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Pharmacology 3 > Anti: Virals, Fungals, Tubercular Agents > Flashcards

Anti: Virals, Fungals, Tubercular Agents Flashcards

0
Q

Varicella-zoster Virus (VSV)

A

chicken pox, and herpes zoster (Shingles)

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1
Q

Herpes Simplex Virus (HSV)

A

Infections of mouth, face, genitalia

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2
Q

Meds for HSV: acyclovir/ Zovirax

A

MOA: Inhibits viral production by suppressing synthesis of viral DNA, activated by enzyme - enzyme converts acyclovir into a compound that inhibits viral DNA polymerase.

IND: Oral herpes simplex, Genital herpes simplex, Varicella, Herpes zoster

AE: Oral: GI upset, HA
IV: Irritation at site of infusion, Nephrotoxicity

DI : Any Nephrotoxic drug

NURS: infuse IV slowly, increase fluid intake

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3
Q

Cytomegalovirus (CMV)

A

Member of Herpes virus family, remains dormant within cells for life. Reactivated in immune compromised patients. Causes infections in GI tract, lungs, eyes (retinitis)

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4
Q

Ganciclovir/ Cytovene

A

MOA: Suppresses synthesis of Viral DNA, Like Acyclovir but more toxic

IND: CMV retinitis in immunocompromised pts. (also used prophyl)
CMV prevention in transplant pts.

AE: Bone marrow suppression
Reproductive toxicity in both men and women

NURS: Monitor WBC count, Platelet count

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5
Q

Hepatitis

A

Inflammation of the liver, viral infection. Five strains: A, B, C, D, E

Paltho: Widespread inflammation of the liver tissue causing hepatic cell scaerring, necrosis and degeneration, may also interrupt bile flow. Lead to liver failure.

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6
Q

Interferon Alpha

A

MOA: Binds to receptors on host cell membrane and blocks viral entry into cells. Also blocks synthesis of viral mRNA, viral proteins, Blocks viral assembly and release.

IND: Chronic Hepatitis B and C

AE: Flu like symptoms, Depression, Heart Damage, Bone Marrow Suppression

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7
Q

Influenza

A

Respiratory tract infection - Fever, chills, cough, sore throat, muscle aches. Two influenza viruses: A & B

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8
Q

Oseltamvir/ Tamiflu

A

MOA: Stops viral spread by inhibiting enzyme needed for replication.

IND: Prophylaxis/treatment for Influenza A & B
Treatment of H1N1 and H5N1

AE: N/V

DI: Live influenza vaccine, Tamiflu will interfere with vaccine.

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9
Q

HIV

A

Causes AIDS, Immune system becomes incompetent due to depletion of T-cells, Leads to risk for opportunistic infections.

Patho: HIV-RNA virus = retrovirus. HIV enters cell when gp120 knobs on viral envelope bind to specific CD4 receptor sites on cells. Viral genetic material enters cell and viral RNA is transcribed into DNA with reverse transcriptase. Viral DNA enters Nucleus of cell and becomes permanent part of genetic structure. HIV infects T-cells, monocyites, brain cells, and nerve cells. Destruction of T-cells causes immune dysfunction. Immune problems start when counts < 500 and severe problems (AIDS) <200

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10
Q

Meds for HIV: HAART (Highly Active Anti-Retroviral Therapy)

A

1: Reverse transcriptase Inhibitors
a: Nucleoside/Nucleotide reverse transcriptase inhibitors (NRTIs)
b: non-Nucleoside reverse transcriptase inhibitors (NNRTIs)
2: Protease inhibitors
3: HIV fusion inhibitors

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11
Q

NRTIs

A

First drugs, similar structure to nucleosides, nucleotides that make up DNA
ex) zidovudine/Retrovir, AZT

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12
Q

Zidovudine/ Retrovir

A

MOA: Inhibits HIV replication by suppressing synthesis of viral DNA by reverse transcriptase, inhibits activity of viral enzyme.

IND: HIV
AE: Bone marrow suppression, Syndrome of lactic acidosis with hepatomegaly, GI

DI: Gancyclovir, any drug that causes bone marrow suppression.

NURS: Monitor Blood cell count, hemoglobin, hematocrit
Monitor arterial blood gas if suspected acidosis
Monitor Liver Function

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13
Q

NNRTIs (Non-nucleoside reverse transcriptase inhibitors)

A

Not structurally related to nucleosides

ex) Efavirenz/ Sustiva, EPV

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14
Q

Efavirenz/ Sustiva

A

MOA: Binds directly to HV reverse transcriptase, suppresses enzyme activity.

