HIV Treatment with Antiretrovirals
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HIV Treatment with Antiretrovirals

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Questions and Answers

What is the primary indication for Hydroxychloroquine?

  • Osteoporosis
  • Rheumatoid Arthritis and Lupus (correct)
  • Malaria
  • Gout

    • How often should patients taking bisphosphonates receive calcium serum level monitoring?

  • Before administration only
  • Not necessary
  • After administration only
  • Before and after administration (correct)

    • What is the primary mechanism of action of Allopurinol?

  • Increase fluid excretion
  • Decrease inflammation
  • Increase uric acid excretion
  • Prevent formation of uric acid (correct)

    • What is the primary action of Calcitonin?

    <p>Stimulate osteoblasts</p> Signup and view all the answers

    What is the primary use of Keratolytics?

    <p>To remove excess keratin</p> Signup and view all the answers

    What is a contraindication for the prolonged use of Keratolytics?

    <p>Infants and clients with diabetes or impaired circulation</p> Signup and view all the answers

    Which of the following antiretroviral medications is a CCR5 antagonist?

    <p>Maraviroc (Selzentry)</p> Signup and view all the answers

    A patient with HIV is being treated with HAART. Which of the following is NOT a goal of HAART therapy?

    <p>Increase susceptibility to infection</p> Signup and view all the answers

    A patient is taking Nelfinavir (Viracept) for HIV. Which of the following adverse effects is most likely to be associated with this medication?

    <p>Lipodystrophy</p> Signup and view all the answers

    A patient with HIV has a CD4 count of 150. Which of the following prophylactic medications is indicated?

    <p>Rifabutin</p> Signup and view all the answers

    A patient with HIV is experiencing muscle pain and cramps. Which of the following antiretroviral medications is most likely responsible for this adverse effect?

    <p>Zidovudine (Retrovir)</p> Signup and view all the answers

    Which of the following medications is classified as a Non-Steroidal Anti-inflammatory Drug (NSAID)?

    <p>Acetylsalicylic Acid (Aspirin)</p> Signup and view all the answers

    What is the primary action of Collagenase?

    <p>Digesting and removing dead tissue from wounds</p> Signup and view all the answers

    Which of the following is a characteristic of Antiseptics?

    <p>Inhibiting bacterial growth</p> Signup and view all the answers

    What is the primary indication for Etanercept?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What is the primary action of Retinoids?

    <p>Increasing the growth of epithelial cells</p> Signup and view all the answers

    What is the primary use of Hydrogen peroxide?

    <p>Acting as a broad spectrum antimicrobial killer</p> Signup and view all the answers

    What is the purpose of the REEDA scale?

    <p>Assessing postpartum perineal trauma and healing</p> Signup and view all the answers

    Which of the following adverse drug reactions can occur with NSAIDs?

    <p>Gastrotoxicity</p> Signup and view all the answers

    What is the primary action of Acetaminophen and what are its indications?

    <p>Pain reliever; used to reduce fever</p> Signup and view all the answers

    What is the maximum daily dose of Acetaminophen for a person with a history of alcohol use?

    <p>2 grams</p> Signup and view all the answers

    What is a common side effect associated with chronic use of corticosteroids?

    <p>Moon face</p> Signup and view all the answers

    Which of the following does NOT accurately describe a characteristic of Methotrexate?

    <p>Ensures rapid improvement in 1 to 2 weeks</p> Signup and view all the answers

    What nursing intervention should be considered for a patient receiving Chrysotherapy?

    <p>Assess for weight gain/loss</p> Signup and view all the answers

    What is the primary use of local anesthetics such as Lidocaine?

    <p>To relieve itching and discomfort</p> Signup and view all the answers

    Which antifungal agent is used topically for treating Candida infections?

    <p>Nystatin</p> Signup and view all the answers

    What nursing implication is crucial when administering an Antineoplastic such as Fluorouracil?

    <p>Children and pets should avoid contact with the cream.</p> Signup and view all the answers

    What is the potential adverse reaction of using antivirals like Docosanol?

