NURS 6521 Week 8: Infections
Prior to the H1N1 influenza pandemic in 2009, it had been more than 40 years since an infectious virus had resulted in such substantial illness, hospitalizations, and deaths on a global scale (CDC, 2010). This can be attributed to improved prevention such as proper hygiene, as well as vaccinations and other drug therapies. However, as the H1N1 pandemic illustrates, infections are sometimes unavoidable even when appropriate prevention methods are implemented. In clinical settings, patients present with various infections including common disorders such as flus and colds, as well as disorders that require more extensive treatment and care such as the human immunodeficiency virus (HIV) or tuberculosis (TB). As an advanced practice nurse, you must evaluate patients presenting with symptoms of infections and recommend appropriate drug treatments.
This week you begin to explore infections by considering issues surrounding the prevalence, management, and education about HIV/AIDS. You also examine viral and bacterial infections, as well as the appropriate use of antimicrobial agents.
Learning Objectives
By the end of this week, students will:
Analyze reasons for the prevalence of HIV/AIDS
Analyze ways health care professionals can change society’s perceptions of HIV/AIDS
Analyze strategies to educate HIV positive patients on treatment and management
Analyze categories of antimicrobial agents
Differentiate between viral and bacterial infections
Analyze the relationship between infections and antimicrobial agents
Understand and apply key terms, concepts, and principles related to prescribing drugs to treat infections and infestations
Photo Credit: E.M. Pasieka/ Science Photo Library/Getty Images
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 8, “Principles of Antimicrobial Therapy” (pp. 111-134)
This chapter covers factors that impact the selection of an antimicrobial treatment regimen. It also examines the clinical uses, adverse events, and drug interactions of various antimicrobial agents such as penicillin.
Chapter 12, “Fungal Infections of the Skin” (pp. 163-196)
This chapter explores the pathophysiology of several fungal infections of the skin as well as related drug treatments and examines the importance of patient education when managing these infections.
Chapter 14, “Bacterial Infections of the Skin” (pp. 181-196)
This chapter begins by examining causes of bacterial infections. It then explores the importance of selecting an appropriate agent for treating bacterial infections.
Chapter 32, “Urinary Tract Infection” (pp. 519-526)
This chapter covers drugs used to treat urinary tract infections and identifies special considerations when treating geriatric patients, pediatric patients, and women.
Chapter 35, “Sexually Transmitted Infections” (pp. 512-535)
This chapter outlines the causes, pathophysiology, and drug treatment of six sexually transmitted infections, including gonorrhea, syphilis, and human papilloma virus infection (HPV). It also examines the importance of selecting the proper agent and monitoring patient response to treatment.
Chapter 49, “Human Immunodeficiency Virus” (pp. 843-860)
This chapter presents the causes, pathophysiology, diagnostic criteria, and prevention methods for HIV. It also covers various methods of drug treatment and patient factors to consider when selecting, administering, and managing drug treatments.
Krummenacher, I., Cavassini, M., Bugnon, O., & Schneider, M. (2011). An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.
Note: Retrieved from the Walden Library databases.
This article analyzes medication adherence in HIV patients and examines factors that increase adherence as well as factors that contribute to termination or discontinuation of treatment.
Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B.,…Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872
This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality and HIV transmission.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Antimicrobials. Baltimore, MD: Author.
This media presentation outlines principles of antimicrobial therapy
Note: The approximate length of this media piece is 7 minutes.
Discussion: Drug Treatments for HIV/AIDS
While HIV/AIDS is still currently incurable, the prognosis for patients with this infectious disease has improved due to advancements in drug treatments. Consider the case of Kristy Aney. Kristy was diagnosed with HIV in 1992 and was told she would survive, at most, 10 more years. Despite unfavorable odds, Kristy is still alive 20 years later. Since her diagnosis, she has witnessed tremendous improvements in HIV/AIDS treatments which have helped patients live longer with fewer side effects. While she acknowledges that these drug treatments have kept her alive, she fears that improvements in drug therapy have led to more people becoming complacent about the disease (Idaho Statesmen, 2012). In fact, the number of people living with HIV/AIDS in the United States is higher than it has ever been (CDC, 2012). This poses the question: Is there a relationship between drug advancements, societal complacency, and infection?
To prepare:
Review Chapter 49 of the Arcangelo and Peterson text, as well as the Montaner et al (2014) articles in the Learning Resources.
Reflect on whether or not the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options for HIV/AIDS.
Consider how health care professionals can help to change perceptions and make people more aware of the realities of the disease.
Think about strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others.
With these thoughts in mind:
By Day 3
Post an explanation of whether or not you think the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options.Then, explain how health care professionals can help to change perceptions and increase awareness of the realities of the disease. Finally, describe strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others.
By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who provided a different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Discussion Rubric
Submission
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 8 Discussion
Assignment:
Antimicrobial Agents
Antimicrobial agents are essential components in the treatment of various bacterial infections as they help to kill or prevent the growth of microbes such as bacteria, fungi, and protozoans. Prior to the discovery of antimicrobial agents, treatment options for patients with bacterial infections were limited. For many patients, treatment often resulted in the amputation of limbs or even death. Today, treatment options for bacterial infections typically have a more positive prognosis. Due to the various types of infections presented in patients, it is essential to be able to identify the underlying cause of the infection—whether bacterial or viral—before recommending drug treatments. This will help you identify whether or not an antimicrobial agent would be appropriate and which specific agent would target the infection. In this Assignment, you consider the appropriate use of antimicrobial agents for infections.
To prepare:
Review this week’s media presentation on principles of antimicrobial therapy, as well as Chapter 8 of the Arcangelo and Peterson text.
Consider the categories of antimicrobial agents.
Think about differences between viral and bacterial infections.
Reflect on why proper identification of the infection is key to selecting the proper antimicrobial agent.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe the categories of antimicrobial agents.
Describe differences between viral and bacterial infections.
Explain why proper identification of viral and bacterial infections is key to selecting the proper antimicrobial agent.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK08Assgn+last name+first initial.(extension)” as the name.
Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 8 Assignment link.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK08Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 8 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 8 Assignment draft, and review the originality report
Submit Your Assignment by Day 7
To submit your Assignment:
Week 8 Assignment
Week 8 Quiz
This week’s Quiz covers the content you have explored this week. The Quiz may include the following topics:
Drug classifications by indication— antimicrobial agents, dermatologic disorders, infections and infestations, immune system
Drug dosage calculations
Drug interactions
Drugs to treat helminthic infections, malaria, protozoa, tuberculosis – as well as topical steroids classified by potency
By Day 7
You have 90 minutes to complete this 36-question Quiz.
This quiz is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz. You are expected to comply with Walden University’s Code of Conduct.
Submission and Grading Information
Submit Your Quiz by Day 7
To submit your Quiz:
Week 8 Quiz
Pharm Wk 8 Main Post
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The amount of people living with AIDS globally reaches almost thirty-eight million with 5000 new infections daily in 2017; more than one million of them living in the United States (HIV.gov, n.d.). Just over half have achieved viral suppression using highly active antiretroviral therapy (HAART) (HIV.gov, n.d.). The following presents the pharmacology of the six classes of drugs used in HIV/AIDS treatment, and treatment as prevention (TasP).
Because each drug class used to treat HIV interrupts a different part of the viral replication cycle, the key to understanding how these medications work is by understanding the steps of the replication and invasion process. Arcangelo, Peterson, Wilbur, and Reinhold (2017) break this down into nine steps starting with the interaction of the viral envelope of HIV RNA with the CD4 receptor on the T lymphocyte to the last phase which consists of the formation of a capsid which shields viral RNA. Treatment choices must be individualized, and initial treatment consists of two nucleoside/nucleotide reverse transcriptase inhibitors plus a protease inhibitor or an integrase strand transfer inhibitor (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). A short description of each class and an example of each follows.
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
NRTIs interfere with the transcription of viral RNA to DNA after the HIV RNA enters the cell (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). These nucleoside and nucleotides analogs enter cells and are incorporated into the DNA chain by reverse (RI) and terminating any further replication of viral RNA (Whalen, Finkel, & Panavelil, 2015) the chain is incomplete, and no further transcription is possible (Animated HIV Science, n.d.). Tenofovir and emtricitabine, also active against the hepatitis B virus, is one of the NRTI combinations used for beginning treatment (Arcangelo et al., 2017)
The bioavailability of tenofovir increases when taken with a high-fat meal, and is minimally bound to protein (DrugBank, n.d.b). Rises in serum creatinine may indicate the need for a dose reduction, and gastrointestinal symptoms are a common adverse effect (Arcangelo et al., 2017). Emtricitabine is well absorbed orally (Whalen et al., 2015). Both drugs are excreted by the kidneys primary unchanged and have long half-lives which allow for once-daily administration (Whalen et al., 2015), and discontinuation of either drug may result in rebound of symptoms in those coinfected with hepatitis B (Arcangelo et al., 2017).
