Antivirals + Cell Wall + Protien Synthesis & DNA + UTI, Antifungal, TB, & Malaria

Certain ________ _______ acts as the target site for the medication. This leads to the inability to grow _________ __________ with the lack of new amino acids.

ribosomal sububits, peptide chains

Doxycycline

(antibiotic) (Tetracycline)

MOA: Bacteriostatic antibiotic (abx) that binds to 30S ribosomal subunit to inhibit binding of transfer RNA to mRNA to inhibit protein synthesis.

Indications:

• Broad spectrum coverage against many gram + & - organisms.

Doxycycline Adverse Effects

• GI is most common, including cramps and N/V/D, along w/ alterations in normal flora & superinfections.

• Bone growth suppression and teeth discoloration in pediatric patients.

• Fatty liver infiltration and renal impairment exacerbation

• Photosensitivity

Doxycycline Nursing Considerations

• Decreased absorption if given with metal ions, including Ca, Fe, and Mg; administer on empty stomach if tolerated.

• Interactions w/ oral contraceptives (reduces effectiveness of birth control pills) and anticoagulants.

• Hepatic and renal monitoring.

• Avoid prolonged sunlight exposure and apply protective measures.

Erythromycin

(antibiotic) (Macrolide) (Third-Line Agent)

MOA: Bacteriostatic abx that binds to 50S ribosomal subunit to block addition of new amino acids growing in the peptide chain.

Indications:

• Most gram + and some gram – coverage.

Erythromycin Adverse Effects

• GI is the most common, including epigastric pain and N/V/D

• QT prolongation → sudden cardiac death (monitor w/ 12-lead/telemetry)

• Hepatotoxicity and ototoxicity

• Numerous medication interactions

Erythromycin Nursing Considerations

• Often first alternative to PCN sensitive bacterial infections if an allergy present.

• Administer via oral route on empty stomach to maximize absorption but can give w/ food if upset stomach persists.

• Avoid in patient w/ pre-existing QT prolongation; monitor heart rhythm on telemetry.

• Can increase half-lives of several medications, notably theophylline and warfarin.

Clindamycin (Cleocin)

(antibiotic) (Linecosamide)

MOA: Similar to macrolides; Bacteriostatic abx that binds to 50S ribosomal subunit to block addition of new amino acids to growing peptide chain.

Indications:

• Gram + and gram = anaerobes and most common gram + aerobes.

Clindamycin (Cleocin) Adverse Effects

(Clindamycin → c. diff) (even if you dont get c. diff, you still get diarrhea)

Severe to fatal c. diff colitis:

• Abdominal pain

• Fever

• Leukocytosis

Non-c. diff diarrhea

Clindamycin (Cleocin) Nursing Considerations

• Monitor and educate patient on monitoring stool and fluid status.

• > 5 loose stools per day concerning for clostridium difficile associated diarrhea and consider D/C clindamycin treatment.

• Vigorous fluid & electrolyte replacement w/ PO vancomycin treatment.

Linezolid (Zyvox)

(antibiotic) (Oxazolidinone)

MOA: Bacteriostatic abx that binds to 23S portion of 50S ribosomal subunit to block formation of initiation complex.

Indications:

• Very broad-spectrum coverage, including MDRO

Linezolid (Zyvox) Adverse Effects

Headache (HA), N/V/D

Myelosuppression (Bone marrow suppression)

• Anemia, leukopenia, and/or thrombocytopenia.

• Pancytopenia

*Is a weak inhibitor of MAO and can lead to interactions.

Linezolid (Zyvox) Nursing Considerations

• Monitor CBC (for the highs and the lows—opportunistic infections) and I/O, especially w/ existing myelosuppressive agents or on other myelosuppressive agents.

• Give w/ food to limit GI upset.

• Monitor for drug interaction w/ MAO (mono amine oxidase) (hypertensive crisis) and SSRI (serotonin syndrome). (so nervous system effects)

Gentamicin

(antibiotic) (Aminoglycoside)

MOA:

• Binds to 30S ribosomal subunit to inhibit protein syntheses, premature termination of protein synthesis, and production of abnormal proteins.

• Causes bactericidal activity effects that persists via post antibiotic effect.