    <p>Headache and skin irritation</p> Signup and view all the answers

    What is a key characteristic of corticosteroids in use for dermatological conditions?

    <p>They interfere with the inflammatory response.</p> Signup and view all the answers

    What is a significant side effect of Methotrexate when used as an antimetabolite?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which of the following medications is a TNF (Tumor Necrosis Inhibitor) and is used to treat rheumatoid arthritis?

    <p>Etanercept</p> Signup and view all the answers

    Which of the following medications requires the patient to be registered with a specific program before they can be dispensed?

    <p>Infliximab</p> Signup and view all the answers

    A patient is prescribed Tretinoin for acne. Which of the following is NOT a potential adverse effect of this medication?

    <p>Increased risk of infections</p> Signup and view all the answers

    Which of the following antiseptics is used prior to surgery to cleanse the body?

    <p>Chlorhexidine</p> Signup and view all the answers

    A patient is being treated with Collagenase for a wound. What is the primary action of this medication?

    <p>Digest and remove dead tissue</p> Signup and view all the answers

    Which of the following medications is an oral contraceptive used to treat acne?

    <p>Ethinyl Estradiol / Norgestimate</p> Signup and view all the answers

    Which of the following statements about Hydrogen peroxide is FALSE?

    <p>It is typically used in high concentrations for wound care</p> Signup and view all the answers

    A patient is receiving treatment for a surgical wound. Which of the following wound care principles should be followed?

    <p>R.E.E.D.A. (for surgical wounds)</p> Signup and view all the answers

    Which of the following is NOT a potential adverse effect of Infliximab?

    <p>Skin discoloration</p> Signup and view all the answers

    What is the primary indication for the use of Povidone-iodine (Betadine)?

    <p>Antiseptic for skin cleansing</p> Signup and view all the answers

    Which antiretroviral medication is classified as an Integrase Inhibitor and is used to inhibit the integration of viral genetic material into the host cell?

    <p>Raltegravir (Isentress)</p> Signup and view all the answers

    What is the primary goal of Highly Active Antiretroviral Therapy (HAART) in the treatment of HIV?

    <p>To decrease viral load and increase CD4 counts</p> Signup and view all the answers

    Which of the following antiretroviral medications is associated with the adverse effect of Lipodystrophy?

    <p>Nelfinavir (Viracept)</p> Signup and view all the answers

    What is the mechanism of action of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?

    <p>They inhibit the conversion of RNA to DNA</p> Signup and view all the answers

    Which of the following is NOT a characteristic of Protease Inhibitors?

    <p>They inhibit the integration of viral genetic material into the host cell</p> Signup and view all the answers

    What is the primary action of Probenecid?

    <p>Enhance uric acid excretion in urine</p> Signup and view all the answers

    What is a common side effect of Bisphosphonates?

    <p>Gastrointestinal upset</p> Signup and view all the answers

    What is the primary use of Calcitonin?

    <p>To treat osteoporosis by increasing bone density</p> Signup and view all the answers

    What is the primary indication for Sulfasalazine?

    <p>To treat rheumatoid arthritis</p> Signup and view all the answers

    What is the primary action of Colchicine?

    <p>To decrease inflammation and prevent gout attacks</p> Signup and view all the answers

    Which medication is indicated for treating psoriasis by restoring the normal rate of epidermal cell proliferation?

    <p>Calcipotriene</p> Signup and view all the answers

    What significant precautions must be taken when using Fluorouracil topically?

    <p>It should be kept away from pregnant women and children.</p> Signup and view all the answers

    Which of the following local anesthetics can be used to provide temporary relief from itching and discomfort?

    <p>Lidocaine</p> Signup and view all the answers

    Which medication helps treat rosacea by preventing and treating minor skin infections?

    <p>Metronidazole</p> Signup and view all the answers

    What is a common adverse reaction to the use of Methotrexate when used as an antimetabolite?

    <p>Thrombocytopenia</p> Signup and view all the answers

    A patient is being treated for a wound with Collagenase. Which of the following BEST describes the primary action of this medication?

