The nurse teaches a patient who is prescribed nirmatrelvir/ritonavir (Paxlovid). Which of these should be included in the patient teaching about Paxlovid?

Choice A rationale The Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for nirmatrelvir/ritonavir (Paxlovid) specifies that it is authorized for use in adults and pediatric patients who are 12 years of age and older and weigh at least 40 kg. Stating only the age is insufficient, as the weight criterion is also essential for safe and effective dosing in the pediatric population, ensuring appropriate pharmacokinetics and minimizing toxicity risks. Choice B rationale Nirmatrelvir/ritonavir (Paxlovid) must be initiated as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. This timeframe is crucial because the drug works by inhibiting the SARS-CoV-2 main protease, which is most effective during the early viral replication phase before the viral load peaks and significant organ damage occurs, thus maximizing therapeutic benefit. Choice C rationale A rash, especially one that is severe or progresses, can be a sign of a hypersensitivity reaction to nirmatrelvir or ritonavir, such as Stevens-Johnson syndrome (SJS) or Toxic Epidermal Necrolysis (TEN). The patient must report this immediately so the medication can be discontinued and appropriate supportive care initiated to prevent life-threatening complications. Choice D rationale Dysgeusia (altered taste sensation), often described as a metallic taste, is a frequently reported adverse effect of nirmatrelvir/ritonavir (Paxlovid). This occurs due to the drug's excretion in saliva. Informing the patient proactively helps to manage expectations and ensure adherence to the medication regimen despite this temporary and bothersome side effect. Choice E rationale Significant weight gain is not a recognized common or serious adverse reaction of nirmatrelvir/ritonavir (Paxlovid). Common side effects include dysgeusia, diarrhea, hypertension, and myalgia. Weight loss might be seen in the context of severe COVID-19 infection, but not as an expected drug effect.