Quiz #2 Study Guide Flashcards
1
Q
General principles of virology include
A
- A virus cannot replicate on its own.
- It must attach to and enter a host cell.
- It then uses the host cell’s energy to synthesize protein, DNA and RNA.
- Viruses are difficult to kill because they live inside cells. (Any drug that kills a virus also kill healthy cells)
2
Q
Purpose of Antiviral Drugs
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Kill or suppress the virus by destroying virions or inhibiting the ability of viruses to replicate; controlled by current antiviral therapy
3
Q
Antiviral Drugs are used for
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Cytomegalovirus Hepatitis viruses Herpesviruses HIV Influenza viruses Respiratory syncytial virus
4
Q
What antiviral drugs are used to treat the flu?
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Amantadine
Rimantadine
Oseltamivir
5
Q
Amantadine
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Only active against Influenza A viruses.
6
Q
Adverse Effects of Amantadine
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Insomnia Nervousness Lightheaded ness Anorexia, Nausea Anticholinergic Effects Orthostatic Hypotension Blurred vision
7
Q
Oseltamivir
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Active against influenza A and B
Reduces duration of illness.
Treatment should begin within 2 days of influenza symptom onset.
8
Q
Adverse Effect of Oseltamivir
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Causes nausea and vomiting
9
Q
Herpes Zoster (Shingles) HHV-3
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Painful: opioids for pain control.
Follows nerve tracts (dermatomes) usually unilateral.
10
Q
What drugs are used to treat herpes zoster?
A
Acyclovir
11
Q
Acyclovir
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Speeds recovery from shingles.
(Best results are generally seen when the antiviral drug is started within 72 hours of symptom onset.)
Synthetic nucleoside analog
Used to suppress replication of HSV-1, HSV-2 and HSV-3.
12
Q
Adverse Effects of Acyclovir
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Nausea, diarrhea
Headache
Burning when topically applied
13
Q
HIV: Virus Characteristics
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-Non living, intracellular parasites -> do not have normal cellular structures -> have RNA OR DNA but NOT both.
Must be in a host cell to replicate.
-Has a capsid around it (protein coating that protects itself)
-Glycoproteins, envelope
14
Q
What drugs are used to treat HIV?
A
Zidovudine
Nevirapine
15
Q
Adverse effects of Zidovudine
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Bone marrow depression
Nephrotoxicity
Hepatoxicity
Decreased WBC
16
Q
Adverse Effects of Nevirapine
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Nonnucleoside reverse transcriptase inhbitor
Used in combination w/ nucleoside reverse transcriptase inhibitors
Well tolerated
17
Q
What is the purpose of immunosuppressants?
A
..
18
Q
What is the use of immunosuppressants?
A
..
19
Q
Nursing implications of immunosuppressants
A
..
20
Q
Organ transplant
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Transplanted organs have antigens that trigger immune response - rejection.
21
Q
What drugs are used to prevent organ rejection?
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Azathioprine (prevents rejection of kidney transplants)
22
Q
What are the adverse effects of azathioprine?
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Bone Marrow Suppression
Development of Lymphoma and other malignancies
Hepatosplenic T-cell lymphoma
23
Q
What is systemic lupus erythematous?
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Multisystem autoimmune inflammatory disease.
24
Q
Pathophysiology of SLE
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Antibodies react with circulating antigen (nucleic acids, erythrocytes, phospholipids, lymphocytes, platelets, etc.)
Reaction forms circulating immune complexes.
25
Clinical Manifestations of SLE
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Photosensitivity, scaly erythematous:
Butterfly skin rash
Plaques with follicular plugging
Scarring
Nonerosive arthritis, pancreatitis, vasculitis, anemia, GN, pleural effusion, endocarditis, thrombosis of intracranial vessels
```
26
Treatment options of SLE
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Hydroxychloroquine
Glucocorticoids
NSAIDS
Immunosuppressive agents
Chronic Support - education, counseling, eat well, exercise
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27
Rheumatoid Arthritis
Autoimmune disorder
Causes inflammation and tissue damage in joints; can also cause anemia, inflammation in lungs, eyes, and pericardium; SQ nodules under the skin.
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Rheumatoid Arthritis Clinical Manifestations
Pain and Stiffness in joints (particularly in the wrist hands, elbows, shoulders, knees and ankles)
Reduced ROM
Affects both sides equally
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Drugs used to treat Rheumatoid Arthritis
Methotrexate
| Entaracept (DMARDs)
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Methotrexate
Inhibits lymphocyte multiplication
| Can be used to treat psoriasis and RA
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Entanercept
Used to treat RA and psoriasis
| Patients must be screened for latex allergy (some dosage forms may contain latex)
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Adverse effects of Methotrexate
*Bone Marrow Suppression
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Adverse Effects of Etanercept
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Headache
Injection Site Reaction
URT Infection
Dizziness
Weakness
```
34
What is MS?
