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Ocular Pharmacology > Antivirals, Antifungals & Antiprotozoans > Flashcards

Antivirals, Antifungals & Antiprotozoans Flashcards

1
Q

antiviral agents are designed to do what?

A

inhibit viral replication or proliferation

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2
Q

enveloped or non-enveloped:

can stay on surfaces longer without the fear of drying out

A

nonenveloped

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3
Q

enveloped or nonenveloped:

can be killed with alcohol, hydrogen peroxide, chlorine, etc.

A

enveloped

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4
Q

what are some examples of enveloped viruses?

A
  • herpesvirus
  • retrovirus
  • coronavirus
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5
Q

what are some examples of nonenveloped viruses?

A

adenovirus & parvovirus

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6
Q

what virus is a cold virus that is the most common cause of eye infections? what kind of eye infections does it cause?

A

adenovirus → highly infectious conjunctivitis and/or keratitis

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7
Q

which serotype of adenovirus is the most common cause of epidemic keratoconjunctivitis (EKC)?

A

adenovirus 8

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8
Q

what is the incubation period of adenovirus 8?

A

~8 days

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9
Q

on days 8-16, what signs appear in an adenovirus 8 infection?

A

conjunctivitis & fine SPK

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10
Q

in an adenovirus 8 infection, what appears on day 8?

A

focal epithelial keratitis

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11
Q

in an adenovirus 8 infection, 8 days after day 8, what sign(s) appears?

A

subepithelial infiltrates

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12
Q

what is the treatment for EKC?

A

no FDA-approved treatment → normally self-resolving

- palliative care & good hygiene

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13
Q

what are some clinical findings in EKC?

A

follicles, palpable PA node, pseudomembranes

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14
Q

what treatment is not FDA approved, but can be used to treat EKC?

A

Betadine protocol (povidone-iodine)

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15
Q

which virus is the most common virus of the human body & why?

A

herpesvirus → resides in nerve ganglia for life

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16
Q

purines or pyrimidines?

two-carbon nitrogen ring bases used to produce DNA/RNA nucleotides adenine & guanine

A

purines

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17
Q

purines or pyrimidines?

one-carbon nitrogen ring bases that are used to produce DNA/RNA nucleotides thymine/uracil & cytosine

A

pyrimidines

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18
Q

what antiviral agents are commonly used to treat herpes (simplex & keratitis)?

A

purine & pyrimidine analogs

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19
Q

trifluridine (Viroptic) 1% topical solution is what type of antiviral agent?

A

pyrimidine analog

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20
Q

what is trifluridine uniquely preserved with?

A

thimerosal 0.001%

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21
Q

what is the treatment regimen for herpesvirus with trifluridine 1% (Viroptic)?

A

1 gtt q2h until re-epithelialized → 1gtt q4h x 7 additional days

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22
Q

what is the maximum recommended use for trifluridine 1% & why?

A

21 days because it is very destructive to the cornea

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23
Q

what kind of antiviral agent is ganciclovir?

A

purine analog

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24
Q

what is the treatment regimen with ganciclovir 0.15% (Zirgan) for HSV keratitis?

A

1gtt 5x/day until healing → 1gtt TID x 7d (or it can come back)

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25
Q

why is ganciclovir preferred over trifluridine for HSV keratitis?

A

less corneal toxicity

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26
Q

ganciclovir has cross-resistance with which antiviral agent?

A

acyclovir

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27
Q

what class of antiviral agents is acyclovir?

A

purine analog

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28
Q

what is the therapy regimen for HSK with acyclovir?

A

400mg PO 5x/d x 7d

29
Q

what is the therapy regimen for HZK with acyclovir?

A

800mg PO 5x/day x 7-10 days

30
Q

when is it most important to treat HZK & why?

A

the first 72 hours to prevent postherpetic neuralgia

31
Q

out of all the purine analogs, which has the poorest GI absorption?

A

acyclovir

32
Q

which antiviral agent is a prodrug of acyclovir & what class is it?

A

valacyclovir → purine analog

33
Q

what is the therapy regimen for HSK with valacyclovir?

A

500mg PO TID x 7-10d

34
Q

what is the therapy regimen for HZK with valacyclovir?

A

1000mg PO TID x 7-10d

35
Q

valacyclovir has cross-sensitivity with which antiviral agent?