    <p>It promotes the breakdown and removal of necrotic tissue, aiding in wound debridement.</p> Signup and view all the answers

    A patient is prescribed Tretinoin (Retin-A) for acne. Which of the following BEST explains the medication's mechanism of action in treating acne?

    <p>It promotes the growth of epithelial cells, leading to faster healing of acne lesions.</p> Signup and view all the answers

    A patient is prescribed Infliximab (Remicade) for rheumatoid arthritis. Which of the following statements is TRUE regarding the mechanism of action of this medication?

    <p>It inhibits the production of antibodies that attack the body's own tissues, reducing autoimmune reactions.</p> Signup and view all the answers

    Which of the following medications requires the patient to be registered with a specific program before they can be dispensed?

    <p>Tretinoin (Retin-A, Renova, Atralin, Ativa)</p> Signup and view all the answers

    A patient is being treated with a wet-to-moist dressing for a wound. Which of the following medications is most likely to be used as an irrigant for this dressing?

    <p>Sodium Hypochlorite Solution (Dakin’s Solution)</p> Signup and view all the answers

    A patient is prescribed Methotrexate for rheumatoid arthritis. Which of the following nursing interventions is MOST crucial to monitor for potential adverse effects?

    <p>Monitor for signs of liver dysfunction and hematologic changes</p> Signup and view all the answers

    A patient with a history of alcohol use is prescribed Acetaminophen for pain relief. Which of the following is the MAXIMUM safe daily dose for this patient?

    <p>2 grams</p> Signup and view all the answers

    A patient is prescribed Ibuprofen for arthritis. Which of the following statements is TRUE regarding the recommended dosage?

    <p>The recommended daily dose for arthritis is 1200 - 2400 mg and can be decreased to 800 - 1200 mg for mild to moderate pain.</p> Signup and view all the answers

    A patient is prescribed a corticosteroid for inflammation. Which of the following statements is TRUE regarding the potential adverse effects?

    <p>Corticosteroids can cause mood swings, weight gain, and fluid retention.</p> Signup and view all the answers

    A patient is receiving Chrysotherapy for rheumatoid arthritis. Which of the following nursing interventions is MOST important to monitor for potential adverse effects?

    <p>Monitor for signs of hypersensitivity reactions and metallic taste</p> Signup and view all the answers

    Study Notes

    Antiretrovirals

    • HIV treatment: inhibit replication of the virus
    • Nucleoside Reverse Transcriptase Inhibitors (NRTI):
      • Inhibit enzyme reverse transcriptase
      • Stop replication in infected cells
      • Examples: Zidovudine (Retrovir)
      • Adverse effects: Lactic acidosis, diarrhea, SOB, muscle pain, hepatotoxicity, lipodystrophy
    • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI):
      • Bind directly to reverse transcriptase
      • Prevent RNA to DNA conversion
      • Examples: Delavirdine (Rescriptor)
      • Adverse effects: Hypersensitivity, Steven Johnson Syndrome, hepatitis
    • Integrase Inhibitors:
      • Block protein integrase
      • Prevent viral genetic material insertion into cells
      • Examples: Raltegravir (Isentress)
      • Adverse effects: Allergy, N&V, diarrhea, hepatotoxicity, fever
    • Protease Inhibitors:
      • Act against protease to prevent protein assembly
      • Examples: Nelfinavir (Viracept)
      • Adverse effects: Lipodystrophy, hyperlipidemia, diabetes
    • Fusion Inhibitors:
      • Inhibit viral duplication
      • Bind with viral particles
      • Examples: Enfuvirtide (Fuzeon)
      • Adverse effects: Neutropenia, pneumonia, injection site reaction
    • CCR5 Antagonists:
      • Prevent entry of CCR5 tropic HIV-1 into cells
      • Examples: Maravviroc (Selzentry)
      • Adverse effects: Respiratory infection, musculoskeletal, hepatotoxic

    Highly Active Antiretroviral Therapy (HAART)

    • Multi-drug approach for HIV treatment
    • Combines 2 NRTI, 1 NNRTI, or 1 protease inhibitor
    • Purpose: decrease drug resistance and improve patient outcomes

