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Group Pharm II > 43-ABX Antifungals and Antivirals > Flashcards

43-ABX Antifungals and Antivirals Flashcards

1
Q

what are the 3 herpes viruses

A

herpes simplex, varicella zoster, cytomegal virus

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2
Q

what differentiates varicella?

A

it is dermatomal

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3
Q

symptoms of CMV

A

retinitis, esophagitis, colitis

usually you are immmunocompromised cd4 <50

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4
Q

is there resistance to acyclovir?

A

no not with HSV or VZV

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5
Q

Is there resistance to gancyclovir

A

yes it is a problem

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6
Q

what drugs treat herpes?

A

nucleoside analogues

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7
Q

examples of Nucleoside analogues

A

acyclovir
famcycovir
valacyclovir

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8
Q

is acyclovir oral or cream or IV?

A

all three- oral lesions with cream

genital with oral

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9
Q

what does acyclovir do for the virus?

A

reduce the pain, and shortens duraion of viral shedding

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10
Q

can it be used in children?

A

yes- to get moms back to work faster

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11
Q

what does acyclovir cause in presence of dehydration

A

crystalluria
it precipitates in the kidney so stay hydrated
ON EXAM YO!

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12
Q

What is gancyclovir for?

A

used to prevent and treat CMV.

ask yourself…do they have HIV, cancer, or transplant pt

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13
Q

is gancyclovir 1st line

A

yes and can be given orally

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14
Q

how potent is gancyclovir?

A

100x more potent than acyclovir but produces ADR’s

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15
Q

what are the ADR’s of Gancyclovir?

A

leukopenia, thrombocytopenia, retinal detachment, liver and renal damage, rash, fever, and GI problems

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16
Q

When is Cidofovir used?

A

used with resistant infections?

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17
Q

ADR’s of cidofovir

A

nephrotoxicity, neutropenia, acidosis

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18
Q

When is trifluridine used?

A

for ocular infection

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19
Q

when you prescribe trifluridine what do you need to be mindful of?

A

it is not carried by all pharmacies so call first

refrigerated

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20
Q

What is foscarent used?

A

active HSV, VZV, CMV

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21
Q

ADR’s of foscarnet?

A

arrythmias, heart failure, seizures, pancreatitis

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22
Q

HIV treatments:

A

combinations result in improved survival

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23
Q

What is HIV treatment now

A

HAART- highly active retroviral therapy

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24
Q

whats bad about HAART?

A

many doses needed during the day

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25
Q

Nuceluoside reverese transcriptase inhibitors

A

NRTI’s

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26
Q

Non-nucleoside reverse transcriptatse inhibitors

A

NNRTIS- act synergystically with NRTI’s

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27
Q

What does most HAART therapy include

A

2 NRTI’s and and NNRTI or a Protease inhibitor

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28
Q

are all reverse transcriptase inhibitors given orally?

A

yes but only zidovudine can be given IV

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29
Q

do Reverse transcriptase inhibitors cross BBB

A

yes

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30
Q

ADR’s of NRTI’s

A

zidovudine -can cause bone marrow suppression

Didanosine ans stavudine can cause pancreatitis

Didanosine also causes hypersensitivity

All cause GI disturbances and Lipodystrophy

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31
Q

What was the first drug and most widely used

A

Zidovudine- AZT

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32
Q

can AZT be combined with stavudine?

A

they antagonize eachother. but it can be combined with others.

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33
Q

which drug reduces transmission of HIV in utero?

A

Zidovudine

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34
Q

Acyclovir has what ADR?

A

crystals in the Kidneys- so keep hydrated

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35
Q

who gets CMV?

A

HIV and Transplant pt’s give them Gancyclovir

36
Q

Back to Didanosine? is this a huge table that needs neutralization of the acidic stomach?

A

yes! truth

37
Q

At what weeks are AZT given to pregnant women who is HIV pos

A

14-34th week

38
Q

What drug is used to treat HIV and Heb C combo?

A

Lamivudine

39
Q

Do NNRTI’s require metabolic activation?

A

NO- given orally and cross the BBB

40
Q

Are NNRTI’s used alone?

A

NO never because of resistance

41
Q

ADR’s of NNRTI

A

Rash is the most common but can progress to SJ

42
Q

What NNRTI is teratogenic?

A

Efavirenz

43
Q

What is the most potent NNRTI?

A

Efavirenz- it is preferred initial treatment

44
Q

What are some other NNRTI’s

A

Efavirenz, Neverapine, Delaviradine

45
Q

Which NNRTI is hepatotoxic?

