APA format 1.5 pages MSN degree 2 references from Walden university library Due Thursday March 15, 2018 at 7pm EST Immune Disorders Two immune deficiency disorders will be discussed in the following text, human immunodeficiency virus (HIV) and psoriasis. Pathophysiology, drug therapy, and adverse effects will be discussed. Furthermore, variations in each disease process will also be presented. The purpose of this discussion post is to further understand the disease process of HIV and psoriasis.   HIV Human immunodeficiency virus is a viral infection that targets the CD4-positive Th cells, which are needed for the development of plasma cells and T cells. The result of this cell depletion results in a negative immune response. With the immune system suppression, the development of acquired immunodeficiency syndrome (AIDS) is possible (Huether & McCance, 2017), p. 194).  Drug Therapy After HIV is diagnosed, the goal of action is to control the virus and prevent the progression to AIDS. Drug therapy is designed to do five things for the patient: suppress the viral load, restore the immune system function, maintain quality of life, prevent HIV related complications, and prevent HIV transmission (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 846).  Medication regimens have been designed and it is important to note the each patient responds differently. The different classes of drug regimens include: nucleoside reverse transcriptase inhibitors (NRTI), nonnucleaoside reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), fusion inhibitors, integrase trans transfer inhibitors (INSTI), and CCR5 Antagonists.  When using NRTI drugs such as, Ziagen, Videx, Emtriva, Epivir, Zerit, and Retrovir, it is important to know that they prevent the transcription of RNA into DNA (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 849). When working with NNRTIs drug such as, Rescriptor, Sustiva, Intelence, Viramune, and Edurant, the drug binds to the reverse transcriptase and prevents the conversion of RNA into DNA Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 851). Protease inhibitors target the cell replication in the later stages. They prevent the development of the polyproteins, which are needed to create new HIV RNA copies. Examples of PIs are Reyataz, Prezista, Lexiva, Crixivan, Kaletra, Viracept, Norvir, Invirase, and Aptivus (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 852). Fusion inhibitors prevents HIV from entering the cells by blocking the fusion process of the virus to the membrane of the CD4 T cells. Fuzeon is the only available drug from this particular class (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 853). The INSTIs available for use are Trivicy, Vitekta, and Isentress. These drugs prevent the HIVs DNA  from entering the genome of the host cell. They are often used in conjunction with NRTI drugs (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 853). The final drug class is the CCR5 Antagonists and ...

1. APA format 1.5 pages MSN degree 2 references from Walden
university library
Due Thursday March 15, 2018 at 7pm EST
Immune Disorders
Two immune deficiency disorders will be discussed in the
following text, human immunodeficiency virus (HIV) and
psoriasis. Pathophysiology, drug therapy, and adverse effects
will be discussed. Furthermore, variations in each disease
process will also be presented. The purpose of this discussion
post is to further understand the disease process of HIV and
psoriasis.
HIV
Human immunodeficiency virus is a viral infection that targets
the CD4-positive Th cells, which are needed for the
development of plasma cells and T cells. The result of this cell
depletion results in a negative immune response. With the
immune system suppression, the development of acquired
immunodeficiency syndrome (AIDS) is possible (Huether &
McCance, 2017), p. 194).
Drug Therapy
After HIV is diagnosed, the goal of action is to control the virus
and prevent the progression to AIDS. Drug therapy is designed
to do five things for the patient: suppress the viral load, restore
the immune system function, maintain quality of life, prevent
HIV related complications, and prevent HIV transmission
(Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 846).

