Anti-virals not in sketchy

Question 1

What is the indication and MoA of docosanol?

Answer 1

Herpes cold sores

Long-chain alcohol that may disturb cell membranes and reduce herpes virus entry into cells

Question 2

What is ganciclovir indicated for?

Answer 2

CMV
EBV
HHV-6
HHV-8

Question 3

What are the indications for foscarnet?

Answer 3

HSV
CMV
VZV
EBV
HHV-6

Question 4

A mutation in UL97 kinase would confer resistance to what drug? (Why?)
What would you use instead?

Answer 4

Ganciclovir (UL97 is CMV’s viral kinase, required by ganciclovir)

Foscarnet

Question 5

What are the adverse effects of foscarnet besides nephrotoxicity (crystals in glomeruli) and electrolyte disturbances?

Answer 5

Myelosuppression and anemia.

Question 6

What is the MoA of pritelivir?

Answer 6

Helicase-primase inhibitor that blocks viral DNA replication

Question 7

What is the indication for pritelivir?

Answer 7

HSV

Question 8

What is the category for the best, newest anti-hepatitis drugs?

What were the 2 sketchy eg’s?

What is their MoA?

Answer 8

Direct-acting antivirals (DAAs)

Sofosbuvir and simeprevir

Competitively inhibit (1*) viral protease. Inhibit (2*) viral RNA polymerase, allosterically or via chain termination. 
Indireclty inhibit viral phosphoprotein activity.

Question 9

What are the side effects of DAA’s?

What can interfere with their effects?

Answer 9

Minor fatigue, headache, nausea, insomnia

P-gp inducers reduce therapeutic effect

Question 10

When should IFN be used with caution?

Answer 10

If pt has cirrhosis

Question 11

Name 2 drugs used to treat hBv

Answer 11

Entecavir

Tenofovir (TFV)

Question 12

What is the MoA for entecavir?

Tenofovir?

Answer 12

Guanosine analogue; inhibits viral polymerase. Inhibits HBV DNA priming, RT and DNA polymerase

Prodrug hydrolyzes to adenine (dAMP) analog, then is phosphorylated to Ten-PPP, then blocks HBV DNA polymerase

Question 13

What are the side effects of entecavir?

Tenofovir?

Answer 13

Lactic acidosis.
Rebound hepatitis

GI symptoms, fatigue, headache, renal failure

Question 14

In which flu strains can amantadine/rimantadine possibly be used?

What about for oseltamivir/zanamivir?

Answer 14

Influenza A (not B or C)

Influenza A and B

Question 15

What is the difference b/w oseltamivir and zanamivir?

Answer 15

Oseltamivir: Oral
Zanamivir: aerosol inhalant

Question 16

What are the SE’s of oseltamivir?

Zanamivir?

Answer 16

Osentamivir: Anxiety, disorientation, headache

Zanamivir: N/V, GI symptoms, insomnia, vertigo

Question 17

What is palivizumab used for? (explain)

Answer 17

AB vs fusion protein of RSV

*Preventative vaccine for at-risk children (not a tx)

(Ribavirin is the nucleoside analogue tx, can’t be used for kids/pregos. Also used for hep C)

Question 18

What virus is pleconaril used to treat?

What’s its mechanism of action?

Answer 18

Enterovirus D68 (a picovirus)

Becomes part of virus, changes virus shape, virus can no longer bind receptor to infect a new cell

Question 19

What can be used as tx for Hep A?

Answer 19

Using the killed vaccine during prodromal period.

Question 20

Tx for aplastic crisis during parvo infection?

Answer 20

IVIG in immunocompromised

Question 21

When is letermovir used, specifically?

MoA?

Answer 21

CMV prophylaxis in transplant pts

Targets the terminase complex (can’t cleave DNA copy)

Question 22

Recall: What does letemovir treat?

What does pritelivir treat?

Answer 22

Letemovir: CMV (prophylaxis)
Pritelivir: HSV