Pharmacologic: purine analogues
PO: Recurrent genital herpes infections. Localized cutaneous herpes zoster infections (shingles) and chickenpox (varicella). IV: Severe initial episodes of genital herpes in nonimmunosuppressed patients. Mucosal or cutaneous herpes simplex infections or herpes zoster infections (shingles) in immunosuppressed patients. Herpes simplex encephalitis. Topical: Cream—Recurrent herpes labialis (cold sores). Ointment—Treatment of limited non–life-threatening herpes simplex infections in immunocompromised patients (systemic treatment is preferred).
Interferes with viral DNA synthesis. Therapeutic Effects: Inhibition of viral replication, decreased viral shedding, and reduced time for healing of lesions.
Adverse Reactions/Side Effects
CNS: SEIZURES, dizziness, headache, hallucinations, trembling. GI: diarrhea, nausea, vomiting, elevated liver enzymes, hyperbilirubinemia, abdominal pain, anorexia. GU: RENAL FAILURE, crystalluria, hematuria, renal pain. Derm: acne, hives, skin rashes, unusual sweating, STEVENS-JOHNSON SYNDROME. Endo: changes in menstrual cycle. Hemat: THROMBOTIC THROMBOCYTOPENIC PURPURA/HEMOLYTIC UREMIC SYNDROME (HIGH DOSES IN IMMUNOSUPPRESSED PATIENTS). Local: pain, phlebitis, local irritation. MS: joint pain. Misc: polydipsia.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.
Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.
Monitor signs of thrombotic thrombocytopenic purpura (purplish spots on the skin, decreased consciousness, fatigue, weakness, shortness of breath on exertion, tachycardia) and hemolytic uremic syndrome (bloody diarrhea and vomiting, decreased urine output). Report these signs to the physician immediately.
Monitor rashes or other skin reactions (hives, acne, abnormal sweating, exfoliation). Notify physician immediately as certain skin reactions may indicate serious hypersensitivity reactions such as Stevens-Johnson syndrome or erythema multiforme.
Assess any joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Assess dizziness or trembling that might affect gait, balance, or other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Assess skin and mucosal lesions to help determine if drug therapy is successful in controlling infection.
Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.
Avoid contact with cutaneous or mucosal lesions when treating patient.
Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions as indicated for specific patients....
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