Immune System and Vaccinations

B Lymphocytes (B Cells)

Make antibodies

Cytolytic T Lymphocytes (Cytolytic T Cells and CD8 Cells)

Attack and kill target cells directly

Helper T Lymphocytes (Helper T cells and CD4 cells)

•Role in antibody production by B cells

•Promote sensitivity reactions

•Help activate cytolytic T cells

Macrophage

•Phagocytosis

•Inflammation

•Acquired & natural immunity

Dendritic Cells

Antigen-presenting

Mast Cells/Basophils

Mediate hypersensitivity reactions

Neutrophils

•Phagocytize bacteria

•Devour cells with antibodies

•Major contribution to inflammatory process

Eosinophils

Attack and destroy foreign particles

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Prototype

zidovudine

zidovudine MOA

Inhibits the reverse transcriptase enzyme in HIV. This enzyme converts viral RNA into DNA, which is needed for the virus to replicate. By blocking this process, it prevents the virus from reproducing & spreading in the body.

zidovudine adverse effects

•Bone marrow suppression

•GI upset: N/V, abdominal pain, diarrhea

•CNS effects: headache, insomnia, dizziness

•Fever, muscle aches

zidovudine patient education

•Report ↑ in fatigue, pale skin or mucous membranes, fever, onset of infection

•Adhere to monthly lab draws

•Report persistent GI issues

•Report persistent headaches, insomnia, dizziness

•Report fever and myalgia

•Notify provider prior to taking any OTC meds due to multiple interactions

zidovudine nursing interventions

•Monitor Hgb & neutrophil counts (baseline & monthly)

•Dose may be reduced or withheld if: Hgb ↓ 25% from baseline, Neutrophil count ↓ 50% from baseline

•Transfuse PRBCs as needed

•Monitor & report GI issues

•Monitor patient's weight

zidovudine contraindications

•Hx of allergy to medication

•Latic acidosis

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Prototype

delavirdine

delavirdine MOA

Blocks the HIV virus from replicating by inhibiting the reverse transcriptase enzyme, which is needed for HIV to convert its RNA into DNA and reproduce.

delavirdine administration

•Oral

•DO NOT take with antacids

•Take at bedtime on empty stomach

delavirdine adverse effects

•Rash can develop into Stevens-Johnson Syndrome or erythema multiforme

•GI upset: N/V, abdominal pain, diarrhea

•↑ liver enzymes

delavirdine patient education

•Report rash and pruritis of skin

•Adhere to periodic liver function tests

•Report persistent GI issues (N/V, D)

•Notify provider prior to taking any OTC meds due to multiple interactions

delavirdine nursing interventions

•Monitor/Report rash, rash w/ fever, lesions in the mouth or eye, blisters, or muscle pain - D/C med

•Monitor for persistent GI effects

•Monitor liver enzymes

•Monitor patient's weight

•Report significant ↓ in weight

Integrase Inhibitor Prototype

raltegravir

raltegravir MOA

Blocks the HIV virus from inserting its genetic material into the DNA of cells, preventing the virus from replicating and spreading in the body.

raltegravir adminstration

•Oral

•Must combine with other HIV medications

•Take with or without food

raltegravir adverse effects

•CNS effects: dizziness, headache

•GI upset: N/V, abdominal pain, diarrhea

raltegravir patient education

•Report dizziness or headache

•Avoid hazardous activities until effects are known

•Report persistent GI issues (N/V, D)

raltegravir nursing interventions

•Monitor for persistent/intolerable GI effects

•Monitor for CNS effects

raltegravir contraindications

•Patients who are just beginning HIV treatment for the 1st time

•Children < 16 years

•Possible contraindication in severe hepatic disorders

Protease Inhibitor Prototype

ritonavir

ritonavir MOA

Inhibits HIV protease enzyme, which is needed for the maturation of HIV particles. When protease is blocked, it prevents the virus from processing proteins, resulting in the production of immature, non-infectious viral particles, which helps to reduce viral load in patients.

ritonavir administration

•Oral

•Take with food

ritonavir adverse effects

•Hyperglycemia & DM

•Fat redistribution

•↑ cholesterol & triglyceride levels → (CV disease)

•↓ bone density → (osteoporosis)

•Liver toxicity

•GI issues (N/V, diarrhea, constipation, heartburn)

ritonavir patient education

•Report ↑ thirst, food intake, urination

•Fat distribution potential

•Report persistent GI issues

•↑ calcium and vitamin D intake

•↑ weight bearing exercise

•Adhere to lipid profile lab draws

•❌smoking

•Report ↑ in abdominal pain, anorexia, & jaundice

•Notify provider prior to taking any OTC meds due to multiple interactions

ritonavir nursing interventions

Monitor For...

•Hyperglycemia & DM

•Cholesterol & triglyceride levels

•Bone density studies

•Persistent GI issues

•Patient's weight

•Liver toxicity

ritonavir contraindications

•Allergy to ritonavir

•Resistance to any protease inhibitor

•Pancreatitis

•Lactation