Viral Replication

• A virus cannot replicate on its own.

• It must attach to and enter a host cell.
• It then uses the host cell’s energy to
synthesize protein, DNA, and RNA.

Viruses are difficult to kill because they

live inside our cells.
• Any drug that kills a virus may also kill normal
cells.
Competent immune system:
• Best response to viral infections
• A well-functioning immune system will eliminate
or effectively destroy virus replication

Immunocompromised patients have frequent viral

infections
• Cancer patients, especially leukemia or lymphoma
• Transplant patients, due to pharmacological therapy
• AIDS patients, disease attacks immune system
Key characteristics of antiviral drugs:
• Able to enter the cells infected with virus.
• Interfere with viral nucleic acid synthesis
and/or regulation.
• Some agents interfere with ability of virus
to bind to cells.
• Some agents stimulate the body’s immune
system.
Viruses killed by current antiviral therapy:

• Cytomegalovirus (CMV)
• Herpes simplex virus (HSV)
• Human immunodeficiency virus (HIV)
• Influenza A (the “flu”)
• Respiratory syncytial virus (RSV)
• Inhibit viral replication
• Inhibit viral attachment
• Prevent genetic copying of virus
• Prevent viral protein production
• Prevents shedding of viral protein
coat
• Prevents viral replication
Common Drugs:
• Amantadine ( Symmetrel)
• Rimantadine ( Flumadine)
– With anti cholinergic effects
• Ribavirin ( Virazole) – Preg. Cat X
• Neuraminidase Inhibitors:
- Oseltamivir ( Tamiflu)
= used for H1N1 and avian flu
– Zanamivir ( Relenza)
• Adverse Effects
– Light headedness, dizziness, insomnia
– N/V
– Hypotension and Urinary Retention
• Nursing Mgt.
– Administer vaccine before the flu season
– Start drug as soon after the client is
exposed (within 48 hrs)
– Safety precautions
• Inhibit viral DNA Replication (nucleosides)
• Competes with virus to form shorter DNA

• Acyclovir ( Zovirax)
• Cidofovir ( Vistide)
• Famciclovir ( Famvir)
• Foscarnet (Foscavir)
– CMV Retinitis, Seizures
• Ganciclovir ( Cytovene)
– CMV, carcinogenic, bone marrow
toxicity
• Valacyclovir ( Valtrex)
• Valganciclovir ( Valcyte)
Adverse Effects
– Nephrotoxicity
– N/V, diarrhea
– Headache and depression
– Alopecia , rashes
– Burning when topically
applied ( Acyclovir)
• Human Immunodeficiency Virus (HIV):
retrovirus that attacks helper T cells, leading
to a decrease in immune function
• AIDS-Related Complex (ARC): diseases that
are characterized by the emergence of a
variety of opportunistic infections and cancers
that occur when the immune system is
depressed and unable to function properly
• Here is alink where you can read more
about the disease process of HIV

