Anti Viral Flashcards by Kaylyn Freeman

3 main Anti HSV/VZV drugs

acyclovir
valacylovir
famciclovir

How well did you know this?

Not at all

Perfectly

what anti-HSV drug is IV

acyclovir

How well did you know this?

Not at all

Perfectly

MOA for Anti HSV/VZV drugs?

competes w/ deoxyguanosine for viral DNA polymerase & goes into viral DNA to terminate the DNA chain

How well did you know this?

Not at all

Perfectly

MOR for Anti HSV/VZV drugs?

alters binding site

How well did you know this?

Not at all

Perfectly

how fast should you intiate Anti HSV/VZV drugs?

w/ in 24-72hrs

How well did you know this?

Not at all

Perfectly

which Anti HSV/VZV drug has poor bioavailability?

acyclovir

How well did you know this?

Not at all

Perfectly

indications for acyclovir

primary/recurrent genital HSV
orolabial HSV
Encephalitis
Primary & secondary VZV

How well did you know this?

Not at all

Perfectly

ADR of acyclovir

large IV doses can cause crystalline nephropathy with reversible AKI

How well did you know this?

Not at all

Perfectly

indications of valacyclovir

primary and recurrent genital HSV

secondary VZV

How well did you know this?

Not at all

Perfectly

what is the special use of valacyclovir in prim or secondary genital HSV?

can suppress clinical and subclinical shedding 50-60%, to prevent transmission to seronegative partners

How well did you know this?

Not at all

Perfectly

why is valacyclovir more bio available than acyclovir?

b/c its prodrug

How well did you know this?

Not at all

Perfectly

what is the twin of valacyclovir in indication and ADR?

famciclovir

How well did you know this?

Not at all

Perfectly

ADR of valacyclovir?

well tolerated

HA = most common

How well did you know this?

Not at all

Perfectly

when does CMV reactivation occur

transplant pts

How well did you know this?

Not at all

Perfectly

3 anti EBV/CMV drugs

ganiciclovir
valganciclovir
letermovir

How well did you know this?

Not at all

Perfectly

how much more potent is ganciclovir than acyclovir?

10x

How well did you know this?

Not at all

Perfectly

indications for ganciclovir?

active retinitis
suppression of retinitis
colitis, esophagitis
prevention of CMV in transplant pts

How well did you know this?

Not at all

Perfectly

ADR of ganiciclovir?

bone marrow suppression (neutropenia)

How well did you know this?

Not at all

Perfectly

Valganciclovir is the prodrug of what?

ganiciclovir

How well did you know this?

Not at all

Perfectly

clinical indications of valganciclovir

induction and maintenance of CMV retinitis

prevention of CMV post transplant

How well did you know this?

Not at all

Perfectly

ADR of valganciclovir

bone marrow suppression (neutropenia)

How well did you know this?

Not at all

Perfectly

letermovir clinical indications

prophylaxis of CMV infection & dz in CMV + adults w/ allogenic HCT

How well did you know this?

Not at all

Perfectly

ADR of letermovir

N/V/D
Cardiac ADR (tachy/a-fib)
Testicular toxicity (only in rats?)

How well did you know this?

Not at all

Perfectly

how does letermovir work?

CMV DNA terminate complex inhibitor–prevents Viral DNA processing and packaging

How well did you know this?

Not at all

Perfectly

does letermovir work against non-CMV viruses?

who gets antiviral influenza tx (susp. or confirmed influenza)?

hospitalized pts severe/complicated illness high risk for complications

what are the 2 amantanes/M2 inhibitors?

amantadine | rimanatadine

MOA of amantadine/rimantadine

block viral uncoating of influenza A--preventing viral penetration into host

when does amantadine/rimantadine need to be given to be effective?

w/ in 48hrs

other uses of amantadine

tx parkinsonism | tx of drug induced EPS

ADR of amantadine/rimantadine

teratogen in animals | -CNS dominant; nervousness, anxiety, light headed, confusion, insomnia

3 neuraminidase inhibitors

oseltamivir zanamivir peramivir

formulation of permivir

Oseltamivir MOR

AA alteration in binding site

clinical use of oseltamivir

chemoprophylaxis of influ. A&B, swine & avian influenza tx of influ. A&B (>2 wks old)

who gets oseltamivir for influ. A & B PROPHYLAXIS

unvacc ppl @ risk for flu complications unvacc HCW w/ exp outbreak in NH

how does oseltamivir treat influ A&B?

