191: Antiviral Drugs Flashcards
What is the mechanism of action of Acyclovir in treating HSV and VZV infections?
Acyclovir is a triphosphate form that has a potent inhibitory effect on herpesvirus-induced DNA polymerases, causing premature termination of nascent viral DNA chains while having relatively little effect on host cell DNA polymerase.
What are the primary indications for Acyclovir use?
Acyclovir is indicated for symptomatic primary or recurrent HSV1/2 infections, chronic suppression of HSV1/2 infections, HSV encephalitis, primary VZV infection, herpes zoster, prevention and treatment of neonatal HSV infection, HSV gingivostomatitis and orolabial cold sores (off-label), prevention of HSV, CMV, or VZV reactivation in hematopoietic stem cell transplant and HIV patients (off-label), and new onset Bell palsy (off-label).
What are the common side effects and precautions associated with Acyclovir?
Common side effects and precautions include renal impairment, renal tubular crystallization with rapid IV administration, CNS toxicity, thrombo-phlebitis, and pregnancy category B.
What is the bioavailability of Acyclovir when administered orally, and how does it distribute in the body?
Acyclovir has an oral bioavailability of 15-30% and is water soluble, allowing it to distribute widely throughout the body, including into the contents of vesicles, cerebrospinal fluid (CSF), and vaginal secretions.
What is the half-life of Acyclovir in different patient populations?
The half-life of Acyclovir varies by patient population: Neonates: 4 hours, Children: 2-3 hours, Adults: 2-3.5 hours, Hemodialysis patients: 5 hours.
What is the active form of Acyclovir, and how does it work?
The active form is acyclovir triphosphate, which inhibits herpesvirus-induced DNA polymerases and causes premature termination of viral DNA.
What is the mechanism of action and pharmacokinetics of Valacyclovir?
Valacyclovir is readily absorbed from the GI tract and almost entirely converted to acyclovir by intestinal and hepatic esterases. Its spectrum of activity is identical to acyclovir but improved. Oral bioavailability is 55%. Half-life: Children: 1.3 - 2.5 hours, Adults: 30 minutes. Excretion is primarily renal.
What are the indications for Valacyclovir?
Indications include initial and recurrent HSV genital infections, suppression and reduction of transmission of genital HSV infections, herpes zoster, herpes labialis, and varicella (chickenpox).
What are the common side effects and precautions associated with Valacyclovir?
Common side effects include acute renal failure, CNS effects (e.g., agitation, hallucinations, seizures, encephalopathy), immediate hypersensitivity, and severe effects of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) among AIDS and transplant patients.
What is the advantage of Valacyclovir over Acyclovir?
Valacyclovir has improved oral bioavailability (55%) compared to acyclovir (15-30%), making it more effective for oral administration.
What is the mechanism of action of Famciclovir and Penciclovir?
Famciclovir is biotransformed to Penciclovir, which is phosphorylated to penciclovir triphosphate. This compound inhibits HSV-2 polymerase and viral DNA polymerases, similar to acyclovir, but allows for more DNA chain extension.
What are the indications for using Famciclovir and Penciclovir?
Indications include initial and recurrent HSV genital infections, suppression of frequently recurring genital HSV infections, initial and recurrent HSV labialis infections, herpes zoster, and varicella infection in HIV patients (off-label).
What are the dosing regimens for Famciclovir in treating primary HSV infection in an immunocompetent host?
Dosage: 250 mg 3x/d, Route: Oral, Duration: 7-10 days.
What are the common side effects and precautions associated with Famciclovir and Penciclovir?
Common side effects include headache, nausea, diarrhea, and dizziness. Pregnancy category: B.
What is the recommended time frame for initiating treatment with Famciclovir and Penciclovir after rash onset?
Treatment should be initiated within 72 hours of rash onset.
What is the mechanism of action of Trifluridine?
Trifluridine is a pyrimidine nucleoside analog that acts as an irreversible competitive inhibitor of thymidylate synthetase and inhibits HSV DNA polymerase through its triphosphate form.
What are the primary indications for Trifluridine?
Trifluridine is indicated for primary and recurrent HSV keratoconjunctivitis, keratitis, and acyclovir-resistant mucocutaneous HSV infections in patients with AIDS (off-label).