    Nursing Implications

    • Baseline testing: HIV antibody, CBC, CD4, HIV RNA
    • Around-the-clock administration
    • Prevent kidney stones
    • Promote adherence
    • Positive outcomes: decrease viral load, increase CD4, decrease serious illness, improved quality of life
    • Treatment of Candida: Fluconazole (Diflucan)
    • Treatment of Pneumocystis Carinii Pneumonia (PCP): Trimethoprim/Sulfamethoxazole (Bactrim, Septra)
    • Treatment of Mycobacterium intracellular Avium Complex (MAC): Macrolides, Rifampin (TB drug), Rifabutin

    Arthritis Medications

    NSAIDs

    • Mechanism of action: inhibit prostaglandin synthesis
    • Inhibit cyclooxygenase (COX enzyme)
    • Examples: Salicylates, Non-Salicylates
    • Salicylates:
      • Acetylsalicylic Acid (Aspirin)
      • Indications: anti-inflammatory, pain, fever
      • Adverse effects: hypersensitivity, gastrotoxicity, neurotoxicity, hematologic reactions, hepatotoxicity, Reye's syndrome
    • Non-Salicylates:
      • Ibuprofen (Advil, Motrin)
      • Naproxen (Aleve, Naprosyn)
      • Celecoxib (Celebrex)
      • Adverse effects: gastrotoxic, neurotoxic, hematologic reactions, hepatotoxic, cardiotoxic

    Acetaminophen

    • Mechanism of action: unknown
    • Indications: mild to moderate pain, fever reducer
    • No anti-inflammatory effects
    • Adverse effects: gastrotoxic, neurotoxic, hematologic reactions, hepatotoxic, cardiotoxic

    Corticosteroids

    • Indications: inflammation, pain, arthritis
    • Examples: prednisone
    • Adverse effects: mood swings, weight gain, fluid retention, increased blood pressure, increased blood sugar
    • Client education: diet, exercise, taper medication, 6 S's (sugar, soggy bones, sick, sad, salt, sex)

    DMARDs

    • Disease Modifying Anti-Rheumatic Drugs
    • Examples: Chrysotherapy, Biologics, Sulfasalazine, Methotrexate, Hydroxychloroquine
    • Prevents further damage to cartilage
    • Chrysotherapy:
      • Gold Salts (metal)
      • Examples: Auranofin (Ridaura)
      • Adverse effects: hypersensitivity, GI, integumentary, hematologic, nephrotoxic
    • Biologics:
      • Infliximab (Remicade)
      • Adverse effects: heart failure, lupus-like syndrome, injection site reactions, liver function
    • Methotrexate:
      • Folic acid antagonist
      • Examples: methotrexate
      • Adverse effects: hepatotoxicity, risk lymphoma, mouth sores
    • Hydroxychloroquine:
      • Anti-malarial
      • Examples: hydroxychloroquine
      • Adverse effects: unknown, monitor CBC, take with meals

    Anti-Gout

    • Colchicine (Colcrys)
      • Action: unknown, decrease inflammation
      • Examples: colchicine
      • Adverse effects: NVD
    • Uric Acid Inhibitor: Allopurinol (Zyloprim)
      • Action: prevent uric acid formation
      • Examples: allopurinol
      • Adverse effects: alopecia, N&V, diarrhea, bone marrow depression, SJS, purpuric rash
    • Uricosuric: Probenecid (Probalan)
      • Action: enhance uric acid excretion in urine
      • Examples: probenecid
      • Adverse effects: headache, fever, dizziness, pruritus, rash, N&V, anorexia

    Anti-Osteoporosis

    • Bisphosphonates
      • Action: inhibit osteoclast
      • Examples: ibandronate (Boniva), alendronate (Fosamax), risedronate (Actonel)
      • Adverse effects: gastrotoxic, esophageal ulcerations, bone pain, headache
    • Hormones
      • Calcitonin (Miacalcin)
      • Examples: calcitonin
      • Adverse effects: unknown, monitor calcium serum levels
    • Selective Estrogen Receptor Modulators
      • Examples: raloxifene
      • Adverse effects: unknown
    • Bone Formation Agent
      • Examples: teriparatide
      • Adverse effects: unknown

