IV/Pharm test 2 HIV AIDS CANCER

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.

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.