Ribavirin

INTRODUCTION

Indications

Inhalation: Treatment of severe lower respiratory tract infections caused by the respiratory syncytial virus (RSV) in infants and young children. PO: Rebetol—with interferon alfa-2b (Intron A) or peginterferon alfa-2b (PEG-Intron) in the treatment of chronic hepatitis C in patients who have failed previous therapy. PO: Copegus—with peginterferon alfa-2a (Pegasys) in the treatment of chronic hepatitis C in patients who have failed previous therapy. Unlabeled Use: Early (within 24 hr of symptoms) secondary treatment of influenza A or B in young adults.

Action

Inhibits viral DNA and RNA synthesis and subsequent replication. Must be phosphorylated intracellularly to be active. Therapeutic Effects: Inhalation: Virustatic action. PO: Decreased progression and sequelae of chronic hepatitis C.

Adverse Reactions/Side Effects

Inhalation

CNS: dizziness, faintness. EENT: blurred vision, conjunctivitis, erythema of the eyelids, ocular irritation, photosensitivity. CV: CARDIAC ARREST, hypotension. Derm: rash. Hemat: hemolytic anemia (with interferon alpha-2b), reticulocytosis.

Oral (may reflect combination with interferon)

CNS: emotional lability (↑ in children), fatigue (↓ in children), impaired concentration (↓ in children), insomnia (↓ in children), irritability (↓ in children). EENT: dry mouth. Resp: dyspnea (↓ in children). GI: anorexia (↑ in children), dyspepsia (↓ in children), vomiting (↑ in children). Hemat: hemolytic anemia. Derm: pruritus (↓ in children). MS: arthralgia (↓ in children). Misc: fever (↑ in children).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of cardiac arrest, and seek immediate medical assistance if the patient collapses, loses consciousness, stops breathing, and lacks a pulse.

• Monitor signs of hemolytic anemia, including unusual weakness and fatigue, dizziness, jaundice, and abdominal pain. Report these signs to the physician immediately.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or faintness.

• Assess any breathing problems, and report difficult or labored breathing (dyspnea).

• Assess any 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.

• Assess dizziness that might affect gait, balance, or 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.

• Be alert for emotional outbursts, impaired concentration, irritability, and fatigue. Notify physician if these symptoms develop.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions as indicated for specific patients.