NRTIs, NNRTIs, Integrase Inhibitors – HIV Drugs (Nursing)

00:01 Now we're on to the next phase conversion and integration.

00:05 So we talked about phase 1, right, binding infusion.

00:09 Now, we're going to focus on conversion and integration.

00:13 Okay so we're looking at that second phase conversion and integration because once inside the T helper cell this HIV changes the genetic material.

00:22 That to me.

00:23 I know it's a nasty virus, but that's amazing that can do it HIV changes.

00:28 Its genetic material.

00:30 So can enter the nucleus of the cell and take control of it.

00:34 Okay so we've got NRTIs, NNRTIs, and integrase inhibitor drugs these three big overarching categories.

00:43 So keep this in mind go back up to that picture where we've got the four cycles.

00:47 We're talking about that second cycle.

00:51 Now I might want a quick jot in NRTIs, rti's and rti's NNRTIs, and integrase inhibitor drugs can drop those in quickly just to remind you everything is phase specific, right, stages of the life cycle.

01:04 So let's look at these drugs and break them down.

01:06 Now this may be one that you're familiar with.

01:08 Zidovudine that's usually called AZT.

01:11 Now it can have some other drug interactions.

01:14 Remember we've talked about when medications become not effective and enter retroviral treatment.

01:20 We're looking at that CD4 T-cell count and it's not coming up high or where we'd like it and their viral load is also not going down where we would like it.

01:29 Maybe it's because of a possible drug interaction.

01:32 This drug can have problems with that.

01:34 Now, what about the adverse effects that the patient might experience? Well, sometimes it can be really hard on the blood cells.

01:41 They can end up with a lactic acidosis with hepatomegaly.

01:45 So that is no good.

01:47 Right acidosis.

01:48 We're talking about a pH imbalance.

01:50 This is lactic acidosis and you end up with an enlarged liver.

01:54 You can also have myopathy problems with the muscles have some pretty significant GI side effects.

02:00 Can I have some central nervous system reactions and others we just lumped in a category for you there.

02:06 Because we wanted to focus on these five.

02:10 So if I'm thinking about this drug, I know that it's an NRTI.

02:14 This one seems to have a few more side effects and we talked about in that first phase.

02:20 So we're going to be watching the liver.

02:22 We're going to be looking at the complete blood count.

02:24 We letting them know for having a muscle issues.

02:28 We know GI effects go along with just about about any type of medication but we're going to help the patient monitor those and then watch for any central nervous system problems.

02:38 Now, you're starting to understand if a patient is particularly sensitive to these medications it sometimes is discouraging for them to deal with these side effects and take this medication every day.

02:51 That's why open communication is a really powerful tool so we can help the patient find a plan that works for them with tolerable side effects.

03:01 Okay so these are the nucleoside reverse transcriptase inhibitors.

03:06 As an example, we've got the drug name for you there.

03:09 This is the non-nucleoside reverse transcriptase inhibitor.

03:14 So that's why we shorten these two NRTI or NNRTI.

03:18 Now, they're a little bit different than the NRTI and structure and the mechanism of action or how they work.

03:24 These drugs than non nucleosides.

03:26 They bind to active center of reverse transcriptase and cause direct inhibition.

03:32 Sounds very official but break that down so they bind to the active center of reverse transcriptase and they cause direct inhibition of that.

03:41 So it's in the second phase they're active and they're administered and that's what it does.

03:47 Now non-nucleoside recipient reverse transcriptase inhibitors were still talking about those.

03:52 Let me give you some examples.

03:54 Now this one is a sustiva is the trade name.

03:57 Just so you recognize that now I've got 4 other options for you to familiarize yourself with these drug names.

04:04 So you'll recognize that these are the medications we use in ART.

04:08 They're NNRTISs but the drug name that you'll see on NCLEX will be the generic.

04:13 So those are the ones that are on the left.

04:16 The ones in parentheses are the brand name.

04:19 So you see they're kind of easier to say but I want you to be able to recognize these drug names should you see them in practice or on an exam.