CHAPTER 10: ANTI-VIRAL AGENTS
Viruses That Respond to Antiviral Therapy
o Influenza A and some respiratory viruses
o Herpes viruses
o Cytomegalovirus (CMV)
o Human immunodeficiency virus (HIV) that causes
acquired-immune deficiency syndrome (AIDS)
o Hepatitis B and C
o Some viruses that cause warts and certain eye
infections
Characteristics of Common Viruses
o A virus cannot replicate on its own.
o It must attach to and enter a host cell.
o It then uses the host cell’s energy to synthesize
protein, DNA, and RNA.
o Viruses are difficult to kill because they live inside
our cells.
o Any drug that kills a virus may also kill our cells.
Characteristics of Antiviral Drugs
o Able to enter the cells infected with virus
o Interfere with viral nucleic acid synthesis and/or
regulation
o Some agents interfere with ability of virus
to bind to cells
o Some agents stimulate the body’s immune system
Common Respiratory Viruses
o Influenza A
o Influenza B
o Respiratory Syncytial Virus
Signs and Symptoms of Respiratory Viruses
o Cough
o Fever
o Inflammation of the nasal mucosa
o Inflammation of the mucosa of the respiratory
track
Influenza A and Respiratory Antivirals
Indications – Prevent shedding of the viral protein coat
Pharmacokinetics – Absorbed readily, excreted
unchanged in the urine, metabolized in the urine and liver,
feces and cellular level. Excreted primarily via urine but also
feces.
Contraindications – Allergy, renal impairment,
pregnancy, or lactating
Adverse Reactions – Dizziness, insomnia, nausea,
orthostatic hypotension and urinary retention
Drug-to-Drug Interactions – Primarily Anticholinergic
agents
Nursing Considerations
Assess:
o Known history of allergy to antivirals
o History of liver or renal dysfunction
o Pregnancy or lactation
o Physical status
o Orientation and reflexes
o VS and lung sounds
Signs and Symptoms of Herpes Virus
o Painful vesicles that often occur in clusters on skin,
cornea, or mucous membranes.
o Usual course of primary disease is two weeks
o Duration of recurrences varies
Signs and Symptoms of CMV
o May be asymptomatic
o Fatigue
o Nausea
o Jaundice
o If contracted during pregnancy can result in stillbirth,
brain damage, or birth defects.
Herpes and Cytomegalovirus Antivirals
Indications – Inhibit viral DNA replication by competing
with viral substrates to form shorter, non-effective DNA
chains
Pharmacokinetics – Readily absorbed in the kidney and
GI tract, metabolized in the liver and excreted primarily in
the urine and feces
Contraindications – Known allergies to antiviral agents,
highly toxic in pregnancy and lactation and renal disease
Adverse Reactions – Nausea, vomiting, headache, rash,
and hair loss, paresthesias, neuropathy and renal
dysfunction
Drug-to-Drug Interactions – Nephrotoxic drugs,
zidovudine and aminoglycosides
Nursing Considerations
Assess:
o History of allergy to antivirals
o Physical status
o Orientation and reflexes
o Skin (color, temperature, and lesions)
o Renal function tests
Signs and Symptoms of HIV/AIDS #1
o Attacks helper T-cells in the immune system
o Acute Infection – Fever, rash, myalgia
o Asymptomatic Infection – Follows acute infection
duration varies
o Persistent Generalized Lymphadenopathy –
Adenopathy persists more than 3 months
o Constitutional Symptoms: Fever lasting more than
a month, involuntary weight loss, chronic fatigue.
o Neurological Disease – Dementia
o Secondary Infections – Pneumocystis carinii,
disseminated herpes simplex
o Drugs Used to Treat HIV/AIDS
o Reverse Transcriptase Inhibitors
o Protease Inhibitors
o Nucleosides- NNRTI and NRTI
o Fusion Inhibitors
o CCR5 Coreceptor Antagonist
o Integrase Inhibitors
Nursing Considerations HIV/AIDS Antiviral
Therapy
Assess:
o History of allergy to antivirals
o Physical status
o Level of orientation
o Skin (color, temperature, and lesions)
o Temperature to monitor for infections.