What are the dosing regimens for Trifluridine?
For HSV keratoconjunctivitis, induction: 1 drop every 2 h (maximum, 9 drops/24 h), maintenance: 1 drop every 4 h (maximum, 6 drops/24 h). For acyclovir-resistant HSV infection in AIDS: 1 drop every 8 h.
What are the common side effects and precautions associated with Trifluridine?
Common side effects include transient local burning or stinging, palpebral edema, epithelial and punctate keratopathy, and stromal edema. Pregnancy category: C.
What is the mechanism of action of Ganciclovir in treating cytomegalovirus infections?
Ganciclovir is phosphorylated by viral kinases to a substrate that competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase, thus inhibiting viral DNA synthesis.
What are the primary indications for Ganciclovir and Valganciclovir?
Indications include CMV retinitis in immunocompromised patients, suppression and prevention of CMV disease in transplant recipients, and CMV esophagitis, colitis, or neurologic disease in HIV patients (off-label).
What are the common side effects associated with Ganciclovir and Valganciclovir?
Common side effects include gastrointestinal issues (diarrhea, nausea, loss of appetite), hematologic issues (anemia, thrombocytopenia, bone marrow aplasia, aplastic anemia), acute renal failure, and neurological symptoms.
What is the elimination half-life of Ganciclovir?
The elimination half-life of Ganciclovir is 4 hours.
What are the dosing regimens for Ganciclovir in treating CMV retinitis?
Induction: 900 mg 2 times a day (oral) or 5 mg/kg every 12 hours (IV). Maintenance: 900 mg every day (oral) or 5 mg/kg every day (IV) until CD4 count >100 after 6 months of HAART.
What is the mechanism of action of Foscarnet?
Foscarnet noncompetitively inhibits viral DNA polymerases at the pyrophosphate binding site.
What are the primary indications for Foscarnet?
Foscarnet is indicated for CMV retinitis, acyclovir-resistant HSV infections, CMV esophagitis or colitis (off-label), and ganciclovir-resistant CMV infections (off-label).
What are the dosing regimens for Foscarnet in treating CMV retinitis?
Induction: 90 mg/kg IV every 12 hours for 14-21 days. Maintenance: 90 mg/kg IV every 24 hours until CD4 count >100 on 6 months of HAART.
What are the major side effects and precautions associated with Foscarnet?
Major side effects include renal toxicity, electrolyte imbalances, nausea/vomiting with diarrhea, anemia, granulocytopenia, fever, headache, and pregnancy category C risk.
What drugs can potentiate the effects of Foscarnet?
Drugs that can potentiate the effects of Foscarnet include Acyclovir/Valacyclovir, aminoglycosides, amphotericin B, cyclosporine, QTc-prolonging agents, methotrexate, and tacrolimus.
What are the indications for the use of Cidofovir?
Indications include CMV retinitis and acyclovir-resistant HSV infections (off-label).
What are the contraindications for Cidofovir?
Contraindications include those with preexisting renal impairment (serum creatinine >1.5 or >2+ proteinuria).
What is the dosing regimen for Cidofovir in treating CMV retinitis?
Induction: 5 mg/kg IV every week for 2 weeks. Maintenance: 5 mg/kg IV every 2 weeks until CD4 count > 100 after 6 months on HAART.
What are the common side effects associated with Cidofovir?
Common side effects include nausea, alopecia, rash, fever, myalgias, asthenia, headache, abdominal pain, diarrhea, dyspepsia, flatulence, increased creatinine, pancreatitis, and hypophosphatemia.
What serious renal side effects are associated with Cidofovir?
Serious renal side effects include renal tubular damage, dose-dependent proximal tubular injury (Fanconi-like), proteinuria, and elevated serum creatinine levels.
What should Cidofovir not be used with?
Cidofovir must NOT be used with tenofovir disoproxil fumarate (TDF).
What is the pregnancy category of Cidofovir?
Pregnancy category C.
What are the mechanisms of action and pharmacokinetics of interferons?
Interferons have broad antiviral and immunomodulating effects and are commonly given subcutaneously.
What are the contraindications for cidofovir?
Contraindications include preexisting renal impairment (serum creatinine >1.5 or >2+ proteinuria).
