IV/Pharm test 2 HIV AIDS CANCER

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Questions and Answers

What is the purpose of administering colony-stimulating factors like filgrastim in chemotherapy?

To manage mucositis and stomatitis

To alleviate nausea and vomiting

To stimulate white blood cell production (correct)

To promote hair regrowth

Which dietary approach can help a patient undergoing chemotherapy manage their anorexia and nausea?

Consuming several small, low-fat meals (correct)

Eating large meals three times a day

Incorporating only liquid diets

Promoting the intake of high-fat foods

What is a common recommendation for managing mucositis in chemotherapy patients?

Use alcohol-based mouthwash regularly

Avoid soft toothbrushes

Perform oral hygiene after meals (correct)

Document oral examinations weekly

What is the primary action of maraviroc in HIV treatment?

Prevents HIV from entering lymphocytes Signup and view all the answers

Which precaution is NOT recommended for a patient undergoing chemotherapy due to neutropenia?

Having multiple visitors during treatment Signup and view all the answers

When is hair loss typically expected to occur after chemotherapy treatment?

7-10 days following treatment Signup and view all the answers

Which adverse effect is associated with acyclovir usage?

Nephrotoxicity Signup and view all the answers

What is a significant contraindication for using ganciclovir?

Neutrophil count of less than 500/mm Signup and view all the answers

What is the purpose of combining 3-4 HIV medications in treatment?

To reduce dosages and side effects Signup and view all the answers

What precaution should be taken when administering chemotherapy?

Wear proper personal protective equipment (PPE) Signup and view all the answers

Which strategy is most effective in managing the symptoms of anemia caused by chemotherapy?

Administering erythropoietic medication and monitoring hemoglobin levels Signup and view all the answers

What is an important intervention for managing thrombocytopenia during chemotherapy?

Monitoring for signs of bleeding and avoiding injuries Signup and view all the answers

Which of the following is a recommended practice for a patient experiencing chemotherapy-induced peripheral neuropathy?

Encouraging foot care and maintaining skin integrity Signup and view all the answers

What is an essential nursing intervention to protect chemotherapy patients from infection?

Monitoring vital signs, particularly temperature Signup and view all the answers

Which of the following statements about patient teaching for those undergoing chemotherapy is correct?

Patients should avoid all forms of crowds at all times Signup and view all the answers

What is the main action of non-nucleoside reverse transcriptase inhibitors (NNRTIs)?

Disable a protein needed by HIV to replicate Signup and view all the answers

Which of the following adverse reactions is associated with nucleoside reverse transcriptase inhibitors (NRTIs)?

Bone marrow depression Signup and view all the answers

What is the function of protease inhibitors (PIs) in HIV treatment?

Inhibit HIV's protease enzyme Signup and view all the answers

What criteria must an adult meet to be eligible for pre-exposure prophylaxis (PrEP) with Emtricitabine and tenofovir disoproxil?

Must be willing to engage in safer sex practices Signup and view all the answers

Which medication is classified as an integrase inhibitor?

Raltegravir Signup and view all the answers

What is the administration method for entry or fusion inhibitors like enfuvirtide?

Subcutaneous injection Signup and view all the answers

Which of the following is NOT an example of a protease inhibitor?

Abacavir Signup and view all the answers

What serious adverse reaction is associated with integrase inhibitors like raltegravir?

Suicidal ideation Signup and view all the answers

A patient on antiretroviral therapy reports perioral numbness and tingling. Which class of drugs is MOST likely causing this symptom?

General Antiretroviral medications Signup and view all the answers

Which of the following adverse effects is MOST indicative of lactic acidosis as a result of HIV medication?

Bone marrow suppression, nausea, and hepatomegaly Signup and view all the answers

A patient recently started antiretroviral therapy and develops a rash. While it could be due to several medications, which specific class of drug has a high association with Stevens-Johnson syndrome?

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Signup and view all the answers

A patient is prescribed enfuvirtide. Which of the following administration methods is MOST appropriate?

