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Pharm EXAM 3 > TB, Virus, Parasites > Flashcards

TB, Virus, Parasites Flashcards

1
Q

Anti-Viral angents include

A
  • Covid-19
  • Herpes Simplex Virus (I & II)
  • Influenza
  • Heb B
  • Heb C
  • HIV
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2
Q

Covid-19 vaccines SE

A

local injection site reactions
systemic symptoms; fevers, chills, fatigue, myalgias, HA

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3
Q

Eligibility for outpatient Covid-19 specific therapy

A

age >65 yr-old
are immunocompromised
multiple medical comorbidities
are >50 yr-old & unvaccinated

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4
Q

Nirmatrelvir MOA

A

inhibits viral replication

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5
Q

Ritonavir MOA

A

pharmacokinetic enhancer w/ no activity against SARS-CoV-2 but inhibits CYP3A-mediated metabolism of nirmatrelvir => increased nirmatrelvir plasma concentration

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6
Q

Why are nirmatrelvir & ritonavir given together?

A

Ritonavir is going to hlep Nirmatrelvir work better

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7
Q

Nirmatrelvir & Ritonavir are recommended to be given within ___ days of symptoms

A

5

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8
Q

Nirmatrelvir & Ritonavir
ADR/SE:

A

GI: diarrhea, dysgeusia (taste disorder)

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9
Q

Acyclovir (Zorirax/Sitavig) Indication

A

Herpes Simplex Virus (HSV) & Varicella Zoster Virus (VZV)
Anti-herpes med- NOT A CURE- decreases s/s

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10
Q

Acyclovir MOA

A

interferes w/ DNA chain replication

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11
Q

Acyclovir ADR/SE

A

*** Nephrotoxicity **(especially w/ IV)
* Seizures
* SJS
* N/V/D
* dizziness
* HA
* pain with IV-phlebitis

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12
Q

Acyclovir Nursing CONSIDERATIONS

A
  • med compliance lessens episodes. Start tx ASAP
  • avoid sexual contact w/ lession present, use condoms, use gloves to assess lession
  • may feel fatigued when starting to take the med
  • Monitor renal function before/during therapy
  • disseminated VZV airborne & contact precautions
  • women w/ genital herpes- yr pap smears=> increased r/f cervical cancer
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13
Q

Oseltamivir (Tamiflu)
SE

Anti-flu

A

N/V/HA

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14
Q

Oseltamivir (Tamiflu)
ADR

A

neuropsychiatric symptoms
(psychosis)

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15
Q

Oseltamivir (Tamiflu)
Nursing Considerations

A
  • flu last 5-10 days, w/ 3-5 being the worst w/ symptoms
  • not curable, but speeds up viral shedding
  • helps lessen symptoms up to 3 days (if given w/in 12hrs of onset)
  • only can be given w/in the 48hrs of symptoms
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16
Q

HBV (hep B)
acute & chronic infections can lead to

B for babies & blood

A

cirrhosis, hepatic failure, hepatocellular carcinoma & death

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17
Q

Whats the therapy goal for HBV?

A

HBV DNA suppression & loss of HBeAG & HBsAG

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18
Q

What are the 6 drugs that treat chronic HBV?

A
  1. Alfa-interferons
    * interferon alpha-2b
    * peginterferon alpha-2a
  2. Nucleoside Analogs
    * **lamivudine
    * adefovir
    * entecavir
    * tenofovir **
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19
Q

Which HBV med is reccomended to start with for treatment?

A

tenofovir alafenamide 25 mg daily
(low drug-resistance & potent)

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20
Q

What are the two formulations of (NRTI) Tenofovir

used for chronic HBV & HIV

A
  • Tenofovir Alafenamide (TAF)
  • Tenofovir Disoproxil Fumarate (TDF)
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21
Q

Tenofovir Alafenamide (TAF) is used as …

A

1st line therapy in tx & its the better option for renal impairment or osteoporosis

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22
Q

Tenofovir ADR

A
  • lactic acidosis
  • hepatomegaly w/ steatosis
  • ARF
23
Q

Tenofovir SE

TDF only

A
  • rash
  • depression
  • HA
24
Q

Tenofovir Nursing Considerations

A
  • Assess renal & liver function
  • teach- concurrent use of NSAIDs & other nephrotoxic drugs may increase risk of ARF, take as directed
  • use birth control to avoid pregnancy
25
Q

Alfa-Interferons ADR/SE

for HBV

A

flu-like s/s, fatigue, neutropenia, depression, alopecia, N/V/D, anorexia

26
Q

Alfa-Interferons Black Box Warning

A

may cause worsen autoimmune, infections & ischemic conditions.
serious neuropsychiatric conditions => SI/suicide

27
Q

Interferon alfa-2b: ____, & are administered _____.

