1.

AGENTS FOR INFLUENZA A AND RESPIRATORY VIRUSES

I. Generic Name: Oseltamivir
II. Brand Name: Tamiflu
III. General Classification: Antiviral agent for Influenza A and Respiratory Viruses
A. Route of drug administration (all routes): oral
B. Dosage (dosage per route): Capsules (30 mg, 45 mg, 75 mg), Powder for oral
suspension (6 mg/ml)
IV. Mechanism of Action (Make a gist/summary): Selective inhibitor of influenza virus
neuraminidase, an enzyme essential for viral replication. Acts against influenza A and B
viruses.
V. Indication (diseases): influenza type A prevention and treatment
VI. Side effects
Frequent (10%–7%):  Nausea, vomiting, diarrhea.
Rare (2%–1%):  Abdominal pain, bronchitis, dizziness, headache, cough, insomnia, fatigue,
vertigo.
VII. Adverse Effects
Colitis, pneumonia, tympanic membrane disorder, fever occur rarely.
VIII. Nursing Considerations
BASELINE ASSESSMENT Obtain baseline laboratory tests as indicated. Confirm presence of
influenza A or B virus.
INTERVENTION/EVALUATION Monitor serum glucose, renal function in pts with influenza
symptoms, diabetes.
PATIENT/FAMILY TEACHING
•  Begin as soon as possible from first appearance of flu symptoms (recommended within 2
days from symptom onset). 
•  Avoid contact with those who are at high risk for influenza. 
•  Not a substitute for flu shot.

2. AGENTS FOR HERPES AND CYTOMEGALOVIRUS

I. Generic Name: Valganciclovir
II. Brand Name: Valcyte
III. General Classification: Antiviral agent for Herpes and Cytomegalovirus
A. Route of drug administration (all routes): oral
B. Dosage (dosage per route): Solution (oral) (50 mg/ml), Tablets (450 mg)
IV. Mechanism of Action (Make a gist/summary): Inhibits binding of deoxyguanosine
triphosphate to DNA polymerase.
V. Indication (diseases): Cytomegalovirus (CMV) Retinitis (AIDS-Related), Prevention of CMV
After Transplant
VI. Side effects
Frequent (16%–9%): Diarrhea, neutropenia, headache.
Occasional (8%–3%): Nausea. Rare (Less Than 3%): Insomnia, paresthesia, vomiting,
abdominal pain, fever.
 VII. Adverse Effects
Hematologic toxicity, including severe neutropenia (most common), anemia,
thrombocytopenia, leukopenia, aplastic anemia, pancytopenia, bone marrow suppression
may occur. Retinal detachment occurs rarely. Overdose may result in renal toxicity. May
decrease sperm production, fertility.
VIII. Nursing Considerations
BASELINE ASSESSMENT Obtain baseline CBC, serum chemistries, renal function, urinalysis;
pregnancy test. Receive full medication history.
INTERVENTION/EVALUATION Monitor I&O, ensure adequate hydration (minimum 1,500
mL/24 hrs). Diligently evaluate CBC for decreased WBCs, Hgb, Hct, platelets; changes in
urinary characteristics, consistency. Question pt regarding vision, therapeutic improvement,
complications.
PATIENT/FAMILY TEACHING
•  ValGANciclovir provides suppression, not cure, of CMV retinitis. 
•  Frequent blood tests are necessary during therapy because of toxic nature of drug. 
•  Ophthalmologic exam q4–6wks during treatment is advised. 
•  Report any new symptom promptly. 
•  May temporarily or permanently inhibit sperm production in men, suppress fertility in
women. 
•  Barrier contraception should be used during and for 90 days after therapy (mutagenic
potential). 
•  Swallow whole; do not chew, crush, dissolve, or divide. 
•  Avoid handling broken/crushed tablets, oral solution. 
•  Report fever, chills, unusual bleeding/bruising, urinary changes.

