Term
| what is a viral capsule composed of |
|
Definition
| lipid envelope with antigenic glycoproteins |
|
|
Term
| where do viruses replicate |
|
Definition
| in the cytoplasm except influenza which replicates in the nucleus |
|
|
Term
| how do DNA viruses replicate there genetic materia, give 5 examples |
|
Definition
DNA transcribed into mRNA by host polymerase
herpes: chicken pox, shingles, CMV
HepB |
|
|
Term
| RNA viruses: how do they replicate their genetic materia, give 5 examples |
|
Definition
mRNA is translated directly into viral proteins via viral RNA polymerase
rubella, HepC, polio, rhinovirus, influenza |
|
|
Term
| two examples of retroviruses |
|
Definition
|
|
Term
| what is the prefered way for anitvirals to work |
|
Definition
| stop virus rather than host cell directed synthesis |
|
|
Term
| what type of virus is HIV classified as (4 ways) |
|
Definition
lentivirus
mammalian, retro, or enveloped virus |
|
|
Term
| what are the three major parts to the HIV genome, what is their general function |
|
Definition
gag: major structural proteins
pol: reverse transcriptase and viral integrase
env: envelope protein for cell binding and entry |
|
|
Term
| what 3 proteins does env make, what do they do |
|
Definition
env protein (GP160) binds CD4 receptor on lymphocytes and macrophages
Gp41 domain: part of env that controls fusion of the virus lipid bilayer with host cell
CCr5: co-receptor required for binding on macrophages |
|
|
Term
| what are the common clinical presentations of HIV |
|
Definition
mononucleosis like
fever
pharyngitis
adenopathi
erythmatous macular or maculopapular rash
primary infection associated with high viral load
persistant decrease in CD4 |
|
|
Term
| what are the aids interventions |
|
Definition
no cure
administer perscribed medications
treat opportunistic infections
maintain standard percautions
psychosocial, financial, or occupational support |
|
|
Term
| what is a NRTI, which 5 do we need to know, what are their abrevirations |
|
Definition
nucleoside reverse transcriptase inhibitor
Zidovudin (AZT, ZDV), didanosine (DDI), lamivudine (3TC), abacavir (ABV), emtricitabine (FTC) |
|
|
Term
| what is a antimetabolite, what drug is an example of this |
|
Definition
drug that looks like something in the body
NRTI |
|
|
Term
| what is the MOA of a NRTI |
|
Definition
• Must be phosphorylated to the 5-triphosphate moiety to be active
• HIV does not encode viral kinases so phorphorlyation is by host kinases and phospotransferases
• 5-triphosphate-DRUG prematurely terminates DNA elongation and competes with natural deoxynucleotides for reverse transcriptases |
|
|
Term
| what are the base analogs involved with each of the NRTI drugs, why do we care |
|
Definition
• Thymidine: AZT, d4T
• Cytosine: 3TC, ddC, FTC
• Adenosine: ABV
• Inosine: ddI
because you cant use to of the same base analogs together |
|
|
Term
| what resistance concerns do we have with NRTIs |
|
Definition
| develops due to mutation of reverse transcriptase |
|
|
Term
| what are the elimination methods of the NRTIs |
|
Definition
• AZT, ABV: eliminated by liver metabolism (glucuronidation)
• D4T, 3TC, ddC, ddI: eliminated by kidney |
|
|
Term
| what are the adverse effects of AZT, what type of drug is this |
|
Definition
bone marrow supression
NTRI |
|
|
Term
| what are the adverse effects of ddl, what type of drug is this |
|
Definition
|
|
Term
| what are the adverse effects of ABV, what type of drug is this |
|
Definition
|
|
Term
| what side effects do most NTRIs have, what predispositions |
|
Definition
lactic acidosis especially in renal issues
peripherial neuropathy is very common |
|
|
Term
| what are the two safest NTRIs, what is wrong with this |
|
Definition
