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INTRODUCTION

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valganciclovir (val-gan-sye-kloe-veer)

Valcyte

Classification

Therapeutic: antivirals

Pharmacologic: guanine nucleoside analogues

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Indications
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Treatment of cytomegalovirus (CMV) retinitis in patients with AIDS. Prevention of CMV disease in kidney, kidney/pancreas, and heart transplant patients at risk.

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Action
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Valganciclovir is a prodrug which is rapidly converted to ganciclovir by intestinal and hepatic enzymes. CMV virus converts ganciclovir to its active form (ganciclovir phosphate) inside host cell, where it inhibits viral DNA polymerase. Therapeutic Effects: Antiviral effect directed preferentially against CMV-infected cells.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, headache, insomnia, agitation, confusion, dizziness, hallucinations, psychosis, sedation. GI: abdominal pain, diarrhea, nausea, vomiting. GU: renal impairment. Hemat: NEUTROPENIA, THROMBOCYTOPENIA, anemia, aplastic anemia, bone marrow depression, pancytopenia. Neuro: ataxia, paresthesia, peripheral neuropathy. Misc: fever, hypersensitivity reactions, infections.

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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 to the physician immediately.

  • Monitor signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemias or other blood dyscrasias. Report these signs to the physician immediately.

  • Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Report these reactions to the physician.

  • Monitor signs of paresthesia and peripheral neuropathy (numbness, tingling). Perform objective tests (nerve conduction, monofilaments) to document any neuropathic changes.

  • Be alert for dizziness or ataxia that might affect gait, balance, or other functional activities. 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.

  • Be alert for agitation, confusion, sedation, hallucinations, psychosis, or other alterations in mental status. Notify the physician promptly if these symptoms develop.

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Interventions
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  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions as indicated for specific patients.

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Patient/Client-Related Instruction
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  • Instruct patient to report signs of kidney impairment, including blood or pus in the urine, increased urinary frequency, cloudy urine, and decreased urine output.

  • Instruct patient and family/caregivers to report other troublesome side effects, including severe or prolonged fever, infection, or GI problems (diarrhea, nausea, vomiting, abdominal pain).

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Pharmacokinetics
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Absorption: 59.4% absorbed following oral administration; rapidly converted to ganciclovir.

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Distribution: Unknown.

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Metabolism and Excretion: Rapidly converted to ganciclovir; ganciclovir is mostly excreted by the kidneys.

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Half-life: 4.1 hr ...

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