Nursing 305 Exam 3 – Antiviral Drugs – Flashcards
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Antiviral Principles
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- The simplest of all organisms - Viruses are very small organisms - Reproduce only within the cells of their hosts; intracellular parasites - Viruses enter the body through basically 4 routes.
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what are the 4 routes that viruses enter the body?
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1. inhalations via respiratory tract, sneezing and coughing. 2. Ingestion via GI tract 3. Transplacentally via placenta 4. Inoculation via the skin or mucous membrane - sexual contact - blood transmission - sharing syringes or needles - organ transplantation - animal bites
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True of False - Viruses are ubiquitous
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TRUE - they are everywhere
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Overview of viral illnesses and treatment
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- Antiviral drugs either kill or suppress viruses by destroying virions or inhibiting their ability to replicate. - even the best/strongest drug probably never fully eradicates a virus. - the body's immune system has the best chance of controlling or eliminating the virus if the immune system is intact.
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Overview of Viral Illnesses and Treatments
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- Currently, antiviral drugs are synthetic compounds which work indirectly by inhibiting viral replication. - only a few viruses can be controlled by current drug therapy: 1. cytomegalovirus (CMV) 2. Hepatitis (A and B specifically) 3. Herpes Virus 4. HIV 5. Influenza A 6. Respiratory Syncytical Virus (RSV)
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Herpes Simplex Virus and Varicella-Zoster Infections - Family of viruses known as Herpesviridae - Several Types
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- Herpes simples virus type 1 (HSV-1) - cold sores, fever blisters - Herpes Simplex Virus type 2 (HSV-2) - genital herpes - Human Herpesvirus 3 (HHV-3) - chickenpox, shingles [AKA herpes zoster or varicella zoster virus (VSV) - Human Herpesvirus 4 (HHV-4) - frequently known as Epstein Barr virus often associated with mononucleosis and chronic fatigue syndrome. - Human Herpesvirus 5 (HHV-5) - commonly known as cytomegalovirus (CMV) cause of CMV retinitis and CMV disease. - Human Herpesvirus 6 (HHV-6) and Human Herpesvirus 7 (HHV-7) - not clinically significant - Human herpesvirus 8 (HHV-8) - virus believed to cause Kaposi's Sarcoma (AIDS associated cancer) ** Types 3-7 usually do not require medication except in the immunosuppressed patient.
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Herpes Simplex Virus
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HSV-1, HSV-2 usually does not cause serious or life threatening illness but both are annoying and highly transmittable through close physical contact. - Outbreaks of painful lesions occur intermittently with periods of latency occurring between outbreak periods. *** Antivirals are not curative, but they act to speed up the remission process and reduce duration of painful symptoms. -- May be prescribed dose for prophylaxis of outbreaks.
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True or False - Antivirals are not curative , but they do act to speed up the remissions process and reduce duration of painful symptoms of the Herpes Simplex virus HSV-1 and HSV-2.
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True
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Varicella-Zoster Virus
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- Most common cause of chicken pox in childhood and remains dormant; may produce shingles in adults. - Chicken pox is a self limiting highly contagious disease characterized by weeping lesions. May lead to scarring of the skin. NOT normally treated with antivirals. - Shingles are caused by reactivation of VSV from its dormancy. Manifested by skin lesions that follow nerve tracts (Dermatomes). Common site is around the trunk. VERY Painful and may require Opioids for relief. Best results occur when med is started within 72 hours of symptom onset.
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Which of the following are is not correct about Chicken Pox? a. Chicken pox is a self limiting virus b. chicken pox is highly contagious c. it is not commonly treated by Antivirals d. it is characterized by weeping lesion e. it is the Varicella-Zoster Virus
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All of the answers are indicative of chicken pox
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Where do shingles present on the body? a. brain b. trunk c. legs d. feet
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Shingles present most commonly on the trunk of the body and follow the nerve tracts (Dermatomes)
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Pharmacology Overview of Antivirals (NON-HIV) - Mechanism of Action and Drug Effects
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- Block activity of polymerase enzyme which normally stimulates synthesis of new viral genomes->impaired viral replication->usually results in low concentration and the ability of the body to remove the virus.
