Carper's 5 Ways of Knowing

P-FORMULARY

DIAGNOSIS: HSV Type 2 1st episode (not severe)19 year old female

THERAPEUTIC OBJECTIVE(S): __ Decrease the duration and severity of the outbreak, identify if the outbreak is HSV 1 or HSV2, identify any concurrent infections, health counselling regarding safe sexual practices, symptoms of STI's, discuss suppressive therapy, treatment and partner follow up

DRUG(S) of CHOICE:

1st Line (no contraindications): Acyclovir 200mg po five times daily for 5-10days (Canadian Guidelines on STI's, 2008)

1st Line contraindications: Famciclovir 250mg tid po for 5 days (Canadian Guidelines on STI's, 2008)

LIMITS on NP PRESCRIBING: NO _x__ *YES ___ > Consult with ____________

CONTRAINDICATIONS

- Hypersensitivity to drug/component

- Caution if renal or hepatic impairment and if nephrotoxic agents (Streptozocin and Cidofivir) are used concurrently (Epocrates, 2011)

- If patient is immunocompromised (Katzung, 2007)

- Elderly patients may need a dose reduction related to reduced renal production (Barton&Sen, 2007).

- Any Aminoglycosides, NSAID's and antivirals should be reported to the health care practitioner (Medline Plus, N.D).

SIDE EFFECTS

- Common Reactions: Nausea, vomitting, diarrhea, headache, malaise, dizziness, arthralgia, rash, lethargy, confusion, photosensitivity (Katzung, 2007)

- Serious Reactions: Seizures, coma, leukopenia, thrombocytopenia, renal impairment (Epocrates,2011)

MONITORING PARAMETER

- A pelvic exam is important to identify symptoms of the infection, observe the cervix/vagina for inflammation, discharge or lesions and to discern if there has been improvement upon follow up .

- Pain management may require the use of analgesics as well as laxatives (Public Health Agency of Canada, 2008).

- Difficult urinating and retention may warrant hospitalization (Public Health Agency of Canada, 2008).

- Be aware of the possibility for aseptic meningitis, cervicitis, urethritis and inform the patient of the symptoms (Barton&Sen, 2007).

HEALTH TEACHING-

Related to drug

- What is the drug?

- Acyclovir is a synthetic nucleoside analogue in the medication class of antivirals (Katzung, 2007).

- What is the drug for?

- Acyclovir is used for viral infections like Herpes Simplex, and is supposed to decrease the pain associated with the sores of HSV. It is used to speed the healing process of the vesicles. It works by stopping the herpes virus from spreading in the body, but does not cure the infection (Barton&Sen, 2007).

- How much to take?

- The medication is 200mg (one capsule) taken 5 times per day by mouth (Public Health Agency of Canada, 2008). Acyclovir should be taken at the same time every day to assist with compliance. The medication should be taken as directed. The client should drink plenty of water while taking the medication, encourage 6-8 glasses minimum per day (Medline Plus, n.d.).

- How does it work?

- Acyclovir inhibits DNA Polymerase and incorporates into