Autoimmune response which causes:
1. Degeneration of CNS myelin
2. Scarring in brain
3. Loss of axons
35
Pathophysiology of MS
Autoreactive T and B cells cross the blood-brain barrier and recognize myelin and oligodendrocyte autoantigens
Triggers inflammation and loss of oligodendrocytes (myelin producing cells)
Activation of brain macrophages contribute to inflammation and injury with plaque formation and axonal degeneration
Loss of myelin disrupts nerve conduction and death of neurons and brain
36
Clinical Manifestations of MS
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Most common:
Parasthesia of the face, trunk, or limbs
Weakness (all four limbs)
Impaired gait
Visual disturbances
Urinary incontinence
```
37
Treatment options for MS
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Corticosteroids
Immunosuppressants
Immune system modulators
Plasma exchange, stem cell therapy
Regular exercise, smoking cessation, decrease stress and extreme fatigue; decrease heat exposure
```
38
Hepatitis B
Milder than Hep C, but can lead to chronic hepatitis or liver failure and death.
Transmission through blood and body fluid exposure, maternal-baby exchange.
39
Clinical Manifestations of Hepatitis B
..
40
What are the phases of Hepatitis B?
Prodromal
Icteric
Recovery Phase
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Prodromal phase
Lasts 1-21 days.
Begins 2 weeks post exposure and ends with appearance of jaundice (fatigue, anorexia, malaise, N/V, HA, cough and low-grade fever)
42
Icteric Phase
1-2 weeks after prodromal phase and lasts 2-6 weeks.
The movement of jaundice occurs.
Hepatosplenomegaly, dark urine and clay color stool.
Acute phase of illness.
43
Recovery Phase
2-4 months.
Begins with resolution of jaundice (average 6-8 weeks after exposure)
Symptoms diminish but hepatomegaly remains.
44
What drugs are used to treat Hepatitis B?
Telbivudine
45
Adverse Effects of Ribavirin
Rash
Conjunctivitis
Anemia
Mild Bronchospasm
46
Adverse Effects of Sofosbuvir
Few side effects: Fatigue, headache, nausea, difficulty sleeping
When taken with amiodarone, may cause slow heart rate which can lead to death
47
Adverse Effects of Interferon
Fatigue, muscle aches, fever/chills
| Loss of appetite, suppression of bone marrow and production of red blood cells.
48
Interferon
Stimulates the body’s immune system to clear the virus.
| Good for acute!
49
Ribavirin
Antiviral Nucleoside analog: Inhibits protein synthesis and viral replication.
Mimics the DNA virus.
50
Sofosbuvir
RNA polymerase inhibitor for the treatment of Hep C.
Can be given without interferon.
Used in combination with ribavirin. Not to be used as monotherapy.
51
What is the function of the liver?
1. Stores large amounts of blood
2. Synthesis of all clotting factors
3. vitamin K storage
4. Kupffer cells
5. Fat synthesization
6. Synthesizes phospholipids and cholesterol
7. Synthesizes plasma proteins
8. Synthesizes serum enzymes
9. Gluconeogenesis
10. Detoxification
11. Storage of minerals and vitamins
12. Bile production
52
What are the clinical manifestations of liver disorders?
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Portal Hypertension
Ascites
Hepatic Encephalopathy
Jaundice
Hepatorenal Syndrome
```
53
Causes of acute liver failure
Acetaminophen OD
Viruses including hepatitis A, B, and C
Reaction to prescription/herbal medication
Ingestion of wild mushroom
54
Causes of chronic liver failure
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Virus -esp B and C
Hemochromatosis (too much iron storage)
Severe malnutrition
Long term alcohol consumption
Cirrhosis
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55
Cirrhosis
Irreversible inflammatory disease that disrupts liver function and structure.
Normal liver cells are replaced with scar tissue -> fibrosis
56
Pathophysiology of Cirrhosis
1. Inflammation
2. Fibrosis and scarring -> portal HTN, splenomegaly, varices, decreased bilirubin matabloism -> increased unconsummated bilirubin (remains fat soluble) -> jaundice
3. Decreased bile in the GI -> light/clay colored stool
4. Decreased fat digestion -> decreased Vitamin K -> decreases clotting factors -> increases bleeding tendencies.
5. Increased urobilinogen -> concentrated dark urine.
6. Decreased protein hormones like angiotensinogen -> activates compensatory
7. Increased ammonia and presence of toxic substances -> encephalopathy
57
Treatment for Cirrhosis includes
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Beta blockers
Nitrate
Diuretics
Lactulose
FFP
Neomycin/Metronidazole
```
58
Diuretics
Spironolactone: Potassium Sparing
Furosemide: Decreases K
Hydrochlorothiazide: Decreases K
59
Vitamin K
Treats and prevents unusual bleeding by increasing body’s production of clotting factors.
