Atazanavir

INTRODUCTION

Indications

HIV infection (with other antiretrovirals).

Action

Inhibits the action of HIV protease, preventing maturation of virions. Therapeutic Effects: ↑ CD4 cell counts and ↓ viral load with subsequent slowed progression of HIV and its sequelae.

Adverse Reactions/Side Effects

When used in combination with other antiretrovirals

CNS: headache, depression, dizziness, insomnia. CV: ↑ PR interval, heart block. GI: nausea, abdominal pain, ↑ bilirubin, cholelithiasis, diarrhea, jaundice, vomiting, ↑ transaminases. Derm: rash. Endo: hyperglycemia. Metab: fat redistribution. MS: myalgia. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• 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.

• 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 levels frequently.

• 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.

• Monitor personality changes such as depression and increased thoughts of suicide. Notify physician if these changes become problematic.

Interventions

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

• Because of the risk of arrhythmias, 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).

Patient/Client-Related Instruction

• Emphasize the importance of taking atazanavir 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 atazanavir does not cure HIV or AIDS or prevent associated or opportunistic infections. Atazanavir does not reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom and avoid sharing needles or donating blood to prevent spreading the AIDS virus to others.

• Inform patient that redistribution and accumulation of body fat may occur, causing central ...