Pharm 236 Ch 35 Antiviral Drugs

Front 1

Viruses cause acquired immunodeficiency syndrome (AIDS), hepatitis, _____________, and other disorders that affect almost every body system

Back 1

`pneumonia

Front 2

Viruses can be spread by secretions from infected people, ingestion of contaminated food or water, __________ in skin or mucus membrane, sexual contact, pregnancy, breastfeeding, and organ transplantation.

Back 2

Breaks

Front 3

Viruses are __________ parasites that gain entry to human host cells by binding to receptors on cell membranes.

Back 3

intracellular

Front 4

The locations and __________ of receptors determine which host cells can be infected by a virus.

Back 4

numbers

Front 5

This drug is applied topically to treat keratoconjunctivitis and corneal ulcers caused by the herpes simplex virus (herpetic keratitis)

Back 5

Trifluridine

Front 6

This drug is similar to the NRTI's in that it inhibits the reverse transcriptase enzyme.

Back 6

Tenofovir (Viread)

Front 7

These drugs inhibits viral reproduction after the drugs are activated by a viral enzyme found in virus infected cells.

Back 7

Foscarnet, Ganciclovir, and valganciclovir

Front 8

These drugs are the oldest IP's

Back 8

Indinavir, ritonavir, and squinavir

Front 9

These drugs penetrate virus infected cells become activated by an enzyme, and inhibit viral DNA reproduction.

Back 9

Acyclorir, famiciclovir, and valacyclovir

Front 10

Describe how viruses use cellular metabolic activities for their own survival and replication.

Back 10

Inside host cells viruses use cellular metabolic activities for their own survival and replication. Viral replication involves dissolution of the protein coating and exposure of the genetic material deoxyribonucleic acid DNA or rebonecleic acid RNA. With DNA viruses, the viral DNA enters the host cells nucleus where it becomes incorporated into the host cells chromosomal DNA. Then host cell genes are coded to produce new viruses. In addition, the viral DNA incorporated into the host cells chromosomal DNA. Then host cell genes are coded to produce new viruses. In addition, the viral DNA incorporated with host DNA is transmitted to the hosts daughter cells during host cell mitosis and becomes part of the inherited genetic information of the host cell and its progeny. With RNA viruses (ex. HIV), viral RNA must be converted to DNA by an enzyme called reverse transcriptase before replication can occur.

Front 11

How do viruses transmit their infection to other host cells?

Back 11

After new viruses are formed they are released from the infected cell either by budding out and breaking off from the cell membrane, or by causing lysis of the cell. When the cell is destroyed, the viruses are released into the blood and surrounding tissues, from which they can transmit the viral infection to other host cells.

Front 12

Describe symptoms usually associated with acute viral infections.

Back 12

Symptoms usually associated with acute viral infections include fever, headache, cough, malaise, muscle pain, photo-phobia. White blood cell counts usually remain normal. Other signs and symptoms vary with the type of virus and body organs involved.

Front 13

How do herpes viruses differ from other viruses?

Back 13

Some viruses, ex. herpes can survive in host cells for many years and cause a chronic, latent infection that periodically becomes reactivated.

Front 14

Describe how viruses induce antibodies and immunity?

Back 14

Antibodies are proteins that defend against microbial or viral invasion. They are very specific (ex. antibody protects only against a specific virus or other antigen).. The protein coat of of the virus allows the immune system of the host to recognize the virus as a foreign invader and to produce antibodies against it. Antibodies against infecting viruses can prevent the viruses from reaching the bloodstream or if they are already in the blood stream, prevent their invasion of host cells. After the virus has penetrated the cell it is protected from antibody action and the host depends on cell mediated immunity to eradicate the virus along with the cell harboring it.

Front 15

Mr. Grant asks you how acyclovir works and whether it will treat his genital herpes. How do you respond? What effect does acyclovir have? What may prolonged or repeated courses of acyclovir result in?

Back 15

Acyclovir, famciclovir and valacyclovir penetrate virus infected cells become activated by an enzyme and inhibit viral DNA reproduction. Acyclovir is used to treat genital herpes; it decreases viral shedding and the duration of skin lesions and pain. It does not eliminate inactive virus in the body and therefore does not prevent recurrence of the disease unless oral drug therapy is continued. Prolonged or repeated courses of acyclovir therapy may result in the emergence of acyclovir resistant viral strains, especially in immunocompromised patients.

