1 / 82

Practical Aspects of Antiretroviral Therapy

Practical Aspects of Antiretroviral Therapy. Nancy R. Calles,R.N.,B.S.N. Treatment Goals for Children. Promote or restore normal growth and development Prevent complicating infections and cancers Improve quality of life Prolong survival. Objectives of this Presentation.

ham
Download Presentation

Practical Aspects of Antiretroviral Therapy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Practical Aspects of Antiretroviral Therapy Nancy R. Calles,R.N.,B.S.N.

  2. Treatment Goals for Children • Promote or restore normal growth and development • Prevent complicating infections and cancers • Improve quality of life • Prolong survival

  3. Objectives of this Presentation • List the names and formulations of antiretrovirals • Describe the dosing of antiretrovirals • Discuss the side effects of antiretrovirals • List drug interactions of antiretrovirals • Discuss practical approaches to administration of antiretrovirals

  4. Nucleoside Reverse Transcriptase Inhibitors • AZT, zidovudine (RETROVIR) • d4T, stavudine (ZERIT) • ddI, didanosine (VIDEX) • ddC, zalcitabine (HIVID) • 3TC, lamivudine (EPIVIR) • ABC, abacavir (ZIAGEN)

  5. Zidovudine (RETROVIR): Formulations • 100 mg capsules • 300 mg tablets • 10 mg/ml yellow liquid, strawberry flavored • Intravenous formulation

  6. Zidovudine (RETROVIR): Dosing • Neonatal: Oral: 2 mg/kg q6h • Neonatal: Intravenous: 1.5 mg/kg q6h • Pediatric: Oral: 90-180 mg/m2 body surface area tid or bid ( 200 max. qid)

  7. Zidovudine (RETROVIR): Side Effects • Most Frequent:Hematological, including anemia and neutropenia • Less common:Myopathy, myositis, and liver toxicity

  8. Zidovudine (RETROVIR):Drug Interactions • Drugs which can be associated with bone marrow suppression should be avoided • Drugs which may increase ZDV concentration should be avoided (probenecid, atovaquone, methadone, valproic acid, and fluconazole)

  9. Zidovudine (RETROVIR): Tips for Caregivers • Tablets and capsules should be stored at room temperature • Protect capsules from moisture • May be taken with or without food

  10. Stavudine (ZERIT):Formulations • 15 mg, 20 mg, 30 mg, and 40 mg capsules • 1 mg/ml cloudy solution

  11. Stavudine (ZERIT):Dosing • Neonatal:Under investigation • Pediatric: Oral:1 mg/kg bid (max. 40 mg bid)

  12. Stavudine (ZERIT):Side Effects • Most frequent:Headache, gastrointestinal complaints, skin rash • Less common:Pancreatitis, peripheral neuropathy, increased liver enzymes

  13. Stavudine (ZERIT):Drug Interactions • Should not be administered with ZDV because of potential antagonism • Drugs which decrease renal function can decrease clearance and should be avoided

  14. Stavudine (ZERIT):Tips for Caregivers • Can be given with or without food • Shake oral solution, keep refrigerated, good for 30 days • Capsules can be opened and sprinkled on mashed potatoes, applesauce or other soft foods

  15. Didanosine (VIDEX): Formulations • 25 mg, 50 mg, 100 mg, and 150 mg orange flavored, chewable tablets • 10 mg/ml white suspension

  16. Didanosine (VIDEX): Dosing • Neonatal: Oral: (infants <90 days old)50 mg/m2 of body surface area • Pediatric: Oral: Dose range: 90-150 mg/m2body surface area bid

  17. Didanosine (VIDEX):Side Effects • Most frequent:Abdominal pain, nausea, vomiting, diarrhea, constipation • Less common:Peripheral neuropathy, pancreatitis, retinal depigmentation, electrolyte abnormalities

  18. Didanosine (VIDEX):Drug Interactions • May decrease the absorption of ketaconazole, itraconazole, and dapsone if administered concomitantly • Tetracycline and fluoroquinolone antibiotic absorption are significantly decreased • Concomitant administration of ddI and DLV decreases the absorption of both

  19. Didanosine (VIDEX): Tips for Caregivers • Give on an empty stomach 1 hour before or 2 hours after a meal • Shake suspension well, keep refrigerated • Give two tablets to ensure adequate buffering, may be dissolved in water • Do not give at the same time as indinavir, ritonavir, or delavirdine

  20. Lamivudine (EPIVIR):Formulations • 150 mg white tablets • 10 mg/ml clear solution

  21. Lamivudine (EPIVIR):Dosing • Neonatal: Oral: (< 30 days old)2 mg/kg bid • Pediatric: Oral:4 mg/kg bid (max. 150 mg bid)

  22. Lamivudine (EPIVIR):Side Effects • Most frequent:Headache, fatigue, nausea, diarrhea, skin rash, abdominal pain • Less common:Pancreatitis, peripheral neuropathy, increased liver enzymes

  23. Lamivudine (EPIVIR):Drug Interactions • No known negative drug interactions

  24. Lamivudine (EPIVIR):Tips for Caregivers • Can be given with or without food • Store oral solution at room temperature • Dosage should be decreased in patients with impaired renal function

