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Hep, Hiv, Influenza Flashcards

0
Q

Zanamivir/oseltamivir
MOA
Brand

A

MOA-prevents neuraminidase cleavage of sialic acid stopping viral release

Zanamivir- relenza
Oseltamivir- tamiflu

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1
Q

Amantadine moa and brand

A

MOA, blocks M2 ion channels preventing viral uncoating in influenza A
Brand, symmetrel, mantadix, Amantan

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2
Q

Ribaviron

MOA

A
  • Multiple modes of action
  • Synthetic nucleoside analog of base guanine
  • Inhibits enzymes adding 5’-methyl guanosine CAP to mRNA
  • Has inhibitory effect on DNA virus replication
  • Inhibits a range of viruses including influenza A/B
  • IV, inhaler, oral (low bioavailability)
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3
Q

Acyclovir/valacyclovir

MOA

A
  • Requires 3 phosphorylation steps for activation (prodrug)
  • 1st step requires viral thymidine thus it is selective!!!
  • Binds to DNA as irreversible complex terminating viral DNA chain
  • Acyclovir 15-20% bioavailability valacyclovir 70%
  • resistance in immunocomprmised patients due to alterations in viral thymidine kinase or viral DNA polymerase
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4
Q

Brivudin/trifluoridine

MOA

A

Thymidine analog inhibits DNA synthesis but non selective so no systemic use
Drug is used in acyclovir resistance

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5
Q

Cidofovir

MOA

A

Cystine analog inhibiting DNA synthesis

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6
Q

Docosanol
MOA
Brand

A

Fusion inhibitor
Inhibits fusion between HSV envelop and plasma membrane preventing re-entry into cells and thus viral replication
Brand- abreva

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7
Q

Foscarnet
Class
MOA

A

Non nucleoside prophosphate analog
-inhibits viral DNA polymerase at concentrations that do not affect human DNA polymerase, not activated by viral kinase, blocks phosphate binding site

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8
Q

Entecavir
MOA
Resistance

A

Nucleoside guanine analog
Inhibits priming of DNA polymerase
Most potent agent for suppression on CHB
Multiple mutations needed for resistance

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9
Q

Tenofovir
MOA
Resistance

A
  • Nucleoside analog of adenosine
  • Rebound hepatitis
  • resistance due to mutation in viral polymerase, can be delayed by combo treatment
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10
Q

Lamivudine
MOA
Resistance

A

Nucleoside analog of cystine

-resistance common at 4 years

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11
Q

Interferons
MOA
AE

A

Stops virus from penetrating cells and boosts immune system

-AEs, flulike symptoms, hepatic enzyme elevations, neurotoxisities, mylosuppression,cardiotaxisity

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12
Q

Ribavirin
MOA
Use
Resistance

A

MOA- multiple, nucleoside analog of base guanine, has inhibitory effect on DNA virus replication, inhibits RNA synthesis of a range of viruses
Use- oral in combo with peg-interferon a is first line for HCV (not used as monotheropy, viral DNA becomes undetectable 30-50% of time
Resistance- in hep patients due to viral RNA polymerase mutation

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13
Q

DAA’s NS3-4A inhibitors

Drugs?

A

Boceprevir, telaprevir, simeprevir

Combo with ribavirin

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14
Q

DAAs NS5A inhibitors

Drugs

A

Ledipasvir, daclatasvir

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15
Q

DAA NS5B substrate mimetic

Drugs

A

Sofosbuvir

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16
Q

Sofosbuvir
MOA
POI

A

MOA- viral RNA polymerase inhibitor
POI- first ever polymerase inhibitor approved by FDA 2013
- in Combo with adenovir or other DAA cures HCV 90%+ of time

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17
Q

Maraviroc
MOA
Use
Resistance

A

MOA-Binds selectively and specifically to chemo kind receptor CCR5 nessary for entrance of HIV into CD4+ cells, prevents interaction between host cells CCR5 and HIV gp120
Use-used in adults with CCR5-tropic HIV-1
Resistance-due to mutations in the v3 loop of the HIV gp120 protein

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18
Q

Enfuvirtide
MOA
Use
Resistance

A

MOA-synthetic 36aa fusion inhibitor, binds to gp41 subunit of viral glycoprotein preventing conformation change preventing host cell membrane fusion with viral membrane
Use- no activity against HIV-2, salvage therapy in combo with other agents
Resistance- mutation in gp1 codon

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19
Q 
Zidovudine
Class
MOA
Use
Resistance
A

Class- NRTI
MOA-deoxythimidine analog
Use- effective against HIV1 and2, reduce rate of transmission from mothers to child, combo with lamivudine
Resistance-high when used alone

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20
Q 
Lamivudine/emtricitabine
Class
MOA
Use
Resistance
A

Class-NRTI
MOA-cytosine analog
Use- HIV 1&2, backbone of current HIV treatments
Resistance-use in Combe to reduce resistance