2. Medication regimens have been designed and it is important to
note the each patient responds differently. The different classes
of drug regimens include: nucleoside reverse transcriptase
inhibitors (NRTI), nonnucleaoside reverse transcriptase
inhibitors (NNRTI), protease inhibitors (PI), fusion inhibitors,
integrase trans transfer inhibitors (INSTI), and CCR5
Antagonists.
When using NRTI drugs such as, Ziagen, Videx, Emtriva,
Epivir, Zerit, and Retrovir, it is important to know that they
prevent the transcription of RNA into DNA (Arcangelo,
Peterson, Wilbur, & Reinhold, 2017, p. 849).
When working with NNRTIs drug such as, Rescriptor, Sustiva,
Intelence, Viramune, and Edurant, the drug binds to the reverse
transcriptase and prevents the conversion of RNA into DNA
Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 851).
Protease inhibitors target the cell replication in the later stages.
They prevent the development of the polyproteins, which are
needed to create new HIV RNA copies. Examples of PIs are
Reyataz, Prezista, Lexiva, Crixivan, Kaletra, Viracept, Norvir,
Invirase, and Aptivus (Arcangelo, Peterson, Wilbur, &
Reinhold, 2017, p. 852).
Fusion inhibitors prevents HIV from entering the cells by
blocking the fusion process of the virus to the membrane of the
CD4 T cells. Fuzeon is the only available drug from this
particular class (Arcangelo, Peterson, Wilbur, & Reinhold,
2017, p. 853).
The INSTIs available for use are Trivicy, Vitekta, and Isentress.
These drugs prevent the HIVs DNA from entering the genome
of the host cell. They are often used in conjunction with NRTI
drugs (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 853).

3. The final drug class is the CCR5 Antagonists and Selsentry is
the only medication amiable. This medication works on the
membrane of CD4 T cells and prevents HIV from entering the
cells by blocking the CCR5 receptors (Arcangelo, Peterson,
Wilbur, & Reinhold, 2017, p. 854).
Each medication regimen is carefully selected for the patient.
Each patient will have a different response. It is also important
to note, the HIV is not curable, as no medication has been
proven to eliminate the virus.
Pediatrics
Unfortunately, HIV in children is something that needs
discussion. It can be detected and diagnosed in infancy. When
infants contract HIV it it typically from their mother during
birth. Treatment with drug therapy varies as children grow.
Interactions may occur with food and other medications.
Compliance and frequent follow ups are needed as these
children are treated. Providing each child with a life full of
quality and low adverse effects is essential (Arcangelo,
Peterson, Wilbur, & Reinhold, 2017, p. 855).
Adverse Effects
Adverse effects depend vary depending on the patient’s
medication regimen. For example, when patients are taking a
NRTI they need to conscious of the development of
gastrointestinal (GI) symptoms such as nausea, vomiting, and
abdominal pain. These symptoms could be indicative of lactic
acidosis with hepatic sweatosis. This rare side effect could lead
to possible death. When taking NNRTIs, patients could also
experience GI symptoms in addition to dizziness, difficulty
concentrating, hallucinations, and odd dreaming. Liver function

4. impairment is also a risk when taking NNRTIs. Gastrointestinal
symptoms, as well as liver transmitases, are side effects related
to PIs. Fusion inhibitors are administered via subcutaneous
injections; therefore, a common side effect is irritation at the
injection site. Rash and fever are another possibility. Adverse
effects of INSTIs vary from headache, diarrhea, reduced renal
function, and hypersensitivity. CCR5 antagonists can case
hepatotoxicity, which can lead to a systematic allergic reaction.
Because of this side effect, CCR5 antagonists are not
recommended as a front line management of HIV (Arcangelo,
Peterson, Wilbur, & Reinhold, 2017, p. 849-854).
Psoriasis
Psoriasis is the inflammatory process of the skin, scalp, or
nails, in which their cell replication is faster than normal. For
example, the epidermis usually sheds in a 14-20 time frame.
With psoriasis, the epidermis sheds in 3-4 days. During this
inflammatory process, the is a conflicting interaction between
macrophages, fibroblasts, dendritic cells, natural killer cells, T
helper cells, and regulatory T cells. This interaction leads to the
production of inflammatory mediators. In addition, the
epidermis and dermis become thicker than normal because of
their cellular hyperproliferation, the alteration in kerotinocyte,
and the expanded dermal vasculature. Skin cells no longer
mature and keratinze, but instead thicken and plaque formation
begins. Because cell metabolism is increased, their is an
increase in blood flow to the skin. This causes redness and
inflammation. The inflammatory process waxes and wanes
depending on triggering factors (Huether & McCance, 2017, p.
1062).
When you hear psoriasis, one typically thinks of skin. It is also
important for health care providers to be educated in psoriatic
arthritis. Typically, it presents itself later in ones life, but it is
possible that children can could experience it as well. Signs and

