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PharmIV
Ch. 40
| Question | Answer |
|---|---|
| Viral replication | Virus cannot replicate on its own. Must attach to enter. Uses hot cell's energy to synthesize protein, DNA, and RNA. Any drug that kills a virus may also kill cells. May be necessary to treat the symptoms instead of the virus. |
| Viral Infections | A well-functioning immune system will eliminate or effectively destroy virus replication. Immunocompromised patients have frequent viral infections: Cancer patients, Transplant patients, AIDS patients. |
| Viruses controlled by current antiviral therapy | Cytomegalovirus (CMV), Hepatitis viruses, Herpes viruses, Human immunodeficiency virus (HIV), Influenza viruses (the “flu”), respiratory syncytial virus (RSV) |
| Viral Illnesses | Bothersome, but survivable. |
| Antiviral Drugs | Antiviral drugs kill or suppress the virus by destroying virions or inhibiting ability to replicate viruses controlled by current antiviral therapy. |
| Antiviral Drugs: Key characteristics | Able to enter the cells infected with virus, Interfere with viral nucleic acid synthesis and/or regulation, Some drugs interfere with ability of virus to bind to cells, Some drugs stimulate the body’s immune system |
| Opportunistic infections | Immunocompromised patients. Require long-term prophylaxis and anti-infective drug therapy. Can be other viruses, fungi, bacteria, or protozoa |
| Antiviral drugs (Classification) | Used to treat infections caused by viruses other than HIV |
| Antiretroviral drugs (Classification) | Used to treat infections caused by HIV, the virus that causes AIDS |
| Virus Infections | Herpes-simplex viruses. HSV-1 (oral herpes). HSV-2 (genital herpes). Human herpesvirus/VZV Chickenpox and shingles (HHV-3 or VZV). Epstein-Barr (HHV-4). Cytomegalovirus (HHV-5). Kaposi’s sarcoma (HHV-8) |
| Antiviral Drugs: Nonretroviral-Mechanism of action | Inhibit viral replication. Used to treat non-HIV viral infections. Influenza viruses. HSV, VZV, CMV. Hepatitis A, B, C (HAV, HBV, NCV) |
| Antiviral Drugs: Nonretroviral-Adverse effects | Vary with each drug. Healthy cells are often killed also, resulting in serious toxicities |
| Antiviral Drugs: Nonretroviral-Amantadine (Symmetrel) | Narrow antiviral spectrum; active only against influenza A. 2008 CDC guidelines do not recommend use for treatment or prevention of flu. CNS effects: insomnia, nervousness, lightheadedness. GI effects: anorexia, nausea, others |
| Antiviral Drugs: Nonretroviral-Rimantadine (Flumadine) | Same spectrum of activity, mechanism of action, and indications as amantadine. Fewer CNS adverse effects. Causes GI upset |
| Antiviral Drugs: Nonretroviral-Acyclovir (Zovirax) | Synthetic nucleoside analog. Used to suppress replication of: HSV-1, HSV-2, VZV. Drug of choice for treatment of initial and recurrent episodes of these infections. Oral, topical, parenteral forms |
| Antiviral Drugs: Nonretroviral-Ganciclovir (Cytovene) | Synthetic nucleoside analog. Treats CMV. Oral, parenteral forms |
| Antiviral Drugs: Nonretroviral-Dose Limiting Toxicities | Ganciclovir-Bone marrow toxicity. Foscarnet and cidofovir-Renal toxicity. |
| Antiviral Drugs: Nonretroviral-Neuraminidase Inhibitors | Oseltamivir (Tamiflu) and Zanamivir (Relenza). Active against influenza types A and B. Reduce duration of illness. Oseltamivir: causes nausea and vomiting. Zanamivir: causes diarrhea, nausea, sinusitis. Treatment should begin within 2 days. |
| Antiviral Drugs: Nonretroviral-Ribavirin | Synthetic nucleoside analog. Given orally, or oral or nasal inhalation. Inhalation form (Virazole) used for hospitalized infants with RSV infections |
| HIV and AIDS | Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). ELISA test. Detects HIV exposure based on presence of human antibodies to the virus in the blood. Retrovirus. |
| HIV and AIDS: Transmission | Transmitted by sexual activity, intravenous drug use, perinatally from mother to child |
| Four Stages of HIV Infection | Stage 1: asymptomatic infection (can last a month). Stage 2: early, general symptoms of disease. Stage 3: moderate symptoms. Stage 4: severe symptoms, often leading to death. WHO model |
| Opportunistic Infections Types | Protozoal: Toxoplasmosis of the brain, others Fungal Candidiasis of the lungs, esophagus, trachea Pneumocystis jiroveci pneumonia |
| Opportunistic Infections Types II | Viral: CMV disease, HSV infection. Bacterial: Various mycobacterial infections. Extrapulmonary TB. Opportunistic neoplasias: Kaposi’s sarcoma. HIV wasting syndrome: Major weight loss, chronic diarrhea, chronic fever |
| Antiretroviral Drugs | HAART. Highly active antiretroviral therapy. Includes at least three medications: “cocktails”. These medications work in different ways to reduce the viral load |
| Antiretroviral Drugs (Medications) | Reverse transcriptase inhibitors (RTIs). Nucleoside RTIs (NRTIs). Nonnucleoside RTIs (NNRTIs). |
| Antiretroviral Drugs (Medication Examples) | Abacavir (Ziagen), Delavirdine (Rescriptor), Didanosine (Videx), Lefavirenze (Sustiva), |
| Antiretroviral Drugs: Zidovudine (Retrovir) | First anti-HIV medication. Nucleoside reverse transcriptase inhibitor. Can be given to pregnant HIV-positive women and newborn babies to prevent maternal transmission of HIV. Major dose-limiting adverse effect: bone marrow suppression |
| Antiretroviral Drugs: Protease inhibitors (PIs) | Inhibit the protease retroviral enzyme, preventing viral replication |
| Antiretroviral Drugs: Protease inhibitors (PIs) (Examples) | Amprenavir (Agenerase). Indinavir (Crixivan). Nelfinavir (Viracept). Ritonavir (Norvir) |
| Antiretroviral Drugs: Fusion inhibitors | Inhibit viral fusion, preventing viral replication. A newer class of antiretroviral drugs. |
| Antiretroviral Drugs: Fusion inhibitors (Example) | Enfuvirtide (Fuzeon) |
| Antiretroviral Drugs: CCR5 antagonist (Examples) | Maraviroc (Selzentry). HIV integrase strand transfer inhibitor. Raltegravir (Isentress) |
| Antiretroviral Drugs: Adverse effects | Vary with each drug. Drug therapy may need to be modified. Goal is to find the regimen that will best control the infection with a tolerable adverse effect profile. Medication regimens change during the course of the illness |
| Nursing Implications I | Thoroughly assess underlying disease and medical history, including allergies. Assess baseline vital signs. Assess for contraindications. Teach proper application technique for ointments, aerosol powders. |
| Nursing Implications II | Instruct patients to consult their physician before taking any other medication. Inform patients that antiviral drugs are not cures but do help to manage symptoms. informed to start therapy with antiviral drugs at the earliest sign of recurrent episodes |
Created by:
maggardba
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