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Pharm Exam 4 > Anti-Virals > Flashcards

Anti-Virals Flashcards

1
Q

Which anti-viral agents are used to treat viral respiratory infections?

A

Oseltamivir
Zanamivir
Ribavirin

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2
Q

Which anti-viral agents are used to treat Herpes viruses/CMV?

A 
Acyclovir  		
Famciclovir	
Valacyclovir	
Ganciclovir		
Foscarnet
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3
Q

Which classes of drugs are anti-HIV?

A
  1. Viral fusion inhibitor
  2. Integrase inhibitor
  3. NRTs/NNRTs
  4. Protease inhibitors
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4
Q

What respiratory infection do anti-viral primarily treat?

A

Influenza

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5
Q

Which anti-viral is also anti-parkinson’s disease?

A

Amantadine

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6
Q

Does Rimantadine get into the brain?

A

No

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7
Q

Which anti-viral drugs are Nucleoside Reverse Transcriptase Inhibitors?

A
  1. Didanosine
  2. Zalcitabine
  3. Zidovudine
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8
Q

Which drugs are anti-viral Protease Inhibitors?

A
  1. Indinavir

2. Saquinavir

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9
Q

T or F: Viruses have ALL cell membranes and walls and are also encapsulated.

A

FALSE:
No cell membrane
No cell wall
Yes encapsulated

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10
Q

Why is selective toxicity an issue with anti-viral drugs?

A

Few drugs are selective enough to prevent viral replication without injury to the host

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11
Q

What is the structure of most anti-viral drugs?

A

Most are nucleoside analogs

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12
Q

Are most drugs virostatic or virocidal?

A

static (they keep the virus in place)

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13
Q

T or F: Current antivirals DO NOT eliminate non replicating or latent virus.

A

True

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14
Q

Clinical efficacy depends on achieving inhibitory concentrations at the site of infections. Where is the site of infection in this context?

A

usually within host cells

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15
Q

What are the 3 steps of initial viron attack?

A
  1. Adsorption
  2. Penetration
  3. Uncoating
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16
Q

What are some potential sites of anti-viral action?

A

Replication of the genome & synthesis of viral proteins

  1. Transcription of viral mRNA
  2. Replication of viral genome
  3. Translation of viral proteins—more tricky
    - Regulatory proteins (early)—translated by host to help handle the viral replication
    - Structural proteins (late)
  4. Posttranslational modification—protease inhib.
  5. Assembly & Release
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17
Q

What are ‘spike proteins’ ?

A

on the surface of the influenza A virus: hemagglutinin [HA] and Neuraminidase [NA] proteins.

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18
Q

What does Hemagglutin do?

A

– bind to target cell receptors containing sialic acid, facilitate cell entry

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19
Q

What does Neuraminidase do?

A

Facilitate release of new virons from infected cells.

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20
Q

What is a controversial adverse effect of the Influenza vaccine?

A

Guillian-Barre Syndrome

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21
Q

What are the 2 Neuraminase Inhibitors? And how are these 2 administered?

A

Oseltamivir (Tamiflu) -Oral

Zanamivir (Relenza) - Inhaled

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22
Q

What 2 drugs are Inhibitors of viral uncoating?

A
  1. Amantadine (Symmetrel)

2. Rimantadine (Flumadine)

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23
Q

What is the MOA of Amantidine and Rimantidine?

A

prevents viral uncoating (M2 membrane matrix protein)
And
possibly release of new virions

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24
Q

What is the limitation of Amantadine and Rimantidine?

A

Activity restricted to RNA viruses – Only influenza A
AND
No longer recommended for prophylaxis or treatment of influenza

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25
Q

Which inhibitor of viral uncoating is not extensively metabolized?

A

Amantidine

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26
Q

Insomnia, dizziness, ataxia
Hallucinations, seizure

These are adverse effects for which anti-viral?

A

Amantadine

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27
Q

What are the Contraindications of Amantidine and Rimantidine?

A

pregnancy & lactation

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28
Q

Does Rimantidine have any CNS effects?

A

Nope–does not get into the brain!

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29
Q

What is the preferred anti-viral for subtype unknown or H1N1?

A

Zanamivir

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30
Q

What is the preferred anti-viral for:
H3N2,
influenza B, or
H1N1 if <7 yrs, or Asthma/COPD?

A

Oseltamavir

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31
Q

What can the combination of Oseltamavir plus Rimantadine be used for?

A

Alternate for HiN1

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32
Q

Is there a vaccine for RSV?

A

Nope

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33
Q

What is RSV?

A

respiratory syncytial virus

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34
Q

What is the preferred treatment for severe infections with RSV in infants and young children?

A

Ribavirin

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35
Q

What anti-viral can be used for this conditions:
Acute hepatitis A, Influenza A & B
Lassa hemorrhagic fever

A

Ribavirin

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36
Q

What would you need to add to Ribavirin if you were treating a patient with Hep C?