Indications: gram + cocci and aerobic gram – bacilli

• Target organisms include E.coli, Klebsiella, & pseudomonas

• Primarily used for serious infections.

Gentamicin Adverse Effects

• Nephrotoxicity due to proximal renal tubule injury.

• Ototoxicity impairing both hearing and balance.

(kind of similar to vancomycin)

Gentamicin Nursing Considerations

• Assess serum peak (dosing—30 minutes after the completed infusion) and trough (nephro), urine output (UOP), & CMP (particularly w/ concurrent nephrotoxic agent use) to assist dosing adjustments and AE monitoring.

• Neuro-focused assessment, including hearing and balance, especially w/ concurrent ototoxic agent usage.

• Increase fluid intake unless contraindicated.

• Do not mix in same IV solution w/ PCN.

Ciprofloxacin (Cipro)

(antibiotic) (Fluoroquinolone)

MOA: Inhibits two enzymes needed for DNA replication and cell division.

Indications:

• Broad spectrum against most aerobic gram – and some gram +.

Ciprofloxacin (Cipro) Adverse Effects

• GI effects (N/V/D) and CDI

• Tendon rupture, particularly achilles (it affects the extracellular matrix and the collagen synthesis in the tendon) (pt. not able to plantar flex, swelling, and loss of function)

• Central Nervous System (CNS) effect

• Phototoxicity

Ciprofloxacin (Cipro) Nursing Considerations

• Educate on tendon injury (achilles) and report early signs.

• Utilize sunscreen and protective clothing.

• Separate administration from dairy products by at least six hours before or two hours after.

Metronidazole (Flagyl)

(antibiotic) (Nitromidazole) (Reasons used over vancomycin would be due to resistance, ototoxicity, and nephrotoxicity)

MOA: After activation into active forms. Interacts w/ bacterial DNA to cause strand breakage and loss of helical structure that results in inhibition of nucleic acid synthesis and cell death.

Indications:

• Anaerobic bacteria infections, particularly CDI; also covers peptostreptococcus, eubacterium, and Bacteroides

• Antiprotozoal coverage

Metronidazole (Flagyl) Adverse Effects

• Most common are GI effects, as well as headache, dry mouth, and fatigue.

• Many interactions that include ethanol, as well as toxicities of lithium, benzos, cyclosporine, CCB, mood stabilizers, and warfarin.

Metronidazole (Flagyl) Nursing Considerations

• Educate not to drink alcohol (ETOH) while on therapy; can cause disulfiram-like reactions.

• Monitor closely for drug interactions from altered metabolism.

• Give w/ food to minimize GI upset.

Daptomycin (Cubicin)

(antibiotic) (Cyclic Lipopeptide)

MOA:

• Causes efflux of intracellular potassium to depolarize the cell.

—>The loss of potassium from the cell causes a failure in maintaining the membrane potential, which is crucial for bacterial survival.

• Inhibit synthesis of DNA, RNA, and protein to cause cell death.

Indications:

• Gram + bacterial infections only; notably can cover MRSA and VRE.

Daptomycin (Cubicin) Adverse Effects

• GI effects common, including constipation, and N/V/D

• Myopathy, especially if already on statin. (rhabdomyolysis)

• Hypotension and hypertension

Daptomycin (Cubicin) Nursing Considerations

• Monitor for any new onset muscle pain or weakness and baseline CK.

• HMG-CoA reductase inhibitors (statins) may be stopped while on daptomycin.

• Monitor V/S closely, particularly for changes in blood pressure.

Parenteral route of administration entails…

Intravenous (IV): Directly into a vein.

Intramuscular (IM): Into a muscle.

Subcutaneous (SC): Under the skin.

Intradermal: Into the dermis layer of the skin.

Penicillin G (benzylpenicillin)

(antibiotic) (Parenteral Route Beta-Lactam)

MOA: Targets PCN-binding proteins (PBP) to weaken the bacterial cell wall through inhibition of transpeptidases and disinhibition of autolysins.

• Transpeptiadse is an enzyme that plays a role in building bacterial cell walls. Penicillin G inhibits that.

• Autolysins are enzymes produced by bacteria that help break down and remodel their own cell walls. When bacteria is exposed to Penicillin G, autolysins continue to break the existing cell wall w/o any new material to replace it.

