Pharmville

• Viruses use host cell enzymes and substrates to reproduce
• Drugs that affect these viruses will also affect the host
• Successful drugs affect the biochemical processes unique to viral replication.

• Type 1 (HSV 1)
• Cause classic cold sore
• Recurrent
• Severity increases with age and immunosupression

• Genital Herpes
• Recurrent

• There is not really a clear divide between the two types, however. HSV1 can also cause genetal sores, and vise versa.
• Both viruses lay dormant within a nerve route until outbreak.
• Most infective at time period immediately before outbreak (lesion).

• After primary infection the virus remains in the body in a dormant state in the nerve ganglia
• patient is asymptomatic

• Reactivation of infection triggers the virus to travel the pathway of the nerve to the skin surface
• Triggers may be:
• Physical or psychological stress
• Sun
• Trauma
• Fever
• Menses
• Fatigue

• How spread
• Direct contact
• Autoinnoculation (Spread of either type from one body part to another)

• Outbreaks
• Last 3-10 days
• Active shedding
• First 3-5 days

• Spread by:
• Respiratory droplets
• Direct contact with active lesion
• Virus containing fluid

• 1 in 4 women will acquire HSV
• Current testing decreased risk of acquiring by 75%
• Did not effect HSV1 if already infected
• Not effective for men
• Did not ultimately come to market.

• AKA Shingles
• Caused by reactivation of latent Varicella-zoster virus
• Those previously exposed to chicken pox
• Contagious to those never exposed to chickenpox
• Dormant virus resides in the dorsal root ganglia of the sensory cranial and spinal nerves
• Multiple lesions occur on the skin innervated by the infected nerve
• Disease of immunosuppression

• Vaccine for chicken pox/shingles
• For those over 60
• Prevents shingles in over half of those over 60---reduces pain in others.

• Contraindications
• Allergic reactions to gelatin
• Allergic reactions to neomycin (aminoglycocides)
• Weakened immune system
• HIV/AIDS
• Steroids
• Cancer treatment
• Hx of leukemia, lymphoma
• Pregnancy
• Temp over 101

• DNA polymerase inhibitors
• Suppresses synthesis of viral DNA
• First choice for infections caused by herpes simplex and varicella-zoster virus
• Administered topically, orally and IV

• Intravenous therapy
• Phlebitis
• Nephrotoxicity

• Oral therapy
• Gastrointestinal
• Vertigo

• Topical
• Stinging sensations

• Acyclovir IS NOT A CURE
• It will not prevent spread to others
• Use of condoms (Genital Herpes)
• No sexual contact when active lesions are present
• Use of OTC lotions, creams may delay healing and cause spread of lesions, may lead to selfinnoculation!

• CMV is related to the herpes virus and is present in almost everyone.
• Especially seen in those who are immunosuppressed
• AIDS (brought CMV to the forefront), Chemo, Transplants
• Infections of the eye are very common.

• Floaters
• Spots, bugs and spider-webs
• Light Flashes
• Blind Spots
• Blurred Vision
• Obstructed areas of vision
• Sudden decrease in vision

Basically destroys vision

• Prodrug version of ganciclovir (acyclover). Becomes identical to acyclover after metabolism.
• Can be given orally
• Adverse effects: Blood dyscrasias (decreases of WBCs, RBCs, and platelets)
• Should be taken with food
• Has potential for mutagenesis and carcinogenesis….handle carefully
• Take intact…no crushing or chewing, increases mutagenic and carcinogenec properties. Prep should be done under a hood, with gloves, wash hands.
• If pregnant, DO NOT HANDLE GANCYCLOVIR
• HCW use cytotoxic chemo precautions

• 6 types of Viral Hepatitis: A; B; C; D; E; G
• Vary by:
• Mode of transmission
• Manner of onset
• Incubation periods
• Enteral Forms: A and E (Vaccine for A)
• Parenteral (needle sticks) Forms: B,C E G (Vaccine for B)
• E occurs in both, so its more virulent.
• C is more contagious than HIV, so use precautions when treating pt with HepC.

• Acute:
• Lasts ~ 6 months
• Liver inflammation, jaundice, Elevation of Liver enzymes
• Usually resolves spontaneously.
• All forms can be accute.

• Chronic:
• Only B, C ,D and G can cause chronic hepatitis (not A and E).
• 90% caused by B and C
• 1.5% of Americans have chronic infection with HBV or HCV
• 5 times more than the number infected with HIV

• Interferon Family (used to treat) can be Alpha, Beta, Gamma
• Actions
• Antiviral
• Immunomodulatory
• Antineoplastic
• Administration
• Parenterally, IM or SQ
• Therapeutic effects
• HBV
• Improved liver histology in 40%
• HCV
• After 12 months-40-50% have normalized liver function

• Adverse effects
• Flu-like syndrome
• Depression

• Available in 2 formulations
• Inhaled (For Respiratory Syncytal Virus –RSV )
• Oral ( For Chronic Hepatitis )

Action is really unknown although several actions are thought to be actively anti-viral

Contraindicated for use in pregnancy nor should pregnant nurses administer the drug (Aerosol)

DO NOT CRUSH!