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs also block the transcription of viral DNA but this is accomplished by interacting directly with reverse transcriptase (RT) enzyme before the transcription process begins (Mechanisms in Medicine, n.d.). Efavirenz is a preferred over other NNRTI, and is well absorbed orally taken on an empty stomach (Whalen et al., 2015). Efavirenz, along with the other medications in this drug class, is metabolized by the cytochrome P-450 enzyme and is a consideration when concomitantly with other drugs that are metabolized by this pathway (Arcangelo et al., 2017). It is administered once daily and should be taken on an empty stomach; common adverse side effects include dizziness, confusion, hallucinations, rash, nausea, and fatigue (RxList, n.d. b). Efavirenz can lengthen the QT interval, use is associated with elevated liver function tests (LFTs), false positives on drug screening tests, and should not be used during pregnancy (Arcangelo et al., 2017).
Protease Inhibitors (PIs)
PIs interfere with the protease-mediated cleavage of polyprotein chains and decreases HIV RNA duplication (Arcangelo et al., 2017). All PIs are CYP3A4 substrates and CYP450 enzyme inhibitors, so drug interactions are common (Whalen et al., 2015). Drugs metabolized by CYP450 enzymes, or CYP450 isoenzyme inducers can all cause a change in serum levels of the PI or concurrent drug (Whalen et al., 2015). Common adverse effects in include nausea, vomiting, and diarrhea; patients taking PIs can experience elevated liver enzymes, hyperlipidemia, hyperglycemia, and lipodystrophy (Arcangelo et al., 2017) The recommended PI combination for treatment naïve patients is darunavir/ritonavir (Arcangelo et al., 2017). The sulfa component of darunavir may cause a rash in some patients (Arcangelo et al., 2017).
Integrase Inhibitors
Integrase strand inhibitors (INSTIs) prevent entry of viral DNA into a host’s cells genome by binding to the active site of the integrase enzyme (Whalen et al., 2015). Elvitegravir, available by itself or in a combination tablet with other medications, belongs to this drug class (Arcangelo et al., 2017). It is highly protein bound, metabolized in the liver, and excreted primarily in the stool (Gilead Sciences, 2014). Elvitegravir must be taken with food and is metabolized by cytochrome CYP3A (Gilead Sciences, 2014). Common side effects are nausea and vomiting; more serious and less frequent side effects include depression, suicidal ideation or attempt (Gilead Sciences, 2014).
Entry Inhibitors (CCR5 Antagonist)
Entry inhibitors block the CCR5 coreceptor which prevents HIV from entering a healthy cell (Arcangelo et al., 2017). Maraviroc is the only drug in this class and prevents the HIV virus from attaching to the T lymphocyte (Whalen et al., 2015). It is not indicated for use as first treatment for HIV, and a tropism assay must be completed before use to ensure that the patient’s strain uses the CCR5 receptor for attachment. Just over one-fifth to one-third of maraviroc is bioavailable, is significantly protein bound in the serum, and metabolized via the CYP3A pathway (DrugBank, n.d. a). Marked drug interactions can occur with use of maraviroc and severe systemic reaction followed by hepatotoxicity have resulted in a black box warning for this medication (Arcangelo et al., 2017).
Fusion Inhibitors
After HIV has attached to CD4 T cell, fusion inhibitors prevent fusion of the virus to the cell (Arcangelo et al., 2017). Enfuvirtide is the only dug in this class, is available only in injectable form, and is indicated for use in patients who have highly resistant forms of the HIV (Arcangelo et al., 2017). Localized site injections are the most common side effect, occurring in over ninety percent of patients and absorption is similar whether injected into the abdomen, thigh, or arm (RxList, n.d.a). It is highly protein bound, does not appear to cross into cerebrospinal fluid, and route of excretion has not been determined in humans (RxList, n.d. a).
Treatment as Prevention (TasP)
Achieving viral suppression also reduces the amount of HIV in genital secretions and results in decreased transmission rates (Arcangelo et al., 2017). Though fifty percent of HIV infected individuals have achieved viral suppression, TasP is the most effective when all HIV patients receive testing, labs, and HAART are available to all infected (Montaner et al., 2014).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice a practical
approach (4th ed.) Philadelphia, PA: Wolters Kluwer
DrugBank. (n.d. a). Miraviroc. Retrieved January 18, 2019, from https://www.drugbank.ca/drugs/DB04835
DrugBank. (n.d. b). Tenofovir disoproxil. Retrieved January 16, 2019, from https://www.drugbank.ca/drugs/DB00300
Gilead Sciences. (2014). Vitekta (elvitegravir) [Highlights of prescribing information]. Retrieved from
https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/203093s000lbl.pdf
HIV.gov. (n.d.). U.S. Statistics. Retrieved January 16,2019, from https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics
Mechanisms in Medicine. (n.d. a). Animation: Mechanisms of action of non-nucleoside reverse transcriptase inhibitors (NNRTIs) [Video file].
Retrieved from http://www.animatedhivscience.com/site/antiviral-animations-mechanisms-of-action-of-non-nucleoside-reverse-
transcriptase-inhibitors-nnrtis.html
Mechanisms in Medicine. (n.d. b). Mechanisms of Action of Nucleoside Reverse Transcriptase Inhibitors (NRTIs). [Video file]. Retrieved
from http://www.animatedhivscience.com/site/animation.aspx?file=animations/antiviral
Montaner, J. S., Lima, V. D., Harrigan, P. R., Lourenco, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is
associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV treatment as prevention”
experience in a Canadian setting []. PLos ONE, 9(2). https://doi.org/10.1372/journal.pone.0087872
RxList. (n.d. a). Fuzeon. Retrieved January 17, 2019, from https://www.rxlist.com/fuzeon-drug.htm#description
RxList. (n.d. b). Sustiva. Retrieved January 16, 2019, from https://www.rxlist.com/sustiva-drug.htm#indications
Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincott illustrated reviews: Pharmacology (6th ed.). Philadelphia, PA: Wolters Kluwer.
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1 month ago
Brandy Barrett
Week 8 Initial Post
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Nurs 6521: Advanced Pharmacology
Week 8 Infections
HIV Prevalence
As we all know HIV affects a devastating amount of people across the United States. According to the HIV Surveillance Reports 1.1 million people are infected with HIV and 1 in 7 people are unaware that they have HIV (CDC, 2018). In my opinion, I do not think the prevalence of HIV is due to increased complacency because of advanced drug options. I would fault the increased opioid epidemic and casual sexual encounters as the reason for prevalence other f HIV in the United States. Yes, I do agree that individuals may not view HIV as a death sentence anymore because we are now aware that individuals can live long normal lives with the disease.
The medications used to try and decrease the risk of transmission antiretroviral (ART) regimens. HIV is a disease cannot be cured, so the next best attempt is to decrease the spread. The goal of treatment is to suppress the viral replication to levels that are undetectable (Arcangelo, Peterson, Wilbur & Reinhold, 2019, p.846). There should be education to reintroduce the seriousness of the disease. Patient’s do need to understand that even though HIV can be managed and individuals can live long lives the medication is not a cure and complications are still possible.
Healthcare professionals can help change the perception and the reality of the disease through education and prevention. According to Arcangelo et al. 2017, tenofovir/emtricitabine in sexually active adults who at increased risk of becoming infected with HIV has helped to decrease the transmission of the disease (p. 856). Safe sex education and needle exchange programs are one way to combat complacency. Talking about the issues keeps the issues relevant in the mind of individuals so that they do not forget that HIV remains a serious health threat.
To educate patients who are HIV positive in adherence to their treatment regimen and reducing the risk of infecting others should take place in multiple settings. Education should happen with their primary care provider, in schools, public health fairs, and anywhere else that a person could be educated. Patients who are infected should understand their diseases fully and how it is transmitted and the benefits of healthy living and medication compliance. As a provider, we should be offering screenings and testing routinely — populations who at higher risk should be targeted with more information and screenings.
Reference:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach(4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the
United States, 2010–2015.HIV Surveillance Supplemental Report 2018;23(No. 1). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published March 2018. Accessed [January 16,2019].
Singh, S., Song, R., Johnson, A. S., McCray, E., & Hall, H. I. (2018). HIV Incidence,
Prevalence, and Undiagnosed Infections in U.S. Men Who Have Sex With Men. Annals Of Internal Medicine, 168(10), 685–694. https://doi-org.ezp.waldenulibrary.org/10.7326/M17-2082
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1 month ago
Antoinette Joseph
Main Post- HIV/AIDS
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HIV and AIDS
Acquired Immunodeficiency Syndrome (AIDS) is a secondary immunodeficiency syndrome as a result of a viral infection with Human Immunodeficiency Virus (HIV) (Huether & McCance, 2017). CD4 positive Th cells, which play an integral role in development of plasma and cytoxic T cells, are infected and destroyed by HIV causing a suppression of immune responses, increasing the acquiring of opportunistic infections, resulting in the development of AIDS (Huether & McCance, 2017). In this post, treatment of HIV/AIDS will be described, increased incidence in relation to increased patient complacency will be discussed, the impact of the healthcare provider on the perception and awareness will be explored, and strategies for education on medication adherence and prevention of transmission will be identified.