A

short half-life
3x/week

28
Q

Peginterferon alf-2a: ____, & are administered _____.

A

long-acting
1x/week

29
Q
A
30
Q

HCV (hep C)
treatment goal:

A

CURE
* Medications decrease HCV RNA levels w/ decreased severity & sequelae of HCV.
* After 12 months of tx-
* ALT normalizes in up to 50% of patients
* HCV-RNA levels are undetectable in up to 40% of patients

31
Q

HCV recommended therapy

A
  • Recommended Naïve Patient with or without Cirrhosis Regimens: Glecaprevir 300mg/pibentasivir 120 mg x 8 weeks (PROTOTYPE); or sofobuvir 400mg/velpatasivr 100 mg x 12 weeks - (without cirrhosis)
  • Obtain HCG test prior to tx
32
Q

Protease Inhibitors
(Glecaprevir, brazoprevir, paritaprevir, ritonavir, simeprevir)
pharmacokinetics :

HCV drugs

A
  • approved for genotype 1 or 4
  • always needs to be used w/ other anti-HCV drug
  • food enhances absorbtion availabitlity to 62%
33
Q

Protease inhibitors ADR

A

hepatic injury
signinficant photosensitivity
rashes

34
Q

Protease Inhibitors
Nurisng Considerations

A
  • screen for HBV as hepatic failure & death have occured
  • needs negative pregnancy test
  • Monitor HCV RNA levels & Liver function tests
  • Educate to wear sunscreen & protective clothing
  • call provider ASAP for s/s hepatotoxicity, rash or photosensitive rash (burning redness, swelling, blisters)
35
Q

NS5A Inhibitors: Pibrentasvir

HCV drug

A

combined w/ glecaprevir
trade name: mavyret
treats genotypes 1-6

36
Q

pibrentasvir is CI w/

A

moderate to severe hepatic impairment

37
Q

Overall HCV
Nursing Considerations

A
  • HCV 1-time screening for US asymptomatic adults w/out liver disease ages 18-79
  • record current meds
  • Monitor & educate about drug interactions
  • Educate proper med administration, adherence, prevention of reinfection
  • Cost (consider economic status)
  • Assess LABS
  • avoid alcohol
38
Q

NPI Sofobuvir SE

A

HA, fatiue

39
Q

Sofobuvir Drug interactions

A

amiodarone => bradycarcia

40
Q

HIV

A

retorvirus targets CD-4 cells
replicates & mutates rapidly
spread trhough bodily fluids (blood, breast milk, semen, vaginal fluids)

41
Q

HIV med goals

5

A

U-U - maximal viral load suppression,
restore/preserve immune function
improve quality of life (QoL)
reduce morbidity & mortality
prevent HIV transmissions

42
Q

HIV initial phase

A

rapid replication, flu like symptoms

43
Q

HIV middle phase

A

prolonged clinical latency, up to 10 yrs

44
Q

HIV last phase

A

AIDS
ooportunistic infections
CD-4 t-cells count < 200 cells/ml

45
Q

Why do we monitor CD4 tcells & viral load?

A

assess immune function & renal function
you want CD4 count to be HIGH & Viral load (amount of HIV in blood) to be LOW =healthy

46
Q

why are 3 antiretroviral drugs from different classes used for HIV therapy?

A

taking a combination of HIV medication every day prevents HIV from destorying CD4 cells and helps lower viral load

47
Q

Preexposure prophalaxis (PrEP) for HIV

A

tenofovir/emtricitabine; for individuals who are HIV negative, take 7-21 days for max effectiveness

48
Q

HIV med treatment
(while awaiting restance testing)

3 options

A

1.dolutegravir + tenofovir & emtricitabine or lamivudine
2. bictegravir- tenofovir alafenamide-emtricitabine (Biktarvy) a single pill cost $4300.56/month
3. Ritonavir-darunavir + tenofovir & emtricitabine or lamivudine

49
Q

NRTIs: **Emtricitabine **
MOA

A

inhibits HIV reverse transcriptase=> viral DNA chain termination

50
Q

NRTIs Emtricitabine
considerations

A

reduced dosage for CKD
assess HBV status
helps w/ lowering HBV DNA (not FDA approved)

51
Q

NRTI: Tenofovir ADRs

A

lactic acidosis
hepatomegaly w/ steatosis
ARF

52
Q

Tenofovir SE

A

Renal
liver function

53
Q

Tenofovir considerations

A

assess renal & liver function
teach use of NSAIDs & other nephrotoxic drugs may increase risk of ARF, take as directed
Use birth control to avoid pregnancy

54
Q
A

Pharm EXAM 3 (8 decks)

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