  25. Abacavir (ZIAGEN):Formulations • 300 mg yellow, capsule-shaped tablets • 20 mg/ml yellow oral solution

  26. Abacavir (ZIAGEN):Dosing • Neonatal: Oral:Not approved for children < 3 months of age • Pediatric: Oral:8 mg/kg bid (max. 300 mg bid)

  27. Abacavir (ZIAGEN):Side Effects • Most frequent:Nausea, fever, vomiting, headache, rash, anorexia, and fatigue • Less common:Hypersensitivity reaction, diarrhea, pancreatitis, increased liver enzymes, elevated blood glucose, elevated triglycerides, and lactic acidosis

  28. Abacavir (ZIAGEN):Drug Interactions • No known significant drug interactions

  29. Abacavir (ZIAGEN):Tips for Caregivers • Give with or without food • Store at room temperature • Teach the signs and symptoms of a hypersensitivity reaction • Instruct parents to call immediately if rash occurs • Provide a medication guide and warning card

  30. Non-Nucleoside Reverse Transcriptase Inhibitors • NVP, nevirapine (VIRAMUNE) • EFV, efavirenz (SUSTIVA) • DLV, delavirdine (RESCRIPTOR)

  31. Nevirapine (VIRAMUNE):Formulations • 200 mg white, oval tablets • 50 mg/5 ml solution

  32. Nevirapine (VIRAMUNE):Dosing • Neonatal: Oral:Under investigation • Pediatric: Oral:(>3 months - 8 years of of age)7 mg/kg bid(> 8 years of age)4 mg/kg bid (max. 200 mg bid)

  33. Nevirapine (VIRAMUNE):Side Effects • Most frequent:Skin rash, sedative effect, headache, diarrhea, nausea • Less common:Elevated liver enzymes

  34. Nevirapine (VIRAMUNE):Drug Interactions • Lowers the levels of rifampin and rifabutin • Should not be administered with ketoconazole or oral contraceptives • Decreases levels of indinavir (recommended indinavir dose in adults is 1000 mg q8h)

  35. Nevirapine (VIRAMUNE):Tips for Caregivers • Give with or without food • Tablets may be broken in half • Shake solution well • Discuss potential for rash • Medication profile should be reviewed carefully prior to starting NVP for potential of multiple drug interactions

  36. Efavirenz (SUSTIVA):Formulations • 50 mg, 100 mg and 200 mg capsules

  37. Efavirenz (SUSTIVA):Dosing • Neonatal: Oral:Not approved for children < 3 years old • Pediatric: Oral:200-600 mg qd (exact dose is dependent on weight)

  38. Efavirenz (SUSTIVA):Side Effects • Most frequent:Rash, CNS symptoms (somnolence, insomnia, abnormal dreams, confusion, abnormal thinking, impaired concentration, hallucinations, euphoria) • Less common:Elevated liver enzymes, hepatitis

  39. Efavirenz (SUSTIVA):Drug Interactions • Should not be taken with midazolam, triazolam, cisapride, and ergot derivatives • Reduces levels of clarithromycin and rifampin • Reduces level of rifabutin • Decreases levels of saquinavir, indinavir, lopinavir

  40. Efavirenz (SUSTIVA): Tips for Caregivers • Give with or without food, but avoid high fat meal • Capsules may be opened and sprinkled on food • Tolerability of CNS side effects can be improved by bedtime dosing

  41. Delavirdine (RESCRIPTOR):Formulations • 100 mg white, capsule-shaped tablets

  42. Delavirdine (RESCRIPTOR):Dosing • Neonatal: Oral:Not approved for use in neonates • Pediatric: Oral:Not approved for use in children less than 16 years old

  43. Protease Inhibitors • NFV, nelfinavir (VIRACEPT) • RTV, ritonavir (NORVIR) • IDV, indinavir (CRIXIVAN) • SQV, saquinavir (FORTOVASE) • APV, amprenavir (AGENERASE) • LPV, lopinavir/r (KALETRA)

  44. Nelfinavir (VIRACEPT):Formulations • 250 mg blue, capsule-shaped tablets • 50 mg/scoop white powder

  45. Nelfinavir (VIRACEPT):Dosing • Neonatal: Oral:Under investigation • Pediatric: Oral:30 mg/kg tid

  46. Nelfinavir (VIRACEPT):Side Effects • Most frequent:Diarrhea • Less common:Abdominal pain, rash, exacerbation of liver disease, hyperglycemia, diabetes, metabolic abnormalities

  47. Nelfinavir (VIRACEPT):Drug Interactions • Do not give with simvastatin, lovastatin, rifampin, cisapride, midazolam, triazolam, dihydroergotamine, ergotamine • Concominant Rifabutin should be reduced to 150 mg qd and nelfinavir increased to 1000 mg tid • Decreases level of oral contraceptives

  48. Nelfinavir (VIRACEPT):Tips for Caregivers • Give with a meal or light snack • Tablets can be crushed or pulverized • Do not give with citrus juice or apple sauce • Powder may be put on food or in liquids • Improve taste by mixing with milk, chocolate milk, pudding or vanilla ice cream

  49. Ritonavir (NORVIR):Formulations • 100 mg white, soft-gelatin capsule • 80 mg/ml orange colored solution

  50. Ritonavir (NORVIR): Dosing • Neonatal: Oral:Under investigation • Pediatrics: Oral:400 mg/m2 body surface area bid (max. 600 mg bid)

More Related