AntiVirals

Pg.1846
Acyclovir (Zovirax)
Famciclovir
ACTION: inhibit viral DNA replication by interfering with viral DNA polymerase.
APPLICATION/INDICATION: Effective against Herpes Simplex 1 and 2, varicella-zoster, herpes
zoster, Epson Barr virus, and cytomegalovirus. Given topically or orally.
NURSING RESPONSIBILITIES: Monitor effectiveness of drug, Monitor Side Effects, Encourage
adequate fluid intake, Inform pt. that drug is not a cure for herpes.
Herper Zoster (Shingles)
ETIOLOGY, EPIDEMIOLOGY and PATHOPHYSIOLOGY:
Pg.1850
Viral skin infection. Latent varicella-zoster virus causes chickenpox. After chickenpox remains
dormant in dorsal root and cranial nerve ganglion. Usually activated when immune compromised
by AIDS, Hodgkins disease, cancer. In U.S. 95-99 % of people 40 and over have antibodies for
H.Z. Singles Vaccine (Zostavax) recommended to people over 60.
CLINICAL MANIFESTATIONS:
Lesions are erythematous vesicles scattered on skin along 1 or 2 adjacent dermatomes. Thoracic
distribution most common but also common on neck, face, and in eyes. Vesicles come in various
sized and with time become cloudy with purulent fluid. Pain, Itching, Burning, Fever Headache,
malaise prior to eruption.
Postherpetic Neuralgi - pain for weeks, months, sometimes lifetime after lesions resolve.
Itching, buring sharp shooting.
DIAGNOSTIC, LAB STUDIES, and MEDICAL MANAGEMENT
Diagnosis with physical assessment and history. Test used to identify virus Polymerase Chain
Reaction. Treatment aimed at shortening course of virus and preventing/alleviating pain. Antiviral
Agents Acyclovir, Famciclovir. Treatment can also include nerve block, tricyclic antidepressants,
anticonvulsants for pain. NO cure.
Herpes Simplex 1, Herpes Simplex 2
ETIOLOGY, EPIDEMIOLOGY and PATHOPHYSIOLOGY:
Pg.1850
(HS1) causes oral lesions or cold soars in approximately 80 % of cases and causes genital lesions
in approximately 20 % of cases. (HS2) causes genital lesions in approximately 80 % of cases and
cause oral lesions in 20 %. Both are more prevalent in women than men. Virus lives in Nerve root
and remains asymptomatic until something triggers an outbreak. Sun, stress and fever are
common triggers.
CLINICAL MANIFESTATIONS:
Lesions are vesicles that are erythematous base and appear in groups. Burning, Stinging, Pain.
Lesions last 2-6 weeks. Usually followed by a second group of lesions that are less severe.
Lesions contain live virus and can be spread by kissing, oral sex, poor hand hygiene, intercourse.
Also: sharing drinks, utensils, toothbrush. Condom use recommended.
DIAGNOSTIC, LAB STUDIES, and MEDICAL MANAGEMENT
Diagnosis is made through symptoms and physical appearance of lesions. Identified by Tzanck
smear or culture. NO Cure but treated. Antivirals are to speed healing.