Treatment
HIV/AIDS treatment options all revolve around inhibiting the DNA and RNA actions within the cell. The goals of treatment are to maintain a suppression of the viral replication at a level that is undetectable, restore and preserve the immune system function, enhance the duration and quality of life, reduction of morbidity and mortality, and preventing transmission of the virus (Arcangelo, Peterson, & Reinhold, 2017). There are six different drug classes that can be utilized as treatment options, Nucleoside Reverse Transcriptase Inhibitors (NRTI), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI), Protease Inhibitors (PI), Fusion Inhibitors (FI), Ingrase Inhibitors (II), and CCR5 Antagonists . Treatment regime is contingent on the history of treatment with the specific patient, is the patient treatment naïve or treatment experienced, the side-effects of the medications, drug to drug interactions, the response to prior treatment options attempted, and the presence of specific receptors on cell membranes (Arcangelo, Peterson, & Reinhold, 2017).
NRTIs interrupts the transcription of the ribonucleic acid (RNA) to deoxyribonucleic acid (DNA) by either inserting itself into the chain, resulting in chain termination or competitive inhibition (Arcangelo, Peterson, & Reinhold, 2017). NTRIs are activated in the target cell through phosphorylation prior to the key activity causing the interruption of the transcription (Arcangelo, Peterson, & Reinhold, 2017). Dosing adjustments are made in individuals with renal impairments because it is eliminated by the kidneys and hypersensitivity usually occurs within the first six weeks (fever, rash, gastrointestinal (GI) disturbances, lethargy, and malaise) (Arcangelo, Peterson, & Reinhold, 2017). Lactic acidosis with steatosis can occur as an adverse reaction, which is rare; however, can increase the risk of death from the adverse reaction. The incidences of an adverse reaction is increased in females, pregnancy, obesity, regime components, and prolonged utilization (Arcangelo, Peterson, & Reinhold, 2017).
There are five types of NNRTIs (Delavirdine, Efavirenz. Etravirine, Nevirapine, and Rilpivirine), which inhibits the conversion of RNA to DNA through binding with reverse transcriptase (Arcangelo, Peterson, & Reinhold, 2017). Adverse effects include GI disturbances, elevation in hepatic transamines, and rash (Arcangelo, Peterson, & Reinhold, 2017). Efavirenz is usually utilized after treatment failure due to the increased incidences of central nervous system (CNS) symptoms (dizziness, impaired concentration, and abnormal dreams), it has been shown to cause birth defects, and side effects usually resolve within 2-4 weeks (Arcangelo, Peterson, & Reinhold, 2017). Nevirapine has the possibility of causing hepatotoxicity (Arcangelo, Peterson, & Reinhold, 2017). NNTRIs have drug-drug interaction with drugs whose metabolism is dependent on the CYP450 SA 4 (Arcangelo, Peterson, & Reinhold, 2017).
The cleavage of polyproteins, responsible for creating new HIV RNA, is hindered by PIs as the mechanism of action (Arcangelo, Peterson, & Reinhold, 2017). There are 9 PIs available, with ritonavir or cobicistat being utilized in combination with other PIs to boost the impact on the virus (Arcangelo, Peterson, & Reinhold, 2017). Numerous drug to drug interactions exist, the pharmacokinetics vary in each drug in this class, and adverse reactions can include GI disturbances, nausea, vomiting, and diarrhea (Arcangelo, Peterson, & Reinhold, 2017). A coinfection with Hepatitis B or Hepatitis C, alcohol abuse, underlying liver disease, and utilization of hepatotoxic agents simultaneously can increase the incidence of hepatotoxicity (Arcangelo, Peterson, & Reinhold, 2017). Other side effects include fat redistribution, hyperlipidemia, and hyperglycemia (Arcangelo, Peterson, & Reinhold, 2017). Drug-drug interactions occur in medications metabolized by in the CY450 (Arcangelo, Peterson, & Reinhold, 2017).
Enfuvirtide is the only drug available in the FI class, which prevents the HIV from moving into the cell through inhibition of the fusion of the virus to the cell membrane of the CD4 T Cell (Arcangelo, Peterson, & Reinhold, 2017). FI should only be utilized in treatment experienced patients, is a subcutaneous injection administered twice a day and almost 100% of the patients have injection site reactions as an adverse reaction (Arcangelo, Peterson, & Reinhold, 2017). Adverse effects also include an increase in the rate of bacterial pneumonia and hypersensitivity reactions (Arcangelo, Peterson, & Reinhold, 2017).
Ingrase Inhibitors (II) protects the host cell DNA through inhibition of the integration of the viral cell’s DNA into the host cell’s DNA (Arcangelo, Peterson, & Reinhold, 2017). There are three available (dolutegravir, elvitegravir, and rattegravir), which are recommended for use with with NTRIs as a backbone for initial therapy in treatment naïve patients (Arcangelo, Peterson, & Reinhold, 2017). There is minimal drug-drug interaction, an increased risk for rhabdomyolysis, adverse reactions can include nausea, headaches, and diarrhea, as well as insomnia and headache in extreme cases (Arcangelo, Peterson, & Reinhold, 2017). Dosing can occur as a once a day dose, for treatment naïve patients, or a twice a day dose for treatment experiences patients (Arcangelo, Peterson, & Reinhold, 2017). Since the absorption is impacted by calcium and irons supplements, and antacids, IIs should be taken 2 hours before or 6 hours after these supplements (Arcangelo, Peterson, & Reinhold, 2017).
Maraviroc is the only CCR5 antagonist available which acts through prevention of the HIV entry by inhibiting the CCR5 receptor on the membrane of the CD4+ T cells (Arcangelo, Peterson, & Reinhold, 2017). Laboratory testing, Coreceptor tropism assay, is required to determine if the virus in the patient contains CCR5 receptors since not all HIV viruses have CCR5 receptors (Arcangelo, Peterson, & Reinhold, 2017). Adverse reactions include a systemic allergic reaction, which can be followed by hepatotoxicity, cough, orthostatic hypotension, rash, and fever (Arcangelo, Peterson, & Reinhold, 2017). There is an increased incidence of drug-drug interaction and this should not be the first line of treatment (Arcangelo, Peterson, & Reinhold, 2017).
Increased Incidence and Increase in Complacency
Approximately 50,000 people are newly diagnosed with HIV every year in the United States (Huether & McCance, 2017). An increase in complacency does play a role in the incidence of HIV; however, the role is viewed by the writer as very small, contingent on the discussed population, compared to the “fear of knowing” the individual has the disease, causing individuals not to be tested (Thapa, et al., 2018). Complacency, as it pertains to HIV treatment would be significant in the middle- to upper- class citizen who can afford treatment for HIV; however, the stigma of having the virus could cancel out the effects the potential “complacency” would cause if the individual decides to act in integrity and disclose the presence of the virus. Complacency becomes an issue when there is no disclosure and the patient is aware of the decreased potential to transmit, and/or, both are aware of the presence of the virus and the decreased incidence of transmission with a low viral load. In summary, the complacency secondary to treatment options is contingent on the presenting scenario.
Healthcare Provider Impact on Perception and Awareness
In the area of perception and awareness, the main role of the healthcare provider is to provide patient centered education, which can be created through candid conversations about the sexual activity of the patient and current knowledge of the viral infection. This would provide the possibility of the provider to supplement existing knowledge about the viral infection and provide methods, unknown to the patient, for the prevention of transmission. The provider should always develop, just like a plan of care, an individualized education plan in order for it to be effective. The implementation of Highly Active Antiretroviral Therapy (HAART) could impact the incidence of transmission; however, it does not eliminate the compete possibility to transmit the disease (Montaner, et al., 2014), which is important to relay to the patient.
Education on Medication Adherence and Prevention of Transmission
A method to increase the medication adherence would be to attempt to develop a plan of care based on the results of an interdisciplinary assessment of the patient (Krummenacher, Cavassini, & Bugnon, 2011). The intervention should not be limited to the drug therapy; however, it should include reminders, calls to review any challenges the patient could be facing, constant re-evaluation of the financial burden of taking the medication, and inclusion of social workers to help mitigate some of the challenges the patient may have with the current medication regime. A multidisciplinary approach will allow a holistic approach of treatment and can be utilized for risk reduction in the high-risk for infection population.