Front 16

Mr. Grant returns for a physician visit 1 yr later. He is compliant with the prescribed acyclovir regimen and experiences few outbreaks. He asks if he can discontinue the medication regimen for a while. What will happen if drug therapy is discontinued?

Back 16

The disease will reoccur. Acyclovir does not prevent recurrence of the disease unless oral drug therapy is continued.

Front 17

Mr. grant asks you how long it will take for the acyclovir to remove the virus from his body. What can you tell him?

Back 17

Acyclovir does not eliminate inactive virus in the body and therefore does not prevent recurrence of the disease unless oral drug therapy is continued.

Front 18

Mr. Grant asks you if there is an ointment that may be applied to the lesions during outbreaks in addition to taking his oral acyclovir. What do you think the physician will order?

Back 18

Acyclovir may be given orally, IV, or applied topically to lesions.

Front 19

Mrs. Water's physician orders a combination of antiretroviral drugs to treat her illness. She states that she is concerned because she fears increased adverse effects. Which of the following is the reason for using combination antiretroviral medications?

a. To increase effectiveness

b. To prevent the emergence of drug resistant viruses

c. to decrease adverse effects

d. To cure the virus in less than 6 weeks

Back 19

a.

Rationale: Antiretroviral drugs are given in combination to increase effectiveness and decrease emergence of drug resistant viruses.

Front 20

Mr. Willis is concerned about how the antiviral drugs he is taking will affect his cells. Viruses are intracellular parasites and have which of the following effects on human cells?

a. They travel from cell to cell without causing damage.

b. They do not affect the human cell

c. They incapacitate the cell for a short time before moving on.

d. They are relatively toxic to human cells.

Back 20

d.

Rationale: Because viruses are intracellular parasites, antiviral drugs are relatively toxic to human cells.

Front 21

For which of the following viral infections is drug therapy available? (select all that apply)

a. Asthmatic bronchitis

b. Herpatitis b and c

c. HIV infection

d. Influenza

Back 21

b,c,d

Rationale: Viral infections for which drug therapy is available including genital herpes, hepatitis, B and C, HIV infection and influenza.

Front 22

To prevent viral infections which of he following precautions should the general public take?

a. Use inter-mitten hand hygiene.

b. Become vaccinated against prevalent virus infections.

c. Wear masks

d. Wear personal protective equipment.

Back 22

b.

Rationale: Vaccinations avoiding contact with people who have viral infections and thorough hand hygiene are effective ways to prevent viral infections.

Front 23

Viral infections commonly occur in which of the following age groups?

a. Young children

b. Older adults

c. All age groups

d. Infants

Back 23

c.

Rationale: Viral infections commonly occur in all age groups.

Front 24

The role of the home care nurse caring for patients with HIV includes with of the following tasks? (select all that apply)

a. Teaching neighborhood groups about the disease and its treatment.

b. Assisting with drug therapy for HIV or opportunistic infections.

c. Coordinating medical and social services.

d. Preventing or minimizing opportunistic infections.

Back 24

b, c, d

Rationale: Home care of patients with HIV infection may include teaching patients and caregivers about the disease and its treatment, assisting with drug therapy for HIV or opportunistic infections, coordination medical and social services, managing symptoms of infection or adverse drug effects, and preventing or minimizing opportunistic infections.

Front 25

Mrs. Leblanc is diagnosed with HIV and hepatitis C, and the physician orders antiviral therapy. You would expect the physician to order monitoring of which of the following laboratory values?

a. CBC

b. Electrolytes

c. LFT's

d. Serum albumin

Back 25

c.

Rationale: When antiviral agents are prescribed all patients with hepatic impairment should be monitored closely for abnormal liver function tests (LFT's) and drug related toxicity.

Front 26

The physician prescribes nevirapine for the treatment of of Mr. Bryant's HIV infection. Based on moderately abnormal LFT's 3 months later, you would expect the physician to do which of the following?

a. Discontinue the drug until LFT's return to baseline

b. Reduce the amount of drug prescirbed

c. Recheck the laboratory values

d. Increase the amount of drug prescribed.

