Nursing Implications for ZIDOVUDINE Retrovir

ZIDOVUDINE (FORMERLY AZIDOTHYMIDINE, AZT) 

(zye-doe′vyoo-deen)

Retrovir 

Classifications:  ANTIVIRAL; NUCLEOSIDE REVERSE TRANSCRIPTASE INHBITOR

Therapeutic: ANTIVIRAL; NRTI

Prototype: Lamivudine Pregnancy

Category: C

AVAILABILITY 

Tablet; capsule; syrup; solution for injection

ACTION & THERAPEUTIC EFFECT 

Appears to act by being incorporated into growing DNA chains by viral reverse transcriptase, thereby terminating viral replication. Zidovudine has antiviral action against HIV, LAV (lymphadenopathy- associated virus), and ARV (AIDS-associated retrovirus).

USES 

Treatment of HIV (along with other antiretroviral agents), prevention of perinatal transfer of HIV during pregnancy.

UNLABELED USES 

Postexposure chemoprophylaxis, thrombocytopenia.

CONTRAINDICATIONS 

Lifethreatening allergic reactions to any of the components of the drug; drug induced lactic acidosis; pronounced hepatotoxicity; lactation.

CAUTIOUS USE 

Severe renal impairment; or impaired hepatic function, alcoholism; anemia; chemotherapy; radiation therapy; bone marrow depression; older adults; pregnancy (category C).

ROUTE & DOSAGE 

HIV Infection 

Adult/Adolescent/Child (at least 30 kg):

PO 300 mg b.i.d. OR 200 mg t.i.d.

IV 1 mg/kg given 5–6 × daily Infant (over 4 weeks)/Child/ Adolescent less than 30 kg:

See package insert for weight based dosing

Prevention of Maternal-Fetal Transmission 

Neonate: PO Greater than 34 wk: 2 mg/kg q6h for 6 wk beginning within 12 h after birth;

IV Full term: 1.5 mg/kg q6h × 6 wk

Maternal: PO 100 mg 5 × daily OR 300 mg b.i.d. from 14–34 wk gestation until delivery IV During labor, 2 mg/kg loading dose, then 1 mg/kg/h until clamping umbilical cord

Toxicity Dosage Adjustment 

Hemoglobin falls below 7.5 g/dL or falls 25% from baseline: Interrupt therapy.

ANC falls below 750 cells/mm3 or decreases 50% from baseline: Interrupt therapy.

NURSING IMPLICATIONS ZIDOVUDINE

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ADMINISTRATION 

Oral

• May be given with or without food. 

Intravenous 

PREPARE: Intermittent: Withdraw required dose from vial and dilute with D5W to a concentration not to exceed 4 mg/mL.

ADMINISTER: Intermittent for HIV infection: Give calculated dose at a constant rate over 60 min; avoid rapid infusion.

IV Infusions for Prevention of Maternal-Fetal Transmission: Give maternal loading dose over 1 h, then continuous infusion at 1 mg/kg/h.

Intermittent Infusion for Prevention of Maternal Transmission of HIV to Neonate: Give calculated dose at a constant rate over 30 min.

INCOMPATIBILITIES: 

Solution/additive: Meropenem.

Y-site: Dexrazoxane, gemtuzumab, lansoprazole, meropenem.

• Store at 15°–25° C (59°–77° F) and protect from light. Store diluted IV solutions refrigerated for 24 h. 

ADVERSE EFFECTS

(≥1%) Body as a Whole: Fever, dyspnea, malaise, weakness, myalgia, myopathy. CNS: Headache, insomnia, dizziness, paresthesias, mild confusion, anxiety, restlessness, agitation. GI: Nausea, diarrhea, vomiting, anorexia, GI pain. Hematologic: Bone marrow depression, granulocytopenia, anemia. Respiratory: Cough, wheezing. Skin: Rash, itching, diaphoresis. Metabolic: Lactic acidosis. 

INTERACTIONS 

Drug: Acetaminophen ganciclovir, interferon-alfa may enhance bone marrow suppression; atovaquone, amphotericin B, aspirin, dapsone, doxorubicin, fluconazole, flucytosine, indomethacin, interferon alfa, methadone, pentamidine, vincristine, valproic acid may increase risk of AZT toxicity; probenecid will decrease AZT elimination, resulting in increased serum levels and thus toxicity. Nelfinavir, rifampin, ritonavir may decrease zidovudine (AZT) concentrations; other ANTIRETROVIRAL AGENTS may cause lactic acidosis and severe hepatomegaly with steatosis; stavudine, doxorubicin may antagonize AZT effects.

PHARMACOKINETICS 

Absorption: Readily from GI tract; 60–70% reaches systemic circulation (firstpass metabolism). Peak: 0.5–1.5 h. Distribution: Crosses blood–brain barrier and placenta. Metabolism: In liver. Elimination: 63–95% in urine. Half-Life: 1 h.

NURSING IMPLICATIONS 

Black Box Warning 

Zidovudine has been associated with hematologic toxicity (including neutropenia and severe anemia), myopathy, lactic acidosis, and severe hepatomegaly with steatosis. 

Assessment & Drug Effects 

• Evaluate patient at least weekly during the first month of therapy. 
• Myelosuppression results in anemia, which commonly occurs after 4–6 wk of therapy, and granulocytopenia in 6–8 wk. 
• Monitor for common adverse effects, especially severe headache, nausea, insomnia, and myalgia.
• Montior lab tests: Baseline and frequent (at least q2wk) blood counts, CD4 (T4) lymphocyte count, Hgb, and granulocyte count to detect hematologic toxicity; periodic LFTs.

Patient & Family Education 

• Contact prescriber promptly if health status worsens or any unusual symptoms develop. 
• Report to prescriber any of the following: Muscle weakness, shortness of breath, symptoms of hepatitis or pancreatitis, or any other unexpected adverse reaction. 
• Understand that this drug is not a cure for HIV infection; you will continue to be at risk for opportunistic infections. 
• Do not share drug with others; take drug exactly as prescribed. 
• Drug does NOT reduce the risk of transmission of HIV infection through body fluids.

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Ditulis oleh Unknown pada tanggal Monday, June 29, 2015