    Integumentary Drugs

    • Emollients
      • Action: moisturize, soften skin
      • Examples: lanolin, mineral oil, petroleum, aloe
    • Keratolytics
      • Action: break down keratin layer
      • Examples: salicylic acid
      • Adverse effects: burning sensation, rash, dry skin, scaling, flu-like syndrome
    • Local Anesthetics
      • Action: inhibit nerve conduction
      • Examples: lidocaine (Xylocaine)
    • Antifungal/Antimycotic
      • Action: treat fungal infections
      • Examples: ketoconazole (Nizoral), clotrimazole (Lotrimin AF, Mycelex)
    • Antiparasitic/Antipediculosis
      • Action: kill parasites
      • Examples: permethrin (Nix)
    • Antimicrobials
      • Action: prevent/treat minor skin infections
      • Examples: metronidazole (Metrogel)
    • Corticosteroids
      • Action: interfere with inflammatory response
      • Examples: hydrocortisone
    • Antivirals
      • Action: inhibit viral DNA synthesis
      • Examples: docosanol (Abreva)
    • Antineoplastics
      • Action: treat actinic keratosis
      • Examples: fluorouracil (Efudex)
      • Adverse effects: redness, crusting, skin irritation

    Antiretrovirals

    • HIV treatment: inhibit replication of the virus
    • Nucleoside Reverse Transcriptase Inhibitors (NRTI):
      • Inhibit enzyme reverse transcriptase
      • Stop replication in infected cells
      • Examples: Zidovudine (Retrovir)
      • Adverse effects: Lactic acidosis, diarrhea, SOB, muscle pain, hepatotoxicity, lipodystrophy
    • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI):
      • Bind directly to reverse transcriptase
      • Prevent RNA to DNA conversion
      • Examples: Delavirdine (Rescriptor)
      • Adverse effects: Hypersensitivity, Steven Johnson Syndrome, hepatitis
    • Integrase Inhibitors:
      • Block protein integrase
      • Prevent viral genetic material insertion into cells
      • Examples: Raltegravir (Isentress)
      • Adverse effects: Allergy, N&V, diarrhea, hepatotoxicity, fever
    • Protease Inhibitors:
      • Act against protease to prevent protein assembly
      • Examples: Nelfinavir (Viracept)
      • Adverse effects: Lipodystrophy, hyperlipidemia, diabetes
    • Fusion Inhibitors:
      • Inhibit viral duplication
      • Bind with viral particles
      • Examples: Enfuvirtide (Fuzeon)
      • Adverse effects: Neutropenia, pneumonia, injection site reaction
    • CCR5 Antagonists:
      • Prevent entry of CCR5 tropic HIV-1 into cells
      • Examples: Maravviroc (Selzentry)
      • Adverse effects: Respiratory infection, musculoskeletal, hepatotoxic

    Highly Active Antiretroviral Therapy (HAART)

    • Multi-drug approach for HIV treatment
    • Combines 2 NRTI, 1 NNRTI, or 1 protease inhibitor
    • Purpose: decrease drug resistance and improve patient outcomes

    Nursing Implications

    • Baseline testing: HIV antibody, CBC, CD4, HIV RNA
    • Around-the-clock administration
    • Prevent kidney stones
    • Promote adherence
    • Positive outcomes: decrease viral load, increase CD4, decrease serious illness, improved quality of life
    • Treatment of Candida: Fluconazole (Diflucan)
    • Treatment of Pneumocystis Carinii Pneumonia (PCP): Trimethoprim/Sulfamethoxazole (Bactrim, Septra)
    • Treatment of Mycobacterium intracellular Avium Complex (MAC): Macrolides, Rifampin (TB drug), Rifabutin