Conclusion
In conclusion, the incidences of HIV continues to be a challenge to decrease. Six classes of medications are present to treat the disease; however, complacency can impact the efficacy based on the patient’s social status and whether they decide to disclose the presence of the infection. Providers have a responsibility to ensure they educate patients through correcting and supplementing the knowledge of the patient. An interdisciplinary approach for treatment and risk reduction would be the most effective method of treatment and prevention.
Reference
Arcangelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins.
Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology. S. Louis, Missouri: Elsivier.
Krummenacher, I., Cavassini, M., & Bugnon, O. (2011). An interdisciplinary HIV-adherence program combining moticational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 550-561.
Montaner, J. S., Lima, V. D., Harrigan, P. R., Lourenco, L., Yip, B., Nosyk, B., . . . Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS Morbidity, MOrtality, and HIV Transmission:The “HIV Treatment as Prevention” Experience in a Canadian Setting. PLOS ONE, 9.
Thapa, S., Hannes, K., Cargo, M., Buve, A., Peters, S., Dauphin, S., & Mathei, C. (2018). Stigma reduction in relation to HIV test uptake in low- and middle- income countries: A realist review. BMC Public Health, 1-21.
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1 month ago
JOEL PIERRE
Discussion – Week 8
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Drug Treatments for HIV/AIDS
Although strategies and information about HIV/AIDS are flourishing across the world, there is no doubt that the incidences of infections are still at a higher level. HIV is one of the most dreaded pathogens of the 21st century. The virus is spreading not only in Africa where more than twenty-five million people are infected but also across the United States and Canada. According to the Center for Disease Control and Prevention (CDC), an estimated number of about 1.2 million US citizens have been infected in the US, and nearly an eighth of the victims are not aware (Laborers Health and Safety Fund. (2017). Therefore, undiagnosed HIV infections form a significant impediment in eradication AIDS. Every year, more than 50000 people are infected with HIV in the US causing the death of about 13000 people annually. Observance to HAART supports to retain the viral load under control and extend the time of progression to AIDS, consequential in near normal life expectancy.
The classes of anti-HIV/AIDS drugs include
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as efavirenz, nevirapine etravirine help turn off a protein needed by HIV to make copies of itself. Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) Abacavir Descovy, lamivudine-zidovudine are defective types of the structure blocks that HIV wishes to duplicate of itself (Center for Disease Control and Prevention (CDC). Protease inhibitors (PIs) atazanavir, darunavir, fosamprenavir are incapacitate HIV protease, additional protein that HIV needs to duplicate of itself. Integrase inhibitors such as raltegravir, and dolutegravir work by deactivating a protein named integrase, which HIV uses to insert its genetic material into CD4 T cells (Center for Disease Control and Prevention (CDC). The pharmacology management differences between viral and bacterial infections. Bacterial infections are instigated by bacteria, and viral infections are instigated by viruses. Conceivably the most significant distinction among bacteria and viruses is that antibiotic drugs typically kill bacteria, nonetheless they aren’t effective against viruses.
Prevalence of HIV/AIDS and its Relationship to Advanced HAART
I support the thinking that prevalence of HIV/AIDS emanates from increased complacency due to the several advanced options of drug treatment. The United States encounters complacency about the needs for preventing HIV hence becoming a barrier for communities to achieve prevention standards. Although there is a significant success in the use of highly active antiretroviral therapies (HAART) witnessed by a reduction in newly reported AIDS cases and deaths, the epidemic control is still challenging(Arcangelo, Peterson, Wilbur, & Reinhold, 2017). There are a continuing number of infected individuals who must face years of multiple daily medications, possibly severe and unpleasant side effects and great expenditure for medicines that suppress the disease and prevent opportunistic infections.
The HAART mostly helps the affected persons to live longer and lead better lives. However, the availability of drug treatment may lull people into believing that there is no importance of instituting preventive measures for HIV/AIDS. Therefore, it is this complacency about the need for prevention that makes it complicated for both individuals and program planners on the infection risk. Nowadays, infected people can lower the amount of the virus in their bodies and also lead a long, healthy and productive life. In some cases, some individuals may forget to take the doses of skip the medications while others may take ‘drug holidays.’ Failing to follow treatment schedules makes the drugs less effective. This diversion from treatment increase drug resistance hence limiting treatment options for infected people in the future.
Health Practitioners’ Perception on the Realities of HIV/AIDS Prevalence
Healthcare professionals can help increase awareness about the brutality of the disease. I believe that, it is an obligation as a health practitioner to assistance individuals comprehend that HIV is not a disease of the past and there are still probabilities of contracting this disease. Individuals essential to be conscious of their own HIV status and understand that, they are putting others at great risk by spreading the disease. The NP should be willing to convey prevention messages, skills and support people with HIV risk behaviors. It involves encouraging them to reduce sexual and drug-related risks. In the US, every individual who abuses drugs should be counseling and treatment services that help them stop substance abuse and prevent further infections (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). At the same, the issue with sexual risks among the drug users should be incorporated in the prevention programs.
The new generation of young people require a comprehensive and continuous health information and appropriate interventions that may help them to develop life-long skills, which empower them to avoid activities that can result in HIV infection. Such programs should involve parents and educators, and they should begin at early age where they advise the adoption of healthy behaviors such as healthy diet and avoidance of substance abuse. Also, healthcare professionals should also improve means of treating sexually transmitted diseases thus reducing the risk of acquiring and transmitting HIV (Arcangelo, Peterson, Wilbur & Reinhold, 2017).
Strategies to Educate HIV Positive Patients on Medication Adherence
Education is key in creating HIV/AIDS awareness and changing people’s perception on the disease and treatment options available to them (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Furthermore, observance interventions contain an individual support factor that includes personalized or group education about HAART. The HAART adherence, the progress of basic medication management skills, and problem-solving with respect to adherence barriers. The victims of the disease should be trained in how to prevent behaviors of re-infection and also avoid drug abuse that could minimize new people being infected. Also, frequent sex education helps the youths in preventing the frequency of intercourse, reduce the number of partners and increase the use of condoms and other contraceptives (Laborers Health and Safety Fund. (2017).
It is important for health providers to be traditionally and culturally knowledgeable and use a multidisciplinary approach to serve and improve by providing teaching to those affected to guarantee a better result. Providing resources, such as places and where these patients can go and get support. Pregnant mothers that are infected with HIV are assisted through perinatal prevention programs. The program has realized significant success in reducing HIV transmission to the unborn babies. Patients with HIV/AIDS positive status should be introduced to a HIV/AIDS adherence program where the patient must meet with his/her health practitioner/specialist and the pharmacist to discuss the challenges and knowledge of AIDS, and medication compliance (Krummenacher et al (2018).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention (2019). CDC FACT SHEET: Today’s HIV/AIDS
Epidemic. Retrieved from https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/
Krummenacher, I., et al (2018). An interdisciplinary
HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.
Laborers Health and Safety Fund. (2017). New HIV Risk: Complacency. Retrieved
January 14, 2019, from laborers health and safety fund: https://www.lhsfna.org/index.cfm/lifelines/september-2015/new-hiv-risk-complacency/
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1 month ago
jennifer stromgren
Week 8 Discussion
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HIV is a retrovirus, following the infection of the host cells, the viral enzyme reverse transcriptase allows synthesis of a DNA molecule that is the inserted into the DNA of the host cell, allowing the virus to replicate ( Arcangelo, Peterson, Eilbur & Reinhold, 2017). Initiating drug therapy is important that all patients, regardless of CD4 count should be offered treatment with ART ( Panel on Antiretroviral Guidelines, 2016). The goal of therapy is focused on sustained supression of viral replication to undetectable levels ( Arcangelo, Peterson, Wilbur & Reinhold, 2017).
Medication Classes
Nucleoside reverse transcriptase inhibitors were the first type of drug available to treat HIV, they are powerful, effective and important medications for treating HIV when combined with other drugs ( U.S> Department of Veterans Affairs, 2018). When HIV enters a healthy cell, it attempts to make copies of itself ( U.S. Department of Veterans Affairs, 2018). The NRTIs work because they block that enzyme, without reverse transcriptase, HIV cannot make new virus copies of itself ( U.S. Department of Veterans Affairs, 2018).
Didanosine in combination with other antiviral agents are indicated for treatment of HIV ( Drugs.com, 2017). Didanosine is rapidly absorbed, with peak plasma concentrations generally observed from 0.50-1.50 hours following oral administration ( Drugs.com, 2017). Didanosine is a synthetic nucleoside analogue of the naturally occuring nucleoside deoxyadenosine in which the 3-hydroxyl is replaced by hydrogen ( Drugs.com, 2017).
