View source for Antivirals (non-HIV)

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''Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and '''must be verified against current manufacturer labeling before clinical use'''. This is educational content, not prescribing guidance.''
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'''Antivirals (non-HIV)''' &mdash; Antiviral; Nucleoside analogs and others by target.

== Identification ==
* '''Therapeutic class:''' Antiviral.
* '''Pharmacologic class:''' Nucleoside analogs and others by target.

== Pharmacology ==
* '''Mechanism of action:''' Inhibit viral replication (acyclovir and valacyclovir target herpes DNA polymerase; oseltamivir inhibits influenza neuraminidase; nirmatrelvir inhibits the SARS-CoV-2 protease boosted by ritonavir; ganciclovir targets CMV; ribavirin and direct-acting agents target their respective viruses).
* '''Onset / peak / duration:''' Best when started early (oseltamivir within 48 hours of flu symptoms).
* '''Half-life / therapeutic level:''' Varies; no routine level.

== Clinical use ==
* '''Indications:''' Herpes simplex and zoster (acyclovir, valacyclovir), influenza (oseltamivir), COVID-19 (nirmatrelvir/ritonavir), CMV (ganciclovir), hepatitis C (sofosbuvir-based) and hepatitis B (entecavir, tenofovir).
* '''Usual dose, route, frequency:''' Acyclovir PO five times daily or IV; valacyclovir PO; oseltamivir twice daily for 5 days; nirmatrelvir/ritonavir twice daily for 5 days.
* '''Maximum dose / adjustments:''' Reduce acyclovir, valacyclovir, and oseltamivir in renal impairment; maintain hydration with IV acyclovir.

== Safety ==
* '''Contraindications:''' Hypersensitivity; nirmatrelvir/ritonavir has many drug interaction contraindications.
* '''Black box warning:''' Ganciclovir and valganciclovir carry boxed warnings for hematologic toxicity (granulocytopenia, anemia, thrombocytopenia) and carcinogenic and teratogenic potential; ribavirin carries boxed warnings for hemolytic anemia and serious teratogenicity (pregnancy contraindicated for the patient and partner).
* '''Interactions:''' Nirmatrelvir/ritonavir interacts with many CYP3A4 drugs (statins, some anticoagulants, sedatives); nephrotoxic drugs with acyclovir.
* '''Pregnancy / lactation:''' Ribavirin contraindicated; others case by case.
* '''High-alert:''' No.

== Adverse effects ==
* '''Common side effects:''' Nausea, headache, dizziness.
* '''Serious effects to report:''' Acyclovir nephrotoxicity and neurotoxicity, ganciclovir marrow suppression, ribavirin anemia, drug interactions with nirmatrelvir/ritonavir.
* '''Antidote / reversal:''' Supportive care.

== Nursing process ==
* '''Assessment before administration:''' Renal function, hydration, full medication list (interactions), pregnancy status (ribavirin).
* '''Interventions during therapy:''' Hydrate well with IV acyclovir; review all interacting drugs before nirmatrelvir/ritonavir; start flu and COVID antivirals early.
* '''Monitor:''' Renal function, CBC (ganciclovir, ribavirin), infection course.
* '''Evaluation / expected outcome:''' Reduced viral illness severity or duration.

== Patient teaching ==
* '''Patient teaching:''' Start early; stay hydrated; report decreased urination; strict contraception with ribavirin.
* '''Notify provider if:''' Decreased urination, confusion, easy bruising, severe fatigue.
* '''Administration tips:''' Maintain hydration; check interactions; begin promptly.

[[Category:Antivirals]]