    Arthritis Medications

    NSAIDs

    • Mechanism of action: inhibit prostaglandin synthesis
    • Inhibit cyclooxygenase (COX enzyme)
    • Examples: Salicylates, Non-Salicylates
    • Salicylates:
      • Acetylsalicylic Acid (Aspirin)
      • Indications: anti-inflammatory, pain, fever
      • Adverse effects: hypersensitivity, gastrotoxicity, neurotoxicity, hematologic reactions, hepatotoxicity, Reye's syndrome
    • Non-Salicylates:
      • Ibuprofen (Advil, Motrin)
      • Naproxen (Aleve, Naprosyn)
      • Celecoxib (Celebrex)
      • Adverse effects: gastrotoxic, neurotoxic, hematologic reactions, hepatotoxic, cardiotoxic

    Acetaminophen

    • Mechanism of action: unknown
    • Indications: mild to moderate pain, fever reducer
    • No anti-inflammatory effects
    • Adverse effects: gastrotoxic, neurotoxic, hematologic reactions, hepatotoxic, cardiotoxic

    Corticosteroids

    • Indications: inflammation, pain, arthritis
    • Examples: prednisone
    • Adverse effects: mood swings, weight gain, fluid retention, increased blood pressure, increased blood sugar
    • Client education: diet, exercise, taper medication, 6 S's (sugar, soggy bones, sick, sad, salt, sex)

    DMARDs

    • Disease Modifying Anti-Rheumatic Drugs
    • Examples: Chrysotherapy, Biologics, Sulfasalazine, Methotrexate, Hydroxychloroquine
    • Prevents further damage to cartilage
    • Chrysotherapy:
      • Gold Salts (metal)
      • Examples: Auranofin (Ridaura)
      • Adverse effects: hypersensitivity, GI, integumentary, hematologic, nephrotoxic
    • Biologics:
      • Infliximab (Remicade)
      • Adverse effects: heart failure, lupus-like syndrome, injection site reactions, liver function
    • Methotrexate:
      • Folic acid antagonist
      • Examples: methotrexate
      • Adverse effects: hepatotoxicity, risk lymphoma, mouth sores
    • Hydroxychloroquine:
      • Anti-malarial
      • Examples: hydroxychloroquine
      • Adverse effects: unknown, monitor CBC, take with meals

    Anti-Gout

    • Colchicine (Colcrys)
      • Action: unknown, decrease inflammation
      • Examples: colchicine
      • Adverse effects: NVD
    • Uric Acid Inhibitor: Allopurinol (Zyloprim)
      • Action: prevent uric acid formation
      • Examples: allopurinol
      • Adverse effects: alopecia, N&V, diarrhea, bone marrow depression, SJS, purpuric rash
    • Uricosuric: Probenecid (Probalan)
      • Action: enhance uric acid excretion in urine
      • Examples: probenecid
      • Adverse effects: headache, fever, dizziness, pruritus, rash, N&V, anorexia

    Anti-Osteoporosis

    • Bisphosphonates
      • Action: inhibit osteoclast
      • Examples: ibandronate (Boniva), alendronate (Fosamax), risedronate (Actonel)
      • Adverse effects: gastrotoxic, esophageal ulcerations, bone pain, headache
    • Hormones
      • Calcitonin (Miacalcin)
      • Examples: calcitonin
      • Adverse effects: unknown, monitor calcium serum levels
    • Selective Estrogen Receptor Modulators
      • Examples: raloxifene
      • Adverse effects: unknown
    • Bone Formation Agent
      • Examples: teriparatide
      • Adverse effects: unknown