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21
Q

Tenofovir
Class
MOA
Use resistance

A

Class-NRTI
MOA-nucleoside analog of adenosine mono phosphate
Use- first line combo with emtricitabine
Resistance-mutation K65R is associated with resistance

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22
Q

Abacavir
Class
MOA

A

Class- NRTI

MOA- guanosine analog

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23
Q

Didanosine
Class
MOA

A

Class- NRTI

MOA-adenine analog

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24
Zalcitabine Class MOA
Class- NRTI | MOA- cytosine analog
25
Stavudine Class MOA
Class- NRTI | MOA- thymidine analog
26
NNRTI common MOA
Bind directly to HIV-1 reverse transcriptase resulting in blockade of RNA and DNA defendant DNA polymerase
27
``` Nevirapine Class MOA Use Resistance ```
Class- NNRTI MOA- inhibitor of HIV reverse transcriptase Use- good bioavailability and is used as treatment and prophylaxis of HIV Resistance- occurs rapidly in monotherapy so used in combo
28
Efavirenz Class MOA Use
Class- NNRTI MOA- inhibits the HIV reverse transcriptase enzyme by binding to an NNRTI pocket Use- take with high fat meat, part of first line HAART therapy
29
Raltegravir Class MOA Use
Class- Integrase inhibitor MOA- integrate strand transfer, the third and final step of the provirus integration and interferes with reverse transcribed HIV DNA into chromosomes of host cell, pyramid ions analog Use- part of some first line HAART regimens
30
Protease inhibitors common MOA
- Prevent post-translational cleavage of the HIV polyprotein - do not need intracellular activation - active against both HIV1&2 - used particularly in patients that have an AIDS defining illness
31
Saquinavir Class MOA Use
Class- PI MOA- mimics a peptide sequence that is a substrate of the HIV protease, first in class Use- second line therapy
32
Alazanavir Class MOA Use
Class- PI MOA- peptide inhibitor of HIV protease Use- first line HAART with NRTI/NNRTI
33
Darunavir Class MOA Use
Class- PI MOA- peptide inhibitor of protease Use- first line HAART
34
Atripla
Emtricitabine +tenofovir+efavirenz
35
Complera
Emtricitabine+tenofovir+rilpivirine
36
Stribild
Emtricitabine+tenofovir+cobicistat
37
ELISA
Screening test for HIV, sensitivity of 90% but must Bo confirmed with western blot if positive result
38
Western blot test
Confirmatory test for HIV, 99.99% specificity when combo with ElISA
39
HIV rapid antibody test
Screening test for HIV, results in 10-20 min, personnel don't need much training, must be confirmed with ELISA and western blot
40
HIV viral load test
Test measures the amount of actively replicating HIV virus. Correlate with disease progression and drug response. Caution is warranted when the test results shows low-level viremia (ie less than 500 copies per ml) as this may represent a false positive test
41
Complete blood count
Anemia, neutropenia, and thrombocytopenia are common in. HIV
42
Absolute CD4 lymphocyte count
Most widely used predictor of HIV progression, risk of progression to AIDS opportunistic infection or malignancy is high with CD4<200 cells/mcl in absence of treatment, normal is 500-1500 cells/mm^3
43
CD4 lymphocyte percentage
Percentage may be more reliable that count, risk of infection to AIdS opportunistic infection or malignancy is high with percentage <14% in the absence of treatment
44
AIDS defonition
Laboratory evidence- lab confirming HIV and CD4 count <14% Clinical evidence- documentation of an AIDS defining condition and lab confirmation of HIV
45
Atripla
Efavirenz+emtricitabine+tenofovir
46
Complera
Rilpivirine+emtricitabine+tenofovir
47
Stribild
Elvitegravir+cobicistat+emtricitabine+tenofovir
48
Combivir
Lamivudine+zidovudine
49
Epzicom
Abacavir+lamivudine
50
Truvada
Tenofovir+emtricitabine
51
Trizivir
Abacavir+zidovudine+lamivudine
52
Which NRTI does not need renal adjustment?
Abacavir
53
Abacavir | Class
NRTI
54
Tenofovir | Class
NRTI
55
Emtricitabine | Class
NRTI
56
Lamivudine | Class
NRTI
57
Didanosine | Class
NRTI
58
Stavudine | Class
NRTI
59
Zidovudine | Class
NRTI
60
Efavirenz | Class
NNRTI
61
Etravirine | Class
NNRTI
62
Nevirapine | Class
NNRTI
63
Rilpivirine | Class
NNRTI
64
Delavirdine | Class
NNRTI
65
Ritonavir Class Use
PI | Low dose boosting (100-200mg)
66
