Antivirals Flashcards
(46 cards)
Which viral infections require antivirals and why?
covid - rep failure
chickenpox - varicella pneumonitis
herpes - encephalitis
viral hep - chronic hep C
Mpox - eye lesions
Which viruses do you always treat?
HIV
Aims of antiviral treatment
reduce mortality
reduce morbidity (severity/duration)
prevent the occurrence in those at risk
reduce transmission from people infected
Which viral processes can antivirals interfere with?
reverse transcription (retroviruses)
transcription
translation
release (cell lysis)
Herpesviruses - what type of virus are they?
DNA viruses
What is the difference in disease course of RNA and DNA viruses?
RNA - acute infection
(except retroviruses)
DNA viruses - acute asymptomatic acute infection and then chronic infection and you never clear them
Key difference between meningitis and encephalitis
encephalitis is inflammation of the brain parenchyma (the brain tissue itself)
-> fever, reduced GCS, seizures, CN abnormalities,
-> usually viral or autoimmune
-> very deadly, 1/2 people with untreated HSV encephalitis will die
Meningitis -> inflammation in the lining of the neck
-> stiff neck, photophobia,
-> usually bacterial
Key difference between meningitis and encephalitis
encephalitis is inflammation of the brain parenchyma (the brain tissue itself)
-> fever, reduced GCS, seizures, CN abnormalities,
-> usually viral or autoimmune
-> very deadly, 1/2 people with untreated HSV encephalitis will die
Meningitis -> inflammation in the lining of the neck
-> stiff neck, photophobia,
-> usually bacterial
Mx of viral encephalitis
IV aciclovir 10 mg/kg TDS
start on suspicion, then get MRI and LP
What encephalitis causes does aciclovir work for?
HSV
varicella
What drug type is aciclovir?
guanosine analogue
4-5x/d
what drug type is valaciclovir?
pro drug - guanosine analogue
oral only
more expensive
TDS
Differences between aciclovir and valaciclovir
valaciclovir pro drug - guanosine analogue
A: oral and IV, 4-5x/d
V: oral only, TDS
What activates aciclovir/valaciclovir
viral thymidine kinase
CMV - when do we worry about it?
immunosuppressed patients
what can CMV cause
colitis
pneumonitis
hepatitis
retinitis
BM suppression
encephalitis/ventriculitis
nephritis
cystitis
myocarditis
When do we treat CMV infection?
only if there is CMV disease
if someone is immunosuppressed and has CMV infection you may monitor the viral load regularly and treat if it Strats going up
When do we treat CMV infection?
only if there is CMV disease
if someone is immunosuppressed and has CMV infection you may monitor the viral load regularly and treat if it Strats going up
CMV drugs
1st line: guanosine analogue
ganciclovir (IV - SE: BM suppression, CI in BM transplant recipients)
valganciclovir (PO)
2nd foscarnet (IV/intravitreal SE: nephrotoxic)
BMT patients with CMV disease - what drug?
2nd line drugs after aciclovir/valaciclovir
EBV management - when antivirals?
if patient had transplant
in renal transplant patients
PTLD ->
PTLD
post transplant lymphoproliferative disease (polyclonal infection)
seen post EBV infection in immunocompromised
oncogenic - you get B sx and this can also progress to lymphoma
can also give rituximab
Influenza - what antivirals can you use?
oseltamivir (tamiflu) - PO or NG
zanamivir (can be inhaled or given IV)
