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Pathology > Mi - Antivirals > Flashcards

Mi - Antivirals Flashcards

1
Q

why is zoonoses more common

A

closer contact
travel
global warming
personal - eat plants, sleep, exercise

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2
Q

what is the Tx for most viral infections

A

NOTHING - just rest

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3
Q

which virus would you always treat

A

HIV

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4
Q

purpose of Tx of virals

A

reduce mortality / morbidity
reduce transmission
post exposure prophylaxis

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5
Q

what areas of cell cycle do antivirals target

A

transcription
translation
host cell lysis

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6
Q

what components of host can antivirals target

A

upregulate immune sustem
downregulate immune system - eg steroids

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7
Q

limits of antivirals

A

host immune capacity
adherence
resistance
toxicity
interactions

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8
Q

what type of viruses are herpes

A

DNA

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9
Q

which type of virus cause acute infection

A

RNA

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10
Q

which type of virus causes chronic infection

A

DNA
- eg HSV, EBV

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11
Q

when is HSV Tx used (7)

A

encephalitis
mucocutaenous (some)
genital lesions (most)
HSV suppression
HSV prophylaxis
VZV - encephalitis / chicken pox / shingles
VZV post exposure prophylaxis

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12
Q

who gets HSV prophylaxis

A

transplant pt

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13
Q

mortality of HSV encephalitis

A

50% if untreated

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14
Q

Tx of HSV encephalitis (inc dose)

A

IV acyclovir 10mg/kg 3x day

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15
Q

Tx for genital herpes

A

valacyclovir or acyclovir

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16
Q

what is acyclovir

A

guanosine analogue
(exam Q++)

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17
Q

how does acyclovir work

A

viral DNA synthesis inhibitors

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18
Q

how can you give acyclovir

A

oral / IV

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19
Q

when is acyclovir always given IV

A

encephalitis

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20
Q

what is valacyclovir

A

prodrug that is metabolised into acyclovir

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21
Q

how is valacyclovir given

A

only orally

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22
Q

2nd line Tx for HSV/VZV

A

foscarnet
cidofovir

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23
Q

when is 2nd line tx for HSV/VZV used

A

acyclovir resistant

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24
Q

what activates acyclovir

A

viral thymidine kinase
(exam Q ++)

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25
Q

MoA of foscarnet

A

DNA polymerase inhibitor

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26
Q

MoA of cidofovir

A

cytidine analogue

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27
Q

how can you become acyclovir resistant

A

mutation in viral thymidine kinase that means acyclovir not taken up into viral genome

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28
Q

who gets CMV Tx

A

neonates
transplant pt

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29
Q

when is CMV Tx given

A

congenital CMV
prophylaxis
CMV disease (ie not just infection)
Sx / signs / organ dysfunction with CMV+ specimens

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30
Q

what complications can CMV cause

A

colitis
pneumonitis
hepatitis
retinitis
bone marrow suppression
(main 5)
also:
encephalitis / ventriculitis
nephritis
cystitis
myocarditis

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31
Q

what sign is seen on CMV colitis biopsy histology

A

owl’s eye

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32
Q

what drugs are used to Tx CMV

A

ganciclovir
valganciclovir

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33
Q

what type of drugs are ganciclovir and valganciclovir

A

guanosine analogues

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34
Q

SE of ganciclovir

A

bone marrow toxicity

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35
Q

who is CI to get ganciclovir

A

BM transplant recipients (causes bone marrow toxicity)

36
Q

how is ganciclovir given

A

IV

37
Q

how is valganciclovir given

A

oral

38
Q

2nd line Tx for CMV

A

foscarnet

39
Q

3rd line Tx for CMV

A

cidofovir

40
Q

4th line Tx for CMV

A

maribavir

41
Q

SE of foscarnet / cidofovir

A

nephrotoxic

42
Q

what drugs are used in prophylaxis for CMV

A

valganciclovir
letermovir (MAB)

43
Q

who is given valganciclovir prophylaxis for CMV

A

solid organ transplant pt

44
Q

who is given letermovir prophylaxis for CMV

A

bone marrow transplant pt

45
Q

Sx of acute EBV

A

tonsilar swelling

46
Q

when would you treat acute EBV and what would you give

A

if tonsils are so swollen that airway is impinged
- steroids

47
Q

what is the chronic EBV infection in immunocompromised pts called

A

post transplant lymphoproliferative disease (PTLD)

