Antiretroviral: NRTI: zidovudine (Retrovir, AZT)
Action: __1__, causing a defective DNA strand; strand is left unfinished.
Use: __2__ (3)
AE: N,D, anorexia, fatigue, HA, __3__ (3)
NC:
Give ___4__; avoid juice
PG C
CI: hypersensitivity, use caution in pre-
1) virus thinks the Rx is the CD4 receptor
2) symptomatic/asymptomatic HIV, PEP for healthcare workers, to decrease transfer from mother to fetus
3) anemia, blood cell toxicity, hepatomegaly
4) on an empty stomach with a full glass of water
Antiretroviral: NNRTI: efavirenz (Sustiva)
Action: __1__, & disrupts the cycle
Use:Preferred Rx; given __(dose)_2_
AE: sleep disorders/nightmares, dizziness, hepatotoxic, __3__
NC:
Give ___4__ time of day to avoid CNS AE
PG __5__!
__6__
1) binds with reverse transcriptase
2) PO q.d.
3) rash
4) at bedtime
5) X
6) teratogen
Antiretroviral: PI: lipinovair w/ ritonavir (Kaletra)
Action: lopinar inhibits __1__; ritonavir delays __2__ breakdown of lopinar, causing a longer half life.
Use: Rx of choice for __3__
AE: N,D, V, fatigue, HA, __4__ (5)
NC:
Give ___5__ with food.
Give _
1) HIV protease
2) liver
3) initial HIV therapy
4) dyspepsia, increased BS, lipodystrophy, increase LDL/Triglycerides, Worsens DM
5) oral solution
6) tabs
Antiviral for HSV: nucleoside analog: acyclovir (Zovirax)
Action: Prevents viral DNA __1__
Use: Rx of choice for __2__ (5)
AE: HA, fatigue, dizziness, HA, __3__ (2)
NC:
Give __4__ for 7-10 days
give with food
Wake up at night to take dose
1) synthesis
2) HSV1, HSV2, CMV, VZV, EBV
3) nephrotoxic (IV), resistance
4) PO
Smallest non-living parasitic agent capable of causing disease
virus
Viruses are ______. (where are they located)
intracellular
Types of viruses:
1. no medical intervention req'd (ex rhinovirus)
2. Rx therapy is req'd to prevent infection/alleviate symptoms (ex. HIV, HBV, HSV)
1. Self limiting
2. Aggtressive treatment
why can antiviral therapy be challenging?
B/c of rapid mutation and b/c viruses are intracellular
Antivirals are ____ spectrum
narrow
Strategies of antiviral therapy:
1. _____ by vaccination
2. Treat active infection with drug that ______cycle
3. Use ____ for long-term therapy so virus can remain dormant.
1. Prevent
2. interrupts replication
3. immunostimulants
Gradual destruction of the immune system
HIV to AID
When should you start pharm.ther for HIV?
in the latent/asymptomatic stage
What are 2 benefits of starting HIV pharmther early?
it will decrease viral load and delay progression of HIV to AIDS
What are 3 negative effects of ealy pharm.ther for HIV?
Very expensive, Rx have bad AE, Resistance can develop
Therapeutic Goals of antiretroviral therapy: (5)
- decrease HIV death/increase survival
- improve quality of life
- restore/preserve immune function
- maximum suppression of viral load
- prevent transfer from mother to child
What lab tests are done to monitor HIV?
absolute CD4 T-cell count, Viral load
HIV test that measures amount of HIV RNA in plasma
absolute CD4 T-cell count
HIV test that tells how quickly the virus is replicating; measures amoutn of HIV RNA in blood
Viral load
how often are HIV tests done
every 3-6 mo
Reasons for HIV treatment failure:
can't tolerate AE, non-adherance, resistance, genetic variability
what is the goal of HAART therapy?
decrease plasma HIV RNA to lowest level
Reverse Transcriptase inhibitors:
- binds to viral enzyme reverse transcriptase and inhibits its action.
- the virus things the druv is the nucloside and binds to that, prevening the virus from being finished.
- NNRTI
- NRTI, NtRTI
antiretroviral class that blocks the final assembly of virions; prevents the cleaving phase
Protease inhibitors
Key Rx in HIV pharmther
PI; (Kaletra)
What antiretroviral drug is used for perinatal transmission prevention?
zidovudine
When should PEP therapy be started?
within 24-36 h SP exposure (for KNOWN HIV exposure)
blister-like lesions on skin, genitals, and other mucosal surfaces
Herpes
what Rx class treats herpes
antivirals
infections of eye, mouth, lips; inital treatment within 5-10 days
HSV1
infections of genitals
HSV2
multi-body systems infections in immunosuppressed patients
cytomegalovirus (CMV)
shingles (zoster) and chicken pox (varicella)
varicella-zoster virus (VZV)
Mononucleosis and Burkitt's lymphoma
Epstein-Barr Virus (EBV)
Pharmther. goals of herpes:
relieve acute symptoms and prevent recurrences
how are chronic herpes outbreaks treatedor pt's with suppressed immune systems?
with prophy antiviral therapy
most common cause of corneal blindness.
ocular herpes
sore throat, fever, sneezing, coughing, chills; spread via airborn droplets
influenza
who should get vaccinated?
people in a nursing home, people with COPD, children under 5/healthy adults over 65, pregnant women and healthcare workers
____ causes inflammation/necrosis of liver cells
viral hepatitis
s/s of acute hepatitis
fever, chills, fatigue, anorexia, N/V
s/s of chronic hepatitis
prolonged fever, jaundice, liver cirrhosis, hepatic failure
Hepatitis that is spread by oral-fecal route; common in parts of the world with poor sanitation.
Hepatitis A
Hepatitis that is spread by exposure to blood and body fluids and from mom to fetus
Hepatitis B
Hepatitis that is stransmitted via blood/body fluids and has no vaccine
Hepatitis C
Identify viral infections that benefit from pharm.ther.
HIV, herpes, hepatitis, influenza
Explain the advantages of HAART pharm.ther of HIV
HAART is structured to treat different cell cycle stages of the virus, making it more effective than a drug only effecting for a certain stage; decreases resistance