MICRO: Antivirals and Influenza Flashcards
What immune modulation treatment is available for genital warts?
Imiquimod
What are the 3 beta-herpes viruses?
CMV and HHV6/7
What are the gamma herpes viruses?
EBV and HHV-8
What are the characteristics of each herpes group?
Alpha -rapid growth
Beta - slow growth
Gamma - oncogenic
What is the MOA of acyclovir? What is it most effective against?
Guanosine analogue - HSV 1> 2> VZV
What is the enzyme which converts acyclovir into active form ?
Viral thymidine kinase (mutation target)
What is the risk of varicella vs zoster in older adults?
Varicella –> pneumonitis
Zoster –> post-herpetic neuralgia
What is the MOA of oseltamivir?
Inhibits influenza neuraminidase
What cells does CMV lie latent in?
Monocytes and DCs
What is the tx of CMV pneumonitis in a post-transplant patient?
Ganciclovir + IVIG
What is the tx for CMV retinitis?
Foscarnet intravitreal
What is used as CMV prophylaxis?
Letermovir in CMV IgG+ HSCT recipients
Or GCV prophylactically in solid organ transplant patients
What is the MOA of letermovir?
CMV specific - DNA terminase inhibitor
What is the MOA of ganciclovir?
Guanosine analogue
How is ganciclovir converted into its active form?
Viral UL97 kinase (resistance target)
Why can you not give ganciclovir in BMT patients?
It is BM toxic - give foscarnet instead
What is the MOA of foscarnet?
Viral DNA polymerase inhibitor - nephrotoxic but not BM toxic
What is the MOA of cidofovir?
Cytidine analogue
What is cidofovir activated by?
No activation required but may require probenicid to prevent its excretion
How is EBV transmitted?
Saliva
How is PTLD diagnosed?
EBV viral load >10^5 c/ml in blood
What is a mAb used for PTLD?
anti-CD20 rituximab
Which influenza mutations means less susceptibility to neuraminidase inhibitors?
H 275 Y mutation in H1N1
What combination treatment can be used for influenza?
Favipravir + oseltamivir
What is the MOA of favipravir?
RNA polymerase inhibitor
What is the MOA of ribavirin?
Guanoside analogue
What mAb is used for RSV?
Palivizumab
What is an antiviral used for SARS-CoV2?
Remdesivir
Molnupiravir
What is the MOA of remdesivir?
Adenosine analogue
What is the MOA of molnupiravir used in SARS-CoV2?
Indices viral RNA mutagenesis
What is a mAb used for SARS-CoV2?
Ronapreve
Sotrovimab
What is the aim of mAbs in SARS-CoV2?
Give early to those at high risk of severe disease
What cytokine immunomodulator is used in SARS-CoV2?
Tocilizumab - IL-6 R antagonist
also anakinra - IL-1 R antagonist
When can you give remdesivir?
All patients <10 days
When can you give cytokine immunomodulation in SARS-CoV2?
Oxygen requirement and high CRP
What is the tx for BK haemorrhagic cystitis?
Cidofovir (+probenicid) + bladder washout + reduce immunosuppression
What is the tx for adenovirus in paed transplant pt?
Cidofovir +/- IVIG
What is the term given to viruses which are heterogenous?
Quasispecies
What is the genetic material of influenza like?
8 segments of dsDNA
Which mutation must avian influenza gain to replicate in humans?
PB2 mutation E627K
What causes antigenic shift?
Reassortment
What is neuraminidase also known as?
Sialic acid enzyme or sialidase
What does the new influenza drug baloxavir target?
PA endonuclease
What Ag is rich in influenza vaccines?
HA
What drug would a COVID patient in ITU most benefit from?
Dexamethasone (virus has probably stopped replicating by the time they reach ITU)