question

Abacavir (Ziagen)

answer

NRTI

question

Emtricitabine (Emtriva)

answer

NRTI

question

Lamivudine (Epivir)

answer

NRTI

question

Didanosine (Videx)

answer

NRTI

question

Zidovudine (Retrovir)

answer

NRTI

question

Tenofovir (Viread)

answer

NRTI

question

Stavudine (Zerit)

answer

NRTI

question

Efavirenz

answer

NNRTI

question

Nevirapine

answer

NNRTI

question

Delavirdine

answer

NNRTI

question

Etravirine

answer

NNRTI

question

Atazanavir (Reyataz)

answer

PI

question

Amprenavir (Agenerase)

answer

PI

question

Darunavir (Prezista)

answer

PI

question

Fosamprenavir (Lexiva)

answer

PI

question

Indinavir (Crixivan)

answer

PI

question

Lopinavir/Ritonavir (Kaletra)

answer

PI

question

Nelfinavir (Viracept)

answer

PI

question

Ritonavir (Norvir)

answer

PI

question

Saquinavir (Invirase)

answer

PI

question

Tipranavir (Aptivus)

answer

PI

question

Enfuvirtide (Fuzeon)

answer

The only agent approved in this class (EI) Entry Inhibitors; acts by a mechanism that inhibits pg41 fusion to prevent HIV cell entry; prevention of the fusion of HIV and CD4 cell and prevents passing the viral genome to the CD4 cell.EI

question

Raltegravir (Isentress)

answer

Integrase Inhibitor (II) (Future/Agents under investigation) Block the insertion of HIV DNA into human DNA by attacking the enzyme that allows thenm to merge. Effective in those clients who had failed other HIV medication regimens.

question

Trizivir

answer

NRTI combo abacavir + lamivudine + zidovudine

question

Combivir

answer

NRTI combo lamivudine + zidovudine

question

Epzicom

answer

NRTI combo abacavir + lamivudine

question

Truvada

answer

NRTI combo emtricitabine + tenofovir

question

Atripla

answer

NRTI + NNRTI combo emtricitabine + tenofovir + efavirenz

question

Protease Inhibitors (PI)

answer

combined with RT inhibitors can reduce viral plasma levels to undetectable levels, offering significant clinical benefits; improved immunological function and prolonged client survival; leading to sustained viral suppression.

question

The goals of Antiretroviral Therapy

answer

1. Suppress viral replication to slow the decline in the number of CD4 cells 2. Suppress viral replication to undetectable levels 3. Reduce the incidence and severity of opportrunistic infections 4. Minimize adverse effect of antiretroviral therapy 5. Improve quality of life 6. Improve survival and reduce morbidity

question

Name of inhibitors that make up the classification of drugs known as Antiretroviral Therapy

answer

1. Reverse transcriptase inhibitors (RTIs) 2. protease inhibitors (PIs) 3. Entry inhibitors (EI)

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Reverse transcriptase inhibitors (RT) inhibitors

answer

1. Nucleoside analogues (N-RTI) 2. Nonnucleoside analogues (NN-RTI)

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Nucleoside analogues (N-(RTI)

answer

Inhibit synthesis of HIV by blocking growth of its DNA Strand

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Nonnucleoside analogues (NN-(RTI)

answer

Bind to the center of reverse transcriptase and directly inhibit its production Metabolized by cytochrome P450

question

Entry Inhibitors (EI)

answer

The only agent approved in this class; acts by a mechanism that inhibits pg41 fusion to prevent HIV cell entry; prevention of the fusion of HIV and CD4 cell and prevents passing the viral genome to the CD4 cell.

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NRTIs complications

answer

Lactic acidosis, hepatic steatosis, peripheral neuropathy, myopathy, pancreatitis, and chronically lipoatrophy.

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Lipoatrophy

answer

Wasting of fat on the exremities, face, and buttocks

question

Enfuvirtide (Fuzeon) (Nursing considerations)

answer

Must be taken by subcutaneous injection in a dose of 90 mg twice daily Does not require dosage adjustment in clients with renal failure or hepatic impairment. Not metabolized by CYP enzymes Not assoicated with any CYP medicated drug-drug interactions Side effects: rash, diarrhea; Serious allergic reactions, including anaphylaxis, fever and hypotension

question

Tipranavir (Aptivus) (Nursing considerations)

answer

Take with food side effects: rash, hepatotoxicity (has sulfonamide moiety), hyperlipidemia, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia

question

Saquinavir (Invirase) (Nursing considerations)

answer

Take within 2 hr of a meal; side effects- GI intolerance, nausea, vomiting, headache, diarrhea, hyperlipidemia, inceased transaminase levels, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia

question

Didanosine (Videx) (Nursing considerations)

answer

Should be taken 1 hr before meals or two hours after meals for optimal absorption Excreted renally, dosage adjustment in renal insufficiency Side effects: pancreatitis, peripheral neuropathy, nausea, lactic acidosis with hepatic steatosis (rare.

