DRUG NAME MECHANISM OF ACTION INDICATION CONTRAINDICATIONS SIDE NURSING CONSIDERATION

EFFECTS/ADVERSE
EFFECTS
Biktarvy Bictegravir– Inhibits HIV-1 Contraindicated in: CNS: abnormal Assessment
Management of HIV
integrase, which is required for  Concurrent use dreams, dizziness,  Assess patient for
(bactigravir/emtricitabine/ viral infection in patients who fatigue, headache,
of dofetilide or change in severity of HIV
tenofovir) replication Emtricitabine– Phosph have no antiretroviral insomnia
rifampin; symptoms and for
orylated intracellularly where it treatment history or in GI: LACTIC
those on a stable  Severe renal ACIDOSIS/HEPATOME symptoms of opportunistic
inhibits HIV reverse transcriptase, impairment; infections during therapy.
antiretroviral regimen with GALY WITH
resulting in viral DNA chain  Severe hepatic STEATOSIS, diarrhea,  May cause lactic
termination Tenofovir– Phosphor HIV-1 RNA <50 copies/mL
for ≥3 mo and no history impairment; ↑ amylase, ↑ liver acidosis and severe
ylated intracellularly where it enzymes, nausea
of treatment failure or no  Lactation: Brea hepatomegaly with
inhibits HIV reverse transcriptase GU: renal impairment
known substitutions st feeding not steatosis. Monitor patient
resulting in disruption of DNA Hemat: neutropenia
synthesis. associated with resistance recommended in Metabolic: hyperlipide for signs (increased serum
to the individual patients with HIV. mia lactate levels, elevated liver
components of the Use Cautiously in: MS: ↑ creatine kinase enzymes, liver enlargement
medication (to replace  Hepatitis B co- Misc: ACUTE on palpation). Therapy
their current antiretroviral infection; EXACERBATION OF should be suspended if
regimen).  History of HEPATITIS B, immune
clinical or laboratory signs
reconstitution
suicidal ideation or syndrome occur.
depression (↑ risk * CAPITALS indicate Lab Test
of suicidal life-threatening. Considerations: Monitor viral
thoughts); Underline indicate load and CD4 cell count
 Renal most frequent. regularly during therapy.
impairment or  Test patients for
receiving chronic hepatitis B virus
nephrotoxic (HBV) before initiating
medications (↑ therapy. Medication is not
risk of renal indicated for treatment of
impairment); HBV. Exacerbations of HBV
 OB:  Use have occurred upon
during pregnancy discontinuation of therapy.
only if potential  Assess serum
benefit justifies creatinine, estimated CCr,
urine glucose and urine
 potential fetal risk; protein during therapy.
 Pedi:  Children Also monitor serum
weighing <25 kg phosphorous in patients
(safety and with chronic kidney
effectiveness not disease. Discontinue
established). therapy in patients who
develop clinically significant
↓ renal function or
evidence of Fanconi
syndrome.
 Monitor liver function
tests in patients co-infected
with HIV and HBV who
discontinue  Biktarvy. May
cause an exacerbation of
hepatitis B. May cause ↑
AST, ALT, bilirubin, creatine
kinase, serum amylase,
serum lipase, and
triglycerides.
 May cause ↓
neutrophil count.
 May cause ↑ LDL
cholesterol.

Patient/Family Teaching
 Emphasize the
importance of taking
medication as directed. Do
not take more than
prescribed amount and do
not stop taking without
consulting health care
professional. Take missed
 doses as soon as
remembered, but not if
almost time for next dose;
do not double doses.
Advise patient to
read  Patient Information 
before starting therapy and
with each Rx refill in case of
changes.
 Instruct patient that
medication should not be
shared with others.
 Inform patient that
medication does not cure
AIDS or prevent associated
or opportunistic infections.
Therapy does not reduce
the risk of transmission of
HIV to others through
sexual contact or blood
contamination. Caution
patient to use a condom
and to avoid sharing
needles or donating blood
to prevent spreading the
AIDS virus to others.
 Instruct patient to
notify health care
professional immediately if
symptoms of lactic acidosis
(tiredness or weakness,
unusual muscle pain,
trouble breathing, stomach
pain with nausea and
 vomiting, cold especially in
arms or legs, dizziness, fast
or irregular heartbeat) or if
signs of hepatotoxicity
(yellow skin or whites of
eyes, dark urine, light
colored stools, lack of
appetite for several days or
longer, nausea, abdominal
pain) occur.
 Instruct patient to
notify health care
professional of all Rx or
OTC medications, vitamins,
or herbal products being
taken and consult health
care professional before
taking any new
medications, especially St.
John's wort.
 Advise patient to notify
health care professional if
signs and symptoms of
immune reconstitution
syndrome (signs and
symptoms of an infection)
occur.
 Rep:  Advise patient
taking oral contraceptives
to use a nonhormonal
method of birth control
during therapy. If
pregnancy is suspected
notify health care
 professional promptly.
Encourage pregnant
women to enroll in the
Antiretroviral Pregnancy
Registry by calling 1-800-
258-4263. Advise female
patient to avoid breast
feeding during therapy.
 Emphasize the
importance of regular
follow-up exams and blood
counts to determine
progress and monitor for
side effects.