IV therapy HIV Cancer

Drug Therapy for HIV/AIDS - Antiretroviral

• Used for HIV infection and AIDS
• Adverse reactions include nausea, vomiting, diarrhea, altered taste, headache, fever, chills, rash, numbness, and tingling (circumoral or peripherally)
• Descovy and Truvada (emtricitabine and tenofovir disoproxil fumarate) are approved for pre-exposure prophylaxis (PrEP)
• PrEP use is indicated for adults willing to engage in safer sex practices, confirmed HIV negative, and with high sexual risk relationships.

Drug Treatment - Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• NNRTIs disable a protein needed by HIV to make copies of itself
• Examples include efavirenz (Sustiva), etravirine (Intelence), and nevirapine (Viramune)
• Potential adverse reactions are rash (Stevens-Johnson syndrome), flu-like symptoms, headache, fatigue, and central nervous system (CNS) manifestations.

Drug Treatment - Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

• NRTIs inhibit DNA synthesis and viral replication of HIV
• Examples include abacavir (Ziagen), emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
• Potential adverse reactions include bone marrow depression, lactic acidosis, nausea, vomiting, diarrhea, and liver damage (hepatomegaly/fatty liver).

Drugs - Protease Inhibitors (PIs)

• PIs disable protease, another protein HIV needs to make copies of itself
• Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), and ritonavir (Norvir)

Drugs - Entry or Fusion Inhibitors

• These drugs prevent HIV from entering CD4 cells
• Examples include enfuvirtide (Fuzeon)
• Used when other antiretrovirals are not effective
• Possible adverse reactions include localized injection site reactions, bacterial pneumonia, fever, chills, rash, and hypotension.

Drug Treatment - Integrase Inhibitors

• Raltegravir (Isentress) disables integrase, a protein HIV uses to insert its genetic material into CD4 cells
• Potential adverse reactions include headache, difficulty sleeping, skin rash, liver injury, kidney failure (renal failure), blood in the urine (hematuria), and suicidal ideation.

Drug Treatment - CCR5 Antagonists

• Prevent HIV from entering lymphocytes
• Example drug is maraviroc (Selzentry)
• Potential adverse reactions include cough, upper respiratory tract infection (URI), central nervous system (CNS) effects (dizziness, paresthesias), liver damage (hepatotoxicity), and pseudomembranous colitis.

Antivirals

• Acyclovir (Zovirax) and Ganciclovir (Zirgan) are antivirals
• Potential adverse effects of acyclovir include nephrotoxicity, requiring increased fluid intake
• Ganciclovir can cause bone marrow suppression, necessitating monitoring of complete blood counts (CBC) and blood platelet counts.
• These medications are contraindicated in patients with low neutrophil counts (less than 500/mm³) or low platelet counts (less than 25,000/mm³).

Drug Treatment - General Considerations

• Combining 3-4 HIV medications can reduce resistance, side effects, and decrease virus levels while increasing CD4 counts
• Lower doses of medications may be used in combination therapies to limit side effects
• Regular monitoring of liver function tests (LFTs), blood urea nitrogen (BUN), creatinine (Cr), and complete blood counts (CBC) is necessary

Chemotherapy

• Cytotoxic drugs kill rapidly dividing cancer cells and some healthy cells, such as skin, hair, intestinal lining, and blood cells (hematopoietic).
• Chemotherapy can harm normal cells, causing adverse effects
• Administration is via intravenous (IV), topical, or direct injection into body cavities
• Proper personal protective equipment (PPE) is required
• Oral medications should not be crushed, split, broken or allowed to be chewed.
• Central venous catheters may be necessary for long-term or repeated treatments

Chemotherapy Complications - Immunosuppression/Neutropenia

• Bone marrow suppression can lead to low white blood cell counts
• Observe for signs of infection.
• Neutropenic precautions are essential.
• These include: private room, avoiding contact with infected individuals, monitoring skin and mucous membranes for signs of infection, and avoiding plants.
• Colony stimulating factors (like filgrastim) can be administered to stimulate white blood cell production

Chemotherapy Complications - Nausea, Vomiting, Anorexia

• Use medications to control nausea and vomiting before and during chemotherapy.
• Administer these medications before scheduled chemotherapy sessions.
• Ensure adequate intake by using non-pharmacological methods like ensuring proper hydration, oral nutrition supplements, and appetite stimulants.
• High protein, high calorie, and nutrient-rich meals are beneficial and small frequent meals.
• Remove unpleasant odors.

Chemotherapy Complications - Alopecia

• Discuss hair loss prevention options such as scarves, wigs, or turbans.
• Patients should select hairpieces before chemotherapy treatment begins.
• Hair loss is temporary and usually returns a few months after treatment
• Patients can decrease weight loss by cutting their hair before chemo
• Encourage sun protection

Chemotherapy Complications - Mucositis and Stomatitis

• Monitor the mouth frequently to detect any issues
• Use topical anesthetics before meals
• Use non-alcoholic mouthwashes
• Soft toothbrush, floss
• Use frequent cool water mouth rinses
• Cold, soft, bland foods high in calories are recommended.

Chemotherapy Complications - Anemia and Thrombocytopenia

• Monitor hemoglobin (Hgb) levels
• Administer erythropoietic medications and iron supplements to help with anemia, if necessary.
• Monitor platelets and bleeding closely if thrombocytopenia is a concern

Chemotherapy Complications - Peripheral Neuropathy

• Monitor for loss of sensation or changes in sensation
• Watch for skin breakdown and orthostatic hypotension
• Be aware of risk of erectile dysfunction
• Encourage good foot care

Treatment - Nursing Interventions

• Monitor injection sites for signs of extravasation, especially if vesicants are administered
• Administer medications as prescribed to control side effects
• Encourage patients to use wigs and other hair coverings before alopecia occurs
• Monitor lab work for side effects
• Prevent injury by taking proper precautions

Treatment - Patient Teaching

• Instruct patients to report signs of infection immediately.
• Emphasize the importance of good hygiene practices
• Teach meticulous perineal care.
• Advise avoidance of crowds during the flu season and people with colds.
• Teach proper food preparation, especially handling uncooked fruits or vegetables

Anticancer Drugs - Adverse Reactions/Precautions

• Bone marrow suppression
• Nausea and vomiting
• Anorexia
• Gastrointestinal (GI) disturbances
• Alopecia
• Pregnancy avoidance

Test your knowledge on antiretroviral drug therapy for HIV/AIDS, including adverse reactions and the use of PrEP. This quiz covers various drug classes such as NNRTIs and NRTIs, and their implications for treatment. Understand the critical aspects of managing HIV infection effectively.