——>Under typical conditions, bacteria regulates autolysin activity to ensure that their cell wall is only broken down at a controlled rate to allow growth and division.

Indications:

• Most used for infections caused by most gram + bacteria (e.g., strep, enterococcus, and staph)

Penicillin G (benzylpenicillin) Adverse Effects

• IM route-related pain, as well as peripheral nerve issues.

• Allergic reactions and possible cross allergy/cephalosporins.

Penicillin G (benzylpenicillin) Nursing Considerations

• Assess for history of allergic reaction s/s; if allergic to penicillin (PCN), possible allergy to cephalosporins.

• Monitor complete blood count (CBC), vital signs, and infection s/s.

Penicillin Allergies

Immediate: 2 to 30 minutes

Accelerated: 1 to 72 hours

Delayed: Days to Weeks

Penicillin Resistance

Beta lactam is the moelecular structure of the antibiotic itself. The bacteria is going to target that specific part and create beta-lactamase (enzyme).

Other PCNs are combined w/ a beta-lactamase inhibitor so we can continue to kill bacteria. (MRSA, VRE)

Sepsis/Septic Shock

Lack of O2 —> Anaerobic metabolism —> Lactate level

According to sepsis guidlines, when should antimicrobial therapy begin?

1 hour (it should given after cultures have been taken)

Piperacillin/tazobactam (Zosyn)

(antimicrobial) (Combination Parenteral Beta-Lactam and Beta-Lactamase Inhibitor)

MOA: Penicillin actions plus inhibition of bacterial beta-lactamase w/ tazobactam.

• Piperacillin is an antibiotic that stop bacteria from building strong cell walls. W/O these walls, bacteria burst and die.

• Tazobactam is a beta-lactamase inhibitor that blocks bacteria that destroy piperacillin.

Indications:

• Extended spectrum (penicillin susceptible organisms plus gram—and anaerobic coverage, including pseudomonas, Enterobacter, Klebsiella)

Piperacillin/tazobactam (Zosyn) Adverse Effects

• Low toxicity

• Allergic reactions

Piperacillin/tazobactam (Zosyn) Nursing Cosniderations

• Assess for history of allergic reaction s/s; if allergic to penicillin (PCN), possible allergy also to cephalosporins

• Monitor complete blood count (CBC), vital signs (v/s), and infection s/s.

• Parenteral route only, monitor IV infusion site and compatibility w/ other antibiotic therapy w/ aminoglycosides. (DIFFERENCE BETWEEN PENICILLIN G IS THAT IT CAN BE USED W/ AMINOGLYCOSIDES SUCH AS GENTAMICIN!!)

We don’t mix penicillins and __________ in the same intravenous solution because it can result in a drug interaction.

aminoglycosides (e.g., gentamicin)

Cephalosporin Generations Differences

First Generation (e.g., cephalexin): Low Activity Against Gram-Negative Bacteria, Low Resistaince to Beta-Lacatamases, and Poor Distribution to Cerebrospinal Fluid.

Second Generation (e.g., cefoxitin): Higher Activity Against Gram-Negative Bacteria, Higher Resistance to Beta-Lactamases, and Poor Distrubution to Cerebrospinal Fluid.

Third Generation (e.g., cefoaxime): Higher Activity Against Gram-Negative Bacteria, Higher Resistance to Beta-Lactamases, and Good Distrubution to Cerebrospinal Fluid.

Fourth Generation (e.g., cefepime): Highest Activity Against Gram-Negative Bacteria, Highest Resistance to Beta-Lactamases, and Good Distrubution to Cerebrospinal Fluid. (broad spectrum coverage)

Fifth Generation (e.g., ceftaroline): High Activity Against Gram-Negative Bacteria, Highest Resistance to Beta-Lactamases, and Good Distrubution to Cerebrospinal Fluid. (broad spectrum coverage)

Cephalosporins

(antibiotic)

MOA: Like penicillins, cephalosporins bind to penicillin-binding proteins to disrupt cell wall synthesis and activate autolysins.

Indications: Indications for each generation will depend on type of coverage needed/type of bacteria involved.

