1 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

Chapter 33
ANTIVIRALS, ANTIMALARIALS,
AND ANTHELMINTICS
2 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Viruses
Viruses
Method of transmission
Coughing, sneezing
Process of replication of itself (virus)
General signs and symptoms
Headache, fever, cough
Nausea, vomiting, diarrhea
Fatigue, muscular pain
3 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Vaccines
Vaccines
Influenza virus vaccine
Changes yearly
Promotes antibody production
Composition: eggs
Success rate
65% to 90%
4 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Antivirals for Influenza
Nonclassified antivirals
Influenza A
Amantidine (Symmetrel)
Rimantadine (Flumadine)
Route
Oral
Side effects
Insomnia, depression, anxiety, confusion, ataxia,
othostatic hypotension, weakness, dizziness,
slurred speech
5 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Antivirals for Influenza (contd)
Neuraminidase inhibitors
Influenza A and B
Zanamivir (Relenza)
Oseltamivir (Tamiflu)
Inhibits viral replication if given within 48 hours of
symptoms
6 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Antivirals
Gamma globulin
Contains antibodies
Given IM to provide passive immunity
Given IV for immediate immunity
Protects 2 to 3 weeks, repeated
Topical non-HIV antivirals
Treat herpes simplex viruses
Idoxuridine (Herplex Liquifilm)
7 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Purine Nucleosides
Action
Interferes with viral DNA synthesis
Effective against various herpes viruses, CMV
Purine nucleosides
Acyclovir (Zovirax)
Treat herpes simplex, herpes zoster, varicella-
zoster virus, CMV
Side effects/adverse reactions
GI distress, headache, confusion, depression,
tremors, lethargy, increased bleeding, hematuria,
blood dyscrasias, nephrotoxicity
8 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Purine Nucleosides (contd)
Acyclovir (Zovirax)
Nursing interventions
Administer IV over 60 minutes.
Monitor CBC, renal and liver function tests, urine
output.
Monitor BP.
Assess for superinfection.
Increase fluid intake.
Instruct client to practice abstinence or use condoms.
9 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Antimalarials
Malaria
Protozoan disease
Incubation period 10 to 35 days
Etiology
Protozoan parasites, Plasmodium spp
Phases
Tissue phase: no symptoms
Erythrocytic phase: fever, chills, sweating,
flulike symptoms
10 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Antimalarials (contd)
Treatment regimen
Combinations used for drug-resistant malaria
Prophylactic measures
Prevent malaria; prevent relapse
Drugs
Hydroxychloroquine (Plaquenil)
Quinine (Quinamm)
Mefloquine (Lariam)
Inhibit growth by interfering with protein
synthesis
11 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Antimalarials (contd)
Side effects/adverse reactions
Plaquenil
GI distress
Mood or mental changes, blurred vision
Blood dyscrasias
Quinine
GI distress, vision changes, dizziness
Confusion, delirium, seizures
Eighth cranial nerve involvement, tinnitus
Renal impairment, blood dyscrasias
Cardiovascular collapse, decreased respirations
12 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Antimalarials (contd)
Nursing interventions
Monitor kidney and liver function.
Take drug with meals to prevent GI distress.
Report vision changes.
Avoid alcohol.
Advise individuals traveling to endemic
countries to take prophylactic drug.
13 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Anthelmintics
Helminths (parasitic worms)
Four groups of helminths
Cestodes (tapeworms)
Trematodes (flukes)
Intestinal nematodes (roundworms)
Tissue-invading nematodes (tissue
roundworms)
14 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Anthelmintics (contd)
Anthelmintics
Usually given 1 to 3 days
Side effects/adverse reactions
GI upset, dizziness, drowsiness, HA, weakness
Nursing interventions
Give after meals to prevent GI distress.
Encourage good hygiene.
Warn against driving motor vehicles.
15 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Case Study
A client who travels extensively has developed
malaria. The physician prescribed mefloquine
(Lariam) and hydroxychloroquine (Plaquenil).

Critical Thinking
1. Differentiate between the tissue phase and the erythrocytic
phase of malaria.
2. Describe the prophylactic drug regimen time frame.
3. Compare the side effects/adverse reactions of antimalarials
to antivirals.
16 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Practice Question #1
Which is the most appropriate nursing intervention
for a client who is taking mefloquine (Lariam) and
hydroxychloroquine (Plaquenil)?

A. Collect a stool specimen.
B. Assess the clients hearing.
C. Advise the client to take showers, not baths.
D. Encourage female clients to have a Pap test
every 6 months.
17 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Practice Question #1 (contd)
Answer: B
Rationale: Hearing should be assessed because
antimalarials may lead to eighth cranial nerve
damage and ototoxicity. Monitoring stools and taking
showers are not necessary with antimalarials but are
appropriate for anthelmintics. Pap tests are not
related to antimalarials but necessary for female
clients with genital herpes.
18 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Practice Question #2
A client is taking acyclovir (Zovirax). Which nursing
intervention is appropriate for this client?

A. Give IV push over 5 minutes.
B. Restrict fluids to 1000 mL/day.
C. Warn client that drowsiness may occur.
D. Encourage client to perform oral hygiene several
times a day.
19 Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.
Practice Question #2
Answer: D
Rationale: Frequent mouth care should be done
because gingival hyperplasia may be a side effect of
prolonged drug therapy. Acyclovir should never be
given IV push. Fluids should be encouraged for
adequate hydration. Drowsiness is not a side effect
of acyclovir.