A

Plus interferon alfa-2b

a “broad spectrum antibiotic

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37
Q

Which two anti-viral are worthless for RSV?

A

amantadine and ranantidine

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38
Q

What is the MOA of Ribavirin?

A

inhibition of viral mRNA synthesis

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39
Q

What is Ribavirin and what is it used for?

A
  • Synthetic guanosine analog

- Effective against broad spectrum of RNA & DNA viruses

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40
Q

How is Ribavirin administered?

A

Effective orally,
IV
AND
aerosol inhalation

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41
Q

Does Ribavirin get into the CNS?

A

No–this is dangerous because the virus can hide out in the brain

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42
Q

What are the Contraindications of Ribavirin?

A

Pregnancy

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43
Q

Which anti-viral has these adverse effects?

increased bilirubin, transient anemia

A

Ribivirin

44
Q

Why is transient anemia bad? What agent causes it?

A

Ribavirin causes it and it is bad because it it caused by drugs interfering with our bone marrow’s ability

45
Q

Which Hepatitis is being treated with this therapy?

interferon-α + ribavirin

A

Hep C

46
Q

How would you treat Hepatitis B ?

A

interferon-α + (Lamivudine—HIV drug)

47
Q

What is an Interferon anyway?!

A

Family of naturally occurring glycoporoteins that interfere with the ability of viruses to infect cells

48
Q

Which interferon has been approved to treat Hep B
Hep C,
Kapok’s sarcoma,
Hairy cell leukemia?

A

-IFN alpha-2b

49
Q

What is the MOA of IFN alpa-2b?

A

Appears to induce host cell enzymes that inhibit viral RNA translation & ultimately lead to degradation of viral mRNA & tRNA

50
Q

How is IFN alpha2b administered?

A

Given IV, SC, IM-(into the CSF)

51
Q

How would you treat Chronic HCV?

A

Rebetron: (interferon alfa-2b + ribavirin)

52
Q

What are the adverse effects of INF alpha2b?

A

fever,
lethargy,
bone marrow depression,
cardiovascular problems

53
Q

If you wanted to treat chronic HCV, what would you add to IFN alpha 2b?

A

Ribavirin

54
Q

What is Acyclovir and what is it’s MOA?

A

Guanosine analog

Selectively inhibits viral DNA polymerase & is incorporated into viral DNA where it acts as a chain terminator

55
Q

Which anti-viral agent is:
monophosphorylated in the cell by the herpes virus-encoded enzyme, thymidine kinase–and which cells are most susceptible?

A
  1. Acyclovir

2. virus-infected cells most susceptible

56
Q

How is Acyclovir administered?

A

IV, PO, or topical(??)

57
Q

Does Acyclovir get into the CSF?

A

Yes

58
Q

What is a caveat to Acyclovir?

A

Accumulates in renal failure

59
Q

If a virus has resistance due to altered or deficient (cytomegalovirus; CMV) thymidine kinase–which drug will not work?

A

Acyclovir

60
Q

What is strange about Acyclovir’s adverse effects?

A

Depend on route of administration

61
Q

What are the therapeutic uses for Acyclovir?

A

Genital & oral herpes (HSV 1 & 2)

62
Q

What is the DOC for Herpes simplex encephalitis? This drug also
accelerates healing of Herpes zoster
and is effective in treating–
Some Epstein-Barr virus (EBV) infections?

A

Acyclovir

63
Q

What virus does Acyclovir NOT treat?

A

CMV

64
Q

What drug accelerates healing of Herpes zoster and is effective against some Epstein-Barr virus (EBV) infections?

A

Acyclovir

65
Q

Which agent is a live attenuated virus vaccine, for the prevention of shingles?

A

Zostavax

66
Q

What is particular about CMV? So what is it treated with?

A

lacks viral thymidine kinase
Ganciclovir (iv, topical) – Analog of Acyclovir
DNA/RNA Polemerase inhibitors

67
Q

What is Cidofovir (Foscarnet) used for?

A

Broad antiviral Activity
CMV,
HSV,
HZV

68
Q

Why should you be careful when prescribing Foscarnet?

A

Nephrotoxicity

69
Q

In treating HSV 1, HSV 2 & HZV, which agent is topical?

A

Penciclovir - topical

70
Q

In treating HSV 1, HSV 2 & HZV, which agents are NOT topical?

A

Famciclovir

Valacyclovir

71
Q

In treating HIV infection, which drug is an early inhibitor?

A

GP41

72
Q

In treating HIV infection, what do the integrase inhibitors do?

A

Viral DNA strand transfer

73
Q

Which anti-viral agents prevent chain elongation?

