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Path - Microbiology > Antivirals > Flashcards

Antivirals Flashcards

1
Q

what is a polymorphonuclear cell?

A

A type of immune cell that has granules (small particles) with enzymes that are released during infections, allergic reactions, and asthma. Neutrophils, eosinophils, and basophils are PMNs.

PMN - is polymorphonuclear neutrophil

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2
Q

what processes does cellular infection trigger?

A
  1. Release of early inflammatory mediators;
    TNF
    Type 1 interferon’s; a/B
    CCL5,CCL11
  2. These trigger immune cells i.ee PMN’s to release cytokines
  3. Trigger NK cells to kill infected cells
  4. Dendritic cells take antigens and make their way to Lymph nodes to present to and activate CD4 T cells. they also trigger cytokine release
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3
Q

List some cytokines

A

IFN-Y

Interleukin 2,4,5,9,12

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4
Q

what do the CD4 t cells do after antigen presentation from dendritic cells?

A

activate CD8 t cells

activate B cells - later produce antibodies

trigger cytokine release

activate eosinophils ?

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5
Q

Viral replication detected by which receptors ?

A

pattern-recognition receptors, Toll-like receptors, RIG-like receptor

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6
Q

list some of restriction factors

A

type 1 interferons (IFNs)
CCL5,CCL11
tnf

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7
Q

Antiviral immune response can be boosted by exogenous immunomodulators. list some for some common viral conditions

A

Interferon Rx for HBV and HCV,
IVIG for viral pneumonitis,
imiquimod for HPV,
steroids for HSE (?)

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8
Q

list some Limiting factors of antiviral therapy?

A

Host immune response

Adherence to treatment / antiviral drug resistance

Drug toxicity

Drug interactions

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9
Q

List some alpha herpes viruses?

A

VZV
HSV1
HSV2

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10
Q

List some beta herpes viruses?

A

CMV
HHV6
HHV7

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11
Q

List some gamma herpes viruses?

A

EBV

HHV8

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12
Q

Which virus causes mononucleosis type illness, oesophagitis, colitis and retinitis?

A

CMV

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13
Q

Which virus causes sixth disease AND encephalitis?

A

HHV6

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14
Q

Which virus causes burkitts lymphoma and infectious mononucleosis?

A

EBV

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15
Q

Which virus causes kaposi sarcoma?

A

HHV8

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16
Q

Which H herpesviruses family is oncogenic?

A

gamma

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17
Q

Which H herpesviruses family has rapid growth and latency in sensory ganglia (dorsal root)?

A

alpha

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18
Q

Which H herpesviruses family has slow growth?

A

beta

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19
Q

Adults infected with VZV are at risk of which complications?

A

pneumonitis

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20
Q

those who get shingles are at risk of which complications?

A

Post-herpetic neuralgia

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21
Q

how does shingles affect the immunocompromised?

A

multidermatomal or disseminated infection with severe complications

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22
Q

define prodrug?

A

A prodrug is an inactive precursor of a drug, that is metabolized into the active form within the body.

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23
Q

what drug type is Valaciclovir?

A

prodrug of aciclovir

high bioavailability

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24
Q

Rx for HSV and VZV - 1st and 2nd line?