o Hepatic and renal function tests and CBC
Non-nucleoside /Nucleoside Reverse Transcriptase
Inhibitors
Indications – Bind directly to HIV reverse transcriptase
blocking both RNA and DNA dependent DNA polymerase
activities /compete with the naturally occurring nucleosides
Pharmacokinetics – Rapidly absorbed from the GI tract,
except (Didanosine) metabolized in the liver, excreted in
the urine and feces
Contraindications – Pregnancy and lactation except
zidovudine, Lamivudine and zalcitabine should not be given
together
Adverse Reactions – Headache, nausea, vomiting, rash,
chills, diarrhea, flu-like syndrome of fever, muscle aches and
pains and bone marrow suppression with Zididovine
Protease Inhibitors
Indications – Block protease activity within the HIV virus
Pharmacokinetics – Rapidly absorbed in the GI tract,
metabolized in the liver and excreted in urine and feces
Contraindications – Pregnancy and lactation and mild to
moderate hepatic dysfunction
Adverse Reactions- GI effects, changes in liver function,
elevated cholesterol and triglyceride levels may occur as
well as Stevens-Johnson syndrome risk
Drug-to-Drug Interactions- Fosamprenavir, pimozide,
rifampin, triazolam, or midazolam
Fusion Inhibitors
Indications – Prevents the fusion of the virus with the
human cellular membrane
Pharmacokinetics – Given sub-q; metabolized in the liver
it is recycled in the tissues it is not excreted
Contraindications – Use cautiously with lung disease and
pregnancy
Adverse Reactions – Headache, dizziness, myalgia,
nausea, vomiting, and diarrhea
Drug-to-Drug Interactions – No reported drug
interactions
CCR5 Coreceptor Antagonist
Indications – Blocks the receptor site on the cell
membrane to which the HIV virus needs to interact to enter
the cell
Pharmacokinetics –Rapidly absorbed from the GI tract,
metabolized in the liver, and excreted primarily through the
feces
Contraindications –Hypersensitivity to any component
of the drug, nursing mothers and liver disease
Adverse Reactions – Dizziness and changes in
consciousness
Drug-to-Drug Interactions – Increased serum levels
and toxicity when combined with cytochrome P450 CYP3A
inhibitors(ketoconazole, lopinavir/ritonavir, ritonavir,
saquinavir, atazanavir, delavirdine
Integrase Inhibitors
Indications –inhibit the activity of the virus-specific
enzyme integrase, an encoded enzyme needed for viral
replication.
Pharmacokinetics –Rapidly absorbed from the GI tract,
metabolized in the liver, and excreted primarily through the
feces
Contraindications –Hypersensitivity to any component
of the drug and nursing mothers
Adverse Reactions – Headache, dizziness, and an
increased risk for the development of rhabdomyolysis and
myopathy
Drug-to-Drug Interactions – decreased serum levels of
either drug if combined with rifampin
Anti-Hepatitis B Agents
Indications- Inhibits reverse transcriptase in the hepatitis
B virus and causes DNA chain termination
Pharmacokinetics- Rapidly absorbed from the GI tract,
metabolized in the liver and excreted in the urine
Contraindications- Known allergy, pregnancy, lactation
and known renal and liver dysfunction
Adverse Effects- Most significant are headache, dizziness,
nausea, diarrhea, and elevated liver enzymes
Drug- to–Drug Interactions-increased risk of renal
toxicity if these drugs are taken with other nephrotoxic
drugs
Nursing Considerations
Assess:
o History of allergy to adefovir, entecavir, or
telbivudine
o Liver and renal function tests
o Physical assessment
o Temperature
o Level of orientation and reflexes
Anti-hepatitis C Agents
Can be used in combination with ribavirin or ribavirin and
peginterferon to treat chronic hepatitis C
o Technivie , and Paritaprevir
Locally Active Antiviral Agents
Indications – Act on viruses by interfering with normal
viral replication and metabolic processes
Pharmacokinetics – Not absorbed systemically
Contraindications – Allergy to the drug
Adverse Reactions – Local burning, stinging, and
discomfort
Nursing Considerations
Assess:
o History of allergy
o Physical assessment
o Infected area, including location, size, and
character of lesions
o Signs of inflammation at the site of infection
Stages of Virus Replication