Pharm Ch 10 PREP

A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client?

Anemia and granulocytopenia

The most common adverse effects of Antiviral therapy for influenza

Anorexia Nausea

Antiviral vs Antiretroviral drugs

Antiviral: tx infections 1. acyclovir(zorvirax) supress HSVI+2, VZV-->Herpes 2. oseltamivir(tamiflu) against influenza a+b, tx must start w/in 2 days of symptoms--FLU Antiretroviral: tx HIV (check for HIV w/ELISA test) 1. HAART (need at least 3 for a 'cocktail') a)sanquinaovir(invirase) b)lipodystrophy syndrome *watch DM pt if using either -hyperglycemia and fat redistribution

There are many antiviral medications on the market. What is the clinical reason for this?

Each medication is only effective against a small number of specific viral infections.

A client's health care provider is considering the addition of efavirenz to the client's drug regimen for the treatment of recently diagnosed HIV. Which aspects of the client's medical history should prompt the nurse to question the use of this drug?

Efavirenz is used cautiously in clients with concomitant use of alcohol or psychoactive drugs because they increase the risk of CNS adverse effects. The drug should be used with caution in clients with a history of hepatitis B or C; they have an increased risk of hepatotoxicity.

A pregnant client's prenatal blood work has returned positive for HIV. What antiretroviral medication would be safest to give this client?

Only zidovudine has been proven to be safe to administer during pregnancy.

A nurse is preparing a presentation for a local community group after media reports about cases of avian influenza in the surrounding region. When explaining the treatment options for avian flu, the nurse should reference what drug?

Oseltamivir

Many of the residents of a long-term care facility have become sick with influenza this winter despite the fact that all residents were immunized earlier in the fall. A nurse who provides care in the facility should recognize the need to have which of the following drugs readily available at the facility?

Oseltamivir phosphate

Your patient is HIV positive and is involved in ART to decrease symptoms and increase lifespan and quality. The regimen currently involves a combination of antiretrovirals. The rationale to support this treatment regimen is: (Select all that apply.)

To increase drug efficacy. To decrease viral mutations.

Rimantadine is used to

Treat and prevent Influenza A

Rimantadine is more commonly associated with

light-headedness and dizziness.

Maraviroc is associated with

paresthesias and fever.

A nurse is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to

stay well hydrated by drinking at least eight 8-oz glasses of water daily.

A client with HIV is frustrated by the size and complexity of the current medication regimen. What should the nurse teach the client about combination therapy for the treatment of HIV?

Use of combination therapy attacks the virus at different stages of the life cycle.

Steps of viral replication

1. Virus adheres to host cell surface 2. Virus enters host cell by pinocytosis 3. Virus sheds its coat 4. Viral nucleic acids replicate 5. Synthesis of viral protein capsid 6. Assembly of new virions and Host cell dies releasing virus to move to other cells

A nurse is caring for a client who has been diagnosed with HIV. The client tells the nurse that he is considering supplementing his antiretroviral drug therapy with an herbal regimen that he read about recently. What should the nurse say in response?

"Some herbal supplements could interfere with your medication, so talk with your physician first."

The client is prescribed docosanol to treat a cold sore on the lip. The client tells the nurse, "I've read some bad things online about the side effects. Is it safe to use?" What is the nurse's best response?

"This is a topical medication that is not absorbed into the body so adverse effects are limited to burning, stinging, or discomfort at the site."

A nurse is teaching a client with herpes zoster to apply acyclovir ointment. What guidance should the nurse include in the instructions?

"Wear gloves when applying the ointment."

A 23-year-old client is prescribed zidovudine for treatment of human immunodeficiency virus (HIV). Which statement indicates that the client has understood the client teaching regarding the action of this medication?

"Zidovudine slows the progression of the disease but does not cure it."

A client comes to the health care facility reporting flulike symptoms. After a thorough assessment, the client is diagnosed with influenza and is to receive oseltamivir. The nurse understands that this drug has been prescribed because the client been symptomatic for less than:

2 days

A nurse is preparing to administer IV acyclovir to a client diagnosed with a herpes simplex viral infection. The health care provider has ordered 5 mg/kg every 8h. The client weighs 60 kg. How much medication will the nurse administer per dose?

