Medications for respiratory syncytial virus (RSV): Nursing pharmacology

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Introduction0:00–0:45

Respiratory syncytial virus, or RSV for short, is an enveloped RNA virus that causes the cells lining the respiratory tract to merge, forming a large multinucleated cell called sensitia.
RSV commonly affects the lower respiratory tract of young children, causing bronchiolitis. Initially, bronchiolitis often resembles the common cold, but in some cases, it can also progress to adalectasis or airway collapse, which causes severe symptoms such as wheezing, dyspnea, and even apnea in young infants.
There are 2 main classes of medication used in the treatment of RSV infection. These include monoclonal antibodies like Pellavizumab and antiviral medications like ribavirin.
Starting with Plavizumab, this medication is administered via intramuscular injection and is given for prevention during the winter months to infants at high risk for RSV including prematurely born infants, and to those with chronic lung disease or congenital heart disease.

Palivizumab0:45–1:24

Now, palavizumab is a monoclonal antibody that targets the fusion protein on the surface of RSV. The fusion protein helps the virus fuse to the host cell membrane and enter it, and also facilitates the fusion between infected cell membranes, resulting in sensytium formation.
So by neutralizing the fusion protein, palavizumab prevents RSV from infecting the host cells and forming sensittia. Common side effects of Palavizumab include injection site reactions like pain, redness, and swelling.

Side effects1:24–1:52

Some clients may also present with fever, chills, and myalgia. Other side effects include nausea, vomiting, dyspnea.
And hypersensitivity reactions like skin rashes, pruritis, angioedema, and even anaphylaxis. Additionally, Palavizumab can also cause thrombocytopenia, which can result in easy bruising or bleeding.
Now, Palavizumab should be used with caution in children with thrombocytopenia and other bleeding disorders due to increased risk of bleeding.

Contraindications1:52–2:09

Additionally, Palavizumab should be used with caution when combined with thrombolytic, antiplatelet, and anticoagulant medications, as it can increase the risk of bleeding.
Now let's switch gears and look at ribavirin, which is usually given orally or through inhalation to reduce the viral load in severe cases of bronchiolitis, and to children who are immunocompromised and have an RSV infection.

Ribavirin2:09–3:06

In addition, ribavirin can be used to treat clients with chronic hepatitis C or E infection. Ribavirin is a purine nucleoside analog, which once administered, goes inside the infected cells and gets picked up by the viral RNA dependent RNA polymerase when trying to synthesize new nucleic acid.
As a result, these fake nucleotides are incorporated into the growing RNA so no additional nucleotides can be added. Ultimately, this brings viral replication to a halt.
Additionally, ribavirin also inhibits the enzyme inosin 5 phosphate dehydrogenase, which is essential to synthesize guany nucleotides.
As a result, the lack of guany nucleotides further impairs viral replication. Now, the most common side effects of ribavirin include headache, fatigue, abdominal pain, and nausea.

Side effects3:06–3:35

Some clients may also experience insomnia, depression, or develop a skin rash, pruritis, and cough. In addition, ribavirin can cause hyperuricemia or increased uric acid levels, since it's not metabolized by cells that lack a nucleus like the red blood cells, and accumulates within them.
Finally, ribavirin has boxed warnings for causing hemolytic anemia and teratogenic effects. Ribavirin is contraindicated during pregnancy, in males whose female partners are pregnant, as well as in clients with hemoglobinopathies like thalassemia and sickle cell anemia.

Contraindications3:35–4:10

Ribavirin should be used with caution in clients with autoimmune hepatitis and severe renal disease. Regarding interactions, ribavirin levels and toxicity can be increased when combined with interferons or nucleoside reverse transcriptase inhibitors like zidovidine or didanosine.
Finally, ribavirin can decrease the levels and effects of Vitamin K antagonists, as well as live attenuated influenza vaccines.
Now, when administering Pellavizumab to your pediatric client as prophylaxis for RSV first review your client's medical history and risk factors for RSV disease.

Nursing considerations & client education4:10–6:34

Then perform a baseline assessment by asking the parents or caregivers about any current signs of infection, such as irritability or poor feeding.
Next, assess your client's weight and vital signs, and listen to lung sounds. Lastly, confirm the correct calculation of the medication to be administered in milligrams per kilogram.
Moving on to client education. Teach the parents or caregivers about RSV and how the medication decreases the risk of their child contracting the disease.
Then explain that this medication is given by injection every month for 5 months, starting right before RSV season and continuing for the duration of the season.
Lastly, teach them about additional ways to reduce the risk of their child getting RSV including maintaining a smoke-free environment, encouraging breastfeeding, keeping their child away from crowds and people who are sick, and practicing good hand hygiene.
Next, review some of the potential side effects of the medication and how to manage them. Injection site reactions such as pain, swelling, and redness can be managed by applying a cool compress to the site.
If their child develops a fever, suggest they offer their child extra fluids, provide a tepid bath, and give their child the prescribed children's acetaminophen.
Lastly, instruct them to seek medical care immediately if the child develops abnormally fast or slow breathing, wheezing, swelling of the face or throat, difficulty swallowing, unusual bruising, an unusual rash, or any other concerning symptoms.
Now, when administering Pellavizumab, first ensure that the emergency equipment is readily available in the event of a severe reaction.
Then, select the correct needle length and injection site and take age-appropriate steps to reduce pain associated with the injection.
For infants, suggest the parent or caregiver hold the baby during administration. Assist them to hold the infant skin to skin, breastfeed during administration, or offer a pacifier dipped in 24% sucrose solution.
Give the injection in the vastus lateralis muscle, and remember not to massage the muscle after giving the injection. Finally, monitor the child for 15 minutes for signs of a hypersensitivity reaction and continue to monitor them for the desired therapeutic effect, which is the absence of RSV infection.
Alright, as a quick recap, respiratory syncytial virus or RSV commonly causes bronchiolitis in young children, especially in those who are born premature, have chronic lung disease, or congenital heart defects.

Review6:34–7:19

The two medications used to treat RSV are peellavizumab, which is a monoclonal antibody most often administered to high-risk infants and children during peak RSV season to prevent RSV, and ribavirin, which is an antiviral medication used to treat RSV.
Nursing considerations when administering RSV medications include performing a baseline assessment, administering the medication, and monitoring for side effects and therapeutic effects.
Client education is focused on learning about RSV, management of side effects, and understanding when to seek immediate medical care.