Wk 2 Antivirals Flashcards
When do antivirals work?
it must get inside the host cells when the virus is still replicating
Often times, the virus has finished…
replicating when signs and symptoms develop
Antivirals can also kill…
healthy cells
A virus is a __ microbe
parasitic
Viruses do not have a __ __ of their own
cell wall
How does a virus live?
Inserts it’s own DNA or RNA into our cells
List some viruses we are able to treat
HSV, HZV, flu, RSV, HIV, CMV, hepatitis
What is acyclovir used to treat?
HSV
What are the routes for acyclovir?
oral tablets liquid topical IV
3 MOA of acycolvir
Interferes with nucleic acid synthesis
Prevents virus from binding
Stimulates immune response
Acyclovir side effects
Gi distress, renal impairment, seizures, ITP
Tissue necrosis in IV form
The shingles vaccine is a __ vaccine
live
What is Shringrix?
Herpes zoster vaccine for those over 50
What does oseltamivir do?
mostly active against flu A but also some flu B
What is the MOA of oseltamivir?
Inhibits neuroamidases
What route is oseltamivir?
only PO
What are the side effects of oseltamivir?
N/V
seizures
renal impairment
What is ganciclovir?
antiviral that treats cytomegalovirus (CMV)
Who is ganciclovir for?
Immunosuppressed people like HIV or transplant patients
What is the MOA of ganciclovir?
Inhibits DNA polyamerases, stops replication
What routes are ganciclovir?
IV and PO
If you crush ganciclovir and get it on your skin, what should you do?
wash hands with soap and water
What are the black box warnings for ganciclovir?
Hematologic toxicity
Fertility impairment
Fetal toxicity
Carcinogenesis
Who has the highest prevalence of HIV?
Black men
What does HIV target?
CD4 on t cells
a mutation of __ actually blocks some strains of HIV from entering the cell
CCR5
First HIV __ to the cell membraine
fuses
Once inside HIV
replicates inside the cell and then moves into the nucelus
Final stage of replication, the virus creates
HIV protease
What re the 7 stages of HIV replication
Binding Fusion Reverse transcription Integration Replication Assembly Budding
A TB skin test for a patient with HIV will be…
False negative
What does HIV use to replicate after it has been integrated into the nucleus?
protease
What are the hallmarks of HIV infection?
Decrease in CD4 t helper cells
Proliferation of HIV particles
What is a normal cd4 t cell count?
Between 500-1500
Early stage of HIV
No antibodies
Infectious
Seroconversion - flu like symptoms
Clinical latency/chronic HIV
Last 3-12 yrs
Asymptomatic or mild symptoms
Stable virus levels
Rapid virus production
body defenses are less effective and person enters symptomatic stage of HIV, has AIDS
AIDS is CD4 count below
200
Thrush is often seen in the __ phase of HIV
acute
White lesions on lateral margins of the tongue occur in
all stages of HIV infection, oral hairy leukoplakia
periodontal disease is common in
all stages of HIV
What are fungal aids defining illnesses
Pulmonary/esophageal candidiasis
Pneumocystitis carinii jiroveci pneumonia
What are viral aids defining illnesses
CMV
HSV chronic ulcer over a month, pulmonary or esaphageal
What are protozoal aids defining illnesses
toxoplasmosis
isoporiasis
cryptosporidiosis
What are bacterial aids defining illnesses
mycobacterium
recurrent pneumonia
salmonella septicemia
What are cancerous aids defining illnesses?
Kaposi’s sarcoma
Cervical cancer
Lymphomas
3 other aids defining illnesses
Wasting syndrome
Encephalopathy
AIDS demential complex
Why has HIV associated dementia decreased?
antiretroviral therapy
4 reasons someone who is exposed doesn’t develop HIV
Duration/frequency of contact
Concentration of virus
Host immune status
Genetic protective factors - defective ccrd
3 methods of transmission
unprotexted sex
parenteral
mother-child
3 things that further increase risk of HIV
oral sex
anal sex
lack of circumcision
How long are babies treated after being born for HIV?
6 weeks
Combination of 3 or 4 drugs to treat HIV is called…
HAART - highly active anti retroviral therapy
3 reasons to use HAART instead of mono therapy
delay or reserve loss of immune function
prplongs life
decreases aids related complications
What are the drawbacks of HAART?
Expensive
long term side effects
drug interactions
life long
CCR5 antagonist
Maraviroc
Fusion inhibitor
Enfurvirtide
Protease Inhibitor
Lopinavir/Ritonavir
Integrase Inhibitor
Raltegravir
Reverse transcript inhibitors
Zidovudine
Efavirenz
Zidovudine NRTI side effects
Severe anemia and neutropenia
Lactic acidosis in female or obese patients
Efavirenz NNRTI side effects
Rash, CNS symptoms
Inhibits p450 system drug interactions
Reltegravir side effects
Well tolerated
Metabolized but UGT caution with other UGT inhibitors
Lopinavir/Ritonavir side effects
Hyperglycemia, lipodystrphy, hyperlipidemia, bones loss
Enfuvirtide side effects
sq bidInjection site reactions
Pneumonia
Hypersensitivity
Maraviroc side effects
Only works with certain strains of HIV, black box liver, drug interaction CYP 3A4. Teach about signs of reaction
What is prep?
Trivada for those at highest risk of new infection
How often are patients on prep followed up with HCP?
every 90 days
What is pep?
Post exposure prophylaxis
When should pep be administered?
2-3 hours after exposure, effectiveness reduced after 72 hours
When is person on pep tested?
6 and then 12 weeks after exposure