Subcutaneous injection (SQ) Signup and view all the answers

A patient is taking raltegravir. Which potential adverse effect would require immediate medical attention?

Suicidal thoughts or ideation Signup and view all the answers

Which of the following medication classes targets the ability of HIV to insert its genetic material into CD4 cells?

Integrase Inhibitors Signup and view all the answers

Which of the following antiretroviral medication classes works by blocking a protein essential for HIV replication after the virus has entered the cell?

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Signup and view all the answers

Which of the following mechanisms of action is characteristic of the medication maraviroc?

Blockage of HIV entry into lymphocytes Signup and view all the answers

A patient is prescribed Truvada as PrEP. Which of these statements represents an important requirement for PrEP?

The individual is HIV-negative, with high-risk sexual partners and engages in safer sex practices Signup and view all the answers

Which of the following best describes how NRTIs exert their antiviral effects?

By acting as a decoy and inhibiting the viral DNA synthesis and replication process Signup and view all the answers

A patient undergoing chemotherapy reports a metallic taste while eating meals. Which of the following interventions would be MOST appropriate?

Replace all metal eating utensils with plastic ones. Signup and view all the answers

A patient on ganciclovir has a neutrophil count of 400. This indicates:

Ganciclovir treatment should be temporarily paused due to an increased risk for infection. Signup and view all the answers

A patient on chemotherapy is experiencing mucositis. Which of the following instructions would be LEAST appropriate?

Use an alcohol based mouthwash. Signup and view all the answers

When educating a patient about oral chemotherapy medications, which of these is the most critical?

Never alter prescribed medication forms without consulting the healthcare team. Signup and view all the answers

Which measure is LEAST effective in preventing infection in a patient with neutropenia?

Discarding room temperature beverages after 2 hours. Signup and view all the answers

A patient with thrombocytopenia is being discharged. Which of the following instructions should be emphasized?

Consider only using an electric razor and avoiding sharp objects. Signup and view all the answers

Which action would MOST likely increase the risk of resistance to antiretroviral medications in a patient with HIV?

Skipping doses when feeling better to reduce side effects. Signup and view all the answers

A patient starting chemotherapy is concerned about alopecia. Which teaching point would be MOST helpful?

Texture and color can be different when hair regrows. Signup and view all the answers

A patient has recently started taking acyclovir. Which of the following is the MOST important teaching point to discuss with the patient?

Adequate fluid intake is necessary to prevent kidney damage. Signup and view all the answers

A patient on chemotherapy presents with fatigue, dizziness, and shortness of breath. Which interventions should be prioritized?

Prioritizing rest and monitoring blood counts. Signup and view all the answers

Study Notes

Drug Therapy for HIV/AIDS - Antiretroviral

Used to treat HIV infection and AIDS
Adverse reactions include nausea, vomiting, diarrhea, altered taste, headache, fever, chills, rash, and numbness/tingling (circumorally or peripherally)
Descovy and Truvada (emtricitabine and tenofovir disoproxil) are approved for pre-exposure prophylaxis (PrEP) for HIV prevention in adults engaging in risky sexual practices and who are HIV-negative.
PrEP drugs are used for adults who:Practice safer sex, are confirmed HIV negative, have high-risk sexual partners

Drug Treatment - NNRTIs

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) inhibit (block)a protein needed by HIV to make copies of itself.
Examples include efavirenz (Sustiva), etravirine (Intelence), and nevirapine (Viramune).
Adverse reactions include rash (Stevens-Johnson syndrome), flu-like symptoms, headaches, fatigue, central nervous system (CNS) effects, and nausea/vomiting/diarrhea

Drug Treatment - NRTIs

Nucleoside reverse transcriptase inhibitors (NRTIs) inhibit (block) HIV's DNA synthesis and viral replication.
Examples include abacavir (Ziagen), emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
Adverse reactions include bone marrow depression, lactic acidosis, nausea/vomiting/diarrhea,fatty liver, enlarged liver (hepatomegaly)

Drugs - Protease Inhibitors (PIs)

Protease inhibitors (PIs) block protease, another protein HIV needs to replicate.
Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), and ritonavir (Norvir).

