ANTI-INFECTIVE AGENTS

Development of Anti-Infective Therapy

1920s
Paul Ehrlich worked on developing a synthetic chemical
effective only against infection-causing cells
Scientists discovered penicillin in a mold sample
1935
The sulfonamides were introduced
 Therapeutic Action

• Interfere with biosynthesis of the bacterial cell

wall
• Prevent the cells of the invading organism from
using substances essential to their growth and
development
• Interfere with steps involved in protein synthesis
 Therapeutic Action

⮚ Interfere with DNA synthesis

⮚ Alter the permeability of the cell membrane to
allow essential cellular components to leak out
Drug Therapy Across the Lifespan
 Anti-infective Activity
• Anti-infectives vary in their effectiveness against invading organisms.
• Some are selective – only effective for a few number of organisms
• Bactericidal – kill the cell
• Bacteriostatic – prevent reproduction of the cell
Narrow Spectrum vs. Broad Spectrum
Narrow Spectrum of Activity
• Effective against only a few microorganisms with a very
specific metabolic pathway or enzyme
Broad Spectrum of Activity
• Useful in treating a wide variety of infections
Therapeutic Action of Anti-Infective Agents
Human Immune Response
❖Goal of anti-infective therapy is reduction of the population
of the invading organism.
❖Drugs that would eliminate all traces of any invading
pathogen might be toxic to the host as well.
❖Immune response is a complex process involving chemical
mediators, leukocytes, lymphocytes, antibodies, and locally
released enzymes and chemicals.
Resistance
• Natural or acquired: Ability over time to adapt to an anti-
infective drug and produce cells that are no longer affected
by a particular drug.
• Anti- infectives act on specific enzyme system or biological
process, many microorganisms that do not act on this system
are not affected by this particular drug
Acquired Resistance
□Microorganisms that were once sensitive to the particular
drug have begun to develop acquired resistance.
□This results in serious clinical problems.
Ways Anti-Infective Agents Acquired Resistance
Develops
1. Producing an enzyme that deactivates the antimicrobial drug
2. Changing cellular permeability to prevent the drug from entering the
cell
3. Altering transport systems to exclude the drug from active transport
into the cell
4. Altering binding sites on the membranes or ribosomes, which then
no longer accept the drug
5. Producing a chemical that acts as an antagonist to the drug
Preventing Resistance

✔Limit the use of antimicrobial agents to the treatment of

specific pathogens sensitive to the drug being used
✔Make sure doses are high enough, and the duration of drug
therapy long enough
✔Be cautious about the indiscriminate use of anti-infectives
Factors Affecting Prescribing Anti-Infective Agents

❖Identification of the correct pathogen

❖Selection of the right drug
• One that causes the least complications for that particular
patient
• One that is most effective against the pathogen involved
Problems with Treating Infections in
Immunosuppressed Patients
1. Anti-infective drugs cannot totally eliminate the pathogen
without causing severe toxicity in the host.
2. These patients do not have the immune response in place to
deal with even a few invading organisms.
Identification of the Pathogen

1. Identification of the infecting pathogen is done by culture

2. A culture of a tissue sample from the infected area is done
• A swab of infected tissue is allowed to grow on an agar
plate
• Staining techniques and microscopic examination identify
the bacterium
3. Stool can be examined for ova and parasites
Sensitivity of Pathogen
✔Shows which drugs are capable of controlling the particular
microorganism
✔Is important with microorganisms that have known resistant
strains
✔Along with a culture, identifies the pathogen and appropriate
drug for treatment
Combination Therapy
⮚Use of a smaller dosage of each drug
⮚Some drugs are synergistic
⮚In infections caused by more than one organism, each pathogen may
react to a different anti-infective agent
⮚Sometimes, the combined effects of the different drugs delay the
emergence of resistant strains
Prophylaxis of Anti-Infective Agents
• People traveling to an area where malaria is endemic
• Patients who are undergoing GI or genitourinary surgery
• Patients with known cardiac valve disease, valve
replacements, and other conditions requiring invasive
procedures
Adverse Reactions to Anti-Infective Therapy
1. Kidney Damage
2. Gastrointestinal (GI) Tract Toxicity
3. Neurotoxicity
4. Hypersensitivity Reactions
5. Superinfections
Adverse Reactions to Anti-Infective Therapy
1. Kidney Damage
2. Gastrointestinal (GI) Tract Toxicity
3. Neurotoxicity
4. Hypersensitivity Reactions
5. Superinfections
ANTIBIOTICS
Antibiotics

