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INTRODUCTION

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ritonavir (ri-toe-na-veer)

Norvir

Classification

Therapeutic: antiretrovirals

Pharmacologic: protease inhibitors

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Indications
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HIV infection (with other antiretrovirals).

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Action
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Inhibits the action of HIV protease and prevents the cleavage of viral polyproteins. Therapeutic Effects: Increased CD4 cell counts and decreased viral load with subsequent slowed progression of HIV infection and its sequelae.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, abnormal thinking, weakness, dizziness, headache, malaise, somnolence, syncope. EENT: pharyngitis, throat irritation. Resp: ANGIOEDEMA, bronchospasm. CV: heart block, orthostatic hypotension, vasodilation. GI: abdominal pain, altered taste, anorexia, diarrhea, nausea, vomiting, constipation, dyspepsia, flatulence. GU: renal insufficiency. Derm: rash, skin eruptions, sweating, urticaria. Endo: hyperglycemia. F and E: dehydration. Metab: hyperlipidemia. MS: increased creatine phosphokinase, myalgia. Neuro: circumoral paresthesia, peripheral paresthesia. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME AND ANAPHYLAXIS, fat redistribution, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • 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 immediately to the physician.

  • Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, hives, itching, raised patches of red or white skin, burning, acne, exfoliation, abnormal sweating). Notify physician immediately, especially about skin responses that may indicate serious allergic reactions such as Stevens-Johnson syndrome and angioedema.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of heart block including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact the physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

  • Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest) or other prolonged or severe respiratory problems (difficult or labored breathing). Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K).

  • Be alert for signs of peripheral paresthesia and neuropathy (numbness, tingling). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and re-examine these values periodically to document drug-induced changes in nerve and muscle 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. Report any sudden or progressive increase in muscle pain or weakness that might indicate myopathy.

  • Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose ...

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