What are the two types of herpes infections and their signs/symptoms?

1. Herpes Simple Virus (HSV) - fever, blisters, cold sores, genital herpes
2. Cytomegalovirus (CMV retinitus) - affects retina of the eye, so blurry vision and decreased visual acuity

What is the topical drug used for herpes simple virus?

acyclovir

What does acyclovir do?

it interrupts viral DNA synthesis

What do we use acyclovir for?

to treat herpes simple virus and genital herpes (decreases duration, pain, and viral shedding (ability to spread))

How would you, as a nurse, apply acyclovir to a patient?

topically with gloved hands and any other PPE

There is also an IV form of acyclovir. What is it called?

Encaphylopathy

What is a drug used to treat Cytomegalovirus?

ganciclovir

How does ganciclovir work?

it inhibits viral DNA synthesis

What are some nursing considerations for ganciclovir?

it can cause renal impairment

Ganciclovir has 2 BBWs. What are they?

1. granulocytopenia (neutropenia), thrombocytopenia
2. maintain contraceptive precautions during and 90 days after use.

What is the oral version of ganciclovir?

valganciclovir (Valcyte)

What would you tell a patient who is just starting valganciclovir?

take with a high fat meal to increase absorption

What is respiratory syncytial virus (RSV)?

respiratory illness that's more severe in babies

What is a symptom of RSV?

cyanosis

What drug would you give to treat RSV?

ribavirin

What does ribavirin do?

interferes with DNA/RNA replication

Who would you use ribavirin for?

in children experiencing RSV

How would you give ribavirin?

via inhalation (monitor for nasal flaring (indicator of respiratory distress))

Ribavirin has a BBW. What is it?

teratogenic

What are some signs and symptoms of influenza (the flu)?

muscle aches, pains, fatigue, fever, nausea, vomiting, diarrhea, headache, shivering, can be deadly

What drug is used to treat influenza?

oseltamivir phosphate

How oseltamivir phosphate work?

doesn't allow for new viruses to escape cell

Who would you use oseltamivir phosphate for?

patients above 1 years old who have influenza

What are some nursing considerations for oseltamivir phsophate?

you can take it prophylactally (for prevention) and has similar symptoms to the flu, so take with food to lower GI upset

Describe how you can get hepatitis A, B, and C and if untreated, what it could cause.

• A - fecal-oral route, close contact with infected person.
• B - contaminated bodily fluids (esp. blood)
• C - same as B

can lead to cirrhosis, liver cancer, liver failure, and death. Hepatitis A and B have a vaccine.

What drug would you give for hepatitis?

Lamivudine

How does Lamivudine work?

it incorporates itself into viral DNA and terminates it

Who would you use Lamivudine for?

patients with chronic hepatitis B and HIV

What are some nursing considerations of Lamivudine?

It can cause pancreatitis (severe upper abdominal pain)

There is a BBW for Lamivudine. What is it?

it can cause lactic acidosis (musculoskeletal pain) and hepatomegaly with steatosis (fatty liver)

What is HIV known as?

a retrovirus (RNA -> DNA) that binds to and destroys CD4 cells (T lymphocytes) that normally help to regulate immune function and can progress to AIDS if left untreated

Describe the steps of HIV to AIDS.

1. virus integrates itself on receptors on host cell membrane
2. Virus uncoats itself an releases RNA into the cell
3. Reverse transcriptase converts virus's RNA to DNA (necessary for viral replication)
4. DNA codes for protein synthesis and produces immature viral particles
5. Enzyme protease assembles immature viral particles into mature virus
6. Mature viruses are released from the host cell

What are the HIV clinical manifestations?

1. Initial phase - flu like symptoms that last weeks
2. Immune response - decreases in viral reproduction. Pt is asymptomatic but infectious
3. Immune system damaged - increased viral reproduction
4. Illness progresses to AIDS - once viral load reaches high level. Serious opportunistic infections occur.

What is the goal of HIV treatment?

to limit viral load and prevent progression to AIDs and transmission to others.

What is PrEP (Truvada)?

daily pill patients who do NOT have HIV but are at high risk for it take to prevent HIV. Pt must take it consistently or the effects will decrease. It only protects against HIV NOT STDs/STIs.

What drugs would you use to treat HIV?

nucleoside reverse transcriptase inhibitors (NRTI) and nonnucleoside reverse transcriptase inhibitors (NNRTI)

What is the prototype drug for nucleoside reverse transcriptase inhibitors (NRTI)?

Zidovudine

How does zidovudine work?

it incorporates itself into viral DNA and terminates it (prevents step 3-4)

Who would you give zidovudine to?

pregnant mothers with HIV to prevent HIV transmission to fetus

Zidovudine has a BBW. What is it?

granulocytopenia, pancytopenia, lactic acidosis, hepatomegaly

What is the prototype drug for non nucleoside reverse transcriptase inhibitors (NNRTIs)?

efavirenz

How do efavirenz work?

incorporates into viral DNA and terminates it (prevents 3-4). has synergy with zidovudine (nucleoside reverse transcriptase inhibitors).

What is efavirenz used to treat?

HIV

What are some nursing considerations with efavirenz?

don't give to patients with hepatic impairment, has a potential for Steven Johnson Syndrome, and has a CNS effect (so take it at night)