Nonnucleoside reverse transcriptase inhibitors interfere with reverse transcriptase by binding directly to the enzyme ( Aids Map, n.d.). They are not competitive with nucleoside reverse transcriptase inhibitors as they work at a different site on the reverse transcriptase enzyme and are not incorporated into the viral DNA ( Aids Map, n.d.).
Delavirdine binds directly to reverse transcriptase, blocking RNA- dependant and DNA- dependant DNA polymerase activities ( Drugs.com, 2018). Delavirdine is rapidly absorbed, low concentration in saliva and semen;concurrent plasma concentration and is excreted in the urine unchanged and feces ( Drugs.com, 2018). Delavirdine is for the tretment of HIV-1 infection in combonation with at least two additional antiretroviral agents ( Drugs.com, 2018).
HIV protease inhibitors are synthetic drugs that inhibit the action of HIV-1 protease, an enzyme that cleaves two precursor protiens into smaller fragments ( Drugs.com, 2018). These fragments are needed for vital growth, ineffectively and replication ( Drugs.com, 2018). Protease inhibitors bind to the active site of the protease enzyme and prevent the maturation of the newly produced virus so they remain non infectious ( Drugs.com, 2018).
Ritonavir is and antiviral medicine that prevents HIV from multipyling in the body, it is used together with other antiviral medications to treat HIV ( Drugs.com, 2018). The absolute bioavailability of ritonavir has not been determined. Nearly all of the plasma radioactivity after a single dose was attributed to unchanged ritonavir ( Drugs.com, 2018). Ritonavir is a peptidomimetic inhibitor of the HIV-1 protease. Inhibition of HIV protease renders the enzyme incapable of processing the Gag-pol polyprotein precursor which leads to production of noninfectious immature HIV particles ( Drugs.com, 2018).
There is a single licensed fusion inhibitor, T-20 (Aids Map, n.d.). T-20 binds to the gp41 glycoprotein and prevents that shape changes that enable virus cell fusion ( Aids Map, n.d.). Since T-20 is a protein that would be destroyed by acids in the stomach, it must be administered by injection ( Aids Map, n.d.). Studies show adding T-20 to an existing antiretorviral regimen can improve response in treatment experienced patients with drug resistant HIV ( Aids Map, n.d.).
Enfuvirtide binds to the first heptad-repeat in the gp41 subunit of the viral envelope glycoprotein ( Drugs.com, 2018). Inhibits the fusion of HIV-1 virus with CD4 cells by blocking the conformational change in gp41 required for membrane and entry into CD4 cells ( Drugs.com, 2018). Metabolism is expected to undergo catabolism via peptidases and proteinases in the liver and kidneys to amin acids;amino acids would be recycled in the body pool ( Drugs.com, 2018). Plasma clearance is decreased in adults with lower body weight and in females after adjusting body weight, however, no adjustment in dose is recommended for gender or weight ( Drugs.com, 2018).
Entry inhibitors work by preventing HIV from entering healthy CD4 cells in the body. They work differently than many approved HIV drugs which are active against HIV after it has infected a CD4 cell (Poz, 2016). Entry inhibitors work by attaching themselves to proteins on the surface of CD4 cells or proteins on the surface of HIV ( Poz, 2016). If entry inhibitors are successful in blocking these proteins, HIV is unable to bind to the surface of the CD4 cells and gain entry into the cells (Poz, 2016).
Maravioric is a CCR5 antagonist, selectively and revirsibly binds to the chemokine coreceptors located on human CD4 cells ( Drugs.com, 2018). CCR5 prevents interaction between the human CCR5 coreceptor and the gp120 subunit of the viral envelope glycoprotein ( Drugs.com, 2018). Metabolized via CYP3A to inactive metabolites and is excreted in the urine ( Drugs.com, 2018).
Integrase strand transfer inhibitors block the action of integrase, a viral enzyme of the HIV type 1, that is involved in integrating viral DNA into the host chromosome ( Drugs.com, 2018). Integrase strand transfer inhibitors are not a cure for HIV or AIDs, however, is used to prevent the HIV virus from multiplying in the host ( Drugs.com, 2018).
Raltegravir inhibits the catalytic activity of integrase, thus preventing integration of the proviral gene into human DNA ( Drugs.com, 2017). Primarily hepatic metabolism and excreted in the feces and urine ( Drugs.com, 2017).
Preceptions and Awareness
As a health care provider it is very important to make patients aware of prevention of HIV and how it is treated. Over the past few years there has been a decline in HIV diagnoses. Educating individuals that at this time you are able to live with HIV due to the advances in medications, however, there continues to not be a cure for the disease, it is possible with the use of medications to have undetectable HIV within the body, however, patients that are HIV positive remain carriers of the disease and are able to pass from person to person.
Education
Educating patients that are HIV positive on the correct uses, side effects and importance of taking medication is key, Having group sessions with other patients that are HIV positive regarding medication may help as the patient may be more open to discussing medications with other individuals, handouts regarding medications may also be helpful. Education regarding safe sex practices are very important as patients are able to pass the disease from person to person. With the advances in drug therapy for HIV patients there would be more adherence to medications, as the patient would be aware they are able to live longer healthier lives with the use of medication.
Reference
Aids Map (n.d.). Fusion Inhibitors. Retrieved from: https://www.aidsmap.com/fusion-inhibitors/page/1729433
Aids Map ( n.d.). Nucleoside RT Inhibitors. Retrieved from: https://www.aidsmap.com/non-nucleoside-rt-inhibitors/page/1729428
Drugs.com (2017). Didanosine. Retrieved from: https://www.drugs.com/pro/didanosine.html
Drugs.com. (2018). Delavirdine. Retrieved from: https://www.drugs.com/ppa/delavidrine.html
Drugs.com (2018). Enfuviritide. Retrieved from:https://www.drugs.com/ppa/enfuvirtide.html
Drugs.com (2018). Integrase Strand Transfer Inhibitor. Retrieved from: https://www.drugs.com/drugs-class/integrase-strand-transfer-inhibitor.html
Drugs.com ( 2018). Maraviroc. Retrieved from: https://www.drugs.com/ppa/maraviroc.html
Drugs.com (2018). Protease Inhibitors. Retrieved from: https://www.drugs.com/drug-class/protease-inhibitors.html
Drugs.com ( 2017). Raltegravir. retrieved from: https;//www.drugs.com/ppa/raltegravir.html
Drugs.com. (2018). Ritonavir. Retrieved from: https://www.drugs.com/mtm/ritonavir.html
Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. (2016). Guidelines for the use of antiretroviral agents in pediatric HIV infection. HHS Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children- A Working Group of the Office of AIDS Research Advisory Council ( OARAC). Retrieved from http://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf
Poz ( 2016). Entry Inhibitors. Retrieved from: https://www.poz.com/drugs/classes/entryinhibitors
U.S. Department of Veterans Affairs. (2018). Nucleoside Reverse Transcriptase Inhibitors. Retrieved from: https://www.hiv.va.gov/patient/treat/NRITs.asp
Arcangelo, V.P, Peterson, A.M., Wilbur, V. & Reinhold, J.A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed). Ambler, PA: Lippincott, Williams & Wilkins
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1 month ago
LAURA TUCKER
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Main Forum
As of 2010, there are about 1.1 million people in the United States that have HIV with 50,000 new cases every year which has stayed stable over some time. There are three reasons that explain the challenges when treating someone with HIV the first is the selection of antiretroviral therapy (ART) base on what genotype the person has and what medications fit with that genotype. Second is the side effects of the medication and if the patient can deal with the side effects of the medications and take their medications when they are supposed to be taken. Third is when a patient does not take their medication the way they are supposed it results in treatment failure and resistance to the regimen (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). “The ultimate goals of HIV therapy are to achieve maximal and sustained suppression of viral load, restoration and preservation of immune system function, enhancement of quality and duration of life, reduction of morbidity and mortality from HIV related complications and prevention of HIV” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Education on safe sex, no needle sharing, and body fluid exchange including breast milk is key to HIV spread prevention.
