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NURS 320 > Exam 2: Viral Infections, Antiviral And Antiretroviral Drugs > Flashcards

Exam 2: Viral Infections, Antiviral And Antiretroviral Drugs Flashcards

1
Q

General Principles of Virology: Viral Replication

A

A virus cannot replicate on its own.

It must attach to and enter a host cell.

It then uses the host cell’s energy to synthesize protein, DNA, and RNA.

Assembly and release of virions (complete, infective form of a virus outside a host cell, with a core of RNA or DNA and a capsid)

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2
Q

Why are viruses difficult to kill?

A

Viruses are difficult to kill because they live inside the cells

Any drug that kills a virus may also kill healthy cells.

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3
Q

Viral Illnesses include

A

Smallpox (poxviruses)
Sore throat
Conjunctivitis (adenoviruses)
Warts
Influenza
Respiratory infections (coronaviruses, rhinoviruses)
Gastroenteritis (rotaviruses, Norwalk-like viruses)
Human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) (retroviruses)
Herpes
Hepatitis

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4
Q

Viral Illnesses Treatment

A

Most viral illnesses are bothersome but survivable

Effective vaccines have prevented some illnesses (i.e. varicella vaccine against chicken pox)

Effective drug therapy is available for a small number of viral infections

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5
Q

Antiviral Drugs

A
  • kill or suppress the virus by destroying virions or inhibiting the ability of viruses to replicate
  • controlled by current antiviral therapy
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6
Q

Immunoglobulins

A

concentrated antibodies that can attack and destroy viruses

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7
Q

IV immunoglobulin (IVIG)

A

can treat immune deficiencies like immune thrombocytopenia (low platelet count)

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8
Q

Medications never fully

A

eradicate a virus completely from its host

Medications give the body’s immune system a better chance of controlling a viral infection

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9
Q

Viruses controlled by current antiviral therapy

A

Cytomegalovirus (CMV)—cidofovir, foscarnet
Hepatitis viruses—C= simeprevir, sofosbuvir; B=telbivudine, tenofovir
Herpesviruses—acyclovir (Zovirax)
HIV—5 categories—common, zidovudine, tenofovir
Influenza viruses (the “flu”)—amantadine, rimantadine, oseltamivir (Tamiflu)
Respiratory syncytial virus (RSV)—ribavirin

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10
Q

Key Characteristics of Antiviral Drugs

A

Able to enter the cells infected with virus

Interfere with viral nucleic acid synthesis, regulation, or both

Some drugs interfere with ability of virus 
to bind to cells

Some drugs stimulate the body’s immune system

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11
Q

Opportunistic Infections

A

Occur in immunocompromised patients
Would not normally harm an immunocompetent person
Require long-term prophylaxis and antiinfective drug therapy
Can be other viruses, fungi, bacteria, or protozoa

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12
Q

Antiviral Drugs (Non-HIV): MOA

A

Most of the current antiviral drugs work by blocking the activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes.

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13
Q

Antiviral Drugs (Non-HIV): Uses

A 
Used to treat non-HIV viral infections:
Influenza viruses
Herpes simplex virus (HSV)
Varicella zoster virus 
Cytomegalovirus (CMV)
Hepatitis
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14
Q

Antiviral Drugs (Non-HIV): Adverse Effects

A

Vary with each drug

Healthy cells are often killed also, resulting in serious toxicities

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15
Q

Antiviral Drugs (Non-HIV): Interactions

A

Vary with each drug

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16
Q

Types of Herpesviridae

A
  1. HSV-1 (oral herpes)
  2. HSV-2 (genital herpes)
  3. Chickenpox and Shingles (HHV-3 or VZV)
  4. Epstein-Barr (HHV-4)
  5. Cytomegalovirus or CMV (HHV-5)
  6. Human herpesviruses 6 and 7 are not especially clinically significant; immunocompromised patients
  7. Kaposi’s Sarcoma (HHV-8)
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17
Q

HSV-2

A

“Neonatal” herpes, often life-threatening
Highly transmissible through close physical contact.
Not Curable

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18
Q

HSV-2 Characteristics

A

Outbreaks of painful skin lesions occur intermittently, with periods of latency.

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19
Q

HSV-2 Treatment

A

Antivirals (acyclovir) can speed up the process of remission and reduce duration of painful lesions
Start medication as early as possible, preferably first 72 hours for best outcomes

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20
Q

Varicella (Chickenpox) (HHV-3 or VZV)

A

Self-limiting
Highly contagious, spread by direct contact with weeping lesions
Varicella virus vaccine recommended for healthy children older than 1 year.