question

Atazanavir (Reyataz) (Nursing considerations)

answer

Take with food, avoid taking with antacids side effects- hyperbilirubinemia, prolinged P-R interval (use with caution in clients with underlyiing conduction defects or concomitant medications that prolong P-R interval) hyperglycemica, fat maldistrubution, possible increased bleeding in clients with hemophilia.

question

Amprenavir (Agenerase) (Nursing considerations)

answer

High fat meal should be avoided; can decrease concentration side effects- GI intolerance, nausea, vomiting, diarrhea, rash, oral paresthesias, hyperlipidemia, inceased transaminase levels, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia.

question

Darunavir (Prezista) (Nursing considerations)

answer

Take with food, (increases concentration) side effects- GI intolerance, nausea, vomiting, diarrhea, rash, oral paresthesias, hyperlipidemia, inceased transaminase levels, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia.

question

Indinavir (Crixivan) (Nursing considerations)

answer

Unboosted: take 1 hr before or 2 hrs after meals; with RTV: may take with or without meals side effects- GI intolerance, nausea,headache, hyperlipidemia, inceased transaminase levels, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia, Nephrolithiasis, indirect hyperbilirubinemia, asthenia, blurred vision, dizziness, metallic taste, thrombocytopenia, alopecia, hemolytic anemia.

question

Lopinavir/Ritonavir (Kaletra) (Nursing considerations)

answer

Take tablet with or without food; take oral solution with food side effects- GI intolerance, nausea, vomiting, diarrhea, asthenia, hyperlipidemia, inceased transaminase levels, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia.

question

Nelfinavir (Viracept) (Nursing considerations)

answer

Take with meal or snack side effects- diarrhea, hyperlipidemia, inceased transaminase levels, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia.

question

Ritonavir (Norvir) (Nursing considerations)

answer

Take with food if possible; take with meal or snack side effects- GI intolerance, nausea, vomiting, diarrhea, rash, paresthesias, hyperlipidemia, inceased transaminase levels, hyperglycemia, fat maldistribution, possible increased bleeding in clients with hemophilia, Hepatitis, taste perversion.

question

Zidovudine (Retrovir) (Nursing considerations)

answer

Medication used in pregnancy for preventing HIV from being passed form mother to child. Maternal **Begins at 14-34 weeks gestation until start of labor; then administer via IV. Neonatal **Begins 8-12 hrs after birth and for first 6 weeks.

question

Antiretroviral Therapy in Pregnancy goals are:

answer

** Prevent mother-to-child transmission. ** Achieve viral suppression to less than 1000 copies/ml to reduce the risk of transmission of HIV to the fetus or newborn.

question

End-Stage AIDS symptoms

answer

Pain, general weight loss, anorexia, neuropathies, dementia, constipation, diarrhea, depression, nausea, and vomiting.

question

Causes of death in AIDS

answer

Liver, kidney failure, malignancies, pneumonias, and end-stage AIDS.

question

Causes of HIV transmission to health care workers

answer

Exposure to a device (needle, scalpel) with visible blood, a needle placed in an artery or vein, a deep injury, large volume losses, or exposure to infectious materials containing a high viral load.

question

Managment of potential HIV exposure

answer

** Initiate within hours ** Continue for 4 weeks ** Two-drug regimen (basic regimen) and/or expaned postexposure prophylaxis (PEP) (lopinavir/ritonavir (Kaletra)

question

Promote client's adherence to the ____ ____.

answer

therapeutic regimen

question

Help client understanding of their ____, ____ ____, ____ and ____ ____.

answer

medication, dosage schedule, food, fluid restrictions.

question

Recommend ____ ____, and ____ of medications is crucial to adherence.

answer

food choices, storage

question

____ representation of the medications and a ____ designed for medications to be taken four time a day may be helpful.

answer

Pictorial, pillbox

question

Other helpful hints includes taking medication with a ____ ____, such as brushing the teeth or feeding the pet; having a ______ remind the client to take the medication.

