Antiretrovirals (HIV)

Antiretrovirals (HIV)

Drug monograph · NCLEX study reference
Therapeutic class	Antiretroviral
Pharmacologic class	NRTIs, integrase inhibitors, NNRTIs, protease inhibitors
Onset / peak / duration	Chronic daily therapy; combination single-tablet regimens common (such as Biktarvy).
Half-life / level	Varies; viral load and CD4 guide therapy.
Routes	PO (oral)
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Supportive care.
Pregnancy / lactation	Managed by HIV specialists; therapy continued to prevent transmission.

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.

Antiretrovirals (HIV) — Antiretroviral; NRTIs, integrase inhibitors, NNRTIs, protease inhibitors.

Identification

• Therapeutic class: Antiretroviral.
• Pharmacologic class: NRTIs, integrase inhibitors, NNRTIs, protease inhibitors.

Pharmacology

• Mechanism of action: Inhibit different steps of HIV replication; combined as antiretroviral therapy to suppress viral load.
• Onset / peak / duration: Chronic daily therapy; combination single-tablet regimens common (such as Biktarvy).
• Half-life / therapeutic level: Varies; viral load and CD4 guide therapy.

Clinical use

• Indications: HIV treatment; emtricitabine/tenofovir also for pre-exposure prophylaxis (PrEP).
• Usual dose, route, frequency: PO once daily for most modern regimens.
• Maximum dose / adjustments: Tenofovir adjusted by renal function; many interactions.

Safety

• Contraindications: Drug-specific (efavirenz with certain psychiatric risk; protease inhibitors with many CYP3A4 drugs).
• Black box warning: Some NRTIs carry class warnings for lactic acidosis and severe hepatomegaly with steatosis; agents active against hepatitis B (tenofovir, emtricitabine) carry warnings for severe hepatitis B flare if stopped; abacavir (not in this prototype set) carries a hypersensitivity boxed warning tied to HLA-B*5701.
• Interactions: Protease inhibitors and efavirenz have extensive CYP interactions; tenofovir with nephrotoxic drugs.
• Pregnancy / lactation: Managed by HIV specialists; therapy continued to prevent transmission.
• High-alert: No.

Adverse effects

• Common side effects: Nausea, diarrhea, headache; efavirenz causes vivid dreams and dizziness.
• Serious effects to report: Renal impairment and bone loss (tenofovir), efavirenz neuropsychiatric effects, immune reconstitution syndrome, hepatitis flare on discontinuation.
• Antidote / reversal: Supportive care.

Nursing process

• Assessment before administration: Renal and hepatic function, viral load and CD4, hepatitis B status, full drug list.
• Interventions during therapy: Stress strict adherence to prevent resistance; review interactions; do not stop abruptly if hepatitis B positive.
• Monitor: Viral load, CD4, renal and hepatic function, adherence.
• Evaluation / expected outcome: Suppressed viral load and preserved immune function.

Patient teaching

• Patient teaching: Take every dose on time; never run out or stop suddenly; report mood changes (efavirenz).
• Notify provider if: Decreased urination, mood changes, new infections, jaundice.
• Administration tips: Once-daily combination tablets; adherence is critical.