A

Aciclovir (po or iv)
Valaciclovir (po )
Famciclovir

2nd line: Foscarnet or cidofovir for ACV-resistant virus

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25
how does acyclovir work? what type of drug is it?
□ Nucleoside (Guanine) analogue that gets incorporated into the growing chain of viral DNA □ elongation of DNA becomes blocked □ So, this class of drugs is also known as 'chain terminators'
26
why does acyclovir work at chain termination?
acyclovir lacks the 3' hydroxyl group necessary for the insertion of an additional nucleotide
27
for hsv and vxv, for which is acyclovir most sentive?
HSV-1 > HSV-2 >> VZV
28
what processes does acyclovir undergo before it can carry out its chain terminatoin abilities?
Monophosphorylated by viral thymidine kinase (TK) and then further phosphorylation by cellular kinases to ACV-PPP (active form) - V high affinity
29
rx for HSV Encephalitis?
Start empiric treatment immediately with iv Acyclovir 10mg/kg tds without waiting for test results
30
when do you treat vzv?
Chickenpox in adults Zoster in adults >50 Primary infection or reactivation in the immunocompromised Neonatal chickenpox Increased risk of complications
31
Where does CMV become latent?
in blood monocytes and dendritic cells
32
pt comes in, yous ee WIDESPREAD RETINAL EXUDATE AND HAEMORRHAGE on ophthalmoscopy ‘OWL’S EYE’ INCLUSIONS on histology and INTERSTITIAL PNEUMONIA what is the diagnosis?
CMV
33
what is the 1st and second line treatment for CMV?
1ST Ganciclovir GCV iv Valganciclovir (VGC) po 2ND Foscarnet FOS iv / intravitreal
34
Ganciclovir Requires activation by what?
viral UL97 kinase enzyme activation is by phosphorylation
35
Ganciclovir is what type of drug?
Guanosine analogue - Inhibits viral DNA synthesis
36
what kind of drug is valgancyclovir?
oral prodrug of ganciclovir
37
In patients with CMV pneumonitis, ganciclovir is used in conjunction with ?
IVIG
38
side effects of Ganciclovir?
Bone marrow toxicity (leukopenia, thrombocytopenia, anaemia, pancytopenia) Renal and hepatic toxicity
39
Ganciclovir Valganciclovir Foscarnet have what MOA?
Inhibits viral DNA synthesis - guanisine analgoues foscarnet - inhibits viral dna polymerase
40
Side effects of foscarnet AND cidofovir ?
Nephrotoxic
41
Cidofovir is what type of drug?
Nucleotide (cytidine) analogue
42
which is there a higher CMV associated mortality; Bone marrow tranplant or SOT?
BMT
43
How to manage CMV in the following patients: - Bone marrow transplant - Solid organ tx - Stem cell tx
Bone marrow transplant; - Treat ; gancyclovir Solid organ tx - Prophylaxis ; valgancyclovir Stem cell tx - monitor and give gan/valgan if pcr +
44
which antivral Directly inhibits viral kinase (UL97)? used in what condition?
Maribavir works in vitro against CMV and EBV
45
which antivral is a CMV DNA terminase* inhibitor?
Letermovir
46
how is EBV tranmitted? which group is commonly affected?
Salivary transmission, infection common in childhood
47
what is Post-Transplant Lymphoproliferative Disease?
Associated with EBV infection Breakdown of immunosurveillance Latently infected B cells – polyclonal expansion -> lymphoma
48
how to Post-Transplant Lymphoproliferative Disease manage?
Reduce immunosuppression Anti-CD20 monoclonal Ab therapy (B cell marker) – rituximab –
49
patient comes in, EBV viral load in blood is > 10^5 c/ml, waht is likely diagnosis?
post-Transplant Lymphoproliferative Disease
50
A 42-year-old lady is admitted with a 2 day history of fever and confusion and presents with new onset seizures. What antiviral medication should she receive as soon as possible? Choose the best answer. ``` Oral aciclovir IV foscarnet Oral valaciclovir IV ganciclovir IV aciclovir ```
E because they have HSV encaphelitis
51
list 2 influenxa surface proteins and their role?
Haemaglutinin: Haemaglutinin regulates binding to airway and entering cells Neuraminidase: responsible for exit of new virus back out of cells and into the airways.
52
list 2 neuramnidase inhibitors and which flu viruses they work against?
1st line - Oseltamivir PO 2nd line - zanamivir NG Effective for both influenza A and B
53
who are those making up the influenza riisk group?
``` Aged ≥ 65 years Immunosuppressed Chronic respiratory disease Chronic heart disease Chronic liver disease Chronic neurological disease Diabetes mellitus Pregnant women Morbid obesity (BMI ≥ 40) Children < 6 months ```
54
Commonest cause of severe respiratory tract illness and hospitalisation of infants worldwide?
RSV - resp syncytial virus causing bronchiolitis
55
which antivirals are effective for Lassa fever and HEV?
ribavarin
56
Charcaterise BK virus infection ?
in childhood minimal symptoms, but subsequent lifelong carriage in kidneys and urinary tract - > reactrivation in immunosuppressed
57
name the Treatment of BK haemorrhagic cystitis?
Bladder washouts Reduce level of immunosuppression if possible Cidofovir iv (+ probenicid) if significant morbidity
58
Treatment of BK nephropathy
Normal human immunoglobulin (~ IVIG) | Reduce level of immunosuppression if possible
59
who contracts Adenovirus? rx?
Paeds transplant recipients Severe multi-organ involvement Rx: Ribavirin Cidofovir iv IVIG
60
which interferons can be used in hep b treatment?
IFN-Y Peg-IFN a-2a (pegasys)
61
list hep b treatment and mmemonic?
Tenofovir and Entecavir - told on placement T - tenofovir I - interferon L - lamivudine E - entecavir
62
list 3 types of hep c viral drugs and targets of action/effect? give examples of their names
protese inhibitors - targets NS3 on hcv RNA (boceprevir) NS5A inhibitors - elbasivir polymerase inhibitors - NS5B , Dasabuvir
63
list 2 mechanims via which viruses acquire resistance?
Diversity - Quasispecies, mutation / recombination Selection - Replication (eg in the presence of suboptimal drug concentrations)
64
list 2 ways to Prevent drug resistance?
Use potent drug regimens to achieve maximal suppression of viral replication (combination Rx / HAART) Increase adherence to treatment (low drug burden, once-daily regimens, patient education…)
65
list 2 Drug resistance assays? give examples of use
Genotypic: Sequencing / resistance mutations Example: HIV drug resistance Phenotypic: Cell culture Plaque reduction assay example: used for HSV drug resistance testing
66
list 2 mechanisms of HSV drug resistance (to acyclovir)?
Mutations usually in viral thymidine kinase (95%), and rarely in the viral DNA polymerase (5%)
67
how to Treat Acyclovir -resistant HSV ? and also gancyclovir resistant cmv?
foscarnet cidofovir
68
HSV drug resistance (to acyclovir) mediates cross-resistance to what drug?
gancyclovir
69
list 2 mechanisms of CMV drug resistance to ganciclovir
In protein kinase gene (UL97) - most common In the DNA polymerase gene (UL54) – rare UL56 terminase gene (letermovir)
70
Name a type of mutation found in influenza A H1N1 that confers resistance to neuraminidase inhibitors?
H275Y - neuraminidase mutation
71
Immunoglobulins are usually given when? list some conditions ?
for prophylaxis or PreP in the following; RSV - palivizumab VZV Hep B Rabies therapeutic in EBV and viral pneumonitis

Path - Microbiology (27 decks)

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