Efavirenz

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Efavirenz

Contraindications

Hypersensitivity, pregnancy, benzodiazepines, ETOH use, Hx of psychiatric illness, liver impairment, elevated cholesterol.

Major adverse effects

50% have CNS disruption. Steven Johnson syndrom, toxic epidurmal necrolysis. Hyperlipidemia, lipodystrophy, hepatotoxicity. Rare but serious: seizure, depressoin, SI, aggresive behavior, paranoia, and mania.

Key Nursing Management

Administer at night to avoid CNS disturbances during the day. Avoid driving first week due to CNS problems. Reinforce importance to adhering to drug therapy. Administer drug on empty stomach. Reinforce the importance of alternative contriceptives.

Pharmacokinetics

Oral administration, absorption is increased with high-fat meal. Peak 3-5 hours. 99% Protein bound. Crosses BBB, placenta, breast milk. Metabolized by P-450 system.

Pharmacodynamics

Inhibits HIV reverse transcriptase by binding directly to active site on reverse transcriptase. This prevents viral RNA - DNA

Core Patient Variables

Psychiatric history should be taken before administration due to adverse effect. Access for pregnancy, hepatic dysfuction, lipid abnormalities, review drug list for interactions, CBC, CMP, lipid panel, liver function, CD4 count, and plasma HIV RNA measurements should all be reviewed. May disrupt oral birth control methods. Garlic may impair serum concentrations. Medication is expensive so review financial abilities.