Virgen Milagrosa University Foundation: COLLEGE of Nursing

Virgen Milagrosa University Foundation
Martin P. Posadas Avenue, San Carlos City, Pangasinan, 2420, Philippines

COLLEGE Of nursing
ANTIVIRAL
I. Anatomy and Structure of Viruses
Virus
 A virus is a small parasite that cannot reproduce by itself. Once it infects a
susceptible cell, however, a virus can direct the cell machinery to produce more
viruses.
 Viruses are unique in that they have been classified as both living and nonliving at
various points in the history of biology. Viruses are not cells but non-living, infectious
particles.
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 A virus particle, also known as a virion, is essentially nucleic acid (DNA or RNA)

enclosed within a protein shell or coat. Viruses are extremely small, approximately 20 -
400 nanometers in diameter.
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 The largest virus, known as the Mimivirus, can measure up to 500 nanometers in
diameter.
VIRAL GENETIC MATERIAL

 Viruses may have double-stranded DNA, double-stranded RNA, single-stranded DNA or
single-stranded RNA.
 The genetic material is not typically exposed but covered by a protein coat known as a
capsid.
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VIRAL CAPSID
 The protein coat that encases viral genetic material is known as a capsid. A capsid is
composed of protein subunits called capsomeres.
 Capsids can have several shapes: polyhedral, rod or complex. Capsids function to
protect the viral genetic material from damage.

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VIRUS REPLICATION
 Viruses are not capable of replicating their genes by themselves. They must rely on a
host cell for reproduction. In order for viral replication to occur, the virus must first
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infect a host cell. The virus injects its genetic material into the cell and uses the cell's
organelles to replicate. Once a sufficient number of viruses have been replicated, the
newly formed viruses lyse or break open the host cell and move on to infect other cells.
This type of viral replication is known as the lytic cycle.
VIRAL DISEASES
 Viruses cause a number of diseases in the organisms they infect. Human infections and
diseases caused by viruses include Ebola fever, chicken pox, measles, influenza,
HIV/AIDS, and herpes. Vaccines have been effective at preventing some types of viral
infections, such as small pox, in humans. They work by helping the body to build an
immune system response against specific viruses.
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 Viral diseases that impact animals include rabies, foot-and-mouth disease, bird flu, and
swine flu. Plant diseases include mosaic disease, ring spot, leaf curl, and leaf roll
diseases. Viruses known as bacteriophages cause disease in bacteria and archaeans.
II. ANTIVIRAL AGENTS
ACYCLOVIR
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 Used predominantly in the treatment of herpes simplex,herpes zoster(shingles),

and varicella zoster(chicken pox) infections,
 Acyclovir does not cure or prevent further occurrence of lesions.
 Acyclovir decreases the severity and length of these outbreaks.
 It helps the sores heal faster, keeps new sores from forming, and decreases
pain/itching.
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HERPES VIRUSES
HERPES ZOSTER(SHINGLES)
best treated within 24 -72 h of onset of rash(blister or intense pain on the skin of one side of
the trunk or head.
Delayed treatment with an antiviral medication can lead to complications , such as intense pain
and postherpetic neuralgia(PHN)
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Herpes Simplex
 Herpes simplex virus (HSV) can be spread by infected individuals who are
asymptomatic or symptomatic during times of viral shedding.
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 HSV-1, which is more commonly associated with oral herpes, is primarily spread by
contact with infected saliva or other secretions.
 HSV-2, which is more commonly associated with genital herpes, is primarily spread
by sexual contact.
Varicella Zoster
 Varicella zoster virus (VZV) is an exclusively human virus that belongs to the α-
herpesvirus family.
 Varicella or chicken pox is the primary infection by the varicella zoster virus. Most
patients contract the disease during their childhood by the inhalation of
respiratory droplets contaminated with the virus.
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VALACYCLOVIR
 is a prodrug that is converted to acyclovir as it is broken down within the body.
 The adverse reaction profile is the same as that for acyclovir has improved bioavailability
means less frequent dosing for valacyclovir.
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 SIDE EFFECTS OF ACYCLOVIR
Impaired renal function ,especially with rapid IV infusion
Lethargy,tremors,confusion, and headache,especially with older adults
Rash,urticaria,pruritus, and photosensitivity
Nausea,vomiting , abdominal pain, and diarrhea
 PRECAUTIONS OR CONTRAINDICATIONS WITH ACYCLOVIR APPLY TO:
Children
Breastfeeding
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Renal Disease
Dehydration
Neurological abnormalities with high dose
ZOSTAVAX
 Is a herpes zoster vaccine approved for prevention of shingles in appropriate
persons aged 50 years and older.
 It decreases the occurrence of herpes zoster by approximately 50-70% and
prevent the development of PHN by two –thirds.
o PATIENT EDUCATION
 Patients being treated with acyclovir should be instructed regarding:
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 The fact that acyclovir is usually effective only with initial infection in relieving
pain and shortening healing of lesions but is no cure and there can be
recurrences of lesions.
 Reporting side effects
 Taking the medicine only as prescribed and not sharing the drug with others.
 Finishing full course as prescribed ,even if feeling better.
 Avoidance of sexual intercourse when visible genital herpes lesions are present
and using protection at other times.
NEURAMINIDASE INHIBITORS
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- Oseltamivir (Tamiflu) and Zanamivir(Relenza) belong to a class of antiviral called