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Pharmacology Overview of Antivirals (NON-HIV) - Indications
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- Treat HSV, VZV, and CMV
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Pharmacology Overview of Antivirals (NON-HIV) - Contraindications
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- Severe Drug Allergy - Amantadine is contraindicated in lactating women, kids<12 years of age, and eczematous rash. - Famiciclovir is contraindicated with allergy to drug itself and penciclovir. - Cidofovir is contraindicated in those with severely compromised renal function - Ribavirin is contraindicated in pregnancy and male partners due to teratogenic potential (ability to cause birth defects)
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Pharmacology Overview of Antivirals (NON-HIV) - Adverse effects
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They are drug specific
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Pharmacology Overview of Antivirals (NON-HIV) - Interactions
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- Usually occur when administered systemically - Lesser degree when given topically
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Antivirals (NON-HIV)
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1. Acyclovir (Zovirax) 2. Ganciclovir (Cytovene) 3. Oseltamivir (Tamiflu) and Zanamivir (Relenza)
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Acyclovir (Zovirax)
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1. Antiviral (NON-HIV) - Drug of choice for treatment of HSV-1, HSV-2, and VZV in the initial stage and recurrent episodes. - Given PO, Topical, or Injectable - Inhibits viral Replication, decreases shedding, and decreases time necessary for the healing of lesions.
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Acyclovir (Zovirax) - side Effects
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- Dizzines - N/V/D - Pain - Phlebitis
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Acyclovir (Zovirax) - Adverse Reactions
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- Seizure - Renal Failure - Thrombocytopenia Purpura
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Acyclovir (Zovirax) - Nursing Implications
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- Assess lesions before and daily during therapy - Monitor neuro status in patients with herpes encephalopathy, and monitor BUN, Creatinine.
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Acyclovir (Zovirax) - Teaching
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- Take med as directed - OTC creams/lotions may delay healing - Advise that acyclovir is not a cure - Condom use is encouraged and no sexual contact should occur while lesion is present - Women with genital herpes should have a PAP test done yearly (branches off of herpes virus are linked to cervical cancer. - Complete the course of the med
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Ganciclovir (Cytovene)
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1. Antiviral (NON-HIV) - Different spectrum of antiviral activity - Indicated for the treatment of CMV as well as preventative in high risk patients; organ transplants. - Carried by 50% of adult population with CMV - In neonates and immune compromised it can be life threatening. - Common site for CMV is the immunosuppressed patient is in the EYE->CMV retinitis->possible blindness. - IV or PO - Opthalmic form is Vitrasert - must be surgically implanted. - **Dose limiting toxicity is bone marrow suppression.
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Ganciclovir (Cytovene) - Side effects
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- decreased visual acuity - vitreous hemmorrhage - thrombocytopenia
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Ganciclovir (Cytovene) - Adverse effects
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- Seizures - GI bleeding
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Ganciclovir (Cytovene) - Nursing Implications
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- culture for CMV (Urine, Blood, Throat) - Assess for signs of infections - Assess for signs of bleeding
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Ganciclovir (Cytovene) - Teaching
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- Take with food and exactly as directed - does not cure CMV - Notify physician if s/s of infection or bleeding occur. - may have teratogenic effects on a fetus - use sunscreen
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Oseltamivir (Tamiflu) and Zanamivir (Relenza)
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- Active against influenza A and B - Relenza is an inhalant - Tamiflu is a pill form
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Oseltamivir (Tamiflu) and Zanamivir (Relenza) - Adverse Effects
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- Nausea and Vomiting
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Oseltamivir (Tamiflu) and Zanamivir (Relenza) - Adverse Reactions
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- Diarrhea, Nausea and Sinusitis
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Oseltamivir (Tamiflu)
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- Available in Oral Form - indicated for prohpylaxis and treatment of influenza
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Zanamivir (Relenza)
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- Supplied in blister packets for inhalation - indicated only of the treatment of active influenza.
