Drug Study

Drug Name acyclovir (acycloguanosine) (ay sye' kloe ver) Alti-Acyclovir (CAN), Avirax (CAN), Zovirax Pregnancy Category B Drug class Antiviral Purine nucleoside analogue Initial genital herpes: 200 mg q 4 hr (1,000 mg/day) for 10 days. Long-term suppressive therapy: 400 mg bid for up to 12 mo. Acute herpes zoster: 800 mg q 4 hr five times daily for 710 days. Chickenpox: 800 mg qid for 5 days. PEDIATRIC PATIENTS Parenteral HSV infections < 12 yr: 10 mg/kg infused IV over 1 hr q 8 hr for 7 days. Shingles, HSV encephalitis: 20 mg/kg IV over 1 hr q 8 hr for 10 days. Neonatal HSV: 10 mg/kg infused over 1 hr q 8 hr for 10 days. Oral < 2 yr: Safety not established. 2 yr and < 40 kg: 20 mg/kg per dose qid (80 mg/kg/day) for 5 days. Dosages ADULTS Parenteral 510 mg/kg infused IV over 1 hr, q 8 hr (15 mg/kg/day) for 710 days. Oral Therapeutic Actions Antiviral activity; inhibits viral DNA replication. Indications

Initial and recurrent mucosal and cutaneous HSV-1 and HSV-2 and varicella zoster infections in immunocompromised patients Severe initial and recurrent genital herpes infections in selected patients Herpes simplex encephalitis Treatment of neonatal herpes simplex virus infections Acute treatment of herpes zoster (shingles) and chickenpox Ointment: Initial HSV genital infections; limited mucocutaneous HSV infections in immunocompromised patients Cream: Recurrent herpes labialis (cold sores) in patients > 12 yr Unlabeled uses: Cytomegalovirus and HSV infection following transplant, herpes simplex infections, varicella pneumonia, disseminated primary eczema herpeticum

Adverse effects Systemic administration

Contraindications

CNS: Headache, vertigo, depression, tremors, encephalopathic changes Dermatologic: Inflammation or phlebitis at injection sites, rash, hair loss GI: Nausea, vomiting, diarrhea, anorexia GU: Crystalluria with rapid IV administration, hematuria

Contraindicated with allergy to acyclovir, seizures, CHF, renal disease, lactation. Use cautiously with pregnancy.

Nursing considerations Assessment History: Allergy to acyclovir, seizures, CHF, renal disease, lactation, pregnancy Physical: Skin color, lesions; orientation; BP, P, auscultation, perfusion, edema; R, adventitious sounds; urinary output; BUN, creatinine clearance Interventions Systemic administration

Topical administration

Dermatologic: Transient burning at site of application

Ensure that the patient is well hydrated. Topical administration Start treatment as soon as possible after onset of signs and symptoms. Wear a rubber glove or finger cot when applying drug. Teaching points Systemic administration Complete the full course of oral therapy, and do not exceed the prescribed dose. Oral acyclovir is not a cure for your disease but should make you feel better. Avoid sexual intercourse while visible lesions are present. You may experience these side effects: Nausea, vomiting, loss of appetite, diarrhea;

40 kg: Use adult dosage. 12 yr: Use adult dosage.

headache, dizziness. Report difficulty urinating, rash, increased severity or frequency of recurrences. Topical administration Wear rubber gloves or finger cots when applying the drug to prevent autoinoculation of other sites and transmission to others. This drug does not cure the disease; application during symptom-free periods will not prevent recurrences. Avoid sexual intercourse while visible lesions are present. This drug may cause burning, stinging, itching, rash; notify your physician if these are pronounced.