5. symptoms include joint pain or stiffness (Van Onselen, 2013).
Drug Therapy
When treating psoriasis, medications are aimed at treating the
inflammatory mediators. Treatment is aimed at restoring skin
moisture, reducing cells turnover, and controlling pruritus.
Each patient’s treatment is different and depends on the degree
of severeness. In mild cases, topical corticosteroids,
moisturizing creams, Vitamin D analogs, and keratolytic agents
are utilized. Narrow-band ultraviolet light therapy is also used.
In severe cases, a more systemic treatment approach is needed.
Approved medications included methotrexate, acitretin, and
cyclopsporine. New therapies are being developed as the
pathophysiology of psoriasis is further learned. Such treatment
includes biologics. The safety and efficiency of this drug group
is still under investigation (Huether & McCance, 2017, p. 1062-
1063).
Pediatrics
The pathophysiological process of developing psoriasis is the
same for children as for adults. It is more often seen in adults
over children. There is some genetic linking to psoriasis, but
exact details are still unknown. Typically, environmental and
systemic triggers will still begin the initial presentation.
Triggers include infection, skin trauma, medications, hormonal
changes, smoking, or alcohol (Vam Onselen, 2013).
When treating children with psoriasis, emollients are commonly
used to help with skin dryness. Emollients also have an anti-
inflammatory property that make them a first line treatment for
children. Other options to treat are topical corticosteroids,
Vitamin D analogues, ditheranol, tar, topical calcineurin
inhibitors, and photosynthesis treatment. Thorough education is

6. necessary for both the child and parents when treating psoriasis.
Allowing the child to demonstrate putting on his or her own
cream may be a beneficial activity. Psychological support may
be necessary while the child is being treated (Van Onselen,
2013).
Reducing Side Effects
Side effects can be managed and reduced by seeking medical
advice as soon as symptoms begin. By completing thorough
education, encouraging follow-up, and avoiding triggering
agents side effects can also be limited. Patients often have
preconceived ideas that nothing can help them. It is important to
recommend dermatology consultation when needed and to
encourage each patient to be open to different therapies.
Treatments do not work the same for each patient. Furthermore,
patients need to be taught how to be compliant with their
treatment (Renton, 2018).
Comparing HIV and Psoriasis
Immune disorders can be frustrating for patients. For HIV, the
patient may have inner guilt or feelings of embarrassment
depending on how they got HIV. Outsiders looking in may
never know they have HIV, but the patient will feel like
everyone knows and everyone is talking about them.
Furthermore, patients with psoriasis may also feel embarrassed,
but more because of the physical evidence. It may be difficult
for these individuals to wear shorts or go swimming without
feeling self conscious. It is important to show patients respect
and to give support as they are facing maladaptive and
physiological responses. By giving these patients a positive
outlook, positive outcomes are more likely to follow.
References

7. Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J.
A. (Eds.).
(2017).
Pharmacotherapeutics
for advanced practice: A practical approach
(4th ed.).
Ambler, PA: Lippincott Williams & Wilkins.
Huether, S. E., & McCance, K. L. (2017).
Understanding
pathophysiology
(6th ed.). St. Louis,
MO: Mosby.
Renton, C. (2018). Late-onset psoriasis: Diagnosis, assessment
and management.
British
Journal Of Community Nursing
,
23
(2), 58-63.
Van Onselen, J. (2013). Managing psoriasis in children and
young people.
Nurse Prescribing
,
11
(7), 330-336.