medication HIV

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medication HIV
2015-10-26 21:48:07

HIV med learning
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  1. review
    • treatment plan for HIV infection
    • - brunner test
    • - other resources- pharm test
    • recommendations of starting therapy based on t cell count
    • - tx decisions are based on CD4 count, viral load, severity of symptoms, pt compliance
    • importance of long term, multi drug therapy
    • accurate assessment of side effects
    • multi-system s/e
    • drug resistance in increa
    • treatment is changing
    • starts as soon as dx
  2. treatment of HIV
    • treat all symptomatic patients and patients with CD4 counts < 200
    • proactive, assess for possible complications
    • and treat
    • goal of therapy: decre viral load, inc dcr count, delay progression and complications
  3. treatment of HIV HAART (highly active acute retroviral therapy)
    new dx
    Protease inhibitor and two NRTI (nucleoside reverse transcriptase)

    non nucleoside reverse transcriptase inihibitor and two NRTI

    know: multi-drug using different MOA at least 2 to 3 different drugs, makes difficult for virus to replicate and decre risk of drug resistance (so it could work in different ways- to inhibit the enzymes to make it more for virus to replicate and reduce the risk of resistance)

    (mono therapy- extremely high risk of drug resistance)
  4. Nucleoside reverse transciptase inhibitor (NRTI)
    • Zidovudine (AZT, Retrovir)
    • AZT - oldest antiviral drug
    • - looks very similar to the building blocks of DNA
    • - virus goes to AZT and doesn't replicate and makes something weird
    • reversion of transciptase- prevents this from happening
    • defective DNA
    • MOA: inhibits the synthesis of DNA of reverse transcriptase, Zidovudine becomes incorporated into the strand of DNA being synthesized- DNA strand is terminated
    • S/e- most serious
    • - bone marrow depression- anemia, granulocytopenia, pancytopenia
    • - other affects- GI, abd pain, h/a
  5. NI teaching
    • adherence
    • it will not eradicate HIV, transmission to others is possible
    • can be given with lamivudine-combivir
    • monitor CBC
    • GI side effects and h/a may resolve after one month of treatment
    • best on empty stomach
    • dont give with fruit juice bc is decr absorption
    • high risk of resistance
  6. Nonnucleoside reverse transcriptase
    • Nevirapine (viramune)
    • MOA- inhibits HIV reverse transcriptase. it binds directly to reverse transcriptase
    • SE: most serious
    • - hepatoxicity
    • other fever h/a rasj, Nv, abd pain
    • best on empty stomach but if cant tolerate then small meal
    • be careful with drug interaction
  7. NI teaching nonnucleoside reverse transcriptase
    • adherence to drug therapy
    • careful monitoring for the first 4 mons for hepatoxicity
    • monitor LFT's
    • assess skin rashes and report to MD
    • small frequent meals to decre GI distress
  8. Protease inhibitors
    mostly all HIV pt get these
    • Saquinavir (invirase)
    • MOA: competitive inhibitor of HIV protease
    • this enzyme is needed for HIV replication
    • Se most common
    • N/D gi distress, h/a, insomonia, hyperglycemia
    • - other effects: deposits of fatty tissue at bases of posterior neck and abdominal area
    • - it is associated with the syndrome of fat redistribution, incre cardiac and pancreatic issue
    • infiltrates heart and pancreas muscles
  9. NI teaching protease inhibitors
    • adherence
    • GI and h/a may resolve after one month of tx
    • assess fat redistribution if present assess lipid panel- trig
    • best adm: two hours after eating high calorie, high fat meal for best absorption
    • drug resistance- virus can mutates
  10. Other agents
    tend to be used later in therapy
    once resistance to other
    • entry and fusion inhibitors:
    • - blocks the fusion of HIV virus to CD4 cell

    • HIV integrase inhibitors
    • - blocks HIV integrase and prevents HIV from inserting its genes into uninfected DNA
  11. medication for complications associated with HIV
    • oral candidiasis
    • - antifungal agent
    • PCP
    • - TMP- SMZ (bactrium)- antibiotic
    • MAC
    • - zithromax or biaxin
    • Chronic Diarrhea
    • - sandostatin
    • last resort- cant control by diet or lomotil
    • peptide- helps to stimulate the reabsorption of water
    • sc- expensive
    • se- GI- N/V
    • Anti protozoan
    • Pentam 300 kills these infection
    • Marinol
    • synthetic marijuana
    • - stimulate appetite/decrease nausea
    • magase too