Card Set Information
Non HIV antivirals Test2
Why is it difficult to treat viral nfxn
Viruses use host cell enzymes and substrates to reproduce
Drugs that affect these viruses will also affect the host
Successful drugs affect the biochemical processes unique to viral replication.
Herpes Simplex Viruses (Type 1)
Type 1 (HSV 1)
Cause classic cold sore
Severity increases with age and immunosupression
Herpes Simplex 2
Herpes Simplex Commonalities
There is not really a clear divide between the two types, however. HSV1 can also cause genetal sores, and vise versa.
Both viruses lay dormant within a nerve route until outbreak.
Most infective at time period immediately before outbreak (lesion).
After primary infection the virus remains in the body in a dormant state in the nerve ganglia
patient is asymptomatic
Reactivation of infection triggers the virus to travel the pathway of the nerve to the skin surface
Triggers may be:
Physical or psychological stress
Autoinnoculation (Spread of either type from one body part to another)
Last 3-10 days
First 3-5 days
Direct contact with active lesion
Virus containing fluid
1 in 4 women will acquire HSV
Current testing decreased risk of acquiring by 75%
Did not effect HSV1 if already infected
Not effective for men
Did not ultimately come to market.
Caused by reactivation of latent Varicella-zoster virus
Those previously exposed to chicken pox
Contagious to those never exposed to chickenpox
Dormant virus resides in the dorsal root ganglia of the sensory cranial and spinal nerves
Multiple lesions occur on the skin innervated by the infected nerve
Disease of immunosuppression
Vaccine for chicken pox/shingles
For those over 60
Prevents shingles in over half of those over 60---reduces pain in others.
Allergic reactions to gelatin
Allergic reactions to neomycin (
Weakened immune system
Hx of leukemia, lymphoma
Temp over 101
Purine Nucleoside Analogs
DNA polymerase inhibitors
Suppresses synthesis of viral DNA
First choice for infections caused by herpes simplex and varicella-zoster virus
Administered topically, orally and IV
Acyclovir (Zovirax) Adverse Effects
Acyclovir (Zovirax) Pt education
Acyclovir IS NOT A CURE
It will not prevent spread to others
Use of condoms (Genital Herpes)
No sexual contact when active lesions are present
Use of OTC lotions, creams may delay healing and cause spread of lesions,
may lead to selfinnoculation!
CMV is related to the herpes virus and is present in almost everyone.
Especially seen in those who are immunosuppressed
AIDS (brought CMV to the forefront), Chemo, Transplants
Infections of the eye are very common.
Spots, bugs and spider-webs
Obstructed areas of vision
Sudden decrease in vision
Basically destroys vision
Prodrug version of ganciclovir (acyclover). Becomes identical to acyclover after metabolism.
Can be given orally
: Blood dyscrasias (decreases of WBCs, RBCs, and platelets)
Should be taken with food
Has potential for mutagenesis and carcinogenesis….handle carefully
Take intact…no crushing or chewing, increases mutagenic and carcinogenec properties. Prep should be done under a hood, with gloves, wash hands.
If pregnant, DO NOT HANDLE GANCYCLOVIR
HCW use cytotoxic chemo precautions
6 types of Viral Hepatitis
: A; B; C; D; E; G
Mode of transmission
Manner of onset
: A and E (Vaccine for A)
Parenteral (needle sticks) Forms
: B,C E G (Vaccine for B)
E occurs in both, so its more virulent.
C is more contagious than HIV, so use precautions when treating pt with HepC.
Accute vs. Chronic Hepatitis
Lasts ~ 6 months
, jaundice, Elevation of Liver enzymes
Usually resolves spontaneously.
All forms can be accute.
Only B, C ,D and G can cause chronic hepatitis
(not A and E).
90% caused by B and C
1.5% of Americans have chronic infection with HBV or HCV
5 times more than the number infected with HIV
Interferon Family (used to treat) can be Alpha, Beta, Gamma
Parenterally, IM or SQ
Improved liver histology in 40%
After 12 months-40-50% have normalized liver function
Available in 2 formulations
Inhaled (For Respiratory Syncytal Virus –RSV )
Oral ( For Chronic Hepatitis )
Action is really unknown although several actions are thought to be actively anti-viral
Contraindicated for use in pregnancy nor should pregnant nurses administer the drug (Aerosol)
DO NOT CRUSH!
