Mi - Antivirals Flashcards by Lottie Barot

why is zoonoses more common

closer contact
travel
global warming
personal - eat plants, sleep, exercise

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what is the Tx for most viral infections

NOTHING - just rest

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which virus would you always treat

HIV

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purpose of Tx of virals

reduce mortality / morbidity
reduce transmission
post exposure prophylaxis

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what areas of cell cycle do antivirals target

transcription
translation
host cell lysis

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what components of host can antivirals target

upregulate immune sustem
downregulate immune system - eg steroids

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limits of antivirals

host immune capacity
adherence
resistance
toxicity
interactions

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what type of viruses are herpes

DNA

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which type of virus cause acute infection

RNA

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which type of virus causes chronic infection

DNA
- eg HSV, EBV

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when is HSV Tx used (7)

encephalitis
mucocutaenous (some)
genital lesions (most)
HSV suppression
HSV prophylaxis
VZV - encephalitis / chicken pox / shingles
VZV post exposure prophylaxis

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who gets HSV prophylaxis

transplant pt

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mortality of HSV encephalitis

50% if untreated

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Tx of HSV encephalitis (inc dose)

IV acyclovir 10mg/kg 3x day

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Tx for genital herpes

valacyclovir or acyclovir

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what is acyclovir

guanosine analogue
(exam Q++)

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how does acyclovir work

viral DNA synthesis inhibitors

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how can you give acyclovir

oral / IV

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when is acyclovir always given IV

encephalitis

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what is valacyclovir

prodrug that is metabolised into acyclovir

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how is valacyclovir given

only orally

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2nd line Tx for HSV/VZV

foscarnet
cidofovir

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when is 2nd line tx for HSV/VZV used

acyclovir resistant

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what activates acyclovir

viral thymidine kinase
(exam Q ++)

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MoA of foscarnet

DNA polymerase inhibitor

MoA of cidofovir

cytidine analogue

how can you become acyclovir resistant

mutation in viral thymidine kinase that means acyclovir not taken up into viral genome

who gets CMV Tx

neonates transplant pt

when is CMV Tx given

congenital CMV prophylaxis CMV disease (ie not just infection) Sx / signs / organ dysfunction with CMV+ specimens

what complications can CMV cause

colitis pneumonitis hepatitis retinitis bone marrow suppression (main 5) also: encephalitis / ventriculitis nephritis cystitis myocarditis

what sign is seen on CMV colitis biopsy histology

owl's eye

what drugs are used to Tx CMV

ganciclovir valganciclovir

what type of drugs are ganciclovir and valganciclovir

guanosine analogues

SE of ganciclovir

bone marrow toxicity

who is CI to get ganciclovir

BM transplant recipients (causes bone marrow toxicity)

how is ganciclovir given

how is valganciclovir given

oral

2nd line Tx for CMV

foscarnet

3rd line Tx for CMV

cidofovir

4th line Tx for CMV

maribavir

SE of foscarnet / cidofovir

nephrotoxic

what drugs are used in prophylaxis for CMV

valganciclovir letermovir (MAB)

who is given valganciclovir prophylaxis for CMV

solid organ transplant pt

who is given letermovir prophylaxis for CMV

bone marrow transplant pt

Sx of acute EBV

tonsilar swelling

when would you treat acute EBV and what would you give

if tonsils are so swollen that airway is impinged - steroids

what is the chronic EBV infection in immunocompromised pts called

post transplant lymphoproliferative disease (PTLD)

who do you need to treat for EBV

PTLD pts

what happens in PTLD

latently EBV infected B cells turnover lots, causing polyclonal expansion which can --> lymphoma

Tx of PTLD

reduce immunosuppression rituximab (anti CD20)

list some resp viruses

influenza rhinovirus RSV covid parainfluenza adenovirus

spectrum of disease in resp viruses

asymptomatic common cold pneumonia resp failure

what proteins coat influenza

haemagluttanin neuraminidase

reservoir of influenza

water birds

post exposure prophylaxis for influenza

oseltamivir

what does rsv cause

bronchiolitis

prevention of RSV

palivizumab (vaccination - MAB)

tx for bronchiolitis

supportive ? IVIG / ribavirin

what causes disease in covid

overexaggerated inflam response

tx for early infection with covid

nirmatrelvir / ritonavir remdesivir molnupiravir

how is nirmatrelvir given

oral

how is remdesivir given

tx for late infection with covid

steroids baricitinib IL6 inhibitors

who gets steroids / baricitinib for covid

those on o2 support

how is early vs late tx for covid different

early = targets virus late = targets host response

how does oseltamivir work

directly inhibits the influenza neuraminidase

tx for monkeypox

tecoviromat

who needs monkeypox tx (3 reasons, 3 examples for each)

severe disease - >100 lesions, encephalitis , sepsis anatomical concerns - eyes / throat / bladder high risk - immunocompromised, pregnant, child

what Sx does BK virus cause

none - almost everyone has had it

who gets Sx with BK virus

transplant pts (bone marrow and renal)

what complication does a bone marrow transplant patient get with BK virus

haemorrhagic cystitis

Mx of haemorrhagic cystitis due to BK in BMT pts

bladder washouts reduce immunosuppression cidofivir if severe

what complication do renal transplant pts get with BK virus

BK nephritis and ureteric stenosis

mx of BK nephritis and ureteric stenosis due to BK virus in renal transplant pts

reduce immunosuppression ? IVIG

what sx does adenovirus commonly cause

none GI sx conjunctival infections

who gets severe adenovirus disease

transplant, esp paediatric transplant

what sx does severe adenovirus give

disseminated / invasive disease

tx for severe adenovirus

none approved ? cidofivir / brincidofivir / IVIG

what is cellular immunotherapy

take immune cells out of donor's arm, put them with the virus you want to target and let them become activated against that virus, then put them into the immune suppressed recipient

how is drug resistance tested for

phenotypic - cell culture and plaque reduction assay genotypic - sequencing / resistance mutations

for which viruses do we do phenotypic drug resistance testing

HSV

for which viruses do we do genotypic drug resistance testing

HIV routinely also can do HBV, HCV, CMV

main mechanism of resistance to acyclovir

thymidine kinase mutation (95%)

who gets drug resistance

immunosuppressed (>99%)

name a mutation for influenza H1N1 that confers resistance to oseltamivir

H257Y - neuraminidase mutation

when are Igs given (3 categories and an example virus for each)

pre exposure prophylaxis - pavilizumab (RSV) post exposure prophylaxis - HBV Ig, rabies Ig, VZV Ig therapeutic - IVIG (CMV) or rituximab (EBV)

Mi - Antivirals Flashcards

(86 cards)