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Infectious Disease 2 > Hep, Hiv, Influenza > Flashcards

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
Q

Zalcitabine
Class
MOA

A

Class- NRTI

MOA- cytosine analog

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25
Q

Stavudine
Class
MOA

A

Class- NRTI

MOA- thymidine analog

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26
Q

NNRTI common MOA

A

Bind directly to HIV-1 reverse transcriptase resulting in blockade of RNA and DNA defendant DNA polymerase

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27
Q 
Nevirapine
Class
MOA
Use
Resistance
A

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

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28
Q

Efavirenz
Class
MOA
Use

A

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

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29
Q

Raltegravir
Class
MOA
Use

A

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

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30
Q

Protease inhibitors common MOA

A
  • 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
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31
Q

Saquinavir
Class
MOA
Use

A

Class- PI
MOA- mimics a peptide sequence that is a substrate of the HIV protease, first in class
Use- second line therapy

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32
Q

Alazanavir
Class
MOA
Use

A

Class- PI
MOA- peptide inhibitor of HIV protease
Use- first line HAART with NRTI/NNRTI

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33
Q

Darunavir
Class
MOA
Use

A

Class- PI
MOA- peptide inhibitor of protease
Use- first line HAART

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34
Q

Atripla

A

Emtricitabine +tenofovir+efavirenz

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35
Q

Complera

A

Emtricitabine+tenofovir+rilpivirine

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36
Q

Stribild

A

Emtricitabine+tenofovir+cobicistat

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37
Q

ELISA

A

Screening test for HIV, sensitivity of 90% but must Bo confirmed with western blot if positive result

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38
Q

Western blot test

A

Confirmatory test for HIV, 99.99% specificity when combo with ElISA

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39
Q

HIV rapid antibody test

A

Screening test for HIV, results in 10-20 min, personnel don’t need much training, must be confirmed with ELISA and western blot

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40
Q

HIV viral load test

A

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
Q

Complete blood count

A

Anemia, neutropenia, and thrombocytopenia are common in. HIV

42
Q

Absolute CD4 lymphocyte count

A

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
Q

CD4 lymphocyte percentage

A

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
Q

AIDS defonition

A

Laboratory evidence- lab confirming HIV and CD4 count <14%

Clinical evidence- documentation of an AIDS defining condition and lab confirmation of HIV

45
Q

Atripla

A

Efavirenz+emtricitabine+tenofovir

46
Q

Complera

A

Rilpivirine+emtricitabine+tenofovir

47
Q

Stribild

A

Elvitegravir+cobicistat+emtricitabine+tenofovir

48
Q

Combivir

A

Lamivudine+zidovudine

49
Q

Epzicom

A

Abacavir+lamivudine

50
Q

Truvada

A

Tenofovir+emtricitabine

51
Q

Trizivir

A

Abacavir+zidovudine+lamivudine

52
Q

Which NRTI does not need renal adjustment?

A

Abacavir

53
Q

Abacavir

Class

A

NRTI

54
Q

Tenofovir

Class

A

NRTI

55
Q

Emtricitabine

Class

A

NRTI

56
Q

Lamivudine

Class

A

NRTI

57
Q

Didanosine

Class

A

NRTI

58
Q

Stavudine

Class

A

NRTI

59
Q

Zidovudine

Class

A

NRTI

60
Q

Efavirenz

Class

A

NNRTI

61
Q

Etravirine

Class

A

NNRTI

62
Q

Nevirapine

Class

A

NNRTI

63
Q

Rilpivirine

Class

A

NNRTI

64
Q

Delavirdine

Class

A

NNRTI

65
Q

Ritonavir
Class
Use

A

PI

Low dose boosting (100-200mg)

66
Q

What is the only PI that is not boosted?

A

Nelfinavir

67
Q

Atazanavir

Class

A

PI

68
Q

Darunavir

Class

A

PI

69
Q

Fosamprenavir

Class

A

PI

70
Q

Indinavir

Class

A

PI

71
Q

Lopinavir

Class

A

PI

72
Q

Nelfinavir

Class

A

PI

only PI that does not require a booster

73
Q

Saquinavir

Class

A

PI

74
Q

Tipranavir

Class

A

PI

75
Q

Raltegravir

Class

A

Integrase inhibitor

76
Q

Elvitegravir

Class

A

Integrase inhibitor

77
Q

Dolutegravir

Class

A

Integrase inhibitor

78
Q

Enfuvirtide

Class

A

Entry inhibitor

79
Q

Maraviroc

Class

A

Entry inhibitor

80
Q

Preferred regime for pregnant women?

A

Zidovudine/lamivudine
PLUS
Lopinavir/ritonavir. Or atazanavir/ritonavir

81
Q

Pregnant women during delivery

A

Add zidovudine IV continuous infusion

C-section is recommended if VL >1000 copies/ml

82
Q

Babies after delivery

A

Mother continue ART and do not breast feed

Infant zidovudine PO x 6 weeks

83
Q

Hepatitis B co infection

A

Must treat with either emtricitabine + tenofovir or lamivudine + tenofovir as NRTI backbone

84
Q

Occupational prevention

A
  • 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
Q

Non occupational prevention

Sexual, IVDU, other

A

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
Q

Prevention in high risk uninflected

(HIV+ partner, MSM) unlabeled for IVDU

A

Truvada PO daily

87
Q

Chlamydia
Signs and symptoms
Treatment

A

Signs and symptoms- mucopurulent discharge and dysuria, conjunctivitis,
Treatment- azythromycin 1g PO x 1 dose, doxycycline 100mg PO x 7 days

88
Q

Chlamydia treatment in pregnancy

A

Azythromycin 1g PO x 1 dose

Amoxicillin 500mg TID PO x 7 days

89
Q

Gonorrhea

Treatment

A

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
Q

Gonorrhea treatment in pregnancy

A

Do not use fluoroquinolone or tetracycline
Use cephalosporin combo
Use azithromycin 2g PO x 1

91
Q

Gonorrhea treatment septic arthritis or meningitis and andocarditis

A

Ceftriaxone IV

92
Q

Syphilis

Pathogenesis

A

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
Q

Syphilis treatment

A

Penicillin G IV (aqueous crystalline or benzathine)

94
Q

Jarisch-herxheimer reaction

A

Acute febrile reaction to syphilis treatment accompanied by headache, myalgia, fever

Treatment- antipyretics, not a drug allergy do not discontinue treatment

95
Q

Trichomoniasis
Clinical manifestation
Treatment

A

Clinical manifestation- diffuse, malodorous, yellow-green vaginal discharge, urethral discharge
Treatment- metronidazole 2g PO x 1
Tinidazole 2g PO x 1

96
Q

Pelvic inflammatory disease
Signs and symptoms
Treatment

A

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
Q

Herpes simplex virus

Treatment

A

Acyclovir, valacyclovir (valtrex), famcyclovir (famvir) other systemic antivirals

98
Q

Human papilloma virus

Treatment

A

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
Q

HIV prevention

A 
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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