Promoting an Optimal Response to Therapy

Because these drugs may be used in the treatment of certain types of severe and sometimes life-threatening viral infections, the patient may be concerned about the diagnosis and prognosis. The nurse should allow the patient time to talk and ask questions about methods of treatment, especially when the drug is given IV. It is important to explain the treatment methods to the patient and family members.

The antiviral drugs are not given intramuscularly or subcutaneously. It is important to prepare the antiviral drugs according to the manufacturer's directions. The administration rate is ordered by the primary health care provider. The nurse takes care to prevent trauma because even slight trauma can result in bruising if the platelet count is low. If injections are given, pressure is applied at the injection site to prevent bleeding. Occasionally, headache or a slight fever may occur in patients taking antiviral drugs. An analgesic may be prescribed to manage these effects.

ACYCLOVIR. Treatment with acyclovir is begun as soon as symptoms of herpes simplex appear. The drug may be given topically, orally, or intravenously. When the drug is given orally, the nurse may give the drug without regard to food. However, if GI upset occurs, acyclovir is administered with food. Patients with a history of congestive heart failure may not be able to tolerate an increase in fluids, so it is important to monitor them closely to prevent fluid overload. Neurologic symptoms such as seizures may occur with the administration of acyclovir. When the drug is administered topically, the nurse should use a finger cot or glove to prevent spread of infection.

AMANTADINE. The nurse administers this drug for the prevention or treatment of respiratory tract illness caused by influenza A virus. Some patients are prescribed this drug to manage extrapyramidal effects caused by drugs used to treat Parkinsonism (See Chaps. 29 and 32). The nurse should protect the capsules from moisture to prevent deterioration. When the drug is administered for symptoms of influenza, it is important to start therapy within 24 to 48 hours after symptoms begin.

DIDANOSINE. For patients with HIV infection who cannot tolerate zidovudine or who have exhibited decreased therapeutic effect with zidovudine, the nurse should administer this drug to the patient with an empty stomach (at least 1 hour before or 2 hours after meals). The tablets are not swallowed whole; the patient should chew them or crush and mix them thoroughly with at least 1 oz of water. The nurse mixes buffered powder with 4 oz of water (not juice), stirs until dissolved, and gives it to the patient to drink immediately. The nurse avoids generating dust when preparing the medication. When cleaning up powdered products, a wet mop or damp sponge is used. The surface is cleaned with soap and water.

RIBAVIRIN. The nurse gives ribavirin by inhalation using a small particle aerosol generator (SPAG-2 aerosol generator). It is important to discard and replace the solution every 24 hours. Treatment with ribavirin lasts for at least 3 days, but not more than 7, for 12 to 18 h/d. Women of childbearing age should not take this drug because evidence links it to birth defects.

ZANAMIVIR. This drug is available as a powder blister for inhalation. The usual dose is 2 inhalations (one 5-mg blister per inhalation) administered with a Diskhaler device. The drug should be started within 2 days' onset of flu symptoms. The drug is taken every 12 hours.

ZIDOVUDINE. The nurse assesses the patient for an increase in severity of symptoms of HIV and for symptoms of opportunistic infections. Capsules and syrup should be protected from light.

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