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Disease Overview of Other Viral Infections - Four merit special mentioning:
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1. west nile virus (WNV) 2. Sever acute respiratory syndrome (SARS) 3. Avian Flu (H5N1) 4. Novel Influenza Virus (H1N1)
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West Nile Virus (WNV)
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- first case occurred in 1999 in New York City - Member of arbovirus family - transmitted by MOSQUITOS - May lead to Meningitis and Encephalitis in humans - Transmitted via Blood transfusion and has been detected in Breast Milk - Currently there are NO antivirals to treat human west nile virus.
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Severe Acute Respiratory Syndrome (SARS)
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- Emerged in 2002 - Usually resolves on its own in 3-4 weeks, but 10-20% of those infected require mechanical ventilation. - Standard antivirals were used, but no specific drug emerged as being specifically helpful. - Cause was determined to be Coronavirus. - Common cause of mld to moderate upper respiratory infections in humans.
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Avian Flu (H5N1)
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- carried in the INTESTINES of many WILD BIRDS throughout the world. - Usually do NOT affect humans but since 1997, case of human infection has occurred. - mostly after exposure to birds or their excrement. - Majority of cases occurred in EUROPE and ASIA. - Human to Human transmission is RARE - Symptoms are flu like symptoms - fever, sore throat, muscle aches, eye infections, acute respiratory distress. - Resistant to amantadine and Rimantadine - affects immunosuppressed people in 3rd world countries.
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Novel Influenza Virus (H1N1)
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- Originally named Swine Flu - Spreads person to person, much like regular seasonal influenza - Symptoms - fever, cough, sore throat, body aches, chills, and fatigue. - VACCINE DEVELOPED in 2009
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HIV AND AIDS
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- First cases recognized in 1981 - Patients developed Pneumocystis Carnii Pneumonia or Karposi's Sarcoma - Patterns also developed in IV drug abusers, and Hemophiliacs, in addition to Homosexual Community. - Other cases developed amount hospitalized patients who received Blood transfusions. - In 1983, Human T-Cell lymphotrophic virus type 3 (HTLV-3) was isolated; this was the cause of AIDS - Virus later renamed, Human Immunodeficiency Virus (HIV); a member of the RETROVIRUS family. - Retroviruses are all RNA viruses and unique in their use of reverse transcriptase during replication. - REVERSE TRANSCRIPTASE promotes the synthesis of mirror image DNA molecules from the viral RNA genome. A second Enzyme, INTEGASE, promotes integration of viral DNA into the host cell DNA->Provirus->new viral RNA genomes and proteins->combine to form mature HIV Virons that infect the host cell.
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Pharmacology Overview of Drugs to Treat HIV - mechanism of actons
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- Block activity of reverse transcriptase.
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Pharmacology Overview of Drugs to Treat HIV - Indications
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- Active HIV infections - Prophylaxis for individuals exposed to the virus and high risk infants with a known potential for exposure.
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Pharmacology Overview of Drugs to Treat HIV - Contraindications
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- Known severe drug allergy
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Pharmacology Overview of Drugs to Treat HIV - Adverse Effects
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- high potential for adverse effects occurring - often need to modify drug therapy due to adverse reactions - goal is to find the regimen that best controls the infection with the least amount of adverse effects. - 25% of HIV infected people have Hepatitis C (HCV)
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Epidemiology of HIV - Transmission
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- Present in blood, semen, and vaginal secretions.
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HIV - At risk populations
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- IV drug abusers, sexually active people with many partners (homosexual and heterosexual), prostitutes, newborns ofHIV+ mothers, blood and organ transplant recipients, and hemophiliacs prior to 1985(blood was not checked)
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HIV - Geographic
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- Ever expanding worldwide - No seasonal pattern
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HIV - Modes of Control
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- Antivirals limit progression, may send it into a degree of remission, but do NOT cure it
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HIV
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- Vaccines for Prevention in trial Mode (Not on the market yet)
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HIV
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- Monogamous sex using safe practices helps limit spread
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HIV
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- Sterile needles used
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HIV
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- Large scale screening programs have been developed to test for blood transfusions, organ transplantation, and clotting factors to give to hemophiliacs (males are usually hemophiliacs)
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Action of HIV Meds
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- Block activity of reverse transcriptase
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HIV Meds Indications
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- Active HIV infections - Prohpylaxis for those exposed to the virus or high risk infants with a known potential exposure.
