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Karch’s Focus on Nursing Pharmacology, 9th Ed., Tucker
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Chapter 10: Antiviral Agents

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Karch’s Focus on Nursing Pharmacology, 9th Ed., Tucker | Registered Nurse (RN) School Study Aid

Chapter 10: Antiviral Agents
25 Picmonics to Learn | 46 mins
Zanamivir (Relenza) and Oseltamivir (Tamiflu)
Indications
Influenza A and B
Treatment and Prophylaxis
Mechanism
Inhibits Release of New Virus
Inhibits Influenza Neuraminidase
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1 min
Influenza Virus
Characteristics
RNA Virus
Orthomyxovirus
Enveloped
Negative Sense
8 Segments
Helical
Hemagglutinin for Viral Entry
Neuraminidase for Virion Release
Genetic Shift
Reassortment of genome to cause major change
Genetic Drift
Minor Antigenic Mutations
Considerations
Reye Syndrome with Aspirin Use
Guillain-Barre Syndrome
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3 mins
Influenza
Assessment
High Fever
Cough
Headache
Muscle Aches
Chills
Intervention
Vaccination
Drug Therapy
Zanamivir (Relenza)
Oseltamivir (Tamiflu)
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2 mins
Herpes Simplex Virus (HSV)
Characteristics
Enveloped
Double Stranded DNA
Linear
Signs and Symptoms
Type 1 HSV
Gingivostomatitis
Keratoconjunctivitis
Encephalitis of Temporal Lobes
Latent in Trigeminal Ganglia
Type 2 HSV
Genital Vesicles
Neonatal Herpes
TORCHES
Latent in Sacral Ganglia
Diagnosis
Tzanck Test
Multinucleated Giant Cells
Cowdry A Inclusions
Treatment
Acyclovir
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2 mins
Cytomegalovirus (CMV)
Characteristics
Enveloped
Double Stranded DNA
Herpesvirus 5
Diagnosis
Non Heterophile Antibodies
Owl's eye inclusions
Signs and Symptoms
Congenital TORCH infection
Mononucleosis
Pneumonia
AIDS retinitis and esophagitis
Infection in transplant recipients
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2 mins
Cytomegalovirus (CMV) TORCH
Signs and Symptoms
Nonspecific TORCH symptoms
Intrauterine Growth Restriction (Retardation)
Deafness
Microcephaly
Seizures
Periventricular Calcifications
Petechial Rash
Blueberry Muffin Rash
Chorioretinitis
Diagnosis
Urine Viral Culture or PCR
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2 mins
Genital Herpes
Mechanism
Herpes Simplex Virus 1 and 2 (HSV)
Assessment
May Be Asymptomatic
Oral or Genital Lesions
Vesicles in Clusters
Pain
Flu-like Symptoms
Antiviral Medications
Acyclovir
Valacyclovir
Famciclovir
Considerations
Infectious During Recurrences
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2 mins
Acyclovir (Zovirax)
Mechanism
Guanosine Analog
Inhibits Viral Replication
Thymidine Kinase Activation
Indications
Herpes Simplex Virus (HSV)
Varicella Zoster Virus (VZV)
Side Effects (Oral)
Headache
GI Distress
Side Effects (IV)
CNS Toxicity
Nephrotoxicity (Crystalline Nephropathy)
Considerations
Prevents Recurrent Episodes
Slow IV Infusion
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2 mins
Human Immunodeficiency Virus (HIV) Diagnosis
HIV-1/2 Antigen/Antibody Immunoassay
HIV-1/2 Antibody Differentiation Immunoassay
Nucleic Acid Testing (NAT)
Viral Load
Polymerase Chain Reaction (PCR) in Neonates
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3 mins
Ganciclovir
Indications
Cytomegalovirus (CMV)
Immunocompromised
Mechanism
Guanosine Analog
Disrupts DNA Synthesis
Inhibits Viral DNA Polymerase
Side Effects
Hematologic Effects
Nephrotoxicity
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1 min
Human Immunodeficiency Virus (HIV) Interventions
Interventions
Adequate Nutrition
Small Frequent Meals
IV Hydration
Emotional Support
HIV Medications
HAART
Considerations
Transmission Education
Strict Asepsis for Invasive Procedures
Treat Opportunistic Infections
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2 mins
Human Immunodeficiency Virus (HIV) Stages
Primary Infection
Within 3 Weeks
