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P A R T 2
Chemotherapeutic agents
combination with other nephrotoxic drugs, such as the
aminoglycoside antibiotics.
The risk of drowsiness also rises when these anti
viral agents are taken with zidovudine, an antiretroviral
agent.
KEY POINTS
■■
Drugs that interfere with viral DNA replication are
used to treat herpes infections and CMV infections.
■■
Antiviral drugs are associated with GI upset and
nausea, confusion, insomnia and dizziness.
AGENTS FOR HIV AND AIDS
The
human immunodeficiency virus (HIV)
attacks the
helper T cells
(CD4 cells) within the immune system.
This virus (an RNA strand) enters the helper T cell,
where it uses reverse transcriptase to copy the RNA
and produce a double-stranded viral DNA. The virus
uses various nucleosides found in the cell to synthesise
this DNA strand. The DNA enters the host cell nucleus
and slides into the chromosomal DNA to change the
cell’s processes to ones that produce new viruses. This
changes the cell into a virus-producing cell. As a result,
the cell loses its ability to perform normal immune func-
tions. The newly produced viruses mature through the
action of various proteases and then are released from
the cell. Upon release, they find a new cell to invade, and
the process begins again. Eventually, as more and more
viruses are released and invade more CD4 cells, the
immune system loses an important mechanism respon-
sible for propelling the immune reaction into full force
when the body is invaded.
KEY POINTS
Care considerations for people receiving
agents for herpes virus and cytomegalovirus
Assessment: history and examination
■
■
Assess people receiving DNA-active antiviral agents
for
contraindications or cautions
: any history of
allergy to antiviral agents
to avoid hypersensitivity
reactions
; renal dysfunction
that might interfere
with the metabolism and excretion of the drug
and increase the risk of renal toxicity
;
severe CNS
disorders
that could be aggravated
;
and pregnancy
or breastfeeding.
■
■
Perform a physical assessment
to establish baseline
data for assessing the effectiveness of the DNA-
active antiviral drug and the occurrence of any
adverse effects associated with drug therapy.
■
■
Assess orientation and reflexes
to monitor CNS
baseline and adverse effects of the drug.
■
■
Examine skin (colour, temperature and lesions)
to
monitor adverse effects such as rashes.
■
■
Evaluate renal function tests
to determine baseline
function of the kidneys and to assess adverse
effects on the kidney and need to adjust the dose
of the drug.
Implementation with rationale
■
■
Administer the drug as soon as possible after the
diagnosis has been made
to improve effectiveness
of the antiviral activity.
■
■
Ensure good hydration
to decrease the toxic effects
on the kidneys.
■
■
Ensure that the person takes the complete course
of the drug regimen
to improve effectiveness and
decrease the risk of the emergence of resistant
viruses.
■
■
Wear protective gloves when applying the drug
topically
to decrease the risk of exposure to the
drug and inadvertent absorption.
■
■
Provide safety precautions (e.g. use of side rails,
appropriate lighting, orientation, assistance) if CNS
effects occur
to protect the person from injury.
■
■
Warn the person that GI upset, nausea and
vomiting can occur
to prevent undue anxiety and
increase awareness of the importance of nutrition.
■
■
Monitor renal function tests periodically during
treatment
to ensure prompt detection and early
intervention, should renal toxicity develop.
■
■
Instruct the person about the drug
to enhance
knowledge about drug therapy and to promote
compliance.
■
■
Provide the following teaching:
–– Avoid sexual intercourse if genital herpes is
being treated because these drugs do not cure the
disease.
–– Wear protective gloves when applying topical
agents.
–– Avoid driving and hazardous tasks if dizziness or
drowsiness occurs.
Evaluation
■
■
Monitor person’s response to the drug (alleviation
of signs and symptoms of herpes or CMV
infection).
■
■
Monitor for adverse effects (orientation and affect,
GI upset and renal function).
■
■
Evaluate the effectiveness of the teaching plan
(person can name the drug, dosage, possible
adverse effects to watch for and specific measures
to help avoid adverse effects).
■
■
Monitor the effectiveness of comfort and safety
measures and compliance with the regimen.
