Chapter 8 Pharmacology

with antiviral agents, to kill the virus, often the ____ must also be harmed

the host cell must also be harmed.

Penciclovir is available

topically

How is anti viral agent Docosanol 10% available

topically and without a prescription

what is often required for toxicity of AZT Zidovudine

transfusions

what is optimal duration of therapy for nucleoside/nucleotide analogs?

unknown, but at least 5 years and some are treated indefinitely

which form of nystatin contains no sugar and may be ideal for patients with diabetes

vaginal tablets

when is hepatitis considered chronic

when it lasts more than 6 months

With Herpes Simplex, most anti viral agents are either ____ or _____ analogs to inhibit ____ synthesis.

with herpes simplex most anti viral agents are either purine or pyrimidine analogs to inhibit DNA synthesis

name of the nucleoside/nucleotide reverse transcriptase inhibitor drug

zidovudine (AZT)

how does zidovudine (AZT) affect cells already containing HIV?

zidovudine does not effect cells already containing HIV

zidovudine is well absorbed ____. Metabolized by the ____ and excreted by ____

zidovudine is well absorbed orally, metabolized by the liver and excreted by the kidneys

zidovudine (AZT) terminates synthesis of viral ____ and inhibits _____ synthesis

zidovudine terminates synthesis of viral DNA and inhibits HIV synthesis.

patients should take saquinavir __ hours after a full meal and should avoid ____

take saquinavir 2 hours after a full meal and avoid sunlight

Nevirapine inhibit the same enzymes as the _____ analogs

nevirapine inhibit the same enzymes as the nucleoside analogs.

Nevirapine is specific for?

nevirapine is specific for HIV-1

does acyclovir prevent transmission and recurrence of infection?

no

How is the absorption of Nystatin and how is it excreted?

not absorbed from mucous membranes or intact skin. Poorly absorbed from GI tract. When taken orally, it is not absorbed, it is excreted unchanged in the feces.

acyclovir is not effective in treatment of ______ but still used extensively.

not effective treating herpes labialis

what are normally the three drugs used in HAART

nucleoside, non-nucleoside reverse transcriptase inhibitor, and a protease inhibitor

what 4 antifungal agents is candida albicans managed with?

nystatin, clotrimazole, ketoconazole, fluconazole

ketonazole is only available in form of

oral tablets

how are interferons used?

parenterally

what advantages (2) does penciclovir have over acyclovir

penciclovir achieves higher concentration within the cell penciclovir remains in the cells longer

penciclovir can reduce both ____ of the lesion and ____ of the lesions on the lips and face

penciclovir can reduce both duration of the lesion and pain of the lesions on the lips and face

with extended use of Ketonazole, patients should have periodic ______ function tests.

periodic liver function tests

Protease inhibitors , Boceprevir and telaprevir are used in combination with?

previous drugs for treatment of chronic Hepatitis C

what can sudden discontinuation of nucleoside/nucleotide analogs cause?

rapid increase in HEP B virus DNA levels and a severe flare up of the disease that can be fatal

what do famciclovir and valacyclovir treat

recurrent episodes of genital herpes acute localized varicella-zoster infection

when used alone, nonnucleoside reverse transcriptase inhibitors such as nevirapine, resistance to them develops _____, and they are often combined with the _____ analogs and the ______ inhibitors.

resistance develops quickly; they are often combined with the nucleoside analogs and protease inhibitors.

What forms is Nystatin available in?

rinse and expectorated, pastilles, vaginal tablet, cream.

Saquinavir prevents maturation of _____ infected cells

saquinavir prevents maturation of HIV infected cells

in what forms is Clotrimazole available

slow dissolving sugar containing lozenge and OTC cream

mechanism of ketonazole is to alter membrane permeability and inhibit _____ transport.

alter membrane permeability and inhibit purine transport

the OTC cream of Clotrimazole is applied to skin or _____ canal to treat denture _____.

applied to skin or vaginal canal to treat denture stomatitis.

