WORKMAN: Understanding Pharmacology, 3rd edition

Chapter 7 Handout

Chapter 7

Antiinfectives:
Antiviral Drugs

Understanding Pharmacology, 3rd ed.

Workman

Copyright © 2024, Elsevier Inc. All rights reserved.

Learning Objectives—Lesson 7.1

1. Explain the names, actions, usual adult dosages,
possible side effects, and adverse effects of the
various types of nonretroviral drug therapies.
2. Describe priority actions to take before and after
giving any of the various types of nonretroviral drug
therapies.
3. Prioritize essential information to teach patients who
take any of the various types of nonretroviral drug
therapies.

Copyright © 2024, Elsevier Inc. All rights reserved.

Viruses
 Intracellular, submicroscopic parasites that
must infect a living cell to reproduce
 Two types:
 Common viruses (nonretroviruses)
 Retroviruses

Copyright © 2024, Elsevier Inc. All rights reserved.

1
 WORKMAN: Understanding Pharmacology, 3rd edition
Chapter 7 Handout

Antiviral Drug Therapy

 Virustatic: Reduces the number of viruses
 Intended responses:
 Shorten the duration or intensity of an existing viral disease
 Prevent reactivation of a dormant viral infection
 Prevent a viral infection from multiplying to the point of
disease
 Allergic reactions always possible
 More serious reactions occur when given intravenously
 Teaching priorities:
 Antiviral drugs must be taken exactly as prescribed; must
take drug long enough to work

Copyright © 2024, Elsevier Inc. All rights reserved.

Drugs for Herpes Simplex

Infections
 Slow viral reproduction
 Most effective against genital herpes infections, Epstein-Barr
virus, cytomegalovirus, varicella-zoster virus
 Side effects: Headache, dizziness, nausea, diarrhea
 Adverse effects: Reduced kidney function, leading to
kidney damage and failure; pain/irritation at injection
site; reduced efficacy of antiseizure drugs
 Teaching priorities: Same as general antiviral drugs
 Life span considerations: Weigh benefits against
risks in pregnancy; not recommended during lactation

Copyright © 2024, Elsevier Inc. All rights reserved.

Drugs for Common Respiratory

Viral Infections
 Baloxavir, oseltamivir, peramivir, zanamivir
 Side effects:
 Headache, nausea/vomiting, diarrhea, dizziness
 Adverse effects:
 Vary by specific drug
 May include acute confusion, delirium,
hallucinations, elevated liver enzymes

Copyright © 2024, Elsevier Inc. All rights reserved.

2
 WORKMAN: Understanding Pharmacology, 3rd edition
Chapter 7 Handout

Administering Drugs for Common

Respiratory Viral Infections
 Check before:
 Ask about drug allergies
 Do not administer peramivir with other drugs
 Check after:
 For IV drugs, assess patient every 15 minutes
 Teaching priorities:
 Take drug exactly as prescribed
 Teach patients taking zanamivir how to use a dry
powder inhaler

Copyright © 2024, Elsevier Inc. All rights reserved.

Ribavirin
 Ribavirin suppresses viral action and reproduction
 Used for viral infections that do not respond to other
antiviral agents
 Side effects:
 Nausea/vomiting, diarrhea, fever, headache, rash,
conjunctivitis, muscle pain, fatigue, dizziness, runny nose,
injection site pain or irritation
 Adverse effects:
 Teratogenic
 Prolonged use may impair functioning of liver, kidneys,
heart, ears. May lead to some forms of cancer.

Copyright © 2024, Elsevier Inc. All rights reserved.

Administering Ribavirin
 Check before:
 Hearing; cardiac, respiratory, neurologic, kidney,
liver functioning
 Blood counts and vital signs
 Ask about other drugs the patient may be taking
 Wear a mask when giving aerosolized form

 Check after:
 Monitor closely for side effects or organ toxicity
 Review lab values daily
 Assess hearing daily

Copyright © 2024, Elsevier Inc. All rights reserved.

3
 WORKMAN: Understanding Pharmacology, 3rd edition
Chapter 7 Handout

Life Span Considerations

for Ribavirin

 Pregnancy and lactation:

 Do not use during pregnancy or breastfeeding!
 Use two forms of contraception while taking the
drug, and 1 month after discontinuing the drug

Copyright © 2024, Elsevier Inc. All rights reserved.

10

Drugs for Chronic Hepatitis C

Infection
 Inhibits viral proteins and enzymes important to virus
replication and reproduction
 Side effects:
 Headache, GI discomfort, rashes, fatigue
 Adverse effects:
 Elevated liver enzymes, jaundice, bone marrow suppression,
angioedema, drug interactions
 Teaching priorities:
 Avoid alcohol
 Women should use two forms of contraception
 Report signs of allergic reaction or jaundice

Copyright © 2024, Elsevier Inc. All rights reserved.

11

Drugs for Chronic Hepatitis B

Infection
 Limits replication and reproduction of HBV; may be
used for months to years
 Side effects:
 Fatigue, headache, fever, rash, muscle aches
 Adverse effects:
 Peginterferon: Psychiatric disorders worsen, bone marrow
suppression
 Entecavir: liver toxicity, lactic acidosis, shallow breathing

 Teaching priorities:
 Avoid alcohol; women use two forms of contraception
 Report new feelings of depression
 Report signs of allergic reaction or jaundice
Copyright © 2024, Elsevier Inc. All rights reserved.

