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U of A NURS 3313 - Antiviral Drugs

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Antiviral DrugsGeneral Principles of Virology- Viral replicationo A virus cannot replicate on its owno It must attach to and enter a host cello It then uses the host cell’s energy to synthesize protein, DNA, and RNAo Viruses are difficult to kill because they live inside the cells Any drug that kills a virus may also kill cellsViral Illnesses- Most viral illnesses are bothersome, but survivable- Effective vaccines have prevented some illnesses- Effective drug therapy is available for a small number of viral infectionsAntiviral Drugs- Antiviral drugs kill or suppress the virus by destroying virions or inhibiting the ability of viruses to replicate; controlled by current antiviral therapy- Immunoglobulins are concentrated antibodies that can attack and destroy viruses- Viruses controlled by current antiviral therapyo Cytomegalovirus (CMV)o Hepatitis viruseso Herpes viruseso Human immunodeficiency virus (HIV)o Influenza viruses (the “flu”)o Respiratory syncytial virus (RSV)- Key characteristics of antiviral drugso Able to enter the cells infected with viruso Interfere with viral nucleic acid synthesis and/or regulationo Some drugs interfere with ability of virus to bind to cellso Some drugs stimulate the body’s immune systemo Best responses to antiviral drugs are in patients with competent immune systemso A healthy immune system works synergistically with the drug to eliminate or suppress viral activity- Opportunistic infectionso Occur in immunocompromised patientso Would not normally harm an immunocompetent persono Require long-term prophylaxis and antiinfective drug therapyo Can be other viruses, fungi (lots of times yeast), bacteria, or protozoa- Antiviral drugso Used to treat infections caused by viruses other than HIV- Antiretroviral drugso Used to treat infections caused by HIV, the virus that causes AIDSHerpes Simplex and Varicella Zoster Virus Infections- Herpes simplex viruseso HSV-1 (oral herpes)o HSV-2 (genital herpes)- Human herpesvirus/VZVo Chickenpox and shingles (HHV-3 or VZV)o Epstein-Barr (HHV-4)o Cytomegalovirus (HHV-5)o Kaposi’s sarcoma (HHV-8)Antiviral Drugs (non-HIV)- Mechanism of actiono Inhibit viral replicationo Used to treat non-HIV viral infections Influenza viruses HSV, VZV CMV Hepatitis A, B, C (HAV, HBV, HCV)- Adverse effectso Vary with each drugo Healthy cells are often killed also, resulting in serious toxicities- amantadine (Symmetrel) o Narrow antiviral spectrum; active ONLY against influenza Ao Most recent guidelines do not recommend use for treatment or prevention of fluo CNS effects: insomnia, nervousness, light-headednesso GI effects: anorexia, nausea, otherso Patients that have Parkinson’s disease often drool, this is a great medication to reduce that - rimantadine (Flumadine) o Same spectrum of activity, mechanism of action, and indications as amantadineo ONLY for influenza A o Fewer CNS adverse effectso Causes GI upset- acyclovir (Zovirax) o Synthetic nucleoside analogo Used to suppress replication of HSV-1, HSV-2, VZVo Drug of choice for treatment of initial and recurrent episodes of these infectionso Oral, topical (cream for pain), parenteral forms When patients use a cream for herpes one and two, use glove or wash hands for 3 minutes after application. You can move herpes infection somewhere else o VIR is anti-viral drug- ganciclovir (Cytovene)o Synthetic nucleoside analogo Used to treat infection with cytomegalovirus (CMV)o Oral, parenteral formso CMV retinitis Ophthalmic form surgically implanted (Vitrasert)- Dose-Limiting Toxicitieso ganciclovir Bone marrow toxicity – monitor CBC o foscarnet and cidofovir Renal toxicity- Neuraminidase Inhibitorso oseltamivir (Tamiflu) and zanamivir (Relenza) Active against influenza types A and B Reduce duration of illness Oseltamivir: causes nausea and vomiting Zanamivir: causes diarrhea, nausea, sinusitis Treatment should begin within 2 days of influenza symptom onset- Ribavirino Synthetic nucleoside analogo Given orally, or by oral or nasal inhalationo Inhalation form (Virazole) used for hospitalized infants with RSV infectionso Curative HIV and AIDS Drugs- ONLY NEED TO KNOW THIS: ******All cause toxicity – most common adverse effect is bone marrow suppression******* Questions1. An 82-year-old woman is unable to take the influenza vaccine due to allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her?A. She should receive the flu vaccine as soon as possible. B. She should receive zanamivir (Relenza) in the inhalation form.C. She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin.D. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.Rationale: Oseltamivir (Tamiflu) is the only one indicated for prophylaxis of influenza infection. Both oseltamivir and zanamivir can be used to treat active influenza illness. Treatment with oseltamivir and zanamivir ideally should begin within 2 days of symptom


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