| 3TC and FTC, they are both cytosine analogs and cannot be used together |
|
|
Term
| what is a NtRTI what drg do we need to know, what is the naming warning |
|
Definition
nucleotide reverse transcriptase inhibitor
tenofovir
has an -ovir but isnt a herpes drug |
|
|
Term
| what is the composition of tenofovir |
|
Definition
| conformulated with entricitabine (truvada), combivir, or enzicon |
|
|
Term
| what is the function of a conformulation |
|
Definition
perferred nucleoside analog combination due to overall efficacy, favorable toxicity, and convenience of dosing
reduce pull burdon and increase pt compliace |
|
|
Term
| what is the MOA of tenofovir |
|
Definition
| single phosphate on surfar nucleotide residue must be phosphorlyated to the active form (tenofovir triphosphate) by the host |
|
|
Term
|
Definition
| in combination with other antiretroviral agents (like a NRTI) |
|
|
Term
| what are the adverse effects of tenofovir |
|
Definition
|
|
Term
what is a NNRTI
what drugs do we need to know |
|
Definition
non-nucleoside reverse transcriptase inhibitor
efacirenz, nevirapine, rillpivirine, etarvirine |
|
|
Term
|
Definition
bind to reverse transcriptase below catalytic site (allosteric inhibition) causing enzyme inactivation
does not require phosphorlyation to become active |
|
|
Term
| what are the resistance issues with NNRTIs |
|
Definition
major issue
develops rapidly and can cause cross resistance with other agents
resolved by combination therapy |
|
|
Term
| what are the pharmacokinetics of the NNRTIs |
|
Definition
nevirapine and efavirenz have good CNS presentation
some P450 effects |
|
|
Term
| what are the adverse effects of NNRTIs |
|
Definition
maculopapular rash
CNS effects with efavirenz |
|
|
Term
| what are the function of proteases in viruses |
|
Definition
|
|
Term
| what are the protease inhibitor drugs we need to know |
|
Definition
| Ritonavir, lopinavir, atazanavir, darunavir |
|
|
Term
| what is the MOA of a protease inhibitor |
|
Definition
| HIV-1 proteast inhibited. it normal cleaves viral precurose proteins so this stops mature virons |
|
|
Term
| what are the resistance issues with PIs |
|
Definition
| mutation of protease causes some |
|
|
Term
| what are the pharmacokinetics |
|
Definition
take with food
indinavir and amprenavir noo need for food |
|
|
Term
|
Definition
• sulfonamide allergy with darunavir (sulfa drugs)
• GI upset, nausea, vomiting, diarrhea (esp nelfinavir)
• Disordered lipid and carb metabolism: central adiposy and insulin release (fat deposition). The longer the use of the drug the more likely to happen |
|
|
Term
| what interactions are there with PIs |
|
Definition
• All protease inhibitiors inhibit P450 enzymes (esp ritonavir which is most potent)
• Rifampin (TB druf): Reduced dose of rifabutin (indinavir and nelfinavir require lesser adjustment) will work for TB |
|
|
Term
| what are some tips on how to use PIs |
|
Definition
| use ritonavir with other PIs to take advantage of its ability to increase plasma levels of other drugs |
|
|
Term
| how does ritonavir increase plasma levels of other drugs |
|
Definition
potent P450 inhibitor
well tolerated at a low dose
can make some additional PI dose lower and less frequent |
|
|
Term
| lopinavir: how is it perscribed, what is the function |
|
Definition
only comes =with ritonavir
boosted due to P450 effects, strong, has few side effects, preferred |
|
|
Term
|
Definition
| blocks gp41 protein on T cell surface ot prevent viral entry |
|
|
Term
| how is a fusion inhibitor used |
|
Definition
| in combo with other HIV drugs when they have failed |
|
|
Term
| drug that is an infusion inhibitor |
|
Definition
|
|
Term
| drug that is a CCR5 receptor antagonist |
|
Definition
|
|
Term