• Antibiotics are defined as:

1. Chemicals that inhibit specific bacteria
2. Made in three ways
• By living microorganisms
• By synthetic manufacture
• Through genetic engineering
Signs of Infection

• Fever
• Lethargy (lack of energy)
• Slow-wave sleep induction (deep sleep)
• Classic signs of inflammation (redness, swelling, heat, and pain)
Antibiotic Use Across the Life Span

• Pediatric Population
• Adult Population
• Geriatric Population
Types of Antibiotics

• Bacteriostatic
• Those substances that prevent the growth of bacteria
• Bactericidal
• Those that kill bacteria directly
Bacteria and antibiotics

1. Gram positive/negative: (+) example: Streptococcus pneumoniae (-)

example: infections of the Gi tract like e-coli
2. Aerobic: depends on oxygen for survival
3. Anaerobic: do not use oxygen
Goal of Antibiotic Therapy

❖Decrease the population of the invading bacteria to a point where the

human immune system can effectively deal with the invader
Selecting Treatment

• Identification of the causative organism

• Based on the culture report, an antibiotic is chosen that has
been known to be effective at treating the invading organism
Bacteria Classification

□ Gram-positive
• The cell wall retains a stain or resists decolorization with alcohol
□ Gram-negative
• The cell wall loses a stain or is decolorized by alcohol
□ Aerobic
• Depend on oxygen for survival
❑Anaerobic
• Do not use oxygen
Bacteria and Resistance to Antibiotics

• Adapt to their environment

• The longer an antibiotic has been in use, the greater the chance that the
bacteria will develop into a resistant strain
Aminoglycosides
⮚A group of powerful antibiotics used to treat serious infections caused
by gram-negative aerobic bacilli
⮚Common medications:
• Amikacin (Amikin), Gentamicin (Garamycin)
• Kanamycin (Kantrex)
• Neomycin (Mycifradin)
• Streptomycin
• Tobramycin (Nebcin, Tobrex)
Aminoglycosides
• Bactericidal
• Indications:
Treatment of serious infections caused by susceptible bacteria
• Actions:
Inhibits protein synthesis in susceptible strains of gram-negative
bacteria causing cell death
Aminoglycosides
Pharmacokinetics-
• Poorly absorbed from the GI tract, but rapidly absorbed after IM
injection, reaching peak levels within 1 hour
• Widely distributed throughout the body, crossing the placenta and
entering breast milk
• Excreted unchanged in the urine and have an average half-life of 2
to 3 hours
• Depend on the kidney for excretion and are toxic to the kidney
Aminoglycosides
• Contraindications-
Known allergies, renal or hepatic disease, hearing loss
• Adverse Effects-
Ototoxicity and nephrotoxicity are the most significant
• Drug-to-Drug Interactions-
Diuretics, neuromuscular blockers, succinylcholine, or citrate
anticoagulated blood
Nursing Considerations for Patients Receiving Aminoglycosides

Assess:
• For possible contraindications or cautions: allergy to any
aminoglycoside
o Perform a physical assessment
• Perform culture and sensitivity tests at the site of infection
• Conduct orientation and reflex assessment
• Assess vital signs
• Perform renal and liver function tests
Prototype Summary: Gentamicin
Carbapenems
• New class of broad-spectrum antibiotics effective against gram-
positive and gram-negative bacteria
• Common medications:
- Doripenem (Doribax)
- Ertapenem (Invanz)
- Imipenem– Cilastatin (Primaxin)
- Meropenem (Merrem IV).
Carbapenems
Bactericidal
Indications-
• Treatment of serious infections caused by susceptible bacteria
• Actions: Inhibit cell membrane synthesis in susceptible bacteria,
leading to cell death
Carbapenems
Pharmacokinetics-
• These drugs are rapidly absorbed if given IM and reach peak
levels at the end of the infusion if given IV.
• They are widely distributed throughout the body, although it
is not known whether they cross the placenta or enter
breastmilk
• Excreted unchanged in the urine and have an average half-
life of 1 to 4 hours
Carbapenems
Contraindications-
• Known allergy to any of the carbapenms or betalactams; seizure
disorders, meningitis, pregnancy and lactation
Adverse Effects-
• Pseudomembranous colitis, Clostridium difficile diarrhea, and
nausea and vomiting can lead to serious dehydration and electrolyte
imbalances, as well as to new serious infections/Superinfections
Drug-to-drug interactions- Valproic acid and Meropenem
Nursing Considerations for Patients Receiving Carbapenems