https://aidsinfo.nih.gov/understanding-hiv-
aids/fact-sheets/19/73/the-hiv-life-cycle
I. Non-Nucleoside Reverse Transcriptase
Inhibitors
- Bind directly to HIV reverse transcriptase,
blocking RNA and DNA-dependent DNA
polymerase activities
- Prevent transfer of information that would
allowthe virus to carry formation of DNA
• Emtricitabine ( Emtriva)
• Delavirdine ( Rescriptor)
• Efavirenz (Sustiva)
• Nevirapine ( Viramune)
II. Nucleoside Reverse Transcriptase
Inhibitor
– Compete with naturally occuring nucleoside
within a human cell that virus would use to
build DNA chain
– DNA chain cannot lengthen and insert to host
DNA
• Abacavir- may cause severe hypersensistivity
• Didasone- may cause pancreatitis
• Emtricitabine - taken once a day
• Lamivudine - treatment for Hepa B
• Zidovudine - safe for pregnancy; may cause
severe BM depression; taken on empty stomach
III. Protease Inhibitors
– Block protease activity thus rendering the virus
ineffective
– Prevents maturation of HIV virus
• Atazanivir (Reyataz)
• Nelfinavir ( Viracept)
• Ritonavir ( Norvir)
• Saquinavir ( Fortovase) – the ONLY non
teratogenic agent
IV. Fusion Inhibitors
– Prevents fusion of virus with human cellular
membrane, which prevents HIV enetering the cell
• Enfuvirtide (Fuzeon) - used above 6 y/o; given
via SQ
• Always used in combination Other Antivirals
V. CCR5 Coreceptor Antagonist
– Blocks receptor site on the cell membrane to
which HIV needs to interact to enter the cell.
• Maraviroc - cause hepatotoxicity
• S/E: Dizziness
VI. Integrase Inhibitors
– Inhibit activity of virus-specific enzyme
integrase, needed for viral replication
• Dolutegravir
• Rategravir
• CNS – headache, dizziness,
peripheral neuropathies, seizures
• GI – N/V, diarrhea,
HEPATOTOXICITY
• Fever and flu like symptoms
• Bone marrow suppression
• Zidovudine – alopecia
• Imiquimod ( Aldara)
• Idoxuridine ( Herplex)
• Ganciclovir ( Vitrasert)
• Penciclovir( Denavir)
– Do not apply on mucous membranes
Adverse Effects:
Local burning, stinging and discomfort
NURSING CARE:
• Check renal and liver function
• Complete course of therapy
• Teach proper application technique
• Stop if rash occurs
• Provide safety precautions
• Emphasize that antivirals are not cures,
they are used to manage the symptoms
Anti-Hepatitis B (ATE)
– Adefovir
– Telbivudine (a NRTI drug)
– Entecavir
ACTION:
- inhibit reverse transcriptase in Hepatitis B
virus and cause DNA chain termination
Anti-Hepatitis C
- Bocefrevir
- Simeprevir
- Stefosbuvir
- Used in combination with Ribavirin (inhaled
anti-influenza) and Peginterferon (prevents
virus replicate cell)
• Ergosterol: steroid-type protein found
in the cell membrane of fungi; similar in
configuration to adrenal hormones and
testosterone
• Fungus: a cellular organism with a hard
cell wall that contains chitin and many
polysaccharides as well as a cell
membrane that contains ergosterols
• Mycosis: disease caused by a fungus
Yeasts
• Single-cell fungi
• Reproduce by budding
• Very useful organisms
– Baking
– Alcoholic beverages
Molds
• Multicellular
• Characterized by long, branching filaments
called hyphae
Four General Types
• Cutaneous
• Subcutaneous
• Superficial
• Systemic*
*Can be life-threatening
*Usually occur in
immunocompromised host
• Alter the cell permeability of fungus
• Bind to the ergosterol to open pores in the
cell membrane
• Toxic to host
• Culture fungus
• Check for drug-drug interactions (CP450
enzyme system)
• Polyenes
– Amphotericin B ( Amphotec)
– Nystatin ( Mycostatin)
• Azoles
– Fluconazole ( Diflucan)
– Itraconazole
– Ketoconazole ( Nizoral)
– Miconazole
• Antimetabolites
– Flucytosine
• Terbinafine ( Lamisil) - safe to be used during
pregnancy
• Hepatotoxicity
• Headache, dizziness, fever, malaise
• Nausea, vomiting dyspepsia
• Rash and pruritus
Drug Interactions
• Azole Family
– increased serum levels of OHA, oral
anticoagulants, digoxin and phenytoin
– Severe CV events with -statin’s and -zolam’s
 • Nystatin
– Swish and swallow
– Swish and spit

• Amphotericin B (given per IV)

– Nephrotoxic
– Monitor for electrolyte imbalances
– Monitor renal function
– Check for thrombophlebitis
DERMATOPHYTES: fungis that
causes mycoses on skin

• Tinea
– Athlete’s foot (tinea pedis), Jock
itch (tinea cruris)

• Candida
– Yeast infections of the mouth
(Thrush) and vagina
• Gentian Violet
• Clotrimazole ( Canesten)
• Ketoconazole ( Nizoral Shampoo)
• Miconazole ( Monistat)
Mechanism of action
• Alter Cell membrane permeability
Adverse Effects
• Prevent systemic absorption
– Hepatotoxicity
– Polyuria with burning sensation
• Irritation, burning sensation and rash
 NURSING CARE:

• Avoid applying on open lesions

• Check correct method:
– Vaginal suppository (stay in supine position for
10 to 15 minutes after application)
– Cream (clean area, dry and avoid occlusive
dressings)
• A single-celled organism that passes through
several stages in its life cycle, including at
least one phase as a human parasite; found
in areas of poor sanitation and hygiene and
crowded living conditions
• Malaria
• Trypanosomiasis
• Leishmaniasis
• Amoebiasis
• Giardiasis
• Trichomoniasis
• Caused by the plasmodium protozoa.
• Four different plasmodium species.
• MOT: the bite of an infected adult
mosquito (Anopheles mosquito)
• Can also be transmitted by infected
individuals via blood transfusion,
congenitally, or via infected needles by
drug abusers.
Two Interdependent Life Cycles
• Sexual cycle: in the mosquito
• Asexual cycle: in the human
– Knowledge of the life cycles is essential in
understanding antimalarial drug treatment.
– Drugs are only effective during the asexual
cycle.
Asexual cycle: two phases
• Exoerythrocytic phase: occurs “outside”
the erythrocyte
• Erythrocytic phase: occurs “inside”
the erythrocyte
Erythrocytes = RBCs
4-aminoquinoline derivatives
• Alter pH within the parasite.
• Interfere with parasite’s ability to metabolize
and use erythrocyte hemoglobin.
• Effective only during the erythrocytic phase.
– Mefloquine ( Lariam)
– Quinine
• For treatment of chloroquine resistant infections
• Can cause severe diarrhea
• Cinchonism ( N/V, tinnitus and Vertigo)
4-aminoquinoline derivatives
• Chloroquine ( Aralen), Hydroxychloroquine
– Mainstay drug
– Bind to parasite nucleoproteins and interfere
with protein synthesis and alter pH
– Interfere with parasite’s ability to metabolize and
use erythrocyte hemoglobin.
– Effective only during the erythrocytic phase
(Acute attack)
– Hepatotoxic, permanent eye damage
• Pyrimethamine ( Daraprim)
– Inhibit folic acid synthesis in the parasite.
– This enzyme is needed by the parasite to
make essential substances.
– Also blocks the synthesis of tetrahydrofolate.

