Raltegravir

INTRODUCTION

Indications

HIV infection (with other antiretrovirals) in patients who are failing other treatments as evidenced by continued viral replication and resistance to other agents.

Action

Inhibits HIV-1 integrase, which is required for viral replication. Therapeutic Effects: Evidence of decreased viral replication and reduced viral load with slowed progression of HIV and its sequelae.

Adverse Reactions/Side Effects

CNS: headache, dizziness, fatigue, weakness. CV: myocardial infarction. GI: diarrhea, abdominal pain, gastritis, hepatitis, vomiting. GU: renal failure/impairment. Hemat: anemia, neutropenia. Metab: lipodystrophy. Misc: hypersensitivity reactions, immune reconstitution syndrome, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Seek immediate medical assistance if symptoms of MI develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, hives, itching). Notify physician immediately if these signs occur.

• Be alert for signs of an unusually aggressive immune reaction to opportunistic infection (immune reconstitution syndrome). Signs include fever, pain, warmth and redness and swelling at the site of infection. Notify physician of these signs immediately.

• Assess dizziness or weakness 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 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 to the physician immediately.

• Monitor signs of anemia (unusual fatigue, shortness of breath with exertion, bruising) and neutropenia (fever, sore throat, signs of infection). Notify physician immediately if these signs occur.

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 MI, use extreme 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 raltegravir 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 raltegravir does not cure HIV or AIDS or prevent associated or opportunistic ...