Chapter 7, Drugs for Viral and Retroviral Infections: Drug Therapy for Retroviral Infections

Question 1 of 15

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Which statement about retroviruses is correct? Select all that apply. One, some, or all responses may be correct.

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  • Viral RNA uses the host cell’s metabolic systems to make new virions.Retroviruses use the host cell’s metabolic systems to create new viral particles that leave the cell to infect additional cells.
• • Retroviruses use DNA as its genes to reproduce.Retroviruses use RNA instead of DNA as its genes to reproduce.
• Correct
  • Retroviruses have an enzyme that is capable of reverse transcribing their RNA into DNA.Viral RNAs enter the host cell carrying a special enzyme called reverse transcriptase. This enzyme is capable of reverse transcribing its RNA into DNA. This viral DNA can then be joined to the host cell’s genome.
• Correct
  • Retroviruses inject their own genetic material into the host cell’s nucleus.The retrovirus inserts its genetic material into the host cell’s DNA.
• • Viral RNAs replicate with a low mutation rate.Retroviruses replicate with a high mutation rate. This increases its ability to evolve and survive.

Question 2 of 15

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Which primary risk factor for HIV/AIDS leads to disease progression? Select all that apply. One, some, or all responses may be correct.

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  • Skipping dosesSkipping doses does not maintain viral suppression, which can lead to the disease becoming resistant to the drug.
• • Using a pillboxUsing a pillbox helps the person take the drugs exactly as ordered every day, which ensures the drugs work properly and avoids disease progression.
• • Maintaining a diaryMaintaining a diary helps with strict compliance and therefore, does not lead to disease progression.
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  • Taking pills at different timesTaking the pills at different times is not recommended. Taking the pills at the same time every day helps drug levels remain steady in the body.
• • Having a cell phone alertHaving a cell phone alert helps remind the person to take the drugs in a timely manner; therefore, does not lead to disease progression.

Question 3 of 15

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Which antiretroviral drug therapy prevents infection of a new cell by preventing the HIV surface protein gp41 from binding to the host cell’s CD4 receptor?

• • Protease inhibitorsProtease inhibitors (PIs) hinders the synthesis of functional proteins, viral replication, and release of viral particles by blocking the HIV protease enzyme.
• • Entry inhibitorsEntry inhibitors/CCR5 antagonists blocks the virus from binding to CCR5 receptors on CD4+ T cells and prohibits entry into host cells, therefore stopping HIV infection.
• Correct
  • Fusion inhibitorsHIV cannot enter the human host cells, called CD4 cells or T cells, to replicate with fusion inhibitors. Fusion inhibitors prevent infection of new cells by not allowing the HIV surface protein gp41 to bind the host cell’s CD4 receptor.
• • Integrase inhibitorsIntegrase inhibitors allows insertion of viral DNA into the host cell’s DNA, and thereby, shutting out the HIV enzyme integrase.

Question 4 of 15

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Which food must be avoided by the patient who is taking nucleoside reverse transcriptase inhibitors?

• • PastaSince pasta is a carbohydrate, it is okay for the patient to consume with nucleoside reverse transcriptase inhibitors.
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  • PizzaFatty foods such as pizza should be avoided when taking with nucleoside reverse transcriptase inhibitors since these drugs cause digestive upsets thereby leading to pancreatitis.
• • BreadThough bread is usually made from highly processed flour, it does not have any properties that would upset the stomach. Bread can be combined with NRTIs.
• • RiceRice is a carbohydrate, which the body breaks down into simple sugars. Once it has entered the bloodstream it may cause a rise in blood sugar; however, it can be combined with NRTIs.

Question 5 of 15

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Which drug is permitted for use throughout the pregnancy of an HIV-infected female? Select all that apply. One, some, or all responses may be correct.

