Antiviral+Drugs-Antitubercular+Drugs

ANTIVIRAL AND ANTITUBERCULAR AGENTS

ANTIVIRAL AGENTS
 *  WHAT IS A VIRUS?[[image:virus.jpg width="160" height="160" align="right"]] **
 * VERY SMALL MICROORGANISMS (much smaller than bacteria)
 * CAN ONLY REPRODUCE INSIDE THE CELL OF A HOST (human, animal, plant, bacteria, protozoans)
 * VIRION (mature virus)
 * Immunocompromised patients have frequent viral infections (Cancer patients, Transplant patients, AIDS patient)


 *  PARTS OF A VIRUS **
 * GENOME (inner core-RNA and DNA stored)
 * CAPSID (protein coat that protects the genome)
 * ENVELOPE (outermost layer-not present in all viruses)


 *  VIRAL REPLICATION **
 * 1) Virus attaches to host cell
 * 2) Uncoationg of virus and entry of viral nucleic acid into host cell nucleus
 * 3) The virus takes control of DNA, RNA, and/or protein productions
 * 4) Production of viral subunits
 * 5) Assemble of virions
 * 6) Release of virions

CURRENT VIRUSES CONTROLLED BY ANTIVIRAL THERAPY **Remember:** Medications do not kill the virus they only reduce the duration of symptoms!
 * Cytomegalovirus(CMV)[[image:virus_2.jpg width="319" height="268" align="right"]]
 * Hepatitis viruses
 * Herpes viruses (HSV)
 * Human immunodeficiency virus (HIV)
 * Influenza viruses (the "flu")
 * respiratory syncytial virus (RSV)

** ANTIVIRAL MEDICATIONS **
 * Antiviral agents (Nonretroviral)-- used to treat viruses other than HIV
 * Antiretroviral agents-- used to treat infections caused by HIV

ANTIVIRAL AGENTS  A. Ganciclovir(DHPG)- B. Acyclovir- **C. Foscarnet (Foscavir) ** **D. Ribavirin- **
 * used to treat CMV retinitis and systemic
 * mechanism of action: inhibits viral replication
 * Administrated by mouth or intravenously (IV)
 * Side effects- Nausea, Vomiting, Anorexia
 * Adverse effects-Bone marrow toxicity
 * used to treat HSV-1, HSV-2, VZV (which include Herpes, Chicken pox, and Shingles)
 * mechanism of action: Inhibits viral replication
 * Administrated by mouth or IV
 * Side effects- Burning when applied topically, Nausea, Vomiting, Diarrhea, Headache
 * Adverse effects- Seizures, Acute Renal failure
 * used to treat CMV in immunodeficient clients
 * used to treat HSV in clients resistant to acyclovir
 * Administrated IV only
 * Side effects- Headache, Nausea, Vomiting, Diarrhea
 * Adverse effects- Seizures Acute renal failure
 * used to treat RSV in hospitalized infant
 * Administered by inhalation
 * Side Effects- Nausea, Vomiting, Tachycardia

INFLUENZA "THE FLU" **You-Tube Video:** How flu Viruses Attack National Geographic a. oseltamivir (Tamiful)
 * DRUGS TO TREAT THE FLU-- **


 * Treats influenza A&B
 * Can be used if symptomatic 2 days or less
 * Administrated by oral route
 * Side effects- Nausea and Vomiting

b. zanamivir (Relenza)
 * Treat influenza A&B
 * Can be used if symptomatic 2 days or less
 * Administrated by inhalation
 * Side effects- Nausea, Diarrhea, Sinusitis

Human Immunodeficiency Virus (HIV)
 * Retrovirus
 * Transmitted by: sexual activity, intravenous drug use, perinatally from mother to child
 * Detected by ELISA (enzyme-linked immunosorbent assay)- based on presence of human antibodies to the virus in the blood
 *  Four stages
 * __Stage one__: Asymptomatic Infection-first few weeks after exposure; will have swollen lymph node; will test HIV negative still
 * __Stage two__: Early, General symptoms of the disease-week 3 to 3 months after exposure; continued swollen lymph nodes, flu-like symptoms; will test HIV positive
 * __Stage three__: Moderate symptoms- continued diarrhea, weight loss, opportunistic infections start (toxoplasmosis of the brain, Candiadiasis of the lungs, esophagus, trachea, PCP, CMV disease, HSV infections, Kaposi's sarcoma)
 * __Stage four__:Severe Symptoms: often lead to death; formally called the Full Blown AIDS stage
 * You-Tube Video: HIV Virus

Antiretroviral Agents:  A. HAART

 B. Zidovudine (AZT)
 * Highly active antiretroviral therapy
 * Includes at least three medications that work in different ways to reduce the viral load
 * Goal is to keep viral load less than 50 copies/ml

