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Study cards 2 > Antiviral > Flashcards

Antiviral Flashcards

1
Q

Viral replication

A

A virus cannot replicate on its own.

It must attach to and enter a host cell.

It then uses the host cell’s energy to synthesize protein, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA).

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2
Q

Virus replication

A

Attachment to host cell

Uncoding of virus and entry of viral nucleic acid into host cell nucleus

Control of DNA, RNA, and protein production

Production of viral subunits

Assembly of virions

Release of virions

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3
Q

Why are viruses hard to kill?

What effects does drugs that destroy viruses has on cells?

A

Viruses are difficult to kill because they live inside the cells.

Any drug that kills viruses may also kill cells.

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4
Q

Viral Illnesses examples

A

Smallpox (poxviruses)
Sore throat and conjunctivitis (adenoviruses)
Warts (papovaviruses)
Influenza (orthomyxoviruses)
Respiratory infections (coronaviruses, rhinoviruses)
Gastroenteritis (rotaviruses, Norwalk-like viruses)
Human immunodeficiency virus (HIV) / acquired immune deficiency syndrome (AIDS) (retroviruses)
Herpes (herpesviruses)
Hepatitis (hepadnaviruses)

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5
Q

Viral illnesses facts

A

Most viral illnesses are bothersome but survivable.

Effective vaccines have prevented some illnesses.

Effective drug therapy is available for a small number of viral infections.

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6
Q

Antiviral Drugs action

A

Kill or suppress the virus by destroying virions or inhibiting the ability of viruses to replicate; controlled by current antiviral therapy

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7
Q

Antiviral: Immunoglobulins

A

concentrated antibodies that can attack and destroy viruses

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8
Q

Viruses controlled by current antiviral therapy:

A

Cytomegalovirus (CMV)
Hepatitis viruses
Herpesviruses
HIV
Influenza viruses (“flu”)
Respiratory syncytial virus (RSV)

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9
Q

Key characteristics of antiviral drugs:

A

Able to enter the cells that are infected with virus

Interfere with viral nucleic acid synthesis or regulation or both

Prevent the fusion process

Some stimulate the body’s immune system.

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10
Q

Antiviral drugs facts

A

Patients with competent immune systems have the best responses to antiviral medications.

A healthy immune system works synergistically
with the drug to eliminate or suppress viral activity.

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11
Q

Opportunistic infections

A

Occur in immunocompromised patients

Would not normally harm an immunocompetent person

Require long-term prophylaxis and anti-infective drug therapy

Can be other viruses, fungi, bacteria, or protozoa

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12
Q

Antiviral drugs is used to treat infections caused by viruses other than?

A

HIV

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13
Q

What is used to treat infections caused by HIV? (the virus that causes AIDS)

A

Antiretroviral drugs

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14
Q

Herpesviridae

(Herpes Simplex and Varicella-Zoster Virus Infections)

A

Herpes simplex virus (HSV) 1 (oral herpes)
HSV 2 (genital herpes)
Human herpesvirus (HHV 3), also known as varicella-zoster virus (VZV) (chickenpox and shingles )
HHV 4: Epstein-Barr virus
HHV 5: CMV
HHV 6 and HHV 7: not especially clinically significant; immunocompromised patients
HHV 8 (Kaposi’s sarcoma)

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15
Q

HSV 2 (genital herpes): Herpesviridae

A

Highly transmissible

“Neonatal” herpes

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16
Q

HHV 3 (VZV) (chickenpox): Herpesviridae

A

varicella virus vaccine

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17
Q

HHV 3 (VZV) (shingles): Herpesviridae

  1. Symptoms?
  2. Treatment?
A

Painful: opioids for pain control

Postherpetic neuralgias (Lasting pain in the areas of skin where the shingles was)

Acyclovir may speed recovery; best results are generally seen when antiviral medication is started within 72 hours of symptom onset.

