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25 Cards in this Set
- Front
- Back
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Amantadine
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M2 protein (ion channel), influenza A - prevent uncoating and inhibit transfer of nucleocapsid (vRNA + protein) into host cytoplasm - B and C lack M2
Pharmacokinetics: Lipophilic, CSF, renal excretion of unchanged drug Adverse: more CNS (hallucination, seizures). Teratogenic C Clinic: Prevention (A), immunodeficient, elderly. Treatment (within 48 h of symptoms). Parkinson's (CNS) |
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Rimantidine
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M2 protein (ion channel), influenza A - prevent uncoating and inhibit transfer of nucleocapsid (vRNA + protein) into host cytoplasm - B and C lack M2
Pharmacokinetics: Less lipophilic, no CSF, renal excretinon after inactivation Adverse: less CNS. Teratogenic (C) Clinic: Prevention (A), immunodeficient, elderly. Treatment (within 48 h of symptoms). |
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Oseltamivir
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Inhibit neuramidase (Inf A and B) that removes sialic acid residue rom glycoproteins/lipids. Blocks release of virus from cell surface
Pharm: Prodrug ethyl ester - convert to active carboxylate in liver. Renal excreation Adverse: Well tolerated, nausea, vomit, terat (C) Clinic: Prevent and treat Influenza A and B |
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Ribavirin
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Mechanism: activated by host kinase: Ribavirin monophosphate inhibits inosine monophosphate dehydrogenase (decreases synth of GTP, vRNA, DNA) - inhibits RNA pol of influenza A and B
Pharmacological: Aerosol, IV, oral - t1/2 RBC = 40 days, t1/2 tissue = 12 days - teratogenic up to 6 mo post therapy in women / men Adverse: Inhalation: apnea, pneumothorax, cardiac arrest Oral or IV: hemolytic anemia Teratogenic - cat X Clinical: Respiratory synctial virus (neonates - aerosol), Lassa fever (IV), Hep C (oral along with INF a-2b for 6-12 mo) |
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Acyclovir
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ANTI HERPES
Guanosine analog prodrug. Viral thymidine kinase initially phosphorylates. Selective to virus-infected cells. Triphosphate inhibits viral DNA pol. Incorporates into viral DNA and terminates chain (lacks 3' OH) Pharm: Topical, oral, IV. High concn CSF, accumulates in patients with renal failure Adverse: Few side effects. IV infusion may cause renal insufficiency or neuro tox. Not Teratogenic (B) Clinic: HSV encephalitis, Herpes genitalis, H. labialis, Shingles (zoster), Varicella, Prophylactic therapy (during immunosupressive therapy) |
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Vidarabine
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Antiherpes. Adenosine analog with arabinose. Prodrug. VIral kinase not involved - host kinases activate (nonselective). Rest of mech similar to acyclovir.
Pharm: Insoluble, requires large Vol of IV fluid for admin. Rapidly deaminated. Adverse: Causes encephalopathy (hearache, dizzy, hallucination, coma) - deaminase low in CSF. Herpes keratitis (topical - acyclovir replaced for systemic) |
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Ganciclovir
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Antiherpes G analog. Prodrug. Cytomegalovirus kinase or HSV thymidine kinase initially phosphorylates. Triphosphate inhibits viral DNA pol. Slow chain elong.
Pharm: IV, 90% elim. renally Adverse: Leukopenia, Thrombocytopenia, Carcinogenic and teratogenic (X). Cytometalic retinitis |
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Influenza (symptoms)
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Abrupt onset of high fever chills, headache, malaise, anorexia and photophobia.
Influenza A or B |
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Influenza treatment
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A: amantadine. Alternate (CNS effects elderly, psych patients, epilepsy = Rimantadine)
B (or A if you want): Oseltamivir |
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Respiratory synctial virus ifx (symptoms)
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10% children <2. Bronchiolitis with acute onset of wheezing. Virus isolated from nasopharyngeal secretions.
Respiratory synctial virus (RNA virus) |
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Respiratory synctial virus ifx (treatment)
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Ribavirin
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Herpes simplex encephalitis (symptoms)
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Low grade fever, headache, lethargy, disorientation. CT scan reveals decreased density in orbital region of frontal lobes / portions of temporal lobes.
HSV-1 |
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Herpes simples encephalitis (treatment)
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Acyclovir (superior to vidarabine). IV to assure enough to CSF - not oral
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Herpes genitalis (symptoms)
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Painful vesicles in genital areas. Systemic: fever, malaise, myalgias. Pregnent: risk ifx of newborn during delivery = c section
HSV2 (DNA virus) |
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Herpes genitalis (treatment)
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Acyclovir (does not elim HSV - recurrant ifx common. Oral therapy continued. Neonatal Herpes treated with acyclovir
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Herpes labialis (symptoms)
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cold sore = pain and paresthesia and erythmatous skin lesions on face and mouth followed by vesiculation and swelling. HSV1
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Herpes Labialis (treatment)
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Acyclovir. If resistant Foscarnet.
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Herpes keratitis (symptoms)
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Corneal blindness, blurred vision, swelling of conjunctival tissue around cornea, dendritic lesions of the cornea. HSV-1
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Herpes keratitis (treatment)
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Vidarabine (topical ointment). If ameboid ulcers present / doesnt respons use Trifluridine (mech similar to vidarabine)
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Shingles (symptoms)
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Elderly. Activation of latent VZV with pain on skin (thoracic or face), encephalitis: headache, hallucinations, hearing noises. VSV isolated from CSF. VZV - DNA virus
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Shingles (Treatment)
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Acyclovir: IV
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Varicella (symptoms)
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Vesicular lesions on neck, back, trunk, face. Some ataxia and cerebellar signs. VZV
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Varicella (treatment)
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Acyclovir (IV / oral)
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Cytomegalic retinitis (symptoms)
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Floating spots in vision. Difficult to read. Fundoscopic exam: alternating area of hemorrhaging and scar tissue on retina. CMV = DNA virus
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Cytomegalic retinitis (treatment)
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Ganciclovir. If resistant use Foscarnet (or a combo of Ganciclovir and Foscarnet).
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