Anti-Virals Flashcards
Anti-tuberculosis Agents (5)
- Isoniazid (INH)
- Rifampin
- Rifapentine
- Pyrazinamine
- Ethambutol
*all PO
Isoniazid (INH) use/moa
- bactericidal activity in TB treatment
- MoA: inhibits synthesis of mycobacterial wall
Isoniazid (INH) AEs/BBW
- AEs: peripheral neuropathy (reduce with Vit B6)
- BBW: severe hepatitis & potent CYP inhibitor
Rifampin/rifapentine use/moa
*rifapentine is long acting analog of rifampin
- bactericidal activity in TB treatment
- MoA: inhibits RNA synthesis by blocking RNA transcription
Rifampin/rifapentine AEs
- hepatotoxicity
- red/orange body secretions that stain
- potent CYP inducer
Pyrazinamine use/moa/AEs
- bactericidal activity in TB treatment
- MoA unknown
- AEs: hepatotoxicity
Ethambutol use/Moa
- bacteriostatic activity in TB treatment
- MoA unknown
choice of drugs for uncomplicated, LATENT TB
- INH 6-9 months
- Rifampin 4 months
choice of drugs for uncomplicated, ACTIVE TB
*think RIPE
- Rifampin
- INH
- Pyrazinamide
- Ethambutol
drugs for herpes simplex virus (HSV 1& 2) & varicella zoster virus (VZV) (2)
- Acyclovir (PO, IV, topical) *prototype
- Valacyclovir (PO) *prodrug of acyclovir
Vala/Acyclovir MoA
- inhibition of viral replication by inhibiting viral DNA polymerase/incorporation of growing viral DNA strand –> no viral DNA synthesis
Vala/Acyclovir side effects (not AEs)
- malaise, headache, N/V/D
Vala/Acyclovir specifically treats what for HSV/VZV
HSV-1 –> prevent cold sores
HSV-2 –> reduce severity and frequency of genital herpes (does not eliminate)
VZV –> chicken pox and shingles
Valganciclovir use/moa
- prevention and treatment of cytomegalovirus (CMV)
- (same MoA as acyclovir) inhibition of viral replication by inhibiting viral DNA polymerase/incorporation of growing viral DNA strand –> no viral DNA synthesis
drugs for Hep C (5ish)
- Interferon alpha 2a & 2b
- Ribavirin
- NS3/4A serine protease inhibitors
- NS5A serine protease inhibitors
- NS5B inhibitors
- Interferon alpha 2a & 2b route/moa
- subQ
- MoA: binds receptors on HOST cell membranes to block VIRAL entry, viral mRNA/proteins synthesis and release
*used in combo with ribavirin for Hep C tx
- Interferon alpha 2a & 2b advantage/AEs/BBW
- long half life, admin only 1xs/week
AEs: - flu like syndrome
- depression/suicide
- combo use may cause birth defects
BBW: cause/worsen autoimmunes, infections, ischemic events
Ribavirin route/MoA
- PO but used in combo with Interferon alpha 2a & 2b
- MoA: inhibits Hep C virus polymerase activity –> no viral RNA replication
Ribavirin AE/BBW
- hemolytic anemia within first 2 weeks of tx
- BBW: significant teratogenic effects, avoid in pregnancy
NS3/4A serine protease inhibitors drugs/route (2)
*end in -previr
- Simeprevir - PO
- paritaprevir - PO
Simeprevir/paritaprevir MoA/indication
- MoA: inhibit NS3/4A serine protease –> prevent HCV replication and maturation
- indication: chronic HCV in combo with other agents
*NOT as monotherapy
Simeprevir/paritaprevir AEs
fatigue, N/V, anemia, headache, severe rash
NS5A serine protease inhibitors drugs/route (2)
*end in -Asvir
- ombitAsvir - PO
- ledipAsvir - PO
OmbitAsvir usually used in combo with..
paritaPrevir + ritonavir
LedipAsvir usually used in combo with..
