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INTRODUCTION

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stavudine (stav-yoo-deen)

d4T, Zerit, Zerit XR

Classification

Therapeutic: antiretrovirals

Pharmacologic: nucleoside reverse transcriptase inhibitors

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Indications
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HIV infection unresponsive or intolerant to conventional therapy.

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Action
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Converted intracellularly to stavudine triphosphate, which inhibits viral DNA synthesis and replication. Therapeutic Effects: Virustatic action against HIV. Decreased viral load and increased cell count. Not curative, but may slow progression of HIV infection and decrease the incidence and severity of its sequelae.

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Adverse Reactions/Side Effects
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CNS: headache, insomnia, weakness. GI: HEPATIC TOXICITY, PANCREATITIS, anorexia, diarrhea. F and E: LACTIC ACIDOSIS. Hemat: anemia. MS: arthralgia, myalgia. Neuro: peripheral neuropathy.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of liver toxicity, including 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 pancreatitis, including upper abdominal pain (especially after eating), indigestion, weight loss, and oily stools. Report these signs to the physician 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 weakness, 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, 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.

  • Monitor any unusual weakness, fatigue, or pallor that might be due to anemia and other blood dyscrasias. Report these signs to the physician.

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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.

  • 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 stavudine 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 stavudine does not cure HIV or AIDS or prevent associated or opportunistic infections. Stavudine 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 ...

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