Chapter 8 Test 3

Question 1

What are the most common non bacterial infects found in a dental office?

Answer 1

Fungal: Candida/ Tinea
Viral: FlU, HIV, HSP,AIDS, Hepatitis

Question 2

Why is a antifungal drug needed to be taken longer?

Answer 2

This is because fungal and viral infections are more difficut to treat than bacterial.

Question 3

How can fungal infections be classified?

Answer 3

-mucosa or skin (mucocutaneous)
- systemic

Question 4

What antifungal treatments are most commonly prescribed?

Answer 4

Nystatin (Mycostatin)
Clotrimazole (Mycelex)
Fluconazole (Diflucan)
Ketoconazole (Nizoral)

Question 5

Which drugs are imidozoles?

Answer 5

Clotrimazole
Fluconazole
Ketoconazole

Question 6

What is the RX name for Nystatin and what do they do?

Answer 6

Can be applied directly to lesions several times daily for several minutes at a time.

can be applied: orally, lozenges, or vaginal tablets

10-14 days treatment.

Question 7

Clotrimazole is?

Answer 7

mycelex

Can be applied directly to lesions several times daily for several minutes at a time.

can be applied: orally, lozenges, or vaginal tablets

10-14 days treatment.

pregnancy C drug

Question 8

Fluconazole is?

Answer 8

Diflucan

For systemic fungal infection

Drug interaction inhibits liver CYP450 enzymes: Benzodiaziepines, Erythromycin

Question 9

Ketoconazole is ?

Answer 9

Nizoral

For systemic fungal infection

Drug interaction inhibits liver CYP450 enzymes: Benzodiaziepines, Erythromycin

Oral admin

Needs Acidic environment

Reactions: GI distress, hepatotoxicity

Pregnancy C drug

Question 10

How must treatments for mucocutaneous infections be administered

Answer 10

Topically

Question 11

What are the common adverse reactions associated with taking antifungals?

Answer 11

• GI Tract distress
• Hepatotoxicity
• Pregnancy C drug

Question 12

How can influenza be treated?

Answer 12

can be treated with Oseltamir (Tamiflu) or Zanamivir (Relenza)

Question 13

Which medication is most commonly used to treat COVID for patients who are not hospitalized? How does it work?

Answer 13

nirmatrelvir + ritonavir (Pazlovid)

• ritonavir (inhibits the cyp 4503a and cyp 2d6) slows down metabolism of nirmatrelvir

Question 14

What types of herpes simplex viruses exist? Which one is most likely to be seen in the office?

Answer 14

HSV-1 causes oropharyngeal lesions ( on face and eyes)
HSV-2 causes genital lesions ( sexual contact)

HSV 1 is the most common on a dental setting

Question 15

What antiviral medications are available for treatment of HSV?

Answer 15

Acyclovir (Zovirax)
Valganciclovir (Valcyte)
valacyclovir ( Valtrex)
Pencyclovir (Denavir)
Docosanol (Abreva)

Question 16

What is a retrovirus?

Answer 16

A retrovirus is a virus that uses RNA as its genomic material. Upon infection with a retrovirus, a cell converts the retroviral RNA into DNA, which in turn is inserted into the DNA of the host cell. The cell then produces more retroviruses, which infect other cells.

Question 17

How does HIV infect cells and produce more viral particles?

Answer 17

Attachment and Entry: HIV targets cells with the CD4 receptor and the CCR5 or CXCR4 coreceptor on their surfaces, primarily CD4+ T cells. The virus’s envelope protein, gp120, binds to the CD4 receptor, and subsequently, to one of the coreceptors, bringing the virus close to the cell membrane. This interaction allows the viral envelope to fuse with the cell membrane, releasing the viral RNA and enzymes into the host cell.

Reverse Transcription: Once inside the cell, HIV’s enzyme reverse transcriptase converts the single-stranded viral RNA into double-stranded DNA. This step is prone to errors, leading to mutations in the viral genome, which can contribute to HIV’s ability to evade the immune system.

Integration: The newly formed viral DNA is transported into the cell nucleus. There, the viral enzyme integrase incorporates the viral DNA into the host cell’s DNA. Once integrated, the viral DNA becomes a part of the host cell’s genome, and it is referred to as a provirus. This allows the virus to remain in the cell for its entire life cycle and “hide” from the immune system.

Transcription and Translation: When the host cell is activated, it initiates transcription of the proviral DNA, creating messenger RNA (mRNA) that contains instructions for making new viral proteins and RNA genomes. The cell’s own ribosomes then translate this mRNA into viral proteins.

Assembly: The newly made viral proteins and RNA genomes gather at the cell membrane. These components begin to form new virus particles by assembling a protein shell around the RNA.

