Chapter 40: Antivirals pg650

Question 1

Viruses can enter the body through at least four routes:

Answer 1

inhalation
through the respiratory tract, ingestion via the gastrointestinal
(GI) tract, transplacentally via mother to infant, and
inoculation via skin or mucous membranes.

Question 2

changes in the cell associated

with viral replication are known as the

Answer 2

cytopathic effect and

usually result in the destruction of the host cell.

Question 3

Drugs that actually destroy virions include

Answer 3

disinfectants and immunoglobulins. Disinfectants such
as povidone-iodine (Betadine) are virucides and are commonly
used to disinfect medical equipment

Question 4

Many drugs for the treatment of HIV are approved by the

U.S. Food and Drug Administration (FDA) via an

Answer 4

accelerated
process, which means that they are approved faster than other
drugs, because of the nature of the illness.

Question 5

All virions contain a genome that consists

of either DNA or RNA

Answer 5

antiviral
drugs interfere with viral nucleic acid synthesis. Other antiviral
drugs work by preventing the fusion process

Question 6

opportunistic

infections

Answer 6

infections caused by organisms

that would not normally harm an immunocompetent person

Question 7

Most antiviral drugs

are

Answer 7

synthetic purine or pyrimidine nucleoside or nucleotide

analogues

Question 8

Antiretroviral drugs

Answer 8

are indicated specifically for
the treatment of infections caused by HIV, the virus that causes
AIDS.

Question 9

Herpes simplex virus type 1 HSV 1

Answer 9

causes mucocutaneous herpes—usually in the form of perioral

blisters (“fever blisters” or “cold sores”).

Question 10

Herpes simplex

virus type 2 (HSV-2)

Answer 10

causes genital herpes

Question 11

Human herpesvirus

3 (HHV-3)

Answer 11

causes both chickenpox and shingles. This virus is
more commonly known as herpes zoster virus or varicella-zoster
virus (VZV)

Question 12

Human herpesvirus 4 (HHV-4),

Answer 12

known as Epstein-Barr virus, is associated with illnesses such
as infectious mononucleosis (“mono”) and chronic fatigue
syndrome.

Question 13

Human herpesvirus 5 (HHV-5)

Answer 13

known as cytomegalovirus (CMV) and is the cause of CMV retinitis
(a serious viral infection of the eye) and CMV disease, which
is most commonly seen in immunocompromised patients

Question 14

Human herpesvirus

8

Answer 14

known as Kaposi’s sarcoma herpesvirus, is an oncogenic
(cancer-inducing) virus believed to cause Kaposi’s sarcoma, an
AIDS-associated cancer

Question 15

Chickenpox, highly contagious

Answer 15

spread by either direct contact with weeping lesions or via

droplet inhalation

Question 16

Zoster lesions are

often quite painful

Answer 16

opioids for
pain control. In addition, postherpetic neuralgias (long-term
nerve pain) remain following shingles outbreaks in up to 50%
of elderly patients

Question 17

vaccines…

Answer 17

varicella virus vaccine was approved in 1995, older than 1 yr old, never had chicken pox
Zostavax, is available for prevention of herpes shingles in
patients 50 years of age or older

Question 18

Because viruses reproduce in human cells

Answer 18

selective killing is
difficult
healthy human cells, in addition
to virally infected cells, may be killed in the process, which
results in more serious toxicities for these drugs

Question 19

Amantadine (Symmetrel) narrow antiviral spectrum…

Answer 19

influenza A viruses

rimantadine

Question 20

Valacyclovir is a

Answer 20

prodrug that is metabolized to acyclovir
in the body

greater oral bioavailability

Question 21

A common

site of CMV infections in the immunocompromised patient

Answer 21

the eye, and it can result in CMV retinitis, a devastating viral
infection that can lead to blindness

Ganciclovir

Question 22

The dose-limiting toxicity of ganciclovir treatment

Answer 22

is bone
marrow suppression, whereas that of foscarnet and cidofovir
is renal toxicity.

Question 23

For example, a heart transplant recipient who contracts CMV
retinitis is immunocompromised because of immunosuppressant
drug therapy and is most likely taking cyclosporine

Answer 23

which
is nephrotoxic. Therefore, using foscarnet in this patient may
be more dangerous than using ganciclovir

Question 24

a patient who contracts a CMV infection and is immunocompromised
because of a bone marrow transplant might be better
treated using

Answer 24

fosarnet

Question 25

Ribavirin (Virazole) is a synthetic nucleoside analogue of guanosine

Answer 25

It interferes with both RNA and DNA synthesis and as a result inhibits both protein synthesis and viral replication overall.

Question 26

stages of HIV The most recent WHO model lists four stages as follows:

Answer 26

* Stage 1: asymptomatic infection * Stage 2: early, general symptoms of disease * Stage 3: moderate symptoms * Stage 4: severe symptoms, often leading to death

Question 27

CD4 refers to the

Answer 27

protein on the cell surface of helper | T lymphocytes, to which HIV virions attach themselves

Question 28

(HAART) refers to

Answer 28

``` Highly active antiretroviral therapy combinations of antiretroviral drugs (“cocktails”) that are now standard for treating HIV-infected patients. ```

Question 29

Zidovudine (Retrovir), also known as azidothymidine or AZT

Answer 29

is given to HIV-infected pregnant women and even to newborn babies to prevent maternal transmission of the virus to the infant

Question 30

Ribavirin | is contraindicated

Answer 30

in pregnant women and in their male sexual partners due to its teratogenic properties; it must also not be handled by health care personnel who are or might be pregnant

Question 31

Ganciclovir is associated

Answer 31

with bone marrow suppression; therefore, assess blood counts prior to and during use.

Question 32

With use of HIV antivirals or antiretrovirals,

Answer 32

Bone demineralization is yet another adverse effect with long-term use, so assessment of calcium and vitamin D levels is crucial

Question 33

Instruct the patient to take oral antivirals

Answer 33

with meals to help minimize GI upset. Also advise the patient to store capsules at room temperature and not to crush or break the capsules

Question 34

Amantadine and other antivirals need to be taken for the

Answer 34

entire course of therapy, and, if a dose is missed, instruct the patient to take the dose as soon as it is remembered or contact the prescriber for further instructions

Question 35

How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated?

Answer 35

All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.

Question 36

Viruses can enter the body through at least four routes:

Answer 36

inhalation through the respiratory tract, ingestion via the GI tract, transplacentally via mother to infant, and inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others).