A

Nucleotide & Non-Nucleotide Reverse Transcriptase Inhibitors (NRTs &NNRTs)

74
Q

Which anti-viral agents are responsible for cleavage of viral polyprotein?

Or in other words: deal with the Inhibition of viral assembly or maturation of the viral particles?

A

Protease inhibitors

75
Q

What is Combination Therapy?

A

Inhibitor of reverse transcriptase plus protease inhibitor

76
Q

What does HAART therapy = ?

A

highly active anti-retroviral therapy—drugs that are:

reverse transcription inhib + protease inhib.

77
Q

What do the Fusion Inhibitors do?

A

prevent HIV from being successfully taken up

78
Q

What is Enfuvirtide?

A

A viral GP41 fusion inhibitor

79
Q

What is Enfuvirtide used for?

A

indicated for treatment-experienced patients with ongoing HIV replication despite current antiretroviral use

80
Q

What are the adv effects of Enfuvirtide?

A
  1. Almost all patients develop local injection site reactions with mild or moderate pain, erythema, induration, nodules and cysts.
  2. Eosinophilia
  3. Systemic hypersensitivity reactions
  4. Increased incidence of bacterial pneumonia.
81
Q

What is Maraviroc?

A

An ORAL viral fusion inhibitor

82
Q

Why is Maraviroc oral?

A

Because it hits a different receptor

83
Q

What receptor does Maraviroc hit that makes it oral?

A

CCR5 coreceptor only;

not CXCR4

84
Q

How do the Integrase inhibitors work? (MOA)

A

Inhibits integration of viral strand DNA into host DNA

85
Q

What drugs are Integrase Inhibitors?

A

Raltegravir

86
Q

What are the adverse effects of Raltegravir?

A

nausea, headache, diarrhea

87
Q

Which drug is most famous bc it is effective to prevent the offspring of HIV women in getting HIV (protects the fetus!) ? What is this drug anyway?

A

It is a Reverse Transcriptase inhib.

Zidovudine

88
Q

What are Abacavir and Didanosine?

A

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors – NRTI

89
Q

What is Combivir?

A

Lamivudine + Zidovudine

NRTIs

90
Q

What drug is

Abacavir +Lamivudine +Zidovudine

A

Trizivir

an NRTI

91
Q

What are NTRIs?

A
  • Analogs of native ribosides (Nucleosides or nucleotides containing ribose)
  • All lacking the 3’-hydroxyl group
92
Q

What is the MOA of the NTRIs?

A

DNA chain elongation is terminated

93
Q

What are the adv effects of NTRIs?

A
  1. Inhibition of mitochondrial DNA polymerase:
    –Peripheral neuropathy, pancreatitis, lipoatrophy
    –Fatal liver Toxicities :
    lactic acidosis hepatomegaly with steatosis
94
Q

What is Zidovudine? and What is its MOA?

A

–Thymidine analog

–AZT is phosphorylated to the triphosphate, incorporated into the growing viral DNA & thus, causes chain termination during DNA synthesis

95
Q

How is Zidovudine administered?

A

Orally

96
Q

Does Zidovudine get into the CNS?

A

Yes (HIV cannot hide here)

97
Q

What is Zidovudine used for?

A
  • -Used in three-drug combination therapy for HIV infection
  • -Prophylaxis for exposure
  • -Decreases transmission of HIV to fetus of infected mothers
98
Q

What are the adv effects of Zidovudine ?

A 
Bone-marrow suppression
HA is common
GI: N/V, anorexia
Avoid or use with caution ( All glucuronidated)
Probenecid
Acetaminophen
Lorazepam
Indomethacin
Cimetidine
99
Q

What are the Non-Nucleoside Reverse Transcriptase Inhibitors (NNTRI’s)?

A

There are 1st gen and 2nd gen:
1st gen:
Efavirenz
2nd gen: Etravirine

100
Q

What is different about these NNTRI’s?

A

Lack effect on blood forming elements

101
Q

Why would you prefer a 2nd get NNTRI over a 1st get?

A

Used when 1st generation resistance a problem

102
Q

What is the preferred NNTRI?

A

Efavirenz

103
Q

What are the 2 Protease inhibitors ?

A

Indinavir

Ritonavir

104
Q

What is the MOA of the Protease inhibitors?

A

Inhibit HIV protease enzyme, preventing post-translational processing of viral polyproteins

105
Q

What are the adverse effects of the protease inhibitors?

A

Well tolerated, GI Sxs most common

106
Q

How are the protease inhibitors given in terms of treatment?

A

Frequently given in combination with AZT and lamivudine –

HAART therapy = highly active anti-retroviral therapy

107
Q

What is Ritonavir’s new job since resistance has emerged against it?

A

SOLUTION: while the liver is chewing in on Rit. The other drug sneaks in and does the job

Pharm Exam 4 (10 decks)

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