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INTRODUCTION

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nevirapine (ne-veer-a-peen)

Viramune

Classification

Therapeutic: antiretrovirals

Pharmacologic: nonnucleoside reverse transcriptase inhibitors

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Indications
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Management of HIV infection in combination with a nucleoside analogue.

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Action
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Binds to the enzyme reverse transcriptase, which results in disruption of DNA synthesis. Therapeutic Effects: Slowed progression of HIV infection and decreased occurrence of sequelae.

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Adverse Reactions/Side Effects
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Reflects combination therapy
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CNS: headache. GI: HEPATOTOXICITY, elevated liver enzyme levels, nausea, abdominal pain, diarrhea, hepatitis, ulcerative stomatitis. Derm: RASH (MAY PROGRESS TO TOXIC EPIDERMAL NECROLYSIS). Hemat: granulocytopenia (increased in children). MS: myalgia. Neuro: paresthesia, peripheral neuropathy. Misc: STEVENS-JOHNSON SYNDROME, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor skin rash and other skin reactions (dermatitis, exfoliation). Report skin problems immediately because they may represent serious hypersensitivity reactions (Stevens-Johnson Syndrome).

  • Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

  • Be alert for signs of paresthesia and peripheral neuropathy (numbness, tingling, decreased muscle strength). 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 any muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

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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 prevent muscle wasting associated with HIV infection and AIDS.

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Patient/Client-Related Instruction
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  • Emphasize the importance of taking nevirapine 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 a health care professional.

  • Inform patient that nevirapine does not cure HIV or AIDS or prevent associated or opportunistic infections. Nevirapine does not reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom, and to avoid sharing needles or donating blood to prevent spreading the AIDS virus to others.

  • Instruct children and family/caregivers to report symptoms of granulocytopenia, including fever, sore throat, mucosal lesions, signs of infection, and bruising.

  • Instruct patient to report other troublesome side effects such as prolonged or severe headache, fever, or GI reactions (nausea, diarrhea, abdominal pain, and inflammation/ulceration in/around the mouth).

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Pharmacokinetics
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Absorption: >90% absorbed after oral administration.

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Distribution: Crosses placenta and enters breast milk; CSF levels are 45% ...

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