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Antiretrovirals for HIV/AIDS - Integrase strand transfer inhibitors: Nursing Pharmacology

Notes

Notes

ANTIRETROVIRALS: INTEGRASE STRAND TRANSFER INHIBITORS, PART 1/2
DRUG NAME
raltegravir (Isentress)
*High Alert Medication*

dolutegravir (Tivicay)
*High Alert Medication*

CLASS
Integrase strand transfer inhibitors
MECHANISM of ACTION
Inhibits HIV integrase, which stops viral replication
INDICATIONS
Treatment of HIV infection in combination with other antiretrovirals
ROUTE(S) of ADMINISTRATION
PO
SIDE EFFECTS
  • Headache, insomnia
  • Nausea, vomiting, diarrhea
  • Elevated liver enzymes
  • Hypersensitivity reactions, immune reconstitution syndrome
  • Hyperglycemia, rhabdomyolysis
  • Hyperglycemia, acute liver failure
CONTRAINDICATIONS & CAUTIONS
  • Pregnancy and breastfeeding
  • Children
  • Hepatic or renal impairment
ANTIRETROVIRALS: INTEGRASE STRAND TRANSFER INHIBITORS, PART 2/2
DRUG NAME
elvitegravir (Vitekta)
*High Alert Medication*

bictegravir / emtricitabine / tenofovir (Biktarvy)
*High Alert Medication*

CLASS
Integrase strand transfer inhibitors
MECHANISM of ACTION
Inhibits HIV integrase, which stops viral replication
INDICATIONS
Treatment of HIV infection in combination with other antiretrovirals
ROUTE(S) of ADMINISTRATION
PO
SIDE EFFECTS
  • Headache, insomnia
  • Nausea, vomiting, diarrhea
  • Elevated liver enzymes
  • Hypersensitivity reactions, immune reconstitution syndrome
  • Acute liver failure, depression, suicidal ideation

CONTRAINDICATIONS & CAUTIONS
  • Pregnancy and breastfeeding
  • Children
  • Hepatic or renal impairment
NURSING CONSIDERATIONS for
ANTIRETROVIRALS: INTEGRASE STRAND TRANSFER INHIBITORS
ASSESSMENT & MONITORING
Assessment and monitoring: raltegravir

Assessment
  • Current symptoms: fatigue fever, and mental status changes
  • Presence of opportunistic infection
  • Weight
  • Vital signs
  • Laboratory test results, HIV RNA level, CD4+ count, liver and renal function tests, CBC, glucose, CK

Monitoring
  • Side effects
  • Evaluate for the therapeutic effect of improvement in their CD4 T-cell count, decreased HIV RNA, improved immune function and quality of life
CLIENT EDUCATION
  • Purpose of medication: helps prevent HIV replication
  • Does not cure HIV or prevent them from infecting others
    • Notify sexual partners about their diagnosis
    • Take precautions to prevent transmission
  • Take consistently, twice daily, without or without food, with an eight ounce glass of water
  • Oral suspension
    • Use the provided mixing cup; add medication packet into 10 mL of water, swirl gently; use the provided oral syringe to measure dose; consume within 30 minutes of mixing
  • Develop schedule for taking multiple prescribed medications
  • Side effects
    • Headache, insomnia, nausea, vomiting, and diarrhea
      • Contact healthcare provider if persistent
    • Report
      • Rhabdomyolysis: unusual muscle pain and weakness or dark-colored urine
      • Severe hypersensitivity reaction: unusual rash, blistering, or the presence of mouth, throat, or nasal sores
Transcript

Antiretrovirals are medications used to treat infections caused by retroviruses. This is a group of RNA viruses that includes human immunodeficiency virus, or HIV, which can cause acquired immunodeficiency syndrome, or AIDS. Now, antiretrovirals include different classes of medications, among which some of the most commonly used are integrase strand transfer inhibitors.

Okay, so integrase strand transfer inhibitors, or INSTIs for short, end in the suffix “-gravir”. This class of antiretrovirals includes raltegravir, dolutegravir, elvitegravir, and bictegravir, which comes in combination with antiretrovirals from the class of nucleoside and nucleotide reverse transcriptase inhibitors or NRTIs, namely emtricitabine and tenofovir.

Integrase strand transfer inhibitors are taken orally. Once administered, they work by blocking the action of the viral enzyme integrase, which allows the virus to insert and integrate its genome into the host’s cell DNA. As a result, blocking this process prevents the virus from multiplying, which halts the infection.

Now, common side effects of integrase inhibitors include headache, insomnia, and gastrointestinal side effects, such as nausea, vomiting, and diarrhea, as well as elevated liver enzymes. In addition, clients taking these medications can develop hypersensitivity reactions, as well as excessive inflammatory response called immune reconstitution syndrome, that can also cause flare-ups of a previously known infection like tuberculosis. Now, some integrase strand transfer inhibitors can have specific side effects. Raltegravir and dolutegravir can cause hyperglycemia, while raltegravir can also cause rhabdomyolysis, and dolutegravir may cause acute liver failure. Finally, clients on elvitegravir can also develop acute liver failure, and may experience depression and suicidal ideation.

Regarding contraindications for integrase inhibitors, precautions should be taken during pregnancy and breastfeeding, as well as in children, and in clients with hepatic or renal impairment.

Now, when caring for a client prescribed raltegravir as part of their antiretroviral regimen for HIV, start your assessment by asking your client about symptoms such as fatigue, fever, and mental status changes. Also, assess for the presence of opportunistic infection, and review their nutrition status to determine if they have any nutritional deficiencies or weight loss. In addition, be sure to obtain their weight and vital signs; and lastly, review their most recent laboratory test results, including CD4 T-cell count, HIV RNA levels, CBC, glucose, hepatic and renal function, and CK levels.