A

Nevirapine which induces CYTP 3a4 and 2b6

46
Q

WHat are some Protease inhibitors

A

Saquinavir
opinavir
atazanavir
Ritonavir-

47
Q

What else besides antiviral does ritonavir do?

A

it boosts plasma levels

48
Q

T/f are protease inhibitors synergystic?

A

yessir so they are given with 2 NRTI’s

it increases CD4 ans slows disease progression

49
Q

ADR’s jof Protease inhibitors?

A

lypodystrophy, hyperlipidemia, insulin resistance, elevated LFT’s

50
Q

Which PI has highest ADR’s?

A

Ritonavir- used for the Boost

51
Q

What are fusion and entry inhibitors

A

inhibit fusion and entry of HIV, and decrease viral load, increase CD4 count

52
Q

what are some F and E inhibitors

A

Maraviroc, enfuvirtide

53
Q

What drug class is Raltegravir

A

integrase strand transfer inhibitor

54
Q

why is raltegravir used?

A

potent activity vs. wild type or multidrug resistant HIV

55
Q

ADR’s of Raltegravir?

A

N/V/D

does not affect CYTP450

56
Q

Treatment considerations with HIV

decision to start antiretrovirals depends on

A

CD4 count
viral load
clinical symptoms

57
Q

should asymptomatic pt’s be treated

A

yes if cd4 count < 200
200-350- consider treatment
>350 if viral load is 100,000 should treat

58
Q

Initial treatment of HIV

A

2 NRTI’s and NNRTI or PI

59
Q

NNRTI regimens are down to how many pills daily

A

1

60
Q

how often do we determine response to meds

A

2-8 weeks and then 3-4 weeks. response may take months

61
Q

Drugs for Influenza Virus

A

which flu virus is out now? H1N1

62
Q

what is primary means of defense

A

vaccine

63
Q

what is most common cause of infectious disease related death

A

influenza

64
Q

what drugs are used for flu?

A

amantanes like amantadine & rimantadine approved for influenza A. not really used anymore

65
Q

what else is amantadine used for?

A

parkinsons

66
Q

What is used for flu now?

A

Neuraminidase Inhibitors

67
Q

what are some Neuraminidase inhibitors

A

Tamiflu (oseltamivir) and Relenza (zanamivir)

68
Q

Can tamiflu be given as prophylaxis

A

yes > 1 year

it decreases severity and reduces duration of illness

69
Q

What is relenza

A

nasal spray to treat the flu > 7 years old

70
Q

ADR’s of Neuraminidase Inhibitors

A

Respiratory and GI problems. Do not use in asthma or Emyphsema give them the shot

71
Q

Will Neuraminidase work within 3 days of onset of illness

A

T

72
Q

Can Neuraminidase inhibitors replace the vaccine?

A

nope used with the vaccine

73
Q

What drugs are used for Hep C?

A

Lamivudine- which treats hep B and HIV also

Tenofovir- treats Hep B and no resistance.

74
Q

what is DOC for HEP B?

A

Tenofovir- it can potentially reverse hepatic cirrhosis

75
Q

Drugs for HEP A and Hep C

A

Ribavirin- broad sprectrum antiviral. covers so many

76
Q

What else can Ribavarin be used for?

A

Only FDA drug used for RSV. these kids will be on others like albuterol

77
Q

ADR’s of Ribavarin

A

can cause Apnea, pneumothorax, and cardiac arrest.

if given IV, it can cause seizures

78
Q

Another ADR of Ribavarin

A

it antagonizes other antivirals ZDV (zidovidine)

79
Q

Drugs for Hep B and C

A

Interferons

80
Q

how are interferons used?

A

chronic active hepatitis, genital warts, hairy cell leukemia, CML, Kaposi sarcoma, renal carcinioma

81
Q

Will AIDs patients with with HEP B respond to interferons

A

Nope- AIDS patients with hep B respond poorly

82
Q

What else are interferons used for

A

genital warts

83
Q

ADR’s of Interferon

A

lots of them.
RAGE- these people are going crazy
we treat you with it until you say uncle. Hematologic toxicity, cardiac arrythmias, change in BP, CNS dysfunction, GI distress and Myalgia

84
Q

what are some Interferson

A

Boceprivir, and Talaprevir. and used in combo for RSV

85
Q

new HEP C drugs because Interferon doesn’t work and has tons of side effects

A

sofosbuvir and ledipasvir.

showed 100% SVR 12 weeks post treatment.

Group Pharm II (8 decks)

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