Assess:
• For possible contraindications or cautions: allergy to any
Carbapenem or beta-lactam
• Perform physical assessment
• Perform culture and sensitivity tests
• Conduct orientation and reflex assessment
• VS and renal function tests
Prototype Summary: Ertapenem
Cephalosporin's
Similar to penicillin in structure and activity
Common medications-
• First generation: cefadroxil (generic) and cephalexin (Keflex)
• Second : cefaclor (Ceclor), cefoxitin (generic), cefprozil (generic),
and cefuroxime (Zinacef)
• Third: cefdinir (Omnicef), cefotaxime (Claforan), cefpodoxime
(generic), ceftazidime (Ceptaz,Tazicef), ceftibuten (Cedax), and
ceftriaxone (Rocephin)
• Fourth: cefditoren (Spectracef) and ceftaroline (Teflaro)
Cephalosporins
• Bactericidal and bacteriostatic
• Indications-
Treatment of infections caused by susceptible bacteria
• Action-
Interfere with the cell wall–building ability of bacteria when they
divide
Cephalosporins
Pharmacokinetics-
• Well absorbed from the GI tract
• Metabolized in the liver, excreted in the urine
• Cross the placenta and enter breast milk (see Contraindications
Cephalosporins
• Contraindications
Allergies to cephalosporins or penicillin, hepatic or renal impairment
• Adverse Effects
Most significant -GI track
• Drug-to-Drug Interactions
Aminoglycosides, oral anticoagulants, ETOH
Nursing Considerations for Patients
Receiving Cephalosporins
Assess:
• For possible contraindications or cautions: known allergy to any
cephalosporin or penicillin
• Perform physical assessment
• Skin for any rash or lesions
• Culture and sensitivity tests
• Renal function tests
Prototype Summary: Cefaclor
 Fluoroquinolones
Relatively new class of antibiotics with a broad spectrum of activity
Common medications-
• ciprofloxacin (Cipro), which is the most widely used
• fluoroquinolone, gemifloxacin (Factive), levofloxacin (Levaquin),
moxifloxacin (Avelox),norfloxacin (Noroxin), ofloxacin (Floxin,
Ocuflox), and finafloxacin (Xtoro)
Fluroquinolones
• Bactericidal
• Indications: Treating infections caused by susceptible strains of gram-
negative bacteria. Includes: urinary track, respiratory track, and skin
infections
• Actions: Interferes with DNA replication in susceptible gram-negative
bacteria, preventing cell reproduction
• Pharmacokinetics: Absorbed in GI tract, metabolized in the liver,
excreted in urine and feces and cross the placenta and enter breast
milk
Fluoroquinolones
• Contraindications
Known allergy, pregnancy, or lactating women and renal disfuntion
• Adverse Effects
Most common: Headache, dizziness, insomnia and depression
• Drug-to-Drug Interactions
Antacids, quinidine, theophylline
Nursing Considerations for Patients Receiving Fluoroquinolones