• Cefazolin (Ancef)—surgical prophylaxis (prevention)

• Cefepime (Maxipime)—resistant organisms

• Cefazoline (Teflaro)—skin infections and HCAP

Cephalosporins Adverse Effects

• Allergic reactions

• Bleeding tendencies through interference w/ vitamin K metabolism. (Warfarin intensification—more anticoagulation)

• Disulfiram-like reactions w/ alcohol. (flushing, n/v, ha, etc.)

Cephalosporins Nursing Considerations

Due to similarity of action w/ PCN, nursing consideration will be the same w/ cephalosporins.

Due to structural similarities, patient w/ a PCN allergy may have a __________ allergy as well. If allergy present, particularly if it is severe, ________ medication should be used.

cephalosporin, neither

Imipenem/cilastatin (Primaxin)

(antibiotic) (Carbapenem) (Metabolized by the kidneys!)

MOA: Bind specifically to Penicillin-Binding Protein (PBP) 1 & 2 to weaken cell wall and can resist beta-lactamases. (Serious infections!)

• Imipenem is a powerful antibiotic that stops bacteria from building their cell walls.

• Cilastatin protects imipenem from being broken down by enzymes in the kidneys, allowing it to stay active longer and work more effectively.

Indications:

• Very broad-spectrum w/ activity against most pathogens, including MDRO, for bone, joint, skin, and soft tissues infections (SSTI), urinary tract infections (UTI), intraabdominal, and pelvic infections.

Imipenem/cilastatin (Primaxin) Adverse Effects

• GI effects most common, including N/V/D

• Seizures, particularly w/ renal impairment (toxins are not wasted and the med is now in the blood, which circulates up to the brain)

• Superinfections

Imipenem/cilastatin (Primaxin) Nursing Considerations

• Co-administered w/ cilastatin to prevent rapid imipenem breakdown in the kidneys.

• Reserve use in patients w/ infections not covered by other antibiotics.

Vancomycin (Vancocin)

(antibiotic)

MOA: Inhibits cell synthesis by binding to molecules that serve as precursors for cell biosynthesis.

Indications:

• Include gram + positive coverage only for bone, joint, and bloodstream infections, particularly MRSA and clostridium difficile infection (CDI). (Oral route for c. diff and IV for MRSA)

Vancomycin (Vancocin) Adverse Effects

• Nephrotoxicity leading to renal failure

• Ototoxicity (med accumulates in the cochlea—hearing + balance)

• Red man syndrome (rashes, itching, flushing, tachycardia, and hypotension) w/ rapid infusion.

• Vancomycin-resistant enterococci (VRE)

Vancomycin (Vancocin) Nursing Considerations

• Usually administered IV (MRSA); oral administration for CDI.

• Monitor trough levels (30 minutes before new administration is due) appropriately.

• Monitor CMP for renal function.

• Monitor CN VIII (8-vestibulocochelar) function.

• Avoid concurrent use w/ other nephrotoxic medications (loop diuretics, ethacrynic acid, aminoglycoside antibiotics).

• Appropriate hygiene and cleaning w/ active CDI patients.

Nirmatrelvir & ritonavir (Paxlovid)

(COVID-19 treatment)

MOA: Nirmatrelvir acts as a protease inhibitor, w/ ritonavir increasing nirmatrelvir’s plasma concentrations via metabolism inhibition.

Indications:

• Oral therapy indicated for symptomatic, non-severe COVID-19 infection w/ risk factors for the development of severe COVID-19 infection.

Nirmatrelvir & ritonavir (Paxlovid) Adverse Effects

• Hypertension

• Diarrhea

• Impaired or altered sense of taste

• Myalgia (muscle pain)

• Rebound COVID-19 infection (retest the pt. for COVID-19)

Nirmatrelvir & ritonavir (Paxlovid) Nursing Considerations

• Patient education on medication regimen (twice daily x 5 days) and adherence.

• Numerous drug interactions; thoroughly assess medication usage during the patient interview. (medication reconciliation)

• Risk of HIV resistance if a patient has an uncontrolled undiagnosed infection.

Molnupiravir (Lageviro)

(COVID-19 treatment)

MOA: Once metabolized and phosphorylated, it is incorporated into viral RNA polymerase resulting in viral genome errors and replication inhibition.