    Integumentary Drugs

    • Emollients
      • Action: moisturize, soften skin
      • Examples: lanolin, mineral oil, petroleum, aloe
    • Keratolytics
      • Action: break down keratin layer
      • Examples: salicylic acid
      • Adverse effects: burning sensation, rash, dry skin, scaling, flu-like syndrome
    • Local Anesthetics
      • Action: inhibit nerve conduction
      • Examples: lidocaine (Xylocaine)
    • Antifungal/Antimycotic
      • Action: treat fungal infections
      • Examples: ketoconazole (Nizoral), clotrimazole (Lotrimin AF, Mycelex)
    • Antiparasitic/Antipediculosis
      • Action: kill parasites
      • Examples: permethrin (Nix)
    • Antimicrobials
      • Action: prevent/treat minor skin infections
      • Examples: metronidazole (Metrogel)
    • Corticosteroids
      • Action: interfere with inflammatory response
      • Examples: hydrocortisone
    • Antivirals
      • Action: inhibit viral DNA synthesis
      • Examples: docosanol (Abreva)
    • Antineoplastics
      • Action: treat actinic keratosis
      • Examples: fluorouracil (Efudex)
      • Adverse effects: redness, crusting, skin irritation

    Antiretrovirals

    • HIV treatment: inhibit replication of the virus
    • Nucleoside Reverse Transcriptase Inhibitors (NRTI):
      • Inhibit enzyme reverse transcriptase
      • Stop replication in infected cells
      • Examples: Zidovudine (Retrovir)
      • Adverse effects: Lactic acidosis, diarrhea, SOB, muscle pain, hepatotoxicity, lipodystrophy
    • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI):
      • Bind directly to reverse transcriptase
      • Prevent RNA to DNA conversion
      • Examples: Delavirdine (Rescriptor)
      • Adverse effects: Hypersensitivity, Steven Johnson Syndrome, hepatitis
    • Integrase Inhibitors:
      • Block protein integrase
      • Prevent viral genetic material insertion into cells
      • Examples: Raltegravir (Isentress)
      • Adverse effects: Allergy, N&V, diarrhea, hepatotoxicity, fever
    • Protease Inhibitors:
      • Act against protease to prevent protein assembly
      • Examples: Nelfinavir (Viracept)
      • Adverse effects: Lipodystrophy, hyperlipidemia, diabetes
    • Fusion Inhibitors:
      • Inhibit viral duplication
      • Bind with viral particles
      • Examples: Enfuvirtide (Fuzeon)
      • Adverse effects: Neutropenia, pneumonia, injection site reaction
    • CCR5 Antagonists:
      • Prevent entry of CCR5 tropic HIV-1 into cells
      • Examples: Maravviroc (Selzentry)
      • Adverse effects: Respiratory infection, musculoskeletal, hepatotoxic

    Highly Active Antiretroviral Therapy (HAART)

    • Multi-drug approach for HIV treatment
    • Combines 2 NRTI, 1 NNRTI, or 1 protease inhibitor
    • Purpose: decrease drug resistance and improve patient outcomes

    Nursing Implications

    • Baseline testing: HIV antibody, CBC, CD4, HIV RNA
    • Around-the-clock administration
    • Prevent kidney stones
    • Promote adherence
    • Positive outcomes: decrease viral load, increase CD4, decrease serious illness, improved quality of life
    • Treatment of Candida: Fluconazole (Diflucan)
    • Treatment of Pneumocystis Carinii Pneumonia (PCP): Trimethoprim/Sulfamethoxazole (Bactrim, Septra)
    • Treatment of Mycobacterium intracellular Avium Complex (MAC): Macrolides, Rifampin (TB drug), Rifabutin

    Arthritis Medications

    NSAIDs

    • Mechanism of action: inhibit prostaglandin synthesis
    • Inhibit cyclooxygenase (COX enzyme)
    • Examples: Salicylates, Non-Salicylates
    • Salicylates:
      • Acetylsalicylic Acid (Aspirin)
      • Indications: anti-inflammatory, pain, fever
      • Adverse effects: hypersensitivity, gastrotoxicity, neurotoxicity, hematologic reactions, hepatotoxicity, Reye's syndrome
    • Non-Salicylates:
      • Ibuprofen (Advil, Motrin)
      • Naproxen (Aleve, Naprosyn)
      • Celecoxib (Celebrex)
      • Adverse effects: gastrotoxic, neurotoxic, hematologic reactions, hepatotoxic, cardiotoxic

