Viral Infections 2.0 Student PDF

Viral Infectio ns CHAPTER 23 MATTHEW MOEHL, PHARMD Introduction and Pathophysiology Viruses are intracellular parasites Incorporates viral DNA into host’s Retroviruses have RNA which must be converted to DNA first ◦ HIV is a retrovirus Turns cell into a “virus factory” Body’s defense are antibodie...

Viral Infectio ns CHAPTER 23 MATTHEW MOEHL, PHARMD Introduction and Pathophysiology Viruses are intracellular parasites Incorporates viral DNA into host’s Retroviruses have RNA which must be converted to DNA first ◦ HIV is a retrovirus Turns cell into a “virus factory” Body’s defense are antibodies HTTPS://COURSES.LUMENLEARNING.COM/MICROBIOLOGY/CHAPTER/THE-VIRAL-LIFE-CYCLE/ HTTPS://IMGUR.COM/GALLERY/3WSWK Types of viruses Avian Influenza A (H5N1) Herpesvirus Infections ◦ Cytomegalovirus (CMV) ◦ Genital Herpes ◦ Herpes Zoster (shingles) Human Immunodeficiency Virus (HIV) Respiratory Syncytial Virus (RSV) Viral Hepatitis ◦ Hepatitis A, B, C https://www.newscientist.com/article/ Herpesviruses Herpes Simplex Virus (HSV) Fever blisters or cold sores on lips, mouth, face Genital herpes Cytomegalovirus - CMV retinitis HTTPS://WWW.CK12.ORG/BIOLOGY/VIRUS-CLASSIFICATION/LESSON/VIRUS-CLASSIFICATION- ADVANCED-BIO-ADV/; HTTPS://WWW.ALLABOUTVISION.COM/CONDITIONS/CMV_RETINITIS_AIDS.HTM  Drugs for Herpesvirus Prototype: acyclovir Nursing (Zovirax) considerations: Mechanism of action: interrupts viral DNA replication Apply topical with gloved hand Use(s): Herpes simplex virus IV form (HSV) Encephalopa Genital herpes thy Decreases duration and pain mintrx pharmacy  Drugs for Cytomegalovirus (CMV) Prototype: Nursing ganciclovir considerations: (Cytovene) Renal impairment Mechanism of 2 BBW’s Granulocytopenia action: inhibits viral (neutropenia), DNA synthesis thrombocytopenia Use(s): Maintain contraceptive precautions during and CMV 90 days after therapy  valganciclovir (Valcyte) Basically the oral Same BBW’s version of Take with high fat ganciclovir meal to increase absorption https://mms.mckesson.com/product/927598/Genentech-USA- 00004003909 Example Questions A client requires treatment A client develops for genital herpes. Why Cytomegalovirus retinitis. would acyclovir be Which is most important to prescribed? consider when administering ganciclovir? A. prevents future viral outbreaks A. administer on an empty stomach B. decreases pain and viral shedding B. assess client’s vision after administration C. prevents superinfection C. assess for reduced D. boosts activity of other genital pain drugs D. administer on a weekly basis Respiratory Syncytial Virus (RSV) Respiratory illness that is You sure more severe in babies that’s ◦ Bluish skin color “just a (cyanosis) cough?” Adults and healthy children can carry the disease with just common cold symptoms HTTPS://NEWS.GSU.EDU/2018/12/17/VACCINE-USING-MICRONEEDLE-PATCH-WITH-RSV-VIRUS-IMMUNE-STI MULATING-COMPOUND-IS-EFFECTIVE-AGAINST-RSV-STUDY-FINDS/  Drugs for RSV Prototype: ribavirin Nursing (Virazole) considerations: BBW for severe Mechanism of teratogenic effects action: interferes with Given via inhalation DNA and RNA replication Monitor for Use(s): signs of RSV in children respiratory distress such as nasal flaring https://medlineplus.gov/ency/imagepages/17279.htm Influenza (Flu) Muscle aches, pains Fatigue Fever Nausea / vomiting Headache Diarrhea Shivering **Can be deadly** HTTPS://WWW.NEWS-MEDICAL.NET/LIFE-SCIENCES/INFLUENZA-A- STRUCTURE.ASPX  Drugs for Influenza Prototype: Nursing oseltamivir considerations: phosphate (Tamiflu) May take Mechanism of prophylactically action: does not allow Some side effects new viruses to escape are similar to flu cell symptoms Use(s): Take with food Influenza in patients to decrease GI > 1 year old upset  Hepatitis A & B have vaccines Hepatitis A ◦ Fecal-oral route, close contact with infected person Hepatitis B ◦ Contaminated blood, other body fluids Hepatitis C ◦ Mostly same as B Cirrhosis, liver cancer, liver failure, death https://newsnetwork.mayoclinic.org/d  Drugs for Hepatitis Prototype: Nursing lamivudine (Epivir) considerations: Mechanism of pancreatitis action: incorporates BBW into the viral DNA and terminates it Lactic acidosis Musculoskeletal Use(s): pain Chronic Hepatitis B Hepatomegaly HIV (off-label) with steatosis Example Questions A client is taking lamivudine and states he has severe upper abdominal pain. On assessment, he has guarding. What does the nurse suspect is wrong with the client? A. hepatomegaly B. pancreatitis C. lactic acidosis D. cardiomyopathy Human Immunodeficiency Virus (HIV) Retrovirus Bind to and eventually destroy CD4+ cells (e.g. T lymphocytes) ◦ CD4+ cells normally help regulate immune function… May need multiple drugs Can progress to acquired human immunodeficiency syndrome (AIDS) HIV clinical manifestations Initial phase ◦ Presents with flu-like symptoms, lasting several weeks Immune response ◦ Decrease in viral reproduction ◦ Asymptomatic, but infectious Immune system damaged ◦ Increased viral reproduction Illness progresses to AIDS ◦ Once viral load reaches high level ◦ Serious opportunistic infections https://aidsinfo.nih.gov/understanding http://i-base.info/guides/testing/viral-l Pre-Exposure Prophylaxis (PrEP) … “a way for people who do That pill is Truvada not have HIV but are at (tenofovir and very high risk of getting emtricitabine) HIV to prevent HIV infection by taking a pill When taken daily, lowers every day.” – CDC.com. risk of HIV infection: ◦ From sex by about 99% ◦ From injection by about 74% If not taken consistently, not as effective. Only protects against HIV… need other protection for other STD’s. https://www.cdc.gov/hiv/risk/prep/ind  Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Prototype: zidovudine Nursing (AZT, Retrovir) considerations: Mechanism of action: BBW incorporates into viral DNA and terminates Granulocytopeni a, pancytopenia Prevent step 3-4 Lactic Use(s): acidosis, Prevent HIV hepatomegaly transmission from mother to fetus  Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) Prototype: Nursing efavirenz considerations (Sustiva) Not for patients Mechanism of with hepatic impairment action: similar to NRTI. Have synergy. Stevens-Johnson Prevent step 3-4. syndrome Use(s): CNS effects Take at night HIV Example Questions A client is receiving A client has been taking zidovudine for treatment of efavirenz for about 1 week. HIV. Which symptom may For which delayed indicate the client is hypersensitivity reaction developing lactic acidosis? should the nurse educate the client? A. low granulocyte count A. CDAD B. severe upper abdominal pain B. neutropenia C. musculoskeletal pain C. anaphylaxis D. disulfiram reaction D. Stevens-Johnson syndrome The End