Indications:

• Oral therapy indicated for symptomatic, non-severe COVID-19 infection w/ risk factors for development of severe COVID-19 infection.

Molnupiravir (Lageviro) Adverse Effects

• Erythema (redness), rash, urticaria.

• Hypersensitivity (skin issues), including anaphylaxis, angioedema.

Molnupiravir (Lageviro) Nursing Considerations

• Alternative outpatient option for those who cannot take Paxlovid. (such as if a patient has HTN, they will go w/ this med)

• Patient education on medication regimen (twice daily x 5 days) and adherence.

• Not commercially available; current use is under EUA from AmerisourceBergen

• Capsules can be administered w/ or w/o food; do not crush, open, or break.

Remdesevir (Veklury)

(IV SARS-CoV-2 Nucleotide Analog RNA Polymerase Inhibitor)

MOA: Inhibits RNA polymerase, which is necessary for viral replication, by acting as an ATP analog which results in delayed chain termination during replication.

Indications:

• Indicated for COVID-19 infection requiring hospitalization and supplemental oxygen in adults and pediatric patients aged 12 or older and weighing at least 40kg.

Remdesevir (Veklury) Adverse Effects

• **Potentially severe bradycardia

• Elevated liver enzymes (AST & ALT)

• Hypersensitivity reactions resulting in anaphylaxis, angioedema, rash, etc.

• Prolonged prothrombin time (PT) (may increase the risk for bleeding—the clotting is taking longer than normal)

Remdesevir (Veklury) Nursing Considerations

• Monitor CMP (Kidney function, Liver function, F&E balance, Glucose, Calcium) and RUQ (that’s where the liver is!) s/s

• Although unlikely, monitor renal function for impairment for duration of therapy.

• Discontinue infusion and provide appropriate intervention if hypersensitivity reactions occur.

BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine)

Two-dose IM mRNA vaccine for prevention of symptomatic COVID-19 at or after day 7 following the second dose (95% efficacy)

BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) & mRNA-1273 (Moderna COVID-19 Vaccine) Adverse Effects

• Injection site soreness

• Fever, chills, fatigue, headache, and lymphadenopathy (swollen lymph nodes) within 24-48 hours.

• Anaphylaxis, very rarely; milder allergic reactions.

BNT162b2 (Pfizer-BioNTech COVID-19 Vaccine) Nursing Considerations

• Patient education, including duration of protection and time between doses (21 days)

• Careful preparation to maximize doses per vial and appropriate amount of diluent (1.8 mL of NS; 0.3 mL administered per dose)

• Once reconstituted, must be used within 6 hours.

• Intramuscular injection soreness can be treated w/ OTC analgesics.

• IM Locations: Deltoid, Vastus Lateralis, Dorsalgluteal

• Monitor patients for 15 minutes post-administration.

mRNA-1273 (Moderna COVID-19 Vaccine)

Two-dose IM mRNA vaccine for prevention of symptomatic COVID-19 at or after day 7 following the second dose (94.1% efficacy)

mRNA-1273 (Moderna COVID-19 Vaccine) Nursing Considerations

• Patient education, including duration of protection and time between doses (28 days)

• Careful preparation to maximize dose per vial.

• Once vial is punctured, must be used within 6 hours

• Intramuscular injection soreness can be treated with OTC analgesics.

• IM Locations: Deltoid, Vastus Lateralis, Dorsalgluteal

• Monitor patients for 15 minutes post-administration

Acyclovir (Zovirax)

(antiviral)

MOA: Inhibits viral replicaiton by suppressing synthesis of viral DNA.

Indications:

• Topical for HSV1 (cold sore)—b/c of the lesions

• PO for HSV2 (Sexual) and VZV (varicella-zoster)

• IV for in immunocompromised patients. (ex: cancer pts., HIV pts., autoimmune disorder like (lupus), transplant pts.)

Acyclovir (Zovirax) Adverse Effects

• *Can take w/o regards to meals.

• Phlebitis and inflammation w/ IV therapy.

• Nephrotoxicity (elevated Creatinine and BUN)

• Neurotoxicity (agitation, delirium, tremors)

Acyclovir (Zovirax) Nursing Considerations

• Viral resistance to therapy. (take it all or else you’ll become resistant!)