Back 26

a.
Nevirapine may cause abnormal LFt's and few cases of fatal hepatitis have been reported. If moderate or severe LFT abnormalities occur, nevirapine administration should be monitored closely for abnormal liver function tests and drug related toxicity.

Front 27

Ms. Jordan is diagnosed with HIV and hepatitis B. The physician prescribes zidovudine. When the LFT's become moderately elevated, the physician can be expected to reduce the dose of zidovudine by how much?

a. 20%

b. 25%

c. 40%

d. 50%

Back 27

d

Rationale: Zidovudine is eliminated slowly and has a longer half life in patients with moderate to severe liver disease. Therefore, daily doses should be reduced by 50% in patients with hepatic impairment.

Front 28

Mr. Canfield is prescribed amantadine as part of the treatment regimen for his Parkinson's disease. Because the patient also is diagnosed with renal disease the physician titrates the dose of amantadine based on which of the following factors?

a. White blood cell count

b. Potassium

c. Creatinine clearance

d. Calcium

Back 28

c.

Rationale: Amantadine, emtricitabine, entecavir, famciclovir, ganciclovir, lamivudine, tel bivudine and valacyclovir are eliminated mainly through the kidneys. In patients with renal impairment, they may accumulate, produce higher blood levels, have longer half lives, and cause toxicity. For all these drugs except famciclovir and emtricitabine, dosage should be reduced with creatinine clearance (CrCl) rates lower than 50mL/min.

Front 29

Ms. Billings is diagnosed with CMV retinitis. They physician orders foscarnet. Renal impairment is most likely to occur within which period of time?

a. First 72hrs of therapy

b. First week of therapy

c. Second week of therapy

d. First month of therapy.

Back 29

c.

Rationale: Foscarnet may cause or worsen renal impairment and should be used with caution in all patients. Manifestations of renal impairment are most likely to occur during the second week of induction therapy, by they may occur any any time during treatment.

Front 30

When foscarnet is administered renal impairment may be minimized by doing which of the following?

a. Monitoring renal function two or three times weekly during induction.

b. Monitoring renal function at least every 2 to 3 months during maintenance therapy.

c. Stopping the drug if creatinine clearance drops to less than 0.2 mL/minute/kg

d. Placing the client on fluid restriction.

Back 30

a.

Rationale: When foscarnet is administered, renal impairment may be minimized by monitoring renal function (ex. at baseline; two or three times weekly during induction; at least every 1 to 2 weeks during maintenance therapy) and reducing dosage accordingly. The drug should be stopped if creatinine clearance drops to less than 0.4mL/min/kg. Adequate hydration should also be maintained throughout the course of drug therapy.

Front 31

Mrs. Clark is prescribed indinavir or her HIV infection. To avoid nephrolithiasis, you should teach the client to do which of the following?

a. Maintain a fluid restriciton of 800mL daily

b. Maintain a fluid restriction of 1000ml daily

c. Consume 48 to 64 oz of fluid a day

d. Consume 64 to 82 oz of fluid a day.

Back 31

c

Rationale: Indinavir may cause nephrolithiasis, flank pain, and hematuria. Symptoms usually subside with increased hydration and drug discontinuation. To avoid nephrolithiasis, patients taking indinavir should consume 48 to 64 oz or 1440mL to 1920mL of water or other fluids daily.

Front 32

Mr. Wallace is prescribed amantadine to prevent influenza A. As the nurse on the unit, you should monitor the patient for which of the following? (select all that apply)

a. CNS effects

b. Gastrointestinal bleeding

c. Cardivascular effects

d. Orthostatic hypotension

Back 32

a,c

Rationale: When amantadine is given to prevent or treat influenza A, dosage should be reduced with renal impairment, and older adults should be closely monitored for CNS effects such as hallucinations, depression, confusion, and cardiovascular effects such as congestive heart failure, and orthostatic hypotension.

Front 33

Jason B., age 10, is prescribed oseltamivir to treat Influenza A. Which of the following is an adverse effect of this drug?

a. Dizziness

b. Hallucinations

c. Difficulty breathing

d. Diarrhea

Back 33

b.

