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4/25 Antivirals Flashcards

1
Q

name 2 neuraminidase inhibitors

A

Oseltamivir

Zanamivir

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2
Q

MoA of Oseltamivir or Zanamivir

A

Inhibits influenza neuraminidase -> decrease release of virus

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3
Q

difference between Oseltamivir or Zanamivir?

A

Oseltamivir – oral drug

Zanamivir – inhaler; limited use in young children or patients who are unable to follow instructions

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4
Q

indications for Oseltamivir or Zanamivir?

A

influenza A/B (trmt/prevention)

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5
Q

name nucleotide analogs (at least 5)

A 
Ribavirin
Acyclovir
Famciclovir
Valacyclovir
Ganciclovir
Valganciclovir
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6
Q

MoA of Ribavirin?

A

nucleotide analog that inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase (prevents ribosomes from binding to viral RNA)

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7
Q

half-life of Ribavirin?

A

long half-life (stored in RBC and released over days)

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8
Q

Indications for Ribavirin?

A

RSV

HepC (chronic)

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9
Q

ADRs of using ribarivin?

A

Hemolytic anemia
Teratogen
Gout

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10
Q

What are 2 alternate drugs that are within the same class as acyclovir?

A

Famciclovir

Valacyclovir (pro-drug)

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11
Q

MoA of Acyclovir?

A

Guanosine analog; phosphorylated by HSV/VZV–TK and subsequently phosphorylated by host enzymes to form a triphosphate

preferentially inhibits viral DNA polymerase chain termination (virus must be actively replicating; NO effect on latent forms)

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12
Q

Why should you be be considered when you prescribe acyclovir?

A

does the patient have renal failure?

renally excreted, therefore dose must be adjusted for patients with renal insufficiency

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13
Q

compare oral bioavailability between acyclovir and the 2 alternate drugs that are within the same class

A

acyclovir: not great
valacyclovir: oral pro-drug of acyclovir; better oral bioavailability
famciclovir: best oral bioavailability

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14
Q

Indications for acyclovir? valacyclovir?

A

HSV (mucocutaneous and genital lesions, encephalitis, pregnant women/neonatal, prophylaxis in immunocompromised patients) = oral acyclovir or valacyclovir

VZV (healthy, immunocompromised, pregnant women/neonates) = valacyclovir*, acyclovir

VZV, uncomplicated = famciclovir

CMV – weak activity

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15
Q

when would you normally prescribe famciclovir?

A

VZV (according to first AID)

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16
Q

Mechanism of resistance for Acyclovir et al?

A

Mutated viral TK

common among immunodeficient patients, eg AIDs patients, who receive ACV for prolonged periods

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17
Q

Side effect of Acyclovir et al?

What can you do to prevent this?

A

Nephropathy due to obstructive crystalline formation; can progress to acute renal failure if not adequately hydrated

CNS disturbances

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18
Q

What is an alternate drug that is within the same class as Ganciclovir?

A

Valganciclovir

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19
Q

What is the mxn of ganciclovir?

A

Guanosine analog that is converted to 5MP by CMV viral kinase and subsequently phosphorylated by host enzymes to form a triphosphate
preferentially inhibits viral DNA polymerase

20
Q

why is ganciclovir more toxic than acyclovir?

A

more toxic to host enzymes than acyclovir because it can actually be incorporated into DNA, thereby inhibiting HOST kinases and DNA polymerases

21
Q

What is valganciclovir?

A

valganciclovir is a pro-drug of ganciclovir; better oral bioavailability

22
Q

Indications for ganciclovir?

A

CMV*
HSV
EBV

23
Q

mechanism of resistance for ganciclovir?

A

UL97 mutated CMV DNA polymerase or lack of viral kinase

24
Q

side effects of ganciclovir?

A 
Bone marrow suppression 
-	Leukopenia
-	Neutropenia
-	Thrombocytopenia
Renal toxicity
Teratogen
25
Q

What is Foscarnet?

A

Pyro”fos”phate inhibitor that binds to the pyrophosphate-binding site of DNA polymerase; does not require activation by viral kinase

26
Q

Indication for Foscarnet?

A

Ganciclovir-resistant CMV retinitis

Acyclovir-resistant HSV

27
Q

Mxn of resistance for Foscarnet

A

mutated DNA polymerase

28
Q

ADR for foscarnet?

A

Nephrotoxicity

Sequesters divalent cations –> Hypo-Ca, Hypo-PO4, Hypo-Mg

29
Q

Mxn of Cidofovir?

A

Nucleotide analog that inhibits viral DNA polymerase; does not require activation by viral kinase

10-100x more active against CMV in vitro

30
Q

Half-life of Cidofovir?

A

long half-life

31
Q

Indications for Cidofovir?

A

Ganciclovir-resistant CMV
Acyclovir-resistant HSV
Molluscum contagiosum
Pox viruses (small pox, vaccinia, monkeypox)

32
Q

Mxn of resistance for Cidofovir?

A

Mutated DNA polymerase

33
Q

Side effect of Cidofovir? ways to prevent it from happening?

A

Nephrotoxicity (coadminister with probenecid and IV saline to toxicity)

34
Q

What is Interferon α and its mechanism of action?

A

glycoproteins with anti-viral and anti-tumor properties; inhibits viral replication and promotes cytotoxic T cell and NK cell activity

35
Q

Indications for Interferon α?

A

Hep B, C
Kaposi Sarcoma
Hairy cell leukemia
Conyloma acuminatum

36
Q

Side effects of Interferon α?

A

Neutropenia
Myopathy
Flu-like symptoms

37
Q

What are Boceprevir and Telapravir?

A

Protease inhibitor that forms a covalent bond with NS3 protease and prevents it from cleaving the HCV polyprotein into functional viral proteins

38
Q

Indications for Boceprevir and Telapravir?

A

HCV – one very specific type only

39
Q

ADR for Boceprevir and Telapravir?

A

Boceprevir – anemia, pancytopenia

Telapravir – anemia, pruritus, skin rash

40
Q

Influenza

Primary treatment

A

Zanamivir

Oseltamivir

41
Q

HSV

Primary treatment
Alternate Drugs
Drugs for resistant strains

A

Acyclovir

Famciclovir
Valacyclovir

Cidofovir
Foscarnet

42
Q

VZV

Primary treatment
Alternate Drugs

A

Famciclovir*
Acyclovir

Valacyclovir

43
Q

CMV

Primary treatment
Alternate Drugs

A

Ganciclovir

Valganciclovir –prophylaxis in immunocompromised hosts

Cidofovir
Foscarnet

44
Q

HepB

Primary treatment
Alternate Drugs
Drugs for resistant strains

A 
Interferon α
adefovir
emtricitabine
tenofovir
entecavir
telbivudine
45
Q

HepC

Primary treatment
Alternate Drugs

A

Interferon α + Ribavirin

Boceprevir
Telapravir

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