-
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
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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
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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)
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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
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NI teaching
AZT
- 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
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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
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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
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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
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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
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Other agents
tend to be used later in therapy
once resistance to other
expensive
- 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
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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
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