anti-microbials

Question 1

when does hep B and C require treatment

Answer 1

when chronic infection

Question 2

anti-viral for hep B and how it works

Answer 2

tenofovir (nucleotide analogue that blocks replication of DNA; given with peginterferon a)

Question 3

describe how tenofovir manages hep B

Answer 3

contains hep B into chronically managed disease, but doesn’t cure it

Question 4

2 anti-virals for hep C and how they work

Answer 4

ribavirin and peginterferon a (nucleoside (purine) analogue preventing viral RNA synthesis), boceprevir (protease inhibitor)

Question 5

describe how hep C is managed

Answer 5

many drugs target many different viral proteins (e.g. p7, NS3/4A, NS5A, NS5B), and aim is to cure hep C (must have vaccine to eradicate)

Question 6

what do drugs and duration of treatment for hep C depend on

Answer 6

genotype, viral load, past treatment experience, degree of liver damage, ability to tolerate prescribed treatment, need for liver transplant

Question 7

2 anti-virals which prevent HIV attachment and entry

Answer 7

enfuvirtide, maraviroc

Question 8

HIV entry inhibitors: mechanism of action of enfuvirtide

Answer 8

binds to HIV GP41 transmembrane receptor

Question 9

HIV entry inhibitors: mechanism of action of maraviroc

Answer 9

block CCR5 chemokine receptor

Question 10

describe how some people are long-term progressors of HIV

Answer 10

delta 32 mutation meaning don’t produce CCR5 receptor, so HIV invades somewhat but not to a huge extent, so takes a very long time to progress disease

Question 11

HIV replication inhibitors: how are nucleoside reverse transcriptase inhibitors, nucleotide reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors activated (compared to each other), and where do they bind

Answer 11

nucleoside RT inhibitors: 3 step phosphorylation process (binds to active sire of enzyme); nucleotide RT inhibitors: fewer phosphorylation steps (binds to active sire of enzyme); non-nucleoside RT inhibitors (no phosphorylation as not incorporated into viral DNA - binds to allosteric site on reverse transcriptase)

Question 12

HIV replication inhibitors: example of nucleoside RT inhibitor

Answer 12

zidovudine

Question 13

HIV replication inhibitors: example of nucleotide RT inhibitor

Answer 13

tenofovir

Question 14

HIV replication inhibitors: example of non-nucleoside RT inhibitor

Answer 14

efavirenz

Question 15

HIV integrase inhibitors: example of HIV integrase inhibitor which prevents integration of viral DNA into host

Answer 15

raltegravir

Question 16

HIV protease inhibitors: 1st generation protease inhibitor which prevents cleavage of Gag for assembly of HIV proteins

Answer 16

saquinavir

Question 17

HIV protease inhibitors: why is low dose ritonavir co-administered with saquinavir

Answer 17

reduces protease inhibitor metabolism, so acts as “booster”

Question 18

treatment for Herpes simplex virus

Answer 18

nucleoside analogues e.g. aciclovir (therefore prevent DNA replication)

Question 19

treatment for influenza

Answer 19

neuraminidase inhibitor e.g. oseltamivir (inhibits neuraminidase protein on influenza envelope)

Question 20

what do nucleoside analogues treat

Answer 20

HIV, hepatitis, herpes simplex

Question 21

what do viral integrase target

Answer 21

HIV integrase

Question 22

what do proteases treat

Answer 22

HIV, hep C