Body Fluid Exposures Medication
- Author: Nathalie Mathieu, MD; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
A tetanus toxoid should be administered intramuscularly. Health care workers who sustain a significant exposure to hepatitis B virus (HBV) and have not been immunized or are nonresponders should receive passive immunization with HBIG. Guidelines on management of occupational exposures to HIV and postexposure prophylaxis are available from the US Public Health Service.[6]
Information on HIV prophylaxis is as follows:
- Standard exposure (presence of identified risk factor* for occupational exposure): zidovudine 600 mg/day PO divided bid PLUS lamivudine 150 mg bid PO for 4 wk
- High-risk exposure (presence of 2 or more risk factors* for occupational exposure): zidovudine, PLUS lamivudine as above, PLUS indinavir 800 mg q8h (or nelfinavir 750 mg q8h or efavirenz 600 mg qhs) for 4 weeks
- Pediatric dosing
- Zidovudine 180 mg/m2/dose PO bid, not to exceed 600 mg/day
- Lamivudine (3TC) 4 mg/kg/dose PO bid, not to exceed 300 mg/day
- Nelfinavir (Viracept) 50-55 mg/kg/dose PO bid, not to exceed 2500 mg/day
- *Risk factors include (1) deep injury, (2) presence of visible blood on the instrument causing the exposure, (3) injury with a device that was placed in the vein or the artery of the source patient, or (4) terminal illness in the source patient.
Nucleoside reverse transcriptase inhibitors (NRTIs)
Class Summary
These agents inhibit reverse transcriptase and cause chain termination when incorporated into a growing viral strand.
Zidovudine (AZT, ZDV, Retrovir)
Thymidine analogue that inhibits viral replication. Retrovir, in combination with 3TC it is known as Combivir, with ABC and 3TC it is known as Trizivir (both Combivir and Trizivir should not be used in patients with renal insufficiency).
Lamivudine (3TC, Epivir)
Cytosine analog that inhibits viral replication. In addition to anti-HIV activity, this agent also suppresses hepatitis B viral DNA replication.
Emtricitabine (Emtriva)
Synthetic nucleoside cytosine analog classified as NRTI. Competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing chain termination.
Tenofovir disoproxil fumarate (Viread)
Antiretroviral agent used in the treatment of AIDS. Inhibits activity of HIV reverse transcriptase by competing with the natural substrate deoxyadenosine 5'-triphosphate and, after incorporation into DNA, by DNA chain termination. Administered as prodrug bis-isopropoxycarbonyloxymethyl ester derivative of tenofovir, which is converted, through various enzymatic processes, to tenofovir, an acyclic nucleoside phosphonate (nucleotide) analog of adenosine 5'-monophosphate. Bioavailability is enhanced by a high fat meal. Prolonged intracellular distribution allows for once-daily dosing.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Class Summary
These agents inhibit HIV-1 replication.
Efavirenz (EFV, Sustiva)
Non-nucleoside reverse transcriptase inhibitor with activity against HIV-1 by binding to reverse transcriptase. Blocks RNA-dependent and DNA-dependent DNA polymerase activities including HIV-1 replication. Does not require intracellular phosphorylation for antiviral activity.
Protease inhibitors (PIs)
Class Summary
These agents block modification of precursor poly proteins responsible for the synthesis of reverse transcriptase and HIV-1 protease.
Indinavir (IDV, Crixivan)
Prevents formation of protein precursors necessary for HIV infection of uninfected cells and viral replication.
Nelfinavir (Viracept)
Inhibits HIV-1 protease, resulting in production of an immature and noninfectious virus.
Immunoglobulins
Class Summary
Patients who may not have been immunized against Clostridium tetani products should receive tetanus immune globulin (Hyper-Tet).
Tetanus immune globulin (TIG)
Used for passive immunization of any person with a wound that might be contaminated with tetanus spores.
Toxoids
Class Summary
These agents are used for tetanus immunization. A booster injection in previously immunized individuals is recommended to prevent this potentially lethal syndrome.
Tetanus toxoid adsorbed or fluid
Induce active immunity against tetanus in selected patients. Tetanus and diphtheria toxoids are immunizing agents of choice for most adults and children (>7 y). Necessary to administer booster doses to maintain tetanus immunity throughout life.
Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen–containing product.
May be administered into deltoid or midlateral thigh muscles of children and adults. In infants, preferred site of administration is mid thigh laterally.
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