| CC5R receptor antagonist MOA |
|
Definition
| CCR5 protein on macrophage (or T cell) surface to prevent viral entry |
|
|
Term
| CCRF receptor antagonist: use |
|
Definition
| in combination with other HIV drugs in treatment experiencded patients |
|
|
Term
| drug that is an intigrase inhibitor, naming issue? |
|
Definition
reltegravin (isentress)
watch out -avir and not a protease inhibitor |
|
|
Term
|
Definition
| inhibits HIV enzyme integrase which integrates viral genetic material into host chromosomes |
|
|
Term
| what is the use of an integrase inhibitor |
|
Definition
| in combination with other HIV drugs in treatment experinced pt who has failed other methods |
|
|
Term
| what are the combination cocktails used in HIV treatment |
|
Definition
2 NRTI + 1-2 PT (one is ritonavir)
OR
2 NRTI + NNRTI
OR
2NRTI + raltegravir |
|
|
Term
| what is the HIV treatment during pregnacy |
|
Definition
| zidovudine: prior to labor and during for mom. six weeks after birth for baby |
|
|
Term
| what qualifications suggest you should start treating AIDs |
|
Definition
severe symptoms, any CD4 count, any HIV RNA count
OR
asymptomatic, CD4 between 200-350 cells/mm
OR
asymptomatic, >35 CD4 cells, >100,000 HIV RNA: sometimes treat |
|
|
Term
| how is a HIV treatment evaluated for success |
|
Definition
monitor viral load, VD4, and clinical symptoms every 3 months
if two or more indicatoes show change (toxicity or treatment failure) change therapy |
|
|
Term
| what are the reasons for HIV therapy failure |
|
Definition
non-adherance
advsere drug reactions
development of reiestance |
|
|
Term
| order of perdicted infections in a HIV pt over time |
|
Definition
bacterial skin infections
varicella zoster, kaposi's sarcoma
oral candidias
pneumocstitis jiroveci pneumona
non-hodgkins lymphoma
Once CD4 halved
cryptococcal meningitis, herpes simplex
CMV, mycobacterium avium |
|
|
Term
| what are 8 common infections associated with HIV |
|
Definition
mycobacterium avium
mucocutaneous herpes zimplex
varicella zoster
CMV
pneumoystis jurioveci
mycobacterium TB isoniazid sensitive
mycobacterium TB isoniazid resstannt
toxoplasma gondii |
|
|
Term
| how is mycobacterium avium treated |
|
Definition
clathromycin 500 mg PO 2x/d
azithromycin 1200 mg PO 1x/wk |
|
|
Term
| how is mucocutaneous herpes simplex treated |
|
Definition
| acyclovir 1-2 g/d PO in 3-5 doses for 7-10d |
|
|
Term
| how is varicella zoster treated |
|
Definition
acyclovir 30 mg mg/kg/d IV in doses
OR
4 g/d PO for 7-10d |
|
|
Term
|
Definition
ganciclovir 7.5-10 mg/kg/d in 2-3 doses for 14d
OR
foscarnet 180 mg/kg/d in 2-3 doses for 14 days |
|
|
Term
| how is pneumocystis jiroveci treated |
|
Definition
| trimethoprim sulfmexthoxazole 1 tab/d |
|
|
Term
| how is mycobacterium TV isoniazid sensitive treated |
|
Definition
|
|
Term
| how is mycobacterium TV isoniazid resistant treated |
|
Definition
| rifampin 600 mg PO qd x 10 mo |
|
|
Term
| how is toxoplasmosis gondii treated |
|
Definition
|
|
Term
|
Definition
| HSV1: cold sores, oral transmission, respiratory secretions, fever, sore, red, swollen throat, vesicles on tongue in 2-12d, cheeks, lips, lymphadenopathy, increased salivation, halitosis, anorexia |
|
|
Term
|
Definition
| HSV2: genital herpies, sexual transmission, malase, tingling, burning, itching, malaize, fluid vesicle that ruptue and become painful |
|
|
Term
| what is the intervention for herpes simplex 7 |
|
Definition
NSAIDs for pain and fever
anesthetic mouth wash
cool compress
topical anesthetics
drying agents
antiherpetics
good hygiene |
|
|
Term
| herpes zoster (shingles) pathophysiology |
|
Definition
herpes virus varicella-zoster is reactivated and causes acute inflammation of dorsal root ganglion of each spinal nerve.