3. AGENTS FOR HIV AND AIDS

I. Generic Name: Tenofovir
II. Brand Name: Viread
III. General Classification: Antiviral drug agent for HIV and Aids (Nucleoside Reverse
Transcriptase Inhibitors (NRTI))
A. Route of drug administration (all routes): oral
B. Dosage (dosage per route): oral tablets: 150 mg, 200 mg, 250 mg, 300 mg, Powder
(oral): 40 mg/g
IV. Mechanism of Action (Make a gist/summary): Tenofovir inhibits HIV reverse transcriptase by
interfering with HIV viral RNA-dependent DNA polymerase.
V. Indication (diseases): HIV infection
VI. Side effects
Occasional (6%–2%):  Diarrhea, nausea, headache, pharyngitis, fatigue
VII. Adverse Effects
If therapy is discontinued, pts co-infected with hepatitis B virus have an increased risk for
viral replication, worsening of hepatic function, and may experience hepatic
decompensation and/or failure. May induce immune reconstitution syndrome
 (inflammatory response to dormant opportunistic infections, such as Mycobacterium avium,
cytomegalovirus, PCP, tuberculosis, or acceleration of autoimmune disorders such as
Graves’ disease, polymyositis, Guillain-Barré). Acute renal failure, Fanconi syndrome (renal
tubular injury with severe hypophosphatemia) were reported. Fatal cases of lactic acidosis,
severe hepatomegaly with steatosis have occurred. Suicidal ideation, depression, suicide
attempt reported in less than 1% of pts (primarily occurred in pts with prior psychiatric
illness).
VIII. Nursing Considerations
BASELINE ASSESSMENT Obtain BUN, serum creatinine, creatinine clearance, GFR; CD4+
count, viral load, HIV-1 RNA level; urine glucose, urine protein. Obtain serum phosphate
level in pts with chronic kidney disease. Test all pts for hepatitis B virus infection. Question
history of depression, suicidal ideation. Receive full medication history (including herbal
products); screen for contraindications/interactions. Offer emotional support.
INTERVENTION/EVALUATION Monitor CD4+ count, viral load, HIV-1 RNA level for treatment
effectiveness. Monitor renal function as clinically indicated. An increase in serum creatinine
greater than 0.4 mg/dL from baseline may indicate renal impairment. If discontinuation of
drug regimen occurs, monitor hepatic function for at least several months. Initiate anti-HBV
therapy if warranted. Cough, dyspnea, fever, excess of band cells on CBC may indicate acute
infection (WBC count may be unreliable in pts with uncontrolled HIV infection). Screen for
immune reconstitution syndrome. Monitor daily pattern of bowel activity, stool consistency;
I&Os.
PATIENT/FAMILY TEACHING
•  Drug resistance can form if therapy is interrupted; do not run out of supply. 
•  As immune system strengthens, it may respond to dormant infections hidden within the
body. Report body aches, chills, cough, fever, night sweats, shortness of breath. 
•  Treatment may cause kidney failure. Report flank pain, darkened urine, decreased urine
output. 
•  Practice safe sex with barrier methods or abstinence. 
•  Lactating females should not breastfeed.

4. ANTI–HEPATITIS B AGENTS
I. Generic Name: Entecavir
II. Brand Name: Baraclude
III. General Classification: Antiviral agents for anti-hepatitis B
A. Route of drug administration (all routes): oral
B. Dosage (dosage per route): Oral Solution:  0.05 mg/mL. Tablets:  0.5 mg, 1 mg.
IV. Mechanism of Action (Make a gist/summary): Inhibits hepatitis B viral polymerase, an
enzyme blocking reverse transcriptase activity.
V. Indication (diseases): Chronic Hepatitis B Virus Infection (No Previous Nucleoside
Treatment), Chronic Hepatitis B Virus Infection (Receiving LamiVUDine, Known LamiVUDine
Resistance, Decompensated Liver Disease)
VI. Side effects
 Occasional (4%–3%):  Headache, fatigue.
Rare (less than 1%):  Diarrhea, dyspepsia, nausea, vomiting, dizziness, insomnia.
VII. Adverse Effects
Lactic acidosis, severe hepatomegaly with steatosis have been reported. Severe, acute
exacerbations of hepatitis B virus infection have been reported in pts who have
discontinued therapy; reinitiation of antihepatitis B therapy may be required. Hematuria
occurs occasionally. May cause development of HIV resistance if HIV untreated.
VIII. Nursing Considerations
BASELINE ASSESSMENT Obtain LFT before beginning therapy and at periodic intervals during
therapy. Offer emotional support. Obtain full medication history.
INTERVENTION/EVALUATION Hepatic function should be monitored closely with both
clinical and laboratory follow-up for at least several mos in pts who discontinue antihepatitis
B therapy. For pts on therapy, closely monitor serum amylase, lipase, bilirubin, ALT, AST,
creatinine, glucose, albumin; platelet count. Assess for evidence of GI discomfort.
PATIENT/FAMILY TEACHING
•  Take medication at least 2 hrs after a meal and 2 hrs before the next meal. 
•  Avoid transmission of hepatitis B infection to others through sexual contact, blood
contamination. 
•  Immediately report unusual muscle pain, abdominal pain with nausea/vomiting, cold
feeling in extremities, dizziness (signs and symptoms signaling onset of lactic acidosis).

