{"id":117,"date":"2019-09-22T17:54:06","date_gmt":"2019-09-22T21:54:06","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/nursingpharmacology\/chapter\/3-14-antivirals\/"},"modified":"2022-03-16T12:53:41","modified_gmt":"2022-03-16T16:53:41","slug":"3-15-antivirals","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/nursingpharmacology\/chapter\/3-15-antivirals\/","title":{"raw":"3.15 Antivirals","rendered":"3.15 Antivirals"},"content":{"raw":"[caption id=\"\" align=\"alignnone\" width=\"1200\"]\"Photos Figure 3.10 Images of viruses (a) Members of the Coronavirus family can cause respiratory infections like the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Here they are viewed under a transmission electron microscope (TEM). (b) Ebolavirus, a member of the Filovirus family. (credit a: modification of work by Centers for Disease Control and Prevention; credit b: modification of work by Thomas W. Geisbert)[\/caption]\r\n\r\nUnlike the complex structure of fungi or protozoa, viral structure is simple.\u00a0 There are several subclasses of antiviral medications: antiherpes, antiinfluenza, anti-hepatitis, and antiretrovirals.\u00a0 Each subclass will be discussed in more detail below.\u00a0 See Figure 3.10[footnote]\"Unknown\" by CNX OpenStax<\/a> is licensed under CC BY 4.0<\/a> Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-3-types-of-microorganisms<\/a>[\/footnote] for images of viruses.\r\n

Subclass: Antiherpes<\/h2>\r\nIndications for Use: <\/strong>Acyclovir (Zovirax) and its derivatives are frequently used for the treatment of herpes and varicella virus infections, including genital herpes, chickenpox, shingles, Epstein-Barr virus infections, and cytomegalovirus infections.\r\n\r\nMechanism of Action:<\/strong> Acyclovir causes termination of the DNA chain during the viral replication process. Acyclovir can be administered either topically or systemically, depending on the infection.[footnote]This work is a derivative of Microbiology<\/a> by OpenStax<\/a> licensed under CC BY 4.0<\/a>. Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction<\/a>[\/footnote]<\/sup>\r\n\r\nSpecial Administration Considerations:<\/strong> Acyclovir use may result in nephrotoxicity.\r\n\r\nClient Teaching & Education:<\/strong> Clients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\r\n

Subclass: AntiInfluenza<\/h2>\r\nIndications for Use: <\/strong>Tamiflu (oseltamivir) is used to target the influenza virus by blocking the release of the virus from the infected cells.\r\n\r\nMechanism of Action:<\/strong> Tamiflu prevents the release of virus from infected cells.\r\n\r\nSpecial Administration Considerations:<\/strong> This medication does not cure influenza, but can decrease flu symptoms and shorten the duration of illness if taken in a timely manner. Ckients are prescribed the medication for prophylaxis against infection, known exposure, or to lesson the course of the illness. If clients experience flu-like symptoms, it is critical that they start treatment within 48 hours of symptom onset.\r\n\r\nClient Teaching & Education:<\/strong> Clients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\r\n\r\nThe influenza virus is one of the few RNA viruses that replicates in the nucleus of cells. Antivirals block the release stage. See Figure 3.11.[footnote]\"Unknown\" by CNX OpenStax<\/a> is licensed under CC BY 4.0<\/a> Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/6-2-the-viral-life-cycle<\/a>[\/footnote]<\/sup>\r\n\r\n[caption id=\"attachment_116\" align=\"aligncenter\" width=\"1024\"]\"Illustration Figure 3.11 Influenza virus replication stages[\/caption]\r\n

