Drugs for Viral

Infections
 Viruses are nonliving agents that infect bacteria, plants, and animals. Viruses
contain none of the cellular organelles necessary for self-survival that are present
in living organisms.
In fact, the structure of viruses is quite primitive compared with that of even the
simplest cell. Surrounded by a protective protein coat, or capsid, a virus
possesses only a few dozen genes, either in the form of ribonucleic acid (RNA)
or deoxyribonucleic acid (DNA), that contain the necessary information needed
for viral replication.
 HIV targets the T4 lymphocyte, using reverse transcriptase to make viral DNA.
The result is gradual destruction of the immune system.
Antiretroviral drugs used in the treatment of HIV-AIDS do not cure the
disease, but they do help many patients live longer.
Pharmacotherapy may be initiated in the acute (symptomatic) or chronic
(asymptomatic) phase of HIV infection. Drugs from five drug classes are used
in various combinations in the pharmacotherapy of HIV-AIDS. The nucleotide
reverse transcriptase inhibitors and the fusion inhibitors have recently been
discovered.
 The reverse transcriptase inhibitors block HIV replication at the level of the
reverse transcriptase enzyme. These include the NRTIs, NNRTIs, and the
NtRTIs.
The protease inhibitors inhibit the final assembly of the HIV virion. They are
always used in combination with other antiretrovirals.
Pharmacotherapy can lessen the severity of acute herpes simplex infections and
prolong the latent period of the disease.
 Drugs are available to prevent and to treat influenza infections. Vaccination is the
best choice, because drugs are relatively ineffective once influenza symptoms
appear.
Hepatitis A and B are best treated through immunization. Newer drugs for HBV
and HBC have led to therapies for chronic hepatitis.
 Three different therapies are approved for chronic HBV pharmacotherapy:
Interferon alfa or PEG interferon. Between 30% to 40% of patients respond to
4 months of therapy. However, 5% to 10% of these patients relapse after
completion of therapy.
Lamivudine (Epivir). Between 25% to 45% of patients respond to therapy,
which lasts 1 year or longer. Emergence of resistant viral strains is becoming a
clinical problem.
Adefovir (Hepsera). Approximately 50% of patients respond to 48 weeks of
therapy. The drug is new, and long-term studies are in progress.
Drugs for Herpesviruses
acyclovir (Zovirax)
cidofovir (Vistide)
docosanol (Abreva)
famciclovir (Famvir)
foscarnet (Foscavir)
ganciclovir (Cytovene, Zirgan)
idoxuridine (Dendrid, Herplex)
penciclovir (Denavir)
trifluridine (Viroptic)
valacyclovir (Valtrex)
 Drugs for Influenza
amantadine (Symmetrel)
rimantadine (Flumadine)

oseltamivir (Tamiflu)
zanamivir (Relenza)
Nursing Process Focus: AntiViral Drug
ASSESSMENT
Obtain a complete health history including immunizations; respiratory, neurologic,
hepatic, or renal disease; and the possibility of pregnancy. Obtain a drug history
including allergies, including specific reactions to drugs, current prescription and OTC
drugs, herbal preparations, and alcohol use.
Be alert topossible drug interactions.
Assess signs and symptoms of current infection, noting onset, duration, characteristics,
and presence or absence of fever or pain.
Evaluate appropriate laboratory findings (e.g., CBC, hepatic and renal function studies,
viral cultures).
 IMPLEMENTATION
Encourage infection control and good hygiene
measures based on disease condition, and follow the
established protocol in hospitalized patients.
Maintain hydration during antiviral therapy. Hydration
may be ordered in the immediate pre- and post-
administration periods. Monitor intake and output in
the hospitalized patient.
When administering medications, instruct the patient,
family, or caregiver in the proper self-administration
techniques followed by teach-back.