virus multiples and antibodies form chicken pox infection to neutralize it |
|
|
Term
| signs and symptoms of herpes zoster 6 |
|
Definition
pain (post herpatic neurlgia)
fever
malaise
small red vesicular lesions errupt and spread in 48-72 hours
10-21 says afrer rash vesicles dry and scab
trigeminal nerve symptoms if there |
|
|
Term
|
Definition
thymidne kinase phosphorlyates acyclovir (faster than host can), host adds additional 2 phosphate
product (acyclo-GTP) is incorporated into the viral DNA and terminates chain growth because it dosent have a 3'hydroxyl to continue the chain |
|
|
Term
| what is acyclovir triphosphate a competitive inhibitor to |
|
Definition
|
|
Term
| what is the acyclovir MOA simillar to, except |
|
Definition
| NRTA MOA with different target |
|
|
Term
| what is the antiviral spectrum of acyclovir: what is the method of administration |
|
Definition
orally for mucocutaneous and genital herpes and prophylaxis of AIDS
IV for severe herpes (encephalitis and neonatal HSV) |
|
|
Term
| what ar the resistance concerns with acyclovir |
|
Definition
mutation in DNA polymerases
lack of thymidine kinase can cross transfer resistance to famciclovir, ganciclovir, and valacyclovit |
|
|
Term
| what are the pharmacokinetics of acyclovir |
|
Definition
topical or oral 5x/d or IV
excreted by kidney |
|
|
Term
| what are the adverse effects of acyclovir |
|
Definition
Gi upset
delerium
tremor
seisures
hypotension
nephrotoxicity (crystal urea: keep well hydrated) |
|
|
Term
| what is the MOA of valacyclovir like, how is the drug used differently |
|
Definition
prodrug of acyclovir and acts like it is used like it
doses less frequently
oral only |
|
|
Term
| what is the MOA of penciclovir like, what is the difference |
|
Definition
| it acts alike acyclovir but is used topically for cold sores |
|
|
Term
| what drug is famciclovir like, how is it different |
|
Definition
it is a prodrug of penciclovir and acts like it.
used like acyclovir but dosed less frequently |
|
|
Term
| what are the three antiherpes drugs for the eye, what is the MOA |
|
Definition
vadarabine, idoxuridine, trifluridine
blocks viral DNA synthesis stopping keratoconjunctivitis and epithelial keratitis due to the viral actions |
|
|
Term
| what are the resistance concerns, pharmacokinetics, and adverse effects with vidarabine, idoxuridine, trifluridine, |
|
Definition
concerned about altered DNA polymerase
given as opthalamic solution
may cause burning, photophobia, visual haze |
|
|
Term
| cidofovir: ganciclovir: MOA, antiviral spectrum, resistance, pharmacokinetics, adverse effects |
|
Definition
chain terminator
antiviral spectrum is same as acyclovir but used only for CMV retinitis
TK- strains are resistant
given via IV
glanciclovir causes marrow supression which is dose limiting
cidofovir causes nephrotoxicity |
|
|
Term
|
Definition
selective inhibitor of pyrophosphate building sote on virus DNA polymerase and reverse transcriptase
not an antimetabolite, no TK or kinase activation needed |
|
|
Term
| foscarnet antiviral spectrum |
|
Definition
CMV retinitis, acylovir-resistant HSV, herpes zoster
used when resistant to acyclovir |
|
|
Term
| foscarnet: resistance concerns, pharmacokinetics, adverse effects |
|
Definition
concerned for mutated DNA polymerase
given via IV
can cause nephrotoxocity and altered electrolyte balance (Ca and P) |
|
|
Term
| what are the different types of influenza, what are their differences |
|
Definition
A: seasonal epidemics, has hemagglutin 1-3 and neuraminidase 1-2 antigens that affect humans
B: sporatic outbreaks, especially iin long term care facilities |
|
|
Term
| what is the most common antigen configuration for influenza |
|
Definition
|
|
Term
| signs and symptoms of linfluenza |
|
Definition
| rapid onset fver, myalgia, headache, malaise, nonproductive cough, sore throat, rhinitis |
|
|
Term