REBETRON: RIBAVIRIN PLUS INTERFERON ALFA-2B
Current treatment for chronic hepatitis C
Ribavirin-nucleoside analog; Mechanism unknown
Kit—contains two drugs, Ribavirin - PO, Interferon Alfa - SQ
Treatment of HCV
Approved for stand-alone therapy… initial research seems to identify improved effectiveness with ribavirin
Long-acting form of interferon alpha 2b
Half life of 40 hours vs 2-3 hrs
Can be given 1x week vs 3 times a week
Identical side and toxic effects
Drugs for Flu
Annual. Changes every year in accordance with what is predicted to come to the US from Asia the year before. Not always accurate.
Inactivated virus. Cannot get flu from vaccine, but may have rxn due to egg content in vaccine serum.
Protection lasts 6 months
Elderly population works only 30-40%, and will last only ~ 4 months
Always ask "Are you allergic to eggs? Have you ever had a rxn to flu vaccine?"
Use to give a live virus called Guillin Berette. Could cause paralysis. Will have some pts who will not take flu vaccine now because they're still afraid of it.
Live, attenuated (virulent components removed) Influenza Vaccine (LAIV)
Temperature sensitive (Cold Adapted). Must be kept cold, almost frozen.
Trivalent; composed of and specific to three viruses.
Intranasal, rub nares together, do not blow nose afterwards.
Approved last year
Not for everyone
You should NOT use Flu Mist if you:
are under 5 years of age
are aged 50 years or over
have asthma or other reactive airway diseases
have chronic underlying medical conditions that may predispose you to severe flu infections
have problems with immune suppression, including those with immune deficiency diseases, such as AIDS or cancer, and people who are being treated with drugs that cause immunosuppression
are allergic to eggs or to a previous dose of the vaccine
children or adolescent receiving aspirin or other salicylates ----->(Reyes Syndrome).
History of Guillain-Barre’ syndrome
Flu Mist Special Considerations
Children age 5-8 who have not received injection need 2 doses at least 6 wks apart
Must be stored at 15 degrees C
Thaw in hand and administer immediately OR
Thaw in refrigorator
Should only be thawed for 24 hours
Administer 1/2 of single use sprayer in one nostril and remainder in other
In upright position
Don’t repeat if sneezes
Mild illness is OK, if fever >101 degrees, do not give.
Cost ~$46 per dose
Inactivated viruses OK
Live viruses 4 weeks apart from flu inhaler.
Amantadine and Ramantadine (1st gen flu meds)
First Generation Drugs
Used for prophylaxis and treatment of Influenza A
Should not take the place of vaccination
difficulty in concentration
DO NOT use in pregnant and lactating women
Oseltamivir and Zanamivir (2nd gen flu meds)
Suppress both Influenza A and B
Not approved for prophylaxis ~ seems to have some efficacy
Only for use in those >18
Symptoms for no more than 2 days
Oseltamivir ~ oral
Zanamivir ~ Inhaled powder
Human Papaloma Virus (HPV) Vaccine
Gardasil Vaccine:Targets 4 viruses that cause up to 70% of all cervical cancers and 90% of genital warts
: Targets 2 viruses known to cause cervical cancer.
CDC recommends vaccination for all girls 11 -12 years, and all boys age 9-26 (gardacil)
13-26 years of age if not already vaccinated (only ages tested)
Series of 3 injections over 6 months
No serious side effects (yeah right) but will see fainting, seizures
SARS: Severe Acute Respiratory Syndrome
Closely related to common cold
Results in atypical pneumonia
Time from exposure to onset of symptoms, 2 - 11 days
Fever ~ 100.4 or higher
Dry, nonproductive cough
West Nile Virus
Detection of IgM antibody to WNV in serum or CSF
Collected within 8 days of disease onset
Recent vaccination or infection with other associated viruses may cause a false positive
Plague Reduction Neutralization Test (PRNT)
West Nile Virus (WNV)
First documented in 1937
Similar to yellow fever, dengue and St. Louis encephalitis
Sudden fever with
Symptoms last 3-6 days
1 in 150 Cases