Subclass: Antiretrovirals<\/h2>\r\nViruses with complex life cycles, such as HIV, can be more difficult to treat. These types of viruses require the use of antiretroviral medications that block viral replication. (See Figure 3.12 to view the viral replication process of HIV.) [footnote]This work is a derivative of \"HIV Virus Replication Cycle<\/a>\" by NIAID<\/a> is licensed under CC BY 2.0<\/a>[\/footnote]<\/sup>\u00a0<\/span>Additionally, antiretrovirals fall under the class of antiviral medications.\r\n\r\n[caption id=\"attachment_116\" align=\"aligncenter\" width=\"406\"]\"Illustration Figure 3.12 HIV attaches to a cell surface receptor of an immune cell and fuses with the cell membrane. Viral contents are released into the cell, where viral enzymes convert the single-stranded RNA genome into DNA and incorporate it into the host genome[\/caption]\r\n\r\nIndications for Use:<\/strong> Antiretrovirals are used for the treatment of illnesses like HIV.\r\n\r\nMechanism of Action:<\/strong> Antiretrovirals impede virus replication.\r\n\r\nSpecial Administration Considerations:<\/strong>\u00a0 Many antiretrovirals may impact renal function; therefore, the client's urine output and renal labs should be monitored carefully for signs of decreased function.\r\n\r\nClient Teaching & Education:<\/strong> Clients who are being treated with antiviral therapy should be instructed about the importance of antiretroviral compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\r\n\r\nNow let's take a closer look at the medication cards for the subclasses of antivirals in Table 3.14a-d.[footnote]Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019[\/footnote]<\/sup>[footnote]UpToDate (2021). Acyclovir<\/em>. https:\/\/www.uptodate.com\/contents\/search<\/a>[\/footnote][footnote]UpToDate (2021). Oseltamivir<\/em>. https:\/\/www.uptodate.com\/contents\/search<\/a>[\/footnote][footnote]UpToDate (2021). Adefovir<\/em>. https:\/\/www.uptodate.com\/contents\/search<\/a>[\/footnote][footnote]UpToDate (2021). Lamivudine-Zidovudine.<\/em> https:\/\/www.uptodate.com\/contents\/search<\/a>[\/footnote] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.\r\n\r\nTables 3.14a Acyclovir Medication Card\r\n\r\nClass\/Subclass:\u00a0 Antivirals\/Antiherpes<\/strong> (prototype:\u00a0 acyclovir<\/a>)\r\n\r\n\"Anti-herpes\r\n\r\nTables 3.14b Oseltamivir Medication Card\r\n\r\nClass\/Subclass:\u00a0 Antivirals\/Anti-Influenza Agents<\/strong> (prototype:\u00a0 oseltamivir<\/a>)\r\n\r\n\"Anti-influenza\r\n\r\nTables 3.14c Adefovir Medication Card\r\n\r\nClass\/Subclass:\u00a0 Antivirals\/Anti-Hepatitis Agents<\/strong> (prototype: adefovir<\/a>)\r\n\r\n\"Anti-hepatitis\r\n\r\nTables 3.14d Lamuvadine-Zidovudine Medication Card\r\n\r\nClass\/Subclass:\u00a0 Antivirals\/Anti-retrovirals<\/strong> (prototype:\u00a0 lamivudine- zidovudine<\/a>)\r\n\r\n\"Antiretroviral\r\n
\r\n

Clinical Reasoning and Decision-Making Activity 3.14<\/strong><\/h2>\r\n<\/header>\r\n
\r\n\r\nUsing the above information, consider the following clinical scenario question:<\/strong>\r\n\r\nA client is prescribed oseltamivir (Tamiflu) for influenza symptoms. The client states to the nurse, \"I hope this medication works quickly! I have felt lousy for the past 5 days!\" What is the nurse's next best response?\r\n\r\nNote: Answers to the activities can be found in the \"Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>\r\n ","rendered":"
\"Photos
Figure 3.10 Images of viruses (a) Members of the Coronavirus family can cause respiratory infections like the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Here they are viewed under a transmission electron microscope (TEM). (b) Ebolavirus, a member of the Filovirus family. (credit a: modification of work by Centers for Disease Control and Prevention; credit b: modification of work by Thomas W. Geisbert)<\/figcaption><\/figure>\n

Unlike the complex structure of fungi or protozoa, viral structure is simple.\u00a0 There are several subclasses of antiviral medications: antiherpes, antiinfluenza, anti-hepatitis, and antiretrovirals.\u00a0 Each subclass will be discussed in more detail below.\u00a0 See Figure 3.10[1]<\/sup><\/a> for images of viruses.<\/p>\n

Subclass: Antiherpes<\/h2>\n

Indications for Use: <\/strong>Acyclovir (Zovirax) and its derivatives are frequently used for the treatment of herpes and varicella virus infections, including genital herpes, chickenpox, shingles, Epstein-Barr virus infections, and cytomegalovirus infections.<\/p>\n

Mechanism of Action:<\/strong> Acyclovir causes termination of the DNA chain during the viral replication process. Acyclovir can be administered either topically or systemically, depending on the infection.[2]<\/sup><\/a><\/sup><\/p>\n

Special Administration Considerations:<\/strong> Acyclovir use may result in nephrotoxicity.<\/p>\n

