Cidofovir

INTRODUCTION

Indications

Management of cytomegalovirus (CMV) retinitis in HIV-infected patients (with probenecid).

Action

Suppresses replication of CMV by inhibiting viral DNA synthesis. Therapeutic Effects: Slows progression of CMV retinitis; may not be curative.

Adverse Reactions/Side Effects

CNS: headache, weakness. EENT: decreased intraocular pressure, hearing loss, iritis, ocular hypotony, uveitis. Resp: dyspnea, pneumonia. GI: HEPATIC DYSFUNCTION, PANCREATITIS, abdominal pain, nausea, vomiting, anorexia, diarrhea. GU: RENAL FAILURE, proteinuria. Derm: alopecia, rash. F and E: decreased serum bicarbonate. Hemat: neutropenia, anemia. Metab: METABOLIC ACIDOSIS. Misc: chills, fever, infection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs immediately to the physician.

• Be alert for signs of liver dysfunction (anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, unusual bleeding or bruising) or pancreatitis (upper abdominal pain after eating, indigestion, weight loss, oily stools). Report these signs to the physician immediately.

• Monitor signs of metabolic acidosis, including headache, lethargy, stupor, seizures, increased respiration, cardiac arrhythmias, weakness, and GI symptoms (nausea, vomiting, abdominal pain). Notify physician immediately if these signs occur.

• Monitor any breathing difficulties; notify physician immediately if patient experiences signs of pneumonia, including cough, fever, chills, dyspnea, and chest pain during inspiration and expiration.

• Be alert for any visual or hearing disturbances; report these problems for further evaluation.

• Monitor signs of neutropenia (fever, sore throat, signs of infection), or unusual weakness, fatigue, and pallor that might be due to anemia. Report these signs to the physician.

Interventions

• 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.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects, including severe or prolonged headache, chills, fever, infection, skin problems (rash, hair loss), or GI problems (diarrhea, nausea, vomiting, loss of appetite, abdominal pain).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Excreted mostly unchanged by the kidneys.

Half-life: Unknown.

Contraindications/Precautions