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Pharmacological Approaches to Treat Viral, Parasitic and Fungal Organisms

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Pharmacological Approaches to Treat Viral, Parasitic and Fungal Organisms PHARMACOLOGICAL APPROACHES TO TREAT VIRAL, PARASITIC AND FUNGAL ORGANISMS Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Antibiotic therapy, as part of a medical plan and lifesaving measure is a primary focus in terms of the general principles that clinicians must understand when selecting a course of pharmacology treatment for an infectious disease. This course is part two of a 2-part series on pathogens and antimicrobial therapy with a focus on general issues affecting antibiotic selection, the types of pathogens and diseases treated, and on specific antibiotics’ indication, administration and potential adverse effects. Antibiotic misuse and resistance is discussed. 1 Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 5 hours. Statement of Learning Need The health literature has identified the inappropriate use of antimicrobial agents, as well as the evolving pathogenicity of varied types of organisms and rising problem of antimicrobial resistance. This is a critical learning topic for health clinicians, especially in the field of infectious disease as decisions are made to treat and educate patients to prevent and address an infectious disease process. Course Purpose To provide clinicians with knowledge of issues in antibiotic pharmacology and related preventive and life saving measures. 2 Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com 1. The efficacy of an antiviral agent depends on its ability a. to be selectively toxic against the virus. b. to overcome the viral resistance strategy. c. to be effective against replicating and latent viruses. d. All of the above. 2. True or False: Most antiviral agents available are only effective against replicating viruses. a. True b. False 3. Anti-viral agents, known as immunomodulating agents, a. interfere with the host cell receptor or co-receptor. b. act directly by inhibiting viral replication at the cellular level. c. augment or modify the host immune system to eradicate the infecting virus. d. inhibit attachment of viral specific glycoproteins to host cells. 4. _________________ is not recommended for immunosuppressed patients because it causes vaccine-induced infection. a. Salk polio vaccine b. Oral polio vaccine c. Zidovudine d. Azidothymidine 5. Complications such as arthritis and arthralgia are reported among women after vaccination with a. live-attenuated measles vaccine. b. killed measles vaccine. c. rubella vaccine. d. the 17D vaccine. 4 Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com Introduction More recently, the development of new chemotherapeutic agents and vaccines has assisted in proper management of certain diseases. A potent antiviral, antiparasitic and antifungal agent should be effective to treat most studied organisms. Specifically, an antiviral agent should be effective against both replicating and latent viruses; it can be used for the treatment of overt viral diseases, or in suppressive, preemptive and prophylactic therapy. It is important to understand the mechanism of pharmacological agents used to treat pathogens in order to guide the choice of drug in infectious disease management. Antiviral Therapy Antiviral agents are drugs used in the treatment of viral infections. They inhibit certain major steps in viral replications, specific enzymes and structures that are important in the viral growth and multiplication. Unlike antibacterial drugs, only limited types of antiviral agent are available for the treatment of specific viral infections. More recently, the development of new chemotherapeutic agents and vaccines has assisted in proper medical management of these diseases. The efficacy of an antiviral agent depends on the ability to be selectively toxic against the virus and to overcome viral resistance.37,38,40-44 Because viruses are obligate intracellular organisms that depend on the host synthetic machinery for replication, an antiviral agent must exhibit selective toxicity against the target virus. It is therefore important to understand the mechanism of actions of this drug, and the side effect and resistance pattern associated with these agents. A primary focus of this course is to discuss various types, uses and approaches to the development of the antiviral agent. In addition, there will be a detailed study about the acquired resistance pattern of viruses to antiviral drugs and available vaccines. 5 Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com Presently, only few viral infections have effective drugs of treatment. These include human immunodeficiency virus, (HIV), respiratory syncytial virus (RSV), varicella zoster virus (VZV), cytomegalovirus (CMV), hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), etc. The development of antiviral agents over the years has been a challenge due to the difficulties in establishing the right diagnosis, isolation and studying viruses. However, in recent years, with the advancement in molecular technique, discovery of highly sensitive and specific viral quantitative method, more antiviral agents are available for the treatment of these diseases. Viruses are obligate intracellular organism that depends on the host cellular machinery for viral replications. During replication, the virus attaches itself to a host cell, and after a successful entry, it uncoats by releasing nucleic acid into the host cell. The released nucleic acid is transcripted to make new copies, which are later translated into viral proteins, and assembled into infective virions. Antiviral agents can target one or more of these stages. A potent antiviral agent should be effective against both replicating and latent viruses. It can be used for the treatment of overt viral diseases, or in suppressive, preemptive and prophylactic therapy. The efficacy of an antiviral agent depends on the ability to be selectively toxic against the virus, and overcome the viral resistance strategy. It is therefore important to understand the mechanism of the antiviral agent in order to guide the choice of drug in disease management. Mechanism of Action Mechanism of action of antiviral agent involves inhibition of virus-specific steps in viral replication. These include: • Attachment to the cell • Penetration 6 Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com • Uncoating of nucleic acid • Transcription and translation of early (regulatory) proteins • Nucleic acid synthesis • Synthesis of late (structural) proteins • Assembly of mature virions • Viral release In addition, since a virus depends mainly on the host cell metabolic activities, potent antiviral agents should inhibit only virus-specific functions without affecting the host. Therefore, the most antiviral agent has limited spectrum of activity. Most compounds with in vitro antiviral effects are not suitable as an antiviral agent because they are harmful to the host. Ordinarily, antiviral agents should be effective for latent and
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