60
Lactulose
Is a laxative -> traps toxic compounds in the colon -> loosening or increasing frequency of stools.
61
Adverse Effects of Diuretics
Drop in Ca, take calcium supplements
62
Adverse Effects of Vitamin K
- Pain, swelling, soreness @ injection site
- Flushing, taste changes, dizziness, rapid heart beat
- Sweating and SOB
63
Adverse Effects of Lactulose
Gas, bloating, burping, stomach pain, nausea and cramps.
| Serious side effects: excessive diarrhea, vomiting, muscle cramps/weakness
64
Hepatitis C
Responsible for most cases of post-transfusion hepatitis.
Also implicated in infections related to IV drug use.
No vaccine yet.
65
Hepatitis C Exposure
50-80% of hepatitis C cases result in chronic hepatitis
66
Clinical Manifestations of Hepatitis C
..
67
Phases of Hepatitis C
1. Prodromal
2. Icteric
3. Recovery
68
What drugs are used to treat hepatitis C?
1. Interferon
2. Ribavirin
3. Sofosbuvir
69
Telbivudine
Nucleoside analogue reverse transcriptase inhibitor
| Treats hep B
70
Adverse Effects of Telbivudine
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Fatigue
Headache
Diarrhea
Nausea
Pain in joints and muscles
```
71
What types of immune responses occur after an organ transplant?
Often humoral response - acute (Antibodies destroy transplanted tissue within days)
Cell mediated response is slower, about 2 weeks after surgery - chronic
72
MHC molecules
The antigens that the body recognizes as foreign
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Tissue Rejection occurs in 2 Stages
1. Sensitization: lymphocytes are alerted and respond to foreign MHC molecules. Rapid proliferation stage.
2. If body is not suppressed adequately: the graft is then destroyed by everlasting cellular and molecular mechanisms.
74
Types of Rejection: 3 Phases
1. Hyperacute rejection
2. Acute Rejection
3. Chronic Rejection
75
Hyperacute Rejection
Occurs within 24 hours, the graft isn’t vascularized into the body usually d/t the presence of preexisting antibodies that try to fight off the antigen.
76
Acute Rejection
Occurs within 1st week, HLA given to the patient matches patient HLA and host will not reject the graft or there is mismatching blood transfusions and the body makes antibodies to attack antigens which lead to rejection.
77
Chronic Rejection
Occurs in several years, resulting from multiple types of acute rejection that the body goes through.
Put on long term immunosuppressive agents.
78
Patients with SLE usually die due to
Complications of disease i.e infection or renal effect
79
Zidovudine: MOA
Structurally like thymine in DNA structure, so it will mimic the reverse transcriptase and cause an ineffective DNA strand.
80
Liver Function: Storage of large amounts of blood
In cases of hemorrhage or trauma, liver is able to maintain adequate amounts of blood
81
Liver function: synthesis of all clotting factors
Prothrombin, fibrinogen and factors I, II, VII, IX and X.
82
Liver Function: Vitamin K
Vit K is essential for synthesis of other clotting factors -> absorption of K depends on adequate bile production.
(So if liver isn’t function to synthesize and produce bile -> inadequate synthesis of Vit K occurs -> inadequate synthesis of other clotting factors)
83
Liver Function: Kupffer cells
Play important role in destroying intestinal bacteria and preventing infections. (Important cell in liver that allows the liver to actually fight bacteria)
84
Liver Function: Fat Synthesis
Fat is synthesized from carbohydrates and protein
85
Liver Function: Synthesis of plasma proteins
Including albumins (maintains oncotic pressure) and globulins (RBC production)
86
Liver Function: Synthesizes serum enzymes
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Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Lactate dehydrogenase (LDH)
Alkaline phosphatase (ALP
```
87
Liver Function: Gluconeogenesis
Responsible for the production of glucose when there is a glucose imbalance.
88
Liver Function: Detoxification
Metabolic detoxication or bio transformation -> diminishes intestinal or renal tubular reabsorption of potentially toxic substances and facilitates intestinal and renal excretion.
89
What kinds of substances are metabolized or detoxified in the liver?
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Alcohol*
Barbiturates*
Amphetamines
Steroids*
Hormones (aldosterone, estrogens, antidiuretic hormone, testosterone)
```
90
Liver Function: Storage of minerals and Vitamins
ADEK and Vitamin B12
Iron (ferritin)
Cu
91
Liver Function: Bile Production
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Fat digestion
Conjugated bile (amino acid +protein + cholesterol + bile salts)
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