Zostavax®

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18
Q

Antiviral Drugs (Non-HIV): Mechanism of action

A

Most of the current antiviral drugs work by blocking the activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes.

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19
Q

Antiviral Drugs (Non-HIV) is used to treat?

A

Influenza viruses
HSV, VZV
CMV
Hepatitis A, B, C

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20
Q

Antiviral Drugs (Non-HIV) Adverse effects

A

Vary with each drug

Healthy cells are often killed also, resulting in serious toxicities.

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21
Q

amantadine hydrochloride (Dom-Amantidine®)

A

Antiviral Drugs (Non-HIV)

Narrow antiviral spectrum; active only against influenza A

Most recent guidelines do not recommend use for treatment or prevention of influenza.

Central nervous system effects: insomnia, nervousness, light-headedness

Gastrointestinal effects: anorexia, nausea, others

22
Q

acyclovir (Zovirax®)

A

Antiviral Drugs (Non-HIV)

Synthetic nucleoside analogue

Used to suppress replication of HSV 1, HSV 2, and VZV

Medication of choice for treatment of initial and
recurrent episodes of these infections

Oral, topical, parenteral forms

23
Q

ganciclovir hydrochloride (Cytovene®, Valcyte®)

A

Antiviral Drugs (Non-HIV) Synthetic nucleoside analogue of guanosine

Used to treat infection caused by CMV

Oral and parenteral forms

CMV retinitis

24
Q

3 Antiviral Drugs (Non HIV)

A

amantadine
acyclovir
ganciclovir

Neuraminidase Inhibitors:
oseltamivir

25
Q

Antiviral Drugs (Non-HIV): Dose-Limiting Toxicities

A

ganciclovir
Bone marrow suppression

foscarnet and cidofovir
Kidney toxicity

26
Q

Antiviral Drugs (Non-HIV): Neuraminidase Inhibitors

A

oseltamivir phosphate (Tamiflu) and zanamivir (Relenza)

27
Q

oseltamivir phosphate (Tamiflu) and zanamivir (Relenza)

A

Active against influenza types A and B

Reduce duration of illness
oseltamivir phosphate: oral use only; causes nausea and vomiting

zanamivir: inhalation drug; causes diarrhea, nausea, sinusitis

Treatment should begin within 2 days of influenza symptom onset.

28
Q

Hepatitis C

  1. 2 facts
  2. Medication
A

Leading cause of chronic liver disease

Most common reason for liver transplantation

ribavirin (Virazole®) orally for treatment of hepatitis C

29
Q

Antiviral Drugs (Non-HIV): Ribavirin

A

Synthetic nucleoside analogue

Routes: oral or nasal inhalation

Inhalation form (Virazole) used for hospitalized infants with respiratory syncytial virus infections

30
Q

HIV and AIDS

A

36.9 million people worldwide are infected with HIV

Retrovirus

Transmitted by sexual activity, intravenous drug use, perinatal transfer from mother to child

The risk for transmission to health care workers via percutaneous (needle-stick) injuries is currently calculated at approximately 0.3%.

Hand hygiene and standard precautions are extremely important

31
Q

Four Stages of HIV Infection

A

Stage 1: Asymptomatic infection

Stage 2: Early, general symptoms of disease

Stage 3: Moderate symptoms

Stage 4: Severe symptoms, including AIDS-defining illnesses, often leading to death

32
Q

Opportunistic Infections

A

Infections caused by organisms that would not normally harm an immunocompetent person

Common examples are individuals with cancer, organ transplant recipients, and individuals with AIDS.

Caused by other non-HIV viruses, bacteria, fungi, and protozoans

Require long-term prophylactic anti-infective drug therapy

33
Q

Antiretroviral Drugs

A

Highly active antiretroviral therapy
-Includes at least three medications
-These medications work in different ways to reduce the viral load.

