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INTRODUCTION

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emtricitabine (em-tri-sit-i-been)

Emtriva

Classification

Therapeutic: antiretrovirals

Pharmacologic: nucleoside reverse transcriptase inhibitors

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Indications
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HIV infection (with other antiretrovirals).

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Action
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Phosphorylated intracellularly where it inhibits HIV reverse transcriptase, resulting in viral DNA chain termination. Therapeutic Effects: Slowed progression of HIV infection and decreased occurrence of sequelae. Increases CD4 cell counts and decreases viral load.

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Adverse Reactions/Side Effects
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CNS: dizziness, headache, insomnia, weakness, depression, nightmares. GI: abdominal pain, diarrhea, nausea, SEVERE HEPATOMEGALY WITH STEATOSIS, dyspepsia, vomiting. Derm: rash, skin discoloration. F and E: LACTIC ACIDOSIS. MS: arthralgia, myalgia. Neuro: neuropathy, paresthesia. Resp: cough, rhinitis. Misc: fat redistribution.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of enlarged, fatty liver (hepatomegaly with steatosis) that can progress to liver dysfunction and liver failure. Signs of liver disease include anorexia, abdominal pain, abdominal swelling (ascites), severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician of these signs immediately.

  • Monitor signs of lactic acidosis, including confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician immediately if these signs occur.

  • Assess any muscle pain or 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.

  • Be alert for signs of peripheral neuropathy (numbness, tingling, muscle weakness). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Implement resistive exercises and other therapeutic exercises as tolerated to maintain muscle strength and function and to prevent muscle wasting associated with HIV infection and AIDS.

  • Because of the risk of lactic acidosis, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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Patient/Client-Related Instruction
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  • Emphasize the importance of taking emtricitabine as directed even if the patient is asymptomatic, and that this drug must always be used in combination with other antiretroviral drugs. Do not take more than prescribed amount, and do not stop taking without consulting health care professional.

  • Inform patient that emtricitabine does not cure HIV or AIDS or prevent associated or opportunistic infections. Emtricitabine does not reduce the risk of transmission of ...

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