IV Therapy, HIV/AIDS, and Cancer Drugs PDF

DRUG THERAPY FOR HIV/AIDS ANTIRETROVIRAL  Used for HIV infection and AIDS Adverse Reactions: N/V/D, altered taste, HA, fever, chills, rash, numbness and tingling circumoral or peripherally. (Descovy, Truvada) Emtricitabine and tenofovir disoproxil is approved for prevention of HIV. Used fo...

DRUG THERAPY FOR HIV/AIDS ANTIRETROVIRAL  Used for HIV infection and AIDS Adverse Reactions: N/V/D, altered taste, HA, fever, chills, rash, numbness and tingling circumoral or peripherally. (Descovy, Truvada) Emtricitabine and tenofovir disoproxil is approved for prevention of HIV. Used for pre-exposure prophylaxis (PrEP) when an adult is willing to engage in safer sex practices, is confirmed HIV negative, and has a sexual high risk relationship. 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). Adverse reactions: Rash (Stevens Johnson syndrome, Flu-like manifestations, HA, fatigue, CNS manifestations, n/d Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs inhibits DNA synthesis and viral replication of HIV virus. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir). Adverse reactions: bone marrow depression, lactic acidosis, nv/d, hepatomegaly/fatty liver DRUGS Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir). Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) Used when unresponsive to other antiretrovirals Adverse reactions – Localized reaction at injection site, bacterial pneumonia, fever, chills, rash, hypotension Administered SQ DRUG TREATMENT Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells. Adverse reactions: HA, difficulty sleeping, skin rash, liver injury, renal failure, hematuria, suicidal ideation CCR5 antagonists. Prevents HIV from entering lymphocytes Example maraviroc (Selzentry) Adverse reactions: cough and URI, CNS effects such as dizziness, paresthesias, hepatotoxicity, pseudomembranous colitis  Antivirals: Acyclovir (Zovirax), Ganciclovir (Zirgan) Adverse effects: Acyclovir - Nephrotoxicity Force fluids Gancyclovir – suppressed bone marrow Watch CBC and platelet counts Contraindicated Neutrophil count less than 500/mm or platelets less 3 than 25,000/mm3 DRUG TREATMENT 3-4 HIV medications in combination with other antiretroviral medications to reduce medication resistance, adverse effects, and dosages. decrease amount of virus and increase CD4 counts This combination may reduce the side effects of one drug because a lower dose may be administered Monitor labs – liver function tests, BUN, Cr, CBC Patient teaching Meds—use, regimen Do not skip, reduce, or change regimen—call doctor if side effects are intolerable No “drug holidays” Keep extra week’s supply on hand CHEMOTHERAPY CHEMOTHERAPY Cytotoxic, kill fast growing cancer cells and health cells such as skin, hair, intestinal mucosa, and hematopoietic cells. Can harm normal cells-adverse effects Can be absorbed through skin and mucous membranes; wear proper PPE Administered IV, topical, body cavities, etc. Oral is just as toxic when handling Do not crush, split, break, or allow the client to chew oral medications Need central catheter since they’re vesicants; usually a port if long term needed  CHEMO COMPLICATIONS  Immunosuppression/neutropenia-bone marrow suppression  Watch labs  Report subtle s/s infection  Monitor skin and MM for s/s infection  Neutropenic precautions  Private room  Avoid infection/stay in room  Avoid plants  Frequent hand hygiene  Avoid invasive procedures unless necessary  Dedicated equipment in patient’s room  Administer colony-stimulating factors to stimulate WBC production (filgrastim) CHEMO COMPLICATIONS Nausea, vomiting, anorexia Meds before and for s/s, especially before meals Administer for several days after chemo scheduled Remove odors Nonpharmacological methods Ensure intake/supplements/appetite stimulate (megace) Mouth care to increase appetite Several small meals (low fat dry meals) High protein, high calorie, nutrient dense foods Plastic easting utensils will help with metallic taste Identify foods that trigger nausea CHEMO COMPLICATIONS Alopecia Discuss options – scarves, wigs, turbans 7-10 days after treatment; select hairpiece before chemo Temporary; will return a months after therapy may be different from original hair Cut hair before chemo to decrease weight Protect from sun CHEMO COMPLICATIONS Mucositis and stomatitis Examine mouth several times a day; document Topical anesthetic before meals Hygiene ac/pc meals Use non-alcoholic anesthetic mouthwashes Soft toothbrush, floss Use Frequent cool water mouth rinses. Meds Cold, soft, bland foods high in calories No alcohol or tobacco CHEMO COMPLICATIONS Anemia and thrombocytopenia Anemia - Assess fatigue, pallor, dizziness, or SOB Rest/activity Erythropoietic medication (epoetin alfa) and antianemic medication (ferrous sulfate) Monitor Hgb Thrombocytopenia – monitor bleeding Meds/lab Blood for either possibly (platelets for thrombo) Electric razor/avoid NSAIDS/injuries CHEMO COMPLICATIONS Chemo induced peripheral neuropathy Assess for loss of sensation Skin breakdown Orthostatic hypotension Risk of erectile dysfunction Good foot care TREATMENT—NURSING INTERVENTIONS Monitor S/E Monitor IV site, vesicants Administer meds to control S/E Good oral hygiene Encourage to buy wig before loss of hair Monitor lab work for S/E Protect from injury Monitor v/s—temp most reliable indicator of infection Wear protective gear when handling drugs or body fluids 48 hours after drug administration TREATMENT—PATIENT TEACHING Report signs of infection Good hygiene practices Good perineal care Avoid crowds during flu season and those with colds or the flu No uncooked fruits or vegetables, cleanse them