Drugs - Entry or Fusion Inhibitors

These drugs block HIV's entry into CD4 cells.
An example is enfuvirtide (Fuzeon).
Used when other antiretrovirals are ineffective.
Side effects include injection site reactions, bacterial pneumonia, fever, chills, rash, and hypotension.
Administered subcutaneously (SQ).

Drug Treatment - Integrase Inhibitors

Raltegravir (Isentress) blocks integrase, a protein HIV uses to insert its genetic material into CD4 cells.
Adverse reactions include headache, difficulty sleeping, skin rash, liver damage, kidney failure(renal failure),hematuria (blood in urine) and suicidal thoughts.

Drug Treatment - CCR5 Antagonists

Maraviroc (Selzentry) prevents HIV from entering lymphocytes.
Adverse effects include cough, upper respiratory infections (URIs), central nervous system effects (dizziness, paresthesias), liver toxicity (hepatotoxicity), and severe diarrhea (pseudomembranous colitis).

Antivirals

Acyclovir (Zovirax) and ganciclovir (Zirgan) are used for certain viral infections.
Acyclovir can cause nephrotoxicity and needs adequate fluid intake.
Ganciclovir can cause bone marrow suppression requiring CBC and platelet count monitoring.
Contraindicated in patients with low neutrophil counts (<500/mm³) or platelet counts (<25,000/mm³).

Drug Treatment - Combination Therapy

Combining 3-4 HIV medications together reduces resistance, side effects, and increases CD4 counts.
Dosage adjustments and lower doses of specific drugs may be used to decrease side effects.
Monitor liver function tests (LFTs), blood urea nitrogen (BUN), creatinine (Cr), and complete blood counts (CBCs).

Patient Teaching for HIV Medications

Adherence to prescribed medication regimen is crucial to avoid drug resistance.
NEVER adjust the medication regimen without consulting the doctor.
No medication breaks are acceptable.
Keep an extra supply of medications on hand. Maintain a one-week supply of medication on hand.

Chemotherapy

Cytotoxic medication that kills rapidly dividing cells, including cancer cells and healthy cells like skin, hair, intestinal mucosa, and hematopoietic cells.
Absorbed through skin and mucous membranes
Nurse requires personal protective equipment (PPE)
Can cause adverse effects on normal cells that include skin, hair, intestinal and blood-producing cells.
Common administration routes include intravenous (IV), topical, and into body cavities (varies with cancer type and protocol).
Oral medications are just as toxic as intravenous chemotherapy.
Never crush, split, break, or chew oral chemotherapy medication.
Administered through central lines or catheters (long term; port)

Chemotherapy Complications - General

Immunosuppression: neutropenia (low white blood cell count) and bone suppression (check CBC regularly)
Neutropenia Precautions:
Monitor lab values.
Monitor skin and mucous membranes for infection signs.
Use private room and strict hygiene protocols.
Avoid contact with infected people or plants/flowers.
Avoid invasive procedures unless necessary.
Use dedicated equipment in patient rooms.
Administer colony-stimulating factors (e.g., Filgrastim) to increase white blood cell production.
Daily temperature monitoring
Avoid potentially contaminated food (fresh fruits/vegetables, undercooked meat/fish/eggs, and certain spices).
Discard room-temperature beverages after an hour.
Wash dishes thoroughly in hot, soapy water.
Daily cleaning of utensils and personal hygiene items (e.g., bleach-cleaning the toothbrush).
Report fevers above 100°F (37.8°C).

