Monica - Week 5 - Exam 2 Flashcards
1
Q
what are the 3 characteristics of viruses?
A
- smaller than bacteria
- transfers via skin or mucous membranes (sexual contact, blood, organ transplant
- replicates inside host cell (fuses to outer membrane
2
Q
what is cell-mediated immunity?
A
- non-specific immune response
- neutrophils, macrophages respond
- lymphocytes release cytokines
3
Q
what do cytokines stimulate?
A
stimulate immune system to attack → T/B cells
4
Q
what is humoral immunity?
A
- specific immune response
- production of antibodies
- attack and destroy viruses
- *body remembers
5
Q
what is the capsid of the virus structure?
A
- the capsid contains contains the virus’ genetic material (DNA and RNA)
6
Q
what is the viral envelope?
A
the viral envelope is made from fatty lipid molecules taken from cells in the host
7
Q
what is the surface proteins of virus structure?
A
these help the virus recognize and bind to cells in the host organism
8
Q
what is the virus genetic material (DNA/RNA)?
A
the virus’ genetic material contains the instructions for making new copies of the virus
9
Q
what are the stages of viral infection?
A
- virus attaches to a cell
- virus penetrates cell membrane and injects nucleic acid (DNA or RNA) into cell
- viral nucleic acid replicates using host cells (our cells)
- new viral nucleic acids are packaged into viral particles and released from the cell ***host cell may be destroyed in the process
10
Q
where does herpes virus “live”?
A
remains latent, non-replicating state in sensory or autonomic nerve root ganglia
11
Q
when does replication of herpes virus occur?
A
replication from immunosuppression, physical or emotional distress (fevers, surgery) → may cause reappearance of lesions
12
Q
is there a cure for herpes viruses?
A
no cure
13
Q
how is herpes virus spread?
A
direct physical contact with the infected person
- can be dormant
- may be asymptomatic
14
Q
what is herpes simplex virus 1?
A
mucocutaneous herpes - eyes, mouth, lips
15
Q
what is herpes simplex virus 2?
A
genital herpes
16
Q
t/f: for HSV1 and HSV2, people can contract even when person doesn’t have symptoms present (sores)
A
TRUE
17
Q
what is human herpes virus (HHV)-3?
A
varicella zoster (chicken pox) herpes zoster (shingles)
18
Q
what can meds for herpes virus do?
A
not cure, but can ↓ severity and frequency of outbreaks
19
Q
T/F: herpes zoster is common in adults > 50 y/o but can occur in 20/30 y/o as well.
A
TRUE
20
Q
how can varicella zoster be transmitted?
A
DIRECT CONTACT + INDIRECT CONTACT - contact (touching blisters) - airborne (breathing) - droplet (sneezing, coughing) INDIRECT - contaminated items (linens/clothing)
21
Q
when can the varicella zoster virus be spread? contagious?
A
can spread in 1 - 2 days before rash; people w/o visible blisters can still infect
22
Q
when does transmission of varicella zoster stop?
A
stops when blisters dry and become crusted
23
Q
T/F: varicella zoster can reactivate and cause shingles
A
TRUE
24
Q
who gets herpes zoster?
A
those with a previous history of chicken pox (varicella zoster)
25
the active shingles virus can cause _______ in someone who has never contracted the virus
```
chicken pox (varicella zoster)
***can't pass shingles to shingles
```
26
how is herpes zoster transmitted?
transmitted via direct contact with blisters only
| **if asymptomatic → no transmission occurs
27
who at risk for developing herpes zoster?
adults > 50, weakened immune system, immunosuppression therapy (corticosteroids/steroids)
28
how long does the blister rash of shingles usually last?
lasts 2 - 4 weeks
29
what are the complications of shingles?
```
post-herpetic neuralgia (after herpes pain; burning; can last months or years)
disseminated zoster ( spreads to other areas of the skin)
```
30
when shingles becomes disseminated what other precaution needs to be put into effect?
airborne precaution - travels like dust
31
is there a vaccine for shingles?
yes - q 5 years, ↓ 50% may not get it
32
T/F: 10 - 20% of people may have shingles if you've had chicken pox
TRUE
33
how do antivirals work?
work by inhibiting viral replication; synergism (work wiith) with host's immune system to suppress or eliminate virus
34
T./F antivirals work best in an immune-competent system
TRUE; not same efficiency in immunosuppressed
35
do antivirals guarantee full eradication of the virus?
no; may not fully eradicate a virus; helps the immune system kick in and control virus; suppresses replication
36
what forms does acyclovir come in?
PO, buccal, IV, and topical forms
37
what is acyclovir used for?
recurrent HSV-1, HSV-2, shingles, and varicella zoster
38
how does acyclovir work?
interferes with viral DNA synthesis; inhibits viral replication. `
39
T/F: acyclorvir is the drug of choice as antiviral
TRUE
40
what is the adverse effect of acyclovir PO?
crystalluria
41
what is the adverse effect of acyclovir topical?
S-J syndrome
42
what is important teaching for acyclovir?
encourage adequate hydration → crystaluria
43
what does buccal acyclovir treat?
treats cold sores
44
what should be assessed with acyclovir?
color and clarity of urine; labs (creatinine + BUN) → kidney function
45
what is the ultimate outcome with acyclovir?
- crusting over and healing of skin lesion
- decreases frequency and severity of recurrences (prophylaxis)
- cessation of pain
46
what is the action of oseltamivir and zanamivir?
inhibits neuraminidase enzyme needed for replication
47
what does neuraminidase enzyme do?
allows virus particles to escape and infect others
48
what are oseltamivir and zanamivir indicated for?
