Didanosine

INTRODUCTION

Indications

HIV infection (with other antiretrovirals).

Action

Inhibits viral replication by interfering with viral RNA-directed DNA polymerase (reverse transcriptase). Converted intracellularly by the phosphorylation process to its active form. Therapeutic Effects: Increase in CD4 cell counts and decreased viral load, with decreased incidence of opportunistic infections and slowed progression in HIV-infected patients.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache, dizziness, insomnia, lethargy, pain, weakness. EENT: rhinitis, ear pain, epistaxis, optic neuritis, parotid gland enlargement, photophobia, retinal depigmentation, sialoadenitis. Resp: cough, asthma. CV: arrhythmias, edema, hypertension, vasodilation. GI: LIVER FAILURE, PANCREATITIS, anorexia, diarrhea, liver function abnormalities, nausea, vomiting, abdominal pain, constipation, dry mouth, dyspepsia, flatulence, hepatic steatosis, stomatitis. GU: urinary frequency. Derm: alopecia, ecchymoses, rash. Endo: fat redistribution, hyperglycemia. Hemat: granulocytopenia, anemia, bleeding, leukopenia. Metab: LACTIC ACIDOSIS, hyperlipidemia, hyperuricemia, weight loss. MS: RHABDOMY-OLYSIS, arthritis, myalgia. Neuro: peripheral neuropathy, poor coordination. Misc: chills, fever, anaphylactoid reactions.

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.

• Be alert for signs of liver failure (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 lactic acidosis, including confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician immediately if these signs occur.

• Assess any musculoskeletal pain, muscle tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. These symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately.

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• 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, fainting, and fatigue/weakness.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report 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 due to vasodilation.

• Monitor signs ...