Anti-viral agents

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Anti-viral agents

  1. 1. Antiviral AgentsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  2. 2. Understanding Viruses Viral Replication • A virus cannot replicate on its own. • It must attach to and enter a host cell. • It then uses the host cell’s energy to synthesize protein, DNA, and RNA.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  3. 3. Understanding Viruses Viruses are difficult to kill because they live inside our cells. • Any drug that kills a virus may also kill our cells.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  4. 4. Viral Infections Competent immune system: • Best response to viral infections • A well-functioning immune system will eliminate or effectively destroy virus replication Immunocompromised patients have frequent viral infections • Cancer patients, especially leukemia or lymphoma • Transplant patients, due to pharmacological therapy • AIDS patients, disease attacks immune systemCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  5. 5. Antivirals Key characteristics of antiviral drugs: • Able to enter the cells infected with virus. • Interfere with viral nucleic acid synthesis and/or regulation. • Some agents interfere with ability of virus to bind to cells. • Some agents stimulate the body’s immune system.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  6. 6. Antivirals Viruses killed by current antiviral therapy: • cytomegalovirus (CMV) • herpes simplex virus (HSV) • human immunodeficiency virus (HIV) • influenza A (the “flu”) • respiratory syncytial virus (RSV)Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  7. 7. Antivirals: Mechanism of Action Inhibit viral replication • Inhibit viral attachment • Prevent genetic copying of virus • Prevent viral protein productionCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  8. 8. Antivirals Synthetic Purine Nucleoside Analogues Two types of nucleosides: Purine nucleosides • guanine • adenosine Pyrimidine nucleosides • thymine • cytosineCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  9. 9. Antivirals: Purine Nucleosides Agent Antiviral Activity guanines acyclovir HSV 1 & 2, VZV ganciclovir (DHPG) CMV retinitis and systemic CMV infection ribavirin (RTCD) Influenza types A and B, RSV, LV, HV adenosines didanosine (ddl) HIV vidarabine (Ara-A) HSV, herpes zosterCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  10. 10. Antivirals: Pyrimidine Nucleosides Agent Antiviral Activity cytosines lamivudine (3TC) HIV zalcitabine (ddC) HIV thymine idoxuridine (IDU) HSV stavudine (d4T) HIV trifluridine HSV zidovudine (AZT) HIVCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  11. 11. Other Antivirals amantadine (Symmetrel) and rimantadine (Flumadine) • influenza A foscarnet (Foscavir) • CMV (retinitis and systemic) Neuraminidase Inhibitors: oseltamivir (Tamiflu) and zanamivir (Relenza) • influenza types A and BCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  12. 12. Antivirals: Side Effects acyclovir • Burning when topically applied, nausea, vomiting, diarrhea, headache amantadine and rimantadine • Anticholinergic effects, insomnia, lightheadedness, anorexia, nausea didanosine (ddl) • Pancreatitis, peripheral neuropathies, seizuresCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  13. 13. Antivirals: Side Effects zidovudine (AZT) • Bone marrow suppression, nausea, headache foscarnet (Foscavir) • Headache, seizures, acute renal failure, nausea, vomiting, diarrhea ganciclovir (Cytovene) • Bone marrow toxicity, nausea, anorexia, vomitingCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  14. 14. Antivirals: Nursing Implications • Before beginning therapy, thoroughly assess underlying disease and medical history, including allergies. • Assess baseline VS and nutritional status. • Assess for contraindications, conditions that may indicate cautious use, and potential drug interactions.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  15. 15. Antivirals: Nursing Implications • Be sure to teach proper application technique for ointments, aerosol powders, etc. • Emphasize hand washing before and after administration of medications to prevent site contamination and spread of infection. • Patients should wear a glove or finger cot when applying ointments or solutions to affected areas.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  16. 16. Antivirals: Nursing Implications • Instruct patients to consult their physician before taking any other medication, including OTC medications. • Emphasize the importance of good hygiene. • Inform patients that antiviral agents are not cures, but do help to manage symptoms.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  17. 17. Antivirals: Nursing Implications • Instruct patients on the importance of taking these medications exactly as prescribed and for the full course of treatment. • With zidovudine: • Inform patients that hair loss MAY occur so that they are prepared for this rare adverse reaction. • This medication should be taken on an empty stomach.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  18. 18. Antivirals: Nursing Implications Monitor for side effects: • effects are varied and specific to each agentCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  19. 19. Antivirals: Nursing Implications Monitor for therapeutic effects: • effects will vary depending on the type of viral infection • Effects range from delayed progression of AIDS and ARC to decrease in flu-like symptoms, decreased frequency of herpes-like flare-ups, or crusting over of herpetic lesions.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

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