Assess:
• Known allergy to any fluoroquinolone
• Perform physical assessment
• Examine the skin for any rash or lesions
• Perform culture and sensitivity tests
• Orientation, affect, and reflexes
• VS, and renal function tests
Prototype Summary: Ciprofloxacin
Penicillins and Penicillinase - Resistant
Antibiotics
First antibiotic introduced for clinical use
Common medications-
• G benzathine (Bicillin, Permapen), penicillin G potassium
(Pfizerpen), penicillin G procaine (Wycillin), penicillin V (generic),
amoxicillin (Amoxil, Trimox), and ampicillin (Principen)
Penicillins and Penicillinase - Resistant
Antibiotics
• Bactericidal
Indications- Severe infections caused by sensitive organisms and broad
spectrum use
Actions- Interfere with the ability of susceptible bacteria to build their
cell walls
Pharmacokinetics- rapidly absorbed from the GI tract, reaching peak
levels in 1 hour. excreted unchanged in the urine and enter breast milk
Penicillins and Penicillinase-Resistant
Antibiotics
• Contraindications - Allergies to penicillin or cephalosporins, renal
disease, use cautiously in patients who are pregnant or lactating
• Adverse Effects-
• Most significant GI tract
• Drug–Drug Interactions-
• Tetracyclines, parenteral aminoglycosides
Nursing Considerations for Patients Receiving
Penicillins and Penicillinase-Resistant Antibiotics
Assess:
• Known allergy to any cephalosporins and penicillins
• Physical
• Skin and mucous membranes for any rashes or lesions
• Culture and sensitivity tests
• Respiratory status
• Abdomen and renal function
Prototype Summary: Amoxicillin
Sulfonamides
1. Drugs that inhibit folic acid synthesis
2. Most common medications-
• sulfadiazine (generic)
• sulfasalazine (Azulfidine)
• cotrimoxazole (Septra, Bactrim)
Sulfonamides
• Bacteriostatic
• Action-
• block para-aminobenzoic acid to prevent the synthesis of folic acid
in susceptible bacteria
• Indications-
• Treatment of infections caused by gram-negative and gram-positive
bacteria
Sulfonamides
Pharmacokinetics
• Well absorbed from the GI tract
• Metabolized in the liver, excreted in the urine and are teratogenic
Sulfonamides
Contraindications-
• Known allergy to any sulfonamide, thiazide diuretics and
pregnancy
Adverse Effects-
• GI symptoms; Renal effects related to the filtration of the drug
Drug-to-Drug Interactions-
• tolbutamide, tolazamide, glyburide, glipizide, or chlorpropamide
and cyclosporine
Nursing Considerations for Patients
Receiving Sulfonamides
Assessment:
• Known allergy to any sulfonamide, sulfonylureas, or thiazide
diuretics
• Physical status
• Skin and mucous membranes for any rash or lesions
• Specimens for culture and sensitivity tests
• Respiratory status
• Orientation, affect, and reflexes
Nursing Considerations for Patients
Receiving Sulfonamides
• Abdomen
• Renal function tests
• Complete blood count
Prototype Summary: Cotrimoxazole
Tetracyclines
Developed as semisynthetic antibiotics based on the structure of a
common soil mold
Most common medications-
• Tetracycline (generic)
• demeclocycline (generic)
• doxycycline (Doryx, Vibromycin)
• minocycline (Arestin, Minocin)
Tetracyclines
• Bacteriostatic
• Action-
• Inhibits protein synthesis in susceptible bacteria, preventing cell
replication
• Indications-
• Treatment of various infections caused by susceptible strains of
bacteria; acne when penicillin is contraindicated for eradication of
susceptible organisms and when penicillin is contraindicated
Tetracyclines
Pharmacokinetics
• Adequately absorbed from the GI tract
• Concentrated in the liver, excreted unchanged in the urine
• Cross the placenta and pass into breast milk
Contraindications-
• Known allergy to tetracyclines or to tartrazine, pregnancy, lactation
and renal and hepatic dysfunction, Penicillin G, oral contraceptive
therapy, methoxyflurane, digoxin
Tetracyclines
❖Adverse Effects-
• Most GI, but possible damage to the teeth and bones.
❖ Drug-to-Drug Interactions –
o penicillin G, oral contraceptives, Digoxin
Nursing Considerations for Patients Receiving Tetracyclines

Assess:
• Known allergy to any tetracycline or to tartrazine
• Physical examination
• Skin for any rash or lesions
• Culture and sensitivity tests
• Respiratory status
• Renal and liver function test reports
Prototype Summary: Tetracycline
Antimycobacterial
• Contain pathogens causing TB and leprosy
• Most common medications-
• Rifabutin (Mycobutin), isoniazid (generic), rifampin (Rifadin),
pyrazinamide (generic), ethambutol, (Myambutol), streptomycin
(generic), and rifapentine, (Priftin)
Antimycobacterial

