{"id":125,"date":"2019-09-22T17:54:06","date_gmt":"2019-09-22T17:54:06","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/3-14-antivirals\/"},"modified":"2021-12-07T11:06:34","modified_gmt":"2021-12-07T11:06:34","slug":"3-14-antivirals","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/3-14-antivirals\/","title":{"raw":"3.14 Antivirals","rendered":"3.14 Antivirals"},"content":{"raw":"[caption id=\"\" align=\"alignnone\" width=\"1200\"]\"Photos Figure 3.10 Images of viruses (a) Members of the Coronavirus family can cause respiratory infections like the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Here they are viewed under a transmission electron microscope (TEM). (b) Ebolavirus, a member of the Filovirus family. (credit a: modification of work by Centers for Disease Control and Prevention; credit b: modification of work by Thomas W. Geisbert)[\/caption]\n\nUnlike the complex structure of fungi or protozoa, viral structure is simple.\u00a0 There are several subclasses of antiviral medications: antiherpes, antiinfluenza, anti-hepatitis, and antiretrovirals.\u00a0 Each subclass will be discussed in more detail below.\u00a0 See Figure 3.10[footnote]\"Unknown\" by CNX OpenStax<\/a> is licensed under CC BY 4.0<\/a> Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-3-types-of-microorganisms<\/a>[\/footnote] for images of viruses.\n

Subclass: Antiherpes<\/h2>\nIndications: <\/strong>Acyclovir (Zovirax) and its derivatives are frequently used for the treatment of herpes and varicella virus infections, including genital herpes, chickenpox, shingles, Epstein-Barr virus infections, and cytomegalovirus infections.\n\nMechanism of Action:<\/strong> Acyclovir causes termination of the DNA chain during the viral replication process. Acyclovir can be administered either topically or systemically, depending on the infection.[footnote]This work is a derivative of Microbiology<\/a> by OpenStax<\/a> licensed under CC BY 4.0<\/a>. Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction<\/a>[\/footnote]<\/sup>\n\nSpecial Administration Considerations:<\/strong> Acyclovir use may result in nephrotoxicity.\n\nPatient Teaching & Education:<\/strong> Patients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n

Subclass: AntiInfluenza<\/h2>\nIndications: <\/strong>Tamiflu (oseltamivir) is used to target the influenza virus by blocking the release of the virus from the infected cells.\n\nMechanism of Action:<\/strong> Tamiflu prevents the release of virus from infected cells.\n\nSpecial Administration Considerations:<\/strong> This medication does not cure influenza, but can decrease flu symptoms and shorten the duration of illness if taken in a timely manner. Patients are prescribed the medication for prophylaxis against infection, known exposure, or to lesson the course of the illness. If patients experience flu-like symptoms, it is critical that they start treatment within 48 hours of symptom onset.\n\nPatient Teaching & Education:<\/strong> Patients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nThe influenza virus is one of the few RNA viruses that replicates in the nucleus of cells. Antivirals block the release stage. See Figure 3.11.[footnote]\"Unknown\" by CNX OpenStax<\/a> is licensed under CC BY 4.0<\/a> Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/6-2-the-viral-life-cycle<\/a>[\/footnote]<\/sup>\n\n[caption id=\"attachment_124\" align=\"aligncenter\" width=\"1024\"]\"Illustration Figure 3.11 Influenza virus replication stages[\/caption]\n