• • AtriplaAtripla (emtricitabine, tenofovir, and efavirenz), which contains efavirenz, can potentially pose harm to the unborn child.
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  • CombivirCombivir (lamivudine and zidovudine) is in the NRTI class of antiretroviral drugs that is commonly given throughout pregnancy for HIV-infected female to help reduce the risk of transmitting HIV to the fetus.
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  • EpzicomEpzicom (lamivudine and abacavir) is in the NRTI class of antiretroviral drugs, which is recommended to be given to HIV pregnant females to reduce the risk of transmitting HIV to the fetus.
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  • TriumeqTriumeq (dolutegravir, abacavir, and lamivudine) is in the integrase inhibitor and NRTI classes of antiretroviral drugs, which are commonly given throughout pregnancy for HIV-infected females to decrease the chance of transmitting HIV to the baby.
• Correct
  • TruvadaTruvada (emtricitabine and tenofovir) is in the NRTI class of antiretroviral drugs that is generally given throughout pregnancy to HIV-infected females to help minimize the risk of transmitting HIV to the unborn child.

Question 6 of 15

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Which instruction would the nurse include when teaching a patient about the use of tenofovir?

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  • “Avoid sexual intercourse until you have taken tenofovir for at least 4 days.”The patient must take tenofovir as prescribed for at least 4 days before it can effectively protect against HIV infection.
• • “If you have had intercourse while taking tenofovir, you must get tested for HIV annually.”The patient taking tenofovir must have their HIV status checked every 3 months.
• • “Tenofovir is a pre-exposure prophylaxis (PrEP), which takes 14 to 21 days for treatment to be completed.”As long as the person remains at risk for the HIV infection, tenofovir should be continued taken daily.
• • “If your partner does not want to use standard sex precautions, tenofovir will still prevent HIV transmission.”Standard sex precautions must be taken to prevent HIV transmission to uninfected sexual partners in addition to being prescribed tenofovir.

Question 7 of 15

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Which sign would the nurse instruct a patient prescribed efavirenz for the treatment of cytomegalovirus to report as an allergic reaction?

• • DiarrheaEfavirenz is in a class of drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs). Diarrhea is a side effect. The patient should avoid fatty and fried foods, which can cause digestive upset.
• Correct
  • Sore throatThe nurse should instruct the patient prescribed efavirenz to report any signs of a sore throat; this is an indication of a severe allergic skin reaction.
• • NauseaNausea is a common side effect of efavirenz. To reduce nausea episodes, encourage the patient to take the drug after eating.
• • DizzinessDizziness is a side effect from taking efavirenz. To avoid dizziness, encourage the patient to move slowly when changing positions.

Question 8 of 15

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Which laboratory value would the nurse suspect as a common side effect of etravirine?

• • Increased creatinine levelThe increase in the creatinine level is an indication that the kidneys are not working too well; however, this is not a common side effect of etravirine.
• • Increased white blood cell countAn increase in white blood cell count is an indication that an infection is present. This is not a common side effect of etravirine.
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  • Decreased red blood cell countA decrease in the patient’s red blood cell count is the most common side effect of etravirine, which can cause anemia.
• • Decreased liver enzymesLiver toxicity is a common side effect of the drug etravirine. There would be an increase in liver enzymes.

Question 9 of 15

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Which instruction would the nurse provide a patient prescribed rilpivirine?

• • Instruct the patient to take rilpivirine along with an antacid.Instruct the patient to take rilpivirine at least one hour before taking an antacid to avoid inhibiting GI absorption.
• • Suggest that rilpivirine be taken at least one hour after taking an antacid.The patient should take rilpivirine at least two hours after taking an antacid to avoid inhibiting GI absorption.
• • Encourage rilpivirine to be taken on an empty stomach.If the patient takes rilpivirine on an empty stomach, it may cause stomach upset.
• Correct
  • Instruct the patient to take rilpivirine with a meal.Instructing the patient to take rilpivirine with a meal will help to avoid GI irritation.

Question 10 of 15

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Which drug would the nurse question if prescribed for a patient with a known sulfa allergy?

• • AtazanavirAtazanavir does not contain sulfa.
• Correct
  • FosamprenavirFosamprenavir should not be given to patients who have a true sulfa allergy because this drug contains sulfa.
• • SaquinavirSaquinavir does not contain sulfa.
• • TipranavirTipranavir does not contain sulfa.

