Anti-virals Flashcards
Nucleoside vs nucleotide
Nucleoside = base + sugar Nucleotide = base + sugar + phosphate
What is used to treat HSV first line and also VZV?
Acyclovir
Acyclovir
Acyclic guanosine derivative
MOA: requires 3 phosphorylation, initial by viral thymidine kinase
AE: renal/neuro tox prevented by hydration and slow infusion
Can be administered topically and IV
How does resistance develop to acyclovir?
Mutation in viral thymidine kinase Use foscarnet (doesn't require phosphorylation)
Drugs for CMV
Ganciclovir
Foscarnet
Ganciclovir
Acyclic guanosine analog
MOA: requires 3 phosphorylation first by CMV kinase
Use: tx/ppx in transplant
AE: myelosuppression
Foscarnet
MOA: inhibits viral DNA/RNA polymerase, HIV RT
No activation required
IV only
AE: renal tox, hyperphosphate, hypokalemia, calcemia, magnesemia
Influenza drugs
Zanamivir
Oseltamivir
Amantadine
Who gets influenza treatment?
Type A (only type for mass infections)
Within 48h of sx onset
For pts at high risk of complications
Neuraminidase Inhibitors
Oseltamivir (oral) Zanamivir (inhalation) MOA: Salic acid analog, inhibit progeny release Against influenza A/B Good for kids, Zanamivir in resistant
NRTI drugs
Abacavir
Lamivudine/emtricitibine
NtRTI drugs
Nucleotide reverse transcription inhib
Tenofovir
NNRTI drugs
Efavirenz
HIV protease inhibitor drugs
Ritonavir
Darunavir
Atazanavir
Entry inhibitor drugs
Enfuvirtide
Maraviroc
Integrase inhibitors drug
Dolutegravir
NRTIs MOA, AE
MOA: competitive inhib of RT, incorporation into viral DNA, must be activated by cellular phosphorylation
AE: lactic acidosis w/ hepatic steatosis
Abacavir
MOA: Guanosine analog
AE: MI, hypersensitivity in HLAB5701
Lamivudine/emtricitabine
Used in HBV treatment
Used with tenofovir
Emtricibien is a fluoridated analog of lamivudine, longer t1/2
Tenofovir
NtTRI, first line w/ emtricitabine
MOA: inhibits HIV RT, chain termination after incorporated
AE: renal accumulation (necrosis, failure, fanconi), bone loss (TDF?TAF)
Efavirenz
MOA: binds directly to HIV RT and inhibits DNA polymerase activity, different binding site from NRTIs
Extensive CYP3A4 metabolism
AE: nightmares, psych
HIV protease inhibitors
Pepitdomimetics
AE: CYP3A4, lipodystrophy, inc TG/LDL
RAD
Ritonavir used as a booster to atazanavir and darunavir
Maraviroc
Entry inhibitor
MOA: CCR5 inhibitor
Used in HIV1 resistant to other drugs
Enfuvirtide
Fusion inhibitor
MOA: binds to gp41 and prevents fusion
Subcut injection only for HIV pts with ongoing replication