The rinse and expectorated form of Nystatin, is a ______ suspension, containing ____% sucrose

aqueous suspension containing 50% sucrose

nucleoside/nucleotide analogs are better tolerated and have better rates of ____ suppression than _____

better rates of virologic suppression than interferons

what is the mechanism of action of clotrimazole?

binds to fungal cell membrane, alters permeability of the cell membrane

name the two protease inhibitors

boceprevir telaprevir

Toxicity of zidovudine (AZT) can be _____ depression leading to anemia, granulocytopenia, and thrombocytopenia

bone marrow depression

with the slow dissolving sugar lozenge of clotrimazole, drug is bound to the _____ mucosa and slowly released. Patients with ____ may have difficulty dissolving this product.

bound to oral mucosa; patients with xerostomia my have trouble dissolving.

adverse reaction to topical administration of acyclovir?

burning, stinging, itching, rash, mild pain

what is the most common oral fungus?

candida albicans

what are the two common fungal and viral infections in the dental office?

candida albicans and Herpes simplex virus

Agents that alter the amount of _____ acid could reduce absorption of ketonazole. What are the name of the agents that alter stomach acid?

stomach acid. These agents that alter stomach acid re H2 receptor blockers, H+ pump inhibitors, anticholinergic agents, antacids.

What is another way the aqueous suspension of Nystatin can be taken

frozen and used as popsicle

how long does it take for pastilles to dissolve? Pastilles allow to bathe lesions in the antifungal agent for a longer period than with the aqueous solution of Nystatin.

15 minutes

Clotrimazole produced elevated liver enzymes in ___ % patients

15% patients had elevated liver enzymes.

atleast ___ hours should elapse between the ingestion of agents that reduce stomach acid and the administration of ketonazole.

2 hours

Vaginal tablets of Nystatin are for use in vaginal infections. Occasionally they are used orally and dissolved in the mouth ____ times daily which allows the drug to remain in contact with the infected oral mucosa.

4 times daily

how many nucleoside/nucleotide analogs are currently available for treatment of chronic hepatitis B?

5

name for chronic disease produced by retrovirus human immunodeficiency virus

AIDS- Acquired Immunodeficiency Syndrome

what two drugs inhibit the metabolism of AZT and potentiate the toxicity

Acetaminophen, and aspirin

What anti viral agent is less toxic to uninfected cells because it is preferentially taken up by infected cells

Acyclovir

How often do adverse reactions to Nystatin occur? High doses of Nystatin will cause? How often are hypersensitivity reactions to Nystatin?

Adverse reactions to Nystatin are minor and infrequent. High doses of Nystatin cause nausea, vomiting, diarrhea Hypersensitivity reactions to Nystatin are rare.

drug name for protease inhibitor

Saquinavir

most frequent adverse reaction with ketonazole

nausea and vomiting

adverse reactions to nonnucleoside reverse transcriptase inhibitors ( nevirapine) ? (4)

CNS: headache, drowsy Rash GI effects: diarrhea, nausea Elevated Liver Function Test values.

what are the other acyclovir adverse effects from oral administration

CNS: vertigo, dizzy, insomnia, irritable, mental depression GI: nausea , vomiting, diarrhea Acne, hair loss, arthralgia, fever, menstrual abnormality, sore throat

What is the name for the synthetic anti fungal agent for the local treatment of oropharyngeal candidiasis (oral thrush)

Clotrimazole

Famciclovir and Valacyclovir are anti viral agents and pro drugs; Famciclovir is converted to? Valacyclovir is converted to?

Famciclovir is converted to penciclovir Valacyclovir is converted to acyclovir

what is the mechanism of action of fluconazole? to inhibit fungal _______ enzymes and prevent synthesis of ____ in the fungal cell membranes.

Fluconazole inhibits fungal CYP-450 enzymes and prevents synthesis of ergosterol in the fungal cell membranes.

what is the most common adverse reaction with Clotrimazole?

GI tract (abdominal pain, diarrhea, nausea)

HAART is the combination of several different classes of ______ drugs and can do what to the rate of replication of HIV?

HAART is combination of several different classes of anti-retroviral drugs and slows rate of HIV replication

how is HIV 2 different from HIV 1?

HIV2 is transmitted from a woman to child while child is in the womb. HIV1 is transmitted during sex, sharing bodily fluids, and IV substance abuse, and during pregnancy/childbirth

oral administration of acyclovir adverse effects... most common?