    Acetaminophen

    • Mechanism of action: unknown
    • Indications: mild to moderate pain, fever reducer
    • No anti-inflammatory effects
    • Adverse effects: gastrotoxic, neurotoxic, hematologic reactions, hepatotoxic, cardiotoxic

    Corticosteroids

    • Indications: inflammation, pain, arthritis
    • Examples: prednisone
    • Adverse effects: mood swings, weight gain, fluid retention, increased blood pressure, increased blood sugar
    • Client education: diet, exercise, taper medication, 6 S's (sugar, soggy bones, sick, sad, salt, sex)

    DMARDs

    • Disease Modifying Anti-Rheumatic Drugs
    • Examples: Chrysotherapy, Biologics, Sulfasalazine, Methotrexate, Hydroxychloroquine
    • Prevents further damage to cartilage
    • Chrysotherapy:
      • Gold Salts (metal)
      • Examples: Auranofin (Ridaura)
      • Adverse effects: hypersensitivity, GI, integumentary, hematologic, nephrotoxic
    • Biologics:
      • Infliximab (Remicade)
      • Adverse effects: heart failure, lupus-like syndrome, injection site reactions, liver function
    • Methotrexate:
      • Folic acid antagonist
      • Examples: methotrexate
      • Adverse effects: hepatotoxicity, risk lymphoma, mouth sores
    • Hydroxychloroquine:
      • Anti-malarial
      • Examples: hydroxychloroquine
      • Adverse effects: unknown, monitor CBC, take with meals

    Anti-Gout

    • Colchicine (Colcrys)
      • Action: unknown, decrease inflammation
      • Examples: colchicine
      • Adverse effects: NVD
    • Uric Acid Inhibitor: Allopurinol (Zyloprim)
      • Action: prevent uric acid formation
      • Examples: allopurinol
      • Adverse effects: alopecia, N&V, diarrhea, bone marrow depression, SJS, purpuric rash
    • Uricosuric: Probenecid (Probalan)
      • Action: enhance uric acid excretion in urine
      • Examples: probenecid
      • Adverse effects: headache, fever, dizziness, pruritus, rash, N&V, anorexia

    Anti-Osteoporosis

    • Bisphosphonates
      • Action: inhibit osteoclast
      • Examples: ibandronate (Boniva), alendronate (Fosamax), risedronate (Actonel)
      • Adverse effects: gastrotoxic, esophageal ulcerations, bone pain, headache
    • Hormones
      • Calcitonin (Miacalcin)
      • Examples: calcitonin
      • Adverse effects: unknown, monitor calcium serum levels
    • Selective Estrogen Receptor Modulators
      • Examples: raloxifene
      • Adverse effects: unknown
    • Bone Formation Agent
      • Examples: teriparatide
      • Adverse effects: unknown

    Integumentary Drugs

    • Emollients
      • Action: moisturize, soften skin
      • Examples: lanolin, mineral oil, petroleum, aloe
    • Keratolytics
      • Action: break down keratin layer
      • Examples: salicylic acid
      • Adverse effects: burning sensation, rash, dry skin, scaling, flu-like syndrome
    • Local Anesthetics
      • Action: inhibit nerve conduction
      • Examples: lidocaine (Xylocaine)
    • Antifungal/Antimycotic
      • Action: treat fungal infections
      • Examples: ketoconazole (Nizoral), clotrimazole (Lotrimin AF, Mycelex)
    • Antiparasitic/Antipediculosis
      • Action: kill parasites
      • Examples: permethrin (Nix)
    • Antimicrobials
      • Action: prevent/treat minor skin infections
      • Examples: metronidazole (Metrogel)
    • Corticosteroids
      • Action: interfere with inflammatory response
      • Examples: hydrocortisone
    • Antivirals
      • Action: inhibit viral DNA synthesis
      • Examples: docosanol (Abreva)
    • Antineoplastics
      • Action: treat actinic keratosis
      • Examples: fluorouracil (Efudex)
      • Adverse effects: redness, crusting, skin irritation

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    Description

    This quiz covers the different types of antiretrovirals used in HIV treatment, including NRTIs and NNRTIs, their mechanism of action, and potential adverse effects.

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