ANTI - VIRAL

More difficult to treat than bacterial

infections because virus depends on
biochemical processor of the host
cells for its replication
Drugs that interfere with virus may
also damage cells
MOA: inhibit viral replication by
interfering viral nucleic acid
synthesis in the cell
I. Agents for Influenza and Respiratory
Viruses
amantadine
(Symmetrel) - PO CI: allergy, pregnancy
oseltamivir (Tamiflu) - & lactation,renal &
PO liver disease
ribavirin (Virazole) – AE: lightheadedness,
aerosol inhalation dizziness, insomia,
nausea, orthostatic
rimantidine hypotension, &
(Flumadine) - PO urinary retention
zanamivir (Relenza) -
DI: with anti
inhaler
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)
 II. Agents for Herpes
Herpesviruses
– Herpes simplex
virus type 1
– HSV2
– HSV3: Varicella-
zoster (chickenpox
or shingles)
– HSV 4: Epstein –
Barr virus
– CMV:
cytomegalovirus
acyclovir (Zovirax)
, famciclovir CI: CNS disorders,
(Famvir), allergy, pregnancy &
valacyclovir lactation, renal
(Valtrex)- = disease
herpes; PO SE: N/V, HA,
depression, rash, hair
cidofovir (Vistide) - loss, inflammation &
IV= CMV in AIDS burning sensation at
foscarnet the site of injection
(Foscavir) = both; and topical
IV AE: renal dysfunction
ganciclovir DI: + other
nephrotoxic meds=
(Cytovene) = long inc toxicity
term treatment & – + zidovudine= inc
prevention of CMV; drowsiness
IV
TOPICAL ANTIVIRALS (HSV)
idoxuridine
Penciclovir
trifluridine
 Nursing Considerations:
Extreme caution to children ( carcinogenic); foscarnet (
affect bone growth & development)
Good hydration ( decrease toxic effects o the kidney)
Administer as soon as possible, compliance
Wear protective gloves when applying the dug topically
( decrease risk of exposure to the drug and inadvertent
absorption)
Safety precautions = CNS effects( orientation, siderails,
lighting, 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
Agents for HIV & AIDS
 integrase

HIV replication and actions of anti- HIV drugs

Enzymes needed by viruses:
Reverse transcriptase – helps uncoat the
virus; single stranded viral RNA is
converted into DNA
Integrase- helps viral DNA migrates into
the nucleus of the cell, where I is spliced
into the host DNA (provirus) =>
duplicated together with the cell genes
every time the cell divides
Protease- assists in the assemble of newly
formed viral particles
 Nucleoside/ Nucleotide Reverse
Transcriptase Inhibitors (NRTIs)
MOA: blocks the zidovudine
reverse (Retrovir)
transcriptase didanosine (Videx)
enzyme needed for stavudine (Zerit)
viral replicaation
lamivudine (Epivir)
abacavir (Ziagen)
tenofovir (Viread)
emtricitabine
(Emtrive)
Fixed dose: NC:
– lamivudine/zidovudine
(Combivir) Should be taken
– abacavir/ lamivudine/ zidovudine with food except
(Trizivir) didanosine (60
– abacavir/ lamivudine (Epzicom) min AC or 2
– efavirenz/ emtricitabine/ hours PC)
tenofovir (Atripla) Requires dosage
– emtricitabine/ tenofovir adjustment
(Truvasa) except abacavir
(creatinine
SE (less tenofovir – renal clearance <
toxicity) 50mL/min)
– GI: nausea, diarrhea, abdominal Fixed dose
pain (transient – 2 weeks) avoided if with
– Mitochondrial toxicity: lactic renal
acidosis, peripheral neuropathy, insufficiency
myopathy, pacreatitis,
lipoatrophy (wasting of fats in
face, buttocks and extemities)
 Protease Inhibitors
MOA: act at the end of
the HIV cycle to
inhibit the production saquinavir
of infectious HIV virus indinavir
lopinavir/ ritonavir ritonavir
(first line)
nelfinavir
atazanivir
NOTE:
fosamprenavir – Ritonavir boosting –
(second either mainstay of PI therapy
boosted with retonavir (potent inhibitory
or not) effect)
amprenavir – Take with food
– + didanosine = one hr
tipranavir before or two hours
darunavir after ritonavir
 Entry Inhibitors
MOA: prevents HIV cell Injection site reaction:
entry (fusion of HIV – Suncutaneous nodules,
and CD4) redness
enfuvirtide – the only – Others: rash. Diarrhea,
serous allergic reaction
agent approved (anaphylaxis)
– Indicated in
combination with 3-5
other anti- retroviral
agents (for clients with
limited tx option)
– Expensive. 90 mg Sub-
Q. BID