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.