Non Hiv Antiviral Pharm

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3 classes of anti viral agents

Back 1

unclassified
chain terminators
neuramidase inhibitors

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herpes simplex virus involves

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mucotaneous surfaces, cns, and occasionally visceral organs

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dna of hsv 1&2

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- linear, double stranded dna virus

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what happens after initail infxn of hsv 1&2

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- goes to latent stage w/ minimal replication until reactivated by some cz

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hsv 1&2 are infection only during

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- pts are infectious at all stages, atlhough the highest viral shedding is at reactivation

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pathway of herpes infection

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herpes enters the body--> herpes virus lies formant in the nerves --> herpes is reactivated causing another outbreak

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hsv 1 affects what areas of the body more

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facial

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hsv 2 affects what areas of the body more

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genital

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herpes simplex virus potential triggers

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- uv light
- stress
-fatigue
-trauma
- chapped lips
- menses
-pregnancy
-food allergies

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herpes simplex virus presentation

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- itching, tingling, numbnes in the area. area will become red and look like a pimples

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hsv type 1&2 otc tx

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1) entry inhibitors
-abreva

2) non-antiviral
- pain relievers, l-lysine
- skin moisturizers, zinc oxide

3) denavir (penciclovir) cream
4) acyclovir (zovirax) cream

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hsv type 1 &2 otc ppx

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- avoid triggers
- sunscreen
-zinc oxide

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varicella zoster aka

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chicken pox

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herpes zoster is aka

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shingles

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pathogenesis of vsv

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primary infection- via inhalation seeding in the nasopharynx leading to viremia
- viremia results in dissemination to the skin w/ resultant lesions
-recurrent infection- reactivation of chicken pox

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chicken pox is spread easily ?

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yes, very contagious

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age group most at risk for vzv

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children 5-9

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chicken pox incubation period

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10-21days

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syx of chicken pox

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- rash, low grade fever, malaise
- skin lesions- evolve frm maculopapular to vesicles in hrs to days
- risk of superinfection w/ staph and strep

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clinical manifestations of zoster (shingles)

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-can occurs at all ages but predominatly affects elderly >60 yo and immunocompromised
- charac by unilateral vesicular eruption of dermatomes
- post herpetic neuralgia- continum of pain

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anti herpetics

chain terminators agents

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- acyclovir
- valacyclovir
-famciclovir

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chain terminators moa

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- all mimic guanine, replace guanine when it would be used in dna chain, but do not allow the nxt nucleic acid to join
- need to be triphos in vivo
- longer intracellular half life than extracellular

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acyclovir
a) formulation
b) se

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a) iv, po
b) possible kidney damage, keep hydrated

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when do you use iv acyclovir

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cns herpes

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valacyclovir
a) formulation
b) indication
c) comp vs acyclovir

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a) only po
b) po indicated for immunocompromised

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famciclovir
a) formulation
b) indications

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-prodrug of penciclovir
a) only avail oral
b) limited indications

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which of the chain terminators need renal adjustment

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- all should be dose adjusted

agents: acyclovir, valacyclovir, famciclovir

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hpv is what kind of virus

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dna virus

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hpv cz what

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warts

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how is hpv spread

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direct contact from a wart to skin

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hpv warts develop

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3-4 m (6wks -2 yrs)

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hpv warts start in

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the basal cells of the epidermis

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tx of hpv

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-caustic agent: salicyclic acid
-cryotherapy (freezing)
-surgical excision
- drugs:
-antivirals- cidofovir
-immune modulators- imiquimod
- laser/electrosurgery

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cmv stands for

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cytomegalovirus

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cmv cz

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common infection that is usually controlled by the immune system

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cmv causes

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retinitis, gi infections, pneumonitis in immunocompromised pts

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pts at risk for cmv

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advanced hiv and transplant most commonly

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hiv pts w/ cmv have cd4 count

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<100

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how do transplant pts get cmv

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highest risk are people who are cmv - and receive cmv+ organ

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clinical presentation of cmv

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- retinitis, colitis, esophagitis, pneumonia, encephalitis

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hiv pts w/ cmv usually presents as

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retinitis

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syx of retinitis

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unilateral visual field loss
dec visual acuity
floaters
flashes
blind spots
fever/wt loss

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dx of cmv

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-fundoscopic examination- cottge cheese on catsup
- viral culture of urine, blood or biopsy

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cmv tx for immediately site threatening dz

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-gancyclovir intravitreal inserts and valgancyclovir 900 mg po qd

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gancyclovir intravitreal inserts are dosed for cmv

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1 insert every 6-8m
decreased visual acuity at 1st, risk of retinal detachment

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tx for cmv peripheral lesions

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- valgancyclovir 900 mg po bid 14-21 d then valgancyclovir 900 mg po qd

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cmv alternative txs

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-all are 14-21 days, follow with valgancyclovir as maintenance
- gancyclovir iv
- foscarnet iv
-cidofovir iv

Front 48

cmv
-ganciclovir
a) moa
b) ae

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a) guanine analogue
- results in chain termination
- poor oral absorption

b) ae
- primary bone marrow suppression
- use w/ caution w/ azt
- poor gi tolerance if given po

Front 49

cmv
-valganciclovir
a) moa
b) dose

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a) prodrug of gcv
-metabolized to gcv after absorption
- allows better absorption through the gi tract tract

dose
-induction: 900 mg po bid for 21 days w/ food
-maintenance: 900 mg po qd w/ food
- dose adj for renal dysfxn

Front 50

cmv
-foscarnet
a) ae

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- nephrotoxicity
-can be severe, watch bun &scr
-adjust dose based on changing renal fxn

electrolyte abnormalities (ca, k, mg, phos)
- foscarnet is in triphosphate form
- loose phosphate cz problems

-penile ulcerations
-irritation from drug in urine
- proper hygiene
-rash
-neutropenia

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cidofovir
a) ae

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- nephrotoxicity: dose depend, probenecid helps protect proximal kidney cells
- neutropenia
- ocular hypotony
- iritis
-check cbc and scr w/ in 24 hrs before dose
-hold if anc <750 or scr> 1.5

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cmv
primary ppx for

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- no primary ppx in hiv
- induction then 3m of maintenance in medium and high risk transplant pts

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cmv secondary ppx

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- valganciclovir 900 mg po bid
- foscarnet 90-120 mg iv qd
- cidofovir 5 mg/kg qoweek: with 2 gm probenecid po 3hrs before dose and 1 gm po at 2 hrs & 8 hrs post-dose

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common viruses

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- picornaviridae
-rhinovirueses ( common cold, sore throat) and enteroviruses ( gi syx usually in infants)