Tipranavir

INTRODUCTION

Indications

Advanced HIV disease resistant to more than one protease inhibitor (must be used with ritonavir).

Action

Inhibits processing of viral polyproteins, preventing formation of mature virions. Therapeutic Effects: ↓ viral load and sequelae of HIV infection.

Adverse Reactions/Side Effects

CV: INTRACRANIAL HEMORRHAGE, fatigue, headache. GI: HEPATOTOXICITY, abdominal pain, diarrhea, nausea, vomiting. Derm: rash (↑ in women and peds). Endo: hyperglycemia. Metab: ↑ cholesterol, ↑ triglycerides. Misc: allergic reactions, bleeding, fat redistribution, fever, immune reconstitution syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of intracranial hemorrhage, including sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances, and loss of consciousness. Seek immediate medical assistance if patient exhibits these signs.

• Monitor signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician immediately if these signs occur.

• Monitor 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.

• Be alert for signs of an unusually aggressive immune reaction to opportunistic infection (immune recon-stitution syndrome). Signs include fever, pain, warmth and redness and swelling at the site of infection. Notify physician of these signs immediately.

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

Interventions

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

• Design and implement aerobic exercise and endurance training programs to help prevent heart disease associated with drug-related hyperlipidemia and other problems with lipid and glucose metabolism.

Patient/Client-Related Instruction

• Emphasize the importance of taking tipranavir 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 tipranavir does not cure HIV or AIDS or prevent associated or opportunistic infections. Tipranavir 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.

• Advise patient that this drug may cause problems in fat ...