Subclass: Antiretrovirals<\/h2>\nViruses with complex life cycles, such as HIV, can be more difficult to treat. These types of viruses require the use of antiretroviral medications that block viral replication. (See Figure 3.12 to view the viral replication process of HIV.) [footnote]This work is a derivative of \"HIV Virus Replication Cycle<\/a>\" by NIAID<\/a> is licensed under CC BY 2.0<\/a>[\/footnote]<\/sup>\u00a0<\/span>Additionally, antiretrovirals fall under the class of antiviral medications.\n\n[caption id=\"attachment_124\" align=\"aligncenter\" width=\"406\"]\"Illustration Figure 3.12 HIV attaches to a cell surface receptor of an immune cell and fuses with the cell membrane. Viral contents are released into the cell, where viral enzymes convert the single-stranded RNA genome into DNA and incorporate it into the host genome[\/caption]\n\nIndications:<\/strong> Antiretrovirals are used for the treatment of illnesses like HIV.\n\nMechanism of Action:<\/strong> Antiretrovirals impede virus replication.\n\nSpecial Administration Considerations:<\/strong>\u00a0 Many antiretrovirals may impact renal function; therefore, the patient's urine output and renal labs should be monitored carefully for signs of decreased function.\n\nPatient Teaching & Education:<\/strong> Patients who are being treated with antiviral therapy should be instructed about the importance of antiretroviral compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grids for the subclasses of antivirals in Table 3.14a-d.[footnote]Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019[\/footnote]<\/sup>\n\nTables 3.14a Acyclovir Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong>\n\nGeneric<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals: Antiherpes<\/th>\nacyclovir<\/a><\/td>\nCheck for allergies\n\nRoute: PO, IV, or topical; do not give IM or subcutaneously (subq)\n\nGive with food if GI distress\n\nIV: Give IV infusion over at least 1 hour to prevent renal tubular damage\n\nUse cautiously if renal impairment, neurological problems, or dehydration\n\nStart therapy as early as possible after signs or symptoms occur\n\nEncourage fluid intake\n\nAvoid sexual contact while lesions present<\/td>\nDrug is not a cure for herpes but improves signs and symptoms of herpes lesions if started early\n\nCan be used long term for prevention of outbreaks<\/td>\nGI distress\n\nMonitor renal function in long-term use, especially if renal impairment\n\nLowers seizure threshold<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nTables 3.14b Oseltamivir Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong>\n\nGeneric<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals:\n\nAntiInfluenza Agents<\/th>\noseltamivir<\/a><\/td>\nCheck for allergies\n\nRoute: PO\n\nMust be given within 48 hours of onset of symptoms\n\nAdminister with food to avoid GI distress\n\nDoes not replace need for annual influenza vaccination<\/td>\nReduce duration of flu symptoms<\/td>\nGI distress\n\nSerious skin\/ hypersensitivity reactions; discontinue immediately\n\nMonitor for neuropsychiatric symptoms\n\nUse cautiously in patients with renal failure, chronic cardiac or respiratory diseases, or any medical condition that may require imminent hospitalization<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nTables 3.14c Adefovir Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong>\n\nGeneric<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals:\n\nAnti-Hepatitis Agents<\/th>\nadefovir<\/a><\/td>\nRoute: PO\n\nProlonged therapy (>1 year or indefinitely) based on patient status\n\nOffer HIV testing; may promote resistance to antiretrovirals in patients with chronic HBV infection who also have unrecognized or untreated HIV infection\n\nDo not stop taking medication unless directed. Monitor hepatic function several months after stopping therapy<\/td>\nMaintain or improve liver function when active disease is present<\/td>\nSevere acute exacerbations of Hepatitis B\n\nNephrotoxicity\n\nLactic acidosis\n\nSevere hepatomegally<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nTables 3.14d Lamuvadine-Zidovudine Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong>\n\nGeneric<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals:\n\nAntiretrovirals\n\nNucleoside\u2013\n\nnucleotide reverse transcriptase inhibitors<\/th>\nlamivudine- zidovudine<\/a><\/td>\nCheck for allergies\n\nLamivudine used to treat HIV-1 infection contains a higher dose of the active ingredient than the lamivudine used to treat chronic HBV infection. Patients with HIV-1 infection should receive only dosing forms appropriate for HIV-1 treatment\n\nUse cautiously in patients with renal impairment\n\nInform patient that drug doesn't cure HIV infection, that opportunistic infections and other complications of HIV infection may still occur, and that transmission of HIV to others through sexual contact or blood contamination is still possible. Taking these medications, along with practicing safer sex and making other lifestyle changes, may decrease the risk of transmitting (spreading) the HIV or hepatitis B virus to other people\n\nTeach symptoms of pancreatitis<\/td>\nDecreases chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer<\/td>\nLactic acidosis\n\nSevere hepatomegaly\n\nStop treatment immediately if pancreatititis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Critical Thinking Activity 3.14a<\/strong><\/h2>\nUsing the above grid information, consider the following clinical scenario question:<\/strong>\n\nA patient is prescribed oseltamivir (Tamiflu) for influenza symptoms. The patient states to the nurse, \"I hope this medication works quickly! I have felt lousy for the past 5 days!\" What is the nurse's next best response?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key\" sections at the end of the book.","rendered":"
\"Photos
Figure 3.10 Images of viruses (a) Members of the Coronavirus family can cause respiratory infections like the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Here they are viewed under a transmission electron microscope (TEM). (b) Ebolavirus, a member of the Filovirus family. (credit a: modification of work by Centers for Disease Control and Prevention; credit b: modification of work by Thomas W. Geisbert)<\/figcaption><\/figure>\n

Unlike the complex structure of fungi or protozoa, viral structure is simple.\u00a0 There are several subclasses of antiviral medications: antiherpes, antiinfluenza, anti-hepatitis, and antiretrovirals.\u00a0 Each subclass will be discussed in more detail below.\u00a0 See Figure 3.10[1]<\/sup><\/a> for images of viruses.<\/p>\n