What are the mechanisms of action and pharmacokinetics of interferons?
- Interferons have broad antiviral and immunomodulating effects.
- Commonly given subcutaneously.
- Plasma half-life:
- > 2 to 3 hours after IV administration.
- > 4 to 6 hours after SC/IM administration.
- Pegylated interferon has a prolonged half-life.
What are the indications for the use of interferons?
- IFN-alpha: viral infections, neoplastic diseases including melanoma.
- IFN-beta: multiple sclerosis.
- IFN-gamma: chronic granulomatous disease.
- Off-label uses include:
- Chronic myelogenous leukemia
- Cutaneous T-cell lymphoma
- Behçet disease
- Desmoid tumor
- Multiple myeloma
- Neuroendocrine tumors
- Renal cell carcinoma
- West Nile virus
What are the common side effects and precautions associated with interferons?
- Common side effects include:
- Flulike symptoms: fever, chills, tachycardia, malaise, myalgia, headache (within 1 to 2 hours).
- Injection site reactions, alopecia, psoriasis, fixed drug eruptions, eczematous drug reactions, sarcoidosis, lupus, pigmentary changes, and lichenoid eruptions.
- Bone marrow suppression, GI- and hepatotoxicity.
- Aggravate neuropsychiatric events.
- Precautions:
- Should NOT be used to treat hepatitis B-related cirrhosis or decompensated liver disease due to risk of further decompensation.
- Pregnancy risk factor C.
- Interferon + ribavirin is category X.
What viral diseases are treated with interferon?
- Condylomata acuminata (intralesional).
- Chronic hepatitis C infection (with or without ribavirin, IM, SC).
- Chronic hepatitis B infection (IM, SC).
- AIDS-related Kaposi sarcoma (IM, SC).
What are the dosing regimens for interferons?
Condition | Dosage | Route | Duration |
|———–|——–|——-|———-|
| Kaposi sarcoma | IFN-α2b 30 million units 3x/week | IM, Subcutaneous | Dependent on response |
| Condyloma acuminata | IFN-α2b 1 million units 3x/week | Intralesional | 3 weeks |
| Chronic hepatitis C (with ribavirin) | PEG-IFN-α2a 180 µg once a week or PEG-IFN-α2b 1.5 µg/kg once a week | Subcutaneous | Dependent on response and genotype |
| Chronic hepatitis B | IFN-α2b 10 million units 3x/week | IM, Subcutaneous | 16 weeks |
What are the seven stages of the HIV life cycle?
- Binding/Attachment: Viral envelope glycoprotein binds to host receptors (CD4) and coreceptors (CCR5 or CXCR4).
- Fusion: HIV envelope and host cell membrane fuse, allowing viral capsid entry.
- Reverse Transcription: Viral reverse transcriptase converts HIV RNA into double-stranded DNA.
- Integration: Viral integrase integrates viral DNA into host DNA.
- Replication: HIV protein chains and RNA are produced using host cell machinery.
- Assembly: Newly replicated proteins and RNA move to the host cell surface and assemble into immature virions.
- Budding and Maturity: Newly formed virion buds out of the host cell, releasing protease that breaks up viral protein chains, resulting in mature virions.
What are the recommended conditions for initiating antiretroviral therapy (ART) in HIV-infected individuals?
ART is recommended for all HIV-infected individuals and should be initiated soon after diagnosis. Conditions that increase urgency for therapy include:
1. Pregnancy
2. Presence of HIV-related complications
3. Opportunistic infections
4. Chronic hepatitis B and C infection
5. Acute symptomatic HIV infection
6. CD4 ≤ 200 cells/μL, rapidly declining CD4 counts, and higher viral loads (>100,000 copies/mL).
What is the recommended action when initial suppression of HIV is not achieved or is lost?
Rapidly change to a new regimen with at least 2 active drugs.
What is the typical time frame for viral load reduction to below limits of assay detection in an ART-naive patient?
Viral load reduction usually occurs within the first 12 to 24 weeks of therapy.
What are some factors that may predispose individuals to adverse effects of antiretroviral therapy (ARV)?