Headache is most common

what are the most common causes of chronic hepatitis, accounting for almost two thirds of all hepatitis cases?

Hepatitis B and C

People with hepatitis ___ are most at risk for developing chronic hepatitis

Hepatitis C patients are most at risk for developing chronic hepatitis

Zidovudine (AZT) toxicity can cause CNS effects , as well as _______ that occurs in almost half the patients.

nausea occurs in almost half the patients with AZT toxicity

name for anti fungal agent used for treatment and management of mucocutaneous and oral pharyngeal candidiasis

Ketoconazole

What is the name of the nonnucleoside reverse transcriptase inhibitor

Nevirapine

is there any harm if the aqueous suspension of Nystatin is swallowed? It will not eradicate ______ candidiasis either.

No harm if nystatin swallowed- it is not absorbed. It will not eradicate pharyngeal candidiasis either.

_______ interfere with action of HIV infected cells while _____ prevent maturation of HIV infected cells.

Nuceloside/Nucleotide reverse transcriptase inhibitors and Non nucleoside reverse transcriptase inhibitors interfere with action of HIV cells while Protease inhibitors prevent maturation of HIV infected cells.

what is the first class of drugs developed to treat HIV

Nucleoside/Nucleotide Reverse Transcriptase Inhibitor

What is the name of the prescription anti-fungal agent produces by Streptomyces noursei, and that is used for both treatment and prevention of oral candidiasis

Nystatin

sugar content is a must that diabetics take into account if they swallow the suspension of _____

Nystatin

Acyclovir has anti viral action against... ( 5)

Simplex types 1 and 2 Varicella-zoster Epstein-Barr Herpes simiae (B Virus) Cytomegalovirus

what can occur at interferon injection site

necrosis

adverse reactions for saquinavir

Rash, hyperglycemia, parasthesis GI: pain, diarrhea, vomiting, buccal mucosa ulceration

when taken orally, Acyclovir is absorbed between ___ and ____% Does food affect absorption of acyclovir?

acyclovir is 15%-30% absorbed when taken orally. no food does not affect acycolvir

absorption of ketonazole requires an ____ environment for dissolution and absorption,

acidic environement to absorb ketonazole

what are the antiviral agents (5)

acyclovir docosanol penciclovir famciclovir and valacyclovir

zidovudine is distributed to most body tissue, including ______ fluid

cerebrospinal fluid

clotrimazole is not recommended in pregnant women or children younger than?

children younger than 3

cream form of nystatin is used on the tissue area surrounding _____. To treat _____ ______.

cream form of nystatin is used on the tissue area surrounding dentures. To treat denture stomatitis.

Docosanol 10% decreases healing time in patients with reccurent ______ herpes when started within ___ hours of the appearance of prodromal symptoms

docosanol 10% decrease healing time in patients with recurrent orolabial herpes when started within 12 hours of the appearance of prodromal symptoms.

what is the oral antifungal agent used to treat oropharyngeal and esophageal candidiasis, serious systemic candida infection, vaginal candidiasis, and candidial infections that do not respond to other agents. Also used prophylactically in immunocompromised patients.

fluconazole

most serious adverse reaction with Ketonazole

hepatotoxicity

oral use of acyclovir treats ______ with unimpressive results

herpes labialis with unimpressive results

what virus has the most interest to the dental worker

herpes virus

Nystatin's mechanism of action is to bind to the fungal cell membrane, _______ membrane permeability, and allows leakage of ____ and other essential cellular constituents.

increase membrane permeability; allow leakage of potassium

how does ketonazole affect anti coagulant warfarin?

increase warfarin blood levels and increase bleeding risk.

what has FDA approved for treating chronic hepatitis B and hepatitis C?

interferon-a

what are endogenous proteins with antiviral, cytotoxic, and immunomodulating action

interferons

what does chronic hepatitis usually lead to

jaundice anorexia malaise

What is the pastille form of Nystatin?

licorice-flavored, rubbery, contains sugar

chronic hepatitis is inflammation of the ___

liver

HAART- Highly active Anti-retroviral Therapy is used for?

management of HIV / AIDS for improved effect by combining drugs

topical use of acyclovir has limited and non life threatening initial and recurrent ______ herpes simplex (HSV-1) in immunocompromised patients

mucocutaneous