Antiviral Agents
Chapter 39
I Viruses
A. Viral replication
1. a virus cannot replicate on its own
2. it must attach to and enter a host cell
3. it then uses the host cell’s energy to synthesize protein, DNA and RNA
B. Viruses are difficult to kill because they live inside our cells
1. any drug that kills a virus may also kill our cells
C. Viral infections
1. a competent immune system is the best way to treat viruses
2. a well functioning immune system will eliminate or effectively destroy virus replication
D. Immunocompromised pts have frequent viral infections
1. CA pts, esp leukemia or lymphoma
2. transplant pts, due to pharmacologic therapy
3. AIDS pts, disease attacks immune system
II Antivirals
A. Viruses killed by current antiviral therapy (killed does not mean cured...suppressed)
1. cytomegalovirus (CMV)
2. hepatitis viruses
3. herpes viruses
4. HIV
5. influenza viruses
6. respiratory syncytial virus (RSV)
B. Key characteristics of anitviral drugs
1. able to enter the cells infected with virus
2. interfere with viral nucleic acid synthesis and/or regulation
3. some agents interfere with ability of virus to bind to cells
4. some agents stimulate the body’s immune system
C. Antiviral medications
1. Antiviral agents
a. used to treat infections caused by viruses other than HIV
2. antiretroviral agents
a. used to treat infections caused by HIV, the virus that causes AIDS
b. HAART (cocktail 10- 30 k/year)
i. highly active antiretroviral therapy
ii. includes at least 3 meds
iii. these meds work in different ways to reduce the viral load
c. side effects
i. numerous and vary with each agent
ii. drug therapy may need to be modified b/c of side effects
iii. goal is to find the regimen that will best control the infection with a tolerable side effect profile
iv. medication regimens change during the course of the illness
III Side effects (antivirals)
A. Zidovudine (given during labor to HIV pts)
1. bone marrow suppression
2. nausea
3. headache
4. foscarnet
5. headache, seizures, acute renal failure, nausea, vomiting, diarrhea, others
B. Ganciclovir
1. bone marrow toxicity
2. n/v, anorexia
IV HIV
A. Human immunodeficiency virus infection
B. ELISA (enzyme-linked immunosorbent assay)
1. detects HIV exposure based on presence of human antibodies to the virus in the blood
C. retrovirus
D. transmitted by:
1. sexual activity
2. intravenous drug use
3. perinatally from mother to child
E. 5 stages of HIV infection
1. primary infection
2. asymptomatic infection
3. persistent generalized lymphadenopathy
4. symptomatic stage
5. progression to full blown aids
V Opportunistic Infections
A. protozoal
1. toxoplasmosis of the brain, others
B. fungal
1. candiadiasis of the lungs, esophagus, trachea
2. PCP, others
C. Viral
1. CMV disease
2. HSV infection, others
D. Bacterial
1. various mycobacterial infections
E. Opportunistic neoplasias
1. Kaposi’s sarcoma
F. others
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