Flu-like Symptoms
Asymptomatic Stage
Years
Symptomatic Stage
CD4+ < 500
AIDS
Opportunistic Infections
CD4+ < 200
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2 mins
Human Immunodeficiency Virus (HIV) Assessment
Assessment
RNA Retrovirus
CD4+ Helper T Cells
Primary Infection
Flu-like Symptoms
Lymphadenopathy
Symptomatic Stage
Fatigue
Diarrhea
Unexplained Weight Loss
White Spots on Tongue
Persistent Fever
Night Sweats
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2 mins
Respiratory Syncytial Virus (RSV) Assessment
Mechanism
Viral Infection Affecting Epithelial Cells
Signs and Symptoms
Begins After a Upper Respiratory Infection
Copious Secretions
Coughing and Sneezing
Wheezing
Otitis Media or Conjunctivitis (Possible Ear or Eye Drainage)
Poor Feeding
Tachypnea
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2 mins
Respiratory Syncytial Virus (RSV) Interventions
Prophylaxis
Palivizumab (Synagis)
Management
Hospitalization
Contact Precautions
Oxygen
Separate Room
Maintain Fluid Intake
Short-acting Beta-Agonist Bronchodilator
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2 mins
Hepatitis C
Characteristics
Enveloped
RNA Virus
Flavivirus
Icosahedral
SS positive Linear
Clinical Features
Most Cases are Due to IV Drug Use
Turns to Chronic Hepatitis in Over 70% of Cases
Cirrhosis
Hepatocellular Carcinoma
Most Common Indication for Liver Transplantation
Associated With Type I MPGN
Porphyria Cutanea Tarda
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2 mins
Hepatitis A
Characteristics
Picornavirus
4 Week Incubation Period
Fecal-oral
Day Care Centers
Travel to Developing Countries
Signs and Symptoms
Usually Asymptomatic
Acute Disease
Jaundice
Fever
Vomiting
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2 mins
Foscarnet
Indications
CMV Retinitis
Acyclovir-resistant HSV
Mechanism
Does Not Require Activation (by Viral Kinase)
Inhibits Viral DNA Polymerase
Pyrophosphate Analog
Resistance through Mutated DNA Polymerase
Side Effects
Nephrotoxicity
Electrolyte Abnormalities
Hypokalemia
Hypocalcemia
Hypomagnesemia
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2 mins
Fusion Inhibitors
Indications
HIV
Drugs
Maraviroc
Binds CCR-5 on T Cells
Blocks Interaction with gp120
Enfuvirtide
Binds gp41
Inhibits Viral Entry
Side Effects
Skin Reactions at Injection Sites (Enfuvirtide)
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2 mins
Integrase Inhibitors
-gravir Suffix
Indications
HIV
Mechanism
Blocks Insertion of Viral Genome
Inhibit Actions of Integrase
Side Effects
Hypercholesterolemia
Increased LFT's
Insomnia
Increased Creatine Kinase (CK)
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1 min
NRTIs for HIV (Drug Names)
Nucleoside Analog
DEALSZ
Didanosine (DDI)
Emtricitabine (FTC)
Abacavir (ABC)
Lamivudine (3TC)
Stavudine (d4T)
Zidovudine (ZDV)
Nucleotide Analog
Tenofovir (TDF)
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2 mins
Cidofovir
Indications
CMV Retinitis
Acyclovir-Resistant HSV
Mechanism
Inhibits Viral DNA Polymerase
Side Effects
Nephrotoxicity
Administer with Probenecid and IV Saline
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1 min
NNRTI Drug Names
Nevirapine (Viramune)
Rilpivirine (Edurant)
Delavirdine (DLV, Rescriptor)
Efavirenz (EFV, Sustiva)
Etravirine (ETR, Intelence)
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54 secs
NRTIs (Nucleoside Reverse Transcriptase Inhibitors)
Indications
HIV
Pregnancy and Prophylaxis given ZDV
Mechanism
Inhibit Nucleotide Binding to Reverse Transcriptase
Chain Termination
Require Phosphorylation
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1 min
NNRTIs (Non-nucleoside Reverse Transcriptase Inhibitors)
Indications
HIV
Mechanism
Do Not Require Intracellular Metabolism
Inhibits Reverse Transcriptase
Side Effects
Rash
Hepatotoxicity
Vivid Dreams and CNS Symptoms
Contraindication
Pregnancy
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2 mins

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