 C. Didanosine (ddl)
 * used to treat HIV, AIDS, ARC
 * Mechanism of Action: Nucleoside Reverse Transcriptase Inhibitor (NRTI)
 * Administered by mouth on an empty stomach (needs a gastric pH of 2 to work) or IV
 * Side effects- Nausea, headache, hair loss
 * Adverse effects- Bone Marrow suppression
 * Safe in pregnancy, breastfeeding, and for use in infants

 D. Nevirapine (Viramune)
 * used to treat HIV, AIDS, ARC
 * Mechanism of Action: NRTI
 * Administered by mouth
 * Side effects- Nausea, Vomiting, Diarrhea
 * Adverse effects- Pancreatitis, Peripheral neuropathy, Seizures,

<span style="color: #800080; display: block; font-family: 'Arial Black',Gadget,sans-serif; text-align: left;"> E. Tenofovir (Viread)
 * used to treat HIV, AIDS,
 * Mechanism of Action: Nonnucleoside Reverse Transcriptase Inhibitors
 * Administered by mouth
 * Adverse effects- Fever, Rash, Nausea, Headache, Abnormal liver function tests

<span style="color: #800080; display: block; font-family: 'Arial Black',Gadget,sans-serif; text-align: left;"> F. Indinavir (Crixavan)
 * used to treat HIV, AIDS,
 * Mechanism of Action: Nucleotide Reverse Transcriptase Inhibitors
 * Administered by mouth
 * Reported effects include Lactic acidosis, Severe hepatomegaly

<span style="color: #800080; font-family: 'Arial Black',Gadget,sans-serif;"> G. Enfuvirtide (Fuzeon)
 * used to treat HIV, AIDS, ARC
 * Mechanism of Action: Protease Inhibitors (PI)
 * Administered by mouth on an empty stomach (needs a pH of 2 to work)
 * Side effects- Nausea, Vomiting, Diarrhea, Headache, Anorexia


 * used to treat HIV, AIDS, ARC
 * Mechanism of Action: inhibits viral fusion
 * Administered by subcutaneous injection
 * Side effects- Anxiety, taste disturbance, anorexia, constipation
 * Adverse effects- Renal failure


 * ANTITUBERCULAR AGENTS **

<span style="color: #ff0000; font-family: 'Arial Black',Gadget,sans-serif;">IMPORTANT INFORMATION TO KNOW BEFORE WE START.....


 * TUBERCULOSIS (TB)
 * Caused by Mycobacterium tuberculosis
 * Antitubercular agents treat all forms of Mycobacterium
 * Common infection sites: Lungs(primary site), Brain, Bone, Liver, Kidney

<span style="color: #ff0000; font-family: 'Arial Black',Gadget,sans-serif;">MYCOBACTERIUM INFECTIONS SPREAD BY:


 * droplets, coughing, sneezing and gain entry by inhalation
 * spread to other body organs via blood and lymphatic system
 * may become dormant or walled off by calcified or fibrous tissue

<span style="color: #ff0000; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">Antitubercular Drugs: Hepatotoxicity || -Metabolized by acetelation -Can be taken with meals for GI upset -No alcohol -Increased blood sugar levels in diabetics -Oral contraceptives lose effectiveness || Headaches || Seizures Ototoxicity || -No alcohol || Red-orange-brown discoloration: urine feces, saliva, tears, skin, sputum || Hepatotoxicity || -No alcohol -Oral contraceptives lose effectiveness ||
 * Name of Drug || Mechanism of Action || Route of Administration || Side Effects || Adverse Effects || Special Considerations ||
 * <span style="color: #800080; font-family: 'Arial Black',Gadget,sans-serif;">Isoniazid (INH) || Cell wall synthesis inhibitor || by mouth (PO), Intramuscular || Peripheral neuropathy (supplement with B6) || Seizures,
 * <span style="color: #800080; font-family: 'Arial Black',Gadget,sans-serif;">Streptomycin || Protein wall synthesis inhibitor || Intramuscular || Tremors, muscle twitching
 * <span style="color: #800080; font-family: 'Arial Black',Gadget,sans-serif;">Rifampin || Protein wall synthesis inhibitor || PO, IV || Headache
 * <span style="color: #800080; font-family: 'Arial Black',Gadget,sans-serif;">Ethambutol || Other || PO || Optic neuritis || Blindness || -No alcohol ||
 * <span style="color: #800080; font-family: 'Arial Black',Gadget,sans-serif;">Pyrazinamide (PZA) || Other || PO || Headache || Hepatotoxicity || -No alcohol ||

<span style="color: #0000ff; font-family: 'Arial Black',Gadget,sans-serif; font-size: 150%;">Now Test Your Knowledge! Crossword Answers

<span style="color: #0000ff; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">Reference: <span style="font-family: Arial,Helvetica,sans-serif;">[|Lilley, L., Harrington, S., & Snyder, J. (2011). Pharmacology and the nursing process. (6th ed.).] <span style="font-family: Arial,Helvetica,sans-serif;"> [|St. Louis: Mosby]