Nelfinavir

INTRODUCTION

Indications

HIV infection (with other antiretrovirals).

Action

Inhibits HIV protease and prevents cleavage of viral polyproteins. Therapeutic Effects: Increased CD4 cell count and decreased viral load. Slowed progression of HIV infection with less sequela.

Adverse Reactions/Side Effects

CNS: SEIZURES, anxiety, depression, dizziness, drowsiness, emotional lability, headache, hyperkinesia, malaise, migraine headache, sleep disorders, suicidal ideation, weakness. EENT: acute iritis, pharyngitis, rhinitis, sinusitis. Resp: dyspnea. GI: diarrhea, anorexia, dyspepsia, elevated liver function studies, epigastric pain, flatulence, GI bleeding, hepatitis, nausea, oral ulcerations, pancreatitis, vomiting. GU: nephrolithiasis, sexual dysfunction. Derm: pruritus, rash, sweating, urticaria. Endo: fat redistribution, hyperglycemia. F and E: dehydration. Hemat: anemia, leukopenia, thrombocytopenia. Metab: hyperlipidemia, hyperuricemia. MS: arthralgia, arthritis, back pain, myalgia, myopathy. Neuro: myasthenia, paresthesia. Misc: allergic reactions, 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 immediately to the physician.

• Be alert for signs of peripheral neuropathy (numbness, tingling) and myopathy (muscle pain, weakness). 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 nerve and muscle function.

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

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

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

• 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.

• 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 personality changes, including anxiety, depression, mood swings, severe restlessness, and increased thoughts of suicide. Notify physician if these changes become problematic.

Interventions

• Implement resistive exercises and other therapeutic exercises as needed to ...