Indinavir

INTRODUCTION

Indications

HIV infection (with other antiretrovirals). Unlabeled Use: Prevention of HIV infection after known exposure (with other antiretrovirals).

Action

Inhibits the action of HIV protease and prevents the cleavage of viral polyproteins. Therapeutic Effects: Slowing of the progression of HIV infection and its sequelae.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, fatigue, headache, insomnia, weakness. GI: abdominal pain, acid regurgitation, altered taste, asymptomatic hyperbilirubinemia, diarrhea, nausea, vomiting. GU: nephrolithiasis. Endo: hyperglycemia. F and E: KETOACIDOSIS. MS: back pain, flank pain. Misc: redistribution of body fat.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hyperglycemia and ketoacidosis, including confusion, drowsiness, fatigue, weakness, rapid breathing, fruity or pungent breath, excessive thirst, frequent urination, nausea, vomiting, and abdominal pain. Notify physician immediately if these signs occur.

• Assess any back or side pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness and drowsiness 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 and report signs of kidney stones (nephrolithiasis), including severe pain in the side and back, pain on urination, bloody urine, and a persistent urge to urinate.

Interventions

• Implement resistive exercises and other therapeutic exercises as tolerated to maintain muscle strength and function and prevent muscle wasting associated with HIV infection and AIDS.

• Because of the risk of ketoacidosis, use 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 indinavir 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 indinavir does not cure HIV or AIDS or prevent associated or opportunistic infections. Indinavir does not reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom, and avoid sharing needles or donating blood to prevent spreading the AIDS virus to others.

• Inform patient that redistribution and accumulation of body fat may occur, causing central obesity, thin arms and legs, dorsocervical fat enlargement (buffalo hump), breast enlargement, and other symptoms that resemble Cushing's syndrome (moon face, striations on abdominal ...