Antiviral therapy

Question 1

4 malignancies associated with viruses

Answer 1

1. cervical cancer - HPV
2. anal - HPV
3. hpatocellular carcinoma - Hep B
4. lymphomas - EBV

Question 2

3 ways to prevent viruses

Answer 2

1. infection control
2. vaccination
3. Ig

Question 3

3 types of antivirals

Answer 3

1. immune modulators
2. virucidal agents - directly inactivate viruses
3. antiviral meds - inhib. replication

Question 4

** what is main antiviral shown to reduce HSV-2 infections

Answer 4

valcyclovir

Question 5

9 steps to viral rep

Answer 5

1. adsorptions
2. penetration
3. uncoating
4. transcritpion
5. translation
6. processing
7. replication
8. assembly
9. budding

Question 6

what is main virus specific step to hit

Answer 6

nucleic acid synthesis

Question 7

4 factors that favor viral resistance development

Answer 7

1. high viral replicative load
2. high intrinsic mutation rate
3. degree of drug exposure
4. ability to mutate without affecting viral fitness

Question 8

herpesvirus structure

Answer 8

DNA in envelope

Question 9

key common feature in all herpes

Answer 9

latency

Question 10

*** antivirals against VZV and HSV (3)

Answer 10

acyclovir + 2 prodrugs valacyclovir and famciclovir

Question 11

**2 antivirals for CMV

Answer 11

ganciclovir and valganciclovir

Question 12

**what is first step in nucleoside mech

Answer 12

must be phosphorylate by viral kinase and then activated by cellular enzymes

Question 13

** second step in nucleoside mech

Answer 13

similar to nucleotides, but missing OH group

Question 14

** third step

Answer 14

used and a nucleotide and terminated sequences

Question 15

2 times to worry about resistence

Answer 15

1. persistent or worsening herpes in immunocompromised

2. persistent worsening CMV in HIV pt on ganciclovir

Question 16

when to use VZV antivirals

Answer 16

1. shingles
2. in HIV PT
3. shingles in V1 dermatome

Question 17

what to use for kaposi sarcoma in HIV PT

Answer 17

treat with antiretrovirals, not anti herpes

Question 18

when are flu drugs used

Answer 18

1. prevent infections in outbreaks

2. treat individuals

Question 19

2 MOA of anitflu

Answer 19

adamantanes - target uncoating by M2 ion channel blocker - can’t get in
neuraminidase inhib - stop clusters from being freed after release

Question 20

**1 neuraminidase to know

Answer 20

oseltamivir - tamiflu

Question 21

**3 anti virals for Hep B

Answer 21

lamivudine
tenofovir
entecavir
- nucleoside analogs
- alone or in combo

Question 22

** 2 drugs for hep C

Answer 22

1. interferon

2. ribavirin - guanaside analogue

Question 23

** 1 drug to know for HPV

Answer 23

imiquimod - activates immune cells to produce antiviral cytokines

Question 24

8 factors to consider with antiviral therapy

Answer 24

1. age
2. site of infection
3. stage of illness
4. underlying disease
5. latency of virus
6. genetic stability of virus
7. dev. of resisitance
8. cost and route of admin

Question 25

when to give HSV drugs (5)

Answer 25

1. child with leukemia
2. maybe genitals to shorten Sx
3. HSV encephalitis
4. keratitis (eye)
5. neonatal herpes

Question 26

when to give CMV drugs

Answer 26

1. retinitis in adv HIV

2. esophageal ulcer