5. ANTI–HEPATITIS C AGENTS
I. Generic Name: Daclatasvir
II. Brand Name: Daklinza
III. General Classification: Antiviral agents for anti-hepatitis C
A. Route of drug administration (all routes): oral
B. Dosage (dosage per route): Tablets: 30 mg, 60 mg, 90 mg.
IV. Mechanism of Action (Make a gist/summary): Inhibits NS5A, a nonstructural protein
encoded by HCV. Binds to N-terminus of NS5A and inhibits both viral RNA replication and
virion assembly. Inhibits viral replication of hepatitis C virus.
V. Indication (diseases): treat chronic hepatitis C infections
VI. Side effects
Occasional (14%–8%): Headache, fatigue, nausea.
Rare (5%): Diarrhea.
VII. Adverse Effects
Symptomatic bradycardia and some cases requiring pacemaker intervention have been
reported when amiodarone is coadministered with sofosbuvir, in combination with another
HCV direct-acting antiviral, including daclatasvir. Bradycardia generally occurred within hrs
to days, but may extend up to 2 wks after initiation. Pts taking beta blockers (e.g.,
metoprolol), those with underlying cardiac disease, or pts with advanced hepatic disease are
at increased risk of bradycardia when treated with amiodarone. Transient, asymptomatic
 elevations of serum lipase levels greater than 3 times upper limit of normal reported in 2%
of pts.
VIII. Nursing Considerations
BASELINE ASSESSMENT Obtain HCV-RNA level, LFT. Receive full medication history, including
herbal products, and screen for contraindications/interactions, esp. concomitant use of
amiodarone or digoxin. Confirm HCV genotype. Question history of bradycardia,
arrhythmias. Assess hydration status.
INTERVENTION/EVALUATION Monitor HCV-RNA level, LFT. Pts requiring treatment with
amiodarone should be monitored with a cardiac monitor in an inpatient setting for the first
48 hrs of initiation. Further outpatient monitoring or self-monitoring of the heart rate
should occur on a daily basis for at least the first 2 wks of treatment. Due to amiodarone’s
long half-life, pts discontinuing amiodarone just prior to starting sofosbuvir, in combination
with daclatasvir, should have similar cardiac monitoring as listed earlier. Immediately report
symptoms of bradycardia.
PATIENT/FAMILY TEACHING
• There is a high risk of drug interactions with other medications. Do not take newly
prescribed medications unless approved by prescriber who originally started treatment. Do
not take herbal products, esp. St. John’s wort.
• Treatment with amiodarone, an antiarrhythmic drug, may increase the risk of a slow
heartbeat and is not recommended during drug therapy. If taking amiodarone, seek
immediate medical attention if chest pain, confusion, dizziness, fainting, lethargy, or
shortness of breath occurs after starting therapy.
• Daclatasvir must be used in combination with sofosbuvir (an antiviral drug) and should not
be used alone.