answer

daily routine, friend

question

A ____ ____ ____ relationship is essential.

answer

trusting client-provider

question

Common with CD4 cell count < 200 cells/ml

answer

**Candida esophagitis **Bacillary angiomatosis **Pneumocystis carinii pneumonia (PCP) also known as(penumocystic jiroveci pneumonia)

question

Common with CD4 cell count < 100 cells/ml

answer

**Cryptococcal meningitis **AIDS dementia **Toxoplasmosis encephalitis encephalitis **Progressive multifocal leukoencephalopathy **Wasting syndrome **Cryptosporidium

question

Common with CD4 cell count < 50 cells/ml

answer

**Mycobacterium avium complex (MAC) **Cytomegalovirus infection

question

Common with CD4 cell count < 350 cells/ml

answer

**Herpes **Tuberculosis **Kaposi sarcoma

question

Highly active antiretroviral therapy (HAART)

answer

***Consist of at least three agents ***Responsible for the reduction in the incidence of opportunistic infections among HIV-postive clients. ***Improved the course of the HIV epidemic

question

Benefit of Highly active antiretroviral therapy (HAART)

answer

**Improved CD4 counts and overall survival **Improved undetectable viral loads by decreasing it. **Preserving and increasing teh number of CD$ T cells, **Preventing resistance and secondary infections and cancer.

question

Regimen of Highly active antiretroviral therapy (HAART)

answer

Contain two nucleoside/nucleotide revers transcriptase inhibitors (NRTI) and either a nonnucleotide reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted or unboosted protease inhibitor (PI).

question

AIDS

answer

Applies to the most advance stages of an HIV infections, characterized by profound immunologic deficits, opportunisitic infection, secondary infections, and malignant neoplasms.

question

Pathology of HIV

answer

Once a person is infected with HIV, crucial immune cells CD4 T cells are disabled and killed. During the course of infection CD4 T cells decline.

question

CD4 T cells

answer

** Plays a crucial role in the immune response ** Signals other cells in the immune system to perform their special functions. ** Also called T-lymphocytes, T-cells, T-helper cells ** Helps to determine if other infections (opportunistic infections) may occur ** Shows the effect of the virus on the immune system.

question

Immune system

answer

Lymphatic tissues, organs, and processes that identify foreign antigens and prevent harm to body.

question

Transmission of HIV

answer

**Sexual contact (oral, vaginal, anal) **Direct blood contact (shared needles, blood transfusions, mother to child (through shared maternal-fetal blood circulation, by direct blood contact during delivery, or in breast milk). ** Accidental needle injury, artificial insemination with donated semen and organ transplant. ** Infants born to mothers with HIV who do not receive HIV therapy during pregnancy.

question

Two markers for determining initiation of treatment and monitoring the efficacy of therapy are the ____ ___ cell count and the _____ _____ _____ or ____ _____.

answer

CD4 T cell, plasma HIV RNA, viral load (VL)

question

Viral Load

answer

**A test to measure the status of person's immune system. **Measures how much HIV is in the blood. **Monitors changes in the HIV infection, guides treatment choices, and monitors how well treatment is working.

question

Normal values for CD4 T cells

answer

800 - 1200 CD4 T cells/mm

question

Adequate treatment response is defined by:

answer

**Increase in CD4 cell count averaging 100-150 cells/mm per year with increase wtihin the first 3 months. **

question

If the viral load _____ , the infection is getting worse; if it ______, the infection is being suppressed.

answer

increases, decreases

question

Viral Load value range goal of therapy are:

answer

** Is a viral load below the limits of detection (< 50-80 copies/ml depending on the essay used). ** Achieved by 16-24 weeks of therapy.

question

The 3 types of HIV viral load assays are:

answer

1. HIV-1 reverse transcriptase polymerase chain reaction assay 2. Nucleic acid amplification test for HIV RNA, and 3. Signal amplification nucleic acid probe assay.

question

HIV is:

answer

** A retrovirus ** It uses 3 different enzymes to genetically encode, replicate, and assemble new virus within the cells (HIV can replicate only inside cells). **

question

HIV consist of 3 enzymes they are:

answer

1. Reverse transcriptase 2. Integrase 3. Protease

question

HIV Life Cycle

answer

1. Virus enters the cell through the CD4 molecule on the cell surface. 2. Reverse transcriptase (RT) enzymes uncoats the virus and a single-stranded viral RNA is converted into DNA. 3. The viral DNA migrates to the nucleus of the cell, where it is spliced into the host DNA by the second enzyme Integrase. 4. Once incorporated, HIV DNA is called the provirus and is duplicated together with the cell genes everytime the cell divides. 5. Protease the third enzyme, assists in the assembly of newly formed viral particles.