Subclass: Antiherpes<\/h2>\n

Indications: <\/strong>Acyclovir (Zovirax) and its derivatives are frequently used for the treatment of herpes and varicella virus infections, including genital herpes, chickenpox, shingles, Epstein-Barr virus infections, and cytomegalovirus infections.<\/p>\n

Mechanism of Action:<\/strong> Acyclovir causes termination of the DNA chain during the viral replication process. Acyclovir can be administered either topically or systemically, depending on the infection.[2]<\/sup><\/a><\/sup><\/p>\n

Special Administration Considerations:<\/strong> Acyclovir use may result in nephrotoxicity.<\/p>\n

Patient Teaching & Education:<\/strong> Patients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[3]<\/sup><\/a><\/sup><\/p>\n

Subclass: AntiInfluenza<\/h2>\n

Indications: <\/strong>Tamiflu (oseltamivir) is used to target the influenza virus by blocking the release of the virus from the infected cells.<\/p>\n

Mechanism of Action:<\/strong> Tamiflu prevents the release of virus from infected cells.<\/p>\n

Special Administration Considerations:<\/strong> This medication does not cure influenza, but can decrease flu symptoms and shorten the duration of illness if taken in a timely manner. Patients are prescribed the medication for prophylaxis against infection, known exposure, or to lesson the course of the illness. If patients experience flu-like symptoms, it is critical that they start treatment within 48 hours of symptom onset.<\/p>\n

Patient Teaching & Education:<\/strong> Patients who are being treated with antiviral therapy should be instructed about the importance of medication compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[4]<\/sup><\/a><\/sup><\/p>\n

The influenza virus is one of the few RNA viruses that replicates in the nucleus of cells. Antivirals block the release stage. See Figure 3.11.[5]<\/sup><\/a><\/sup><\/p>\n

\"Illustration
Figure 3.11 Influenza virus replication stages<\/figcaption><\/figure>\n

Subclass: Antiretrovirals<\/h2>\n

Viruses with complex life cycles, such as HIV, can be more difficult to treat. These types of viruses require the use of antiretroviral medications that block viral replication. (See Figure 3.12 to view the viral replication process of HIV.) [6]<\/sup><\/a><\/sup>\u00a0<\/span>Additionally, antiretrovirals fall under the class of antiviral medications.<\/p>\n

\"Illustration
Figure 3.12 HIV attaches to a cell surface receptor of an immune cell and fuses with the cell membrane. Viral contents are released into the cell, where viral enzymes convert the single-stranded RNA genome into DNA and incorporate it into the host genome<\/figcaption><\/figure>\n

Indications:<\/strong> Antiretrovirals are used for the treatment of illnesses like HIV.<\/p>\n

Mechanism of Action:<\/strong> Antiretrovirals impede virus replication.<\/p>\n

Special Administration Considerations:<\/strong>\u00a0 Many antiretrovirals may impact renal function; therefore, the patient’s urine output and renal labs should be monitored carefully for signs of decreased function.<\/p>\n

Patient Teaching & Education:<\/strong> Patients who are being treated with antiviral therapy should be instructed about the importance of antiretroviral compliance. They may also experience significant fatigue, so periods of rest should be encouraged.[7]<\/sup><\/a><\/sup><\/p>\n

Now let’s take a closer look at the medication grids for the subclasses of antivirals in Table 3.14a-d.[8]<\/sup><\/a><\/sup><\/p>\n

Tables 3.14a Acyclovir Medication Grid<\/p>\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong><\/p>\n

Generic<\/strong><\/th>\n

Administration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals: Antiherpes<\/th>\nacyclovir<\/a><\/td>\nCheck for allergies<\/p>\n

Route: PO, IV, or topical; do not give IM or subcutaneously (subq)<\/p>\n

Give with food if GI distress<\/p>\n

IV: Give IV infusion over at least 1 hour to prevent renal tubular damage<\/p>\n

Use cautiously if renal impairment, neurological problems, or dehydration<\/p>\n

Start therapy as early as possible after signs or symptoms occur<\/p>\n

Encourage fluid intake<\/p>\n

Avoid sexual contact while lesions present<\/td>\n

Drug is not a cure for herpes but improves signs and symptoms of herpes lesions if started early<\/p>\n

Can be used long term for prevention of outbreaks<\/td>\n

GI distress<\/p>\n

Monitor renal function in long-term use, especially if renal impairment<\/p>\n

Lowers seizure threshold<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Tables 3.14b Oseltamivir Medication Grid<\/p>\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong><\/p>\n

