Antifungals, Antivirals (Including HIV) Flashcards
List some pharmacologic challenges with tuberculosis
resistance
bacteria exists in active & dormant phases
- need drugs for a long time to “wait” for active phase
d/t long drug therapy, adherence can be an issue
length of treatment for TB
6-24 months +
How many different anti-infective drugs should be used at once in the treatment of TB
2-7
Most TB drugs can result in toxicity to:
liver
adverse effects of isoniazid
hepatotoxicity
peripheral neuropathy
CNS symptoms
adverse effects of rifampin
hepatotoxicity
harmless discoloration of body fluid
GI disturbances
adverse effects of pyrazinamide
hepatotoxicity (the MOST)
polyarthralgia
adverse effects of ethambutol
optic neuritis (most significant)
allergic reactions
GI upset
rarely
- peripheral neuropathy
- renal damage
- thrombocytopenia
mechanism of action of amphotericin B
binds fungal cell membrane, results in increased leakage of electrolytes & cell death
length of treatment required with amphotericin B
1.5-4 months
amphotericin B drug elimination
unknown… drug can be detected in the body up to a year later
adverse effects of amphotericin B
infusion reactions
phlebitis
nephrotoxicity
hypokalemia
bone marrow suppressio n
**preferable to observe patients in the hospital during treatment
Alternatives to amphotericin B
azoles
Adverse effect of azoles
cardiosuppression
liver injury
mechanism of action of echinocandins
disrupt fungal cell wall
list a echinocandin
micafungin
definition: antiseptic
agent applied to living tissues
definition: disinfectant
applied to objects (too harsh for living tissues)
definition: sterilization
complete destruction of all microorganisms
definition: germicide
drug that kills microorganisms
definition: germistatic
suppression of microorganism growth & replication (doesn’t kill)
most important measure to prevent spread of infection in healthcare facilities
handwashing
What are some ways antivirals can work?
- block entry of virus into host cell
- block replication of viral DNA
- block production of viral proteins
Drugs for HSV & VZV
acyclovir
valcyclovir
mechanism of action of acyclovir
inhibition of viral replication (suppresses viral DNA synthesis)
adverse effect of acyclovir
IV = nephrotoxicity
PO = N/V/diarrhea
What is ganciclovir used for?
CMV
mechanism of action of ganciclovir
prevents replication of viral DNA
adverse effects of ganciclovir
bone marrow suppression
teratogenesis
adverse effects of PEG-IFA
flulike symptoms
neuropsych effects (SI)
various organ dysfunction
hemolytic anemia
teratogenic
mechanism of action of sofosbuvir
blocks transcription of HCV RNA
does PEG-IFA cure hepC? Does sofosbuvir cure hepC?
PEG-IFA = no
sofosbuvir = yes
list two drugs to treat hepatitis B
lamivudine
entacavir
adverse effects of antivirals used to treat HepB
minimal
how long is treatment for HIV required?
for life
How many different medications are utilized in HAART therapy
3 or more
What are the 5 drug categories in HAART therapy?
- nucleoside reverse transcriptase inhibitors
- nonnucleoside reverse transcriptase inhibitors
- protease inhibitors
- fusion inhibitors
- integrase inhibitors
mechanism of action of NRTIs
prevent further DNA replication
adverse effects of NRTIs
lactic acidosis
hepatic steatosis
mechanism of action of NNRTIs
binds reverse transcriptase preventing DNA replication
adverse effects of NNRTIs
CNS = dizziness, insomnia, nightmares
severe rash
liver damage
mechanism of action of protease inhibitors
block protease which is required for HIV maturation
adverse effects of protease inhibitors
hyperglycemia
elevated LFTs
PR prolongation
mechanism of action of fusion inhibitors
block HIV viral entry into host cells
adverse effects of fusion inhibitors
injection site reactions
mechanism of action of integrase inhibitors
terminate integration of HIV into DNA (prevents viral replication)
adverse effects of integrase inhibitors
(rare)
rash
liver failure