Zidovudine

INTRODUCTION

Indications

HIV infection (with other antiretrovirals). Reduction of maternal/fetal transmission of HIV.

Action

Following intracellular conversion to its active form, inhibits viral RNA synthesis by inhibiting the enzyme DNA polymerase (reverse transcriptase). Prevents viral replication. Therapeutic Effects: Virustatic action against selected retroviruses. Slowed progression and ↓ sequelae of HIV infection. ↓ viral load and improved CD4 cell counts. ↓ transmission of HIV to infants born to HIV-infected mothers.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache, weakness, anxiety, confusion, ↓ mental acuity, dizziness, insomnia, mental depression, restlessness, syncope. GI: abdominal pain, diarrhea, nausea, anorexia, drug-induced hepatitis, dyspepsia, oral mucosa pigmentation, vomiting. Derm: nail pigmentation. Endo: gynecomastia. Hemat: anemia, granulocytopenia, pure red-cell aplasia, thrombocytosis. MS: back pain, myopathy. Neuro: tremor.

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.

• Assess any back pain, muscle tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. These symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately.

• Monitor signs of granulocytopenia (fever, sore throat, mucosal lesions, signs of infection, bruising, bleeding), thrombocytosis (headache, chest pain, dizziness, fainting, vision problems, numbness/tingling in the hands and feet), or unusual weakness and fatigue that might be due to anemia and other blood dyscrasias. Report these signs to the physician.

• Assess dizziness or syncope 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.

• Be alert for anxiety, restlessness, confusion, decreased alertness, mental depression, or other alterations in mental status. Notify the physician promptly if these symptoms develop.

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.

Patient/Client-Related Instruction

• Emphasize the importance of taking zidovudine 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 zidovudine does not cure HIV or AIDS or prevent associated or opportunistic infections. Zidovudine does not reduce the risk of transmission of HIV to others ...