Generic<\/strong><\/th>\n

Administration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals:<\/p>\n

AntiInfluenza Agents<\/th>\n

oseltamivir<\/a><\/td>\nCheck for allergies<\/p>\n

Route: PO<\/p>\n

Must be given within 48 hours of onset of symptoms<\/p>\n

Administer with food to avoid GI distress<\/p>\n

Does not replace need for annual influenza vaccination<\/td>\n

Reduce duration of flu symptoms<\/td>\nGI distress<\/p>\n

Serious skin\/ hypersensitivity reactions; discontinue immediately<\/p>\n

Monitor for neuropsychiatric symptoms<\/p>\n

Use cautiously in patients with renal failure, chronic cardiac or respiratory diseases, or any medical condition that may require imminent hospitalization<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Tables 3.14c Adefovir Medication Grid<\/p>\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong><\/p>\n

Generic<\/strong><\/th>\n

Administration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals:<\/p>\n

Anti-Hepatitis Agents<\/th>\n

adefovir<\/a><\/td>\nRoute: PO<\/p>\n

Prolonged therapy (>1 year or indefinitely) based on patient status<\/p>\n

Offer HIV testing; may promote resistance to antiretrovirals in patients with chronic HBV infection who also have unrecognized or untreated HIV infection<\/p>\n

Do not stop taking medication unless directed. Monitor hepatic function several months after stopping therapy<\/td>\n

Maintain or improve liver function when active disease is present<\/td>\nSevere acute exacerbations of Hepatitis B<\/p>\n

Nephrotoxicity<\/p>\n

Lactic acidosis<\/p>\n

Severe hepatomegally<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Tables 3.14d Lamuvadine-Zidovudine Medication Grid<\/p>\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/<\/strong><\/p>\n

Generic<\/strong><\/th>\n

Administration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antivirals:<\/p>\n

Antiretrovirals<\/p>\n

Nucleoside\u2013<\/p>\n

nucleotide reverse transcriptase inhibitors<\/th>\n

lamivudine- zidovudine<\/a><\/td>\nCheck for allergies<\/p>\n

Lamivudine used to treat HIV-1 infection contains a higher dose of the active ingredient than the lamivudine used to treat chronic HBV infection. Patients with HIV-1 infection should receive only dosing forms appropriate for HIV-1 treatment<\/p>\n

Use cautiously in patients with renal impairment<\/p>\n

Inform patient that drug doesn’t cure HIV infection, that opportunistic infections and other complications of HIV infection may still occur, and that transmission of HIV to others through sexual contact or blood contamination is still possible. Taking these medications, along with practicing safer sex and making other lifestyle changes, may decrease the risk of transmitting (spreading) the HIV or hepatitis B virus to other people<\/p>\n

Teach symptoms of pancreatitis<\/td>\n

Decreases chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer<\/td>\nLactic acidosis<\/p>\n

Severe hepatomegaly<\/p>\n

Stop treatment immediately if pancreatititis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Critical Thinking Activity 3.14a<\/strong><\/h2>\n

Using the above grid information, consider the following clinical scenario question:<\/strong><\/p>\n

A patient is prescribed oseltamivir (Tamiflu) for influenza symptoms. The patient states to the nurse, “I hope this medication works quickly! I have felt lousy for the past 5 days!” What is the nurse’s next best response?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.<\/p>\n

  1. \"Unknown\" by CNX OpenStax<\/a> is licensed under CC BY 4.0<\/a> Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-3-types-of-microorganisms<\/a> ↵<\/a><\/li>
  2. This work is a derivative of Microbiology<\/a> by OpenStax<\/a> licensed under CC BY 4.0<\/a>. Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction<\/a> ↵<\/a><\/li>
  3. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  4. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  5. \"Unknown\" by CNX OpenStax<\/a> is licensed under CC BY 4.0<\/a> Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/6-2-the-viral-life-cycle<\/a> ↵<\/a><\/li>
  6. This work is a derivative of \"HIV Virus Replication Cycle<\/a>\" by NIAID<\/a> is licensed under CC BY 2.0<\/a> ↵<\/a><\/li>
  7. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  8. Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019 ↵<\/a><\/li><\/ol><\/div>","protected":false},"author":2,"menu_order":14,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[49],"contributor":[],"license":[53],"class_list":["post-125","chapter","type-chapter","status-publish","hentry","chapter-type-numberless","license-cc-by"],"part":84,"_links":{"self":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/125","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/users\/2"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/125\/revisions"}],"predecessor-version":[{"id":126,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/125\/revisions\/126"}],"part":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/84"}],"metadata":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/125\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=125"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=125"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=125"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=125"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}