Factors include:
- Concomitant use of medications with overlapping and additive toxicities
- Comorbid conditions that increase the risk of or exacerbate adverse effects
- Drug-drug interactions that may lead to an increase in drug toxicities
- Genetic factors that predispose patients to abacavir (ABC) hypersensitivity reaction.
What are the two types of prophylaxis mentioned for HIV prevention?
- Preexposure Prophylaxis (PrEP)
- Postexposure Prophylaxis
What is a key consideration regarding drug interactions in antiretroviral therapy?
Pharmacokinetic (PK) drug-drug interactions between antiretroviral (ARV) drugs and concomitant medications may lead to changes in drug exposure.
What is the mechanism of action of Maraviroc?
Maraviroc selectively binds to the human chemokine receptor CCR5 on the cell membrane, preventing the interaction of HIV-1 gp120 and CCR5 necessary for CCR5-tropic HIV-1 to enter cells.
What are the side effects and precautions associated with Enfuvirtide?
Enfuvirtide can cause mucocutaneous side effects such as local injection site reactions, induration, erythema, nodules, and cysts. Other side effects include gastrointestinal upset and an increased risk of bacterial pneumonias.
What are the side effects associated with Abacavir?
Abacavir can cause fatal hypersensitivity reactions, particularly in patients with the HLA-B*5701 allele, who are at a higher risk.
What are the common side effects of Emtricitabine?
Emtricitabine can cause fat redistribution, leading to an increased amount of fat in the upper back and neck (‘buffalo hump’), breast, and around the trunk. It may also cause hyperpigmentation primarily of palms and/or soles, and various types of rash including hypersensitivity reactions.
What are the side effects of Didanosine?
Didanosine can cause rash, pruritus, xerostomia, alopecia, lipodystrophy, SJS, vasculitis, pancreatitis, and peripheral neuropathy.
What are the side effects of Lamivudine?
Lamivudine can cause alopecia, rash, pruritus, fat redistribution, and neutropenia.
What are the side effects of Tenofovir?
Tenofovir can cause rash (including macular, papular, pustular, vesiculobullous, or urticarial), pruritus, diaphoresis, headache, and nausea. It can also elevate didanosine levels and lower atazanavir levels.
A patient with HIV is experiencing hypersensitivity reactions characterized by rash and organ dysfunction. Which drug is likely responsible?
Abacavir is likely responsible. The HLA-B*5701 allele increases the risk of hypersensitivity reactions.
A patient with HIV is prescribed maraviroc. What is its mechanism of action?
Maraviroc selectively binds to the CCR5 receptor, preventing HIV-1 entry into cells. Major side effects include hepatotoxicity and mucocutaneous reactions like Stevens-Johnson syndrome.
A patient with HIV is prescribed enfuvirtide. What is its mechanism of action?
Enfuvirtide mimics a portion of glycoprotein 41, preventing viral fusion with the host cell membrane. Common side effects include local injection site reactions.
A patient with HIV is experiencing severe hypersensitivity reactions. Which genetic test should be performed before initiating therapy?
The HLA-B*5701 test should be performed to assess the risk of abacavir hypersensitivity.
What are the side effects associated with Zidovudine?
- Lipodystrophy
- Skin/nail pigmentation changes (blue)
- Stevens–Johnson syndrome
- Toxic epidermal necrolysis
- Urticaria and morbilliform eruption
- Bone marrow suppression
- GI intolerance
- Mitochondrial toxicity: may manifest as hepatic steatosis, peripheral neuropathy, pancreatitis, dyslipidemia, fat maldistribution, and lipoatrophy.
- Lamivudine + didanosine + nelfinavir may cause onset of bullous pemphigoid.
What is the mechanism of action of Non-Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NNRTIs)?
NNRTIs bind near the catalytic site of reverse transcriptase and alter the enzymes’ ability to change conformation, which increases enzyme rigidity and prevents normal polymerization function, thereby reducing the viral replication rate.
What are the side effects and precautions associated with Etravirine?
- Self-limiting rash (19%)
- Teratogenic effects
- Requires acidic environment for absorption; must not be given with H2 blockers.
What are the side effects of Raltegravir?
- Severe, potentially life-threatening and fatal skin reactions (e.g., SJS, hypersensitivity reaction, TEN).
What is the mechanism of action of Integrase Strand Transfer Inhibitors (INSTIs)?