• Action-
• Act on the DNA of the bacteria leading to lack of growth and
eventual bacterial death for TB and Leprosy
• Indications- Treatment of TB and Leprosy
• Pharmacokinetics-
• Well absorbed from the GI tract
• Metabolized in the liver, excreted in the urine, cross the placenta
and enter breast
Antimycobacterial
• Contraindications
Allergy, renal or hepatic failure, CNS dysfunction and pregnancy
• Adverse Effects
CNS effects and GI irritation
• Drug-to-Drug Interactions
Rifampin and INH can cause liver toxicity
Nursing Considerations for Patients
Receiving Antimycobacterials
Assess:
• Known allergy to any antimycobacterial drug
• History of renal or hepatic disease and CNS dysfunction
• Physical examination
• Skin for any rash or lesions
• Culture and sensitivity testing
• Respiratory status and evaluate renal and hepatic function tests
Prototype Summary: Isoniazid
Other Antibiotics
Ketolides, Lincosamides, Lipoglycopeptides, Macrolides,
Oxazolidinones, Monobactam,
• Antibiotics that do not fit into the large antibiotic classes
• Most common medications-
• telithromycin (Ketek), telithromycin, Clindamycin (Cleocin)
televancin (Vibativ), dalbavancin (Dalvance), and oritavancin
(Orbactiv), azithromycin (Zithromax), clarithromycin (Biaxin),
Tedizolid (Sivextra) and linezolid (Zyvox), and aztreonam
(Azactam)
Other Antibiotics
• Bactericidal and bacteriostatic
• Actions and Indications- Treatment of severe infections
Pharmacokinetics-
• All rapidly absorbed, metabolized by the liver and excreted in urine
or feces and may cross the placenta, and does pass into breast milk
Other Antibiotics
• Contraindications and Cautions-
• Known allergy, hepatic or renal impairment, Myasthenia Gravis,
pregnant and lactating patients, phenylketonuria, MAO
inhibitors,
• Adverse Effects-
• Most significant CNS and GI, hepatic enzyme elevation and
superinfections
Other Antibiotics
Drug to -Drug Interactions-

• Pimozide, simvastatin, lovastatin, or atorvastatin, NSAIDs,

nafcillin, cephradine, and metronidazole, foods containing
tyramine with Oxazolidinones and MAO inhibitors
Nursing Considerations for patients receiving
Other Antibiotics
Assess-
• Known allergy to ketolides, lincosamides, lipoglycopeptides,
macrolides, oxazolidinones, and monobactams
• History of renal and hepatic disease
• Physical assessment
• Skin for any rash or lesions
• Culture and sensitivity testing
Nursing Considerations for patient
receiving Other Antibiotics
Assess-
• Temperature to detect infection
• Liver and renal function test values
• Baseline electrocardiogram
Prototype Summary: Telithromycin
Prototype Summary: Clindamycin
Prototype Summary: Erythromycin
Prototype Summary: Aztreonam
New Classes of Antibiotics and Adjuncts

• Daptomycin
• Linezolid (Zyvox)
• Fidaxomicin (Dificid)
• Tigecycline
Antiviral Agents
Viruses That Respond to Antiviral Therapy

• Influenza A and some respiratory viruses

• Herpes viruses
• Cytomegalovirus (CMV)
• Human immunodeficiency virus (HIV) that causes acquired-immune
deficiency syndrome (AIDS)
• Hepatitis B and C
• Some viruses that cause warts and certain eye infections
Characteristics of Common Viruses

• A virus cannot replicate on its own.