300mg

What is the normal range for CD4+ cells in the human body?

800 to 1200 CD4+ cells/mm3

When focusing on the lifestyle of the patient with HIV, what are important teaching considerations? (Select all that apply.)

Advise the patient about the adverse effect of granulocytopenia. Take drug therapy as prescribed. Transmission can occur while on medication.

The nurse is to administer enfuvirtide (Fuzeon) to a 27-year-old man. After the medication has been reconstituted with sterile water, the nurse will:

After reconstituting enfuvirtide with sterile water, the solution should be allowed to sit until the powder dissolves completely, which may be as much as 45 minutes. The remaining dose should be refrigerated in a vial and not in a syringe.

A nurse is caring for a client diagnosed with HIV. The client wants to know when they will be started on medication for their disease. What would be the nurse's best response?

CD4 T-cell count less than 350 cells/mm3 or Infected pregnant or HIV-associated renal disease or Hep B & HIV

A client with a diagnosis of AIDS has been prescribed valganciclovir. The nurse should expect that this client has developed what AIDS-related complication?

CMV retinitis

Ribavirin is contraindicated in patients with

Cardiac disease

A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient?

Combination antiretroviral therapy

A nurse is caring for a client who is taking acyclovir. What is likely to be a priority nursing diagnoses for this client?

Common adverse effects of acyclovir and other antiviral drugs include anorexia, nausea, and vomiting, all of which can interfere with the ckient's nutritional intake.

Which microorganism is known to cause retinitis in people with HIV/AIDS?

Cytomegalovirus

A client for whom antiretroviral therapy has been prescribed informs the nurse that the client is taking oral contraceptives. What should the nurse inform the client is one of the effects of combining birth control pills with antiretroviral therapy?

Decreases effectiveness of birth control pills

A 38-year-old man is being treated for HIV-1 with nevirapine (Viramune). Signs of severe liver dysfunction have been noted the drug will be

Discontinued

The nurse is reviewing the medication instruction for the client taking acyclovir.

Does NOT cure but decreases symptoms and severity. Complete the entire treatment RASH or ITCH = Alergic reaction Lesions turn RED = Secondary bacterial infection.

A client is receiving nevirapine as part of a treatment for HIV infection. The nurse would instruct the client about which adverse effects as most commonly experienced?

Dry mouth and dyspepsia

Be very careful while administering rimantadine to patients who have a history of

Epilepsy

Locally active antiviral agents can be applied to open lesions.

FALSE

The nurse is caring for a client who has been on ritonavir. The nurse identifies an adverse reaction in relation to body fat. What does the nurse see when assessing this client?

Fat has moved to the center of the body and the client appears to have thinner arms and legs.

After reviewing information about the drugs used to treat herpes virus and CMV infections, a group of students demonstrate understanding about these drugs when they identify which of the following as being available only for intravenous administration?

Foscarnet

The nurse is caring for a client with AIDS who has developed cytomegalovirus (CMV). The nurse anticipates the health care provider will order which drug to treat this client?

Ganciclovir

A client is receiving ganciclovir for the long-term treatment and prevention of cytomegalovirus infection. What should the nurse do when administering this drug?

Give it IV over 60 minutes

A client with active AIDS is infected with a retrovirus. This virus is better known as which?

HIV

acyclovir is useful to treat which infection?

Herpes

Antiviral drugs have limited use because they are effective against only a small number of specific viral infections, including which of the following?

Human immunodeficiency virus (HIV) Herpes simplex virus (HSV) Cytomegalovirus (CMV)

A client is diagnosed with cytomegalovirus infection and is to receive foscarnet. The nurse would expect to administer this drug by which route?

I.V.

A school nurse is talking with a health class of freshman high school students about human immunodeficiency virus (HIV). What patient would the nurse tell the students is at the greatest risk of contracting HIV?

I.V. Durg user

Which of the following would be least likely to cause a drug interaction when rimantadine is prescribed?

Ibuprofen

A 58-year-old with HIV is starting treatment with Combivir. He currently has a CD4+ cell count of less than 200 cells/mL and a viral load greater than 45,000 copies/mL. The nurse treating the client knows that what is a sign of effective drug therapy?