Rationale: Oseltamivir may be used in children 1yr of age and older. However, some serious adverse effects have been reported in children 16yrs and younger who were taking oseltamivir. The adverse effects include neurologic and psychiatric problems ex. delirium, hallucinations, confusion, abnormal behavior, seizures, enchephalitis and a few severe skin reactions.

Front 34

Ms. Butler is HIV positive and pregnant with her first child. At 14 to 34 weeks of gestation, the physician orders zidovudine. Which of the following dosages is correct?

a. 75mg PO five times a day

b. 50mg PO five times a day

c. 25mg PO five times a day

d. 100mg PO five times a day

Back 34

d

Rationale: HIV seropostive pregnant women should receive zidovudine to prevent perinatal transmission. At 14 to 34 weeks of gestation, zidovudine should be administered at a dose of 100mg PO five times a day until delivery.

Front 35

What constitutes viral load?

a. viral levels in the tissues

b. HIV DNA Particles within the blood.

c. HIV RNA particles within the blood.

d. All sites of viral reproduction.

Back 35

c

Rationale: Viral load is a measure of the number of HIF RNA particals within the blood; it does not measure viral levels in tissues, where viral reproduction may be continuing.

Front 36

Patients should be assessed for signs and symptoms of adverse drug effects approximately every ____ months during antiviral therapy.

Back 36

3 Months

Front 37

Viral vaccines are used to control epidemics of viral disease in a community or to produce which of the following types of immunity in patients who have not yet been exposed?

a. Passive immunity

b. Intermittent immunity

c. Immunity to all viruses

d. Active immunity.

Back 37

a

Rationale: Viral vaccines are used to control epidemics of viral disease in a community or to produce active immunity in patients who have not yet been exposed.

Front 38

Which of the following are two methods to prevent sexually transmitted viral infections such as genital herpes? (select all that apply)

a. Complete abstinence

b. Avoiding sex with skin lesions are present

c. Use of a diaphragm when lesions are present

d. Using condoms

Back 38

b, d

Rationale: When sexually transmitted viral infections such as genital herpes transmission can be prevented by avoiding sex when skin lesions are present and by using condoms.

Front 39

_________, __________, and _______ penetrate virus infected cells and become activated by an enzyme that inhibit viral DNA reproduction and are used in the treatment of herpes simplex and herpes zoster infections.

Back 39

Acyclovir, famiciclovir, valacyclovir

Front 40

What drugs are used for herpes virus infections?

Back 40

Acyclovir (zovirax)
Faiciclovir (famvir)
Foscarnet (foscavir)
Ganciclovir (cytovene)
Trifluridine (viropitc)
Valacyclovir (valtrex)
Valganciclovir (valcyte)

Front 41

This drug is used when a patient presents with oral mucocutanious lesions (ex. cold sores, fever blisters, genital herpes), herpes simplex encephalitis, varicella (chicken pox), in immunocompromised hosts, herpes zoster (shingles) in normal and immunocompromised patients.

Back 41

Acyclovir

Front 42

This drug is used when a patient presents with acute herpes zoster or genital herpes.

Back 42

Famciclovir (famvir)

Front 43

This drug is used to treat CMV retinitis in a person with AIDS and acyclovir resistant mucocutaneous HSV infections in ICH.

Back 43

Foscarnet (Foscavir)

Front 44

What drug would you expect the doctor to order when patients presents with CMV retinitis in ICH prevention of CMV disease in patient with organ transplants or advanced HIV infection.

Back 44

Ganciclovir (cytovene)

Front 45

Patients comes in with keratoconjunctivitis caused by herpes viruses, what would you expect the doctor to order?

Back 45

Trifluridine (viroptic)

Front 46

Pt has a history of recurrent genial herpes, herpes labialis, herpes zoster, and is immunocopetent. What would the doctor order?

Back 46

Valaxyclovir (valtrex) For that OMG blistery miserable feeling :) (Must beware of renal impairment)

Front 47

Pt is given this for the prevention and treatment of CMV retinitis (eye herpes).

Back 47

Valganciclovir (valcyte)

Front 48

True or false? Acyclovir can be given orally, IV, or applied topically.

Back 48

True

Front 49

True or false?

Oral and IV acyclovir are excreted mainly in urine, and dosage should be decreased inpatients who are older or who have renal impairment.

Back 49

True

Front 50

The normal serum creatinine range for men is _______ mg/dL. The normal range for women is ______ mg/dL.

