Ganciclovir

INTRODUCTION

Indications

IV: Treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients, including HIV-infected patients (may be used with foscarnet). Prevention of CMV infection in transplant patients at risk. PO: Maintenance treatment of stable CMV retinitis in immunocompromised patients after initial IV treatment and prevention of CMV retinitis in patients with advanced HIV infection.

Action

CMV converts ganciclovir to its active form (ganciclovir phosphate) inside the host cell, where it inhibits viral DNA polymerase. Therapeutic Effects: Antiviral effect directed preferentially against CMV-infected cells.

Adverse Reactions/Side Effects

CNS: SEIZURES, abnormal dreams, coma, confusion, dizziness, drowsiness, headache, malaise, nervousness. EENT: retinal detachment intravitreal only: decreased visual acuity, vitreous hemorrhage, hyphema, intraocular pressure spikes, lens opacities, macular abnormalities, optic nerve changes, uveitis. Resp: dyspnea. CV: arrhythmias, edema, hypertension, hypotension. GI: GI BLEEDING, abdominal pain, increased liver enzymes, nausea, vomiting. GU: gonadal suppression, hematuria, renal toxicity. Derm: alopecia, photosensitivity, pruritus, rash, urticaria. Endo: hypoglycemia. Hemat: neutropenia, thrombocytopenia, anemia, eosinophilia. Local: pain/phlebitis at IV site. Neuro: ataxia, tremor. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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 GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

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

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor signs of neutropenia (fever, sore throat, signs of infection), eosinophilia (fatigue, weakness, myalgia); thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

• Be alert for nervousness, confusion, excessive drowsiness, lethargy, or other alterations in mental status. Notify physician promptly if these symptoms develop.

• Assess dizziness, tremor, or ataxia that might affect gait, balance, or other functional activities (See Appendices C, E). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor and report signs of hypoglycemia, especially ...