IND: HIV - Usually in combo with zidovudine and another NRTI

AE: CNS Symptoms, Rash, Liver Damage, Teratogenic
DI: Competes with other drugs for metabolism by P450
Induces P450 - accelerates own metabolism along with others
NURS: MUST TAKE ON EMPTY STOMACH
High fat meals increase plasma levels
Monitor Liver function.

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15
Q

Protease Inhibitors

A

Are not used alone, risk of drug resistance. Combined with reverse transcriptase inhibitors.
ex) Lopinavir-ritonavir/ Kaletra

16
Q

Lopinavir-ritonavir/ Kaletra

A

MOA: Binds to HIV protease, prevents enzyme from cleaving HIV polyproteins–> virus remains immature and noninfectious.

IND: HIV

AE: Hyperglycemia
Fat maldistribution, more fat distribution to torso
Hyperlipidemia
Reduced bone mineral density –> Osteoporosis
Hepatotoxicity
DI: P450 inhibitors: Grapefruit juice, Ketoconazole (anti-fungal)
P450 inducers: Rifampin, anti-seizure meds
NURS: Monitor blood sugar, teach pt S&S of hyperglycemia,
Monitor LFT (Liver Function Tests)

17
Q

HIV Fusion Inhibitors:

Enfuvirtide/ Fuzeion, T-20 (sq)

A

MOA: Prevents HIV from fusing with cell membrane of CD4 cells. blocks entry.

IND: HIV Infections that are resistant to other antiretrovirals

AE: Injection site reaction - pain/tenderness
Pneumonia - Bacterial
Hypersensitivity reaction

18
Q

Types of Fungal infections

A

Systemic Infections:

 a: opportunistic - Candidiasis, aspergillosis, cryptoccosis, mucormycosis
 b: Non-opportunistic - sporotrichosis, blastomycosis, histoplasmosis, coccidiodomycosis

Superficial Infections:

 a: candidiasis - mouth, vaginal, any moist area
 b: dermatophytic infections - Tinea pedis, tinea corporus, tinea cruris, tinea captis
19
Q

Types of antifungals:

A

Polyenes -Bind to ergosterol, a component of the fungal cell membrane, causes increase in cell permeability, cells leak intracellular components, no longer viable

Azoles- inhibits synthesis of ergosterol, w/o ergosterol there is leakage of cellular components

20
Q

Amphotericin B

A

Polyene, Given IV

MOA: Binds to ergosterol - component of the fungal cell membrane, causes increase in cell permeability, cells leak intracellular components, no longer viable.

IND: Broad spectrum for systemic fungal infections

AE: Infusion reactions - Fever, chills, rigors, shaking, inflammation
Neprotoxicity
hypokalemia
bone marrow suppression

DI: other nephrotoxic agents

NURS: Monitor creatinine, K levels, I&O, RBC count.

21
Q

Nystantin

A 
Polyene
IND: Candidiasis:
          Oral, esophageal: suspension, lozenges, tablet
          Skin: cream, ointment, powder
          Vaginal: Vaginal tablet

AE: Oral and Topical

22
Q

Azoles;

Itraconazole (Neg Inotropic agent)

A

MOA: Inhibits synthesis of ergosterol. without ergosterol leakage of cellular components.

IND: Broad spectrum for systemic fungal infections. Alternative to Ampho B

AE: Hepatotoxicity
Cardiac SUppression
DI: Azoles are P450 inhibitors,
Warfarin, digoxin, oral hypoglycemic agents, antacids

23
Q

Tuberculosis

A

Infectious disease caused by Mycobacterium tuberculosis.

Patho: Airborne droplets. Bacillus inspired into lungs causes inflammation, which causes neutrophil and macrophage activity. Engulf bacilli, sealed off, forming tubercle lesion. Infected tissue within tubercle dies, scar tissue grows around the lesion.

24
Q

Meds for TB

A

Isoniazid/ INH

Rifampin/ Rimactane

25
Q

Isoniazid/ INH

A

MOA: May inhibit synthesis of mycolic acid (affects cell wall)

IND: Used as a single drug for prophylaxis of TB
Used in combo with other antiTB drugs for treatment

AE: Hepatotoxicity
       Peripheral neuropathy (due to decrease in Vit. B6)

DI: Dilantin, warfarin, rifampin, alcohol
INH is a P450 inhibitor

NURS: teach patient about signs of liver disease, monitor liver enzymes

26
Q

Rifampin/ Rimactane

A

MOA: Inhibits mycobacterial protein synthesis

IND: Treatment of active TB in combo with another drug

AE: Hepatotoxicity
Discoloration of body fluids - Orange urine, sweat

DI: Oral contraceptive, warfarin, dilantin: Rifampin is P450 inducer
Alcohol, isoniazid: Increase risk of liver damage

Pharmacology 3 (5 decks)

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