antimycobacterials, antifungals, and antivirals

Question 1

what are 4 antimycobacterials?

Answer 1

pyrazinamide (PAZ)
isoniazid (INH)
ethambutol (EMB)
rifampin (RIF)

Question 2

is PAZ bacteriostatic or bactericidal?

Answer 2

bacteriostatic

Question 3

pyrazinamide (PAZ) MOA

Answer 3

uncertain, requires activation via hydrolytic enzymes to form pyrazoic acid

Question 4

PAZ use

Answer 4

active TB (m. tuberculosis only)

Question 5

is INH bacteriostatic or bactericidal?

Answer 5

bactericidial

Question 6

MOA of INH

Answer 6

inhibits mycolic acid synthesis

Question 7

ADR/ DIs of INH

Answer 7

peripheral neuropathy
weak MAOI
must take pyridoxine (B6)

Question 8

use of INH

Answer 8

active and latent TB

Question 9

is EMB bacteriostatic or bactericidal?

Answer 9

bacteriostatic

Question 10

MOA of EMB

Answer 10

inhibits formation of arabinogalactan (component of cell wall)

Question 11

ADR of EMB

Answer 11

visual disturbances–> can’t tell red from green

Question 12

use of EMB

Answer 12

active TB and MAC infections

Question 13

is RIF bacteriostatic or bactericidal?

Answer 13

bactericidal

Question 14

MOA of RIF

Answer 14

inhibits DNA dependent RNA polymerase

Question 15

ADR/ DI of RIF

Answer 15

extremely potent CYP450 INDUCER
orange-red secretions

Question 16

use of RIF

Answer 16

rifampin- TB
rifabutin- MAC
MRSA

Question 17

list 3 types of antifungals

Answer 17

polyenes
azoles
echinocandins

Question 18

polyene examples

Answer 18

amphotericin B and nystatin

Question 19

MOA of polyenes

Answer 19

binds ergosterol in fungal cell membranes–> leaky pores

Question 20

ADR of polyenes

Answer 20

nephrotoxicity
infusion rxns
electrolyte abnormalities (hypokalemia)

Question 21

azole MOA

Answer 21

inhibits fungal P450 dependent enzymes blocking ergosterol synthesis

Question 22

ADR/ DI of azoles

Answer 22

QT prolongation
inhibits CYP450!!!!!

Question 23

what does fluconazole NOT treat

Answer 23

candida krusei

Question 24

how to take itraconazole

Answer 24

caps- with means
solution- empty stomach
take with soda

Question 25

how should you take voriconazole

Answer 25

take 1 hr after meal (food decreases absorption)

Question 26

how should you take posaconazole

Answer 26

PO- take with food or soda

Question 27

echinocandins MOA

Answer 27

inhibits glucan synthase--> decreased cell wall synthesis

Question 28

ADR of echinocandins

Answer 28

GI effects hepatotoxicity

Question 29

NRTI MOA

Answer 29

inhibits HIV reverse transcriptase after phosphorylation by cellular enzymes

Question 30

list 5 NRTIs

Answer 30

abacavir (ABC) emtricitabine (FTC) lamivudine (3TC) tenofovir (TDF) zidovudine (AZT, ZDV)

Question 31

the NRTI ABC has what ADR

Answer 31

hypersensitivity HLA B*5701

Question 32

uses of NRTIs

Answer 32

HIV Hep B- TDF, FTC, 3TC

Question 33

list 4 NNRTIs

Answer 33

efavirenz (EFV) etravirine (ETR) nevirapine (NVP) rilpivirine (RPV)

Question 34

NNRTI MOA

Answer 34

inhibits same enzyme as NRTIs but work through different mechanism

Question 35

NNRTI drug that is pregnancy category D

Answer 35

EFV- efavirenz

Question 36

NNRTI inducers

Answer 36

NVP- nevirapine ETR- etavirine

Question 37

NNRTI with mixed inducer/ inhibitor profile

Answer 37

EFV

Question 38

use of NNRTIs

Answer 38

HIV

Question 39

list 4 protease inhibitors

Answer 39

atazanavir (ATV) darunavir (DRV) Lopinavir (LPV) Ritonavir (RTV)

Question 40

protease inhibitor MOA

Answer 40

inhibits viral protein processing by binding to site of protease activity on HIV

Question 41

ADR of protease inhibitors

Answer 41

severe n/v/d--> take with food

Question 42

DI of protease inhibitors

Answer 42

strong CYP450 INHIBITORS

Question 43

this refers to using potenent inhibition of drug metabolizing enzymes of ritonavir to increase concentrations and half-lives of other PIs

Answer 43

boosting

Question 44

what is the only PI used without boosting?

Answer 44

ATV

Question 45

use of PIs

Answer 45

HIV

Question 46

list 3 integrase inhibitors

Answer 46

raltegravir (RAL) Elvitegravir (EVG) dolutegravir (DTG)

Question 47

integrase inhibitor MOA

Answer 47

blocks integration of proviral gene into human DNA

Question 48

this class of antivirals are the newest class of ART and are very well tolerated and have now become 1st line tx of HIV

Answer 48

integrase inhibitors

Question 49

name a CCR5 inhibitor

Answer 49

maraviroc (MVC)

Question 50

maraviroc MOA

Answer 50

inhibits CCR5 receptors on cell membrane and prevent entry of HIV into cell

Question 51

ADR of CCR5 inhibitors

Answer 51

hepatotoxicity--> black box warning

Question 52

genetic testing is REQUIRED for what antiviral?

Answer 52

maraviroc (MVC)

Question 53

what test must be taken before starting maraviroc?

Answer 53

HIV tropism w/ trofile test must be CCR5 + !!!!

Question 54

name 3 antiretrovirals for COVID

Answer 54

paxlovid remdesivir malnupiravir

Question 55

MOA of paxlovid

Answer 55

protease inhibitor binding to enzyme to prevent replication

Question 56

remdesivir MOA

Answer 56

RNA polymerase inhibitor

Question 57

malnupiravir MOA

Answer 57

acts as ribonucleoside analog for viral RNA polymerase increasing mutations

Question 58

these 2 antivirals for herpes are prodrugs

Answer 58

valacyclovir famciclovir

Question 59

herpes antivirals MOA

Answer 59

inhibits viral DNA polymerase

Question 60

list 2 neuraminidase inhibitors

Answer 60

oseltamivir zanamivir

Question 61

neuraminidase inhibitor MOA

Answer 61

prevents viral neuraminidase enzyme from releasing new virions from host cell, preventing further replication

Question 62

ADR of zanamivir

Answer 62

pulmonary effects--> AVOID IN ASTHMA or other respiratory disease