Tx of viral skin infections

Question 1

topical drugs move in 3 ways to reach their target

Answer 1

1. transcellularly
2. paracellularly
3. via the appendages (hair follicles)

Question 2

which drugs can be given PO only (3)

Answer 2

famciclovir, valacyclovir, valganciclovir

Question 3

name the drugs that can be given IV only (2)

Answer 3

cidofovir, foscarnet

Question 4

name the drugs that can be given IV/PO (2)

Answer 4

ganciclovir, acyclovir

Question 5

which skin condition requires immediate in hospital IV acyclovir

Answer 5

dermatitis herpatiformes

(HSV infection on top of atopic dermititis

Question 6

which drugs are pro drugs

Answer 6

valacyclovir–> acyclovir
valganciclovir–> ganctyclovir
famciclovir–>penciclovir

Question 7

tx for pox family viruses (1)

Answer 7

cidofovir

Question 8

Tx for varicella zoster (shingles) (3)

Answer 8

acyclovir, valacyclovir, famcivlovir,

Question 9

tx for varicella chicken pox (2)

Answer 9

acyclovir, valacyclovir

Question 10

tx for HHV-6 (4)

Answer 10

cidofovir, foscarnet, ganciclovir, valganciclovir

Question 11

tx for HHV-7 (1)

Answer 11

cidofovir

Question 12

tx for HHV-8 (aka KSHV) (4)

Answer 12

cidofovir, famciclovir, ganciclovir, valacyclovir

Question 13

tx for HHV-8 infection*??

Answer 13

ganciclovir, valganciclovir

Question 14

used to treat herpes labialis

Answer 14

penciclovir–> a metabolite of famciclovir

Question 15

acyclovir used to treat

Answer 15

varicella zoster and varicella chicken pox

Question 16

cidofovir usewul against

Answer 16

pox viruses, HHV6, 7 and 8 (not active)

Question 17

famciclovir used to treat

Answer 17

varicella zoster, HHV8 (not active)

Question 18

foscarnet used to treat

Answer 18

HHV-6

Question 19

gaciclovir used to treat

Answer 19

HHV6, HHV8, HHV8 active

Question 20

valacyclovir used to treat

Answer 20

Varicella zoster, varicella chicken pox, HHV8 (not active)

Question 21

Valganciclovir used to treat

Answer 21

HHV-6, HHV 8 active

Question 22

describe herpes virus

Answer 22

linear, DNA, enveloped, icosahedral

Question 23

herpes virus life cycle

Answer 23

attachment, entry, uncoating, localisation to the nucleus
>immediate early proteins transcribed
>DNA replication
>bulk of genes (late genes) exressed
>late proteins incorporated into forming new virion progeny
>release/lysis

Question 24

name the immediate early genes

Answer 24

thymidine kinase

DNA polymerase

Question 25

drugs that inhibit DNA polymerase after transcription of the Immediate early gene products

Answer 25

foscarnet, ganciclovir, acyclovir, valacylovir, valganciclovir, cidofovir *i think its just all of them

Question 26

DNA viruses translate mRNA into protein using....

Answer 26

host ribosomes

Question 27

how does acyclovir and valacyclovir work in the nucleus

Answer 27

viral thymidine kinase (an immediate early gene product)--> takes it from AMP--ATP..then it is preferentially encorporated into the gorowing DNA replicating chain...the chain is then terminated

Question 28

why does acyclovir cause chain termination

Answer 28

lacks the 3' oh group needed for addition of new subunit

Question 29

ganciclovir/ valganiclovir have what difference from vala and acyclovir

Answer 29

they HAVE the 3' OH group...so further DNA synthesis is possible once encorporated

Question 30

foscarnet acts via

Answer 30

pyrophosphate binding site of viral DNA polymerase (a immediate early product) AS WELL AS REVERSE TRANSCRIPTASE--> prevents celavage of pyrophosphate (Pi-Pi) from nucleotide triphosphate--> stalling further primer template extension *stuck in the PPP form--> needs to be P form)

Question 31

which drugs competitively inhibit viral DNA polymerase; compete with dGTP for incorporation into viral DNA

Answer 31

``` Acylovir valacyclovir ganciclovir valganciclovir famciclovir ```

Question 32

Cidofovir MOA

Answer 32

competitively inhibit viral DNA polymerase; compete with dCTP for incorporation into viral DNA

Question 33

KINASE DEFICIENT viral strains (not encoding a thymidine kinase) are resistant to which drugs

Answer 33

* drugs that require activation and triple phosphorylation to their active products 1. Acyclovir 2. Valacyclovir 3. Famciclovir 4. ganciclovir 5. Valaganiclovir

Question 34

drugs that will work on kinase deficient strains

Answer 34

cidofovir foscarnet *administered in their active state, do not require phosphorylation to be active

Question 35

metabolism for all of these drugs

Answer 35

little metab renally eliminiated dose adjustment needed if renal failure..if not all can cause renal failure

Question 36

lest side effects and best tolerated anti-viral

Answer 36

famcivlovir

Question 37

ADE's for acyclovir and valacylvovir

Answer 37

neurotoxicity and seizures

Question 38

ADE's for cidofovir

Answer 38

nephrotoxicity | minitor creatinine and urinary protein

Question 39

drug that requires probenacid prophyllaxis and normal saline

Answer 39

cidofovir

Question 40

ADE'S FOR FAMCICLOVIR

Answer 40

NONE

Question 41

ade's for foscarnet

Answer 41

electrolyte imbalance | chelate Calcium ions

Question 42

ADE's for gancilclovir and valnagciclovir

Answer 42

anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia, teratogen

Question 43

proven teratogens

Answer 43

ganciclovir | valganciclovir

Question 44

which drugs will have cross reactive hypersensitivity

Answer 44

``` acyclovir famciclovir ganciclovir valacyclovir valganciclovir ```

Question 45

treating HHV6 with Valganciclovir or Ganciclovir->and have a hypersensitivty reaction-> can switch to

Answer 45

cidofovir or foscarnet

Question 46

treating HHV-8 (not active) with Fam,Gan or Val and have hypersensitivity reaction...can switch to

Answer 46

cidofovir-- only thing effective and non-allergic