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Herpes/CMV
Non-retroviral agents
| Question | Answer |
|---|---|
| Herpes Simplex 1 & 2 | 1 - oral 2 - genital |
| Varicella-Zoster | chicken pox, shingles |
| Alpha herpes virus | HSV 1 & 2, VZV |
| Beta herpes virus | CMV, HHV 6 & 7 (HH-human herpes virus) |
| Gamma herpes virus | EBV (Epstein-Barr), HHV 8 |
| CMV will cause | CMV retinitis, encephalitis in HIV, colitis, pneumonitis, CNS infection lead to organ disease; occur most in advanced immunosuppressed pts |
| Anti-Herpes and anti-CMV agents inhibit what to stop infection? | DNA polymerase (copy viral DNA) |
| Anti-Herpes Agents | acyclovir,valacyclovir, famciclovir, docosanol (abreva), penciclovir, trifluridine |
| Acyclovir, penciclovir; ganciclovir (treat CMV) (anti herpes agent) | requires activation by 3 phosphorylation; 1st-viral thymidine kinase;competitive inhibition of viral DNA polymerase and inhibition of viral DNA synthesis=chain termination; 2.5-3hrs; excretion-kidneys; drink water to prevent nephrotoxicity;10x potent |
| mutation of DNA polymerase (enzyme no longer inhibited by drug) and viral thymidine (drug is no longer activated) | resistance to anti-herpes agents |
| Valacyclovir (anti herpes agent) | ester prodrug of acyclovir (greater absorption, 3-5x blood levels) |
| Famciclovir (anti herpes agent) | active against all herpes except CMV, needs to activated, NVD/HA, good absorption |
| Docosanol (abreva) (anti herpes agent) | 22 carbon alcohol, inhibits HSV fusion (entry) w/cell membrane; topical |
| Penciclovir (anti herpes agent) | topical, active metabolite of famciclovir, excreted urine (kidneys) |
| Trifluridine (anti herpes agent) | fluorinated pyrimidine nucleoside, need no activation |
| Anti-CMV Agents | ganciclovir, valganciclovir, foscarnet, cidofovir; inhibit CMV (viral) DNA polymerase |
| acyclovir,valacyclovir, famciclovir, docosanol (abreva), penciclovir, trifluridine | Anti-Herpes Agents |
| ganciclovir, valganciclovir, foscarnet, cidofovir | Anti-CMV Agents |
| Ganciclovir (anti-CMV agent) | need activation (phosphyloration) by CMV specific kinase, excreted renal, poor PO absorption, IV/intraocular implant (CMV retinitis); 4 hrs, cleared by dialysis, MYELOSUPPRESSION, neutropenia, NVD, rash, HA, altered liver enzymes, peripheral neuropathy |
| Valganciclovir (anti-CMV agent) | ester prodrug of ganciclovir, take w/food, excreted renal, well absorbed, metabolized in liver and intestinal wall to be converted to ganciclovir, lost via dialysis |
| Foscarnet (anti-CMV agent) | inhibits viral DNA/RNA polymerase and HIV RT WITHOUT phosphorylation (no activation)against wide-range of HSV 1 and 2, CMV, VZV, EBV; excreted renal, toxic, IV only, 3-7 hrs, poor PO absorption, NEPHROTOXICITY |
| Foscarnet interactions/S&S (anti-CMV agent) | aminoglycosides:nephrotoxicity-NVD, anemia,altered ca+/phosphate levels,high urine concentrations, genital ulcerations, high liver enzymes impenem(beta lactam - carbapenems group)=seizures CNS toxicity: HA, hallucinations, seizures (impenem interaction) |
| Cidofovir (anti-CMV agent) | potent inhibitor of viral DNA polymerase, broad spectrum(HSV,CMV),phosphorylated independent of viral kinases(not specific-bad);excreted renal,infused w/probenecid to prevent tubular secretion of cidofovir and nephrotoxicity; neutropenia, uveitis (uvea) |
| prehydrate w/NS to prevent dose-dependent renal tubule toxicity | cidofovir (anti-CMV agent) |
| Cidofovir (anti-CMV agent) | avoid with other nephrotoxicity meds: aminoglycosides, foscarnet, NSAIDS |
| need no activation (phosphyloration) by viral kinase | foscarnet (HSV agent), cidofovir (CMV agent, trifluridine (HSV agent) |
| inhibition of viral DNA polymerase | acyclovir,vidarabine,foscarnet,ganiciclovir |
| esters | added to drug for better absorption than in the tissues |
| Viral DNA polymerase | enzyme that makes copies of viral DNA (replication) |
Created by:
cburrows
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