INSTIs inhibit HIV integrase, preventing the integration of HIV-1 DNA into host genomic DNA, which blocks the formation of the HIV-1 provirus and propagation of the viral infection.
What are the common side effects of Protease Inhibitors (PIs)?
- Lipodystrophy: most common side effect, may relate to inhibition of ZMPSTE24.
- Other mucocutaneous side effects include:
- Morbilliform rash
- Generalized erythema
- SJS
- Striae
- Paronychia
- Ingrown toenails
- Pruritus
- Xerosis
- Desquamative cheilitis
- Icterus (especially with atazanavir)
What is the role of Ritonavir in the treatment of HIV?
Ritonavir is used for its good oral bioavailability, but side effects limit the dose. It is also metabolized via the hepatic cytochrome P450 (CYP) system and is often used to boost the effects of other protease inhibitors.
A patient with HIV is experiencing severe lipodystrophy. Which class of drugs is most likely responsible?
Nucleoside reverse transcriptase inhibitors (NRTIs) are most likely responsible. The hallmark toxicity is mitochondrial toxicity, which can manifest as hepatic steatosis and lipoatrophy.
A patient with HIV is on a protease inhibitor regimen and develops lipodystrophy. What is the likely mechanism behind this side effect?
Lipodystrophy may be related to the inhibition of ZMPSTE24, an enzyme involved in removing the farnesylated tail of prelamin.
A patient with HIV is experiencing severe skin reactions, including Stevens-Johnson syndrome. Which class of drugs is most likely responsible?
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are most likely responsible, particularly nevirapine.
A patient with HIV is on a regimen including dolutegravir. What is the mechanism of action of this drug?
Dolutegravir inhibits HIV integrase, preventing viral DNA integration into the host genome. Side effects include hypersensitivity reactions and liver injury.
A patient with HIV is experiencing peripheral neuropathy and hepatic steatosis. Which class of drugs is responsible?
Nucleoside reverse transcriptase inhibitors (NRTIs) are responsible. The underlying mechanism is mitochondrial toxicity.
A patient with HIV is experiencing severe anemia and bone marrow suppression. Which drug is likely responsible?
Zidovudine is likely responsible. It is primarily used as a nucleoside reverse transcriptase inhibitor in HIV therapy.
A patient with HIV is experiencing severe rash and systemic symptoms. Which drug is likely responsible?
Raltegravir is likely responsible. The recommended action is immediate discontinuation of the drug.
A patient with HIV is experiencing severe GI intolerance and nail pigmentation changes. Which drug is likely responsible?
Zidovudine is likely responsible.
A patient with HIV is experiencing severe fat redistribution. Which drug class is responsible?
Protease inhibitors are responsible. Manifestations include increased fat in the upper back and neck, breast, and trunk.
A patient with HIV is experiencing severe lactic acidosis. Which drug class is responsible?
Nucleoside reverse transcriptase inhibitors (NRTIs) are responsible. The underlying mechanism is mitochondrial toxicity.
What is the mechanism of action of the entry inhibitor drug AMD-070?
AMD-070 is a selective, reversible, small molecule CXCR4 chemokine co-receptor antagonist.
How does the drug Cabotegravir function in the context of HIV treatment?
Cabotegravir prevents viral DNA integration into the host genome.
What is the role of the drug Doravirine in HIV treatment?
Doravirine acts as a noncompetitive inhibitor of HIV-1 reverse transcriptase.
What is the function of the maturation inhibitor BMS-955176?
BMS-955176 binds to HIV-1 Gag, inhibiting the final protease-mediated cleavage event.
What is the purpose of the gene therapy product SB-728-T in HIV treatment?
SB-728-T aims to provide HIV-infected individuals with a reproducible pool of CD4 T cells that are permanently resistant to HIV entry, potentially improving immune restoration and functional control of HIV.
What is the risk of progression to liver cirrhosis in patients with untreated acute HCV infection?
The risk of progression to liver cirrhosis is approximately 15% to 30% within 20 years for patients with untreated acute HCV infection.
What are the stages of the HCV life cycle?
The stages of the HCV life cycle include:
- Attachment: Binding of HCV particles onto hepatocytes.
