Antibiotics VI (Antivirals) Flashcards

1
Q

What are the agents used to treat DNA viruses and their respective viruses?

A
  • Nucleoside analogs for HSV/VSV (acyclovir)
  • Nucleoside analogs for CMV (ganciclovir)
  • Pyrophosphate analog for HSV/VSV/CMV (Foscarnet)
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2
Q

What are the generalizable MOA of the antivirals for DNA viruses?

A
  • Typically prodrug
  • Require bioactivation
  • Active cogener binds to the nucleic acid polymerase
  • Cogener lacks essential functional group to continue replication
  • Termination of nucleic acid synthesis
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3
Q

What is a vital characteristic that applies to all antivirals?

A

The must have a greater affinity for viral activating enzyme than the mammalian counterpart

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4
Q

What is acyclovir active against?

A

HSV and VZV

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5
Q

What is ganciclovir effective against?

A

CMV in HIV patients

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6
Q

Which disease requires a higher dose of acyclovir? HSV or VZV?

A

VZV

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7
Q

Why is acyclovir so widely used? What are its SEs?

A

Relatively well-tolerated

CNS side effects (seizures, altered mental status) can occur if IV acyclovir is dosed inappropriately

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8
Q

What is the structure that ganciclovir mimics?

A

guanine analogue specifically for CMV

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9
Q

What is the main utility of ganciclovir?

A

Tx and prophylaxis of CMV retinitis in HIV

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10
Q

SEs of ganciclovir?

A
  • Neutropenia and Thrombocytopenia are major dose-dependent (and dose-limiting) toxicities
  • Adverse CNS effects
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11
Q

Serious complication of CMV in HIV patients?

A

CMV retinitis

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12
Q

What is the broad spectrum antiviral drug?

A

Foscarnet (pyrophosphate congener)

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13
Q

What is the spectrum of foscarnet?

A

HSV/VZV/CMV and RNA viruses including HIV

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14
Q

When would Foscarnet be used instead of acyclovir?

A

If acyclovir resistant-HSV/VZV strains are infectious agent

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15
Q

What are the most commonly used neuraminidase inhibitors?

A

Oseltamivir

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16
Q

What is oseltamivir used to treat?

A

Influenza A and B

17
Q

How do neuraminidase inhibitors work?

A

Prevent viral release from host cells

18
Q

When is prophylactic oseltamivir use considered?

A

Seasonal prevention for high risk populations (Nursing home patients), Post-exposure prophylaxis for family members at high risk for severe disease

19
Q

What is the optimal treatment window for oseltamivir?

A

Within 1-2 days of Syx onset

20
Q

SEs of oseltamivir?

A

Neuropsyciatric toxicity - when overprescribed

21
Q

What are the nucleoside reverse transcriptase inhibitors for HIV?

A

Zidovudine (Retrovir) and Lamivudine

22
Q

What is the non-nucleoside reverse transcriptase inhibitor used for HIV?

23
Q

What are the HIV protease inhibitors?

A

Amprenavir, ritonavir

24
Q

What are the protease inhibitors for HCV?

A

Bocepravir, telepravir

25
What two drugs are used for resistant strains of HIV?
* Fusion inhibitor - enfurvitide * Integrase inhibitor - raltegravir
26
What are the side effects of protease inhibitor drugs?
Lipodystrophy syndrome: Major long term adverse effects from class are hyperglycemia, hyperlipidemia, and fat distribution
27
What is the general strategy for HIV Tx?
Combination Tx with many drugs
28
What is the most aggressive schema in HAART?
Two NRTIs, a NNRTI, and a protease inhibitor