• Monitor renal function and fluid status.

• Monitor neuro status.

• Only decreases s/s in genitals; avoid sexual contact when lesions present and use protection.

• Use finger cot/rubber glove w/ topical.

Ganciclovir (Cytovene)

(antiviral)

MOA: Inhibits viral replication by suppressing synthesis of viral DNA and incorporating it into the chain causing chain termination.

Indications:

• Prevention and treatment of Cytomegalovirus (CMV) infection in immunocompromised patients.

Ganciclovir (Cytovene) Adverse Effects

• Granulocytopenia (low WBCs) (bone marrow suppression)

• Thrombocytopenia (low platelets)

• Teratogenic

Ganciclovir (Cytovene) Nursing Considerations

• Monitor CBC for changes in WBCs and PLT.

• Co-administration w/ CSF (colony/colonizing stimulating factor); administer PO w/ food.

—>CSF helps stimulate the production of white blood cells, reducing the risk of infections by boosting the immune system during treatment.

• Education on contraception.

Simeprevir (Olysio)

(antiviral) (Protease Inhibitor) (HEP. C MED)

Not indicated as monotherapy—only used in combination w/ other agents.

MOA: Inhibits viral protease, an enzyme needed for HCV (Hepatitis C) replication.

Simeprevir (Olysio) Adverse Effects

• Most common are headache, nausea, and fatigue.

• Hepatic injury

• Photosensitivity (sunlight exposure)

• Rash

Simeprevir (Olysio) Nursing Considerations

• Monitor hepatitis s/s and liver enzymes (AST & ALT).

• Caution w/ sulfa allergies (ex: Bactrim) and amiodarone (antiarrhythmic). –Question the order, Call the MD, or stop the medication.

**This med contains a sulfa in its chemcial structure, which is why there is caution w/ other sulfa meds. Heart-releated issues when used w/ amiodarone.

Daclatasvir (Daklinza)

(antiviral) (NS5A Inhibitor) (HEP. C MED)

MOA: Inhibits NS5A proteins that is necessary for replication and assesmbly to prevent formation of HCV (Hepatitis C).

Daclatasvir (Daklinza) Adverse Effects

• Most common are headache and fatigue.

• Possible anemia (RBCs—H&H)

Daclatasvir (Daklinza) Nursing Considerations

• Monitor hepatitis s/s and liver enzymes (ALT & AST).

• Monitor CBC.

• Due to numerous drug interactions, educate patient on not starting new medications w/o counseling first. (Get a medication reconciliation!)

Ribavirin (Rebetol)

(antiviral) Never used as monotherapy—only effective when combined w/ interferon alfa.

MOA: Unclear, but increases patient response to interferon alfa.

Ribavirin (Rebetol) Adverse Effects

• Flu-like symptoms (cough, runny nose, fever, etc.)

• Hemolytic anemia

• Fetal Injury

Ribavirin (Rebetol) Nursing Considerations

• Monitor mental status. (due to combo w/ other med ;D)

• Monitor complete blood count (CBC)—for anemia.

• Monitor hepatitis s/s and liver enzymes (ALT & AST).

• Extended use of contraception due to prolonged half-life.

Interferon Alfa

(antiviral)
MOA:

• Blocks viral entry into cells.

• Blocks synthesis of viral messenger RNA and viral proteins.

• Blocks viral assembly and release.

Indications:

• Indicated for both HBV (Hep B.) and HCV (Hep C.)

Interferon Alfa Administration

• Conventional therapy SQ/IM 3 times/week.

• Long-acting therapy SQ once/week.

Interferon Alfa Adverse Effects

• Most common are flu-like s/s (cough, runny nose, fever, etc.).

• Neuropsychiatric (depression, anxiety).

• Bone marrow suppression w/ long term use.

Interferon Alfa Nursing Considerations

• Acetaminophen PRN for flu-like s/s.

• Monitor mental status.

• Monitor CBC.

• Monitor hepatitis s/s and liver enzymes (ALT & AST).

• Rotate injection sites.

Lamivudine (Epvir)

(antiviral) (Nucloeside analog)

MOA: Suppress HBV (Hepatitis B) replication by inhibiting viral DNA synthesis.

