MICRO: Antivirals and Influenza

Question 1

What immune modulation treatment is available for genital warts?

Answer 1

Imiquimod

Question 2

What are the 3 beta-herpes viruses?

Answer 2

CMV and HHV6/7

Question 3

What are the gamma herpes viruses?

Answer 3

EBV and HHV-8

Question 4

What are the characteristics of each herpes group?

Answer 4

Alpha -rapid growth
Beta - slow growth
Gamma - oncogenic

Question 5

What is the MOA of acyclovir? What is it most effective against?

Answer 5

Guanosine analogue - HSV 1> 2> VZV

Question 6

What is the enzyme which converts acyclovir into active form ?

Answer 6

Viral thymidine kinase (mutation target)

Question 7

What is the risk of varicella vs zoster in older adults?

Answer 7

Varicella –> pneumonitis

Zoster –> post-herpetic neuralgia

Question 8

What is the MOA of oseltamivir?

Answer 8

Inhibits influenza neuraminidase

Question 9

What cells does CMV lie latent in?

Answer 9

Monocytes and DCs

Question 10

What is the tx of CMV pneumonitis in a post-transplant patient?

Answer 10

Ganciclovir + IVIG

Question 11

What is the tx for CMV retinitis?

Answer 11

Foscarnet intravitreal

Question 12

What is used as CMV prophylaxis?

Answer 12

Letermovir in CMV IgG+ HSCT recipients

Or GCV prophylactically in solid organ transplant patients

Question 13

What is the MOA of letermovir?

Answer 13

CMV specific - DNA terminase inhibitor

Question 14

What is the MOA of ganciclovir?

Answer 14

Guanosine analogue

Question 15

How is ganciclovir converted into its active form?

Answer 15

Viral UL97 kinase (resistance target)

Question 16

Why can you not give ganciclovir in BMT patients?

Answer 16

It is BM toxic - give foscarnet instead

Question 17

What is the MOA of foscarnet?

Answer 17

Viral DNA polymerase inhibitor - nephrotoxic but not BM toxic

Question 18

What is the MOA of cidofovir?

Answer 18

Cytidine analogue

Question 19

What is cidofovir activated by?

Answer 19

No activation required but may require probenicid to prevent its excretion

Question 20

How is EBV transmitted?

Answer 20

Saliva

Question 21

How is PTLD diagnosed?

Answer 21

EBV viral load >10^5 c/ml in blood

Question 22

What is a mAb used for PTLD?

Answer 22

anti-CD20 rituximab

Question 23

Which influenza mutations means less susceptibility to neuraminidase inhibitors?

Answer 23

H 275 Y mutation in H1N1

Question 24

What combination treatment can be used for influenza?

Answer 24

Favipravir + oseltamivir

Question 25

What is the MOA of favipravir?

Answer 25

RNA polymerase inhibitor

Question 26

What is the MOA of ribavirin?

Answer 26

Guanoside analogue

Question 27

What mAb is used for RSV?

Answer 27

Palivizumab

Question 28

What is an antiviral used for SARS-CoV2?

Answer 28

Remdesivir | Molnupiravir

Question 29

What is the MOA of remdesivir?

Answer 29

Adenosine analogue

Question 30

What is the MOA of molnupiravir used in SARS-CoV2?

Answer 30

Indices viral RNA mutagenesis

Question 31

What is a mAb used for SARS-CoV2?

Answer 31

Ronapreve | Sotrovimab

Question 32

What is the aim of mAbs in SARS-CoV2?

Answer 32

Give early to those at high risk of severe disease

Question 33

What cytokine immunomodulator is used in SARS-CoV2?

Answer 33

Tocilizumab - IL-6 R antagonist | also anakinra - IL-1 R antagonist

Question 34

When can you give remdesivir?

Answer 34

All patients <10 days

Question 35

When can you give cytokine immunomodulation in SARS-CoV2?

Answer 35

Oxygen requirement and high CRP

Question 36

What is the tx for BK haemorrhagic cystitis?

Answer 36

Cidofovir (+probenicid) + bladder washout + reduce immunosuppression

Question 37

What is the tx for adenovirus in paed transplant pt?

Answer 37

Cidofovir +/- IVIG

Question 38

What is the term given to viruses which are heterogenous?

Answer 38

Quasispecies

Question 39

What is the genetic material of influenza like?

Answer 39

8 segments of dsDNA

Question 40

Which mutation must avian influenza gain to replicate in humans?

Answer 40

PB2 mutation E627K

Question 41

What causes antigenic shift?

Answer 41

Reassortment

Question 42

What is neuraminidase also known as?

Answer 42

Sialic acid enzyme or sialidase

Question 43

What does the new influenza drug baloxavir target?

Answer 43

PA endonuclease

Question 44

What Ag is rich in influenza vaccines?

Answer 44

HA

Question 45

What drug would a COVID patient in ITU most benefit from?

Answer 45

Dexamethasone (virus has probably stopped replicating by the time they reach ITU)