Chemotherapy Complications - Specific

Nausea, vomiting, and loss of appetite (anorexia)
Administer antiemetics before meals to prevent.
Antiemetic medications may be needed at home for several days after chemotherapy.
Administering anti-nausea drugs in the chemo schedule.
Remove strong smells.
Utilize non-pharmacological strategies (e.g., acupressure, relaxation).
Ensuring adequate nutrition (high protein, high calorie, nutrient-dense meals). Example: Megase
Ensuring small, low-fat dry meals.
Ensuring good oral hygiene (soft toothbrush, mouthwash) to prevent infections.
Use plastic eating utensils to avoid metallic taste.
Identify and avoid food sensitivities.
ALOPECIA*
Alopecia (hair loss) — discuss options like wigs, turbans, or scarves before therapy.
May initiate 7–10 days after treatment.
Temporary, often returns within a few months after therapy.
May differ in texture or color.
Shorten hair before therapy to reduce weight loss and extend time before hair loss.
Protect scalp from sun.
MUCOSITIS AND Stomatitis*
Mucositis and stomatitis (mouth sores).
Use frequent cool water rinses; provide soft toothbrush, and non-alcoholic mouthwash.
Utilize topical anesthetic before meals.
Practice meticulous mouth hygiene, pre-and post-meals.
Use a soft toothbrush and floss gently.
Medications to treat mouth sores.
Soft, cold, bland high-calorie foods.
Avoid alcohol and tobacco.
Monitor for signs of bleeding.
Use electric razors, avoid NSAIDs to prevent bleeding.
Monitor for signs of infection; oral hygiene is critical
Anemia and thrombocytopenia (low blood counts)*
Assess for fatigue, weakness, dizziness, shortness of breath.
Prioritize rest.
Administer erythropoietin medication (e.g., Epoetin alfa).
Provide iron supplements (ferrous sulfate).
Monitor hemoglobin levels regularly.
Thrombocytopenia (low platelet counts)*
Monitor bleeding tendencies
May need blood transfusion or platelet transfusion
Utilize electric razor
Avoid NSAIDs
Prevent injury

Chemotherapy - Treatment Interventions

Monitor IV sites, vesicants, and adverse effects (S/E).
Administer medications to control adverse effects.
Advise patients to wear appropriate protective gear (PPE).
Encourage good oral hygiene.
Advise patients to purchase wigs before hair loss occurs.
Monitor lab work to detect side effects/complications.
Monitor vital signs to detect infections.
Protect the patient from injury. Monitor for signs of infection, especially fever.

Chemotherapy - Patient Teaching

WARN patients to report any signs of infection.
Encourage good hygiene practices.
Emphasize good perineal care.
Advise avoiding crowds/people during the flu season.
Warn patients to avoid eating uncooked foods and clean them thoroughly.

Adverse Reactions/Precautions in Anti-Cancer Drugs

Bone marrow suppression: Monitor to detect and prevent infection.
Nausea and vomiting: Anti-nausea medications are important in treating and preventing these symptoms.
Gastroenterological distress (GI disturbances): Dietary changes can help with this.
Alopecia (hair loss): Options like wigs, turbans, and scarves can be discussed before therapy.
Pregnancy: Contraindicated, and inform patients before treatment.
Chemo-induced Peripheral Neuropathy.
- Assess sensations for loss (hands, feet, limbs).
- May cause pain.
- Monitor for orthostatic hypotension.
- Evaluate for erectile dysfunction.
- Ensure proper foot care.
Chemotherapy management requires a multidisciplinary team to monitor side effects.
Protect the IV site as chemotherapy is vesicant.
Administer medications to control side effects.
Maintain good oral hygiene.
Encourage wig use if appropriate.
Regularly monitor lab work (CBCs, complete metabolic panels, etc.).
Prevent injuries.
Monitor vital signs (especially temperature which is a critical sign of infection, even in readings that appear lower than expected).
Wear protective gear when handling chemotherapy drugs and body fluids for 48 hours after administration.
Educate patients about side effect recognition, hygiene, avoiding crowds, clean handling of food, and other precautions.

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Description

This quiz covers essential information about drug therapy for HIV/AIDS, focusing on antiretroviral medications. It includes details about adverse reactions, specific drugs such as Descovy and Truvada, and the mechanisms of action for NNRTIs and NRTIs. Test your knowledge on the various treatments available and their side effects.