Lamivudine (Epvir) Adverse Effects

• Lactic Acidosis

• Pancreatitis

• Hepatomegaly

Lamivudine (Epvir) Nursing Considerations

• Give the lowest dose possible to patients who are HIV positive.

• Monitor amylase and lipase. (for the pancreatitis)

• Monitor ABGs (for the lactic acidosis)

• Educate patient to take medication as prescribed.

Oseltamivir (Tamiflu)

(antiviral) (Nueraminidase Inhibitor)

MOA: Inhibits nueraminidase to prevent viral replication and pevents newly formed viral particles from spreading to other cells.—It’s not killing the flu; It is decreasing your time for being sick!

Oseltamivir (Tamiflu) Adverse Effects

• Generally well-tolerated but better if taken w/ food.

• Most common is N/V.

• Hypersensitivity and neuropsychiatric s/s are rare.

Oseltamivir (Tamiflu) Nursing Considerations

• Rapid flu testing possible before to confirm diagnosis.

• Carefully assess for vaccination history and onset of s/s (within 48 hours) (less than 48)

• Educate patient to monitor allergic reaction s/s, particularly w/ integumentary system.

Palivizumab (Synagis)

(IM moncolonal antibody)

MOA: An antibody that binds to surface protein on RSV (Respiratory Syncytial Virus) (baby) and prevents replication.

Palivizumab (Synagis) Adverse Effects

• Hypersensitivity reactions

• Anaphylaxis (rare)

Palivizumab (Synagis) Nurisng Considerations

• Use appropriate IM administration techniques. (ex: monitoring pt. 15 minutes after injection)

• IM Locations: Deltoid, Vastus Lateralis, Dorsalgluteal

• Use caution w/ mild hypersensitivity reactions.

• Discontinue w/ severe hypersensitivity reactions.

Baloxavir Marboxil (Xofluza)

(antiviral) (PO Endonuclease Inhibitor) (Treats Influenza)

MOA: Endonuclease inhibitor that is converted to baloxavir which inhibits protein activity for viral gene replication.

Baloxavir Marboxil (Xofluza) Adverse Effects

• Uncommon

• Do not administer w/ salts (calcium, iron, magnesium)—these reduce absorption of the med making it less effective in treatment.

Baloxavir Marboxil (Xofluza) Nursing Considerations

• Administration w/ the LAIV (Live Attenuated Influenza Vaccine) may decrease the effectiveness of the vaccine.

• Take within 48 hours of symptom onset.

What are the 3 enzymes needed for the viral replication of HIV?

• Reverse Transcriptase (Step 3)

• Intergrase (Step 5)

• Protease (Step 10)

Abacavir (Ziagen)

(antiviral) (PO Nucleoside Reverse Transcriptase Inhibitor) (NRTI) (Step 3)

MOA: NRTI that inhibit HIV replication by suppressing synthesis of DNA through acting as substrates for reverse transcriptase.

Abacavir (Ziagen) Adverse Effects

• Lactic acidosis and hepatic steatosis (fatty liver) r/t mitochondrial toxicity.

• Possible evidence for increased risk for MI.

• Hypersensitivity

Abacavir (Ziagen) Nursing Considerations

• Genetic testing for HLA-B*5701—to determine whether pt’s are sensitive to the medication.

• Monitor for cardiac and Lactic Acidosis s/s (ABGs)

• Use of safe (sex) practices to prevent transmission

• Other first-line NRTI include lamivudine, tenofovir, and emtricitabine.

Efavirenz (Sustiva)

(antiviral) (PO Non-Nucleoside Reverse Transcriptase Inhibitor) (NNRTI)

MOA: NNRTI that inhibit HIV replication by suppressing synthesis of DNA through binding to active center of reverse transcriptase enzyme. (working outside of the nucleus)

Efavirenz (Sustiva) Adverse Effects

• CNS symptoms are common (dizziness, drowsiness)

• Rash (SJS)

• Teratogenicity

Efavirenz (Sustiva) Nursing Considerations

• Numerous drug interactions, including those for HIV.

• Taking medication at hs (bedtime) on empty stomach can reduce CNS symptoms.

• Educate on CNS symptoms and rash.

• Educate on contraception.