A

acyclovir

36
Q

which antiviral agent is better suited for deeper infections such as stromal keratitis?

A

valacyclovir

37
Q

which antiviral agent is a penciclovir prodrug with extended plasma life? what class is it?

A

famciclovir → purine analog

38
Q

what is the therapy regimen for HSK with famciclovir?

A

250mg TID x 7-10d

39
Q

what is the therapy regimen for HZK with famciclovir?

A

500 mg TID x 7-10d

40
Q

when someone is allergic to acyclovir or valacyclovir, what antiviral agent can they use?

A

famciclovir

41
Q

what are the ocular sequelae of viral infections?

A

blepharitis, conjunctivitis, epithelial & stromal keratitis, uveitis, retinitis, acute retinal necrosis (in severe cases)

42
Q

what are the two types of fungi that can cause fungal infections

A
  • budding unicellular yeasts

- branching filamentous molds

43
Q

what ocular structures are involved in fungal infections?

A

cornea, conjunctiva, lens, ciliary body, vitreous body, uvea

44
Q

what are the two types of yeast that can cause ocular involvement in an infection?

A

candida, cryptococcus

45
Q

what are the three types of molds that can cause ocular involvement in an infection?

A

aspergillus, fusarium, curvularia

46
Q

what can enhance the risk of a fungal infection?

A
  • CL wear
  • steroids
  • trauma (including LASIK)
  • immunocompromised
47
Q

which class of antifungals work by increase membrane permeability?

A

polyenes

48
Q

what are the two polyenes & what do they treat?

A
  • amphotericin B (yeasts = nonfilamentous)

- natamycin (mold = filamentous)

49
Q

which polyene is the only FDA approved topical?

A

natamycin

50
Q

are there any adverse reactions with polyenes?

A

amphotericin B can cause renal toxicity (esp. with IV)

51
Q

what class of antifungals inhibits DNA synthesis?

A

pyrimidines

52
Q

name a drug that is a pyrimidine, & what is its MOA?

A

flucytosine → inhibits thymidine synthesis

53
Q

is flucytosine fungistatic or fungicidal?

A

fungistatic

54
Q

what are the adverse reactions of flucytosine?

A

bone marrow toxicity & hepatotoxicity

55
Q

what class of antifungals inihibit protein synthesis? what is their MOA?

A

azoles → impair ergosterol synthesis & inhibit some cytochrome P450 enzymes which may reduce metabolism of other drugs

56
Q

what class of antifungals are these?

  • ketoconazole
  • fluconazole
  • posaconazole
  • voriconazole
  • itraconazole
  • miconazole
A

azoles

57
Q

which two azoles can cause hepatotoxicity?

A

ketoconazole & fluconazole

58
Q

what class of antifungals are cell wall inhibitors? what is their MOA?

A

echinocandins → inhibit glucan synthese which weakens cell walls

59
Q

what are some echinocandins?

A

casofungin, micafungin, anidulafungin

60
Q

why do echinocandins have less risk of hepatotoxicity?

A

because they are not metabolized by the liver

61
Q

which classes of antifungals have developing resistance?

A

pyrimidines & azoles

62
Q

what is one of the most common soil or waterborne protozoa?

A

acanthamoeba

63
Q

which organism is responsible for the most virulent form of infectious keratitis & has the worst prognosis? what type of organism is it?

A

acanthamoeba - protozoa

64
Q

most acanthamoeba keratitis cases are caused by what?

A

CL wear > trauma

65
Q

what medical therapy can be used to for acanthamoeba infections? give some examples

A

topical biguanides qh-q3h x 3-4wks

  • polyhexamethylene biguanide 0.02% (PHMB)
  • bisbiguanide 0.02% (chlorhexidine)
66
Q

what has similar presentation as an acanthamoeba infection?

A

topical anesthetic abuse syndrome

67
Q

what protozoal infection comes from poorly cooked food, unwashed vegetables, exposure to cat feces?

A

toxoplasmosis gondii infection

68
Q
  • sulfadiazine + pyrimethamine (Sulfadoxine)
  • sulfamethoxazole + trimethoprim (Bactrim)
  • clindamycin
  • spiramycin

these are all used to treat what?

A

acute toxoplasmosis infections

69
Q

what can you use to treat latent toxoplasmosis infections?

A

atovaquone & clindamycin

Ocular Pharmacology (9 decks)

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