| what lavs should you get to diagnose inflenze |
|
Definition
| CBC, chem pannels, viral culture (best but longest) |
|
|
Term
| what drugs are used to teat influenza |
|
Definition
amantadine and rimantidine
zanamivir and osteltamivir |
|
|
Term
| amantidine and rimantidine MOA |
|
Definition
| inhibit uncoating of influenza A, rase endosomal pH (need acidic for enzyme function). target M2 protein |
|
|
Term
| amantidine and rimantidine antiviral spectrum |
|
Definition
influenza A prophylaxis and treatment within 40 hours of contact (except it is 92% resistant)
amantidine has some usefelness in parkinsinism (increases dopaine)
used in oselatamivit resistant areas (combined with zanamavir) |
|
|
Term
| amantidine and rimantidine pharmacokinetics |
|
Definition
oral amantadine: penetrates CNS, not metabolized
rimantidine: does not penetrate CNS, very metabolized (water solube0 |
|
|
Term
| amantidine and rimantidine adverse effects |
|
Definition
amatadone: CNS effects )insomnia, dizzyness, seizures, hallucinations)
ramantadine: GI upset |
|
|
Term
| zanamivir and osteltamivir (tamaflu) MOA |
|
Definition
| inhibit budding, neuraminidase inhibitor |
|
|
Term
| zanamivir and osteltamivir (tamaflu) antiviral spectrum |
|
Definition
influenza A and B prophylaxis and treatment
commonly used |
|
|
Term
| zanamivir and osteltamivir (tamaflu) pharmacokinetics: |
|
Definition
zanamivir: disc inhaled
ozeltamivit: oral, give within 12 h of onset |
|
|
Term
| zanamivir and osteltamivir (tamaflu) adverse effects |
|
Definition
| GI upset, headache, bronchitis |
|
|
Term
| respiratory synctial virus (RSV): organism, infection process, common infected, clinical appearance, normal care |
|
Definition
paramycovirus
infection of respiratory tract and prominent rhinorrhea
common in kids 0-2yo in winter
looks like common cold to pneumonaw
usually treated with bronchodilators and supportive care |
|
|
Term
|
Definition
|
|
Term
|
Definition
converted to ribavirin-triphosphate and inhibits viral mRNA synthesis
antimetabolite |
|
|
Term
| ribavirin antiviral spectrum |
|
Definition
not recommened in children with bronchiolitis or pneeumonia
laslas fever, hantavirus associated hemorrhagic fever, RSV |
|
|
Term
| ribavirin pharmacokinetics |
|
Definition
| aerosol for inhalation, IV or viral hemorrhagic fever, RSV |
|
|
Term
| ribavirin adverse effects |
|
Definition
| bronchial irritation, myelosupression when systemic |
|
|
Term
|
Definition
| humanized monoclonial antobidy against RSV F glycoprotein |
|
|
Term
| palivisuamb antiviral spectrum |
|
Definition
for select infants and kids under 24 mo
used to prevent RSV |
|
|
Term
| where do herpes infect, what do they cause |
|
Definition
infect and damage liver
jaundice, release of liver enzymes |
|
|
Term
| what are the three herpes viruses |
|
Definition
picornovirus
serum hepatitis
flavivirus |
|
|
Term
| picornovirus: type, aka, type of infection, tx |
|
Definition
RNA virus
causes HepA
fecal-oral route
no drugs needed |
|
|
Term
| serum hepatitis; aka, type of virus, spread by |
|
Definition
hepadenvirus
DNA virus
causes HepB
spread by blood or sex |
|
|
Term
| glavivirus: type, aka, spread by |
|
Definition
RNA virus
causes HepC
spread by blood or sex |
|
|
Term
|
Definition
interferon-a
adefovir
lamivudine |
|
|
Term
| interferon a: what does it treat, MOA, pharmacokinetics, adverse effects |
|
Definition
treats HepB and HepC (Hep C also needs ribavirin)
inhibits viral RNA translation
giben IV, penetrates cns
lethargy, marrow supression, ChF, acute hypersensitivity reaction |
|
|
Term
| adefovir: treats, pharmacokinetics, MOA, adverse reactiopns |
|
Definition
treats HepB
take for 1 year
nucleotide is converted to triphosphate form to inhibit DNA polymerase
low nephrotoxicity |
|
|
Term
| lamivudine; treats, take for how long |
|
Definition
| treas HepB, take for 1 year |
|
|