• It must attach to and enter a host cell.
• It then uses the host cell’s energy to synthesize protein, DNA, and
RNA.
• Viruses are difficult to kill because they live inside our cells.
• Any drug that kills a virus may also kill our cells.
Stages of Virus Replication
Characteristics of Antiviral Drugs

• Able to enter the cells infected with virus

• Interfere with viral nucleic acid synthesis and/or regulation
• Some agents interfere with ability of virus
to bind to cells
• Some agents stimulate the body’s immune system
Common Respiratory Viruses

• Influenza A
• Influenza B
• Respiratory Syncytial Virus
Signs and Symptoms of Respiratory Viruses

• Cough
• Fever
• Inflammation of the nasal mucosa
• Inflammation of the mucosa of the respiratory track
Antivirals Across the Lifespan
Influenza A and Respiratory Antivirals

• Indications – Prevent shedding of the viral protein coat

• Pharmacokinetics – Absorbed readily, excreted unchanged in the urine,
metabolized in the urine and liver, feces and cellular level. Excreted
primarily via urine but also feces.
• Contraindications – Allergy, renal impairment, pregnancy, or lactating
• Adverse Reactions – Dizziness, insomnia, nausea, orthostatic
hypotension and urinary retention
• Drug-to-Drug Interactions – Primarily Anticholinergic agents
Nursing Considerations for Respiratory Antiviral Therapy

Assess:
• Known history of allergy to antivirals
• History of liver or renal dysfunction
• Pregnancy or lactation
• Physical status
• Orientation and reflexes
• VS and lung sounds
Prototype of Respiratory Antiviral Agents
Signs and Symptoms of Herpes Virus

• Painful vesicles that often occur in clusters on skin, cornea, or mucous

membranes.
• Usual course of primary disease is two weeks
• Duration of recurrences varies
Signs and Symptoms of CMV

• May be asymptomatic
• Fatigue
• Nausea
• Jaundice
• If contracted during pregnancy can result in stillbirth, brain damage, or
birth defects.
Herpes and Cytomegalovirus Antivirals

• Indications – Inhibit viral DNA replication by competing with viral

substrates to form shorter, non-effective DNA chains
• Pharmacokinetics – Readily absorbed in the kidney and GI tract,
metabolized in the liver and excreted primarily in the urine and feces
• Contraindications – Known allergies to antiviral agents, highly toxic in
pregnancy and lactation and renal disease
• Adverse Reactions – Nausea, vomiting, headache, rash, and hair loss,
paresthesias, neuropathy and renal dysfunction
• Drug-to-Drug Interactions – Nephrotoxic drugs, zidovudine and
aminoglycosides
Nursing Considerations for Herpes Virus and Cytomegalovirus

Assess:
• History of allergy to antivirals
• Physical status
• Orientation and reflexes
• Skin (color, temperature, and lesions)
• Renal function tests
Prototype of Herpes and Cytomegalovirus Agents
Signs and Symptoms of HIV/AIDS

• Attacks helper T-cells in the immune system

• Acute Infection – Fever, rash, myalgia
• Asymptomatic Infection – Follows acute infection duration varies
• Persistent Generalized Lymphadenopathy – Adenopathy persists more
than 3 months
• Constitutional Symptoms: Fever lasting more than a month,
involuntary weight loss, chronic fatigue.
• Neurological Disease – Dementia
Signs and Symptoms of HIV/AIDS
• Secondary Infections – Pneumocystis carinii, disseminated herpes
simplex
Drugs Used to Treat HIV/AIDS

• Reverse Transcriptase Inhibitors

• Protease Inhibitors
• Nucleosides- NNRTI and NRTI
• Fusion Inhibitors
• CCR5 Coreceptor Antagonist
• Integrase Inhibitors
Non nucleoside /Nucleoside Reverse Transcriptase Inhibitors

• Indications – Bind directly to HIV reverse transcriptase blocking both

RNA and DNA dependent DNA polymerase activities /compete with
the naturally occurring nucleosides
• Pharmacokinetics – Rapidly absorbed from the GI tract, except
(Didanosine) metabolized in the liver, excreted in the urine and feces
• Contraindications – Pregnancy and lactation except zidovudine,
Lamivudine and zalcitabine should not be given together
• Adverse Reactions – Headache, nausea, vomiting, rash, chills,
diarrhea, flu-like syndrome of fever, muscle aches and pains and bone
marrow suppression with Zididovine
Protease Inhibitors

