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29.09 Anti-Infective – Antivirals

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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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Video 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.

Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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