Back 50

men is 0.5-1.5 mg/dL
women is 0.6-1.2 mg/dL

Front 51

True or false?

A high serum (blood) creatinine level means kidney damage

Back 51

True

Front 52

Healthy adults have a GFR of about 140*; normal is greater than 90. Children and the elderly usually have lower GFR levels. A GFR less than _____ is kidney failure.

Back 52

15

Front 53

Normal BUN level for healthy individuals is _____ mg/dL in adults, and _____ mg/dL in children.

Back 53

7-20 mg/dL in adults,

5-18 mg/dL in children

Front 54

__________ and ___________ are the drugs of choice for herpes zoster and recurrent genital herpes.

Back 54

Famiciclovir and valacyclovir

Front 55

Famciclovir is metabolized to ___________ its active form and excreted mainly in the urine.

Back 55

penciclovir

Front 56

Valacyclovir is metabolized to _________ by enzymes in the liver or intestine and is eventually excreted in the urine.

Back 56

acyclovir

Front 57

___________, _______, and ____________ also inhibit viral reproduction after the drugs are activated by a viral enzyme found in virus infected cells. The drugs are used to treat cytomegalovirus (CMV) retinitis.

Back 57

Foscarnet, ganciclovir, valganciclovir

Front 58

________ is used to treat acyclovir reststant mucocutaneous herpes simplex infections in people with impaired immune function.

Back 58

Foscarnet

Front 59

_______ and __________ are sued to prevent CMV disease mainly in patients with organ transplants or HIV disease.

Back 59

Valganciclovir and ganciclovir

Front 60

________ causes granulocytopenia and thrombocytopenia in 20 to 40% of recipients, often during the first 2 weeks of therapy. If sever bone-marrow depression occurs this drug should be discontinued.

Back 60

Granciclovir

Front 61

___________ is applied topically to treat keratoconjunctivitis and corneal ulcers caused by the herpes simplex virus and should not be used longer than 21 because of possible ocular toxicity.

Back 61

Trifluridine

Front 62

What drugs are used for Influenza virus infection?

Back 62

Amantadine (Symmetrel)
Oseltamivir (Tamiflu)
Rimantadine (Flumadine)
Zanamivir (Relenza)

Front 63

These drugs is used for the prevention or treatment of influenza A.

Back 63

1. Amantadine (Symmetrel)

2. Oseltamivir (Tamiflu)

3. Rimantadine (Flumadine); used for prophylaxis of influenza A in children

Front 64

This drug is used for the prevention or treatment of influenza A and B and is administered by Oral inhalation.

Back 64

Zanamivir (Relenza)

Front 65

_____ and ______ inhibit replication of the influenza A virus and are used to prevent or treatment of influenza A infections.

Back 65

Amantadine and Rimantadine

Front 66

_________ is excreted in the urine unchanged and can accumulate in older adults and others with impaired renal function.

Back 66

Amantadine

Front 67

________ is extensively metabolized and small amounts are excreted in the urine.

Back 67

rimantadine

Front 68

What are the most common adverse side effects of amantadine and rimantadine?

Back 68

GI = anorexia and nausea

CNS = nervousness, lightheadedness, difficulty concentrating.

Front 69

_______ and _________ are approved for prevention or treatment of influenza a or b in patient with symptoms for 2 days or less. These drugs also have activity against influenza A (H5N1)

Back 69

Oseltamivir (Tamiflu) and Zanamivir (Relenza)

Front 70

High plasma levels of this have been associated with delirium, hallucinations, seizures, coma, and cardiac dysrhythmias.

Back 70

Amantadine

Front 71

_________ has been associated with exacerbations of pre-existing seizure disorder and psychiatric symptoms.

Back 71

Amantadine

Front 72

This drugs can fight Influenza a or b but comes in a powder form. However, it may cause bronchospasm in patients with asthma or COPD.

Back 72

Zanamivir

Front 73

___________ is used mainly for the treatment of bronchiolitis or pneumonia caused by respiratory syncytial virus RSV. Drug is administered via aerosol.

Back 73

Ribavirin

Front 74

What are the drugs used to treat Hepatitis B?

Back 74

Adefovir
Entecavir
Interferon
Lamivudine (Epirvir HBV)
Telbivudine

Front 75

What drug is used to treat hepatitis C?