Nucleoside Reverse Transcriptase Inhibitors
Nucleoside Reverse Transcriptase Inhibitors (NRTI)work by blocking reverse transcriptase. When reverse transcriptase and reverse transcription is blocked it prevents HIV from replicating (U.S. Department of Health and Human Services, 2019). Abacavir is metabolized mainly in the liver. Exposure is increase with alcohol use. Having HLA-B*5701 gene allele increases the odd of having a hypersensitivity reaction and should be used with caution (Atta, De Seigneux, & Lucas, 2019). It is contraindicated in moderate to severe hepatic impairment and can be taken with or with out meal, should not be rechallenged if patient has a hypersensitivity. Also, can be used in combination with other drugs such as lamivudine and dolutegravir. “ It is an effective component of ART. (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Lamivudine is metabolized mainly by the kidneys and dose is adjusted do to renal insufficiency (Atta, De Seigneux, & Lucas, 2019). When discontinued if patient also has Hep B a severe acute exacerbation happens. May be taken with or without food also (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Emtricitabine is like lamivudine as it also metabolizes in the kidneys and can have effects on Hep B patients if stopped as well as can be taken without without food (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Tenofovir Disoproxil Fumarate (TDF) is the most widely used treatment for HIV but is being replaced by Tenofovir Alafenamide Fumarate (TAF) because TAF is more stable in the plasma and safer on the kidneys but may be contraindicated in patient with diabetes and chronic liver disease (Atta, De Seigneux, & Lucas, 2019). TDF can also have an effect on patient with hep B when stopped and can be taken with or without meal (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Didanosine is metabolized in the liver. Side effects include “pancreatitis, peripheral neuropathy, optic neuritis, lactic acidosis with hepatic steatosis, and noncirrhotic portal hypertension” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Do not use in patients taking allopurinol or ribavirin and needs to be taken 30 minutes before meals or 2 hours after a meal. In renal patients the dose will need to be adjusted (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI)
NNRTI also inhibit HIV from using reverse transcriptase to copy itself (U.S. Department of Veteran Affairs, n.d.). They should not be taken with St. John’s wart, rifapentine, simeprevir, dasabuvir, ombitasvir, and partaprevir and are most likely to cause GI symptoms. They are metabolized by cytochrome P-450 3A4 isoenzyme system in the liver (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Efavirenz should be taken on an empty stomach at bedtime. Should be avoided during pregnancy (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Nevirapine should be avoided in patients with moderate to severe hepatic impairment and can be taken with or without meals (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Rilpivirine should not be given with anticonvulsants such as phenytoin, phenobarbital, carbamazepine, and oxcarbazepine as well as rifampin. It needs to be taken with a meal (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). NNRTIs have also shown low genetic barrier for resistance and should not be used as the first line of ART (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Protease Inhibitors
Protease Inhibitors (PI) were brought into the market in the mid 1990’s and have shown durable effects and high barriers to resistance. They inhibit they final stage of polyproteins creating new HIV RNA. They should not be taken with St. john’s wart, simvastatin, lovastatin, amiodarone, dronedarone, ranolazine, cisapride, pimozide, midazolam, triazolam, lurasidone, ergot alkaloids, alfuzosin, salmeterol, fluticasone, salmeterol, simeprevir, dasabuvir, ombitasvir, paritaprevir, sildenafil when used for pulmonary hypertension (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Most should be taken with meals except indinavir should be taken 1 hour before a meal or 2 hours after and saquinavir and tipranavir should not be taken if patient has hepatic impairment (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Fusion Inhibitors
Fusion Inhibitors has only one drug in its class called enfuvirtide. “it inhibits the fusion of the virus to the cell membrane of the CD4 T cell which prevents HIV from entering the cell” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). It is usually used with patients that have had the disease for a while and that are resistant to other antiretroviral drugs. This drug is an injection that needs to be done twice a day and kept in the refrigerator when reconstituted as well as used within 24 hours. It is also associated with a higher rate of bacterial pneumonia (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Integrase Inhibitors
Integrase Inhibitors (II) are used as a first line treatment for newly diagnosed HIV patients in combination with NRTIs (Atta, De Seigneux, & Lucas, 2019). “They prevent the integration of the viral DNA into the host cell’s genome” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Raltegravir is metabolized by the liver (Atta, De Seigneux, & Lucas, 2019). It can be taken with or without meals just like dolutegravir but elvitegravir should be taken with a meal. (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
CCR 5 Antagonist
CCR5 Antagonist has one drug in it is class called maraviroc. “It blocks the CCR5 receptor one the membrane of CD4 T cells preventing HIV from entering” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Before the drug is given a test need to be done to see if the virus utilizes CCR5 receptor. May cause a cough, orthostatic hypotension and dizziness. Should not be given with end stage renal disease or renal impairment. Can be taken with or without food (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Atta, M. G., De Seigneux, S., & Lucas, G. M. (2019). Clinical pharmacology in HIV therapy. Clinical Journal of American Society of Nephrology, 14(1). Retrieved from https://doi.org/10.2215/CJN.02240218
U.S. Department of Health and Human Services. (2019, January 16). Nucleoside reverse transcriptase inhibitor (NRTI) definition. Retrieved from https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/902/nucleoside-reverse-transcriptase-inhibitor
U.S. Department of Veteran Affairs. (n.d.). Non-nucleoside reverse transcriptase inhibitors (NNRTIs or ‘non-nukes’). Retrieved from https://www.hiv.va.gov/patient/treat/NNRTIs.asp
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1 month ago
Sarah Schoner
Week 8 Main Post
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Week Eight: Drug Treatments for HIV/AIDS
Sarah Schoner
HIV/AIDS
AIDS that goes untreated reduces the number of CD4 T-cells in the body weakening the immune system and resulting in the body’s inability to fight off infections and some diseases (CDC, n.d.). While there is no cure for HIV/AIDS, significant advancements have been made pharmacologically with anti-retroviral therapies (ART) that have extended the life expectancy for individuals with HIV. There are six anti-retroviral therapy classifications that work on reducing the viral load.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
NRTIs work through either chain termination or competitive inhibition after undergoing intracellular phosphorylation (Arcangelo, 2017). Didanosine, an NRTI, inhibits in vitro replication of HIV via chain termination and interference with HIV-RNA dependent DNA polymerase (didanosine, n.d.). Didanosine is 42% bioavailable in adults, 25% in children, and is less than 5% protein bound (didanosine, n.d.). It is metabolized in the liver and excreted in the urine (didanosine, n.d.). Lactic acidosis with hepatic steatosis may occur in patients prescribed NRTIs (Arcangelo, 2017). Diarrhea, peripheral neuropathy, increased amylase, and abdominal pain can occur with didanosine use.
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs work by binding to reverse transcriptase causing interference with the conversion of RNA to DNA (Arcangelo, 2017). Rilpivirine inhibits HIV-1 replication by noncompetitive inhibition of HIV-1 reverse transcriptase (rilpivirine, n.d.). Rilpivirine’s absolute bioavailability is unknown and it reaches peak plasma time in 4-5 hours (rilpivirine, n.d.). It is 99.7% protein bound, primarily to albumin and is metabolized by CYP3A (rilpivirine, n.d.). Rilpivirine is excreted through the feces and urine (rilpivirine, n.d.). Most commonly experienced adverse effects include gastrointestinal symptom, rash, and an elevation in hepatic transaminases (Arcangelo, 2017).
HIV Protease Inhibitors
This classification of medications works by inhibiting the protease-mediated cleavage of the polyproteins that are responsible for generating the new HIV RNA copies (Arcangelo, 2017). Indinavir, a protease inhibitor, inhibits the cleavage of Gag-Pol polyprotein precursors (indinavir, n.d.). Indinavir has good bioavailability, is 60% protein bound, and is hepatically metabolized by CYP3A4 (indinavir, n.d.). Indinavir is excreted through the feces and urine (indinavir, n.d.). Adverse effects include nephrolithiasis, hyperbilirubinemia, nausea, headache, dizziness, and rash (indinavir, n.d.).
Fusion Inhibitor
Enfuvirtide, a synthetic peptide, which acts through inhibiting the fusion of HIV-1 with CD4+ cell membrane (enfuvirtide, n.d.). Enfuvirtide has a bioavailability of 84% and reaches a peak in 4-8 hours. It has a volume of distribution of 5.5L and is metabolized through hydrolysis (enfuvirtide, n.d.). Plasma clearance of enfuvirtide is decreased in adults with lower body weight and in females, but this does not impact dosing (Enfuvirtide, 2018). Renal function also impacts the clearance of enfuvirtide (Enfuvirtide, 2018). Adverse effects include pain at the injection site, erythema, and induration (enfuvirtide, n.d.). Additional side effects may include diarrhea, nausea, and fatigue (enfuvirtide, n.d.).
Entry Inhibitor/CCR5 Antagonist
Maraviroc, an early inhibitor, blocks the interaction between human CCR5 and HIV-1 gp120, preventing them from entering the cells (maraviroc, n.d.). Maraviroc has a bioavailability between 23-33% and reaches a peak in 0.5-4 hours (maraviroc, n.d.). It is 76% protein bound with a volume of distribution of 194L (maraviroc, n.d.). Maraviroc is metabolized by cytochrome P450 system with CYP3A serving as the major enzyme involved in the metabolization (maraviroc, n.d.). Maraviroc is excreted through the feces and urine (maraviroc, n.d.). Adverse effects include upper respiratory infections, arthritis, cough, pyrexia, rash, and fever (maraviroc, n.d.). Hepatotoxicity may occur.
