Chemotherapy Patients
Anti-Platelet Aggregate
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Thrombocytopenia
Platelets (PLT) Lab Values
Hematocrit (Hct) Lab Values
Oncology Module Intro
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Lymphoma
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Lymphoma
Anti Tumor Antibiotics
Brain Tumors
Head/Neck Assessment
Corticosteroids
Pediatric Oncology Basics
Head/Neck Assessment
Corticosteroids
Multiple Myeloma
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan (NCP) for Acute Kidney Injury
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
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 Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Liver Cancer
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Cirrhosis (Liver)
Nutrition (Diet) in Disease
Liver Function Tests
Liver/Gallbladder Module Intro
Cirrhosis Case Study (45 min)
Barbiturates
Anti-Infective – Antitubercular
Benzodiazepines
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Creatinine (Cr) Lab Values
Coagulation Studies (PT, PTT, INR)
Albumin Lab Values
Furosemide (Lasix) Nursing Considerations
Anti-Infective – Antitubercular
Barbiturates
Enteral & Parenteral Nutrition (Diet, TPN)
Cholesterol (Chol) Lab Values
Atorvastatin (Lipitor) Nursing Considerations
Creatinine (Cr) Lab Values
Total Bilirubin (T. Billi) Lab Values
Cholesterol (Chol) Lab Values
Albumin Lab Values
Benzodiazepines
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Antimicrobial Vaccinations
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Fluid Volume Overload
Nursing Care Plan (NCP) for Hypovolemic Shock
Septic Shock (Sepsis) Case Study (45 min)
Nursing Care Plan (NCP) for Cardiogenic Shock
Hypovolemic Shock Case Study (OB sim) (60 min)
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Cardiogenic Shock
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Cardiogenic Shock
Shock
Shock Module Intro
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Distributive Shock
Sepsis Concept Map
Sepsis Concept Map
Nursing Care Plan (NCP) for Diabetes Insipidus
Massive Transfusion Protocol
Disseminated Intravascular Coagulation Case Study (60 min)
Burn Injury Case Study (60 min)
Spinal Cord Injury Case Study (60 min)
Cerebral Perfusion Pressure Case Study (60 min)
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Metabolic Acidosis (interpretation and nursing diagnosis)
Burn Injuries
Disseminated Intravascular Coagulation (DIC)
Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Fluid Volume Deficit
Nursing Care and Pathophysiology for Sepsis
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
ARDS causes Nursing Mnemonic (GUT PASS)
Nursing Care Plan (NCP) for Spinal Cord Injury
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Nursing Care Plan (NCP) for Sepsis
Nursing Care Plan (NCP) for Renal Calculi
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Penetrating Thoracic Trauma
Renin Angiotensin Aldosterone System (RAAS)
Burn Injuries
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Dialysis & Other Renal Points
Blunt Chest Trauma
Spinal Cord Injury