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MICRO ADYA > Microbiology 21 - Antivirals > Flashcards

Microbiology 21 - Antivirals Flashcards

1
Q

What is the mechanism of action of acyclovir?

A

Guanosine analogue that prevents elongation of DNA

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2
Q

Which viruses is acyclovir particularly useful for?

A

VZV
HSV 1 + 2

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3
Q

Which antiviral is used in HSV encephalitis?

A

High dose IV acyclovir

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4
Q

What is ganciclovir used for?

A

Pretty much only for treatment of CMV in the imunocompromised and neonates

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5
Q

What is the main side effect of ganciclovir?

A

Bone marrow toxicity

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6
Q

When is foscarnet used?

A

To treat CMV in patients where ganciclovir is contra-indicated (eg neutropaenic patients- because ganciclovir risks bone marrow failure)

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7
Q

Mechanism of action of direct acting antiviral drugs

Examples of drug classes - and which is the most common?

A

They target proteins that are specific to viruses

Examples: protease inhibitors, polymerase inhibitors, integrase inhibitors

Most common- protease inhibitors

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8
Q

How does immunomodulation help antiviral response? Examples?

A

They improve the human immune response

Examples: interferon, IVIG

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9
Q

Classification of human herpes viruses?

A
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10
Q

VZV vs Herpes Zoster

A

VZV- causes chickenpox. primary infection

Herpes zoster (aka zoster)- causes shingles when VZV is reactivated

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11
Q

Distribution of shingles in immunocompetent vs immunocompromised patients

A

Immunocompetent: in dermatomal distribution

Immunocompromised: in widespread distribution (non-dermatomal)

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12
Q

Complications of herpes zoster

A

Post-herpetic neuralgia- severe after 50 y/o

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13
Q

Indications for treatment of VZV

A
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14
Q

Why is VZV (chickenpox) in adults dangerous?

A

Increased risk of complications such as pneumonitis

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15
Q

What two main infections can HSV cause? What are the indications of treatment? And what is the treatment?

A

Encephalitis

  • affects temporal lobe, presents with altered cognitive function/consciousness
  • indications for treatment: MUST TREAT!!
  • Treatment: IV aciclovir 10mg/kg TDS, 14-21 days
    • start treatment BEFORE confirming infection with tests

Meningitis

  • parenchyma not affected
  • not as severe as HSV encephalitis- except in immunocompomirsed people
  • Indications: immunocompromised or very unwell
  • Treatment:
    • IV aciclovir for 2-3 days –> switch to oral aciclovir for 10 days OR
    • PO valaciclovir - prodrug of aciclovir (activated in liver)
      • Advantage: orally available
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16
Q

Ganciclovir MOA

A

Guanosinde analogue chain terminator. (prevents DNA elongation)

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17
Q

Foscarnet MOA

Main side effect of foscarnet

A

Non-competitive inhibitor of viral DNA polymerase

Main side effect: nephrotoxic

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18
Q

Cidofovir MOA and main side effect

A

Competitive inhibitor of viral DNA synthesis

Main side effect: nephrotoxicty

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19
Q

Who gets infected with CMV?

A

This is an opportunistic virus

cause severe disease in the immunocompromised

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20
Q

What is the best treatment for paediatric adenovirus infection?

A

Combination of cidofovir and IV Ig

21
Q

Classic histological feature of CMV

Also- where does it normally reside?

A

Owl’s eye inclusions

Normally resides dormant in monocytes and dendritic cells

22
Q

Symptoms of CMV in immunocompromised and neonates

A

immunocompromised

bone marrow suppression

retinitis- retinal exudates and haemorrhages

pneumonitis

hepatitis

colitis

encephalitis

neonates

23
Q

Tx of CMV

A

First line: IV ganciclovir or PO valganciclovir

Second line: IV Foscarnet (when ganciclovir is contraindicated eg bone marrow failure)

Third line: IV Cidofovir

24
Q

Main side effect and contraindication of gancilovir

A

Bone marrow toxicity - C/I in bone marrow transplant patients

25
Disease course of EBV
26
What is a complication of EBV in post transplant patients? \*any transplant not just bone marrow How is it treated?
PTLD- post transplant lymphoproliferative disease -\> predisposes to lymphoma therefore needs to be treated Treatment: reduce immunosuppression, rituximab
27
Main antivirals for influenza virus
Neuraminidase inhibitors * Oseltamivir (Tamiflu) * Zanamivir (Relenza)
28
Which antiviral is most useful for treating RSV (bronchiolitis in children)?
Ribavarin - but there is a lack of good evidence for its efficacy
29
What drug is given to infant groups at high risk of RSV?
Palivizumab Indications: * preterm * heart or lung disease * SCID * long-term ventilation
30
SARS COV2 drugs: a) early drugs b) Treatment of Haemophagocytic Lymphohistiocytosis (HLH) c) Treatment of Cytokine release syndrome (CRS)- used in ICU d) New drugs
a) early drugs - remdesevir - Broad spectrum adenosine nucleotide analogue pro-drug - Ruxolitinib: JAK1 and JAK2 inhibitor b) Anakinra- IL-1 receptor antagonist c) Tocilizumab- IL-6 receptor antagonist d) new drugs : * Favipravir- mild to moderate disease * Nafamostat
31
What does BK virus infection cause?
Primary BK infection in childhood causes minimal symptoms but leads to lifelong carriage in the kidneys and urinary tract Causes problems post-transplant (bone marrow and kidney)
32
Tx of BK haemorrhagic cystitis
* Bladder washouts * Reduce immunosuppression if possible * Cidofovir IV (+probenecid)
33
Tx of BK nephropathy
* Reduce immunosuppression if possible * IVIG cidofovir cannot be used because it is nephrotoxic!!
34
What treatment can clear chronic hep B in 3-7% of patients?
48 week course of pergolated interferon gamma
35
Adenovirus: who does it affect and how do you treat it?
MOstly affects paediatric transplant patients **Treatment:** * Cidofovir IV * IVIG
36
Mechanism of drug resistance to aciclovr
Majority are due to mutation in viral thymidine kinase
37
Mechanism of resistance of influenza to neuraminidase inhibitors
H275Y mutation
38
Mechanism of resistance of CMV to ganciclovir
mutations in protein kinase gene (UL97)
39
What are the two main types of herpes viruses and what infection do they cause?
HSV1: cold sores (herpes labialis) HSV2: genital herpes. can also cause aseptic meningitis.
40
What is the post exposure prophyalxis for VZV?
VZIG given to immunocompromised and pregnant women
41
What is the vaccine against varicella?
Attenuated OKA strain contraindicated in pregnancy
42
Treatment of shingles?
Indications: symptomatic children or (\<24H OF ONSET OF RASH) healthy adult smokers, chronic lung disease, \>20/40 gravid - aciclovir or famciclovir or valaciclovir - topical eye drops plus oral for olpthalmic - PEP- for immunocompromised
43
Where does HHV6 lie dormant?
Lies dormant in monocytes and lymphocytes
44
WHat is roseola infantum also called?
Exanthem subitum
45
What diseases can HHV8 cause?
In immunocompromised: - kaposi's sarcoma - primary effusion lymphoma - castleman's disease (non-cancerous growth in lymph nodes)
46
Which group of people do JC virus and BK virus infect?
Immunocomprimsed
47
What family is JC virus and BK virus?
polyomaviridiae
48
What does JC virus cause in immunocompromised?
Causes progressive multifocal leukoencephalopathy + rapidly demyelinating disease + neurological deificts

MICRO ADYA (22 decks)

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