question

Indications for Antiretroviral Therapy

answer

** Asymptomatic clients with a CD4 T cell count 350 and viral load > 100,000 copies/ml

question

Appropriate agents are selected based on _____, ____ ____, ____ ____, food restriction, side effects and potenital ____ ____ interactions.

answer

co-morbidities, pregnancy status, adherence potential, drug-drug

question

Combination therapy known as ___ ____ ____ ____ is the current treatment recommendation.

answer

highly active antiretroviral therapy (HAART)

question

Medications designed to slow or inhibit the three HIV-related enzymes are called_________ medications.

answer

Antiretroviral

question

Client Teaching - General

answer

**explain how virus may cause severe damage to the immune system. ** Describe modes of transmission of the virus. **Explain common emotional responses. **Explain the need for monitoring health practices. **Emphasize protective precautions to decrease risk of exposure and infection as necessary **Advise client not to visit anyone with any type of respiratory infection. **Provide information about manageing future pregancies to reduce risk of HIV transmission to unborn children. **Provide personal drug therapy plan in writing **Inform client that certain foods and herbal products may interact with antiretrovirals. **Establish client/family partnership in the plan.

question

Client Teaching - Self-Administration

answer

**Assist client to develop a system for taking the correct dose of the correct medications at the correct time **Instruct client in importance of having an adequate supply of medication so there is no interruption in the schedule. **For pediatric clients teach swallowing techniques

question

Client Teaching - Diet

answer

**Advise client to eat a variety of foods, **Advise client how to minimize side effects (take specific drug with food) **Discuss BRAT diet (Banana, rice, applesauce and toas) for management of diarrhea.

question

Nursing Interventions

answer

**Promote adherence/compliance to the therapeutic regimen **Promote meticulous hand washing; apply standard precautions **Administer increased fluids, up to 2400 ml/d unless contraindicated **Monitor laboratory reports for indications of decreasing CD4 T-lymphocyte cell counts; inform primary care provider **Refer client for preventive care measures including annual PAP, eye, and dental examinations. **Refer client for nutritional counseling. **Refer client for spiritual support.

question

Dx Ineffective health maintenance related to

answer

knowledge deficit about HIV/AIDS

question

Dx Fear related to

answer

potential outcome of HIV screening

question

Dx Imbalanced nutrition; less than body requirements related to

answer

nausea and vomiting

question

Dx Ineffective coping and/or comprimised family coping related to

answer

situational crises

question

Dx Risk for infection related to

answer

compromised immune system (CD4 cell count < 200

question

Dx Inffectrive therapeutic regimen adherence related to

answer

difficulty managing medications and lack of knowledge about drug interactions with food

question

Dx Distrubed body image related to

answer

excess weight loss

question

Dx Deficient knowledge related to

answer

medication management

question

Dx Impaired memory related to

answer

diseas progression

question

Assess for ____ and ____ disorders; use of ____ ____.

answer

renal, hepatic, oral contraceptives

question

Assess for signs and symptoms related to clinical progression toward a ____ ____ ____ including profound involuntary weight loss, chronic diarrhea, chronic weight loss, intermittent or constant fever.

answer

depressed immune system

question

Refer hight risk clients who test _____ to counseling

answer

negative

question

Obtain client history for clients who test _____ for HIV.

answer

postive

question

Efavirenz (Nursing consideration)

answer

First-choice drug within NNRTI class **contraindicated in pregnancy (Category D) b/c neural tube defects have been reported after early human gestational exposure. **CNS toxicities including dizziness, sedation, nightmares, euphoria, or loss of concentration may occur in up to 50% of clients. **use cautiously in clients with depression or a history of preeexisting psychiatric or mental illness

question

Nevirapine (Nursing consideration)

answer

**Used as an alternative in adult females during pregnancy or women who are planning to conceive **greater risk of severe rash and hepatotoxicity.

question

Delavirdine (Nursing consideration)

answer

** Least potent antiviral activity **Not recommended as part of an initial regimen

Chapter 34 – Antiretroviral Agents HIV- and AIDS-Related Drugs – Flashcards

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