sofosBuvir
OmbitAsvir/LedipAsvir MoA/Indications
- MoA: inhibit NS5A serine protease –> no HCV maturation
- treat chronic HCV in combo with other HCV drugs
*NOT for monotherapy
OmbitAsvir/LedipAsvir AEs
- headache, fatigue, N/V, anemia
NS5B inhibitor drug/route
*ends in -Buvir
- SofosBuvir (prodrug converted in liver)
- PO
SofosBuvir MoA/indication
- MoA: HCV NS5B polymerase inhibitor
- indication: first line agent in combo with other HCV drugs
*NOT for monotherapy
SofosBuvir AEs
- fatigue
- diarrhea
- anemia
- Headache
classes of meds for HIV tx (highly active antiretroviral treatment) (6)
- nucleoside/tide RTIs (NRTIs)
- non-nucleoside RTIs (NNRTIs)
- protease Inhibitors (PIs)
- integrase strand transfer inhibitors (INSTI)
- HIV fusion inhibitor
- CCR5 Antagonists
NRTIs drugs/route/moa
- all PO
- Emtricitabine
- Tenofovir
- blocks incorporation of viral DNA by preventing reverse transcriptase to add more bases
NRTIs AE/BBW
- pruritus, rash
- BBW: lactic acidosis, severe hepatomegaly
NNRTIs drug/route/moa
*PO
- Efavirenz
- direct inhibition of HIV reverse transcriptase
NNRTIs AEs
- Erythema, rash, SJS
- Liver failure
- depression, psychosis, suicidal thoughts
- teratogen –> avoid in pregnancy
Protease Inhibitor (PI) drug/route/moA
- Ritonavir - PO
- Inhibits HIV protease –>prevent maturation of HIV
Ritoniavir (PI) AEs
- AV block, prolonged PR interval
- hyperglycemia, hypercholesterolemia
- pancreatitis
- hepatitis, hepatotoxicity
- immune hypersensitivity reaction
- SJS
- BBW: co admin w/ hypnotics, anti-arrythmics/ergot derivatives –> life threatening AEs due to CYP enzyme inhibition
INSTI drug/route/moa
- Elvintegravir
- PO
- Inhibit HIV integrase –> prevent viral DNA integration into human nucleus and DNA
HIV fusion inhibitor drug/route/moa
- Enfuvirtide
- Sub Q
- Prevent HIV infusion with lymphocyte cell membrane –> block HIV entry and replication
CCR5 Antagonist drug/route/moa
- Maraviroc
- PO
- binds CCR5 receptor –> blocks viral entry
HIV regimens (3 general types, at least 3 meds in each)
- NNRTI based (1 NNRTI + 2 NRTIs)
- INSTI based ( INSTI + 2 NRTIs)
- Boosted PI (PI + 2 NRTIs)
Neuraminidase inhibitor drugs/routes (3)
*ends in -mivir
- Oseltamivir - PO
- Zanamivir - Inhalation
- Peramivir - IV
Neuraminidase inhibitor Moa/AE
- MoA: inhibits neuraminidase (enzyme requires for viral replication); active against influenza A, B & H1N1
- AE: N/V –> give with food to avoid
Baloxavir MoA/AEs
- MoA: selectively inhibits endonuclease function in the polymerase acidic proteins, that are essential for viral replication
- AEs: diarrhea, bronchitis, nausea, sinusitis, headache
Approved COVID19 drugs/routes (3)
- Tocilizumab - IV/SubQ
- Remdesivir - IV
- Baricitinib - PO
Tocilizumab MoA/Indication
- MoA: binds to IL6 receptors, inhibits IL6 inflammatory pathways
- Ind: hospitalized COVID adults, on corticosteroids, supp. O2, mechanical ventilation, or ECMO
Remdesivir MoA/Indication
- MoA: a direct acting antiviral that inhibits viral RNA synthesis
- Ind: tx for COVID adults/peds, in or out of hospital, with mild-moderate COVID and are at high risk for severe progression (hospitalization or death)
Baricitinib MoA/Indication
- MoA: JAK inhibitor, reduces IL6 inflammatory responses; directly interfere with endocytosis of SARS-CoV-2 into susceptible cells
- Ind: tx for COVID adults in hospital on supp. oxygen, mechanical ventilation, or ECMO
Paxlovid (nirmatrelvir + ritonavir) indication/MoA
- emergency antiviral used for tx of adults/peds with mild-moderate COVID
- MoA: nirmatrelvir inhibits required breakdown of viral proteins necessary for viral replication;
Ritonavir increases the effect of nirmatrelvir via CYP3A4 inhibitions