Client Teaching & Education:<\/strong> Clients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[3]<\/sup><\/a><\/sup><\/p>\n

Subclass: AntiInfluenza<\/h2>\n

Indications for Use: <\/strong>Tamiflu (oseltamivir) is used to target the influenza virus by blocking the release of the virus from the infected cells.<\/p>\n

Mechanism of Action:<\/strong> Tamiflu prevents the release of virus from infected cells.<\/p>\n

Special Administration Considerations:<\/strong> This medication does not cure influenza, but can decrease flu symptoms and shorten the duration of illness if taken in a timely manner. Ckients are prescribed the medication for prophylaxis against infection, known exposure, or to lesson the course of the illness. If clients experience flu-like symptoms, it is critical that they start treatment within 48 hours of symptom onset.<\/p>\n

Client Teaching & Education:<\/strong> Clients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[4]<\/sup><\/a><\/sup><\/p>\n

The influenza virus is one of the few RNA viruses that replicates in the nucleus of cells. Antivirals block the release stage. See Figure 3.11.[5]<\/sup><\/a><\/sup><\/p>\n

\"Illustration
Figure 3.11 Influenza virus replication stages<\/figcaption><\/figure>\n

Subclass: Antiretrovirals<\/h2>\n

Viruses with complex life cycles, such as HIV, can be more difficult to treat. These types of viruses require the use of antiretroviral medications that block viral replication. (See Figure 3.12 to view the viral replication process of HIV.) [6]<\/sup><\/a><\/sup>\u00a0<\/span>Additionally, antiretrovirals fall under the class of antiviral medications.<\/p>\n

\"Illustration
Figure 3.12 HIV attaches to a cell surface receptor of an immune cell and fuses with the cell membrane. Viral contents are released into the cell, where viral enzymes convert the single-stranded RNA genome into DNA and incorporate it into the host genome<\/figcaption><\/figure>\n

Indications for Use:<\/strong> Antiretrovirals are used for the treatment of illnesses like HIV.<\/p>\n

Mechanism of Action:<\/strong> Antiretrovirals impede virus replication.<\/p>\n

Special Administration Considerations:<\/strong>\u00a0 Many antiretrovirals may impact renal function; therefore, the client’s urine output and renal labs should be monitored carefully for signs of decreased function.<\/p>\n

Client Teaching & Education:<\/strong> Clients who are being treated with antiviral therapy should be instructed about the importance of antiretroviral compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[7]<\/sup><\/a><\/sup><\/p>\n

Now let’s take a closer look at the medication cards for the subclasses of antivirals in Table 3.14a-d.[8]<\/sup><\/a><\/sup>[9]<\/sup><\/a>[10]<\/sup><\/a>[11]<\/sup><\/a>[12]<\/sup><\/a> Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.<\/p>\n

Tables 3.14a Acyclovir Medication Card<\/p>\n

Class\/Subclass:\u00a0 Antivirals\/Antiherpes<\/strong> (prototype:\u00a0 acyclovir<\/a>)<\/p>\n

\"Anti-herpes<\/p>\n

Tables 3.14b Oseltamivir Medication Card<\/p>\n

Class\/Subclass:\u00a0 Antivirals\/Anti-Influenza Agents<\/strong> (prototype:\u00a0 oseltamivir<\/a>)<\/p>\n

\"Anti-influenza<\/p>\n

Tables 3.14c Adefovir Medication Card<\/p>\n

Class\/Subclass:\u00a0 Antivirals\/Anti-Hepatitis Agents<\/strong> (prototype: adefovir<\/a>)<\/p>\n

\"Anti-hepatitis<\/p>\n

Tables 3.14d Lamuvadine-Zidovudine Medication Card<\/p>\n

Class\/Subclass:\u00a0 Antivirals\/Anti-retrovirals<\/strong> (prototype:\u00a0 lamivudine- zidovudine<\/a>)<\/p>\n

\"Antiretroviral<\/p>\n

\n
\n

Clinical Reasoning and Decision-Making Activity 3.14<\/strong><\/h2>\n<\/header>\n
\n

Using the above information, consider the following clinical scenario question:<\/strong><\/p>\n

A client is prescribed oseltamivir (Tamiflu) for influenza symptoms. The client states to the nurse, “I hope this medication works quickly! I have felt lousy for the past 5 days!” What is the nurse’s next best response?<\/p>\n

Note: Answers to the activities can be found in the “Answer Key<\/a>” sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n

 <\/p>\n

Media Attributions<\/h2>