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Chapter 13Chapter 13

Antivirals, Antiretrovirals and Antifungal Medications

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Chapter 13

Lesson 13.1

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Learning ObjectivesLearning Objectives

• Describe how antiviral and antiretroviral medications work

• List common medications used in treating AIDS and AIDS-related fungal infections

• Outline Standard Precautions the nurse takes in limiting exposure to AIDS

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HIV InfectionHIV Infection

Acquired immunodeficiency syndrome (AIDS)– Viral disease– High mortality rate

High-risk populations include:– Homosexual and bisexual men– Intravenous drug users– People in prison – Female sexual partners of people in high-risk groups– Children born to mothers at risk

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AntiviralsAntivirals

Action and Uses • Decrease symptoms of viral infection• Lessen the symptoms of viral illness in

immunocompromised patients or adults and children at risk

Adverse Reactions– Hepatotoxicity, nephrotoxicity, blood

dyscrasias, peripheral neuropathies

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Antivirals (cont.)Antivirals (cont.)

Nursing Implications and Patient Teaching• Medications do not cure• Follow specific storage instructions• Reporting adverse reactions• Administration

– Encourage immunocompromised clients in areas with impure water supplies to drink bottled water only

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AntiretroviralsAntiretrovirals

Action• Interfere with the ability of a retrovirus to

reproduce or replicate• Two types:

– Reverse transcriptase inhibitors• Act early in viral life cycle

– Protease inhibitors• Act later in viral life cycle

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Antiretrovirals (cont.)Antiretrovirals (cont.)

Uses– Slow advance of AIDS– Maintain immunity– Prevention of HIV in infants born to HIV-

infected mothers– Prevention of HIV in healthcare workers

exposed to HIV

Drug Interactions

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Antiretrovirals (cont.)Antiretrovirals (cont.)

Nursing Implications and Patient Teaching• Adherence is essential• Medications do not cure• Report all drugs and supplements used,

including OTC and CAM• Signs and symptoms of pancreatitis• Signs and symptoms of peripheral neuropathy

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Antiretrovirals (cont.)Antiretrovirals (cont.)

Nursing Implications and Patient Teaching

(cont.)• Routes of disease transmission• Need for social and financial support

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AntifungalsAntifungals

Action– Fungistatic– Fungicidal

Uses– Treat mycotic infections

• Fungal-specific medications• Systemic medications

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Antifungals (cont.)Antifungals (cont.)

Common Antifungal Medications:Ketoconazole (Nizoral)

• Broad-spectrum fungistatic and fungicidal action• Used to treat oral thrush, candidiasis,

histoplasmosis

Nystatin (Mycostatin)• Antibiotic with fungistatic and fungicidal action• Used to treat intestinal, vaginal, and oral fungal

infections caused by Candida strains

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Antifungals (cont.)Antifungals (cont.)

Common Antifungal Medications (cont.)

Amphotericin B (Amphotec)• Systemic drug

Griseofulvin• Activity decreased with barbiturates

Metronidazole (Flagyl)• Related drug for mixed fungal and bacterial or

protozoa infections; interacts with alcohol

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Antifungals (cont.)Antifungals (cont.)

Nursing Implications and Patient Teaching• Take all the medication as ordered; do not stop when

symptoms disappear• Avoid alcohol• Report nausea, vomiting, and diarrhea; watch for easy

bruising, sore throat, rash, or fever• Nystatin must be shaken thoroughly before use• Intolerance to the sun (photosensitivity) can occur with

griseofulvin therapy• Cleanliness of hair, skin and nails will limit spread