6. LOCALLY ACTIVE ANTIVIRAL AGENTS

I. Generic Name: Trifluridine
II. Brand Name: Viroptic
III. General Classification: Locally Active Antiviral Agent
A. Route of drug administration (all routes): oral
B. Dosage (dosage per route): Fixed-Dose Combination Tablets:  trifluridine/tipiracil:
15 mg/6.14 mg, 20 mg/8.19 mg.
IV. Mechanism of Action (Make a gist/summary): Trifluridine (active cytotoxic component)
interferes with DNA synthesis and cell proliferation of cancer cells.
V. Indication (diseases): Colorectal cancer, hematologic/nonhematologic toxicity, renal
impairment, hepatic impairment
VI. Side effects
Frequent (52%–19%):  Asthenia, fatigue, nausea, diarrhea, decreased appetite, vomiting,
abdominal pain, pyrexia.
Occasional (8%–7%):  Stomatitis, dysgeusia, alopecia.
VII. Adverse Effects
 Severe and/or life-threatening myelosuppression including anemia (77% of pts), grade 3
anemia (18% of pts), neutropenia (67% of pts), grade 3 or 4 neutropenia (27% and 11% of
pts), thrombocytopenia (42% of pts), grade 3 or 4 thrombocytopenia (5% and 1% of pts),
febrile neutropenia (3.8% of pts) may occur. Infectious processes including nasopharyngitis,
urinary tract infection reported in 2%–4% of pts. Pulmonary embolism occurred in 2% of pts.
Interstitial lung disease occurs rarely.
VIII. Nursing Considerations
BASELINE ASSESSMENT Obtain baseline CBC and screen for anemia, neutropenia,
thrombocytopenia. Obtain vital signs. Verify pregnancy status before start of each cycle.
Screen for active infection, history of pulmonary embolism. Assess hydration status.
Question pt’s usual stool characteristics (color, frequency, consistency).
INTERVENTION/EVALUATION Follow proper handling and disposal procedures for cytotoxic
drugs. Monitor ANC, CBC on day 15 of each cycle. If any grade 3 or 4 hematologic toxicity
occurs, repeat ANC, CBC more frequently. If chest pain, dyspnea, tachycardia occurs,
provide supplemental O2 and obtain radiologic testing to rule out pulmonary embolism.
Diligently monitor for infection. Monitor daily stool pattern, consistency. Encourage PO
intake. Monitor for bleeding if thrombocytopenia occurs.
PATIENT/FAMILY TEACHING
•  Blood levels will be monitored regularly. 
•  Treatment may cause fetal harm. Female pts of childbearing potential should use
effective contraception during treatment. Immediately report suspected pregnancy. Do not
breastfeed. 
•  Male pts must use condoms during sexual activity. 
•  Immediately report chest pain, difficult breathing, fast heart rate, rapid breathing; may
indicate life-threatening blood clot in the lungs. 
•  Report symptoms of bone marrow suppression or infection such as bruising easily, chills,
cough, dizziness, fainting, fever, shortness of breath, weakness, or burning with urination. 
•  Avoid crowds, those with active infection. 
•  Take within 1 hr of breakfast and evening meal. 
•  Drink plenty of fluids. 
•  Report diarrhea, nausea, vomiting that is not controlled by antinausea, antidiarrheal
medication. 
•  Report bleeding of any kind.

7. SYSTEMIC ANTIFUNGAL AGENTS

I. Generic Name: Vorizonazole
II. Brand Name: Vfend
III. General Classification: Systemic Antifungal Agent
A. Route of drug administration (all routes): oral, IV
B. Dosage (dosage per route): Injection, Powder for Reconstitution: 200 mg. Powder
for Oral Suspension: 200 mg/5 mL. Tablets: 50 mg, 200 mg.
 IV. Mechanism of Action (Make a gist/summary): Interferes with fungal cytochrome activity,
decreasing ergosterol synthesis, inhibiting fungal cell membrane formation. Damages fungal
wall membrane
V. Indication (diseases): Invasive aspergillosis, Candidemia, Other Deep Tissue Candida
Infections, Esophageal Candidiasis
VI. Side effects
Frequent (20%–6%): Abnormal vision, fever, nausea, rash, vomiting.
Occasional (5%–2%): Headache, chills, hallucinations, photophobia, tachycardia,
hypertension.
VII. Adverse Effects
Hepatotoxicity (jaundice, hepatitis, hepatic failure), acute renal failure have occurred in
severely ill pts.
VIII. Nursing Considerations
BASELINE ASSESSMENT Obtain baseline serum hepatic/renal function tests; ECG. Correct
electrolyte deficiencies prior to initiating treatment. Receive full medication history and
screen for interactions. Question medical history as listed in Precautions.
INTERVENTION/EVALUATION Monitor serum renal function, LFT. Monitor visual function
(visual acuity, visual field, color perception) for drug therapy lasting longer than 28 days.
PATIENT/FAMILY TEACHING
• Take at least 1 hr before or 1 hr after a meal.
• Avoid grapefruit products.
• Avoid driving at night.
• Report visual changes (blurred vision, photophobia, yellowing of skin/eyes).
• Avoid performing hazardous tasks if changes in vision occur.
• Avoid direct sunlight.
• Women of childbearing potential should use effective contraception.

