VIRUS LIFE CYCLE

STEP 1: Attachment- The virus comes in contact with the host’s cell
STEP 2: Penetration- The virus enters the cell body and the cell engulfs the virus
STEP 3: Biosynthesis and replication- The virus releases its RNA/DNA (uncoating) and uses the
cell’s energy to create new virus RNA/DNA
STEP 4: Assembly- The new viral RNA/DNA particles are assembled within the host’s cell
STEP 5: Release- The new viral particles are released into the body and cause viral infection

VIRAL INFECTION
• More difficult to treat than bacterial infections because virus depends on biochemical
processor of the host
• Viruses are much smaller than bacteria.
• Viruses can't reproduce on their own. Unlike bacteria, which can survive on its own, viruses
need a living host to survive. So, when viruses get into the body, they take over
certain cells and use structures in those cells to make more copies of the virus.
Influenza and Respiratory Viruses
Ex. Bocavirus, Coronavirus, Metapneumovirus, Parainfluenza virus, Respiratory Adenovirus,
Respiratory Syncytial Virus, Respiratory viral infections, Rhinovirus, SARS-CoV
Medications:
• amantadine (Symmetrel) - PO
• oseltamivir (Tamiflu) - PO
• ribavirin (Virazole) – aerosol inhalation
• rimantidine (Flumadine) - PO
• zanamivir (Relenza) – inhaler

MOA: inhibit viral replication by interfering viral nucleic acid synthesis in the cell (STEP 3)
CI: allergy, pregnancy & lactation, renal & liver disease
AE: lightheadedness, dizziness, insomnia, nausea, orthostatic hypotension, & urinary retention
DI: with anti-cholinergic drugs = increase atropine like effect

Nursing Considerations:
✓ Start regimen as soon after the exposure to the virus as possible (achieve best effectiveness
and decrease the risk of complications)
✓ Administer the full course of drug
✓ Provide safety measures ( protect patient from injury)
Herpesviruses
Ex.
• Herpes simplex virus type 1
• HSV2
• HSV3: Varicella- zoster (chickenpox or shingles)
• HSV 4: Epstein – Barr virus
• CMV: cytomegalovirus

Medications:
• acyclovir (Zovirax)
• famciclovir (Famvir)
• valacyclovir (Valtrex)
• cidofovir (Vistide)
• foscarnet (Foscavir) = both; IV
• ganciclovir (Cytovene) = long term treatment & prevention of Cytomegalo Virus; IV

CI: CNS disorders, allergy, pregnancy & lactation, renal disease

SE: N/V, HA, depression, rash, hair loss, inflammation & burning sensation at the site of injection and
topical
AE: renal dysfunction
DI: + other nephrotoxic meds= increase toxicity
+ zidovudine= increase drowsiness

TOPICAL ANTIVIRALS (HSV)

• idoxuridine
• Penciclovir
• trifluridine

Nursing Considerations:
• Extreme caution to children (carcinogenic); foscarnet (affect bone growth & development)
• Good hydration (decrease toxic effects of the kidney)
• Administer as soon as possible, monitor for compliance
• Wear protective gloves when applying the drug topically ( to decrease risk of exposure to the
drug and inadvertent absorption)
• Safety precautions = CNS effects (monitor orientation, raise siderails, provide good lighting,
offer assistance)
• Warn that GI upset, N/V can occur (prevent undue anxiety, increase awareness of the
importance of nutrition)
• Monitor renal function
• Avoid sexual intercourse if with genital herpes
• Avoid driving and hazardous tasks if with dizziness & drowsiness

HIV & AIDS

Enzymes needed by viruses:

• Reverse transcriptase- helps in uncoating the virus (STEP 3); single stranded viral RNA is
converted into DNA
• Integrase- helps viral DNA migrate into the nucleus of the cell, where it is spliced into the host
DNA (provirus) and duplicated together with the cell genes every time the cell divides
• Protease- assists in the assembly (STEP 4) of newly formed viral particles

Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

MOA: blocks the reverse transcriptase enzyme needed for viral replication
• zidovudine (Retrovir)
• didanosine (Videx)
 • stavudine (Zerit)
• lamivudine (Epivir)
• abacavir (Ziagen)
• tenofovir (Viread)
• emtricitabine (Emtrive)
Fixed dose (Fixed-dose combinations of antiretrovirals are multiple antiretroviral drugs combined into
a single pill, which helps reduce pill burden.):
• lamivudine/zidovudine (Combivir)
• abacavir/ lamivudine/ zidovudine (Trizivir)
• abacavir/ lamivudine (Epzicom)
• efavirenz/ emtricitabine/ tenofovir (Atripla)
• emtricitabine/ tenofovir (Truvasa)

✓ SE: (less tenofovir – renal toxicity)

✓ GI: nausea, diarrhea, abdominal pain (transient – 2 weeks)
✓ Mitochondrial toxicity: lactic acidosis, peripheral neuropathy, myopathy, pacreatitis,
lipoatrophy (wasting of fats in face, buttocks and extremities)

Nursing Considerations:
✓ Should be taken with food except Didanosine (60 min AC or 2 hours PC)
✓ Requires dosage adjustment except abacavir (creatinine clearance < 50mL/min)
✓ Fixed dose avoided if with renal insufficiency

Non- nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

MOA: prevent viral replication by competing with binding of the reverse transcriptase enzyme at the
active site
• Used to reserve protease inhibitors (resistance)

Eg.
• efavirenz (Sustiva)
– First-choice drug
– Pregnancy Category: D
– CNS toxicities: dizziness, sedation, nightmares, euphoria, loss of concentration
– Administered as a component of Atripla (Fixed dose)
– Taken once a day at hour of sleep
– Take on empty stomach / with low fat meal (prevent excessive drug absorption)

• nevirapine ( Viramune) – alternative

– Pregnancy (1st tri)
– Recommended for those planning to conceive
– For those not using effective/ consistent contraception
< risk: rash hepatotoxicity

• delavirdine (Rescriptor)
– Least potent antiviral activity

Protease Inhibitors
MOA: act at the end of the HIV cycle to inhibit the production of infectious HIV virus
• lopinavir/ ritonavir (first line)
• atazanivir
• fosamprenavir (second either boosted with retonavir or not)
• amprenavir
• tipranavir
• darunavir
• saquinavir
 • indinavir
• ritonavir
• nelfinavir

NOTE:
– Ritonavir boosting – mainstay of Protease Inhibitor therapy (potent inhibitory effect)
– Take with food
– + didanosine = one hour before or two hours after ritonavir

Entry Inhibitors
MOA: prevents HIV cell entry (fusion of HIV and CD4) (STEP 2)

• enfuvirtide – the only agent approved

– Indicated in combination with 3-5 other anti- retroviral agents (for clients with limited
treatment option)
– Expensive
– Recommended dose: 90 mg Subcutaneous twice a day
– Injection site reaction:
▪ Subcutaneous nodules, redness
▪ Others: rash. Diarrhea, serous allergic reaction (anaphylaxis)