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IOS 11 Exam 2
Treatment of CMV
| Question | Answer |
|---|---|
| Drugs that treat CMV | Ganciclovir, Foscarnet, Cidofovir |
| Ganciclovir MOA | Guanine nucleoside analogue is converted to monophosphate by viral protein kinase an enzyme encoded by CMV specific UL97 gene. The result is the inhibition of viral DNA. Also available as ocular implants |
| Resistance to Ganciclovir | Mediated by UL97gene, there is also a rare point mutation in DNA polymerase |
| PK of Ganciclovir | Terrible absorption, given as Valganciclovir to improve up to 60-70%, Good CNS, eye, Excreted in the urine unchanges MUST BE GIVEN WITH FOOD!!! |
| Side effects of ganciclovir | Bone marrow suppression, cutaneous rash, GI, CNS-neuropathy, in Implants-retinal detachment, hemorrhage |
| Foscarnet MOA | Inorganic pyrophosphate compound that inhibits viral DNA polymerase through reversible inhibition binding to pyrophosphate. DOES NOT require phosphorylation to be active. Active against Ganciclovir strains |
| Cidofocir MOA | Nucleotide cytosine (already monophosphorylated) Does have cross-resistance to ganciclovir through polymerase mutations not be UL97. It also inhibits viral DNA polymerase |
| Cidofocir is administrated with | Probenecid to reduce renal tubular secretion and increase half life |
| SIde effects of Cidofovir | Nephrotoxicity, neutropenia, Ocular effects, rash, bicarbonate wasting through the urine |
| Foscarnet side effects | Nephrotoxcity, Nephrogenic diabetes insipidus,electrolyte abnormalities |
| CMV characteristics | Herpesviridae, is a dsDNA virus , largest known to infect man |
| CMV transmission | From human to human, by 60yo 80-100% of population is infected. Can also be transmitted via organ transplant |
| CMV MOA | Establishes latency in the myeloid progenetor cells, epithelial cells of solid organs, circulating monocytes . Is shed in the saliva, urine and cervial secretions |
| CMV retinitis characteristics | A severe complication seen almost exculsively in AIDS patients. It is a progressive, irreversible disease characterized by severe retinal inflammation |
| Diagnosis of CMV | IgG indigated a past infection, IgM indicated a Current/recent infection, or PCR |
| Treatment of CMV | Ganciclovir -GIve it with food or Foscarnet id resistant to ganciclovir, or Cidofovir |
| Induction Dosing of Ganciclovir | 5mg/kg IV Q12h x 14-21 days |
| Long term suppressive treatment is with | Valganciclovir 900mg PO QD |
| CMV IVIG | Not universally recommended but maybe beneficial in certain populations |
| Prophylactic therapy used in | Transplant patients to increase survial of Bone marrow transplant patients |
| Active infection treat, and Long term suppresive therapy | Ganciclovir then Valganciclovir |
Created by:
liza001
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