- effective against influenza A + B
49
what is oseltamivir indicated for?
treatment of uncomplicated illness and prevention of flu
50
what form does oseltamivir come in?
suspension and oral tablet
51
when should oseltamivir be taken?
start within 2 days of exposure
52
T/F: oseltamivir may ↓ therapeutic effects of flu vaccine
TRUE; avoid 2 days prior to vaccine or if you've had the vaccine and experience flue symptoms → wait 2 weeks
53
what form does zanamivir come in?
powder form inhaler
54
what is zanamivir indicated for?
treatment and prophylactic flu related s/sx
55
what are the AEs of oseltamivir and zanamivir?
none common; behavioral possible → agitation, delirium, confusion
56
what teaching should be done with zanamivir and oseltamivir?
start within 2 days of exposure
57
what is the outcome of zanamivir and oseltamivir?
↓ duration or prevention of flu-related sxs
58
what is candida?
a fungus that usually lives on skin and mucous membranes
59
what occurs when there is an overgrowth of candida?
superficial and systemic infections
60
what types of candida infections are there?
thrush, yeast infections, athlete's foot
61
what are the types of possible systemic infection?
histoplasmosis, aspergillosis, coccidiomycosis (↑ risk of fungal infections in ↓ immunecompromised)
62
__________ candida infections form in immmunocompromised patient and the immunosuppressed
opportunistic
63
T/F candida is difficult to treat and has an extensive treatment
TRUE; treatment can last weeks to months
64
what is nystatin indicated for ?
tx of skin, vaginal, and oropharyngeal candidiasis - fungal infections
65
how does nystatin work?
disrupts fungal cell wall membrane → allows intracellular contents to leak out
66
what forms is nystatin available in?
available in lozenge, suspension, tablets, ointment, and powder
67
what is important to teach with nystatin lozenges?
must be dissolved orally; cannot chew
68
what is important to teach with nystatin suspension?
must use swish-and-swallow; if taking multiple meds→ oral first then nystatin; shouldn't eat or drink for 20 min; if sleeping or can't follow direction → paint their mouth
69
what 2 teaching points are important with a general fungal infection?
- keep affected areas clean and dry (use something to wick away moisture - pillow case0
- wear light/cool clothing
70
what are the adverse effects of nystatin?
cramps with oral forms; skin irritations with topicals
71
how are systemic fungal infections caused?
inhaled spores affect respiratory system
72
what are the 3 main systemic fungal infections?
histoplasmosis, aspergillosis, and cocciodiomycosis
73
what are 3 characteristics of histoplasmosis?
- most common in US
- found in bird and bat droppings
- transmitted during cleanup or demolition of projects
74
what are 2 characteristics of aspergillosis?
- acquired from nosocomial or environment sources (mold spores thrive in air vents)
- likely to infect weakened immune systems
75
what are 3 characteristics of cocciodiomycosis?
- aka "valley fever" caused by coccidioides
- lives in soil; mostly found in mexico/central america
- infection in the lungs, can become disseminated → can be deadly
76
what are the sxs of all three systemic fungal infections?
dry cough, wheezing, SOB, fever, chest pain, fatigue, chills, body aches → 1 - 3 weeks after exposure to spores
77
what are the indications for fluconazole?
oropharyngeal or esophageal candidiasis; serious systemic infections
78
what is the action of fluconazole?
inhibits synthesis of fungal sterols → disrupts cell wall membrane → contents leak out
79
what is important to assess with fluconazole?
ASSESS KIDNEY FUNCTION (>80% excreted unchanged by kidneys, < 10% metabolized by liver)
- monitor BUN, creatinine, and liver function tests (ALK)
80
what forms does fluconazole come in?
PO and IV
81
what are the AEs of fluconazole?
GI distress (diarrhea/cramping) , SJ syndrome with immunosuppression
82
what are the drug to drug interactions of fluconazole?
may ↑ risk of bleeding with warfarin and ↑ hypoglycemic effects of glipizide and glyburide (↓ BGs)
83
what are the indications of amphotericin B?
progressive, systemic fungal infections
84
T/F amphotericin B is fungistatic or fungicidal
TRUE
85
T/F amphotericin B can cause acute infusion reactions and nephrotoxicity
TRUE
86
`what are the AEs of amphotericin B?
nephrotoxicity, chest pain, hypotension, ↑ liver enzymes, hypokalemia, chills, fever, phlebitis
87
what are the 7 NIs of amphotericin B?
- assess VS q1h and anaphylaxis
- ensure adequate hydration
- may pre-medicate w/ antipyretics, antihistamines, corticosteroids, analgesics, and anti-emetics
- monitor infusion closely during and after admin
- infuse slowly over 2 - 6 hrs
- own pump line
- elimination slow (can be detected 7 wks after D/C)
88
what of medication is metronidazole?
bactericidal, trichomonacidal (parasites that cause STIs), and amebicidal (amebes) - broad spectrum coverage (doesn't cover fungal)
89
how does metronidazole work?
disrupts DNA and protein synthesis
90
whatare the indications of metronidazole?
intra-abdominal, skin-to-skin structures, lower-respiratory tract, bone/joint, and septicemia
91
what is the spectrum coverage for PO metronidazole?
c. diff (IV form also effective) - mild/mod (PO) → vancomycin first line for c diff.
dysentery, trichomoniasis,
h. pylori (can cause peptic ulcers)
92
what are the AEs of metronidazole?
abd. pain, anorexia, dizziness, dry mouth, metallic taste
93
drug-drug interactions for metronidazole?
↑ effects of warfarin