Integrase Strand Transfer Inhibitors (INSTI)
Raltegravir, an INSTI, was the first approved for use. It works by inhibiting the catalytic activity of HIV-1 integrase, an HIV encoded enzyme that is required for viral replication (raltegravir, n.d.). Raltegravir is roughly 83% protein bound and is primarily metabolized by UGT1A1-mediated glucuronidation (raltegravir, n.d.). Raltegravir is eliminated in the feces and urine (raltegravir, n.d.). Raltegravir use can result in elevation of creatine kinase with possible rhabdomyolysis (Arcangelo, 2017).
HIV Prevalence and Increased Complacency
In a study by Zuma et al (2016), that was conducted in South Africa, while more individuals were being exposed to ARTs and more individuals were living longer with HIV, other behavioral related factors needed greater attention. They found an increase in risky behaviors, particularly early sexual debut, low condom usage, increased promiscuity, and decreased levels of knowledge surrounding HIV (Zuma et al., 2016). Individuals unaware of their HIV status make up nearly one-third of the ongoing transmission of HIV in the United States (Skarbinski et al., 2015). Substantial proportions of adolescents are sexually active and have multiple partners. I feel that certainly, these medications may have caused as a complacency as there is not a worldwide AIDS epidemic with people who are actively dying that is also being covered by the media. I would also strongly support that there is less awareness surrounding AIDS/HIV and that individuals engage in riskier sexual behaviors, and at even younger ages.
Health Care Providers and Strategies
I feel that one of the most important things healthcare providers can do is to engage in conversations with their patients about sex regarding ways to protect themselves from sexually transmitted infections (STIs). In a study by Goldstein, Carlson, & Halpern-Felsher (2018), inpatient providers asked about sex less than half of the time with their adolescent patients. While 80% of providers found it appropriate to talk with these patients about contraceptive methods only 35.8% had actually done so (Goldstein, Carlosn, & Halpern-Felsher, 2018). There are significant opportunities for providers in the inpatient and outpatient settings to engage young adults and adolescents in conversations about HIV/AIDS and ways to protect themselves from other STIs. The most significant strategy that providers could create is to get themselves comfortable with having these conversations with their patients, engaging patients in dialogs, and educating them on the dangers of STIs, including HIV/AIDS regardless of their age.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A practical approach (4 ed.). Ambler, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention. (n.d.). About HIV/AIDS. Retrieved from https://www.cdc.gov/hiv/basics/whatishiv.html
didanosine. (n.d.). Retrieved from https://reference.medscape.com/drug/videx-ec-didanosine-342609#10
Enfuvirtide. (2018). Retrieved from https://www.drugs.com/ppa/enfuvirtide.html
enfuvirtide. (n.d.). Retrieved from https://reference.medscape.com/drug/fuzeon-enfuvirtide-342637#10
indinavir. (n.d.). Retrieved from https://reference.medscape.com/drug/crixivan-idv-indinavir-342620#10
maraviroc. (n.d.). Retrieved from https://reference.medscape.com/drug/selzentry-maraviroc-342638#10
raltegravir. (n.d.). Retrieved from https://reference.medscape.com/drug/isentress-isentress-hd-raltegravir-342603#10
rilpivirine. (n.d.). Retrieved from https://reference.medscape.com/drug/edurant-rilpivirine-999657#10
Skarbinski, J., Rosenberg, E., Paz-Bailey, G., Hall, I., Rose, C. E., Viall, A. H., … Mermin, J. H. (2015, April). Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. Journal of the American Medical Association, 175(4), 588-596. http://dx.doi.org/10.1001/jamainternmed.2014.8180
Zuma, K., Shisana, O., Rehle, T. M., Simbayi, L. C., Jooste, S., Zungu, N., … Abdullah, F. (2016, January 1). New insight into HIV epidemic in South Africa: key findings from the National HIV Prevalence, Incidence and Behavior Survey, 2012. African Journal of AIDS Research: AJAR, 15(1), 67-75.
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1 month ago
Collette Dillon
WEEK EIGHT- HIV
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NURS 6521- Advanced Pharmacology
INITIAL POST
Human Immunodeficiency Virus and Categories of Medications
Human immunodeficiency virus (HIV) tends to attack the immune system of the individual that is infected by it, making the immune system incapable of defending itself. The HIV attacks the T- cells causing it to replicate itself while at the same time making more of the virus (Center for Disease Control, 2017). Therefore, it is imperative that correct antivirals are used to treat the HIV, and strict adherence to treatment is followed. There are several categories of antivirals that are used to treat HIV, they are; “nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 antagonists, post-attachment inhibitors, and integrase strand transfer inhibitors (INSTIs)” (U.S. Department of Health and Human Services, 2019).
Nucleoside reverse transcriptase inhibitors(NRTI’s)– prevent the replication of ribonucleic acid (RNA) from converting into deoxyribonucleic acid (DNA) in doing this these categories of medication which in include Abacavir, Emtricitabine, Lamivudine among others prevent the HIV from infecting more healthy cells. These medications can be taken anywhere from once a day to even four times depending on which one is chosen from the category. NRTIs are highly bioavailability ranging from 40- 92%, serum half-life ranges from 1.5 hours to 14 hours, with intracellular serum ranging from 7-22 hours, metabolized in the liver and excreted by the urinary system and feces (Smith, 2018). Medication adjustment should be made for patients who have renal and hepatic issues (Smith, 2018). According to Smith (2018), some potential side effects are lactic acidosis which can be fatal, confusion, rash and dizziness among others.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) consist of five medications that are currently approved by the Food and Drug Administration. These medications are; nevirapine, delavirdine, efavirenz, etravirine, and rilpivirine, (Usach, Melis and Peris, 2013). NNRTIs mechanism of action consisting of holding on to and preventing HIV enzyme from making more copies of themselves (Smith, 2018). NNRTIs medications are mainly metabolized in the liver and are mainly taken once per day, they are taken with food and have oral bioavailability of between 42- 92 percentage, half-life serum anywhere between 25- 50 hours, route of elimination is through urine and feces (Usach et al., 2013). Some possible side effects are rash, elevated liver enzymes, headaches, insomnia, and depression, among others (Smith, 2018).
Protease inhibitors (PIs)- It was reported by U.S. Department of Health and Human Services, 2019) that these class of medications stops the enzyme that is needed to convert immature viral proteins into a mature virus that will attack other healthy helper cells or CD4 cells. Some examples of these categories of medications are; Atazanavir, Darunavir, and Fosamprenavir, among others. These medications are absorbed by the gastrointestinal system and food increase the absorption and bioavailability rate, they are metabolized in the liver, eliminated through urine and feces (Smith, 2018). Once more dose adjustments are required for those with hepatic and renal insufficiency (Smith, 2018). The side effect is nausea, vomiting, weight loss and taste bud alteration (Smith, 2018).
Entry inhibitors and Integrase strand transfer inhibitors (INSTIs)- These two classes of medication consist of Enfuvirtide, Maraviroc, Dolutegravir among others, these medications work by preventing the HIV from inserting the virus into the DNA of the host, by preventing this, the infected cells are unable to replicate themselves, therefore destroying their abilities to attack CD4 cells (Smith, 2018). Some of these medications can be taken without or with food. The serum half-life ranges from 4 to 14 hours, they are metabolized the liver, some potential side effects are coughing, trouble with breathing, fever, and chills, among others (Smith, 2018).
Cysteine – Cysteine Chemokine Receptor 5 (CCR5 antagonists)- Prevent the coreceptor on the immune cells from letting the HIV inside the cells (Smith, 2018). An example of this class of medication is Maraviroc, it is metabolized in the gastrointestinal system and eliminated from the body through the liver into the renal system, the half-life of 14- 18 hours and have possible side effects of a cough, rash, respiratory infection (upper) among other (Smith, 2018).
HIV Medication Compliance and Adherence
Although there has been a great stride in the development and advancement in medication regime in antiviral treatment therapy compliance and adherence continue to be an issue. Most antivirals medication are now only required to be taken once a day, therefore limiting potential side effects and to increase adherence to treatment. There are still issues with patients who are not following their medication regimen guidelines. According to Fagbami, Oluwasanijo, Fitzpatrick, Fairchild, Shin and Donato (2015) this may be attributed to due to lack of support both from family members and healthcare providers. Patients who experience side effects such as diarrhea, nausea, depression among others tend to do better whenever they have the support of family members who can assist on days when side effects are at their highest (Fagbami, et al., 2015). According to (Fagbami et al., (2015) in their study that was conducted that participants with support from their communities, children, family members and open communication and trust in their healthcare providers yield higher compliance and adherence to antiviral treatment regime medication therapy. Poor patient and provider interaction were found to be a huge contributing factor to adherence, especially whenever there is a perception that there was lack of sympathy and empathy for the patients by healthcare providers (Fagbami, et al., 2015).