Question 11 of 15

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The nurse suspects that a patient prescribed darunavir (Prezista) 800 mg orally twice daily has developed liver toxicity. Which assessment data supports this hypothesis? Select all that apply. One, some, or all responses may be correct.

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  • Nausea and vomitingNausea and vomiting are signs of possible liver toxicity.
• • Decrease in urine outputA decrease in urine output is a sign of kidney toxicity.
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  • JaundiceA patient prescribed darunavir should be observed for jaundice since this drug can cause liver toxicity.
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  • Severe abdominal painAn observation of severe abdominal pain is an indication that darunavir may be causing liver toxicity.
• • Muscle twitches and crampsMuscle twitches and cramps is indicative of kidney toxicity.
• • Swelling of feet and anklesA finding of swelling of the feet and ankles supports kidney toxicity.

Question 12 of 15

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A nurse is reinforcing discharge teaching with a patient who has HIV and has been prescribed lopinavir/ritonavir (Kaletra) 400 mg orally twice daily. Which statement by the patient indicates understanding of the teaching?

• • “I will take my blood pressure before taking my meds.”It is imperative for a patient to record blood pressure when taking drugs for hypertension, not HIV.
• • “I will weigh myself every morning at the same time.”When taking lopinavir/ritonavir, it is not necessary for the patient to record daily weight. A patient taking diuretics will most likely weigh herself daily.
• Correct
  • “I will record my pulse daily.”The patient should check pulse daily and report a low heart rate since lopinavir/ritonavir can impair electrical conduction and potentially lead to heart block.
• • “I will check my blood sugar before meals.”Typically, blood sugar checks are needed for a patient requiring insulin, not for a patient who is taking lopinavir/ritonavir.

Question 13 of 15

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Which administration route would the nurse use to give enfuvirtide?

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  • SubcutaneousEnfuvirtide (Fuzeon) for HIV requires a subcutaneous injection.
• • OralEnfuvirtide (Fuzeon) is not to be given by mouth.
• • IntramuscularEnfuvirtide (Fuzeon) is not to be administered via intramuscular injection because the muscle does not absorb it.
• • IntravenousEnfuvirtide (Fuzeon) is not given intravenously because it would increase the concentration of drug in the bloodstream.

Question 14 of 15

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The nurse would instruct the patient to report new-onset muscle pain when taking which drug? Select all that apply. One, some, or all responses may be correct.

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  • Dolutegravir (Tivicay)Dolutegravir (Tivicay) is an integrase inhibitor, which can cause muscle breakdown.
• • Maraviroc (Selzentry)Maraviroc (Selzentry) is entry inhibitors and therefore does not cause muscle breakdown.
• Correct
  • Elvitegravir (Vitekta)Elvitegravir (Vitekta) is an integrase inhibitor, which potentially causes rhabdomyolysis.
• • Enfuvirtide (Fuzeon)Enfuvirtide (Fuzeon) is a fusion inhibitor and therefore does not cause muscle breakdown.
• Correct
  • Raltegravir (Isentress)Since raltegravir (Isentress) is an integrase inhibitor, the nurse should instruct the patient to report new-onset muscle pain, which is an indication of muscle breakdown.

Question 15 of 15

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Which drug would the nurse question if prescribed to a pregnant patient?

• • Atazanavir (Reyataz) 300 mg orally dailyAtazanavir is a protease inhibitor, which is safe to take during pregnancy.
• • Dolutegravir (Tivicay) 50 mg orally once or twice dailyDolutegravir is an integrase inhibitor that does not increase the risk of birth defects.
• • Elvitegravir (Vitekta) 85–150 mg orally once dailyElvitegravir is an integrase inhibitor that has not been shown to cause harm to the fetus.
• Correct
  • Raltegravir (Isentress) 400 mg orally twice dailyRaltegravir is an integrase inhibitor that should not be given to pregnant females because this drug is associated with an increased risk of birth defects.