Chapter 60: Immunological Medications

The antiretroviral therapy section examines how combination highly active antiretroviral therapy targets multiple stages of viral replication through distinct drug classes. Nucleoside and nucleotide reverse transcriptase inhibitors function by incorporating into viral DNA chains to terminate replication, with agents like zidovudine and abacavir carrying risks including bone marrow suppression, lactic acidosis, and hepatotoxicity. Nonnucleoside reverse transcriptase inhibitors such as nevirapine and efavirenz directly inhibit the enzyme without incorporation, presenting adverse effects including severe rash, hepatitis, and central nervous system disturbances. Protease inhibitors block viral maturation through enzyme inhibition, causing gastrointestinal upset, dyslipidemia, and hepatic dysfunction. Fusion inhibitors prevent viral cell entry, while integrase inhibitors and CCR5 antagonists represent newer mechanisms targeting integration and co-receptor binding respectively. The chapter then addresses pharmacological management of opportunistic infections prevalent in immunocompromised populations, including Pneumocystis jiroveci pneumonia treated with trimethoprim-sulfamethoxazole, fungal infections managed through amphotericin B and azole antifungals, and cytomegalovirus controlled with ganciclovir and foscarnet. Transplant immunosuppressive therapy involves calcineurin inhibitors like cyclosporine and tacrolimus that suppress T cell activation, antimetabolites including azathioprine and mycophenolate that inhibit lymphocyte proliferation, mTOR inhibitors such as sirolimus, and monoclonal antibodies targeting lymphocyte populations. Critical nursing considerations include monitoring for nephrotoxicity, infection risk, bone marrow suppression, and hypertension across immunosuppressant classes. The chapter emphasizes medication adherence for antiretroviral regimens, live vaccine contraindications, laboratory value monitoring including complete blood counts and hepatic function, and comprehensive client education regarding lifelong therapy requirements and adverse effect recognition.