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21
Q

Herpes Zoster (Shingles) HHV-3

A

Painful (opioids for pain control)
Follow nerve tracts (dermatitis): usually unilateral
Postherpetic neuralgias

22
Q

Shingles Treatment

A
  • Acyclovir may speed recovery; best results are generally seen when the antiviral drug is started within 72 hours of symptom onset
  • Zostavax: Immunization given in patients 50 years of age and older
23
Q

Antiviral Drugs: Acyclovir (Zovirax)

A

Synthetic nucleoside analog

Oral, topical (burns upon application), or parenteral forms

24
Q

Antiviral Drugs: Acyclovir (Zovirax): Uses

A

Used to suppress replication of HSV-1, HSV-2, HSV-3 (VZV)

Drug of choice for treatment of initial and recurrent episodes of these infections

25
Q

Antiviral Drugs (Non-HIV): 
Dose-Limiting Toxicities

A

Some antivirals at higher doses can cause toxicities the body; therefore they are dose-limited
Examples are:
Ganciclovir (Cytovene): CMV treatment and bone marrow toxicity
Foscarnet and cidofovir (Vistide): CMV in AIDS patients and Renal toxicity

26
Q

Antiviral Drugs (Non-HIV): 
Neuraminidase Inhibitors

A

Treatment of Influenza Virus

27
Q

Antiviral Drugs (Non-HIV): 
Neuraminidase Inhibitors include

A

Oseltamivir (Tamiflu)

Zanamivir (Relenza)

28
Q

Antiviral Drugs (Non-HIV): 
Neuraminidase Inhibitors (Oseltamivir and Zanamivir)

A

Active against influenza types A and B

Reduce duration of illness

29
Q

Antiviral Drugs (Non-HIV): 
Neuraminidase Inhibitors Oseltamivir causes

A

N/V

30
Q

Antiviral Drugs (Non-HIV): 
Neuraminidase Inhibitors Zanamivir causes

A

Diarrhea, nausea and sinusitis

31
Q

Antiviral Drugs (Non-HIV): 
Neuraminidase Inhibitors (Oseltamivir and Zanamivir) Treatment should begin

A

within 2 days of influenza symptom onset.

32
Q

Retrovirus

A

Type of virus that uses RNA as its genetic material.

33
Q

HIV and AIDS

A

Retrovirus

Transmitted by sexual activity, intravenous drug use, perinatally from mother to child

34
Q

HIV and AIDS viral factors

A

Developed virus is easily inactivated and must be transmitted in body fluids

Disease has a long incubation period

Virus can shed before development of identifiable symptoms

35
Q

Four Stages of HIV Infection

A

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

36
Q

Antiretroviral Drugs: Highly active antiretroviral therapy (HAART)

A

Used to treat infections caused by HIV

Includes at least three medications

These medications work in different ways to reduce the viral load

37
Q

Antiretroviral Drugs include

A 
HAART
Reverse Transcriptase Inhibitors (RTIs)
Protease Inhibitors (PIs)
Fusion Inhibitors
Entry Inhibitor: CCR5 co-receptor antagonists
HIV integrate strand transfer inhibitors
38
Q

Antiretroviral Drugs: Adverse Effects

A

Numerous and vary with each drug

Drug therapy may need to be modified because of adverse effects

39
Q

Goal for Antiretroviral Therapy

A

is to find the regimen that will best control the infection with a tolerable adverse effect profile.
Medication regimens change during the course of illness.

40
Q

Antiretroviral Drugs: Zidovudine (Retrovir)

A

Synthetic nucleoside analogue reverse transcriptase inhibitor

First anti-HIV drug

41
Q

Zidovudine (Retrovir) has been replaced d/t

A

dose-limiting adverse effect of bone marrow suppression

Still used for HIV-infected pregnant women and newborn babies

42
Q

Nevirapine (Viramune)

A

Nonnucleoside reverse transcriptase inhibitor (NNRTIs)

Used in combination with nucleoside reverse transcriptase inhibitors (NRTIs)

Well tolerated

43
Q

Nevirapine (Viramune): Common Adverse Effects

A

rash, fever, nausea, headache, abnormal liver function test results

44
Q

Indinavir (Crixivan)

A

Protease Inhibitor (PI)
Typically given with two nucleoside reverse transcriptase inhibitors (NRTIs)
Increased CD4 counts; decreased viral load

45
Q

Indinavir (Crixivan) administration

A

Best absorbed in acidic gastric environment (do not combine with food)
Drink at least 48 oz of water/day.

46
Q

Enfuvirtide (Fuzeon): MOA

A

Fusion inhibitors
Suppresses the fusion process whereby a virion (complete, infective form of a virus) is attached to the outer membrane of a host T cell before entry into the cell and subsequent viral replication

47
Q

Enfuvirtide (Fuzeon): Uses

A

Used for treatment of HIV infection in combination with other antiretroviral drugs.
Use of this drug in combination with other standard antiretroviral drugs: markedly reduced viral loads.

48
Q

Maraviroc (Selzentry)

A

C-C chemokine receptor type 5 (CCR5) antagonists

Selective, slowly reversible, small molecule antagonist of the interaction between the chemokine co-receptor located on the CD4 cells and the virus…blocks this interaction

49
Q

Maraviroc (Selzentry) Uses

A

Used for resistant strains of HIV-1

50
Q

Maraviroc (Selzentry): Adverse Effects

A

Hepatotoxicity

NURS 320 (28 decks)

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