Anti-virals

Question 1

Nucleoside vs nucleotide

Answer 1

Nucleoside = base + sugar
Nucleotide = base + sugar + phosphate

Question 2

What is used to treat HSV first line and also VZV?

Answer 2

Acyclovir

Question 3

Acyclovir

Answer 3

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

Question 4

How does resistance develop to acyclovir?

Answer 4

Mutation in viral thymidine kinase
Use foscarnet (doesn't require phosphorylation)

Question 5

Drugs for CMV

Answer 5

Ganciclovir

Foscarnet

Question 6

Ganciclovir

Answer 6

Acyclic guanosine analog
MOA: requires 3 phosphorylation first by CMV kinase
Use: tx/ppx in transplant
AE: myelosuppression

Question 7

Foscarnet

Answer 7

MOA: inhibits viral DNA/RNA polymerase, HIV RT
No activation required
IV only
AE: renal tox, hyperphosphate, hypokalemia, calcemia, magnesemia

Question 8

Influenza drugs

Answer 8

Zanamivir
Oseltamivir
Amantadine

Question 9

Who gets influenza treatment?

Answer 9

Type A (only type for mass infections)
Within 48h of sx onset
For pts at high risk of complications

Question 10

Neuraminidase Inhibitors

Answer 10

Oseltamivir (oral)
Zanamivir (inhalation)
MOA: Salic acid analog, inhibit progeny release
Against influenza A/B
Good for kids, Zanamivir in resistant

Question 11

NRTI drugs

Answer 11

Abacavir

Lamivudine/emtricitibine

Question 12

NtRTI drugs

Nucleotide reverse transcription inhib

Answer 12

Tenofovir

Question 13

NNRTI drugs

Answer 13

Efavirenz

Question 14

HIV protease inhibitor drugs

Answer 14

Ritonavir
Darunavir
Atazanavir

Question 15

Entry inhibitor drugs

Answer 15

Enfuvirtide

Maraviroc

Question 16

Integrase inhibitors drug

Answer 16

Dolutegravir

Question 17

NRTIs MOA, AE

Answer 17

MOA: competitive inhib of RT, incorporation into viral DNA, must be activated by cellular phosphorylation
AE: lactic acidosis w/ hepatic steatosis

Question 18

Abacavir

Answer 18

MOA: Guanosine analog
AE: MI, hypersensitivity in HLAB5701

Question 19

Lamivudine/emtricitabine

Answer 19

Used in HBV treatment
Used with tenofovir
Emtricibien is a fluoridated analog of lamivudine, longer t1/2

Question 20

Tenofovir

Answer 20

NtTRI, first line w/ emtricitabine
MOA: inhibits HIV RT, chain termination after incorporated
AE: renal accumulation (necrosis, failure, fanconi), bone loss (TDF?TAF)

Question 21

Efavirenz

Answer 21

MOA: binds directly to HIV RT and inhibits DNA polymerase activity, different binding site from NRTIs
Extensive CYP3A4 metabolism
AE: nightmares, psych

Question 22

HIV protease inhibitors

Answer 22

Pepitdomimetics
AE: CYP3A4, lipodystrophy, inc TG/LDL
RAD
Ritonavir used as a booster to atazanavir and darunavir

Question 23

Maraviroc

Answer 23

Entry inhibitor
MOA: CCR5 inhibitor
Used in HIV1 resistant to other drugs

Question 24

Enfuvirtide

Answer 24

Fusion inhibitor
MOA: binds to gp41 and prevents fusion
Subcut injection only for HIV pts with ongoing replication

Question 25

Dolutegravir

Answer 25

Integrase inhibitor
MOA: inhibits viral DNA strand integration in host genome
Useful in HIV that is resistant to other
AE: well tolerated