Etravirine

INTRODUCTION

Indications

HIV infection (with other antiretrovirals).

Action

Binds to the enzyme reverse transcriptase which results in disrupted viral DNA synthesis. Therapeutic Effects: Evidence of decreased viral replication and reduced viral load with slowed progression of HIV and its sequelae.

Adverse Reactions/Side Effects

CNS: SEIZURES, anxiety, confusion, fatigue, headache, insomnia, sleep disorders. EENT: blurred vision, vertigo. CV: MYOCARDIAL INFARCTION, angina pectoris, atrial fibrillation, hypertension. GI: nausea, abdominal pain, anorexia, dry mouth, hepatitis, stomatitis, vomiting. GU: renal failure. Endo: gynecomastia, hyperglycemia, hyperlipidemia. Hemat: anemia, hemolytic anemia. Derm: rash. Metab: fat redistribution. Neuro: peripheral neuropathy. MS: hemarthrosis. Misc: allergic reactions, including STEVENS-JOHNSON SYNDROME, IMMUNE RECONSTITUTION SYNDROME.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor continually for signs of MI such as sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea. Seek immediate medical assistance if patient develops these signs.

• 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 immediately to the physician.

• Monitor skin rash and other skin reactions (dermatitis, exfoliation). Report skin problems immediately because they may represent serious hypersensitivity reactions (Stevens-Johnson syndrome).

• 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 heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, angina pectoris, 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).

• Monitor signs of anemia and hemolytic anemia, including unusual fatigue, shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, and chest pain. Report these signs to the physician.

• Monitor signs of renal failure, including decreased urine output, increased BP, muscle cramps/twitching, edema/weight gain from fluid retention, yellowishbrown skin, and confusion that progresses to seizures and coma. Report these signs 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 any joint pain and attempt to determine if pain is caused by bleeding into the joint (hemarthrosis). Notify physician of suspected hemarthrosis.

Interventions

• Implement resistive exercises and other ...