34
Q

Antiretroviral Drugs: Reverse transcriptase inhibitors (two sub-classes)

A

Block activity of the enzyme reverse transcriptase, preventing production of new viral DNA

-Nucleoside Reverse transcriptase Inhibitors (NRTI)
-Non-Nucleoside Reverse transcriptase Inhibitors (NNRTI)

35
Q

Antiretroviral Drugs: Protease inhibitors

A

Inhibit the protease retroviral enzyme, preventing viral replication

36
Q

Antiretroviral Drugs: Fusion inhibitor

A

Inhibit viral fusion, preventing viral replication

37
Q

Antiretroviral Drugs: Entry inhibitor

A

CCR5 co-receptor antagonists (maraviroc)

38
Q

Antiretroviral Drugs: Integrase inhibitors (raltegravir potassium)

A
39
Q

Indinavir

A

Protease Inhibitor (PI) class

Can be monotherapy or in combination

Recommended intake without foods; protein fatty foods reduces absorption

Produces an increase in CD4+ cell counts; also reduces viral load

Drink with lots of fluids to reduce risk of nephrolithiasis (kidney stones)

40
Q

Zidovudine (AZT)

A

Important:

Major dose limiting adverse effect of bone marrow suppression

Often used in combination with Didanosine (NRTI) to avoid the above adverse effect

Other

Nucleoside reverse transcriptase inhibitor class
First anti-HIV medication that showed the best promise against the AIDS epidemic
Also effective against maternal-newborn transmission of virus

41
Q

Antiretroviral Drugs:enfuvirtide (Fuzeon®)

A

Fusion inhibitor

Suppresses the fusion process whereby a virion is attached to the outer membrane of a host T cell before entry into the cell and subsequent viral replication

In combination with other antiretroviral drugs, used for treatment of HIV infection

Use in combination with other standard antiretroviral drugs markedly reduced viral loads

Currently available only in injectable form

42
Q

Antiretroviral Drugs: Adverse Effects

A

Numerous; vary with each medication

Drug therapy may need to be modified because of adverse effects.

Goal is to find the regimen that will best control the infection while having a tolerable adverse effect profile.

Medication regimens change during the course of the illness.

43
Q

FYI: Occupational Exposure

A

Chemoprophylaxis for occupational exposure to HIV:

–Tenofovir (NRTI) + Lamivudine (NRTI) + Raltegravir (integrase inhibitor)

–Follow up appoints and baseline blood testing begin within 72 hours post exposure (monitor for HIV status as well as drug toxicity); during drug therapy and after; process depends on facility protocol

44
Q

Other Viral Infections

A

Avian influenza (“bird flu”)
West Nile virus
Severe acute respiratory syndrome (SARS)
H1N1 influenza virus (“swine flu”)

45
Q

Nursing Implications

A

Emphasize handwashing before and after administration of medications, to prevent site contamination and spread of infection.

Instruct patients to wear a glove or finger cot when applying ointments or solutions to affected areas.

Emphasize the importance of good hygiene.

Inform patients that antiviral medications are not cures but do help to manage symptoms.

Instruct patients to start therapy with antiviral medications at the earliest sign of recurrent episodes of genital herpes or herpes zoster.

46
Q

Monitor therapeutic effects.

A

Effects range from delayed progression of HIV infection and AIDS as well as a decrease in flulike symptoms, a decrease in the frequency of herpetic flare-ups, or a crusting over of herpetic lesions.

47
Q

zidovudine adverse effect

A

bone marrow suppression

48
Q

HIV needle stick injury 3 medications

A

tenofovir, lamivudine, raltegravir

49
Q

acyclovir for genital herpes

A

this drug will help lesions dry and crust over

50
Q

HIV therapy

A

no cure, will not eliminate virus

use of multiple drugs is more effective against resistant strains of HIV

goal of treatment is to reduce viral load

this therapy reduces incidence of opportunistic infections

51
Q

ganciclovir sodium after an organ transplant

A

ganciclovir sodium is given to prevent CMV infection

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