• Indications – Block protease activity within the HIV virus

• Pharmacokinetics – Rapidly absorbed in the GI tract, metabolized in the
liver and excreted in urine and feces
• Contraindications – Pregnancy and lactation and mild to moderate
hepatic dysfunction
• Adverse Reactions- GI effects, changes in liver function, elevated
cholesterol and triglyceride levels may occur as well as Stevens-Johnson
syndrome risk
• Drug-to-Drug Interactions- Fosamprenavir, pimozide, rifampin,
triazolam, or midazolam
Fusion Inhibitors

• Indications – Prevents the fusion of the virus with the human cellular
membrane
• Pharmacokinetics – Given sub-q; metabolized in the liver it is recycled
in the tissues it is not excreted
• Contraindications – Use cautiously with lung disease and pregnancy
• Adverse Reactions – Headache, dizziness, myalgia, nausea, vomiting,
and diarrhea
• Drug-to-Drug Interactions – No reported drug interactions
CCR5 Coreceptor Antagonist
• Indications – Blocks the receptor site on the cell membrane to which the
HIV virus needs to interact to enter the cell
• Pharmacokinetics –Rapidly absorbed from the GI tract, metabolized in
the liver, and excreted primarily through the feces
• Contraindications –Hypersensitivity to any component of the drug,
nursing mothers and liver disease
• Adverse Reactions – Dizziness and changes in consciousness
• Drug-to-Drug Interactions – Increased serum levels and toxicity when
combined with cytochrome P450 CYP3A inhibitors(ketoconazole,
lopinavir/ritonavir, ritonavir, saquinavir, atazanavir, delavirdine
Integrase Inhibitors

• Indications –inhibit the activity of the virus-specific enzyme integrase,

an encoded enzyme needed for viral replication.
• Pharmacokinetics –Rapidly absorbed from the GI tract, metabolized in
the liver, and excreted primarily through the feces
• Contraindications –Hypersensitivity to any component of the drug and
nursing mothers
• Adverse Reactions – Headache, dizziness, and an increased risk for the
development of rhabdomyolysis and myopathy
• Drug-to-Drug Interactions – decreased serum levels of either drug if
combined with rifampin
Nursing Considerations for HIV/AIDS Antiviral Therapy

Assess:
• History of allergy to antivirals
• Physical status
• Level of orientation
• Skin (color, temperature, and lesions)
• Temperature to monitor for infections.
• Hepatic and renal function tests and CBC
Prototype of HIV/AIDS Antiviral Agents: NNRTI
Prototype of HIV/AIDS Antiviral Agents: NRTI
Prototype of HIV/AIDS
Antiviral Agents
Prototype of HIV/AIDS
Antiviral Agents
Prototype of HIV/AIDS
Antiviral Agents
Prototype of HIV/AIDS
Antiviral Agents
Anti-Hepatitis B Agents

• Indications- Inhibits reverse transcriptase in the hepatitis B virus and

causes DNA chain termination
• Pharmacokinetics- Rapidly absorbed from the GI tract, metabolized in
the liver and excreted in the urine
• Contraindications- Known allergy, pregnancy, lactation and known renal
and liver dysfunction
• Adverse Effects- Most significant are headache, dizziness, nausea,
diarrhea, and elevated liver enzymes
• Drug- to–Drug Interactions-increased risk of renal toxicity if these drugs
are taken with other nephrotoxic drugs
Nursing Considerations for Receiving Agents
for Hepatitis B
Assess:
• History of allergy to adefovir, entecavir, or telbivudine
• Liver and renal function tests
• Physical assessment
• Temperature
• Level of orientation and reflexes
Prototype of Hepatitis B Antiviral Agents
Anti-hepatitis C Agents

• See Protease Inhibitors

• Can be used in combination with ribavirin or ribavirin and

peginterferon to treat chronic hepatitis C
• Technivie , and Paritaprevir
Locally Active Antiviral Agents

• Indications – Act on viruses by interfering with normal viral

replication and metabolic processes
• Pharmacokinetics – Not absorbed systemically
• Contraindications – Allergy to the drug
• Adverse Reactions – Local burning, stinging, and discomfort
Nursing Considerations for Locally Active Antiviral Agents

Assess:
• History of allergy
• Physical assessment
• Infected area, including location, size, and character of lesions
• Signs of inflammation at the site of infection
Thanks!