Neuraminidase inhibitors and are indicated for the treatment of uncomplicated acute
illness caused by influenza types A and B.
Ribavirin
- a drug with the broadest spectrum of antiviral activity, ribavirin is used via nasal and
oral inhalation for the treatment of infants and young children with respiratory
syncytial virus (RSV) infections.
- Respiratory syncytial virus (RSV) is a common, and very contagious, virus that infects the
respiratory tract of most children before their second birthday
SIDE EFFECTS OF RIBAVIRIN:
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Respiratory complications
Hypotension and cardiac arrest
Anemia
Rash and conjunctivitis
 Contraindicated during pregnancy or lactation. Health care professionals and

visitorswho are pregnant or lactating should be warned about the serious risk of close
contact with patients receiving ribavirin inhalation therapy.
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III. TREATMENT OF HUMAN IMMUNODEFICIENCY VIRUS/AIDS INFECTIONS
 The treatment of HIV infection consists of Highly Active Antiretroviral

therapy(HAART) using combinations of three or more antiretroviral(ARV) agents and
in one several factors that has led to a decline in the US mortality rate of AIDS.
Goal of HIV THERAPY
“to achieve maximal and durable suppressions of HIV-related

morbidity,prolong survival and prevent behaviour associated HIV transmission.
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IV. ANTIRETROVIRAL AGENTS
Antiretroviral Protease Inhibitors

 Protease inhibitors block the activity of the HIV enzyme essential for viral
replication late in the viral life cycle.
 Antiretroviral therapy (ART ) is the use of HIV medicines to treat HIV
infection. People on ART take a combination of HIV medicines (called an HIV
treatment regimen) every day.
 Side Effects can include:

- All PIs are associated with GI intolerance, including nausea, vomiting and
diarrhea.
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- Taste alteration in patients receiving ritonavir,especially the liquid formulation.

- Fat redistribution hyperlipidemia and insulin resistance.
- Hyperglycemia,new onset diabetes mellitus and diabetic ketoacidosis
andexacerbation of existing diabetes.
- Increase spontaneous bleeding episodes in haemophilia patients.
- Indinavir may cause kidney stones.
Nucleoside Reverse Transcriptase Inhibitors

 NRTIs inhibit an enzyme responsible for viral replication early in the viral life
cycle.
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 Zidovudine (ZDV,Retrovir) was the first agent to be approved for the

treatment of HIV, followed by more than six other NRTIs.
 Side effects of NRTIs can include:

- Lactic acidosis and liver dysfunction.
- Flare-up of chronic active hepatitis B with abrupt withdrawal of emtricitabine and
Lamivudine.
- Bone marrow suppression of anemia and/or neutropenia with zidovudine.
- Pancreatitis with didanosine.
 Interactions of NRTIs include:
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- Alcohol
- Antacids and iron preparations.
- Other drugs that are nephrotoxic.
Non-nucleoside Reverse Transcriptase Inhibitors