• Primaquine
– Only exoerythrocytic drug.
– Binds and alters DNA.
– Prevention of relapse
• Headache, dizziness, shaking and chills
• N/V, dyspepsia and anorexia
• Hepatic dysfunction
• Rash, pruritus and alopecia
• Permanent eye damage (Chloroquine)
PREVENTION of Malaria:
- Drugs are taken 1-2 days before travel, all
throughout and 7 days after leaving area of
high-risk in malaria
NURSING CARE:

• Avoid pregnancy and until 2 months post

treatment (Teratogenic)
• Assess for Cinchonism
• Provide safety
• Check liver function
• Assess eye function
Amoebiasis
• CA: Entamoeba
Histolytica
• MOT: fecal-oral
• 2 Stages:
– Cystic
• protozoa live long
outside or inside
the body
– Trophozoite
• human large
intestine
• Leishmaniasis: skin, mucous membrane
• Trypanosomiasis: African sleeping
sickness, Chagas’ disease
• Trichomoniasis: vaginal infections
• Giardiasis: intestinal
• Pneumocystis carinii Pneumonia
(PCP): lungs -AIDS
Inhibit DNA synthesis
• Atovaquone ( Mepron)
– PCP in AIDS
• Metronidazole ( Flagyl)
– Amoebiasis, trichomoniasis, giardiasis
• Pentamidine ( Pentam 300)
– Trypanosomiasis and leishmaniasis
• Tinodazole ( Tindamax)
– Trichomoniasis, giardiasis and amoebiasis
• CNS – headache, dizziness, ataxia,
peripheral neuropathy
• GI – Nausea, Vomiting, Unpleasant taste
(metallic taste), cramps
NI: take with meals, SFF and oral hygiene
• Hepatotoxicity
- avoid alcohol during treatment and 3 days after
• Superinfection
• Worm that can cause
disease by invading the
human body
Nematode ( Round Worm)
pinworm, whipworm,
threadwrom, Ascaris, or
hookworm
Cestode
Tapeworm with a head and
segmented body parts that is
capable of growing to several
yards in the human intestine
• Trichinosis:
– ingestion of encysted roundworm larvae in
undercooked pork;
– invade muscle, nervous tissue
– can cause pneumonia, heart failure, and encephalitis
• Filariasis (Elephantiasis):
– an infection of the blood and tissues
– worm embryos injected by mosquitoes to human host
– overwhelm the lymphatic system
– cause massive inflammatory reactions
– swelling of the hands, feet, legs, arms, scrotum, or
breast
• Schistosomiasis:
– blood fluke carried by a snail
– Attaches to a persons skin in contact with
freshwater or ponds
– Causes a pruritic rash
– S/Sx: Fever, chills and headache, diarrhea,
liver and brain inflammation
– Mgt: Praziquantel
 Interfere with the metabolic
processes of particular worms
• Albendazole ( Zentel)
• Ivermectin
• Mebendazole ( Antiox)
• Oxamniquine
• Praziquantel ( Biltricide)
• Pyrantel ( Combantrin)
• Thiabendazole ( Minthezol)
• Mebendazole and Pyrantel
– Not generally absorbed by the GI tract
– Abdominal disconfort, diarrhea and pain
• Others absorbed systemically
– Headache, dizziness, fever, chills and malaise
– Rash, pruritus and alopecia
– Thiabendazole – Steven johnsons Syndrome
– Albendazole – renal failure and bone marrow
suppression
• Emphasize proper hygiene
• Handwashing
• Change clothes, underwear and
bedclothes and sheets daily
• Take the drug at prescribed time and to
complete the course of treatment
Stay safe!! Please refer to the instructions
given for additional learning and answer
the guide questions given.