48
Q

who do you need to treat for EBV

A

PTLD pts

49
Q

what happens in PTLD

A

latently EBV infected B cells turnover lots, causing polyclonal expansion which can –> lymphoma

50
Q

Tx of PTLD

A

reduce immunosuppression
rituximab (anti CD20)

51
Q

list some resp viruses

A

influenza
rhinovirus
RSV
covid
parainfluenza
adenovirus

52
Q

spectrum of disease in resp viruses

A

asymptomatic
common cold
pneumonia
resp failure

53
Q

what proteins coat influenza

A

haemagluttanin
neuraminidase

54
Q

reservoir of influenza

A

water birds

55
Q

post exposure prophylaxis for influenza

A

oseltamivir

56
Q

what does rsv cause

A

bronchiolitis

57
Q

prevention of RSV

A

palivizumab (vaccination - MAB)

58
Q

tx for bronchiolitis

A

supportive
? IVIG / ribavirin

59
Q

what causes disease in covid

A

overexaggerated inflam response

60
Q

tx for early infection with covid

A

nirmatrelvir / ritonavir
remdesivir
molnupiravir

61
Q

how is nirmatrelvir given

A

oral

62
Q

how is remdesivir given

A

IV

63
Q

tx for late infection with covid

A

steroids
baricitinib
IL6 inhibitors

64
Q

who gets steroids / baricitinib for covid

A

those on o2 support

65
Q

how is early vs late tx for covid different

A

early = targets virus
late = targets host response

66
Q

how does oseltamivir work

A

directly inhibits the influenza neuraminidase

67
Q

tx for monkeypox

A

tecoviromat

68
Q

who needs monkeypox tx (3 reasons, 3 examples for each)

A

severe disease - >100 lesions, encephalitis , sepsis
anatomical concerns - eyes / throat / bladder
high risk - immunocompromised, pregnant, child

69
Q

what Sx does BK virus cause

A

none - almost everyone has had it

70
Q

who gets Sx with BK virus

A

transplant pts (bone marrow and renal)

71
Q

what complication does a bone marrow transplant patient get with BK virus

A

haemorrhagic cystitis

72
Q

Mx of haemorrhagic cystitis due to BK in BMT pts

A

bladder washouts
reduce immunosuppression
cidofivir if severe

73
Q

what complication do renal transplant pts get with BK virus

A

BK nephritis and ureteric stenosis

74
Q

mx of BK nephritis and ureteric stenosis due to BK virus in renal transplant pts

A

reduce immunosuppression
? IVIG

75
Q

what sx does adenovirus commonly cause

A

none
GI sx
conjunctival infections

76
Q

who gets severe adenovirus disease

A

transplant, esp paediatric transplant

77
Q

what sx does severe adenovirus give

A

disseminated / invasive disease

78
Q

tx for severe adenovirus

A

none approved
? cidofivir / brincidofivir / IVIG

79
Q

what is cellular immunotherapy

A

take immune cells out of donor’s arm, put them with the virus you want to target and let them become activated against that virus, then put them into the immune suppressed recipient

80
Q

how is drug resistance tested for

A

phenotypic - cell culture and plaque reduction assay
genotypic - sequencing / resistance mutations

81
Q

for which viruses do we do phenotypic drug resistance testing

A

HSV

82
Q

for which viruses do we do genotypic drug resistance testing

A

HIV routinely
also can do HBV, HCV, CMV

83
Q

main mechanism of resistance to acyclovir

A

thymidine kinase mutation (95%)

84
Q

who gets drug resistance

A

immunosuppressed (>99%)

85
Q

name a mutation for influenza H1N1 that confers resistance to oseltamivir

A

H257Y - neuraminidase mutation

86
Q

when are Igs given (3 categories and an example virus for each)

A

pre exposure prophylaxis - pavilizumab (RSV)
post exposure prophylaxis - HBV Ig, rabies Ig, VZV Ig
therapeutic - IVIG (CMV) or rituximab (EBV)

Pathology (87 decks)

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