Antivirals for herpesviruses: Nursing pharmacology

Herpesviruses are a family of DNA viruses that include herpes simplex virus or HSV types 1 and 2, varicella-zoster virus or VZV, cytomegalovirus or CMV for short, Epstein-Barr virus or EBV, and human herpesvirus or HHV 6, 7, and 8.

Certain herpesvirus infections can be treated with a class of antiviral medications called guanosine analogs, which include medications that end in the suffix -clovir.

The main drugs used to treat herpes infections include valacyclovir, valganciclovir, and famciclovir, which are given orally, as well as acyclovir and ganciclovir, which can also be administered topically or intravenously in addition to orally.Once administered, guanosine analogs act by inserting into the replicating viral DNA.

As a result, viral DNA synthesis is halted, ultimately stopping viral replication.Now, clients taking guanosine analogs may experience headache and nausea.

These medications can also cause a skin rash, pruritus, nephrotoxicity, and hypersensitivity reactions like Stevens-Johnson syndrome and angioedema.

Acyclovir and valacyclovir can cause neurological side effects, including agitation, tremors, confusion, and myoclonus; more rarely, clients can develop hallucinations, and even encephalopathy or seizures.

Acyclovir and valacyclovir can also lead to thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome. Acyclovir can also cause pain or phlebitis at the injection site when given intravenously.

On the other hand, famciclovir can cause menstrual changes and hepatotoxicity. Finally, valganciclovir has boxed warnings for hematologic toxicity, carcinogenesis, impaired fertility, and fetal toxicity.Now, regarding contraindications, guanosine analogs should be used with caution during pregnancy and breastfeeding, and in clients with neurologic, hepatic, or renal disease.

Acyclovir and valacyclovir should also be used cautiously when there’s an electrolyte imbalance or dehydration. In addition, acyclovir should not be used in combination with zidovudine, as it increases the level of zidovudine and the risk of neurologic side effects; aminoglycosides combined with acyclovir increase the risk of nephrotoxicity.Okay, now, when your client with a genital herpes simplex virus infection is prescribed an antiviral medication like acyclovir, first perform a baseline assessment, noting their current symptoms, including lesion location, as well as the presence of pain, itching, or drainage.

Then, review recent laboratory test results, including renal and hepatic function, CBC, and polymerase chain reaction, or PCR for short, and herpes culture test.

Alright, moving on to client education. Explain to your client that their medication will help decrease symptoms caused by the herpes simplex virus; however, it does not eliminate the infection or stop the virus from spreading to others.

Emphasize the importance of refraining from sexual activity if they have sores or other signs of herpes and to always use latex or polyurethane condoms during sex, even if no sores are present.

Then, instruct them to take their medication with plenty of water, with or without food, on a regular schedule, and remind them to stay well hydrated during treatment.

Next, review with your client some of the side effects they could experience including headaches, fatigue, nausea, and vomiting.

Prompt your client to contact their healthcare provider if these side effects are persistent or their herpes symptoms do not resolve or get worse.

Finally, during treatment with an antiviral like acyclovir, monitor for the development of side effects, and evaluate for the therapeutic response of an absence of lesions and herpes simplex symptoms.Alright, as a quick recap ….

Herpesviruses are a group of DNA viruses which include the herpes simplex virus, varicella-zoster virus, and cytomegalovirus.

A group of antiviral medications called guanosine analogs are used to treat herpesviruses. These medications include acyclovir, ganciclovir, valacyclovir, valganciclovir, and famciclovir, and they work by inhibiting viral DNA replication.

Potential side effects include headache and nausea, as well as more serious side effects such as nephrotoxicity, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome.

When caring for a client prescribed an antiviral medication to treat herpes viruses, nursing considerations include performing a baseline assessment, as well as monitoring for side effects and evaluating for the desired therapeutic effects.

Client education is focused on safe self-administration, as well as learning to recognize side effects, and when to notify the