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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
Nuceluoside reverese transcriptase inhibitors
NRTI's
26
Non-nucleoside reverse transcriptatse inhibitors
NNRTIS- act synergystically with NRTI's
27
What does most HAART therapy include
2 NRTI's and and NNRTI or a Protease inhibitor
28
are all reverse transcriptase inhibitors given orally?
yes but only zidovudine can be given IV
29
do Reverse transcriptase inhibitors cross BBB
yes
30
ADR's of NRTI's
zidovudine -can cause bone marrow suppression Didanosine ans stavudine can cause pancreatitis Didanosine also causes hypersensitivity All cause GI disturbances and Lipodystrophy
31
What was the first drug and most widely used
Zidovudine- AZT
32
can AZT be combined with stavudine?
they antagonize eachother. but it can be combined with others.
33
which drug reduces transmission of HIV in utero?
Zidovudine
34
Acyclovir has what ADR?
crystals in the Kidneys- so keep hydrated
35
who gets CMV?
HIV and Transplant pt's give them Gancyclovir
36
Back to Didanosine? is this a huge table that needs neutralization of the acidic stomach?
yes! truth
37
At what weeks are AZT given to pregnant women who is HIV pos
14-34th week
38
What drug is used to treat HIV and Heb C combo?
Lamivudine
39
Do NNRTI's require metabolic activation?
NO- given orally and cross the BBB
40
Are NNRTI's used alone?
NO never because of resistance
41
ADR's of NNRTI
Rash is the most common but can progress to SJ
42
What NNRTI is teratogenic?
Efavirenz
43
What is the most potent NNRTI?
Efavirenz- it is preferred initial treatment
44
What are some other NNRTI's
Efavirenz, Neverapine, Delaviradine
45
Which NNRTI is hepatotoxic?
Nevirapine which induces CYTP 3a4 and 2b6
46
WHat are some Protease inhibitors
Saquinavir opinavir atazanavir Ritonavir-
47
What else besides antiviral does ritonavir do?
it boosts plasma levels
48
T/f are protease inhibitors synergystic?
yessir so they are given with 2 NRTI's | it increases CD4 ans slows disease progression
49
ADR's jof Protease inhibitors?
lypodystrophy, hyperlipidemia, insulin resistance, elevated LFT's
50
Which PI has highest ADR's?
Ritonavir- used for the Boost
51
What are fusion and entry inhibitors
inhibit fusion and entry of HIV, and decrease viral load, increase CD4 count
52
what are some F and E inhibitors
Maraviroc, enfuvirtide
53
What drug class is Raltegravir
integrase strand transfer inhibitor
54
why is raltegravir used?
potent activity vs. wild type or multidrug resistant HIV
55
ADR's of Raltegravir?
N/V/D | does not affect CYTP450
56
Treatment considerations with HIV decision to start antiretrovirals depends on
CD4 count viral load clinical symptoms
57
should asymptomatic pt's be treated
yes if cd4 count < 200 200-350- consider treatment >350 if viral load is 100,000 should treat
58
Initial treatment of HIV
2 NRTI's and NNRTI or PI
59
NNRTI regimens are down to how many pills daily
1
60
how often do we determine response to meds
2-8 weeks and then 3-4 weeks. response may take months
61
Drugs for Influenza Virus
which flu virus is out now? H1N1
62
what is primary means of defense
vaccine
63
what is most common cause of infectious disease related death
influenza
64
what drugs are used for flu?
amantanes like amantadine & rimantadine approved for influenza A. not really used anymore
65
what else is amantadine used for?
parkinsons
66
What is used for flu now?
Neuraminidase Inhibitors
67
what are some Neuraminidase inhibitors
Tamiflu (oseltamivir) and Relenza (zanamivir)
68
Can tamiflu be given as prophylaxis
yes > 1 year | it decreases severity and reduces duration of illness
69
What is relenza
nasal spray to treat the flu > 7 years old
70
ADR's of Neuraminidase Inhibitors
Respiratory and GI problems. Do not use in asthma or Emyphsema give them the shot
71
Will Neuraminidase work within 3 days of onset of illness
T
72
Can Neuraminidase inhibitors replace the vaccine?
nope used with the vaccine
73
What drugs are used for Hep C?
Lamivudine- which treats hep B and HIV also Tenofovir- treats Hep B and no resistance.
74
what is DOC for HEP B?
Tenofovir- it can potentially reverse hepatic cirrhosis
75
Drugs for HEP A and Hep C
Ribavirin- broad sprectrum antiviral. covers so many
76
What else can Ribavarin be used for?
Only FDA drug used for RSV. these kids will be on others like albuterol
77
ADR's of Ribavarin
can cause Apnea, pneumothorax, and cardiac arrest. | if given IV, it can cause seizures
78
Another ADR of Ribavarin
it antagonizes other antivirals ZDV (zidovidine)
79
Drugs for Hep B and C
Interferons
80
how are interferons used?
chronic active hepatitis, genital warts, hairy cell leukemia, CML, Kaposi sarcoma, renal carcinioma
81
Will AIDs patients with with HEP B respond to interferons
Nope- AIDS patients with hep B respond poorly
82
What else are interferons used for
genital warts
83
ADR's of Interferon
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
what are some Interferson
Boceprivir, and Talaprevir. and used in combo for RSV
85
new HEP C drugs because Interferon doesn't work and has tons of side effects
sofosbuvir and ledipasvir. | showed 100% SVR 12 weeks post treatment.

Group Pharm II (8 decks)

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