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Side Effects. ARV Nurse Training Programme Marcus McGilvray & Nicola Willis. “ I’ve heard that ARVs are toxic. Is it true?”. “ But what about the ARV side effects?”. “ People say they are poisons ”. Side Effects. It is true ARVs do have side effects BUT….. Many other drugs also have
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Reactions ARV Nurse Training Program Marcus McGilvray & Nicola Willis ARV Nurse Training, Africaid, 2004

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" I\'ve heard that ARVs are poisonous. Is it valid?" " But shouldn\'t something be said about the ARV reactions?" " People say they are toxic substances " ARV Nurse Training, Africaid, 2004

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Side Effects It is genuine ARVs do have symptoms BUT… .. Numerous different medications likewise have reactions – even basic anti-infection agents and painkillers ARV Nurse Training, Africaid, 2004

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What are the Side Effects? These rely on upon … . the medications utilized the individual Not all medications influence all individuals similarly ARV Nurse Training, Africaid, 2004

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"Adequate" (transient) Versus "Unsatisfactory" (extreme, risky) … ..in any case, ALL must be accounted for with the goal that they can be overseen suitably! Diverse sorts ARV Nurse Training, Africaid, 2004

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Transient Side Effects Many are transient in the initial couple of weeks e.g. migraine, sickness, the runs, retching Other drug can by used to oversee/lighten these indications Patients need IMMENSE SUPPORT and ENCOURAGEMENT to proceed with regimen ARV Nurse Training, Africaid, 2004

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Severe Side Effects Some reactions might be extreme e.g. rash, hepatitis, lactic acidosis, pancreatitis, hyperlipidaemia, fringe neuropathy The Doctor may need to change the ARVs being taken by the patient Early distinguishing proof and incite, proper administration is fundamental! ARV Nurse Training, Africaid, 2004

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Side Effects of NRTIs AZT (Retrovir): iron deficiency, migraine, liver harmfulness, neutropenia, thrombocytopenia 3TC (Epivir): queasiness, looseness of the bowels, cerebral pain, exhaustion, skin rash, stomach torment, increment LFTs D4T (Zerit): migraine, sickness, regurgitating, the runs, rash, increment LFTs, fringe neuropathy, pancreatitis DDI (Videx): sickness, spewing, the runs, abdo torment, peripheral neuropathy, increment LFTs, pancreatitis ARV Nurse Training, Africaid, 2004

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Side Effects of NNRTIs Efavirenz (Stocrin): rash, narcotic impacts, migraine, sickness, the runs, distinctive dreams, a sleeping disorder, increment LFTs, hepatitis, liver disappointment Nevirapine (Viramune): migraine, queasiness, rash, diarrhoea, increment LFTs, hepatitis, liver disappointment ARV Nurse Training, Africaid, 2004

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Side Effects of PIs Nelfinavir (Viracept): queasiness, retching, the runs, headache, asthenia, abdo torment, rash, hyperglycaemia Ritonavir (Norvir): queasiness, heaving, the runs, stomach torment, anorexia, increment LFTs, pancreatitis, hyperlipidemia, hyperglycemia, circumoral paresthesia ARV Nurse Training, Africaid, 2004

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Diarrhea Possible causes : OIs (e.g. cryptosporidium, CMV, giardia, salmonella, shigella) Antibiotics ARVs (e.g PIs, ddI, Abacavir) i.e. not as a matter of course ARV-related but rather it is basic Severity and term variable Dependent on individual and medication ARV Nurse Training, Africaid, 2004

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Management of Diarrhea Identify cause : feces test to prohibit OI Rehydration : empower liquids >3L/day Replace potassium : bananas, potatoes, chicken, fish Soluble filaments : beats, oats, bananas, apples, pears Anti-looseness of the bowels drugs : e.g. loperamide Support & Encouragement to advance Adherence! ARV Nurse Training, Africaid, 2004

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Nausea and Vomiting Possible causes: OIs (e.g. intense diarrhoeal diseases) ARVs (eg 3TC, ddI, D4T, EFV, NVP & PIs) i.e. not as a matter of course ARV-related but rather it is basic ARV Nurse Training, Africaid, 2004

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Management of Nausea & Vomiting Exclude other cause : e.g. OI, diarrhoeal illness, pregnancy Investigation : e.g. U+Es Anti-emetic drugs : e.g. Maxalon Dietary Advice : hold fast to dietary prerequisites of ARV medications Other : e.g. little, visit suppers; space admission of liquids/solids; maintain a strategic distance from greasy, broiled nourishment; salty, dry sustenances; icy nourishments, stay lifted; home grown teas Change Regimen : ?? Diminish dose or recurrence; stop drug Support & Encouragement to advance Adherence! ARV Nurse Training, Africaid, 2004

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Skin Problems Possible causes : Interaction between insusceptible framework and HIV (e.g. seroconversion ailment, pruritic rash) Infections (e.g. bacterial, viral, contagious) ARVs (e.g. NVP, 3TC, D4T, EFV, NFV) Severity and term variable Most are mellow and can be dealt with ARV Nurse Training, Africaid, 2004

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Management of Skin Problems Mild skin rash : treatment can be proceeded with; treat with prednisone, antihistamines; exhortation on not utilizing cleansers & antiperspirants Severe rash: stop and don\'t take once more! Nevirapine: rash experienced in 20-30% of patients; 2% experience life-debilitating Stevens Johnson Syndrome; NVP is started in low measurements, expanding to full dosage more than 2 weeks Support & Encouragement to advance Adherence ARV Nurse Training, Africaid, 2004

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Anemia Possible causes: Common with AZT OIs e.g. MAI Maybe HIV related (Rare in CD4 >200mL) Management: Routine checking of FBC Reduce dosage/change drug e.g. ddI Support & Encouragement to advance Adherence ARV Nurse Training, Africaid, 2004

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Regular observing of blood levels is key to recognize ARV toxicities Appropriate intercession can then be made FBC LFTs U&Es Cholesterol Glucose Other toxicities… .. ARV Nurse Training, Africaid, 2004

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Our Role… … As medical caretakers, we have a crucial part to play in guaranteeing reactions are recognized, overseen and treated fittingly and viably ARV Nurse Training, Africaid, 2004

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How would we do this?........ Teaching patients Prompt acknowledgment and reporting Understanding lab tests and results Explaining lab tests to patients Therapeutic mediation Providing backing and advising for patient and family Ensuring follow up of patients Educating the overall population ARV Nurse Training, Africaid, 2004

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In turn… … . We can guarantee wellbeing of our patients Enhance personal satisfaction for individuals taking ARVs through helpful mediation Promote adherence , through comprehension of reactions Dispel myths and misguided judgments about ARVs ARV Nurse Training, Africaid, 2004

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Patients taking ARVs face an extremely troublesome test BUT together, we CAN have a major effect ARV Nurse Training, Africaid, 2004

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