12

4
 WORKMAN: Understanding Pharmacology, 3rd edition
Chapter 7 Handout

Life Span Considerations for

Drugs for Chronic Hepatitis B
Infection
 Pregnancy and lactation:
 Studies have not been performed
 Strong likelihood of peginterferon causing
pregnancy loss
 Peginterferon and entecavir contraindicated during
pregnancy and breastfeeding

Copyright © 2024, Elsevier Inc. All rights reserved.

13

Drugs for COVID-19 Infection

 New retrovirus that first appeared in 2019
 As of publication, no specific drugs or
therapies fully approved
 Approved for emergency use authorization by
FDA:
 Remdesivir, casirivimab/imdevimab, Paxlovid
 Other treatments:
 Convalescent serum containing antibodies from
recovered patients, additional antibiotics and
antiinflammatories
Copyright © 2024, Elsevier Inc. All rights reserved.

14

Administering Drugs for COVID-

19 Infection
 Side effects:
 Injection site reactions, fever, muscle aches,
nausea, taste changes, diarrhea, hypertension
 Adverse effects:
 Unknown; likely include allergic reaction, renal
toxicity, increased liver enzymes, anemia, liver
toxicity
 Check before:
 Confirm COVID-19 infection, strict aseptic
technique

Copyright © 2024, Elsevier Inc. All rights reserved.

15

5
 WORKMAN: Understanding Pharmacology, 3rd edition
Chapter 7 Handout

Learning Objectives—Lesson 7.2

4. Explain the names, actions, usual adult dosages,
possible side effects, and adverse effects of the
various types of retroviral drug therapies.
5. Describe priority actions to take before and after
giving any of the different types of retroviral drug
therapies.
6. Prioritize essential information to teach patients who
take any of the different types of retroviral drug
therapies.
7. Explain appropriate life span considerations for the
various types of nonretroviral and retroviral drug
therapies.

Copyright © 2024, Elsevier Inc. All rights reserved.

16

Retroviruses
 Always use RNA as their genetic material
 Allow high efficiency of cellular infection
 Human immune deficiency virus (HIV)

Copyright © 2024, Elsevier Inc. All rights reserved.

17

HIV/AIDS
 HIV attacks the immune system
 Most severe form of immune deficiency
disease caused by HIV infection is acquired
immune deficiency syndrome (AIDS)
 Everyone with AIDS has HIV infection
 Not everyone with HIV infection has AIDS
 Opportunistic infections

Copyright © 2024, Elsevier Inc. All rights reserved.

18

6
 WORKMAN: Understanding Pharmacology, 3rd edition
Chapter 7 Handout

Seven Classes of
Antiretroviral Drugs
 Nucleoside analog reverse transcriptase
inhibitors (NRTIs)
 Non-nucleoside analog reverse transcriptase
inhibitors (NNRTIs)
 Protease inhibitors (PIs)
 Fusion inhibitors
 CCR5 antagonists
 Integrase strand transfer inhibitors (INSTIs)
 Attachment inhibitors
Copyright © 2024, Elsevier Inc. All rights reserved.

19

Antiretroviral Therapy
 Virustatic
 Drug resistance common; related to missed drug
doses
 New combination therapy is easier to manage (1-3
pills per day)
 Be alert to allergic reactions
 Intended response: suppression of viral reproduction,
delay progression to later stages, prevent
transmission
 Measured by “viral load” and decreased opportunistic
infections; immune function improved

Copyright © 2024, Elsevier Inc. All rights reserved.

20

Common Side Effects and Adverse

Effects of Combination ART

 Side effects:
 Rash, nausea, vomiting, abdominal pain,
headache, fatigue, weight gain, difficulty sleeping,
vivid dreams or nightmares
 Adverse effects:
 Elevated liver enzymes, jaundice, increased risk of
birth defects, many interactions with other drugs

Copyright © 2024, Elsevier Inc. All rights reserved.

21

7
 WORKMAN: Understanding Pharmacology, 3rd edition
Chapter 7 Handout

Priority Actions for Combination

ART
 Check patient for liver problems, glucose
levels (if diabetic)
 Lifelong treatment; ensure appropriate, in-
depth education
 Obtain a list of all drugs patient is currently
taking
 Teaching priorities:
 Take drugs exactly as prescribed, be aware of
signs of liver toxicity, do not change other drugs
without discussing with a provider

Copyright © 2024, Elsevier Inc. All rights reserved.

22

Life Span Considerations for

Combination ART
 Pediatric considerations:
 Not approved for use in children
 Pregnancy and lactation:
 Not approved; HIV positive mothers are instructed
not to breastfeed.
 Older adults:
 Be careful of drug interactions

Copyright © 2024, Elsevier Inc. All rights reserved.

23

Drugs for Preexposure

Prophylaxis of HIV Infection
 Prevent sexual transmission of HIV
 Combination drugs emtricitabine and
tenofovir for HIV-1 negative patients with a
partner who is HIV-1 positive
 Does not replace safer sex practices

Copyright © 2024, Elsevier Inc. All rights reserved.

24