Changing Perceptions about HIV and Patient Education
Many of the stigmas that still occurs with HIV is that it still is seen as a disease that is causing my immoral behaviors. Cultural beliefs and norms also play a role in some of the stigma that is associated with HIV. To combat some of these stigmas continuous education about the disease is needed, there needs to be open and honest communication, none judgmental attitudes.
Healthcare providers should educate patients on the importance of adhering to their medication regimen, and how the lack of adherence can have an impact on the longevity of the lives and cause rapid progression of the virus. Seeing that skipping doses of medication can lead to mutation of the virus that causes medication resistance. Healthcare providers can inform their patients about the importance of using protective methods whenever they are intimate with their partner, take medication daily seeing that doing this can lower the viral load, therefore decreasing the chances of infecting someone, for substance abusers’ users, don’t share needles, use only clean needles (U. S Department of Health Services, 2019).
There are many factors such as side effects, interaction with other medications that patient is taking, working schedule, depression, lack of coverage and substance use disorders that can greatly impact medication compliance and adherence, therefore, it is important that treatment plans are individualized and based on the preference of the patient.
References
Center for Disease Control (2017). Hiv in the southern united states. Retrieved from
https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf
Fagbami, O., Oluwasanjo, A., Fitzpatrick, C., Fairchild, R., Shin, A., & Donato, A. (2015).
Factors supporting and inhibiting adherence to hiv medication regimen in women: a qualitative analysis of patient interviews. The open AIDS journal, 9, 45-50. doi:10.2174/1874613601509010045
Smith, C.L. (2018). Hiv/infection disease. Retrieved from
file:///C:/Users/coldi/Downloads/ACCP%20Updates%20in%20Therapeutics%C2%AE%202018-%20Pharmacotherapy%20Preparatory%20Review%20and%20Recertification%20Course.pdf
Usach, I., Melis, V., & Peris, J. E. (2013). Non-nucleoside reverse transcriptase inhibitors: a
review on pharmacokinetics, pharmacodynamics, safety, and tolerability. Journal of the International AIDS Society, 16(1), 1-14. doi:10.7448/IAS.16.1.18567
U.S. Department of Health and Human Services. (2019). Understanding hiv. Retrieved from
https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/1561/drug-class/
S. Department of Health and Human Services (2019). Understanding hiv-aids fact-sheets.
Retrieved from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/48/the-basics-of-hiv-prevention
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Bacterial and viral infections
Collette Dillon
Walden University
January 2019
Categories of antibacterial agents
Various classifications have been identified to have some effects on the causative agents of bacterial and viral infections. According to Almand, Moore & Jaykus (2017), some of the most effective antibacterial agents include cell wall synthesis inhibitors, protein synthesis inhibitor, and deoxyribonucleic acid (DNA) synthesis inhibitors among other miscellaneous agents that are quite significant in the management of gram-positive, gram-negative, anaerobic and aerobic bacterial infections.
Beta-lactams fall beneath the categories of cell wall synthesis inhibitors such as penicillin, cephalosporins, monobactams, and carbapenems. Sweeney, Wong & Khatri (2016) argue that beta-lactams act by inhibiting the process of synthesizing the peptidoglycan layer which is associated with the bacterial cell wall. Some of the most common drug effects of beta-lactams include rashes, nausea, and superinfection among others. Beta-lactam agents usually kill bacteria that surround the cell-wall as they block the process of linking molecules together by the bacterial infection agents. While these medications are cost-effective, they tend to carry a lot of potential adverse reactions. Attaway, Jasin, and Sullivan (1991) found a possible hereditary link in persons with allergies to these drugs (p. 227). Additionally, another group of cell-wall inhibitors includes non-beta lactams which include glycoproteins among other agents.
The drugs that belong to the protein synthesis inhibitors category include tetracyclines, macrolides, and ketolides among others. Agents such as macrolides mechanically work against bacterial infections by binding to the 50s ribosomal subunits and this action inhibits the transfer of peptidyl. These inhibitors also slow or stop the proliferation process that may directly lead to the generation of new proteins (Iikura, Hojo, Koketsu, Watanabe, Sato, Chino & Naka, 2015). In addition, (Sweeney et al, 2016) convey that protein synthesis inhibitors have been directly
associated with blockage of ribosomal linings which may lead to reduced or lack of production of proteins which is quite significant for various developments in the body.
Another significant group of antibacterial agents includes deoxyribonucleic acid (DNA) synthesis inhibitors, for instance, folate synthesis inhibitors such as sulfonamides and folate reductase inhibitors among others. These agents work by blocking the formation and action of bacterial ribonucleic acid (RNA) polymerase. However, these agents only target the gram-positive and some gram-negative bacteria as they do not have any interaction with the mammalian RNA polymerases. (Sweeney et al., 2016) assert that the most common drug side effects associated with this group of antibacterial agents are nausea and antibiotic resistance. As such, prolonged usage of these drugs may lead to inactiveness of the immune system.
Pharmacological differences between bacterial and viral infections
As the names ‘bacterial infection’ and ‘viral infection’ suggest, the main causative agents of bacterial infections are bacteria while viral infections are caused by viruses. Furthermore, (Sweeney, et al., 2016) asserts that bacterial infections can be killed and destroyed by antibacterial drugs while on the contrary; such drugs may not be quite useful for viral management. Antibiotics do not work against viruses since they have different survival and replication mechanisms from bacteria. Similarly, pharmacological management of viral infections involves the provision of viral-specific medications to the affected persons.
On the other hand, in most cases, management of bacterial infections entails administering affected individuals with antibiotics; however, the physicians should put antibiotic resistance and its health effects into consideration. Although these infections may have similar symptoms, physicians should ensure that they appropriately understand the nature of these infections before administering any forms of drugs to the affected patients. The most common bacterial infections include a whooping cough, ear infection and urinary tract infections among others. On the other hand, the most common viral infections include flu and HIV among others.
The significance of proper identification of viral and bacterial infections
Iikura et al. (2015) convey that before administering patients with an antimicrobial agent, the physicians should be aware of whether a given individual is suffering from a bacterial or a viral
infection. Furthermore, drugs such as antibiotics do not necessarily target the viral diseases such as human immunodeficiency virus (HIV) and thus, administering such drugs without accurately diagnosing the patient of a bacterial infection may cause more harm than good to the affected individual. According to (Iikura et al., 2015), viruses infect the human cells by attacking the human’s DNA for reproduction. Moreover, most viral infections do not usually require special medical attention since it is the sole duty of the immune system to ensure that the body is protected against such diseases. (Almand et al., 2017) argue that antibiotics usually function by targeting bacterial cells and additionally, antiviral drugs work by interfering with the viral enzymes. Although not all bacteria are harmful and can cause bacterial infection such as the gut bacteria which help in digestion, most of the bacterial infections can be treated through the use of antibacterial agents. However, some strains are already resistant to these agents, and as such, the use of antibacterial agents may not be sufficient enough to kill or reduce the infections caused by these organisms.
Since not all bacteria are harmful, physicians should not only understand the difference between bacterial and viral infections but also the harmful and non-harmful bacterial infections before administering any drugs. Some viruses can also be managed by the immune system. For instance, the T-lymphocytes can help in killing and preventing the viruses from multiplying and therefore, administering inappropriate drugs may stop or decrease the effectiveness of the immune system.
Conclusion
Understanding the pharmacological differences between bacterial and viral infections is quite significant in ensuring that appropriate medications are administered to the affected persons.
Moreover, the antibacterial agents should not be used regularly as they may lead to resistance and again, the physicians must fully be aware of the fact that antibacterial agents do not work against
viral infections due to the differential survival and replication mechanisms. Proper identification of bacterial and viral infections is quite significant in the pharmacological management of the diseases that arise from these infections. It is clear that antimicrobial therapy is complex, and it is extremely
important for the provider to look at all factors to get optimal outcomes for his patient. Disease process, economic considerations, patient preferences, and genetic processes all are part of the goal of an individualized care plan and best outcome for the person being treated.
References
Almand, E. A., Moore, M. D., & Jaykus, L. A. (2017). Virus-bacteria interactions: an emerging topic in human infection. Viruses, 9(3), 58.
Attaway, N., Jasin, H. & Sullivan, T. (1991) Familial Drug Allergy. Journal of Allergy & Clinical Immunology. Volume 87, Issue 1, Part 2, 227 https://doi.org/10.1016/0091-6749(91)91632-4
Iikura, M., Hojo, M., Koketsu, R., Watanabe, S., Sato, A., Chino, H., … & Naka, G. (2015). The importance of bacterial and viral infections associated with adult asthma exacerbations in clinical practice. PLoS One, 10(4), e0123584.
Sweeney, T. E., Wong, H. R., & Khatri, P. (2016). Robust classification of bacterial and viral infections via integrated host gene expression diagnostics. Science translational medicine, 8(346), 346ra91-346ra91.
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