Increased CD4+ (T helper) cell counts and decreased viral load.

When describing the action of an integrase inhibitor, the nurse understands that this class of drug acts by which mechanism?

Inhibiting the activity of a virus specific encoded enzyme needed for viral replication

A client with AIDS develops cytomegalovirus retinitis. The health care provider orders cidofovir. The nurse would prepare the client for administration of the drug by which route?

Intravenous

A female client is diagnosed with HIV and hepatitis C, and the health care provider orders antiviral therapy. The nurse would expect the provider to order monitoring of which laboratory value?

LFTs When antiviral agents are prescribed, all clients with hepatic impairment should be monitored closely for abnormal liver function tests (LFTs) and drug-related toxicity.

A client with HIV has had a CCR5 co-receptor antagonist added to the antiretroviral regimen. What assessment should the nurse prioritize?

Liver Functions. Severe hepatotoxicity has been reported with maraviroc.

Antivirals should be used cautiously in patients with

Low Blood Cell Counts

Which would be most important to stress with a client who is receiving adefovir for treatment of chronic hepatitis B?

Maintenance of a continuous adequate supply of drug, an acute exacerbation of hepatitis B when the drug is stopped.

The nurse is caring for a patient who has HIV and is taking saquinavir therapy. What should the nurse include in the dietary education for this patient?

NO grapefruit or pomegranate juice.

A client with a diagnosis of HIV has impaired renal function due to a concurrent diagnosis of diabetic nephropathy. What medication is most appropriate to treat this client's HIV?

Nelfinavir

Which was the first class of drugs developed to treat HIV infections?

Nucleoside reverse transcriptase inhibitors

A 3-month-old infant has been diagnosed with respiratory syncytial virus (RSV) and will begin treatment with inhaled ribavirin. Which of the following measures should be taken in the care of this patient and administration of ribavirin?

Nurses who are pregnant or who may be pregnant should not administer the drug.

A nurse is preparing to administer famciclovir to a client with a herpes virus infection. The nurse should expect to administer this drug by which route?

ORAL

In which of the following patients is the use of cidofovir contraindicated?

Patients with renal impairment

A HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. Which of the following symptoms should the nurse monitor for and immediately report to the care provider?

Peripheral neuropathy

ribavirin (Virazole) for inhalation is used to treat which virus?

RSV

A patient being treated for HIV with saquinavir informs the nurse they he has been "suffering from depression" and taking St. John's wort to help. What is important for the nurse to discuss with this patient?

Refraining from use of St. John's wort, which can cause decreased effectiveness of saquinavir

A 70-year-old man is being treated for herpes zoster virus. He has been prescribed acyclovir (Zovirax). The clinic nurse should prioritize assessments of which of the following?

Renal Function

A client is receiving zanamivir. When describing this drug, the nurse understands that it is absorbed through which mechanism?

Respiratory tract

The nurse is caring for a child with respiratory syncytial virus (RSV). Which drug should the nurse expect the pediatrician to order?

Ribavirin

The client with HIV is experiencing nausea and vomiting related to antiviral medications. The client has lost 20 pounds in the last 2 months since initiating the drug therapy regimen. What is the highest priority nursing diagnosis for this client?

Risk for imbalanced nutrtion

A client is being treated with saquinavir for AIDS. The client history includes a BMI of 37.98%, hyperlipidemia, and sleep apnea. Based on the client history, why would caution be used when the client is started on saquinavir?

Saquinavir drug therapy should be used cautiously in clients with elevated triglyceride or cholesterol levels because fat redistribution and hyperlipidemia are among the adverse effects associated with the use of PIs. Because the drug is largely metabolized by the liver, saquinavir should be used with caution in clients with preexisting hepatic dysfunction, not with elevated cholesterol levels. Dosage change may be required in patients with diabetes. Association with cardiovascular events is not the reason for the caution.

What laboratory studies would be important for the nurse to especially monitor to check for lactic acidosis in the pregnant client on zidovudine therapy, especially during the last trimester?

Serum electrolytes and liver function tests

An elderly female client is admitted to the medical floor with pustules on her body that travel along the nerve route in her legs and arms. The health care provider prescribes the drug acyclovir (Zovirax). What disease is this client demonstrating?