Current treatment for chronic hepatitis C

• Action
• Ribavirin-nucleoside analog; Mechanism unknown

Kit—contains two drugs, Ribavirin - PO, Interferon Alfa - SQ

Adverse effects

• Flu-like symptoms
• Depression
• Hemolytic anemia
• Birth defects

• Treatment of HCV
• Approved for stand-alone therapy… initial research seems to identify improved effectiveness with ribavirin
• Long-acting form of interferon alpha 2b
• Half life of 40 hours vs 2-3 hrs
• Can be given 1x week vs 3 times a week
• Identical side and toxic effects

• Influenza Vaccine
• Annual. Changes every year in accordance with what is predicted to come to the US from Asia the year before. Not always accurate.
• Inactivated virus. Cannot get flu from vaccine, but may have rxn due to egg content in vaccine serum.
• 70-90% effective
• Protection lasts 6 months
• Elderly population works only 30-40%, and will last only ~ 4 months
• Given IM
• Always ask "Are you allergic to eggs? Have you ever had a rxn to flu vaccine?"
• Use to give a live virus called Guillin Berette. Could cause paralysis. Will have some pts who will not take flu vaccine now because they're still afraid of it.

• Live, attenuated (virulent components removed) Influenza Vaccine (LAIV)
• Temperature sensitive (Cold Adapted). Must be kept cold, almost frozen.
• Trivalent; composed of and specific to three viruses.
• Intranasal, rub nares together, do not blow nose afterwards.
• Approved last year
• Not for everyone

• are under 5 years of age
• are aged 50 years or over
• have asthma or other reactive airway diseases
• have chronic underlying medical conditions that may predispose you to severe flu infections
• have problems with immune suppression, including those with immune deficiency diseases, such as AIDS or cancer, and people who are being treated with drugs that cause immunosuppression
• are allergic to eggs or to a previous dose of the vaccine
• children or adolescent receiving aspirin or other salicylates ----->(Reyes Syndrome).
• History of Guillain-Barre’ syndrome
• Pregnant woman

• Children age 5-8 who have not received injection need 2 doses at least 6 wks apart
• Must be stored at 15 degrees C
• Thaw in hand and administer immediately OR
• Thaw in refrigorator
• Should only be thawed for 24 hours
• Administer 1/2 of single use sprayer in one nostril and remainder in other
• In upright position
• Don’t repeat if sneezes
• Mild illness is OK, if fever >101 degrees, do not give.
• Cost ~$46 per dose
• Other immunizations??
• Inactivated viruses OK
• Live viruses 4 weeks apart from flu inhaler.

• First Generation Drugs
• Used for prophylaxis and treatment of Influenza A
• Should not take the place of vaccination
• Adverse effects:
• Nervousness
• Lightheadedness
• difficulty in concentration
• Sleep disturbances
• DO NOT use in pregnant and lactating women

• 2nd Generation
• Neuraminidase Inhibitors
• Suppress both Influenza A and B
• Not approved for prophylaxis ~ seems to have some efficacy
• Only for use in those >18
• Symptoms for no more than 2 days
• Oseltamivir ~ oral
• Zanamivir ~ Inhaled powder

• Gardasil Vaccine:Targets 4 viruses that cause up to 70% of all cervical cancers and 90% of genital warts
• Cervarix: Targets 2 viruses known to cause cervical cancer.
• CDC recommends vaccination for all girls 11 -12 years, and all boys age 9-26 (gardacil)
• 13-26 years of age if not already vaccinated (only ages tested)
• Series of 3 injections over 6 months
• No serious side effects (yeah right) but will see fainting, seizures

• Coronvirus ~SARS-CoV
• Closely related to common cold
• Results in atypical pneumonia
• Time from exposure to onset of symptoms, 2 - 11 days
• Fever ~ 100.4 or higher
• Myalgia
• HA
• Malaise
• Chills
• Dry, nonproductive cough
• Difficulty breathing

• Detection of IgM antibody to WNV in serum or CSF
• Collected within 8 days of disease onset
• Recent vaccination or infection with other associated viruses may cause a false positive
• Plague Reduction Neutralization Test (PRNT)

• First documented in 1937
• Arbovirus
• Similar to yellow fever, dengue and St. Louis encephalitis
• Risk factors:
• Advanced age
• Immunosuppression

• Mild infection
• Sudden fever with
• malaise
• anorexia
• HA
• N/V
• Symptoms last 3-6 days
• Severe infection
• 1 in 150 Cases
• aseptic meningitis
• Encephalitis