 NNRTIs also inhibit an enzyme responsible for viral replication early in the viral
life cycle.
 Nevirapine (Viramune) was the first NNRTI to be approved.
 Adverse reactions with NNRTIs can include:
- Hepatotoxicity and cutaneous reactions.
- Psychiatric adverse effects with efavirenz and rilpivirine.
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 Side effects of NNRTIs can include:

- CNS symptoms including dizziness,insomnia,abnormal dreams and
confusion.
 Interactions with NNRTIs are many.Check with the pharmacist before
administering with other drugs.
 Dietary considerations with NNRTIs:
- Always check instructions regarding administration.
Fusion Inhibitors
- Has been shown to block entry of HIV into cells, which may keep the virus
from reproducing.
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- Enfuvirtide (Fuzeon) was the first FI approved for treatment-experienced

patients with ongoing HIV replication despite current ARV use.It is administered
by subcutaneous injection twice daily.
CCR5 Antagonists
- CCR5 anatgonists block a coreceptor required for HIV entry to human cells.
- Maraviroc (Selzentry) is the first oral CCR5 antagonist and is used in
conjunction with other ARVs.
Integrase Inhibitors
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- Raltegravir (Isentress) is the first ARV in this class that is designed to slow the
advancement of HIV infection by blocking the enzyme needed for viral
replication.
 Adverse effects are nausea,headache,diarrhea, and pyrexia.
- Refampin can decrease plasma concentrations of raltegravir.
-
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 PATIENT EDUCATION
o Patientstaking antiretroviral should be instructed regarding:
o The fact that there is no cure for HIV and opportunistic infections may develop.
o Taking the drug in an upright position with full glass of water.
o Taking the drug exactly as prescribed and not stopping abruptly.
Reporting any change in health status or side effects

o Not exceeding the prescribed dosage.
o Not sharing the drug with others.
o Not taking any other drugs unless prescribed.
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Virgen Milagrosa University Foundation

Martin P. Posadas Avenue, San Carlos City, Pangasinan, 2420, Philippines

I. Anatomy and Structure of Viruses

 A virus particle, also known as a virion, is essentially nucleic acid (DNA or RNA)

VIRAL GENETIC MATERIAL

II. ANTIVIRAL AGENTS

 Used predominantly in the treatment of herpes simplex,herpes zoster(shingles),

 SIDE EFFECTS OF ACYCLOVIR

Impaired renal function ,especially with rapid IV infusion

Lethargy,tremors,confusion, and headache,especially with older adults

Rash,urticaria,pruritus, and photosensitivity

Nausea,vomiting , abdominal pain, and diarrhea

 PRECAUTIONS OR CONTRAINDICATIONS WITH ACYCLOVIR APPLY TO:

Neurological abnormalities with high dose

- Oseltamivir (Tamiflu) and Zanamivir(Relenza) belong to a class of antiviral called

SIDE EFFECTS OF RIBAVIRIN:

Hypotension and cardiac arrest

Rash and conjunctivitis

 Contraindicated during pregnancy or lactation. Health care professionals and

III. TREATMENT OF HUMAN IMMUNODEFICIENCY VIRUS/AIDS INFECTIONS

 The treatment of HIV infection consists of Highly Active Antiretroviral

Goal of HIV THERAPY

“to achieve maximal and durable suppressions of HIV-related

IV. ANTIRETROVIRAL AGENTS

Antiretroviral Protease Inhibitors

 Side Effects can include:

- Taste alteration in patients receiving ritonavir,especially the liquid formulation.

Nucleoside Reverse Transcriptase Inhibitors

 Zidovudine (ZDV,Retrovir) was the first agent to be approved for the

 Side effects of NRTIs can include:

 Interactions of NRTIs include:

Non-nucleoside Reverse Transcriptase Inhibitors

 Side effects of NNRTIs can include:

- Enfuvirtide (Fuzeon) was the first FI approved for treatment-experienced

Reporting any change in health status or side effects

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