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HIV Meds - Contraindications
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- Known allergy
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HIV Meds Goal
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- to find the best collection of drugs which controls symptoms with the least amount of side effects
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AZT [Prototype] HIV med
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- effect is virustatic against retrovirus causing a slowed progression of HIV infection, decreased viral workload, and improved.
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AZT side effects
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- H/A, Weakness, Abdominal Pain, Nausea, Diarrhea, Anemia
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AZT Adverse effects
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- Seizures
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AZT
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Assess for change in severity of symptoms of HIV
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AZT - teaching
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- take as directed - Do NOT share with others - May cause Dizziness, or Fainting - Does NOT cure HIVand does NOT reduce the risk of transmission. - Seek medical attention for FEVER, SORE THROAT, SIGNS OF INFECTIONS (because they are immunocompromised) - Avoid OTC meds until cleared by physician - Emphasize importance of follow up exams and blood work.
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AZT
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- works by inhibiting Viral RNA synthesis by inhibiting DNA Polymerase.
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Viral Hepatitis
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- has increased in recent years. Common types: - Hepatitis A (HAV) - Hepatitis B (HBV) - Hepatitis C (HCV)
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Hepatitis A
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- Vaccine - transmitted by fecal-oral route, close contact with an infected person, food borne outbreaks, secondary to infected food handlers, or contaminated products. - Survives for a LONG TIME, resists freezing, detergents, and acids. - ** DEACTIVATED BY CHLORINE AND TEMPERATURES >185. - reproduces ONLY in the LIVER and GI cells and is released into the blood. - Average incubations time is 25-30 days. - Person is infectious during incubation phase and for 7-10 days after symptoms develop, so you would be infected and not know it for 40 days.
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Hepatitis B
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- Vaccine - transmitted by contact with contaminated blood and other bodily fluids, sharing needles, sexual contact with an infected person, acupuncture, hemodialysis, tattooing, piercings. - Healthcare and Public safety workers at increased risk due to injury by contaminated needles and exposure to bodily fluids. - Approximately 70,000 americans are infected with HBV/year; approximately 5000 will die of complications. - Can live on surfaces up to 3 DAYS. - Incubation period is 30-180 days. - Can lead to CIRRHOSIS, LIVER CA, LIVER FAILURE, and DEATH.
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Hepatitis C
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- NO vaccine - contemned blood and other bodily fluids - High risk populations: Healthcare workers, public personnel, IV drug abusers, those with multiple sex partners, hemodialysis, tattoos, piercings, blood transfusions prior to 1990, transmitted via placenta at birth. - Incubation period is 14-80 days. - Often found in the 20-39 age group. - May be ASYMPTOMATIC and then develop chronic liver disease.
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Treatment of Hepatitis
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- Incidence has decreased due to vaccines for Hepatitis A and B. - Drugs are: - Adefovir (Hepsera) - Entecavir (baraclude) - Telbivudine (Epivir HBV) - Ribavirin (Virazole) - treatment for Hepatitic C is a combination of Ribavirin and Peginterferon alfa-2a.
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Prevention of Viral infections
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- Vaccines (highly encouraged that you get it) - Good hand hygiene is imperative - covering mouth and nose when sneezing or coughing - treat symptoms - recognize and treat complications - HIV/HPV/Hepatitis educations (They do this as early as elementary school)
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Vaccines
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- Produce active immunity before exposure - Used to control epidemics within a community (Herd effect) - Cervical Cancer occurs due to some strains of HPV, chicken pox, measles, hepatitis A and B, herpes zoster, mumps, polio, rubella, small pox, and yellow fever. Vaccines offer protection from Influenza A, B, Avian A, and rabies.
