HIV
Drug Adherence
Supplies to enhance drug adherence
- Drug organizers, Mobile device alarms
- Drug map with pictures
- Drug diary
- Supportive help from others
CCR5 antagonists (Maraviroc) SE
SE Include:
- Upper respiratory infections cough, pyrexia, Rash, Dizziness, ABDD pain, liver tox
Post exposure prophylaxis regimens
Initiated within 72 hours and continued for 4 weeks
Cyclosporine / Tacrolimus SE
Can cause nephrotoxicity, infection, hypertension, and hirsutism and Gingival hyperplasia (Use soft toothbrush)
Avoid crowds (Neutropenic precautions)
Use birth control
Maintenance therapy for transplants
Mammalian Target of Rapamycin Inhibitors (Sirolimus and Everolimus)
- Prevents renal rejection, increased risk of infection
- Raises cholesterol and triglycerides
- SE: Rash/acne, Amenia, joint pain, hypokalemia
Action of NRTIs (Tenofovir, Zidovudine) and SE
Inhibits viral replication by interfering with HIV viral RNA dependent DNA polymerase
SE: NVD, rash, peripheral neuropathy, pancreatitis, myopathy, Leukopenia, Fatigue
Integrase Strand Transfer Inhibitors (Dolutegravir, Elvitegravir, Raltegravir) SE
SE Include:
- ND, rash Insomnia, HA, pyrexia, Hepatic damage, Rhabdomyolysis
Transplant drug risks
Immunosuppression: Increased risk of infection (No live vaccines and report WBC under 4000)
Bone marrow suppression: Increased risk for bleeding and infections. (Check platelet count)
Prednisone for transplant pts
It is used for anti inflammatory effects due to and acute organ rejection
5 Ss for SE
1) Swollen: wgt gain
2) Sepsis
3) Sugar increased = hyperglycemia
4) Skinny bones = Leads to osteoporosis
5) Sight = Cataracts risk
NON nucleoside reverse transcriptase inhibitors (Efavirenz) SE
SE include:
- NV rash, dizziness, insomnia, neuropathy, liver failure
Opportunistic Infections
Tuberculosis, Cytomegalovirus, Toxoplasmosis, Mycobacterium avium complex, Kaposi Sarcoma
Indication of drug transplant rejection
Flu like s/s is the first s/s
Immunosuppression and reason for multidrug therapy
This is used to reduce the toxicity risk from other drugs such as immunosuppressants that could possibly cause toxicity
Protease Inhibitors (Atazanavir) SE
SE Include:
- NVD, rash, insulin resistance, hemolytic anemia, SJS, Hyperlipidemia
HIV tx in pregnancy
Timing and selections of regimen are different than non pregnant individuals
Want to achieve maximal and sustained viral suppression
Factors influencing drug adherence
Factors vary from societies, however, simply forgetting the regimen, annoyance, embarrassment all play a role in med adherence
To promote: Education, supportive therapy, coping skills
Immunosuppressant drugs (Basiliximab)
Prevents body from producing an immune response to a transplant (rejection)
Can cause severe anaphylaxis and NO live vaccines
Cannot be used in pregnant patients
Fusion (Entry) Inhibitors (Enfuvirtide, ibalizumab) SE
SE Include: Diarrhea, Rash, Injection reactions, Anaphylaxis, Fever, hypotension
Immune reconstruction inflammatory syndrome
In relation to a specific opportunistic pathogen inflammatory response with antiretroviral therapy being changed or started
Paridoxial: Exacerbation of treated OI
Unmasking: Response to undiagnosed or subclinical OI
Neutropenic precautions
Avoid heavy crowds
Cook all raw meat
Wash hands often
Avoid FRESH fruits and veggies bc of potential infection
Maintenance Therapy for organ transplants
Costimulation Blockers: Belatacept
- used for epstein-barr virus seropositive pts only
Prevents kidney rejection in combination with other meds, NO live vaccines