8. LOCAL ANTIFUNGAL AGENTS

I. Generic Name: Terbinafine
II. Brand Name: Lamisil
III. General Classification: Topical/Local Antifungal Agents
A. Route of drug administration (all routes): oral, topical
B. Dosage (dosage per route): Cream: 1% Gel (topical): 1% Oral granules: 125 mg,
187.5 mg Solution (topical): 1% Spray (topical): 1% Tablets: 250 mg
IV. Mechanism of Action (Make a gist/summary): Inhibits the conversion of squalene
monooxygenase to squalene epoxidase, a key enzyme in fungal biosynthesis. The resulting
squalene accumulation weakens cell membranes and creates a deficiency of ergosterol, the
fungal membrane component necessary for normal fungal growth.
V. Indication (diseases): Tinea cruris; tinea corporis; tinea pedis; tinea versicolor,
Onychomycosis of fingernail or toenail, tinea capitis
VI. Side effects
 VII. Adverse Effects
CNS: headache, depression
EENT: visual disturbances
GI: nausea, diarrhea, dyspepsia, abdominal pain, flatulence
Hematologic: neutropenia
Hepatic: hepatic failure
Skin: burning, stinging, dryness, itching, and local irritation (with topical form); rash;
pruritus; urticaria; erythema multiforme; Stevens-Johnson syndrome
Other: taste and smell disturbances
VIII. Nursing Considerations
•Because terbinafine has been linked to serious adverse hepatic effects, expect to
send nail specimens for laboratory testing to confirm onychomycosis before starting
therapy.
•Be aware that drug shouldn’t be given to patients with chronic or active hepatic disease or
renal impairment.
•Monitor patient for hepatic failure (anorexia, dark urine, fatigue, jaundice, nausea, pale
stools, right upper abdominal pain, and vomiting). Expect to stop drug and obtain liver
function tests if these problems develop.
Patient monitoring
● Monitor CBC and liver function tests.
2Watch for signs and symptoms of erythema multiforme. Report early indications before
they progress to Stevens-Johnson syndrome. Patient teaching
● Tell patient he may take with or without food.
● Advise caregiver that oral granules should be sprinkled on nonacidic food, such as pudding
or mashed potatoes and not to use fruit-based food such as applesauce.
● Advise caregiver that oral granules should be swallowed without being chewed.
● Instruct patient to avoid coffee, tea, and colas, which can worsen adverse drug reactions.
● Tell patient drug may take 4 weeks to be effective in fingernail infections and 10 weeks in
toenail infections. Urge him to keep taking it even though symptoms don’t improve right
away.
2Advise patient to immediately report rash, sore throat, cough, fever, or yellowing of skin or
eyes.
● Instruct patient how to use topical drug, to wash affected area with soap and water and
dry area completely before applying drug, and to wash hands after each use.
● Instruct patient not to place occlusive dressing over affected area after applying cream.
● Advise patient to wear well-fitting, ventilated shoes and to change shoes and socks at least
once daily when receiving treatment for athlete’s foot.
● Caution patient not to let topical drug contact eyes, nose, or mouth.
● As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.

9. ANTI-MALARIAL AGENTS
 I. Generic Name: Chloroquine
II. Brand Name: Aralen
III. General Classification: Antiprotozoal: Anti-malarial agent
A. Route of drug administration (all routes): oral
B. Dosage (dosage per route): Tablets: 250 mg (150-mg base), 500 mg (300-mg base)
IV. Mechanism of Action (Make a gist/summary): Antimalarial action may occur through
inhibition of protein synthesis and alteration of DNA in susceptible parasites.
V. Indication (diseases): Uncomplicated acute malarial attacks, Malaria prophylaxis,
Extraintestinal amebiasis
VI. Side effects
Nausea, vomiting, abdominal cramps, headache, and diarrhea
VII. Adverse Effects
CNS: mild and transient headache, personality changes, dizziness, vertigo neuropathy,
seizures
CV: hypotension, ECG changes
EENT: blurred vision, difficulty focusing, reversible corneal changes, irreversible retinal
damage leading to vision loss, scotomas, ototoxicity, tinnitus, nerve deafness
GI: nausea, vomiting, diarrhea, abdominal pain, stomatitis, anorexia
Hematologic: agranulocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia
Skin: lichen planus eruptions, skin and mucosal pigmentation changes, pruritus, pleomorphic
skin eruptions
VIII. Nursing Considerations
Patient monitoring:
● Monitor hepatic enzyme levels in patients with hepatic disease.
● Assess creatinine levels in patients with renal insufficiency or failure.
● In long-term therapy (as for lupus or rheumatoid arthritis), be aware that desired effects
may be delayed for up to 6 months.
● Be aware that drug is secreted in breast milk but not in sufficient amounts to prevent
malaria in infant.
Patient teaching:
● Tell patient to take drug with food at evenly spaced intervals.
● Instruct patient to immediately report blurred vision or hearing changes.
● In areas where malaria is endemic, advise pregnant patient to consult prescriber about
taking drug.
● Inform patient on long-term therapy that beneficial effects may take up to 6 months.
● As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs, tests, and behaviors mentioned above.

10. ANTHELMENTIC AGENTS

I. Generic Name: Ivermectin
II. Brand Name: Stromectol
III. General Classification:
A. Route of drug administration (all routes):
B. Dosage (dosage per route):
IV. Mechanism of Action (Make a gist/summary):
V. Indication (diseases):
VI. Side effects
VII. Adverse Effects
VIII. Nursing Considerations