Back 75

Ribavirin (Virazole)

Front 76

What are the five classes of antiretroviral drugs?

Back 76

1. Nucleoside Reverse Transcriptase Inhibitors (NRTI's)

2. Nucleotide reverse transcriptase inhibitor

3. Non nucleoside reverse transcriptase inhibitors (NNRT's)

4. Protease Inhibitors

5. Entry Inhibitors

Front 77

These drugs are structurally similar to DNA components adenosine, cytosine, guanosine, and thymidine and easily enter human cells and viruses in human cells. What drug class is this?

Back 77

Nucleoside reverse transcriptase inhibitor (NRTI's)

Front 78

What are the Nucleoside Reverse Transcrpitase inhibitor drugs?

Back 78

Abacavir

emtricitabine

Lamivudine

Zidovudine

Front 79

This is the prototype for the NRTI's and is an able substitute for thymidine.

Back 79

Zidovudine

Front 80

This prototoype NRTI is well absorbed and metabolized in the liver to an acitve metabolite which is excreted in the urine. However, patients can be at risk for severe anemia, neutropenia, lactic acidosis, and hepatomegaly with steatosis.

Back 80

Zidovudine

Front 81

True or false?

All NRTI's have Black box warnings that include lactic acidosis, and hepatomegaly with steatosis.

Back 81

True

Front 82

____________is a physiological condition characterized by low pH in body tissues and blood (acidosis) accompanied by the buildup of lactate especially D-lactate, and is considered a distinct form of metabolic acidosis.[1] The condition typically occurs when cells receive too little oxygen (hypoxia), for example during vigorous exercise.

Back 82

Lactic acidosis

Front 83

This NRTI is well absorbed; 50% bound to plasma proteins; metabolized to inactive metabolites that are excreted in the urine and feces

Back 83

Abacavir

Front 84

This NRTI is well absorbed and metabolized in the liver and excreted mainly in urine.

Back 84

Emtricitabine (Emtriva)

Front 85

This NRTI Used to treat HIV infection and chronic hepatitis B. It is well absorbed and mainly eliminated unchanged in urine.

Back 85

Lamivudine (Epivir)

Front 86

This drug is similar to the NRTI's in that it inhibits the reverse transcriptase enzyme. However, it differs structurally, and this difference helps to prevent the development of drug resistant strains.

Back 86

Tenofovir (Viread)

Front 87

What are the non nucleoside reverse transcriptase inhibitors?

Back 87

Efavirenz (sustiva)
Nevirapine (Viramune)

Front 88

This NNRTI' is well absorbed; induces drug metabolizing enzymes in the liver. May cause central nervous system side effects

Back 88

Efavirenz (sustiva)

Front 89

This NNRTI is well absorbed and induces drug metabolizing enzymes in the liver. However, it puts a patient at risk for hepatitis, hepatic necrosis, hepatic failure, and severe skin reactions.

Back 89

Nevirapine (Viramune)

Front 90

Name the Protease Inhibitors.

Back 90

Atazanavir (Reyataz)
Darunavir (Prezista)
Fosamprenavir (Lexiva)
Indinavir (Crixivan)
Nelfinavir (Viracept)
Ritonavir (Norvir)
Saquinavir (invirase)
Tipranavir (aptivus)

Front 91

What are two major concerns with PI's?

Back 91

Viral resistance and drug interactions.

Front 92

True or false

Most PI's are metabolized in the liver by cytochrome P450 enzyme system and should be used cautiously in patients with liver impairment.

Back 92

True

Front 93

True or false

Give abacavir, combivir, emtricitabine, famciclovir, fosamprenavir, kaletra tables, lamivudine, nevirapine, tenofovir, trizivir, valacyclovir, and zidovudine with or with out food.

Back 93

true

Front 94

True or false

DO not give abacavir with a high fat meal.

Back 94

true

Front 95

True or false?

Give atripla, efavirenz, entecavir, or indiavir on an empty stomach 1hr before meals or 2hrs after meals.

Back 95

true

Front 96

True or false?

Give atazanavir, darunavir, ganciclovir, keletra oral solution, nelfinavir, ritonavir, and tripanvair with food.

Back 96

True