McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 0  Antiviral agents

CRITICAL THINKING SCENARIO Antiviral agents for HIV and AIDS

THE SITUATION H.P. is a 34-year-old attorney who was diagnosed with AIDS, having had a positive HIV test 3 years ago. Although his T cell count had been stabilised with treatment with zidovudine and efavirenz, it recently dropped remarkably. He presents with numerous opportunistic infections and Kaposi sarcoma. H.P. admits that he has been under tremendous stress at work and at home in the last few weeks. He begins a combination regimen of lamivudine, zidovudine and ritonavir. CRITICAL THINKING What are the important care implications in this case? What role would stress play in the progress of this disease? What specific issues should be discussed? What other clinical implications should be considered? DISCUSSION Combination therapy with antivirals has been found to be effective in decreasing some of the morbidity and mortality associated with HIV and AIDS. However, this treatment does not cure the disease. H.P. needs to understand that opportunistic infections can still occur and that regular medical help should be sought. He also needs to understand that these drugs do not decrease the risk of transmitting HIV by sexual contact or through blood contamination and he should be encouraged to take appropriate precautions. It is important to make a dosing schedule for H.P., or even to prepare a weekly medication dispenser, to ensure that all medications are taken as indicated. H.P. should also receive interventions to help him decrease his stress because activation of the sympathetic nervous system during periods of stress depresses the immune system. Further depression of his immune system could accelerate the development of opportunistic infections and decrease the effectiveness of his antiviral drugs. Measures that could be used to decrease stress should be discussed and tried with H.P. Discussing the adverse effects that H.P. may experience is important because GI upset and discomfort may occur while he is taking all of these anti-HIV/AIDS medications. Small, frequent meals may help alleviate the discomfort. It is important that every effort be made to maintain H.P.’s nutritional state, and a nutritional consultation may be necessary if GI effects are severe. H.P. also may experience dizziness, fatigue and confusion, which could cause more problems for him at work and may necessitate changes in his workload. Because some of the prescribed drugs must be taken around the clock, provisions may be needed to

allow H.P. to take his drugs on time throughout the day. For example, he may need to wear an alarm wristwatch, establish planned breaks in his schedule at dosing times, or devise other ways to follow his drug regimen without interfering with his work schedule. The adverse effects and inconvenience of taking this many drugs may add to his stress. It is important that a healthcare provider work consistently with him to help him to manage his disease and treatment as effectively as possible. CARE GUIDE FOR H.P.: ANTIVIRAL AGENTS FOR HIV AND AIDS Assessment: History and examination Allergies to any of these drugs CNS: affect, reflexes, orientation GI: abdominal and liver evaluation Haematological: FBC and differential; viral load; T-cell levels; renal and hepatic function tests Implementation Monitor FBC and differential before and every 2 weeks during therapy. Provide comfort and implement safety measures: assistance, temperature control, lighting control, mouth care, back rubs. Provide small, frequent meals and monitor nutritional status. Monitor for opportunistic infections and arrange treatment as indicated. Provide support and reassurance for dealing with drug effects and discomfort. Provide teaching regarding drug name, dosage, adverse effects, warnings, precautions, use of OTC or herbal remedies, and signs to report. Evaluation Evaluate drug effects: relief of signs and symptoms of AIDS and AIDS-related complex (ARC) stabilisation of T-cell levels. Monitor for adverse effects: GI alterations, dizziness, confusion, headache, fever. Monitor for drug–drug interactions as indicated for each drug. Evaluate effectiveness of teaching plan. Evaluate effectiveness of comfort and safety measures. Teaching for H.P. A combination of antiviral drugs has been prescribed to treat your HIV infection. These drugs work in combination Bone marrow depression Renal or liver dysfunction Skin: colour, lesions, texture