Acyclovir (Zovirax)

Drug class

Therapeutic effects/uses
To treat HSV-1, HSV-2 (genital), herpes zoster, varicella-zoster virus, CMV

Mode of action
Interference with viral synthesis of DNA

Hypersensitivity, severe renal and hepatic disease
Caution: electrolyte imbalance, dehydration, seizure disorder, nursing mothers, and young children

Drug interactions
increase nephron-neurotoxicity with aminoglycosides, amphotericin B, probenecid, interferon; decreases effect of phenytoin

Lab interactions
May increase AST, ALT, BUN

nausea, anorexia, vomiting, diarrhea, headache, tremors, agitation, lethargy, rash, pruritus, increased bleeding time, phlebitis at IV site

Life threatening adverse reactions and others
Life threatening: Neuropathy, seizures, nephrotoxicity (large doses), thrombocytopenia, leukopenia

Other: Urticaria, anemia, crystalluria, paresthesias

What other assessments are important for a patient taking acyclovir?
Patient’s urinary output. An antiviral drug such as acyclovir can affect renal function.

Blood pressure. Acyclovir may cause orthostatic hypotension. Teach patient to rise slowly!

True or False: Monitor patient for superimposed infection (superinfection) caused by high dose and prolonged use of an antiviral such as acyclovir.

Important drug admin info for acyclovir
Dilute in an appropriate amount of solutions as indicated in the drug circular when giving IV.

Administer over 60 mins IV.

NEVER give acyclovir as a bolus (IV push).

Patient teaching
Advise patient to maintain adequate fluid intake to ensure sufficient hydration for drug therapy and increase urine output.

Instruct patient with genital herpes to avoid spreading infection via abstinence or condom use. Teach women with genital herpes to have a Pap test done as indicated by health care provider.

Gingival hyperplasia (red, swollen gums) can occur with prolonged use of antiviral drugs. What do you teach the patient?
Encourage patient to perform oral hygiene several times a day.

Guide patient to report what adverse reactions?
decrease in urine output, and CNS changes such as dizziness, anxiety or confusion

Nursing interventions:
Administer IV over 60 minutes
Monitor CBC, renal/liver function tests, urine output
Assess for superinfection
Increase Fluid intake
Instruct client to practice abstinence or use condoms
Perform oral hygiene
Watch for orthostatic hypotension

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