Shingles

A male patient has been prescribed efavirenz as monotherapy for HIV. On follow-up visits to the clinic, it will be most important for the nurse to assess for which of the following?

Signs of microbial resistance. Resistant virus emerges rapidly when efavirenz is administered as monotherapy or in combination with other NNRTIs

What would the nurse recognize as the primary goal(s)of highly active antiretroviral therapy (HAART)? Select all that apply.

Suppress virema. Preserve CD4 counts. Delay drug-resistant mutations.

Children younger than the age of 12 years should not receive indinavir.

TRUE

An HIV-positive patient is being treated for hypothyroidism with levothyroxine. The patient is also taking saquinavir therapy for HIV. Which clinical manifestations by the patient should the nurse be concerned about?

Tachycardia, intolerance to heat, weight loss. Sanqui INHIBITS Levo

The nurse is caring for a 3-year-old with HIV. The nurse knows that, when administering antiviral drug therapy in young children with HIV, dosage calculations are typically based on:

The clients weight

The nurse is providing health education to a client who has recently been diagnosed with HIV and will soon begin antiretroviral therapy. What teaching point should the nurse prioritize?

The need to adhere rigidly to the prescribed drug schedule

An HIV-positive patient is taking etavirenz and tells the nurse that she now has fat on the upper back and neck but is losing fat in the extremities and face. What does the nurse determine is causing this patient's symptoms?

The patient has lipodystrophy from the etavirenz.

A nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which would the nurse include as the primary reason?

The use of multiple drugs allows attack on the virus at different points in its life cycle.

A client is administered a nucleotide reverse transcriptase inhibitor in combination with a nonnucleotide reverse transcriptase inhibitor. What is the rationale when administering these medications together?

They have synergistic antiviral effects.

Zanamivir is approved for treatment and prevention of

Uncomplicated influenza. Adults and Children 7yr (+). Symptomatic for less than 2 days.

Oseltamivir is used for the treatment and prevention of

Uncomplicated influenza. Symptomatic for less than 2 days.

The health care provider prescribes zanamivir to a client. When developing the teaching plan, the nurse should include what important instructions?

Using the special inhaler included with the drug to administer it.

To prevent viral infections, what precaution should the general public take?

Vaccinations

The nursing student asks the instructor why it is more difficult to develop antiviral drugs than anti-infectives. The nursing instructor's best reply would be which?

Viruses are tiny and replicate inside cells.

A patient is being tested for HIV using the EIA (enzyme immunoassay). The EIA shows antibodies. The nurse expects the physician to order what test to confirm the EIA test results?

Western blot test

A female HIV-positive patient with a high CD4 count has been taking nevirapin (Viramune) for 9 weeks. What clinical manifestations indicate to the nurse that the patient is having complications from this medication?

Yellow sclera and hepatomegaly Severe, life-threatening and in some cases fatal hepatotoxicity, particularly in the first 18 weeks, has been reported in patients treated with nevirapine. In some cases, patients presented with nonspecific prodromal signs or symptoms of hepatitis and progressed to hepatitis. Female gender and patients with higher CD4 counts at initiation of therapy are increased risk factors for this complication.

It will be most important for the nurse to monitor nevirapine therapy for a male patient during the first few months of therapy in order to:

assess for potentially life-threatening hepatotoxicity or skin reactions.

Tenofovir and fosamprenavir are associated with

body fat distribution, leading to buffalo hump and thin arms and legs

What are the hypersensitivity reactions to Abacavir? (Appear within 6 weeks)

diarrhea, abdominal pain, sore throat, cough, and shortness of breath. Discontinue the therapy.

A 50-year-old HIV-positive client is being treated for cytomegalovirus (CMV) with intravenous acyclovir. The nurse should recognize the possibility of a serious adverse drug effect directly associated with this medication if the client reports:

hallucinations

A nurse is caring for a patient, who has been prescribed the antiviral drug amantadine. Which of the following adverse reactions specific to amantadine should the nurse monitor for?

hypotension and insomnia

What should the nurse's assessment of the client prior to administration of antiviral drugs include?

vital signs resistance to infection client's general state of health