Efavirenz is primarily used to inhibit HIV reverse transcriptase and is administered orally, with increased absorption when taken with a high-fat meal. It has a high protein-binding capacity and can cross the blood-brain barrier, placenta, and breast milk.
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.
