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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
Alfa-Interferons ADR/SE | for HBV
flu-like s/s, fatigue, neutropenia, depression, alopecia, N/V/D, anorexia
26
Alfa-Interferons Black Box Warning
may cause worsen autoimmune, infections & ischemic conditions. serious neuropsychiatric conditions => SI/suicide
27
Interferon alfa-2b: ____, & are administered _____.
short half-life 3x/week
28
Peginterferon alf-2a: ____, & are administered _____.
long-acting 1x/week
29
30
HCV (hep C) treatment goal:
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
HCV recommended therapy
* 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
Protease Inhibitors (**Glecaprevir**, brazoprevir, paritaprevir, ritonavir, simeprevir) pharmacokinetics : | HCV drugs
* approved for genotype 1 or 4 * always needs to be used w/ other anti-HCV drug * food enhances absorbtion availabitlity to 62%
33
Protease inhibitors ADR
hepatic injury signinficant photosensitivity rashes
34
Protease Inhibitors Nurisng Considerations
* 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
NS5A Inhibitors: Pibrentasvir | HCV drug
combined w/ glecaprevir trade name: mavyret treats genotypes 1-6
36
pibrentasvir is CI w/
moderate to severe hepatic impairment
37
Overall HCV Nursing Considerations
* 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
NPI Sofobuvir SE
HA, fatiue
39
Sofobuvir Drug interactions
amiodarone => bradycarcia
40
HIV
retorvirus targets CD-4 cells replicates & mutates rapidly spread trhough bodily fluids (blood, breast milk, semen, vaginal fluids)
41
HIV med goals | 5
U-U - maximal viral load suppression, restore/preserve immune function improve quality of life (QoL) reduce morbidity & mortality prevent HIV transmissions
42
HIV initial phase
rapid replication, flu like symptoms
43
HIV middle phase
prolonged clinical latency, up to 10 yrs
44
HIV last phase
AIDS ooportunistic infections CD-4 t-cells count < 200 cells/ml
45
Why do we monitor CD4 tcells & viral load?
assess immune function & renal function you want CD4 count to be HIGH & Viral load (amount of HIV in blood) to be LOW =healthy
46
why are 3 antiretroviral drugs from different classes used for HIV therapy?
taking a combination of HIV medication every day prevents HIV from destorying CD4 cells and helps lower viral load
47
Preexposure prophalaxis (PrEP) for HIV
tenofovir/emtricitabine; for individuals who are HIV negative, take 7-21 days for max effectiveness
48
HIV med treatment (while awaiting restance testing) | 3 options
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
NRTIs: **Emtricitabine ** MOA
inhibits HIV reverse transcriptase=> viral DNA chain termination
50
NRTIs Emtricitabine considerations
reduced dosage for CKD assess HBV status helps w/ lowering HBV DNA (not FDA approved)
51
NRTI: Tenofovir ADRs
lactic acidosis hepatomegaly w/ steatosis ARF
52
Tenofovir SE
Renal liver function
53
Tenofovir considerations
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

Pharm EXAM 3 (8 decks)

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