What is the only PI that is not boosted?
Nelfinavir
67
Atazanavir | Class
PI
68
Darunavir | Class
PI
69
Fosamprenavir | Class
PI
70
Indinavir | Class
PI
71
Lopinavir | Class
PI
72
Nelfinavir | Class
PI | ***only PI that does not require a booster***
73
Saquinavir | Class
PI
74
Tipranavir | Class
PI
75
Raltegravir | Class
Integrase inhibitor
76
Elvitegravir | Class
Integrase inhibitor
77
Dolutegravir | Class
Integrase inhibitor
78
Enfuvirtide | Class
Entry inhibitor
79
Maraviroc | Class
Entry inhibitor
80
Preferred regime for pregnant women?
Zidovudine/lamivudine PLUS Lopinavir/ritonavir. Or atazanavir/ritonavir
81
Pregnant women during delivery
Add zidovudine IV continuous infusion C-section is recommended if VL >1000 copies/ml
82
Babies after delivery
Mother continue ART and do not breast feed Infant zidovudine PO x 6 weeks
83
Hepatitis B co infection
Must treat with either emtricitabine + tenofovir or lamivudine + tenofovir as NRTI backbone
84
Occupational prevention
- Initiate within hours rather than days after exposure - atleast 2 or 3 drug regime - truvada plus Raltegravir or atazanavir/ritonavir or Darunavir/ritonavir - testing at 6weeks, 12 weeks and 6 months
85
Non occupational prevention | Sexual, IVDU, other
Efavirenz plus lamivudine or emtricitabine plus zidovudine or tenofovir Lopinavir/ritonavir plus lamivudine or emtricitabine plus zidovudine HIV testing at 6 weeks, 12 weeks and 6 months
86
Prevention in high risk uninflected | (HIV+ partner, MSM) unlabeled for IVDU
Truvada PO daily
87
Chlamydia Signs and symptoms Treatment
Signs and symptoms- mucopurulent discharge and dysuria, conjunctivitis, Treatment- azythromycin 1g PO x 1 dose, doxycycline 100mg PO x 7 days
88
Chlamydia treatment in pregnancy
Azythromycin 1g PO x 1 dose | Amoxicillin 500mg TID PO x 7 days
89
Gonorrhea | Treatment
Ceftriaxone 250mg IM plus azithromycin 1g PO x1 or doxycycline 100 mg PO bid x 7 days If ceftriaxone is unavailable substitute for cefixime If penicillin/cephalosporin allergic azithromycin 2g PO x 1
90
Gonorrhea treatment in pregnancy
Do not use fluoroquinolone or tetracycline Use cephalosporin combo Use azithromycin 2g PO x 1
91
Gonorrhea treatment septic arthritis or meningitis and andocarditis
Ceftriaxone IV
92
Syphilis | Pathogenesis
Primary- onset 21 days heal spontaneously in 1-8 weeks, development of primary lesion at site of infection Secondary- onset 6wks-6months after primary resolve in 4-10wks, generalized skin eruptions mucosal lesions lymphadenopathy Latent- (70% of untreated patients) early 12 months, positive serologic test but asympomatic Tertiary- 2-40 years after infection, affect any organ (CNS= neurosyphilis)
93
Syphilis treatment
Penicillin G IV (aqueous crystalline or benzathine)
94
Jarisch-herxheimer reaction
Acute febrile reaction to syphilis treatment accompanied by headache, myalgia, fever Treatment- antipyretics, not a drug allergy do not discontinue treatment
95
Trichomoniasis Clinical manifestation Treatment
Clinical manifestation- diffuse, malodorous, yellow-green vaginal discharge, urethral discharge Treatment- metronidazole 2g PO x 1 Tinidazole 2g PO x 1
96
Pelvic inflammatory disease Signs and symptoms Treatment
Pelvic or lower abdominal pain, cervical or uterine tenderness, cervical or vaginal mucopurulent discharge, fever, WBC on vaginal secretions Treatment, inpatient- cefotetan 2g IV or cefixime 2g IV plus doxycycline, clindamycin plus gentamicin Outpatient- ceftriaxone plus doxycycline plus metronidazole
97
Herpes simplex virus | Treatment
Acyclovir, valacyclovir (valtrex), famcyclovir (famvir) other systemic antivirals
98
Human papilloma virus | Treatment
Patient-applied modalities- podofilox 0.5% solution or gel, imiquimod 5% cream, sinecatechins 15% ointment Provider-applied modalities- cryotherapy with liquid nitrogen or cryoprobe, podophyllin resin 10-25%, trichloracetic acid (TCA) or bicolor acetic acid (BCA) 80-90%, surgical removal
99
HIV prevention
``` Vaccine Gardasil (HPV4)- types 6,11,16,18. For males age 9-26 for prevention of genital warts and females age 9-26 for prevention of cervical cancer AND genital warts Cervarix (HPV2)- types 16 and 18. Females age 10-25 for prevention of cervical cancer ```

Infectious Disease 2 (1 decks)

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