- Cell entry: Clathrin-mediated endocytosis.
What are the stages of the HCV life cycle?
The stages of the HCV life cycle include:
- Attachment: Binding of HCV particles onto hepatocytes.
- Cell entry: Clathrin-mediated endocytosis allows HCV particles to enter early endosomes.
- Fusion: pH-dependent membrane fusion releases the HCV genome into the cytosol.
- Translation and Replication: Viral genome is translated into a polyprotein, cleaved into mature viral proteins.
- Assembly: Dependent on cellular lipid metabolism and viral proteins.
- Release: HCV virions are released as lipoviral particles essential for infectivity.
What are the currently approved direct-acting antivirals (DAAs) for HCV treatment?
Currently approved DAAs include:
- Protease (NS3/4A) inhibitors: paritaprevir, simeprevir, elbasvir, grazoprevir.
- NS5A inhibitors: daclatasvir, ledipasvir, ombitasvir.
- Polymerase (NS5B) inhibitors: sofosbuvir (nucleot(s)ide analog), dasabuvir (nonnucleoside analog).
What is the primary efficacy endpoint for HCV treatment?
The primary efficacy endpoint for HCV treatment is the Sustained Virologic Response (SVR), defined as undetectable HCV RNA levels at a specified end point after completion of therapy, with SVR at 12 weeks being the adopted standard.
What are the side effects associated with PEG-IFN-alpha and Ribavirin combination therapy?
Side effects associated with PEG-IFN-alpha and Ribavirin combination therapy include:
- Localized injection site reactions: erythema, tenderness, pruritus, rashes, cutaneous necrosis.
- Other reactions: blistering reactions, granulomatous dermatitis, lupus-like reactions, embolia cutis medicamentosa, localized alopecia.
- Alopecia: occurs in 28% to 36% of patients.
- Skin rash: occurs in 21%, often as eczematous dermatitis.
- Other adverse effects: flulike symptoms, fatigue, bone marrow suppression/cytopenias, mood disturbances, and “black box” warnings for hemolytic anemia and teratogenicity for Ribavirin.
What are the side effects and precautions associated with boceprevir and telaprevir?
- Boceprevir: anemia, neutropenia, dysgeusia.
-
Telaprevir: rash, pruritis, anorectal discomfort, diarrhea, anemia.
- Rash: 50% of cases occurred within the first 4 weeks of therapy; mostly Grade 1 or 2 and did not progress; may cause drug rash with eosinophilia and systemic symptoms (DRESS) and SJS.
What are the side effects of Simeprevir and Sofosbuvir when used in combination with other treatments?
- Simeprevir (Olysio): rash within 4 weeks, photosensitivity, pruritis, nausea, transient hyperbilirubinemia.
-
Sofosbuvir (Sovaldi):
- Used with PEG-IFN-α + ribavirin: fatigue, nausea, anemia, neutropenia.
- Used with ribavirin: fatigue, headache, nausea, pruritis.
What are the common side effects of Ledipasvir and Sofosbuvir (Harvoni)?
- Common side effects: fatigue, headache, nausea, diarrhea.
- Rash: occurs in 7% of patients, pruritis in 1% to 2%.
What are the key characteristics of NRTIs used for treating Hepatitis B?
-
NRTIs: commonly used to treat Hepatitis B virus (HBV) infection.
- Administered orally once daily, with dose adjustments for renal impairment (creatinine clearance <50 mL/min).
- Inhibit polymerase activity of HBV.
- Black Box warning: includes risk of mitochondrial toxicity and associated conditions such as myopathy, peripheral neuropathy, hepatic steatosis, pancreatitis, dyslipidemia, lipoatrophy, and lactic acidosis.
Which agents are preferred for the treatment of Hepatitis B?
- Preferred agents: entecavir or tenofovir.
-
Other NRTIs approved for treatment of HBV include:
- lamivudine
- adefovir
- telbivudine.
A patient with chronic hepatitis C is being treated with sofosbuvir and ledipasvir. What is the goal of this therapy, and what are common side effects?
The goal is sustained virologic response (SVR), defined as undetectable HCV RNA levels 12 weeks after therapy. Common side effects include fatigue, headache, and nausea.