Budding and Maturation: Immature virus particles bud from the host cell, taking a portion of the cell membrane with them. During or after budding, the viral enzyme protease cleaves newly synthesized polyproteins into functional viral proteins. This process, called maturation, results in fully infectious HIV particles ready to infect new cells.

Question 18

What are the goals of antiretroviral therapy?

Answer 18

Aims to reduce the viral load of HIV : lower load= fewer infected CD4+ cells.

Anti-HIV medications have different mechanisms

Question 19

How are nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors different? How do they prevent HIV infection from becoming worse?

Answer 19

1. Mechanism of Action:

NRTIs: These drugs are similar to the building blocks of DNA (nucleosides). When HIV tries to use reverse transcriptase to convert its RNA into DNA, NRTIs get incorporated into the growing viral DNA strand. Since they are faulty “building blocks,” they stop the DNA chain from growing further. This halts the replication process, preventing HIV from making complete copies of itself.

NNRTIs: Instead of mimicking DNA building blocks, NNRTIs work by directly binding to reverse transcriptase in a different spot, changing its shape and function. This prevents the enzyme from converting viral RNA into DNA, also stopping replication.

2. How They Slow HIV Progression:
   Both NRTIs and NNRTIs prevent HIV from multiplying. By blocking replication, they keep the amount of virus (viral load) in the body low, which helps preserve the immune system, particularly CD4+ T cells. With fewer new viruses being produced, the immune system can function better, which helps prevent HIV from progressing to AIDS.
3. Why They’re Used Together:
   In treatment, NRTIs and NNRTIs are often combined with other antiretroviral drugs to increase effectiveness. Using a combination reduces the chances of the virus developing resistance, making it harder for HIV to adapt and survive in the body.

Question 20

What are the two types of HIV treatments: RT inhibitors?

Answer 20

Nucleoside analogues
None-nucleoside anaglogues

Question 21

How do protease inhibitors work?

Answer 21

Protease inhibitors (PIs) are HIV drugs that block the protease enzyme, which HIV needs to make mature, infectious particles. Normally, protease cuts large protein chains into smaller, functional proteins for new viruses. PIs bind to and disable protease, so the virus can’t produce complete, infectious particle

Question 22

How do fusion inhibitors work?

Answer 22

Blocking Entry: Fusion inhibitors attach to a protein on the surface of HIV, preventing it from merging with the cell membrane of a CD4+ T cell (an immune cell).

Preventing Infection: By stopping the fusion process, the drug prevents HIV from injecting its genetic material into the cell. Without entering the cell, HIV cannot replicate.

Question 23

How does an integrase inhibitor work? Who is most likely to use an integrase inhibitor?

Answer 23

How Integrase Inhibitors Work
Blocking DNA Insertion: After HIV enters a cell, it converts its RNA into DNA and tries to integrate this viral DNA into the cell’s DNA. The integrase enzyme helps with this integration step.

Inhibition of Integration: Integrase inhibitors block the integrase enzyme, preventing HIV from inserting its DNA into the cell’s DNA. This stops HIV from establishing a long-term infection in the cell and producing more virus particles.

Who Uses Integrase Inhibitors?
Integrase inhibitors are commonly used by:

People newly diagnosed with HIV, as they are part of first-line treatment due to their effectiveness and fewer side effects.

People with resistance to other HIV drugs, since integrase inhibitors target a unique step in the HIV lifecycle.

Individuals looking for highly potent treatments with a lower pill burden, as integrase inhibitors are often included in once-daily combination pills.

Question 24

What is HAART? What combinations of drugs might be involved in HAART?

Answer 24

Highly Active AntiRetroviral Therapy”: combination of three drugs in at least two classess of antiretroviral medications.

Aims to reduce viral load below detectable limits
Helps with the prevention of development of resistance in HIV.

Combination of drugs: Truvada (Two RT inhibitors)
Atripla: (Combines three RT inhibitors)
Complera (comes three RT in hibitors)

Question 25

What drug interactions are associated with the use of antiretrovirals?

Answer 25

Asprin
Acetaminophen
NSAIDs
Antibitoics
Local Anesthetics

Question 26

What adverse reactions are associated with the use of antiretrovirals?

Answer 26

Bone marrow suppression
nausea/vomiting
dizziness
paresthesias
vision effects
skin reactions

Question 27

How is chronic hepatitis treated?

Answer 27

These are viral infection that causes liver inflammation: Either type can become chronic

Hepatitis B: treated with nucleosides/nucleotide analogues: tenofovir and emtrictiabine( emtriva)

Hepatitis C: Treaed with different drugs including protease.