decreases severity and duration of symptoms | decreases LRTI complications

how long do you treat flu w/ oseltamivir

5 days

who is at risk for influenza complications?

``` <2 y/o >65 y/o chronic cardiopulm disorders (asthma, HF) pregnancy or post partum (<2wks) <19 on ASA therapy American indian/alaskan native BMI >40 NH resident pts w/ metabolic dz pts w/ auto-immune dz pts w/ NM disorders ```

what bacteria often accompanies viral pneumonia w/ influenza?

strep pneumo or s. aures

dose of oseltamivir

75 mg PO BID x 5 d

ADR in kids of oseltamivir?

neuropsych events (self injury, confusion, delirium)

Zanamivir ADR

nasal/throat discomfort | bronchospams (asthma/COPD pts)

what does zanamivir fight?

viruses that are amantadine/rimantadine resistant & oseltamivir-resistant influenza strains

what drug is a Polymerase Acidic Endonuclease Inhibitors?

Baloxavir

MOA of Baloxavir

inhibits Cap-dependent endonuclease activity to prevent viral replication

what is Baloxavir effective against?

influenza A&B including NA inhibitor resistant strains

can you use Baloxavir for prophylaxis?

when should Baloxavir been started

w/ in 48hrs

what should you avoid taking when on Baloxavir

multivalent cations

what are the old antiretroviral classes

NRTI NNRTI Protease inhibitors

what are the new antiretroviral classes

fusion inhibitors entry inhibitors integrase inhibitors post-attachment inhibitors

MOA of NRTI

interfere w/ HIV viral RNA dependent DNA polymerase to inhibit viral replication

what do NRTI induce?

mitochrondial dysfunction

what are clinical manifestations of NRTI on mitochorndia?

``` neuropathy myopathy CMP pancreatitis hepatic stenosis lactic acidosis ```

what are the ADRs of Zidovudine (AZT)

anemia neutropenia hyperpigmentation of oral mucosa and nailbed

what are the ADRs of Stavudine (d4T)?

pancreatitis | peripheral neuropathy

what are the NRTI thyaimne analogs?

Zidovudine | Stavudine

what are the NRTI cytosine analogs? what extra activity do they have?

lamivudine (3TC) Emtricitabine (FTC) *HBV+ activity

ADR of lamivudine and Emtricitabine

none | -well tolerated

what are the NRTI adenine analogs?

didanosine (ddl) | Tenofovir (TDR-->TAF)

what is special activity of tenovir?

HBV+ activity

ADR of tenovir?

none | -well-tolerated

ADRs of didanosine?

pancreatitis | peripheral neuropathy

what is the NRTI guanine analog?

abacavir (ABC)

ADRS of abacavir

hyperseensitivty rxn

what HLA has hypersensitivty rxns to abacavir?

B*5701

do we rechallange abacavir if they have a rxn?

what NRTI combo is approved to prevent HIV

TDF/FTC

what is TAF/FTC/BIC

Biktarvy

3 1st gen NNRTI's

nevirapine (NVP) Delavirdine (DLV) Efavirenz (EFV)

ADRs of nevairapine

hepatotoxicity | severe rash

ADRs of efavirenz

teratogen rash *drug interactions CNS disengagement (1-3hrs post dose)

3 2nd gen NNRTI

Etravirine (ETR) Doravirine (DOR) Rilpivirine (RPV)

what was rilpivirine designed for

activity against HIV w/ mutations that are resistant to NRTI

ADR of 2nd gen NNRTI

severe rash

MOA of NNRTI

block reverse transcriptase, to prevent DNA replication

what is FTC/TDF/RPV

Complera

what is the main Protease Inhibitor?

Draunavir

MOA of Protease Inhibitors

bind to HIV protease to inhibit clevage of Gag-pol polyprotien precursor---form immature non-infectious viral particles

what are ritonavir and cobi used for?

increasing conc. of PI

what are drug interactions of COBI?

inhibitor of 3A4, 2D6, Pgp | *know statins, steroids, pde5 inhibitors, antiplatelets/ anticoagulatns, ABX, CCBs

what do all PI's have CYP interactions with?

3A4

ADR of Protease Inhibitors

N/V/D Hyperglycemia/insulin resistance/HLD hepatoxicitiy fat wasting

which protease inhibitor is a sulfonylarlamine?

Darunavir

what 4 drugs are integrase strand transfer inhibitors

ralegavir (RAL) elevitegravir (EVG) Dolutegravir(DTG) Bictegravir (BIC)

MOA of INSTI

inhibit integrase to prevent integration of proviral gene into human DNA

if an HIV strand is resistant to ralte and elevite, what is it probably still susuceptible to?

dolutegravir

ADR of INSTI

N/V/D | abd. pain

what kind of a drug is Enfuvirtide

fusion inhibitor

MOA of Enfuvirtide

bind to gp41 subunit of viral envelope glycoprotein--inhibits fusion of HIV to CD4 cells

what kind of drug is Maravioc?

entry inhibitor

MOA of maraviroc

CCR5 antagonist--binds to chemokine corereceptors on CD4 cells = Cell entry blocked

what kind of drug is Ibalizumab

Post-attachment inhibitor (CD4 monocolonal AB)

MOA of Ibalizumab

blocks entry of HIV into CD4 cells to prevent transmission via cell-cell fusion

when is Ibalizumab used?

MDR HIV

when is Combined Anti-retroviral therapy iniated

dx of pt no matter the CD4 count | ASAP

common CART?

2 NRTI + 1 INSTI or + PI (DRV)

is CART therapy life long

yes

what is a PEARL about pts when they start CART

they need to be ready--b/c nonadherance causes resistance issues

who do we test for HCV?

pts 18-79 y/o

1st line HCV drug

Sofosubvir-velpatasvir

what can you not mix sofosubvir with?

amiodarone

what alters velpatasvir absorption

H2RA/PPI

ADR of Sofosubvir-velpatasvir

HA | fatigue

what is the 2nd line HCV drug

Glecaprevir-pibrentasvir

ADR of Glecaprevir-pibrentasvir

HA fatigue nausea