A patient with hepatitis C is being treated with a combination of sofosbuvir and ribavirin. What are the common side effects of this regimen?
Common side effects include fatigue, headache, nausea, and pruritus.
A patient with hepatitis C is being treated with daclatasvir and sofosbuvir. What is the goal of this therapy, and what are common side effects?
The goal is sustained virologic response (SVR). Common side effects include fatigue, headache, and nausea.
A patient with hepatitis C is being treated with simeprevir. What are the common side effects, and what is its indication?
Common side effects include rash, photosensitivity, and pruritus. It is indicated for use in combination with sofosbuvir or PEG-IFN-α plus ribavirin.
A patient with hepatitis C is being treated with sofosbuvir and velpatasvir. What is the goal of this therapy, and what are common side effects?
The goal is sustained virologic response (SVR). Common side effects include headache, fatigue, and nausea.
What are the adverse effects associated with Tenofovir?
Adverse effects of Tenofovir include:
- Nephrotoxicity
- Fanconi syndrome
- Rashes (including maculopapular, urticarial, vesiculobullous, pustular, and lichenoid rashes)
What is the only effective treatment for persons with HDV coinfection?
PEG-IFNα is the only effective treatment for persons with HDV coinfection.
What are the indications for initiation of treatment in patients with hepatitis B?
Indications for initiation of treatment include:
1. ALF or decompensated cirrhosis (NRTIs only)
2. Significant liver injury or fibrosis, indicated by elevated ALT levels or biopsy-proven inflammation and/or fibrosis plus active HBV viremia.
3. Immunosuppressive therapy.
What are the adverse effects of Oseltamivir and Peramivir?
Adverse effects:
| Drug | Adverse Effects |
|————–|————————————|
| Oseltamivir | SJS, EM |
| Peramivir | SJS, EM, urticaria, maculopapular rash |
What is the duration of treatment for patients treated with PEG-IFNα?
Patients treated with PEG-IFNα are typically treated for 48 weeks.
A patient with hepatitis B and HIV coinfection requires treatment. Which drugs are preferred, and why?
Preferred drugs include tenofovir, entecavir, and lamivudine because they are active against both HBV and HIV.
A patient with severe influenza is prescribed oseltamivir. What is the mechanism of action of this drug, and what are its potential adverse effects?
Oseltamivir is a neuraminidase inhibitor that prevents the release of new viral particles. Adverse effects include Stevens-Johnson syndrome (SJS) and erythema multiforme (EM).
A patient with chronic hepatitis B is being treated with entecavir. What is the mechanism of action of this drug, and what are its adverse effects?
Entecavir inhibits HBV polymerase activity. Adverse effects include nephrotoxicity and rashes.
A patient with chronic hepatitis B is being treated with tenofovir. What are its major adverse effects?
Major adverse effects include nephrotoxicity and Fanconi syndrome.
What is the effectiveness time frame for initiating Acyclovir for varicella and herpes zoster?
Acyclovir is most effective when initiated within __ hours for varicella and __ hours for herpes zoster.
What is the effectiveness time frame for initiating Valacyclovir after first diagnosis and recurrent episodes?
Valacyclovir is most effective when initiated within __ hours of first diagnosis and __ hours of onset of recurrent episode.
What side effect is associated with the medication mentioned in the content?
This medication has a side effect of symmetrical intertriginous and flexural exanthem.
Which medication is available in a 1% ophthalmic aqueous solution for the treatment of HSV conjunctivitis?
The medication available in 1% ophthalmic aqueous solution for treatment of HSV conjunctivitis is Acyclovir.
What are the first-line ART recommendations for HIV among different populations?
First-line ART of HIV among adults, pregnant/breastfeeding individuals, adolescents, and children varies and needs to be specified.
What are the recommended regimens for HIV preexposure and postexposure prophylaxis?
HIV preexposure prophylaxis regimen and postexposure prophylaxis (for adults and children) need to be specified.
What is the hallmark toxicity of NRTIs that may manifest as hepatic steatosis and peripheral neuropathy?
The hallmark toxicity of NRTIs that may manifest as hepatic steatosis and peripheral neuropathy needs to be specified.
What are the preferred agents for HBV treatment?
The preferred agents for HBV treatment need to be specified.
